***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Nursing documentation is an important part of clinical documentation . However , documentation of the nursing process is frequently lacking quality . There are high expectations that computer support in nursing documentation will help improve documentation quality . This study aim ed to examine whether the introduction of a computer based nursing documentation system can improve documentation quality . A prospect i ve intervention study was conducted on 4 wards of the University Medical Center Heidelberg over a period of 18 months . Two wards in the Psychiatric University Medical Center Heidelberg were involved in the research study , as well as a dermatological and a pediatric ward . The results of the study show a significant improvement of documentation quantity and quality on three of the four wards . Positive aspects include completeness of documentation on the nursing process , formal aspects and subjective quality improvement by the nurses . Negative aspects were mainly associated with the contents of the care plans At an antenatal clinic in St. Thomas 's Hospital , London , 246 expectant mothers were r and omly allocated to hold either their own maternity case notes or the st and ard co-operation card . Information was collected on three occasions during their care on attitudes and health behaviour . Clinical outcomes were recorded and the effects of the two systems on clinic administration were observed . More of the notes group expressed satisfaction with most aspects of their care and delivery and significantly more of the notes group felt well informed and satisfied with their companion during labour . There were no differences in clinical outcomes between the two groups except that , for no identifiable systematic reason , there were more assisted deliveries among the notes group . A number of administrative advantages result ed from mothers holding their own notes and although initial reservations were found amongst professional staff interviewed at the start of the study , the results proved persuasive and the practice of giving mothers their own notes is now to be extended throughout the department Despite the widespread use of home based child health records of varying complexity in Engl and , there is a notable absence of their evaluation . Such a record booklet developed in the West Lambeth Health Authority has been used by parents , doctors , and community nurses to build up an independent chronological record of a child 's birth statistics , health , growth , immunisation , development checks , and contacts with health services . A r and omised controlled evaluation of the record , analyses of entries in it , and a survey of the views of mothers and health professionals using the record have been carried out . The need for such a record was confirmed by those question ed and analyses of entries in the booklet helped to modify and improve it . The evaluation was unable to show , however , any effect of the record on immunisation and developmental assessment service uptake . Its value in improving communication between the numerous health and other care agencies was dependent on its proper use OBJECTIVE In intensive care units ( ICUs ) , patient outcome depends on quality of nutritional support . We investigated the effect of computerized information systems ( CISs ) on quality of nutritional support by comparing two ICUs with or without CIS and burned patients before and after CIS implementation . METHODS Part 1 was a 2-wk prospect i ve survey in two units of a surgical ICU : unit A ( 11 beds ) without CIS and unit B ( four beds ) with CIS . Part 2 consisted of two 18-mo periods in burn patients before and after  CIS  implementation . Nurses and doctors belonged to the same team ; procedures were identical . A computer page was configured to retrieve data related to nutritional support . RESULTS A total of 1313 ICU days were analyzed in 109 patients . Patients ' characteristics were similar in parts 1 and 2 . In part 1 , nutritional support was required 38 % of days . Nutritional route was similar but data were more frequently missing in unit A. Energy delivery was higher with CIS but below target values in both units ( 31+/-11 % of target in unit A , 77+/-4 % in unit B ) . Computations were incomplete and time consuming for unit A versus B ( 11+/-2 versus 2+/-1 min/patient , P<0.0001 ) . In part 2 , in the 54 burn patients , use of postpyloric feeding tubes and energy delivery increased with CIS , result ing in less weight loss . CONCLUSION Computerized information systems favored st and ardization of nutritional care and monitoring , thus decreasing time required for writing and computations . Follow-up was improved and nutrient delivery was closer to target values , thus increasing quality of care .  In burn patients , the better data visibility was associated with a significant improvement in nutrient delivery A two-month r and omized , controlled trial based on 60 patients has been performed on a ward of the Department of Psychiatry at Heidelberg University Medical Center , Germany , to investigate the influence of computer-based nursing documentation on time investment for documentation , quality of documentation and user acceptance . Time measurements , question naires , documentation analysis and interviews were used to compare patients documented with the computer-based system ( PIK group ) with the control group ( patients documented with the paper-based system ) .  The results showed the advantages and disadvantages of computer-based nursing documentation .  Time needed for nursing care planning was lower in the PIK group . Some formal aspects of quality were considerably better in the PIK group . On the other h and , time required for documentation of tasks and for report writing was greater in the PIK group . User acceptance increased significantly during the study . The interviews indicated a positive influence of PIK on the cooperation between nurses and physicians Abstract Objective . Nowadays , registration of patient data on paper is gradually being replaced by registration using an intensive care information system ( ICIS ) . The aim of this study was to evaluate the effect of the use of an ICIS on nursing activity . Design . R and omized controlled trial with a crossover design . Setting . An 18-bed medical-surgical ICU in a teaching hospital . Patients , nurses and interventions . During a 6week period 145 consecutive adult patients admitted to the ICU after uncomplicated cardiothoracic surgery were r and omized into two groups : for one group the documentation was carried out using a paper-based registration ( Paper ) , in the second group an ICIS was used for documentation . Measurements and results . The nursing activities for these patients were studied during two separate periods : the admission period and the registration phase ( the period directly following the admission procedure ) . The duration of the admission procedure was measured by time-motion analysis and the nursing activities in the registration phase were studied by work sampling methodology . All nursing activities during the registration phase were grouped in four main categories : patient care , documentation , unit-related and personal time . The duration of the admission procedure was longer in the ICIS group ( 18.1±4.1 versus 16.8±3.1 min , p<0.05 ) . In the registration phase , a 30 % reduction in documentation time ( Paper 20.5 % of total nursing time versus ICIS 14.4 % , p<0.001 ) , corresponding to 29 min ( per 8h nursing shift ) was achieved . This time was completely re-allocated to patient care . Conclusions . The use of the present ICIS in patients after cardiothoracic surgery alters nursing activity ; it reduces the time for documentation and increases the time devoted to patient care . Electronic Supplementary Material is available if you access this article at http://dx.org/10.1007/s00134-002-1542-9 . On that page ( frame on the left side ) , a link takes you directly to the supplementary material The purpose of this study was to determine how use of a st and ardized nomenclature for nursing diagnosis and intervention statements on the computerized nursing care plan in a long-term care ( LTC ) facility would affect patient outcomes , as well as organizational processes and outcomes . An experimental design was used to compare the effects of two methods of documentation : Computer care plan and paper care plan .  Twenty participants ( 10 in each group ) were r and omly assigned to either group . No statistically significant differences were found by group for demographic data . Repeated measures ANOVA was computed for each of the study variables with type of care plan , written or computerized , as the independent variable . There were no statistically significant differences between participants , group ( care plan ) , within subjects ( across time ) , or interaction ( group and time ) effects for the dependent variables : Level of care , activities of daily living , perception of pain , cognitive abilities , number of medications , number of bowel medications , number of constipation episodes , weight , percent of meals eaten , and incidence of alteration in skin integrity . There were significantly more nursing interventions and activities on the computerized care plan , although this care plan took longer to develop at each of the three time periods . Results from this study suggest that use of a computerized plan of care increases the number of documented nursing activities and interventions , but further research is warranted to determine if this potential advantage can be translated into improved patient and organizational outcomes in the long-term care setting Abstract Objective To investigate whether a form of advance agreement for people with severe mental illness can reduce the use of inpatient services and compulsory admission or treatment . Design Single blind r and omised controlled trial , with r and omisation of individual patients . The investigator was blind to allocation . Setting Eight community mental health teams in southern Engl and . Participants 160 people with an operational diagnosis of psychotic illness or non-psychotic bipolar disorder who had experienced a hospital admission within the previous two years . Intervention The joint crisis plan was formulated by the patient , care coordinator , psychiatrist , and project worker and contained contact information , details of mental and physical illnesses , treatments , indicators for relapse , and advance statements of preferences for care in the event of future relapse . Main outcome measures Admission to hospital , bed days , and use of the Mental Health Act over 15 month follow up . Results Use of the Mental Health Act was significantly reduced for the intervention group , 13 % ( 10/80 ) of whom experienced compulsory admission or treatment compared with 27 % ( 21/80 ) of the control group ( risk ratio 0.48 , 95 % confidence interval 0.24 to 0.95 , P = 0.028 ) . As a consequence , the mean number of days of detention ( days spent as an inpatient while under a section of the Mental Health Act ) for the whole intervention group was 14 compared with 31 for the control group ( difference 16 , 0 to 36 , P = 0.04 ) . For those admitted under a section of the Mental Health Act , the number of days of detention was similar in the two groups ( means 114 and 117 , difference 3 , −61 to 67 , P = 0.98 ) . The intervention group had fewer admissions ( risk ratio 0.69 , 0.45 to 1.04 , P = 0.07 ) . There was no evidence for differences in bed days ( total number of days spent as an inpatient ) ( means 32 and 36 , difference 4 , −18 to 26 , P = 0.15 for the whole sample ; means 107 and 83 , difference −24 , −72 to 24 , P = 0.39 for those admitted ) . Conclusions Use of joint crisis plans reduced compulsory admissions and treatment in patients with severe mental illness . The reduction in overall admission was less . This is the first structured clinical intervention that seems to reduce compulsory admission and treatment in mental health services AIM To investigate whether a comprehensive strategy involving both patients and professionals , with the introduction of a diabetes passport as a key component , improves diabetes care . METHODS The first 150 consecutive patients who visited their internist for a diabetes check up at the internal medicine outpatient departments at each of nine Dutch general hospitals were included in this 1 year clustered , r and omised , controlled trial . Health care professionals attended an educational meeting about the use and dissemination of the diabetes passport which is a patient held record . They also received aggregated feedback on baseline data and personal feedback . Educational meetings were also organised for patients . Patient files were used in conjunction with question naires to determine adherence rates . Data were analysed using multilevel regression analysis . RESULTS Small but significant changes were found in mean HbA1c levels . In the intervention group , positive health changes for patients were found ( -0.3 % ) when compared to those in the control group ( + 0.2 % ) . Diastolic blood pressure improved slightly , but no changes were found in systolic blood pressure or cholesterol . Improvements were found with regard to levels of examination of patients ' feet and in patient education . CONCLUSIONS Efforts to improve professional practice involving both professionals and patients led to small improvements in HbA1c and diastolic blood pressure levels . Further study is needed to establish whether a better structured health care delivery , operating in a more supportive environment can enhance these effects Physicians were much less likely than other primary care team members to use a Web-based application to counsel patients with diabetes about behavior change To assess a policy of women holding and thus having constant access to their own obstetric records , 290 women attending a peripheral consultant clinic in Newbury , West Berkshire , were r and omly allocated to hold either their full case notes , or the more usual co‐operation card . Women holding their full records were significantly more likely to feel in control of their antenatal care ( rate ratio 1·45 ; 95 % confidence interval 1·08–1·95 ) and to feel it was easier to talk to doctors and midwives ( rate ratio 1·73 ; 95 % confidence interval 1·16‐2·59 ) . No other beneficial effects were detected . Asked about their preferences for any subsequent pregnancies , women holding their own records in the index pregnancy were more likely to say they would prefer to hold the same kind of record again in a subsequent pregnancy than were women holding a co‐operation card ( rate ratio 1·56 ; 95 % confidence interval 1·34–1·81 ) . There was no evidence of negative effects . In particular , women holding their case notes did not feel more anxious than co‐operation card holders . The policy of women holding their notes result ed in savings in elerical time , without evidence of an increase in the rate of lost notes AIM AND OBJECTIVES The aim of this paper is to present a study describing nurses ' adherence to the VIPS model by evaluating the quality of nursing assessment , and the quantity of completed nursing care plans . BACKGROUND N 
    Output:
    
Studies of nursing care planning systems and total nurse records demonstrated uncertain or equivocal results .
We found some limited evidence of effects on practice attributable to changes in record systems .
It is clear from the literature that it is possible to set up the r and omised trials or other quasi-experimental design s needed to produce evidence for practice .