***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: AIMS The purpose of this r and omized controlled clinical trial was to examine the effects of three couples-focused interventions and a control condition on women and men 's resolution of depression and grief during the first year after miscarriage . METHODS Three hundred forty-one couples were r and omly assigned to nurse caring ( NC ) ( three counseling sessions ) , self-caring ( SC ) ( three video and workbook modules ) , combined caring ( CC ) ( one counseling session plus three SC modules ) , or control ( no treatment ) . Interventions , based on Swanson 's Caring Theory and Meaning of Miscarriage Model , were offered 1 , 5 , and 11 weeks after enrollment . Outcomes included depression ( CES-D ) and grief , pure grief ( PG ) and grief-related emotions ( GRE ) . Differences in rates of recovery were estimated via multilevel modeling conducted in a Bayesian framework . RESULTS Bayesian odds ( BO ) ranging from 3.0 to 7.9 favored NC over all other conditions for accelerating women 's resolution of depression . BO of 3.2 - 6.6 favored NC and no treatment over SC and CC for resolving men 's depression . BO of 3.1 - 7.0 favored all three interventions over no treatment for accelerating women 's PG resolution , and BO of 18.7 - 22.6 favored NC and CC over SC or no treatment for resolving men 's PG . BO ranging from 2.4 to 6.1 favored NC and SC over CC or no treatment for hastening women 's resolution of GRE . BO from 3.5 to 17.9 favored NC , CC , and control over SC for resolving men 's GRE . CONCLUSIONS NC had the overall broadest positive impact on couples ' resolution of grief and depression . In addition , grief resolution ( PG and GRE ) was accelerated by SC for women and CC for men BACKGROUND Responses to miscarriage range from relief to devastation , yet there have been no r and omized controlled studies that demonstrate significant effects of counseling with women who miscarry . OBJECTIVE To test the effects of caring-based counseling , measurement , and time on the integration of loss ( miscarriage impact ) and women 's emotional well-being ( moods and self-esteem ) in the first year after miscarrying . METHOD ANCOVA was used in this r and omized , longitudinal Solomon four-group experimental investigation . Enrolled were 242 ; 185 completed . Outcomes included : self-esteem , overall emotional disturbance , anger , depression , anxiety , confusion , overall miscarriage impact , personal significance , devastating event , lost baby , and isolated . RESULTS During the first year after loss ( a ) caring was effective in reducing overall emotional disturbance , anger , and depression ; and ( b ) time passing led to increased self-esteem and decreased anxiety , depression , anger , confusion , and personal significance of loss . CONCLUSION Caring , measurement , and time had some positive and significant effects on the integration of loss and enhancement of well-being in the first year subsequent to miscarrying OBJECTIVE The aim of this study was to examine the impact of medical and psychological interventions on  women 's distress after early miscarriage . METHODS This was a prospect i ve study of women attending for a routine scan at 10 - 14 weeks of gestation and found to have a missed miscarriage . An intervention group of 66 women had medical investigations  to ascertain the cause of miscarriage , and at 5 weeks after the scan , they all had a medical consultation to discuss the results of the investigations . These 66 women were r and omly allocated into a group which received further psychological counselling ( MPC , n=33 ) , and a group which received no psychological counselling ( MC , n=33 ) . They were compared to a  control group of 61 women who received no specific postmiscarriage counselling . All participants completed preintervention and postintervention measures and 4-month follow-up question naires . RESULTS The scores on the outcome variables decreased significantly with time for all three groups . In group MPC , compared to controls , there was a significantly greater decrease over time in the levels of grief , self-blame , and worry and , compared to MC group , a significantly greater decrease in grief and worry . In group MC , compared to controls , there was a significantly greater decrease in self-blame . In the MC and MPC groups , those with an identified cause of the miscarriage had significantly lower levels of anxiety and self-blame over time than those with a nonidentified cause . CONCLUSIONS Psychological counselling , in addition to medical investigations and consultation , is beneficial in reducing  women 's distress after miscarriage . However , absence of an identifiable cause of miscarriage led to the maintenance of the initial anxiety levels , which should have otherwise decreased with time Background . Women 's grief after miscarriage is substantial and important . Women who experience early miscarriage do not constitute a homogenous group . The aim of this study is to measure whether a structured follow‐up visit to a midwife ( group 1 ) at 21–28 days after early miscarriage could reduce the women 's grief , measured using the perinatal grief scale Swedish short version ( PGS ) after a further 3 months ( i.e. 4 months after the miscarriage ) , compared to a regular follow‐up visit to a midwife ( group 2 ) . Methods . We performed an open r and omized study of women who experienced early miscarriage ( n = 88 ) . The midwife 's attitude in group 1 came from Swanson science theory of midwifery . In group 2 , the women were offered only the ordinary type of consultation at a regular visit . A question naire with the PGS was used in both groups . Four months after the miscarriage , a second question naire with the same perinatal grief scale was sent by post . Results . There was a 30 % greater reduction in grief in group 1 than that in group 2 , when comparing the first and second measurements ( not significant ) . The biggest differences were in the subscales active grief and difficulty in coping . Women with the subdiagnosis missed abortions had , as a group , significantly higher PGS scores at both visits , especially in active grief and difficulty in coping , regardless of the type of follow‐up visit . Conclusions . A structured follow‐up visit did not , in comparison with a regular follow‐up visit , imply any significant reduction in grief as measured using the PGS scale . However , the subgroup missed abortion had more extensive grief than the other women with miscarriage . Structured follow‐up visits are not imperative for all women with early miscarriage Abstract Objective To ascertain whether a clinical ly important difference exists in the incidence of gynaecological infection between surgical management and expectant or medical management of miscarriage . Design R and omised controlled trial comparing medical and expectant management with surgical management of first trimester miscarriage . Setting Early pregnancy assessment units of seven hospitals in the United Kingdom . Participants Women of less than 13 weeks ' gestation , with a diagnosis of early fetal demise or incomplete miscarriage . Interventions Expectant management ( no specific intervention ) ; medical management ( vaginal dose of misoprostol preceded , for women with early fetal demise , by oral mifepristone 24 - 48 hours earlier ) ; surgical management ( surgical evacuation ) . Main outcome measures Confirmed gynaecological infection at 14 days and eight weeks ; need for unplanned admission or surgical intervention . Results 1200 women were recruited : 399 to expectant management , 398 to medical management , and 403 to surgical management . No differences were found in the incidence of confirmed infection within 14 days between the expectant group ( 3 % ) and the surgical group ( 3 % ) ( risk difference 0.2 % , 95 % confidence interval − 2.2 % to 2.7 % ) or between the medical group ( 2 % ) and the surgical group ( 0.7 % , − 1.6 % to 3.1 % ) . Compared with the surgical group , the number of unplanned hospital admissions was significantly higher in both the expectant group ( risk difference − 41 % , − 47 % to − 36 % ) and the medical group ( − 10 % , − 15 % to − 6 % ) . Similarly , when compared with the surgical group , the number of women who had an unplanned surgical curettage was significantly higher in the expectant group ( risk difference − 39 % , − 44 % to − 34 % ) and the medical group ( − 30 % , − 35 % to − 25 % ) . Conclusions The incidence of gynaecological infection after surgical , expectant , and medical management of first trimester miscarriage is low ( 2 - 3 % ) , and no evidence exists of a difference by the method of management . However , significantly more unplanned admissions and unplanned surgical curettage occurred after expectant management and medical management than after surgical management . Trial registration National Research Register : N0467011677/N0467073587 OBJECTIVE To examine the fertility and pregnancy wastage rates in a group of presumably fertile couples . DESIGN Prospect i ve observational study of 200 couples desiring to achieve pregnancy over 12 menstrual cycles coupled with pregnancy outcome follow-up . SETTING A university-based obstetrics and gynecological center . PATIENTS Personal interviews and question naires were used to screen couples for entry into the study . Couples were counseled to have intercourse centered on predicted day of ovulation . Phase 1 included the first three cycles in which women collected daily morning urine sample s , underwent midcycle postcoital tests , and , if late for their menses , presented for serum hCG testing . Phase 2 encompassed the next nine cycles in which women were contacted monthly by phone and underwent serum hCG testing if menses was delayed . Urine sample s from cycles in which clinical ( serum hCG ) pregnancy did not occur underwent sensitive hCG testing to detect occult pregnancies . Pregnancies were followed until delivery to ascertain outcome . RESULTS Eighty-two percent of the 200 couples followed for the entire study period conceived . The maximal fertility rate was approximately 30 % per cycle in the first two cycles . This rate quickly tapered over the remainder of the study . Pregnancy wastage during phase 1 accounted for 31 % of the pregnancies detected . Forty-one percent ( 15/36 ) of these losses were seen only by urine hCG testing and were categorized as occult . Eleven of these same patients later achieved clinical ly recognized conceptions during the study . CONCLUSIONS These results support the concept that the efficiency of human reproduction is maximum at approximately 30 % per cycle . A very significant number of these pregnancies end in spontaneous abortion . In addition , pregnancy loss before missed menses occurs in a significant proportion of women About a fifth of pregnancies end in miscarriage , leading to emotional consequences , such as anxiety and depression , which may last for a number of months . Despite this , women are not routinely provided with follow-up care . Anecdotal evidence suggests that follow-up focusing on emotional experiences may have beneficial effects . This study tests the hypothesis that the psychological debriefing process has a positive influence on emotional adaptation .  Women were assessed , using the Hospital Anxiety and Depression Scale and Impact of Events Scale , at one week and four months post-miscarriage . Half the women also received psychological debriefing at two weeks . Intrusion and avoidance scores were initially as high as those of post-trauma victims , but had significantly decreased by four months . Depression was not detected at any time point , but anxiety was significantly higher than community sample estimates at one week and four months . Psychological debriefing was perceived to be helpful , but did not influence emotional adaptation . A number of hypotheses are provided to explain these results . Outcome scores at one week significantly predicted outcome at four months , suggesting that early assessment would be important in determining which women should be offered intervention Miscarriage occurs in 10 - 20 % of clinical ly recognized pregnancies and is associated with two- to fourfold increases in depressive symptoms . No counseling programs for depressed miscarrying women have been manualized or evaluated for safety and efficacy . We investigated whether depressive symptoms decline substantially among miscarrying women receiving one to six weekly sessions of manualized , telephone-administered interpersonal counseling ( IPC ) , a variant of interpersonal psychotherapy ( IPT ) in an open trial . Depressive symptom levels were measured with the Center for Epidemiologic Studies -Depression ( CES-D ) scale .  Of 65 women evaluated , 24 were study eligible ; 17 consented to participate .  Change in symptom levels was evaluated by comparing baseline to postintervention CES-D scores in an intention to treat ( ITT ) sample ( n=17 ) and a completer sub sample ( n=9 ) . The latter sample comprised women reevaluated postintervention . In the ITT sample , the CES-D mean score declined from 25.4 to 18.8 [ mean within-subject change=6.6 , 95 % confidence interval (CI)=1.4 - 11.6 ] ; in the completer sub sample , it declined from 23.6 to 11.2 ( mean within-subject change=12.3 , 95 % CI=4.0 - 20.7 ) . Findings from this small open trial suggest that IPC decreases depressive symptoms after miscarriage . A r and omized , controlled trial of IPC 's  safety and efficacy with depressed miscarrying women is warranted OBJECTIVE Miscarriage , which occurs in 10 % to 20 % of clinical ly recognized pregnancies , is associated with an increased risk for subsyndromal depression . We examined whether Interpersonal Counseling ( IPC ) was superior to treatment as usual ( TAU ) in reducing subsyndromal depression among miscarrying women and , secondarily , superior to TAU in improving role functioning . METHOD Nineteen of 2 
    Output:
    
There was no significant difference in psychological well being including anxiety , grief , depression avoidance and self-blame .
Some subscales showed statistical significance in favour of counselling and some in favour of no counselling .
AUTHORS ' CONCLUSIONS Evidence is insufficient to demonstrate that psychological support such as counselling is effective post-miscarriage .