***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: Recent re-evaluation of preventive health care has result ed in more limited and directed guidelines ; nonetheless , physician compliance has remained poor . This study assessed whether an inexpensive reminder system of preventive care checklists would improve physician implementation of periodic health measures .  Residents in internal medicine were r and omly placed into two groups : one received a copy of the appropriate checklist with each patient 's medical record ; the other did not . After one year , 200 r and omly selected records were audited to determine the proportion of recommendations implemented for each patient . Residents who received checklists performed appropriate preventive health measures at a significantly higher rate than those who did not ( 0.56 + /- 0.26 versus 0.39 + /- 0.22 , p less than 0.002 ) . The actual use of the checklist to record the results was associated with an even higher rate of compliance compared with instances in which the checklists were provided but not used and instances in which checklists were not received ( 0.70 + /- 0.21 versus 0.44 + /- 0.24 and 0.39 + /- 0.22 , respectively , p less than 0.002 ) . These data suggest that a physician 's use of simple checklists can provide an inexpensive and effective means of improving implementation of periodic health maintenance 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 In an academic general medicine clinic , we performed a r and omized , controlled trial to compare ( 1 ) the effects of supplying monthly feedback reports of compliance with preventive care protocol s by 135 internal medicine house staff with ( 2 ) the effects of specific reminders given to them at the time of patient visits . The protocol s were r and omly divided into two groups , A and B , and half the house staff were given feedback for Group A and half for Group B. Thus , each group served as a control for the other . Each feedback group was also r and omly assigned to receive reminders for either Group A or B protocol s. House staff receiving feedback more often complied with fecal occult blood testing , mammography , pneumococcal vaccination , use of metronidazole , and combined Group A and B protocol s than did controls ( P < 0.01 ) . There was also significantly more compliance with the same protocol s by house staff receiving reminders , but the increase for fecal occult blood testing , pneumococcal vaccination , and combined Group A protocol s was twice that seen in physicians given feedback alone . In addition , reminders alone increased compliance with oral calcium supplementation . Overall compliance with the preventive care protocol s was low : 10 - 15 % in physicians receiving neither feedback nor reminders , increasing to 15 - 30 % in those receiving reminders . Physician compliance with suggested preventive care protocol s can be increased by both delayed feedback and immediate reminders , but reminders have a greater effect OBJECTIVE --To discover whether systematic methods of call and recall are more effective than a non- systematic method and to see which of the two systematic methods was more effective . DESIGN -- Prospect i ve r and omised controlled trial over a year . SETTING --One group general practice . PATIENTS --416 Women over 35 eligible for a smear test who had never had a cervical smear test or in whom a smear test was overdue ( previous test more than five years before ) . INTERVENTIONS --One group received written invitations to have a smear taken . The second group had their notes tagged so that the doctor would remind them ( when they attended for another reason ) to have a smear test . No special intervention was made in the third group . MAIN OUTCOME MEASURE -- Performance of a cervical smear test during the year of the study . RESULTS --32 % ( 45/140 ) of the screened group , 27 % ( 39/142 ) of the tagged group , and 15 % ( 20/134 ) of the control group had a smear test during the year . The percentage of women having a smear test in the screened group was not significantly different from that in the tagged group , but the percentages in the two groups were significantly different from that in the control group . Whether a woman had had a previous smear test significantly affected the uptake of the invitation to have a smear test independently of the method of invitation . CONCLUSIONS --The systematic methods of call and recall were more effective than a non- systematic method . There was no significant difference between the two systematic methods ( sending letters or tagging the notes ) at one year 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 BACKGROUND We compared the efficacy of a computer-generated prompt sheet placed on the front of patients ' charts with a patient-carried prompt card to remind physicians to perform selected health maintenance items . METHODS A r and omized prospect i ve single-blind study was performed in private practice offices in rural eastern North Carolina , with 28 family practitioners and nine general internists participating . Twenty-two physicians were r and omized to the computer prompt group and 22 to the card prompt group .  Four physicians in the computer group did not complete the study because of computer software problems , and three physicians did not complete the study because their limited staff was unable to enter patient data into the computer . Before the intervention , 20 patient charts ( 10 males and 10 females ) from each physician were audited for the performance of influenza vaccinations , stool for occult blood , pap smears , breast examinations performed by the physicians , and mammograms . One year after the intervention was instituted , chart audits for the above five items were done again on 20 different patient charts for each physician . RESULTS There was a 7 % increase in the performance of influenza vaccinations  in the card group ( 17 % vs 24 % ) compared with a 6 % increase in the computer group ( 20 % vs 26 % ) . There was a 5 % decrease in the performance of stool for occult blood in the card group ( 28 % vs 23 % ) compared with a 1 % increase in the computer group ( 30 % vs 31 % ) . There was an 11 % decrease in the performance of pap smears in the card group ( 26 % vs 15 % ) compared with a 3 % increase in the computer group ( 23 % vs 26 % ) . There was a 2 % decrease in the performance of breast examinations by the physician in the card group ( 35 % vs 33 % ) compared with a 3 % increase in the computer group ( 30 % vs 33 % ) . Finally , there was a 3 % increase in the performance of mammograms in the card group ( 22 % vs 25 % ) compared with an 11 % increase in the computer group ( 15 % vs 26 % ) . CONCLUSIONS Our data show a greater increase in performance of health maintenance items in the computer-prompted group . The performance of stool for occult blood , pap smears , breast examinations performed by the physician , and mammograms were increased more in the computer-prompted group than in the card group . However , there was not a statistically significant difference after intervention for any of the audited health maintenance items for either the computer group or the card group . Overall , health maintenance measures were performed in only a minority of appropriate patients 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 In a r and omized trial three ways of increasing rates of cervical screening  were compared for women attending a family medicine center . Working from computerized medical records , 1,587 women aged 18 to 35 years who were overdue for a screening test were included in the study . In a control group , no formal method was used to encourage patients to attend for screening , and 13.7 percent obtained a test within the trial year . In one intervention group the physician was issued a message identifying those women visiting the center for a routine appointment who were due for screening ; 16.1 percent were screened . Sending a letter to patients in a second group yielded a 25.9 percent compliance rate . In a third group the practice nurse called patients on the telephone to advise them to obtain the test , and 20.0 percent complied . Reminders issued to the physician provide a low-cost , opportunistic approach to reach women who happen to visit the practice , but this approach should be supplemented by telephoning or sending a letter to those women who do not attend regularly Despite its demonstrated efficacy in reducing breast carcinoma mortality , screening mammography remains underutilized and its promotion in the primary care setting provides an important opportunity for intervention 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 Performance of health maintenance procedures by internal medicine house staff is inadequate , yet little has been published outlining means to improve performance rates . We prospect ively studied the effectiveness of a reminder system to improve screening by Pap smear , rectal examination with stool guaiac test , breast examination , and  pneumococcal vaccine administration in two resident outpatient clinics . Performance of these preventive health measures was determined during a six-week baseline period and again after five months of chart reminders to residents in one clinic , and after six months without reminders . For the intervention , a physician 's assistant screened each chart and attached a reminder to the front indicating which procedures were overdue based on published recommendations . Health screening behavior was not significantly different between the two resident clinics during baseline . After the five-month reminder intervention , residents in both groups moderately increased their preventive health activities over baseline ; however , only the reminded group showed significant improvement ( chi 2 = 11.60 , P less than .001 ) . Six months after remainders were discontinued there was no difference in overall performance between the two clinics ( chi 2 = 2.79 , NS ) . The reminded group did preserve its significant improvement over the bas 
    Output:
    
Evidence in this review of studies published from 1986 through 2004 indicates that reminder/recall systems can effectively increase screening with mammography , Pap , fecal occult blood tests , and flexible sigmoidoscopy .