***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: The introduction , more than half a century ago , of properly r and omised trials in which the treatment allocation was rigorously concealed was a watershed in the evaluation of treatment effects.1 But this major advance did not come out of the blue : as was highlighted at a recent conference in Oxford ( Beating biases in therapeutic research : historical perspectives , www.wuhmo.ox.ac.uk/docs/BeatingBiases.html ) , attempts to combat bias in therapeutic evaluation had in fact been made during the preceding few centuries.2–4 In the 18th century , the traditional practice of cl aim ing therapeutic achievement on the basis of pathophysiological theories and anecdotal “ successes ” started to be challenged by medical non-conformists who wrote careful , prospect i ve , analytical accounts of medical treatments , some of which included comparison with a control group.4 These “ arithmetic observationists and experimentalists”4 recognised the need In a prospect i ve study of stress fractures the hypothesis that a shock-absorbing orthotic device worn within military boots could lessen the incidence of stress fractures was tested . The incidence of metatarsal , tibial , and femoral stress fractures was lower in the orthotic group , but only the latter difference was statistically significant . The time of onset and the location of stress fractures between orthotic and nonorthotic users did not differ . These findings suggest that the incidence of femoral stress fractures , which are the most dangerous type of stress fracture because of their high risk of developing into displaced fractures , can be reduced by an orthotic device Sedentary individuals , particularly new military recruits , who start a physical training program have a substantial risk of developing an overuse injury of the lower limb . In this study we investigated the effect of neoprene insoles on the incidence of overuse injuries during 9 weeks of basic military training . The experimental group consisted of 237 r and omly selected new recruits , while 1151 recruits were the control group . Insoles were given to the experimental group and compliance was monitored . A panel of doctors documented and classi fied all injuries occurring during the 9 week period . A total of 54 ( 22.8 % ) and 237 ( 31.9 % ) injuries were reported in the experimental and control groups , re spectively . In both groups , the majority of injuries were overuse ( experimental group , 90.7 % ; control group , 86.4 % ) . The mean weekly incidence of total overuse injuries and tibial stress syndrome was significantly lower ( P < 0.05 ) in the experimental group . The mean incidence of stress fractures was lower in the experimental group but not significantly so ( 0.05 < P < 0.1 ) . This study shows that the incidence of total overuse injuries and tibial stress syndrome during 9 weeks of basic military training can be reduced by wearing insoles In a prospect i ve study of stress fractures the hypothesis that training with custom made biomechanical shoe orthoses could lessen the incidence of stress fractures in infantry recruits was tested . Recruits were assigned r and omly to groups and given soft biomechanical orthoses or semirigid biomechanical orthoses and compared with a control group that did not train in biomechanical orthoses .  All recruits wore infantry boots with soles design ed like those of basketball shoes . Recruits were examined biweekly during 14 weeks of basic training . The incidence of stress fractures was 15.7 % for the recruits with the semirigid biomechanical orthoses , 10.7 % for the recruits with the soft biomechanical orthoses , and 27 % for the control group . The soft biomechanical orthoses were tolerated better by the recruits than were the semirigid devices . Among trainees at high risk for stress fractures , prophylactic use of custom made biomechanical orthoses may be warranted BACKGROUND Only about a third of people with asthma attend an annual review . Clinicians need to identify cost-effective ways to improve access and ensure regular review . AIM To compare the cost-effectiveness of nurse-led telephone with face-to-face asthma review s. DESIGN OF STUDY Cost-effectiveness analysis based on a 3-month r and omised controlled trial . SETTING Four general practice s in Engl and . METHOD Adults due an asthma review were r and omised to telephone or face-to-face consultations .  Trial nurses recorded proportion review ed , duration of consultation , and abortive calls/missed appointments . Data on use of healthcare re sources were extracted from GP records . Cost-effectiveness was assessed from the health service perspective ; sensitivity analyses were based on proportion review ed and duration of consultation . RESULTS A total of 278 people with asthma were r and omised to surgery ( n = 141 ) or telephone ( n = 137 ) review . Onehundred- and -one ( 74 % ) of those with asthma in the telephone group were review ed versus 68 ( 48 % ) in the surgery group ( P < 0.001 ) . Telephone consultations were significantly shorter ( mean duration telephone = 11.19 minutes [ st and ard deviation { SD } = 4.79 ] versus surgery = 21.87 minutes [ SD = 6.85 ] , P < 0.001 ) . Total respiratory healthcare costs per patient over 3 months were similar ( telephone = pounds sterling 64.49 [ SD = 73.33 ] versus surgery = pounds sterling 59.48 [ SD = 66.02 ] , P = 0.55 ) . Total costs of providing 101 telephone versus 68 face-to-face asthma review s were also similar ( telephone = pounds sterling 725.84 versus surgery = pounds sterling 755.70 ) , but mean cost per consultation achieved was lower in the telephone arm ( telephone = pounds sterling 7.19 [ SD = 2.49 ] versus surgery = pounds sterling 11.11 [ SD = 3.50 ] ; mean difference = - pounds sterling 3.92 [ 95 % confidence interval = - pounds sterling 4.84 to pounds sterling 3.01 ] , P < 0.001 ) . CONCLUSIONS Telephone consultations enable a greater proportion of asthma patients to be review ed at no additional cost to the health service . This mode of delivering care improves access and reduces cost per consultation achieved The utility of shock-absorbing boot and sneaker inserts for reducing the occurrence of lower limb pain among male US Army basic trainees was evaluated . Every other training unit was given inserts . The inserts were issued prior to the start of training when combat boots and sneakers were fitted . According to post-training question naires and the participants ' medical records , the inserts did not have any preventive effect on occurrence of lower limb problems during training . Five hundred seventeen trainees were issued inserts  , 397 were followed but not issued inserts , and 218 were not issued but purchased them on their own . Thirty-eight percent of those issued inserts had lower limb pain problems compared with 29 % of those not issued inserts and 38 % of those who bought their own . There was no statistical difference between these rates of occurrence . Prior to training , there were minor differences between the groups ' scores on physical fitness test scores and run times . These differences disappeared during training so that there were no differences among the groups on either training or clinical variables during or after basic training As part of a larger study of the effect of foot shape on functioning , 47 Royal Australian Air Force recruits with flexible flat feet who were embarking on a 10-week basic training course took part in a r and omized controlled trial of orthotic therapy . In particular , recruits were assigned at r and om to an untreated group or a group that received Australian Orthotics Laboratory , three-quarter-length , flexible , shoe inserts . The groups were assessed at baseline and week 8 . Outcome measures included pain , injury , foot health , and quality of life . The untreated group ( n = 22 ) had a greater proportion of heavier recruits  than did the treated group ( n = 25 ) . There were no significant differences in outcome measures at baseline . Only one-half of the group assigned to orthotic therapy  wore the orthotics most or all of the time . At the end of the trial , although the results were not statistically significant , those who were provided with orthotics and wore them had the least lower limb pain and the best general foot health and quality of life . Notably , none of the recruits who wore their orthotics most or all of the time sustained a training injury A prospect i ve controlled trial was carried out to determine the usefulness of a viscoelastic polymer insole in prevention of stress fractures and stress reactions of the lower extremities .  The subjects were 3,025 US Marine recruits who were followed for 12 weeks of training at Parris Isl and , South Carolina .  Polymer and st and ard mesh insoles were systematic ally distributed in boots that were issued to members of odd and even numbered platoons . The most important finding was that an elastic polymer insole with good shock absorbency properties did not prevent stress reactions of bone during a 12-week period of vigorous physical training . To control for the confounding effects of running in running shoes , which occurred for about one and one-half hours per week for the first five weeks , we also examined the association of age of shoes and cost of shoes with injury incidence . A slight trend of increasing stress injuries by increasing age of shoes was observed . However , this trend did not account for the similarity of rates in the two insole groups . In addition , we observed a strong trend of decreasing stress injury rate by history of increasing physical activity , as well as a higher stress injury rate in White compared to Black recruits . The results of the trial were not altered after controlling for these factors . This prospect i ve study confirms previous clinical reports of the association of stress fractures with physical activity history . The clinical application of a shock absorbing insole as a preventive for lower extremity stress reactions is not supported in these uniformly trained recruits . The findings are relevant to civilian population Background : Foot orthoses are widely prescribed both to treat existing pathological conditions and to prevent overuse injuries , but little is known about the effect of their material composition and fabrication technique on patient comfort and the incidence of overuse injuries . Material s and Methods : The acceptance rates and comfort scores of soft custom , soft prefabricated , semirigid biomechanical , and semirigid prefabricated orthoses and their effect on the incidence of stress fractures , ankle sprains , and foot problems were studied in a prospect i ve , r and omized , single-blinded clinical trial among 874 infantry recruits during basic training . Results : A statistically significantly lower number of recruits given soft prefabricated orthoses ( 53 % ) finished basic training in their assigned devices than in the soft custom group ( 72 % ) , in the semirigid biomechanical group ( 75 % ) , and in the semirigid prefabricated group ( 82 % ) ( p = .003 ) . For recruits who finished training in their assigned orthoses , the soft custom ( 3.54 ) and soft prefabricated ( 3.43 ) orthoses had significantly higher comfort scores than the semirigid biomechanical ( 3.23 ) and prefabricated ( 3.17 ) orthoses , ( p = .0001 ) . There was no statistically significant difference in the incidence of stress fractures , ankle sprains , or foot problems between recruits using the different types of orthoses . Conclusions : These findings suggest that if a foot orthosis is being dispensed as prophylaxis for overuse injuries in an active , healthy population , there is little justification for prescribing semirigid biomechanical orthoses . Their cost is high compared to other types of orthoses , without an advantage in comfort or a reduction in stress fractures , ankle sprains , and foot problems 
    Output:
    
It is not clear why telephone consultations are briefer , i.e. if it is due to loss of physical examination time , discussion of fewer problems , less health promotion , less social speech or if it is achieved at the expense of patient-centredness or holistic care .
In a recent pilot study of out-of-hours telephone consultations ( Heaney D , personal communication 2005 ) clinical quality , while difficult to measure reliably , appeared worryingly poor .
While most patients have access to telephones , the most disadvantaged may only have access to expensive mobile devices .
In addition , some minority groups such as those who are hard of hearing ( 43 % of those over 70 years11 ) and those who do not use English as a first language may be disadvantaged by systems that insist on the telephone being the first point of contact .
Currently , telephone consulting appears to be rather indiscriminately used for many very different problems , presentations and patient groups despite scant information on quality of care , patient acceptability and impact on workload .
Particularly as this form of consultation appears to be increasingly used and in new ways it is important to establish for which types of consultation and problems and for which patients it is most appropriate .