***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: Abstract Objective : To compare the effect of individual educational visits versus group visits using academic detailing to discuss prescribing of highly anticholinergic antidepressants in elderly people . Design : R and omised controlled trial with three arms ( individual visits , group visits , and a control arm ) . Setting : Southwest Netherl and s. Participants : 190 general practitioners and 37 pharmacists organised in 21 peer review groups were studied using a data base covering all prescriptions to people covered by national health insurance in the area ( about 240 000 ) . Intervention : All general practitioners and pharmacists in both intervention arms were offered two educational visits . For physicians in groups r and omised to the individual visit arm , 43 of 70 general practitioners participated ; in the group visit intervention arm , five of seven groups ( 41 of 52 general practitioners ) participated . Main outcome measures : Numbers of elderly people ( 60 years ) with new prescriptions of highly anticholinergic antidepressants and less anticholinergic antidepressants . Results : An intention to treat analysis found a 26 % reduction in the rate of starting highly anticholinergic antidepressants in elderly people ( 95 % confidence interval —4 % to 48 % ) in the individual intervention arm and 45 % ( 8 % to 67 % ) in the group intervention arm . The use of less anticholinergic antidepressants increased by 40 % ( 6 % to 83 % ) in the individual intervention arm and 29 % ( —7 % to 79 % ) in the group intervention arm . Conclusions : Both the individual and the group visits decreased the use of highly anticholinergic antidepressants and increased the use of less anticholinergic antidepressant in elderly people . These approaches are practical means to improve prescribing by continuing medical education BACKGROUND Underst and ing pre-test probability and baseline risks helps to interpret the results of diagnostic tests and the benefits of treatment , but how good is the underst and ing of these concepts ? OBJECTIVES Our aim was to assess the ability of GPs and consultant physicians to make accurate estimates and underst and the application of pre-test probability and baseline risk for two common clinical conditions . METHODS A two-stage question naire survey based on case scenarios of patients with angina and congestive heart failure was carried out of 202 physicians , r and omly selected from the members of the Royal College of Physicians in the NW of Engl and , 205 GPs r and omly chosen from the practice list of the NW Health Authorities and 128 MRCGP examiners attending an examiners meeting . A total of 115 , 106 and 81 members of these groups , respectively , responded to the first stage , and 44 , 46 and 64 to the second . The main outcome measures were the stated likelihood of true ischaemic heart disease ( IHD ) being present and the predicted 1-year mortality ; the impact of changing prevalence and baseline risk on these results ; and interpretation of different methods of risk presentation . RESULTS Estimates of pre-test probability of IHD being present ranged from 5 to 100 % and of baseline risk of 1-year mortality from 0 to 86 % . More GP examiners and consultant physicians understood the impact of increasing age on the test result than did the r and om sample of GPs . A majority of each group correctly said that increasing age would reduce the number needed to treat ( NNT ) . Presentation of benefit as relative risk reduction was a greater stimulus to starting treatment than the NNT or measures of population impact . CONCLUSION Clinicians should collect data to allow a better knowledge of the likelihood of disease and of baseline risk in their patient population s. Methods to increase the underst and ing of the influence of pre-test probability on diagnostic test results and of how to quantify and demonstrate the impact of the benefit of interventions should be explored BACKGROUND Different methods have previously been tested to affect GPs ' prescribing habits . Attention has been drawn to benzodiazepines and antipsychotic drugs that are associated with several adverse effects in the elderly . OBJECTIVE To evaluate if educational outreach visits to GP practice s can affect the prescribing of  benzodiazepines and antipsychotic drugs to the elderly and to evaluate the opinions of the participating GPs on such education . METHODS In the county of Skåne , Sweden , 41 GP practice s were invited to participate in educational outreach visits .  Fifteen GP practice s accepted the invitation . Practice s were r and omised to active ( 8 practice s , 23 physicians ) and  control group ( 7 practice s , 31 physicians ) . After the educational outreach visits prescribing of benzodiazepines and antipsychotic drugs to patients 65 years or older were measured for 1 year . The control group participated in the education after the study period . The opinions of GPs on educational outreach visits were evaluated . RESULTS One year after the educational outreach visits there were significant decreases in the active group compared to control group in the prescribing of medium- and long-acting benzodiazepines and total benzodiazepines but not so for antipsychotic drugs . CONCLUSIONS Educational outreach visits can be effective in modifying GPs ' prescribing habits . We have shown this to be so for prescribing of benzodiazepines to elderly patients in primary health care . Educational outreach visits are also very well appreciated by participating GPs AIMS This was a pilot study of the use of a clinical pharmacist as a therapeutics adviser ( academic detailer ) to modify antibiotic prescribing by general practitioners . METHODS Following a visit by the adviser ( March-May ) , 112 general practitioners were recruited and r and omised to control or active groups . A panel of experts prepared a best practice chart of recommended drugs for upper and lower respiratory tract infections , otitis media and urinary tract infections . The adviser made a 10 - 15 min visit to each prescriber in the active group ( June-July ) , gave them the chart and discussed its recommendations briefly . Doctors in the control group were not visited nor given the chart . Prescription numbers for all prescribers were obtained from the Commonwealth Health Insurance Commission for the pre(March-May ) and postdetailing ( August-September ) periods using a three month lag time for data collection . Data for total numbers of prescriptions and for selected individual antibiotics used in these two periods were analysed using nonparametric statistics . RESULTS Prescribing patterns were similar for the control and active groups in the predetailing period . For both groups , there were significant ( P<0.03 ) increases ( 45 % for control and 40 % for active ) in total number of antibiotic prescriptions in the post compared with the predetailing period . This trend was anticipated on the basis of the winter seasonal increase in respiratory infections . In line with the chart recommendations for first-line treatment , doctors in the active group prescribed significantly more  amoxycillin  ( P<0.02 ) and  doxycycline  ( P<0.001 ) in the post vs predetailing periods . By contrast , doctors in the control group prescribed significantly more  cefaclor  ( P<0.03 ) and  roxithromycin  ( P<0.03 ) , drugs that were not recommended . The total cost of antibiotics prescribed by doctors in the control group increased by 48 % ( $ 37 150 ) from the preto postdetailing periods . In the same time period , the costs for the active group increased by only 35 % ( $ 21 020 ) . CONCLUSIONS We conclude that the academic detailing process was successful in modifying prescribing patterns and that it also decreased prescription numbers and costs . Application of the scheme on a nationwide basis could not only improve prescriber choice of the most appropriate antibiotic but also result in a significant saving of health care dollars Objective To investigate the feasibility and acceptability of academic detailing in general practice in the North-East-Fl and ers region of Belgium . Methods All local quality groups in the study region were r and omly allocated to either ( 1 ) two academic detailing visits to the individual members or ( 2 ) two academic detailing visits during the meetings of the local quality group . During these visits , the results of a systematic review of the literature on non-steroidal anti-inflammatory agents ( NSAIDs ) were presented . Results Of 14 local quality groups , 12 allocated to the individual intervention agreed to participate . Of the 184 physicians invited to receive an academic detailer , 142 had two visits on NSAIDs . One hundred and five physicians gave their opinion on the visits by means of a question naire . The great majority of the responders ( 90 % ) wished to receive an  academic detailer  on other topics in the future , with a frequency of two visits per year . Of 13 local quality groups , 12 allocated to the group intervention , with a total number of 192 physicians who agreed to participate . Ten local quality groups with 166 members received the information on NSAIDs . The actual attendance rate per intervention session was approximately two out of three physicians . All 166 physicians of the participating local quality groups were offered an evaluation form , and 79 responded . Of the responders who received the full group intervention , 88 % wished to have more  academic detailing visits  on other topics in their local quality group . A comparison between the evaluation forms of the individual and the group intervention revealed no major differences concerning the acceptability of the intervention . Conclusion The pilot study showed that academic detailing  is feasible in the North-East-Fl and ers region of Belgium . Both the individual visits and the visits to the local quality groups were rated positively , and a majority of the general practitioners who returned the evaluation question naire wished to receive such visits in the future . The structure of the local quality groups implies limitations to the practical organisation of a visit , but requires less time investment than individual visits OBJECTIVE : To determine whether the way in which information on benefits and harms of long-term hormone replacement therapy ( HRT ) is presented influences family physicians ’ intentions to prescribe this treatment . DESIGN : Family physicians were r and omized to receive information on treatment outcomes expressed in relative terms , or as the number needing to be treated ( NNT ) with HRT to prevent or cause an event . A control group received no information . SETTING : Primary care . PARTICIPANTS : Family physicians practicing in the Hunter Valley , New South Wales , Australia . INTERVENTION : Estimates of the impact of long-term HRT on risk of coronary events , hip fractures , and breast cancer were summarized as relative ( proportional ) decreases or increases in risk , or as NNT . MEASUREMENTS AND MAIN RESULTS : Intention to prescribe HRT  for seven hypothetical patients was measured on Likert scales . Of 389 family physicians working in the Hunter Valley , 243 completed the baseline survey and 215 participated in the r and omized trial . Baseline intention to prescribe varied across patients —it was highest in the presence of risk factors for hip fracture , but coexisting risk factors for breast cancer had a strong negative influence . Overall , a larger proportion of subjects receiving information expressed as NNT had reduced intentions , and a smaller proportion had increased intentions to prescribe HRT  than those receiving the information expressed in relative terms , or the control group . However , the differences were small and only reached statistical significance for three hypothetical patients . Framing effects were minimal when the hypothetical patient had coexisting risk factors for breast cancer . CONCLUSIONS : Information framing had some effect on family physicians ’ intentions to prescribe HRT , but the effects were smaller than those previously reported , and they were modified by the presence of serious potential adverse treatment effects 
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Users of academic detailing rated it as being more valuable than other forms of CME .
Generally , interview data confirmed question naire data with the exception that interview informants did not view having CME provided by a non-physician as a barrier .
Interview informants mentioned that the evidence -based approach adopted by academic detailing had led them to more critically evaluate information from other CME programs , pharmaceutical representatives , and journal articles , but not advice from specialists .
Conclusion Users of academic detailing highly value its educational value and tend to view information from other sources more critically because of its evidence -based approach .
Non-users are unlikely to adopt academic detailing despite its high educational value because they find using office time for CME too much of a barrier .