***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: 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 OBJECTIVE --To evaluate guidelines for general practice management and referral of infertile couples .  Guidelines were implemented with a disease specific reminder at the time of consultation ( the guidelines were embedded within a structured infertility management sheet for each couple ) . DESIGN --Pragmatic r and omised controlled trial . Participating practice s were r and omised to a group that received the guidelines and a control group . SETTING --82 general practice s in Grampian region . SUBJECTS--100 couples referred by general practitioners receiving the guideline and 100 couples referred by control general practitioners . MAIN OUTCOME MEASURES --Whether the general practitioner had taken a full sexual history and examined and investigated both partners appropriately . RESULTS --Characteristics of patients referred by study and control general practitioners did not differ significantly at baseline . Compliance with the guidelines increased for all targeted activities . General practitioners in the study group were more likely to take a sexual history ( for example , couples ' use of fertile period , 85 % v 69 % , p < 0.01 ) ; examine both partners ( female partner , 68 % v 52 % , p < 0.05 ; male partner 39 % v 13 % , p < 0.01 ) ; and investigate both partners ( day 21 progesterone , 72 % v 41 % , p < 0.001 ; semen analysis , 51 % v 41 % , p > 0.05 ) . Improvements were greater when general practitioners used the disease specific reminder . CONCLUSION --Receiving guidelines led to improvements in the process of care of infertile couples within general practice . This effect was enhanced when the guidelines were embedded in a structured infertility management sheet for each couple STUDY OBJECTIVE To test whether physicians who receive a continuing education program ( " Quit for Life " ) about how to counsel smokers to quit would counsel smokers more effectively and have higher rates of long-term smoking cessation among their patients who smoke . DESIGN R and omized trial with blinded assessment of principal outcomes . SETTING Four health maintenance organization medical centers in northern California . SUBJECTS Eighty-one internists assigned by blinded r and omization to receive training ( 40 ) or serve as controls ( 41 ) . Consecutive sample s of smokers visiting each physician ( mean , 25.6 patients per experimental and 25.2 per control physician ) . INTERVENTIONS Internists received 3 hours of training about how to help smokers quit . Physicians and their office staff also were given self-help booklets to distribute free to smokers and were urged to use a system of stickers on charts to remind physicians to counsel smokers about quitting . MEASUREMENTS AND MAIN RESULTS On the basis of telephone interviews with patients after visiting the physician , we determined that internists who attended the Quit for Life program  discussed smoking with more patients who smoked , spent more time counseling them about smoking , helped more patients set date s to quit smoking , gave out more self-help booklets , and made more follow-up appointments to discuss smoking than did internists in the control group . One year later , the rate of biochemically confirmed , long-term ( greater than or equal to 9 months ) abstinence from smoking was 1 % higher among all patients of trained internists than among patients of controls ( 95 % CI , -0.1 % to + 2.3 % ) , and 2.2 % ( + 0.2 % to + 4.3 % ) higher among the patients who most wanted to quit smoking . CONCLUSIONS This continuing education program substantially changed the way physicians counseled smokers . As a result , a few more patients who wanted to quit smoking achieved long-term abstinence We assessed the impact of three conditions on one-year smoking cessation rates .  Physicians in 70 community general practice s were r and omly allocated by practice to one of three groups : In the usual care group , smoking patients were to receive the care they normally would receive . In the gum only group , physicians were asked to speak to patients about smoking cessation and offer nicotine gum . In the gum plus group , physicians were trained in the experimental intervention . This intervention involved advice to stop smoking , the setting of a quit date , the offer of nicotine gum , and four follow-up visits .  Smoking cessation was measured by self-report after one year and vali date d using saliva cotinine measures . Using a criterion of at least three months of abstinence , 8.8 % of the patients of the trained physicians had stopped smoking at the one-year follow-up compared with 4.4 % and 6.1 % of the patients in the usual care and gum only groups , respectively Abstract Objective : To test the effects of feedback of information about patients ' asthma to primary care teams . Design : Patients ' reports of morbidity , use of health services , and drug use on question naire was given to primary care teams . R and omised controlled trial with general practice s as the subject of the intervention was used to test effectiveness of supplying information . Setting : Primary care in district health authority , London . Subjects : 23 general practice s , each of which notified at least 20 asthmatic patients aged 15 - 60 years for each principal . Practice s were r and omly allocated to an intervention group ( receiving feedback of information on control of asthma ) or a control group ( no feedback ) . Intervention : Information on cards inserted in patients ' medical records ; booklet copies of information for team members ; formal presentation to primary care teams ; poster displays of data on patients in each practice . Main outcome measures : Type and frequency of asthma symptoms , use of health services , use of asthma drugs . Results : Reported morbidity at entry to the study was substantial : 45 % ( 818 ) patients reported breathlessness at least once a week . Less than half these patients were using inhaled steroids regularly . Intervention and control groups did not differ in practice or patient characteristics on entry to the study . In spite of the potential for improvement no differences were observed between the two practice groups at the end of the study —for example , breathlessness at least once a week in last six months was experienced by 36 % in intervention group v 35 % in control group ( t=−0.27 , P<0.79 ) ; surgery attendance in last six months by 48 % v 48 % ( t=−0.05 , P<0.96 ) ; regular use of inhaled steroids by 60 % v 58 % ( t=0.51 , P<0.62 ) . Conclusion : Feedback to general practitioners of information about patients ' asthma does not on its own lead to change in the outcome of clinical care The hypothesis that general practitioners would obtain better outcomes for patients with hypertension using a computer  than doctors not using a computer  was tested . Sixty family physicians were r and omised to two treatment strategies . " Test " physicians completed a data collection form after each visit from a patient with hypertension and mailed the forms to the test centre for processing . Computer feedback on management was mailed to the doctors . This encouraged doctors to apply the " stepped care " protocol , supplied charts of diastolic blood pressure v time , and ranked patients ' diastolic blood pressures by percentile . Letters were mailed to patients to remind them of appointments . " Control " doctors filled out the same data collection forms as test physicians , but neither doctors nor patients received computer feedback . Physicians who used the computer saw more patients per practice than control doctors ( test 50 patients , control 40 ) . For all patients the length of follow up was significantly longer in test practice s ( test 199 days , control 167 ) , and a smaller percentage dropped out of active treatment in test practice s ( test 37.5 % , control 42.1 % ) . For patients with " moderate " hypertension of a baseline diastolic pressure of greater than 104 mm Hg the mean score of the last recorded pressure was below the goal of 90 mm Hg in test practice s ( 88.5 mm Hg ) , but it failed to reach this goal in control practice s ( 93.3 mm Hg ) . A greater average reduction of diastolic pressure was achieved in test practice s ( test 21.7 mm Hg , control 16.7 mm Hg ) . Though patients with " moderate " hypertension were better controlled in test practice s than in control practice s , the patients in test practice s visited their doctors less often ( test 13.3 visits per patient-year , control 17.4 visits ) . Among patients with newly detected hypertension test practice s achieved a greater reduction in diastolic pressure than control practice s ( test 15.1 mm Hg v control 11.3 mm Hg ) and more sustained control of hypertension ( test 323 days per patient-year with a diastolic pressure of 90 mm Hg or less v control 259 days ) We design ed this study to determine whether an intensive 1-day educational workshop involving family physicians  in establishing essential criteria for hypertension management would significantly affect the short-term outcomes of hypertensive patients in their practice s. Forty r and omly selected physicians were separated into three groups : those who would be involved in establishing the criteria ( 15 ) , those who would receive the criteria by mail ( 15 ) and those who would act as controls and not be aware of the criteria ( 10 ) . We found no significant difference between the three groups in the number of hypertensive patients whose condition remained uncontrolled after the intervention . We conclude that physicians ' participation in the establishment of st and ards of care for conditions such as hypertension or their awareness of such st and ards does not independently result in significantly better patient outcomes . Consequently , we recommend that physicians and health care planners concerned with improving outcomes not rely on any single intervention strategy when planning change OBJECTIVE --To compare the effectiveness of three methods of taking an antenatal history on the quality of obstetric care . DESIGN --R and omised controlled trial . SETTING --Antenatal clinic of St James 's University Hospital , Leeds . SUBJECTS--2424 women attending the hospital for the first ( booking ) visit . INTERVENTIONS --Histories were taken by midwives using an unstructured paper question naire , a structured paper question naire ( incorporating a checklist ) , or an interactive computerised question naire ( incorporating 101 clinical reminders ) . MAIN OUTCOME MEASURES --The number of clinical responses to factors arising from the antenatal booking history according to method of taking the history . Actions were categorised as medical and surgical , obstetric , personal , current symptoms and treatment , related to maternal age , and related to two common actions ( cervical smear testing and dental hygiene ) and were weighted for clinical importance by 10 obstetricians . RESULTS --Overall the unstructured question naire generated 1063 actions , the structured question naire 1146 , and the computerised question naire 1122 . The clinical importance of these actions was lowest for the unstructured question naire ( overall total value score 1987 v 2182 and 2110 for the structured and computerised question naires respectively ) . The structured question naire was better than the computerised question naire in the medical and surgical ( total value score 191 v 184 ) , obstetric ( 275 v 241 ) , and personal ( 430 v 360 ) categories but inferior in the current symptoms category ( 179 v 191 ) . CONCLUSION --Structured question naires ( computerised or paper ) provide more and better information , and their use improves clinical response to risk factors . Computerised systems offer no further advantage in antenatal clinics To examine the effects of intensive patient and /or physician diabetes education on patient health outcomes , a controlled trial was conducted in which internal medicine residents and their 532 diabetic patients were r and omly assigned to : routine care ; patient education ; physician education ; or both patient and physician education . Patient outcome data were analyzed either by analysis of covariance on post intervention values ( 2-hour post-pr and ial plasma glucose [ PPG ] ; body weight [ BW ] ; blood pressure [ BP ] ; or analysis of variance conducted on change values ( fasting plasma glucose [ FPG ] and glycosylated hemoglobin [ A1Hgb ] ) . After patient education , significant improvements were observed in FPG , A1Hgb , BW , and systolic and diastolic BP . Physician education result ed in significant decreases in FPG , A1Hgb and BW . The combination of patient plus physician education result ed in the greatest improvements in patients ' health outcomes including FPG , A1Hgb , PPG , BW and diastolic BP . Adjusted systolic BPs were not significantly different in the two groups . While these physiologic improvements were statistically and probably clinical ly significant , hyperglycemia and obesity still persisted . Thus , achieving optimal patient outcomes for a chronic disease like diabetes mellitus may require a greater or more effective use of re sources than currently estimated The effectiveness of small group education of general practitioners  in the management of asth 
    Output:
    
There is very little evidence that the use of CPGs improves patient outcomes in primary medical care , but most studies published to date have used older guidelines and methods , which may have been insensitive to small changes in outcomes .
Research is needed to determine whether the newer , evidence -based CPGs have an effect on patient outcomes