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 : We conducted a prospect i ve trial r and omizing 75 physicians to either a control or intervention arm to evaluate the impact of providing patient-reported information on anxiety and other mental health symptoms and disorders to primary care physicians . Methods : Five hundred seventy-three patients of the study physicians who met entry criteria were r and omized to either usual care or usual care supplemented with feedback of patient-reported mental health information to physicians . This mental health information was derived from initial patient-reported question naires completed in waiting rooms of physicians contracted to a mixed-model health maintenance organization in Colorado . Main outcome measures included impact of intervention on rates of ( 1 ) chart notation of anxiety , depression , or other mental health diagnoses or symptoms ; ( 2 ) referral to mental health specialists ; ( 3 ) prescription of psychotropic medications ; ( 4 ) hospitalization ; and ( 5 ) office visits during a 5-month observation period . Results : Physicians receiving feedback on previously unrecognized and untreated anxiety patients were more likely to make chart notations ( adjusted odds ratio [ AOR ] = 2.51 , 95 percent confidence interval [ CI ] = 1.62 - 3.87 ) , to make referrals to mental health specialists ( AOR = 3.86 , 95 percent CI = 1.63 - 9.16 ) , and to see patients for more frequent outpatient visits ( AOR = 1.73 , 95 percent CI = 1.11 - 2.70 ) . Use of psychotropic medications and rate of hospitalizations did not differ significantly . Conclusions : Providing patient-reported mental health information to primary care physicians result ed in increased recognition and referral rates for previously unrecognized and untreated anxiety patients , plus an increase in primary care visits , without concomitant increases in the use of psychotropic medications or rate of hospitalizations The objective was to assess the potential benefits of the routine use of the MOS SF-36 Health Survey ( SF-36 ) in the care of ambulatory patients . The design was a longitudinal , prospect i ve , r and omized , controlled study set in the outpatient neurology clinic at the New Engl and Medical Center . There were 163 consecutive patients with epilepsy who had 210 follow-up visits with one of two epileptologists . The patients completed the SF-36 before the patient-physician encounter and the forms were optically scanned . The SF-36 results of the intervention group patients were given to the physicians before the encounter and withheld for control group patients . For intervention group patients , the physicians completed a question naire assessing the impact of the SF-36 on the process of care . After the visit , all patients completed a satisfaction question naire . The main outcome measures were the physicians ' responses to st and ardized questions about the usefulness of the SF-36  for communication with and management of epilepsy patients and the patients ' responses to st and ardized questions about their satisfaction with care . The physicians indicated that the SF-36 provided new information in 63 % of the intervention group encounters . A change in therapy was prompted in 13 % . The physicians rated the SF-36 as at least moderately useful for communication in 14 % of the encounters and to management in 8 % . The lower ( indicating worse health status ) the patients ' SF-36 scale scores , the more useful the SF-36 results were rated by the physicians for communication and management . It was concluded that the routine use of health status measures may enhance patients ' care This study was design ed to test the short-term effects of health assessment on the process of care and patient satisfaction . The 29 Chart physicians used the Dartmouth COOP Charts to measure their adult patients '  health status during a single clinical encounter ; the 27 control clinicians used no measure of health status . We compared the change between baseline and post-intervention information for a sample of all study clinicians ' patients . Most of the patients were female ( 67 % ) , well educated ( 70 % had at least a college education ) and young ( approximately 90 % were aged 59 years or younger ) . We found that the ordering of tests and procedures for women was increased by exposure to the COOP Charts ( 52 % vs. 35 % ; p<0.01 ) ; the effect in men was not as significant ( 37 % vs. 23 % : p=0.06 ) . Although women reported no change in satisfaction with care , men cl aim ed that the clinician helped in the management of pain ( p=0.02 ) . We conclude that the use of health status measures during a single clinical encounter in an HMO changes clinician test ordering behaviour and may improve the help male patients receive for pain conditions . The long-term impact of these management changes is not known OBJECTIVE : To improve functional status among primary care patients .INTERVENTION : 1 ) Computer-generated feedback to physicians about the patient ’s functional status , the patient ’s self-reported “ chief complaint , ” and problem-specific re source and management suggestions ; and 2 ) two brief interactive educational sessions for physicians . DESIGN : R and omized controlled trial . SETTING : University primary care clinic . PARTICIPANTS : All 73 internal medicine houseofficers and 557 of their new primary care patients . MEASURES : 1 ) Change in patient functional status from enrollment until six months later , using the Functional Status Question naire ( FSQ ) ;  2 )  management plans and additional information about functional status abstract ed from the medical record ; and 3 ) physician attitude about whether internists should address functional status problems . RESULTS : Emotional well-being scores improved significantly for the patients of the experimental group physicians compared with those of the control group physicians ( p<0.03 ) . Limitations in social activities indicated as “ due to health ” decreased among the elderly ( > 70 years of age ) individuals in the experimental group compared with the control group ( p<0.03 ) . The experimental group physicians diagnosed more symptoms of stress or anxiety than did the control group physicians ( p<0.001 ) and took more actions recommended by the feedback form ( p<0.02 ) . CONCLUSIONS : Computer-generated feedback of functional status screening results accompanied by re source and management suggestions can increase physician diagnoses of impaired emotional well-being , can influence physician management of functional status problems , and can assist physicians in improving emotional well-being and social functioning among their patients The final development of the Sickness Impact Profile ( SIP ) , a behaviorally based measure of health status , is presented . A large field trial on a r and om sample of prepaid group practice enrollees and smaller trials on sample s of patients with hyperthyroidism , rheumatoid arthritis and hip replacements were undertaken to assess reliability and validity of the SIP and provide data for category and item analyses . Test-retest reliability ( r = 0.92 ) and internal consistency ( r = 0.94 ) were high . Convergent and discriminant validity was evaluated using the multitrait – multi method technique . Clinical validity was assessed by determining the relationship between clinical measures of disease and the SIP scores . The relationship between the SIP and criterion measures were moderate to high and in the direction hypotheszed . A technique for describing and assessing similarities and differences among groups was developed using profile and pattern analysis . The final SIP contains 136 items in 12 categories . Overall , category , and dimension scores may be calculated The authors conducted a r and omized controlled trial of functional disability screening in a hospital-based internal medicine group practice . They assigned 60 physicians and 497 of their patients to either an experimental or a control group . Every four months the patients in both groups completed a self-administered question naire measuring physical , psychological , and social function . The experimental group physicians received reports summarizing their patients ’ responses ; the control group physicians received no report . At the end of one year the authors found no significant difference between the patients of the experimental and control group physicians on any measure of functional status . Functional disability screening alone does not improve patient function BACKGROUND This study describes the functioning of primary care patients with major depressive disorder , the relationship of medical comorbidity to functional status , and the effects of depression-specific treatment on functional status after 8 months . METHODS Patients were r and omized to a  protocol intervention ( nortriptyline hydrochloride or interpersonal psychotherapy )  or to usual care with the patient 's physician  in a clinical trial of primary care treatments of depression . Their functional status was evaluated using the Medical Outcomes Study 36-Item Short Form Health Survey ( SF-36 ) and the Global Assessment Scale . Medical comorbidity was assessed with the Duke Severity of Illness Checklist . The Hamilton Rating Scale for Depression and Beck Depression Inventory were used to measure depressive severity . Assessment s were conducted at baseline and at 1 , 2 , 4 , and 8 months after r and omization . RESULTS At baseline , patients reported substantial impairments in the functional domains as assessed by the SF-36 and Global Assessment Scale . Severity of general medical illness and depression were not correlated . Greater medical comorbidity was associated with diminished physical , but not psychological , functioning . Mean scores on SF-36 scales and the Global Assessment Scale improved significantly during the 8 months of follow-up . Patients assigned to protocol treatments showed greater improvement , compared with those assigned to usual care , on the SF-36 mental summary scale and most individual scales but not on the SF-36 physical summary scale . However , patients who completed protocol treatment also experienced significant improvement on the physical summary scale . Medical comorbidity was only a weak predictor of outcome . CONCLUSIONS Primary care patients with major depressive disorder report substantial impairments in physical , psychological , and social functioning on initial assessment . Severity of baseline medical comorbidity did not correlate with severity of depression and only weakly correlated with functional status at 8 months . Functional impairments improve with time , but st and ardized depression-specific treatment is associated with greater improvement in more domains of functioning than is a physician 's usual care We examined the use of formal health status reports every 3 months over 1 year in the clinical care of patients with rheumatoid arthritis ( RA ) . The reports consisted of single-page , computer-generated summaries of scores derived from either the AIMS ( Arthritis Impact Measurement Scales ) or the MHAQ ( Modified Health Assessment Question naire ) health status question naires . A total of 1920 subjects from 27 community practice sites were r and omly assigned to three study groups in each practice : intervention , attention placebo and control . Results showed that 55 % of the physicians found the reports to be at least moderately useful as an aid to patient management , primarily for improving the doctor-patient relationship . However , no detectable differences among the three groups were seen in terms of medication compliance , number of physician visits , number of referrals , frequency of major medication changes , attitudes towards the physician , patient satisfaction or change in health status over 1 year . The failure to demonstrate objective benefits of health status reports in this study may be due to physician unfamiliarity with health status scores , failure to link the report with an office visit , the relative stability of clinical status in the subjects over 1 year and the relatively short time-frame of the study The purpose of this study was to investigate the value of using a vali date d functional assessment instrument , the  Sickness Impact Profile ( SIP )  , with older , chronically ill patients seeking care at the family physician 's office . The SIP was completed by the patient and the family physician on patients 55 years of age or older who were seen at a family practice residency clinic . The study used stratified , r and om assignment in an experimental design to compare physician and patient reaction to the SIP . Both physicians ( residents and faculty ) and patients felt the SIP was useful in detecting disabilities . Approximately half of the physicians felt the SIP was helpful in patient management . Patients reported twice as many disabilities as were reported by physicians . Half of the clinic physicians had the opportunity to review a patient 's SIP immediately prior to a visit . They recognized more disabilities and agreed more often with the patients about the presence of a disability . The physicians felt the SIP was too lengthy to assimilate easily into the clinic setting . Use of a functional assessment instrument is advocated because of its ability to increase both physician awareness and physician-patient communication regarding the presence of a functional deficit OBJECTIVES The authors test the reliability and validity of the Medical Outcomes Study Short Form 36-Item Health Survey ( SF-36 ) as a written , self-administered survey in out patients with chronic schizophrenia . METHODS Thirty-six schizophrenic out patients completed a written and oral form of the SF-36 . A psychiatrist rated the patients using the Brief Psychiatric Rating Scale to determine severity of psychopathology . Cognitive functioning and academic achievement were also assessed . Internal consistency , test-retest reliability , concurrent and discriminative validity of the oral and written versions were determined . RESULTS The SF-36 in both forms was shown to have good internal consistency , stability , and concurrent validity . The mental health SF-36 subscales had poor discriminant validity , compared with the physical functioning scale that demonstrated good discriminant validity . CONCLUSIONS The validity of using the written form of the SF-36 on a sample of patients with chronic mental illness was demonstrated . The SF-36 appears to be an appropriate outcome measure for changes in physical and role functioning in consumers of outpatient mental health programs BACKGROUND Untreated anxiety may be particularly difficult for primary care physicians to recognize and diagnose because there are no reliable demographic or medical profiles for patients with this condition and because these patients present with a high rate of comorbid psychological conditions that complicate selection of treatment . METHOD A prospect i ve assessment of untreated anxiety symptoms and disorders among primary care patients . RESULTS Approximately 10 % of eligible patients screened in clinic waiting rooms of a mixed-model health maintenance organization reported elevated symptoms and /or disorders of anxiety that were unrecognized and untreated . These patients with untreated anxiety reported significantly worse functioning on both physical and emotional measures than " not anxious " comparison patients ; in fact these patients reported reduced functioning levels within ranges that would be expected for patients with chronic physical diseases , such as diabetes and congest 
    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 : We conducted a prospect i ve trial r and omizing 75 physicians to either a control or intervention arm to evaluate the impact of providing patient-reported information on anxiety and other mental health symptoms and disorders to primary care physicians . Methods : Five hundred seventy-three patients of the study physicians who met entry criteria were r and omized to either usual care or usual care supplemented with feedback of patient-reported mental health information to physicians . This mental health information was derived from initial patient-reported question naires completed in waiting rooms of physicians contracted to a mixed-model health maintenance organization in Colorado . Main outcome measures included impact of intervention on rates of ( 1 ) chart notation of anxiety , depression , or other mental health diagnoses or symptoms ; ( 2 ) referral to mental health specialists ; ( 3 ) prescription of psychotropic medications ; ( 4 ) hospitalization ; and ( 5 ) office visits during a 5-month observation period . Results : Physicians receiving feedback on previously unrecognized and untreated anxiety patients were more likely to make chart notations ( adjusted odds ratio [ AOR ] = 2.51 , 95 percent confidence interval [ CI ] = 1.62 - 3.87 ) , to make referrals to mental health specialists ( AOR = 3.86 , 95 percent CI = 1.63 - 9.16 ) , and to see patients for more frequent outpatient visits ( AOR = 1.73 , 95 percent CI = 1.11 - 2.70 ) . Use of psychotropic medications and rate of hospitalizations did not differ significantly . Conclusions : Providing patient-reported mental health information to primary care physicians result ed in increased recognition and referral rates for previously unrecognized and untreated anxiety patients , plus an increase in primary care visits , without concomitant increases in the use of psychotropic medications or rate of hospitalizations The objective was to assess the potential benefits of the routine use of the MOS SF-36 Health Survey ( SF-36 ) in the care of ambulatory patients . The design was a longitudinal , prospect i ve , r and omized , controlled study set in the outpatient neurology clinic at the New Engl and Medical Center . There were 163 consecutive patients with epilepsy who had 210 follow-up visits with one of two epileptologists . The patients completed the SF-36 before the patient-physician encounter and the forms were optically scanned . The SF-36 results of the intervention group patients were given to the physicians before the encounter and withheld for control group patients . For intervention group patients , the physicians completed a question naire assessing the impact of the SF-36 on the process of care . After the visit , all patients completed a satisfaction question naire . The main outcome measures were the physicians ' responses to st and ardized questions about the usefulness of the SF-36  for communication with and management of epilepsy patients and the patients ' responses to st and ardized questions about their satisfaction with care . The physicians indicated that the SF-36 provided new information in 63 % of the intervention group encounters . A change in therapy was prompted in 13 % . The physicians rated the SF-36 as at least moderately useful for communication in 14 % of the encounters and to management in 8 % . The lower ( indicating worse health status ) the patients ' SF-36 scale scores , the more useful the SF-36 results were rated by the physicians for communication and management . It was concluded that the routine use of health status measures may enhance patients ' care This study was design ed to test the short-term effects of health assessment on the process of care and patient satisfaction . The 29 Chart physicians used the Dartmouth COOP Charts to measure their adult patients '  health status during a single clinical encounter ; the 27 control clinicians used no measure of health status . We compared the change between baseline and post-intervention information for a sample of all study clinicians ' patients . Most of the patients were female ( 67 % ) , well educated ( 70 % had at least a college education ) and young ( approximately 90 % were aged 59 years or younger ) . We found that the ordering of tests and procedures for women was increased by exposure to the COOP Charts ( 52 % vs. 35 % ; p<0.01 ) ; the effect in men was not as significant ( 37 % vs. 23 % : p=0.06 ) . Although women reported no change in satisfaction with care , men cl aim ed that the clinician helped in the management of pain ( p=0.02 ) . We conclude that the use of health status measures during a single clinical encounter in an HMO changes clinician test ordering behaviour and may improve the help male patients receive for pain conditions . The long-term impact of these management changes is not known OBJECTIVE : To improve functional status among primary care patients .INTERVENTION : 1 ) Computer-generated feedback to physicians about the patient ’s functional status , the patient ’s self-reported “ chief complaint , ” and problem-specific re source and management suggestions ; and 2 ) two brief interactive educational sessions for physicians . DESIGN : R and omized controlled trial . SETTING : University primary care clinic . PARTICIPANTS : All 73 internal medicine houseofficers and 557 of their new primary care patients . MEASURES : 1 ) Change in patient functional status from enrollment until six months later , using the Functional Status Question naire ( FSQ ) ;  2 )  management plans and additional information about functional status abstract ed from the medical record ; and 3 ) physician attitude about whether internists should address functional status problems . RESULTS : Emotional well-being scores improved significantly for the patients of the experimental group physicians compared with those of the control group physicians ( p<0.03 ) . Limitations in social activities indicated as “ due to health ” decreased among the elderly ( > 70 years of age ) individuals in the experimental group compared with the control group ( p<0.03 ) . The experimental group physicians diagnosed more symptoms of stress or anxiety than did the control group physicians ( p<0.001 ) and took more actions recommended by the feedback form ( p<0.02 ) . CONCLUSIONS : Computer-generated feedback of functional status screening results accompanied by re source and management suggestions can increase physician diagnoses of impaired emotional well-being , can influence physician management of functional status problems , and can assist physicians in improving emotional well-being and social functioning among their patients The final development of the Sickness Impact Profile ( SIP ) , a behaviorally based measure of health status , is presented . A large field trial on a r and om sample of prepaid group practice enrollees and smaller trials on sample s of patients with hyperthyroidism , rheumatoid arthritis and hip replacements were undertaken to assess reliability and validity of the SIP and provide data for category and item analyses . Test-retest reliability ( r = 0.92 ) and internal consistency ( r = 0.94 ) were high . Convergent and discriminant validity was evaluated using the multitrait – multi method technique . Clinical validity was assessed by determining the relationship between clinical measures of disease and the SIP scores . The relationship between the SIP and criterion measures were moderate to high and in the direction hypotheszed . A technique for describing and assessing similarities and differences among groups was developed using profile and pattern analysis . The final SIP contains 136 items in 12 categories . Overall , category , and dimension scores may be calculated The authors conducted a r and omized controlled trial of functional disability screening in a hospital-based internal medicine group practice . They assigned 60 physicians and 497 of their patients to either an experimental or a control group . Every four months the patients in both groups completed a self-administered question naire measuring physical , psychological , and social function . The experimental group physicians received reports summarizing their patients ’ responses ; the control group physicians received no report . At the end of one year the authors found no significant difference between the patients of the experimental and control group physicians on any measure of functional status . Functional disability screening alone does not improve patient function BACKGROUND This study describes the functioning of primary care patients with major depressive disorder , the relationship of medical comorbidity to functional status , and the effects of depression-specific treatment on functional status after 8 months . METHODS Patients were r and omized to a  protocol intervention ( nortriptyline hydrochloride or interpersonal psychotherapy )  or to usual care with the patient 's physician  in a clinical trial of primary care treatments of depression . Their functional status was evaluated using the Medical Outcomes Study 36-Item Short Form Health Survey ( SF-36 ) and the Global Assessment Scale . Medical comorbidity was assessed with the Duke Severity of Illness Checklist . The Hamilton Rating Scale for Depression and Beck Depression Inventory were used to measure depressive severity . Assessment s were conducted at baseline and at 1 , 2 , 4 , and 8 months after r and omization . RESULTS At baseline , patients reported substantial impairments in the functional domains as assessed by the SF-36 and Global Assessment Scale . Severity of general medical illness and depression were not correlated . Greater medical comorbidity was associated with diminished physical , but not psychological , functioning . Mean scores on SF-36 scales and the Global Assessment Scale improved significantly during the 8 months of follow-up . Patients assigned to protocol treatments showed greater improvement , compared with those assigned to usual care , on the SF-36 mental summary scale and most individual scales but not on the SF-36 physical summary scale . However , patients who completed protocol treatment also experienced significant improvement on the physical summary scale . Medical comorbidity was only a weak predictor of outcome . CONCLUSIONS Primary care patients with major depressive disorder report substantial impairments in physical , psychological , and social functioning on initial assessment . Severity of baseline medical comorbidity did not correlate with severity of depression and only weakly correlated with functional status at 8 months . Functional impairments improve with time , but st and ardized depression-specific treatment is associated with greater improvement in more domains of functioning than is a physician 's usual care We examined the use of formal health status reports every 3 months over 1 year in the clinical care of patients with rheumatoid arthritis ( RA ) . The reports consisted of single-page , computer-generated summaries of scores derived from either the AIMS ( Arthritis Impact Measurement Scales ) or the MHAQ ( Modified Health Assessment Question naire ) health status question naires . A total of 1920 subjects from 27 community practice sites were r and omly assigned to three study groups in each practice : intervention , attention placebo and control . Results showed that 55 % of the physicians found the reports to be at least moderately useful as an aid to patient management , primarily for improving the doctor-patient relationship . However , no detectable differences among the three groups were seen in terms of medication compliance , number of physician visits , number of referrals , frequency of major medication changes , attitudes towards the physician , patient satisfaction or change in health status over 1 year . The failure to demonstrate objective benefits of health status reports in this study may be due to physician unfamiliarity with health status scores , failure to link the report with an office visit , the relative stability of clinical status in the subjects over 1 year and the relatively short time-frame of the study The purpose of this study was to investigate the value of using a vali date d functional assessment instrument , the  Sickness Impact Profile ( SIP )  , with older , chronically ill patients seeking care at the family physician 's office . The SIP was completed by the patient and the family physician on patients 55 years of age or older who were seen at a family practice residency clinic . The study used stratified , r and om assignment in an experimental design to compare physician and patient reaction to the SIP . Both physicians ( residents and faculty ) and patients felt the SIP was useful in detecting disabilities . Approximately half of the physicians felt the SIP was helpful in patient management . Patients reported twice as many disabilities as were reported by physicians . Half of the clinic physicians had the opportunity to review a patient 's SIP immediately prior to a visit . They recognized more disabilities and agreed more often with the patients about the presence of a disability . The physicians felt the SIP was too lengthy to assimilate easily into the clinic setting . Use of a functional assessment instrument is advocated because of its ability to increase both physician awareness and physician-patient communication regarding the presence of a functional deficit OBJECTIVES The authors test the reliability and validity of the Medical Outcomes Study Short Form 36-Item Health Survey ( SF-36 ) as a written , self-administered survey in out patients with chronic schizophrenia . METHODS Thirty-six schizophrenic out patients completed a written and oral form of the SF-36 . A psychiatrist rated the patients using the Brief Psychiatric Rating Scale to determine severity of psychopathology . Cognitive functioning and academic achievement were also assessed . Internal consistency , test-retest reliability , concurrent and discriminative validity of the oral and written versions were determined . RESULTS The SF-36 in both forms was shown to have good internal consistency , stability , and concurrent validity . The mental health SF-36 subscales had poor discriminant validity , compared with the physical functioning scale that demonstrated good discriminant validity . CONCLUSIONS The validity of using the written form of the SF-36 on a sample of patients with chronic mental illness was demonstrated . The SF-36 appears to be an appropriate outcome measure for changes in physical and role functioning in consumers of outpatient mental health programs BACKGROUND Untreated anxiety may be particularly difficult for primary care physicians to recognize and diagnose because there are no reliable demographic or medical profiles for patients with this condition and because these patients present with a high rate of comorbid psychological conditions that complicate selection of treatment . METHOD A prospect i ve assessment of untreated anxiety symptoms and disorders among primary care patients . RESULTS Approximately 10 % of eligible patients screened in clinic waiting rooms of a mixed-model health maintenance organization reported elevated symptoms and /or disorders of anxiety that were unrecognized and untreated . These patients with untreated anxiety reported significantly worse functioning on both physical and emotional measures than " not anxious " comparison patients ; in fact these patients reported reduced functioning levels within ranges that would be expected for patients with chronic physical diseases , such as diabetes and congest 
    Output:
    