***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 Although cognitive-behavioral therapy for Unexplained Physical Symptoms ( UPS ) is effective in secondary care , studies done in primary care produced implementation problems and conflicting results . We evaluated the effectiveness of a cognitive-behavioral group training tailored to primary care patients and provided by a secondary community mental-health service reaching out into primary care . Methodology /Principal Findings The effectiveness of this training was explored in a r and omized controlled trial . In this trial , 162 patients with UPS classified as undifferentiated somatoform disorder or as chronic pain disorder were r and omized either to the training or a waiting list .  Both lasted 13 weeks . The preservation of the training 's effect was analyzed in non-r and omized follow-ups , for which the waiting group started the training after the waiting period . All patients attended the training were followed-up after three months and again after one year . The primary outcomes were the physical and the mental summary scales of the SF-36 . Secondary outcomes were the other SF-36-scales and the SCL-90-R. The courses of the training 's effects in the r and omized controlled trial and the follow-ups were analyzed with linear mixed modeling . In the r and omized controlled trial , the training had a significantly positive effect on the quality of life in the physical domain ( Cohen 's d = 0.38;p = .002 ) , but this overall effect was not found in the mental domain . Regarding the secondary outcomes , the training result ed in reporting an improved physical ( Cohen 's d = 0.43;p = 0.01 ) , emotional ( Cohen 's d = 0.44;p = .0.01 ) , and social ( Cohen 's d = 0.36;p = 0.01 ) functioning , less pain and better functioning despite pain ( Cohen 's d = 0.51;p = < 0.001 ) , less physical symptoms ( Cohen 's d = −.23;p = 0.05 ) and less sleep difficulties ( Cohen 's d = −0.25;p = 0.04 ) than time in the waiting group . During the non-r and omized follow-ups , there were no relapses . Conclusions / Significance The cognitive-behavioral group training tailored for UPS in primary care and provided by an outreaching secondary mental-health service appears to be effective and to broaden the accessibility of treatment for UPS . Trial Registration TrialRegister.nl Abstract Objective : To examine the additional effect of cognitive behavioural therapy for patients with medically unexplained physical symptoms in comparison with optimised medical care . Design : R and omised controlled trial with follow up assessment s six and 12 months after the baseline evaluation . Setting : General medical outpatient clinic in a university hospital . Subjects : An intervention group of 39 patients and a control group of 40 patients . Interventions : The intervention group received between six and 16 sessions of cognitive behavioural therapy . Therapeutic techniques used included identification and modification of dysfunctional automatic thoughts and behavioural experiments aim ed at breaking the vicious cycles of the symptoms and their consequences . The control group received optimised medical care . Main outcome measures : The degree of change , frequency and intensity of the presenting symptoms , psychological distress , functional impairment , hypochondriacal beliefs and attitudes , and ( at 12 months of follow up ) number of visits to the general practitioner . Results : At six months of follow up the intervention group reported a higher recovery rate ( odds ratio 0.40 ; 95 % confidence interval 0.16 to 1.00 ) , a lower mean intensity of the physical symptoms ( difference −1.2 ; −2.0 to −0.3 ) , and less impairment of sleep ( odds ratio 0.38 ; 0.15 to 0.94 ) than the controls . After adjustment for coincidental baseline differences the intervention and control groups also differed with regard to frequency of the symptoms ( 0.32 ; 0.13 to 0.77 ) , limitations in social ( 0.35 ; 0.14 to 0.85 ) and leisure ( 0.36 ; 0.14 to 0.93 ) activities , and illness behaviour ( difference −2.5 ; −4.6 to −0.5 ) . At 12 months of follow up the differences between the groups were largely maintained . Conclusion : Cognitive behavioural therapy seems to be a feasible and effective treatment in general medical patients with unexplained physical symptoms Background Although Cognitive-Behavioral Therapy ( CBT ) is effective for Unexplained Physical Symptoms ( UPS ) , some therapists in clinical practice seem to believe that CBT outcome will diminish if psychiatric comorbidity is present . The result is that patients with a psychiatric comorbidity are redirected from treatment for UPS into treatment for mental health problems . To explore whether this selection and allocation are appropriate , we explored whether CBT outcomes in UPS could be predicted by variables assessed at baseline and used in routine- practice assessment s. Methods Patients ( n=162 ) with UPS classified as undifferentiated somatoform disorder or chronic pain disorder were followed up until one year after they had attended a CBT group training .  The time-points of the follow-up were at the end of CBT ( immediate outcome ) , three months after CBT ( short-term outcome ) , and one year after CBT ( long-term outcome ) .CBT outcome was measured using the Physical Component Summary of the SF-36 , which was the primary outcome measure in the r and omized controlled trial that studied effectiveness of the CBT group training . Predictors were : 1 . ) psychological symptoms ( global severity score of SCL-90 ) , 2 . ) personality-disorder characteristics ( sum of DSM-IV axis II criteria confirmed ) , 3 . ) psychiatric history ( past presence of DSM-IV axis I disorders ) , and 4 . ) health-related quality of life in the mental domain ( mental component summary of SF-36 ) . The effect of this predictor set was explored using hierarchical multiple regression analyses into which these predictors had been entered simultaneously , after control for : a. ) pretreatment primary outcome scores , b. ) age , c. ) gender , d. ) marital status , and e. ) employment . Results The predictor set was significant only for short-term  CBT outcome , where it explained 15 % of the variance . A better outcome was predicted by more psychological symptoms , fewer personality-disorder characteristics , the presence of a psychiatric history , and a better quality of life in the mental domain . Conclusions As the predictors do not seem to predict CBT outcome consistently over time , the need for selection and allocation of patients for CBT is doubtful . It seems that this would unnecessarily deprive patients of effective treatment . Trial registration Nederl and s Trial Register , Abstract Background Somatoform disorders are characterized by the presence of multiple somatic symptoms without an organic cause that completely explains their symptoms . These patients generate a high cost in health services . We aim to evaluate the effectiveness and feasibility of a cognitive-behaviour therapy ( CBT ) programme , administered in group and individual formats in primary care for patients who are diagnosed with abridged somatization disorder . Method / design Design : Multicentre , r and omized , controlled trial involving 3 groups , one of which is the control group consisting of st and ardized recommended treatment for somatization disorder in primary care ( Smith 's norms ) and the 2 others , the intervention groups , consisting of cognitive-behavioural therapy ( 10 sessions ) administered in individual format ( intervention group 1 ) or in group format ( intervention group 2 ) . Setting : 29 primary care health centres in the province of Zaragoza and 3 primary care health centres in the province of Mallorca , Spain . Sample : N = 204 patients , ( 68 in each of the three groups ) , aged 18–65 years , able to underst and and read Spanish , who fulfil Escobar 's criteria of Abridgged Somatization Disorder ( SSI 4,6 ) , stable with pharmacotherapy over the previous month , and who will remain stable for the next 3 months in the doctor 's opinion , having signed informed consent . Intervention : Control group : St and ardized recommended treatment for somatization disorder in primary care ( Smith 's norms ) . Intervention group : 10 weekly sessions of CBT , following a protocol design ed by Prof. Escobar 's group at UMDNJ , USA . There are 2 different treatment conditions : individual and group format . Measurements : Survey on the use of health services , number and severity of somatic symptoms , anxiety , depression , quality of life and clinical global impression . The interviewers will not know which group the patient belongs to ( blind ) . The assessment s will be carried out at baseline , post-treatment , 6 months and 12 post-treatment . Main variables : Utilization of health services , number and severity of somatic symptoms . Analysis : The analysis will be per intent to treat . We will use the general linear models of the SPSS v.15 statistical package , to analyse the effect of treatment on the result variable ( utilization of health services , number and severity of somatic symptoms ) . Discussion It is necessary to develop more effective psychological treatments for somatoform disorders . This r and omised clinical trial will determine whether cognitive behaviour therapy , both in group or in individual format , is effective for the treatment of these patients .Trial registration Current controlled trials IS RCT OBJECTIVE Our aim was to assess cost-effectiveness of mindfulness-based cognitive therapy ( MBCT ) compared with enhanced usual care ( EUC ) in treating patients with persistent medically unexplained symptoms(MUS ) . METHODS A full economic evaluation with a one year time horizon was performed from a societal perspective . Costs were assessed by prospect i ve cost diaries . Health-related Quality of Life was measured using SF-6D . Outcomes were costs per Quality -Adjusted Life Year ( QALY ) . Bootstrap simulations were performed to obtain mean costs , QALY scores and incremental cost-effectiveness ratios ( ICERs ) . RESULTS  MBCT participants ( n=55 ) had lower hospital costs and higher mental health care costs than patients who received EUC ( n=41 ) . Mean bootstrapped costs  for MBCT were € 6269 , and € 5617 for EUC ( 95 % uncertainty interval for difference : -€1576 ; € 2955 ) . QALYs were 0.674 for MBCT and 0.663 for EUC . MBCT was on average more effective and more costly than EUC , result ing in an ICER of € 56,637 per QALY gained . At a willingness to pay of € 80,000 per QALY , the probability that MBCT is cost-effective is 57 % . CONCLUSION Total costs were not statistically significantly different between MBCT and EUC . However , MBCT seemed to cause a shift in the use of health care re sources as mental health care costs were higher and hospital care costs lower in the MBCT condition . Due to the higher drop-out in the EUC condition the cost-effectiveness of MBCT might have been underestimated . The shift in health care use might lead to more effective care for patients with persistent MUS . The longer-term impact of MBCT for patients with persistent MUS needs to be further studied In order to determine the health effects of an intervention that reduces the cost of care for somatization disorder ( SD ) patients , 59 primary care physicians were r and omized to receive a psychiatric consultation letter providing treatment recommendations for 73 patients either at baseline or the end of the year-long study . Seventy of these patients ( 96 % ) were followed every 4 months for 1 year by a research assistant blind to r and omization . A year following the intervention , patients of experimental physicians reported greater physical capacity than patients of control physicians ( mean difference = 17.9 , 95 % CI 1.0 - 34.9 ) with a $ 466 reduction ( 95 % CI $ 132-$699 ) in health care charges . In addition to a net 21 % reduction in health care charges for the typical SD patient , the consultation letter improved physical functioning in a group of highly impaired subjects BACKGROUND Reattribution is frequently taught to general practitioners ( GPs ) as a structured consultation that provides a psychological explanation for medically unexplained symptoms . AIMS To determine if practice -based training of GPs in reattribution changes doctor-patient communication , thereby improving outcomes in patients with medically unexplained symptoms of 3 months ' duration . METHOD Cluster r and omised controlled trial in 16 practice s , 74 GPs and 141 patients with medically unexplained symptoms of 6 hours of reattribution training v. treatment as usual .  RESULTS With training , the proportion of consultations mostly consistent with reattribution increased ( 31 v. 2 % , P=0.002 ) . Training was associated with decreased quality of life ( health thermometer difference -0.9 , 95 % CI -1.6 to -0.1 ; P=0.027 ) with no other effects on patient outcome or health contacts . CONCLUSIONS Practice -based training in reattribution changed doctor-patient communication without improving outcome of patients with medically unexplained symptoms The objective of this research was to identify determinants of the magnitude of intracluster correlation coefficients ( ICCs ) in cluster r and omized trials from the field of implementation research . A survey of experts was conducted to generate a priori hypotheses of factors that might affect ICC size . Hypotheses were tested on empirical estimates of ICCs calculated from 21 implementation research data sets , mainly from the UK . Effects of setting ( primary or secondary care ) , type of variable ( process or outcome ) , type of measurement ( objective or subjective ) , prevalence of outcome and size of cluster were tested . In total , 220 ICCs were available ( range 0 to 0.415 ) . Significant differences in ICC magnitude were found . The ICCs were significantly higher for process than for outcome variables , and for secondary care outcomes compared with primary care outcomes . The effects of prevalence and size were less clear cut . There was no evidence to suggest that type of measurement affected ICC size . In conclusion , accurate estimates of 
    Output:
    
When all psychological therapies included this review were combined they were superior to usual care or waiting list in terms of reduction of symptom severity , but effect sizes were small .
Compared with usual care or waiting list conditions , CBT reduced somatic symptoms , with a small effect and substantial differences in effects between CBT studies .
The effects were durable within and after one year of follow-up .
Compared with enhanced or structured care , psychological therapies generally were not more effective for most of the outcomes .
Compared with enhanced care , CBT was not more effective .
The intervention groups reported no major harms .
In daily practice , there is also a substantial proportion of participants not willing to accept psychological treatments for somatoform disorders or MUPS .