***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: Abstrac Objective : To test the effect of extra non-directive information about prenatal testing , given individually or in a class . Setting : Antenatal clinics in a district general hospital and a university hospital . Design : R and omised controlled trial ; participants allocated to control group or offer of extra information individually or in class . Subjects : 1691 women booking antenatal care before 15 weeks ' gestation . Interventions : All participants received the usual information about prenatal tests from hospital staff . Individual participants were offered a separate session with a research midwife in which prenatal screening was described in detail . Class participants were offered the same extra information in an early prenatal class . Main outcome measures : Attendance at extra information sessions ; uptake rates of prenatal tests ; levels of anxiety , underst and ing , and satisfaction with decisions . Results : Attendance at classes was lower than at individual sessions ( adjusted odds ratio 0.45 ; 95 % confidence interval 0.35 to 0.58 ) .  Ultrasonography  was almost universally accepted ( 99 % ) and was not affected by either intervention . Uptake of cystic fibrosis testing , high in controls ( 79 % ) , was lowered in the individual group ( 0.44 ; 0.20 to 0.97 ) and classes ( 0.39 ; 0.18 to 0.86 ) . Uptake of screening for Down 's syndrome , already low ( 34 % ) in controls , was not further depressed by extra information in classes ( 0.99 ; 0.70 to 1.39 ) and was slightly higher in the individual group ( 1.45 ; 1.04 to 2.02 ) . Women offered extra information had improved underst and ing and were more satisfied with information received ; satisfaction with decisions about prenatal testing was unchanged . The offer of individual information reduced anxiety later in pregnancy . Conclusions : Ultrasonography is valued for non-medical reasons and chosen even by fully informed people who eschew prenatal diagnosis . The offer of extra information has no overall adverse effects on anxiety and reduces uptake of blood tests when background uptake rate is high ( but not when it is already low ) . High uptake of prenatal blood tests suggests compliant behaviour and need for more information Background By providing information on the relative merits and potential harms of the options available and a framework to clarify preferences , decision aids can improve knowledge and realistic expectations and decrease decisional conflict in individuals facing decisions between alternative forms of action . Decision-making about prenatal testing for fetal abnormalities is often confusing and difficult for women and the effectiveness of decision aids in this field has not been established . This study aims to test whether a decision aid for prenatal testing of fetal abnormalities , when compared to a pamphlet , improves women 's informed decision-making and decreases decisional conflict . Methods / design A cluster design ed r and omised controlled trial is being conducted in Victoria , Australia . Fifty General Practitioners ( GPs ) have been r and omised to one of two arms : providing women with either a decision aid or a pamphlet . The two primary outcomes will be measured by comparing the difference in percentages of women identified as making an informed choice and the difference in mean decisional conflict scores between the two groups . Data will be collected from women using question naires at 14 weeks and 24 weeks gestation . The sample size of 159 women in both arms of the trial has been calculated to detect a difference of 18 % ( 50 to 68 % ) in informed choice between the two groups . The required numbers have been adjusted to accommo date the cluster design , miscarriage and participant lost – to – follow up . Baseline characteristics of women will be summarised for both arms of the trial . Similarly , characteristics of GPs will be compared between arms . Differences in the primary outcomes will be analysed using ' intention-to-treat ' principles . Appropriate regression techniques will adjust for the effects of clustering and include covariates to adjust for the stratifying variable and major potential confounding factors . Discussion The findings from this trial will make a significant contribution to improving women 's experience of prenatal testing and will have application to a variety of maternity care setting s. The evaluation of a tailored decision aid will also have implication s for pregnancy care providers by identifying whether or not such a re source will support their role in providing prenatal testing information Background Most women use some method of pain relief during labour . There is extensive research evidence available of pharmacological pain relief during labour ; however this evidence is not readily available to pregnant women . Decision aids are tools that present evidence based information and allow preference elicitation . Methods We developed a labour analgesia decision aid . Using a RCT design women either received a decision aid or a pamphlet .  Eligible women were primiparous , ≥ 37 weeks , planning a vaginal birth of a single infant and had sufficient English to complete the trial material s. We used a combination of affective ( anxiety , satisfaction and participation in decision-making ) and behavioural outcomes ( intention and analgesia use ) to assess the impact of the decision aid , which were assessed before labour . Results 596 women were r and omised ( 395 decision aid group , 201 pamphlet group ) . There were significant differences in knowledge scores between the decision aid group and the pamphlet group ( mean difference 8.6 , 95 % CI 3.70 , 13.40 ) . There were no differences between decisional conflict scores ( mean difference -0.99 ( 95 % CI -3.07 , 1.07 ) , or anxiety ( mean difference 0.3 , 95 % CI -2.15 , 1.50 ) . The decision aid group were significantly more likely to consider their care providers opinion ( RR 1.28 95%CI 0.64 , 0.95 ) . There were no differences in analgesia use and poor follow through between antenatal analgesia intentions and use . Conclusions This decision aid improves women 's labour analgesia knowledge without increasing anxiety . Significantly , the decision aid group were more informed of labour analgesia options , and considered the opinion of their care providers more often when making their analgesia decisions , thus improving informed decision making . Trial Registration Trial registration no : IS RCT Objectives To describe the development , validation and inter-rater reliability of an instrument to measure the  quality of patient decision support technologies ( decision aids ) . Design Scale development study , involving construct , item and scale development , validation and reliability testing . Setting There has been increasing use of decision support technologies – adjuncts to the discussion s clinicians have with patients about difficult decisions . A global interest in developing these interventions exists among both for-profit and not-for-profit organisations . It is therefore essential to have internationally accepted st and ards to assess the quality of their development , process , content , potential bias and method of field testing and evaluation . Methods Scale development study , involving construct , item and scale development , validation and reliability testing . Participants Twenty-five research er-members of the International Patient Decision Aid St and ards Collaboration worked together to develop the instrument ( IPDASi ) . In the fourth Stage ( reliability study ) , eight raters assessed thirty r and omly selected decision support technologies . Results IPDASi measures quality in 10 dimensions , using 47 items , and provides an overall quality score ( scaled from 0 to 100 ) for each intervention . Overall IPDASi scores ranged from 33 to 82 across the decision support technologies sample d ( n = 30 ) , enabling discrimination . The inter-rater intraclass correlation for the overall quality score was 0.80 . Correlations of dimension scores with the overall score were all positive ( 0.31 to 0.68 ) . Cronbach 's alpha values for the 8 raters ranged from 0.72 to 0.93 . Cronbach 's alphas based on the dimension means ranged from 0.50 to 0.81 , indicating that the dimensions , although well correlated , measure different aspects of decision support technology quality . A short version ( 19 items ) was also developed that had very similar mean scores to IPDASi and high correlation between short score and overall score 0.87 ( CI 0.79 to 0.92 ) . Conclusions This work demonstrates that IPDASi has the ability to assess the quality of decision support technologies . The existing IPDASi provides an assessment of the quality of a DST 's components and will be used as a tool to provide formative advice to DSTs developers and summative assessment s for those who want to compare their tools against an existing benchmark Prenatal diagnosis ( PND ) is offered routinely as part of pregnancy care to a large number of women at increased risk of fetal anomalies . Despite an extraordinary growth in the use of PND and significant re source allocation , few studies have examined outcomes of PND counseling , and virtually no research has evaluated the relative efficacy of various approaches to genetic counseling . This study was a r and omized trial that compared which counseling methods – individual , group , and use of a decision aid – are effective in PND counseling for women of advanced maternal age ( ≥35 years ) and their partners . Three hundred and fifty‐two women and 225 partners completed pre‐ and post‐intervention question naires assessing changes in knowledge , decisional conflict , state anxiety , satisfaction , use of PND , and pregnancy outcomes . All participants showed a significant increase in knowledge and a decrease in decisional conflict post intervention . Those in the group intervention showed a significantly greater increase in knowledge than those in the individual counseling intervention . While high levels of satisfaction were reported by all , those in individual counseling were significantly more satisfied than those receiving group counseling or the decision aid . This study has shown unique benefits with each type of intervention such that women and their partners preferred individual genetic counseling , while they learned best in group‐counseling sessions , and experienced the least decisional conflict regarding genetic testing with a decision aid Abstract Objective : To compare the effectiveness of touch screen system with information leaflet for providing women with information on prenatal tests . Design : R and omised controlled trial ; participants allocated to intervention group ( given access to touch screen and leaflet information ) or control group ( leaflet information only ) . Setting : Antenatal clinic in university teaching hospital . Subjects : 875 women booking antenatal care . Interventions : All participants received a leaflet providing information on prenatal tests . Women in the intervention arm also had access to touch screen information system in antenatal clinic . Main outcome measures : Women 's informed decision making on prenatal testing as measured by their uptake of and underst and ing of the purpose of specific tests ; their satisfaction with information provided ; and their levels of anxiety . Results : All women in the trial had a good baseline knowledge of prenatal tests . Women in the intervention group did not show any greater underst and ing of the purpose of the tests than control women . However , uptake of detailed anomaly scans was significantly higher in intervention group than the control group ( 94 % ( 351/375 ) v 87 % ( 310/358 ) , P=0.0014 ) . Levels of anxiety among nulliparous women in intervention group declined significantly over time ( P<0.001 ) . Conclusions : The touch screen seemed to convey no benefit over well prepared leaflets in improving underst and ing of prenatal tests among the pregnant women . It did , however , seem to reduce levels of anxiety and may be most effective for providing information to selected women who have a relevant adverse history or abnormal results from tests in their current pregnancy OBJECTIVES (1)To compare an interactive multimedia decision aid ( IMDA ) with a leaflet and a video to give information about prenatal screening for Down syndrome and ( 2 ) to determine the women 's acceptance of IMDA . METHODS Two hundred and one women were recruited from the prenatal clinic of a university teaching hospital and r and omised into the intervention group ( IMDA , video , and information leaflet ) or the control group ( video and information leaflet ) . RESULTS There were no significant differences in the initial decision for and the final uptake of the prenatal screening test between the control and intervention groups . The proportion of women who were undecided was less than 10 % in both groups . Of the women in the intervention group , 86.6 % and 78.9 % agreed that IMDA was user-friendly and acceptable , respectively . Significantly more women aged < 35 ( 88.1 % ) accepted IMDA than women aged > or = 35 ( 68.3 % ) ( P = 0.030 ) , but the logistic regression analysis did not confirm this finding after adjusting for other factors ( computer knowledge and usage of computer ) . CONCLUSION The use of IMDA did not affect the women 's overall uptake rate of the prenatal screening test for Down syndrome . More women less than 35 years accepted IMDA probably because they used computer more frequently and had more computer knowledge OBJECTIVE To investigate clinical and ultrasonographic predictors of outcome of  external cephalic version  at term . DESIGN Prospect i ve observational study . SETTING University obstetric unit . POPULATION All external cephalic versions performed over two years ( n = 243 ) . METHODS Nineteen different clinical and ultrasonographic variables were recorded before each procedure . The ability of each of the 19 variables to predict the success or failure of external cephalic version was assessed by univariate analysis . The study population was then divided into two subgroups of 129 and 114 patients by r and om allocation using computer generated numbers .  Logistic regression was performed in each subgroup to assess the relative importance and independence of the important variables . The derived regression models were then applied to the other subgroup of patients to assess accuracy and reproducibility . RESULTS The overall success rate of the procedure was 69.5 % . Both regression models identified the same three variables as independent predictors of failed versions : 1 . presenting part engaged ; 2 . difficult to palpate the fetal head , and 3 . a tense uterus on palpation . The two models correctly predicted 75.2 % and 84.2 % of outcomes in the other subgroup . If uterine tone , which was assessed after administration of tocolytic , was excluded from the analysis , the other two factors remained in the models , with the addition of nulliparity as a significant predictor of failed external cephalic version . The chance of success of external cephalic version in the original 24 
    Output:
    
Use of decision aids is associated with a number of positive effects including reduced anxiety , lower decisional conflict , improved knowledge , improved satisfaction and increased perception of having made an informed choice .
Conclusions Patient decision aids have the potential to improve obstetric care .