***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 Engaging practicing physicians in educational strategies that reinforce guideline adoption and improve the quality of healthcare may be difficult . Push technologies such as email offer new opportunities to engage physicians in online educational reinforcing strategies . The objectives are to investigate 1 ) the effectiveness of email announcements in engaging recruited community-based primary care physicians in an online guideline reinforcement strategy design ed to promote Chlamydia screening , 2 ) the characteristics of physicians who respond to email announcements , as well as 3 ) how quickly and when they respond to email announcements . Methods Over a 45-week period , 445 recruited physicians received up to 33 email contacts announcing and reminding them of an online women 's health guideline reinforcing CME activity . Participation was defined as physician log-on at least once to the website . Data were analyzed to determine participation , to compare characteristics of participants with recruited physicians who did not participate , and to determine at what point and when participants logged on . Results Of 445 recruited physicians with accurate email addresses , 47.2 % logged on and completed at least one module . There were no significant differences by age , race , or specialty between participants and non- participants . Female physicians , US medical graduates and MDs had higher participation rates than male physicians , international medical graduates and DOs . Physicians with higher baseline screening rates were significantly more likely to log on to the course . The first 10 emails were the most effective in engaging community-based physicians to complete the intervention . Physicians were more likely to log on in the afternoon and evening and on Monday or Thursday . Conclusions Email course reminders may enhance recruitment of physicians to interventions design ed to reinforce guideline adoption ; physicians ' response to email reminders may vary by gender , degree , and country of medical training . Repetition of email communications contributes to physician online participation Introduction Critical care physicians may benefit from immediate access to medical reference material . We evaluated the feasibility and potential benefits of a h and held computer based knowledge access system linking a central academic intensive care unit ( ICU ) to multiple community-based ICUs . Methods Four community hospital ICUs with 17 physicians participated in this prospect i ve interventional study . Following training in the use of an internet-linked , up date able h and held computer knowledge access system , the physicians used the h and held devices in their clinical environment for a 12-month intervention period . Feasibility of the system was evaluated by tracking use of the h and held computer and by conducting surveys and focus group discussion s. Before and after the intervention period , participants underwent simulated patient care scenarios design ed to evaluate the information sources they accessed , as well as the speed and quality of their decision making . Participants generated admission orders during each scenario , which were scored by blinded evaluators . Results Ten physicians ( 59 % ) used the system regularly , predominantly for nonmedical applications ( median 32.8/month , interquartile range [ IQR ] 28.3–126.8 ) , with medical software accessed less often ( median 9/month , IQR 3.7–13.7 ) . Eight out of 13 physicians ( 62 % ) who completed the final scenarios chose to use the h and held computer for information access . The median time to access information on the h and held h and held computer was 19 s ( IQR 15–40 s ) . This group exhibited a significant improvement in admission order score as compared with those who used other re sources ( P = 0.018 ) . Benefits and barriers to use of this technology were identified . Conclusion An up date able h and held computer system is feasible as a means of point-of-care access to medical reference material and may improve clinical decision making . However , during the study , acceptance of the system was variable . Improved training and new technology may overcome some of the barriers we identified Abstract Objective : To underst and the factors influencing the adoption of a  computerised clinical decision support system  for two chronic diseases in general practice . Design : Practice based , longitudinal , qualitative interview study . Setting : Five general practice s in north east Engl and . Participants : 13 respondents ( two practice managers , three nurses , and eight general practitioners ) gave a total of 19 semistructured interviews . 40 people in practice s included in the r and omised controlled trial ( 34 doctors , three nurses ) and interview study ( three doctors , one previously interviewed ) gave feedback . Results : Negative comments about the decision support system significantly outweighed the positive or neutral comments . Three main areas of concern among clinicians emerged : timing of the guideline trigger , ease of use of the system , and helpfulness of the content . Respondents did not feel that the system fitted well within the general practice context . Experience of “ on-dem and ” information sources , which were generally more positively viewed , informed the comments about the system . Some general practitioners suggested that nurses might find the guideline content more clinical ly useful and might be more prepared to use a computerised decision support system , but lack of feedback from nurses who had experienced the system limited the ability to assess this . Conclusions : Significant barriers exist to the use of complex clinical decision support systems for chronic disease by general practitioners . Key issues include the relevance and accuracy of messages and the flexibility to respond to other factors influencing decision making in primary care . What is already known on this topic R and omised controlled trials of complex computerised decision support systems have found low rates of use and no effects on process and outcomes of care What this study adds Clinicians found a  computerised decision support system for chronic disease in general practice to be difficult to use and unhelpful clinical ly It did not fit well into a general practice consultation and compared unfavourably with “ on-dem and ” information “ Active ” decision support can make clinicians aware of gaps between their own practice and “ best ” practice , but computer prompts need to be relevant and A double-blind r and omised controlled trial was conducted on a group of Hong Kong hospital clinicians . The objective was to test if a three-hour educational workshop ( with supervised h and s-on practice ) is more effective ( than no training ) to improve clinical question formulation , information-seeking skills , knowledge , attitudes , and search outcomes . The design was a post-test-only control group ; recruitment by stratified r and omization ( by profession ) , blocked at 800 .  End-user training was more effective than no training in improving clinical question formulation , in raising awareness , knowledge , confidence and use of data bases , but had made no impact on preference for secondary data bases . It changed the attitude of clinicians to become more positive towards the use of electronic information services ( EIS ) . Participants had higher search performance and outcomes ( satisfaction with information obtained ( NNT = 3 ) , EIS satisfaction ( NNT = 3 ) and success in problem solving ( NNT = 4 ) ) . The workshop improved knowledge and skills in evidence -based search ing , but this effect gradually eroded with time . Search logs confirmed that follow-up is required if effects are to be sustained . Longer effects on search behaviours appear to be positive . A r and omised controlled trial is valuable in identifying cause- and -effect relations and to quantify the magnitude of the effects for management decision-making An ethnographic ( participant observation ) study was undertaken of the socio-technical processes involved in the implementation , within a r and omized controlled trial , of a home telehealth nursing service for patients with chronic obstructive pulmonary disease ( COPD ) . Ethnographic field notes were taken about technology-related tasks and the interplay between the research team and the 12 nurses who were to use the telehealth equipment .  Views of the technology were linked to views of professional self-image and status . The technology was sometimes seen as unhelpful in establishing effective relationships with patients . Considerable work by all participants , over a period of months , was required to develop the technology in ways that minimized the risk to the stability of the specialist service and existing nurse – patient relationships . Our work highlights the complex problems that health professionals encounter when they try to integrate new technologies into routine service delivery . The concerns arising from the interplay of new technology with existing professional practice s and relationships go beyond simple issues of training OBJECTIVE Usage of computer re sources at the point of care has a positive effect on physician decision making . Pediatricians ' information-seeking behaviors are not well characterized . The goal of this study was to characterize quantitatively the information-seeking behaviors of general pediatricians and specifically compare their use of computers , including digital libraries , before and after an educational intervention . METHODS General pediatric residents and faculty at a US Midwest children 's hospital participated . A control ( year 1 ) versus intervention group ( year 2 ) research design was implemented . Eligible pediatrician pools overlapped , such that some participated first in the control group and later as part of the intervention . The intervention group received a 10-minute individual training session and h and out on how to use a pediatric digital library to answer professional questions . A general medical digital library was also available . Pediatricians in both the control and the intervention groups were surveyed using the critical incident technique during 2 6-month time periods . Both groups were telephoned for 1- to 2-minute interviews and were asked , " What pediatric question ( s ) did you have that you needed additional information to answer ? " The main outcome measures were the differences between the proportion of pediatricians who use computers and digital libraries and a comparison of the number of times that pediatricians use these re sources before and after intervention . RESULTS A total of 58 pediatricians were eligible , and 52 participated ( 89.6 % ) . Participant demographics between control ( N = 41 ; 89.1 % ) and intervention ( N = 31 ; 70.4 % ) were not statistically different . Twenty pediatricians were in both groups . Pediatricians were slightly less likely to pursue answers after the intervention ( 94.7 % vs 89.2 % ) ; the primary reason cited for both groups was a lack of time . The pediatricians were as successful in finding answers in each group ( 95.7 % vs 92.7 % ) , but the intervention group took significantly less time ( 8.3 minutes vs 19.6 minutes ) . After the intervention , pediatricians used computers and digital libraries more to answer their questions and spent less time using them . CONCLUSION This study showed higher rates of physician questions pursued and answered and higher rates of computer use at baseline and after intervention compared with previous studies . Pediatricians who seek answers at the point of care therefore should begin to shift their information-seeking behaviors toward computer re sources , as they are as effective but more time-efficient OBJECTIVES Information technology is a rapidly exp and ing branch of science which has affected other sciences . One example of using information technology in medicine is the Electronic Medical Records system .  One medical university in Iran decided to introduce such system in its hospital . This study was design ed to identify the factors which influence the quality of medical documentation when paper-based records are replaced with electronic records . METHODS A set of 300 electronic medical records  was r and omly selected and evaluated against eleven checklists in terms of documentation of medical information , availability , accuracy and ease of use . To get the opinion of the care-providers on the electronic medical records system , ten physicians and ten nurses were interviewed by using of semi-structured guidelines . The results were also compared with a prior study with 300 paper-based medical records . RESULTS The quality of documentation of the medical records was improved in areas where nurses were involved , but those parts which needed physicians ' involvement were actually worse . High workloads , shortage of bedside hardware and lack of software features were prominent influential factors in the quality of documentation . The results also indicate that the retrieval of information from the electronic medical records is easier and faster , especially in emergency situations . CONCLUSIONS The electronic medical records system can be a good substitute for the paper-based medical records system . However , according to this study , some factors such as low physician acceptance of the electronic medical record system , lack of administrative mechanisms ( for instance supervision , neglecting physicians and /or nurses in the development and implementation phases and also continuous training ) , availability of hardware as well as lack of specific software features can negatively affect transition from a paper-based system to an electronic system STUDY OBJECTIVE We introduced self-service access to the medical literature data base , MEDLINE , into clinical setting s to assess the frequency , patterns , purpose s , and success of use . DESIGN Longitudinal descriptive study . SETTING Inpatient and outpatient services of a university medical center . PARTICIPANTS All trainees and attending staff working at the service sites were invited to participate ; 158 ( 84 % ) did so . INTERVENTIONS Free online access was provided to MEDLINE through GRATEFUL MED software . Participants were offered a 2-hour introduction to online search ing and 2 hours of free search time . MEASUREMENTS AND MAIN RESULTS For each search , a computer program requested identification of the user and the question to be addressed . Search transactions were recorded automatically . Interviews were conducted after a r and om sample of search es , and search questions were given to more expert search ers to run for comparison with the original . Eighty-one percent of participants did search es on study computers , at a mean rate of 2.7 search es per month . On comparison search es , participants retrieved 55 % of the number of relevant articles retrieved by reference librarians ( P = 0.024 ) and 50 % more irrelevant articles ( P less than 0.001 ) . Forty-seven percent of search es on patient problems affected clinical decisions , but often on scanty information . CONCLUSIONS MEDLINE search ing from clinical setting s is feasible with brief training and affects clinical decisions . However , inexperienced search ers miss many relevant citations and search inefficiently . Further studies are needed to assess the impact of search ing on physician performance and patient care Background With the public ’s increased use of the Internet , the use of email as a means of communication between patients and physicians will likely increase . Yet , despite evidence of increased interest by patients , email use by physicians for clinical care has been slow . Objective To examine the factors associated with  physician-patient email  , and report on the physicians ’ adherence to recognized guidelines for email communication . Methods Cross-sectional survey ( March – May , 2005 ) of all primary care physicians ( n = 10253 ) , and a 25 % stratified , r and om sample of all ambulatory clinical specialists ( n =  
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Perception of the benefits of the innovation ( system usefulness ) was the most common facilitating factor , followed by ease of use .
Issues regarding design , technical concerns , familiarity with ICT , and time were the most frequent limiting factors identified .