***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 The European R and omised study of Screening for Prostate Cancer ( ERSPC ) has shown significant reductions in prostate cancer mortality after 9 years and 11 years of follow-up , but screening is controversial because of adverse events such as overdiagnosis . We provide up date d results of mortality from prostate cancer with follow-up to 2010 , with analyses truncated at 9 , 11 , and 13 years . METHODS ERSPC is a multicentre , r and omised trial with a predefined central ised data base , analysis plan , and core age group ( 55 - 69 years ) , which assesses prostate-specific antigen ( PSA ) testing in eight European countries . Eligible men aged 50 - 74 years were identified from population registries and r and omly assigned by computer generated r and om numbers to screening or no intervention ( control ) . Investigators were masked to group allocation . The primary outcome was prostate cancer mortality in the core age group . Analysis was by intention to treat . We did a secondary analysis that corrected for selection bias due to non-participation . Only incidence and no mortality data at 9 years ' follow-up are reported for the French centres . This study is registered with Current Controlled Trials , number IS RCT N49127736 . FINDINGS With data truncated at 13 years of follow-up , 7408 prostate cancer cases were diagnosed in the intervention group and 6107 cases in the control group .  The rate ratio of prostate cancer incidence between the intervention and control groups was 1·91 ( 95 % CI 1·83 - 1·99 ) after 9 years ( 1·64 [ 1·58 - 1·69 ] including France ) , 1·66 ( 1·60 - 1·73 ) after 11 years , and 1·57 ( 1·51 - 1·62 ) after 13 years . The rate ratio of prostate cancer mortality was 0·85 ( 0·70 - 1·03 ) after 9 years , 0·78 ( 0·66 - 0·91 ) after 11 years , and 0·79 ( 0·69 - 0·91 ) at 13 years . The absolute risk reduction of death from prostate cancer at 13 years was 0·11 per 1000 person-years or 1·28 per 1000 men r and omised , which is equivalent to one prostate cancer death averted per 781 ( 95 % CI 490 - 1929 ) men invited for screening or one per 27 ( 17 - 66 ) additional prostate cancer detected . After adjustment for non-participation , the rate ratio of prostate cancer mortality in men screened was 0·73 ( 95 % CI 0·61 - 0·88 ) . INTERPRETATION In this up date the ERSPC confirms a substantial reduction in prostate cancer mortality attributable to testing of PSA , with a substantially increased absolute effect at 13 years compared with findings after 9 and 11 years . Despite our findings , further quantification of harms and their reduction are still considered a prerequisite for the introduction of populated-based screening . FUNDING Each centre had its own funding responsibility Background Self-management programs for patients with heart failure can reduce hospitalizations and mortality . However , no programs have analyzed their usefulness for patients with low literacy . We compared the efficacy of a heart failure self-management program design ed for patients with low literacy versus usual care .  Methods We performed a 12-month r and omized controlled trial . From November 2001 to April 2003 , we enrolled participants aged 30–80 , who had heart failure and took furosemide .  Intervention patients received education on self-care emphasizing daily weight measurement , diuretic dose self-adjustment , and symptom recognition and response . Picture-based educational material s , a digital scale , and scheduled telephone follow-up were provided to reinforce adherence . Control patients received a generic heart failure brochure and usual care . Primary outcomes were combined hospitalization or death , and heart failure-related quality of life . Results 123 patients ( 64 control , 59 intervention ) participated ; 41 % had inadequate literacy . Patients in the intervention group had a lower rate of hospitalization or death ( crude incidence rate ratio ( IRR ) = 0.69 ; CI 0.4 , 1.2 ; adjusted IRR = 0.53 ; CI 0.32 , 0.89 ) . This difference was larger for patients with low literacy ( IRR = 0.39 ; CI 0.16 , 0.91 ) than for higher literacy ( IRR = 0.56 ; CI 0.3 , 1.04 ) , but the interaction was not statistically significant . At 12 months , more patients in the intervention group reported monitoring weights daily ( 79 % vs. 29 % , p < 0.0001 ) . After adjusting for baseline demographic and treatment differences , we found no difference in heart failure-related quality of life at 12 months ( difference = -2 ; CI -5 , + 9 ) . Conclusion A primary care-based heart failure self-management program design ed for patients with low literacy reduces the risk of hospitalizations or death Sub clinical prostate cancer is common in men > 50 years of age .  Population -based screening of men aged between 55 and 69 years , using prostate-specific antigen ( PSA ) testing , has been evaluated in r and omised trials [ 1 , 2 ] . After a median follow-up of 13 years , the European screening trial demonstrated a relative reduction in the risk of prostate cancer mortality of 21 % ( 29 % if adjusted for non-compliance ) . However , 781 men needed to be invited for screening and 27 patients needed to be treated to prevent one death  from prostate cancer . Risk-adapted early detection of prostate cancer using a baseline PSA level has also been evaluated in retrospective cohort studies . The baseline PSA at or before the age of 50 years is associated with the risk of prostate cancer mortality over the subsequent 25 years [ 3 ] Objective To assess whether screening for prostate cancer reduces prostate cancer specific mortality . Design Population based r and omised controlled trial . Setting Department of Urology , Norrköping , and the South-East Region Prostate Cancer Register . Participants All men aged 50 - 69 in the city of Norrköping , Sweden , identified in 1987 in the National Population Register ( n=9026 ) . Intervention From the study population , 1494 men were r and omly allocated to be screened by including every sixth man from a list of date s of birth . These men were invited to be screened every third year from 1987 to 1996 . On the first two occasions screening was done by digital rectal examination only . From 1993 , this was combined with prostate specific antigen testing , with 4 µg/L as cut off . On the fourth occasion ( 1996 ) , only men aged 69 or under at the time of the investigation were invited . Main outcome measures Data on tumour stage , grade , and treatment from the South East Region Prostate Cancer Register . Prostate cancer specific mortality up to 31 December 2008 . Results In the four screenings from 1987 to 1996 attendance was 1161/1492 ( 78 % ) , 957/1363 ( 70 % ) , 895/1210 ( 74 % ) , and 446/606 ( 74 % ) , respectively . There were 85 cases ( 5.7 % ) of prostate cancer diagnosed in the screened group and 292 ( 3.9 % ) in the control group . The risk ratio for death from prostate cancer in the screening group was 1.16 ( 95 % confidence interval 0.78 to 1.73 ) . In a Cox proportional hazard analysis comparing prostate cancer specific survival in the control group with that in the screened group , the hazard ratio for death from prostate cancer was 1.23 ( 0.94 to 1.62 ; P=0.13 ) . After adjustment for age at start of the study , the hazard ratio was 1.58 ( 1.06 to 2.36 ; P=0.024 ) . Conclusions After 20 years of follow-up the rate of death from prostate cancer did not differ significantly between men in the screening group and those in the  control group . Trial registration Current Controlled Trials , IS RCT N06342431 BACKGROUND The prostate component of the Prostate , Lung , Colorectal , and Ovarian ( PLCO ) Cancer Screening Trial was undertaken to determine whether there is a reduction in prostate cancer mortality from screening using serum prostate-specific antigen ( PSA ) testing and digital rectal examination ( DRE ) . Mortality after 7 - 10 years of follow-up has been reported previously . We report extended follow-up to 13 years after the trial . METHODS A total of 76 685 men , aged 55 - 74 years , were enrolled at 10 screening centers between November 1993 and July 2001 and r and omly assigned to the intervention  ( organized screening of annual PSA testing for 6 years and annual DRE for 4 years ; 38 340 men ) and control ( usual care , which sometimes included opportunistic screening ; 38 345 men ) arms . Screening was completed in October 2006 . All incident prostate cancers and deaths from prostate cancer through 13 years of follow-up or through December 31 , 2009 , were ascertained . Relative risks ( RRs ) were estimated as the ratio of observed rates in the intervention and control arms , and 95 % confidence intervals ( CIs ) were calculated assuming a Poisson distribution for the number of events . Poisson regression modeling was used to examine the interactions with respect to prostate cancer mortality between trial arm and age , comorbidity status , and pretrial PSA testing . All statistical tests were two-sided . RESULTS Approximately 92 % of the study participants were followed to 10 years and 57 % to 13 years . At 13 years , 4250 participants had been diagnosed with prostate cancer in the intervention arm compared with 3815 in the control arm . Cumulative incidence rates for prostate cancer in the intervention and control arms were 108.4 and 97.1 per 10 000 person-years , respectively , result ing in a relative increase of 12 % in the intervention arm ( RR = 1.12 , 95 % CI = 1.07 to 1.17 ) . After 13 years of follow-up , the cumulative mortality rates from prostate cancer in the intervention and control arms were 3.7 and 3.4 deaths per 10 000 person-years , respectively , result ing in a non-statistically significant difference between the two arms ( RR = 1.09 , 95 % CI = 0.87 to 1.36 ) . No statistically significant interactions with respect to prostate cancer mortality were observed between trial arm and age ( P(interaction ) = .81 ) , pretrial PSA testing ( P(interaction ) = .52 ) , and comorbidity ( P(interaction ) = .68 ) . CONCLUSIONS After 13 years of follow-up , there was no evidence of a mortality benefit for organized annual screening in the PLCO trial compared with opportunistic screening , which forms part of usual care , and there was no apparent interaction with age , baseline comorbidity , or pretrial PSA testing PURPOSE This clinical trial is aim ed at evaluating the impact of prostate cancer screening on cancer-specific mortality . SUBJECTS AND METHODS Forty-six thous and four hundred and eighty-six ( 46,486 ) men aged 45 - 80 years registered in the electoral roll of the Quebec city area were r and omized in 1988 between screening and no screening . Screening included measurement of serum prostatic specific antigen ( PSA ) using 3.0 ng/ml as upper limit of normal and digital rectal examination ( DRE ) at first visit . At follow-up visits , serum PSA only was used . RESULTS Seventy-four ( 74 ) deaths from prostate cancer occurred in the 14,231 unscreened controls while 10 deaths were observed in the screened group of 7,348 men during the first 11 years following r and omization . Median follow-up of screened men was 7.93 years . A Cox proportional hazards model of the age at death from prostate cancer shows a 62 % reduction ( P < 0.002 , Fisher 's exact test ) of cause-specific mortality in the screened men ( P = 0.005 ) . These results are in agreement with the continuous decrease of prostate cancer mortality observed in North America PURPOSE Many clinicians lack re sources to engage patients in shared decision making for prostate cancer screening . We sought to evaluate whether previsit educational decision aids facilitate shared decision making . METHODS This r and omized controlled study compared a Web-based and a paper-based decision aid with no previsit education .  Men aged 50 to 70 years undergoing a health maintenance examination at a large family practice were enrolled . The primary outcome was patient-reported level of control over the decision to be screened . Secondary outcomes included frequency of screening , patient knowledge , decisional conflict , and time spent discussing screening . RESULTS A total of 497 men participated ( 75 control , 196 brochure , 226 Web site ) . Patients exposed to either aid were no more likely than control patients to report a collaborative decision : 36 % of patients in each group reported equally sharing decision responsibility . Exposure to either decision aid increased patients ’ involvement in decision making compared with the control condition ( Web site , P = .03 
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Individual trial estimates ( 46.7 % ) also suggest that SDM may reduce or neutralise physicians ’ tendency for PSA screening , and may improve the accuracy of patients ’ perception of lifetime-risks and men ’s views towards screening .
There was no evidence on the effects of SDM on health outcomes .
Conclusions There is currently insufficient evidence to support a clear association of  SDM on patient- and SDM-related outcomes for decisions about PSA testing .
It should address the absence of evidence , particularly on health outcomes