***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: A group of 200 patients who presented in general practice with symptoms but no abnormal physical signs and in whom no definite diagnosis was made were r and omly selected for one of four consultations : a consultation conducted in a " positive manner , " with and without treatment , and a consultation conducted in a " non-positive manner , " called a negative consultation , with and without treatment . Two weeks after consultation there was a significant difference in patient satisfaction between the positive and negative groups but not between the treated and untreated groups . Similarly , 64 % of those receiving a positive consultation  got better , compared with 39 % of those who received a negative consultation ( p = 0.001 ) and 53 % of those treated got better compared with 50 % of those not treated ( p = 0.5 ) This study looked at the possible harmful effects of detection and treatment for hypertension . Patients with borderline blood pressure ( diastolic 96 - 109 mmHg ) were r and omized into two groups : an intervention group receiving treatment for hypertension and a control group not told about any problem and left untreated . The morbidity in these two groups were studied for differences . During the period studied , the patients in the investigation group saw the doctor more frequently and had a larger number of diseases classified than the control group . When consultations involving hypertension and its follow up were excluded , however , no differences were demonstrable between the groups . Problem behaviour , psychosomatic and functional affections and symptom diagnoses were evenly distributed over the two groups . The difference in blood pressure between the two groups after completion of the study was not marked : the decrease in diastolic blood pressure averaged 7.6 mmHg in the control group versus 9.1 mmHg in the intervention group . In cases where the initial blood pressure values are only slightly raised , careful monitoring of blood pressure over a long period seems to be as effective as treatment for hypertension . The general practitioner should focus especially on anticipation in this sense BACKGROUND When initiating treatment , it has been shown that only one quarter of the physicians discuss potential side effects with patients . There are several possible reasons , but , in particular , many physicians are concerned that the power of suggestion may lead some patients to experience an increase in side effects if they are fully informed . Accordingly , this study was design ed to determine whether providing  patients  with information about potential side effects of new medications increases the reported incidence of those side effects . METHODS All clinic patients are r and omly assigned to one of four firms . Two firms served as the intervention group and two served as control groups . All patients receiving new prescriptions for the angiotensin-converting enzyme inhibitors , trimethoprim/sulfamethoxazole , or nonsteroidal anti-inflammatory drugs were recruited . Patients without telephones were excluded . Intervention patients received verbal instructions and a h and out describing the name , purpose , dose , and three most common side effects of the drug . Control patients received usual discharge instructions . Patients were interviewed 14 to 21 days later using a st and ardized question naire . RESULTS There was no difference in incidence of targeted side effects for specific medications between the study groups ( 38 % vs 37 % ) . Study groups were similar with regard to age , sex , financial status , and type of medication prescribed . CONCLUSION Informing patients of potential side effects prior to starting a new medication does not lead to an increased incidence of those side effects . This should not be a reason for physicians to avoid warning patients of potential side effects To examine whether written informed consent might influence the results of clinical trials the effect of placebo when given with or without informed consent to patients suffering from insomnia was studied . The study was a single blind observer blinded trial , and patients were paired according to sex , age , and hospital environment . R and omisation assigned the first patient of each pair to the control group ( without informed consent ) or the group to give informed consent . Of the 56 patients , 26 refused to give informed consent , and the age and sex distribution of these differed significantly ( p less than 0.02 ) from the 30 pairs of patients ultimately enrolled into the study . In this " biased " sample , the hypnotic activity of placebo was significantly higher in the control group ( p less than 0.05 ) . It is concluded that the informed consent procedure biases the results of clinical trials and might affect their general applicability We carried out two studies to determine the effects of feedback on subsequent blood pressure and heart rate readings in subjects without significant cardiovascular abnormalities . In both studies the subjects were r and omly assigned to be told that their blood pressure was normal or was high or to receive no feedback at all ; 3 minutes later another reading was taken and correct feedback provided . Study 1 was done in 114 patients who attended a family practice teaching unit for an office visit ; subjects taking cardioactive medication or with chronically elevated blood pressure ( diastolic pressure more than 95 mm Hg ) or known low pressure ( diastolic pressure less than 60 mm Hg ) were excluded . Half of the subjects received feedback from a nurse and the other half from a physician . We found no effect of type of feedback or type of practitioner on subsequent readings . No adaptation of diastolic blood pressure or heart rate took place , whereas a similar rest period in the laboratory consistently triggers cardiovascular adaptation . Given the field nature of the study it was not clear whether the intervention was not powerful or whether the practitioner-patient interactions diffused the effects of an otherwise powerful intervention . Therefore , a second study with the same design was carried out in a controlled laboratory setting with 61 university students who believed they were in the adaptation phase of an experimental stress protocol . The subjects did not interact with the experimenter , who provided only the initial feedback , via intercom . The findings replicated those of study 1 : type of feedback had no significant effect on subsequent blood pressure levels , and all types of feedback prevented cardiovascular adaptation . We recommend that patients be allowed to rest alone for at least 10 minutes before blood pressure is measured . Our findings suggest that practitioners need not be concerned about telling normotensive or borderline hypertensive patients that their blood pressure is elevated OBJECTIVE To ascertain whether the quality of physician-patient communication makes a significant difference to patient health outcomes . DATA SOURCES The MEDLINE data base was search ed for articles published from 1983 to 1993 using " physician-patient relations " as the primary medical subject heading . Several bibliographies and conference proceedings were also review ed . STUDY SELECTION R and omized controlled trials ( RCTs ) and analytic studies of physician-patient communication in which patient health was an outcome variable . DATA EXTRACTION The following information was recorded about each study : sample size , patient characteristics , clinical setting , elements of communication assessed , patient outcomes measured , and direction and significance of any association found between aspects of communication and patient outcomes . DATA SYNTHESIS Of the 21 studies that met the final criteria for review , 16 reported positive results , 4 reported negative ( i.e. , nonsignificant ) results , and 1 was inconclusive . The quality of communication both in the history-taking segment of the visit and during discussion of the management plan was found to influence patient health outcomes . The outcomes affected were , in descending order of frequency , emotional health , symptom resolution , function , physiologic measures ( i.e. , blood pressure and blood sugar level ) and pain control . CONCLUSIONS Most of the studies review ed demonstrated a correlation between effective physician-patient communication and improved patient health outcomes . The components of effective communication identified by these studies can be used as the basis both for curriculum development in medical education and for patient education programs . Future research should focus on evaluating such educational programs To determine whether informed consent in a therapeutic trial modifies the analgesic effect of naproxen and placebo , we conducted a prospect i ve , r and omised , single dose , placebo-controlled trial . Patients were r and omly selected to receive or not information concerning the study . All patients included were then given a single dose of naproxen and placebo according to a crossover , double-blind design . Forty-nine patients with mild or moderate cancer pain which did not need narcotic analgesics entered the study . Twenty-five received both treatments without any information and constituted the uninformed group . Twenty-four had a complete information about the trial ; six refused to participate . The 18 others constituted the informed-consent group . Visual analogue scales of pain before and 30 , 60 , 120 and 180 min after the intake of naproxen and placebo were recorded . As an analgesic , naproxen was more effective than placebo in both groups of patients ( p = 0.001 ) . For naproxen as well as for placebo , the analgesic effect was better in the informed-consent group compared to the uninformed group ( p = 0.012 ) . The difference in therapeutic activity between naproxen and placebo was moderately higher in the uninformed patients ( p = 0.08 ) . We concluded that , in contrast with parallel studies , giving information in a crossover , placebo-controlled trial may increase the apparent efficacy of both the tested agent and the placebo , and decrease the perceived difference the two The influence of four variables ( status of communicator of drug effects , attitude of dentist , attitude of dental technician , and message of drug effects ) on the obtainment of placebo effects in an oral surgery clinic was investigated . Dependent variables were ( 1 ) rating of pain experienced from  m and ibular-block injection  , ( 2 ) pre-post placebo state anxiety  , and ( 3 )  pre-postplacebo  fear of injection . Enthusiastic messages of drug effects produced statistically and clinical ly significant reductions in postplacebo fear of injection and state anxiety and markedly lower ratings of pain experienced during injection of local anesthetic . Although there was a strong tendency for positive placebo effects to occur when the dental staff was perceived as friendly and supportive , only the attitude factors obtained statistical significance . The status of the communicator accounted for very small portions of the variance Homeless adults often visit emergency departments and often leave dissatisfied . We tested whether compassionate care , by improving patient satisfaction , can alter subsequent use of emergency services . We identified 133 consecutive homeless adults visiting one inner-city emergency department who were not acutely psychotic , extremely intoxicated , unable to speak English , or medically unstable . Half were r and omly assigned to receive compassionate contact from trained volunteers .  All patients otherwise had usual care and were followed for repeat visits to emergency departments . We found that rates of use were high , with patients making an average of seven visits a year ( 0.60 per month ) . More than a third of all patients made two or more visits within two days of each other . The average number of visits per month after intervention was significantly lower for patients who received compassionate care ( 0.43 vs 0.65 , p = 0.018 ) . Analyses adjusting for each patient 's previous rate of use confirmed that compassionate care led to a one third reduction in the number of return visits within one month ( 95 % CI 14 to 40 % ) . Compassionate management of selected homeless adults decreases repeat visits to the emergency department . One explanation is that patients tend to return frequently until they are satisfied with their treatment Edrophonium is a widely used provocative agent in the evaluation of noncardiac chest pain , with reported positivity rates of 30 - 55 % . The influence of a subjective response and psychological factors on test results have not been examined previously . A retrospective analysis was performed to compare positivity rates for three physicians in the same laboratory . This was followed by a prospect i ve study of 62 patients with noncardiac chest pain r and omized to two groups . Group 1 patients were told that intravenous medication was given to observe changes in the tracing . Group 2 patients were told that the injection was to elicit their usual pain . During the 2-yr retrospective review , 260 patients were tested . The positivity rate varied from 31.1 % with physician A to 20.2 % with physician B and 7.5 % for physician C ( p = 0.001 for A vs. C , and p = 0.04 for B vs. C ) . In the prospect i ve study , chest pain was elicited in nine of 62 patients ( 14.5 % ) . Two of the 29 patients in group 1 ( 6.9 % ) and seven of 33 patients in group 2 ( 21.2 % ) contributed to this result . Contraction amplitude and duration increased similarly in all groups . These data suggest that edrophonium testing may be influenced by coaching , that manometric changes are similar in positive and negative tests , and that the prevalence of positive tests is lower than previously reported This study evaluated the effects of placebo medication on pulmonary responses in asthmatics , and investigated the roles of expectancy and anxiety . Twelve adult asthmatics were recruited for a laboratory experiment described as a study of the effectiveness of a new bronchodilator . Distilled nebulized water was inhaled in each session . The solution was described as water in session 1 ( control ) , while in sessions 2 and 3 subjects were told that the nebulizer contained a chemical likely to cause chest tightness and wheezing ( bronchoconstrictive suggestion ) . Prior to the inhalation sequence in sessions 2 and 3 , subjects inhaled from an aerosol that they were told contained either a powerful new drug ( placebo ) or a non-active substance ( neutral ) . Pulmonary function was measured with the forced oscillation technique and spirometry , while autonomic parameters , anxiety and expectancies were also monitored . Pulmonary function deteriorated following the inhalations accompanied by bronchoconstrictive suggestion , and this effect was abolished by pre-treatment with placebo . Neither subject expectations nor changes in anxiety were associated with the experimental manipulations . The implication s of these results for theories of placebo action are considered The effects of an anorexigenic agent ( dextroamphetamine ) and a placebo on weight loss in 64 obese female patients were evaluated over a period of 4 weeks . Half of the patients were field dependent and half were field independent . This psychological categorization of the patients refers to individual differences in analytic functioning in perception that can be objective ly evaluated and appears to parallel personality trait differences that have been noted between placebo reactors and nonreactors . An investigational drug or known drug treatment condition was created . Data from the study showed that : ( 1 ) Pat 
    Output:
    
INTERPRETATION There is much inconsistency regarding emotional and cognitive care , although one relatively consistent finding is that physicians who adopt a warm , friendly , and reassuring manner are more effective than those who keep consultations formal and do not offer reassurance