You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Temporal stability of alcohol screening measures in a psychiatric setting.
Abstract 1:
The authors evaluated the test-retest reliability of two common screening instruments administered in a psychiatric setting . The Michigan Alcoholism Screening Test ( MAST ; M. L. Selzer , 1971 ) and the CAGE ( D. Mayfield , G. McLeod , & P. Hall , 1974 ) were administered twice , separated by a 1-week interval , to 71 people receiving outpatient psychiatric services and 64 people in the community with no reported history of psychiatric care . The MAST ( r = .95 ) and the CAGE ( r = .80 ) demonstrated adequate test-retest reliability and showed little evidence of variation with respect to degree or direction when administered in a psychiatric setting . Compared to a non clinical sample , reliability estimates obtained in a psychiatric setting were only slightly lower and more variable . In the psychiatric sample , younger men who had a history of alcohol use disorder were found to be the least reliable . Overall , data suggest that people with severe and persistent mental disorders can offer reliable information about their alcohol-related problems


Title 2:
Screening for problem drinking : Comparison of CAGE and AUDIT.
Abstract 2:
OBJECTIVE To compare self-administered versions of three question naires for detecting heavy and problem drinking :  the CAGE , the Alcohol Use Disorders Identification Test ( AUDIT ) , and an augmented version of the CAGE . DESIGN Cross-sectional surveys . SETTING Three Department of Veterans Affairs general medical clinics . PATIENTS R and om sample of consenting male out patients who consumed at least 5 drinks over the past year ( " drinkers " ) . Heavy drinkers were over sample d. MEASUREMENTS An augmented version of the CAGE was included in a question naire mailed to all patients . The AUDIT was subsequently mailed to " drinkers . " Comparison st and ards , based on the tri-level World Health Organization alcohol consumption interview and the Diagnostic Interview Schedule , included heavy drinking ( > 14 drinks per week typically or > /=5 drinks per day at least monthly ) and active DSM-IIIR alcohol abuse or dependence ( positive diagnosis and at least one alcohol-related symptom in the past year ) . Areas under receiver operating characteristic curves ( AUROCs ) were used to compare screening question naires . MAIN RESULTS Of 393 eligible patients , 261 ( 66 % ) returned the AUDIT and completed interviews . For detection of active alcohol abuse or dependence , the CAGE augmented with three more questions ( AUROC 0.871 ) performed better than either the CAGE alone or AUDIT ( AUROCs 0.820 and 0.777 , respectively ) . For identification of heavy-drinking patients , however , the AUDIT performed best ( AUROC 0.870 ) . To identify both heavy drinking and active alcohol abuse or dependence , the augmented CAGE and AUDIT both performed well , but the  AUDIT  was superior ( AUROC 0.861 ) . CONCLUSIONS For identification of patients with heavy drinking or active alcohol abuse or dependence , the self-administered AUDIT was superior to the CAGE in this population


Title 3:
Development of a screening questionnaire for the general hospital and general practices.
Abstract 3:
The purpose of this study was to develop a sensitive as well as brief screening question naire by combining the well-known instruments CAGE and the Michigan Alcoholism Screening Test ( MAST ) in detecting patients with alcohol dependence or abuse in general hospitals and general practice s. The number of items was reduced by means of logistic regression and item analysis based on data of 1,167 consecutive admissions of a general hospital who completed both question naires . Further data were derived from a sample of 774 patients from 10 r and omly selected general practice s. A solution with nine items was vali date d in a second sample of 436 hospital in patients . In all three sample s , cases screening positive were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry to provide ICD-10 and DSM-III-R or DSM-IV diagnosis . In addition , 103 subjects with negative screening results were interviewed in the second general hospital sample . On grounds of the data of all three sample s , a solution of seven items was chosen . This instrument comprises two  CAGE  and five MAST questions ( Leubeck Alcohol Dependence and Abuse Screening Test ; LAST ) and was significantly higher in sensitivity than CAGE and SMAST . Data were robust in all three sample s. It is concluded that the LAST is an optimized instrument for use in general hospital and general practice


Title 4:
Screening for alcohol abuse using the CAGE questionnaire.
Abstract 4:
A prospect i ve study of 518 patients admitted to the orthopedic and medical services of a community-based teaching hospital during a six-month period was performed to test the hypothesis that a short , easily administered question naire would improve the detection rate by physicians of alcohol abuse . The CAGE question naire -- a mnemonic for attempts to cut back on drinking , being annoyed at criticisms about drinking , feeling guilty about drinking , and using alcohol as an eye opener -- was utilized as a screening instrument . The mean corpuscular volume of red blood cells , liver transaminase levels , and the gamma-glutamyl transpeptidase level were also evaluated as screening tests . The presence or absence of alcoholism and alcohol abuse for a consecutive sample of CAGE-negative patients and all patients answering " yes " to one or more of the CAGE questions was established through the administration of the Michigan Alcoholism Screening Test , a detailed chart review , and analysis of quantity of alcohol consumed . Diagnostic criteria were those described in the Diagnostic and Statistical Manual III . The prevalence of alcohol abuse was 20 percent . The mean corpuscular volume , gamma-glutamyl transpeptidase value , and liver transaminase levels were very insensitive as screening tests . In contrast , the CAGE question naire had a sensitivity of 85 percent and a specificity of 89 percent . Only 63 percent of the alcoholic subjects and alcohol abusers were detected by their physicians , and in only 24 percent of these cases did a physician address the problem with the patient . The CAGE question naire is a simple , sensitive , and specific screening test for alcohol abusers


Title 5:
Computerized administration of alcoholism screening tests in a primary care setting.
Abstract 5:
This study compared the use of computerized versus paper- and -pencil administration of three commonly employed alcohol screening tests -- the Short Michigan Alcoholism Screening Test ( SMAST-13 ) , CAGE ( an acronym for four questions to discern problem drinking ) , and a quantity-frequency scale . These instruments were administered to 280 adults receiving health care in three primary care clinics in south- central Wisconsin . One hundred forty patients were r and omly assigned to complete these instruments on a Macintosh SE , and 140 were assigned to the paper- and -pencil versions . Patients were classified as alcoholic based on responses to the Diagnostic Interview Schedule and DSM-III criteria . Results indicated the sensitivity and specificity of these instruments were similar for the two methods of administration . The sensitivity of the SMAST-13 was 0.56 for computer administration and 0.58 for the pencil- and -paper form . The findings suggest that computer administration of these instruments is at least as effective as use of the st and ard pencil- and -paper method . The data show that computers can be used for direct entry of information by patients , avoiding separate coding of paper- and -pencil information into a computerized format for clinical systems that use system-wide computerization of medical information


Title 6:
Alcoholism: the keys to the CAGE.
Abstract 6:
PURPOSE To compare the efficiency of screening for alcoholism using two different introduction s to the CAGE questions . PATIENTS Forty-three alcoholics on inpatient medical and surgical services were identified through r and om distribution of the Michigan Alcoholism Screening Test . METHODS Participants were r and omized to two groups receiving different introduction s to the CAGE questions . Group I was introduced by a simple open-ended question . Group II patients were asked first to quantitate the volume and frequency of their drinking . The outcome measures were the scores on the four  CAGE questions  recorded by an independent observer . RESULTS Eighteen of 21 ( 86 % ) patients in Group I admitted to prior attempts to cut back on their drinking as compared with 8 of 22 ( 36 % ) in Group II ( p = 0.002 ) . Likewise 10 of 21 ( 49 % ) patients in the first group admitted to annoyance compared with just 3 of 22 ( 14 % ) in Group II . The average scores per patient in the two groups were significantly different : Group I = 2.52 versus Group II = 1.23 ( p = 0.0002 ) . Using a screening CAGE score of two or more to identify an alcoholic patient , the open-ended introduction identified 95 % of the alcoholics compared with only 32 % when the closed-ended introduction was used ( p < 0.0001 ) . CONCLUSION Our study demonstrates that the sensitivity of the CAGE question naire in screening for alcoholism is dramatically enhanced by an open-ended introduction . In contrast , the sensitivity of these questions is greatly reduced when preceded by inquiries that seek to define the quantity and frequency of drinking


Title 7:
Validation of the screening strategy in the NIAAA "Physicians' Guide to Helping Patients with Alcohol Problems".
Abstract 7:
OBJECTIVE This study was undertaken to determine the diagnostic test characteristics of the alcohol screening strategy recommended in the National Institute on Alcoholism and Alcohol Abuse ( NIAAA ) " Physicians ' Guide to Helping Patients with Alcohol Problems . " METHOD A research interview was performed on patients who presented to one urban emergency department ( N = 395 ; 61 % women ) . It asked three alcohol consumption questions , the CAGE question naire , and about past alcohol problems . The NIAAA-recommended screen was considered positive for alcohol consumption in excess of 14 drinks per week or 4 drinks per occasion for men , or 7 drinks per week or 3 drinks per occasion for women , or a CAGE score of 1 or greater . A sample of patients ( n = 250 ) received the Composite International Diagnostic Interview substance abuse module , a gold st and ard interview , to determine lifetime or prior 12-month alcohol abuse or dependence ; results were adjusted for verification bias . RESULTS The prevalence of lifetime : alcohol abuse or dependence was 13 % , for which the NIAAA strategy was 81 % sensitive and 80 % specific . The prevalence of alcohol abuse or dependence in the prior 12 months was 10 % , for which the strategy was 83 % sensitive and 84 % specific . Its positive likelihood ratio exceeded that of the CAGE , augmented CAGE or consumption questions alone , and its negative likelihood ratio was the lowest . CONCLUSIONS The screening strategy combining alcohol consumption and CAGE questions recommended in the NIAAA " Physicians ' Guide " is valid , and has superior test characteristics compared to the CAGE alone , in this predominantly black ( 86 % ) emergency department population . Its brevity and simple interpretation recommend wider dissemination of the NIAAA " Physicians ' Guide , " although future research should examine its test characteristics in other clinical setting s and with other population


Title 8:
Comparison of CAGE questionnaire and computer-assisted laboratory profiles in screening for covert alcoholism
Abstract 8:
To identify the most effective method of screening for covert alcoholism Ewing 's CAGE question naire was compared with several computer-assisted laboratory data profiles in a prospect ively gathered , r and om sample of 915 adults admitted to a general hospital . Whether a subject was alcohol dependent ( n = 244 ) or not ( n = 671 ) , as defined by DSM-III-R , was determined on the basis of a structured interview . The CAGE question naire was highly sensitive ( 76 % ) and specific ( 94 % ) for recognition of alcohol dependence ( positive predictive power 87 % ) . None of the discriminant laboratory functions gave recognition rates greater than chance alone . Until the sensitivities , specificities , and positive predictive powers of computer-assisted methods improve , brief interview alone remains the best screening method for general hospital population
RESULTS CAGE has demonstrated high test-retest reliability ( 0.80 - 0.95 ) , and adequate correlations ( 0.48 - 0.70 ) with other screening instruments .
The question naire is a valid tool for detecting  alcohol abuse and dependence  in medical and surgical in patients , ambulatory medical patients , and psychiatric in patients ( average sensitivity 0.71 , specificity 0.90 ) .
Its performance in primary care patients has been varied , while it has not performed well in white women , prenatal women , and college students .
Furthermore , it is not an appropriate screening test for less severe forms of drinking .
CONCLUSIONS CAGE is short , feasible to use , and easily applied in clinical practice .