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: Sleep disturbances are commonly reported in youth with chronic pain . We examined whether online cognitive-behavioral therapy ( CBT ) for pain management would impact youth 's sleep . Subjective sleep quality and actigraphic sleep were evaluated in 33 youth ( M = 14.8 years ; 70 % female ) with chronic pain participating in a larger r and omized controlled trial of online-CBT . The Internet treatment condition ( n = 17 ) received 8–10 weeks of online-CBT + st and ard care , and the wait-list control condition ( n = 16 ) continued with st and ard care . Although pain improved with online-CBT , no changes were observed in sleep outcomes . Shorter pretreatment sleep duration was associated with less improvement in posttreatment functioning . Findings underscore the need for further development in psychological therapies to more intensively target sleep loss in youth with chronic pain Abstract Although pain and function improve at immediate posttreatment for youth receiving cognitive behavioral therapy for chronic pain , limited data are available to underst and changes that youth make during psychological treatment . We sought to characterize distinct trajectory patterns of change in pain and function to underst and the temporal association of these changes during internet-delivered cognitive behavioral therapy ( CBT ) . Weekly repeated assessment s of pain and function were conducted during 8 weeks of treatment among 135 adolescents , aged 11 to 17 years , with chronic pain who were r and omized to the cognitive behavioral intervention arm of an ongoing trial of internet-delivered CBT ( Web-based management of adolescent pain ; Web-MAP2 ) . Using r and om-effects growth mixture models , we characterized pain and functional disability trajectories finding distinct trajectory groups indicating patterns of both linear and quadratic effects . Trajectories of change showed that some patients ' pain and functional disability were improving , others worsened or changed minimally . Paired t tests compared the within-subject relative change rate in pain and function demonstrating similar change range for pain and function during the treatment period . There was no support for improvements in either pain or function to precede changes in the other domain . Findings may be useful in informing future studies of psychosocial treatments for pediatric chronic pain to consider how to target treatment strategies to distinct patient response profiles . This may lead to the development of intervention strategies that can both more effectively target children 's pain and function during treatment and lead to sustained changes after treatment BACKGROUND Pain in adolescents with cancer ( 12 - 18 years ) is common and negatively impacts health-related quality of life ( HRQL ) . The Pain Squad+ smartphone app , which provides adolescents with real-time pain self-management support , was developed to address this issue . This study evaluated the implementation of the app to inform a future r and omized controlled trial ( RCT ) and obtain treatment effect estimates for pain intensity , pain interference , HRQL , and self-efficacy . PROCEDURE A one-group baseline/post study design with 40 adolescents recruited from two pediatric tertiary care centers was used . Baseline question naires were completed and adolescents used the app at least twice daily for 28 days , receiving algorithm-informed self-management advice depending on their reported pain . A nurse received alerts in response to sustained pain and contacted adolescents to assist in pain care . Post study question naires were completed . Descriptive analyses , with exploratory inferential testing conducted on health outcome data , were used to address study aims . RESULTS Most ( 40/52 ; 77 % ) eligible adolescents participated . Two participants withdrew participation . Intervention fidelity was impacted by technical difficulties ( occurring for 15 % of participants ) and a prolonged time for nurse contact in the event of sustained pain . Adherence to pain reporting was 68.8 ± 38.1 % . Outcome measure completion rates were high and the intervention was acceptable to participants . Trends in improvements in pain intensity , pain interference , and HRQL were significant , with effect sizes of 0.23 - 0.67 . CONCLUSIONS Implementation of Pain Squad+ is feasible and the app appears to improve pain-related outcomes for adolescents with cancer . A multicenter RCT will be undertaken to examine app effectiveness Background Many promising technological innovations in health and social care are characterized by nonadoption or ab and onment by individuals or by failed attempts to scale up locally , spread distantly , or sustain the innovation long term at the organization or system level . Objective Our objective was to produce an evidence -based , theory-informed , and pragmatic framework to help predict and evaluate the success of a technology-supported health or social care program . Methods The study had 2 parallel components : ( 1 ) secondary research ( hermeneutic systematic review ) to identify key domains , and ( 2 ) empirical case studies of technology implementation to explore , test , and refine these domains . We studied 6 technology-supported programs — video outpatient consultations , global positioning system tracking for cognitive impairment , pendant alarm services , remote biomarker monitoring for heart failure , care organizing software , and integrated case management via data sharing — using longitudinal ethnography and action research for up to 3 years across more than 20 organizations . Data were collected at micro level ( individual technology users ) , meso level ( organizational processes and systems ) , and macro level ( national policy and wider context ) . Analysis and synthesis was aided by sociotechnically informed theories of individual , organizational , and system change . The draft framework was shared with colleagues who were introducing or evaluating other technology-supported health or care programs and refined in response to feedback . Results The literature review identified 28 previous technology implementation frameworks , of which 14 had taken a dynamic systems approach ( including 2 integrative review s of previous work ) . Our empirical data set consisted of over 400 hours of ethnographic observation , 165 semistructured interviews , and 200 documents . The final nonadoption , ab and onment , scale-up , spread , and sustainability ( NASSS ) framework included questions in 7 domains : the condition or illness , the technology , the value proposition , the adopter system ( comprising professional staff , patient , and lay caregivers ) , the organization(s ) , the wider ( institutional and societal ) context , and the interaction and mutual adaptation between all these domains over time . Our empirical case studies raised a variety of challenges across all 7 domains , each classified as simple ( straightforward , predictable , few components ) , complicated ( multiple interacting components or issues ) , or complex ( dynamic , unpredictable , not easily disaggregated into constituent components ) . Programs characterized by complicatedness proved difficult but not impossible to implement . Those characterized by complexity in multiple NASSS domains rarely , if ever , became mainstreamed . The framework showed promise when applied ( both prospect ively and retrospectively ) to other programs . Conclusions Subject to further empirical testing , NASSS could be applied across a range of technological innovations in health and social care . It has several potential uses : ( 1 ) to inform the design of a new technology ; ( 2 ) to identify technological solutions that ( perhaps despite policy or industry enthusiasm ) have a limited chance of achieving large-scale , sustained adoption ; ( 3 ) to plan the implementation , scale-up , or rollout of a technology program ; and ( 4 ) to explain and learn from program failures BACKGROUND The use of non-pharmacological pain management remains adhoc within acute paediatric burns pain management protocol s despite ongoing acknowledgement of its role . Advancements in adult based pain services including the integration of virtual reality has been adapted to meet the needs of children in pain , as exemplified by the development of multi-modal distraction ( MMD ) . This easy to use , h and held interactive device uses customized programs design ed to inform the child about the procedure he/she is about to experience and to distract the child during dressing changes . AIM ( 1 ) To investigate if either MMD procedural preparation ( MMD-PP ) or distraction ( MMD-D ) has a greater impact on child pain reduction compared to st and ard distraction ( SD ) or h and held video game distraction ( VG ) , ( 2 ) to underst and the impact of MMD-PP and MMD-D on clinic efficiency by measuring length of treatment across groups , and lastly , ( 3 ) to assess the efficacy of distraction techniques over three dressing change procedures . METHODS A prospect i ve r and omised control trial was completed in a paediatric tertiary hospital Burns Outpatient Clinic . Eighty participants were recruited and studied over their first three dressing changes .  Pain was assessed using vali date d child report , caregiver report , nursing observation and physiological measures . RESULTS MMD-D and MMD-PP were both shown to significantly relieve reported pain ( p < or=0.05 ) and reduce the time taken for dressings ( p < or=0.05 ) compared to SD and VG . The positive effects of both MMD-D and MMD-PP were sustained with subsequent dressing changes . CONCLUSIONS The use of MMD as a preparatory or a distraction tool in an outpatient burns clinic offered superior pain reduction across three dressing changes to children when compared to st and ard practice s or h and held video games . This device has the potential to improve clinic efficiency with reductions in treatment lengths Abstract Adolescents with chronic pain are often socially isolated , having never met others with chronic pain , and often feel misunderstood by healthy peers . Adolescence is a sensitive period for developing one 's sense of self and autonomy , which often occurs in the context of peer relationships . This developmental process is disrupted in adolescents when their chronic pain interferes with their social interactions . Peer mentoring is proposed as a developmentally timely intervention . The aim of this study is to develop and test the feasibility , acceptability , and impact of the iPeer2Peer program . The iPeer2Peer program is a tailored peer mentorship program that provides modeling and reinforcement by peers ( trained young adults with chronic pain aged 18 - 25 years who have learned to successfully manage their pain ) . This program aim ed to enhance self-management of chronic pain in adolescents through 10 Skype video calls over the course of 8 weeks . A pilot r and omized controlled trial design using waitlist controls was used in an adolescent chronic pain sample . Twenty-eight adolescents aged 14.8 ± 1.6 years ( 93 % female ) completed the trial ( intervention : n = 12 ; control n = 16 ) . Three adolescents completed the intervention after completing their participation in the control arm . The iPeer2Peer program was feasible and acceptable , provided the adolescents were given more time to complete all 10 calls . When compared with controls , adolescents who completed the iPeer2Peer program had significant improvement in self-management skills and their coping efforts were more successful . The iPeer2Peer program is a promising peer mentoring intervention that complements st and ard care for adolescents with chronic pain BACKGROUND : Interactive Health Communication Applications ( IHCAs ) are computer-based , usually web-based health information packages for patients that combine information with at least one of social support , decision support , or behaviour change support . These are innovations in health care and their effects on health are uncertain . OBJECTIVES : To assess the effects of IHCAs for people with chronic disease . SEARCH STRATEGY : We design ed a four-part search strategy . First , we search ed electronic bibliographic data bases for published work ; second , we search ed the grey literature and third , we search ed for ongoing and recently completed clinical trials in the appropriate data bases . Finally , research ers of included studies were contacted , and reference lists from relevant primary and review articles were followed up . As IHCAs require relatively new technology , the search commenced at 1990 where possible . SELECTION CRITERIA : R and omised controlled trials ( RCTs ) of Interactive Health Communication Applications for adults and children with chronic disease . DATA COLLECTION AND ANALYSIS : One review er screened abstract s. Two review ers screened all c and i date studies to determine eligibility , apply quality criteria , and extract data from included studies . Authors of included RCTs were contacted for missing data . Results of RCTs were pooled using a r and om effects model and st and ardised mean differences ( SMDs ) were calculated to provide net effect sizes . MAIN RESULTS : We screened 24,757 unique citations and retrieved 958 papers for further assessment , yielding 28 RCTs involving 4042 participants . One of these had an inadequate method of concealment of allocation , and sensitivity analyses were performed to determine the effects of including or excluding these data in the meta-analyses . Results in the abstract are from the meta-analyses excluding data from this study .IHCAs were found to have a positive effect on knowledge ( SMD 0.49 ; 95 % confidence interval ( CI ) 0.14 to 0.84 ) and on social support ( SMD 0.47 ; 95 % CI 0.28 to 0.66 ) . IHCAs were found to have no effect on self-efficacy ( SMD 0.15 ; 95 % CI -0.13 to 0.43 ) or behavioural outcomes ( SMD -0.09 ; 95 % CI -0.49 to 0.32 ) . IHCAs had a negative effect on clinical outcomes ( SMD -0.32 ; 95 % CI -0.63 to -0.02 ) . REVIEW ERS ' CONCLUSIONS : The number and range of IHCAs is increasing rapidly ; however there is a shortage of high quality evaluative data . Consumers who wish to increase their knowledge or social support amongst people with a similar problem may find an IHCA helpful . However , consumers whose primary aim is to achieve optimal clinical outcomes should not use an IHCA at present . Further research is needed to determine the reason for this negative effect on clinical outcomes , whether an optimal IHCA can achieve behaviour change and improved health outcomes , and if so , what are the essential features of such an IHCA , and the extent to which they differ according to patient group or condition ABSTRACT Cognitive – behavioral therapy ( CBT ) interventions show promise for decreasing chronic pain in youth . However , the availability of CBT is limited by many factors including distance to major treatment centers and expense . This study evaluates a more accessible treatment approach for 
    Output:
    
agent
Conclusion : Systemic changes to academic and funding structures could better support eHealth tool availability and may reduce potential for research waste .
***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: Sleep disturbances are commonly reported in youth with chronic pain . We examined whether online cognitive-behavioral therapy ( CBT ) for pain management would impact youth 's sleep . Subjective sleep quality and actigraphic sleep were evaluated in 33 youth ( M = 14.8 years ; 70 % female ) with chronic pain participating in a larger r and omized controlled trial of online-CBT . The Internet treatment condition ( n = 17 ) received 8–10 weeks of online-CBT + st and ard care , and the wait-list control condition ( n = 16 ) continued with st and ard care . Although pain improved with online-CBT , no changes were observed in sleep outcomes . Shorter pretreatment sleep duration was associated with less improvement in posttreatment functioning . Findings underscore the need for further development in psychological therapies to more intensively target sleep loss in youth with chronic pain Abstract Although pain and function improve at immediate posttreatment for youth receiving cognitive behavioral therapy for chronic pain , limited data are available to underst and changes that youth make during psychological treatment . We sought to characterize distinct trajectory patterns of change in pain and function to underst and the temporal association of these changes during internet-delivered cognitive behavioral therapy ( CBT ) . Weekly repeated assessment s of pain and function were conducted during 8 weeks of treatment among 135 adolescents , aged 11 to 17 years , with chronic pain who were r and omized to the cognitive behavioral intervention arm of an ongoing trial of internet-delivered CBT ( Web-based management of adolescent pain ; Web-MAP2 ) . Using r and om-effects growth mixture models , we characterized pain and functional disability trajectories finding distinct trajectory groups indicating patterns of both linear and quadratic effects . Trajectories of change showed that some patients ' pain and functional disability were improving , others worsened or changed minimally . Paired t tests compared the within-subject relative change rate in pain and function demonstrating similar change range for pain and function during the treatment period . There was no support for improvements in either pain or function to precede changes in the other domain . Findings may be useful in informing future studies of psychosocial treatments for pediatric chronic pain to consider how to target treatment strategies to distinct patient response profiles . This may lead to the development of intervention strategies that can both more effectively target children 's pain and function during treatment and lead to sustained changes after treatment BACKGROUND Pain in adolescents with cancer ( 12 - 18 years ) is common and negatively impacts health-related quality of life ( HRQL ) . The Pain Squad+ smartphone app , which provides adolescents with real-time pain self-management support , was developed to address this issue . This study evaluated the implementation of the app to inform a future r and omized controlled trial ( RCT ) and obtain treatment effect estimates for pain intensity , pain interference , HRQL , and self-efficacy . PROCEDURE A one-group baseline/post study design with 40 adolescents recruited from two pediatric tertiary care centers was used . Baseline question naires were completed and adolescents used the app at least twice daily for 28 days , receiving algorithm-informed self-management advice depending on their reported pain . A nurse received alerts in response to sustained pain and contacted adolescents to assist in pain care . Post study question naires were completed . Descriptive analyses , with exploratory inferential testing conducted on health outcome data , were used to address study aims . RESULTS Most ( 40/52 ; 77 % ) eligible adolescents participated . Two participants withdrew participation . Intervention fidelity was impacted by technical difficulties ( occurring for 15 % of participants ) and a prolonged time for nurse contact in the event of sustained pain . Adherence to pain reporting was 68.8 ± 38.1 % . Outcome measure completion rates were high and the intervention was acceptable to participants . Trends in improvements in pain intensity , pain interference , and HRQL were significant , with effect sizes of 0.23 - 0.67 . CONCLUSIONS Implementation of Pain Squad+ is feasible and the app appears to improve pain-related outcomes for adolescents with cancer . A multicenter RCT will be undertaken to examine app effectiveness Background Many promising technological innovations in health and social care are characterized by nonadoption or ab and onment by individuals or by failed attempts to scale up locally , spread distantly , or sustain the innovation long term at the organization or system level . Objective Our objective was to produce an evidence -based , theory-informed , and pragmatic framework to help predict and evaluate the success of a technology-supported health or social care program . Methods The study had 2 parallel components : ( 1 ) secondary research ( hermeneutic systematic review ) to identify key domains , and ( 2 ) empirical case studies of technology implementation to explore , test , and refine these domains . We studied 6 technology-supported programs — video outpatient consultations , global positioning system tracking for cognitive impairment , pendant alarm services , remote biomarker monitoring for heart failure , care organizing software , and integrated case management via data sharing — using longitudinal ethnography and action research for up to 3 years across more than 20 organizations . Data were collected at micro level ( individual technology users ) , meso level ( organizational processes and systems ) , and macro level ( national policy and wider context ) . Analysis and synthesis was aided by sociotechnically informed theories of individual , organizational , and system change . The draft framework was shared with colleagues who were introducing or evaluating other technology-supported health or care programs and refined in response to feedback . Results The literature review identified 28 previous technology implementation frameworks , of which 14 had taken a dynamic systems approach ( including 2 integrative review s of previous work ) . Our empirical data set consisted of over 400 hours of ethnographic observation , 165 semistructured interviews , and 200 documents . The final nonadoption , ab and onment , scale-up , spread , and sustainability ( NASSS ) framework included questions in 7 domains : the condition or illness , the technology , the value proposition , the adopter system ( comprising professional staff , patient , and lay caregivers ) , the organization(s ) , the wider ( institutional and societal ) context , and the interaction and mutual adaptation between all these domains over time . Our empirical case studies raised a variety of challenges across all 7 domains , each classified as simple ( straightforward , predictable , few components ) , complicated ( multiple interacting components or issues ) , or complex ( dynamic , unpredictable , not easily disaggregated into constituent components ) . Programs characterized by complicatedness proved difficult but not impossible to implement . Those characterized by complexity in multiple NASSS domains rarely , if ever , became mainstreamed . The framework showed promise when applied ( both prospect ively and retrospectively ) to other programs . Conclusions Subject to further empirical testing , NASSS could be applied across a range of technological innovations in health and social care . It has several potential uses : ( 1 ) to inform the design of a new technology ; ( 2 ) to identify technological solutions that ( perhaps despite policy or industry enthusiasm ) have a limited chance of achieving large-scale , sustained adoption ; ( 3 ) to plan the implementation , scale-up , or rollout of a technology program ; and ( 4 ) to explain and learn from program failures BACKGROUND The use of non-pharmacological pain management remains adhoc within acute paediatric burns pain management protocol s despite ongoing acknowledgement of its role . Advancements in adult based pain services including the integration of virtual reality has been adapted to meet the needs of children in pain , as exemplified by the development of multi-modal distraction ( MMD ) . This easy to use , h and held interactive device uses customized programs design ed to inform the child about the procedure he/she is about to experience and to distract the child during dressing changes . AIM ( 1 ) To investigate if either MMD procedural preparation ( MMD-PP ) or distraction ( MMD-D ) has a greater impact on child pain reduction compared to st and ard distraction ( SD ) or h and held video game distraction ( VG ) , ( 2 ) to underst and the impact of MMD-PP and MMD-D on clinic efficiency by measuring length of treatment across groups , and lastly , ( 3 ) to assess the efficacy of distraction techniques over three dressing change procedures . METHODS A prospect i ve r and omised control trial was completed in a paediatric tertiary hospital Burns Outpatient Clinic . Eighty participants were recruited and studied over their first three dressing changes .  Pain was assessed using vali date d child report , caregiver report , nursing observation and physiological measures . RESULTS MMD-D and MMD-PP were both shown to significantly relieve reported pain ( p < or=0.05 ) and reduce the time taken for dressings ( p < or=0.05 ) compared to SD and VG . The positive effects of both MMD-D and MMD-PP were sustained with subsequent dressing changes . CONCLUSIONS The use of MMD as a preparatory or a distraction tool in an outpatient burns clinic offered superior pain reduction across three dressing changes to children when compared to st and ard practice s or h and held video games . This device has the potential to improve clinic efficiency with reductions in treatment lengths Abstract Adolescents with chronic pain are often socially isolated , having never met others with chronic pain , and often feel misunderstood by healthy peers . Adolescence is a sensitive period for developing one 's sense of self and autonomy , which often occurs in the context of peer relationships . This developmental process is disrupted in adolescents when their chronic pain interferes with their social interactions . Peer mentoring is proposed as a developmentally timely intervention . The aim of this study is to develop and test the feasibility , acceptability , and impact of the iPeer2Peer program . The iPeer2Peer program is a tailored peer mentorship program that provides modeling and reinforcement by peers ( trained young adults with chronic pain aged 18 - 25 years who have learned to successfully manage their pain ) . This program aim ed to enhance self-management of chronic pain in adolescents through 10 Skype video calls over the course of 8 weeks . A pilot r and omized controlled trial design using waitlist controls was used in an adolescent chronic pain sample . Twenty-eight adolescents aged 14.8 ± 1.6 years ( 93 % female ) completed the trial ( intervention : n = 12 ; control n = 16 ) . Three adolescents completed the intervention after completing their participation in the control arm . The iPeer2Peer program was feasible and acceptable , provided the adolescents were given more time to complete all 10 calls . When compared with controls , adolescents who completed the iPeer2Peer program had significant improvement in self-management skills and their coping efforts were more successful . The iPeer2Peer program is a promising peer mentoring intervention that complements st and ard care for adolescents with chronic pain BACKGROUND : Interactive Health Communication Applications ( IHCAs ) are computer-based , usually web-based health information packages for patients that combine information with at least one of social support , decision support , or behaviour change support . These are innovations in health care and their effects on health are uncertain . OBJECTIVES : To assess the effects of IHCAs for people with chronic disease . SEARCH STRATEGY : We design ed a four-part search strategy . First , we search ed electronic bibliographic data bases for published work ; second , we search ed the grey literature and third , we search ed for ongoing and recently completed clinical trials in the appropriate data bases . Finally , research ers of included studies were contacted , and reference lists from relevant primary and review articles were followed up . As IHCAs require relatively new technology , the search commenced at 1990 where possible . SELECTION CRITERIA : R and omised controlled trials ( RCTs ) of Interactive Health Communication Applications for adults and children with chronic disease . DATA COLLECTION AND ANALYSIS : One review er screened abstract s. Two review ers screened all c and i date studies to determine eligibility , apply quality criteria , and extract data from included studies . Authors of included RCTs were contacted for missing data . Results of RCTs were pooled using a r and om effects model and st and ardised mean differences ( SMDs ) were calculated to provide net effect sizes . MAIN RESULTS : We screened 24,757 unique citations and retrieved 958 papers for further assessment , yielding 28 RCTs involving 4042 participants . One of these had an inadequate method of concealment of allocation , and sensitivity analyses were performed to determine the effects of including or excluding these data in the meta-analyses . Results in the abstract are from the meta-analyses excluding data from this study .IHCAs were found to have a positive effect on knowledge ( SMD 0.49 ; 95 % confidence interval ( CI ) 0.14 to 0.84 ) and on social support ( SMD 0.47 ; 95 % CI 0.28 to 0.66 ) . IHCAs were found to have no effect on self-efficacy ( SMD 0.15 ; 95 % CI -0.13 to 0.43 ) or behavioural outcomes ( SMD -0.09 ; 95 % CI -0.49 to 0.32 ) . IHCAs had a negative effect on clinical outcomes ( SMD -0.32 ; 95 % CI -0.63 to -0.02 ) . REVIEW ERS ' CONCLUSIONS : The number and range of IHCAs is increasing rapidly ; however there is a shortage of high quality evaluative data . Consumers who wish to increase their knowledge or social support amongst people with a similar problem may find an IHCA helpful . However , consumers whose primary aim is to achieve optimal clinical outcomes should not use an IHCA at present . Further research is needed to determine the reason for this negative effect on clinical outcomes , whether an optimal IHCA can achieve behaviour change and improved health outcomes , and if so , what are the essential features of such an IHCA , and the extent to which they differ according to patient group or condition ABSTRACT Cognitive – behavioral therapy ( CBT ) interventions show promise for decreasing chronic pain in youth . However , the availability of CBT is limited by many factors including distance to major treatment centers and expense . This study evaluates a more accessible treatment approach for 
    Output:
    