Medical confidence.

If medical confidentiality is not observed patients may well be reluctant to disclose information to their doctors or even to seek medical advice. Therefore, argues the author, it is of the utmost importance that doctors strive to protect medical confidentiality, particularly now when it is under threat not only in this country but also overseas. The profession must cease to regard ethical issues to do with confidentiality, and indeed to do with all areas of medical practice, as abstract phenomena requiring no justification. If it does not then it will come under increasing and justified criticism from the community it serves.     

A vote for no confidence

This paper considers the justifications for adhering to a principle of confidentiality within medical practice. These are found to derive chiefly from respect for individual autonomy, the doctor/patient contract, and social utility. It is suggested that these will benefit more certainly if secrecy is rejected and the principle of confidentiality is removed from the area of health care.     

自信心团体训练对社交焦虑症患者的影响

目的:探讨自信心团体训练对社交焦虑症患者的影响。方法:将60例社交焦虑症患者分为两组,研究组患者参加自信心团体训练,每周2次,共5周,对照组患者不采取任何治疗手段。比较两组患者社交焦虑量表评分和自信心量表评分。结果:研究组患者社交焦虑评分较对照组显著降低,自信心评分较对照组显著升高,差异均有统计学意义(P<0.05)。结论:自信心团体训练有助于社交焦虑症患者改善社交焦虑状态和增强自信心。     

Dynamic confidence during simulated clinical tasks

Objective: Doctors'' confidence in their actions is important for clinical performance. While static confidence has been widely studied, no study has examined how confidence changes dynamically during clinical tasks. Method: The confidence of novice (n = 10) and experienced (n = 10) trainee anaesthetists was measured during two simulated anaesthetic crises, bradycardia (easy task) and failure to ventilate (difficult task). Results: As expected, confidence was high in the novice and experienced groups in the easy task. What was surprising, however, was that confidence during the difficult task decreased for both groups, despite appropriate performance. Conclusions: Given that confidence affects performance, it is alarming that doctors who may be acting unsupervised should lose dynamic confidence so quickly. Training is needed to ensure that confidence does not decrease inappropriately during a correctly performed procedure. Whether time on task interacts with incorrect performance to produce further deficits in confidence should now be investigated.     

Estimating prognosis for nursing home residents with advanced dementia

Context  Survival varies for patients with advanced dementia, and accurate prognostic tools have not been developed. A small proportion of patients admitted to hospice have dementia, in part because of the difficulty in predicting survival. Objectives  To identify factors associated with 6-month mortality in newly admitted nursing home residents with advanced dementia and to create a practical risk score to predict 6-month mortality in this population. Design, Setting, and Participants  This was a retrospective cohort study of data from the Minimum Data Set (MDS). All Medicare or Medicaid licensed nursing homes in New York and Michigan were included. Participants had advanced dementia and were admitted to New York nursing homes between June 1, 1994, and December 30, 1998 (derivation cohort, n = 6799), and to Michigan nursing homes from October 1, 1998, through July 30, 2000 (validation cohort, n = 4631). Main Outcome Measures  MDS factors associated with 6-month mortality were determined in the derivation group, and the resulting mortality risk score was evaluated in the validation cohort. Risk score performance was compared with the cut point of 7c on the Functional Assessment Staging (FAST) scale. Results  Among residents with advanced dementia, 28.3% (n = 1922) died within 6 months of nursing home admission in the derivation cohort; 35.1% (n = 1626) died in the validation cohort. The 6-month mortality rate increased across risk scores (possible range, 0-19): 0 points, 8.9% mortality; 1 to 2, 10.8%; 3 to 5, 23.2%; 6 to 8, 40.4%; 9 to 11, 57.0%; and at least 12, 70.0% in the validation cohort. The area under the receiver operating characteristic (AUROC) curve for predicting 6-month mortality was 0.74 and 0.70 in the derivation and validation cohorts, respectively. Our risk score demonstrated better discrimination to predict 6-month mortality (AUROC, 0.64 for a cutoff of =" BORDER="0">6 points vs 0.51 for FAST stage 7c). Conclusion  A risk score based on 12 variables from the MDS estimates 6-month mortality for nursing home residents with advanced dementia with greater accuracy than existing prognostic guidelines.      

B超测量胎儿腹径在巨大儿预测中的应用--附168例分析

目的 探讨一种Ｂ超预测巨大儿物简便、实用的方法。方法 回顾性分析１９９４年１月 １９９８年１２月间出生的巨大儿共１６８例。结果 胎儿腹径「ＡＤ＝（ＴＡＤ＋ＡＰＡＤ）／２」≥１１０ｍｍ者１４５例,预测巨在儿符合率为８６．３１％。与ＡＣ、ＡＤ＋ＢＰＤ、ＡＤ＋ＦＬ、ＡＤ＋ＢＰＤ＋ＰＬ相似,优于ＢＰＤ、ＦＬ、ＢＰＤ＋ＦＬ及宫高＋腹围。结论 Ｂ超测量胎儿腹径预测巨大儿简便、实用、准确,值得临床推广应用。     

Estimating Consumer Familiarity with Health Terminology: A Context-based Approach

Objectives

Effective health communication is often hindered by a “vocabulary gap” between language familiar to consumers and jargon used in medical practice and research. To present health information to consumers in a comprehensible fashion, we need to develop a mechanism to quantify health terms as being more likely or less likely to be understood by typical members of the lay public. Prior research has used approaches including syllable count, easy word list, and frequency count, all of which have significant limitations.

Design

In this article, we present a new method that predicts consumer familiarity using contextual information. The method was applied to a large query log data set and validated using results from two previously conducted consumer surveys.

Measurements

We measured the correlation between the survey result and the context-based prediction, syllable count, frequency count, and log normalized frequency count.

Results

The correlation coefficient between the context-based prediction and the survey result was 0.773 (p < 0.001), which was higher than the correlation coefficients between the survey result and the syllable count, frequency count, and log normalized frequency count (p ≤ 0.012).

Conclusions

The context-based approach provides a good alternative to the existing term familiarity assessment methods.     

突聋患者疗效估计的判别分析

目的 :从统计学角度为指导选择突聋患者的治疗方案服务。方法 :收集近 5年突聋住院患者 6 3例计76耳 ,将资料录入微机进行描述性统计分析和多类判别分析。结果 :发现本组病例男性为主 (占 73 % ) ,年龄平均为 40岁 ;多类判别分析表明X3(发病至就诊时间 )、X9(电测听异常 )、X10 (声阻抗异常 )及X11(治疗方案 )共 4个变量是影响本组突聋患者康复转归的主导因素 ,据此建立 2类判别分析模型。结论 :理论上讲其模型可用于指导选择突聋患者的治疗方案 ,具有一定临床实际意义