You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
The development of effective behaviour change interventions to support the use of malaria rapid diagnostic tests by Tanzanian clinicians
Abstract 1:
Background Parasitological confirmation is now recommended for all cases of suspected malaria . The roll-out of rapid diagnostic tests ( RDTs ) is hoped to enable this goal in low re source setting s through point of care testing . However , simply making RDTs available has not led to high uptake of the tests or adherence to results by clinicians , with malaria continuing to be overdiagnosed in many setting s. We undertook to design an evidence -based intervention package that would be sufficient to support the introduction of RDTs at dispensaries in Tanzania , to be evaluated through the Targeting Artemisinin Combination Therapy ( TACT ) cluster r and omised controlled trial . Methods We describe five steps in our intervention design : formative research , review of existing evidence and theory , a workshop to define the intervention approach and content and results of formative research , engagement with behaviour change theory and literature , detailed design of intervention material s and piloting and pretesting of intervention material s. This involved fieldwork with a total of 19 health workers and 212 community members in northeast Tanzania . Results The formative research suggested that RDTs were a potential source of conflict in the health worker-patient interaction , but that health workers used various techniques to resolve this , including provision of antimalarial drugs for RDT-negative patients . Our review s showed that evidence was mixed regarding the effectiveness of different methods and theories to support change in prescribing practice . Our design process is presented , drawing from this collective evidence . We describe the final TACT intervention package ( including interactive small group workshops , feedback text messages , motivational text messages and patient information leaflets and posters ) in terms of its programme theory and implementation theory . Conclusions Our study suggests that evidence -based design of complex interventions is possible . The use of formative research to underst and malaria overdiagnosis in context was central to the design of the intervention as well as empirical research to test material s and methods prior to implementation . The TACT interventions may be appropriate for other setting s where clinicians face similar challenges with malaria diagnostics . Trial registration NCT01292707


Title 2:
Improving prescribing of antihypertensive and cholesterol-lowering drugs: a method for identifying and addressing barriers to change
Abstract 2:
Background We describe a simple approach we used to identify barriers and tailor an intervention to improve pharmacological management of  hypertension and hypercholesterolaemia .  We also report the results of a post hoc exercise and survey we carried out to evaluate our approach for identifying barriers and tailoring interventions . Methods We used structured reflection , search ed for other relevant trials , surveyed general practitioners and talked with physicians during pilot testing of the intervention . The post hoc exercise was carried out as focus groups of international research ers in the field of quality improvement in health care . The post hoc survey was done by telephone interviews with physicians allocated to the experimental group of a r and omised trial of our multifaceted intervention .  Results A wide range of barriers was identified and several interventions were suggested through structured reflection . The survey led to some adjustments . Study ing other trials and pilot testing did not lead to changes in the design of the intervention . Neither the post hoc focus groups nor the post hoc survey revealed important barriers or interventions that we had not considered or included in our tailored intervention . Conclusions A simple approach to identifying barriers to change appears to have been adequate and efficient . However , we do not know for certain what we would have gained by using more comprehensive methods and we do not know whether the result ing intervention would have been more effective if we had used other methods . The effectiveness of our multifaceted intervention is under evaluation in a r and omised controlled trial


Title 3:
Identification of randomized controlled trials in systematic reviews: accuracy and reliability of screening records.
Abstract 3:
A study was conducted to estimate the accuracy and reliability of  review ers when screening records for relevant trials for a systematic review . A sensitive search of ten electronic bibliographic data bases yielded 22 571 records of potentially relevant trials . Records were allocated to four review ers such that two review ers examined each record and so that identification of trials by each review er could be compared with those identified by each of the other review ers . Agreement between review ers was assessed using Cohen 's kappa statistic . Ascertainment intersection methods were used to estimate the likely number of trials missed by review ers . Full copies of reports were obtained and assessed independently by two research ers for eligibility for the review . Eligible reports formed the ' gold st and ard ' against which an assessment was made about the accuracy of screening by review ers . After screening , 301 of 22 571 records were identified by at least one review er as potentially relevant . Agreement was ' almost perfect ' ( kappa>0.8 ) within two pairs , ' substantial ' ( kappa>0.6 ) within three pairs and ' moderate ' ( kappa>0.4 ) within one pair . Of the 301 records selected , 273 complete reports were available . When pairs of review ers agreed on the potential relevance of records , 81 per cent were eligible ( range 69 to 91 per cent ) . If review ers disagreed , 22 per cent were eligible ( range 12 to 45 per cent ) . Single review ers missed on average 8 per cent of eligible reports ( range 0 to 24 per cent ) , whereas pairs of review ers did not miss any ( range 0 to 1 per cent ) . The use of two review ers to screen records increased the number of r and omized trials identified by an average of 9 per cent ( range 0 to 32 per cent ) . Review ers can reliably identify potentially relevant records when screening thous and s of records for eligibility . Two review ers should screen records for eligibility , whenever possible , in order to maximize ascertainment of relevant trials
Conclusions There is an agreement across methods of four tasks that need to be completed when design ing individual-level interventions : identifying barriers , selecting intervention components , using theory , and engaging end-users .