Employing computational linguistics techniques to identify limited patient health literacy: Findings from the ECLIPPSE study

ObjectiveTo develop novel, scalable, and valid literacy profiles for identifying limited health literacy patients by harnessing natural language processing.Data SourceWith respect to the linguistic content, we analyzed 283 216 secure messages sent by 6941 diabetes patients to physicians within an integrated system''s electronic portal. Sociodemographic, clinical, and utilization data were obtained via questionnaire and electronic health records.Study DesignRetrospective study used natural language processing and machine learning to generate five unique “Literacy Profiles” by employing various sets of linguistic indices: Flesch‐Kincaid (LP_FK); basic indices of writing complexity, including lexical diversity (LP_LD) and writing quality (LP_WQ); and advanced indices related to syntactic complexity, lexical sophistication, and diversity, modeled from self‐reported (LP_SR), and expert‐rated (LP_Exp) health literacy. We first determined the performance of each literacy profile relative to self‐reported and expert‐rated health literacy to discriminate between high and low health literacy and then assessed Literacy Profiles’ relationships with known correlates of health literacy, such as patient sociodemographics and a range of health‐related outcomes, including ratings of physician communication, medication adherence, diabetes control, comorbidities, and utilization.Principal FindingsLP_SR and LP_Exp performed best in discriminating between high and low self‐reported (C‐statistics: 0.86 and 0.58, respectively) and expert‐rated health literacy (C‐statistics: 0.71 and 0.87, respectively) and were significantly associated with educational attainment, race/ethnicity, Consumer Assessment of Provider and Systems (CAHPS) scores, adherence, glycemia, comorbidities, and emergency department visits.ConclusionsSince health literacy is a potentially remediable explanatory factor in health care disparities, the development of automated health literacy indicators represents a significant accomplishment with broad clinical and population health applications. Health systems could apply literacy profiles to efficiently determine whether quality of care and outcomes vary by patient health literacy; identify at‐risk populations for targeting tailored health communications and self‐management support interventions; and inform clinicians to promote improvements in individual‐level care.     

云南省跨境婚姻家庭艾滋病、梅毒和乙肝检测现状分析

目的 了解云南省中-缅、中-老、中-越跨境婚姻家庭艾滋病、梅毒和乙肝检测情况,为完善跨境婚姻家庭预防母婴传播相关服务政策提供科学依据。 方法 对目前居住在云南省边境地区的中国籍和跨境婚姻家庭进行调查和访谈,收集一般人口学特征、最近一次怀孕期间三病检测情况等信息。经整理后,使用构成比和率对指标进行计算,使用卡方检验、秩和检验比较中国籍和跨境婚姻家庭各项检测服务状况。 结果 外籍媳妇主要以农民、文盲/小学、无经济收入的少数民族为主。配偶检测率,老挝籍低于当地中国籍媳妇（〖XC五号.EPS;P〗=7.87,P=0.005）,缅甸籍、越南籍与当地中国籍没有差异;缅甸籍高于老挝籍和越南籍（〖XC五号.EPS;P〗=41.84,P＜0.001）。三病检测点知晓率,缅甸籍媳妇低于当地中国籍媳妇（〖XC五号.EPS;P〗=6.11,P＜0.03）,越南籍、老挝籍与当地中国籍没有差异;老挝籍高于缅甸籍和越南籍（〖XC五号.EPS;P〗=44.03,P＜0.001）。获得预防母婴传播相关知识比例,三个外籍媳妇均低于当地中国籍（〖XC五号.EPS;P〗=19.84,P＜0.001;〖XC五号.EPS;P〗=7.52,P=0.006;〖XC五号.EPS;P〗=4.38,P=0.036）。 结论 边境地区针对跨境婚姻家庭开展艾滋病、梅毒和乙肝预防母婴传播相关工作取得实效,三病检测情况与当地中国籍基本一致,但在其他服务利用上仍存在一定差距,外籍媳妇孕早期三病检测率及其配偶检测率、相关预防母婴传播知识获取还有待提升,需要运用更加有效的服务管理模式来促进三病检测可及性的进一步提高。     

学科馆员队伍建设及其在医学文献采访中的作用

文章论述了学科馆员队伍的建设以及学科馆员在医学文献采访工作中的作用，介绍了苏州大学图书馆在这些方面的实践和取得的成效。     

近年血小板减少性紫癜文献分析

本文通过对1995-2003年有关血小板减少性紫癜文献年代分布、期刊分布、著者、文献主题词分布等方面进行统计分析,寻找其研究热点和发展趋势,为临床研究及治疗提供借鉴。     

医学文献检索虚拟课堂

本文就《医学文献检索》虚拟课堂的建设提出了构想,包括实现技术、硬软件需求和课堂内容组织等。并提供了建设实例。     

Crossed aphasia. An update

The aim of this article is to present an update of a rare but interesting problem: crossed aphasia. This term indicates the presence of aphasia after unilateral cerebral lesion of the hemisphere ipsilateral to the patient's dominant hand. We report two cases, review the most relevant literature, and analyze clinical, neuroanatomical, and neurophysiological aspects, taking in consideration the various interpretations proposed to explain this unusual language disorder.     

《中国海洋药物》杂志刊载论文的引文分析

采用文献计量学方法,对１９８９年－１９９３年《中国海洋药物》杂志刊载论文的引文进行了分析。结果表明,此间共刊载论文１８１篇,共有引文１３０１条,每篇论文平均引文量为７．９８条。自引率为１２．７６％,在全部引文中,期刊占６５．１０％,图书占２７．６０％,其中占７．３０％;语种分布中文占６５．７２％,英文占２９．１３％,日文占５．０７％,俄文占０．０８％。１０年文献累计利用率,中文为８３．２７％,外文     

江苏历代医家,医籍及其地域分布研究

整理研究了江苏自后汉至民国的二千年间,见于著录的４１５０名医家和３７１５部医著的时代和地域分布,宋以后,尤其是明清时期,江南一带社会相对安定,封建朝廷南迁,为江苏的经济文化发展提供了历史机遇、也是江苏中医发展的极盛时期。这一时期涌现的医家、医籍分别占总数的９８．６％、９６．８％。说明了社会的稳定进步、生产力的发展提高、经济科技的繁荣发达是医学发展的基础和源泉。     

Intra-Operative Direct Electrical Stimulations of the Central Nervous System: The Salpêtrière Experience With 60 Patients

Indications of surgical treatment for lesions in the central nervous system depend on the risk of a definitive neurological deficit, related to the benefit of resection. Detection of eloquent areas is then necessary because of major individual variability. Neuro-imaging functional techniques are in development and are beginning to be efficient for cortical sensorymotor mapping, but still lack sensitivity and specificity for language mapping, and remain unable to give real-time data during surgery and to perform sub-cortical mapping. The more precise and reliable method of functional mapping is represented by the intra-operative direct electrical stimulations (DES), which allow identification and preservation of essential pathways for motricity, sensibility and language, at each level of the central nervous system (cortico-subcortical). We report our experience of DES in the surgery of tumours and vascular malformations located in supra-tentorial brain eloquent areas, with a consecutive series of 60 patients operated on under general or local anaesthesia, from November 1996 until May 1999 in our department at La Salpêtrière Hospital. Presenting symptoms in the 60 subjects (39 males, 21 females, mean age: 45 years) were seizures in 37 cases with normal clinical examination, and mild neurological deficit in 29 cases. MRI showed 60 supra-tentorial brain lesions: 30 precentral, 12 postcentral, 14 perisylvian in the dominant hemisphere, 4 deep-seated. All subjects underwent surgical resection using DES, with supratentorial cortico-subcortical mapping under general anaesthesia for motor areas detection in 43 cases and under local anaesthesia for sensori-motor and/or language tasks in 17 cases. The final histological diagnosis was 44 gliomas (31 low-grade and 13 high-grade), 9 metastasis, 3 cavernomas, 4 arteriovenous malformations (AVM). Resection was total or subtotal in 52 cases (87%) and partial in 8 cases (13%). 29 patients had no post-operative deficit, while the other 31 patients were impaired post-operatively, with in all cases, except 3, a complete recovery delayed for 15 days to 3 months (overall morbidity: 5%). The median follow up was 14 months. Intra-operative direct electrical stimulations of the central nervous system constitute a reliable, precise and safe method, allowing the realization of a functional mapping useful for all operations of lesions located in eloquent areas. This technique allows a minimization of definitive post-operative neurological deficit, and concurrently an improvement in the quality of resection.     

Spinal neurinomas and meningiomas in children

Summary The literature on spinal neurinomas (N) and meningiomas (M) in children is reviewed, and five personal cases of N are added (one in the context of Recklinghausen's disease). The cases of N totalled 151, and of M 69, accounting respectively for 10.9% and 4.3% of childhood spinal tumours and 2.6% and 1.3% of spinal N and M of all ages. Sixty-one cases of N (16 in the context of Recklinghausen's disease) and 26 cases of M (5 in the context of Recklinghausen's disease) are analyzed in detail. N occurs chiefly between ages 9 and 15 years, the sex ratio is 3 2, all levels of the spinal canal are equally affected, and extradural N or conditions with an extradural component (48%) are more frequent than in adults (26.9%). M occurs chiefly between 12 and 15 years, the sex ratio is 3 2, the prevalence of the thoracic segment (47.8%) is less marked than in adults (81%), and the frequency of the extradural site (10.6%) is close to the sum of the extradural and dumb-bell lesions in adults (11.1%). In children vertebral signs,i.e., spinal rigidity and tenderness, and spasm of paravertebral muscles, are more intense, earlier, and more frequent than in adults, and the clinical history is shorter. The chances of recovery from neurological deficits are greater, as are those of malignant degeneration.