***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: We developed a computer-stored medical record system containing a limited set of the total clinical data base -- primarily diagnostic studies and treatments . This system responds to its own content according to physician-authored reminder rules . To determine the effect of the reminder messages generated by 1490 rules on physician behavior , we r and omly assigned practitioners in a general medicine clinic to study or control groups . The computer found indications for six different actions per patient in 12 467 patients during a 2-year study : 61 study group residents who received computer  reminders responded to 49 % of these indications ; 54 control group residents , to only 29 % ( p less than 0.0001 ) . Preventive care ( occult blood testing , mammographic screening , weight reduction diets , influenza and pneumococcal vaccines ) was affected . The intentions of the study group to use a given action for an indication predicted their response to the indications ( p less than 0.03 , r2 = 0.33 ) . The intentions of the control residents did not OBJECTIVE Compare weight loss and maintenance between a face-to-face ( FTF ) weight management clinic and a clinic delivered via virtual reality ( VR ) . METHODS Participants were r and omized to 3 months of weight loss with a weekly clinic delivered via FTF or VR and then 6 months ' weight maintenance delivered with VR . Data were collected at baseline and 3 and 6 months for weight and process variables . Twenty overweight and obese individuals ( 31.1 ± 3.6 years of age ; body mass index , 32.8 ± 5.1 ; 85 % females ; 20 % minorities ) responded to advertisement and met inclusion criteria . Diets ( 1,200 - 1,800 kcal/d ) used prepackaged meals , fruits and vegetables , and physical activity ( 300 min/wk ) . RESULTS Weight loss was significantly greater for FTF at 10.8 % compared with 7.6 % for VR ( P < .05 ) . However , weight maintenance was significantly greater for VR at 14.0 % compared with 9.5 % for FTF ( P < .05 ) . CONCLUSIONS AND IMPLICATION S Virtual reality compares favorably with FTF for weight loss and may facilitate greater weight maintenance OBJECTIVE To compare two strategies for childhood obesity management : ambulatory assistance ( individual ) and educational program ( in group ) . METHOD Children and adolescents from 7 to 13 years of age were selected at r and om . They were divided into two groups : individually assisted or assisted in groups . An educational program about childhood obesity was created , with monthly meetings that consisted of lectures with parents ' participation and group work . Simultaneously , children and teenagers of the other group received individual ambulatory assistance . The program took place for six months . Body composition , eating habits and physical activities were assessed before and after interventions . RESULTS The sample comprised 38 children and adolescents whose mean age was 9.9 years . The program was more effective in increasing physical activity ( p = 0.003 ) , specially walking ( p = 0.003 ) , as well as in reducing total cholesterol ( p = 0.038 ) . Reduction of body mass index , obesity index and caloric intake was similar in both groups . As for food habits , ambulatory assistance increased the intake of fruits ( p = 0.033 ) and vegetables ( p = 0.002 ) and reduced the amount of French fries and crisps ( p = 0.041 ) , while children participating in the program reduced the intake of soft drinks ( p = 0.022 ) , s and wiches , pizza and fast food ( p = 0.006 ) . CONCLUSIONS Both strategies for h and ling childhood obesity were favorable to changes in food and physical activity habits . Group assistance was as effective as individual assistance , consolidating it as an alternative for obesity treatment Objectives To test the impact of provider performance pay for anaemia reduction in rural China . Design A cluster r and omised trial of information , subsidies , and incentives for school principals to reduce anaemia among their students . Enumerators and study participants were not informed of study arm assignment . Setting 72 r and omly selected rural primary schools across northwest China . Participants 3553 fourth and fifth grade students aged 9 - 11 years . All fourth and fifth grade students in sample schools participated in the study . Interventions Sample schools were r and omly assigned to a control group , with no intervention , or one of three treatment arms : ( a ) an information arm , in which principals received information about anaemia ; ( b ) a subsidy arm , in which principals received information and unconditional subsidies ; and ( c ) an incentive arm , in which principals received information , subsidies , and financial incentives for reducing anaemia among students . Twenty seven schools were assigned to the control arm ( 1816 students at baseline , 1623 at end point ) , 15 were assigned to the information arm ( 659 students at baseline , 596 at end point ) , 15 to the subsidy arm ( 726 students at baseline , 667 at end point ) , and 15 to the incentive arm ( 743 students at baseline , 667 at end point ) . Main outcome measures Student haemoglobin concentrations . Results Mean student haemoglobin concentration rose by 1.5 g/L ( 95 % CI –1.1 to 4.1 ) in information schools , 0.8 g/L ( –1.8 to 3.3 ) in subsidy schools , and 2.4 g/L ( 0 to 4.9 ) in incentive schools compared with the control group . This increase in haemoglobin corresponded to a reduction in prevalence of anaemia ( Hb < 115 g/L ) of 24 % in incentive schools . Interactions with pre-existing incentives for principals to achieve good academic performance led to substantially larger gains in the information and incentive arms : when combined with incentives for good academic performance , associated effects on student haemoglobin concentration were 9.8 g/L ( 4.1 to 15.5 ) larger in information schools and 8.6 g/L ( 2.1 to 15.1 ) larger in incentive schools . Conclusions Financial incentives for health improvement were modestly effective . Underst and ing interactions with other motives and pre-existing incentives is critical . Trial registration number IS RCT N76158086 Background : Primary care providers often fail to identify patients who are overweight or obese or discuss weight management with them . Electronic health record-based tools may help providers with the assessment and management of overweight and obesity . Purpose : We describe the design of a trial to examine the effectiveness of electronic health record-based tools for the assessment and management of overweight and obesity among adult primary care patients , as well as the challenges we encountered . Methods : We developed several new features within the electronic health record used by primary care practice s affiliated with Brigham and Women ’s Hospital in Boston , MA . These features included ( 1 ) reminders to measure height and weight , ( 2 ) an alert asking providers to add overweight or obesity to the problem list , ( 3 ) reminders with tailored management recommendations , and ( 4 ) a Weight Management screen . We then conducted a pragmatic , cluster-r and omized controlled trial in 12 primary care practice s. Results : We r and omized 23 clinical teams ( “ clinics ” ) within the practice s to the intervention group ( n = 11 ) or the control group ( n = 12 ) . The new features were activated only for clinics in the intervention group . The intervention was implemented in two phases : the height and weight reminders went live on 15 December 2011 ( Phase 1 ) , and all of the other features went live on 11 June 2012 ( Phase 2 ) . Study enrollment went from December 2011 through December 2012 , and follow-up ended in December 2013 . The primary outcomes were 6-month and 12-month weight change among adult patients with body mass index ≥25 who had a visit at one of the primary care clinics during Phase 2 . Secondary outcome measures included the proportion of patients with a recorded body mass index in the electronic health record , the proportion of patients with body mass index ≥25 who had a diagnosis of overweight or obesity on the electronic health record problem list , and the proportion of patients with body mass index ≥25 who had a follow-up appointment about their weight or were prescribed weight loss medication . Lessons learned : We encountered challenges in our development of an intervention within the existing structure of an electronic health record . For example , although we decided to r and omize clinics within primary care practice s , this decision may have introduced contamination and led to some imbalance of patient characteristics between the intervention and control practice s. Using the electronic health record as the primary data source reduced the cost of the study , but not all desired data were recorded for every participant . Conclusion : Despite the challenges , this study should provide valuable information about the effectiveness of electronic health record-based tools for addressing overweight and obesity in primary care Abstract Objective To evaluate a training programme intended to improve the management of obesity , delivered to general practice teams . Design Cluster r and omised trial . Setting Northern and Yorkshire region of Engl and Participants 44 general practice s invited consecutively attending obese adults to participate ; 843 patients attended for collection of baseline data and were subsequently r and omised . Intervention 4.5 hour training programme promoting an obesity management model . Main outcome measures Difference in weight between patients in intervention and control groups at 12 months ( main outcome measure ) and at 3 months and 18 months ; change in practitioners ' knowledge and behaviour in obesity management consultations . Results Twelve months after training the patients in the intervention group were 1 ( 95 % confidence interval - 1.9 to 3.9 ) kg heavier than controls ( P = 0.5 ) . Some evidence indicated that practitioners ' knowledge had improved . Some aspects of the management model , including recording weight , target weight , and dietary targets , occurred more frequently in intervention practice s after the training , but in absolute terms levels of implementation were low . Conclusion A training package promoting a brief , prescriptive approach to the treatment of obesity through lifestyle modification , intended to be incorporated into routine clinical practice , did not ultimately affect the weight of this motivated and at risk cohort of patients BACKGROUND Healthcare costs attributable to obesity have previously involved estimations based on costs of diseases commonly considered as having obesity as an underlying factor . AIM To quantify the impact of obesity on total primary care drug prescribing . DESIGN OF STUDY Review of computer generated and h and written prescriptions to determine total prescribing volume for all drug classes . SETTING Twenty-three general practice surgeries in the UK . METHOD Stratified r and om selection of 1150 patients who were obese ( body mass index [ BMI ] > 30 kg/m(2 ) ) and 1150 age and sex-matched controls of normal weight ( BMI 18.5-<25 kg/m(2 ) ) . Retrospective review of medical records over an 18-month period . RESULTS A higher percentage of patients who were obese , compared with those of normal weight , were prescribed at least one drug in the following disease categories : cardiovascular ( 36 % versus 20 % ) , central nervous system ( 46 % versus 35 % ) , endocrine ( 26 % versus 18 % ) , and musculoskeletal and joint disease ( 30 % versus 22 % ) . All of these categories had a P-value of < 0.001 . Other categories , such as gastrointestinal ( 24 % versus 18 % ) , infections ( 42 % versus 35 % ) , skin ( 24 % versus 19 % ) had a P-value of < 0.01 , while respiratory diseases ( 18 % versus 21 % ) had a P-value of < 0.05 . Total prescribing volume was significantly higher for the group with obesity and was increased in the region of two- to fourfold in a wide range of prescribing categories : ulcer healing drugs , lipid regulators , beta-adrenoreceptor drugs , drugs affecting the rennin angiotensin system , calcium channel blockers , antibacterial drugs , sulphonylureas , biguanides , non-steroidal anti-inflammatories ( NSAIDs ) ( P<0.001 ) and fibrates , angiotensin II antagonists , and thyroid drugs ( P<0.05 ) . The main impact on prescribing volumes is from numbers of patients treated , although in some areas there is an effect from greater dosage or longer treatment in those who are obese including calcium channel blockers , antihistamines , hypnotics , drugs used in the treatment of nausea and vertigo , biguanides , and NSAIDs ( P<0.05 ) reflected in significantly increased defined daily dose prescribing . CONCLUSIONS This large study of contemporary practice indicates that obesity more than doubled prescribing in most drug categories Background Obesity affects 25 % of the UK adult population but modest weight loss can reduce the incidence of obesity-related chronic disease . Some effective weight loss treatments exist but there is no nationally available National Health Service ( NHS ) treatment service , and general practitioners ( GPs ) rarely discuss weight management with patients or support behavior change . Evidence shows that commercial weight management services , that most primary care trusts have ' on prescription ' , are more effective than primary care treatment . Methods / design We propose a controlled trial where patients will be r and omized to receive either the offer of help by referral to a weight management service and follow-up to assess progress , or advice to lose weight on medical grounds . The primary outcome will be weight change at 12-months . Other questions are : what actions do people take to manage their weight in response to the two GP intervention types ? How do obese patients  feel about GPs opportunistically discussing weight management and how does this 
    Output:
    
We found little convincing evidence for a clinical ly-important effect on participants ' weight or BMI of any of the evaluated interventions .
As only two studies reported on cost , we know little about cost effectiveness across the evaluated interventions