***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: We developed a computer-stored medical record system containing a limited set of the total clinical data base -- primarily diagnostic studies and treatments . This system responds to its own content according to physician-authored reminder rules . To determine the effect of the reminder messages generated by 1490 rules on physician behavior , we r and omly assigned practitioners in a general medicine clinic to study or control groups . The computer found indications for six different actions per patient in 12 467 patients during a 2-year study : 61 study group residents who received computer  reminders responded to 49 % of these indications ; 54 control group residents , to only 29 % ( p less than 0.0001 ) . Preventive care ( occult blood testing , mammographic screening , weight reduction diets , influenza and pneumococcal vaccines ) was affected . The intentions of the study group to use a given action for an indication predicted their response to the indications ( p less than 0.03 , r2 = 0.33 ) . The intentions of the control residents did not Abstract Objective To evaluate a training programme intended to improve the management of obesity , delivered to general practice teams . Design Cluster r and omised trial . Setting Northern and Yorkshire region of Engl and Participants 44 general practice s invited consecutively attending obese adults to participate ; 843 patients attended for collection of baseline data and were subsequently r and omised . Intervention 4.5 hour training programme promoting an obesity management model . Main outcome measures Difference in weight between patients in intervention and control groups at 12 months ( main outcome measure ) and at 3 months and 18 months ; change in practitioners ' knowledge and behaviour in obesity management consultations . Results Twelve months after training the patients in the intervention group were 1 ( 95 % confidence interval - 1.9 to 3.9 ) kg heavier than controls ( P = 0.5 ) . Some evidence indicated that practitioners ' knowledge had improved . Some aspects of the management model , including recording weight , target weight , and dietary targets , occurred more frequently in intervention practice s after the training , but in absolute terms levels of implementation were low . Conclusion A training package promoting a brief , prescriptive approach to the treatment of obesity through lifestyle modification , intended to be incorporated into routine clinical practice , did not ultimately affect the weight of this motivated and at risk cohort of patients BACKGROUND Healthcare costs attributable to obesity have previously involved estimations based on costs of diseases commonly considered as having obesity as an underlying factor . AIM To quantify the impact of obesity on total primary care drug prescribing . DESIGN OF STUDY Review of computer generated and h and written prescriptions to determine total prescribing volume for all drug classes . SETTING Twenty-three general practice surgeries in the UK . METHOD Stratified r and om selection of 1150 patients who were obese ( body mass index [ BMI ] > 30 kg/m(2 ) ) and 1150 age and sex-matched controls of normal weight ( BMI 18.5-<25 kg/m(2 ) ) . Retrospective review of medical records over an 18-month period . RESULTS A higher percentage of patients who were obese , compared with those of normal weight , were prescribed at least one drug in the following disease categories : cardiovascular ( 36 % versus 20 % ) , central nervous system ( 46 % versus 35 % ) , endocrine ( 26 % versus 18 % ) , and musculoskeletal and joint disease ( 30 % versus 22 % ) . All of these categories had a P-value of < 0.001 . Other categories , such as gastrointestinal ( 24 % versus 18 % ) , infections ( 42 % versus 35 % ) , skin ( 24 % versus 19 % ) had a P-value of < 0.01 , while respiratory diseases ( 18 % versus 21 % ) had a P-value of < 0.05 . Total prescribing volume was significantly higher for the group with obesity and was increased in the region of two- to fourfold in a wide range of prescribing categories : ulcer healing drugs , lipid regulators , beta-adrenoreceptor drugs , drugs affecting the rennin angiotensin system , calcium channel blockers , antibacterial drugs , sulphonylureas , biguanides , non-steroidal anti-inflammatories ( NSAIDs ) ( P<0.001 ) and fibrates , angiotensin II antagonists , and thyroid drugs ( P<0.05 ) . The main impact on prescribing volumes is from numbers of patients treated , although in some areas there is an effect from greater dosage or longer treatment in those who are obese including calcium channel blockers , antihistamines , hypnotics , drugs used in the treatment of nausea and vertigo , biguanides , and NSAIDs ( P<0.05 ) reflected in significantly increased defined daily dose prescribing . CONCLUSIONS This large study of contemporary practice indicates that obesity more than doubled prescribing in most drug categories Forty smokers and 47 overweight individuals were recruited for a home correspondence program for either smoking cessation or weight loss . Participants were assigned to one of four programs for changing their respective health behaviors : ( 1 ) a home correspondence program conducted entirely by mail , ( 2 ) the mail program with supplemental financial contigency contracts tied to completion of written homework , ( 3 ) the correspondence programs supplemented both by homework contracts and by regular calls to a telephone answering system , and ( 4 ) a st and ard behavioral group program which acted as a comparison condition . Results showed that all three correspondence approaches produced significant changes in health behaviors equal to the changes experienced by participants in the st and ard group program . The implication of these findings for development of low cost programs for disease prevention are discussed This paper explores the role of balancing covariates between treatment groups in the design of cluster r and omized trials . General expressions are obtained for two criteria to evaluate design s for parallel group studies with two treatments . The first is the variance of the estimated treatment effect and the second is the extent to which the estimated treatment effect is changed by adjusting for covariates . It is argued that the second of these is more important for cluster r and omized trials . Methods of obtaining balanced design s from covariates which are available at the start of a study are proposed . An imbalance measure is used to compare the extent to which design s balance important covariates between the arms of a trial . Several approaches to selecting a well balanced design are possible . A method that r and omly selects one member from the class of design s with acceptable bias will allow r and omization inference as well as model-based inference . The methods are illustrated with data from a trial of school-based sex education STUDY OBJECTIVE : To study the clinical and cost outcomes of providing nutritional counselling to patients with one or more of the following conditions : overweight , hypertension and type 2 diabetes . DESIGN : The study was design ed as a r and om controlled trial . Consecutive patients were screened opportunistically for one or more of the above conditions and r and omly allocated to one of two intervention groups ( doctor/dietitian or dietitian ) or a control group . Both intervention groups received six counselling sessions over 12 months from a dietitian . However , in the doctor/dietitian group it was the doctor and not the dietitian who invited the patient to join the study and the same doctor also review ed progress at two of the six counselling sessions . SETTING : The study was conducted in a university group general practice set in a lower socioeconomic outer suburb of Perth , Western Australia . PATIENTS : Of the 273 patients r and omly allocated to a study group , 198 were women . Age ranged from 25 to 65 years . Seventy eight per cent of patients resided in the lower two socioecnomic quartiles , 56 per cent described their occupation as home duties and 78 per cent were partnered . RESULTS : Both intervention groups reduced weight and blood pressure compared with the control group . Patients in the doctor/dietitian group were more likely to complete the 12 month programme than those in the dietitian group . Patients in the doctor/dietitian group lost an average of 6.7 kg at a cost of $ A9.76 per kilogram , while the dietitian group lost 5.6 kg at a cost of $ A7.30 per kilogram . CONCLUSION : General practitioners , in conjunction with a dietitian , can produce significant weight and blood pressure improvement by health promotion methods In a r and omized double-blind trial , 60 obese patients were assigned in groups of 12 to five therapists . The patients for each therapist were then r and omly assigned in groups of four to placebo or one of two preparations of mazindol . Ninety-three percent of the patients completed the nine weeks of treatment . Weight loss averaged 1.1 lb per week and there was no advantage to pharmacological agents over placebo . However , there were significant differences between therapists . Weight loss by the patients assigned to physicians was no better than for those assigned to nonphysician personnel , but there were significant differences between individual nonphysician personnel . These findings support the concept that nonphysician personnel may be effective in treating many obese patients . In addition , we could not find a significant effect of either form of mazindol when compared to placebo Aims /hypothesis . The aim of the Diabetes Prevention Study is to assess the efficacy of an intensive diet-exercise programme in preventing or delaying  Type II ( non-insulin-dependent ) diabetes mellitus in subjects with impaired glucose tolerance , to evaluate the effects of the intervention programme on cardiovascular risk factors and to assess the determinants for the progression to diabetes in persons with impaired glucose tolerance . Methods . A total of 523 overweight subjects with impaired glucose tolerance ascertained by two oral glucose tolerance tests were r and omised to either a control or intervention group . The control subjects received general information at the start of the trial about the lifestyle changes necessary to prevent diabetes and about annual follow-up visits . The intervention subjects had seven sessions with a nutritionist during the first year and a visit every 3 months thereafter aim ed at reducing weight , the intake of saturated fat and increasing the intake of dietary fibre . Intervention subjects were also guided individually to increase their physical activity .  Results . During the first year , weight loss in the first 212 study subjects was 4.7 ± 5.5 vs 0.9 ± 4.1 kg in the intervention and control group , respectively ( p < 0.001 ) . The plasma glucose concentrations ( fasting : 5.9 ± 0.7 vs 6.4 ± 0.8 mmol/l , p < 0.001 ; and 2-h 7.8 ± 1.8 vs 8.5 ± 2.3 mmol/l , p < 0.05 ) were significantly lower in the intervention group after the first year of intervention . Favourable changes were also found in blood pressure , serum lipids and anthropometric indices in the intervention group . Conclusion /interpretation . The interim results show the efficacy and feasibility of the lifestyle intervention programme . [ Diabetologia ( 1999 ) 42 : 793–801 OBJECTIVE : To describe methods , recruitment success , and 1-y results of a study evaluating the effectiveness of phone- and mail-based weight-loss interventions in a managed care setting . DESIGN : R and omized clinical trial with three groups , that is , usual care , mail intervention , and phone intervention . SUBJECTS : In total , 1801 overweight members of a managed-care organization ( MCO ) . MEASUREMENTS : Height , weight , medical status , and weight-loss history were measured at baseline . Participation in intervention activities was monitored for 12 months in the two active treatment groups . Self-reported weight was obtained at 6 and 12 months . RESULTS : More individuals assigned to mail treatment started it ( 88 % ) than did those assigned to phone treatment ( 69 % ) . However , program completion rates were higher in the phone ( 36 % ) than mail ( 7 % ) intervention . The mean weight losses were 1.93 , 2.38 , and 1.47 kg at 6 months in the mail , phone , and usual care groups , respectively . The differences between the phone and usual care groups were statistically significant . The mean weight losses at 12 months did not differ by treatment group ( 2.28 kg mail , 2.29 kg phone , and 1.92 kg usual care ) . Greater weight loss was seen in men , older participants , and those with no prior experience in a weight-loss program . Heavier participants and those who reported current treatment for depression lost less weight . CONCLUSION : Although mail- and phone-based weight-loss programs can be delivered to large numbers of people in an MCO setting , additional work is needed to enhance their clinical efficacy as well as to assess their costs This experiment evaluated the efficacy of television delivery of a  behavioral weight reduction program .  Seventy-one overweight adults were r and omly assigned to a live-contact weight loss group that was videotaped for viewing by other groups , a live-contact group that was not videotaped , a television-delivered group that observed the videotaped weight loss sessions , or a waiting-list control group . Participants in all 3 treatment groups lost significantly more weight during the 8-week treatment program than those in the waiting-list control group . There was no significant weight loss differences among the 3 treatment groups during the program . These weight changes were maintained at 3-month follow-up . At 15-month follow-up , the television-delivered group and the live-contact group maintained their weight losses , whereas the videotaped group did not . Cost-effectiveness analyses indicated that the television-delivered group received the most cost-effective treatment The Consoli date d St and ards of Reporting Trials ( CONSORT ) statement was developed to improve the reporting of r and omised controlled trials . It was initially published in 1996 and focused on the reporting of parallel group r and omised controlled trials . The statement was revised in  
    Output:
    
One trial found no significant difference between st and ard care and either mail or phone interventions in reducing patients ' weight .