The effectiveness of computerized clinical guidelines in the process of care: a systematic review

<p>Abstract</p> <p>Background</p> <p>Clinical practice guidelines have been developed aiming to improve the quality of care. The implementation of the computerized clinical guidelines (CCG) has been supported by the development of computerized clinical decision support systems.</p> <p>This systematic review assesses the impact of CCG on the process of care compared with non-computerized clinical guidelines.</p> <p>Methods</p> <p>Specific features of CCG were studied through an extensive search of scientific literature, querying electronic databases: Pubmed/Medline, Embase and Cochrane Controlled Trials Register. A multivariable logistic regression was carried out to evaluate the association of CCG's features with positive effect on the process of care.</p> <p>Results</p> <p>Forty-five articles were selected. The logistic model showed that Automatic provision of recommendation in electronic version as part of clinician workflow (Odds Ratio [OR]= 17.5; 95% confidence interval [CI]: 1.6-193.7) and Publication Year (OR = 6.7; 95%CI: 1.3-34.3) were statistically significant predictors.</p> <p>Conclusions</p> <p>From the research that has been carried out, we can conclude that after implementation of CCG significant improvements in process of care are shown. Our findings also suggest clinicians, managers and other health care decision makers which features of CCG might improve the structure of computerized system.</p

Whiting–related sediment export along the Middle Miocene carbonate ramp of Great Bahama Bank.

International audienc

Two colonisation stages generate two different patterns of genetic diversity within native and invasive ranges of Ulex europaeus

Genetic diversity and the way a species is introduced influence the capacity of populations of invasive species to persist in, and adapt to, their new environment. The diversity of introduced populations affects their evolutionary potential, which is particularly important for species that have invaded a wide range of habitats and climates, such as European gorse, Ulex europaeus. This species originated in the Iberian peninsula and colonised Europe in the Neolithic; over the course of the past two centuries it was introduced to, and has become invasive in, other continents. We characterised neutral genetic diversity and its structure in the native range and in invaded regions. By coupling these results with historical data, we have identified the way in which gorse populations were introduced and the consequences of introduction history on genetic diversity. Our study is based on the genotyping of individuals from 18 populations at six microsatellite loci. As U. europaeus is an allohexaploid species, we used recently developed tools that take into account genotypic ambiguity. Our results show that genetic diversity in gorse is very high and mainly contained within populations. We confirm that colonisation occurred in two stages. During the first stage, gorse spread out naturally from Spain towards northern Europe, losing some genetic diversity. During the second stage, gorse was introduced by humans into different regions of the world, from northern Europe. These introductions resulted in the loss of rare alleles but did not significantly reduce genetic diversity and thus the evolutionary potential of this invasive species

Population dynamics during the Neolithic transition and the onset of megalithism in Portugal according to summed probability distribution of radiocarbon determinations

As field data accumulates, the study of Neolithic Portugal has been receiving increasing attention recently, from material culture and subsistence to ideology. However, little is known about population dynamics. In this paper, we use a judicious selection of radiocarbon determinations to evaluate demographic phenomena within the 9.500-5.000 cal BP range (thus, starting in the Late Mesolithic) making use of "summed probability distribution" analysis. In greater Portugal, results show a negative deviation (i.e. demographic decrease) at 6.400-6.300 cal BP and a positive deviation (i.e. demographic increase) at 5.350-4.950 cal BP. These can be explained, respectively, by the impact of farming about one millennium after its introduction (confirming the "Neolithic demographic transition" model) and by the full establishment of the "secondary products revolution" in the Late Neolithic. However, individual analyses of the northern and southern halves of the country-i.e. using the Mondego river valley as an ecological-geographical divide-show rather contrasting trajectories, with scarce Mesolithic populations and a demographic increase in the megalithism in the North, whereas in the South a demographic crisis occurred at the onset of megalithism (which remains to be fully explained) being followed in the Late Neolithic by a sharp demographic increase. Further summed probability distribution analyses of radiocarbon determinations, particularly if combined with other populational proxies, will be able in the future to detect other demographic events taking place in space and time.Juan de la Cierva postdoctoral grant [FJCI-2016-30588]Catalonian government [PGC2018-096943-B-C21]Spanish governmentSpanish GovernmentEuropean Commission [2017-SGR-1302]APOSTD Postdoctoral grant by the Valencian government [APOST/2019/179]info:eu-repo/semantics/publishedVersio