***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 Complete diagnostic evaluation or CDE ( i.e. , colonoscopy or combined flexible sigmoidoscopy plus barium enema X-ray ) is often not performed for persons with an abnormal screening fecal occult blood test ( FOBT+ ) result . METHOD This study evaluated the impact of a reminder-feedback and educational outreach intervention on primary care practice CDE recommendation and performance rates . Four hundred seventy primary care physicians ( PCPs ) in 318 practice s participated in the study . Patients were mailed an FOBT kit annually as part of a screening program . Practice s were r and omly assigned to a Control Group ( N = 198 ) or an Intervention Group ( N = 120 ) . During an 18-month pre-r and omization period and a 9-month post-r and omization period , 2992 screening FOBT+ patients were identified . Intervention practice s received the screening program and the intervention . Control practice s received only the screening program . Study outcomes were baseline-adjusted CDE recommendation and performance rates . RESULTS At baseline , about two-thirds of FOBT+ patients received a CDE recommendation , and about half had a CDE performed . At endpoint , CDE recommendation and performance rates were both significantly higher for the Intervention as compared to the Control practice s ( OR = 2.28 ; 95 % CI : 1.37 , 3.78 , and OR = 1.63 ; 95 % CI : 1.06 , 2.50 , respectively ) . CONCLUSIONS The reminder-feedback plus educational outreach intervention significantly increased CDE recommendation and performance Background Little is known about the impact of implementing nursing-oriented best practice guidelines on the delivery of patient care in either hospital or community setting s. Methods A naturalistic study with a prospect i ve , before and after design documented the implementation of six newly developed nursing best practice guidelines ( asthma , breastfeeding , delirium-dementia-depression ( DDD ) , foot complications in diabetes , smoking cessation and venous leg ulcers ) . Eleven health care organisations were selected for a one-year project . At each site , clinical re source nurses ( CRNs ) worked with managers and a multidisciplinary steering committee to conduct an environmental scan and develop an action plan of activities ( i.e. education sessions , policy review ) . Process and patient outcomes were assessed by chart audit ( n = 681 pre-implementation , 592 post-implementation ) . Outcomes were also assessed for four of six topics by in-hospital/home interviews ( n = 261 pre-implementation , 232 post-implementation ) and follow-up telephone interviews ( n = 152 pre , 121 post ) . Interviews were conducted with 83/95 ( 87 % ) CRN 's , nurses and administrators to describe recommendations selected , strategies used and participants ' perceived facilitators and barriers to guideline implementation . Results While statistically significant improvements in 5 % to 83 % of indicators were observed in each organization , more than 80 % of indicators for breastfeeding , DDD and smoking cessation did not change . Statistically significant improvements were found in > 50 % of indicators for asthma ( 52 % ) , diabetes foot care ( 83 % ) and venous leg ulcers ( 60 % ) . Organizations with > 50 % improvements reported two unique implementation strategies which included h and s-on skill practice sessions for nurses and the development of new patient education material s. Key facilitators for all organizations included education sessions as well as support from champions and managers while key barriers were lack of time , workload pressure and staff resistance . Conclusion Implementation of nursing best practice guidelines can result in improved practice and patient outcomes across diverse setting s yet many indicators remained unchanged . Mobilization of the nursing workforce to actively implement guidelines and to monitor the delivery of their care is important so that patients may learn about and receive recommended healthcare Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background Many challenges arise in complex organizational interventions that threaten research integrity . This article describes a T ool for E valuating Research Implementation Ch allenges ( TECH ) , developed using a complexity science framework to assist research teams in assessing and managing these challenges . Methods During the implementation of a multi-site , r and omized controlled trial ( RCT ) of organizational interventions to reduce resident falls in eight nursing homes , we inductively developed , and later codified the TECH . The TECH was developed through processes that emerged from interactions among research team members and nursing home staff participants , including a purposive use of complexity science principles . Results The TECH provided a structure to assess challenges systematic ally , consider their potential impact on intervention feasibility and fidelity , and determine actions to take . We codified the process into an algorithm that can be adopted or adapted for other research projects . We present selected examples of the use of the TECH that are relevant to many complex interventions . Conclusions Complexity theory provides a useful lens through which research procedures can be developed to address implementation challenges that emerge from complex organizations and research design s. Sense-making is a group process in which diverse members interpret challenges when available information is ambiguous ; the groups ’ interpretations provide cues for taking action . Sense-making facilitates the creation of safe environments for generating innovative solutions that balance research integrity and practical issues . The challenges encountered during implementation of complex interventions are often unpredictable ; however , adoption of a systematic process will allow investigators to address them in a consistent yet flexible manner , protecting fidelity . Research integrity is also protected by allowing for appropriate adaptations to intervention protocol s that preserve the feasibility of ‘ real world ’ interventions BACKGROUND Patients with heart failure have scarce knowledge of their condition and frequently report poor quality of life . In spite of numerous studies showing improvement of survival and reduction in hospitalizations , several epidemiological studies showed that substantial proportion of patients are not receiving appropriate treatment . Intensive multidisciplinary approach can improve management of the patients with heart failure . AIM To assess the efficacy of intensive patient management in heart failure clinic with respect to patient knowledge , pharmacological management , and quality of life . METHODS From out patients , visiting the heart failure clinic in period form March 2002 to March 2003 , we prospect ively enrolled patients with heart failure due to systolic dysfunction . Patient knowledge about their condition was assessed by a knowledge question naire . Data on their clinical characteristics , diagnostic and pharmacological management were analyzed . Quality of life was assessed with Minnesota Living with Heart Failure Question naire ( MLHFQ ) . Patients rated their quality of life and heath on a seven-category descriptive scale from 1 ( best ) to 7 ( worst ) . Data are shown as mean ( S.D. ) . RESULTS In this period we treated 50 patients ( 33 men ) , aged 67 ( 12 ) years .  Patient knowledge about their condition improved after two visits to heart failure clinic ( 4.8 ( 1.5 ) vs. 7.3 ( 1.4 ) , p<0.001 ) . More patients were treated with beta blockers ( 40 % vs. 84 % , p<0.001 ) while there was a positive trend for treatment with angiotensin-converting enzyme inhibitors ( 94 % vs. 98 % ) and spironolactone ( 54 % vs. 70 % ) . Equivalent mean daily dose of enalapril  ( 11.0 ( 11.0 ) mg to 16.7 ( 8.7 ) mg , p<0.001 ) and  carvedilol  ( 13.0 ( 11.5 ) mg to 32.1 ( 18.2 ) mg , p<0.001 ) increased . Out-patient management was associated with improvement of MLHFQ score ( 47 ( 18 ) vs. 34 ( 16 ) ) , NYHA class ( 2.9 ( 0.4 ) vs. 2.5 ( 0.7 ) ) , quality of life score ( 5.3 ( 1.1 ) vs. 3.7 ( 1.0 ) ) , and health score ( 5.1 ( 1.1 ) vs. 3.7 ( 1.1 ) ) ( p<0.001 for all ) . CONCLUSIONS Intensive management in heart failure clinic can be effective for translation of guidelines into clinical practice . It also improves patient 's knowledge and quality of life as well as reduces the hospitalizations in heart failure patients OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity PURPOSE We examined whether a continuing medical education intervention increased general practitioners ' ability to select the proper pharmacological treatment for patients with osteoarthritis . SUBJECTS AND METHODS Eight towns in Quebec , Canada were r and omly allocated to one of four intervention options , workshop and decision tree , workshop , decision tree , or no intervention .  All general practitioners practicing in each town were eligible to participate . We evaluated all dispensed prescriptions for either a  cyclooxygenase (COX)-2 inhibitor , nonselective nonsteroidal anti-inflammatory drug or acetaminophen  written by eligible general practitioners between May 2000 and June 2001 to elderly patients suffering from osteoarthritis . We used a multi-level Bayesian hierarchical model to assess the impact of the interventions on prescription adequacy . RESULTS We analyzed 5318 dispensed prescriptions written by 249 general practitioners in the five-month preintervention period and 4610 dispensed prescriptions written by the same physicians in the five-month postintervention period . A score of zero or one was given to every prescription , with one indicating prescription adequacy according to guidelines provided during the interventions . Bayesian hierarchical models showed some improvement in scores in the post- versus preintervention periods in all four groups . The probability of an improvement in the towns allocated the workshop and decision tree over the control was 94 % , compared with 74 % in the workshop group and 55 % in the decision tree group . CONCLUSION An interactive approach offered by peers and complemented by easy to use guidelines may enhance the general practitioner 's ability to manage osteoarthritis patients Abstract Objectives To assess the extent and pattern of implementation of guidance issued by the National Institute for Clinical Excellence ( NICE ) . Design Interrupted time series analysis , review of case notes , survey , and interviews . Setting Acute and primary care trusts in Engl and and Wales . Participants All primary care prescribing , hospital pharmacies ; a r and om sample of 20 acute trusts , 17 mental health trusts , and 21 primary care trusts ; and senior clinicians and managers from five acute trusts . Main outcome measures Rates of prescribing and use of procedures and medical devices relative to evidence based guidance .  Results 6308 usable patient audit forms were returned . Implementation of NICE guidance varied by trust and by topic . Prescribing of some taxanes for cancer ( P < 0.002 ) and  orlistat for obesity ( P < 0.001 ) significantly increased in line with guidance . Prescribing of drugs for Alzheimer 's disease and prophylactic extraction of wisdom teeth showed trends consistent with , but not obviously a consequence of , the guidance . Prescribing practice often did not accord with the details of the guidance . No change was apparent in the use of hearing aids , hip prostheses , implantable cardioverter defibrillators , laparoscopic hernia repair , and laparoscopic colorectal cancer surgery after NICE guidance had been issued . Conclusions Implementation of NICE guidance has been variable . Guidance seems more likely to be adopted when there is strong professional support , a stable and convincing evidence base , and no increased or unfunded costs , in organisations that have established good systems for tracking guidance implementation and where the profession 
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This did not appear to be associated with guideline topic , use of theory or barrier assessment , or number or type of implementation approaches and strategies .
Education for professionals or patients and print material were the most commonly employed strategies for translating guidelines to practice .