***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 and cost-effectiveness of two information-based provider reminder interventions design ed to improve self-care management and outcomes of heart failure ( HF ) patients . DATA SOURCES / STUDY SETTING Interview and agency administrative data on 628 home care patients with a primary diagnosis of HF . STUDY DESIGN Patients were treated by nurses r and omly assigned to usual care or one of two intervention groups . The basic intervention was an e-mail to the patient 's nurse highlighting six HF-specific clinical recommendations . The augmented intervention supplemented the initial nurse reminder with additional clinician and patient re sources . DATA COLLECTION Patient interviews were conducted 45 days post admission to measure self-management behaviors , HF-specific outcomes ( Kansas City Cardiomyopathy Question naire-KCCQ ) , health-related quality of life ( EuroQoL ) , and service use . PRINCIPAL FINDINGS Both interventions improved the mean KCCQ summary score ( 15.3 and 12.9 percent , respectively ) relative to usual care ( p < or = .05 ) . The basic intervention also yielded a higher EuroQoL score relative to usual care ( p < or = .05 ) . In addition , the interventions had a positive impact on medication knowledge , diet , and weight monitoring . The basic intervention was more cost-effective than the augmented intervention in improving clinical outcomes . CONCLUSIONS This study demonstrates the positive impact of targeting evidence -based computer reminders to home health nurses to improve patient self-care behaviors , knowledge , and clinical outcomes . It also advances the field 's limited underst and ing of the cost-effectiveness of selected strategies for translating research into practice Background The aim of this project was to assess whether outreach visits would improve the implementation of evidence based clinical practice in the area of falls reduction and stroke prevention in a residential care setting . Methods Twenty facilities took part in a r and omized controlled trial with a seven month follow-up period . Two outreach visits were delivered by a pharmacist . At the first a summary of the relevant evidence was provided and at the second detailed audit information was provided about fall rates , psychotropic drug prescribing and stroke risk reduction practice s ( BP monitoring , aspirin and warfarin use ) for the facility relevant to the physician . The effect of the interventions was determined via pre- and post-intervention case note audit . Outcomes included change in percentage patients at risk of falling who fell in a three month period prior to follow-up and changes in use of psychotropic medications . Chi-square tests , independent sample s t-test , and logistic regression were used in the analysis . Results Data were available from case notes at baseline ( n = 897 ) and seven months follow-up ( n = 902 ) , 452 residential care staff were surveyed and 121 physicians were involved with 61 receiving outreach visits . Pre- and post-intervention data were available for 715 participants . There were no differences between the intervention and control groups for the three month fall rate . We were unable to detect statistically significant differences between groups for the psychotropic drug use of the patients before or after the intervention . The exception was significantly greater use of " as required " antipsychotics in the intervention group compared with the control group after the pharmacy intervention ( RR = 4.95 ; 95%CI 1.69–14.50 ) . There was no statistically significant difference between groups for the numbers of patients " at risk of stroke " on aspirin at follow-up . Conclusions While the strategy was well received by the physicians involved , there was no change in prescribing patterns . Patient care in residential setting s is complex and involves contributions from the patient 's physician , family and residential care staff . The project highlights challenges of delivering evidence based care in a setting in which there is a paucity of well controlled trial evidence but where significant health outcomes can be attained BACKGROUND Benzodiazepine use by elderly patients is associated with adverse outcomes including increased risk of falls and fractures , motor vehicle accidents and cognitive impairment . Recent studies suggest that individualized feedback and education to physicians may improve drug prescribing . In this study , we evaluated an intervention to address the inappropriate prescribing of benzodiazepines for elderly patients . METHODS We identified 1624 primary care physicians who wrote at least 10 prescriptions for the target drugs in a 2-month period and r and omly assigned these physicians to the intervention group or the control group . We obtained data from the Ontario Drug Benefit cl aims data base , which covers all Ontario residents aged 65 years and over for drugs selected from a minimally restrictive formulary . Every 2 months for 6 months , confidential profiles of benzodiazepine prescription use coupled with evidence -based educational bulletins were mailed to the intervention group . The control group received feedback and educational bulletins about first-line antihypertension drug prescribing for elderly patients . Our main outcome measures were reductions in the proportion of each physician 's total benzodiazepine prescriptions for long-acting agents , combinations of benzodiazepines with other psychoactive medications ( including other benzodiazepines ) and long-term benzodiazepine therapy . RESULTS After r and omization , 168 physicians agreed to be in the intervention group and 206 in the control group . Their demographic and prescribing characteristics were similar . Although the proportion of long-acting benzodiazepine prescriptions decreased by 0.7 % in the intervention group between the baseline period and the end of the intervention period ( from 20.3 % , or a mean of 29.5 prescriptions , to 19.6 % , or a mean of 27.7 prescriptions ) and increased by 1.1 % in the control group ( from 19.8 % , or a mean of 26.4 prescriptions , to 20.9 % , or a mean of 27.7 prescriptions ) ( p = 0.036 ) , this difference was not clinical ly significant . There was no significant difference over the study period in either combination prescribing of benzodiazepines or in prescriptions for long-term benzodiazepine therapy . INTERPRETATION We did not find that a program of confidential feedback and educational material offered to Ontario primary care physicians had a clinical ly significant impact on their benzodiazepine prescribing Background Early identification of permanent hearing impairment in children enables appropriate intervention which reduces adverse developmental outcomes . The UK Government has introduced a universal hearing screening programme for neonates . All involved health professionals , including those in Primary Care , need to be aware of the service to enable them to offer appropriate support to their patients . A programme of information dissemination within Primary Care was therefore undertaken . The aim of the current study was to determine the extent to which the information had reached General Practitioners ( GPs ) , the GPs ' preferred mode of dissemination and the sources from which GPs accessed information Methods Postal question naire survey of a r and omised sample of 1000 GPs in the Phase I pilot sites of the Neonatal Hearing Screening Programme ( NHSP ) . Results Responses were received from 54.2 % of the sample . Just under 50 % of those responding had received information , 62.2 % of respondents said they would like to receive more information and the preferred methods of dissemination were the written word and web-sites to allow access when needed . Few GPs perceive themselves to have a core role in the delivery of the NHSP and thence a need for knowledge in the subject . Many are keen to delegate detail to a third party , usually the health visitor , who has traditionally had responsibility for hearing screening . Conclusions Dissemination efforts for service developments of relevance to GPs should concentrate on advertising a website address via brief but memorable posted literature and /or articles in relevant journals and magazines . The website should be GP-friendly , and have a dedicated area for GPs including information of specific relevance and downloadable information sheets OBJECTIVE To determine the extent of self-reported use of prescription medications in an Australian community sample . DESIGN , SETTING AND PARTICIPANTS Face-to-face interviews with a r and om , representative sample of the South Australian population ( aged > or = 15 years ) living in metropolitan and rural areas . The study , a Health Omnibus Survey , was conducted between March and June 2004 . MAIN OUTCOME MEASURES Reported number of prescribed medications used per person , most common categories of medication , and use by individuals of multiple medications for the same body system . RESULTS From 4700 households selected , 3015 participants were interviewed ( 65.9 % response rate ) . Of respondents , 46.8 % were using prescribed medications ; 171 respondents ( 5.7 % ) were taking six or more medications , and four were taking 16 or more ; 23.2 % were using medications for the cardiovascular system , with 11.9 % using agents acting on the renin-angiotensin system . Prescription medication use increased with age , with over 10 % of respondents aged > or = 55 years using six or more medications . CONCLUSIONS Use of multiple prescribed medications was common , with the potential for significant drug interactions . Assuming a similar pattern of medication use Australia-wide , reducing the number of prescribed medications by one for people taking six or more medications would save the federal government about 380 million dollars a year BACKGROUND Despite ongoing concern about adverse effects and dependence on benzodiazepines , approximately 2 % of Australians are still taking them on a regular basis . The aim of this study was to evaluate the effectiveness of an educational outreach or ' academic detailing ' program about prescribing of benzodiazepines . METHOD In this r and omised trial general practice registrars ( n = 157 ) in New South Wales were allocated to an intervention group ( n = 79 ) , which received a 20 minute educational outreach visit ; or a control group ( n = 78 ) which received an intervention on an unrelated topic .  Prescribing behaviour was monitored by a pre-intervention and two post-intervention practice activity surveys . MAIN OUTCOME MEASURES These were the rate of benzodiazepine prescribing for all indications , for anxiety and for sleep disorders . RESULTS Overall benzodiazepine prescribing by the intervention group declined from 2.3 to 1.7 per 100 encounters , while the control group also declined from 2.2 to 1.6 per 100 encounters . Analysis of variance showed this was a significant drop over time ( P = 0.042 ) but there was no difference between groups ( P = 0.99 ) . The prescribing decrease observed was in continuing rather than initial prescriptions . CONCLUSIONS A marked decrease in benzodiazepine prescribing was seen over the course of the study in both intervention and control groups but no differential effect due to the educational outreach visit was found OBJECTIVE To describe how general practitioners use computers for clinical purpose s. DESIGN Mail survey of a cross-sectional national stratified r and om sample of 3000 GPs in primary care setting s between 10 October and 31 December 2005 . MAIN OUTCOME MEASURES Use of computers  , and use of computerised clinical functions such as prescribing , medication checking , generating health summaries , running recall systems , and writing progress notes . RESULTS Of 1186 GPs responding ( 39.5 % response rate ) , 90 % used a clinical software package . GPs used clinical packages for prescribing ( 98 % ) , checking for drug-drug interactions ( 88 % ) , recording a reason for prescribing ( 65 % ) , to order laboratory tests ( 85 % ) , run recall systems ( 78 % ) , and record progress notes ( 64 % ) . Less frequently used functions included generating lists of patients needing vaccines ( 43 % ) and taking the same medication ( 39 % ) . Less than 20 % of GPs who used a clinical package accessed computerised information during the consultation . CONCLUSIONS Australian general practice has achieved near-universal clinical computerisation . Electronic prescribing alone has probably improved efficiency and quality of care , and reduced medication errors . Increasing the use of other functions , such as accessing online decision support and maintaining registries of patients , is likely to lead to further health gains , especially in managing chronic conditions INTRODUCTION Adverse drug events ( ADEs ) are associated with inappropriate prescribing ( IP ) and result in increased morbidity , mortality and re source utilisation . We used Beers ' Criteria to determine the three-month prevalence of IP in a non-selected community-dwelling population of acutely ill older people requiring hospitalisation . METHODS A prospect i ve , observational study of 597 consecutive acute admissions was performed . Diagnoses and concurrent medications were recorded before hospital physician intervention , and Beers ' Criteria applied . RESULTS Mean patient age ( SD ) was 77 ( 7 ) years .  Median number of medications was 5 , range 0 - 13 . IP occurred in 32 % of patients ( n = 191 ) , with 24 % , 6 % and 2 % taking 1 , 2 and 3 inappropriate medications respectively . Patients taking > 5 medications were 3.3 times more likely to receive an inappropriate medication than those taking < or = 5 medications ( OR 3.34 : 95 % , CI 2.37 - 4.79 ; P<0.001 ) . Forty-nine per cent of patients with inappropriate prescriptions were admitted with adverse effects of the inappropriate medications . Sixteen per cent of all admissions were associated with such adverse effects . CONCLUSION IP is highly prevalent in acutely ill older patients and is associated with polypharmacy and hospitalisation . However , Beers ' Criteria can not be used as a gold st and ard as they do not comprehensively address all aspects of IP in older people OBJECTIVE : To determine whether reminder cards in medical records enhance the effectiveness of audit with feedback in improving the care of patients taking long term benzodiazepine drugs . DESIGN : R and omised trial , practice 
    Output:
    
Conclusions Studies which used a multi-faceted approach had the largest and most sustained reductions in benzodiazepines use .
It appears that support groups for patients , non-voluntary recruitment of GPs , and oral delivery of alerts or feedback may all improve the outcomes of interventions .
The choice of outcome measures , delivery style of educational messages , and requests by GPs to stop benzodiazepines , either in a letter or face to face , showed no differences on the success rates of the intervention