***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: Multiphasic screening as a case-finding tool was evaluated in a r and omized , controlled study . For each of 112 physicians , a patient was assigned to one of three groups : multiphasic screening group ( SG ) , chart abstract group ( AG ) , or chart review group ( RG ) . Medical problem lists constructed before and after receiving additional information were compared . Physicians for 36 SG patients identified considerably more new medical problems , both total ( 77 ) and ones they considered important ( 25 ) , than 40 AG physicians ( 14 and 8) and 36 RG physicians ( 4 and 0 ) . One year later , 38 of the 95 newly identified problems had been acted on , 31 in the SG . Medical care was affected in nine patients : six in SG , two in AG , and one in RG . Multiphasic screening may help physicians identify new medical problems in clinic patients A system has been constructed to evaluate the design , implementation , and analysis of  r and omized control trials ( RCT ) . The degree of quadruple blinding ( the r and omization process , the physicians and patients as to therapy , and the physicians as to ongoing results ) is considered to be the most important aspect of any trial . The analytic techniques are scored with the same emphasis as is placed on the control of bias in the planning and implementation of the studies . Description of the patient and treatment material s and the measurement of various controls of quality have less weight . An index of quality of a RCT is proposed with its pros and cons . If published papers were to approximate these principles , there would be a marked improvement in the quality of r and omized control trials . Finally , a reasonable st and ard design and conduct of trials will facilitate the interpretation of those with conflicting results and help in making valid combinations of undersized trials Aims : A study was undertaken to explore how menopausal women are affected by awareness of potential risk of osteoporosis . Methods : A qualitative interview study , including analysis of in-depth interviews with 17 women who independently gave views on risk , out of 24 women interviewed about their menopausal symptoms . The women were selected on the basis of a survey including 1261 women chosen at r and om , to cover a broad spectrum of Danish women , their menopausal experiences , and contact with the healthcare system . The study was part of a larger project targeting menopause . Results : Awareness of osteoporosis risk caused a feeling of uncertainty and worry in some women . Only women reacting in this way seemed to act in order to prevent future fractures . The affected women were puzzled to realize that risk-reducing medication could introduce new hazards . Most of the women had heard about osteoporosis related to menopause as culturally embedded knowledge . Conclusions : Making individual women uncertain and worried must be considered a potentially serious side effect of health promotion . The findings raise the question of whether introducing healthy people to the threat of future diseases is ethically justifiable . As hormonal treatment is no longer recommended for long-term use , it is suggested that the strong link between osteoporosis and menopause should be toned down when counselling menopausal women OBJECTIVES This study was undertaken to determine whether adding a benefit for preventive services  to older Medicare beneficiaries would affect utilization and costs under Medicare . METHODS The demonstration used an experimental design , enrolling 4195 older , community-dwelling Medicare recipients . Medicare cl aims data for the 2 years in which the preventive visits occurred were compared for the  intervention ( n = 2105 ) and control ( n = 2090 ) groups .  Monthly allowable charges for Part A and Part B services and number of hospital discharges and ambulatory visits were compared . RESULTS There were no significant differences in the charges between the groups owing to the intervention , although total charges were somewhat lower for the intervention group even when the cost of the intervention was included . Charges for both groups rose significantly as would be expected for an aging population . A companion paper describes a modest health benefit . CONCLUSIONS There appears to be a modest health benefit with no negative cost impact . This finding gives an early quantitative basis for the discussion of whether to extend Medicare benefits to include a general preventive visit from a primary care clinician OBJECTIVE To determine the rates at which private primary -care clinics are recommending blood pressure and cholesterol measurement , smoking cessation , clinical breast examination , screening mammography , Papanicolaou testing , and influenza and pneumococcus immunizations . MATERIAL AND METHODS We conducted a mail survey of 7,997 r and omly selected patients from 44 primary -care clinics in and around Minneapolis-St . Paul , Minnesota , of whom 6,830 ( 85.4 % ) completed the question naire on preventive services delivery rates . The responses were analyzed statistically , including stratification by reason for the clinic visit . RESULTS On the average , about two-thirds of the patients in each clinic reported being up-to- date on preventive services before their clinic visit ; an exception was pneumococcus immunization ( mean rate , 33 % ) . Except for blood pressure and smoking cessation advice , less than 30 % of patients who were not up-to- date on a preventive service were offered it if the clinic visit was for a reason other than a checkup or physical examination . For patients who said that they saw their physician for a checkup or physical examination , the rate was more than 50 % only for Papanicolaou smear . In contrast , nearly all responding practitioners agreed that each of the eight preventive services was very important or important . CONCLUSION Preventive services consensus goals are not being met , even for patients who report that their clinic visit was for a checkup or physical examination . This finding suggests that it may be necessary to develop clinical systems that support and enable the delivery of preventive services BACKGROUND The U.S. Congress m and ated evaluations , initiated in 1989 , to determine whether extending Medicare benefits to include preventive services would improve health status , reduce costs of care , and improve health risk behaviors of beneficiaries . METHODS The Johns Hopkins Medicare Preventive Services Demonstration was a r and omized trial in which Medicare beneficiaries were assigned either to an intervention group that was offered yearly preventive visits for 2 years and optional counseling visits to their primary care provider or to a control group that received usual care . This report describes the effect of the intervention over a period of 2 years on smoking , problem alcohol use , and sedentary lifestyle . RESULTS Differences were observed between the intervention and control groups in the extent to which changes occurred in smoking and problem alcohol use , but none of the differences was statistically significant . The proportion of smokers who quit was higher in the intervention group than in the control group ( 24.2 vs 17.9 % , P = 0.09 ) . However , a higher proportion of problem drinkers in the control group improved ( 67.1 vs 57.0 % , P = 0.183 ) . There was virtually no difference between the intervention and the control groups in the proportion with improvement in sedentary lifestyle . CONCLUSIONS This study demonstrates the difficulty of bringing about health behavior change in older patients in the course of a yearly preventive visit for 2 years with their primary care physician when the visit encompasses screening and immunizations , as well as health behavior counseling directed by the physician . Further study is required to determine whether a more intense program of counseling for health behavior change among older persons by their primary care providers would be effective Abstract Objective : To determine the effectiveness of health checks , performed by nurses in primary care , in reducing risk factors for cardiovascular disease and cancer . Design : R and omised controlled trial . Setting : Five urban general practice s in Bedfordshire . Subjects : 2205 men and women who were r and omly allocated a first health check in 1989 - 90 and a re-examination in 1992 - 3 ( the intervention group ) ; 1916 men and women who were r and omly allocated an initial health check in 1992 - 3 ( the control group ) . All subjects were aged 35 - 64 at recruitment in 1989 . Main outcome measures : Serum total cholesterol concentration , blood pressure , body mass index , and smoking prevalence ( with biochemical validation of cessation ) ; self reported dietary , exercise , and alcohol habits . Results : Mean serum total cholesterol was 3.1 % lower in the intervention group than controls ( difference 0.19 mmol/l ( 95 % confidence interval 0.12 to 0.26 ) ; in women it was 4.5 % lower ( P<0.0001 ) and in men 1.6 % ( P<0.05 ) , a significant difference between the sexes ( P<0.01 ) . Self reported saturated fat intake was also significantly lower in the intervention group . Systolic and diastolic blood pressures and body mass index were respectively 1.9 % , 1.9 % , and 1.4 % lower in the intervention group ( P<0.005 in all cases ) . There was a 3.9 % ( 2.4 to 5.3 ) difference in the percentage of subjects with a cholesterol concentration > /=8 mmol/l , but no significant differences in the number with diastolic blood pressure > /=100 mm Hg or body mass index > /=30 kg/m2 . There was no significant difference between the two groups in prevalence of smoking or excessive alcohol use . Annual rechecks were no more effective than a single recheck at three years , but health checks led to a significant increase in visits to the nurse according to patients ' degree of cardiovascular risk . Conclusions : The benefits of health checks were sustained over three years . The main effects were to promote dietary change and reduce cholesterol concentrations ; small differences in blood pressure may have been attributable to accommodation to measurement . The benefits of systematic health promotion in primary care are real , but must be weighed against the costs in relation to other priorities . Key messages Key messages There is little effect on smoking or alcohol use , and more targeted approaches to modifying these behaviours may be appropriate Systematic implementation of health checks might lead to a reduction in risk of myocardial infa rct ion among those who attend of about 5 - 15 % ; men , who are at higher risk , show less change than women Health checks consume substantial re sources , and their effect is attenuated by non-attendance The benefits of health promotion through primary care must be weighed against their costs and in relation to other Medicare beneficiaries enrolled in a health maintenance organization ( HMO ) were r and omized to a preventive services benefit package for 2 years or to usual care . At 24- and 48-month followups , the treatment group had completed more advance directives , participated in more exercise , and consumed less dietary fat than the control group . Unexpectedly , more deaths occurred in the treatment group . Surviving treatment-group enrollees reported higher satisfaction with health , less decline in self-rated health status , and fewer depressive symptoms than surviving control participants . Despite these changes , the intervention did not yield lower cost per quality -adjusted life year in this historically prevention-oriented HMO The Multiphasic Health Checkup Evaluation Study , a long-term clinical trial , has been completed . A study group of 5156 men and women age 35 - 54 at entry was urged to have annual multiphasic health checkups ( MHCs ) for 16 years . A control group of 5557 comparable subjects was not so urged but was followed up in a comparable fashion . The mean and median number of MHCs per person were 6.8 and 6 , respectively , in the study group and 2.8 and 1 , respectively , in the control group . During 16 years the study group experienced a 30 % reduction ( p less than 0.05 ) in deaths from pre-specified " potentially postponable " causes , largely associated with lower death rates from colorectal cancer and hypertension . This reduction was most pronounced in the early years of the study . The two groups did not differ to a statistically significant degree in mortality from all other causes ( 84 % of total mortality ) or in total mortality . There was no difference in self-reported disability in the overall groups . In the setting of our prepaid health care plan where MHCs were already available on a voluntary basis , a program of urging middle-aged persons to undergo regular MHCs brought about a substantial reduction in mortality from preselected diseases Many smokers and ex-smokers worry about their health . Given that worry keeps attention focused on the threat , it was expected that worrying about health in smokers would motivate them to quit and in ex-smokers may prevent relapse . Furthermore , worry was expected to influence the process of smoking cessation in interaction with self-efficacy , which is a measure of control over smoking , and with disengagement beliefs , which distorts the threatening meaning of potential motivating information . In the present study 380 smokers and 324 ex-smokers were recruited to join a prospect i ve study with a follow-up of eight months . At T1 , smoking/quitting behavior , worry and the other psychological constructs were assessed . At T2 quitting activity in smokers and relapse in ex-smokers were assessed . As expected , smokers who worried about the health effects of smoking reported higher quitting activity at T2 . The three-way interactions between worry , self-efficacy and disengagement beliefs in the prospect i ve prediction of quitting activity and relapse were significant : Among smokers with high self-efficacy combined with strong disengagement beliefs , worry led to more quitting activity . Among ex-smokers with low self-efficacy combined with strong disengagement beliefs , worry led to more relapse . The present results suggest new ways of approaching the stimulation of quitting and the prevention of relapse This study examines the longitudinal ( 48 months ) effects of a preventive services intervention trial with Medicare beneficiaries . The health promotion intervention incorporated a series of workshops and targeted individualized counseling dealing primarily with nutrition and exercise . All subjects completed a health risk appraisal ( HRA ) question naire , which served as a dependent measure . Results show significant , positive changes in intervention subjects in two activity outcomes ,  aerobic activity and stretching exercis 
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Despite this legislation and continued use of the PHE , there is a lack of clear evidence demonstrating that the PHE improves patient outcomes or reduces health care costs .
The GRADE classification scheme incorporates a systematic approach toward assessing the entire body of literature on specific outcomes in which points are assigned to ( or