Computer-generated reminders delivered on paper to healthcare professionals: effects on professional practice and healthcare outcomes.

Clinical practice does not always reflect best practice and evidence, partly because of unconscious acts of omission, information overload, or inaccessible information. Reminders may help clinicians overcome these problems by prompting them to recall information that they already know or would be expected to know and by providing information or guidance in a more accessible and relevant format, at a particularly appropriate time. This is an update of a previously published review. To evaluate the effects of reminders automatically generated through a computerized system (computer-generated) and delivered on paper to healthcare professionals on quality of care (outcomes related to healthcare professionals' practice) and patient outcomes (outcomes related to patients' health condition). We searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers up to 21 September 2016 together with reference checking, citation searching and contact with study authors to identify additional studies. We included individual- or cluster-randomized and non-randomized trials that evaluated the impact of computer-generated reminders delivered on paper to healthcare professionals, alone (single-component intervention) or in addition to one or more co-interventions (multi-component intervention), compared with usual care or the co-intervention(s) without the reminder component. Review authors working in pairs independently screened studies for eligibility and abstracted data. For each study, we extracted the primary outcome when it was defined or calculated the median effect size across all reported outcomes. We then calculated the median improvement and interquartile range (IQR) across included studies using the primary outcome or median outcome as representative outcome. We assessed the certainty of the evidence according to the GRADE approach. We identified 35 studies (30 randomized trials and five non-randomized trials) and analyzed 34 studies (40 comparisons). Twenty-nine studies took place in the USA and six studies took place in Canada, France, Israel, and Kenya. All studies except two took place in outpatient care. Reminders were aimed at enhancing compliance with preventive guidelines (e.g. cancer screening tests, vaccination) in half the studies and at enhancing compliance with disease management guidelines for acute or chronic conditions (e.g. annual follow-ups, laboratory tests, medication adjustment, counseling) in the other half.Computer-generated reminders delivered on paper to healthcare professionals, alone or in addition to co-intervention(s), probably improves quality of care slightly compared with usual care or the co-intervention(s) without the reminder component (median improvement 6.8% (IQR: 3.8% to 17.5%); 34 studies (40 comparisons); moderate-certainty evidence).Computer-generated reminders delivered on paper to healthcare professionals alone (single-component intervention) probably improves quality of care compared with usual care (median improvement 11.0% (IQR 5.4% to 20.0%); 27 studies (27 comparisons); moderate-certainty evidence). Adding computer-generated reminders delivered on paper to healthcare professionals to one or more co-interventions (multi-component intervention) probably improves quality of care slightly compared with the co-intervention(s) without the reminder component (median improvement 4.0% (IQR 3.0% to 6.0%); 11 studies (13 comparisons); moderate-certainty evidence).We are uncertain whether reminders, alone or in addition to co-intervention(s), improve patient outcomes as the certainty of the evidence is very low (n = 6 studies (seven comparisons)). None of the included studies reported outcomes related to harms or adverse effects of the intervention. There is moderate-certainty evidence that computer-generated reminders delivered on paper to healthcare professionals probably slightly improves quality of care, in terms of compliance with preventive guidelines and compliance with disease management guidelines. It is uncertain whether reminders improve patient outcomes because the certainty of the evidence is very low. The heterogeneity of the reminder interventions included in this review also suggests that reminders can probably improve quality of care in various settings under various conditions

Démographie médicale : indicateurs et observatoires. Revue des pratiques en Suisse et ailleurs.

Disposer d’informations pertinentes et suffisamment détaillées concernant les ressources humaines du secteur de la santé est indispensable à la gouvernance du système, afin de permettre de fournir les soins de santé nécessaires à la population. Ce rapport, établi à la demande du Service de la santé publique du canton de Vaud, décrit les observatoires et indicateurs décrivant les ressources humaines en santé, plus spécifiquement en lien avec la démographie médicale, existant en Suisse et à l’étranger. L’information a été recherchée sur Internet en identifiant les sources potentielles (organismes étatiques, institutions ou organisations publiques nationales et internationales, associations de professionnels de la santé (médecins)) et dans la littérature médicale, dans le but d’identifier les données existantes, les sources et les types d’indicateurs relevés. La littérature scientifique a aussi été examinée à la recherche d’études et de modèles pertinents au monitoring et prédictions quant à la démographie médicale. La Suisse, ainsi que plusieurs pays qui nous entourent, disposent d’informations récoltées de routine la plupart du temps, notamment dans les processus de formation, certification, enregistrement, ou financement des médecins et de leurs activités. Les informations obtenues pour l’établissement de ce rapport sont présentées dans une description succincte, accompagnée de tableaux et figures

Urgences hyperglycémiques en pratique ambulatoire - Prise en charge multidisciplinaire du diabète : recommandations pour la pratique clinique

L’élaboration et la mise en œuvre de ces recommandations pour la pratique clinique (RPC) visent à promouvoir l’application pertinente et coordonnée de pratiques de soins optimales d’un diabète par l’ensemble des professionnels des soins concernés. Ces RPC ont également pour but de fédérer et d’harmoniser la prise en charge du diabète, qui est actuellement très variable dans le canton de Vau

Illusory Increases in Font Size Improve Letter Recognition

Visual performance of human observers depends not only on the optics of the eye and early sensory encoding but also on subsequent cortical processing and representations. In two experiments, we demonstrated that motion adaptation can enhance as well as impair visual acuity. Observers who experienced an expanding motion aftereffect exhibited improved letter recognition, whereas observers who experienced a contracting motion aftereffect showed impaired letter recognition. We conclude that illusory enlargement and shrinkage of a visual stimulus can modulate visual acuity

Conduite automobile et diabète: Prise en charge multidisciplinaire du diabète : recommandations pour la pratique clinique

L’élaboration et la mise en œuvre de ces recommandations pour la pratique clinique (RPC) visent à promouvoir l’application pertinente et coordonnée de pratiques de soins optimales d’un diabète par l’ensemble des professionnels des soins concernés. Ces RPC ont également pour but de fédérer et d’harmoniser la prise en charge du diabète, qui est actuellement très variable dans le canton de Vaud. L’ESSENTIEL Devoir d’information des soignants chez une personne diabétique traitée par un hypoglycémiant - Informer la personne sur la conduite et le diabète et documenter la transmission de ces informations

Effect of measuring patient satisfaction during or after staying in a psychiatric hospital

BACKGROUND: Patient satisfaction surveys are commonly conducted to evaluate health care quality. However, little is known about the impact of the time point of survey administration on the level of satisfaction, questionnaire acceptability, and costs, especially for inpatient psychiatric care. AIMS: To assess whether inpatient satisfaction, questionnaire acceptability, and total costs of study differ according to the time point of questionnaire administration for inpatient psychiatric care. METHOD AND SAMPLE: Inpatients completed the ©Saphora-Psy, a French validated tool measuring satisfaction with care with 35 items assessing 7 dimensions of care, 2-3 days before leaving the ward (first phase). Four to eight weeks after discharge, patients received the same instrument at home (second phase). Time needed to fill the questionnaire and items assessing its acceptability were requested. RESULTS: Only fifty of 104 inpatients in the acute psychiatric hospital, aged &gt;18, who completed the first questionnaire, participated to the second phase, although they all agreed to complete it twice. The participation rate during the hospital stay was 47%. Acceptability did not differ significantly. The mean proportion of missing values was slightly higher after hospital stay (3.84%) than during hospital stay (3.52%), while the number of manuscript comments was identical (n=13). Global evaluation of the questionnaire was similar when administered after or before discharge (excellent/very good : 41% and 42% respectively). General satisfaction with care was rated higher when measured during (vs after) hospital stay. Satisfaction was significantly lower when measured after discharge on four items: nursing staff's empathy (p=0.02) and communication about care (p=0.03), smoking directives (p=0.01), and information regarding treatment after discharge (p=0.01). Costs were about eight times higher during the first phase. CONCLUSIONS: Satisfaction appeared to vary slightly according to the time point of questionnaire administration, with higher ratings measured during hospital stay. In terms of acceptability, the surveys offered identical rates. The costs were much higher during the first phase, due to the hot pursuit of patients about to leave the hospital. [Authors]]]> Patient Satisfaction; Quality of Health Care; Questionnaires; Hospitals, Psychiatric; Hospitalization eng oai:serval.unil.ch:BIB_8CB02C4CD096 2022-05-07T01:22:28Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_8CB02C4CD096 Change in defense mechanisms and coping patterns during the course of 2-year-long psychotherapy and psychoanalysis for recurrent depression: a pilot study of a randomized controlled trial. info:doi:10.1097/NMD.0b013e3182982982 info:eu-repo/semantics/altIdentifier/doi/10.1097/NMD.0b013e3182982982 info:eu-repo/semantics/altIdentifier/pmid/23817160 Kramer, U. de Roten, Y. Perry, J.C. Despland, J.N. info:eu-repo/semantics/article article 2013 Journal of Nervous and Mental Disease, vol. 201, no. 7, pp. 614-620 info:eu-repo/semantics/altIdentifier/eissn/1539-736X urn:issn:0022-3018 <![CDATA[Very little research has been conducted so far to study the potential mechanisms of change in long-term active psychological treatments of recurrent depression. The present pilot randomized controlled trial aimed to determine the feasibility of studying the change process occurring in patients during the course of 2-year-long dynamic psychotherapy, psychoanalysis, and cognitive therapy, as compared with clinical management. In total, eight outpatients presenting with recurrent depression, two patients per treatment arm, were included. All patients were randomly assigned to one of the four treatment conditions. Defense mechanisms and coping patterns were assessed using validated observer-rated methodology based on transcribed, semistructured follow-along independent dynamic interviews. The results indicated that, whereas some patients in the active treatments changed on the symptomatic levels, some others remained unchanged during the course of their 2-year-long treatment. However, with regard to potential mechanisms of change in these patients, changes in defense mechanisms and coping patterns were revealed to be important processes over time in successful therapies and, to a lesser extent, in less successful treatments. No change was found either on outcome or on the process measure for the control condition, that is, clinical management. These results are discussed along with previous data comparing change in defense mechanisms and coping during the course of treatments

Occupy: in theory and practice

This paper situates the discourse of the Occupy movement within the context of radical political philosophy. Our analysis takes place on two levels. First, we conduct an empirical analysis of the ‘official’ publications of Occupy Wall Street (OWS) and Occupy London (OL). Operationalising core concepts from the framing perspective within social movement theory, we provide a descriptive-comparative analysis of the ‘collective action frames’ of OWS and OL. Second, we consider the extent to which radical political philosophy speaks to the discourse of Occupy. Our empirical analysis reveals that both movements share diagnostic frames, but there were notable differences in terms of prognostic framing. The philosophical discussion suggests that there are alignments between anarchist, post-anarchist and post-Marxist ideologies at the level of both identity and strategy. Indeed, the absence of totalising anti-capitalist or anti-statist positions in Occupy suggests that – particularly with Occupy London – alignments are perhaps not so distant from typically social democratic demands

Chronic Eczematous Eruptions of the Elderly Are Associated with Chronic Exposure to Calcium Channel Blockers: Results from a Case–Control Study

It has been suggested that chronic eczematous eruptions of the elderly could be associated with chronic drug exposure. To determine the drugs associated with these eruptions, we conducted a case–control study on 102 cases and 204 controls. Cases were consecutive patients older than 60 years presenting with an eczematous eruption that had evolved continuously or recurrently for more than 3 months without a reliable cause. Two controls were matched to each case on age, sex, in/outpatient origin, and center. Information about drug exposure was obtained from patients and their pharmacists. Drug use for more than 3 months within the year preceding the eruption was compared between cases and controls. An association was found between calcium channel blockers (CCB) and eczema, with a matched OR (odds ratio) of 2.5 (95% CI (confidence interval): 1.3–4.6). To ascertain the course of patients after CCB withdrawal, two ancillary studies were performed on 74 patients with eczematous eruptions from our department before the case–control study period, and on 101 patients registered in the French “Pharmacovigilance” database. Healing of these eruptions after CCB withdrawal occurred in 83 and 68% of these cases, respectively. The long-term use of CCB is a risk factor for chronic eczematous eruptions of the elderly