***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 Background : Many diagnostic errors are caused by premature closure of the diagnostic process . To help prevent premature closure , we developed checklists that prompt physicians to consider all reasonable diagnoses for symptoms that commonly present in primary care . Methods : We enrolled 14 primary care physicians and 100 patients in a r and omized clinical trial . The study took place in an emergency department ( 5 physicians ) and a same-day access clinic ( 9 physicians ) . The physicians were r and omized to usual care vs. diagnostic checklist . After completing the history and physical exam , checklist physicians read aloud a differential diagnosis checklist for the chief complaint . The primary outcome was diagnostic error , which was defined as a discrepancy between the diagnosis documented at the acute visit and the diagnosis based on a 1-month follow-up phone call and record review . Results : There were 17 diagnostic errors . The mean error rate among the seven checklist physicians was not significantly different from the rate among the seven usual-care physicians ( 11.2 % vs. 17.8 % ; p=0.46 ) . In a post-hoc subgroup analysis , emergency physicians in the checklist group had a lower mean error rate than emergency physicians in the usual-care group ( 19.1 % vs. 45.0 % ; p=0.04 ) . Checklist physicians considered more diagnoses than usual-care physicians during the patient encounters ( 6.5 diagnoses [ SD 4.2 ] vs. 3.4 diagnoses [ SD 2.0 ] , p<0.001 ) . Conclusions : Checklists did not improve the diagnostic error rate in this study . However further development and testing of checklists in larger studies may be warranted Background : The occurrence of delayed diagnosis of injury ( DDI ) among pediatric trauma patients represents a breakdown in trauma care . Although some DDI may be unavoidable , the rate of DDI may be used as a measure of quality improvement . Objective : We sought to investigate DDI in admitted pediatric trauma patients while a design ated pediatric trauma response team was used and compare this with the prior incidence of DDI ( 4.3 % ) before initiation of the response team . Methods : Primary Children 's Medical Center ( PCMC ) is a regional tertiary pediatric trauma center . This analysis used the prospect ively gathered PCMC Trauma Data base , and included all hospitalized pediatric trauma patients from 1997 through 2000 . Results : A total of 3265 patients were included ; no patients were excluded . A DDI occurred in 15 ( 0.46 % ; 95 % CI : 0.31 , 0.79 ) trauma patients . The DDI patients were more severely injured with significantly higher Injury Severity Scores , lower TRISS Probability of Survival values , longer hospitalizations ( P ≤ 0.05 , Mann-Whitney U ) , and were more frequently admitted to the PICU ( P ≤ 0.05 , χ2 ) than the non-DDI patient population . In a previous study , our incidence of missed injury was 4.3 % ( 50/1175 ; 95 % CI : 3.3 , 5.6 ) ; with implementation of a design ated trauma response team and trauma service , the incidence of DDI was reduced nearly 10-fold to 0.46 % ( 15/3265 ; 95 % CI : 0.31 , 0.79 ) . Conclusions : Implementation of an effective trauma team and trauma service was associated with a significant reduction in DDI Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objectives To report the implementation of a trigger review method ( TRM ) in primary care , with a particular focus on its impact on patient safety-related findings . Design Cross-sectional structured review of r and om sample s ( n=25 ) of electronic records of ‘ high-risk ’ patient groups conducted twice per year ( each for a retrospective review period of 3 months ) . Setting 274 general practice s in two regions of Scotl and . Intervention Contractual incentivisation of TRM implementation . Main outcome measures Practice participation rate ; characteristics of patient safety incidents ( PSIs ) , for example , their prevalence , type , perceived severity and preventability ; and actions or intended actions undertaken during and after trigger review s. Results 274 of 318 eligible practice s ( 86.2 % ) returned 536 TRM Summary Reports , which outlined findings from review s of 13 351 electronic patient records . 1887 ( 14.1 % ) PSIs were recorded , with a mean of 3.5 ( 536/1887 ) per Summary Report ( SD±1.6 ) . Of these , 830 ( 44.0 % ) were judged to have caused mild to moderate harm , with 262 ( 13.9 % ) cases result ing in more severe harm . A total of 852 PSIs ( 46.2 % ) were rated as preventable or potentially preventable . In 459 Summary Reports ( 85.6 % ) , review ers indicated implementing one or more improvement actions during the actual TRM process ; and 2177 actions after completion of the TRM process ( mean 4.1 ( SD±3.3 ) actions per review ) . Conclusions The great majority of clinician review ers ‘ successfully ’ applied the TRM , uncovering important but previously undetected PSIs , which prompted care teams to take action during and after the trigger review s. The method and data generated have the potential to drive improvements in related care processes at the practice , regional and national health system level . TRM arguably increased ‘ ownership ’ of the safety challenge and clinician engagement in implementing their solutions to specific problems identified . Our results suggest that the TRM has potential as a feasible , pragmatic approach to improving primary care safety and quality OBJECTIVE The aim of this study was to determine the effect that the computer interpretation ( CI ) of electrocardiograms ( EKGs ) has on the accuracy of resident ( noncardiologist ) physicians reading EKGs .  DESIGN A r and omized , controlled trial was conducted in a laboratory setting from February through June 2001 , using a two-period crossover design with matched pairs of subjects r and omly assigned to sequencing groups . MEASUREMENTS Subjects '  interpretive accuracy of discrete ,  cardiologist-determined EKG findings  were measured as judged by a board-certified internist . RESULTS Without the CI , subjects interpreted 48.9 % ( 95 % confidence interval , 45.0 % to 52.8 % ) of the findings correctly . With the CI , subjects interpreted 55.4 % ( 51.9 % to 58.9 % ) correctly ( p < 0.0001 ) . When the CIs that agreed with the gold st and ard ( Correct CIs ) were not included , 53.1 % ( 47.7 % to 58.5 % ) of the findings were interpreted correctly . When the correct CI was included , accuracy increased to 68.1 % ( 63.2 % to 72.7 % ; p < 0.0001 ) . When computer advice that did not agree with the gold st and ard ( Incorrect CI ) was not provided to the subjects , 56.7 % ( 48.5 % to 64.5 % ) of findings were interpreted correctly . Accuracy dropped to 48.3 % ( 40.4 % to 56.4 % ) when the incorrect computer advice was provided ( p = 0.131 ) . Subjects erroneously agreed with the incorrect CI more often when it was presented with the EKG 67.7 % ( 57.2 % to 76.7 % ) than when it was not 34.6 % ( 23.8 % to 47.3 % ; p < 0.0001 ) . CONCLUSIONS Computer decision support systems can generally improve the interpretive accuracy of internal medicine residents in reading EKGs . However , subjects were influenced significantly by incorrect advice , which tempers the overall usefulness of computer-generated advice in this and perhaps other areas OBJECTIVE To evaluate the relative effectiveness of computer and manual reminder systems on the implementation of a clinical practice guideline . DESIGN Seventy-eight out patients in a mental health clinic were r and omly assigned within clinician to one of the two reminder systems . The computer system , called CaseWalker , reminded clinicians when guideline -recommended screening for mood disorder was due , ensured the fidelity of the diagnosis of major depressive disorder to criteria of the Diagnostic and Statistical Manual of Mental Disorders , 4th edition ( DSM-IV ) , and generated a progress note . The manual system was a checklist inserted in the paper medical record . MEASURES Screening rates for mood disorder and the completeness of the documentation of which DSM-IV criteria were met by patients who were said to have major depressive disorder were compared . RESULTS The CaseWalker , compared with the paper checklist , result ed in a higher screening rate for mood disorder ( 86.5 vs. 61 percent , P = 0.008 ) and a higher rate of complete documentation of DSM-IV criteria ( 100 vs. 5.6 percent , P < 0.001 ) . CONCLUSIONS In an outpatient mental health clinic , computer reminders were shown to be superior to manual reminders in improving adherence to a clinical practice guideline for depression Background Computerized clinical decision support systems are information technology-based systems design ed to improve clinical decision-making . As with any healthcare intervention with cl aims to improve process of care or patient outcomes , decision support systems should be rigorously evaluated before widespread dissemination into clinical practice . Engaging healthcare providers and managers in the review process may facilitate knowledge translation and uptake . The objective of this research was to form a partnership of healthcare providers , managers , and research ers to review r and omized controlled trials assessing the effects of computerized decision support for six clinical application areas : primary preventive care , therapeutic drug monitoring and dosing , drug prescribing , chronic disease management , diagnostic test ordering and interpretation , and acute care management ; and to identify study characteristics that predict benefit . Methods The review was undertaken by the Health Information Research Unit , McMaster University , in partnership with Hamilton Health Sciences , the Hamilton , Niagara , Haldim and , and Brant Local Health Integration Network , and pertinent healthcare service teams . Following agreement on information needs and interests with decision-makers , our earlier systematic review was up date d by search ing Medline , EMBASE , EBM Review data bases , and Inspec , and review ing reference lists through 6 January 2010 . Data extraction items were exp and ed according to input from decision-makers . Authors of primary studies were contacted to confirm data and to provide additional information . Eligible trials were organized according to clinical area of application . We included r and omized controlled trials that evaluated the effect on practitioner performance or patient outcomes of patient care provided with a  computerized clinical decision support system compared with patient care without such a system . Results Data will be summarized using descriptive summary measures , including proportions for categorical variables and means for continuous variables . Univariable and multivariable logistic regression models will be used to investigate associations between outcomes of interest and study specific covariates . When reporting results from individual studies , we will cite the measures of association and p-values reported in the studies . If appropriate for groups of studies with similar features , we will conduct meta-analyses . Conclusion A decision-maker- research er partnership provides a model for systematic review s that may foster knowledge translation and uptake OBJECTIVE Communication of abnormal test results in the outpatient setting is prone to error . Using information technology can improve communication and improve patient safety . We st and ardized processes and procedures in a computerized test result notification system and examined their effectiveness to reduce errors in communication of abnormal imaging results . DESIGN We prospect ively analyzed outcomes of computerized notification of abnormal test results ( alerts ) that providers did not explicitly acknowledge receiving in the electronic medical record of an ambulatory multispecialty clinic . MEASUREMENTS In the study period , 190,799 outpatient visits occurred and 20,680 outpatient imaging tests were performed . We tracked 1,017 transmitted alerts electronically . Using a taxonomy of communication errors , we focused on alerts in which errors in acknowledgment and reception occurred . Unacknowledged alerts were identified through electronic tracking . Among these , we performed chart review s to determine any evidence of documented response , such as ordering a follow-up test or consultation . If no response was documented , we contacted providers by telephone to determine their awareness of the test results and any follow-up action they had taken . These processes confirmed the presence or absence of alert reception . RESULTS Providers failed to acknowledge receipt of over one-third ( 368 of 1,017 ) of transmitted alerts . In 45 of these cases ( 4 % of abnormal results ) , the imaging study was completely lost to follow-up 4 weeks after the date of study . Overall , 0.2 % of outpatient imaging was lost to follow-up . The rate of lost to follow-up imaging was 0.02 % per outpatient visit . CONCLUSION Imaging results continue to be lost to follow-up in a computerized test result notification system that alerted physicians through the electronic medical record . Although comparison data from previous studies are limited , the rate of results lost to follow-up appears to be lower than that reported in systems that do not use information technology comparable to what we evaluated OBJECTIVE to compare the ability of computer-aided diagnosis and contrast radiography for the diagnosis of acute mechanical small bowel obstruction . DESIGN Prospect i ve r and omised trial . SETTING Kaunas University of Medicine , Lithuania . SUBJECTS 80 patients with small bowel obstruction with no clinical evidence of strangulation who were r and omised into two groups ( n = 40 in each ) to be investigated by computer-aided diagnosis and contrast radiography .  INTENVENTIONS : 37 patients required operation ( 46 % ) 
    Output:
    
There is some evidence that trigger algorithms , including computer based and alert systems , may reduce delayed diagnosis and improve diagnostic accuracy .
In trauma setting s , strategies such as additional patient review ( e.g. trauma teams ) reduced missed diagnosis and in radiology departments review strategies such as team meetings and error documentation may reduce diagnostic error rates over time .