***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: Objective To assess whether an assertive outreach intervention after suicide attempt could reduce the frequency of subsequent suicidal acts , compared with st and ard treatment . Design R and omised , parallel group , superiority trial with blinded outcome assessment . Setting Outpatient intervention at one location at Copenhagen University Hospital , Denmark . Participants Patients older than 12 years admitted to regional hospitals in Copenhagen with a suicide attempt within the past 14 days . We excluded patients diagnosed with schizophrenia spectrum disorders and patients living in institutions . Intervention Case management through assertive outreach that provided crisis intervention and flexible problem solving . This approach incorporated motivational support and actively assisted patients to scheduled appointments to improve adherence with after-treatment as an add on to st and ard treatment . Main outcome Repeated suicide attempt and death by suicide , recorded in medical records and death register at 1-year follow-up . Results 243 patients were included . During 12 months of follow-up , 20/123 ( 16 % ) patients in the intervention group had been registered in hospital records with subsequent suicide attempt , compared with 13/120 ( 11 % ) in the control group ( odds ratio 1.60 , 95 % confidence interval 0.76 to 3.38 ; P=0.22 ) . By contrast , self reported data on new events showed 11/95 ( 12 % ) in the intervention group versus 13/74 ( 18 % ) in the control group ( 0.61 , 0.26 to 1.46 ; P=0.27 ) . By imputing missing data on the selfreported outcomes , we estimated 15/123 ( 12 % ) events in the intervention group and 23/120 ( 19 % ) in the control group ( 0.69 , 0.34 to 1.43 ; P=0.32 ) . Conclusion Assertive outreach showed no significant effect on subsequent suicide attempt . The difference in rates of events between register data and self reported data could indicate detection bias . Trial registration Clinical Trials.gov NCT00700089 Aims and method To assess the feasibility of conducting a larger , definitive r and omised controlled trial of manual-assisted cognitive therapy ( MACT ) , a brief focused therapy to address self-harm and promote engagement in services . We established recruitment , r and omisation and assessment of outcome within a sample of these complex patients admitted to a general hospital following self-harm . We assessed symptoms of depressed mood , anxiety and suicidality at baseline and at 3 months ’ follow-up . Results Twenty patients were r and omised to the trial following an index episode of self-harm , and those allocated to MACT demonstrated improvement in anxiety , depression and suicidal ideation . Clinical implication s It is feasible to recruit a sample of these complex patients to a r and omised controlled trial of MACT following an index episode of self-harm . There is preliminary support that MACT could be an acceptable and effective intervention in patients with personality disorder and substance misuse This study reports the outcomes , during follow-up , of a low-cost postcard intervention in a R and omized Control Trial of hospital-treated self-poisoning ( n = 2300 ) . The intervention was 9 postcards over 12 months ( plus usual treatment ) versus usual treatment . Three binary endpoints at 12–24 months ( n = 2001 ) were : any suicidal ideation , suicide attempt , or self-cutting . There was a significant reduction in any suicidal ideation ( RRR 0.20 CI 95 % 0.13–0.27 ) , ( NNT 8 , 6–13 ) , and any suicide attempt ( RRR 0.31 , 0.06–0.50 ) , ( NNT 35 , 19–195 ) , in this non-western population . However , there was no effect on self-cutting ( RRR -0.01 , -1.05–0.51 ) . Sustained , brief contact by mail may reduce some forms of suicidal behavior in self-poisoning patients during the post intervention phase OBJECTIVE To determine whether brief intervention and contact is effective in reducing subsequent suicide mortality among suicide attempters in low and middle-income countries . METHODS Suicide attempters ( n = 1867 ) identified by medical staff in the emergency units of eight collaborating hospitals in five culturally different sites ( Campinas , Brazil ; Chennai , India ; Colombo , Sri Lanka ; Karaj , Islamic Republic of Iran ; and Yuncheng , China ) participated , from January 2002 to October 2005 , in a r and omized controlled trial to receive either treatment as usual , or treatment as usual plus brief intervention and contact ( BIC ) , which included patient education and follow-up . Overall , 91 % completed the study . The primary study outcome measurement was death from suicide at 18-month follow-up . FINDINGS Significantly fewer deaths from suicide occurred in the BIC than in the treatment-as-usual group ( 0.2 % versus 2.2 % , respectively ; chi2 = 13.83 , P < 0.001 ) . CONCLUSION This low-cost brief intervention may be an important part of suicide prevention programmes for underre source d low- and middle-income countries Suitably trained junior doctors selected parasuicides with no immediate medical or psychiatric treatment needs on initial assessment in a casualty department . This group was then r and omly allocated to  hospital admission  ( 38 cases ) or discharge home ( 39 cases ) . One week later there were no significant differences between groups on diverse outcome measures , including repetition rate , psychological symptoms , and social functioning . A second follow-up using the same measures at 16 weeks also failed to demonstrate any differences between groups , both of which showed considerable overall improvement . A parasuicide management policy consisting of assessment in a casualty department and selective discharge was appropriate for 15 % of a hospital-referred population . This lends support to recent government recommendations , but caution should be exercised before such a result is generalised Objective To determine whether Therapeutic Assessment ( TA ) versus assessment as usual ( AAU ) improves engagement with follow-up in adolescents presenting with self-harm . Design R and omised controlled trial with 3 months naturalistic follow-up . Setting Child and adolescent mental health services in two London National Health Service Trusts . Participants 26 clinicians r and omised into TA and AAU groups recruited 70 newly referred adolescents with self-harm . Interventions TA , a manualised procedure including a basic psychosocial assessment and a 30 min therapeutic intervention ; AAU , st and ard psychosocial assessment . Main outcome measures Attendance at the first follow-up session ; number of the follow-up sessions attended and changes in Strengths and Difficulties Question naire and Children 's Global Assessment Scale scores . All measures were adjusted for clustering , social class , changes of therapist and previous contact with services . Results Using the data on all participants ( n=70 ) , those in the TA group were significantly more likely to attend the first follow-up appointment : 29 ( 83 % ) versus 17 ( 49 % ) , OR 5.12 , 95 % CI ( 1.49 to 17.55 ) and more likely to attend four or more treatment sessions : 14 ( 40 % ) versus 4 ( 11 % ) , OR 5.19 , 95 % CI ( 2.22 to 12.10 ) . Three months after the initial assessment there were no statistically significant differences between the groups on Strengths and Difficulties Question naire scores : 15.6 versus 16.0 , mean difference −0.37 , 95 % CI ( −3.28 to 2.53 ) or Children 's Global Assessment Scale scores : 64.6 versus 60.1 , mean difference 4.49 , 95 % CI ( −0.98 to 9.96 ) . Conclusions TA was associated with statistically significant improvement in engagement . TA could be usefully applied at the point of initial assessment for adolescents with self-harm . Trial registration IS RCT N 81605131 http://www.controlled-trials.com/IS RCT BACKGROUND Repetition of self-poisoning is common . AIMS To report the 24-month outcomes of a non-obligatory postcard intervention ( plus treatment as usual ) compared with treatment as usual . METHOD In a r and omised-controlled trial ( Zelen design ) conducted in Newcastle , Australia , eight postcards were sent to participants over a 12-month period . The principal outcomes were the proportion of participants with one or more repeat episodes of self-poisoning and the number of repeat episodes per person . RESULTS No significant reduction was observed in the proportion of people repeating self-poisoning in the intervention group ( 21.2 % , 95 % CI 17.0 - 25.3 ) compared with the control group ( 22.8 % , 95 % CI 18.7 - 27.0 ; chi(2)=0.32 , d.f.=1 , P=0.57 ) ; the difference between groups was -1.7 % ( 95 % CI -7.5 to 4.2 ) . There was a significant reduction in the rate of repetition , with an incidence risk ratio of 0.49 ( 95 % CI 0.33 - 0.73 ) . CONCLUSIONS A postcard intervention maintained the halving of the rate of repetition of hospital-treated self-poisoning events over a 2-year period , although it did not significantly reduce the proportion of individuals who repeated self-poisoning BACKGROUND Repetition of hospital-treated self-poisoning and admission to psychiatric hospital are both common in individuals who self-poison . AIMS To evaluate efficacy of postcard intervention after 5 years . METHOD A r and omised controlled trial of individuals who have self-poisoned :  postcard intervention ( eight in 12 months ) plus treatment as usual v. treatment as usual . Our primary outcomes were self-poisoning admissions and psychiatric admissions ( proportions and event rates ) . RESULTS There was no difference between groups for any repeat-episode self-poisoning admission ( intervention group : 24.9 % , 95 % CI 20.6 - 29.5 ; control group : 27.2 % , 95 % CI 22.8 - 31.8 ) but there was a significant reduction in event rates ( incidence risk ratio ( IRR ) = 0.54 , 95 % CI 0.37 - 0.81 ) , saving 306 bed days . There was no difference for any psychiatric admission ( intervention group : 38.1 % , 95 % CI 33.1 - 43.2 ; control group : 35.5 % , 95 % CI 30.8 - 40.5 ) but there was a significant reduction in event rates ( IRR = 0.66 , 95 % CI 0.47 - 0.91 ) , saving 2565 bed days . CONCLUSIONS A postcard intervention halved self-poisoning events and reduced psychiatric admissions by a third after 5 years . Substantial savings occurred in general hospital and psychiatric hospital bed days We carried out a r and omized controlled trial to determine whether an intensive intervention after a suicide attempt could decrease by half the risk of a repeat attempt in the following two years . After initial assessment and r and omization , experimental subjects attended 18 therapy appointments over one year  , including one home visit , and measures to improve attendance .  Control subjects received the usual care . Of 63 experimental subjects , 35 % made a repeat attempt , and so did 30 % of 63 control subjects . The study had a 99 % power to detect the desired decrease of risk ( 30 % to 15 % ) . Clearly , the intervention did not achieve its objective Abstract Objective To determine whether an intervention using postcards ( postcards from the EDge project ) reduces repetitions of hospital treated deliberate self poisoning . Design R and omised controlled trial . Setting Regional referral service for general hospital treated deliberate self poisoning in Newcastle , Australia . Participants 772 patients aged over 16 years with deliberate self poisoning . Intervention Non-obligatory intervention using eight postcards over 12 months along with st and ard treatment compared with st and ard treatment alone . Main outcome measures Proportion of patients with one or more repeat episodes of deliberate self poisoning and the number of repeat episodes for deliberate self poisoning per person in 12 months . Results The proportion of repeaters with deliberate self poisoning in the intervention group did not differ significantly from that in the control group ( 57/378 , 15.1 % , 95 % confidence interval 11.5 % to 18.7 % v 68/394 , 17.3 % , 13.5 % to 21.0 % : difference between groups -2 % , -7 % to 3 % ) . In unadjusted analysis the number of repetitions were significantly reduced ( incidence risk ratio 0.55 , 0.35 to 0.87 ) . Conclusion A postcard intervention reduced repetitions of deliberate self poisoning , although it did not significantly reduce the proportion of individual repeaters BACKGROUND Hospital-treated self-poisoning is common , with limited effective interventions for reducing subsequent suicidal behaviour . AIMS To test the efficacy of a postcard intervention to reduce suicidal behaviour . METHOD R and omised controlled trial of individuals who self-poisoned ( n = 2300 ) , the intervention consisted of nine postcards sent over 12 months versus usual treatment . Outcomes assessed at 12 months ( n = 2113 ) were suicidal ideation , suicide attempts and self-cutting ( proportion and event rates ) . RESULTS There was a significant reduction in any suicidal ideation ( relative risk reduction ( RRR ) = 0.31 , 95 % CI 
    Output:
    
Conclusion Active contact and follow-up interventions are recommended for suicidal patients admitted to an ED to prevent repeat suicide attempts during the highest-risk period of 6 months .