***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: Objective The objective was to evaluate the effect of a clinic-based intervention program on mammography use by inner-city women . Design A r and omized controlled trial employing firm system methodology was conducted . Setting The study setting was a general internal medicine clinic in the university-affiliated county hospital serving metropolitan Seattle . Participants Women aged 50 to 74 years with at least one routine clinic appointment ( when they were due for mammography ) during the study period were enrolled in the trial ( n=314 ) . Interventions The intervention program emphasized nursing involvement and included physician education , provider prompts , use of audiovisual an printed patient education material s , transportation assistance in the form of bus passes , preppointment telephone or postcard reminders , and rescheduling assistance . Control firm women received usual care . Measurement and Main Results Mammography completion within 8 weeks of clinic visits was significantly higher among intervention ( 49 % ) than control ( 22 % ) firm women ( p<.001 ) . These effects persisted after adjustment for potential confounding by age , race , medical insurance coverage , and previous mammography experience at the hospital ( odds ratio 3.5 ; 95 % confidence interval 1.9 , 6.5 ) . The intervention effect was modified by type of insurance coverage as well as prior mammography history . Process evaluation indicated that bus passes and rescheduling efforts did not contribute to the observed increases in screening participation . Conclusions A clinic-based program incorporating physician education , provider prompts , patient education material s , and appointment reminders and emphasizing nursing involvement can facilitate adherence to breast cancer screening guidelines among inner-city women OBJECTIVES Message tailoring , based on individual needs and circumstances , is commonly used to enhance face-to-face patient counseling . Only recently has individual tailoring become feasible for printed messages . This study sought to determine whether printed tailored recommendations addressing women 's specific screening and risk status and perceptions about breast cancer and mammography are more effective than st and ardized printed recommendations . METHODS Computer-assisted telephone interviews were conducted with 435 women , aged 40 to 65 years , who had visited family practice groups within the previous 2 years . Subjects were r and omly allocated to receive individually tailored or st and ardized mammography recommendation letters mailed from physicians to patients ' homes . Follow-up interviews were conducted 8 months later . RESULTS Tailored letter recipients were more likely to remember and to have read more of their letters than st and ardized version recipients . After controlling for baseline status , tailored letter receipt was associated with more favorable follow-up mammography status for women with incomes below $ 26,000 and for Black women . CONCLUSIONS Tailored messages are a more effective medium for physicians ' mammography recommendations ; tailoring may be especially important for women of low socioeconomic status This paper discusses the results from the field test of a multimedia health education intervention , design ed to provide breast cancer education for low income Latinas . The purpose of the field test was to ascertain whether the intervention produced significant changes in breast cancer knowledge and attitude , and screening intentions . A total of 1197 Latina women participated in the field study at six different sites . The majority of the participants were under 65 years of age , foreign-born with less than eight years of education and a weekly household income that fell in the lowest income quintile for 1998 ( < $ 350.00 ) . Participants were r and omly assigned to a control or intervention condition . The control group was interviewed about their  breast cancer knowledge , attitude and mammography intentions  prior to exposure to the intervention , and served as the baseline group . Women in the intervention group exhibited higher knowledge scores than the pretest group ( Chi sq . , p ≤ 0001 ) . Never-screened women exhibited the largest differences in knowledge scores relative to the baseline sample . The intervention also increased the likelihood of women seeking information about a mammogram To determine effective methods of promoting routine cancer screening , we r and omly assigned 62 internal medicine residents to receive cancer screening reminders ( computer-generated lists of overdue tests at patients ' visits ) , audit with feedback ( monthly seminars about screening , with feedback about their performance rates ) , or no intervention ( controls ) .  Half of the residents in each group also were r and omized to receive patient education ( patients received literature and notices of overdue tests ) . We review ed a sample of each physician 's medical records to assess performance of seven tests during 9-month periods before and after initiating the interventions . Cancer screening reminders increased performance of six of seven tests ; audit with feedback , four of seven tests ; and patient education , one of two targeted breast cancer screening tests . The results indicate that the cancer screening reminders strategy was the most effective in promoting the performance of routine cancer screening tests To estimate the effect of cost sharing on seeking care for serious and minor symptoms , we analyzed data for 3539 persons aged 17 to 61 from the R and Health Insurance Experiment . Participants were r and omly assigned to a free-care group or to insurance plans requiring them to pay part of the costs ( cost-sharing group ) . Annual surveys were administered to determine if participants had serious and minor symptoms during the preceding month and whether they saw a physician . Serious symptoms were judged by a panel of physicians to warrant care in most instances ; minor symptoms were judged neither to be severe nor to warrant care in most instances . The cost-sharing group was nearly one third less likely than the free-care group to see a physician when they had minor symptoms ( 6.3 % compared with 9.0 % ; p less than 0.04 ) . The free-care and cost-sharing groups did not differ significantly in seeking care for serious symptoms ( 22.3 % compared with 17.9 % ; p = 0.095 ) . However , for participants with low socioeconomic status who began the study in poor health , the prevalence of serious symptoms was higher in the cost-sharing than the free-care group ( 29.1 % compared with 23.8 % , p less than 0.004 ) The study evaluated a theory-based breast cancer control program specially developed for less acculturated Latinas . The authors used a quasi-experimental design with r and om assignment of Latinas into experimental ( n = 51 ) or control ( n = 37 ) groups that completed one pretest and two posttest surveys . The experimental group received the educational program , which was based on B and ura 's self-efficacy theory and Freire 's empowerment pedagogy . Outcome measures included knowledge , perceived self-efficacy , attitudes , breast self-examination ( BSE ) skills , and mammogram use . At posttest 1 , controlling for pretest scores , the experimental group was significantly more likely than the control group to have more medically recognized knowledge ( sum of square [ SS ] = 17.0 , F = 6.58 , p < .01 ) , have less medically recognized knowledge ( SS = 128.8 , F = 39.24 , p < .001 ) , greater sense of perceived self-efficacy ( SS = 316.5 , F = 9.63 , p < .01 ) , and greater adeptness in the conduct of BSE ( SS = 234.8 , F = 153.33,p < .001 ) . Cancer control programs design ed for less acculturated women should use informal and interactive educational methods that incorporate skill-enhancing and empowering techniques To investigate whether medical housestaff report race information differently during case presentations of black patients and white patients , a prospect i ve observational study was performed . Without informing housestaff , a chief resident recorded data during consecutive case presentations over two months . For each presentation , the data included : 1 ) whether , where , and how often race was identified ; 2 ) whether certain prospect ively selected , “ possibly unflattering characteristics ” were mentioned ; and 3 ) whether any “ justifying ” diagnoses were considered during presentation or subsequent discussion . Justifying diagnoses were those in which a patient ’s race was important in considering the likelibood of possible diagnoses . Twenty-three bouse officers presented 18 black and 35 white patients . A single East Indian patient was excluded from analysis . Race was specified more often during presentations of black than of white patients ( 16 of 18 for blacks vs. 19 of 36 for whites ; p<0.01 ) . For two black patients , a justifying diagnosis was considered , but excluding these patients did not change the results . Two other differences did not achieve statistical significance . Race was more often specified prominently and repeatedly during presentations of black patients . Among patients to whom “ possibly unflattering ” characteristics were attributed , race was more likely to be specified for blacks ( 10 of 10 ) than for whites ( 4 of 9 ) . These case presentations appeared to show a subtle bias OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Screening mammography is underutilized in many primary care practice s. We design ed a prospect i ve , controlled trial to evaluate two strategies for improving the utilization of mammography in an academic general medicine clinic . We assigned teams of house officers to ( 1 ) physician audit with periodic feedback , ( 2 ) a visit-based strategy directed at both patient and physician , or ( 3 ) a no intervention concurrent control arm . After 6 months , the percentage of 50- to 74-year-old women meeting the st and ard of an annual mammogram  was 36 % for patients in the control arm , 62 % for patients of feedback residents , and 54 % for patients of the arm receiving the visit-based strategy . Patients of female providers were slightly more likely to meet the st and ard , but no effects were detected for patient race , new as opposed to follow-up patient , or higher frequency of clinic visits . We conclude that audit with feedback and a new visit-based strategy of a patient cue associated with a simplification of the ordering process each greatly improved the rate of utilization of screening mammography . Practitioners could reasonably choose the strategy most suited to their own situation Abstract OBJECTIVE : To determine if women would have higher breast and cervical cancer screening rates  if lay health advisers recommended screening and offered a convenient screening opportunity . DESIGN : Controlled trial . SETTING : Urban county teaching hospital . PARTICIPANTS : Women aged 40 years and over attending appointements in several non- primary -care outpatient clinics . INTERVENTIONS : Lay health advisers assessed the participants ’ breast and cervical cancer screening status and offered women in the intervention group who were due for screening an appointment with a female nurse practitioner . MEASUREMENTS AND MAIN RESULTS : Screening rates at base-line and at follow-up 1 year after the intervention were determined . At follow-up , the mammography rate was 69 % in the intervention group versus 63 % in the usual care group ( p=.009 ) , and the Pap smear rate was 70 % in the intervention group versus 63 % in the usual care group ( p=.02 ) . In women who were due for screening at baseline , the mammography rate was 60 % in the intervention group versus 50 % in the usual care group ( p=.006 ) , and the Pap smear rate was 63 % in the intervention group versus 50 % in the usual care group ( p=.002 ) . The intervention was effective across age and insurance payer strata , and was particularly effective in Native American women . CONCLUSIONS : Breast and cervical cancer screening rates were improved in women attending non- primary -care outpatient clinics by using lay health advisers and a nurse practitioner to perform screening . The effect was strongest in women in greatest need of screening Objective : To improve compliance with computer-generated reminders to perform fecal occult blood testing ( FOBT ) , mammography , and cervical Papanicolaou ( Pap ) testing . Design : Six-month prospect i ve , r and omized , controlled trial . Setting : Academic primary care general internal medicine practice .Subjects : Thirty-one general internal medicine faculty , 145 residents , and 5,407 patients with scheduled visits who were eligible for any of the three cancer screening protocol s 
    Output:
    
Among patient-targeted screening interventions , those that are culturally tailored or addressed financial or logistical barriers are generally more effective than reminder-based interventions , especially among women with fewer financial re sources and those without previous mammography .
Chart-based reminders increase physician adherence to mammography guidelines but are less effective at increasing clinical breast examination .
Several trials demonstrate that case management is an effective strategy for expediting diagnostic testing after screening abnormalities have been found .
Additional support for these and other proven health care organization-based interventions appears justified and may be necessary to eliminate racial and ethnic breast cancer disparities