***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: Abstract Objective : To examine the additional effect of cognitive behavioural therapy for patients with medically unexplained physical symptoms in comparison with optimised medical care . Design : R and omised controlled trial with follow up assessment s six and 12 months after the baseline evaluation . Setting : General medical outpatient clinic in a university hospital . Subjects : An intervention group of 39 patients and a control group of 40 patients . Interventions : The intervention group received between six and 16 sessions of cognitive behavioural therapy . Therapeutic techniques used included identification and modification of dysfunctional automatic thoughts and behavioural experiments aim ed at breaking the vicious cycles of the symptoms and their consequences . The control group received optimised medical care . Main outcome measures : The degree of change , frequency and intensity of the presenting symptoms , psychological distress , functional impairment , hypochondriacal beliefs and attitudes , and ( at 12 months of follow up ) number of visits to the general practitioner . Results : At six months of follow up the intervention group reported a higher recovery rate ( odds ratio 0.40 ; 95 % confidence interval 0.16 to 1.00 ) , a lower mean intensity of the physical symptoms ( difference −1.2 ; −2.0 to −0.3 ) , and less impairment of sleep ( odds ratio 0.38 ; 0.15 to 0.94 ) than the controls . After adjustment for coincidental baseline differences the intervention and control groups also differed with regard to frequency of the symptoms ( 0.32 ; 0.13 to 0.77 ) , limitations in social ( 0.35 ; 0.14 to 0.85 ) and leisure ( 0.36 ; 0.14 to 0.93 ) activities , and illness behaviour ( difference −2.5 ; −4.6 to −0.5 ) . At 12 months of follow up the differences between the groups were largely maintained . Conclusion : Cognitive behavioural therapy seems to be a feasible and effective treatment in general medical patients with unexplained physical symptoms PURPOSE Patients with nonischemic chest pain frequently experience recurrent symptoms , have persistent functional and occupational disability , and are high utilizers of health-care re sources . Our aim was to evaluate the efficacy of a cognitive-behavioral treatment for patients with noncardiac chest pain . PATIENTS AND METHODS Subjects were recruited from patients with at least weekly episodes of noncardiac chest pain , as diagnosed by a cardiologist . The main outcome measures were frequency and intensity of chest pain at 6 and 12 months . RESULTS Seventy-two patients were enrolled in the study ; 37 were assigned to cognitive-behavior therapy and 35 to usual care . Sixty-five patients completed the study . Intervention patients improved significantly with regard to frequency and intensity of chest pain : 15 ( 48 % ) of the 31 patients in the treatment group were pain free at 12-month follow-up compared with 4 ( 13 % ) of the 33 patients in the control group ( P = 0.002 ) . CONCLUSIONS Cognitive-behavioral therapy for noncardiac chest pain patients was effective compared with usual care 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 ) In order to determine the health effects of an intervention that reduces the cost of care for somatization disorder ( SD ) patients , 59 primary care physicians were r and omized to receive a psychiatric consultation letter providing treatment recommendations for 73 patients either at baseline or the end of the year-long study . Seventy of these patients ( 96 % ) were followed every 4 months for 1 year by a research assistant blind to r and omization . A year following the intervention , patients of experimental physicians reported greater physical capacity than patients of control physicians ( mean difference = 17.9 , 95 % CI 1.0 - 34.9 ) with a $ 466 reduction ( 95 % CI $ 132-$699 ) in health care charges . In addition to a net 21 % reduction in health care charges for the typical SD patient , the consultation letter improved physical functioning in a group of highly impaired subjects Among a sample of 767 high utilizers of health care , 51 % were identified as distressed by an elevated score on the SCL anxiety and depression scales , the SCL somatization scale , or by their primary -care physician . These distressed high utilizers were found to have a high prevalence of chronic medical problems and significant limitation of activities caused by illness . In the prior year , they made an average of 15 medical visits and 15 telephone calls to the clinic . The Diagnostic Interview Schedule was completed on 119 distressed high utilizers r and omly assigned to an intervention group in a controlled trial of psychiatric consultation . The following DSM-III-R disorders were most common : major depression 23.5 % , dysthymic disorder 16.8 % , generalized anxiety disorder 21.8 % , and somatization disorder 20.2 % . Two thirds had a lifetime history of major depression . The examination result ed in an improved diagnostic assessment for 40 % of intervention patients and a revised treatment plan for 67 % PURPOSE Patients seeking care for medically unexplained physical symptoms pose a major challenge at primary care sites , and there are very few well-accepted and properly evaluated interventions to manage such patients . METHODS We tested the effectiveness of a cognitive behavior therapy (CBT)-type intervention delivered in primary care for patients with medically unexplained physical symptoms . Patients were r and omly assigned to receive either the intervention plus a consultation letter or usual clinical care plus a consultation letter . Physical and psychiatric symptoms were assessed at baseline , at the end of treatment , and at a 6-month follow-up . All treatments and assessment s took place at the same primary care clinic where patients sought care . RESULTS A significantly greater proportion of patients in the intervention group had physical symptoms rated by clinicians as “ very much improved ” or “ much improved ” compared with those in the usual care group ( 60 % vs 25.8 % ; odds ratio = 4.1 ; 95 % confidence interval , 1.9–8.8 ; P<.001 ) . The intervention ’s effect on unexplained physical symptoms was greatest at treatment completion , led to relief of symptoms in more than one-half of the patients , and persisted months after the intervention , although its effectiveness gradually diminished . The intervention also led to significant improvements in patient-reported levels of physical symptoms , patient-rated severity of physical symptoms , and clinician-rated depression , but these effects were no longer noticeable at follow-up . CONCLUSIONS This time-limited , CBT-type intervention significantly ameliorated unexplained physical complaints of patients seen in primary care and offers an alternative for managing these common and problematic complaints in primary care setting Objective This study was design ed to examine whether a brief hospital intervention design ed to alter patients ’ perceptions about their myocardial infa rct ion ( MI ) would result in a better recovery and reduced disability . Design In a prospect i ve r and omized study , 65 consecutive patients with their first MI aged were assigned to receive an intervention design ed to alter their perceptions about their MI or usual care from rehabilitation nurses . Patients were assessed in hospital before and after the intervention and at 3 months after discharge from hospital . Results The intervention caused significant positive changes in patients ’ views of their MI . Patients in the intervention group also reported they were better prepared for leaving hospital ( p < .05 ) and subsequently returned to work at a significantly faster rate than the control group ( p < .05 ) . At the 3-month follow-up , patients in the intervention group reported a significantly lower rate of angina symptoms than control subjects ( 14.3 vs. 39.3 , p < .03 ) . There was no significant differences in rehabilitation attendance between the two groups . Conclusions An in-hospital intervention design ed to change patients ’ illness perceptions can result in improved functional outcome after MI OBJECTIVE To compare the effectiveness of a multifaceted intervention in patients with depression in primary care with the effectiveness of " usual care " by the primary care physician . DESIGN A r and omized controlled trial among primary care patients with major depression or minor depression . PATIENTS Over a 12-month period a total of 217 primary care patients who were recognized as depressed by their primary care physicians and were willing to take antidepressant medication were r and omized , with 91 patients meeting criteria for major depression and 126 for minor depression . INTERVENTIONS Intervention patients received increased intensity and frequency of visits over the first 4 to 6 weeks of treatment ( visits 1 and 3 with a primary care physician , visits 2 and 4 with a psychiatrist ) and continued surveillance of adherence to medication regimens during the continuation and maintenance phases of treatment . Patient education in these visits was supplemented by videotaped and written material s. MAIN OUTCOME MEASURES Primary outcome measures included short-term ( 30-day ) and long-term ( 90-day ) use of antidepressant medication at guideline dosage levels , satisfaction with overall care for depression and antidepressant medication , and reduction in depressive symptoms . RESULTS In patients with major depression , the intervention group had greater adherence than the usual care controls to adequate dosage of antidepressant medication for 90 days or more ( 75.5 % vs 50.0 % ; P < .01 ) , were more likely to rate the quality of the care they received for depression as good to excellent ( 93.0 % vs 75.0 % ; P < .03 ) , and were more likely to rate antidepressant medications as helping somewhat to helping a great deal ( 88.1 % vs 63.3 % ; P < .01 ) . Seventy-four percent of intervention patients with major depression showed 50 % or more improvement on the Symptom Checklist-90 Depressive Symptom Scale compared with 43.8 % of controls ( P < .01 ) , and the intervention patients also demonstrated a significantly greater decrease in depression severity over time compared with controls ( P < .004 ) . In patients with minor depression , the intervention group had significantly greater adherence than controls to adequate dosage of antidepressant medication for 90 days or more ( 79.7 % vs 40.3 % ; P < .001 ) and more often rated antidepressant medication as helping somewhat to helping a great deal ( 81.8 % vs 61.4 % ; P < .02 ) . However , no significant differences were found between the intervention and control groups in the percentage of patients who were satisfied with the care they received for depression ( 94.4 % vs 89.3 % ) , in the percentage who experienced a 50 % or more decrease in depressive symptoms , or in the decrease of depressive symptoms over time . CONCLUSION A multifaceted intervention consisting of collaborative management by the primary care physician and a consulting psychiatrist , intensive patient education , and surveillance of continued refills of antidepressant medication improved adherence to antidepressant regimens in patients with major and with minor depression . It improved satisfaction with care and result ed in more favorable depressive outcomes in patients with major , but not minor , depression CONTEXT Hypochondriasis is a chronic , distressing , and disabling condition that is prevalent in ambulatory medical practice . Until recently , no specific treatment has been clearly demonstrated to be effective . OBJECTIVE To assess the efficacy of a cognitive behavior therapy ( CBT ) for hypochondriasis . DESIGN A r and omized , usual care control group design , conducted between September 1997 and November 2001 . The individual primary care physician was the unit of r and omization , and all patients clustered within each physician 's practice were assigned to the experimental treatment ( individual CBT and a consultation letter to the primary care physician ) or to the control condition . Subjects were assessed immediately before and 6 and 12 months after the completion of treatment . SETTING AND PARTICIPANTS Participants were 80 patients from primary care practice s and 107 volunteers responding to public announcements , all of whom exceeded a predetermined cutoff score on a hypochondriasis self-report question naire on 2 successive occasions . INTERVENTION A scripted , 6-session , individual CBT intervention was compared with medical care as usual . The CBT was accompanied by a consultation letter sent to the patient 's primary care physician . MAIN OUTCOME MEASURES Hypochondriacal beliefs , fears , attitudes , and somatic symptoms ; role function and impairment . RESULTS A total of 102 individuals were assigned to CBT and 85 were assigned to medical care as usual .  The sociodemographic and clinical characteristics of the 2 groups were similar at baseline . Using an intent-to-treat analytic strategy , a consistent pattern of statistically and clinical ly significant treatment effects was found at both 6- and 12-month follow-up , adjusting for baseline covariates that included educational level 
    Output:
    
AUTHORS ' CONCLUSIONS There is limited evidence that a CL is effective in terms of medical costs and improvement of physical functioning for patients with MUPS in primary care .
The results are even less pronounced in patients with clinical ly less severe , but more meaningful , forms of MUPS and the results vary for other patient-related outcomes .
There is very limited evidence that a joint consultation with the patient by a psychiatrist in the presence of the physician , together with the provision of a CL , reduces severity of somatization symptoms and medical consumption