What about doctors? The impact of medical errors

Medical error is a distressing event to the patient and the health care providers. The impact of such events has been well studied on patients but poorly on health professionals. These events are still considered as a taboo in the medical culture and hence missed as great learning opportunities. They have negative impact on doctors' emotional wellbeing, general quality of life, and their professional practice and conduct. Medical errors and adverse events also affect the quality and cost of the health service. Health service administrations should provide healthcare professionals involved in such events with professional support and counselling services, and should consider and treat them as second victims.     

Medication‐related problems in patients referred to aged care and memory clinics at a tertiary care hospital

Aim: To investigate the prevalence of medication‐related problems (MRPs) in patients attending aged care and memory disorder clinics and explore the potential role of a clinical pharmacist to obtain medication histories and identify unresolved MRPs. Methods: The clinical pharmacist interviewed patients and reviewed their medication regimens in the outpatient clinics. Clinical significance of pharmacist‐identified MRPs was rated by an independent expert panel using validated criteria. Results: Forty‐six patients (mean age 82 years) were reviewed. They took a median of nine medications, of which three were not recorded in the medical record. One hundred and thirteen MRPs (median 2.0 per patient) were identified by the pharmacist. Independent review rated 35% of MRPs as high or extreme risk. Thirty‐seven (33%) MRPs related to medications not recorded in the medical record. Conclusions: Medication‐related problems were present for most patients. Involvement of a clinical pharmacist resulted in a more comprehensive medication history and identified unresolved MRPs.     

生铁落药学研究概况

在广泛文献检索基础上,文章对生铁落的种属、成分、药理及临床应用等进行了概述,为深入开发利用提供科学资料。     

Extracting MRS discriminant functional features of brain tumors

The current challenge in automatic brain tumor classification based on MRS is the improvement of the robustness of the classification models that explicitly account for the probable breach of the independent and identically distributed conditions in the MRS data points. To contribute to this purpose, a new algorithm for the extraction of discriminant MRS features of brain tumors based on a functional approach is presented. Functional data analysis based on region segmentation (RSFDA) is based on the functional data analysis formalism using nonuniformly distributed B splines according to spectral regions that are highly correlated. An exhaustive characterization of the method is presented in this work using controlled and real scenarios. The performance of RSFDA was compared with other widely used feature extraction methods. In all simulated conditions, RSFDA was proven to be stable with respect to the number of variables selected and with respect to the classification performance against noise and baseline artifacts. Furthermore, with real multicenter datasets classification, RSFDA and peak integration (PI) obtained better performance than the other feature extraction methods used for comparison. Other advantages of the method proposed are its usefulness in selecting the optimal number of features for classification and its simplified functional representation of the spectra, which contributes to highlight the discriminative regions of the MR spectrum for each classification task. Copyright © 2012 John Wiley & Sons, Ltd.     

Case numbers for a randomized clinical trial of boron neutron capture therapy for Glioblastoma multiforme

Boron neutron capture therapy (BNCT) with Na₂B₁₂H₁₁SH (BSH) or p-dihydroxyborylphenylalanine (BPA), and with a combination of both, was compared to radiotherapy with temozolomide, and the number of patients required to show statistically significant differences between the treatments was calculated. Whereas arms using BPA require excessive number of patients in each arm, a two-armed clinical trial with BSH and radiotherapy plus temozolomide is feasible.     

Influence of trial design,heterogeneity and regulatory environment on the results of clinical trials: An appraisal in the context of recent trials on acute stroke intervention

The outcome of randomized controlled trials can vary depending on the eligibility criteria of the patients entering into the trial, as well as the heterogeneity of the eligible population and/or the interventions. If the subject population and/or interventions are heterogeneous, the final outcome of the trial depends on the degree of concordance of effects of the subgroups of interventions on the subgroups of the subject population. The considerations that go into the calculation of sample size and determination of the study stopping rules also would affect the nature of the outcome of the study. In this paper we try to examine these phenomena with respect to the recent trials on endovascular therapy in acute ischemic stroke.     

Placebo controlled evaluation of Xilei San,a herbal preparation in patients with intractable ulcerative proctitis

Background and Aim: Topical mesalamine or corticosteroid has shown efficacy in patients with ulcerative proctitis, but patients often become refractory to these interventions. Xilei San is a herbal preparation with evidence of anti‐inflammatory effects. We evaluated the efficacy of topical Xilei San in ulcerative proctitis patients. Methods: In a double blind setting, 30 patients with intractable ulcerative proctitis despite ≥ 4 weeks of topical mesalamine or corticosteroid were randomly assigned to True (n = 15) and placebo (n = 15). Patients in True received suppository Xilei San (0.1 g/dose per day of Xilei San), the other 15 received placebo suppository. The initial efficacy was evaluated on day 14. Primary endpoint of the trial was avoiding relapse during 180 days, relapse meant recurrence of active disease. Riley's index was applied for endoscopic and histological evaluations, while patients' quality of life was evaluated by an inflammatory bowel disease questionnaire. Results: On day 14, the number of patients who achieved remission, clinical activity index ≤ 4 in True was significantly higher versus placebo (P < 0.04). Likewise, at day 180, an 81.8% of patients in True were without relapse versus 16.7% in placebo (P < 0.001). Further, significant endoscopic (P < 0.01), histological (P < 0.02) and inflammatory bowel disease questionnaire (P < 0.04) improvements were observed in True, but not in placebo. Conclusions: This is the first controlled investigation showing significant clinical and endoscopic efficacy for Xilei San in patients with intractable ulcerative proctitis. Topical Xilei San was well tolerated, and was without safety concerns.