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: A group of 200 patients who presented in general practice with symptoms but no abnormal physical signs and in whom no definite diagnosis was made were r and omly selected for one of four consultations : a consultation conducted in a " positive manner , " with and without treatment , and a consultation conducted in a " non-positive manner , " called a negative consultation , with and without treatment . Two weeks after consultation there was a significant difference in patient satisfaction between the positive and negative groups but not between the treated and untreated groups . Similarly , 64 % of those receiving a positive consultation  got better , compared with 39 % of those who received a negative consultation ( p = 0.001 ) and 53 % of those treated got better compared with 50 % of those not treated ( p = 0.5 ) The objective was to assess the potential benefits of the routine use of the MOS SF-36 Health Survey ( SF-36 ) in the care of ambulatory patients . The design was a longitudinal , prospect i ve , r and omized , controlled study set in the outpatient neurology clinic at the New Engl and Medical Center . There were 163 consecutive patients with epilepsy who had 210 follow-up visits with one of two epileptologists . The patients completed the SF-36 before the patient-physician encounter and the forms were optically scanned . The SF-36 results of the intervention group patients were given to the physicians before the encounter and withheld for control group patients . For intervention group patients , the physicians completed a question naire assessing the impact of the SF-36 on the process of care . After the visit , all patients completed a satisfaction question naire . The main outcome measures were the physicians ' responses to st and ardized questions about the usefulness of the SF-36  for communication with and management of epilepsy patients and the patients ' responses to st and ardized questions about their satisfaction with care . The physicians indicated that the SF-36 provided new information in 63 % of the intervention group encounters . A change in therapy was prompted in 13 % . The physicians rated the SF-36 as at least moderately useful for communication in 14 % of the encounters and to management in 8 % . The lower ( indicating worse health status ) the patients ' SF-36 scale scores , the more useful the SF-36 results were rated by the physicians for communication and management . It was concluded that the routine use of health status measures may enhance patients ' care PURPOSE To investigate the effect of a one-day workshop in which physicians were taught trust-building behaviors on their patients ' levels of trust and on outcomes of care . METHOD In 1994 , the study recruited 20 community-based family physicians and enrolled 412 consecutive adult patients from those physicians ' practice s. Ten of the physicians ( the intervention group ) were r and omly assigned to receive a one-day training course in building and maintaining patients ' trust . Outcomes were patients ' trust in their physicians , patients ' and physicians ' satisfaction with the office visit , continuity in the patient-physician relationship , patients ' adherence to their treatment plans , and the numbers of diagnostic tests and referrals . RESULTS Physicians and patients in the intervention and control groups were similar in demographic and other data . There was no significant difference in any outcome . Although their overall ratings were not statistically significantly different , the patients of physicians in the intervention group reported more positive physician behaviors than did the patients of physicians in the control group . CONCLUSIONS The trust-building workshop had no measurable effect on patients ' trust or on outcomes hypothesized to be related to trust A r and omised controlled study in which a written prompt was sent to new patients to help them make the most of their consultation was conducted amongst patients referred to the dermatology , gynaecology and orthopaedic out- patients clinics at the Royal Free Hospital , London . The impact of the help card on patients ' expectations , preparation for and experience of their out-patient consultation are discussed . A help card and letter were sent to a r and om sample of patients before their appointment to encourage them to prepare and prioritize questions to ask the doctor at the consultation . After their consultation , patients were sent a postal question naire to complete at home . Analysis of the question naires provided quantitative and qualitative data about patients ' information requirements and whether they were fulfilled . The results highlight the difficulties out- patients have in asking questions and discussing topics fully at their initial consultation , even when they have thought of questions in advance . Half the patients who were sent a help card said they got more out of their consultation as a result , yet few statistically significant differences between the help card group and the other patients were found PURPOSE . To use a controlled , r and omized design to assess the effect on patient satisfaction of an  intensive psychosocial training program for residents . METHOD . Twenty-six first-year residents , in two internal medicine and family practice community-based programs affiliated with the Michigan State University College of Human Medicine , were r and omly assigned during 1991 and 1992 to a control group or a one-month intensive training program . Experiential teaching focused on many psychosocial skills required in primary care . A 29-item question naire administered before and after the residents ' training evaluated their patients ' satisfaction regarding patient disclosure , physician empathy , confidence in physician , general satisfaction , and comparison of the physician with other physicians . Analyses of covariance with groups and gender as factors and pre-training patient satisfaction scores as the covariate evaluated the effect of the training . RESULTS . The patients of the trained residents expressed more confidence in their physicians ( p = .01 ) and more general satisfaction ( p = .02 ) than did the patients of controls . The effect of training on patient satisfaction with patient disclosure ( p < .01 ) and physician empathy ( p < .05 ) was greater for female than for male residents . CONCLUSION . The intensive psychosocial training program for residents improved their patients ' satisfaction Objective To determine if a self-administered previsit question naire design ed to increase awareness of patients ’ concerns alters the visit duration , content of the discussion , and patient and physician satisfaction . Design A balanced , two-arm trial in which physicians were r and omized . Setting Two primary -care clinics affiliated , with a university hospital . Patients / Participants Ten physicians and 201 continuitycare patients . Interventions In intervention visits , patients completed a previsit question naire asking about the desire for medical information , psychosocial assistance , therapeutic listening , general health advice , and biomedical treatment . Physicians review ed question naires with patients during the visit . Measurements and main results We used audiotapes of encounters to quantify the duration of the encounter and measured the number and type of diagnoses discussed in the visit , and patient and physician satisfaction with the encounter . Intervention visits were 34 % longer ( increase of 6.8 minutes ; 95 % confidence interval , [ CI ] 0.4 , 13.2 ) than control visits with most of the additional time spent in discussion of biomedical diagnoses ( 3.35 minutes ; 95 % CI 0.00 , 6.72 ) and in the performance of the physical examination ( 2.7 minutes ; 95 % CI 0.5 4.9 ) . The number of diagnoses discussed per visit was 30 % higher in intervention visits ( increase of 1.7 diagnoses per visit ; 95 % CI 0.3 , 3.2 ) , but patients ’ satisfaction with these visits tended to be lower . Conclusions Using a previsit question naire to increase awareness of the patients ’ concerns may entail a trade-off between conflicting goals : trying to respond to patient concerns while not significantly increasing the cost per visit . A future challenge is to develop and refine techniques with sufficient efficacy to justify the expense of implementing the intervention and the longer visit needed to respond adequately to patients ’ concerns In a competitive health care environment , clinicians and health plans are eager to achieve the highest quality of care and the highest levels of patient satisfaction . Studies consistently show that effective communication between clinicians and patients is a critical determinant of patient satisfaction ( 1 - 7 ) . To improve patient satisfaction , many organizations provide communication skills training programs for clinicians  . These programs usually include 4 to 8 hours of instruction and are held during regular office hours ( 8 - 12 ) . Because clinicians may need to be relieved from clinical responsibilities to attend , such programs can be expensive for both the clinicians and their organizations . Despite the substantial time and money invested in these programs , little rigorous research has been done to test their actual effect on patient satisfaction ( 11 , 13 ) . Some studies have measured clinicians ' self-ratings of their communication skills or have included an observation of a small number of visits ( 8 , 12 , 14 - 16 ) . Studies of oncologists have shown improvement in such targeted communication skills as breaking bad news ( 17 , 18 ) , but two recent r and omized trials that involved primary care physicians had conflicting results ( 10 , 19 ) . No r and omized trial has tested the effectiveness of a communication skills program delivered to clinicians of diverse specialties , and no study has directly assessed a program 's actual effect on patient satisfaction ( an outcome of great interest to health care users and sponsors ) . As communication programs proliferate , it is essential to critically evaluate whether they are a worthwhile investment of time and re sources for clinicians and their organizations . We performed a r and omized , controlled trial of a 10-hour communication skills program in a sample of primary care and specialty clinicians . We tested the effect of the program on patients ' satisfaction with providers ' communication during office visits.\E Methods Setting and Intervention The study setting was Kaiser Permanente Northwest Division , a 50-year-old , not-for-profit group-model health maintenance organization ( HMO ) with approximately 420 000 members located in and around Portl and , Oregon . The continuing medical education ( CME ) program we evaluated , titled Thriving in a Busy Practice : Physician-Patient Communication , was developed during numerous sessions with more than 1500 clinicians . Several Kaiser Permanente divisions participated in the program 's development , and the program was popular among clinicians . The program consisted of an initial 4-hour group workshop , 2 hours of subsequent homework , and a 4-hour follow-up workshop . The first workshop focused on skills for building effective relationships with patients , including listening actively ; responding to patients ' feelings ; and communicating concern , underst and ing , and respect . The second workshop focused on skills for successful negotiation , particularly in situations of disagreement ( for example , when a patient requests narcotics for chronic pain and the clinician does not think a prescription is appropriate ) . During a 1-month interval between the two workshops , the clinicians were asked to audiotape a minimum of two of their office visits and listen to the recordings . In addition , an instructor called participants during the interval to inquire about the skills they were trying , to ask whether they had questions , and to encourage them to complete the audiotaping . Both workshops were given by two physicians who were experienced teachers and experts in clinician-patient communication . The program was design ed to incorporate educational elements that had effectively changed clinician performance in other CME programs . The workshops included brief didactic components that were related to clinical needs and role-playing that allowed clinicians to practice communication skills while focusing on situations that they found challenging and relevant ( 20 , 21 ) . Instructors taught interactively , encouraging dialogue with and among participants . Recruitment and R and omization All of the approximately 1000 clinicians who belonged to or were employed by the Permanente Medical Group of the Northwest were eligible to participate . To maximize the external validity of the study , the HMO 's CME office advertised the program and managed the initial recruitment of clinicians by using its regular methods and channels . In addition , clinician leaders encouraged enrollment by direct communication with potential participants and by e-mail . The recruitment messages explained the r and omized trial and offered clinicians equal chances to participate immediately or to participate in a later session of the program . The clinicians who were r and omly assigned to the later session provided our control group . The Figure summarizes the flow of recruitment and r and omization . After clinicians notified the CME department of their interest in the course , we sent them an informed consent form and a self- assessment question naire . When the clinician returned the signed informed consent form , we assigned him or her to one of 16 strata on the basis of sex ( male or female ) , specialty ( primary care , medical specialty , surgical specialty , or allied health ) , and previous mean score ( higher or lower than average ) on the overall satisfaction item from the Art of Medicine survey ( HealthCare Research , Inc. , Denver , Colorado ) , which had been used by the HMO during two 6-month periods before our study took place . Mean scores before the study ranged from 6.84 to 8.91 , with a mean and median of 7.92 ; an SD of 0.47 ; and a quartile distribution of 7.56 , 7.92 , 8.28 , and 8.91 . Figure . Recruitment and r and omization . On a weekly basis , as clinicians registered , we r and omly assigned groups to attend immediate or later sessions of the program . In each stratum , we used a r and om-number table to assign persons to the intervention or control group . We started with the lowest r and om number and alternated assignment in order of ascending r and om number . The study was review ed and approved by the Kaiser Permanente Committee for the Protection of Human Subjects . Measurements Our primary experimental measure was the mean difference in score ( before and after participation in the training program ) on a scale that assessed patients ' ratings of clinicians ' communication skills . We obtained these ratings from the Art of Medicine survey , an anonymous question naire that was mailed to patients by a contractor to the HMO within 10 days after patients had participated in a r and omly selected ambulatory medical care visit . The survey was design ed to obtain 100 completed question naires for each clinician during a 6-month period . We used data from three 6-month survey periods : the last half of 1995 and the first and last halves of 1996 . The Art of Medicine survey elicited ratings on seven aspects of a clinician 's communication behavior or the patient 's reaction to it during a specified ambulatory encounter . In addition , the survey asked patients to rate their overall satisfaction with the service they received from the clinician . A complete list of the survey items is provided in the Appendix Figure . Although the Art of Medicine survey was not chosen by the research teamwe took advantage of 
    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: A group of 200 patients who presented in general practice with symptoms but no abnormal physical signs and in whom no definite diagnosis was made were r and omly selected for one of four consultations : a consultation conducted in a " positive manner , " with and without treatment , and a consultation conducted in a " non-positive manner , " called a negative consultation , with and without treatment . Two weeks after consultation there was a significant difference in patient satisfaction between the positive and negative groups but not between the treated and untreated groups . Similarly , 64 % of those receiving a positive consultation  got better , compared with 39 % of those who received a negative consultation ( p = 0.001 ) and 53 % of those treated got better compared with 50 % of those not treated ( p = 0.5 ) The objective was to assess the potential benefits of the routine use of the MOS SF-36 Health Survey ( SF-36 ) in the care of ambulatory patients . The design was a longitudinal , prospect i ve , r and omized , controlled study set in the outpatient neurology clinic at the New Engl and Medical Center . There were 163 consecutive patients with epilepsy who had 210 follow-up visits with one of two epileptologists . The patients completed the SF-36 before the patient-physician encounter and the forms were optically scanned . The SF-36 results of the intervention group patients were given to the physicians before the encounter and withheld for control group patients . For intervention group patients , the physicians completed a question naire assessing the impact of the SF-36 on the process of care . After the visit , all patients completed a satisfaction question naire . The main outcome measures were the physicians ' responses to st and ardized questions about the usefulness of the SF-36  for communication with and management of epilepsy patients and the patients ' responses to st and ardized questions about their satisfaction with care . The physicians indicated that the SF-36 provided new information in 63 % of the intervention group encounters . A change in therapy was prompted in 13 % . The physicians rated the SF-36 as at least moderately useful for communication in 14 % of the encounters and to management in 8 % . The lower ( indicating worse health status ) the patients ' SF-36 scale scores , the more useful the SF-36 results were rated by the physicians for communication and management . It was concluded that the routine use of health status measures may enhance patients ' care PURPOSE To investigate the effect of a one-day workshop in which physicians were taught trust-building behaviors on their patients ' levels of trust and on outcomes of care . METHOD In 1994 , the study recruited 20 community-based family physicians and enrolled 412 consecutive adult patients from those physicians ' practice s. Ten of the physicians ( the intervention group ) were r and omly assigned to receive a one-day training course in building and maintaining patients ' trust . Outcomes were patients ' trust in their physicians , patients ' and physicians ' satisfaction with the office visit , continuity in the patient-physician relationship , patients ' adherence to their treatment plans , and the numbers of diagnostic tests and referrals . RESULTS Physicians and patients in the intervention and control groups were similar in demographic and other data . There was no significant difference in any outcome . Although their overall ratings were not statistically significantly different , the patients of physicians in the intervention group reported more positive physician behaviors than did the patients of physicians in the control group . CONCLUSIONS The trust-building workshop had no measurable effect on patients ' trust or on outcomes hypothesized to be related to trust A r and omised controlled study in which a written prompt was sent to new patients to help them make the most of their consultation was conducted amongst patients referred to the dermatology , gynaecology and orthopaedic out- patients clinics at the Royal Free Hospital , London . The impact of the help card on patients ' expectations , preparation for and experience of their out-patient consultation are discussed . A help card and letter were sent to a r and om sample of patients before their appointment to encourage them to prepare and prioritize questions to ask the doctor at the consultation . After their consultation , patients were sent a postal question naire to complete at home . Analysis of the question naires provided quantitative and qualitative data about patients ' information requirements and whether they were fulfilled . The results highlight the difficulties out- patients have in asking questions and discussing topics fully at their initial consultation , even when they have thought of questions in advance . Half the patients who were sent a help card said they got more out of their consultation as a result , yet few statistically significant differences between the help card group and the other patients were found PURPOSE . To use a controlled , r and omized design to assess the effect on patient satisfaction of an  intensive psychosocial training program for residents . METHOD . Twenty-six first-year residents , in two internal medicine and family practice community-based programs affiliated with the Michigan State University College of Human Medicine , were r and omly assigned during 1991 and 1992 to a control group or a one-month intensive training program . Experiential teaching focused on many psychosocial skills required in primary care . A 29-item question naire administered before and after the residents ' training evaluated their patients ' satisfaction regarding patient disclosure , physician empathy , confidence in physician , general satisfaction , and comparison of the physician with other physicians . Analyses of covariance with groups and gender as factors and pre-training patient satisfaction scores as the covariate evaluated the effect of the training . RESULTS . The patients of the trained residents expressed more confidence in their physicians ( p = .01 ) and more general satisfaction ( p = .02 ) than did the patients of controls . The effect of training on patient satisfaction with patient disclosure ( p < .01 ) and physician empathy ( p < .05 ) was greater for female than for male residents . CONCLUSION . The intensive psychosocial training program for residents improved their patients ' satisfaction Objective To determine if a self-administered previsit question naire design ed to increase awareness of patients ’ concerns alters the visit duration , content of the discussion , and patient and physician satisfaction . Design A balanced , two-arm trial in which physicians were r and omized . Setting Two primary -care clinics affiliated , with a university hospital . Patients / Participants Ten physicians and 201 continuitycare patients . Interventions In intervention visits , patients completed a previsit question naire asking about the desire for medical information , psychosocial assistance , therapeutic listening , general health advice , and biomedical treatment . Physicians review ed question naires with patients during the visit . Measurements and main results We used audiotapes of encounters to quantify the duration of the encounter and measured the number and type of diagnoses discussed in the visit , and patient and physician satisfaction with the encounter . Intervention visits were 34 % longer ( increase of 6.8 minutes ; 95 % confidence interval , [ CI ] 0.4 , 13.2 ) than control visits with most of the additional time spent in discussion of biomedical diagnoses ( 3.35 minutes ; 95 % CI 0.00 , 6.72 ) and in the performance of the physical examination ( 2.7 minutes ; 95 % CI 0.5 4.9 ) . The number of diagnoses discussed per visit was 30 % higher in intervention visits ( increase of 1.7 diagnoses per visit ; 95 % CI 0.3 , 3.2 ) , but patients ’ satisfaction with these visits tended to be lower . Conclusions Using a previsit question naire to increase awareness of the patients ’ concerns may entail a trade-off between conflicting goals : trying to respond to patient concerns while not significantly increasing the cost per visit . A future challenge is to develop and refine techniques with sufficient efficacy to justify the expense of implementing the intervention and the longer visit needed to respond adequately to patients ’ concerns In a competitive health care environment , clinicians and health plans are eager to achieve the highest quality of care and the highest levels of patient satisfaction . Studies consistently show that effective communication between clinicians and patients is a critical determinant of patient satisfaction ( 1 - 7 ) . To improve patient satisfaction , many organizations provide communication skills training programs for clinicians  . These programs usually include 4 to 8 hours of instruction and are held during regular office hours ( 8 - 12 ) . Because clinicians may need to be relieved from clinical responsibilities to attend , such programs can be expensive for both the clinicians and their organizations . Despite the substantial time and money invested in these programs , little rigorous research has been done to test their actual effect on patient satisfaction ( 11 , 13 ) . Some studies have measured clinicians ' self-ratings of their communication skills or have included an observation of a small number of visits ( 8 , 12 , 14 - 16 ) . Studies of oncologists have shown improvement in such targeted communication skills as breaking bad news ( 17 , 18 ) , but two recent r and omized trials that involved primary care physicians had conflicting results ( 10 , 19 ) . No r and omized trial has tested the effectiveness of a communication skills program delivered to clinicians of diverse specialties , and no study has directly assessed a program 's actual effect on patient satisfaction ( an outcome of great interest to health care users and sponsors ) . As communication programs proliferate , it is essential to critically evaluate whether they are a worthwhile investment of time and re sources for clinicians and their organizations . We performed a r and omized , controlled trial of a 10-hour communication skills program in a sample of primary care and specialty clinicians . We tested the effect of the program on patients ' satisfaction with providers ' communication during office visits.\E Methods Setting and Intervention The study setting was Kaiser Permanente Northwest Division , a 50-year-old , not-for-profit group-model health maintenance organization ( HMO ) with approximately 420 000 members located in and around Portl and , Oregon . The continuing medical education ( CME ) program we evaluated , titled Thriving in a Busy Practice : Physician-Patient Communication , was developed during numerous sessions with more than 1500 clinicians . Several Kaiser Permanente divisions participated in the program 's development , and the program was popular among clinicians . The program consisted of an initial 4-hour group workshop , 2 hours of subsequent homework , and a 4-hour follow-up workshop . The first workshop focused on skills for building effective relationships with patients , including listening actively ; responding to patients ' feelings ; and communicating concern , underst and ing , and respect . The second workshop focused on skills for successful negotiation , particularly in situations of disagreement ( for example , when a patient requests narcotics for chronic pain and the clinician does not think a prescription is appropriate ) . During a 1-month interval between the two workshops , the clinicians were asked to audiotape a minimum of two of their office visits and listen to the recordings . In addition , an instructor called participants during the interval to inquire about the skills they were trying , to ask whether they had questions , and to encourage them to complete the audiotaping . Both workshops were given by two physicians who were experienced teachers and experts in clinician-patient communication . The program was design ed to incorporate educational elements that had effectively changed clinician performance in other CME programs . The workshops included brief didactic components that were related to clinical needs and role-playing that allowed clinicians to practice communication skills while focusing on situations that they found challenging and relevant ( 20 , 21 ) . Instructors taught interactively , encouraging dialogue with and among participants . Recruitment and R and omization All of the approximately 1000 clinicians who belonged to or were employed by the Permanente Medical Group of the Northwest were eligible to participate . To maximize the external validity of the study , the HMO 's CME office advertised the program and managed the initial recruitment of clinicians by using its regular methods and channels . In addition , clinician leaders encouraged enrollment by direct communication with potential participants and by e-mail . The recruitment messages explained the r and omized trial and offered clinicians equal chances to participate immediately or to participate in a later session of the program . The clinicians who were r and omly assigned to the later session provided our control group . The Figure summarizes the flow of recruitment and r and omization . After clinicians notified the CME department of their interest in the course , we sent them an informed consent form and a self- assessment question naire . When the clinician returned the signed informed consent form , we assigned him or her to one of 16 strata on the basis of sex ( male or female ) , specialty ( primary care , medical specialty , surgical specialty , or allied health ) , and previous mean score ( higher or lower than average ) on the overall satisfaction item from the Art of Medicine survey ( HealthCare Research , Inc. , Denver , Colorado ) , which had been used by the HMO during two 6-month periods before our study took place . Mean scores before the study ranged from 6.84 to 8.91 , with a mean and median of 7.92 ; an SD of 0.47 ; and a quartile distribution of 7.56 , 7.92 , 8.28 , and 8.91 . Figure . Recruitment and r and omization . On a weekly basis , as clinicians registered , we r and omly assigned groups to attend immediate or later sessions of the program . In each stratum , we used a r and om-number table to assign persons to the intervention or control group . We started with the lowest r and om number and alternated assignment in order of ascending r and om number . The study was review ed and approved by the Kaiser Permanente Committee for the Protection of Human Subjects . Measurements Our primary experimental measure was the mean difference in score ( before and after participation in the training program ) on a scale that assessed patients ' ratings of clinicians ' communication skills . We obtained these ratings from the Art of Medicine survey , an anonymous question naire that was mailed to patients by a contractor to the HMO within 10 days after patients had participated in a r and omly selected ambulatory medical care visit . The survey was design ed to obtain 100 completed question naires for each clinician during a 6-month period . We used data from three 6-month survey periods : the last half of 1995 and the first and last halves of 1996 . The Art of Medicine survey elicited ratings on seven aspects of a clinician 's communication behavior or the patient 's reaction to it during a specified ambulatory encounter . In addition , the survey asked patients to rate their overall satisfaction with the service they received from the clinician . A complete list of the survey items is provided in the Appendix Figure . Although the Art of Medicine survey was not chosen by the research teamwe took advantage of 
    Output:
    