***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 Mobile phone sensors can be used to develop context -aware systems that automatically detect when patients require assistance . Mobile phones can also provide ecological momentary interventions that deliver tailored assistance during problematic situations . However , such approaches have not yet been used to treat major depressive disorder . Objective The purpose of this study was to investigate the technical feasibility , functional reliability , and patient satisfaction with Mobilyze ! , a mobile phone- and Internet-based intervention including ecological momentary intervention and context sensing . Methods We developed a mobile phone application and supporting architecture , in which machine learning models ( ie , learners ) predicted patients ’ mood , emotions , cognitive/motivational states , activities , environmental context , and social context based on at least 38 concurrent phone sensor values ( eg , global positioning system , ambient light , recent calls ) . The website included feedback graphs illustrating correlations between patients ’ self-reported states , as well as didactics and tools teaching patients behavioral activation concepts . Brief telephone calls and emails with a clinician were used to promote adherence . We enrolled 8 adults with major depressive disorder in a single-arm pilot study to receive Mobilyze ! and complete clinical assessment s for 8 weeks . Results Promising accuracy rates ( 60 % to 91 % ) were achieved by learners predicting categorical context ual states ( eg , location ) . For states rated on scales ( eg , mood ) , predictive capability was poor . Participants were satisfied with the phone application and improved significantly on self-reported depressive symptoms ( betaweek = –.82 , P < .001 , per- protocol Cohen d = 3.43 ) and interview measures of depressive symptoms ( betaweek = –.81 , P < .001 , per- protocol Cohen d = 3.55 ) . Participants also became less likely to meet criteria for major depressive disorder diagnosis ( bweek = –.65 , P = .03 , per- protocol remission rate = 85.71 % ) . Comorbid anxiety symptoms also decreased ( betaweek = –.71 , P < .001 , per- protocol Cohen d = 2.58 ) . Conclusions Mobilyze ! is a scalable , feasible intervention with preliminary evidence of efficacy . To our knowledge , it is the first ecological momentary intervention for unipolar depression , as well as one of the first attempts to use context sensing to identify mental health-related states . Several lessons learned regarding technical functionality , data mining , and software development process are discussed . Trial Registration Clinical trials.gov NCT01107041 ; http:// clinical trials.gov/ct2/show/NCT01107041 ( Archived by WebCite at http://www.webcitation.org/60CVjPH0n OBJECTIVE To examine the effects of direct skill training and guided training for promoting independence after stroke . DESIGN Single-blind r and omized pilot study . SETTING Inpatient rehabilitation facility . PARTICIPANTS Participants in inpatient rehabilitation with acute stroke and cognitive impairments ( N=43 ) . INTERVENTIONS Participants were r and omized to receive direct skill training ( n=22 , 10 sessions as adjunct to usual inpatient rehabilitation ) or guided training ( n=21 , same dose ) . MAIN OUTCOME MEASURE The FIM assessed independence at baseline , rehabilitation discharge , and months 3 , 6 , and 12 . RESULTS Linear mixed models ( r and om intercept , other effects fixed ) revealed a significant intervention by time interaction ( F4,150=5.11 , P<.001 ) , a significant main effect of time ( F4,150=49.25 , P<.001 ) , and a significant effect of stroke severity ( F1,150=34.46 , P<.001 ) . There was no main effect of intervention ( F1,150=.07 , P=.79 ) . Change in FIM scores was greater for the direct group at rehabilitation discharge ( effect size of between-group differences , d=.28 ) and greater for the guide group at months 3 ( d=.16 ) , 6 ( d=.39 ) , and 12 ( d=.53 ) . The difference between groups in mean 12-month change scores was 10.57 points . CONCLUSIONS Guided training , provided in addition to usual care , offered a small advantage in the recovery of independence , relative to direct skill training . Future studies examining guided training in combination with other potentially potent intervention elements may further advise best practice s in rehabilitation for individuals with cognitive impairments after acute stroke Background Web-based programs have been developed for informal caregivers of people with Alzheimer ’s disease ( PWAD ) . However , these programs can prove difficult to adopt , especially for older people , who are less familiar with the Internet than other population s. Despite the fundamental role of usability testing in promoting caregivers ’ correct use and adoption of these programs , to our knowledge , this is the first study describing this process before evaluating a program for caregivers of PWAD in a r and omized clinical trial . Objective The objective of the study was to describe the development process of a fully automated Web-based program for caregivers of PWAD , aim ing to reduce caregivers ’ stress , and based on the user-centered design approach . Methods There were 49 participants ( 12 health care professionals , 6 caregivers , and 31 healthy older adults ) that were involved in a double iterative design allowing for the adaptation of program content and for the enhancement of website usability . This process included three component parts : ( 1 ) project team workshops , ( 2 ) a proof of concept , and ( 3 ) two usability tests . The usability tests were based on a mixed methodology using behavioral analysis , semistructured interviews , and a usability question naire . Results The user-centered design approach provided valuable guidelines to adapt the content and design of the program , and to improve website usability . The professionals , caregivers ( mainly spouses ) , and older adults considered that our project met the needs of isolated caregivers . Participants underlined that contact between caregivers would be desirable . During usability observations , the mistakes of users were also due to ergonomics issues from Internet browsers and computer interfaces . Moreover , negative self-stereotyping was evidence d , when comparing interviews and results of behavioral analysis . Conclusions Face-to-face psycho-educational programs may be used as a basis for Web-based programs . Nevertheless , a user-centered design approach involving targeted users ( or their representatives ) remains crucial for their correct use and adoption . For future user-centered design studies , we recommend to involve end-users from preconception stages , using a mixed research method in usability evaluations , and implementing pilot studies to evaluate acceptability and feasibility of programs Nonadherence to medication is a widespread problem in schizophrenia and is associated with poor clinical outcomes and inappropriate management and utilization of re sources . The aim of the current investigation was to assess the impact of telemonitoring of medication adherence on symptomatology and service use in patients with schizophrenia . A total of 108 schizophrenia patients were r and omized into three equal groups according to the approaches used to assess medication adherence ; self-report , pill counting , and telemonitoring . Telementoring was achieved through an innovative new platform called @HOME . This platform offers clinicians early warnings about impeding nonadherence as well as information about the pattern of medication taking . Patient 's adherence was observed over an 8-week period , during which patient 's clinical status and service use were recorded . In comparison to the other two groups , patients using @HOME showed improvement in the Global Clinical Impression Scale and a significant reduction in emergency visits and medical appointments . The @HOME platform was highly acceptable by patients , caregivers , and professionals , and required minimal training for implementation . The results of the study suggest that the use of telemonitoring in psychiatric setting s was both feasible and acceptable and may be associated with significant clinical and service related benefits Background Treatments and organizational changes supported by eHealth are beginning to play an important role in improving disease treatment outcome and providing cost-efficient care management . “ Improvehealth.eu ” is a novel eHealth service to support the treatment of patients with depressive disorder . It offers active patient engagement and collaborative care management by combining Web- and mobile-based information and communication technology systems and access to care managers . Objectives Our objective was to assess the feasibility of a novel eHealth service . Methods The intervention — the “ Improvehealth.eu ” service — was explored in the course of a pilot study comparing two groups of patients receiving treatment as usual and treatment as usual with eHealth intervention .  We compared patients ’ medication adherence and outcome measures between both groups and additionally explored usage and overall perceptions of the intervention in intervention group . Results The intervention was successfully implemented in a pilot with 46 patients , of whom 40 were female . Of the 46 patients , 25 received treatment as usual , and 21 received the intervention in addition to treatment as usual . A total of 55 % ( 12/25 ) of patients in the former group and 45 % ( 10/21 ) in the latter group finished the 6-month pilot . Available case analysis indicated an improvement of adherence in the intervention group ( odds ratio [ OR ] = 10.0 , P = .03 ) . Intention-to-treat analysis indicated an improvement of outcome in the intervention group ( ORs ranging from 0.35 to 18 ; P values ranging from .003 to .20 ) , but confidence intervals were large due to small sample sizes . Average duration of use of the intervention was 107 days . The intervention was well received by 81 % ( 17/21 ) of patients who reported feeling actively engaged , in control of their disease , and that they had access to a high level of information . In all , 33 % ( 7/21 ) of the patients also described drawbacks of the intervention , mostly related to usability issues . Conclusions The results of this pilot study indicate that the intervention was well accepted and helped the patients in the course of treatment . The results also suggest the potential of the intervention to improve both medication adherence and outcome measures of treatment , including reduction of depression severity and patients becoming “ healthy . Introduction Help4Mood is an interactive system with an embodied virtual agent ( avatar ) to assist in self-monitoring of patients receiving treatment for depression .  Help4Mood supports self-report and biometric monitoring and includes elements of cognitive behavioural therapy . We aim ed to evaluate system use and acceptability , to explore likely recruitment and retention rates in a clinical trial and to obtain an estimate of potential treatment response with a view to conducting a future r and omised controlled trial ( RCT ) . Methods We conducted a pilot RCT of Help4Mood in three centres , in Romania , Spain and Scotl and , UK . Patients with diagnosed depression ( major depressive disorder ) and current mild/moderate depressive symptoms were r and omised to use the system for four weeks in addition to treatment as usual ( TAU ) or to TAU alone . Results Twenty-seven individuals were r and omised and follow-up data were obtained from 21 participants ( 12/13 Help4Mood , 9/14 TAU ) . Half of participants r and omised to Help4Mood used it regularly ( more than 10 times ) ; none used it every day . Acceptability varied between users . Some valued the emotional responsiveness of the system , while others found it too repetitive . Intention to treat analysis showed a small difference in change of Beck Depression Inventory II ( BDI-2 ) scores  ( Help4Mood –5.7 points , TAU –4.2 ) . Post-hoc on-treatment analysis suggested that participants who used Help4Mood regularly experienced a median change in BDI-2 of –8 points . Conclusion Help4Mood is acceptable to some patients receiving treatment for depression although none used it as regularly as intended . Changes in depression symptoms in individuals who used the system regularly reached potentially meaningful levels Background and Aim Mild to moderate depression is common in those with cardiovascular disease and undertreated . We aim ed to evaluate the effectiveness of internet-delivered Cognitive Behaviour Therapy ( iCBT ) on depressive symptom severity and adherence to medical advice and lifestyle interventions in adults with mild to moderate depression and high cardiovascular disease ( CVD ) risks . Methods R and omised double-blind , 12 week attention-controlled trial comparing an iCBT programme ( E-couch ) with an internet-delivered attention control health information package ( HealthWatch , n = 282 ) . The primary outcome was depression symptom level on the nine-item Patient Health Question naire ( PHQ-9 ) ( trial registration : ACTRN12610000085077 ) . Results 487/562 ( 88 % ) participants completed the endpoint assessment . 383/562 ( 70 % ) were currently treated for cardiovascular disease and 314/562 ( 56 % ) had at least one other comorbid condition . In ITT analysis of 562 participants iCBT produced a greater decline in the mean PHQ-9 score compared to the attention control of 1.06 ( 95 % CI : 0.23–1.89 ) points , with differences between the two arms increasing over the intervention period ( time by treatment effect interaction p = .012 ) . There were also larger improvements in adherence ( 2.16 points ; 95 % CI : 0.33–3.99 ) , reductions in anxiety ( 0.96 points ; 95 % CI : 0.19–1.73 ) , and a greater proportion engaging in beneficial physical activity ( Odds Ratio 1.91 , 95%CI : 1.01–3.61 ) in the iCBT participants but no effect upon disability , or walking time/day . There were no withdrawals due to study related adverse events . Conclusions In people with mild to moderate depression and high levels of CVD risk factors , a freely accessible iCBT programme ( http://www.ecouch.anu.edu.au ) produced a small , but robust 
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We revealed that in practice and in several conceptual papers , evaluation is performed at the end of the intervention .
For our second research question , we discovered aspects of efficiency and effectiveness that are proposed to be assessed during interventions .
We conclude that the development of more robust and comprehensive evaluation of eHealth studies or an improved validation of evaluation methods could ease the transferability of results among similar studies .