***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: OBJECTIVE Most data on the prevalence and behaviour of skin cancers is based on hospital studies . The scarcity of community based general practice skin surveys prompted this study . The aim of the survey was to : record the relative frequency of different skin tumours in an Adelaide general practice and compare these with rates published elsewhere . to record clinical accuracy of diagnosis , infection rates and completeness of excision . METHOD Five year prospect i ve study recording age , sex , site of excision and histological diagnosis of 369 skin excisions in a general practice . A sub study recorded clinical diagnostic accuracy , with subsequent histological diagnosis . RESULTS Non-melanotic skin cancer ( NMSC ) accounted for 59.9 % of the total lesions with basal cell carcinomas ( BCCs ) accounting for 30.6 % , squamous cell carcinomas ( SCCs ) 21.7 % , and intra epithelial cancer 7.6 % . The most frequent excision site was head , neck and face . A total of 75 % of SCCs occurred on sun exposed areas , whereas a significant proportion of BCCs occurred on the shoulder and trunk ( 37.1 % ) ; this agrees with recent trends in Australia . Clinical accuracy when compared with histology was 77 % comparing favourably with other published data . CONCLUSION Skin cancer continues to be a major community health issue in Australia in which general practitioners are heavily involved . Due to their expertise and early intervention at a community level , much is being done to reduce this cost in the community . Further research on NMSC trends are needed , especially in general practice A decision support system for the management of  oral hypoglycaemic therapy  in type II diabetes was evaluated . The ruleset contained therein forms the basis of a prototype computer programme , but in order to assess the robustness of the individual rules , it was decided it was necessary to use a paper-based form of the ruleset . A nurse with no previous experience of managing type II diabetes was trained to use the system and then undertook the exclusive management of half of all new type II diabetics , from a district population of 300,000 , over a 16-month period . General practice s within this area were divided into two groups , study and control , matching for size , geographical area and st and ards of existing diabetes care . Patients ( n = 102 ) from the study group practice s were then assigned to her care . Those patients ( n = 116 ) in the control group of practice s were treated according to their normal procedures . The decision support system for oral hypoglycaemic therapy was based on the following criteria : the current type of treatment ( six levels ) ; current glycaemic control ( HbA1 and FBS)-whether improving , steady or worsening ; and weight-%IBW , whether rising , steady or falling . Each of these parameters was carefully defined on the basis of established practice and clinical experience . Patients after initial education were seen at their usual clinic by the nurse only , on a monthly basis , until satisfactory glycaemic control was established and thereafter review ed 3 monthly . She was also responsible for ensuring the organisation of Diabetes Annual Review procedures . The medical records of the control group patients were examined at the end of the study and data on glycaemic control and Annual Review s extracted . In the study group 98 % patients achieved HbA1 levels within the normal range and all patients had full annual review s performed . The control practice s achieved much poorer degrees of metabolic control ( P < 0.01 ) and completed fewer annual review s. The study group did not demonstrate a significantly increased frequency of clinical hypoglycaemia consequent upon better blood sugar control . No exceptions to the ruleset , as initially defined , were detected . In conclusion , this decision support system was successful at achieving st and ards of diabetes control and care equal to or better than conventional structures of diabetes care . Implementation of such a system , on a simple computer platform , could greatly assist and possibly improve diabetes management in general practice Objective To evaluate whether  nurse run clinics in general practice improve secondary prevention in patients with coronary heart disease . Design R and omised controlled trial . Setting A r and om sample of 19 general practice s in northeast Scotl and . Patients 1173 patients ( 685 men and 488 women ) under 80 years with working diagnoses of coronary heart disease , but without terminal illness or dementia and not housebound .  Intervention Nurse run clinics promoted medical and lifestyle aspects of secondary prevention and offered regular follow up . Main outcome measures Components of secondary prevention assessed at baseline and one year were : aspirin use ; blood pressure management ; lipid management ; physical activity ; dietary fat ; and smoking status . A cumulative score was generated by counting the number of appropriate components of secondary prevention for each patient . Results There were significant improvements in aspirin management ( odds ratio 3.22 , 95 % confidence interval 2.15 to 4.80 ) , blood pressure management ( 5.32 , 3.01 to 9.41 ) , lipid management ( 3.19 , 2.39 to 4.26 ) , physical activity ( 1.67 , 1.23 to 2.26 ) and diet ( 1.47 , 1.10 to 1.96 ) . There was no effect on smoking cessation ( 0.78 , 0.47 to 1.28 ) . Of six possible components of secondary prevention , the baseline mean was 3.27 . The adjusted mean improvement attributable to intervention was 0.55 of a component ( 0.44 to 0.67 ) . Improvement was found regardless of practice baseline performance . Conclusions  Nurse run clinics proved practical to implement in general practice and effectively increased secondary prevention in coronary heart disease . Most patients gained at least one effective component of secondary prevention and , for them , future cardiovascular events and mortality could be reduced by up to a third Although low dose aspirin reduces risk in patients with heart disease , many such patients do not receive daily prophylactic aspirin.1 We report a trial of feedback of general practitioners ' data on aspirin prescribing aim ed at increasing coded aspirin prescribing in patients with heart disease . Computerised practice s were r and omised to receive feedback on their prescribing , either of aspirin for patients with ischaemic heart disease or of hormone replacement therapy for women who had had hysterectomies . We approached 48 practice s in north London ; nine refused , and 11 were excluded . Of the 28 ( 58 % ) practice s in the study , seven were single h and ed and six had five or more partners . All participating practice s used the emis computer system except two that used Paradoc ; both systems yielded sufficiently reliable and comparable data . Eligible practice s had to have computerised information on hysterectomies and ischaemic heart disease and use their systems for repeat prescribing . Practice s were then r and omised by using sealed envelopes to Abstract Objective : To determine whether locally developed guidelines on asthma and diabetes disseminated through practice based education improve quality of care in non-training , inner city general practice s. Design : R and omised controlled trial with each practice receiving one set of guidelines but providing data on the management of both conditions . Subjects:24 inner city , non-training general practice s. Setting : East London . Main outcome measures : Recording of key variables in patient records ( asthma : peak flow rate , review of inhaler technique , review of asthma symptoms , prophylaxis , occupation , and smoking habit ; diabetes : blood glucose concentration , glycaemic control , funduscopy , feet examination , weight , and smoking habit ) ; size of practice disease registers ; prescribing in asthma ; and use of structured consultation “ prompts . ” Results : In practice s receiving diabetes guidelines , significant improvements in recording were seen for all seven diabetes variables . Both groups of practice s showed improved recording of review of inhaler technique , smoking habit , and review of asthma symptoms . In practice s receiving asthma guidelines , further improvement was seen only in recording of review of inhaler technique and quality of prescribing in asthma . Sizes of disease registers were unchanged . The use of structured prompts was associated with improved recording of four of seven variables on diabetes and all six variables on asthma . Conclusions : Local guidelines disseminated via practice based education improve the management of diabetes and possibly of asthma in inner city , non-training practice s. The use of simple prompts may enhance this improvement This study examined the blood pressure ( BP ) control and number of drugs prescribed for a sample of hypertensive patients from 18 practice s in Northeast Engl and . Out of a total of 35,379 registered patients aged 40 - 69 years , 2995 ( 8.5 % ) were on treatment for hypertension . Data was abstract ed from the practice records of a r and om sample of 691 patients . Using British Hypertension Society st and ards , BP control was optimal for systolic pressure ( less than 160 mm Hg ) in 469 ( 68 % ) , and for diastolic pressure ( less than 90 mm Hg ) in 345 ( 50 % ) , but only 269 ( 39 % ) had optimally controlled systolic and diastolic pressures . Sixty-one per cent were taking one drug and 39 % two or more ; 82 % of patients aged 40 - 49 years but only 61 % of those aged 60 - 69 years had optimally controlled systolic pressures . Forty-three per cent of the 40 to 49-year-old group and 56 % of the 60 to 69-year-old group had optimally controlled diastolic pressures . A strong inverse relationship was found between age and systolic BP control but there was no association between age and diastolic pressure or the number of drugs being prescribed . Sub-optimal BP control is a major problem and remedial strategies should stress the greater gain from treating older patients OBJECTIVES To monitor the documentation of blood pressure measurements and other cardiovascular risk factors in general practice patients with hypertension . METHOD Twenty-five case notes of patients diagnosed as hypertensive were r and omly selected from each of 58 participating general practitioners in suburban general practice in Adelaide , South Australia and were monitored by two registered nurses . MAIN OUTCOME MEASURES to assess whether blood pressure readings , weight , smoking history , alcohol intake and family history were documented , and whether  electrocardiogram , plasma lipids , urinalysis and biochemical screen ( which includes blood urea nitrogen , creatinine , glucose , electrolytes and uric acid ) had been undertaken . RESULTS Data from 1446 hypertensive patients showed that for the last three blood pressure values recorded , 483 ( 33 % ) had an average level of 140/90 mm Hg or less and 1100 ( 76 % ) had an average of 160/95 mm Hg or less . The other cardiovascular risk factors selected were variably recorded , with biochemical screen being most commonly recorded [ 1198 ( 83 % ) ] and family history [ 423 ( 29 % ) ] the least . CONCLUSIONS Inadequacies in the control of hypertension and in the documentation of other cardiovascular risk factors suggest that further educational initiatives are required in this common chronic illness Initiation , distribution , concomitants and follow-up of cholesterol testing were studied in Grampian . Data were examined for 4979 patients , representing all patients in one year from those general practice s who made exclusive use of the clinical chemistry laboratory for cholesterol testing .  A r and om sample of 215 patients was studied in further detail . Age and sex distribution , results of cholesterol tests and their follow-up , nature and results of associated biochemical tests , test initiation , testing rates by practice , and prescription rates of lipid lowering agents by practice were measured . Cholesterol testing was mostly in line with current knowledge of cardiovascular risk , and associated with further cardiovascular and biochemical assessment . There was a 90-fold range in practice cholesterol testing rates , and a similarly wide range in prescription rates of lipid lowering agents ; there was a significant correlation between these . Rates and results of follow-up testing suggests a “ rule of halves ” for cholesterol testing BACKGROUND The appropriateness of epilepsy as a topic for general practice audit activity has been emphasized , but few audits have been undertaken to data and those that have are small scale . Historically , management of epilepsy has been a neglected area , and services for people with epilepsy remain generally poor . AIM The study was design ed to examine the process of care for people with epilepsy through a region-wide audit of general practitioner records . METHOD General practitioners in 31 r and omly selected general practice s in one UK health region undertook a  notes audit  for all patients identified as having active epilepsy ( patients who had had seizures in the last 2 years , or were currently seizure-free but on antiepileptic medication ) . A st and ard pro forma was used to collect information relating to diagnosis , drug treatment , and primary and secondary care contacts . RESULTS Recording of information in the notes was generally good , but poor for some key items essential to the effective management of the condition ; results suggest that a number of recommendations about provision of care for epilepsy are not being met : in particular , EEG and CT investigations often appear poorly directed ; prescribed antiepileptic therapy is not always optimal ; significant numbers of patients are being treated in hospital by non-neurologists ; there is little evidence of any regular review being undertaken by general practitioners of their patients with epilepsy ; and counselling about the non- clinical aspects of epilepsy often appears inadequate . CONCLUSIONS Despite recommendations in a number of recent reports , gaps and inconsistencies in epilepsy care persist , both at the primary and secondary level . The means by which such shortcomings can be reduced ( e.g. by specialist epilepsy nurses working across the primary - secondary care interface ) should now be systematic ally examined . The study has highlighted a need for 
    Output:
    
This study adopts an overview of the magnitude and the nature of clinical quality problems in general practice in three countries .