***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 : Poor cancer survival rates in the United Kingdom are often blamed on delayed medical care . A local audit of endometrial cancer revealed a variety of preventable delays . We surveyed practice in the South West of Engl and to see if this was an isolated or widespread problem . Methods : All 15 hospitals in the South West of Engl and collected information prospect ively from all women with endometrial cancer over 3 months in the spring of 2009 . Results : There were delays in all stages of the uterine cancer pathway . Excluding extraneous cases , 52 % of women waited more than a month and 12 % waited more than 6 months to see their GP from the onset of symptoms . Almost half the cases said they were unaware that abnormal bleeding was a symptom of cancer . Only a quarter of women had treatment within 31 days from the outpatient visit to first definitive treatment and 18 % waited more than the target of 62 days for their treatment . Conclusions : Significant treatment delays occur because women do not report bleeding . If this is replicated throughout Britain , approximately 1000 women per year will delay presentation for at least 3 months and 600 will wait for more than 6 months OBJECTIVE To describe why , when and to whom general practitioners refer women with symptoms possibly attributable to cervical , endometrial or ovarian cancers , and to identify patient and GP factors that predict referral to either a gynaecologist or a gynaecological oncologist . DESIGN AND SETTING A national survey of GPs between 1 April and 31 August 2009 using a r and omised incomplete block design based on case vignettes , and using a self-completed postal or online question naire . PARTICIPANTS A sample of GPs , stratified by location and r and omly selected from a data base of GPs maintained by the Australasian Medical Publishing Company . MAIN OUTCOME MEASURES Proportion of vignettes that were deemed to reflect a high probability of cancer being referred ; and the patient and clinician factors that were the strongest predictors of referral . RESULTS Of the 3082 GPs who were selected for participation , 1402 responded , giving a response rate of 45.5 % . Overall , for vignettes identified as describing women with a high probability of cancer , 75 % were referred by metropolitan GPs and 73 % by rural practitioners . Metropolitan GPs were significantly more likely to refer women in scenarios indicative of endometrial cancer than rural GPs . For all three cancers , GPs were significantly more likely to refer a patient to a gynaecologist ( between 70.8 % and 95.4 % ) than a gynaecological oncologist . Metropolitan GPs had significantly greater access to both private and public gynaecological oncologists than their rural counterparts . Referral rates were higher for ovarian and cervical cancer ( 83 % and 80 % , respectively ) and lower for endometrial cancer ( 68 % ) . For all three cancers , patient factors were stronger predictors of referral than the demographic factors of participating GPs . CONCLUSION There appears to be significant variation in referral practice s among GPs and this variation is greater for endometrial cancer , for which there are currently no evidence -based clinical practice guidelines in Australia . There is a need for further research into underst and ing the basis of these differences , including a review of the existing guidelines for ovarian and cervical cancer and the development of guidelines for endometrial cancer Background Disadvantaged population s face many barriers to cancer care , including limited support in navigating through the complexities of the healthcare system . Family members play an integral role in caring for patients and provide valuable care coordination ; however , the effect of family navigators on adherence to cancer screening has not previously been evaluated . Training and evaluating trusted family members and other support persons may improve cancer outcomes for vulnerable patients . Methods Guided by principles of community based participatory research ( CBPR ) , “ Evaluating Coaches of Older Adults for Cancer Care and Healthy Behaviors ( COACH ) ” is a community-based r and omized controlled trial to assess the effectiveness of a trained participant- design ated coach ( support person or care giver ) in navigating cancer-screening for older African American adults , 50–74 years old . Participants are r and omly assigned as dyads ( participant + coach pair ) to receiving either printed educational material s only ( PEM — control group ) or educational material s plus coach training ( COACH — intervention group ) . We defined a coach as family member , friend , or other lay support person design ated by the older adult . The coach training is design ed as a one-time , 35- to 40-minute training consisting of : 1 ) a didactic session that covers the role of the coach , basic facts about colorectal , breast and cervical cancers ( including risk factors , signs and symptoms and screening modalities ) , engaging the healthcare provider in cancer screening , insurance coverage for screening , and related healthcare issues , 2 ) three video skits addressing misconceptions about and planning for cancer screening , and 3 ) an interactive role-play session with the trainer to reinforce and practice strategies for encouraging the participant to get screened . The primary study outcome is the difference in the proportion of participants completing at least one of the recommended screenings ( for breast , cervix or colorectal cancer ) between the control and intervention groups . Discussion Building on trusted patient contacts to encourage cancer screening , COACH is a highly sustainable intervention in a high-risk population . It has the potential to minimize the effect of mistrust of the medical establishment on screening behaviors by mobilizing participants ’ existing support networks . If effective , the intervention could have a high impact on health care disparities research across multiple diseases . Trial registration Clinical Trials.gov ( NCT01613430 ) . Registered June 5 , Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies Background The grading of recommendation , assessment , development and evaluation ( GRADE ) approach is widely implemented in health technology assessment and guideline development organisations throughout the world . GRADE provides a transparent approach to reaching judgements about the quality of evidence on the effects of a health care intervention , but is complex and therefore challenging to apply in a consistent manner . Methods We developed a checklist to guide the research er to extract the data required to make a GRADE assessment . We applied the checklist to 29 meta-analyses of r and omised controlled trials on the effectiveness of health care interventions . Two review ers used the checklist for each paper and used these data to rate the quality of evidence for a particular outcome . Results For most ( 70 % ) checklist items , there was good agreement between review ers . The main problems were for items relating to indirectness where considerable judgement is required . Conclusions There was consistent agreement between review ers on most items in the checklist . The use of this checklist may be an aid to improving the consistency and reproducibility of GRADE assessment s , particularly for inexperienced users or in rapid review s without the re sources to conduct assessment s by two research ers independently A postmenopausal bleeding ( PMB ) clinic was set up to provide quicker access for consultation ,  transvaginal ultrasound ( TVS ) and pipelle endometrial sampling  in one visit . The aim of the study was to evaluate the impact of a one-stop PMB clinic on reaching a diagnosis and initiating treatment . One hundred and seven women have been referred to PMB clinic since the service started . We analysed the prospect i ve findings of 80 patients who met the criteria of direct GP referral to PMB clinic . The mean time from GP referral to consultation at PMB clinic was 14.8 days ( range : 2 - 24 days ) ; 97.5 % of women had TVS and abnormal findings were reported in 67.5 % . Pipelle endometrial sampling was performed in 31 patients and a sample obtained successfully in 21 women . Ten women were referred directly for diagnostic hysteroscopy and another 10 had hysteroscopy after a failed pipelle sampling . Twenty-four women ( 30 % ) were discharged back to their general practitioners ( GPs ) after reassurance by consultation and normal TVS . Seventy women ( 87.5 % ) considered a single PMB clinic visit was satisfactory . This study demonstrates the effective role of the one-stop PMB clinic to provide quick reassurance , arrive at a diagnosis and initiate plan of management during a single outpatient visit The value of any new therapeutic strategy or treatment is determined by the magnitude of its clinical benefit balanced against its cost . Evidence for clinical benefit from new treatment options is derived from clinical research , in particular phase III r and omised trials , which generate unbiased data regarding the efficacy , benefit and safety of new therapeutic approaches . To date , there is no st and ard tool for grading the magnitude of clinical benefit of cancer therapies , which may range from trivial ( median progression-free survival advantage of only a few weeks ) to substantial ( improved long-term survival ) . Indeed , in the absence of a st and ardised approach for grading the magnitude of clinical benefit , conclusions and recommendations derived from studies are often hotly disputed and very modest incremental advances have often been presented , discussed and promoted as major advances or ' breakthroughs ' . Recognising the importance of presenting clear and unbiased statements regarding the magnitude of the clinical benefit from new therapeutic approaches derived from high- quality clinical trials , the European Society for Medical Oncology ( ESMO ) has developed a vali date d and reproducible tool to assess the magnitude of clinical benefit for cancer medicines , the ESMO Magnitude of Clinical Benefit Scale ( ESMO-MCBS ) . This tool uses a rational , structured and consistent approach to derive a relative ranking of the magnitude of clinical ly meaningful benefit that can be expected from a new anti-cancer treatment . The ESMO-MCBS is an important first step to the critical public policy issue of value in cancer care , helping to frame the appropriate use of limited public and personal re sources to deliver cost-effective and affordable cancer care . The ESMO-MCBS will be a dynamic tool and its criteria will be revised on a regular basis The cluster r and omized trial  with a concurrent economic evaluation is considered the gold st and ard evaluative design for the conduct of implementation research evaluating different strategies to promote the transfer of research findings into clinical practice . This has implication s for the planning of such studies , as information is needed on the effects of clustering on both effectiveness and efficiency outcomes . This paper describes the design considerations specific to implementation research studies , focusing particularly on the estimation of sample size requirements and on the need for reliable information on intracluster correlation coefficients for both effectiveness and efficiency outcomes OBJECTIVE To evaluate endometrial cancer ( EC ) risk assessment and early detection strategies in high-risk population s , we design ed a large , prospect i ve cohort study of women undergoing endometrial evaluation to assess risk factors and collect novel biospecimens for future testing of emerging EC biomarkers . Here we report on the baseline findings of this study . METHODS Women aged ≥45 years were enrolled at the Mayo Clinic from February 2013-June 2018 . Risk factors included age , body mass index ( BMI ) , smoking , oral contraceptive and hormone therapy use , and parity . We collected vaginal tampons , endometrial biopsies , and Tao brush sample s. We estimated mutually-adjusted odds ratios ( OR ) and 95 % confidence intervals ( CI ) using multinomial logistic regression ; outcomes included EC , atypical hyperplasia , hyperplasia without atypia , disordered proliferative endometrium , and polyps , versus normal endometrium . RESULTS Subjects included 1205 women with a mean age of 55 years ; 55 % were postmenopausal , and 90 % had abnormal uterine bleeding .  The prevalence of EC was 4.1 % ( n = 49 ) , predominantly diagnosed in postmenopausal women ( 85.7 % ) .  Tampons and Tao brushings  were obtained from 99 % and 68 % of women , respectively . Age ( OR 1.14 , 95 % CI 1.1 - 1.2 ) and BMI ( OR 1.39 , 95 % CI 1.1 - 1.7 ) were positively associated with EC ; atypical hyperplasia ( OR 1.07 , 95 % CI 1.0 - 1.1 ; OR 2.00 , 95 % CI 1.5 - 2.6 , respectively ) , and polyps ( OR 1.06 , 95 % CI 1.0 - 1.1 ; OR 1.17 , 95 % CI 1.0 - 1.3 , respectively ) ; hormone therapy use and smoking were inversely associated with EC ( OR 0.42 , 95 % , 0.2 - 0.9 ; OR 0.43 , 95 % CI , 0.2 - 0.9 , respectively ) . Parity and past oral contraception use were not associated with EC . CONCLUSIONS Well-established EC risk factors may have less discriminatory accuracy in high-risk population s. Future analyses will integrate risk factor assessment with biomarker testing for EC detection 
    Output:
    
There is currently an absence of evidence to indicate the effectiveness of health education interventions involving healthcare providers or individuals or both to promote early presentation and referral for women with  endometrial cancer  symptoms .