'Not everything that can be counted counts and not everything that counts can be counted'– towards a critical exploration of modes of satisfaction measurement in sheltered housing

This paper reflects on a research project funded by a consortium of leading sheltered housing (SH) providers and their regulatory body, the Housing Corporation. The project aimed to ascertain which aspects of SH older people perceived to be central to their satisfaction and the methods they judged most appropriate to measuring this. We outline key policy developments of importance to SH (specifically the development of performance measurement regimes), and changes in the nature of SH, which are driving providers to re‐evaluate how they measure user satisfaction. We discuss the aims of the project, our methodology and findings, and conclude by raising critical questions about the process of measuring satisfaction within an increasingly managerialised housing system. We argue that this favours standardised methods of information gathering (such as questionnaires) rather than engage with clients in order to develop methods and systems capable of eliciting qualitative issues of concern to them. Our conclusions are, we believe, applicable to health and social care provision, where similar tensions exist around performance measurement and user satisfaction.     

Facilitating access to glucometer reagents increases blood glucose self-monitoring frequency and improves glycaemic control: a prospective study in insulin-treated diabetic patients.

AIMS: To investigate whether availability of glucometer reagents increases the frequency of self-blood glucose monitoring (SBGM) and improves glycaemic control in diabetic patients. METHODS: Sixty-two insulin-treated diabetic patients were randomized to two groups, matched for age, gender, education, income, type and duration of diabetes, years of insulin treatment, number of daily insulin injections, and haemoglobin (Hb)A1c. All patients were given a glucometer, but one group (no cost, NC) was provided glucometer test strips free of charge. The other group (control, C) had to purchase strips as they found it necessary. Both groups of patients were followed longitudinally at 2-monthly intervals for 12 months with measurement of blood glucose and HbA1c, and the frequency of SBGM was determined by downloading the glucometer memory. RESULTS: The SBGM frequency was significantly higher in the NC group vs. the C group during the first 4 months (2.0 +/- 0.2 tests/day vs. 1.4 +/- 0.1 tests/day, P<0.025). Mean HbA1c remained stable over the 12 months in the NC group, whereas an increase with time was observed in the C group. The difference in HbA1c between the two groups was significant (P<0.002) after 6 months. Random blood glucose measured at each visit and average glucose recorded by the glucometer were also lower in the NC group vs. the C group (P<0.005). There was a negative correlation between HbA1c and SBGM frequency, and HbA1c in patients testing at least twice a day was lower than in those testing less than twice a day (8.8 +/- 0.2% vs. 9.6 +/- 0.2%, P<0.001). CONCLUSIONS: In this prospective study, having easy access to glucometer strips provided free of charge to patients increased SBGM frequency. The relationship between HbA1c and SBGM frequency supports the view that SBGM is an essential tool in diabetes management.     

导管射频消融治疗飞行员快速心律失常临床分析

目的探讨导管射频消融（RFCA）在治疗飞行员多种快速性心律失常中的安全性及临床应用价值，探讨飞行员快速性心律失常的航空医学鉴定标准。方法对13例快速性心律失常的飞行员进行了电生理（EP）检查，特发性室性心动过速（VT）1例，频发室性期前收缩（VE）2例，阵发性心房纤颤（AF）1例，房室折返性心动过速（AVRT）5例，房室结折返性心动过速（AVNRT）3例，房性心动过速（AT）1例。对其中12例采用RFCA治疗。结果RFCA即刻成功率为100％，全组无并发症发生。1例房性心动过速未行导管射频消融治疗。所有飞行员术后地面观察6个月后，返院进行随访复查，同时进行飞行鉴定。12例导管射频消融治疗，术后6个月24h动态心电图、12导联心电图检查和食道电生理检查均未检测到术前的同型快速性心律失常发作，延迟成功率为100％，医学鉴定合格。1例AT仍有发作，飞行不合格。结论对于飞行员快速性心律失常进行导管射频消融治疗是一种安全、有效的治疗方法。心脏电生理检查应作为飞行员快速性心律失常医学鉴定的主要指标之一。     

Use of self-efficacy and dyspnea perceptions to predict functional performance in people with COPD.

This correlational and comparative study explored whether self-reports of self-efficacy and dyspnea perceptions predict the perceived level of functional performance in adults who have chronic obstructive pulmonary disease (COPD). The convenience sample included 97 Caucasian men (52) and women (45). Participants had to have a forced expiratory volume in 1 second (FEV1) of less than 70% predicted, and a FEV1/forced vital capacity (FVC) of less than 70%. Participants were recruited from pulmonary function laboratories and from better breather support groups in a Midwestern state. Three standardized, self-report instruments, COPD Self-Efficacy Scale (CSES), the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ), and Functional Performance Inventory (FPI) were used to measure the participants' self-report of their perceptions of self-efficacy, dyspnea, and functional performance. Dyspnea predicted 38.1% of the variance in functional performance, with self-efficacy contributing an additional 6.5% to the variance in the total sample. Self-efficacy predicted 36.5% of the variance in functional performance in men, with dyspnea contributing an additional 7.2% to the variance. However, in women, only dyspnea was a significant predictor of functional performance, at 48.5% when both dyspnea and self-efficacy were entered as independent variables. To improve patients' perceptions of functional performance, nurses can use methods such as breathing techniques and upper- and lower-body exercises that increase optimal management of dyspnea. Nurses may increase the self-efficacy of managing dyspnea by helping patients master breathing techniques and exercise through coaching and providing vicarious experiences through patient support groups or pulmonary rehabilitation programs.     

The Physical Inactivity Matrix: Lessons from the classification of physical inactivity interventions

Physical inactivity (PI), a leading modifiable cause of disease and injury, is endemic in industrialised nations. Although considerable research has been undertaken in this field, we lack a system to synthesise the research literature to inform policy and identify research needs. The aims of this study were to (1) develop a system to classify physical inactivity intervention studies, (2) examine the distribution of PI interventions published in the peer-reviewed health literature using the system, and (3) consider implications for future research. We developed the Physical Inactivity Matrix (PIM), with 12 intervention points, created by the intersection of two dimensions: the intervention target (individual, physical environment and social/cultural environment) and the activity focus (transport, work/school, leisure and consumer). A formal search of the health research literature identified 529 eligible studies and each was classified into one of the 12 cells of the PIM. Most studies were categorised as: individual-leisure (68%), individual-work/school (12%) or social/cultural environment-leisure (13%). Only 4% targeted the physical environment. The findings of this initial application of the PIM support the call for greater investment in policies, interventions and research that focus on the relationship between the environment and PI, and transportation in particular. There would be merit in establishing the inter-rater reliability of the PIM and applying it to a wider variety of studies, including those published in the transportation and urban planning literatures. The PIM could be a useful tool for monitoring trends in research directions and funding levels over time and across countries.     

Optimization of self-reference thermometry using complex field estimation.

Referenceless, or self-reference, thermometry is a technique for mapping temperature differences in the region of interest (ROI) using the baseline phase estimated by extrapolating the field in the surrounding region for estimation (RFE) and subtracting the estimated baseline from the measured field. In the present work a self-reference technique based on complex field estimation using 2D polynomials comprising complex-valued coefficients was proposed and optimized. Numerical simulations with a Gaussian-profiled phase distribution demonstrated that the ROI radius had to be 2.3-2.5 times the standard deviation (SD) of the Gaussian function in order to keep the error below 8% of the peak phase change. The area ratio between the ROI and the RFE had to be larger than 2.0 to maintain the error level. Based on the simulations, and phantom and volunteer experiments, the complex-based method with independently optimized polynomial orders for the two spatial dimensions was compared with the phase-based method using the similar-order optimization strategy. The complex-based method appeared to be useful when phase unwrapping was not removed. Otherwise, the phase-based method yielded equivalent results with less polynomial orders.     

Aptitude for physical exercise in a population of female hospital workers

Summary The aim of this study was to evaluate the level of physical capacity in a female hospital population of Paris and its suburbs. A total of 1505 women working in the selected departments filled in a questionnaire concerning their working conditions, life habits and health and also attended a medical examination. The effort test performed consisted in flexing the legs 20 times with the chest held straigt, in 40 s. The heart rates were measured for the first, the second and the third minutes of recovery (first 15 s multiplied by 4). The blood pressure was measured just after the heart rate, for the first and the third minute. Recovery indices have been constituted from the results. The respective weights of anthropometric and sociodemographic risk factors for recovery indices were studied in multiple logistic regression models. The classification enables us to consider about 25%–30% of our population as having a satisfactory physical capacity, about 26%–27% as having an acceptable capacit, and about 24%–27% as having a weak capacity. About 21% of the population presented an excessive pressure reaction and 44% a questionable pressure reaction. Our results concerning the level of physical capacity of the female nursing staff should be taken into account especially in the future planning of work loads and architectural choices, which must avoid excessive physical burdens in relation to this level. An improvement in the level of physical capacity could be envisaged as well.     

低强度超短波对小鼠体质及智力的影响

本实验探讨了低强度超短波对小鼠连续三代辐射,对学习、记忆、拉力、运动耐力和周围血象的影响。用81MHz,10～12V/m 的超短波进行辐射,每天辐射2小时,每周6天。结果表明:经过超短波辐射的各代小鼠与对照组相比,学习能力、记忆能力、拉力及运动耐力有明显的降低,且运动耐力有进行性降低的趋势,而经过辐射的三代小鼠红细胞、血红蛋白含量及白细胞数均明显增高,每个红细胞的血红蛋白含量则低于对照组。     

Patient satisfaction with and recommendation of a hospital: effects of interpersonal and technical aspects of hospital care.

OBJECTIVES: To examine patient satisfaction with and recommendation of a hospital, with a special focus on the correlation of these measures to patient ratings of interpersonal and technical performance of the hospital. DESIGN: Telephone survey of patients with four specific conditions after their discharge from hospitals. SETTING: Accredited district teaching hospitals and above, nationwide in Taiwan. PARTICIPANTS: A total of 4945 patients from 126 hospitals diagnosed with or undergoing procedures related to stroke, diabetes mellitus, Caesarean section, or appendectomy were interviewed by telephone. MAIN OUTCOME MEASURES: Overall patient satisfaction and recommendation were measured by single-item questions. Interpersonal skills were measured by three items: doctors' explanation, attitude, and caring. Technical skills were measured by another three items: hospital equipment, clinical competence, and outcome of treatment. RESULTS: Interpersonal skills were as influential or more influential than clinical competence on patient satisfaction for three of the four disease categories. In contrast, technical competence was a more influential predictor for recommendation for patients in all four disease categories. CONCLUSION: The preliminary results imply that a hospital with high percentage of patient satisfaction does not necessarily receive a high level of recommendation. This finding provides new insights for researchers and for hospital managers who devote resources exclusively for achieving the highest possible levels of patient satisfaction.     

包裹胰岛微囊的物理性能研究

用３％海藻酸钠及２．２％ＣａＣｌ＿２所制备的微囊在高流速及高浓度的蔗糖溶液冲击下未见破裂，且微囊包裹活细胞经过二小时的剧烈搅拌，亦无损漏。改进法所制备的微囊具有良好的机械强度，其物理性能已达到临床进行包膜胰岛移植治疗糖尿病的要求。