***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 The evaluation of more than one intervention in the same r and omised controlled trial can be achieved using a parallel group design . However this requires increased sample size and can be inefficient , especially if there is also interest in considering combinations of the interventions . An alternative may be a factorial trial , where for two interventions participants are allocated to receive neither intervention , one or the other , or both . Factorial trials require special considerations , however , particularly at the design and analysis stages . Discussion Using a 2 × 2 factorial trial as an example , we present a number of issues that should be considered when planning a factorial trial . The main design issue is that of sample size . Factorial trials are most often powered to detect the main effects of interventions , since adequate power to detect plausible interactions requires greatly increased sample sizes . The main analytical issues relate to the investigation of main effects and the interaction between the interventions in appropriate regression models . Presentation of results should reflect the analytical strategy with an emphasis on the principal research questions . We also give an example of how baseline and follow-up data should be presented . Lastly , we discuss the implication s of the design , analytical and presentational issues covered . Summary Difficulties in interpreting the results of factorial trials if an influential interaction is observed is the cost of the potential for efficient , simultaneous consideration of two or more interventions . Factorial trials can in principle be design ed to have adequate power to detect realistic interactions , and in any case they are the only design that allows such effects to be investigated Abstract Objectives : To determine how medical students apply research evidence that varies in validity of methods and importance of results to a clinical decision . Design : Students examined a st and ardised patient with a whiplash injury , decided whether to order a cervical spine radiograph , and rated their confidence in their decision . They then read one of four r and omly assigned variants of a structured abstract from a study of a decision rule that argued against such a procedure in this patient . Variants factorially combined two levels of validity of methods ( prospect i ve cohort or chart review ) with two levels of importance of results ( high sensitivity or high specificity rule ) . After reading the abstract , students repeated their choice and rated their confidence . Setting : Academic medical centre in the United States . Participants : 164 graduating medical students . Main outcome measures : Proportion of students in each group whose beliefs shifted or stayed the same . Results : When abstract s were of low importance students were more likely to shift their beliefs in favour of radiography  , which was not supported by the evidence ( odds ratio 3.42 , 95 % confidence interval 1.10 to 10.66 ) . Neither method ological validity nor the interaction between validity and importance influenced decision shift . Few students acquired all necessary clinical data from the patient . Conclusions : Although the students could apply concepts of diagnostic testing , greater focus is needed on appraisal of validity and application of evidence to a particular patient . What is already known on this topic Evidence based medicine is increasingly emphasised and taught in medical schools Few studies have assessed the ability of physicians to apply literature findings to clinical decisions What this paper adds In making decisions about ordering investigations during a st and ardised patient exam students were sensitive to the importance of results This effect was not moderated by validity of the study that produced the results or whether the students had collected enough information to apply the OBJECTIVES To evaluate a new format of a summary , which presents research from synthesized evidence to patients and the public . STUDY DESIGN AND SETTING We conducted a r and omized controlled trial in 143 members of the public from five countries ( Canada , Norway , Spain , Argentina , and Italy ) . Participants received either a new summary format ( a plain language summary [ PLS ] ) or the current format used in Cochrane systematic review s. The new PLS presents information about the condition and intervention , a narrative summary of results , and a table of results with absolute numbers for effects of the intervention and quality of the evidence using Grading of Recommendations Assessment , Development , and Evaluation . RESULTS With the new PLS , more participants understood the benefits and harms and quality of evidence ( 53 % vs. 18 % , P < 0.001 ) ; more answered each of the five questions correctly ( P ≤ 0.001 for four questions ) ; and they answered more questions correctly , median 3 ( interquartile range [ IQR ] : 1 - 4 ) vs. 1 ( IQR : 0 - 1 ) , P < 0.001 ) . Better underst and ing was independent of education level . More participants found information in the new PLS reliable , easy to find , easy to underst and , and presented in a way that helped make decisions . Overall , participants preferred the new PLS . CONCLUSION This new PLS format for patients and the public is a promising tool to translate evidence from synthesized research OBJECTIVE To measure the effects of a summary -of- findings ( SoF ) table on user satisfaction , underst and ing , and time spent finding key results in a Cochrane review . STUDY DESIGN AND SETTING We r and omized participants in an evidence -based practice workshop ( r and omized controlled trial [ RCT ] I ) and a Cochrane Collaboration entities meeting ( RCT II ) to receive a Cochrane review with or without an SoF table .  In RCT I , we measured user satisfaction . In RCT II , we measured correct comprehension and time spent finding key results . RESULTS RCT I : Participants with the SoF table ( n=47 ) were more likely to " agree " or " strongly agree " that it was easy to find results for important outcomes than ( n=25 ) participants without the SoF table-68 % vs. 40 % ( P=0.021 ) . RCT II : Participants with the SoF table ( n=18 ) were more likely to correctly answer two questions regarding results than ( n=15 ) those without the SoF table : 93 % vs. 44 % ( P=0.003 ) and 87 % vs. 11 % ( P<0.001 ) . Participants with the SoF table spent an average of 90 seconds to find key information compared with 4 minutes for participants without the SoF table ( P=0.002 ) . CONCLUSION In two small trials , we found that inclusion of an SoF table in a review improved underst and ing and rapid retrieval of key findings compared with review s with no SoF table Objective . To develop and obtain feedback about a summary format for Cochrane review s that is accessible to a consumer audience , without oversimplification or incorrect presentation . Methods . We developed 3 versions of a Plain Language Summary ( PLS ) format of a Cochrane Systematic Review .  Using a semi-structured interview guide we tested these versions among 34 members of the public in Norway , Argentina , Canada , and Australia . The authors analyzed feedback , identified problems , and generated new solutions before retesting to produce a final version of a Plain Language Summary format . Results . Participants preferred results presented as words , supplemented by numbers in a table . There was a lack of underst and ing regarding the difference between a review and an individual study , that the effect is rarely an exact number , that evidence can be of low or high quality , and that level of quality is a separate issue from intervention effect . Participants also found it difficult to move between presentations of dichotomous and continuous outcomes . Rephrasing the introduction helped participants grasp the concept of a review . Confidence intervals were largely ignored or misunderstood . Our attempts to explain them were only partially successful . Text modifiers ( ‘ ‘ probably , ’ ’ ‘ ‘ may ’ ’ ) to convey different levels of quality were only partially understood , whereas symbols with explanations were more helpful . Participants often understood individual information elements about effect size and quality of these results , but did not always actively merge these elements . Conclusion . Through testing and iteration the authors identified and addressed several problems , using explanations , rephrasing , and symbols to present scientific concepts . Other problems remain , including how best to present confidence intervals and continuous outcomes . Future research should also test information elements in combination rather than in isolation . The new Plain Language Summary format is being evaluated in a r and omized controlled trial 
    Output:
    
Prior knowledge and belief predicted student response to the clear finding review , while years of midwifery education predicted response to the uncertain finding review .
Conclusions Abstract s with and without conclusions generated similar student responses .
PLS with conclusions gave similar results to abstract s with and without conclusions .
Removing the conclusions from a PLS with uncertain findings led to more problems with interpretation