***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 aim of the SPHERE study is to design , implement and evaluate tailored practice and personal care plans to improve the process of care and objective clinical outcomes for patients with established coronary heart disease ( CHD ) in general practice across two different health systems on the isl and of Irel and .CHD is a common cause of death and a significant cause of morbidity in Irel and . Secondary prevention has been recommended as a key strategy for reducing levels of CHD mortality and general practice has been highlighted as an ideal setting for secondary prevention initiatives . Current indications suggest that there is considerable room for improvement in the provision of secondary prevention for patients with established heart disease on the isl and of Irel and . The review literature recommends structured programmes with continued support and follow-up of patients ; the provision of training , tailored to practice needs of access to evidence of effectiveness of secondary prevention ; structured recall programmes that also take account of individual practice needs ; and patient-centred consultations accompanied by attention to disease management guidelines . Methods SPHERE is a cluster r and omised controlled trial , with practice -level r and omisation to intervention and control groups , recruiting 960 patients from 48 practice s in three study centres ( Belfast , Dublin and Galway ) . Primary outcomes are blood pressure , total cholesterol , physical and mental health status ( SF-12 ) and hospital re-admissions . The intervention takes place over two years and data is collected at baseline , one-year and two-year follow-up . Data is obtained from medical charts , consultations with practitioners , and patient postal question naires . The SPHERE intervention involves the implementation of a structured systematic programme of care for patients with CHD attending general practice . It is a multi-faceted intervention that has been developed to respond to barriers and solutions to optimal secondary prevention identified in preliminary qualitative research with practitioners and patients . General practitioners and practice nurses attend training sessions in facilitating behaviour change and medication prescribing guidelines for secondary prevention of CHD . Patients are invited to attend regular four-monthly consultations over two years , during which targets and goals for secondary prevention are set and review ed . The analysis will be strengthened by economic , policy and qualitative components BACKGROUND The decreased use of electronic fetal monitoring ( EFM ) for healthy women in labour and the increased provision of professional support to all women in labour is recommended by experts . We evaluated the effectiveness of a community-wide approach to transferring research results to practice using a regional committee , newsletter articles and annual conference presentations compared with an additional tailored hospital intervention involving workshops to enhance self-efficacy for nurses , policy review , multidisciplinary meetings , rounds and unit discussion s. METHODS We compared the proportion of women at low risk who received EFM and the proportion of nurses ' time spent providing labour support before and after the intervention within each of 4 hospitals ( 2 tertiary and 2 secondary ) . One hospital of either type was r and omly selected to receive the tailored intervention .  R and omly selected charts ( n = 200 ) were review ed for the use of EFM at each hospital before ( 1995 ) and after ( 1996 ) the intervention . Trained observers at r and omly selected times recorded the nurses ' activities , including time spent providing labour support before and after the intervention . RESULTS At the intervention secondary hospital , there was a large decrease in the use of EFM  , from 90.1 % before to 41.0 % after the intervention ( p < 0.001 ) , but no change in nurses ' time spent providing labour support . At the intervention tertiary hospital there was no change in EFM rates , but there was a small , statistically significant increase in time spent providing labour support ( 23.5 % to 29.8 % , p < 0.001 ) . A negative effect on time spent providing labour support was found at the control secondary hospital ( decrease from 19.6 % to 12.8 % , p < 0.001 ) , with no change in the EFM rate . At the control tertiary hospital there was a small decrease in the use of EFM  , from 99.5 % to 91.4 % ( p < 0.001 ) , but no change in time spent providing labour support . INTERPRETATION The results are mixed , and the tailored intervention thus appeared to have limited effects . No association was found between the reduction in the use of EFM  and an increase in nurses ' time spent providing labour support Background Apart from direct protection and reduced productivity loss during epidemics , the main reason to immunize healthcare workers ( HCWs ) against influenza is to provide indirect protection of frail patients through reduced transmission in healthcare setting s. Because the vaccine uptake among HCWs remains far below the health objectives , systematic programs are needed to take full advantage of such vaccination . In an earlier report , we showed a mean 9 % increase of vaccine uptake among HCWs in nursing homes that implemented a systematic program compared with control homes , with higher rates in those homes that implemented more program elements . Here , we report in detail the process of the development of the implementation program to enable research ers and practitioners to develop intervention programs tailored to their setting . Methods We applied the intervention mapping ( IM ) method to develop a theory- and evidence -based intervention program to change vaccination behaviour among HCWs in nursing homes . Results After a comprehensive needs assessment , we were able to specify proximal program objectives and selected methods and strategies for inducing behavioural change . By consensus , we decided on planning of three main program components , i.e. , an outreach visit to all nursing homes , plenary information meetings , and the appointment of a program coordinator -- preferably a physician -- in each home . Finally , we planned program adoption , implementation , and evaluation . Conclusion The IM methodology result ed in a systematic , comprehensive , and transparent procedure of program development . A potentially effective intervention program to change influenza vaccination behaviour among HCWs was developed , and its impact was assessed in a clustered r and omised controlled trial UNLABELLED INTRODUCTION AND OBJECTIVES . Clinical practice in unstable angina is not always based on best evidence . Guidelines have the potential to improve quality of health care . There are no r and omised trials assessing implementation strategies in the public healthcare system of Spain yet . OBJECTIVE to compare the effectiveness of a multifaceted strategy ( interactive educational meetings , local consensus process ) for guideline implementation in unstable angina , with a passive dissemination strategy . Patients and method . SETTING 10 wards from 3 university hospitals in Sevilla . PARTICIPANTS 153 specialists ( cardiologists , internists ) and their patients admitted for an unstable angina episode . DESIGN a pragmatic , before and after cluster r and omized controlled trial . Intervention was delivered from January to April 1998 . Retrospective data collection took place in July 1999 , of those pre and post-intervention episodes attended from January to October 1997 and from September 1998 to June 1999 , respectively . OUTCOMES compliance with the guideline recommendations for coronary angiography and stress testing , and ejection fraction assessment . RESULTS The multifaceted strategy compared with the passive one , was associated with an absolute improvement in the appropriateness of use of coronary angiography and stress testing of 11 % ( 95 % CI , 0.85 - 21.1 ) , P=.03 . There was no association for the assessment of the ejection fraction : absolute improvement of 1.1 % ( 95 % CI , --15.9 to 18.1 ) , P=.88 . CONCLUSIONS Our results show that a combination of interactive educational meetings and local consensus process delivered to wards of physicians may improve the appropriateness of use of coronary angiography and stress testing 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 Astract Background Evidence implementation continues to challenge health professionals most especially those from developing countries . Filipino physiotherapists represent a group of health professionals in a developing country who by tradition and historical practice , take direction from a doctor , on treatment options . Lack of autonomy in decision-making challenges their capacity to deliver evidence -based care . However , this scenario should not limit them from updating and up-skilling themselves on evidence - based practice ( EBP ) . EBP training tailored to their needs and practice was developed to address this gap . This study will be conducted to assess the effectiveness of a tailored EBP-training program for Filipino physiotherapists , in improving knowledge , skills , attitudes and behaviour to EBP . Participation in this program aims to improve capacity to EBP and engage with referring doctors to determine the most effective treatments for their patients . Methods / Design A double blind r and omised controlled trial , assessing the effectiveness of the EBP training intervention , compared with a waitlist control , will be conducted . An adequately powered sample of 54 physiotherapists from the Philippines will be recruited and r and omly allocated to EBP intervention or waitlist control . Intervention : The EBP program for Filipino physiotherapists is a one-day program on EBP principles and techniques , delivered using effective adult education strategies . It consists of lectures and practical workshops . A novel component in this program is the specially-developed recommendation form , which participants can use after completing their training , to assist them to negotiate with referring doctors regarding evidence -based treatment choices for their patients .Pre and post measures of EBP knowledge , skills and attitudes will be assessed in both groups using the Adapted Fresno Test and the Questions to EBP attitudes . Behaviour to EBP will be measured using activity diaries for a period of three months . Discussion Should the EBP-training program be found to be effective in improving EBP-uptake in Filipino physiotherapists , it will form the basis of a much needed national intervention which is context ually appropriate to Filipino physiotherapists . It will therefore form the genesis for a model for building EBP capacity of other health professionals in the Philippines as well as physiotherapists in developing countries . Trial Registration Current Controlled Trials : IS RCT BACKGROUND The number of people residing in nursing homes has increased . General practitioners ( GPs ) receive an increased capitation fee for elderly patients in recognition of their higher consultation rate . However , there is no distinction between elderly patients residing in nursing homes and those in the community . AIM To determine whether nursing home residents receive greater general practice input than people residing in the community . METHOD Prospect i ve comparative study of all 345 residents of eight nursing homes in Glasgow and a 2:1 age , sex , and GP matched comparison group residing in the community . A comparison of contacts with primary care over three months in terms of frequency , nature , length , and outcome was carried out . RESULTS Nursing home residents received more total contacts with primary care staff ( P < 0.0001 ) and more face-to-face consultations with GPs ( P < 0.0001 ) . They were more likely to be seen as an emergency ( P < 0.01 ) but were no more likely to be referred to hospital , and were less likely to be followed-up by their GP ( P < 0.0001 ) . Although individual consultations with nursing home residents were shorter than those with the community group ( P < 0.0001 ) , the overall time spent consulting with them was longer ( P < 0.001 ) . This equated to an additional 28 minutes of time per patient per annum . Some of this time would have been offset by less time spent travelling , since 61 % of nursing home consultations were done during the same visit as other consultations , compared with only 3 % of community consultations ( P < 0.0001 ) . CONCLUSION Our study suggests that nursing home residents do require a greater input from general practice than people of the same age and sex who are residing in the community . While consideration may be given to greater financial reimbursement of GPs who provide medical care to nursing home residents , consideration should also be given to restructuring the medical cover for nursing home residents . This would result in a greater scope for proactive and preventive interventions and for consulting with several patients during one visit BACKGROUND We assessed patient outcomes 90 days after hospital admission for stroke following a multidisciplinary intervention targeting evidence -based management of fever , hyperglycaemia , and swallowing dysfunction in acute stroke units ( ASUs ) . METHODS In the Quality in Acute St 
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Despite the increase in the number of new studies identified , our overall finding is similar to that of the previous review .
Tailored implementation can be effective , but the effect is variable and tends to be small to moderate .
It is not yet clear how best to tailor interventions and therefore not clear what the effect of an optimally tailored intervention would be