***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 To strengthen suicide prevention skills in mental health care in The Netherl and s , multidisciplinary teams throughout the country are trained in the application of the new  Dutch guideline on the assessment and treatment of  suicidal behavior . Previous studies have shown beneficial effects of additional efforts for guideline implementation on professionals ’ attitude , knowledge , and skills . However , the effects on patients are equally important , but are rarely measured . The main objective of this study is to examine whether patients of multidisciplinary teams who are trained in guideline application show greater recovery from suicide ideation than patients of untrained teams . Methods / Design This is a multicentre cluster r and omized controlled trial ( RCT ) , in which multidisciplinary teams from mental health care institutions are matched in pairs , and r and omly allocated to either the experimental or control condition . In the experimental condition , next to the usual dissemination of the guideline ( internet , newsletter , books , publications , and congresses ) , teams will be trained in the application of the guideline via a 1-day small interactive group training program supported by e-learning modules . In the control condition , no additional actions next to usual dissemination of the guideline will be undertaken . Assessment s at patient level will start when the experimental teams are trained . Assessment s will take place upon admission and after 3 months , or earlier if the patient is discharged . The primary outcome is suicide ideation . Secondary outcomes are non-fatal suicide attempts , level of treatment satisfaction , and societal costs . Both a cost-effectiveness and cost-utility analysis will be performed . The effects of the intervention will be examined in multilevel models . Discussion The strengths of this study are the size of the study , RCT design , training of complete multidisciplinary teams , and the willingness of both management and staff to participate . Trial registration Netherl and s trial register : Objectives : To determine whether writing clinical guideline recommendations in behaviourally specified “ plain English ” language increases the likelihood of their implementation by service users ( patients ) . Design : R and omised controlled trial in which participants received either the original text of the National Institute for Clinical Excellence ( NICE ) public guidelines for the management of schizophrenia or a behaviourally specified text with the same content . Setting : Mental health service user networks and voluntary sector organisations within two inner London boroughs . Participants : Eighty four mental health service users recruited by post or face to face contact at service user meetings . Intervention : The section of the NICE public guidelines for schizophrenia concerning psychological and pharmacological treatments was rewritten to improve style and behavioural specificity by applying evidence -based and psychologically informed principles of good written communication . Outcome measures : Cognitive predictors of behaviour , as specified by the evidence based theory of planned behaviour , constituted the primary outcome as it was not possible to measure the actual behaviour of guideline implementation . The predictors were behavioural intentions to implement the guidelines , attitudes towards implementation , and perceived behavioural control over implementation . Satisfaction with the guidelines and perceived comprehension were also measured . Results : Behaviourally specified “ plain English ” guidelines led to stronger intentions to implement the guidelines , more positive attitudes towards them , and greater perceived behavioural control over using them . There was no difference in satisfaction or perceived comprehension . Conclusions : Writing guidelines with high behavioural specificity in conjunction with the use of “ plain English ” may be a simple and effective method of increasing their implementation . Evaluation with a behavioural outcome is now needed Background People with severe mental illnesses ( SMI ) are at increased risk of cardiovascular disease ( CVD ) . Clinical guidelines recommend regular screening for CVD risk factors . We evaluated a nurse led intervention to improve screening rates across the primary - secondary care interface . Methods Six community mental health teams ( CMHTs ) were r and omised to receive either the nurse led intervention plus education pack ( n = 3 ) or education pack only ( n = 3 ) . Intervention ( 6 months ) : The nurse promoted CVD screening in primary care and then in CMHTs . Patients who remained unscreened were offered screening by the nurse . After the intervention participants with SMI were recruited from each CMHT to collect outcome data . Main outcome : Numbers screened during the six months , confirmed in General Practice notes . Results All six CMHTs approached agreed to r and omisation . 121 people with SMI participated in outcome interviews during two waves of recruitment ( intervention arm n = 59 , control arm n = 62 ) . Participants from both arms of the trial had similar demographic profiles and rates of previous CVD screening in the previous year , with less than 20 % having been screened for each risk factor . After the trial , CVD screening had increased in both arms but participants from the intervention arm were significantly more likely to have received screening for blood pressure ( 96 % vs 68 % ; adjusted Odds Ratio ( OR ) 13.6 ; 95 % CI : 3.5 - 38.4 ) , cholesterol ( 66.7 % vs 26.9 % , OR 6.1 ; 3.2 - 11.5 ) , glucose ( 66.7 % vs 36.5 % OR 4.4 ; 2.7 - 7.1 ) , BMI ( 92.5 % vs 65.2 % OR 6.5 ; 2.1 - 19.6 ) , and smoking status ( 88.2 % vs 57.8 % OR 5.5 ; 3.2 - 9.5 ) and have a 10 year CVD risk score calculated ( 38.2 % vs 10.9 % ) OR 5.2 1.8 - 15.3 ) . Within the intervention arm approximately half the screening was performed in general practice and half by the trial nurse . Conclusions The nurse-led intervention was superior , result ing in an absolute increase of approximately 30 % more people with SMI receiving screening for each CVD risk factor . The feasibility of the trial was confirmed in terms of CMHT recruitment and the intervention , but the response rate for outcome collection was disappointing ; possibly a result of the cluster design . The trial was not large or long enough to detect changes in risk factors . Trial Registration International St and ard R and omised Controlled Trial Registration Number ( IS RCT RN ) 58625025 Outpatient medication adherence is a major problem , especially for patients repeatedly hospitalized for psychiatric disorders . This study included 39 such patients who were receiving case management services from a community mental health center . Patients were matched and r and omly assigned to receive in a single session either ( 1 ) information regarding medication and its benefits , ( 2 ) guidelines for assuring adherence which encompassed all phases related to pill-taking including filling prescriptions , use of a pill container , transportation , self-reminders , doctor 's appointments and so forth , or ( 3 ) the same guidelines as ( 2 ) above but given in the presence of a family member who was enlisted in support . The results showed that adherence increased to about 94 % after the guidelines were given for both the individual and family guideline procedure , whereas adherence remained unchanged at 73 % after the medication information procedure . These results suggest a practical means for assuring a high level of medication adherence for patients with psychiatric disorders OBJECTIVE Despite the frequent use of the Positive and Negative Syndrome Scale ( PANSS ) for rating the symptoms of schizophrenia , the clinical meaning of its total score and of the cut-offs that are used to define treatment response ( e.g. at least 20 % or 50 % reduction of the baseline score ) are as yet unclear . We therefore compared the PANSS with simultaneous ratings of Clinical Global Impressions ( CGI ) . METHOD PANSS and CGI ratings at baseline ( n = 4091 ) , and after one , two , four and six weeks of treatment taken from a pooled data base of seven pivotal , multi-center antipsychotic drug trials on olanzapine or amisulpride in patients with exacerbations of schizophrenia were compared using equipercentile linking . RESULTS Being considered " mildly ill " according to the CGI approximately corresponded to a PANSS total score of 58 , " moderately ill " to a PANSS of 75 , " markedly ill " to a PANSS of 95 and severely ill to a PANSS of 116 . To be " minimally improved " according to the CGI score was associated with a mean percentage PANSS reduction of 19 % , 23 % , 26 % and 28 % at weeks 1 , 2 , 4 and 6 , respectively . The corresponding figures for a CGI rating " much improved " were 40 % , 45 % , 51 % and 53 % . CONCLUSIONS The results provide a better framework for underst and ing the clinical meaning of the PANSS total score in drug trials of schizophrenia patients with acute exacerbations . Such studies may ideally use at least a 50 % reduction from baseline cut-off to define response rather than lower thresholds . In treatment resistant population s , however , even a small improvement can be important , so that a 25 % cut-off might be appropriate OBJECTIVES To evaluate the effectiveness of efforts to translate and disseminate evidence -based guidelines about atypical antipsychotic use to nursing homes ( NHs ) . DESIGN Three-arm , cluster r and omized trial . SETTING NHs . PARTICIPANTS NHs in the state of Connecticut . MEASUREMENTS Evidence -based guidelines for atypical antipsychotic prescribing were translated into a toolkit targeting NH stakeholders , and 42 NHs were recruited and r and omized to one of three toolkit dissemination strategies : mailed toolkit delivery ( minimal intensity ) ; mailed toolkit delivery with quarterly audit and feedback reports about facility-level antipsychotic prescribing ( moderate intensity ) ; and in-person toolkit delivery with academic detailing , on-site behavioral management training , and quarterly audit and feedback reports ( high intensity ) . Outcomes were evaluated using the Reach , Effectiveness , Adoption , Implementation , Maintenance ( RE- AIM ) framework . RESULTS Toolkit awareness of 30 % ( 7/23 ) of leadership of low-intensity NHs , 54 % ( 19/35 ) of moderate-intensity NHs , and 82 % ( 18/22 ) of high-intensity NHs reflected adoption and implementation of the intervention . Highest levels of use and knowledge among direct care staff were reported in high-intensity NHs . Antipsychotic prescribing levels declined during the study period , but there were no statistically significant differences between study arms or from secular trends . CONCLUSION RE- AIM indicators suggest some success in disseminating the toolkit and differences in reach , adoption , and implementation according to dissemination strategy but no measurable effect on antipsychotic prescribing trends . Further dissemination to external stakeholders such as psychiatry consultants and hospitals may be needed to influence antipsychotic prescribing for NH residents OBJECTIVE To determine the effectiveness of an intervention to promote medication adherence . METHOD Data were collected for adults with exacerbation of schizophrenia who were treated at one of 6 U.S. Department of Veterans Affairs ( VA ) Medical Centers ( VAMCs ) in 3 regional VA networks ( Veterans Integrated Service Networks [ VISNs ] ) from March 1999 to October 2000 . All 6 VAMCs received a basic guideline implementation strategy for medication management of schizophrenia using usual VA procedures . One VAMC within each VISN was r and omly selected to receive an enhanced implementation strategy design ed to promote guideline -concordant prescribing by physicians and medication adherence by patients . In the enhanced strategy , a research nurse worked with study participants to identify medication adherence barriers and to develop patient-specific strategies to overcome those barriers . Participants ( N = 349 ) were interviewed at enrollment and 6 months later , using the Structured Clinical Interview for the Positive and Negative Syndrome Scale ( PANSS ) , the Barnes Akathisia Rating Scale , and the Schizophrenia Outcomes Module ( SCHIZOM ) . Medication adherence was measured via subjects ' self-report , using the SCHIZOM , and from data abstract ed from medical records . RESULTS Participants were primarily male ( 94 % ) and nonwhite ( 69 % , primarily African American ) with a mean age of 46 years .  Medication adherence at follow-up was modeled using logistic regression , controlling for adherence at baseline , demographic characteristics , PANSS total score , akathisia at baseline , family history of mental illness , and substance abuse . A logistic regression model for adherence at follow-up was significant ( likelihood ratio = 52.72 , df = 14 , p < .0001 ) . Patients enrolled at sites receiving the enhanced intervention were almost twice as likely to be adherent at follow-up . Those who were nonadherent at baseline were significantly less likely to be adherent at follow-up . In addition , adherence at follow-up was significantly greater at 2 of the VA networks as compared to the third network . CONCLUSIONS These data suggest that a patient-centered strategy to identify and overcome barriers to adherence can improve adherence to antipsychotic medications BACKGROUND Scientific literature review s aim to summarize the state of knowledge and published empirical evidence . In contrast , medical guidelines are intervention tools that aim to improve physician behaviour and patient outcome . They can have positive effects , but they can also have negative effects . Their effects must be tested by research . METHODS In a r and omized controlled trial , 103 psychiatrists in private practice were either provided with the WHO depression guideline only ( information group ) , or provided with the WHO depression guideline and trained for one day in this guideline ( intervention group ) , or left uninformed ( control group ) . They then treated a total of 497 patients according to individual clinical considerations and the needs of the patients . Observation of routine treatment lasted 12weeks 
    Output:
    
The preliminary pattern of evidence suggests that uncertainty remains about clinical ly meaningful and sustainable effects of treatment guidelines on patient outcomes and how best to implement such guidelines for maximal benefit