***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: BACKGROUND Medication errors are common , and while most such errors have little potential for harm they cause substantial extra work in hospitals . A small proportion do have the potential to cause injury , and some cause preventable adverse drug events . OBJECTIVE To evaluate the impact of computerized physician order entry ( POE ) with decision support in reducing the number of medication errors . DESIGN Prospect i ve time series analysis , with four periods . SETTING AND PARTICIPANTS All patients admitted to three medical units were studied for seven to ten-week periods in four different years . The baseline period was before implementation of POE , and the remaining three were after . Sophistication of POE increased with each successive period . INTERVENTION Physician order entry with decision support features such as drug allergy and drug-drug interaction warnings . MAIN OUTCOME MEASURE Medication errors , excluding missed dose errors . RESULTS During the study , the non-missed-dose medication error rate fell 81 percent , from 142 per 1,000 patient-days in the baseline period to 26.6 per 1,000 patient-days in the final period ( P < 0.0001 ) . Non-intercepted serious medication errors ( those with the potential to cause injury ) fell 86 percent from baseline to period 3 , the final period ( P = 0.0003 ) . Large differences were seen for all main types of medication errors : dose errors , frequency errors , route errors , substitution errors , and allergies . For example , in the baseline period there were ten allergy errors , but only two in the following three periods combined ( P < 0.0001 ) . CONCLUSIONS Computerized POE substantially decreased the rate of non-missed-dose medication errors . A major reduction in errors was achieved with the initial version of the system , and further reductions were found with addition of decision support features We studied the effectiveness of a computer program based on a mathematic model of warfarin dynamics in assisting with the initial phases of anticoagulation . In retrospective evaluations the program was successful in predicting prothrombin complex activity ( PCA ) responses for three different groups of subjects , indicating that the model is a good representation of the physiologic system . In a prospect i ve evaluation of the program a computer‐assisted group of 10 patients was compared with a control group of 10 patients who did not receive computer assistance .  Because of the program 's very conservative upper limits for warfarin dosage in the first few days of therapy , the computer‐assisted patients required slightly more time ( 6 days ) , on the average , to first reach PCA values in the 20 % to 30 % therapeutic range than did the control patients ( 4.8 days ) . After the desired PCA had been achieved , however , the computer‐assisted group remained within the therapeutic range for 83 % of the time compared to only 60 % for the control group . This difference was due primarily to much less overanticoagulation of the computer‐assisted patients than of the controls OBJECTIVE To review all r and omized clinical trials addressing the efficacy of  clinical information systems  and to determine the clinical setting s , types of interventions , and effects studied . DATA SOURCES Extensive and systematic MEDLINE search es were conducted using a combination of medical subject headings ( MeSH ) and textword terms to collect trial reports . Manual search es of books and monographs as well as informal contacts were also used . STUDY SELECTION The eligibility criteria were ( 1 ) r and omized controlled clinical trial , ( 2 ) computerized information intervention in the study group , and ( 3 ) effect measured on the process or outcome of care . DATA EXTRACTION Two research assistants independently abstract ed from the selected reports the following structured information : trial sites , computerized interventions , effect variables , and outcomes . Three investigators evaluated the combined list of trial features for setting , intervention , and effect . The statistical analysis included an evaluation of agreement in developing classifications and an analysis of the ratio of positive trial outcomes . DATA SYNTHESIS Most information services were tested in outpatient care ( 82 % ) , particularly in primary care ( 66 % ) . The information intervention targeted the provider in 64 % of the trials . The effect was primarily measured for the process of care ( 76 % ) . Provider prompt/reminder , computer-assisted treatment planner , interactive patient education/therapy , and patient prompt/reminder were significantly successful interventions ( sign test , P < .05 ) . CONCLUSIONS R and omized clinical trials confirm that four generic information interventions are active ingredients of computer systems and can make a significant difference in family medicine ( physician and patient reminders , treatment planner , and patient education ) . To manage care and improve quality , primary care computer systems should incorporate these effective information services 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 More than half of emergency department diagnoses of acute cardiac ischemia ( acute myocardial infa rct ion or unstable angina pectoris ) prove to be incorrect [ 1 ] , leading to approximately 2 million unnecessary hospitalizations associated with $ 8 billion in costs annually in the United States [ 2 ] . Underdiagnosis of acute ischemia also occurs : Approximately 2 % of emergency department patients with acute infa rct ion are sent home [ 3 , 4 ] . Unnecessary hospitalization for patients incorrectly presumed to have acute ischemia must be reduced without increasing inadvertent discharges of those with acute ischemia [ 5 , 6 ] . To address this problem , we developed an acute cardiac ischemia predictive instrument to provide real-time guidance for triage decisions in the emergency department [ 1 ] . Programmed initially into a h and -held calculator , a logistic regression formula computed a patient 's probability ( 0 % to 100 % ) of having acute ischemia on the basis of seven yes/no questions , including the presence of chest pain , chest pain as the chief symptom , a history of heart attack or nitroglycerine use , and electrocardiogram ST-segment or T-wave abnormalities . In a 2300-patient controlled clinical trial done in urban and rural hospitals in 1980 - 1981 , providing patients ' probability values of acute ischemia to emergency department physicians improved triage decisions : Admissions to the coronary care unit ( CCU ) for patients without acute ischemia were reduced by 30 % and missed cases of acute ischemia did not increase [ 1 ] . Unfortunately , the calculator-based instrument was not user-friendly for busy emergency department physicians and found limited use . In addition , it required physician interpretation of the ST segment and T waves , which may be incorrect 25 % of the time [ 7 ] , introducing error into predictions . To address these issues , a new version of the instrument was developed for incorporation into conventional computerized electrocardiograph [ 8 - 12 ] . It was design ed to compute the probability value either by using data obtained during real-time emergency department care or retrospective review ; thus , we called it an acute cardiac ischemia time-insensitive predictive instrument ( ACI-TIPI ) [ 8 , 13 ] . This was accomplished primarily by replacing the variables from the medical history with age , sex , and the presence of Q waves on electrocardiography . More detailed data on ST and T waves were also added . Diagnostic performance was equivalent to that of the original version , and no further variables were needed . Of note , classic long-term coronary risk factors , such as hypercholesterolemia and smoking , were not important predictors of acute ischemia in the emergency department compared with the variables used in ACI-TIPI [ 8 , 14 ] . To acquire the ACI-TIPI probability in clinical use , the user enters the patient 's age and sex and indicates whether chest or left arm pain is the primary symptom ; the electrocardiograph then directly measures the waveforms and computes and prints the probability of acute ischemia on the electrocardiogram header for the physician 's immediate use ( Figure 1 ) . Figure 1 . Example of an acute cardiac ischemia time-insensitive predictive instrument ( ACI-TIPI ) electrocardiogram printed by conventional electrocardiograph for the trial . We report the results of a clinical trial to test the effect of electrocardiogram-based ACI-TIPI on emergency department triage of patients with chest pain or other symptoms suggestive of acute cardiac ischemia . We sought to determine whether its use would reduce unnecessary hospital and CCU admission for emergency department patients without cardiac ischemic disease or with stable angina pectoris while not reducing hospitalization of emergency department patients with acute ischemia ( unstable angina or acute infa rct ion ) . Because our previous work showed that the bed capacity of the hospital CCU influences emergency department triage [ 15 ] and that the effects of ACI-TIPI vary with the training level of residents [ 9 ] , we hypothesized that the effect of ACI-TIPI would differ according to the bed capacities of CCUs and physician training status . Thus , we included hospitals with a wide range of CCU bed capacities and emergency department training programs . Methods Sites The study was conducted at 10 hospitals , including public , private , community , and tertiary hospitals with urban , suburban , and semi-rural catchment areas ( Baystate Medical Center [ Springfield , Massachusetts ] ; Boston City Hospital , Boston University Medical Center , and New Engl and Medical Center [ Boston , Massachusetts ] ; Medical College of Virginia [ Richmond , Virginia ] ; Medical College of Wisconsin [ Milwaukee , Wisconsin ] ; Newton-Wellesley Hospital [ Newton , Massachusetts ] ; Rhode Isl and Hospital [ Providence , Rhode Isl and ] ; University of Cincinnati Medical Center [ Cincinnati , Ohio ] ; and University of North Carolina Hospitals [ Chapel Hill , North Carolina ] ) . All emergency departments had internal medicine residents ; four had emergency medicine residents . Patients We included all consenting emergency department patients who 1 ) were at least 30 years of age or at least 18 years of age if they were suspected of using or were reported to have used cocaine recently and 2 ) had a chief symptom of chest , left arm , jaw , or epigastric pain or discomfort ; shortness of breath ; dizziness ; palpitations ;  or other symptoms suggestive of  acute ischemia .  Intervention The ACI-TIPI was installed in each emergency department 's native br and electrocardiographs by using software and necessary equipment up grade s provided by the manufacturer . Both br and s used ( Hewlett-Packard [ Palo Alto , California ] and Marquette [ Milwaukee , Wisconsin ] ) generated equivalent predictions in the same format ( Figure 1 ) . Manufacturers had no input in the design or conduct of the study , data analysis , or reporting of results . The trial was carried out over 7 alternating months of control and intervention periods starting in May 1993 . On presentation to the emergency department , each patient 's ACI-TIPI probability of acute ischemia was automatically computed by the electrocardiograph . During intervention periods , the probability was automatically printed on the electrocardiogram header , with an indication that it was to supplement , not replace physician judgment , along with the st and ard electrocardiogram interpretive header text . During control periods , only the st and ard header text was printed . Data Collection Sociodemographic information , initial and follow-up clinical features , electrocardiographic information , creatine kinase-MB test results , training level and supervision of the triaging physician , and hospital bed capacities were recorded at presentation to the emergency department , during hospitalization , and at the 30-day follow-up . The follow-up rate for data needed to assign confirmed true diagnoses , including those for patients who were not hospitalized , was 99 % . The ACI-TIPI electrocardiograph allowed real-time acquisition of the following variables : age , sex , presence of chest or left arm pain , a chief symptom of chest or left arm pain , pathologic Q waves , and the presence and degree of ST-segment elevation or depression and T-wave elevation or inversion [ 9 , 10 ] . Data Analysis Confirmed diagnoses were assigned by site physicians ( who were blinded to study group assignment ) on the basis of presentation and clinical course , initial and follow-up electrocardiograms , and creatine kinase-MB test results by using World Health Organization criteria [ 16 ] . Angina severity was classified by Canadian Cardiovascular Society classification criteria [ 17 ] and time since angina onset or pattern change . By using an iterative modified Delphi process based on the practice s and opinions of study site emergency physicians , cardiologists , and other experts , we defined the following diagnostic groups for analysis a priori : 1 ) patients with acute cardiac ischemia [ acute infa rct ion 
    Output:
    
On the basis of a subset of 287 controlled HIS studies , there is some evidence for improved quality of care , but in varying degrees across topic areas .