***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: To determine whether clinical errors can be reduced by prospect i ve computer suggestions about the management of simple clinical events , I studied the responses of nine physicians to computer suggestions generated by 390 protocol s in a controlled crossover design . These protocol s dealt primarily with conditions managed ( e.g. , elevated blood pressure ) or caused ( e.g. , liver toxicity ) by drugs . Physicians responded to 51 per cent of 327 events when given , and 22 per cent of 385 events when not given computer suggestions . Neither level of postgraduate training ( first-year postgraduate or third-year post-graduate ) nor the order in which physicians served as study and control subjects had statistically significant overall effect on the results . It appears that the prospect i ve reminders do reduce errors , and that many of these errors are probably due to man 's limitations as a data processor rather than to correctable human deficiencies In an examination of the relationships among plasma aminoglycoside concentrations , the minimal inhibitory concentration ( MIC ) for the infecting organism , and therapeutic outcome , data were analyzed from 236 patients with gram-negative bacterial infections who were participants in four clinical trials of gentamicin , tobramycin , and amikacin .  Clinical response to therapy occurred in 188 ( 80 % ) patients . Elevated maximal and mean peak aminoglycoside concentration/MIC ratios were strongly associated with clinical response ( P less than .00001 and P less than .0001 , respectively ) . A grade d dose-response effect was found between an increasing maximal peak concentration/MIC ratio and clinical response . By logistic regression the peak concentration/MIC ratios were associated significantly with clinical response after adjustment for underlying severity of illness and other factors correlated with response . These results demonstrate that a high peak concentration relative to the MIC for the infecting organism is a major determinant of the clinical response to aminoglycoside therapy To determine the association of aminoglycoside plasma levels with therapeutic outcome in gram-negative pneumonia , the case reports of 37 patients from four prospect i ve , r and omized , controlled trials of gentamicin , tobramycin , and amikacin were analyzed . Twenty ( 54 percent ) of these patients had a favorable outcome . Patients with maximal one-hour postinfusion ( peak ) levels of 7 micrograms/ml or greater for gentamicin and tobramycin or 28 micrograms/ml or greater for amikacin more often had successful outcomes ( 14 of 20 , 70 percent ) than those with levels less than this ( six of 19 , 32 percent ) ( p less than 0.006 ) . Patients with overall mean peak levels of 6 micrograms/ml or greater for gentamicin and tobramycin or 24 micrograms/ml or greater for amikacin more often had successful outcomes than those with levels less than this ( six of 17 , 35 percent ) ( p less than 0.04 ) . The initial patient temperature , serum urea nitrogen/creatinine ratio , initial polymorphonuclear leukocyte count , and age were also associated with outcome ; but by multivariate analysis , achieving an adequate peak concentration was the most important discriminating factor . These results suggest the potential importance of achieving adequate aminoglycoside levels in patients with gram-negative pneumonia To determine the association of aminoglycoside levels with mortality from gram-negative bacteremia , we analyzed the case reports of patients from four prospect i ve , r and omized , and controlled clinical trials of gentamicin , tobramycin , and amikacin . Twelve ( 13.5 % ) of 89 patients died . One ( 2.4 % ) death occurred in 41 patients with early ( 1-hr postinfusion ) peak concentrations of greater than 5 micrograms/ml of gentamicin and tobramycin and of greater than 20 micrograms of amikacin/ml ; nine deaths ( 20.9 % ) occurred in 43 patients with lower concentrations . Five ( 8.3 % ) deaths occurred in 60 patients with mean peak concentrations for the entire course of therapy of greater than 5 micrograms/ml of gentamicin and tobramycin and of greater than 20 micrograms of amikacin/ml ; five ( 20.8 % ) deaths occurred in 24 patients with lower concentrations . Stepwise discriminant analysis showed that therapeutic early peak concentration was a significant factor in the presence of three other factors : severity of underlying illness , peak temperature , and initial leukocyte count . The results suggest the importance of achieving adequate early aminoglycoside levels in patients with gram-negative bacteremia 
    Output:
    
MAIN RESULTS Twenty-six comparisons ( 23 articles ) were included ( as compared to fifteen comparisons in the original review ) including a wide range of drugs in inpatient and outpatient setting s. Interventions usually targeted doctors although some studies attempted to influence prescriptions by pharmacists and nurses .
This review suggests that computerized advice for drug dosage has some benefits : it increased the initial dose of drug , increased serum drug concentrations and led to a more rapid therapeutic control .
It also reduced the risk of toxic drug levels and the length of time spent in the hospital .
However , it had no effect on adverse reactions .
In addition , there was no evidence to suggest that some decision support technical features ( such as its integration into a computer physician order entry system ) or aspects of organization of care ( such as the setting ) could optimise the effect of computerised advice