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: Aim Achieving target recruitment in r and omized controlled trials ( RCTs ) is challenging . This paper compares our experience of recruiting for an RCT with the predictions made in our proposal . Methods Participating UK primary care practice s search ed their computer data bases  to identify patients ( 12 years and over ) with asthma who may be poorly controlled . Postal invitations were sent to all patients identified . Respondees were prescreened by phone , to assess their asthma control and establish their mobile phone suitability . Potentially eligible patients were booked for a trial recruitment visit . Results We recruited 288 patients ( 2.4 % of those invited ) across 32 practice s , with a total list size of 311,926 patients . This compares to our predicted recruitment of 312 patients from a population of 72,000 patients in six to eight practice s. In addition to the recognized problem of poor response rates , the major challenges were insufficiently discriminating computer search es and incompatibilities between mobile phone h and sets , networks and the asthma application . Conclusion Our data have implication s for clinicians , managers , and research ers in primary care . Research ers in this area may wish to consider our data when design ing their recruitment strategies . Improved coding of asthma morbidity data in clinical practice would ease identification of poorly controlled patients , both for clinical interventions and recruitment to trials . If telehealth is to become mainstream , there needs to be st and ardization of applications , operating platforms , and network capabilities Objective To determine whether mobile phone based monitoring improves asthma control compared with st and ard paper based monitoring strategies . Design Multicentre r and omised controlled trial with cost effectiveness analysis . Setting UK primary care . Participants 288 adolescents and adults with poorly controlled asthma ( asthma control question naire ( ACQ ) score ≥1.5 ) from 32 practice s. Intervention Participants were central ly r and omised to twice daily recording and mobile phone based transmission of symptoms , drug use , and peak flow with immediate feedback prompting action according to an agreed plan or paper based monitoring . Main outcome measures Changes in scores on asthma control question naire and self efficacy ( knowledge , attitude , and self efficacy asthma question naire ( KASE-AQ ) ) at six months after r and omisation . Assessment of outcomes was blinded . Analysis was on an intention to treat basis . Results There was no significant difference in the change in asthma control or self efficacy between the two groups ( ACQ : mean change 0.75 in mobile group v 0.73 in paper group , mean difference in change −0.02 ( 95 % confidence interval −0.23 to 0.19 ) ; KASE-AQ score : mean change −4.4 v −2.4 , mean difference 2.0 ( −0.3 to 4.2 ) ) . The numbers of patients who had acute exacerbations , steroid courses , and unscheduled consultations were similar in both groups , with similar healthcare costs . Overall , the mobile phone service was more expensive because of the expenses of telemonitoring . Conclusions Mobile technology does not improve asthma control or increase self efficacy compared with paper based monitoring when both groups received clinical care to guidelines st and ards . The mobile technology was not cost effective . Trial registration Clinical Trials NCT00512837 OBJECTIVE Mobile phone short message service ( SMS ) has been suggested as a potentially powerful tool to improve asthma outcomes , and it can overcome external barriers such as time and distance to participate education programs . We wanted to know whether SMS can help to overcome intrinsic barriers such as perceived control of asthma ( PCA ) . SUBJECTS AND METHODS One hundred fifty out patients with asthma were r and omly assigned to the control , traditional , and SMS groups . Patients in all groups received verbal education based on the Global Initiative for Asthma , and patients in the traditional group received additional individualized asthma action plan for self-management with peak expiratory flow monitoring and recording asthma diary , while patients in the SMS group received additional daily SMS reminders on their mobile phone . The six-item PCA Question naire ( PCAQ-6 ) , St and ard Asthma-Specific Quality of Life [ AQLQ(S ) ] , spirometry , blood and induced sputum cell count , follow-up compliance rate , medicine compliance rate , and emergency department ( ED ) visits data were collected at the initial visit and at 12 weeks . RESULTS In total , 71 participants completed the trial for analysis .  Patients ' PCAQ-6 score was significantly increased in the SMS and traditional groups ( p<0.001 ) after 12 weeks , and the change of patients ' PCAQ-6 score in the SMS group was higher than in the traditional group ( p=0.018 ) . Patients in the SMS group had the highest AQLQ(S ) score and follow-up rate after 12 weeks . The change in PCAQ-6 score was associated with change in AQLQ(S ) score ( r=0.442 ) . Patients in all groups had better forced expiratory volume in 1 s ( FEV1 % ) and fewer ED visits after 12 weeks , but no significant differences were found among the three groups in the changes of FEV1 % and blood and induced sputum eosinophil counts and neutrophil counts . CONCLUSIONS SMS can improve PCA , and it has a greater advantage in improving follow-up rate and asthma-specific quality of life than traditional programs The self-management of asthma can improve clinical outcomes . Recently , mobile telephones have been widely used as an efficient , instant personal communication tool . This study investigated whether a self-care system will achieve better asthma control through a mobile telephone-based interactive programme . This was a prospect i ve , controlled study in outpatient clinics . From 120 consecutive patients with moderate-to-severe persistent asthma , 89 were eventually recruited for the study , with 43 in the mobile telephone group ( with a mobile telephone-based interactive asthma self-care system )  . In the mobile telephone group , mean±sem peak expiratory flow rate significantly increased at 4 ( 378.2±9.3 L·min−1 ; n = 43 ; p = 0.020 ) , 5 ( 378.2±9.2 L·min−1 ; n = 43 ; p = 0.008 ) and 6 months ( 382.7±8.6 L·min−1 ; n = 43 ; p = 0.001 ) compared to the control group . Mean±sem forced expiratory volume in 1 s significantly increased at 6 months ( 65.2±3.2 % predicted ; n = 43 ; p<0.05 ) . Patients in the mobile telephone group had better quality of life after 3 months , as determined using the Short Form-12 ® physical component score , and fewer episodes of exacerbation and unscheduled visits than the control group . Patients in the mobile telephone group significantly increased their mean daily dose of either systemic or inhaled corticosteroids compared with the control group . The mobile telephone-based interactive self-care system provides a convenient and practical self-monitoring and -management of asthma , and improves asthma control Background Long-term asthma management falls short of the goals set by international guidelines . The Internet is proposed as an attractive medium to support guided self-management in asthma . Recently , in a multicenter , pragmatic r and omized controlled parallel trial with a follow-up period of 1 year , patients were allocated Internet-based self-management ( IBSM ) support ( Internet group [ IG ] ) or usual care ( UC ) alone . IBSM support was automatically terminated after 12 months of follow-up . In this study , IBSM support has been demonstrated to improve asthma-related quality of life , asthma control , lung function , and the number of symptom-free days as compared to UC . IBSM support was based on known key components for effective self-management and included weekly asthma control monitoring and treatment advice , online and group education , and communication ( both online and offline ) with a respiratory nurse . Objective The objective of the study was to assess the long-term effects of providing patients 1 year of IBSM support as compared to UC alone . Methods Two hundred adults with physician-diagnosed asthma ( 3 or more months of inhaled corticosteroids prescribed in the past year ) from 37 general practice s and 1 academic outpatient department who previously participated were invited by letter for additional follow-up at 1.5 years after finishing the study . The Asthma Control Question naire ( ACQ ) and the Asthma Quality of Life Question naire ( AQLQ ) were completed by 107 participants ( 60 UC participants and 47 IG participants ) . A minimal clinical important difference in both question naires is 0.5 on a 7-point scale . Results At 30 months after baseline , a sustained and significant difference in terms of asthma-related quality of life of 0.29 ( 95 % CI 0.01 - 0.57 ) and asthma control of -0.33 ( 95 % CI -0.61 to -0.05 ) was found in favor of the IBSM group . No such differences were found for inhaled corticosteroid dosage or for lung function , measured as forced expiratory volume in 1 second . Conclusions Improvements in asthma-related quality of life and asthma control were sustained in patients who received IBSM support for 1 year , even up to 1.5 years after terminating support . Future research should be focused on implementation of IBSM on a wider scale within routine asthma care . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 79864465 ; http://www.controlled-trials.com/IS RCT N79864465 ( Archived by WebCite at http://www.webcitation.org/6J4VHhPk4 ) We have evaluated the feasibility of using the mobile phone short message service ( SMS ) for symptom monitoring in patients with asthma . All consecutive patients admitted to hospital for asthma during an 11-month period were considered for enrolment ( n = 497 ) . Those meeting the inclusion criteria were r and omized into a control ( n = 60 ) and intervention group ( n = 60 ) . Patients in the intervention group received SMS messages according to a structured workflow , while patients in the control group had no SMS support . In the intervention group , the mean response rate to the messages was 82 % . There was an improvement in the Asthma Control Test ( ACT ) scores in 36 subjects in the intervention group compared to 28 subjects in the control group . There were reductions in the number of nebulizations in 54 subjects in the control group compared to 50 subjects in the intervention group , and reductions in emergency department visits in 57 subjects in the control group compared to 51 subjects in the intervention group . However , none of these differences were significant . There was no reduction in admission rates in either group ( P = 0.5 ) . The service was accepted by most patients , but its long-term effectiveness on the management of asthma remains to be determined Background Self-management of asthma may improve asthma outcomes . The Internet has been suggested as a tool for the monitoring and self-management of asthma . However , in a recent study we found that a Web interface had some disadvantages and that users stopped using the application after a short while . Objective The primary objective of this study was to evaluate , from a user perspective , the feasibility of using short message service ( SMS ) for asthma diary data collection through mobile phones . The secondary objective was to investigate patient compliance with an  SMS diary  , as measured by response rates over time . Methods The study included quantitative response rate data , based on SMS collection , and qualitative data from a traditional focus group setting . In a period of 2 months , the participants received 4 SMS messages each day , including a medication reminder , a request to enter peak flow , data on sleep loss , and medication dosage . Participants were asked to reply to a minimum of 3 of the messages per day . Diary inputs were collected in a data base and the response rate per patient was expressed as the number of diary inputs ( SMS replies ) divided by diary requests ( product of number of days in the study and the number of diary questions per day ) for each participant . After the study period , the participants were invited to a focus group interview addressing the participants ' attitudes to their disease , their experience with the SMS asthma diary , and their future expectations from the SMS asthma diary . Results Twelve patients with asthma ( 6 males , 6 females ) participated in the data collection study . The median age was 38.5 ( range : 13 – 57 ) years . The median response rate per patient was 0.69 ( range : 0.03 – 0.98 ) , ie , half the participants reported more than about two thirds of the requested diary data . Furthermore , response rates were relatively steady during the study period with no signs of decreasing usage over time . From the subsequent focus group interview with 9 users we learned that , in general , the participants were enthusiastic about the SMS diary – it became an integrated part of their everyday life . However , the participants wished for a simpler diary with only one SMS message to respond to and a system with a Web interface for system customization and graphical display of diary data history . Conclusion This study suggests that SMS collection of asthma diary data is feasible , and that SMS may be a tool for supporting the self-management of asthma ( and possibly other chronic diseases ) in motivated and self-efficacious patients because mobile phones are a part of people 's everyday lives and enable active requests for data wherever the patient is . The combination of SMS data collection and a traditional Web page for data display and system customization may be a better and more usable tool for patients than the use of Web-based asthma diaries which suffer from high attrition rates Home peak expiratory flow ( PEF ) measurement is recommended by asthma guidelines . In a 16-week r and omized controlled study on 16 subjects with asthma ( 24.6 6.5 years old , asthma duration small ze , Cyrillic 6 months ) , we examined Global System for 
    Output:
    
agent
***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: Aim Achieving target recruitment in r and omized controlled trials ( RCTs ) is challenging . This paper compares our experience of recruiting for an RCT with the predictions made in our proposal . Methods Participating UK primary care practice s search ed their computer data bases  to identify patients ( 12 years and over ) with asthma who may be poorly controlled . Postal invitations were sent to all patients identified . Respondees were prescreened by phone , to assess their asthma control and establish their mobile phone suitability . Potentially eligible patients were booked for a trial recruitment visit . Results We recruited 288 patients ( 2.4 % of those invited ) across 32 practice s , with a total list size of 311,926 patients . This compares to our predicted recruitment of 312 patients from a population of 72,000 patients in six to eight practice s. In addition to the recognized problem of poor response rates , the major challenges were insufficiently discriminating computer search es and incompatibilities between mobile phone h and sets , networks and the asthma application . Conclusion Our data have implication s for clinicians , managers , and research ers in primary care . Research ers in this area may wish to consider our data when design ing their recruitment strategies . Improved coding of asthma morbidity data in clinical practice would ease identification of poorly controlled patients , both for clinical interventions and recruitment to trials . If telehealth is to become mainstream , there needs to be st and ardization of applications , operating platforms , and network capabilities Objective To determine whether mobile phone based monitoring improves asthma control compared with st and ard paper based monitoring strategies . Design Multicentre r and omised controlled trial with cost effectiveness analysis . Setting UK primary care . Participants 288 adolescents and adults with poorly controlled asthma ( asthma control question naire ( ACQ ) score ≥1.5 ) from 32 practice s. Intervention Participants were central ly r and omised to twice daily recording and mobile phone based transmission of symptoms , drug use , and peak flow with immediate feedback prompting action according to an agreed plan or paper based monitoring . Main outcome measures Changes in scores on asthma control question naire and self efficacy ( knowledge , attitude , and self efficacy asthma question naire ( KASE-AQ ) ) at six months after r and omisation . Assessment of outcomes was blinded . Analysis was on an intention to treat basis . Results There was no significant difference in the change in asthma control or self efficacy between the two groups ( ACQ : mean change 0.75 in mobile group v 0.73 in paper group , mean difference in change −0.02 ( 95 % confidence interval −0.23 to 0.19 ) ; KASE-AQ score : mean change −4.4 v −2.4 , mean difference 2.0 ( −0.3 to 4.2 ) ) . The numbers of patients who had acute exacerbations , steroid courses , and unscheduled consultations were similar in both groups , with similar healthcare costs . Overall , the mobile phone service was more expensive because of the expenses of telemonitoring . Conclusions Mobile technology does not improve asthma control or increase self efficacy compared with paper based monitoring when both groups received clinical care to guidelines st and ards . The mobile technology was not cost effective . Trial registration Clinical Trials NCT00512837 OBJECTIVE Mobile phone short message service ( SMS ) has been suggested as a potentially powerful tool to improve asthma outcomes , and it can overcome external barriers such as time and distance to participate education programs . We wanted to know whether SMS can help to overcome intrinsic barriers such as perceived control of asthma ( PCA ) . SUBJECTS AND METHODS One hundred fifty out patients with asthma were r and omly assigned to the control , traditional , and SMS groups . Patients in all groups received verbal education based on the Global Initiative for Asthma , and patients in the traditional group received additional individualized asthma action plan for self-management with peak expiratory flow monitoring and recording asthma diary , while patients in the SMS group received additional daily SMS reminders on their mobile phone . The six-item PCA Question naire ( PCAQ-6 ) , St and ard Asthma-Specific Quality of Life [ AQLQ(S ) ] , spirometry , blood and induced sputum cell count , follow-up compliance rate , medicine compliance rate , and emergency department ( ED ) visits data were collected at the initial visit and at 12 weeks . RESULTS In total , 71 participants completed the trial for analysis .  Patients ' PCAQ-6 score was significantly increased in the SMS and traditional groups ( p<0.001 ) after 12 weeks , and the change of patients ' PCAQ-6 score in the SMS group was higher than in the traditional group ( p=0.018 ) . Patients in the SMS group had the highest AQLQ(S ) score and follow-up rate after 12 weeks . The change in PCAQ-6 score was associated with change in AQLQ(S ) score ( r=0.442 ) . Patients in all groups had better forced expiratory volume in 1 s ( FEV1 % ) and fewer ED visits after 12 weeks , but no significant differences were found among the three groups in the changes of FEV1 % and blood and induced sputum eosinophil counts and neutrophil counts . CONCLUSIONS SMS can improve PCA , and it has a greater advantage in improving follow-up rate and asthma-specific quality of life than traditional programs The self-management of asthma can improve clinical outcomes . Recently , mobile telephones have been widely used as an efficient , instant personal communication tool . This study investigated whether a self-care system will achieve better asthma control through a mobile telephone-based interactive programme . This was a prospect i ve , controlled study in outpatient clinics . From 120 consecutive patients with moderate-to-severe persistent asthma , 89 were eventually recruited for the study , with 43 in the mobile telephone group ( with a mobile telephone-based interactive asthma self-care system )  . In the mobile telephone group , mean±sem peak expiratory flow rate significantly increased at 4 ( 378.2±9.3 L·min−1 ; n = 43 ; p = 0.020 ) , 5 ( 378.2±9.2 L·min−1 ; n = 43 ; p = 0.008 ) and 6 months ( 382.7±8.6 L·min−1 ; n = 43 ; p = 0.001 ) compared to the control group . Mean±sem forced expiratory volume in 1 s significantly increased at 6 months ( 65.2±3.2 % predicted ; n = 43 ; p<0.05 ) . Patients in the mobile telephone group had better quality of life after 3 months , as determined using the Short Form-12 ® physical component score , and fewer episodes of exacerbation and unscheduled visits than the control group . Patients in the mobile telephone group significantly increased their mean daily dose of either systemic or inhaled corticosteroids compared with the control group . The mobile telephone-based interactive self-care system provides a convenient and practical self-monitoring and -management of asthma , and improves asthma control Background Long-term asthma management falls short of the goals set by international guidelines . The Internet is proposed as an attractive medium to support guided self-management in asthma . Recently , in a multicenter , pragmatic r and omized controlled parallel trial with a follow-up period of 1 year , patients were allocated Internet-based self-management ( IBSM ) support ( Internet group [ IG ] ) or usual care ( UC ) alone . IBSM support was automatically terminated after 12 months of follow-up . In this study , IBSM support has been demonstrated to improve asthma-related quality of life , asthma control , lung function , and the number of symptom-free days as compared to UC . IBSM support was based on known key components for effective self-management and included weekly asthma control monitoring and treatment advice , online and group education , and communication ( both online and offline ) with a respiratory nurse . Objective The objective of the study was to assess the long-term effects of providing patients 1 year of IBSM support as compared to UC alone . Methods Two hundred adults with physician-diagnosed asthma ( 3 or more months of inhaled corticosteroids prescribed in the past year ) from 37 general practice s and 1 academic outpatient department who previously participated were invited by letter for additional follow-up at 1.5 years after finishing the study . The Asthma Control Question naire ( ACQ ) and the Asthma Quality of Life Question naire ( AQLQ ) were completed by 107 participants ( 60 UC participants and 47 IG participants ) . A minimal clinical important difference in both question naires is 0.5 on a 7-point scale . Results At 30 months after baseline , a sustained and significant difference in terms of asthma-related quality of life of 0.29 ( 95 % CI 0.01 - 0.57 ) and asthma control of -0.33 ( 95 % CI -0.61 to -0.05 ) was found in favor of the IBSM group . No such differences were found for inhaled corticosteroid dosage or for lung function , measured as forced expiratory volume in 1 second . Conclusions Improvements in asthma-related quality of life and asthma control were sustained in patients who received IBSM support for 1 year , even up to 1.5 years after terminating support . Future research should be focused on implementation of IBSM on a wider scale within routine asthma care . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 79864465 ; http://www.controlled-trials.com/IS RCT N79864465 ( Archived by WebCite at http://www.webcitation.org/6J4VHhPk4 ) We have evaluated the feasibility of using the mobile phone short message service ( SMS ) for symptom monitoring in patients with asthma . All consecutive patients admitted to hospital for asthma during an 11-month period were considered for enrolment ( n = 497 ) . Those meeting the inclusion criteria were r and omized into a control ( n = 60 ) and intervention group ( n = 60 ) . Patients in the intervention group received SMS messages according to a structured workflow , while patients in the control group had no SMS support . In the intervention group , the mean response rate to the messages was 82 % . There was an improvement in the Asthma Control Test ( ACT ) scores in 36 subjects in the intervention group compared to 28 subjects in the control group . There were reductions in the number of nebulizations in 54 subjects in the control group compared to 50 subjects in the intervention group , and reductions in emergency department visits in 57 subjects in the control group compared to 51 subjects in the intervention group . However , none of these differences were significant . There was no reduction in admission rates in either group ( P = 0.5 ) . The service was accepted by most patients , but its long-term effectiveness on the management of asthma remains to be determined Background Self-management of asthma may improve asthma outcomes . The Internet has been suggested as a tool for the monitoring and self-management of asthma . However , in a recent study we found that a Web interface had some disadvantages and that users stopped using the application after a short while . Objective The primary objective of this study was to evaluate , from a user perspective , the feasibility of using short message service ( SMS ) for asthma diary data collection through mobile phones . The secondary objective was to investigate patient compliance with an  SMS diary  , as measured by response rates over time . Methods The study included quantitative response rate data , based on SMS collection , and qualitative data from a traditional focus group setting . In a period of 2 months , the participants received 4 SMS messages each day , including a medication reminder , a request to enter peak flow , data on sleep loss , and medication dosage . Participants were asked to reply to a minimum of 3 of the messages per day . Diary inputs were collected in a data base and the response rate per patient was expressed as the number of diary inputs ( SMS replies ) divided by diary requests ( product of number of days in the study and the number of diary questions per day ) for each participant . After the study period , the participants were invited to a focus group interview addressing the participants ' attitudes to their disease , their experience with the SMS asthma diary , and their future expectations from the SMS asthma diary . Results Twelve patients with asthma ( 6 males , 6 females ) participated in the data collection study . The median age was 38.5 ( range : 13 – 57 ) years . The median response rate per patient was 0.69 ( range : 0.03 – 0.98 ) , ie , half the participants reported more than about two thirds of the requested diary data . Furthermore , response rates were relatively steady during the study period with no signs of decreasing usage over time . From the subsequent focus group interview with 9 users we learned that , in general , the participants were enthusiastic about the SMS diary – it became an integrated part of their everyday life . However , the participants wished for a simpler diary with only one SMS message to respond to and a system with a Web interface for system customization and graphical display of diary data history . Conclusion This study suggests that SMS collection of asthma diary data is feasible , and that SMS may be a tool for supporting the self-management of asthma ( and possibly other chronic diseases ) in motivated and self-efficacious patients because mobile phones are a part of people 's everyday lives and enable active requests for data wherever the patient is . The combination of SMS data collection and a traditional Web page for data display and system customization may be a better and more usable tool for patients than the use of Web-based asthma diaries which suffer from high attrition rates Home peak expiratory flow ( PEF ) measurement is recommended by asthma guidelines . In a 16-week r and omized controlled study on 16 subjects with asthma ( 24.6 6.5 years old , asthma duration small ze , Cyrillic 6 months ) , we examined Global System for 
    Output:
    