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: 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 OBJECTIVES To investigate the maintenance of physical activity 12 months after two 1-year Internet-based physical activity interventions in patients with RA . METHODS This follow-up study was a r and omized comparison of an Internet-based individualized training ( IT ) and a general training ( GT ) programme in sedentary RA patients . Outcome measures included physical activity ( meeting public health recommendations for moderate physical activity , i.e. 30 min for at least 5 days/week ; or vigorous physical activity , i.e. 20 min for at least 3 days/week ) , functional ability and quality of life ( QoL ) . RESULTS Of the 152 RA patients who completed the initial study , 110 ( 72 % ) were available at follow-up . At 24 months , the proportions of patients meeting public health recommendations for moderate intensity physical activity were significantly higher compared with baseline in both the IT and GT groups ( 19 and 24 % , respectively , P < 0.05 ) , whereas the proportions of patients meeting the recommendation for vigorous activity was only significantly higher compared with baseline in the IT group ( P < 0.05 ) but not in the GT group . There were no differences between the IT and GT groups concerning proportions of patients meeting moderate or vigorous physical activity recommendations at 24 months . Apart from a significantly higher RAQoL score in the IT group at 24 months compared with baseline , there were no significant differences within or between the programmes regarding functional ability or QoL. CONCLUSION In RA patients , the effectiveness of both an individualized and a general 1-year Internet-based physical activity programme is sustained with respect to moderate intensity physical activity up to 12 months after the interventions Evidence -based medicine integrates clinical expertise , patients ' values and preferences , and the best available evidence from the medical literature . Evidence -based orthopedics is a model to assist surgeons to improve the process of asking questions , obtaining relevant information efficiently , and making informed decisions with patients . With an increasing appreciation for higher levels of evidence , orthopedic surgeons should move away from lower forms of evidence . The adoption of r and omized trials and high- quality prospect i ve studies to guide patient care requires 2 prerequisites : ( 1 ) greater appreciation for the conduct of r and omized trials in orthopedics and ( 2 ) improved education and training in evidence -based method ologies in surgery OBJECTIVE To compare the accuracy of existing classification criteria for the diagnosis of psoriatic arthritis ( PsA ) and to construct new criteria from observed data . METHODS Data were collected prospect ively from consecutive clinic attendees with PsA and other inflammatory arthropathies . Subjects were classified by each of 7 criteria . Sensitivity and specificity were compared using conditional logistic regression analysis . Latent class analysis was used to calculate criteria accuracy in order to confirm the validity of clinical diagnosis as the gold st and ard definition of " case"-ness . Classification and Regression Trees methodology and logistic regression were used to identify items for new criteria , which were then constructed using a receiver operating characteristic curve . RESULTS Data were collected on 588 cases and 536 controls with rheumatoid arthritis ( n = 384 ) , ankylosing spondylitis ( n = 72 ) , undifferentiated arthritis ( n = 38 ) , connective tissue disorders ( n = 14 ) , and other diseases ( n = 28 ) . The specificity of each set of criteria was high . The sensitivity of the Vasey and Espinoza method ( 0.97 ) was similar to that of the method of McGonagle et al ( 0.98 ) and greater than that of the methods of Bennett ( 0.44 ) , Moll and Wright ( 0.91 ) , the European Spondylarthropathy Study Group ( 0.74 ) , and Gladman et al ( 0.91 ) . The CASPAR ( ClASsification criteria for Psoriatic ARthritis ) criteria consisted of established inflammatory articular disease with at least 3 points from the following features : current psoriasis ( assigned a score of 2 ; all other features were assigned a score of 1 ) , a history of psoriasis ( unless current psoriasis was present ) , a family history of psoriasis ( unless current psoriasis was present or there was a history of psoriasis ) , dactylitis , juxtaarticular new bone formation , rheumatoid factor negativity , and nail dystrophy . These criteria were more specific ( 0.987 versus 0.960 ) but less sensitive ( 0.914 versus 0.972 ) than those of Vasey and Espinoza . CONCLUSION The CASPAR criteria are simple and highly specific but less sensitive than the Vasey and Espinoza criteria OBJECTIVE To determine the efficacy of an Internet-based Arthritis Self-Management Program ( ASMP ) as a re source for arthritis patients unable or unwilling to attend small-group ASMPs , which have proven effective in changing health-related behaviors and improving health status measures . METHODS R and omized intervention participants were compared with usual care controls at 6 months and 1 year using repeated- measures analyses of variance . Patients with rheumatoid arthritis , osteoarthritis , or fibromyalgia and Internet and e-mail access ( n = 855 ) were r and omized to an intervention  ( n = 433 ) or  usual care control ( n = 422 ) group . Measures included 6 health status variables ( pain , fatigue , activity limitation , health distress , disability , and self-reported global health ) , 4 health behaviors ( aerobic exercise , stretching and strengthening exercise , practice of stress management , and communication with physicians ) , 5 utilization variables ( physician visits , emergency room visits , chiropractic visits , physical therapist visits , and nights in hospital ) , and self-efficacy . RESULTS At 1 year , the intervention group significantly improved in 4 of 6 health status measures and self-efficacy . No significant differences in health behaviors or health care utilization were found . CONCLUSION The Internet-based ASMP proved effective in improving health status measures at 1 year and is a viable alternative to the small-group ASMP OBJECTIVE To determine the effects of participation in a low-impact aerobic exercise program on fatigue , pain , and depression ; to examine whether intervention groups compared with a control group differed on functional ( grip strength and walk time ) and disease activity ( total joint count , erythrocyte sedimentation rate , and C-reactive protein ) measures and aerobic fitness at the end of the intervention ; and to test which factors predicted exercise participation . METHODS A convenience sample of 220 adults with rheumatoid arthritis ( RA ) , ages 40 - 70 , was r and omized to 1 of 3 groups : class exercise , home exercise using a videotape , and control group . Measures were obtained at baseline ( T1 ) , after 6 weeks of exercise ( T2 ) , and after 12 weeks of exercise ( T3 ) . RESULTS Using structural equation modeling , overall symptoms ( latent variable for pain , fatigue , and depression ) decreased significantly at T3 ( P < 0.04 ) for the class exercise group compared with the control group . There were significant interaction effects of time and group for the functional measures of walk time and grip strength : the treatment groups improved more than the control group ( P < or= 0.005 ) . There were no significant increases in measures of disease activity . Fatigue and perceptions of benefits and barriers to exercise affected participants ' amount of exercise , supporting previous research . CONCLUSION This study supported the positive effects of exercise on walk time and grip strength , and demonstrated that fatigue and perceived benefits /barriers to exercise influenced exercise participation . Furthermore , overall symptoms of fatigue , pain , and depression were positively influenced in this selective group of patients with RA ages 40 - 70 years The objective of this RCT was to assess the efficacy of an online pain self-management program with adults who had a self-reported doctor diagnosis of arthritis pain ( N = 228 ) . Participants were recruited via flyers and online postings then r and omized to the experimental condition or the wait-list control condition . Individuals in the experimental condition reported significantly ( 1 ) increased arthritis self-efficacy and ( 2 ) reduced pain catastrophizing from baseline to follow up compared to those in the control condition . High user engagement ( > 204.5 min on the website ) was also significantly associated with improved self-management outcomes . These findings suggest that use of an online self-management program may positively impact self-efficacy and catastrophizing among adults with arthritis pain at 6 month follow up . Nonsignificant findings for hypothesized variables such as pain intensity and health behaviors are also discussed . Future longitudinal research is needed to assess if cognitive changes associated with participation in an online self-management program leads to reduced pain BACKGROUND PAH trials traditionally use 6MW as the primary endpoint . Concerns regarding a " ceiling effect " masking efficacy have led to exclusion of patients with milder disease from most trials ( BL 6MW>450 m ) . STRIDE I evaluated the selective endothelin A receptor antagonist , sitaxsentan ( SITAX ) , in a 12-week r and omized , double-blind , trial ( 178 patients ) employing  placebo ( PBO )  , 100 mg or 300 mg SITAX orally once daily in PAH and included patients with NYHA class II , congenital heart disease and a BL 6MW>450 m , groups often excluded from previous trials . METHODS We analyzed 6MW effects For All Pts ( intention-to treat ) and those meeting Traditional enrollment criteria , defined as patients with NYHA class III or IV and 6MW < or = 450 m at BL with idiopathic PAH or PAH related to connective tissue disease . The 100 mg and 300 mg SITAX arms are pooled based on similar treatment effects on 6MW . CONCLUSION Existence of a " ceiling effect " is supported by these data . The magnitude of the treatment effect and statistical power when using 6MW as the endpoint . Comparisons between PAH trials that do not adjust for the effects of differing enrollment criteria require caution Background Rheumatoid arthritis ( RA ) is chronic systematic disease that affects people during the most productive period of their lives . Web-based health interventions have been effective in many studies ; however , there is little evidence and few studies showing the effectiveness of online social support and especially gamification on patients ’ behavioral and health outcomes . Objective The aim of this study was to look into the effects of a Web-based intervention that included online social support features and gamification on physical activity , health care utilization , medication overuse , empowerment , and RA knowledge of RA patients . The effect of gamification on website use was also investigated . Methods We conducted a 5-arm parallel r and omized controlled trial for RA patients in Ticino ( Italian-speaking part of Switzerl and ) 
    Output:
    
agent
There is very limited evidence for the effectiveness of IDIs on PA and HRQoL in RA and JIA and no evidence for their effectiveness in PsA or AS
***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 : 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 OBJECTIVES To investigate the maintenance of physical activity 12 months after two 1-year Internet-based physical activity interventions in patients with RA . METHODS This follow-up study was a r and omized comparison of an Internet-based individualized training ( IT ) and a general training ( GT ) programme in sedentary RA patients . Outcome measures included physical activity ( meeting public health recommendations for moderate physical activity , i.e. 30 min for at least 5 days/week ; or vigorous physical activity , i.e. 20 min for at least 3 days/week ) , functional ability and quality of life ( QoL ) . RESULTS Of the 152 RA patients who completed the initial study , 110 ( 72 % ) were available at follow-up . At 24 months , the proportions of patients meeting public health recommendations for moderate intensity physical activity were significantly higher compared with baseline in both the IT and GT groups ( 19 and 24 % , respectively , P < 0.05 ) , whereas the proportions of patients meeting the recommendation for vigorous activity was only significantly higher compared with baseline in the IT group ( P < 0.05 ) but not in the GT group . There were no differences between the IT and GT groups concerning proportions of patients meeting moderate or vigorous physical activity recommendations at 24 months . Apart from a significantly higher RAQoL score in the IT group at 24 months compared with baseline , there were no significant differences within or between the programmes regarding functional ability or QoL. CONCLUSION In RA patients , the effectiveness of both an individualized and a general 1-year Internet-based physical activity programme is sustained with respect to moderate intensity physical activity up to 12 months after the interventions Evidence -based medicine integrates clinical expertise , patients ' values and preferences , and the best available evidence from the medical literature . Evidence -based orthopedics is a model to assist surgeons to improve the process of asking questions , obtaining relevant information efficiently , and making informed decisions with patients . With an increasing appreciation for higher levels of evidence , orthopedic surgeons should move away from lower forms of evidence . The adoption of r and omized trials and high- quality prospect i ve studies to guide patient care requires 2 prerequisites : ( 1 ) greater appreciation for the conduct of r and omized trials in orthopedics and ( 2 ) improved education and training in evidence -based method ologies in surgery OBJECTIVE To compare the accuracy of existing classification criteria for the diagnosis of psoriatic arthritis ( PsA ) and to construct new criteria from observed data . METHODS Data were collected prospect ively from consecutive clinic attendees with PsA and other inflammatory arthropathies . Subjects were classified by each of 7 criteria . Sensitivity and specificity were compared using conditional logistic regression analysis . Latent class analysis was used to calculate criteria accuracy in order to confirm the validity of clinical diagnosis as the gold st and ard definition of " case"-ness . Classification and Regression Trees methodology and logistic regression were used to identify items for new criteria , which were then constructed using a receiver operating characteristic curve . RESULTS Data were collected on 588 cases and 536 controls with rheumatoid arthritis ( n = 384 ) , ankylosing spondylitis ( n = 72 ) , undifferentiated arthritis ( n = 38 ) , connective tissue disorders ( n = 14 ) , and other diseases ( n = 28 ) . The specificity of each set of criteria was high . The sensitivity of the Vasey and Espinoza method ( 0.97 ) was similar to that of the method of McGonagle et al ( 0.98 ) and greater than that of the methods of Bennett ( 0.44 ) , Moll and Wright ( 0.91 ) , the European Spondylarthropathy Study Group ( 0.74 ) , and Gladman et al ( 0.91 ) . The CASPAR ( ClASsification criteria for Psoriatic ARthritis ) criteria consisted of established inflammatory articular disease with at least 3 points from the following features : current psoriasis ( assigned a score of 2 ; all other features were assigned a score of 1 ) , a history of psoriasis ( unless current psoriasis was present ) , a family history of psoriasis ( unless current psoriasis was present or there was a history of psoriasis ) , dactylitis , juxtaarticular new bone formation , rheumatoid factor negativity , and nail dystrophy . These criteria were more specific ( 0.987 versus 0.960 ) but less sensitive ( 0.914 versus 0.972 ) than those of Vasey and Espinoza . CONCLUSION The CASPAR criteria are simple and highly specific but less sensitive than the Vasey and Espinoza criteria OBJECTIVE To determine the efficacy of an Internet-based Arthritis Self-Management Program ( ASMP ) as a re source for arthritis patients unable or unwilling to attend small-group ASMPs , which have proven effective in changing health-related behaviors and improving health status measures . METHODS R and omized intervention participants were compared with usual care controls at 6 months and 1 year using repeated- measures analyses of variance . Patients with rheumatoid arthritis , osteoarthritis , or fibromyalgia and Internet and e-mail access ( n = 855 ) were r and omized to an intervention  ( n = 433 ) or  usual care control ( n = 422 ) group . Measures included 6 health status variables ( pain , fatigue , activity limitation , health distress , disability , and self-reported global health ) , 4 health behaviors ( aerobic exercise , stretching and strengthening exercise , practice of stress management , and communication with physicians ) , 5 utilization variables ( physician visits , emergency room visits , chiropractic visits , physical therapist visits , and nights in hospital ) , and self-efficacy . RESULTS At 1 year , the intervention group significantly improved in 4 of 6 health status measures and self-efficacy . No significant differences in health behaviors or health care utilization were found . CONCLUSION The Internet-based ASMP proved effective in improving health status measures at 1 year and is a viable alternative to the small-group ASMP OBJECTIVE To determine the effects of participation in a low-impact aerobic exercise program on fatigue , pain , and depression ; to examine whether intervention groups compared with a control group differed on functional ( grip strength and walk time ) and disease activity ( total joint count , erythrocyte sedimentation rate , and C-reactive protein ) measures and aerobic fitness at the end of the intervention ; and to test which factors predicted exercise participation . METHODS A convenience sample of 220 adults with rheumatoid arthritis ( RA ) , ages 40 - 70 , was r and omized to 1 of 3 groups : class exercise , home exercise using a videotape , and control group . Measures were obtained at baseline ( T1 ) , after 6 weeks of exercise ( T2 ) , and after 12 weeks of exercise ( T3 ) . RESULTS Using structural equation modeling , overall symptoms ( latent variable for pain , fatigue , and depression ) decreased significantly at T3 ( P < 0.04 ) for the class exercise group compared with the control group . There were significant interaction effects of time and group for the functional measures of walk time and grip strength : the treatment groups improved more than the control group ( P < or= 0.005 ) . There were no significant increases in measures of disease activity . Fatigue and perceptions of benefits and barriers to exercise affected participants ' amount of exercise , supporting previous research . CONCLUSION This study supported the positive effects of exercise on walk time and grip strength , and demonstrated that fatigue and perceived benefits /barriers to exercise influenced exercise participation . Furthermore , overall symptoms of fatigue , pain , and depression were positively influenced in this selective group of patients with RA ages 40 - 70 years The objective of this RCT was to assess the efficacy of an online pain self-management program with adults who had a self-reported doctor diagnosis of arthritis pain ( N = 228 ) . Participants were recruited via flyers and online postings then r and omized to the experimental condition or the wait-list control condition . Individuals in the experimental condition reported significantly ( 1 ) increased arthritis self-efficacy and ( 2 ) reduced pain catastrophizing from baseline to follow up compared to those in the control condition . High user engagement ( > 204.5 min on the website ) was also significantly associated with improved self-management outcomes . These findings suggest that use of an online self-management program may positively impact self-efficacy and catastrophizing among adults with arthritis pain at 6 month follow up . Nonsignificant findings for hypothesized variables such as pain intensity and health behaviors are also discussed . Future longitudinal research is needed to assess if cognitive changes associated with participation in an online self-management program leads to reduced pain BACKGROUND PAH trials traditionally use 6MW as the primary endpoint . Concerns regarding a " ceiling effect " masking efficacy have led to exclusion of patients with milder disease from most trials ( BL 6MW>450 m ) . STRIDE I evaluated the selective endothelin A receptor antagonist , sitaxsentan ( SITAX ) , in a 12-week r and omized , double-blind , trial ( 178 patients ) employing  placebo ( PBO )  , 100 mg or 300 mg SITAX orally once daily in PAH and included patients with NYHA class II , congenital heart disease and a BL 6MW>450 m , groups often excluded from previous trials . METHODS We analyzed 6MW effects For All Pts ( intention-to treat ) and those meeting Traditional enrollment criteria , defined as patients with NYHA class III or IV and 6MW < or = 450 m at BL with idiopathic PAH or PAH related to connective tissue disease . The 100 mg and 300 mg SITAX arms are pooled based on similar treatment effects on 6MW . CONCLUSION Existence of a " ceiling effect " is supported by these data . The magnitude of the treatment effect and statistical power when using 6MW as the endpoint . Comparisons between PAH trials that do not adjust for the effects of differing enrollment criteria require caution Background Rheumatoid arthritis ( RA ) is chronic systematic disease that affects people during the most productive period of their lives . Web-based health interventions have been effective in many studies ; however , there is little evidence and few studies showing the effectiveness of online social support and especially gamification on patients ’ behavioral and health outcomes . Objective The aim of this study was to look into the effects of a Web-based intervention that included online social support features and gamification on physical activity , health care utilization , medication overuse , empowerment , and RA knowledge of RA patients . The effect of gamification on website use was also investigated . Methods We conducted a 5-arm parallel r and omized controlled trial for RA patients in Ticino ( Italian-speaking part of Switzerl and ) 
    Output:
    