***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: CONTEXT Data are sparse on the effect of varying the duration s of  internal medicine attending physician ward rotations .  OBJECTIVE To compare the effects of 2- vs 4-week inpatient attending physician rotations on unplanned patient revisits , attending evaluations by trainees , and attending propensity for burnout . DESIGN , SETTING , AND PARTICIPANTS Cluster r and omized crossover noninferiority trial , with attending physicians as the unit of crossover r and omization and 4-week rotations  as the active control , conducted in a US university-affiliated teaching hospital in academic year 2009 . Participants were 62 attending physicians who staffed at least 6 weeks of inpatient service , the 8892 unique patients whom they discharged , and the 147 house staff and 229 medical students who evaluated their performance . INTERVENTION Assignment to r and om sequences of 2- and 4-week rotations . MAIN OUTCOME MEASURES Primary outcome was 30-day unplanned revisits ( visits to the hospital 's emergency department or urgent ambulatory clinic , unplanned readmissions , and direct transfers from neighboring hospitals ) for patients discharged from 2- vs 4-week within-attending-physician rotations .  Noninferiority margin was a 2 % increase ( odds ratio [ OR ] of 1.13 ) in 30-day unplanned patient revisits . Secondary outcomes were length of stay ; trainee evaluations of attending physicians ; and attending physician reports of burnout , stress , and workplace control . RESULTS Among the 8892 patients , there were 2437 unplanned revisits . The percentage of 30-day unplanned revisits for patients of attending physicians on 2-week rotations was 21.2 % compared with 21.5 % for 4-week rotations ( mean difference , -0.3 % ; 95 % CI , -1.8 % to + 1.2 % ) . The adjusted OR of a patient having a 30-day unplanned revisit after 2- vs 4-week rotations was 0.97 ( 1-sided 97.5 % upper confidence limit , 1.07 ; noninferiority P = .007 ) . Average length of stay was not significantly different ( geometric means for 2- vs 4-week rotations were 67.2 vs 67.5 hours ; difference , -0.9 % ; 95 % CI , -4.7 % to + 2.9 % ) . Attending physicians were more likely to score lower in their ability to evaluate trainees after 2- vs 4-week rotations by both house staff ( 41 % vs 28 % rated less than perfect ; adjusted OR , 2.10 ; 95 % CI , 1.50 - 3.02 ) and medical students ( 82 % vs 69 % rated less than perfect ; adjusted OR , 1.41 ; 95 % CI , 1.06 - 2.10 ) . They were less likely to report higher scores of both burnout severity ( 16 % vs 35 % ; adjusted OR , 0.39 ; 95 % CI , 0.26 - 0.58 ) and emotional exhaustion ( 19 % vs 37 % ; adjusted OR , 0.45 ; 95 % CI , 0.31 to 0.64 ) after 2- vs 4-week rotations . CONCLUSIONS The use of 2-week inpatient attending physician rotations compared with 4-week rotations did not result in an increase in unplanned patient revisits . It was associated with better self-rated measures of attending physician burnout and emotional exhaustion but worse evaluations by trainees . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00930111 Background : Shorter resident duty periods are increasingly m and ated to improve patient safety and physician well-being . However , increases in continuity-related errors may counteract the purported benefits of reducing fatigue . We evaluated the effects of  3 resident schedules in the intensive care unit ( ICU ) on patient safety , resident well-being and continuity of care . Methods : Residents in 2 university-affiliated ICUs were r and omly assigned ( in 2-month rotation-blocks from January to June 2009 ) to in-house overnight schedules of 24 , 16 or 12 hours . The primary patient outcome was adverse events . The primary resident outcome was sleepiness , measured by the 7-point Stanford Sleepiness Scale . Secondary outcomes were patient deaths , preventable adverse events , and residents ’ physical symptoms and burnout . Continuity of care and perceptions of ICU staff were also assessed . Results : We evaluated 47 ( 96 % ) of 49 residents , all 971 admissions , 5894 patient-days and 452 staff surveys . We found no effect of schedule ( 24- , 16- or 12-h shifts ) on adverse events ( 81.3 , 76.3 and 78.2 events per 1000 patient-days , respectively ; p = 0.7 ) or on residents ’ sleepiness in the daytime ( mean rating 2.33 , 2.61 and 2.30 , respectively ; p = 0.3 ) or at night ( mean rating 3.06 , 2.73 and 2.42 , respectively ; p = 0.2 ) . Seven of 8 preventable adverse events occurred with the 12-hour schedule ( p = 0.1 ) . Mortality rates were similar for the 3 schedules . Residents ’ somatic symptoms were more severe and more frequent with the 24-hour schedule ( p = 0.04 ) ; however , burnout was similar across the groups . ICU staff rated residents ’ knowledge and decision-making worst with the 16-hour schedule . Interpretation : Our findings do not support the purported advantages of shorter duty schedules . They also highlight the trade-offs between residents ’ symptoms and multiple secondary measures of patient safety . Further delineation of this emerging signal is required before widespread system change . Trial registration : Clinical Trials.gov , no. NCT00679809 PURPOSE The increasing use of electronic medical records during the clinical encounter brings not only benefits but also barriers that may affect the doctor-patient relationship and increase the work burden of the physician . We evaluated whether the use of an electronic medical record scribe in an academic urology program would ameliorate these problems . MATERIAL S AND METHODS We r and omly assigned electronic medical record scribes to the office hours of 5 academic urologists , and using surveys we evaluated patient and physician acceptance and satisfaction . RESULTS Patients were accepting of an electronic medical record scribe  and satisfaction rates were high ( 93 % vs 87 % in the absence of a scribe , p = 0.36 ) . Patients were comfortable disclosing urological information in the presence of the scribe . Physicians were dramatically more satisfied with office hours when a scribe was present ( 69 % vs 19 % , p < 0.001 ) . We were unable to determine whether the presence of a scribe improves productivity . CONCLUSIONS Electronic medical record scribes in a urology practice may be a practical solution to provide documentation while maintaining or improving the doctor-patient relationship because they increase physician satisfaction and do not detract from patient satisfaction OBJECTIVE . To mitigate the risks of fatigue-related medical errors , the Accreditation Council for Graduate Medical Education introduced work hour limits for resident physicians in 2003 . Our goal was to determine whether work hours , sleep , and safety changed after implementation of the Accreditation Council for Graduate Medical Education st and ards . METHODS . We conducted a prospect i ve cohort study in which residents from 3 large pediatric training programs provided daily reports of work hours and sleep . In addition , they completed reports of near-miss and actual motor vehicle crashes , occupational exposures , self-reported medical errors , and ratings of educational experience . They were screened for depression and burnout . Concurrently , at 2 of the centers , data on medication errors were collected prospect ively by using an established active surveillance method . RESULTS . A total of 220 residents provided 6007 daily reports of their work hours and sleep , and 16 158 medication orders were review ed . Although scheduling changes were made in each program to accommo date the st and ards , 24- to 30-hour shifts remained common , and the frequency of residents ’ call remained largely unchanged . There was no change in residents ’ measured total work hours or sleep hours . There was no change in the overall rate of medication errors , and there was a borderline increase in the rate of resident physician ordering errors , from 1.06 to 1.38 errors per 100 patient-days . Rates of motor vehicle crashes , occupational exposures , depression , and self-reported medical errors and overall ratings of work and educational experiences did not change . The mean length of extended- duration ( on-call ) shifts decreased 2.7 % to 28.5 hours , and rates of resident burnout decreased significantly ( from 75.4 % to 57.0 % ) . CONCLUSIONS . Total hours of work and sleep did not change after implementation of the duty hour st and ards . Although fewer residents were burned out , rates of medication errors , resident depression , and resident injuries and educational ratings did not improve RATIONALE Around-the-clock intensivist presence in intensive care units ( ICUs ) has been promoted as necessary to optimize outcomes . Little data have addressed how it affects the multiple stakeholders in such care . OBJECTIVES To assess effects of around-the-clock intensivist presence on intensivists , patients , families , housestaff , and nurses . METHODS This 32-week , crossover pilot trial of two intensivist staffing models , performed in two Canadian ICUs , alternated 8-week blocks of two staffing models : the st and ard model , where one intensivist worked for 7 days , taking night call from home ; and the shift work model , where one intensivist worked 7 day shifts , while other intensivists remained in the ICU at night . MEASUREMENTS AND MAIN RESULTS Surveys scaled from 0 - 100 points assessed outcomes for 24 intensivists ( primary outcome : burnout ) ; 119 families ( satisfaction ) ; 74 nurses  ( satisfaction with collaboration and communications , role conflict ) ; and 34 housestaff ( autonomy , supervision , and learning opportunities ) . Outcomes for 501 patients included mortality , length of stay , and re source use . Intensivists doing shift work experienced less burnout ( -6.9 points ; P = 0.04 ) . Adjusted hospital mortality ( odds ratio , 1.22 ; P = 0.44 ) , ICU length of stay ( -6 h ; P = 0.46 ) , and family satisfaction ( 0.9 points ; P = 0.79 ) did not differ between staffing models . Under shift work staffing , nurses reported more role conflict ( 9 points ; P < 0.001 ) , whereas nighttime housestaff reported less autonomy , more supervision , but no difference in learning opportunities . CONCLUSIONS Shiftwork staffing was better for intensivists and most were receptive once they had experienced it . Although there were no evident negative outcomes for patients or families , further evaluation is needed to clarify how around-the-clock intensivist staffing influences the various stakeholders in ICU care , given power considerations in this study . Clinical trial registered with www . clinical trials.gov ( NCT 01146691 ) Background Use of electronic health records ( EHRs ) is associated with physician stress and burnout . While emergency departments and subspecialists have used scribes to address this issue , little is known about the impact of scribes in academic primary care . Objective Assess the impact of a scribe on  physician and patient satisfaction at an academic general internal medicine ( GIM ) clinic . Design Prospect i ve , pre-post-pilot study . During the 3-month pilot , physicians had clinic sessions with and without a scribe . We assessed changes in ( 1 ) physician workplace satisfaction and burnout , ( 2 ) time spent on EHR documentation , and ( 3 ) patient satisfaction . Participants Six GIM faculty and a convenience sample of their patients ( N = 325 ) at an academic GIM clinic . Main Measures A 21-item pre- and 44-item post-pilot survey assessed physician workplace satisfaction and burnout . Physicians used logs to record time spent on EHR documentation outside of clinic hours . A 27-item post-visit survey assessed patient satisfaction during visits with and without the scribe . Key Results Of six physicians , 100 % were satisfied with clinic workflow post-pilot ( vs. 33 % pre-pilot ) , and 83 % were satisfied with EHR use post-pilot ( vs. 17 % pre-pilot ) . Physician burnout was low at baseline and did not change post-pilot . Mean time spent on post-clinic EHR documentation decreased from 1.65 to 0.76 h per clinic session ( p = 0.02 ) . Patient satisfaction was not different between patients who had clinic visits with vs. without scribe overall or by age , gender , and race . Compared to patients 65 years or older , younger patients were more likely to report that the physician was more attentive and provided more education during visits with the scribe present ( p = 0.03 and 0.02 , respectively ) . Male patients were more likely to report that they disliked having a scribe ( p = 0.03 ) . Conclusion In an academic GIM setting , employment of a scribe was associated with improved physician satisfaction without compromising patient satisfaction PURPOSE Comprehensiveness is lauded as 1 of the 5 core virtues of primary care , but its relationship with outcomes is unclear . We measured associations between variations in comprehensiveness of practice among family physicians and healthcare utilization and costs 
    Output:
    
The largest benefits result ed from interventions that improved processes , promoted team-based care , and incorporated the use of scribes/medical assistants to complete EHR documentation and tasks .
Implementation of EHR interventions to improve clinical workflows worsened burnout , but EHR improvements had positive effects .
Time interventions had mixed effects on burnout .
The results of our study suggest that organization-directed workplace interventions that improve processes , optimize EHRs , reduce clerical burden by the use of scribes , and implement team-based care can lessen physician burnout .
Benefits of process changes can enhance physician resiliency , augment care provided by the team , and optimize the coordination and communication of patient care and health information