***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 
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    ***EXAMPLES*** 
    Input: BACKGROUND Improved blood-glucose control decreases the progression of diabetic microvascular disease , but the effect on macrovascular complications is unknown . There is concern that sulphonylureas may increase cardiovascular mortality in patients with type 2 diabetes and that high insulin concentrations may enhance atheroma formation . We compared the effects of intensive blood-glucose control with either sulphonylurea or insulin and conventional treatment on the risk of microvascular and macrovascular complications in patients with type 2 diabetes in a r and omised controlled trial . METHODS 3867 newly diagnosed patients with type 2 diabetes , median age 54 years ( IQR 48 - 60 years ) , who after 3 months ' diet treatment had a mean of two fasting plasma glucose ( FPG ) concentrations of 6.1 - 15.0 mmol/L were r and omly assigned intensive policy with a sulphonylurea ( chlorpropamide , glibenclamide , or glipizide ) or with insulin , or conventional policy with diet . The aim in the intensive group was FPG less than 6 mmol/L. In the conventional group , the aim was the best achievable FPG with diet alone ; drugs were added only if there were hyperglycaemic symptoms or FPG greater than 15 mmol/L. Three aggregate endpoints were used to assess differences between conventional and intensive treatment :  any diabetes-related endpoint ( sudden death , death from hyperglycaemia or hypoglycaemia , fatal or non-fatal myocardial infa rct ion , angina , heart failure , stroke , renal failure , amputation [ of at least one digit ] , vitreous haemorrhage , retinopathy requiring photocoagulation , blindness in one eye , or cataract extraction ) ; diabetes-related death ( death from myocardial infa rct ion , stroke , peripheral vascular disease , renal disease , hyperglycaemia or hypoglycaemia , and sudden death ) ; all-cause mortality . Single clinical endpoints and surrogate sub clinical endpoints were also assessed . All analyses were by intention to treat and frequency of hypoglycaemia was also analysed by actual therapy . FINDINGS Over 10 years , haemoglobin A1c ( HbA1c ) was 7.0 % ( 6.2 - 8.2 ) in the intensive group compared with 7.9 % ( 6.9 - 8.8 ) in the conventional group -- an 11 % reduction . There was no difference in HbA1c among agents in the intensive group . Compared with the conventional group , the risk in the intensive group was 12 % lower ( 95 % CI 1 - 21 , p=0.029 ) for any diabetes-related endpoint ; 10 % lower ( -11 to 27 , p=0.34 ) for any diabetes-related death ; and 6 % lower ( -10 to 20 , p=0.44 ) for all-cause mortality . Most of the risk reduction in the any diabetes-related aggregate endpoint was due to a 25 % risk reduction ( 7 - 40 , p=0.0099 ) in microvascular endpoints , including the need for retinal photocoagulation . There was no difference for any of the three aggregate endpoints between the three intensive agents ( chlorpropamide , glibenclamide , or insulin ) . Patients in the intensive group had more hypoglycaemic episodes than those in the conventional group on both types of analysis ( both p<0.0001 ) . The rates of major hypoglycaemic episodes per year were 0.7 % with conventional treatment , 1.0 % with chlorpropamide , 1.4 % with glibenclamide , and 1.8 % with insulin .  Weight gain was significantly higher in the intensive group ( mean 2.9 kg ) than in the conventional group ( p<0.001 ) , and patients assigned insulin had a greater gain in weight ( 4.0 kg ) than those assigned chlorpropamide ( 2.6 kg ) or glibenclamide ( 1.7 kg ) . INTERPRETATION Intensive blood-glucose control by either sulphonylureas or insulin substantially decreases the risk of microvascular complications , but not macrovascular disease , in patients with type 2 diabetes . ( ABSTRACT TRUNCATED OBJECTIVE To identify and analyse factors underlying intern prescribing errors to inform development of specific medication-safety interventions . DESIGN A prospect i ve qualitative study that involved face-to-face interviews and human-factor analysis . SETTING A tertiary referral teaching hospital , Brisbane , Queensl and , February-June , 2004 . PARTICIPANTS Fourteen intern prescribers involved in 21 errors . METHOD A structured question naire was used to identify factors causing the errors . Transcripts were analysed on the basis of human-error theory to identify underlying themes . MAIN OUTCOME MEASURES Factors underlying prescribing errors . RESULTS Errors were multifactorial , with a median of 4 ( range , 2 - 5 ) different types of performance-influencing factors per error . Lack of drug knowledge was not the single causative factor in any incident . The factors in new-prescribing errors included team , individual , patient and task factors . Factors associated with errors in represcribing were environment , task and number of weeks into the term . Defences against error , such as other clinicians and guidelines , were porous , and supervision was inadequate or not tailored to the patient , task , intern or environment . Factors were underpinned by an underlying culture in which prescribing is seen as a repetitive low-risk chore . CONCLUSION To reduce the risk of prescribing errors , a range of strategies addressing patient , task , individual , team and environment factors must be introduced Background Many r and omized trials involve measuring a continuous outcome - such as pain , body weight or blood pressure - at baseline and after treatment . In this paper , I compare four possibilities for how such trials can be analyzed : post-treatment ; change between baseline and post-treatment ; percentage change between baseline and post-treatment and analysis of covariance ( ANCOVA ) with baseline score as a covariate . The statistical power of each method was determined for a hypothetical r and omized trial under a range of correlations between baseline and post-treatment scores . Results ANCOVA has the highest statistical power . Change from baseline has acceptable power when correlation between baseline and post-treatment scores is high;when correlation is low , analyzing only post-treatment scores has reasonable power . Percentage change from baseline has the lowest statistical power and was highly sensitive to changes in variance . Theoretical considerations suggest that percentage change from baseline will also fail to protect from bias in the case of baseline imbalance and will lead to an excess of trials with non-normally distributed outcome data . Conclusions Percentage change from baseline should not be used in statistical analysis . Trialists wishing to report this statistic should use another method , such as ANCOVA , and convert the results to a percentage change by using mean baseline scores Abstract Objective : To determine whether tight control of blood pressure with either a β blocker or an angiotensin converting enzyme inhibitor has a specific advantage or disadvantage in preventing the macrovascular and microvascular complications of type 2 diabetes . Design : R and omised controlled trial comparing an angiotensin converting enzyme inhibitor ( captopril ) with a β blocker ( atenolol ) in patients with type 2 diabetes aim ing at a blood pressure of < 150/<85 mm Hg . Setting : 20 hospital based clinics in Engl and , Scotl and , and Northern Irel and . Subjects : 1148 hypertensive patients with type 2 diabetes ( mean age 56 years , mean blood pressure 160/94 mm Hg ) . Of the 758 patients allocated to tight control of blood pressure , 400 were allocated to captopril and 358 to atenolol . 390 patients were allocated to less tight control of blood pressure . Main outcome measures : Predefined clinical end points , fatal and non-fatal , related to diabetes , death related to diabetes , and all cause mortality . Surrogate measures of microvascular and macrovascular disease included urinary albumin excretion and retinopathy assessed by retinal photography . Results : Captopril and atenolol were equally effective in reducing blood pressure to a mean of 144/83 mm Hg and 143/81 mm Hg respectively , with a similar proportion of patients ( 27 % and 31 % ) requiring three or more antihypertensive treatments . More patients in the captopril group than the atenolol group took the allocated treatment : at their last clinic visit , 78 % of those allocated captopril and 65 % of those allocated atenolol were taking the drug ( P<0.0001 ) . Captopril and atenolol were equally effective in reducing the risk of macrovascular end points . Similar proportions of patients in the two groups showed deterioration in retinopathy by two grade s after nine years ( 31 % in the captopril group and 37 % in the atenolol group ) and developed clinical grade albuminuria ≥300 mg/l ( 5 % and 9 % ) . The proportion of patients with hypoglycaemic attacks was not different between groups , but mean weight gain in the atenolol group was greater ( 3.4 kg v 1.6 kg ) . Conclusion : Blood pressure lowering with captopril or atenolol was similarly effective in reducing the incidence of diabetic complications . This study provided no evidence that either drug has any specific beneficial or deleterious effect , suggesting that blood pressure reduction in itself may be more important than the treatment used The management of anticoagulant therapy  for hospitalized patients by seven certified pharmacist prescribers and one physician  was compared . Eighty-one consecutive patients referred to the anticoagulation service were r and omly assigned to two groups . For patients in the pharmacist-prescriber group , the physician independently monitored laboratory results and simulated heparin and warfarin doses . The roles of pharmacist and physician were reversed for patients in the physician-prescriber group . According to an established protocol , adjustments in heparin sodium infusion rate were based on activated partial thromboplastin time ( PTT ) ; warfarin sodium dosage was adjusted using a proconvertin and prothrombin ( P&P ) method .  Heparin doses , warfarin doses , and clotting-test results were compared for patients in the two prescriber groups ; simulated and actual doses also were compared . Patients were observed for complications of anticoagulant therapy . There were no significant differences in the mean heparin and warfarin doses administered to patients in the two prescribed groups . Similarly , PTT and number of days to reach therapeutic P&P were not significantly different . Within each group , the mean prescribed and simulated  heparin doses were not significantly different . There were no episodes of major bleeding , but four patients in the pharmacist-prescriber group had minor bleeding . While the results are not applicable to all pharmacists or all setting s , the certified pharmacist prescribers in this study adjusted anticoagulant therapy as well as an experienced physician Objectives Current evidence to support non-medical prescribing is predominantly qualitative , with little evaluation of accuracy , safety and appropriateness . Our aim was to evaluate a new model of service for the Australia healthcare system , of inpatient medication prescribing by a pharmacist in an elective surgery preadmission clinic ( PAC ) against usual care , using an endorsed performance framework . Design Single centre , r and omised controlled , two-arm trial . Setting Elective surgery PAC in a Brisbane-based tertiary hospital . Participants 400 adults scheduled for elective surgery were r and omised to intervention or control . Intervention A pharmacist generated the inpatient medication chart to reflect the patient 's regular medication , made a plan for medication perioperatively and prescribed venous thromboembolism ( VTE ) prophylaxis . In the control arm , the medication chart was generated by the Resident Medical Officers . Outcome measures Primary outcome was frequency of omissions and prescribing errors when compared against the medication history . The clinical significance of omissions was also analysed . Secondary outcome was appropriateness of VTE prophylaxis prescribing . Results There were significantly less unintended omissions of medications : 11 of 887 ( 1.2 % ) intervention orders compared with 383 of 1217 ( 31.5 % ) control ( p<0.001 ) . There were significantly less prescribing errors involving selection of drug , dose or frequency : 2 in 857 ( 0.2 % ) intervention orders compared with 51 in 807 ( 6.3 % ) control ( p<0.001 ) . Orders with at least one component of the prescription missing , incorrect or unclear occurred in 208 of 904 ( 23 % ) intervention orders and 445 of 1034 ( 43 % ) controls ( p<0.001 ) . VTE prophylaxis on admission to the ward was appropriate in 93 % of intervention patients and 90 % controls ( p=0.29 ) . Conclusions Medication charts in the intervention arm contained fewer clinical ly significant omissions , and prescribing errors , when compared with controls . There was no difference in appropriateness of VTE prophylaxis on admission between the two groups . Trial Registration Registered with ANZCTR — ACTR Number Objectives To evaluate the views of Australian pharmacists on  exp and ed pharmacist prescribing roles and identify important drivers and barriers to its implementation . Setting Pharmacists in Australia . Method Data were collected using a self-administered question naire distributed nationally to a r and om sample of pharmacists either directly , or in the case of one state , via community pharmacies . One-way ANOVA and ϰ2 testing were used to identify significant associations . F 
    Output:
    
Conclusions : This review provides low to moderate evidence that pharmacists can prescribe to the same st and ards as doctors .
Pharmacists are better at adhering to dosing guidelines when prescribing by protocol and make significantly less prescribing errors when charting patients ’ usual medications on admission to hospital