Reprint of “The Single-Case Reporting Guideline In BEhavioural interventions (SCRIBE) 2016: explanation and elaboration”

There is substantial evidence that research studies reported in the scientific literature do not provide adequate information so that readers know exactly what was done and what was found. This problem has been addressed by the development of reporting guidelines which tell authors what should be reported and how it should be described. Many reporting guidelines are now available for different types of research designs. There is no such guideline for one type of research design commonly used in the behavioral sciences, the single-case experimental design (SCED). The present study addressed this gap. This report describes the Single-Case Reporting guideline In BEhavioural interventions (SCRIBE) 2016, which is a set of 26 items that authors need to address when writing about SCED research for publication in a scientific journal. Each item is described, a rationale for its inclusion is provided, and examples of adequate reporting taken from the literature are quoted. It is recommended that the SCRIBE 2016 is used by authors preparing manuscripts describing SCED research for publication, as well as journal reviewers and editors who are evaluating such manuscripts.Published versio

Guías de práctica clínica en francés y español: análisis de la superestructura

The purpose of this paper is to provide elements that will help to further understand the clinical practice guideline genre in French and in Spanish, thereby facilitating the work of authors and translators. The study thus focuses on the analysis of the superstructure, with a view to offering guidelines for the construction of a sample prototype. First, we describe and define the genre in question. In the second section, we refer to the materials and methodological framework employed, describing the sub-domain chosen for analysis (rare diseases), the compilation and processing of the corpus and, finally, the research methodology implemented. The final section presents and discusses the results of the corpus analysis, which indicate the importance of advocating a single unique superstructure for the genre in question.El objetivo de este trabajo es proporcionar elementos que permitan un mejor conocimiento del género textual “guía de práctica clínica” en francés y en español que facilite su redacción y su traducción. Para ello, nos centramos en el estudio de la superestructura con la finalidad de ofrecer pautas para el establecimiento de un modelo prototípico. En primer lugar, se lleva a cabo una descripción y delimitación del género objeto de estudio. En segundo lugar, se recogen los datos relativos a los materiales y el marco metodológico, describiéndose el subdominio seleccionado (enfermedades raras), la compilación y el tratamiento del corpus, así como la metodología de investigación adoptada. En el apartado final, se presentan los datos obtenidos tras el análisis del corpus y se discuten los resultados, los cuales ponen de manifiesto la importancia de abogar por una estandarización superestructural del género

Streamlining Hospital IT - Improving the Admission Process

We analyzed the admission workflow in three Swiss hospitals of different size for normal and emergency admissions. Our goal was to detect shortcomings mainly in the administrative admission process due to media breaks. We obtained 9 different workflows (three per hospital) and a total of 22 shortcomings in the admission process which were present or likely in two or more of the hospitals. A considerable number could be traced back to missing information requiring time consuming extra work. We drafted five potential IT-based workflow changes and made, together with the hospital partners, a cost-benefit analysis which solution would be most interesting. As a result, a concept for an open multi center hospital admission portal was drafted, which, in theory, should influence 8 of the 22 problems found. Specifically, the prototype of the portal was designed for a direct triangular interaction between the referring doctor, the patient and the hospital staff

Implementation science: a role for parallel dual processing models of reasoning?

BACKGROUND: A better theoretical base for understanding professional behaviour change is needed to support evidence-based changes in medical practice. Traditionally strategies to encourage changes in clinical practices have been guided empirically, without explicit consideration of underlying theoretical rationales for such strategies. This paper considers a theoretical framework for reasoning from within psychology for identifying individual differences in cognitive processing between doctors that could moderate the decision to incorporate new evidence into their clinical decision-making. DISCUSSION: Parallel dual processing models of reasoning posit two cognitive modes of information processing that are in constant operation as humans reason. One mode has been described as experiential, fast and heuristic; the other as rational, conscious and rule based. Within such models, the uptake of new research evidence can be represented by the latter mode; it is reflective, explicit and intentional. On the other hand, well practiced clinical judgments can be positioned in the experiential mode, being automatic, reflexive and swift. Research suggests that individual differences between people in both cognitive capacity (e.g., intelligence) and cognitive processing (e.g., thinking styles) influence how both reasoning modes interact. This being so, it is proposed that these same differences between doctors may moderate the uptake of new research evidence. Such dispositional characteristics have largely been ignored in research investigating effective strategies in implementing research evidence. Whilst medical decision-making occurs in a complex social environment with multiple influences and decision makers, it remains true that an individual doctor's judgment still retains a key position in terms of diagnostic and treatment decisions for individual patients. This paper argues therefore, that individual differences between doctors in terms of reasoning are important considerations in any discussion relating to changing clinical practice. SUMMARY: It is imperative that change strategies in healthcare consider relevant theoretical frameworks from other disciplines such as psychology. Generic dual processing models of reasoning are proposed as potentially useful in identifying factors within doctors that may moderate their individual uptake of evidence into clinical decision-making. Such factors can then inform strategies to change practice

Improving Design Optimization and Optimization-based Design Knowledge Discovery

The use of design optimization in the early stages of architectural design process has attracted a high volume of research in recent years. However, traditional design optimization requires a significant amount of computing time, especially when there are multiple design objectives to achieve. What’s more, there is a lack of studies in the current research on automatic generation of architectural design knowledge from optimization results. This paper presents computational methods for creating and improving a closed loop of design optimization and knowledge discovery in architecture. It first introduces a design knowledge-assisted optimization improvement method with the techniques - offline simulation and Divide & Conquer (D&C) - to reduce the computing time and improve the efficiency of the design optimization process utilizing architectural domain knowledge. It then describes a new design knowledge discovery system where design knowledge can be discovered from optimization through an automatic data mining approach. The discovered knowledge has the potential to further help improve the efficiency of the optimization method, thus forming a closed loop of improving optimization and knowledge discovery. The validations of both methods are presented in the context of a case study with parametric form-finding for a nursing unit design with two design objectives: minimizing the nurses’ travel distance and maximizing daylighting performance in patient rooms

Changes in prescribing patterns of benzodiazepines after training of general practitioners

RESUMO: Introdução: As benzodiazepinas são os fármacos ansiolíticos e hipnóticos mais utilizados. O elevado consumo destes fármacos tem representado uma preocupação devido aos efeitos secundários do seu uso prolongado e dependência. Portugal tem a maior utilização de benzodiazepinas na Europa. Este estudo pretende analisar a alteração do padrão de prescrição de benzodiazepinas após uma intervenção com clínicos gerais. Métodos: A intervenção consistiu numa sessão educacional a um grupo de clínicos gerais. Foi comparado o padrão de prescrição de benzodiazepinas dos médicos intervencionados com o de um grupo de médicos não intervencionado da mesma região e com o de um grupo de médicos não intervencionados de outra região. Analisaram-­‐se as prescrições de 12 meses antes e depois da intervenção. A análise do padrão de prescrição utilizou como metodologia a Dose Diária Definida (DDD) e a Dose Diária Definida por 1000 pacientes por dia (DHD). A análise estatística recorreu a métodos de regressão segmentada. Resultados: Houve uma diminuição no padrão de prescrição de benzodiazepinas no grupo intervencionado após a intervenção (p=0.005). Houve também uma redução no padrão de prescrição no grupo não intervencionada da mesma região (p=0.037) e no grupo não-intervencionado da região diferente (p=0.010). Analisando por género, prescritores do género feminino prescrevem uma quantidade maior de benzodiazepinas. Os clínicos gerais do género feminino intervencionados tiveram a maior redução na prescrição após a intervenção (p=0.008). Discussão: Os dados demonstraram que a intervenção reduziu a prescrição de benzodiazepinas após a intervenção. A diminuição geral do padrão de prescrição poderá ser explicada pelo efeito de Hawthorne ou pela contaminação entre os três grupos de clínicos gerais. Os dados disponíveis não explicam as diferenças nos padrões de prescrição por género. Conclusão: Este estudo demonstra como uma única intervenção tem um impacto positivo na melhoria dos padrões de prescrição. A replicação desta intervenção poderá representar uma oportunidade para alterar a prescrição de benzodiazepinas em Portugal. -----------------------------ABSTRACT: Introduction: Benzodiazepines are the most utilized anxiolytic and hypnotic drugs. The high consumption of benzodiazepines has been a concern due to the reported side effects of long-­‐term use and dependence. Portugal has the highest benzodiazepine utilisation in Europe. This study aims to analyse the change in General Practitioners’ (GPs) benzodiazepine prescription pattern after na intervention period. Methods: An educational session was delivered to a group of intervened GPs. The benzodiazepine prescription pattern of the intervened group was compared to the pattern of a non-­‐intervened matched group from the same region, and to the pattern of another non-­‐intervened matched group from a diferente region. The research time frame was 12 month before and after intervention. The analysis of the prescription trends used the Defined Daily Dose (DDD) and Defined Daily Dose per 1000 patients per day (DHD) methodology. The statistical methods consisted of segmented regression analysis. Results: There was a decrease in benzodiazepine prescription pattern of intervened GPs after intervention (p=0.005). There was also a decrease in benzodiazepine prescription pattern for the non-­‐intervened group from the same region (p=0.037) and for the non-­‐ intervened group from a diferente region (p=0.010). Concerningthe analysis by gender, female gender prescribed a higher amount of benzodiazepines. The intervened female gender prescribers presented the highest decrease in prescription trend after intervention (p=0.008). Discussion: The data demonstrated that the intervention was effective in reducing benzodiazepine prescription after intervention. The general decrease in prescription trend might be explained by a Hawthorne effect or a contamination effect between the three groups of GPs. The available data couldn´t explain the diferences in prescription patterns by gender. Conclusion: This study demonstrates how a single intervention has a positive impact on improving prescription trends. The replication of this intervention might be an opportunity to changing the worrying benzodiazepine utilisation in Portugal