***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 Colorectal cancer ( CRC ) screening is underutilized despite evidence that screening reduces mortality . OBJECTIVE To assess the effect of an intervention targeting physicians and their patients on rates of CRC screening . DESIGN A r and omized clinical trial of community physicians and their patients . PARTICIPANTS Ninety-four community primary care physicians r and omly assigned to an intervention consisting of academic detailing and direct mailings to patients or a control group .  Patients aged 50 to 79 years in the intervention group physicians received a letter from their physician , a brochure on CRC screening , and a packet of fecal occult blood test ( FOBT ) cards . MEASUREMENTS After 1 year we measured receipt of the following : ( 1 ) FOBT in the past 2 years , ( 2 ) flexible sigmoidoscopy ( SIG ) or colonoscopy ( COL ) in the previous 5 years , and ( 3 ) any CRC screening . We report the percent change from baseline in both groups . RESULTS 9,652 patients were enrolled for 2 years , and 3,732 patients were enrolled for 5 years . There was no increase in any CRC screening that occurred in the intervention group for patients enrolled for 2 years ( 12.7 increase vs 12.5 % , P=.51 ) . Similar results were seen for any CRC screening among patients enrolled for 5 years ( 9.7 % increase vs 8.6 % , P=.45 ) . The only outcome on which the intervention had an effect was on patient rates of screening SIG ( 7.4 % increase vs 4.4 % , P<.01 ) . CONCLUSION With the exception of an increase in rates of SIG in the intervention group , the intervention had no effect on rates of CRC screening . Future interventions should assess innovative approaches to increase rates of CRC screening BACKGROUND Complete diagnostic evaluation or CDE ( i.e. , colonoscopy or combined flexible sigmoidoscopy plus barium enema X-ray ) is often not performed for persons with an abnormal screening fecal occult blood test ( FOBT+ ) result . METHOD This study evaluated the impact of a reminder-feedback and educational outreach intervention on primary care practice CDE recommendation and performance rates . Four hundred seventy primary care physicians ( PCPs ) in 318 practice s participated in the study . Patients were mailed an FOBT kit annually as part of a screening program . Practice s were r and omly assigned to a Control Group ( N = 198 ) or an Intervention Group ( N = 120 ) . During an 18-month pre-r and omization period and a 9-month post-r and omization period , 2992 screening FOBT+ patients were identified . Intervention practice s received the screening program and the intervention . Control practice s received only the screening program . Study outcomes were baseline-adjusted CDE recommendation and performance rates . RESULTS At baseline , about two-thirds of FOBT+ patients received a CDE recommendation , and about half had a CDE performed . At endpoint , CDE recommendation and performance rates were both significantly higher for the Intervention as compared to the Control practice s ( OR = 2.28 ; 95 % CI : 1.37 , 3.78 , and OR = 1.63 ; 95 % CI : 1.06 , 2.50 , respectively ) . CONCLUSIONS The reminder-feedback plus educational outreach intervention significantly increased CDE recommendation and performance BACKGROUND To promote prevention and early detection of cancer , the authors conducted a three-year intervention targeting Vietnamese physicians in solo practice in California . METHODS Twenty subjects who had received their medical training in Vietnam were recruited into a r and omized controlled trial . The intervention included computerized or manual cancer screening reminders , continuing medical education seminars , Vietnamese- language health education material s , newsletters , and oncology data -query programs . Evaluation included chart audits for eight targeted activities pre- and post-intervention . RESULTS Before the intervention , annual physician performance rates were low for all eight activities : routine checkups ( 65.6 % ) , Pap testing ( 13.8 % ) , pelvic examinations ( 19.8 % ) , clinical breast examinations ( 13.3 % ) , mammography ( 6.4 % ) , hepatitis B serologies ( 21.9 % ) , hepatitis B immunizations ( 12.8 % ) , and smoking cessation counseling ( 1.6 % ) . After the intervention , performance rates increased significantly for smoking cessation counseling ( p = 0.02 ) , Pap testing ( p = 0.004 ) , and pelvic examinations ( p = 0.01 ) . CONCLUSIONS The results demonstrate the efficacy of an intervention targeting Vietnamese primary care physicians in promoting smoking cessation counseling , Pap testing , and pelvic examinations , but not other cancer prevention activities A multifaceted , individualized , physician education program design ed to increase the breast cancer screening practice s of community-based primary care physicians is described and the results are evaluated . Community-based surveys identified primary care providers with breast cancer screening educational needs who were assigned , using a factorial design , to an intervention or control condition . The sample included 154 control and 128 intervention physicians . The intervention consisted of a 1 - 2h in-office training program and /or self- study workbook .  Self-reported overall breast cancer screening need scores improved for a greater proportion of intervention than control physicians , particularly those receiving the in-office intervention ( P=0.03 ) . Clinical breast examination ( CBE ) need declined ( P=0.01 ) ; use of provider reminder systems increased ( P=0.02 ) ; preparedness to counsel about CBE ( P=0.04 ) and recognition that age is an important risk factor for breast cancer ( P=0.02 ) improved in more intervention compared to control physicians BACKGROUND Urban minority groups , such as those living in northern Manhattan and the South Bronx , are generally underserved with regard to breast cancer prevention and screening practice s. Primary care physicians are critical for the recommendation of mammography and clinical breast examinations to their patients . DESIGN Two medically underserved communities were matched and block r and omized . The aim of the study was to assess the efficacy of academic detailing in increasing recommendations for breast cancer screening in community-based primary care physicians . SETTING / PARTICIPANTS Ninety-four primary care community-based ( ie , not hospital-based ) physicians in northern Manhattan were compared with 74 physicians in the South Bronx who received no intervention .  INTERVENTION INTERVENTION participants received multicomponent physician-directed education , academic detailing , using the American Cancer Society guidelines for the early detection of breast cancer . MAIN OUTCOME MEASURES We administered interviews to ask about primary care physicians ' recommendation of mammography and clinical breast examination . They were also queried about their knowledge of major risk factors and perceived barriers to breast cancer screening . We conducted medical audits of 710 medical charts 2 years before and after the intervention . RESULTS Using a mixed models linear analysis , we found a statistically significant intervention effect on the recommendation of mammography and clinical breast examination  ( according to medical audit ) by female patients age 40 and over . INTERVENTION group physicians correctly identified significantly more risk factors for breast cancer , and significantly fewer barriers to practice , than did comparison physicians . CONCLUSIONS We found some evidence of improvement in breast cancer screening practice s due to academic detailing among primary care physicians practicing in urban underserved communities BACKGROUND Very little effort has been directed to enable GPs to better informed decisions about PSA screening among their male patients . OBJECTIVES To evaluate an innovative programme design ed to enhance GPs ' capacity to promote informed decision making by male patients about PSA screening . METHODS The study design was a cluster r and omised controlled trial set in New South Wales , Australia 's most populous state . 277 GPs were recruited through a major pathology laboratory . The interventions were three telephone-administered ' peer coaching ' sessions integrated with educational re sources for GPs and patients and the main outcome measures were : GP knowledge ; perceptions of patient involvement in informed decision making ; GPs ' own decisional conflict ; and perceptions of medicolegal risk . RESULTS Compared with GPs allocated to the control group , GPs allocated to our intervention gained significantly greater knowledge about PSA screening and related information [ Mean 6.1 out of 7 ; 95 % confidence interval ( CI ) = 5.9 - 6.3 versus 4.8 ; 95 % CI = 4.6 - 5.0 ; P < 0.001 ] . They were less likely to agree that patients should remain passive when making decisions about PSA screening [ Odds ratio ( OR ) = 0.11 ; 95 % CI = 0.04 - 0.31 ; P < 0.001 ] . They perceived less medicolegal risk when not acceding to an ' uninformed ' patient request for a PSA test ( OR = 0.31 ; 95 % CI 0.19 - 0.51 ) . They also demonstrated lower levels of personal decisional conflict about the PSA screening ( Mean 25.4 ; 95 % CI 24.5 - 26.3 versus 27.8 ; 95 % CI 26.6 - 29.0 ; P = 0.0002 ) . CONCLUSION A ' peer coaching ' programme , supplemented by education material s , holds promise as a strategy to equip GPs to facilitate informed decision making amongst their patients BACKGROUND Screening reduces colorectal cancer mortality , but effective screening tests remain underused . Systematic reminders to patients and physicians could increase screening rates METHODS We conducted a r and omized controlled trial of patient and physician reminders in 11 ambulatory health care centers . Participants included 21 860 patients aged 50 to 80 years who were overdue for colorectal cancer screening and 110 primary care physicians . Patients were r and omly assigned to receive mailings containing an educational pamphlet , fecal occult blood test kit , and instructions for direct scheduling of flexible sigmoidoscopy or colonoscopy . Physicians were r and omly assigned to receive electronic reminders during office visits with patients overdue for screening . The primary outcome was receipt of fecal occult blood testing , flexible sigmoidoscopy , or colonoscopy over 15 months , and the secondary outcome was detection of colorectal adenomas . RESULTS Screening rates were higher for patients who received mailings compared with those who did not ( 44.0 % vs 38.1 % ; P < .001 ) . The effect increased with age : + 3.7 % for ages 50 to 59 years ; + 7.3 % for ages 60 to 69 years ; and + 10.1 % for ages 70 to 80 years ( P = .01 for trend ) . Screening rates were similar among patients of physicians receiving electronic reminders and the control group ( 41.9 % vs 40.2 % ; P = .47 ) . However , electronic reminders tended to increase screening rates among patients with 3 or more primary care visits ( 59.5 % vs 52.7 % ; P = .07 ) . Detection of adenomas tended to increase with patient mailings ( 5.7 % vs 5.2 % ; P = .10 ) and physician reminders ( 6.0 % vs 4.9 % ; P = .09 ) . CONCLUSIONS Mailed reminders to patients are an effective tool to promote colorectal cancer screening , and electronic reminders to physicians may increase screening among adults who have more frequent primary care visits Background Few patients with lower bowel symptoms who consult their general practitioner need a specialist opinion . However data from referred patients suggest that those who are referred would benefit from detailed assessment before referral . Methods A cluster r and omised factorial trial . 44 general practice s in North Trent , UK . Practice s were offered either an electronic interactive referral pro forma , an educational outreach visit by a local colorectal surgeon , both or neither . The main outcome measure was the proportion of cases with severe diverticular disease , cancer or precancerous lesions and inflammatory bowel disease in those referred by each group . A secondary outcome was a referral letter quality score . Semi-structured interviews were conducted to identify key themes relating to the use of the software Results From 150 invitations , 44 practice s were recruited with a total list size of 265,707 . There were 716 consecutive referrals recorded over a six-month period , for which a diagnosis was available for 514 . In the combined software arms 14 % ( 37/261 ) had significant pathology , compared with 19 % ( 49/253 ) in the non-software arms , relative risk 0.73 ( 95 % CI : 0.46 to 1.15 ) . In the combined educational outreach arms 15 % ( 38/258 ) had significant pathology compared with 19 % ( 48/256 ) in the non-educational arms , relative risk 0.79 ( 95 % CI : 0.50 to 1.24 ) . Pro forma practice s documented better assessment of patients at referral . Conclusion There was a lack of evidence that either intervention increased the proportion of patients with organic pathology among those referred . The interactive software did improve the amount of information relayed in referral letters although we were unable to confirm if this made a significant difference to patients or their health care providers . The potential value of either intervention may have been diminished by their limited uptake within the context of a cluster r and omised clinical trial . A number of lessons were learned in this trial of novel innovations BACKGROUND Colorectal cancer is the second leading cause of cancer mortality in israel . Unfortunately , compliance with annual fecal occult blood testing is very low . OBJECTIVE To assess the effectiveness 
    Output:
    
RESULTS We found sufficient evidence that interactive education , computerised reminder systems and audit and feedback delivered to clinicians may significantly increase several cancer detection measures in the short term and some evidence that they promote early diagnosis .
Whilst educational outreach and local opinion leaders had some effect , formal education alone seemed ineffectual .
Certain educational interventions delivered at a clinician as well as at a practice level may promote the early diagnosis of cancer in primary care .
There is currently limited evidence for their long-term sustainability and effectiveness