***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: STUDY OBJECTIVE To determine whether use of the T-System ( Emergency Services Consultants , Irving , TX ) template-generated medical documentation system ( 1 ) decreases physician evaluation time in the emergency department , ( 2 ) increases gross billing under the 1997 Health Care Financing Administration guidelines by minimizing downcoding caused by inadequate documentation , and ( 3 ) increases physician satisfaction with the documentation process , compared with the undirected written narrative format . METHODS A prospect i ve , r and omized , unblinded , controlled , convenience trial of documentation with the T-System of ED templates versus undirected written documentation was conducted in the ED of a county-owned , university-affiliated hospital . All patients seen between the hours of 7 AM and 10 PM during a 16-day period were included . The intervention was varying the method of documentation of the emergency physician . Adequacy of r and omization to the 2 documentation groups was assessed by comparing ED triage classification , patient disposition , level of training of the evaluating physician , and whether ED consultation with other services occurred . Outcome measurements included emergency physician total evaluation and treatment time , professional bill , and satisfaction , as evaluated by a question naire completed after the study period . The 2 documentation groups were compared by an intention-to-treat analysis and by Student 's t test and the median test as appropriate . RESULTS A total of 1,228 patient encounters were included .  Emergency physician total evaluation and treatment time with template-directed documentation was 4.6 minutes less than with undirected recording , a difference that was not significant ( 95 % confidence interval [ CI ] , -9.2 to 18.3 ) . Gross billing was $ 29 . 60 more per patient ( 95 % CI , $ 22.20 to $ 37.00 ) with the T-System , as assessed by our hospital coders . This difference was caused by a mean.50 ( 95 % CI,.39 to.60 ) higher level of evaluation and management coding . Physicians preferred the T-System ( P < .0005 ) . CONCLUSION Use of template-assisted documentation in the ED was associated with higher gross billing and physician satisfaction but no significant decrease in emergency physician total evaluation time Inpatient medical notes often fail to record important details of patient history and findings on clinical examination . To overcome problems with content and legibility of notes we introduced preprinted notes for the admission of children to this hospital . The quality of the information recorded for 100 children whose admissions were clerked with the preprinted notes was compared with that recorded for 100 whose admissions were recorded with the traditional notes .  All case notes were selected r and omly and retrospectively from traditional notes written from April to October 1993 and from preprinted notes  written from October 1993 to April 1994 . The quality of information was assessed according to the presence or absence of 25 agreed core clinical details and the number of words per clerking . In admissions recorded with the preprinted notes the mean number of core clinical details present was significantly higher than those recorded with traditional notes ( 24.0 v 17.6 , p < 0.00001 ) . Admissions recorded with the preprinted notes were also significantly shorter ( mean 144 words v 184 words , p < 0.0001 ) . The authors conclude that information about children admitted to hospital is both more complete and more succinct when recorded using preprinted admission sheets CONTEXT Clinicians document cancer patients ' symptoms in free-text format within electronic health record visit notes . Although symptoms are critically important to quality of life and often herald clinical status changes , computational methods to assess the trajectory of symptoms over time are woefully underdeveloped . OBJECTIVES To create machine learning algorithms capable of extracting patient-reported symptoms from free-text electronic health record notes . METHODS The data set included 103,564 sentences obtained from the electronic clinical notes of 2695 breast cancer patients receiving paclitaxel-containing chemotherapy at two academic cancer centers between May 1996 and May 2015 . We manually annotated 10,000 sentences and trained a conditional r and om field model to predict words indicating an active symptom ( positive label ) , absence of a symptom ( negative label ) , or no symptom at all ( neutral label ) . Sentences labeled by human coder were divided into training , validation , and test data sets . Final model performance was determined on 20 % test data unused in model development or tuning . RESULTS The final model achieved precision of 0.82 , 0.86 , and 0.99 and recall of 0.56 , 0.69 , and 1.00 for positive , negative , and neutral symptom labels , respectively . The most common positive symptoms were pain , fatigue , and nausea . Machine-based labeling of 103,564 sentences took two minutes . CONCLUSION We demonstrate the potential of machine learning to gather , track , and analyze symptoms experienced by cancer patients during chemotherapy . Although our initial model requires further optimization to improve the performance , further model building may yield machine learning methods suitable to be deployed in routine clinical care , quality improvement , and research applications INTRODUCTION Smoking prevalence remains high in some vulnerable groups , including those who misuse substances , have a mental illness , are homeless , or are involved with the criminal justice system .  E-cigarette use is increasing and may support smoking cessation/reduction . METHODS Systematic review of quantitative and qualitative data on the effectiveness of e-cigarettes for smoking cessation/reduction among vulnerable groups . Data bases search ed were MEDLINE , EMBASE , PsychINFO , CINAHL , ASSIA , ProQuest Dissertations and Theses , and Open Grey . Narrative synthesis of quantitative data and thematic synthesis of qualitative data . RESULTS 2628 records and 46 full texts were screened ; 9 studies were identified for inclusion . Due to low quality of evidence , it is uncertain whether e-cigarettes are effective for smoking cessation in vulnerable population s. A moderate quality study suggested that e-cigarettes were as effective as nicotine replacement therapy . Four studies suggested significant smoking reduction ; however , three were uncontrolled and had sample sizes below 30 . A prospect i ve cohort study found no differences between e-cigarette users and nonusers . No significant adverse events and minimal side effects were identified . Qualitative thematic synthesis revealed barriers and facilitators associated with each component of the COM-B ( capability , opportunity , motivation , and behavior ) model , including practical barriers ; perceptions of effectiveness for cessation/reduction ; design features contributing to automatic and reflective motivation ; smoking bans facilitating practical opportunity ; and social connectedness increasing social opportunity . CONCLUSION Further research is needed to identify the most appropriate device types for practicality and safety , level of support required in e-cigarette interventions , and to compare e-cigarettes with current best practice smoking cessation support among vulnerable groups . IMPLICATION S Smoking prevalence among people with mental illness , substance misuse , homelessness , or criminal justice system involvement remains high . E-cigarettes could support cessation . This systematic review found limited quantitative evidence assessing effectiveness . No serious adverse events were identified . Qualitative thematic synthesis revealed barriers and facilitators mapping to each component of the COM-B ( capability , opportunity , motivation , and behavior ) model , including practical barriers ; perceived effectiveness ; design features contributing to automatic and reflective motivation ; smoking bans facilitating practical opportunity ; and social connectedness increasing social opportunity . Further research should consider appropriate devices for practicality and safety , concurrent support , and comparison with best practice smoking cessation support Background : Improving the quality and safety of patients seen in an emergency department ( ED ) has become a priority in Italy . The Tuscan Regional Health Ministry has supported quality improvement projects in several Tuscan EDs in cooperation with Harvard Medical International and Harvard Medical School . Objective : To improve the triage process , we assessed the completeness of documenting the vital signs of patients seen at triage in the ED of the University Hospital Santa Chiara , Pisa , Italy . At the University Hospital of Pisa 's ED , triage is based on 5 categories , each identified by a color : white ( lowest priority ) , blue , green , yellow , and red ( highest priority ) . For patients triaged as " yellow , " blood pressure , heart rate , and oxygen saturation are considered m and atory vital signs and important components of a complete patient record . The aims of this project were as follows : 1 ) to assess the percentage of patients seen during ED triage in whom vital signs were recorded in the clinical record , 2 ) to analyze the reasons for missing vital sign data , and 3 ) to design and implement a strategy to improve the percentage of patients in whom vital signs were recorded . Methods : This project began in November 2005 with the identification of a multidisciplinary ED Quality Team . Faculty from Harvard Medical School provided a 2-day training course on the methods and tools of clinical quality improvement . After the training , the team defined their improvement project . The clinical quality improvement project followed a Plan-Do- Study -Act cycle . Preintervention and postintervention data collection consisted of a retrospective analysis of one-third of all patients triaged in the " yellow " category who were admitted to the ED during 1 month , r and omly selected using a computer-generated list . Results : A total of 245 clinical records in the preintervention ( March 2006 ) and 251 ( April-May 2007 ) during the postintervention were included . We found that in 77.9 % ( 191/245 ) of these records , vital signs were correctly recorded during the preintervention period . Patients with limb trauma and those with abdominal complaints represented the vast majority of patients in whom vital sign data were missing . The postintervention data revealed an improvement in the documentation of m and atory vital signs from 77.9 % to 87.9 % . Conclusions : Creating a multidisciplinary team and implementing a formal quality improvement project improved vital sign documentation at triage for a group of patients seen during ED triage in 1 Italian hospital OBJECTIVES Our goal was to determine the effectiveness of an intervention aim ed at improving the emergency department ( ED ) documentation of pediatric injuries . METHODS All physicians and nursing staff in the ED of an urban teaching hospital and trauma centre underwent focused injury surveillance training  and were instructed how to document 14 injury-specific data elements . Pocket reminder cards were provided , and pediatric injury charts were flagged . Subsequently , r and om sample s of pediatric injury charts were analyzed from a 3-month period prior to the intervention and from the corresponding months after the intervention . Post-intervention documentation was compared to pre-intervention documentation for the 14 pre-defined data elements . RESULTS Six of the 14 data elements were charted more frequently , and 2 less frequently during the post-intervention phase . Odds ratios ranged from 4.59 ( 95%CI , 3.40 to 6.19 ) for charting " the presence of an adult observer " to 0.09 ( 95%CI , 0.01 to 0.76 ) for charting " sports equipment related to the injury . " The " flagging " of injury charts , as a visual reminder for clinicians to document injury data , seemed to be the most effective component of the intervention . CONCLUSION A simple intervention , consisting of staff training , chart modification , and visual flagging of charts , can increase the amount of injury information documented by ED clinicians . Efforts to improve ED charting are most likely to succeed if they include visual prompts for clinicians STUDY OBJECTIVE To assess the effect of preprinted , structured , complaint-specific patient encounter forms on documentation , use of testing , and treatment compared with free-text record keeping . DESIGN Nonr and omized case-control trial . SETTING University-affiliated , tertiary referral hospital emergency department . METHODS The records of all patients with lacerations , pharyngitis , asthma , or isolated closed-head injury during an eight-month period were review ed . INTERVENTION Use of structured complaint-specific patient encounter forms versus traditional free-text record keeping . MAIN OUTCOME MEASURE The null hypothesis was that there would be no differences in documentation , test use , or practice when the structured forms were used compared with free-text record keeping . RESULTS Differences in documentation that favored the use of the structured forms for all four problems studied were seen consistently . Not only was documentation improved , but test use also was affected in a way that decreased use . In addition , in certain areas ( eg , treatment of pharyngitis ) , clinical practice also was changed . CONCLUSION Structured , problem-specific ED records improve documentation and affect both re source use and clinical practice . These forms may be useful for improving communication and reimbursement as well as for medicolegal documentation . They provide a method for st and ardized quality assurance review and clinical data abstract ion . Finally , they provide a method for active dissemination of clinical st and ards AIM To determine if the introduction of preformatted patient record charts improved documentation by doctors in a rural emergency department . METHODS All medical records of patients who were discharged from the emergency department were collected and analysed for a period of two weeks ( control ) . The preformatted patient charts were then introduced for a further two weeks , and analysed for the presence or absence of key content items RESULTS After exclusions , 137 control charts and 96 preformatted charts were collected and analysed . It was found that , overall , there was a significant improvement in the number of the key items documented ( p<0.005 ) . There was a trend towards improvement in four parameters , but for three other key content items , there was a nonsignificant decline in documentation st and ards . CONCLUSION A structured proforma does improve documentation . However , the improvement is small and further studies are required before use of preformatted patient records for the undifferentiated emergency department patients can be recommended OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s 
    Output:
    
Conclusions Promising approaches to improving physician documentation in emergency department setting s include audit/feedback , reminders , templates , and multi-pronged education interventions .