Quality of care by race and gender for congestive heart failure and pneumonia

BACKGROUND: Variations in the rates of major procedures by race and gender are well described, but few studies have assessed the quality of care by race and gender for basic hospital services. OBJECTIVE: To assess quality of care by race and gender. RESEARCH DESIGN: Retrospective review of medical records. SUBJECTS: Stratified random sample of 2,175 Medicare beneficiaries hospitalized for congestive heart failure or pneumonia in Illinois, New York, and Pennsylvania during 1991 and 1992. MEASURES: Explicit process criteria and implicit review by physicians. RESULTS: In adjusted analyses, black patients with congestive heart failure or pneumonia received lower quality of care overall than other patients with these conditions by both explicit process criteria and implicit review (P < 0.05). On explicit measures, overall quality of care did not differ by gender for either condition, but significant differences were noted on explicit subscales. Women received worse cognitive care than men from physicians for both conditions, better cognitive care from nurses for pneumonia, and better therapeutic care for congestive heart failure (P < 0.05). Women received worse quality of care than men by implicit review (P = 0.03) for congestive heart failure but not pneumonia. CONCLUSIONS: Consistent racial differences in quality of care persist in basic hospital services for two common medical conditions. Physicians, nurses, and policy makers should strive to eliminate these differences. Gender differences in quality of care are less pronounced and may vary by condition and type of provider or service.     

Perceptions of cancer-related information among cancer survivors: a report from the American Cancer Society's Studies of Cancer Survivors

BACKGROUND.: Sources of cancer-related information are rapidly increasing, but little is known about whether the health information available to cancer survivors meets their needs. METHODS.: The authors surveyed 778 Massachusetts cancer survivors 3, 6, or 11 years after their diagnosis for 6 common cancers. They analyzed their views about 5 types of cancer-related information, the quality of that information, barriers to getting it, their experiences with physicians providing cancer care, and the quality of their cancer care. RESULTS.: Among 462 (61%) respondents who reported needing cancer information, many gave unfavorable ratings (fair or poor) of the quality of cancer information regarding cancer support groups (38%), long-term side effects (36%), experiences of other cancer patients (26%), and cancer physicians (26%). About 20% of respondents reported sometimes experiencing barriers to obtaining cancer information, although fewer than 10% usually or always experienced barriers. For both men and women, worse physical and mental functioning was associated with greater need for information, worse ratings of information quality, and more barriers to obtaining information (all P<.01). Cancer survivors who were black or had lower incomes reported more problems obtaining needed information, and younger women had greater information needs than older women (all P <.01). CONCLUSIONS.: Opportunities exist to improve the quality, content and delivery of cancer-related information to survivors, especially for those who are racial/ethnic minorities, have low incomes, or are in worse physical or mental health. Providing information more effectively to cancer survivors may improve their care and health outcomes. Cancer 2008. (c) 2008 American Cancer Society.     

Performance characteristics of a point of care C-reactive protein assay.

BACKGROUND: C-reactive protein (CRP) is a non-specific marker of inflammation that can be used for atherosclerotic risk assessment. This application requires increased precision at low CRP concentrations compared to traditional assays. METHODS: The Micros CRP analyzer (ABX Diagnostics) is a small bench top device. Its limit of detection, limit of quantitation, linearity and imprecision were assessed. Method comparison studies were performed using samples both inside and outside the reference interval. Anticoagulant effects and the prozone effect were also evaluated. RESULTS: The limit of detection was 0.1 mg/l. The method was linear from 2 to 60 and 0.3 to 60 mg/l using systematic error limits of 10% and 20%, respectively. The total imprecision was <8% for CRP concentrations from 0.7 to 9.1 mg/l. A prozone effect was seen at CRP concentrations >500 mg/l. Using samples from 120 apparently healthy adults, the Micros CRP method demonstrated excellent concordance with the BN II high sensitivity CRP (hs-CRP) method. The Micros CRP method compared well with a nephelometric method using samples with elevated CRP concentrations. CONCLUSIONS: The Micros CRP method is adequate for atherosclerotic risk prediction in clinical practice but does not have adequate accuracy at CRP concentrations <2 mg/l for epidemiological studies.     

血管介入治疗妇科恶性肿瘤急性大出血13例

1 临床资料 1996-03/2004-12采用血管性介入疗法治疗妇科恶性肿瘤所致的急性大出血13例,年龄43～65(平均47)岁,均为已婚已育.     

ZnPPⅪ对肺动脉内皮依赖性舒张反应的影响

目的 :通过观察血红素氧化酶抑制剂锌原卟啉Ⅸ (zineprotoporphyrinⅨ ,ZnPPⅨ )对乙酰胆碱 (acetyl choline,Ach)内皮依赖性血管舒张反应的影响 ,探讨内源性一氧化碳 (carbonmonoxide,CO)对肺血管的舒张作用。方法 :取Wistar大鼠肺动脉环 ,制备Ach浓度效应曲线 ,冲洗后平衡 6 0min ,分别加入一氧化氮 (nitricoxide,NO)合成酶抑制剂L NAME 30 μmol/L或L NAME 30 μmol /L +ZnPPⅨ 10 μmol/L ,孵育 30min后 ,重复制备Ach浓度效应曲线 ,观察给药前后Ach浓度效应关系的变化。结果 :用去氧肾上腺素收缩肺动脉后 ,Ach能对内皮完整的肺动脉引起浓度依赖性舒张 ,血管环用L NAME孵育后 ,舒张反应受抑 ,10 -5mol/L的Ach只引起 (40 .3± 5 .1) %的舒张反应 ,而用ZnPPⅨ及L NAME共同孵育后 ,舒张反应进一步受抑或消失 ,10 -5mol/L的Ach只能引起 (11.1± 8.4 ) %的舒张反应或不引起舒张反应。结论 :ZnPPⅨ可抑制Ach的内皮依赖性舒张反应 ,提示内源性CO与NO共同参与了Ach的内皮依赖性血管舒张反应 ,CO对肺血管平滑肌有舒张作用     

高效液相色谱法测定白血病人依托泊苷血药浓度及其药物动力学研究

目的：测定10位白血病8个时间点血清中VP16浓度,并进行药物动力学研究,方法：HPLC（标法）,流动相,甲醇－乙腈－水（50：10：40,v/v),波长254nm。结果：分离良好,回收率＞92％,日内,日间精密度＜5％,药动学参数为二房室开放模型,老年人t1/2β有较明显延长。结论：本法提取简便,灵敏度高,精密度高,肾功能不良者应减量,适用于基医院VP16的临床监测。     

Primary-care Clinician Perceptions of Racial Disparities in Diabetes Care

Summary Background Primary-care clinicians can play an important role in reducing racial disparities in diabetes care. Objective The objective of the study is to determine the views of primary-care clinicians regarding racial disparities in diabetes care. Design The design of the study is through a survey of primary-care clinicians (response rate = 86%). Participants The participants of the study were 115 physicians and 54 nurse practitioners and physician assistants within a multisite group practice in 2007. Measurements and Main Results We identified sociodemographic characteristics of each clinician’s diabetic patient panel. We fit multivariable logistic regression models to identify predictors of supporting the collection of data on patients’ race and acknowledging the existence of racial disparities among patients personally treated. Among respondents, 79% supported the collection of data on patients’ race. Whereas 88% acknowledged the existence of racial disparities in diabetes care within the U.S. health system, only 40% reported their presence among patients personally treated. Clinicians caring for greater than or equal to 50% minority patients were more likely to support collection of patient race data (adjusted odds ratio [OR] 9.0; 95% confidence interval [CI] 1.2–65.0) and report the presence of racial disparities within their patient panel (adjusted OR 12.0; 95% CI 2.5–57.7). Clinicians were more likely to perceive patient factors than physician or health system factors as mediators of racial disparities; however, most supported interventions such as increasing clinician awareness (84%) and cultural competency training (88%). Conclusions Most primary-care clinicians support the collection of data on patients’ race, but increased awareness about racial disparities at the local level is needed as part of a targeted effort to improve health care for minority patients.     

反向遗传操作技术在流感病毒中的应用研究

反向遗传操作技术(reverse genetics, RG)是近年来比较热门的一门技术,该技术可以在DNA水平上对病毒基因组进行各种修饰或改造,然后通过拯救病毒的表型变化来判断这些基因操作的效果,从而可以对病毒基因组表达调控机制、病毒致病的分子机理等进行研究.我们通过对近年来国外有关文献的回顾,希望能够正确看待病毒拯救技术的利弊,注意生物安全性,希望能够为防治可能发生的流感病毒流散和传播提供新的思路.