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PubMed2000

A controlled time-series trial of clinical reminders: using computerized firm systems to make quality improvement research a routine part of mainstream practice.

OBJECTIVE: To explore the feasibility of conducting unobtrusive interventional research in community practice settings by integrating firm-system techniques with time-series analysis of relational-repository data. STUDY SETTING: A satellite teaching clinic divided into two similar, but geographically separated, primary care group practices called firms. One firm was selected by chance to receive the study intervention. Forty-two providers and 2,655 patients participated. STUDY DESIGN: A nonrandomized controlled trial of computer-generated preventive reminders. Net effects were determined by quantitatively combining population-level data from parallel experimental and control interrupted time series extending over two-month baseline and intervention periods. DATA COLLECTION: Mean rates at which mammography, colorectal cancer screening, and cholesterol testing were performed on patients due to receive each maneuver at clinic visits were the trial's outcome measures. PRINCIPAL FINDINGS: Mammography performance increased on the experimental firm by 154 percent (0.24 versus 0.61, p = .03). No effect on fecal occult blood testing was observed. Cholesterol ordering decreased on both the experimental (0.18 versus 0.1 1, p = .02) and control firms (0.13 versus 0.07, p = .03) coincident with national guidelines retreating from recommending screening for young adults. A traditional uncontrolled interrupted time-series design would have incorrectly attributed the experimental-firm decrease to the introduction of reminders. The combined analysis properly indicated that no net prompting effect had occurred, as the difference between firms in cholesterol testing remained stochastically stable over time (0.05 versus 0.04, p = .75). A logistic-regression analysis applied to individual-level data produced equivalent findings. The trial incurred no supplementary data collection costs. CONCLUSIONS: The apparent validity and practicability of our reminder implementation study should encourage others to develop computerized firm systems capable of conducting controlled time-series trials.

Adult↗
PubMedDate not supplied

[History of the mainstream scientific research at the Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences].

The classical reflex theory of the higher nervous activity has been developed in the works of E.A. Asratyan, the first director of the Institute, and his scientific school. The novel aspects of the theory have been developed: the principle of system organization; the concept of the nervous center as a set of structures located in different areas of the central nervous system; conditioned switchover, the mechanism of conditioned connection closure; the origin and localization of conditioned inhibition; the two-way, forward and backward conditioned connections. The elaboration of physiological mechanisms of the active goal-directed motivated behavior was begun. V.S. Rusinov and his collaborates have developed the concept of the dominanta and role of the stationary excitation foci in the integrative brain activity. M.N. Livanov has created the concept of the spatio-temporal organization of bioelectric potential and systemic organization of brain activity. P.V. Simonov, beginning from 1964, has developed the need-informational theory of the human and animal higher nervous activity (behavior). As distinct from the theories that originate from a single viewpoint and reject all the others, Simonov's theory is integrative and follows the logic of development of brain science.

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