***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: Objectives : To evaluate the effect on the process of care of an active strategy to implement clinical guidelines on physiotherapy for low back pain . Design : A cluster r and omised controlled trial comparing an active strategy with st and ard dissemination . Setting : Primary care physiotherapy practice s. Participants : 113 physiotherapists were r and omly allocated to receive the guidelines by mail ( control group ) or to receive an additional active strategy ( intervention group ) which consisted of a multifaceted programme including education , discussion , role playing , feedback , and reminders . Main outcome measures : Adherence to the guidelines was measured by means of individual patients ’ forms recording the treatment completed by the physiotherapist . The forms were assessed using an algorithm based on the number of treatment sessions , treatment goals , interventions , and patient education . Results : Physiotherapists in the intervention group more often correctly limited the number of treatment sessions for patients with a normal course of back pain ( OR 2.39 ; 95 % CI 1.12 to 5.12 ) , more often set functional treatment goals ( OR 1.99 ; 95 % CI 1.06 to 3.72 ) , more often used mainly active interventions ( OR 2.79 ; 95 % CI 1.19 to 6.55 ) , and more often gave adequate patient education ( OR 3.59 ; 95 % CI 1.35 to 9.55 ) . They also adhered more to all four criteria ( OR 2.05 ; 95 % CI 1.15 to 3.65 ) . Conclusions : The active strategy moderately improved adherence to the guidelines . Active strategies are recommended to implement the clinical guidelines on physiotherapy for low back pain BACKGROUND AND PURPOSE An active strategy was developed for the implementation of the clinical guidelines on physical therapy for patients with low back pain . The effect of this strategy on patients ' physical functioning , coping strategy , and beliefs regarding their low back pain was studied . SUBJECTS One hundred thirteen primary care physical therapists treated a total of 500 patients . METHODS The physical therapists were r and omly assigned to 1 of 2 groups . The control group received the guidelines by mail ( st and ard passive method of dissemination ) . The intervention group , in contrast , received an additional active training strategy consisting of 2 sessions with education , group discussion , role playing , feedback , and reminders .  Patients with low back pain , treated by the participating therapists , completed question naires on physical functioning , pain , sick leave , coping , and beliefs . RESULTS Physical functioning and pain in the 2 groups improved substantially in the first 12 weeks . Multilevel longitudinal analysis showed no differences between the 2 groups on any outcome measure during follow-up . DISCUSSION AND CONCLUSION The authors found no additional benefit to applying an active strategy to implement the physical therapy guidelines for patients with low back pain . Active implementation strategies are not recommended if patient outcomes are to be improved The effects of the electronic display of guideline -based , patient-specific treatment suggestions on pharmacist work patterns were studied . A total of 28 pharmacists at a hospital-based ambulatory care pharmacy were r and omly assigned to intervention and control groups . The intervention group had access to electronic treatment suggestions for heart failure , ischemic heart disease , reactive airways disease , and uncomplicated hypertension , while the control group did not . Starting 9 and 19 months after the initial display of treatment suggestions , all pharmacists recorded the time they spent on a variety of activities , the purpose of each activity , and persons contacted during the activity ; these observations were recorded in response to a pager-like device that r and omly buzzed four times an hour . A total of 11,102 observations were recorded . Pharmacists in the intervention group spent significantly more of their time discussing information , advising and informing , and solving problems than pharmacists in the control group but significantly less of their time checking and filling prescriptions . Pharmacists in both groups completed a majority of their work alone , but pharmacists in the intervention group worked significantly less by themselves and significantly more with other pharmacy personnel , patients , and physicians and nurses than control-group pharmacists . The delivery of patient-specific information to pharmacists at the time of dispensing had a significant positive impact on pharmacist work patterns The choice of study design for guideline implementation studies will determine the confidence with which the observed effects can be attributed to the interventions under study . In general , cluster r and omized trials , of which there are different types , provide the most robust design . However , the use of these design s has implication s for the power , conduct and analysis of studies . Wherever possible , design s allowing head-to-head comparisons , which incorporate baseline measures of performance , should be used ABSTRACT Studies have shown benefits to patients from improved interventions involving antimicrobial therapy .  The purpose of the present study was to evaluate prospect ively the impact of improved interventions by ( i ) the use of TheraTrac 2 , a computer software program which electronically links susceptibility testing results immediately to the pharmacy and alerts pharmacists of potential interventions , and ( ii ) the education of pharmacists involving microbiologic topics . The study group had the new intervention program . The control group had interventions performed the way that they had previously been done by manually review ing hard copies of susceptibility testing data . In a 5-month period , all in patients whose last names began with A to K were the study group ; in patients whose last names began with L to Z were controls . Three analyses were done ; one analysis ( analysis A ) involved only patients with interventions , one analysis ( analysis B ) involved all patients for whom antimicrobial testing was done and who were matched for diagnosis-related groups ( DRGs ) , regardless of whether an intervention occurred , and one analysis ( analysis C ) involved these DRG-matched patients by using severity-adjusted data . In analysis A , the study group had a 4.8 % decreased rate of mortality , an average of a 16.5-day decreased length of stay per patient , and $ 20,886 decreased variable direct costs per patient . None of these differences was statistically significant . In analysis B , the study patients had a 1.2 % higher mortality rate ( P = 0.741 ) , an average of a 2.7-day decreased length of stay per patient ( P = 0.035 ) , and $ 2,626 decreased variable direct costs per patient ( P = 0.008 ) . In analysis C , the study patients had a 1.4 % lower mortality rate , a 1.2-day decreased length of stay per patient , and $ 1,466 decreased variable direct costs per patient . In conclusion , the institution of this program caused substantial cost savings QUESTION Are implementation strategies involving education any more effective than mere dissemination of clinical practice guidelines in changing physiotherapy practice and reducing patient disability after acute whiplash ? DESIGN Cluster-r and omised trial . PARTICIPANTS Twenty-seven physiotherapists from different private physiotherapy clinics and the 103 patients ( 4 dropouts ) who presented to them with acute whiplash . INTERVENTION The implementation group of physiotherapists underwent education by opinion leaders about whiplash guidelines and the dissemination group had the guidelines mailed to them . OUTCOME MEASURES The primary outcome was patient disability , measured using the Functional Rating Index , collected on admission to the trial and at 1.5 , 3 , 6 and 12 months . Physiotherapist knowledge about the guidelines was measured using a custom-made question naire . Physiotherapist practice and cost of care were measured by audit of patient notes . RESULTS There were no significant differences between groups for any of the patient outcomes at any time . The implementation patients had 0.6 points ( 95 % CI -7.8 to 6.6 ) less disability than the dissemination patients at 12 months ; 44 % more physiotherapists in the implementation group reported that they prescribed two out of the five guideline -recommended treatments ; and 32 % more physiotherapists actually prescribed them . The cost of care for patients in the implementation group was $ 255 ( 95 % CI -1505 to 996 ) less than for patients in the dissemination group . CONCLUSION Although the active implementation program increased guideline -consistent practice , patient outcomes and cost of care were not affected PURPOSE Clinical guidelines are design ed to assist in the management of specific diseases ; however , these guidelines are often neglected in the delivery of care . The purpose of this study was to determine whether clinician use of an clinical practice guideline would increase in response to having , at the patient visit , a decision support system based on a practice guideline that generates a customized management protocol for the individual patient using data from the patient 's electronic medical record . SUBJECTS AND METHODS In a 6-month controlled trial at a primary care clinic , 58 primary care clinicians were r and omized to receive either a special encounter form with the computer-generated guideline recommendations or a st and ard encounter form . The effect of computer-generated advice on clinician behavior was measured as rate of compliance with guideline recommendations . Data from 30 clinicians were analyzed ; data from 28 clinicians were excluded because these clinicians did not meet predefined criteria for minimum exposure to diabetic patient care . RESULTS Availability of patient management recommendations generated by the decision support system result ed in a two-fold increase in clinician compliance with care guidelines for diabetes mellitus ( P = 0.01 ) . Median compliance for the group receiving the recommendations was 32.0 % versus 15.6 % for the control group . CONCLUSION Decision support based on a clinical practice guideline is an effective tool for assisting clinicians in the management of diabetic patients . This decision support system provides a model for how a clinical practice guideline can be integrated into the care process by computer to assist clinicians in managing a specific disease through helping them comply with care st and ards . Use of decision support systems based on clinical practice guidelines could ultimately improve the quality of medical care Objective : To evaluate the clinical and cost effectiveness of two training strategies to promote the use of research evidence in speech and language therapy ( SLT ) management  of poststroke dysphagia . Design : Pragmatic , cluster r and omized trial . Setting : Seventeen SLT departments in north-west Engl and . Participants : Two SLTs from each department received training and cascaded information across their department . Process of care was measured from the notes of 708 patients with acute poststroke dysphagia across eight departments allocated to training strategy A , and 762 patients across nine departments in strategy B. Interventions : Strategy A : training on the critical appraisal of published research papers and practice guidelines . Strategy B : strategy A plus training on management of change in clinical practice . Main outcome measures : Pre- and post-training adherence to practice guidelines in poststroke dysphagia management , based on a review of case notes . Incremental cost of increased adherence to clinical guidelines . Results : Departments ' practice differed in adherence to guidelines . Departments changed following training ( F=2.22 , df 16 , 1436 , p=0.004 ) . The effect of training strategy on clinical practice was not significant . Strategy B departments engaged in more activities relating to research use following training than strategy A. Total costs of training averaged £ 2001 , t2892 , $ 3886 ( SD £ 502 , t726 , $ 975 ) for strategy A and £ 3366 , t4866 , $ 6537 ( SD £ 2121 , t3066 , $ 4119 ) for strategy B. Conclusions : Training in research implementation in addition to critical appraisal and guideline introduction is associated with increased dissemination activities and awareness of research information , but not with changes in clinical practice within six months of training . The department in which SLTs work influences their use of research . The process of poststroke dysphagia management can be measured using a tool developed from practice guidelines OBJECTIVE To conduct a cost analysis and cost-effectiveness study based on a r and omized clinical trial of basic nutrition care ( BC ) and practice guidelines nutrition care ( PGC ) provided by dietitians in outpatient clinics . DESIGN Subjects with non-insulin-dependent diabetes mellitus ( NIDDM ) from three states ( Minnesota , Florida , Colorado ) were r and omly assigned to a group receiving BC or a group receiving PGC for a 6-month clinical trial . Along with data about medical and clinical outcomes , data about cost re sources were collected . The cost-effectiveness of PGC compared with BC was calculated using per-patient costs and glycemic outcomes for the 6 months of the study . A net cost-effectiveness ratio comparing BC and PGC , including the cost savings result ing from changes in medical therapy , was also calculated . SUBJECTS The study reports on a sample of 179 subjects with NIDDM between the ages of 38 and 76 years who completed the clinical trial . RESULTS Patients in the PGC group experienced a mean 1.1 + /- 2.8 mmol/L decrease in fasting plasma glucose level 6 months after entry to the study , for a total per-patient cost of $ 112 .  PGC costs included one glycated hemoglobin assay used by the dietitian to evaluate nutrition outcomes . Patients in the BC group experienced a mean 0.4 + /- 2.7 mmol/L decrease , for a total per-patient cost of $ 42 . In the PGC group , 17 persons had changes in therapy , which yielded an average 12-month cost savings prorated for all patients of $ 31.49 . In contrast , in the BC group , 9 persons had changes in therapy , for an average 12-month prorated cost savings of $ 3.13 . Each unit of change in fasting plasma glucose level from entry to the 6-month follow-up can be achieved with an investment of $ 5.75 by implementing BC or of $ 5. 
    Output:
    
Multi-faceted interventions were no more effective than single intervention strategies and effects of the same strategy varied across trials .
There is no evidence to support a set guideline implementation strategy for allied health professionals .