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: Objective To assess whether an assertive outreach intervention after suicide attempt could reduce the frequency of subsequent suicidal acts , compared with st and ard treatment . Design R and omised , parallel group , superiority trial with blinded outcome assessment . Setting Outpatient intervention at one location at Copenhagen University Hospital , Denmark . Participants Patients older than 12 years admitted to regional hospitals in Copenhagen with a suicide attempt within the past 14 days . We excluded patients diagnosed with schizophrenia spectrum disorders and patients living in institutions . Intervention Case management through assertive outreach that provided crisis intervention and flexible problem solving . This approach incorporated motivational support and actively assisted patients to scheduled appointments to improve adherence with after-treatment as an add on to st and ard treatment . Main outcome Repeated suicide attempt and death by suicide , recorded in medical records and death register at 1-year follow-up . Results 243 patients were included . During 12 months of follow-up , 20/123 ( 16 % ) patients in the intervention group had been registered in hospital records with subsequent suicide attempt , compared with 13/120 ( 11 % ) in the control group ( odds ratio 1.60 , 95 % confidence interval 0.76 to 3.38 ; P=0.22 ) . By contrast , self reported data on new events showed 11/95 ( 12 % ) in the intervention group versus 13/74 ( 18 % ) in the control group ( 0.61 , 0.26 to 1.46 ; P=0.27 ) . By imputing missing data on the selfreported outcomes , we estimated 15/123 ( 12 % ) events in the intervention group and 23/120 ( 19 % ) in the control group ( 0.69 , 0.34 to 1.43 ; P=0.32 ) . Conclusion Assertive outreach showed no significant effect on subsequent suicide attempt . The difference in rates of events between register data and self reported data could indicate detection bias . Trial registration Clinical Trials.gov NCT00700089 Objectives To evaluate the completeness of descriptions of non-pharmacological interventions in r and omised trials , identify which elements are most frequently missing , and assess whether authors can provide missing details . Design Analysis of consecutive sample of r and omised trials of non-pharmacological interventions . Data sources and study selection All reports of r and omised trials of non-pharmacological interventions published in 2009 in six leading general medical journals ; 133 trial reports , with 137 interventions , met the inclusion criteria . Data collection Using an eight item checklist , two raters assessed the primary full trial report , plus any reference material s , appendices , or websites . Questions about missing details were emailed to corresponding authors , and relevant items were then reassessed . Results Of 137 interventions , only 53 ( 39 % ) were adequately described ; this was increased to 81 ( 59 % ) by using 63 responses from 88 contacted authors . The most frequently missing item was the “ intervention material s ” ( 47 % complete ) , but it also improved the most after author response ( 92 % complete ) . Whereas some authors ( 27/70 ) provided material s or further information , other authors ( 21/70 ) could not ; their reasons included copyright or intellectual property concerns , not having the material s or intervention details , or being unaware of their importance . Although 46 ( 34 % ) trial interventions had further information or material s readily available on a website , many were not mentioned in the report , were not freely accessible , or the URL was no longer functioning . Conclusions Missing essential information about interventions is a frequent , yet remediable , contributor to the worldwide waste in research funding . If trial reports do not have a sufficient description of interventions , other research ers can not build on the findings , and clinicians and patients can not reliably implement useful interventions . Improvement will require action by funders , research ers , and publishers , aided by long term repositories of material s linked to publications BACKGROUND Rates of self-harm are high and have recently increased . This trend and the repetitive nature of self-harm pose a significant challenge to mental health services . AIMS To determine the efficacy of a structured group problem-solving skills training ( PST ) programme as an intervention approach for self-harm in addition to treatment as usual ( TAU ) as offered by mental health services . METHOD A total of 433 participants ( aged 18 - 64 years ) were r and omly assigned to TAU plus PST or TAU alone . Assessment s were carried out at baseline and at 6-week and 6-month follow-up and repeated hospital-treated self-harm was ascertained at 12-month follow-up . RESULTS The treatment groups did not differ in rates of repeated self-harm at 6-week , 6-month and 12-month follow-up . Both treatment groups showed significant improvements in psychological and social functioning at follow-up . Only one measure ( needing and receiving practical help from those closest to them ) showed a positive treatment effect at 6-week ( P = 0.004 ) and 6-month ( P = 0.01 ) follow-up . Repetition was not associated with waiting time in the PST group . CONCLUSIONS This brief intervention for self-harm is no more effective than treatment as usual . Further work is required to establish whether a modified , more intensive programme delivered sooner after the index episode would be effective BACKGROUND Implementation intentions link triggers for self-harm with coping skills and appear to create an automatic tendency to invoke coping responses when faced with a triggering situation . AIMS To test the effectiveness of implementation intentions in reducing suicidal ideation and behaviour in a high-risk group . METHOD Two hundred and twenty-six patients who had self-harmed were r and omised to : ( a ) forming implementation intentions with a ' volitional help sheet ' ; ( b ) self-generating implementation intentions without help ; or ( c ) thinking about triggers and coping , but not forming implementation intentions . We measured self-reported suicidal ideation and behaviour , threats of suicide and likelihood of future suicide attempt at baseline and then again at the 3-month follow-up . RESULTS All suicide-related outcome measures were significantly lower at follow-up among patients forming implementation intentions compared with those in the control condition ( ds>0.35 ) . The volitional help sheet result ed in fewer suicide threats ( d = 0.59 ) and lowered the likelihood of future suicide attempts ( d = 0.29 ) compared with patients who self-generated implementation intentions . CONCLUSIONS Implementation intention-based interventions , particularly when supported by a volitional help sheet , show promise in reducing future suicidal ideation and behaviour Suitably trained junior doctors selected parasuicides with no immediate medical or psychiatric treatment needs on initial assessment in a casualty department . This group was then r and omly allocated to  hospital admission  ( 38 cases ) or discharge home ( 39 cases ) . One week later there were no significant differences between groups on diverse outcome measures , including repetition rate , psychological symptoms , and social functioning . A second follow-up using the same measures at 16 weeks also failed to demonstrate any differences between groups , both of which showed considerable overall improvement . A parasuicide management policy consisting of assessment in a casualty department and selective discharge was appropriate for 15 % of a hospital-referred population . This lends support to recent government recommendations , but caution should be exercised before such a result is generalised BACKGROUND Repetition of hospital-treated self-poisoning and admission to psychiatric hospital are both common in individuals who self-poison . AIMS To evaluate efficacy of postcard intervention after 5 years . METHOD A r and omised controlled trial of individuals who have self-poisoned :  postcard intervention ( eight in 12 months ) plus treatment as usual v. treatment as usual . Our primary outcomes were self-poisoning admissions and psychiatric admissions ( proportions and event rates ) . RESULTS There was no difference between groups for any repeat-episode self-poisoning admission ( intervention group : 24.9 % , 95 % CI 20.6 - 29.5 ; control group : 27.2 % , 95 % CI 22.8 - 31.8 ) but there was a significant reduction in event rates ( incidence risk ratio ( IRR ) = 0.54 , 95 % CI 0.37 - 0.81 ) , saving 306 bed days . There was no difference for any psychiatric admission ( intervention group : 38.1 % , 95 % CI 33.1 - 43.2 ; control group : 35.5 % , 95 % CI 30.8 - 40.5 ) but there was a significant reduction in event rates ( IRR = 0.66 , 95 % CI 0.47 - 0.91 ) , saving 2565 bed days . CONCLUSIONS A postcard intervention halved self-poisoning events and reduced psychiatric admissions by a third after 5 years . Substantial savings occurred in general hospital and psychiatric hospital bed days BACKGROUND We carried out a large r and omized trial of a brief form of cognitive therapy , manual-assisted cognitive behaviour therapy ( MACT ) versus treatment as usual ( TAU ) for deliberate self-harm . METHOD Patients presenting with recurrent deliberate self-harm in five centres were r and omized to either MACT or ( TAU ) and followed up over 1 year .  MACT patients received a booklet based on cognitive behaviour therapy ( CBT ) principles and were offered up to five plus two booster sessions of CBT from a therapist in the first 3 months of the study . Ratings of parasuicide risk , anxiety , depression , social functioning and global function , positive and negative thinking , and quality of life were measured at baseline and after 6 and 12 months . RESULTS Four hundred and eighty patients were r and omized . Sixty per cent of the  MACT group had both the booklet and CBT sessions . There were seven suicides , five in the TAU group . The main outcome measure , the proportion of those repeating deliberate self-harm in the 12 months of the study , showed no significant difference between those treated with MACT ( 39 % ) and treatment as usual ( 46 % ) ( OR 0.78 , 95 % CI 0.53 to 1.14 , P=0.20 ) . CONCLUSION Brief cognitive behaviour therapy is of limited efficacy in reducing self-harm repetition , but the findings taken in conjunctin with the economic evaluation ( Byford et al. 2003 ) indicate superiority of MACT over TAU in terms of cost and effectiveness combined We carried out a r and omized controlled trial to determine whether an intensive intervention after a suicide attempt could decrease by half the risk of a repeat attempt in the following two years . After initial assessment and r and omization , experimental subjects attended 18 therapy appointments over one year  , including one home visit , and measures to improve attendance .  Control subjects received the usual care . Of 63 experimental subjects , 35 % made a repeat attempt , and so did 30 % of 63 control subjects . The study had a 99 % power to detect the desired decrease of risk ( 30 % to 15 % ) . Clearly , the intervention did not achieve its objective OBJECTIVE The authors evaluated the effectiveness of brief cognitive-behavioral therapy ( CBT ) for the prevention of  suicide attempts in military personnel . METHOD In a r and omized controlled trial , active-duty Army soldiers at Fort Carson , Colo. , who either attempted suicide or experienced suicidal ideation with intent , were r and omly assigned to treatment as usual ( N=76 ) or treatment as usual plus brief CBT ( N=76 ) . Assessment of incidence of suicide attempts during the follow-up period was conducted with the Suicide Attempt Self-Injury Interview . Inclusion criteria were the presence of suicidal ideation with intent to die during the past week and /or a suicide attempt within the past month . Soldiers were excluded if they had a medical or psychiatric condition that would prevent informed consent or participation in outpatient treatment , such as active psychosis or mania . To determine treatment efficacy with regard to incidence and time to suicide attempt , survival curve analyses were conducted . Differences in psychiatric symptoms were evaluated using longitudinal r and om-effects models . RESULTS From baseline to the 24-month follow-up assessment , eight participants in brief CBT ( 13.8 % ) and 18 participants in treatment as usual ( 40.2 % ) made at least one suicide attempt ( hazard ratio=0.38 , 95 % CI=0.16 - 0.87 , number needed to treat=3.88 ) , suggesting that soldiers in brief CBT were approximately 60 % less likely to make a suicide attempt during follow-up than soldiers in treatment as usual . There were no between-group differences in severity of psychiatric symptoms . CONCLUSIONS Brief CBT was effective in preventing follow-up suicide attempts among active-duty military service members with current suicidal ideation and /or a recent suicide attempt Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more This r and omized controlled trial was design ed to evaluate the effectiveness of using  crisis coping cards ( n = 32 )  in the case management of suicide prevention compared with case management without the use of coping cards ( n = 32 ) over a 3-month intervention period . The generalized estimating equation was used to examine the interaction effect between treatments and time on suicide risk , depression , anxiety , and hopelessness . Results indicated that subsequent suicidal behaviors , severity of suicide risk , depression , anxiety , and hopelessness were reduced more in the coping card intervention group compared to the case management only group . Moreover , for the survival curves of time to suicide reattempt , the coping card group 
    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: Objective To assess whether an assertive outreach intervention after suicide attempt could reduce the frequency of subsequent suicidal acts , compared with st and ard treatment . Design R and omised , parallel group , superiority trial with blinded outcome assessment . Setting Outpatient intervention at one location at Copenhagen University Hospital , Denmark . Participants Patients older than 12 years admitted to regional hospitals in Copenhagen with a suicide attempt within the past 14 days . We excluded patients diagnosed with schizophrenia spectrum disorders and patients living in institutions . Intervention Case management through assertive outreach that provided crisis intervention and flexible problem solving . This approach incorporated motivational support and actively assisted patients to scheduled appointments to improve adherence with after-treatment as an add on to st and ard treatment . Main outcome Repeated suicide attempt and death by suicide , recorded in medical records and death register at 1-year follow-up . Results 243 patients were included . During 12 months of follow-up , 20/123 ( 16 % ) patients in the intervention group had been registered in hospital records with subsequent suicide attempt , compared with 13/120 ( 11 % ) in the control group ( odds ratio 1.60 , 95 % confidence interval 0.76 to 3.38 ; P=0.22 ) . By contrast , self reported data on new events showed 11/95 ( 12 % ) in the intervention group versus 13/74 ( 18 % ) in the control group ( 0.61 , 0.26 to 1.46 ; P=0.27 ) . By imputing missing data on the selfreported outcomes , we estimated 15/123 ( 12 % ) events in the intervention group and 23/120 ( 19 % ) in the control group ( 0.69 , 0.34 to 1.43 ; P=0.32 ) . Conclusion Assertive outreach showed no significant effect on subsequent suicide attempt . The difference in rates of events between register data and self reported data could indicate detection bias . Trial registration Clinical Trials.gov NCT00700089 Objectives To evaluate the completeness of descriptions of non-pharmacological interventions in r and omised trials , identify which elements are most frequently missing , and assess whether authors can provide missing details . Design Analysis of consecutive sample of r and omised trials of non-pharmacological interventions . Data sources and study selection All reports of r and omised trials of non-pharmacological interventions published in 2009 in six leading general medical journals ; 133 trial reports , with 137 interventions , met the inclusion criteria . Data collection Using an eight item checklist , two raters assessed the primary full trial report , plus any reference material s , appendices , or websites . Questions about missing details were emailed to corresponding authors , and relevant items were then reassessed . Results Of 137 interventions , only 53 ( 39 % ) were adequately described ; this was increased to 81 ( 59 % ) by using 63 responses from 88 contacted authors . The most frequently missing item was the “ intervention material s ” ( 47 % complete ) , but it also improved the most after author response ( 92 % complete ) . Whereas some authors ( 27/70 ) provided material s or further information , other authors ( 21/70 ) could not ; their reasons included copyright or intellectual property concerns , not having the material s or intervention details , or being unaware of their importance . Although 46 ( 34 % ) trial interventions had further information or material s readily available on a website , many were not mentioned in the report , were not freely accessible , or the URL was no longer functioning . Conclusions Missing essential information about interventions is a frequent , yet remediable , contributor to the worldwide waste in research funding . If trial reports do not have a sufficient description of interventions , other research ers can not build on the findings , and clinicians and patients can not reliably implement useful interventions . Improvement will require action by funders , research ers , and publishers , aided by long term repositories of material s linked to publications BACKGROUND Rates of self-harm are high and have recently increased . This trend and the repetitive nature of self-harm pose a significant challenge to mental health services . AIMS To determine the efficacy of a structured group problem-solving skills training ( PST ) programme as an intervention approach for self-harm in addition to treatment as usual ( TAU ) as offered by mental health services . METHOD A total of 433 participants ( aged 18 - 64 years ) were r and omly assigned to TAU plus PST or TAU alone . Assessment s were carried out at baseline and at 6-week and 6-month follow-up and repeated hospital-treated self-harm was ascertained at 12-month follow-up . RESULTS The treatment groups did not differ in rates of repeated self-harm at 6-week , 6-month and 12-month follow-up . Both treatment groups showed significant improvements in psychological and social functioning at follow-up . Only one measure ( needing and receiving practical help from those closest to them ) showed a positive treatment effect at 6-week ( P = 0.004 ) and 6-month ( P = 0.01 ) follow-up . Repetition was not associated with waiting time in the PST group . CONCLUSIONS This brief intervention for self-harm is no more effective than treatment as usual . Further work is required to establish whether a modified , more intensive programme delivered sooner after the index episode would be effective BACKGROUND Implementation intentions link triggers for self-harm with coping skills and appear to create an automatic tendency to invoke coping responses when faced with a triggering situation . AIMS To test the effectiveness of implementation intentions in reducing suicidal ideation and behaviour in a high-risk group . METHOD Two hundred and twenty-six patients who had self-harmed were r and omised to : ( a ) forming implementation intentions with a ' volitional help sheet ' ; ( b ) self-generating implementation intentions without help ; or ( c ) thinking about triggers and coping , but not forming implementation intentions . We measured self-reported suicidal ideation and behaviour , threats of suicide and likelihood of future suicide attempt at baseline and then again at the 3-month follow-up . RESULTS All suicide-related outcome measures were significantly lower at follow-up among patients forming implementation intentions compared with those in the control condition ( ds>0.35 ) . The volitional help sheet result ed in fewer suicide threats ( d = 0.59 ) and lowered the likelihood of future suicide attempts ( d = 0.29 ) compared with patients who self-generated implementation intentions . CONCLUSIONS Implementation intention-based interventions , particularly when supported by a volitional help sheet , show promise in reducing future suicidal ideation and behaviour Suitably trained junior doctors selected parasuicides with no immediate medical or psychiatric treatment needs on initial assessment in a casualty department . This group was then r and omly allocated to  hospital admission  ( 38 cases ) or discharge home ( 39 cases ) . One week later there were no significant differences between groups on diverse outcome measures , including repetition rate , psychological symptoms , and social functioning . A second follow-up using the same measures at 16 weeks also failed to demonstrate any differences between groups , both of which showed considerable overall improvement . A parasuicide management policy consisting of assessment in a casualty department and selective discharge was appropriate for 15 % of a hospital-referred population . This lends support to recent government recommendations , but caution should be exercised before such a result is generalised BACKGROUND Repetition of hospital-treated self-poisoning and admission to psychiatric hospital are both common in individuals who self-poison . AIMS To evaluate efficacy of postcard intervention after 5 years . METHOD A r and omised controlled trial of individuals who have self-poisoned :  postcard intervention ( eight in 12 months ) plus treatment as usual v. treatment as usual . Our primary outcomes were self-poisoning admissions and psychiatric admissions ( proportions and event rates ) . RESULTS There was no difference between groups for any repeat-episode self-poisoning admission ( intervention group : 24.9 % , 95 % CI 20.6 - 29.5 ; control group : 27.2 % , 95 % CI 22.8 - 31.8 ) but there was a significant reduction in event rates ( incidence risk ratio ( IRR ) = 0.54 , 95 % CI 0.37 - 0.81 ) , saving 306 bed days . There was no difference for any psychiatric admission ( intervention group : 38.1 % , 95 % CI 33.1 - 43.2 ; control group : 35.5 % , 95 % CI 30.8 - 40.5 ) but there was a significant reduction in event rates ( IRR = 0.66 , 95 % CI 0.47 - 0.91 ) , saving 2565 bed days . CONCLUSIONS A postcard intervention halved self-poisoning events and reduced psychiatric admissions by a third after 5 years . Substantial savings occurred in general hospital and psychiatric hospital bed days BACKGROUND We carried out a large r and omized trial of a brief form of cognitive therapy , manual-assisted cognitive behaviour therapy ( MACT ) versus treatment as usual ( TAU ) for deliberate self-harm . METHOD Patients presenting with recurrent deliberate self-harm in five centres were r and omized to either MACT or ( TAU ) and followed up over 1 year .  MACT patients received a booklet based on cognitive behaviour therapy ( CBT ) principles and were offered up to five plus two booster sessions of CBT from a therapist in the first 3 months of the study . Ratings of parasuicide risk , anxiety , depression , social functioning and global function , positive and negative thinking , and quality of life were measured at baseline and after 6 and 12 months . RESULTS Four hundred and eighty patients were r and omized . Sixty per cent of the  MACT group had both the booklet and CBT sessions . There were seven suicides , five in the TAU group . The main outcome measure , the proportion of those repeating deliberate self-harm in the 12 months of the study , showed no significant difference between those treated with MACT ( 39 % ) and treatment as usual ( 46 % ) ( OR 0.78 , 95 % CI 0.53 to 1.14 , P=0.20 ) . CONCLUSION Brief cognitive behaviour therapy is of limited efficacy in reducing self-harm repetition , but the findings taken in conjunctin with the economic evaluation ( Byford et al. 2003 ) indicate superiority of MACT over TAU in terms of cost and effectiveness combined We carried out a r and omized controlled trial to determine whether an intensive intervention after a suicide attempt could decrease by half the risk of a repeat attempt in the following two years . After initial assessment and r and omization , experimental subjects attended 18 therapy appointments over one year  , including one home visit , and measures to improve attendance .  Control subjects received the usual care . Of 63 experimental subjects , 35 % made a repeat attempt , and so did 30 % of 63 control subjects . The study had a 99 % power to detect the desired decrease of risk ( 30 % to 15 % ) . Clearly , the intervention did not achieve its objective OBJECTIVE The authors evaluated the effectiveness of brief cognitive-behavioral therapy ( CBT ) for the prevention of  suicide attempts in military personnel . METHOD In a r and omized controlled trial , active-duty Army soldiers at Fort Carson , Colo. , who either attempted suicide or experienced suicidal ideation with intent , were r and omly assigned to treatment as usual ( N=76 ) or treatment as usual plus brief CBT ( N=76 ) . Assessment of incidence of suicide attempts during the follow-up period was conducted with the Suicide Attempt Self-Injury Interview . Inclusion criteria were the presence of suicidal ideation with intent to die during the past week and /or a suicide attempt within the past month . Soldiers were excluded if they had a medical or psychiatric condition that would prevent informed consent or participation in outpatient treatment , such as active psychosis or mania . To determine treatment efficacy with regard to incidence and time to suicide attempt , survival curve analyses were conducted . Differences in psychiatric symptoms were evaluated using longitudinal r and om-effects models . RESULTS From baseline to the 24-month follow-up assessment , eight participants in brief CBT ( 13.8 % ) and 18 participants in treatment as usual ( 40.2 % ) made at least one suicide attempt ( hazard ratio=0.38 , 95 % CI=0.16 - 0.87 , number needed to treat=3.88 ) , suggesting that soldiers in brief CBT were approximately 60 % less likely to make a suicide attempt during follow-up than soldiers in treatment as usual . There were no between-group differences in severity of psychiatric symptoms . CONCLUSIONS Brief CBT was effective in preventing follow-up suicide attempts among active-duty military service members with current suicidal ideation and /or a recent suicide attempt Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more This r and omized controlled trial was design ed to evaluate the effectiveness of using  crisis coping cards ( n = 32 )  in the case management of suicide prevention compared with case management without the use of coping cards ( n = 32 ) over a 3-month intervention period . The generalized estimating equation was used to examine the interaction effect between treatments and time on suicide risk , depression , anxiety , and hopelessness . Results indicated that subsequent suicidal behaviors , severity of suicide risk , depression , anxiety , and hopelessness were reduced more in the coping card intervention group compared to the case management only group . Moreover , for the survival curves of time to suicide reattempt , the coping card group 
    Output:
    