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Objectives Electronic health record (EHR) systems are used extensively in healthcare; their design can influence clinicians’ behaviour. We conducted a systematic review of EHR-based interventions aimed at changing the clinical practice of general practitioners in the UK, assessed their effectiveness and applied behaviour change theory to identify lessons for other settings.Design Mixed methods systematic review.Data sources MEDLINE, EMBASE, CENTRAL and APA PsycINFO were searched up to March 2023.Eligibility criteria Quantitative and qualitative findings from randomised controlled trials (RCTs) controlled before-and-after studies and interrupted time series of EHR-based interventions in UK general practice were included.Data extraction and synthesis Quantitative synthesis was based on Cochrane’s Synthesis without Meta-analysis. Interventions were categorised using the Behaviour Change Wheel and MINDSPACE frameworks and effectiveness determined by vote-counting using direction of effect. Inductive thematic synthesis was used for qualitative studies.Results Database searching identified 3824 unique articles; 10 were included (from 2002 to 2021), comprising eight RCTs and two associated qualitative studies. Four of seven quantitative studies showed a positive effect on clinician behaviour and three on patient-level outcomes. Behaviour change techniques that may trigger emotions and required less cognitive engagement appeared to have positive effects. Qualitative findings indicated that interventions reassured clinicians of their decisions but were sometimes ignored.Conclusion Despite widespread use, there is little high quality, up-to-date experimental evidence evaluating the effectiveness of EHR-based interventions in UK general practice. The evidence suggested EHR-based interventions may be effective at changing behaviour. Persistent, simple action-oriented prompts appeared more effective than complex interventions requiring greater cognitive engagement. However, studies lacked detail in intervention design and theory behind design choices. Future research should seek to optimise EHR-based behaviour change intervention design and delineate limitations, providing theory-based justification for interventions. This will be of increasing importance with the growing use of EHRs to influence clinicians’ decisions.PROSPERO registration number CRD42022341009.

Multiple sources of evidence address the contribution of speed and speeding in crashes: police crash reports, in-depth crash investigations, studies of speed and serious crash risk, assessments of survival and injury rates for various impact speeds, and evaluations of the safety outcomes of speed management interventions. These sources of evidence all indicate that speed is a major factor in crash trauma, but appear to differ in estimates of the extent of the role of speed. This paper employs New Zealand as a country case study, undertaking a targeted assessment of data from the different sources to better determine the roles of speed and speeding in serious crashes. We find that apparent mismatches of estimates of the role of speed from different sources largely arise for two reasons. First, the studies vary in methodology and thus validity, and second the data from the different sources provide answers to fundamentally different questions, which are then incorrectly subsumed into the general question of the role of speed. Finally, we answer the question: ‘What is the extent of the role of speed in crashes, and particularly deaths and serious injuries?’ by providing answers to the different ways of couching these questions. Depending on the question, correct answers range from 20% to 100% of serious crashes. By combining evidence from different sources, we estimate that speeding is involved in around 60% of fatal crashes in New Zealand, and that speeds above New Zealand’s Safe and Appropriate Speeds are involved in around 71% of injury crashes.

This anatomical program for high-school biology teachers, a university-driven capacity- building exercise, achieved its aims of: (1) determining the participants’ profiles; (2) increasing the anatomical knowledge of participants; and (3) evaluating the online program. The webinar program comprised 4 lectures, including discussion, preceded and followed by a test consisting of 19 anatomy questions. Of 867 high-school biology teachers who registered an interest, 222 completed the post-program test and feedback questionnaire; however, only 153 (111 females, 42 males) completed both pre-program and post-program tests and the feedback questionnaire. A significant (P