***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 convenience sample ( n = 60 ) of two comparable groups of cardiac bypass patients was studied to assess the effectiveness of a structured teaching guide used by nurses in educating patients and families about normal postoperative recovery and risk-factor modification . One group was educated by an unstructured method , and the other group received structured teaching with the use of a written guide developed by nurses experienced in open-heart recovery . Both groups had higher total knowledge scores postoperatively than preoperatively . To assess whether the type of teaching had affected changes in behavior , a six-week postoperative health interview was conducted , and a follow-up question naire was mailed at one year Abstract Objective : To evaluate the effects of secondary prevention clinics run by nurses in general practice on the health of patients with coronary heart disease . Design : R and omised controlled trial of clinics over one year with assessment by self completed postal question naires and audit of medical records at the start and end of the trial . Setting : R and om sample of 19 general practice s in northeast Scotl and . Subjects : 1173 patients ( 685 men and 488 women ) under 80 years with working diagnoses of coronary heart disease who did not have terminal illness or dementia and were not housebound . Intervention : Clinic staff promoted medical and lifestyle aspects of secondary prevention and offered regular follow up . Main outcome measures : Health status measured by the SF-36 question naire , chest pain by the angina type specification , and anxiety and depression by the hospital anxiety and depression scale . Use of health services before and during the study . Results : There were significant improvements in six of eight health status domains ( all functioning scales , pain , and general health ) among patients attending the clinic . Role limitations attributed to physical problems improved most ( adjusted difference 8.52 , 95 % confidence interval 4.16 to 12.9 ) . Fewer patients reported worsening chest pain ( odds ratio 0.59 , 95 % confidence interval 0.37 to 0.94 ) . There were no significant effects on anxiety or depression . Fewer intervention group patients required hospital admissions ( 0.64 , 0.48 to 0.86 ) , but general practitioner consultation rates did not alter . Conclusions : Within their first year secondary prevention clinics improved patients ' health and reduced hospital admissions . Key messages Nurse led clinics in general practice were used to promote secondary prevention to patients with coronary heart disease Within the first year the health of patients invited to the clinics improved Most benefit was in functional status , but chest pain improved too There was no effects on anxiety or depression There were significant reductions in hospital admissions in the first The aims of this pilot study , which compares day patient with inpatient care for management of active RA were ( i ) to test the feasibility of a trial protocol design including the method of r and omization and the practicality of data collection , and ( ii ) to obtain preliminary information on economic cost and clinical outcome of these two methods of management . Twenty consecutive patients requiring admission for management of active RA were r and omized to receive either day patient or inpatient care . All hospital , transport , community and indirect costs incurred over a 6-month period from recruitment were collected for each patient . Disease activity and clinical outcome were assessed using the Ritchie articular index , ESR , Health Assessment Question naire , Functional Independence Measure and Hospital Anxiety and Depression Scale . The trial protocol was found to be feasible and no patient allocated to the day patient group requested or required to be transferred to inpatient care . Day care was significantly cheaper than inpatient care despite higher transport costs ; the total cost of treating 10 day patients was UK 10,272 pounds compared with 14,528 pounds for 10 in patients . Clinical outcome was comparable in both groups for all parameters studied and there was no obvious detrimental effect on patients receiving day care . This pilot study demonstrates that day care is feasible and acceptable to patients with active RA . The preliminary data suggest that day care is substantially cheaper than inpatient care and does not apparently compromise clinical outcome The purpose of the study was to investigate the effect of nursing care based on Orem 's nursing theory on nutritional self-care of myocardial infa rct ion patients . Self-efficacy was explored as a disposition which may motivate behavioral change . One hundred and four subjects were r and omly assigned to treatment or  control groups . The nursing intervention , which took place during the first 6 weeks following hospital discharge , was effective in supporting healthy low-fat eating behavior .  Nursing care influenced patients ' self-care agency but lacked impact on self-efficacy for healthy eating BACKGROUND Wide variation exists in acute myocardial infa rct ion ( AMI ) management , leading to differences in outcomes . OBJECTIVE To assess the impact of the quality improvement initiative on appropriate management of AMI . DESIGN Prospect i ve patient identification , retrospective medical record review . PATIENTS All patients with AMI discharged alive ( N = 497 ) from our institution between April 1 , 1995 , and February 28 , 1997 . MAIN OUTCOME MEASURE The effect of quality improvements  directed at the patient , nurse , and physician on the adherence to key quality indicators .  RESULTS The quality improvement initiative correlated with more frequent use of reperfusion therapy  ( 98 % ) , and with aspirin use in the emergency department ( 95 % ) , in ideal eligible patients . Similarly , adherence to discharge quality indicators , including use of aspirin  ( 97 % ) ,  beta-blockers  ( 94 % ) ,  angiotensin-converting enzyme inhibitors  ( 90 % ) , and  lipid-lowering agents  ( 67 % ) ; avoidance of calcium channel blockers  ( 93 % ) ; a low-fat diet  ( 96 % ) ;  smoking cessation counseling  ( 94 % ) ; and outpatient rehabilitation referral  ( 70 % ) was higher , including in the very old ( those aged > /=80 years ) and in women . The use of a patient education tool was associated with a higher adherence to most quality indicators compared with patients in whom this was not used : discharge aspirin ( 99 % vs 96 % ; P = .02 ) , beta-blocker ( 98 % vs 91 % ; P = .002 ) , angiotensin-converting enzyme inhibitor ( 95 % vs 86 % ; P = .01 ) , and lipid-lowering agent ( 71 % vs 62 % ; P = .04 ) use ; outpatient rehabilitation ( 82 % vs 63 % ; P=.001 ) ; and documentation of smoking cessation counseling ( 98 % vs 87 % ; P = . 001 ) . CONCLUSIONS Implementation of a quality improvement program was associated with a high adherence to quality -of-care indicators for AMI . Patient-directed feedback before discharge improved adherence to key indicators for AMI beyond that achieved with tools only directed at caregivers A multicenter clinical trial was conducted to evaluate the effects on compliance of a group counseling program for cardiac patients and spouses . The sample comprised 58 couples in which one of the partners had documented atherosclerotic heart disease and was enrolled in an outpatient cardiac rehabilitation program . The experimental intervention involved a ten-week series of group sessions based on symbolic interactionist role theory . The research used a quasi-experimental , three-group , time-series design : Experimental group 1 consisted of 17 patients and their spouses who participated in group counseling ; experimental group 2 consisted of 22 patients and their spouses , but only the patients participated in the group series ; the control group consisted of 19 patients and their spouses who did not participate in the experimental program .  Data were collected at baseline , ten weeks , and six months on four cardiac risk factors : weight loss , blood pressure , exercise , and smoking . Repeated measures analysis of variance showed a significant difference ( P less than 0.01 ) in mean body fat among treatment groups , with experimental group 2 having the greatest decrease over time . Patients in both experimental groups demonstrated lowered blood pressure , with a significant decrease ( P less than 0.05 ) in systolic blood pressure . Again , the largest decrease was in experimental group 2 . Changes in weekly exercise level were not significantly different among groups , although the highest compliance was reported by experimental group 1 patients . Results support the efficacy of group counseling based on an interactionist role theory framework to increase compliance . The anticipated effect of spouse participation was not confirmed PURPOSE Cardiac rehabilitation ( CR ) programs have been shown to promote numerous health benefits among patients with active coronary heart disease ( CHD ) , but little is known about the percentage of eligible CHD patients who enroll in CR . METHODS A survey was performed of 500 r and omly chosen CR programs in operation in the United States during 1990 . Patient characteristics and enrollment data were combined with data from the 1990 National Hospital Discharge Survey to estimate the percentage of eligible patients who participated in early outpatient ( Phase II ) CR programs after myocardial infa rct ion ( MI ) , after coronary angioplasty ( PTCA ) , or after coronary artery bypass surgery ( CABS ) . RESULTS Completed surveys were returned by 163 programs ( 32.6 % ) with information on 1,322 women and 1,418 men who enrolled in their programs in 1990 . Women were older , more likely to be single , and had more traditional CHD risk factors than men . Only a minority of MI , PTCA , and CABS survivors enrolled in CR programs ( 10.8 % , 10.3 % and 23.4 % , respectively ) . Enrollment was particularly low for post-MI and post-CABS women as compared with men : 6.9 % versus 13.3 % ( P < .001 ) , and 20.2 % versus 24.6 % ( P < .001 ) , respectively . Enrollment was generally lowest for nonwhites , those over age 65 , and those living in the southern United States . CONCLUSIONS Cardiac rehabilitation programs are used by a minority of eligible patients , particularly among women , nonwhites , and the elderly . To meet newly released national guidelines that recommend CR services for most patients recovering from MI , PTCA , or CABS , and to still contain costs , new methods need to be explored that can exp and the delivery of CR services in clinical setting The effect of increased nurse support on patients below 70 years of age attending an out-patient clinic following acute myocardial infa rct ion was evaluated .  Patients who saw a nurse 14 days after discharge ( n=56 ) were compared to a control group ( n=47 ) who , following the ordinary routines , were first seen 8 weeks after discharge . Increased nurse support had positive effects on psychosocial variables such as depressive feelings , expected quality of life in the future , and satisfaction with contact with the staff . However , no effects were found on any of the cardiac variables . Patients in the intervention group showed a decrease in depressive feelings during the 8 weeks follow-up period , whereas there was an increase for the control group . The patients in the intervention group also tended to have a better belief in the future compared to the control group . Patients in the intervention group were more satisfied with the staff contact than were the control group & NA ; Previous research has documented high rates of noncompliance to prescribed medical therapy in patients recovering from myocardial infa rct ion ( MI ) . This study was undertaken to determine if patients who subsequently drop out of a structured cardiac rehabilitation program  could be prospect ively distinguished from those who remain in the program based upon their initial baseline characteristics . Thirty‐five consecutive patients with recent MIs underwent comprehensive physical and psychological assessment s at entry into the program , and were followed for a period of 1 year . The 14 patients who dropped out of the program could be distinguished from the compliers on the basis of their reduced left ejection fraction assessed by first pass radionuclide angiography at rest and during peak exercise . In addition , their psychological profiles assessed by the MMPI indicated the dropouts were more depressed , hypochondriacal , anxious , and introverted and had lower ego strength than those who remained in the program . Statistical analysis further indicated that psychological variables were associated with noncompliance independently of physical status . These findings suggest that MI patients who are unlikely to adhere to this form of medical therapy may be prospect ively identified based upon their initial physical and psychological characteristics A home-based exercise programme has been found to be as useful as a hospital-based one in improving cardiovascular fitness after an acute myocardial infa rct ion . To find out whether a comprehensive home-based programme would reduce psychological distress , 176 patients with an acute myocardial infa rct ion were r and omly allocated to a self-help rehabilitation programme based on a heart manual or to receive st and ard care plus a placebo package of information and informal counselling .  Psychological adjustment , as assessed by the Hospital Anxiety and Depression Scale , was better in the rehabilitation group at 1 year . They also had significantly less contact with their general practitioners during the following year and significantly fewer were readmitted to hospital in the first 6 months . The improvement was greatest among patients who were clinical ly anxious or depressed at discharge from hospital . The cost-effectiveness of the home-based programme has yet to be compared with that of a hospital-based programme , but the findings of this study indicate that it might be worth offering such a package to all patients with acute myocardial infa rct ion Effects of a post-hospitolization group health education programme for patients with coronary heart disease . A health education programme was offered to groups of coronary heart patients and their partners after discharge from hospital . A r and omized pre-test post-test control group design was used to evaluate the effects of this experimental intervention . The health education programme was offered to 109 coronary heart patients in groups of between five and eight patients together with their partners in addition to st and ard medical care and physical training . A control group of 108 patients received only st and ard medical care and physical training . 
    Output:
    
Rates of referral and attendance were similar in Wales , but somewhat lower in Northern Irel and .
It was found that referral and attendance of  older people and women at cardiac rehabilitation tended to be low .
It was also suggested that patients from ethnic minorities and those with angina or heart failure were less likely to be referred to or join programmes .
A wide range of local interventions suggested awareness of the problem of uptake .
Excluded patients tended to be older with more severe presentation of cardiac disease .
Experiences of patients suggested that uptake may be improved by addressing issues of motivation and relevance of rehabilitation to future well-being , co-morbidities , site and time of programme , transport and care for dependents .
Systematic review of studies supported the use of letters , pamphlets or home visits to motivate patients and the use of trained lay visitors .
Self-management techniques showed some value in promoting adherence to lifestyle changes .
Studies examining professional compliance found that professional support for practice nurses may have value in the coordination of postdischarge care .
CONCLUSIONS Provision of outpatient cardiac rehabilitation in the UK is low and little is known about the capacity of cardiac rehabilitation centres to increase this provision .
There is an uncoordinated approach to audit data collection and few interventions aim ed at improving the situation have been formally evaluated .
Motivational communications and trained lay volunteers may improve uptake of cardiac rehabilitation , as may self-management techniques .
Experience of low-cost interventions and good practice exists within rehabilitation centres , although cost information frequently is not reported .
Increased provision of outpatient cardiac rehabilitation will require extra re sources .