Web-based system for training and dissemination of a magnification chromoendoscopy classification

AIM： To evaluate the use of web-based technologies to assess the learning curve and reassess reproducibility of a simplified version of a classification for gastric magnification chromoendoscopy （MC）. METHODS： As part of a multicenter trial, a hybrid approach was taken using a CD-ROM, with 20 films of MC lasting 5 s each and an ＂autorun＂ file triggering a local HTML frameset referenced to a remote questionnaire through an Internet connection. Three endoscopists were asked to prospectively and independently classify 10 of these films randomly selected with at least 3 d apart. The answers were centrally stored and returned to participants together with adequate feedback with the right answer. RESULTS： For classification in 3 groups, both intra- [Cohen＇s kappa （K） = 0.79-1.00 to 0.89-1.00] and inter-observer agreement increased from 1st （moderate） to 6th observation （k = 0.94）. Also, agreement with reference increased in the last observations （0.90, 1.00 and 1.00, for observers A, B and C, respectively）. Validity of 100% was obtained by all observers at their 4th observation. When a 4th （sub）group was considered, inter-observer agreement was almost perfect （K = 0.92） at 6th observation. The relation with reference clearly improved into K （0.93-1.00） and sensitivity （75%-100%） at their 6th observations. CONCLUSION： This MC classification seems to be easily explainable and learnable as shown by excellent intra- and inter-observer agreement, and improved agreement with reference. A web system such as the one used in this study may be useful for endoscopic or other image based diagnostic procedures with respect to definition, education and dissemination.

Methadone Maintenance Treatment Program in Portuguese Community Pharmacies

MMT （Methadone maintenance treatment） is an effective way to treat opioid dependence. In Portugal, an MMT program has been available in pharmacies since January 1998, when a formal agreement was signed by the IDT, I.P. （Institute on Drugs and Drug Addiction）, the PPS （Portuguese Pharmaceutical Society）, and the ANF （National Association of Pharmacies）. In January 2004, the INFARMED （National Authority of Medicine and Health Products） became a partner of the program. The possibility of continuing the treatment at a community pharmacy was restricted to patients receiving a stabilized dose of methadone at IDT, I.P. treatment centers. Pharmacists joining the MMT were given mandatory training. Patients on the MMT program received daily doses of methadone solution under directly observed therapy, and were followed up by trained pharmacists. From January 1998 to January 2013, 3,090 patients underwent MMT in Portuguese community pharmacies. The delivery of MMT at community pharmacy level is feasible. This strategy improves access and adherence to methadone treatment, thus helping to reduce the use of illegal opioids. Community pharmacists fully demonstrated their ability to perform extended roles in public health and harm-reduction strategies. Interaction and close cooperation between the different health professionals and organizations involved were crucial to achieve adequate support to the patients.

Feature reduction with PCA/ KPCA for gait classification with different assistive devices

Purpose–The purpose of this paper is to propose a gait analysis technique that aims to identify differences and similarities in gait performance between three different assistive devices(ADs).Design/methodology/approach–Two feature reduction techniques,linear principal component analysis(PCA)and nonlinear kernel-PCA(KPCA),are expanded to provide a comparison of the spatio-temporal,symmetrical indexes and postural control parameters among the three different ADs.Then,a multiclass support vector machine(MSVM)with different approaches is designed to evaluate the potential of PCA and KPCA to extract relevant gait features that can differentiate between ADs.Findings–Results demonstrated that symmetrical indexes and postural control parameters are better suited to provide useful information about the different gait patterns that total knee arthroplasty(TKA)patients present when walking with different ADs.The combination of KPCA and MSVM with discriminant functions(MSVM DF)resulted in a noticeably improved performance.Such combination demonstrated that,with symmetric indexes and postural control parameters,it is possible to extract with high-accuracy nonlinear gait features for automatic classification of gait patterns with ADs.Originality/value–The information obtained with the proposed technique could be used to identify benefits and limitations of ADs on the rehabilitation process and to evaluate the benefit of their use in TKA patients.