手术同意书的法律意义及其形式内容改进

从法律的角度分析，现行《手术同意书》并不是医院转移风险和责任的手段，在法律意义上，它是医疗机构和医务人员向患者及其家属履行了如实告知义务的书面证明文件，是患者或其家属行使选择权的形式，同时也是患者或其家属因享有的权利而需承担相应责任的书面依据。为与其法律意义相一致，无论在形式还是部分内容上，以及签字权的归属上，都有必要对手术同意书做出适当改进，建议改用由《手术风险告知书》、《手术志愿申请书》、《手术拒绝书》组成的“两部三段式”结构。     

A review of the content and format of transgender-related webpages

Transgender persons represent a highly diverse group of individuals who have been historically underserved, despite being disproportionately at risk for HIV (human immunodeficiency virus) and other health conditions. Despite the need for more research on transgender health issues, no review of online transgender-related resources has been conducted. The purpose of this study was to broadly characterize (1) the types of transgender-related webpages that appear as a result of keyword searches, and (2) the extent to which webpages differ in content and format depending on whether the intended audience for the webpage was transgender individuals, health professionals, or the general population. An online search using 28 keywords yielded 204 eligible webpages, of which 58% targeted transgendered individuals, 23% targeted health professionals, and 39% targeted the general public. The highest percentage of webpages appeared to be operated and/or created by transgender individuals or groups (46%), followed by for-profit businesses (17%). The majority of mental health (80%), HIV-related (89%), and primary care (100%) webpages targeted health professionals. Although various features are available that may increase user interest in and perceived credibility of a webpage, the results show that many of these features were underutilized. There appears to be significant opportunity to develop web resources that directly target unique subgroups within the transgender community to improve their health outcomes, increase the visibility of features that increase user interest and perceived credibility of webpages, and possibly train transgender individuals to seek relevant online information.     

Patient-reported physical activity questionnaires: A systematic review of content and format

Background

Many patients with chronic illness are limited in their physical activities. This systematic review evaluates the content and format of patient-reported outcome (PRO) questionnaires that measure physical activity in elderly and chronically ill populations.

Methods

Questionnaires were identified by a systematic literature search of electronic databases (Medline, Embase, PsychINFO & CINAHL), hand searches (reference sections and PROQOLID database) and expert input. A qualitative analysis was conducted to assess the content and format of the questionnaires and a Venn diagram was produced to illustrate this. Each stage of the review process was conducted by at least two independent reviewers.

Results

104 questionnaires fulfilled our criteria. From these, 182 physical activity domains and 1965 items were extracted. Initial qualitative analysis of the domains found 11 categories. Further synthesis of the domains found 4 broad categories: 'physical activity related to general activities and mobility', 'physical activity related to activities of daily living', 'physical activity related to work, social or leisure time activities', and '(disease-specific) symptoms related to physical activity'. The Venn diagram showed that no questionnaires covered all 4 categories and that the '(disease-specific) symptoms related to physical activity' category was often not combined with the other categories.

Conclusions

A large number of questionnaires with a broad range of physical activity content were identified. Although the content could be broadly organised, there was no consensus on the content and format of physical activity PRO questionnaires in elderly and chronically ill populations. Nevertheless, this systematic review will help investigators to select a physical activity PRO questionnaire that best serves their research question and context.     

The influence of the closure format on the storage stability and moisture content of freeze-dried influenza antigen

Low moisture content is seen as crucial to achieving long term stability of freeze dried biologics and reference materials. Highly hygroscopic freeze-dried material are susceptible to moisture ingress over time which can lead to degradation and loss of biological potency. This study compared vials with unprocessed stoppers, vials with vacuum-oven dried stoppers and glass ampoules in order to determine the superior long term storage format in terms of moisture ingress and potency. B/Phuket influenza antigen was chosen as the model biological standard and the lyophilized antigen was stored at −20, 25 and 45 °C over a 1 year period. Ampoules had no significant moisture change across all storage temperatures as would be anticipated. Moisture content results at −20 °C showed no significant differences between ampoules, vials with vacuum-oven dried stoppers and vials with unprocessed stoppers over 12 months. Vials with vacuum-oven dried stoppers performed similarly to ampoules at −20 °C and 20 °C, but had a small increase in moisture content after 6 months at 45 °C. Vials with unprocessed stoppers preformed the worst and exhibited the largest moisture ingress after just 3 months at both 20 °C and 45 °C. Single radial immunodiffusion (SRD) potency assays showed at −20 °C and 20 °C there was no significant difference between all closure formats. At 45 °C there was a drop in potency for all closure formats, but ampoules and vials with vacuum-oven dried stoppers retained higher potency than vials with unprocessed stoppers. Thus, while ampoules are still considered to be the gold standard format for long term storage stability, using vials with vacuum-oven dried stoppers provides comparable stability and moisture integrity at −20 °C and 20 °C storage.     

Criterion and content validity of a novel structured haggling contingent valuation question format versus the bidding game and binary with follow-up format

Contingent valuation question formats that will be used to elicit willingness to pay for goods and services need to be relevant to the area they will be used in order for responses to be valid. A novel contingent valuation question format called the "structured haggling technique" (SH) that resembles the bargaining system in Nigerian markets was designed and its criterion and content validity compared with those of the bidding game (BG) and binary-with-follow-up (BWFU) technique. This was achieved by determining the willingness to pay (WTP) for insecticide-treated nets (ITNs) in Southeast Nigeria. Content validity was determined through observation of actual trading of untreated nets together with interviews with sellers and consumers. Criterion validity was determined by comparing stated and actual WTP. Stated WTP was determined using a questionnaire administered to 810 household heads and actual WTP was determined by offering the nets for sale to all respondents one month later. The phi (correlation) coefficient was used to compare criterion validity across question formats. The phi coefficients were SH (0.60: 95% C.I. 0.50-0.71), BG (0.42: 95% C.I. 0.29-0.54) and the BWFU (0.32: 95% C.I. 0.20-0.44), implying that the BG and SH had similar levels of criterion-validity while the BWFU was the least criterion-valid. However, the SH was the most content-valid. It is necessary to validate the findings in other areas where haggling is common. Future studies should establish the content validity of question formats in the contexts in which they will be used before administering questionnaires.     

The conflation of gender and sex: Gaps and opportunities in HIV data among transgender women and MSM

ABSTRACT

Historically, HIV studies have conflated men who have sex with men (MSM) with transgender (trans) women, explicitly excluded trans individuals, or included sample sizes of trans people that are too small to reach meaningful conclusions. Despite the heavy burden of HIV among trans women, conflation of this population with MSM has limited the information available on the social and behavioural factors that increase HIV vulnerability among trans women and how these factors may differ from MSM. Using data sets from quantitative studies among MSM (n?=?645) and trans women (n?=?89), as well as qualitative in-depth interviews with 30 trans women in Baltimore, we explore what these data tell us about similarities and differences in HIV vulnerability between the two groups and where they leave gaps in our understanding. We conclude with implications for data collection and intervention development.