***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 : Several studies have evaluated whether evidence -based medicine ( EBM ) training courses can improve skills such as literature search ing and critical appraisal but to date , few data exist on whether teaching EBM skills and providing evidence -based re sources result in change in behavior or clinical outcomes . This study was conducted to evaluate whether a multifaceted EBM intervention consisting of teaching EBM skills and provision of electronic evidence re sources changed clinical practice . DESIGN : Before/after study . SETTING : The medical inpatient units at a district general hospital . PARTICIPANTS : Thirty-five attending physicians and 12 medicine residents . INTERVENTION : A multicomponent EBM intervention was provided including an EBM training course of seven 1-hour sessions , an EBM syllabus and textbook , and provision of evidence -based re sources on the hospital network . MEASUREMENTS AND MAIN RESULTS : The primary outcome of the study was the quality of evidence in support of therapies initiated for the primary diagnoses in 483 consecutive patients admitted during the month before and the month after the intervention . Patients admitted after implementation of the EBM intervention were significantly more likely to receive therapies proven to be beneficial in r and omized controlled trials ( 62 % vs 49 % ; P=.016 ) . Of these trial-proven therapies , those offered after the EBM intervention were significantly more likely to be based on high- quality r and omized controlled trials ( 95 % vs 87 % ; P=.023 ) . CONCLUSIONS : A multifaceted intervention design ed to teach and support EBM significantly improved evidence -based practice patterns in a district general hospital This critical review examines the efficacy of communication interventions for improving communication outcomes in adolescents with acquired brain injury . Five articles were included in this review . Studies included four Level 1 design s ( i.e. , one r and omized controlled trial ( RCT ) , one single subject crossover design , one single subject multiple baseline design , one single subject design ) , and one Level 3 design ( i.e. , single group preposttest design ) . Overall , the results of this review revealed suggestive evidence that communication interventions are effective at improving communication outcomes for adolescents with acquired brain injury . Clinical implication s and future research recommendations are also discussed Objective To determine whether  fellowship training in critical care medicine with critical appraisal exercises improves the ability and confidence of fellows to evaluate the medical literature .  Design Prospect i ve , interventional pilot study . Setting Multidisciplinary critical care medicine training program at a large university hospital . InterventionFellows were given three didactic sessions covering study design , analysis , and critical appraisal techniques . During the course of the year , each fellow was required to review one article from the literature and present a critique of this article to the group and faculty ( Journal Club ) . Fellows were guided in the preparation of this presentation by one of the critical care medicine faculty . Finally , a written analysis and critique of the article was performed by each fellow . Measurements and Main Results A test was given to each fellow at the beginning and end of the academic year . This test consisted of two pairs of articles on therapy for acute lung injury . For the pretest , each fellow was assigned , at r and om , one pair of articles . Fellows were given 1 hr to review both articles and to fill out a six-point test to assess their ability and confidence to appraise each article . At the end of the year , each fellow was tested on the opposite pair , the tests were grade d in a blinded fashion and the results of each test were compared . Six fellows completed both pre- and posttests . These paired results were analyzed separately , whereas results for another six fellows were conducted as an unpaired analysis . Mean scores increased both for the paired analysis ( 4.1 ± 0.7 vs. 5.1 ± 0.5;p = .015 ) and for the unpaired analysis ( 4.3 ± 0.6 vs. 5.0 ± 0.5;p = .012 ) . Self-reported confidence in critical appraisal also increased ( 2.5 ± 0.5 vs. 3.9 ± 0.7;p = .004 and 2.6 ± 0.5 vs. 3.9 ± 0.6;p < .001 , respectively ) . Conclusion Critical appraisal exercises used in the training of critical care medicine fellows appear to improve both ability and confidence to appraise relevant medical literature Background Attitudes and barriers to implementing EBM have been examined extensively , but scant evidence exists regarding the impact of EBM teaching on primary care physicians ’ point of care behavior . Objective Gaining insight into behavioral and attitudinal changes of facilitators and participants during a multifaceted EBM educational intervention . Design , setting , and participants A qualitative study on primary care physicians and facilitators from a large HMO selected from the intervention arm of a parallel controlled trial using purpose ful sampling . We conducted focus groups with 13 facilitators and 17 physicians and semi-structured interviews with 10 facilitators and 11 physicians . Results Both facilitators and participants believed EBM enhanced the quality of their practice . The intervention affected attitudes and knowledge , but had little impact on physicians ’ ability to utilize pre-appraised re sources at the point of care . Using EBM re sources during consultation was perceived to be a complex task and impractical in a busy setting . Conversely , a positive impact on using medication data bases was noted . Medication data bases were perceived as easy to use during consultations in which the benefits outweighed the barriers . The intervention prompted physicians to write down clinical questions more frequently and to search for answers at home . Conclusions This study underlines the need not only to enhance EBM skills , but also to improve the ease of use of EBM re sources at the point of care . Tasks should be simplified by tailoring evidence -based information retrieval systems to the busy clinical schedule . Participants ’ recommendations to establish an HMO decision support service should be considered STUDY OBJECTIVES To compare the performance of an evidence -based medicine ( EBM ) approach and a traditional approach to teaching critical appraisal skills to emergency medicine residents . METHODS This was a prospect i ve , case-controlled trial of 32 emergency medicine residents ( 16 control and 16 intervention ) . Intervention residents were exposed to a monthly , 1-hour journal club using an EBM approach to critical appraisal over the course of 1 year .  Control residents were exposed to a traditional , unstructured journal club , also monthly . Both groups were given a factitious article to evaluate in an essay format before and after the 12-month study period . The Wilcoxon rank sum test was used to compare mean improvement in test scores for each group . RESULTS The mean improvement in test scores was 1.80 for the control group and 1.53 for the intervention group ; these values were not significantly different ( P = .90 ) . The difference in mean change in test score between the 2 groups was.27 points . CONCLUSION Compared with a traditional approach , an EBM approach to teaching critical appraisal did not appear to improve the critical appraisal skills of emergency medicine residents . However , because of the small number of subjects studied , small differences in critical appraisal skill improvement can not be ruled out OBJECTIVE To investigate whether a limited teaching intervention , based on principles of adult education , could change residents ' literature reading attitudes , behaviors , and knowledge . DESIGN The educational intervention supplemented an ongoing bimonthly journal club . The effects on residents were studied prospect ively before and four months following the intervention . SETTING A community hospital internal medicine training program . PARTICIPANTS All 14 residents : six in the first year , and four each in the second and third years of training . INTERVENTION A one-hour seminar incorporating principles of adult education , including the use of multiple teaching modalities . The content was based on the critical literature reading guidelines published by the McMaster group . Reinforcement of learning objectives was achieved by learner participation , written assignments , active feedback , and follow-up in subsequent journal clubs . RESULTS Residents improved their performances on objective testing of critical appraisal knowledge by 60 % ( p = 0.02 ) . They reported improved ability to appraise original research articles critically ( p = 0.01 ) and reported spending more useful time reading . Unaffected were the total time spent reading journals , the reasons for reading them , and the perceived value of journals in " keeping up " with advances in medical knowledge . CONCLUSION Journal clubs are important to residents , and their effectiveness in teaching critical appraisal and promoting reading of the literature may be augmented by applying principles of adult education BACKGROUND We performed a prospect i ve controlled trial of a monthly journal club to determine if it would increase pediatric residents ' knowledge of clinical epidemiology and biostatistics . METHODS  Intervention residents received two didactic sessions before the journal club started . Eight monthly journal club sessions followed . Pediatric residents at another institution served as controls .  Intervention and control  residents completed a pre- and post-test on clinical epidemiology and biostatistics . RESULTS Neither the intervention nor the control group showed a significant change in test scores over the 9-month period . CONCLUSION A more intensive and more structured approach is needed to effectively teach clinical epidemiology and biostatistics to residents Background A discipline which critically looks at the evidence for practice should itself be critically examined . Credible evidence for the effectiveness of training in evidence -based healthcare ( EBHC ) is essential . We attempted to summarise the current knowledge on evaluating the effectiveness of training in EBHC while identifying the gaps . Methods A working group of EBHC teachers developed a conceptual framework of key areas of EBHC teaching and practice in need of evidence mapped to appropriate methods and outcomes . A literature search was conducted to review the current state of research in these key areas . Studies of training interventions that evaluated effectiveness by considering learner , patient or health system outcomes in terms of knowledge , skills , attitude , judgement , competence , decision-making , patient satisfaction , quality of life , clinical indicators or cost were included . There was no language restriction . Results Of 55 articles review ed , 15 met the inclusion criteria : six systematic review s , three r and omised controlled trials and six before-after studies . We found weak indications that undergraduate training in EBHC improves knowledge but not skills , and that clinical ly integrated postgraduate teaching improves both knowledge and skills . Two r and omised controlled trials reported no impact on attitudes or behaviour . One before-after study found a positive impact on decision-making , while another suggested change in learners ' behaviour and improved patient outcome . We found no studies assessing the impact of EBHC training on patient satisfaction , health-related quality of life , cost or population -level indicators of health . Conclusions Literature evaluating the effectiveness of training in EBHC has focused on short-term acquisition of knowledge and skills . Evaluation design s were method ologically weak , controlled trials appeared inadequately powered and systematic review s could not provide conclusive evidence owing to weakness of study design An investigation was made as to whether studies have found  journal clubs for physicians in training to be effective for improving patient . care , teaching critical appraisal skills , improving reading habits , increasing knowledge of clinical epidemiology and biostatistics , and increasing the use of medical literature in clinical practice . A literature search was undertaken using 10 data bases and retrieval systems and h and search es of journals , conference proceedings and personal files . The rigor of studies meeting the inclusion criteria was analyzed using a protocol based on methods established by the Cochrane Collaboration . One r and omized controlled trial found an improvement in knowledge of clinical epidemiology and biostaristics , reading habits , and the use of medical literature in practice , but no improvement in critical appraisal skills . Six less method ologically rigorous studies found possible improvement in critical appraisal skills . It is concluded that journal clubs may improve knowledge of clinical epidemiology and biostatistics , reading habits , and the use of medical literature in practice . A multi-center , r and omized controlled trial of journal clubs is needed to assess whether journal clubs improve critical appraisal skills This study sought to identify the attitudes of family practice residents toward journal clubs and the effect that preparing a journal club session has on the resident 's view of the medical literature . Residents from Valley Medical Center were prospect ively assessed over a three-year period . Residents selected the improvement of critical appraisal skills  as the most important journal club goal . However , they reported that their journal club experiences did not improve their opinions of the journals selected . The results are discussed in the context of recent trends in journal clubs OBJECTIVE To determine the effectiveness of different types of interventions in improving  health professional performance and health outcomes . DATA SOURCES MEDLINE , SCI SEARCH , CINAHL and the Research and Development Re source Base in CME were search ed for trials of  educational interventions in the health care professions published between 1970 and 1993 inclusive . STUDY SELECTION Studies were selected if they provided objective measurements of  health professional performance or health outcomes  and employed r and om or quasi-r and om allocation methods in their study design s to assign individual subjects or groups . Interventions included such activities as conferences , outreach visits , the use of local opinion leaders , audit and feedback , and reminder systems . DATA EXTRACTION Details extracted from the studies included the study design ; the unit of allocation ( e.g. , patient , provider , practice , hospital ) ; the characteristics of the targeted health care professionals , educational interventions and patients ( when appropriate ) ; and the main outcome measure . DATA SYNTHESIS The inclusion criteria were met by 102 trials . Areas of behaviour change included general patient management , preventive services , prescribing practice s , treatment of specific conditions such as hypertension or diabetes , and diagnostic service or hospital utilization . Dissemination-only strategies , such as conferences or the mailing of unsolicited material s , demonstrated little or no changes in health professional behaviour or health outcome when used alone . More complex interventions , such as the use of outreach visits or local opinion leaders , ranged from ineffective to highly effective but were most often moderately effective ( result ing in reductions of 20 % to 50 % in the incidence of inappropriate performance ) . CONCLUSION There are no " magic bullets " for improving the quality of health care , but there are a wide range of interventions available that , if used appropriately , could lead to important improvements in professional practice and patient outcomes The journal club is 
    Output:
    
The effectiveness of JCs in supporting evidence -based decision making is not clear .