Clustering clinical trials with similar eligibility criteria features

ObjectivesTo automatically identify and cluster clinical trials with similar eligibility features.MethodsUsing the public repository ClinicalTrials.gov as the data source, we extracted semantic features from the eligibility criteria text of all clinical trials and constructed a trial-feature matrix. We calculated the pairwise similarities for all clinical trials based on their eligibility features. For all trials, by selecting one trial as the center each time, we identified trials whose similarities to the central trial were greater than or equal to a predefined threshold and constructed center-based clusters. Then we identified unique trial sets with distinctive trial membership compositions from center-based clusters by disregarding their structural information.ResultsFrom the 145,745 clinical trials on ClinicalTrials.gov, we extracted 5,508,491 semantic features. Of these, 459,936 were unique and 160,951 were shared by at least one pair of trials. Crowdsourcing the cluster evaluation using Amazon Mechanical Turk (MTurk), we identified the optimal similarity threshold, 0.9. Using this threshold, we generated 8806 center-based clusters. Evaluation of a sample of the clusters by MTurk resulted in a mean score 4.331 ± 0.796 on a scale of 1–5 (5 indicating “strongly agree that the trials in the cluster are similar”).ConclusionsWe contribute an automated approach to clustering clinical trials with similar eligibility features. This approach can be potentially useful for investigating knowledge reuse patterns in clinical trial eligibility criteria designs and for improving clinical trial recruitment. We also contribute an effective crowdsourcing method for evaluating informatics interventions.     

罪犯人格特征研究

目的用人格诊断问卷(PDQ-4+)调查罪犯群体人格障碍阳性率,探讨罪犯人群人格的特殊性。方法以PDQ-4+问卷为工具,按照整群随机抽样的原则调查罪犯群体378人。结果罪犯人群样本的PDQ-4+总分及各项分量表均分都显著高于大学生人群和普通人群,差异均有统计学意义(t=2.62~22.59,P0.01或P0.001);各分量表得分的百分位显示在P90、P95位的得分普遍高出原量表划界分;方差分析表明反社会型、边缘型、被动攻击型、表演型及P总分在年龄上差异有统计学意义(F=5.67,4.03,2.63,4.98,2.49;或P0.01),反社会型、边缘型、表演型、自恋型、回避型、依赖型、被动攻击型分量表分及量表总分在罪犯曾经的职业类型上差异均有统计学意义(F=11.77,3.09,2.87,3.33,3.49,3.86,3.87;P0.05或P0.01);t检验表明,罪犯PDQ-4+总分及分量表分在性别上差异有统计学意义(t=2.17~7.23,P0.05);分层聚类分析表明,罪犯群体人格可分为3种不同类型。结论罪犯人格障碍存在高阳性率,且受多种因素影响,以人格障碍测验为基础的三分类人格模型是一个有效的分类模型,有助于监狱对犯人开展分类矫治工作。     

安宁疗护研究热点的共词聚类分析

目的 分析安宁疗护研究热点,了解该领域研究现状及发展趋势。方法 以“hospice care”为主题词,采用主题检索方法对PuMed数据库中2008-2018年发表的安宁疗护相关文献进行主题检索,运用Bicomb、SPSS 24.0 软件对其进行共词聚类分析。 结果 共检索到相关文献2 968篇,截取高频关键词41个,通过共词聚类分析总结出 2008-2018年安宁疗护相关文献年发表数量虽然出现几次波动,但总体来说仍处于较高水平且趋于稳定,其中美国的相关研究论文最多,总结安宁疗护研究的共词聚类可归纳为6个热点:①安宁疗护中心标准;②安宁疗护开展现状;③安宁疗护护理实践;④安宁疗护与心理学;⑤安宁疗护的管理;⑥经济学与伦理。结论 本研究总结了安宁疗护的研究热点及其文献分布,可为今后安宁疗护的研究发展提供参考依据。     

French Spine Surgery Society guidelines for management of spinal surgeries during COVID-19 pandemic

Since the outbreak of coronavirus disease 2019 (COVID-19) in December 2019 in China, various measures have been adopted in order to attenuate the impact of the virus on the population. With regard to spine surgery, French physicians are devoted to take place in the national plan against COVID-19, the French Spine Surgery Society therefore decided to elaborate specific guidelines for management of spinal disorders during COVID-19 pandemic in order to prioritize management of patients. A three levels stratification was elaborated with Level I: Urgent surgical indications, Level II: Surgical indications associated to a potential loss of chance for the patient and Level III: Non-urgent surgical indications. We also report French experience in a COVID-19 cluster region illustrated by two clinical cases. We hope that the guidelines formulated by the French Spine Surgery Society and the experience of spine surgeons from a cluster region will be helpful in order optimizing the management of patients with urgent spinal conditions during the pandemic.     

Adaptive behavior profiles in young children with autism spectrum disorder diagnosed under DSM-5 criteria

BackgroundThis study explored adaptive behavior profiles in a clinical sample of well-characterized children aged one to three years with ASD.MethodProfiles were compared to a sample of children with non-ASD developmental delays. Cluster analyses were performed to determine whether differences in adaptive skills effectively distinguished children with ASD from other young children presenting for assessment due to behavioral or other concerns, but who received other non-ASD diagnoses.ResultsA profile of motor > daily living > socialization > communication skills was found in both children with ASD and children with non-spectrum diagnoses, showing that this profile is not unique to young children with ASD. A two-group cluster solution was found which differentiated children by developmental functioning level rather than by diagnosis.DiscussionThe results of this study provide support for two developmental profiles for adaptive functioning in children with ASD: an average to borderline delayed profile and a borderline to more severely delayed profile that may remain stable or worsen over time. They additionally highlight the importance of delivering early targeted interventions to children with ASD who have greater deficits in adaptive functioning due to their association with poorer long-term outcomes.     

Prevalence of cluster headache in the Republic of Georgia: results of a population-based study and methodological considerations

We present a study of the general-population prevalence of cluster headache in the Republic of Georgia and discuss the advantages and challenges of different methodological approaches. In a community-based survey, specially trained medical residents visited 500 adjacent households in the capital city, Tbilisi, and 300 households in the eastern rural area of Kakheti. They interviewed all ( n  = 1145) biologically unrelated adult occupants using a previously validated questionnaire. The household responses rates were 92% in Tbilisi and 100% in Kakheti. The survey identified 32 persons with possible cluster headache, who were then personally interviewed by one of two headache-experienced neurologists. Cluster headache was confirmed in one subject. The prevalence of cluster headache was therefore estimated to be 87/100 000 (95% confidence interval < 258/100 000). We used a conservative approach, which has an obvious advantage of high-quality data collection, but is very demanding of manpower and time.     

Improving pharmacist-patient communications based on King's theory of goal attainment: Study protocol for a cluster randomized controlled trial

IntroductionPrevious studies revealed widespread poor communications between pharmacists and patients in various settings. But little is known about how pharmacists communicate with patients and its impact on patient outcomes. King's theory of goal attainment (TGA) describes the dynamic interpersonal interactions in which a patient develops and attains certain goals.This study aims to: (i) test the TGA model in the interface between pharmacists and patients; and (ii) evaluate the effects of TGA-guided interventions.MethodsThe study will be conducted in 30 community pharmacies recruited from three cities in China's Hubei province. It will start with a baseline cross-sectional survey on 640 patients to test the hypothesized TGA model in community pharmacies. An intervention program will then be developed based on the TGA model and will be evaluated in a matched-pair cluster randomized trial. The participating pharmacies will be pair-matched and randomly allocated to an intervention group and a control group. Pharmacists in the intervention group will receive three sessions of training in line with the TGA model over one year, compared with a pharmaceutical training program in the control group without a communication component. A double-blind procedure will apply. Changes in patient experience in communications and pharmaceutical care will be analyzed.Ethics and dissemination:The study was approved by the Research Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (IORG: IORG 0003571).Trial registrationChiCTR1800014679.     

Peripheral Neurostimulation for the Treatment of Refractory Cluster Headache,Long-Term Follow-Up: Case Report

Introduction: Cluster headache is a headache syndrome characterized by periodic episodes of intense headache with spontaneous remission. There are recent reports utilizing occipital nerve stimulation for the successful management of medically refractory cases of cluster headache. Methods: The case of an 18‐year‐old boy with chronic, refractory, recurrent cluster headaches is presented. He was treated surgically with combined occipital, supraorbital, and infraorbital nerve stimulation. Results: Prior to operation, the patient suffered three to four episodes of cluster headache per day, for four years. After implantation of occipital, supraorbital, and infraorbital nerve stimulators, the patient averages at most three to four headaches per month, at 36‐month follow‐up. Conclusion: Peripheral neurostimulation is safe and efficacious in the management of chronic, medically refractory cluster headache syndrome. The efficacy of treatment was found to be persistent after three years.