***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 
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    Input: Objective To evaluate the effectiveness of home delivered pragmatic rehabilitation — a programme of gradually increasing activity design ed collaboratively by the patient and the therapist— and supportive listening — an approach based on non-directive counselling — for patients in primary care with chronic fatigue syndrome/myalgic encephalomyelitis or encephalitis ( CFS/ME ) . Design Single blind , r and omised , controlled trial . Setting 186 general practice s across the north west of Engl and between February 2005 and May 2007 . Participants 296 patients aged 18 or over with CFS/ME ( median illness duration seven years ) diagnosed using the Oxford criteria . Interventions Participants were r and omly allocated to pragmatic rehabilitation , supportive listening , or general practitioner treatment as usual . Both therapies were delivered at home in 10 sessions over 18 weeks by one of three adult specialty general nurses who had received four months ’ training , including supervised practice , in each of the interventions . GP treatment as usual was unconstrained except that patients were not to be referred for systematic psychological therapies during the treatment period . Main outcome measures The primary clinical outcomes were fatigue and physical functioning at the end of treatment ( 20 weeks ) and 70 weeks from recruitment compared with GP treatment as usual .  Lower fatigue scores and higher physical functioning scores denote better outcomes . Results A total of 257 ( 87 % ) of the 296 patients who entered the trial were assessed at 70 weeks , the primary outcome point . Analysis was on an intention to treat basis , with robust treatment effects estimated after adjustment for missing data using probability weights . Immediately after treatment ( at 20 weeks ) , patients allocated to pragmatic rehabilitation ( n=95 ) had significantly improved fatigue ( effect estimate -1.18 , 95 % confidence interval -2.18 to -0.18 ; P=0.021 ) but not physical functioning ( -0.18 , 95 % CI -5.88 to + 5.52 ; P=0.950 ) compared with patients allocated to treatment as usual ( n=100 ) . At one year after finishing treatment ( 70 weeks ) , there were no statistically significant differences in fatigue or physical functioning between patients allocated to pragmatic rehabilitation and those on treatment as usual ( -1.00 , 95 % CI -2.10 to + 0.11 ; P=0.076 and + 2.57 , 95 % CI 3.90 to + 9.03 ; P=0.435 ) . At 20 weeks , patients allocated to supportive listening ( n=101 ) had poorer physical functioning than those allocated to treatment as usual ( -7.54 , 95 % CI -12.76 to -2.33 ; P=0.005 ) and no difference in fatigue . At 70 weeks , patients allocated to supportive listening did not differ significantly from those allocated to treatment as usual on either primary outcome . Conclusions For patients with CFS/ME in primary care , pragmatic rehabilitation delivered by trained nurse therapists  improves fatigue in the short term compared with unconstrained GP treatment as usual , but the effect is small and not statistically significant at one year follow-up . Supportive listening delivered by trained nurse therapists is not an effective treatment for CFS/ME . Trial registration International St and ard R and omised Controlled Trial Number I RCT N74156610 BACKGROUND Patients frequently present with unexplained fatigue in primary care , but there have been few treatment trials in this context . We aim ed to test cognitive behaviour therapy ( CBT ) and grade d exercise therapy ( GET ) for patients presenting to their family doctor with fatigue . Secondly , we described the outcome for a cohort of patients who presented to the same doctors with fatigue , who received st and ard care , plus a booklet . METHOD This was a r and omized trial , followed by a prospect i ve cohort study . Twenty-two practice s in SE Engl and referred 144 patients aged 16 to 75 years with over 3 months of unexplained fatigue . Self-rated fatigue score , the hospital anxiety and depression rating scale , functional impairment , physical step-test performance and causal attributions were measured . In the trial six sessions of CBT or GET were r and omly allocated . RESULTS In the therapy groups the mean fatigue score decreased by 10 points ( 95 % confidence interval ( CI ) = -25 to -15 ) , with no significant difference between groups ( mean difference = -1.3 ; CI = -3.9 to 1.3 ) . Fewer patients attended for GET . At outcome one-half of patients had clinical ly important fatigue in both r and omized groups , but patients in the group offered CBT were less anxious . Twenty-seven per cent of the patients met criteria for CFS at baseline . Only 25 % of this subgroup recovered , compared to 60 % of the subgroup that did not meet criteria for CFS . CONCLUSIONS Short courses of GET were not superior to CBT for patients consulting with fatigue of over 3 months in primary care . CBT was easier ' to sell ' . Low recovery in the CFS subgroup suggests that brief treatment is too short BACKGROUND Although hypochondriasis is generally thought to be a chronic and stable condition with a relatively low remission rate , this disorder remains understudied . METHODS This is a 4- to 5-year prospect i ve case-control study of DSM-III-R hypochondriasis . Medical out patients meeting DSM diagnostic criteria for hypochondriasis completed an extensive research battery assessing hypochondriacal symptoms , medical and psychiatric comorbidity , functional status and role impairment , and medical care . A comparison group of nonhypochondriacal patients from the same setting underwent the same battery . Four to 5 years later , both cohorts were re-interviewed . RESULTS One hundred twenty hypochondriacal and 133 nonhypochondriacal comparison patients were originally studied . Follow-up was obtained on 73.5 % ( n = 186 ) of all patients . At follow-up , the hypochondriacal sample was significantly ( P<.001 ) less hypochondriacal and had less somatization ( P<.001 ) and disability than at inception , but 63.5 % ( n = 54 ) still met DSM-III-R diagnostic criteria . When compared with the comparison group using repeated measures multivariate analysis of variance , these changes remained statistically significant ( P<.0001 ) . Changes in medical and psychiatric comorbidity did not differ between the 2 groups . When hypochondriacal patients who did and did not meet diagnostic criteria at follow-up were compared , the latter had significantly less disease conviction ( P<.05 ) and somatization ( P<.01 ) at inception , and their incidence of major medical illness during the follow-up period was significantly ( P<.05 ) greater . CONCLUSIONS Hypochondriacal patients show a considerable decline in symptoms and improvement in role functioning over 4 to 5 years but two thirds of them still meet diagnostic criteria . Hypochondriasis , therefore , carries a very substantial , long-term burden of morbidity , functional impairment , and personal distress Abstract Background Somatoform disorders are characterized by the presence of multiple somatic symptoms without an organic cause that completely explains their symptoms . These patients generate a high cost in health services . We aim to evaluate the effectiveness and feasibility of a cognitive-behaviour therapy ( CBT ) programme , administered in group and individual formats in primary care for patients who are diagnosed with abridged somatization disorder . Method / design Design : Multicentre , r and omized , controlled trial involving 3 groups , one of which is the control group consisting of st and ardized recommended treatment for somatization disorder in primary care ( Smith 's norms ) and the 2 others , the intervention groups , consisting of cognitive-behavioural therapy ( 10 sessions ) administered in individual format ( intervention group 1 ) or in group format ( intervention group 2 ) . Setting : 29 primary care health centres in the province of Zaragoza and 3 primary care health centres in the province of Mallorca , Spain . Sample : N = 204 patients , ( 68 in each of the three groups ) , aged 18–65 years , able to underst and and read Spanish , who fulfil Escobar 's criteria of Abridgged Somatization Disorder ( SSI 4,6 ) , stable with pharmacotherapy over the previous month , and who will remain stable for the next 3 months in the doctor 's opinion , having signed informed consent . Intervention : Control group : St and ardized recommended treatment for somatization disorder in primary care ( Smith 's norms ) . Intervention group : 10 weekly sessions of CBT , following a protocol design ed by Prof. Escobar 's group at UMDNJ , USA . There are 2 different treatment conditions : individual and group format . Measurements : Survey on the use of health services , number and severity of somatic symptoms , anxiety , depression , quality of life and clinical global impression . The interviewers will not know which group the patient belongs to ( blind ) . The assessment s will be carried out at baseline , post-treatment , 6 months and 12 post-treatment . Main variables : Utilization of health services , number and severity of somatic symptoms . Analysis : The analysis will be per intent to treat . We will use the general linear models of the SPSS v.15 statistical package , to analyse the effect of treatment on the result variable ( utilization of health services , number and severity of somatic symptoms ) . Discussion It is necessary to develop more effective psychological treatments for somatoform disorders . This r and omised clinical trial will determine whether cognitive behaviour therapy , both in group or in individual format , is effective for the treatment of these patients .Trial registration Current controlled trials IS RCT This study reports the results of a r and omized trial of a psychiatric consultation intervention with distressed , high utilizing patients of 18 physicians in two primary care clinics .  Psychiatric consultation was associated with a significant increase in the use of antidepressants in intervention patients compared with controls in the first 6 months after intervention . Intervention patients were also significantly more likely to continue  antidepressant treatment  than control patients . The primary care physicians receiving psychiatric consultations increased the rate of prescribing antidepressant medications  in their practice from 32 prescriptions filled per 1,000 visits before their participation in four consultations to 44 new prescriptions per 1,000 visits in the 12-month period after . There were no significant differences between intervention patients and controls at 6 and 12 months after r and omization in psychiatric distress , functional disability , or utilization of health care ( ambulatory visits , radiographic and laboratory testing services , admissions to inpatient medical care ) BACKGROUND Reattribution is frequently taught to general practitioners ( GPs ) as a structured consultation that provides a psychological explanation for medically unexplained symptoms . AIMS To determine if practice -based training of GPs in reattribution changes doctor-patient communication , thereby improving outcomes in patients with medically unexplained symptoms of 3 months ' duration . METHOD Cluster r and omised controlled trial in 16 practice s , 74 GPs and 141 patients with medically unexplained symptoms of 6 hours of reattribution training v. treatment as usual .  RESULTS With training , the proportion of consultations mostly consistent with reattribution increased ( 31 v. 2 % , P=0.002 ) . Training was associated with decreased quality of life ( health thermometer difference -0.9 , 95 % CI -1.6 to -0.1 ; P=0.027 ) with no other effects on patient outcome or health contacts . CONCLUSIONS Practice -based training in reattribution changed doctor-patient communication without improving outcome of patients with medically unexplained symptoms BACKGROUND Somatisation is highly prevalent in primary care ( present in 25 % of visiting patients ) but often goes unrecognised . Non-recognition may lead to ineffective treatment , risk of iatrogenic harm , and excessive use of healthcare services . AIM To examine the effect of training on diagnosis of somatisation in routine clinical practice by general practitioners ( GPs ) . DESIGN OF STUDY Cluster r and omised controlled trial , with practice s as the r and omisation unit . SETTING Twenty-seven general practice s ( with a total of 43 GPs ) in Vejle County , Denmark . METHOD Intervention consisted of a multifaceted training programme ( the TERM [ The Extended Reattribution and Management ] model ) . Patients were enrolled consecutively over a period of 13 working days .  Psychiatric morbidity was assessed by means of a screening question naire . GPs categorised their diagnoses in another question naire . The primary outcome was GP diagnosis of somatisation and agreement with the screening question naire . RESULTS GPs diagnosed somatisation less frequently than had previously been observed , but there was substantial variation between GPs . The difference between groups in the number of diagnoses of somatisation failed to reach the 5 % significance ( P = 0.094 ) . However , the rate of diagnoses of medically unexplained physical symptoms was twice as high in the intervention group as in the control group ( 7.7 % and 3.9 % , respectively , P = 0.007 ) . Examination of the agreement between GPs ' diagnoses and the screening question naire revealed no significant difference between groups . CONCLUSION Brief training increased GPs ' awareness of medically unexplained physical symptoms . Diagnostic accuracy according to a screening question naire remained unaffected but was difficult to evaluate , as there is no agreement on a gold st and ard for somatisation in general practice BACKGROUND Fatigue is a common complaint that may lead to long-term sick leave and work disability . AIMS To assess the efficacy of cognitive-behavioural therapy by general practitioners for unexplained , persistent fatigue among employees . METHO 
    Output:
    
Current evidence does not answer the question whether enhanced care delivered by front line primary care professionals has an effect or not on the outcome of patients with functional somatic symptoms .
There is some indication from this and other review s that more intensive interventions are more successful in changing patient outcomes