Background Clinician notes are structured in a variety of ways. This research pilot tested an innovative study design and explored the impact of note formats on diagnostic accuracy and documentation review time. Objective To compare two formats for clinical documentation (narrative format vs. list of findings) on clinician diagnostic accuracy and documentation review time. Method Participants diagnosed written clinical cases, half in narrative format, and half in list format. Diagnostic accuracy (defined as including correct case diagnosis among top three diagnoses) and time spent processing the case scenario were measured for each format. Generalised linear mixed regression models and bias-corrected bootstrap percentile confidence intervals for mean paired differences were used to analyse the primary research questions. Results Odds of correctly diagnosing list format notes were 26% greater than with narrative notes. However, there is insufficient evidence that this difference is significant (75% CI 0.8–1.99). On average the list format notes required 85.6 more seconds to process and arrive at a diagnosis compared to narrative notes (95% CI -162.3, −2.77). Of cases where participants included the correct diagnosis, on average the list format notes required 94.17 more seconds compared to narrative notes (75% CI -195.9, −8.83). Conclusion This study offers note format considerations for those interested in improving clinical documentation and suggests directions for future research. Balancing the priority of clinician preference with value of structured data may be necessary. Implications This study provides a method and suggestive results for further investigation in usability of electronic documentation formats.

BACKGROUND: Personalizing approaches to prevention and treatment of obesity will be a crucial aspect of precision health initiatives. However, in considering individual susceptibility to obesity, much remains to be learned about how to support healthy weight management in different population subgroups, environments and geographical locations. SUBJECTS/METHODS: The International Weight Control Registry (IWCR) has been launched to facilitate a deeper and broader understanding of the spectrum of factors contributing to success and challenges in weight loss and weight loss maintenance in individuals and across population groups. The IWCR registry aims to recruit, enroll and follow a diverse cohort of adults with varying rates of success in weight management. Data collection methods include questionnaires of demographic variables, weight history, and behavioral, cultural, economic, psychological, and environmental domains. A subset of participants will provide objective measures of physical activity, weight, and body composition along with detailed reports of dietary intake. Lastly, participants will be able to provide qualitative information in an unstructured format on additional topics they feel are relevant, and environmental data will be obtained from public sources based on participant zip code. CONCLUSIONS: The IWCR will be a resource for researchers to inform improvements in interventions for weight loss and weight loss maintenance in different countries, and to examine environmental and policy-level factors that affect weight management in different population groups. This large scale, multi-level approach aims to inform efforts to reduce the prevalence of obesity worldwide and its associated comorbidities and economic impacts. TRIAL REGISTRATION: NCT04907396 (clinicaltrials.gov) sponsor SB Roberts; Tufts University IRB #13075.

SummaryThe American Society for Bariatric Surgery established a set of standards for bariatric surgery Centers of Excellence accreditation programme in 2003. While several research efforts have shown that post‐bariatric surgery outcomes were poorer in unaccredited as compared to accredited hospitals, others have questioned the same. This research effort sought to use random effects meta‐analysis to quantitatively summarize the existing research efforts analysing this association, which were published between January 2000 and October 2018. Out of the total 559 articles, 13 that quantitatively analysed the effect of accreditation on post‐operative mortality‐ and morbidity‐related outcomes were included in the analysis. Overall, the weighted pooled estimates showed that compared to accredited, in the unaccredited hospitals, the odds of mortality were twice as high (odds ratio: 1.83; confidence interval: 1.49, 2.25), and those for morbidity were 1.23 times higher (1.11, 1.36). Estimates varied by the data source used, and the effect estimate used (odds or risk ratios). Overall, the odds of poor post‐operative outcomes were higher among unaccredited hospitals as compared to accredited. However, there were analytic differences and other limitations among the existing efforts. Future research efforts conducting independent analyses on these data sources, keeping the methodology consistent are needed.