***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 Self-management programs for patients with heart failure can reduce hospitalizations and mortality . However , no programs have analyzed their usefulness for patients with low literacy . We compared the efficacy of a heart failure self-management program design ed for patients with low literacy versus usual care .  Methods We performed a 12-month r and omized controlled trial . From November 2001 to April 2003 , we enrolled participants aged 30–80 , who had heart failure and took furosemide .  Intervention patients received education on self-care emphasizing daily weight measurement , diuretic dose self-adjustment , and symptom recognition and response . Picture-based educational material s , a digital scale , and scheduled telephone follow-up were provided to reinforce adherence . Control patients received a generic heart failure brochure and usual care . Primary outcomes were combined hospitalization or death , and heart failure-related quality of life . Results 123 patients ( 64 control , 59 intervention ) participated ; 41 % had inadequate literacy . Patients in the intervention group had a lower rate of hospitalization or death ( crude incidence rate ratio ( IRR ) = 0.69 ; CI 0.4 , 1.2 ; adjusted IRR = 0.53 ; CI 0.32 , 0.89 ) . This difference was larger for patients with low literacy ( IRR = 0.39 ; CI 0.16 , 0.91 ) than for higher literacy ( IRR = 0.56 ; CI 0.3 , 1.04 ) , but the interaction was not statistically significant . At 12 months , more patients in the intervention group reported monitoring weights daily ( 79 % vs. 29 % , p < 0.0001 ) . After adjusting for baseline demographic and treatment differences , we found no difference in heart failure-related quality of life at 12 months ( difference = -2 ; CI -5 , + 9 ) . Conclusion A primary care-based heart failure self-management program design ed for patients with low literacy reduces the risk of hospitalizations or death Background Peak oxygen uptake ( VO2 ) testing is commonly used to assess chronic heart failure ( CHF ) patients ’ exercise tolerance . The test requires maximal effort ; however , many participants have low confidence ( self-efficacy ) to perform optimally . Purpose This r and omized controlled trial examined the effectiveness of a modeling intervention to increase Peak VO2 ( PVO2 ) and self-efficacy in people diagnosed with CHF . Methods Twenty participants with a diagnosis of CHF were r and omized to either an intervention ( modeling DVD ) or a control group . Both groups completed a measure of self-efficacy prior to performing two PVO2 tests , each separated by 7 days . After completing the first test ( T1 ) the intervention group watched a 10-min coping model DVD . All participants returned 1 week later ( T2 ) to complete identical study procedures . Results Analysis of covariance results showed that compared with the participants in the control group , those assigned to the modeling intervention had higher PVO2 at T2 , F ( 1 , 19 ) = 4.38 , p = 0.05 , ή2 = 0.21 and self-efficacy , F ( 1 , 19 ) = 5.80 , p < 0.05 , ή2 = 0.25 . Only partial support was found for change in self-efficacy mediating treatment outcome ( PVO2 ) . Conclusions Watching a modeling video is associated with increased PVO2 and self-efficacy . These results have implication s for testing patients in a clinical setting to maximize exercise tolerance test results 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 Outcomes related to chronic heart failure ( HF ) remain relatively poor , despite advances in pharmacological therapy and medical and nursing care . Experts agree that outpatient care may be among the factors that affect HF outcomes . We hypothesized that the method by which outpatient care is delivered may affect outcomes in this patient population . METHODS A prospect i ve , r and omized design was used to compare HF outcomes from 216 patients r and omized to 1 of 2 home health care delivery methods for 3 months after discharge . Care was delivered by the home nurse visit ( HNV ) or the nurse telemanagement ( NTM ) method . In the latter , patients used transtelephonic home monitoring devices to measure their weight , blood pressure , heart rate , and oxygen saturation . These data were transmitted daily to a secure Internet site . An advanced- practice nurse worked collaboratively with a cardiologist and subsequently treated patients via the telephone . Both delivery methods used the same HF-specific clinical guidelines to direct care . Outcomes include HF readmissions and length of stay , anxiety , depression , self-efficacy , and quality of life . Data were primarily tested using a 2-group analysis of variance ( ANOVA ) . We used a repeated- measures ANOVA to conduct preintervention-postintervention analyses . RESULTS After 3 months , patients in the  NTM group ( n = 108 ; mean + /- SD age , 62.9 + /- 13.2 years ; 83 % African American ; 64 % female ) had fewer HF readmissions ( 13 vs 24 ; P</=.001 ) with shorter lengths of stay ( 49.5 vs 105.0 days ; P</=.001 ) compared with the HNV group ( n = 108 ; mean + /- SD age , 63.2 + /- 12.6 years ; 89 % African American ; 62 % female ) . Hospitalization charges at 3 months were less in the NTM group compared with the HNV group ( $ 65 023 vs $ 177 365 ; P</=.02 ) . At 6 and 12 months , cumulative readmission charges in the NTM group were also less ( $ 223 638 vs $ 500 343 [ P<.03 ] and $ 541 378 vs $ 677 710 [ P</=.16 ] , respectively ) compared with the HNV group . Quality of life was significantly improved for both groups when we compared postintervention and preintervention scores . CONCLUSION The adaptation of state-of-the-art computerized technology to closely monitor patients with HF with advanced- practice nurse care under the guidance of a cardiologist significantly improves HF management while reducing the cost of care Nonadherence to medical treatment among heart failure patients is high and results in frequent exacerbations and premature death . This treatment-only pilot study examined whether a year-long group-based self-management intervention is feasible and improves self-management skills in patients with mild-to-moderate heart failure ( ejection fraction < or = 40 % and New York Heart Association functional class I , II , or III ) . A total of 31 of 100 recruited patients ( 31 % ) agreed to participate . Twenty-six ( 84 % ) completed the year-long self-management program . Compared with baseline , the intervention was associated with an increase in overall self-efficacy in practicing self-management skills ( p<0.001 ) and in four of five specific self-management skills . Patients and their group leaders also reported an increase in actual use of self-management skills ( p<0.001 ) and in several psychosocial outcomes . The success of this pilot study suggests the need for a r and omized clinical trial to test the efficacy of group-based self-management training on medical outcomes BACKGROUND Heart failure is a common and important cause of morbidity and mortality . Disease management offers promise in reducing the need for hospitalization and improving quality of life for heart failure patients , but experimental data on the efficacy of such programs are limited . METHODS AND RESULTS A total of 151 patients hospitalized with heart failure were r and omized to usual care or scheduled telephone calls by specially trained nurses promoting self-management and guideline -based therapy as prescribed by primary physicians . Nurses also screened patients for heart failure exacerbations , which they managed with supplemental diuretics or by contacting the primary physician for instructions . Outcomes included time to hospital encounter , mortality , number and cost of hospitalizations , functional status , and satisfaction with care . Intervention patients had a longer time to encounter ( hazard ratio [ HR ] = 0.67 ; 95 % confidence interval [ CI ] 0.47 - 0.96 ; P = .029 ) , hospital readmission ( HR = 0.67 ; CI 0.46 - 0.99 ; P = .045 ) , and heart failure-specific readmission ( HR = 0.62 ; CI 0.38 - 1.03 ; P = .063 ) . The number of admissions , hospital days , and hospital costs were significantly lower during the first 6 months after intervention but not at 1 year . The intervention had little effect on functional status , mortality , and satisfaction with care . CONCLUSION A nurse-administered , telephone-based disease management program delayed subsequent health care encounters , but had minimal impact on other outcomes OBJECTIVE Patients with heart failure need education and support to improve knowledge and self-care .  Shared medical groups that provide education and support have been successful in other patient population s. This study compares an advanced practice nurse-led shared medical appointment intervention in the office setting with st and ard care relative to self-care and knowledge among community-living adults with heart failure . METHODS Participants were r and omized to shared appointment and st and ard care groups  , and completed the Heart Failure Knowledge Test and Self-Care Heart Failure Index at baseline and 8 weeks . RESULTS From baseline to 8 weeks , Heart Failure Knowledge Test scores improved more for the intervention group than the control group ( F time X group = 4.90 , df = 1.21 ; P = .038 ) . There was no difference in groups ' rates of change on the total Self-Care Heart Failure Index . CONCLUSION The findings reveal improved knowledge when education and support are provided in a shared medical appointment setting . The shared medical visit model may be feasible as a way to provide patients with heart failure and their families with ongoing education and a supportive environment The purpose of this pilot study was to ( a ) determine the feasibility of providing a heart failure disease management program through an in-home telehealth communication device ( Health Buddy ® ) and ( b ) compare the effectiveness of the Health Buddy ® with traditional home management strategies ( telephonic , home visit ) in achieving selected patient outcomes ( self-efficacy , functional status , depression , and health-related quality of life ) . Ninety participants completed the study through 2 months . Thirty percent of participants were either eliminated prior to or withdrawn after enrollment from the study based on Health Buddy ® issues . A mixed model ANOVA revealed those who received telephonic disease management experienced decreased confidence in their ability to manage their heart failure whereas all other groups experienced increased confidence . Further ANOVA analyses indicated improvement over time with no group differences for functional status , depression , or health-related quality of life . These findings suggest that delivering a disease management program through a telehealth communication device is feasible and may be as effective as traditional methods BACKGROUND Self-management of dietary sodium restriction by persons with heart failure ( HF ) is difficult and usually occurs within the home setting and within a family context . OBJECTIVE To compare a patient and family education ( EDUC ) intervention with a combined education and family partnership intervention ( EDUC + FPI ) for effects on improving dietary sodium self-management in persons with HF . METHODS Patients with HF and a family member ( FM ) were r and omized to EDUC ( n = 29 dyads ) or EDUC + FPI ( n = 32 dyads ) . Participants with HF were primarily White males with a mean age of 61 years ( + /-12 ) . The FMs were primarily women and spouses and had a mean age of 54 years ( + /-17 ) .  Self-reported dietary sodium ( Diet NA ) intake and 24-hr urinary sodium ( Urine NA ) were measured at baseline ( BL ) and 3 months ( 3 M ) after intervention . Data were analyzed with descriptive statistics , generalized least squares regression , paired t test , and chi-square test . RESULTS Groups did not differ by age , gender , or clinical variables ; however , family functioning ( Family APGAR ) scores were slightly higher in the EDUC + FPI group at BL . Both groups decreased Diet NA and Urine NA from BL to 3 M ; the EDUC + FPI group showed greater decrease in Urine NA and had a greater percentage of those who decreased Urine NA by at least 15 % ( p = .04 ) . Regression analysis to predict Urine NA revealed a significant Group x Time interaction ( p = .03 ) when accounting for time-varying measures of body mass index ( p = .001 ) . DISCUSSION 
    Output:
    
Both short- and long-term interventions can improve self-efficacy demonstrating that the duration of the intervention can vary and still be successful .
Existing evidence suggests that it is not the amount of education ( number of sessions/length of sessions ) that improves self-efficacy , but some other factor or factors that remain unknown at present .