***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 OBJECTIVE To identify the most frequent obstacles preventing physicians from answering their patient-care questions and the most requested improvements to clinical information re sources . DESIGN Qualitative analysis of questions asked by 48 r and omly selected generalist physicians during ambulatory care . MEASUREMENTS Frequency of reported obstacles to answering patient-care questions and recommendations from physicians for improving clinical information re sources . RESULTS The physicians asked 1,062 questions but pursued answers to only 585 ( 55 % ) . The most commonly reported obstacle to the pursuit of an answer was the physician 's doubt that an answer existed ( 52 questions , 11 % ) . Among pursued questions , the most common obstacle was the failure of the selected re source to provide an answer ( 153 questions , 26 % ) . During audiotaped interviews , physicians made 80 recommendations for improving clinical information re sources . For example , they requested comprehensive re sources that answer questions likely to occur in practice with emphasis on treatment and bottom-line advice . They asked for help in locating information quickly by using lists , tables , bolded subheadings , and algorithms and by avoiding lengthy , uninterrupted prose . CONCLUSION Physicians do not seek answers to many of their questions , often suspecting a lack of usable information . When they do seek answers , they often can not find the information they need . Clinical re source developers could use the recommendations made by practicing physicians to provide re sources that are more useful for answering clinical questions 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 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 Despite the availability of an increasing array of empirically vali date d adolescent drug abuse prevention programs , program material s and evaluation findings are poorly disseminated . CD-ROM and the Internet hold promise for disseminating this information to schools and agencies that directly serve youth , and to policy-making bodies that exercise control over funds to support adolescent drug abuse prevention programming . However , data on the relative efficacy of these newer technologies over conventional print means of dissemination are lacking . METHODS Recruited through schools , community agencies , and policy-making bodies , 188 professionals were r and omized to receive prevention program material s via  pamphlets  ( 55 participants ) , CD-ROM ( 64 participants ) , and the Internet ( 69 participants ) . Participants completed pretest , posttest , and 6-month follow-up measures that assessed their access to prevention program material s ; self-efficacy for identifying , obtaining , and recommending these programs ; and their likelihood of requesting , implementing , and recommending prevention programs to their constituents . RESULTS Participants exposed to dissemination via CD-ROM and the Internet evidence d the greatest short- and long-term gains on accessibility , self-efficacy , and behavioral intention variables . CONCLUSIONS CD-ROM and the Internet are viable means for disseminating adolescent drug abuse prevention programs to schools , community agencies , and policy-making bodies , and should be increasingly used for dissemination purpose BACKGROUND AND OBJECTIVES It is not yet known if personal digital assistant (PDA)-assisted evidence -based medicine ( EBM ) courses in postgraduate training enhance knowledge of common clinical problems . This study 's objective was to determine if PDA-assisted EBM training would improve clinical knowledge . METHODS In a controlled trial , intervention group residents received InfoRetriever on a PDA coupled with an EBM course integrated within clinical rotations in family medicine . The effect of the intervention and the rate of use of InfoRetriever on a written test of knowledge were evaluated after adjusting for baseline knowledge scores . The test measured knowledge of primary care management of hypertension and diabetes as well as estimation of disease probability . RESULTS There was no effect on first posttest knowledge scores of the intervention overall or of the rate with which participants had used InfoRetriever during the intervention . However , when intervention group residents retook the test with access to InfoRetriever while taking the knowledge test , scores increased 7.4 % ( + 2.4 correct test questions ) . Access to InfoRetriever Clinical Prediction Rules on a PDA , however , had an unclear effect on residents ' ability to estimate disease probability . CONCLUSIONS There was no effect of a PDA-assisted EBM course on knowledge test scores , although using the PDA during the test results in higher scores . It is unclear if using PDA Clinical Prediction Rules can improve residents ' estimates of disease probability OBJECTIVE To assess the change in frequency and methods with which a pilot group of rural physicians consulted on-line medical re sources before and after an educational intervention . DESIGN Physicians were r and omly assigned to an educational intervention or control group . Self-administered question naires were completed before and 3 months after the intervention . SETTING Rural practice s in southwestern Ontario . PARTICIPANTS Eighty rural ( defined as a population of 15000 or less ) physicians in southwestern Ontario , with a computer with Internet access . INTERVENTIONS Individualized 3-hour training session on using the World Wide Web to research patient-related questions . MAIN OUTCOME MEASURES Frequency of access and comfort with on-line medical information were compared after intervention with baseline data using the Wilcoxon two- sample test . RESULTS At follow up , the intervention group showed a significant improvement over the control group in their frequency of accessing the World Wide Web to address patient-related questions ( P = .009 ) , in their comfort level in using on-line data bases ( P = .032 ) , and in their frequency of accessing on-line data bases ( P = .044 ) . CONCLUSION Rural physicians ' comfort and competence in using computers to address patient problems can be improved by an individualized 3-hour training session OBJECTIVE The aim of this study was to compare the clinical impact of computerized decision support with and without electronic access to clinical guidelines and laboratory data on antibiotic prescribing decisions . DESIGN A crossover trial was conducted of four levels of computerized decision support-no support , antibiotic guidelines , laboratory reports , and laboratory reports plus a decision support system ( DSS ) , r and omly allocated to eight simulated clinical cases 
    Output:
    
Neither study assessed changes in patient outcomes or the costs of provision of the electronic re source and the implementation of the recommended evidence -based practice s. AUTHORS ' CONCLUSIONS Overall there was insufficient evidence to support or refute the use of electronic retrieval of healthcare information by healthcare providers to improve practice and patient care