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 Heart failure ( HF ) is a prevalent chronic disease in older adults that requires extensive self-care to prevent decompensation and hospitalization . Cognitive impairment may impact the ability to perform HF self-care activities . We examined the association between cognitive impairment and adherence to self-care in patients hospitalized for acute HF . Design Prospect i ve cohort study . Setting and participants A total of 577 patients ( mean age = 71 years , 44 % female ) hospitalized for HF at five medical centers in the United States and Canada . Measurements and methods Participants were interviewed for information on self-reported adherence to self-care using the European Heart Failure Self-care Behaviour Scale . We assessed cognitive impairment in three domains ( memory , processing speed , and executive function ) using st and ardized measures . Patients ’ demographic and clinical characteristics were obtained through medical record review . Multivariable linear regression was used to examine the association between cognitive impairment and self-care practice s adjusting for demographic and clinical factors . Results A total of 453 patients ( 79 % ) were impaired in at least one cognitive domain . Average adherence to self-care activities among patients with global cognitive impairment did not differ significantly from those without cognitive impairment ( 30.5 versus 29.6 ; 45-point scale ) . However , impaired memory was associated with lower self-care scores ( P = 0.006 ) in multivariable models . Conclusion Cognitive impairment is highly prevalent among older patients hospitalized for HF .  Memory impairment is associated with poorer adherence to self-care practice s. Screening for memory impairment in patients with HF may help to identify patients at risk for poor self-care who may benefit from tailored disease management programs Background and Objectives This study examined the association of cognitive function with self-care and major adverse cardiac events ( MACE ) among heart failure ( HF ) patients . Subjects and Methods In this prospect i ve study , 86 out patients with HF completed face-to-face interviews including neuropsychological testing to evaluate cognitive function and the use of the Self-Care of Heart Failure Index to measure self-care . Functional status was assessed with the New York Heart Association ( NYHA ) classification . Follow-up data on MACE were obtained at 24 months after enrollment . Results Compared with the Korean norm values , more than half of the HF patients had cognitive deficits in global function ( 33.0 % ) , immediate recall ( 65.1 % ) , delayed recall memory ( 65.1 % ) , and executive function ( 60.5 % ) . Patients with symptomatic HF ( ≥NYHA class II ) had the higher risk for substantially poor cognitive function in all areas of cognitive function than asymptomatic HF patients ( NYHA class I , p<0.05 ) . Most patients demonstrated poor self-care adequacy in maintenance ( 84.9 % ) , management of symptoms ( 100 % ) , and confidence ( 86.0 % ) . After adjustment for age and gender , memory function was significantly associated with self-care confidence ( odds ratio 1.41 , 95 % confidence interval 1.03 - 1.92 , p=0.033 ) . No relationship was found between cognition and self-care maintenance . There were 19 MACE 's during the 24-month follow-up . Patients without MACE had a significantly higher global cognitive function ( p=0.024 ) , while no cognitive domains were significant predictors of MACE when adjusted for age and gender . Conclusion HF patients with memory loss have poorer self-care confidence . Studies are warranted to examine the functional implication of cognitive deficits and adverse outcomes in a larger sample Objective Treatment recommendation and guidelines for patients with heart failure ( HF ) can be complex , and past work has shown that patients with HF demonstrate low rates of adherence to recommended health behaviors . Although previous work has identified several medical , demographic , and psychosocial predictors of the capacity to adhere to treatment recommendations of persons with HF , little is known about the contribution of cognitive impairment to reported treatment adherence in this population . Methods A total of 149 persons with HF ( mean [ st and ard deviation ] = 68.08 [ 10.74 ] years ) completed a brief fitness assessment and neuropsychological testing . Treatment adherence was assessed using the  Heart Failure Compliance Question naire , a brief measure that asks participants to report their adherence to a variety of recommended health behaviors ( i.e. , medication management , diet , and exercise , among others ) . Results The percentage of participants who reported poor overall adherence was 16.1 % , with particularly high rates of nonadherence to dietary and exercise recommendations . Hierarchical regression analyses adjusting for possible confounds revealed that reduced performance on attention ( & bgr ; = .26 , p = .01 ) , executive function ( & bgr ; = .18 , p = .04 ) , and language ( & bgr ; = .22 , p = .01 ) was associated with poorer overall adherence . Follow-up analyses showed that these cognitive domains were associated with behaviors such as keeping doctor appointments , medication management , and dietary recommendations ( p < .05 for all ) . Conclusions The current findings demonstrate that cognitive function is an independent contributor to adherence in older adults with HF . Prospect i ve studies that objective ly measure treatment adherence are needed to clarify these findings and identify possible strategies to improve outcomes in this population . Trial Registration : clinical trials.gov Identifier : NCT00871897 OBJECTIVE The Chronic Disease Self-Management Programme (CDSMP)was recently evaluated among patients with congestive heart failure ( CHF ) in a r and omized controlled trial ( n = 317 ) with twelve months of follow-up after the start of the programme . That trial demonstrated short-term improvements in cardiac-specific quality of life . The current study assessed which of the patients participating in this trial benefited most from the CDSMP with respect to cardiac-specific quality of life . METHODS Subgroup analyses were conducted using mixed-effects linear regression models to assess the relationship between patient characteristics and the effects of the CDSMP on cardiac-specific quality of life . RESULTS In the short term , patients with better cognitive status benefited more from the CDSMP than their poorer functioning counterparts . In addition , lower educated patients benefited more from the CDSMP than their higher educated counterparts during total follow-up . CONCLUSION Subgroup effects were found for cognitive status and educational level . Future research should be performed to vali date current findings and further explore the conditions under which CHF patients may benefit more from the programme . PRACTICE IMPLICATION S These results indicate that lower educated patients , in particular , should be encouraged to participate in the CDSMP . In addition , healthcare practitioners are recommended to take into account potential cognitive impairments of patients Background Patients with chronic heart failure ( CHF ) experience a number of debilitating symptoms , which impact on activities of daily living and result in poor quality of life . Prospect i ve memory , which is defined as memory to carry out future intentions , has not been investigated in this group . However , emerging evidence suggests CHF patients have difficulties with cognitive processes related to prospect i ve memory . Self-care , which partly relies on prospect i ve memory , is essential in symptom management and preventing acute clinical deterioration . This study aims to measure prospect i ve memory in CHF patients , and examine the relationship between prospect i ve memory and CHF self-care . Methods / Design A comprehensive neuropsychological assessment will be conducted to assess a range of cognitive functions and psychopathology . The primary focus will be an assessment of prospect i ve memory using a well-established behavioral measure ;  Virtual Week .  Thirty CHF patients attending a nurse-led management program will be recruited from three hospital sites in Melbourne , Australia and their self-care behaviors will be assessed using the Self-care Chronic Heart Failure Index ( SCHFI ) , a vali date d self-report tool . An additional 30 healthy controls , matched on age , gender , and IQ will be recruited from the general community . Discussion This is a group comparison study that will provide an evaluation of the prospect i ve memory abilities of CHF patients . The findings of this research will provide insight into whether prospect i ve memory may be hindering patients ’ ability to perform adequate self-care Background Cognitive impairment is seen in up to three quarters of heart failure ( HF ) patients and has a significant negative impact on patients ’ health outcomes . Prospect i ve memory , which is defined as memory to carry out future intentions , is important for functional independence in older adults and involves application of multiple cognitive processes that are often impaired in HF patients . The objective of this study is to examine the effects of prospect i ve memory training on patients ’ engagement in HF self-care and health outcomes , carer strain and quality of life . Methods / design The proposed study is a r and omised , controlled trial in which 200 patients diagnosed with HF , and their carers will be recruited from 3 major hospitals across Melbourne . Eligible patients with HF will be r and omised to receive either : 1 ) The Virtual Week Training Program - a computerised prospect i ve memory ( PM ) training program ( intervention ) or 2 ) non-adaptive computer-based word puzzles ( active control ) .  HF patients ’ baseline cognitive function will be compared to a healthy control group ( n = 60 ) living independently in the community . Patients will undergo a comprehensive assessment of PM , neuropsychological functioning , self-care , physical , and emotional functioning . Assessment s will take place at baseline , 4 weeks and 12 months following intervention . Carers will complete measures assessing quality of life , strain , perceived control in the management of the patients ’ HF symptoms , and ratings of the patients ’ level of engagement in HF self-care behaviours . Discussion If the Virtual Week Training Program is effective in improving : 1 ) prospect i ve memory ; 2 ) self-care behaviours , and 3 ) wellbeing in HF patients , this study will enhance our underst and ing of impaired cognitive processes in HF and potentially is a mechanism to reduce healthcare costs . Trial registration Australian New Zeal and Clinical Trials Registry # 366376 ; 27 May 2014 . https://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?id=366376&is Clinical Trial = False A DESCRIPTIVE CORRELATIONAL study was conducted to test the efficacy of the Model of Self-Care in Chronic Illness . The model , an adaption and extension of the Health Belief Model , was developed to describe and relate the variables that influence effective self-care among ambulatory chronically ill adults . Participants ( n = 181 ) were r and omly selected from the waiting lists of an ambulatory care clinic of a major military medical center . The research examined general self-care , i.e. , behaviors to promote health and prevent illness , and therapeutic self-care , i.e. , education , diet , and other behaviors prescribed for a specific illness . Self-concept was correlated significantly with general as well as medication and dietary self-care . Psychological status and general health motivations influence general self-care . Stepwise multiple regression analyses demonstrated that costs of medication , patients ' psychological status and perceptions of the seriousness of their illnesses , and vulnerability to complications were significantly related to medication self-care , while costs and perceptions or seriousness and vuinerability were significantly related to dietary self-care OBJECTIVE Medication nonadherence has been a persistent problem over the past three decades ; forgetting and being distracted from regular routines are the barriers most frequently cited by patients . Prior research on cognitive function and medication adherence has yielded mixed results . DESIGN This report compares findings of three studies : All were longitudinal , two were r and omized controlled intervention trials , and one was descriptive . Sample s of adult patients taking once daily lipid-lowering medication , diabetic patients with comorbid conditions on complex regimens , and early stage breast cancer patients on hormonal therapy  completed similar batteries of st and ardized , valid , neuropsychological tests at baseline . MAIN OUTCOME MEASURES Adherence to medication regimens , over time , was tracked with electronic event monitors . RESULTS Medication nonadherence was prevalent in all studies . Deficits in attention/mental flexibility and /or working memory predicted nonadherence in all studies ; impaired executive function was related to poor adherence in one study . CONCLUSION These findings suggest that better mental efficiency may be the key to better medication adherence with any regimen , and that targeted cognitive functions , which can be easily and quickly assessed , may identify patients at risk of poor adherence regardless of diagnosis or regimen Background : The borderline condition between health and dementia , defined as Clinical Dementia Rating ( CDR ) 0.5 , should be detected for the possible prediction of dementia . Since the CDR requires information from collateral sources , it is difficult to rate people living alone . The aim is to develop a set of tests without collateral information for detecting CDR 0.5 and converters to dementia . Methods : 625 participants were selected from the community ; 412 were CDR 0 ( healthy ) , 168 were CDR 0.5 ( defined here as mild cognitive impairment ; MCI ) , and were 45 CDR 1 + ( dementia ) .  Neuropsychological tests were administered to assess memory , orientation , attention and executive function . We analyzed various combinations of tests by receiver operating characteristic curve and area under the curve ( AUC ) . Among the participants , 497 were r and omly selected to be re-examined after 5 years to predict further decline towards dementia . Results : We found that a combination of tests for orientation , memory , attention , executive function , and abstract ion and judgment could discriminate subjects with MCI from healthy participants with high accuracy ( AUC = 0.83 ) . The predictive accuracy was better than that of the Mini Mental State Examination ( AUC = 0.77 ) . The same tests , except orientation , 
    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 Heart failure ( HF ) is a prevalent chronic disease in older adults that requires extensive self-care to prevent decompensation and hospitalization . Cognitive impairment may impact the ability to perform HF self-care activities . We examined the association between cognitive impairment and adherence to self-care in patients hospitalized for acute HF . Design Prospect i ve cohort study . Setting and participants A total of 577 patients ( mean age = 71 years , 44 % female ) hospitalized for HF at five medical centers in the United States and Canada . Measurements and methods Participants were interviewed for information on self-reported adherence to self-care using the European Heart Failure Self-care Behaviour Scale . We assessed cognitive impairment in three domains ( memory , processing speed , and executive function ) using st and ardized measures . Patients ’ demographic and clinical characteristics were obtained through medical record review . Multivariable linear regression was used to examine the association between cognitive impairment and self-care practice s adjusting for demographic and clinical factors . Results A total of 453 patients ( 79 % ) were impaired in at least one cognitive domain . Average adherence to self-care activities among patients with global cognitive impairment did not differ significantly from those without cognitive impairment ( 30.5 versus 29.6 ; 45-point scale ) . However , impaired memory was associated with lower self-care scores ( P = 0.006 ) in multivariable models . Conclusion Cognitive impairment is highly prevalent among older patients hospitalized for HF .  Memory impairment is associated with poorer adherence to self-care practice s. Screening for memory impairment in patients with HF may help to identify patients at risk for poor self-care who may benefit from tailored disease management programs Background and Objectives This study examined the association of cognitive function with self-care and major adverse cardiac events ( MACE ) among heart failure ( HF ) patients . Subjects and Methods In this prospect i ve study , 86 out patients with HF completed face-to-face interviews including neuropsychological testing to evaluate cognitive function and the use of the Self-Care of Heart Failure Index to measure self-care . Functional status was assessed with the New York Heart Association ( NYHA ) classification . Follow-up data on MACE were obtained at 24 months after enrollment . Results Compared with the Korean norm values , more than half of the HF patients had cognitive deficits in global function ( 33.0 % ) , immediate recall ( 65.1 % ) , delayed recall memory ( 65.1 % ) , and executive function ( 60.5 % ) . Patients with symptomatic HF ( ≥NYHA class II ) had the higher risk for substantially poor cognitive function in all areas of cognitive function than asymptomatic HF patients ( NYHA class I , p<0.05 ) . Most patients demonstrated poor self-care adequacy in maintenance ( 84.9 % ) , management of symptoms ( 100 % ) , and confidence ( 86.0 % ) . After adjustment for age and gender , memory function was significantly associated with self-care confidence ( odds ratio 1.41 , 95 % confidence interval 1.03 - 1.92 , p=0.033 ) . No relationship was found between cognition and self-care maintenance . There were 19 MACE 's during the 24-month follow-up . Patients without MACE had a significantly higher global cognitive function ( p=0.024 ) , while no cognitive domains were significant predictors of MACE when adjusted for age and gender . Conclusion HF patients with memory loss have poorer self-care confidence . Studies are warranted to examine the functional implication of cognitive deficits and adverse outcomes in a larger sample Objective Treatment recommendation and guidelines for patients with heart failure ( HF ) can be complex , and past work has shown that patients with HF demonstrate low rates of adherence to recommended health behaviors . Although previous work has identified several medical , demographic , and psychosocial predictors of the capacity to adhere to treatment recommendations of persons with HF , little is known about the contribution of cognitive impairment to reported treatment adherence in this population . Methods A total of 149 persons with HF ( mean [ st and ard deviation ] = 68.08 [ 10.74 ] years ) completed a brief fitness assessment and neuropsychological testing . Treatment adherence was assessed using the  Heart Failure Compliance Question naire , a brief measure that asks participants to report their adherence to a variety of recommended health behaviors ( i.e. , medication management , diet , and exercise , among others ) . Results The percentage of participants who reported poor overall adherence was 16.1 % , with particularly high rates of nonadherence to dietary and exercise recommendations . Hierarchical regression analyses adjusting for possible confounds revealed that reduced performance on attention ( & bgr ; = .26 , p = .01 ) , executive function ( & bgr ; = .18 , p = .04 ) , and language ( & bgr ; = .22 , p = .01 ) was associated with poorer overall adherence . Follow-up analyses showed that these cognitive domains were associated with behaviors such as keeping doctor appointments , medication management , and dietary recommendations ( p < .05 for all ) . Conclusions The current findings demonstrate that cognitive function is an independent contributor to adherence in older adults with HF . Prospect i ve studies that objective ly measure treatment adherence are needed to clarify these findings and identify possible strategies to improve outcomes in this population . Trial Registration : clinical trials.gov Identifier : NCT00871897 OBJECTIVE The Chronic Disease Self-Management Programme (CDSMP)was recently evaluated among patients with congestive heart failure ( CHF ) in a r and omized controlled trial ( n = 317 ) with twelve months of follow-up after the start of the programme . That trial demonstrated short-term improvements in cardiac-specific quality of life . The current study assessed which of the patients participating in this trial benefited most from the CDSMP with respect to cardiac-specific quality of life . METHODS Subgroup analyses were conducted using mixed-effects linear regression models to assess the relationship between patient characteristics and the effects of the CDSMP on cardiac-specific quality of life . RESULTS In the short term , patients with better cognitive status benefited more from the CDSMP than their poorer functioning counterparts . In addition , lower educated patients benefited more from the CDSMP than their higher educated counterparts during total follow-up . CONCLUSION Subgroup effects were found for cognitive status and educational level . Future research should be performed to vali date current findings and further explore the conditions under which CHF patients may benefit more from the programme . PRACTICE IMPLICATION S These results indicate that lower educated patients , in particular , should be encouraged to participate in the CDSMP . In addition , healthcare practitioners are recommended to take into account potential cognitive impairments of patients Background Patients with chronic heart failure ( CHF ) experience a number of debilitating symptoms , which impact on activities of daily living and result in poor quality of life . Prospect i ve memory , which is defined as memory to carry out future intentions , has not been investigated in this group . However , emerging evidence suggests CHF patients have difficulties with cognitive processes related to prospect i ve memory . Self-care , which partly relies on prospect i ve memory , is essential in symptom management and preventing acute clinical deterioration . This study aims to measure prospect i ve memory in CHF patients , and examine the relationship between prospect i ve memory and CHF self-care . Methods / Design A comprehensive neuropsychological assessment will be conducted to assess a range of cognitive functions and psychopathology . The primary focus will be an assessment of prospect i ve memory using a well-established behavioral measure ;  Virtual Week .  Thirty CHF patients attending a nurse-led management program will be recruited from three hospital sites in Melbourne , Australia and their self-care behaviors will be assessed using the Self-care Chronic Heart Failure Index ( SCHFI ) , a vali date d self-report tool . An additional 30 healthy controls , matched on age , gender , and IQ will be recruited from the general community . Discussion This is a group comparison study that will provide an evaluation of the prospect i ve memory abilities of CHF patients . The findings of this research will provide insight into whether prospect i ve memory may be hindering patients ’ ability to perform adequate self-care Background Cognitive impairment is seen in up to three quarters of heart failure ( HF ) patients and has a significant negative impact on patients ’ health outcomes . Prospect i ve memory , which is defined as memory to carry out future intentions , is important for functional independence in older adults and involves application of multiple cognitive processes that are often impaired in HF patients . The objective of this study is to examine the effects of prospect i ve memory training on patients ’ engagement in HF self-care and health outcomes , carer strain and quality of life . Methods / design The proposed study is a r and omised , controlled trial in which 200 patients diagnosed with HF , and their carers will be recruited from 3 major hospitals across Melbourne . Eligible patients with HF will be r and omised to receive either : 1 ) The Virtual Week Training Program - a computerised prospect i ve memory ( PM ) training program ( intervention ) or 2 ) non-adaptive computer-based word puzzles ( active control ) .  HF patients ’ baseline cognitive function will be compared to a healthy control group ( n = 60 ) living independently in the community . Patients will undergo a comprehensive assessment of PM , neuropsychological functioning , self-care , physical , and emotional functioning . Assessment s will take place at baseline , 4 weeks and 12 months following intervention . Carers will complete measures assessing quality of life , strain , perceived control in the management of the patients ’ HF symptoms , and ratings of the patients ’ level of engagement in HF self-care behaviours . Discussion If the Virtual Week Training Program is effective in improving : 1 ) prospect i ve memory ; 2 ) self-care behaviours , and 3 ) wellbeing in HF patients , this study will enhance our underst and ing of impaired cognitive processes in HF and potentially is a mechanism to reduce healthcare costs . Trial registration Australian New Zeal and Clinical Trials Registry # 366376 ; 27 May 2014 . https://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?id=366376&is Clinical Trial = False A DESCRIPTIVE CORRELATIONAL study was conducted to test the efficacy of the Model of Self-Care in Chronic Illness . The model , an adaption and extension of the Health Belief Model , was developed to describe and relate the variables that influence effective self-care among ambulatory chronically ill adults . Participants ( n = 181 ) were r and omly selected from the waiting lists of an ambulatory care clinic of a major military medical center . The research examined general self-care , i.e. , behaviors to promote health and prevent illness , and therapeutic self-care , i.e. , education , diet , and other behaviors prescribed for a specific illness . Self-concept was correlated significantly with general as well as medication and dietary self-care . Psychological status and general health motivations influence general self-care . Stepwise multiple regression analyses demonstrated that costs of medication , patients ' psychological status and perceptions of the seriousness of their illnesses , and vulnerability to complications were significantly related to medication self-care , while costs and perceptions or seriousness and vuinerability were significantly related to dietary self-care OBJECTIVE Medication nonadherence has been a persistent problem over the past three decades ; forgetting and being distracted from regular routines are the barriers most frequently cited by patients . Prior research on cognitive function and medication adherence has yielded mixed results . DESIGN This report compares findings of three studies : All were longitudinal , two were r and omized controlled intervention trials , and one was descriptive . Sample s of adult patients taking once daily lipid-lowering medication , diabetic patients with comorbid conditions on complex regimens , and early stage breast cancer patients on hormonal therapy  completed similar batteries of st and ardized , valid , neuropsychological tests at baseline . MAIN OUTCOME MEASURES Adherence to medication regimens , over time , was tracked with electronic event monitors . RESULTS Medication nonadherence was prevalent in all studies . Deficits in attention/mental flexibility and /or working memory predicted nonadherence in all studies ; impaired executive function was related to poor adherence in one study . CONCLUSION These findings suggest that better mental efficiency may be the key to better medication adherence with any regimen , and that targeted cognitive functions , which can be easily and quickly assessed , may identify patients at risk of poor adherence regardless of diagnosis or regimen Background : The borderline condition between health and dementia , defined as Clinical Dementia Rating ( CDR ) 0.5 , should be detected for the possible prediction of dementia . Since the CDR requires information from collateral sources , it is difficult to rate people living alone . The aim is to develop a set of tests without collateral information for detecting CDR 0.5 and converters to dementia . Methods : 625 participants were selected from the community ; 412 were CDR 0 ( healthy ) , 168 were CDR 0.5 ( defined here as mild cognitive impairment ; MCI ) , and were 45 CDR 1 + ( dementia ) .  Neuropsychological tests were administered to assess memory , orientation , attention and executive function . We analyzed various combinations of tests by receiver operating characteristic curve and area under the curve ( AUC ) . Among the participants , 497 were r and omly selected to be re-examined after 5 years to predict further decline towards dementia . Results : We found that a combination of tests for orientation , memory , attention , executive function , and abstract ion and judgment could discriminate subjects with MCI from healthy participants with high accuracy ( AUC = 0.83 ) . The predictive accuracy was better than that of the Mini Mental State Examination ( AUC = 0.77 ) . The same tests , except orientation , 
    Output:
    