健康调查简表及其在妇科疼痛相关疾病中的应用进展②

本文介绍健康调查简表(SF-36)的发展及引进中国后在临床的应用概况，重点介绍其在妇科以慢性盆腔疼痛为主要症状相关疾病，如盆腔炎、子宫内膜异位症等的应用概况。临床如能将SF-36与特定疾病量表结合，将为妇科慢性盆腔疼痛评估提供一个重要而有意义的工具。     

Surveying general practitioners: a new avenue

SUMMARY

Background: The validity of opinions expressed in questionnaire surveys diminishes with lower response rates. Recent research suggests that general practitioners (GPs) are more likely to respond to questionnaire surveys if they are motivated to do so because the subject of the survey is perceived as relevant to the practitioner at the time of the survey, and there is an opportunity to respond without encroaching on existing obligations or interests.

Aim: To compare the results of a questionnaire survey administered by two routes: a postal survey with reminders and after an educational meeting with no reminders.

Methods: A validated questionnaire with 19 questions using a Likert scale seeking views about the ideal contents of a referral letter to colorectal surgeons was administered to GPs attending a monthly educational meeting in one locality in the UK and by post to a different group in a second locality. The response rate and demographic characteristics of the GPs were compared for respondents, non-respondents, attenders and non-attenders to the educational meeting. The mean responses to the questions on the Likert scale were used to produce a schedule to score the contents of referral letters. The schedules produced by the two methods (postal/educational meeting) were used to score 551 referral letters at one district general hospital. Mean scores calculated using the two schedules derived by the postal and educational routes were compared. Cases diagnosed with 'significant organic pathology' as defined in a previous study were identified. The predictive value of the scores in identifying these cases was compared.

Results: 88% (138/157) of GPs in the locality attended the educational meeting and were invited to participate in the survey. Non-attenders were more likely to be assistants, locums or part-time practitioners. Overall 71% (98) of the GPs responded to the survey. There were no significant demographic differences between the respondents and non-respondents to the survey. Response rates to the survey conducted by the two routes were similar. Referral letter 'quality' scores derived via the two alternative routes were equally valuable in predicting which patients had significant organic pathology.

Conclusions: Responses to questionnaire surveys are equally valid when administered via an educational meeting or by post. The value of the educational meeting approach was the relative ease of administering the questionnaire and the rapid turn around of replies. However this method may exclude the views of part-time practitioners who were more likely to fail to attend. These practitioners may need to be targeted by alternative routes in questionnaire surveys.     

Shorter sentences for drug mules: The early impact of the sentencing guidelines in England and Wales

Abstract

Aims: In February 2012, new sentencing guidelines for drug offences became effective in all courts in England and Wales. An explicit aim was to reduce the length of sentences for drug “mules” and so make them more proportionate. Methods: This article examines their early impact drawing on data from the Court Proceedings Database and the Crown Court Sentencing Survey for importing/exporting a Class A drug. Findings: Overall, the guidelines have achieved their intended aim. The length of the average custodial sentence for drug trafficking fell following the introduction of the guidelines, largely due to taking defendants' roles into account. Notably, three-quarters of those in “lesser” roles received sentences less than four years, representing an important change. Nonetheless, around 10% of mules received very long sentences due to the continued use of drug weight in sentencing. Conclusion: The new guidelines represent an internationally important innovation in drug policy reform.     

Effects of differential privacy techniques: Considerations for end users

We study the effects of differentially private (DP) noise injection techniques in a survey data setting, using the release of cost of early care and education estimates from the National Survey of Early Care and Education as a motivating example. As an example of how DP noise injection affects statistical estimates, our analysis compares the relative performance of DP techniques in the context of releasing estimates of means, medians, and regression coefficients. The results show that for many statistics, basic DP techniques show good performance provided that the privacy budget does not need to be split over too many estimates. Throughout, we show that small decisions, such as the number of bins in a histogram or the scaling of a variable in a regression equation, can have sometimes dramatic effects on the end results. Because of this, it is important to develop DP techniques with an eye towards the most important aspects of the data for end users.     

Patient knowledge of hysterectomy and pap screening after minimally invasive hysterectomy

ObjectiveTo determine whether women know their own cervical cancer screening recommendations after hysterectomy, and to evaluate patients’ understanding of hysterectomy terminology and cervical cancer screening.MethodsA 19-item questionnaire was developed and administered to 413 women who had undergone minimally invasive hysterectomy with benign pathology between January 2008 and January 2012.ResultsA total of 190 women (46%) participated in the survey. The majority of respondents were Caucasian (61%) and had a college education (66%). Fifty-nine percent of respondents knew that a Pap test screens for cervical cancer, and 40% knew that HPV is related to cervical cancer. Eight-four percent understood that Pap screening is recommended if a woman still has a cervix after hysterectomy. Only 67% correctly identified if their cervix had been removed during their own surgery and if they needed future cervical cancer screening per current guidelines. Caucasian race and higher income were significant predictors of hysterectomy and screening knowledge.ConclusionKnowledge regarding Pap tests, HPV, and implications of a supracervical hysterectomy is lacking, even among a post-hysterectomy population.Practical implicationsPatient educational information is needed to improve perioperative counseling regarding the type of hysterectomy performed and indications for future cervical cancer screening.     

A user-centered approach to developing a new tool measuring the behavioural and social drivers of vaccination

BackgroundChildren around the world remain under-vaccinated for many reasons. To develop effective vaccine delivery programmes and monitor intervention impact, vaccine programme implementers need to understand reasons for under-vaccination within their local context. The World Health Organization (WHO) Working Group on the Behavioural and Social Drivers of Vaccination (BeSD) is developing standardised tools for assessing childhood vaccine acceptance and uptake that can be used across regions and countries. The tools will include: (1) a validated survey; (2) qualitative interview guides; and (3) corresponding user guidance. We report a user-centred needs assessment of key end-users of the BeSD tools.MethodsTwenty qualitative interviews (Apr-Aug 2019) with purposively sampled vaccine programme managers, partners and stakeholders from UNICEF and WHO country and regional offices. The interviews assessed current systems, practices and challenges in data utilisation and reflections on how the BeSD tools might be optimised. Framework analysis was used to code the interviews.ResultsRegarding current practices, participants described a variety of settings, data systems, and frequencies of vaccination attitude measurement. They reported that the majority of data used is quantitative, and there is appetite for increased use of qualitative data. Capacity for conducting studies on social/behavioural drivers of vaccination was high in some jurisdictions and needed in others. Issues include barriers to collecting such data and variability in sources. Reflecting on the tools, participants described the need to explore the attitudes and practices of healthcare workers in addition to parents and caregivers. Participants were supportive of the proposed mixed-methods structure of the tools and training in their usage, and highlighted the need for balance between tool standardisation and flexibility to adapt locally.ConclusionsA user-centred approach in developing the BeSD tools has given valuable direction to their design, bringing the use of behavioural and social data to the heart of programme planning.     

Medical Ultrasound Disinfection and Hygiene Practices: WFUMB Global Survey Results

As ultrasound technology rapidly evolves and is used more frequently in every area of medical diagnosis and treatment, it may be overlooked as a potential vector in the transmission of a health care-associated infection. A survey on disinfection and hygiene practice in medical ultrasound was disseminated via the World Federation for Ultrasound in Medicine and Biology (WFUMB) to its six member federations and associated ultrasound societies globally. One thousand twenty-nine responses were obtained across a broad range of ultrasound practitioners. A total of 76% of respondents used transducer covers every time to scan open wounds and 71% when blood and bodily fluids were present or for an interventional procedure. Approved high-level disinfectants are not always used, even when blood comes into contact with the transducer or after endocavity scans. Alcohol-based wipes were used by many respondents to clean both external transducers and endocavity transducers. Open-ended responses indicated that a large caseload hindered the time required for cleaning and that access to clear guidelines would be beneficial. Global survey results indicate that some users do not comply with disinfection practice, and there is a gap in knowledge on basic infection prevention and control education within the ultrasound unit. As the infectious status of a patient is not often disclosed prior to an ultrasound examination, training in suitable protocols for the cleaning and disinfection of ultrasound equipment is imperative to mitigate the risk of potential infection.     

辽西地区健康体检者血脂水平调查分析

目的了解来我院体检的辽西地区体检人员的血清总胆固醇(TC)和血清三酰甘油(TG)水平与性别之间的关系。方法对11817例地方体检人员的检查资料进行整理分析,按性别进行分组,分为男性体检人员组(6656例)和女性体检人员组(5161例),用酶法检测体检者TC和TG水平,运用统计学方法(t检验,卡方检验)对检验结果进行调查分析。结果男性体检人员组的TC和TG水平与女性体检人员组的TC和TG水平比较差异均有统计学意义(P<0.05)。男性体检人员组中TC异常的发生率为44.01%(2929/6656),女性体检人员组中TC异常的发生率为28.19%(1455/5161),男性体检人员组的TC异常的发生率和女性体检人员组的TC异常的发生率比较差异有统计学意义(P<0.05)。男性体检人员组中TG异常的发生率为45.43%(3024/6656),女性体检人员组中TG异常的发生率为16.93%(874/5161),男性体检人员组的TG异常的发生率和女性体检人员组的TG异常的发生率比较差异有统计学意义(P<0.05)。结论辽西地区男性的TC和TG水平高于女性,并具有显著性差异。TC和TG异常的发生与性别因素相关。