***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: AIMS AND OBJECTIVES To detect problems when classifying pressure ulcers and to examine whether an e-learning program is able to increase the classification skills of qualified nurses and nursing students . BACKGROUND Both the distinction between pressure ulcer grade s and the differentiation between moisture lesions is difficult . Misclassification and incorrect identification of the lesions results in inadequate preventive and therapeutic measures . Education and training are important for spreading evidence -based insights about this topic . DESIGN Repeated measure design , consisting of one pretest and three posttests . METHODS The experimental intervention consisted of a one-hour session during which the participants independently went over an e-learning program . The control intervention consisted of a one-hour lecture . Both interventions had the same learning contents . A convenience sample of 212 qualified nurses and 214 final-year nursing students was r and omly assigned to an experimental- and a control group . RESULTS In the pretest , the classification skills were low . After the intervention , these skills improved significantly in both groups . The nursing students achieved better results when using the e-learning program . Among the qualified nurses , there was no difference between the learning methods . Although the classification skills decreased in the posttests , they did not drop under the level of the pretest . CONCLUSION The actual classification system does not provide the necessary information about the severity of a pressure ulcer . The differential diagnosis between a moisture lesion was complicated . The classification skills of the qualified nurses and nursing students increased by both learning methods . Repetition remains , however , necessary . RELEVANCE TO CLINICAL PRACTICE Both instruction methods are adequate to acquire the knowledge about the differences between moisture lesions and pressure ulcers .  E-learning allows study ing in one 's own time and place , and could therefore be very suitable for repetition of the training . How to organise this training could be a subject for further research OBJECTIVE Nurses need to be competent and confident in performing drug calculations to ensure patient safety . The purpose of this study is to compare an interactive e-drug calculations package , developed using Cognitive Load Theory as its theoretical framework , with traditional h and out learning support on nursing students ' drug calculation ability , self-efficacy and support material satisfaction . DESIGN A cluster r and omised controlled trial comparing the e-package with traditional h and out learning support was conducted with a September cohort ( n=137 ) and a February cohort ( n=92 ) of second year diploma nursing students . Students from each cohort were geographically dispersed over 3 or 4 independent sites . MEASUREMENTS Students from each cohort were invited to participate , halfway through their second year , before and after a 12 week clinical practice placement . During their placement the intervention group received the e-drug calculations package while the control group received traditional ' h and out ' support material .  Drug calculation ability and self-efficacy tests were given to the participants pre- and post-intervention . Participants were given the support material satisfaction scale post-intervention . RESULTS Students in both cohorts r and omised to e-learning were more able to perform drug calculations than those receiving the h and out ( September : mean 48.4 % versus 34.7 % , p=0.027 ; February : mean 47.6 % versus 38.3 % , p=0.024 ) . February cohort students using the e-package were more confident in performing drug calculations than those students using h and outs ( self-efficacy mean 56.7 % versus 45.8 % , p=0.022 ) . There was no difference in improved self-efficacy between intervention and control for students in the September cohort . Students who used the package were more satisfied with its use than the students who used the h and out ( mean 29.6 versus 26.5 , p=0.001 ) , particularly with regard to the package enhancing their learning ( p=0.023 ) , being an effective way to learn ( p=0.005 ) , providing practice and feedback ( p<0.001 ) , being accessible ( p=0.027 ) , user friendly ( p=0.02 ) and providing learning enjoyment ( p=0.022 ) . CONCLUSION It is essential that nurses are educated and supported to become , and remain , confident and competent in performing drug calculations . This study found the e-drug calculations package , based on Cognitive Load Theory , to be significantly more effective than a h and out in improving students ' drug calculation ability and self-efficacy , with students who used the package being significantly more satisfied with its use than students who used the h and out . This package could particularly be useful for the continuing professional development of any healthcare professional involved in drug calculations Oral healthcare providers have a clinical opportunity for early detection of disordered eating behaviors because they are often the first health professionals to observe overt oral and physical signs . Curricula regarding early recognition of this oral/systemic medical condition are limited in oral health educational programs . Web-based learning can supplement and reinforce traditional learning and has the potential to develop skills . The study purpose was to determine the efficacy of a theory-driven Web-based training program to increase the capacity of oral health students to perform behaviors related to the secondary prevention of disordered eating behaviors . Using the Reach , Effectiveness , Adoption , Implementation and Maintenance evaluation framework , a longitudinal group-r and omized controlled trial involving 27 oral health classes from 12 oral health education programs in the United States was implemented to assess the efficacy of the Web-based training on attitudes , knowledge , self-efficacy and skills related to the secondary prevention of disordered eating behaviors . Mixed-model analysis of covariance indicated substantial improvements among students in the intervention group ( effect sizes : 0.51 - 0.83 ) on all six outcomes of interest . Results suggest that the Web-based training program may increase the capacity of oral healthcare providers to deliver secondary prevention of disordered eating behaviors . Implication s and value of using the Reach , Effectiveness , Adoption , Implementation and Maintenance framework are discussed The objective of this study was to evaluate the effectiveness of e-learning as a supplement to on-campus education for the acquisition of skills in palpation and ultrasound examination of the knee in a physiotherapy degree course . Forty-six students ( 28 females ) from the University of Granada , with a mean age of 21.5 yrs , received 4 h of theoretical and practical on-campus training on palpation and ultrasound examination of the knee joint . They were then r and omly distributed into two groups : experimental , with free access to the ECOFISIO website on musculoskeletal palpation and ultrasound assessment ; and control , with access to documents and books on the topic . Structured objective clinical evaluation  ( SOCE ) and multiple-choice question naire ( MCQ ) were used to assess the educational intervention . We also measured the time taken by the students to generate a reliable ultrasound image and to localize a specific knee structure by palpation . There was no significant intergroup difference in the acquisition of theoretical knowledge as assessed by the MCQ ( p = 0.39 ) . Scores were significantly higher in the experimental group than in the control group for skills in palpation ability ( p = 0.041 ) and ultrasound assessment ( p < 0.001 ) of the knee . Students in the e-learning group needed less time to palpate the musculoskeletal structure ( p = 0.041 ) but more time ( p = 0.012 ) to obtain their superior ultrasound images . In conclusion , these results contribute evidence that e-learning is an effective educational strategy for physiotherapy students to acquire skills in palpation and ultrasound imaging of the knee as a supplement to on-campus education The purpose of the study was to assess the effectiveness of supplementing traditional classroom teaching with Web-based learning design when teaching intramuscular injection nursing skills . Four clusters of nursing students at a junior college in eastern Taiwan were r and omly assigned to experimental and control groups . A total of 147 students ( 80 in the experimental group , 67 in the control group ) completed the study . All participants received the same classroom lectures and skill demonstration . The experimental group interacted using a Web-based course and were able to view the content on dem and . The students and instructor interacted via a chatroom , the bulletin board , and e-mail . Participants in the experimental group had significantly higher scores on both intramuscular injection knowledge and skill learning . A Web-based design can be an effective supplementing learning tool for teaching nursing knowledge and skills Purpose Computer-based methods of instruction offer the possibility of helping medical students to learn clinical skills and professionalism . Without rigorous documentation of its pedagogic advantages , the utility of Internet-based teaching is not solidly grounded . The authors carried out a prospect i ve , r and omized study of educational outcomes , comparing a traditional classroom course in clinical ethics with the same course supplemented by Internet-based discussion . Methods Introduction to Clinical Ethics is a sophomore medical school course that teaches a specific method for analyzing clinical ethical problems . One sophomore class was r and omly assigned to either classroom teaching alone ( traditional group ; n = 65 ) or classroom teaching supplemented with Internet-based discussion s of cases illustrating ethical issues  ( Internet component group ; n = 62 ) . A final case analysis comprehensively evaluated students ' underst and ing of the analytic method taught in the course . Grade s for both groups on the final case analyses , which were rated by two external review ers , were compared . Results The students ' underst and ing of ethical analysis , as measured by grade s of external review ers on the final paper , was significantly higher for those in the course with the Internet component than it was for those in the traditional course ( 3.0 ± 0.6 and 2.6 ± 0.7 , respectively ; p < .005 ) . Conclusion The study documents the incremental value of Internet-based teaching of clinical ethics to sophomore medical students Background Electronic Voting Systems have been used for education in a variety of disciplines . Outcomes from these studies have been mixed . Because results from these studies have been mixed , we examined whether an EVS system could enhance a lecture 's effect on educational outcomes . Methods A cohort of 127 Year 5 medical students at the University of Adelaide was stratified by gender , residency status and academic record then r and omised into 2 groups of 64 and 63 students . Each group received consecutive 40-minute lectures on two clinical topics . One group received the EVS for both topics . The other group received traditional teaching only . Evaluation was undertaken with two , 15- question multiple-choice question naires ( MCQ ) assessing knowledge and problem solving and undertaken as a written paper immediately before and after the lectures and repeated online 8–12 weeks later . St and ardised institutional student question naires were completed for each lecture and independent observers assessed student behaviour during the lectures . Lecturer 's opinions were assessed by a question naire developed for this study . Results Two-thirds of students r and omised to EVS and 59 % of students r and omised to traditional lectures attended . One-half of the students in the EVS group and 41 % in the traditional group completed all question naires . There was no difference in MCQ scores between EVS and traditional lectures ( p = 0.785 ) . The cervical cancer lectures showed higher student ranking in favour of EVS in all parameters . The breast cancer lectures showed higher ranking in favour of traditional lectures in 5 of 7 parameters ( p < 0.001 ) . The observed higher-order lecturer-students interactions were increased in the EVS lecture for one lecturer and reduced for the other . Both lecturers felt that the EVS lectures were difficult to prepare , that they were able to keep to time in the traditional lectures , that the educational value of both lecture styles was similar , and that they were neutral-to-slightly favourably disposed to continue with the EVS technology . The 2 lecturers disagreed regarding the ease of preparation of the traditional lecture , their ability to keep to time in the EVS lecture , and personal satisfaction with the EVS lecture . The lecturers felt that EVS encouraged student participation and helped identify where students were having difficulty . Conclusion In this setting , EVS technology used in large group lectures did not offer significant advantages over the more traditional lecture format OBJECTIVE The purpose of this study is to compare whether students '  learning outcomes would be better in a design ed learning environment ( WebCT ) than in a conventional web site ( WWW ) with similar course material but without special learning tools . CONTEXT Third-year medical students in an introductory course on medical informatics at the University of Helsinki , Finl and . METHODS Students were r and omly assigned to a WebCT group ( n=39 ) and a WWW group ( n=46 ) . The students in the WebCT group utilized the course material in general discussion groups , special discussion s about lectures , quizzes and students ' own notes . The WWW group had access only to the course material . The learning outcome was assessed by administering an on-line examination and the learning experience of the students was assessed by an on-line quiz . RESULTS The course grade was significantly higher in the WebCT group as compared to the WWW group . This finding was more prominent among females . The students of the WebCT group also experienced significantly more improvement in collaboration with the use of computers than the students in the WWW group . CONCLUSIONS Based on our results , web-based learning seems to be more effective when students are provided with specially design ed learning tools OBJECTIVES To compare the effectiveness of small-group training in correct inhaler technique with self-directed Internet-based training . DESIGN Pharmacy students were r and omly allocated to 1 of 2 groups : small-group training ( n = 123 ) or self-directed Internet-based training ( n = 113 ) . Prior to intervention delivery , all participants were given a placebo Turbuhaler and product information leaflet and received inhaler technique training based on their group .  Technique was assessed following training and predictors of correct inhaler technique were examined . ASSESSMENT There was a significant improvement in the number of participants demonstrating correct technique in both groups ( small group training , 12 % to 63 % ; p < 0.05 ; and Internet-based training , 9 % to 59 % ; p < 0.05 ) post intervention , with no significant difference between the groups in the percent change ( n = 23 
    Output:
    
The current evidence base suggests that online eLearning is equivalent , possibly superior to traditional learning .