***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 Computerized medical decision support tools have been shown to improve the quality of care and have been cited by the Institute of Medicine as one method to reduce pharmaceutical errors . We evaluated the impact of an antiinfective decision support tool in a pediatric intensive care unit ( PICU ) . METHODS We enhanced an existing adult antiinfective management tool by adding and changing medical logic to make it appropriate for pediatric patients . Process and outcomes measures were monitored prospect ively during a 6-month control and a 6-month intervention period . M and atory use of the decision support tool was initiated for all antiinfective orders in a 26-bed PICU during the intervention period . Clinician opinions of the decision support tool were surveyed via question naire . RESULTS The rate of pharmacy interventions for erroneous drug doses declined by 59 % . The rate of anti-infective subtherapeutic patient days decreased by 36 % , and the rate of excessive-dose days declined by 28 % . The number of orders placed per antiinfective course decreased 11.5 % , and the robust estimate of the antiinfective costs per patient decreased 9 % . The type of anti-infectives ordered and the number of antiinfective doses per patient remained similar , as did the rates of adverse drug events and antibiotic-bacterial susceptibility mismatches . The surveyed clinicians reported that use of the program improved their antiinfective agent choices as well as their awareness of impairments in renal function and reduced the likelihood of adverse drug events . CONCLUSIONS Use of the pediatric antiinfective decision support tool in a PICU was considered beneficial to patient care by the clinicians and reduced the rates of erroneous drug orders , improved therapeutic dosage targets , and was associated with a decreased robust estimate of antiinfective costs per patient . antiinfective agents , decision support systems , drug therapy , medication errors , child , infant 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 Introduction The study aim ed to compare the impact of computerised physician order entry ( CPOE ) without decision support with h and -written prescribing ( HWP ) on the frequency , type and outcome of medication errors ( MEs ) in the intensive care unit . Methods Details of MEs were collected before , and at several time points after , the change from HWP to CPOE . The study was conducted in a London teaching hospital 's 22-bedded general ICU . The sampling periods were 28 weeks before and 2 , 10 , 25 and 37 weeks after introduction of CPOE . The unit pharmacist prospect ively recorded details of MEs and the total number of drugs prescribed daily during the data collection periods , during the course of his normal chart review . Results The total proportion of MEs was significantly lower with CPOE ( 117 errors from 2429 prescriptions , 4.8 % ) than with HWP ( 69 errors from 1036 prescriptions , 6.7 % ) ( p < 0.04 ) . The proportion of errors reduced with time following the introduction of CPOE ( p < 0.001 ) . Two errors with CPOE led to patient harm requiring an increase in length of stay and , if administered , three prescriptions with CPOE could potentially have led to permanent harm or death . Differences in the types of error between systems were noted . There was a reduction in major/moderate patient outcomes with CPOE when non-intercepted and intercepted errors were combined ( p = 0.01 ) . The mean baseline APACHE II score did not differ significantly between the HWP and the CPOE periods ( 19.4 versus 20.0 , respectively , p = 0.71 ) . Conclusion Introduction of CPOE was associated with a reduction in the proportion of MEs and an improvement in the overall patient outcome score ( if intercepted errors were included ) . Moderate and major errors , however , remain a significant concern with CPOE CONTEXT Adverse drug events ( ADEs ) are a significant and costly cause of injury during hospitalization . OBJECTIVES To evaluate the efficacy of 2 interventions for preventing nonintercepted serious medication errors , defined as those that either result ed in or had potential to result in an ADE and were not intercepted before reaching the patient . DESIGN Before-after comparison between phase 1 ( baseline ) and phase 2 ( after intervention was implemented ) and , within phase 2 , a r and omized comparison between physician computer order entry ( POE ) and the combination of POE plus a team intervention . SETTING Large tertiary care hospital . PARTICIPANTS For the comparison of phase 1 and 2 , all patients admitted to a stratified r and om sample of 6 medical and surgical units in a tertiary care hospital over a 6-month period , and for the r and omized comparison during phase 2 , all patients admitted to the same units and 2 r and omly selected additional units over a subsequent 9-month period . INTERVENTIONS A physician computer order entry system ( POE ) for all units and a team-based intervention that included changing the role of pharmacists , implemented for half the units . MAIN OUTCOME MEASURE Nonintercepted serious medication errors . RESULTS Comparing identical units between phases 1 and 2 , nonintercepted serious medication errors decreased 55 % , from 10.7 events per 1000 patient-days to 4.86 events per 1000 ( P=.01 ) . The decline occurred for all stages of the medication-use process . Preventable ADEs declined 17 % from 4.69 to 3.88 ( P=.37 ) , while nonintercepted potential ADEs declined 84 % from 5.99 to 0.98 per 1000 patient-days ( P=.002 ) . When POE-only was compared with the POE plus team intervention combined , the team intervention conferred no additional benefit over POE . CONCLUSIONS Physician computer order entry decreased the rate of nonintercepted serious medication errors by more than half , although this decrease was larger for potential ADEs than for errors that actually result ed in an ADE OBJECTIVE Authors evaluated whether displaying context sensitive links to infrequently accessed educational material s and patient information via the user interface of an inpatient computerized care provider order entry ( CPOE ) system would affect access rates to the material s. DESIGN The CPOE of V and erbilt University Hospital ( VUH ) included " baseline " clinical decision support advice for safety and quality . Authors augmented this with seven new primarily educational decision support features . A prospect i ve , r and omized , controlled trial compared clinicians ' utilization rates for the new material s via two interfaces . Control subjects could access study -related decision support from a menu in the st and ard CPOE interface . Intervention subjects received active notification when study -related decision support was available through context sensitive , visibly highlighted , selectable hyperlinks . MEASUREMENTS Rates of opportunities to access and utilization of study -related decision support material s from April 1999 through March 2000 on seven VUH Internal Medicine wards . RESULTS During 4,466 intervention subject-days , there were 240,504 ( 53.9/subject-day ) opportunities for study -related decision support , while during 3,397 control subject-days , there were 178,235 ( 52.5/subject-day ) opportunities for such decision support , respectively ( p = 0.11 ) . Individual intervention subjects accessed the decision support features  at least once on 3.8 % of subject-days logged on ( 278 responses ) ; controls accessed it at least once on 0.6 % of subject-days ( 18 responses ) , with a response rate ratio adjusted for decision support frequency of 9.17 ( 95 % confidence interval 4.6 - 18 , p < 0.0005 ) . On average , intervention subjects accessed study -related decision support material s once every 16 days individually and once every 1.26 days in aggregate . CONCLUSION Highlighting availability of context -sensitive educational material s and patient information through visible hyperlinks significantly increased utilization rates for study -related decision support when compared to " st and ard " VUH CPOE methods , although absolute response rates were low BACKGROUND Although they are effective in outpatient setting s , computerized reminders have not been proved to increase preventive care in inpatient setting s. METHODS We conducted a r and omized , controlled trial to determine the effects of computerized reminders on the rates at which four preventive therapies were ordered for in patients . During an 18-month study period , a computerized system processed on-line information for all 6371 patients admitted to a general-medicine service ( for a total of 10,065 hospitalizations ) , generating preventive care reminders as appropriate . Physicians who were in the intervention group viewed these reminders when they were using a computerized order-entry system for in patients . RESULTS The reminder system identified 3416 patients ( 53.6 percent ) as eligible for preventive measures that had not been ordered by the admitting physician . For patients with at least one indication , computerized reminders result ed in higher adjusted ordering rates for pneumococcal vaccination ( 35.8 percent of the patients in the intervention group vs. 0.8 percent of those in the control group , P<0.001 ) ,  influenza vaccination ( 51.4 percent vs. 1.0 percent , P < 0.001 ) , prophylactic heparin ( 32.2 percent vs. 18.9 percent , P<0.001 ) , and prophylactic aspirin at discharge ( 36.4 percent vs. 27.6 percent , P<0.001 ) . CONCLUSIONS A majority of hospitalized patients in this study were eligible for preventive measures , and computerized reminders significantly increased the rate of delivery of such therapies BACKGROUND Numerous studies have shown that specific computerized interventions may reduce medication errors , but few have examined adverse drug events ( ADEs ) across all stages of the computerized medication process . We describe the frequency and type of inpatient ADEs that occurred following the adoption of multiple computerized medication ordering and administration systems , including computerized physician order entry ( CPOE ) . METHODS Using explicit st and ardized criteria , pharmacists classified inpatient ADEs from prospect i ve daily review s of electronic medical records from a r and om sample of all admissions during a 20-week period at a Veterans Administration hospital . We analyzed ADEs that necessitated a changed treatment plan . RESULTS Among 937 hospital admissions , 483 clinical ly significant inpatient ADEs were identified , accounting for 52 ADEs per 100 admissions and an incidence density of 70 ADEs per 1000 patient-days . One quarter of the hospitalizations had at least 1 ADE . Of all ADEs , 9 % result ed in serious harm , 22 % in additional monitoring and interventions , 32 % in interventions alone , and 11 % in monitoring alone ; 27 % should have result ed in additional interventions or monitoring . Medication errors contributed to 27 % of these ADEs . Errors associated with ADEs occurred in the following stages : 61 % ordering , 25 % monitoring , 13 % administration , 1 % dispensing , and 0 % transcription . The medical record reflected recognition of 76 % of the ADEs . CONCLUSIONS High rates of ADEs may continue to occur after implementation of CPOE and related computerized medication systems that lack decision support for drug selection , dosing , and monitoring OBJECTIVE Medication errors are a major concern of health care professionals and medical institutions , especially errors involving children . Studies in adults have shown that computerized physician order entry ( CPOE ) systems reduce medication errors and adverse drug events ( ADEs ) . The effect of CPOE implementation in a pediatric population has not been reported . The objective of this study was to evaluate the impact of CPOE on the frequency of errors in the medication ordering process in a pediatric critical care unit ( PCCU ) . METHODS A prospect i ve trial was conducted of 514 pediatric patients who were admitted to a 20-bed PCCU in a tertiary-care children 's hospital before and after implementation of CPOE .  Medication errors were identified after review of all orders during the study period and then further classified as potential ADEs , medication prescribing errors ( MPE ) , and rule violations ( RV ) . RESULTS A 
    Output:
    
The impact of CPOE systems was especially positive in the category adherence to guidelines , but also to some extent in alerts and appropriateness of alerts ; costs and organizational efficiency ; and satisfaction and usability .
Some recent studies suggested that errors , adverse drug events ( ADEs ) and even mortality increased after CPOE implementation .
Only in the category time the impact has been shown to be negative , but this only refers to the physician 's time , not the net time .
Except for safety , on the whole spectrum of outcomes , results of RCT studies were in line with non- RCT study results