***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 Portable h and -held information technology offers much promise not only in assessing dietary intake in the real world , but also in providing dietary feedback to individuals . However , stringent research design s have not been employed to examine whether it can be effective in modifying dietary behaviors . The purpose of this pilot study was to evaluate the efficacy of a h and -held computer ( i.e. , personal digital assistant [ PDA ] ) for increasing vegetable and whole-grain intake over 8 weeks in mid-life and older adults , using a r and omized study design . METHODS Twenty-seven healthy adults aged > or = 50 were r and omized and completed the 8-week study . Intervention participants received an instructional session and a PDA programmed to monitor their vegetable and whole-grain intake levels twice per day and to provide daily individualized feedback , goal - setting , and support . Controls received st and ard , age-appropriate , written nutritional education material s.  Dietary intake was assessed via the Block Food Frequency Question naire at baseline and 8 weeks . RESULTS Relative to controls , intervention participants reported significantly greater increases in vegetable servings ( 1.5 - 2.5 servings/day ; p=0.02 ) , as well as a trend toward greater intake of dietary fiber from grains ( 3.7 - 4.5 servings/day ; p=0.10 ) . CONCLUSIONS This study 's findings provide preliminary evidence that using portable h and -held technology to provide daily individualized feedback on dietary behavior in the real world can increase the dietary intake of healthy food groups OBJECTIVES To determine the effect of patient characteristics and of specific guidelines that were developed for managing warfarin therapy in older adults and included in an in-house computer program on anticoagulation quality . DESIGN Thirteen-month observational study . SETTING Acute care , extended care , and rehabilitation geriatric wards of a teaching hospital in Paris , France . PARTICIPANTS Hospitalized patients ( N=307 , mean age 86.1 + /- 6.1 ) treated with warfarin with a therapeutic international normalized ratio range of 2.0 to 3.0 . INTERVENTION Patients were assigned according to care unit to the computer-generated dosing group ( CGD ) or the st and ard management group ( SM ; usual physician-based care ) . MEASUREMENTS Relationships between anticoagulation quality criteria and covariates ( age , sex , warfarin indication , treatment phase , follow-up duration , model of care ) . RESULTS According to multivariate analysis , only model of care and follow-up duration independently influenced anticoagulation control ; the proportion of time within therapeutic INR range 2.0 to 3.0 was significantly greater in the CGD group than in the SM group ( 59 % vs 48 % , P=.004 ) . When a wider INR range was analyzed ( 1.8 - 3.2 ) , the proportion of time within range was 73 % versus 64 % ( P=.006 ) . Use of the computer was associated with fewer days with INRs greater than 3 , a smaller percentage of INRs of 4 or greater , a longer time to the first INR of 4.0 or greater , and a smaller mean number of INRs per month than SM ( all P<.01 ) . CONCLUSION Initiation regimen and long-term rules that have specifically been developed and included in a computerized dosage program improve quality of anticoagulation in elderly in patients , allowing them to benefit from a quality of care as high as that of younger ambulatory patients PURPOSE This health communication project measured the psychosocial influences of computer anxiety , computer confidence , and computer self-efficacy in older adults at six meal congregate sites . The adults completed a five-week education intervention , based on B and ura 's self-efficacy model , design ed to assist older adults in retrieving and evaluating health information re sources on the Internet . METHODS One hundred thirty-seven participants , ages sixty-five and older , were r and omized in a controlled , two-group , pre-post , repeated measures design . Participants in the intervention group received a two-hour training session , once a week for five weeks . The  Computer Confidence Subscale and Computer Anxiety Subscale of the Computer Attitude Scale and the Computer Self-Efficacy Measure were administered to both groups at three time intervals : at baseline , completion of the five-week intervention , and six weeks after completion of the intervention . Data were analyzed using repeated measures analysis of variance . RESULTS Findings showed a reduction in computer anxiety and increases in computer confidence and computer self-efficacy in retrieving and evaluating online health information ( P<0.001 ) . DISCUSSION The study suggests an array of possibilities to engage older adults in the use of Internet health information re sources to better contribute to their health , independence , safety , and wellness BACKGROUND with increasing prevalence of diabetes in older people , it is important to underst and factors that affect their outcomes . The Informatics for Diabetes Education and Telemedicine ( IDEATel ) project is a demonstration project to evaluate the feasibility and effectiveness of telemedicine with diverse , medically underserved , older diabetes patients . Subjects were r and omised to telemedicine case management or usual care .  This intervention has been shown to result in improved medical outcomes and self-efficacy . Self-efficacy refers to one 's belief that (s)he can successfully engage in a behaviour . Self-efficacy has been shown to relate to behaviour change and glycaemic control in middle-aged individuals , but not studied in older individuals . OBJECTIVES to assess whether ( a ) diabetes self-efficacy relates to the primary medical outcome of glycaemic control , and to secondary outcomes ( blood pressure and cholesterol ) , and ( b ) whether , after an intervention , change in diabetes self-efficacy relates to change in these medical outcomes in a group of older , ethnically diverse individuals . METHODS three waves of longitudinal data from participants in IDEATel were analysed . RESULTS diabetes self-efficacy at baseline correlated with glycaemic control , blood pressure and cholesterol . An increase in diabetes self-efficacy over time was related to an improvement in glycaemic control ( P < 0.0001 ) , but not in blood pressure and lipid levels . The intervention was significantly related to improved self-efficacy over time ( P < 0.0001 ) , and both directly ( P = 0.022 ) and indirectly through self-efficacy ( P < 0.001 ) to improved glycaemic control . The mediation effect of self-efficacy was also significant ( P < 0.004 ) . CONCLUSIONS diabetes self-efficacy is a relevant construct for older diabetes patients . Thus , interventions that target enhanced self-efficacy may also result in improved glycaemic control Traditional pet therapy enhances individual wellbeing . However , there are situations where a substitute artificial companion ( i.e. , robotic pet ) may serve as a better alternative because of insufficient available re sources to care for a real pet , allergic responses to pets , or other difficulties . This pilot study , which compared the benefits of a robotic cat and a plush toy cat as interventions for elderly persons with dementia , was conducted at a special care unit of a large , not-for-profit nursing home . Various aspects of a person 's engagement and affect were assessed through direct observations . Though not identical , similar trends were seen for the two cats . Interacting with the cats was linked with decreased agitation and increased pleasure and interest . The study is intended to pave the way for future research on robotherapy with nursing home residents OBJECTIVE To examine the effectiveness of delivering of computer-generated discharge summaries to general practice by email , fax , post and patient h and delivery . DESIGN Blinded , r and omized controlled trial . A pre- study audit ascertaining baseline statistics and a follow-up survey were conducted with general practice to determine preferred medium for receiving discharge communication . PARTICIPANTS AND SETTING 196 geriatric patients who were admitted to the aged care ward of a 300-bed metropolitan teaching hospital . Twenty-eight patients were lost to follow-up and 52 general practice s participated in the final survey . The pre- study audit followed 63 discharges from the same ward . INTERVENTION 168 eligible patients were r and omly assigned to have their electronic discharge summary sent by email ( n=40 ) , fax ( n=48 ) , post ( n=40 ) or patient h and delivery ( n=40 ) . MAIN OUTCOME MEASURES Receipt of discharge summary by the general practice clinic within 7 days of patient discharge from hospital . RESULTS The receipt rates for email ( 73.9 % , n=17 ) and fax were comparable ( 69.4 % , n=25 ; chi(2)=0.137 , df=1 , P=0.712 ) , and significantly higher ( chi(2)=19.86 , df=3 , P<0.0002 ) than post ( 43.8 % , n=14 ) and patient h and delivery ( 24.2 % , n=8 ) . General practice s indicated that fax was the most preferred method ( 82.7 % ) for communication of discharge summaries . The majority of general practice s ( 75.0 % ) utilized an electronic system for storage of patient information while 88.5 % of practice s reported using medical prescribing software . CONCLUSIONS Transmission of computer-generated discharge summaries by fax or email offers the most effective method of communicating with primary care physicians , as long as accurate contact information is available . Although fax is still the most preferred , email has many advantages that could potentially allow it to replace fax as a st and ard mode for delivery of discharge communication OBJECTIVES To develop and characterize an automated syndromic surveillance mechanism for early identification of older emergency department ( ED ) patients with possible life-threatening infection . DESIGN Prospect i ve , consecutive-enrollment , single-site observational study . SETTING A large university medical center with an annual ED census of 75,273 . PARTICIPANTS Patients aged 70 and older admitted to the ED and having two or more systemic inflammatory response syndrome ( SIRS ) criteria during their ED stay . MEASUREMENTS A search algorithm was developed to screen the census of the ED through its clinical information system . A study coordinator confirmed all patients electronically identified as having a probable infectious explanation for their visit . RESULTS Infection accounted for 28 % of ED and 34 % of final hospital diagnoses . Identification using the software tool alone carried a 1.63 relative risk of infection ( 95 % confidence interval CI51.09 - 2.44 ) compared with other ED patients sufficiently ill to require admission . Follow-up confirmation by a study coordinator increased the risk to 3.06 ( 95 % CI52.11 - 4.44 ) . The sensitivity of the strategy overall wasmodest ( 14 % ) , but patients identified were likely to have an infectious diagnosis ( specificity 598 % ) . The most common SIRS criterion triggering the electronic notification was the combination of tachycardia and tachypnea . CONCLUSION A simple clinical informatics algorithm can detect infection in elderly patients in real time with high specificity . The utility of this tool for research and clinical care may be substantial Despite the benefits associated with a physically active lifestyle , many older adults are insufficiently active to achieve health gain , and also exhibit decreased activity levels with age . Insufficient physical activity in this population is associated with increased morbidity , mortality and dem and on health care services and expenditure . There is a clear need for effective intervention to encourage physical activity in older adults . The aim of this paper is to describe the development and participant evaluation of a r and omized controlled trial of TeleWalk , a telephone-based motivational counseling intervention to encourage physical activity in adults aged 65 years and older . Participants ( N = 186 , mean age 74 + /- 6 years ) were recruited through their General Practitioner ( primary care physician ) and r and omized to either receive eight telephone counseling sessions and related printed material s over 3 months ( intervention group ) or participate in outcome assessment s only ( control group ) . Intervention group participants were mailed an anonymous evaluation question naire on intervention completion . A high response rate was achieved ( 70 % ) . All respondents ( 100 % ) agreed or strongly agreed that a good overall level of service and support was provided , and that the counselor was underst and ing and supportive . Nearly all respondents agreed or strongly agreed that the service was professional , the counselor advice was helpful and motivating and the information provided was relevant ( 97 , 95 and 89 % , respectively ) . Most ( 87 % ) agreed or strongly agreed that the telephone calls encouraged them to be physically active . Among the participants who received printed material , most agreed or strongly agreed that these encouraged them to become or remain active . Findings from this evaluation can be used to inform such interventions and ensure their relevance to community-dwelling older adults UNLABELLED The Self-care Pain Management Project assessed the feasibility and efficacy of delivering online mind-body self-care techniques to 78 adults aged 55 and older with chronic pain . To assess feasibility , the study monitored use of the intervention and documented participant satisfaction . A r and omized trial with intervention ( n = 41 ) and waiting list comparison groups ( n = 37 ) was used to assess changes in pain intensity , limitations due to pain , pain self-efficacy , depression , anxiety , and awareness of responses to pain from baseline to follow-up at 6 weeks . There were statistically significant results for between-group difference in awareness of responses to pain , improvements in pain intensity and pain interference for both groups , and increases in confidence with using nonmedical self-care techniques to manage pain for the intervention group . Reductions in mean pain scores reported by the intervention group at log on and log off also suggest that the intervention may have an immediate impact on 
    Output:
    
On aggregate , the most consistent finding proves to be the positive outcomes of GGHIT in terms of clinical processes .
Although less frequently studied , positive impacts were found on patients ' health , productivity , efficiency and costs , clinicians ' satisfaction , patients ' satisfaction and patients ' empowerment .