MODen : programme d’éducation thérapeutique dans la schizophrénie centré sur l’équilibre alimentaire et le plaisir,sollicitant les fonctions cognitives : étude pilote

IntroductionSchizophrenia causes psychological difficulties (with positive and/or negative symptoms) as well as cognitive disabilities (attention, memory, executive functions and social cognition). Moreover, 40 to 60% of patients suffer from an excess of weight or obesity (due to bad eating habits, eating disorders or medication). All these difficulties impair their autonomy and their insertion into the society. In this context, setting-up a therapeutic tool, which may have cognitive benefits seems relevant. Thus, MODen is a therapeutic educational tool whose aim is to improve cognitive functions and the symptoms by using “nutritional balance” as an aid.MethodIn this treatment program, two therapists lead a group of 5 to 8 patients which group meets once a week during two to four hours for 16 weeks, divided in 4 cycles. The first three weeks of each cycle consists of theoretical instruction: patients talk about their eating habits, information is given about nutritional balance and preparation of meals. In the different cycles, flexibility, planning, memory and attention are trained. For instance, the work on categorisation of foods and nutritional balance allow enhancing flexibility abilities. Writing down the lists of different ingredients needed for one week's meals and preparation of meals train planning abilities. MODen also takes into account ecological issues such as the limited budget of patients to do their shopping (this budget is around 4 euros per meal in France). The budget is also linked to planning abilities and reasoning. Finally, during the last session of each cycle the group prepares a meal (from the shopping to cooking). This last session is all about sharing and social cognition abilities. By the end of the program, patients will have prepared four meals together. Also “homework” has to be done each week in order to facilitate memorisation of what has been learned during the last session and to prepare the beginning of the next session.ResultsIn a pilot study with 8 patients with schizophrenia (DSM-IV), improvements in PANSS negative symptoms and disorganization (respectively P < 0.02; P < 0.02) were observed. An underlying improvement at BECS scores was also observed (P < 0.08). Regarding those preliminary results as well as the ecological qualities of this program, this therapeutic tool could be relevant in the treatment of patients with schizophrenia.     

建立年幼儿童哮喘诊断标准及预测工具的探索

与其他年龄段儿童相比,年幼儿童是发生哮喘的高危年龄段.由于临床表现非特异、喘息表型多样、辅助检查难以实施等原因,年幼儿童哮喘的诊断对临床医师而言存在一定困难.近二十年来,国内外对年幼儿童诊断标准及预测工具的探索从未停止,而我国也亟需建立起年幼儿童哮喘的诊断标准.该文综述国内外建立年幼儿童哮喘诊断标准及预测工具的过程,为建立我国新的年幼儿童哮喘诊断标准及预测工具提供参考.     

本草纲目药物警戒数据库设计与应用研究

目的:为深入分析研究本草纲目中的药物警戒思想提供新方法。方法:基于本草纲目金陵本文献著作设计了药物警戒数据库,阐述了数据库建立的要求和存储模型的选取,以及数据库的概念和逻辑设计。结果:在此数据库的基础上可建立知识发现系统,应用数据挖掘算法,对本草纲目中的药物警戒思想进行分析。结论:本草纲目药物警戒思想数据库的建立可以为深入研究药物警戒思想提供方便、准确的手段,此方法也可应用于其他文献著作研究。     

Retrieval of overviews of systematic reviews in MEDLINE was improved by the development of an objectively derived and validated search strategy

ObjectivesLocating overviews of systematic reviews is difficult because of an absence of appropriate indexing terms and inconsistent terminology used to describe overviews. Our objective was to develop a validated search strategy to retrieve overviews in MEDLINE.Study Design and SettingWe derived a test set of overviews from the references of two method articles on overviews. Two population sets were used to identify discriminating terms, that is, terms that appear frequently in the test set but infrequently in two population sets of references found in MEDLINE. We used text mining to conduct a frequency analysis of terms appearing in the titles and abstracts. Candidate terms were combined and tested in MEDLINE in various permutations, and the performance of strategies measured using sensitivity and precision.ResultsTwo search strategies were developed: a sensitivity-maximizing strategy, achieving 93% sensitivity (95% confidence interval [CI]: 87, 96) and 7% precision (95% CI: 6, 8), and a sensitivity-and-precision–maximizing strategy, achieving 66% sensitivity (95% CI: 58, 74) and 21% precision (95% CI: 17, 25).ConclusionThe developed search strategies enable users to more efficiently identify overviews of reviews compared to current strategies. Consistent language in describing overviews would aid in their identification, as would a specific MEDLINE Publication Type.     

Development and field testing of a decision support tool to facilitate shared decision making in contraceptive counseling

ObjectiveWe developed and formatively evaluated a tablet-based decision support tool for use by women prior to a contraceptive counseling visit to help them engage in shared decision making regarding method selection.MethodsDrawing upon formative work around women’s preferences for contraceptive counseling and conceptual understanding of health care decision making, we iteratively developed a storyboard and then digital prototypes, based on best practices for decision support tool development. Pilot testing using both quantitative and qualitative data and cognitive testing was conducted. We obtained feedback from patient and provider advisory groups throughout the development process.ResultsNinety-six percent of women who used the tool in pilot testing reported that it helped them choose a method, and qualitative interviews indicated acceptability of the tool’s content and presentation. Compared to the control group, women who used the tool demonstrated trends toward increased likelihood of complete satisfaction with their method. Participant responses to cognitive testing were used in tool refinement.ConclusionOur decision support tool appears acceptable to women in the family planning setting.Practice implicationsFormative evaluation of the tool supports its utility among patients making contraceptive decisions, which can be further evaluated in a randomized controlled trial.     

Take the HEAT: A pilot study on improving communication with angry families

ObjectiveOur objective was to evaluate the utility of an educational program consisting of a workshop based on the Take the HEAT communication strategy, designed specifically for addressing patients who are angry, using a novel tool to evaluate residents’ skills in employing this method.Methods33 first-year pediatric and internal medicine-pediatrics residents participated in the study. The workshop presented the Take the HEAT (Hear, Empathize, Apologize, Take action) strategy of communication. Communication skills were assessed through standardized patient encounters at baseline and post-workshop. Encounters were scored using a novel assessment tool.ResultsAfter the workshop, residents’ Take the HEAT communication improved from baseline total average score 23.15 to total average score 25.36 (Z = −3.428, p < 0.001). At baseline, empathy skills were the lowest. Intraclass Correlation Coefficient demonstrated substantial agreement (0.60 and 0.61) among raters using the tool.ConclusionFirst-year pediatric trainees’ communication with angry families improved with education focused on the Take the HEAT strategy. Poor performance by residents in demonstrating empathy should be explored further.Practice implicationsThis study demonstrates the utility of a brief communications curriculum aimed at improving pediatric residents' ability to communicate with angry families.     

Maximizing computational tools for successful drug discovery

Drug discovery is an iterative cycle of identifying promising hits followed by lead optimization via bioisosteric replacements. In the search for compounds affording good bioactivity, equal importance should also be placed on achieving those with favorable pharmacokinetic properties. Thus, the balance and realization of both key properties is an intricate problem that requires great caution. In this editorial, the authors explore the available computational tools in the context of the extant of big data that has borne out via advents of the Omics revolution. As such, the selection of appropriate computational tools for analyzing the vast number of chemical libraries, target proteins and interactomes is the first step toward maximizing the chance for success. However, in order to realize this, it is also necessary to have a solid foundation on the big concepts of drug discovery as well as knowing which tools are available in order to give drug discovery scientists the best opportunity.