***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: OBJECTIVES This study was conducted to assess the impact of an interactive seminar based on self-regulation theory on 1 ) the treatment practice s and communications and education behavior of physicians , 2 ) the health status and medical care utilization of their pediatric patients with asthma , and 3 ) the satisfaction with care of the subjects ' parents . METHODS A total of 74 general practice pediatricians were assigned to either a program or a control group in a r and omized controlled study . Data were collected from physicians at baseline , and 69 ( 93 % ) provided follow-up data 5 months after the program . Data were also collected from 637 of their patients at baseline , and in a 22-month window after the intervention , 472 ( 74 % ) of this number provided follow-up data . RESULTS After the seminar , physicians in the program group were more likely than were control group physicians to address patients ' fears about medicines , review written instructions , provide a sequence of educational messages , write down how to adjust the medicines at home when symptoms change , and report that they spent less time with their patients . Parents of the children treated by program physicians were significantly more likely than were  control group parents to report that the physician had been reassuring , described as a goal that the child be fully active , and gave information to relieve specific worries . After a visit with the physician , these parents were also more likely to report that they knew how to make management decisions at home . After the intervention compared to controls , patients of physicians in the program group were more likely to have received a prescription for inhaled antiinflammatory medicine and to have been asked by the physician to demonstrate how to use a metered-dose inhaler . After the intervention , children seen by program physicians made significantly fewer nonemergency office visits and visits for follow-up of an episode of symptoms ; however , there were no differences in emergency department visits and hospitalizations . Among children who were placed on inhaled corticosteroids during this study , however , children treated by physicians who had received education had significantly fewer symptoms and fewer follow-up office visits , nonemergency physician office visits , emergency department visits , and hospitalizations . CONCLUSIONS The interactive seminar based on theories of self-regulation led to patient-physician encounters that were of shorter duration , had significant impact on the prescribing and communications behavior of physicians , led to more favorable patient responses to physicians ' actions , and led to reductions in health care utilization BACKGROUND It is a common view that psychodynamic treatment does not help much to ameliorate the symptoms of panic and agoraphobia . The effects of an insight-oriented treatment on central anxiety symptoms are the subject of the present controlled study . METHODS Forty patients with severe panic and agoraphobia were admitted to an inpatient anxiety treatment program . Most of the patients had been treated by pharmacological means unsuccessfully . The patients were r and omly assigned to pure client-centered therapy or to additional behavioral exposure treatment . Client-centered and behavioral agoraphobia manuals were used . The patients were examined on admission , at discharge and at 3 , 6 , and 12 months follow-up for panic ( Structured Clinical Interview for DSM III-R -- SCID ) , anxiety ( Hamilton Anxiety Scale ) , agoraphobia ( SCID , Fear Survey Schedule ) , and depressive ( Hamilton Depression Scale ) symptoms . RESULTS Both client-centered treatment and a combination with exposure treatment reduced panic , avoidance and depressive symptoms significantly . For a short period the combined treatment was superior in patients ' coping actively with anxiety and improving agoraphobic symptoms . However , at 1-year follow-up there was no further difference in the reduction of anxiety and depressive symptoms . CONCLUSIONS The results are discussed with regard to the combination of these forms of therapy and to widespread skepticism about the efficacy of insight-oriented treatment BACKGROUND Older persons who re hospitalized for acute illnesses often lose their independence and are discharged to institutions for long-term care . METHODS We studied 651 patients 70 years of age or older who were admitted for general medical care at a teaching hospital ; these patients were r and omly assigned to receive usual care or to be cared for in a special unit design ed to help older persons maintain or achieve independence in self-care activities . The key elements of this program were a specially prepared environment ( with , for example , uncluttered hallways , large clocks and calendars , and h and rails ) ; patient-centered care emphasizing independence , including specific protocol s for prevention of disability and for rehabilitation ; discharge planning with the goal of returning the patient to his or her home ; and intensive review of medical care to minimize the adverse effects of procedures and medications . The main outcome we measured ws the change from admission to discharge in the number of five basic activities of daily living ( bathing , getting dressed , using the toilet , moving from a bed to a chair , and eating ) that the patient could perform independently . RESULTS Twenty-four patients in each group died in the hospital . At the time of discharge , 65 ( 21 percent ) of the 303 surviving patients in the intervention group were classified as much better in terms of their ability to perform basic activities of daily living , 39 ( 13 percent ) as better , 151 ( 50 percent ) as unchanged , 22 ( 7 percent ) as worse , and 26 ( 9 percent ) as much worse . In the usual care group , 40 ( 13 percent ) of the 300 surviving patients were classified as much better , 33 ( 11 percent ) as better , 163 ( 54 percent ) as unchanged , 39 ( 13 percent ) as worse , and 25 ( 8 percent ) as much worse ( P = 0.009 ) . The difference between the groups remained significant ( P = 0.04 ) in a multivariable model in which we controlled for potentially confounding base-line characteristics of the patients . Lengths of stay and hospital charges were similar in the two groups . Fewer patients assigned to the intervention group were discharged to long-term care institutions ( 43 patients [ 14 percent ] , as compared with 67 patients [ 22 percent ] in the usual-care group ; P = 0.01 ) . Among the 493 patients discharged to private homes , similar proportions ( about 10 percent ) in the two groups were admitted to long-term care institutions during the three months after discharge . CONCLUSIONS Specific changes in the provision of acute hospital care can improve the ability of a heterogeneous group of acutely ill older patients to perform basic activities of daily living at the time of discharge from the hospital and can reduce the frequency of discharge to institutions for long-term care PURPOSE . To use a controlled , r and omized design to assess the effect on patient satisfaction of an  intensive psychosocial training program for residents . METHOD . Twenty-six first-year residents , in two internal medicine and family practice community-based programs affiliated with the Michigan State University College of Human Medicine , were r and omly assigned during 1991 and 1992 to a control group or a one-month intensive training program . Experiential teaching focused on many psychosocial skills required in primary care . A 29-item question naire administered before and after the residents ' training evaluated their patients ' satisfaction regarding patient disclosure , physician empathy , confidence in physician , general satisfaction , and comparison of the physician with other physicians . Analyses of covariance with groups and gender as factors and pre-training patient satisfaction scores as the covariate evaluated the effect of the training . RESULTS . The patients of the trained residents expressed more confidence in their physicians ( p = .01 ) and more general satisfaction ( p = .02 ) than did the patients of controls . The effect of training on patient satisfaction with patient disclosure ( p < .01 ) and physician empathy ( p < .05 ) was greater for female than for male residents . CONCLUSION . The intensive psychosocial training program for residents improved their patients ' satisfaction Thirty six young doctors who as medical students had been r and omly allocated to either video feedback training or conventional teaching in interviewing skills during a psychiatry clerkship were reassessed five years later . Each doctor interviewed one patient with a psychiatric illness and two with a physical illness . Each interview was rated independently . Both groups had improved since the fourth year clerkship , but those given feedback training had maintained their superiority in the skills associated with accurate diagnosis . This superiority was as evident in their interviews with physically ill patients as it was with psychiatric patients . Both groups , however , still used " closed " questions and were more reluctant to cover psychosocial problems in physically ill patients . Those trained conventionally were clinical ly inadequate in both these aspects and in clarifying their patients ' statements . Given these lasting benefits , all medical students should have feedback training in interviewing skills BACKGROUND Medical practitioners have considerable untapped potential to assist patients in stopping smoking . However , marked deficits have been found in the amount and type of training medical practitioners receive in smoking cessation counseling with little attention paid to determination of effective training methods . METHOD A r and omized controlled trial was conducted to examine the relative effectiveness of four different educational programs in teaching smoking cessation skills to 5th-year medical students in an Australian medical school . The four programs comprised : ( a ) a traditional didactic lecture mode ( control group ) , ( b ) audio feedback through the use of audiotaped role plays , ( c ) role plays with peer feedback , and ( d ) video feedback . Students ' smoking cessation intervention skills were assessed prior to training and at the end of term via videotaped interviews with simulated patients . RESULTS Senior medical students demonstrated significantly improved skills in smoking intervention when exposed to any of the educational approaches other than traditional didactic teaching . No overall differences in smoking intervention skills were found between the three experimental training methods . CONCLUSIONS Specific training in smoking cessation techniques is necessary to increase the intervention skills of medical students . Traditional teaching methods are ineffective in developing smoking cessation intervention skills . Enhanced teaching , of an appropriate nature , at undergraduate and postgraduate levels is needed In a competitive health care environment , clinicians and health plans are eager to achieve the highest quality of care and the highest levels of patient satisfaction . Studies consistently show that effective communication between clinicians and patients is a critical determinant of patient satisfaction ( 1 - 7 ) . To improve patient satisfaction , many organizations provide communication skills training programs for clinicians  . These programs usually include 4 to 8 hours of instruction and are held during regular office hours ( 8 - 12 ) . Because clinicians may need to be relieved from clinical responsibilities to attend , such programs can be expensive for both the clinicians and their organizations . Despite the substantial time and money invested in these programs , little rigorous research has been done to test their actual effect on patient satisfaction ( 11 , 13 ) . Some studies have measured clinicians ' self-ratings of their communication skills or have included an observation of a small number of visits ( 8 , 12 , 14 - 16 ) . Studies of oncologists have shown improvement in such targeted communication skills as breaking bad news ( 17 , 18 ) , but two recent r and omized trials that involved primary care physicians had conflicting results ( 10 , 19 ) . No r and omized trial has tested the effectiveness of a communication skills program delivered to clinicians of diverse specialties , and no study has directly assessed a program 's actual effect on patient satisfaction ( an outcome of great interest to health care users and sponsors ) . As communication programs proliferate , it is essential to critically evaluate whether they are a worthwhile investment of time and re sources for clinicians and their organizations . We performed a r and omized , controlled trial of a 10-hour communication skills program in a sample of primary care and specialty clinicians . We tested the effect of the program on patients ' satisfaction with providers ' communication during office visits.\E Methods Setting and Intervention The study setting was Kaiser Permanente Northwest Division , a 50-year-old , not-for-profit group-model health maintenance organization ( HMO ) with approximately 420 000 members located in and around Portl and , Oregon . The continuing medical education ( CME ) program we evaluated , titled Thriving in a Busy Practice : Physician-Patient Communication , was developed during numerous sessions with more than 1500 clinicians . Several Kaiser Permanente divisions participated in the program 's development , and the program was popular among clinicians . The program consisted of an initial 4-hour group workshop , 2 hours of subsequent homework , and a 4-hour follow-up workshop . The first workshop focused on skills for building effective relationships with patients , including listening actively ; responding to patients ' feelings ; and communicating concern , underst and ing , and respect . The second workshop focused on skills for successful negotiation , particularly in situations of disagreement ( for example , when a patient requests narcotics for chronic pain and the clinician does not think a prescription is appropriate ) . During a 1-month interval between the two workshops , the clinicians were asked to audiotape a minimum of two of their office visits and listen to the recordings . In addition , an instructor called participants during the interval to inquire about the skills they were trying , to ask whether they had questions , and to encourage them to complete the audiotaping . Both workshops were given by two physicians who were experienced teachers and experts in clinician-patient communication . The program was design ed to incorporate educational elements that had effectively changed clinician performance in other CME programs . The workshops included brief didactic components that were related to clinical needs and role-playing that allowed clinicians to practice communication skills while focusing on situations that they found challenging and relevant ( 20 , 21 ) . Instructors taught interactively , encouraging dialogue with and among participants . Recruitment and R and omization All of the approximately 1000 clinicians who belonged to or were employed by the Permanente Medical Group of the Northwest were eligible to participate . To maximize the external validity of the study , the HMO 's CME office advertised the program and managed the initial recruitment of clinicians by using its regular methods and channels . In addition , clinician leaders encouraged enrollment by direct communication with potential participants and by e-mail . The recruitment messages explained the r and omized trial and offered clinicians equal chances to participate immediately or to participate in a later session of the program . The clinicians who were r and omly assigned to the later session provided our control group . The Figure summarizes the flow of recruit 
    Output:
    
There is fairly strong evidence to suggest that some interventions to promote patient-centred care in clinical consultations may lead to significant increases in the patient centredness of consultation processes .
There is also some evidence that training health care providers  in patient-centred approaches may impact positively on patient satisfaction with care .
REVIEW ER 'S CONCLUSIONS Interventions to promote patient-centred care within clinical consultations may significantly increase the patient centredness of care .
However , there is limited and mixed evidence on the effects of such interventions on patient health care behaviours or health status ; or on whether these interventions might be applicable to providers other than physicians .