***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: Objective : To test the effectiveness of different systems of reminding patients about their appointments in order to reduce the rate of failed attendance . The expense in implementing a reminder system for patients was also estimated . Design : A clinical study in a single-h and ed dental practice .Subjects : Patients were reminded about their appointment using either postal , manual telephone or automated telephone reminders ( or all three combined ) . A control group received no reminders .  500 patient attendances were recorded in each group . Results : Patients failed to attend  for 130 of the 2500 appointments considered in the study . There was a significant reduction in the failed attendance rate from 9.4 % ( with no reminder ) to a minimum of 3 % when a reminder was given to the patient before the appointment . However , there was no significant difference among the four reminder test groups , indicating that the form of the reminder made no difference to the failure rate . Conclusions : Reminding patients using postal or manual telephone techniques is effective at improving attendance . All of the reminder methods , telephone and postal , provided net cost savings rather than additional BACKGROUND Previous research has demonstrated the efficacy of an interactive expert system intervention for  smoking cessation for a general population . The intervention provides individualized feedback that guides participants through the stages of change for cessation . Enhancing the expert system by adding proactive telephone counseling or a stimulus control computer design ed to produce nicotine fading could produce preventive programs with greater population impacts . METHODS Four interventions were compared : ( a ) the interactive expert system intervention ; ( b ) the expert system intervention plus counselor calls ; ( c ) the expert system intervention plus the stimulus control computer ; and ( d ) an assessment only condition . A 4 ( intervention ) x 4 ( occasions ) ( 0,6,12 , and 18 months ) design was used . Smokers were contacted at home via telephone or mail . The initial subject pool was the 24,178 members of a managed care company . Screening was completed for 19,236 members ( 79.6 % ) , of whom 4,653 were smokers ; 85.3 % of the smokers were enrolled . RESULTS Thirty-eight percent were in the precontemplation stage , 45 % in the contemplation stage , and only 17 % in the preparation stage . At 18 months , the expert system result ed in 23.2 % point prevalence abstinence , which was 33 % greater than that of assessment only . The counselor enhancement produced increased cessation at 12 months but not at 18 months . The stimulus control computer produced no improvement , result ing in 20 % worse cessation rates than the assessment only condition . CONCLUSIONS The enhanced conditions failed to outperform the expert system alone . The study also demonstrated the ability of the interactive expert system to produce significantly greater cessation in a population of smokers than assessment alone BACKGROUND As part of a r and omized controlled trial , problem drinkers who recently initiated natural recovery on their own were offered access to an interactive voice response ( IVR ) self-monitoring ( SM ) system as a sobriety maintenance tool during early recovery when relapse risk is high . Because observed IVR utilization was variable , predictors of utilization were evaluated to inform knowledge of population s likely to access and use IVR services . METHODS Participants were 87 untreated community-dwelling adults who recently initiated sobriety following longst and ing high-risk drinking practice s and alcohol-related problems ( M=16.58 years , SD=10.95 ) . Baseline interviews assessed pre-resolution drinking practice s and problems , and behavioral economic ( BE ) measures of reward preferences ( delay discounting , pre-resolution monetary allocation ) . Participants had IVR access for 24 weeks to report daily drinking and to hear weekly recovery-focused messages . RESULTS IVR use ranged from 0 to 100 % . Frequent ( n=28 ) , infrequent ( n=42 ) , and non-caller ( n=17 ) groups were identified . Non-callers tended to be younger and to report heavier pre-resolution drinking . Frequent callers ( ≥70 % of IVR days ) tended to be older , male non-smokers with higher/stable socio-economic status and lower delay discounting compared to infrequent callers . Premature drop-out typically occurred fairly abruptly and was related to extended binge drinking . CONCLUSIONS Characteristics common in the untreated problem drinker population were associated with higher IVR utilization . This large under-served population segment can be targeted for lower intensity alcohol interventions using an IVR platform BACKGROUND Brief interventions for  problem drinking  in medical setting s are effective but rarely conducted , mainly due to insufficient time . A stepped care approach ( starting with a very brief intervention and intensifying efforts in case of no success ) could save re sources and enlarge effectiveness ; however , research is lacking . The present study compares a full care brief intervention for patients with at-risk drinking , alcohol abuse or dependence with a stepped care approach in a r and omized controlled trial . METHODS Participants were proactively recruited from general practice s in two northern German cities . In total , 10,803 screenings were conducted ( refusal rate : 5 % ) . Alcohol use disorders according to DSM-IV were assessed with the Munich-Composite International Diagnostic Interview ( M-CIDI ) . Eligible participants were r and omly assigned to one of three conditions : ( 1 ) stepped care ( SC ) : a computerized intervention plus up to three 40-min telephone-based interventions depending on the success of the previous intervention ; ( 2 ) full-care ( FC ) : a computerized intervention plus a fixed number of four 30-min telephone-based interventions that equals the maximum of the stepped care intervention ; ( 3 ) an untreated control group ( CG ) .  Counseling effort in the intervention conditions and quantity/frequency of drinking were assessed at 12-month follow-up . RESULTS SC participants received roughly half of the amount of intervention in minutes compared to FC participants . Both groups did not differ in drinking outcomes . Compared to CG , intervention showed small to medium effect size for at-risk drinkers . CONCLUSIONS Study results reveal that a stepped care approach can be expected to increase cost-effectiveness of brief interventions for individuals with at-risk drinking Background Poor adherence to antiretroviral treatment has been a public health challenge associated with the treatment of HIV . Although different adherence-supporting interventions have been reported , their long term feasibility in low income setting s remains uncertain . Thus , there is a need to explore sustainable context ual adherence aids in such setting s , and to test these using rigorous scientific design s. The current ubiquity of mobile phones in many re source -constrained setting s , make it a context ually appropriate and relatively low cost means of supporting adherence . In India , mobile phones have wide usage and acceptability and are potentially feasible tools for enhancing adherence to medications . This paper presents the study protocol for a trial , to evaluate the influence of mobile phone reminders on adherence to first-line antiretroviral treatment in South India . Methods / Design 600 treatment naïve patients eligible for first-line treatment as per the national antiretroviral treatment guidelines will be recruited into the trial at two clinics in South India . Patients will be r and omized into control and intervention arms . The control arm will receive the st and ard of care ; the intervention arm will receive the st and ard of care plus mobile phone reminders . Each reminder will take the form of an automated call and a picture message . Reminders will be delivered once a week , at a time chosen by the patient . Patients will be followed up for 24 months or till the primary outcome i.e. virological failure , is reached , whichever is earlier . Self-reported adherence is a secondary outcome . Analysis is by intention-to-treat . A cost-effectiveness study of the intervention will also be carried out . Discussion Stepping up telecommunications technology in re source -limited healthcare setting s is a priority of the World Health Organization . The trial will evaluate if the use of mobile phone reminders can influence adherence to first-line antiretrovirals in an Indian context .Trial Registration Trial registration : IS RCT N79261738 BACKGROUND Treatment of COPD requires multiple pharmacological and non-pharmacological intervention strategies . One target is physical inactivity because it leads to disability and contributes to poor physical and mental health . Unfortunately , less than 1 % of eligible patients have access to gold-st and ard pulmonary rehabilitation . METHODS A single-site parallel group r and omized trial was design ed to determine if a self-management lifestyle physical activity intervention would improve physical functioning and dyspnea . During the first six weeks after enrollment patients receive COPD self-management education delivered by a health coach using a workbook and weekly telephone calls . Patients are then r and omized to usual care or the physical activity intervention . The 20 week physical activity intervention is delivered by the health coach using a workbook supported by alternating one-on-one telephone counseling and computer assisted telephone calls . Theoretical foundations include social cognitive theory and the transtheoretical model . RESULTS Primary outcomes include change in Chronic Respiratory Question naire ( CRQ ) dyspnea domain and 6-minute walk distance measured at 6- , 12- , and 18-months after r and omization . Secondary outcomes include other CRQ domains ( fatigue , emotion , and mastery ) , SF-12 , and health care utilization . Other measures include process outcomes and clinical characteristics . CONCLUSIONS This theory driven self-management lifestyle physical activity intervention is design ed to reach patients unable to complete center-based pulmonary rehabilitation . Results will advance knowledge and methods for dissemination of a potentially cost-effective program for patients with COPD Background Most r and omized controlled trials of interventions design ed to promote cancer screening , particularly those targeting poor and minority patients , enroll selected patients . Relatively little is known about the benefits of these interventions among unselected patients . Methods / Design " Get Screened " is an American Cancer Society-sponsored r and omized controlled trial design ed to promote mammography and colorectal cancer screening in a primary care practice serving low-income patients . Eligible patients who are past due for mammography or colorectal cancer screening are entered into a tracking registry and r and omly assigned to early or delayed intervention . This 6-month intervention is multimodal , involving patient prompts , clinician prompts , and outreach . At the time of the patient visit , eligible patients receive a low-literacy patient education tool . At the same time , clinicians receive a prompt to remind them to order the test and , when appropriate , a tool design ed to simplify colorectal cancer screening decision-making . Patient outreach consists of personalized letters , automated telephone reminders , assistance with scheduling , and linkage of uninsured patients to the local National Breast and Cervical Cancer Early Detection program . Interventions are repeated for patients who fail to respond to early interventions . We will compare rates of screening between r and omized groups , as well as planned secondary analyses of minority patients and uninsured patients . Data from the pilot phase show that this multimodal intervention triples rates of cancer screening ( adjusted odds ratio 3.63 ; 95 % CI 2.35 - 5.61 ) . Discussion This study protocol is design ed to assess a multimodal approach to promotion of breast and colorectal cancer screening among underserved patients . We hypothesize that a multimodal approach will significantly improve cancer screening rates . The trial was registered at Clinical Trials.gov The authors examined whether tailored self-management support ( SMS ) strategies reach patients in a safety net system and explored variation by language , literacy , and insurance . English- , Spanish- , and Cantonese-speaking diabetes patients were r and omized to weekly automated telephone disease  management ( ATDM ) or monthly group medical visits . The SMS programs employ distinct communication methods but share common objectives , including behavioral “ action plans . ” Reach was measured using three complementary dimensions : ( a ) participation among clinics , clinicians , and patients ; ( b ) patient representativeness ; and ( c ) patient engagement with SMS . Participation rates were high across all levels and preferentially attracted Spanish- language speakers , uninsured , and Medicaid recipients . Although both programs engaged a significant proportion in action planning , ATDM yielded higher engagement , especially among those with limited English proficiency and limited literacy . These results provide important insights for health communication and translational research with respect to realizing the public health benefits of SMS and can inform system-level planning to reduce health disparities OBJECTIVE To evaluate the effectiveness of a lifestyle intervention for male workers in the construction industry at risk of cardiovascular disease ( CVD ) . METHODS In a r and omized controlled trial performed in the Netherl and s between 2007 and 2009 , usual care was compared to 6 months of individual counseling using motivational interviewing techniques , delivered face to face and by telephone . Participants aim ed at improving energy balance-related behavior or smoking cessation . Linear regression analyses were performed to determine the effects . RESULTS Body weight had significantly decreased at 6 ( β=-1.9 , 95 % CI -2.6 ; -1.2 ) and 12 months ( β=-1.8 , 95%CI -2.8 ; -1.1 ) . The intervention effects were also significant for diastolic blood pressure at 6 months ( β=-1.7 , 95 % CI -3.3 ; -0.1 ) . Among participants who had aim ed at energy balance , the intervention had a significant favorable effect on body weight at 6 ( β=-2.1 , 95 % CI -2.9 ; -1.3 ) and 12 months ( β=-2.2 , 95 % CI -3.1 ; -1.3 ) and at HDL cholesterol ( β=0.05 , 95 
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It may also increase osteoporosis screening .
ATCS Plus interventions probably slightly increase cervical cancer screening ( moderate certainty ) , but effects on osteoporosis screening are uncertain .
Multimodal ATCS versus usual care showed conflicting effects ( positive and uncertain ) on medication adherence .
ATCS Plus probably slightly ( versus control ; moderate certainty ) or probably ( versus usual care ; moderate certainty ) improves medication adherence but may have little effect on adherence to tests ( versus control ) .
IVR probably slightly improves medication adherence versus control ( moderate certainty ) .
Compared with usual care , IVR probably improves test adherence and slightly increases medication adherence up to six months but has little or no effect at longer time points ( moderate certainty ) .
Unidirectional ATCS , compared with control , may have little effect or slightly improve medication adherence ( low certainty ) .
In condition-specific areas , the effects of ATCS varied , including by the type of ATCS intervention in use .
Multimodal ATCS probably decrease both cancer pain and chronic pain as well as depression ( moderate certainty ) , but other ATCS types were less effective .
Depending on the type of intervention , ATCS may have small effects on outcomes for physical activity , weight management , alcohol consumption , and diabetes mellitus .
ATCS have little or no effect on outcomes related to heart failure , hypertension , mental health or smoking cessation , and there is insufficient evidence to determine their effects for preventing alcohol/substance misuse or managing illicit drug addiction , asthma , chronic obstructive pulmonary disease , HIV/AIDS , hypercholesterolaemia , obstructive sleep apnoea , spinal cord dysfunction or psychological stress in carers .