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 The rising costs of health care are of great concern , particularly for the chronically ill . Interventions that promote health status and well being while teaching appropriate use of the health care system have led to cost savings among patients with osteoarthritis . We carried out social support and education interventions with patients with fibromyalgia ( FM ) and assessed the effect on health care costs , psychosocial variables , and health status . METHODS Participants were 600 patients with FM who were members of a health maintenance organization . They were r and omly assigned to one of 2 experimental groups ( social support ; social support and education ) or to a no-treatment control group . Assessment s were conducted at baseline and following a one year intervention . Health care cost data were obtained directly from participants ' medical records . RESULTS Results indicated significant reductions in all groups ' costs of prescriptions , laboratory tests , and visits to a nurse , nurse practitioner and /or physicians ' assistant . All groups also showed improvements on variables assessing effect of FM , self-efficacy , depression , and knowledge of FM . The social support and education group was less helpless after one year than the other groups ; differential changes for all other variables were not significant . CONCLUSION The study did not reveal differential changes in health care costs among participants in the experimental and control groups . These findings emphasize the importance of using objective health care utilization data when calculating health care costs , as well as the value of including a no-treatment control group to prevent erroneous conclusions about treatment efficacy This pilot , r and omized controlled trial analyzed the effects of a cognitive behavioral therapy ( CBT , n = 20 ) for insomnia  vs a sleep hygiene ( SH , n = 20 ) program on the three attentional networks ( alertness , orienting , and executive function ) and other additional outcome measures ( sleep , pain , depression , anxiety , and daily functioning ) of fibromyalgia patients . The CBT group showed significant improvement in alertness ( F(1 , 28 ) = 11.84 , p = .0018 ) , executive functioning ( F(1 , 28 ) = 15.76 , p = .00059 ) , sleep quality ( F(1 , 38 ) = 6.33 , p = .016 ) , and a trend to improvement in daily functioning ( p > .06 ) , as compared with the SH group . The improvement in executive functioning was significantly related to the changes in sleep ( r = 0.40 , p = .026 ) . A CBT for insomnia represents a useful intervention in fibromyalgia patients not only regarding sleep disturbance but also attentional dysfunction and probably daily functioning The present study focused on the evaluation of the effects of operant behavioural ( OBT ) and cognitive behavioural ( CBT ) treatments for fibromyalgia syndrome ( FMS ) . One hundred and twenty-five patients who fulfilled the American College of Rheumatology criteria for FMS were r and omly assigned to OBT ( n = 43 ) , CBT ( n = 42 ) , or an attention-placebo ( AP ) treatment ( n = 40 ) that consisted of discussion s of FMS-related problems . Assessment s of physical functioning , pain , affective distress , and cognitive and behavioural variables were performed pre-treatment and post-treatment as well as 6 and 12 months post-treatment . Patients receiving the OBT or CBT reported a significant reduction in pain intensity post-treatment ( all Fs > 3.89 , all Ps < 0.01 ) . In addition , the CBT group reported statistically significant improvements in cognitive ( all Fs > 7.95 , all P < 0.01 ) and affective variables ( all Fs > 2.99 , all Ps < 0.02 ) , and the OBT group demonstrated statistically significant improvements in physical functioning and behavioural variables ( all Fs > 5.99 , all Ps < 0.001 ) compared with AP . The AP group reported no significant improvement but actually deterioration in the outcome variables . The post-treatment effects for the OBT and CBT groups were maintained at both the 6- and 12-month follow-ups . These results suggest that both OBT and CBT are effective in treating patients with FMS with some differences in the outcome measures specifically targeted by the individual treatments compared with an unstructured discussion group . The AP group showed that unstructured discussion of FMS-related problems may be detrimental OBJECTIVE Studies have suggested that the Arthritis Self-Management Program ( ASMP ) course is effective at reducing arthritis pain and health care costs  in volunteer participants . There have been no reports of trials of the ASMP in the context of primary care physicians ' practice s , where the potential for spreading the program may be greatest . We conducted a r and omized controlled trial of the ASMP course in a large primary care physician network . METHODS Patients with osteoarthritis , rheumatoid arthritis , or fibromyalgia were recruited for the study . Subjects in the intervention practice s received the 6 week course and those in the control practice s received only the ASMP book , without course .  Disability , pain , self-efficacy , mental health , and satisfaction were measured using vali date d instruments at baseline and at 4 months . RESULTS One hundred thirteen patients were recruited for the ASMP course  ( intervention ) and completed baseline and 4 month followup question naires . Eighty-four percent completed at least 4 of 6 classes . Seventy-four patients received the ASMP manual ( controls ) and completed both question naires . Patients in the intervention and control groups had similar baseline pain ( p = 0.94 ) , self-efficacy to control pain ( p = 0.90 ) , mental health ( p = 0.10 ) , and vitality scores ( p = 0.21 ) , but those in the intervention arm had slightly less disability ( p = 0.04 ) . At 4 months , there was no significant improvement from baseline in any endpoint and no difference between patients in the intervention and control groups ( all p > 0.2 ) . Patient satisfaction with arthritis care and outcomes was no different for intervention and control patients ( all p > 0.3 ) . All types of health care re source use were similar at baseline and followup for both intervention and control groups ( all p > 0.2 ) . CONCLUSION While the ASMP course has been found to be effective in other patient groups , there were no significant clinical benefits noted at 4 months in patients recruited from primary care practice Objectives A recent meta- analysis concluded that multicomponent treatments are effective for some fibromyalgia ( FM ) symptoms . The objective of this study was to examine whether a psychoeducational intervention implemented in primary care is more effective than usual care for improving the functional status of patients with FM . Methods This study was based on a r and omized controlled trial . The 484 patients with FM included in a data base of the Viladecans Hospital ( Barcelona , Spain ) were eligible for screening . Finally , 108 patients were r and omly assigned to the intervention and 108 patients were assigned to usual care . The intervention comprised nine 2-hour sessions ( 5 sessions of education and 4 sessions of autogenic relaxation ) . The patients were assessed before and after the intervention with a battery of instruments ( measuring sociodemographic data , medical comorbidities , functional status , trait anxiety , and social desirability ) . Results The posttreatment drop-out rate was 9.7 % ( intervention : 6.5 % ; control : 13 % ) . The intention-to-treat analyses showed significant differences between the groups at posttreatment : the intervention group improved in physical impairment , days not feeling well , pain , general fatigue , morning fatigue , stiffness , anxiety , and depression ( medium effect size in most cases ) . The patients who responded to the intervention reported less trait anxiety at baseline than nonresponders . The absolute risk reduction with the intervention was 36.1 % ( 95 % confidence interval : 23.3 - 48.8 ) and the number needed to treat was 3 ( 95 % confidence interval : 2.0 - 4.3 ) . Discussion A 2-month psychoeducational intervention improves the functional status of FM patients to a greater extent than usual care , at least in the short-term . The social desirability bias did not explain the reported outcomes . Trait anxiety was associated with response to treatment . Trial Registration NCT00550966 A r and omized controlled trial was conducted to assess the efficacy of an individually administered form of cognitive behavioral treatment for fibromyalgia . In an additive design , 76 patients diagnosed with fibromyalgia were r and omly assigned to either the experimental treatment ( affective-cognitive behavioral therapy , 10 individual sessions , one per week ) administered concurrently with treatment-as-usual or to an unaugmented treatment-as-usual condition . Statistical analysis conducted at the end of treatment ( 3 months after the baseline assessment ) and at a followup ( 9 months after the baseline assessment ) indicated that the patients receiving the experimental treatment reported less pain and overall better functioning than control patients , both at posttreatment and at followup . The implication s of these findings for future research are discussed & NA ; Mindfulness‐based stress reduction ( MBSR ) is a structured 8‐week group program teaching mindfulness meditation and mindful yoga exercises . MBSR aims to help participants develop nonjudgmental awareness of moment‐to‐moment experience . Fibromyalgia is a clinical syndrome with chronic pain , fatigue , and insomnia as major symptoms . Efficacy of MBSR for enhanced well‐being of fibromyalgia patients was investigated in a 3‐armed trial , which was a follow‐up to an earlier quasi‐r and omized investigation . A total of 177 female patients were r and omized to one of the following : ( 1 ) MBSR , ( 2 ) an active control procedure controlling for nonspecific effects of MBSR , or ( 3 ) a  wait list  . The major outcome was health‐related quality of life ( HRQoL ) 2 months post‐treatment . Secondary outcomes were disorder‐specific quality of life , depression , pain , anxiety , somatic complaints , and a proposed index of mindfulness . Of the patients , 82 % completed the study . There were no significant differences between groups on primary outcome , but patients overall improved in HRQoL at short‐term follow‐up ( P = 0.004 ) . Post hoc analyses showed that only MBSR manifested a significant pre‐to‐post‐intervention improvement in HRQoL ( P = 0.02 ) . Furthermore , multivariate analysis of secondary measures indicated modest benefits for MBSR patients . MBSR yielded significant pre‐to‐post‐intervention improvements in 6 of 8 secondary outcome variables , the active control in 3 , and the wait list in 2 . In conclusion , primary outcome analyses did not support the efficacy of MBSR  in fibromyalgia , although patients in the MBSR arm appeared to benefit most . Effect sizes were small compared to the earlier , quasi‐r and omized investigation . Several method ological aspects are discussed , e.g. , patient burden , treatment preference and motivation , that may provide explanations for differences . In a 3‐armed r and omized controlled trial in female patients suffering from fibromyalgia , patients benefited modestly from a mindfulness‐based stress reduction intervention OBJECTIVE To study , for the first time , service utilization and costs in fibromyalgia , a prevalent syndrome associated with high levels of pain , functional disability , and emotional distress . METHODS Five hundred thirty-eight fibromyalgia patients from 6 rheumatology centers were enrolled in a 7-year prospect i ve study of fibromyalgia outcome . Patients were assessed every 6 months with vali date d , mailed question naires which included questions regarding fibromyalgia symptoms and severity , utilization of services , and work disability . RESULTS Fibromyalgia patients averaged almost 10 outpatient medical visits per year , and when nontraditional treatments were considered , this number increased to approximately 1 visit per month . Patients were hospitalized at a rate of 1 hospitalization every 3 years . In each 6-month study period , patients used a mean of 2.7  fibromyalgia-related drugs . Costs increased over the course of the study . The mean yearly per-patient cost in 1996 dollars was $ 2,274 . However , results were skewed by high utilizers , and many patients used few services and had limited costs . Total costs and utilization were independently associated with the number of self-reported comorbid or associated conditions , functional disability , and global disease severity . Compared with patients with other rheumatic disorders , those with fibromyalgia were more likely to have lifetime surgical interventions , including back or neck surgery , appendectomy , carpal tunnel surgery , gynecologic surgery , abdominal surgery , and tonsillectomy , and were more likely than other rheumatic disease patients to report comorbid or associated conditions . Almost 50 % of hospitalizations occurring during the study were related to fibromyalgia-associated symptoms . CONCLUSION The average yearly cost for service utilization among fibromyalgia patients is $ 2,274 . Fibromyalgia patients have high lifetime and current rates of utilization of all types of medical services . They report more symptoms and comorbid or associated conditions than patients with other rheumatic conditions , and symptom reporting is linked to service utilization and , to a lesser extent , functional disability and global disease severity Summary Treatment with Cognitive Behavioral Therapy leads to clinical improvements in fibromyalgia patients , paired with increased activity and connectivity in the brain ’s pain modulatory regions . ABSTRACT Interventions based on Cognitive Behavioral Therapy ( CBT ) are widely used to treat chronic pain , but the brain mechanisms responsible for these treatment effects are poorly understood . The aim of this study was to vali date the relevance of the cortical control theory in response to an exposure‐based form of CBT , Acceptance and Commitment Therapy , in patients with chronic pain . Forty‐three female patients diagnosed with fibromyalgia 
    Output:
    
agent
CBTs provided a small incremental benefit over control interventions in reducing pain , negative mood and disability at the end of treatment and at long-term follow-up .
The dropout rates due to any reason did not differ between CBTs and controls
***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 The rising costs of health care are of great concern , particularly for the chronically ill . Interventions that promote health status and well being while teaching appropriate use of the health care system have led to cost savings among patients with osteoarthritis . We carried out social support and education interventions with patients with fibromyalgia ( FM ) and assessed the effect on health care costs , psychosocial variables , and health status . METHODS Participants were 600 patients with FM who were members of a health maintenance organization . They were r and omly assigned to one of 2 experimental groups ( social support ; social support and education ) or to a no-treatment control group . Assessment s were conducted at baseline and following a one year intervention . Health care cost data were obtained directly from participants ' medical records . RESULTS Results indicated significant reductions in all groups ' costs of prescriptions , laboratory tests , and visits to a nurse , nurse practitioner and /or physicians ' assistant . All groups also showed improvements on variables assessing effect of FM , self-efficacy , depression , and knowledge of FM . The social support and education group was less helpless after one year than the other groups ; differential changes for all other variables were not significant . CONCLUSION The study did not reveal differential changes in health care costs among participants in the experimental and control groups . These findings emphasize the importance of using objective health care utilization data when calculating health care costs , as well as the value of including a no-treatment control group to prevent erroneous conclusions about treatment efficacy This pilot , r and omized controlled trial analyzed the effects of a cognitive behavioral therapy ( CBT , n = 20 ) for insomnia  vs a sleep hygiene ( SH , n = 20 ) program on the three attentional networks ( alertness , orienting , and executive function ) and other additional outcome measures ( sleep , pain , depression , anxiety , and daily functioning ) of fibromyalgia patients . The CBT group showed significant improvement in alertness ( F(1 , 28 ) = 11.84 , p = .0018 ) , executive functioning ( F(1 , 28 ) = 15.76 , p = .00059 ) , sleep quality ( F(1 , 38 ) = 6.33 , p = .016 ) , and a trend to improvement in daily functioning ( p > .06 ) , as compared with the SH group . The improvement in executive functioning was significantly related to the changes in sleep ( r = 0.40 , p = .026 ) . A CBT for insomnia represents a useful intervention in fibromyalgia patients not only regarding sleep disturbance but also attentional dysfunction and probably daily functioning The present study focused on the evaluation of the effects of operant behavioural ( OBT ) and cognitive behavioural ( CBT ) treatments for fibromyalgia syndrome ( FMS ) . One hundred and twenty-five patients who fulfilled the American College of Rheumatology criteria for FMS were r and omly assigned to OBT ( n = 43 ) , CBT ( n = 42 ) , or an attention-placebo ( AP ) treatment ( n = 40 ) that consisted of discussion s of FMS-related problems . Assessment s of physical functioning , pain , affective distress , and cognitive and behavioural variables were performed pre-treatment and post-treatment as well as 6 and 12 months post-treatment . Patients receiving the OBT or CBT reported a significant reduction in pain intensity post-treatment ( all Fs > 3.89 , all Ps < 0.01 ) . In addition , the CBT group reported statistically significant improvements in cognitive ( all Fs > 7.95 , all P < 0.01 ) and affective variables ( all Fs > 2.99 , all Ps < 0.02 ) , and the OBT group demonstrated statistically significant improvements in physical functioning and behavioural variables ( all Fs > 5.99 , all Ps < 0.001 ) compared with AP . The AP group reported no significant improvement but actually deterioration in the outcome variables . The post-treatment effects for the OBT and CBT groups were maintained at both the 6- and 12-month follow-ups . These results suggest that both OBT and CBT are effective in treating patients with FMS with some differences in the outcome measures specifically targeted by the individual treatments compared with an unstructured discussion group . The AP group showed that unstructured discussion of FMS-related problems may be detrimental OBJECTIVE Studies have suggested that the Arthritis Self-Management Program ( ASMP ) course is effective at reducing arthritis pain and health care costs  in volunteer participants . There have been no reports of trials of the ASMP in the context of primary care physicians ' practice s , where the potential for spreading the program may be greatest . We conducted a r and omized controlled trial of the ASMP course in a large primary care physician network . METHODS Patients with osteoarthritis , rheumatoid arthritis , or fibromyalgia were recruited for the study . Subjects in the intervention practice s received the 6 week course and those in the control practice s received only the ASMP book , without course .  Disability , pain , self-efficacy , mental health , and satisfaction were measured using vali date d instruments at baseline and at 4 months . RESULTS One hundred thirteen patients were recruited for the ASMP course  ( intervention ) and completed baseline and 4 month followup question naires . Eighty-four percent completed at least 4 of 6 classes . Seventy-four patients received the ASMP manual ( controls ) and completed both question naires . Patients in the intervention and control groups had similar baseline pain ( p = 0.94 ) , self-efficacy to control pain ( p = 0.90 ) , mental health ( p = 0.10 ) , and vitality scores ( p = 0.21 ) , but those in the intervention arm had slightly less disability ( p = 0.04 ) . At 4 months , there was no significant improvement from baseline in any endpoint and no difference between patients in the intervention and control groups ( all p > 0.2 ) . Patient satisfaction with arthritis care and outcomes was no different for intervention and control patients ( all p > 0.3 ) . All types of health care re source use were similar at baseline and followup for both intervention and control groups ( all p > 0.2 ) . CONCLUSION While the ASMP course has been found to be effective in other patient groups , there were no significant clinical benefits noted at 4 months in patients recruited from primary care practice Objectives A recent meta- analysis concluded that multicomponent treatments are effective for some fibromyalgia ( FM ) symptoms . The objective of this study was to examine whether a psychoeducational intervention implemented in primary care is more effective than usual care for improving the functional status of patients with FM . Methods This study was based on a r and omized controlled trial . The 484 patients with FM included in a data base of the Viladecans Hospital ( Barcelona , Spain ) were eligible for screening . Finally , 108 patients were r and omly assigned to the intervention and 108 patients were assigned to usual care . The intervention comprised nine 2-hour sessions ( 5 sessions of education and 4 sessions of autogenic relaxation ) . The patients were assessed before and after the intervention with a battery of instruments ( measuring sociodemographic data , medical comorbidities , functional status , trait anxiety , and social desirability ) . Results The posttreatment drop-out rate was 9.7 % ( intervention : 6.5 % ; control : 13 % ) . The intention-to-treat analyses showed significant differences between the groups at posttreatment : the intervention group improved in physical impairment , days not feeling well , pain , general fatigue , morning fatigue , stiffness , anxiety , and depression ( medium effect size in most cases ) . The patients who responded to the intervention reported less trait anxiety at baseline than nonresponders . The absolute risk reduction with the intervention was 36.1 % ( 95 % confidence interval : 23.3 - 48.8 ) and the number needed to treat was 3 ( 95 % confidence interval : 2.0 - 4.3 ) . Discussion A 2-month psychoeducational intervention improves the functional status of FM patients to a greater extent than usual care , at least in the short-term . The social desirability bias did not explain the reported outcomes . Trait anxiety was associated with response to treatment . Trial Registration NCT00550966 A r and omized controlled trial was conducted to assess the efficacy of an individually administered form of cognitive behavioral treatment for fibromyalgia . In an additive design , 76 patients diagnosed with fibromyalgia were r and omly assigned to either the experimental treatment ( affective-cognitive behavioral therapy , 10 individual sessions , one per week ) administered concurrently with treatment-as-usual or to an unaugmented treatment-as-usual condition . Statistical analysis conducted at the end of treatment ( 3 months after the baseline assessment ) and at a followup ( 9 months after the baseline assessment ) indicated that the patients receiving the experimental treatment reported less pain and overall better functioning than control patients , both at posttreatment and at followup . The implication s of these findings for future research are discussed & NA ; Mindfulness‐based stress reduction ( MBSR ) is a structured 8‐week group program teaching mindfulness meditation and mindful yoga exercises . MBSR aims to help participants develop nonjudgmental awareness of moment‐to‐moment experience . Fibromyalgia is a clinical syndrome with chronic pain , fatigue , and insomnia as major symptoms . Efficacy of MBSR for enhanced well‐being of fibromyalgia patients was investigated in a 3‐armed trial , which was a follow‐up to an earlier quasi‐r and omized investigation . A total of 177 female patients were r and omized to one of the following : ( 1 ) MBSR , ( 2 ) an active control procedure controlling for nonspecific effects of MBSR , or ( 3 ) a  wait list  . The major outcome was health‐related quality of life ( HRQoL ) 2 months post‐treatment . Secondary outcomes were disorder‐specific quality of life , depression , pain , anxiety , somatic complaints , and a proposed index of mindfulness . Of the patients , 82 % completed the study . There were no significant differences between groups on primary outcome , but patients overall improved in HRQoL at short‐term follow‐up ( P = 0.004 ) . Post hoc analyses showed that only MBSR manifested a significant pre‐to‐post‐intervention improvement in HRQoL ( P = 0.02 ) . Furthermore , multivariate analysis of secondary measures indicated modest benefits for MBSR patients . MBSR yielded significant pre‐to‐post‐intervention improvements in 6 of 8 secondary outcome variables , the active control in 3 , and the wait list in 2 . In conclusion , primary outcome analyses did not support the efficacy of MBSR  in fibromyalgia , although patients in the MBSR arm appeared to benefit most . Effect sizes were small compared to the earlier , quasi‐r and omized investigation . Several method ological aspects are discussed , e.g. , patient burden , treatment preference and motivation , that may provide explanations for differences . In a 3‐armed r and omized controlled trial in female patients suffering from fibromyalgia , patients benefited modestly from a mindfulness‐based stress reduction intervention OBJECTIVE To study , for the first time , service utilization and costs in fibromyalgia , a prevalent syndrome associated with high levels of pain , functional disability , and emotional distress . METHODS Five hundred thirty-eight fibromyalgia patients from 6 rheumatology centers were enrolled in a 7-year prospect i ve study of fibromyalgia outcome . Patients were assessed every 6 months with vali date d , mailed question naires which included questions regarding fibromyalgia symptoms and severity , utilization of services , and work disability . RESULTS Fibromyalgia patients averaged almost 10 outpatient medical visits per year , and when nontraditional treatments were considered , this number increased to approximately 1 visit per month . Patients were hospitalized at a rate of 1 hospitalization every 3 years . In each 6-month study period , patients used a mean of 2.7  fibromyalgia-related drugs . Costs increased over the course of the study . The mean yearly per-patient cost in 1996 dollars was $ 2,274 . However , results were skewed by high utilizers , and many patients used few services and had limited costs . Total costs and utilization were independently associated with the number of self-reported comorbid or associated conditions , functional disability , and global disease severity . Compared with patients with other rheumatic disorders , those with fibromyalgia were more likely to have lifetime surgical interventions , including back or neck surgery , appendectomy , carpal tunnel surgery , gynecologic surgery , abdominal surgery , and tonsillectomy , and were more likely than other rheumatic disease patients to report comorbid or associated conditions . Almost 50 % of hospitalizations occurring during the study were related to fibromyalgia-associated symptoms . CONCLUSION The average yearly cost for service utilization among fibromyalgia patients is $ 2,274 . Fibromyalgia patients have high lifetime and current rates of utilization of all types of medical services . They report more symptoms and comorbid or associated conditions than patients with other rheumatic conditions , and symptom reporting is linked to service utilization and , to a lesser extent , functional disability and global disease severity Summary Treatment with Cognitive Behavioral Therapy leads to clinical improvements in fibromyalgia patients , paired with increased activity and connectivity in the brain ’s pain modulatory regions . ABSTRACT Interventions based on Cognitive Behavioral Therapy ( CBT ) are widely used to treat chronic pain , but the brain mechanisms responsible for these treatment effects are poorly understood . The aim of this study was to vali date the relevance of the cortical control theory in response to an exposure‐based form of CBT , Acceptance and Commitment Therapy , in patients with chronic pain . Forty‐three female patients diagnosed with fibromyalgia 
    Output:
    