***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: Data from the Dialysis Outcomes and Practice Patterns Study ( DOPPS ) allow estimation of the percentage of patients outside published hemodialysis guidelines and their associated mortality risk . We estimated the number of life years that could be gained from adherence to four of these guidelines and two other modifiable practice s , i.e. dialysis dose , phosphate control , improved anemia , partial correction of serum albumin , reduced interdialytic weight gain and less use of catheters for vascular access . We extrapolated DOPPS data on these practice s and guidelines to the US hemodialysis population for a 5-year projected period . Of the practice s we examined , the highest relative risk of mortality was associated with having albumin < 3.5 g/dl ( relative risk = 1.38 , p < 0.0001 ) ; 20.5 % of the patients in the study fell outside the target range . The adjusted sum of the patient years attributable to all six practice patterns was 143,617 ; a more conservative estimate , modeling life years potentially gained by bringing half of all patients outside targets within them , is 69,367 . The magnitude of potential savings in life years should encourage greater adherence to guidelines and practice s that are significantly associated with better survival PURPOSE . To examine the associations between ( 1 ) the economic indicators of hospital costs , charges , and length of stay ( LOS ) for inpatient cases and ( 2 ) the use of MEDLINE search es for such cases . METHOD . An outcome -based , objective , prospect i ve study with an economic evaluation was conducted from September 1989 to September 1990 at three metropolitan Detroit teaching hospitals representing both allopathic and osteopathic care . The study consisted of ( 1 ) 192 test cases , derived from a consecutive sample of in patients of all ages for whom MEDLINE search es were requested at the participating medical libraries , and ( 2 ) 10,409 control cases , which were of the same diagnosis-related groups ( DRGs ) as the test cases but did not involve identified MEDLINE search es .  Statistical analysis included the use of multivariate analyses of variance and correlation coefficients . Comparisons of cases were made on case-by-case and DRG bases regarding total patient costs , charges , and lengths of stay for cases with or without MEDLINE search es . RESULTS . The test cases were found to have a higher severity of illness . Among test cases , statistically significant relationships existed between ( 1 ) hospital expenses and LOS and ( 2 ) hospital expenses and the timing of the search during hospitalization when controlling for LOS . When cases were matched for DRG and LOS , the cases with early search es ( i.e. , conducted during the first half of hospitalization ) had significantly lower expenses . CONCLUSION . Of the test-case patients ( for whom MEDLINE search es were conducted during hospitalization ) , those whose search es were conducted earlier had statistically significantly lower costs , charges , and lengths of stay than those whose search es were conducted later Cardiovascular disease ( CVD ) is a major cause of morbidity and mortality among patients with chronic renal insufficiency ( CRI ) .  beta-Adrenergic blockers , acetylsalicylic acid ( ASA ) , angiotensin-converting enzyme ( ACE ) inhibitors , and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors ( statins ) all reduce CVD mortality , but little is known about the extent to which these medications are used in patients with CRI . This study , a prospect i ve cross-sectional study of consecutive patients seen by nephrologists in four Canadian centers for follow-up of progressive CRI in 1999 , was performed to investigate the prevalence of coronary risk factors and use of cardioprotective medications among patients with CRI . Patients had creatinine clearances of 75 mL/min or less but were not on dialysis therapy . Three hundred four consecutive patients meeting the inclusion criteria were enrolled . Mean age was 60.8 + /- 15.7 years , mean creatinine clearance was 30.3 + /- 18 mL/min , and the case mix of kidney diseases was similar to that in the Canadian Organ Replacement Registry data . One hundred seventeen of 304 patients ( 38.5 % ) had a history of previous CVD , and the prevalence of CVD was greater in patients with more severe CRI . Two hundred forty-three patients ( 79.9 % ) had a history of hypertension , 132 patients ( 43.4 % ) had hyperlipidemia , 114 patients ( 37.5 % ) had diabetes mellitus , and 71 patients ( 27.3 % ) were smokers . Thirty-five percent of the patients with CVD had blood pressures greater than 140/90 mm Hg ; 103 patients ( 33.9 % ) were administered beta-blockers ; 196 patients ( 64.5 % ) , ACE inhibitors or angiotensin-receptor blockers ; 83 patients ( 27.3 % ) , ASA ; and 56 patients ( 18.4 % ) , statins . Patients with diabetes were not more likely than those without diabetes to be prescribed cardioprotective medications . CVD is common in the predialysis population , and its prevalence increases with more severe kidney failure . Despite this , the use of cardioprotective medications  is relatively low , and many patients had suboptimal blood pressure control . Given the high burden of disease in these patients , beta-blockers and ACE inhibitors should be used to control hypertension and /or for cardioprotection , and the increased use of ASA and statins should be considered Introduction : Our underst and ing about the role of the Internet as a re source for physicians has improved in the past several years with reports of patterns for use and measures of impact on medical practice . The purpose of this study was to begin to shape a theory base for more fully describing physicians ' information‐seeking behaviors as they apply to Internet use and applications for continuing education providers to more effectively support learning . Methods : A survey about Internet use and physician information seeking was administered by facsimile transmission to a r and om sample of 3,347 physicians . Results : Almost all physicians have access to the Internet , and most believe it is important for patient care . The most frequent use is in accessing the latest research on specific topics , new information in a disease area , and information related to a specific patient problem . Critical to seeking clinical information is the credibility of the source , followed by relevance , unlimited access , speed , and ease of use . Electronic media are viewed as increasingly important sources for clinical information , with decreased use of journals and local continuing medical education ( CME ) . Barriers to finding needed information include too much information , lack of specific information , and navigation or search ing difficulties . Discussion : The Internet has become an important force in how physicians deliver care . Underst and ing more about physician information‐seeking needs , behaviors , and uses is critical to CME providers to support a self‐directed curriculum for each physician . A shift to increased use of electronic CME options points to new dem and s for users and providers . Specific information about how physicians create a question and search for re sources is an area that requires providers to develop new skills PURPOSE The aim of this study was to determine the information needs of primary care physicians in Spain and to describe their information-seeking patterns . METHODS This observational study took place in primary care practice s located in Madrid , Spain . Participants were a r and om stratified sample of 112 primary care physicians .  Physicians ’ consultations were video recorded for 4 hours . Clinical questions arising during the patient visit and the sources of information used within the consultation to answer questions were identified . Physicians with unanswered questions were followed up by telephone 2 weeks later to determine whether their questions had since been answered and the sources of information used . Clinical questions were classified by topic and type of information . RESULTS A total of 3,511 patient consultations ( mean length , 7.8 minutes ) were recorded , leading to 635 clinical questions ( 0.18 questions per consultation ) . The most frequent questions were related to diagnosis ( 53 % ) and treatment ( 26 % ) . The most frequent generic type of questions was “ What is the cause of symptom x ? ” ( 20.5 % ) . Physicians search ed for answers to 22.8 % of the questions ( 9.6 % during consultations ) . The time taken and the success rate in finding an answer during a consultation and afterward were 2 minutes ( 100 % ) and 32 minutes ( 75 % ) , respectively . CONCLUSIONS Primary care physicians working in setting s where consultations are of short duration have time to answer only 1 in 5 of their questions . Better methods are needed to provide answers to questions that arise in office practice in setting s where average consultation time is less than 10 minutes Many published papers include large numbers of significance tests . These may be difficult to interpret because if we go on testing long enough we will inevitably find something which is “ significant . ” We must beware of attaching too much importance to a lone significant result among a mass of non-significant ones . It may be the one in 20 which we expect by chance alone . Lee et al simulated a clinical trial of the treatment of coronary artery disease by allocating 1073 patient records from past cases  into two “ treatment ” groups at r and om.1 They then analysed the outcome as if it were a genuine trial of two treatments . The analysis was quite detailed and thorough . As we would expect , it failed to show any significant difference in survival between those patients allocated to the two treatments . Patients were then subdivided by two variables which affect prognosis , the number of diseased coronary vessels and whether the left ventricular contraction pattern was normal or abnormal . A significant difference in survival between the two “ treatment ” groups was found in those patients with three diseased vessels ( the maximum ) and abnormal ventricular contraction . As this would be the subset of patients with the worst prognosis , the finding would be easy to account for by saying that the superior “ treatment ” BACKGROUND Current recommendations for the management of chronic renal insufficiency ( CRI ) include the use of angiotensin-converting enzyme inhibitors ( ACEI ) and achieving target blood pressure control . We design ed this study to describe the use of these therapeutic strategies , and to investigate barriers to their implementation . METHODS This was a prospect i ve study of 304 consecutive CRI patients , seen at follow-up in four nephrology clinics across Canada . The use of  blood pressure control and antihypertensive medication ( AHM ) in each of these clinics was recorded , and a question naire was administered to nephrologists to determine the basis for decisions concerning AHM regimens and ACEI use/non-use . RESULTS Mean age was 60.8+/-15.7 years , mean creatinine clearance was 30.3+/-18 ml/min , and underlying renal diseases were similar to registry data .  Mean arterial pressure ( MAP ) achieved was 99.4+/-14.4 and 98.9+/-11.9 mmHg in individuals with > 1 and < /=1 g/day proteinuria , respectively . When similarly stratified by proteinuria , mean systolic blood pressures were 141.4+/-23.5 and 140.9+/-20.3 mmHg , and mean diastolic blood pressures were 78.4+/-14.0 and 77.9+/-11.4 mmHg , respectively . Blood pressure control , according to published guidelines , was achieved in 128 patients ( 42.1 % ) . A further 86 ( 28.3 % ) patients had their AHM increased . The remaining 90 ( 29.6 % ) did not have their AHM increased . Of these , 40 were labelled ' at target blood pressure ' ( mean MAP 100.5+/-5.4 mmHg ) , 19 ' office hypertension ' and 11 ' unfavourable risk/benefit ratios ' . There were 108/304 ( 35.5 % ) patients who were not taking ACEI or ARB ( angiotensin receptor antagonist ) : 34/108 ( 31 % ) had previous ACEI failure due to hyperkalaemia ( 21/108 , 19 % ) or acute renal failure ( 17/108 , 16 % ) , and 61/108 ( 55 % ) were felt ' unlikely to benefit ' ( categories not mutually exclusive ) . Miscommunication with the primary physician and medication costs were not identified as significant barriers to improved blood pressure control or ACEI use . CONCLUSIONS Approximately 40 % of CRI patients are achieving current blood pressure goals and 64 % are prescribed ACEI/ARB in tertiary care nephrology clinics . Although the use of these strategies may be increasing , there remains room for improvement . Physicians should remain aware of the need to use these proven strategies in patients with CRI Abstract Objectives : To characterise the information needs of family doctors by collecting the questions they asked about patient care during consultations and to classify these in ways that would be useful to developers of knowledge bases . Design : Observational study in which investigators visited doctors for two half days and collected their questions . Taxonomies were developed to characterise the clinical topic and generic type of information sought for each question . Setting : Eastern Iowa . Participants : R and om sample of 103 family doctors . Main outcome measures : Number of questions posed , pursued , and answered ; topic and generic type of information sought for each question ; time spent pursuing answers ; information re sources used . Results : Participants asked a total of 1101 questions . Questions about drug prescribing , obstetrics and gynaecology , and adult infectious disease were most common and comprised 36 % of all questions . The taxonomy of generic questions included 69 categories ; the three most common types , comprising 24 % of all questions , were “ What is the cause of symptom X ? ” “ What is the dose of drug X ? ” and “ How should I manage disease or finding X ? ” Answers to most questions ( 702 
    Output:
    
Discussion If these filters improve search performance , physicians will be able to search MEDLINE for renal evidence more effectively , in less time , and with less frustration .