***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 Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results Objectives : To compare implication s of using the logistic EuroSCORE and a locally derived model when analysing individual surgeon mortality outcomes . Design : Retrospective analysis of prospect ively collected data . Setting : All NHS hospitals undertaking adult cardiac surgery in northwest Engl and . Patients : 14 637 consecutive patients , April 2002 to March 2005 . Main outcome measures : We have compared the predictive ability of the logistic EuroSCORE ( uncalibrated ) , the logistic EuroSCORE calibrated for contemporary performance and a locally derived logistic regression model . We have used each to create risk-adjusted individual surgeon mortality funnel plots to demonstrate high mortality outcomes . Results : There were 458 ( 3.1 % ) deaths . The expected mortality and receiver operating characteristic ( ROC ) curve values were : uncalibrated EuroSCORE −5.8 % and 0.80 , calibrated EuroSCORE −3.1 % and 0.80 , locally derived model −3.1 % and 0.82 . The uncalibrated EuroSCORE plot showed one surgeon to have mortality above the northwest average , and no surgeon above the 95 % control limit ( CL ) . The calibrated EuroSCORE plot and the local model showed little change in surgeon ranking , but significant differences in identifying high mortality outcomes . Two of three surgeons above the 95 % CL using the calibrated EuroSCORE revert to acceptable outcomes when the local model is applied but the finding is critically dependent on the calibration coefficient . Conclusions : The uncalibrated EuroSCORE significantly overpredicted mortality and is not recommended . Instead , the EuroSCORE should be calibrated for contemporary performance . The differences demonstrated in defining high mortality outcomes when using a model built for purpose suggests that the choice of risk model is important when analysing surgeon mortality outcomes Background Consumers are increasingly exposed to comparative healthcare information ( information about the quality of different healthcare providers ) . Partly because of its complexity , the use of this information has been limited . The objective of this study was to examine how the amount of presented information influences the comprehension and use of  comparative healthcare information when important consumer characteristics and skills are taken into account . Methods In this r and omized controlled experiment , comparative information on total hip or knee surgery was used as a test case . An online survey was distributed among 800 members of the NIVEL Insurants Panel and 76 hip- or knee surgery patients . Participants were assigned to one of four subgroups , who were shown 3 , 7 , 11 or 15 quality aspects of three hospitals .  We conducted Kruskall-Wallis tests , Chi-square tests and hierarchical multiple linear regression analyses to examine relationships between the amount of information and consumer characteristics and skills ( literacy , numeracy , active choice behaviour ) on one h and , and outcome measures related to effectively using information ( comprehension , perceived usefulness of information , hospital choice , ease of making a choice ) on the other h and . Results 414 people ( 47 % ) participated . Regression analysis showed that the amount of information slightly influenced the comprehension and the perceived usefulness of comparative healthcare information . It did not affect consumers ’ hospital choice and ease of making this choice . Consumer characteristics ( especially age ) and skills ( especially literacy ) were the most important factors affecting the comprehension of information and the ease of making a hospital choice . For the perceived usefulness of comparative information , active choice behaviour was the most influencing factor . Conclusion The effects of the amount of information were not unambiguous . It remains unclear what the ideal amount of quality information to be presented would be . Reducing the amount of information will probably not automatically result in more effective use of comparative healthcare information by consumers . More important , consumer characteristics and skills appeared to be more influential factors contributing to information comprehension and use . Consequently , we would suggest that more emphasis on improving consumers ’ skills is needed to enhance the use of comparative healthcare information BACKGROUND Reports on the comparative performance of physicians are becoming increasingly common . Little is known , however , about the credibility of these reports with target audiences or their influence on the delivery of medical services . METHODS Since 1992 , Pennsylvania has published the Consumer Guide to Coronary Artery Bypass Graft Surgery  , which lists annual risk-adjusted mortality rates for all hospitals and surgeons providing such surgery in the state . In 1995 , we surveyed a r and omly selected sample of 50 percent of Pennsylvania cardiologists and cardiac surgeons to find out whether they were aware of the guide and , if so , to determine their views on its usefulness , limitations , and influence on providers . RESULTS Eighty-two percent of the cardiologists and all the cardiac surgeons were aware of the guide . Only 10 percent of these respondents reported that its mortality rates were " very important " in assessing the performance of a cardiothoracic surgeon . Less than 10 percent reported discussing the guide with more than 10 percent of their patients who were c and i date s for a coronary-artery bypass graft ( CABG ) . Eighty-seven percent of the cardiologists reported that the guide had a minimal influence or none on their referral recommendations . For both groups , the most important limitations of the guide were the absence of indicators of quality other than mortality ( cited by 78 percent ) , inadequate risk adjustment ( 79 percent ) , and the unreliability of data provided by hospitals and surgeons ( 53 percent ) . Fifty-nine percent of the cardiologists reported increased difficulty in finding surgeons willing to perform CABG surgery  in severely ill patients who required it , and 63 percent of the cardiac surgeons reported that they were less willing to operate on such patients . CONCLUSIONS The Consumer Guide to Coronary Artery Bypass Graft Surgery has limited credibility among cardiovascular specialists . It has little influence on referral recommendations and may introduce a barrier to care for severely ill patients . If publicly released performance reports are intended to guide the choice of providers without impeding access to medical care , a collaborative process involving physicians may enhance the credibility and usefulness of the reports Objectives : To study changes in coronary artery surgery practice in the years spanning publication of cardiac surgery mortality data in the UK . Methods : A retrospective analysis of prospect ively collected data from all National Health Service centres undertaking adult cardiac surgery in northwest Engl and was carried out . Patients undergoing coronary artery surgery for the first time between April 1997 and March 2005 were included . Changes in observed , predicted and risk adjusted mortality ( EuroSCORE ) were studied . Evidence of risk-averse behaviour was looked for by examining the number of patients at low risk ( EuroSCORE 0–5 ) , high risk ( 6–10 ) , and very high risk ( 11 or more ) , before and after public disclosure . Results : 25 730 patients underwent coronary artery surgery during the study period . The observed mortality decreased from 2.4 % in 1997–8 to 1.8 % in 2004–5 ( p = 0.014 ) . The expected mortality ( EuroSCORE ) increased from 3.0 to 3.5 ( p<0.001 ) . The observed to expected mortality ratio decreased from 0.8 to 0.51 ( p<0.05 ) . The total number and percentage of patients who were at low risk , high risk and very high risk was 2694 ( 84.6 % ) , 449 ( 14.1 % ) and 41 ( 1.3 % ) before and 2654 ( 81.7 % ) , 547 ( 16.8 % ) and 47 ( 1.4 % ) after public disclosure , respectively , demonstrating a significant increase in the number and proportion of high risk patients undergoing surgery ( p<0.001 ) . Conclusions : Publication of cardiac surgery mortality data in the UK has been associated with decreased risk adjusted mortality on retrospective analysis of a large patient data base . There is no evidence that fewer high risk patients are undergoing surgery because mortality rates are published 
    Output:
    
There was anecdotal evidence of quality improvement measures adopted by low-rated hospitals in New York .
Most studies reported only on the effectiveness of public reporting , rather than addressing how effects accrue .
There is some evidence that public reporting can be an incentive for low performing surgeons to improve quality .
Negative incentive on patient selection as suggested in the USA have not yet been observed in the UK