***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: We developed a computer-stored medical record system containing a limited set of the total clinical data base -- primarily diagnostic studies and treatments . This system responds to its own content according to physician-authored reminder rules . To determine the effect of the reminder messages generated by 1490 rules on physician behavior , we r and omly assigned practitioners in a general medicine clinic to study or control groups . The computer found indications for six different actions per patient in 12 467 patients during a 2-year study : 61 study group residents who received computer  reminders responded to 49 % of these indications ; 54 control group residents , to only 29 % ( p less than 0.0001 ) . Preventive care ( occult blood testing , mammographic screening , weight reduction diets , influenza and pneumococcal vaccines ) was affected . The intentions of the study group to use a given action for an indication predicted their response to the indications ( p less than 0.03 , r2 = 0.33 ) . The intentions of the control residents did not A system has been constructed to evaluate the design , implementation , and analysis of  r and omized control trials ( RCT ) . The degree of quadruple blinding ( the r and omization process , the physicians and patients as to therapy , and the physicians as to ongoing results ) is considered to be the most important aspect of any trial . The analytic techniques are scored with the same emphasis as is placed on the control of bias in the planning and implementation of the studies . Description of the patient and treatment material s and the measurement of various controls of quality have less weight . An index of quality of a RCT is proposed with its pros and cons . If published papers were to approximate these principles , there would be a marked improvement in the quality of r and omized control trials . Finally , a reasonable st and ard design and conduct of trials will facilitate the interpretation of those with conflicting results and help in making valid combinations of undersized trials Objective : To improve the delivery of preventive care in a medical clinic , a controlled trial was conducted of two interventions that were expected to influence delivery of preventive services differently , depending on level of initiative required of the physician or patient to complete a service . Design : A prospect i ve , controlled trial of five-months ’ duration . Setting : A university hospital-based , general medical clinic . Participants : Thirty-nine junior and senior medical residents who saw patients in stable clinic teams throughout the study .Intervention : A computerized reminder system for physicians and a patient question naire and educational h and out on preventive care . Measurements and main results : Delivery of five of six audited preventive services improved significantly after the interventions were introduced . The computerized reminder alone increased completion rates of services that relied primarily on physician initiative ; the question naire alone increased completion rate of the service that depended more on patient compliance as well as on some physician-dependent services . Both interventions used together were slightly less effective in improving performance of physician-dependent services than the computerized reminder used alone . Conclusions : These interventions can improve the delivery of preventive care but they differ in their impacts on physician and patient behaviors . Overall , the computer reminder was the more effective intervention To determine effective methods of promoting routine cancer screening , we r and omly assigned 62 internal medicine residents to receive cancer screening reminders ( computer-generated lists of overdue tests at patients ' visits ) , audit with feedback ( monthly seminars about screening , with feedback about their performance rates ) , or no intervention ( controls ) .  Half of the residents in each group also were r and omized to receive patient education ( patients received literature and notices of overdue tests ) . We review ed a sample of each physician 's medical records to assess performance of seven tests during 9-month periods before and after initiating the interventions . Cancer screening reminders increased performance of six of seven tests ; audit with feedback , four of seven tests ; and patient education , one of two targeted breast cancer screening tests . The results indicate that the cancer screening reminders strategy was the most effective in promoting the performance of routine cancer screening tests BACKGROUND Screening reduces colorectal cancer mortality , but effective screening tests remain underused . Systematic reminders to patients and physicians could increase screening rates METHODS We conducted a r and omized controlled trial of patient and physician reminders in 11 ambulatory health care centers . Participants included 21 860 patients aged 50 to 80 years who were overdue for colorectal cancer screening and 110 primary care physicians . Patients were r and omly assigned to receive mailings containing an educational pamphlet , fecal occult blood test kit , and instructions for direct scheduling of flexible sigmoidoscopy or colonoscopy . Physicians were r and omly assigned to receive electronic reminders during office visits with patients overdue for screening . The primary outcome was receipt of fecal occult blood testing , flexible sigmoidoscopy , or colonoscopy over 15 months , and the secondary outcome was detection of colorectal adenomas . RESULTS Screening rates were higher for patients who received mailings compared with those who did not ( 44.0 % vs 38.1 % ; P < .001 ) . The effect increased with age : + 3.7 % for ages 50 to 59 years ; + 7.3 % for ages 60 to 69 years ; and + 10.1 % for ages 70 to 80 years ( P = .01 for trend ) . Screening rates were similar among patients of physicians receiving electronic reminders and the control group ( 41.9 % vs 40.2 % ; P = .47 ) . However , electronic reminders tended to increase screening rates among patients with 3 or more primary care visits ( 59.5 % vs 52.7 % ; P = .07 ) . Detection of adenomas tended to increase with patient mailings ( 5.7 % vs 5.2 % ; P = .10 ) and physician reminders ( 6.0 % vs 4.9 % ; P = .09 ) . CONCLUSIONS Mailed reminders to patients are an effective tool to promote colorectal cancer screening , and electronic reminders to physicians may increase screening among adults who have more frequent primary care visits BACKGROUND Colorectal cancer is the second leading cause of cancer mortality in israel . Unfortunately , compliance with annual fecal occult blood testing is very low . OBJECTIVE To assess the effectiveness of interventions to increase FOBT screening  in primary care clinics in Israel . METHODS A prospect i ve , r and omized study included all 50 - 75 year old enrollees of six family physicians in two primary care clinics . The register of two physicians , one from each clinic , was allocated to one of three groups . Two FOBT reminder strategies were tested : a physician reminder ( 753 patients ) , and a patient reminder that was either a phone call ( 312 patients ) or a letter ( 337 patients ) . The control group ( 913 patients ) of physicians continued administering their regular level of care . The main outcome measure was the percentage of patients undergoing FOBT screening  in each study arm at the conclusion of the one year study period . RESULTS In the intervention groups 14.3 % ( 201/1,402 ) were screened using the FOBT over the course of the study year . Using an intent-to-screen analysis , the screening rate in the physician and patient reminder groups was significantly higher than in the control group ( 16.5 and 11.9 % , vs. 1.2 % respectively , P < 0.0001 ) . Phone reminders were significantly more effective than letters ( 14.7 vs. 9.2 % , P = 0.01 ) . CONCLUSIONS Various reminder systems for FOBT are beneficial , especially those centered around the family physician . Further research should focus on this area , in conjunction with other novel approaches The Cancer Prevention Reminder System is a computer-based system design ed to increase the delivery of periodic health maintenance procedures . The program provides printed reminders that identify patients ' overdue procedures , prints summary reports of the percentage of patients who are eligible and overdue for a procedure , and prints mailing labels for patients . We performed a r and omized , controlled trial in which the effects of  computer-based reminders  were compared with those of two other interventions among residents in a university-based group practice Objective : To improve compliance with computer-generated reminders to perform fecal occult blood testing ( FOBT ) , mammography , and cervical Papanicolaou ( Pap ) testing . Design : Six-month prospect i ve , r and omized , controlled trial . Setting : Academic primary care general internal medicine practice .Subjects : Thirty-one general internal medicine faculty , 145 residents , and 5,407 patients with scheduled visits who were eligible for any of the three cancer screening protocol s . Intervention : Primary care teams of internal medicine residents and faculty received either routine computer reminders ( control ) or the same reminders to which they were required to circle one of four responses : 1 ) “ done/order today , ” 2 ) “ not applicable to this patient , ” 3 ) “ patient refused , ” or 4 ) “ next visit . ” Results : Intervention physicians complied more frequently than control physicians with all reminders combined ( 46 % vs 38 % , respectively , p=0.002 ) and separately with reminders for FOBT ( 61 % vs 49 % , p=0.0007 ) and mammography ( 54 % vs 47 % , p=0.036 ) but not cervical Pap testing ( 21 % vs 18 % , p=0.2 ) . Intervention residents responded significantly more often than control residents to all reminders together and separately to reminders for FOBT and mammography but not Pap testing . There was no significant difference between intervention and control faculty , but the compliance rate for control faculty was significantly higher than the rate for control residents for all reminders together and separately for FOBT but not mammography or Pap testing . The intervention ’s effect was greatest for patients ≥70 years old , with significant results for all tests , together and singly , for residents but not faculty . Intervention physicians felt that the reminders were not applicable 21 % of the time ( due to inadequate data in patients ’ electronic medical records ) and stated that their patients refused 10 % of the time . Conclusions : Requiring physicians to respond to computer-generated reminders improved their compliance with preventive care protocol s , especially for elderly patients for whom control physicians ’ compliance was the lowest . However , 100 % compliance with cancer screening reminders will be unattainable due to incomplete data and patient refusal Organizational barriers play a key role in colorectal cancer ( CRC ) screening disparities in low-income minorities . This is a prospect i ve , r and omized trial to determine whether a patient navigator ( PN ) can help overcome the organizational barriers low-income minorities face in trying to obtain screening colonoscopy . Patients of average risk for CRC were referred by their primary care physician for screening colonoscopy .  After the PN received the referral , patients were r and omly assigned to either receive navigation ( PN+ ) to screening colonoscopy or not receive navigation ( PN- ) . We hypothesized that a PN would increase patient compliance with screening colonoscopy . A total of 21 patients were enrolled in the pilot study ( PN+ = 13 , PN- = 8) ; 54 % of navigated patients completed screening colonoscopy versus 13 % of nonnavigated patients ( p = 0.058 ) . Eighty-six percent of navigated patients had an excellent or very good colon prep ; however , there was no difference in prep quality between groups ( p = 0.10 ) . One-hundred percent of navigated patients were very satisfied with navigation services . A PN improves compliance with screening colonoscopy in low-income minorities . Larger studies are needed to evaluate what features of navigation are most effective in facilitating completion of screening colonoscopy Despite an emerging consensus on appropriate preventive services , a minority of patients receive them . A study was undertaken to assess the impact of computer-generated reminders to adult patients , their physicians , or both patients and physicians on adherence to five recommended preventive services : cholesterol measurements , fecal occult blood testing , mammography , Papanicolaou smears , and tetanus immunization . During the academic year 1988 - 1989 , all 7397 adult patients and their 49 physicians in a university family medicine clinical practice were r and omized by practice group into one of four study groups : control , physician reminders , patient reminders , and both physician and patient reminders . Adherence was defined in community-oriented terms : the percentage of patients within each group who had received the preventive service in the recommended interval . During the study period , adherence to four of the five preventive services increased significantly , with the largest increases in the physician and patient reminder group : cholesterol measurements increased from 19.5 % to 38.1 % , fecal occult blood testing 9.3 % to 27.0 % , mammography 11.4 % to 27.1 % , and tetanus immunization 23.4 % to 35.4 % ( for each increase , P less than .0001 , McNemar 's chi-square test ) . In general , increases were greater in blacks and in patients with any form of insurance coverage .  Computer-based physician and patient reminder systems have great promise of improving adherence to preventive services in primary care setting OBJECTIVE To test the effectiveness of a patient-initiated , touch-sensitive computer system ( TSCS ) for improving screening rates for cancers of the breast , cervix , colon and rectum , and oral cavity . DESIGN One-year , r and omized , controlled trial with primary care practice as the unit of analysis . SETTING Sixty primary care practice s , r and omly recruited from 329 nonteaching practice s in a southeastern state . SUBJECTS R and om sample of the medical records of 50 male and female adult patients before intervention and 50 adult patients after intervention in each practice and a r and om sample of 507 TSCS users . INTERVENTIONS Touch- 
    Output:
    
Conclusion : Reminding physicians about those patients due for FOB testing may not improve the effectiveness of a colorectal cancer screening programme .