Methotrexate Therapy for Ectopic Pregnancy in Adolescents

To determine the suitability and efficacy of methotrexate (MTX) therapy for adolescent patients with ectopic pregnancy. Patients with ectopic pregnancy were treated with methotrexate, 50mg/m2 intramuscularly. Follow-up determinations of quantitative βhCG levels were done on days 1, 4, and 7. They were then seen weekly until βhCG levels were less than 15mIU/ml. Adolescents with ectopic pregnancy (55 patients) received MTX therapy and comprised the study group. They were compared with 186 adults similarly treated. The groups were compared for treatment outcome and for compliance with the rigid protocol requirements. Treatment success was defined as a patient who required no surgical intervention and whose βhCG levels declined to <15mIU/ml. 85% of patients required no surgical intervention following MTX injection. Surgical intervention rates were slightly higher and success rates slightly lower for adolescent patients, but these differences were not statistically significant (p=.71). Although adult patients were more likely to have a perfect compliance rating, comparison of all compliance categories showed no significant differences (p=.17). MTX therapy is satisfactory for adolescent patients. It is effective, and adolescent patients are able to comply with the requirements of a rigid protocol

Aggregating expert judgement

In a paper written some 25 years ago, I distinguished three contexts in which one might wish to combine expert judgements of uncertainty: the expert problem, the group decision problem and the textbook problem. Over the intervening years much has been written on the first two, which have the focus of a single decision context, but little on the third, though the closely related field of meta-analysis has developed considerably. With many developments in internet technology, particularly in relation to interactivity and communication, the textbook problem is gaining in importance since data and expert judgements can be made available over the web to be used by many different individuals to shape their own beliefs in many different contexts. Moreover, applications such as web-based decision support, e-participation and e-democracy are making algorithmic ‘solutions’ to the group decision problem attractive, despite many results showing we know that such solutions are, at best, rare and, at worst, illusory. In this paper I survey developments since my earlier paper and note some unresolved issues. Then I turn to how expert judgement might be used within web-based group decision support, as well as in e-participation and e-democracy contexts. The latter points to a growing importance of the textbook problem and suggests that Cooke’s principles for scientific reporting of expert judgement studies may need enhancing for such studies to be used by a wider audience