***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: Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more CONTEXT Cognitive function in older adults is related to independent living and need for care . However , few studies have addressed whether improving cognitive functions might have short- or long-term effects on activities related to living independently . OBJECTIVE To evaluate whether 3 cognitive training interventions improve mental abilities and daily functioning in older , independent-living adults . DESIGN R and omized , controlled , single-blind trial with recruitment conducted from March 1998 to October 1999 and 2-year follow-up through December 2001 . SETTING AND PARTICIPANTS Volunteer sample of 2832 persons aged 65 to 94 years recruited from senior housing , community centers , and hospital/clinics in 6 metropolitan areas in the United States . INTERVENTIONS Participants were r and omly assigned to 1 of 4 groups : 10-session group training for memory ( verbal episodic memory ; n = 711 ) , or reasoning ( ability to solve problems that follow a serial pattern ; n = 705 ) , or speed of processing ( visual search and identification ; n = 712 ) ; or a no-contact control group ( n = 704 ) . For the 3 treatment groups , 4-session booster training was offered to a 60 % r and om sample 11 months later . MAIN OUTCOME MEASURES Cognitive function and cognitively dem and ing everyday functioning . RESULTS Thirty participants were incorrectly r and omized and were excluded from the analysis . Each intervention improved the targeted cognitive ability compared with baseline , durable to 2 years ( P<.001 for all ) . Eighty-seven percent of speed- , 74 % of reasoning- , and 26 % of memory-trained participants demonstrated reliable cognitive improvement immediately after the intervention period . Booster training enhanced training gains in speed ( P<.001 ) and reasoning ( P<.001 ) interventions ( speed booster , 92 % ; no booster , 68 % ; reasoning booster , 72 % ; no booster , 49 % ) , which were maintained at 2-year follow-up ( P<.001 for both ) . No training effects on everyday functioning were detected at 2 years . CONCLUSIONS Results support the effectiveness and durability of the cognitive training interventions in improving targeted cognitive abilities . Training effects were of a magnitude equivalent to the amount of decline expected in elderly persons without dementia over 7- to 14-year intervals . Because of minimal functional decline across all groups , longer follow-up is likely required to observe training effects on everyday function BACKGROUND Memory loss is common in heart failure ( HF ) patients , but few interventions have been tested to treat it . The objective of this study was to evaluate efficacy of a cognitive training intervention , Brain Fitness , to improve memory , serum brain-derived neurotropic factor ( BDNF ) levels , working memory , processing speed , executive function , instrumental activities of daily living , mobility , depressive symptoms , and health-related quality of life . METHODS AND RESULTS Twenty-seven HF patients were r and omly assigned to Brain Fitness and health education active control interventions . Data were collected at baseline and 8 and 12 weeks . Linear mixed models analyses were completed . Patients in the Brain Fitness group were older with lower ejection fraction . At 12 weeks , a group by time interaction effect was found for serum BDNF levels ( P = .011 ) : serum BDNF levels increased among patients who completed Brain Fitness and decreased among patients who completed health education . No differences were found in memory , but a group by time interaction ( P = .046 ) effect was found for working memory . CONCLUSIONS Findings support efficacy of Brain Fitness in improving working memory and serum BDNF levels as a biomarker of intervention response . A r and omized controlled study is needed among a larger more diverse group of HF patients The Advanced Cognitive Training for Independent and Vital Elderly ( ACTIVE ) trial is a r and omized , controlled , single-masked trial design ed to determine whether cognitive training interventions ( memory , reasoning , and speed of information processing ) , which have previously been found to be successful at improving mental abilities under laboratory or small-scale field conditions , can affect cognitively based measures of daily functioning . Enrollment began during 1998 ; 2-year follow-up will be completed by January 2002 . Primary outcomes focus on measures of cognitively dem and ing everyday functioning , including financial management , food preparation , medication use , and driving . Secondary outcomes include health-related quality of life , mobility , and health-service utilization .  Trial participants ( n = 2832 ) are aged 65 and over , and at entry into the trial , did not have significant cognitive , physical , or functional decline .  Because of its size and the carefully developed rigor , ACTIVE may serve as a guide for future behavioral medicine trials of this nature OBJECTIVES Feasibility and efficacy of computerized auditory cognitive training ( ACT ) was examined among patients with heart failure ( HF ) . BACKGROUND Individuals with HF have four times increased risk of cognitive impairment , yet cognitive intervention studies are sparse . METHODS A pilot r and omized controlled design was used . RESULTS  The ACT group ( n = 9 ) and control group ( n = 8) had similar baseline characteristics . Seven participants ( 78 % ) completed ≥ 18 hours of ACT . Medium effect sizes were observed for improved cognition as indicated by auditory processing speed ( d = 0.78 ) , speech processing ( d = 0.88 ) , and working memory ( d = 0.44 - 0.50 ) . Small effect sizes were found for improved functional outcomes including HF selfcare ( d = 0.34 ) , Timed Instrumental Activities of Daily Living ( d = 0.32 ) , Six-Minute Walk Test ( d = 0.38 ) and Short-Form-36 ( d = 0.22 ) relative to controls . CONCLUSION Results indicated ACT is feasible among persons with HF . Despite a small sample size , ACT showed potential for improved speed of processing and working memory and improved functional outcomes , and warrants further exploration OBJECTIVES To examine the effectiveness of a transitional care intervention delivered by advanced practice nurses ( APNs ) to elders hospitalized with heart failure . DESIGN R and omized , controlled trial with follow-up through 52 weeks postindex hospital discharge . SETTING Six Philadelphia academic and community hospitals . PARTICIPANTS Two hundred thirty-nine eligible patients were aged 65 and older and hospitalized with heart failure . INTERVENTION A 3-month APN-directed discharge planning and home follow-up protocol . MEASUREMENTS Time to first rehospitalization or death , number of rehospitalizations , quality of life , functional status , costs , and satisfaction with care . RESULTS Mean age of patients ( control n=121 ; intervention n=118 ) enrolled was 76 ; 43 % were male , and 36 % were African American .  Time to first readmission or death was longer in intervention patients ( log rank chi(2)=5.0 , P=.026 ; Cox regression incidence density ratio=1.65 , 95 % confidence interval=1.13 - 2.40 ) . At 52 weeks , intervention group patients had fewer readmissions ( 104 vs 162 , P=.047 ) and lower mean total costs ( $ 7,636 vs $ 12,481 , P=.002 ) . For intervention patients , only short-term improvements were demonstrated in overall quality of life ( 12 weeks , P<.05 ) , physical dimension of quality of life ( 2 weeks , P<.01 ; 12 weeks , P<.05 ) and patient satisfaction ( assessed at 2 and 6 weeks , P<.001 ) . CONCLUSION A comprehensive transitional care intervention for elders hospitalized with heart failure increased the length of time between hospital discharge and readmission or death , reduced total number of rehospitalizations , and decreased healthcare costs , thus demonstrating great promise for improving clinical and economic outcomes The evidence base of what works in chronic care management programs is underdeveloped . To fill the gap , we pooled and reanalyzed data from ten r and omized clinical trials of heart failure care management programs to discern how program delivery methods contribute to patient outcomes . We found that patients enrolled in programs using multi-disciplinary teams and in programs using in-person communication  had significantly fewer hospital readmissions and readmission days than routine care patients had . Our study offers policymakers and health plan administrators important guideposts for developing an evidence base on which to build effective policy and programmatic initiatives for chronic care management Objective : Cognitive deficits pose serious problems for older adults with heart failure ( HF ) .  Cognitive speed of processing training improves cognition among older adults but has not been examined among older adults with HF . Method : Data from the ACTIVE study were used to examine the effects of cognitive speed of processing training on cognitive and functional performance among older adults with HF . Results : Of the 54 participants included in the analyses , 23 who were r and omized to cognitive training performed significantly better on a composite of everyday speed of processing from pre- to post-training compared with 31 participants who were r and omized to the control group , F(1 , 51 ) = 28.67 , p ≤ .001 , η p 2 = .360 . Discussion : Results indicate that  speed of processing training may improve everyday cognitive performance among older adults with HF . Future studies should investigate the longitudinal effects of cognitive training with HF patients 
    Output:
    
Intervention effects also seemed to confer transferrable benefits to functional outcomes of daily living .
Conclusion Computerized cognitive trainings show promise in enhancing the cognition of patients with HF .
The stability of the current findings would need to be tested in RCTs with larger sample sizes to vali date the use of CCTs in targeting cognitive impairment and self-care abilities for patients with HF