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Effective Clinical Practice

January/February 2001

ORIGINAL ARTICLES

Decision Support and the Appropriate Use of Fibrinolysis in Myocardial Infarction
John Kellett

Since 1994, a small rural hospital in Ireland has used a decision-support computer program (DSCP) aimed at improving decisions about the use of fibrinolytic therapy. This before-and-after study showed that although overall rates of fibrinolysis did not change after implementation of the DSCP, the therapy is being better directed to appropriate patients.
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Colorectal Cancer Screening in Massachusetts: Measuring Compliance with Current Guidelines
Stephen Erban, Jane Zapka, Elaine Puleo, and Maureen Vickers-Lahti

Measuring adherence to colorectal screening guidelines is complex because of multiple acceptable screening methods. This phone survey demonstrates that about one half of Massachusetts residents are screened by a variety of methods.
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Randomized Trial of Fructosamine Home Monitoring in Patients with Diabetes
Diana B. Petitti, Richard Contreras, and James Dudl

The addition of home monitoring of fructosamine (a measure of long-term glycemic control) to routine glucose monitoring did not improve glycemic control in this randomized trial. Glycemic control in both groups, however, improved substantially over the study period.
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UNANSWERED QUESTIONS: RESEARCH UNDER CONSTRUCTION

How Effective Is the Computer-Based Clinical Practice Guideline?
Ted A. Eytan and Harold I. Goldberg

The positive effect of computerized reminders at the point of care has been shown at the University of Washington. However, the path to successful implementation involves many variables, from concordance of a new guideline with established standards of care to the accessibility of the guideline within an electronic medical record.
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EDITORIALS

Computer-Based Decision Support: Wishing on a Star?
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Colorectal Cancer Screening: Keeping the Options Open
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PRIMER

Group Randomized Trials
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