Healthcare Provider Attitudes Towards the Problem List in an Electronic Health Record: A Mixed-Methods Qualitative Study

Background: The problem list is a key part of the electronic health record (EHR) that allows practitioners to see a patient’s diagnoses and health issues. Yet, as the content of the problem list largely represents the subjective decisions of those who edit it, patients’ problem lists are often unreliable when shared across practitioners. The lack of standards for how the problem list is compiled in the EHR limits its effectiveness in improving patient care, particularly as a resource for clinical decision support and population management tools. The purpose of this study is to discover practitioner opinions towards the problem list and the logic behind their decisions during clinical situations. Materials and methods: An observational cross-sectional study was conducted at two major Boston teaching hospitals. Practitioners’ opinions about the problem list were collected through both in-person interviews and an online questionnaire. Questions were framed using vignettes of clinical scenarios asking practitioners about their preferred actions towards the problem list. Results: These data confirmed prior research that practitioners differ in their opinions over managing the problem list, but in most responses to a questionnaire, there was a common approach among the relative majority of respondents. Further, basic demographic characteristics of providers (age, medical experience, etc.) did not appear to strongly affect attitudes towards the problem list. Conclusion: The results supported the premise that policies and EHR tools are needed to bring about a common approach. Further, the findings helped identify what issues might benefit the most from a defined policy and the level of restriction a problem list policy should place on the addition of different types of information

The short-term impact of the alcohol act on alcohol-related deaths and hospital admissions in Scotland: a natural experiment

Background and aim: The introduction of the Alcohol Act in Scotland on 1 October 2011, which included a ban on multi-buy promotions, was likely associated with a fall in off-trade alcohol sales in the year after its implementation. The aim of this study was to test if the same legislation was associated with reduced levels of alcohol-related deaths and hospital admissions in the 3-year period after its introduction. Design: A natural experiment design using time series data to assess the impact of the Alcohol Act legislation in Scotland. Comparisons were made with unexposed populations in the rest of Great Britain. Setting Scotland with comparable data obtained for geographical control groups in other parts of Great Britain. Participants: For alcohol-related deaths, a total of 17,732 in Scotland and 88,001 in England/Wales across 169 four-week periods between January 2001 and December 2013. For alcohol-related hospital admissions, a total of 121,314 in Scotland and 696,892 in England across 182 four-week periods between January 2001 and December 2014. Measurements: Deaths and hospital admissions in Scotland and control groups that were wholly attributable to alcohol for consecutive four-week periods between January 2001 and December 2014. Data were obtained by age, sex and area-based socioeconomic position. Findings: There was no evidence to suggest that the Alcohol Act was associated with changes in the overall rate of alcohol-related deaths [incidence rate ratio (IRR) 0.99, 95% confidence interval (0.91 to 1.07)] or hospital admissions [IRR 0.98 (0.95 to 1.02)] in Scotland. In control group analyses, the pseudo intervention variable was not associated with a change in alcohol-related death rates in England/Wales [IRR 0.99 (0.95 to 1.02)], but was associated with an increase in alcohol-related hospital admission rates in England [IRR 1.05 (1.03 to 1.07)]. In combined models, the interaction analysis did not provide support for a ‘net effect’ of the legislation on alcohol-related deaths in Scotland compared with England/Wales [IRR 0.99 (0.95 to 1.04)], but suggested a net reduction in hospital admissions for Scotland compared with England [IRR 0.93 (0.87 to 0.98)]. Conclusion: The implementation of the Alcohol Act in Scotland has not been associated clearly with a reduction in alcohol-related deaths or hospital admissions in the 3-year period after it was implemented in October 2011

Unhealthy Diet Is Associated With Poor Sleep in Preschool-Aged Children

Unhealthy dietary choices are associated with poor sleep in children through adults. Yet, how diet and sleep are related in early childhood, when diet is reliant on parent choices around food availability, is unknown. The authors aimed to explore how frequency of fruit, vegetable, fast food, and soda consumption are associated with preschool children’s sleep quality. They also considered how parenting factors may impact the relationship between children’s sleep and diet. Actigraphy data were collected from 383 children 33–70 months old. Caregivers reported on child food and beverage frequency, demographics, and health items. Parenting strategies were assessed using the Parenting Scale. Multiple linear regression was used to examine associations between sleep and dietary measures with socioeconomic status, race-ethnicity, physical activity, and body mass index as covariates. Shorter nap duration was associated with more frequent consumption of fruits and vegetables (B = –3.6, p = .03). Shorter nighttime and 24-hr sleep durations were associated with more frequent consumption of fast food (B = –6.5, p = .01; B = –5.8, p = .01). Shorter nighttime sleep and later sleep onset were associated with more frequent soda consumption (B = –9.2, p = .01; B = 0.23, p = .001). Use of ineffective parenting strategies was negatively associated with fruit and vegetable consumption (r = –.29, p = .01) and positively associated with soda consumption (r = .25, p = .02) but was unrelated to sleep measures. Thus, ineffective parenting strategies may underlie child access to unhealthy foods, which, in turn, contributes to poor sleep. Encouraging healthier dietary habits and educating caregivers on how to reinforce such practices may lead to better sleep outcomes in early childhood

Predicting intervention priorities for wildlife conflicts

There is growing interest in developing effective interventions to manage socially‐ and environmentally‐damaging conservation conflicts. Recent studies have identified a wide variety of different intervention strategies in various contexts but the reasons why one type of intervention is chosen over another remain underexplored. In this international study we surveyed conservation researchers and practitioners (N = 427) to explore how the characteristics of conflicts and characteristics of decision‐makers influence conflict recommendations. Using a fully‐factorial design, we experimentally manipulated three aspects of eight different conflict scenarios – the development status of the country, the conflict framing, and whether wildlife killing was illegal – and recorded whether respondents prioritised one of five intervention types: wildlife impact reduction, awareness, enforcement, economic incentives or stakeholder engagement. We also recorded information on respondents’ demographic and disciplinary backgrounds. Stakeholder‐based interventions were recommended most often in the survey and in written feedback. However, fitting multinomial mixed logit models with no missing scenarios (N = 411), we find that recommendations are influenced by small changes in the details of conflict, and differ according to respondent characteristics. Enforcement and awareness interventions are prioritised more in conflicts in more highly developed nations and by respondents with more natural‐science backgrounds and less experience of conflicts. Contrastingly, economic interventions are prioritised more when wildlife killing is described as illegal. Respondent age, gender and the development status of their home country also predicted some intervention decisions. Further interrogating the influences shaping conservation decision‐making will help towards developing evidence‐informed interventions

Testing for Near and Far Transfer Effects with a Short, Face-to-Face Adaptive Working Memory Training Intervention in Typical Children

A relatively quick, face-to-face, adaptive working memory training intervention was assessed in 5- to 8-year-old typically developing children, randomly allocated to a six-week intervention condition, or an active control condition. All children received 18 sessions of 10 minutes, three times/week for six weeks. Assessments of six working memory skills, word reading and mathematics were administered at pre-test, post-test, and six month follow-up. Additional measures of word reading, mathematics, spelling and reading comprehension were given at a 12 month follow-up. At post-test, the trained group showed significantly larger gains than the control group on the two trained executive-loaded working memory tasks (Listening Recall, Odd One Out Span) and on two untrained working memory tasks (Word Recall, Counting Recall). These "near transfer" effects were still apparent at six month follow-up. "Far transfer" effects were less evident: there was no difference between the groups in their gains on single word reading and mathematics over 12 months, and spelling skills did not differ at 12 month follow-up. However, the trained group showed significantly higher reading comprehension scores than the control group at 12 month follow-up. Thus, improving the ability to divide attention between processing and storage may have had specific benefits for reading comprehension

Multiple reassortment events in the evolutionary history of H1N1 influenza A virus since 1918

The H1N1 subtype of influenza A virus has caused substantial morbidity and mortality in humans, first documented in the global pandemic of 1918 and continuing to the present day. Despite this disease burden, the evolutionary history of the A/H1N1 virus is not well understood, particularly whether there is a virological basis for several notable epidemics of unusual severity in the 1940s and 1950s. Using a data set of 71 representative complete genome sequences sampled between 1918 and 2006, we show that segmental reassortment has played an important role in the genomic evolution of A/H1N1 since 1918. Specifically, we demonstrate that an A/H1N1 isolate from the 1947 epidemic acquired novel PB2 and HA genes through intra-subtype reassortment, which may explain the abrupt antigenic evolution of this virus. Similarly, the 1951 influenza epidemic may also have been associated with reassortant A/H1N1 viruses. Intra-subtype reassortment therefore appears to be a more important process in the evolution and epidemiology of H1N1 influenza A virus than previously realized

YETI observations of the young transiting planet candidate CVSO 30 b

CVSO 30 is a unique young low-mass system, because, for the first time, a close-in transiting and a wide directly imaged planet candidates are found around a common host star. The inner companion, CVSO 30 b, is the first possible young transiting planet orbiting a previously known weak-lined T-Tauri star. With five telescopes of the 'Young Exoplanet Transit Initiative' (YETI) located in Asia, Europe and South America we monitored CVSO 30 over three years in a total of 144 nights and detected 33 fading events. In two more seasons we carried out follow-up observations with three telescopes. We can confirm that there is a change in the shape of the fading event between different observations and that the fading event even disappears and reappears. A total of 38 fading event light curves were simultaneously modelled. We derived the planetary, stellar, and geometrical properties of the system and found them slightly smaller but in agreement with the values from the discovery paper. The period of the fading event was found to be 1.36 s shorter and 100 times more precise than the previous published value. If CVSO 30 b would be a giant planet on a precessing orbit, which we cannot confirm, yet, the precession period may be shorter than previously thought. But if confirmed as a planet it would be the youngest transiting planet ever detected and will provide important constraints on planet formation and migration time-scales.Comment: 14 pages (20 with appendix), 7 figures (16 with appendix), 6 tables (7 with appendix

July 1964

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