***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: Objectives To compare screening practice s and beliefs in patients with and without a clinical ly important family history . Design We mailed a brief question naire asking about family history and a second , longer survey asking about knowledge of and beliefs about colorectal cancer to all respondents with a family history and a r and om sample of respondents without a family history of colorectal cancer . We review ed electronic medical records for screening examinations and recording of family history . Participants One thous and eight hundred seventy of 6,807 r and omly selected patients ages 35–55 years who had been continuously enrolled in a large multispecialty group practice for at least 5 years . Measurements Recognition of increased risk , screening practice s , and beliefs — all according to strength of family history and patient ’s age . Results Nineteen percent of respondents reported a family history of colorectal cancer . In 11 % , this history was strong enough to warrant screening before age 50 years . However , only 39 % ( 95 % CI 36 , 42 ) of respondents under the age of 50 years said they had been asked about family history and only 45 % of those with a strong family history of colorectal cancer had been screened appropriately . Forty-six percent of patients with a strong family history did not know that they should be screened at a younger age than average risk people . Medical records mentioned family history of colorectal cancer in 59 % of patients reporting a family history . Conclusions More efforts are needed to translate information about family history of colorectal cancer into the care of patients BACKGROUND : Internal medicine residents are deficient in their knowledge about familial colorectal cancer ( CRC ) and thus unable to comply with appropriate screening guidelines . The objective of this study was to evaluate the effectiveness of a mixed educational program that incorporates both a didactic lecture ( DL ) and interactive , case-based seminar ( ICBS ) , plus distribution of a personal digital assistant (PDA)-based risk assessment tool . METHODS : Internal medicine resident continuity care teams were r and omly assigned to an intervention ( 9 teams ; 43 residents ) or control ( 11 teams ; 39 residents ) arm . Both groups participated in a DL addressing the current status of CRC screening for average , moderate , and high-risk groups . Intervention teams also participated in a 1-h pre-clinic ICBS that included vignettes about patients at moderate or high risk of CRC because of family history , following which they received the risk assessment tool by e-mail .  Knowledge and clinical risk assessment skills were evaluated using pre/posttests , patient exit interviews , and chart audits . RESULTS : Baseline test scores were similar for both groups ( intervention , 51%vs control , 54 % ; P = 0.35 ) . Immediate post-ICBS scores ( intervention group only ) significantly increased to 82 % ( p < 0.001 ) . Six-month post-ICBS scores declined for the intervention group but remained significantly higher than 6-month control group scores ( 63%vs 56 % , P = 0.002 ) , which were unchanged from baseline . No significant differences were observed with respect to family history-taking or documentation skills . CONCLUSION : A mixed educational program that incorporates both a DL and ICBS is more effective that the DL alone for increasing knowledge about familial CRC risk but may have limited influence on clinical risk assessment skills A consistent predictor of a woman 's risk for breast cancer is a family history of the disease . Most studies of family history and breast cancer have used the number of affected relatives in the family to calculate relative risk , but they have not considered the heterogeneity of the familial risk for breast cancer in a systematic way . With the use of data from a large prospect i ve mortality study of US adults , the authors compared simple classification of family history of breast cancer ( yes/no ) to the method of using a quantitative family history score method , which takes into account the effects of family structure , age , and birth cohort as predictors of breast cancer mortality . After 9 years of follow-up , 1,428 cases of fatal breast cancer  were observed among 453,073 women with complete information on number and age of siblings and family history . With the use of the  family history score  , about one-third of women with a positive family history of breast cancer were at no higher risk for breast cancer mortality than those without a family history of the disease . As a quantitative measure of relative risk for each family , family history score gave a better fit to the data , and it provided an incremental improvement of predictive accuracy of developing fatal breast cancer . Family history score  can also be used as a categorical variable to stratify families . This allows research ers to focus on which risk groups would benefit from conducting further genetic analysis and to test the effects of genetic factors , environmental exposure , and gene-environment interactions on the etiology of the development of breast cancer BACKGROUND Innovative technologies that enable the collection of family history information and the assessment of breast cancer risk have a potential to enhance the quality of preventive care . We developed a computerized tool that supports stratification of breast cancer risk , genetic risk assessment in the clinical environment ( GRACE ) . METHODS In a preliminary evaluation of the tool 's impact , we r and omized women with a family history of breast cancer ( n=72 ) to either use the GRACE tool or undergo risk counseling by a nurse specialist .  RESULTS There was no statistically significant differences between the GRACE  and nurse counselling  groups in risk perceptions ( F=.03 , P>.05 ) and cancer-related worries ( F=.80 , P>.05 ) . However , patients reported more positive attitudes toward working with the nurse . CONCLUSION It was feasible to use GRACE in a Clinic . Additional research is required to identify solutions for providing emotional support in conjunction with the tool Background Many preventable diseases such as ischemic heart diseases and breast cancer prevail at a large scale in the general population .  Computerized decision support systems are one of the solutions for improving the quality of prevention strategies . Methods The system called EsPeR ( Personalised Estimate of Risks ) combines calculation of several risks with computerisation of guidelines ( cardiovascular prevention , screening for breast cancer , colorectal cancer , uterine cervix cancer , and prostate cancer , diagnosis of depression and suicide risk ) . We present a qualitative evaluation of its ergonomics , as well as it 's underst and ing and acceptance by a group of general practitioners . We organised four focus groups each including 6–11 general practitioners . Physicians worked on several structured clinical scenari os with the help of EsPeR , and three senior investigators leaded structured discussion sessions . Results The initial sessions identified several ergonomic flaws of the system that were easily corrected . Both clinical scenarios and discussion sessions identified several problems related to the insufficient comprehension ( expression of risks , definition of familial history of disease ) , and difficulty for the physicians to accept some of the recommendations . Conclusion Educational , socio-professional and organisational components ( i.e. time constraints for training and use of the EsPeR system during consultation ) as well as acceptance of evidence -based decision-making should be taken into account before launching computerised decision support systems , or their application in r and omised trials BACKGROUND Subjects with a positive family history of colorectal cancer ( CRC ) have an increased risk of developing CRC themselves . This risk depends on the number of affected relatives and the age at diagnosis . AIM The aim of this study was to assess the prevalence of a positive family history of CRC , within a r and om cohort among the dutch population . METHODS A total of 5072 subjects aged between 45 and 70 years were invited to fill in an anonymous question naire about the occurrence of CRC in their first-degree relatives ( FDR ) . RESULTS The question naire was returned by 3973 subjects ( 78.3 % ) . Thirty responders ( 0.8 % ) had CRC themselves . Of all unaffected responders , 441 ( 11.2 % ) subjects reported a positive family history of CRC . Ninety ( 2.3 % ) responders reported having an FDR with CRC diagnosed before the age of 50 , or reported two or more FDRs with CRC . CONCLUSION The prevalence of a positive family history of CRC is substantial . Identification of this high-risk group by obtaining a thorough family history is the first step in targeting preventive measures The objective was to evaluate the effect of an assessment strategy using the computer decision support system ( the GRAIDS software ) , on the management of familial cancer risk in British general practice in comparison with best current practice . The design included cluster r and omised controlled trial , and involved forty-five general practice teams in East Anglia , UK . R and omised to GRAIDS ( Genetic Risk Assessment on the Internet with Decision Support ) support ( intervention n=23 ) or comparison ( n=22 ) . Training in the new assessment strategy and access to the GRAIDS software ( GRAIDS arm ) was conducted , compared with an educational session and guidelines about managing familial breast and colorectal cancer risk ( comparison ) were mailed . Outcomes were measured at practice , practitioner and patient levels . The primary outcome measure , at practice level , was the proportion of referrals made to the Regional Genetics Clinic for familial breast or colorectal cancer that were consistent with referral guidelines . Other measures included practitioner confidence in managing familial cancer ( GRAIDS arm only ) and , in patients : cancer worry , risk perception and knowledge about familial cancer . There were more referrals to the Regional Genetics Clinic from GRAIDS than comparison practice s ( mean 6.2 and 3.2 referrals per 10 000 registered patients per year ; mean difference 3.0 referrals ; 95 % confidence interval ( CI ) 1.2–4.8 ; P=0.001 ) ; referrals from GRAIDS practice s were more likely to be consistent with referral guidelines ( odds ratio (OR)=5.2 ; 95 % CI 1.7–15.8 , P=0.006 ) . Patients referred from GRAIDS practice s had lower cancer worry scores at the point of referral ( mean difference −1.44 95 % CI −2.64 to −0.23 , P=0.02 ) . There were no differences in patient knowledge about familial cancer . The intervention increased GPs ' confidence in managing familial cancer . Compared with education and mailed guidelines , assessment including computer decision support increased the number and quality of referrals to the Regional Genetics Clinic for familial cancer risk , improved practitioner confidence and had no adverse psychological effects in patients . Trials are registered under N0181144343 in the UK National Research Register Purpose : The study goals were to ( 1 ) determine the proportion of unselected individuals at increased risk for diseases with known genetic components and ( 2 ) compare the documentation and quality of risk assessment between a question naire , a pedigree interview , and chart review . Methods : Seventy-eight patients seen in a division of internal medicine were r and omized into two groups , which completed a question naire or underwent a pedigree interview . Chart notes were compared to both study tools . Results : Sixty-two ( 79.5 % ) of the 78 participants scored at increased risk for at least one category . Either of the two study tools found significantly more people at high risk ( 48/78 , 61.5 % ) than the chart review ( 31/78 , 39.7 % ) ( P = 0.01 ) . Conclusions : Approximately 20 % of patients in an unselected internal medicine practice were at an increased risk that was not documented in review ed chart notes . Targeted family history analysis reveals patients who require increased medical surveillance , preventive measures , or genetic counseling/testing BACKGROUND GPs are increasingly expected to meet the needs of patients concerned about their risk of inherited breast cancer , but may lack skills or confidence to use complex management guidelines . We developed an evidence -based , multifaceted intervention intended to promote confidence and skills in this area . OBJECTIVE To evaluate the effectiveness of the intervention in improving GP confidence in managing patients concerned about genetic risk of breast cancer . METHODS DESIGN Cluster r and omized controlled trial . SETTING General practice s in the Grampian region of Scotl and . SUBJECTS GPs and the patients they referred for genetic counselling for risk of breast cancer . MAIN OUTCOME MEASURES GPs ' self-reported confidence in four activities related to genetics ; rates of referral of patients at elevated genetic risk ; and referred patients ' underst and ing of cancer risk factors . RESULTS No statistically significant differences were observed between intervention and control arms in the primary or secondary outcomes . A possible effect of the intervention on the proportion of referred patients who were at elevated risk could not be discounted . Only a small proportion of intervention GPs attended the educational session , were aware or the software , or made use of it in practice . CONCLUSIONS No convincing evidence of the effectiveness of the intervention was found , probably reflecting barriers to its use in routine practice PURPOSE / OBJECTIVES To measure psychological distress and test the feasibility of a psychological intervention to reduce distress in patients undergoing risk assessment . DESIGN Descriptive . SETTING A comprehensive cancer center located in the southeastern United States . SAMPLE 20 first-degree relatives of women diagnosed with breast cancer ( X age = 42 ; range = 21 - 70 ) completed the risk assessment process . Three were lost to follow-up at three months , leaving a total of 17 evaluable patients . METHODS Data collection was by means of family/medical history forms and question naires administered at baseline and one and three months . Participants were r and omized to either a control group consisting of st and ard education about risk for breast cancer or to an intervention group consisting of st and ard education plus a psychological intervention design ed to teach stress-management skills . MAIN RESEARCH VARIABLES Psychological distress , depressive symptoms , intrusive thoughts about breast cancer , and perceived risk for developing breast cancer . FINDINGS Delivery of a psychological intervention proved feasible . Although no statistically significant differences existed between the intervention and control groups on distress and depressive symptoms , the intervention group reported fewer intrusive thoughts about breast cancer at follow-up . Risk did not 
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Reporting accuracy was better for relatives free of cancer ( specificity ) than those with cancer ( sensitivity ) .
Accuracy was better for breast and colorectal than for ovarian and prostate cancers .
Irrespective of study design , compared to best current practice ( genetic interviews ) and st and ard primary care practice ( family history in medical records ) the FHxTs performed well .
They were presented in a range of computer-based and paper-based formats , and preliminary evidence indicated potential efficacy , but not definitive effectiveness in practice .
Although limited in generalizability , informants reporting their cancer family history have greater accuracy for relatives free of cancer than those with cancer .
Reporting accuracy may vary among different cancer types .
The few tools that were evaluated performed well against both best and st and ard clinical practice .