You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Computer-assisted learning compared with weekly seminars for teaching fundamental electrocardiography to junior medical students.
Abstract 1:
This study was design ed to assess whether a self- study interactive computer program is more effective than weekly seminars for teaching fundamental skills of electrocardiographic interpretation to junior medical students . Forty-two students were assigned to the computer and 41 to the seminar group .  A test was given to each participant at the beginning and end of each rotation . The computer group used a computer-assisted learning program , and the seminar group met weekly with a cardiologist to review electrocardiograms . Attendance at a minimum of 80 % of the seminars or completion of 80 % of the computer-assisted learning program was required for inclusion in the statistical analysis . The mean difference in test scores before and after study was 5.69 for the computer group and 4.36 for the seminar group ( P less than .02 by one-tailed t-test ) . These results indicate that the computer group performed significantly better than the seminar group . We believe this difference to be educationally important


Title 2:
Impact of a clinical scenario on accuracy of electrocardiogram interpretation
Abstract 2:
To examine the effect of clinical history on the electrocardiogram ( ECG ) interpretation skills of physicians with different levels of expertise , we r and omly allocated to an ECG test package 30 final-year medical students , 15 second-year internal medicine residents , and 15 university cardiologists at university-affiliated teaching hospitals . All participants interpreted the same set of 10 ECGs . Each ECG was accompanied by a brief clinical history suggestive of the correct ECG diagnosis , or the most plausible alternative diagnosis , or no history . Provision of a correct history improved accuracy by 4 % to 12 % compared with no history , depending on level of training . Conversely , a misleading history compared with no history reduced accuracy by 5 % for cardiologists , 25 % for residents , and 19 % for students . Clinical history also affected the paticipants ’ frequencies of listing ECG features consistent with the correct diagnosis and features consistent with the alternative diagnosis ( allp values < .05 ) . For physicians at all levels of expertise , clinical history has an influence on ECG diagnostic accuracy , both improving accuracy when the history suggests the correct diagnosis , and reducing accuracy when the history suggests an alternative diagnosis


Title 3:
Diagnostic interpretation of electrocardiograms in population-based research: computer program research physicians, or cardiologists?
Abstract 3:
We assessed the performance of diagnostic  electrocardiogram ( ECG )  interpretation by the computer program MEANS and by  research physicians  , compared to cardiologists , in a physician-based study . To establish a strategy for ECG interpretation in health surveys , we also studied the diagnostic capacity of three scenarios : use of the computer program alone ( A ) , computer program and cardiologist ( B ) , and computer program , research physician , and cardiologist ( C ) . A stratified r and om sample of 381 ECGs was drawn from ECGs collected in the Rotterdam Study ( n = 3057 ) , which were interpreted both by a trained research physician using a form for structured clinical evaluation and by MEANS . All ECGs were interpreted independently by two cardiologists ; if they disagreed ( n = 175 ) the ECG was judged by a third cardiologist . Five ECG diagnoses were considered : anterior and inferior myocardial infa rct ion ( MI ) , left and right bundle branch block ( LBBB and RBBB ) , and left ventricular hypertrophy ( LVH ) . Overall , sensitivities and specificities of MEANS and the research physicians were high . The sensitivity of MEANS ranged from 73.8 % to 92.9 % and of the research physician ranged from 71.8 % to 96.9 % . The specificity of MEANS ranged from 97.5 % to 99.8 % and of the research physician from 96.3 % to 99.6 % . To diagnose LVH , LBBB , and RBBB , use of the computer program alone gives satisfactory results . Preferably , all positive findings of anterior and inferior MI by the program should be verified by a cardiologist . We conclude that diagnostic ECG interpretation by computer can be very helpful in population -based research , being at least as good as ECG interpretation by a trained research physician , but much more efficient and therefore less expensive


Title 4:
Do computer generated ECG reports improve interpretation by accident and emergency senior house officers?
Abstract 4:
OBJECTIVES To determine whether access to a computer generated electrocardiogram ( ECG ) report can reduce errors of interpretation by senior house officers ( SHOs ) in an accident and emergency department . METHODS Ten SHOs were asked to interpret 50 ECGs each : 25 with computer generated reports , 25 without . Their answers , and the computer generated reports , were compared with a “ gold st and ard ” produced by two experienced clinicians . The primary outcome measure was the proportion of major errors of interpretation . RESULTS The computer reading system made two major errors ( 4 % , 95 % confidence interval ( CI ) 1.1 % to 13.5 % ) compared with the gold st and ard . Access to the computer report did not significantly reduce major errors among SHOs ( 46 ( 18.4 % ) with report v 56 ( 22.4 % ) without , odds ratio 0.64 , 95 % CI 0.36 % to 1.14 % , p=0.13 ) or improve the proportion completely correct ( 104 ( 41.6 % ) with reportv 91 ( 36.4 % ) without , odds ratio 1.43 , 95 % CI 0.88 to 2.33 , p=0.15 ) . CONCLUSIONS SHOs have a high error rate when interpreting ECGs , which is not significantly reduced by access to a computer generated report .  Junior doctors should continue to seek expert senior help when they have to interpret a difficult ECG


Title 5:
The Effects of Computer-assisted Electrocardiographic Interpretation on Physicians' Diagnostic Decisions
Abstract 5:
Objective . To evaluate the effect of computer-assisted interpretation of electrocardiograms ( ECGs ) on diagnostic decision making by primary care physicians . Design . R and omized controlled trial . Setting . Primary care physicians ' outpatient clinics in or near the Minneap olis/St . Paul metropolitan area . Participants . Forty family physicians and general internists who were members of either of two large consortia of clinics . Intervention . Subjects evaluated ten clinical vignettes accompanied by ECGs and reported their diagnostic impressions . The vignettes were based on actual patient visits . Half of the subjects received ECGs with computer-generated reports , the other half received the same ECGs without reports . Main outcome measures . ECG reading time ; agreement with the clinical diagnosis ; agreement with the computer report ; diagnostic confidence . Results . The subjects receiving the reports were more likely to agree with the clinical diagnoses of the original cases , particularly for two vignettes in which the diagnoses were uncommon and were mentioned in the reports . The subjects receiving the reports were also more likely to make diagnoses that were consistent with the reports , even when the reports were erroneous . Those receiving the reports spent , on average , 15 seconds less time looking at each ECG , a 25 % decrease . Conclusions . In simulated cases , primary care physicians appear to use computer interpre tations of ECGs when available , as shown by enhanced diagnostic accuracy and modestly reduced time spent reading the tracings . However , erroneous reports may mislead physi cians . Since the effects of computerized ECG interpretation do not appear to have been uniformly favorable in this mock- clinical setting , it will be important to evaluate the effects of this technology in actual practice . Key words : computer-assisted diagnosis ; computer-as sisted decision making ; physician decision making ; electrocardiogram . ( Med Decis Making 1995;15:107 - 112


Title 6:
Differences between local investigator and core laboratory interpretation of the admission electrocardiogram in patients with unstable angina pectoris or non-Q-wave myocardial infarction (a Thrombin Inhibition in Myocardial Ischemia [TRIM] substudy).
Abstract 6:
The present study compares the on-site interpretation of an admission electrocardiogram ( ECG ) with core laboratory results in a large , multicenter trial of 516 patients diagnosed with unstable angina pectoris or non-Q-wave myocardial infa rct ion . The local investigators evaluated the admission ECG regarding ST-T changes before the ECGs were sent to the core laboratory for blinded interpretation . The strength of agreement between the observations was described by kappa statistics . There was a poor agreement regarding identification of ST-segment elevation , with 17 patients identified by the local investigator versus 92 by the core laboratory ( kappa = 0.05 ) . There was a fair agreement on ST-segment depression with 158 patients diagnosed on-site versus 64 by the core laboratory ( kappa = 0.38 ) . Identification of T-wave inversion demonstrated good agreement with 306 patients diagnosed on-site versus 280 by the core laboratory ( kappa = 0.63 ) . A moderate agreement regarding identification of a normal ECG was found with 101 patients on-site versus 135 in the core laboratory ( kappa = 0.42 ) . Independent variables , including peak creatine kinase-MB and 30-day outcome , were more closely related to core laboratory results than the local investigator 's interpretation of the admission ECG . Thus , in the present study , considerable differences were demonstrated between the on-site interpretation of the admission ECG and the blinded evaluation performed in the core laboratory regarding relatively simple electrocardiographic variables . The results suggest that more widespread use of independent evaluation of clinical data should be incorporated in future clinical trials


Title 7:
Improving the interpretation of electrocardiographs in an accident and emergency department.
Abstract 7:
In this study we have examined the ability of senior house officers in the Accident and Emergency ( A&E ) Department to interpret  electrocardiographs ( ECGs )  and tested the value of a single seminar and guidelines on interpretation . We prospect ively audited ECG interpretation taken from notes over a two-month period and repeated this audit following a single seminar by a consultant cardiologist and after the issue of guidelines . A formal test of interpretation of a set of 20 ECGs by senior house officers in A&E was also carried out . 245 case notes were review ed and in one third the ECG was interpreted incorrectly by senior house officers in A&E but incorrect clinical management followed in only 3.2 % of cases . Following the intervention , 242 case notes were review ed and serious misinterpretations were halved as was the number of patients mismanaged as a result ( 1.7 % ) . In conclusion , formal training in ECG interpretation can reduce serious errors
Advanced Cardiac Life Support programs sponsored by the AHA also provide supplemental instruction and testing on abnormal cardiac rhythm recognition in emergency setting s. Successful completion of residency , board certification , and Advanced Cardiac Life Support training are one reasonable method of objective documentation that a physician is competent to interpret bedside ECGs in routine and emergency setting s , pending additional outcomes -based research .
Cardiologists also demonstrate greater accuracy than noncardiologists in ECG interpretation during st and ardized examinations of ECG interpretation when minimal history is given ( 15 ) .