Applying item response theory to enhance health outcomes assessment

Background Health-related quality of life (HRQL) is an accepted outcome measure in patients with mood and anxiety disorders. Yet, surprisingly little attention has been paid to the determinants. In this paper we test the hypothesis that it is associated with personality traits while controlling for mental disorders. Methods A large sample of outpatients (n=640) with mood and anxiety disorders was studied. The empirically supported five factor model of normal personality traits was assessed using the NEO-FFI and includes: neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness. Mental disorders were assessed with the CIDI, and HRQL with the SF-36. Results Regression analyses revealed that the NEO-FFI scores, with the exception of conscientiousness, were significantly associated with SF-36 subscales and summary scores, independently from the mental disorders. The percentage of explained variance due to the personality traits was highest for the subscales Vitality (10.0%), Mental Health (13.3%) and the Mental Health Summary Score (9.5%). Furthermore, specific personality traits were related to specific SF-36 subscales. Conclusions A low HRQL of patients with mood or anxiety disorders is not only determined by the disease or the current health but is also shaped by personality traits that are relatively stable throughout an individual's life time.     

南通市居民健康知识水平现状及对策

为全面了解和准确掌握南通市各行各业、中小学校健康知识的知晓情况,对创建国家卫生城市健康教育工作进行效果评估。调查显示,南通市11个片区健康知识的总知晓率居民为93.42%,学生为91.08%。要真正提高全体市民的健康教育水平,下一步必须采取三大对策,即:形成“抓反复、反复抓”的常态机制;加大健康教育投入;教育部门加强全市学生的健康知识普及工作,对卫生部门列入学校卫生的指标加以考核。只有这样,南通市的健康教育工作才能跃上新台阶。     

试论主体性教育

主体性教育问题的研究是时传统教育的继承和超越，是教育改革理论发展的重要取向。主体性教育遵循教育发展的客观规律和人全面发展的内在要求，已成为当代教育的主题，主体性教育是21世纪教育发展的主旋律。     

病案质量问题与改进

病案作为记录医疗活动过程的重要载体,包含着各类丰富的信息。医疗服务质量评价有很多内容是通过病案实现的。作者分析了包括"三级医师查房"在内的20余项在病案中反映的医疗服务质量项目,指出影响质量判断的常见因素,并提出解决的对策与措施。     

‘Translation is not enough’: using the Global Person Generated Index (GPGI) to assess individual quality of life in Bangladesh,Thailand, and Ethiopia

Currently few subjective measures of Quality of Life (QoL) are available for use in developing countries, which limits their theoretical, methodological, and practical contribution (for example, exploring the relationship between economic development and QoL, and ensuring effective and equitable service provision). One reason for this is the difficulty of ensuring that translated measures preserve conceptual, item, semantic, operational, measurement; and functional equivalence (Herdman, M., Fox-Rushby, J., & Badia, X. (1998). Quality of Life Research, 7, 331), which is illustrated by an account of the translation, pre-piloting, and administration of a new individualised QoL measure, the Global Person Generated Index or 'GPGI'. The GPGI is based on the widely used Patient Generated Index (Ruta, Camfield, & Martin, (2004) Quality of Life Research, 13, 1545.) and offers many of the advantages of the participatory approaches commonly used in developing countries, with added methodological rigour, and quantitative outcomes. It was successfully validated in Bangladesh, Thailand, and Ethiopia, using quantitative and qualitative methods--open-ended, semi-structured interviews (SSIs), conducted immediately post-administration. Both the measure and method of 'qualitative validation' described later in the paper offer an exciting alternative for future researchers and practitioners in this field. The quantitative results suggest the GPGI shows cultural sensitivity, and is able to capture both the areas that are important to respondents, and aspects of life one would expect to impact on QoL in developing countries. There were strong correlation between scores from the GPGI and SSIs for the area of health, and moderate correlations for 'material wellbeing' (MWB)('Material wellbeing' refers to respondents' perceptions of their achievement in the areas of farming, debt reduction, assets, crops, livestock, job, land, property, and agriculture) and children. Weak to moderate correlations were observed between the Satisfaction with Life Scale and the GPGI; however, the highest coefficient was between the GPGI and the most conceptually similar item. Statistically significant differences were seen in GPGI scores between rich and poor, urban and rural respondents, and different countries. Health and material wellbeing scores, derived from the SSIs, also showed a linear relationship with GPGI scores, with a suggestion of curvilinearity at the higher levels, as predicted by a general QoL causal model. In conclusion, the GPGI has great potential for use in this area, especially when supported by extensive interviewer training, and supplemented with a cognitive appraisal schedule.     

用秩和比法对我院的10个公示病种医疗质量进行综合评价

目的对我院2005年度公示的10个病种进行医疗质量综合评价。方法采用秩和比法(RSR)进行统计分析。结果我院的10个公示病种被划分成4个医疗质量等级:老年性白内障、小儿支气管肺炎2个病种质量为优,急性阑尾炎、腹股沟疝(单侧)、子宫平滑肌瘤、剖宫产4个病种质量为良,胃大切、脑梗塞、急性心肌梗塞3个病种质量为中,脑出血1个病种质量为差。结论通过对综合指数秩和比(RSR)的计算并根据其值分级归档,反映出所研究病种之间存在着医疗质量高低的差异。控制和降低本院临床常见病种的医药费用,进行医疗全程连续性控制,为患者提供经济有效的医疗服务。     

More than 10 years registration of continuing medical education as part of quality control by The Netherlands Society for Oto‐Rhino‐Laryngology and Cervico‐Facial Surgery

More than 10 years registration of continuing medical education as part of quality control by The Netherlands Society for Oto‐Rhino‐Laryngology and Cervico‐Facial Surgery After more than 10 years registration, 93% of ENT specialists in The Netherlands fulfil the requirements for continuing medical education in spite of the fact that sanctions (no re‐registration) have not been implemented to date. Improvements have been made over the years. Information about how to set up a comparable system was supplied to 10 other scientific societies. A recurrent point for discussion is whether or not to award points for presentations, papers and (co)publications. On the one hand, it seems reasonable to reward the effort but, on the other hand, it creates practical problems. As a matter of fact, all members who give papers and write articles appear to attend more than enough postgraduate education. The process of accurate registration of continuing medical education, including accreditation and certification, is time‐consuming. Moreover, it requires intensive and essential supervision by an experienced colleague who has a thorough knowledge of the specialist field.     

Impact of cosmetic care on quality of life in breast cancer patients during chemotherapy and radiotherapy: an initial randomized controlled study

BACKGROUND: Breast cancer is the most common cancer in women and therefore represents a major problem in public health. Data from patients' self-report questionnaires provide valuable information about the side-effects that patients may view as having a significantly detrimental impact on their quality of life (QOL) and yet are not always recognized as important by healthcare professionals. Cosmetology is a specific care for patients and there is actually no scientific evidence regarding effects on QOL for women with breast cancer. OBJECTIVE: The purpose of this study is to assess the impact of cosmetic care on QOL in breast cancer patients during chemotherapy and radiotherapy. METHODS: We developed a prospective, multicentre, randomized, controlled study including 27 patients. All the patients had to fill in a French-validated dermatologic specific quality-of-life questionnaire to compare the QOL of the two groups, the cosmetic group and the control group, at three different times of the adjuvant treatment. RESULTS: The results show a statistically significant difference between the cosmetic group and the control group in two areas of QOL: mood state and self-perception of the disease. CONCLUSION: This study emphasizes the interest of cosmetic care in breast cancer patients. However, further larger trials are needed to confirm this study.     

现代中医药发展战略思考

建国几十年来，由于党和政府的大力提倡和扶持，中医药得到了很大发展，但相对于西医的发展势头仍显不足。尤其是近10多年来，由于现代科技及现代管理学的有力推动，西医获得了突飞猛进的发展，然而，中医却由于种种原因发展相对缓慢。在这各行各业竞相发展的现代社会，中医要生存，就蓝须发展，中医要发展，就妊须总揽全局，从战略高度克服中医药发展的各种不利因素，充分发挥各方面的有利条件。