***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 Psychological theories of behaviour may provide a framework to guide the design of interventions to change professional behaviour . Behaviour change interventions , design ed using psychological theory and targeting important motivational beliefs , were experimentally evaluated for effects on the behavioural intention and simulated behaviour of GPs in the management of uncomplicated upper respiratory tract infection ( URTI ) . Methods The design was a 2 × 2 factorial r and omised controlled trial . A postal question naire was developed based on three theories of human behaviour : Theory of Planned Behaviour ; Social Cognitive Theory and Operant Learning Theory . The beliefs and attitudes of GPs regarding the management of URTI without antibiotics and rates of prescribing on eight patient scenarios were measured at baseline and post-intervention . Two theory-based interventions , a " grade d task " with " action planning " and a " persuasive communication " , were incorporated into the post-intervention question naire . Trial groups were compared using co-variate analyses . Results Post-intervention question naires were returned for 340/397 ( 86 % ) GPs who responded to the baseline survey . Each intervention had a significant effect on its targeted behavioural belief : compared to those not receiving the intervention GPs completing Intervention 1 reported stronger self-efficacy scores ( Beta = 1.41 , 95 % CI : 0.64 to 2.25 ) and GPs completing Intervention 2 had more positive anticipated consequences scores ( Beta = 0.98 , 95 % CI = 0.46 to 1.98 ) . Intervention 2 had a significant effect on intention ( Beta = 0.90 , 95 % CI = 0.41 to 1.38 ) and simulated behaviour ( Beta = 0.47 , 95 % CI = 0.19 to 0.74 ) . Conclusion GPs ' intended management of URTI was significantly influenced by their confidence in their ability to manage URTI without antibiotics and the consequences they anticipated as a result of doing so . Two targeted behaviour change interventions differentially affected these beliefs . One intervention also significantly enhanced GPs ' intentions not to prescribe antibiotics for URTI and result ed in lower rates of prescribing on patient scenarios compared to a control group . The theoretical frameworks utilised provide a scientific rationale for underst and ing how and why the interventions had these effects , improving the reproducibility and generalisability of these findings and offering a sound basis for an intervention in a " real world " trial . Trial registration Clinical trials.gov BACKGROUND Suspected acute viral upper respiratory tract infection ( SAVURTI ) is the commonest acute reason why children consult in general practice . The clinical course varies widely and about one in five children re-consult for the same SAVURTI episode . If clinicians had feasible tools for predicting which children are likely to suffer a prolonged course , then additional explanations and possibly treatments could be provided at the initial consultation that might enable carers to manage the condition without re-consulting . OBJECTIVE To identify features available on the day of consulting that might predict a prolonged clinical course among children with SAVURTI . METHOD Regression analysis using Canadian Respiratory Illness and Flu Scale ( CARIFS ) data from a r and omized controlled trial cohort of children aged from 6 months to 12 years consulting in general practice with SAVURTI . RESULTS Two variables from the clinician 's records ( ' age ' and ' cough ' ) and two variables from the CARIFS completed by carers on the day of consulting ( ' fever ' and ' low energy , tired ' ) explained approximately 15 % of the variation present in CARIFS scores on day seven . CONCLUSION Children and carers may benefit from a clear account of the evidence that the clinical course of RTIs in children varies widely and may be longer that expected , and that prediction for individuals is difficult Background Biomedical research constantly produces new findings , but these are not routinely incorporated into health care practice . Currently , a range of interventions to promote the uptake of emerging evidence are available . While their effectiveness has been tested in pragmatic trials , these do not form a basis from which to generalise to routine care setting s. Implementation research is the scientific study of methods to promote the uptake of research findings , and hence to reduce inappropriate care . As clinical practice is a form of human behaviour , theories of human behaviour that have proved to be useful in other setting s offer a basis for developing a scientific rationale for the choice of interventions . Aims The aims of this protocol are 1 ) to develop interventions to change beliefs that have already been identified as antecedents to antibiotic prescribing for sore throats , and 2 ) to experimentally evaluate these interventions to identify those that have the largest impact on behavioural intention and behavioural simulation . Design The clinical focus for this work will be the management of uncomplicated sore throat in general practice . Symptoms of upper respiratory tract infections are common presenting features in primary care . They are frequently treated with antibiotics , and research evidence is clear that antibiotic treatment offers little or no benefit to otherwise healthy adult patients .Reducing antibiotic prescribing in the community by the " prudent " use of antibiotics is seen as one way to slow the rise in antibiotic resistance , and appears safe , at least in children . However , our underst and ing of how to do this is limited . Participants will be general medical practitioners .  Two theory-based interventions will be design ed to address the discriminant beliefs in the prescribing of antibiotics for sore throat , using empirically derived re sources . The interventions will be evaluated in a 2 × 2 factorial r and omised controlled trial delivered in a postal question naire survey . Two outcome measures will be assessed : behavioural intention and behavioural simulation Little is known about incorporation of new knowledge from r and omised clinical trials into clinical practice . Thrombolytic therapy was shown to reduce the mortality of acute myocardial infa rct ion in several large trials published during 1986 - 88 . To examine the effect of these data on clinical practice , we analysed the supply of thrombolytic drugs in a representative English region ( population 4.7 million ) in 1987 - 92 . During the study period there were over 10,000 hospital admissions per year in the region for acute myocardial infa rct ion . From a very low initial level ,  thrombolytic drug use rose slowly for several years after publication of the trial results and reached a plateau in 1991 - 92 . Rates of use per 1000 patients admitted with myocardial infa rct ion varied almost six-fold between districts in 1989 - 90 and over two-fold in 1991 - 92 . Level of use attained by districts in the latter period was strongly associated with the extent of their previous participation in multicentre trials of thrombolysis ( p = 0.003 ) ; we estimate that 35 - 50 % of patients admitted with acute myocardial infa rct ion were receiving thrombolytics . The full potential of thrombolytic treatment has still not been achieved in routine care and the limiting factors need to be defined Background Psychological models can be used to underst and and predict behaviour in a wide range of setting s. However , they have not been consistently applied to health professional behaviours , and the contribution of differing theories is not clear . The aim of this study was to explore the usefulness of a range of psychological theories to predict health professional behaviour relating to management of upper respiratory tract infections ( URTIs ) without antibiotics . Methods Psychological measures were collected by postal question naire survey from a r and om sample of general practitioners ( GPs ) in Scotl and . The outcome measures were clinical behaviour ( using antibiotic prescription rates as a proxy indicator ) ,  behavioural simulation ( scenario-based decisions to managing URTI with or without antibiotics ) and behavioural intention ( general intention to managing URTI without antibiotics ) . Explanatory variables were the constructs within the following theories : Theory of Planned Behaviour ( TPB ) , Social Cognitive Theory ( SCT ) , Common Sense Self-Regulation Model ( CS-SRM ) , Operant Learning Theory ( OLT ) , Implementation Intention ( II ) , Stage Model ( SM ) , and knowledge ( a non-theoretical construct ) . For each outcome measure , multiple regression analysis was used to examine the predictive value of each theoretical model individually . Following this ' theory level ' analysis , a ' cross theory ' analysis was conducted to investigate the combined predictive value of all significant individual constructs across theories . Results All theories were tested , but only significant results are presented . When predicting behaviour , at the theory level , OLT explained 6 % of the variance and , in a cross theory analysis , OLT ' evidence of habitual behaviour ' also explained 6 % . When predicting  behavioural simulation  , at the theory level , the proportion of variance explained was : TPB , 31 % ; SCT , 26 % ; II , 6 % ; OLT , 24 % . GPs who reported having already decided to change their management to try to avoid the use of antibiotics made significantly fewer scenario-based decisions to prescribe . In the cross theory analysis , perceived behavioural control ( TPB ) , evidence of habitual behaviour ( OLT ) , CS-SRM cause ( chance/bad luck ) , and intention entered the equation , together explaining 36 % of the variance . When predicting intention , at the theory level , the proportion of variance explained was : TPB , 30 % ; SCT , 29 % ; CS-SRM 27 % ; OLT , 43 % . GPs who reported that they had already decided to change their management to try to avoid the use of antibiotics had a significantly higher intention to manage URTIs without prescribing antibiotics . In the cross theory analysis , OLT evidence of habitual behaviour , TPB attitudes , risk perception , CS-SRM control by doctor , TPB perceived behavioural control and CS-SRM control by treatment entered the equation , together explaining 49 % of the variance in intention . Conclusion The study provides evidence that psychological models can be useful in underst and ing and predicting clinical behaviour . Taking a theory-based approach enables the creation of a replicable methodology for identifying factors that predict clinical behaviour . However , a number of conceptual and method ological challenges remain OBJECTIVES : General practitioners ( GPs ) in the UK continue to prescribe antibiotics for patients with sore throats despite evidence that they are ineffective and can contribute to the growth of antibiotic resistance in the population . This study uses the theory of planned behaviour ( TPB ) to investigate the strength of intention to prescribe  antibiotics , and to identify the salient beliefs associated with this intention . DESIGN : Cross-sectional study testing hypotheses derived from the TPB . METHOD : A 66-item postal question naire was distributed to a r and om sample of GPs in one NHS region ( N = 185 ) . The question naire included measures of  intention to prescribe antibiotics , attitude , behavioural beliefs and evaluations , normative beliefs and evaluations , perceived behavioural control , control beliefs , and past prescribing .  RESULTS : Two-thirds of the GPs returned complete question naires ( N = 126 , 68 % ) . The majority intended to prescribe antibiotics for less than half of their patients with sore throats ( N = 69 , 55 % ) . The variables specified in TPB predicted 48 % of the variance in intention , with past behaviour adding a further 15 % . Seven salient beliefs distinguished between doctors who intend to prescribe antibiotics and those who do not . CONCLUSIONS : Attitudes towards antibiotics and control beliefs are important predictors of intention to prescribe , as predicted by TPB . Interventions could target salient beliefs associated with motivation to prescribe A consistent finding in health services research is the report of uneven uptake of research findings . Implementation trials have a variable record of success in effectively influencing clinicians ' behaviour . A more systematic approach may be to conduct Intervention Modelling Experiments before service-level trials , examining intervention effects on ' interim endpoints ' representing clinical behaviour , derived from empirically supported psychological theories . The objectives were to : ( 1 ) Design Intervention Modelling Experiments by backward engineering a ' real-world ' r and omised controlled trial ( NEXUS ) ; ( 2 ) examine the applicability of psychological theories to clinical decision-making ; ( 3 ) explore whether psychological theories can illuminate how interventions achieve their effects . A 2 x 2 factorial r and omised controlled trial was design ed with pre- and post-intervention data collection by postal question naire surveys . The first survey was used to generate feedback data and the interventions were delivered in the second survey . General medical practitioners ( GPs ) in Engl and and Scotl and participated . First survey respondents were r and omised twice to receive or not audit and feedback and educational reminder messages . The main outcome measures included behavioural intention ( general plan to refer for lumbar X-rays ) and simulated behaviour ( specific , scenario-based , decisions to refer for lumbar X-ray ) . Predictors were attitude , subjective norm , perceived behavioural control ( theory of planned behaviour ) , self-efficacy ( social cognitive theory ) and decision difficulty . Both interventions significantly influenced simulated behaviour , but neither influenced behavioural intention . There were no interaction effects . All theoretically derived cognitions significantly predicted simulated behaviour . Only subjective norm was not predictive of behavioural intention . The effect of audit and feedback on simulated behaviour was mediated through perceived behavioural control . The results of this study suggest that Intervention Modelling Experiments , using psychological models to help isolate mediators of clinical decision-making , may be a means of developing more potent interventions , and selecting implementation interventions with a greater likelihood of success in a service-level r and omised controlled trial Objective The lag between publication of evidence for clinical practice and implementation by clinicians may be decades . Research using psychological models demonstrates that changing intention is very important in changing behaviour . This study examined an intervention ( rehearsing alternative actions ) to change dentists ' intention to implement evidence -based practice ( EBP ) for third molar ( TM ) management . Design R and omised controlled trial / postal . Setting Primary care . Subjects and methods Dentists were r and omly selected from the Scottish Dental Practice 
    Output:
    
Conclusion It is feasible to systematic ally develop theoretically-based interventions to change professional practice .