BACKGROUND & AIMS: :Improvements in health care are slow, in part because doctors and nurses lack skills in quality improvement, patient safety, and interprofessional teamwork. This article reports on the Retooling for Quality and Safety initiative of the Josiah Macy Jr. Foundation and the Institute for Healthcare Improvement, which sought to integrate improvement and patient safety into medical and nursing school curricula. In one academic year, 2009-10, the initiative supported new learning activities (87 percent of which were interprofessional, involving both medical and nursing students) in classrooms, simulation centers, and clinical care settings that involved 1,374 student encounters at six universities. The work generated insights-described in this article-into which learning goals require interprofessional education; how to create clinically based improvement learning for all students; and how to demonstrate the effects on students' behavior, organizational practice, and benefits to patients. A commonly encountered limiting factor for the programs was the lack of a critical mass of clinically based faculty members who were ready to teach about the improvement of care. What's more, the paucity of robust evaluation strategies for such programs suggests a future research agenda that deserves to be funded.

背景与目标： ：医疗保健方面的改进缓慢，部分原因是医生和护士缺乏提高质量，患者安全和跨专业团队合作的技能。本文报道了Josiah Macy Jr. Foundation和医疗保健改善研究所的“质量与安全重塑计划”倡议，该倡议旨在将改善和患者安全纳入医疗和护理学校的课程中。在2009-10学年的一个学年中，该计划支持了教室，模拟中心和临床护理环境中的新学习活动（其中87％是跨专业的，涉及医学和护理学的学生），涉及六所大学的1,374名学生。这项工作产生了本文中介绍的见解，其中的学习目标需要跨专业的教育；如何为所有学生创建基于临床的改进学习；以及如何证明对学生的行为，组织实践和对患者的好处的影响。该计划的一个普遍遇到的限制因素是缺乏足够数量的临床教师来准备教授改善护理的知识。而且，此类计划缺乏强有力的评估策略，这表明未来的研究议程值得资助。

BACKGROUND & AIMS: :This study examined postconcussion symptom reporting within the first 5 years after mild traumatic brain injury (mTBI). Participants were 167 U.S. military service members (mean age, 27.6 years; 74.3% blast; 96.4% male) who were evaluated subsequent to injuries sustained in theater during Operations Iraqi and Enduring Freedom (92.8%) or from other combat-related operations. Participants completed the Neurobehavioral Symptom Inventory and Post-Traumatic Stress Disorder Checklist within 3 months of injury and at least one follow-up telephone interview at 6 (n = 46), 12 (n = 89), 24 (n = 54), 36 (n = 42), 48 (n = 30), and/or 60 months (n = 25) postinjury. Approximately half of the sample (49.7%) met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) symptom criteria for postconcussion disorder (PCD) at baseline. At all six follow-ups, 46.1-72.0% met DSM-IV criteria for PCD. However, only 20.4-48.0% reported persistent PCD from baseline to follow-up. A substantial minority had also improved (4.0-24.1%) or "developed" new symptoms (16.9-27.8%). Using regression analyses, baseline symptoms were somewhat predictive of PCD symptom reporting at follow-up, though this was not always reliable. Follow-up for all service members who sustain a combat-related mTBI in the context of polytrauma, regardless of the presence or absence of symptom reporting in the acute recovery stage, should be considered the rule, not the exception.

背景与目标： ：这项研究检查了轻度脑外伤（mTBI）后头5年内脑震荡后症状的报告。参加者有167名美国军人（平均年龄27.6岁；爆炸74.3％；男性96.4％），他们在伊拉克和持久自由行动（92.8％）或其他战斗相关行动的战区受伤后接受了评估。参与者在受伤后3个月内完成了神经行为症状清单和创伤后应激障碍检查清单，并在6（n = 46），12（n = 89），24（n = 54），36进行了至少一次随访电话访谈（n = 42），48（n = 30）和/或受伤后60个月（n = 25）。大约一半的样本（49.7％）在基线时符合脑震荡后疾病（PCD）的精神疾病诊断和统计手册，第四版（DSM-IV）症状标准。在所有六次随访中，46.1-72.0％的患者符合PCD的DSM-IV标准。但是，只有20.4-48.0％的人报告了从基线到随访的持续PCD。相当一部分人也有改善（4.0-24.1％）或“发展”新症状（16.9-27.8％）。使用回归分析，基线症状在某种程度上可以预测随访时PCD症状的报告，尽管这并不总是可靠的。在多发性创伤的情况下维持与战斗有关的mTBI的所有服役人员的随访，无论在急性恢复阶段是否存在症状报告，都应视为常规，而不是例外。

BACKGROUND & AIMS: The health care industry is in the throes of remarkably penetrating and destabilizing change, the effects of which have been felt earliest by perinatal service directors. In anticipation of future trends marked by rampant change, a survey of perinatal service directors and vice presidents was conducted to elicit their opinions about the current and future states of perinatal health care. Findings supported the notions that change is a constant, that clinical and service excellence is a mandate, and that collaboration is key. Future success will require many old behaviors and systems to be replaced. Leadership to guide us to the future has never been more important.

背景与目标： 卫生保健行业正处在深刻渗透和破坏稳定的变革的阵痛之中，围产期服务主管最早感受到了这种变革的影响。为了预见未来变化趋势明显的趋势，对围产期服务主管和副总裁进行了一项调查，以征询他们对围产期保健的当前和未来状态的意见。研究结果支持以下观念：变革是永恒的，临床和服务卓越是使命，协作是关键。未来的成功将需要替换许多旧的行为和系统。引领我们走向未来的领导力从未如此重要。

BACKGROUND & AIMS: :"First responders" are people trained in advanced first aid who can respond at the same time as, and often more quickly than, ambulance services to suspected medical emergencies. Hatzolah is a volunteer First Responder group, based on halakhic (Jewish legal) principles, in a localised area of metropolitan Melbourne with the highest density of Holocaust survivors outside Israel. Low numbers of "call-outs" to Victoria's Metropolitan Ambulance Service (MAS) from this community suggested that many were reluctant to make contact with a "uniformed" external agency. Hatzolah is an autonomous organisation operating under adapted MAS clinical practice guidelines and clinical governance processes. Hatzolah responders undergo an 18-month MAS training course comprising first aid, cardiopulmonary resuscitation, the use of semiautomated defibrillators, and oxygen therapy. We describe the first 11 years (1995-2005) of the Hatzolah service. The number of patients attended to annually has risen steadily, peaking at 867 in 2005. The most frequent reasons for call-outs were falls (19.4%), chest pain (9.7%), or respiratory distress (7.6%). Hatzolah's median response times were 2 or 3 min for all cases. They attended 35 patients with cardiac arrest (median response time, 2 min), and arrived before the MAS to 29 call-outs (83%). Nineteen patients (54%) with cardiac arrest were resuscitated and transported from the scene alive. Among those transported, significantly more had a shockable cardiac rhythm (50% v 13%, P = 0.03). Five (14%) survived to hospital discharge. Hatzolah has evolved into an organisation providing a complementary service to the MAS. It serves as a model for the establishment of other metropolitan community First Responder groups.

背景与目标： ：“急救人员”是受过高级急救训练的人员，可以与救护车服务同时对可疑医疗紧急情况做出响应，并且通常比救护车服务更快。哈佐拉（Hatzolah）是自愿响应的“第一响应者”团体，基于犹太人（犹太法律）原则，在墨尔本以外的以色列大屠杀幸存者密度最高的大都市墨尔本本地区域中。来自该社区的维多利亚大都会救护车服务（MAS）的“召集”次数很少，这表明许多人不愿与“统一”的外部机构进行联系。 Hatzolah是根据适应性MAS临床实践指南和临床治理流程运作的自治组织。 Hatzolah响应者接受为期18个月的MAS培训课程，包括急救，​​心肺复苏，半自动除颤器的使用和氧气疗法。我们描述了Hatzolah服务的前11年（1995-2005年）。每年看病的人数一直稳定增长，在2005年达到867例的峰值。最常见的原因是跌倒（19.4％），胸痛（9.7％）或呼吸窘迫（7.6％）。在所有情况下，Hatzolah的中位反应时间均为2或3分钟。他们治疗了35例心脏骤停的患者（中位反应时间为2分钟），并在MAS之前到达了29个呼出处（83％）。复苏了19例心脏骤停患者（54％），并从现场转移了生命。在被转运的人中，明显的人具有令人震惊的心律（50％对13％，P = 0.03）。五（14％）人存活到医院出院。 Hatzolah已发展成为向MAS提供补充服务的组织。它是建立其他大都市社区“第一响应者”团体的典范。

BACKGROUND & AIMS: :Thirty-five patients with definite multiple sclerosis (MS) were studied. They underwent neuropsychological testing and magnetic resonance imaging (MRI). The MRI findings at different brain areas levels were compared with the neuropsychological findings. A quantitative system was used to measure MRI-MS lesions. In this series, a positive correlation was established between memory and learning disturbances measured by Battery 144, and the lesions measured by MRI (total, hemispheric and, particularly, periventricular lesions). MRI can detect MS lesions, and this study shows that a correlation between MRI and neuropsychological findings is possible if quantitative methods are used to distinguish different MS involvement areas in relation to neuropsychological tasks. These findings suggest that hemispheric lesions in MS produce cognitive disturbances and MRI could be a useful tool in predicting memory and learning impairment.

背景与目标： ：研究了35例明确的多发性硬化症（MS）患者。他们接受了神经心理学测试和磁共振成像（MRI）。将不同大脑区域水平的MRI检查结果与神经心理学检查结果进行比较。定量系统用于测量MRI-MS病变。在这个系列中，通过电池144测量的记忆和学习障碍与通过MRI测量的病变（总的，半球的，尤其是脑室周围的病变）之间建立了正相关。 MRI可以检测MS病变，这项研究表明，如果使用定量方法区分与神经心理学任务相关的不同MS累及区域，则MRI与神经心理学发现之间可能存在关联。这些发现表明，MS的半球病变会产生认知障碍，而MRI可能是预测记忆和学习障碍的有用工具。

BACKGROUND & AIMS: BACKGROUND:Patient satisfaction, one of the main components of quality of care, is a crucial phenomenon for the overall health care delivery system. Even though a number of studies have been conducted about patient satisfaction in different health services, studies in radiology services are flimsy in Ethiopia. This study aimed at assessing patient satisfaction towards radiological service and associated factors in Hawassa University Teaching and Referral hospital. METHODS:An institution based cross-sectional study was conducted among 321 adult patients presented for radiological service in the study area using stratified sampling technique. Patient satisfaction was measured using SERVQUAL (Service Quality) tool that consisted of seven items: accessibility, quality of radiological service, courtesy of radiology staff, existence of good communication with service provider and desk worker, physical environment and privacy technique. Exit interviews of patients were conducted using a structured and pretested questionnaire. Data was collected by three grade ten completed trained data collectors from May 12 to May 28, 2016. Multiple logistic regressions were used to identify independent factors associated with patient satisfaction on radiological services using SPSS version 21. RESULTS:The overall patient satisfaction towards radiological service was 71.6%. Satisfaction to accessibility of the service was 84.5% while it was 80.6% to courtesy of the staff. Similarly, 81.6% reported satisfied with quality of the service and 59.4% and 71% of reported satisfied with physical environment and radiological service provider respectively. On the other hand, 99.7% of the respondents were dissatisfied with privacy of the service. The study revealed that patients who attended primary school (AOR = 0.317, 95% CI: 0.11-0.88), unemployed patients (AOR = 0.067, 95% CI: 0.007-0.622) and patients who had short waiting time to enter into examination room less than one hour (AOR = 4.12, 95% CI: 1.4-11.62) were factors associated with patients satisfaction. CONCLUSION:This study found that majority of respondents was satisfied with the radiological services. Respondent's education level, occupation as well as duration of time taken to enter into examination room were important factors influencing the satisfaction condition. Hence, concerted effort is needed to constantly improve on patient satisfaction to better radiology returns arising from improved patient patronage. It is recommended to give great care and attention to clients during radiological examination procedure and also suggested that the department should decrease time taken to enter into examination room. On the other hand, the reasons behind more educated clients were less satisfied with radiologic service than more educated respondents need further investigation.

背景与目标： 背景：患者满意度是医疗质量的主要组成部分之一，是整个医疗服务体系中的关键现象。即使在不同的卫生服务机构中进行了许多有关患者满意度的研究，但在埃塞俄比亚，放射科的研究仍然很薄弱。这项研究旨在评估霍瓦萨大学教学与转诊医院对放射服务及相关因素的患者满意度。
方法：采用分层抽样技术，对研究区的321名成年放射科成年患者进行了基于机构的横断面研究。使用SERVQUAL（服务质量）工具测量患者满意度，该工具包括七个项目：可访问性，放射线服务质量，放射线人员的礼貌，与服务提供者和服务台工作人员的良好沟通，身体环境和隐私技术。使用结构化且经过预先测试的问卷对患者进行出站采访。数据由2016年5月12日至2016年5月28日由三个十位完成培训的十年级数据收集者收集。使用Logistic回归分析使用SPSS 21版使用放射线回归确定与患者对放射服务的满意度相关的独立因素。
结果：患者对放射科服务的总体满意度为71.6％。对该服务的可访问性满意度为84.5％，而工作人员的礼貌满意度为80.6％。同样，分别对服务质量表示满意的有81.6％，对物理环境和放射服务提供者表示满意的有59.4％和71％。另一方面，有99.7％的受访者对服务的私密性不满意。研究显示，上小学的患者（AOR = 0.317，95％CI：0.11-0.88），失业的患者（AOR = 0.067，95％CI：0.007-0.622）和等待时间短的患者进入考场少于一小时（AOR = 4.12，95％CI：1.4-11.62）是与患者满意度相关的因素。
结论：本研究发现大多数受访者对放射学服务感到满意。受访者的文化程度，职业以及进入考场的时间是影响满意度的重要因素。因此，需要共同努力以不断提高患者的满意度，以改善患者的光顾，从而获得更好的放射学回报。建议在放射检查过程中要格外注意和照顾客户，并建议部门减少进入检查室的时间。另一方面，受过良好教育的客户对放射线服务的满意度低于对受过教育的受访者的满意度，这是需要进一步调查的原因。

BACKGROUND & AIMS: :Patient safety is one of the greatest challenges facing health care today and nurses are well placed to find opportunities for enhancing care and making it safer. Nurse education has an important role to play in ensuring future professions have capabilities and confidence to meet this challenge however this requires new pedagogies in nurse education. This paper reports on an initiative to develop the safety improvement and leadership capabilities of final year nursing students using Action Learning to support students to undertake a safety improvement project in the clinical setting. A qualitative, interpretive research approach was used to explore students' experiences of participation in Action Learning. 52 nursing students from a UK University participated in the study. Student accounts of their experiences were generated through focus group and individual interviews and data were subject to thematic analysis. Findings are discussed in relation to three categories including "creating an enabling environment", "learning through action and reflection" and "the emergence of safety improvement and leadership practices." The study findings provide valuable insights into how AL processes can engender personal leadership capabilities and support students to make a valuable contribution to safer care practices, both as students and as future health care professionals.

背景与目标： ：患者的安全性是当今医疗保健面临的最大挑战之一，护士已准备好寻找机会来加强护理并使其更加安全。护士教育在确保未来的职业具有应对这一挑战的能力和信心方面可以发挥重要作用，但这需要在护士教育中采用新的教学法。本文报告了一项旨在通过行动学习来发展最终护理学生的安全改进和领导能力的倡议，以支持学生在临床环境中开展安全改进项目。使用定性，解释性研究方法来探索学生参与行动学习的经验。来自英国大学的52名护理专业学生参加了这项研究。通过专题小组对学生的经历进行描述，并通过专题访谈对个人访谈和数据进行分析。讨论了与三个类别有关的发现，包括“创造有利的环境”，“通过行动和反思进行学习”以及“安全改进和领导实践的出现”。研究结果为AL过程如何提高个人领导能力和支持学生（无论是作为学生还是将来的医疗保健专业人员）对更安全的护理实践做出了宝贵的贡献提供了宝贵的见解。

BACKGROUND & AIMS: OBJECTIVES:To determine the willingness of accountable care organizations (ACOs) to bear financial risk for the healthcare they provide. DESIGN AND METHODS:Structured interviews conducted between January and June 2012 with 57 ACOs led by hospitals and physician groups located throughout the United States. Findings are based on the 38 ACOs that were actively providing care under an ACO payment arrangement at the time of the interview. RESULTS:Among these ACOs, 71% cover a portion of their ACO population with contracts that put the ACOs at some financial risk, while 45% have risk-based contracts for their entire ACO population. Payments based on fee-for-service (FFS) billing still dominate, as 92% of ACOs use FFS-based billing for at least a portion of their ACO population and 71% are fully reimbursed using FFS-based billing. CONCLUSIONS:Under the auspices of an ACO, providers are accepting some financial risk for their accountable care patient population. There is still strong reliance on FFS-based billing methods as providers experiment with different payment models.

背景与目标： 目的：确定责任医疗组织（ACO）承担为其提供的医疗服务承担财务风险的意愿。
设计与方法：2012年1月至6月间对57个ACO（由美国各地的医院和医师小组领导）进行了结构化访谈。调查结果基于采访时根据ACO付款安排积极提供护理的38个ACO。
结果：在这些ACO中，有71％的合同覆盖了一部分ACO人群，使ACO承受了一定的财务风险，而45％的合同中有针对整个ACO人群的基于风险的合同。基于服务费（FFS）计费的付款仍然占主导地位，因为92％的ACO至少有一部分ACO人口使用基于FFS的计费，而71％的ACO使用基于FFS的计费完全偿还。
结论：在ACO的主持下，提供者正在为其负责的护理患者群体承担一些财务风险。由于提供商尝试使用不同的支付模型，因此仍然强烈依赖基于FFS的计费方法。

BACKGROUND & AIMS: :Mutation of the DNA-binding region of the FOXP2 protein causes an inherited language disorder. A recent study provides the first data on mice with this mutation, which exhibit deficits in motor-skill learning and abnormal properties of neural circuits that contribute to these skills.

背景与目标： ：FOXP2蛋白的DNA结合区的突变会导致遗传性语言障碍。最近的一项研究提供了具有这种突变的小鼠的首批数据，这些小鼠表现出运动技能学习的缺陷和有助于这些技能的神经回路异常特性。

BACKGROUND & AIMS: :We have previously shown in normal subjects that motor adaptation to imposed visual rotation is significantly enhanced when tested few days later. This occurs through a process of sleep-dependent memory consolidation. Here we ascertained whether patients with Parkinson's disease (PD) learn, improve, and retain new motor skills in the same way as normal subjects. We tested 16 patients in early stages of PD and 21 control subjects over two days. All subjects performed reaching movements on a digitizing tablet. Vision of the limb was precluded with an opaque screen; hand paths were shown on the screen with the targets' position. Unbeknownst to the subjects, the hand path on the screen was rotated by 30 degrees . In experiment 1, patients taking dopaminergic treatment and controls adapted to rotation with targets appearing in an unpredictable order. In experiment 2, drug-naïve patients and controls adapted to rotation in a less challenging task where target's appearance was predictable. Patients and controls made similar movements and adapted to rotation in the same way. However, when tested again over the following days, controls' performance significantly improved compared to training, while patients' performance did not. This lack of consolidation, which is present in the early stages of the disease and is independent from therapy, may be due to abnormal homeostatic processes that occur during sleep.

背景与目标： ：我们之前在正常受试者中显示，几天后进行测试后，运动适应视觉旋转的能力会大大增强。这是通过依赖于睡眠的内存合并过程来发生的。在这里，我们确定帕金森氏病（PD）的患者是否以与正常受试者相同的方式学习，改善和保留新的运动技能。我们在两天内测试了PD早期的16例患者和21例对照对象。所有对象均在数字化平板电脑上进行了移动动作。不透明的屏幕无法显示四肢的视力；屏幕上显示了目标位置的手形路径。被摄对象不知道，屏幕上的手部路径旋转了30度。在实验1中，接受多巴胺能治疗和控制的患者适应了旋转，并且靶标以无法预测的顺序出现。在实验2中，没有药物治疗的患者和对照组在难以预测的任务中适应了旋转，其中目标的出现是可预测的。患者和对照者进行相似的运动，并以相同的方式适应旋转。但是，在接下来的几天中再次进行测试时，与训练相比，对照组的表现显着改善，而患者的表现却没有。这种缺乏固结的现象是在疾病的早期阶段出现的，并且与治疗无关，这可能是由于睡眠期间发生的异常体内平衡过程引起的。

BACKGROUND & AIMS: :K. Cheng (1986) suggested that learning the geometry of enclosing surfaces takes place in a geometric module blind to other spatial information. Failures to find blocking or overshadowing of geometry learning by features near a goal seem consistent with this view. The authors present an operant model in which learning spatial features competes with geometry learning, as in the Rescorla-Wagner model. Relative total associative strength of cues at a location determines choice of that location and thus the frequencies of reward paired with each cue. The model shows how competitive learning of local features and geometry can appear to result in potentiation, blocking, or independence, depending on enclosure shape and kind of features. The model reproduces numerous findings from dry arenas and water mazes.

背景与目标： ：K Cheng（1986）建议，学习封闭表面的几何形状是在对其他空间信息不了解的几何模块中进行的。未能通过目标附近的要素找到阻碍或过度学习几何学习的现象似乎与此视图一致。作者提出了一个操作模型，其中与Rescorla-Wagner模型一样，学习空间特征与几何学习竞争。某个位置的提示的相对总关联强度决定了该位置的选择，并因此决定了与每个提示配对的奖励频率。该模型显示了根据局部形状和特征种类，竞争性学习局部特征和几何形状会如何导致增强，阻断或独立性。该模型重现了来自干竞技场和迷宫般的大量发现。

BACKGROUND & AIMS: :Recognizing that robust information on health systems in other countries can provide valuable lessons for the English National Health Service, the Department of Health commissioned an academic team to provide an 'On-call Facility for International Healthcare Comparisons' in 2005. This paper describes the work of this novel approach to informing policy and reviews the experience of the first two years. It illustrates the well-documented challenges of comparative analysis of health systems. One important issue is understanding the health system context so as to interpret phenomena and draw appropriate policy conclusions. Other challenges include the potential tension between academic interest and rigour, and the need for timely analysis to inform the Department of Health's rapidly changing policy agenda. The diversity and nature of topics covered, as well as the rapid turn-around time have meant that the Facility has had to balance rigour and timeliness carefully to ensure the value and relevance of reports. A strong research base linked with an international network of country experts promotes the provision of high quality analyses at relatively low costs. However, such an arrangement can only be sustained if it provides scope for additional primary research. A formal evaluation of the influence on health care policy-making in England is not yet available. Such knowledge will be of crucial importance for the development of similar resources elsewhere.

背景与目标： ：卫生部认识到其他国家/地区强大的卫生系统信息可以为英国国家卫生服务局提供宝贵的经验，因此在2005年委托一个学术团队提供“国际医疗比较的待命服务”。这种新颖的方法来指导政策并回顾前两年的经验。它说明了卫生系统比较分析中有据可查的挑战。一个重要的问题是了解卫生系统的背景情况，以便解释现象并得出适当的政策结论。其他挑战包括学术兴趣和严格性之间的潜在紧张关系，以及需要及时分析以告知卫生部迅速变化的政策议程的挑战。所涉主题的多样性和性质以及快速的周转时间，意味着该基金必须认真权衡严格性和及时性，以确保报告的价值和相关性。强大的研究基础与国家专家的国际网络相联系，促进了以相对较低的成本提供高质量的分析。但是，只有为其他基础研究提供了范围，这样的安排才能维持下去。目前尚无关于英格兰对卫生保健政策制定影响的正式评估。这些知识对于开发其他地方的类似资源至关重要。

BACKGROUND & AIMS: OBJECTIVES:To examine attitudes to the Mental Capacity Act's new statutory Independent Mental Capacity Advocate (IMCA) service in England and Wales and consider the implications for its delivery. METHODS:Quantitative data describing all referrals to the seven pilot IMCA services (January 2006-March 2007) and qualitative data from semi-structured interviews with 18 doctors, 21 senior nurses and one discharge planning manager in four general hospitals in England. RESULTS:Of 127 hospital-based referrals to the seven pilot IMCA services, 29 (23%) were for patients facing serious medical treatments, 52% of whom were judged to lack decision-making capacity due to a learning disability; ninety-eight (77%) were for patients facing a change of accommodation upon hospital discharge, 62% of whom were elderly and lacked capacity due to dementia. While aware of the potential benefits of the IMCA service, clinicians were generally negative about the contribution advocates could make to patients' medical care and thought they could only contribute usefully in a minority of ethically complicated decisions. In contrast, they were more positive about the involvement of advocates in hospital discharge decisions and hoped that they would improve current discharge practice. CONCLUSIONS:Clinicians held ambivalent attitudes towards the involvement of a statutory IMCA service in medical decisions, reflecting beliefs that the service was largely impractical and unnecessary given current procedures for making medical decisions in patients' 'best interests'. Conversely, clinicians were more likely to support advocacy in discharge decisions because they believed that non-medically qualified advocates could make a valuable contribution to decisions that were seen as predominantly social and where practice was frequently considered deficient. By holding these beliefs, clinicians are failing to have due regard for the IMCA service as a statutory measure for safeguarding patients' interests.

背景与目标： 目的：研究对《心理能力法案》在英格兰和威尔士新成立的法定独立心理能力提倡者（IMCA）服务的态度，并考虑对其实施的影响。
方法：定量数据描述了所有转诊给七个IMCA试点服务（2006年1月至2007年3月）的数据，以及来自与英格兰四家综合医院的18位医生，21位高级护士和一位出院计划经理进行的半结构式访谈的定性数据。
结果：在七项IMCA试点服务的127例医院转诊中，有29例（23％）是针对面临严重医疗的患者，其中52％被判定为因学习障碍而缺乏决策能力；百分之九十八（77％）的病人是出院后面临住宿变更的患者，其中62％为老年人且因痴呆症而无能力。在意识到IMCA服务的潜在好处的同时，临床医生通常对倡导者可以对患者的医疗服务做出的贡献持否定态度，并认为他们只能在少数道德上复杂的决定中做出有益的贡献。相反，他们对倡导者参与医院出院决定更为积极，并希望他们能够改善目前的出院实践。
结论：临床医生对将法定IMCA服务纳入医疗决策持矛盾态度，反映出这样一种信念，即鉴于当前为患者“最大利益”做出医疗决策的程序，该服务在很大程度上是不切实际和不必要的。相反，临床医生更有可能支持出院决策方面的倡导，因为他们认为没有医学资历的倡导者可以为那些被认为主要是社会行为且经常被认为缺乏实​​践的决策做出有价值的贡献。抱着这些信念，临床医生就没有适当考虑IMCA服务作为保护患者利益的法定措施。

BACKGROUND & AIMS: BACKGROUND:Word sense disambiguation (WSD) is critical in the biomedical domain for improving the precision of natural language processing (NLP), text mining, and information retrieval systems because ambiguous words negatively impact accurate access to literature containing biomolecular entities, such as genes, proteins, cells, diseases, and other important entities. Automated techniques have been developed that address the WSD problem for a number of text processing situations, but the problem is still a challenging one. Supervised WSD machine learning (ML) methods have been applied in the biomedical domain and have shown promising results, but the results typically incorporate a number of confounding factors, and it is problematic to truly understand the effectiveness and generalizability of the methods because these factors interact with each other and affect the final results. Thus, there is a need to explicitly address the factors and to systematically quantify their effects on performance. RESULTS:Experiments were designed to measure the effect of "sample size" (i.e. size of the datasets), "sense distribution" (i.e. the distribution of the different meanings of the ambiguous word) and "degree of difficulty" (i.e. the measure of the distances between the meanings of the senses of an ambiguous word) on the performance of WSD classifiers. Support Vector Machine (SVM) classifiers were applied to an automatically generated data set containing four ambiguous biomedical abbreviations: BPD, BSA, PCA, and RSV, which were chosen because of varying degrees of differences in their respective senses. Results showed that: 1) increasing the sample size generally reduced the error rate, but this was limited mainly to well-separated senses (i.e. cases where the distances between the senses were large); in difficult cases an unusually large increase in sample size was needed to increase performance slightly, which was impractical, 2) the sense distribution did not have an effect on performance when the senses were separable, 3) when there was a majority sense of over 90%, the WSD classifier was not better than use of the simple majority sense, 4) error rates were proportional to the similarity of senses, and 5) there was no statistical difference between results when using a 5-fold or 10-fold cross-validation method. Other issues that impact performance are also enumerated. CONCLUSION:Several different independent aspects affect performance when using ML techniques for WSD. We found that combining them into one single result obscures understanding of the underlying methods. Although we studied only four abbreviations, we utilized a well-established statistical method that guarantees the results are likely to be generalizable for abbreviations with similar characteristics. The results of our experiments show that in order to understand the performance of these ML methods it is critical that papers report on the baseline performance, the distribution and sample size of the senses in the datasets, and the standard deviation or confidence intervals. In addition, papers should also characterize the difficulty of the WSD task, the WSD situations addressed and not addressed, as well as the ML methods and features used. This should lead to an improved understanding of the generalizablility and the limitations of the methodology.

背景与目标： 背景：字词歧义消除（WSD）在生物医学领域对于提高自然语言处理（NLP），文本挖掘和信息检索系统的精度至关重要，因为歧义词会对准确访问包含生物分子实体（例如基因）的文献产生负面影响蛋白质，细胞，疾病和其他重要实体。已经开发出自动技术来解决许多文本处理情况下的WSD问题，但是该问题仍然是一个具有挑战性的问题。有监督的WSD机器学习（ML）方法已应用于生物医学领域，并显示出令人鼓舞的结果，但结果通常包含许多混杂因素，并且由于这些因素相互影响，真正了解这些方法的有效性和可推广性是有问题的彼此影响最终结果。因此，需要明确解决这些因素并系统地量化其对性能的影响。
结果：设计了实验来测量“样本量”（即数据集的大小），“感官分布”（即歧义词的不同含义的分布）和“难易程度”（即歧义词的含义之间的距离）对WSD分类器的性能。支持向量机（SVM）分类器应用于自动生成的数据集，该数据集包含四个歧义生物医学缩写：BPD，BSA，PCA和RSV，这是由于它们各自含义上的差异程度不同而选择的。结果表明：1）增加样本大小通常会降低错误率，但这主要限于良好分离的感官（即，感官之间的距离较大的情况）；在困难的情况下，需要极大地增加样本数量以略微提高性能，这是不切实际的； 2）当感官可分离时，感官分布对性能没有影响； 3）当多数感官超过90时％，WSD分类器并不比使用简单多数感官更好； 4）错误率与各种感官的相似性成正比； 5）使用5倍或10倍交叉比对时结果之间没有统计学差异验证方法。还列举了影响性能的其他问题。
结论：将ML技术用于WSD时，有几个不同的独立方面会影响性能。我们发现将它们组合成一个单一的结果会模糊对基本方法的理解。尽管我们仅研究了四个缩写，但我们使用了一种完善的统计方法，该方法可以保证结果对于具有相似特征的缩写很可能是可推广的。我们的实验结果表明，为了了解这些ML方法的性能，至关重要的是，论文要报告基线性能，数据集中感官的分布和样本大小以及标准偏差或置信区间。此外，论文还应描述WSD任务的难度，WSD解决和未解决的情况以及所使用的ML方法和功能。这应该导致人们对通用性和方法的局限性有了更好的了解。

BACKGROUND & AIMS: :Forty patients who had been treated for three years in an ad-hoc, assertive treatment team for patients who had suffered a first psychotic episode were compared to forty patients who had been followed up after a first psychotic episode in a community mental health team. All patients had suffered a first or early psychotic episode. The main differences between the two teams was that the ad-hoc team was assertive in its approach, offered more structured psycho-education, relapse prevention and psycho-social interventions, and had a policy of using atypical anti-psychotics at the lowest effective dose. There were many differences in outcome measures at the end of three years between the two groups. The EI patients are more likely to be taking medication at the end of three years. They are more compliant with medication. They are more likely to be prescribed atypical medication. The EI patients are more likely to have returned to work or education. The EI patients are more likely to remain living with their families. They are less likely to suffer depression to the extent of requiring anti-depressants. They appear to commit less suicide attempts. The patients in the EI service also appear to be less likely to suffer relapse and re-hospitalisation, and are less likely to have involuntary admission to hospital. They have systematic relapse prevention plans based on early warning signs. They and their families receive more psycho-education. These indications suggest that the EI patients are at the end of three years better able to manage their illness/vulnerability on their own than the CMHT patients. More patients in the EI group stopped using illicit drugs than in the CMHT group. All the above changes were statistically significant except for the number of patients who stopped using illicit drugs. In this case it is believed that the sample size was too small to demonstrate significance. These results suggest that an ad-hoc early intervention team is more effective than standard community mental health team in treating psychotic illness.

背景与目标： ：在社区精神卫生小组中，对在首次精神病发作后接受特设，果断治疗团队治疗的40名患者与在第一次精神病发作后进行了随访的40位患者进行了比较。所有患者均经历了第一次或早期精神病发作。这两个团队之间的主要区别在于，特设团队在方法上很果断，提供了更结构化的心理教育，预防复发和心理社会干预，并制定了以最低有效剂量使用非典型抗精神病药的政策。两组在三年结束时的结局指标之间存在许多差异。 EI患者在三年结束时更有可能服用药物。他们对药物的依从性更高。他们更有可能被开具非典型药物。 EI患者更有可能重返工作岗位或接受教育。 EI患者更有可能继续与家人同住。他们不太可能因需要抗抑郁药而患上抑郁症。他们似乎没有自杀的企图。 EI服务中的患者似乎也不太可能遭受复发和再次住院，并且也不太可能自愿住院。他们根据预警信号制定了系统的预防复发计划。他们和他们的家人接受了更多的心理教育。这些迹象表明，与CMHT患者相比，EI患者在三年结束时能够更好地自行控制疾病/脆弱性。与CMHT组相比，EI组中停止使用违禁药物的患者更多。除停止使用违禁药物的患者人数外，以上所有变化均具有统计学意义。在这种情况下，可以认为样本量太小而无法显示出显着性。这些结果表明，特设的早期干预小组在治疗精神病方面比标准的社区精神卫生小组更有效。