***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 As more and more elderly people are being cared for in residential and nursing homes , how best can their psychiatric needs be met ? We report on evaluation of a behavioural intervention by an old-age psychiatry hospital outreach team . METHODS This r and omised controlled trial of a training and education intervention over 6 months was done in south Manchester , UK . 12 matched nursing and residential homes were r and omised to the  control or intervention group and within each , the staff selected 10 residents whose behavioural problems made them difficult to care for . Care staff in the intervention homes attended seminars from the hospital outreach team and received weekly visits from a psychiatric nurse to assist in developing care planning skills . The main outcome measures were cognitive impairment and depression , behavioural disturbance , and functional ability , assessed by the geriatric mental state schedule , Crichton Royal behaviour rating scale , and Barthel index , respectively . FINDINGS Residents in the intervention group had significantly improved scores for depression ( before- and -after change difference -0.5 [ 95 % CI -0.8 to -0.1 ] ) and for cognitive impairment ( -0.7 [ -1.1 to -0.2 ] ) but not for behaviour rating or Barthel index .  INTERPRETATION Elderly residents can benefit from improved quality of care achieved by training from a hospital outreach team There is today a wide consensus regarding the need to improve communication skills ( CS ) of health-care professionals ( HCPs ) dealing with cancer patients .  Psychological training programs ( PTPs ) may be useful to acquire the needed CS . Testing the efficacy of PTP will allow to define their optimal content . The present study was design ed to assess the impact of a PTP on HCP stress , attitudes and CS , and on HCP and patients ' satisfaction with HCP communication skills in a r and omised study . A total of 115 oncology nurses were r and omly assigned to a 105-h PTP or to a waiting list .  Stress was assessed with the Nursing Stress Scale , attitudes with a Semantic Differential Question naire , CS used during one simulated and one actual patient interview with the Cancer Research Campaign Workshop Evaluation Manual , and satisfaction with the nurses ' CS with a question naire completed by the patients and the nurses . Trained ( TG ) and control ( CG ) groups were compared at baseline , after 3 months ( just following training for TG ) and after 6 months ( 3 months after the end of training for TG ) . Compared to controls , trained nurses reported positive changes on their stress levels ( P⩽0.05 ) and on their attitudes ( P⩽0.05 ) . Positive training effects were found on CS used during the simulated interview : a significant increase in facilitative behaviours ( open questions : P⩽0.001 ; evaluative functions : P⩽0.05 ) and a significant decrease in inhibitory behaviours ( inappropriate information : P⩽0.01 ; false reassurance : P⩽0.05 ) . Less positive training effects were found regarding interviews with a cancer patient : a significant increase in educated guesses ( P⩽0.001 ) was noticed . No training effect was observed on nurses ' satisfaction levels , but a positive training effect was found on patients ' satisfaction levels ( P⩽0.01 ) . Although results outline PTP efficacy , they indicate the need to design PTP , amplifying the transfer of learned CS to clinical practice PURPOSE We wanted to assess the effectiveness of intensive education for physicians  compared with a traditional session on communicating with breast cancer patients . METHODS A r and omized controlled trial was conducted in practice s in London , Hamilton , and Toronto , Canada , with 17 family physicians , 16 surgeons , and 18 oncologists , and with 102 patients of the surgeons and oncologists . Doctors were r and omized to 1 of 2 continuing education approaches : a traditional 2-hour version ( control group ) , or a new 6-hour intensive version including exploring the patients ’ perspectives and review ing videotapes and receiving feedback ( intervention group ) . Communication behavior of the physicians was measured objective ly both before and after the intervention . As well , 4 postintervention patient outcomes were measured , by design only for surgeons and oncologists : patient-centerdness of the visit , satisfaction , psychological distress , and feeling better . RESULTS No significant differences were found on the communication score of the intervention vs the control physicians when controlling for preintervention communication scores . Intervention family physicians , however , had significantly higher communication subscores than control family physicians . Also , patients of the intervention surgeons and oncologists were significantly more satisfied ( scores of 82.06 vs 77.78 , P = .03 ) and felt better ( 88.2 % vs 70.6 % , P=.02 ) than patients of the control surgeons and oncologists when controlling for covariates and adjusting for clustering within doctor . CONCLUSIONS The continuing medical education intervention was effective in terms of some but not all physician and patient outcomes UNLABELLED INTRODUCTION AND OBJECTIVES . Clinical practice in unstable angina is not always based on best evidence . Guidelines have the potential to improve quality of health care . There are no r and omised trials assessing implementation strategies in the public healthcare system of Spain yet . OBJECTIVE to compare the effectiveness of a multifaceted strategy ( interactive educational meetings , local consensus process ) for guideline implementation in unstable angina , with a passive dissemination strategy . Patients and method . SETTING 10 wards from 3 university hospitals in Sevilla . PARTICIPANTS 153 specialists ( cardiologists , internists ) and their patients admitted for an unstable angina episode . DESIGN a pragmatic , before and after cluster r and omized controlled trial . Intervention was delivered from January to April 1998 . Retrospective data collection took place in July 1999 , of those pre and post-intervention episodes attended from January to October 1997 and from September 1998 to June 1999 , respectively . OUTCOMES compliance with the guideline recommendations for coronary angiography and stress testing , and ejection fraction assessment . RESULTS The multifaceted strategy compared with the passive one , was associated with an absolute improvement in the appropriateness of use of coronary angiography and stress testing of 11 % ( 95 % CI , 0.85 - 21.1 ) , P=.03 . There was no association for the assessment of the ejection fraction : absolute improvement of 1.1 % ( 95 % CI , --15.9 to 18.1 ) , P=.88 . CONCLUSIONS Our results show that a combination of interactive educational meetings and local consensus process delivered to wards of physicians may improve the appropriateness of use of coronary angiography and stress testing BACKGROUND Doctor-patient communication is an essential component of general practice . Improvement of GPs ' communication patterns is an important target of training programmes . Available studies have so far failed to provide conclusive evidence of the effectiveness of educational interventions to improve  doctor-patient communication . AIM To examine the effectiveness of a learner-centred approach that focuses on actual needs , to improve GPs ' communication with patients . DESIGN OF STUDY R and omised controlled trial . SETTING One hundred volunteer GPs in the Netherl and s. METHOD The intervention identified individual GPs ' deficiencies in communication skills by observing authentic consultations in their own surgery . This performance assessment was followed by structured activities in small group meetings , aim ed at remedying the identified shortcomings . Outcomes were measured using videotaped consultations in the GPs ' own surgery before and after the intervention . Communication skills were rated using the MAAS-Global , a vali date d checklist . RESULTS The scores in the intervention group demonstrated a significant improvement compared with those of the control group ( 95 % confidence interval = 0.04 to 0.75 ) . The effect size was moderate to large ( d-value = 0.66 ) . The level of participation significantly contributed to the effectiveness . Largest improvement was found on patient-centred communication skills . CONCLUSION The approach of structured individual improvement activities based on performance assessment is more effective in improving communication skills than current educational activities Reports of cluster r and omised trials require additional information to allow readers to interpret them accurately The effective reporting of r and omised controlled trials has received useful attention in recent years . Many journals now require that reports conform to the guidelines in the Consoli date d St and ards of Reporting Trials ( CONSORT ) statement , first published in 1996 and revised in 2001 . The statement includes a checklist of items that should be included in the trial report . These items are evidence based whenever possible and are regularly review ed . The statement also recommends including a flow diagram to show the flow of participants from group assignment through to the final analysis . The CONSORT statement focused on reporting parallel group r and omised trials in which individual participants are r and omly assigned to study groups . However , in some situations it is preferable to r and omly assign groups of individuals ( such as families or medical practice s ) rather than individuals . Reasons include the threat of contamination of some interventions ( such as dietary interventions ) if individual r and omisation is used . 5 Also , in certain setting s r and omisation by group may be the only feasible method of conducting a trial . Trials with this design are variously known as field trials , community based trials , place based trials , or ( as in this paper ) cluster r and omised trials . In an earlier discussion paper we considered the implication s of the CONSORT statement for the reporting of cluster r and omised trials . Here we present up date d guidance , based on the 2001 revision of the CONSORT statement OBJECTIVE To determine the quality of  spirometry performed in primary care practice and to assess the impact of formal training . DESIGN R and omized , controlled prospect i ve interventional study . SETTING Primary care practice , Auckl and City , New Zeal and . PARTICIPANTS Thirty r and omly selected primary care practice s r and omized to " trained " or " usual " groups . One doctor and one practice nurse were nominated to participate from each practice . INTERVENTIONS " Trained " was defined as participation in an " initial " spirometry workshop at week 0 and a " maintenance of st and ards " workshop at week 12 . " Usual " was defined as no formal training until week 12 , when participants they attended the same " initial " workshop provided for the trained group . The study duration was 16 weeks . Each practice was provided with a spirometer to be used at their clinical discretion . MEASUREMENTS AND RESULTS Spirometry data were uploaded weekly and analyzed using American Thoracic Society ( ATS ) criteria for acceptability and reproducibility . The workshops were assessed objective ly with practical and written assessment s , confirming a significant training effect . However , analysis of spirometry performed in clinical practice by the trained practitioners revealed three acceptable blows in only 18.9 % of patient tests . In comparison , 5.1 % of patient tests performed by the usual practitioners had three acceptable blows ( p<0.0001 ) . Only 13.5 % of patient tests in the trained group and 3.4 % in the usual group ( p<0.0001 ) satisfied full acceptability and reproducibility criteria . However , 33.1 % and 12.5 % of patient tests in the trained and usual groups , respectively ( p<0.0001 ) , achieved at least two acceptable blows , the minimum requirement . Nonacceptability was largely ascribable to failure to satisfy end-of-test criteria ; a blow of at least 6 s. Visual inspection of the results of these blows as registered on the spirometer for the presence of a plateau on the volume-time curve suggests that < 15 % were acceptable . CONCLUSIONS Although a significant training effect was demonstrated , the quality of the spirometry performed in clinical practice did not generally satisfy full ATS criteria for acceptability and reproducibility . Further study would be required to determine the clinical impact . However , the ATS guidelines allow for the use of data from unacceptable or nonreproducible maneuvers at the discretion of the interpreter . Since most of the failures were end-of-test related , the FEV1 levels are likely to be valid . Our results serve to emphasize the importance of effective training and quality assurance programs to the provision of successful spirometry in primary care practice OBJECTIVE to document the effectiveness of an educational intervention in improving knowledge of and practice in dispensing  emergency contraception ( EC ) among drugstore personnel in Thail and . METHODS Sixty of 120 drugstores in Hat Yai , a city in Southern Thail and , were r and omly selected , and half of them were r and omly assigned to participate in an  educational program . Well-trained " secret " shoppers went into each store before the intervention and at 1 and 3 months after the program to assess the knowledge of and practice in dispensing EC among the drugstore personnel . RESULTS Dispensing practice s at baseline were poor to fair and knowledge was fair in both groups . Sellers in the intervention group improved significantly in choice of drug , advice provided , and knowledge of the time limit for initiating EC , but those in the control group did not . However , proper history taking on the time of intercourse and menstrual cycle was poor in both groups at all study periods . CONCLUSION All drugstore personnel should be educated on the importance of history taking and on the time limit for initiating EC Aims : To evaluate the effectiveness of an evidence based group educational outreach visit on prescription patterns of  non-steroidal anti-inflammatory drugs ( NSAIDs ) in primary care . Design : R and omised controlled simple blind trial , with r and omisation into three groups : experimental ( evidence based educational outreach visit ) , placebo ( conventional education session ) , and control ( without intervention ) . Setting : The 24 primary care centres of the National Institute of Healthcare Network in a rural province of Aragon , Spain . Participants : The 24 primary health care teams of the network , with 158 general practitioners ( GPs ) . The teams were r and omised into the groups , experimental ( 8 teams , 48 GPs ) , placebo ( 8 teams , 54 GPs ) , and control ( 8 teams ,  
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AUTHORS ' CONCLUSIONS Educational meetings alone or combined with other interventions , can improve professional practice and healthcare outcomes for the patients .
The effect is most likely to be small and similar to other types of continuing medical education , such as audit and feedback , and educational outreach visits .
Strategies to increase attendance at educational meetings  , using mixed interactive and didactic formats , and focusing on outcomes that are likely to be perceived as serious may increase the effectiveness of educational meetings .
Educational meetings alone are not likely to be effective for changing complex behaviours