***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: Background : Dysphagia is common after stroke . The onset time of swallowing rehabilitation following stroke has an important role in the recovery of dysphagia and preventing of its complications , but it was either highly variable or was not stated in previous trials . The aim of this study was investigation effects of onset time of swallowing therapy on recovery from dysphagia following stroke . Methods : Sixty dysphagia patients due to stroke range of age 60 - 74 ( 67.1 ± 3.8 ) , participated in this r and omized clinical trial study . The patients allocated in Early , Medium and Late groups , on the base of initiation of swallowing therapy after the stroke . After basic clinical and video fluoroscopic swallowing study assessment s , traditional swallowing therapy was initiated 3 times per week for 3 months . The outcome measures were North-Western dysphagia patient check sheet , functional oral intake scale , video fluoroscopy , and frequency of pneumonia . Statistical analysis was done by repeated measure ANOVA , Bonferroni and χ2 tests . Results : Three groups of patients in terms of demographic and clinical characteristics were similar in the pre-treatment P > 0.050 . Onset time  of swallowing therapy  after stroke was effective on swallowing recovery on the main outcome variables . So that in first group patients , recovery was rather than other groups P < 0.050 . Furthermore , the frequency of pneumonia in the early group was less than other groups and in the early group no patients experienced pneumonia P = 0.002 . Conclusion : Our data suggested that early interventions for dysphagia in stroke have an important role in recovery from dysphagia and prevention of complications like aspiration pneumonia Background — Outpatient cardiac rehabilitation ( CR ) decreases mortality rates but is underutilized . Current median time from hospital discharge to enrollment is 35 days . We hypothesized that an appointment within 10 days would improve attendance at  CR orientation . Methods and Results — At hospital discharge , 148 patients with a nonsurgical qualifying diagnosis for CR were r and omized to receive a CR orientation appointment either within 10 days ( early ) or at 35 days ( st and ard ) . The primary end point was attendance at CR orientation . Secondary outcome measures were attendance at ≥1 exercise session , the total number of exercise sessions attended , completion of CR , and change in exercise training workload while in CR . Average age was 60±12 years ; 56 % of participants were male and 49 % were black , with balanced baseline characteristics between groups .  Median time ( 95 % confidence interval ) to orientation was 8.5 ( 7–13 ) versus 42 ( 35 to NA [ not applicable ] ) days for the early and st and ard appointment groups , respectively ( P<0.001 ) . Attendance rates at the orientation session were 77 % ( 57/74 ) versus 59 % ( 44/74 ) in the early and st and ard appointment groups , respectively , which demonstrates a significant 18 % absolute and 56 % relative improvement ( relative risk , 1.56 ; 95 % confidence interval , 1.03–2.37 ; P=0.022 ) . The number needed to treat was 5.7 . There was no difference ( P>0.05 ) in any of the secondary outcome measures , but statistical power for these end points was low . Safety analysis demonstrated no difference between groups in CR-related adverse events . Conclusions — Early appointments for CR significantly improve attendance at orientation . This simple technique could potentially increase initial CR participation nationwide . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT01596036 BACKGROUND Triage liaison physicians ( TLPs ) have been employed in overcrowded emergency departments ( EDs ) ; however , their effectiveness remains unclear . OBJECTIVES To evaluate the implementation of TLP shifts at an academic tertiary care adult ED using comprehensive outcome reporting . METHODS A six-week TLP clinical research project was conducted between December 9 , 2005 , and February 9 , 2006 . A TLP was deployed for nine hours ( 11 AM to 8 PM ) daily to initiate patient management , assist triage nurses , answer all medical consult or transfer calls , and manage ED administrative matters . The study was divided into three two-week blocks ; within each block , seven days were r and omized to TLP shifts and the other seven to control shifts . Outcomes included patient length of stay , proportion of patients who left without complete assessment , staff satisfaction , and episodes of ambulance diversion . RESULTS TLPs assessed a median of 14 patients per shift ( interquartile range , 13 - 17 ) , received 15 telephone calls per shift ( interquartile range , 14 - 20 ) , and spent 17 - 81 minutes per shift consulting on the telephone . The number of patients and their age , gender , and triage score during the TLP and control shifts were similar . Overall , length of stay was decreased by 36 minutes compared with control days ( 4:21 vs. 4:57 ; p = 0.001 ) . Left without complete assessment cases decreased from 6.6 % to 5.4 % ( a 20 % relative decrease ) during the TLP coverage . The ambulance wait time and number of episodes of ambulance diversion were similar on TLP and control days . CONCLUSIONS A TLP improved important outcomes in an overcrowded ED and could improve delivery of emergency medical care in similar tertiary care EDs Study Design . A single blind r and omized controlled trial comparing two models of care for patients with acute simple low back pain . Objectives . To compare two research -based models of care for acute low back pain and investigate the effect of the timing of physical intervention . Summary of Background Data . National guidelines offer conflicting information on the delivery of physical treatment in the management of acute low back pain . The guidelines suggest two different models of care . Direct comparisons between these models are lacking in the literature . The present study aims to compare these approaches to the management of acute low back pain . Methods . Among 804 referred patients , 102 subjects met the specific admission criteria and were r and omly assigned to an “ assess/advise/treat ” group or an “ assess/advise/wait ” group . The intervention consisted of biopsychosocial education , manual therapy , and exercise . Assessment of short-term outcome enables comparison to be made between intervention and advice to stay active . Assessment of long-term outcome enables comparison to be made between early and late intervention . Study outcomes of reported pain ( Visual Analogue Scale ) , functional disability ( the Rol and and Morris Disability Question naire ) , mood ( Modified Zung Self Rated Depression Score , Modified Somatic Perception Question naire , State-Trait Anxiety Inventory ) , general health ( Euroqol ) , and quality of life ( Short Form 36 ) were assessed at baseline , 6 weeks , 3 months , and 6 months . Results . At 6 weeks , the assess/advise/treat group demonstrated greater improvements in disability , mood , general health , and quality of life than patients in the assess/advise/wait group ( P < 0.05 ) . Disability and pain were not significantly different between the groups at long-term follow up ( P > 0.05 ) . However , mood , general health , and quality of life remained significantly better in the assess/advise/treat group ( P < 0.05 ) . Conclusions . At short-term , intervention is more effective than advice on staying active , leading to more rapid improvement in function , mood , quality of life , and general health . The timing of intervention affects the development of psychosocial features . If treatment is provided later , the same psychosocial benefits are not achieved . Therefore , an assess/advise/treat model of care seems to offer better outcomes than an assess/advise/wait model of care Objectives : To assess whether initial patient consult by senior clinicians reduces numbers of patients waiting to be  seen as an indirect measure of waiting time throughout the emergency department ( ED ) . Methods : An emergency medicine consultant and a senior ED nurse ( G or F grade ) , known as the IMPACT team , staffed the triage area for four periods of four hours per week , Monday to Friday between 9 am to 5 pm for three months between December 2001 and February 2002 when staffing levels permitted . Patients normally triaged by a nurse in this area instead had an early consultation with the IMPACT team . Data were collected prospect ively on all patients seen by the IMPACT team . The number of patients waiting to be seen ( for triage , in majors and in minors ) was assessed every two hours during the IMPACT sessions and at corresponding times when no IMPACT team was operational . Results : There was an overall reduction in the number of patients waiting to be seen in the department from 18.3 to 5.5 ( p<0.0001 ) at formal two hourly assessment s. The largest difference was seen in minors . Of the patients seen at triage by the IMPACT team , 48.9 % were discharged home immediately after assessment and treatment . With the IMPACT team present , no patient waited more than four hours for initial clinical consult . Conclusions : By using a senior clinical team for initial patient consultation , the numbers of patients waiting fell dramatically throughout the ED . Many patients can be effectively treated and discharged after initial consult by the IMPACT team Objective To evaluate the effectiveness of a structured group education programme on biomedical , psychosocial , and lifestyle measures in people with newly diagnosed type 2 diabetes . Design Multicentre cluster r and omised controlled trial in primary care with r and omisation at practice level . Setting 207 general practice s in 13 primary care sites in the United Kingdom . Participants 824 adults ( 55 % men , mean age 59.5 years ) . Intervention A structured group education programme for six hours delivered in the community by two trained healthcare professional educators compared with usual care . Main outcome measures Haemoglobin A1c levels , blood pressure , weight , blood lipid levels , smoking status , physical activity , quality of life , beliefs about illness , depression , and emotional impact of diabetes at baseline and up to 12 months . Main results Haemoglobin A1c levels at 12 months had decreased by 1.49 % in the intervention group compared with 1.21 % in the control group . After adjusting for baseline and cluster , the difference was not significant : 0.05 % ( 95 % confidence interval −0.10 % to 0.20 % ) . The intervention group showed a greater weight loss : −2.98 kg ( 95 % confidence interval −3.54 to −2.41 ) compared with 1.86 kg ( −2.44 to −1.28 ) , P=0.027 at 12 months . The odds of not smoking were 3.56 ( 95 % confidence interval 1.11 to 11.45 ) , P=0.033 higher in the intervention group at 12 months . The intervention group showed significantly greater changes in illness belief scores ( P=0.001 ) ; directions of change were positive indicating greater underst and ing of diabetes . The intervention group had a lower depression score at 12 months : mean difference was −0.50 ( 95 % confidence interval −0.96 to −0.04 ) ; P=0.032 . A positive association was found between change in perceived personal responsibility and weight loss at 12 months ( β=0.12 ; P=0.008 ) . Conclusion A structured group education programme for patients with newly diagnosed type 2 diabetes result ed in greater improvements in weight loss and smoking cessation and positive improvements in beliefs about illness but no difference in haemoglobin A1c levels up to 12 months after diagnosis . Trial registration Current Controlled Trials IS RCT N17844016 Background : Although effective treatment of depressed patients requires regular follow-up contacts and symptom monitoring , an efficient method for assessing treatment outcome is lacking . We investigated responsiveness to treatment , reproducibility , and minimal clinical ly important difference of the  Patient Health Question naire-9 ( PHQ-9 )  , a st and ard instrument for diagnosing depression in primary care . Methods : This study included 434 intervention subjects from the IMPACT study , a multisite treatment trial of late-life depression ( 63 % female , mean age 71 years ) . Changes in  PHQ-9 scores over the course of time were evaluated with respect to change scores of the SCL-20 depression scale as well as 2 independent structured diagnostic interviews for depression during a 6-month period . Test-retest reliability and minimal clinical ly important difference were assessed in 2 subgroups of patients who completed the PHQ-9 twice exactly 7 days apart . Results : The PHQ-9 responsiveness as measured by effect size was significantly greater than the SCL-20 at 3 months ( −1.3 versus −0.9 ) and equivalent at 6 months ( −1.3 versus −1.2 ) . With respect to structured diagnostic interviews , both the PHQ-9 and the SCL-20 change scores accurately discriminated patients with persistent major depression , partial remission , and full remission . Test-retest reliability of the PHQ-9  was excellent , and its minimal clinical ly important difference for individual change , estimated as 2 st and ard errors of measurement , was 5 points on the 0 to 27 point PHQ-9 scale . Conclusions : Well-vali date d as a diagnostic measure , the PHQ-9 has now proven to be a responsive and reliable measure of depression treatment outcomes . Its responsiveness to treatment coupled with its brevity makes the PHQ-9 an attractive tool for gauging response to treatment in individual patient care as well as in clinical research Study Design An inception cohort design was used in which 421 patients were evaluated systematic ally with a st and ard battery of psychosocial assessment tests ( Structured Interview for DSM-III-R Diagnosis , Minnesota Multiphasic Personality Inventory , and Million Visual Pain Analog Scale ) within 6 weeks of acute back pain onset . Objectives 
    Output:
    
There was low-level evidence that reduced wait time is associated with moderate improvement in workplace participation for patients seeking care for musculoskeletal conditions ; and moderate improvement in exercise tolerance for patients referred to cardiac rehabilitation .
There was inconsistent evidence that improvements in quality of life , patient satisfaction and psychological symptoms may be associated with shorter wait times .
Pain , function and physical activity outcomes were not associated with wait time .
Conclusions This review found low-level evidence suggesting an association between early access to community outpatient services and improvement of some patient outcomes .
Specifically , shorter wait times from referral to first visit for musculoskeletal pain services may improve patient work participation .
Shorter wait times for cardiac rehabilitation may improve patient exercise capacity .
The effects of a short wait time for other patient conditions and patient outcomes , including quality of life , psychological symptoms and patient experience , are inconclusive .