***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: To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results Reports of cluster r and omised trials require additional information to allow readers to interpret them accurately The effective reporting of r and omised controlled trials has received useful attention in recent years . Many journals now require that reports conform to the guidelines in the Consoli date d St and ards of Reporting Trials ( CONSORT ) statement , first published in 1996 and revised in 2001 . The statement includes a checklist of items that should be included in the trial report . These items are evidence based whenever possible and are regularly review ed . The statement also recommends including a flow diagram to show the flow of participants from group assignment through to the final analysis . The CONSORT statement focused on reporting parallel group r and omised trials in which individual participants are r and omly assigned to study groups . However , in some situations it is preferable to r and omly assign groups of individuals ( such as families or medical practice s ) rather than individuals . Reasons include the threat of contamination of some interventions ( such as dietary interventions ) if individual r and omisation is used . 5 Also , in certain setting s r and omisation by group may be the only feasible method of conducting a trial . Trials with this design are variously known as field trials , community based trials , place based trials , or ( as in this paper ) cluster r and omised trials . In an earlier discussion paper we considered the implication s of the CONSORT statement for the reporting of cluster r and omised trials . Here we present up date d guidance , based on the 2001 revision of the CONSORT statement BACKGROUND Childhood malnutrition is common in Malawi , and the st and ard treatment , which follows international guidelines , results in poor recovery rates . Higher recovery rates have been seen in pilot studies of home-based therapy with ready-to-use therapeutic food ( RUTF ) . OBJECTIVE The objective was to compare the recovery rates among children with moderate and severe wasting , kwashiorkor , or both receiving either home-based therapy with RUTF or st and ard inpatient therapy .  DESIGN A controlled , comparative , clinical effectiveness trial was conducted in southern Malawi with 1178 malnourished children . Children were systematic ally allocated to either st and ard therapy ( 186 children ) or home-based therapy with RUTF ( 992 children ) according to a stepped wedge design to control for bias introduced by the season of the year . Recovery , defined as reaching a weight-for-height z score > -2 , and relapse or death were the primary outcomes . The rate of weight gain and the prevalence of fever , cough , and diarrhea were the secondary outcomes . RESULTS Children who received home-based therapy with RUTF were more likely to achieve a weight-for-height z score > -2 than were those who received st and ard therapy ( 79 % compared with 46 % ; P < 0.001 ) and were less likely to relapse or die ( 8.7 % compared with 16.7 % ; P < 0.001 ) . Children who received home-based therapy with RUTF had greater rates of weight gain ( 3.5 compared with 2.0 g . kg(-1 ) . d(-1 ) ; difference : 1.5 ; 95 % CI : 1.0 , 2.0 g . kg(-1 ) . d(-1 ) ) and a lower prevalence of fever , cough , and diarrhea than did children who received st and ard therapy . CONCLUSION Home-based therapy with RUTF is associated with better outcomes for childhood malnutrition than is st and ard therapy Maintaining greater than 95 % adherence to antiretroviral medication is necessary in order to have the greatest therapeutic impact on HIV infection . Furthermore , evidence suggests that adherence rates of between 70 % and 89 % are significantly associated with viral rebound and the development of drug resistance . Adherence rates at and above the 95 % level are difficult for patients to achieve and maintain . Our aim was to determine if an adherence intervention could improve adherence among patients attending an ambulatory care clinic at a large public hospital . The intervention was delivered by a multidisciplinary team of health care professionals and consisted of education coupled with the provision of devices design ed to assist patient memory and adherence . A crucial component of the intervention consisted of the identification of patient specific barriers to adherence and the development of strategies to circumvent these problems . Adherence was assessed using patient self-report over the past 4 , 7 , and 28 days and by calculation of the Morisky score . The study was conducted as a r and omised controlled trial using the stepped wedge design with a total of 68 subjects r and omised to receive the intervention over a 20-week period .  Adherence before and after the intervention formed the analysis . There was a significant decrease in the number of missed doses over the past 4 ( 1.9 to 1.0 , p < 0.001 ) , 7 ( 3.0 to 1.8 , p < 0.001 ) and 28 ( 7.4 to 4.2 , p < 0.001 ) days and a decrease in the Morisky score , indicating an improvement in medication taking behaviour ( 1.3 to 0.5 p < 0.001 ) BACKGROUND A r and omized study of the effect on people 's  health of improving their housing is underway in Torbay . The link between poor health , particularly respiratory health , and poor housing conditions has been recognized for a long time , but there have been few intervention studies to demonstrate that improving housing can improve health . In 1994 , South and West Devon Health Authority set up a community development project in a deprived area of Torbay , in response to the concerns of local primary health-care workers . A community development worker helped local residents survey their homes for dampness and record their respiratory symptoms . The survey reported high levels of condensation/dampness and respiratory illness and the Council agreed to direct the majority of their housing improvement funds to the estate over the next 3 years . The Health Authority , University of Plymouth and Torbay Council were successful in obtaining funding to evaluate the housing improvements from the NHS R & D programme . PARTICIPANTS AND METHODS Of 119 houses eligible for the study , 50 were chosen at r and om and improved in the first year . The rest were improved the following year . Question naires screening for health problems were sent to all 580 residents and baseline surveys of the indoor environment were also carried out . More detailed health surveys were completed by community nurses visiting residents in their homes . All adults were asked to complete SF-36 and GHQ 12 question naires , as well as disease-specific question naires if appropriate . PROGRESS All houses in the study have now been improved , including insulation , double-glazing , re-roofing , heating , ventilation and electrical rewiring . Follow-up surveys are underway Our aim was to determine if a comprehensive adherence package improved self reported adherence to antiretroviral therapy .  The adherence package included an education programme , individualized planning of regimens , and the opportunity for a patient to choose from a number of adherence aids and reminder devices . A r and omized step wedge design was used . Forty-three individuals were r and omized to begin the intervention over a five-month period . There was a substantial fall in the number of missed doses reported for the last four days ( 0.76 to 0.38 , P = 0.03 ) and last seven days ( 1.5 to 0.74 , P = 0.005 ) but not for the last 28 days ( 2.5 to 2.5 , P = 0.63 ) . There was no statistical difference in the viral load or CD4 lymphocyte count in the period before or after the intervention . The Morisky score during the pre and post intervention periods was significantly different ( P = 0.006 ) , 2.9 ( SD 0.9 ) and 3.3 ( SD 0.8 ) respectively . This adherence package improved self reported adherence during the last four and seven days Objective The purpose of the study was to investigate the effects of introducing a critical care outreach service on in-hospital mortality and length of stay in a general acute hospital . Design A pragmatic ward-r and omised trial design was used , with intervention introduced to all wards in sequence . No blinding was possible . Setting Sixteen adult wards in an 800-bed general hospital in the north of Engl and . Patients and participants All admissions to the 16 surgical , medical and elderly care wards during 32-week study period were included ( 7450 patients in total , of whom 2903 were eligible for the primary comparison ) . Interventions Essential elements of the Critical Care Outreach service introduced during the study were a nurse-led team of nurses and doctors experienced in critical care , a 24-h service , emphasis on education , support and practical help for ward staff . Measurements and results The main outcome measures were in-hospital mortality and length of stay .  Outreach intervention  reduced in-hospital mortality compared with control ( two-level odds ratio : 0.52 ( 95 % CI 0.32–0.85 ) . A possible increased length of stay associated with outreach was not fully supported by confirmatory and sensitivity analyses . Conclusions The study suggests outreach reduces mortality in general hospital wards . It may also increase length of stay , but our findings on this are equivocal 
    Output:
    
Results The 12 studies included in this review describe evaluations of a wide range of interventions , across different diseases in different setting s. However the stepped wedge design appears to have found a niche for evaluating interventions in developing countries , specifically those concerned with HIV .