***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 
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    Input: Background The aim of this project was to assess whether outreach visits would improve the implementation of evidence based clinical practice in the area of falls reduction and stroke prevention in a residential care setting . Methods Twenty facilities took part in a r and omized controlled trial with a seven month follow-up period . Two outreach visits were delivered by a pharmacist . At the first a summary of the relevant evidence was provided and at the second detailed audit information was provided about fall rates , psychotropic drug prescribing and stroke risk reduction practice s ( BP monitoring , aspirin and warfarin use ) for the facility relevant to the physician . The effect of the interventions was determined via pre- and post-intervention case note audit . Outcomes included change in percentage patients at risk of falling who fell in a three month period prior to follow-up and changes in use of psychotropic medications . Chi-square tests , independent sample s t-test , and logistic regression were used in the analysis . Results Data were available from case notes at baseline ( n = 897 ) and seven months follow-up ( n = 902 ) , 452 residential care staff were surveyed and 121 physicians were involved with 61 receiving outreach visits . Pre- and post-intervention data were available for 715 participants . There were no differences between the intervention and control groups for the three month fall rate . We were unable to detect statistically significant differences between groups for the psychotropic drug use of the patients before or after the intervention . The exception was significantly greater use of " as required " antipsychotics in the intervention group compared with the control group after the pharmacy intervention ( RR = 4.95 ; 95%CI 1.69–14.50 ) . There was no statistically significant difference between groups for the numbers of patients " at risk of stroke " on aspirin at follow-up . Conclusions While the strategy was well received by the physicians involved , there was no change in prescribing patterns . Patient care in residential setting s is complex and involves contributions from the patient 's physician , family and residential care staff . The project highlights challenges of delivering evidence based care in a setting in which there is a paucity of well controlled trial evidence but where significant health outcomes can be attained OBJECTIVE To test the effect of a complex guideline -based intervention on agitation and psychotropic prescriptions . DESIGN , SETTING , PARTICIPANTS Cluster r and omized controlled trial ( VIDEANT ) with blinded assessment of outcome in 18 nursing homes in Berlin , Germany , comprising 304 dementia patients . INTERVENTION Training , support , and activity therapy intervention , delivered at the level of each nursing home , focusing on the management of agitation in dementia . Control group nursing homes  received treatment as usual . MEASUREMENTS Levels of agitated and disruptive behavior ( Cohen-Mansfield agitation inventory [ CMAI ] ) as the primary outcome . Number of neuroleptics , antidepressants , and cholinesterase inhibitors ( ChEIs ) prescribed in defined daily dosages ( DDDs ) . RESULTS Of 326 patients screened , 304 ( 93.3 % ) were eligible and cluster-r and omized to 9 intervention ( n = 163 ) and 9 control ( n = 141 ) nursing homes . Data were collected from 287 ( 94.4 % ) patients at 10 months . At 10 months , compared with controls , nursing home residents with dementia in the intervention group exhibited significantly less agitation as measured with the CMAI ( adjusted mean difference , 6.24 ; 95 % CI 2.03 - 14.14 ; P = .009 ; Cohen 's d = 0.43 ) , received fewer neuroleptics ( P < .05 ) , more  ChEIs  ( P < .05 ) , and more antidepressants ( P < .05 ) . CONCLUSION Complex guideline -based interventions are effective in reducing agitated and disruptive behavior in nursing home residents with dementia . At the same time , increased prescription of ChEIs and antidepressants together with decreased neuroleptic prescription suggests an effect toward guideline -based pharmacotherapy OBJECTIVES To evaluate the effectiveness of efforts to translate and disseminate evidence -based guidelines about atypical antipsychotic use to nursing homes ( NHs ) . DESIGN Three-arm , cluster r and omized trial . SETTING NHs . PARTICIPANTS NHs in the state of Connecticut . MEASUREMENTS Evidence -based guidelines for atypical antipsychotic prescribing were translated into a toolkit targeting NH stakeholders , and 42 NHs were recruited and r and omized to one of three toolkit dissemination strategies : mailed toolkit delivery ( minimal intensity ) ; mailed toolkit delivery with quarterly audit and feedback reports about facility-level antipsychotic prescribing ( moderate intensity ) ; and in-person toolkit delivery with academic detailing , on-site behavioral management training , and quarterly audit and feedback reports ( high intensity ) . Outcomes were evaluated using the Reach , Effectiveness , Adoption , Implementation , Maintenance ( RE- AIM ) framework . RESULTS Toolkit awareness of 30 % ( 7/23 ) of leadership of low-intensity NHs , 54 % ( 19/35 ) of moderate-intensity NHs , and 82 % ( 18/22 ) of high-intensity NHs reflected adoption and implementation of the intervention . Highest levels of use and knowledge among direct care staff were reported in high-intensity NHs . Antipsychotic prescribing levels declined during the study period , but there were no statistically significant differences between study arms or from secular trends . CONCLUSION RE- AIM indicators suggest some success in disseminating the toolkit and differences in reach , adoption , and implementation according to dissemination strategy but no measurable effect on antipsychotic prescribing trends . Further dissemination to external stakeholders such as psychiatry consultants and hospitals may be needed to influence antipsychotic prescribing for NH residents OBJECTIVES To assess the feasibility of a multifaceted strategy to translate evidence -based guidelines for treating nursing home-acquired pneumonia ( NHAP ) into practice using a small intervention trial . DESIGN Pre-posttest with untreated control group . SETTING Two Colorado State Veterans Homes ( SVHs ) during two influenza seasons . PARTICIPANTS Eighty-six residents with two or more signs of lower respiratory tract infection . INTERVENTION Multifaceted , including a formative phase to modify the intervention , institutional-level change emphasizing immunization , and availability of appropriate antibiotics ; interactive educational sessions for nurses ; and academic detailing . MEASUREMENTS Subjects ' SVH medical records were review ed for guideline compliance retrospectively for the influenza season before the intervention and prospect ively during the intervention . Bivariate comparisons-of-care processes between the intervention and control facility before and after the intervention were made using the Fischer exact test . RESULTS At the intervention facility , compliance with five of the guidelines improved : influenza vaccination , timely physician response to illness onset , x-ray for patients not being hospitalized , use of appropriate antibiotics , and timely antibiotic initiation for unstable patients . Chest x-ray and appropriate and timely antibiotics were significantly better at the intervention than at the control facility during the intervention year but not during the control year . CONCLUSION Multifaceted , evidence -based , NHAP guideline implementation improved care processes in a SVH . Guideline implementation should be studied in a national sample of nursing homes to determine whether it improves quality of life and functional outcomes of this debilitating illness for long-term care residents OBJECTIVE To test the effectiveness of using a full-time project nurse to assist residential aged care facilities in using evidence -based approaches to falls injury prevention . DESIGN , SETTING AND PARTICIPANTS Cluster r and omised controlled trial involving 5391 residents in 88 aged care facilities in the Hunter and Lower Mid North Coast areas of New South Wales . Residents were followed for 545 days or until death or discharge . Data were collected from July 2005 to June 2007 . INTERVENTION Employment of a project nurse to encourage best- practice falls injury prevention strategies during the 17-month intervention period . MAIN OUTCOME MEASURES Monthly data about falls , falls injury and falls injury prevention programs ; audit of hospitalisation for fractured neck of femur . RESULTS Despite significant increases in the provision of hip protectors and use of vitamin D supplementation in both intervention and control facilities , there was no difference in the number of falls or falls injuries between the intervention and control groups , nor a reduction in falls overall . There was also no difference between the 7-month pre-intervention period and the intervention period in the number of falls or falls injuries . Factors related to residents having an increased risk of falls with fractured neck of femur included being ambulant , having dementia , increasing age , and having a high falls risk assessment score . CONCLUSION It is difficult to change falls risk among high-risk population s , including people with dementia . The use of important strategies such as hip protectors and vitamin D and calcium supplementation increased during the study , probably with contamination of control facilities . Longer follow-up may be required to measure the impact on falls outcomes of the strategy of using a facilitating nurse . TRIAL REGISTRATION Australian New Zeal and Clinical Trials Registry ACTRN12605000540617 In this prospect i ve cluster r and omized controlled trial we evaluated the impact of short-term provision of enhanced infection control support on infection control practice in nursing homes in South London . Twelve nursing homes were recruited , six each in intervention ( 300 residents ) and control ( 265 residents ) groups . Baseline observations of h and hygiene facilities , environmental cleanliness and safe disposal of clinical waste showed poor compliance in both groups . Post-intervention observations showed improvement in both groups . There was no statistical difference between the two groups in the compliance for h and hygiene facilities ( P=0.69 ) ; environmental cleanliness ( P=0.43 ) and safe disposal of clinical waste ( P=0.96 ) . In both groups , greatest improvement was in compliance with safe disposal of clinical waste and the least improvement was in h and hygiene facilities . Since infection control practice improved in intervention and control groups , we could not demonstrate that provision of short-term , enhanced , infection control support in nursing homes had a significant impact in infection control practice 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 BACKGROUND Frail older people admitted to nursing homes are at risk of a range of adverse outcomes , including pressure ulcers .  Clinical decision support systems are believed to have the potential to improve care and to change the behaviour of healthcare professionals . OBJECTIVES To determine whether a multi-faceted tailored strategy to implement an electronic clinical decision support system for  pressure ulcer prevention improves adherence to recommendations for pressure ulcer prevention in nursing homes . DESIGN Two-armed r and omized controlled trial in a nursing home setting in Belgium . The trial consisted of a 16-week implementation intervention between February and June 2010 , including one baseline , four intermediate , and one post-testing measurement . Primary outcome was the adherence to guideline -based care recommendations  ( in terms of allocating adequate pressure ulcer prevention in residents at risk ) . Secondary outcomes were the change in resident outcomes ( pressure ulcer prevalence ) and intermediate outcomes ( knowledge and attitudes of healthcare professionals ) . SETTING R and om sample of 11 wards ( 6 experimental ; 5 control ) in a convenience sample of 4 nursing homes in Belgium . PARTICIPANTS In total , 464 nursing home residents and 118 healthcare professionals participated . METHODS The experimental arm was involved in a multi-faceted tailored implementation intervention of a clinical decision support system , including interactive education , reminders , monitoring , feedback and leadership . The control arm received a hard-copy of the pressure ulcer prevention protocol , supported by st and ardized 30 min group lecture . RESULTS Patients in the intervention arm were significantly more likely to receive fully 
    Output:
    
Conclusions Little is known about how to improve the implementation of guidelines in nursing homes , and the evidence to support or discourage particular interventions is inconclusive .