***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 develop a short instrument , called DISCERN , which will enable patients and information providers to judge the quality of written information about treatment choices . DISCERN will also facilitate the production of new , high quality , evidence -based consumer health information . DESIGN : An expert panel , representing a range of expertise in consumer health information , generated criteria from a r and om sample of information for three medical conditions with varying degrees of evidence : myocardial infa rct ion , endometriosis , and chronic fatigue syndrome . A graft instrument , based on this analysis , was tested by the panel on a r and om sample of new material for the same three conditions . The panel re-drafted the instrument to take account of the results of the test . The DISCERN instrument was finally tested by a national sample of 15 information providers and 13 self help group members on a r and om sample of leaflets from 19 major national self help organisations . Participants also completed an 8 item question naire concerning the face and content validity of the instrument . RESULTS : Chance corrected agreement ( weighted kappa ) for the overall quality rating was kappa = 0.53 ( 95 % CI kappa = 0.48 to kappa = 0.59 ) among the expert panel , kappa = 0.40 ( 95 % CI kappa = 0.36 to kappa = 0.43 ) among information providers , and kappa = 0.23 ( 95 % CI kappa = 0.19 to kappa = 0.27 ) among self help group members . Higher agreement levels were associated with experience of using the instrument and with professional knowledge of consumer health information . Levels of agreement varied across individual items on the instrument , reflecting the need for subjectivity in rating certain criteria . The trends in levels of agreement were similar among all groups . The final instrument consisted of 15 questions plus an overall quality rating . Responses to the question naire after the final testing revealed the instrument to have good face and content validity and to be generally applicable . CONCLUSIONS : DISCERN is a reliable and valid instrument for judging the quality of written consumer health information . While some subjectivity is required for rating certain criteria , the findings demonstrate that the instrument can be applied by experienced users and providers of health information to discriminate between publications of high and low quality . The instrument will also be of benefit to patients , though its use will be improved by training The effectiveness of an advice package design ed to restructure the restaurant environment and encourage parent praise was examined . Experiment 1 assessed the usefulness of the package when used with experimenter assistance . Videotapes were used to record the target child 's behavior . Pre-meal inappropriate behavior decreased an average of 51 % across target children . Mealtime inappropriate behavior and parent praise and disapproval were also measured . Experiment 2 was design ed to determine whether families could implement the package without experimenter assistance and whether effects obtained would generalize to a different restaurant . Data were taken in vivo . Nine families were r and omly assigned to one of three groups . Group assignment determined the order in which families went to two restaurants , the number of dinners each family participated in , and the point at which parents received the advice package . The order in which the families went to the two restaurants as well as the number of baseline meals was counterbalanced . Results of Experiment 2 showed that , when using the advice package , parents in all sequences were able to decrease pre-meal inappropriate behavior of their children , and that these effects generalized to a second restaurant Department of Parent and Child NursingUniversity of WashingtonClinic mothers of 35 conduct-disordered children were r and omly assigned to awaiting list  control group  , 9 weeks of individual therapy , or 9 weeks of therapist-led group therapy based on a st and ardized videotape modeling program .  Mothers and their children were assessed at baseline , immediately after treatment , and 1year later by home visits , twice-per-week telephone reports , and question naires . One month after treatment , both groups of treated mothers showed significantattitudinal and behavioral improvements compared with untreated controls . Ad-ditionally , the children in the two treatment groups showed reductions in childnoncompliance compared with control children . At the 1-year follow-up , not onlywere most of the changes in mothers ' behaviors maintained , but both treatmentgroups of children continued to show significant reductions in noncompliant and deviant behaviors . There were no significant differences on any of the attitudinalor behavioral measures between individual and videotape modeling group discussion therapies at the immediate or 1-year follow-up . Total therapist time was approx-imately 251 hr for the entire individual group and 48 hr for the entire videotape discussion group . Although both treatments seem to offer equivalent and sustainedimprovements for parents and conduct-disordered children , the therapeutic efficiencyof the videotape modeling group format is more cost-effective . In response to the large numbers of childrenwith conduct disorders and the shortage ofprofessional personnel , there has been an in-creasing emphasis on training parents as ther-apists for their own children . Several excellent review s ( Berkowitz & Graziano , 1972 ; Gra-ziano , 1977 ; Johnson KMorel and , Schwebel , Beck , & Wells , 1982 ; Pawlicki Regular night waking of young children is one of the most common problems encountered by parents . This study compared a st and ardized night waking programme that involved organized bedtime routines , procedures for settling the child and for the h and ling of crying , calling out and getting out of bed , with a group which received written information only and a waiting list control group . The children receiving the st and ard programme and those receiving written information only showed significant improvement over children in the waiting list group . This result supports the use of written parent instructions with or without therapist support The effectiveness of bibliotherapy as an adjunct to stimulant medication in the treatment of children with attention-deficit hyperactivity disorder was investigated . Subjects were r and omly assigned to the experimental group , or the control group . Parents in the experimental group received a written protocol ( bibliotherapy ) outlining behavioral techniques for managing oppositional child behavior . Results indicated significant differences favoring the experimental group on st and ardized measures of the intensity of behavior problems in the home , parental knowledge of behavioral principles , and teacher ratings of behavior . This bibliotherapy approach appears to offer an inexpensive adjunct to stimulant medication in the treatment of attention-deficit hyperactivity disorder when individual or group behavior management training is not feasible Arousal Training is a fast , simple , and effective form of bibliotherapy for nocturnal enuresis with non- clinical children between 6 and 12 years of age . The parents act as therapists . They reward the operant behavior-pattern following the urine alarm . The success rate is 98 % ( N = 41 ) , which is significantly high when compared to the control conditions ( 79 % , N = 86 ) . There was a response rate of 100 % and no drop-out from therapy . All parents ( N = 127 ) completed and returned the record . The results of a follow-up of this bibliotherapy ( N = 113 ) 2 1/2 years later are presented . The success rate of Arousal Training  was still significantly higher ( 92 % continent ) when compared to the urine device with specific instructions ( 77 % ) and urine alarm only ( 72 % ) . Arousal Training is the treatment of choice for non- clinical enuretic children between 6 and 12 years of age The Montréal Longitudinal Study of Disruptive Boys , an experimental study , was design ed to underst and boys who were considered disruptive in kindergarten . One part of the study involved assessing effects of a preventive treatment program carried out during the boys ' early years in primary school . This paper reports on the outcome of the r and omized treatment experiment 3 years after treatments ended . Disruptive boys were r and omly allocated to a treated group and two nontreated groups . Treatment consisted of parent training and training of boys for social skills , fantasy play and television viewing .  Results suggest that the treatment program had some positive effects . Some of the improvements were not evident immediately after treatment ended The study tested alternative intervention strategies to reduce escalation in problem behaviors among high-risk young adolescents ( 11 to 14 years old ) . A total of 158 families with young adolescents ( male and female ) participated in this study . Of these , 119 families were r and omly assigned to 1 of the following intervention conditions : ( a ) parent focus , ( b ) teen focus , ( c ) parent and teen focus , ( d ) self-directed change ( material s only ) . In addition , 39 families of young adolescents were recruited as a quasi-experimental control . Parent focus and teen focus interventions result ed in immediate beneficial effects in observed and reported family conflict . The parent intervention conditions showed immediate beneficial effects on behavior problems at school . Longitudinal trends suggest that the parent focus condition may reduce subsequent tobacco use , compared with all other approaches . Interventions that aggregated high-risk youths into groups , however , showed the highest escalations in tobacco use and problem behavior at school , beginning at termination and persisting to follow-up . These findings are discussed with respect to the need to re-evaluate strategies that aggregate high-risk youths into intervention programs and focus more on strategies to engage parents in prevention This study examines the specific effects of adding a broader based , videotape treatment component ( ADVANCE ) to a basic videotape parent skills training program ( GDVM ) . ADVANCE treatment trains parents to cope with interpersonal distress through improved communication , problem solving , and self-control skills . Seventy-eight families with a child diagnosed as oppositional-defiant or conduct-disordered were r and omly assigned to either GDVM alone or GDVM plus ADVANCE . Parent reports of child adjustment and parent distress , assessment of child 's knowledge of social skills , as well as independent observations of mother- and father-child interactions and communication and of problem solving between parents were obtained at pre- and post-GDVM and at post-ADVANCE . Both groups significantly improved at short-term follow-up . ADVANCE produced additional significant improvements in parents ' communication , problem-solving skills , and consumer satisfaction , as well as children 's increased knowledge of prosocial solutions . The clinical significance of these findings is discussed This paper examines the impact of a 12-episode television series , " Families " , on  disruptive child behavior and family adjustment .  This media intervention comprises the first of a five-level early intervention parenting and family support strategy , known as Triple P ( Positive Parenting Program ) . Fifty-six parents of children aged between 2 and 8 years were r and omly assigned to either watching the television series or to a waitlist control group . Compared to the control group , parents in the television viewing ( TV ) condition reported significantly lower levels of disruptive child behavior and higher levels of perceived parenting competence , immediately following intervention . Prior to intervention approximately 42.9 % of the children in the TV condition were in the clinical ly elevated range for disruptive child behavioral problems . This had reduced to 14.3 % following intervention . In addition , a high level of consumer acceptability was reported by parents in the TV condition . All post-intervention effects were maintained at 6-month follow-up . Implication s for public health approaches to family mental health are discussed BACKGROUND The treatment of deliberate self-harm ( parasuicide ) remains limited in efficacy . Despite a range of psychosocial , educational and pharmacological interventions only one approach , dialectical behaviour therapy , a form of cognitive-behaviour therapy ( CBT ) , has been shown to reduce repeat episodes , but this is lengthy and intensive and difficult to extrapolate to busy clinical practice . We investigated the effectiveness of a new manual-based treatment varying from bibliotherapy ( six self-help booklets ) alone to six sessions of cognitive therapy linked to the booklets , which contained elements of dialectical behaviour therapy . METHODS Thirty-four patients , aged between 16 and 50 , seen after an episode of deliberate self-harm , with personality disturbance within the flamboyant cluster and a previous parasuicide episode within the past 12 months , were r and omly assigned to treatment  with manual-assisted cognitive-behaviour therapy ( MACT N = 18 ) or treatment as usual ( TAU N = 16 ) . Assessment of clinical symptoms and social function were made at baseline and repeated by an independent assessor masked to treatment allocation at 6 months . The number and rate of all parasuicide attempts , time to next episode and costs of care were also determined . RESULTS Thirty-two patients ( 18 MACT ; 14 TAU ) were seen at follow-up and 10 patients in each group ( 56 % MACT and 71 % TAU ) had a suicidal act during the 6 months . The rate of suicidal acts per month was lower with MACT ( median 0.17/month MACT ; 0.37/month TAU ; P = 0.11 ) and self-rated depressive symptoms also improved ( P = 0.03 ) . The treatment involved a mean of 2.7 sessions and the observed average cost of care was 46 % less with MACT ( P = 0.22 ) . CONCLUSIONS Although limited by the small sample , the results of this pilot study suggest that this new form of cognitive-behaviour therapy is promising in its efficacy and feasible in clinical practice The efficacy of cognitive bibliotherapy for adolescents experiencing mild and moderate depressive symptomatology was examined with a group of 22 community-dwelling adolescents .  Cognitive bibliotherapy was determined to be superior to a delayed-treatment control condition . The treatment produced both statistically and clinical ly significant improvements in depressive symptoms . Treatment gains were maintained at 1-month follow-up . A significant decrease in dysfunctional thoughts , but not in negative automatic thoughts , was found after treatment . These results contribute to converging evidence on the efficacy of cognitive-behavioral treatments for adolescents experiencing depressive symptoms Parents of 43 conduct- problem children , aged 3– 8 years , were r and omly assigned to one of two treatments : an individually self- administered video-tape modeling treatment ( IVM ) and IVM treatment plus therapist consultation ( IVMC ) . R and omization also included a waiting- list control group ( CON ) . Compared 
    Output:
    
MAIN RESULTS In general ,  media-based therapies for behavioural disorders in children had a moderate effect when compared with both no-treatment controls and with st and ard care .
Significant improvements were often made with the addition of up to 2 hours of therapist time .
REVIEW ER 'S CONCLUSIONS These formats of delivering behavioural interventions for carers of children are possibly worth considering in clinical practice .
For straightforward cases media-based interventions may be enough to make clinical ly significant changes in a child 's behaviour , and reduce the amount of time primary care workers have to devote to each case .
Consequently this would increase the number of families who could possibly benefit from this type of intervention .
Media-based therapies would therefore appear to have both clinical and economic implication s as regards the treatment of children with behavioural problems