***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: Abstract Objective : To evaluate the use of a computerised support system for decision making for implementing evidence based clinical guidelines for the management of asthma and angina in adults in primary care . Design : A before and after pragmatic cluster r and omised controlled trial utilising a two by two incomplete block design . Setting : 60 general practice s in north east Engl and . Participants : General practitioners and practice nurses in the study practice s and their patients aged 18 or over with angina or asthma . Main outcome measures : Adherence to the guidelines , based on review of case notes and patient reported generic and condition specific outcome measures . Results : The computerised decision support system had no significant effect on consultation rates , process of care measures ( including prescribing ) , or any patient reported outcomes for either condition . Levels of use of the software were low . Conclusions : No effect was found of computerised evidence based guidelines on the management of asthma or angina in adults in primary care . This was probably due to low levels of use of the software , despite the system being optimised as far as was technically possible . Even if the technical problems of producing a system that fully supports the management of chronic disease were solved , there remains the challenge of integrating the systems into clinical encounters where busy practitioners manage patients with complex , multiple conditions Objective To develop an empirically based framework of the aspects of r and omised controlled trials addressed by qualitative research . Design Systematic mapping review of qualitative research undertaken with r and omised controlled trials and published in peer- review ed journals . Data sources MEDLINE , Pre MEDLINE , EMBASE , the Cochrane Library , Health Technology Assessment , PsycINFO , CINAHL , British Nursing Index , Social Sciences Citation Index and ASSIA . Eligibility criteria Articles reporting qualitative research undertaken with trials published between 2008 and September 2010 ; health research , reported in English . Results 296 articles met the inclusion criteria . Articles focused on 22 aspects of the trial within five broad categories . Some articles focused on more than one aspect of the trial , totalling 356 examples . The qualitative research focused on the intervention being trialled ( 71 % , 254/356 ) ; the design , process and conduct of the trial ( 15 % , 54/356 ) ; the outcomes of the trial ( 1 % , 5/356 ) ; the measures used in the trial ( 3 % , 10/356 ) ; and the target condition for the trial ( 9 % , 33/356 ) . A minority of the qualitative research was undertaken at the pretrial stage ( 28 % , 82/296 ) . The value of the qualitative research to the trial itself was not always made explicit within the articles . The potential value included optimising the intervention and trial conduct , facilitating interpretation of the trial findings , helping trialists to be sensitive to the human beings involved in trials , and saving money by steering research ers towards interventions more likely to be effective in future trials . Conclusions A large amount of qualitative research undertaken with specific trials has been published , addressing a wide range of aspects of trials , with the potential to improve the endeavour of generating evidence of effectiveness of health interventions . Research ers can increase the impact of this work on trials by undertaking more of it at the pretrial stage and being explicit within their articles about the learning for trials and evidence -based practice Background Computer-based decision support has been effective in providing alerts for preventive care . Our objective was to determine whether a personalized asthma management computer-based decision support increases the quality of asthma management and reduces the rate of out-of-control episodes . Methods A cluster-r and omized trial was conducted in Quebec , Canada among 81 primary care physicians and 4447 of their asthmatic patients . Patients were followed from the first visit for 3–33 months . The physician control group used the Medical Office of the 21st century ( MOXXI ) system , an integrated electronic health record . A custom-developed asthma decision support system was integrated within MOXXI and was activated for physicians in the intervention group . Results At the first visit , 9.8 % ( intervention ) to 12.9 % ( control ) of patients had out-of-control asthma , which was defined as a patient having had an emergency room visit or hospitalization for respiratory-related problems and /or more than 250 doses of fast-acting β-agonist ( FABA ) dispensed in the past 3 months . By the end of the trial , there was a significant increase in the ratio of doses of inhaled corticosteroid use to fast-acting β-agonist ( 0.93 vs. 0.69 : difference : 0.27 ; 95 % CI : 0.02–0.51 ; P = 0.03 ) in the intervention group . The overall out-of-control asthma rate was 54.7 ( control ) and 46.2 ( intervention ) per 100 patients per year ( 100 PY ) , a non-significant rate difference of −8.7 ( 95 % CI : −24.7 , 7.3 ; P = 0.29 ) . The intervention ’s effect was greater for patients with out-of-control asthma at the beginning of the study , a group who accounted for 44.7 % of the 5597 out-of-control asthma events during follow-up , as there was a reduction in the event rate of −28.4 per 100 PY ( 95 % CI : −55.6 , −1.2 ; P = 0.04 ) compared to patients with in-control asthma at the beginning of the study ( −0.08 [ 95 % CI : −10.3 , 8.6 ; P = 0.86 ] ) . Discussion This study evaluated the effectiveness of a novel computer-assisted ADS system that facilitates systematic monitoring of asthma control status , follow-up of patients with out of control asthma , and evidence -based , patient-specific treatment recommendations . We found that physicians were more likely to use ADS for out-of-control patients , that in the majority of these patients , they were advised to add an inhaled corticosteroid or a leukotriene inhibitor to the patient s treatment regimen , and the intervention significantly increased the mean ratio of inhaled corticosteroids to FABA during follow-up . It also reduced the rate of out-of-control episodes during follow up among patients whose asthma was out-of-control at the time of study entry . Future research should assess whether coupling patient-specific treatment recommendations , automated follow-up , and home care with comparative feedback on quality and outcomes of care can improve guideline adoption and care outcomes . Conclusions A primary care-personalized asthma management system reduced the rate of out-of-control asthma episodes among patients whose asthma was poorly controlled at the study ’s onset . Trial Registration Clinical trials.gov Identifier : NCT00170248 http:// clinical OBJECTIVE Computer-based clinical decision support systems ( CDSSs ) vary greatly in design and function . Using a taxonomy that we had previously developed , we describe the characteristics of CDSSs reported in the literature . METHODS We search ed PubMed and the Cochrane Library for r and omized controlled trials ( RCTs ) published in English between 1998 and 2003 that evaluated CDSSs .  We coded each CDSS using our taxonomy . RESULTS 58 studies met our inclusion criteria . The 74 reported CDSSs varied greatly in context of use , knowledge and data sources , nature of decision support offered , information delivery , and workflow impact . Two distinct subsets of CDSSs were seen : patient-directed systems that provided decision support for preventive care or health-related behaviors via mail or phone ( 38 % of systems ) , and inpatient systems targeting clinicians with online decision support and direct online execution of the recommendations ( 18 % ) . 84 % of the CDSSs required extra staffing for h and ling CDSS-related input or output . CONCLUSION Reported CDSSs are heterogeneous along many dimensions . Caution should be taken in generalizing the results of CDSS RCTs to different clinical or workflow setting Beta‐agonist overuse is associated with adverse outcomes in asthma , however , the relationships between different metrics of salbutamol use and future risk are uncertain . BACKGROUND US national guidelines recommend assessing short-acting beta-agonist ( SABA ) medication use as a marker of asthma severity and control . However , the relationship between recent SABA use and asthma exacerbations is not currently known . OBJECTIVE To evaluate the proximal relationship between the type and frequency of SABA use and asthma-related outcomes . METHODS We evaluated SABA use among patients with asthma ages 5 to 56 years who were members of a large health maintenance organization in southeast Michigan . Frequency of use was estimated from pharmacy data assessing the timing and amount of SABA fills . Cox proportional hazards models were used to examine the prospect i ve relationship between average daily SABA use for 3 months and outcomes associated with poor asthma control ( ie , oral corticosteroids use , asthma-related emergency department visits , and asthma-related hospitalizations ) . We separately accounted for SABA metered-dose inhaler ( MDI ) and SABA nebulizer use . RESULTS Of the 2,056 patients who met study criteria , 1,569 ( 76.3 % ) had used a SABA medication in their baseline year . After adjusting for potential confounders , SABA nebulizer use was associated with asthma-related emergency department visits ( adjusted hazard ratio [ aHR ] , 6.32 ; 95 % confidence interval [ CI ] , 2.38 to 16.80 ) and asthma-related hospitalizations ( aHR , 21.62 ; 95 % CI , 3.17 to 147.57 ) . In contrast , frequency of SABA MDI use was not associated with these outcomes . CONCLUSIONS Frequency of SABA use during a 3-month period was associated with poor asthma outcomes . The relationship with poor asthma outcomes was strongest for SABA nebulizer use , suggesting that the type of SABA used is also of prognostic importance PRIMARY OBJECTIVE To investigate whether computer decision support software used in the management of patients with asthma improves clinical outcomes . RESEARCH DESIGN R and omized controlled trial with practice s each reporting on 30 patients with asthma over a 6 month period . METHODS AND PROCEDURES 447 patients were r and omly selected from practice asthma registers managed by 17 general practice s from throughout the UK . Intervention practice s used the software during consultations with these patients throughout the study while control practice s did not . MAIN OUTCOMES AND RESULTS Practice consultations , acute exacerbations of asthma , hospital contacts , symptoms on assessment and medication use . A smaller proportion of patients within the intervention group initiated practice consultations for their asthma : 34 ( 22 % ) vs 111 ( 34 % ) , odds ratio ( OR ) = 0.59 , 95 % confidence interval ( CI ) ( 0.37 - 0.95 ) ; and suffered acute asthma exacerbations : 12 ( 8 % ) vs 57 ( 17 % ) , OR = 0.43 , 95 % CI = 0.21 - 0.85 six months after the introduction of the computer decision support software . There were no discernable differences in reported symptoms , maintenance prescribing or use of hospital services between the two groups . CONCLUSION The use of computer decision support software that implements guidelines during patient consultations may improve clinical outcomes for patients with asthma BACKGROUND Excessive use of short-acting β2-agonists ( SABA ) indicates impaired asthma control . OBJECTIVE To determine whether real-time outreach to excessive SABA users reduces SABA canister dispensings . METHODS After real-time determination of a seventh SABA canister dispensing in the prior 12 months by using informational pharmacy technology , 12 to 56 year old patients with physician-coded asthma and inhaled corticosteroid dispensing were block r and omized by prior asthma specialist care and medication step-care level into intervention ( n = 1001 ) and control groups ( n = 998 ) . Intervention included real-time letter notification to patients and an electronic message to their physician with management suggestions , including facilitated allergy referral for patients without prior asthma specialist care . The control group received this organization 's st and ard asthma care management without research contact .  Frequency of the seventh SABA canister dispensing in the follow-up year was the primary outcome . RESULTS Compared with controls , intervention patients reached 7 SABA canister dispensings less frequently ( 50.7 % vs 57.1 % ; risk ratio 0.89 [ 95 % CI , 0.82 - 0.97 ] ; P = .007 ) and later ( hazard ratio 0.80 [ 95 % CI , 0.71 - 0.91 ; P < .001 ) . SABA canister dispensings ( mean ± SD ) were less in intervention ( 7.5 ± 4.9 canisters ) than controls ( 8.6 ± 5.3 canisters ) ( rate ratio 0.87 [ 95 % CI , 0.82 - 0.93 ] ; P < .001 ) . The intervention reduced the risk of ≥7 SABA canister dispensings in patients without specialist care compared with patients with specialist care in the prior 3 years ( P < .001 ) ( P = .04 for interaction by prior specialist care ) . Visits to allergists were more frequent for intervention patients ( 30.9 % ) than for control patients ( 16.8 % ) ( risk ratio 1.83 [ 95 % CI , 1.54 - 2.16 ] ; P < .001 ) . Asthma exacerbations were unaffected . 
    Output:
    
There is some evidence that electronic alerts reduce excessive prescribing of SABAs , when delivered as part of a multicomponent intervention in an integrated health care system .