***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 Hyperglycaemia , fever , and swallowing dysfunction are poorly managed in the admission phase of acute stroke , and patient outcomes are compromised . Use of evidence -based guidelines could improve care but have not been effectively implemented . Our study aims to develop and trial an intervention based on multidisciplinary team-building to improve management of fever , hyperglycaemia , and swallowing dysfunction in patients following acute stroke . Methods and design Metropolitan acute stroke units ( ASUs ) located in New South Wales , Australia will be stratified by service category ( A or B ) and , within strata , by baseline patient recruitment numbers ( high or low ) in this prospect i ve , multicentre , single-blind , cluster r and omised controlled trial ( C RCT ) . ASUs then will be r and omised independently to either intervention or control groups . ASUs allocated to the intervention group will receive : unit-based workshops to identify local barriers and enablers ; a st and ardised core education program ; evidence -based clinical treatment protocol s ; and ongoing engagement of local staff . Control group ASUs will receive only an abridged version of the National Clinical Guidelines for Acute Stroke Management . The following outcome measures will be collected at 90 days post-hospital admission : patient death , disability ( modified Rankin Score ) ; dependency ( Barthel Index ) and Health Status ( SF-36 ) . Additional measures include : performance of swallowing screening within 24 hours of admission ; glycaemic control and temperature control . Discussion This is a unique study of research transfer in acute stroke . Providing optimal inpatient care during the admission phase is essential if we are to combat the rising incidence of debilitating stroke . Our C RCT will also allow us to test interventions focussed on multidisciplinary ASU teams rather than individual disciplines , an imperative of modern hospital services . Trial Registration Australia New Zeal and Clinical Trial Registry ( ANZCTR ) No : Background : The effect of regular and expected printed educational material s on physician prescribing behaviour has not been studied . We sought to measure the impact of a series of evidence -based drug therapy letters mailed to physicians in British Columbia on prescribing to newly treated patients . Methods : A paired , cluster r and omized community design was used . The study population included 499 physicians from 24 local health areas in British Columbia . Local health areas were paired by number of physicians , and 1 of each pair was r and omly selected and its physicians assigned to an intervention group or a control group . The intervention was 12 issues of an evidence -based series called Therapeutics Letter . Physicians in the control group ( n = 241 ) received the letters 3–8 months after physicians in the intervention group ( n = 258 ) . The impact on prescribing to newly treated patients  ( defined as patients who had not previously made a cl aim for any medication from the class of drugs profiled in the letter ) was analyzed using the drug cl aims data base of BC Pharmacare , a publicly funded drug benefits program that covered all seniors and people receiving social assistance . Results : The probability of prescribing a drug recommended in the Therapeutics Letter rather than another drug in the same class increased by 30 % in the 3 months after the mailing of the letter relative to the preceding 3 months , adjusted for any before – after changes in the control group ( relative risk 1.30 ; 95 % confidence interval 1.13–1.52 ) . No letter achieved statistical significance on its own . However , 11 of the 12 letters produced prescribing changes in the predicted direction such that the overall result was significant when their effect was combined . Interpretation : The combined effect of an ongoing series of printed letters distributed from a credible and trusted source can have a clinical ly significant effect on prescribing to newly treated patients BACKGROUND A multistate r and omized study conducted under the Health Care Financing Administration 's ( HCFA 's ) Health Care Quality Improvement Program ( HCQIP ) offered the opportunity to compare the effect of a written feedback intervention ( WFI ) with that of an enhanced feedback intervention ( EFI ) on improving the anticoagulant management of Medicare beneficiaries who present to the hospital with venous thromboembolic disease . METHODS Twenty-nine hospitals in five states were r and omly assigned to receive written hospital-specific feedback ( WFI ) of feedback enhanced by the participation of a trained physician , quality improvement tools , and an Anticoagulant Management of Venous Thrombosis ( AMVT ) project liaison ( EFI ) . Differences in the performance of five quality indicators between baseline and remeasurement were assessed . Quality managers were interviewed to determine perceptions of project implementation . RESULTS No significant differences in the change from baseline to remeasurement were found between the two intervention groups . Significant improvement in one indicator and significant decline in two indicators were found for one or both groups . Yet 59 % of all quality managers perceived the AMVT project as being successful to very successful , and more EFI quality managers perceived success than did WFI managers ( 71 % versus 40 % ) . In the majority of EFI hospitals , physician liaisons played an important role in project implementation . CONCLUSION Study results indicated that the addition of a physician liaison , quality improvement tools , and a project liaison did not provide incremental value to hospital-specific feedback for improving quality of care . Future studies with larger sample sizes , lengthier follow-up periods , and interventions that include more of the elements shown to affect practice behavior change are needed to identify an optimal feedback model for use by external quality management organizations Background Naproxen and naproxen sodium are non-steroidal anti-inflammatory drugs used in a variety of painful conditions , including the treatment of postoperative pain . This review aims to assess the efficacy , safety and duration of action of a single oral dose of naproxen/naproxen sodium for moderate to severe acute postoperative pain in adults , compared with placebo . Methods The Cochrane Library ( issue 4 2002 ) , EMBASE , PubMed , MEDLINE and an in-house data base were search ed for r and omised , double blind , placebo controlled trials of a single dose of orally administered naproxen or naproxen sodium in adults with acute postoperative pain .  Pain relief or pain intensity data were extracted and converted into dichotomous information to give the number of patients with at least 50 % pain relief over 4 to 6 hours . Relative benefit and number-needed-to-treat were then calculated . The percentage of patients with any adverse event , number-needed-to-harm , and time to remedication were also calculated . Results Ten trials with 996 patients in met the inclusion criteria . Six trials compared naproxen sodium 550 mg ( 252 patients ) with placebo ( 248 patients ) ; the NNT for at least 50 % pain relief over six hours was 2.6 ( 95 % confidence interval 2.2 to 3.2 ) . There was no significant difference between the number of patients experiencing any adverse event on treatment compared with placebo .  Weighted mean time to remedication was 7.6 hours for naproxen sodium 550 mg ( 206 patients ) and 2.6 hours for placebo ( 205 patients ) . Four other trials used lower doses . Conclusion A single oral dose of naproxen sodium 550 mg is an effective analgesic in the treatment of acute postoperative pain . A low incidence of adverse events was found , although these were not reported consistently Background The implementation of new medical knowledge into general practice is a complex process . Blended learning may offer an effective and efficient educational intervention to reduce the knowledge-to- practice gap . The aim of this study was to compare knowledge acquisition about dementia management between a blended learning approach using online modules in addition to quality circles ( QCs ) and QCs alone . Methods In this cluster-r and omised trial with QCs as clusters and general practitioners ( GPs ) as participants , 389 GPs from 26 QCs in the western part of Germany were invited to participate . Data on the GPs ' knowledge were obtained at three points in time by means of a question naire survey . Primary outcome was the knowledge gain before and after the interventions . A subgroup analysis of the users of the online modules was performed . Results 166 GPs were available for analysis and filled out a knowledge test at least two times . A significant increase of knowledge was found in both groups that indicated positive learning effects of both approaches . However , there was no significant difference between the groups . A subgroup analysis of the GPs who self-reported that they had actually used the online modules showed that they had a significant increase in their knowledge scores . Conclusion A blended learning approach was not superior to a QCs approach for improving knowledge about dementia management . However , a subgroup of GPs who were motivated to actually use the online modules had a gain in knowledge . Trial registration Current Controlled Trials IS RCT N36550981 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 Introduction Renal tract imaging after urinary tract infection ( UTI ) has been widely recommended but clinical practice varies substantially among paediatricians . Aim To describe changes in knowledge and reported ordering practice s of paediatricians in response to an evidence based summary about prevalence of abnormalities and test performance of renal tract imaging , in the setting of UTI in children . Methods 354 paediatricians were r and omly selected from a register of Australasian physicians and surveyed 14 months before , and concurrent with , a summary of a relevant systematic review . Respondents ' estimates were dichotomised and labelled as correct when within 5 % of the evidence -based value . Frequency of correct responses was compared using McNemar 's test for paired proportions . Results Response rate for the return of both surveys was 61 % ( 215/354 ) . Provision of the evidence summary significantly improved knowledge of the frequencies of associated renal tract abnormalities ( vesicoureteric reflux and kidney damage ) , with an increase in correct responses of about 30 % post summary ( p<0.001 for reflux and damage ) . Prior to the summary , clinicians underestimated the sensitivity of all imaging tests for the diagnosis of renal damage and reflux by about 30 % , with an increase in correct responses of 30–50 % for all tests after the summary ( p<0.001 for all ) . In contrast , reported imaging practice s for all tests showed no significant change in practice after receipt of the evidence summary . Conclusions Provision of evidence based information on rates of abnormality and test sensitivity improved knowledge but did not result in any significant change in reported practice . Properties of diagnostic tests conventionally thought to modify use , sensitivity and likelihood of detecting abnormalities , did not influence test ordering practice The purpose of this r and omized controlled community trial is to evaluate the effects of a community intervention utilizing opinion leaders and educational strategies on the cancer pain management knowledge , attitudes , and the practice s of physicians and nurses , and cancer pain reported by patients . Six Minnesota communities participated in the study . The three communities r and omized to the intervention received educational programs over 15 months . The clinical community opinion leaders participated in a minifellowship , developed community task forces , and interacted with their peers . This strategy was reinforced with community outreach programs , clinical practice guidelines , educational material s , and media events . The primary study end point was patients ' pain intensity score . Comparing intervention to control communities , pain prevalence declined slightly , pain management index improved slightly , pain intensity scores increased slightly , patient and family attitude scores did not change , and physicians ' and nurses ' knowledge and attitude scores improved slightly . None of these changes , however , reached statistical significance . Participation in at least one intervention program improved physicians ' and nurses ' knowledge and attitude scores that approached statistical significance . Our results suggest that community opinion leaders combined with other educational programs may improve cancer pain 
    Output:
    
Mass mailing a printed bulletin which summarises systematic review evidence may improve evidence -based practice when there is a single clear message , if the change is relatively simple to accomplish , and there is a growing awareness by users of the evidence that a change in practice is required .