***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: Purpose Poor medication adherence in adolescents with asthma results in poorly controlled disease and increased morbidity . The aim of the ADolescent Adherence Patient Tool ( ADAPT ) study is to develop an mHealth intervention to support self-management and to evaluate the effectiveness in improving medication adherence and asthma control . Intervention The ADAPT intervention consists of an interactive smartphone application ( app ) connected to a desktop application for health care providers , in this study , the community pharmacist . The app contains several functions to improve adherence as follows : 1 ) a question naire function to rate asthma symptoms and monitor these over time ; 2 ) short movie clips with medication and disease information ; 3 ) a medication reminder ; 4 ) a chat function with peers ; and 5 ) a chat function with the pharmacist . The pharmacist receives data from the patient ’s app through the desktop application , which enables the pharmacist to send information and feedback to the patient . Study design The ADAPT intervention is tested in a community pharmacy-based cluster r and omized controlled trial in the Netherl and s , aim ing to include 352 adolescents with asthma . The main outcome is adherence , measured by patient ’s self-report and refill adherence calculated from pharmacy dispensing records . In addition , asthma control , illness perceptions , medication beliefs , and asthma-related quality of life are measured . Conclusion This study will provide in-depth knowledge on the effectiveness of an mHealth intervention to support asthma self-management in adolescents . These insights will also be useful for adolescents with other chronic diseases OBJECTIVE To test the efficacy of a weight loss mobile app based on recommender systems and developed by experts in health promotion and computer science to target social support and self-monitoring of diet , physical activity ( PA ) , and weight ( Social POD app ) , compared to a commercially available diet and PA tracking app ( st and ard ) . MATERIAL S AND METHODS Overweight adults [ N=51 ] were recruited and r and omly assigned to either the experimental group [ n=26 ; theory-based podcasts (TBP)+Social POD app ] or the comparison group ( n=25 ; TBP+st and ard app ) . The Social POD app issued notifications to encourage users to self-monitor and send theory-based messages to support users who had not self-monitored in the previous 48h . Independent sample s t-test were used to examine group differences in kilograms lost and change in BMI . Analysis of covariance was used to analyze secondary outcomes while controlling for baseline values . RESULTS Participant attrition was 12 % ( n=3 experimental and n=3 comparison ) . Experimental group participants lost significantly more weight ( -5.3 kg , CI : -7.5 , -3.0 ) than comparison group ( -2.23 kg , CI : -3.6 , -1.0 ; d=0.8 , r=0.4 , p=0.02 ) and had a greater reduction in BMI ( p=0.02 ) . While there were significant differences in positive outcome expectations between groups ( p=0.04 ) other secondary outcomes ( e.g. , caloric intake and social support ) were not significant . DISCUSSION Use of the Social POD app result ed in significantly greater weight loss than use of a commercially available tracking app . This mobile health intervention has the potential to be widely disseminated to reduce the risk of chronic disease associated with overweight and obesity Background Chronic diseases , including diabetes mellitus , are the leading cause of mortality and disability in the United States . Current solutions focus primarily on diagnosis and pharmacological treatment , yet there is increasing evidence that patient-centered models of care are more successful in improving and addressing chronic disease outcomes . Objective The objective of this clinical trial is to evaluate the impact of a mobile health ( mHealth ) enabled nurse health coaching intervention on self-efficacy among adults with type-2 diabetes mellitus . Methods A r and omized controlled trial was conducted at an academic health system in Northern California . A total of 300 participants with type-2 diabetes were scheduled to be enrolled through three primary care clinics . Participants were r and omized to either usual care or intervention . All participants received training on use of the health system patient portal . Participants in the intervention arm received six scheduled health-coaching telephone calls with a registered nurse and were provided with an activity tracker and mobile application that integrated data into the electronic health record ( EHR ) to track their daily activity and health behavior decisions . All participants completed a baseline survey and follow-up surveys at 3 and 9 months . Primary and secondary outcomes include diabetes self-efficacy , hemoglobin A1c ( HbA1c ) , and quality of life measures . Results Data collection for this trial , funded by the Patient-Centered Outcomes Research Institute , will be completed by December 2017 . Results from the trial will be available mid-2018 . Conclusions This protocol details a patient-centered intervention using nurse health coaching , mHealth technologies , and integration of patient-generated data into the EHR . The aim of the intervention is to enhance self-efficacy and health outcomes by providing participants with a mechanism to track daily activity by offering coaching support to set reasonable and attainable health goals , and by creating a complete feedback loop by bringing patient-generated data into the EHR . Trial Registration Clinical Trials.gov NCT02672176 ; https:// clinical trials.gov/ct2/show/NCT02672176 ( Archived by WebCite at http://www.webcitation.org/6xEQXe1M5 Background The use of web-based monitoring for lung cancer patients is growing in interest because of promising recent results suggesting improvement in cancer and re source utilization outcomes . It remains an open question whether the overall survival ( OS ) in these patients could be improved by using a web-mediated follow-up rather than classical scheduled follow-up and imaging . Methods Advanced-stage lung cancer patients without evidence of disease progression after or during initial treatment were r and omly assigned in a multicenter phase III trial to compare a web-mediated follow-up algorithm ( experimental arm ) , based on weekly self-scored patient symptoms , with routine follow-up with CT scans scheduled every three to six months according to the disease stage ( control arm ) . In the experimental arm , an alert email was automatically sent to the oncologist when self-scored symptoms matched predefined criteria . The primary outcome was OS . Results From June 2014 to January 2016 , 133 patients were enrolled and 121 were retained in the intent-to-treat analysis ; 12 deemed ineligible after r and om assignment were not subsequently followed . Most of the patients ( 95.1 % ) had stage III or IV disease . The median follow-up was nine months . The median OS was 19.0 months ( 95 % confidence interval [ CI ] = 12.5 to noncalculable ) in the experimental and 12.0 months ( 95 % CI = 8.6 to 16.4 ) in the control arm ( one-sided P = .001 ) ( hazard ratio = 0.32 , 95 % CI = 0.15 to 0.67 , one-sided P = .002 ) . The performance status at first detected relapse was 0 to 1 for 75.9 % of the patients in the experimental arm and for 32.5 % of those in the control arm ( two-sided P < .001 ) . Optimal treatment was initiated in 72.4 % of the patients in the experimental arm and in 32.5 % of those in the control arm ( two-sided P < .001 ) . Conclusions A web-mediated follow-up algorithm based on self-reported symptoms improved OS due to early relapse detection and better performance status at relapse Background Chronic kidney disease ( CKD ) is a growing global problem affecting around 10 % of many countries ’ population s. Providing appropriate palliative care services ( PCS ) to those with advanced kidney disease is becoming paramount . Palliative/supportive care alongside usual CKD clinical treatment is gaining acceptance in nephrology services although the collaboration with and use of PCS is not consistent . Methods The goal of this study was to track and quantify the health service utilisation of people with CKD stages 3 - 5 over the last 12 months of life . Patients were recruited from a kidney health service ( Queensl and , Australia ) for this prospect i ve , longitudinal study . Data were collected for 12 months ( or until death , whichever was sooner ) during 2015 - 17 from administrative health sources . Emergency department presentations ( EDP ) and inpatient admissions ( IPA ) ( collectively referred to as critical events ) were review ed by two Nephrologists to gauge if the events were avoidable . Results Participants ( n = 19 ) with a median age of 78 years ( range 42 - 90 ) , were mostly male ( 63 % ) , 79 % had CKD stage 5 , and were heavy users of health services during the study period . Fifteen patients ( 79 % ) collectively recorded 44 EDP ; 61 % occurred after-hours , 91 % were triaged as imminently and potentially life-threatening and 73 % were admitted . Seventy-four IPA were collectively recorded across 16 patients ( 84 % ) ; 14 % occurred on weekends or public holidays . Median length of stay was 3 days ( range 1 - 29 ) . The median number of EDP and IPA per patient was 1 and 2 ( range 0 - 12 and 0 - 20 ) respectively . The most common trigger to both EDP ( 30 % ) and IPA ( 15 % ) was respiratory distress . By study end 37 % of patients died , 63 % were known to PCS and 11 % rejected a referral to a PCS . All critical events were deemed unavoidable . Conclusions Few patients avoided using acute health care services in a 12 month period , highlighting the high service needs of this cohort throughout the long , slow decline of CKD . Proactive end-of-life care earlier in the disease trajectory through integrating renal and palliative care teams may avoid acute presentations to hospital through better symptom management and planned care pathways OBJECTIVES This study evaluated the effectiveness ( changes in health behaviors , health status , and health service utilization ) of a self-management program for chronic disease design ed for use with a heterogeneous group of chronic disease patients . It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities . METHODS The study was a six-month r and omized , controlled trial at community-based sites comparing treatment subjects with wait-list control subjects .  Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease , lung disease , stroke , or arthritis .  Health behaviors , health status , and health service utilization , as determined by mailed , self-administered question naires , were measured . RESULTS Treatment subjects , when compared with control subjects , demonstrated improvements at 6 months in weekly minutes of exercise , frequency of cognitive symptom management , communication with physicians , self-reported health , health distress , fatigue , disability , and social/role activities limitations . They also had fewer hospitalizations and days in the hospital . No differences were found in pain/physical discomfort , shortness of breath , or psychological well-being . CONCLUSIONS An intervention design ed specifically to meet the needs of a heterogeneous group of chronic disease patients , including those with comorbid conditions , was feasible and beneficial beyond usual care in terms of improved health behaviors and health status . It also result ed in fewer hospitalizations and days of hospitalization BACKGROUND Diabetes is a chronic disease , with high prevalence across many nations , which is characterized by elevated level of blood glucose and risk of acute and chronic complication . The Kingdom of Saudi Arabia ( KSA ) has one of the highest levels of diabetes prevalence globally . It is well-known that the treatment of diabetes is complex process and requires both lifestyle change and clear pharmacologic treatment plan . To avoid the complication from diabetes , the effective behavioural change and extensive education and self-management is one of the key approaches to alleviate such complications . However , this process is lengthy and expensive . The recent studies on the user of smart phone technologies for diabetes self-management have proven to be an effective tool in controlling hemoglobin ( HbA1c ) levels especially in type-2 diabetic ( T2D ) patients . However , to date no reported study addressed the effectiveness of this approach in the in Saudi patients . This study investigates the impact of using mobile health technologies for the self-management of diabetes in Saudi Arabia . METHODS In this study , an intelligent mobile diabetes management system ( SAED ) , tailored for T2D patients in KSA was developed . A pilot study of the SAED system was conducted in Saudi Arabia with 20 diabetic patients for 6 months duration . The patients were r and omly categorized into a control group who did not use the SAED system and an intervention group whom used the SAED system for their diabetes management during this period . At the end of the follow-up period , the HbA1c levels in the patients in both groups were measure together with a diabetes knowledge test was also conducted to test the diabetes awareness of the patients . RESULTS The results of SAED pilot study showed that the patients in the intervention group were able to significantly decrease their HbA1c levels compared to the control group . The SAED system also enhanced the diabetes awareness amongst the patients in the intervention group during the trial period . These outcomes confirm the global studies on the effectiveness of smart phone technologies in diabetes management . The significance of the study is that this was one of the first such studies conducted on Saudi patients and of their acceptance for such technology in their diabetes self-management treatment plans . CONCLUSIONS The pilot study of the SAED system showed that a mobile health technology can significantly improve the HbA1C levels among Saudi diabetic and improve their disease management plans . The SAED system can also be an effective and low-cost solution in improving the quality of life of diabetic patients in 
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Conclusions : The development of an m-Health application could become a complementary monitoring tool during palliative care .
However , it seems important to question the impact of technique in the professional – patient relationship and avoid the pitfalls of st and ardizing palliative care and reducing the patient to a “ sick ” health technician .