***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: Subtle behavioral characteristics are examined to explain the reluctance of physicians to promote r and  omized controlled trials  and their willingness to accept therapeutic hypotheses that have not been adequately tested . These deterrents to instituting controlled trials include reverence for authority , reverence for tradition , a compulsion to treat , reluctance to surrender authority , fear , and the influence of uncontrolled pilot trials . Another behavioral pitfall is the tendency to be influenced by the quantity of data without regard to quality OBJECTIVE To help people who give health information to the public develop the skills they need to make sense of evidence about effectiveness . DESIGN Educational approach , preceded by careful planning with representatives of possible participants . SETTING AND STUDY OF PARTICIPANTS : Staff in consumer health information services and members of maternity self-help groups in the UK in summer 1995 . INTERVENTIONS Pairs of half-day workshops introducing participants to r and omised controlled trials and systematic review s and to their critical appraisal . The workshops were run participatively and had at their centre a critical appraisal session in small groups . MAIN OUTCOME MEASURES Attendance at workshops , satisfaction and enjoyment of workshops ; comments at a follow-on event . RESULTS Four pairs of workshops were held ( three for consumer health information services , one for maternity self-help groups ) , 54 people attended a pair of workshops and a further 34 attended individual workshops . The workshops were enjoyed and found to be a good use of time . CONCLUSIONS It is feasible to introduce critical appraisal skills to people whose primary role is to give health information to the public . There is a need for comparative evaluation of different approaches Abstract Objectives : To determine the attitude of general practitioners towards  evidence based medicine  and their related educational needs . Design : A question naire study of general practitioners . Setting : General practice in the former Wessex region , Engl and . Subjects : R and omly selected sample of 25 % of all general practitioners ( 452 ) , of whom 302 replied . Main outcome measures : Respondents ' attitude towards evidence based medicine , ability to access and interpret evidence , perceived barriers to practising evidence based medicine  , and best method of moving from  opinion  based to evidence based medicine . Results : Respondents mainly welcomed evidence based medicine and agreed that its practice improves patient care . They had a low level of awareness of extracting journals , review publications , and data bases ( only 40 % knew of the Cochrane Data base of Systematic Review s ) , and , even if aware , many did not use them . In their surgeries 20 % had access to bibliographic data bases and 17 % to the world wide web . Most had some underst and ing of the technical terms used . The major perceived barrier to practising evidence based medicine was lack of personal time . Respondents thought the most appropriate way to move towards evidence based general practice was by using evidence based guidelines or proposals developed by colleagues . Conclusion : Promoting and improving access to summaries of evidence , rather than teaching all general practitioners literature search ing and critical appraisal , would be the more appropriate method of encouraging evidence based general practice . General practitioners who are skilled in accessing and interpreting evidence should be encouraged to develop local evidence based guidelines and advice . Key messages Despite considerable variation in 302 general practitioners ' attitudes to the promotion of evidence based medicine , most were welcoming and agreed that it improved patient care There was a low level of awareness of extracting journals , review publications , and data bases relevant to evidence based medicine , and the major perceived barrier to its practice was lack of personal time In their surgery only 20 % of general practitioners had access to Medline or other bibliographic data bases and 17 % had access to the world wide web Most had some underst and ing of the technical terms used in evidence based medicine , but less than a third felt able to explain to others the meaning of these terms Respondents thought that the best way to move from opinion based practice towards evidence based medicine was by using evidence based guidelines or protocol s developed by OBJECTIVE --To assess the differences among surgeons in postoperative complications , postoperative mortality , and survival in patients undergoing surgery for colorectal cancer . DESIGN -- Prospect i ve study of patients with colorectal cancer managed by one of 13 consultant surgeons , none of whom had a special interest in colorectal surgery . SETTING --Royal Infirmary , Glasgow . PATIENTS --645 sequential patients with colorectal cancer presenting over the six years from 1974 to 1979 . MAIN OUTCOME MEASURES --Postoperative complications , postoperative mortality ( within 30 days ) , and survival ( up to 10 years ) ; predictive factors for postoperative mortality and survival ; and relative hazard rate ratios for individual surgeons . RESULTS --The proportion of patients undergoing apparently curative resection  varied among surgeons from 40 % to 76 % ; overall postoperative mortality varied from 8 % to 30 % . After curative resection  postoperative mortality varied from 0 % to 20 % , local recurrence from 0 % to 21 % , and the rate of anastomotic leak from 0 % to 25 % . Survival at 10 years in patients who underwent curative resection varied from 20 % to 63 % , two year survival in those who underwent palliative resection varied from 7 % to 32 % , and median survival in those who underwent palliative diversion varied from one to eight months . The hazard rate ratios among individual surgeons , taking into account the identified risk factors , varied from 0.56 to 2.03 , from 0.17 to 1.92 , and from 0.57 to 1.50 for curative resection , palliative resection , and palliative diversion , respectively . CONCLUSION --There were significant variations in patient outcome among surgeons after surgery for colorectal cancer ; such differences compromise survival . A considerable improvement in overall survival might be achieved if such surgery were undertaken by surgeons with a special interest in colorectal surgery or surgical oncology PURPOSE : Although the r and omized , controlled trial has gained preeminence as the criterion st and ard for evaluating pharmaceutical treatments , r and omized controlled trials in surgery have been perceived as difficult to surmount . Furthermore , attitudes of surgeons toward r and omized , controlled trials are not well understood . We determined the views of Australian surgeons about feasibility of and barriers to surgical r and omized trials . METHODS : All members of the Section of Colon and Rectal Surgery of the Royal Australasian College of Surgeons ( n=147 ) and all Australian colorectal subspecialist surgeons ( n=72 ) were mailed a question naire that included questions about surgical r and omized , controlled trials . RESULTS : A total of 195 surgeons responded ( 89 percent ) . Two-thirds ( 66.7 percent ; 95 percent confidence interval 59.5–73.1 ) of respondents agreed that “ R and omized controlled trials should be the study design of choice ” to evaluate new surgical procedures . Only 19 percent ( 95 percent confidence interval 13.9–25.3 ) endorsed the statement that “ too much emphasis is placed on results of r and omized controlled trials . ” Barriers to conducting surgical r and omized , controlled trials identified by the majority included insufficient funding ( 74.4 percent ; 95 percent confidence interval 67.5–80.2 ) , a lack of support from the wider surgical community ( 55.9 percent ; 95 percent confidence interval 48.6–62.9 ) , and difficulties in convincing patients to accept r and om allocation to treatment ( 62.6 percent ; 95 percent confidence interval 55.3–69.3 ) . CONCLUSION : These results reveal positive attitudes among Australian surgeons toward r and omized , controlled trials , although concerns about the feasibility of r and omized , controlled trials have been reinforced BACKGROUND We report a prospect i ve r and omised comparison between laparoscopic and small-incision cholecystectomy in 200 patients which was design ed to eliminate bias for or against either technique . METHODS Patients were r and omised in the operating theatre and anaesthetic technique and pain-control methods were st and ardised . Four experienced surgeons did both types of procedure . Identical wound dressings were applied in both groups so that carers could be kept blind to the type of operation . FINDINGS There was no significant difference between the groups for age , sex , body mass index , and American Society of Anaesthesiologists grade . Laparoscopic cholecystectomy took significantly longer than small-incision cholecystectomy ( median 65 [ range 27 - 140 ] min vs 40 [ 18 - 142 ] min , p<0.001 ) . The operating time included operative cholangiography which was attempted in all patients . We found no significant difference between the groups for hospital stay ( postoperative nights in hospital , median 3 - 0 [ 1 - 17 ] nights for laparoscopic vs 3 - 0 [ 1 - 14 ] nights for small-incision , p=0.74 ) , time back to work for employed persons ( median 5 - 0 weeks vs 4.0 weeks ; p=0.39 ) , and time to full activity ( median 3 - 0 weeks vs 3.0 weeks ; p=0.15 ) . INTERPRETATION Laparoscopic cholecystectomy takes longer to do than small-incision cholecystectomy and does not have any significant advantages in terms of hospital stay or postoperative recovery Abstract Objectives : To estimate the proportion of interventions in general practice that are based on evidence from clinical trials and to assess the appropriateness of such an evaluation . Design : Retrospective review of case notes . Setting : One suburban training general practice . Subjects : 122 consecutive doctor-patient consultations over two days . Main outcome measures : Proportions of interventions based on r and omised controlled trials  ( from literature search with Medline , pharmaceutical data bases , and st and ard textbooks ) , on  convincing non-experimental evidence , and without substantial evidence . Results : 21 of the 122 consultations recorded were excluded due to insufficient data ; 31 of the interventions were based on r and omised controlled trial evidence and 51 based on convincing non-experimental evidence . Hence 82/101 ( 81 % ) of interventions were based on evidence meeting our criteria . Conclusions : Most interventions within general practice are based on evidence from clinical trials , but the methods used in such trials may not be the most appropriate to apply to this setting . Key messages Key messages 81 % of general practice can be described as evidence based using this method of assessment Evidence derived from different method ologies may be important for the assessment of the evidence base of general We considered using a r and omized trial to assess the value of laparoscopic cholecystectomy in the treatment of symptomatic gallstones . The pros and cons for the timing of such a trial were in favour of not beginning the trial until surgeons learned to use the new procedure safely and effectively , and until key endpoints and outcome indices could be identified and assessed using valid measures . Instead an observational study was implemented to monitor the learning curve of surgeons as they mastered the laparoscopic equipment and procedures , and to assess the responses of the patients to the procedure . In the first 100 patients , the procedure proved to be as safe and feasible to use as conventional surgery , and there were strong benefits in terms of quicker recovery of the patients with less pain , discomfort , and a reduced length of hospital stay . The responses of the surgeons and the patients to the new procedure now place ethical constraints on the planning of a r and omized controlled trial . Currently , comprehensive surveillance and monitoring of laparoscopic cholecystectomy is the only realistic method with which to assess the impact of this new technology in our clinic OBJECTIVES To determine the proportion of paediatric  surgical interventions that are evidence -based and to identify areas where r and omised controlled trials ( RCTs ) or further research are required . DESIGN Prospect i ve review of paediatric general surgical in patients . SETTING A regional paediatric surgical unit . SUBJECTS All consecutive paediatric general surgical patients admitted in November , 1995 . MAIN OUTCOME MEASURES Each patient on whom a diagnosis had been made was allocated a primary diagnosis and primary intervention ( n=281 ) . On the basis of expert knowledge , Plusnet Medline , and ISI Science Citation data base search es , each intervention was categorised according to the level of supporting evidence : category 1 , intervention based on RCT evidence ; category 2 , intervention with convincing non-experimental evidence such that an RCT would be unethical and unjustified ; category 3 , intervention without substantial supportive evidence . RESULTS Of 281 patient interventions , 31 ( 11 % ) were based on controlled trials and 185 ( 66 % ) on convincing non-experimental evidence . Only 23 % of interventions were category 3 . CONCLUSIONS In common with other medical specialties , the majority of paediatric surgical interventions are based on sound evidence . However , only 11 % of interventions are based on RCT data , perhaps reflecting the nature of surgical practice . Further RCTs or research is indicated in a proportion of category 3 interventions BACKGROUND The objective of this study was , first to determine what proportion of clinical treatment evaluation questions involving surgical operations could be answered by a r and omized controlled trial ( RCT ) . Second , for those questions not amenable to a RCT , to determine the problems that potentially preclude the initiation of RCT in an ideal clinical research setting . METHODS A sample of treatment evaluation questions involving a surgical procedure  was obtained by a computerized search of the surgical literature . Problems precluding a RCT were defined . Their face validity and interobserver and intraobserver reliability were assessed . By use of these criteria , the sample questions were evaluated to determine whether a RCT 
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We think that the principles of EBM can be applied to make the inevitable process of rationing fair and reproducible .
Conclusions : We believe that most critics consider EBM to be a potentially dangerous tool , because they fear it will be used against themselves .
Thus , these conflicts only prove that EBM as a methodology may have a strong impact on solving them .