***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: To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results Abstract Objective To test the effectiveness of an evidence based model for management of depression in primary care with support from quality improvement re sources . Design Cluster r and omised controlled trial . Setting Five healthcare organisations in the United States and 60 affiliated practice s. Patients 405 patients , aged ≥ 18 years , starting or changing treatment for depression .  Intervention Care provided by clinicians , with staff providing telephone support under supervision from a psychiatrist . Main outcome measures Severity of depression at three and six months ( Hopkins symptom checklist-20 ) : response to treatment ( ≥ 50 % decrease in scores ) and remission ( score of < 0.5 ) . Results At six months , 60 % ( 106 of 177 ) of patients in intervention practice s had responded to treatment compared with 47 % ( 68 of 146 ) of patients in usual care practice s ( P = 0.02 ) . At six months , 37 % of intervention patients showed remission compared with 27 % for usual care patients ( P = 0.014 ) . 90 % of intervention patients rated their depression care as good or excellent at six months compared with 75 % of usual care patients ( P = 0.0003 ) . Conclusion Re sources such as quality improvement programmes can be used effectively in primary care to implement evidence based management of depression and improve outcomes for patients with depression Among a sample of 119 distressed high-utilizers of primary care , 45 % of patients evaluated by a psychiatrist as needing antidepressant treatment had been treated in the year before the examination . However , only 11 % of the patients needing antidepressants had received adequate dosage and duration of pharmacotherapy . In the year following the intervention , study patients whose physicians were advised regarding treatment during a psychiatric consultation  were more likely to receive  antidepressant medications  ( 52.7 % ) relative to a r and omized control group ( 36.1 % ) . However , the intervention did not significantly increase the provision of adequate antidepressant therapy  ( 37.1 % vs 27.9 % ) . Among study patients using antidepressants , patient characteristics did not differentiate patients who received adequate dosage and duration of antidepressant medications from those who did not . Analysis of data on the duration of antidepressant therapy for all health maintenance organization enrollees initiating use of antidepressants showed that only 20 % of patients who had been given prescriptions for first-generation antidepressants ( amitriptyline , imipramine , or doxepin ) filled four or more prescriptions in the following six months , compared to 34 % of patients who had prescriptions for newer antidepressants ( nortriptyline , desipramine , trazodone and fluoxetine ) . Experimental research evaluating whether these newer medications ( with more favorable side effect profiles ) improve adherence , and thereby patient outcome , is needed Background Anxiety and depressive disorders are highly prevalent disorders and are mostly treated in primary care . The management of these disorders by general practitioners is not always consistent with prevailing guidelines because of a variety of factors . Design ing implementation strategies tailored to prospect ively identified barriers could lead to more guideline -recommended care . Although tailoring of implementation strategies is promoted in practice , little is known about the effect on improving the quality of care for the early recognition , diagnosis , and stepped care treatment allocation in patients with anxiety or depressive disorders in general practice . This study examines whether the tailored strategy supplemented with training and feedback is more effective than providing training and feedback alone . Methods In this cluster r and omised controlled trial , a total of 22 general practice s will be assigned to one of two conditions : ( 1 ) training , feedback , and tailored interventions and ( 2 ) training and feedback . The primary outcome measure is the proportion of patients who have been recognised to have anxiety and /or depressive disorder .  The secondary outcome measures in patients are severity of anxiety and depressive symptoms , level of functioning , expectation towards and experience with care , quality of life , and economic costs . Measures are taken after the start of the intervention at baseline and at three- and six-month follow-ups . Secondary outcome measures in general practitioners are adherence to guideline -recommended care in care that has been delivered , the proportion of antidepressant prescriptions , and number of referrals to specialised mental healthcare facilities . Data will be gathered from the electronic medical patient records from the patients included in the study . In a process evaluation , the identification of barriers to change and the relations between prospect ively identified barriers and improvement interventions selected for use will be described , as well as the factors that influence the provision of guideline -recommended care . Discussion It is hypothesised that the adherence to guideline recommendations will be improved by design ing implementation interventions that are tailored to prospect ively identified barriers in the local context of general practitioners . Currently , there is insufficient evidence on the most effective and efficient approaches to tailoring , including how barriers should be identified and how interventions should be selected to address the barriers . Trial registration This study reports the results of a r and omized trial of a psychiatric consultation intervention with distressed , high utilizing patients of 18 physicians in two primary care clinics .  Psychiatric consultation was associated with a significant increase in the use of antidepressants in intervention patients compared with controls in the first 6 months after intervention . Intervention patients were also significantly more likely to continue  antidepressant treatment  than control patients . The primary care physicians receiving psychiatric consultations increased the rate of prescribing antidepressant medications  in their practice from 32 prescriptions filled per 1,000 visits before their participation in four consultations to 44 new prescriptions per 1,000 visits in the 12-month period after . There were no significant differences between intervention patients and controls at 6 and 12 months after r and omization in psychiatric distress , functional disability , or utilization of health care ( ambulatory visits , radiographic and laboratory testing services , admissions to inpatient medical care ) Background Anxiety is a common mental health problem seen in primary care . However , its management in clinical practice varies greatly . Clinical practice guidelines ( CPGs ) have the potential to reduce variations and improve the care received by patients by promoting interventions of proven benefit . However , uptake and adherence to their recommendations can be low . Method / design This study involves a community based on cluster r and omized trial in primary healthcare centres in the Madrid Region ( Spain ) . The project aims to determine whether the use of implementation strategy ( including training session , information , opinion leader , reminders , audit , and feed-back ) of CPG for patients with anxiety disorders in primary care is more effective than usual diffusion . The number of patients required is 296 ( 148 in each arm ) , all older than 18 years and diagnosed with generalized anxiety disorder , panic disorder , and panic attacks by the Diagnostic and Statistical Manual of Mental Disorders-IV ( DSM-IV ) . They are chosen by consecutive sampling . The main outcome variable is the change in two or more points into Goldberg anxiety scale at six and twelve months . Secondary outcome variables include quality of life ( EuroQol 5D ) , and degree of compliance with the CPG recommendations on treatment , information , and referrals to mental health services . Main effectiveness will be analyzed by comparing the patients percentage improvement on the Goldberg scale between the intervention group and the control group . Logistic regression with r and om effects will be used to adjust for prognostic factors . Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis . Discussion There is a need to identify effective implementation strategies for CPG for the management of anxiety disorders present in primary care . Ensuring the appropriate uptake of guideline recommendations can reduce clinical variation and improve the care patients receive . Trial registration IS RCT N : IS RCT Context Most successful disease management interventions for depression care have required intensive involvement of care managers or mental health specialists . Contribution The authors r and omly assigned 41 primary care physicians from 5 clinics to receive either depression decision support or usual care . Depression decision support was provided by a team that included a psychiatrist and a nurse care manager and involved an initial telephone contact , patient education , monthly record review , and sending a progress report to primary care physicians every 3 months . Depression severity improved equally in both groups over 12 months , despite evidence that intervention clinicians delivered more depression-related services . Implication s Decision support improved processes of depression care but not outcomes . The Editors Depression is a common problem worldwide . According to projections from the World Health Organization ( WHO ) , depression will be the second leading cause of disability in the developed world by 2020 ( 1 ) . One in 10 primary care patients meets criteria for major depression ( 2 ) , yet underrecognition and undertreatment are common ( 3 , 4 ) . Untreated depression is associated with increased deaths , adverse medical outcomes , deficits in function and well-being , and increased use of health services ( 3 , 59 ) . Multifaceted , collaborative interventions have been shown to improve depression-related outcomes in primary care ( 1022 ) . These interventions include decision support for clinicians , self-management support for patients , clinical information systems modifications , and care management . Care management typically consists of patient education and activation , symptom and treatment adherence monitoring , and self-management reinforcement ( 23 ) . Most collaborative depression interventions have relied on intensive involvement of care managers and specialists , usually shifting responsibility and workload toward mental health or research teams . Clinical systems may not be capable of sustaining this level of intensity . We therefore developed a multifaceted depression decision support intervention , which was design ed to optimize primary care clinicians ' abilities to treat depression without adding substantial new re sources . We aim ed to determine the effect of depression decision support on clinical outcomes and processes of care among patients with depression in a Veterans Affairs ( VA ) primary care setting . Methods Design Overview Our clinician-level , cluster r and omized , controlled trial studied depression decision support versus usual care . We r and omly assigned clinicians to either group and nested patients within clinician group assignment . We recruited participants between July 2002 and October 2003 from 5 primary care clinics of a VA medical center and followed patients for 12 months . The local institutional review board approved the study , and all patients and clinicians gave written informed consent . Setting Approximately 25000 veterans were treated during the study period in the 5 primary care clinics ( 3 urban and 2 rural clinics ) . Mental health clinicians are available on site in all clinics to provide consultation and brief treatment . A separate , more traditional mental health clinic serves approximately 8000 patients with chronic mental illnesses . Participants Full- and part-time staff physicians , fellows , physician assistants , and nurse practitioners were eligible to participate , and 41 ( 95 % ) of 43 eligible clinicians agreed to participate . To decrease variability in baseline depression-related knowledge and skills , we invited all clinicians to participate in the MacArthur Foundation depression education program ( 2427 ) before r and omization . In two 4-hour sessions , the program addresses communication skills and knowledge related to recognizing and managing depression . All patients of participating clinicians were eligible for the study . Research assistants review ed medical records of patients with upcoming primary care appointments ( within 4 to 6 weeks ) . They excluded patients who had received treatment from mental health specialists within the previous 6 months ; who had received a diagnosis of psychotic disorder , dementia , or bipolar disorder ; or who were considered to be terminally ill . They mailed study introduction letters to nonexcluded patients . The letters informed the patients that the research team would call them within 2 weeks unless they declined screening by notifying the study office . Telephone screening measures included the  Patient Health Question naire ( PHQ-9 ) ( 28 ) and the  Short Blessed Test screening  for dementia ( 29 ) . We invited patients with PHQ-9 scores of 10 to 25 ( moderate to severe depression ) ( 30 ) to attend in-person enrollment interviews . We referred patients with PHQ-9 scores greater than 25 ( very severe depression ) or active dangerous ideation for urgent care , and we excluded them from participation . Enrollment interviews were scheduled within 2 weeks of primary care visits and usually took place the same day . The primary inclusion criterion was a repeated PHQ-9 score of 10 to 25 or a Hopkins Symptom Checklist-20 ( SCL-20 ) ( 31 ) score of 1.0 or greater at the enrollment interview . Of the 5434 patients who were mailed study introduction letters , 3500 ( 64 % ) were reached by telephone and were offered screening ( Figure 1 ) , 
    Output:
    
There is evidence that consultation liaison improves mental health for up to three months ; and satisfaction and adherence for up to 12 months in people with mental disorders , particularly those who are depressed .
Primary care providers were also more likely to provide adequate treatment and prescribe pharmacological therapy for up to 12 months .
There was also some evidence that consultation liaison may not be as effective as collaborative care in terms of mental disorder symptoms , disability , general health status , and provision of treatment .