***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 Physical activity promotion is a priority , but contribution of physicians ' interventions is unclear . The effectiveness of the PEPAF ( " Experimental Program for Physical Activity Promotion " ) , which was implemented exclusively by physicians in routine primary care from October 2003 to December 2004 , was assessed . METHODS Fifty-six Spanish family physicians were r and omized to either the intervention ( n = 29 ) or st and ard care ( n = 27 ) arm of the trial . The physicians recruited 4317 physically inactive patients ( 2248 for intervention and 2069 for control protocol s ) from a systematic sample after assessing their physical activity in routine practice . Intervention physicians provided advice to all patients and a physical activity prescription to the subgroup attending an additional appointment ( 30 % ) . The main outcome measure was the change in physical activity measured by blinded nurses using the 7-Day Physical Activity Recall . Secondary outcomes included cardiorespiratory fitness and health-related quality of life . RESULTS At 6 months , intervention patients increased physical activity more than controls ( adjusted difference , 18 min/wk [ 95 % confidence interval , 6 - 31 min/wk ] ; metabolic equivalent tasks x hours per week , 1.3 [ 95 % CI , 0.4 - 2.2 ] ) . The proportion of the population achieving minimal physical activity recommendations was 3.9 % higher in the intervention group ( 1.2%-6.9 % ; number needed to treat , 26 ) . No differences were found in secondary outcomes . The effect of intervention was positively modified in subjects older than 50 years ( P < or = .01 ) and in the prescription subgroup ( P < .001 ) . CONCLUSIONS Family physicians were effective for increasing physical activity of primary care patients . Overall clinical effect was small but relevant for population public health . Within the intervention program , clinical ly relevant effects were seen in patients receiving a physical activity prescription . Trial Registration clinical trials.gov Identifier : NCT00131079 Objectives Primary : To compare the effectiveness of intensive group and individual interventions for  smoking cessation in a primary health care setting ; secondary : to identify the variables associated with smoking cessation . Methods Three-pronged clinical trial with r and omisation at the individual level . We performed the following : an intensive individual intervention ( III ) , an intensive group intervention ( IGI ) and a minimal intervention ( MI ) . Included in the study were smokers who were prepared to quit smoking . Excluded from the study were individuals aged less than 18 years or with severe mental conditions or terminal illnesses . The outcome measure was continued abstinence at 12 months confirmed through CO-oximetry ( CO ) . The analysis was based on intention to treat . Results In total , 287 smokers were recruited : 81 in the III , 111 in the IGI , and 95 in the MI .  Continued abstinence at 12 months confirmed through CO was 7.4 % in the III , 5.4 % in the IGI , and 1 % in the MI . No significant differences were noted between III and MI on the one h and , and between IGI and MI on the other [ RR 7.04 ( 0.9 - 7.2 ) and RR 5.1 ( 0.6 - 41.9 ) , respectively ] . No differences were noted between IGI and III [ RR 0.7 ( 0.2 - 2.2 ) ] . In multivariate analysis , only overall visit length showed a statistically significant association with smoking cessation . Conclusions The effectiveness of intensive smoking interventions in this study was lower than expected . No statistically significant differences were found between the results of individual and group interventions .Trial registration numberIS RCT Moderate to severe chronic kidney disease ( CKD ) is associated with increased cardiovascular risk . Usually nephrologists are primarily responsible for the care of CKD patients . However , in many cases treatment goals , as formulated in guidelines , are not met . The addition of a nurse practitioner might improve the quality of care . The Multifactorial Approach and Superior Treatment Efficacy in Renal Patients with the Aid of Nurse Practitioners ( MASTERPLAN ) study is a r and omized controlled multicenter trial , aim ed at investigating whether a multifactorial approach in patients with moderate to severe CKD ( stage 3 and 4 ) to achieving treatment goals using both a polydrug strategy and lifestyle treatment either with or without the addition of a nurse practitioner will reduce cardiovascular risk and slow the decline of kidney function .  Patients ( n=793 ) have been r and omized to nurse care or physician care . In the nurse-care arm of the study , nurse practitioners use flowcharts to address risk factors requiring drug and /or lifestyle modification . They have been trained to coach patients by motivational interviewing with the aim of improving patient self-management . At baseline , both treatment groups show equal distributions with regard to key variables in the study . Moreover , in only 1 patient were all risk factors within the limits as defined in various guidelines , which underscores the relevance of our initiative OBJECTIVE To determine if lifestyle improved at a short term through an intervention to involve patients in cardiovascular risk management by the practice nurse . METHODS The IMPALA study ( 2006 , the Netherl and s ) was a cluster-r and omised controlled trial involving 25 general practice s and 615 patients who were eligible for cardiovascular risk management . The intervention consisted of ( 1 ) individual 10-year cardiovascular risk assessment , ( 2 ) risk communication , ( 3 ) use of a decision aid and ( 4 ) adapted motivational interviewing , applied by practice nurses in two consultations . Outcomes were smoking , alcohol , diet , physical activity and the secondary outcomes risk perception , anxiety , confidence about the decision and satisfaction with the communication , measured at baseline and after 12 weeks . RESULTS Patients of both groups improved their lifestyle , but no relevant significant differences between the groups were found . Intervention group patients improved in terms of the appropriateness of risk perception , although not significantly . Intervention group patients improved significantly in terms of appropriateness of anxiety and were more satisfied with the communication compared to control group patients . CONCLUSION The intervention seems to have improved the patients ' risk perception , anxiety and satisfaction with the communication , which are important conditions for shared decision making . However , we found no additional effect of the intervention on lifestyle Background : Promoting physical activity is an important public health strategy for long-term reductions in incidence or severity of clinical disease . Benefits to health-related quality of life ( HRQL ) and subjective well-being may be as important and take less time to accrue . Purpose : We examined the HRQL benefits of a social-cognitive-theory-based intervention of the Activity Counseling Trial ( ACT ) , both directly in terms of changes in physical fitness and indirectly from increased self-efficacy associated with the intervention . Methods : In ACT , 395 female and 479 male inactive patients ages 35 to 75 years were r and omized to one of : physician advice , advice plus behavioral counseling during primary care visits , or advice plus behavioral counseling that also included telephone contact and behavioral classes .  Participants were assessed at baseline , 6 months , and 24 months . HRQL was assessed as perceived quality of life , perceived stress , depression , and general health . Satisfaction with function and appearance , self-efficacy , and social support were also assessed . Results : At 24 months women who received counseling or assistance had significant reductions in daily stress and improvements in satisfaction with body function compared to those receiving advice only . Men had reductions in daily stress across all treatment arms . These results mirrored V02max changes observed per group . Change in barriers self-efficacy was significantly associated with reductions in daily stress at 24 months . Conclusions : Patient benefit from ACT intervention was mediated by enhanced cardiorespiratory fitness and by barriers self-efficacy The goal of evidence -based medicine is ultimately to improve patient outcomes and quality of care .  Systematic review s of the available published evidence are required to identify interventions that lead to improvements in behavior , health , and well-being . Authoritative literature review s depend on the quality of published research and research reports . The Consoli date d St and ards for Reporting Trials ( CONSORT ) Statement ( www.consort-statement.org ) was developed to improve the design and reporting of interventions involving r and omized clinical trials ( RCTs ) in medical journals . We describe the 22 CONSORT guidelines and explain their application to behavioral medicine research and to evidence -based practice . Additional behavioral medicine-specific guidelines ( e.g. , treatment adherence ) are also presented . Use of these guidelines by clinicians , educators , policymakers , and research ers who design , report , and evaluate or review RCTs will strengthen the research itself and accelerate efforts to apply behavioral medicine research to improve the processes and outcomes of behavioral medicine practice Background : There is an alarming prevalence of obesity and sedentariness in Western countries . An ideal context for health promotion and preventive medicine seems to be the setting of primary care provided by the general practitioner ( GP ) . Purpose : Therefore , this study evaluated the impact of GPs’brief physical activity counseling for overweight and obese patients . Methods : Individuals recruited during routine physician visits were r and omly split into an  experimental ( n = 48 ) group that received the Patient-centered Assessment and Counseling for Exercise ( PACE ) protocol , and a usual-care control ( n = 48 ) group .  Body mass index ( BMI ) and abdominal girth were assessed as objective biometrical parameters . Patients in the experimental group self-reported their readiness for physical activity and self-efficacy . Results : The experimental group had significantly better BMI and abdominal girth compared with the control group after a 5- to 6-month follow-up . Furthermore , the experimental group progressed in their stage of physical activity readiness and increased their self-efficacy . Conclusions : The GPs’counseling for physical activity using the PACE protocol influenced mediators and biometrical outcomes in an Italian primary care context PURPOSE the purpose of this study was to compare selected diabetes care processes and outcomes of nurse practitioners ( NPs ) and physicians ( MDs ) in the primary care of adults with type 2 diabetes . METHODS Adults with type 2 diabetes and no regular source of primary care were enrolled from the emergency room and r and omized to an NP or MD practice .  Chart review s were conducted to assess processes of care ; patient interviews and hemoglobin Al C ( Al C ) testing were performed to measure patient outcomes . RESULTS NPs were more likely than MDs to document provision of general diabetes education and education about nutrition , weight , exercise , and medications . They were more likely to document patient height , urinalyses results , and Al C values . No differences were found in documenting current medications ; alcohol , illicit drug , or tobacco use ; depression ; weight and blood pressure ; foot and cardiovascular exams ; blood glucose and creatinine testing ; or referral to ophthalmologists . No differences were found in patient outcomes . CONCLUSIONS This study provides preliminary evidence of interdisciplinary differences in the processes of care employed by primary care NPs and MDs in caring for patients with type 2 diabetes . NPs documented the provision of diabetes education and selected monitoring tests more frequently than MDs ; however , these differences were not reflected in 6-month patient outcomes Objective To evaluate whether  nurse run clinics in general practice improve secondary prevention in patients with coronary heart disease . Design R and omised controlled trial . Setting A r and om sample of 19 general practice s in northeast Scotl and . Patients 1173 patients ( 685 men and 488 women ) under 80 years with working diagnoses of coronary heart disease , but without terminal illness or dementia and not housebound .  Intervention Nurse run clinics promoted medical and lifestyle aspects of secondary prevention and offered regular follow up . Main outcome measures Components of secondary prevention assessed at baseline and one year were : aspirin use ; blood pressure management ; lipid management ; physical activity ; dietary fat ; and smoking status . A cumulative score was generated by counting the number of appropriate components of secondary prevention for each patient . Results There were significant improvements in aspirin management ( odds ratio 3.22 , 95 % confidence interval 2.15 to 4.80 ) , blood pressure management ( 5.32 , 3.01 to 9.41 ) , lipid management ( 3.19 , 2.39 to 4.26 ) , physical activity ( 1.67 , 1.23 to 2.26 ) and diet ( 1.47 , 1.10 to 1.96 ) . There was no effect on smoking cessation ( 0.78 , 0.47 to 1.28 ) . Of six possible components of secondary prevention , the baseline mean was 3.27 . The adjusted mean improvement attributable to intervention was 0.55 of a component ( 0.44 to 0.67 ) . Improvement was found regardless of practice baseline performance . Conclusions  Nurse run clinics proved practical to implement in general practice and effectively increased secondary prevention in coronary heart disease . Most patients gained at least one effective component of secondary prevention and , for them , future cardiovascular events and mortality could be reduced by up to a third STUDY OBJECTIVE : To study the clinical and cost outcomes of providing nutritional counselling to patients with one or more of the following conditions : overweight , hypertension and type 2 diabetes . DESIGN : The study was design ed as a r and om controlled trial . Consecutive patients were screened opportunistically for one or more of the above conditions and r and omly allocated to one of two intervention groups ( doctor/dietitian or dietitian ) or a control group . Both intervention groups received six counselling sessions over 12 months from a diet 
    Output:
    
Physicians and nurses seem equally capable of providing face-to-face communication-related BCTs in primary care .
Behavioral counseling , motivational interviewing , education and advice all seem effective communication-related BCTs .
However , BCTs were also found in less successful studies .
Furthermore , based on existing literature , one primary care profession does not seem better equipped than the other to provide face-to-face communication-related BCTs .
PRACTICE IMPLICATION S There is evidence that behavioral counseling , motivational interviewing , education and advice can be used as effective communication-related BCTs by physicians and nurses .