You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
An educational intervention to improve data recording in the management of ischaemic heart disease in primary care.
Abstract 1:
BACKGROUND Gaps in computerized medical records and a lack of a systematic approach to data recording make progress towards achieving quality st and ards in primary care difficult to demonstrate . The aim of this study was to examine the effect of an educational intervention on data quality in primary care . METHODS A before- and -after study of key data quality measures was carried out in 87 general practice s in eight primary care organizations in Engl and in phase 1 and 84 general practice s in phase 2 . The subjects were 19,470 patients with ischaemic heart disease in phase 1 and 19,784 patients in phase 2 . The main outcome measures were improvement in the completeness and quality of the computerized medical record . Anonymized data were extracted from clinical information systems and processed to produce comparative information on each practice . Data quality workshops were arranged , in which reflection can take place , backed up by summary statistics . Practice visits provided training and personalized feedback of patients needing intervention . RESULTS In the patients with heart disease , nearly 16,000 new clinical entries were made in the key improvement areas . The percentage of patients advised to quit smoking increased by 49.3 per cent , from 23.6 per cent to 61.9 per cent . There were also significant improvements in many other aspects of management . CONCLUSION Focused interventions that provide targeted and relevant clinical information can be implemented in primary care . Such interventions can lead to a rise in data quality in primary care , but their effectiveness needs to be further tested in more rigorous research setting s such as r and omized controlled trials


Title 2:
Improving general practitioner clinical records with a quality assurance minimal intervention.
Abstract 2:
BACKGROUND Although good medical records have been associated with good care , there is considerable room for their improvement in general practice . AIM To improve the quality of general practice medical records at minimal cost . METHOD A total of 150 r and omly sample d general practitioners ( GPs ) in suburban Brisbane , Australia , were r and omized in a controlled trial to receive or not receive an intervention . The intervention consisted of 6 to 12 one-hour monthly meetings when the pairs of GPs assessed sample s of each other 's medical records using a 12-item instrument . This was developed previously by a process of consensus of general practice teachers . Mean scores of 10 medical records selected at r and om from before the intervention started and one year later were compared . RESULTS After the intervention , the increase in the total score ( for which the maximum possible was 18 ) for the intervention GPs ( from a baseline of 11.5 to 12.3 ) was not significantly greater than for the controls ( from 11.4 to 11.7 ) . Legibility and being able to determine the doctor 's assessment of the consultation were significantly improved . The post-intervention increase of 1.06 ( 9.3 % ) of the total scores of the 47 % of intervention GPs who complied with the intervention was significantly greater than that for the controls . CONCLUSION The quality assurance activity improved some components of the quality of GPs ' clinical records . However , the improvement was small , and the search for activities for Australian GPs that demonstrate an improvement in the quality of their practice must continue


Title 3:
Identification of randomized controlled trials in systematic reviews: accuracy and reliability of screening records.
Abstract 3:
A study was conducted to estimate the accuracy and reliability of  review ers when screening records for relevant trials for a systematic review . A sensitive search of ten electronic bibliographic data bases yielded 22 571 records of potentially relevant trials . Records were allocated to four review ers such that two review ers examined each record and so that identification of trials by each review er could be compared with those identified by each of the other review ers . Agreement between review ers was assessed using Cohen 's kappa statistic . Ascertainment intersection methods were used to estimate the likely number of trials missed by review ers . Full copies of reports were obtained and assessed independently by two research ers for eligibility for the review . Eligible reports formed the ' gold st and ard ' against which an assessment was made about the accuracy of screening by review ers . After screening , 301 of 22 571 records were identified by at least one review er as potentially relevant . Agreement was ' almost perfect ' ( kappa>0.8 ) within two pairs , ' substantial ' ( kappa>0.6 ) within three pairs and ' moderate ' ( kappa>0.4 ) within one pair . Of the 301 records selected , 273 complete reports were available . When pairs of review ers agreed on the potential relevance of records , 81 per cent were eligible ( range 69 to 91 per cent ) . If review ers disagreed , 22 per cent were eligible ( range 12 to 45 per cent ) . Single review ers missed on average 8 per cent of eligible reports ( range 0 to 24 per cent ) , whereas pairs of review ers did not miss any ( range 0 to 1 per cent ) . The use of two review ers to screen records increased the number of r and omized trials identified by an average of 9 per cent ( range 0 to 32 per cent ) . Review ers can reliably identify potentially relevant records when screening thous and s of records for eligibility . Two review ers should screen records for eligibility , whenever possible , in order to maximize ascertainment of relevant trials


Title 4:
Research Paper: Data Quality of General Practice Electronic Health Records: The Impact of a Program of Assessments, Feedback, and Training
Abstract 4:
OBJECTIVE The aim of this study was to investigate the impact of a program of repeated assessment s , feedback , and training on the quality of coded clinical data in general practice . DESIGN A prospect i ve uncontrolled intervention study was conducted in a general practice research network . MEASUREMENTS Percentage of  recorded consultations  with a coded problem title and percentage of patients receiving a specific drug ( e.g. , tamoxifen ) who had the relevant morbidity code ( e.g. , breast cancer ) were calculated . Annual period prevalence of 12 selected morbidities was compared with parallel data derived from the fourth National Study of Morbidity Statistics from General Practice ( MSGP4 ) . RESULTS The first two measures showed variation between practice s at baseline , but on repeat assessment s all practice s improved or maintained their levels of coding . The period prevalence figures also were variable , but over time rates increased to levels comparable with , or above , MSGP4 rates . Practice s were able to provide time and re sources for feedback and training sessions . CONCLUSION A program of repeated assessment s , feedback , and training appears to improve data quality in a range of practice s. The program is likely to be generalizable to other practice s but needs a trained support team to implement it that has implication s for cost and re sources


Title 5:
General practitioner records on computer--handle with care.
Abstract 5:
This 1 year prospect i ve study involved nine general practitioners in an urban health centre who routinely record all patient contacts on computer .  The study determines by comparison with a manual record how accurately doctors record laboratory investigations on computer and compares the effectiveness of three interventions in improving the completeness of computerized recording of presenting symptoms , problems/diagnoses and laboratory investigations . Recording was analysed for 1 month prior to and for two 1 month periods following each intervention . A control group was used . A total of 7983 patient contacts were analysed . Intervention led to an improvement in the recording of presenting symptoms and problems/diagnoses . Recording of investigations on the computer  showed no improvement , remaining at one-third of the total in the treatment room book for both study and control doctors . The effectiveness of the different forms of intervention depended on both the aspect of the consultation considered and the familiarity of individual doctors with the method of data collection . Aspects considered less important required greater intervention to bring about a marked improvement , as did doctors relatively new to the practice . It may not be possible to get all aspects of the consultation recorded with the same degree of accuracy . This has implication s for the accuracy of retrospective studies dependent on existing computerized data


Title 6:
[Recording of drug prescriptions in medical records. How to improve the quality?].
Abstract 6:
OBJECTIVE To describe the evaluation of a program to improve the recording of drug prescribing in medical records . DESIGN Experimental study with before and after measurements , without a control group , of the medical files of all patients who consulted during 2 different weeks , 9 months apart . SETTING Family Medicine Unit of Centre hospitalier de l'Université Laval . PARTICIPANTS Teachers and residents in the Family Medicine Unit . MAIN OUTCOME MEASURE Proportion of prescriptions for drugs having a systemic effect ( n = 206 for week before , n = 257 for week after ) for which the following information was recorded : concentration , dosage , quantity prescribed or length of treatment , number of renewals . RESULTS After the program , recording frequency increased from 86 % to 97 % for concentration , 80 % to 95 % for dosage , 52 % to 79 % for the quantity prescribed , and 20 % to 71 % for number of renewals . Both groups of doctors showed a notable improvement , except for the recording of quantity prescribed by residents , which remained stable . CONCLUSION We observed an improvement in the recording of drug prescriptions in medical files . The program had a greater effect on teachers who had been exposed to activities that are known to be effective in improving recording
Attempts at data quality improvement often involve some sort of individualized feedback , and nearly all attempts seem to have some positive effect .
We still lack empirical knowledge as to how improvement can be brought about