***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 Analyzing drop out rates and when they occur may give important information about the patient characteristics and trial characteristics that affect the overall uptake of an intervention . Methods We search ed Medline and the Cochrane library from the beginning of the data bases to May 2006 for published systematic review s that compared the effects of self-monitoring ( self-testing ) or self-management ( self-testing and self-dosage ) of oral anticoagulation or self-monitored blood glucose in type 2 diabetics who were not using insulin .  We assessed all study withdrawals pre-r and omization and post r and omization and sought information on the reasons for discontinuation of all participants .To measure the differential between groups in attrition we used the relative attrition ( RA ) , which is equivalent to relative risk but uses attrition as the outcome ( i.e. attrition in intervention group/attrition in control group ) . We determined the percentage drop outs for control and intervention groups and used DerSimonian and Laird r and om effects models to estimate a pooled relative attrition . L'abbe type plots created in R ( version 2.0.2 ) were used to represent the difference in the relative attrition among the trials with 95 % confidence areas and weights derived from the r and om effects model . Results With  self-monitoring of blood glucose in type 2 diabetes , attrition ranged from 2.3 % to 50.0 % in the intervention groups and 0 % to 40.4 % in the control groups . There was no significant difference between the intervention and control , with an overall RA of 1.18 [ 95 % CI , 0.70–2.01 ] . With  self-monitoring of oral anticoagulation attrition ranged from 0 % to 43.2 % in the intervention groups and 0 % to 21.4 % in the control group . The RA was significantly greater in the intervention group , combined RA , 6.05 [ 95 % CI , 2.53–14.49 ] . Conclusion This paper demonstrates the use of relative attrition as a new tool in systematic review methodology which has the potential to identify patient , intervention and trial characteristics which influences attrition in trials The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . R and omised trials are at the heart of evidence -based healthcare , but the methods and infrastructure for conducting these sometimes complex studies are largely evidence free . Trial Forge ( www.trialforge.org ) is an initiative that aims to increase the evidence base for trial decision making and , in doing so , to improve trial efficiency . This paper summarises a one-day workshop held in Edinburgh on 10 July 2014 to discuss Trial Forge and how to advance this initiative . We first outline the problem of inefficiency in r and omised trials and go on to describe Trial Forge . We present participants ’ views on the processes in the life of a r and omised trial that should be covered by Trial Forge . General support existed at the workshop for the Trial Forge approach to increase the evidence base for making r and omised trial decisions and for improving trial efficiency . Agreed upon key processes included choosing the right research question ; logistical planning for delivery , training of staff , recruitment , and retention ; data management and dissemination ; and close down . The process of linking to existing initiatives where possible was considered crucial . Trial Forge will not be a guideline or a checklist but a ‘ go to ’ website for research on r and omised trials methods , with a linked programme of applied methodology research , coupled to an effective evidence -dissemination process . Moreover , it will support an informal network of interested trialists who meet virtually ( online ) and occasionally in person to build capacity and knowledge in the design and conduct of efficient r and omised trials . Some of the re sources invested in r and omised trials are wasted because of limited evidence upon which to base many aspects of design , conduct , analysis , and reporting of clinical trials . Trial Forge will help to address this lack of evidence PURPOSE / OBJECTIVES To develop the Meaning of Life Intervention in response to the need for brief and meaning-focused interventions in palliative care and to establish potential effect sizes for future full-scale r and omized , controlled trials . DESIGN A r and omized , controlled trial conducted to pilot test the Meaning of Life Intervention . SETTING A 68-bed oncology inpatient ward in an urban acute general hospital in Hong Kong . SAMPLE 84 patients with advanced-stage cancer . Fifty-eight completed the study . METHODS Assessment s of outcome variables were conducted at baseline and one day and two weeks after the intervention . Patients were r and omly allocated to the intervention group or the control group . Repeated measures analysis of covariance were conducted to assess the impact of the Meaning of Life Intervention on participants ' quality of life . MAIN RESEARCH VARIABLES The primary outcome was quality of life and was measured by the Quality -of-Life Concerns in the End-of-Life ( QOLC-E ) question naire and with a single-item scale on global quality of life . The eight subscales of the QOLC-E served as secondary outcomes . FINDINGS Statistically significant main effects were noted for the group in the QOLC-E question naire total score , the single-item scale on global quality of life , and the existential distress subscale of the QOLC-E question naire . The effects represented a medium effect size . CONCLUSIONS The results of this pilot study show that the Meaning of Life Intervention can improve quality of life , particularly existential distress . IMPLICATION S FOR NURSING The Meaning of Life Intervention represents a potentially effective and efficient intervention that is feasible for implementation by nursing staff for patients with advanced-stage cancer in a palliative care setting Diverse analysis approaches have been proposed to distinguish data missing due to death from nonresponse , and to summarize trajectories of longitudinal data truncated by death . We demonstrate how these analysis approaches arise from factorizations of the distribution of longitudinal data and survival information . Models are illustrated using cognitive functioning data for older adults . For unconditional models , deaths do not occur , deaths are independent of the longitudinal response , or the unconditional longitudinal response is averaged over the survival distribution . Unconditional models , such as r and om effects models fit to unbalanced data , may implicitly impute data beyond the time of death . Fully conditional models stratify the longitudinal response trajectory by time of death . Fully conditional models are effective for describing individual trajectories , in terms of either aging ( age , or years from baseline ) or dying ( years from death ) . Causal models ( principal stratification ) as currently applied are fully conditional models , since group differences at one timepoint are described for a cohort that will survive past a later timepoint . Partly conditional models summarize the longitudinal response in the dynamic cohort of survivors . Partly conditional models are serial cross-sectional snapshots of the response , reflecting the average response in survivors at a given timepoint rather than individual trajectories . Joint models of survival and longitudinal response describe the evolving health status of the entire cohort . Research ers using longitudinal data should consider which method of accommodating deaths is consistent with research aims , and use analysis methods accordingly An innovative non-pharmacological intervention called Voix d'Or ( ® ) ( Golden Voice ) was proposed in the Cognitive behavioral unit ( CBU ) of the Memory center at the Hospices civils in Lyon .  Voix d'Or ( ® ) offers eight sound activities disseminated via an audio device based on different approaches sociotherapeutic ( music therapy , reminiscence , relaxation , reorientation in reality ) . The aim of this study was to test the effects of the Voix d'Or ( ® ) program on behavioral and psychological symptoms of dementia ( BPSD ) in patients with Alzheimer 's disease hospitalized in the CBU . Twenty four patients with agitation and /or apathy and /or anxiety and /or depression were included . Patients were r and omly selected in the intervention group exposed to Voix d'Or versus a control group exposed to usual occupational activities . Patients were assessed before ( T0 ) and after ( T1 ) the intervention period . Several variables were measured : frequency and severity of behavioral disorders , anxiety , depression , agitation and apathy . A significant improvement of anxiety level between T0 and T1was observed in the group with Voix d'Or ( ® ) compared to the control group . This study suggests that this non-pharmacological intervention may be beneficial on anxiety in patients with Alzheimer 's disease BACKGROUND AND OBJECTIVE R and omization does not protect against bias due to missing observations . In addition , different reasons for missing observations may lead to different invalid results . The purpose of this study was to illustrate how r and omized intervention studies can be threatened by bias due to missing observations because of death or nonresponse . METHODS A r and omized clinical trial of the effect of  psychosocial intervention on well-being after an operation for colorectal cancer was conducted in Denmark . Patients were interviewed 3 , 6 , 12 , and 24 months after discharge from hospital . RESULTS We found that the probability of nonresponse decreased with increasing anxiety score in the intervention group , but it increased with increasing anxiety score in the control group . This could lead to severe bias in an analysis of the effect of intervention on anxiety . Low physical functioning and low global health status and quality of life were related to an increased probability of dying before the next follow-up , and this association could explain the associations between anxiety and depression , respectively , and the probability of dying observed in crude analyses . CONCLUSION Our study emphasizes the importance of performing specific missing data analyses in any study of well-being variables Intention-to-treat ( ITT ) analyses are the st and ard way to evaluate r and omized controlled trials ( RCTs ) to minimize Type I errors related to differential rates of noncompletion from one study arm . People in palliative care often die sooner than predicted as a direct result of disease progression , some of whom will be participating in RCTs and who will , therefore , withdraw or die after r and omization for reasons unrelated to the intervention . This proportion of withdrawals is statistically negligible in other clinical disciplines , but commonplace in hospice/palliative care , creating a systematic bias away from the true effect . ITT analyses in hospice/palliative care that deem all withdrawals to be treatment failures or that impute data from deteriorating participants systematic ally underestimate the benefits of interventions , reducing the power of these studies . Equally unacceptable would be a per protocol analysis that excludes all withdrawals after r and omization as this will underestimate toxicity . A modified analytic approach is needed on a continuum between ITT and per protocol analyses . To address data after r and omization where there is a high rate of withdrawals because of death or deterioration , criteria need to include being : 1 ) prespecified in the original protocol ; 2 ) clinical ly absolutely the result of disease progression ; 3 ) identified by the blinded Independent Data Monitoring Committee as being unrelated to the intervention(s ) ; and 4 ) accounted for in the study 's CONSORT diagram . Such data should not be included in the analysis of the primary outcome . This article aims to define a better way of balancing Type I and Type II errors in hospice/palliative care RCT analyses using the palliative-modified ITT analysis . Arguably , the palliative-modified ITT analysis should be the primary evaluation of hospice/palliative care Phase III studies but , as a minimum , should routinely be the key sensitivity analysis BACKGROUND AND STUDY AIMS There are limited data on the role of antireflux biliary stents . This single-center r and omized trial compared the endoscopic use of partly covered antireflux metal stents ( pcARMS ) with that of st and ard uncovered self-exp and able metal stents ( ucSEMS ) for the palliation of nonhilar malignant biliary obstruction . PATIENTS AND METHODS Between August 2007 and February 2012 , patients with nonhilar malignant biliary obstruction were r and omly assigned to treatment with either  pcARMS or ucSEMS . Subsequent follow-up was conducted in clinic or by phone . The primary outcome was onset of cholangitis within 12 months of stenting . Secondary outcomes included other morbidities , stent dysfunctions , and survival . RESULTS Altogether 112 patients were included , 56 in each group . The stents were successfully deployed in all patients . Satisfactory jaundice control was achieved in 49 cases in the pcARMS group , compared with 47 in the ucSEMS group ( P = 0.135 ) . Fewer patients experienced cholangitis in the pcARMS group than in the ucSEMS group ( 10 vs. 21 patients ; P = 0.035 ) , and the frequency of episodes was less ( P = 0.022 ) . Respectively , 17 and 29 stent dysfunctions before death were observed in the pcARMS and ucSEMS groups ( P = 0.051 ) and the median stent patency was 13.0 ( st and ard deviation [ SD ] 3.4 ) and 10.0 ( 1.2 ) months , respectively ( P = 0.044 ) . At final follow-up , in January 2013 , 50 /52 and 52 /55 patients had died and no difference in median survival was seen between the two groups ( 8.0 vs. 9.0 months , P = 0.56 ) . CONCLUSIONS Stenting with pcARMS compared with st and ard ucSEMS reduces risk of ascending cholangitis and has longer stent patency , but does not increase patient survival . Chictr.org . number , ChiCTR-TRC-11001800 Background and Goals : Endoscopic stent insertion is considered the method of choice for palliation of malignant bile duct obstruction ( MBDO ) . However , it can cause complications and requires periodic stent exchanges 
    Output:
    
Conclusion The overall proportion and differential rates and reasons for MD reduce the power and potentially introduce bias to palliative care trials