human
***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 / OBJECTIVES To examine the relationships among fatigue and physical and mental quality of life ( QOL ) and different adjuvant chemotherapy regimens in patients with stage I-IIIA breast cancer prior to , during , and after treatment . DESIGN Longitudinal , descriptive design embedded in a r and omized , clinical trial . SETTING Outpatient oncology clinics in the midwestern United States . SAMPLE 196 postoperative women , mean age of 52 years , receiving anthracycline-based chemotherapy regimens : dose-dense taxane , dose-st and ard taxane , or dose-st and ard without taxane . METHODS The Piper Fatigue Scale and Medical Outcomes Study SF-36(R ) ( v.2 ) Survey were completed 48 hours prior to treatment 1 , at treatments 4 and 8 , and 30 days after the final treatment . MAIN RESEARCH VARIABLES Fatigue , adjuvant chemotherapy regimen , and QOL . FINDINGS Fatigue and mental QOL changed significantly over time for all regimens , but the patterns of change did not differ based on regimen . Physical QOL changed significantly over time for all regimens , and the pattern of change differed based on whether taxanes were received . Higher fatigue was correlated with lower physical and mental QOL prior to and 30 days after the final treatment , regardless of regimen . CONCLUSIONS Women who receive taxanes are at higher risk for lower physical QOL over time . Higher fatigue was associated with lower QOL regardless of the chemotherapy regimens . IMPLICATION S FOR NURSING Clinicians should screen patients for fatigue and assess for contributing factors at clinic visits . Methods to integrate evidence -based fatigue interventions into practice should be tested and outcomes evaluated OBJECTIVES : Sleep disturbances are common in patients with gastroesophageal reflux disease ( GERD ) . This study examined the effects of esomeprazole on nighttime heartburn , GERD-related sleep disturbances , sleep quality , work productivity , and regular activities . METHODS : This multicenter , r and omized , double-blind , placebo-controlled trial included adults with GERD-associated sleep disturbances and moderate-to-severe nighttime heartburn ( recorded by patient diary during screening ) . Patients received oral esomeprazole 40 mg ( n = 220 ) or 20 mg ( n = 226 ) or placebo ( n = 229 ) once daily for 4 wk . The primary outcome was relief of nighttime heartburn . Secondary outcomes included resolution of sleep disturbances , sleep quality measured by the Pittsburgh Sleep Quality Index ( PSQI ) question naire , and work productivity measured by the Work Productivity and Activity Impairment Question naire . RESULTS : Nighttime heartburn was relieved in 53.1 % ( 111/209 ) , 50.5 % ( 111/220 ) , and 12.7 % ( 28/221 ) of patients who received esomeprazole 40 mg , esomeprazole 20 mg , and placebo , respectively . Differences ( 95 % CI ) versus placebo were 40.5 % ( 32.4 % , 48.5 % ) and 37.8 % ( 29.9 % , 45.7 % ) and were highly significant ( p < 0.0001 ) . GERD-related sleep disturbances resolved in significantly more ( p < 0.0001 ) patients who received esomeprazole 40 ( 73.7 % ) or 20 mg ( 73.2 % ) than in those who received placebo ( 41.2 % ) . Both esomeprazole groups had greater PSQI global score changes from baseline ( p < 0.0001 vs placebo ) and more ( p < 0.0001 vs placebo ) work hours saved per week per patient compared with baseline ( esomeprazole 40 mg , 11.6 h ; esomeprazole 20 mg , 12.3 h ; placebo , 6.2 h ) . CONCLUSIONS : Esomeprazole reduced nighttime heartburn and GERD-related sleep disturbances and improved sleep quality and work productivity Objective . Sleep disturbance and chronic fatigue are common in rheumatoid arthritis ( RA ) and contribute to disability , symptomatology , and healthcare use . It has long been recognized in other population s that exercise can improve sleep and diminish fatigue . The effect of exercise on sleep quality and fatigue in RA has not been evaluated . Methods . Ours is a r and omized controlled study in RA to determine the effect of an exercise program on sleep quality and fatigue . These were measured using the Pittsburgh Sleep Quality Index and the Fatigue Severity Scale .  Patients were r and omized to either a 12-week , home-based exercise intervention or usual care . The exercise program consisted of specific exercises to target individual deficiencies identified using the Health Assessment Question naire ( HAQ ) with cardiovascular work as per the guidelines . The intervention group was evaluated on a 3-week basis . Full evaluation was carried out at baseline and at 12 weeks . Results . Forty patients were r and omized to the intervention with 38 controls . In the exercise intervention group , there was a statistically significant improvement in HAQ ( p = 0.00 ) , pain ( p = 0.05 ) , stiffness ( p = 0.05 ) , sleep quality ( p = 0.04 ) , and fatigue ( p = 0.04 ) . In our control group , there was a statistically significant improvement demonstrated in their overall perceptions of the benefits of exercise , but none of the other variables . Conclusion . Our study demonstrates that an exercise program result ed in significant improvement in sleep quality and fatigue . This is particularly interesting given the importance of fatigue as an outcome measure in RA and gives us yet another reason to prescribe exercise in this population OBJECTIVE Exercise can improve sleep quality , but for whom and by what means remains unclear . We examined moderators and mediators of objective sleep improvements in a 12-month r and omized controlled trial among underactive midlife and older adults reporting mild/moderate sleep complaints . METHODS Participants ( N = 66 , 67 % women , 55 - 79 years ) were r and omized to moderate-intensity exercise or health education control .  Putative moderators were gender , age , physical function , self-reported global sleep quality , and physical activity levels . Putative mediators were changes in BMI , depressive symptoms , and physical function at 6 months . Objective sleep outcomes measured by in-home polysomnography were percent time in Stage I sleep , percent time in Stage II sleep , and number of awakenings during the first third of sleep at 12 months . RESULTS Baseline physical function and sleep quality moderated changes in Stage I sleep ; individuals with higher initial physical function ( p = .01 ) and poorer sleep quality ( p = .03 ) had greater improvements . Baseline physical activity level moderated changes in Stage II sleep ( p = .04 ) and number of awakenings ( p = .01 ) ; more sedentary individuals had greater improvements . Decreased depressive symptoms ( CI:-1.57 to -0.02 ) mediated change in Stage I sleep . Decreased depressive symptoms ( CI:-0.75 to -0.01 ) , decreased BMI ( CI:-1.08 to -0.06 ) , and increased physical function ( CI : 0.01 to 0.72 ) mediated change in number of awakenings . CONCLUSIONS Initially less active individuals with higher initial physical function and poorer sleep quality improved the most . Affective , functional , and metabolic mediators specific to sleep architecture parameters were suggested . These results indicate strategies to more efficiently treat poor sleep through exercise in older adults Patients with neurological diseases often suffer from sleep disturbances . Insomnia among adult brain tumor patients has usually been studied as part of quality -of-life studies , or some case reports on insomnia in these patients have been described . The authors aim ed to study insomnia in a prospect i ve study setting among patients with primary brain tumors and evaluate whether insomnia is related to tumor laterality . Entire study population consisted of 70 patients with a solitary primary supratentorial brain tumor treated surgically at the Clinic for Neurosurgery , Oulu University Hospital . The overall functional state of the patients was assessed by the Karnofsky Performance Scale  ,  depression  was measured by Beck Depression Inventory , and insomnia by Nottingham Health Profile .  Repeated measurements were assessed before tumor operation as well as 3 months and one year after surgery . Prevalence of insomnia among patients with a primary brain tumor waiting for surgery was higher compared to general population , but level of insomnia significantly decreased as soon as 3 months after tumor operation . Patients with a bilateral primary brain tumor had significantly more often insomnia without comorbid depression compared to patients with a left or right tumor for up to one year after operation . The authors suggest that insomnia among patients with a bilateral brain tumor may not be associated with depression but have other biological background OBJECTIVE To evaluate the basic 8-week People with Arthritis Can Exercise ( PACE ) program for improvements in primary ( symptoms , functioning , level of physical activity ) and secondary ( psychosocial ) outcomes . METHODS A total of 346 individuals with self-reported arthritis from 18 sites participated in a r and omized controlled trial of PACE . Outcomes were measured at baseline and 8 weeks . The intervention group completed self-reported assessment s at 3 and 6 months . Two-level multiple linear regression models were estimated to calculate adjusted outcome means in the intervention and control groups . A mixed-effects repeated- measures model was used to calculate adjusted means in the intervention group at 3 and 6 months . Both intent-to-treat ( ITT ) and as-treated ( AT ) analyses were conducted . RESULTS At 8 weeks , the intervention group had improvements in the following outcomes : 2 symptom outcomes ( pain , fatigue ) and 1 psychosocial outcome ( self-efficacy for managing arthritis ) in the ITT analyses ; 1 symptom outcome ( pain ) , 1 function outcome ( chair st and s ) , and 1 psychosocial outcome ( self-efficacy for arthritis management ) in the AT analyses . In addition , completers who attended > or=9 classes had improvements in 3 symptom outcomes ( pain , fatigue , stiffness ) , 2 function outcomes ( 10-pound lifts , chair st and s ) , and 1 psychosocial outcome ( self-efficacy for arthritis management ) at 8 weeks . Relative to baseline , PACE participants maintained significant improvements in symptoms at 6 months , but declined in function and self-efficacy for exercise . CONCLUSION If adults with arthritis attend a majority of PACE classes , they may expect improvements in symptoms , self-efficacy for arthritis management , and upper and lower extremity function . Achieving sustained improvement in outcomes may require continued participation in PACE Background : Insomnia is a prevalent health complaint that is often difficult to evaluate reliably . There is an important need for brief and valid assessment tools to assist practitioners in the clinical evaluation of insomnia complaints . Objective : This paper reports on the clinical validation of the  Insomnia Severity Index ( ISI )  as a brief screening measure of insomnia and as an outcome measure in treatment research . The psychometric properties ( internal consistency , concurrent validity , factor structure ) of the ISI were evaluated in two sample s of insomnia patients . Methods : The first study examined the internal consistency and concurrent validity of the ISI  in 145 patients evaluated for insomnia at a sleep disorders clinic . Data from the ISI were compared to those of a sleep diary measure . In the second study , the concurrent validity of the  ISI  was evaluated in a sample of 78 older patients who participated in a r and omized-controlled trial of behavioral and pharmacological therapies for insomnia . Change scores on the  ISI  over time were compared with those obtained from sleep diaries and polysomnography .  Comparisons were also made between ISI scores obtained from patients , significant others , and clinicians . Results : The results of Study 1 showed that the  ISI  has adequate internal consistency and is a reliable self-report measure to evaluate perceived sleep difficulties . The results from Study 2 also indicated that the ISI is a valid and sensitive measure to detect changes in perceived sleep difficulties with treatment . In addition , there is a close convergence between scores obtained from the ISI patient 's version and those from the clinician 's and significant other 's versions . Conclusions : The present findings indicate that the ISI is a reliable and valid instrument to quantify perceived insomnia severity . The ISI is likely to be a clinical ly useful tool as a screening device or as an outcome measure in insomnia treatment research We examined individual responses to cognitive-behavior therapy for  insomnia in 51 persons with chronic pain to determine the rate of clinical ly significant change and to identify predictors of successful treatment response . Outcome measures consisted of the Pittsburgh Sleep Quality Index ( PSQI ) and diary measures of sleep latency and sleep continuity . Using reliable change indices , 57 % of participants were statistically improved on the PSQI after 7 weeks of treatment , but only 18 % were considered fully recovered from their sleep problems . No demographic variables predicted treatment response but persons who reliably improved on the PSQI had a lower sleep self-efficacy at baseline . Improvers showed a significant increase in sleep self-efficacy ratings and a decrease in self-reported levels of distress and pain-related disability . These results suggest that patients with insomnia secondary to chronic medical conditions can be helped with cognitive-behavior therapy , although most individuals continue to have mild or subthreshold sleep problems at posttreatment OBJECTIVE To investigate the generalizability of the results of a r and omized controlled trial on the effectiveness of long-term , high-intensity exercises in the rheumatoid arthritis patients in training ( RAPIT ) trial by comparing the characteristics of the participants with the non participants . M 
    Output:
    
agent
This review could find no consistent or conclusive evidence on whether exercise impacts on sleep in people who have rheumatoid arthritis , therefore no firm conclusions can be made .
However , there is some indication that exercise may have positive benefits on sleep in people who have rheumatoid arthritis .
***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 / OBJECTIVES To examine the relationships among fatigue and physical and mental quality of life ( QOL ) and different adjuvant chemotherapy regimens in patients with stage I-IIIA breast cancer prior to , during , and after treatment . DESIGN Longitudinal , descriptive design embedded in a r and omized , clinical trial . SETTING Outpatient oncology clinics in the midwestern United States . SAMPLE 196 postoperative women , mean age of 52 years , receiving anthracycline-based chemotherapy regimens : dose-dense taxane , dose-st and ard taxane , or dose-st and ard without taxane . METHODS The Piper Fatigue Scale and Medical Outcomes Study SF-36(R ) ( v.2 ) Survey were completed 48 hours prior to treatment 1 , at treatments 4 and 8 , and 30 days after the final treatment . MAIN RESEARCH VARIABLES Fatigue , adjuvant chemotherapy regimen , and QOL . FINDINGS Fatigue and mental QOL changed significantly over time for all regimens , but the patterns of change did not differ based on regimen . Physical QOL changed significantly over time for all regimens , and the pattern of change differed based on whether taxanes were received . Higher fatigue was correlated with lower physical and mental QOL prior to and 30 days after the final treatment , regardless of regimen . CONCLUSIONS Women who receive taxanes are at higher risk for lower physical QOL over time . Higher fatigue was associated with lower QOL regardless of the chemotherapy regimens . IMPLICATION S FOR NURSING Clinicians should screen patients for fatigue and assess for contributing factors at clinic visits . Methods to integrate evidence -based fatigue interventions into practice should be tested and outcomes evaluated OBJECTIVES : Sleep disturbances are common in patients with gastroesophageal reflux disease ( GERD ) . This study examined the effects of esomeprazole on nighttime heartburn , GERD-related sleep disturbances , sleep quality , work productivity , and regular activities . METHODS : This multicenter , r and omized , double-blind , placebo-controlled trial included adults with GERD-associated sleep disturbances and moderate-to-severe nighttime heartburn ( recorded by patient diary during screening ) . Patients received oral esomeprazole 40 mg ( n = 220 ) or 20 mg ( n = 226 ) or placebo ( n = 229 ) once daily for 4 wk . The primary outcome was relief of nighttime heartburn . Secondary outcomes included resolution of sleep disturbances , sleep quality measured by the Pittsburgh Sleep Quality Index ( PSQI ) question naire , and work productivity measured by the Work Productivity and Activity Impairment Question naire . RESULTS : Nighttime heartburn was relieved in 53.1 % ( 111/209 ) , 50.5 % ( 111/220 ) , and 12.7 % ( 28/221 ) of patients who received esomeprazole 40 mg , esomeprazole 20 mg , and placebo , respectively . Differences ( 95 % CI ) versus placebo were 40.5 % ( 32.4 % , 48.5 % ) and 37.8 % ( 29.9 % , 45.7 % ) and were highly significant ( p < 0.0001 ) . GERD-related sleep disturbances resolved in significantly more ( p < 0.0001 ) patients who received esomeprazole 40 ( 73.7 % ) or 20 mg ( 73.2 % ) than in those who received placebo ( 41.2 % ) . Both esomeprazole groups had greater PSQI global score changes from baseline ( p < 0.0001 vs placebo ) and more ( p < 0.0001 vs placebo ) work hours saved per week per patient compared with baseline ( esomeprazole 40 mg , 11.6 h ; esomeprazole 20 mg , 12.3 h ; placebo , 6.2 h ) . CONCLUSIONS : Esomeprazole reduced nighttime heartburn and GERD-related sleep disturbances and improved sleep quality and work productivity Objective . Sleep disturbance and chronic fatigue are common in rheumatoid arthritis ( RA ) and contribute to disability , symptomatology , and healthcare use . It has long been recognized in other population s that exercise can improve sleep and diminish fatigue . The effect of exercise on sleep quality and fatigue in RA has not been evaluated . Methods . Ours is a r and omized controlled study in RA to determine the effect of an exercise program on sleep quality and fatigue . These were measured using the Pittsburgh Sleep Quality Index and the Fatigue Severity Scale .  Patients were r and omized to either a 12-week , home-based exercise intervention or usual care . The exercise program consisted of specific exercises to target individual deficiencies identified using the Health Assessment Question naire ( HAQ ) with cardiovascular work as per the guidelines . The intervention group was evaluated on a 3-week basis . Full evaluation was carried out at baseline and at 12 weeks . Results . Forty patients were r and omized to the intervention with 38 controls . In the exercise intervention group , there was a statistically significant improvement in HAQ ( p = 0.00 ) , pain ( p = 0.05 ) , stiffness ( p = 0.05 ) , sleep quality ( p = 0.04 ) , and fatigue ( p = 0.04 ) . In our control group , there was a statistically significant improvement demonstrated in their overall perceptions of the benefits of exercise , but none of the other variables . Conclusion . Our study demonstrates that an exercise program result ed in significant improvement in sleep quality and fatigue . This is particularly interesting given the importance of fatigue as an outcome measure in RA and gives us yet another reason to prescribe exercise in this population OBJECTIVE Exercise can improve sleep quality , but for whom and by what means remains unclear . We examined moderators and mediators of objective sleep improvements in a 12-month r and omized controlled trial among underactive midlife and older adults reporting mild/moderate sleep complaints . METHODS Participants ( N = 66 , 67 % women , 55 - 79 years ) were r and omized to moderate-intensity exercise or health education control .  Putative moderators were gender , age , physical function , self-reported global sleep quality , and physical activity levels . Putative mediators were changes in BMI , depressive symptoms , and physical function at 6 months . Objective sleep outcomes measured by in-home polysomnography were percent time in Stage I sleep , percent time in Stage II sleep , and number of awakenings during the first third of sleep at 12 months . RESULTS Baseline physical function and sleep quality moderated changes in Stage I sleep ; individuals with higher initial physical function ( p = .01 ) and poorer sleep quality ( p = .03 ) had greater improvements . Baseline physical activity level moderated changes in Stage II sleep ( p = .04 ) and number of awakenings ( p = .01 ) ; more sedentary individuals had greater improvements . Decreased depressive symptoms ( CI:-1.57 to -0.02 ) mediated change in Stage I sleep . Decreased depressive symptoms ( CI:-0.75 to -0.01 ) , decreased BMI ( CI:-1.08 to -0.06 ) , and increased physical function ( CI : 0.01 to 0.72 ) mediated change in number of awakenings . CONCLUSIONS Initially less active individuals with higher initial physical function and poorer sleep quality improved the most . Affective , functional , and metabolic mediators specific to sleep architecture parameters were suggested . These results indicate strategies to more efficiently treat poor sleep through exercise in older adults Patients with neurological diseases often suffer from sleep disturbances . Insomnia among adult brain tumor patients has usually been studied as part of quality -of-life studies , or some case reports on insomnia in these patients have been described . The authors aim ed to study insomnia in a prospect i ve study setting among patients with primary brain tumors and evaluate whether insomnia is related to tumor laterality . Entire study population consisted of 70 patients with a solitary primary supratentorial brain tumor treated surgically at the Clinic for Neurosurgery , Oulu University Hospital . The overall functional state of the patients was assessed by the Karnofsky Performance Scale  ,  depression  was measured by Beck Depression Inventory , and insomnia by Nottingham Health Profile .  Repeated measurements were assessed before tumor operation as well as 3 months and one year after surgery . Prevalence of insomnia among patients with a primary brain tumor waiting for surgery was higher compared to general population , but level of insomnia significantly decreased as soon as 3 months after tumor operation . Patients with a bilateral primary brain tumor had significantly more often insomnia without comorbid depression compared to patients with a left or right tumor for up to one year after operation . The authors suggest that insomnia among patients with a bilateral brain tumor may not be associated with depression but have other biological background OBJECTIVE To evaluate the basic 8-week People with Arthritis Can Exercise ( PACE ) program for improvements in primary ( symptoms , functioning , level of physical activity ) and secondary ( psychosocial ) outcomes . METHODS A total of 346 individuals with self-reported arthritis from 18 sites participated in a r and omized controlled trial of PACE . Outcomes were measured at baseline and 8 weeks . The intervention group completed self-reported assessment s at 3 and 6 months . Two-level multiple linear regression models were estimated to calculate adjusted outcome means in the intervention and control groups . A mixed-effects repeated- measures model was used to calculate adjusted means in the intervention group at 3 and 6 months . Both intent-to-treat ( ITT ) and as-treated ( AT ) analyses were conducted . RESULTS At 8 weeks , the intervention group had improvements in the following outcomes : 2 symptom outcomes ( pain , fatigue ) and 1 psychosocial outcome ( self-efficacy for managing arthritis ) in the ITT analyses ; 1 symptom outcome ( pain ) , 1 function outcome ( chair st and s ) , and 1 psychosocial outcome ( self-efficacy for arthritis management ) in the AT analyses . In addition , completers who attended > or=9 classes had improvements in 3 symptom outcomes ( pain , fatigue , stiffness ) , 2 function outcomes ( 10-pound lifts , chair st and s ) , and 1 psychosocial outcome ( self-efficacy for arthritis management ) at 8 weeks . Relative to baseline , PACE participants maintained significant improvements in symptoms at 6 months , but declined in function and self-efficacy for exercise . CONCLUSION If adults with arthritis attend a majority of PACE classes , they may expect improvements in symptoms , self-efficacy for arthritis management , and upper and lower extremity function . Achieving sustained improvement in outcomes may require continued participation in PACE Background : Insomnia is a prevalent health complaint that is often difficult to evaluate reliably . There is an important need for brief and valid assessment tools to assist practitioners in the clinical evaluation of insomnia complaints . Objective : This paper reports on the clinical validation of the  Insomnia Severity Index ( ISI )  as a brief screening measure of insomnia and as an outcome measure in treatment research . The psychometric properties ( internal consistency , concurrent validity , factor structure ) of the ISI were evaluated in two sample s of insomnia patients . Methods : The first study examined the internal consistency and concurrent validity of the ISI  in 145 patients evaluated for insomnia at a sleep disorders clinic . Data from the ISI were compared to those of a sleep diary measure . In the second study , the concurrent validity of the  ISI  was evaluated in a sample of 78 older patients who participated in a r and omized-controlled trial of behavioral and pharmacological therapies for insomnia . Change scores on the  ISI  over time were compared with those obtained from sleep diaries and polysomnography .  Comparisons were also made between ISI scores obtained from patients , significant others , and clinicians . Results : The results of Study 1 showed that the  ISI  has adequate internal consistency and is a reliable self-report measure to evaluate perceived sleep difficulties . The results from Study 2 also indicated that the ISI is a valid and sensitive measure to detect changes in perceived sleep difficulties with treatment . In addition , there is a close convergence between scores obtained from the ISI patient 's version and those from the clinician 's and significant other 's versions . Conclusions : The present findings indicate that the ISI is a reliable and valid instrument to quantify perceived insomnia severity . The ISI is likely to be a clinical ly useful tool as a screening device or as an outcome measure in insomnia treatment research We examined individual responses to cognitive-behavior therapy for  insomnia in 51 persons with chronic pain to determine the rate of clinical ly significant change and to identify predictors of successful treatment response . Outcome measures consisted of the Pittsburgh Sleep Quality Index ( PSQI ) and diary measures of sleep latency and sleep continuity . Using reliable change indices , 57 % of participants were statistically improved on the PSQI after 7 weeks of treatment , but only 18 % were considered fully recovered from their sleep problems . No demographic variables predicted treatment response but persons who reliably improved on the PSQI had a lower sleep self-efficacy at baseline . Improvers showed a significant increase in sleep self-efficacy ratings and a decrease in self-reported levels of distress and pain-related disability . These results suggest that patients with insomnia secondary to chronic medical conditions can be helped with cognitive-behavior therapy , although most individuals continue to have mild or subthreshold sleep problems at posttreatment OBJECTIVE To investigate the generalizability of the results of a r and omized controlled trial on the effectiveness of long-term , high-intensity exercises in the rheumatoid arthritis patients in training ( RAPIT ) trial by comparing the characteristics of the participants with the non participants . M 
    Output:
    