***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 The use of mobile apps  for health and well being promotion has grown exponentially in recent years . Yet , there is currently no app- quality assessment tool beyond “ star”-ratings . Objective The objective of this study was to develop a reliable , multidimensional measure for trialling , classifying , and rating the quality of mobile health apps . Methods A literature search was conducted to identify articles containing explicit Web or app quality rating criteria published between January 2000 and January 2013 . Existing criteria for the assessment of app quality were categorized by an expert panel to develop the new Mobile App Rating Scale ( MARS ) subscales , items , descriptors , and anchors . There were sixty well being apps that were r and omly selected using an iTunes search for MARS rating . There were ten that were used to pilot the rating procedure , and the remaining 50 provided data on interrater reliability . Results There were 372 explicit criteria for assessing Web or app quality that were extracted from 25 published papers , conference proceedings , and Internet re sources . There were five broad categories of criteria that were identified including four objective quality scales : engagement , functionality , aesthetics , and information quality ; and one subjective quality scale ; which were refined into the 23-item MARS . The MARS demonstrated excellent internal consistency ( alpha = .90 ) and interrater reliability intraclass correlation coefficient ( ICC = .79 ) . Conclusions The MARS is a simple , objective , and reliable tool for classifying and assessing the quality of mobile health apps . It can also be used to provide a checklist for the design and development of new high quality health apps Purpose Patients undergoing radiotherapy for prostate cancer suffer from a variety of symptoms which influence health-related quality of life . We have developed an application ( Interaktor ) for smartphones and tablets for early detection , reporting and management of symptoms , and concerns during treatment for prostate cancer . The study evaluates the effect on symptom burden and quality of life when using the application for real-time symptom assessment and management during radiotherapy for localized prostate cancer . Methods A non-r and omized controlled study was used at two university hospitals in Sweden where 64 patients constituted a control group and 66 patients made up an intervention group . The intervention group was asked to report symptoms via the application daily during the treatment as well as 3 weeks after . The EORTC QLQ-C30 and its module PR25 and the Sense of Coherence question naire were administered at three time points in both groups . Results The intervention group rated significantly lower levels of fatigue and nausea at the end of radiotherapy . Moreover , they had significantly less burden in emotional functioning , insomnia , and urinary-related symptoms at the end of treatment as well as 3 months later compared with the control group . In the multivariate analyses , with education and sense of coherence as covariates , the intervention group still significantly rated emotional functioning ( p = 0.007 ) , insomnia ( p = 0.017 ) , and urinary-related symptoms ( p = 0.008 ) as better than the control group at T2 . ConclusionS tudy findings suggest that Interaktor could be an efficient mHealth tool for facilitating supportive care needs during cancer treatment Background Mobile health apps for diabetes self-management have different functions . However , the efficacy and safety of each function are not well studied , and no classification is available for these functions . Objective The aims of this study were to ( 1 ) develop and vali date a taxonomy of apps for diabetes self-management , ( 2 ) investigate the glycemic efficacy of  mobile app-based interventions among adults with diabetes in a systematic review of r and omized controlled trials ( RCTs ) , and ( 3 ) explore the contribution of different function to the effectiveness of entire app-based interventions using the taxonomy . Methods We developed a 3-axis taxonomy with columns of clinical modules , rows of functional modules and cells of functions with risk assessment s. This taxonomy was vali date d by review ing and classifying commercially available diabetes apps . We search ed MEDLINE , EMBASE , the Cochrane Central Register of Controlled Trials , the Chinese Biomedical Literature Data base , and Clinical Trials.gov from January 2007 to May 2016 . We included RCTs of adult out patients with diabetes that compared using  mobile app-based interventions with usual care alone . The mean differences ( MDs ) in hemoglobin A1c ( HbA1c ) concentrations and risk ratios of adverse events were pooled using a r and om-effects meta- analysis . After taxonomic classification , we performed exploratory subgroup analyses of the presence or absence of each module across the included app-based interventions . Results Across 12 included trials involving 974 participants , using app-based interventions was associated with a clinical ly significant reduction of HbA1c ( MD 0.48 % , 95 % CI 0.19%-0.78 % ) without excess adverse events . Larger HbA1c reductions were noted among patients with type 2 diabetes than those with type 1 diabetes ( MD 0.67 % , 95 % CI 0.30%-1.03 % vs MD 0.37 % , 95 % CI –0.12%-0.86 % ) . Having a complication prevention module in app-based interventions was associated with a greater HbA1c reduction ( with complication prevention : MD 1.31 % , 95 % CI 0.66%-1.96 % vs without : MD 0.38 % , 95 % CI 0.09%-0.67 % ; intersubgroup P=.01 ) , as was having a structured display ( with structured display : MD 0.69 % , 95 % CI 0.32%-1.06 % vs without : MD 0.69 % , 95 % CI –0.18%-0.53 % ; intersubgroup P=.03 ) . However , having a clinical decision-making function was not associated with a larger HbA1c reduction ( with clinical decision making : MD 0.19 % , 95 % CI –0.24%-0.63 % vs without : MD 0.61 % , 95 % CI 0.27%-0.95 % ; intersubgroup P=.14 ) . Conclusions The use of mobile app-based interventions yields a clinical ly significant HbA1c reduction among adult out patients with diabetes , especially among those with type 2 diabetes . Our study suggests that the clinical decision-making function needs further improvement and evaluation before being added to apps Background Brief interventions via the internet have been shown to reduce university students ’ alcohol intake . This study tested two smartphone applications ( apps ) targeting drinking choices on party occasions , with the goal of reducing problematic alcohol intake among Swedish university students . Methods Students were recruited via e-mails sent to student union members at two universities . Those who gave informed consent , had a smartphone , and showed risky alcohol consumption according to the Alcohol Use Disorders Identification Test ( AUDIT ) were r and omized into three groups . Group 1 had access to the Swedish government alcohol monopoly ’s app , Promillekoll , offering real-time estimated blood alcohol concentration ( eBAC ) calculation ; Group 2 had access to a web-based app , PartyPlanner , developed by the research group , offering real-time eBAC calculation with planning and follow-up functions ; and Group 3 participants were controls . Follow-up was conducted at 7 weeks . Results Among 28574 students offered participation , 4823 agreed to join ; 415 were excluded due to incomplete data , and 1932 fulfilled eligibility criteria for r and omization . Attrition was 22.7–39.3 percent , higher among heavier drinkers and highest in Group 2 .  Self-reported app use was higher in Group 1 ( 74 % ) compared to Group 2 ( 41 % ) . Per- protocol analyses revealed only one significant time-by-group interaction , where Group 1 participants increased the frequency of their drinking occasions compared to controls ( p = 0.001 ) . Secondary analyses by gender showed a significant difference among men in Group 1 for frequency of drinking occasions per week ( p = 0.001 ) , but not among women . Among all participants , 29 percent showed high-risk drinking , over the recommended weekly drinking levels of 9 ( women ) and 14 ( men ) st and ard glasses . Conclusions Smartphone apps can make brief interventions available to large numbers of university students . The apps studied using eBAC calculation did not , however , seem to affect alcohol consumption among university students and one app may have led to a negative effect among men . Future research should : 1 ) explore ways to increase user retention , 2 ) include apps facilitating technical manipulation for evaluation of added components , 3 ) explore the effects of adapting app content to possible gender differences , and 4 ) offer additional interventions to high-risk users . Trial registration clinical trials.gov : NCT01958398 BACKGROUND Nonpharmacological intervention for individuals with mild cognitive impairment ( MCI ) needs further investigation . OBJECTIVE Test efficacy of an eight-week Chinese calligraphy writing training course in improving attentional control and working memory . METHODS Ninety-nine participants with MCI were r and omized into the eight-week calligraphy writing ( n = 48 ) or control ( tablet computer ) training ( n = 51 ) . Outcomes of the interventions were attentional control , working memory , visual scan and processing speed . They were measured at baseline , post-training , and six-month follow-up . RESULTS Calligraphy writing , when compared with control , significantly improved working memory as reflected from DST-Backward sequence ( p = 0.009 ) and span scores ( p = 0.002 ) , and divided attention as reflected from CTT2 ( p < 0.001 ) , and at the post-training . The unique improvement in working memory ( span : p < 0.001 ; sequence : p = 0.008 ) of the intervention group was also found at follow-up when comparing with those at baseline . Changes in the other outcome measures were not statistically significant . CONCLUSION The findings provide support that Chinese calligraphy writing training for eight weeks using a cognitive approach would improve working memory and to a lesser extent attentional control functions of patients with early MCI . They also demonstrate the usefulness of using mind- and -body practice for improving specific cognitive functions BACKGROUND AND OBJECTIVES Patient self-management has been shown to improve health outcomes . We developed a smartphone-based system to boost self-care by patients with CKD and integrated its use into usual CKD care . We determined its acceptability and examined changes in several clinical parameters . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS We recruited patients with stage 4 or 5 CKD attending outpatient renal clinics who responded to a general information newsletter about this 6-month proof-of-principle study . The smartphone application targeted four behavioral elements : monitoring BP , medication management , symptom assessment , and tracking laboratory results . Prebuilt customizable algorithms provided real-time personalized patient feedback and alerts to providers when predefined treatment thresholds were crossed or critical changes occurred . Those who died or started RRT within the first 2 months were replaced . Only participants followed for 6 months after recruitment were included in assessing changes in clinical measures . RESULTS In total , 47 patients ( 26 men ; mean age = 59 years old ; 33 % were ≥65 years old ) were enrolled ; 60 % had never used a smartphone . User adherence was high ( > 80 % performed ≥80 % of recommended assessment s ) and sustained . The mean reductions in home BP readings between baseline and exit were statistically significant ( systolic BP , -3.4 mmHg ; 95 % confidence interval , -5.0 to -1.8 and diastolic BP , -2.1 mmHg ; 95 % confidence interval , -2.9 to -1.2 ) ; 27 % with normal clinic BP readings had newly identified masked hypertension . One hundred twenty-seven medication discrepancies were identified ; 59 % were medication errors that required an intervention to prevent harm . In exit interviews , patients indicated feeling more confident and in control of their condition ; clinicians perceived patients to be better informed and more engaged . CONCLUSIONS Integrating a smartphone-based self-management system into usual care of patients with advanced CKD proved feasible and acceptable , and it appeared to be clinical ly useful . The results provide a strong rationale for a r and omized , controlled trial We performed a pilot r and omized , controlled trial of intensive , computer-based cognitive training in 47 subjects with mild cognitive impairment . The intervention group performed exercises specifically design ed to improve auditory processing speed and accuracy for 100 min/d , 5 d/wk for 6 weeks ; the control group performed more passive computer activities ( reading , listening , visuospatial game ) for similar amounts of time . Subjects had a mean age of 74 years and 60 % were men ; 77 % successfully completed training . On our primary outcome , Repeatable Battery for Assessment of Neuropsychological Status total scores improved 0.36 st and ard deviations ( SD ) in the intervention group ( P=0.097 ) compared with 0.03 SD in the control group ( P=0.88 ) for a nonsignificant difference between the groups of 0.33 SD ( P=0.26 ) . On 12 secondary outcome measures , most differences between the groups were not statistically significant . However , we observed a pattern in which effect sizes for verbal learning and memory measures tended to favor the intervention group whereas effect sizes for language and visuospatial function measures tended to favor the control group , which raises the possibility that these training programs may have domain-specific effects . We conclude that intensive , computer-based mental activity is feasible in subjects with mild cognitive impairment and that larger trials are warranted Objective To determine whether mobile phone based monitoring improves asthma control compared with st and ard paper based monitoring strategies . Design Mult 
    Output:
    
Results Of 13 review s and six single studies assessing efficacy , consistent evidence of benefit was seen only with apps for diabetes , as measured by decreased glycosylated haemoglobin levels ( HbA1c ) .
Some , but not all , studies showed benefit in asthma , low back pain , alcohol addiction , heart failure , ischaemic heart disease and cancer .
There was no evidence of benefit in COPD , cognitive impairment or CKD .
In all studies , benefits were clinical ly marginal and none related to morbid events or hospitalisation .
Conclusion Evidence of clinical benefit of most available apps is very limited .
Design features that enhance usability and maximise efficacy were identified .
This paper presents a comprehensive review of evidence relating to the efficacy , usability and evaluation of apps for 11 common diseases aim ed at assisting patients in self-management .
Consistent evidence of benefit was only seen for diabetes apps ; there was absent or conflicting evidence of benefit for apps for the remaining 10 diseases .
Benefits that were detected were of marginal clinical importance , with no reporting of hard clinical end-points , such as mortality or hospitalisations .
Many apps lacked design features that the literature identified as enhancing usability and potential to confer benefit .