维多利亚州住院病人满意度监测的方法学

文章全面地介绍了维多利亚州住院病人满意度监测的方法，包括工具设计的目的、原则和开发过程、问卷的结构、数据采集和分析方法，以及监测结果的表达和应用方式。     

Mammographic density and risk of breast cancer by age and tumor characteristics

Introduction

Understanding whether mammographic density (MD) is associated with all breast tumor subtypes and whether the strength of association varies by age is important for utilizing MD in risk models.

Methods

Data were pooled from six studies including 3414 women with breast cancer and 7199 without who underwent screening mammography. Percent MD was assessed from digitized film-screen mammograms using a computer-assisted threshold technique. We used polytomous logistic regression to calculate breast cancer odds according to tumor type, histopathological characteristics, and receptor (estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor (HER2)) status by age (<55, 55–64, and ≥65 years).

Results

MD was positively associated with risk of invasive tumors across all ages, with a two-fold increased risk for high (>51%) versus average density (11-25%). Women ages <55 years with high MD had stronger increased risk of ductal carcinoma in situ (DCIS) compared to women ages 55–64 and ≥65 years (P_{age-interaction} = 0.02). Among all ages, MD had a stronger association with large (>2.1 cm) versus small tumors and positive versus negative lymph node status (P’s < 0.01). For women ages <55 years, there was a stronger association of MD with ER-negative breast cancer than ER-positive tumors compared to women ages 55–64 and ≥65 years (P_{age-interaction} = 0.04). MD was positively associated with both HER2-negative and HER2-positive tumors within each age group.

Conclusion

MD is strongly associated with all breast cancer subtypes, but particularly tumors of large size and positive lymph nodes across all ages, and ER-negative status among women ages <55 years, suggesting high MD may play an important role in tumor aggressiveness, especially in younger women.     

澳大利亚全科医学服务质量管理框架、措施及借鉴

本文系统地介绍了澳大利全科医学服务的质量管理框架,并从以病人为中心的战略;全科医生教育、培训、认证和持续发展;全科医学服务质量标准;促进信息管理和信息技术应用等4个方面,阐述澳大利亚持续改善全科医学服务质量的具体措施,为我国全科医学和社区卫生服务的发展提供可借鉴的经验。     

Cardiac arrhythmias six months following traumatic spinal cord injury

ObjectiveTo investigate the incidence of cardiac arrhythmias at six months following traumatic spinal cord injury (SCI) and to compare the prevalence of arrhythmias between participants with cervical and thoracic SCI.DesignA prospective observational study using continuous twenty-four-hour Holter monitoring.SettingInpatient rehabilitation unit of a university research hospital and patient home setting.ParticipantsFifty-five participants with acute traumatic SCI were prospectively included. For each participant, the SCI was characterized according to the International Standards for Neurological Classification of SCI by the neurological level and severity according to the American Spinal Injury Association Impairment Scale.Outcome measuresComparisons between demographic characteristics and arrhythmogenic occurrences as early as possible after SCI (4 ± 2 days) followed by 1, 2, 3, 4 weeks and 6 month time points of Holter monitoring.ResultsBradycardia (heart rate [HR] <50 bpm) was present in 29% and 33% of the participants with cervical (C1–C8) and thoracic (T1–T12) SCI six months after SCI, respectively. The differences in episodes of bradycardia between the two groups were not significant (P < 0.54). The mean maximum HR increased significantly from 4 weeks to 6 months post-SCI (P < 0.001), however mean minimum and maximum HR were not significantly different between the groups at the six-month time point. There were no differences in many arrhythmias between recording periods or between groups at six months.ConclusionsAt the six-month timepoint following traumatic SCI, there were no significant differences in occurrences of arrhythmias between participants with cervical and thoracic SCI compared to the findings observed in the first month following SCI.     

Prevalence of depression in coronary heart disease in China: a systematic review and meta-analysis

Background Coronary heart diseases （CHD） have been identified as one of topmost diseases affecting the Chinese population.However,depression in CHD has not been reported and there are limited high quality empirical studies in China focused on the prevalence of the comorbidity.This study aimed to estimate the pooled prevalence of depression with CHD in China.Methods Systematic review and meta-analysis of published epidemiologic studies on the depression in CHD patients in China were conducted.The research findings dated before 30 September 2013 were obtained from Ovid Medline,EMBASE and two Chinese electronic publication libraries WANFANG and CNKI.We used ＂cardiovascular disease＂,＂depression＂ and ＂China＂ as the search themes in Ovid Medline and EMBASE and ＂cardiovascular disease＂ and ＂depression＂ in WANFANG and CNKI.Random-effects meta-analysis was used to estimate the prevalence of depression in CHD patients.Results Twenty-seven studies were included in the review.Twenty-three studies had 5 236 participants who were hospitalized and four studies had 1 353 participants from community.The overall prevalence of depression in CHD from hospital was 51% （95% CI：0.43,0.58; Ⅰ-squared=97%,P=-0.000）.The prevalence of depression in CHD from community ranged between 34.6% to 45.8%,and the severe depression was found ranging between 3.1% to 11.2%.Conclusions On comparing data with other countries,the prevalence of depression in CHD among admitted patients in China was found to be high.The physicians and healthcare providers should pay more attention to the ＂physical-mental＂ health of the CHD patients.     

从澳大利亚护理实践的演变看中国社区护理的发展(二)——中国社区护理的发展和挑战

目的从历史纵深角度,探讨我国护理的发展沿革及社区护理面临的严峻挑战,揭示阻碍社区护理发展的历史和文化渊源,从而为制定发展社区护理的政策,迎接老龄化社区卫生服务挑战,提供有意义的依据。方法以文献研究和政策分析作为主要的研究手段。结果中国的护士源于鸦片战争后医学传教士带来的西医技术医学体系,从传统的家庭护理一步跨入医院为中心的护理。然而机构内护理与东方文化传统的矛盾,医护比例的严重倒置,以及护理培训制度不健全,不但影响了医院护理质量,也使得社区护理资源奇缺。社区护理教育边缘化和人力发展严重滞后,是困扰我国社区卫生服务发展的主要障碍。结论大力发展社区护理是保证社区协调发展和满足人群健康需要的关键战略。我国的社区护理发展与其他国家一样,受到历史传承因素的影响,面临迅速增长的社区需要与发育不良的社区护理之间的矛盾,医学界和政府都应该从历史和文化的角度理解这个问题的背景,并从中获得启迪。     

澳大利亚建立全民医疗保险的政治过程

本文采用描述政治过程的方法，比较全面地回顾了澳大利亚全民医疗保险的缘起，并特别关注系统建立和完善过程中政治因素的影响和对中国同行的启示。全民医疗保险制度是一个具有鲜明政治特征的社会政策，它是人权运动和社会公平思想与传统的经济学和市场理论相互较量的结果。全民医疗保险正在成为中国学术界和政界的一个重要议题，是提高卫生服务的公平性和可及性，建立和谐社会的重要方面。澳大利亚建立全民医疗保险的故事，可以让我们开阔视野和深入思考。