***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: Objectives To compare screening practice s and beliefs in patients with and without a clinical ly important family history . Design We mailed a brief question naire asking about family history and a second , longer survey asking about knowledge of and beliefs about colorectal cancer to all respondents with a family history and a r and om sample of respondents without a family history of colorectal cancer . We review ed electronic medical records for screening examinations and recording of family history . Participants One thous and eight hundred seventy of 6,807 r and omly selected patients ages 35–55 years who had been continuously enrolled in a large multispecialty group practice for at least 5 years . Measurements Recognition of increased risk , screening practice s , and beliefs — all according to strength of family history and patient ’s age . Results Nineteen percent of respondents reported a family history of colorectal cancer . In 11 % , this history was strong enough to warrant screening before age 50 years . However , only 39 % ( 95 % CI 36 , 42 ) of respondents under the age of 50 years said they had been asked about family history and only 45 % of those with a strong family history of colorectal cancer had been screened appropriately . Forty-six percent of patients with a strong family history did not know that they should be screened at a younger age than average risk people . Medical records mentioned family history of colorectal cancer in 59 % of patients reporting a family history . Conclusions More efforts are needed to translate information about family history of colorectal cancer into the care of patients BACKGROUND : Internal medicine residents are deficient in their knowledge about familial colorectal cancer ( CRC ) and thus unable to comply with appropriate screening guidelines . The objective of this study was to evaluate the effectiveness of a mixed educational program that incorporates both a didactic lecture ( DL ) and interactive , case-based seminar ( ICBS ) , plus distribution of a personal digital assistant (PDA)-based risk assessment tool . METHODS : Internal medicine resident continuity care teams were r and omly assigned to an intervention ( 9 teams ; 43 residents ) or control ( 11 teams ; 39 residents ) arm . Both groups participated in a DL addressing the current status of CRC screening for average , moderate , and high-risk groups . Intervention teams also participated in a 1-h pre-clinic ICBS that included vignettes about patients at moderate or high risk of CRC because of family history , following which they received the risk assessment tool by e-mail .  Knowledge and clinical risk assessment skills were evaluated using pre/posttests , patient exit interviews , and chart audits . RESULTS : Baseline test scores were similar for both groups ( intervention , 51%vs control , 54 % ; P = 0.35 ) . Immediate post-ICBS scores ( intervention group only ) significantly increased to 82 % ( p < 0.001 ) . Six-month post-ICBS scores declined for the intervention group but remained significantly higher than 6-month control group scores ( 63%vs 56 % , P = 0.002 ) , which were unchanged from baseline . No significant differences were observed with respect to family history-taking or documentation skills . CONCLUSION : A mixed educational program that incorporates both a DL and ICBS is more effective that the DL alone for increasing knowledge about familial CRC risk but may have limited influence on clinical risk assessment skills A consistent predictor of a woman 's risk for breast cancer is a family history of the disease . Most studies of family history and breast cancer have used the number of affected relatives in the family to calculate relative risk , but they have not considered the heterogeneity of the familial risk for breast cancer in a systematic way . With the use of data from a large prospect i ve mortality study of US adults , the authors compared simple classification of family history of breast cancer ( yes/no ) to the method of using a quantitative family history score method , which takes into account the effects of family structure , age , and birth cohort as predictors of breast cancer mortality . After 9 years of follow-up , 1,428 cases of fatal breast cancer  were observed among 453,073 women with complete information on number and age of siblings and family history . With the use of the  family history score  , about one-third of women with a positive family history of breast cancer were at no higher risk for breast cancer mortality than those without a family history of the disease . As a quantitative measure of relative risk for each family , family history score gave a better fit to the data , and it provided an incremental improvement of predictive accuracy of developing fatal breast cancer . Family history score  can also be used as a categorical variable to stratify families . This allows research ers to focus on which risk groups would benefit from conducting further genetic analysis and to test the effects of genetic factors , environmental exposure , and gene-environment interactions on the etiology of the development of breast cancer BACKGROUND Innovative technologies that enable the collection of family history information and the assessment of breast cancer risk have a potential to enhance the quality of preventive care . We developed a computerized tool that supports stratification of breast cancer risk , genetic risk assessment in the clinical environment ( GRACE ) . METHODS In a preliminary evaluation of the tool 's impact , we r and omized women with a family history of breast cancer ( n=72 ) to either use the GRACE tool or undergo risk counseling by a nurse specialist .  RESULTS There was no statistically significant differences between the GRACE  and nurse counselling  groups in risk perceptions ( F=.03 , P>.05 ) and cancer-related worries ( F=.80 , P>.05 ) . However , patients reported more positive attitudes toward working with the nurse . CONCLUSION It was feasible to use GRACE in a Clinic . Additional research is required to identify solutions for providing emotional support in conjunction with the tool Background Many preventable diseases such as ischemic heart diseases and breast cancer prevail at a large scale in the general population .  Computerized decision support systems are one of the solutions for improving the quality of prevention strategies . Methods The system called EsPeR ( Personalised Estimate of Risks ) combines calculation of several risks with computerisation of guidelines ( cardiovascular prevention , screening for breast cancer , colorectal cancer , uterine cervix cancer , and prostate cancer , diagnosis of depression and suicide risk ) . We present a qualitative evaluation of its ergonomics , as well as it 's underst and ing and acceptance by a group of general practitioners . We organised four focus groups each including 6–11 general practitioners . Physicians worked on several structured clinical scenari os with the help of EsPeR , and three senior investigators leaded structured discussion sessions . Results The initial sessions identified several ergonomic flaws of the system that were easily corrected . Both clinical scenarios and discussion sessions identified several problems related to the insufficient comprehension ( expression of risks , definition of familial history of disease ) , and difficulty for the physicians to accept some of the recommendations . Conclusion Educational , socio-professional and organisational components ( i.e. time constraints for training and use of the EsPeR system during consultation ) as well as acceptance of evidence -based decision-making should be taken into account before launching computerised decision support systems , or their application in r and omised trials BACKGROUND Subjects with a positive family history of colorectal cancer ( CRC ) have an increased risk of developing CRC themselves . This risk depends on the number of affected relatives and the age at diagnosis . AIM The aim of this study was to assess the prevalence of a positive family history of CRC , within a r and om cohort among the dutch population . METHODS A total of 5072 subjects aged between 45 and 70 years were invited to fill in an anonymous question naire about the occurrence of CRC in their first-degree relatives ( FDR ) . RESULTS The question naire was returned by 3973 subjects ( 78.3 % ) . Thirty responders ( 0.8 % ) had CRC themselves . Of all unaffected responders , 441 ( 11.2 % ) subjects reported a positive family history of CRC . Ninety ( 2.3 % ) responders reported having an FDR with CRC diagnosed before the age of 50 , or reported two or more FDRs with CRC . CONCLUSION The prevalence of a positive family history of CRC is substantial . Identification of this high-risk group by obtaining a thorough family history is the first step in targeting preventive measures The objective was to evaluate the effect of an assessment strategy using the computer decision support system ( the GRAIDS software ) , on the management of familial cancer risk in British general practice in comparison with best current practice . The design included cluster r and omised controlled trial , and involved forty-five general practice teams in East Anglia , UK . R and omised to GRAIDS ( Genetic Risk Assessment on the Internet with Decision Support ) support ( intervention n=23 ) or comparison ( n=22 ) . Training in the new assessment strategy and access to the GRAIDS software ( GRAIDS arm ) was conducted , compared with an educational session and guidelines about managing familial breast and colorectal cancer risk ( comparison ) were mailed . Outcomes were measured at practice , practitioner and patient levels . The primary outcome measure , at practice level , was the proportion of referrals made to the Regional Genetics Clinic for familial breast or colorectal cancer that were consistent with referral guidelines . Other measures included practitioner confidence in managing familial cancer ( GRAIDS arm only ) and , in patients : cancer worry , risk perception and knowledge about familial cancer . There were more referrals to the Regional Genetics Clinic from GRAIDS than comparison practice s ( mean 6.2 and 3.2 referrals per 10 000 registered patients per year ; mean difference 3.0 referrals ; 95 % confidence interval ( CI ) 1.2–4.8 ; P=0.001 ) ; referrals from GRAIDS practice s were more likely to be consistent with referral guidelines ( odds ratio (OR)=5.2 ; 95 % CI 1.7–15.8 , P=0.006 ) . Patients referred from GRAIDS practice s had lower cancer worry scores at the point of referral ( mean difference −1.44 95 % CI −2.64 to −0.23 , P=0.02 ) . There were no differences in patient knowledge about familial cancer . The intervention increased GPs ' confidence in managing familial cancer . Compared with education and mailed guidelines , assessment including computer decision support increased the number and quality of referrals to the Regional Genetics Clinic for familial cancer risk , improved practitioner confidence and had no adverse psychological effects in patients . Trials are registered under N0181144343 in the UK National Research Register Purpose : The study goals were to ( 1 ) determine the proportion of unselected individuals at increased risk for diseases with known genetic components and ( 2 ) compare the documentation and quality of risk assessment between a question naire , a pedigree interview , and chart review . Methods : Seventy-eight patients seen in a division of internal medicine were r and omized into two groups , which completed a question naire or underwent a pedigree interview . Chart notes were compared to both study tools . Results : Sixty-two ( 79.5 % ) of the 78 participants scored at increased risk for at least one category . Either of the two study tools found significantly more people at high risk ( 48/78 , 61.5 % ) than the chart review ( 31/78 , 39.7 % ) ( P = 0.01 ) . Conclusions : Approximately 20 % of patients in an unselected internal medicine practice were at an increased risk that was not documented in review ed chart notes . Targeted family history analysis reveals patients who require increased medical surveillance , preventive measures , or genetic counseling/testing PURPOSE / OBJECTIVES To measure psychological distress and test the feasibility of a psychological intervention to reduce distress in patients undergoing risk assessment . DESIGN Descriptive . SETTING A comprehensive cancer center located in the southeastern United States . SAMPLE 20 first-degree relatives of women diagnosed with breast cancer ( X age = 42 ; range = 21 - 70 ) completed the risk assessment process . Three were lost to follow-up at three months , leaving a total of 17 evaluable patients . METHODS Data collection was by means of family/medical history forms and question naires administered at baseline and one and three months . Participants were r and omized to either a control group consisting of st and ard education about risk for breast cancer or to an intervention group consisting of st and ard education plus a psychological intervention design ed to teach stress-management skills . MAIN RESEARCH VARIABLES Psychological distress , depressive symptoms , intrusive thoughts about breast cancer , and perceived risk for developing breast cancer . FINDINGS Delivery of a psychological intervention proved feasible . Although no statistically significant differences existed between the intervention and control groups on distress and depressive symptoms , the intervention group reported fewer intrusive thoughts about breast cancer at follow-up . Risk did not predict anxiety levels . A large majority ( 73 % ) of the women overestimated the risk of breast cancer at baseline . CONCLUSIONS This study demonstrated the feasibility of a multidisciplinary team approach to breast cancer risk assessment and counseling and management of psychological distress in first-degree relatives of women with breast cancer . The data suggest that a psychological intervention may reduce cancer-specific psychological distress in women at increased risk for breast cancer . IMPLICATION S FOR NURSING PRACTICE Oncology nurses can play an important role in the delivery of interventions to educate and reduce distress in women undergoing breast cancer risk assessment BACKGROUND Screening for colorectal cancer is effective in family members with a high risk of this condition , owing to single gene mutations . However , it is not known which is the most effective method of ascertaining these families at high risk . AIMS To investigate whether a case-finding approach using computerised general practitioner ( GP ) registers would improve the ascertainment of families at high risk of colorectal cancer due to family history . DESIGN OF STUDY Prospect i ve GP register study . SETTING General practice s in Oxfordshire . METHOD Identification of patients with colorectal cancer using GP registers  , followed by a family history question naire survey to identify those at 
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Few tools have been developed specifically for primary care setting s. The few that have been evaluated performed well .
The very limited evidence , which depends in part on extrapolation from studies in setting s other than primary care , suggests that systematic tools may add significant family health information compared with current primary care practice .