***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: OBJECTIVES Despite studies that show improvements in both st and ards of care and outcomes with the judicious application of clinical practice guidelines ( CPGs ) , their clinical utilization remains low . This r and omized controlled trial examined the use of a wirelessly networked mobile computer ( MC ) by physicians at the bedside with access to an emergency department information system , decision support tools ( DSTs ) , and other software options . METHODS Each of ten volunteer emergency physicians was r and omized using a matched-pair design to work five shifts in st and ard fashion ( desktop computer [ DC ] access ) and five shifts with a wirelessly networked MC . Work pattern issues and electronic CPG/DST use were compared using end-of-shift satisfaction question naires and review of a CPG/DST data base . Repeated- measures analysis of variance was used to examine between-shift differences . RESULTS A total of 100 eight-hour shifts were evaluated ; 99 % compliance with postshift question naires was achieved . Using a seven-point Likert scale ( MC values first ) , MCs were rated as being as fast ( 5.04 vs. 4.54 ; p=0.13 ) and convenient ( 5.08 vs. 4.14 ; p=0.07 ) as DCs . Overall , physicians rated MCs to be less efficient ( 3.18 vs. 4.30 ; p=0.02 ) but encouraged more frequent use of DSTs ( 4.10 vs. 3.47 ; p=0.03 ) without impacting doctor-patient communication ( 2.78 vs. 2.96 ; p=0.51 ) . During the study period , physician use of an intranet Web application ( eCPG ) was more frequent during shifts assigned to the MC when compared with the DC ( eCPG uses/shift , 3.6 vs. 2.0 ; p=0.033 ) . CONCLUSIONS The MC technology permitted physicians to access information at the bedside and increased the use of CPG/DST tools . According to physicians , patients appeared to accept their use of information technology to assist in decision making . Development of improved computer technology may address the major limitation of MC portability OBJECTIVE : To determine the effectiveness of a quality improvement program to improve pediatricians ' adherence to existing , evidence -based , attention-deficit/hyperactivity disorder ( ADHD ) practice guidelines . METHODS : Forty-nine community-based pediatricians at 8 practice s participated in a cluster-r and omized trial . Practice s were matched according to the numbers of pediatricians and the proportions of patients receiving Medicaid . The medical charts for a r and om sample of patients with ADHD for each of the participating pediatricians were examined at baseline and 6 months . All practice s participated in 4 sessions of training , including didactic lectures and office flow modification workshops . Practice s were then given access to an ADHD Internet portal that allowed parents , teachers , and pediatricians to input information ( eg , rating scales ) about patients , after which information was scored , interpreted , and formatted in a report style that was helpful for assessment and treatment of patients with ADHD . Physicians evaluated their practice behaviors quarterly and addressed underperforming areas . RESULTS : Pediatricians in the intervention group , compared with those in the control group , demonstrated significantly higher rates of many American Academy of Pediatrics – recommended ADHD care practice s , including collection of parent ( Cohen 's d = 0.69 ) and teacher ( d = 0.68 ) rating scales for assessment of children with ADHD , use of Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , criteria ( d = 0.85 ) , and use of teacher rating scales to monitor treatment responses ( d = 1.01 ) . CONCLUSION : A quality improvement intervention that can be widely disseminated by using Internet-based information technology significantly improved the quality of ADHD care in community-based pediatric setting Background Research to assess the effect of interventions to improve the processes of shared decision making and self-management directed at health care professionals is limited . Using the protocol of Intervention Mapping , a Web-based intervention directed at health care professionals was developed to complement and optimize health services in patient-centered care . Objective The objective of the Web-based intervention was to increase health care professionals ’ intention and encouraging behavior toward patient self-management , following cardiovascular risk management guidelines . Methods A r and omized controlled trial was used to assess the effect of a theory-based intervention , using a pre-test and post-test design . The intervention website consisted of a module to help improve professionals ’ behavior , a module to increase patients ’ intention and risk-reduction behavior toward cardiovascular risk , and a parallel module with a support system for the health care professionals . Health care professionals ( n=69 ) were recruited online and r and omly allocated to the  intervention group ( n=26 ) or ( waiting list ) control group ( n=43 ) , and invited their patients to participate . The outcome was improved professional behavior toward health education , and was self-assessed through question naires based on the Theory of Planned Behavior . Social-cognitive determinants , intention and behavior were measured pre-intervention and at 1-year follow-up . Results The module to improve professionals ’ behavior was used by 45 % ( 19/42 ) of the health care professionals in the intervention group . The module to support the health professional in encouraging behavior toward patients was used by 48 % ( 20/42 ) . The module to improve patients ’ risk-reduction behavior was provided to 44 % ( 24/54 ) of patients . In 1 of every 5 patients , the guideline for cardiovascular risk management was used . The Web-based intervention was poorly used . In the intervention group , no differences in social-cognitive determinants , intention and behavior were found for health care professionals , compared with the control group . We narrowed the intervention group and no significant differences were found in intention and behavior , except for barriers . Results showed a significant overall difference in barriers between the intervention and the control group ( F 1=4.128 , P=.02 ) . Conclusions The intervention was used by less than half of the participants and did not improve health care professionals ’ and patients ’ cardiovascular risk-reduction behavior . The website was not used intensively because of time and organizational constraints . Professionals in the intervention group experienced higher levels of barriers to encouraging patients , than professionals in the control group . No improvements were detected in the processes of shared decision making and patient self-management . Although participant education level was relatively high and the intervention was pre-tested , it is possible that the way the information was presented could be the reason for low participation and high dropout . Further research embedded in professionals ’ regular consultations with patients is required with specific emphasis on the processes of dissemination and implementation of innovations in patient-centered care . Trial Registration Netherl and s Trial Register Number ( NTR ) : NTR2584 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=2584 ( Archived by WebCite at http://www.webcitation.org/6STirC66r ) CONTEXT Despite evidence that a variety of continuing medical education ( CME ) techniques can foster physician behavioral change , there have been no r and omized trials comparing performance outcomes for physicians participating in Internet-based CME with physicians participating in a live CME intervention  using approaches documented to be effective . OBJECTIVE To determine if Internet-based CME can produce changes comparable to those produced via live , small-group , interactive CME with respect to physician knowledge and behaviors that have an impact on patient care . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial conducted from August 2001 to July 2002 . Participants were 97 primary care physicians drawn from 21 practice sites in Houston , Tex , including 7 community health centers and 14 private group practice s. A control group of 18 physicians from these same sites received no intervention .  INTERVENTIONS Physicians were r and omly assigned to an Internet-based CME intervention that could be completed in multiple sessions over 2 weeks , or to a single live , small-group , interactive CME workshop . Both incorporated similar multifaceted instructional approaches demonstrated to be effective in live setting s. Content was based on the National Institutes of Health National Cholesterol Education Program -- Adult Treatment Panel III guidelines . MAIN OUTCOME MEASURES Knowledge was assessed immediately before the intervention , immediately after the intervention , and 12 weeks later . The percentage of high-risk patients who had appropriate lipid panel screening and pharmacotherapeutic treatment according to guidelines was documented with chart audits conducted over a 5-month period before intervention and a 5-month period after intervention . RESULTS Both interventions produced similar and significant immediate and 12-week knowledge gains , representing large increases in percentage of items correct ( pretest to posttest : 31.0 % [ 95 % confidence interval { CI } , 27.0%-35.0 % ] ; pretest to 12 weeks : 36.4 % [ 95 % CI , 32.2%-40.6 % ] ; P<.001 for all comparisons ) . Chart audits revealed high baseline screening rates in all study groups ( > or = 93 % ) with no significant postintervention change . However , the Internet-based intervention was associated with a significant increase in the percentage of high-risk patients treated with pharmacotherapeutics according to guidelines ( preintervention , 85.3 % ; postintervention , 90.3 % ; P = .04 ) . CONCLUSIONS Appropriately design ed , evidence -based online CME can produce objective ly measured changes in behavior as well as sustained gains in knowledge that are comparable or superior to those realized from effective live activities The purpose of this r and omized , controlled , home care intervention was to test the effectiveness of two nurse-targeted , e-mail-based interventions to increase home care nurses ' adherence to pain assessment and management guidelines , and to improve patient outcomes . Nurses from a large urban non-profit home care organization were assigned to usual care or one of two interventions upon identification of an eligible cancer patient with pain . The basic intervention consisted of a patient-specific , one-time e-mail reminder highlighting six pain-specific clinical recommendations . The augmented intervention supplemented the initial e-mail reminder with provider prompts , patient education material , and clinical nurse specialist outreach .  Over 300 nurses were r and omized and outcomes of 673 of their patients were review ed . Data collection involved clinical record abstract ion of nurse care practice s and patient interviews completed approximately 45 days after start of care . The intervention had limited effect on nurse-documented care practice s but patient outcomes were positively influenced . Patients in the augmented group improved significantly over the control group in ratings of pain intensity at its worst , whereas patients in the basic group had better ratings of pain intensity on average . Other outcomes measures were also positively influenced but did not reach statistical significance . Our findings suggest that although reminders have some role in improving cancer pain management , a more intensive approach is needed for a generalized nursing workforce with limited recent exposure to state-of-the-art pain management practice OBJECTIVE To investigate the effectiveness of an Inpatient Diabetes Management Program ( IDMP ) on physician knowledge and inpatient glycemic control . METHODS Residents assigned to General Internal Medicine inpatient services were r and omized to receive the IDMP ( IDMP group ) or usual education only ( non-IDMP group ) . Both groups received an overview of inpatient diabetes management in conjunction with reminders of existing order sets on the hospital Web site . The IDMP group received print copies of the program and access to an electronic version for a personal digital assistant ( PDA ) . A Diabetes Knowledge Test ( DKT ) was administered at baseline and at the end of the 1-month rotation . The frequency of hyperglycemia among patients under surveillance by each group was compared by using capillary blood glucose values and a dispersion index of glycemic variability . IDMP users completed a question naire related to the program . RESULTS Twenty-two residents participated ( 11 in the IDMP group and 11 in the non-IDMP group ) .  Overall Diabetes Knowledge Test scores improved in both groups ( IDMP : 69 % ± 1.7 % versus 83 % ± 2.1 % , P = .003 ; non-IDMP : 76 % ± 1.2 % versus 84 % ± 1.4 % , P = .02 ) . The percentage of correct responses for management of corticosteroid-associated hyperglycemia ( P = .004 ) and preoperative glycemic management ( P = .006 ) improved in only the IDMP group . The frequency of hyperglycemia ( blood glucose level > 180 mg/dL ) and the dispersion index ( 5.3 ± 7.6 versus 3.7 ± 5.6 ; P = .2 ) were similar between the 2 groups . CONCLUSION An IDMP was effective at improving physician knowledge for managing hyperglycemia in hospitalized patients treated with corticosteroids or in preparation for surgical procedures . Educational programs directed at improving overall health care provider knowledge for inpatient glycemic management may be beneficial ; however , improvements in knowledge do not necessarily result in improved glycemic outcomes Background Clinical practice guidelines are important for transmitting research findings into practice and facilitating the application of evidence -based practice ( EBP ) . There is a paucity of knowledge about the impact of guideline implementation strategies in primary care physical therapy . The aim of this study was to evaluate the effect of a guideline implementation intervention in primary care physical therapy in western Sweden . Methods An implementation strategy based on theory and current evidence was developed . A tailored , multi-component implementation intervention , addressing earlier identified determinants , was carried out in three areas comprising 28 physical therapy practice s including 277 physical therapists ( PTs ) ( intervention group ) . In two adjacent areas , 171 PTs at 32 practice s received no intervention ( control group ) . The core component of the intervention was an implementation seminar with group discussion s. Among other components were a website and email rem 
    Output:
    
Results Website studies demonstrated significant improvements in perceived usefulness and perceived ease of use , but not for knowledge , reducing barriers , and intention to use clinical practice guidelines .
Computer software studies demonstrated significant improvements in perceived usefulness , but not for knowledge and skills .
Web-based workshop and email studies demonstrated significant improvements in knowledge , perceived usefulness , and skills .
An electronic educational game intervention demonstrated a significant improvement from baseline in knowledge after 12 and 24 weeks .
Computerized decision support system studies demonstrated variable findings for improvement in skills .
Multifaceted interventions demonstrated significant improvements in beliefs about capabilities , perceived usefulness , and intention to use clinical practice guidelines , but variable findings for improvements in skills .
Most multifaceted studies demonstrated significant improvements in knowledge .
Conclusions The findings suggest that health professionals ’ perceived usability and practice behavior change vary by type of information and communication technology .
Heterogeneity and the paucity of properly conducted studies did not allow for a clear comparison between studies and a conclusion on the effectiveness of information and communication technologies as a knowledge translation strategy for the dissemination of clinical practice guidelines