***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: OBJECTIVE To compare three simple methods of presenting information to patients about the risk of Down 's syndrome . STUDY DESIGN R and omised controlled trial of 150 " low risk " women booking for antenatal care before 19 weeks gestation at Sunderl and Royal Hospital . After informing the women about the purpose of the study and reassuring them that they were " low risk " , each patient was given a question naire , which used one of three different methods ( graphic , written and interactive ) to present information about the risk of Down 's syndrome . A visual analogue scale allowed us to assess their level of underst and ing and anxiety before and after the information about risk was given to them . RESULTS All three methods significantly altered patients ' perception and anxiety about the risk of Down 's syndrome . The interactive method was found to be the most effective of the three . CONCLUSION This pilot study suggests that discussing the patients ' worries about fetal anomalies with medical staff can markedly reduce their degree of anxiety . The interactive method was most effective at putting information across to the patient . It significantly reduced their level of anxiety as well as their overall worry about pregnancy Background Despite increasing recognition of the importance of involving patients in decisions on preventive healthcare interventions , little is known about how well patients underst and and utilise information provided on the relative benefits from these interventions . The aim of this study was to explore whether lay people can discriminate between preventive interventions when effectiveness is presented in terms of relative risk reduction ( RRR ) , and whether such discrimination is influenced by presentation of baseline risk . Methods The study was a r and omised cross-sectional interview survey of a representative sample ( n = 1,519 ) of lay people with mean age 59 ( range 40–98 ) years in Denmark . In addition to demographic information , respondents were asked to consider a hypothetical drug treatment to prevent heart attack . Its effectiveness was r and omly presented as RRR of 10 , 20 , 30 , 40 , 50 or 60 percent , and half of the respondents were presented with quantitative information on the baseline risk of heart attack . The respondents had also been asked whether they were diagnosed with hypercholesterolemia or had experienced a heart attack . Results In total , 873 ( 58 % ) of the respondents consented to the hypothetical treatment . While 49 % accepted the treatment when RRR = 10 % , the acceptance rate was 58–60 % for RRR>10 . There was no significant difference in acceptance rates across respondents irrespective of whether they had been presented with quantitative information on baseline risk or not . Conclusion In this study , lay people 's decisions about therapy were only slightly influenced by the magnitude of the effect when it was presented in terms of RRR . The results may indicate that lay people have difficulties in discriminating between levels of effectiveness when they are presented in terms of RRR OBJECTIVE Informed medical decision making requires comprehending statistical information . We aim ed to improve the underst and ing of conveying health-related statistical information with graphical representations compared with numerical representations . First , we investigated whether the iconicity of representations ( i.e. , their abstract ness vs. concreteness ) affected comprehension and recall of statistical information . Second , we investigated whether graph literacy helps to identify individuals who comprehend graphical representations better than numerical representations . METHOD Participants ( N = 275 ) were r and omly assigned to  receive different representations of health-related statistical information , ranging from very low iconicity ( numbers ) to very high iconicity ( icon arrays including photographs ) . Comprehension and recall of the information were assessed . Additionally , participants rated the accessibility of the information and the attractiveness of the representation . Graph literacy was assessed by means of a recently developed scale . RESULTS The only difference between representations that affected comprehension and recall was the difference between graphics and numbers ; the actual level of iconicity of graphics did not matter . Individuals with high graph literacy had better comprehension and recall when presented with graphics instead of numbers , and they rated graphical information as more accessible than numerical information , whereas the reverse was true for individuals with low graph literacy , F(4 , 185 ) = 2.60 , p = .04 , η(p)(² ) = .05 , and F(4 , 245 ) = 2.71 , p = .03 , η(p)(2 ) = .04 , respectively . Both groups judged graphical representations  as more attractive than numerical representations . CONCLUSION An assessment of graph literacy distinguished individuals who are best informed with graphical representations of statistical information from those who are better informed with numerical representations Abstract Decisions about lifestyle play a key role in influencing health . Illnesses such as heart disease result from combinations of factors , making it hard for people to evaluate alternatives ( e.g. , knowing how much exercise might give similar benefit to eating more fruit and vegetables ) . Computers can provide customized risk leaflets and interactive displays , which may encourage people to explore potential lifestyle changes by showing the consequences for future health of specific combinations of lifestyle changes . This empirical study invited 24 adult volunteers to use the information from a customized leaflet or interactive display to advise hypothetical patients about lifestyle changes . Advisers used both leaflet and computer for different patients , with order counterbalanced across volunteers . It was found that more combinations of lifestyle factors were explored with the interactive display , especially by the younger volunteers , without this taking more time . Most of the older volunteers preferred interacting with the computer , and rated it as easier to use than the leaflet . It is concluded that easy to use computer interfaces can be devised that help people explore the health consequences of personal decisions about lifestyle , and that people prefer interactive assistance rather than using printed alternatives Background Different presentations of treatment effects can affect decisions . However , previous studies have not evaluated which presentations best help people make decisions that are consistent with their own values . We undertook a pilot study to compare different methods for doing this . Methods and Findings We conducted an Internet-based r and omized trial comparing summary statistics for communicating the effects of statins on the risk of coronary heart disease ( CHD ) . Participants rated the relative importance of treatment consequences using  visual analogue scales ( VAS ) and category rating scales ( CRS ) with five response options . We r and omized participants to either VAS or CRS first and to one of six summary statistics : relative risk reduction ( RRR ) and five absolute measures of effect : absolute risk reduction , number needed to treat , event rates , tablets needed to take , and natural frequencies ( whole numbers ) . We used logistic regression to determine the association between participants ' elicited values and treatment choices . 770 participants age 18 or over and literate in English completed the study . In all , 13 % in the VAS-first group failed to complete their VAS rating , while 9 % of the CRS-first group failed to complete their scoring ( p = 0.03 ) . Different ways of weighting the elicited values had little impact on the analyses comparing the different presentations . Most ( 51 % ) preferred the RRR compared to the other five summary statistics ( 1 % to 25 % , p = 0.074 ) . However , decisions in the group presented the RRR deviated substantially from those made in the other five groups . The odds of participants in the RRR group deciding to take statins were 3.1 to 5.8 times that of those in the other groups across a wide range of values ( p = 0.0007 ) . Participants with a scientific background , who were more numerate or had more years of education were more likely to decide not to take statins . Conclusions Internet-based trials comparing different presentations of treatment effects are feasible , but recruiting participants is a major challenge . Despite a slightly higher response rate for CRS , VAS is preferable to avoid approximation of a continuous variable . Although most participants preferred the RRR , participants shown the RRR were more likely to decide to take statins regardless of their values compared with participants who were shown any of the five other summary statistics . Trial Registration Controlled-Trials.com IS RCT OBJECTIVE To experimentally test whether using pictographs ( image matrices ) , incremental risk formats , and varied risk denominators would influence perceptions and comprehension of side effect risks in an online decision aid about prophylactic use of tamoxifen to prevent primary breast cancers . METHODS We recruited 631 women with elevated breast cancer risk from two healthcare organizations . Participants saw tailored estimates of the risks of 5 side effects : endometrial cancer , blood clotting , cataracts , hormonal symptoms , and sexual problems . Presentation format was r and omly varied in a three factor design : ( A ) risk information was displayed either in pictographs or numeric text ; ( B ) presentations either reported total risks with and without tamoxifen or highlighted the incremental risk most relevant for decision making ; and ( C ) risk estimates used 100 or 1000 person denominators . Primary outcome measures included risk perceptions and gist knowledge . RESULTS Incremental risk formats consistently lowered perceived risk of side effects but result ed in low knowledge when displayed by numeric text only . Adding pictographs , however , produced significantly higher comprehension levels . CONCLUSIONS Pictographs make risk statistics easier to interpret , reducing biases associated with incremental risk presentations . PRACTICE IMPLICATION S Including graphs in risk communications is essential to support an informed treatment decision-making process Background The increasing use of computer-administered risk communications affords the potential to replace static risk graphics with animations that use motion cues to reinforce key risk messages . Research on the use of animated graphics , however , has yielded mixed findings , and little research exists to identify the specific animations that might improve risk knowledge and patients ’ decision making . Objective To test whether viewing animated forms of st and ard pictograph ( icon array ) risk graphics displaying risks of side effects would improve people ’s ability to select the treatment with the lowest risk profile , as compared with viewing static images of the same risks . Methods A total of 4198 members of a demographically diverse Internet panel read a scenario about  two hypothetical treatments for thyroid cancer . Each treatment was described as equally effective but varied in side effects ( with one option slightly better than the other ) . Participants were r and omly assigned to receive all risk information in 1 of 10 pictograph formats in a quasi-factorial design . We compared a control condition of static grouped icons with a static scattered icon display and with 8 Flash-based animated versions that incorporated different combinations of ( 1 ) building the risk 1 icon at a time , ( 2 ) having scattered risk icons settle into a group , or ( 3 ) having scattered risk icons shuffle themselves ( either automatically or by user control ) . We assessed participants ’ ability to choose the better treatment ( choice accuracy ) , their gist knowledge of side effects ( knowledge accuracy ) , and their graph evaluation ratings , controlling for subjective numeracy and need for cognition . Results When compared against static grouped-icon arrays , no animations significantly improved any outcomes , and most showed significant performance degradations . However , participants who received animations of grouped icons in which at-risk icons appeared 1 at a time performed as well on all outcomes as the static grouped-icon control group . Displays with scattered icons ( static or animated ) performed particularly poorly unless they included the settle animation that allowed users to view event icons grouped . Conclusions Many combinations of animation , especially those with scattered icons that shuffle r and omly , appear to inhibit knowledge accuracy in this context . Static pictographs that group risk icons , however , perform very well on measures of knowledge and choice accuracy . These findings parallel recent evidence in other data communication context s that less can be more — that is , that simpler , more focused information presentation can result in improved underst and ing . Decision aid design ers and health educators should proceed with caution when considering the use of animated risk graphics to compare two risks , given that evidence -based , static risk graphics appear optimal Objective : To determine whether the use of verbal descriptors suggested by the European Union ( EU ) such as “ common ” ( 1–10 % frequency ) and “ rare ” ( 0.01–0.1 % ) effectively conveys the level of risk of side effects to people taking a medicine . Design : R and omised controlled study with unconcealed allocation . Participants : 120 adults taking simvastatin or atorvastatin after cardiac surgery or myocardial infa rct ion . Setting : Cardiac rehabilitation clinics at two hospitals in Leeds , UK . Intervention : A written statement about one of the side effects of the medicine ( either constipation or pancreatitis ) . Within each side effect condition half the patients were given the information in verbal form and half in numerical form ( for constipation , “ common ” or 2.5 % ; for pancreatitis , “ rare ” or 0.04 % ) . Main outcome measure : The estimated likelihood of the side effect occurring . Other outcome measures related to the perceived severity of the side effect , its risk to health , and its effect on decisions about whether to take the medicine . Results : The mean likelihood estimate given for the constipation side effect was 34.2 % in the verbal group and 8.1 % in the numerical group ; for pancreatitis it was 18 % in the verbal group and 2.1 % in the numerical group . The verbal descriptors were associated with more negative perceptions of the medicine than their equivalent numerical descriptors . Conclusions : Patients want and need underst and able information about medicines and their risks and benefits . This is essential if they are to become partners in medicine taking . The use of verbal descriptors to improve the level of information about side effect risk leads to overestimation of the level of harm and may lead patients to make inappropriate decisions about whether or not they take the medicine Background Breast cancer risk education enables women make informed decisions regarding their options for screening and risk reduction . We aim ed to determine whether patient education regarding breast cancer risk using a bar graph , with or without a frequency format diagram , improved the accuracy of risk perception . Methods We conducted a prospect i ve , r and omized trial among women at increased risk for breast cancer . The main outcome measurement was patients ' estimation of their breast cancer risk before and after education with a bar graph ( BG group ) or bar graph plus a frequency format diagram ( BG+FF group ) , which was assessed by previsit and postvisit question naires . Results Of 150 women in the study , 74 were assigned to the BG group and 76 to the BG+FF group . Overall , 72 % of women overestimated their risk of breast cancer . The improvement in accuracy of risk perception from the previsit to the postvisit question naire ( BG group , 19 % to 61 % ; BG+FF group , 13 % 
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Yet another review identified strong evidence that patients misinterpret RRRs and supported the effectiveness of graphs in communicating harms ( 7 ) .