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:
Protocol for an overview of systematic reviews of interventions to reduce unscheduled hospital admissions among adults
Abstract 1:
Introduction Unscheduled hospital admissions are an increasing burden on health systems worldwide . To date , initiatives to reduce admissions have had limited success as it is unclear which strategies effectively reduce admissions and are supported by a strong evidence -base . Therefore , we will conduct an overview to find , assess and summarise all published peer- review ed systematic review s of r and omised controlled trials that examine the effect of an intervention on  unplanned admissions among adults . Methods and analysis This is a protocol for a systematic overview of review s. We will search four data bases : Ovid MEDLINE , PubMed , Cochrane Data base of Systematic Review s and the Cochrane Data base of Abstract s of Review s of Effects . We will consider systematic review s and meta-analyses of r and omised controlled trials in adults ( ≥16 years old ) evaluating the effect of any intervention on unscheduled hospital admissions including those to treat , monitor , diagnose or prevent a health problem . We will only include review s that identified unscheduled hospitalisations as a prespecified outcome . Two authors will independently screen articles for inclusion using a priori criteria . We will assess the quality of included review s and extract ratings of the quality of evidence from within each review . We will create a hierarchical list of interventions based on estimates of absolute admission reductions and the quality of the evidence . Presentation of results will align with guidelines in the Cochrane H and book of Systematic Review s of Interventions and the Preferred Reporting Items for Systematic Review s and Meta- Analysis statement . Ethics and dissemination Ethics approval is not required . We will su bmi t the results of this study for peer- review publication . The results will inform future research and could be used by healthcare managers , administrators and policymakers to guide re source allocation decisions and inform local implementation and optimisation of interventions to reduce unscheduled hospital admissions


Title 2:
Echinacea for Treating the Common Cold
Abstract 2:
BACKGROUND Echinacea is widely used to treat the common cold . OBJECTIVE To assess the potential benefits of echinacea as a treatment of common cold . DESIGN R and omized , controlled trial . ( Clinical Trials.gov registration number : NCT00065715 ) SETTING Dane County , Wisconsin . PATIENTS 719 patients , aged 12 to 80 years , with new-onset common cold . INTERVENTION Patients were assigned to 1 of 4 parallel groups : no pills , placebo pills ( blinded ) , echinacea pills ( blinded ) , or echinacea pills ( unblinded , open-label ) . Echinacea groups received the equivalent of 10.2 g of dried echinacea root during the first 24 hours and 5.1 g during each of the next 4 days . Indistinguishable placebo tablets contained only inert ingredients . MEASUREMENTS The primary outcome was the area under the curve for global severity , with severity assessed twice daily by self-report using the Wisconsin Upper Respiratory Symptom Survey , short version . Secondary outcomes included interleukin-8 levels and neutrophil counts from nasal wash , assessed at intake and 2 days later . RESULTS Of the 719 patients enrolled , 713 completed the protocol . Mean age was 33.7 years , 64 % were female , and 88 % were white .  Mean global severity was 236 and 258 for the blinded and unblinded echinacea groups , respectively ; 264 for the blinded placebo group ; and 286 for the no-pill group . A comparison of the 2 blinded groups showed a 28-point trend ( 95 % CI , -69 to 13 points ) toward benefit for echinacea ( P = 0.089 ) . Mean illness duration in the blinded and unblinded echinacea groups was 6.34 and 6.76 days , respectively , compared with 6.87 days in the blinded placebo group and 7.03 days in the no-pill group . A comparison of the blinded groups showed a nonsignificant 0.53-day ( CI , -1.25 to 0.19 days ) benefit ( P = 0.075 ) . Median change in interleukin-8 levels and neutrophil counts were also not statistically significant ( 30 ng/L and 1 cell/high-power field [ hpf ] in the no-pill group , 39 ng/L and 1 cell/hpf in the blinded placebo group , 58 ng/L and 2 cells/hpf in the blinded echinacea group , and 70 ng/L and 1 cell/hpf in the open-label echinacea group ) . LIMITATION Higher-than-expected variability limited power to detect small benefits . CONCLUSION Illness duration and severity were not statistically significant with echinacea compared with placebo . These results do not support the ability of this dose of the echinacea formulation to substantively change the course of the common cold . PRIMARY FUNDING SOURCE National Center for Complementary and Alternative Medicine , National Institutes of Health


Title 3:
When expectations predict experience: the influence of psychological factors on chemotherapy toxicities.
Abstract 3:
CONTEXT Patients with cancer undergoing similar treatments experience variable severity and frequency of side effects not adequately explained by pharmacological mechanisms , suggesting psychological influence . OBJECTIVES First , this study aim ed to further examine the relationship between patients ' expectations of multiple chemotherapy-related toxicities and experiences . Second , this study aim ed to explore the impact of anxiety and cancer coping styles to aid in informing interventions to lessen such expectations . METHODS A total of 59 eligible , consenting patients with cancer rated their expectations of 20 chemotherapy toxicities on 100-point linear analogue self- assessment indicators before treatment and completed the Spielberger State Anxiety Inventory and the Mental Adjustment to Cancer scale . Patients then rated their experience of side effects after one chemotherapy session . RESULTS Regressions controlling primary treating nurse influence and patient performance status showed toxicity experience was significantly predicted by patient expectations of mood changes , bleeding , skin itchiness , hair loss , feeling tired , and sleep disturbance ( β=0.30 - 0.55 ) . Anxiety was significantly related to expectations of nervousness and mood changes ; the coping style Fighting Spirit showed no significant associations , whereas conversely , Anxious Preoccupation showed some degree of association with all 20 toxicities ( r=0.11 - 0.34 ) . CONCLUSION Findings support the growing contention that patient expectations influence experience , negatively impacting quality of life . As it is unethical to withhold treatment information , research into screening for at-risk patients and offering brief interventions to minimize Anxious Preoccupation could be one way to reduce overall side effect burden , perhaps in the case of many medical interventions


Title 4:
A practical guide to informed consent to treatment
Abstract 4:
A year ago BMJ Publications released a 350 page tome that many people will regard as the last word on informed consent to treatment.1 What is missing from this otherwise comprehensive compendium is a practical guide for clinicians at the coalface . In an effort to overcome this deficit we have generated a menu of alternative styles of informed consent . The first five options relate to consent for treatment within r and omised controlled trials , and the final six are options for use in routine clinical practice . We are confident that our menu will help frontline clinicians and patients in practice . It may also help medical ethicists in theory . # # # # Summary points Many alternative styles of informed consent to treatment exist , along with much theory , a few principles , and different st and ards of consent within and outside r and omised trials , but concise practical advice about the available alternatives is not readily accessible We have assembled a menu of options to help frontline clinicians and patients to select whichever form of consent meets their particular needs and circumstances # # # Human sacrifice r and omised controlled trial consent “ The research ethics committee that approved this trial on your behalf would like you to know that future generations might ( or might not ) appreciate it if you would put your life at risk by joining this trial . Although we will keep your individual trial results confidential ( especially if they run contrary to our hypothesis ) and you are free to insist on conventional treatment or withdraw at any time , let 's face it — you are a human guinea pig . The investigators responsible for the study may have conducted a systematic review of relevant previous studies to see whether one of the alternative treatments has already been shown to be superior , but this sort of evidence is beyond the interest and competency of our local research ethics committee , which is primarily interested in protecting
Conclusions and implication s of key findings AEs in trial placebo groups are common and can not be attributed entirely to natural history .