70,995 research outputs found
Effectiveness of the application of an electronic medication management support system in patients with polypharmacy in general practice: a study protocol of cluster-randomised controlled trial (AdAM)
No full textMüller BS, Klaaßen-Mielke R, Gonzalez-Gonzalez AI, et al. Effectiveness of the application of an electronic medication management support system in patients with polypharmacy in general practice: a study protocol of cluster-randomised controlled trial (AdAM). BMJ open. 2021;11(9): e048191.INTRODUCTION: Clinically complex patients often require multiple medications. Polypharmacy is associated with inappropriate prescriptions, which may lead to negative outcomes. Few effective tools are available to help physicians optimise patient medication. This study assesses whether an electronic medication management support system (eMMa) reduces hospitalisation and mortality and improves prescription quality/safety in patients with polypharmacy.; METHODS AND ANALYSIS: Planned design: pragmatic, parallel cluster-randomised controlled trial; general practices as randomisation unit; patients as analysis unit. As practice recruitment was poor, we included additional data to our primary endpoint analysis for practices and quarters from October 2017 to March 2021. Since randomisation was performed in waves, final study design corresponds to a stepped-wedge design with open cohort and step-length of one quarter.; SCOPE: general practices, Westphalia-Lippe (Germany), caring for BARMER health fund-covered patients.; POPULATION: patients (≥18 years) with polypharmacy (≥5 prescriptions).; SAMPLE SIZE: initially, 32 patients from each of 539 practices were required for each study arm (17200 patients/arm), but only 688 practices were randomised after 2years of recruitment. Design change ensures that 80% power is nonetheless achieved.; INTERVENTION: complex intervention eMMa.; FOLLOW-UP: at least five quarters/cluster (practice). recruitment: practices recruited/randomised at different times; after follow-up, control group practices may access eMMa.; OUTCOMES: primary endpoint is all-cause mortality and hospitalisation; secondary endpoints are number of potentially inappropriate medications, cause-specific hospitalisation preceded by high-risk prescribing and medication underuse.; STATISTICAL ANALYSIS: primary and secondary outcomes are measured quarterly at patient level. A generalised linear mixed-effect model and repeated patient measurements are used to consider patient clusters within practices. Time and intervention group are considered fixed factors; variation between practices and patients is fitted as random effects. Intention-to-treat principle is used to analyse primary and key secondary endpoints.; ETHICS AND DISSEMINATION: Trial approved by Ethics Commission of North-Rhine Medical Association. Results will be disseminated through workshops, peer-reviewed publications, local and international conferences.; TRIAL REGISTRATION: NCT03430336. ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT03430336). © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ
The UN-SUSTAINABLE Match in HCV Recipients. Evidences from the Italian D-MELD Study on Balancing Donor-Recipient Risk Factors
No full textThe UN-SUSTAINABLE Match in HCV Recipients. Evidences from the Italian D-MELD Study on Balancing Donor-Recipient Risk Factor
Use of an Electronic Medication Management Support System in Patients with Polypharmacy in General Practice: A Quantitative Process Evaluation of the AdAM Trial
No full textBrünn R, Lemke D, Basten J, et al. Use of an Electronic Medication Management Support System in Patients with Polypharmacy in General Practice: A Quantitative Process Evaluation of the AdAM Trial. Pharmaceuticals. 2022;15(6): 759.Polypharmacy is associated with a risk of negative health outcomes. Potentially inappropriate medications, interactions resulting from contradicting medical guidelines, and inappropriate monitoring, all increase the risk. This process evaluation (PE) of the AdAM study investigates implementation and use of a computerized decision-support system (CDSS). The CDSS analyzes medication appropriateness by including claims data, and hence provides general practitioners (GPs) with full access to patients’ medical treatments. We based our PE on pseudonymized logbook entries into the CDSS and used the four dimensions of the Medical Research Council PE framework. Reach, which examines the extent to which the intended study population was included, and Dose, Fidelity, and Tailoring, which examine how the software was actually used by GPs. The PE was explorative and descriptive. Study participants were representative of the target population, except for patients receiving a high level of nursing care, as they were treated less frequently. GPs identified and corrected inappropriate prescriptions flagged by the CDSS. The frequency and intensity of interventions documented in the form of logbook entries lagged behind expectations, raising questions about implementation barriers to the intervention and the limitations of the PE. Impossibility to connect the CDSS to GPs’ electronic medical records (EMR) of GPs due to technical conditions in the German healthcare system may have hindered the implementation of the intervention. Data logged in the CDSS may underestimate medication changes in patients, as documentation was voluntary and already included in EMR
Use of an electronic medication management support system in patients with polypharmacy in general practice: study protocol of a quantitative process evaluation of the AdAM trial
No full textBruenn R, Lemke D, Chapidi K, et al. Use of an electronic medication management support system in patients with polypharmacy in general practice: study protocol of a quantitative process evaluation of the AdAM trial. Therapeutic Advances in Drug Safety . 2022;13: 20420986211073215.Background: Interventional studies on polypharmacy often fail to significantly improve patient-relevant outcomes, or confine themselves to measuring surrogate parameters. Interventions and settings are complex, with many factors affecting results. The AdAM study's aim is to reduce hospitalization and death by requiring general practitioners (GPs) to use a computerized decision-support system (CDSS). The study will undergo a process evaluation to identify factors for successful implementation and to assess whether the intervention was implemented as intended. Objective: To evaluate our complex intervention, based on the Medical Research Council's guideline dimensions. Research Questions: We will assess implementation (reach, fidelity, dose, tailoring) by asking: (1) Who took part in the intervention (proportion of GPs using the CDSS, proportion of patients enrolled in them)? Information on GPs' and patients' characteristics will also be collected. (2) How many and which medication alerts were dealt with? (3) Was the intervention implemented as intended? (4) On what days did GPs use the intervention tool? Methods: The process evaluation is part of a stepped-wedge cluster-randomized controlled trial. Characteristics of practices, GPs and patients using the CDSS will be compared with the non-participating population. CDSS log data will be analyzed to evaluate how the number of medication alerts changed between baseline and 2 months later, and to identify the kind of alerts that were dealt with. Comparison of enrolled patients on weekdays versus weekends will shed light on GPs' use of the CDSS in the absence or presence of patients. Outcomes will be presented using descriptive statistics, and significance tests will be used to identify associations between them. We will conduct subgroup analyses, including time effects to account for software improvements. Discussion: This study protocol is the basis for conducting analyses of the quantitative process evaluation. By providing insight into how GPs conduct medication reviews, the evaluation will provide context to the trial results and support their interpretation. The evaluation relies on the proper documentation by GPs, potentially limiting its explanatory power
A new social-cognitive developmental perspective on prejudice: The interplay between morality and group identity.
No full textWe argue that prejudice should be investigated in the context of social-cognitive development and the interplay between morality and group identity. Our new perspective examines how children consider group identity (and group norms) along with their developing moral beliefs about fairness and justice. This is achieved by developing an integrated framework drawing on developmental and social psychological theories of prejudice. This synthesis results in a perspective which provides a more contextualized analysis of prejudice development than previously offered by developmental theories. We describe research which supports our view that social norms, intergroup contact and perceived out-group threat affect the relative weight children place on moral and group-based criteria during the development of prejudice
When Do Children Dislike Ingroup Members? Resource Allocation from Individual and Group Perspectives
No full textDo children like ingroup members who challenge group norms about resource allocation? Further, do children evaluate from their own individual perspective? Participants (N = 381), aged 9.5 and 13.5 years, evaluated members of their own group who deviated from group norms about resource allocation by either: (1) advocating for equal allocation in contrast to the group norm of inequality; or (2) advocating for inequality when the group norm was to divide equally. With age, participants differentiated their own individual favorability from the group's favorability of deviant members of the ingroup. Further, when deciding between group loyalty and equal allocation, children and adolescents gave priority to equality, rejecting group decisions to dislike ingroup members who advocated for equality
Adam Smith and Moral Knowledge
No full textThis paper examines the contribution of The Theory of Moral Sentiments to the study of how we acquire moral knowledge. In Smith, this is associated with the moral judgment of an impartial spectator, a hypothetical ideal conjured in the imagination of an agent. This imagined spectator has the properties of impartiality, information and sympathy. I argue Smith develops this construct in the context of personal ethics, i.e., as a guide to moral conduct in personal relationships. There are limitations, however, to this model for personal ethics, as acknowledged by Smith himself and suggested by subsequent social science findings. Moreover, this model does not necessarily extend to social ethics, i.e., to moral judgment in less personal economic and social interactions, such as firms, industries and governments. Hence, I propose modifying the spectator model in light of modern social science methods and of Smith’s own insights to address its limitations for personal ethics and to provide it with a foundation for social ethics. The proposed approach is based on a quasi-spectator, i.e., the empirical analysis of the moral views of real spectators whose properties approximate those of the ideal spectator. A review of quasi-spectator studies suggests this as a promising method for informing both descriptive and prescriptive ethics.Adam Smith, ethics, moral knowledge
All repair and reconstruction. Techniques from the SANTI study group
No full textBackground: Combining an anterior cruciate ligament (ACL) reconstruction with an anterolateral ligament (ALL) reconstruction results in significant advantages including reduced graft rupture rates, a lower risk of reoperation for secondary meniscectomy, improved knee stability, and higher rates of return to preinjury levels of sport. Indications: The previously reported indications for combined ACL and ALL reconstruction are as follows: ACL reconstruction revision; high-grade pivot shift test; long-term ACL rupture; young patients; pivoting activities; concomitant medial meniscus repair, and, specifically, regarding the ALL repair, it must be an acute surgery (within 15 days from injury). Technique Description: Several modern techniques have been described to repair and reconstruct the ALL. This technical note details a number of these techniques performed by the Scientific Anterior Cruciate Ligament Network International (SANTI) Study Group. Results: First, we describe a combined ACL reconstruction and double-bundle ALL reconstruction using hamstring autograft. Secondly, we describe a single-bundle ALL reconstruction using gracilis autograft. Thirdly, we describe an ALL reconstruction technique using a knotless soft anchor, which provides shallow fixation and prevents tunnel convergence. Finally, we describe a technique for ALL repair. Conclusion: Several techniques have been described to repair and reconstruct the ALL, all offering significant advantages over an isolated ACL reconstruction. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication
Robust automated detection of microstructural white matter degeneration in Alzheimer’s disease using machine learning classification of multicenter DTI data
No full textDiffusion tensor imaging (DTI) based assessment of white matter fiber tract integrity can support the diagnosis of Alzheimer’s disease (AD). The use of DTI as a biomarker, however, depends on its applicability in a multicenter setting accounting for effects of different MRI scanners. We applied multivariate machine learning (ML) to a large multicenter sample from the recently created framework of the European DTI study on Dementia (EDSD). We hypothesized that ML approaches may amend effects of multicenter acquisition. We included a sample of 137 patients with clinically probable AD (MMSE 20.6±5.3) and 143 healthy elderly controls, scanned in nine different scanners. For diagnostic classification we used the DTI indices fractional anisotropy (FA) and mean diffusivity (MD) and, for comparison, gray matter and white matter density maps from anatomical MRI. Data were classified using a Support Vector Machine (SVM) and a Naïve Bayes (NB) classifier. We used two cross-validation approaches, (i) test and training samples randomly drawn from the entire data set (pooled cross-validation) and (ii) data from each scanner as test set, and the data from the remaining scanners as training set (scanner-specific cross-validation). In the pooled cross-validation, SVM achieved an accuracy of 80% for FA and 83% for MD. Accuracies for NB were significantly lower, ranging between 68% and 75%. Removing variance components arising from scanners using principal component analysis did not significantly change the classification results for both classifiers. For the scanner-specific cross-validation, the classification accuracy was reduced for both SVM and NB. After mean correction, classification accuracy reached a level comparable to the results obtained from the pooled cross-validation. Our findings support the notion that machine learning classification allows robust classification of DTI data sets arising from multiple scanners, even if a new data set comes from a scanner that was not part of the training sample
Development of the positive-negative asymmetry effect: In-group exclusion norm as a mediator of children’s evaluations on negative attributes.
No full textTwo studies were conducted that go beyond previous research by examining when and why children might show intergroup bias in the attribution of positive, but not negative traits (PNAE: the positive-negative asymmetry effect, Mummendey & Otten, 1998). In Study 1 (n = 107) children completed a ‘mixed’ trait attribution task in a dichotomous group context. As predicted there was a developmental trend between 7 and 12 years of age in the PNAE. The seven year olds were the only age group not to show the effect. Study 1 also found a quadratic developmental trend in children’s national intergroup bias. Study 2 (n = 62) replicated the developmental path of the PNAE found in Study 1 using a wider age range of 6 to 16 years. This study used a ‘mixed’ list of traits which weren’t only antonyms and a procedure that made the positive and negative trait dimensions explicitly independent. Significantly, Study 2 found ingroup exclusion norm partially mediated the development of the PNAE. These findings support an account of the positive-negative asymmetry effect based upon normative processes
- …
