***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 evaluate a training workshop for community pharmacy personnel  to improve their counselling in smoking cessation based on the stage-of-change model . DESIGN A r and omised controlled trial of community pharmacies and pharmacy customers . SETTING All 76 non-city community pharmacies registered in Grampian , Scotl and , were invited to participate . Sixty-two pharmacies ( 82 % ) were recruited . SUBJECTS All the intervention pharmacy personnel were invited to attend the training ; 40 pharmacists and 54 assistants attended . A total of 492 customers who smoked ( 224 intervention , 268 controls ) were recruited during the 12-month recruitment period ( overall recruitment rate 63 % ) . MAIN OUTCOME MEASURES The perceptions of customers and pharmacy personnel of the pharmacy support and self-reported smoking cessation rates for the two groups of customers at one , four , and nine months . RESULTS The intervention customer respondents were significantly more likely to have discussed stopping smoking with pharmacy personnel , 85 % ( 113 ) compared with 62 % ( 99 ) of the controls ( p<0.001 ) . The former also rated their discussion more highly ; 34 % ( 45 ) of the intervention customers compared with 16 % ( 25 ) of the controls rated it as “ very useful ” ( p = 0.048 ) . Assuming non-responders had lapsed , one-month point prevalence of abstinence was cl aim ed by 30 % of intervention customers and 24 % of controls ( p = 0.12 ) ; four months ’ continuous abstinence was cl aim ed by 16 % of intervention customers and 11 % of controls ( p = 0.094 ) ; and nine months ’ continuous abstinence was cl aim ed by 12 % of intervention customers and 7 % of controls ( p = 0.089 ) . These trends in outcome were not affected by potential confounders ( sex , age , socioeconomic status , nicotine dependence , and type of nicotine replacement product used ) or adjustment for clustering . CONCLUSIONS The intervention was associated with increased and more highly rated counselling , and a trend toward higher smoking cessation rates , indicating that community pharmacy personnel have the potential to make a significant contribution to national smoking cessation targets BACKGROUND To date only a few studies have evaluated the long-term influence of smoking and smoking cessation on periodontal health . The present study , therefore , was undertaken with the aim to prospect ively investigate the influence of smoking exposure over time on the periodontal health condition in a targeted population before and after a follow-up interval of 10 years . METHODS The primary study base consisted of a population of occupational musicians that was investigated the first time in 1982 and scheduled for reinvestigation in 1992 and 2002 . The 1992 investigation included 101 individuals from the baseline study constituting a prospect i ve cohort including 16 smokers , who had continued to smoke throughout the entire length of the 10-year period ; 28 former smokers who had ceased smoking an average of approximately 9 years before the commencement of the baseline study ; 40 non-smokers , who denied ever having smoked tobacco ; and 17 individuals whose smoking pattern changed or for whom incomplete data were available . The clinical and radiographic variables used for the assessment of the periodontal health condition of the individual were frequency of periodontally diseased sites ( probing depth > or = 4 mm ) , gingival bleeding ( % ) , and periodontal bone height ( % ) . The oral hygiene st and ard was evaluated by means of a st and ard plaque index . RESULTS The changes over the 10 years with respect to frequency of diseased sites indicated an increased frequency in continuous smokers versus decreased frequencies in former smokers and non-smokers . Controlling for age and frequency of diseased sites at baseline , the 10-year change was significantly associated with smoking ( P < 0.001 ) . The differences between current smokers and non-smokers , and between current and former smokers , respectively , were statistically significant ( P<0.001 ) . Moreover , the 10-year change increased significantly with increasing smoking exposure controlling for age ( P= 0.01 ) . In terms of periodontal bone height , the 10-year changes implied statistically significant reductions within current as well as former smokers ( P < 0.001 and P < 0.05 , respectively ) , but not within non-smokers . The overall change was significantly associated with smoking controlling for age and bone height level at baseline ( P<0.01 ) , including statistically significant differences between current smokers and non-smokers and between current and former smokers , respectively ( P<0.05 ) . Moreover , the 10-year bone height reduction increased significantly with increasing smoking exposure controlling for age ( P < 0.05 ) . With regard to gingival bleeding , the 10-year differences between smoking groups were not statistically significant . Plaque index remained low throughout in all smoking groups at an overall average level of about 0.8 . CONCLUSIONS The results suggest that periodontal health is compromised by chronic smoking as evidence d by an increase of periodontally diseased sites concomitant with loss of periodontal bone height , as compared to non-smokers whose periodontal health condition remained unaltered throughout the 10-year period of investigation . The periodontal health condition in former smokers , similar to that of non-smokers , remained stable , suggesting that smoking cessation is beneficial to periodontal health OBJECTIVE Our objective was to determine the effectiveness of training obstetric and family practice residents to provide smoking cessation advice . STUDY DESIGN The effectiveness of the trained residents '  advice was assessed from exit interviews of pregnant smokers taking part in a r and omized , controlled trial of smoking cessation advice .  Exit interview responses were compared by chi 2 analysis . RESULTS Training result ed in significant changes in the advice provided by the residents , with greater emphasis on gaining a commitment to smoking behavior change , but not in the average time providing the advice , approximately 3 minutes . Adherence to the protocol was maintained at 80 % . Significantly more women who received the brief structured advice agreed to stop smoking ( 54 % ) or cut down their cigarette consumption ( 28 % ) compared with women in the control group ( 14 % and 6 % , respectively ) , p = 0.0001 . CONCLUSION The structured advice consistently provided by the trained residents was effective in gaining commitments from pregnant smokers to change their smoking behavior We describe a r and omized trial design ed to evaluate the effectiveness of a smokeless tobacco cessation intervention delivered by dental hygienists as part of a patient 's regularly scheduled cleaning visit . Seventy-five practice s were r and omized to continue their usual care ( n=25 ; 239 smokeless tobacco using patients enrolled ) or to receive training to provide a tobacco cessation intervention ( n=50 ; 394 smokeless tobacco using patients enrolled ) . Patient reports indicated that the training program was successful in getting hygienists to implement the intervention . The intervention produced a strong effect on sustained quitting for smokeless tobacco users but had no impact on secondary outcomes , including unsuccessful quit attempts , future intent to quit using smokeless tobacco , and change in readiness to quit using . Frequency of smokeless tobacco use and receipt of specific components of the intervention , including the video and written material s , predicted sustained cessation . Since this intervention was delivered by dental hygienists as part of a patient 's regularly scheduled cleaning visit , it is easily disseminable BACKGROUND Family physicians ( FPs ) in Australia underutilize effective strategies to help patients stop smoking . We conducted a cluster r and omization trial to evaluate a multifaceted , practice -based intervention involving audit , feedback , and academic detailing to improve FP smoking cessation advice . METHODS Sixty FPs in 39 practice s participated . FPs ' provision of smoking cessation advice was measured by patient recall , medical record audit , and FP self-report . Logistic regression analysis using generalized estimating equations was performed to assess improvements in practice , after adjustment for clustering by practice . RESULTS Improvements between baseline and posttest in patient recall of FP advice about  nicotine replacement patches and gum  were significantly greater in the intervention than in the control group ( P = 0.0056 and P = 0.0002 , respectively ) . While there were substantial increases in patient recall of assessment of smoking status and FP use of " quit date s , " behavioral advice , and written material s in the intervention group , these changes were not significantly greater than those in the control group . Notation of patients ' smoking status and smoking cessation advice in medical records remained suboptimal in both groups . CONCLUSIONS This multifaceted intervention was successful only in promoting FPs ' use of nicotine replacement therapy . While the use of other effective cessation strategies appeared to increase , a larger trial is needed for further evaluation BACKGROUND Medical practitioners have considerable untapped potential to assist patients in stopping smoking . However , marked deficits have been found in the amount and type of training medical practitioners receive in smoking cessation counseling with little attention paid to determination of effective training methods . METHOD A r and omized controlled trial was conducted to examine the relative effectiveness of four different educational programs in teaching smoking cessation skills to 5th-year medical students in an Australian medical school . The four programs comprised : ( a ) a traditional didactic lecture mode ( control group ) , ( b ) audio feedback through the use of audiotaped role plays , ( c ) role plays with peer feedback , and ( d ) video feedback . Students ' smoking cessation intervention skills were assessed prior to training and at the end of term via videotaped interviews with simulated patients . RESULTS Senior medical students demonstrated significantly improved skills in smoking intervention when exposed to any of the educational approaches other than traditional didactic teaching . No overall differences in smoking intervention skills were found between the three experimental training methods . CONCLUSIONS Specific training in smoking cessation techniques is necessary to increase the intervention skills of medical students . Traditional teaching methods are ineffective in developing smoking cessation intervention skills . Enhanced teaching , of an appropriate nature , at undergraduate and postgraduate levels is needed OBJECTIVE --To test the impact of physician education and facilitator assisted office system interventions on cancer early detection and preventive services . DESIGN --A r and omised trial of two interventions alone and in combination . SETTING AND SUBJECTS -- Physicians in 98 ambulatory care practice s in the United States . INTERVENTIONS --The education intervention consisted of a day long physician meeting directed at improving knowledge , attitudes , and skills relevant to cancer prevention and early detection . The office system intervention consisted of assistance from a project facilitator in establishing routines for providing needed services . These routines included division of responsibilities for providing services among physicians and their staff and the use of medical record flow sheets . MAIN OUTCOME MEASURES --The proportions of patients provided the cancer prevention and early detection services  indicated annually according to the US National Cancer Institute . RESULTS --Based on cross sectional patient surveys , the office system intervention was associated with an increase in mammography , the recommendation to do breast self examination , clinical breast examination , faecal occult blood testing , advice to quit smoking , and the recommendation to decrease dietary fat . Education was associated only with an increase in mammography . Record review for a patient cohort confirmed cross sectional survey findings regarding the office system for mammography and faecal occult blood testing . CONCLUSION --Community practice s assisted by a facilitator in the development and implementation of an office system can substantially improve provision of cancer early detection and preventive services BACKGROUND The high prevalence of behavioral risk factors for cardiovascular diseases dem and s innovative approaches to achieving behavior change . Primary care physicians are in an ideal position for offering such interventions . PURPOSE To evaluate whether training of primary care physicians in counseling skills based on the Transtheoretical Model ( TTM ) leads to motivational and behavioral changes in their patients . METHOD Seventy-four primary care physicians in Germany were r and omly assigned to either an intervention condition ( one day of training in TTM-based counseling plus brochures matched to their patients ' " stages of change " ) or a control condition ( usual care ) . Baseline and 12-month follow-up data were collected from 305 of their patients who signed up for a health check-up . OUTCOME MEASURE Patients ' movements across the stages of change for smoking , diet , exercise and stress management . RESULTS After 12 months , patients of physicians in the intervention group did not show more movement through the stages of change for any of the behaviors than did patients of control physicians . Additionally , there were no differences between groups in counseling frequency , counseling intensity , or patient satisfaction with counseling . CONCLUSIONS A high dropout rate at follow-up and result ing " power " problems limit the possible conclusions . The high numbers of patients in early stages of change and the minimal improvement over time underline the need for improving motivational counseling skills of primary care physicians in Germany . In our study the dissemination of these strategies failed . We offer lessons we feel can be learned from this outcome . Further studies should focus on ways to enhance the process of educating physicians for implementing counseling strategies in primary care setting STUDY OBJECTIVE To test whether physicians who receive a continuing education program ( " Quit for Life " ) about how to counsel smokers to quit would counsel smokers more effectively and have higher rates of long-term smoking cessation among their patients who smoke . DESIGN R and omized trial with blinded assessment of principal outcomes . SETTING Four health maintenance organization medical centers in northern California . SUBJECTS Eighty-one internists assigned by blinded r and omization to receive training ( 40 ) or serve as controls ( 41 ) . Consecutive sample s of smokers visiting each physician ( 
    Output:
    
No evidence of an effect was observed for the provision of nicotine gum/replacement therapy .
AUTHORS ' CONCLUSIONS Training health professionals to provide smoking cessation interventions had a measurable effect on the point prevalence of smoking , continuous abstinence and professional performance .