急性ST段抬高心肌梗死患者应用急救医疗服务的影响因素

目的探讨急性ST段抬高心肌梗死（ST-segment elevation myocardial infarction,STEMI）患者到达医院时交通工具的选择类型及影响患者选择急救医疗服务（emergency medical service,EMS）的因素。方法我院住院并确诊的412例STEMI患者,根据是否应用EMS到医院分为两组：EMS组和自我转运组。对比分析两组患者应用急救医疗服务的情况。结果有26.90%的患者应用EMS到医院,单因素分析表明：CAD住院史、恶心、呕吐、头晕、晕厥、症状突然发作、症状进展、发病初期等症状消失、不愿打扰别人、院前就诊次数、认为是心脏起源疾病、恐惧感、重视症状是有意义的变量。多因素Logistic回归分析表明STEMI患者选择EMS的独立变量是院前就诊（0.49,0.33～0.73）,恶心（2.57,1.58～4.19）,晕厥（5.49,2.05～14.70）,症状进展（1.98,1.19～3.29）,等待症状消失（0.55,0.34～0.89）,认为是心脏起源疾病（2.37,1.44～3.91）。结论1/4的STEMI患者应用EMS到达医院,只有当患者感觉病重时才想到EMS,应当宣传EMS不仅仅是运输工具,同时也是及早诊断和治疗的手段。     

Integrating children's services in England: national evaluation of children's trusts

Background Poor co‐ordination of services can have severe consequences for disadvantaged children with complex needs. Since 2003 national and local governments in England embarked on sweeping reforms aimed at improving and integrating local health, education and social services for children. These were to be organized locally by children's trusts and piloted by 35 children's trust pathfinders. Methods This study described and compared the experience of integrating children's services in all 35 children's trust pathfinders, covering 20% of children in England. It had a prospective mixed‐methods design. Over 3 years we interviewed 147 managers and professionals working in the children's trusts, including 172 semi‐structured interviews, carried out two questionnaire surveys of the 35 children's trusts and analysed official documents. Results In most areas different agencies jointly commissioned children's services, especially for mental health, disabilities and multi‐purpose children's centres, and increasingly pooled finances. Provision of multi‐agency and multi‐professional services was increasing. Professionals generally supported these changes but found them stressful. All children's trusts appointed directors of children's services and established boards representing multiple agencies. Systems for sharing information about individual children were mostly in place but were still underused. Health services were generally less involved in joint work than were local authorities' education and social care services, with notable exceptions. Areas where local authorities and health authorities shared geographical boundaries made most progress. Some children's trusts made few changes beyond their statutory obligations. Conclusion Children's trusts enabled major changes to services in areas where local actors and organizations were motivated and empowered. In other areas the remit of children's trusts was often too broad and vague to overcome entrenched organizational and professional divisions and interests. Policymakers need to balance facilitation of change in areas with dynamic change agents with methods for ensuring that dormant areas and agencies are not left behind.     

Mental health service users’ experiences of an education intervention based on a European Union project: A comparison between nine European countries

Mental health service users (MHSUs) often face difficulties in achieving successful participation in education; however, the tools that could help them succeed are rarely investigated. This study aimed to illuminate the experiences of MHSUs in an education intervention based on a European Union (EU) project. Their experiences are compared across nine EU countries. The data were collected through individual interviews with MHSUs (n = 47) at day activity centres that provide mental health services. An inductive content analysis was used as the method of analysis. Three main categories, which include seven subcategories, are revealed by the analysis. The main categories are as follows: (i) the factors related to MHSUs’ educational preparedness, (ii) the dimensions of the learning environment, and (iii) the effects of training intervention. The MHSUs’ experiences with the education intervention were similar across all countries. The findings showed that this education intervention is a multidimensional process. It contains social, mental, and physical dimensions linked to a learner and learning environment. These dimensions influence the MHSUs’ ability to participate in the education process. At its best, the education intervention supports the personal growth of MHSUs and prepares them for social integration. An education intervention can be a usable tool in the rehabilitation of MHSUs if the multidimensional nature of education is taken into consideration. Therefore, designing and executing education interventions requires the attendance of the MHSUs in cooperation with mental health and education professionals. Our findings suggest a tentative framework that can be used in designing and executing education for MHSUs.     

Acute oncology service: assessing the need and its implications

Cancer patients often have complex and difficult inpatient diagnostic and treatment pathways that involve many different specialities within secondary care. With current severe resource constraints, improvements in outcomes and patient experience need to be both cost-efficient and effective. We review the reports that will shape national cancer care in coming years and use data gathered from our own hospital to highlight important issues in the development of inpatient cancer services and the emergence of a new specialty; acute oncology.     

Levels of acute health service use among cancer survivors in the United Kingdom

Background

In the United Kingdom, there are approximately two million cancer survivors (3.2% of the entire population), composed of groups of people in different phases of survivorship and with different health service needs. The aim of this study was to quantify the level of acute health service utilisation by cancer survivors in the UK, according to tumour type, age, sex, time since diagnosis, and time until death.

Methods

Linked national cancer registry and hospital activity data were analysed. The data covered all cancer-related admissions to public hospitals operated by the National Health Service in England occurring in 2006 among people diagnosed with cancer in the period 1990-2006. The intensity of cancer-related health service utilisation was categorised as ‘none’, ‘low’ (up to 10% of an individual’s time), or ‘high’ (>10% of an individual’s time), among groups defined by time since diagnosis and time until death. Results were extrapolated from the population of England in 2006 (51 million) to that of the UK in 2008 (61 million).

Findings

Sixty one thousand of the two million cancer survivors (3%) were in the ‘high’ utilisation category; 240,000 (12%) were in the ‘low’ category; 1.70 million (85%) had no cancer-related hospital admissions. 147,000 cancer survivors (7%) were in the last year of their life, and it was this group that had the highest levels of hospital utilisation. 1.57 million cancer survivors (78%) were more than 1 year from both diagnosis and death, and had no cancer related hospital admissions.

Interpretation

A considerable proportion of cancer survivors in the UK have a high level of hospital utilisation soon after diagnosis or before death, but the large majority of them are neither recently diagnosed nor near the end of their life, and do not utilise acute health services for cancer-related care.     

Prospective predictors of psychosocial support service use after cancer

Objective: To identify prospective predictors of psychosocial support service utilisation by people with cancer. Consistent with the theory of planned behaviour (TPB), attitudes towards help seeking and behavioural intentions were predicted to lead to greater support service utilisation. Methods: A heterogeneous sample of cancer patients from a regional cancer treatment centre in Australia completed a prospective survey (n=439 at recruitment, 61.2% response rate; n=396 at follow‐up) examining the utilisation of psychosocial support services. Demographic variables (age and gender), social support, social constraints, cancer specific distress, and positive and negative attitudes towards help seeking were examined as prospective predictors of support service use. Further, a series of regression analyses explored mediation of the relationship between attitudes to seeking help and support service use by behavioural intentions. Results: Approximately 14% of cancer patients reported using a psychosocial support service in the 6 months following the time of the first study. Females and patients with more positive attitudes towards help seeking were more likely to have utilised a support service in the 6 months following recruitment. The relationship between positive attitudes to seeking help and psychosocial support service use was mediated by behavioural intentions. Conclusions: The TPB appears to have utility in explaining in part use of psychosocial help services. Future studies should include contextual factors in the model. Copyright © 2010 John Wiley & Sons, Ltd.     

Perspectives on eating disorders and service provision: A qualitative study of healthcare professionals

The study examined healthcare professionals' perspectives of eating disorder patients and services. Qualitative semi‐structured interviews were conducted with 18 healthcare professionals resulting in two themes. First, the practical difficulties of meeting the complex service needs of people with eating disorders were illustrated. Second, staff recognised patient diversity and the consequent need for individualised interventions. Services are frustrated in meeting patient needs due to complex resource limitations, which do not amount only to lack of funding. Rather than eating disordered patients being viewed as ‘difficult’, as reported in previous qualitative research, they are only difficult in a context of limited resources. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.