human
***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: OBJECTIVE To determine the effectiveness of providing written information in enhancing patient underst and ing and retention . DESIGN A multicentre prospect i ve r and omized study was conducted in university-affiliated ambulatory surgical centres . One hundred consecutive patients seen for rhinoplasty consultation were included . Patients were r and omly assigned to ( 1 ) those receiving traditional oral dialogue of the surgical risks or ( 2 ) those receiving an oral discussion and a written pamphlet outlining the risks of the procedure . Fourteen to 18 days after the consultation , each patient was contacted for an assessment of risk recall . RESULTS Overall risk recall was higher in the group that received written information ( 2.3 vs 1.3 of 5 risks ; p < .008 ) . As well , in the group that received a pamphlet , patients with university and postgraduate levels of education had a better rate of recall ( p < .05 ) . Female patients in both groups reported higher risk recall ( p < .01 ) . CONCLUSION Patient risk recall of rhinoplasty is improved with the addition of written information during the informed consent process . As the process of informed consent plays a very decisive role in facial plastic surgery , enhanced postoperative satisfaction may result from the use of supplemental educational material A series of UK and European audits have revealed that a high proportion of patients remain dissatisfied with the information they received following a diagnosis of cancer . Additional educational aids are often required to facilitate the consent process , and our previous work showed a high level of acceptability for video-directed information for this purpose . In this study a multidisciplinary team of health professionals worked with patients , a documentary film company and experienced television personalities to produce an information film . The aim of this study was to assess the benefits of receiving a cassette to take home following the first consultation and this was evaluated in a r and omised multicentre controlled study among 220 patients receiving chemotherapy or radiotherapy over a 6-month period . There was a significant correlation between satisfaction and reduced treatment-related anxiety overall . In the video group , the mean Hospital Anxiety and Depression ( HAD ) anxiety score was significantly lower during treatment compared with the non-video group ( 4.6+/-3.7 ( range : 0 - 18 ) versus 7.4+/-5.2 ( range : 0 - 20 ) , Chi square test P=0.001 ) . Likewise , the mean HAD depression scores were also significantly lower in the patients prepared for the side-effects of treatment with the video ( 2.9+/-2.9 ( range : 0 - 13 ) versus 5.3+/-4.7 ( range : 0 - 21 ) Chi square test P=0.001 ) . 81 % felt the video was helpful , only 5 % of patients felt this extra information was worrying . Well design ed video cassettes should be regarded as a useful additional information strategy , within routine oncology practice Background : Deciding what risks to disclose before a procedure is often challenging for clinicians . Consecutive patients undergoing elective fibreoptic bronchoscopy  were r and omised to receive simple or more detailed written information about the risks of the procedure and the effects on anxiety and satisfaction levels were compared . Methods : A 100 mm anxiety visual analogue scale ( VAS ) and a modified Amsterdam preoperative anxiety ( scored 4–20 ) scale ( APAIS ) were completed before and after reading the design ated information leaflet . Following bronchoscopy , subjects completed a satisfaction question naire . Results : Of 142 consecutive patients , 122 ( 86 % ) ( mean age 57.8 years , 53 % male ) completed the study . Baseline demographic , clinical and anxiety measures were similar in the two groups . Those who received more detailed risk information had significantly greater increase in anxiety levels than those who received simple information on both the VAS ( mean 14.0 ( 95 % CI 10.1 to 17.9 ) vs 2.5 ( 95 % CI −1.4 to 6.4 ) , p<0.001 ) and the APAIS ( 1.73 ( 95 % CI 1.19 to 2.26 ) vs 0.57 ( 95 % CI 0.05 to 1.10 ) , p<0.001 ) . Almost twice as many of those receiving detailed risk information reported that they felt they had received too much information about complications or that the information they had received about bronchoscopy had been worrying . Conclusions : Provision of more detailed risk information before bronchoscopy may come at the cost of a small but significant increase in anxiety OBJECTIVE To examine the effects of an educational intervention , in the form of printed material , on  patient knowledge and recall of possible risks from  parotidectomy or thyroidectomy .  DESIGN Prospect i ve , r and omized , controlled study conducted during a 9-month period . SETTING Head and neck surgery clinic of an academic tertiary care hospital . PATIENTS One hundred twenty-five consecutive patients older than 16 years who were undergoing thyroidectomy or parotidectomy at the head and neck surgery clinic were recruited . Four patients were excluded from analysis because their follow-up interview was not within the required limits . INTERVENTION At the preoperative visit during the routine consent process , both groups received a verbally delivered checklist of risks specific for the surgery to be performed . The intervention group was also given a pamphlet with written information accompanied by illustrations . MAIN OUTCOME MEASURES The effectiveness of the educational intervention  was determined by comparing the average rate of risk recall between the intervention and control groups . The effects of age , sex , level of education , and time between the consent and recall interviews on recall rate were also assessed . RESULTS The overall risk recall rate for both procedures was 39.1 % . The recall rate of the intervention group was 50.3 % compared with 29.5 % for the control group ( P<.001 ) . CONCLUSIONS The intervention consistently improved risk recall for all patients regardless of age , sex , and level of education . Patients ' ability to recall potential risks was significantly increased by an educational intervention ; all patients would benefit from this intervention 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 Background Before any invasive procedure , physicians have a legal obligation to inform patients . Traditionally , this involves a discussion with a physician , supplemented by written leaflet information directed at the specific procedure . Objective Comparison of the use and effectiveness of computer-based visualization opposed to st and ardized conversation for providing patients with information of forthcoming procedures ( coronary catheters or endoscopy procedures ) . Methods Prospect i ve , r and omized trial with 56 participants allocated in two different groups : Visualization Group ( st and ardized information supported by a tool for displaying two-dimensional pictures to explain medical facts as well as informative leaflet ) or Control Group ( st and ardized information and informative leaflet only ) . Detailed information was given about the indication , the probable complications and the details of the forthcoming procedures ( coronary catheters or endoscopy procedures ) . All participants had to reach a Karnofsky Score of 70 points and be able to underst and German or English . Main outcome measures were patient 's satisfaction with physician-patient conversation , patient 's acquired knowledge and duration of the intervention as described above . Results Patients of the Visualization Group were more satisfied with the conversation and had higher knowledge scores after the conversation . A Mann-Whitney-U-Test between the two groups showed that these differences in satisfaction ( P<0.001 ) and knowledge ( P=<0.006 ) were statistically significant . Length of time needed for the conversation was slightly higher in the Visualization Group , but this difference was not statistically significant ( 25 versus 23 min ; P= 0.441 ) . No differences could be found due to differing age or educational level in the results of the Visualization and the Control Group . Conclusions Using computerized visualization increased the satisfaction and knowledge of the patients . The presentation of the visualized information in the Visualization Group did not dem and significantly more time than the st and ard conversation in the Control Group Background . There is limited evidence about how to ensure that patients are helped to make informed medical care decisions . Objective . To test a decision support intervention for uterine fibroid treatments . Design and Setting . Practical clinical trial to test informed choice assistance in 4 r and omly assigned gynecology clinics compared to 5 others providing a pamphlet . Patients . Three hundred women facing a treatment decision for fibroids over a 13-month period . Intervention . Mailed DVD and brochure about fibroid treatments plus the Ottawa decision guide and an offer of counseling soon after an index visit . Measurements . Mailed survey 6 to 8 weeks later asking about knowledge , preferences , and satisfaction with decision support . Results . In total , 244 surveys were completed for an adjusted response rate of 85.4 % . On a 5-point scale , intervention subjects reported more treatment options being mentioned ( 3.0 v. 2.4 ) , had a higher knowledge score ( 3.3 v. 2.8 ) , and were more likely to report being adequately informed ( 4.4 v. 4.0 ) , and their decision was both more satisfactory ( 4.3 v. 4.0 ) and more consistent with their personal values ( 4.5 v. 4.2 ) . Neither knowledge nor use of the intervention was associated with greater concordance between preferences and decisions . Limitations . Implementation of intervention may not have been well timed to the decision for some patients , limiting their use of the material s and counseling . Conclusion . It is difficult to integrate structured decision support consistently into practice . Decision support for benign uterine conditions showed effects on knowledge and satisfaction but not on concordance In a recent article , Leigh ( J Bone Joint Surg [ Br ] 88-B:16–18 , 2006 ) notes that patients do not lay down memory when being counselled as to the risks involved in prospect i ve surgery . In our article we focused on the patients ’ recall of risk factors involved in elective spinal surgery . We assessed the influence of written information provided to the patients during the consenting process on their recall of operative risks . The study was a prospect i ve r and omised study . All patients having elective spinal surgery were included in our study from February 2006 to November 2006 as a consecutive series . Patients were r and omised into two groups , one of which received routine consent with verbal explanations ( group 1 ) , the other received the same information supplemented by a written sheet explaining the risks of the surgery ( group 2 ) . Two weeks later we assessed patients ’ recall of the risk involved in the surgery with a question naire and compared both groups with a Student t-test .  Fifty-three patients ( twenty in group 1 and twenty three in group 2 ) were involved . We noted a significant difference between the two groups in terms of mean number of risks recalled and number of patients recalling each risk ( p < 0.001 and p < 0.005 , respectively ) . The addition of a written sheet given to patients during the consenting process makes a significant difference in terms of their recall of the surgical risks in elective lumbar spine surgery . We advocate the routine use of written booklets during the consenting process . RésuméRappel : dans un article récent , Leigh montre que les patients ne se souviennent pas très bien des indicationsqui leur ont été données en ce qui concerne l’information sur les risques avant une intervention chirurgicale . Nous avons souhaité , dans notre étude mettre l’accent sur les risques pouvant survenir dans la chirurgie rachidienne . Nous avons essayé d’évaluer l ’ importance de l’information écrite lors de la mise en place du consentement éclairé de ces patients . Méthode : cette étude est une étude prospect i ve r and omisée . Tous les patients devant bénéficier d’une chirurgie rachidienne ont été inclus dans notre étude sur une période s’étalant de février 2006 à novembre 2006 . Tous les patients consécutifs ont été r and omisés en deux groupes . Le premier groupe n’ayant que des explications par voie orale , ( groupe 1 ) et le deuxième groupe avec un complément d’informations écrites , ( groupe 2 ) . Deux semaines après , ces patients ont été évalués avec un question naire et les deux groupes ont été comparés . Résultats : 53 patients dans le groupe 1 et 23 dans le groupe 2 ont été pris en compte dans cette étude . Nous avons 
    Output:
    
agent
We have identified efforts by research ers to investigate interventions which seek to improve information delivery and consideration of information to enhance  informed consent .
The interventions used consistently improve patient knowledge , an important prerequisite for informed consent .
This is encouraging and these measures could be widely employed although we are not able to say with confidence which types of interventions are preferable .
Our results should be interpreted with caution due to the high levels of heterogeneity associated with many of the main analyses although we believe there is broad evidence of beneficial outcomes for patients with the pragmatic application of interventions .
***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: OBJECTIVE To determine the effectiveness of providing written information in enhancing patient underst and ing and retention . DESIGN A multicentre prospect i ve r and omized study was conducted in university-affiliated ambulatory surgical centres . One hundred consecutive patients seen for rhinoplasty consultation were included . Patients were r and omly assigned to ( 1 ) those receiving traditional oral dialogue of the surgical risks or ( 2 ) those receiving an oral discussion and a written pamphlet outlining the risks of the procedure . Fourteen to 18 days after the consultation , each patient was contacted for an assessment of risk recall . RESULTS Overall risk recall was higher in the group that received written information ( 2.3 vs 1.3 of 5 risks ; p < .008 ) . As well , in the group that received a pamphlet , patients with university and postgraduate levels of education had a better rate of recall ( p < .05 ) . Female patients in both groups reported higher risk recall ( p < .01 ) . CONCLUSION Patient risk recall of rhinoplasty is improved with the addition of written information during the informed consent process . As the process of informed consent plays a very decisive role in facial plastic surgery , enhanced postoperative satisfaction may result from the use of supplemental educational material A series of UK and European audits have revealed that a high proportion of patients remain dissatisfied with the information they received following a diagnosis of cancer . Additional educational aids are often required to facilitate the consent process , and our previous work showed a high level of acceptability for video-directed information for this purpose . In this study a multidisciplinary team of health professionals worked with patients , a documentary film company and experienced television personalities to produce an information film . The aim of this study was to assess the benefits of receiving a cassette to take home following the first consultation and this was evaluated in a r and omised multicentre controlled study among 220 patients receiving chemotherapy or radiotherapy over a 6-month period . There was a significant correlation between satisfaction and reduced treatment-related anxiety overall . In the video group , the mean Hospital Anxiety and Depression ( HAD ) anxiety score was significantly lower during treatment compared with the non-video group ( 4.6+/-3.7 ( range : 0 - 18 ) versus 7.4+/-5.2 ( range : 0 - 20 ) , Chi square test P=0.001 ) . Likewise , the mean HAD depression scores were also significantly lower in the patients prepared for the side-effects of treatment with the video ( 2.9+/-2.9 ( range : 0 - 13 ) versus 5.3+/-4.7 ( range : 0 - 21 ) Chi square test P=0.001 ) . 81 % felt the video was helpful , only 5 % of patients felt this extra information was worrying . Well design ed video cassettes should be regarded as a useful additional information strategy , within routine oncology practice Background : Deciding what risks to disclose before a procedure is often challenging for clinicians . Consecutive patients undergoing elective fibreoptic bronchoscopy  were r and omised to receive simple or more detailed written information about the risks of the procedure and the effects on anxiety and satisfaction levels were compared . Methods : A 100 mm anxiety visual analogue scale ( VAS ) and a modified Amsterdam preoperative anxiety ( scored 4–20 ) scale ( APAIS ) were completed before and after reading the design ated information leaflet . Following bronchoscopy , subjects completed a satisfaction question naire . Results : Of 142 consecutive patients , 122 ( 86 % ) ( mean age 57.8 years , 53 % male ) completed the study . Baseline demographic , clinical and anxiety measures were similar in the two groups . Those who received more detailed risk information had significantly greater increase in anxiety levels than those who received simple information on both the VAS ( mean 14.0 ( 95 % CI 10.1 to 17.9 ) vs 2.5 ( 95 % CI −1.4 to 6.4 ) , p<0.001 ) and the APAIS ( 1.73 ( 95 % CI 1.19 to 2.26 ) vs 0.57 ( 95 % CI 0.05 to 1.10 ) , p<0.001 ) . Almost twice as many of those receiving detailed risk information reported that they felt they had received too much information about complications or that the information they had received about bronchoscopy had been worrying . Conclusions : Provision of more detailed risk information before bronchoscopy may come at the cost of a small but significant increase in anxiety OBJECTIVE To examine the effects of an educational intervention , in the form of printed material , on  patient knowledge and recall of possible risks from  parotidectomy or thyroidectomy .  DESIGN Prospect i ve , r and omized , controlled study conducted during a 9-month period . SETTING Head and neck surgery clinic of an academic tertiary care hospital . PATIENTS One hundred twenty-five consecutive patients older than 16 years who were undergoing thyroidectomy or parotidectomy at the head and neck surgery clinic were recruited . Four patients were excluded from analysis because their follow-up interview was not within the required limits . INTERVENTION At the preoperative visit during the routine consent process , both groups received a verbally delivered checklist of risks specific for the surgery to be performed . The intervention group was also given a pamphlet with written information accompanied by illustrations . MAIN OUTCOME MEASURES The effectiveness of the educational intervention  was determined by comparing the average rate of risk recall between the intervention and control groups . The effects of age , sex , level of education , and time between the consent and recall interviews on recall rate were also assessed . RESULTS The overall risk recall rate for both procedures was 39.1 % . The recall rate of the intervention group was 50.3 % compared with 29.5 % for the control group ( P<.001 ) . CONCLUSIONS The intervention consistently improved risk recall for all patients regardless of age , sex , and level of education . Patients ' ability to recall potential risks was significantly increased by an educational intervention ; all patients would benefit from this intervention 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 Background Before any invasive procedure , physicians have a legal obligation to inform patients . Traditionally , this involves a discussion with a physician , supplemented by written leaflet information directed at the specific procedure . Objective Comparison of the use and effectiveness of computer-based visualization opposed to st and ardized conversation for providing patients with information of forthcoming procedures ( coronary catheters or endoscopy procedures ) . Methods Prospect i ve , r and omized trial with 56 participants allocated in two different groups : Visualization Group ( st and ardized information supported by a tool for displaying two-dimensional pictures to explain medical facts as well as informative leaflet ) or Control Group ( st and ardized information and informative leaflet only ) . Detailed information was given about the indication , the probable complications and the details of the forthcoming procedures ( coronary catheters or endoscopy procedures ) . All participants had to reach a Karnofsky Score of 70 points and be able to underst and German or English . Main outcome measures were patient 's satisfaction with physician-patient conversation , patient 's acquired knowledge and duration of the intervention as described above . Results Patients of the Visualization Group were more satisfied with the conversation and had higher knowledge scores after the conversation . A Mann-Whitney-U-Test between the two groups showed that these differences in satisfaction ( P<0.001 ) and knowledge ( P=<0.006 ) were statistically significant . Length of time needed for the conversation was slightly higher in the Visualization Group , but this difference was not statistically significant ( 25 versus 23 min ; P= 0.441 ) . No differences could be found due to differing age or educational level in the results of the Visualization and the Control Group . Conclusions Using computerized visualization increased the satisfaction and knowledge of the patients . The presentation of the visualized information in the Visualization Group did not dem and significantly more time than the st and ard conversation in the Control Group Background . There is limited evidence about how to ensure that patients are helped to make informed medical care decisions . Objective . To test a decision support intervention for uterine fibroid treatments . Design and Setting . Practical clinical trial to test informed choice assistance in 4 r and omly assigned gynecology clinics compared to 5 others providing a pamphlet . Patients . Three hundred women facing a treatment decision for fibroids over a 13-month period . Intervention . Mailed DVD and brochure about fibroid treatments plus the Ottawa decision guide and an offer of counseling soon after an index visit . Measurements . Mailed survey 6 to 8 weeks later asking about knowledge , preferences , and satisfaction with decision support . Results . In total , 244 surveys were completed for an adjusted response rate of 85.4 % . On a 5-point scale , intervention subjects reported more treatment options being mentioned ( 3.0 v. 2.4 ) , had a higher knowledge score ( 3.3 v. 2.8 ) , and were more likely to report being adequately informed ( 4.4 v. 4.0 ) , and their decision was both more satisfactory ( 4.3 v. 4.0 ) and more consistent with their personal values ( 4.5 v. 4.2 ) . Neither knowledge nor use of the intervention was associated with greater concordance between preferences and decisions . Limitations . Implementation of intervention may not have been well timed to the decision for some patients , limiting their use of the material s and counseling . Conclusion . It is difficult to integrate structured decision support consistently into practice . Decision support for benign uterine conditions showed effects on knowledge and satisfaction but not on concordance In a recent article , Leigh ( J Bone Joint Surg [ Br ] 88-B:16–18 , 2006 ) notes that patients do not lay down memory when being counselled as to the risks involved in prospect i ve surgery . In our article we focused on the patients ’ recall of risk factors involved in elective spinal surgery . We assessed the influence of written information provided to the patients during the consenting process on their recall of operative risks . The study was a prospect i ve r and omised study . All patients having elective spinal surgery were included in our study from February 2006 to November 2006 as a consecutive series . Patients were r and omised into two groups , one of which received routine consent with verbal explanations ( group 1 ) , the other received the same information supplemented by a written sheet explaining the risks of the surgery ( group 2 ) . Two weeks later we assessed patients ’ recall of the risk involved in the surgery with a question naire and compared both groups with a Student t-test .  Fifty-three patients ( twenty in group 1 and twenty three in group 2 ) were involved . We noted a significant difference between the two groups in terms of mean number of risks recalled and number of patients recalling each risk ( p < 0.001 and p < 0.005 , respectively ) . The addition of a written sheet given to patients during the consenting process makes a significant difference in terms of their recall of the surgical risks in elective lumbar spine surgery . We advocate the routine use of written booklets during the consenting process . RésuméRappel : dans un article récent , Leigh montre que les patients ne se souviennent pas très bien des indicationsqui leur ont été données en ce qui concerne l’information sur les risques avant une intervention chirurgicale . Nous avons souhaité , dans notre étude mettre l’accent sur les risques pouvant survenir dans la chirurgie rachidienne . Nous avons essayé d’évaluer l ’ importance de l’information écrite lors de la mise en place du consentement éclairé de ces patients . Méthode : cette étude est une étude prospect i ve r and omisée . Tous les patients devant bénéficier d’une chirurgie rachidienne ont été inclus dans notre étude sur une période s’étalant de février 2006 à novembre 2006 . Tous les patients consécutifs ont été r and omisés en deux groupes . Le premier groupe n’ayant que des explications par voie orale , ( groupe 1 ) et le deuxième groupe avec un complément d’informations écrites , ( groupe 2 ) . Deux semaines après , ces patients ont été évalués avec un question naire et les deux groupes ont été comparés . Résultats : 53 patients dans le groupe 1 et 23 dans le groupe 2 ont été pris en compte dans cette étude . Nous avons 
    Output:
    