***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 AND OBJECTIVES Data collection remains of utmost importance to avoid publication bias in systematic review s. Our objectives were to compare search strategies with and without method ological terms in Medline , to find out how other data bases complement Medline , and how these strategies affect the pooled estimates of the accuracy . STUDY DESIGN AND SETTING A study was eligible if it prospect ively compared ultrasound to venography for the diagnosis of deep venous thrombosis in the lower limbs . All relevant articles found with all data bases , search ed from 1966 through 2003 , constitute the reference st and ard . Sensitivity was defined as the proportion of relevant studies found by Medline search es divided by the total number of articles in the reference st and ard . RESULTS Of a total of 1,473 citations , 237 abstract s were included . The sensitivity of strategies without method ological terms was higher ( 96 % ) than those with ( 95 % , 76 % , and 95 % ) . Search es of multiple data bases found seven articles not found with Medline . Search es of congress proceedings ( International Society of Thrombosis and Haemostasis ) found three abstract s not published in full . The diagnostic odds ratio OR was 5.66 ( 95 % confidence interval CI = 4.84 - 6.48 ) when multiple data bases were search ed and 5.57 ( 95 % CI = 3.49 - 7.65 ) when only English- language articles in Medline were identified . CONCLUSION Medline search es combining free text and MeSH terms were more sensitive . Single Medline search affects only marginally the pooled estimate accuracy OBJECTIVE The Centers for Disease Control and Prevention recommends that HIV testing be a st and ard part of medical care ; however , testing is voluntary and some patients decline . We evaluated 2 brief interventions to promote rapid HIV testing among STD clinic patients who initially declined testing . METHOD Using a r and omized controlled trial , patients either viewed an educational digital video disc ( DVD ) or participated in stage-based behavioral counseling ( SBC ) provided by a nurse .  Sixty clients presenting for care at a STD clinic who initially declined HIV testing at registration and during risk behavior screening participated in the study . RESULTS The primary outcome was whether patients agreed to be tested for HIV . The secondary outcomes included attitudes , knowledge , and stage-of-change regarding HIV testing . Patients receiving both interventions improved their attitudes and knowledge about testing ( ps < .01 ) . Patients receiving SBC agreed to testing more often ( 45 % ) than did patients who viewed the DVD ( 19 % ; p < .05 ) . CONCLUSIONS Brief interventions can increase rapid HIV testing acceptance among patients who are reluctant to be tested ; counseling guided by behavioral science theory is more effective than a well- design ed information-based intervention OBJECTIVE We compare rates of rapid HIV testing , test offer , and acceptance in an urban emergency department ( ED ) when conducted by dedicated HIV counselors versus current members of the ED staff . METHODS The Universal Screening for HIV Infection in the Emergency Room [ USHER ] trial is a prospect i ve r and omized controlled trial that implemented an HIV screening program in the ED of an urban tertiary medical center . ED patients were screened and consented for trial enrollment by an USHER research assistant . Eligible subjects were r and omized to rapid HIV testing ( oral OraQuick ) offered by a dedicated counselor ( counselor arm ) or by an ED provider ( provider arm ) . In the counselor arm , counselors-without other clinical responsibilities-assumed nearly all testing-related activities ( consent , counseling , delivery of test results ) . In the provider arm , trained ED emergency service assistants ( nursing assistants ) consented and tested the participant in the context of other ED-related responsibilities . In this arm , ED house officers , physician assistants , or attending physicians provided HIV test results to trial participants . Outcome measures were rates of HIV testing and test offer among individuals consenting for study participation . Among individuals offered the test , test acceptance was also measured . RESULTS From February 2007 through July 2008 , 8,187 eligible patients were approached in the ED , and 4,855 ( 59 % ) consented and were r and omized to trial participation . The mean age was 37 years , 65 % were women , and 42 % were white . The overall testing rate favored the counselor arm ( 57 % versus 27 % ; P<.001 ) ; 80 % ( 1,959/2,446 ) of subjects in the counselor arm were offered an HIV test compared with 36 % ( 861/2,409 ) in the provider arm ( P<.001 ) . HIV test acceptance was slightly higher in the provider arm ( counselor arm 71 % versus provider arm 75 % ; P = .025 ) . CONCLUSION Routine rapid HIV testing in the ED was accomplished more frequently by dedicated HIV counselors than by ED staff in the course of routine clinical work . Without dedicated staff , HIV testing in this setting may not be truly routine Background UK guidelines recommend routine HIV testing in healthcare setting s if the local diagnosed HIV prevalence > 2/1000 persons . This prospect i ve study assessed the feasibility and acceptability , to patients and staff , of routinely offering HIV tests in four setting s : Emergency Department , Acute Care Unit , Dermatology Out patients and Primary Care . Modelling suggested the estimated prevalence of undiagnosed HIV infection in attendees would exceed 1/1000 persons . The prevalence identified prospect ively was not a primary outcome . Methods Permanent staff completed question naires assessing attitudes towards  routine HIV testing  in their workplace before testing began . Subsequently , over a three-month period , patients aged 16–65 were offered an HIV test  by study staff . Demographics , uptake , results , and departmental activity were collected . Subsets of patients completed question naires . Analyses were conducted to identify factors associated with test uptake . Findings Question naires were received from 144 staff . 96 % supported the expansion of HIV testing , but only 54 % stated that they would feel comfortable delivering testing themselves , with 72 % identifying a need for training . Of 6194 patients offered a test , 4105 ( 66·8 % ) accepted ( 61·8–75·4 % across sites ) . Eight individuals were diagnosed with HIV ( 0–10/1000 across sites ) and all transferred to care . Younger people , and males , were more likely to accept an HIV test . No significant associations were found between uptake and ethnicity , or clinical site . Question naires were returned from 1003 patients . The offer of an HIV test  was acceptable to 92 % . Of respondents , individuals who had never tested for HIV before were more likely to accept a test , but no association was found between test uptake and sexual orientation . Conclusions HIV testing in these setting s is acceptable , and operationally feasible . The strategy successfully identified , and transferred to care , HIV-positive individuals . However , if HIV testing is to be included as a routine part of patients ’ care , additional staff training and infrastructural re sources will be required Background HIV testing is cost-effective in unselected general medical population s , yet testing rates among those at risk remain low , even among those with regular primary care . HIV rapid testing is effective in many healthcare setting s , but scant research has been done within primary care setting s or within the US Department of Veteran ’s Affairs Healthcare System . Objectives We evaluated three methods proven effective in other diseases/ setting s : nurse st and ing orders for testing , streamlined counseling , and HIV rapid testing . Design R and omized , controlled trial with three intervention models : model A ( traditional counseling/testing ) ; model B ( nurse-initiated screening , traditional counseling/testing ) ; model C ( nurse-initiated screening , streamlined counseling/rapid testing ) . Participants Two hundred fifty-one patients with primary /urgent care appointments in two VA clinics in the same city ( one large urban hospital , one freest and ing outpatient clinic in a high HIV prevalence area ) . Measurements Rates of HIV testing and receipt of results ; sexual risk reduction ; HIV knowledge improvement . Results Testing rates were 40.2 % ( model A ) , 84.5 % ( model B ) , and 89.3 % ( model C ; p = < .01 ) . Test result receipt rates were 14.6 % ( model A ) , 31.0 % ( model B ) , 79.8 % ( model C ; all p = < .01 ) . Sexual risk reduction and knowledge improvement did not differ significantly between counseling methods . Conclusions Streamlined counseling with rapid testing significantly increased testing and receipt rates over current practice without changes in risk behavior or posttest knowledge . Increased testing and receipt of results could lead to earlier disease identification , increased treatment , and reduced morbidity/mortality . Policymakers should consider streamlined counseling/rapid testing when implementing routine HIV testing into primary /urgent care STUDY OBJECTIVE A clinical prediction tool , the Denver HIV Risk Score , was recently developed to help identify patients with increased probability of undiagnosed HIV infection . Our goal was to compare targeted rapid HIV screening using the Denver HIV Risk Score to nontargeted rapid HIV screening in an urban emergency department ( ED ) and urgent care . METHODS We used a prospect i ve , before-after design at an urban medical center with an approximate annual census of 110,000 visits . Patients aged 13 years or older were eligible for screening .  Targeted HIV screening of  patients identified as high-risk by nurses using the Denver HIV Risk Score during medical screening was compared to nontargeted HIV screening offered by medical screening nurses during 2 separate 4-month time periods . The primary outcome was newly diagnosed HIV-infected patients . RESULTS 28,506 patients presented during the targeted phase , 1,718 were identified as high-risk , and 551 completed HIV testing . Of these , 7 ( 1.3 % , 95 % confidence interval [ CI ] 0.5 % to 2.6 % ) were newly diagnosed with HIV infection . 29,510 patients presented during the nontargeted phase and 3,591 completed HIV testing . Of these , 7 ( 0.2 % , 95 % CI 0.1 % to 0.4 % ) were newly diagnosed with HIV infection .  Targeted HIV screening was significantly associated with identification of newly diagnosed HIV infection when compared to nontargeted screening , adjusting for patient demographics and payer status ( relative risk [ RR ] 10.4 , 95 % CI 3.4 to 32.0 ) . CONCLUSION Targeted HIV screening using the Denver HIV Risk Score was strongly associated with new HIV diagnoses when compared to nontargeted screening . Although both HIV screening methods identified the same absolute number of newly diagnosed patients , significantly fewer tests were required during the targeted phase to achieve the same effect BACKGROUND To lower the number of undiagnosed infections and to improve early detection , international health agencies have promoted nontargeted human immunodeficiency virus ( HIV ) screening in health care setting s , including emergency departments ( EDs ) . This strategy remains controversial and has yet to be tested on a large scale . We assessed the public health impact of nontargeted HIV-rapid test ( RT ) screening among ED patients in the metropolitan area of Paris ( 11.7 million inhabitants ) , where half of France 's new HIV cases are diagnosed annually . METHODS During a r and omly assigned 6-week period for each of the 29 participating EDs , 18- to 64-year-old patients who were able to provide consent for HIV testing were offered a fingerstick whole-blood HIV RT . Main outcome measures were the number of patients tested for HIV and their characteristics vs those of the general metropolitan Paris population and the proportion of newly diagnosed HIV-positive patients among those tested and their characteristics vs those from the national HIV case surveillance . RESULTS Among 138,691 visits , there were 78,411 eligible patients , 20,962 of whom ( 27.0 % ) were offered HIV RT ; 13,229 ( 63.1 % ) accepted testing and 12,754 ( 16.3 % ) were tested . The ED patients ' characteristics reflected the general population distribution . Eighteen patients received new HIV diagnoses ( 0.14 % ; 95 % confidence interval , 0.08%-0.22 % ) . Like national HIV case surveillance patients , they belonged to a high-risk group ( n = 17 ) , were previously tested ( n = 12 ) , and were either symptomatic or had a CD4 lymphocyte count lower than 350/μL , suggesting late-stage infections ( n = 8) ; 12 patients were linked to care . CONCLUSIONS Nontargeted HIV testing in EDs was feasible but identified only a few new HIV diagnoses , often at late stages , and , unexpectedly , most patients belonged to a high-risk group . Our findings do not support the implementation of nontargeted screening of the general population in EDs BACKGROUND Early diagnosis of HIV infection reduces morbidity and mortality associated with late presentation . Despite UK guidelines , the HIV testing rate has not increased . We have introduced universal HIV screening in an open-access returning traveller clinic . METHODS Data were prospect ively recorded for all patients attending the open-access returning traveller clinic between August 2008 and December 2010 .  HIV testing was offered to all patients from May 2009 ; initially testing with laboratory sample s ( phase 1 ) and subsequently a point-of-care test ( POCT ) ( phase 2 ) . RESULTS A total of 4965 patients attended the clinic ; 13 
    Output:
    
The studies showed a trend in higher test offering , better acceptance and higher delivery rates with the implementation of nurse-driven HIV screening .
The review supports the implementation of  nurse-driven HIV screening .