***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 This study assessed the effect of a h and held computer-based decision support system ( DSS ) on  antibiotic use and patient outcomes in a critical care unit . DESIGN A DSS containing four types of evidence ( patient microbiology reports , local antibiotic guidelines , unit-specific antibiotic susceptibility data for common bacterial pathogens , and a clinical pulmonary infection score calculator ) was developed and implemented on a  h and held computer  for use in the intensive care unit at a tertiary referral hospital . System impact was assessed in a prospect i ve " before/after " cohort trial lasting 12 months . Outcome measures were defined daily doses ( DDDs ) of antibiotics per 1,000 patient-days , patient length of stay , and mortality . RESULTS The number of admissions , APACHE ( Acute Physiology , Age , and Chronic Health Evaluation ) II and SAPS ( Simplified Acute Physiology Score ) II for patients in preintervention , and intervention ( DSS use ) periods were statistically comparable . The mean patient length of stay and the use of antibiotics in the unit during six months of the DSS use decreased from 7.15 to 6.22 bed-days ( p = 0.02 ) and from 1,767 DDD to 1,458 DDD per 1,000 patient-days ( p = 0.04 ) , respectively , with no change in mortality . The DSS was accessed 674 times during 168 days of the trial . Microbiology reports and antibiotic guidelines were the two most commonly used ( 53 % and 22.5 % , respectively ) types of evidence . The greatest reduction was observed in the use of beta-lactamase-resistant penicillins and vancomycin . CONCLUSION H and held computer-based decision support contributed to a significant reduction in patient length of stay and antibiotic prescribing in a critical care unit The purpose of the study was to compare the proportion of obesity-related diagnoses in clinical encounters ( N = 1874 ) documented by nurses using a personal digital assistant-based log with and without obesity decision support features . The experimental group encounters in the r and omized controlled trial had significantly more ( P = .000 ) obesity-related diagnoses ( 11.3 % ) than did the control group encounters ( 1 % ) and a significantly lower false negative rate ( 24.5 % vs 66.5 % , P = .000 ) . The study findings provide evidence that integration of a decision support feature that automatically calculates an obesity-related diagnosis increases diagnoses and decreases missed diagnoses and suggest that such systems have the potential to improve the quality of obesity-related care Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE To evaluate the effectiveness of a personal digital assistant (PDA)-based clinical decision support system ( CDSS ) on nonsteroidal anti-inflammatory drug ( NSAID ) prescribing safety in the outpatient setting . DESIGN The design was a r and omized , controlled trial conducted in a university-based resident clinic . Internal medicine residents received a PDA-based CDSS suite . For intervention residents , the CDSS included a prediction rule for NSAID-related gastrointestinal risk assessment and treatment recommendations . Unannounced st and ardized patients ( SPs ) trained to portray musculoskeletal symptoms presented to study physicians . Safety outcomes were assessed from the prescriptions given to the SPs . Each prescription was review ed by a committee of clinicians blinded to participant , intervention group assignment , and baseline or follow-up status . MEASUREMENTS Prescriptions were judged as safe or unsafe . The main outcome measure was the differential change in unsafe prescribing of NSAIDs for the intervention versus the control group . RESULTS At baseline , the mean proportion of cases per physician with unsafe prescriptions for the two groups was similar ( 0.27 vs. 0.29 , p > 0.05 ) . Controlling for baseline performance , intervention participants prescribed more safely than controls after receiving the CDSS ( 0.23 vs. 0.45 [ F = 4.24 , p < 0.05 ] ) . With the CDSS , intervention participants documented more complete assessment of patient gastrointestinal risk from NSAIDs . CONCLUSION PARTICIPANTS provided with a PDA-based CDSS for NSAID prescribing made fewer unsafe treatment decisions than participants without the CDSS Summary Background Health workers ' malaria case-management practice s often differ from national guidelines . We assessed whether text-message reminders sent to health workers ' mobile phones could improve and maintain their adherence to treatment guidelines for outpatient paediatric malaria in Kenya . Methods From March 6 , 2009 , to May 31 , 2010 , we did a cluster-r and omised controlled trial at 107 rural health facilities in 11 districts in coastal and western Kenya . With a computer-generated sequence , health facilities were r and omly allocated to either the intervention group , in which all health workers received text messages on their personal mobile phones on malaria case-management for 6 months , or the control group , in which health workers did not receive any text messages . Health workers were not masked to the intervention , although patients were unaware of whether they were in an intervention or control facility . The primary outcome was correct management with artemether-lumefantrine , defined as a dichotomous composite indicator of treatment , dispensing , and counselling tasks concordant with Kenyan national guidelines . The primary analysis was by intention to treat . The trial is registered with Current Controlled Trials , IS RCT N72328636 . Findings 119 health workers received the intervention . Case-management practice s were assessed for 2269 children who needed treatment ( 1157 in the intervention group and 1112 in the control group ) . Intention-to-treat analysis showed that correct artemether-lumefantrine management improved by 23·7 percentage-points ( 95 % CI 7·6–40·0 ; p=0·004 ) immediately after intervention and by 24·5 percentage-points ( 8·1–41·0 ; p=0·003 ) 6 months later . Interpretation In re source -limited setting s , malaria control programmes should consider use of text messaging to improve health workers ' case-management practice s. Funding The Wellcome Trust OBJECTIVE To examine whether Palm Prevention , a free software tool for Palm OS personal digital assistants ( PDAs ) that provides quick access to preventive guidelines in a patient-specific manner at the point of care , improved adherence to five preventive measures in primary care . DESIGN Prospect i ve intervention pilot study . SETTING Vancouver , BC , and surrounding area . PARTICIPANTS Eight general practitioners . INTERVENTIONS Each physician used Palm Prevention for five preventive measures during routine preventive health visits with 10 patients ( n = 80 ) . Charts of consenting patients were review ed for documentation of recommended maneuvers . MAIN OUTCOME MEASURES Rates of adherence to five evidence -based guidelines selected from the Canadian and American task forces on preventive care and incorporated into Palm Prevention . RESULTS Intervention and control physicians were similar in their familiarity with and use of PDAs , and they recruited similar patients for the study . Intervention and control groups had similar rates of screening for hypertension . Intervention improved adherence to the remaining four guidelines : cervical cancer screening increased 22 % ( only absolute increases are reported ) ; hyperlipidemia screening increased 30 % ; colorectal cancer screening increased 27 % ; and  prophylaxis with acetylsalicylic acid in high-risk patients increased 38 % . Participants were surveyed after the study ; all reported that they found the software helpful and would continue using Palm Prevention . Usage statistics showed that study participants used the tool outside the trial : users entered between 28 and 68 unique patients into the program during the 2-month intervention . CONCLUSION This pilot study suggests PDAs are useful in improving preventive care and facilitating translation of knowledge into practice . This was particularly apparent with newer guidelines OBJECTIVE Personal digital assistants ( PDAs ) are popular with physicians : in 2003 , 33 % of Canadian doctors reported using them in their practice s. We do not know , however , whether using a PDA changes the behaviour of practising physicians . We studied the effectiveness of a PDA software application to help family physicians diagnose angina among patients with chest pain . DESIGN Prospect i ve r and omized controlled pilot trial using a cluster design . SETTING Primary care practice s in the Toronto area . PARTICIPANTS Eighteen family physicians belonging to the North Toronto Primary Care Research Network ( Nortren ) or recruited from a local hospital . INTERVENTIONS We r and omized physicians to receive a Palm PDA ( which included the angina diagnosis software ) or to continue conventional care . Physicians prospect ively recorded the process of care for patients aged 30 to 75 presenting with suspected angina , over 7 months . MAIN OUTCOME MEASURES Did the process of care for patients with suspected angina improve when their physicians had PDAs and software ? The primary outcomes we looked at were frequency of cardiac stress test orders for suspected angina , and the appropriateness of referral for cardiac stress testing at presentation and for nuclear cardiology testing after cardiac stress testing . Secondary outcome was referrals to cardiologists . RESULTS The software led to more overall use of cardiac stress testing ( 81 % vs 50 % ) . The absolute increase was 31 % ( P = .007 , 95 % confidence interval [ CI ] 8 % to 58 % ) . There was a trend toward more appropriate use of stress testing ( 48.6 % with the PDA vs 28.6 % control ) , an increase of 20 % ( P = .284 , 95 % CI -11.54 % to 51.4 % ) . There was also a trend toward more appropriate use of nuclear cardiology following cardiac stress testing ( 63.0 % vs 45.5 % ) , an absolute increase of 17.5 % ( P = .400 , 95 % CI -13.9 % to 48.9 % ) . Referrals to cardiologists did not increase ( 38.2 % with the PDA vs 40.9 % , P = .869 ) . CONCLUSION A PDA-based software application can lead to improved care for patients with suspected angina seen in family practice s ; this finding requires confirmation in a larger study OBJECTIVE To assess the acceptability and usage of a st and alone personal digital assistant (PDA)-based clinical decision-support system ( CDSS ) for the diagnosis and management of acute respiratory tract infections ( RTIs ) in the outpatient setting . DESIGN Observational study performed as part of a larger r and omized trial in six rural communities in Utah and Idaho from January 2002 to March 2004 . Ninety-nine primary care providers received a  PDA-based CDSS for use at the point-of-care , and were asked to use the tool with at least 200 patients with suspected RTIs . MEASUREMENTS Clinical data were collected electronically from the devices at periodic intervals . Providers also completed an exit question naire at the end of the study period . RESULTS Providers logged 14,393 cases using the CDSS , the majority of which ( n=7624 ; 53 % ) were from family practitioners . Overall adherence with CDSS recommendations for the five most common diagnoses ( pharyngitis , otitis media , sinusitis , bronchitis , and upper respiratory tract infection ) was 82 % . When antibiotics were prescribed ( 53 % of cases ) , adherence with the CDSS-recommended antibiotic was high ( 76 % ) . By logistic regression analysis , the odds of adherence with CDSS recommendations increased significantly with each ten cases completed ( P=0.001 ) . Question naire respondents believed the CDSS was easy to use , and most ( 44/65 ; 68 % ) did not believe it increased their encounter time with patients , regardless of prior experience with PDAs . CONCLUSION A st and alone PDA-based CDSS for acute RTIs used at the point-of-care can encourage better outpatient antimicrobial prescribing practice s and easily gather a rich set of clinical data BACKGROUND Testing for pulmonary embolism often differs from that recommended by evidence -based guidelines . OBJECTIVE To assess the effectiveness of a h and held clinical decision-support system to improve the diagnostic work-up of suspected pulmonary embolism among patients in the emergency department . DESIGN Cluster r and omized trial . Assignment was by r and om-number table , providers were not blinded , and outcome assessment was automated . ( Clinical Trials.gov registration number : NCT00188032 ) . SETTING 20 emergency departments in France . PATIENTS 1103 and 1768 consecutive out patients with suspected pulmonary embolism . INTERVENTION After a preintervention period involving 20 centers and 1103 patients , in which providers grew accustomed to inputting clinical data into h and held devices and investigators assessed baseline testing , emergency departments were r and omly assigned to activation of a decision-support system on the devices ( 10 centers , 753 patients ) or posters and pocket cards that showed vali date d diagnostic strategies ( 10 centers , 1015 patients ) . MEASUREMENTS Appropriateness of diagnostic work-up , defined as any sequence of tests that yielded a posttest probability less than 5 % or greater than 85 % ( primary outcome ) or as strict adherence to guideline recommendations ( secondary outcome ) ; number of tests 
    Output:
    
Effectiveness was demonstrated across three distinct functions that emerged from the data : accessing information for clinical knowledge , adherence to guidelines and diagnostic decision making .
When healthcare professionals used h and held computers to access clinical information , their knowledge improved significantly more than peers who used paper re sources .
When clinical guideline recommendations were presented on h and held computers , clinicians made significantly safer prescribing decisions and adhered more closely to recommendations than peers using paper re sources .
Finally , healthcare professionals made significantly more appropriate diagnostic decisions using clinical decision making tools on h and held computers compared to colleagues who did not have access to these tools .
Conclusion Healthcare professionals ’ use of h and held computers may improve their information seeking , adherence to guidelines and clinical decision making .
H and held computers can provide real time access to and analysis of clinical information .
The integration of clinical decision support systems within h and held computers offers clinicians the highest level of synthesis ed evidence at the point of care .