***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: Background Spontaneous reporting of adverse drug reactions ( ADRs ) is one approach to increasing our knowledge on the risks of drugs in clinical practice . Under-reporting is a shortcoming of this system . Objectives To evaluate if repeated e-mails with attachments on ADR information can affect ( 1 ) the reporting of ADRs and ( 2 ) the quality of the ADR reports . Methods All 117 heads of primary health care units in the region of Västra Götal and in Sweden were r and omly allocated ( 1:1 ) to an intervention group or a control group . The intervention consisted of e-mails with attachments sent out to each of the 117 heads in January , May and September 2007 . These e-mails included ( 1 ) the heading “ Every ADR report is important ” , ( 2 ) a current case report of an ADR and ( 3 ) instructions on how to report . The number of reports from each primary health care unit run by the same head was registered , as was the quality of the report . The quality was defined as high if the ADR was ( 1 ) serious , ( 2 ) unexpected or ( 3 ) related to the use of new drugs and not labeled as common in the summary of product characteristics . All other reports were regarded as low- quality reports . Results The total number of reports increased from 89 in 2006 to 111 in 2007 ( P = 0.037 ) . No difference in the number of reports between intervention ( n = 56 ) and control ( n = 55 ) units could be detected . The proportion of high- quality reports before and after the intervention was 36 and 48 % , respectively ( intervention , P = 0.11 ) and 40 and 36 % , respectively ( control , P = 0.55 ) . Conclusions No apparent effect of repeated ADR e-mails on the reporting of ADRs could be detected , although an increase in the reporting rate in general was noted OBJECTIVE To assess the impact and cost-effectiveness of two information-based provider reminder interventions design ed to improve self-care management and outcomes of heart failure ( HF ) patients . DATA SOURCES / STUDY SETTING Interview and agency administrative data on 628 home care patients with a primary diagnosis of HF . STUDY DESIGN Patients were treated by nurses r and omly assigned to usual care or one of two intervention groups . The basic intervention was an e-mail to the patient 's nurse highlighting six HF-specific clinical recommendations . The augmented intervention supplemented the initial nurse reminder with additional clinician and patient re sources . DATA COLLECTION Patient interviews were conducted 45 days post admission to measure self-management behaviors , HF-specific outcomes ( Kansas City Cardiomyopathy Question naire-KCCQ ) , health-related quality of life ( EuroQoL ) , and service use . PRINCIPAL FINDINGS Both interventions improved the mean KCCQ summary score ( 15.3 and 12.9 percent , respectively ) relative to usual care ( p < or = .05 ) . The basic intervention also yielded a higher EuroQoL score relative to usual care ( p < or = .05 ) . In addition , the interventions had a positive impact on medication knowledge , diet , and weight monitoring . The basic intervention was more cost-effective than the augmented intervention in improving clinical outcomes . CONCLUSIONS This study demonstrates the positive impact of targeting evidence -based computer reminders to home health nurses to improve patient self-care behaviors , knowledge , and clinical outcomes . It also advances the field 's limited underst and ing of the cost-effectiveness of selected strategies for translating research into practice Background The effects of various educational strategies have been examined in continuing medical education . Web-based learning has emerged as an alternative to ordinary classroom lessons . Objective To investigate whether an interactive Web-based course including personal guidance via email or cellular phone texting may be used to improve practice behavior of general practitioners in the management of atopic dermatitis . Methods General practitioners from all over Norway were eligible for this r and omized controlled educational trial . During a period of 6 months , doctors in the intervention group were offered the opportunity to participate in a Web-based course on the management of atopic dermatitis . This was combined with guidance via email or multimedia messaging service ( MMS ) through mobile phones from a dermatologist . In the control group there was no education or guidance . Main outcome measures were the duration of topical steroid treatment prescribed to patients with atopic dermatitis ( primary outcome ) , number of treatment modalities , and number of referred patients . Results We enrolled 46 physicians : 24 doctors were allocated to the intervention group and 22 doctors to the control group . They reported a total of 190 patient treatments . There were no statistically significant differences in the duration of topical steroid treatment or number of treatment modalities between the groups . The lack of effect on the primary outcome may be due to attrition as 54 % ( 13/24 ) of the participants did not complete the course . 42 % ( 10/24 ) of physicians sent at least one educational request via email or MMS . While 11 % ( 8/73 ) of treatment reports in the intervention group were referred to a health care specialist ( eg , dermatologist or pediatrician ) , 30 % ( 21/71 ) of treatment reports in the control group did so . This difference in the number of referrals was significant ( P = .03 ) . Conclusions A Web-based educational intervention aim ed at general practitioners combined with personal support can reduce the number of  atopic dermatitis patient referrals to specialists Physicians are often unaware of the results of tests pending at discharge ( TPADs ) . The authors design ed and implemented an automated system to notify the responsible inpatient physician of the finalized results of TPADs using secure , network email . The system coordinates a series of electronic events triggered by the discharge time stamp and sends an email to the identified discharging attending physician once finalized results are available . A carbon copy is sent to the primary care physicians in order to facilitate communication and the subsequent transfer of responsibility . Logic was incorporated to suppress selected tests and to limit notification volume . The system was activated for patients with TPADs discharged by r and omly selected inpatient-attending physicians during a 6-month pilot . They received approximately 1.6 email notifications per discharged patient with TPADs . Eighty-four per cent of inpatient-attending physicians receiving automated email notifications stated that they were satisfied with the system in a brief survey ( 59 % survey response rate ) . Automated email notification is a useful strategy for managing results of TPADs Background To provide doctors with producer-independent information to facilitate choice of treatment is an important task . The objective of the present study was to evaluate if an e-mail with a drug information attachment has effects on sales of prescribed drugs and if the design of the attachment is of importance . Methods The Swedish pharmaceutical benefit board found rizatriptan ( Maxalt ® ) 10 mg to be the most cost-effective triptan . All 119 heads of primary care units in western Sweden were r and omized to receive information concerning this conclusion via ( i ) e-mail with attachment I , ( ii ) e-mail with attachment II or ( iii ) no information ( control ) . Attachment I was a short one ( heading plus three lines text ) , whereas attachment II was a long one ( heading plus one page text and one page with tables ) . The change in percentage rizatriptan of total triptans sold before and after the intervention ( May – July 2004 and May – July 2005 , respectively ) was compared between the groups . Results Totally 48,229 ( 2004 ) and 50,674 ( 2005 ) defined daily doses of triptans were prescribed and sold during May – July in primary care units in the western part of Sweden . The absolute change in percentage rizatriptan was greater in the intervention groups compared with the control group 2 ( 25th – 75th percentile : -3 – 7 ) vs 0 ( -7 - 5 ) , P = 0.031 ) . The absolute change in percentage rizatriptan did not differ between the two attachment groups ( P = 0.93 ) . Conclusion An e-mail with a drug information attachment may influence sales of prescribed drugs . No difference between different design s of the attachment could be detected Background Electronic mail ( email ) has the potential to improve communication between physicians and patients . Methods We conducted two research studies in a family practice setting : 1 ) a brief , anonymous patient survey of a convenience sample to determine the number of clinic patients receptive to communicating with their physician via email , and 2 ) a r and omized , controlled pilot study to assess the feasibility of providing health education via email to family practice patients . Results Sixty-eight percent of patients used email  , and the majority of those ( 80 % ) were interested in using  email  to communicate with the clinic . The majority also reported that their email address changed less frequently than their home address ( 65 % , n = 173 ) or telephone number ( 68 % , n = 181 ) . Forty-two percent were willing to pay an out-of-pocket fee to have email access to their physicians . When evaluating email initiated by the clinic , 26 % of otherwise eligible patients could not participate because they lacked email access ; those people were more likely to be black and to be insured through Medicaid . Twenty-four subjects agreed to participate , but one-third failed to return the required consent form by mail . All participants who received the intervention emails said they would like to receive  health education emails  in the future . Conclusion Our survey results show that patients are interested in  email communication  with the family practice clinic . Our feasibility study also illustrates important challenges in physician-initiated electronic communication . The ' digital divide ' – decreased access to electronic technologies in lower income groups – is an ethical concern in the use of email for patient-physician communication OBJECTIVE To examine the effectiveness of delivering of computer-generated discharge summaries to general practice by email , fax , post and patient h and delivery . DESIGN Blinded , r and omized controlled trial . A pre- study audit ascertaining baseline statistics and a follow-up survey were conducted with general practice to determine preferred medium for receiving discharge communication . PARTICIPANTS AND SETTING 196 geriatric patients who were admitted to the aged care ward of a 300-bed metropolitan teaching hospital . Twenty-eight patients were lost to follow-up and 52 general practice s participated in the final survey . The pre- study audit followed 63 discharges from the same ward . INTERVENTION 168 eligible patients were r and omly assigned to have their electronic discharge summary sent by email ( n=40 ) , fax ( n=48 ) , post ( n=40 ) or patient h and delivery ( n=40 ) . MAIN OUTCOME MEASURES Receipt of discharge summary by the general practice clinic within 7 days of patient discharge from hospital . RESULTS The receipt rates for email ( 73.9 % , n=17 ) and fax were comparable ( 69.4 % , n=25 ; chi(2)=0.137 , df=1 , P=0.712 ) , and significantly higher ( chi(2)=19.86 , df=3 , P<0.0002 ) than post ( 43.8 % , n=14 ) and patient h and delivery ( 24.2 % , n=8 ) . General practice s indicated that fax was the most preferred method ( 82.7 % ) for communication of discharge summaries . The majority of general practice s ( 75.0 % ) utilized an electronic system for storage of patient information while 88.5 % of practice s reported using medical prescribing software . CONCLUSIONS Transmission of computer-generated discharge summaries by fax or email offers the most effective method of communicating with primary care physicians , as long as accurate contact information is available . Although fax is still the most preferred , email has many advantages that could potentially allow it to replace fax as a st and ard mode for delivery of discharge communication Background A synergistic cytotoxic effect has been hypothesized for taxanes and capecitabine , a prodrug of 5-fluorouracil . Based on pre clinical studies , this synergism has been attributed to an up-regulation of the enzyme thymidine phosphorylase ( TP ) . Beside tumour tissue , TP is highly expressed in white blood cells , possibly causing increased hematotoxicity , when taxanes are combined with capecitabine . So far , this hypothesis has not been investigated in humans . Methods A total of 128 consecutive blood sample s were collected from eight patients with advanced breast cancer receiving paclitaxel weekly at a dose of 80 mg/m2 . To assess the expression of TP in blood cells , sample s were collected prior to first therapy , at the end of infusion , and up to 15 days thereafter . This procedure was repeated during the sixth application of paclitaxel . After isolation of the peripheral mononuclear blood cells , the expression of TP was assessed by ELISA . In parallel ,  paclitaxel level in plasma was evaluated at three selected time points as pharmacokinetic control parameter . Results  Paclitaxel concentrations at the end of infusion did not change significantly from week 1 to week 6 . The expression of TP in peripheral mononuclear blood cells decreased significantly after infusion below pretherapeutic values ( p = 0.023 ; n = 8) . After the nadir on day 3 , the expression of TP increased moderately returning to baseline levels within one week . The overall picture in week 6 was similar to week 1 . Using a trend analysis , neither a short-term nor a long-term induction of TP was observed . Conclusion TP in peripheral mononuclear blood cells was hardly regulated under therapy with paclitaxel . Therefore , no increased haematotoxicity due to TP upregulation is expected from the combination of taxanes and capecitabine To determine whether a clinical decision support system can favorably impact the delivery of emergency department and hospital services . R and omized clinical trial of three clinical decision support delivery modalities : email messages to care managers ( email ) , printed reports to clinic administrators ( report ) and letters to patients ( letter ) conducted among 20,1 
    Output:
    
The email reminder changed health professional actions significantly , with professionals more likely to provide guideline -recommended osteoporosis treatment ( bone density measurement or osteoporosis medication , or both ) when compared with usual care .
The evidence for its impact on patient behaviours or actions was inconclusive .