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: BACKGROUND AND AIMS Psychological interventions are used in patients with inflammatory bowel disease ( IBD ) but there is uncertainty about who the optimal target population is . Multi-convergent therapy ( MCT ) is a form of psychotherapy that combines mindfulness meditation with aspects of cognitive behavioural therapy and has been used in the management of irritable bowel syndrome ( IBS ) . This study aim ed to assess the feasibility and efficacy of MCT in the management of IBD patients with either functional abdominal symptoms or high perceived stress levels . METHODS Sixty-six IBD patients in clinical remission with either IBS-type symptoms or high perceived stress levels were r and omly allocated to a 16-week MCT course or waiting list control group . Patients were followed-up for one year with the Inflammatory Bowel Disease Question naire ( IBDQ ) as the primary outcome measurement . RESULTS A higher mean IBDQ score was observed in the active group compared to controls at the 4-month assessment ( 167 vs. 156 , p=0.081 ) , but this was not statistically significant nor did it reached the predefined clinical ly significant difference of 20 . In patients with IBS-type symptoms at baseline there was a significantly higher mean IBDQ score in the active group compared to controls ( 161 vs. 145 , p=0.021 ) . There was no difference between groups in relapse rate based on faecal calprotectin measurement . CONCLUSIONS IBS-type symptoms in patients with IBD represent a potential therapeutic target to improve quality of life . This study suggests that MCT may be useful in the management of these symptoms but larger studies are required to confirm this . CLINICAL TRIAL REGISTRATION NUMBER NCT01426568 OBJECTIVE A previous r and omised controlled trial demonstrated that a cognitive behavioural therapy ( CBT ) self-management intervention significantly improved  irritable bowel syndrome ( IBS ) symptoms and disability  compared to treatment as usual ( TAU ) . The current study analysed additional data to establish whether ; 1 ) cognitive , behavioural and emotional factors hypothesized to perpetuate IBS symptoms and disability changed following CBT and , 2 ) ascertain if changes in these factors over the intervention period mediated treatment effects 6-months later . METHOD IBS patients ( CBT = 31 , TAU = 33 ) completed measures pre- and -post intervention including : Brief Illness Perception Question naire , Hospital Anxiety & Depression Scale and Cognitive and Behavioural Responses to Symptoms Question naire . Path models were evaluated to determine whether changes in cognitive and behavioural factors over the treatment period mediated treatment effects . RESULTS Compared to TAU , CBT patients showed significant positive changes on several cognitive variables but not anxiety and depression following intervention . Positive change in illness perceptions following intervention mediated the treatment effect on improved IBS symptom severity and social adjustment six months later . Changes in damaging beliefs mediated the effect on social adjustment . CONCLUSIONS Change in cognition rather than mood mediated treatment related improvements . Changing negative perceptions of IBS appears to be a particularly important treatment mechanism Abstract Inflammatory bowel disease ( IBD ) is frequently associated with chronic abdominal pain ( CAP ) . Transcranial direct current stimulation ( tDCS ) has been proven to reduce chronic pain . This study aim ed to investigate the effects of tDCS in patients with CAP due to IBD . This r and omized , sham-controlled , double blind , parallel- design ed study included 20 patients with either Crohn disease or ulcerative colitis with CAP ( ≥3/10 on the visual analog scale ( VAS ) in 3/6 months ) . Anodal or sham tDCS was applied over the primary motor cortex for 5 consecutive days ( 2 mA , 20 minutes ) . Assessment s included VAS , pressure pain threshold , inflammatory markers , and question naires on quality of life , functional and disease specific symptoms ( Irritable Bowel Syndrome – Severity Scoring System [ IBS – SSS ] ) , disease activity , and pain catastrophizing . Follow-up data were collected 1 week after the end of the stimulation . Statistical analyses were performed using analysis of variance and t tests . There was a significant reduction of abdominal pain in the anodal tDCS group compared with sham tDCS . This effect was evident in changes in VAS and pressure pain threshold on the left and right sides of the abdomen . In addition , 1 week after stimulation , pain reduction remained significantly decreased in the right side of the abdomen . There was also a significant reduction in scores on pain catastrophizing and on IBS – SSS when comparing both groups . Inflammatory markers and disease activity did not differ significantly between groups throughout the experiment . Transcranial direct current stimulation proved to be an effective and clinical ly relevant therapeutic strategy for CAP in IBD . The analgesic effects observed are unrelated to inflammation and disease activity , which emphasizes central pain mechanisms in CAP OBJECTIVES Despite the toll of inflammatory bowel disease ( IBD ) on adjustment , many patients are resilient to the challenges associated with living with IBD , and successfully cope with their illness and thrive . Yet there is little research on why some individuals with IBD enter a trajectory of growth , while others may struggle to adapt . The aim of this study was to investigate the adjustment-related factors that distinguished thriving , resilience , and loss in people with IBD across personal growth , life satisfaction , and relationship quality domains . DESIGN Prospect i ve cohort design with two data collection points , 6 months apart . METHODS From a sample of 420 people with active IBD who completed an online survey , 152 participants completed the follow-up survey and were included in the analyses . Participants completed measures of thriving , and cognitive , affective , social , and disease-related variables known to predict adjustment . RESULTS Time 1 ANCOVAs and pairwise comparisons controlling for demographics distinguished loss from resilience and thriving on the four outcomes - coping efficacy , illness acceptance , depressive symptoms , and perceived social support - for all three domains . Time 2 ANCOVAs and pairwise comparisons controlling for baseline outcomes revealed that the Time thriving categories predicted differences in Time 2 adjustment , mainly for the life satisfaction domain , with those experiencing loss reporting poorer adjustment than those experiencing resilience and thriving . CONCLUSIONS Findings highlight the distinctions among profiles of thriving , resilience , and loss in adjustment to IBD , and suggest that strategies that enhance coping and address depressive symptoms may optimize thriving in the context of IBD . Statement of contribution What is already known on this subject ? Inflammatory bowel disease ( IBD ) is associated with depression , poor coping , and stressful symptoms . Previous research has focused mainly on poor adjustment to IBD rather than on positive growth . There is little research on why some patients with IBD thrive or are resilient , while others struggle to adapt . What does this study add ? This study is the first to longitudinally examine the profiles of thriving , resilience , and loss in individuals with IBD . The thriving profiles differed in coping efficacy , illness acceptance , depressive symptoms , and social support outcomes at Time 1 , and predicted adjustment at T2 mainly for the life satisfaction domain . Strategies that enhance coping and social support may optimize thriving in the context of IBD Background Inflammatory bowel disease ( IBD ; Crohn ’s disease , CD and Ulcerative colitis , UC ) and irritable bowel syndrome ( IBS ) have overlapping symptoms . Few prevalence studies of IBS in quiescent IBD have used colonoscopy with histology to confirm inactive disease . The aims were ( 1 ) to determine the percentage of IBD patients in deep remission whose persistent IBS-like symptoms ( IBD/IBS+ ) would cause them to be classified as having active disease , based on the calculation of Harvey Bradshaw Index ( HBI ) or UC disease activity index ( UCDAI ) ; ( 2 ) to identify demographic and disease characteristics that are associated with IBD/IBS+ . Methods This was a prospect i ve study at a single tertiary care IBD center . 96/112 patients with colonoscopy and histology confirmed quiescent disease consented and completed Rome III criteria for IBS Survey  , and the  hospital anxiety and depression scale ( HADS ) . Other demographic and disease specific data were collected . Results 36 % ( 28/77 ) and 37 % ( 7/19 ) of CD and UC patients , respectively , met diagnostic criteria for IBS . Significantly higher HBI/UCDAI scores ( p = 0.005 ) and low short inflammatory bowel disease question naire ( SIBDQ ) scores ( p ≤ 0.0001 ) were seen in IBD/IBS+ patients . 29 % of patients in deep remission were mis-categorized by HBI/UCDAI as having active disease when they fulfilled Rome III criteria for IBS . Psychiatric diagnosis ( OR 3.53 95 % CI 1.2–10.2 ) and earlier onset of IBD ( OR 1.056 95 % CI 1.015–1.096 ) were associated with IBD/IBS+ . Patients fulfilling IBS criteria had higher hospital anxiety and depression scale ( HADS ) . Conclusion IBD/IBS+ affect scoring of IBD disease activity scales and become less useful in guiding treatment plans Objective To evaluate the clinical effectiveness of two modes of cognitive – behavioural therapy ( CBT ) for IBS compared with treatment as usual ( TAU ) in refractory IBS . Design A three-arm r and omised controlled trial assessing telephone-delivered CBT ( TCBT ) , web-based CBT ( WCBT ) with minimal therapist support , and TAU . Blinding participants and therapists was not possible . Chief investigator , assessors and statisticians were blinded . Participants were adults with refractory IBS ( clinical ly significant symptoms for ≥12 months despite first-line therapies ) , recruited by letter and opportunistically from 74 general practice s and three gastroenterology centres in London and South of Engl and between May 2014 to March 2016 . Co- primary outcomes were IBS Symptom Severity Score ( IBS-SSS ) and Work and Social Adjustment Scale ( WSAS ) at 12 months . Results 558/1452 ( 38.4 % ) patients screened for eligibility were r and omised : 76 % female : 91 % white : mean age 43 years . ( 391/558 ) 70.1 % completed 12 months of follow-up . Primary outcomes : Compared with TAU ( IBS-SSS 205.6 at 12 months ) , IBS-SSS was 61.6 ( 95 % CI 33.8 to 89.5 ) points lower ( p<0.001 ) in TCBT and 35.2 ( 95 % CI 12.6 to 57.8 ) points lower ( p=0.002 ) in WCBT at 12 months . Compared with TAU ( WSAS score 10.8 at 12 months ) WSAS was 3.5 ( 95 % CI 1.9 to 5.1 ) points lower ( p<0.001 ) in TCBT and 3.0 ( 95 % CI 1.3 to 4.6 ) points lower ( p=0.001 ) in WCBT . All secondary outcomes showed significantly greater improvement ( p≤0.002 ) in CBT arms compared with TAU . There were no serious adverse reactions to treatment . Conclusion Both CBT interventions were superior to TAU up to 12 months of follow-up . Trial registration number IS RCT N44427879 
    Output:
    
agent
Psychosocial factors associated with pain-related interference included depression , catastrophising , fear avoidance , lower self-efficacy and worse mental well-being .
Conclusions Pain in IBD is significantly associated with cognitive and behavioural factors as well as low mood .
***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: BACKGROUND AND AIMS Psychological interventions are used in patients with inflammatory bowel disease ( IBD ) but there is uncertainty about who the optimal target population is . Multi-convergent therapy ( MCT ) is a form of psychotherapy that combines mindfulness meditation with aspects of cognitive behavioural therapy and has been used in the management of irritable bowel syndrome ( IBS ) . This study aim ed to assess the feasibility and efficacy of MCT in the management of IBD patients with either functional abdominal symptoms or high perceived stress levels . METHODS Sixty-six IBD patients in clinical remission with either IBS-type symptoms or high perceived stress levels were r and omly allocated to a 16-week MCT course or waiting list control group . Patients were followed-up for one year with the Inflammatory Bowel Disease Question naire ( IBDQ ) as the primary outcome measurement . RESULTS A higher mean IBDQ score was observed in the active group compared to controls at the 4-month assessment ( 167 vs. 156 , p=0.081 ) , but this was not statistically significant nor did it reached the predefined clinical ly significant difference of 20 . In patients with IBS-type symptoms at baseline there was a significantly higher mean IBDQ score in the active group compared to controls ( 161 vs. 145 , p=0.021 ) . There was no difference between groups in relapse rate based on faecal calprotectin measurement . CONCLUSIONS IBS-type symptoms in patients with IBD represent a potential therapeutic target to improve quality of life . This study suggests that MCT may be useful in the management of these symptoms but larger studies are required to confirm this . CLINICAL TRIAL REGISTRATION NUMBER NCT01426568 OBJECTIVE A previous r and omised controlled trial demonstrated that a cognitive behavioural therapy ( CBT ) self-management intervention significantly improved  irritable bowel syndrome ( IBS ) symptoms and disability  compared to treatment as usual ( TAU ) . The current study analysed additional data to establish whether ; 1 ) cognitive , behavioural and emotional factors hypothesized to perpetuate IBS symptoms and disability changed following CBT and , 2 ) ascertain if changes in these factors over the intervention period mediated treatment effects 6-months later . METHOD IBS patients ( CBT = 31 , TAU = 33 ) completed measures pre- and -post intervention including : Brief Illness Perception Question naire , Hospital Anxiety & Depression Scale and Cognitive and Behavioural Responses to Symptoms Question naire . Path models were evaluated to determine whether changes in cognitive and behavioural factors over the treatment period mediated treatment effects . RESULTS Compared to TAU , CBT patients showed significant positive changes on several cognitive variables but not anxiety and depression following intervention . Positive change in illness perceptions following intervention mediated the treatment effect on improved IBS symptom severity and social adjustment six months later . Changes in damaging beliefs mediated the effect on social adjustment . CONCLUSIONS Change in cognition rather than mood mediated treatment related improvements . Changing negative perceptions of IBS appears to be a particularly important treatment mechanism Abstract Inflammatory bowel disease ( IBD ) is frequently associated with chronic abdominal pain ( CAP ) . Transcranial direct current stimulation ( tDCS ) has been proven to reduce chronic pain . This study aim ed to investigate the effects of tDCS in patients with CAP due to IBD . This r and omized , sham-controlled , double blind , parallel- design ed study included 20 patients with either Crohn disease or ulcerative colitis with CAP ( ≥3/10 on the visual analog scale ( VAS ) in 3/6 months ) . Anodal or sham tDCS was applied over the primary motor cortex for 5 consecutive days ( 2 mA , 20 minutes ) . Assessment s included VAS , pressure pain threshold , inflammatory markers , and question naires on quality of life , functional and disease specific symptoms ( Irritable Bowel Syndrome – Severity Scoring System [ IBS – SSS ] ) , disease activity , and pain catastrophizing . Follow-up data were collected 1 week after the end of the stimulation . Statistical analyses were performed using analysis of variance and t tests . There was a significant reduction of abdominal pain in the anodal tDCS group compared with sham tDCS . This effect was evident in changes in VAS and pressure pain threshold on the left and right sides of the abdomen . In addition , 1 week after stimulation , pain reduction remained significantly decreased in the right side of the abdomen . There was also a significant reduction in scores on pain catastrophizing and on IBS – SSS when comparing both groups . Inflammatory markers and disease activity did not differ significantly between groups throughout the experiment . Transcranial direct current stimulation proved to be an effective and clinical ly relevant therapeutic strategy for CAP in IBD . The analgesic effects observed are unrelated to inflammation and disease activity , which emphasizes central pain mechanisms in CAP OBJECTIVES Despite the toll of inflammatory bowel disease ( IBD ) on adjustment , many patients are resilient to the challenges associated with living with IBD , and successfully cope with their illness and thrive . Yet there is little research on why some individuals with IBD enter a trajectory of growth , while others may struggle to adapt . The aim of this study was to investigate the adjustment-related factors that distinguished thriving , resilience , and loss in people with IBD across personal growth , life satisfaction , and relationship quality domains . DESIGN Prospect i ve cohort design with two data collection points , 6 months apart . METHODS From a sample of 420 people with active IBD who completed an online survey , 152 participants completed the follow-up survey and were included in the analyses . Participants completed measures of thriving , and cognitive , affective , social , and disease-related variables known to predict adjustment . RESULTS Time 1 ANCOVAs and pairwise comparisons controlling for demographics distinguished loss from resilience and thriving on the four outcomes - coping efficacy , illness acceptance , depressive symptoms , and perceived social support - for all three domains . Time 2 ANCOVAs and pairwise comparisons controlling for baseline outcomes revealed that the Time thriving categories predicted differences in Time 2 adjustment , mainly for the life satisfaction domain , with those experiencing loss reporting poorer adjustment than those experiencing resilience and thriving . CONCLUSIONS Findings highlight the distinctions among profiles of thriving , resilience , and loss in adjustment to IBD , and suggest that strategies that enhance coping and address depressive symptoms may optimize thriving in the context of IBD . Statement of contribution What is already known on this subject ? Inflammatory bowel disease ( IBD ) is associated with depression , poor coping , and stressful symptoms . Previous research has focused mainly on poor adjustment to IBD rather than on positive growth . There is little research on why some patients with IBD thrive or are resilient , while others struggle to adapt . What does this study add ? This study is the first to longitudinally examine the profiles of thriving , resilience , and loss in individuals with IBD . The thriving profiles differed in coping efficacy , illness acceptance , depressive symptoms , and social support outcomes at Time 1 , and predicted adjustment at T2 mainly for the life satisfaction domain . Strategies that enhance coping and social support may optimize thriving in the context of IBD Background Inflammatory bowel disease ( IBD ; Crohn ’s disease , CD and Ulcerative colitis , UC ) and irritable bowel syndrome ( IBS ) have overlapping symptoms . Few prevalence studies of IBS in quiescent IBD have used colonoscopy with histology to confirm inactive disease . The aims were ( 1 ) to determine the percentage of IBD patients in deep remission whose persistent IBS-like symptoms ( IBD/IBS+ ) would cause them to be classified as having active disease , based on the calculation of Harvey Bradshaw Index ( HBI ) or UC disease activity index ( UCDAI ) ; ( 2 ) to identify demographic and disease characteristics that are associated with IBD/IBS+ . Methods This was a prospect i ve study at a single tertiary care IBD center . 96/112 patients with colonoscopy and histology confirmed quiescent disease consented and completed Rome III criteria for IBS Survey  , and the  hospital anxiety and depression scale ( HADS ) . Other demographic and disease specific data were collected . Results 36 % ( 28/77 ) and 37 % ( 7/19 ) of CD and UC patients , respectively , met diagnostic criteria for IBS . Significantly higher HBI/UCDAI scores ( p = 0.005 ) and low short inflammatory bowel disease question naire ( SIBDQ ) scores ( p ≤ 0.0001 ) were seen in IBD/IBS+ patients . 29 % of patients in deep remission were mis-categorized by HBI/UCDAI as having active disease when they fulfilled Rome III criteria for IBS . Psychiatric diagnosis ( OR 3.53 95 % CI 1.2–10.2 ) and earlier onset of IBD ( OR 1.056 95 % CI 1.015–1.096 ) were associated with IBD/IBS+ . Patients fulfilling IBS criteria had higher hospital anxiety and depression scale ( HADS ) . Conclusion IBD/IBS+ affect scoring of IBD disease activity scales and become less useful in guiding treatment plans Objective To evaluate the clinical effectiveness of two modes of cognitive – behavioural therapy ( CBT ) for IBS compared with treatment as usual ( TAU ) in refractory IBS . Design A three-arm r and omised controlled trial assessing telephone-delivered CBT ( TCBT ) , web-based CBT ( WCBT ) with minimal therapist support , and TAU . Blinding participants and therapists was not possible . Chief investigator , assessors and statisticians were blinded . Participants were adults with refractory IBS ( clinical ly significant symptoms for ≥12 months despite first-line therapies ) , recruited by letter and opportunistically from 74 general practice s and three gastroenterology centres in London and South of Engl and between May 2014 to March 2016 . Co- primary outcomes were IBS Symptom Severity Score ( IBS-SSS ) and Work and Social Adjustment Scale ( WSAS ) at 12 months . Results 558/1452 ( 38.4 % ) patients screened for eligibility were r and omised : 76 % female : 91 % white : mean age 43 years . ( 391/558 ) 70.1 % completed 12 months of follow-up . Primary outcomes : Compared with TAU ( IBS-SSS 205.6 at 12 months ) , IBS-SSS was 61.6 ( 95 % CI 33.8 to 89.5 ) points lower ( p<0.001 ) in TCBT and 35.2 ( 95 % CI 12.6 to 57.8 ) points lower ( p=0.002 ) in WCBT at 12 months . Compared with TAU ( WSAS score 10.8 at 12 months ) WSAS was 3.5 ( 95 % CI 1.9 to 5.1 ) points lower ( p<0.001 ) in TCBT and 3.0 ( 95 % CI 1.3 to 4.6 ) points lower ( p=0.001 ) in WCBT . All secondary outcomes showed significantly greater improvement ( p≤0.002 ) in CBT arms compared with TAU . There were no serious adverse reactions to treatment . Conclusion Both CBT interventions were superior to TAU up to 12 months of follow-up . Trial registration number IS RCT N44427879 
    Output:
    