***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 The decreased use of electronic fetal monitoring ( EFM ) for healthy women in labour and the increased provision of professional support to all women in labour is recommended by experts . We evaluated the effectiveness of a community-wide approach to transferring research results to practice using a regional committee , newsletter articles and annual conference presentations compared with an additional tailored hospital intervention involving workshops to enhance self-efficacy for nurses , policy review , multidisciplinary meetings , rounds and unit discussion s. METHODS We compared the proportion of women at low risk who received EFM and the proportion of nurses ' time spent providing labour support before and after the intervention within each of 4 hospitals ( 2 tertiary and 2 secondary ) . One hospital of either type was r and omly selected to receive the tailored intervention .  R and omly selected charts ( n = 200 ) were review ed for the use of EFM at each hospital before ( 1995 ) and after ( 1996 ) the intervention . Trained observers at r and omly selected times recorded the nurses ' activities , including time spent providing labour support before and after the intervention . RESULTS At the intervention secondary hospital , there was a large decrease in the use of EFM  , from 90.1 % before to 41.0 % after the intervention ( p < 0.001 ) , but no change in nurses ' time spent providing labour support . At the intervention tertiary hospital there was no change in EFM rates , but there was a small , statistically significant increase in time spent providing labour support ( 23.5 % to 29.8 % , p < 0.001 ) . A negative effect on time spent providing labour support was found at the control secondary hospital ( decrease from 19.6 % to 12.8 % , p < 0.001 ) , with no change in the EFM rate . At the control tertiary hospital there was a small decrease in the use of EFM  , from 99.5 % to 91.4 % ( p < 0.001 ) , but no change in time spent providing labour support . INTERPRETATION The results are mixed , and the tailored intervention thus appeared to have limited effects . No association was found between the reduction in the use of EFM  and an increase in nurses ' time spent providing labour support Opinion leaders ( OLs ) are members within a social group with significant social influence over others . A guideline on urinary catheter care was introduced in three groups ( A , B and C ) of two r and omly allocated wards . Two OLs per ward were identified by nurses in groups A and B , using a sociometric method . For education , inservice lectures for 30 % of  nurses  and OLs tutorials for all nurses were used in group A ; OLs tutorials in B , lectures in C and ward nurses were in turn responsible for educating new arrivals of student nurses . Before and after the education programme , the guideline 's frequency of practice was assessed by surveying 30 % of r and omly selected nurses and by direct observation for incorrect practice s. A student 's quiz on the guideline was also conducted . For all three methods of measurement , the best results were in group A followed by B and C ; and the differences for the three groups were significant ( p less than 0.05 ) . This indicates that continuing education in the hospital can be effectively conducted by the enlistment of ward OLs Studies at area hospitals revealed many gaps between research evidence and intrapartum nursing practice s. A r and omized controlled trial involving 20 hospitals was used to evaluate the effectiveness of a marketing strategy to promote research -based nursing care . It was hypothesized that the strategy would result in lower rates of epidural analgesia , through increasing the amount of support nurses provided to their patients . Other outcomes included rates of narcotic analgesia , episiotomy , and operative delivery . The marketing strategy was unsuccessful in improving intrapartum nursing care . Much more research is needed about the factors that facilitate improvements in nursing practice The statistical methodology of health research experiments published in Lancet , the New Engl and Journal of Medicine , and Medical Care between 1975 and 1980 for the presence or absence of an error of experimental design and analysis was examined . The error is the result of inappropriately using patient-related observations as the unit of analysis to form conclusions about provider behavior or outcomes determined jointly by patients and providers . The error was present in 20 of 28 ( 71 % ) health care experiments addressing an issue of health provider professional performance . Its usual effect is to increase erroneously the power of an experiment to detect differences between experimental and control groups . It is likely that this type of error could be avoided by the explicit and prospect i ve definition of hypotheses and the population s to which they are intended to pertain BACKGROUND Pain prevalence in nursing homes remains high , with multiple resident , staff , and physician barriers presenting serious challenges to its improvement . AIMS The study aims were to ( 1 ) develop and test a multifaceted , culturally competent intervention to improve nursing home pain practice s ; ( 2 ) improve staff , resident , and physician knowledge and attitudes about pain and its management ; ( 3 ) improve actual pain practice s in nursing homes ; and ( 4 ) improve nursing home policies and procedures related to pain . METHODS A multifaceted , culturally competent intervention was developed and tested in six Colorado nursing homes , with another six nursing homes serving as control sites . Both educational and behavioral change strategies were employed . FINDINGS The intervention was successful in improving the percentage of residents reporting constant pain in the treatment homes . Context ual factors ( implementation of Medicare 's Nursing Home Compare report card ) appeared to exert a positive influence on pain documentation . There was no reduction in the percentage of residents reporting pain or reporting moderate/severe pain . DISCUSSION Multiple challenges to quality improvement exist in nursing homes . Turnover of nursing staff reduced actual exposure to the intervention , and turnover of directors of nursing influenced constancy of message and overall facility stability . Residents often failed to report their pain , and physicians were reluctant to alter their prescribing practice s. IMPLICATION S Any intervention to improve pain management in nursing homes must target explicitly the residents , nursing home staff , and primary care physicians . Implementation strategies need to accommo date the high turnover rates among staff , as well as the changes among the nursing home leadership . CONCLUSIONS Pain is a complex problem in the nursing home setting . Multiple factors must be considered in both the design and implementation of interventions to improve pain practice s and reduce pain prevalence in nursing homes This research tested the effectiveness of the second tier of interventions in a two-tiered nursing intervention model design ed to improve quality of care for residents in long-term care facilities ( LTCFs ) . The first tier of the model called for gerontological advanced practice nurses ( GAPNs ) to provide direct care and to teach staff to implement care protocol s for residents with incontinence , pressure ulcers , depression , and aggression . Results of the first-tier study indicated significant improvement in resident outcomes in incontinence , pressure ulcers , and aggression . In the second tier , GAPNs added a set of organization-level ( OL ) interventions including membership on the LTCF quality assurance committee and collaborating with staff on problem-solving teams . Analysis following the addition of OL interventions revealed significant improvement in both depression scores and in the trajectory of depression in residents of the LTCF where OL interventions were used It is not uncommon for a decade to pass between the time a research problem is identified and the time that research -based solutions are translated into st and ards for care . This quasi-experimental study demonstrated the effectiveness of a collaborative research utilization model directed towards the transfer of specific research -based knowledge ( pain assessment ) into practice for the purpose of helping to solve pain management problems . At the same time , nurses who participated in the model significantly improved their competency in research utilization and their attitudes towards research when compared to a control group who did not participate in the model ABSTRACT This study examines the effects of a home health intervention design ed to st and ardize nursing care , strengthen nurses ' support for patient self-management and yield better CHF patient outcomes . Participants were 371 Medicare CHF patients served by 205 nurses r and omized to intervention and control groups in a large urban home health care agency ( HHA ) . The intervention consisted of an evidence -based nursing protocol , patient self-care guide , and training to improve nurses ' teaching and support skills . Outcome measures included home care , physician and emergency department ( ED ) use , hospital admission , condition-specific quality of life ( QoL ) , satisfaction with home care services and survival at 90 days . The intervention was associated with a marginally significant reduction in the volume of skilled nursing visits ( p = .074 ) , and a reduction variation in the typical number of visits provided ( p < .05 ) , without a significant increase in physician or ED use or patient mortality . Hypothesized improvement in other outcomes did not occur OBJECTIVE To test the effectiveness of two interventions design ed to improve the adoption of evidence -based practice s by home health nurses caring for heart failure ( HF ) patients . DATA SOURCES / STUDY SETTING Information on nurse practice s was abstract ed from the clinical records of patients admitted between June 2000 and November 2001 to the care of 354 study nurses at a large , urban , nonprofit home care agency . STUDY DESIGN The study employed a r and omized design with nurses assigned to usual care or one of two intervention groups upon identification of an eligible patient . The basic intervention was a one-time e-mail reminder highlighting six HF-specific clinical recommendations . The augmented intervention consisted of the initial e-mail reminder supplemented by provider prompts , patient education material , and clinical nurse specialist outreach . DATA COLLECTION At each home health visit provided by a study nurse to an eligible HF patient during the 45-day follow-up period , a structured chart abstract ion tool was used to collect information on whether the nurse provided the care practice s highlighted in the e-mail reminder . PRINCIPAL FINDINGS Both the basic and the augmented interventions greatly increased the practice of evidence -based care , according to patient records , in the areas of patient assessment and instructions about HF disease management . While not all results were statistically significant at conventional levels , intervention effects were positive in virtually all cases and effect magnitudes frequently were large . CONCLUSIONS The results of this r and omized trial strongly support the efficacy of just-in-time evidence -based reminders as a means of changing clinical practice among home health nurses who are geographically dispersed and spend much of their time in the field THE R AND OMIZED controlled trial ( RCT ) , more than any other methodology , can have a powerful and immediate impact on patient care . Ideally , the report of such an evaluation needs to convey to the reader relevant information concerning the design , conduct , analysis , and generalizability of the trial . This information should provide the reader with the ability to make informed judgments regarding the internal and external validity of the trial . Accurate and complete reporting also benefits editors and review ers in their deliberations regarding su bmi tted manuscripts . For RCTs to ultimately benefit patients , the published report should be of the highest possible st and ard Despite the fact that the nursing literature is replete with calls to make the practice of nursing research based , little is known about the structure and function of research utilization . The purpose of this study was to explore the conceptual structure of research utilization . Data were collected from a r and omly selected sample of 600 registered nurses practicing in western Canada . Using the techniques of structural equation modeling ( with LISREL ) , competing models representing conceptual structures of research utilization were developed and evaluated . In the first model , a simplex style of model , the investigator proposed that a nurse 's early responses would influence subsequent responses to the question measuring research utilization , implying a time ordered causal sequence . In the second style of model , a common cause ( or factor-like ) model , the investigator proposed a stable underlying concept , research utilization , that was relatively insensitive to prompting and time ordering . The simplex style of model failed to reach acceptable indices of fit . The common cause model fit the data well , suggesting that instrumental , conceptual , and persuasive research utilization exist and that a global measure of research utilization may be defensible The need for clear reporting of r and omized controlled trials has been emphasized recently . The CONSORT Statement has made evidence -based suggestions for a checklist and a patient flow diagram . Adapting this for cluster r and omized controlled trials presents particular challenges . Simple changes in the checklist and diagram for the completely r and omized two level cluster r and omized trials are suggested for discussion . An example taken from an unpublished trial demonstrates that these changes are less simple to implement , although extensions to electronic publications may be helpful . These suggestions should be formally evaluated . Further work is required to consider the cases of more levels and of stratified or pair-matched cluster r and omized trials OBJECTIVE To assess whether language of publication restrictions impact the estimates of an intervention 's effectiveness , whether such impact is similar for conventional medicine and complementary medicine interventions , and whether the results are influenced by publication bias and statistical heterogeneity . STUDY DESIGN AND SETTING We set out to examine the extent to which including reports of r and omized  controlled trials ( RCTs ) in language s other than English ( LOE ) influences the results of systematic review s , using a broad data set of 42 language -inclusive systematic review s , involving 662 RCTs , including both conventional medicine ( CM ) and complementary and alternative medicine ( CAM ) interventions .  RESULTS For CM interventions , language -restricted systematic review s , compared with language -inclusive ones , did not introduce biased results , in terms of estimates of intervention effectiveness ( r and om effects ration of odds rations ROR=1.02 ; 95 % CI=0.83 - 1.26 ) . For CAM interventions , however , language -restricted systematic review s result ed in a 63 % smaller protective effect estimate than language -inclusive review s ( r and om effects ROR=1.63 ; 95 % CI=1.03 - 2.60 ) . CONCLUSION Language 
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Conclusion Little is known about how to increase research use in nursing , and the evidence to support or refute specific interventions is inconclusive .