***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: Three hundred eleven employees of the National Institutes of Health volunteered to take 1 gm of ascorbic acid or lactose placebo in capsules three times a day for nine months . At the onset of a cold , the volunteers were given an additional 3 gm daily of either a placebo or ascorbic acid .  One hundred ninety volunteers completed the study . Dropouts were defined as those who missed at least one month of drug ingestion . They represented 44 % of the placebo group and 34 % of those taking ascorbic acid . Analysis of these data showed that ascorbic acid had at best only a minor influence on the duration and severity of colds , and that the effects demonstrated might be explained equally well by a break in the double blind In a r and omised , controlled trial , patients with joint diseases and concomitant treatment with NSAIDs and diuretics received systematic education . The intervention group was given information by a self-conducted , interactive Kodak Photo-CD program in addition to personal drug information and non-commercial drug leaflets . Awareness of drug interactions and encouragement of self-adjustment of treatment was focused on . Control patients received conventional information . Three months after r and omisation , knowledge was tested by means of a question naire . At 3 months there was a significant difference in attained score between the intervention group and the control group . Greater knowledge was achieved , especially on drug interaction , in the intervention group . In conclusion , less than 1 h of systematic education significantly improved  patients ' knowledge on essential issues of concomitant treatment with NSAIDs and diuretics . Knowledge of effects , side-effects and interactions of drugs is essential for self-adjustment of treatment . The method employed , which is st and ardised and produces a reproducible quantity of education , might be applicable to several other medical conditions Publisher Summary This chapter focuses on the bias in analytic research .  Case-control studies are attractive . They can be executed quickly and at low cost , even when the disorders of interest are rare . The execution of pilot case-control studies is becoming automated ; strategies have been devised for the “ computer scanning ” of large files of hospital admission diagnoses and prior drug exposures , with detailed analyses carried out in the same data set on an ad hoc basis . As evidence of their growing popularity , when one original article was r and omly selected from each issue of The New Engl and Journal of Medicine , The Lancet , and the Journal of the American Medical Association for the years 1956 , 1966 , and 1976 , the proportion that reported case-control analytic studies increased fourfold over these two decades ; however , the proportion reporting cohort analytic studies fell by half ; a general trend toward fewer study subjects but more study authors was also noted OBJECTIVE To evaluate the short term efficacy of a community based physical therapy ( PT ) program for people with rheumatoid arthritis ( RA ) through a single blind r and omized controlled trial . METHODS Adults with active RA were referred by their physician for community based PT . Participants were r and omized to either an  immediate intervention group [ experimental group ( EG ) ] or a wait list control group  ( CG ) . The intervention was a st and ardized program of education and exercise consisting of at least 4 visits or 3 h of PT over 6 weeks . Baseline , 6 , and 12 week assessment s were by a blinded independent assessor . The primary outcome instrument was the Stanford Arthritis Self-Efficacy Scale ( SES ) and secondary outcome measures included the ACREU Rheumatoid Arthritis Knowledge Question naire ( KQ ) and visual analog scale for pain ( VAS ) . Duration of morning stiffness , grip strength , and tender joint count were also collected at each assessment . Outcome analysis was conducted using analysis of variance . RESULTS Of 150 eligible and r and omized participants , 127 completed the study according to protocol . Baseline analysis showed no differences between the EG and CG for demographics , disease status , or other characteristics . At the 6 week assessment , primary outcome analysis for those who completed the protocol identified a mean change ( improvement ) of 13.5 % in the EG and 5.8 % in the CG , representing a 7.7 % difference in change scores between the 2 groups [ F(1,121 ) = 6.03 ; p = 0.015 ] . A statistically significant difference in change scores was also identified for the KQ [ F(1,120 ) = 6.67 ; p = 0.011 ] , but not for the VAS . Disease status measures did not change , except for duration of morning stiffness , which improved by 68.8 min in the EG and 8.3 min in the CG ( F(1,121 ) = 4.50 ; p = 0.036 ] . CONCLUSION Four hours of a community based PT intervention delivered over 6 weeks significantly improved self-efficacy , disease management knowledge and morning stiffness in people with RA Rheumatic patients very often suffer from chronic pain and impairment and show psychological reactions as a consequence of their physical condition . These reactions may vary from psychophysiological symptoms to anger , anxiety , or depression . We developed a cognitive-behavioral treatment programme in a group setting format with components of relaxation , cognitive restructuring , and the promotion of well-being .  Subjects included in the study were given diagnoses of low back pain , tension headache , rheumatoid arthritis , and ankylosing spondylitis . Treatment effects in different diagnostic groups were compared to each other , supporting the assumption that pain reduction is greatest in low back pain and least in ankylosing spondylitis . Subjects with inflammatory rheumatic diseases showed some improvement in self-reported physical complaints and in their feelings of well-being Self-instruction is one means of providing patient education , allowing the health professional to teach a larger number of persons than with one-to-one or group instruction and at a lower cost . The purpose of this study was to examine the effects of self-instruction on learning , satisfaction with the teaching approach , and health status of persons with rheumatoid arthritis ( RA ) . A control-group pretest-posttest design was used . Thirty subjects receiving care at a rheumatology clinic who met study criteria were r and omly assigned to two groups : self-instruction and control . One-way analysis of covariance on posttest Rheumatoid Arthritis Knowledge Inventory ( RAKI ) scores , with the pretest as covariate , was used to examine the difference in learning between the self-instruction and control groups . There was a significant difference between the groups ( P = 0.01 ) . Participants who completed the self-instructional program had improved scores on the posttest as compared to the control . Subjects rated self-instruction as an effective teaching strategy in terms of promoting learning about RA and patient acceptability . t-Test demonstrated no significant difference between the groups in health status . Significant correlations were found between subjects ' test scores and selected variables OBJECTIVE In rheumatoid arthritis , education programmes successfully impart knowledge but , notwithst and ing issues of empowerment , this knowledge has to be translated into behavioural change to have a chance of improving disease outcome . Arguably , behavioural change must also occur early if outcomes are to be improved . For these reasons , we planned a study of patient education in early disease , with radiological damage and quality of life as the main outcome variables . METHODS We performed a r and omized controlled trial in people with rheumatoid arthritis of < 5 yr duration . The main intervention was a 4 week education programme , each weekly session lasting 2 h. Assessment s were made at entry , at 4 weeks and at 12 months . The main outcome variables were the modified Larsen radiological score for the h and s and the SF-36 quality of life question naire . Secondary outcome variables were the Health Assessment Question naire ( HAQ ) , Ritchie Articular Index ( RAI ) , Patient Knowledge Question naire ( PKQ ) , Compliance Question naire ( CQ ) , plasma viscosity ( PV ) , pharmaceutical changes and consulting behaviour . RESULTS The patient numbers were 34 ( 10 male , 24 female ) for the control group and 43 ( 16 male , 27 female ) for the education group . The groups were matched for age ( 56.5 yr for control , 55 yr for education ) , disease duration ( 3.5 yr vs 3.0 yr ) and duration of second-line drug therapy ( 14 months vs 12 months ) . We found no significant difference between the groups for Larsen scores at 12 months , although scores for the education group were lower ( 39.5 vs 43.0 , P = 0.13 ) . The ' social functioning ' and ' general health perception ' subscales of the SF-36 showed a significant improvement in the education group , but no significant differences between groups were seen . No significant differences were found for the HAQ , RAI , PV and CQ , but the education group had more disease-specific knowledge than the control group at 12 months ( PKQ scores : 17 vs 21 , P = 0.0002 ) . No differences were found for out-patient visits and in-patient admissions , but the education group had slightly more changes in second-line drugs during the study ( 0.43 changes/person in the control group , 0.51 changes/person in the education group ) . CONCLUSIONS We found no significant difference between the groups in our primary outcome measures , but a trend in favour of the education group was found in radiological progression . Further studies of this kind , using larger patient numbers , are required since the difference may result from improved self-care , better compliance with joint protection strategies and , possibly , improved drug compliance OBJECTIVES This study evaluated the effectiveness ( changes in health behaviors , health status , and health service utilization ) of a self-management program for chronic disease design ed for use with a heterogeneous group of chronic disease patients . It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities . METHODS The study was a six-month r and omized , controlled trial at community-based sites comparing treatment subjects with wait-list control subjects .  Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease , lung disease , stroke , or arthritis .  Health behaviors , health status , and health service utilization , as determined by mailed , self-administered question naires , were measured . RESULTS Treatment subjects , when compared with control subjects , demonstrated improvements at 6 months in weekly minutes of exercise , frequency of cognitive symptom management , communication with physicians , self-reported health , health distress , fatigue , disability , and social/role activities limitations . They also had fewer hospitalizations and days in the hospital . No differences were found in pain/physical discomfort , shortness of breath , or psychological well-being . CONCLUSIONS An intervention design ed specifically to meet the needs of a heterogeneous group of chronic disease patients , including those with comorbid conditions , was feasible and beneficial beyond usual care in terms of improved health behaviors and health status . It also result ed in fewer hospitalizations and days of hospitalization Group counseling and education were studied in patients with rheumatoid arthritis ( RA ) . Patients were matched and r and omly assigned to a control ( CG ) or experimental ( EG ) group . Each group attended an educational session but only the EG participated in 12 weekly group counseling sessions . A test of knowledge about RA and psychological tests were administered before and after these sessions . The EG improved their scores in 2 areas of self-concept and in factual knowledge . There was no increase in depression level . These results provide evidence that formal educational sessions and group counseling may be important in the management of patients with RA A r and omized clinical trial was performed to evaluate a psychological treatment intervention and a social support program , compared with a control program in which no adjunct treatment was rendered , and their effects upon pain behavior , affect , and disease activity of 53 patients with rheumatoid arthritis . The psychological intervention produced significant reductions in patients ' pain behavior and disease activity at posttreatment . Significant reductions were also observed in trait anxiety at posttreatment and 6-month followup . Relaxation training may have been the most important component of the psychological intervention . The social support program produced a significant reduction in trait anxiety only at posttreatment . This is the first well-controlled study to demonstrate reduced pain behavior , disease activity , and trait anxiety following psychological treatment One hundred subjects with arthritis were r and omized into lay-taught , or professional-taught 12-h arthritis self-management courses , or a control group .  Outcomes , knowledge , exercise , relaxation , disability , pain , and number of physician visits were measured aat baseline and 4 months . Professional-taught groups demonstrated greater knowledge gain while lay-taught groups had greater changes in relaxation ( p less than .01 ) and a tendency toward less disability . Although it is impossible to draw definitive conclusions , this study suggests that lay leaders can teach arthritis self-management courses with results similar to those achieved by professionals OBJECTIVE The effects of treatment counseling or symptom monitoring telephone intervention strategies on the health outcomes of patients with rheumatoid arthritis ( RA ) or osteoarthritis ( OA ) , compared with usual care , were assessed . METHODS A 3-group , r and omized , controlled 9-month trial was conducted incorporating 405 patients with RA or OA and using the Arthritis Impact Measurement Scales ( AIMS 2 ) as the outcome measure . RESULTS Analyses of covariance showed that the AIMS 2 total health status of the treatment counseling group ( effect size = 33 , P < 0.01 ) , but not the symptom monitoring group ( effect size = 0.21 , P = 0.10 ) , was significantly improved , compared with usual care , for both RA and OA patients . The specific types of benefits differed significantly between RA and OA patients . The mean number of medical visits by OA patients in the treatment counseling group was also significantly reduced ( P < 0.01 ) . CONCLUSION Telephone contact using the treatment counseling strategy produced significant , but different , health status benefits for RA and OA patients . The symptom monitoring strategy produced modest benefits OBJECTIVE The 
    Output:
    
We found significant effects of patient education at first follow-up for scores on disability , joint counts , patient global assessment , psychological status , and depression .
A trend favouring patient education was found for scores on pain .
Physician global assessment was not assessed in any of the included studies .
The dimensions of anxiety and disease activity showed no significant effects .
At final follow up no significant effects of patient education were found , although there was a trend favouring patient education for scores on disability .
REVIEW ER 'S CONCLUSIONS Patient education as provided in the studies review ed here had small short-term effects on disability , joint counts , patient global assessment , psychological status and depression .
There was no evidence of long-term benefits in adults with rheumatoid arthritis