A qualitative analysis of patients’ perception of microwave endometrial ablation as a satisfactory treatment for heavy menstrual blood loss

To explore and analyse patients’ views and comments on microwave endometrial ablation (MEA), we designed a simple and concise questionnaire of 10 items that the participants answered by ticking boxes. They were invited to add their own comments and opinions if they wished. The questionnaire survey was posted to 470 patients who were treated with MEA at Derriford Hospital between 1997 and 2003. We received replies from 343 patients (73%), of whom 165 included handwritten comments (48%). These were reviewed using content thematic analysis. This paper describes the findings of this analysis. Of the 343 respondents, 127 expressed their satisfaction, 32 would recommend MEA to others, and 17 claimed that MEA had transformed their lives. They used words such as “delighted,” “grateful,” “fantastic,” “I cannot tell you how wonderful it has been,” “freedom at last,” “I feel so much better within myself,” “I cannot begin to describe the feelings of well-being and relief I have experienced since I had this treatment,” and “it has changed my life from being housebound to never giving my periods a thought.” Thirty-eight patients were not satisfied; of these, 14 were experiencing moderate to severe pain, and six claimed to have developed severe pain de novo. Their comments included “I was disappointed MEA did not work for me” and “I get heavy bleeding and pain each month, [whereas] before I had no period pains at all.” In conclusion, MEA has been a “miracle cure” for many women who responded, with around 77% being satisfied with this treatment. For a small number, MEA was not successful. For some women, pain was a problem that either developed de novo or was preexisting in the form of dysmenorrhoea. In this paper we also mention success rates and figures from quantitative studies, and we recommend including quotes from satisfied patients in patient information leaflets to further help women and their physicians make informed choices about managing heavy menstrual blood loss, particularly when medical treatment is known to be less successful and with some women being concerned about its side effects.Shortly after this paper was submitted, Emad Louis tragically died from complications following surgery, whilst waiting to take up his post as a Consultant at St. Mary’s Hospital, Isle of Wight. We remember him with great affection as a wonderful colleague, who is held in the highest regard by his patients and all who worked with him. He is greatly missed.He leaves a wife and son who are enormously proud that his research has been published.     

静脉与硬膜外PCA用于剖宫产术后镇痛的对比观察

目的：比较自控静脉镇痛（PCIA）和自控硬膜外镇痛（PCEA）用于剖宫产术后镇痛的有效性、安全性及不良反应。方法：选择剖宫产术后病人90例，随机分为PCIA组、PCEA组和对照组，每组30例。PCIA组和PCEA组术后立即使用自控镇痛（PCA）泵．对照组则不用任何药物镇痛。采用视觉模拟评分法（VAS）对术后1、4、8、24、48h各时间段进行镇痛效果评价和镇静评分并同时观察病人术后肠蠕动恢复情况、拔尿管后排尿情况、子宫复旧情况及产后出血、恶心呕吐、皮肤瘙痒、呼吸抑制等不良反应。结果：同一时间段PCIA组与PCEA组VAS评分比较无显著差异（P〉0．05）．但均小于对照组（P〈0．01）；术后肠蠕动恢复时间、子宫复旧情况、产后出血及恶心、呕吐、皮肤瘙痒、嗜睡等不良反应发生率三组比较无显著差异（P〉0．05）；拔尿管后排尿困难发生率PCIA组明显低于PCEA组（P〈0．05）；呼吸循环抑制PCEA组多于PCIA组，但差异不显著（P〉0．05）。结论：PCIA组与PCEA组均有良好的术后镇痛效果．但PCIA组拔尿管后排尿困难的发生率低．对呼吸循环影响小，镇痛质量优于PCEA组。     

Computer-assisted medication review for asthmatic patients as a basis for intervention Constructing and validating an algorithmic computer instrument in pharmacy practice

OBJECTIVE: To construct and validate a computer instrument that identifies asthma patients receiving--theoretically--suboptimal drug therapy in community pharmacies, by the use of patient medication records. This selection enables the pharmacist to assist these patients in using medicines appropriately. METHODS: According to Dutch asthma guidelines which describe a stepwise approach and in order to define correct profiles for the use at each level of these guidelines, the optimum use of drugs in the different levels in asthma treatment was expressed in defined daily doses (DDDs) per pharmacological drug-group during a period of one year. An algorithmic computer instrument was developed to select patients with medication use deviant from these profiles. By using nine different selection profiles, the computer instrument stratified patients according to the medication records filed in the pharmacy computer. Patient medication records in four community pharmacies were investigated to validate the selection profiles as indicators for theoretically suboptimal drug use by asthma patients. The validation was performed by comparing the professional judgement of participating pharmacists with the selections made by the computer. MAIN OUTCOME MEASURE: Positive predictive value and negative predictive value of the selection made by algorithmic computer instrument. Rate of false-positive results. RESULTS: The computer instrument identified asthma patients using theoretically suboptimal drug therapy with approximately 95% predictive value compared with the professional judgement of the pharmacists. The rate of false-positive results was 5%. CONCLUSION: The results of the algorithmic computer instrument and the professional judgement of the pharmacists are in close agreement. The instrument will be utilised in further research in the IPMP study (Interventions on the principle of Pulmonary Medication Profiles) investigating the role of Dutch community pharmacists in counselling patients who are at risk of suboptimal drug use in the treatment of their asthma.     

加强临床会诊管理提高医疗诊治水平

加强临床会诊管理是提高医疗诊治水平和医疗质量的有效途径之一。通过回顾分析临床相关资料，发现临床误诊误治的主要原因是专科医生受专业限制、病史资料搜集不全和过分依赖辅助检查及临床思维片面局限。提出加强临床会诊管理非常重要，它可以解决临床难题，提高诊断准确率；促进技术，提高抢救成功率；培养和提高年轻医生的诊治水平；保护患方利益，减少医疗纠纷。并提出了进一步完善和执行会诊制度的几点措施：修订会诊标准，规范会诊程序，加强临床会诊管理监督，建立会诊结果追踪和回顾性病例讨论制度。     

Semi-supervised learning of the electronic health record for phenotype stratification

Patient interactions with health care providers result in entries to electronic health records (EHRs). EHRs were built for clinical and billing purposes but contain many data points about an individual. Mining these records provides opportunities to extract electronic phenotypes, which can be paired with genetic data to identify genes underlying common human diseases. This task remains challenging: high quality phenotyping is costly and requires physician review; many fields in the records are sparsely filled; and our definitions of diseases are continuing to improve over time. Here we develop and evaluate a semi-supervised learning method for EHR phenotype extraction using denoising autoencoders for phenotype stratification. By combining denoising autoencoders with random forests we find classification improvements across multiple simulation models and improved survival prediction in ALS clinical trial data. This is particularly evident in cases where only a small number of patients have high quality phenotypes, a common scenario in EHR-based research. Denoising autoencoders perform dimensionality reduction enabling visualization and clustering for the discovery of new subtypes of disease. This method represents a promising approach to clarify disease subtypes and improve genotype-phenotype association studies that leverage EHRs.     

‘No “Sane” Person Would Have Any Idea’: Patients’ Involvement in Late Nineteenth-century British Asylum?Psychiatry

In his 1895 textbook, Mental Physiology, Bethlem Royal Hospital physician Theo Hyslop acknowledged the assistance of three fellow hospital residents. One was a junior colleague. The other two were both patients: Walter Abraham Haigh and Henry Francis Harding. Haigh was also thanked in former superintendent George Savage’s book Insanity and Allied Neuroses (1884). In neither instance were the patients identified as such. This begs the question: what role did Haigh and Harding play in asylum theory and practice? And how did these two men interpret their experiences, both within and outside the asylum? By focusing on Haigh and Harding’s unusual status, this paper argues that the notion of nineteenth-century ‘asylum patient’ needs to be investigated by paying close attention to specific national and institutional circumstances. Exploring Haigh and Harding’s active engagement with their physicians provides insight into this lesser-known aspect of psychiatry’s history. Their experience suggests that, in some instances, representations of madness at that period were the product of a two-way process of negotiation between alienist and patient. Patients, in other words, were not always mere victims of ‘psychiatric power’; they participated in the construction and circulation of medical notions by serving as active intermediaries between medical and lay perceptions of madness.     

The utilization of Arabic online drug information among adults in Saudi Arabia

In Saudi Arabia, the utilization of the world wide web has become increasingly popular. However, the exact figure of such use is unknown. This study aimed to determine the percentage of, and experience with, online Arabic drug information by Arabic-speaking adults in Saudi Arabia. A web based questionnaire was used. The questionnaire language was Arabic. Public were invited to participate in the survey through e-mails, Twitter, WhatsApp and Facebook in March 2012. The survey included 17 items examining the types of accessed Arabic drug information, the respondent’s demographics, their ability to easily find and understand Arabic drug-related information, and their trustfulness and dependency on such information websites. Of the 422 Arabic speaking adults who answered the questionnaire, 88% stated that they used Arabic websites to answer drug-related questions. Of the respondents, 50% had a bachelor’s degree, 44% were young adults, over half were female (60%), and 72% of them have a chronic disease. The ease of retrieving online information was the most common reason (69%) for consulting such websites. Google as a search engine was the most frequently (86%) accessible website. Although respondents reported different drug-related topics in their online searching, the search for adverse effects was the most common (68%). Respondents claimed that they could easily find (65%) and understand (49%) the drug-related information. Although a good number of respondents qualified this type of information as good, double-checking of information on other websites was highly recommended. Trustfulness was one of the important parameters to measure and 205 respondents (55%) claimed that they only trusted half of the information cited. Moreover, around 48% of respondents considered that finding the same information on more than one website increased its trustfulness. Surprisingly, 54% of respondents did not depend on Arabic information websites when making decisions on drug use. There are a high proportion of Arabic speaking people in Saudi Arabia using and consulting Arabic drug information websites. This information is easily found and understood. However, the quality and trustfulness of such websites are not high enough to depend on them. A qualified Arabic drug information website is important to meet this need.