***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 BACKGROUND Physicians have difficulty keeping up with new evidence from medical research . METHODS We developed the McMaster Premium LiteratUre Service ( PLUS ) , an internet-based addition to an existing digital library , which delivered quality - and relevance -rated medical literature to physicians , matched to their clinical disciplines . We evaluated PLUS in a cluster-r and omized trial of 203 participating physicians in Northern Ontario , comparing a Full-Serve version ( that included alerts to new articles and a cumulative data base of alerts ) with a Self-Serve version ( that included a passive guide to evidence -based literature ) . Utilization of the service was the primary trial end-point . RESULTS Mean logins to the library rose by 0.77 logins/month/user ( 95 % CI 0.43 , 1.11 ) in the Full-Serve group compared with the Self-Serve group . The proportion of Full-Serve participants who utilized the service during each month of the study period showed a sustained increase during the intervention period , with a relative increase of 57 % ( 95 % CI 12 , 123 ) compared with the Self-Serve group . There were no differences in these proportions during the baseline period , and following the crossover of the Self-Serve group to Full-Serve , the Self-Serve group 's usage became indistinguishable from that of the Full-Serve group ( relative difference 4.4 ( 95 % CI -23.7 , 43.0 ) . Also during the intervention and crossover periods , measures of self-reported usefulness did not show a difference between the 2 groups . CONCLUSION A quality - and relevance -rated online literature service increased the utilization of evidence -based information from a digital library by practicing physicians Abstract OBJECTIVE : To determine if a simple educational intervention can increase  resident physician literature search activity .  DESIGN : R and omized controlled trial . SETTING : University hospital-based internal medicine training program . PATIENTS / PARTICIPANTS : Forty-eight medical residents rotating on the general internal medicine service . INTERVENTIONS : One-hour didactic session , the use of well-built clinical question cards , and practical sessions in clinical question building . MEASUREMENTS AND MAIN RESULTS : Objective data from the library information system that included the number of log-ons to MEDLINE , search ing volume , abstract s viewed , full-text articles viewed , and time spent search ing . Median search activity as measured per person per week ( control vs intervention ) : number of log-ons to MEDLINE ( 2.1 vs 4.4 , P<.001 ) ; total number of search sets ( 24.0 vs 74.2 , P<.001 ) ; abstract s viewed ( 5.8 vs 17.7 , P=.001 ) ; articles viewed ( 1.0 vs 2.6 , P=.005 ) ; and hours spent search ing ( 0.8 vs 2.4 , P<.001 ) . CONCLUSIONS : A simple educational intervention can markedly increase resident search ing activity Background Effective strategies for implementing best practice s in low and middle income countries are needed . RHL is an annually up date d electronic publication containing Cochrane systematic review s , commentaries and practical recommendations on how to implement evidence -based practice s. We are conducting a trial to evaluate the improvement in obstetric practice s using an active dissemination strategy to promote uptake of recommendations in The WHO Reproductive Health Library ( RHL ) . Methods A cluster r and omized trial to improve obstetric practice s in 40 hospitals in Mexico and Thail and is conducted . The trial uses a stratified r and om allocation based on country , size and type of hospitals . The core intervention consists of three interactive workshops delivered over a period of six months . The main outcome measures are changes in clinical practice s that are recommended in RHL measured approximately a year after the first workshop . Results The design and implementation of a complex intervention using a cluster r and omized trial design are presented . Conclusion Design ing the intervention , choosing outcome variables and implementing the protocol in two diverse setting s has been a time-consuming and challenging process . We hope that sharing this experience will help others planning similar projects and improve our ability to implement change Background Evidence -Based Medicine ( EBM ) is an important competency for the healthcare professional . Experimental evidence of EBM educational interventions from rigorous research studies is limited . The main objective of this study was to assess EBM learning ( knowledge , attitudes and self-reported skills ) in undergraduate medical students with a r and omized controlled trial . Methods The educational intervention was a  one-semester EBM course in the 5th year of a public medical school in Mexico . The study design was an experimental parallel group r and omized controlled trial for the main outcome measures in the 5th year class ( M5 EBM vs. M5 non-EBM groups ) , and quasi-experimental with static-groups comparisons for the 4th year ( M4 , not yet exposed ) and 6th year ( M6 , exposed 6 months to a year earlier ) groups . EBM attitudes , knowledge and self-reported skills were measured using Taylor ’s question naire and a summative exam which comprised of a 100-item multiple-choice question ( MCQ ) test . Results 289 Medical students were assessed : M5 EBM=48 , M5 non-EBM=47 , M4=87 , and M6=107 . There was a higher reported use of the Cochrane Library and secondary journals in the intervention group ( M5 vs. M5 non-EBM ) . Critical appraisal skills and attitude scores were higher in the intervention group ( M5 ) and in the group of students exposed to EBM instruction during the previous year ( M6 ) . The knowledge level was higher after the intervention in the M5 EBM group compared to the M5 non-EBM group ( p<0.001 , Cohen 's d=0.88 with Taylor 's instrument and 3.54 with the 100-item MCQ test ) . M6 Students that received the intervention in the previous year had a knowledge score higher than the M4 and M5 non-EBM groups , but lower than the M5 EBM group . Conclusions Formal medical student training in EBM produced higher scores in attitudes , knowledge and self-reported critical appraisal skills compared with a r and omized control group . Data from the concurrent groups add validity evidence to the study , but rigorous follow-up needs to be done to document retention of EBM abilities Background Provision of online evidence at the point of care is one strategy that could provide clinicians with easy access to up-to- date evidence in clinical setting s in order to support evidence -based decision making . Objective The aim was to determine long-term use of an online evidence system in routine clinical practice . Methods This was a prospect i ve cohort study . 59 clinicians who had a computer with Internet access in their consulting room participated in a 12-month trial of Quick Clinical , an online evidence system specifically design ed around the needs of general practitioners ( GPs ) . Patterns of use were determined by examination of computer logs and survey analysis . Results On average , 9.9 search es were conducted by each GP in the first 2 months of the study . After this , usage dropped to 4.4 search es per GP in the third month and then levelled off to between 0.4 and 2.6 search es per GP per month . The majority of search es ( 79.2 % , 2013/2543 ) were conducted during practice hours ( between 9 am and 5 pm ) and on weekdays ( 90.7 % , 2315/2543 ) . The most frequent search es related to diagnosis ( 33.6 % , 821/2291 ) and treatment ( 34.5 % , 844/2291 ) . Conclusion GPs will use an online evidence retrieval system in routine practice ; however , usage rates drop significantly after initial introduction of the system . Long-term studies are required to determine the extent to which GPs will integrate the use of such technologies into their everyday clinical practice and how this will affect the satisfaction and health outcomes of their patients Background Previous studies have shown that Norwegian public health physicians do not systematic ally and explicitly use scientific evidence in their practice . They work in an environment that does not encourage the integration of this information in decision-making . In this study we investigate whether a theoretically grounded tailored intervention to diffuse evidence -based public health practice increases the physicians ' use of research information . Methods 148 self-selected public health physicians were r and omised to an intervention group ( n = 73 ) and a control group ( n = 75 ) . The intervention group received a multifaceted intervention while the control group received a letter declaring that they had access to library services . Baseline assessment s before the intervention and post-testing immediately at the end of a 1.5-year intervention period were conducted . The intervention was theoretically based and consisted of a workshop in evidence -based public health , a newsletter , access to a specially design ed information service , to relevant data bases , and to an electronic discussion list . The main outcome measure was behaviour as measured by the use of research in different documents . Results The intervention did not demonstrate any evidence of effects on the objective behaviour outcomes . We found , however , a statistical significant difference between the two groups for both knowledge scores : Mean difference of 0.4 ( 95 % CI : 0.2–0.6 ) in the score for knowledge about EBM-re sources and mean difference of 0.2 ( 95 % CI : 0.0–0.3 ) in the score for conceptual knowledge of importance for critical appraisal . There were no statistical significant differences in attitude- , self-efficacy- , decision-to-adopt- or job-satisfaction scales . There were no significant differences in Cochrane library search ing after controlling for baseline values and characteristics . Conclusion Though demonstrating effect on knowledge the study failed to provide support for the hypothesis that a theory-based multifaceted intervention targeted at identified barriers will change professional behaviour Background Online information retrieval systems have the potential to improve patient care but there are few comparative studies of the impact of online evidence on clinicians ' decision-making behaviour in routine clinical work . Methods / design A r and omized controlled parallel design is employed to assess the effectiveness of an online evidence retrieval system , Quick Clinical ( QC ) in improving clinical decision-making processes in general practice . Eligible clinicians are r and omised either to receive access or not to receive access to QC in their consulting rooms for 12 months . Participants complete pre- and post trial surveys . Two-hundred general practitioners are recruited . Participants must be registered to practice in Australia , have a computer with Internet access in their consulting room and use electronic prescribing . Clinicians planning to retire or move to another practice within 12 months or participating in any other clinical trial involving electronic extraction of prescriptions data are excluded from the study .The primary end-points for the study is clinician acceptance and use of QC and the result ing change in decision-making behaviour . The study will examine prescribing patterns related to frequently prescribed medications where there has been a recent significant shift in recommendations regarding their use based upon new evidence . Secondary outcome measures include self-reported changes in diagnosis , patient education , prescriptions written , investigations and referrals . Discussion A trial under experimental conditions is an effective way of examining the impact of using QC in routine general practice consultations BACKGROUND The recent availability of low-cost tablet computers can facilitate bedside information retrieval by clinicians . OBJECTIVE To evaluate the effect of physician tablet use in the Emergency Department . DESIGN Prospect i ve cohort study comparing physician workstation usage with and without a tablet . SETTING 55,000 visits/year Level 1 Emergency Department at a tertiary academic teaching hospital . PARTICIPANTS 13 emergency physicians ( 7 Attendings , 4 EM3s , and 2 EM1s ) worked a total of 168 scheduled shifts ( 130 without and 38 with tablets ) during the study period . INTERVENTION Physician use of a tablet computer while delivering direct patient care in the Emergency Department . MAIN OUTCOME MEASURES The primary outcome measure was the time spent using the Emergency Department Information 
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We included r and omized , non-r and omized , and cluster r and omized controlled trials ( RCTs , N RCTs , C RCTs ) , controlled clinical trials ( CCTs ) , interrupted time series ( ITS ) , and controlled before- and -after studies (CBAs).The comparisons were : electronic versus printed health information ; EHI on different electronic devices ( e.g. desktop , laptop or tablet computers , etc . ;
This review provided no evidence that the use of EHI translates into improved clinical practice or patient outcomes , though it does suggest that when practitioners are provided with EHI and education or training , the use of EHI increases .
We have defined use as the activity of logging into an EHI re source , but based on our findings use does not automatically translate to the application of EHI in practice .