human
***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: Recent re-evaluation of preventive health care has result ed in more limited and directed guidelines ; nonetheless , physician compliance has remained poor . This study assessed whether an inexpensive reminder system of preventive care checklists would improve physician implementation of periodic health measures .  Residents in internal medicine were r and omly placed into two groups : one received a copy of the appropriate checklist with each patient 's medical record ; the other did not . After one year , 200 r and omly selected records were audited to determine the proportion of recommendations implemented for each patient . Residents who received checklists performed appropriate preventive health measures at a significantly higher rate than those who did not ( 0.56 + /- 0.26 versus 0.39 + /- 0.22 , p less than 0.002 ) . The actual use of the checklist to record the results was associated with an even higher rate of compliance compared with instances in which the checklists were provided but not used and instances in which checklists were not received ( 0.70 + /- 0.21 versus 0.44 + /- 0.24 and 0.39 + /- 0.22 , respectively , p less than 0.002 ) . These data suggest that a physician 's use of simple checklists can provide an inexpensive and effective means of improving implementation of periodic health maintenance OBJECTIVES To apply and evaluate the effects of a program for computer generated physician reminders , integrated with an electronic patient record ( EPR ) system , for opportunistic health screening in elderly patients . DESIGN A pilot study design ed as a 20-month clinical trial with a control group and a 20-month non-intervention follow-up using a computer reminder program that selects patients for screening in five intervention areas ( diabetes , hypertension , cobalamin deficiency , hypothyroidism and anaemia ) . SETTING Four primary health care ( PHC ) centres in suburban Stockholm . SUBJECTS The intervention was design ed for patients 70 years or older from one health care centre who visited a general practitioner ( GP ) during the first 20-month period . Patients from the three remaining centres served as controls . MAIN OUTCOME MEASURES The number of patients who underwent the tests , who had pathological test results , new diagnoses and new pharmacological treatments in both patient groups . RESULTS In total , 602 patients underwent screening and 1989 were controls . There was a statistically significant , moderate or marked increase ( 13 - 75 % ) in the number of patients who were tested in all five intervention areas . An increase in pathological test results ( 1 - 8 % ) was found in two areas : hypertension and cobalamin deficiency . There was an increase in the number of patients with the diagnosis of cobalamin deficiency during the study . At follow-up a decrease in new diagnoses for anaemia was found . CONCLUSION The system seems to be associated with a moderate to large increase in laboratory and manual screening tests for both established and new screening areas . The effect on clinical outcomes was found mainly in a not-yet-established screening area ( cobalamin deficiency ) , indicating that the system may be clinical ly useful when introducing new screening services Background — Indirect evidence shows that alerting users with clinical decision support systems seems to change behavior more than requiring users to actively initiate the system . However , r and omized trials comparing these methods in a clinical setting are lacking . We studied the effect of both alerting and on-dem and decision support with respect to screening and treatment of dyslipidemia based on the guidelines of the Dutch College of General Practitioners . Methods and Results — In a clustered r and omized trial design , 38 Dutch general practice s ( 77 physicians ) and 87 886 of their patients ( 39 433 men 18 to 70 years of age and 48 453 women 18 to 75 years of age ) who used the ELIAS electronic health record participated . Each practice was assigned to receive alerts , on-dem and support , or no intervention . We measured the percentage of patients screened and treated after 12 months of follow-up . In the alerting group , 65 % of the patients requiring screening were screened ( relative risk versus control=1.76 ; 95 % confidence interval , 1.41 to 2.20 ) compared with 35 % of patients in the on-dem and group ( relative risk versus control=1.28 ; 95 % confidence interval , 0.98 to 1.68 ) and 25 % of patients in the control group . In the alerting group , 66 % of patients requiring treatment were treated ( relative risk versus control=1.40 ; 95 % confidence interval , 1.15 to 1.70 ) compared with 40 % of patients ( relative risk versus control=1.19 ; 95 % confidence interval , 0.94 to 1.50 ) in the on-dem and group and 36 % of patients in the control group . Conclusion — The alerting version of the clinical decision support systems significantly improved screening and treatment performance for dyslipidemia by general practitioners Background Primary care provides most of the evidence -based chronic disease prevention and screening services offered by the healthcare system . However , there remains a gap between recommended preventive services and actual practice . This trial ( the BETTER Trial ) aim ed to improve preventive care of heart disease , diabetes , colorectal , breast and cervical cancers , and relevant lifestyle factors through a practice facilitation intervention set in primary care . Methods Pragmatic two-way factorial cluster RCT with Primary Care Physicians ’ practice s as the unit of allocation and individual patients as the unit of analysis . The setting was urban Primary Care Team practice s in two Canadian provinces . Eight Primary Care Team practice s were r and omly assigned to receive the practice -level intervention or wait-list control ;  4 physicians in each team ( 32 physicians ) were r and omly assigned to receive the patient-level intervention or wait-list control .  Patients r and omly selected from physicians ’ rosters were stratified into two groups : 1 ) general and 2 ) moderate mental illness . The interventions involved a multifaceted , evidence -based , tailored practice -level intervention with a Practice Facilitator , and a patient-level intervention involving a one-hour visit with a Prevention Practitioner where patients received a tailored ‘ prevention prescription ’ . The primary outcome was a composite Summary Quality Index of 28 evidence -based chronic disease prevention and screening actions with pre-defined targets , expressed as the ratio of eligible actions at baseline that were met at follow-up . A cost-effectiveness analysis was conducted . Results 789 of 1,260 ( 63 % ) eligible patients participated . On average , patients were eligible for 8.96 ( SD 3.2 ) actions at baseline . In the adjusted analysis , control patients met 23.1 % ( 95 % CI : 19.2 % to 27.1 % ) of target actions , compared to 28.5 % ( 95 % CI : 20.9 % to 36.0 % ) receiving the practice -level intervention , 55.6 % ( 95 % CI : 49.0 % to 62.1 % ) receiving the patient-level intervention , and 58.9 % ( 95 % CI : 54.7 % to 63.1 % ) receiving both practice - and patient-level interventions ( patient-level intervention versus control , P < 0.001 ) . The benefit of the patient-level intervention was seen in both strata . The extra cost of the intervention was $ 26.43CAN ( 95 % CI : $ 16 to $ 44 ) per additional action met . Conclusions A Prevention Practitioner can improve the implementation of clinical ly important prevention and screening for chronic diseases in a cost-effective manner Background Practice facilitation has been associated with meaningful improvements in disease prevention and quality of patient care . Using practice facilitation , the Improved Delivery of Cardiovascular Care ( IDOCC ) project aim ed to improve the delivery of evidence -based cardiovascular care in primary care practice s across a large health region . Our goal was to evaluate IDOCC ’s impact on adherence to processes of care delivery . Methods A pragmatic stepped wedge cluster r and omized trial recruiting primary care providers in practice s located in Eastern Ontario , Canada ( Clinical Trials.gov : NCT00574808 ) . Participants were r and omly assigned by region to one of three steps . Practice facilitators were intended to visit practice s every 3–4 ( year 1—intensive ) or 6–12 weeks ( year 2—sustainability ) to support changes in practice behavior . The primary outcome was mean adherence to indicators of evidence -based care measured at the patient level . Adherence was assessed by chart review of a r and omly selected cohort of 66 patients per practice in each pre-intervention year , as well as in year 1 and year 2 post-intervention . Results Eighty-four practice s ( 182 physicians ) participated . On average , facilitators had 6.6 ( min : 2 , max : 11 ) face-to-face visits with practice s in year 1 and 2.5 ( min : 0 max : 10 ) visits in year 2 . We collected chart data from 5292 patients . After adjustment for patient and provider characteristics , there was a 1.9 % ( 95 % confidence interval ( CI ) : −2.9 to −0.9 % ) and 4.2 % ( 95 % CI : −5.7 to −2.6 % ) absolute decrease in mean adherence from baseline to intensive and sustainability years , respectively . Conclusions IDOCC did not improve adherence to best- practice guidelines . Our results showed a small statistically significant decrease in mean adherence of question able clinical significance . Potential reasons for this result include implementation challenges , competing priorities in practice s , a broad focus on multiple chronic disease indicators , and use of an overall index of adherence . These results contrast with findings from previously reported facilitation trials and highlight the complexities and challenges of translating research findings into clinical practice .Trial registration Clinical Trials.gov BACKGROUND Decision-support information technology is often adopted to improve clinical decision making , but it is rarely rigorously evaluated . Congress m and ated the evaluation of Problem-Knowledge Couplers ( PKC Corp , Burlington , Vt ) , a decision-support tool proposed for the Department of Defense 's new health information network . METHODS This was a patient-level r and omized trial conducted at 2 military practice s. A total of 936 patients were allocated to the intervention group  and 966 to usual care .  Couplers were applied before routine ambulatory clinic visits . The primary outcome was quality of care , which was assessed based on the total percentage of any of 24 health care quality process measures ( opportunities to provide evidence -based care ) that were fulfilled . Secondary outcomes included medical re sources consumed within 60 days of enrollment and patient and provider satisfaction . RESULTS There were 4639 health care opportunities ( 2374 in the Coupler group and 2265 in the usual-care group ) , with no difference in the proportion of opportunities fulfilled ( 33.9 % vs 30.7 % ; P = .12 ) . Although there was a modest improvement in performance on screening/preventive measures , it was offset by poorer performance on some measures of acute care . Coupler patients used more laboratory and pharmacy re sources than usual-care patients ( logarithmic mean difference , 71 dollars ) . No difference in patient satisfaction was observed between groups , and provider satisfaction was mixed . CONCLUSION This study provides no strong evidence to support the utility of this decision-support tool , but it demonstrates the value of rigorous evaluation of decision-support information technology BACKGROUND there is inadequate evidence to support currently formulated NHS strategies to achieve health promotion and preventative care in older people through broad-based screening and assessment in primary care . The most extensively evaluated delivery instrument for this purpose is Health Risk Appraisal ( HRA ) . This article describes a trial using HRA to evaluate the effect on health behaviour and preventative-care uptake in older people in NHS primary care . METHODS a r and omised controlled trial was undertaken in three London primary care group practice s. Functionally independent community-dwelling patients older than 65 years ( n = 2,503 ) received a self-administered Health Risk Appraisal for Older Persons ( HRA-O ) question naire leading to computer-generated individualised written feedback to participants and general practitioners ( GPs ) , integrated into practice information-technology ( IT ) systems . All primary care staff received training in preventative health in older people . The main outcome measures were self-reported health behaviour and preventative care uptake at 1-year follow-up . RESULTS of 2,503 individuals r and omised , 2,006 respondents ( 80.1 % ) ( intervention , n = 940 , control n = 1,066 ) were available for analysis . Intervention group respondents reported slightly higher pneumococcal vaccination uptake and equivocal improvement in physical activity levels compared with controls . No significant differences were observed for any other categories of health behaviour or preventative care measures at 1-year follow-up . CONCLUSIONS HRA-O implemented in this way result ed in minimal improvement of health behaviour or uptake of preventative care measures in older people . Supplementary reinforcement involving contact by health professionals with patients over and above routine clinical encounters may be a prerequisite to the effectiveness of IT-based delivery systems for health promotion in older people Objective To compare the effect of an invitation promoting informed choice for screening with a st and ard invitation on attendance and motivation to engage in preventive action . Design R and omised controlled trial . Setting Four English general practice s. Participants 1272 people aged 40 - 69 years , at risk for diabetes , identified from practice registers using a vali date d risk score and invited to attend for screening . Intervention Intervention was a previously vali date d invitation to inform the decision to attend screening , presenting diabetes as a serious potential problem , and providing details of possible costs and benefits 
    Output:
    
agent
Conclusions Interventions using physician reminders , using dedicated personnel to deliver screening , and provision of financial incentives were found to be effective in increasing CVD risk factors screening uptake
***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: Recent re-evaluation of preventive health care has result ed in more limited and directed guidelines ; nonetheless , physician compliance has remained poor . This study assessed whether an inexpensive reminder system of preventive care checklists would improve physician implementation of periodic health measures .  Residents in internal medicine were r and omly placed into two groups : one received a copy of the appropriate checklist with each patient 's medical record ; the other did not . After one year , 200 r and omly selected records were audited to determine the proportion of recommendations implemented for each patient . Residents who received checklists performed appropriate preventive health measures at a significantly higher rate than those who did not ( 0.56 + /- 0.26 versus 0.39 + /- 0.22 , p less than 0.002 ) . The actual use of the checklist to record the results was associated with an even higher rate of compliance compared with instances in which the checklists were provided but not used and instances in which checklists were not received ( 0.70 + /- 0.21 versus 0.44 + /- 0.24 and 0.39 + /- 0.22 , respectively , p less than 0.002 ) . These data suggest that a physician 's use of simple checklists can provide an inexpensive and effective means of improving implementation of periodic health maintenance OBJECTIVES To apply and evaluate the effects of a program for computer generated physician reminders , integrated with an electronic patient record ( EPR ) system , for opportunistic health screening in elderly patients . DESIGN A pilot study design ed as a 20-month clinical trial with a control group and a 20-month non-intervention follow-up using a computer reminder program that selects patients for screening in five intervention areas ( diabetes , hypertension , cobalamin deficiency , hypothyroidism and anaemia ) . SETTING Four primary health care ( PHC ) centres in suburban Stockholm . SUBJECTS The intervention was design ed for patients 70 years or older from one health care centre who visited a general practitioner ( GP ) during the first 20-month period . Patients from the three remaining centres served as controls . MAIN OUTCOME MEASURES The number of patients who underwent the tests , who had pathological test results , new diagnoses and new pharmacological treatments in both patient groups . RESULTS In total , 602 patients underwent screening and 1989 were controls . There was a statistically significant , moderate or marked increase ( 13 - 75 % ) in the number of patients who were tested in all five intervention areas . An increase in pathological test results ( 1 - 8 % ) was found in two areas : hypertension and cobalamin deficiency . There was an increase in the number of patients with the diagnosis of cobalamin deficiency during the study . At follow-up a decrease in new diagnoses for anaemia was found . CONCLUSION The system seems to be associated with a moderate to large increase in laboratory and manual screening tests for both established and new screening areas . The effect on clinical outcomes was found mainly in a not-yet-established screening area ( cobalamin deficiency ) , indicating that the system may be clinical ly useful when introducing new screening services Background — Indirect evidence shows that alerting users with clinical decision support systems seems to change behavior more than requiring users to actively initiate the system . However , r and omized trials comparing these methods in a clinical setting are lacking . We studied the effect of both alerting and on-dem and decision support with respect to screening and treatment of dyslipidemia based on the guidelines of the Dutch College of General Practitioners . Methods and Results — In a clustered r and omized trial design , 38 Dutch general practice s ( 77 physicians ) and 87 886 of their patients ( 39 433 men 18 to 70 years of age and 48 453 women 18 to 75 years of age ) who used the ELIAS electronic health record participated . Each practice was assigned to receive alerts , on-dem and support , or no intervention . We measured the percentage of patients screened and treated after 12 months of follow-up . In the alerting group , 65 % of the patients requiring screening were screened ( relative risk versus control=1.76 ; 95 % confidence interval , 1.41 to 2.20 ) compared with 35 % of patients in the on-dem and group ( relative risk versus control=1.28 ; 95 % confidence interval , 0.98 to 1.68 ) and 25 % of patients in the control group . In the alerting group , 66 % of patients requiring treatment were treated ( relative risk versus control=1.40 ; 95 % confidence interval , 1.15 to 1.70 ) compared with 40 % of patients ( relative risk versus control=1.19 ; 95 % confidence interval , 0.94 to 1.50 ) in the on-dem and group and 36 % of patients in the control group . Conclusion — The alerting version of the clinical decision support systems significantly improved screening and treatment performance for dyslipidemia by general practitioners Background Primary care provides most of the evidence -based chronic disease prevention and screening services offered by the healthcare system . However , there remains a gap between recommended preventive services and actual practice . This trial ( the BETTER Trial ) aim ed to improve preventive care of heart disease , diabetes , colorectal , breast and cervical cancers , and relevant lifestyle factors through a practice facilitation intervention set in primary care . Methods Pragmatic two-way factorial cluster RCT with Primary Care Physicians ’ practice s as the unit of allocation and individual patients as the unit of analysis . The setting was urban Primary Care Team practice s in two Canadian provinces . Eight Primary Care Team practice s were r and omly assigned to receive the practice -level intervention or wait-list control ;  4 physicians in each team ( 32 physicians ) were r and omly assigned to receive the patient-level intervention or wait-list control .  Patients r and omly selected from physicians ’ rosters were stratified into two groups : 1 ) general and 2 ) moderate mental illness . The interventions involved a multifaceted , evidence -based , tailored practice -level intervention with a Practice Facilitator , and a patient-level intervention involving a one-hour visit with a Prevention Practitioner where patients received a tailored ‘ prevention prescription ’ . The primary outcome was a composite Summary Quality Index of 28 evidence -based chronic disease prevention and screening actions with pre-defined targets , expressed as the ratio of eligible actions at baseline that were met at follow-up . A cost-effectiveness analysis was conducted . Results 789 of 1,260 ( 63 % ) eligible patients participated . On average , patients were eligible for 8.96 ( SD 3.2 ) actions at baseline . In the adjusted analysis , control patients met 23.1 % ( 95 % CI : 19.2 % to 27.1 % ) of target actions , compared to 28.5 % ( 95 % CI : 20.9 % to 36.0 % ) receiving the practice -level intervention , 55.6 % ( 95 % CI : 49.0 % to 62.1 % ) receiving the patient-level intervention , and 58.9 % ( 95 % CI : 54.7 % to 63.1 % ) receiving both practice - and patient-level interventions ( patient-level intervention versus control , P < 0.001 ) . The benefit of the patient-level intervention was seen in both strata . The extra cost of the intervention was $ 26.43CAN ( 95 % CI : $ 16 to $ 44 ) per additional action met . Conclusions A Prevention Practitioner can improve the implementation of clinical ly important prevention and screening for chronic diseases in a cost-effective manner Background Practice facilitation has been associated with meaningful improvements in disease prevention and quality of patient care . Using practice facilitation , the Improved Delivery of Cardiovascular Care ( IDOCC ) project aim ed to improve the delivery of evidence -based cardiovascular care in primary care practice s across a large health region . Our goal was to evaluate IDOCC ’s impact on adherence to processes of care delivery . Methods A pragmatic stepped wedge cluster r and omized trial recruiting primary care providers in practice s located in Eastern Ontario , Canada ( Clinical Trials.gov : NCT00574808 ) . Participants were r and omly assigned by region to one of three steps . Practice facilitators were intended to visit practice s every 3–4 ( year 1—intensive ) or 6–12 weeks ( year 2—sustainability ) to support changes in practice behavior . The primary outcome was mean adherence to indicators of evidence -based care measured at the patient level . Adherence was assessed by chart review of a r and omly selected cohort of 66 patients per practice in each pre-intervention year , as well as in year 1 and year 2 post-intervention . Results Eighty-four practice s ( 182 physicians ) participated . On average , facilitators had 6.6 ( min : 2 , max : 11 ) face-to-face visits with practice s in year 1 and 2.5 ( min : 0 max : 10 ) visits in year 2 . We collected chart data from 5292 patients . After adjustment for patient and provider characteristics , there was a 1.9 % ( 95 % confidence interval ( CI ) : −2.9 to −0.9 % ) and 4.2 % ( 95 % CI : −5.7 to −2.6 % ) absolute decrease in mean adherence from baseline to intensive and sustainability years , respectively . Conclusions IDOCC did not improve adherence to best- practice guidelines . Our results showed a small statistically significant decrease in mean adherence of question able clinical significance . Potential reasons for this result include implementation challenges , competing priorities in practice s , a broad focus on multiple chronic disease indicators , and use of an overall index of adherence . These results contrast with findings from previously reported facilitation trials and highlight the complexities and challenges of translating research findings into clinical practice .Trial registration Clinical Trials.gov BACKGROUND Decision-support information technology is often adopted to improve clinical decision making , but it is rarely rigorously evaluated . Congress m and ated the evaluation of Problem-Knowledge Couplers ( PKC Corp , Burlington , Vt ) , a decision-support tool proposed for the Department of Defense 's new health information network . METHODS This was a patient-level r and omized trial conducted at 2 military practice s. A total of 936 patients were allocated to the intervention group  and 966 to usual care .  Couplers were applied before routine ambulatory clinic visits . The primary outcome was quality of care , which was assessed based on the total percentage of any of 24 health care quality process measures ( opportunities to provide evidence -based care ) that were fulfilled . Secondary outcomes included medical re sources consumed within 60 days of enrollment and patient and provider satisfaction . RESULTS There were 4639 health care opportunities ( 2374 in the Coupler group and 2265 in the usual-care group ) , with no difference in the proportion of opportunities fulfilled ( 33.9 % vs 30.7 % ; P = .12 ) . Although there was a modest improvement in performance on screening/preventive measures , it was offset by poorer performance on some measures of acute care . Coupler patients used more laboratory and pharmacy re sources than usual-care patients ( logarithmic mean difference , 71 dollars ) . No difference in patient satisfaction was observed between groups , and provider satisfaction was mixed . CONCLUSION This study provides no strong evidence to support the utility of this decision-support tool , but it demonstrates the value of rigorous evaluation of decision-support information technology BACKGROUND there is inadequate evidence to support currently formulated NHS strategies to achieve health promotion and preventative care in older people through broad-based screening and assessment in primary care . The most extensively evaluated delivery instrument for this purpose is Health Risk Appraisal ( HRA ) . This article describes a trial using HRA to evaluate the effect on health behaviour and preventative-care uptake in older people in NHS primary care . METHODS a r and omised controlled trial was undertaken in three London primary care group practice s. Functionally independent community-dwelling patients older than 65 years ( n = 2,503 ) received a self-administered Health Risk Appraisal for Older Persons ( HRA-O ) question naire leading to computer-generated individualised written feedback to participants and general practitioners ( GPs ) , integrated into practice information-technology ( IT ) systems . All primary care staff received training in preventative health in older people . The main outcome measures were self-reported health behaviour and preventative care uptake at 1-year follow-up . RESULTS of 2,503 individuals r and omised , 2,006 respondents ( 80.1 % ) ( intervention , n = 940 , control n = 1,066 ) were available for analysis . Intervention group respondents reported slightly higher pneumococcal vaccination uptake and equivocal improvement in physical activity levels compared with controls . No significant differences were observed for any other categories of health behaviour or preventative care measures at 1-year follow-up . CONCLUSIONS HRA-O implemented in this way result ed in minimal improvement of health behaviour or uptake of preventative care measures in older people . Supplementary reinforcement involving contact by health professionals with patients over and above routine clinical encounters may be a prerequisite to the effectiveness of IT-based delivery systems for health promotion in older people Objective To compare the effect of an invitation promoting informed choice for screening with a st and ard invitation on attendance and motivation to engage in preventive action . Design R and omised controlled trial . Setting Four English general practice s. Participants 1272 people aged 40 - 69 years , at risk for diabetes , identified from practice registers using a vali date d risk score and invited to attend for screening . Intervention Intervention was a previously vali date d invitation to inform the decision to attend screening , presenting diabetes as a serious potential problem , and providing details of possible costs and benefits 
    Output:
    