***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: Background . It is often difficult to predict the timing and frequency of asthma attacks . In addition to interrupting the daily life of both the affected child and his/her family , asthma can also pose sudden danger to a child . Based on clinical observations , many asthma‐affected children and their parents must constantly adjust themselves to the uncertainty of the disease , which leads to increased stress on the family . The use of care maps has demonstrated increased efficiency and effectiveness in the care of asthma patients from a variety of setting s. Objective . We design ed this study to construct and evaluate a care map for asthmatic children in Taiwan . Specific attention was placed on comparing the study and control subjects by parental knowledge of asthma , medication used for asthma , hospital readmission , and health care re source usage . Subjects and Methods . The care map was constructed by in‐depth interviews with eight sets of parents of children with asthma . Forty‐four parents of 42 asthma children were r and omized into two groups in the Allergic Clinic of the Chang Gung Children 's Hospital . The experimental group of 22 parents received  individual instruction and training sessions in addition to the regular care provided to the control group of 22 parents . Results . Forty‐two children with asthma were surveyed in this study . To examine the reliability and validity of a care map for children with asthma , a quantitative survey was conducted with 42 outpatient parents with asthmatic children . There was less emergency room attending rate in experimental group ( 6/month ; p < 0.05 ) The underst and ing of the disease was much improved in parents of experimental group ( 13.85 ± 1.04 vs. 10.91 ± 2.14 ; p < 0.01 ) . Furthermore , parents acquired a more positive attitude to asthma , and almost all of the control group had irregular follow‐ups by a physician and had irregular use of medication . Conclusion . This study emphasizes that a  care map  in children with asthma ( CACM ) can be used to educate parents in how to provide the best treatment plan for their children . This study also shows how a CACM can help parents train their children in the best behaviors during asthma attacks . Empathetic assessment and elimination of cultural barriers , a well‐ design ed educational program , and a mutually developed treatment plan could significantly improve the quality of life for families and specific asthma outcomes Background : Major depression is a frequent and serious disorder in older medical in patients . Because the condition goes undetected and untreated in most of these patients , we conducted a r and omized clinical trial to evaluate the effectiveness of a strategy of systematic detection and multidisciplinary treatment of depression in this population . Methods : Consecutive patients aged 65 years or more admitted to general medical services in a primary care hospital between October 1999 and November 2002 were screened for depression with the Diagnostic Interview Schedule ( DIS ) within 48 hours after admission . Patients found to have major depression were r and omly allocated to receive the intervention or usual care . The intervention involved consultation and treatment by a psychiatrist and follow-up by a research nurse and the patient 's family physician . Research assistants , blind to group allocation , collected data from the patients at enrolment and at 3 and 6 months later using the Hamilton Depression Rating Scale ( HAMD ) , the Medical Outcomes 36-item Short Form ( SF-36 ) , the DIS , the Mini-Mental State Examination ( MMSE ) , the Older Americans Re sources and Services ( OARS ) question naire to assess basic and instrumental activities of daily living ( OARS-ADL and OARS-IADL ) and the Rating Scale for Side Effects . Data on the severity of illness , length of hospital stay , health services and medication use , mortality and process of care were also collected . The primary outcome measures were the HAMD and SF-36 . Results : Of 1500 eligible patients who were screened , 157 were found to have major depression and consented to participate ( 78 in the intervention group and 79 in the usual care group ) . At r and omization , there were no clinical ly or statistically significant differences between the 2 groups . Sixty-four patients completed follow-up to 6 months , 57 withdrew , and 36 died . At 6 months , there were no clinical ly or statistically significant differences the 2 groups in HAMD or SF-36 scores or any of the secondary outcome measures . Interpretation : We were unable to demonstrate that systematic detection and multidisciplinary care of depression was more beneficial than usual care for elderly medical in patients OBJECTIVE To compare a practice of protocol -directed sedation during mechanical ventilation implemented by nurses with traditional non- protocol -directed sedation administration . DESIGN R and omized , controlled clinical trial . SETTING Medical intensive care unit ( 19 beds ) in an urban teaching hospital . PATIENTS Patients requiring mechanical ventilation ( n = 321 ) . INTERVENTIONS Patients were r and omly assigned to receive either protocol -directed sedation ( n = 162 ) or non- protocol -directed sedation ( n = 159 ) . MEASUREMENTS AND MAIN RESULTS The median duration of mechanical ventilation was 55.9 hrs ( 95 % confidence interval , 41.0 - 90.0 hrs ) for patients managed with protocol -directed sedation and 117.0 hrs ( 95 % confidence interval , 96.0 - 155.6 hrs ) for patients receiving non- protocol -directed sedation . Kaplan-Meier analysis demonstrated that patients in the protocol -directed sedation group had statistically shorter duration s of mechanical ventilation than patients in the non- protocol -directed sedation group ( chi-square = 7.00 , p = .008 , log rank test ; chi-square = 8.54 , p = .004 , Wilcoxon 's test ; chi-square = 9.18 , p = .003 , -2 log test ) . Lengths of stay in the intensive care unit ( 5.7+/-5.9 days vs. 7.5+/-6.5 days ; p = .013 ) and hospital ( 14.0+/-17.3 days vs. 19.9+/-24.2 days ; p < .001 ) were also significantly shorter among patients in the protocol -directed sedation group . Among the 132 patients ( 41.1 % ) receiving continuous intravenous sedation , those in the protocol -directed sedation group ( n = 66 ) had a significantly shorter duration of continuous intravenous sedation than those in the non- protocol -directed sedation group ( n = 66 ) ( 3.5+/-4.0 days vs. 5.6+/-6.4 days ; p = .003 ) . Patients in the protocol -directed sedation group also had a significantly lower tracheostomy rate compared with patients in the non- protocol -directed sedation group ( 10 of 162 patients [ 6.2 % ] vs. 21 of 159 patients [ 13.2 % ] , p = .038 ) . CONCLUSIONS The use of protocol -directed sedation can reduce the duration of mechanical ventilation , the intensive care unit and hospital lengths of stay , and the need for tracheostomy among critically ill patients with acute respiratory failure BACKGROUND AND PURPOSE Integrated Care Pathway ( ICP ) is an organized , goal -defined , and time-managed plan that has the potential of facilitating timely interdisciplinary coordination , improving discharge planning , and reducing length of hospital stay . METHODS An ICP for stroke rehabilitation based on evidence of best practice , professional st and ards , and existing infrastructure was developed . Its effectiveness was tested in 152 stroke patients undergoing rehabilitation who were r and omized to receive ICP care coordinated by an experienced nurse ( n=76 ) or conventional multidisciplinary care ( n=76 ) . RESULTS The age , sex , premorbid functional ability , and stroke characteristics of the 2 groups were comparable . There were no differences in mortality rates ( 10 [ 13 % ] versus 6 [ 8 % ] ) , institutionalization ( 10 [ 13 % ] versus 16 [ 21 % ] ) , or length of hospital stay ( 50+/-19 versus 45+/-23 days ) between patients receiving ICP or multidisciplinary care . Patients receiving conventional multidisciplinary care improved significantly faster between 4 and 12 weeks ( median change in Barthel Activities of Daily Living Index 6 versus 2 ; P<0.01 ) and had higher Quality of Life scores at 12 weeks ( 65 versus 59 ; P=0.07 ) and 6 months ( 72 versus 63 ; P<0.005 ) . There were no significant differences in the mean duration of physiotherapy ( 42.8+/-41.2 versus 39.4+/-36.4 hours ) or occupational therapy ( 8.5+/-7.5 versus 8.0+/-7.5 hours ) received between the 2 groups . CONCLUSIONS ICP management offered no benefit over conventional multidisciplinary care on a stroke rehabilitation unit . Functional recovery was faster and Quality of Life outcomes better in patients receiving conventional multidisciplinary care Outcome for  bipolar disorder  remains suboptimal despite the availability of efficacious treatments . To improve treatment effectiveness in clinical practice , a Veterans Affairs study team created a care model conceptually similar to the lithium clinics of the 1970s but augmented by principles of more recent collaborative care models for chronic medical illnesses . This intervention consists of improving patients ' self-management skills through psychoeducation ; supporting providers ' decision making through simplified practice guidelines ; and enhancing access to care , continuity of care , and information flow through the use of a nurse care coordinator . In this article , which is part I of a two-part report , the authors summarize the conceptual background and development of the intervention , describe the design of a three-year , 11-site r and omized effectiveness trial , and report data describing its successful implementation . Trial design emphasized aspects of effectiveness to support generalizability of the findings and eventual dissemination of the intervention . Part II ( see companion article , this issue ) reports clinical , functional , and overall cost outcomes of the trial OBJECTIVES We tested the hypothesis that an emergency department-based protocol for rapidly ruling out myocardial ischemia would reduce hospital time and expense but maintain diagnostic accuracy . BACKGROUND Patients with a missed diagnosis of myocardial infa rct ion have a high mortality rate ; however , providing routine hospital care to low risk patients may not be time- or cost-effective . METHODS One hundred low risk patients were entered into the study and r and omized either to an  emergency department-based rapid rule-out protocol  ( n = 50 ) or to  routine hospital care  ( n = 50 ) . Patients receiving routine care were managed by their attending physicians . The rapid protocol included serum enzyme testing at 0 , 3 , 6 and 9h , serial electrocardiograms with continuous ST segment monitoring and , if results were negative , a predischarge grade d exercise test . Study patients were also compared with 160 historical control subjects .  RESULTS Myocardial infa rct ion or unstable angina occurred in 6 % of patients within 30 days ; no diagnoses were missed . By intention to treat analysis ( n = 50 in each group ) , the hospital stay was shorter and charges were lower with the rapid protocol than with routine care ( p = 0.001 ) . Among patients in whom ischemia was ruled out , those assigned to the rapid protocol had a shorter hospital stay ( median 11.9 vs. 22.8 h , p = 0.0001 ) and lower initial ( $ 893 vs $ 1,349 , p = 0.0001 ) and 30-day ( $ 898 vs. $ 1,522 , p = 0.0001 ) hospital charges than did patients given routine care . In historical control subjects , the hospital stay was longer ( median 34.5 h , p = 0.001 vs. either group ) and charges greater ( median $ 2,063 , p = 0.001 , vs rapid protocol , p = 0.02 , vs. routine care group ) . CONCLUSIONS In low risk patients who present to the emergency department with chest pain , the rapid protocol ruled out myocardial infa rct ion and unstable angina more quickly and cost-effectively than did routine hospital care CONTEXT Large variations exist among hospitals in the use of treatment re sources for community-acquired pneumonia ( CAP ) . Lack of a common approach to the diagnosis and treatment of CAP has been cited as an explanation for these variations . OBJECTIVE To determine if use of a critical pathway improves the efficiency of treatment for CAP without compromising the well-being of patients . DESIGN Multicenter controlled clinical trial with cluster r and omization and up to 6 weeks of follow-up . SETTING Nineteen teaching and community hospitals in Canada . PATIENTS A total of 1743 patients with CAP presenting to the emergency department at 1 of the participating institutions between January 1 and July 31 , 1998 . INTERVENTION Hospitals were assigned to continue conventional management ( n = 10 ) or implement the critical pathway ( n = 9 ) , which consisted of a clinical prediction rule to guide the admission decision , levofloxacin therapy , and practice guidelines . MAIN OUTCOME MEASURES Effectiveness of the critical pathway , as measured by health-related quality of life on the Short-Form 36 Physical Component Summary ( SF-36 PCS ) scale at 6 weeks ; and re source utilization , as measured by the number of bed days per patient managed ( BDPM ) . RESULTS Quality of life and the occurrence of complications , readmission , and mortality were not different for the 2 strategies ; the 1-sided 95 % confidence limit of the between-group difference in the SF-36 PCS change score was 2.4 points , which was within a predefined 3-point boundary for equivalence . Pathway use was associated with a 
    Output:
    
The authors concluded that clinical pathways are associated with reduced in-hospital complications and improved documentation