***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: OBJECTIVE To assess the impact of diverse  continuing medical education ( CME ) interventions on  physician performance and health care outcomes .  DATA SOURCES Using continuing medical education and related phrases , we performed regular search es of the indexed literature ( MEDLINE , Social Science Index , the National Technical Information Service , and Educational Research Information Clearinghouse ) from 1975 through 1991 . In addition , for these years , we used manual search es , key informants , and requests to authors to locate other indexed articles and the nonindexed literature of adult and continuing professional education . STUDY SELECTION From the result ing data base we selected studies that met the following criteria : r and omized controlled trials ; educational programs , activities , or other interventions ; studies that included 50 % or more physicians ; follow-up assessment s of at least 75 % of study subjects ; and objective assessment s of either physician performance or health care outcomes . DATA EXTRACTION Studies were review ed for data related to physician specialty and setting . Continuing medical education interventions were classified by their mode(s ) of activity as being predisposing , enabling , or facilitating . Using the statistical tests supplied by the original investigators , physician performance outcomes and patient outcomes were classified as positive , negative , or inconclusive . DATA SYNTHESIS We located 777 CME studies , of which 50 met all criteria . Thirty-two of these analyzed physician performance ; seven evaluated patient outcomes ; 11 examined both measures . The majority of the 43 studies of physician performance showed positive results in some important measures of re source utilization , counseling strategies , and preventive medicine . Of the 18 studies of health care outcomes , eight demonstrated positive changes in patients ' health care outcomes . CONCLUSION Broadly defined CME interventions using practice -enabling or reinforcing strategies consistently improve physician performance and , in some instances , health care outcomes 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 Traditional continuing medical education ( CME ) has not been successful in improving physicians ' practice . This project evaluated the use of e-mail to deliver evidence -based moderated case discussion s to family physicians . METHODS In a r and omized controlled trial , 58 southwestern Ontario physicians were recruited and r and omly assigned to receive two evidence -based cases ( type 2 diabetes , prevention ) or were put on a waiting list to receive the same . On-line discussion s took place about each case . Data were collected using two knowledge question naires , charts audits , and st and ardized patient visits for each of the two cases . RESULTS The two groups were similar except for rural/urban and solo versus group practice . The latter was related to outcomes , and analyses were controlled for this variable . The intervention group showed statistically significant improvements compared to the control group for knowledge and chart-audit scores for one of the two cases . CONCLUSIONS Using a r and omized control design , this e-mail CME method demonstrated mixed effectiveness OBJECTIVE To explore how clinical and demographic variables impact on the management of diabetes mellitus in general practice . DESIGN A structured vignette survey was conducted in Australia . This included nine vignettes chosen at r and om from 128 developed around seven clinical variables . Respondents were asked to recommend a change in treatment and make specific recommendations . A r and om sample of general practitioners ( GPs ) were recruited . Two diabetologists involved in the development of national guidelines also participated . RESULTS 125 ( 13.8 % ) GPs participated . Statistical analyses were used to generate outcome measures . GPs recommended a change in treatment for most ( 81.1 % ) cases ; were less likely to prescribe a statin  ( 68.5 % GPs vs. 76.3 % diabetologists ) , less likely to treat hypertension ( 66.7 % vs.89 % ) and less likely to refer for lifestyle modification ( 82.3 % vs. 96.5 % ) . Significant disagreement occurred around prescribing or changing oral hypoglycaemics . No GP characteristics showed significant impact . The proportion of GPs who agreed with diabetiologists on dose and choice of drugs was 35.7 % for statins , 49.6 % for antihypertensives and 39.6 % for oral hypoglycaemics . CONCLUSIONS There were significant differences between diabetologists and GPs on the management of diabetes . The survey suggests significant under-dosing by GPs . These findings warrant further investigation OBJECTIVES To evaluate the implementation of clinical guidelines for diabetes mellitus in general practice with a specific computer-based clinical decision support system ( CDSS ) as part of the intervention . METHODS R and omized study with health center as unit . General practice in Sør- and Nord-Trøndelag counties in Norway , 380,000 inhabitants . Seventeen health centers with 24 doctors and 499 patients with diabetes mellitus were in the intervention group and 12 health centers with 29 doctors and 535 patients were in the control group . Main outcome measures were group differences in fractions of patients without registration s ( process evaluation ) and mean group differences for the same variables ( patient outcome evaluation ) . RESULTS Statistically significant group differences were experienced for fractions of patients without registration of cigarette smoking ( intervention group , 82.6 % ; control group 94.5 % ) , body mass index ( 78.2 % vs. 93.0 % ) , and sufficient registration s for calculation of risk score for myocardial infa rct ion ( 91.1 % vs. 98.3 % ) ; all during 18 months . Large center variations were shown for all variables . The only statistically significant group difference was -2.3 mm Hg ( 95 % CI , -3.8 , -0.8 ) in diastolic blood pressure in favor of the intervention group . Statistically insignificant differences in favor of the intervention group were HbA1c , -0.1 % ( 95 % CI , -0.4 , 0.1 ) , systolic blood pressure , -1.2 mm Hg ( 95 % CI , -4.4 , 2.0 ) . Statistically insignificant differences in favor of the control group were fractions of smokers , + 3.0 % ( 95 % CI , -4.0 , 10.0 ) , body mass index , + 0.3 kg/m2 ( 95 % CI , -0.8 , 1.4 ) , risk score in female + 0.1 ( 95 % CI , -5.1 , 5.2 ) , and risk score in male + 2.6 ( 95 % CI , -14.2 , 19.5 ) . CONCLUSIONS Implementation of clinical guidelines for diabetes mellitus in general practice , by means of a CDSS and several procedures for implementation , did not result in a clinical ly significant change in doctors ' behavior or in patient outcome Introduction : Statements of commitment to change are advocated both to promote and to assess continuing education interventions . However , most studies of commitment to change have used self‐reported outcomes , and self‐reports may significantly overestimate actual performance . As part of an educational r and omized controlled trial , this study documented changes that family physicians committed to make in their prescribing and then used third‐party data to examine actual changes . Method : Following participation in a continuing medical education program using interactive small groups , physicians were asked to identify changes that they planned to make in their practice s. For prescribing changes related to four conditions , data from a provincial pharmacy registry were analyzed for 6‐month periods before and after the educational intervention . Results : A total of 207 physicians participated in the project , which involved monthly meetings of 30 peer learning groups . Ninety‐nine physicians received experimental case‐based educational modules ± personal prescribing feedback , and 91 of these indicated that they planned to make at least one change in practice . Of the 209 intended changes , 71 % were directly related to the prescribing messages in the material s. Discussion : In three of four indicator conditions , physicians who expressed a commitment to change were significantly more likely to change their actual prescribing for the target medications in the following 6 months . The percentage of physicians who did change their prescribing varied significantly by condition . Further study of the process of translating commitment to change into real practice change is needed Clinical guidelines have been developed to assist with the management of patient care ; however , these guidelines are frequently neglected in clinical practice . Computer-generated reminders enhance guideline use , but these systems often fail to achieve high rates of guideline utilization . This study was design ed to test the hypothesis that computer-generated , individualized feedback regarding adherence to care guidelines will significantly improve clinician compliance with guideline recommendations presented through a computer-assisted management protocol .  Half of the 45 primary care clinicians employed at a primary care clinic affiliated with an academic medical center , were r and omized to receive a biweekly electronic mail message consisting of a computer-generated report summarizing his/her response to care guideline recommendations for the diabetic patients seen during the previous 2 weeks . Clinician compliance with guideline recommendations was the primary outcome measure . This study demonstrated that the intervention significantly increased clinician compliance with the guideline recommendations without incurring high maintenance expenses . Median compliance among the intervention group was 35 % versus 6.1 % among the control group ( p < 0.01 ) . Electronically distributed , computer-generated , individualized feedback regarding clinician use of care guideline recommendations is an effective way to enhance compliance with a care guideline Introduction : Formal didactic continuing medical education ( CME ) is relatively ineffective for changing physician behaviur . Diabetes mellitus is an increasingly prevalent disease , and interventions to improve adherence to clinical practice guidelines ( CPGs ) are needed . Methods : A stratified , cluster‐r and omized , controlled trial design was used to evaluate the effects of a teleconferenced educational detailing ( TED ) CME on glycemic control ( hemoglobin [ Hb ] A1c ) and family physician adherence to national diabetes guidelines . TED employed sequential , small‐group , case‐based education using CPGs delivered by a diabetes specialist . Medical record audit data from baseline through the end of a 12‐month postintervention period were compared for the control and intervention groups . Satisfaction with the intervention was evaluated . Results : Sixty‐one physicians provided 660 medical records . The intervention did not affect mean Hb A1c levels but did significantly ( p = .04 ) alter the distribution of patients by category of glycemic control , with fewer in the intervention group in inadequate control ( 15.8 % versus 23.9 % ) . More patients took insulin ( alone or with oral agents ) in the intervention group ( 21.2 % versus 12.0 % , p = .03 ) , and more took oral agents only in the control group ( 89.0 % versus 82.9 % , p = .005 ) . More patients in the intervention group had documentation of body mass index ( 7.8 % versus 1.9 % , p < .02 ) , eye exam ( 12.1 % versus 5.1 % , p = .02 ) , and treatment plan ( 43.5 % versus 23.6 % , p = .01 ) and used a flow sheet ( 14.6 % versus 7.7 % , p < .03 ) . Although there was general satisfaction with the teleconferencing format , specialist educators found the format more challenging than the family physicians . 
    Output:
    
There was little evidence of the impact of general practitioner educational interventions on patient outcomes .
CONCLUSIONS Few studies examined the effectiveness of general practitioner Type 2 diabetes education in improving general practitioner satisfaction , knowledge , practice s and /or patient outcomes .