***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 To compare three simple methods of presenting information to patients about the risk of Down 's syndrome . STUDY DESIGN R and omised controlled trial of 150 " low risk " women booking for antenatal care before 19 weeks gestation at Sunderl and Royal Hospital . After informing the women about the purpose of the study and reassuring them that they were " low risk " , each patient was given a question naire , which used one of three different methods ( graphic , written and interactive ) to present information about the risk of Down 's syndrome . A visual analogue scale allowed us to assess their level of underst and ing and anxiety before and after the information about risk was given to them . RESULTS All three methods significantly altered patients ' perception and anxiety about the risk of Down 's syndrome . The interactive method was found to be the most effective of the three . CONCLUSION This pilot study suggests that discussing the patients ' worries about fetal anomalies with medical staff can markedly reduce their degree of anxiety . The interactive method was most effective at putting information across to the patient . It significantly reduced their level of anxiety as well as their overall worry about pregnancy Purpose The purpose of this study was to test effects of a culturally competent , dietary self-management intervention on physiological outcomes and dietary behaviors for African Americans with type 2 diabetes . Methods A longitudinal experimental study was conducted in rural South Carolina with a sample of 97 adult African Americans with type 2 diabetes who were r and omly assigned to either usual care or the intervention . The intervention consisted of 4 weekly classes in low-fat dietary strategies , 5 monthly peer-professional group discussion s , and weekly telephone follow-up . The culturally competent approach reflected the ethnic beliefs , values , customs , food preferences , language , learning methods , and health care practice s of southern African Americans . Results Body mass index and dietary fat behaviors were significantly lowered in the experimental group . At 6 months , weight decreased 1.8 kg ( 4 lb ) for the experimental group and increased 1.9 kg ( 4.2 lb ) for the control group , a net difference of 3.7 kg ( 8.2 lb ) . The experimental group reduced high-fat dietary habits to moderate while high-fat dietary habits of the control group remained essentially unchanged . A trend in reduction of A1C and lipids was observed . Conclusions Results suggest the effectiveness of a culturally competent dietary self-management intervention in improving health outcomes for southern African Americans , especially those at risk due to high-fat diets and body mass index ≥ 35 kg/mm2 . Given the burgeoning problem of obesity in South Carolina and the nation , the time has come to focus on aggressive weight management . Diabetes educators are in pivotal positions to assume leadership in achieving this goal for vulnerable , rural population OBJECTIVE To experimentally test whether using pictographs ( image matrices ) , incremental risk formats , and varied risk denominators would influence perceptions and comprehension of side effect risks in an online decision aid about prophylactic use of tamoxifen to prevent primary breast cancers . METHODS We recruited 631 women with elevated breast cancer risk from two healthcare organizations . Participants saw tailored estimates of the risks of 5 side effects : endometrial cancer , blood clotting , cataracts , hormonal symptoms , and sexual problems . Presentation format was r and omly varied in a three factor design : ( A ) risk information was displayed either in pictographs or numeric text ; ( B ) presentations either reported total risks with and without tamoxifen or highlighted the incremental risk most relevant for decision making ; and ( C ) risk estimates used 100 or 1000 person denominators . Primary outcome measures included risk perceptions and gist knowledge . RESULTS Incremental risk formats consistently lowered perceived risk of side effects but result ed in low knowledge when displayed by numeric text only . Adding pictographs , however , produced significantly higher comprehension levels . CONCLUSIONS Pictographs make risk statistics easier to interpret , reducing biases associated with incremental risk presentations . PRACTICE IMPLICATION S Including graphs in risk communications is essential to support an informed treatment decision-making process BACKGROUND The ideal method of providing stroke patients with information has not been established . OBJECTIVES To evaluate the effectiveness of providing stroke patients with computer-generated tailored written information . DESIGN R and omised controlled trial with blinded assessor . SETTING Acute stroke unit . PARTICIPANTS 138 stroke patients . METHODS Patients were r and omised to receive either computer-generated tailored written information about stroke or generic written information while in hospital . Three months following discharge , a blinded assessor evaluated the outcomes of knowledge about stroke , self-efficacy ( Self-Efficacy to Perform Self-Management Behaviours Scale ) , anxiety and depression ( Hospital Anxiety and Depression ( HAD ) Scale ) , perceived health status ( COOP charts ) , satisfaction with content and presentation of the written information received ( separate 10-point visual analogue scale for content and presentation ) , and desire for additional information . RESULTS Complete data were obtained for 133 ( 96.4 % ) patients . Patients in the intervention group were significantly more satisfied with the content ( difference on a 10-point visual analogue scale was 1 , 95 % confidence interval 0.4 to 1.7 , P = 0.003 ) and presentation ( difference on a 10-point visual analogue scale was 1.2 , 95 % confidence interval 0.6 to 1.9 , P < 0.001 ) . Significantly , fewer patients in the intervention group desired additional information about stroke at follow-up than patients in the control group ( 4.5 % versus 32.8 % ; P < 0.001 ) . Anxiety change scores improved slightly more in favour of the control group ( 1.4 difference on the HAD subscale , 95 % confidence interval 0.2 to 2.8 , P = 0.03 ) . No significant differences between the groups were observed for any of the other outcome measures . INTERPRETATION Providing stroke patients with computer-generated tailored written information improved satisfaction with the information that was received and was more effective in meeting patients ' informational needs than non-tailored information , but had no effect on knowledge about stroke , self-efficacy , depression , or perceived health status BACKGROUND We tested an intervention based on social learning theory ( SLT ) to improve colorectal  cancer ( CRC ) screening among Native Hawaiians , a group with low CRC screening rates . METHOD Sixteen Hawaiian civic clubs agreed to r and omization . Eight control clubs received a culturally targeted presentation , a free Fecal Occult Blood Test ( FOBT ) , and a reminder call . Eight experimental clubs also received culturally targeted education and free testing ; but , in line with SLT , education was delivered by a Native Hawaiian physician and Native Hawaiian CRC survivor , and members received an FOBT demo , were challenged to involve a family member in screening , and were telephoned multiple times to address change-related emotions and barriers . RESULTS One hundred twenty-one members age 50 and older from 16 clubs participated . At the club level , screening rates were modestly increased in four experimental clubs and six control clubs . Surprisingly , 64 % of participants reported being up to date with CRC screening at baseline . Only 13 individuals ( five in experimental arm and eight in the control arm ) were screened for the first time through this intervention , increasing the percent screened from 59 % to 67 % in the experimental group and from 69 % to 85 % in the control group . Although individuals in the experimental arm were more likely to rate the intervention as culturally appropriate , both arms realized similar and significant gains in CRC knowledge , attitudes , intent , and self-efficacy . CONCLUSIONS For Native Hawaiian individuals belonging to a network of civic clubs , an intervention based on SLT delivered by a Native Hawaiian physician and CRC survivor was less effective at further increasing compliance than was a culturally targeted educational session delivered by a non-Hawaiian nurse . That CRC screening compliance was high prior to our intervention suggests that we targeted a very health conscious segment of the Native Hawaiian population . Future work should focus on underserved segments of this indigenous group Background Breast cancer risk education enables women make informed decisions regarding their options for screening and risk reduction . We aim ed to determine whether patient education regarding breast cancer risk using a bar graph , with or without a frequency format diagram , improved the accuracy of risk perception . Methods We conducted a prospect i ve , r and omized trial among women at increased risk for breast cancer . The main outcome measurement was patients ' estimation of their breast cancer risk before and after education with a bar graph ( BG group ) or bar graph plus a frequency format diagram ( BG+FF group ) , which was assessed by previsit and postvisit question naires . Results Of 150 women in the study , 74 were assigned to the BG group and 76 to the BG+FF group . Overall , 72 % of women overestimated their risk of breast cancer . The improvement in accuracy of risk perception from the previsit to the postvisit question naire ( BG group , 19 % to 61 % ; BG+FF group , 13 % to 67 % ) was not significantly different between the 2 groups ( P = .10 ) . Among women who inaccurately perceived very high risk ( ≥ 50 % risk ) , inaccurate risk perception decreased significantly in the BG+FF group ( 22 % to 3 % ) compared with the BG group ( 28 % to 19 % ) ( P = .004 ) . Conclusion Breast cancer risk communication using a bar graph plus a frequency format diagram can improve the short-term accuracy of risk perception among women perceiving inaccurately high risk OBJECTIVE To determine whether an advance directive re design ed to meet most adults ' literacy needs ( fifth grade reading level with graphics ) was more useful for advance care planning than a st and ard form ( > 12th grade level ) . METHODS We enrolled 205 English and Spanish-speaking patients , aged > /=50 years from an urban , general medicine clinic . We r and omized participants to review either form . Main outcomes included acceptability and usefulness in advance care planning . Participants then review ed the alternate form ; we assessed form preference and six-month completion rates . RESULTS Forty percent of enrolled participants had limited literacy . Compared to the st and ard form , the re design ed form was rated higher for acceptability and usefulness in care planning , P</=0.03 , particularly for limited literacy participants ( P for interaction < /=0.07 ) . The re design ed form was preferred by 73 % of participants . More participants r and omized to the re design ed form completed an advance directive at six months ( 19 % vs. 8 % , P=0.03 ) ; of these , 95 % completed the re design ed form . CONCLUSIONS The re design ed advance directive was rated more acceptable and useful for advance care planning and was preferred over a st and ard form . It also result ed in higher six-month completion rates . PRACTICE IMPLICATION S An advance directive re design ed to meet most adults ' literacy needs may better enable patients to engage in advance care planning Background Australian epidemiologists have recognised that lay readers have difficulty underst and ing statistical graphs in reports on population health . This study aim ed to provide evidence for graph design improvements that increase comprehension by non-experts . Methods This was a double-blind , r and omised , controlled trial of graph- design interventions , conducted as a postal survey . Control and intervention participants were r and omly selected from telephone directories of health system employees . Eligible participants were on duty at the listed location during the study period . Controls received a booklet of 12 graphs from original publications , and intervention participants received a booklet of the same graphs with design modifications . A question naire with 39 interpretation tasks was included with the booklet . Interventions were assessed using the ratio of the prevalence of correct responses given by the intervention group to those given by the control group for each task . Results The response rate from 543 eligible participants ( 261 intervention and 282 control ) was 67 % . The prevalence of correct answers in the control group ranged from 13 % for a task requiring knowledge of an acronym to 97 % for a task identifying the largest category in a pie chart . Interventions producing the greatest improvement in comprehension were : changing a pie chart to a bar graph ( 3.6-fold increase in correct point reading ) , changing the y axis of a graph so that the upward direction represented an increase ( 2.9-fold increase in correct judgement of trend direction ) , a footnote to explain an acronym ( 2.5-fold increase in knowledge of the acronym ) , and matching the y axis range of two adjacent graphs ( two-fold increase in correct comparison of the relative difference in prevalence between two population subgroups ) . Conclusion Profound population health messages can be lost through use of overly technical language and unfamiliar statistical measures . In our study , most participants did not underst and age st and ardisation and confidence intervals . Inventive approaches are required to address this problem OBJECTIVE To determine the effectiveness of a pictorial ' mind map ' together with the Arthritis Research Campaign ( ARC ) booklet for imparting knowledge to participants with rheumatoid arthritis ( RA ) . Also , we wished to relate this to their reading ability . METHODS We studied 363 participants with RA . Reading ability was assessed using the REALM , and knowledge was assessed using the Knowledge Scale Question naire ( KSQ ) . Information on educational attainment , disease state and levels of anxiety and depression was also collected . Participants were r and omly assigned to receive either the ARC booklet alone or the booklet and the mind map together . RESULTS A significant minority ( 15 % ) of participants were functionally illiterate .  There was a statistically significant increase in knowledge across both groups from baseline to re assessment after they were given the literature , but there was no difference in attainment between the groups . The more literate participants gained more knowledge regardless of the information they were given . They were also significantly less anxious and less depressed . CONCLUSIONS The ARC booklet with or without the mind map was associated with a significant increase in knowledge .  Poor readers had poor educational attainment and poor knowledge acquisition . The information on the mind map was not more accessible to 
    Output:
    
Presentation of numerical data , verbal presentation of risks and diagrams , graphics and charts are based on good evidence .