***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 : The effect of regular and expected printed educational material s on physician prescribing behaviour has not been studied . We sought to measure the impact of a series of evidence -based drug therapy letters mailed to physicians in British Columbia on prescribing to newly treated patients . Methods : A paired , cluster r and omized community design was used . The study population included 499 physicians from 24 local health areas in British Columbia . Local health areas were paired by number of physicians , and 1 of each pair was r and omly selected and its physicians assigned to an intervention group or a control group . The intervention was 12 issues of an evidence -based series called Therapeutics Letter . Physicians in the control group ( n = 241 ) received the letters 3–8 months after physicians in the intervention group ( n = 258 ) . The impact on prescribing to newly treated patients  ( defined as patients who had not previously made a cl aim for any medication from the class of drugs profiled in the letter ) was analyzed using the drug cl aims data base of BC Pharmacare , a publicly funded drug benefits program that covered all seniors and people receiving social assistance . Results : The probability of prescribing a drug recommended in the Therapeutics Letter rather than another drug in the same class increased by 30 % in the 3 months after the mailing of the letter relative to the preceding 3 months , adjusted for any before – after changes in the control group ( relative risk 1.30 ; 95 % confidence interval 1.13–1.52 ) . No letter achieved statistical significance on its own . However , 11 of the 12 letters produced prescribing changes in the predicted direction such that the overall result was significant when their effect was combined . Interpretation : The combined effect of an ongoing series of printed letters distributed from a credible and trusted source can have a clinical ly significant effect on prescribing to newly treated patients The effect of a drug-use review ( DUR ) program intervention on physician prescribing after the results of a r and omized clinical trial were published was studied . A Veterans Administration ( VA ) cooperative study published in June 1986 showed that congestive heart failure ( CHF ) patients who had hydralazine and isosorbide  added to their drug therapy had less mortality than patients given digoxin and diuretics with or without prazosin .  Physicians with at least one CHF patient who was receiving the less effective therapy were r and omly assigned to intervention and control groups . In September 1986 , intervention-group physicians ( n = 288 ) were mailed a letter and question naire from the DUR program coordinator , the journal article , and a drug history profile of a CHF patient who might benefit from the information .  Control physicians received no mailing . The question naire asked whether the physicians already knew about the VA study , intended to alter their prescribing , and could identify factors that would affect their decision . Two thirds of intervention-group physicians were already aware of the VA study . One third indicated that they intended to alter drug therapy based on the study results ; factors significantly associated with the intent to adopt a change were physician training and experience , comments by peers , new drug availability , and the size of the reduction in mortality . During four months after the intervention , only 5 physicians in the two groups switched their patients to both hydralazine and isosorbide ( full change ) ; 23 switched them to at least one of the drugs or discontinued prazosin ( partial change ) . There was no significant difference in the number of full or partial changes between groups . ( ABSTRACT TRUNCATED AT 250 WORDS Background Implementation of new guidelines into clinical practice is often incomplete . Direct mail is a simple way of providing information to physicians and may improve implementation of new guidelines on basic life support ( BLS ) . The aim of this study was to describe knowledge of the most recent European Resuscitation Council ( ERC ) Guidelines for BLS among general practitioners ( GPs ) and investigate whether direct mail improves theoretical knowledge of these guidelines . Methods All general practice clinics ( n=351 ) in Central Denmark Region were r and omised to receive either direct mail  ( intervention ) or no direct mail ( control ) . The direct mail consisted of the official ERC BLS/AED poster and a cover letter outlining changes in compression depth and frequency in the new guidelines . In general practice clinics r and omised to intervention , every GP received a direct mail addressed personally to him/her . Two weeks later , a multiple-choice question naire on demographics and BLS guidelines were mailed to GPs in both groups . Results In total , 830 GPs were included in this study ( direct mail , n=408 ; control , n=422 ) . The response rate was 58 % . The majority ( 91 % ) of GPs receiving direct mail were familiar with BLS Guidelines 2010 compared to 72 % in the control group ( P<0.001 ) . Direct mail improved knowledge of the new recommended chest compression depth ( 67 % vs. 40 % , P<0.001 ) and chest compression frequency ( 62 % vs. 40 % , P<0.001 ) . Conclusion Direct mail improved knowledge of changes in BLS guidelines and thus facilitated the implementation of this knowledge into clinical practice . Resuscitation councils and medical societies may consider using direct mail as a simple strategy to facilitate implementation of changes in clinical guidelines BACKGROUND GPs are often the first point of contact for patients with prodromal schizophrenia . Early intervention , and therefore early detection , of schizophrenia is pivotal for the further disease course . However , recent studies have revealed that , due to its low prevalence in general practice and its insidious features , prodromal schizophrenia often remains unnoticed . AIM To test whether a repeated sensitisation method using clinical vignettes can improve diagnostic knowledge of GPs . DESIGN OF STUDY Postal survey using anonymous question naires . Repeated sensitisation model using clinical vignettes . SETTING GPs in three distinct regions in Switzerl and covering a general population of 1.43 million . METHOD The study was conducted between September 2008 and October 2009 . Question naires were sent to 1138 GPs at baseline , and at 6 and 12 months . After r and omisation , 591 GPs were sensitised at 1 , 3 , and 5 months , while no sensitisation was carried out in the remaining 547 GPs . RESULTS The overall response rate was 66 % ( 750 GPs ) . Sensitised GPs demonstrated a highly significant increase in diagnostic knowledge at 6 and at 12 months when compared to their own baseline knowledge scores and also to non-sensitised GPs ( P<0.001 ) . In particular , awareness of insidious features , such as functional decline and social withdrawal as signs of prodromal schizophrenia , accounted for this effect . CONCLUSION Theoretical knowledge of prodromal schizophrenia among GPs can successfully be increased by repeated sensitisation models using clinical vignettes Abstract Objective To test the effectiveness of educational interventions in improving detection rates and management of dementia in primary care . Design Unblinded , cluster r and omised , before and after controlled study . Setting General practice s in the United Kingdom ( central Scotl and and London ) between 1999 and 2002 . Interventions Three educational interventions : an electronic tutorial carried on a CD Rom ; decision support software built into the electronic medical record ; and practice based workshops . Participants 36 practice s participated in the study . Eight practice s were r and omly assigned to the electronic tutorial ; eight to decision support software ; 10 to practice based workshops ; and 10 to control . Electronic and manual search es yielded 450 valid and usable medical records . Main outcome measures Rates of detection of dementia and the extent to which medical records showed evidence of improved concordance with guidelines regarding diagnosis and management . Results Decision support software ( P = 0.01 ) and practice based workshops ( P = 0.01 ) both significantly improved rates of detection compared with control . There were no significant differences by intervention in the measures of concordance with guidelines . Conclusions Decision support systems and practice based workshops are effective educational approaches in improving detection rates in dementia Introduction This cluster r and omised trial evaluated an intervention to decrease x-ray referrals and increase giving advice to stay active for people with acute low back pain ( LBP ) in general practice . Methods General practice s were r and omised to either  access to a guideline for acute LBP ( control ) or facilitated interactive workshops ( intervention ) . We measured behavioural predictors ( e.g. knowledge , attitudes and intentions ) and fear avoidance beliefs . We were unable to recruit sufficient patients to measure our original primary outcomes so we introduced other outcomes measured at the general practitioner ( GP ) level : behavioural simulation ( clinical decision about vignettes ) and rates of x-ray and CT-scan ( medical administrative data ) . All those not involved in the delivery of the intervention were blinded to allocation . Results 47 practice s ( 53 GPs ) were r and omised to the control and 45 practice s ( 59 GPs ) to the intervention . The number of GPs available for analysis at 12 months varied by outcome due to missing confounder information ; a minimum of 38 GPs were available from the intervention group , and a minimum of 40 GPs from the control group . For the behavioural constructs , although effect estimates were small , the intervention group GPs had greater intention of practising consistent with the guideline for the clinical behaviour of x-ray referral . For behavioural simulation , intervention group GPs were more likely to adhere to guideline recommendations about x-ray ( OR 1.76 , 95%CI 1.01 , 3.05 ) and more likely to give advice to stay active ( OR 4.49 , 95%CI 1.90 to 10.60 ) . Imaging referral was not statistically significantly different between groups and the potential importance of effects was unclear ; rate ratio 0.87 ( 95%CI 0.68 , 1.10 ) for x-ray or CT-scan . Conclusions The intervention led to small changes in GP intention to practice in a manner that is consistent with an evidence -based guideline , but it did not result in statistically significant changes in actual behaviour . Trial Registration Australian New Zeal and Clinical Trials Registry Background : In Italy many diabetics still lack adequate care in general practice . We assessed the effectiveness of different strategies for the implementation of an evidence -based guideline for the management of noncomplicated type 2 diabetes among General Practitioners ( GPs ) of Lazio region . Methods : Three-arm cluster-r and omised controlled trial with GPs as units of r and omisation ( clusters ) . 252 GPs were r and omised either to an active strategy ( training module with administration of the guideline ) , or to a passive dissemination ( administration of the guideline only ) , or to usual care ( control ) . Data on prescriptions of tests and drugs were collected by existing information systems , whereas patients ' data came from GPs ' data bases . Process outcomes were measured at the cluster level one year after the intervention . Primary outcomes concerned the measurement of glycosilated haemoglobin and the commissioning of micro and macrovascular complications assessment tests . In order to assess the physicians ' drug prescribing behaviour secondary outcomes were also calculated . Results : GPs identified 6395 uncomplicated type 2 patients with a high prevalence of cardiovascular risk factors . Data on GPs baseline performance show low proportions of glycosilated haemoglobin assessment s. Results of the C- RCT analysis indicate that the active implementation strategy was ineffective relating to all primary outcomes ( respectively , OR 1.06 [ 95 % IC : 0.76–1.46 ] ; OR 1.07 [ 95 % IC : 0.80–1.43 ] ; OR 1.4 [ 95 % IC:0.91–2.16 ] . Similarly , passive dissemination of the guideline showed no effect . Conclusion : In our region compliance of GPs with guidelines was not enhanced by a structured learning programme . Implementation through organizational measures appears to be essential to induce behavioural changes . Trial registration : IS RCT N80116232 . Published : 4 June 2007 BMC Health Services Research 2007 , 7:79 doi:10.1186/1472 - 6963 - 7 - 79 Received : 25 August 2006 Accepted : 4 June 2007 This article is available from : http://www.biomed central .com/1472 - 6963/7/79 © 2007 Perria et al ; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0 ) , which permits unrestricted use , distribution , and reproduction in any medium , provided the original work is properly cited Background To determine the effectiveness of a single checklist reminder form to improve the delivery of preventive health services at adult health check-ups in a family practice setting . Methods A prospect i ve cluster r and omized controlled trial was conducted at four urban family practice clinics among 38 primary care physicians affiliated with the University of Toronto .  Preventive Care Checklist Forms © were created to be used by family physicians at adult health check-ups over a five-month period . The sex-specific forms incorporate evidence -based recommendations on preventive health services and documentation space for routine procedures such as physical examination . The forms were used in two intervention clinics and two control clinics . Rates and relative risks ( RR ) of the performance of 13 preventive health maneuvers at baseline and post-intervention and the percentage of up-to- date preventive health services delivered per patient were compared between the two groups . Results R and omly-selected charts were review ed at baseline ( n = 509 ) and post-intervention ( n = 608 ) . Baseline rates for provision of preventive health services ranged from 3 % ( fecal occult blood testing ) to 93 % ( blood pressure measurement ) , similar to other setting s. The percentage of up-to- date preventive health 
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No significant effect was found on clinical ly important patient outcomes , physician behaviour , or physician cognition when PEMs were compared to usual care .
Conclusions PEMs were not effective at improving patient outcomes , knowledge , or behaviour of PCPs .