***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 Asthma continues to be a substantial cause of morbidity in pediatric population s. New strategies are needed to provide cost-effective educational interventions for children with asthma , particularly those in the inner city . OBJECTIVE To assess the effectiveness of a multimedia educational software program about asthma . SETTING A hospital-based primary care clinic and an affiliated neighborhood health center . DESIGN R and omized , controlled trial . POPULATION Children 3 to 12 years old with physician-diagnosed asthma . INTERVENTION An interactive educational computer program , Asthma Control , design ed to teach children about asthma and its management . Using a graphic display of a child going through simulated daily events , the game emphasizes : 1 ) monitoring ; 2 ) allergen identification ; 3 ) use of medications ; 4 ) use of health services ; and 5 ) maintenance of normal activity . Control group participants review ed printed educational material s with a research assistant . OUTCOMES Acute health care use ( emergency department and outpatient ) was the primary outcome . Secondary outcome measures included maternal report of asthma symptom severity , child functional status and school absences , satisfaction with care , and parental and child knowledge of asthma . RESULTS A total of 137 families were enrolled in the study ( 76 intervention , 61 control ) . Both intervention and control groups showed substantial improvement in all outcomes during the 12-month follow-up period . Aside from improvement in knowledge after use of the computer program , no differences were demonstrated between the 2 groups in primary or secondary outcome measures . Children reported enjoyment of program use . CONCLUSIONS This trial of an educational software program found that it did not produce greater improvement than occurred with review of traditional written material s. Because both groups showed substantial improvement over baseline , computer-based education may be more cost-effective . Alternatively , improvements in illness severity over time may overshadow the effects of such interventions . Rigorous comprehensive evaluations such as this are necessary to assess new interventions intended to improve management and outcomes of asthma OBJECTIVE To evaluate Watch , Discover , Think and Act ( WDTA ) , a theory-based application of CD-ROM educational technology for pediatric asthma self-management education . DESIGN A prospect i ve pretest posttest r and omized intervention trial was used to assess the motivational appeal of the computer-assisted instructional program and evaluate the impact of the program in eliciting change in knowledge , self-efficacy , and attributions of children with asthma . Subjects were recruited from large urban asthma clinics , community clinics , and schools . Seventy-six children 9 to 13 years old were recruited for the evaluation . RESULTS Repeated- measures analysis of covariance showed that knowledge scores increased significantly for both groups , but no between-group differences were found ( P : = 0.55 ) ; children using the program scored significantly higher ( P : < 0.01 ) on questions about steps of self-regulation , prevention strategies , and treatment strategies . These children also demonstrated greater self-efficacy ( P : < 0.05 ) and more efficacy building attribution classification of asthma self-management behaviors ( P : < 0.05 ) than those children who did not use the program . CONCLUSION The WDTA is an intrinsically motivating educational program that has the ability to effect determinants of asthma self-management behavior in 9- to 13-year-old children with asthma . This , coupled with its reported effectiveness in enhancing patient outcomes in clinical setting s , indicates that this program has application in pediatric asthma education OBJECTIVE Deficits in executive functioning , including working memory ( WM ) deficits , have been suggested to be important in attention-deficit/hyperactivity disorder ( ADHD ) . During 2002 to 2003 , the authors conducted a multicenter , r and omized , controlled , double-blind trial to investigate the effect of improving WM by computerized , systematic practice of WM tasks . METHOD Included in the trial were 53 children with ADHD ( 9 girls ; 15 of 53 inattentive subtype ) , aged 7 to 12 years , without stimulant medication . The compliance criterion ( > 20 days of training ) was met by 44 subjects , 42 of whom were also evaluated at follow-up 3 months later . Participants were r and omly assigned to use either the treatment computer program for training WM or a comparison program . The main outcome measure was the span-board task , a visuospatial WM task that was not part of the training program . RESULTS For the span-board task , there was a significant treatment effect both post-intervention and at follow-up . In addition , there were significant effects for secondary outcome tasks measuring verbal WM , response inhibition , and complex reasoning . Parent ratings showed significant reduction in symptoms of inattention and hyperactivity/impulsivity , both post-intervention and at follow-up . CONCLUSIONS This study shows that WM can be improved by training in children with ADHD . This training also improved response inhibition and reasoning and result ed in a reduction of the parent-rated inattentive symptoms of ADHD Twenty children ( 12 boys , 8 girls ; mean age = 10.4 years ) with P-type dyslexia ( accurate but slow and fragmented reading ) and 20 children ( 12 boys , 8 girls ; mean age = 10.3 years ) with L-type dyslexia ( hurried , inaccurate reading ) were treated with visual hemisphere-specific stimulation employing the HEMSTIM computer program . Stimulation was produced by presenting words to the left ( L-dyslexia ) or to the right ( P-dyslexia ) visual field . Children in the control condition received treatment with neutral words , whereas children in the experimental condition received treatment with anxiety-laden words . After treatment , the children with L-dyslexia in the experimental group made fewer substantive errors and more fragmentations on a text-reading task than did the children with L-dyslexia in the control group . The results are explained as being the consequence of additional activation of the right hemisphere caused by the anxiety-laden words . It is concluded that children with L-dyslexia can benefit from the use of such words in the HEMSTIM program INTRODUCTION Different procedures have demonstrated efficacy to teach cognitive and metacognitive strategies to problem solving in mathematics . Some studies have used computer-based problem solving instructional programs . AIM To analyze in students with learning disabilities the efficacy of a cognitive strategies training for problem solving , with three instructional delivery formats : a teacher-directed program ( T-D ) , a computer-assisted instructional ( CAI ) program , and a combined program ( T-D + CAI ) . SUBJECTS AND METHODS Forty-four children with mathematics learning disabilities , between 8 and 10 years old participated in this study . The children were r and omly assigned to one of the three instructional formats and a control group without cognitive strategies training . In the three instructional conditions which were compared all the students learnt problems solving linguistic and visual cognitive strategies trough the self-instructional procedure . Several types of measurements were used for analysing the possible differential efficacy of the three instructional methods implemented : solving problems tests , marks in mathematics , internal achievement responsibility scale , and school behaviours teacher ratings . RESULTS AND CONCLUSIONS Our findings show that the T-D training group and the T-D + CAI group improved significantly on math word problem solving and on marks in Maths from pre- to post-testing . In addition , the results indicated that the students of the T-D + CAI group solved more real-life problems and developed more internal attributions compared to both control and CAI groups . Finally , with regard to school behaviours , improvements in school adjustment and learning problems were observed in the students of the group with a combined instructional format ( T-D + CAI ) & NA ; Electronic diary assessment of pain and disability has become increasingly popular in adult chronic pain research but use of this methodology with children has received limited attention . The aim of this study was to compare two formats of a prospect i ve daily diary ( h and held computer = e‐diary ; paper diary = p‐diary ) on children 's compliance , accuracy , and acceptability ratings . Sixty children , ages 8–16 ( M=12.3 ) with headaches or juvenile idiopathic arthritis , were r and omized to receive either  e‐diaries administered via home visits ( n=30 ) or  p‐diaries  ( n=30 ) h and ed out during clinic visits for return by mail . Results demonstrated significant mean differences in diary entries completed between groups , with children with e‐diaries completing more days ( M=6.6 ) compared to children with p‐diaries ( M=3.8 ) , P<0.001 . Diaries returned by children in the p‐diary group contained significantly more errors and omissions compared to diaries returned by children in the e‐diary group ( which contained none ) , P<0.001 . Children rated both diary formats as highly acceptable and easy to use . A significant gender × diary format interaction ( P<0.01 ) was found for compliance where boys demonstrated greater compliance with the e‐diary format . Findings demonstrated that the e‐diary was feasible to use with children and showed significantly greater compliance and accuracy in diary recording compared to traditional paper diaries in a population of children with recurrent pain OBJECTIVE To determine whether health outcomes of children who have asthma can be improved through the use of an Internet-enabled interactive multimedia asthma education program . METHODS Two hundred twenty-eight children with asthma visiting a pediatric pulmonary clinic were r and omly assigned to control and intervention groups . Children and caregivers in both groups received traditional patient education based on the National Asthma Education and Prevention Program . Intervention group participants received additional self-management education through the Interactive Multimedia Program for Asthma Control and Tracking .  Pediatric Asthma Care Knowledge Survey , Pediatric Asthma Caregiver 's Quality of Life Question naire , asthma symptom history , spirometry , and health services utilization data were collected at the initial visit and at 3 and 12 months . RESULTS Interactive Multimedia Program for Asthma Control and Tracking significantly increased asthma knowledge of children and caregivers , decreased asthma symptom days ( 81 vs 51 per year ) , and decreased number of emergency department visits ( 1.93 vs 0.62 per year ) among the intervention group participants . The intervention group children were also using a significantly lower average daily dose of inhaled corticosteroids ( 434 vs 754 micro g [ beclomethasone equivalents ] ) at visit 3 . Asthma knowledge of all 7- to 17-year-old children correlated with fewer urgent physician visits ( r = 0.37 ) and less frequent use of quick-relief medicines ( r = 0.30 ) . CONCLUSIONS Supplementing conventional asthma care with interactive multimedia education can significantly improve asthma knowledge and reduce the burden of childhood asthma This study assessed the effects of assigned versus self-selected goals and contingent versus noncontingent gameplay conditions , delivered during computer-assisted math computation drill- and - practice sessions . Participants were 20 high school pupils with learning disabilities who had active Individualized Education Plan ( IEP ) goals that targeted the improvement of computational skills . Students were assigned r and omly to goal conditions and , within goal conditions , to contingency groups .  Math computation performance was measured pre- , mid- , and posttreatment . Analyses of variance indicated that students who selected their goals performed better than pupils with assigned goals . No differences existed between the contingency groups . Implication s for practice are discussed The rising tide of obesity erodes the health of youths and many times results in adult obesity . The purpose of this investigation was to examine the effectiveness of an eight-session health promotion/transtheoretical model Internet/video-delivered intervention to increase physical activity and reduce dietary fat  among low-income , culturally diverse , seventh- grade students . Those who completed more than half the sessions increased exercise , t ( 103 ) = -1.99 , p = .05 , and decreased the percentage of dietary fat , t ( 87 ) = 2.73 , p = .008 . Responses to the intervention by stage of change , race , and income are examined BACKGROUND The prevalence , health care expenditures , and hospitalization experiences are important considerations among elderly population s with multiple chronic conditions . METHODS A cross-sectional analysis was conducted on a nationally r and om sample of 1 217 103 Medicare fee-for-service beneficiaries aged 65 and older living in the United States and enrolled in both Medicare Part A and Medicare Part B during 1999 .  Multiple logistic regression was used to analyze the influence of age , sex , and number of types of chronic conditions on the risk of incurring inpatient hospitalizations for ambulatory care sensitive conditions and hospitalizations with preventable complications among aged Medicare beneficiaries . RESULTS In 1999 , 82 % of aged Medicare beneficiaries had 1 or more chronic conditions , and 65 % had multiple chronic conditions .  Inpatient admissions for ambulatory care sensitive conditions and hospitalizations with preventable complications increased with the number of chronic conditions . For example , Medicare beneficiaries with 4 or more chronic conditions were 99 times more likely than a beneficiary without any chronic conditions to have an admission for an ambulatory care sensitive condition ( 95 % confidence interval , 86 - 113 ) . Per capita Medicare expenditures increased with the number of types of chronic conditions from $ 211 among beneficiaries without a chronic condition to $ 13 973 among beneficiaries with 4 or more types of chronic conditions . CONCLUSIONS The risk of an avoidable inpatient admission or a preventable complication in an inpatient setting increases dramatically with the number of chronic conditions . Better primary care , especially coordination of care , could reduce avoidable hospitalization rates , especially for individuals with multiple chronic conditions The study evaluates the progress of eight children aged 3 - 5 years with autism attending a specialist teaching unit in their development of reading skills in two conditions : computer instructed learning and book based learning . The authors developed a direct observation schedule to monitor autistic behaviours using computerized techniques . The children were matched by age , severity of autistic symptom 
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The results from these studies indicated that biomedical informatics applications have favourable clinical and patient outcomes including , but not limited to , reduced number of emergency room visits , improved knowledge on disease management , and enhanced satisfaction .
Conclusion Published studies suggested positive impacts of informatics predominantly in pediatric asthma .
As electronic tools become more widely adopted , there will be opportunities to improve patient care in a wide range of chronic illnesses through informatics solutions