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: Bt steps is a patient-centered behavioral therapy program that uses a manual and a computer-driven interactive voice response system to assess and treat obsessive compulsive disorder .  This nine-step program contains a self- assessment module and a self-treatment module that provides teaching on exposure and ritual prevention . The patient reads about the steps in a manual and then uses a touch-tone telephone to contact the program , in which a recorded voice conducts the interview . Of 40 patients in an open 12-week trial in the United States and London , 35 completed the self- assessment module , and 17 completed at least two sessions of  exposure and ritual prevention . The system produced statistically significant improvements on measures of obsessive compulsive disorder A true experimental , posttest only , control group design was used to pilot test the effectiveness of a telephone nursing intervention in increasing community survival , and decreasing the number and length of rehospitalizations for persons with schizophrenia . The vulnerability model was used as a framework for the study . The intervention was hypothesized to function as a moderating factor to reduce the effects of stress on vulnerable persons with schizophrenia . Experimental subjects received telephone nursing intervention weekly for 3 months ;  control subjects received informational calls at weeks 6 and 12 .  Readmission rates were 13 % ( n = 2 ) for experimental subjects and 23 % ( n = 5 ) for controls . Compared with controls , experimental subjects experienced a 4 % increase in community survival and a 27 % reduction in length of stay if readmission occurred . These preliminary data suggest that telephone intervention can increase community survival in persons with schizophrenia . Future studies should focus on increasing sample size and refining the intervention BACKGROUND There is great potential dem and for treatment of bulimia nervosa and binge eating disorder . Skilled therapists are in short supply . Self-help and guided self-help based upon books have shown some promise as an economical alternative to full therapy in some cases . AIMS To investigate the efficacy and effectiveness of self-help with and without guidance in a specialist secondary service . METHOD A r and omised controlled trial comparing three forms of self-help over 4 months with a waiting-list comparison group and measurement of service consumption  over the subsequent 8 months . RESULTS Self-help delivered with four sessions of face-to-face guidance led to improved outcome over 4 months . There is also some evidence to support the use of telephone guidance . A minority of participants achieved lasting remission of their disorder in relation to self-help , but there was no significant difference in final outcome between the groups after they had progressed through the stepped care programme . Patients initially offered guided self-help had a lower long-term drop-out rate . CONCLUSIONS Guided self-help is a worthwhile initial response to bulimia nervosa and binge eating disorder . It is a treatment that could be delivered in primary care and in other non-specialist setting Over the last decade , much has been published concerning the information needs of patients and their families on and after discharge from hospital . With ever-decreasing lengths of stay in hospital following cardiac surgery as a result of technological improvements and the relentless pressure for beds , the time available for nurses to attend to these needs has been reduced dramatically , thus presenting new challenges to nurses . This study examines the levels of anxiety and depression in 78 elective cardiac surgery patients on discharge and at five weeks after , but before their recall to the outpatient department . The study tests the hypothesis that telephone follow-up from the ward will reduce patients ' anxiety and depression levels in the early post-discharge period . The findings indicated that patients found follow-up calls beneficial and helpful , but follow-up calls did not reduce anxiety and depression levels in the early post-discharge period Most depressed patients are seen and treated exclusively by primary care clinicians . However , primary care patients with depression are often not adequately treated . The aims of this pilot study were to measure the impact of a telephone disease management program on patient outcome and clinician adherence to practice guidelines , measure the relationship of clinician adherence to patient outcome , and explore the measurement of patient adherence to clinician recommendations and its impact on patient outcomes . Thirty-five primary care practice s in the University of Pennsylvania Health System were r and omized to telephone disease management ( TDM ) or " usual care " ( UC ) .  All patients received a baseline and a 16-week follow-up clinical evaluation performed over the telephone . Those from TDM practice s also received follow-up contact at least every 3 weeks , with formal evaluations at weeks 6 and 12 . These interval contacts were design ed to facilitate patient and clinician adherence to a treatment algorithm based on the Agency for Health Research and Quality ( AHRQ ) practice guidelines . Depressive symptoms evaluated with the Community Epidemiologic Survey of Depression ( CES-D ) scale as well as guideline adherence were the primary outcome measures . Sixty-one patients were enrolled in this pilot project . The overall effect for CES-D scores over time was significant , ( P < .001 ) , indicating that those participating in the trial ( both TDM and UC groups ) showed significant improvement . The interaction between intervention condition and time was also significant ( P < .05 ) , indicating that TDM patients improved significantly more over time than did UC patients . A greater proportion of TDM patients had CES-D scores < 16 by Week 16 ( 66.7 versus 33.3 % ; chi(2 ) , P < .05 ) . The improvement in depression outcome for the TDM group was related to its impact on improving clinician adherence to depression treatment algorithms . The TDM pilot did not show a statistically significant effect on improving patient adherence to clinician recommendations , however . This preliminary data suggests that TDM for depression improves both clinician guideline adherence and patient outcomes in the acute phase of depression . The effect on patient outcome is at least partially explained by the effect of TDM on clinician adherence to depression treatment algorithms This study examined the efficacy of an 8-week telephone-administered cognitive-behavioral therapy ( CBT ) for the treatment of depressive symptomatology in multiple sclerosis ( MS ) patients . The treatment , Coping with MS ( CMS ) , included a patient workbook design ed to structure the treatment , provide visual aids , and help with homework assignments .  Thirty-two patients with MS , who scored at least 15 on the Profile of Mood States Depression-Dejection scale , were r and omly assigned to either the telephone CMS or to a usual-care control ( UCC ) condition . Depressive symptomatology decreased significantly in the CMS condition compared with the UCC condition . Furthermore , adherence to interferon beta-1a , a disease-modifying medication for the treatment of MS , was significantly better at the 4-month follow-up among patients who received CMS as compared with those in the UCC condition BACKGROUND Depression is a frequently occurring condition in family practice patients , but time limitations may hamper the physician 's ability to it treat effectively . Referrals to mental health professionals are frequently resisted by patients . The need for more effective treatment strategies led to the development and evaluation of a telephone-based , problem-solving intervention . METHODS Patients in a family practice residency practice were evaluated through the Medical Outcomes Study Depression Screening Scale and the Diagnostic Interview Schedule to identify those with subthreshold or minor depression . Twenty-nine subjects were r and omly assigned to either a treatment or comparison group . Initial scores on the Hamilton Depression Rating Scale were equivalent for the groups and were in the mildly depressed range . Six problem-solving therapy sessions were conducted over the telephone by graduate student therapists supervised by a psychiatrist . RESULTS Treatment group subjects had significantly lower post-intervention scores on the Hamilton Depression Rating Scale compared with their pre-intervention scores ( P < .05 ) . Scores did not differ significantly over time in the comparison group . Post-intervention , treatment group subjects also had lower Beck Depression Inventory scores than did the comparison group ( P < .02 ) , as well as more positive scores for social health ( P < .002 ) , mental health ( P < .05 ) , and self-esteem ( P < .05 ) on the Duke Health Profile . CONCLUSIONS The findings indicate that brief , telephone-based treatment for minor depression in family practice setting s may be an efficient and effective method to decrease symptoms of depression and improve functioning . Nurses in these setting s with appropriate training and supervision may also be able to provide this treatment OBJECTIVE To evaluate the efficacy and acceptability of a self-help program for mild-to-moderate depression that combined treatment booklets and telephone calls to a computer-aided Interactive Voice Response ( IVR ) system . METHOD In an open trial , 41 patients from Boston , Massachusetts ; Madison , Wisconsin ; and London , Engl and , used COPE , a 12-week self-help system for depression . COPE consisted of an introductory videotape and 9 booklets accompanied by 11 telephone calls to an IVR system that made self-help recommendations to patients based on information they entered . RESULTS All 41 patients successfully completed the self- assessment in the booklets and telephone calls ; 28 ( 68 % ) also completed the 12-week self-help program . Hamilton Rating Scale for Depression ( HAM-D ) and Work and Social Adjustment scores improved significantly ( 41 % and 42 % mean reduction in the intent-to-treat sample , respectively , p < .001 ) . Eighteen ( 64 % ) of the 28 completers were considered responders on the basis of > or = 50 % reduction in their HAM-D scores . There was a higher percentage of completers in the pooled U.S. sites ( 82 % vs. 43 % ) , and U.S. completers improved more than those in the United Kingdom ( 73 % vs. 43 % were responders ) . Most ( 68 % ) of the calls were made outside usual office hours , Monday-Friday , 9:00 a.m. to 5:00 p.m. Expectation of effectiveness and time spent making COPE calls ( more treatment modules ) correlated positively with improvement over 12 weeks . Mean call length for completers was 14 minutes . CONCLUSION A self-help system comprised of a computer-aided telephone system and a series of booklets was used successfully by people with mild-to-moderate depression . These preliminary results are encouraging for people who can not otherwise access ongoing , in-person therapy This study of continuing care for substance dependent patients compared a telephone-based monitoring and brief counseling intervention ( TEL ) with 2 face-to-face interventions , relapse prevention ( RP ) and st and ard 12-step group counseling ( STND ) .  The participants were graduates of intensive outpatient programs who had current dependence on alcohol and /or cocaine . Self-report , collateral , and biological measures of alcohol and cocaine use were obtained over a 12-month follow-up . The treatment groups did not differ on abstinence-related outcomes in the complete sample ( N = 359 ) or on cocaine use outcomes in participants with cocaine dependence ( n = 268 ) . However , in participants with alcohol dependence only ( n = 91 ) , TEL produced better alcohol use outcomes than STND on all measures examined and better outcomes than RP on some of the measures The need for treating milder forms of depression has recently been of increased interest . This was a r and omized , controlled study to evaluate the effects of telephone-based problem-solving therapy for mild depression . Comparison groups were a treatment-as-usual group and another group receiving stress-management training by telephone .  From 1,742 family practice patients screened for depression , 54 with mild depression entered the study .  Treatment was provided by experienced family practice nurses , trained and supervised in the treatments . The Hamilton Rating Scale for Depression was administered before and after the intervention period , and the Beck Depression Inventory and Duke Health Profile were administered at the end of the intervention period . Of the 36 subjects assigned to the problem-solving and stress-management groups , half dropped out early in the study . Five from the treatment-as-usual group were lost to follow-up . In the remaining subjects , there was a significant decrease in depression scores . There were no significant differences in the amount of decrease between the groups on any scores . The small sample and high dropout rate limit the interpretation of the findings . However , since all subjects tended to improve , regardless of treatment received , mild levels of depression may generally remit even without focal intervention , and watchful waiting may be a reasonable alternative for management CONTEXT Both antidepressant medication and structured psychotherapy have been proven efficacious , but less than one third of people with depressive disorders receive effective levels of either treatment . OBJECTIVE To compare usual primary care for depression with 2 intervention programs : telephone care management and telephone care management plus telephone psychotherapy . DESIGN Three-group r and omized controlled trial with allocation concealment and blinded outcome assessment conducted between November 2000 and May 2002 . SETTING AND PARTICIPANTS A total of 600 patients beginning antidepressant treatment for depression were systematic ally sample d from 7 group-model primary care clinics ; patients already receiving psychotherapy were excluded . INTERVENTIONS Usual primary care ; usual care plus a telephone care management program including at least 3 outreach calls , feedback to the treating physician , and care coordination ; usual care plus care management integrated with a structured 8-session cognitive-behavioral psychotherapy program delivered by telephone . MAIN OUTCOME MEASURES Blinded telephone interviews at 6 weeks , 3 months , and 6 months assessed depression severity ( Hopkins Symptom Checklist Depression Scale and the Patient Health Question naire ) , patient-rated improvement , and satisfaction with treatment . Computerized administrative data examined use of antidepressant medication and outpatient visits . RESULTS Treatment participation rates were 97 % for telephone care management and 93 % for telephone care management plus psychotherapy . Compared with usual care , the telephone psychotherapy intervention led to lower mean Hopkins Symptom Checklist Depression Scale depression scores ( P = .0 
    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: Bt steps is a patient-centered behavioral therapy program that uses a manual and a computer-driven interactive voice response system to assess and treat obsessive compulsive disorder .  This nine-step program contains a self- assessment module and a self-treatment module that provides teaching on exposure and ritual prevention . The patient reads about the steps in a manual and then uses a touch-tone telephone to contact the program , in which a recorded voice conducts the interview . Of 40 patients in an open 12-week trial in the United States and London , 35 completed the self- assessment module , and 17 completed at least two sessions of  exposure and ritual prevention . The system produced statistically significant improvements on measures of obsessive compulsive disorder A true experimental , posttest only , control group design was used to pilot test the effectiveness of a telephone nursing intervention in increasing community survival , and decreasing the number and length of rehospitalizations for persons with schizophrenia . The vulnerability model was used as a framework for the study . The intervention was hypothesized to function as a moderating factor to reduce the effects of stress on vulnerable persons with schizophrenia . Experimental subjects received telephone nursing intervention weekly for 3 months ;  control subjects received informational calls at weeks 6 and 12 .  Readmission rates were 13 % ( n = 2 ) for experimental subjects and 23 % ( n = 5 ) for controls . Compared with controls , experimental subjects experienced a 4 % increase in community survival and a 27 % reduction in length of stay if readmission occurred . These preliminary data suggest that telephone intervention can increase community survival in persons with schizophrenia . Future studies should focus on increasing sample size and refining the intervention BACKGROUND There is great potential dem and for treatment of bulimia nervosa and binge eating disorder . Skilled therapists are in short supply . Self-help and guided self-help based upon books have shown some promise as an economical alternative to full therapy in some cases . AIMS To investigate the efficacy and effectiveness of self-help with and without guidance in a specialist secondary service . METHOD A r and omised controlled trial comparing three forms of self-help over 4 months with a waiting-list comparison group and measurement of service consumption  over the subsequent 8 months . RESULTS Self-help delivered with four sessions of face-to-face guidance led to improved outcome over 4 months . There is also some evidence to support the use of telephone guidance . A minority of participants achieved lasting remission of their disorder in relation to self-help , but there was no significant difference in final outcome between the groups after they had progressed through the stepped care programme . Patients initially offered guided self-help had a lower long-term drop-out rate . CONCLUSIONS Guided self-help is a worthwhile initial response to bulimia nervosa and binge eating disorder . It is a treatment that could be delivered in primary care and in other non-specialist setting Over the last decade , much has been published concerning the information needs of patients and their families on and after discharge from hospital . With ever-decreasing lengths of stay in hospital following cardiac surgery as a result of technological improvements and the relentless pressure for beds , the time available for nurses to attend to these needs has been reduced dramatically , thus presenting new challenges to nurses . This study examines the levels of anxiety and depression in 78 elective cardiac surgery patients on discharge and at five weeks after , but before their recall to the outpatient department . The study tests the hypothesis that telephone follow-up from the ward will reduce patients ' anxiety and depression levels in the early post-discharge period . The findings indicated that patients found follow-up calls beneficial and helpful , but follow-up calls did not reduce anxiety and depression levels in the early post-discharge period Most depressed patients are seen and treated exclusively by primary care clinicians . However , primary care patients with depression are often not adequately treated . The aims of this pilot study were to measure the impact of a telephone disease management program on patient outcome and clinician adherence to practice guidelines , measure the relationship of clinician adherence to patient outcome , and explore the measurement of patient adherence to clinician recommendations and its impact on patient outcomes . Thirty-five primary care practice s in the University of Pennsylvania Health System were r and omized to telephone disease management ( TDM ) or " usual care " ( UC ) .  All patients received a baseline and a 16-week follow-up clinical evaluation performed over the telephone . Those from TDM practice s also received follow-up contact at least every 3 weeks , with formal evaluations at weeks 6 and 12 . These interval contacts were design ed to facilitate patient and clinician adherence to a treatment algorithm based on the Agency for Health Research and Quality ( AHRQ ) practice guidelines . Depressive symptoms evaluated with the Community Epidemiologic Survey of Depression ( CES-D ) scale as well as guideline adherence were the primary outcome measures . Sixty-one patients were enrolled in this pilot project . The overall effect for CES-D scores over time was significant , ( P < .001 ) , indicating that those participating in the trial ( both TDM and UC groups ) showed significant improvement . The interaction between intervention condition and time was also significant ( P < .05 ) , indicating that TDM patients improved significantly more over time than did UC patients . A greater proportion of TDM patients had CES-D scores < 16 by Week 16 ( 66.7 versus 33.3 % ; chi(2 ) , P < .05 ) . The improvement in depression outcome for the TDM group was related to its impact on improving clinician adherence to depression treatment algorithms . The TDM pilot did not show a statistically significant effect on improving patient adherence to clinician recommendations , however . This preliminary data suggests that TDM for depression improves both clinician guideline adherence and patient outcomes in the acute phase of depression . The effect on patient outcome is at least partially explained by the effect of TDM on clinician adherence to depression treatment algorithms This study examined the efficacy of an 8-week telephone-administered cognitive-behavioral therapy ( CBT ) for the treatment of depressive symptomatology in multiple sclerosis ( MS ) patients . The treatment , Coping with MS ( CMS ) , included a patient workbook design ed to structure the treatment , provide visual aids , and help with homework assignments .  Thirty-two patients with MS , who scored at least 15 on the Profile of Mood States Depression-Dejection scale , were r and omly assigned to either the telephone CMS or to a usual-care control ( UCC ) condition . Depressive symptomatology decreased significantly in the CMS condition compared with the UCC condition . Furthermore , adherence to interferon beta-1a , a disease-modifying medication for the treatment of MS , was significantly better at the 4-month follow-up among patients who received CMS as compared with those in the UCC condition BACKGROUND Depression is a frequently occurring condition in family practice patients , but time limitations may hamper the physician 's ability to it treat effectively . Referrals to mental health professionals are frequently resisted by patients . The need for more effective treatment strategies led to the development and evaluation of a telephone-based , problem-solving intervention . METHODS Patients in a family practice residency practice were evaluated through the Medical Outcomes Study Depression Screening Scale and the Diagnostic Interview Schedule to identify those with subthreshold or minor depression . Twenty-nine subjects were r and omly assigned to either a treatment or comparison group . Initial scores on the Hamilton Depression Rating Scale were equivalent for the groups and were in the mildly depressed range . Six problem-solving therapy sessions were conducted over the telephone by graduate student therapists supervised by a psychiatrist . RESULTS Treatment group subjects had significantly lower post-intervention scores on the Hamilton Depression Rating Scale compared with their pre-intervention scores ( P < .05 ) . Scores did not differ significantly over time in the comparison group . Post-intervention , treatment group subjects also had lower Beck Depression Inventory scores than did the comparison group ( P < .02 ) , as well as more positive scores for social health ( P < .002 ) , mental health ( P < .05 ) , and self-esteem ( P < .05 ) on the Duke Health Profile . CONCLUSIONS The findings indicate that brief , telephone-based treatment for minor depression in family practice setting s may be an efficient and effective method to decrease symptoms of depression and improve functioning . Nurses in these setting s with appropriate training and supervision may also be able to provide this treatment OBJECTIVE To evaluate the efficacy and acceptability of a self-help program for mild-to-moderate depression that combined treatment booklets and telephone calls to a computer-aided Interactive Voice Response ( IVR ) system . METHOD In an open trial , 41 patients from Boston , Massachusetts ; Madison , Wisconsin ; and London , Engl and , used COPE , a 12-week self-help system for depression . COPE consisted of an introductory videotape and 9 booklets accompanied by 11 telephone calls to an IVR system that made self-help recommendations to patients based on information they entered . RESULTS All 41 patients successfully completed the self- assessment in the booklets and telephone calls ; 28 ( 68 % ) also completed the 12-week self-help program . Hamilton Rating Scale for Depression ( HAM-D ) and Work and Social Adjustment scores improved significantly ( 41 % and 42 % mean reduction in the intent-to-treat sample , respectively , p < .001 ) . Eighteen ( 64 % ) of the 28 completers were considered responders on the basis of > or = 50 % reduction in their HAM-D scores . There was a higher percentage of completers in the pooled U.S. sites ( 82 % vs. 43 % ) , and U.S. completers improved more than those in the United Kingdom ( 73 % vs. 43 % were responders ) . Most ( 68 % ) of the calls were made outside usual office hours , Monday-Friday , 9:00 a.m. to 5:00 p.m. Expectation of effectiveness and time spent making COPE calls ( more treatment modules ) correlated positively with improvement over 12 weeks . Mean call length for completers was 14 minutes . CONCLUSION A self-help system comprised of a computer-aided telephone system and a series of booklets was used successfully by people with mild-to-moderate depression . These preliminary results are encouraging for people who can not otherwise access ongoing , in-person therapy This study of continuing care for substance dependent patients compared a telephone-based monitoring and brief counseling intervention ( TEL ) with 2 face-to-face interventions , relapse prevention ( RP ) and st and ard 12-step group counseling ( STND ) .  The participants were graduates of intensive outpatient programs who had current dependence on alcohol and /or cocaine . Self-report , collateral , and biological measures of alcohol and cocaine use were obtained over a 12-month follow-up . The treatment groups did not differ on abstinence-related outcomes in the complete sample ( N = 359 ) or on cocaine use outcomes in participants with cocaine dependence ( n = 268 ) . However , in participants with alcohol dependence only ( n = 91 ) , TEL produced better alcohol use outcomes than STND on all measures examined and better outcomes than RP on some of the measures The need for treating milder forms of depression has recently been of increased interest . This was a r and omized , controlled study to evaluate the effects of telephone-based problem-solving therapy for mild depression . Comparison groups were a treatment-as-usual group and another group receiving stress-management training by telephone .  From 1,742 family practice patients screened for depression , 54 with mild depression entered the study .  Treatment was provided by experienced family practice nurses , trained and supervised in the treatments . The Hamilton Rating Scale for Depression was administered before and after the intervention period , and the Beck Depression Inventory and Duke Health Profile were administered at the end of the intervention period . Of the 36 subjects assigned to the problem-solving and stress-management groups , half dropped out early in the study . Five from the treatment-as-usual group were lost to follow-up . In the remaining subjects , there was a significant decrease in depression scores . There were no significant differences in the amount of decrease between the groups on any scores . The small sample and high dropout rate limit the interpretation of the findings . However , since all subjects tended to improve , regardless of treatment received , mild levels of depression may generally remit even without focal intervention , and watchful waiting may be a reasonable alternative for management CONTEXT Both antidepressant medication and structured psychotherapy have been proven efficacious , but less than one third of people with depressive disorders receive effective levels of either treatment . OBJECTIVE To compare usual primary care for depression with 2 intervention programs : telephone care management and telephone care management plus telephone psychotherapy . DESIGN Three-group r and omized controlled trial with allocation concealment and blinded outcome assessment conducted between November 2000 and May 2002 . SETTING AND PARTICIPANTS A total of 600 patients beginning antidepressant treatment for depression were systematic ally sample d from 7 group-model primary care clinics ; patients already receiving psychotherapy were excluded . INTERVENTIONS Usual primary care ; usual care plus a telephone care management program including at least 3 outreach calls , feedback to the treating physician , and care coordination ; usual care plus care management integrated with a structured 8-session cognitive-behavioral psychotherapy program delivered by telephone . MAIN OUTCOME MEASURES Blinded telephone interviews at 6 weeks , 3 months , and 6 months assessed depression severity ( Hopkins Symptom Checklist Depression Scale and the Patient Health Question naire ) , patient-rated improvement , and satisfaction with treatment . Computerized administrative data examined use of antidepressant medication and outpatient visits . RESULTS Treatment participation rates were 97 % for telephone care management and 93 % for telephone care management plus psychotherapy . Compared with usual care , the telephone psychotherapy intervention led to lower mean Hopkins Symptom Checklist Depression Scale depression scores ( P = .0 
    Output:
    