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: To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results Objectives Primary : To compare the effectiveness of intensive group and individual interventions for  smoking cessation in a primary health care setting ; secondary : to identify the variables associated with smoking cessation . Methods Three-pronged clinical trial with r and omisation at the individual level . We performed the following : an intensive individual intervention ( III ) , an intensive group intervention ( IGI ) and a minimal intervention ( MI ) . Included in the study were smokers who were prepared to quit smoking . Excluded from the study were individuals aged less than 18 years or with severe mental conditions or terminal illnesses . The outcome measure was continued abstinence at 12 months confirmed through CO-oximetry ( CO ) . The analysis was based on intention to treat . Results In total , 287 smokers were recruited : 81 in the III , 111 in the IGI , and 95 in the MI .  Continued abstinence at 12 months confirmed through CO was 7.4 % in the III , 5.4 % in the IGI , and 1 % in the MI . No significant differences were noted between III and MI on the one h and , and between IGI and MI on the other [ RR 7.04 ( 0.9 - 7.2 ) and RR 5.1 ( 0.6 - 41.9 ) , respectively ] . No differences were noted between IGI and III [ RR 0.7 ( 0.2 - 2.2 ) ] . In multivariate analysis , only overall visit length showed a statistically significant association with smoking cessation . Conclusions The effectiveness of intensive smoking interventions in this study was lower than expected . No statistically significant differences were found between the results of individual and group interventions .Trial registration numberIS RCT Background Drug related problems ( DRPs ) are common among elderly patients who are discharged from the hospital and are using several drugs for their chronic diseases . Examples of drug related problems are contra-indications , interactions , adverse drug reactions and inefficacy of treatment . Causes of these problems include prescription errors and non-compliance with treatment . The aim of this study is to examine the effect of medication review and cognitive behaviour therapy of discharged patients by community pharmacists to minimize the occurrence of drug related problems . Methods / Design A r and omized controlled trial will be performed . Community pharmacists will be r and omized into a control group and an intervention group . 342 Patients , aged over 60 years , discharged from general and academic hospitals , using five or more prescription drugs for their chronic disease will be asked by their pharmacy to participate in the study . Patients r and omized to the control group will receive usual care according to the Dutch Pharmacy St and ard . The medication of patients r and omised to the intervention group will be review ed by the community pharmacist with use of the national guidelines for the treatment of diseases , when patients are discharged from the hospital . The Pharmaceutical Care network Europe Registration form will be used to record drug related problems . Trained pharmacy technicians will counsel patients at home at baseline and at 1,3,6,9 and 12 months , using Cognitive Behaviour Treatment according to the Theory of Planned Behaviour . The patient 's attitude towards medication and patient 's adherence will be subject of the cognitive behaviour treatment . The counselling methods that will be used are motivational interviewing and problem solving treatment . Patients adherence towards drug use will be determined with use of the Medication Adherence Report Scale Question naire . There will be a follow-up of 12 months . The two primary outcome measures are the difference in occurrence of DRPs between intervention and control group and adherence with drug use . Secondary endpoints are attitude towards drug use , incidence of Re-hospitalisations related to medicines , functional status of the patient , quality of life and the cost-effectiveness of this intervention . Discussion Combining both medication review and Cognitive Behaviour Treatment may decrease DRPs and may result in more compliance with drug use among patients discharged from the hospital and using 5 or more chronic drugs . Trial registration Dutch Trial Register Background Although for more than a decade healthcare systems have attempted to provide evidence -based mental health treatments , the availability and use of psychotherapies remains low . A significant need exists to identify simple but effective implementation strategies to adopt complex practice s within complex systems of care . Emerging evidence suggests that facilitation may be an effective integrative implementation strategy for adoption of complex practice s. The current pilot examined the use of external facilitation for adoption of cognitive behavioral therapy ( CBT ) in 20 Department of Veteran Affairs ( VA ) clinics . Methods The 20 clinics were paired on facility characteristics , and 23 clinicians from these were trained in CBT .  A clinic in each pair was r and omly selected to receive external facilitation . Quantitative methods were used to examine the extent of CBT implementation in 10 clinics that received external facilitation compared with 10 clinics that did not , and to better underst and the relationship between individual providers ' characteristics and attitudes and their CBT use . Costs of external facilitation were assessed by tracking the time spent by the facilitator and therapists in activities related to implementing CBT . Qualitative methods were used to explore context ual and other factors thought to influence implementation . Results Examination of change scores showed that facilitated therapists averaged an increase of 19 % [ 95 % CI : ( 2 , 36 ) ] in self-reported CBT use from baseline , while control therapists averaged a 4 % [ 95 % CI : ( -14 , 21 ) ] increase . Therapists in the facilitated condition who were not providing CBT at baseline showed the greatest increase ( 35 % ) compared to a control therapist who was not providing CBT at baseline ( 10 % ) or to therapists in either condition who were providing CBT at baseline ( average 3 % ) . Increased CBT use was unrelated to prior CBT training . Barriers to CBT implementation were therapists ' lack of control over their clinic schedule and poor communication with clinical leaders . Conclusions These findings suggest that facilitation may help clinicians make complex practice changes such as implementing an evidence -based psychotherapy . Furthermore , the substantial increase in  CBT usage among the facilitation group was achieved at a modest cost Background Despite concerns that facilitating informed choice would decrease diabetes screening uptake , ' informed choice ' invitations that increased knowledge did not affect attendance ( the DICISION trial ) . We explored possible reasons using data from an experimental analogue study undertaken to develop the invitations . We tested a model of the impact on knowledge , attitude and intentions of a diabetes screening invitation design ed to facilitate informed choices . Methods 417 men and women aged 40 - 69 recruited from town centres in the UK were r and omised to receive either an invitation for diabetes screening design ed to facilitate informed choice or a st and ard type of invitation .  Knowledge of the invitation , attitude towards diabetes screening , and intention to attend for diabetes screening were assessed two weeks later . Results Attitude was a strong predictor of screening intentions ( β = .64 , p = .001 ) . Knowledge added to the model but was a weak predictor of intentions ( β = .13 , p = .005 ) . However , invitation type did not predict attitudes towards screening but did predict knowledge ( β = -.45 , p = .001 ) , which mediated a small effect of invitation type on intention ( indirect β = -.06 , p = .017 ) . Conclusions These findings may explain why information about the benefits and harms of screening did not reduce diabetes screening attendance in the DICISION trial Objectives To evaluate the completeness of descriptions of non-pharmacological interventions in r and omised trials , identify which elements are most frequently missing , and assess whether authors can provide missing details . Design Analysis of consecutive sample of r and omised trials of non-pharmacological interventions . Data sources and study selection All reports of r and omised trials of non-pharmacological interventions published in 2009 in six leading general medical journals ; 133 trial reports , with 137 interventions , met the inclusion criteria . Data collection Using an eight item checklist , two raters assessed the primary full trial report , plus any reference material s , appendices , or websites . Questions about missing details were emailed to corresponding authors , and relevant items were then reassessed . Results Of 137 interventions , only 53 ( 39 % ) were adequately described ; this was increased to 81 ( 59 % ) by using 63 responses from 88 contacted authors . The most frequently missing item was the “ intervention material s ” ( 47 % complete ) , but it also improved the most after author response ( 92 % complete ) . Whereas some authors ( 27/70 ) provided material s or further information , other authors ( 21/70 ) could not ; their reasons included copyright or intellectual property concerns , not having the material s or intervention details , or being unaware of their importance . Although 46 ( 34 % ) trial interventions had further information or material s readily available on a website , many were not mentioned in the report , were not freely accessible , or the URL was no longer functioning . Conclusions Missing essential information about interventions is a frequent , yet remediable , contributor to the worldwide waste in research funding . If trial reports do not have a sufficient description of interventions , other research ers can not build on the findings , and clinicians and patients can not reliably implement useful interventions . Improvement will require action by funders , research ers , and publishers , aided by long term repositories of material s linked to publications Developing an evidence base for making public health decisions will require using data from evaluation studies with r and omized and nonr and omized design s. Assessing individual studies and using studies in quantitative research syntheses require transparent reporting of the study , with sufficient detail and clarity to readily see differences and similarities among studies in the same area . The Consoli date d St and ards of Reporting Trials ( CONSORT ) statement provides guidelines for transparent reporting of r and omized clinical trials . We present the initial version of the Transparent Reporting of Evaluations with Nonr and omized Design s ( TREND ) statement . These guidelines emphasize the reporting of theories used and descriptions of intervention and comparison conditions , research design , and methods of adjusting for possible biases in evaluation studies that use nonr and omized design Background The increased prevalence of overweight and obesity warrants preventive actions , particularly among people in transitional stages associated with lifestyle changes , such as occupational retirement . The purpose is to investigate the effect of a one year low-intensity computer-tailored energy balance programme among recent retirees on waist circumference , body weight and body composition , blood pressure , physical activity and dietary intake . Methods A r and omised controlled trial was conducted among recent retirees ( N = 413 ; mean age 59.5 years ) . Outcome measures were assessed using anthropometry , bio-impedance , blood pressure measurement and question naires . Results Waist circumference , body weight and blood pressure decreased significantly in men of the intervention and control group , but no significant between-group-differences were observed at 12 or at 24-months follow-up . A significant effect of the programme was only observed on waist circumference ( -1.56 cm ( 95%CI : -2.91 to -0.21 ) ) at 12 month follow up among men with low education ( n = 85 ) . Physical activity and dietary behaviours improved in both the intervention and control group during the intervention period . Although , these behaviours changed more favourably in the intervention group , these between-group-differences were not statistically significant . Conclusions The multifaceted computer-tailored programme for recent retirees did not appear to be effective . Apparently the transition to occupational retirement and /or participation in the study had a greater impact than the intervention programme . Trial registration Clinical Trials NCT00122213 Background In many low- and middle-income countries , where tobacco use is common , tuberculosis is also a major problem . Tobacco use increases the risk of developing tuberculosis , secondary mortality , poor treatment compliance and relapses . In countries with TB epidemic , even a modest relative risk leads to a significant attributable risk . Treating tobacco dependence , therefore , is likely to have benefits for controlling tuberculosis in addition to reducing the non-communicable disease burden associated with smoking . In poorly re source d health systems which face a dual burden of disease secondary to tuberculosis and tobacco , an integrated approach to tackle tobacco dependence in TB control could be economically desirable . During TB screening , health professionals come across large numbers of patients with respiratory symptoms , a significant proportion of which are likely to be 
    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: To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results Objectives Primary : To compare the effectiveness of intensive group and individual interventions for  smoking cessation in a primary health care setting ; secondary : to identify the variables associated with smoking cessation . Methods Three-pronged clinical trial with r and omisation at the individual level . We performed the following : an intensive individual intervention ( III ) , an intensive group intervention ( IGI ) and a minimal intervention ( MI ) . Included in the study were smokers who were prepared to quit smoking . Excluded from the study were individuals aged less than 18 years or with severe mental conditions or terminal illnesses . The outcome measure was continued abstinence at 12 months confirmed through CO-oximetry ( CO ) . The analysis was based on intention to treat . Results In total , 287 smokers were recruited : 81 in the III , 111 in the IGI , and 95 in the MI .  Continued abstinence at 12 months confirmed through CO was 7.4 % in the III , 5.4 % in the IGI , and 1 % in the MI . No significant differences were noted between III and MI on the one h and , and between IGI and MI on the other [ RR 7.04 ( 0.9 - 7.2 ) and RR 5.1 ( 0.6 - 41.9 ) , respectively ] . No differences were noted between IGI and III [ RR 0.7 ( 0.2 - 2.2 ) ] . In multivariate analysis , only overall visit length showed a statistically significant association with smoking cessation . Conclusions The effectiveness of intensive smoking interventions in this study was lower than expected . No statistically significant differences were found between the results of individual and group interventions .Trial registration numberIS RCT Background Drug related problems ( DRPs ) are common among elderly patients who are discharged from the hospital and are using several drugs for their chronic diseases . Examples of drug related problems are contra-indications , interactions , adverse drug reactions and inefficacy of treatment . Causes of these problems include prescription errors and non-compliance with treatment . The aim of this study is to examine the effect of medication review and cognitive behaviour therapy of discharged patients by community pharmacists to minimize the occurrence of drug related problems . Methods / Design A r and omized controlled trial will be performed . Community pharmacists will be r and omized into a control group and an intervention group . 342 Patients , aged over 60 years , discharged from general and academic hospitals , using five or more prescription drugs for their chronic disease will be asked by their pharmacy to participate in the study . Patients r and omized to the control group will receive usual care according to the Dutch Pharmacy St and ard . The medication of patients r and omised to the intervention group will be review ed by the community pharmacist with use of the national guidelines for the treatment of diseases , when patients are discharged from the hospital . The Pharmaceutical Care network Europe Registration form will be used to record drug related problems . Trained pharmacy technicians will counsel patients at home at baseline and at 1,3,6,9 and 12 months , using Cognitive Behaviour Treatment according to the Theory of Planned Behaviour . The patient 's attitude towards medication and patient 's adherence will be subject of the cognitive behaviour treatment . The counselling methods that will be used are motivational interviewing and problem solving treatment . Patients adherence towards drug use will be determined with use of the Medication Adherence Report Scale Question naire . There will be a follow-up of 12 months . The two primary outcome measures are the difference in occurrence of DRPs between intervention and control group and adherence with drug use . Secondary endpoints are attitude towards drug use , incidence of Re-hospitalisations related to medicines , functional status of the patient , quality of life and the cost-effectiveness of this intervention . Discussion Combining both medication review and Cognitive Behaviour Treatment may decrease DRPs and may result in more compliance with drug use among patients discharged from the hospital and using 5 or more chronic drugs . Trial registration Dutch Trial Register Background Although for more than a decade healthcare systems have attempted to provide evidence -based mental health treatments , the availability and use of psychotherapies remains low . A significant need exists to identify simple but effective implementation strategies to adopt complex practice s within complex systems of care . Emerging evidence suggests that facilitation may be an effective integrative implementation strategy for adoption of complex practice s. The current pilot examined the use of external facilitation for adoption of cognitive behavioral therapy ( CBT ) in 20 Department of Veteran Affairs ( VA ) clinics . Methods The 20 clinics were paired on facility characteristics , and 23 clinicians from these were trained in CBT .  A clinic in each pair was r and omly selected to receive external facilitation . Quantitative methods were used to examine the extent of CBT implementation in 10 clinics that received external facilitation compared with 10 clinics that did not , and to better underst and the relationship between individual providers ' characteristics and attitudes and their CBT use . Costs of external facilitation were assessed by tracking the time spent by the facilitator and therapists in activities related to implementing CBT . Qualitative methods were used to explore context ual and other factors thought to influence implementation . Results Examination of change scores showed that facilitated therapists averaged an increase of 19 % [ 95 % CI : ( 2 , 36 ) ] in self-reported CBT use from baseline , while control therapists averaged a 4 % [ 95 % CI : ( -14 , 21 ) ] increase . Therapists in the facilitated condition who were not providing CBT at baseline showed the greatest increase ( 35 % ) compared to a control therapist who was not providing CBT at baseline ( 10 % ) or to therapists in either condition who were providing CBT at baseline ( average 3 % ) . Increased CBT use was unrelated to prior CBT training . Barriers to CBT implementation were therapists ' lack of control over their clinic schedule and poor communication with clinical leaders . Conclusions These findings suggest that facilitation may help clinicians make complex practice changes such as implementing an evidence -based psychotherapy . Furthermore , the substantial increase in  CBT usage among the facilitation group was achieved at a modest cost Background Despite concerns that facilitating informed choice would decrease diabetes screening uptake , ' informed choice ' invitations that increased knowledge did not affect attendance ( the DICISION trial ) . We explored possible reasons using data from an experimental analogue study undertaken to develop the invitations . We tested a model of the impact on knowledge , attitude and intentions of a diabetes screening invitation design ed to facilitate informed choices . Methods 417 men and women aged 40 - 69 recruited from town centres in the UK were r and omised to receive either an invitation for diabetes screening design ed to facilitate informed choice or a st and ard type of invitation .  Knowledge of the invitation , attitude towards diabetes screening , and intention to attend for diabetes screening were assessed two weeks later . Results Attitude was a strong predictor of screening intentions ( β = .64 , p = .001 ) . Knowledge added to the model but was a weak predictor of intentions ( β = .13 , p = .005 ) . However , invitation type did not predict attitudes towards screening but did predict knowledge ( β = -.45 , p = .001 ) , which mediated a small effect of invitation type on intention ( indirect β = -.06 , p = .017 ) . Conclusions These findings may explain why information about the benefits and harms of screening did not reduce diabetes screening attendance in the DICISION trial Objectives To evaluate the completeness of descriptions of non-pharmacological interventions in r and omised trials , identify which elements are most frequently missing , and assess whether authors can provide missing details . Design Analysis of consecutive sample of r and omised trials of non-pharmacological interventions . Data sources and study selection All reports of r and omised trials of non-pharmacological interventions published in 2009 in six leading general medical journals ; 133 trial reports , with 137 interventions , met the inclusion criteria . Data collection Using an eight item checklist , two raters assessed the primary full trial report , plus any reference material s , appendices , or websites . Questions about missing details were emailed to corresponding authors , and relevant items were then reassessed . Results Of 137 interventions , only 53 ( 39 % ) were adequately described ; this was increased to 81 ( 59 % ) by using 63 responses from 88 contacted authors . The most frequently missing item was the “ intervention material s ” ( 47 % complete ) , but it also improved the most after author response ( 92 % complete ) . Whereas some authors ( 27/70 ) provided material s or further information , other authors ( 21/70 ) could not ; their reasons included copyright or intellectual property concerns , not having the material s or intervention details , or being unaware of their importance . Although 46 ( 34 % ) trial interventions had further information or material s readily available on a website , many were not mentioned in the report , were not freely accessible , or the URL was no longer functioning . Conclusions Missing essential information about interventions is a frequent , yet remediable , contributor to the worldwide waste in research funding . If trial reports do not have a sufficient description of interventions , other research ers can not build on the findings , and clinicians and patients can not reliably implement useful interventions . Improvement will require action by funders , research ers , and publishers , aided by long term repositories of material s linked to publications Developing an evidence base for making public health decisions will require using data from evaluation studies with r and omized and nonr and omized design s. Assessing individual studies and using studies in quantitative research syntheses require transparent reporting of the study , with sufficient detail and clarity to readily see differences and similarities among studies in the same area . The Consoli date d St and ards of Reporting Trials ( CONSORT ) statement provides guidelines for transparent reporting of r and omized clinical trials . We present the initial version of the Transparent Reporting of Evaluations with Nonr and omized Design s ( TREND ) statement . These guidelines emphasize the reporting of theories used and descriptions of intervention and comparison conditions , research design , and methods of adjusting for possible biases in evaluation studies that use nonr and omized design Background The increased prevalence of overweight and obesity warrants preventive actions , particularly among people in transitional stages associated with lifestyle changes , such as occupational retirement . The purpose is to investigate the effect of a one year low-intensity computer-tailored energy balance programme among recent retirees on waist circumference , body weight and body composition , blood pressure , physical activity and dietary intake . Methods A r and omised controlled trial was conducted among recent retirees ( N = 413 ; mean age 59.5 years ) . Outcome measures were assessed using anthropometry , bio-impedance , blood pressure measurement and question naires . Results Waist circumference , body weight and blood pressure decreased significantly in men of the intervention and control group , but no significant between-group-differences were observed at 12 or at 24-months follow-up . A significant effect of the programme was only observed on waist circumference ( -1.56 cm ( 95%CI : -2.91 to -0.21 ) ) at 12 month follow up among men with low education ( n = 85 ) . Physical activity and dietary behaviours improved in both the intervention and control group during the intervention period . Although , these behaviours changed more favourably in the intervention group , these between-group-differences were not statistically significant . Conclusions The multifaceted computer-tailored programme for recent retirees did not appear to be effective . Apparently the transition to occupational retirement and /or participation in the study had a greater impact than the intervention programme . Trial registration Clinical Trials NCT00122213 Background In many low- and middle-income countries , where tobacco use is common , tuberculosis is also a major problem . Tobacco use increases the risk of developing tuberculosis , secondary mortality , poor treatment compliance and relapses . In countries with TB epidemic , even a modest relative risk leads to a significant attributable risk . Treating tobacco dependence , therefore , is likely to have benefits for controlling tuberculosis in addition to reducing the non-communicable disease burden associated with smoking . In poorly re source d health systems which face a dual burden of disease secondary to tuberculosis and tobacco , an integrated approach to tackle tobacco dependence in TB control could be economically desirable . During TB screening , health professionals come across large numbers of patients with respiratory symptoms , a significant proportion of which are likely to be 
    Output:
    