***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: Medical applications frequently contain a wide range of functionalities . Users are often unaware of all of the functionalities available . More effective ways of delivering information about available functionalities to the users are needed . We conducted a pseudo-r and omized controlled trial to determine whether interruptive alerts will increase utilization of several functionalities by the users of the Pre-Admission Medication List ( PAML ) Builder application at two academic medical centers . In a log-linear model , alerts increased total utilization of the promoted functionalities per PAML built by 70 % compared to the controls at the site level ( p<0.0001 ) . At the user level , frequency of utilization of the PAML Builder functionalities by individual users increased by 0.03 for every extra alert shown to the user ( p<0.0001 ) . Alerts led to a nearly 2-fold increase in utilization of the promoted functionalities .  Interruptive alerts are an effective method of delivering information about application functionalities to users OBJECTIVES To evaluate the effectiveness of computer-assisted decision support in reducing potentially inappropriate prescribing to older adults . DESIGN R and omized , controlled trial . SETTING An academic emergency department ( ED ) in Indianapolis , Indiana , where computerized physician order entry was used to write all medication prescriptions . PARTICIPANTS Sixty-three emergency physicians were r and omized to the intervention ( 32 physicians ) or control ( 31 physicians ) group . INTERVENTION Decision support that advised against use of nine potentially inappropriate medications and recommended safer substitute therapies . MEASUREMENTS The primary outcome was the proportion of ED visits by seniors that result ed in one or more prescriptions for an inappropriate medication . The main secondary outcomes were the proportions of medications prescribed that were inappropriate and intervention physicians ' reasons for rejecting the decision support . RESULTS The average age of the patients was 74 , two-thirds were female , and just over half were African American . Decision support was provided 114 times to intervention physicians , who accepted 49 ( 43 % ) of the recommendations . Intervention physicians prescribed one or more inappropriate medications during 2.6 % of ED visits by seniors , compared with 3.9 % of visits managed by control physicians ( P=.02 ; odds ratio=0.55 , 95 % confidence interval=0.34 - 0.89 ) . The proportion of all prescribed medications that were inappropriate significantly decreased from 5.4 % to 3.4 % . The most common reason for rejecting decision support was that the patient had no prior problems with the medication . CONCLUSION Computerized physician order entry with decision support significantly reduced prescribing of potentially inappropriate medications for seniors . This approach might be used in other efforts to improve ED care . TRIAL REGISTRATION Clinical trials.gov Identifier : NCT00297869 Objectives The Parkl and formula for maintenance and resuscitation fluid requirements in the first 24 hours after pediatric burns is widely used , but calculation errors frequently occur . Two different novel aids to calculation , a dedicated electronic device and a mechanical disc calculator , are described and compared with the conventional method of calculation ( pen and paper , assisted by a general purpose calculator ) . Methods In a blinded r and omized volunteer study , 21 participants performed a total of 189 calculations using simulated patient data to compare the accuracy and speed of 3 different methods for calculating resuscitation fluid requirements based on the pediatric Parkl and formula . Bespoke software generated the simulated patient data and recorded accuracy and speed of all participant responses . Results Sixty-five percent of calculations with the electronic device , 35 % using the disc and 44 % using the pen/paper methods were within ±5 % of the correct value and considered “ correct ” for clinical purpose s. The method used strongly affected the tendency to make errors ( logistic regression ) . With thresholds of error magnitude classed as very small ( > 5 % ) , small ( > 25 % ) , medium ( > 50 % ) and large ( > 100 % ) of the correct value respectively , the electronic method produced fewer errors than both disc and pen/paper methods at all error thresholds . Disc produced more errors than pen/paper at the greater than 5 % threshold but fewer at the greater than 25 % , greater than 50 % , and greater than 100 % thresholds . Conclusions Both novel devices provide safer and faster alternatives to conventional methods for calculation of fluid requirements in pediatric burns Objectives Gentamicin and vancomycin are narrow-therapeutic-index antibiotics with potential for high toxicity requiring dose individualisation and continuous monitoring . Clinical decision support ( CDS ) tools have been effective in reducing gentamicin and vancomycin dosing errors . Online dose calculators for these drugs were implemented in a London National Health Service hospital . This study aim ed to evaluate the impact of these calculators on the accuracy of gentamicin and vancomycin initial doses . Methods The study used a pre – postintervention design . Data were collected using electronic patient records and paper notes . R and om sample s of gentamicin and vancomycin initial doses administered during the 8 months before implementation of the calculators were assessed retrospectively against hospital guidelines . Following implementation of the calculators , doses were assessed prospect ively . Any gentamicin dose not within ±10 % and any vancomycin dose not within ±20 % of the guideline -recommended dose were considered incorrect . Results The intranet calculator pages were visited 721 times ( gentamicin=333 ; vancomycin=388 ) during the 2-month period following the calculators ’ implementation . Gentamicin dose errors fell from 61.5 % ( 120/195 ) to 44.2 % ( 95/215 ) , p<0.001 . Incorrect vancomycin loading doses fell from 58.1 % ( 90/155 ) to 32.4 % ( 46/142 ) , p<0.001 . Incorrect vancomycin first maintenance doses fell from 55.5 % ( 86/155 ) to 33.1 % ( 47/142 ) , p<0.001 . Loading and first maintenance vancomycin doses were both incorrect in 37.4 % ( 58/155 ) of patients before and 13.4 % ( 19/142 ) after calculator implementation , p<0.001 . Conclusions This study suggests that gentamicin and vancomycin dose calculators significantly improved the prescribing of initial doses of these agents . Therefore , healthcare organisations should consider using such CDS tools to support the prescribing of these high-risk drugs Abbreviation use is a preventable cause of medication errors . The objective of this study was to test whether computerized alerts design ed to reduce medication abbreviations and embedded within an electronic progress note program could reduce these abbreviations in the non-computer-assisted h and written notes of physicians . Fifty-nine physicians were r and omized to one of three groups : a  forced correction alert group ; an auto-correction alert group ; or a group that received no alerts . Over time , physicians in all groups significantly reduced their use of these abbreviations in their h and written notes . Physicians exposed to the forced correction alert showed the greatest reductions in use when compared to controls ( p=0.02 ) and the auto-correction alert group ( p=0.0005 ) . Knowledge of unapproved abbreviations was measured before and after the intervention and did not improve ( p=0.81 ) . This work demonstrates the effects that alert systems can have on physician behavior in a non-computerized environment and in the absence of knowledge BACKGROUND The effectiveness of computerized physician order entry ( CPOE ) systems has been modest , largely because clinicians frequently override electronic alerts . METHODS To evaluate the effectiveness of a nearly " hard stop " CPOE prescribing alert intended to reduce concomitant orders for warfarin and trimethoprim-sulfamethoxazole , a r and omized clinical trial was conducted at 2 academic medical centers in Philadelphia , Pennsylvania . A total of 1981 clinicians were assigned to either an intervention group receiving a nearly hard stop alert or a control group receiving the st and ard practice . The study duration was August 9 , 2006 , through February 13 , 2007 . RESULTS The proportion of desired responses ( ie , not reordering the alert-triggering drug within 10 minutes of firing ) was 57.2 % ( 111 of 194 hard stop alerts ) in the intervention group and 13.5 % ( 20 of 148 ) in the control group ( adjusted odds ratio , 0.12 ; 95 % confidence interval , 0.045 - 0.33 ) . However , the study was terminated early because of 4 unintended consequences identified among patients in the intervention group : a delay of treatment with trimethoprim-sulfamethoxazole  in 2 patients and a delay of treatment with warfarin in another 2 patients . CONCLUSIONS An electronic hard stop alert as part of an inpatient CPOE system seemed to be extremely effective in changing prescribing . However , this intervention precipitated clinical ly important treatment delays in 4 patients who needed immediate drug therapy . These results illustrate the importance of formal evaluation and monitoring for unintended consequences of programmatic interventions intended to improve prescribing habits . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00870298 INTRODUCTION Computerised physician order entry with clinical decision support system ( CPOE+CDSS ) is an important tool in attempting to reduce medication errors . The objective of this study was to evaluate the impact of a CPOE+CDSS on ( 1 ) the frequency of errors in ordering resuscitation ( CPR ) medications and ( 2 ) the time for printing out the order form , in a paediatric critical care department ( PCCD ) . METHODS SETTING An 18-bed PCCD in a tertiary-care children 's hospital . DESIGN Prospect i ve cohort study . MEASURES Compilation and comparison of number of errors and time to fill in forms before and after implementation of CPOE+CDSS .  Time to fill in conventional , simulated and CPOE forms was measured and compared . RESULTS There were three reported incidents of errors among 13,124 CPR medications orders during the year preceding implementation of CPOE+CDSS . These represent errors that escaped the triple check by three independent staff members . There were no errors after CPOE+CDSS was implemented ( 100 % error reduction for 46,970 orders ) . Time to completion of drug forms dropped from 14 min 42 s to 2 min 14s ( p < 0.001 ) . CONCLUSIONS CPOE+CDSS completely eliminated errors in filling in the forms and significantly reduced time to completing the form STUDY OBJECTIVE Emergency physicians prescribe several discharge medications that require dosage adjustment for patients with renal disease . The hypothesis for this research was that decision support in a computerized physician order entry system would reduce the rate of excessive medication dosing for patients with renal impairment . METHODS This was a r and omized , controlled trial in an academic emergency department ( ED ) , in which computerized physician order entry was used to write all prescriptions for patients being discharged from the ED . The sample included 42 physicians who were r and omized to the intervention ( 21 physicians ) or control ( 21 physicians ) group . The intervention was decision support that provided dosing recommendations for targeted medications for patients aged 18 years and older when the patient 's estimated creatinine clearance level was below the threshold for dosage adjustment . The primary outcome was the proportion of targeted medications that were excessively dosed . RESULTS For 2,783 ( 46 % ) of the 6,015 patient visits , the decision support had sufficient information to estimate the patient 's creatinine clearance level . The average age of these patients was 46 years , 1,768 ( 64 % ) were women , and 1,523 ( 55 % ) were black . Decision support was provided 73 times to physicians in the intervention group , who excessively dosed 31 ( 43 % ) prescriptions . In comparison , control physicians excessively dosed a significantly larger proportion of medications : 34 of 46 , 74 % ( effect size=31 % ; 95 % confidence interval 14 % to 49 % ; P=.001 ) . CONCLUSION Emergency physicians often prescribed excessive doses of medications that require dosage adjustment for renal impairment . Computerized physician order entry with decision support significantly reduced excessive dosing of targeted medications PURPOSE S To evaluate the effects of a computerized physician order entry ( CPOE ) system in the cardiac intensive care unit by detecting prescription errors ( PEs ) and also to assess the impact on working conditions . METHODS A longitudinal , prospect i ve , before-after study was conducted during the periods before and after the implementation of the CPOE system . Clinical pharmacists were responsible for the registration , description and classification of PEs , and their causes and severity , according to an international taxonomy . Professionals were also surveyed for their opinion , concerns , and level of satisfaction . RESULTS A total of 470 treatment orders containing 5729 prescriptions were evaluated . The CPOE result ed in a marked reduction in the number of PEs : error rate was 44.8 % ( 819 errors among 1829 prescriptions ) with h and written orders and 0.8 % ( 16 among 2094 prescriptions ) at the final electronic phase ( P < .001 ) . Lapses were the main cause of error in both prescription methods . Most errors did not reach the patients . Errors related with the computerized system were scarce . Most users were satisfied with many aspects of this technology , although a higher workload was reported . CONCLUSIONS Computerized physician order entry in the cardiac intensive care unit proved to be a safe and effective strategy in reducing PEs and was globally well received by professionals BACKGROUND Studies that have looked at the effectiveness of computerized decision support 
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Most studies examined decision support systems as a means of reducing errors or risk , particularly associated with medication prescribing , whereas a few studies evaluated the impact medical informatics – based decision support systems have on workflow or operations efficiency .
Most studies identified benefits associated with decision support systems , but some indicate there is room for improvement