***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 Interventions design ed to narrow the gap between research findings and clinical practice may be effective , but also costly . Economic evaluations are necessary to judge whether such interventions are worth the effort . We have evaluated the economic effects of a tailored intervention to support the implementation of guidelines for the use of antihypertensive and cholesterol-lowering drugs . The tailored intervention was evaluated in a r and omized trial , and was shown to significantly increase the use of thiazides for patients started on antihypertensive medication , but had little or no impact on other outcomes . The increased use of thiazides was not expected to have an impact on health outcomes . Methods and Findings We performed cost-minimization and cost-effectiveness analyses on data from a r and omized trial involving 146 general practice s from two geographical areas in Norway . Each practice was r and omized to either the tailored intervention ( 70 practice s ; 257 physicians ) or control group ( 69 practice s ; 244 physicians ) . Only patients that were being started on antihypertensive medication were included in the analyses . A multifaceted intervention was tailored to address identified barriers to change . Key components were an educational outreach visit with audit and feedback , and computerized reminders . Pharmacists conducted the visits . A cost-minimization framework was adopted , where the costs of intervention were set against the reduced treatment costs ( principally due to increased use of thiazides rather than more expensive medication ) . The cost-effectiveness of the intervention was estimated as the cost per additional patient being started on thiazides . The net annual cost ( cost minimization ) in our study population was US$ 53,395 , corresponding to US$ 763 per practice . The cost per additional patient started on thiazides ( cost-effectiveness ) was US$ 454 . The net annual savings in a national program was modeled to be US$ 761,998 , or US$ 540 per practice after 2 y. In this scenario the savings exceeded the costs in all but two of the sensitivity analyses we conducted , and the cost-effectiveness was estimated to be US$ 183 . Conclusions We found a significant shift in prescribing of antihypertensive drugs towards the use of thiazides in our trial . A major reason to promote the use of thiazides is their lower price compared to other drugs . The cost of the intervention was more than twice the savings within the time frame of our study . However , we predict modest savings over a 2-y period 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 BACKGROUND Family physicians ( FPs ) in Australia underutilize effective strategies to help patients stop smoking . We conducted a cluster r and omization trial to evaluate a multifaceted , practice -based intervention involving audit , feedback , and academic detailing to improve FP smoking cessation advice . METHODS Sixty FPs in 39 practice s participated . FPs ' provision of smoking cessation advice was measured by patient recall , medical record audit , and FP self-report . Logistic regression analysis using generalized estimating equations was performed to assess improvements in practice , after adjustment for clustering by practice . RESULTS Improvements between baseline and posttest in patient recall of FP advice about  nicotine replacement patches and gum  were significantly greater in the intervention than in the control group ( P = 0.0056 and P = 0.0002 , respectively ) . While there were substantial increases in patient recall of assessment of smoking status and FP use of " quit date s , " behavioral advice , and written material s in the intervention group , these changes were not significantly greater than those in the control group . Notation of patients ' smoking status and smoking cessation advice in medical records remained suboptimal in both groups . CONCLUSIONS This multifaceted intervention was successful only in promoting FPs ' use of nicotine replacement therapy . While the use of other effective cessation strategies appeared to increase , a larger trial is needed for further evaluation Abstract Objective : To determine whether locally developed guidelines on asthma and diabetes disseminated through practice based education improve quality of care in non-training , inner city general practice s. Design : R and omised controlled trial with each practice receiving one set of guidelines but providing data on the management of both conditions . Subjects:24 inner city , non-training general practice s. Setting : East London . Main outcome measures : Recording of key variables in patient records ( asthma : peak flow rate , review of inhaler technique , review of asthma symptoms , prophylaxis , occupation , and smoking habit ; diabetes : blood glucose concentration , glycaemic control , funduscopy , feet examination , weight , and smoking habit ) ; size of practice disease registers ; prescribing in asthma ; and use of structured consultation “ prompts . ” Results : In practice s receiving diabetes guidelines , significant improvements in recording were seen for all seven diabetes variables . Both groups of practice s showed improved recording of review of inhaler technique , smoking habit , and review of asthma symptoms . In practice s receiving asthma guidelines , further improvement was seen only in recording of review of inhaler technique and quality of prescribing in asthma . Sizes of disease registers were unchanged . The use of structured prompts was associated with improved recording of four of seven variables on diabetes and all six variables on asthma . Conclusions : Local guidelines disseminated via practice based education improve the management of diabetes and possibly of asthma in inner city , non-training practice s. The use of simple prompts may enhance this improvement Background Despite accurate diagnostic tests and effective therapies , the management of osteoporosis has been observed to be suboptimal in many setting s. We tested the effectiveness of an intervention to improve care in patients at-risk of osteoporosis . Design R and omized controlled trial . Participants Primary care physicians and their patients at-risk of osteoporosis , including women 65 years and over , men and women 45 and over with a prior fracture , and men and women 45 and over who recently used ≥90 days of oral glucocorticoids . InterventionA multifaceted program of education and reminders delivered to primary care physicians as well as mailings and automated telephone calls to patients . Outcome : Either undergoing a bone mineral density ( BMD ) testing or filling a prescription for a bone-active medication during the 10 months of follow-up . Results After the intervention , 144 ( 14 % ) patients in the intervention group and 97 ( 10 % ) patients in the control group received either a BMD test or filled a prescription for an osteoporosis medication . This represents a 4 % absolute increase and a 45 % relative increase ( 95 % confidence interval 9–93 % , p = 0.01 ) in osteoporosis management between the intervention and control groups . No differences between groups were observed in the incidence of fracture . Conclusion An intervention targeting primary care physicians and their at-risk patients increased the frequency of BMD testing and /or filling prescriptions for osteoporosis medications . However , the absolute percentage of at-risk patients receiving osteoporosis management remained low Background : Research into adverse events ( AEs ) has highlighted the need to improve patient safety . AEs are unintended injuries or complications result ing in death , disability or prolonged hospital stay that arise from health care management . We estimated the incidence of AEs among patients in Canadian acute care hospitals . Methods : We r and omly selected 1 teaching , 1 large community and 2 small community hospitals in each of 5 provinces ( British Columbia , Alberta , Ontario , Quebec and Nova Scotia ) and review ed a r and om sample of charts for nonpsychiatric , nonobstetric adult patients in each hospital for the fiscal year 2000 .  Trained review ers screened all eligible charts , and physicians review ed the positively screened charts to identify AEs and determine their preventability . Results : At least 1 screening criterion was identified in 1527 ( 40.8 % ) of 3745 charts . The physician review ers identified AEs in 255 of the charts . After adjustment for the sampling strategy , the AE rate was 7.5 per 100 hospital admissions ( 95 % confidence interval [ CI ] 5.7– 9.3 ) . Among the patients with AEs , events judged to be preventable occurred in 36.9 % ( 95 % CI 32.0%–41.8 % ) and death in 20.8 % ( 95 % CI 7.8%–33.8 % ) . Physician review ers estimated that 1521 additional hospital days were associated with AEs . Although men and women experienced equal rates of AEs , patients who had AEs were significantly older than those who did not ( mean age [ and st and ard deviation ] 64.9 [ 16.7 ] v. 62.0 [ 18.4 ] years ; p = 0.016 ) . Interpretation : The overall incidence rate of AEs of 7.5 % in our study suggests that , of the almost 2.5 million annual hospital admissions in Canada similar to the type studied , about 185 000 are associated with an AE and close to 70 000 of these are potentially preventable Objective To assess the effect of educational outreach visits on antibiotic prescribing for acute dental pain in primary care . Study design R and omised controlled trial ( RCT ) . Setting General dental practice s in four health authority areas in Wales . Subjects and methods General dental practitioners were recruited to the study and r and omly allocated to one of the three study groups ( control group , guideline group or intervention group ) . Following the intervention , practitioners completed a st and ardised question naire for each patient that presented with acute dental pain . Interventions The control group received no intervention . The guideline group received educational material by post . The intervention group received educational material by post and an academic detailing visit by a trained pharmacist . The educational material included evidence -based guidelines on prescribing for acute dental pain and patient information leaflets . Main outcome measures The number of antibiotic prescriptions issued to patients presenting with dental pain and the number of ' inappropriate ' antibiotic prescriptions . Antibiotics were considered to be inappropriate if the patient did not have symptoms indicative of spreading infection . Results A total of 1,497 completed question naires were received from 23 , 20 and 27 general dental practitioners in the control , guideline and intervention group respectively . Patients in the intervention group received significantly fewer antibiotic prescriptions than patients in the control group ( OR ( 95 % CI ) 0.63 ( 0.41 , 0.95 ) ) and significantly fewer inappropriate antibiotic prescriptions ( OR ( 95 % CI ) 0.33 ( 0.21 , 0.54 ) ) . However , antibiotic and inappropriate antibiotic prescribing were not significantly different in the guideline group compared to the control group ( OR ( 95 % CI ) 0.83 ( 0.55 , 1.21 ) and OR ( 95 % CI ) 0.82 ( 0.53 , 1.29 ) respectively 
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These factors reflect the complexity of real-world practice and can result in suboptimal medication use that contributes to drug-related morbidity and mortality.5 In 2000 , the cost of drug-related morbidity and mortality result ing from drug-related problems exceeded $ 177.4 billion US in the United States.6 According to a Canadian study completed in 2000 , adverse drug reactions occur frequently ( 7.5 per 100 hospital admissions),7 are preventable (36.9%)7 and prolong hospital stay by an average of 3.6 days.8 Key points Academic detailing has been shown to improve patient health outcomes .
Points cles Il a ete demontre que la visite academique ameliore les result ats pour la sante des patients .
Some improvements in the appropriate prescribing by physicians for antibiotics,11–13 benzodiazepines,14–16 NSAIDs,17,18 acid-peptic disease management19 and diuretics for hypertension20 have been observed .