***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: Although evidence -based practice ( EBP ) improves health care quality , decreases costs , and empowers nurses , there is a paucity of intervention studies design ed to test models of how to enhance nurses '  use of EBP .  Therefore , the specific aim of this study was to determine the preliminary effects of implementing the Advancing Research and Clinical practice through close Collaboration ( ARCC ) model on nurses ' EBP beliefs , EBP implementation behaviors , group cohesion , productivity , job satisfaction , and attrition/turnover rates . A 2-group r and omized controlled pilot trial was used with 46 nurses from the Visiting Nurse Service of New York . The ARCC group versus an attention control group had stronger EBP beliefs , higher EBP implementation behaviors , more group cohesion , and less attrition/turnover . Implementation of the ARCC model in health care systems may be a promising strategy for enhancing EBP and improving nurse and cost outcomes Background Little is known about the impact of implementing nursing-oriented best practice guidelines on the delivery of patient care in either hospital or community setting s. Methods A naturalistic study with a prospect i ve , before and after design documented the implementation of six newly developed nursing best practice guidelines ( asthma , breastfeeding , delirium-dementia-depression ( DDD ) , foot complications in diabetes , smoking cessation and venous leg ulcers ) . Eleven health care organisations were selected for a one-year project . At each site , clinical re source nurses ( CRNs ) worked with managers and a multidisciplinary steering committee to conduct an environmental scan and develop an action plan of activities ( i.e. education sessions , policy review ) . Process and patient outcomes were assessed by chart audit ( n = 681 pre-implementation , 592 post-implementation ) . Outcomes were also assessed for four of six topics by in-hospital/home interviews ( n = 261 pre-implementation , 232 post-implementation ) and follow-up telephone interviews ( n = 152 pre , 121 post ) . Interviews were conducted with 83/95 ( 87 % ) CRN 's , nurses and administrators to describe recommendations selected , strategies used and participants ' perceived facilitators and barriers to guideline implementation . Results While statistically significant improvements in 5 % to 83 % of indicators were observed in each organization , more than 80 % of indicators for breastfeeding , DDD and smoking cessation did not change . Statistically significant improvements were found in > 50 % of indicators for asthma ( 52 % ) , diabetes foot care ( 83 % ) and venous leg ulcers ( 60 % ) . Organizations with > 50 % improvements reported two unique implementation strategies which included h and s-on skill practice sessions for nurses and the development of new patient education material s. Key facilitators for all organizations included education sessions as well as support from champions and managers while key barriers were lack of time , workload pressure and staff resistance . Conclusion Implementation of nursing best practice guidelines can result in improved practice and patient outcomes across diverse setting s yet many indicators remained unchanged . Mobilization of the nursing workforce to actively implement guidelines and to monitor the delivery of their care is important so that patients may learn about and receive recommended healthcare Background . The influence of an opinion leader intervention on adherence to Unstable Angina ( UA ) guidelines compared with a traditional quality improvement model was investigated . Research Design . A group-r and omized controlled trial with 2210 patients from 21 hospitals was design ed . There were three intervention arms : ( 1 ) no intervention ( NI ) ; ( 2 ) a traditional Health Care Quality Improvement Program ( HCQIP ) ; and ( 3 ) a physician opinion leader in addition to the HCQIP model ( OL ) . Quality indicators included :  electrocardiogram within 20 minutes , antiplatelet therapy within 24 hours and at discharge , and heparin and & bgr;-blockers  during hospitalization . Hospitals could determine the specific indicators they wished to target . Potential cases of UA were identified from Medicare cl aims data . UA confirmation was determined by a clinical algorithm based on data abstract ed from medical records . Data analyses included both hospital level analysis ( analysis of variance ) and patient level analysis ( generalized linear models ) . Results . The only statistically significant postintervention difference in percentage compliant was greater improvement for the OL group in the use of antiplatelet therapy at 24 hours in both hospital level ( P = 0.01 ) and patient level analyses ( P < 0.05 ) compared with the HCQIP and NI groups . When analyses were confined to hospitals that targeted specific indicators , compared with the HCQIP hospitals , the OL hospitals showed significantly greater change in percentage compliant postintervention in both antiplatelet therapy during the first 24 hours ( 20.2 % vs. −3.9 % , P = 0.02 ) and heparin ( 31.0 % vs.9.1 % , P = 0.05 ) . Conclusions . The influence of physician opinion leaders was unequivocally positive for only one of five quality indicators . To maximize adherence to best practice s through physician opinion leaders , more research on how these physicians influence health care delivery in their organizations will be required BACKGROUND Very little effort has been directed to enable GPs to better informed decisions about PSA screening among their male patients . OBJECTIVES To evaluate an innovative programme design ed to enhance GPs ' capacity to promote informed decision making by male patients about PSA screening . METHODS The study design was a cluster r and omised controlled trial set in New South Wales , Australia 's most populous state . 277 GPs were recruited through a major pathology laboratory . The interventions were three telephone-administered ' peer coaching ' sessions integrated with educational re sources for GPs and patients and the main outcome measures were : GP knowledge ; perceptions of patient involvement in informed decision making ; GPs ' own decisional conflict ; and perceptions of medicolegal risk . RESULTS Compared with GPs allocated to the control group , GPs allocated to our intervention gained significantly greater knowledge about PSA screening and related information [ Mean 6.1 out of 7 ; 95 % confidence interval ( CI ) = 5.9 - 6.3 versus 4.8 ; 95 % CI = 4.6 - 5.0 ; P < 0.001 ] . They were less likely to agree that patients should remain passive when making decisions about PSA screening [ Odds ratio ( OR ) = 0.11 ; 95 % CI = 0.04 - 0.31 ; P < 0.001 ] . They perceived less medicolegal risk when not acceding to an ' uninformed ' patient request for a PSA test ( OR = 0.31 ; 95 % CI 0.19 - 0.51 ) . They also demonstrated lower levels of personal decisional conflict about the PSA screening ( Mean 25.4 ; 95 % CI 24.5 - 26.3 versus 27.8 ; 95 % CI 26.6 - 29.0 ; P = 0.0002 ) . CONCLUSION A ' peer coaching ' programme , supplemented by education material s , holds promise as a strategy to equip GPs to facilitate informed decision making amongst their patients Studies at area hospitals revealed many gaps between research evidence and intrapartum nursing practice s. A r and omized controlled trial involving 20 hospitals was used to evaluate the effectiveness of a marketing strategy to promote research -based nursing care . It was hypothesized that the strategy would result in lower rates of epidural analgesia , through increasing the amount of support nurses provided to their patients . Other outcomes included rates of narcotic analgesia , episiotomy , and operative delivery . The marketing strategy was unsuccessful in improving intrapartum nursing care . Much more research is needed about the factors that facilitate improvements in nursing practice Background . As familial cancer genetic services moves into community practice increased numbers of trained health professionals are needed to counsel individuals seeking cancer risk information . Nurses have been targeted to provide cancer risk assessment and counseling . To help prepare nurses for this role , a 5-day training in familial cancer risk assessment and counseling followed by a long-distance mentorship to support continued skill development in the work environment was conducted by Fox Chase Cancer Center , Philadelphia , PA . Methods . Four cohorts ( N = 41 ) have completed the training and were r and omized to either an immediate or delayed mentorship . A formative evaluation assessed the nurse ’s ability to consult with other genetic health professionals and build self-efficacy in counseling skills via responses to question naire . A post-mentorship interview evaluated the usefulness , timing and length of the mentorship . Results . For both groups , there was a statistically significant improvement in self-efficacy for all skills from baseline to 6 months and an increased number of nurses consulting with genetic health professionals . All the nurses reported the value of the mentorship and those with less cancer risk counseling experience prior to the training needed support and re sources for further skill and program development . Lessons learned from this formative evaluation are provided Pain in children is infrequently assessed and managed by nurses . One-on-one coaching based on audit with feedback and the use of opinion leaders have been effective in changing professional health care practice s. Coaching by an opinion leader for changing pediatric nurses ' pain practice s was tested in a clustered r and omized trial in six Canadian pediatric hospitals . The rate of pain assessment s , nurses ' knowledge , and nonpharmacological interventions increased in the coaching group . However , there were significant site differences that could not be attributed to the coaching but to factors inherent in the sites . The context in which interventions are implemented will influence the effectiveness of individualized interventions A r and omized controlled trial with 76 physicians in 16 community hospitals evaluated audit and feedback and local opinion leader education as methods of encouraging compliance with a guideline for the management of women with a previous cesarean section . The guideline recommended clinical actions to increase trial of labor and vaginal birth rates . Charts for all 3552 cases in the study groups were audited . After 24 months the trial of labor and vaginal birth rates in the audit and feedback group were no different from those in the control group , but rates were 46 % and 85 % higher , respectively , among physicians educated by an opinion leader . Duration of hospital stay was lower in the opinion leader education group than in the other two groups . The overall cesarean section rate was reduced only in the opinion leader education group . There were no adverse clinical outcomes attributable to the interventions . The use of opinion leaders improved the quality of care BACKGROUND The paradigm shift to evidence -based nursing practice in the United States has been slow . Although multiple barriers to evidence -based practice ( EBP ) have been identified through prior studies , there is a gap in the literature specifically identifying key variables ( e.g. , belief that EBP produces quality outcomes ) that are correlated with the extent to which nurses engage in EBP . AIM The primary aims of this study were to ( 1 ) describe nurses ' knowledge , beliefs , skills , and needs regarding EBP ; ( 2 ) determine whether relationships exist among these variables ; and ( 3 ) describe major barriers and facilitators to EBP . METHODS A descriptive survey was conducted with a convenience sample of 160 nurses who were attending EBP conferences or workshops in four states located within the Eastern Region of the United States . RESULTS Although participant beliefs about the benefit of EBP were high , knowledge of EBP was relatively low . Significant relationships were found between the extent to which the nurses ' practice is evidence -based and ( 1 ) nurses ' knowledge of EBP , ( 2 ) nurses ' beliefs about the benefits of EBP , ( 3 ) having an EBP mentor , and ( 4 ) using the Cochrane Data base of Systematic Review s and the National Guideline Clearinghouse . CONCLUSION AND IMPLICATION S Health care systems need to implement interventions that not only increase nurses ' EBP knowledge and skills , but also strengthen their beliefs about the benefit of evidence -based care . EBP mentors may be key in accelerating a more rapid shift toward evidence -based nursing practice . Theoretically driven r and omized controlled trials are urgently needed to test the effectiveness of interventions on advancing evidence -based care CONTEXT The effectiveness of recruiting local medical opinion leaders to improve quality of care is poorly understood . OBJECTIVE To evaluate a guideline -implementation intervention of clinician education by local opinion leaders and performance feedback to ( 1 ) increase use of lifesaving drugs ( aspirin and thrombolytics in eligible elderly patients , beta-blockers in all eligible patients ) for acute myocardial infa rct ion ( AMI ) , and ( 2 ) decrease use of a potentially harmful therapy ( prophylactic lidocaine ) . DESIGN R and omized controlled trial with hospital as the unit of r and omization , intervention , and analysis . SETTING Thirty-seven community hospitals in Minnesota . PATIENTS All patients with AMI admitted to study hospitals over 10 months before ( 1992 - 1993 , N=2409 ) or after ( 1995 - 1996 , N=2938 ) the intervention . INTERVENTION Using a vali date d survey , we identified opinion leaders at 20 experimental hospitals who influenced peers through small and large group discussion s , informal consultations , and revisions of protocol s and clinical pathways . They focused on ( 1 ) evidence ( drug efficacy ) , ( 2 ) comparative performance , and ( 3 ) barriers to change . Control hospitals received mailed performance feedback . MAIN OUTCOME MEASURES Hospital-specific changes before and after the intervention in the proportion of eligible patients receiving each study drug . RESULTS Among experimental hospitals , the median change in the proportion of eligible elderly patients receiving aspirin  was + 0.13 ( 17 % increase from 0.77 at baseline ) , 
    Output:
    
There were mixed findings for changes in professionals ' behaviors and impact on practitioners ' and patients ' outcomes : some outcomes improved , while others showed no difference .