Rapid‐access cardiology services: can these reduce the burden of acute chest pain on Australian and New Zealand health services?

Chest pain is common and places a significant burden on hospital resources. Many patients with undifferentiated low‐ to intermediate‐risk chest pain are admitted to hospital. Rapid‐access cardiology (RAC) services are hospital co‐located, cardiologist‐led outpatient clinics that provide rapid assessment and immediate management but not long‐term management. This service model is described as part of chest pain management and the National Service Framework for coronary heart disease in the United Kingdom (UK). We review the evidence on the effectiveness, safety and acceptability of RAC services. Our review finds that early assessment in RAC outpatient services of patients with suspected angina, without high‐risk features suspicious of an acute coronary syndrome, is safe, can reduce hospitalisations, is cost effective and has good medical practitioner and patient acceptability. However, the literature is limited in that the evaluation of this model of care has been only in the UK. It is potentially suited to other settings and needs further evaluation in other settings to assess its utility.     

Retention and HIV seroconversion among drug users on methadone maintenance treatment in Yunnan,China

Setting: Thirteen methadone maintenance treatment (MMT) clinics across Yunnan, the province with the highest human immunodeficiency virus (HIV) burden in China.Objectives: To determine, among HIV-negative participants on MMT, the proportion lost to follow-up (defined as those who missed the 6-monthly follow-up examination), factors associated with loss to follow-up (LFU), HIV seroconversion rate and factors associated with seroconversion.Design: Prospective cohort study from October 2008 to April 2011. All participants were administered a pre-tested structured questionnaire to capture associated factors and offered HIV testing every 6 months. χ² test and log-binomial regression were used for data analysis.Results: Of 1146 participants, 541 (47%) were lost to follow-up in 2.5 years. Factors associated with higher LFU proportion include <6 months of previous MMT, inconvenient location of the MMT clinic and average methadone dose ⩽60 mg/day, with adjusted relative risks (RRs) of respectively 1.4 (95%CI 1.2–1.5), 1.2 (95%CI 1.0–1.4) and 1.1 (95%CI 1.0–1.3). The overall HIV seroconversion rate was 6.6 (95%CI 3.7–11.0) per 1000 person-years. Not living with a partner contributed to higher HIV rates, with an adjusted RR of 3.6 (95%CI 1.0–12.8).Conclusion: The retention rate of MMT participants in Yunnan was not satisfactory. Decentralising service delivery in the community and making directly observed treatment more convenient has the potential to improve retention.     

COVID-19 Among US Dialysis Patients: Risk Factors and Outcomes From a National Dialysis Provider

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2~6岁儿童牙科诊室行为影响因素研究

目的探寻2~6岁儿童牙科诊室行为的影响因素,建立简便易行的低龄儿童牙科诊室行为预测模型。方法对96例接受牙科治疗的2~6岁儿童的牙科诊室行为评估分为配合组与不配合组;问卷调查获取家长口腔健康意识、母亲牙科焦虑、儿童日常行为特点及情绪类型等资料;使用SPSS11.5软件分析组间各因素差异及与牙科诊室行为的相关程度。结果两组患儿年龄(4.35±0.83 vs 3.85±1.07)和情绪应激性(17.77±4.88 vs 23.23±4.76)之间差异有统计学意义(P0.05);治疗持续时间、幼儿园入园表现、家长对儿童口腔疾患的责任承担度与儿童口腔诊室行为均存在显著相关性(P0.05)。结论通过治疗前与家长的针对性沟通可有效预测低龄儿童牙科诊室行为。     

Outpatient Care Participation and Six-Month Status: Results with an Inner City Impoverished Alcoholic Veterans Population

One hundred and thirty-seven impoverished, inner city, predominately Black alcoholic veterans were divided into four groups based on the frequency of their attendance at an outpatient clinic. They were assessed 6 months after their joining the clinic. In general, many variables reflecting lessened alcohol consumption were connected with greater amounts of clinic attendance. In most instances a month or more of attendance at the clinic appeared necessary before the positive changes started to occur.