***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: BACKGROUND Inadequate treatments are reported for depressed patients cared for by primary care physicians ( PCPs ) . Providing feedback and evidence -based treatment recommendations for depression to PCPs via electronic medical record improves the quality of interventions . METHODS Patients presenting to an urban academically affiliated primary care practice were screened for major depression with the Primary Care Evaluation of Mental Disorders ( PRIME-MD ) . During 20-month period , 212 patients met protocol - eligibility criteria and completed a baseline interview . They were cared for by 16 board-certified internists , who were electronically informed of their patients ' diagnoses , and r and omized to 1 of 3 methods of exposure to guideline -based advice for treating depression ( active , passive , and usual care ) . Ensuing treatment patterns were assessed by medical chart review and by patient self-report at baseline and 3 months . RESULTS Median time for PCP response to the electronic message regarding the patient 's depression diagnosis was 1 day ( range , 1 - 95 days ) . Three days after notification , 120 ( 65 % ) of 186 PCP responses indicated agreement with the diagnosis , 24 ( 13 % ) indicated disagreement , and 42 ( 23 % ) indicated uncertainty . Primary care physicians who agreed with the diagnoses sooner were more likely to make a medical chart notation of depression , begin  antidepressant medication therapy , or refer to a mental health specialist ( P<.001 ) . There were no differences in the agreement rate or treatments provided across guideline exposure conditions . CONCLUSIONS Electronic feedback of the diagnosis of major depression can affect PCP initial management of the disorder . Further study is necessary to determine whether this strategy , combined with delivery of treatment recommendations , can improve clinical outcomes in routine practice OBJECTIVE In 2004 , results from The Texas Medication Algorithm Project ( TMAP ) showed better clinical outcomes for patients whose physicians adhered to a paper- and -pencil algorithm  compared to patients who received st and ard clinical treatment for major depressive disorder ( MDD ) . However , implementation of and fidelity to the treatment algorithm among various providers was observed to be inadequate . A computerized decision support system ( CDSS ) for the implementation of the TMAP algorithm for depression has since been developed to improve fidelity and adherence to the algorithm . METHOD This was a 2-group , parallel design , clinical trial ( one patient group receiving MDD treatment from physicians using the CDSS and the other patient group receiving usual care ) conducted at 2 separate primary care clinics in Texas from March 2005 through June 2006 . Fifty-five patients with MDD ( DSM-IV criteria ) with no significant difference in disease characteristics were enrolled , 32 of whom were treated by physicians using CDSS and 23 were treated by physicians using usual care .  The study 's objective was to evaluate the feasibility and efficacy of implementing a CDSS to assist physicians acutely treating patients with MDD compared to usual care in primary care . Primary efficacy outcomes for depression symptom severity were based on the 17-item Hamilton Depression Rating Scale ( HDRS(17 ) ) evaluated by an independent rater . RESULTS Patients treated by physicians employing CDSS had significantly greater symptom reduction , based on the HDRS(17 ) , than patients treated with usual care ( P < .001 ) . CONCLUSIONS The CDSS algorithm , utilizing measurement-based care , was superior to usual care for patients with MDD in primary care setting s. Larger r and omized controlled trials are needed to confirm these findings . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00551083 BACKGROUND The health system must develop effective solutions to the growing challenges it faces with respect to individuals who suffer with mental health disorders and addictions . The purpose of this study was to evaluate the usability and potential impact on outcomes of a knowledge translation system aim ed at improving client-centered , evidence -based care for hospitalized individuals with schizophrenia . METHODOLOGY A pre-posttest design was used . The e-Volution-TREAT system was implemented on two inpatient units at a large mental health facility . Thirty-seven nurses , allied health workers , and physicians participated from two units . Data collection involved question naires , semistructured interviews , and observations . Thirty-eight consenting clients ' outcome data were collected from organizational records . RESULTS Overall , staff participants were very satisfied with the functions of the e-Volution-TREAT system . Barriers to using the system were identified by participants related to the work environment , to understaffing , equipment problems , discomfort with technology , and a focus on short-term rather than long-term goals . There was moderate uptake of guidelines related to social issues , and low uptake of guidelines related to family support and addictions . There were significant improvements in four client outcomes over time , specifically aggressive behavior , depression , withdrawal , and psychosis . CONCLUSIONS In conclusion , users were overall satisfied with the e-Volution-TREAT system , although expressed challenges related to workload that interfered with time to utilize the system . It would be premature to conclude the change in client outcomes was related to the e-Volution-TREAT system without a r and omized controlled trial with outcomes compared to a control group . Future research needs to incorporate strategies for modifying the context and engage clinicians who are in a position of influence to model change Background Electronic guideline -based decision support systems have been suggested to successfully deliver the knowledge embedded in clinical practice guidelines . A number of studies have already shown positive findings for decision support systems such as drug-dosing systems and computer-generated reminder systems for preventive care services . Methods A systematic literature search ( 1990 to December 2008 ) of the English literature indexed in the Medline data base , Embase , the Cochrane Central Register of Controlled Trials , and CRD ( DARE , HTA and NHS EED data bases ) was conducted to identify evaluation studies of electronic multi-step guideline implementation systems in ambulatory care setting s. Important inclusion criterions were the multidimensionality of the guideline ( the guideline needed to consist of several aspects or steps ) and real-time interaction with the system during consultation . Clinical decision support systems such as one-time reminders for preventive care for which positive findings were shown in earlier review s were excluded . Two comparisons were considered : electronic multidimensional guidelines versus usual care ( comparison one ) and electronic multidimensional guidelines versus other guideline implementation methods ( comparison two ) . Results Twenty-seven publications were selected for analysis in this systematic review . Most design s were cluster r and omized controlled trials investigating process outcomes more than patient outcomes . With success defined as at least 50 % of the outcome variables being significant , none of the studies were successful in improving patient outcomes . Only seven of seventeen studies that investigated process outcomes showed improvements in process of care variables compared with the usual care group ( comparison one ) . No incremental effect of the electronic implementation over the distribution of paper versions of the guideline was found , neither for the patient outcomes nor for the process outcomes ( comparison two ) . Conclusions There is little evidence at the moment for the effectiveness of an increasingly used and commercialised instrument such as electronic multidimensional guidelines . After more than a decade of development of numerous electronic systems , research on the most effective implementation strategy for this kind of guideline -based decision support systems is still lacking . This conclusion implies a considerable risk towards inappropriate investments in ineffective implementation interventions and in suboptimal care OBJECTIVE Strategies to effectively and efficiently screen for depression remain elusive in the primary care setting . The purpose of this study was to assess the feasibility of a  depression screening program in which patients completed a vali date d question naire in the waiting room . Using Optical Mark Reader technology ( PatientLink ) , patient responses were interfaced into the electronic health record ( EHR ) , where the responses and score were available to practitioners at the time of the visit . METHOD This was a prospect i ve , observational study that enrolled all consenting patients , aged 18 years and older , who spoke English and arrived for any type of visit during a 1-week period at a family practice clinic ( the first week of August 2004 ) . Patient feedback was sought using a st and ardized survey . Feedback from practitioners and staff was sought using focus group methodology . The primary outcome measure was the proportion of patients successfully screened for depression by the front desk personnel using PatientLink . RESULTS A total of 189 patients met eligibility criteria . Of those , 169 ( 89.4 % ) were successfully screened for depression . Of the patients who completed PHQ-9 question naires , 30 ( 17.8 % ) met DSM-IV criteria for moderate to severe depression . Four ( 2.4 % ) of these subjects with major depressive disorder were found not to have preexisting documentation of a depressive disorder in the medical record . In no case was the lack of successful screening due to technology error . Patients , staff , and practitioners supported this new screening strategy . No additional staff were needed to conduct the screening program . CONCLUSION This study demonstrates that depression screening using a Scantron-based PHQ-9 question naire completed by patients in the waiting room and uploaded into an EHR is technically feasible and re source efficient OBJECTIVE To evaluate the relative effectiveness of computer and manual reminder systems on the implementation of a clinical practice guideline . DESIGN Seventy-eight out patients in a mental health clinic were r and omly assigned within clinician to one of the two reminder systems . The computer system , called CaseWalker , reminded clinicians when guideline -recommended screening for mood disorder was due , ensured the fidelity of the diagnosis of major depressive disorder to criteria of the Diagnostic and Statistical Manual of Mental Disorders , 4th edition ( DSM-IV ) , and generated a progress note . The manual system was a checklist inserted in the paper medical record . MEASURES Screening rates for mood disorder and the completeness of the documentation of which DSM-IV criteria were met by patients who were said to have major depressive disorder were compared . RESULTS The CaseWalker , compared with the paper checklist , result ed in a higher screening rate for mood disorder ( 86.5 vs. 61 percent , P = 0.008 ) and a higher rate of complete documentation of DSM-IV criteria ( 100 vs. 5.6 percent , P < 0.001 ) . CONCLUSIONS In an outpatient mental health clinic , computer reminders were shown to be superior to manual reminders in improving adherence to a clinical practice guideline for depression Purpose : National guidelines recommend screening all persons with depression for bipolar disorder ( BPD ) ; one way to facilitate screening is through the use of electronic health records ( EHRs ) . This study examined the impact of an EHR-based screening and decision support tool on diagnosis and treatment of BPD among patients diagnosed with depression in primary care offices . Methods : This nonr and omized , controlled trial was conducted in a national network of offices using EHRs . The intervention included a screening instrument and other tools for diagnosis and management of BPD , which were embedded into the EHR . This instrument automatically activated when a patient with a diagnosis of depression but no diagnosis of BPD was seen in the office . The primary outcomes were the rates of new diagnoses of BPD and prescription of new BPD medications during the 6-month study period ( April to October 2009 ) . Results : Twenty-one offices with 75 clinicians and 8355 adult patients with depression composed the intervention group , whereas 17 offices with 81 clinicians and 8799 adult patients with depression served as the comparison group . The screening tool was used with 47.5 % of intervention patients , of whom 2.5 % scored at high or very high risk for BPD . Intervention patients were more likely than comparison patients to be newly diagnosed with BPD ( 1.11 % vs. 0.36 % ; P < .01 ) and be prescribed new BPD medications ( 1.85 % vs. 1.19 % ; P < .01 ) . Conclusions : The study suggests that EHR-based tools can be useful for screening and management of BPD for patients with depression in primary care offices CONTEXT The Texas Medication Algorithm Project is an evaluation of an algorithm-based disease management program for the treatment of the self-declared persistently and seriously mentally ill in the public mental health sector . OBJECTIVE To present clinical outcomes for patients with major depressive disorder ( MDD ) during 12-month algorithm-guided treatment ( ALGO ) compared with treatment as usual ( TAU ) . DESIGN Effectiveness , intent-to-treat , prospect i ve trial comparing patient outcomes in clinics offering ALGO with matched clinics offering TAU . SETTING Four ALGO clinics , 6 TAU clinics , and 4 clinics that offer TAU to patients with MDD but provide ALGO for schizophrenia or bipolar disorder . Patients Male and female out patients with a clinical diagnosis of MDD ( psychotic or nonpsychotic ) were divided into  ALGO and TAU groups . The ALGO group included patients who required an antidepressant medication change or were starting antidepressant therapy .  The TAU group initially met the same criteria , but because medication changes were made less frequently in the TAU group , patients were also recruited if their Brief Psychiatric Rating Scale total score was higher than the median for that clinic 's routine quarterly evaluation of each patient . MAIN OUTCOME MEASURES Primary outcomes included ( 1 ) symptoms measured by the 30-item Inventory of Depressive Symptomatology-Clinician-Rated scale ( IDS-C(30 ) ) and ( 2 ) function measured by the Mental Health Summary score of the Medical Outcomes Study 12-item Short-Form Health Survey ( SF-12 ) obtained every 3 months . A secondary outcome was the 30-item Inventory of Depressive Symptomatology-Self-Report scale ( IDS-SR(30 ) ) . RESULTS All patients improved during the study ( P<.001 ) , but ALGO patients had significantly greater symptom reduction on both the IDS-C(30 ) and IDS-SR(30 ) compared 
    Output:
    
In general , the CDSS had a positive impact on different aspects , such as the screening and diagnosis , treatment , improvement in depressive symptoms and quality of life , and referral of patients .
The use of CDSS could thus serve to optimise care of depression in various scenarios by providing recommendations based on the best evidence available and facilitating decision-making in clinical practice