***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: OBJECTIVE To assess the effects on health care re source utilization of a network of microcomputer workstations for writing all inpatient orders . DESIGN R and omized controlled clinical trial . SETTING Inpatient internal medicine service of an urban public hospital . SUBJECTS A total of 5219 internal medicine patients and the 68 teams of house officers , medical students , and faculty internists who cared for them . INTERVENTION Microcomputer workstations , linked to a comprehensive electronic medical record system , for writing all inpatient orders . MAIN OUTCOME MEASURES Total inpatient charges for each admission and charges for specific categories of orders . A time-motion study of selected interns assessed the ordering system 's time consumption . RESULTS Intervention teams generated charges that were $ 887 ( 12.7 % ) lower per admission than did control teams ( P = .02 ) . Significant reductions ( P < .05 ) were demonstrated separately for bed charges , diagnostic test charges , and drug charges . Reductions of similar proportion and statistical significance were found for hospital costs . The mean length of stay was 0.89 day shorter for intervention resident teams ( P = .11 ) . Interns in the intervention group spent an average of 33 minutes longer ( 5.5 minutes per patient ) during a 10-hour observation period writing orders than did interns in the control group ( P < .0001 ) . CONCLUSIONS A network of microcomputer workstations for writing all inpatient orders significantly lowered patient charges and hospital costs . This would amount to savings of more than $ 3 million in charges annually for this hospital 's medicine service and potentially tens of billions of dollars nationwide . However , the system required more physician time than did the paper charts . Research at other sites and system advances to reduce time requirements are warranted To assess the effectiveness of predetermined investigation criteria for the examination of faecal sample s from in patients , cultured stool specimens were prospect ively examined for Salmonella spp , Shigella spp , Campylobacter spp and Clostridium difficile , and screened microscopically for intestinal parasites . Out of a total of 505 specimens , 421 ( 83 % ) fulfilled the criteria for examination for C difficile , 254 ( 50 % ) for Salmonella spp , Shigella spp , and Campylobacter spp , and 87 ( 17 % ) for intestinal parasites . Isolation rates for these organisms in those groups of patients where examination was indicated were 22.5 % for C difficile and 9.1 % for Salmonella spp , Shigella spp , and Campylobacter spp ; the detection rate for parasites was 3.5 % . In those patients where the criteria did not suggest investigation , the isolation or detection rates were 3.6 % for C difficile , 0 % for Salmonella spp , Shigella spp , and Campylobacter spp , and 1.7 % for intestinal parasites , suggesting that the use of predetermined investigation criteria was effective HYPOTHESES Laboratory investigations are inappropriately utilized in the Pediatric OPD of Ramathibodi Hospital and this is due to lack of knowledge and unawareness of the cost of tests . OBJECTIVES 1 ) To obtain information on laboratory utilization . 2 ) To evaluate the appropriateness of the residents ' test ordering behavior . 3 ) To estimate the cost of unnecessary tests . 4 ) To reduce the utilization by combined education , feedback , and peer- review strategies . STUDY DESIGN R and omized controlled trial carried out from January 1987 to May 1988 , consisting of pre-intervention period ( Jan-May 1987 ) . intervention period ( June-November 1987 ) , and post-intervention period ( July 1987-May 1988 ) . STUDY POPULATION There were 3 intervention groups and 3 control control groups which were stratified by level of seniority as 10 first year residents ( R1I vs R1C ) , 8 second year residents ( R2I vs R2C ) , and 18 staff ( SI vs SC ) . INTERVENTION For the residents , education on diagnostic tests , chart audit and feedback on their test ordering behavior were provided twice a week . The second year residents also played an active role in giving comments on the first year residents ' performances . For the staff , the strategy used was peer- review . The simulated cases derived from the actual medical records serviced by the residents were review ed and rated , according to the appropriateness of the residents ' test ordering behavior , from 0 ( poor ) to 10 ( excellent ) . A score of less than 5 was considered to indicate inappropriate ordering behavior . OUTCOME 1 ) Numbers and cost of tests per patient for each group . 2 ) The achievement of a score indicating appropriate test ordering behavior of the resident groups . STATISTICAL ANALYSIS Kruskal-Wallis test , Mann Whitney test , Wilcoxon test and Chi-square test . RESULTS 1 . The utilization pattern was not correlated to the level of seniority of the physicians . 2 . There was inappropriate laboratory utilization in this group of residents : overutilization defined as should not be ordered ( 26.9 % ) , and underutilization defined as should have been ordered ( 17.7 % ) . Most of the inappropriateness occurred in the ordering of microbiology ( 50 % ) and special blood chemistry ( 40 % ) . 3 . Only the number of tests per patient ordered by the R2I group was significantly lower than that of the R2C group in the late post-intervention period . The cost of tests per patient ordered by the R2C group was significantly increased as compared to their baseline . This suggested that the combination of education , chart audit and active feedback strategies was more effective than each strategy alone . 4 . The appropriateness of the test ordering behavior of the resident intervention groups improved during the post-intervention period , although the change was not statistically significant . The control groups ' behavior was statistically worse . This suggested that the strategy prevented the inappropriateness of test ordering behavior . 5 . With the intervention , the overutilization significantly decreased while the underutilization increased . The underutilization might be a consequence of cost containment on laboratory utilization . 6 . The cost of unnecessary tests accounted for 17.6 per cent of the total cost of tests ordered by the residents The st and ard way to assess medical technologies is to conduct a r and omized clinical trial . Patients are r and omly assigned to groups receiving alternative treatments , and outcomes are monitored over a long period of time . For example , some victims of left main coronary artery disease may undergo coronary artery bypass surgery , and others may receive medical treatment with nitroglycerine and beta blockers . Comparison of five-year mortality and morbidity in the two groups helps to determine the relative appropriateness of the two procedures . In addition , information about quality of life and cost can also be collected and compared BACKGROUND Fecal cultures are often inappropriately requested in the investigation of diarrhea . OBJECTIVES To develop and determine the efficacy of practice guidelines for the ordering and processing of stool cultures that are su bmi tted for the diagnosis of community-acquired diarrhea . METHODS The results of stool cultures that were su bmi tted to the microbiology laboratory of a tertiary care nonteaching community hospital were retrospectively review ed . Following the implementation of guidelines , the efficacy was evaluated by comparison of fecal culture results in a prospect i ve manner . RESULTS Analysis of results of stool cultures that were obtained from 3072 patients during a 3-year period revealed that ( 1 ) the sensitivity ( 40 % ) and predictive value ( 20 % ) of finding neutrophils in smear preparations were too low to be clinical ly useful , ( 2 ) routine cultures from patients with nosocomial diarrhea were uniformly negative , and ( 3 ) multiple specimens from a patient rarely provided additional information . Based on these findings , new guidelines were developed and implemented with the cooperation of clinical staff . Three-month follow-up results showed that the total number of specimens , the number of specimens from patients with nosocomial diarrhea , and multiple specimens declined by 37.7 % , 70.6 % , and 50 % , respectively . However , the isolation rate of pathogens increased from 11.7 % to 18.7 % . CONCLUSIONS The application of practice guidelines that include elimination of smear examination of rectal swabs , exclusion of routine cultures from patients with nosocomial diarrhea , and rejection of repeated cultures can result in significant cost saving without adversely affecting patient care We studied the effect of informing physicians of the charges for outpatient diagnostic tests on their ordering of such tests in an academic primary care medical practice . All tests were ordered at microcomputer workstations by 121 physicians . For half ( the intervention group ) , the charge for the test being ordered and the total charge for tests for that patient on that day were displayed on the computer screen . The remaining physicians ( control group ) also used the computers but received no message about charges . The primary outcomes measured were the number of tests ordered and the charges for tests per patient visit . In the 14 weeks before the study , the number of tests ordered and the average charge for tests per patient visit were similar for the intervention and control groups . During the 26-week intervention period , the physicians in the intervention group ordered 14 percent fewer tests per patient visit than did those in the control group ( P less than 0.005 ) , and the charges for tests were 13 percent ( $ 6.68 per visit ) lower ( P less than 0.05 ) . The differences were greater for scheduled visits ( 17 percent fewer tests and 15 percent lower charges for the intervention group ; P less than 0.01 ) than for unscheduled ( urgent ) visits ( 11 percent fewer tests and 10 percent lower charges ; P greater than 0.3 ) . During the 19 weeks after the intervention ended , the number of tests ordered by the physicians in the intervention group was only 7.7 percent lower than the number ordered by the physicians in the control group , and the charges for tests were only 3.5 percent lower ( P greater than 0.3 ) . Three measures of possible adverse outcomes --number of hospitalizations , emergency room visits , and outpatient visits during the study period and the following six months -- were similar for the patients seen by the physicians in both groups . We conclude that displaying the charges for diagnostic tests significantly reduced the number and cost of tests ordered , especially for patients with scheduled visits . The effects of this intervention did not persist after it was discontinued We developed statistical equations to predict abnormalities on eight commonly ordered diagnostic tests and we gave the predictions to 112 physicians practicing in an academic internal medicine practice . Half of each physician 's patients were r and omized to intervention status .  All diagnostic tests were ordered by microcomputer , and when a physician ordered one of the eight study tests for an intervention patient , the computer displayed the probability ( 0 % to 100 % ) that the test would be positive for the main abnormality being tested for . The physician could then cancel the test if desired . During a six-month controlled trial , when there were more than 15,000 scheduled patient visits , patient charges for the eight study tests were 8.8 % less for the intervention patients . The largest reductions ( greater than 10 % ) were for serum electrolyte level tests and complete blood cell counts , the two most commonly ordered tests . Physicians ordered fewer low-probability tests for intervention patients than for controls , suggesting that with timely predictive information , physicians can target tests to higher-risk patients STUDY OBJECTIVE To determine the effect of displaying previous results of diagnostic tests on the ordering of selected outpatient tests . DESIGN Sixteen-week controlled trial with a 13-week pre-intervention and 8-week post-intervention observation periods . Patients were r and omly assigned to intervention or control groups so that each physician was his or her own control . Only scheduled visits were included . R and omization occurred before the pre-intervention observation period . SETTING Academic primary care general medicine clinic affiliated with an urban general hospital . SUBJECTS Pre-intervention period : 111 physicians ( 97 internal medicine residents , 14 faculty internists ) , 4683 patients , 5942 scheduled visits . INTERVENTION period : same 111 physicians , 5946 patients , 8148 visits . Post-intervention period : 76 physicians ( 62 residents , 14 faculty ) , 2571 patients , 2858 scheduled visits . INTERVENTION With an order for one of eight selected diagnostic tests through microcomputer workstations , a window was opened on the screen and previous test results were displayed along with the time interval between the first and last result . Tests were ordered for control patients into the same workstations without previous results displayed . MEASUREMENTS AND MAIN RESULTS Previous results of one or more study tests were available for display for 96 % of scheduled patients . Significantly lower results ( p less than 0.05 by paired t-test ) for the selected tests were found for intervention patient visits than for control visits : charges per visit ( mean + /- SE ) for intervention patients $ 12.17 + /- 0.62 , compared with $ 13.99 + /- 0.77 for controls , a 13.0 % difference ; tests per visit were 0.51 + /- 0.03 , compared with 0.56 + /- 0.03 , an 8.5 % difference . The number of study tests ordered decreased significantly for intervention patients ( 16.8 % ) and for controls ( 10.9 % ) . During the post-intervention period , ordering of study tests increased for both groups , but the increase from the intervention period was not significant . CONCLUSIONS Presenting physicians with previous test results reduced the ordering of those tests . The actual effect may have been greater than 13 % , because there were reductions in study tests ordered for both intervention and control patients during the intervention period when compared with the pre-intervention period , and both tended to rise after the intervention , or display , was turned off To determine if the application of an information-based management system in adult intensive care units ( ICU ) can produce sustained decre 
    Output:
    
Evidence supporting the explicit criteria was frequently weak by the st and ards suggested for therapeutic maneuvers , but was nonetheless compelling based on principles of physiology , pharmacology , and probability .