***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: 200 adult respiratory distress syndrome patients were included in a prospect i ve multicenter r and omized trial to determine the efficacy of computerized decision support . The study was done in 10 medical centers across the United States . There was no significant difference in survival between the two treatment groups ( mean 2 = 0.49 p = 0.49 ) or in ICU length of stay between the two treatment groups when controlling for survival ( F(1df ) = 0.88 , p = 0.37 . ) There was a significant reduction in morbidity as measured by multi-organ dysfunction score in the protocol group ( F(1df ) = 4.1 , p = 0.04 ) as well as significantly lower incidence and severity of overdistension lung injury ( F(1df ) = 45.2 , p < 0.001 ) . We rejected the null hypothesis . Efficacy was best for the protocol group . Protocol s were used for 32,055 hours ( 15 staff person years , 3.7 patient years or 1335 patient days ) . Protocol s were active 96 % of the time . 38,546 instructions were generated . 94 % were followed . This study indicates that care using a computerized decision support system for ventilator management can be effectively transferred to many different clinical setting s and significantly improve patient morbidity Patients are often discharged before burn wounds are fully healed , which requires home care nurses to manage complex burn care . This study evaluated patient outcomes at 3 periods : ( 1 ) before visiting nurses participated in a burn care education program , ( 2 ) after visiting nurses participated in a burn education program , and ( 3 ) after the implementation of a burn clinical pathway . A r and om sample of 54 patient records from the first 2 periods and the entire sample of 12 records from the third period were review ed . Demographic variables included age , sex , race , percentage of total body surface area burned , and mechanism of burn . Outcome variables measured were weight maintenance , wound infection , pain management , unplanned readmissions to the burn unit , and documentation of patient education . The findings of this study show the positive impact of education in combination with the use of a burn home care clinical pathway OBJECTIVE to evaluate a nurse-led management plan and care pathway for older people discharged from an Accident and Emergency Department after a fall . DESIGN r and omized controlled trial . SETTING a large teaching hospital . SUBJECTS 348 consecutive patients aged 65 or over attending the Accident and Emergency Department with a fall . INTERVENTIONS we r and omized patients to falls nurse intervention or usual care . Within 4 weeks , the intervention group received a home assessment to address easily modifiable risk factors for falls . This included assessment s of medication , ECG , blood pressure , cognition , visual acuity , hearing , vestibular dysfunction , balance , mobility , feet and footwear . All patients were given advice and education about general safety in the home . MAIN OUTCOME MEASURES Further falls , functional ability , re-attendance at the Accident and Emergency Department and admission to hospital . RESULTS at 6 months post-Index fall , 36 patients in the intervention group and 39 patients in the control group had had 89 and 145 falls respectively . Although the intervention group had less falls , this was not significant ( P>0.05 ) . Similarly , the intervention group had fewer fall-related admissions and bed days ( 8 and 69 respectively ) than the control group ( 10 and 233 respectively ) . The intervention group scored significantly higher in indicators of function ( P<0.05 ) and mobility within the community ( P<0.02 ) . CONCLUSIONS although the differences were not significant , patients in the intervention group had fewer falls , less hospital attendances and spent less time in hospital . Moreover , patients in the intervention group were more functionally independent at 6 months post-Index fall Background and Purpose — Integrated care pathways ( ICP ) may not reduce disability , institutionalization , or duration of hospitalization compared with conventional multidisciplinary team ( MDT ) care in organized stroke rehabilitation . Their potential to improve patient heath status or satisfaction with care is not known . Methods — A comparison of quality of life , caregiver strain , and patient/caregiver satisfaction at 6 months after stroke was undertaken in 152 stroke patients r and omized to receive ICP or MDT care .  Differences in processes of care were recorded with the use of a predefined schedule . Multivariate analyses were undertaken to identify the effect of age , sex , stroke severity , functional status , mood , and use of care pathway on quality of life score . Results — The 2 groups were comparable for baseline characteristics of age , sex , stroke severity , and initial disability . MDT care was characterized by greater emphasis on return of higher function and caregiver needs compared with ICP . EuroQol Visual Analogue Scale ( EQ-VAS ) scores were higher in the MDT group ( median , 72 versus 63;P < 0.005 ) , who also had higher scores for EuroQol dimension of social functioning ( P = 0.014 ) . Higher EQ-VAS scores were independently related to MDT care ( P = 0.04 ) , Rankin score ( P = 0.01 ) , and psychological function ( P < 0.0001 ) but not to age , sex , or stroke severity . There were no significant differences in patient or caregiver satisfaction between the 2 setting s. Conclusions — Better quality of life in patients receiving conventional MDT care may be attributable to improved social functioning and greater attention to higher function and caregiver needs during rehabilitation CONCEPTUAL FRAMEWORK The Academic Center for Evidence -based Practice ( ACE ) Star Model was used to implement an evidence -based clinical practice guideline ( CPG ) in order to decrease  ventilator-associated pneumonia ( VAP ) incidence rates and ventilator days . The goal was to interrupt person-to-person transmission of bacteria and bacterial colonization using low-cost , evidence -based strategies to prevent VAP . DISCOVERY : Two geographically proximate medical centers , inclusive of five intensive care units located in the southwestern region of the United States had significant variations in their VAP rates . EVIDENCE SUMMARY Using the U.S. Preventive Services Task Force grading criteria , the results of 69 studies were used to establish a clinical practice guideline to prevent ventilator-associated pneumonia . TRANSLATION : A clinical practice guideline was developed for the prevention of VAP and included five nursing activities : ( a ) head-of-bed elevation ; ( b ) oral care ; ( c ) ventilator tubing condensate removal ; ( d ) h and hygiene ; and ( e ) glove use . The effect of the CPG , inclusive of an educational intervention , was measured using an observational , prospect i ve , quasi-experimental design . INTEGRATION : A multidisciplinary education team developed a self-learning packet , educational material s , and storyboards for the staff as dissemination strategies . Strategies also included e-mail , one-on-one teaching with clinicians , and feedback on guideline adoption and VAP rate reports . EVALUATION Observation data were collected to evaluate adoption of the CPG  while caring for 106 ventilated patients .  VAP rates changed at both hospitals although the change was not statistically significant . Additionally , the ICU length of stay declined at both facilities , causing cost savings . DISCUSSION These results support the idea that adoption of evidence -based practice s contributes to decreased VAP rates . For a successful program , ICU leaders should emphasize strategies that routinize adoption of evidence -based CPGs OBJECTIVE : To test the cost effectiveness of  Hospital in the Home  compared to hospital admission for acute medical conditions OBJECTIVE To test the hypothesis that implementation of a practice guideline for blood gas measurement would decrease numbers and increase appropriateness of tests ( according to criteria in the guideline ) for up to 1 yr after introduction of the guideline . DESIGN Numbers of tests and appropriateness of each test were measured retrospectively during each of five periods : two baseline periods 2 yrs and 1 yr before introduction of the guideline and three follow-up periods 2 to 3 months , 6 to 7 months , and 12 to 13 months after introduction of the guideline . SETTING A ten-bed multidisciplinary intensive care unit ( ICU ) within a 500-bed tertiary teaching hospital . PATIENTS A r and om sample of 30 patients admitted to the ICU during each of the periods specified above . INTERVENTIONS The nominal group process was used to develop a new guideline and a multipronged educational approach was used to facilitate implementation of the guideline . MEASUREMENTS AND MAIN RESULTS At 2 to 3 months , test numbers decreased from 4.9 + /- 1.6 to 3.1 + /- 1.8 ( SD ) tests/patient/day and to 2.4 + /- 1.2 tests/patient/day at 12 to 13 months . Appropriateness increased from a mean of 44 % at baseline to 78 % at 2 to 3 months and 79 % at 12 to 13 months . There were no differences in Acute Physiology and Chronic Health Evaluation scores or ICU mortality among the patient groups and no differences in number of ventilator days or time to wean from ventilation . Cost-minimization analysis showed that the incremental cost-saving 1 yr after introduction of the guideline was $ 19.18 per patient per day . CONCLUSIONS Implementation of this guideline for arterial blood gas measurement increases efficiency of test utilization without prolonging mechanical ventilation or affecting outcome Total knee arthroplasty ( TKA ) may result in severe pain , and single-injection femoral nerve blocks ( SFNB ) have been demonstrated to have a limited duration of analgesia . Continuous femoral nerve blocks ( CFNB ) can prolong the analgesic duration of SFNB . We prospect ively r and omized 36 patients undergoing TKA to CFNB versus SFNB  and evaluated the effect on hospital length of stay ( LOS ) as the primary outcome within a st and ardized clinical pathway . Secondary outcomes included visual analog scale ( VAS ) pain scores , opioid consumption , and long-term functional recovery at 12 wk . Mean VAS resting scores were significantly lower among patients who received CFNB versus SFNB : first day ( 1.7 vs 3.3 [ P = 0.002 ] ) and second day ( 0.9 vs 3.2 [ P < 0.0001 ] ) after surgery . Mean maximal VAS scores during physical therapy were significantly lower among patients who received CFNB versus SFNB : first day ( 4.7 vs 6.3 [ P = 0.01 ] ) and second day ( 3.9 vs 6.1 [ P = 0.0005 ] ) after surgery . Mean oxycodone consumption was significantly lower among patients who received CFNB versus SFNB : 15 mg versus 40 mg ( P = < 0.0001 ) on the first day after surgery ; 20 mg versus 43 mg ( P = 0.0004 ) on the second day after surgery . There was no difference in hospital LOS ( 3.8 vs 3.9 days ) or long-term functional recovery ( 117 ° versus 113 ° knee flexion at 12 wk ) between the two groups . The lack of effect provided by increased duration of analgesia  ( from CFNB ) after TKA may now have minimal impact on hospital LOS and long-term functional recovery in the contemporary healthcare environment within the United States Eight question naires , which were developed from Hsu ( 1989 , 1995 ) quality monitoring tool ( A and B question naires for four types of patients ) , were r and omly selected to monitor orthopaedic nursing care quality in pre and post-test . Eight question naires that included 50 criteria in each question naire were developed to assure the quality of nursing care . Data collection methods for the quality tools were : ( 1 )  information from the patient ’s record ; ( 2 )  observation of the patient ; ( 3 )  interview with the patient ; ( 4 )  interview with the nurse ; ( 5 ) observation of the nurse ; ( 6 )  observation of the patient ’s environment  , and ( 7 )  observer ’s inference .  Each criterion had design ated methods for its data collection . Observers classified the r and omly selected patients and then appropriate question naires were sequentially selected . The observer review ed the patient ’s chart and completed patients ’ Correspondence : Brian T.-H. Chen , FL.18 - 1 , No. 151 , Section 4 , Shin-yi Rd , Taipei , Taiwan Telephone : 00886910025454 , E-mail : Study objective : To evaluate the impact of a protocol on partner abuse ( PA ) at increasing identification and improving acute management of abused women by emergency department ( ED ) staff UNLABELLED This study , conducted before and after the implementation of an  acute pain service ( APS ) in a 1000-bed hospital , describes the process of the implementation of an APS . The nursing , anesthesia , and surgery departments were involved . In this study we sought to evaluate the results of a continuous quality improvement program by defining quality indicators and using quality tools . A quality program in accordance with current st and ards of acute pain treatment ( multimodal ) was worked out to enhance pain relief for all surgical in patients . A survey of nurses ' knowledge with regard to postoperative pain was conducted , and a  visual analog scale ( VAS ) was introduced to assess pain intensity . Both nurses and physicians became familiar with evidence -based guidelines concerning postoperative pain . The entire process was monitored in three consecutive surveys and enrolled 2383 surgical in patients .  Pain indicators based on VAS and analgesic consumption were recorded during the first 72 postoperative hours . After a baseline survey about current practice s of pain treatment , a nurse-based , anesthesiologist-supervised APS was implemented . The improvement in pain relief , expressed as VAS scores , was assessed in two further surveys . A quality manual was written and implemented . A major improvement in pain scores was observed after 
    Output:
    
There was no evidence of differences in readmission to hospital or in-hospital mortality .
Length of stay was the most commonly employed outcome measure with most studies reporting significant reductions .
Clinical pathways are associated with reduced in-hospital complications and improved documentation without negatively impacting on length of stay and hospital costs