Effect of hospital characteristics on outcome of patients with gastric cancer: A population based study in North-East Netherlands

Background

Surgical resection is an important factor in the curative treatment of gastric cancer. However a variety of aspects of surgical treatment that potentially influence outcome are still not well defined. This study aims to assess the influence of hospital type, referral pattern and proximal or distal location of the tumour on the ultimate survival.

Methods

From January 1994 to January 2007, a total of 5245 patients were diagnosed with gastric adenocarcinoma in the region of the Comprehensive Cancer Centre North-East Netherlands. Hospitals in this region were categorized into three types: teaching university (TU), teaching non-university (TNU), and non-teaching hospitals (NT). The influence of hospital type, referral for surgery and location of the tumour on the relative survival of operated patients was studied.

Results

Of the 5245 patients, 2334 patients underwent surgery. For operated patients, the 5-year relative survival was 42.5% for the TU versus 34.0% and 35.5% for respectively TNU and NT hospitals (p = 0.064), with no difference (p = 0.38) in relative survival (25.6–31.9%) in the proximal tumours. A significant difference was found between the hospitals in the 5-year relative survival in the distal tumours; 59.7% in the TU versus 36.4% in the TNU and 36% in the NT (p = 0.03 univariate), however this was not confirmed in the multivariate analysis (p = 0.184). High referral centres did not perform better as far as survival is concerned than low referral hospitals.In conclusion the hospital type in our region did not significantly influence outcome of surgery for gastric cancer.     

学龄前儿童弱视筛查标准研究

目的了解学龄前儿童的视力和屈光发育状况,探讨该年龄段儿童弱视筛查中的视力和屈光度筛选标准。方法横断面调查研究。对海淀区24所幼儿园3~6岁儿童进行视力和屈光度检查。3岁儿童采用图形视力表,4岁以上用标准对数视力表。屈光度检查用SureSight手持式自动验光仪在自然状态下进行。用M（Q1~Q3）描述各年龄组视力和屈光度的分布特征,用秩和检验比较不同年龄组间视力和屈光度分布差异,以百分位数法确定95%参考值范围。结果球镜度M（Q1~Q3）：3岁和4岁均为1.25 D（1.00~1.75 D）,5岁和6岁均为1.50 D（1.00~1.75 D）,3~6岁不同年龄组间球镜度分布差异有统计学意义（χ2=77.60,P<0.01）。柱镜度：各年龄组均为-0.50 D（-0.75~-0.25 D）,不同年龄组间柱镜度分布差异有统计学意义（χ2=60.41,P<0.01）,两两比较3岁和4岁组之间差异有统计学意义（Z=-4.75,P<0.008）,3岁儿童柱镜度较其他组偏小。视力：3岁为0.6（0.6~0.7）,4岁为0.8（0.8~1.0）,5岁和6岁均为1.0（1.0~1.0）,不同年龄组间视力分布差异有统计学意义（χ2=11 323.87,P<0.01）,两两比较各年龄组间差异均有统计学意义（P＜0.008）,随年龄增长视力逐渐提高。视力正常儿童的球镜度P2.5~P97.5：3岁+0.50~+2.75 D,4岁+0.50~+2.50 D,5岁+0.50~+2.75 D,6岁+0.50~+3.00 D,柱镜度P5：3岁-1.50 D,4~6岁-1.25 D;屈光度正常儿童的视力P5分别为3岁和4岁0.6,5岁和6岁0.8。柱镜度数变化对视力的影响较大,球镜度数变化对视力的影响相对较小。结论视力筛选标准：3岁和4岁＜0.6,5岁和6岁＜0.8;球镜度筛选标准：3~6岁球镜≤+0.25 D和≥+3.00 D;柱镜度筛选标准：3岁≤-1.75 D,4~6岁 ≤-1.50 D。自然状态下屈光筛查球镜度范围可适当放宽,柱镜度范围应相对严格。     

Access to Cancer Specialist Care and Treatment in Patients With Advanced Stage Lung Cancer

Background

Access to specialty care is critical for patients with advanced stage lung cancer. This study assessed access to cancer specialists and cancer treatment in a broad population of patients with advanced stage lung cancer.

The effectiveness of continuing training for traditional birth attendants on their reproductive health-care knowledge and performance

Objective

to evaluate the effectiveness of continuing training for traditional birth attendants (TBAs) on their reproductive knowledge and performance.

Setting

Mzuzu Central Hospital in the northern region of Malawi.

Participants and analysis

a total of 81 TBAs trained during 2004 and 2006 in Mzuzu, Malawi received continuing training courses. Their reproductive knowledge was assessed by a structured questionnaire during 2004 and 2007. A multivariate generalised estimating equation (GEE) model was constructed to determine the associations between their reproductive knowledge scores and age, years of education, time since the last training course, test frequency and number of babies delivered.

Findings

from July 2004 to June 2007, a total of 1984 pregnant women visited these trained TBAs. A total of 79 (4.0%) mothers were referred to health facilities before the birth due to first-born or difficult pregnancies. No maternal deaths occurred among the remaining mothers. There were 26 deaths among 1905 newborn babies, giving a perinatal mortality rate of 13.6 per 1000 live births. The GEE model demonstrated that knowledge scores of TBAs were significantly higher for TBAs under the age of 45 years, TBAs with more than five years of education, TBAs who had taken a training course within one year, and TBAs with a higher test frequency.

Conclusion and implications for practice

continuing training courses are effective to maintain the reproductive knowledge and performance of trained TBAs. It is recommended that continuing training should be offered regularly, at least annually.     

Referral practices in patients suffering from non‐malignant chronic pain

This paper presents the results of a prospective observational cohort study investigating referral practices to six specialized pain centres (SPCs) in 303 patients with headache (HD), low back pain (LBP), and neuropathic pain (NP). The study was divided into three parts. Part 1: The pain health care history (contacts with general practitioners and specialists, further referrals, time spans, therapies) before first contact with the SPC. Part 2: Reality of pain therapy and management in the SPC (patients’ attrition, interdisciplinarity of therapy and novel therapeutic strategies instigated). Part 3: Follow‐up and assessment of pain levels (NRS, SES), disability scores (PDI), QoL scores (SF 12), and anxiety and depression scores (HADS) at 0, 6 and 12 months. Using an ordinal linear regression model, factors predicting a good treatment outcome were identified. On average it took 3 years of pain symptoms before first consultation with GP. The median time period from the first pain sensations until the appointment in the SPC was 12 years. Nearly half of the referrals to specialists or SPCs were initiated by a non‐professional. In the SPC the medication was changed in 71% of cases. Care was interdisciplinary in only 32%. At 6 and 12 months after the first contact with the SPC, only 20% of the patients had improved with respect to levels of pain and psychometric data. A high degree of chronicity, a history of pain‐associated surgeries and low social support were negative predictors for treatment outcome.     

天津市三甲医院肺结核可疑者转诊未到位的相关因素分析

目的分析转诊后未到位肺结核可疑者未到位原因,探讨进一步提高转诊到位率的措施。方法采用统一培训调查员,入户填写调查问卷方法对315例转诊后未就诊肺结核可疑症状者进行调查,使用SPSS10.0软件包进行统计分析。结果完成有效调查问卷181份,未就诊者多为低收入（94.1%）、低学历（80.7%）的社会弱势人群,已在其他医院就诊除外肺结核（54.5%）、自觉症状消失/好转（17.4%）、经济困难（6.6%）、行动不便（6.0%）、交通困难（4.8%）、药店自购药（4.2%）等为患者未就诊的主要原因。结论结核病防治专业机构加大工作的积极性和主动性、在全社会强化健康促进工作、特别是强化免费诊治政策的宣传,不断提高与医疗机构的合作程度、提高医务人员传染病报告卡填写质量,加强对抗结核药品的管理力度等措施以提高转诊患者的到位率。     

Otitis media referrals - the general practitioner perspective

OBJECTIVE: Otitis media management involves both primary and specialist health care. The present study used data on GP referrals to estimate the proportion of children with otitis media referred from primary to specialist care, study variation in referral pattern and factors that influence GP behaviour. METHODS: Data on general practitioners' view on collaborative aspects of specialist health care was collected in a cross-sectional questionnaire survey among all Norwegian GPs in 2004 (N=1633). The outcome of interest was referral routines for otitis media at first visit and at follow-up. RESULTS: Mean referral for otitis media was 22%, most commonly at follow-up visit. Twenty-seven percent of children with otitis media were sent to ENT departments and 73% to practicing otolaryngologists. Variation in referral pattern among GPs was moderate. GPs with specialty in general medicine had 6% fewer referrals. Separate analysis on referral to practicing otolaryngologists showed that GP work load and availability to practicing specialists increased referral, whereas availability to hospital services reduced the probability. CONCLUSION: In Norway, otitis media management mainly takes place in primary care. Completed specialty in general medicine reduces referrals and non-medical factors influence referral behaviour. We suggest that learning groups may contribute to update knowledge in primary care and fewer referrals to specialists.     

结核病专科医院实施结核病人信息登记、转诊及转报工作制度的探索

目的探索在省级结核病专科医院实施结核病人信息登记、转诊及转报制度的可行性和有效性。方法对2003年7月制定结核病人信息登记制度以来登记、转报的结核病人资料及动态变化进行分析。结果通过该制度的实施,加大了查痰力度,涂阳病人的比例由10．1％提高到23．3％,未查痰病人的比例由66．3％下降至16．5％;登记的结核病人全部转报至病人住址所在地的结防机构。结论结核病人信息登记、疫情报告、转诊和转报这一工作制度在省级结核病专科医院的建立和实施,提高了专科医院医务人员的痰检意识,结核病人信息集中管理以及定期向结防机构的转报,有利于防治机构采取措施对病人的进一步跟踪治疗管理。