***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 
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    Input: Background : We conducted a prospect i ve trial r and omizing 75 physicians to either a control or intervention arm to evaluate the impact of providing patient-reported information on anxiety and other mental health symptoms and disorders to primary care physicians . Methods : Five hundred seventy-three patients of the study physicians who met entry criteria were r and omized to either usual care or usual care supplemented with feedback of patient-reported mental health information to physicians . This mental health information was derived from initial patient-reported question naires completed in waiting rooms of physicians contracted to a mixed-model health maintenance organization in Colorado . Main outcome measures included impact of intervention on rates of ( 1 ) chart notation of anxiety , depression , or other mental health diagnoses or symptoms ; ( 2 ) referral to mental health specialists ; ( 3 ) prescription of psychotropic medications ; ( 4 ) hospitalization ; and ( 5 ) office visits during a 5-month observation period . Results : Physicians receiving feedback on previously unrecognized and untreated anxiety patients were more likely to make chart notations ( adjusted odds ratio [ AOR ] = 2.51 , 95 percent confidence interval [ CI ] = 1.62 - 3.87 ) , to make referrals to mental health specialists ( AOR = 3.86 , 95 percent CI = 1.63 - 9.16 ) , and to see patients for more frequent outpatient visits ( AOR = 1.73 , 95 percent CI = 1.11 - 2.70 ) . Use of psychotropic medications and rate of hospitalizations did not differ significantly . Conclusions : Providing patient-reported mental health information to primary care physicians result ed in increased recognition and referral rates for previously unrecognized and untreated anxiety patients , plus an increase in primary care visits , without concomitant increases in the use of psychotropic medications or rate of hospitalizations Background : Clinical trial evidence in controversial areas such as complementary and alternative medicine ( CAM ) must be approached with an open mind . Objective : To determine what factors may influence practitioners ' interpretation of evidence from CAM trials . Research Design : In a mailed survey of 2400 US CAM and conventional medicine practitioners we included 2 hypothetical factorial vignettes of positive and negative research results for CAM clinical trials . Vignettes contained r and omly varied journal ( Annals of Internal Medicine vs. Journal of Complementary and Alternative Medicine ) and CAM treatment type ( acupuncture , massage , glucosamine , meditation , and reiki ) . Response items also included r and omly varied patient circumstances — chronic refractory symptoms and the patient requesting CAM . Measures : All practitioners rated the effectiveness and their willingness to recommend the therapy for a described patient . We used logistic regression to determine the independent influence of the 4 factors on respondents ' effectiveness and legitimacy judgments . Results : A total of 1561 practitioners responded ( 65 % ) . Relative to Reiki , conventional medicine practitioners were most willing to recommend glucosamine  ( OR = 3.0 ; 95 % CI [ 1.6–5.4 ] ) , than massage ( 1.9 [ 1.1–3.3 ] ) , acupuncture ( 1.3 [ 0.8–2.2 ] ) , and meditation ( 1.2 [ 0.7–2.0 ] ) . CAM practitioners rated  acupuncture as effective more than other CAM therapies ( OR = 5.8 [ 2.6–12.8 ] compared with Reiki ) , and were more willing to recommend acupuncture  ( OR = 12.3 [ 4.8–31.8 ] ) . When presented evidence of inefficacy , CAM practitioners were most willing to recommend acupuncture  relative to other CAM therapies ( OR = 15.5 [ 9.0–26.9 ] ) . Conclusions : Practitioners ' judgments about CAM trial evidence depend on the type of treatments reported . Confirmation bias may play a role in the clinical translation of new evidence from clinical trials CONTEXT Previous studies have found that routine screening for depression does not improve patient outcome unless it is combined with case management . However , these studies were conducted before the widespread use of SSRIs or in setting s other than traditional primary care . PURPOSE This study investigated whether screening for depressive symptoms improves outcomes for depressed patients seen in rural fee-for-service primary care offices . METHODS Depression screening was conducted at 2 private rural clinics in Iowa using the PHQ-9 .  Patients with depressive symptoms were r and omized to the control group or the intervention group , where providers were given completed PHQ-9 question naires at the baseline visit . The outcome PHQ-9 scores were assessed by telephone at 4 , 10 , and 24 weeks after the index visit . FINDINGS A total of 861 patients were screened for depressive symptoms ; 51 subjects enrolled in the trial . The intervention and control groups did not significantly differ with respect to changes in PHQ-9 scores at any of the 3 follow-up times . They also did not differ with respect to the proportion of subjects who were actively managed with medication or by referral to a mental health specialist : 46 % vs 33 % ( P = .38 ) for all subjects and 50 % vs 50 % ( P = .96 ) for subjects with major depression at baseline . CONCLUSIONS Screening for depressive symptoms with the PHQ-9 in 2 rural medical clinics did not significantly increase physicians ' active management of depression or lead to improved patient outcomes Objectives : To measure the prevalence of high scores on the Geriatric Depression Scale in an inpatient unit for older people and assess whether administration of this instrument increased the use of antidepressant medication . Design : R and omized controlled trial . Setting : Inpatient unit for assessment , treatment and rehabilitation of older adults in a district hospital . Subjects : Consecutive admissions to the inpatient unit were approached . Of 198 people , 100 gave consent and were r and omized to receive the intervention . Interventions : The  Geriatric Depression Scale and the Folstein Mini-mental State Examination were administered to the intervention group . The Nottingham Instrumental Activities of Daily Living question naire and the Folstein Mini-mental State Examination were administered to the placebo group . The scores of these instruments and a copy of the completed instrument were placed in the subject 's case notes . For those subjects r and omized to receive the Geriatric Depression Scale an interpretation of the score was written in the case notes . Main outcome measures : The primary outcome measure was whether antidepressant medication was listed on the discharge summary for the admission . Other outcome measures were death , readmission and use of antidepressant medication three months after administration of the instruments . Results : There was a prevalence of Geriatric Depression Scale scores greater than 10 of 52 % in the 50 people administered this instrument . Six out of 46 people administered the Geriatric Depression Scale  , who were discharged in the study period , were on antidepressant medication at discharge . Three out of 47 people administered the placebo instrument were on antidepressant medication at discharge . The absolute difference in proportions was 6.7 % , 95 % confidence interval 19 to – 5.3 % . Conclusions : A high proportion of patients admitted to an inpatient unit for assessment , treatment and rehabilitation scored in the depressed range on the Geriatric Depression Scale ; however , use of the Geriatric Depression Scale in this clinical setting did not increase the use of antidepressant medication . This may be because the instrument is too nonspecific Abstract BACKGROUND : Major depression is common in older adults and is associated with increased health care costs . Depression often remains unrecognized in older adults , especially in primary care . OBJECTIVE : To evaluate the cost-effectiveness of a disease management program for major depression in elderly primary care patients compared with usual care . DESIGN : Economic evaluation alongside a cluster r and omized-controlled trial . PARTICIPANTS : Consecutive patients of 55 years and older were screened for depression using the Geriatric Depression Scale and the PRIME-MD was used for diagnosis . INTERVENTIONS : General practitioners in the intervention group received training on how to implement the disease management program consisting of screening , patient education , drug therapy with paroxetine , and supportive contacts . General practitioners in the usual care group were blind to the screening results . Treatment in this group was not restricted in any way . MEASUREMENTS : Severity of depression , recovery from depression , and quality of life . Re source use measured over a 12-month period using interviews and valued using st and ard costs . RESULTS : Differences in clinical outcomes between the intervention and usual care group were small and statistically insignificant . Total costs were $ 2,123 in the intervention and $ 2,259 in the usual care group ( mean difference −$136 , 95 % confidence interval : −$1,194 ; $ 1,110 ) . Cost-effectiveness planes indicated that there were no statistically significant differences in cost-effectiveness between the 2 groups . CONCLUSIONS : This disease management program for major depression in elderly primary care patients had no statistically significant relationship with clinical outcomes , costs , and cost-effectiveness . Therefore , based on these results , continuing usual care is recommended OBJECTIVE A r and omized controlled trial was conducted to examine the clinical effectiveness of providing general practitioners ( GPs ) with the results of a self-administered computerized assessment of common mental disorders . METHOD Attenders at a general practice in a deprived inner city area of South London were identified using case finding question naires . Six hundred and eighty-one subjects were r and omly allocated to three groups which differed in the information provided to the GP : 1 ) no additional information was given to the GP ; 2 ) the results of the 12 item General Health Question naire ( GHQ ) were given to the GP ( the GHQ is a paper and pencil question naire that assesses common mental disorders ) ; 3 ) the results of a self-administered computerized assessment ( PROQSY ) of common mental disorders were provided for the GP . RESULTS Clinical outcome was assessed using the 12-item GHQ . Consultations with the GP , prescriptions and referrals within and outside the practice were also recorded . The group in whom the GP received the results of the computerized assessment showed a modest clinical improvement , relative to the other two groups after 6 weeks . There was no difference in clinical outcome between the groups at 6 months . There appeared to be no increase in consultations or prescriptions in the computerized assessment group . CONCLUSIONS Self-administered computerized assessment s for psychiatric disorder have potential as a means of improving the clinical outcome of patients in primary care . It is likely that the effectiveness of the approach would be greatly increased by linking the results of computerized assessment s to clinical practice guidelines , tailored to the individual patient by means of computerized technology The usefulness of the  Zung Self-Rating Depression Scale  as a screening instrument to uncover masked depression , and the benefits of early identification and treatment with alprazolam , were evaluated in a general medical practice population . There was a 95 % scale acceptance by patients and a 12 % overall prevalence of depression based on SDS results . Patients who scored in the depressed range on the SDS were , on a r and omized basis , either identified immediately to their physicians and treated with alprazolam ( N = 21 ) or identified after 4 weeks ( natural history controls , N = 20 ) . Treatment result ed in improvement in 66 % of the identified group versus a 35 % spontaneous improvement in the control group ( p less than .05 ) OBJECTIVE To determine the validity of a two- question case-finding instrument for depression as compared with six previously vali date d instruments . DESIGN The test characteristics of a two- question case-finding instrument that asks about depressed mood and anhedonia were compared with six common case-finding instruments , using the Quick Diagnostic Interview Schedule as a criterion st and ard for the diagnosis of major depression . SETTING Urgent care clinic at the San Francisco Department of Veterans Affairs Medical Center . PARTICIPANTS Five hundred thirty-six consecutive adult patients without mania or schizophrenia . MEASUREMENTS AND MAIN RESULTS Measurements were two questions from the Primary Care Evaluation of Mental Disorders patient question naire , both the long and short forms of the Center for Epidemiologic Studies Depression Scale , both the long and short forms of the  Book Depression Inventory , the Symptom-Driven Diagnostic System for Primary Care , the Medical Outcomes Study depression measure , and the Quick Diagnostic Interview Schedule . The prevalence of depression , as determined by the st and ardized interview , was 18 % ( 97 of 536 ) . Overall , the case-finding instruments had sensitivities of 89 % to 96 % and specificities of 51 % to 72 % for diagnosing major depression . A positive response to the two-item instrument had a sensitivity of 96 % ( 95 % confidence interval [ CI ] , 90 - 99 % ) and a specificity of 57 % ( 95 % CI 53 - 62 % ) . Areas under the receiver operating characteristic curves were similar for all of the instruments , with a range of 0.82 to 0.89 . CONCLUSIONS The two- question case-finding instrument is a useful measure for detecting depression in primary care . It has similar test characteristics to other case-finding instruments and is less time-consuming OBJECTIVE : To describe primary care physicians ’ clinical decision making regarding late-life depression .  DESIGN : Longitudinal collection of data regarding physicians ’ clinical assessment s and the volume and content of patients ’ ambulatory visits as part of a r and omized clinical trial of a physician-targeted intervention to improve the treatment of late-life depression . SETTING : Academic primary care group practice . PATIENTS / PARTICIPANTS : One-h 
    Output:
    
Based on this analysis of two meta-analyses we hypothesise that strongly held prior beliefs ( confirmation bias ) may have influenced inclusion and exclusion criteria of studies , and their interpretation .