***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: Background Transition from pediatric to adult diabetes care is a high risk period during which there is an increased rate of disengagement from care . Suboptimal transition has been associated with higher risks for acute and chronic diabetes-related complications . The period of emerging adulthood challenges current systems of healthcare delivery as many young adults with type 1 diabetes ( T1D ) default from diabetes care and are at risk for diabetes complications which are undetected and therefore untreated . Despite the importance of minimizing loss to follow-up there are no r and omized control trials evaluating models of transition from pediatric to adult diabetes care . Methods / Design This is a multicentre r and omized controlled trial . A minimum of 188 subjects with T1D aged between 17 and 20 years will be evaluated . Eligible subjects will be recruited from three pediatric care centres and r and omly assigned in a 1:1 ratio to a structured transition program that will span 18 months or to receive st and ard diabetes care . The structured transition program is a multidisciplinary , complex intervention aim ing to provide additional support in the transition period . A Transition Coordinator will provide transition support and will provide the link between pediatric and adult diabetes care . The Transition Coordinator is central to the intervention to facilitate ongoing contact with the medical system as well as education and clinical support where appropriate . Subjects will be seen in the pediatric care setting for 6 months and will then be transferred to the adult care setting where they will be seen for one year . There will then be a one-year follow-up period for outcome assessment . The primary outcome is the proportion of subjects who fail to attend at least one outpatient adult diabetes specialist visit during the second year after transition to adult diabetes care . Secondary outcome measures include A1C frequency measurement and levels , diabetes related emergency room visits and hospital admissions , frequency of complication screening , and subject perception and satisfaction with care . Discussion This trial will determine if the support of a Transition Coordinator improves health outcomes for this at-risk population of young adults . Trial registration Trial Registration Number : Objectives : The aim of the study was twofold ; 1 ) to develop a clinical pharmacist-led 12 month lasting follow-up program for patients with established coronary heart disease ( CHD ) discharged from the University Hospital of North Norway , and 2 ) to explore the impact of the program with regards to adherence to a medication assessment tool for secondary prevention of CHD and change in biomedical risk factors . Methods : A total of 102 patients aged 18 - 82 years were enrolled in a non-blinded r and omized controlled trial with an intervention group and a control group . The intervention comprised medication reconciliation , medication review and patient education during three meetings ; at discharge , after three months and after twelve months . The control group received st and ard care from their general practitioner . Primary outcomes were adherence to clinical guideline recommendations concerning prescription , therapy goal achievement and lifestyle education  defined in the medication assessment tool for secondary prevention of CHD ( MAT-CHDSP ) . Secondary outcomes included changes in the biomedical risk factors cholesterol , blood pressure and blood glucose . Results : Ninety-four patients completed the trial , 48 intervention group patients and 46 controls . Appropriate prescribing was high , but therapy goal achievement was low in both groups . Overall adherence to MAT-CHDSP criteria increased in both groups and was significantly higher in the intervention group at study end , 78.4 % vs. 62.0 % , p<0.001 . The difference was statistically significant for the documented lifestyle advices in intervention group patients . No significant improvements in biomedical risk factors were observed in favor of the intervention group . Conclusions : The study showed an increased guideline adherence in both study groups . This indicates that attention to clinical practice guideline recommendations in itself increases adherence – which may be a clinical pharmacist task . A larger adequately powered study is needed to show a significant difference in biomedical risk factor improvements in favor of the intervention . Amendments to the follow-up program are suggested before implementation in st and ard patient care can be recommended Abstract Objective To assess the impact of leaflets encouraging patients to raise concerns and to discuss symptoms or other health related issues in the consultation . Design R and omised controlled trial . Setting Five general practice s in three setting s in the United Kingdom . Participants 636 consecutive patients , aged 16 - 80 years , r and omised to receive a general leaflet , a depression leaflet , both , or neither . Main outcomes Mean item score on the medical interview satisfaction scale , consultation time , prescribing , Rerral , and investigation . Results The general leaflet  increased patient satisfaction and was more effective with shorter consultations ( leaflet 0.64 , 95 % confidence interval 0.19 to 1.08 ; time 0.31 , 0.0 to 0.06 ; interaction between both −0.045 , −0.08 to—0.009 ) , with similar results for subscales related to the different aspects of communication . Thus for a 10 minute consultation the leaflet increased satisfaction by 7 % ( seven centile points ) and for a five minute consultation by 14 % . The leaflet overall caused a small non-significant increase in consultation time ( 0.36 minutes , −0.54 to 1.26 ) . Although there was no change in prescribing or Rerral , a general leaflet increased the numbers of investigations ( odds ratio 1.43 , 1.00 to 2.05 ) , which persisted when controlling for the major potential confounders of perceived medical need and patient pRerence ( 1.87 , 1.10 to 3.19 ) . Most of excess investigations were not thought strongly needed by the doctor or the patient . The depression leaflet had no significant effect on any outcome . Conclusions Encouraging patients to raise issues and to discuss symptoms and other health related issues in the consultation improves their satisfaction and perceptions of communication , particularly in short consultations . Doctors do , however , need to elicit expectations to prevent needless investigations Purpose . To conduct a pilot test of a decision aid design ed to help patients choose among currently recommended colorectal cancer screening programs . Methods . R and omized controlled trial comparing a patient decision aid based on multi criteria decision-making theory with a simple educational intervention . Patient population . 96 patients at average risk for colorectal cancer seen in an Internal Medicine practice in Rochester , New York . Outcome measures . The two primary outcome measures were patient decision process and the decision outcome . Patient decision process was assessed using the decisional conflict scale . Decision outcome was defined as the proportion of colorectal cancer screening plans carried out . Results . After controlling for the effects of the physicians in a factorial analysis of variance , patients who used the decision aid had lower decisional conflict regarding colorectal cancer screening decisions ( F ratio6.47 , P = 0.01 ) due to increased knowledge , better clarity of values , and higher ratings of the quality of the decisions they made . There was no difference between the groups in decision outcomes : 52 % of patients in the control group and 49 % in the experimental group completed planned screening tests ( P = 1.0 ) . Conclusions . In a pilot study , a multi criteria -based patient decision aid for colorectal cancer screening improved patients ’ decision-making processes but had no effect on the implementation of screening plans Background : There is still debate over the benefit of self-management programmes for adults with asthma . A brief self-management programme given during a hospital admission for acute asthma was tested to determine whether it would reduce readmission . Method : A r and omised controlled trial was performed in 280 adult patients with acute asthma admitted over 29 months . Patients on the self-management programme ( SMP ) received 40–60 minutes of education supporting a written self-management plan . Control patients received st and ard care ( SC ) . Results : One month after discharge SMP patients were more likely than SC patients to report no daytime wheeze ( OR 2.6 , 95 % CI 1.5 to 5.3 ) , no night disturbance ( OR 2.0 , 95 % CI 1.2 to 3.5 ) , and no activity limitation ( OR 1.5 , 95 % CI 0.9 to 2.7 ) . Over 12 months 17 % of SMP patients were re-admitted compared with 27 % of SC patients ( OR 0.5 , 95 % CI 0.3 to 1.0 ) . Among first admission patients , OR readmission ( SMP v SC ) was 0.2 ( 95 % CI 0.1 to 0.7 ) , p<0.01 . For patients with a previous admission , OR readmission was 0.8 ( 95 % CI 0.4 to 1.6 ) , p=0.6 . SMP patients were more likely than SC patients to be prescribed inhaled steroids at discharge ( 99 % v 92 % , p=0.03 ) , oral steroids ( 98 % v 90 % , p=0.06 ) , and to have hospital follow up ( 98 % v 84 % , p<0.01 ) but adjustment for these differences did not diminish the effect of the self-management programme . Conclusions : A brief self-management programme during hospital admission reduced post discharge morbidity and readmission for adult asthma patients . The benefit of the programme may have been greater for patients admitted for the first time . The programme also had a small but significant effect on medical management at discharge Objective To evaluate the effectiveness on glycaemic control of a training programme in consultation skills for paediatric diabetes teams . Design Pragmatic cluster r and omised controlled trial . Setting 26 UK secondary and tertiary care paediatric diabetes services . Participants 79 healthcare practitioners ( 13 teams ) trained in the intervention ( 359 young people with type 1 diabetes aged 4 - 15 years and their main carers ) and 13 teams allocated to the control group ( 334 children and their main carers ) . Intervention Talking Diabetes programme , which promotes shared agenda setting and guiding communication style , through flexible menu of consultation strategies to support patient led behaviour change . Main outcome measures The primary outcome was glycated haemoglobin ( HbA1c ) level one year after training . Secondary outcomes were clinical measures ( hypoglycaemic episodes , body mass index , insulin regimen ) , general and diabetes specific quality of life , self reported and proxy reported self care and enablement , perceptions of the diabetes team , self reported and carer reported importance of , and confidence in , undertaking diabetes self management measured over one year . Analysis was by intention to treat . An integrated process evaluation included audio recording a sample of 86 routine consultations to assess skills shortly after training ( intervention group ) and at one year follow-up ( intervention and control group ) . Two key domains of skill assessment were use of the guiding communication style and shared agenda setting . Results 660/693 patients ( 95.2 % ) provided blood sample s at follow-up . Training diabetes care teams had no effect on HbA1c levels ( intervention effect 0.01 , 95 % confidence interval −0.02 to 0.04 , P=0.5 ) , even after adjusting for age and sex of the participants . At follow-up , trained staff ( n=29 ) were more capable than controls ( n=29 ) in guiding ( difference in means 1.14 , P<0.001 ) and agenda setting ( difference in proportions 0.45 , 95 % confidence interval 0.22 to 0.62 ) . Although skills waned over time for the trained practitioners , the reduction was not significant for either guiding ( difference in means −0.33 , P=0.128 ) or use of agenda setting ( difference in proportions −0.20 , −0.42 to 0.05 ) . 390 patients ( 56 % ) and 441 carers ( 64 % ) completed follow-up question naires . Some aspects of diabetes specific quality of life improved in controls : reduced problems with treatment barriers ( mean difference −4.6 , 95 % confidence interval −8.5 to −0.6 , P=0.03 ) and with treatment adherence ( −3.1 , −6.3 to −0.01 , P=0.05 ) . Short term ability to cope with diabetes increased in patients in intervention clinics ( 10.4 , 0.5 to 20.4 , P=0.04 ) . Carers in the intervention arm reported greater excitement about clinic visits ( 1.9 , 1.05 to 3.43 , P=0.03 ) and improved continuity of care ( 0.2 , 0.1 to 0.3 , P=0.01 ) . Conclusions Improving glycaemic control in children attending specialist diabetes clinics may not be possible through brief , team-wide training in consultation skills . Trial registration Current Controlled Trials IS RCT N61568050 BACKGROUND AND OBJECTIVES : Interactive voice response systems integrated with electronic health records have the potential to improve primary care by engaging parents outside clinical setting s via spoken language . The objective of this study was to determine whether use of an interactive voice response system , the Personal Health Partner ( PHP ) , before routine health care maintenance visits could improve the quality of primary care visits and be well accepted by parents and clinicians . METHODS : English-speaking parents of children aged 4 months to 11 years called PHP before routine visits and were r and omly assigned to groups by the system at the time of the call . Parents ’ spoken responses were used to provide tailored counseling and support goal setting for the upcoming visit . Data were transferred to the electronic health records for review during visits . The study occurred in an urban hospital-based pediatric primary care center . Participants were called after the visit to assess ( 1 ) comprehensiveness of screening and counseling , ( 2 ) assessment of medications and their management , and ( 3 ) parent and clinician satisfaction . RESULTS : PHP was able to identify and counsel in multiple areas . 
    Output:
    
We are uncertain about the effect of patient-reported health information interventions on desirable patient health outcomes and patient satisfaction ( very low-certainty evidence ) .
Patient information interventions may improve healthcare professionals ' adherence to recommended clinical practice ( low-certainty evidence ) .
Patient education interventions may slightly increase the number of patients with desirable health outcomes ( low-certainty evidence ) .
We found that two types of patient-mediated interventions , patient-reported health information and patient education , probably improve professional practice by increasing healthcare professionals ' adherence to recommended clinical practice ( moderate-certainty evidence ) .
Other patient-mediated interventions , such as patient information may also improve professional practice ( low-certainty evidence ) .