Impact of an Electronic Health Record-Based Interruptive Alert Among Patients With Headaches Seen in Primary Care: Cluster Randomized Controlled Trial.

Background: Headaches, including migraines, are one of the most common causes of disability and account for nearly 20%-30% of referrals from primary care to neurology. In primary care, electronic health record-based alerts offer a mechanism to influence health care provider behaviors, manage neurology referrals, and optimize headache care. Objective: This project aimed to evaluate the impact of an electronic alert implemented in primary care on patients' overall headache management. Methods: We conducted a stratified cluster-randomized study across 38 primary care clinic sites between December 2021 to December 2022 at a large integrated health care delivery system in the United States. Clinics were stratified into 6 blocks based on region and patient-to-health care provider ratios and then 1:1 randomized within each block into either the control or intervention. Health care providers practicing at intervention clinics received an interruptive alert in the electronic health record. The primary end point was a change in headache burden, measured using the Headache Impact Test 6 scale, from baseline to 6 months. Secondary outcomes included changes in headache frequency and intensity, access to care, and resource use. We analyzed the difference-in-differences between the arms at follow-up at the individual patient level. Results: We enrolled 203 adult patients with a confirmed headache diagnosis. At baseline, the average Headache Impact Test 6 scores in each arm were not significantly different (intervention: mean 63, SD 6.9; control: mean 61.8, SD 6.6; P=.21). We observed a significant reduction in the headache burden only in the intervention arm at follow-up (3.5 points; P=.009). The reduction in the headache burden was not statistically different between groups (difference-in-differences estimate -1.89, 95% CI -5 to 1.31; P=.25). Similarly, secondary outcomes were not significantly different between groups. Only 11.32% (303/2677) of alerts were acted upon. Conclusions: The use of an interruptive electronic alert did not significantly improve headache outcomes. Low use of alerts by health care providers prompts future alterations of the alert and exploration of alternative approaches.

Social monkeys learn more slowly: Social network centrality and age are positively related to learning errors by capuchin monkeys (Cebus [Sapajus] apella).

The cognitive demand on animals to learn, maintain, and remember the complexities of social relationships is theoretically higher for individuals who live more complex social lives. Previous research has suggested that both across and within species, the cognitive ability to flexibly learn and manipulate information may increase with increased social complexity. In this study, we determined the relationship between social complexity and cognitive performance on 2 related tests of general learning: associative learning and reversal learning. Subjects were 16 members of a socially housed group of brown capuchin monkeys (Cebus [Sapajus] apella). A general learning score was extracted from a principal component analysis on learning rate across 5 repetitions of each of the 2 tasks. The complexity of each monkey's social life was characterised by their centrality in the grooming social network of the group. Generalised learning scores were predicted by age and network centrality, but in contrast to predictions, older monkeys and monkeys that were more central to the network made more errors. Future studies focusing on specific cognitive abilities that are theoretically linked to species-specific fitness and behavioural outcomes, rather than broad cognitive categories like learning, will be essential for clarifying the relationship between cognition and social complexity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Is Empathy the Default Response to Suffering? A Meta-Analytic Evaluation of Perspective Taking's Effect on Empathic Concern.

We conducted a series of meta-analytic tests on experiments in which participants read perspective-taking instructions-that is, written instructions to imagine a distressed persons' point of view ("imagine-self" and "imagine-other" instructions), or to inhibit such actions ("remain-objective" instructions)-and afterwards reported how much empathic concern they experienced upon learning about the distressed person. If people spontaneously empathize with others, then participants who receive remain-objective instructions should report less empathic concern than do participants in a "no-instructions" control condition; if people can deliberately increase how much empathic concern they experience, then imagine-self and imagine-other instructions should increase empathic concern relative to not receiving any instructions. Random-effects models revealed that remain-objective instructions reduced empathic concern, but "imagine" instructions did not significantly increase it. The results were robust to most corrections for bias. Our conclusions were not qualified by the study characteristics we examined, but most relevant moderators have not yet been thoroughly studied.