***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: AIMS To assess Sweet Talk , a text-messaging support system design ed to enhance self-efficacy , facilitate uptake of intensive insulin therapy and improve glycaemic control in paediatric patients with Type 1 diabetes . METHODS One hundred and twenty-six patients fulfilled the eligibility criteria ; Type 1 diabetes for > 1 year , on conventional insulin therapy , aged 8 - 18 years . Ninety-two patients were r and omized to conventional insulin therapy  ( n = 28 ) , conventional therapy and Sweet Talk ( n = 33 ) or  intensive insulin therapy and Sweet Talk ( n = 31 ) . Goal - setting at clinic visits was reinforced by daily text-messages from the Sweet Talk software system , containing personalized goal -specific prompts and messages tailored to patients ' age , sex and insulin regimen . RESULTS HbA(1c ) did not change in patients on conventional therapy without or with Sweet Talk ( 10.3 + /- 1.7 vs. 10.1 + /- 1.7 % ) , but improved in patients r and omized to intensive therapy and Sweet Talk ( 9.2 + /- 2.2 % , 95 % CI -1.9 , -0.5 , P < 0.001 ) . Sweet Talk was associated with improvement in diabetes self-efficacy  ( conventional therapy 56.0 + /- 13.7 , conventional therapy plus Sweet Talk 62.1 + /- 6.6 , 95 % CI + 2.6 , + 7.5 , P = 0.003 ) and self-reported adherence  ( conventional therapy 70.4 + /- 20.0 , conventional therapy plus Sweet Talk 77.2 + /- 16.1 , 95 % CI + 0.4 , + 17.4 , P = 0.042 ) . When surveyed , 82 % of patients felt that Sweet Talk had improved their diabetes self-management and 90 % wanted to continue receiving messages . CONCLUSIONS Sweet Talk was associated with improved self-efficacy and adherence ; engaging a classically difficult to reach group of young people . While Sweet Talk alone did not improve glycaemic control , it may have had a role in supporting the introduction of intensive insulin therapy . Scheduled , tailored text messaging offers an innovative means of supporting adolescents with diabetes and could be adapted for other health-care setting s and chronic diseases Background Bariatric surgery is the most effective means of long-term weight loss . Knowledge gaps and lack of engagement in pre-operative patients can result in suboptimal outcome after surgery . Mobile technology , utilizing ecological momentary assessment (EMA)/intervention ( EMI ) , has shown tremendous promise in changing behaviors . The primary objective of the study is to assess feasibility of using smartphone app with EMA/EMI functionality to prepare patients for bariatric surgery . Methods Subjects seeking primary bariatric surgery were provided a smartphone app containing video-based education modules with linked assessment s to evaluate mastery of topic . Subjects received algorithmic EMA text messages soliciting a response regarding lifestyle behavior . Upon answering , subjects received tailored EMI text messaging supporting healthy lifestyle . Results Thirty subjects ( 27 female and 3 male ) , with age of 41.3 ± 11.4 years and BMI of 46.3 ± 7.4 kg/m2 were enrolled . Twenty subjects completed the study . Ten subjects withdrew . On average , seven out of nine education modules were completed ( 70.9 ± 27.3 % ) , and 37.8/123 EMA were answered ( 30.7 ± 21.7 % ) , with response time of 17.4 ± 4.4 min . Subjects reported high satisfaction with the app . Many felt that the app fit into their routine “ somewhat easily ” or “ very easily ” ( n = 12 ) , had “ perfect ” amount of EMA messages ( n = 8) , and was very helpful in preparing for surgery ( n = 7 ) . Conclusions This study is the first to reveal the feasibility of using a smartphone app in the education and engagement of patients prior to bariatric surgery . The app was well-received based on subject satisfaction scores and revealed trends toward positive behavior change and increased weight loss . R and omized trials are necessary to delineate true efficacy OBJECTIVE Regular follow-up is essential to successful management of childhood cataract . We sought to assess whether a mobile phone short message service ( SMS ) for parents of children with cataract could improve follow-up adherence and the proportion of procedures performed in timely fashion . DESIGN R and omized , controlled trial . This trial is registered with Clinical Trials.gov , NCT01417819 . PARTICIPANTS We included 258 parent-child pairs involved in the Childhood Cataract Program of the Chinese Ministry of Health . METHODS Participants were r and omized ( 1:1 ) to a mobile phone SMS intervention or st and ard follow-up appointments .  All participants were scheduled to attend ≥ 4 follow-up appointments according to the protocol . Parents in the intervention group received SMS automated reminders before scheduled appointments . The  control group parents did not receive SMSs or any alternative reminder of scheduled appointments . Regular ocular examinations and analyses were performed by investigators masked to group allocation ; however , study participants and the manager in charge of r and omization and sending SMSs were not masked . MAIN OUTCOME MEASURES Number of follow-up appointments attended , additional surgeries , laser treatments , changes in eyeglasses prescription , and occurrence of secondary ocular hypertension . RESULTS Among parent-child participants , 135 were r and omly assigned to the SMS intervention and 123 to st and ard appointments . Attendance rates for the SMS group ( first visit , 97.8 % ; second , 91.9 % ; third , 92.6 % ; fourth , 83 % ) were significantly higher than those for the control group ( first visit , 87.8 % ; second , 69.9 % ; third , 56.9 % ; fourth , 33.3 % ) . The increase in attendance rate for total number of follow-up visits with SMS reminders was 47.2 % ( relative risk [ RR ] for attendance , 1.47 ; 95 % confidence interval [ CI ] , 1.16 - 1.78 ; P = 0.003 ) . The number needed to remind ( NNR ) to gain 1 additional visit by 1 child was 3 ( 95 % CI , 1.8 - 4.2 ) . A total of 247 clinical interventions were carried out in the SMS group and 134 in the control group ( RR , 1.68 ; 95 % CI , 1.37 - 1.99 ; P = 0.007 ) . The NNR to result in 1 additional clinical intervention was 5 ( 95 % CI , 3.5 - 6.5 ) . CONCLUSIONS The SMS reminders significantly improved follow-up adherence in pediatric cataract treatment . Using readily available mobile phone re sources may be an effective and economic strategy to improve management of childhood cataract in China . FINANCIAL DISCLOSURE(S ) The authors have no proprietary or commercial interest in any of the material s discussed in this article ABSTRACT BACKGROUND Little is known regarding the prevalence or risk factors for non-comprehension and non-compliance  with discharge instructions among older adults . OBJECTIVE To quantify the prevalence of non-comprehension and non-compliance with discharge instructions and to identify associated patient characteristics . RESEARCH DESIGN Prospect i ve cohort study .SUBJECTSFour hundred and fifty adults aged ≥ 65 admitted to medical and surgical units of a tertiary care facility and meeting inclusion criteria . MEASURES We collected information on demographics , psycho-social factors , discharge diagnoses , and medications using surveys and patient medical records . Domains within discharge instructions included  medications , follow-up appointments , diet , and exercise .  At 5 days post-discharge , we assessed comprehension by asking patients about their discharge instructions , and compared responses to written instructions from medical charts . We assessed compliance among patients who understood their instructions . RESULTS Prevalence of non-comprehension was 5 % for follow-up appointments , 27 % for medications , 48 % for exercise and 50 % for diet recommendations . Age was associated with non-comprehension of medication [ odds ratio ( OR ) 1.07 ; 95 % confidence interval ( CI ) 1.04 , 1.12 ] and follow-up appointment ( OR 1.08 ; 95 % CI 1.00 , 1.17 ) instructions . Male sex was associated with non-comprehension of diet instructions ( OR 1.91 ; 95 % CI 1.10 , 3.31 ) . Social isolation was associated with non-comprehension of exercise instructions ( OR 9.42 ; 95 % CI 1.50 , 59.11 ) Depression was associated with non-compliance with medication ( OR 2.29 ; 95 % CI 1.02 , 5.10 ) and diet instructions ( OR 3.30 ; 95 % CI 1.24 , 8.83 ) . CONCLUSIONS Non-comprehension  of discharge instructions among older adults is prevalent , multi-factorial , and varies by domain Background Despite the proliferation of health information technology ( IT ) interventions , descriptions of the unique considerations for conducting r and omized trials of health IT interventions intended for patient use are lacking . Purpose Our purpose is to describe the protocol to evaluate Pocket PATH ® ( Personal Assistant for Tracking Health ) , a novel health IT intervention , as an exemplar of how to address issues that may be unique to a r and omized controlled trial ( RCT ) to evaluate health IT intended for patient use . Methods An overview of the study protocol is presented . Unique considerations for health IT intervention trials and strategies are described to maintain equipoise , to monitor data safety and intervention fidelity , and to keep pace with changing technology during such trials . Lessons Learned The sovereignty granted to technology , the rapid pace of changes in technology , ubiquitous use in health care , and obligation to maintain the safety of research participants challenge research ers to address these issues in ways that maintain the integrity of intervention trials design ed to evaluate the impact of health IT interventions intended for patient use . Conclusions Our experience evaluating the efficacy of Pocket PATH may provide practical guidance to investigators about how to comply with established procedures for conducting RCTs and include strategies to address the unique issues associated with the evaluation of health IT for patient use Objective : There is limited evidence on whether growing mobile phone availability in sub-Saharan Africa can be used to promote high adherence to antiretroviral therapy ( ART ) . This study tested the efficacy of short message service ( SMS ) reminders on adherence to ART among patients attending a rural clinic in Kenya . Design : A r and omized controlled trial of four SMS reminder interventions with 48 weeks of follow-up . Methods : Four hundred and thirty-one adult patients who had initiated ART within 3 months were enrolled and r and omly assigned to a control group or one of the four intervention groups . Participants in the intervention groups received SMS reminders that were either short or long and sent at a daily or weekly frequency .  Adherence was measured using the medication event monitoring system .  The primary outcome was whether adherence exceeded 90 % during each 12-week period of analysis and the 48-week study period . The secondary outcome was whether there were treatment interruptions lasting at least 48 h. Results : In intention-to-treat analysis , 53 % of participants receiving weekly SMS reminders achieved adherence of at least 90 % during the 48 weeks of the study , compared with 40 % of participants in the control group ( P = 0.03 ) . Participants in groups receiving weekly reminders were also significantly less likely to experience treatment interruptions exceeding 48 h during the 48-week follow-up period than participants in the control group ( 81 vs. 90 % , P = 0.03 ) . Conclusion : These results suggest that SMS reminders may be an important tool to achieve optimal treatment response in re source -limited setting Adolescent organ transplant recipients have an increased risk of developing skin cancer . The aim of this study was to evaluate the technical feasibility and acceptability of short messaging service-based sun protection recommendations for adolescent patients .  Sun-protective knowledge and behaviour were also evaluated using st and ardized question naires and telephone interviews . Twenty-six organ transplant recipients aged 13 - 22 years participated in face-to-face sun protection training . Subsequently , participants received sun protection reminders via text messages for 4 weeks . Of the participants 95 % reported that they checked text messages on a regular basis . Of the 26 organ transplant recipients 19 completed question naires before sun protection training and 4 weeks later ; 16 % ( 3/19 ) knew the meaning of the UV-index before training . After training , 74 % ( 14/19 ) remembered that the term UV-index describes the maximum daily level of local UV radiation .  Text message-based sun protection recommendations are well accepted and technically feasible in adolescent organ transplant recipients IMPORTANCE With growing national focus on reducing readmissions , there is a need to comprehensively assess the quality of transitional care , including discharge practice s , patient perspectives , and patient underst and ing . OBJECTIVE To conduct a multifaceted evaluation of transitional care from a patient-centered perspective . DESIGN Prospect i ve observational cohort study , May 2009 through April 2010 . SETTING Urban , academic medical center . PARTICIPANTS Patients 65 years and 
    Output:
    
Both mobile applications and SMS-based interventions increased adherence to medications and protocol s and improved clinic attendance .
Lower readmission rates and emergency room visits were reported .
Satisfaction with automated communication systems was high for both patients and physicians .
Mobile interventions provide a sophisticated yet simple tool to improve perioperative healthcare .