The reliability of survey assessments of characteristics of medical clinics

OBJECTIVE: To assess the reliability of survey measures of organizational characteristics based on reports of single and multiple informants. DATA SOURCE: Survey of 330 informants in 91 medical clinics providing care to HIV-infected persons under Title III of the Ryan White CARE Act. STUDY DESIGN: Cross-sectional survey. DATA COLLECTION METHODS: Surveys of clinicians and medical directors measured the implementation of quality improvement initiatives, priorities assigned to aspects of HIV care, barriers to providing high-quality HIV care, and quality improvement activities. Reliability of measures was assessed using generalizability coefficients. Components of variance and clinician-director differences were estimated using hierarchical regression models with survey items and informants nested within organizations. PRINCIPAL FINDINGS: There is substantial item- and informant-related variability in clinic assessments that results in modest or low clinic-level reliability for many measures. Directors occasionally gave more optimistic assessments of clinics than did clinicians. CONCLUSIONS: For most measures studied, obtaining adequate reliability requires multiple informants. Using multiple-item scales or multiple informants can improve the psychometric performance of measures of organizational characteristics. Studies of such characteristics should report the organizational level reliability of the measures used.     

Food safety and environmental issues in animal welfare

Food safety, protection of the environment and animal welfare are three concerns consumers have about modern food production systems. Standards dealing with these three issues can be in conflict, and finding ways to reduce this conflict is essential as international standards governing animal welfare develop. These conflicts can be reduced if flexible animal welfare standards are animal-based and attempt to directly assess the state of the animals themselves rather than prescribing the conditions under which the animals are reared. Animal welfare is often treated as an ethical issue, and is therefore difficult to deal with under current trade agreements. A greater appreciation of the link between animal welfare and animal health makes the link with food safety clearer. Improvements in animal welfare have the potential to reduce on-farm risks to food safety, principally through reduced stress-induced immunosuppression, reduced incidence of infectious disease on farms and reduced shedding of human pathogens by farm animals, and through reduced antibiotic use and antibiotic resistance. Health problems of farm animals continue to be serious threats to animal welfare, and measures of disease incidence can serve as animal-based measures of animal welfare. Continued development of hazard analysis and critical control point-based approaches to animal welfare would allow a smoother integration of animal welfare and food safety standards.     

A case for medical, environmental, and safety screening

Agriculture is one of the most hazardous occupations in the United States, yet there has been no improvement noted over the past 30 years. While occupational health and safety improvements have been noted in other industrial sections, agriculture continues to pose many unusual health threats to the farmer. Screening programs are fraught with many problems in view of the widely dispersed nature of agriculture. Pulmonary function studies, dust levels, serological testing, hearing testing and noise level production, and cholinesterase levels are but a few of the tools that are available, and are helpful in looking for problems in this most vital industry in the United States.     

G20杭州峰会医疗保障医疗点的设置

本文就G20杭州峰会医疗保障医疗点的设置原则和场馆医疗点、定点酒店医疗点的布置作了阐述;并就医疗保障医疗点的人员配置、设备配备、处置流程、保障任务等作了介绍,为国际大型会议活动医疗保障医疗点的设置提供借鉴。     

A survey of demand for medical care in three public health clinics in Rio de Janeiro, Brazil

A sample survey was conducted in three public ambulatory medical care units in Rio de Janeiro in order to show the demographic and nosological aspects of the clientele as well as to evaluate the quality of clinic records. The sample included 2,029 patients registered in the health clinics and 3,980 consultants from October 1, 1990 to September 30, 1991. The diagnoses were coded according to the 9th revision of the International Classification of Dieases. Females accounted for about 60% of the sample, and more than a half were between 15 and 49 years of age. Children under 10 years old made up 28% of the total. About 38% of the patients came from the poor areas of the city: the "favelas". The case files were poorly filled out, frequently lacking useful information. The most frequent cause was classified in the XVIo chapter of the ICD - ill-defined causes, followed by respiratory, infectious, genitourinary and circulatory diseases. External causes predominated in one of the health clinics, which is an emergency service. There was a great demand for preventive measures, such as prenatal care and child care, even at the clinic that was traditionally devoted only to curative medicine. The most frequent specific diagnoses were upper respiratory tract infection, hypertension, gynecological problems, prenatal care, and skin diseases. There were no records for referrals to other health services. The poor quality of the medical records causes problems in terms of quality of health care. Use of such record-keeping systems, even while criticizing them, is essential to improve them.     

Assisted reproductive technologies: medical safety issues in the older woman

Abstract Previous study has shown that in the United States, most maternal deaths and severe obstetric complications due to chronic disease are potentially preventable through improved medical care before conception. Many women who need assisted reproductive technology (ART) because of infertility are older than the average pregnant woman. Risks for such chronic diseases as obesity, diabetes mellitus, chronic hypertension, cardiovascular disease (CVD), and malignancy greatly increase with maternal age. Chronic illness increases the risk of the in vitro fertilization (IVF) procedure and is also associated with increased obstetric risk and even death. The objective of this review is to outline the potential risks for older women who undergo ART procedures and pregnancy and to characterize guidelines for evaluation before enrollment in ART programs. A PubMed search revealed that very few studies have related to pre-ART medical evaluation. Therefore, we suggest a pre-ART medical assessment, comparable to the recommendations of the American Heart Association before noncompetitive physical activity and the American Society of Anesthesiologists before elective surgery. This assessment should include a thorough medical questionnaire and medical examination. Further evaluation and treatment should follow to ensure the safety of ART procedures and of ensuing pregnancies.     

67所医务室卫生资源和服务调查

通过对６７所企事业单位医务室人、财、物资源和卫生服务的调查。结果显示，医务室在初级卫生保健中发挥了重要作用，是卫生服务体系的重要组成部分。为了加强医务室的建设和管理，我们建议医务室应与上级医疗机构和合同单位建立新型的合作关系，扩大服务范围并建立新的保健模式     

A team approach to OR environmental issues

At Munroe Regional Medical Center in Ocala, FL, an effective partnership between Materials Management and the Operating Room was begun by building consensus around a shared concern--minimizing the Operating Room's impact on the environment. To accurately evaluate cost-in-use issues, Materials Management and the OR needed a better understanding of each other's processes, procedures and decision-making criteria. Materials Management observed surgical procedures to understand product requirements, and OR personnel were given financial information on such matters as group purchasing and disposal costs. After considering all the data, the MM/OR team decided to continue using single-use polypropylene gowns rather than switch to reusable gowns. Success in this endeavor led the team to institute a disposable wrap recycling program. Lasting benefits of the collaboration include higher cost consciousness among clinicians, open communications, greater supplier accountability for cradle-to-grave cost estimates and team building.     

A survey of pain relief clinics in the South Western Region

All the district general hospitals in the South Western Health Region have a pain relief service in existence or planned for the immediate future. Almost all are recognized by the allocation of anaesthetic consultant sessions. In most cases, this allocation is less than the time required for pain relief. All the consultants concerned work in single disciplinary clinics and accept both in-patient and out-patient referrals. They provide an advisory and therapeutic service to patients in the care of other clinicians and give tuition, mainly to junior anaesthetists. Most also undertake domiciliary assessment and treatment. In most clinics the Pain Relief Service is hampered by inadequate facilities. The minimum facilities for a basic efficient service are here reviewed.     

A survey of medical equipment displayed at the "Healthcare-2004" exhibition

Surveyed in the paper is medical equipment displayed, November 29-December 3, 2004, in the Exhibition Hall in Krasnaya Presnya within the framework of the "Healthcare, Medical Equipment and Drugs-2004" Exhibition. The survey is made for the below categories of medical equipment: instruments and apparatuses; X-ray, neonatal, ophthalmologic and stomatological equipment; medical instruments; laboratory medical equipment; equipment for rehabilitation of patients and disabled and mobile medical equipment. A conclusion is made on that a lot of novel high-quality and high-tech medical equipment has emerged in the Russian market. The diversified equipment displayed at the Exhibition enables any medical facility to choose for its needs the most appropriate medical equipment, instruments and spares.     

目前有关避孕药安全性的争议问题

该文阐述了目前避孕药安全性有争议的4个问题,包括避孕药是否增加静脉血栓,子宫肌瘤,子宫颈癌和骨密度降低等不良反应的相关风险。表明对有恰当的适应证,使用中能有较好观察的育龄妇女,使用避孕药仍然是可供选择的有价值的避孕措施。     

Food safety issues and information needs: an online survey of public health inspectors

In the study described in this article, the authors investigated the perceptions and needs of public health inspectors (PHIs) in the province of Ontario, Canada, with regard to food safety issues and information resources. A cross-sectional online survey of 239 Ontario PHIs was conducted between April and June 2009. Questions pertained to their perceptions of key food safety issues and foodborne pathogens, knowledge confidence, available resources, and resource needs. All respondents rated time-temperature abuse, inadequate hand washing, and cross contamination as important food safety issues. Salmonella, Campylobacter, and E. coli O157:H7 were pathogens reported to be of concern to 95% of respondents (221/233). Most respondents indicated that they were confident in their knowledge of food safety issues and foodborne pathogens, but wanted a central, online resource for food safety information and ongoing food safety education training for PHIs. The data from the authors' study can be used in the development of information resources targeted to the needs of PHIs involved in food safety.