***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 
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    Input: BACKGROUND The Coronary Health Assessment Study ( CHAS ) was developed to determine the feasibility of using patient-specific , multifactorial computerized coronary risk profiles as a clinical decision aid to support primary prevention of CHD . METHODS Study participants included 253 community based physicians , r and omized into profile and control groups , and 958 of their patients . The profile group physicians received coronary risk profiles for their patients within 10 working days after the baseline patient assessment providing early feedback . The control group received their profiles only if the patient was clinical ly reevaluated during a 3-month follow-up visit . Patients ' coronary risk factors were evaluated at baseline and at follow-up . RESULTS The profile group had a significantly higher ( P < 0.05 ) ratio of high-risk/low-risk patients who returned for a follow-up visit compared to the control group ( 1.23 vs 0.77 ) . The patients in the profile group also had significantly ( P < 0.05 ) greater mean reductions in total cholesterol ( -0.5 vs -0.1 mmol/L ) , LDL cholesterol ( -0.4 vs 0.0 mmol/L ) , the total cholesterol/ HDL ratio ( -0.6 vs -0.2 ) , and the predicted 8-year coronary risk ( -1.8 vs -0.3 % ) . CONCLUSIONS Computer-generated coronary risk profiles can be effective in assisting physicians to identify high-risk patients . Their use is also associated with significantly greater improvements in the serum lipid profiles and the overall coronary risk of these patients Low bone mineral density is a major risk factor for future fragility fracture [ 1 - 4 ] . This led the World Health Organization to include bone mineral density measurement in the definition of osteoporosis [ 5 ] . Quantitation of axial bone mineral density is most often done with dual x-ray absorptiometry , although radiography and ultrasonography of appendicular bone mass are being actively studies as alternative techniques [ 6 , 7 ] . Despite the high prevalence of osteoporosis and osteopenia [ 8 ] and the availability of therapy to prevent and treat these conditions , it has been estimated that few patients at risk are referred for bone mineral density measurements [ 9 ] . This low testing rate may result from the cost and lack of widespread availability of diagnostic equipment . However , it may also result from underuse of existing diagnostic facilities that occurs because physicians have difficulty comprehending the often brief technical reports . We hypothesized that giving primary care physicians more detailed clinical reporting ( compared with brief technical reporting ) of bone mineral density results would increase the use , underst and ing , and acceptance of bone densitometry and would affect subsequent management of osteoporosis . Methods All primary care physicians ( general internists , family practitioners , and gynecologists ) ordering dual x-ray absorptiometry ( Hologic 1000W , Waltham , Massachusetts ) for bone mineral density measurements between 2 October 1995 and 23 April 1996 at the osteoporosis center of a community teaching hospital were enrolled . When their patients underwent their first procedure , physicians were r and omly assigned by a computer-generated allocation sequence to receive either short technical reports or long narrative clinical reports ( Appendix ) and a printout generated by the bone densitometer software that contained morphometry , bone density data , and statistical comparisons with control groups in tabular format . Specialists with expertise in bone metabolism received the short reports and were not included in the study . Reports were written by two endocrinologists trained in bone metabolism . Clinical information was obtained from a data base compiled by the bone density technologist during the procedure . The study was approved by the Human Studies Review Committee of UMass Memorial Health Care ( Worcester , Massachusetts ) . One of the authors interviewed the physicians by telephone by using an intake form after the physicians had received at least two reports in a given format . Physicians were asked whether they understood various concepts of bone densitometry ; if they answered yes , they were asked to explain the concept . Specific questions about individual patients ( Appendix ) were then posed to each physician with the data base available to the investigator and the office record available to the primary care physician . A minimum of two and a maximum of six reports were included in the analysis for each physician . After the interview , physicians who had received the short technical reports began to receive the long clinical reports and were reinterviewed after having received at least two long reports . Numerical data were analyzed by using the t-test , the Mann-Whitney rank-sum test , one-way analysis of variance , or Kruskal-Wallis analysis of variance on ranks ; Bonferroni correction was used where appropriate . Nominal data were analyzed with the Fisher exact test or the z-test , the McNemar test , or the chi-square test ; Yates correction for continuity was used . Individual patient data were clustered by physician and averaged before analysis . Data were analyzed by using Sigma Stat ( J and el Scientific , San Rafael , California ) , and a P value less than 0.05 was considered significant in all analyses . The funding source for this study had no role in gathering , analyzing , or interpreting the data or in the decision to su bmi t the paper for publication . Results Sixty-eight physicians were enrolled over 7 months and were followed for an additional 10 months . Eleven physicians were omitted from the analysis because they did not remain in practice in the area or did not meet protocol requirements . Thirty-five physicians were r and omly assigned to receive the short reports ; they ordered 0.72 0.71 tests per month before the first interview . Twenty-two physicians were r and omly assigned to receive the long reports ; they ordered 1.30 1.21 tests per month before the first interview ( P = 0.002 compared with physicians who received the short reports [ 95 % CI for difference of means , 0.36 to 0.79 ] ) . Thirty-three internists ordered 640 tests , 13 family practitioners ordered 136 tests , and 11 gynecologists ordered 118 tests . Patients referred by internists were older ( 63.0 8.4 years compared with 56.7 4.7 years ; P = 0.044 ) and more likely to have had fragility fractures ( 19 % compared with 1 % ; P = 0.044 ) than patients referred by gynecologists . The indications for testing among all physicians included risk factors ( 25 % ) , patient concerns ( 23 % ) , menopause ( 15 % ) , history of fracture ( 12 % ) , and steroid treatment ( 8 % ) . The only difference seen by physician specialty was that more internists ( 17 % ) than gynecologists ( 1 % ) ordered tests because of history of fracture ( P = 0.048 ) . At the first interview , 32 % of physicians who received the long reports and 3 % of those who received the short reports understood the concepts of T ( SD from young adult reference mean ) and Z ( SD from age-matched controls ) scores ( Table 1 ) ( P = 0.005 ) . Eighty-six percent of physicians who received the long reports and 30 % of those who received the short reports understood the role of bone mineral density in the definition of osteoporosis ( P < 0.001 ) . Forty-five percent of physicians who received the long reports and 12 % of those who received the short reports understood how fracture risk related to bone mineral density ( P = 0.014 ) . No differences by physician specialty were seen . Table 1 . Effect of Style of  Reporting of Bone Mineral Density on Primary Care Physicians ' Underst and ing of Bone Densitometry We saw trends toward fewer formal referrals to specialists , more testing to rule out secondary causes of osteoporosis , and more changes in the pharmacologic treatment of osteoporosis in patients whose reports were in the long format compared with those whose reports were in the short format , but these differences were not statistically significant ( Table 2 ) . When specialty was analyzed , 61 % of patients of gynecologists who received long reports and 19 % of patients whose reports were in the short format received changes in the pharmacologic treatment of osteoporosis  ( P = 0.021 ) . Table 2 . Effect of Style of Reporting of Bone Mineral Density on Primary Care Physicians '  Management of Osteoporosis * Physicians found that 36 % of the 112 short reports and 1 % of the 176 long reports were confusing ( P = 0.003 ) . Of the 20 physicians who were interviewed after receiving the short reports and again after receiving the long reports , 100 % requested that use of the long format be continued . Of the 42 physicians interviewed after receiving the long reports , 88 % requested continued use of this format . Discussion Clinical reporting of bone mineral density test results to primary care physicians compared with brief technical reporting leads to increased use and underst and ing of bone densitometry and changes in the management of osteoporosis . The Consensus Statement of the International Panel on the Clinical Utility of Bone Mass Measurements includes the suggestion that bone mass data be accompanied by a clinical interpretation , including a narrative report , to allow better decision making by the primary care physician [ 6 ] . A survey of 181 primary care physicians in Tucson , Arizona , showed that bone mineral density , relative fracture risk , and the World Health Organization definition of osteoporosis were of primary value , whereas clinical recommendations were less important [ 10 ] . In contrast , our physicians preferred to receive reports with treatment and follow-up recommendations , perhaps because they actually received the reports and were able to appreciate their usefulness . The practice patterns of the physicians in Tucson and the relatively small group of physicians referring to our osteoporosis center may differ . Other limitations of our study include the potential bias of the interviewer , who was aware of report style assignment during the interview , and an imbalance between the numbers of physicians initially assigned to each group , which might have been avoided by monitoring and adjusting the r and omization process . Our results do not suggest that bone density reports should be st and ardized ; rather , primary care physicians require a customized report depending on their knowledge base and their needs . For example , although we sent different reports to primary care physicians and specialists , three primary care physicians requested the short report instead of the long report and one specialist requested that clinical recommendations be attached to the short report . Reports generated at different institutions may vary according to local background and individual needs . The clinical format may also be useful for transmitting new guidelines or diagnostic and treatment strategies . For example , during the study , new data became available on the clinical utility of bone markers [ 11 ] , and suggestions for the use of these markers were included in a few selected reports . Although one may surmise that physicians who order many bone density tests would eventually ask to receive the short report rather than the long report , this did not occur in our study , at least in part because some of the physicians found the long report to be a valuable addition to the medical record or a useful document to send to patients for their review . Most of the tests ordered were initial base-line studies . In the future , the long reports would also be helpful in discussing the significance of changes in bone BACKGROUND Identifying the appropriate long-term anti-thrombotic therapy following acute ischaemic stroke is a challenging area in which computer-based decision support may provide assistance . AIM To evaluate the influence on prescribing practice of a computer-based decision support system ( CDSS ) that provided patient-specific estimates of the expected ischaemic and haemorrhagic vascular event rates under each potential anti-thrombotic therapy . DESIGN Cluster-r and omized controlled trial . METHODS We recruited patients who presented for a first investigation of ischaemic stroke or TIA symptoms , excluding those with a poor prognosis or major contraindication to anticoagulation . After observation of routine prescribing practice ( 6 months ) in each hospital , centres were r and omized for 6 months to either control ( routine practice observed ) or intervention ( practice observed while the CDSS provided patient-specific information ) . We compared , between control and intervention centres , the risk reduction ( estimated by the CDSS ) in ischaemic and haemorrhagic vascular events achieved by long-term anti-thrombotic therapy , and the proportions of subjects prescribed the optimal therapy identified by the CDSS . RESULTS Sixteen hospitals recruited 1952 subjects . When the CDSS provided information , the mean relative risk reduction attained by prescribing increased by 2.7 percentage units ( 95%CI -0.3 to 5.7 ) and the odds ratio for the optimal therapy being prescribed was 1.32 ( 0.83 to 1.80 ) . Some 55 % ( 5/9 ) of clinicians believed the CDSS had influenced their prescribing . CONCLUSIONS Cluster-r and omized trials provide excellent frameworks for evaluating novel clinical management methods . Our CDSS was feasible to implement and acceptable to clinicians , but did not substantially influence prescribing practice for anti-thrombotic drugs after acute ischaemic stroke Study objective : To evaluate the effectiveness of two teaching interventions to increase  residents ’ performance of smoking cessation counseling .  Design : R and omized controlled factorial trial . Setting : Eleven residency programs , in internal medicine ( six ) , family medicine ( three ) , and pediatrics ( two ) . Programs were located in three university medical centers and four university-affiliated community hospitals . Participants : 261 residents who saw ambulatory care patients at least one half-day per week , and 937 returning patients aged 17 to 75 years who reported having smoked five or more cigarettes in the preceding seven days . Of the 937 , 843 were eligible for follow-up , and 659 ( 78 % ) were interviewed by phone at six months . Interventions : Two interventions ( tutorial and prompt ) and four groups . The tutorial was a two-hour educational program in minimal-contact smoking cessation counseling for residents . The prompt was a chart-based reminder to assist physician counseling . One group of residents received the tutorial ; one , the prompt ; and one , both . A fourth group received no intervention . 
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CONCLUSIONS Several features were closely correlated with decision support systems ' ability to improve patient care significantly .