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

Etude d’une pyodermite particulièrement rebelle chez le chien isolement d’Actinobacillus equuli associé à un staphylocoque

Vallée A., Durieux Jean, Durieux M., Virat Bernard. Etude d'une pyodermite particulièrement rebelle chez le chien isolement d'Actinobacillus equuli associé à un staphylocoque . In: Bulletin de l'Académie Vétérinaire de France tome 113 n°3, 1960. pp. 153-156

As above, so below: whole transcriptome profiling demonstrates strong molecular similarities between avian dorsal and ventral pallial subdivisions

Over the last two decades, beginning withthe Avian Brain Nomenclature Forum in2000, major revisions have been made to our understanding of the organization andnomenclature of the avian brain. However, there are still unresolved questions on avianpallial organization, particularly whether the cells above the vestigial ventricle representdistinct populations to those below it or similar populations. To test these two hypothe-ses, we profiled the transcriptomes of the major avian pallial subdivisions dorsal and ven-tral to the vestigial ventricle boundary using RNA sequencing and a new zebra finchgenome assembly containing about 22,000annotated, complete genes. We found thatthe transcriptomes of neural populations above and below the ventricle were remarkablysimilar. Each subdivision in dorsal pallium (Wulst) had a corresponding molecular counter-part in the ventral pallium (dorsal ventricularridge). In turn, each corresponding subdivi-sion exhibited shared gene co-expression modules that contained gene sets enriched infunctional specializations, such as anatomical structure development, synaptic transmis-sion, signaling, and neurogenesis. Thesefindings are more in line with the continuumhypothesis of avian brain subdivision organization above and below the vestigial ventriclespace, with the pallium as a whole consisting offour major cell populations (intercalatedpallium, mesopallium, hyper-nidopallium, andarcopallium) instead of seven (hyperpalliumapicale, interstitial hyperpallium apicale, intercalated hyperpallium, hyperpalliumdensocellare, mesopallium, nidopallium, and arcopallium). We suggest adopting a morestreamlined hierarchical naming system thatreflects the robust similarities in geneexpression, neural connectivity motifs, and function. These findings have important impli-cations for our understanding of overall vertebrate brain evolution

Seasonal patterns of oral antihistamine and intranasal corticosteroid purchases from Australian community pharmacies : a retrospective observational study

Acknowledgments The abstract of this paper was presented at the Respiratory Effectiveness Group 2016 Annual Summit as a poster presentation with interim findings. The poster’s abstract was published in “Poster Abstracts” in The Journal of Thoracic Disease (Vol. 8, Supplement 5, 5 July 2016). http://jtd.amegroups.com/article/view/8504.Peer reviewedPublisher PD

Clusterwise Independent Component Analysis (C-ICA):An R package for clustering subjects based on ICA patterns underlying three-way (brain) data

In many areas of science, like neuroscience, genomics and text mining, several important and challenging research questions imply the study of (subject) heterogeneity present in three-way data. In clinical neuroscience, for example, disclosing differences or heterogeneity between subjects in resting state networks (RSNs) underlying multi-subject fMRI data (i.e., time by voxel by subject three-way data) may advance the subtyping of psychiatric and mental diseases. Recently, the Clusterwise Independent Component Analysis (C-ICA) method was proposed that enables the disclosure of heterogeneity between subjects in RSNs that is present in multi-subject rs-fMRI data [1]. Up to now, however, no publicly available software exists that allows to fit C-ICA to empirical data at hand. The goal of this paper, therefore, is to present the CICA R package, which contains the necessary functions to estimate the C-ICA parameters and to interpret and visualize the analysis output. Further, the package also includes functions to select suitable initial values for the C-ICA model parameters and to determine the optimal number of clusters and components for a given empirical data set (i.e., model selection). The use of the main functions of the package is discussed and demonstrated with simulated data. Herewith, the necessary analytical choices that have to be made by the user (e.g., starting values) are explained and showed step by step. The rich functionality of the package is further illustrated by applying C-ICA to empirical rs-fMRI data from a group of Alzheimer patients and elderly control subjects and to multi-country stock market data. Finally, extensions regarding the C-ICA algorithm and procedures for model selection that could be implemented in future releases of the package are discussed

Real-life treatment of rhinitis in Australia : a historical cohort study of prescription and over-the-counter therapies for patients with and without additional respiratory disease

Peer reviewedPublisher PD

Medication-related costs of rhinitis in Australia : a NostraData cross-sectional study of pharmacy purchases

Peer reviewedPublisher PD

Altered splicing of the BIN1 muscle-specific exon in humans and dogs with highly progressive centronuclear myopathy

Amphiphysin 2, encoded by BIN1, is a key factor for membrane sensing and remodelling in different cell types. Homozygous BIN1 mutations in ubiquitously expressed exons are associated with autosomal recessive centronuclear myopathy (CNM), a mildly progressive muscle disorder typically showing abnormal nuclear centralization on biopsies. In addition, misregulation of BIN1 splicing partially accounts for the muscle defects in myotonic dystrophy (DM). However, the muscle-specific function of amphiphysin 2 and its pathogenicity in both muscle disorders are not well understood. In this study we identified and characterized the first mutation affecting the splicing of the muscle-specific BIN1 exon 11 in a consanguineous family with rapidly progressive and ultimately fatal centronuclear myopathy. In parallel, we discovered a mutation in the same BIN1 exon 11 acceptor splice site as the genetic cause of the canine Inherited Myopathy of Great Danes (IMGD). Analysis of RNA from patient muscle demonstrated complete skipping of exon 11 and BIN1 constructs without exon 11 were unable to promote membrane tubulation in differentiated myotubes. Comparative immunofluorescence and ultrastructural analyses of patient and canine biopsies revealed common structural defects, emphasizing the importance of amphiphysin 2 in membrane remodelling and maintenance of the skeletal muscle triad. Our data demonstrate that the alteration of the muscle-specific function of amphiphysin 2 is a common pathomechanism for centronuclear myopathy, myotonic dystrophy, and IMGD. The IMGD dog is the first faithful model for human BIN1-related CNM and represents a mammalian model available for preclinical trials of potential therapies