The effects of psychiatric symptoms on quality of life assessments among the chronic mentally ill

This study of chronically mentally disabled persons in community residences examined the discriminant validity of subjective quality of life indicators and self-report mental health indices to determine the potential confounding effects of psychopathology on the assessment of quality of life (QOL). Factor analyses and difference-score reliabilities identified a general QOL construct and a general mental health construct with 27% common variance. However, psychiatric symptoms did not significantly (p less than .05) alter the bivariate and multivariate relationships among the QOL ratings, except in the health domain in which the correlations of health-related QOL indicators with global QOL were significantly (p less than .05) attenuated after removing the effects of psychopathology. The results suggest that psychopathology does not introduce bias into the overall structure of QOL data, but they also indicate the importance of controlling for mental health effects in the assessment of patients' self-rated health and satisfaction with health care.     

Gender,Migration and Place of Qualification of Doctors in the UK: Perceptions of Inequality,Morale and Career Aspiration

This article draws on a large British Medical Association (BMA) survey which allows the comparison of doctors who qualified in the UK with International Medical Graduates (IMG) who qualified overseas. It does this with respect to inequality, morale and career aspiration. The paper argues that the human-capital protection of qualifications, profession and status is not sufficient to equal the experiences of migrant doctors with those of doctors who qualified in the UK. Moreover, the article provides a gendered analysis which demonstrates clear differences between women and men and shows that place of qualification intensifies the gendered experience of a medical career. Drawing on intersectional insights shows that women IMGs are the most disadvantaged despite the apparent protection of high human capital.     

A Welcome to the International Statistical Conferences

Criteria for assessing the effectiveness of a medical screening program are difficult to define; medical knowledge and screening procedures change rapidly, and self-selection at medical screens is unavoidable. This article discusses these and other basic issues in evaluation of medical screening programs with particular reference to results from the HIP breast cancer study. In addition, the article reviews various statistical models that describe the processes of disease and screening. The models are shown to be statistically indistinguishable in practice because of the small sample sizes typically available in medical screening trials. Finally the article suggests incorporating knowledge from clinical trials and from studies of robustness into statistical models designed to identify reasonable strategies for screening.     

Treatment Choice With Trial Data: Statistical Decision Theory Should Supplant Hypothesis Testing

Abstract

A central objective of empirical research on treatment response is to inform treatment choice. Unfortunately, researchers commonly use concepts of statistical inference whose foundations are distant from the problem of treatment choice. It has been particularly common to use hypothesis tests to compare treatments. Wald’s development of statistical decision theory provides a coherent frequentist framework for use of sample data on treatment response to make treatment decisions. A body of recent research applies statistical decision theory to characterize uniformly satisfactory treatment choices, in the sense of maximum loss relative to optimal decisions (also known as maximum regret). This article describes the basic ideas and findings, which provide an appealing practical alternative to use of hypothesis tests. For simplicity, the article focuses on medical treatment with evidence from classical randomized clinical trials. The ideas apply generally, encompassing use of observational data and treatment choice in nonmedical contexts.     

医疗保险对农村居民家庭消费的影响分析--基于不同收入层级的跨地区比较

利用2009、2010农村固定观察点数据,分析了医疗保险对不同地区、不同收入层级的农村居民家庭医疗消费支出和非医疗消费支出的影响。实证结果表明：医疗保险对农村居民家庭的医疗类消费不存在显著影响,对非医疗类消费支出则存在显著的正向促进作用。分地区来看,医疗保险对东西部地区农村居民家庭医疗类消费的影响差异显著,对东中部地区农村居民家庭非医疗类消费支出的影响同样差异显著;分收入层级来看,医疗保险对家庭医疗类消费的影响在不同收入层级的农村居民家庭之间不存在显著差异,但对非医疗类消费支出的影响在不同收入层级之间差异显著。此外,商业医疗保险作为医疗保险体系的重要组成部分,对促进农村消费起到带动作用。最后,本文从加大政府补贴和完善保障机制两个方面提出政策建议以期有效降低农村居民家庭超常的预防性储蓄,促进农村居民家庭消费。     

财政扶持政策对西部地区农民参加新农村合作医疗的影响——基于自然实验的研究途径

本文将对西部农民参加新农村合作医疗的财政扶持政策的实施作为一个自然实验,应用微观经济计量方法分析了财政扶持政策对西部农民参加新农村合作医疗的影响。研究结果表明,与2004年相比,2006年西部农民参加新农村合作医疗的概率增加了96.46%,说明针对西部农民参加新农村合作医疗的财政扶持政策作用效果显著。     

Social Work and Complex Care Systems: The Case of People Hospitalised with a Disability

Health and hospital system reforms prioritise efficiency. However, initiatives can impact on people with new or existing disabilities who require time to maximise functional independence. With greater demands for shorter hospital stays social workers face increasing pressure to facilitate discharge. This paper reports findings from research identifying factors contributing to extended stays for adults with disabilities. We sought to better understand patient characteristics and discharge planning challenges by analysing a clinical dataset of 80 patients and qualitative interviews with five experienced hospital social workers. Three key factors are identified: issues around rehabilitation services; assessment and planning for community care; and availability of and access to discharge options. Strategies to reduce length of stay are reported. We argue that building collaborative partnerships and working across multiple, complex systems and disciplines are vital to ensure these patients access appropriate community-based resources within the current health reform environment.     

医务社会工作者：他们的工作与专业训练

英美医务社会工作起源于医院社会工作,北京协和医院社会工作开创亚太地区和中国医院社会工作的先河。蒲爱德是中国医院社会工作服务模式的奠基人。她首次系统阐述开展医院社会工作的必要性、重要性和紧迫性,科学总结协和医院社会土作服务模式,明确提出医院社会工作者的配置原则、职责范围、服务方法和专业训练途径,为当代中国医院社会工作人才队伍建设提供宝贵历史经验,具有重要的现实意义、理论意义和政策意义。     

Strengthening implementation success using large-scale consensus decision-making - A new approach to creating medical practice guidelines

A study involving over 2000 stoma care nurses in the development of best practice guidelines for the assessment of peristomal body profiles, patient engagement and patient follow-up was conducted in 2018. The study was designed to develop guidelines for stoma care treatment and product selection and to decrease the evidence to implementation gap. The project built on research evidence from a literature review of 77 articles. The results of the literature review were then used to inform a series of Delphi surveys sent out to stoma care nurses through Association and industry list-serves in 11 languages. The Delphi surveys were followed by a face2face professionally facilitated discussions among nurse-research experts. The project concluded with a facilitated consensus dialogue among 960 stoma care nurses from 25 countries, resulting in an implementation plan to ensure the guidelines become a normal part of routine patient care. The study resulted in a set of medical practice guidelines for stoma care nurses, designed to improve patient outcomes and patient quality of life, that were accepted and adopted into routine medical practice across 25 countries. This article describes the study and how the process used, coined the ‘Modified Delphi Process’ by the process designer, led to faster implementation than is generally experienced in the medical community.     

A hazard model of the probability of medical school drop-out in the UK

Summary.  From individual level longitudinal data for two entire cohorts of medical students in UK universities, we use multilevel models to analyse the probability that an individual student will drop out of medical school. We find that academic preparedness—both in terms of previous subjects studied and levels of attainment therein—is the major influence on withdrawal by medical students. Additionally, males and more mature students are more likely to withdraw than females or younger students respectively. We find evidence that the factors influencing the decision to transfer course differ from those affecting the decision to drop out for other reasons.