***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 Osteoporosis is a serious but treatable condition . However , appropriate therapy utilization of the disease remains suboptimal . Thus , the objective of the study was to change physicians ' therapy administration behavior in accordance with the Osteoporosis Canada 2002 guidelines . Methods The Project was a two year cohort study that consisted of five Quality Circle ( QC ) phases that included : 1 ) Training & Baseline Data Collection , 2 ) First Educational Intervention & First Follow-Up Data Collection 3 ) First Strategy Implementation Session , 4 ) Final Educational Intervention & Final Follow-up Data Collection , and 5 ) Final Strategy Implementation Session . A total of 340 family physicians formed 34 QCs and participated in the study . Physicians evaluated a total of 8376 , 7354 and 3673 r and omly selected patient charts at baseline , follow-up # 1 and the final follow-up , respectively . Patients were divided into three groups ; the high-risk , low-risk , and low-risk without fracture groups . The generalized estimating equations technique was utilized to model the change over time of whether physicians Results The odds of appropriate therapy was 1.29 ( 95 % CI : 1.13 , 1.46 ) , and 1.41 ( 95 % CI : 1.20 , 1.66 ) in the high risk group , 1.15 ( 95 % CI : 0.97 , 1.36 ) , and 1.16 ( 95 % CI : 0.93 , 1.44 ) in the low risk group , and 1.20 ( 95 % CI : 1.01 , 1.43 ) , and 1.23 ( 95 % CI : 0.97 , 1.55 ) in the low risk group without fractures at follow-up # 1 and the final follow-up , respectively . Conclusion QCs methodology was successful in increasing physicians ' appropriate use of osteoporosis medications in accordance with Osteoporosis Canada guidelines Background Multimorbid patients frequently receive complex medication regimens and are at higher risk for adverse drug reactions and hospitalisations . Managing patients with polypharmacy is dem and ing , because it requires coordination of multiple prescribers and intensive monitoring . Three evidence -based recommendations addressing polypharmacy in primary care are structured medication counselling , use of medication lists and medication review s to avoid potentially inappropriate medication ( PIM ) . Although promising to improve patient outcomes , these recommendations are not well implemented in German routine care . Implementation of guidelines is often hindered by specific “ determinants of change ” . “ Tailored ” interventions are design ed to specifically address previously identified determinants . This study examines a tailored intervention tto implement the aforementioned recommendations into German primary care practice s. This study is part of the European Tailored Interventions for Chronic Diseases project , which aims at contributing knowledge about the methods used for tailoring . Methods / Design The study is design ed as a cluster r and omized controlled trial with primary care practice s of general practitioners ( GPs ) who are organized in quality circles . Quality circles will be the unit of r and omization with a 1:1 ratio . Follow-up time is 6 months . GPs and healthcare assistants in the intervention group will receive training on medication management . Each GP will create a tailored concept of how to implement the three recommendations into his/her practice . Evidence -based checklists for medication counselling and medication review s will be provided for physicians . A tablet PC with an interactive educational tool and information leaflets will be provided for use by patients to inform about the necessity of continuous medication management . Control practice s will not receive special training and will provide care as usual . Primary outcome is the degree of implementation of the three recommendations , which will be measured using a prespecified set of indicators . Additionally , the PIM prescription rate , patient activation , patients ’ beliefs about medicine , medication adherence and patients ’ social support will be measured . Discussion This study will contribute knowledge about the feasibility of implementing recommendations for managing patients with polypharmacy in primary care practice s. Additionally , this study will contribute knowledge about methods for tailoring of implementation interventions .Trial registration Clinical trials.govIS RCT AIM This paper is a report of a study to test the effect of participating in a reflecting peer-support group on self-reported health , burnout and on perceived changes in work conditions . BACKGROUND Stress-related conditions are one of the most common causes for long-term sick-leave . There is limited evidence for the effectiveness of person-directed interventions aim ed at reducing stress levels in healthcare workers . Prior research in the relationship between support and burnout show somewhat inconsistent results . METHOD A r and omized controlled trial with peer-support groups as the intervention was conducted with 660 healthcare workers scoring above the 75th percentile on the exhaustion dimension of the Oldenburg Burnout Inventory . One hundred and fifty-one ( 22.9 % ) agreed to participate . The intervention started in 2002 with 51 participants ( 96.1 % were women ) , 80 of whom constituted the control group .  Potential differences in outcome measures 12 months after the intervention were compared using ancova , and data collected was completed in 2004 . Qualitative content analyses were used to analyse reported experiences from group participation . RESULTS Statistically significant intervention effects were found for general health , perceived quantitative dem and s at work , participation and development opportunities at work and in support at work . Seven categories of experiences from participating were identified : talking to others in a similar situation , knowledge , sense of belonging , self-confidence , structure , relief of symptoms and behavioural change . CONCLUSION Peer-support groups using a problem-based method could be a useful and comparatively inexpensive tool in alleviating work-related stress and burnout Background Multimorbid patients receiving polypharmacy represent a growing population at high risk for negative health outcomes . Tailoring is an approach of systematic intervention development taking account of previously identified determinants of practice . The aim of this study was to assess the effect of a tailored program to improve the implementation of three important processes of care for this patient group : ( a ) structured medication counseling including brown bag review s , ( b ) the use of medication lists , and ( c ) structured medication review s to reduce potentially inappropriate medication . Methods We conducted a cluster-r and omized controlled trial with a follow-up time of 9 months . Participants were general practitioners ( GPs ) organized in quality circles and participating in a GP-centered care contract of a German health insurance . Patients aged > 50 years , suffering from at least 3 chronic diseases , receiving more than 4 drugs , and being at high risk for medication-related events according to the assessment of the treating GP were enrolled . The tailored program consisted of a workshop for GPs and health care assistants , educational material s and reminders for patients , and the elaboration of implementation action plans . The primary outcome was the change in the degree of implementation between baseline and follow-up , measured by a summary score of 10 indicators . The indicators were based on structured surveys with patients and GPs . Results We analyzed the data of 21 GPs ( 10 - intervention group , 11 - control group ) and 273 patients ( 130 - intervention group , 143 - control group ) . The increase in the degree of implementation was 4.2 percentage points ( 95 % confidence interval : −0.3 , 8.6 ) higher in the intervention group compared to the control group ( p = 0.1 ) . Two of the 10 indicators were significantly improved in the intervention group : medication counseling ( p = 0.017 ) and brown bag review ( p = 0.012 ) . Secondary outcomes showed an effect on patients ’ self-reported use of medication lists when buying drugs in the pharmacy ( p = 0.03 ) . Conclusions The tailored program may improve implementation of medication counseling and brown bag review whereas the use of medication lists and medication review s did not improve . No effect of the tailored program on the combined primary outcome could be substantiated . Due to limitations of the study , results have to be interpreted carefully . The factors facilitating and hindering successful implementation will be examined in a comprehensive process evaluation . Trial registration numberIS RCT N34664024 , assigned Three years ago , we founded this journal focusing on publishing systematic review s , systematic review protocol s , and associated method ological development papers . Systematic review s , which developed in the social sciences in the 1970s , began to gain rapid momentum during the 1990s in response to concerns by policymakers and clinicians about the scientific validity of the prevailing paradigm of traditional narrative review s written by authoritative experts . What distinguished systematic review s was the use of formal explicit methods , in other words pre-specification , of what exactly was the question to be answered , how evidence was search ed for and assessed , and how it was synthesized in order to reach the conclusion . Importantly , these formal methods were described as part of the review itself in a Methods section . In turn , these methods themselves became the subject of hypothesis-testing studies , as investigators sought how best to search for evidence , assess studies for quality or risk of bias , determine under what conditions meta- analysis was justified , and how to best determine and characterize our confidence in the conclusions . The results of these hypothesis-testing studies led over time to improvements in the methods we use for systematic review s. Thus , systematic review s and this journal are part of an ever-evolving process whose foundations are rooted in the scientific method . Today , new forms of review s are appearing . These have emerged in response to policymakers and other stakeholders ’ needs for information , sometimes emergently or urgently , for which the existing systematic review model does not quite fit . Hence , the rapid review , when time is of the essence ; the scoping review , when what is needed is not detailed answers to specific questions but rather an overview of a broad field ; the evidence map , a cousin of scoping review s that commonly has a specific visual presentation of the evidence across a broad field ; and the realist review , where the question of interest includes how and why complex social interventions work in certain situations , rather than assume they either do or do not work at all . As Editors , we regularly get contacted by prospect i ve authors asking whether realist review s , or scoping review s , etc . , are “ within the scope ” for Systematic Review s , and therefore we judge it an opportune time to state our position on this matter . It is our view that all of these new forms of review s are related to systematic review s , similar to the way that different biological Species within the same Family are related to each other . We consider “ systematic review s ” to be the Family and the different forms of review s to be the different species . Just as in the biological classification , where the related organisms must share certain characteristics , so too must the different types of review s share a common characteristic . In this case , what is shared is their foundation in the scientific method , with their methods articulated in advance in sufficient detail that the review can be reproduced by others . A further defining feature is that there are scholars devoted to improving the methods over time via hypothesis-testing studies . Systematic Review s has responded to these emerging techniques and already publishes papers reporting methods and findings from the systematic review family and has for example published an extremely popular series on rapid review s. We would like to consoli date this position and invite su bmi ssion of these new species of review s , as long as they meet the qualifications just listed . We expect this process of evolution to continue and to refine the methods such that in 10 years ’ time , there will appear new , as yet unimagined species of review s— and perhaps some current species of review will become extinct . Thus , it is with the scientific method , which we believe is the foundation that unites the Family of systematic review Background Several studies suggest that General Practitioners ( GPs ) prefer " traditional " media such as journals or quality circles when they are seeking out different options to meet their continuing medical education ( CME ) requirements . A survey was design ed in order to gain a better underst and ing of German General Practitioners ' preferences for different forms of educational media that will meet their CME needs . Methods Four hundred and forty nine ( N = 449 ) German physicians were contacted to take part in this study on the occasion of one of their quality circle meetings . The participating physicians received a st and ardized 26-item- question naire that surveyed their preferences for different forms of educational media . A factor analysis was performed in order to determine whether the observed variables can be explained largely or entirely in terms of the underlying patterns . Results Two hundred and sixty-four physicians with an average age of 51.1 years participated ( 28.5 % female , 71.5 % male ) . We found that GPs favor learning environments such as : journals , colleagues , and quality circles .  New  media like the internet was used less often for their learning activities , even though the usage of the internet in general was quite high . The most important requirements for media in medical education as perceived by the participants were its relevancy for daily practice and dependability . Conclusion Despite a growing use of the Internet it seems that German GPs favor " classical/traditional " setting s for their learning activities . These results should be taken into consideration when planning CME or CPD programs or other learning activities . Trial registration Current Controlled Trials IS RCT N36550981 Background Research literature consistently documents that scientifically based therapeutic recommendations are not always followed in the hospital or in the primary care setting . Currently , there is evidence that some general practitioners in Australia are not prescribing appropriately for patients diagnosed with 1 ) hypertension ( HT ) and 2 ) chronic heart failure ( CHF ) . The objectives of this study were to improve general practitioner ’s drug treatment management of these patients through feedback on their own prescribing and small group discussion s with peers and a trained group facilitator . The impact evaluation includes quantitative assessment of prescribing changes at 6 , 9 , 12 and 18 months after the intervention . Methods A pragmatic multi site cluster RCT began recruiting practice s in October 2009 to evaluate the effects of a multi-faceted quality improvement ( QI ) intervention on prescribing practice among Australian general practitioners ( GP ) in relation to patients with CHF and HT . General practice s were recruited nationally through General Practice Networks across Australia . Participating practice s were r and omly allocated to one of three groups : two groups received the QI intervention 
    Output:
    
Quality circles are not st and ardized and their techniques are complex .
Studies also suggested participation may affirm self-esteem and increase professional confidence .