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

Особенности развития гаптофитовых и динофитовых водорослей в олигоценовых бассейнах Северного Перитетиса

На основании изучения наннопланктона и диноцист проведены палеоэкологические реконструкции разных типов олигоценовых бассейнов Северного Перитетиса. Установлены ассоциации фитопланктона морских глубоководных, мелководных, относительно холодно- и тепловодных, а также лагунных палеобассейнов. Гаптофитовые (наннопланктон) присутствуют только в карбонатных прослоях пород, наиболее благоприятные условия для их развития были в Карпатском бассейне кросненского типа, в бассейнах самого раннего рюпеля Германии и юга Украины. Диноцисты представлены во всех типах олигоценовых бассейнов. Установлены корреляционные уровни по нанно- и динопланктону, позволяющие обосновать нижнюю и верхнюю границы олигоцена и уровень опреснения в середине рюпеля.Вивчення нанопланктону та диноцист з різних типів олігоценових басейнів Північного Перитетіса дозволило провести палеоекологічні реконструкції. Встановлені асоціації фітопланктону морських глибоководних, прибережно-мілководних відносно холодно- и тепловодних, лагунних, напівізольованих з ендеміками. Нанопланктон виявлено лише в карбонатних прошарках, найбільш сприятливі умови для його розвитку були у Карпатському басейні кросненського типу, у самому ранньому рюпелі Німеччини та півдня України. Диноцисти виявлені у всіх типах олігоценових басейнів. Встановлені корелятивні рівні за нано- та динопланктоном, які дозволяють обґрунтувати нижню і верхню границі олігоцену та рівень розпріснення в середині рюпелю.A study of nannofossils and dinocysts from different types of Oligocene basins of the Northern Peri-Thetys resulted in paleoecological reconstructions. The following phytoplankton associations were recognized: cold-water; littoral shallow-water relatively cold- and warm-water; lagoon; semi-isolated with endemics. Nannofossils were present in carbonaceous sediments, with more favorable conditions for them being in the Carpathian basin of Krosnensky type, in the earliest Rupelian of Germany and Southern Ukraine. Dinocysts were identified in all types of Oligocene basins. Correlation levels identified by nannofossils and dinocysts allowed us to substantiate the lower and upper Oligocene boundaries and degree of desalination in the Middle Rupelian

Low agreement for assessing the risk of postoperative deep venous thrombosis when deciding prophylaxis strategies: a study using clinical vignettes

BACKGROUND: Several clinical practice guidelines (CPG) on antithrombotic prophylaxis in surgical patients help to decide about the prophylaxis strategy based on the patient risk of deep venous thrombosis (DVT). However, the physician risk estimates of DVT could have little inter-observer reproducibility, which could lead to different individual prophylaxis practices. METHODS: Physicians were asked to evaluate DVT risk in eight clinical vignettes, describing actual patients cared for in our hospital. The vignettes included all possible levels of DVT risk. RESULTS: The degree of prophylaxis strategies accuracy was 63% (95% CI 523–75%). Overall agreement was 0.32 (z = 7.61, p < 0.001) and for each level of risk kappa was 0.38 (z = 6.50, p < 0.001); 0.1 (z = 1.65, p < 0.049) and 0.5 (z = 8.45, p < 0.001) for small, moderate and high risk group respectively CONCLUSIONS: Our results showed that there is poor agreement when physicians have to evaluate the risk for postoperative DVT, and in the cases of low and moderate risks of DVT there is the smallest agreement. In addition, the data also showed that the overall accuracy of DVT prophylaxis strategy was only moderate and the risk evaluation did not correlate to the selection of the strategy. The issue of inter-observers variability should be taken into account when CPG performance are analysed, especially when considering the risk-evaluation to choose the appropriate actions

Virtual signatures of dark sectors in Higgs couplings

Where collider searches for resonant invisible particles loose steam, dark sectors might leave their trace as virtual effects in precision observables. Here we explore this option in the framework of Higgs portal models, where a sector of dark fermions interacts with the standard model through a strong renormalizable coupling to the Higgs boson. We show that precise measurements of Higgs-gauge and triple Higgs interactions can probe dark fermions up to the TeV scale through virtual corrections. Observation prospects at the LHC and future lepton colliders are discussed for the so-called singlet-doublet model of Majorana fermions, a generalization of the bino-higgsino scenario in supersymmetry. We advocate a two-fold search strategy for dark sectors through direct and indirect observables.Comment: 20 pages, 7 figures, 1 tabl

Contribution of Case Reports to Brain Metastases Research: Systematic Review and Analysis of Pattern of Citation

Research activity related to different aspects of prevention, prediction, diagnosis and treatment of brain metastases has increased during recent years. One of the major databases (Scopus) contains 942 scientific articles that were published during the 5-year time period 2006–2010. Of these, 195 (21%) reported on single patient cases and 12 (1%) were reports of 2 cases. Little is known about their influence on advancement of the field or scientific merits. Do brain metastases case reports attract attention and provide stimuli for further research or do they go largely unrecognized? Different measures of impact, visibility and quality of published research are available, each with its own pros and cons. For the present evaluation, article citation rate was chosen. The median number of citations overall and stratified by year of publication was 0, except for the year 2006 when it was 2. As compared to other articles, case reports remained more often without citation (p<0.05 except for 2006 data). All case reports with 10 or more citations (n = 6) reported on newly introduced anticancer drugs, which commonly are prescribed to treat extracranial metastases, and the responses observed in single patients with brain metastases. Average annual numbers of citations were also calculated. The articles with most citations per year were the same six case reports mentioned above (the only ones that obtained more than 2.0 citations per year). Citations appeared to gradually increase during the first two years after publication but remained on a generally low or modest level. It cannot be excluded that case reports without citation provide interesting information to some clinicians or researchers. Apparently, case reports describing unexpected therapeutic success gain more attention, at least in terms of citation, than others

Long-Lasting Metabolic Imbalance Related to Obesity Alters Olfactory Tissue Homeostasis and Impairs Olfactory-Driven Behaviors.

Obesity is associated with chronic food intake disorders and binge eating. Food intake relies on the interaction between homeostatic regulation and hedonic signals among which, olfaction is a major sensory determinant. However, its potential modulation at the peripheral level by a chronic energy imbalance associated to obese status remains a matter of debate. We further investigated the olfactory function in a rodent model relevant to the situation encountered in obese humans, where genetic susceptibility is juxtaposed on chronic eating disorders. Using several olfactory-driven tests, we compared the behaviors of obesity-prone Sprague-Dawley rats (OP) fed with a high-fat/high-sugar diet with those of obese-resistant ones fed with normal chow. In OP rats, we reported 1) decreased odor threshold, but 2) poor olfactory performances, associated with learning/memory deficits, 3) decreased influence of fasting, and 4) impaired insulin control on food seeking behavior. Associated with these behavioral modifications, we found a modulation of metabolism-related factors implicated in 1) electrical olfactory signal regulation (insulin receptor), 2) cellular dynamics (glucorticoids receptors, pro- and antiapoptotic factors), and 3) homeostasis of the olfactory mucosa and bulb (monocarboxylate and glucose transporters). Such impairments might participate to the perturbed daily food intake pattern that we observed in obese animals

Truncation, validity, uncertainties

The truncation of the standard-model effective field theory, its validity andthe associated uncertainties have been discussed in meetings of the LHC EFT WG.Proposals were made by participants to address these issues. No consensus wasreached and no formal recommendation is therefore put forward at this time.None of the proposals has been approved or validated and further work is neededto establish a prescription. This note aims at summarizing the proposals andpoints of debate.<br

Truncation, validity, uncertainties

The truncation of the standard-model effective field theory, its validity andthe associated uncertainties have been discussed in meetings of the LHC EFT WG.Proposals were made by participants to address these issues. No consensus wasreached and no formal recommendation is therefore put forward at this time.None of the proposals has been approved or validated and further work is neededto establish a prescription. This note aims at summarizing the proposals andpoints of debate.<br