***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 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 Objective The objective was to evaluate the effect of a clinic-based intervention program on mammography use by inner-city women . Design A r and omized controlled trial employing firm system methodology was conducted . Setting The study setting was a general internal medicine clinic in the university-affiliated county hospital serving metropolitan Seattle . Participants Women aged 50 to 74 years with at least one routine clinic appointment ( when they were due for mammography ) during the study period were enrolled in the trial ( n=314 ) . Interventions The intervention program emphasized nursing involvement and included physician education , provider prompts , use of audiovisual an printed patient education material s , transportation assistance in the form of bus passes , preppointment telephone or postcard reminders , and rescheduling assistance . Control firm women received usual care . Measurement and Main Results Mammography completion within 8 weeks of clinic visits was significantly higher among intervention ( 49 % ) than control ( 22 % ) firm women ( p<.001 ) . These effects persisted after adjustment for potential confounding by age , race , medical insurance coverage , and previous mammography experience at the hospital ( odds ratio 3.5 ; 95 % confidence interval 1.9 , 6.5 ) . The intervention effect was modified by type of insurance coverage as well as prior mammography history . Process evaluation indicated that bus passes and rescheduling efforts did not contribute to the observed increases in screening participation . Conclusions A clinic-based program incorporating physician education , provider prompts , patient education material s , and appointment reminders and emphasizing nursing involvement can facilitate adherence to breast cancer screening guidelines among inner-city women BACKGROUND Antibiotic misuse is common and costly and may promote antibiotic resistance . We tested the efficacy of a targeted one-on-one educational program ( " academic detailing " ) design ed to improve the appropriateness of broad-spectrum antibiotic use . METHODS A r and omized controlled trial was conducted in a large US teaching hospital . During an 18-week study period , 17 general medical , oncology , and cardiology services either received academic detailing or did not . The intervention was prompted by an order for either levofloxacin or ceftazidime that led to a computer-based review of data for that patient . Orders for the 2 target antibiotics deemed unnecessary by a priori criteria were included in the study . The primary outcome examined was the number of days that unnecessary levofloxacin or ceftazidime was administered in intervention and control groups . RESULTS Before the trial , intervention and control services had similar prescribing patterns for the target antibiotics ; the drugs were used for similar indications throughout the study period . During the intervention , there was a reduction of 37 % in days of unnecessary levofloxacin or ceftazidime use per 2-week interval on services r and omized to the educational intervention vs control services ( P < .001 ) . In multivariable analyses controlling for baseline prescribing and study interval , the rate of unnecessary use of the 2 target antibiotics was reduced by 41 % on the intervention services compared with controls ( 95 % confidence interval , 44%-78 % ; P < .001 ) . Length of stay , intensive care unit transfers , readmission rates , and in-hospital death rates were similar in both groups ( P > or = .10 for all ) . CONCLUSION Targeted one-on-one education is a practical , effective , and safe method for reducing excessive broad-spectrum antibiotic use 1 . The effect of providing information about medicines by a short ' sales ' interview between individual general practitioners and an ' academic representative ' on prescribing was investigated . 2 . The promotional campaign was design ed to encourage a rational approach to prescribing of non-steroidal anti-inflammatory agents in an intervention group of 101 general practitioners selected at r and om from the Leeds Family Practitioner Committee ( FPC ) . The remaining general practitioners in the Leeds FPC acted as a reference group . 3 . The prescribing data for each group for 5 months immediately prior to and 5 months following intervention were compared . 4 . Intervention produced a significant increase ( P less than 0.005 ) in the prescribing cost of ibuprofen  , the non-steroidal promoted as first choice agent , which was sustained for at least 5 months . 5 . Prescribing of the second choice agent , piroxicam  , decreased in the reference group but not in the intervention group . 6 . There was a decrease in the average prescribing cost of pounds 6.60 per doctor per month in the intervention group compared with the reference group Abstract Objective : To investigate the feasibility of improving screening for carriers of haemoglobin disorders in general practice by using a nurse facilitator to work with primary care teams and the relevant haematology laboratories ; to identify problems in communication between all those involved in delivering the service , and to implement solutions . Design : Two year , practice based r and omised controlled trial . Setting : North London area where 29 % of residents and 43 % of births are in ethnic groups at risk for haemoglobin disorders . Subjects : 26 of the 93 practice s using the services of the area 's haematology laboratory agreed to take part and were r and omly divided into control and intervention practice s. Main outcome measure : Change in number of requests for screening tests for haemoglobin disorders made by control and intervention practice s in baseline and intervention years . Results : The number of screening tests requested varied from 0 - 150 in the 93 practice s in the baseline year . Study practice s tended to have made a moderate number of requests ( 10 - 50 ) during this period . During the intervention year intervention practice s made 292 more requests ( 99 % increase ) and control practice s made 74 fewer requests ( 23 % decrease ; P=0.001 for difference in median change ) . Four practice s , three of which were singleh and ed , accounted for 75 % of the increase . The number of requests from intervention practice s , adjusted for baseline requests , was 3.2 times higher than control practice s ( P<0.0001 ) . Conclusion : General practitioners and practice nurses are willing to undertake a new genetic screening service ( or exp and an existing one ) if they are persuaded that it benefits the health of a significant proportion of their practice population . They need appropriate tools ( for example , information material s for carriers and groups at risk ) , and the laboratory must be sensitive to their needs . Preconceptional carrier screening and counselling need to be coupled with antenatal screening The effect of clinical pharmacy services on  prescribing patterns and drug costs for nonsteroidal anti-inflammatory drugs ( NSAIDs ) and salicylates in a primary -care clinic operated by a health-maintenance organization ( HMO ) was studied . Two pharmacists provided clinical services to a r and omly selected cluster of family practice physicians in the HMO for six months . A second family practice cluster served as a control group . The pharmacists alerted prescribers to the availability of low-cost alternatives ( such as ibuprofen and salicylates ) and review ed the medication profiles of patients receiving high-cost NSAIDs . Data were collected for both physician clusters for nine months before and six months after the pharmacists ' intervention . Changes in the mean numbers of prescriptions for ibuprofen and piroxicam  per 1000 enrollees per physician in the baseline and evaluation periods were not significantly different between the two groups . Significantly more prescriptions for salicylates  were written by physicians in the intervention group than in the control group during the evaluation period . Annualized mean drug ingredient costs per enrollee and per prescription for NSAIDS and salicylates  decreased during the evaluation period in both groups , but these differences were not significant . In relatively unstructured interactions with physicians and nurses , clinical pharmacists were not able to reduce the costs associated with NSAIDs but did have a modest effect on altering  salicylate prescribing patterns . This clinical pharmacy program was not economically self-sustaining during the first six months of operation , since operating costs exceeded anticipated savings The Audit Commission endorsed the role of the prescribing adviser in promoting safe , rational and cost‐effective prescribing by general medical practitioners ( GPs ) . However , whether such roles should involve practice visits , facilitation of educational meetings , production of local bulletins , or a combination of these and other approaches is unclear . Few UK studies have investigated the best methods to influence prescribing on a large scale in primary care . The present study was design ed to determine the effectiveness of active compared to passive practice specific prescribing feedback . The programme focused on non‐steroidal anti‐inflammatory drugs ( NSAIDs ) since concern has been expressed about their use , which accounts for 4 % of volume and 5 % of the cost of UK National Health Service drugs prescribed in primary care , Sixty‐six of the 91 general medical practice s contracted to Gwent Health Authority agreed to participate in the study and were r and omly stratified by practice size , locality , fund‐holding and dispensing status into 2 groups . Group 1 received active feedback via practice visits from the pharmaceutical prescribing adviser to present prescribing analysis and cost data ( PACT ) concerning NSAID use . Group 2 received passive feedback , a practice specific prescribing analysis workbook that contained similar information to that given to Group 1 practice s. Practice s not wishing to enter the study were used as a self selected reference group ( Group 3 ) which received no information on NSAIDs from the prescribing adviser . Practice visits and the distribution and completion of workbooks occurred between September 1993 and March 1994 , PACT data for all NSAIDs was used to identify changes in prescribing before and after the programme . A combination of 27 indicators , in terms of items and cost per 1000 patients , were chosen to identify overall changes and potential switches between individual drugs , or to generic alternatives . Comparison of the practice s in each of the three groups at analysis revealed similar distribution in terms of stratification criteria . Eleven ( 38 % ) Group 2 practice s returned completed workbooks . Overview indicators ( those not targeted ) showed similar trends of either increase or decrease , in cost and volume , across all three groups , whereas targeted indicators demonstrated a more mixed picture between groups . In summary the total number of statistically significant changes for targeted indicators in Groups 1 , 2 , and 3 were 10 , 8 and 1 ( changes in items per 1000 patients ) , and 12 , 10 and 3 ( changes in cost per 1000 patients ) respectively . Targeted indicators revealed more statistically significant changes in Group 1 ( active feedback ) than Group 2 passive feedback ) which showed more changes than Group 3 ( reference group ) . Active feedback was more effective at bringing about a required change than the use of passive feedback ; both approaches had more impact than that registered by the reference group . The Group 2 analysis presented included both responders and non‐responders , thus a more marked benefit of the workbook was perhaps masked . These results have implication s for the future provision of prescribing advice to practice s. Advisers currently use both active and passive methods to provide prescribing feedback 
    Output:
    
EOVs alone or when combined with other interventions have effects on prescribing that are relatively consistent and small , but potentially important .
Their effects on other types of professional performance vary from small to modest improvements , and it is not possible from this review to explain that variation