Commentary: At the Center of Decision Making in Mental Health Services and Interventions Research: Patients,Clinicians, or Relationships?

Wills and Holmes-Rovner (2006) highlight the fact that despite growing interest in the role of patient preferences and shared decision making with clinicians in the general health services research community, relatively little is known about the impact of these preferences and processes on actual decisions, service delivery engagement, or intervention outcomes in the mental health field. This commentary expands on three important points raised in Wills and Holmes-Rovner's article: (a) the need for more and better research on values assessment, (b) contextual factors in the decision-making process, and (c) the measurement of patient preferences regarding their level of involvement in decision making.     

基于PACS的MRI影像多媒体教学与报告系统的研究

目的：开发基于医院影像归档和通讯系统（picture archiving and communication system，PACS）环境的MRI（磁共振显像）影像多媒体教学与报告系统。方法：医院PACS系统符合DICOM3.0标准，采用1000M光纤主干网，100M交换到桌面；在临床医生浏览工作站安装多媒体教学系统，在诊断工作站安装教学系统与报告系统；科学内容按部位分类，以树枝模式管理。教学字资料来源于具有一定权威的教科书、专及期刊。图像资料来源于各部位经病理及临床证实的病例，直接从PACS系统提取，经标注说明后，以件形式存放于PACS图像服务器硬盘。结果：MRI辅助影响教学系统能够实时调阅最合适病种的MRI征象、临床特点、病理、鉴别诊断、典型图像及注释、正常断面解剖等，供教学、诊断和报告参考。结论：PACS环境下MRI辅助影像学系统，能满足临床医生和低年资影像诊断医生对MRI影像知识进一步继续医学教育的需求，能为影像诊断医生提供教学及科研工具，提高MR室工作质量和工作效率。     

DicomWorks: Software for Reviewing DICOM Studies and Promoting Low-cost Teleradiology

DicomWorks is freeware software for reading and working on medical images [digital imaging and communication in medicine (DICOM)]. It was jointly developed by two research laboratories, with the feedback of more than 35,000 registered users throughout the world who provided information to guide its development. We detail their occupations (50% radiologists, 20% engineers, 9% medical physicists, 7% cardiologists, 6% neurologists, and 8% others), geographic origins, and main interests in the software. The viewer’s interface is similar to that of a picture archiving and communication system viewing station. It provides basic but efficient tools for opening DICOM images and reviewing and exporting them to teaching files or digital presentations. E-mail, FTP, or DICOM protocols are supported for transmitting images through a local network or the Internet. Thanks to its wide compatibility, a localized (15 languages) and user-friendly interface, and its opened architecture, DicomWorks helps quick development of non proprietary, low-cost image review or teleradiology solutions in developed and emerging countries.     

Involving the patient: a prospective study on use, appreciation and effectiveness of an information system in head and neck cancer care

OBJECTIVE: To determine use, appreciation and effectiveness of an electronic health information support system in head and neck (H&N) cancer care. DESIGN: A prospective evaluation study. The evaluated system has four different functions: (1) communication amongst health care providers and between health care providers and patients, (2) information for health care providers and patients, (3) contact with fellow sufferers and (4) monitoring of discharged patients by means of electronic questionnaires. Evaluation of the system was done both objectively using automatically created log files and stored messages, and subjectively by using paper questionnaires from patients and general practitioners (GPs). SETTING: Department of Otorhinolaryngology and Head and Neck Surgery of a tertiary health care centre in the Netherlands. The system was put at patients' disposal for a period of 6 weeks following discharge from the hospital after surgery for H&N cancer, and was additional to standard care. PARTICIPANTS: Head and neck cancer patients, hospital physicians, members of a hospital-based support team, GPs, district nurses and speech therapists. MAIN OUTCOME MEASURES: Actual use of the system by patients and health care providers. Patients' appreciation for each of the system's four different functions. GPs' appreciation for the system. Capability to detect potential patient problems with the system. RESULTS: The system was used by 36 H&N cancer patients, 10 hospital physicians, 2 members of the support team, 8 GPs, 2 district nurses and 2 speech therapists. The total number of patient-sessions was 982: an average of 27.3 sessions per patient during the 6 weeks study period. In total, 456 monitoring questionnaires were completed. The support team in hospital responded with 231 actions. In 16 cases, an extra appointment was made for a patient with the hospital physician. Out of these cases, immediate action was considered necessary eight times. Patients appreciated the system highly, rating it with an average score of 8.0 on a 10-point scale. All patients used the monitoring function, and rated 'monitoring' with a mean score of 8.0 on a 10-point scale. Least used and appreciated was the 'contact with fellow sufferers' function. Only 8 out of possible 36 GPs used the system, rating it with an average of 5.6 on a 10-point scale. CONCLUSIONS: The electronic health information support system was used intensively and highly appreciated by H&N cancer patients. The system enabled the early detection of occurring health problems that required direct intervention. ICT can play an additional role in the management of patients, also in a relatively elderly and computer illiterate patient population.     

Coordinated Movement of Bile Canalicular Networks Reconstructed by Rat Small Hepatocytes

Hepatocytes in vivo have a potential for liver regeneration, but it has been very difficult to reconstruct hepatic organoids in vitro. Recent studies have shown that small hepatocytes (SHs) can reconstruct hepatic organoids including functional bile canaliculi (BC). In the present study we analyzed the movement of BC formed in the hepatic organoids, focusing on the coordination of contraction and dilation among cells and the mechanism producing the coordination. Hepatic cells, including SHs, were isolated from an adult rat liver and cultured. Time-lapse images of BC movements were taken and analyzed in cells treated with or without cytochalasin B (CB). Time-lapse images revealed that all BC, regardless of region contracted in a coordinated manner. Actin filaments were observed along the BC even after the BC networks treated with CB dilated markedly. Microinjection of dye was also carried out to investigate the flow thorough BC. Secreted fluorescein from the injected cell flowed along BC, and gap junctional protein connexin 32 was expressed along BC networks, suggesting cell-to-cell communication. Thus, groups of hepatocytes in the hepatic organoids act in a coordinated manner through intercellular communication.     

Hemispheric control of unilateral and bilateral responses to lateralized light stimuli after callosotomy and in callosal agenesis

Normally, simple digital or manual responses to a light stimulus in the right or left visual hemifields are performed faster with uncrossed hand-field combinations than with crossed hand-field combinations. Because of the organization of visual and motor pathways, the integration of uncrossed responses is assumed to occur within a single hemisphere, whereas a time-consuming inter-hemispheric transfer via the corpus callosum is considered to be necessary for the integration of crossed responses. However, callosal transfer may be dispensable for those crossed responses which can be controlled through ipsilaterally descending motor pathways by the hemisphere receiving the visual stimulus. We investigated crossed-uncrossed differences (CUDs) in speed of simple visuomotor responses to lateralized flashes in one subject with total section of the corpus callosum and two subjects with complete callosal agenesis. We recorded the reaction times as well as the premotor times, as indicated by the electromyographic latencies of the prime movers, of three types of responses: a distal response involving a thumb flexion, a proximal response chiefly involving a forearm flexion and an axial response involving a shoulder elevation. Further, the three types of responses to a single lateralised flash were performed both unilaterally and bilaterally. The three acallosal subjects showed CUDs greatly exceeding normal values on distal responses, either unilateral or bilateral, and on unilateral proximal responses. These abnormally long CUDs stood in sharp contrast to the insignificant CUDs exhibited by the same subjects on bilateral proximal responses and on unilateral and bilateral axial responses in agreement with correspondingly insignificant CUDs reported for normal subjects. These results confirm that a callosal contribution is important for the execution of fast distal and unilateral proximal responses to a visual stimulus directed to the hemisphere ipsilateral to the responding hand. By contrast, the other types of crossed responses appear to be efficiently coordinated across the midline without the aid of the corpus callosum. This is in keeping with the hypothesis that they are governed by a bilaterally distributed motor system which is preferentially activated for the execution of symmetrical bilateral movements, employing axial and proximal limb muscles.     

Childless elderly: Theoretical perspectives and practical concerns

Almost nothing is concretely known about childless elderly in cross-cultural perspective. Few published papers have appeared on this social category in the West, although childless elders make up (at least) 20% of the population of elderly in many Western nations. Little is known about childless elderly in the Third World. This paper provides some theoretical background to the study of childless elderly and articulates some social policy concerns about them. It suggests that there are five important questions to examine concerning the lives of childless elderly. These include, how childless aged are or are not provided for in societies in which a great deal of the care of the aged is undertaken by children; how kinship functions as a matrix for care; how the increasingly common phenomenon of voluntary childless may give meaning to childlessness in late life; how childlessness fits with such social science models such as the developmental cycle; and, the relationship of this phenomenon to changing opportunities for women. The paper further examines how factors such as fertility, systems of caregiving, the social meaning of childlessness, alternatives to childlessness such as adoption, and educational and economic opportunities may affect the lives of childless elders.     

科学传播视域下的医学期刊知识服务——以《中华医学杂志》为例

【目的】 探索医学期刊的知识服务实践,为医学期刊的科学传播创新提供参考。【方法】 以《中华医学杂志》为研究对象,采用案例研究法和文献分析法进行系统研究。【结果】 借助继续医学教育、微信平台、重要文章发布会、数据库,以及优先出版、按需出版、开放阅读等方式,《中华医学杂志》打造多元化场景的知识服务、联结传播渠道,从而使得科学共同体和公众读者获得较好的知识服务体验。【结论】 医学期刊的知识服务实践应以科学传播为宗旨,在实现增值服务的同时,推进科学知识在科学共同体和普通读者间的传播。     

国际典型综合类科技期刊公众传播特点及对我国综合类科技期刊公众传播能力建设的启示

【目的】 分析国际顶级综合类科技期刊公众传播模式及特点,为我国科技期刊公众传播能力建设提供建议。【方法】 以Altmetric Top 100入选论文数量最多的Nature、Science和PNAS三刊为研究对象,剖析其在公众传播产品、媒体传播体系和新闻媒体人才支撑等方面的模式和特征。对照分析我国最有影响力的综合类科技期刊《国家科学评论》和《科学通报》的公众传播特点。【结果】 以《国家科学评论》和《科学通报》为代表的我国综合类科技期刊的公众传播能力提升迅速,但仍存在新闻传媒人才短缺、期刊集约化程度不高、公众传播机制尚未建立等问题。【结论】 我国综合类科技期刊需要着力增强传媒人才培育、集约化品牌发展、公众传播机制建设,以促进我国科技期刊公众传播能力提升。     

Are We Neglecting Nutrition in UK Medical Training? A Quantitative Analysis of Nutrition-Related Education in Postgraduate Medical Training Curriculums

Suboptimal nutrition is a major cause of morbidity and mortality in the United Kingdom (UK). Although patients cite physicians as trusted information sources on diet and weight loss, studies suggest that the management of nutrition-related disorders is hindered by insufficient medical education and training. Objectives of this study were to: (1) Quantify nutrition-related learning objectives (NLOs) in UK postgraduate medical training curriculums and assess variation across specialties; (2) assess inclusion of nutrition-related modules; (3) assess the extent to which NLOs are knowledge-, skill-, or behaviour-based, and in which Good Medical Practice (GMP) Domain(s) they fall. 43 current postgraduate curriculums, approved by the General Medical Council (GMC) and representing a spectrum of patient-facing training pathways in the UK, were included. NLOs were identified using four keywords: ‘nutrition’, ‘diet’, ‘obesity’, and ‘lifestyle’. Where a keyword was used in a titled section followed by a number of objectives, this was designated as a ‘module’. Where possible, NLOs were coded with the information to address objective 3. A median of 15 NLOs (mean 24) were identified per curriculum. Eleven specialties (25.6%) had five or less NLOs identified, including General Practice. Surgical curriculums had a higher number of NLOs compared with medical (median 30 and 8.5, respectively), as well as a higher inclusion rate of nutrition-related modules (100% of curriculums versus 34.4%, respectively). 52.9% of NLOs were knowledge-based, 34.9% skill-based, and 12.2% behaviour-based. The most common GMP Domain assigned to NLOs was Domain 1: Knowledge, Skills and Performance (53.0%), followed by Domain 2: Safety and Quality (20.6%), 3: Communication, Partnership and Teamwork (18.7%), and 4: Maintaining Trust (7.7%). This study demonstrates considerable variability in the number of nutrition-related learning objectives in UK postgraduate medical training. As insufficient nutrition education and training may underlie inadequate doctor-patient discussions, the results of this analysis suggest a need for further evaluation of nutrition-related competencies in postgraduate training.