***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: The aim of this study was to establish the relative importance of risk factors for mortality after acute upper gastrointestinal haemorrhage , and to formulate a simple numerical scoring system that categorizes patients by risk . A prospect i ve , unselected , multicentre , population based study was undertaken using st and ardised question naires in two phases one year apart . A total of 4185 cases of acute upper gastrointestinal haemorrhage over the age of 16 identified over a four month period in 1993 and 1625 cases identified subsequently over a three month period in 1994 were included in the study . It was found that age , shock , comorbidity , diagnosis , major stigmata of recent haemorrhage , and rebleeding are all independent predictors of mortality when assessed using multiple logistic regression . A numerical score using these parameters has been developed that closely follows the predictions generated by logistical regression equations . Haemoglobin , sex , presentation ( other than shock ) , and drug therapy ( non-steroidal anti-inflammatory drugs and anticoagulants ) are not represented in the final model . When tested for general applicability in a second population , the scoring system was found to reproducibly predict mortality in each risk category . In conclusion , a simple numerical score can be used to categorize patients presenting with acute upper gastrointestinal haemorrhage by risk of death . This score can be used to determine case mix when comparing outcomes in audit and research and to calculate risk st and ardised mortality . In addition , this risk score can identify 15 % of all cases with acute upper gastrointestinal haemorrhage at the time of presentation and 26 % of cases after endoscopy who are at low risk of rebleeding and negligible risk of death and who might therefore be considered for early discharge or outpatient treatment with consequent re source savings BACKGROUND AND PURPOSE Elderly stroke patients in particular are at risk of receiving less than optimal care . We studied the effects of the department care ( medicine versus neurology ) on the outcome of elderly stroke patients in a r and omized controlled trial with 1-year follow-up . METHODS A total of 243 consecutive patients aged 65 years or older with acute stroke were r and omized to receive care in the Departments of Medicine or the Department of Neurology of a university teaching hospital with a referral area of 1.1 million . The outcome was assessed by mortality , length of hospital stay , ability to live at home on discharge , Barthel Index , and Rankin grade s at 1 year . RESULTS There were no differences in sex and age , severity or type of stroke , other diseases , or social factors between the two groups . One-year mortality was 21 % in both patients treated by the Departments of Medicine and those treated by the Department of Neurology . Patients treated by the Department of Neurology were discharged an average of 16 days earlier ( 24 versus 40 days ) . The length of hospital stay of patients aged younger than 75 years differed significantly ( P = .02 ) . Patients r and omized to neurological wards more often went directly home ( 75 % versus 62 % ; P = .03 ) , and their functional status was better as assessed with Barthel Index and Rankin grade s at 1 year ( P = .02 and P = .03 , respectively ) . Independent predictors of a better functional outcome and shorter hospital stay by stepwise multivariate analysis included management by the Department of Neurology . CONCLUSIONS Well-organized management of elderly stroke patients was associated with a better outcome . It was also the more economical alternative Patient educational programs supervised by non-physicians are becoming popular , but comparison of their effect on outcome with that of physician teaching is limited . We developed a nurse-supervised class for patients with symptomatic gastroesophageal reflux ( GER ) . Primary physicians referred patients to the program . The patients ' initial knowledge and the program 's excellent cognitive effect were unrelated to demographic and symptom data . One hundred twelve consecutive patients were alternately given appointments either with the class or with a gastroenterologist . Although failed appointments and inappropriate referrals excluded some patients , the remainder of the two groups were similar with regard to demographic and symptom data and their return rate of follow-up question naires . They reported equivalent symptomatic improvement and therapeutic compliance after 2 weeks and 2 months . The program 's success prompts us to continue this form of patient education BACKGROUND Cryptosporidiosis , an intestinal parasitic infection , has gained considerable media attention since a 1993 waterborne outbreak in Milwaukee , Wis , in which more than 400,000 persons became ill . However , the incidence of and risk factors for human cryptosporidiosis in the general US population are unknown . It has been suggested , but not documented , that physicians are generally unaware of the need to specifically request testing for this organism . OBJECTIVE To assess physician awareness of cryptosporidiosis and knowledge of laboratory testing for Cryptosporidium oocysts . METHODS A self-administered question naire was mailed to a stratified r and om sample of Connecticut physicians . Specialties were limited to physicians in internal medicine , gastroenterology , infectious disease , pediatrics , and family or general practice . Responses were compared among specialties . RESULTS While most physicians were aware that cryptosporidiosis causes watery diarrhea ( range , 67%-98 % ) , particularly in patients with acquired immunodeficiency syndrome ( > 85 % of all specialties ) , many did not know the symptoms or failed to identify other groups at increased risk . More than 75 % of gastroenterologists , general or family practitioners , internists , and pediatricians never or rarely order diagnostic testing for Cryptosporidium even when their patients have symptoms consistent with cryptosporidiosis . More than 30 % of physicians assumed Cryptosporidium testing was included in a st and ard ova and parasite examination . CONCLUSIONS Cryptosporidiosis is likely to be unrecognized and underdiagnosed in Connecticut . This may occur because many physicians are unaware of cryptosporidiosis , unsure of the symptoms , do not test for it , or do not order the appropriate test . Unless there is more widespread use of specific tests , it will be difficult to evaluate specific preventive initiatives to limit the overall health impact of cryptosporidiosis Objectives : We sought to examine the extent to which physicians recognize H. pylori as a causal agent in peptic ulcer disease or as a potential cofactor in other gastrointestinal diseases , and to observe how this knowledge has influenced diagnostic and therapeutic practice s. Methods : We used a national mail survey in the U.S. between February and May of 1996 , querying 5994 U.S. physicians ( family/general practitioners [ FPs ] , internists [ IMs ] , and gastroenterologists ) selected at r and om from three different membership data bases of professional associations . Results : The response rate was 52 % . More than 95 % of physicians who treat symptoms empirically would prescribe acid suppressant therapy rather than anti-H. pylori therapy . Between 43 % and 66 % of physicians , varying in frequency by medical specialty , would treat the infection in H. pylori-positive patients with nonulcer dyspepsia . In confirmed peptic ulcer disease , between 88 % and 100 % of physicians would treat the H. pylori infection , depending on the physician group and whether or not the presentation of an ulcer was recurrent . Although 103 distinct anti-H. pylori regimens were reported , 89 % of the gastroenterologists and 70 % of the primary care physicians ( PCPs ) used combinations of antimicrobials with reported cure rates of at least 80 % . Conclusions : General knowledge regarding H. pylori-associated diseases was widespread among primary care physicians and gastroenterologists . However , anti-H. pylori therapies judged ineffective were reported as the first choice regimen by 5 % of gastroenterologists and 18 % of primary care physicians . Gastroenterologists appear to implement the latest scientific developments in the field rapidly whereas PCPs manifest a delayed response , due to either insufficient knowledge or to other factors influencing their approach to treatment BACKGROUND In the hierarchy of research design s , the results of r and omized , controlled trials are considered to be evidence of the highest grade , whereas observational studies are viewed as having less validity because they reportedly overestimate treatment effects . We used published meta-analyses to identify  r and omized clinical trials and observational studies that examined the same clinical topics . We then compared the results of the original reports according to the type of research design . METHODS A search of the Medline data base for articles published in five major medical journals from 1991 to 1995 identified meta-analyses of r and omized , controlled trials and meta-analyses  of either cohort or case-control studies that assessed the same intervention . For each of five topics , summary estimates and 95 percent confidence intervals were calculated on the basis of data from the individual r and omized , controlled trials and the individual observational studies . RESULTS For the five clinical topics and 99 reports evaluated , the average results of the observational studies were remarkably similar to those of the r and omized , controlled trials . For example , analysis of 13 r and omized , controlled trials of the effectiveness of bacille  Calmette-Guérin vaccine in preventing active tuberculosis yielded a relative risk of 0.49 ( 95 percent confidence interval , 0.34 to 0.70 ) among vaccinated patients , as compared with an odds ratio of 0.50 ( 95 percent confidence interval , 0.39 to 0.65 ) from 10 case-control studies . In addition , the range of the point estimates for the effect of vaccination was wider for the r and omized , controlled trials ( 0.20 to 1.56 ) than for the observational studies ( 0.17 to 0.84 ) . CONCLUSIONS The results of well- design ed observational studies ( with either a cohort or a case-control design ) do not systematic ally overestimate the magnitude of the effects of treatment as compared with those in r and omized , controlled trials on the same topic OBJECTIVES The authors examine how specialist and generalist physicians adapted their practice patterns to emerging information on the role of Helicobacter pylori in peptic ulcer disease ( PUD ) . METHODS Data were collected via a mail survey sent to national r and om sample s of gastroenterologists , family practitioners , and general internists in April 1994 . A Cox proportional hazards regression was used to evaluate the determinants of the timing of adoption of antibiotic therapy for suspected or confirmed PUD . RESULTS Most respondents ( 99.1 % of specialists and 64.6 % of generalists ) had prescribed  antibiotic therapy  to eradicate Helicobacter pylori at least once . The median specialist adopted 21 months before the medical generalist . Timing of adoption also was related to gender , board certification , PUD case load , and practice setting . CONCLUSIONS Gastroenterologists were more likely than primary care physicians to adopt antibiotic therapy for PUD , even before the evidence of this therapy 's effectiveness was conclusive . Primary care physicians remained less likely to adopt after efficacy was established . The slower adoption by primary care physicians appeared to be related both to having less information than specialists about the new therapy and to more conservative practice styles . Measures to facilitate the flow of information about new technologies to primary care physicians may be warranted . Research on interspecialty differences in adoption of new therapies can contribute to underst and ing the consequences of the current shift from specialist- to generalist-driven care BACKGROUND Our aim was to compare the effectiveness and patient satisfaction with flexible sigmoidoscopy performed by a registered nurse , general surgeons , and gastroenterology fellows . METHODS Consecutive out patients referred for sigmoidoscopy  were assigned to have the procedure performed by the first available provider . Depth of insertion of the sigmoidoscope , complications , duration of the procedure , and percentage of patients with adenomas were recorded . After the procedure , patients completed a vali date d patient satisfaction question naire . RESULTS Mean depth of insertion was less for general surgeons compared with the nurse and gastroenterology fellows ( 50 vs 53 vs 54 cm , respectively ; p = 0.01 ) . Mean duration of procedure was longer for the nurse compared with general surgeons and gastroenterology fellows ( 8.3 vs 7.6 vs 6.8 min , respectively ; p = 0.0001 ) . Percentage of patients with adenomas was similar among patients who underwent sigmoidoscopy by the  endoscopists  ( 7 % vs 8 % vs 9 % ; p = 0.81 ) . No differences were detected between endoscopists for overall satisfaction ( p = 0.60 ) , technical skills of the endoscopist ( p = 0.58 ) , communication skills of the endoscopist ( p = 0.61 ) , or interpersonal skills of the endoscopist ( p = 0.59 ) . CONCLUSION No clinical ly significant differences in effectiveness or patient satisfaction were detected with flexible sigmoidoscopy performed by a registered nurse , general surgeons , or gastroenterology fellows BACKGROUND Because the literature suggests numerous indicators of common bile duct stones , we undertook a systematic assessment of physicians ' judgments of the clinical utility of eight indicators : patient age , history of jaundice , history of pancreatitis , levels of serum alanine aminotransferase , alkaline phosphatase , amylase , and total bilirubin , and common bile duct diameter on ultrasonography . METHODS R and om sample s of 1500 gastroenterologists and 1500 surgeons were sent a survey asking them to indicate the importance of each potential indicator of common bile duct stones , the likelihood of common bile duct stones 
    Output:
    
RESULTS : Care provided by gastroenterologists for GI bleeding and diverticulitis result ed in significantly shorter length of hospital stay .
Gastroenterologists diagnosed celiac disease more accurately than generalists , and more adequately diagnosed colorectal cancer and prescribed antimicrobials for peptic ulcer disease .
There was no difference between gastroenterologists and generalists in terms of colonoscopy procedure time , and family physicians detected a greater number of cancers .
Furthermore , there was no difference in the outcomes of gastroesophageal reflux disease therapy in patients seen by gastroenterologists , versus those educated by nurses .
The survey articles suggested that gastroenterologists were more likely to test and treat for Helicobacter pylori in patients with peptic ulcer disease , and were more likely recommended for medical versus surgical therapy .
Gastroenterologists had a lower threshold for ordering ERCP before cholecystectomy than surgeons , but had similar responses regarding indications for surgery in inflammatory bowel disease .
Finally , primary care physicians were less likely to associate symptoms of profuse watery diarrhea with cryptosporidium infection compared with gastroenterologists and infectious disease specialists .
: We reached the following conclusions : 1 ) The results suggest that gastroenterologists deliver effective and efficient care for GI bleeding and diverticulitis and provide more effective diagnosis in certain disorders .