***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: The purpose of our prospect i ve , controlled study was to determine whether providing the results of a psychiatric screening instrument , the General Health Question naire ( GHQ ) , to emergency physicians would result in a change in the detection and management of patients with psychosocial problems . Five hundred ninety-nine emergency department patients were enrolled , 242 in the control and 357 in the intervention group . Noncritical patients , selected by presenting complaint , were given the GHQ to complete before physician evaluation ; those whose GHQ scores were high ( 10 or higher ) were identified as having a greater likelihood of having psychosocial problems . During the intervention phase , physicians were provided the patient 's GHQ score before beginning their evaluation , as well as a specific mechanism for psychosocial referral . A significantly greater proportion of patients with high GHQ scores in both study groups were judged by physicians to have a psychiatric problem ( P less than .0001 ) . During the intervention phase , patients with high scores more frequently were assigned a psychiatric diagnosis ( 14.1 % vs 7.7 % ) and received psychosocial referral ( 36.1 % vs 5.7 % ) . However , only the latter difference was statistically significant ( P less than .0001 ) . The majority ( 85.7 % ) of patients offered psychosocial referral accepted their referral . There was no difference in the number of laboratory tests ordered or medical/surgical referrals requested between patients in the control or intervention groups with high scores . Therefore , providing GHQ results to emergency physicians led to more frequent psychiatric diagnoses and psychosocial referrals of patients with high GHQ scores but did not alter their medical management The objective was to assess the potential benefits of the routine use of the MOS SF-36 Health Survey ( SF-36 ) in the care of ambulatory patients . The design was a longitudinal , prospect i ve , r and omized , controlled study set in the outpatient neurology clinic at the New Engl and Medical Center . There were 163 consecutive patients with epilepsy who had 210 follow-up visits with one of two epileptologists . The patients completed the SF-36 before the patient-physician encounter and the forms were optically scanned . The SF-36 results of the intervention group patients were given to the physicians before the encounter and withheld for control group patients . For intervention group patients , the physicians completed a question naire assessing the impact of the SF-36 on the process of care . After the visit , all patients completed a satisfaction question naire . The main outcome measures were the physicians ' responses to st and ardized questions about the usefulness of the SF-36  for communication with and management of epilepsy patients and the patients ' responses to st and ardized questions about their satisfaction with care . The physicians indicated that the SF-36 provided new information in 63 % of the intervention group encounters . A change in therapy was prompted in 13 % . The physicians rated the SF-36 as at least moderately useful for communication in 14 % of the encounters and to management in 8 % . The lower ( indicating worse health status ) the patients ' SF-36 scale scores , the more useful the SF-36 results were rated by the physicians for communication and management . It was concluded that the routine use of health status measures may enhance patients ' care This study was design ed to test the short-term effects of health assessment on the process of care and patient satisfaction . The 29 Chart physicians used the Dartmouth COOP Charts to measure their adult patients '  health status during a single clinical encounter ; the 27 control clinicians used no measure of health status . We compared the change between baseline and post-intervention information for a sample of all study clinicians ' patients . Most of the patients were female ( 67 % ) , well educated ( 70 % had at least a college education ) and young ( approximately 90 % were aged 59 years or younger ) . We found that the ordering of tests and procedures for women was increased by exposure to the COOP Charts ( 52 % vs. 35 % ; p<0.01 ) ; the effect in men was not as significant ( 37 % vs. 23 % : p=0.06 ) . Although women reported no change in satisfaction with care , men cl aim ed that the clinician helped in the management of pain ( p=0.02 ) . We conclude that the use of health status measures during a single clinical encounter in an HMO changes clinician test ordering behaviour and may improve the help male patients receive for pain conditions . The long-term impact of these management changes is not known Objectives : To measure the prevalence of high scores on the Geriatric Depression Scale in an inpatient unit for older people and assess whether administration of this instrument increased the use of antidepressant medication . Design : R and omized controlled trial . Setting : Inpatient unit for assessment , treatment and rehabilitation of older adults in a district hospital . Subjects : Consecutive admissions to the inpatient unit were approached . Of 198 people , 100 gave consent and were r and omized to receive the intervention . Interventions : The  Geriatric Depression Scale and the Folstein Mini-mental State Examination were administered to the intervention group . The Nottingham Instrumental Activities of Daily Living question naire and the Folstein Mini-mental State Examination were administered to the placebo group . The scores of these instruments and a copy of the completed instrument were placed in the subject 's case notes . For those subjects r and omized to receive the Geriatric Depression Scale an interpretation of the score was written in the case notes . Main outcome measures : The primary outcome measure was whether antidepressant medication was listed on the discharge summary for the admission . Other outcome measures were death , readmission and use of antidepressant medication three months after administration of the instruments . Results : There was a prevalence of Geriatric Depression Scale scores greater than 10 of 52 % in the 50 people administered this instrument . Six out of 46 people administered the Geriatric Depression Scale  , who were discharged in the study period , were on antidepressant medication at discharge . Three out of 47 people administered the placebo instrument were on antidepressant medication at discharge . The absolute difference in proportions was 6.7 % , 95 % confidence interval 19 to – 5.3 % . Conclusions : A high proportion of patients admitted to an inpatient unit for assessment , treatment and rehabilitation scored in the depressed range on the Geriatric Depression Scale ; however , use of the Geriatric Depression Scale in this clinical setting did not increase the use of antidepressant medication . This may be because the instrument is too nonspecific The authors estimated components of variance and intraclass correlation coefficients ( ICCs ) to aid in the design of complex surveys and community intervention studies by analyzing data from the Health Survey for Engl and 1994 . This cross-sectional survey of English adults included data on a range of lifestyle risk factors and health outcomes . For the survey , households were sample d in 720 postal code sectors nested within 177 district health authorities and 14 regional health authorities . Study subjects were adults aged 16 years or more .  ICCs and components of variance were estimated from a nested r and om-effects analysis of variance . Results are presented at the district health authority , postal code sector , and household levels . Between-cluster variation was evident at each level of clustering . In these data , ICCs were inversely related to cluster size , but design effects could be substantial when the cluster size was large . Most ICCs were below 0.01 at the district health authority level , and they were mostly below 0.05 at the postal code sector level . At the household level , many ICCs were in the range of 0.0 - 0.3 . These data may provide useful information for the design of epidemiologic studies in which the units sample d or allocated range in size from households to large administrative areas OBJECTIVE A r and omized controlled trial was conducted to examine the clinical effectiveness of providing general practitioners ( GPs ) with the results of a self-administered computerized assessment of common mental disorders . METHOD Attenders at a general practice in a deprived inner city area of South London were identified using case finding question naires . Six hundred and eighty-one subjects were r and omly allocated to three groups which differed in the information provided to the GP : 1 ) no additional information was given to the GP ; 2 ) the results of the 12 item General Health Question naire ( GHQ ) were given to the GP ( the GHQ is a paper and pencil question naire that assesses common mental disorders ) ; 3 ) the results of a self-administered computerized assessment ( PROQSY ) of common mental disorders were provided for the GP . RESULTS Clinical outcome was assessed using the 12-item GHQ . Consultations with the GP , prescriptions and referrals within and outside the practice were also recorded . The group in whom the GP received the results of the computerized assessment showed a modest clinical improvement , relative to the other two groups after 6 weeks . There was no difference in clinical outcome between the groups at 6 months . There appeared to be no increase in consultations or prescriptions in the computerized assessment group . CONCLUSIONS Self-administered computerized assessment s for psychiatric disorder have potential as a means of improving the clinical outcome of patients in primary care . It is likely that the effectiveness of the approach would be greatly increased by linking the results of computerized assessment s to clinical practice guidelines , tailored to the individual patient by means of computerized technology OBJECTIVE : To improve functional status among primary care patients .INTERVENTION : 1 ) Computer-generated feedback to physicians about the patient ’s functional status , the patient ’s self-reported “ chief complaint , ” and problem-specific re source and management suggestions ; and 2 ) two brief interactive educational sessions for physicians . DESIGN : R and omized controlled trial . SETTING : University primary care clinic . PARTICIPANTS : All 73 internal medicine houseofficers and 557 of their new primary care patients . MEASURES : 1 ) Change in patient functional status from enrollment until six months later , using the Functional Status Question naire ( FSQ ) ;  2 )  management plans and additional information about functional status abstract ed from the medical record ; and 3 ) physician attitude about whether internists should address functional status problems . RESULTS : Emotional well-being scores improved significantly for the patients of the experimental group physicians compared with those of the control group physicians ( p<0.03 ) . Limitations in social activities indicated as “ due to health ” decreased among the elderly ( > 70 years of age ) individuals in the experimental group compared with the control group ( p<0.03 ) . The experimental group physicians diagnosed more symptoms of stress or anxiety than did the control group physicians ( p<0.001 ) and took more actions recommended by the feedback form ( p<0.02 ) . CONCLUSIONS : Computer-generated feedback of functional status screening results accompanied by re source and management suggestions can increase physician diagnoses of impaired emotional well-being , can influence physician management of functional status problems , and can assist physicians in improving emotional well-being and social functioning among their patients OBJECTIVE : To describe primary care physicians ’ clinical decision making regarding late-life depression .  DESIGN : Longitudinal collection of data regarding physicians ’ clinical assessment s and the volume and content of patients ’ ambulatory visits as part of a r and omized clinical trial of a physician-targeted intervention to improve the treatment of late-life depression . SETTING : Academic primary care group practice . PATIENTS / PARTICIPANTS : One-hundred and eleven primary care physicians who completed a structured question naire to describe their clinical assessment s immediately following their evaluations of 222 elderly patients who had reported symptoms of depression on screening question naires . EVTERVENTIONS : Intervention physicians were provided with their patient ’s score on the Hamilton Depression rating scale ( HAM-D ) and patient-specific treatment recommendations prior to completing the question naire regarding their clinical assessment .MAIN RESULTS : Those physicians not provided HAM-D scores were just as likely to rate their patients as depressed , as determined by specific query of these physicians regarding their clinical assessment s. A physician ’s clinical rating of likely depression did not consistently result in the formulation of treatment intentions or actions . Treatment intentions and actions were facilitated by provision of treatment algorithms , but treatment was received by fewer than half of the patients whom physicians intended to treat . Barriers to treatment appear to include both physician and patient doubts about treatment benefits . CONCLUSIONS : Lack of recognition of depressive symptoms did not appear to be the primary barrier to treatment . Recognition of symptoms and access to treatment algorithms did not consistently result in progression to subsequent stages in treatment decision making . More research is needed to determine how patients and physicians weigh the potential risks and benefits of treatment and how accurately they make these judgments The study assessed the effect of screening for mental disorder by means of the General Health Question naire ( GHQ ) on the rate of detection of  mental disorder by fourteen physicians in a primary -care clinic . After completing the GHQ , patients were r and omised into control ( 722 patients ) and experimental ( 730 patients ) groups .  GHQ results of the experimental group were made available to the physicians ; those of the control group were not . Sociodemographic factors influenced the physicians ' rate of diagnosis of mental disorders ( rates were lower for men , students , and patients with at least a partial college education than in subjects who had a low income , less than 7 years of school , or were widowed ) but there was no difference between control and experimental groups ( 16.8 % vs 16.0 % ) . Among patients with a prior diagnosis of a mental disorder , twice as many were found to have mental disorders by the physicians as by the GHQ ( 70 % vs 33 % ) CONTEXT Care of patients with depression in managed primary care setting s often fails to meet guideline st and ards , but the long-term impact of quality improvement ( QI ) programs for depression care in such setting s is unknown . OBJECTIVE To determine if QI programs in managed care practice s for depressed primary care patients improve quality of care , health outcomes , and employment . DESIGN R and omized controlled trial initiated from June 1996 to March 1997 . SETTING Forty-six primary care clinics 
    Output:
    
There is substantial evidence that routinely administered case finding/screening question naires for depression have minimal impact on the detection , management or outcome of depression by clinicians .