Variables that influence diagnosis and treatment of the eating disorders within primary care settings: a vignette study

OBJECTIVE: This study examined the influence of clinical and nonclinical features of case presentation on the diagnosis and treatment of eating disorders in primary care. METHOD: Family physicians from a defined region of the UK were provided with two vignettes, characterizing eating disorder presentations in primary care. Case gender, ethnicity, weight status, and diabetes history were experimentally manipulated. Outcome variables included the primary diagnosis and the treatment course selected for each case. RESULTS: Female cases were more likely to receive an eating disorder diagnosis, even when their symptoms were identical to those of males. Nonclinical demographic variables also influenced treatment decisions. Weight status and physical comorbidity had a limited influence on treatment pathways. CONCLUSION: Nonclinical features of case presentations are used when making eating disorder diagnoses and in selecting treatment. Decision-making in primary care does not reflect recommendations from clinical guidance, and this disparity might increase the risk of complications in the care of sub-groups of eating-disordered patients.     

Social work influence on interdisciplinary ethical decision making in health care settings

Because of structural and philosophical changes in health care, social work practitioners are having to interact more with other practitioners in health care settings. Many of those interactions are interdisciplinary and often involve an understanding of the application of professional values and ethics. The authors have suggested that social workers' influence on ethical decision making is correlated directly to their ability to contribute to those decisions. In their study, the authors tested five independent variables and one dependent variable to show the factors that are related significantly to social workers' influence on ethical decision-making processes in multidisciplinary health care settings.     

The influence of a "culture of referral" on access to care in rural settings after myocardial infarction

Access to care is an issue for rural people who require tertiary care following a myocardial infarction (MI). Access to specialized cardiac health services is contingent upon referral to tertiary care in urban centers. Using a critical ethnographic approach, rural women, their nurses and physicians were interviewed to explore how rurality affected women's referral and access to care following a MI. Findings reflect that a previously undocumented culture of referral that was shaped by human factors influenced access to care. The culture of referral reflected an urban-centric approach to the provision of cardiovascular services and a medical hierarchy within the referral system. The findings extend conceptual understandings of access to health care in relation to rural populations.     

Translating culture and language: a research note on multilingual settings

Abstract Language and translation are not treated as part of the problematic in sociological research when compared with that of social anthropology, and this relative inattention can be related to the parallel development of the two disciplines. Ethnographic evidence from studies of identity, social support and wellbeing among Glasgow Punjabis suggests that the complex and strategic blending and switching of vocabulary, tone and accent is one means through which identities and support networks are negotiated and affirmed. The hybrid use of language can and should be reflected in the way that research is conducted with multilingual communities and some preliminary suggestions are made.     

GE医疗经验谈

GE公司是全球500强的巨头，GE医疗系统医学成像部是目前全球三大医学成像设备公司(GE、飞利浦和西门子)之一。GE医疗在过去几年中均以两位数的年增长率在增长，在中国的年增长速度更是达到了50％。GE医疗2001年的营业额达到了90多亿美元。GE为什么有这样好的业绩，GE医疗美洲部总裁兼CEO Mary Elizabeth(Beth)Klein女士在接待美国弗洛斯特市场调研公司采访时说了一些他们的经验，她的介绍或许对我们有所启发，特编其中一小部份供有兴趣参考。     

Facilitating HIV disclosure across diverse settings: a review

HIV status disclosure is central to debates about HIV because of its potential for HIV prevention and its links to privacy and confidentiality as human-rights issues. Our review of the HIV-disclosure literature found that few people keep their status completely secret; disclosure tends to be iterative and to be higher in high-income countries; gender shapes disclosure motivations and reactions; involuntary disclosure and low levels of partner disclosure highlight the difficulties faced by health workers; the meaning and process of disclosure differ across settings; stigmatization increases fears of disclosure; and the ethical dilemmas resulting from competing values concerning confidentiality influence the extent to which disclosure can be facilitated. Our results suggest that structural changes, including making more services available, could facilitate HIV disclosure as much as individual approaches and counseling do.     

Student assessment in community settings: a comprehensive approach

Student assessment in community settings presents problems for medical teachers, e.g. difficulties in assessing the contribution of individual members to group work, and lack of test standardization due to varying field conditions. The Faculty of Medicine, University of Gezira, Sudan is a community-oriented, community-based medical school which has adopted a comprehensive approach to student assessment in community settings using various methods, including peer assessment, a supervisory checklist, community feedback, reports from students, short essay questions (SEQs) and multiple choice questions (MCQs). Each method focuses on a specific aspect of the objectives of the community-based programme and is weighted in the final grade according to the extent to which objectives were covered. This assessment programme contrasts with the conventional teacher-centred approach, and is continuously monitored and improved using a variety of sources of information. A total of 105 students participated in a study designed to measure the reliability and validity of this approach. The reliability of the methods was tested by computing the alpha coefficient and was found to range between 0·77 and 0·92. This was considered acceptable. The validity of the instruments was examined using confirmatory factor analysis, and their content validity was reviewed. The results show that the comprehensive approach used is fairly valid. It is suggested that the University's approach is successful in solving some of the problems of student assessment in community settings.     

Tuberculosis transmission in nontraditional settings: a decision-tree approach

BACKGROUND: Tuberculosis (TB) transmission in nontraditional settings and relationships (non-TSR) often eludes detection by conventional contact investigation and is increasingly common. The U.S.-based National Tuberculosis Genotyping and Surveillance Network collected epidemiologic data and genotyping results of Mycobacterium tuberculosis isolates from 1996 to 2000. METHODS: In 2003-2004, we determined the number and characteristics of TB patients in non-TSR that were involved in recent transmission, generated a decision tree to profile those patients, and performed a case-control study to identify predictors of being in non-TSR. RESULTS: Of 10,844 culture-positive reported TB cases that were genotyped, 4724 (43.6%) M. tuberculosis isolates were clustered with at least one other isolate. Among these, 520 (11%) had epidemiologic linkages discovered during conventional contact investigation or cluster investigation and confirmed by genotyping results. The decision tree identified race/ethnicity (non-Hispanic white or black) as having the greatest predictive ability to determine patients in non-TSR, followed by being aged 15 to 24 years and having positive or unknown HIV infection status. From the 520, 85 (16.4%) had non-TSR, and 435 (83.6%) had traditional settings and relationships (TSR). In multivariate analyses, patients in non-TSR were significantly more likely than those in TSR to be non-Hispanic white (adjusted odds ratio [aOR]=6.1; 95% confidence interval [CI]=1.7-21.1]) or to have an M. tuberculosis isolate resistant to rifampin (aOR=5.2; 95% CI=1.5-17.7). CONCLUSIONS: Decision-tree analyses can be used to enhance both the efficiency and effectiveness of TB prevention and control activities in identifying patients in non-TSR.     

Surveillance on self-report: a trial of health and safety monitoring in occupational settings

A method for monitoring health and safety in the workplace, referred to as 'surveillance on self-report', is presented. This occupational health and safety monitoring method consists of a collection of data on certain aspects of health and safety obtained by dispensing self-administered questionnaires to employees or managers and supervisors in workplaces, and administering regular feedback on the responses. Based on the responses, a continual monitoring and improvement on certain aspects of health and safety were possible in two workplaces in New Zealand. This study has shown a methodology for the surveillance of hazard control and monitoring, injuries and illnesses, and organizational policies in occupational settings.     

GE螺旋CT两例故障维修

阐述了解决GE螺旋CT扫描掉高压和系统死机故障的过程。