***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 —Delay from onset of acute coronary syndrome ( ACS ) symptoms to hospital admission continues to be prolonged . To date , community education campaigns on the topic have had disappointing results . Therefore , we conducted a clinical r and omized trial to test whether an intervention tailored specifically for patients with ACS and delivered one-on-one would reduce prehospital delay time . Methods and Results — Participants ( n=3522 ) with documented coronary heart disease were r and omized to experimental ( n=1777 ) or control ( n=1745 ) groups . Experimental patients received education and counseling about ACS symptoms and actions required .  Patients had a mean age of 67±11 years , and 68 % were male . Over the 2 years of follow-up , 565 patients ( 16.0 % ) were admitted to an emergency department with ACS symptoms a total of 842 times . Neither median prehospital delay time ( experimental , 2.20 versus control , 2.25 hours ) nor emergency medical system use ( experimental , 63.6 % versus control , 66.9 % ) was different between groups , although experimental patients were more likely than control to call the emergency medical system if the symptoms occurred within the first 6 months following the intervention ( P=0.036 ) . Experimental patients were significantly more likely to  take aspirin after symptom onset than control patients ( experimental , 22.3 % versus control , 10.1 % , P=0.02 ) . The intervention did not result in an increase in emergency department use ( experimental , 14.6 % versus control , 17.5 % ) . Conclusions —The education and counseling intervention did not lead to reduced prehospital delay or increased ambulance use . Reducing the time from onset of ACS symptoms to arrival at the hospital continues to be a significant public health challenge . Clinical Trial Registration — clinical trials.gov . Identifier NCT00734760 Background and Purpose — Less than 25 % of stroke patients arrive to an emergency department within the 3-hour treatment window . Stroke Warning Information and Faster Treatment ( SWIFT ) compared an interactive intervention ( II ) with enhanced educational ( EE ) material s on recurrent stroke arrival times in a prospect i ve cohort of multiethnic stroke/transient ischemic attack survivors . Methods — A single-center r and omized controlled trial ( 2005–2011 ) r and omized participants to EE ( bilingual stroke preparedness material s ) or II ( EE plus in-hospital sessions ) . We assessed differences by r and omization in the proportion arriving to emergency department <3 hours , prepost intervention arrival <3 hours , incidence rate ratio for total events , and stroke knowledge and preparedness capacity . Results — SWIFT r and omized 1193 participants ( 592 EE , 601 II ) : mean age 63 years ; 50 % female , 17 % black , 51 % Hispanic , 26 % white . At baseline , 28 % arrived to emergency department <3 hours . Over 5 years , first recurrent stroke ( n=133 ) , transient ischemic attacks ( n=54 ) , or stroke mimics ( n=37 ) were documented in 224 participants . Incidence rate ratio=1.31 ( 95 % confidence interval=1.05–1.63 ; II to EE ) . Among II , 40 % arrived <3 hours versus 46 % EE ( P=0.33 ) . In prepost analysis , there was a 49 % increase in the proportion arriving <3 hours ( P=0.001 ) , greatest among Hispanics ( 63 % , P<0.003 ) . II had greater stroke knowledge at 1 month ( odds ratio=1.63 ; 1.23–2.15 ) . II had higher preparedness capacity at 1 month ( odds ratio=3.36 ; 1.86 , 6.10 ) and 12 months ( odds ratio=7.64 ; 2.49 , 23.49 ) . Conclusions — There was no difference in arrival <3 hours overall between II and EE ; the proportion arriving <3 hours increased in both groups and in race-ethnic minorities . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00415389 BACKGROUND The literature suggests that people delay too long prior to attending emergency departments with acute coronary syndrome ( ACS ) symptoms . This delay is referred to as prehospital delay . Patient decision delay contributes most significantly to prehospital delay . OBJECTIVES Using a r and omized controlled trial , we tested an educational intervention to reduce patient prehospital delay in ACS and promote appropriate responses to symptoms . METHODS Eligible patients who were admitted across five emergency departments ( EDs ) in Dublin were recruited to the study ( n = 1944 ; control : 972 , intervention : 972 ) . RESULTS Median baseline prehospital delay times did not differ significantly between the groups at baseline ( Mann-Whitney U , p = 0.34 ) ( CONTROL : 4.28 h , 25(th ) percentile = 1.71 , 75(th ) percentile = 17.37 ; Intervention 3.96 h , 25(th ) percentile = 1.53 , 75(th ) percentile = 18.51 ) . Both groups received usual in-hospital care . In addition , patients r and omized to the intervention group received a 40-min individualized education session using motivational techniques . This was reinforced 1 month later by telephone . Of the 1944 , 314 ( 16.2 % ) were readmitted with ACS symptoms : 177 ( 18.2 % ) and 137 ( 14.1 % ) of the intervention and control groups , respectively . Prehospital delay times were again measured . Median delay time was significantly lower in the intervention compared to the control group ( 1.7 h vs. 7.1 h ; p ≤ 0.001 ) . Appropriately , those in the intervention group reported their symptoms more promptly to another person ( p = 0.01 ) and fewer consulted a general practitioner ( p = 0.02 ) . There was no significant difference in ambulance use ( p = 0.51 ) or nitrate use ( p = 0.06 ) between the groups . CONCLUSION It is possible to reduce prehospital delay time in ACS , but the need for renewed emphasis on ambulance use is important OBJECTIVES A 10-month direct mail campaign was implemented to increase use of emergency medical services via 911 calls and to reduce prehospital delay for individuals experiencing acute myocardial infa rct ion symptoms . METHODS This prospect i ve , r and omized , controlled trial involved three intervention groups ( receiving brochures with informational , emotional , or social messages ) and a control group . RESULTS Intervention effects were not observed except for individuals who had a history of acute myocardial infa rct ion and who were discharged with a diagnosis of acute myocardial infa rct ion ; their 911 use was meaningfully higher in each intervention group than in the control group . CONCLUSIONS The mailings affected only the individuals at greatest risk Prehospital delay is a major problem in the management of patients with acute cardiac ischemia . The authors created a patient teaching program consisting of an educational video and written instructions design ed to reduce prehospital delays in patients with chest pain . Patients who received st and ard discharge instructions served as the control group , whereas those who received the new patient teaching in addition to st and ard discharge instructions  served as the intervention group . Of the 500 enrolled , 19 % were rehospitalized within 1 year . Analysis of rehospitalizations showed no significant difference between the two groups on the three outcome variables : percentage who presented within the first hour of pain , use of ambulance , and time from anginal onset to emergency department arrival . In a comparison of the index hospitalization to the rehospitalization , there was a significant increase in the use of ambulances for the intervention group , p = .03 , but not for the control group Background and Purpose — Only a small minority of acute stroke patients receive approved acute stroke therapy . We performed a community and professional behavioral intervention project to increase the proportion of stroke patients treated with approved acute stroke therapy .  Methods — This study used a quasi-experimental design .  Intervention and comparison communities were compared at baseline and during educational intervention .  The communities were based in 5 nonurban East Texas counties . The multilevel intervention worked with hospitals and community physicians while changing the stroke identification skills , outcome expectations , and social norms of community residents . The primary goal was to increase the proportion of patients treated with intravenous recombinant tissue plasminogen activator ( rTPA )  from 1 % to 6 % of all cerebrovascular events in the intervention community . Results — We prospect ively evaluated 1733 patients and vali date d 1189 cerebrovascular events .  Intravenous rTPA treatment increased from 1.38 % to 5.75 % among all cerebrovascular event patients in the intervention community ( P = 0.01 ) compared with a change from 0.49 % to 0.55 % in the comparison community ( P = 1.00 ) . Among the  ischemic stroke patients , an increase from 2.21 % to 8.65 % was noted in the intervention community ( P = 0.02 ) . The comparison group did not appreciably change ( 0.71 % to 0.86 % , P = 1.00 ) . Of eligible intravenous rTPA c and i date s , treatment increased in the intervention community from 14 % to 52 % ( P = 0.003 ) and was unchanged in the comparison community ( 7 % to 6 % , P = 1.00 ) . Conclusions — An aggressive , multilevel stroke educational intervention program can increase delivery of acute stroke therapy . This may have important public health implication s for reducing disability on a national level Background Urgent assessment is essential after stroke . Several countries have had public education campaigns , based on the FAST ( Face-Arm-Speech-Time ) test to reduce delays in seeking attention . However , the impact of these campaigns on patient behavior is uncertain . Methods We prospect ively determined  patient behavior  after incident major stroke ( NIHSS > 3 ) in a UK population based study ( Oxford Vascular Study ) before ( 2002–2008 ) and after ( 2009–2013 ) introduction of the FAST TV-campaign and assessed any sustained impact of campaign continuation . Results Among 668 consecutive patients with major stroke , medical attention was sought by a byst and er in 553 ( 89·6 % ) . Patients were more likely to present directly to emergency services ( OR = 2·18 , 95%CI:1·54–3·09 , P < 0·0001 ) after the campaign and to arrive at hospital within 3 h ( OR = 2·18 , 1·55–3·06 , P < 0·0001 ) . Median [ IQR ] time to seeking attention fell from 53 [ 15–265 ] to 31 [ 7–120 ] minutes ( P = 0·005 ) and median time to hospital arrival from 185 [ 88–885 ] to 119 [ 78–256 ] minutes ( P < 0·0001 ) . On time-series analysis improvements in hospital arrival within 3 h and use of emergency medical services were significantly associated to initiation of the campaign ( aOR = 3·11 , 1·53–6·29 , P = 0·002 ; and 2·22 , 1·05–4·67 , P = 0·036 , respectively ) , independent of trend , age , sex , ethnicity , educational level , social class , prior stroke and stroke severity , and have been sustained to 2013 . Conclusion Delays to seeking and receiving medical attention after major stroke in the UK . fell strikingly in 2009 , coinciding with the start of the FAST TV campaign . That medical attention was sought by a byst and er in nearly 90 % of cases illustrates the importance of mass-media public education rather than focused programs in high-risk groups for major stroke As part of the recruitment efforts for the National Institutes of Health Tissue Plasminogen Activator Pilot Study , public education and awareness campaigns were conducted to encourage early hospital arrival . We evaluated the change in arrival times during the course of the study for all stroke patients , including those who were not entered into study . Methods Data were gathered on all patients presenting within 24 hours of stroke onset to all of the study hospitals . Coincident with the start of the study , educational and promotional programs , which stressed signs and symptoms of stroke and the need to call 911 , were presented to physicians , paramedical personnel , and the public . The study was divided into four quartiles to analyze differences in time to hospital arrival and use of 911 . Results Of 2099 patients screened , time data were available on 1116 . During the course of the study , the mean time from symptom onset to hospital arrival declined significantly ( 3.2 hours versus 1.5 hours ) . Patients arrived for treatment sooner at community hospitals than at university/teaching hospitals . The use of 911  increased from 39 % in the first quartile of the study to 60 % in the fourth quartile . This was a consistent finding in all study sites . Increased use of 911  was seen almost exclusively in patients with nonhemorrhagic stroke . Conclusions Times from stroke onset to hospital arrival decreased significantly during the course of the National Institutes of Health Tissue Plasminogen Activator Pilot Study . Significantly increased use of 911  was the likely major explanation for the shortened arrival times . The decrease in arrival times may be a consequence of the public and professional education programs conducted at all study sites OBJECTIVE : 
    Output:
    
No clear pattern between BCTs and effectiveness was found .
Conclusions Around half of the interventions to reduce prehospital delay with time-critical symptoms report a significant reduction in delay time .
It is not clear what differentiates effective from non-effective interventions , although in relation to patient delay particularly additional use of BCTs might be helpful .