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: & NA ; The feasibility of altering a Type A style of life was investigated in 1012 nonsmoking predominantly male postinfa rct ion volunteers in the San Francisco Bay area . A total of 862 were r and omly allocated into an experimental section receiving a combination of Type A and cardiac counseling , or a control section receiving cardiac counseling alone . The remaining 150 formed a nonr and om but statistically equivalent comparison section . Assessment s of change in Type A behavior were made by the participant , his or her spouse , a work colleague , and an independent rater of a videotaped structured interview . Psychometric analyses indicated that these instruments were valid and reliable measures of Type A behavior . After 24 months , participants receiving Type A/cardiac counseling exhibited a significantly greater reduction in Type A behavior than the other two sections , and had a lower cardiovascular recurrence rate than the comparison section only . No differences among the three sections were observed in total cholesterol or resting blood pressure . The results suggest that Type A behavior can be altered by group counseling in postinfa rct ion volunteers and that such alteration is superior to no group counseling at all in the secondary prevention of coronary heart disease OBJECTIVE Although the Enhancing Recovery in Coronary Heart Disease ( ENRICHD ) treatment was design ed to include individual therapy and cognitive behavioral group training for patients with depression and /or low perceived social support , only 31 % of treated participants received group training .  Secondary analyses classified intervention participants into two subgroups , ( 1 ) individual therapy only or ( 2 ) group training ( i.e. , coping skills training ) plus individual therapy , to determine whether medical outcomes differed in participants who received the combination of group training and individual therapy compared to participants who received individual therapy only or usual care . METHODS Secondary analyses of 1243 usual care , 781 individual therapy only , and 356 group plus individual therapy myocardial infa rct ion ( MI ) patients were performed . Depression was diagnosed using modified Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ( DSM-IV ) criteria ; low perceived social support was determined by the ENRICHD Social Support Instrument . Psychosocial treatment followed MI , and for participants with severe or unremitting depression , was supplemented with a selective serotonin reuptake inhibitor . Cox proportional hazards regression was used to estimate intervention effects on time to first occurrence of the composite end point of death plus nonfatal MI . To control for confounding of group participation with survival ( because individual sessions preceded group ) , we used risk set sampling to match minimal survival time of those receiving or not receiving group training . RESULTS Analyses correcting for differential survival among comparison groups showed that group plus individual therapy was associated with a 33 % reduction ( hazard ratio=0.67 ; 95 % confidence interval , 0.49 - 0.92 , P=.01 ) in medical outcome compared to usual care . No significant effect on event-free survival was associated with individual therapy alone . The group training benefit was reduced to 23 % ( hazard ratio=0.77 ; 95 % confidence interval : 0.56 - 1.07 , P=.11 ) in the multivariate-adjusted model . CONCLUSIONS Findings suggest that adding group training to individual therapy may be associated with reduction in the composite end point . A r and omized controlled trial is warranted to definitively resolve this issue & NA ; A trial of brief group therapy as part of a rehabilitation program for postmyocardial infa rct ion ( MI ) patients was carried out . Forty‐four patients surviving their first MI were r and omly allocated to either group therapy or control group status and were followed over 4 years . An additional group of 17 patients were referred for post‐MI group therapy sessions after the termination of the controlled experiment and were followed for 3 years . Patients who received group therapy had significantly less follow‐up coronary morbidity and mortality , and returned to work at significant higher percentages than control patients . Although neither group therapy nor control group patients meaningfully altered conventional coronary risk factors , group therapy patients ( in the controlled trial ) successfully altered selected coronary‐prone behaviors . Educational information regarding the physiological and psychological aspects of coronary heart disease , presented in the group therapy sessions , was forgotten over follow‐up . It is concluded that the supportive aspects of the group therapy experience played the most important role in determining the rehabilitation advantages seen for treatment patients CONTEXT There has been little research on the treatment of depression after coronary artery bypass surgery . OBJECTIVE To test the efficacy of 2 nonpharmacological interventions for depression after  coronary artery bypass surgery  compared with usual care . DESIGN A 12-week , r and omized , single-blind clinical trial with outcome evaluations at 3 , 6 , and 9 months . SETTING Outpatient research clinic at Washington University School of Medicine , St Louis , Missouri . PATIENTS One hundred twenty-three patients who met the DSM-IV criteria for major or minor depression within 1 year after surgery . INTERVENTION Twelve weeks of cognitive behavior therapy or supportive stress management .  Approximately half of the participants were taking non study antidepressant medications .  MAIN OUTCOME MEASURE Remission of depression , defined as a score of less than 7 on the 17-item Hamilton Rating Scale for Depression . RESULTS Remission of depression occurred by 3 months in a higher proportion of patients in the cognitive behavior therapy ( 71 % ) and supportive stress-management ( 57 % ) arms than in the usual care group ( 33 % ) ( chi(2)(2 ) = 12.22 , P = .002 ) . Covariate-adjusted Hamilton scores were lower in the cognitive behavior therapy ( mean [ st and ard error ] , 5.5 [ 1.0 ] ) and the supportive stress-management ( 7.8 [ 1.0 ] ) arms than in the usual care arm ( 10.7 [ 1.0 ] ) at 3 months . The differences narrowed at 6 months , but the remission rates differed again at 9 months ( 73 % , 57 % , and 35 % , respectively ; chi(2)(2 ) = 12.02 , P = .003 ) . Cognitive behavior therapy was superior to usual care at most points on secondary measures of depression , anxiety , hopelessness , stress , and quality of life . Supportive stress management was superior to usual care only on some of the measures . CONCLUSIONS Both cognitive behavior therapy and supportive stress management are efficacious for treating depression after coronary artery bypass surgery , relative to usual care . Cognitive behavior therapy had greater and more durable effects than supportive stress management on depression and several secondary psychological outcomes . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00042198 Objective : The Enhancing Recovery in Coronary Heart Disease study was a multicenter clinical trial in which patients with depression and /or low perceived social support after an acute myocardial infa rct ion were r and omly assigned to an intervention consisting of cognitive behavior therapy and , in some cases , sertraline , or to usual care . There was no difference in survival between the groups . A possible reason why the intervention failed to affect survival is that too many patients with mild , transient depression were enrolled . Another is that some patients died too soon to complete the intervention . This analysis evaluates whether there was a difference in late ( ie , ≥6 months after the myocardial infa rct ion ) mortality among initially depressed patients who had a Beck Depression Inventory score ≥10 and a past history of major depression , and who completed the 6-month post-treatment assessment . It also examines the relationship between change in depression and late mortality . Methods : Out of the 1,165 ( 47 % ) of the Enhancing Recovery in Coronary Heart Disease study participants who met our criteria , 57 died  in the first 6 months , and 858 ( 409 usual care , 449 intervention ) completed the 6-month assessment . Cox regression was used to analyze survival . Results : The intervention did not affect late mortality . However , intervention patients whose depression did not improve were at higher risk for late mortality than were patients who responded to treatment . Conclusions : Patients whose depression is refractory to cognitive behavior therapy and sertraline , two st and ard treatments for depression , are at high risk for late mortality after myocardial infa rct ion One hundred fifty-six myocardial infa rct ion patients were r and omly assigned to either exercise plus relaxation and breathing therapy ( treatment A , n = 76 ) or to exercise training only ( treatment B , n = 80 ) . Effects on exercise testing showed a more pronounced training bradycardia and a remarkable improvement in ST abnormalities in treatment A ( p less than 0.005 ) . A model was developed to integrate the various exercise parameters into a single measure for training benefit . Approximately half the patients showed a training success , with a more positive and less negative outcome in treatment A ( p = 0.09 ) . The odds for failure were 0.25 for treatment A and 0.51 for treatment B ( odds ratio : 2.04 ; 95 % confidence interval , 0.94 to 4.6 ) . Thus the risk of failure was reduced by half when relaxation was added to exercise training . These results indicate that exercise training is not successful in all MI patients and that relaxation therapy enhances training benefit Objective Depression is common following an acute cardiac event and can occur at a time when behaviour change is strongly recommended to reduce the risk of further cardiovascular events . The ‘ Beating Heart Problems ’ programme was design ed to support cardiac patients in behaviour change and mood management . Methods The programme was based on cognitive behaviour therapy and motivational interviewing . A r and omized controlled trial ( RCT ) comparing the 8-week group programme with usual care was undertaken between 2007 and 2010 . All patients attended a hospital-based clinic for assessment of physiological risk factors at baseline ( 6 weeks after their acute event ) , and at 4- and 12-month follow up . Psychological and behavioural indicators were assessed by self-report question naires . Of the 275 patients enrolled into the RCT , 42 ( 15 % ) had Beck Depression Inventory-II scores > 13 at baseline . Treatment and control group comparisons were undertaken for this subgroup , using growth curve modelling and testing for group differences over time in psychological , physiological , health behaviour , and self-efficacy measures . Results Significantly greater improvements ( p < 0.01 ) in depression symptoms and self-rated health were reported for the intervention group , as well as significantly larger gains in confidence in managing depression ( p < 0.05 ) and anger ( p < 0.01 ) . Trends ( 0.05 < p < 0.10 ) for larger treatment group improvements were also seen for anxiety symptoms and confidence in managing anxiety . Conclusion A group secondary -prevention programme that integrates behavioural and mood management strategies leads to decreased depression , increased confidence , and improved health perceptions in depressed cardiac patients Background —Blacks have disproportionately high rates of cardiovascular disease . Psychosocial stress may contribute to this disparity . Previous trials on stress reduction with the Transcendental Meditation ( TM ) program have reported improvements in cardiovascular disease risk factors , surrogate end points , and mortality in blacks and other population s. Methods and Results —This was a r and omized , controlled trial of 201 black men and women with coronary heart disease who were r and omized to the TM program or health education .  The primary end point was the composite of all-cause mortality , myocardial infa rct ion , or stroke . Secondary end points included the composite of cardiovascular mortality , revascularizations , and cardiovascular hospitalizations ; blood pressure ; psychosocial stress factors ; and lifestyle behaviors . During an average follow-up of 5.4 years , there was a 48 % risk reduction in the primary end point in the TM group ( hazard ratio , 0.52 ; 95 % confidence interval , 0.29–0.92 ; P=0.025 ) . The TM group also showed a 24 % risk reduction in the secondary end point ( hazard ratio , 0.76 ; 95 % confidence interval , 0.51–0.1.13 ; P=0.17 ) . There were reductions of 4.9 mmHg in systolic blood pressure ( 95 % confidence interval −8.3 to –1.5 mmHg ; P=0.01 ) and anger expression ( P<0.05 for all scales ) . Adherence was associated with survival . Conclusions —A selected mind – body intervention , the TM program , significantly reduced risk for mortality , myocardial infa rct ion , and stroke in coronary heart disease patients . These changes were associated with lower blood pressure and psychosocial stress factors . Therefore , this practice may be clinical ly useful in the secondary prevention of cardiovascular disease . Clinical Trial Registration —URL : www . clinical trials.gov Unique identifier : NCT01299935 The report aims to review the literature and describe the methods used for retention of patients in a clinical study . The Enhanced Recovery in Coronary Heart Disease ( ENRICHD ) trial was a multicenter , r and omized clinical trial design ed to evaluate the effects of a psychosocial intervention on cardiovascular morbidity and mortality . A total of 2481 patients met the criteria for depression , low social support , or both after a myocardial infa rct ion and needed to be followed . Follow-up evaluation consisted of telephone interviews 3 , 9 , 12 , 24 , 36 , and 48 months after enrollment and clinic visits scheduled at 6 , 18 , 30 , 42 , and 54 months . Creative strategies used to achieve optimum retention of this complex patient population over a long follow-up period are presented . Strategies to 
    Output:
    
agent
Conclusions We found that psychological intervention  improved psychological symptoms and reduced cardiac mortality for people with CHD .
However , there remains considerable uncertainty regarding the magnitude of these effects and the specific techniques most likely to benefit people with different presentations of CHD
***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: & NA ; The feasibility of altering a Type A style of life was investigated in 1012 nonsmoking predominantly male postinfa rct ion volunteers in the San Francisco Bay area . A total of 862 were r and omly allocated into an experimental section receiving a combination of Type A and cardiac counseling , or a control section receiving cardiac counseling alone . The remaining 150 formed a nonr and om but statistically equivalent comparison section . Assessment s of change in Type A behavior were made by the participant , his or her spouse , a work colleague , and an independent rater of a videotaped structured interview . Psychometric analyses indicated that these instruments were valid and reliable measures of Type A behavior . After 24 months , participants receiving Type A/cardiac counseling exhibited a significantly greater reduction in Type A behavior than the other two sections , and had a lower cardiovascular recurrence rate than the comparison section only . No differences among the three sections were observed in total cholesterol or resting blood pressure . The results suggest that Type A behavior can be altered by group counseling in postinfa rct ion volunteers and that such alteration is superior to no group counseling at all in the secondary prevention of coronary heart disease OBJECTIVE Although the Enhancing Recovery in Coronary Heart Disease ( ENRICHD ) treatment was design ed to include individual therapy and cognitive behavioral group training for patients with depression and /or low perceived social support , only 31 % of treated participants received group training .  Secondary analyses classified intervention participants into two subgroups , ( 1 ) individual therapy only or ( 2 ) group training ( i.e. , coping skills training ) plus individual therapy , to determine whether medical outcomes differed in participants who received the combination of group training and individual therapy compared to participants who received individual therapy only or usual care . METHODS Secondary analyses of 1243 usual care , 781 individual therapy only , and 356 group plus individual therapy myocardial infa rct ion ( MI ) patients were performed . Depression was diagnosed using modified Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ( DSM-IV ) criteria ; low perceived social support was determined by the ENRICHD Social Support Instrument . Psychosocial treatment followed MI , and for participants with severe or unremitting depression , was supplemented with a selective serotonin reuptake inhibitor . Cox proportional hazards regression was used to estimate intervention effects on time to first occurrence of the composite end point of death plus nonfatal MI . To control for confounding of group participation with survival ( because individual sessions preceded group ) , we used risk set sampling to match minimal survival time of those receiving or not receiving group training . RESULTS Analyses correcting for differential survival among comparison groups showed that group plus individual therapy was associated with a 33 % reduction ( hazard ratio=0.67 ; 95 % confidence interval , 0.49 - 0.92 , P=.01 ) in medical outcome compared to usual care . No significant effect on event-free survival was associated with individual therapy alone . The group training benefit was reduced to 23 % ( hazard ratio=0.77 ; 95 % confidence interval : 0.56 - 1.07 , P=.11 ) in the multivariate-adjusted model . CONCLUSIONS Findings suggest that adding group training to individual therapy may be associated with reduction in the composite end point . A r and omized controlled trial is warranted to definitively resolve this issue & NA ; A trial of brief group therapy as part of a rehabilitation program for postmyocardial infa rct ion ( MI ) patients was carried out . Forty‐four patients surviving their first MI were r and omly allocated to either group therapy or control group status and were followed over 4 years . An additional group of 17 patients were referred for post‐MI group therapy sessions after the termination of the controlled experiment and were followed for 3 years . Patients who received group therapy had significantly less follow‐up coronary morbidity and mortality , and returned to work at significant higher percentages than control patients . Although neither group therapy nor control group patients meaningfully altered conventional coronary risk factors , group therapy patients ( in the controlled trial ) successfully altered selected coronary‐prone behaviors . Educational information regarding the physiological and psychological aspects of coronary heart disease , presented in the group therapy sessions , was forgotten over follow‐up . It is concluded that the supportive aspects of the group therapy experience played the most important role in determining the rehabilitation advantages seen for treatment patients CONTEXT There has been little research on the treatment of depression after coronary artery bypass surgery . OBJECTIVE To test the efficacy of 2 nonpharmacological interventions for depression after  coronary artery bypass surgery  compared with usual care . DESIGN A 12-week , r and omized , single-blind clinical trial with outcome evaluations at 3 , 6 , and 9 months . SETTING Outpatient research clinic at Washington University School of Medicine , St Louis , Missouri . PATIENTS One hundred twenty-three patients who met the DSM-IV criteria for major or minor depression within 1 year after surgery . INTERVENTION Twelve weeks of cognitive behavior therapy or supportive stress management .  Approximately half of the participants were taking non study antidepressant medications .  MAIN OUTCOME MEASURE Remission of depression , defined as a score of less than 7 on the 17-item Hamilton Rating Scale for Depression . RESULTS Remission of depression occurred by 3 months in a higher proportion of patients in the cognitive behavior therapy ( 71 % ) and supportive stress-management ( 57 % ) arms than in the usual care group ( 33 % ) ( chi(2)(2 ) = 12.22 , P = .002 ) . Covariate-adjusted Hamilton scores were lower in the cognitive behavior therapy ( mean [ st and ard error ] , 5.5 [ 1.0 ] ) and the supportive stress-management ( 7.8 [ 1.0 ] ) arms than in the usual care arm ( 10.7 [ 1.0 ] ) at 3 months . The differences narrowed at 6 months , but the remission rates differed again at 9 months ( 73 % , 57 % , and 35 % , respectively ; chi(2)(2 ) = 12.02 , P = .003 ) . Cognitive behavior therapy was superior to usual care at most points on secondary measures of depression , anxiety , hopelessness , stress , and quality of life . Supportive stress management was superior to usual care only on some of the measures . CONCLUSIONS Both cognitive behavior therapy and supportive stress management are efficacious for treating depression after coronary artery bypass surgery , relative to usual care . Cognitive behavior therapy had greater and more durable effects than supportive stress management on depression and several secondary psychological outcomes . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00042198 Objective : The Enhancing Recovery in Coronary Heart Disease study was a multicenter clinical trial in which patients with depression and /or low perceived social support after an acute myocardial infa rct ion were r and omly assigned to an intervention consisting of cognitive behavior therapy and , in some cases , sertraline , or to usual care . There was no difference in survival between the groups . A possible reason why the intervention failed to affect survival is that too many patients with mild , transient depression were enrolled . Another is that some patients died too soon to complete the intervention . This analysis evaluates whether there was a difference in late ( ie , ≥6 months after the myocardial infa rct ion ) mortality among initially depressed patients who had a Beck Depression Inventory score ≥10 and a past history of major depression , and who completed the 6-month post-treatment assessment . It also examines the relationship between change in depression and late mortality . Methods : Out of the 1,165 ( 47 % ) of the Enhancing Recovery in Coronary Heart Disease study participants who met our criteria , 57 died  in the first 6 months , and 858 ( 409 usual care , 449 intervention ) completed the 6-month assessment . Cox regression was used to analyze survival . Results : The intervention did not affect late mortality . However , intervention patients whose depression did not improve were at higher risk for late mortality than were patients who responded to treatment . Conclusions : Patients whose depression is refractory to cognitive behavior therapy and sertraline , two st and ard treatments for depression , are at high risk for late mortality after myocardial infa rct ion One hundred fifty-six myocardial infa rct ion patients were r and omly assigned to either exercise plus relaxation and breathing therapy ( treatment A , n = 76 ) or to exercise training only ( treatment B , n = 80 ) . Effects on exercise testing showed a more pronounced training bradycardia and a remarkable improvement in ST abnormalities in treatment A ( p less than 0.005 ) . A model was developed to integrate the various exercise parameters into a single measure for training benefit . Approximately half the patients showed a training success , with a more positive and less negative outcome in treatment A ( p = 0.09 ) . The odds for failure were 0.25 for treatment A and 0.51 for treatment B ( odds ratio : 2.04 ; 95 % confidence interval , 0.94 to 4.6 ) . Thus the risk of failure was reduced by half when relaxation was added to exercise training . These results indicate that exercise training is not successful in all MI patients and that relaxation therapy enhances training benefit Objective Depression is common following an acute cardiac event and can occur at a time when behaviour change is strongly recommended to reduce the risk of further cardiovascular events . The ‘ Beating Heart Problems ’ programme was design ed to support cardiac patients in behaviour change and mood management . Methods The programme was based on cognitive behaviour therapy and motivational interviewing . A r and omized controlled trial ( RCT ) comparing the 8-week group programme with usual care was undertaken between 2007 and 2010 . All patients attended a hospital-based clinic for assessment of physiological risk factors at baseline ( 6 weeks after their acute event ) , and at 4- and 12-month follow up . Psychological and behavioural indicators were assessed by self-report question naires . Of the 275 patients enrolled into the RCT , 42 ( 15 % ) had Beck Depression Inventory-II scores > 13 at baseline . Treatment and control group comparisons were undertaken for this subgroup , using growth curve modelling and testing for group differences over time in psychological , physiological , health behaviour , and self-efficacy measures . Results Significantly greater improvements ( p < 0.01 ) in depression symptoms and self-rated health were reported for the intervention group , as well as significantly larger gains in confidence in managing depression ( p < 0.05 ) and anger ( p < 0.01 ) . Trends ( 0.05 < p < 0.10 ) for larger treatment group improvements were also seen for anxiety symptoms and confidence in managing anxiety . Conclusion A group secondary -prevention programme that integrates behavioural and mood management strategies leads to decreased depression , increased confidence , and improved health perceptions in depressed cardiac patients Background —Blacks have disproportionately high rates of cardiovascular disease . Psychosocial stress may contribute to this disparity . Previous trials on stress reduction with the Transcendental Meditation ( TM ) program have reported improvements in cardiovascular disease risk factors , surrogate end points , and mortality in blacks and other population s. Methods and Results —This was a r and omized , controlled trial of 201 black men and women with coronary heart disease who were r and omized to the TM program or health education .  The primary end point was the composite of all-cause mortality , myocardial infa rct ion , or stroke . Secondary end points included the composite of cardiovascular mortality , revascularizations , and cardiovascular hospitalizations ; blood pressure ; psychosocial stress factors ; and lifestyle behaviors . During an average follow-up of 5.4 years , there was a 48 % risk reduction in the primary end point in the TM group ( hazard ratio , 0.52 ; 95 % confidence interval , 0.29–0.92 ; P=0.025 ) . The TM group also showed a 24 % risk reduction in the secondary end point ( hazard ratio , 0.76 ; 95 % confidence interval , 0.51–0.1.13 ; P=0.17 ) . There were reductions of 4.9 mmHg in systolic blood pressure ( 95 % confidence interval −8.3 to –1.5 mmHg ; P=0.01 ) and anger expression ( P<0.05 for all scales ) . Adherence was associated with survival . Conclusions —A selected mind – body intervention , the TM program , significantly reduced risk for mortality , myocardial infa rct ion , and stroke in coronary heart disease patients . These changes were associated with lower blood pressure and psychosocial stress factors . Therefore , this practice may be clinical ly useful in the secondary prevention of cardiovascular disease . Clinical Trial Registration —URL : www . clinical trials.gov Unique identifier : NCT01299935 The report aims to review the literature and describe the methods used for retention of patients in a clinical study . The Enhanced Recovery in Coronary Heart Disease ( ENRICHD ) trial was a multicenter , r and omized clinical trial design ed to evaluate the effects of a psychosocial intervention on cardiovascular morbidity and mortality . A total of 2481 patients met the criteria for depression , low social support , or both after a myocardial infa rct ion and needed to be followed . Follow-up evaluation consisted of telephone interviews 3 , 9 , 12 , 24 , 36 , and 48 months after enrollment and clinic visits scheduled at 6 , 18 , 30 , 42 , and 54 months . Creative strategies used to achieve optimum retention of this complex patient population over a long follow-up period are presented . Strategies to 
    Output:
    