***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 success of a human intervention trial depends upon the ability to recruit eligible volunteers . Many trials fail because of unrealistic recruitment targets and flawed recruitment strategies . In order to predict recruitment rates accurately , research ers need information on the relative success of various recruitment strategies . Few published trials include such information and the number of participants screened or approached is not always cited . Methods This paper will describe in detail the recruitment strategies employed to identify older adults for recruitment to a 6-month r and omised controlled dietary intervention trial which aim ed to explore the relationship between diet and immune function ( The FIT study ) . The number of people approached and recruited , and the reasons for exclusion , will be discussed . Results Two hundred and seventeen participants were recruited to the trial . A total of 7,482 letters were sent to potential recruits using names and addresses that had been supplied by local Family ( General ) Practice s. Eight hundred and forty three potential recruits replied to all methods of recruitment ( 528 from GP letters and 315 from other methods ) . The eligibility of those who replied was determined using a screening telephone interview , 217 of whom were found to be suitable and agreed to take part in the study . Conclusion The study demonstrates the application of multiple recruitment methods to successfully recruit older people to a r and omised controlled trial . The most successful recruitment method was by contacting potential recruits by letter on NHS headed note paper using contacts provided from General Practice s. Ninety percent of recruitment was achieved using this method . Adequate recruitment is fundamental to the success of a research project , and appropriate strategies must therefore be adopted in order to identify eligible individuals and achieve recruitment targets . Trial registration numberIS RCT N45031464 Reports of cluster r and omised trials require additional information to allow readers to interpret them accurately The effective reporting of r and omised controlled trials has received useful attention in recent years . Many journals now require that reports conform to the guidelines in the Consoli date d St and ards of Reporting Trials ( CONSORT ) statement , first published in 1996 and revised in 2001 . The statement includes a checklist of items that should be included in the trial report . These items are evidence based whenever possible and are regularly review ed . The statement also recommends including a flow diagram to show the flow of participants from group assignment through to the final analysis . The CONSORT statement focused on reporting parallel group r and omised trials in which individual participants are r and omly assigned to study groups . However , in some situations it is preferable to r and omly assign groups of individuals ( such as families or medical practice s ) rather than individuals . Reasons include the threat of contamination of some interventions ( such as dietary interventions ) if individual r and omisation is used . 5 Also , in certain setting s r and omisation by group may be the only feasible method of conducting a trial . Trials with this design are variously known as field trials , community based trials , place based trials , or ( as in this paper ) cluster r and omised trials . In an earlier discussion paper we considered the implication s of the CONSORT statement for the reporting of cluster r and omised trials . Here we present up date d guidance , based on the 2001 revision of the CONSORT statement Background It is notoriously difficult to recruit patients to r and omised controlled trials in primary care . This is particularly true when the disease process under investigation occurs relatively infrequently and must be investigated during a brief time window . Bell 's palsy , an acute unilateral paralysis of the facial nerve is just such a relatively rare condition . In this case study we describe the organisational issues presented in setting up a large r and omised controlled trial of the management of Bell 's palsy across primary and secondary care in Scotl and and how we managed to successfully recruit and retain patients presenting in the community . Methods Where possible we used existing evidence on recruitment strategies to maximise recruitment and retention . We consider that the key issues in the success of this study were ; the fact that the research was seen as clinical ly important by the clinicians who had initial responsibility for recruitment ; employing an experienced trial co-ordinator and dedicated research ers willing to recruit participants seven days per week and to visit them at home at a time convenient to them , hence reducing missed patients and ensuring they were retained in the study ; national visibility and repeated publicity at a local level delivered by locally based principal investigators well known to their primary care community ; encouraging recruitment by payment to practice s and reducing the workload of the referring doctors by providing immediate access to specialist care ; good collaboration between primary and secondary care and basing local investigators in the otolarnygology trial centres Results Although the recruitment rate did not meet our initial expectations , enhanced retention meant that we exceeded our planned target of recruiting 550 patients within the planned time-scale . Conclusion While difficult , recruitment to and retention within multi-centre trials from primary care can be successfully achieved through the application of the best available evidence , establishing good relationships with practice s , minimising the workload of those involved in recruitment and offering enhanced care to all participants . Primary care trialists should describe their experiences of the methods used to persuade patients to participate in their trials when publishing their results Background Recruitment of patients by health professionals is reported as one of the most challenging steps when undertaking studies in primary care setting s. Numerous investigations of the barriers to patient recruitment in trials which recruit patients to receive an intervention have been published . However , we are not aware of any studies that have reported on the recruitment barriers as perceived by health professionals to recruiting patients into cluster r and omised trials where patients do not directly receive an intervention . This particular subtype of cluster trial is commonly termed a professional-cluster trial . The aim of this study was to investigate factors that contributed to general practitioners recruitment of patients in a professional-cluster trial which evaluated the effectiveness of an intervention to increase general practitioners adherence to a clinical practice guideline for acute low-back pain . Method General practitioners enrolled in the study were posted a question naire , consisting of quantitative items and an open-ended question , to assess possible reasons for poor patient recruitment . Descriptive statistics were used to summarise quantitative items and responses to the open-ended question were coded into categories . Results Seventy-nine general practitioners completed at least one item ( 79/94 = 84 % ) , representing 68 practice s ( 85 % practice response rate ) , and 44 provided a response to the open-ended question . General practitioners recalled inviting a median of two patients with acute low-back pain to participate in the trial over a seven-month period ; they reported that they intended to recruit patients , but forgot to approach patients to participate ; and they did not perceive that patients had a strong interest or disinterest in participating . Additional open-ended comments were generally consistent with the quantitative data . Conclusion A number of barriers to the recruitment of patients with acute low-back pain by general practitioners in a professional-cluster trial were identified . These barriers were similar to those that have been identified in the literature surrounding the recruitment of patients in individual patient r and omised trials . To advance the evidence base for patient recruitment strategies in primary care setting s , trialists undertaking professional-cluster trials need to develop and evaluate patient recruitment strategies that minimise the efforts required by practice staff to recruit patients , while also meeting privacy and ethical responsibilities and minimising the risk of selection bias . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN012606000098538 ( date registered 14/03/2006 ) BACKGROUND Specialist National Health Service clinics for smoking cessation have increased in number , but most smokers prefer less intensive self-help and many smokers have no serious intentions to attempt to quit . Computer-tailored self-help material s can be adapted to provide advice to less motivated smokers , and can also take into account features such as level of education and socio-economic circumstance . OBJECTIVE To assess the feasibility of delivering tailored feedback to a large population by identifying smokers from general practice records , with the aim of informing a large-scale trial of effectiveness . METHOD Question naires were sent to a r and om sample of smokers ( n = 876 ) aged between 18 and 65 years , identified from records in four practice s. Smokers returning the question naire ( n = 78 ) were r and omized to receive st and ard information , or to receive st and ard information plus computer-tailored feedback reports . Follow-up question naires were sent 3 months after the return of the baseline question naire . RESULTS The recruitment strategy yielded a response rate of 8.9 % , and a 66.7 % follow-up rate . There were no significant differences in outcome between the two conditions , and no significant differences in outcome between practice s. In the Intervention group significantly more of those who remembered receiving the tailored advice letter had made a quit attempt ( 6[60%]/3[21.4 % ] , P < 0.05 ) . CONCLUSION This pilot study demonstrated the feasibility of carrying out such a trial to evaluate the effectiveness of delivering an intervention for smoking cessation in primary care , and highlighted issues that should be addressed in considering the design of a large-scale trial Background Financial incentives have been used for many years internationally to improve quality of care in general practice . The aim of this pilot study was to determine if offering general practitioners ( GP ) a small incentive payment per test would increase  chlamydia testing in women aged 16 to 24 years , attending general practice . Methods General practice clinics ( n = 12 ) across Victoria , Australia , were cluster r and omized to receive either a $ AUD5 payment per chlamydia test or no payment for testing 16 to 24 year old women for chlamydia . Data were collected on the number of chlamydia tests and patient consultations undertaken by each GP over two time periods : 12 month pre-trial and 6 month trial period . The impact of the intervention was assessed using a mixed effects logistic regression model , accommodating for clustering at GP level . Results Testing increased from 6.2 % ( 95 % CI : 4.2 , 8.4 ) to 8.8 % ( 95 % CI : 4.8 , 13.0 ) ( p = 0.1 ) in the control group and from 11.5 % ( 95 % CI : 4.6 , 18.5 ) to 13.4 % ( 95 % CI : 9.5 , 17.5 ) ( p = 0.4 ) in the intervention group . Overall , the intervention did not result in a significant increase in chlamydia testing in general practice . The odds ratio for an increase in testing in the intervention group compared to the control group was 0.9 ( 95 % CI : 0.6 , 1.2 ) . Major barriers to increased chlamydia testing reported by GPs included a lack of time , difficulty in remembering to offer testing and a lack of patient awareness around testing . Conclusions A small financial incentive alone did not increase chlamydia testing  among young women attending general practice . It is possible small incentive payments in conjunction with reminder and feedback systems may be effective , as may higher financial incentive payments . Further research is required to determine if financial incentives can increase testing in Australian general practice , the type and level of financial scheme required and whether incentives needs to be part of a multi-faceted package . Trial Registration Australian New Zeal and Clinical Trial Registry ACTRN12608000499381 BACKGROUND Recruiting adequate numbers of participants represents a major problem to the completion of r and omised clinical trials in primary care . Information on different recruitment strategies applied in one trial is scarce . AIM To evaluate the application of two recruitment strategies in one trial . DESIGN OF STUDY The study was performed within the framework of a r and omised clinical trial on the effectiveness of a behavioural treatment for patients with chronic shoulder complaints . SETTING Thirty-two general practice s in the Netherl and s. METHOD Patients recruited during a consultation with their GP for chronic shoulder complaints were compared with  patients recruited by advertisement in a local newspaper  as regards baseline characteristics , withdrawals ( drop-outs and losses to follow-up ) and post-treatment clinical outcomes . RESULTS Patients recruited by the GPs ( n = 83 ) were similar to those recruited by advertisement ( n = 83 ) in terms of demographic characteristics and clinical outcome measures at baseline , but differed slightly in disease characteristics and treatment preferences . Recruitment strategy was not related to reasons for or numbers of withdrawals . Improvements on outcome measures were greater in patients recruited by the GPs , irrespective of allocated treatment . Results on the clinical effectiveness of treatments at the end of the treatment period or during follow-up were neither modified by recruitment strategy , nor by differences between the two strategy groups in patient characteristics found at baseline . CONCLUSION Using two recruitment strategies did not influence the outcomes on clinical effectiveness in this trial . However , recruitment strategy should be considered as a putative modifying factor in the design of a study Recruitment methods heavily impact budget and outcomes in clinical trials . We conducted a post-hoc examination of the efficiency and cost of three different recruitment methods used in Journey for Control of Diabetes : the IDEA Study , a r and omized controlled trial evaluating outcomes of group and individual diabetes education in New Mexico and Minnesota . Electronic data bases were used to identify health plan members with diabetes and then one of the following three methods was used to recruit study participants : 1 .  Minnesota Method 1 - -Mail only ( first half of recruitment period ) . Mailed invitations with return-response forms . 2 .  Minnesota Method 2 - -Mail and selective phone calls ( second half of recruitment period ) . Mailed invitations with return-response forms and subsequent phone calls to nonresponders . 3 .  New Mexico Method 3 - -Mail and non-selective phone calls ( full recruitment period ) : Mailed invitations with subsequent phone calls to all . The combined methods succeeded in meeting the recruitment goal of 623 subjects . There were 147 subjects recruited using Minnesota 's Method 1 , 190 using Minnesota 's Method 2 , and 286 using New Mexico 's Method 3 
    Output:
    
The most effective recruitment in primary care research requires practitioner involvement .
The active participation of primary care practitioners in both the design and conduct of research helps to identify strategies that are congruent with the context in which patient care is delivered .
This is reported to be the optimal recruitment strategy