***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: Abstract Objective : To evaluate the use of a computerised support system for decision making for implementing evidence based clinical guidelines for the management of asthma and angina in adults in primary care . Design : A before and after pragmatic cluster r and omised controlled trial utilising a two by two incomplete block design . Setting : 60 general practice s in north east Engl and . Participants : General practitioners and practice nurses in the study practice s and their patients aged 18 or over with angina or asthma . Main outcome measures : Adherence to the guidelines , based on review of case notes and patient reported generic and condition specific outcome measures . Results : The computerised decision support system had no significant effect on consultation rates , process of care measures ( including prescribing ) , or any patient reported outcomes for either condition . Levels of use of the software were low . Conclusions : No effect was found of computerised evidence based guidelines on the management of asthma or angina in adults in primary care . This was probably due to low levels of use of the software , despite the system being optimised as far as was technically possible . Even if the technical problems of producing a system that fully supports the management of chronic disease were solved , there remains the challenge of integrating the systems into clinical encounters where busy practitioners manage patients with complex , multiple conditions Background A r and omised trial of a multifaceted intervention for improving adherence to clinical practice guidelines for the pharmacological management of hypertension and hypercholesterolemia increased prescribing of thiazides , butdetected no impact onthe use of cardiovascular risk assessment toolsor achievement of treatment targets . We carried out a predominantly quantitative process evaluation to help explain and interpret the trial- findings . Methods Several data - sources were used including :  question  naires completed by  pharmacists  immediately after educational outreach visits  , semi-structured interviews with physicians subjected to the intervention , and data extracted from their electronic medical records . Multivariate regression analyses were conducted to explore the association between possible explanatory variables and the observed variation across practice s for the three main outcomes . Results The attendance rate during the educational sessions in each practice was high ; few problems were reported , and the physicians were perceived as being largely supportive of the recommendations we promoted , except for some scepticism regarding the use of thiazides as first-line antihypertensive medication . Multivariate regression models could explain only a small part of the observed variation across practice s and across trial- outcomes , and key factors that might explain the observed variation in adherence to the recommendations across practice s were not identified . Conclusion This study did not provide compelling explanations for the trial results . Possible reasons for this include a lack of statistical power and failure to include potential explanatory variables in our analyses , particularly organisational factors . More use of qualitative research methods in the course of the trial could have improved our underst and ing Background : Recent clinical trials indicate that treatment with lipid modifying therapy improves outcomes in patients with ischemic heart disease ( IHD ) and low levels of high density lipoprotein ( HDL ) cholesterol . The results of these trials , however , have not been widely implemented in clinical practice . Objectives : To develop and test an intervention design ed to increase the rate of prescription of lipid modifying therapy  and to determine the relative effectiveness of three different prompts ( progress notes , patient letters , or computer chart reminders ) . Methods : The study was conducted in 11 US Department of Veterans Affairs Medical Centers . The effect of the intervention on the proportion of eligible patients receiving lipid modifying therapy  was compared between five intervention sites and six matched control sites using a controlled before and after study design . Additionally , 92 providers within the intervention clinics were r and omized to receive one of the three prompts . Data were analyzed using logistic regression modeling which incorporated terms to account for the clustered nature of the data . Results : At the intervention sites the prescription rate increased from 8.3 % during the pre-intervention period to 39.1 % during the intervention ( OR = 6.5 , 95 % CI 5.2 to 8.2 , p<0.0001 ) but remained unchanged at the control sites . The interaction between group ( control v intervention ) and time period was highly significant ( p<0.0001 ) . The adjusted odds of receiving a prescription during the intervention period was 3.1 times higher at the intervention sites than at the control sites ( 95 % CI 2.1 to 4.7 ) . Overall , there was no significant difference in prescription rates among the three prompt groups . However , there was a significant interaction between prompt group and site , indicating that the efficacy of the prompts differed by site . Conclusion : An intervention for primary care providers consisting of an educational workshop , opinion leader influence , and prompts substantially increased the prescription rate of lipid modifying therapy BACKGROUND A cluster r and omized trial of tailored interventions to support the implementation of guidelines for  sore throat and urinary tract infection  found little or no change in the main outcomes , which were antibiotic prescriptions , use of laboratory tests and use of telephone consultations . There was great variation between the practice s in the change in these outcomes . OBJECTIVES Our aim was to evaluate how the interventions were received and to underst and why practice s did or did not change . METHODS The trial was conducted in general practice s in Norway . Data for this process evaluation were collected from the 120 practice s that completed the trial . Multiple methods were used : observations , semi-structured telephone interviews , a postal survey and data extracted from electronic medical records . We investigated factors that might explain a lack of change , including : agreement with the guidelines ; communication within each practice ; degree of participation in the project ; taking time to discuss the guidelines and their implementation ; use of the  components of the interventions ; and routines for telephone consultations .  Possible explanatory factors were explored in relation to variation in change and the overall extent of change in rates of use of antibiotics , laboratory tests and telephone consultations . RESULTS Sixty-three per cent of practice s agreed with the guidelines . Only 35 % reported having regular meetings , and 33 % discussed the project before its start , although 75 % reported agreement about participating within the practice . Only 33 % reported meeting to discuss the guidelines . Use of the components of the interventions ranged from 11 % for the increased fee for telephone consultations to 48 % for the computerized decision support . Forty-four per cent reported problems with telephone routines . No single factor explained the observed variation in the extent of change across practice s. CONCLUSIONS Inadequate time , re sources and support were the most salient factors that might explain a lack of change . Problems with internal communication and telephone routines were important contributing factors in many practice Objectives : To determine whether addition of an electronic sepsis evaluation and management tool to electronic sepsis alerting improves compliance with treatment guidelines and clinical outcomes in septic ICU patients . Design : A pragmatic r and omized trial . Setting : Medical and surgical ICUs of an academic , tertiary care medical center . Patients : Four hundred and seven patients admitted during a 4-month period to the medical or surgical ICU with a diagnosis of sepsis established at the time of admission or in response to an electronic sepsis alert . Interventions : Patients were r and omized to usual care or the availability of an electronic tool capable of importing , synthesizing , and displaying sepsis-related data from the medical record , using logic rules to offer individualized evaluations of sepsis severity and response to therapy , informing users about evidence -based guidelines , and facilitating rapid order entry . Measurements and Main Results : There was no difference between the  electronic tool ( 218 patients ) and usual care ( 189 patients ) with regard to the primary outcome of time to completion of all indicated Surviving Sepsis Campaign 6-hour Sepsis Resuscitation Bundle elements ( hazard ratio , 1.98 ; 95 % CI , 0.75–5.20 ; p = 0.159 ) or time to completion of each element individually . ICU mortality , ICU-free days , and ventilator-free days did not differ between intervention and control . Providers used the tool to enter orders in only 28 % of available cases . Conclusions : A comprehensive electronic sepsis evaluation and management tool is feasible and safe but did not influence guideline compliance or clinical outcomes , perhaps due to low utilization OBJECTIVE To assess the effects on health care re source utilization of a network of microcomputer workstations for writing all inpatient orders . DESIGN R and omized controlled clinical trial . SETTING Inpatient internal medicine service of an urban public hospital . SUBJECTS A total of 5219 internal medicine patients and the 68 teams of house officers , medical students , and faculty internists who cared for them . INTERVENTION Microcomputer workstations , linked to a comprehensive electronic medical record system , for writing all inpatient orders . MAIN OUTCOME MEASURES Total inpatient charges for each admission and charges for specific categories of orders . A time-motion study of selected interns assessed the ordering system 's time consumption . RESULTS Intervention teams generated charges that were $ 887 ( 12.7 % ) lower per admission than did control teams ( P = .02 ) . Significant reductions ( P < .05 ) were demonstrated separately for bed charges , diagnostic test charges , and drug charges . Reductions of similar proportion and statistical significance were found for hospital costs . The mean length of stay was 0.89 day shorter for intervention resident teams ( P = .11 ) . Interns in the intervention group spent an average of 33 minutes longer ( 5.5 minutes per patient ) during a 10-hour observation period writing orders than did interns in the control group ( P < .0001 ) . CONCLUSIONS A network of microcomputer workstations for writing all inpatient orders significantly lowered patient charges and hospital costs . This would amount to savings of more than $ 3 million in charges annually for this hospital 's medicine service and potentially tens of billions of dollars nationwide . However , the system required more physician time than did the paper charts . Research at other sites and system advances to reduce time requirements are warranted OBJECTIVE To evaluate the use of an automated test ordering and feedback system ( named GRIF ) in daily practice . The system produces recommendations to general practitioners ( GPs ) to improve the application of accepted practice guidelines for test ordering . METHODS A r and omised controlled trial with balanced block design was carried out in general practice s in two regions of the Netherl and s from August 2000 to July 2001 . We implemented the GRIF system on the workstations at the offices of the participating GPs . The GPs ( n=11 ) were asked to use GRIF during patient consultation instead of filling in the paper request form . The system displayed critical comments about their non-adherence to the guidelines as apparent from the request forms . RESULTS The median time of producing the comments plus the response time of the GP was 13s . Of the 2780 presented recommendations , 4.3 % were accepted . Advice of the GRIF system that presents a concrete test to request in a particular situation is adhered to most frequently . Finally , there seems to be a decrease of accepted comments over the trial period . CONCLUSION Computerised recommendations should contain , if possible , suggestions for alternative tests to improve the application of these recommendations . Furthermore , creative solutions must be developed to avoid that GPs get used to the recommendations of critiquing systems and to stimulate a better adherence to these recommendations OBJECTIVE A research prototype Physician Workstation ( PWS ) incorporating a graphical user interface and a drug ordering module was compared with the existing hospital information system in an academic Veterans Administration General Medical Clinic . Physicians in the intervention group received recommendations for drug substitutions to reduce costs and were alerted to potential drug interactions . The objective was to evaluate the effect of the PWS on user satisfaction , on health-related outcomes , and on costs . DESIGN A one-year , two-period , r and omized controlled trial with 37 subjects . MEASUREMENTS Differences in the reliance on noncomputer sources of information , in user satisfaction , in the cost of prescribed medications , and in the rate of clinical ly relevant drug interactions were assessed . RESULTS The study subjects logged onto the workstation an average of 6.53 times per provider and used it to generate 2.8 % of prescriptions during the intervention period . On a five-point scale ( 5 = very satisfied , 1 = very dissatisfied ) , user satisfaction declined in the PWS group ( 3.44 to 2.98 p = 0.008 ) , and increased in the control group ( 3.23 to 3.72 , p < 0.0001 ) . CONCLUSION The intervention physicians did not use the PWS frequently enough to influence information-seeking behavior , health outcomes , or cost . The study design did not determine whether the poor usage result ed from satisfaction with the control system , problems using the PWS intervention , or the functions provided by the PWS intervention . Evaluative studies should include provisions to improve the chance of successful implementation as well as to yield maximum information if a negative study occurs BACKGROUND Decision-support information technology is often adopted to improve clinical decision making , but it is rarely rigorously evaluated . Congress m and ated the evaluation of Problem-Knowledge Couplers ( PKC Corp , Burlington , Vt ) , a decision-support tool proposed for the Department of Defense 's new health information network . METHODS This was a patient-level r and omized trial conducted at 2 military practice s. A total of 936 patients were allocated to the intervention group  and 966 to usual care .  Couplers were applied before routine ambulatory clinic visits . The primary outcome was quality of care , which was assessed based on the total percentage of any of 24 health care quality process measures ( opportunities to provide evidence -based care ) that were fulfilled . Secondary outcomes included medical re sources consumed within 60 days of enrollment and patient and provider satisfaction . RESULTS There were 4639 health care opportunities ( 2374 in the Coupler group and 2265 in the usual-care group ) , with no difference in the proportion of opportunities fulfilled ( 33.9 % vs 30.7 % ; P = .12 ) . Although there was a modest improvement in performance on screening/preventive measures , it was offset by poorer performance on some measures 
    Output:
    
Patients and healthcare consumers identified guideline -based CDS as an important quality improvement intervention and perceived the GUIDES checklist as a suitable and useful strategy .
Relying on a structured approach may prevent that important factors are missed