***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: A r and omized controlled trial of an information and medical record booklet design ed to improve patient underst and ing and participation in the management of hypertension was conducted in six inner London general practice s. After one year there were no significant differences between the group who had received the booklets and the control group in mean systolic or diastolic blood pressure , but the study group scored significantly higher on knowledge about hypertension and its management . However , the difference between the two groups was small , possibly because both groups started with a high level of underst and ing about hypertension and its management . In addition , the mean diastolic blood pressure in the control group showed that the treatment provided was already satisfactory , and that there was little need for improvement . Nevertheless , the information booklet evaluated in this study provides health professionals with a highly acceptable method of informing the patient about hypertension and its management and could be used both in hospital and general practice Background Hypertension is one of the key factors causing cardiovascular diseases which make up the most frequent cause of death in industrialised nations . However about 60 % of hypertensive patients in Germany treated with antihypertensives do not reach the recommended target blood pressure . The involvement of patients in medical decision making fulfils not only an ethical imperative but , furthermore , has the potential of higher treatment success . One concept to enhance the active role of patients is shared decision making . Until now there exists little information on the effects of shared decision making trainings for general practitioners on patient participation and on lowering blood pressure in hypertensive patients . Methods / Design In a cluster-r and omised controlled trial 1800 patients receiving antihypertensives will be screened with 24 h ambulatory blood pressure monitoring in their general practitioners ’ practice s. Only patients who have not reached their blood pressure target ( approximately 1200 ) will remain in the study ( T1 – T3 ) . General practitioners of the intervention group will take part in a shared decision making-training after baseline assessment ( T0 ) . General practitioners of the control group will treat their patients as usual . Primary endpoints are change of systolic blood pressure and change of patients ’ perceived participation . Secondary endpoints are changes of diastolic blood pressure , knowledge , medical adherence and cardiovascular risk . Data analysis will be performed with mixed effects models . Discussion The hypothesis underlying this study is that shared decision making , realised by a shared decision making training for general practitioners , activates patients , facilitates patients ’ empowerment and contributes to a better hypertension control . This study is the first one that tests this hypothesis with a ( cluster- ) r and omised trial and a large sample size . Trial registration WHO International Clinical Trials : http://apps.who.int/trial search /Trial.aspx?TrialID = Background To improve risk factor management in diabetes , we need to support effective interactions between patients and healthcare providers . Our aim is to develop and evaluate a treatment decision aid that offers personalised information on treatment options and outcomes , and is intended to empower patients in taking a proactive role in their disease management . Important features are : ( 1 ) involving patients in setting goals together with their provider ; ( 2 ) encourage them to prioritise on treatments that maximise relevant outcomes ; and ( 3 ) integration of the decision aid in the practice setting and workflow . As secondary aim , we want to evaluate the impact of different presentation formats , and learn more from the experiences of the healthcare providers and patients with the decision aid . Methods and design We will conduct a r and omised trial comparing four formats of the decision aid in a 2 × 2 factorial design with a control group . Patients with type 2 diabetes managed in 18 to 20 primary care practice s in The Netherl and s will be recruited . Excluded are patients with a recent myocardial infa rct ion , stroke , heart failure , angina pectoris , terminal illness , cognitive deficits , > 65 years at diagnosis , or not able to read Dutch . The decision aid is offered to the patients immediately before their quarterly practice consultation . The same decision information will be available to the healthcare provider for use during consultation . In addition , the providers receive a set of treatment cards , which they can use to discuss the benefits and risks of different options . Patients in the  control group will receive care as usual . We will measure the effect of the intervention on patient empowerment , satisfaction with care , beliefs about medication , negative emotions , health status , prescribed medication , and predicted cardiovascular risk . Data will be collected with question naires and automated extraction from medical records in 6 months before and after the intervention . Discussion This decision aid is innovative in supporting patients and their healthcare providers to make shared decisions about multiple treatments , using the patient ’s data from electronic medical records . The results can contribute to the further development and implementation of electronic decision support tools for the management of chronic diseases . Trial registration Dutch Trial register NTR1942 CONTEXT Decision aids can increase patient involvement in treatment decision making . However , questions remain regarding their effects and cost implication s. OBJECTIVE To evaluate the effects of information , with and without a structured preference elicitation interview , on treatment choices , health outcomes , and costs . DESIGN , SETTING , AND PARTICIPANTS A r and omized controlled trial with 2 years of follow-up . Between October 1996 and February 1998 , 894 women with uncomplicated menorrhagia were recruited from 6 hospitals in southwest Engl and . Women were r and omized to the control group , information alone group ( information ) , or information plus interview group ( interview ) . INTERVENTIONS Women in both intervention groups were sent an information pack ( a booklet and complementary videotape ) 6 weeks before their specialist consultation . Immediately before their consultation , women in the interview group underwent structured interview , to clarify and elicit their preferences . MAIN OUTCOME MEASURES Self-reported health status was the main outcome ; secondary outcomes included treatments received and costs . Cost analyses adopted a UK health service ( payer ) perspective , and were based on patient-reported re source use data and are reported in 1999 - 2000 US dollars . RESULTS The interventions had no consistent effect on health status . Hysterectomy rates were lower for women in the interview group ( 38 % ) ( adjusted odds ratio [ OR ] , 0.60 ; 95 % confidence interval [ CI ] , 0.38 - 0.96 ) than in the control group ( 48 % ) and women who received the information alone ( 48 % ) ( adjusted OR , 0.52 ; 95 % CI , 0.33 - 0.82 ) . The interview group had lower mean costs ( $ 1566 ) than the control group ( $ 2751 ) ( mean difference , $ 1184 ; 95 % CI , $ 684-$2110 ) and the information group $ 2026 ( mean difference , $ 461 ; 95 % CI , $ 236-$696 ) . CONCLUSIONS Neither intervention had an effect on health status . Providing women with information alone did not affect treatment choices ; however , the addition of an interview to clarify values and elicit preferences had a significant effect on women 's management and result ed in reduced costs The authors assessed whether patient empowerment in the management of hypertension improved more with the practice of shared decision making ( SDM ) than by education programs . In a prospect i ve controlled clinical study , 15 general practitioners in Nuremberg , Germany who were specially trained to conduct SDM consultations participated in a 12-month study . Hypertensive patients ( N=86 ) were included ; N=40 were in the SDM group and N=46 were in the control group , if blood pressures were > or = 135 / 85 mm Hg ( self measurement ) and patients had no signs of cardiovascular complications or severe hypertension . All participants in the SDM group and the control group were enrolled in an education program on hypertension in small groups . The SDM group participants also had 4 special consultations to share medical decisions . The main outcome measures were the effect of SDM on blood pressure control . After 1 year blood pressure had decreased in all participants : Delta-9.26 + /- 10.2 mm Hg/Delta-5.33 + /- 9.5 mm Hg in the SDM group ( P<0.001 ) compared to Delta-6.0 + /- 11.8 mm Hg/Delta-3.0 + /- 8.3 mm Hg in the control group . There was no significant difference between the 2 groups . The study group practice d more  SDM  than controls , but blood pressure control was not significantly better . Patient empowerment by means of an education program in small groups and creating awareness of hypertensive disease helps to improve the outcome of hypertension treatment .  SDM , however , did not improve management when compared to an education program , which is much easier to implement in general practice Concordance -- that is , shared decision-making between doctors and patients --is nowadays accepted as an integral part of good clinical practice . It is of particular importance in the case of treatments with only marginal benefits such as those recommended in guidelines for the management of common , chronic diseases . However , the implementation of guideline -based medicine conflicts with that of concordance . Studies indicate that patients are not adequately informed about their treatment . Clinical guidelines for conditions such as cardiovascular disease are based on large-scale r and omized trials and the complex nature of the data limits effective communication especially in an environment characterized by time constraints . But other factors may be more relevant , notably pressures to comply with guidelines and financial rewards for meeting targets : it is simply not in the interests of doctors to disclose accurate information . Studies show that patients are far from impressed by the small benefits derived from large scale trials . Indeed , faced with absolute risk reductions , patients decline treatment promoted by guidelines . To participate in clinical decisions , patients require unbiased information concerning outcomes with and without treatment , and the absolute risk reduction ; they should be told that most patients receiving long-term medication obtain no benefit despite being exposed to adverse drug reactions ; furthermore , they should be made aware of the question able validity of large-scale trials and that these studies may be influenced by those with a vested interest . Genuine concordance will inevitably lead to many patients rejecting the recommendations of guidelines and encourage a more critical approach to clinical research and guideline -based medicine Background Hypertension is one of the key factors causing cardiovascular diseases . A substantial proportion of treated hypertensive patients do not reach recommended target blood pressure values . Shared decision making ( SDM ) is to enhance the active role of patients . As until now there exists little information on the effects of SDM training in antihypertensive therapy , we tested the effect of an SDM training programme for general practitioners ( GPs ) . Our hypotheses are that this SDM training ( 1 ) enhances the participation of patients and ( 2 ) leads to an enhanced decrease in blood pressure ( BP ) values , compared to patients receiving usual care without prior SDM training for GPs . Methods The study was conducted as a cluster r and omised controlled trial ( c RCT ) with GP practice s in Southwest Germany . Each GP practice included patients with treated but uncontrolled hypertension and /or with relevant comorbidity . After baseline assessment ( T0 ) GP practice s were r and omly allocated into an intervention and a control arm . GPs of the intervention group took part in the SDM training . GPs of the control group treated their patients as usual . The intervention was blinded to the patients . Primary endpoints on patient level were ( 1 ) change of patients ’ perceived participation ( SDM-Q-9 ) and ( 2 ) change of systolic BP ( 24h-mean ) . Secondary endpoints were changes of ( 1 ) diastolic BP ( 24h-mean ) , ( 2 ) patients ’ knowledge about hypertension , ( 3 ) adherence ( MARS-D ) , and ( 4 ) cardiovascular risk score ( CVR ) . Results In total 1357 patients from 36 general practice s were screened for blood pressure control by ambulatory blood pressure monitoring ( ABPM ) . Thereof 1120 patients remained in the study because of uncontrolled ( but treated ) hypertension and /or a relevant comorbidity . At T0 the intervention group involved 17 GP practice s with 552 patients and the  control group 19 GP practice s with 568 patients . The effectiveness analysis could not demonstrate a significant or relevant effect of the SDM training on any of the endpoints . Conclusion The study hypothesis that the SDM training enhanced patients ’ perceived participation and lowered their BP could not be confirmed . Further research is needed to examine the impact of patient participation on the treatment of hypertension in primary care . Trial registration German Clinical Trials Register ( DRKS ) : Background Disparities in health and healthcare are extensively documented across clinical conditions , setting s , and dimensions of healthcare quality . In particular , studies show that ethnic minorities and persons with low socioeconomic status receive poorer quality of interpersonal or patient-centered care than whites and persons with higher socioeconomic status . Strong evidence links patient-centered care to improvements in patient adherence and health outcomes ; therefore , interventions that enhance this dimension of care are promising strategies to improve adherence and overcome disparities in outcomes for ethnic minorities and poor persons . Objective This paper describes the design of the Patient-Physician Partnership ( Triple P ) Study . The goal of the study is to compare the relative effectiveness of the patient and physician intensive interventions , separately , and in combination with one another , with the effectiveness of minimal interventions . The main hypothesis is that patients in the intensive intervention groups will have better adherence to appointments , medication , and lifestyle recommendations at three and twelve months than patients in minimal intervention groups . The study also examines other process and outcome measures , including patient-physician communication behaviors , patient ratings of care , health service utilization , and blood pressure control . Methods A total of 50 primary care physicians and 279 of their ethnic minority or poor patients with hypertension were recruited into a r and omized controlled trial with a two by two factorial design . The study used a patient-centered , culturally tailored , education and activation intervention for patients with active follow-up delivered by a community health worker in the clinic . It also included a computerized , self- study communication skills training program for physicians , delivered via an interactive CD-ROM , with tailored feedback to address their individual communication skills needs . Conclusion The Triple P study will provide new knowledge about 
    Output:
    
Conclusions Despite widespread calls for shared decision making to be embedded in health care , there is little evidence to inform shared decision making for hypertension , one of the most common conditions managed in primary care