***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 —Delay from onset of acute coronary syndrome ( ACS ) symptoms to hospital admission continues to be prolonged . To date , community education campaigns on the topic have had disappointing results . Therefore , we conducted a clinical r and omized trial to test whether an intervention tailored specifically for patients with ACS and delivered one-on-one would reduce prehospital delay time . Methods and Results — Participants ( n=3522 ) with documented coronary heart disease were r and omized to experimental ( n=1777 ) or control ( n=1745 ) groups . Experimental patients received education and counseling about ACS symptoms and actions required .  Patients had a mean age of 67±11 years , and 68 % were male . Over the 2 years of follow-up , 565 patients ( 16.0 % ) were admitted to an emergency department with ACS symptoms a total of 842 times . Neither median prehospital delay time ( experimental , 2.20 versus control , 2.25 hours ) nor emergency medical system use ( experimental , 63.6 % versus control , 66.9 % ) was different between groups , although experimental patients were more likely than control to call the emergency medical system if the symptoms occurred within the first 6 months following the intervention ( P=0.036 ) . Experimental patients were significantly more likely to  take aspirin after symptom onset than control patients ( experimental , 22.3 % versus control , 10.1 % , P=0.02 ) . The intervention did not result in an increase in emergency department use ( experimental , 14.6 % versus control , 17.5 % ) . Conclusions —The education and counseling intervention did not lead to reduced prehospital delay or increased ambulance use . Reducing the time from onset of ACS symptoms to arrival at the hospital continues to be a significant public health challenge . Clinical Trial Registration — clinical trials.gov . Identifier NCT00734760 Background There has been increasing interest in the ability of the internet to produce behaviour change . The focus of this study was to describe program exposure across three intervention groups from a r and omised trial ( RT ) comparing traditional face-to-face , internet-mediated ( combined internet plus face-to-face ) , and internet-only program delivery . Methods Baseline and immediately post-intervention survey data , and exposure rates from participants that commenced the RT were included ( n = 192 ) . Exposure was defined as either face-to-face attendance , website usage , or a combination of both for the internet-mediated group . Characteristics of participants who were exposed to at least 75 % of the program material were explored . Descriptive analysis and logistical regression were used to examine differences between groups for program exposure . Results All groups showed decrease in program exposure over time . Differences were also observed ( χ2 = 10.37 , p < 0.05 ) , between intervention groups . The internet-mediated ( OR = 2.4 , 95 % CI 1.13–5.1 ) and internet-only ( OR = 2.96 , 95 % CI 1.38–6.3 ) groups were more likely to have been exposed to at least 75 % of the program compared to the face-to-face group . Participants with high physical activity self-efficacy were 1.82 ( 95 % CI 1.15–2.88 ) times more likely to have been exposed to 75 % of the program , and those allocated to the face-to-face group were less likely to have attended 75 % of the face-to-face sessions if they were classified as obese ( OR = 0.21 95 % CI 0.04–0.96 ) . Conclusion These results suggest that the internet groups were as effective as the face-to-face delivery mode in engaging participants in the program material . However , different delivery methods may be more useful to different sub- population s. It is important to explore which target groups that internet-based programs are best suited , in order to increase their impact The goal of evidence -based medicine is ultimately to improve patient outcomes and quality of care .  Systematic review s of the available published evidence are required to identify interventions that lead to improvements in behavior , health , and well-being . Authoritative literature review s depend on the quality of published research and research reports . The Consoli date d St and ards for Reporting Trials ( CONSORT ) Statement ( www.consort-statement.org ) was developed to improve the design and reporting of interventions involving r and omized clinical trials ( RCTs ) in medical journals . We describe the 22 CONSORT guidelines and explain their application to behavioral medicine research and to evidence -based practice . Additional behavioral medicine-specific guidelines ( e.g. , treatment adherence ) are also presented . Use of these guidelines by clinicians , educators , policymakers , and research ers who design , report , and evaluate or review RCTs will strengthen the research itself and accelerate efforts to apply behavioral medicine research to improve the processes and outcomes of behavioral medicine practice BACKGROUND The literature suggests that people delay too long prior to attending emergency departments with acute coronary syndrome ( ACS ) symptoms . This delay is referred to as prehospital delay . Patient decision delay contributes most significantly to prehospital delay . OBJECTIVES Using a r and omized controlled trial , we tested an educational intervention to reduce patient prehospital delay in ACS and promote appropriate responses to symptoms . METHODS Eligible patients who were admitted across five emergency departments ( EDs ) in Dublin were recruited to the study ( n = 1944 ; control : 972 , intervention : 972 ) . RESULTS Median baseline prehospital delay times did not differ significantly between the groups at baseline ( Mann-Whitney U , p = 0.34 ) ( CONTROL : 4.28 h , 25(th ) percentile = 1.71 , 75(th ) percentile = 17.37 ; Intervention 3.96 h , 25(th ) percentile = 1.53 , 75(th ) percentile = 18.51 ) . Both groups received usual in-hospital care . In addition , patients r and omized to the intervention group received a 40-min individualized education session using motivational techniques . This was reinforced 1 month later by telephone . Of the 1944 , 314 ( 16.2 % ) were readmitted with ACS symptoms : 177 ( 18.2 % ) and 137 ( 14.1 % ) of the intervention and control groups , respectively . Prehospital delay times were again measured . Median delay time was significantly lower in the intervention compared to the control group ( 1.7 h vs. 7.1 h ; p ≤ 0.001 ) . Appropriately , those in the intervention group reported their symptoms more promptly to another person ( p = 0.01 ) and fewer consulted a general practitioner ( p = 0.02 ) . There was no significant difference in ambulance use ( p = 0.51 ) or nitrate use ( p = 0.06 ) between the groups . CONCLUSION It is possible to reduce prehospital delay time in ACS , but the need for renewed emphasis on ambulance use is important Loss to follow-up is often hard to avoid in r and omised trials . This article suggests a framework for intention to treat analysis that depends on making plausible assumptions about the missing data and including all participants in sensitivity We describe a framework for defining  pilot and feasibility studies  focusing on studies conducted in preparation for a r and omised controlled trial . To develop the framework , we undertook a Delphi survey ; ran an open meeting at a trial methodology conference ; conducted a review of definitions outside the health research context ; consulted experts at an international consensus meeting ; and review ed 27 empirical pilot or feasibility studies . We initially adopted mutually exclusive definitions of pilot and feasibility studies . However , some Delphi survey respondents and the majority of open meeting attendees disagreed with the idea of mutually exclusive definitions . Their viewpoint was supported by definitions outside the health research context , the use of the terms ‘ pilot ’ and ‘ feasibility ’ in the literature , and participants at the international consensus meeting . In our framework , pilot studies are a subset of feasibility studies , rather than the two being mutually exclusive . A feasibility study asks whether something can be done , should we proceed with it , and if so , how . A pilot study asks the same questions but also has a specific design feature : in a pilot study a future study , or part of a future study , is conducted on a smaller scale . We suggest that to facilitate their identification , these studies should be clearly identified using the terms ‘ feasibility ’ or ‘ pilot ’ as appropriate . This should include feasibility studies that are largely qualitative ; we found these difficult to identify in electronic search es because research ers rarely used the term ‘ feasibility ’ in the title or abstract of such studies . Investigators should also report appropriate objectives and methods related to feasibility ; and give clear confirmation that their study is in preparation for a future r and omised controlled trial design ed to assess the effect of an intervention PURPOSE To compare delay and circumstances of decisions to seek care in patients with acute myocardial infa rct ion ( AMI ) in the United States ( US ) , Engl and , Australia , South Korea , and Japan . DESIGN Comparative prospect i ve design . METHODS Patients diagnosed with AMI ( N = 913 ) were interviewed within 72 hours of hospital admission for confirmed AMI using the Response to Symptoms Question naire . Delay times were calculated from review of emergency room records and patients ' interviews . Analysis of variance was used to test differences in delay time among countries . FINDINGS Median delay ranged from 2.5 hours in Engl and to 6.4 hours in Australia , with the three Pacific Rim countries reporting median delay times > 4 hours . The majority of patients experienced initial symptoms at home ( range : 56 % in Japan to 73 % in the US ) with the most common witness being a family member ( 32 % in South Korea to 48 % in Engl and ) . Ambulance use was widely divergent with the highest use in Engl and ( 85 % ) and the lowest use in the US ( 42 % ) . CONCLUSIONS In all countries , median delay was too long to obtain maximum benefit from AMI therapies , particularly thrombolysis . Education and counseling of patients and families to reduce prehospital delay in AMI episodes might be more effective if the various factors influencing patients ' first responses to symptoms are considered , as well as differences in health care systems A consistent finding in health services research is the report of uneven uptake of research findings . Implementation trials have a variable record of success in effectively influencing clinicians ' behaviour . A more systematic approach may be to conduct Intervention Modelling Experiments before service-level trials , examining intervention effects on ' interim endpoints ' representing clinical behaviour , derived from empirically supported psychological theories . The objectives were to : ( 1 ) Design Intervention Modelling Experiments by backward engineering a ' real-world ' r and omised controlled trial ( NEXUS ) ; ( 2 ) examine the applicability of psychological theories to clinical decision-making ; ( 3 ) explore whether psychological theories can illuminate how interventions achieve their effects . A 2 x 2 factorial r and omised controlled trial was design ed with pre- and post-intervention data collection by postal question naire surveys . The first survey was used to generate feedback data and the interventions were delivered in the second survey . General medical practitioners ( GPs ) in Engl and and Scotl and participated . First survey respondents were r and omised twice to receive or not audit and feedback and educational reminder messages . The main outcome measures included behavioural intention ( general plan to refer for lumbar X-rays ) and simulated behaviour ( specific , scenario-based , decisions to refer for lumbar X-ray ) . Predictors were attitude , subjective norm , perceived behavioural control ( theory of planned behaviour ) , self-efficacy ( social cognitive theory ) and decision difficulty . Both interventions significantly influenced simulated behaviour , but neither influenced behavioural intention . There were no interaction effects . All theoretically derived cognitions significantly predicted simulated behaviour . Only subjective norm was not predictive of behavioural intention . The effect of audit and feedback on simulated behaviour was mediated through perceived behavioural control . The results of this study suggest that Intervention Modelling Experiments , using psychological models to help isolate mediators of clinical decision-making , may be a means of developing more potent interventions , and selecting implementation interventions with a greater likelihood of success in a service-level r and omised controlled trial CONTEXT Delayed access to medical care in patients with acute myocardial infa rct ion ( AMI ) is common and increases myocardial damage and mortality . OBJECTIVE To evaluate a community intervention to reduce patient delay from symptom onset to hospital presentation and increase emergency medical service ( EMS ) use . DESIGN AND SETTING The Rapid Early Action for Coronary Treatment Trial , a r and omized trial conducted from 1995 to 1997 in 20 US cities ( 10 matched pairs ; population range , 55,777 - 238,912 ) in 10 states . PARTICIPANTS A total of 59,944 adults aged 30 years or older presenting to hospital emergency departments ( EDs ) with chest pain , of whom 20,364 met the primary population criteria of suspected acute coronary heart disease on admission and were discharged with a coronary heart disease-related diagnosis . INTERVENTION One city in each pair was r and omly assigned to an 18-month intervention that targeted mass media , community organizations , and professional , public , and patient education to increase appropriate patient actions for AMI symptoms ( primary population , n=10,563 ) . The other city in each pair was r and omly assigned to reference status ( primary population , n=9801 ) . MAIN OUTCOME MEASURES Time from symptom onset to ED arrival and EMS use , compared between intervention and reference city pairs . RESULTS General population surveys provided evidence of increased public awareness and knowledge of program messages . Patient delay from symptom onset to hospital arrival at baseline ( median , 140 minutes ) was identical in the intervention and reference communities . Delay time decreased in intervention communities by -4.7 % per year ( 95 % confidence interval [ CI ] , -8.6 % to -0.6 % ) , but the change did not 
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DISCUSSION Positive results changing intentions would lead to a r and omized controlled trial of the behaviour change intervention in clinical practice , assessing patient delay in the event of actual symptoms .