***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 Psychosocial problems in socioeconomically deprived communities are not always amenable to traditional medical approaches . Mothers living in these areas are a particularly vulnerable group . The objective of this study was to evaluate the effectiveness of a lengthened multi-disciplinary team consultation in primary care in reducing  anxiety and depression in mothers . Methods This was a prospect i ve r and omised controlled trial of a multidisciplinary team consultation against normal care .  94 mothers were recruited from three general practice s from an area of extreme socio-economic deprivation . Mothers r and omised into the intervention group attended a multidisciplinary consultation with up to four case-specific health care professionals . Consultations addressed medical , psychological and social problems and lasted up to one hour . Conventional primary care continued to be available to the intervention families . Control group families received normal primary care services . The outcomes measured were anxiety and depression as using the Hospital Anxiety and Depression Scale ( HADS ) , health status using SF36v2 , and quality of life using the abbreviated Schedule for the Evaluation of Individual Quality of Life ( SEIQoL-DW ) at baseline , 6 months and 12 months . Results Ordered logistic regression was used to analyse the data . There was no significant difference found between intervention and control groups after 6 months and 12 months in all of the measured outcomes . Conclusions The new lengthened multi-disciplinary team consultation did not have any impact on the mental health , general health , and quality of life of mothers after 6 and 12 months . Other methods of primary health care delivery in socio-economically deprived communities need to be evaluated There is a burgeoning literature on communication in general practice . It is often assumed that trained GPs know and practice the techniques described , but that time is a major constraint . In two experimental studies patients were given shorter or longer appointments  , and the doctors ' use of different verbal interventions was measured . Our analysis focused on how individual doctors varied in their use of  interviewing techniques  according to the time available . When more time was available some interventions were used more frequently by all doctors , but for other interventions the response was variable . For example , GPs who normally used facilitation frequently used it more often when greater time was available , whereas doctors who used this technique less frequently tended not to change when more time was available . This suggests that , at least in the short term , there is a differential response to changes in the time available in the consultation , with increased time being a necessary but not sufficient condition to promote the greater use of the communication techniques which doctors use less frequently OBJECTIVE To report patient responses to the General Practice Assessment Question naire ( GPAQ ) as a measure of satisfaction with health care received from Australian general practitioners . DESIGN , SETTING AND PARTICIPANTS A clustered cross-sectional study involving general practice patients from 30 r and omly selected general practice s in Victoria . Between January and December 2005 , a screening survey , including a postal version of the GPAQ , was mailed to 17 780 eligible patients . MAIN OUTCOME MEASURE Scores on the six GPAQ items . RESULTS We analysed data from 7130 patients who completed the screening survey and fulfilled our eligibility criteria . Levels of patient satisfaction with general practice care were generally high : mean GPAQ scores ranged from 68.6 ( 95 % CI , 66.1 - 71.0 ) for satisfaction with access to the practice to 84.0 ( 95 % CI , 82.2 - 85.4 ) for satisfaction with communication . Intracluster correlations for the GPAQ items ranged from 0.016 for overall satisfaction with the practice to 0.163 for satisfaction with access to the practice . Compared with national benchmarks in the United Kingdom , the GPs and practice s participating in our study were rated higher on all six GPAQ items . Multivariable mixed effects linear regression showed that patients who were older , rated their health more highly , visited their GP more frequently and saw the same GP each time tended to express greater satisfaction with their care . CONCLUSION Generally patients reported high levels of satisfaction with GP care . Greater satisfaction with care was associated with older patients , good health , more frequent contact with the GP , and seeing the one GP consistently A controlled trial was carried out to determine whether longer booking intervals at surgeries affected general practitioners ' self-assessed levels of stress and arousal .  Sixteen general practitioners from 10 practice s took part . Surgery sessions with patients booked at 10 minute intervals ( experimental sessions ) were compared with the doctors ' usual booking intervals of between 7.5 and 5.0 minutes ( control sessions ) .  Stress and arousal were assessed by the general practitioner before and after each surgery session using a mood adjective check list . The study included 109 experimental and 184 control sessions . The median consultation length increased from six minutes in the control sessions to seven minutes in the experimental sessions . At the end of the experimental sessions , stress scores were lower , and arousal scores higher than at the end of the control sessions ( P less than 0.001 ) . There were no significant differences between experimental and control sessions in stress or arousal at the start of the sessions . Favourable mood changes were seen more consistently in the experimental sessions than control sessions , with less than a quarter of doctors showing increased stress or decreased arousal after sessions relative to before . It is concluded that longer booking intervals are of psychological advantage to general practitioners Intermittent acute inflammation of aural , nasal , and articular cartilage is typical of relapsing polychondritis.1 Laboratory tests are unhelpful , though a raised erythrocyte sedimentation rate and mild leucocytosis are usually present . ' Definitive diagnosis was made by the histological appearance of affected cartilage . Audiovestibular damage may occur as the presenting symptom , ' and in our patient deafness may have been the first manifestation of the disease . Difficulty with intubation many years later suggests that tracheal cartilage was affected . Hashimoto 's thyroiditis with myxoedema,5 goitre , l and diabetes mellitus3 5 have been associated with relapsing polychondritis and often precede the cartilaginous manifestations by many years . To our knowledge there has been no report of Graves 's disease , diabetes mellitus , and vitiligo occurring in a patient with relapsing polychondritis and gastric parietal cell and intrinsic factor antibodies . We postulate that the associated widespread autoimmune disease in this case of relapsing -polychondritis suggests an organ-specific autoimmune aetiology for the condition . The presence of circulating specific antihuman cartilage antibodies supports this view , though the antigen is unidentified . The finding of anticartilage antibodies in two out of three cases led to a similar conclusion .2 The relation between clinical disease of cartilage and circulating anticartilage antibodies is at present unknown . Cell-mediated immunity to cartilage has also been reported in polychondritis.3 4 A search for anticartilage antibodies together with clinical and immunological evidence of other autoimmune disease should be made in all suspected cases OBJECTIVE --To see whether extending appointment length from seven and a half minutes or less to 10 minutes per patient would increase health promotion in general practice consultations . DESIGN --Controlled trial of 10 minute appointments . Consultations were compared with control surgeries in which the same doctors booked patients at their normal rate ( median six minutes per patient ) . SETTING --10 general practice s in Nottinghamshire . SUBJECTS--16 general practitioners were recruited . Entry criteria were a booking rate of eight or more patients an hour , a wish for longer consultations , and plans to increase appointment length . MAIN OUTCOME MEASURES -- Duration of consultations ; recording of blood pressure , weight , and cervical cytology in the medical record ; recording of advice about smoking , alcohol , diet , exercise , and immunisation in the medical record ; reporting of the above activities by patients . RESULTS --Mean consultation times were 8.25 minutes in the experimental sessions and 7.04 and 7.16 minutes in the control sessions . Recording of blood pressure , smoking , alcohol consumption , and advice about immunisation was significantly more frequent in the experimental sessions , and the proportion of consultations in which one or more items of health education were recorded in the medical notes increased by an average of over 6 % in these sessions . Patients more often reported discussion of smoking and alcohol consumption and coverage of previous health problems in the experimental sessions . There was little change in discussion of exercise , diet , and weight or cervical cytology activity . CONCLUSIONS --Shortage of time is a major factor in general practitioners ' failure to realise their potential in health promotion . General practice should be organised so that doctors can run 10 minute appointment sessions In a study in which patients were allocated non- systematic ally to surgeries booked at 5 , 7.5 , and 10 minute intervals 623 consultations were taperecorded . In surgeries booked at longer intervals doctors used the extra time to take a fuller history from their patients . In surgeries booked at 10 minute intervals doctors spent more time explaining the patient 's problem , explaining the proposed management , and in discussing prevention and health education , these increases not being evident in surgeries booked at 7.5 minute intervals An experiment was carried out in which patients who were seeking appointments for a consultation in a general practice in south London attended  consulting sessions booked at 5 , 7.5 , or 10 minute intervals . The particular session that the patient attended was determined non- systematic ally . The clinical content of the consultation was recorded on an encounter sheet and on audio-tape . At the end of each consultation patients were invited to complete a question naire design ed to measure satisfaction with the consultation . The stress engendered in doctors carrying out surgery sessions booked at different intervals of time was also measured . At surgery sessions booked at 5 minute intervals , compared with 7.5 and 10 minute intervals , the doctors spent less time with the patients and identified fewer problems , and the patients were less satisfied with the consultation . Blood pressure was recorded twice as often in surgery sessions that were booked at 10 minute intervals compared with those booked at 5 minute intervals . There was no evidence that patients who attended sessions booked at shorter intervals received more prescriptions , were investigated or referred more often to hospital specialists , or returned more often for further consultations within four weeks . There was no evidence that the doctors experienced more stress in dealing with consultations that were booked at 5 minute intervals than at consultations booked at 7.5 and 10 minute intervals , though they complained of shortage of time more often in surgery sessions that were booked at shorter intervals BACKGROUND Shared decision-making ( SDM ) between professionals and patients is increasingly advocated from ethical principles . Some data are accruing about the effects of such approaches on health or other patient-based outcomes . These effects often vary substantially between studies . OBJECTIVE Our aim was to evaluate the effects of training GPs in SDM , and the use of simple risk communication aids in general practice , on patient-based outcomes . METHODS A cluster r and omized trial with crossover was carried out with the participation of 20 recently qualified GPs in urban and rural general practice s in Gwent , South Wales . A total of 747 patients with known atrial fibrillation , prostatism , menorrhagia or menopausal symptoms were invited to a consultation to review their condition or treatments . After baseline , participating doctors were r and omized to receive training in ( i ) SDM skills ; or ( ii ) the use of simple risk communication aids , using simulated patients . The alternative training was then provided for the final study phase . Patients were r and omly allocated to a consultation during baseline or intervention 1 ( SDM or risk communication aids ) or intervention 2 phases . A r and omly selected half of the consultations took place in ' research clinics ' to evaluate the effects of more time for consultations , compared with usual surgery time . Patient-based outcomes were assessed at exit from consultation and 1 month follow-up . These were : COMRADE instrument ( principal measures ; subscales of risk communication and confidence in decision ) , and a range of secondary measures ( anxiety , patient enablement , intention to adhere to chosen treatment , satisfaction with decision , support in decision making and SF-12 health status measure ) . Multilevel modelling was carried out with outcome score as the dependent variable , and follow-up point ( i.e. exit or 1 month later for each patient ) , patient and doctor levels of explanatory variables . RESULTS No statistically significant changes in patient-based outcomes due to the training interventions were found : COMRADE risk communication score increased 0.7 [ 95 % confidence interval ( CI ) -0.92 to 2.32 ] after risk communication training and 0.9 ( 95 % CI -0.89 to 2.35 ) after SDM training ; and COMRADE satisfaction with communication score increased by 1.0 ( 95 % CI -1.1 to 3.1 ) after risk communication , and decreased by 0.6 ( 95 % CI 2.7 to -1.5 ) after SDM training . Patients ' confidence in the decision ( 2.1 increase , 95 % CI 0.7 - 3.5 , P < 0.01 ) and expectation to adhere to chosen treatments ( 0.7 increase , 95 % CI 0.04 - 1.36 , P < 0.05 ) were significantly greater among patients seen in the research clinics ( when more time was available ) compared with usual surgery time . Most outcomes deteriorated between exit and 1 month later . There was no interaction between intervention effects . CONCLUSION Patients can be more involved in treatment decisions , and risks and benefits of treatment options can be explained in more detail , without adversely affecting patient-based outcomes . SDM and risk communication may be advocated from values and ethical principles even without evidence of health gain or improvement in patient-based outcomes , but the re sources required to enhance these professional skills must also be taken into consideration . These data also indicate the benefits of extra consultation time 
    Output:
    
We did not find sufficient evidence to support or refute a policy of altering the lengths of primary care physicians ' consultations .