***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 
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    Input: PURPOSE Individuals experiencing myocardial infa rct ion ( MI ) report anxiety , depression , diminished quality of life ( QOL ) , and reduced sexual activity . DESIGN AND METHODS We examined return to sexual activity post-MI , and pilot tested a comprehensive sexual counseling intervention based on social-cognitive theory . The intervention in this pretest/posttest preexperimental study used an informational video , newsletters , and telephone counseling , with cardiac patients ( N = 10 ) and partners ( N = 3 ) . Measures included QOL ; knowledge ; sexual anxiety , depression , self-efficacy , and satisfaction . FINDINGS At 8 weeks , only 60 % had returned to sexual activity , with low QOL and sexual satisfaction for patients and partners . PRACTICE IMPLICATION S Supportive interventions by nurses are needed to assist MI patients and partners return to sexual activity Twenty-eight male cardiac patients who had either experienced myocardial infa rct ion or undergone coronary bypass surgery were assigned to a treatment condition and participated in a 3-month , exercise-based Cardiac Rehabilitation Program , whereas 20 other cardiac patients were assigned to a routine-care condition and did not participate in the rehabilitation program .  Cardiovascular , psychological , and psychosocial functioning were assessed before treatment or routine care was begun , after 3 months of treatment or routine care , and 4 months later . Results indicated that patients in the treatment condition evidence d reliably more efficient cardiovascular functioning ( resting heart rate , resting diastolic blood pressure , treadmill exercise performance , exercise heart rate , exercise systolic blood pressure ) , better underst and ing of heart disease , better underst and ing of and reported compliance with treatment recommendations , more positive self-perceptions ( health , body concept , self-concept , progress toward goals ) , and better psychosocial functioning ( e.g. , decreased employmentrelated stress , more active use and enjoyment of leisure time , more physical and sexual activity ) .  Chronic patients benefited as much from the treatment as did acute patients , and the beneficial effects for all treated patients were evident not only just after rehabilitation , but also 4 months later . This investigation appears to be the first such test of effects of this type of treatment , and the results have wide generalizability and applicability Background Sexual problems are common among people with coronary heart disease and can adversely affect patients ' quality of life . GPs are ideally placed to deal with these problems . Research suggests that GPs are reluctant to address sexual problems but little is known about what currently takes place in practice . The aim of this study was to examine GPs ' self-reported behaviour and attitudes to discussing sexual problems with people with coronary heart disease . Method Design : A cross-sectional survey which administered 230 postal question naires to a nationally representative , stratified r and om sample of GPs in the Republic of Irel and . GPs were asked about current practice , knowledge , awareness and confidence in dealing with sexual problems , barriers to addressing sexual problems , and about improving services in this area . Results Responses were available for 61 GPs ( 27 % response rate ) . Seventy percent of GPs reported that they rarely or never discussed sexual problems with coronary patients . While all GPs believed addressing sexual problems was important , many GPs reported lacking awareness , knowledge and confidence in addressing sexual problems . The main barriers were lack of time , feeling the patient was n't ready and lack of training in the area . GPs wanted more training and guidelines for practice . Conclusions There is currently no st and ardised protocol for GPs for dealing with sexual problems among coronary patients . Awareness of these issues appears to be low among GPs . Services could be improved by developing practice guidelines for brief , effective actions or assessment s , providing training in the area and improving information re sources and support services for referral This study prospect ively examined the role of cognitive behavioral therapy ( CBT ) in ( 1 ) alleviating psychological and somatic distress , and ( 2 ) lowering arrhythmic events requiring shocks . Forty-nine of 61 consecutive patients were r and omized into therapy ( CBT , n = 25 ) or no therapy ( NT , n = 24 ) and completed a battery of self-report question naires at baseline and at 9-month follow-up . CBT was administered at preimplant , predischarge , and at seven routine follow-up visits . Patients were 65 + /- 10 years old , 65 % were men , and 92 % Caucasian . Eighteen ( 72 % ) CBT patients and 18 ( 75 % ) NT patients were retained at follow-up . Compared to CBT patients , NT patients reported higher levels of depression ( P = 0.046 ) , more anxiety ( P = 0.013 ) , more psychological distress ( P = 0.015 ) , poorer overall adjustment ( P = 0.009 ) , and poorer sexual functioning ( P = 0.003 ) . Mean number of shocks did not differ between the CBT and NT groups ( 2.85 vs 2.30 , respectively ) ; however , more patients in the CBT group ( 61 % ) than the NT group ( 33 % ) received shocks ( P = 0.070 ) . At follow-up , a subgroup analysis revealed that the significant differences observed between the CBT and NT groups were attributable to the patients who received shocks in both groups . In conclusion , CBT was associated with decreased depression , decreased anxiety , and increased adjustment for ICD recipients , particularly among those patients receiving shocks . CBT can be administered effectively at routine follow-up visits or transtelephonically with little added inconvenience to the ICD recipient Background Growing evidence exists that living with an ICD can lead to fear and avoidance behaviour including the avoidance of physical activity . It has been suggested that psychological stress can increase the risk of shock and predict death . Small studies have indicated a beneficial effect arising from exercise training and psychological intervention , therefore a large-scale rehabilitation programme was set up . Methods / Design A mixed methods embedded experimental design was chosen to include both quantitative and qualitative measures . A r and omised clinical trial is its primary component . 196 patients ( power-calculated ) were block r and omised to either a control group or intervention group at a single centre . The intervention consists of a 1-year psycho-educational component provided by two nurses and a 12-week exercise training component provided by two physiotherapists . Our hypothesis is that the COPE-ICD programme will reduce avoidance behaviour , sexual dysfunction and increase quality of life , increase physical capability , reduce the number of treatment-dem and ing arrhythmias , reduce mortality and acute re-hospitalisation , reduce sickness leading to absence from work and be cost-effective . A blinded investigator will perform all physical tests and data collection . Discussion Most participants are men ( 79 % ) with a mean age of 58 ( range 20 - 85 ) . Most ICD implantations are on primary prophylactic indication ( 66 % ) . 44 % is NYHA II . Mean walk capacity ( 6MWT ) is 417 m. Mean perception of General Health ( SF-36 ) is PCS 42.6 and MCS 47.1.A large-scale ICD rehabilitation trial including psycho-educational intervention and exercise training has been initiated and will report findings starting in 2011.Trial Registration Clinical Trials.gov : A two-group r and omized clinical trial was used to test the hypothesis that patients with myocardial infa rct ion ( MI ) who receive both written instructions and a videotape to view at home will have greater knowledge , better quality of life , less anxiety , greater sexual satisfaction , and will resume sexual activity more quickly than will those who receive written instructions alone . The participants , 115 patients diagnosed with an MI , were pretested in the hospital and followed at home at 1 , 3 , and 5 months . The intervention was an educational videotape on return to  sexual activity .  Significant improvements in knowledge were found for the experimental group at 1 month . The videotape intervention provides an alternative method for education to facilitate recovery post-MI For this study a r and omized clinical trial was design ed to test the effects of an early home recovery information intervention on physical functioning , psychological distress , and symptom frequency 1 month following coronary artery bypass graft surgery ( CABG ) . Recovery outcomes were compared between two groups : those receiving an audiotape of information on expected physical sensations and their management ( Cardiac Home Information Program [ CHIP ] ) in addition to the usual care , and those receiving the usual cardiac discharge information protocol .  A nonprobability sample of 180 patients ( 84 women and 96 men ; mean age = 62 years ) was equally distributed between the two study groups . When controlling for age , comorbidity , and cardiac functional status , the results showed positive effects on physical functioning in women and psychological distress , vigor and fatigue in men . Consistent with other studies , women had worse physical functioning and more symptom frequency than men . These findings indicate that the CHIP intervention is an effective method to prepare CABG patients for home recovery Introduction Sexuality is an important part of people ’s physical and mental health . Patients with heart disease often suffer from sexual dysfunction . Sexual dysfunction has a negative impact on quality of life and well-being in persons with heart disease , and sexual dysfunction is associated with anxiety and depression . Treatment and care possibilities seem to be lacking . Studies indicate that non-pharmacological interventions such as exercise training and psychoeducation possess the potential of reducing sexual dysfunction in patients with heart disease . The CopenHeartSF trial will investigate the effect of a comprehensive sexual rehabilitation programme versus usual care . Methods and analysis CopenHeartSF is an investigator-initiated r and omised clinical superiority trial with blinded outcome assessment , with 1:1 central r and omisation to sexual rehabilitation plus usual care versus usual care alone . Based on sample size calculations , 154 male patients with impaired sexual function due to implantable cardioverter defibrillator or ischaemic heart disease will be included from two university hospitals in Denmark . All patients receive usual care and patients allocated to the experimental intervention group follow a 12-week sexual rehabilitation programme consisting of an individualised exercise programme and psychoeducative consultation with a specially trained nurse . The primary outcome is sexual function measured by the International Index of Erectile Function . The secondary outcome measure is psychosocial adjustment to illness by the Psychosocial Adjustment to Illness Scale , sexual domain . A number of explorative analyses will also be conducted . Ethics and dissemination CopenHeartSF is approved by the regional ethics committee ( no H-4 - 2012 - 168 ) and the Danish Data Protection Agency ( no 2007 - 58 - 0015 ) and is performed in accordance with good clinical practice and the Declaration of Helsinki in its latest form . Registration Clinical trials.gov identifier : NCT01796353 The present study was conducted to examine whether a sexual rehabilitation intervention program , which was developed during the present study and design ed for stroke patients and their spouses , was effective in terms of sexual knowledge and satisfaction and frequency of sexual activity at 1 month after intervention . The study subjects were conveniently selected from stroke patients admitted to the neurology department at a university hospital located in Incheon , South Korea . A total of 46 subjects ( 12 couples for the experimental group and 11 couples for the control group ) were included .  Sexual knowledge , sexual satisfaction , frequency of sexual activity , level of cognitive function , and performance with respect to daily living activities were measured . The results obtained demonstrated that the devised sexual rehabilitation intervention program significantly increased sexual satisfaction and frequency of sexual activity , but that it did not promote sexual knowledge . The present study has meaning because the intervention program could be used as a practical guideline for post-stroke sexual rehabilitation . In addition , the findings of this study provide evidence regarding the usefulness of sexual education and counseling on the sexual health of post-stroke patients and their spouses The British Heart Foundation and the Chest , Heart and Stroke Association have allocated funds to develop cardiac rehabilitation programmes . We have recently completed and now evaluate an exercise-based rehabilitation course reinforced with advice about return to normal activity for 110 patients who had suffered acute myocardial infa rct ion . Patients admitted to the Plymouth cardiac care unit were r and omised into groups : a control group to receive st and ard hospital care , and a rehabilitation group who , in addition , received an exercise programme reinforced with advice . Patients were assessed at entry to the study and at intervals thereafter . Assessment was by question naire and objective tests consisting of a 12-minute walking test and weekly outpatient pedometry . In the rehabilitation group patients were able to walk further and faster , return to work earlier , undertake more housework , and resume normal sexual activity ; they were less short of breath and did not experience more angina . However , the rehabilitation course brought little benefit to the patients ' perception of well-being and their anxiety about health or their outlook on life .  Exercise and advice are important components of a rehabilitation programme , but more attention needs to be given to the psychological aspects of recovery from a heart attack Sexual dysfunction is a common problem of increasing incidence that is associated with multiple co-morbid conditions and chronic diseases . In heart failure , however , exact numbers are unknown , in part secondary to under-reporting and under-interrogating by health care providers . A gender-specific question naire was modified from established sexual dysfunction question naires to correspond to a non-r and omized outpatient heart failure population , to assess the prevalence and demographic distribution of sexual dysfunction and potential treatments expectations . One-hundred patients in a stable hemodynamic condition in New York Heart Association classes I – III participated . Eighty-seven percent of women were diagnosed with female  sexual dysfunction  compared to 84 % of men with erectile dysfunction . Eighty percent of women reported reduced lubrication , which result ed in frequent unsuccessful intercourse in 76 % . Thirty-six percent of patients thought that sexual activity could harm their current cardiac condition ; 
    Output:
    
We found no high quality evidence to support the effectiveness of sexual counselling for sexual problems in patients with cardiovascular disease .