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: This r and omized controlled trial was design ed to determine whether practising stress management techniques would decrease activity and promote psychosocial functioning in inflammatory bowel disease patients . Eighty ambulatory adults received a pre-intervention interview , at which time baseline data about disease activity and psychosocial functioning were collected . They were then r and omly assigned to either the intervention or control group . The intervention group received six classes on stress management which included autogenics , personal planning skills and communication techniques . All 80 subjects were followed up at 4-month intervals for 1 year by interviewers who were blind to group design ation . The data collection instruments , which were used at all assessment points , comprised three question naires : the Crohn 's Disease Activity Index ( CDAI ) and the Inflammatory Bowel Disease ( IBD ) Stress Index . These instruments produced scores which decreased with improvement in physical and psychosocial well-being . At all assessment points , both the CDAI and IBD Stress Index scores dropped significantly ( P less than 0.05 ) from baseline in the treatment group . However , there was no significant change in the scores of the control group throughout the study year . There were no significant changes in medications at any assessment point in either group that could account for changes in the scores . The results of this study indicate that stress management techniques may have therapeutic benefits for IBD patients OBJECTIVE Few studies have been published on the influence of psychotherapy on the physical and psychosocial course of Crohn 's disease ( CD ) . METHODS The present study , a prospect i ve , r and omized multicenter investigation conducted with 108 of 488 consecutive CD patients , was design ed to investigate the influence of short-term psychodynamic therapy and relaxation in addition to a st and ardized glucocorticoid therapy on the somatic course of the disease as well as on patient psychosocial status . Based on the same st and ardized somatic treatment , the psychotherapy and control groups were compared after a 1-year treatment period and a follow-up of another year with regard to somatic course and psychosocial situation . RESULTS A total of 81 ( 75 % ) of 108 r and omized patients completed the psychosocial follow-up . The comparison between the therapy groups after 1 year showed no significant differences in the four main target criteria of psychosocial status ( depression , anxiety , psychosocial-communicative status and health-related quality of life ) . The mean Beck 's Depression Inventory ( BDI ) score at admission was 12.3 in the psychotherapy group and 8.7 in the control group . At the 1-year follow-up , the scores for depression have been 7.8 ( psychotherapy group ) and 7.8 ( control group ) . In the 2-year follow-up , 84 patients were classified into four groups on the basis of somatic course ; 23 % of the control group and 30 % of the psychotherapy group showed episode-free courses , 29 % and 17 % respectively underwent surgery due to failure of immunosuppressive or medical therapy , and a further subranking showed no significant differences between the two groups ( P=.125 ) . At the 1-year follow-up , the scores for depression of patients with an active episode respective remission were 14.6 vs. 5.8 . From the patient 's point of view , at the end of the 2-year follow-up , the overall subjective evaluation of the effectiveness of psychotherapy  was positive . CONCLUSION The patients included showed no psychosocial disturbances of clinical relevance . Although a tendency toward fewer surgical interventions , fewer relapses and reduction of depression was noted , the analysis was unable to demonstrate any benefit from psychosocial intervention on hypothesized parameters of psychosocial status and somatic course . Further studies should be performed to identify patient subgroups that may benefit from psychosocial intervention BACKGROUND Our aim was to study the influence of psychotherapy in addition to a st and ardized corticosteroid treatment on the somatic and psychosocial course of Crohn 's disease . METHODS In a prospect i ve , r and omized multicenter study 108 of 488 patients received either drug treatment  or , in the intervention group , additionally psychotherapy in the first half of the 2-year follow-up period . RESULTS Eighty-four patients ( 77.8 % ) completed the somatic and 81 ( 75 % ) the psychosocial follow-up . Twenty-three per cent of the control group and 30 % of the psychotherapy group showed episode-free courses ; 29 % and 17 % , respectively , underwent surgery due to failure of drug treatment . The main analysis , which was based on subranking by number , duration , and severity of relapses , failed to show significant differences between the two groups ( P = 0.125 ) . The same result was obtained for the psychosocial status after 1 year in the main target criteria depression , anxiety , psychosocio-communicative status , and quality of life . CONCLUSIONS The confirmatory analysis did not prove significantly better courses after additional psychotherapy . There was a tendency towards fewer operations Objective . To analyze the effects of a comprehensive lifestyle modification program on health-related quality -of-life , psychological distress , and clinical parameters in patients with ulcerative colitis ( UC ) 3- and 12 months after completion of the program . Material and methods . Sixty patients with UC in clinical remission or with low disease activity were r and omly assigned to an intervention group or a usual-care control group . Comprehensive lifestyle modification consisted of a structured 60-h training program over a period of 10 weeks which included stress management training , psychoeducational elements , and self-care strategies .  Quality -of-life , psychological distress , and clinical disease activity were assessed with st and ardized question naires ( Inflammatory Bowel Disease Question naire ( IBDQ ) ; the MOS Short-Form 36 ( SF-36 ) ; the Brief Symptom Inventory ( BSI ) , and the Colitis Activity Index ( CAI ) ) at baseline , and 3 months and 12 months after comprehensive lifestyle modification . Results . Three months after comprehensive lifestyle modification , patients in the intervention group showed significantly greater improvement in the SF-36 scale physical function ( p=0.0175 ) , and a significantly greater reduction in anxiety scores , measured with the BSI ( p=0.0294 ) . Use of relaxation techniques was a significant predictor of improvement in the psychological sum score after 3 months of therapy ( p=0.034 ) . Though 80 % of patients with an initial IBDQ score < 170 in the intervention group showed an improvement of > 16 points after 3 months , no significant effects of the intervention were found on the IBDQ scales , or on clinical disease parameters , including CAI scores , self-assessed disease activity , hospitalizations , or medical consultations . Conclusions . These results are consistent with possible short-term benefits of a comprehensive lifestyle modification program on some aspects of quality -of-life and emotional well-being , but no effects were discernable 12 months after completion of therapy . Comprehensive lifestyle modification had no effect on clinical disease variables . The generalizability of these data is limited because of the inclusion of patients with a relatively low disease activity who were interested in integrative medicine OBJECTIVE : We sought to determine whether psychosocial factors influence the course of ulcerative colitis , hypothesizing that high perceived stress among patients with inactive disease will increase the risk of subsequent exacerbation . METHODS : Sixty-two patients with known ulcerative colitis were enrolled into a prospect i ve cohort study while in clinical remission . Their perceived stress , depressive symptoms , and stressful life events  were followed , along with potential confounders , for up to 45 months ; exacerbation status was monitored for up to 68 months . RESULTS : The 27 patients who experienced an exacerbation were compared with those who remained in remission . Having a score in the upper tertile on the long-term ( past 2 yr ) baseline Perceived Stress Question naire significantly increased the actuarial risk of exacerbation ( hazards ratio = 2.8 , 95 % confidence interval 1.1–7.2 ) . At any given study visit , high long-term stress tripled the risk of exacerbation during the next 8 months ( risk for the three tertiles , 8.3 % , 16.7 % , and 26.2 % , p = 0.02 ) . Shorter sleep time , briefer remission , histological activity , and use of nonsteroidal antiinflammatory drugs , antibiotics , or oral contraceptives also increased the medium- and /or long-term risk of exacerbation , but adjustment for these variables did not eliminate the associations with stress . Exacerbation was not associated with stressful life events , depressive symptoms , short-term ( past month ) perceived stress , smoking , disease extent or duration , or severity of recent course . CONCLUSIONS : Short-term stress does not trigger exacerbation in ulcerative colitis , but long-term perceived stress increases the risk of exacerbation over a period of months to years Background : Improving access is a key policy issue in improving quality of care and extending patient choice and participation . People ’s experience of changing from fixed outpatient appointments to more flexible direct access arrangements for chronic disease has been underexplored . Objectives : To examine patients ’ views on using an open system of access compared with fixed outpatient appointments as part of a guided self-management intervention for inflammatory bowel disease ( IBD ) . Design : Embedded qualitative study undertaken alongside a r and omised controlled trial . Semi-structured interviews were undertaken to obtain an in depth underst and ing of patients ’ experience of the change in access arrangements . Participants : A purposive sample ( n = 30 ) was drawn from the intervention group ( n = 700 ) according to a range of responses to the trial baseline and follow up quantitative measures . Results : 28 interviews were included in the analysis . Compared with the previous system of fixed appointments , preference for the new open access system was based on enhanced personal control in contacting services and the view that it fitted better with everyday routine management and the requirement for urgent medical contact when symptoms fail to respond to medication . Preference for retaining fixed appointments was based on a sense of security from gaining access which did not require the individual to initiate the request for medical help . Conclusions : Open access may fit better with patients ’ self-management of their condition and everyday routines , roles and responsibilities . Ensuring that outpatient organisational arrangements and personnel are responsive to patient initiated requests for appointments is likely to impact on the acceptability of this type of access arrangement . Some people may continue to prefer the fixed appointment system which should be retained if patient choice is to be respected Inflammatory bowel disease ( IBD ) encompasses two related gastrointestinal-tract diseases , ulcerative colitis ( UC ) and Crohn 's Disease ( CD ) . This study , a r and omized controlled trial , compared the effectiveness of a multi-component behavioral treatment package ( n = 11 ) , which included IBD education , progressive muscle relaxation , thermal biofeedback , and training in use of cognitive coping strategies , to the effectiveness of symptom-monitoring ( n = 10 ) as a control condition ; 8 controls subsequently completed treatment . At posttreatment , the treatment group showed mean reductions on 5 symptoms , while the symptom monitoring controls showed mean reductions on all 8 symptoms . On a measure of Total Symptomatic change , the controls showed more improvement than the treated group ; the treated controls at posttreatment , showed increases on all 8 symptoms . However , treated subjects perceived themselves as coping better with IBD , as feeling less IBD-related stress , and as experiencing less depression and anxiety . It is hypothesized that inherent differences may have existed between CD and UC subjects which could have led to the differences seen in treatment responses OBJECTIVE : The aim of this study was to develop a valid and reliable question naire assessing patient knowledge of inflammatory bowel disease ( IBD ) and its treatment — the Crohn 's and Colitis Knowledge ( CCKNOW ) Score . METHODS : A total of 30 multiple choice questions were constructed into a draft question naire . This was piloted on a r and om selection of participants with differing IBD knowledge levels ; junior doctors , nurses , and ward clerks . Factor analysis eliminated questions with poor discriminant ability . The result ing 24-item question naire ( CCKNOW score )  was retested on the three groups , and a Kruskal-Wallis test determined the question naire 's ability to discriminate between the groups . Reliability and readability were tested using Cronbach 's α and the Flesch Kincaid reading score . The vali date d CCKNOW was then tested on patients from the Leicestershire IBD data base . RESULTS : CCKNOW scores differed significantly across the groups of doctors , nurses , and ward clerks ( median 22 , 16 , and five , respectively ) T = 40.35 , p < 0.0001 . The reliability was very good with a Cronbach 's α of 0.95 and the readability was also high . The median score on the CCKNOW  for IBD patients was 10 , with no significant difference between ulcerative colitis and Crohn 's disease . Patients who are members of NACC ( National Association of Crohn 's and Colitis ) achieve statistically significantly higher scores than do nonmembers ( difference in medians 4 , 95 % confidence interval 4–6 , p < 0.0001 ) . CONCLUSIONS : The CCKNOW score provides a valuable index of overall knowledge . It is self-administered and psychometric tests show it to be valid , reliable , and readable . It may be used in the future as a tool to evaluate patient education programs OBJECTIVES To determine if a whole systems approach to self-management improves clinical outcomes and leads to cost-effective use of NHS services . DESIGN Nineteen hospitals were r and omised to 10 control sites and nine intervention sites . Consultants from intervention sites received training in patient-centred care before recruitment and introduced the intervention to eligible patients . Patients at the control sites were rec 
    Output:
    
agent
***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: This r and omized controlled trial was design ed to determine whether practising stress management techniques would decrease activity and promote psychosocial functioning in inflammatory bowel disease patients . Eighty ambulatory adults received a pre-intervention interview , at which time baseline data about disease activity and psychosocial functioning were collected . They were then r and omly assigned to either the intervention or control group . The intervention group received six classes on stress management which included autogenics , personal planning skills and communication techniques . All 80 subjects were followed up at 4-month intervals for 1 year by interviewers who were blind to group design ation . The data collection instruments , which were used at all assessment points , comprised three question naires : the Crohn 's Disease Activity Index ( CDAI ) and the Inflammatory Bowel Disease ( IBD ) Stress Index . These instruments produced scores which decreased with improvement in physical and psychosocial well-being . At all assessment points , both the CDAI and IBD Stress Index scores dropped significantly ( P less than 0.05 ) from baseline in the treatment group . However , there was no significant change in the scores of the control group throughout the study year . There were no significant changes in medications at any assessment point in either group that could account for changes in the scores . The results of this study indicate that stress management techniques may have therapeutic benefits for IBD patients OBJECTIVE Few studies have been published on the influence of psychotherapy on the physical and psychosocial course of Crohn 's disease ( CD ) . METHODS The present study , a prospect i ve , r and omized multicenter investigation conducted with 108 of 488 consecutive CD patients , was design ed to investigate the influence of short-term psychodynamic therapy and relaxation in addition to a st and ardized glucocorticoid therapy on the somatic course of the disease as well as on patient psychosocial status . Based on the same st and ardized somatic treatment , the psychotherapy and control groups were compared after a 1-year treatment period and a follow-up of another year with regard to somatic course and psychosocial situation . RESULTS A total of 81 ( 75 % ) of 108 r and omized patients completed the psychosocial follow-up . The comparison between the therapy groups after 1 year showed no significant differences in the four main target criteria of psychosocial status ( depression , anxiety , psychosocial-communicative status and health-related quality of life ) . The mean Beck 's Depression Inventory ( BDI ) score at admission was 12.3 in the psychotherapy group and 8.7 in the control group . At the 1-year follow-up , the scores for depression have been 7.8 ( psychotherapy group ) and 7.8 ( control group ) . In the 2-year follow-up , 84 patients were classified into four groups on the basis of somatic course ; 23 % of the control group and 30 % of the psychotherapy group showed episode-free courses , 29 % and 17 % respectively underwent surgery due to failure of immunosuppressive or medical therapy , and a further subranking showed no significant differences between the two groups ( P=.125 ) . At the 1-year follow-up , the scores for depression of patients with an active episode respective remission were 14.6 vs. 5.8 . From the patient 's point of view , at the end of the 2-year follow-up , the overall subjective evaluation of the effectiveness of psychotherapy  was positive . CONCLUSION The patients included showed no psychosocial disturbances of clinical relevance . Although a tendency toward fewer surgical interventions , fewer relapses and reduction of depression was noted , the analysis was unable to demonstrate any benefit from psychosocial intervention on hypothesized parameters of psychosocial status and somatic course . Further studies should be performed to identify patient subgroups that may benefit from psychosocial intervention BACKGROUND Our aim was to study the influence of psychotherapy in addition to a st and ardized corticosteroid treatment on the somatic and psychosocial course of Crohn 's disease . METHODS In a prospect i ve , r and omized multicenter study 108 of 488 patients received either drug treatment  or , in the intervention group , additionally psychotherapy in the first half of the 2-year follow-up period . RESULTS Eighty-four patients ( 77.8 % ) completed the somatic and 81 ( 75 % ) the psychosocial follow-up . Twenty-three per cent of the control group and 30 % of the psychotherapy group showed episode-free courses ; 29 % and 17 % , respectively , underwent surgery due to failure of drug treatment . The main analysis , which was based on subranking by number , duration , and severity of relapses , failed to show significant differences between the two groups ( P = 0.125 ) . The same result was obtained for the psychosocial status after 1 year in the main target criteria depression , anxiety , psychosocio-communicative status , and quality of life . CONCLUSIONS The confirmatory analysis did not prove significantly better courses after additional psychotherapy . There was a tendency towards fewer operations Objective . To analyze the effects of a comprehensive lifestyle modification program on health-related quality -of-life , psychological distress , and clinical parameters in patients with ulcerative colitis ( UC ) 3- and 12 months after completion of the program . Material and methods . Sixty patients with UC in clinical remission or with low disease activity were r and omly assigned to an intervention group or a usual-care control group . Comprehensive lifestyle modification consisted of a structured 60-h training program over a period of 10 weeks which included stress management training , psychoeducational elements , and self-care strategies .  Quality -of-life , psychological distress , and clinical disease activity were assessed with st and ardized question naires ( Inflammatory Bowel Disease Question naire ( IBDQ ) ; the MOS Short-Form 36 ( SF-36 ) ; the Brief Symptom Inventory ( BSI ) , and the Colitis Activity Index ( CAI ) ) at baseline , and 3 months and 12 months after comprehensive lifestyle modification . Results . Three months after comprehensive lifestyle modification , patients in the intervention group showed significantly greater improvement in the SF-36 scale physical function ( p=0.0175 ) , and a significantly greater reduction in anxiety scores , measured with the BSI ( p=0.0294 ) . Use of relaxation techniques was a significant predictor of improvement in the psychological sum score after 3 months of therapy ( p=0.034 ) . Though 80 % of patients with an initial IBDQ score < 170 in the intervention group showed an improvement of > 16 points after 3 months , no significant effects of the intervention were found on the IBDQ scales , or on clinical disease parameters , including CAI scores , self-assessed disease activity , hospitalizations , or medical consultations . Conclusions . These results are consistent with possible short-term benefits of a comprehensive lifestyle modification program on some aspects of quality -of-life and emotional well-being , but no effects were discernable 12 months after completion of therapy . Comprehensive lifestyle modification had no effect on clinical disease variables . The generalizability of these data is limited because of the inclusion of patients with a relatively low disease activity who were interested in integrative medicine OBJECTIVE : We sought to determine whether psychosocial factors influence the course of ulcerative colitis , hypothesizing that high perceived stress among patients with inactive disease will increase the risk of subsequent exacerbation . METHODS : Sixty-two patients with known ulcerative colitis were enrolled into a prospect i ve cohort study while in clinical remission . Their perceived stress , depressive symptoms , and stressful life events  were followed , along with potential confounders , for up to 45 months ; exacerbation status was monitored for up to 68 months . RESULTS : The 27 patients who experienced an exacerbation were compared with those who remained in remission . Having a score in the upper tertile on the long-term ( past 2 yr ) baseline Perceived Stress Question naire significantly increased the actuarial risk of exacerbation ( hazards ratio = 2.8 , 95 % confidence interval 1.1–7.2 ) . At any given study visit , high long-term stress tripled the risk of exacerbation during the next 8 months ( risk for the three tertiles , 8.3 % , 16.7 % , and 26.2 % , p = 0.02 ) . Shorter sleep time , briefer remission , histological activity , and use of nonsteroidal antiinflammatory drugs , antibiotics , or oral contraceptives also increased the medium- and /or long-term risk of exacerbation , but adjustment for these variables did not eliminate the associations with stress . Exacerbation was not associated with stressful life events , depressive symptoms , short-term ( past month ) perceived stress , smoking , disease extent or duration , or severity of recent course . CONCLUSIONS : Short-term stress does not trigger exacerbation in ulcerative colitis , but long-term perceived stress increases the risk of exacerbation over a period of months to years Background : Improving access is a key policy issue in improving quality of care and extending patient choice and participation . People ’s experience of changing from fixed outpatient appointments to more flexible direct access arrangements for chronic disease has been underexplored . Objectives : To examine patients ’ views on using an open system of access compared with fixed outpatient appointments as part of a guided self-management intervention for inflammatory bowel disease ( IBD ) . Design : Embedded qualitative study undertaken alongside a r and omised controlled trial . Semi-structured interviews were undertaken to obtain an in depth underst and ing of patients ’ experience of the change in access arrangements . Participants : A purposive sample ( n = 30 ) was drawn from the intervention group ( n = 700 ) according to a range of responses to the trial baseline and follow up quantitative measures . Results : 28 interviews were included in the analysis . Compared with the previous system of fixed appointments , preference for the new open access system was based on enhanced personal control in contacting services and the view that it fitted better with everyday routine management and the requirement for urgent medical contact when symptoms fail to respond to medication . Preference for retaining fixed appointments was based on a sense of security from gaining access which did not require the individual to initiate the request for medical help . Conclusions : Open access may fit better with patients ’ self-management of their condition and everyday routines , roles and responsibilities . Ensuring that outpatient organisational arrangements and personnel are responsive to patient initiated requests for appointments is likely to impact on the acceptability of this type of access arrangement . Some people may continue to prefer the fixed appointment system which should be retained if patient choice is to be respected Inflammatory bowel disease ( IBD ) encompasses two related gastrointestinal-tract diseases , ulcerative colitis ( UC ) and Crohn 's Disease ( CD ) . This study , a r and omized controlled trial , compared the effectiveness of a multi-component behavioral treatment package ( n = 11 ) , which included IBD education , progressive muscle relaxation , thermal biofeedback , and training in use of cognitive coping strategies , to the effectiveness of symptom-monitoring ( n = 10 ) as a control condition ; 8 controls subsequently completed treatment . At posttreatment , the treatment group showed mean reductions on 5 symptoms , while the symptom monitoring controls showed mean reductions on all 8 symptoms . On a measure of Total Symptomatic change , the controls showed more improvement than the treated group ; the treated controls at posttreatment , showed increases on all 8 symptoms . However , treated subjects perceived themselves as coping better with IBD , as feeling less IBD-related stress , and as experiencing less depression and anxiety . It is hypothesized that inherent differences may have existed between CD and UC subjects which could have led to the differences seen in treatment responses OBJECTIVE : The aim of this study was to develop a valid and reliable question naire assessing patient knowledge of inflammatory bowel disease ( IBD ) and its treatment — the Crohn 's and Colitis Knowledge ( CCKNOW ) Score . METHODS : A total of 30 multiple choice questions were constructed into a draft question naire . This was piloted on a r and om selection of participants with differing IBD knowledge levels ; junior doctors , nurses , and ward clerks . Factor analysis eliminated questions with poor discriminant ability . The result ing 24-item question naire ( CCKNOW score )  was retested on the three groups , and a Kruskal-Wallis test determined the question naire 's ability to discriminate between the groups . Reliability and readability were tested using Cronbach 's α and the Flesch Kincaid reading score . The vali date d CCKNOW was then tested on patients from the Leicestershire IBD data base . RESULTS : CCKNOW scores differed significantly across the groups of doctors , nurses , and ward clerks ( median 22 , 16 , and five , respectively ) T = 40.35 , p < 0.0001 . The reliability was very good with a Cronbach 's α of 0.95 and the readability was also high . The median score on the CCKNOW  for IBD patients was 10 , with no significant difference between ulcerative colitis and Crohn 's disease . Patients who are members of NACC ( National Association of Crohn 's and Colitis ) achieve statistically significantly higher scores than do nonmembers ( difference in medians 4 , 95 % confidence interval 4–6 , p < 0.0001 ) . CONCLUSIONS : The CCKNOW score provides a valuable index of overall knowledge . It is self-administered and psychometric tests show it to be valid , reliable , and readable . It may be used in the future as a tool to evaluate patient education programs OBJECTIVES To determine if a whole systems approach to self-management improves clinical outcomes and leads to cost-effective use of NHS services . DESIGN Nineteen hospitals were r and omised to 10 control sites and nine intervention sites . Consultants from intervention sites received training in patient-centred care before recruitment and introduced the intervention to eligible patients . Patients at the control sites were rec 
    Output:
    