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: Seventy two women drinking 21 units ( 210 g ) or more of alcohol per week were recruited from an opportunistic screening programme in eight English general practice s. The women were r and omized into control and treatment groups . Women in the treatment group received ten minutes advice from their general practitioner to reduce alcohol consumption .  At one year follow-up , when analyzed by intention to treat , women in the treatment group had reduced their alcohol consumption from an average of 35 - 24 units per week . Similar reductions were found in the control group ( from 37 - 27 units per week ) . The lack of evidence for a treatment effect may be explained by contamination of the control group by informal interventions Context Brief interventions reduce alcohol use in out patients who drink unhealthy amounts but are not alcohol-dependent . Their effect in medical in patients is unknown . Contribution The authors screened all adult medical in patients at an urban teaching hospital and r and omly assigned 341 risky drinkers to a 30-minute motivational counseling intervention followed gy treatment planning or to usual care . By 3 months , the same proportion of patients from both groups had received alcohol assistance , and both groups had reduced their drinking to the same degree . Caution s Three quarters of the participants met Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , criteria for alcohol dependence . Implication s In this well-done study , brief intervention did not affect alcohol-related outcomes in persons who drank unhealthy amounts . The Editors Professional organizations recommend that clinicians screen their patients for unhealthy alcohol use ( that is , the spectrum from drinking risky amounts to dependence ) and conduct a brief intervention when indicated ( 1 , 2 ) . Despite this recommendation and the existence of brief , valid screening tools ( 35 ) , patients with unhealthy alcohol use often are not identified and do not receive timely care . Although widely recommended , brief intervention has proven efficacy in decreasing alcohol consumption and related consequences only in unhealthy drinkers without alcohol dependence and in outpatient setting s ( 6 ) . Its efficacy among other population s ( for example , persons with alcohol dependence ) and in inpatient setting s remains unclear ( 7 ) . Evidence suggests , however , that medical in patients a group with a high prevalence of alcohol-related problemsmay benefit from brief intervention . Some studies have demonstrated the efficacy of brief intervention in setting s similar to medical services in which alcohol-related problems are common and their related consequences are severe ( 8 , 9 ) . Further , brief interventions are well suited to medical services . Patients who otherwise might not seek care are accessible and have time for an intervention . Persons admitted because of an alcohol-related problem may recognize the link between drinking and hospitalization , thus providing a teachable moment ( 10 ) . Also , busy staff might implement a brief intervention because of its brevity and flexibility . The unmet need for alcohol screening and intervention and opportunities for implementation underscore the importance of determining the efficacy of brief intervention in medical in patients with unhealthy alcohol use . In addition , evaluating its effectiveness and practicality in real-world setting s is critical to help clinicians make informed decisions when treating their patients ( 11 ) . Therefore , we conducted a r and omized , controlled trial to examine whether screening followed by brief intervention would improve alcohol-related outcomes in typical medical in patients ( that is , a racially diverse group with a range of unhealthy alcohol use , comorbid conditions , and readiness to change ) . We hypothesized that screening and brief intervention would lead to the following : receipt of alcohol assistance ( for example , specialty treatment ) among persons with alcohol dependence and , among all persons decreased alcohol consumption , alcohol-related problems , and health care utilization and improved readiness to change and health-related quality of life . Methods Patients As previously described , we recruited patients from the inpatient medical service of a large , urban teaching hospital ( 12 ) . Trained research associates approached all patients who were age 18 years or older and whose physicians did not decline patient contact . Patients fluent in English or Spanish who gave verbal consent were asked to complete a screening interview to determine eligibility : currently ( past month ) drinking risky amounts ( defined for eligibility as > 14 st and ard drinks/wk or 5 drinks/occasion for men and > 11 drinks/wk or 4 drinks/occasion for women and persons 66 years ) ; 2 contacts to assist with follow-up ; no plans to move from the area in the next year ; and a Mini-Mental State Examination score of 21 or greater ( 13 , 14 ) . Research associates assessed demographic characteristics and administered the  Alcohol Use Disorders Identification Test ( AUDIT )  ( 15 ) by interview . To better characterize current alcohol use , they assessed the average numbers of drinking-days per week and drinks consumed on a typical day , and the maximum number of drinks consumed per occasion ( 16 , 17 ) . For the first 7 months of the study , research associates asked these additional questions only to patients with an AUDIT score of 8 or greater ( a recommended cutoff for screening ) ( 18 ) . For the remaining 22 months , research associates asked the additional questions to anyone who drank in the past 12 months to maximize identification of drinkers of risky amounts . Lastly , the research associates asked all patients who were drinking risky amounts to describe their readiness to change by using a visual analog scale ranging from 0 to 10 ( 19 ) . Enrolled patients provided written informed consent and were compensated for each completed interview . The institutional review board at Boston University Medical Center approved this study . We secured additional privacy protection with a certificate of confidentiality from the National Institute on Alcohol Abuse and Alcoholism . Assessment at Enrollment Research associates interviewed patients before r and omization to assess the characteristics shown in Table 1 . One author review ed the medical records to determine medical diagnoses ( 29 ) . Diagnoses of alcohol use disorders were based on the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ( 30 ) , and were determined with the Composite International Diagnostic Interview ( CIDI ) Alcohol Module ( 31 , 32 ) . Table 1 . Characteristics at Enrollment of All Study Patients and of the Subgroup with Alcohol Dependence * R and omization and Intervention An off-site data management group generated assignments to control and intervention groups by using a permuted block ( size 8) r and omization procedure stratified by AUDIT score ( < 12 vs. 12 ) and provided us the assignments in sealed opaque envelopes . We used the AUDIT score to stratify because we could not score the CIDI before r and omization . After each baseline assessment , research associates opened an envelope and informed the patient of his or her assignment . Patients in the control group received usual care ( that is , they were told the screening results and that they could discuss their drinking with their physicians ) . Specialists were available by referral . Systematic alcohol screening and brief intervention were not routine at this hospital . We assigned patients in the intervention group to a 30-minute session of brief motivational counseling ( 19 , 33 ) conducted by counseling and clinical psychology doctoral students whom we trained and supervised . Sessions were audiotaped and included feedback , an open discussion , and construction of a change plan ( Appendix ) . Outcomes and Measurements The first primary outcome was self-reported receipt of alcohol assistance in the past 3 months by patients with CIDI-determined alcohol dependence . This outcome was measured at the 3-month follow-up visit with a st and ardized interview based on the Treatment Services Review ( 34 ) and Form 90 ( 35 ) . Assistance included residential treatment , outpatient treatment ( for example , specialty counseling or therapy ) , medications , employee assistance programs , or mutual-help groups ( for example , Alcoholics Anonymous ) . The other primary outcome was the change in the number of mean drinks per day in the past 30 days from enrollment to 12 months among all patients . We determined consumption with the Timeline Follow-back method ( 36 ) . Five secondary consumption outcomes ( past 30 days ) included changes from enrollment to 12 months in the numbers of heavy drinking episodes ( 5 drinks/occasion for men and 4 drinks/occasion for women and for persons 66 y ) and days abstinent ; and the proportions of patients drinking risky amounts ( > 14 drinks/wk or 5 drinks/occasion for men and > 7 drinks/wk or 4 drinks/occasion for women and persons 66 y ) ( 37 ) , having 1 or more heavy drinking episodes , and abstaining for all 30 days . Other secondary outcomes included the changes at 12 months in readiness to change ( Taking Steps scale on the Stages of Change Readiness and Treatment Eagerness Scale ) ( 38 ) , alcohol problems ( total score on the Short Inventory of Problems ) ( 39 ) , physical and mental health-related quality of life ( Physical and Mental Component Summary scale scores on the Short-Form Health Survey ) ( 40 ) , and emergency department visits and days of medical hospitalization ( both determined by a st and ardized interview based on the Treatment Services Review and Form 90 ) ( 34 , 35 ) . Follow-up Procedures Research associates conducted follow-up visits , which included re assessment of most domains covered at enrollment , usually in person and at 3 and 12 months ( 10 % and 13 % , respectively , by telephone ; similar by r and omized group ) . They performed  alcohol breath tests  at in-person follow-up visits ( 41 ) . Although they were involved in the r and omization assignment , research associates were not involved in the intervention . Further , 64 % of patients at 3-month follow-up and 85 % of patients at 12-month follow-up were interviewed by a different research associate than at baseline . Statistical Analysis We analyzed all patients in the groups to which they were r and omly assigned . Reported P values are 2-tailed and are considered statistically significant if they were less than 0.05 . We analyzed data with SAS/STAT software , versions 8.2 and 9.1.3 ( SAS Institute , Inc. , Cary , North Carolina ) . To describe the study sample and to compare groups , we used the chi-square test , Fisher exact test , 2- sample t test , and Wilcoxon rank-sum test , as appropriate . For the primary analyses , we used logistic and Objective : We sought to estimate the effect of screening and brief intervention ( SBI ) for risky alcohol use on the health care utilization  of risky drinkers in 4 managed care organizations . Research Design : A quasi-experimental group design was implemented in which 12 participating primary care clinics r and omly were assigned to 1 of 3 study conditions . In one condition , physicians , physician assistants , and nurse practitioners delivered the brief intervention . In another condition , midlevel professionals ( usually nurses ) performed the brief intervention . In the third condition , SBI was not performed . Using administrative cl aims data , we estimated the effect of SBI on individual-level annual days of total and inpatient health care utilization ; annual outpatient visits ; annual emergency room visits ; and annual visits related to alcohol , drug , or mental health conditions . Negative binomial regression models were used to control for other factors that may affect health care utilization . Results : Across all categories of care , the pre- to postintervention change in average health care utilization among risky drinkers in the intervention clinics was not significantly different from that of risky drinkers in the comparison clinics . Conclusions : Our findings suggest that there is no effect of  SBI  on the health care utilization of risky drinkers in the year following the intervention . Although SBI does not appear to reduce health care utilization , previous studies find that it significantly reduces the alcohol consumption of risky drinkers . Because these reductions presumably improve patients ’ overall health and well-being , managed care organizations may still find it beneficial to implement SBI on a broad scale Sixteen general practitioners participated in a controlled trial of the Scottish Health Education Group 's  DRAMS ( drinking reasonably and moderately with self-control ) scheme . The scheme was evaluated by r and omly assigning 104 heavy or problem drinkers to three groups - a group participating in the DRAMS scheme  ( n = 34 ) , a group given simple advice only ( n = 32 ) and a non-intervention control group ( n = 38 ) . Six month follow-up information was obtained for 91 subjects ( 87.5 % of initial sample ) . There were no significant differences between the groups in reduction in alcohol consumption , but patients in the DRAMS group showed a significantly greater reduction in a logarithmic measure of serum gamma-glutamyl-transpeptidase than patients in the group receiving advice only . Only 14 patients in the DRAMS group completed the full DRAMS procedure . For the sample as a whole , there was a significant reduction in alcohol consumption , a significant improvement on a measure of physical health and well-being , and significant reductions in the logarithmic measure of serum gamma-glutamyl transpeptidase and in mean corpuscular volume . The implication s of these findings for future research into controlled drinking minimal interventions in general practice are discussed The objective of the study was to estimate the effect of a brief alcohol-reduction intervention on health care use . Male veterans aged 55 years and older drinking more than guideline limits participated in an effective primary care-based r and omized clinical trial to reduce drinking . Repeated measures ANCOVA assessed short-term and long-term changes in both inpatient and outpatient utilization .  Stage of change ( SOC ) was assessed in a sub sample to test for interaction between SOC and the intervention . Veterans exposed to the intervention used more outpatient medical services in the short term . Long-term effects on inpatient/outpatient use were not observed . SOC did not moderate the effect of the intervention but was associated with differential use of health care services . A cost-effective brief intervention to reduce drinking may spur increased efforts to seek health care . Early detection and management of alcohol-related or other illnesses might be expected to accrue savings in later years BACKGROUND Alcohol use in older adults is common . It is associated with depression , hypert 
    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: Seventy two women drinking 21 units ( 210 g ) or more of alcohol per week were recruited from an opportunistic screening programme in eight English general practice s. The women were r and omized into control and treatment groups . Women in the treatment group received ten minutes advice from their general practitioner to reduce alcohol consumption .  At one year follow-up , when analyzed by intention to treat , women in the treatment group had reduced their alcohol consumption from an average of 35 - 24 units per week . Similar reductions were found in the control group ( from 37 - 27 units per week ) . The lack of evidence for a treatment effect may be explained by contamination of the control group by informal interventions Context Brief interventions reduce alcohol use in out patients who drink unhealthy amounts but are not alcohol-dependent . Their effect in medical in patients is unknown . Contribution The authors screened all adult medical in patients at an urban teaching hospital and r and omly assigned 341 risky drinkers to a 30-minute motivational counseling intervention followed gy treatment planning or to usual care . By 3 months , the same proportion of patients from both groups had received alcohol assistance , and both groups had reduced their drinking to the same degree . Caution s Three quarters of the participants met Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , criteria for alcohol dependence . Implication s In this well-done study , brief intervention did not affect alcohol-related outcomes in persons who drank unhealthy amounts . The Editors Professional organizations recommend that clinicians screen their patients for unhealthy alcohol use ( that is , the spectrum from drinking risky amounts to dependence ) and conduct a brief intervention when indicated ( 1 , 2 ) . Despite this recommendation and the existence of brief , valid screening tools ( 35 ) , patients with unhealthy alcohol use often are not identified and do not receive timely care . Although widely recommended , brief intervention has proven efficacy in decreasing alcohol consumption and related consequences only in unhealthy drinkers without alcohol dependence and in outpatient setting s ( 6 ) . Its efficacy among other population s ( for example , persons with alcohol dependence ) and in inpatient setting s remains unclear ( 7 ) . Evidence suggests , however , that medical in patients a group with a high prevalence of alcohol-related problemsmay benefit from brief intervention . Some studies have demonstrated the efficacy of brief intervention in setting s similar to medical services in which alcohol-related problems are common and their related consequences are severe ( 8 , 9 ) . Further , brief interventions are well suited to medical services . Patients who otherwise might not seek care are accessible and have time for an intervention . Persons admitted because of an alcohol-related problem may recognize the link between drinking and hospitalization , thus providing a teachable moment ( 10 ) . Also , busy staff might implement a brief intervention because of its brevity and flexibility . The unmet need for alcohol screening and intervention and opportunities for implementation underscore the importance of determining the efficacy of brief intervention in medical in patients with unhealthy alcohol use . In addition , evaluating its effectiveness and practicality in real-world setting s is critical to help clinicians make informed decisions when treating their patients ( 11 ) . Therefore , we conducted a r and omized , controlled trial to examine whether screening followed by brief intervention would improve alcohol-related outcomes in typical medical in patients ( that is , a racially diverse group with a range of unhealthy alcohol use , comorbid conditions , and readiness to change ) . We hypothesized that screening and brief intervention would lead to the following : receipt of alcohol assistance ( for example , specialty treatment ) among persons with alcohol dependence and , among all persons decreased alcohol consumption , alcohol-related problems , and health care utilization and improved readiness to change and health-related quality of life . Methods Patients As previously described , we recruited patients from the inpatient medical service of a large , urban teaching hospital ( 12 ) . Trained research associates approached all patients who were age 18 years or older and whose physicians did not decline patient contact . Patients fluent in English or Spanish who gave verbal consent were asked to complete a screening interview to determine eligibility : currently ( past month ) drinking risky amounts ( defined for eligibility as > 14 st and ard drinks/wk or 5 drinks/occasion for men and > 11 drinks/wk or 4 drinks/occasion for women and persons 66 years ) ; 2 contacts to assist with follow-up ; no plans to move from the area in the next year ; and a Mini-Mental State Examination score of 21 or greater ( 13 , 14 ) . Research associates assessed demographic characteristics and administered the  Alcohol Use Disorders Identification Test ( AUDIT )  ( 15 ) by interview . To better characterize current alcohol use , they assessed the average numbers of drinking-days per week and drinks consumed on a typical day , and the maximum number of drinks consumed per occasion ( 16 , 17 ) . For the first 7 months of the study , research associates asked these additional questions only to patients with an AUDIT score of 8 or greater ( a recommended cutoff for screening ) ( 18 ) . For the remaining 22 months , research associates asked the additional questions to anyone who drank in the past 12 months to maximize identification of drinkers of risky amounts . Lastly , the research associates asked all patients who were drinking risky amounts to describe their readiness to change by using a visual analog scale ranging from 0 to 10 ( 19 ) . Enrolled patients provided written informed consent and were compensated for each completed interview . The institutional review board at Boston University Medical Center approved this study . We secured additional privacy protection with a certificate of confidentiality from the National Institute on Alcohol Abuse and Alcoholism . Assessment at Enrollment Research associates interviewed patients before r and omization to assess the characteristics shown in Table 1 . One author review ed the medical records to determine medical diagnoses ( 29 ) . Diagnoses of alcohol use disorders were based on the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ( 30 ) , and were determined with the Composite International Diagnostic Interview ( CIDI ) Alcohol Module ( 31 , 32 ) . Table 1 . Characteristics at Enrollment of All Study Patients and of the Subgroup with Alcohol Dependence * R and omization and Intervention An off-site data management group generated assignments to control and intervention groups by using a permuted block ( size 8) r and omization procedure stratified by AUDIT score ( < 12 vs. 12 ) and provided us the assignments in sealed opaque envelopes . We used the AUDIT score to stratify because we could not score the CIDI before r and omization . After each baseline assessment , research associates opened an envelope and informed the patient of his or her assignment . Patients in the control group received usual care ( that is , they were told the screening results and that they could discuss their drinking with their physicians ) . Specialists were available by referral . Systematic alcohol screening and brief intervention were not routine at this hospital . We assigned patients in the intervention group to a 30-minute session of brief motivational counseling ( 19 , 33 ) conducted by counseling and clinical psychology doctoral students whom we trained and supervised . Sessions were audiotaped and included feedback , an open discussion , and construction of a change plan ( Appendix ) . Outcomes and Measurements The first primary outcome was self-reported receipt of alcohol assistance in the past 3 months by patients with CIDI-determined alcohol dependence . This outcome was measured at the 3-month follow-up visit with a st and ardized interview based on the Treatment Services Review ( 34 ) and Form 90 ( 35 ) . Assistance included residential treatment , outpatient treatment ( for example , specialty counseling or therapy ) , medications , employee assistance programs , or mutual-help groups ( for example , Alcoholics Anonymous ) . The other primary outcome was the change in the number of mean drinks per day in the past 30 days from enrollment to 12 months among all patients . We determined consumption with the Timeline Follow-back method ( 36 ) . Five secondary consumption outcomes ( past 30 days ) included changes from enrollment to 12 months in the numbers of heavy drinking episodes ( 5 drinks/occasion for men and 4 drinks/occasion for women and for persons 66 y ) and days abstinent ; and the proportions of patients drinking risky amounts ( > 14 drinks/wk or 5 drinks/occasion for men and > 7 drinks/wk or 4 drinks/occasion for women and persons 66 y ) ( 37 ) , having 1 or more heavy drinking episodes , and abstaining for all 30 days . Other secondary outcomes included the changes at 12 months in readiness to change ( Taking Steps scale on the Stages of Change Readiness and Treatment Eagerness Scale ) ( 38 ) , alcohol problems ( total score on the Short Inventory of Problems ) ( 39 ) , physical and mental health-related quality of life ( Physical and Mental Component Summary scale scores on the Short-Form Health Survey ) ( 40 ) , and emergency department visits and days of medical hospitalization ( both determined by a st and ardized interview based on the Treatment Services Review and Form 90 ) ( 34 , 35 ) . Follow-up Procedures Research associates conducted follow-up visits , which included re assessment of most domains covered at enrollment , usually in person and at 3 and 12 months ( 10 % and 13 % , respectively , by telephone ; similar by r and omized group ) . They performed  alcohol breath tests  at in-person follow-up visits ( 41 ) . Although they were involved in the r and omization assignment , research associates were not involved in the intervention . Further , 64 % of patients at 3-month follow-up and 85 % of patients at 12-month follow-up were interviewed by a different research associate than at baseline . Statistical Analysis We analyzed all patients in the groups to which they were r and omly assigned . Reported P values are 2-tailed and are considered statistically significant if they were less than 0.05 . We analyzed data with SAS/STAT software , versions 8.2 and 9.1.3 ( SAS Institute , Inc. , Cary , North Carolina ) . To describe the study sample and to compare groups , we used the chi-square test , Fisher exact test , 2- sample t test , and Wilcoxon rank-sum test , as appropriate . For the primary analyses , we used logistic and Objective : We sought to estimate the effect of screening and brief intervention ( SBI ) for risky alcohol use on the health care utilization  of risky drinkers in 4 managed care organizations . Research Design : A quasi-experimental group design was implemented in which 12 participating primary care clinics r and omly were assigned to 1 of 3 study conditions . In one condition , physicians , physician assistants , and nurse practitioners delivered the brief intervention . In another condition , midlevel professionals ( usually nurses ) performed the brief intervention . In the third condition , SBI was not performed . Using administrative cl aims data , we estimated the effect of SBI on individual-level annual days of total and inpatient health care utilization ; annual outpatient visits ; annual emergency room visits ; and annual visits related to alcohol , drug , or mental health conditions . Negative binomial regression models were used to control for other factors that may affect health care utilization . Results : Across all categories of care , the pre- to postintervention change in average health care utilization among risky drinkers in the intervention clinics was not significantly different from that of risky drinkers in the comparison clinics . Conclusions : Our findings suggest that there is no effect of  SBI  on the health care utilization of risky drinkers in the year following the intervention . Although SBI does not appear to reduce health care utilization , previous studies find that it significantly reduces the alcohol consumption of risky drinkers . Because these reductions presumably improve patients ’ overall health and well-being , managed care organizations may still find it beneficial to implement SBI on a broad scale Sixteen general practitioners participated in a controlled trial of the Scottish Health Education Group 's  DRAMS ( drinking reasonably and moderately with self-control ) scheme . The scheme was evaluated by r and omly assigning 104 heavy or problem drinkers to three groups - a group participating in the DRAMS scheme  ( n = 34 ) , a group given simple advice only ( n = 32 ) and a non-intervention control group ( n = 38 ) . Six month follow-up information was obtained for 91 subjects ( 87.5 % of initial sample ) . There were no significant differences between the groups in reduction in alcohol consumption , but patients in the DRAMS group showed a significantly greater reduction in a logarithmic measure of serum gamma-glutamyl-transpeptidase than patients in the group receiving advice only . Only 14 patients in the DRAMS group completed the full DRAMS procedure . For the sample as a whole , there was a significant reduction in alcohol consumption , a significant improvement on a measure of physical health and well-being , and significant reductions in the logarithmic measure of serum gamma-glutamyl transpeptidase and in mean corpuscular volume . The implication s of these findings for future research into controlled drinking minimal interventions in general practice are discussed The objective of the study was to estimate the effect of a brief alcohol-reduction intervention on health care use . Male veterans aged 55 years and older drinking more than guideline limits participated in an effective primary care-based r and omized clinical trial to reduce drinking . Repeated measures ANCOVA assessed short-term and long-term changes in both inpatient and outpatient utilization .  Stage of change ( SOC ) was assessed in a sub sample to test for interaction between SOC and the intervention . Veterans exposed to the intervention used more outpatient medical services in the short term . Long-term effects on inpatient/outpatient use were not observed . SOC did not moderate the effect of the intervention but was associated with differential use of health care services . A cost-effective brief intervention to reduce drinking may spur increased efforts to seek health care . Early detection and management of alcohol-related or other illnesses might be expected to accrue savings in later years BACKGROUND Alcohol use in older adults is common . It is associated with depression , hypert 
    Output:
    