Feedback GAP : study protocol for a cluster-randomized trial of goal setting and action plans to increase the effectiveness of audit and feedback interventions in primary care

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Spherical single-roll dynamos at large magnetic Reynolds numbers

This paper concerns kinematic helical dynamos in a spherical fluid body surrounded by an insulator. In particular, we examine their behaviour in the regime of large magnetic Reynolds number \Rm, for which dynamo action is usually concentrated upon a simple resonant stream-surface. The dynamo eigensolutions are computed numerically for two representative single-roll flows using a compact spherical harmonic decomposition and fourth-order finite-differences in radius. These solutions are then compared with the growth rates and eigenfunctions of the Gilbert and Ponty (2000) large \Rm asymptotic theory. We find good agreement between the growth rates when \Rm>10^4, and between the eigenfunctions when \Rm>10^5.Comment: 36 pages, 8 figures. V2: incorrect labels in Fig3 corrected. The article appears in Physics of Fluids, 22, 066601, and may be found at http://pof.aip.org/phfle6/v22/i6/p066601_s1 . (Copyright 2010 American Institute of Physics. This article may be downloaded for personal use only. Any other use requires prior permission of the author and the American Institute of Physics

Channelling the force of audit and feedback : averting the dark side

Funding EMD is funded through a personal fellowship from the Healthcare Improvement Studies Institute, supported by the Health Foundation’s grant to the University of Cambridge. JMG holds a Canada Research Chair in Health Knowledge Transfer and Uptake. NMI holds a Canada Research Chair in Implementation of Evidence-based PracticePeer reviewedPostprin

Sleep disturbances during the menopausal transition : the role of sleep reactivity and arousal predisposition

Background Sleep disturbances are common during the menopausal transition and several factors can contribute to this increased incidence. This study examined the association between sleep reactivity, arousal predisposition, sleep disturbances, and menopause. Methods Data for this study were derived from a longitudinal, population-based study on the natural history of insomnia. A total of 873 women (40–60 years) were divided into two groups according to their menopausal status at baseline: reproductive (n = 408) and postmenopausal (n = 465). Participants were evaluated annually throughout the five-year follow-up period. Four questionnaires were used to examine sleep quality, insomnia severity, sleep reactivity, and arousal predisposition. The data were analyzed using two approaches: cross-sectional with a multivariate analysis and binary regression, and longitudinal with a linear mixed models using menopausal groups (3) x time (5) design. Results Cross-sectional analyses showed that postmenopausal women reported significantly more severe insomnia and poorer sleep quality than reproductive women. Sleep reactivity and arousal predisposition were significant predictors of sleep disturbances. Longitudinal analyses revealed increased sleep disturbances in the two years before and after the menopausal transition. Sleep reactivity and arousal predisposition did not moderate the temporal relationship between menopausal transition and sleep disturbances. Conclusion More sleep disturbances were reported during the menopausal transition, but those difficulties were not explained by sleep reactivity and arousal predisposition. These results suggest the involvement of other psychophysiological factors in the development of sleep disturbances during the menopause

The role of digital health for post-surgery care of older patients with hip fracture: A scoping review

Background: Digital health interventions can potentially improve the integration of the health care systems. Hip fracture is a serious injury for older people and integrated post-surgery care is vital for good recovery. Objective: We aimed to characterise digital health interventions used for hip fracture post-surgery care, and further to examine the extent to which of these interventions address the World Health Organisation (WHO) integrated care for older people (ICOPE) framework. Methods: A scoping review was conducted, by searching the literature from English and Chinese databases and trial registries. Keywords included hip fracture, post-surgery care and digital health interventions. Interventional, observational, qualitative studies and case reports were included. We used a combined framework, WHO ICOPE and WHO digital health intervention classifications, to support data synthesis. Results: A total of 4,542 articles were identified, of which 39 studies were included in the analysis. We identified only six randomised controlled trials. Digital health interventions were mainly used to help doctors provide clinical care and facilitate service delivery between the patients and healthcare providers. No studies focused on health workforce, financial policy or the development of infrastructure. The primary users were healthcare providers and patients, without healthcare managers or the use of data services. Most digital health interventions focused on physical therapy, bone protection and falls prevention. Limited interventions were implemented in low-and middle-income countries. Conclusion: A stronger evidence base is needed to expand the use of digital health for post-surgery care of hip fracture patients, including high-quality larger-scale studies, more focus in resource-constrained settings, expanding to more users and capabilities of interventions, and exploring the role of digital health for the integrated care model to mitigate health system challenges

Impact of CONSORT extension for cluster randomised trials on quality of reporting and study methodology : review of random sample of 300 trials, 2000-8

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Natural history of excessive daytime sleepiness : a population-based 5-year longitudinal study

Study Objective: To document the rates of persistent, remitted, and intermittent excessive daytime sleepiness (EDS) in a longitudinal 5-year community study of adults and to assess how changes in risk factors over time can predict improvement of daytime sleepiness (DS). Methods: Participants were recruited in 2007–2008 as part of a population-based epidemiological study implemented in Canada. They completed postal assessments at baseline and at each yearly follow-up. An Epworth Sleepiness Scale total score >10 indicated clinically significant EDS; a 4-point reduction between two consecutive evaluations defined DS improvement. Socio-demographic, lifestyle, health characteristics, and sleep-related measures (e.g. insomnia symptoms, sleep duration, sleep medication) were self-reported at each time point. Cox proportional-hazard models were used to predict EDS and DS remissions over 5 years. Results: Among the 2167 participants, 33% (n = 714) met criteria for EDS at baseline, of whom 33% had persistent EDS, 44% intermittent EDS, and 23% remitted EDS over the follow-up. Furthermore, 61.4% of 2167 initial participants had stable DS, 27.1% sustained DS improvement and 8.5% transient improvement over the follow-up. The main predictors of EDS remission or DS improvement were normal weight, taking less hypnotics, having hypertension, increased nighttime sleep duration, and decreased insomnia, and depressive symptoms. Conclusion: EDS waxes and wanes over time with frequent periods of remission and is influenced by behavioral characteristics and changes in psychological, metabolic, and nighttime sleep patterns. Targeting these predictors in future interventions is crucial to reduce DS in the general adult population

Characteristics of individuals with insomnia who seek treatment in a clinical setting versus those who volunteer for a randomized controlled trial

The generalizability of outcome data derived from insomnia clinical trials is based largely on the extent to which research volunteers resemble clinical patients. This study compared sociodemographic, sleep, psychological, and medical characteristics of individuals who volunteered for an insomnia treatment study (n = 120) to patients who sought treatment in a clinical setting (n = 106). The samples did not differ on most sleep and medical variables, but clinical patients had a higher prevalence of mood disorders, greater anxiety and depression symptoms, and higher perceived insomnia severity. Differences on psychological variables were accentuated by the research selection process. It is suggested to minimize exclusion based on psychological comorbidity in order to enhance ecological validity of randomized controlled trials of insomnia treatments

Insomnia and daytime cognitive performance : a meta-analysis

Objectives : Individuals with insomnia consistently report difficulties pertaining to their cognitive functioning (e.g., memory, concentration). However, objective measurements of their performance on neuropsychological tests have produced inconsistent findings. This meta-analysis was conducted to provide a quantitative summary of evidence regarding the magnitude of differences between individuals with primary insomnia and normal sleepers on a broad range of neuropsychological measures. Methods : Reference databases (PubMed, PsycInfo, Dissertation Abstracts International) were searched for studies comparing adults with primary insomnia to normal sleepers on neuropsychological measures. Dependent variables related to cognitive and psychomotor performance were extracted from each study. Variables were classified independently by two licensed neuropsychologists according to the main cognitive function being measured. Individual effect sizes (Cohen's d) were weighted by variability and combined for each cognitive function using a fixed effects model. Average effect sizes and their 95% confidence intervals were computed for each cognitive function. Results : Twenty-four studies met inclusion criteria, for a total of 639 individuals with insomnia and 558 normal sleepers. Significant impairments (p < 0.05) of small to moderate magnitude were found in individuals with insomnia for tasks assessing episodic memory (ES = −0.51), problem solving (ES = −0.42), manipulation in working memory (ES = −0.42), and retention in working memory (ES = −0.22). No significant group differences were observed for tasks assessing general cognitive function, perceptual and psychomotor processes, procedural learning, verbal functions, different dimensions of attention (alertness, complex reaction time, speed of information processing, selective attention, sustained attention/vigilance) and some aspects of executive functioning (verbal fluency, cognitive flexibility). Conclusion : Individuals with insomnia exhibit performance impairments for several cognitive functions, including working memory, episodic memory and some aspects of executive functioning. While the data suggests that these impairments are of small to moderate magnitude, further research using more ecologically valid measures and normative data are warranted to establish their clinical significance