***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: UNLABELLED RATIONALE , AIMS & OBJECTIVE : Tools for the assessment of the quality of research studies tend to be specific to a particular research design ( e.g. r and omized controlled trials , or qualitative interviews ) . This makes it difficult to assess the quality of a body of research that addresses the same or a similar research question but using different approaches . The aim of this paper is to describe the development and preliminary evaluation of a  quality assessment tool that can be applied to a method ologically diverse set of research articles . METHODS The  16-item quality assessment tool ( QATSDD )  was assessed to determine its reliability and validity when used by health services research ers in the disciplines of psychology , sociology and nursing . Qualitative feedback was also gathered from mixed- methods health research ers regarding the comprehension , content , perceived value and usability of the tool . RESULTS Reference to existing widely used quality assessment tools and experts in systematic review confirmed that the components of the tool represented the construct of ' good research technique ' being assessed . Face validity was subsequently established through feedback from a sample of nine health research ers .  Inter-rater reliability was established through substantial agreement between three review ers when applying the tool to a set of three research papers ( κ = 71.5 % ) , and good to substantial agreement between their scores at time 1 and after a 6-week interval at time 2 confirmed test-retest reliability . CONCLUSIONS The QATSDD shows good reliability and validity for use in the quality assessment of a diversity of studies , and may be an extremely useful tool for review ers to st and ardize and increase the rigour of their assessment s in review s of the published papers which include qualitative and quantitative work OBJECTIVE Although early warning scores were originally derived as bedside tools for alerting the medical staff , they may serve as decision rules for the admission of medical patients . We conducted this study to investigate the ability of the  Modified Early Warning Score ( MEWS )  to identify a subset of patients at risk of deterioration , who might benefit from an increased level of attention . DESIGN Prospect i ve , single centre , cohort study . SETTING A 64-bedded medical ward in a public , non-teaching Hospital in Italy . PATIENTS All patients consecutively admitted from 15th November 2005 to 9th June 2006 . INTERVENTIONS On admission , the attending physician measured five physiological parameters ( systolic blood pressure , pulse rate , respiratory rate , body temperature and level of consciousness ) and calculated the MEWS .  The main outcome measures were in-hospital mortality and a composite of mortality and transfer to a higher level of care . A secondary end-point was the length of stay for discharged patients . MEASUREMENTS AND RESULTS In all , 1107 patients were admitted ; 621 ( 56.1 % ) were women and 486 were men . Patients of female gender were also older ( mean age 80.6 years ) than men ( mean age 77.1 ; p < 0.05 ) . Of 1107 , 995 patients ( 89.9 % ) were older than 64 years . A total of 966 patients were discharged , 102 deceased and 39 were transferred . In comparison with the lowest score , the risk of death was incremental among all the MEWS categories , as well as the risk of the combined outcome of death and transfer , and highly significant ( risk of death , chi(2 ) for trend 136.307 ; risk of death or transfer , chi(2 ) for trend 105.762 ; p < 0.00001 for both ) . Patients with MEWS < or = 4 were discharged after a mean stay of 8.3 days , and alive patients with MEWS of five or more were discharged after a mean stay of 9.4 days ( p = ns ) . A patient with a MEWS of zero at admission has a very low probability to die or to be transferred because of clinical instability ( OR 0.14 , 95 % CI : 0.08 - 0.24 ) . CONCLUSIONS We have confirmed that the MEWS , even when calculated once on admission , is a simple but highly useful tool to predict a worse in-hospital outcome Background In 2007 , the initiation of a patient safety campaign led to the introduction of Ward Observational Charts ( WOC ) and Medical Early Warning Score ( MEWS ) at Naestved Regional Hospital . This included systematic measuring of vital signs of all patients in order to prevent patient deterioration and assure timely and correct initiation of treatment . The aim of this study was to assess to what degree WOC guidelines being followed by ward staff . Design and Setting A 7-day prospect i ve , observational , r and omised , cross-sectional , point prevalence study of WOC guideline compliance in hospitalised patients on twelve wards at Naestved Hospital . Results The study included 132 patients . Of these , 58 % had been observed and managed correctly according to WOC guidelines . 77 % had all MEWS elements recorded by staff . One patient had no MEWS elements recorded . Only 38 % of patients with abnormal MEWS were correctly escalated by nursing staff . Staff was aware of the abnormal MEWS observed by investigator in 60 % of the patients . Each element of WOC was on average recorded by staff in 90 % of the patients . Conclusion At the time of our study , the long-term implementation of WOC guidelines has not been completed satisfactorily . The lacking component in the implementation of MEWS and WOC is the documentation of action taken upon finding an abnormal value . Unsuccessful implementation could result in incorrect results from evaluation of an early warning system . We suggest a re design of the training programme to educate staff in recognising and caring for critically ill patients at Naestved Hospital Abstract Objective . To document the characteristics and incidence of serious abnormalities in patients prior to admission to intensive care units . Design and setting . Prospect i ve follow-up study of all patients admitted to intensive care in three acute-care hospitals . Patients . The study population totalled 551 patients admitted to intensive care : 90 from the general ward , 239 from operating rooms ( OR ) and 222 from the Emergency Department ( ED ) . Measurements and results . Patients from the general wards had greater severity of illness ( APACHE II median 21 ) than those from the OR ( 15 ) or ED ( 19 ) . A greater percentage of patients from the general wards ( 47.6 % ) died than from OR ( 19.3 % ) and ED ( 31.5 % ) . Patients from the general wards had a greater number of serious antecedents before admission to intensive care 43 ( 72 % ) than those from OR 150 ( 64.4 % ) or ED 126 ( 61.8 % ) . Of the 551 patients 62 had antecedents during the period 8–48 h before admission to intensive care , and 53 had antecedents both within 8 and 48 h before their admission . The most common antecedents during the 8 h before admission were hypotension ( n=199 ) , tachycardia ( n=73 ) , tachypnoea ( n=64 ) , and sudden change in level of consciousness ( n=42 ) . Concern was expressed in the clinical notes by attending staff in 70 % of patients admitted from the general wards . Conclusions . In over 60 % of patients admitted to intensive care potentially life-threatening abnormalities were documented during the 8 h before their admission . This may represent a patient population who could benefit from improved resuscitation and care at an earlier stage The Early Warning Score ( EWS ) is a simple physiological scoring system suitable for bedside application . The ability of a modified Early Warning Score ( MEWS ) to identify medical patients at risk of catastrophic deterioration in a busy clinical area was investigated . In a prospect i ve cohort study , we applied MEWS to patients admitted to the 56-bed acute Medical Admissions Unit ( MAU ) of a District General Hospital ( DGH ) . Data on 709 medical emergency admissions were collected during March 2000 . Main outcome measures were death , intensive care unit ( ICU ) admission , high dependency unit ( HDU ) admission , cardiac arrest , survival and hospital discharge at 60 days . Scores of 5 or more were associated with increased risk of death ( OR 5.4 , 95%CI 2.8 - 10.7 ) , ICU admission ( OR 10.9 , 95%CI 2.2 - 55.6 ) and HDU admission ( OR 3.3 , 95%CI 1.2 - 9.2 ) . MEWS can be applied easily in a DGH medical admission unit , and identifies patients at risk of deterioration who require increased levels of care in the HDU or ICU . A clinical pathway could be created , using nurse practitioners and /or critical care physicians , to respond to high scores and intervene with appropriate changes in clinical management AIM To determine whether the introduction of a multi-faceted intervention ( newly design ed ward observation chart , a track and trigger system and an associated education program , COMPASS ) to detect clinical deterioration in patients would decrease the rate of predefined adverse outcomes . METHODS A prospect i ve , controlled before- and -after intervention of trial was conducted in all consecutive adult patients admitted to four medical and surgical wards during a 4 month period , 1157 and 985 , respectively . A sub-group of patients underwent vital sign and medical review analysis  pre-intervention ( 427 ) and post-intervention ( 320 ) . The outcome measures included : number of unplanned admissions to the intensive care unit ( ICU ) , Medical Emergency Team ( MET ) review s and unexpected hospital deaths , vital sign documentation frequency and incidence of a medical review following clinical deterioration . This study is registered , ACTRN12609000808246 . RESULTS Reductions were seen in unplanned admissions to ICU ( 21/1157 [ 1.8 % ] vs. 5/985 [ 0.5 % ] , p=0.006 ) and unexpected hospital deaths ( 11/1157 [ 1.0 % ] vs. 2/985 [ 0.2 % ] , p=0.03 ) during the intervention period . Medical review s for patients with significant clinical instability ( 58/133 [ 43.6 % ] vs. 55/79 [ 69.6 % ] p<0.001 ) and number of patients receiving a MET review increased ( 25/1157 [ 2.2 % ] vs. 38/985 [ 3.9 % ] p=0.03 ) during the intervention period . Mean daily frequency of documentation of all vital signs increased during the intervention period ( 3.4 [ SE 0.22 ] vs. 4.5 [ SE 0.17 ] , p=0.001 ) . CONCLUSION The introduction of a multi-faceted intervention to detect clinical deterioration may benefit patients through increased monitoring of vital signs and the triggering of a medical review following an episode of clinical instability BACKGROUND Patients with a cardiac arrest or unplanned intensive care admission show gradual decline in clinical condition preceding the event . This can be objectified by measuring the vital parameters and subsequently determining the Modified Early Warning Score ( MEWS ) . Contact with the physician by nurses may be structured using the Situation- Background - Assessment - Recommendation ( SBAR ) communication instrument . The aim of our study was to evaluate whether nurses trained in the use of MEWS and SBAR tools were more likely to recognize a deteriorating patient . DESIGN AND SETTING This prospect i ve quasi-experimental trial in the Academic Medical Center in Amsterdam , the Netherl and s included three medical and three surgical wards . INTERVENTIONS A group of 47 trained and 48 non-trained nurses were presented with a case of a deteriorating patient , and subsequent assessment and actions regarding the patient case were measured . RESULTS Of the trained nurses , 77 % versus 58 % of the non-trained group assessed the patient immediately . On subsequent assessment of the patient , respiratory rate was measured twice as frequently ( 53 % trained versus 25 % non-trained , p=0.025 ) . No differences were found in the measurement of other vital parameters . The MEWS was determined by 11 % of trained nurses . Subsequent notification of the physician was performed by 67 % of the trained versus 43 % of the non-trained nurses . The SBAR communication tool was used by only one nurse . CONCLUSIONS Trained nurses are able to identify a deteriorating patient and react more appropriately . However , despite rigorously implementing MEWS/SBAR methodology , these tools were rarely used BACKGROUND Early warning scores ( EWSs ) assign points to clinical observations and generate scores to help clinicians identify deteriorating patients . Despite marginal predictive accuracy in retrospective data sets and a paucity of studies prospect ively evaluating their clinical effectiveness , pediatric EWSs are commonly used . OBJECTIVE To identify mechanisms beyond their statistical ability to predict deterioration by which physicians and nurses use EWSs to support their decision making . DESIGN Qualitative study . SETTING A children 's hospital with a rapid response system . PARTICIPANTS Physicians and nurses who recently cared for patients with false-positive and false-negative EWSs ( score failures ) . INTERVENTION Semistructured interviews . MEASUREMENTS Themes identified through grounded theory analysis . RESULTS Four themes emerged among the 57 subjects interviewed : ( 1 ) The EWS facilitates safety by alerting physicians and nurses to concerning changes and prompting them to think critically about deterioration . ( 2 ) The EWS provides less-experienced nurses with vital sign reference ranges . ( 3 ) The EWS serves as evidence that empowers nurses to overcome barriers to escalating care . ( 4 ) In stable patients , those with baseline abnormal physiology , and those experiencing neurologic d 
    Output:
    
Conclusion PTTSs can improve patient safety and quality of care .