***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: Abstract Objective : To compare the effect of individual educational visits versus group visits using academic detailing to discuss prescribing of highly anticholinergic antidepressants in elderly people . Design : R and omised controlled trial with three arms ( individual visits , group visits , and a control arm ) . Setting : Southwest Netherl and s. Participants : 190 general practitioners and 37 pharmacists organised in 21 peer review groups were studied using a data base covering all prescriptions to people covered by national health insurance in the area ( about 240 000 ) . Intervention : All general practitioners and pharmacists in both intervention arms were offered two educational visits . For physicians in groups r and omised to the individual visit arm , 43 of 70 general practitioners participated ; in the group visit intervention arm , five of seven groups ( 41 of 52 general practitioners ) participated . Main outcome measures : Numbers of elderly people ( 60 years ) with new prescriptions of highly anticholinergic antidepressants and less anticholinergic antidepressants . Results : An intention to treat analysis found a 26 % reduction in the rate of starting highly anticholinergic antidepressants in elderly people ( 95 % confidence interval —4 % to 48 % ) in the individual intervention arm and 45 % ( 8 % to 67 % ) in the group intervention arm . The use of less anticholinergic antidepressants increased by 40 % ( 6 % to 83 % ) in the individual intervention arm and 29 % ( —7 % to 79 % ) in the group intervention arm . Conclusions : Both the individual and the group visits decreased the use of highly anticholinergic antidepressants and increased the use of less anticholinergic antidepressant in elderly people . These approaches are practical means to improve prescribing by continuing medical education PURPOSE Postpartum depression is common but inadequately recognized and undertreated . Continuing depressive symptoms are associated with adverse outcomes for the woman , her infant , and family . We wanted to determine the effect of a practice -based training program for screening , diagnosis , and management of depression in postpartum mothers . METHODS In this practice -based effectiveness study , 28 practice s were r and omized to usual care ( n = 14 ) or intervention ( n = 14 ) , and 2,343 women were enrolled between 5 and 12 weeks ’ postpartum . The intervention sites received education and tools for postpartum depression screening , diagnosis , initiation of therapy , and follow-up within their practice s. Usual-care practice s received a 30-minute presentation about postpartum depression . Screening information for the usual care was obtained from baseline surveys sent directly to the central site but was not available for patient care . Outcomes were based on patient-reported outcomes ( level of depressive symptoms ) from surveys at 6 and 12 months , plus medical record review ( diagnosis and therapy initiation ) . RESULTS Among the 2,343 women enrolled , 1,897 ( 80.1 % ) provided outcome information , and were included in the analysis . Overall , 654 ( 34.5 % of 1,897 ) women had elevated screening scores indicative of depression , with comparable rates in the intervention and usual-care groups . Among the 654 women with elevated postpartum depression screening scores , those in the intervention practice s were more likely to receive a diagnosis ( P = .0006 ) and therapy for postpartum depression ( P = .002 ) . They also had lower depressive symptom levels at 6 ( P = .07 ) and 12 months ’ ( P=.001 ) postpartum . CONCLUSIONS Primary care – based screening , diagnosis , and management improved  mother ’s depression  outcomes at 12 months . This practical approach could be implemented widely with modest re sources OBJECTIVE In 2004 , results from The Texas Medication Algorithm Project ( TMAP ) showed better clinical outcomes for patients whose physicians adhered to a paper- and -pencil algorithm  compared to patients who received st and ard clinical treatment for major depressive disorder ( MDD ) . However , implementation of and fidelity to the treatment algorithm among various providers was observed to be inadequate . A computerized decision support system ( CDSS ) for the implementation of the TMAP algorithm for depression has since been developed to improve fidelity and adherence to the algorithm . METHOD This was a 2-group , parallel design , clinical trial ( one patient group receiving MDD treatment from physicians using the CDSS and the other patient group receiving usual care ) conducted at 2 separate primary care clinics in Texas from March 2005 through June 2006 . Fifty-five patients with MDD ( DSM-IV criteria ) with no significant difference in disease characteristics were enrolled , 32 of whom were treated by physicians using CDSS and 23 were treated by physicians using usual care .  The study 's objective was to evaluate the feasibility and efficacy of implementing a CDSS to assist physicians acutely treating patients with MDD compared to usual care in primary care . Primary efficacy outcomes for depression symptom severity were based on the 17-item Hamilton Depression Rating Scale ( HDRS(17 ) ) evaluated by an independent rater . RESULTS Patients treated by physicians employing CDSS had significantly greater symptom reduction , based on the HDRS(17 ) , than patients treated with usual care ( P < .001 ) . CONCLUSIONS The CDSS algorithm , utilizing measurement-based care , was superior to usual care for patients with MDD in primary care setting s. Larger r and omized controlled trials are needed to confirm these findings . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00551083 Objective : The goal of this study was to assess the effects of training primary care providers ( PCPs ) to use Motivational Interviewing ( MI ) when treating depressed patients on providers ' MI performance and patients ' expressions of interest in depression treatment ( “ change talk ” ) and short-term treatment adherence . Methods : This was a cluster r and omized trial in urban primary care clinics ( 3 intervention , 4 control ) . We recruited 21 PCPs ( 10 intervention , 11 control ) and 171 English-speaking patients with newly diagnosed depression ( 85 intervention , 86 control ) .  MI training included a baseline and up to 2 refresher classroom trainings , along with feedback on audiotaped patient encounters . We report summary measures of technical ( rate of MI-consistent statements per 10 minutes during encounters ) and relational ( global rating of “ MI Spirit ” ) MI performance , the association between MI performance and number of MI trainings attended ( 0 , 1 , 2 , or 3 ) , and rates of patient change talk regarding depression treatments ( physical activity , antidepressant medication ) . We report PCP use of physical activity recommendations and antidepressant prescriptions and patients ' short-term physical activity level and prescription fill rates . Results : Use of MI-consistent statements was 26 % higher for MI-trained versus control PCPs ( P = .005 ) . PCPs attending all 3 MI trainings ( n = 6 ) had 38 % higher use of MI-consistent statements ( P < .001 ) and were over 5 times more likely to show beginning proficiency in MI Spirit ( P = .036 ) relative to control PCPs . Although PCPs ' use of physical activity recommendations and antidepressant prescriptions was not significantly different by r and omization arm , patients seen by MI-trained PCPs had more frequent change talk ( P = .001 ) . Patients of MI-trained PCPs also expressed change talk about physical activity 3 times more frequently ( P = .01 ) and reported more physical activity ( 3.05 vs 1.84 days in the week after the visit ; P = .007 ) than their counterparts visiting untrained PCPs . Change talk about antidepressant medication and fill rates were similar by r and omization arm ( P > .05 for both ) . Conclusions : MI training result ed in improved MI performance , more depression-related patient change talk , and better short-term adherence This study tests whether a managed behavioral health care organization can influence adherence to practice guidelines for the treatment of  major depression  in a r and omized trial of guideline dissemination . Guidelines were disseminated to mental health clinicians ( N=443 ) under one of three conditions : ( 1 ) a general mailing of guidelines to clinicians , ( 2 ) a mailing in which guidelines were targeted to a patient starting treatment with the clinician , and ( 3 ) no mailing of guidelines . The results showed no effects of guideline dissemination as measured by self-report of patients and clinicians and through episode characteristics derived from cl aims data , despite sentinel effects . Results also showed high rates of clinician-reported guideline adherence that were not detected in the cl aims data , indicating significant undertreatment of depression . Results suggest that mental health systems must look to other dissemination strategies to improve adherence to st and ards of care and raise the performance of independent practicing BACKGROUND Scientific literature review s aim to summarize the state of knowledge and published empirical evidence . In contrast , medical guidelines are intervention tools that aim to improve physician behaviour and patient outcome . They can have positive effects , but they can also have negative effects . Their effects must be tested by research . METHODS In a r and omized controlled trial , 103 psychiatrists in private practice were either provided with the WHO depression guideline only ( information group ) , or provided with the WHO depression guideline and trained for one day in this guideline ( intervention group ) , or left uninformed ( control group ) . They then treated a total of 497 patients according to individual clinical considerations and the needs of the patients . Observation of routine treatment lasted 12weeks . Physicians and patients documented the course of illness and treatment , including the patient-physician interaction . RESULTS Psychiatrists in the intervention group saw more psychosocial stressors in their patients , prescribed higher dosages of medication , had fewer drop-outs , and rated treatment outcome as better . The ratings of patient-physician interactions indicated more strain in their relationships . CONCLUSIONS The results show both positive and negative effects of guideline exposure , but only in the training group and not in the information group . Guidelines should be empirically tested before being called " evidence based " . Every guideline should also explain how it can or must be implemented in order to become effective Background The prevalence of depression is high and the elderly have an increased risk of developing chronic course . International data suggest that depression in the elderly is under-recognised , the latency before clinicians provide a treatment plan is longer and elderly patients with depression are not offered psychotherapy to the same degree as younger patients . Although recommendations for the treatment of elderly patients with depression exist , health-care professionals adhere to these recommendations to a limited degree only . We conducted a systematic review to identify recommendations for managing depression in the elderly and prioritised six recommendations . We identified and prioritised the determinants of practice related to the implementation of these recommendations in primary care , and subsequently discussed and prioritised interventions to address the identified determinants . The objective of this study is to evaluate the effectiveness of these tailored interventions for the six recommendations for the management of elderly patients with depression in primary care . Methods / design We will conduct a pragmatic cluster r and omised trial comparing the implementation of the six recommendations using tailored interventions with usual care . We will r and omise 80 municipalities into one of two groups : an intervention group , to which we will deliver tailored interventions to implement the six recommendations , and a  control group , to which we will not deliver any intervention . We will r and omise municipalities rather than patients , individual clinicians or practice s , because we will deliver the intervention for the first three recommendations at the municipal level and we want to minimise the risk of contamination across GP practice s for the other three recommendations . The primary outcome is the proportion of actions taken by GPs that are consistent with the recommendations . Discussion This trial will investigate whether a tailored implementation approach is an effective strategy for improving collaborative care in the municipalities and health-care professionals ’ practice towards elderly patients with depression in primary care . The effectiveness evaluation described in this protocol will be accompanied with a process evaluation exploring why and how the interventions were effective or ineffective . Trial registration Clinical Trials.gov : Background Meta-analyses show collaborative care models ( CCMs ) with nurse care management are effective for improving primary care for depression . This study aim ed to develop CCM approaches that could be sustained and spread within Veterans Affairs ( VA ) .  Evidence -based quality improvement ( EBQI ) uses QI approaches within a research / clinical partnership to re design care . The study used EBQI methods for CCM re design , tested the effectiveness of the locally adapted model as implemented , and assessed the context ual factors shaping intervention effectiveness . Methods The study intervention is EBQI as applied to CCM implementation . The study uses a cluster r and omized design as a formative evaluation tool to test and improve the effectiveness of the re design process , with seven intervention and three non-intervention VA primary care practice s in five different states . The primary study outcome is patient antidepressant use . The context evaluation is descriptive and uses subgroup analysis . The primary context evaluation measure is naturalistic primary care clinician ( PCC ) predilection to adopt CCM.For the r and omized evaluation , trained telephone research interviewers enrolled consecutive primary care patients with major depression in the evaluation , referred enrolled patients in intervention practice s to the implemented  CCM  , and re-surveyed at seven months . Results Interviewers enrolled 288 CCM site and 258 non-CCM site patients . Enrolled intervention site patients were more likely to receive appropriate antidepressant care ( 66 % versus 43 % , p = 0.01 ) , but showed no significant difference in symptom improvement compared to usual care . In terms of context , only 40 % of enrolled patients received complete care management per protocol . PCC predilection to adopt CCM had substantial effects on patient participation 
    Output:
    
Results were heterogeneous and analyses comparing provider interventions with usual clinical practice did not indicate a statistically significant difference in guideline adherence across studies .
There was some evidence that provider interventions improved individual outcomes such as medication prescribing and indirect comparisons indicated more complex provider interventions may be associated with more favorable outcomes .
We did not identify types of provider interventions that were consistently associated with improvements across indicators of adherence and across studies .
Effects on patients ’ health in these RCTs were inconsistent across studies and outcomes .
Conclusions Existing RCTs describe a range of provider interventions to increase adherence to depression guidelines .