The purpose of the present study was to determine whether patients with common foot disorders have different medical outcomes depending on whether podiatrists, orthopedic surgeons, or other physicians provided their medical care in rural or urban areas. A validated medical effectiveness score was formulated using indirect standardization of risk-adjusted morbidity, based on patient reports from a national random household interview survey of 3,270 subjects. Patients in rural and urban areas did not differ significantly in medical outcomes across provider types, but there was a trend for patients in rural areas to have poorer outcomes. The medical effectiveness score of podiatrists was 3.9 times higher (indicating more beneficial outcomes) than that of orthopedic surgeons or other physicians (p < 0.01). Patients that visited podiatrists for common foot problems reported significantly more beneficial outcomes than those who visited other types of health care providers.

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Purpose of review Transgender individuals experience unique health disparities but are the subject of little focused health research. This manuscript reviews current literature on transgender medical and mental health outcomes and proposes research priorities to address knowledge gaps. Recent findings Published research in transgender healthcare consists primarily of case reports, retrospective and crosssectional studies, involving largely European settings. Challenges to US-based transgender health research include a diverse population where no single center has sufficient patient base to conduct clinical research with statistical rigor. Treatment regimens are heterogeneous and warrant study for best practices. Current research suggests increased mortality and depression in transgender individuals not receiving optimal care, and possibly a modest increase in cardiovascular risk related to hormone therapy. Current evidence does not support concerns for hormone-related malignancy risk. Summary The priorities for transgender medical outcomes research should be to determine health disparities and comorbid health conditions over the life span, along with the effects of mental health, medical, and surgical interventions on morbidity and mortality. Specific outcomes of interest based on frequency in the literature, potential severity of outcome, and patient-centered interest, include affective disorders, cardiovascular disease, malignancies, fertility, and time dose-related responses of specific interventions.

醫療品質對於醫院管理而言，是一重要且應關心的議題。醫療品質所涵蓋的層面十分廣泛，本研究以醫療品質專家Donabedian（1988）的靶心模式中，位於靶心的醫療技術為本研究中有關醫療品質的定義，來探討醫療品質的影響因素。 對於醫療品質的影響因素，Donabedian提出由醫療結構、醫療過程及醫療結果來衡量醫療品質，而其中結構會影響過程，而過程會影響結果。若我們將病患接受醫療照護後健康狀況的改變結果，視為醫療品質的衡量依據，則影響此醫療結果的因素則來自結構及過程。因此本研究中探討結構中醫師因素，及醫療過程中醫療的因素及病患因素，試圖由此三大構面找出影響醫療結果品質的因素。 以國內某醫學中心的眼科部為實證對象，蒐集的樣本為88年10月至89年3月，於此個案醫院接受白內障手術的住院病患，利用病歷資料中的記錄，並追蹤3月內的門診資料，擷取所需的預後結果為品質指標而進行分析。本研究中選取的醫療結果品質指標有四項分別為：1.手術後最佳視力，2.是否發生手術相關併發症，3.手術時間，4.復原時間。 醫療人員的素質及數量等皆會影響醫療結果品質的好壞，本研究中，由於是由醫師負責整個手術（白內障手術）前的檢查、手術的決定及執行、及術後的處置，醫師為整個醫療過程是否達到品質標準的重要決定因素，所以主要以醫師素質為探討的對象。本研究以探討醫師長期經驗（醫師執業的時間）、短期經驗（醫師近二年所執行之白內障手術量）及職級對於醫療品質的影響。 白內障手術方式手術方式不同則會影響有兩種，其流程及困難度皆不同，所以會對於醫療結果品質有影響。本研究中醫療因素即探討不同手術方式對於醫療結果品質的影響。 醫療過程是由病患與醫師共同互動完成的，所以本研究將病患的因素列入醫療品質影響因素的探討。探討病患的年齡及是否併存有其他眼科疾病二因素對於醫療結果品質的影響。 本研究複迴歸分析結果顯示，醫師因素中醫師長期經驗可得較短的手術時間；醫師短期經驗可得較佳的術後視力及較短的復原時間。手術方式中新式超音波晶體乳化術，則雖可得較佳的術後視力及縮短復原時間，但會造成較多的手術相關併發症。病患因素中以病患併有其他眼科疾病，會影響術後最佳視力及復原時間較長。 綜合上述，本研究發現，醫師因素、醫療因素及病患因素皆會影響醫療結果品質，對於個案醫院再擬定品質管理策略時，應就不同的影響因素，擬定管理方針，以改善白內障的醫療結果品質。 / Quality of health care is an important performance measure for hospitals. In this paper, I investigate the drivers of quality performance of cataract surgery at medical center. I regard some factors as the drivers of quality performance. Quality performance of cataract surgery is measured by medical outcomes: 1.the visual acuity after surgery, 2.the complication rate, 3.the operation time and 4.the recovery time. Three groups of factors are included in this paper: 1.service agent factors (e.g. the long term experience of doctors, the short term experience of doctors and the employment status of doctors), 2.service factors (e.g. the operation methods) and 3.customer factors (e.g. the age of the patients and the co-existence of other ophthalmalogic diseases of the patients). My study demonstrates the following results: 1. The long-term experience of doctors shortens the operation time. 2. The short-term experience of doctors affects positively the post operational visual acuity and shortens the recovery time. 3. Phacoemulsification, the latest operation method, gets better post operational visual acuity and shorter recovery time than does extracapusle cataract extraction. However, more complications happen in the patient group with phacoemulsification. 4. The patients with co-existing ophthalmalogic diseases have worse post operational visual acuity and longer recovery time than do the patients without diseases.

AIMS: This study investigated the perception of generic and disease-specific Health-Related Quality of Life (HRQoL) for adults living with hearing impairment (HI) in Aotearoa/New Zealand (NZ). This study aimed to answer three questions: (1) What is the perception of HRQoL amongst adults with hearing impairment in NZ? (2) How do these perceptions compare to adults with HI living in other countries for which we have data? (3) What are the demographic and audiometric variables related to device ownership? METHOD: HRQoL, demographic, and audiometric information was collected from 126 adults in NZ. The following demographic information was collected: age, relationship length, hours worked per week, income, ancestry, sex, level of education, city size, and sexual orientation. The following audiologic information was also collected: ownership of hearing aids (HA), ownership of hearing assistance technology (HAT), better-ear pure-tone average (BEPTA), worse-ear pure-tone average (WEPTA), and signal-to-noise ratio loss (SNR loss). HRQoL information was collected using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36; Ware & Sherbourne, 1992), and the Hearing Handicap Inventory (HHI) for both elderly (HHIE) and adults (HHIA; Ventry & Weinstein, 1982; Newman, Weinstein, Jacobson, & Hug, 1991). Variables discriminating HA and HAT owners from non-owners were also analysed. RESULTS: The relationship between demographic variables and HRQoL scores revealed that only age and income were significant. Audiometric variables had significant relationships with disease-specific HRQoL scores, as well as HA and HAT ownership. Finally, disease-specific HRQoL scores and all audiometric variables differentiated HA owners from non- owners, but demographic variables did not. Generic HRQoL scores and all audiometric variables differentiated HAT owners from non-owners. CONCLUSIONS: These results suggest that the negative impacts of HI on HRQoL as reported overseas are also present in NZ, and that not only do audiometric variables including SNR loss are related to HRQoL, but HRQoL is a significant predictor for HA and HAT ownership. Further QoL research is warranted amongst the HI population in NZ to identify and understand any causal relationships present amongst these variables. Furthermore, HRQoL instruments and a test of speech understanding in noise have been shown to provide additional meaningful information, and therefore clinicians might consider including them during consultation.