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 : Cancer patients experience many physical and psychosocial problems for which they need support . WebChoice is an Internet-based , interactive health communication application that allows cancer patients to monitor their symptoms and problems , provides individually tailored information and self-management support , e-communication with expert cancer nurses , and an e-forum for group discussion with other patients . Objective : The objective of this study was to examine the effects of WebChoice on symptom distress ( primary outcome ) , depression , self-efficacy , health-related quality of life , and social support ( secondary outcomes ) . Methods : In this 1-year repeated- measures r and omized controlled trial , 325 breast and prostate cancer patients were r and omized into 1 experimental group  with access to WebChoice and 1 control group who received URLs of publicly available cancer Web sites . Results : Group differences on symptom distress were significant only for the global symptom distress index on the Memorial Symptom Assessment Scale ( slope estimate , −0.052 [ 95 % confidence interval , −0.101 to −0.004 ] ; t = 4.42 ; P = .037 ) . There were no significant group differences on secondary outcomes . Additional analyses showed significant within-group improvements in depression in the experimental group only . In the control group , self-efficacy and health-related quality of life deteriorated significantly over time . Conclusion : This r and omized controlled trial is one of the first to evaluate effects of an interactive health communication application to support cancer patients in illness management on symptoms . Although only 1 hypothesis was partially supported , the combined results show a clear trend toward better scores in the intervention group on most outcome measures . Implication s for Practice : If findings can be supported with additional research , WebChoice may become an important tool to support nursing care that can equip cancer patients to better manage their illness This longitudinal study evaluated the effect a prostate cancer-specific online support group had for self-assessed quality of life .  Participants ( N = 40 ) were r and omly assigned to an online support group or the control group . Data consisted of four previously vali date d quality -of-life measurements . Analysis determined that over time , quality of life improved for those in the online group and decreased for those in the control group , but returned to baseline at eight weeks . Providing support using online methods is effective ; the length of time this intervention should be provided to patients will require further research BACKGROUND Telemedicine in an ambulatory surgical population remains incompletely evaluated . OBJECTIVE To investigate patient encounters in the outpatient setting using video visit ( VV ) technology compared to traditional office visits ( OVs ) . DESIGN , SETTING , AND PARTICIPANTS From June 2013 to March 2014 , 55 prescreened men with a history of prostate cancer were prospect ively r and omized . VVs , with the patient at home or at work , were included in the outpatient clinic calendar of urologists . INTERVENTION Remote VV versus traditional OV . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS An equivalence analysis was used to assess the primary outcome , visit efficiency as measured by time studies . Secondary outcomes were patient/provider satisfaction and costs . RESULTS AND LIMITATIONS There were 28 VVs and 27 OVs . VVs were equivalent in efficiency to relative to OVs , as measured by patient-provider face time ( mean 14.5 vs 14.3min ; p=0.96 ) , patient wait time ( 18.4 vs 13.0min ; p=0.20 ) , and total time devoted to care ( 17.9 vs 17.8min ; p=0.97 ) . There were no significant differences in patient perception of visit confidentiality , efficiency , education quality , or overall satisfaction . VVs incurred lower costs , including distance traveled ( median 0 vs 95 miles ) , travel time ( 0 vs 95min ) , missed work ( 0 vs 1 d ) , and money spent on travel ( $ 0 vs $ 48 ; all p<0.0001 ) . There was a high level of urologist satisfaction for both VVs ( 88 % ) and OVs ( 90 % ) . The major limitation was sample size . CONCLUSIONS VV in the ambulatory postprostatectomy setting may have a future role in health care delivery models . We found equivalent efficiency , similar satisfaction , but significantly reduced patient costs for VV compared to OV . Further prospect i ve analyses are warranted . PATIENT SUMMARY Among men with surgically treated prostate cancer , we evaluated the utility of remote video visits compared to office visits for outpatient consultation with a urologist . Video visits were associated with equivalent efficiency , similar satisfaction , and significantly lower patient costs when compared to office visits . We conclude that video visits may have a future role in health care delivery models OBJECTIVE The purpose of this trial was to compare usual patient education plus the Internet-based Personal Patient Profile-Prostate , vs. usual education alone , on conflict associated with decision making , plus explore time-to-treatment , and treatment choice . METHODS A r and omized , multi-center clinical trial was conducted with measures at baseline , 1- , and 6 months . Men with newly diagnosed localized prostate cancer ( CaP ) who sought consultation at urology , radiation oncology , or multi-disciplinary clinics in 4 geographically-distinct American cities were recruited . Intervention group participants used the Personal Patient Profile-Prostate , a decision support system comprised of customized text and video coaching regarding potential outcomes , influential factors , and communication with care providers . The primary outcome , patient-reported decisional conflict , was evaluated over time using generalized estimating equations to fit generalized linear models . Additional outcomes , time-to-treatment , treatment choice , and program acceptability/usefulness , were explored . RESULTS A total of 494 eligible men were r and omized ( 266 intervention ; 228 control ) . The intervention reduced adjusted decisional conflict over time compared with the control group , for the uncertainty score ( estimate -3.61 ; ( confidence interval , -7.01 , 0.22 ) , and values clarity ( estimate -3.57 ; confidence interval ( -5.85,-1.30 ) . Borderline effect was seen for the total decisional conflict score ( estimate -1.75 ; confidence interval ( -3.61,0.11 ) . Time-to-treatment was comparable between groups , while undecided men in the intervention group chose brachytherapy more often than in the control group . Acceptability and usefulness were highly rated . CONCLUSION The Personal Patient Profile-Prostate is the first intervention to significantly reduce decisional conflict in a multi-center trial of American men with newly diagnosed localized CaP. Our findings support efficacy of P3P for addressing decision uncertainty and facilitating patient selection of a CaP treatment that is consistent with the patient values and preferences Background Prostate cancer is the most common cancer affecting men in the United States . Management options for localized disease exist , yet an evidence -based criterion st and ard for treatment still has to emerge . Although 5-year survival rates approach 98 % , all treatment options carry the possibility for significant side effects , such as erectile dysfunction and urinary incontinence . It is therefore recommended that patients be actively involved in the treatment decision process . We have developed an Internet/CD-ROM-based multimedia Prostate Interactive Educational System ( PIES ) to enhance patients ’ treatment decision making . PIES virtually mirrors a health center to provide patients with information about prostate cancer and its treatment through an intuitive interface , using videos , animations , graphics , and texts . Objectives ( 1 ) To examine the acceptability and feasibility of the PIES intervention and to report preliminary outcomes of the program in a pilot trial among patients with a new prostate cancer diagnosis , and ( 2 ) to explore the potential impact of tailoring PIES treatment information to participants ’ information-seeking styles on study outcomes . Methods Participants ( n = 72 ) were patients with newly diagnosed localized prostate cancer who had not made a treatment decision . Patients were r and omly assigned to 3 experimental conditions : ( 1 ) control condition ( providing information through st and ard National Cancer Institute brochures ; 26 % ) , and PIES ( 2 ) with tailoring ( 43 % ) and ( 3 ) without tailoring to a patient ’s information-seeking style ( 31 % ) . Question naires were administrated before ( t1 ) and immediately after the intervention ( t2 ) . Measurements include evaluation and acceptability of the PIES intervention , monitoring/blunting information-seeking style , psychological distress , and decision-related variables ( eg , decisional confidence , feeling informed about prostate cancer and treatment , and treatment preference ) . Results The PIES program was well accepted by patients and did not interfere with the clinical routine . About 79 % of eligible patients ( 72/91 ) completed the pre- and post-PIES intervention assessment s. Patients in the PIES groups compared with those in the control condition were significantly more likely to report higher levels of confidence in their treatment choices , higher levels of helpfulness of the information they received in making a treatment decision , and that the information they received was emotionally reassuring . Patients in the PIES groups compared with those in the control condition were significantly less likely to need more information about treatment options , were less anxious about their treatment choices , and thought the information they received was clear ( P < .05 ) . Tailoring PIES information to information-seeking style was not related to decision-making variables . Conclusions This pilot study confirms that the implementation of PIES within a clinical practice is feasible and acceptable to patients with a recent diagnosis of prostate cancer . PIES improved key decision-making process variables and reduced the emotional impact of a difficult medical decision Purpose Many prostate cancer survivors experience compromised health-related quality of life ( HRQOL ) as a result of prostate cancer . We examined relationships between types and intensities of activity and sedentary behavior  and prostate cancer-related HRQOL , overall , and by demographic , disease , and treatment characteristics . Methods Associations between post-diagnosis activity and sedentary behavior  and HRQOL domains ( urinary incontinence , urinary irritation/obstruction , bowel , sexual , and vitality/hormonal ) were prospect ively examined in men diagnosed with non-metastatic prostate cancer in the Health Professionals Follow-up Study ( n = 1917 ) using generalized linear models . Results After adjusting for potential confounders , higher duration of total , non-vigorous , and walking activity was associated with higher vitality/hormonal functioning scores ( p-trends , < 0.0001 ) . Effects were small ( d = 0.16–0.20 ) but approached clinical significance for men in the highest vs. lowest activity categories . Survivors who walked ≥90 min/week at a normal pace , or faster , reported higher hormone/vitality scores ( p = 0.001 ) than men walking < 90 min at an easy pace . Weightlifting was associated with increased urinary incontinence ( p-trend , 0.02 ) . Total activity was associated with higher hormone/vitality functioning in men who were ≥5 years post-treatment , had more advanced disease ( Gleason score ≥7 ) , and had ≥1 comorbid condition . No relationships were observed between vigorous activity or sedentary behavior and HRQOL . Conclusions Increased duration of  non-vigorous  activity and walking post-diagnosis was positively associated with better hormone/vitality functioning . Specifically , engaging in ≥5 h of non-vigorous activity or ≥3 h of walking per week may be beneficial . Implication s for Cancer SurvivorsEncouraging men to engage in non-vigorous activity and walking may be helpful for managing prostate cancer-related HRQOL Purpose When faced with a significant recruitment challenge for three nationwide psychoeducational trials targeting prostate and breast cancer patients , the Cancer Information Service Research Consortium initiated outreach efforts to increase accrual . Recruitment is reported by major outreach strategy to inform the use of similar campaigns , either as primary recruitment efforts or to supplement “ in-reach ” recruitment within oncology setting s. Methods During a 33-month period , recruitment was tracked from the National Cancer Institute ’s Cancer Information Service ( CIS ) , the American Cancer Society ( ACS ) , Dr. Susan Love Research Foundation ’s Love/Avon Army of Women ( AOW ) , Internet advertising , press releases , radio/television interviews , recruitment material s in community venues , and outreach to churches and cancer support organizations . Results Across projects , the majority ( 89 % ) of recruited participants ( N = 2,134 ) was obtained from the CIS ( n = 901 , 19 months of recruitment ) , AOW ( n = 869 , 18 months ) , and ACS ( n = 123 , 12 months ) . Other efforts showed minimal gain in recruitment . Conclusions Cancer information programs ( e.g. , CIS and ACS ) and registries of individuals willing to participate in cancer-related research ( e.g. , AOW ) can represent exceptional re sources for outreach recruitment of cancer patients , especially when the eligibility criteria are highly restrictive . However , these re sources do not yield sample s representative of the larger population of adults diagnosed with cancer , and conclusions from such trials must be tempered accordingly . Implication s for cancer survivorsInadequate recruitment to r and omized controlled trials limits the creation of useful interventions for cancer survivors . By enrolling in cancer registries and taking part in research , cancer survivors can contribute to the development of effective re sources for the survivor population Background According to the CONSORT statement , significance testing of baseline differences in r and omized controlled trials should not be performed . In fact , this practice has been discouraged by numerous authors throughout the last forty years . During that time span , reporting of baseline differences has substantially decreased in the leading general medical journals . Our own experience in the field of nutrition behavior research however , is that co- authors , review ers and even editors are still very persistent in their dem and for these tests . The aim of this paper is therefore to negate this dem and by providing clear evidence as to why testing for baseline differences between intervention groups statistically is superfluous and 
    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: Background : Cancer patients experience many physical and psychosocial problems for which they need support . WebChoice is an Internet-based , interactive health communication application that allows cancer patients to monitor their symptoms and problems , provides individually tailored information and self-management support , e-communication with expert cancer nurses , and an e-forum for group discussion with other patients . Objective : The objective of this study was to examine the effects of WebChoice on symptom distress ( primary outcome ) , depression , self-efficacy , health-related quality of life , and social support ( secondary outcomes ) . Methods : In this 1-year repeated- measures r and omized controlled trial , 325 breast and prostate cancer patients were r and omized into 1 experimental group  with access to WebChoice and 1 control group who received URLs of publicly available cancer Web sites . Results : Group differences on symptom distress were significant only for the global symptom distress index on the Memorial Symptom Assessment Scale ( slope estimate , −0.052 [ 95 % confidence interval , −0.101 to −0.004 ] ; t = 4.42 ; P = .037 ) . There were no significant group differences on secondary outcomes . Additional analyses showed significant within-group improvements in depression in the experimental group only . In the control group , self-efficacy and health-related quality of life deteriorated significantly over time . Conclusion : This r and omized controlled trial is one of the first to evaluate effects of an interactive health communication application to support cancer patients in illness management on symptoms . Although only 1 hypothesis was partially supported , the combined results show a clear trend toward better scores in the intervention group on most outcome measures . Implication s for Practice : If findings can be supported with additional research , WebChoice may become an important tool to support nursing care that can equip cancer patients to better manage their illness This longitudinal study evaluated the effect a prostate cancer-specific online support group had for self-assessed quality of life .  Participants ( N = 40 ) were r and omly assigned to an online support group or the control group . Data consisted of four previously vali date d quality -of-life measurements . Analysis determined that over time , quality of life improved for those in the online group and decreased for those in the control group , but returned to baseline at eight weeks . Providing support using online methods is effective ; the length of time this intervention should be provided to patients will require further research BACKGROUND Telemedicine in an ambulatory surgical population remains incompletely evaluated . OBJECTIVE To investigate patient encounters in the outpatient setting using video visit ( VV ) technology compared to traditional office visits ( OVs ) . DESIGN , SETTING , AND PARTICIPANTS From June 2013 to March 2014 , 55 prescreened men with a history of prostate cancer were prospect ively r and omized . VVs , with the patient at home or at work , were included in the outpatient clinic calendar of urologists . INTERVENTION Remote VV versus traditional OV . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS An equivalence analysis was used to assess the primary outcome , visit efficiency as measured by time studies . Secondary outcomes were patient/provider satisfaction and costs . RESULTS AND LIMITATIONS There were 28 VVs and 27 OVs . VVs were equivalent in efficiency to relative to OVs , as measured by patient-provider face time ( mean 14.5 vs 14.3min ; p=0.96 ) , patient wait time ( 18.4 vs 13.0min ; p=0.20 ) , and total time devoted to care ( 17.9 vs 17.8min ; p=0.97 ) . There were no significant differences in patient perception of visit confidentiality , efficiency , education quality , or overall satisfaction . VVs incurred lower costs , including distance traveled ( median 0 vs 95 miles ) , travel time ( 0 vs 95min ) , missed work ( 0 vs 1 d ) , and money spent on travel ( $ 0 vs $ 48 ; all p<0.0001 ) . There was a high level of urologist satisfaction for both VVs ( 88 % ) and OVs ( 90 % ) . The major limitation was sample size . CONCLUSIONS VV in the ambulatory postprostatectomy setting may have a future role in health care delivery models . We found equivalent efficiency , similar satisfaction , but significantly reduced patient costs for VV compared to OV . Further prospect i ve analyses are warranted . PATIENT SUMMARY Among men with surgically treated prostate cancer , we evaluated the utility of remote video visits compared to office visits for outpatient consultation with a urologist . Video visits were associated with equivalent efficiency , similar satisfaction , and significantly lower patient costs when compared to office visits . We conclude that video visits may have a future role in health care delivery models OBJECTIVE The purpose of this trial was to compare usual patient education plus the Internet-based Personal Patient Profile-Prostate , vs. usual education alone , on conflict associated with decision making , plus explore time-to-treatment , and treatment choice . METHODS A r and omized , multi-center clinical trial was conducted with measures at baseline , 1- , and 6 months . Men with newly diagnosed localized prostate cancer ( CaP ) who sought consultation at urology , radiation oncology , or multi-disciplinary clinics in 4 geographically-distinct American cities were recruited . Intervention group participants used the Personal Patient Profile-Prostate , a decision support system comprised of customized text and video coaching regarding potential outcomes , influential factors , and communication with care providers . The primary outcome , patient-reported decisional conflict , was evaluated over time using generalized estimating equations to fit generalized linear models . Additional outcomes , time-to-treatment , treatment choice , and program acceptability/usefulness , were explored . RESULTS A total of 494 eligible men were r and omized ( 266 intervention ; 228 control ) . The intervention reduced adjusted decisional conflict over time compared with the control group , for the uncertainty score ( estimate -3.61 ; ( confidence interval , -7.01 , 0.22 ) , and values clarity ( estimate -3.57 ; confidence interval ( -5.85,-1.30 ) . Borderline effect was seen for the total decisional conflict score ( estimate -1.75 ; confidence interval ( -3.61,0.11 ) . Time-to-treatment was comparable between groups , while undecided men in the intervention group chose brachytherapy more often than in the control group . Acceptability and usefulness were highly rated . CONCLUSION The Personal Patient Profile-Prostate is the first intervention to significantly reduce decisional conflict in a multi-center trial of American men with newly diagnosed localized CaP. Our findings support efficacy of P3P for addressing decision uncertainty and facilitating patient selection of a CaP treatment that is consistent with the patient values and preferences Background Prostate cancer is the most common cancer affecting men in the United States . Management options for localized disease exist , yet an evidence -based criterion st and ard for treatment still has to emerge . Although 5-year survival rates approach 98 % , all treatment options carry the possibility for significant side effects , such as erectile dysfunction and urinary incontinence . It is therefore recommended that patients be actively involved in the treatment decision process . We have developed an Internet/CD-ROM-based multimedia Prostate Interactive Educational System ( PIES ) to enhance patients ’ treatment decision making . PIES virtually mirrors a health center to provide patients with information about prostate cancer and its treatment through an intuitive interface , using videos , animations , graphics , and texts . Objectives ( 1 ) To examine the acceptability and feasibility of the PIES intervention and to report preliminary outcomes of the program in a pilot trial among patients with a new prostate cancer diagnosis , and ( 2 ) to explore the potential impact of tailoring PIES treatment information to participants ’ information-seeking styles on study outcomes . Methods Participants ( n = 72 ) were patients with newly diagnosed localized prostate cancer who had not made a treatment decision . Patients were r and omly assigned to 3 experimental conditions : ( 1 ) control condition ( providing information through st and ard National Cancer Institute brochures ; 26 % ) , and PIES ( 2 ) with tailoring ( 43 % ) and ( 3 ) without tailoring to a patient ’s information-seeking style ( 31 % ) . Question naires were administrated before ( t1 ) and immediately after the intervention ( t2 ) . Measurements include evaluation and acceptability of the PIES intervention , monitoring/blunting information-seeking style , psychological distress , and decision-related variables ( eg , decisional confidence , feeling informed about prostate cancer and treatment , and treatment preference ) . Results The PIES program was well accepted by patients and did not interfere with the clinical routine . About 79 % of eligible patients ( 72/91 ) completed the pre- and post-PIES intervention assessment s. Patients in the PIES groups compared with those in the control condition were significantly more likely to report higher levels of confidence in their treatment choices , higher levels of helpfulness of the information they received in making a treatment decision , and that the information they received was emotionally reassuring . Patients in the PIES groups compared with those in the control condition were significantly less likely to need more information about treatment options , were less anxious about their treatment choices , and thought the information they received was clear ( P < .05 ) . Tailoring PIES information to information-seeking style was not related to decision-making variables . Conclusions This pilot study confirms that the implementation of PIES within a clinical practice is feasible and acceptable to patients with a recent diagnosis of prostate cancer . PIES improved key decision-making process variables and reduced the emotional impact of a difficult medical decision Purpose Many prostate cancer survivors experience compromised health-related quality of life ( HRQOL ) as a result of prostate cancer . We examined relationships between types and intensities of activity and sedentary behavior  and prostate cancer-related HRQOL , overall , and by demographic , disease , and treatment characteristics . Methods Associations between post-diagnosis activity and sedentary behavior  and HRQOL domains ( urinary incontinence , urinary irritation/obstruction , bowel , sexual , and vitality/hormonal ) were prospect ively examined in men diagnosed with non-metastatic prostate cancer in the Health Professionals Follow-up Study ( n = 1917 ) using generalized linear models . Results After adjusting for potential confounders , higher duration of total , non-vigorous , and walking activity was associated with higher vitality/hormonal functioning scores ( p-trends , < 0.0001 ) . Effects were small ( d = 0.16–0.20 ) but approached clinical significance for men in the highest vs. lowest activity categories . Survivors who walked ≥90 min/week at a normal pace , or faster , reported higher hormone/vitality scores ( p = 0.001 ) than men walking < 90 min at an easy pace . Weightlifting was associated with increased urinary incontinence ( p-trend , 0.02 ) . Total activity was associated with higher hormone/vitality functioning in men who were ≥5 years post-treatment , had more advanced disease ( Gleason score ≥7 ) , and had ≥1 comorbid condition . No relationships were observed between vigorous activity or sedentary behavior and HRQOL . Conclusions Increased duration of  non-vigorous  activity and walking post-diagnosis was positively associated with better hormone/vitality functioning . Specifically , engaging in ≥5 h of non-vigorous activity or ≥3 h of walking per week may be beneficial . Implication s for Cancer SurvivorsEncouraging men to engage in non-vigorous activity and walking may be helpful for managing prostate cancer-related HRQOL Purpose When faced with a significant recruitment challenge for three nationwide psychoeducational trials targeting prostate and breast cancer patients , the Cancer Information Service Research Consortium initiated outreach efforts to increase accrual . Recruitment is reported by major outreach strategy to inform the use of similar campaigns , either as primary recruitment efforts or to supplement “ in-reach ” recruitment within oncology setting s. Methods During a 33-month period , recruitment was tracked from the National Cancer Institute ’s Cancer Information Service ( CIS ) , the American Cancer Society ( ACS ) , Dr. Susan Love Research Foundation ’s Love/Avon Army of Women ( AOW ) , Internet advertising , press releases , radio/television interviews , recruitment material s in community venues , and outreach to churches and cancer support organizations . Results Across projects , the majority ( 89 % ) of recruited participants ( N = 2,134 ) was obtained from the CIS ( n = 901 , 19 months of recruitment ) , AOW ( n = 869 , 18 months ) , and ACS ( n = 123 , 12 months ) . Other efforts showed minimal gain in recruitment . Conclusions Cancer information programs ( e.g. , CIS and ACS ) and registries of individuals willing to participate in cancer-related research ( e.g. , AOW ) can represent exceptional re sources for outreach recruitment of cancer patients , especially when the eligibility criteria are highly restrictive . However , these re sources do not yield sample s representative of the larger population of adults diagnosed with cancer , and conclusions from such trials must be tempered accordingly . Implication s for cancer survivorsInadequate recruitment to r and omized controlled trials limits the creation of useful interventions for cancer survivors . By enrolling in cancer registries and taking part in research , cancer survivors can contribute to the development of effective re sources for the survivor population Background According to the CONSORT statement , significance testing of baseline differences in r and omized controlled trials should not be performed . In fact , this practice has been discouraged by numerous authors throughout the last forty years . During that time span , reporting of baseline differences has substantially decreased in the leading general medical journals . Our own experience in the field of nutrition behavior research however , is that co- authors , review ers and even editors are still very persistent in their dem and for these tests . The aim of this paper is therefore to negate this dem and by providing clear evidence as to why testing for baseline differences between intervention groups statistically is superfluous and 
    Output:
    