***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 The purpose of this study was to assess whether implementing emergency department ( ED ) physician performance feedback reports improves adherence to evidence -based guidelines for use of CT for evaluation of pulmonary embolism ( PE ) beyond that achieved with clinical decision support ( CDS ) alone . SUBJECTS AND METHODS This prospect i ve r and omized controlled trial was conducted from January 1 , 2012 , to December 31 , 2013 , at an urban level 1 adult trauma center ED . Attending physicians were stratified into quartiles by use of CT for  evaluation of PE in 2012 and were r and omized to receive quarterly feedback reporting or not , beginning January 2013 . Reports consisted of individual and anonymized group data on guideline adherence ( using the Wells criteria ) , use of CT for PE ( number of CT examinations for PE per 1000 patients ) , and yield ( percentage of CT examinations for PE with positive findings ) . We compared guideline adherence ( primary outcome ) and use and yield ( secondary outcomes ) of CT for PE between the control and intervention groups in 2013 and with historical imaging data from 2012 . RESULTS Of 109,793 ED patients during the control and intervention periods , 2167 ( 2.0 % ) underwent CT for evaluation of PE . In the control group , guideline adherence remained unchanged between 2012 ( 78.8 % [ 476/604 ] ) and 2013 ( 77.2 % [ 421/545 ] ) ( p = 0.5 ) ; in the intervention group , guideline adherence increased 8.8 % after feedback report implementation , from 78.3 % ( 426/544 ) to 85.2 % ( 404/474 ) ( p < 0.05 ) . Use and yield were unchanged in both groups . CONCLUSION Implementation of quarterly feedback reporting result ed in a modest but significant increase in adherence to evidence -based guidelines for use of CT for evaluation of PE  in ED patients , enhancing the impact of CDS alone . These results suggest potentially synergistic effects of traditional performance improvement tools with CDS to improve guideline adherence OBJECTIVES Despite studies that show improvements in both st and ards of care and outcomes with the judicious application of clinical practice guidelines ( CPGs ) , their clinical utilization remains low . This r and omized controlled trial examined the use of a wirelessly networked mobile computer ( MC ) by physicians at the bedside with access to an emergency department information system , decision support tools ( DSTs ) , and other software options . METHODS Each of ten volunteer emergency physicians was r and omized using a matched-pair design to work five shifts in st and ard fashion ( desktop computer [ DC ] access ) and five shifts with a wirelessly networked MC . Work pattern issues and electronic CPG/DST use were compared using end-of-shift satisfaction question naires and review of a CPG/DST data base . Repeated- measures analysis of variance was used to examine between-shift differences . RESULTS A total of 100 eight-hour shifts were evaluated ; 99 % compliance with postshift question naires was achieved . Using a seven-point Likert scale ( MC values first ) , MCs were rated as being as fast ( 5.04 vs. 4.54 ; p=0.13 ) and convenient ( 5.08 vs. 4.14 ; p=0.07 ) as DCs . Overall , physicians rated MCs to be less efficient ( 3.18 vs. 4.30 ; p=0.02 ) but encouraged more frequent use of DSTs ( 4.10 vs. 3.47 ; p=0.03 ) without impacting doctor-patient communication ( 2.78 vs. 2.96 ; p=0.51 ) . During the study period , physician use of an intranet Web application ( eCPG ) was more frequent during shifts assigned to the MC when compared with the DC ( eCPG uses/shift , 3.6 vs. 2.0 ; p=0.033 ) . CONCLUSIONS The MC technology permitted physicians to access information at the bedside and increased the use of CPG/DST tools . According to physicians , patients appeared to accept their use of information technology to assist in decision making . Development of improved computer technology may address the major limitation of MC portability STUDY OBJECTIVE To determine whether use of the T-System ( Emergency Services Consultants , Irving , TX ) template-generated medical documentation system ( 1 ) decreases physician evaluation time in the emergency department , ( 2 ) increases gross billing under the 1997 Health Care Financing Administration guidelines by minimizing downcoding caused by inadequate documentation , and ( 3 ) increases physician satisfaction with the documentation process , compared with the undirected written narrative format . METHODS A prospect i ve , r and omized , unblinded , controlled , convenience trial of documentation with the T-System of ED templates versus undirected written documentation was conducted in the ED of a county-owned , university-affiliated hospital . All patients seen between the hours of 7 AM and 10 PM during a 16-day period were included . The intervention was varying the method of documentation of the emergency physician . Adequacy of r and omization to the 2 documentation groups was assessed by comparing ED triage classification , patient disposition , level of training of the evaluating physician , and whether ED consultation with other services occurred . Outcome measurements included emergency physician total evaluation and treatment time , professional bill , and satisfaction , as evaluated by a question naire completed after the study period . The 2 documentation groups were compared by an intention-to-treat analysis and by Student 's t test and the median test as appropriate . RESULTS A total of 1,228 patient encounters were included .  Emergency physician total evaluation and treatment time with template-directed documentation was 4.6 minutes less than with undirected recording , a difference that was not significant ( 95 % confidence interval [ CI ] , -9.2 to 18.3 ) . Gross billing was $ 29 . 60 more per patient ( 95 % CI , $ 22.20 to $ 37.00 ) with the T-System , as assessed by our hospital coders . This difference was caused by a mean.50 ( 95 % CI,.39 to.60 ) higher level of evaluation and management coding . Physicians preferred the T-System ( P < .0005 ) . CONCLUSION Use of template-assisted documentation in the ED was associated with higher gross billing and physician satisfaction but no significant decrease in emergency physician total evaluation time Objective . Medication errors are common among pediatric patients and in emergency departments ( EDs ) . Such errors may lead to prolonged hospitalization , unnecessary diagnostic tests and treatments , and death . The objective of this study was to determine whether the use of a structured order sheet reduces the incidence of medication errors in a pediatric ED . Methods . The study was a r and omized , controlled study that was conducted in a tertiary care pediatric hospital . Eighteen days were r and omized into 2 study groups : days during which the regular blank order sheets were used and days during which preprinted , formatted , order sheets were used .  All patients ’ charts from these days were review ed by 2 medical students , who extracted demographic , clinical , and therapeutic data into a data base . Two pediatric emergency physicians , blinded to the form used , review ed the data base and independently decided whether an error had occurred and the severity of the error . Results . Within the study period , there were 2157 visits to the ED . A total of 2058 ( 95.4 % ) charts were available for review . A total of 411 ( 52.2 % ) orders for drugs in the ED were ordered on the regular form , and 376 ( 47.8 % ) were given on the new form . Drug errors were identified in 68 ( 16.6 % ) orders when the regular form was used and in 37 ( 9.8 % ) of the orders on the new form . Using the new form was associated with a significant reduction in the risk for an error ( odds ratio : 0.55 ; 95 % confidence interval : 0.34–0.90 ) . Conclusions . The use of a preprinted structured order form significantly reduces medication errors among pediatric patients in the ED Background Potential adverse drug events ( PADEs ) are defined as being potentially harmful unintentional medication discrepancies . Discrepancies regarding medication history ( MH ) often occur when a patient is being admitted to a hospital ’s emergency department ( ED ) ; they are clinical ly important and represent a significant source of data regarding adverse drug events occurring during emergency admission to hospital . This study sought to measure the impact of pharmacist-acquired MH during admission to an ED ; it focused on whether a patient ’s current home medication regimen being available for a doctor when consulting a patient in an ED would have reduced potential adverse drug events . Method A multicentre , double-blind , r and omised , controlled parallel-group study was carried out at 3 large teaching hospitals in Bogota , Colombia . Two hundred and seventy patients who had been admitted to an ED were enrolled ; each had a st and ardised , comprehensive MH interview , focusing on a patient ’s current home medication regimen prior to being seen by a doctor . Data recorded on the admission medication order form was available to be used by a doctor during consultation in the ED . The main outcome dealt with comparing the intervention and control groups regarding the percentage of patients having at least 1 potential adverse drug event . Results There were 811 PADE ( 3.35 per patient ) , 528 ( 65 % ) on the st and ard care arm and 283 ( 35 % ) on an intervention arm . Most PADEs were judged to have had the potential to cause moderate discomfort ( 42.6 % ) , 33.4 % were deemed unlikely to have caused harm and 23.9 % were judged to have had the potential to cause clinical deterioration . Conclusion Many patients suffer potentially adverse drugs events during the transition of care from home to a hospital . Patient safety-focused medication reconciliation during admission to an ED involving a pharmacist and drawing up a history of complete medication could contribute towards reducing the risk of PADES occurring and improve follow-up of patients ’ medication-based therapy . Trial registration 28/10/2012 , IS RCT N63455839 OBJECTIVE To cope with emergency departments ( EDs ) being progressively overcrowded , the concept of specialized emergency nurses ( SENs ) was conceived . In this study , the ability of SENs to treat ankle/foot injuries was assessed . METHODS  Regular emergency nurses were trained in a 2-day session that addressed all aspects of ankle/foot injuries . A r and omized controlled trial was set up in which the diagnostic accuracy of SENs was compared with that of house officers ( HOs ) . Secondary outcome parameter was patient satisfaction measured by a st and ardized question naire . RESULTS In total , 512 consecutive patients were included . The sensitivity of SENs was 0.94 ( 95 % confidence interval [ CI ] , 0.78 - 0.99 ) compared with 0.78 ( 95 % CI , 0.57 - 0.91 ) of HOs . Specificity was 0.94 ( 95 % CI , 0.90 - 0.97 ) for SENs compared with 0.95 ( 95 % CI , 0.91 - 0.98 ) for HOs . The delivered care by SENs was found to be significantly better and the median waiting time at the ED was significantly reduced ( 21 minutes for SENs vs 32 minutes for HOs ) . CONCLUSIONS Specialized emergency nurses are capable of assessing and treating ankle/foot injuries accurately with excellent patient satisfaction and with a reduction of waiting times . Other injury-specific courses are now developed for this approach Abstract Acute gastroenteritis ( AGE ) is one of the most frequent reasons for young children to visit emergency departments ( EDs ) . We aim ed to evaluate ( 1 ) feasibility of a nurse-guided clinical decision support system for rehydration treatment in children with AGE and ( 2 ) the impact on diagnostics , treatment , and costs compared with usual care by attending physician . A r and omized controlled trial was performed in 222 children , aged 1 month to 5 years at the ED of the Erasmus MC-Sophia Children ’s hospital in The Netherl and s ( 2010–2012 ) . Outcome included ( 1 ) feasibility , measured by compliance of the nurses , and ( 2 ) length of stay ( LOS ) at the ED , the number of diagnostic tests , treatment , follow-up , and costs . Due to failure of post-ED weight measurement , we could not evaluate weight difference as measure for dehydration . Patient characteristics were comparable between the intervention ( N = 113 ) and the usual care group ( N = 109 ) . Implementation of the clinical decision support system proved a high compliance rate . The st and ardized use of oral ORS ( oral rehydration solution )  significantly increased from 52 to 65%(RR2.2 , 95%CI 1.09–4.31 p < 0.05 ) . We observed no differences in other outcome measures . Conclusion : Implementation of nurse-guided clinical decision support system on rehydration treatment in children with AGE showed high compliance and increase st and ardized use of ORS , without differences in other outcome measures .What is Known:• Acute gastroenteritis is one of the most frequently encountered problems in pediatric emergency departments.• Guidelines advocate st and ardized oral treatment in children with mild to moderate dehydration , but appear to be applied infrequently in clinical practice .What is New:• Implementation of a nurse-guided clinical decision support system on treatment of AGE in young children showed good feasibility , result ing in a more st and ardized ORS use in children with 
    Output:
    
RESULTS We produced 10 recommendations for implementing new evidence -based interventions in the emergency department , which cover identifying a practice gap , evaluating the evidence , planning the intervention strategy , monitoring , providing feedback during implementation , and desired qualities of future implementation research .