***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 : A needle thoracocentesis should be performed with maximal safety and optimal efficacy in mind . Mobile video telephony ( VT ) could be used to facilitate instructions for the accurate performance of needle thoracocentesis in an emergency setting . This new communication method will increase the accuracy of identifying the relevant anatomical site during the decompression technique . Methods : A prospect i ve r and omised manikin study was performed to investigate the effectiveness of using VT as a method of instruction for the identification of anatomical l and marks during the performance of needle thoracocentesis . Results : The overall success rate was significantly higher in the VT group which performed needle thoracocentesis under the guidance of VT than in the non-VT group who performed the procedure without VT-aided instruction . The instrument difficulty score and procedure satisfaction score were significantly lower in the VT group than in the non-VT group . Conclusion : Identification of the correct anatomical l and mark for needle thoracocentesis can be performed with instructions provided via VT because a dispatcher can monitor every step and provide correct instructions . This new technology will improve critical care medicine Introduction : This r and omized controlled trial ( RCT ) investigated the effectiveness of and satisfaction with small‐group problem‐based learning ( PBL ) versus a didactic lecture approach to guideline dissemination in asthma management controlling for confounders common in comparative educational interventions . Methods : Sites were selected as either lecture or PBL using simple r and omization . All participants were exposed to similar educational re sources to ensure treatment equivalency . Instruments included st and ardized program/speaker evaluation forms and a vali date d case‐based question naire with a visual analogue scale measuring the level of confidence of responses . The latter was presented immediately pre‐ and post‐intervention and 3 months later . The statistician was blinded to intervention groups . Results : Overall , 52 family physicians agreed to participate , 23 in the PBL sessions ( mean 4.6 per group ) and 29 in the didactic lecture sessions ( mean 7.25 ) . There was no significant difference between the groups with respect to the knowledge gained at each test administration . Participants rated the lecturer or facilitator equally well as having established a positive learning environment . PBL participants rated the perceived educational value of the program higher than did lecture participants ( 4.36 vs. 3.93 ; p = .04 ) . Both groups experienced a significant increase in asthma‐related knowledge post‐intervention . Attrition rates for the 3‐month post‐test were 14 % for PBL participants versus 32 % for lecture‐based participants . Discussion : PBL was as effective in knowledge uptake and retention as lecture‐based continuing medical education ( CME ) programs . Further study is warranted to investigate whether the assessment of higher educational value or an increase in response rate to delayed testing is replicable in other RCTs addressing common confounders and if these factors influence future CME participation , changes in physician clinical behavior , or patient health outcomes OBJECTIVE : To compare the effectiveness of  training for eclampsia  in local hospitals and a regional simulation center , with and without teamwork theory . METHODS : This study is a r and omized controlled trial of training in local hospitals and in a simulation center in the United Kingdom . Midwives and obstetricians working at participating hospitals were r and omly assigned to 24 teams . Teams were r and omly allocated to training in local hospitals or at a simulation center , and to teamwork theory or not .  Performance was evaluated before and after training with a st and ardized eclampsia scenario captured on video . Outcome measures were completion of tasks , time to completion of tasks , administration of magnesium sulfate , and quality of teamwork . RESULTS : Training was associated with an increase in completion of basic tasks ; 87 % before training and 100 % afterward . Basic tasks were completed more quickly ; 55 seconds compared with 27 seconds , P=.012 . The magnesium sulfate loading dose was administered by 61 % of teams before training and by 92 % afterward ( P=.040 ) . There was a shorter median time to administration ( 116 seconds less ; P=.011 ) . Training at the simulation center was not associated with additional improvement . Teamwork generally improved ( median global score rose from 2.5 to 4.0 ; P<.001 ) but there was no additional benefit from teamwork training . CONCLUSION : Training result ed in enhanced performance with higher rates of completion for basic tasks , shorter times to administration of magnesium sulfate , and improved teamwork . There was no additional benefit from training in a simulation center , and none from teamwork theory . CLINICAL TRIAL REGISTRATION : IS RCT N , http://is rct n.org , IS RCT N67906788 , reference number 0270030 LEVEL OF EVIDENCE : Background : Simulation-based training is useful in improving physicians ' skills . However , no r and omized controlled trials have been able to demonstrate the effects of simulation teaching in real-life patient care . This study aim ed to determine whether simulation-based training or an interactive seminar result ed in better patient care during weaning from cardiopulmonary bypass (CPB)—a high stakes clinical setting . Methods : This study was conducted as a prospect i ve , single-blinded , r and omized controlled trial . After institutional research board approval , 20 anesthesiology trainees , postgraduate year 4 or higher , inexperienced in CPB weaning , and 60 patients scheduled for elective coronary artery bypass grafting were recruited . Each trainee received a teaching syllabus for CPB weaning 1 week before attempting to wean a patient from CPB ( pretest ) . One week later , each trainee received a 2-h training session with either high-fidelity simulation-based training or a 2-h interactive seminar . Each trainee then weaned patients from CPB within 2 weeks ( posttest ) and 5 weeks ( retention test ) from the intervention . Clinical performance was measured using the vali date d Anesthesiologists ' Nontechnical Skills Global Rating Scale and a checklist of expected clinical actions . Results : Pretest Global Rating Scale and checklist performances were similar . The simulation group scored significantly higher than the seminar group at both posttest ( Global Rating Scale [ mean ± st and ard error ] : 14.3 ± 0.41 vs. 11.8 ± 0.41 , P < 0.001 ; checklist : 89.9 ± 3.0 % vs. 75.4 ± 3.0 % , P = 0.003 ) and retention test ( Global Rating Scale : 14.1 ± 0.41 vs. 11.7 ± 0.41 , P < 0.001 ; checklist : 93.2 ± 2.4 % vs. 77.0 ± 2.4 % , P < 0.001 ) . Conclusion : Skills required to wean a patient from CPB can be acquired through simulation-based training . Compared with traditional interactive seminars , simulation-based training leads to improved performance in patient care by senior trainees in anesthesiology Introduction : Family physicians ( FPs ) underuse opportunities to provide smoking cessation advice during routine consultations with patients who smoke .  Distance learning is a promising approach to continuing medical education , particularly for FPs practicing in rural and remote areas . We developed a distance learning module , conducting a r and omized trial to assess its educational impact on knowledge , attitudes and skills ( “ competence ” ) , self‐rated competence , confidence , and readiness to change . Method : Volunteer FPs were r and omly allocated to receive either a distance learning module or a preventive care guideline . Self‐administered question naires were completed at baseline and post‐test . Results : Fifty‐three FPs enrolled in the study . There were no changes in knowledge or attitudes . Change in skills was limited to a reduction in use of one ineffective technique , namely “ nicotine fading . ” Change in self‐rated competence between baseline and post‐test was significantly greater for the intervention than for the control group , however ( p = .03 ) . Although self‐ratings of confidence increased significantly between baseline and post‐test in both groups , the magnitude of change was no greater in the intervention than in the control group ( p = .3 ) . Both groups demonstrated only nonsignificant shifts in readiness to change . Discussion : These modest changes are of uncertain educational value , inviting caution before recommending distance learning approaches to promote smoking cessation advice in family practice Background A cluster r and omised trial was conducted to determine the effectiveness of locally adapted practice guidelines and education about paediatric asthma management , delivered to general practitioners ( GPs ) in small group interactive workshops . Methods Twenty-nine practice s were r and omly allocated to one of three study arms . Australian asthma management guidelines were adapted to accommo date characteristics of the local area . GPs in the intervention arm ( Group 1 , n = 18 GPs ) participated in a small group based education program and were provided with the adapted guidelines .  One control arm ( Group 2 , n = 18 GPs ) received only the adapted guidelines , while the other control arm ( Group 3 , n = 15 GPs ) received an unrelated education intervention .  GPs ' knowledge , attitudes and management of paediatric asthma was assessed . Results Post intervention , intervention arm GPs were no more likely to provide a written asthma action plan , but were better able to assess the severity of asthma attack ( Group 1vs Group 2 p = 0.05 and Group 1 vs Group 3 p = 0.01 ) , better able to identify patients at high risk of severe attack ( Group 1vs Group 3 p = 0.06 ) , and tended to score higher on the asthma knowledge question naire ( Group 1 vs Group 2 p = 0.06 and Group 1 vs Group 3 p = 0.2 ) . Most intervention arm GPs felt more confident than control GPs to manage acute asthma attack and ongoing management of infrequent episodic asthma . Conclusion Using interactive small group workshops to disseminate locally adapted guidelines was associated with improvement in GP 's knowledge and confidence to manage asthma , but did not change GP 's self-reported provision of written action plans PURPOSE We investigated whether an online educational program based on spacing effect principles could significantly improve the acquisition and retention of medical knowledge . MATERIAL S AND METHODS In this r and omized , controlled trial involving urology residents in the United States and Canada participants r and omized to cohort 1 ( bolus education )  were  e-mailed  a vali date d set of 96 study questions on 4 urology topic areas in June 2005 . Residents in cohort 2 ( spaced education )  were sent daily educational e-mails during 27 weeks ( June to December 2005 ) , each of which contained 1 or 2 study questions presented in a repeating , spaced pattern . In November 2005 participants completed the Urology In-Service Examination . Participants were also r and omized to 1 of 5 outcome cohorts , which completed a 32-item online test at staggered time points ( 1 to 14 weeks ) after completion of the spaced education program . RESULTS Of 537 participants 400 ( 74 % ) completed the online staggered tests and 515 ( 96 % ) completed the In-Service Examination .  Residents in the spaced education cohort demonstrated significantly greater online test scores than those in the bolus cohort ( ANOVA p < 0.001 ) . One-way ANOVA with trend analysis revealed that online test scores for the spaced education cohort remained stable with no significant differences with time , while test scores in the bolus cohort demonstrated a significant linear decrease ( p = 0.007 ) . The specific learning gains attributable to Spaced Education were robust when controlling for use of the study material s but they did not generalize to higher scores on the In-Service Examination . CONCLUSIONS Online spaced education improves the acquisition and retention of clinical knowledge Abstract Objective To assess the educational effectiveness on learning evidence based medicine of a h and held computer clinical decision support tool compared with a pocket card containing guidelines and a control . Design R and omised controlled trial . Setting University of Hong Kong , 2001 . Participants 169 fourth year medical students . Main outcome measures Factor and individual item scores from a vali date d question naire on five key self reported measures : personal application and current use of evidence based medicine ; future use of evidence based medicine ; use of evidence during and after clerking patients ; frequency of discussing the role of evidence during teaching rounds ; and self perceived confidence in clinical decision making . Results The h and held computer improved participants ' educational experience with evidence based medicine the most , with significant improvements in all outcome scores . More modest improvements were found with the pocket card , whereas the control group showed no appreciable changes in any of the key outcomes . No significant deterioration was observed in the improvements even after withdrawal of the h and held computer during an eight week washout period , suggesting at least short term sustainability of effects . Conclusions Rapid and convenient access to valid and relevant evidence on a portable computing device can improve learning in evidence based medicine , increase current and future use of evidence , and boost students ' confidence in clinical decision making Summary Background Health workers ' malaria case-management practice s often differ from national guidelines . We assessed whether text-message reminders sent to health workers ' mobile phones could improve and maintain their adherence to treatment guidelines for outpatient paediatric malaria in Kenya . Methods From March 6 , 2009 , to May 31 , 2010 , we did a cluster-r and omised controlled trial at 107 rural health facilities in 11 districts in coastal and western Kenya . With a computer-generated sequence , health facilities were r and omly allocated to either the intervention group , in which all health workers received text messages on their personal mobile phones on malaria case-management for 6 months , or the control group , in which health workers did not receive any text messages . Health workers were not masked to the intervention , although patients were unaware of whether they were in an intervention or control facility . The primary outcome was correct management with artemether-lumefantr 
    Output:
    
Results The evidence suggests the use of multiple techniques that allow for interaction and enable learners to process and apply information .
Case-based learning , clinical simulations , practice and feedback are identified as effective educational techniques .
Didactic techniques that involve passive instruction , such as reading or lecture , have been found to have little or no impact on learning outcomes .
Repetitive interventions , rather than single interventions , were shown to be superior for learning outcomes .
Setting s similar to the workplace improved skill acquisition and performance .
Computer-based learning can be equally or more effective than live instruction and more cost efficient if effective techniques are used .
Effective techniques can lead to improvements in knowledge and skill outcomes and clinical practice behaviours , but there is less evidence directly linking CPE to improved clinical outcomes .
Conclusions Educational techniques are critical to learning outcomes .
Targeted , repetitive interventions can result in better learning outcomes .
CPE can lead to improved learning outcomes if effective techniques are used .
Limited data indicate that there may also be an effect on improving clinical practice behaviours .