human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Patient nonadherence is common for the st and ard mental health treatments in primary care : antidepressants and referrals to specialty mental health treatment . This is one of few studies to prospect ively identify predictors of nonadherence . METHODS We observed 95 veterans attending an internal medicine clinic prescribed antidepressant medication or referred to mental health treatment .  We collected information on sociodemographic factors , health beliefs , preferences about treatment , past experiences , and treatment knowledge . RESULTS At 1 month , medication adherence was greater when patients experienced previous pharmacy trouble and traveled for less than 30 minutes to reach the clinic . Appointment attendance improved when patients were ready for treatment , perceived benefits , and saw their physician as collaborative . At 6 months , medication adherence was greater when patients reported a preference for medicine treatment , traveled for less than 30 minutes , and perceived greater benefits . Fewer negative effects from previous mental health treatment improved adherence to appointments . In multivariate analyses examining adherence to all treatments , greater readiness for treatment predicted 1-month adherence , whereas being unmarried and seeing the physician as more collaborative improved 6-month adherence . CONCLUSIONS Adherence to antidepressant medications and to mental health referrals should be examined separately . A brief initial assessment for nonadherence risk factors may identify persons for targeted adherence promoting interventions BACKGROUND A r and omised controlled trial was conducted in an acute treatment setting to examine the effectiveness of compliance therapy , a brief pragmatic intervention targeting treatment adherence in psychotic disorders , based on motivational interviewing and recent cognitive approaches to psychosis . METHOD Seventy-four patients with psychotic disorders according to DSM-III-R criteria recruited from consecutive admissions to an acute in-patient unit , received 4 - 6 sessions of either compliance therapy or non-specific counselling , and were followed-up over 18 months . The principal outcome measures were observer-rated compliance , attitudes to treatment , insight and social functioning . RESULTS Significant advantages were found for the compliance therapy group post-treatment on measures of insight , attitudes to treatment and observer-rated compliance which were retained over the follow-up period . Global social functioning improved relatively more over time in the compliance therapy group compared with the control group . Survival in the community prior to readmission was significantly longer in the compliance therapy group . CONCLUSIONS The results support the effectiveness of compliance therapy in improving functioning and community tenure after an acute psychotic episode Abstract Objective : To determine whether compliance therapy , a cognitive-behavioural intervention , could improve compliance with treatment and hence social adjustment in acutely psychotic in patients , and if so , whether the effect persisted six months later . Design : R and omised controlled trial of compliance therapy and non-specific counselling , each comprising 4 - 6 sessions lasting 10 - 60 minutes . Setting : Acute psychiatric admissions ward serving an inner London catchment area . Subjects : 47 patients with psychosis . Main outcome measures : Informant and observer reported measure of compliance ; observer assessed global functioning after intervention and three and six months later ; self rated attitudes to drug treatment after the intervention and one month later ; symptom scores after intervention and six months later . Results : 25 patients received compliance therapy and showed significantly greater improvements in their attitudes to drug treatment and in their insight into illness and compliance with treatment compared with the control group . These gains persisted for six months . The intervention group was 5.2 times more likely than the control group to reach a criterion level of compliance ( 95 % confidence interval 1.5 to 18.3 ) . Global functioning showed a tendency to improve more in the intervention group after a delay ( odds ratio 3.0 ( 0.8 to 11.5 ) to reach the criterion level at six months ) . Four subjects given compliance therapy and six in the control group were readmitted during follow up ( odds ratio 2.0 ( 0.48 to 8.2 ) ) . Conclusions : Compliance therapy is a pragmatic method for improving compliance with drug treatment in psychotic in patients and its gains persist for at least six months . Overall functioning may also be enhanced . Key messages Key messages Compliance is strongly related to attitudes to treatment and to insight The study found that such attitudes may be influenced by a simple and brief intervention known as compliance therapy Compliance therapy compared with non-specific counselling leads to improved compliance The improvement is sustained for at least six months and may lead to improved social Objective This report evaluates the effects of a depression relapse prevention program on disability outcomes among patients treated for depression at high risk for relapse . Material s and Methods Primary care patients initiating antidepressant treatment for depression were assessed 6 to 8 weeks after the initial prescription . Patients responding to initial treatment but at high risk for relapse were r and omized to usual care or a relapse prevention intervention ( N = 386 ) . The 12-month relapse prevention program included systematic patient education , two psycho-educational visits with a depression prevention specialist , shared decision-making regarding maintenance pharmacotherapy , and ongoing monitoring of medication adherence and depressive symptoms via telephone and mail .  Disability outcomes were assessed via blinded telephone assessment s at 3 , 6 , 9 , and 12 months using SF-36 and Sheehan Disability scales . Results Usual care patients and relapse prevention program patients had high rates of use of maintenance pharmacotherapy . Both relapse prevention and usual care patients showed improved functioning over the 12-month follow-up period . One of the three disability measures ( the SF-36 Social Function scale ) showed a significant intervention effect because of continuing improvement at 9 and 12 month follow-up , whereas the Sheehan Disability Scale showed a nonsignificant trend toward greater improvements in disability among relapse prevention patients than among usual care controls . Conclusions Moderate effects of a relapse prevention intervention on depressive symptoms were associated with modest and variable effects on disability outcomes . Inconsistent effects of the intervention for disability outcomes may be because of the high rates of maintenance pharmacotherapy among usual care patients , relatively mild levels of depressive symptoms among both intervention and control patients at baseline , the absence of a specific relapse prevention effect of the intervention , and the result ant modest differences in depressive symptoms between intervention and control patients in this trial OBJECTIVE Compliance with antipsychotic medication is a major issue in schizophrenia treatment , and noncompliance with antipsychotic treatment is closely related to relapse and rehospitalization . An enhanced involvement of patients with schizophrenia in treatment decisions ( " shared decision making " ) is expected to improve long-term compliance and reduce rehospitalizations . The aim of the present analysis was to study whether shared decision making ( SDM ) in antipsychotic drug choice would influence long-term outcome . METHOD From February 2003 to January 2004 , psychiatric state hospital in patients with a diagnosis of schizophrenia ( ICD-10 ; N = 107 ) were recruited for the trial using a cluster-r and omized controlled design . An SDM program on antipsychotic drug choice consisting of a decision aid and a planning talk between patient and physician was compared with routine care with respect to long-term compliance and rehospitalizations ( 6-month and 18-month follow-up ) . RESULTS On the whole , we found high rates of noncompliance and rehospitalization . There were no differences between intervention and control groups in the univariate analyses . However , when controlling for confounding factors in a multivariate analysis , there was a positive trend ( p = .08 ) that patients in the SDM intervention had fewer rehospitalizations . Additionally , a higher desire of the patient for autonomy and better knowledge at discharge were associated with higher hospitalization rates . CONCLUSION The intervention studied showed a positive trend but no clear beneficial effect on long-term outcomes . A more thorough implementation of SDM ( e.g. , iterative administration of decision aid ) might yield larger effects . Those patients with higher participation preferences are at higher risk for poor treatment outcomes and therefore require special attention . Strategies to match these patients ' needs might improve compliance and long-term outcomes OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity BACKGROUND The relative effectiveness of second-generation ( atypical ) antipsychotic drugs as compared with that of older agents has been incompletely addressed , though newer agents are currently used far more commonly . We compared a first-generation antipsychotic , perphenazine , with several newer drugs in a double-blind study . METHODS A total of 1493 patients with schizophrenia were recruited at 57 U.S. sites and r and omly assigned to receive olanzapine ( 7.5 to 30 mg per day ) , perphenazine ( 8 to 32 mg per day ) , quetiapine ( 200 to 800 mg per day ) , or risperidone ( 1.5 to 6.0 mg per day ) for up to 18 months . Ziprasidone ( 40 to 160 mg per day ) was included after its approval by the Food and Drug Administration . The primary aim was to delineate differences in the overall effectiveness of these five treatments . RESULTS Overall , 74 percent of patients discontinued the study medication before 18 months ( 1061 of the 1432 patients who received at least one dose ) : 64 percent of those assigned to olanzapine , 75 percent of those assigned to perphenazine , 82 percent of those assigned to quetiapine , 74 percent of those assigned to risperidone , and 79 percent of those assigned to ziprasidone . The time to the discontinuation of treatment for any cause was significantly longer in the olanzapine group than in the quetiapine ( P<0.001 ) or risperidone ( P=0.002 ) group , but not in the perphenazine ( P=0.021 ) or ziprasidone ( P=0.028 ) group . The times to discontinuation because of intolerable side effects were similar among the groups , but the rates differed ( P=0.04 ) ; olanzapine was associated with more discontinuation for weight gain or metabolic effects , and perphenazine was associated with more discontinuation for extrapyramidal effects . CONCLUSIONS The majority of patients in each group discontinued their assigned treatment owing to inefficacy or intolerable side effects or for other reasons . Olanzapine was the most effective in terms of the rates of discontinuation , and the efficacy of the conventional antipsychotic agent perphenazine appeared similar to that of quetiapine , risperidone , and ziprasidone . Olanzapine was associated with greater weight gain and increases in measures of glucose and lipid metabolism The goals of this study were to examine how physician communication style impacts client beliefs and medication taking behavior during treatment for depression . The study uses a communication framework and prospect i ve design to examine  physician communication  and client beliefs as treatment is initiated and again 2 months later . Two telephone interviews were conducted with 100 clients enrolled from 23 community pharmacies . Clients report that physician communication styles vary . In follow-up , 25 % of the clients were not satisfied with their medication and 82 % reported missing doses or stopping treatment earlier than recommended . Path analysis showed that physician initial communication style positively influences client knowledge and initial beliefs about the medication . Clients with more positive beliefs about the treatment are more likely to see the physician in follow-up and are more satisfied with treatment after attempting medication use . Physician follow-up communication style and client satisfaction are both predictive of better medication adherence OBJECTIVE Patient-centred depression care approaches should better address barriers of insufficient patient information and involvement in the treatment decision process . Additional research is needed to test the effect of increased patient participation on outcomes . The aim 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Patient nonadherence is common for the st and ard mental health treatments in primary care : antidepressants and referrals to specialty mental health treatment . This is one of few studies to prospect ively identify predictors of nonadherence . METHODS We observed 95 veterans attending an internal medicine clinic prescribed antidepressant medication or referred to mental health treatment .  We collected information on sociodemographic factors , health beliefs , preferences about treatment , past experiences , and treatment knowledge . RESULTS At 1 month , medication adherence was greater when patients experienced previous pharmacy trouble and traveled for less than 30 minutes to reach the clinic . Appointment attendance improved when patients were ready for treatment , perceived benefits , and saw their physician as collaborative . At 6 months , medication adherence was greater when patients reported a preference for medicine treatment , traveled for less than 30 minutes , and perceived greater benefits . Fewer negative effects from previous mental health treatment improved adherence to appointments . In multivariate analyses examining adherence to all treatments , greater readiness for treatment predicted 1-month adherence , whereas being unmarried and seeing the physician as more collaborative improved 6-month adherence . CONCLUSIONS Adherence to antidepressant medications and to mental health referrals should be examined separately . A brief initial assessment for nonadherence risk factors may identify persons for targeted adherence promoting interventions BACKGROUND A r and omised controlled trial was conducted in an acute treatment setting to examine the effectiveness of compliance therapy , a brief pragmatic intervention targeting treatment adherence in psychotic disorders , based on motivational interviewing and recent cognitive approaches to psychosis . METHOD Seventy-four patients with psychotic disorders according to DSM-III-R criteria recruited from consecutive admissions to an acute in-patient unit , received 4 - 6 sessions of either compliance therapy or non-specific counselling , and were followed-up over 18 months . The principal outcome measures were observer-rated compliance , attitudes to treatment , insight and social functioning . RESULTS Significant advantages were found for the compliance therapy group post-treatment on measures of insight , attitudes to treatment and observer-rated compliance which were retained over the follow-up period . Global social functioning improved relatively more over time in the compliance therapy group compared with the control group . Survival in the community prior to readmission was significantly longer in the compliance therapy group . CONCLUSIONS The results support the effectiveness of compliance therapy in improving functioning and community tenure after an acute psychotic episode Abstract Objective : To determine whether compliance therapy , a cognitive-behavioural intervention , could improve compliance with treatment and hence social adjustment in acutely psychotic in patients , and if so , whether the effect persisted six months later . Design : R and omised controlled trial of compliance therapy and non-specific counselling , each comprising 4 - 6 sessions lasting 10 - 60 minutes . Setting : Acute psychiatric admissions ward serving an inner London catchment area . Subjects : 47 patients with psychosis . Main outcome measures : Informant and observer reported measure of compliance ; observer assessed global functioning after intervention and three and six months later ; self rated attitudes to drug treatment after the intervention and one month later ; symptom scores after intervention and six months later . Results : 25 patients received compliance therapy and showed significantly greater improvements in their attitudes to drug treatment and in their insight into illness and compliance with treatment compared with the control group . These gains persisted for six months . The intervention group was 5.2 times more likely than the control group to reach a criterion level of compliance ( 95 % confidence interval 1.5 to 18.3 ) . Global functioning showed a tendency to improve more in the intervention group after a delay ( odds ratio 3.0 ( 0.8 to 11.5 ) to reach the criterion level at six months ) . Four subjects given compliance therapy and six in the control group were readmitted during follow up ( odds ratio 2.0 ( 0.48 to 8.2 ) ) . Conclusions : Compliance therapy is a pragmatic method for improving compliance with drug treatment in psychotic in patients and its gains persist for at least six months . Overall functioning may also be enhanced . Key messages Key messages Compliance is strongly related to attitudes to treatment and to insight The study found that such attitudes may be influenced by a simple and brief intervention known as compliance therapy Compliance therapy compared with non-specific counselling leads to improved compliance The improvement is sustained for at least six months and may lead to improved social Objective This report evaluates the effects of a depression relapse prevention program on disability outcomes among patients treated for depression at high risk for relapse . Material s and Methods Primary care patients initiating antidepressant treatment for depression were assessed 6 to 8 weeks after the initial prescription . Patients responding to initial treatment but at high risk for relapse were r and omized to usual care or a relapse prevention intervention ( N = 386 ) . The 12-month relapse prevention program included systematic patient education , two psycho-educational visits with a depression prevention specialist , shared decision-making regarding maintenance pharmacotherapy , and ongoing monitoring of medication adherence and depressive symptoms via telephone and mail .  Disability outcomes were assessed via blinded telephone assessment s at 3 , 6 , 9 , and 12 months using SF-36 and Sheehan Disability scales . Results Usual care patients and relapse prevention program patients had high rates of use of maintenance pharmacotherapy . Both relapse prevention and usual care patients showed improved functioning over the 12-month follow-up period . One of the three disability measures ( the SF-36 Social Function scale ) showed a significant intervention effect because of continuing improvement at 9 and 12 month follow-up , whereas the Sheehan Disability Scale showed a nonsignificant trend toward greater improvements in disability among relapse prevention patients than among usual care controls . Conclusions Moderate effects of a relapse prevention intervention on depressive symptoms were associated with modest and variable effects on disability outcomes . Inconsistent effects of the intervention for disability outcomes may be because of the high rates of maintenance pharmacotherapy among usual care patients , relatively mild levels of depressive symptoms among both intervention and control patients at baseline , the absence of a specific relapse prevention effect of the intervention , and the result ant modest differences in depressive symptoms between intervention and control patients in this trial OBJECTIVE Compliance with antipsychotic medication is a major issue in schizophrenia treatment , and noncompliance with antipsychotic treatment is closely related to relapse and rehospitalization . An enhanced involvement of patients with schizophrenia in treatment decisions ( " shared decision making " ) is expected to improve long-term compliance and reduce rehospitalizations . The aim of the present analysis was to study whether shared decision making ( SDM ) in antipsychotic drug choice would influence long-term outcome . METHOD From February 2003 to January 2004 , psychiatric state hospital in patients with a diagnosis of schizophrenia ( ICD-10 ; N = 107 ) were recruited for the trial using a cluster-r and omized controlled design . An SDM program on antipsychotic drug choice consisting of a decision aid and a planning talk between patient and physician was compared with routine care with respect to long-term compliance and rehospitalizations ( 6-month and 18-month follow-up ) . RESULTS On the whole , we found high rates of noncompliance and rehospitalization . There were no differences between intervention and control groups in the univariate analyses . However , when controlling for confounding factors in a multivariate analysis , there was a positive trend ( p = .08 ) that patients in the SDM intervention had fewer rehospitalizations . Additionally , a higher desire of the patient for autonomy and better knowledge at discharge were associated with higher hospitalization rates . CONCLUSION The intervention studied showed a positive trend but no clear beneficial effect on long-term outcomes . A more thorough implementation of SDM ( e.g. , iterative administration of decision aid ) might yield larger effects . Those patients with higher participation preferences are at higher risk for poor treatment outcomes and therefore require special attention . Strategies to match these patients ' needs might improve compliance and long-term outcomes OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity BACKGROUND The relative effectiveness of second-generation ( atypical ) antipsychotic drugs as compared with that of older agents has been incompletely addressed , though newer agents are currently used far more commonly . We compared a first-generation antipsychotic , perphenazine , with several newer drugs in a double-blind study . METHODS A total of 1493 patients with schizophrenia were recruited at 57 U.S. sites and r and omly assigned to receive olanzapine ( 7.5 to 30 mg per day ) , perphenazine ( 8 to 32 mg per day ) , quetiapine ( 200 to 800 mg per day ) , or risperidone ( 1.5 to 6.0 mg per day ) for up to 18 months . Ziprasidone ( 40 to 160 mg per day ) was included after its approval by the Food and Drug Administration . The primary aim was to delineate differences in the overall effectiveness of these five treatments . RESULTS Overall , 74 percent of patients discontinued the study medication before 18 months ( 1061 of the 1432 patients who received at least one dose ) : 64 percent of those assigned to olanzapine , 75 percent of those assigned to perphenazine , 82 percent of those assigned to quetiapine , 74 percent of those assigned to risperidone , and 79 percent of those assigned to ziprasidone . The time to the discontinuation of treatment for any cause was significantly longer in the olanzapine group than in the quetiapine ( P<0.001 ) or risperidone ( P=0.002 ) group , but not in the perphenazine ( P=0.021 ) or ziprasidone ( P=0.028 ) group . The times to discontinuation because of intolerable side effects were similar among the groups , but the rates differed ( P=0.04 ) ; olanzapine was associated with more discontinuation for weight gain or metabolic effects , and perphenazine was associated with more discontinuation for extrapyramidal effects . CONCLUSIONS The majority of patients in each group discontinued their assigned treatment owing to inefficacy or intolerable side effects or for other reasons . Olanzapine was the most effective in terms of the rates of discontinuation , and the efficacy of the conventional antipsychotic agent perphenazine appeared similar to that of quetiapine , risperidone , and ziprasidone . Olanzapine was associated with greater weight gain and increases in measures of glucose and lipid metabolism The goals of this study were to examine how physician communication style impacts client beliefs and medication taking behavior during treatment for depression . The study uses a communication framework and prospect i ve design to examine  physician communication  and client beliefs as treatment is initiated and again 2 months later . Two telephone interviews were conducted with 100 clients enrolled from 23 community pharmacies . Clients report that physician communication styles vary . In follow-up , 25 % of the clients were not satisfied with their medication and 82 % reported missing doses or stopping treatment earlier than recommended . Path analysis showed that physician initial communication style positively influences client knowledge and initial beliefs about the medication . Clients with more positive beliefs about the treatment are more likely to see the physician in follow-up and are more satisfied with treatment after attempting medication use . Physician follow-up communication style and client satisfaction are both predictive of better medication adherence OBJECTIVE Patient-centred depression care approaches should better address barriers of insufficient patient information and involvement in the treatment decision process . Additional research is needed to test the effect of increased patient participation on outcomes . The aim 
    Output:
    