***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 Cognitive behavioral therapy is recommended in the National Institute for Clinical Excellence guidelines for the treatment of bulimia nervosa . In order to make this treatment option more accessible to patients , interactive online CBT programs have been developed that can be used in the user ’s own home , in privacy , and at their convenience . Studies investigating online CBT for bulimic type eating disorders have provided promising results and indicate that , with regular support from a clinician or trained support worker , online CBT can be effective in reducing bulimic symptoms . Two main factors distinguish this study from previous research in this area . First , the current study recruited a wide range of adults with bulimic type symptoms from the community . Second , the participants in the current study had used cCBT  with support from a non clinical support worker rather than a specialist eating disorder clinician . Objective To investigate participants ’ experiences of using an online self-help cognitive behavioral therapy ( CBT ) package ( Overcoming Bulimia Online ) for bulimia nervosa ( BN ) and eating disorders not otherwise specified ( EDNOS ) . Methods Eight participants with a mean age of 33.9 years took part in semi-structured interviews  . Interviews were transcribed and analyzed using a 6-step thematic analysis process . Results Saturation was achieved , and 7 themes were identified in the data set . These were : ( 1 ) conceptualizing eating disorders , ( 2 ) help-seeking behavior , ( 3 ) aspects of the intervention , ( 4 ) motivation to use the online package , ( 5 ) privacy and secrecy with regard to their eating problems , ( 6 ) recovery and the future , and ( 7 ) participant engagement describing individuals ’ thoughts on taking part in the online research study . Conclusions Participants suggested that online CBT self-help represented a generally desirable and acceptable treatment option for those with bulimic type eating problems , despite some difficulties with motivation and implementation of some elements of the package . Trial Registration International St and ard R and omized Controlled Trial Number of the original RCT that this study is based on : IS RCT N41034162 ; http://www.controlled-trials.com/IS RCT N41034162 ( Archived by WebCite at http://www.webcitation.org/6Ey9sBWTV BACKGROUND Manualized cognitive-behavioural treatment ( CBT ) is underutilized in the treatment of bulimic symptoms . Internet-delivered treatment may reduce current barriers . OBJECTIVE This study aim ed to assess the efficacy of a new online CBT of bulimic symptoms . METHOD Participants with bulimic symptoms ( n = 105 ) were r and omly allocated to online CBT , bibliotherapy or waiting list/delayed treatment condition . Data were gathered at pre-treatment , post-treatment and 1-year follow-up . OUTCOME MEASURES The primary outcome measures were the Eating Disorder Examination Question naire ( EDE-Q ) and the frequency of binge eating and purging episodes . The secondary outcome measure was the Body Attitude Test . RESULTS Dropout from Internet treatment was 26 % . Intention-to-treat ANCOVAs of post-test data revealed that the EDE-Q scores and the frequency of binging and purging reduced more in the online CBT group compared with the bibliotherapy and waiting list groups ( pooled between-group effect size : d = 0.9 ) . At 1-year follow-up , improvements in the online CBT group had sustained . CONCLUSION This study identifies online CBT as a viable alternative in the treatment of bulimic symptoms Abstract The goal of this study was to develop a cognitive – behavioral self-help manual for anorexia nervosa . Patients diagnosed with anorexia nervosa ( N=102 ) , binge eating/purging type ( AN-B/P ) , were consecutively assigned to one of two conditions : 6-week manualized guided self-help or a wait-list control .  All patients thereafter received inpatient treatment in a hospital for behavioral medicine . The primary outcome variable was the number of days in inpatient treatment . Secondary outcome variables were measures of psychopathology . Results showed that duration of inpatient treatment was significantly shorter ( by 5.2 days ) among participants receiving guided self-help . Body image , slimness ideal , general psychopathology , and some bulimic symptoms improved significantly during self-help . The authors conclude that , to increase effects of therapist-guided self-help in AN-B/P , additional variants of a self-help manual should be tried in different therapeutic setting The present study investigated the efficacy of self-help based on cognitive behaviour therapy in combination with Internet support in the treatment of bulimia nervosa and binge eating disorder . After confirming the diagnosis with an in-person interview , 73 patients were r and omly allocated to treatment or a waiting list control group . Treated individuals showed marked improvement after 12 weeks of self-help compared to the control group on both primary and secondary outcome measures . Intent-to-treat analyses revealed that 37 % ( 46 % among completers ) had no binge eating or purging at the end of the treatment and a considerable number of patients achieved clinical ly significant improvement on most of the other measures as well . The results were maintained at the 6-month follow-up , and provide evidence to support the continued use and development of self-help programmes I SHALL discuss the combination of estimates of relative prevalence or incidence , commonly referred to as relative risk , obtained from retrospective 2 X 2 tables . Barnet Woolf ' described the method in 1954 and J. B. S. Haldane2 introduced some modifications shortly afterward in the Annals of Human Genetics . Figure 1 shows how  retrospective case and control data  may be classified . There are usually some background classes based on age , sex , race , occupation , and the like . Within each such class , individuals are further classified into a 2 X 2 table according to the presence or absence of the disease being studied and the presence or absence of a defined characteristic of focal interest . For any single 2 X 2 table , Cornfield3 has shown a simple way to estimate the risk of disease among those wvith the characteristic , relative to the risk of disease among those without the characteristic . This is done , as illustrated below Figure 1 , by taking the ratio of diagonal products of the cell frequencies . This is a maximum likelihood estimate of the relative risk of disease in the parent population , provided that it is assumed that the cases and controls have been selected at r and om and that cases comprise a negligible portion of the population . It is also possible to obtain a combined , unconditioned , maximum likelihood estimate of relative risk based on all of the 2 X 2 tables . However , the method is time-consuming , involving the iterative solution of sets of quadratic equations . Unless such a method is programed for the computer , I feel that the less tedious procedure to be described is adequate for most practical purpose s. Strictly speaking , the maximum likelihood estimate just described has infinite bias and it is positively skewed . To help remedy these defects , the number , 1/2 , is added to each cell frequency before obtaining the ratio of diagonal products ; furthermore , the natural logarithm of this ratio is taken . The result ing value is an estimate of natural log relative risk . Woolf pointed out that the logarithmic transformation tends to remove skew and Haldane showed that of all possible numbers which might be added to or subtracted from the cell frequencies , 1/2 is the number which reduces the bias of the estimate to a minimum . This estimate of log relative risk is shown in the first column of Figure 2 . The estimated Background Guided self-help programs for depression ( with associated therapist contact ) have been successfully delivered over the Internet . However , previous trials of pure self-help Internet programs for depression ( without therapist contact ) , including an earlier trial conducted by us , have failed to yield positive results . We hypothesized that methods to increase participant usage of the intervention , such as postcard or telephone reminders , might result in significant effects on depression . Objectives This paper presents a second r and omized trial of a pure self-help Internet site , ODIN ( Overcoming Depression on the InterNet ) , for adults with self-reported depression . We hypothesized that frequently reminded participants receiving the Internet program would report greater reduction in depression symptoms and greater improvements in mental and physical health functioning than a comparison group with usual treatment and no access to ODIN . Methods This was a three-arm r and omized control trial with a usual treatment control group and two ODIN intervention groups receiving reminders through postcards or brief telephone calls . The setting was a nonprofit health maintenance organization ( HMO ) . We mailed recruitment brochures by US post to two groups : adults ( n = 6030 ) who received depression medication or psychotherapy in the previous 30 days , and an age- and gender-matched group of adults ( n = 6021 ) who did not receive such services . At enrollment and at 5- , 10- and 16-weeks follow-up , participants were reminded by email ( and telephone , if nonresponsive ) to complete online versions of the Center for Epidemiological Studies Depression Scale ( CES-D ) and the Short Form 12 ( SF-12 ) . We also recorded participant HMO health care services utilization in the 12 months following study enrollment . Results Out of a recruitment pool of 12051 approached subjects , 255 persons accessed the Internet enrollment site , completed the online consent form , and were r and omized to one of the three groups : ( 1 ) treatment as usual control group without access to the ODIN website ( n = 100 ) , ( 2 ) ODIN program group with postcard reminders ( n = 75 ) , and ( 3 ) ODIN program group with telephone reminders ( n = 80 ) . Across all groups , follow-up completion rates were 64 % ( n = 164 ) at 5 weeks , 68 % ( n = 173 ) at 10 weeks , and 66 % ( n = 169 ) at 16 weeks . In an intention-to-treat analysis , intervention participants reported greater reductions in depression compared to the control group ( P = .03 ; effect size = 0.277 st and ard deviation units ) . A more pronounced effect was detected among participants who were more severely depressed at baseline ( P = .02 ; effect size = 0.537 st and ard deviation units ) . By the end of the study , 20 % more intervention participants moved from the disordered to normal range on the CES-D. We found no difference between the two intervention groups with different reminders in outcomes measures or in frequency of log-ons . We also found no significant intervention effects on the SF-12 or health care services . Conclusions In contrast to our earlier trial , in which participants were not reminded to use ODIN , in this trial we found a positive effect of the ODIN intervention compared to the control group . Future studies should address limitations of this trial , including relatively low enrollment and follow-up completion rates , and a restricted number of outcome measures . However , the low incremental costs of delivering this Internet program makes it feasible to offer this type of program to large population s with widespread Internet access Background This study compared the best available treatment for bulimia nervosa , cognitive – behavioural therapy ( CBT ) augmented by fluoxetine if indicated , with a stepped-care treatment approach in order to enhance treatment effectiveness . Aims To establish the relative effectiveness of these two approaches . Method This was a r and omised trial conducted at four clinical centres ( Clinical trials.gov registration number : NCT00733525 ) . A total of 293 participants with bulimia nervosa were r and omised to one of two treatment conditions : manual-based CBT delivered in an individual therapy format involving 20 sessions over 18 weeks and participants who were predicted to be non-responders after 6 sessions of CBT had fluoxetine added to treatment ; or a stepped-care approach that began with supervised self-help , with the addition of fluoxetine in participants who were predicted to be non-responders after six sessions , followed by CBT for those who failed to achieve abstinence with self-help and medication management . Results Both in the intent-to-treat and completer sample s , there were no differences between the two treatment conditions in inducing recovery ( no binge eating or purging behaviours for 28 days ) or remission ( no longer meeting DSM – IV criteria ) . At the end of 1-year follow-up , the stepped-care condition was significantly superior to CBT . Conclusions Therapist-assisted self-help was an effective first-level treatment in the stepped-care sequence , and the full sequence was more effective than CBT suggesting that treatment is enhanced with a more individualised approach BACKGROUND The evidence base for the treatment of adolescents with bulimia nervosa ( BN ) is limited . AIMS To assess the feasibility , acceptability , and clinical outcomes of a web-based cognitive-behavioural ( CBT ) intervention for adolescents with bulimic symptomatology . METHOD 101 participants were recruited from eating disorders clinics or from beat , a UK-wide eating disorders charity . The programme consisted of online CBT sessions ( ' Overcoming Bulimia Online ' ) , peer support via message boards , and email support from a clinician . Participants ' bulimic symptomatology and service utilisation were assessed by interview at baseline and at three and six months . Participants ' views of the treatment package were also determined . RESULTS There were significant improvements in eating disorder symptoms and service contacts from baseline to three months , which were maintained at six months . Participants ' views of the intervention were positive . CONCLUSIONS The intervention has the potential for use as a first step in the treatment of adolescents with bulimic symptomatology OBJECTIVE The current study examined the usefulness of a new , cognitive-based self-help manual for bulimia nervosa . METHOD Twenty people were provided with assessment and six sessions of guided self-help using the manual . Participants were assessed for eating-related behaviors and attitudes and psychopathology at pretreatment , posttreatment , and at the 3-month follow-up . Assessment instruments included the Eating Disorder Examination , Symptom Check 
    Output:
    
None of the patient , study and intervention characteristics predicted intervention completion rates .
Intervention outcomes were moderated by the provision of personal guidance by a health professional , the number of guidance sessions as well as participants ' age , BMI , and eating disorder related attitudes ( Restraint , Eating , Weight and Shape Concerns ) at baseline ( after adjusting for study dropout and intervention completion rates ) .
Guidance particularly improved adherence and outcomes in sample s of patients with bulimia nervosa ; specialist guidance led to higher intervention completion rates and larger intervention effects on some outcomes than non-specialist guidance .