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 Patient education material s can assist patient decision making on prostate cancer screening . Objective To explore the effectiveness of presenting health information on prostate cancer screening using video , internet , and written interventions on patient decision making , attitudes , knowledge , and screening interest . Design R and omized controlled trial . Participants A total of 161 men aged over 45 , who had never been screened for prostate cancer , were r and omized to receive information on prostate cancer screening . Measurements Participants were assessed at baseline and 1-week postintervention for decisional conflict , screening interest , knowledge , anxiety , and decision-making preference . Results A total of 156 men were followed-up at 1-week postintervention . There was no statistical , or clinical , difference in mean change in decisional conflict scores between the 3 intervention groups ( video vs internet −0.06 [ 95 % CI −0.24 to 0.12 ] ; video vs pamphlet 0.04 [ 95%CI −0.15 to 0.22 ] ; internet vs pamphlet 0.10 [ 95%CI −0.09 to 0.28 ] ) . There was also no statistically significant difference in mean knowledge , anxiety , decision-making preference , and screening interest between the 3 intervention groups . Conclusion Results from this study indicate that there are no clinical ly significant differences in decisional conflict when men are presented health information on prostate cancer screening via video , written material s , or the internet . Given the equivalence of the 3 methods , other factors need to be considered in deciding which method to use . Health professionals should provide patient health education material s via a method that is most convenient to the patient and their preferred learning style AIMS International guidelines on ethics in biomedical research require that the informed consent of all enrolled participants is obtained . A written document describing the research , the informed consent ( IC ) document , must be given to all participants by the investigator . Most IC documents are long , containing much information . The aim of the present study was to determine whether the modification of the IC document by a working group or systematic improvement in its lexicosyntactic readability can improve comprehension of the written information given to patients participating in biomedical research . METHODS One hundred and fifty-nine patients were r and omized to read one of the three versions of the IC document : unchanged document , document modified using systematic improvement of lexicosyntactic readability and document modified by a working group . RESULTS Neither the improvement in the lexicosyntactic readability , nor the intervention of the working group significantly improved the score of objective comprehension for the subjects included in this study : it was 66.6 ( 95 % confidence interval 64.0 , 69.2 ) for the control group , 68.8 ( 66.2 , 71.4 ) for the group with the document improved for lexicosyntactic readability and 69.2 ( 66.0 , 72.4 ) for the group who read the document improved by the working group ( P= 0.38 ) . CONCLUSIONS We failed to show that improving IC document comprehension through a lexicosyntactic approach or by a working group leads to better comprehension OBJECTIVE To determine if functional health literacy ( FHL ) mediates the relationship between socio-economic status , and perception of the risk of lifestyle behaviors for cancer . METHODS Cross-sectional , r and om population survey , 2824 people aged ≥15 years , September-October 2008 , included newest vital sign measure of FHL . RESULTS Less than adequate FHL occurred in 45.1 % . People who perceived behavioral factors ( smoking , diet , obesity , alcohol , physical activity ) to be not important , or did not know if they were important cancer risks , were more likely to have inadequate FHL . In a logistic regression model adjusted for age , gender , education , income , occupation , country of birth and area of residence , inadequate FHL was associated with 2 - 3 ( OR=1.9 ; 95 % CI : 1.2 - 3.0 ) and 4 or more self-reported lifestyle risk factors ( OR=2.8 ; 95 % CI : 1.6 - 5.0 ) . In a structural equation model of the relationship of socio-economic status , perceptions of risk and behaviors there was significant mediation effect of FHL on the path from SES to health perceptions , estimated 29.4 % of the total effect . CONCLUSION A specific focus on the literacy dem and s made on individuals from health promotion and material s with a view to improving health communication is indicated . PRACTICE IMPLICATION S Health literacy is important for health promotion PURPOSE : To determine the effectiveness of verbal , written , and videotaped descriptions of cataract surgery on patients ’ underst and ing of the risks , benefits , and treatment alternatives . SETTING : Veterans Affairs Boston Healthcare System , Boston , Massachusetts , USA . DESIGN : R and omized prospect i ve study . METHODS : Patients eligible for cataract surgery were r and omized into 1 of 4 arms of the informed consent process as follows : Group 1 , conventional verbal information ; Group 2 , conventional verbal information plus second‐ grade reading level brochure ; Group 3 , conventional verbal information plus eighth‐ grade reading level brochure ; Group 4 , conventional verbal information plus American Academy of Ophthalmology DVD Underst and ing Cataract Surgery : Patient Education DVD Featuring an Aid to Informed Consent . After the informed consent process , patients in each group completed a 12‐ question question naire discussing the surgical procedure , its benefits , its foreseeable and unforeseeable risks , and the alternatives to cataract surgery . Scores in each group were calculated as the number of correct responses out of 12 questions . RESULTS : Patients in Group 2 ( mean score 10.8 ± 1.29 [ SD ] ) and Group 4 ( mean score 10.56 ± 1.44 ) scored significantly higher than patients in Group 1 ( mean score 7.68 ± 2.80 ) or Group 3 ( mean score 9.08 ± 1.60 ) . Previous cataract surgery and education level had no significant influence on recall of the informed‐consent process . CONCLUSIONS : Concise informed consent information sheets at lower reading grade levels and videotape presentation optimized patient underst and ing of the risks , benefits , and treatment alternatives to cataract surgery . The cost – benefit of these results is important because better patient underst and ing has the potential to decrease the risk for indemnity payments awarded because of inadequate informed consent . Financial Disclosure : No author has a financial or proprietary interest in any material or method mentioned Objective To investigate the association between low functional health literacy ( ability to read and underst and basic health related information ) and mortality  in older adults . Design Population based longitudinal cohort study based on a stratified r and om sample of households . Setting Engl and . Participants 7857 adults aged 52 or more who participated in the second wave ( 2004 - 5 ) of the English Longitudinal Study of Ageing and survived more than 12 months after interview . Participants completed a brief four item test of functional health literacy  , which assessed underst and ing of written instructions for taking an aspirin tablet . Main outcome measure Time to death , based on all cause mortality through October 2009 . Results Health literacy was categorised as high ( maximum score , 67.2 % ) , medium ( one error , 20.3 % ) , or low ( more than one error , 12.5 % ) . During follow-up ( mean 5.3 years ) 621 deaths occurred : 321 ( 6.1 % ) in the high health literacy category , 143 ( 9.0 % ) in the medium category , and 157 ( 16.0 % ) in the low category . After adjusting for personal characteristics , socioeconomic position , baseline health , and health behaviours , the hazard ratio for all cause mortality for participants with low health literacy was 1.40 ( 95 % confidence interval 1.15 to 1.72 ) and with medium health literacy was 1.15 ( 0.94 to 1.41 ) compared with participants with high health literacy . Further adjustment for cognitive ability reduced the hazard ratio for low health literacy to 1.26 ( 1.02 to 1.55 ) . Conclusions A third of older adults in Engl and have difficulties reading and underst and ing basic health related written information . Poorer underst and ing is associated with higher mortality . The limited health literacy capabilities within this population have implication s for the design and delivery of health related services for older adults in Engl and OBJECTIVE Experts recommend that adults have their global cardiovascular risk assessed . We investigated whether icon arrays increase underst and ing , recall , perception of CVR , and behavioral intent as compared with numerical information . METHODS Male outpatient veterans , at an intermediate to high cardiovascular risk participated in a r and omized controlled trial of a computer tutorial presenting individualized risk . Message format was presented in 3 formats : percentages , frequencies , and frequencies with icon arrays . We assessed underst and ing immediately ( T1 ) and recall at 20 min ( T2 ) and 2 weeks ( T3 ) after the intervention . We assessed perceptions of importance /seriousness , intent to adhere , and self-efficacy at T1 . Self-reported adherence was assessed at T3 . RESULTS One-hundred and twenty male veterans participated . Age , education , race , health literacy and numeracy were comparable at baseline . There were no differences in underst and ing at T1 [ p = .31 ] and recall at T3 [ p = .10 ] . Accuracy was inferior with frequencies with icon arrays than percentages or frequencies at T2 [ p ≤ .001 ] . There were no differences in perception of seriousness and importance for heart disease , behavioral intent , self-efficacy , actual adherence and satisfaction .  CONCLUSION Icon arrays may impair short-term recall of CVR . PRACTICE IMPLICATION S Icon arrays will not necessarily result in better underst and ing and recall of medical risk in all patients OBJECTIVE To examine whether explanatory illustrations can improve older adults '  comprehension of written health information . METHODS Six short health-related texts were selected from websites and pamphlets . Young and older adults were r and omly assigned to read health-related texts alone or texts accompanied by explanatory illustrations .  Eye movements were recorded while reading . Word recognition , text comprehension , and comprehension of the illustrations were assessed after reading . RESULTS Older adults performed as well as or better than young adults on the word recognition and text comprehension measures . However , older adults performed less well than young adults on the illustration comprehension measures . Analysis of readers ' eye movements showed that older adults spent more time reading illustration-related phrases and fixating on the illustrations than did young adults , yet had poorer comprehension of the illustrations . CONCLUSION Older adults might not benefit from text illustrations because illustrations can be difficult to integrate with the text . PRACTICE IMPLICATION S Health practitioners should not assume that illustrations will increase older adults ' comprehension of health information OBJECTIVE To determine whether an advance directive re design ed to meet most adults ' literacy needs ( fifth grade reading level with graphics ) was more useful for advance care planning than a st and ard form ( > 12th grade level ) . METHODS We enrolled 205 English and Spanish-speaking patients , aged > /=50 years from an urban , general medicine clinic . We r and omized participants to review either form . Main outcomes included acceptability and usefulness in advance care planning . Participants then review ed the alternate form ; we assessed form preference and six-month completion rates . RESULTS Forty percent of enrolled participants had limited literacy . Compared to the st and ard form , the re design ed form was rated higher for acceptability and usefulness in care planning , P</=0.03 , particularly for limited literacy participants ( P for interaction < /=0.07 ) . The re design ed form was preferred by 73 % of participants . More participants r and omized to the re design ed form completed an advance directive at six months ( 19 % vs. 8 % , P=0.03 ) ; of these , 95 % completed the re design ed form . CONCLUSIONS The re design ed advance directive was rated more acceptable and useful for advance care planning and was preferred over a st and ard form . It also result ed in higher six-month completion rates . PRACTICE IMPLICATION S An advance directive re design ed to meet most adults ' literacy needs may better enable patients to engage in advance care planning OBJECTIVE To determine the effectiveness of a pictorial ' mind map ' together with the Arthritis Research Campaign ( ARC ) booklet for imparting knowledge to participants with rheumatoid arthritis ( RA ) . Also , we wished to relate this to their reading ability . METHODS We studied 363 participants with RA . Reading ability was assessed using the REALM , and knowledge was assessed using the Knowledge Scale Question naire ( KSQ ) . Information on educational attainment , disease state and levels of anxiety and depression was also collected . Participants were r and omly assigned to receive either the ARC booklet alone or the booklet and the mind map together . RESULTS A significant minority ( 15 % ) of participants were functionally illiterate .  There was a statistically significant increase in knowledge across both groups from baseline to re assessment after they were given the literature , but there was no difference in attainment between the groups . The more literate participants gained more knowledge regardless of the information they were given . They were also significantly less anxious and less depressed . CONCLUSIONS The ARC booklet with or without the mind map was associated with a significant increase in knowledge .  Poor readers had poor educational attainment and poor knowledge acquisition . The information on the mind map was not more accessible to them . Different educational strategies will be necessary to educate these patients ABSTRACT BACKGROUND Despite federal laws requiring language access in healthcare setting s , most US pharmacies are unable to provide prescription ( Rx ) medication instructions to limited English proficient ( LEP ) patients in their native language . OBJECTIVE To evaluate the efficacy of health literacy-informed , multilingual Rx instructions ( 
    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: Background Patient education material s can assist patient decision making on prostate cancer screening . Objective To explore the effectiveness of presenting health information on prostate cancer screening using video , internet , and written interventions on patient decision making , attitudes , knowledge , and screening interest . Design R and omized controlled trial . Participants A total of 161 men aged over 45 , who had never been screened for prostate cancer , were r and omized to receive information on prostate cancer screening . Measurements Participants were assessed at baseline and 1-week postintervention for decisional conflict , screening interest , knowledge , anxiety , and decision-making preference . Results A total of 156 men were followed-up at 1-week postintervention . There was no statistical , or clinical , difference in mean change in decisional conflict scores between the 3 intervention groups ( video vs internet −0.06 [ 95 % CI −0.24 to 0.12 ] ; video vs pamphlet 0.04 [ 95%CI −0.15 to 0.22 ] ; internet vs pamphlet 0.10 [ 95%CI −0.09 to 0.28 ] ) . There was also no statistically significant difference in mean knowledge , anxiety , decision-making preference , and screening interest between the 3 intervention groups . Conclusion Results from this study indicate that there are no clinical ly significant differences in decisional conflict when men are presented health information on prostate cancer screening via video , written material s , or the internet . Given the equivalence of the 3 methods , other factors need to be considered in deciding which method to use . Health professionals should provide patient health education material s via a method that is most convenient to the patient and their preferred learning style AIMS International guidelines on ethics in biomedical research require that the informed consent of all enrolled participants is obtained . A written document describing the research , the informed consent ( IC ) document , must be given to all participants by the investigator . Most IC documents are long , containing much information . The aim of the present study was to determine whether the modification of the IC document by a working group or systematic improvement in its lexicosyntactic readability can improve comprehension of the written information given to patients participating in biomedical research . METHODS One hundred and fifty-nine patients were r and omized to read one of the three versions of the IC document : unchanged document , document modified using systematic improvement of lexicosyntactic readability and document modified by a working group . RESULTS Neither the improvement in the lexicosyntactic readability , nor the intervention of the working group significantly improved the score of objective comprehension for the subjects included in this study : it was 66.6 ( 95 % confidence interval 64.0 , 69.2 ) for the control group , 68.8 ( 66.2 , 71.4 ) for the group with the document improved for lexicosyntactic readability and 69.2 ( 66.0 , 72.4 ) for the group who read the document improved by the working group ( P= 0.38 ) . CONCLUSIONS We failed to show that improving IC document comprehension through a lexicosyntactic approach or by a working group leads to better comprehension OBJECTIVE To determine if functional health literacy ( FHL ) mediates the relationship between socio-economic status , and perception of the risk of lifestyle behaviors for cancer . METHODS Cross-sectional , r and om population survey , 2824 people aged ≥15 years , September-October 2008 , included newest vital sign measure of FHL . RESULTS Less than adequate FHL occurred in 45.1 % . People who perceived behavioral factors ( smoking , diet , obesity , alcohol , physical activity ) to be not important , or did not know if they were important cancer risks , were more likely to have inadequate FHL . In a logistic regression model adjusted for age , gender , education , income , occupation , country of birth and area of residence , inadequate FHL was associated with 2 - 3 ( OR=1.9 ; 95 % CI : 1.2 - 3.0 ) and 4 or more self-reported lifestyle risk factors ( OR=2.8 ; 95 % CI : 1.6 - 5.0 ) . In a structural equation model of the relationship of socio-economic status , perceptions of risk and behaviors there was significant mediation effect of FHL on the path from SES to health perceptions , estimated 29.4 % of the total effect . CONCLUSION A specific focus on the literacy dem and s made on individuals from health promotion and material s with a view to improving health communication is indicated . PRACTICE IMPLICATION S Health literacy is important for health promotion PURPOSE : To determine the effectiveness of verbal , written , and videotaped descriptions of cataract surgery on patients ’ underst and ing of the risks , benefits , and treatment alternatives . SETTING : Veterans Affairs Boston Healthcare System , Boston , Massachusetts , USA . DESIGN : R and omized prospect i ve study . METHODS : Patients eligible for cataract surgery were r and omized into 1 of 4 arms of the informed consent process as follows : Group 1 , conventional verbal information ; Group 2 , conventional verbal information plus second‐ grade reading level brochure ; Group 3 , conventional verbal information plus eighth‐ grade reading level brochure ; Group 4 , conventional verbal information plus American Academy of Ophthalmology DVD Underst and ing Cataract Surgery : Patient Education DVD Featuring an Aid to Informed Consent . After the informed consent process , patients in each group completed a 12‐ question question naire discussing the surgical procedure , its benefits , its foreseeable and unforeseeable risks , and the alternatives to cataract surgery . Scores in each group were calculated as the number of correct responses out of 12 questions . RESULTS : Patients in Group 2 ( mean score 10.8 ± 1.29 [ SD ] ) and Group 4 ( mean score 10.56 ± 1.44 ) scored significantly higher than patients in Group 1 ( mean score 7.68 ± 2.80 ) or Group 3 ( mean score 9.08 ± 1.60 ) . Previous cataract surgery and education level had no significant influence on recall of the informed‐consent process . CONCLUSIONS : Concise informed consent information sheets at lower reading grade levels and videotape presentation optimized patient underst and ing of the risks , benefits , and treatment alternatives to cataract surgery . The cost – benefit of these results is important because better patient underst and ing has the potential to decrease the risk for indemnity payments awarded because of inadequate informed consent . Financial Disclosure : No author has a financial or proprietary interest in any material or method mentioned Objective To investigate the association between low functional health literacy ( ability to read and underst and basic health related information ) and mortality  in older adults . Design Population based longitudinal cohort study based on a stratified r and om sample of households . Setting Engl and . Participants 7857 adults aged 52 or more who participated in the second wave ( 2004 - 5 ) of the English Longitudinal Study of Ageing and survived more than 12 months after interview . Participants completed a brief four item test of functional health literacy  , which assessed underst and ing of written instructions for taking an aspirin tablet . Main outcome measure Time to death , based on all cause mortality through October 2009 . Results Health literacy was categorised as high ( maximum score , 67.2 % ) , medium ( one error , 20.3 % ) , or low ( more than one error , 12.5 % ) . During follow-up ( mean 5.3 years ) 621 deaths occurred : 321 ( 6.1 % ) in the high health literacy category , 143 ( 9.0 % ) in the medium category , and 157 ( 16.0 % ) in the low category . After adjusting for personal characteristics , socioeconomic position , baseline health , and health behaviours , the hazard ratio for all cause mortality for participants with low health literacy was 1.40 ( 95 % confidence interval 1.15 to 1.72 ) and with medium health literacy was 1.15 ( 0.94 to 1.41 ) compared with participants with high health literacy . Further adjustment for cognitive ability reduced the hazard ratio for low health literacy to 1.26 ( 1.02 to 1.55 ) . Conclusions A third of older adults in Engl and have difficulties reading and underst and ing basic health related written information . Poorer underst and ing is associated with higher mortality . The limited health literacy capabilities within this population have implication s for the design and delivery of health related services for older adults in Engl and OBJECTIVE Experts recommend that adults have their global cardiovascular risk assessed . We investigated whether icon arrays increase underst and ing , recall , perception of CVR , and behavioral intent as compared with numerical information . METHODS Male outpatient veterans , at an intermediate to high cardiovascular risk participated in a r and omized controlled trial of a computer tutorial presenting individualized risk . Message format was presented in 3 formats : percentages , frequencies , and frequencies with icon arrays . We assessed underst and ing immediately ( T1 ) and recall at 20 min ( T2 ) and 2 weeks ( T3 ) after the intervention . We assessed perceptions of importance /seriousness , intent to adhere , and self-efficacy at T1 . Self-reported adherence was assessed at T3 . RESULTS One-hundred and twenty male veterans participated . Age , education , race , health literacy and numeracy were comparable at baseline . There were no differences in underst and ing at T1 [ p = .31 ] and recall at T3 [ p = .10 ] . Accuracy was inferior with frequencies with icon arrays than percentages or frequencies at T2 [ p ≤ .001 ] . There were no differences in perception of seriousness and importance for heart disease , behavioral intent , self-efficacy , actual adherence and satisfaction .  CONCLUSION Icon arrays may impair short-term recall of CVR . PRACTICE IMPLICATION S Icon arrays will not necessarily result in better underst and ing and recall of medical risk in all patients OBJECTIVE To examine whether explanatory illustrations can improve older adults '  comprehension of written health information . METHODS Six short health-related texts were selected from websites and pamphlets . Young and older adults were r and omly assigned to read health-related texts alone or texts accompanied by explanatory illustrations .  Eye movements were recorded while reading . Word recognition , text comprehension , and comprehension of the illustrations were assessed after reading . RESULTS Older adults performed as well as or better than young adults on the word recognition and text comprehension measures . However , older adults performed less well than young adults on the illustration comprehension measures . Analysis of readers ' eye movements showed that older adults spent more time reading illustration-related phrases and fixating on the illustrations than did young adults , yet had poorer comprehension of the illustrations . CONCLUSION Older adults might not benefit from text illustrations because illustrations can be difficult to integrate with the text . PRACTICE IMPLICATION S Health practitioners should not assume that illustrations will increase older adults ' comprehension of health information OBJECTIVE To determine whether an advance directive re design ed to meet most adults ' literacy needs ( fifth grade reading level with graphics ) was more useful for advance care planning than a st and ard form ( > 12th grade level ) . METHODS We enrolled 205 English and Spanish-speaking patients , aged > /=50 years from an urban , general medicine clinic . We r and omized participants to review either form . Main outcomes included acceptability and usefulness in advance care planning . Participants then review ed the alternate form ; we assessed form preference and six-month completion rates . RESULTS Forty percent of enrolled participants had limited literacy . Compared to the st and ard form , the re design ed form was rated higher for acceptability and usefulness in care planning , P</=0.03 , particularly for limited literacy participants ( P for interaction < /=0.07 ) . The re design ed form was preferred by 73 % of participants . More participants r and omized to the re design ed form completed an advance directive at six months ( 19 % vs. 8 % , P=0.03 ) ; of these , 95 % completed the re design ed form . CONCLUSIONS The re design ed advance directive was rated more acceptable and useful for advance care planning and was preferred over a st and ard form . It also result ed in higher six-month completion rates . PRACTICE IMPLICATION S An advance directive re design ed to meet most adults ' literacy needs may better enable patients to engage in advance care planning OBJECTIVE To determine the effectiveness of a pictorial ' mind map ' together with the Arthritis Research Campaign ( ARC ) booklet for imparting knowledge to participants with rheumatoid arthritis ( RA ) . Also , we wished to relate this to their reading ability . METHODS We studied 363 participants with RA . Reading ability was assessed using the REALM , and knowledge was assessed using the Knowledge Scale Question naire ( KSQ ) . Information on educational attainment , disease state and levels of anxiety and depression was also collected . Participants were r and omly assigned to receive either the ARC booklet alone or the booklet and the mind map together . RESULTS A significant minority ( 15 % ) of participants were functionally illiterate .  There was a statistically significant increase in knowledge across both groups from baseline to re assessment after they were given the literature , but there was no difference in attainment between the groups . The more literate participants gained more knowledge regardless of the information they were given . They were also significantly less anxious and less depressed . CONCLUSIONS The ARC booklet with or without the mind map was associated with a significant increase in knowledge .  Poor readers had poor educational attainment and poor knowledge acquisition . The information on the mind map was not more accessible to them . Different educational strategies will be necessary to educate these patients ABSTRACT BACKGROUND Despite federal laws requiring language access in healthcare setting s , most US pharmacies are unable to provide prescription ( Rx ) medication instructions to limited English proficient ( LEP ) patients in their native language . OBJECTIVE To evaluate the efficacy of health literacy-informed , multilingual Rx instructions ( 
    Output:
    