***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 : Mindfulness trainings are increasingly offered in workplace environments in order to improve health and productivity . Whilst promising , there is limited research on the effectiveness of mindfulness interventions in workplace setting s. Objective : To examine the feasibility and effectiveness of a Workplace Mindfulness Training ( WMT ) in terms of burnout , psychological well-being , organizational and team climate , and performance . Methods : This is a preliminary field study in four companies . Self-report question naires were administered up to a month before , at start of , and right at the end of the WMT , result ing in a pre-intervention and an intervention period . There was no separate control group . A total of 425 participants completed the surveys on the different time points . Linear mixed model analyses were used to analyze the data . Results : When comparing the intervention period with the pre-intervention period , significantly greater improvements were found in measures of burnout ( mean difference = 0.3 , p < 0.001 ) , perceived stress ( mean difference = -0.2 , p < 0.001 ) , mindfulness [ mean difference = 1.0 for the Freiburg Mindfulness Inventory ( FMI ) and 0.8 for the Mindfulness Attention Awareness Scale ( MAAS ) , both p < 0.001 ] , and well-being ( mean difference = 0.4 , p < 0.001 ) . Additionally , greater increases in team climate , organizational climate and personal performance were reported during the intervention compared to the pre-intervention period with largest improvements in team cooperation ( mean difference = 0.3 , p < 0.001 ) , productivity ( mean difference = 0.5 , p < 0.001 ) , and stress ( mean difference = -0.4 , p < 0.001 ) . Effect sizes were large for mindfulness ( d > 0.8 ) , moderate for well-being , burnout and perceived stress ( d = 0.5–0.8 ) , and ranged from low to moderate for organizational and team climate and personal performance ( d = 0.2–0.8 ) . Conclusion : These preliminary data suggest that compared to the pre-intervention period , the intervention period was associated with greater reductions in burnout and perceived stress , improvements in mindfulness , well-being , and increases in team and organizational climate and personal performance . Due to design limitations , no conclusions can be drawn on the extent to which the WMT or non-specific factors such as time have contributed to the findings . Further studies , preferably using r and omized controlled design s with longer follow up periods are needed to evaluate whether the associations found can be attributed to the WMT and whether these sustain after the training Background Internet- and mobile based stress-management interventions ( iSMI ) may be an effective means to address the negative consequences of occupational stress . However , available results from r and omised controlled trials are conflicting . Moreover , it is yet not clear whether guided or unguided self-help iSMI provide better value for money . Internet-based mental health interventions without guidance are often much less effective than interventions including at least some guidance from a professional . However , direct comparisons in r and omised controlled trials are scarce and , to the best of our knowledge , the comparative (cost)-effectiveness of guided vs. unguided iSMI has not yet been studied . Hence , this study investigates the acceptability and ( cost- ) effectiveness of minimal guided and unguided iSMI in employees with heightened levels of perceived stress . Methods A three-armed r and omised controlled trial ( RCT ) will be conducted to compare a minimal guided and unguided iSMI with a waiting list control condition ( WLC ) . Both active conditions are based on the same iSMI , i.e. GET.ON Stress , and differ only with regard to the guidance format . Employees with heightened levels of perceived stress ( PSS ≥ 22 ) will be r and omised to one of three conditions . Primary outcome will be comparative changes in perceived stress ( PSS ) . Secondary outcomes include changes in self-reported depression , work-engagement , presenteeism and absenteeism . Moreover , a cost-effectiveness analysis will be conducted from a societal perspective , including both direct medical costs and costs related to productivity losses . In addition , a cost-benefit analysis will be conducted from the employer ’s perspective . Incremental net-benefit regression analyses will address the question if there are any baseline factors ( i.e. subgroups of employees ) associated with particularly favorable cost-effectiveness when the experimental intervention is offered . Assessment s take place at baseline , 7 weeks post-treatment and 6 months after r and omisation . Discussion Online-based ( guided ) self-help interventions could be an acceptable , effective and economically sustainable approach to offer evidence -based intervention alternatives to reduce the negative consequences associated with work-related stress . This study evaluates the ( cost- ) effectiveness of two versions of an iSMI , minimal guided and unguided iSMI . Thus , the present study will further enhance the evidence -base for iSMI and provide valuable information about the optimal balance between outcome and economic costs . Trial registration German Clinical Trial Registration ( DRKS ) : DRKS00005687 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background R and omised controlled trials ( RCTs ) of social interventions are often criticised as failing to open the ‘ black box ’ whereby they only address questions about ‘ what works ’ without explaining the underlying processes of implementation and mechanisms of action , and how these vary by context ual characteristics of person and place . Realist RCTs are proposed as an approach to evaluation science that addresses these gaps while preserving the strengths of RCTs in providing evidence with strong internal validity in estimating effects . Methods In the context of growing interest in design ing and conducting realist trials , there is an urgent need to offer a worked example to provide guidance on how such an approach might be practically taken forward . The aim of this paper is to outline a three-staged theoretical and method ological process of undertaking a realist RCT using the example of the evaluation of a  whole-school restorative intervention aim ing to reduce aggression and bullying in English secondary schools . Discussion First , informed by the findings of our initial pilot trial and sociological theory , we elaborate our theory of change and specific a priori hypotheses about how intervention mechanisms interact with context to produce outcomes . Second , we describe how we will use emerging findings from the integral process evaluation within the RCT to refine , and add to , these a priori hypotheses before the collection of quantitative , follow-up data . Third , we will test our hypotheses using a combination of process and outcome data via quantitative analyses of effect mediation ( examining mechanisms ) and moderation ( examining context ual contingencies ) . The results are then used to refine and further develop the theory of change . Conclusion The aim of the realist RCT approach is thus not merely to assess whether the intervention is effective or not , but to develop empirically informed mid-range theory through a three-stage process . There are important implication s for those involved with reporting and review ing RCTs , including the use of new , iterative protocol s . Trial registration Current Controlled Trials IS RCT N10751359 ( Registered 11 March 2014 Background Mental health complaints are quite common in health care employees and can have adverse effects on work functioning . The aim of this study was to evaluate an e-mental health ( EMH ) approach to workers ' health surveillance ( WHS ) for nurses and allied health professionals . Using the waiting-list group of a previous r and omized controlled trial with high dropout and low compliance to the intervention , we studied the pre- and posteffects of the EMH approach in a larger group of participants . Methods We applied a pretest – posttest study design . The WHS consisted of online screening on impaired work functioning and mental health followed by online automatically generated personalized feedback , online tailored advice , and access to self-help EMH interventions . The effects on work functioning , stress , and work-related fatigue after 3 months were analyzed using paired t tests and effect sizes . Results One hundred and twenty-eight nurses and allied health professionals participated at pretest as well as posttest . Significant improvements were found on work functioning ( p = 0.01 ) and work-related fatigue ( p < 0.01 ) . Work functioning had relevantly improved in 30 % of participants . A small meaningful effect on stress was found ( Cohen d = .23 ) in the participants who had logged onto an EMH intervention ( 20 % , n = 26 ) . Conclusion The EMH approach to WHS improves the work functioning and mental health of nurses and allied health professionals . However , because we found small effects and participation in the offered EMH interventions was low , there is ample room for improvement BACKGROUND Nursing is a notoriously high-stress occupation - emotionally taxing and physically draining , with a high incidence of burnout . In addition to the damaging effects of stress on nurses ' health and well being , stress is also a major contributor to attrition and widespread shortages in the nursing profession . Although there exist promising in-person interventions for addressing the problem of stress among nurses , the experience of our group across multiple projects in hospitals has indicated that the schedules and workloads of nurses can pose problems for implementing in-person interventions , and that web-based interventions might be ideally suited to addressing the high levels of stress among nurses . PURPOSE The purpose of this study was to evaluate the effectiveness of the web-based BREATHE : Stress Management for Nurses program . METHODS The r and omized controlled trial was conducted with 104 nurses in five hospitals in Virginia and one hospital in New York . The primary outcome measure was perceived nursing-related stress . Secondary measures included symptoms of distress , coping , work limitations , job satisfaction , use of substances to relieve stress , alcohol consumption , and underst and ing depression and anxiety . RESULTS Program group participants experienced significantly greater reductions than the control group on the full Nursing Stress Scale , and six of the seven subscales . No other significant results were found . Moderator analysis found that nurses with greater experience benefitted more . CONCLUSION Using a web-based program holds tremendous promise for providing nurses with the tools they need to address nursing related stress 
    Output:
    
The results of this work will provide recommendations on the use of digital interventions for the promotion of psychological well-being at work .