978 research outputs found

    Rationale, design, and implementation protocol of an electronic health record integrated clinical prediction rule (iCPR) randomized trial in primary care

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    <p>Abstract</p> <p>Background</p> <p>Clinical prediction rules (CPRs) represent well-validated but underutilized evidence-based medicine tools at the point-of-care. To date, an inability to integrate these rules into an electronic health record (EHR) has been a major limitation and we are not aware of a study demonstrating the use of CPR's in an ambulatory EHR setting. The integrated clinical prediction rule (iCPR) trial integrates two CPR's in an EHR and assesses both the usability and the effect on evidence-based practice in the primary care setting.</p> <p>Methods</p> <p>A multi-disciplinary design team was assembled to develop a prototype iCPR for validated streptococcal pharyngitis and bacterial pneumonia CPRs. The iCPR tool was built as an active Clinical Decision Support (CDS) tool that can be triggered by user action during typical workflow. Using the EHR CDS toolkit, the iCPR risk score calculator was linked to tailored ordered sets, documentation, and patient instructions. The team subsequently conducted two levels of 'real world' usability testing with eight providers per group. Usability data were used to refine and create a production tool. Participating primary care providers (n = 149) were randomized and intervention providers were trained in the use of the new iCPR tool. Rates of iCPR tool triggering in the intervention and control (simulated) groups are monitored and subsequent use of the various components of the iCPR tool among intervention encounters is also tracked. The primary outcome is the difference in antibiotic prescribing rates (strep and pneumonia iCPR's encounters) and chest x-rays (pneumonia iCPR only) between intervention and control providers.</p> <p>Discussion</p> <p>Using iterative usability testing and development paired with provider training, the iCPR CDS tool leverages user-centered design principles to overcome pervasive underutilization of EBM and support evidence-based practice at the point-of-care. The ongoing trial will determine if this collaborative process will lead to higher rates of utilization and EBM guided use of antibiotics and chest x-ray's in primary care.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov Identifier <a href="http://www.clinicaltrials.gov/ct2/show/NCT01386047">NCT01386047</a></p

    Search for Pair-Produced Resonances Decaying to Quark Pairs in Proton-Proton Collisions at √s = 13  TeV

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    A general search for the pair production of resonances, each decaying to two quarks, is reported. The search is conducted separately for heavier resonances (masses above 400 GeV), where each of the four final-state quarks generates a hadronic jet resulting in a four-jet signature, and for lighter resonances (masses between 80 and 400 GeV), where the pair of quarks from each resonance is collimated and reconstructed as a single jet resulting in a two-jet signature. In addition, a b-tagged selection is applied to target resonances with a bottom quark in the final state. The analysis uses data collected with the CMS detector at the CERN LHC, corresponding to an integrated luminosity of 35.9  fb⁻¹, from proton-proton collisions at a center-of-mass energy of 13 TeV. The mass spectra are analyzed for the presence of new resonances, and are found to be consistent with standard model expectations. The results are interpreted in the framework of R-parity-violating supersymmetry assuming the pair production of scalar top quarks decaying via the hadronic coupling λ′′312 or λ′′323 and upper limits on the cross section as a function of the top squark mass are set. These results probe a wider range of masses than previously explored at the LHC, and extend the top squark mass limits in the ˜t→qq′ scenario

    Search for electroweak production of charginos and neutralinos in multilepton final states in proton-proton collisions at √s = 13 TeV

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    Results are presented from a search for the direct electroweak production of charginos and neutralinos in signatures with either two or more leptons (electrons or muons) of the same electric charge, or with three or more leptons, which can include up to two hadronically decaying tau leptons. The results are based on a sample of proton-proton collision data collected at s√=13 TeV, recorded with the CMS detector at the LHC, corresponding to an integrated luminosity of 35.9 fb⁻¹. The observed event yields are consistent with the expectations based on the standard model. The results are interpreted in simplified models of supersymmetry describing various scenarios for the production and decay of charginos and neutralinos. Depending on the model parameters chosen, mass values between 180 GeV and 1150 GeV are excluded at 95% CL. These results significantly extend the parameter space probed for these particles in searches at the LHC. In addition, results are presented in a form suitable for alternative theoretical interpretations

    Search for Standard Model Production of Four Top Quarks with Same-Sign and Multilepton Final States in Proton–proton Collisions at √s = 13 TeV

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    A search for standard model production of four top quarks (tt¯tt¯) is reported using events containing at least three leptons (e,μ) or a same-sign lepton pair. The events are produced in proton–proton collisions at a center-of-mass energy of 13TeV at the LHC, and the data sample, recorded in 2016, corresponds to an integrated luminosity of 35.9fb[superscript −1]. Jet multiplicity and flavor are used to enhance signal sensitivity, and dedicated control regions are used to constrain the dominant backgrounds. The observed and expected signal significances are, respectively, 1.6 and 1.0 standard deviations, and the tt¯tt¯ cross section is measured to be 16.9[superscript +13.8][subscript −11.4] fb, in agreement with next-to-leading-order standard model predictions. These results are also used to constrain the Yukawa coupling between the top quark and the Higgs boson to be less than 2.1 times its expected standard model value at 95% confidence level

    Search for Low Mass Vector Resonances Decaying to Quark-Antiquark Pairs in Proton-Proton Collisions at √s = 13 TeV

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    A search is reported for a narrow vector resonance decaying to quark-antiquark pairs in proton-proton collisions at √s = 13 TeV, collected with the CMS detector at the LHC. The data sample corresponds to an integrated luminosity of 2.7 fb⁻¹. The vector resonance is produced at large transverse momenta, with its decay products merged into a single jet. The resulting signature is a peak over background in the distribution of the invariant mass of the jet. The results are interpreted in the framework of a leptophobic vector resonance and no evidence is found for such particles in the mass range of 100-300 GeV. Upper limits at 95% confidence level on the production cross section are presented in a region of mass-coupling phase space previously unexplored at the LHC. The region below 140 GeV has not been explored by any previous experiments

    Search for supersymmetry in events with at least one photon, missing transverse momentum, and large transverse event activity in proton-proton collisions at √s = 13 TeV

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    A search for physics beyond the standard model in final states with at least one photon, large transverse momentum imbalance, and large total transverse event activity is presented. Such topologies can be produced in gauge-mediated supersymmetry models in which pair-produced gluinos or squarks decay to photons and gravitinos via short-lived neutralinos. The data sample corresponds to an integrated luminosity of 35.9 fb[superscript −1] of proton-proton collisions at s√=13 TeV recorded by the CMS experiment at the LHC in 2016. No significant excess of events above the expected standard model background is observed. The data are interpreted in simplified models of gluino and squark pair production, in which gluinos or squarks decay via neutralinos to photons. Gluino masses of up to 1.50-2.00 TeV and squark masses up to 1.30-1.65 TeV are excluded at 95% confidence level, depending on the neutralino mass and branching fraction. Keywords: Hadron-Hadron scattering (experiments); Supersymmetry; Photon productio

    Search for a new scalar resonance decaying to a pair of Z bosons in proton-proton collisions at √s=13 TeV

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    A search for a new scalar resonance decaying to a pair of Z bosons is performed in the mass range from 130 GeV to 3 TeV, and for various width scenarios. The analysis is based on proton-proton collisions recorded by the CMS experiment at the LHC in 2016, corresponding to an integrated luminosity of 35.9 fb⁻¹ at a center-of-mass energy of 13 TeV. The Z boson pair decays are reconstructed using the 4ℓ, 2ℓ2q, and 2ℓ2ν final states, where ℓ = e or μ. Both gluon fusion and electroweak production of the scalar resonance are considered, with a free parameter describing their relative cross sections. A dedicated categorization of events, based on the kinematic properties of associated jets, and matrix element techniques are employed for an optimal signal and background separation. A description of the interference between signal and background amplitudes for a resonance of an arbitrary width is included. No significant excess of events with respect to the standard model expectation is observed and limits are set on the product of the cross section for a new scalar boson and the branching fraction for its decay to ZZ for a large range of masses and widths. Keywords: Hadron-Hadron scattering (experiments); Higgs physic
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