***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 primary aim of this study was to evaluate the effectiveness of an intervention to increase the implementation of healthy eating and physical activity policies and practice s by centre-based childcare services . The study also sought to determine if the intervention was effective in improving child dietary intake and increasing child physical activity levels while attending childcare . Methods A parallel group , r and omised controlled trial was conducted in a sample of 128 childcare services . Intervention strategies included provision of implementation support staff , securing executive support , staff training , consensus processes , academic detailing visits , tools and re sources , performance monitoring and feedback and a communications strategy . The primary outcome of the trial was the proportion of services implementing all seven healthy eating and physical activity policies and practice s targeted by the intervention . Outcome data were collected via telephone surveys with nominated supervisors and room leaders at baseline and immediately post-intervention . Secondary trial outcomes included the differences between groups in the number of serves consumed by children for each food group within the Australian Guide to Healthy Eating and in the proportion of children engaged in sedentary , walking or very active physical activity assessed via observation in a r and om sub sample of 36 services at follow-up . Results There was no significant difference between groups for the primary trial outcome ( p = 0.44 ) . Relative to the control group , a significantly larger proportion of intervention group services reported having a written nutrition and physical activity policy ( p = 0.05 ) and providing adult-guided activities to develop fundamental movement skills ( p = 0.01 ) . There were no significant differences between groups at follow-up on measures of child dietary intake or physical activity . Conclusions The findings of the trial were equivocal . While there was no significant difference between groups for the primary trial outcome , the intervention did significantly increase the proportion of intervention group services implementing two of the seven healthy eating and physical activity policies and practice s. High levels of implementation of a number of policies and practice s at baseline , significant obesity prevention activity in the study region and higher than previously reported intra-class correlation of child behaviours may , in part , explain the trial findings .Trial registration Australian Clinical Trials Registry ( reference ACTRN12612000927820 ) Background : Greater than 65 percent of the United States ( US ) population is overweight , with 32 percent obese . It is a problem in both developed and developing nations . While guidelines exist , counseling by physicians about obesity and weight loss is inconsistent , and physician approaches to obesity management have limited success . This study attempted to increase involvement in translating proven research into practice to improve physician awareness and improve outcomes of overweight/obesity . Twenty-one physicians in a suburban , middle class population in the Midwestern United States participated . Methods : Physician obesity awareness , weight , height , BMI , blood pressure , lipids , and glycohemoglobin were measured from 641 patients at baseline and were compared to 631 at 12-month follow-up . All 21 physicians received academic detailing and were presented with their clinical outcomes . Ten physicians received an Enhanced Intervention . They were additionally asked to place a sticker in the chart of their overweight or obese patients . Results : Fifty-three percent of physicians were not comfortable discussing obesity with their patients at baseline , decreasing to 0 % at followup ( p=0.041 ) . Reference to obesity management by Intervention physicians increased from 2.4 % to 9.2 % ( p=0.001 ) while for Enhanced Intervention physicians documentation increased from 3.9 % to 15.6 % ( p=0.002 ) . Those patients in the Enhanced Intervention group lost an average of 6.19 lbs ( 3.3 % ) ( p=0.083 ) during the one year period versus 4.6 lbs ( 2.5 % ) ( p=0.20 ) in the Intervention group . The BMI dropped 1.2 in the Intervention group and 0.72 in the Enhanced Intervention group . The data from both groups was pooled at both baseline and follow-up . The average weight of patients decreased from 185.7 lbs to 180.3 lbs ( excluding outliers weighing > 311 lbs ) . This 5.4 pound loss was significant ( p=0.027 ) . The BMI decreased from 30.1 to 29.1 ( p=0.095 ) . Cardiovascular co-morbidities improved . Conclusion : Obesity and overweight have a very high prevalence in a primary care community based setting s. Clinicians are not comfortable diagnosing and managing obese and overweight patients . A combination of academic detailing and presentation of outcomes to physicians will improve their awareness and result in improved clinical outcomes including weight loss Background : In developing effective interventions to increase colorectal cancer ( CRC ) screening in at risk population s , a necessary first requirement is feasibility . This paper describes how the RESPECT approach to health education guided the conceptualization and implementation of physician-directed academic detailing ( AD ) to increase practice -wide CRC screening uptake . Methods : Physician-directed AD was one intervention component in a large educational r and omized controlled trial to increase CRC screening uptake . Study participants , primarily urban minority , were aged 50 or older , insured for CRC screening with no out-of-pocket expense and out of compliance with current screening recommendations . The trial was conducted in the New York City metropolitan area . Participants identified their primary care physician ; 564 individuals were recruited , representing 459 physician practice s. Two-thirds of the physician practice s were r and omized to receive AD . The RESPECT approach , modified for AD , comprises : 1 ) Rapport , 2 ) Educate , but do n’t overwhelm , 3 ) Start with physicians where they are , 4 ) Philosophical orientation based on a humanistic approach to education , 5 ) Engagement of the physician and his/her office staff , 6 ) Care and show empathy , and 7 ) Trust . Feasibility was assessed as rate of AD delivery . Results : The AD was delivered to 283 ( 92.5 % ) of the 306 practice s assigned to receive it ; 222/283 ( 78.4 % ) delivered to the doctor . Conclusion : The AD was feasible and acceptable to implement across a range of clinical setting s. The RESPECT approach offers a framework for tailoring educational efforts , allowing flexibility , as opposed to strict adherence to a highly structured script or a universal approach OBJECTIVES To evaluate the effectiveness of efforts to translate and disseminate evidence -based guidelines about atypical antipsychotic use to nursing homes ( NHs ) . DESIGN Three-arm , cluster r and omized trial . SETTING NHs . PARTICIPANTS NHs in the state of Connecticut . MEASUREMENTS Evidence -based guidelines for atypical antipsychotic prescribing were translated into a toolkit targeting NH stakeholders , and 42 NHs were recruited and r and omized to one of three toolkit dissemination strategies : mailed toolkit delivery ( minimal intensity ) ; mailed toolkit delivery with quarterly audit and feedback reports about facility-level antipsychotic prescribing ( moderate intensity ) ; and in-person toolkit delivery with academic detailing , on-site behavioral management training , and quarterly audit and feedback reports ( high intensity ) . Outcomes were evaluated using the Reach , Effectiveness , Adoption , Implementation , Maintenance ( RE- AIM ) framework . RESULTS Toolkit awareness of 30 % ( 7/23 ) of leadership of low-intensity NHs , 54 % ( 19/35 ) of moderate-intensity NHs , and 82 % ( 18/22 ) of high-intensity NHs reflected adoption and implementation of the intervention . Highest levels of use and knowledge among direct care staff were reported in high-intensity NHs . Antipsychotic prescribing levels declined during the study period , but there were no statistically significant differences between study arms or from secular trends . CONCLUSION RE- AIM indicators suggest some success in disseminating the toolkit and differences in reach , adoption , and implementation according to dissemination strategy but no measurable effect on antipsychotic prescribing trends . Further dissemination to external stakeholders such as psychiatry consultants and hospitals may be needed to influence antipsychotic prescribing for NH residents Academic detailing is rarely practised in developing countries . A r and omized control trial on healthcare service was conducted to evaluate the impact of academic detailing programme on the adherence of primary healthcare providers in Banke district , Nepal , to childhood diarrhoea treatment guidelines recommended by World Health Organization/United Nations Children 's Fund ( WHO/UNICEF ) . The participants ( N=209 ) were systematic ally divided into control and intervention groups . Four different academic detailing sessions on childhood diarrhoea management were given to participants in the intervention group . At baseline , 6 % of the participants in the control and 8.3 % in the intervention group were adhering to the treatment guidelines which significantly ( p<0.05 ) increased among participants in the intervention ( 65.1 % ) than in the control group ( 16.0 % ) at the first follow-up . At the second follow-up , 69.7 % of participants in the intervention group were adhering to the guidelines , which was significantly ( p<0.05 ) greater than those in the control group ( 19.0 % ) . Data also showed significant improvement in prescribing pattern of the participants in the intervention group compared to the control group . Therefore , academic detailing can be used for promoting adherence to treatment guidelines in developing countries , like Nepal AIMS Improvement collaboratives consisting of various components are used throughout health care to improve quality , but no study has identified which components work best . This study tested the effectiveness of different components in addiction treatment services , hypothesizing that a combination of all components would be most effective . DESIGN An unblinded cluster-r and omized trial assigned clinics to one of four groups : interest circle calls ( group teleconferences ) , clinic-level coaching , learning sessions ( large face-to-face meetings ) and a combination of all three . Interest circle calls functioned as a minimal intervention comparison group . SETTING Out-patient addiction treatment clinics in the United States . PARTICIPANTS Two hundred and one clinics in five states . MEASUREMENTS Clinic data managers su bmi tted data on three primary outcomes : waiting-time ( mean days between first contact and first treatment ) , retention ( percentage of patients retained from first to fourth treatment session ) and annual number of new patients . State and group costs were collected for a cost-effectiveness analysis . FINDINGS Waiting-time declined significantly for three groups : coaching ( an average of 4.6 days/clinic , P = 0.001 ) , learning sessions ( 3.5 days/clinic , P = 0.012 ) and the combination ( 4.7 days/clinic , P = 0.001 ) . The coaching and combination groups increased significantly the number of new patients ( 19.5 % , P = 0.028 ; 8.9 % , P = 0.029 ; respectively ) . Interest circle calls showed no significant effect on outcomes . None of the groups improved retention significantly . The estimated cost per clinic was $ 2878 for coaching versus $ 7930 for the combination . Coaching and the combination of collaborative components were about equally effective in achieving study aims , but coaching was substantially more cost-effective . CONCLUSIONS When trying to improve the effectiveness of addiction treatment services , clinic-level coaching appears to help improve waiting-time and number of new patients while other components of improvement collaboratives ( interest circles calls and learning sessions ) do not seem to add further value BACKGROUND Management of  acute maxillary sinusitis ( AMS )  is not optimal ; antibiotics are often prescribed for viral sinusitis , which leads to many problems including those with antimicrobial resistance . Guidelines have been proposed as a means to change the professional practice s. OBJECTIVE Our aim was to study whether a nationwide guidelines implementation programme has an effect on the management of AMS in primary care . METHODS A multi-centre r and omized controlled trial was conducted in 30 health centres ( HCs ) covering a population of 819 777 people from 1998 to 2002 . The participating HCs were r and omized to implement guidelines either according to a problem-based learning ( PBL ) or an academic detailing ( AD ) method facilitated by local GPs . Data were gathered during 1 week in November in all study years and also from external control HCs in 2002 . The main outcome measure was compliance with the key points of AMS management in national Current Care guidelines . RESULTS Implementation of guidelines produced minor changes towards the recommended practice s in the management of AMS . Use of the first-line drug amoxicillin increased slightly ( from 39 % to 48 % in AD centres and from 33 % to 45 % in PBL centres , controls 40 % ) . Proportion of courses of antibiotics with recommended duration increased in MIKSTRA study centres ( from 34 % to 40 % in AD centres and from 32 % to 47 % in PBL centres , controls 43 % ) . CONCLUSIONS A nationwide guidelines implementation project produced modest changes in the management of AMS . There were no significant differences between AD and PBL education methods . Less than half the HCs were able to realize the project as intended , which decreases the internal validity of the study . The guidelines implementation might have benefited of more focussed targets and approaches that took into account the problems and practice s of each HC AIM To study the effects of a team-based model for continuous quality improvement ( CQI ) on primary care practice management . DESIGN OF STUDY R and omised controlled trial . SETTING Twenty-six intervention and 23 control primary care practice s in the Netherl and s. METHOD Practice s interested in taking part in the CQI project  were , after assessment of their practice organisation , r and omly assigned 
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Conclusions Our results demonstrate that practice facilitation with regular , tailored follow up is a powerful component of a successful organizational change strategy .
Academic detailing alone or combined with audit and feedback alone is ineffective without intensive follow up .
Provision of educational material s and use of audit and feedback are often integral components of multifaceted implementation strategies .
However , we did n’t find examples where those relatively limited strategies were effective as st and alone interventions .