***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 The benefit of regular multidimensional assessment of older people remains controversial . The majority of trials have been too small to produce adequate evidence to inform policy . Despite the lack of a firm evidence base , UK primary care practitioners ( general practitioners ) are required to offer an annual health check to patients aged 75 years and over . Design Cluster-r and omised factorial trial in primary care comparing a package of assessment s ( i ) universal versus targeted assessment and ( ii ) management by the primary care team ( PC ) or a multidisciplinary geriatric assessment team ( GM ) . The unit of r and omization is the general practice . Methods Older people aged 75 and over eligible for the over 75s health check and excluding those in nursing homes or terminally ill were invited to participate . All participants receive a  brief assessment covering all areas of the over 75s check . In the universal arm all participants also receive a  detailed health and social assessment by a study nurse while in the targeted arm only participants with a pre-determined number and range of problems at the brief assessment go on to have the detailed assessment . The study nurse follows a st and ard protocol based on results and responses in the detailed assessment to make referrals to ( i ) the r and omised management team ( PC or GM ) ( ii ) other medical services , health care workers or agencies ( iii ) emergency referrals to the GP . The main outcomes are mortality , hospital and institutional admissions and quality of life . 106 practice s and 33,000 older people have been recruited to the trial Aims : There is ongoing debate over the effectiveness of preventive home visits ( PHVs ) for the elderly . A municipality in the north of Sweden carried out a controlled trial of such visits . Healthy seniors aged 75 years and over received two PHVs per year over 2 years . The aim of this study was to do a cost utility analysis of the intervention . Methods : The intervention group ( n=196 ) was compared with a control group ( n=346 ) , and a  cost utility analysis was performed . The analysis was carried out with three different time perspectives . Data were source d from official documents and medical and social records . Results : From a societal perspective , using a time period of 4 years , the analysis of PHVs to healthy seniors showed net savings . When including estimated future costs for health and elderly care during gained life years , the result changed from a net saving to a cost of Euro 200,000 . A lifetime perspective also result ed in net savings if the costs of future health and elderly care were not included in the analysis . In this case , the total costs rose to approximately Euro 900,000 . The cost could also be expressed as Euro 14,200 per quality -adjusted life year gained if future costs for elderly care and healthcare were included . Conclusions : PHVs represent a cost-effective intervention in this setting . The costs are justified by the outcomes Objective To quantify the psychological impact of primary care based stepwise screening for type 2 diabetes . Design Controlled trial and comparative study embedded in a r and omised controlled trial . Setting 15 practice s ( 10 screening , five control ) in the ADDITION ( Cambridge ) trial in the east of Engl and . Participants 7380 adults ( aged 40 - 69 ) in the top fourth for risk of having undiagnosed type 2 diabetes ( 6416 invited for screening , 964 controls ) . Interventions Invited for screening for type 2 diabetes or not invited ( controls ) , incorporating a comparative study of subgroups of screening attenders . Attenders completed question naires after a r and om blood glucose test and at 3 - 6 months and 12 - 15 months later . Controls were sent question naires at corresponding time points . Non-attenders were sent question naires at 3 - 6 months and 12 - 15 months . Main outcome measures State anxiety ( Spielberger state anxiety inventory ) , anxiety and depression ( hospital anxiety and depression scale ) , worry about diabetes , and self rated health . Results No significant differences were found between the screening and control participants at any time — for example , difference in means ( 95 % confidence intervals ) for state anxiety after the initial blood glucose test was −0.53 , −2.60 to 1.54 , at 3 - 6 months was 1.51 ( −0.17 to 3.20 ) , and at 12 - 15 months was 0.57 , −1.11 to 2.24 . After the initial test , compared with participants who screened negative , those who screened positive reported significantly poorer general health ( difference in means −0.19 , −0.25 to −0.13 ) , higher state anxiety ( 0.93 , −0.02 to 1.88 ) , higher depression ( 0.32 , 0.08 to 0.56 ) , and higher worry about diabetes ( 0.25 , 0.09 to 0.41 ) , although effect sizes were small . Small but significant trends were found for self rated health across the screening subgroups at 3 - 6 months ( P=0.047 ) and for worry about diabetes across the screen negative groups at 3 - 6 months and 12 - 15 months ( P=0.001 ) . Conclusions Screening for type 2 diabetes has limited psychological impact on patients . Implementing a national screening programme based on the stepwise screening procedure used in the ADDITION ( Cambridge ) trial is unlikely to have significant consequences for patients ' psychological health . Trial registration Current Controlled Trials IS RCT N99175498 Cluster r and omization trials are increasingly being used in primary care research . The main feature of these trials is that patients are nested within large clusters such as physician practice s or communities and the intervention is applied to the cluster . This study design necessitates calculation of intraclass correlation coefficients in order to determine the required sample size . The purpose of this study is to determine intraclass correlation coefficients for a number of outcome measures at the primary care practice level . The CEART study is a  r and omized trial testing the effectiveness of translating ATP III guidelines into clinical practice , with primary care physician practice s as the unit of r and omization and patients as the unit of data collection . The intraclass correlation coefficient ( ICC ) was<0.02 and the design effect ranged from 1.0 to 2.3 , respectively , for weight , total cholesterol , LDL , non-HDL , glucose , creatinine , and % at non-HDL goal . For smoking status , body mass index , systolic blood pressure , HDL cholesterol triglycerides , total cholesterol/HDL ratio and % at LDL goal , the ICC was 0.02 - 0.047 and the design effect was 2.6 - 4.1 . The largest ICCs ( 0.05 - 0.12 ) and design effects ( 4.4 - 9.4 ) were found for height and diastolic blood pressure . These findings suggest that cluster r and omization may substantially increase the sample size necessary to maintain adequate statistical power for selected outcomes such as diastolic blood pressure studies compared with simple r and omization for most outcomes evaluated in this study where the design effect is small to moderate . Overall , the ICCs presented will be useful in calculating sample sizes at the primary care level Aim : The aim of this article is to describe the program and study design of our preventive home visit model that targets the specific care needs of Japanese ambulatory frail elders living at home . Methods : The program focused on ambulatory frail elders who were certified as being in the two lowest levels of care need in the Long-Term Care Insurance system and eligible for care , but who were currently not using long-term care services . To provide efficient community-based preventive care , we developed a program model composed of structured assessment s and individualized care recommendations conducted by community care nurses or workers . The assessment protocol focused on locomotion , activities of daily living , social activities , health status , and possibility of abuse . Care needs were clarified every six months over two years . The effectiveness of the program is being assessed in a r and omized controlled trial . Results : A total of 243 elders were assigned r and omly to the preventive home-visit intervention ( n=122 ) or control group ( n=121 ) . Their mean age was 80 years , 76 % were women , and 25 % lived alone . Outcomes including ADLs , IADLs , depression , and social support were measured by postal question naire at baseline , and at 12- and 24-month follow-ups . Utilization of public health or long-term care insurance and service uses over the period is also being documented . Conclusions : The design ’s unique elements of regular evaluation of healthcare needs for targeted individuals within the long-term care insurance context will allow new underst and ing of the role and effectiveness of preventive home visits Objectives To assess whether screening improves the detection of atrial fibrillation  ( cluster r and omisation ) and to compare systematic and opportunistic screening . Design Multicentred cluster r and omised controlled trial , with subsidiary trial embedded within the intervention arm . Setting 50 primary care centres in Engl and , with further individual r and omisation of patients in the intervention practice s. Participants 14 802 patients aged 65 or over in 25 intervention and 25 control practice s. Interventions Patients in intervention practice s were r and omly allocated to systematic screening ( invitation for electrocardiography ) or opportunistic screening ( pulse taking and invitation for electrocardiography if the pulse was irregular ) . Screening took place over 12 months in each practice from October 2001 to February 2003 . No active screening took place in control practice s. Main outcome measure Newly identified atrial fibrillation . Results The detection rate of new cases of atrial fibrillation was 1.63 % a year in the intervention practice s and 1.04 % in control practice s ( difference 0.59 % , 95 % confidence interval 0.20 % to 0.98 % ) . Systematic and opportunistic screening detected similar numbers of new cases ( 1.62 % v 1.64 % , difference 0.02 % , −0.5 % to 0.5 % ) . Conclusion Active screening for atrial fibrillation detects additional cases over current practice . The preferred method of screening in patients aged 65 or over in primary care is opportunistic pulse taking with follow-up electrocardiography . Trial registration Current Controlled Trials IS RCT N19633732 OBJECTIVES To apply and evaluate the effects of a program for computer generated physician reminders , integrated with an electronic patient record ( EPR ) system , for opportunistic health screening in elderly patients . DESIGN A pilot study design ed as a 20-month clinical trial with a control group and a 20-month non-intervention follow-up using a computer reminder program that selects patients for screening in five intervention areas ( diabetes , hypertension , cobalamin deficiency , hypothyroidism and anaemia ) . SETTING Four primary health care ( PHC ) centres in suburban Stockholm . SUBJECTS The intervention was design ed for patients 70 years or older from one health care centre who visited a general practitioner ( GP ) during the first 20-month period . Patients from the three remaining centres served as controls . MAIN OUTCOME MEASURES The number of patients who underwent the tests , who had pathological test results , new diagnoses and new pharmacological treatments in both patient groups . RESULTS In total , 602 patients underwent screening and 1989 were controls . There was a statistically significant , moderate or marked increase ( 13 - 75 % ) in the number of patients who were tested in all five intervention areas . An increase in pathological test results ( 1 - 8 % ) was found in two areas : hypertension and cobalamin deficiency . There was an increase in the number of patients with the diagnosis of cobalamin deficiency during the study . At follow-up a decrease in new diagnoses for anaemia was found . CONCLUSION The system seems to be associated with a moderate to large increase in laboratory and manual screening tests for both established and new screening areas . The effect on clinical outcomes was found mainly in a not-yet-established screening area ( cobalamin deficiency ) , indicating that the system may be clinical ly useful when introducing new screening services Multiphasic screening as a case-finding tool was evaluated in a r and omized , controlled study . For each of 112 physicians , a patient was assigned to one of three groups : multiphasic screening group ( SG ) , chart abstract group ( AG ) , or chart review group ( RG ) . Medical problem lists constructed before and after receiving additional information were compared . Physicians for 36 SG patients identified considerably more new medical problems , both total ( 77 ) and ones they considered important ( 25 ) , than 40 AG physicians ( 14 and 8) and 36 RG physicians ( 4 and 0 ) . One year later , 38 of the 95 newly identified problems had been acted on , 31 in the SG . Medical care was affected in nine patients : six in SG , two in AG , and one in RG . Multiphasic screening may help physicians identify new medical problems in clinic patients Background The global burden of the major vascular diseases is projected to rise and to remain the dominant non-communicable disease cluster well into the twenty first century . The Department of Health in Engl and has developed the NHS Health Check service as a policy initiative to reduce population vascular disease risk . The aims of this study were to monitor population changes in cardiovascular disease ( CVD ) risk factors over the first year of the new service and to assess the value of tailored lifestyle support , including motivational interview with ongoing support and referral to other services . Methods R and omised trial comparing NHS Health Check service only with NHS Health Check service plus additional lifestyle support in Stoke on Trent , Engl and . Thirty eight general practice s and 601 ( 365 usual care , 236 additional lifestyle support ) patients were recruited and r and omised independently between September 2 
    Output:
    
General health checks are unlikely to be beneficial