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: Although Post-traumatic Stress Disorder ( PTSD ) is common among patients seeking care at medical clinics , little is known about the performance of screening instruments for this disorder in these setting s. Previous studies of acute trauma population s using the  PTSD Checklist ( PCL )  have suggested that scores of 45 - 50 provide the best discrimination between cases and noncases . We gave the PCL  to 1,225 r and omly selected women enrolled in an HMO . After interviewing a sample of 261 of these women using a structured , clinician-administered PTSD interview , we compared the results of the PCL to the clinician interviews over a range of possible cut scores using Receiver Operating Characteristic analysis . The optimum balance of sensitivity and specificity for this population was a score of 30 , yielding a sensitivity of.82 and specificity of.76 . The positive and negative likelihood ratios for this cut score were 3.40 and 0.24 , respectively . By comparison , the use of 45 as a cut score would result in very low sensitivity ( .36 ) in this setting . The lower cut score found in this study may indicate that the use of previously published cut scores of 45 - 50 may not optimize the function of the PCL as a screening tool outside of acute trauma setting s due to an unacceptably high number of false negative cases OBJECTIVE To examine posttraumatic stress disorder ( PTSD ) in mothers of survivors of childhood cancer . Comorbidity of anxiety and depressive disorders , prevalence of sub clinical PTSD , and the utility of a self-report measure as a screening instrument for PTSD were also investigated . METHOD Mothers ( n = 65 ) completed a question naire self-report PTSD checklist ( PCL-C ) .  Mothers were administered several modules of the SCID : nonpatient edition by telephone , including the PTSD , Generalized Anxiety , and Major Depressive Disorder modules . RESULTS We diagnosed 6.2 % of the sample with current PTSD . An additional 20 % had sub clinical PTSD . One of four mothers with PTSD diagnoses had a comorbid diagnosis of an anxiety and depressive disorder . The PCL-C evidence d diagnostic utility as a screening instrument . However , a moderate number of false-positives would result if the recommended cut-off on the instrument was used . CONCLUSIONS The PCL-C had diagnostic utility in screening mothers of childhood cancer survivors . The presence of comorbid diagnoses such as anxiety and depression should be examined We examined the psychometric properties of the  PTSD Checklist ( PCL ) , a self-report instrument design ed to assess symptoms of posttraumatic stress disorder . Three hundred ninety-two participants recruited in a university setting completed the PCL in addition to several well-established self-report instruments design ed to assess various forms of psychopathology ( e.g. , depression , general anxiety , PTSD ) . Ninety participants returned for readministration of selected measures . Findings provided support for psychometric properties of the PCL  , including internal consistency , test – retest reliability , convergent validity , and discriminant validity . Additional strengths of the PCL are discussed PURPOSE This article evaluates the comparability of the telephone and in-person Structured Clinical Interview for DSM-IV ( SCID ) interviews in assessing patients with social anxiety disorder ( SAD ) as an independent anxiety diagnosis . DESIGN AND METHODS One hundred subjects were r and omly selected and interviewed with the SCID , once by telephone and once in person ( 1 - 3 months later ) . FINDINGS The prevalence of SAD assessed with the telephone interviews was 56 % , whereas the in-person prevalence was 52 % , with no statistically significant difference . The test-retest kappa for the 200 interviews was .84 , indication of excellent agreement . PRACTICE IMPLICATION S These findings , along with the existing evidence of their validity , should encourage the use of SCID by telephone for SAD diagnostic interviews The SCID was administered twice , once by telephone and once in person ( 1 week later ) to 41 college age men . For major depression ( lifetime K = .64 , current K = .66 ) , results indicated good agreement . The lifetime occurrence estimate based on the telephone SCID diagnosis was lower than the in-person SCID estimate . Kappas for specific diagnoses were calculable for simple phobia ( lifetime K = .47 , current K = -.03 ) and social phobia ( lifetime K = .29 ) . Base rates were less than 10 % for all individual diagnoses except lifetime major depression ; therefore , the kappas may be unstable . For all diagnoses where there were any positive cases , percentages of negative agreement and specificity were high , whereas percentages of positive agreement and sensitivity were lower . Overall agreement was fair for specific lifetime diagnoses but poor for current diagnoses . These results suggest caution in assuming comparability of in-person and telephone SCID diagnoses . Circumstances under which a telephone SCID may be useful and ways to improve reliability are discussed OBJECTIVE This study assessed the psychopathological effects of combat in veterans with and without combat stress reaction . METHOD Veterans ( N=214 ) from the 1982 Lebanon War were assessed in a prospect i ve longitudinal design : 131 suffered from combat stress reaction during the war , and 83 did not . They were evaluated 1 , 2 , 3 , and 20 years after the war . RESULTS Combat stress reaction is an important vulnerability marker . Veterans with combat stress reaction were 6.6 times more likely to endorse posttraumatic stress disorder ( PTSD ) at all four measurements , their PTSD was more severe , and they were at increased risk for exacerbation/reactivation . A qualitative analysis of the profile of PTSD symptoms revealed some time-related changes in the symptom configuration of veterans who did not suffer from combat stress reaction . In both groups , the course fluctuated ; PTSD rates dropped 3 years postwar and rose again 17 years later ; 23 % of veterans without combat stress reaction reported delayed PTSD . CONCLUSIONS These findings suggest that the detrimental effects of combat are deep and enduring and follow a complex course , especially in combat stress reaction casualties . The implication s of aging and ongoing terror in impeding recovery from the psychological wounds of war are discussed PTSD affects a substantial number of women in medical setting s and is associated with significant distress and impairment . There are effective methods of treating trauma-related distress , but a minority seek such care . Thus , primary care is an important setting in which to identify individuals with PTSD . We sent question naires , including the  PTSD Checklist — Civilian Version ( PCL-C )  , to 419 female veterans who were seen in our primary care clinic in 1998 ; 56 % ( N = 221 ) returned the measures . A r and om subset ( n = 49 ) was interviewed to establish psychiatric diagnoses . The results provide qualified support for the use of the PCL-C total score with a lowered cutoff score as a screening measure for PTSD in female veterans in primary care RATIONALE AND OBJECTIVES Quality Assessment of Diagnostic Accuracy Studies ( QUADAS ) is a new tool to measure the method ological quality of diagnostic accuracy studies in systematic review s. We used data from a systematic review of magnetic resonance spectroscopy ( MRS ) in the characterization of suspected brain tumors to provide a preliminary evaluation of the inter-rater reliability of QUADAS . MATERIAL S AND METHODS A structured literature search identified 19 diagnostic accuracy studies . These publications were distributed r and omly to primary and secondary review ers for dual independent assessment . Review ers recorded method ological quality by using QUADAS on a custom- design ed spreadsheet . We calculated correlation , percentage of agreement , and kappa statistic to assess inter-rater reliability . RESULTS Most studies in our review were judged to have used an accurate reference st and ard . Conversely , the MRS literature frequently failed to specify the length of time between index and reference tests or that the clinicians were unaware of the index test findings when reporting the reference st and ard . There was good correlation ( rho = 0.78 ) between review ers in assessment of the overall number of quality criteria met . However , mean agreement for individual QUADAS questions was only fair ( kappa = 0.22 ) and ranged from no agreement beyond chance ( kappa < 0 ) to moderate agreement ( kappa = 0.58 ) . CONCLUSION Inter-rater reliability in our study was relatively low . Nevertheless , we believe that QUADAS potentially is a useful tool for highlighting the strengths and weaknesses of existing diagnostic accuracy studies . Low reliability suggests that different review ers will reach different conclusions if QUADAS is used to exclude " low- quality " articles from meta-analyses . We discuss methods for improving the validity and reliability of QUADAS 
    Output:
    
agent
Findings indicated that although studies generally met st and ards in several quality areas , there is still room for improvement .
Areas for improvement include establishing representativeness , adequately describing clinical and demographic characteristics of the sample , and presenting better descriptions of important aspects of test and reference st and ard execution .
In addition , study quality has not appreciably improved since the publication of the STARD Statement in 2003 .
***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: Although Post-traumatic Stress Disorder ( PTSD ) is common among patients seeking care at medical clinics , little is known about the performance of screening instruments for this disorder in these setting s. Previous studies of acute trauma population s using the  PTSD Checklist ( PCL )  have suggested that scores of 45 - 50 provide the best discrimination between cases and noncases . We gave the PCL  to 1,225 r and omly selected women enrolled in an HMO . After interviewing a sample of 261 of these women using a structured , clinician-administered PTSD interview , we compared the results of the PCL to the clinician interviews over a range of possible cut scores using Receiver Operating Characteristic analysis . The optimum balance of sensitivity and specificity for this population was a score of 30 , yielding a sensitivity of.82 and specificity of.76 . The positive and negative likelihood ratios for this cut score were 3.40 and 0.24 , respectively . By comparison , the use of 45 as a cut score would result in very low sensitivity ( .36 ) in this setting . The lower cut score found in this study may indicate that the use of previously published cut scores of 45 - 50 may not optimize the function of the PCL as a screening tool outside of acute trauma setting s due to an unacceptably high number of false negative cases OBJECTIVE To examine posttraumatic stress disorder ( PTSD ) in mothers of survivors of childhood cancer . Comorbidity of anxiety and depressive disorders , prevalence of sub clinical PTSD , and the utility of a self-report measure as a screening instrument for PTSD were also investigated . METHOD Mothers ( n = 65 ) completed a question naire self-report PTSD checklist ( PCL-C ) .  Mothers were administered several modules of the SCID : nonpatient edition by telephone , including the PTSD , Generalized Anxiety , and Major Depressive Disorder modules . RESULTS We diagnosed 6.2 % of the sample with current PTSD . An additional 20 % had sub clinical PTSD . One of four mothers with PTSD diagnoses had a comorbid diagnosis of an anxiety and depressive disorder . The PCL-C evidence d diagnostic utility as a screening instrument . However , a moderate number of false-positives would result if the recommended cut-off on the instrument was used . CONCLUSIONS The PCL-C had diagnostic utility in screening mothers of childhood cancer survivors . The presence of comorbid diagnoses such as anxiety and depression should be examined We examined the psychometric properties of the  PTSD Checklist ( PCL ) , a self-report instrument design ed to assess symptoms of posttraumatic stress disorder . Three hundred ninety-two participants recruited in a university setting completed the PCL in addition to several well-established self-report instruments design ed to assess various forms of psychopathology ( e.g. , depression , general anxiety , PTSD ) . Ninety participants returned for readministration of selected measures . Findings provided support for psychometric properties of the PCL  , including internal consistency , test – retest reliability , convergent validity , and discriminant validity . Additional strengths of the PCL are discussed PURPOSE This article evaluates the comparability of the telephone and in-person Structured Clinical Interview for DSM-IV ( SCID ) interviews in assessing patients with social anxiety disorder ( SAD ) as an independent anxiety diagnosis . DESIGN AND METHODS One hundred subjects were r and omly selected and interviewed with the SCID , once by telephone and once in person ( 1 - 3 months later ) . FINDINGS The prevalence of SAD assessed with the telephone interviews was 56 % , whereas the in-person prevalence was 52 % , with no statistically significant difference . The test-retest kappa for the 200 interviews was .84 , indication of excellent agreement . PRACTICE IMPLICATION S These findings , along with the existing evidence of their validity , should encourage the use of SCID by telephone for SAD diagnostic interviews The SCID was administered twice , once by telephone and once in person ( 1 week later ) to 41 college age men . For major depression ( lifetime K = .64 , current K = .66 ) , results indicated good agreement . The lifetime occurrence estimate based on the telephone SCID diagnosis was lower than the in-person SCID estimate . Kappas for specific diagnoses were calculable for simple phobia ( lifetime K = .47 , current K = -.03 ) and social phobia ( lifetime K = .29 ) . Base rates were less than 10 % for all individual diagnoses except lifetime major depression ; therefore , the kappas may be unstable . For all diagnoses where there were any positive cases , percentages of negative agreement and specificity were high , whereas percentages of positive agreement and sensitivity were lower . Overall agreement was fair for specific lifetime diagnoses but poor for current diagnoses . These results suggest caution in assuming comparability of in-person and telephone SCID diagnoses . Circumstances under which a telephone SCID may be useful and ways to improve reliability are discussed OBJECTIVE This study assessed the psychopathological effects of combat in veterans with and without combat stress reaction . METHOD Veterans ( N=214 ) from the 1982 Lebanon War were assessed in a prospect i ve longitudinal design : 131 suffered from combat stress reaction during the war , and 83 did not . They were evaluated 1 , 2 , 3 , and 20 years after the war . RESULTS Combat stress reaction is an important vulnerability marker . Veterans with combat stress reaction were 6.6 times more likely to endorse posttraumatic stress disorder ( PTSD ) at all four measurements , their PTSD was more severe , and they were at increased risk for exacerbation/reactivation . A qualitative analysis of the profile of PTSD symptoms revealed some time-related changes in the symptom configuration of veterans who did not suffer from combat stress reaction . In both groups , the course fluctuated ; PTSD rates dropped 3 years postwar and rose again 17 years later ; 23 % of veterans without combat stress reaction reported delayed PTSD . CONCLUSIONS These findings suggest that the detrimental effects of combat are deep and enduring and follow a complex course , especially in combat stress reaction casualties . The implication s of aging and ongoing terror in impeding recovery from the psychological wounds of war are discussed PTSD affects a substantial number of women in medical setting s and is associated with significant distress and impairment . There are effective methods of treating trauma-related distress , but a minority seek such care . Thus , primary care is an important setting in which to identify individuals with PTSD . We sent question naires , including the  PTSD Checklist — Civilian Version ( PCL-C )  , to 419 female veterans who were seen in our primary care clinic in 1998 ; 56 % ( N = 221 ) returned the measures . A r and om subset ( n = 49 ) was interviewed to establish psychiatric diagnoses . The results provide qualified support for the use of the PCL-C total score with a lowered cutoff score as a screening measure for PTSD in female veterans in primary care RATIONALE AND OBJECTIVES Quality Assessment of Diagnostic Accuracy Studies ( QUADAS ) is a new tool to measure the method ological quality of diagnostic accuracy studies in systematic review s. We used data from a systematic review of magnetic resonance spectroscopy ( MRS ) in the characterization of suspected brain tumors to provide a preliminary evaluation of the inter-rater reliability of QUADAS . MATERIAL S AND METHODS A structured literature search identified 19 diagnostic accuracy studies . These publications were distributed r and omly to primary and secondary review ers for dual independent assessment . Review ers recorded method ological quality by using QUADAS on a custom- design ed spreadsheet . We calculated correlation , percentage of agreement , and kappa statistic to assess inter-rater reliability . RESULTS Most studies in our review were judged to have used an accurate reference st and ard . Conversely , the MRS literature frequently failed to specify the length of time between index and reference tests or that the clinicians were unaware of the index test findings when reporting the reference st and ard . There was good correlation ( rho = 0.78 ) between review ers in assessment of the overall number of quality criteria met . However , mean agreement for individual QUADAS questions was only fair ( kappa = 0.22 ) and ranged from no agreement beyond chance ( kappa < 0 ) to moderate agreement ( kappa = 0.58 ) . CONCLUSION Inter-rater reliability in our study was relatively low . Nevertheless , we believe that QUADAS potentially is a useful tool for highlighting the strengths and weaknesses of existing diagnostic accuracy studies . Low reliability suggests that different review ers will reach different conclusions if QUADAS is used to exclude " low- quality " articles from meta-analyses . We discuss methods for improving the validity and reliability of QUADAS 
    Output:
    