***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: In an academic general medicine clinic , we performed a r and omized , controlled trial to compare ( 1 ) the effects of supplying monthly feedback reports of compliance with preventive care protocol s by 135 internal medicine house staff with ( 2 ) the effects of specific reminders given to them at the time of patient visits . The protocol s were r and omly divided into two groups , A and B , and half the house staff were given feedback for Group A and half for Group B. Thus , each group served as a control for the other . Each feedback group was also r and omly assigned to receive reminders for either Group A or B protocol s. House staff receiving feedback more often complied with fecal occult blood testing , mammography , pneumococcal vaccination , use of metronidazole , and combined Group A and B protocol s than did controls ( P < 0.01 ) . There was also significantly more compliance with the same protocol s by house staff receiving reminders , but the increase for fecal occult blood testing , pneumococcal vaccination , and combined Group A protocol s was twice that seen in physicians given feedback alone . In addition , reminders alone increased compliance with oral calcium supplementation . Overall compliance with the preventive care protocol s was low : 10 - 15 % in physicians receiving neither feedback nor reminders , increasing to 15 - 30 % in those receiving reminders . Physician compliance with suggested preventive care protocol s can be increased by both delayed feedback and immediate reminders , but reminders have a greater effect BACKGROUND A multistate r and omized study conducted under the Health Care Financing Administration 's ( HCFA 's ) Health Care Quality Improvement Program ( HCQIP ) offered the opportunity to compare the effect of a written feedback intervention ( WFI ) with that of an enhanced feedback intervention ( EFI ) on improving the anticoagulant management of Medicare beneficiaries who present to the hospital with venous thromboembolic disease . METHODS Twenty-nine hospitals in five states were r and omly assigned to receive written hospital-specific feedback ( WFI ) of feedback enhanced by the participation of a trained physician , quality improvement tools , and an Anticoagulant Management of Venous Thrombosis ( AMVT ) project liaison ( EFI ) . Differences in the performance of five quality indicators between baseline and remeasurement were assessed . Quality managers were interviewed to determine perceptions of project implementation . RESULTS No significant differences in the change from baseline to remeasurement were found between the two intervention groups . Significant improvement in one indicator and significant decline in two indicators were found for one or both groups . Yet 59 % of all quality managers perceived the AMVT project as being successful to very successful , and more EFI quality managers perceived success than did WFI managers ( 71 % versus 40 % ) . In the majority of EFI hospitals , physician liaisons played an important role in project implementation . CONCLUSION Study results indicated that the addition of a physician liaison , quality improvement tools , and a project liaison did not provide incremental value to hospital-specific feedback for improving quality of care . Future studies with larger sample sizes , lengthier follow-up periods , and interventions that include more of the elements shown to affect practice behavior change are needed to identify an optimal feedback model for use by external quality management organizations Objective To investigate the effectiveness and cost-effectiveness of different guideline implementation strategies , using the Scottish Intercollegiate Guidelines Network ( SIGN ) Guideline 42 ' Management of unerupted and impacted third molar teeth ' ( published 2000 ) as a model . Design A pragmatic , cluster RCT ( 2 × 2 factorial design ) .Subjects Sixty-three dental practice s across Scotl and . Clinical records of all 16—24-year-old patients over two , four-month periods in 1999 ( pre-intervention ) and 2000 ( post-intervention ) were search ed by a clinical research er blind to the intervention group . Data were also gathered on the costs of the interventions . Interventions Group 1 received a copy of SIGN 42 Guideline and had an opportunity to attend a postgraduate education course ( PGEC ) . In addition to this , group 2 received audit and feedback ( A and F ) . Group 3 received a computer aided learning ( CAL ) package . Group 4 received A and F and CAL.Principal outcome measurement The proportion of patients whose treatment complied with the guideline . Results The weighted t-test for A and F versus no A and F ( P=0.62 ) and CAL versus no CAL ( P=0.76 ) were not statistically significant . Given the effectiveness results ( no difference ) the cost effectiveness calculation became a cost-minimisation calculation . The minimum cost intervention in the trial consisted of providing general dental practitioners ( GDPs ) with guidelines and the option of attending PGEC courses . Routine data which subsequently became available showed a Scotl and -wide fall in extraction s prior to data collection . Conclusion In an environment in which pre-intervention compliance was unexpectedly high , neither CAL nor A and F increased the dentists ' compliance with the SIGN guideline compared with mailing of the guideline and the opportunity to attend a postgraduate course . The cost of the CAL arm of the trial was greater than the A and F arm . Further work is required to underst and dental professionals ' behaviour in response to guideline implementation strategies Background Our professional development plan aim ed to improve the primary care management of acute asthma , which is known to be suboptimal . Methods We invited 59 general practice s in Grampian , Scotl and to participate . Consenting practice s were r and omised to early and delayed intervention groups . Practice s undertook audits of their management of all acute attacks ( excluding children under 5 years ) occurring in the 3 months preceding baseline , 6-months and 12-months study time-points . The educational programme [ including feedback of audit results , attendance at a multidisciplinary interactive workshop , and formulation of development plan by practice teams ] was delivered to the early group at baseline and to the delayed group at 6 months . Primary outcome measure was recording of peak flow compared to best/predicted at 6 months . Analyses are presented both with , and without adjustment for clustering . Results 23 consenting practice s were r and omised : 11 to early intervention . Baseline practice demography was similar . Six early intervention practice s withdraw before completing the baseline audit . There was no significant improvement in our primary outcome measure ( the proportion with peak flow compared to best/predicted ) at either the 6 or 12 month time points after adjustment for baseline and practice effects . However , the between group difference in the adjusted combined assessment score , whilst non-significant at 6 months ( Early : 2.48 ( SE 0.43 ) vs. Delayed 2.26 ( SE 0.33 ) p = 0.69 ) reached significance at 12 m ( Early:3.60 ( SE 0.35 ) vs. Delayed 2.30 ( SE 0.28 ) p = 0.02 ) . Conclusion We demonstrated no significant benefit at the a priori 6-month assessment point , though improvement in the objective assessment of attacks was shown after 12 months . Our practice development programme , incorporating audit , feedback and a workshop , successfully engaged the healthcare team of participating practice s , though future r and omised trials of educational interventions need to recognise that effecting change in primary care practice s takes time . Monitoring of the assessment of acute attacks proved to be a feasible and responsive indicator of quality care OBJECTIVE Management of diabetes is frequently suboptimal in primary care setting s , where providers often fail to intensify therapy when glucose levels are high , a problem known as clinical inertia . We asked whether interventions targeting clinical inertia can improve outcomes . RESEARCH DESIGN AND METHODS A controlled trial over a 3-year period was conducted in a municipal hospital primary care clinic in a large academic medical center . We studied all patients ( 4,138 ) with type 2 diabetes who were seen in continuity clinics by 345 internal medicine residents and were r and omized to be control subjects or to receive one of three interventions . Instead of consultative advice , the interventions were hard copy computerized reminders that provided patient-specific recommendations for management at the time of each patient 's visit , individual face-to-face feedback on performance for 5 min every 2 weeks , or both . RESULTS Over an average patient follow-up of 15 months within the intervention site , improvements in and final HbA1c ( A1C ) with feedback + reminders ( deltaA1C 0.6 % , final A1C 7.46 % ) were significantly better than control ( deltaA1C 0.2 % , final A1C 7.84 % , P < 0.02 ) ; changes were smaller with feedback only and reminders only ( P = NS vs. control ) . Trends were similar but not significant with systolic blood pressure ( sBP ) and LDL cholesterol . Multivariable analysis showed that the feedback intervention independently facilitated attainment of American Diabetes Association goals for both A1C and sBP . Over a 2-year period , overall glycemic control improved in the intervention site but did not change in other primary care sites ( final A1C 7.5 vs. 8.2 % , P < 0.001 ) . CONCLUSIONS Feedback on performance aim ed at overcoming clinical inertia and given to internal medicine resident primary care providers improves glycemic control . Partnering generalists with diabetes specialists may be important to enhance diabetes management in other primary care setting Background —It is difficult to put research findings into clinical practice by either guidelines or prescription feedback . Aim —To study the effect on the quality of prescribing by a combined intervention of providing individual feedback and deriving quality criteria using guideline recommendations in peer review groups . Methods —199 general practitioners in 32 groups were r and omised to participate in peer review meetings related to either asthma or urinary tract infections . The dispensing by the participating doctors of antiasthmatic drugs and antibiotics during the year before the intervention period provided the basis for prescription feedback . The intervention feedback was design ed to describe the treatment given in relation to recommendations in the national guidelines . In each group the doctors agreed on quality criteria for their own treatment of the corresponding diseases based on these recommendations . Comparison of their prescription feedback with their own quality criteria gave each doctor the proportion of acceptable and unacceptable treatments . Main outcome measure — Difference in the prescribing behaviour between the year before and the year after the intervention . Results —Before intervention the mean proportions of acceptably treated asthma patients in the asthma group and urinary tract infection ( control ) group were 28 % and 27 % , respectively . The mean proportion of acceptably treated patients in the asthma group was increased by 6 % relative to the control group ; this difference was statistically significant . The mean proportions of acceptable treatments of urinary tract infection before intervention in the urinary tract infection group and asthma ( control ) group were 12 % for both groups which increased by 13 % in the urinary tract infection group relative to the control group . Relative to the mean pre-intervention values this represented an improvement in treatment of 21 % in the asthma group and 108 % in the urinary tract infection group . Conclusions —Deriving quality criteria of prescribing by discussing guideline recommendations gave the doctors a basis for judging their treatment of individual patients as acceptable or unacceptable . Presented with feedback on their own prescribing , they learned what they did right and wrong . This provided a foundation for improvement and the process thus instigated result ed in the doctors providing better quality patient care BACKGROUND Improvement in the delivery of influenza and pneumococcal vaccinations to high-risk groups is an important aspect of preventive care for primary healthcare teams . AIM To investigate the effect of an educational outreach visit to primary healthcare teams on influenza and pneumococcal vaccination uptake in high-risk patients . DESIGN Cluster r and omised controlled trial . SETTING Thirty general practice s in the Trent region , UK . METHODS Fifteen practice s were r and omised to intervention and 15 to the control group after stratifying for baseline vaccination rate . All intervention practice s were offered and received an educational outreach visit to primary healthcare teams , in addition to audit and feedback directed at improving influenza and pneumococcal vaccination rates in high-risk groups . Control practice s received audit and feedback alone . All practice s measured influenza and pneumococcal vaccination rates in high-risk groups . Primary outcomes were improvements in vaccination rates in patients aged 65 years and over , and  patients with coronary heart disease ( CHD ) , diabetes and a history of splenectomy .  RESULTS Improvements in pneumococcal vaccination rates in the intervention practice s were significantly greater compared with controls in patients with CHD , 14.8 % versus 6.5 % ( odds ratio [ OR ] = 1.23 , 95 % confidence interval [ CI ] = 1.13 to 1.34 ) and diabetes , 15.5 % versus 6.8 % ( OR = 1.18 , 95 % CI = 1.08 to 1.29 ) but not splenectomy , 6.5 % versus 4.7 % ( OR = 0.96 , 95 % CI = 0.65 to 1.42 ) . Improvements for influenza vaccination were also usually greater in intervention practice s but did not reach statistical significance . The increases for influenza vaccination in intervention versus control practice s were for CHD , 18.1 % versus 13.1 % ( OR = 1.06 , 95 % CI = 0.99 to 1.12 ) ; diabetes , 15.5 % versus 12.0 % ( OR = 1.07 , 95 % CI = 0.99 to 1.16 ) , splenectomy 16.1 % versus 2.9 % ( OR = 1.22 , 95 % CI = 0.78 to 1.93 ) ; and those over 65 years 20. 
    Output:
    
Conclusions The explicit use of theory in studies of audit and feedback was rare .
A range of theories was found , but not consistency of theory use .