***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 influence of an opinion leader intervention on adherence to Unstable Angina ( UA ) guidelines compared with a traditional quality improvement model was investigated . Research Design . A group-r and omized controlled trial with 2210 patients from 21 hospitals was design ed . There were three intervention arms : ( 1 ) no intervention ( NI ) ; ( 2 ) a traditional Health Care Quality Improvement Program ( HCQIP ) ; and ( 3 ) a physician opinion leader in addition to the HCQIP model ( OL ) . Quality indicators included :  electrocardiogram within 20 minutes , antiplatelet therapy within 24 hours and at discharge , and heparin and & bgr;-blockers  during hospitalization . Hospitals could determine the specific indicators they wished to target . Potential cases of UA were identified from Medicare cl aims data . UA confirmation was determined by a clinical algorithm based on data abstract ed from medical records . Data analyses included both hospital level analysis ( analysis of variance ) and patient level analysis ( generalized linear models ) . Results . The only statistically significant postintervention difference in percentage compliant was greater improvement for the OL group in the use of antiplatelet therapy at 24 hours in both hospital level ( P = 0.01 ) and patient level analyses ( P < 0.05 ) compared with the HCQIP and NI groups . When analyses were confined to hospitals that targeted specific indicators , compared with the HCQIP hospitals , the OL hospitals showed significantly greater change in percentage compliant postintervention in both antiplatelet therapy during the first 24 hours ( 20.2 % vs. −3.9 % , P = 0.02 ) and heparin ( 31.0 % vs.9.1 % , P = 0.05 ) . Conclusions . The influence of physician opinion leaders was unequivocally positive for only one of five quality indicators . To maximize adherence to best practice s through physician opinion leaders , more research on how these physicians influence health care delivery in their organizations will be required BACKGROUND Public agencies responsible for implementing health care policies often adapt and disseminate clinical practice guidelines , but the effectiveness of mass dissemination of guidelines is unknown . AIM To study the effects of guideline dissemination on physicians ' prescribing practice s for the treatment of stable angina pectoris . DESIGN R and omized controlled trial . METHODS A sample of 3293 Quebec physicians were r and omly assigned to receive a one-page summary of clinical practice guidelines on the treatment of stable angina ( in February 1999 ) , to receive the summary and a reminder ( in February and March 1999 , respectively ) , or to receive no intervention ( controls ) . The prescribing profiles of participants , as well as sociodemographic characteristics of the physicians and their patients , were examined for June-December 1999 . RESULTS The intervention had no effect on prescription rates of beta-blockers , antiplatelet agents , or hypolipaemic drugs . Compared to 1997 data for the same physicians , there was an overall 10 % increase in appropriate prescription rates , irrespective of the intervention . DISCUSSION In-house production and dissemination of clinical practice guidelines may not improve physicians ' practice patterns if there is pre-existing substantial scientific consensus on the issue Abstract Objective : To study the efficacy of case method learning , for general practitioners , on patients ' lipid concentrations in the secondary prevention of coronary artery disease . Design : Prospect i ve controlled trial . Setting : Södertälje , Stockholm County , Sweden . Participants : 255 consecutive patients with coronary artery disease . Intervention : Guidelines were mailed to all general practitioners ( n=54 ) and presented at a common lecture . General practitioners who were r and omised to the intervention group participated in recurrent case method learning dialogues at their primary healthcare centres during a two year period . A locally well known cardiologist served as a facilitator . Main outcome measure : Concentration of low density lipoprotein cholesterol at baseline and after two years . Analysis according to intention to treat ( intervention and control groups ( n=88 ) ) was based on group affiliation at baseline . Results : Low density lipoprotein cholesterol was reduced by 0.5 mmol/l ( 95 % confidence interval 0.2 to 0.8 mmol/l ) ( 9.3 % ( 2.9 % to 15.8 % ) ) from baseline in patients in the intervention group and by 0.5 ( 0.1 to 0.9 ) mmol/l compared with controls ( P<0.05 ) . No change occurred in the control group ( 0.0 ( −0.2 to 0.2 ) mmol/l ) . Low density lipoprotein cholesterol decreased by 0.6 ( 0.4 to 0.8 ) mmol/l in a group of patients who received specialist care . Conclusion : Case method learning result ed in a lowering of low density lipoprotein cholesterol in the primary care patients with coronary artery disease comparable to that achieved at a specialist clinic . Conventional presentation of practice guidelines had no effect PURPOSE To assess the effects of an intervention involving dissemination of treatment recommendations to primary care physicians treating out patients with acute myocardial infa rct ion or heart failure . METHODS The study comprised 509 patients with myocardial infa rct ion and 323 patients with heart failure who were discharged from hospital . The primary care physicians caring for these patients were assigned r and omly to either the intervention or control group ; the intervention group was mailed practice guidelines immediately after patient discharge , and patients were cited by name . During a 6-month assessment period , the records of primary care physicians ( and cardiologists , if any ) were review ed to assess mean conformance with the guidelines , using seven measures of care for myocardial infa rct ion and eight measures of care for heart failure . RESULTS After adjusting for demographic and clinical characteristics of patients , and the number of eligible measures per patient , we observed no effect of the intervention on care of patients with myocardial infa rct ion ( odds ratio [ OR ] = 0.98 ; 95 % confidence interval [ CI ] : 0.81 to 1.17 ) or heart failure ( OR = 1.25 ; 95 % CI : 0.96 to 1.59 ) . However , there was a higher likelihood of conformance with measures for patients with infa rct ion ( OR = 1.56 ; 95 % CI : 1.29 to 1.87 ) or heart failure ( OR = 1.71 ; 95 % CI : 1.29 to 2.23 ) who had also been seen by a cardiologist during the 6-month assessment period . CONCLUSION Mailing treatment recommendations did not improve the quality of care of recently discharged patients with myocardial infa rct ion or heart failure . However , efforts to include cardiologists in the care of these patients might be worthwhile Background — Hypertension control rates remain suboptimal . Pharmacists ’ scope of practice is evolving , and their position in the community may be ideal for improving hypertension care . We aim ed to study the impact of pharmacist prescribing on blood pressure ( BP ) control in community-dwelling patients . Methods and Results — We design ed a patient-level , r and omized , controlled trial , enrolling adults with above-target BP ( as defined by Canadian guidelines ) through community pharmacies , hospitals , or primary care teams in 23 communities in Alberta . Intervention group patients received an assessment of BP and cardiovascular risk , education on hypertension , prescribing of antihypertensive medications , laboratory monitoring , and monthly follow-up visits for 6 months ( all by their pharmacist ) . Control group patients received a wallet card for BP recording , written hypertension information , and usual care from their pharmacist and physician . Primary outcome was the change in systolic BP at 6 months . A total of 248 patients ( mean age , 64 years ; 49 % male ) were enrolled .  Baseline mean±SD systolic/diastolic BP was 150±14/84±11 mm Hg . The intervention group had a mean±SE reduction in systolic BP at 6 months of 18.3±1.2 compared with 11.8±1.9 mm Hg in the control group , an adjusted difference of 6.6±1.9 mm Hg ( P=0.0006 ) . The adjusted odds of patients achieving BP targets was 2.32 ( 95 % confidence interval , 1.17–4.15 in favor of the intervention ) . Conclusions — Pharmacist prescribing for patients with hypertension result ed in a clinical ly important and statistically significant reduction in BP . Policy makers should consider an exp and ed role for pharmacists , including prescribing , to address the burden of hypertension . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00878566 Background : The 2007 American College of Cardiologists/American Heart Association Guidelines on Perioperative Cardiac Evaluation and Care for Noncardiac Surgery is the st and ard for perioperative cardiac evaluation . Recent work has shown that residents and anesthesiologists do not apply these guidelines when tested . This research hypothesized that a decision support tool would improve adherence to this consensus guideline . Methods : Anesthesiology residents at four training programs participated in an unblinded , prospect i ve , r and omized , cross-over trial in which they completed two tests covering clinical scenarios . One quiz was completed from memory and one with the aid of an electronic decision support tool . Performance was evaluated by overall score ( % correct ) , number of incorrect answers with possibly increased cost or risk of care , and the amount of time required to complete the quizzes both with and without the cognitive aid . The primary outcome was the proportion of correct responses attributable to the use of the decision support tool . Results : All anesthesiology residents at four institutions were recruited and 111 residents participated . Use of the decision support tool result ed in a 25 % improvement in adherence to guidelines compared with memory alone ( P < 0.0001 ) , and participants made 77 % fewer incorrect responses that would have result ed in increased costs . Use of the tool was associated with a 3.4-min increase in time to complete the test ( P < 0.001 ) . Conclusions : Use of an electronic decision support tool significantly improved adherence to the guidelines as compared with memory alone . The decision support tool also prevented inappropriate management steps possibly associated with increased healthcare costs BACKGROUND : Electronic information systems have been proposed as one means to reduce medical errors of commission ( doing the wrong thing ) and omission ( not providing indicated care ) . OBJECTIVE : To assess the effects of computer-based cardiac care suggestions . DESIGN : A r and omized , controlled trial targeting primary care physicians and pharmacists . SUBJECTS : A total of 706 out patients with heart failure and /or ischemic heart disease . INTERVENTIONS : Evidence -based cardiac care suggestions , approved by a panel of local cardiologists and general internists , were displayed to physicians and pharmacists as they cared for enrolled patients . MEASUREMENTS : Adherence with the care suggestions , generic and condition-specific quality of life , acute exacerbations of their cardiac disease , medication compliance , health care costs , satisfaction with care , and physicians ’ attitudes toward guidelines . RESULTS : Subjects were followed for 1 year during which they made 3,419 primary care visits and were eligible for 2,609 separate cardiac care suggestions . The intervention had no effect on physicians ’ adherence to the care suggestions ( 23 % for intervention patients vs 22 % for controls ) . There were no intervention-control differences in quality of life , medication compliance , health care utilization , costs , or satisfaction with care . Physicians viewed guidelines as providing helpful information but constraining their practice and not helpful in making decisions for individual patients . CONCLUSIONS : Care suggestions generated by a sophisticated electronic medical record system failed to improve adherence to accepted practice guidelines or outcomes for patients with heart disease . Future studies must weigh the benefits and costs of different ( and perhaps more Draconian ) methods of affecting clinician behavior AIM OF THE STUDY The European Resuscitation Council ( ERC ) guidelines changed in 2005 . We investigated the impact of these changes on no flow time and on the quality of cardiopulmonary resuscitation ( CPR ) .  MATERIAL S AND METHODS Simulated cardiac arrest ( CA ) scenarios were managed r and omly in manikins using ERC 2000 or 2005 guidelines . Pairs of paramedics/paramedic students treated 34 scenarios with 10min of continuous ventricular fibrillation . The rhythm was analysed and defibrillation shocks were delivered with a semi-automatic defibrillator , and breathing was assisted with a bag-valve-mask ; no intravenous medication was given . Time factors related to human intervention and time factors related to device , rhythm analysis , charging and defibrillation were analysed for their contribution to no flow time ( time without chest compression ) . Chest compression quality was also analysed . RESULTS No flow time ( mean+/-S.D. ) was 66+/-3 % of CA time with ERC 2000 and 32+/-4 % with ERC 2005 guidelines ( P<0.001 ) . Human factor interventions occupied 114+/-4s ( ERC 2000 ) versus 107+/-4s ( ERC 2005 ) during 600-s scenarios ( P=0.237 ) . Device factor interventions took longer using ERC 2000 guidelines : 290+/-19s versus 92+/-15s ( P<0.001 ) . The total number of chest compressions 
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Conclusions : This systematic review showed that CPGs could be useful to improve the process and structure of health care and , to a lesser extent , to improve the results in patients .
There are probably still undiscovered variables that interfere with the use of the CPGs and , therefore , with their impact .