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: OBJECTIVES To determine if laypersons ' knowledge about palliative care can improve with a brief education intervention . METHODS 152 adults were recruited to participate in a web-based r and omized intervention trial that followed a 2 (content) × 2 ( format ) between-subjects design . Groups received either a video intervention , an information page intervention , a video control , or an information page control . An ANCOVA with contrast coding of two factors was utilized to assess if knowledge , as measured by the Palliative Care Knowledge Scale ( PaCKS ) , increased post intervention . RESULTS There was a significant difference between intervention group means and control group means on PaCKS scores from T1 to T2 F(1 , 139)=11.10 , p=0.00 , ηp2=0.074 . There was no significant difference in PaCKS change scores between the video intervention and information page intervention . CONCLUSIONS This study demonstrates that an information page and a brief video can improve knowledge of palliative care in laypersons . PRACTICE IMPLICATION S Self-administered educational interventions could be made available in diverse setting s in order to reach patients and their families who may benefit from but are unaware of palliative care . Interventions more intensive than the one tested in this study might result in even more significant improvements in knowledge PURPOSE / OBJECTIVES To evaluate use of a CD-ROM titled Completing a Life among patients diagnosed with serious illnesses for comfort level with content and ease of computer use . DESIGN A prospect i ve pilot study collected a convenience sample of 50 people diagnosed with life-limiting illnesses during a six-month period . SETTING The hematology/oncology department of a large healthcare system located in a metropolitan area in the midwestern United States . SAMPLE Convenience sample of 50 patients diagnosed with life-limiting illnesses . Of the patients enrolled ( age range = 38 - 93 years ) , 72 % were female , 68 % were Caucasian , 50 % were diagnosed with breast cancer or nonsolid tumors , and 40 % were newly diagnosed . METHODS Subjects viewed the CD-ROM and completed pre- and post-intervention surveys . MAIN RESEARCH VARIABLES Comfort level with educational media , comfort level of information viewed , and areas of CD-ROM viewed compared to age and stage of illness . FINDINGS Ninety percent of patients reported that they were somewhat or very comfortable with the CD-ROM  as a learning tool , and ease of use was rated at 98 % . Patients ' comfort level with the material increased from 76 % to 90 % after they viewed the CD-ROM . CONCLUSIONS The pilot study suggests that the Completing a Life CD-ROM can be used with patients facing serious or life-limiting illnesses as an additional re source tool for information . IMPLICATION S FOR NURSING Nurses typically provide the bulk of educational material for their patients . With limited re sources available regarding management of life-limiting illnesses , this re source may provide an excellent addition to re sources currently available Objectives This study examined the differential impact of two telehealth programs for women caring for an older adult with a neurocognitive disorder . Outcomes examined were depressive symptoms , upset following disruptive behaviors , anxious and angry mood states , and caregiving self‐efficacy . Methods Women cohabitating with a family member diagnosed with a neurocognitive disorder were assigned via r and om allocation to either of the following : ( 1 ) a 14‐week behavioral intervention using video instructional material s , workbook and telephone coaching in behavioral management , pleasant events scheduling , and relaxation or ( 2 ) a basic education guide and telephone support comparison condition . Telephone assessment s were conducted by interviewers blind to treatment condition at pre‐intervention , post‐intervention , and 6 months following intervention . Results For those providing in‐home care at post‐treatment , depressive symptoms , upset following disruptive behaviors , and negative mood states were statistically lower in the behavioral coaching condition than in the basic education and support condition . Reliable change index analyses for Beck Depression Inventory II scores favored the behavioral coaching condition . Caregiving self‐efficacy scores for obtaining respite and for managing patient behavioral disturbances were significantly higher in the coaching condition . Effect sizes were moderate but not maintained at the 6‐month follow‐up . Conclusions This study provides some initial evidence for the efficacy of a telehealth behavioral coaching intervention compared with basic education and telephone support . Carers ' abilities to maintain strategy use during progressive disorders such as Alzheimer 's disease likely require longer intervention contact than provided in the current study . Dementia carers , including those living in rural areas , can benefit from accessible and empirically supported interventions that can be easily disseminated across distances at modest cost . © 2015 The Authors . International Journal of Geriatric Psychiatry Published by John Wiley & Sons , Background : Conversations about goals of care and cardiopulmonary resuscitation (CPR)/intubation for patients with advanced heart failure can be difficult . This study examined the impact of a video decision support tool and patient checklist on advance care planning for patients with heart failure . Methods : This was a multisite , r and omized , controlled trial of a video-assisted intervention and advance care planning checklist versus a verbal description in 246 patients ≥64 years of age with heart failure and an estimated likelihood of death of > 50 % within 2 years . Intervention participants received a verbal description for goals of care ( life-prolonging care , limited care , and comfort care ) and CPR/intubation plus a 6-minute video depicting the 3 levels of care , CPR/intubation , and an advance care planning checklist . Control subjects received only the verbal description . The primary analysis compared the proportion of patients preferring comfort care between study arms immediately after the intervention . Secondary outcomes were CPR/intubation preferences and knowledge ( 6-item test ; range , 0–6 ) after intervention . Results : In the intervention group , 27 ( 22 % ) chose life-prolonging care , 31 ( 25 % ) chose limited care , 63 ( 51 % ) selected comfort care , and 2 ( 2 % ) were uncertain . In the control group , 50 ( 41 % ) chose life-prolonging care , 27 ( 22 % ) selected limited care , 37 ( 30 % ) chose comfort care , and 8 ( 7 % ) were uncertain ( P<0.001 ) . Intervention participants ( compared with control subjects ) were more likely to forgo CPR ( 68 % versus 35 % ; P<0.001 ) and intubation ( 77 % versus 48 % ; P<0.001 ) and had higher mean knowledge scores ( 4.1 versus 3.0 ; P<0.001 ) . Conclusions : Patients with heart failure who viewed a video were more informed , more likely to select a focus on comfort , and less likely to desire CPR/intubation compared with patients receiving verbal information only . Clinical Trial Registration : URL : http://www . clinical trials.gov . Unique identifier : NCT01589120 PURPOSE To determine whether the use of a goals -of-care video to supplement a verbal description can improve end-of-life decision making for patients with cancer . METHODS Fifty participants with malignant glioma were r and omly assigned to either a verbal narrative of goals -of-care options at the end of life ( control ) , or a video after the same verbal narrative ( intervention ) in this r and omized controlled trial . The video depicts three levels of medical care : life-prolonging care ( cardiopulmonary resuscitation [ CPR ] , ventilation ) , basic care ( hospitalization , no CPR ) , and comfort care ( symptom relief ) . The primary study outcome was participants ' preferences for end-of-life care . The secondary outcome was participants ' uncertainty regarding decision making ( score range , 3 to 15 ; higher score indicating less uncertainty ) . Participants ' comfort level with the video was also measured . RESULTS Fifty participants were r and omly assigned to either the verbal narrative ( n = 27 ) or video ( n = 23 ) . After the verbal description , 25.9 % of participants preferred life-prolonging care , 51.9 % basic care , and 22.2 % comfort care . In the video arm , no participants preferred life-prolonging care , 4.4 % preferred basic care , 91.3 % preferred comfort care , and 4.4 % were uncertain ( P < .0001 ) . The mean uncertainty score was higher in the video group than in the verbal group ( 13.7 v 11.5 , respectively ; P < .002 ) . In the intervention arm , 82.6 % of participants reported being very comfortable watching the video . CONCLUSION Compared with participants who only heard a verbal description , participants who viewed a goals -of-care video were more likely to prefer comfort care and avoid CPR , and were more certain of their end-of-life decision making . Participants reported feeling comfortable watching the video BACKGROUND  Cardiopulmonary resuscitation ( CPR ) is an important advance directive ( AD ) topic in patients with progressive cancer ; however such discussion s are challenging . OBJECTIVE This study investigates whether video educational information about CPR engenders broader advance care planning ( ACP ) discourse . METHODS Patients with progressive pancreas or hepatobiliary cancer were r and omized to an educational CPR video or a similar CPR narrative . The primary end-point was the difference in ACP documentation one month posttest between arms . Secondary end-points included study impressions ; pre- and post-intervention knowledge of and preferences for CPR and mechanical ventilation ; and longitudinal patient outcomes . RESULTS Fifty-six subjects were consented and analyzed . Rates of ACP documentation ( either formal ADs or documented discussion s ) were 40 % in the video arm ( 12/30 ) compared to 15 % in the narrative arm ( 4/26 ) , OR=3.6 [ 95 % CI : 0.9 - 18.0 ] , p=0.07 . Post-intervention knowledge was higher in both arms . Posttest , preferences for CPR had changed in the video arm but not in the narrative arm . Preferences regarding mechanical ventilation did not change in either arm . The majority of subjects in both arms reported the information as helpful and comfortable to discuss , and they recommended it to others . More deaths occurred in the video arm compared to the narrative arm , and more subjects died in hospice setting s in the video arm . CONCLUSIONS This pilot r and omized trial addressing downstream ACP effects of video versus narrative decision tools demonstrated a trend towards more ACP documentation in video subjects . This trend , as well as other video effects , is the subject of ongoing study OBJECTIVE Few studies have evaluated the end-of-life preferences of elderly patients in rural communities and whether preferences are associated with level of health literacy . DESIGN R and omized controlled trial of a goals -of-care video decision aid of advanced dementia . PARTICIPANTS Elderly subjects ( 65 years or older ) at a primary care clinic in rural Louisiana . METHODS Half of subjects heard a verbal description of advanced dementia and the goals of care ; the other half heard the same verbal description and then viewed the video decision aid . End points were the preferred goal of care in advanced dementia : life-prolonging care ( cardiopulmonary resuscitation [ CPR ] , etc . ) , limited care ( hospitalization but not CPR ) , or comfort care ( symptom relief ) . The principal category for analysis was the difference in proportions of subjects preferring comfort care for each characteristic including r and omization group and health literacy level . RESULTS Seventy-six subjects were r and omized to the verbal ( n = 43 ) or video ( n = 33 ) arms of the study . Among subjects receiving the verbal description of advanced dementia and the goals of care , 31 ( 72 % ) preferred comfort ; 5 ( 12 % ) chose limited ; and 7 ( 16 % ) desired life-prolonging . In the video group , 30 ( 91 % ) preferred comfort ; 3 ( 9 % ) chose limited ; and none desired life-prolonging ( χ(2 ) = 6.3 , df = 2 , p = 0.047 ) . Factors associated with greater likelihood of opting for comfort included greater health literacy ( unadjusted odds ratio [ OR ] 12.1 ; 95 % confidence interval [ CI ] , 2.4 - 62.6 ) and r and omization to the video ( unadjusted OR 3.9 ; 95 % CI , 1.0 - 15.1 ) . CONCLUSION Rural subjects with higher health literacy were more likely to want comfort care compared to those with lower levels of health literacy . Furthermore , subjects who viewed a video decision aid were more likely to opt for comfort compared to those who solely listened to a verbal description . These findings suggest that video can help elicit preferences and that interventions to empower such patients need to be design ed in a manner that is sensitive to health literacy INTRODUCTION When patients are unable to make important end-of-life decisions , doctors ask surrogate decision makers to provide insight into patients ' preferences . Unfortunately , multiple studies have shown that surrogates ' knowledge of patient preferences is poor . We hypothesized that a video decision tool would improve concordance between patients and their surrogates for end-of-life preferences .  OBJECTIVE To compare the concordance of preferences among elderly patients and their surrogates listening to only a verbal description of advanced dementia or viewing a video decision support tool of the disease after hearing the verbal description . METHODS This was a r and omized controlled trial of a convenience sample of community-dwelling elderly subjects ( > or = 65 years ) and their surrogates , and was conducted at 2 geriatric clinics affiliated with 2 academic medical centers in Boston . The study was conducted between September 1 , 2007 , and May 30 , 2008 . R and om assignment of patient and surrogate dyads was to either a verbal narrative or a video decision support tool after the verbal narrative . End points were goals of care chosen by the patient and predicted goals of care by the 
    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: OBJECTIVES To determine if laypersons ' knowledge about palliative care can improve with a brief education intervention . METHODS 152 adults were recruited to participate in a web-based r and omized intervention trial that followed a 2 (content) × 2 ( format ) between-subjects design . Groups received either a video intervention , an information page intervention , a video control , or an information page control . An ANCOVA with contrast coding of two factors was utilized to assess if knowledge , as measured by the Palliative Care Knowledge Scale ( PaCKS ) , increased post intervention . RESULTS There was a significant difference between intervention group means and control group means on PaCKS scores from T1 to T2 F(1 , 139)=11.10 , p=0.00 , ηp2=0.074 . There was no significant difference in PaCKS change scores between the video intervention and information page intervention . CONCLUSIONS This study demonstrates that an information page and a brief video can improve knowledge of palliative care in laypersons . PRACTICE IMPLICATION S Self-administered educational interventions could be made available in diverse setting s in order to reach patients and their families who may benefit from but are unaware of palliative care . Interventions more intensive than the one tested in this study might result in even more significant improvements in knowledge PURPOSE / OBJECTIVES To evaluate use of a CD-ROM titled Completing a Life among patients diagnosed with serious illnesses for comfort level with content and ease of computer use . DESIGN A prospect i ve pilot study collected a convenience sample of 50 people diagnosed with life-limiting illnesses during a six-month period . SETTING The hematology/oncology department of a large healthcare system located in a metropolitan area in the midwestern United States . SAMPLE Convenience sample of 50 patients diagnosed with life-limiting illnesses . Of the patients enrolled ( age range = 38 - 93 years ) , 72 % were female , 68 % were Caucasian , 50 % were diagnosed with breast cancer or nonsolid tumors , and 40 % were newly diagnosed . METHODS Subjects viewed the CD-ROM and completed pre- and post-intervention surveys . MAIN RESEARCH VARIABLES Comfort level with educational media , comfort level of information viewed , and areas of CD-ROM viewed compared to age and stage of illness . FINDINGS Ninety percent of patients reported that they were somewhat or very comfortable with the CD-ROM  as a learning tool , and ease of use was rated at 98 % . Patients ' comfort level with the material increased from 76 % to 90 % after they viewed the CD-ROM . CONCLUSIONS The pilot study suggests that the Completing a Life CD-ROM can be used with patients facing serious or life-limiting illnesses as an additional re source tool for information . IMPLICATION S FOR NURSING Nurses typically provide the bulk of educational material for their patients . With limited re sources available regarding management of life-limiting illnesses , this re source may provide an excellent addition to re sources currently available Objectives This study examined the differential impact of two telehealth programs for women caring for an older adult with a neurocognitive disorder . Outcomes examined were depressive symptoms , upset following disruptive behaviors , anxious and angry mood states , and caregiving self‐efficacy . Methods Women cohabitating with a family member diagnosed with a neurocognitive disorder were assigned via r and om allocation to either of the following : ( 1 ) a 14‐week behavioral intervention using video instructional material s , workbook and telephone coaching in behavioral management , pleasant events scheduling , and relaxation or ( 2 ) a basic education guide and telephone support comparison condition . Telephone assessment s were conducted by interviewers blind to treatment condition at pre‐intervention , post‐intervention , and 6 months following intervention . Results For those providing in‐home care at post‐treatment , depressive symptoms , upset following disruptive behaviors , and negative mood states were statistically lower in the behavioral coaching condition than in the basic education and support condition . Reliable change index analyses for Beck Depression Inventory II scores favored the behavioral coaching condition . Caregiving self‐efficacy scores for obtaining respite and for managing patient behavioral disturbances were significantly higher in the coaching condition . Effect sizes were moderate but not maintained at the 6‐month follow‐up . Conclusions This study provides some initial evidence for the efficacy of a telehealth behavioral coaching intervention compared with basic education and telephone support . Carers ' abilities to maintain strategy use during progressive disorders such as Alzheimer 's disease likely require longer intervention contact than provided in the current study . Dementia carers , including those living in rural areas , can benefit from accessible and empirically supported interventions that can be easily disseminated across distances at modest cost . © 2015 The Authors . International Journal of Geriatric Psychiatry Published by John Wiley & Sons , Background : Conversations about goals of care and cardiopulmonary resuscitation (CPR)/intubation for patients with advanced heart failure can be difficult . This study examined the impact of a video decision support tool and patient checklist on advance care planning for patients with heart failure . Methods : This was a multisite , r and omized , controlled trial of a video-assisted intervention and advance care planning checklist versus a verbal description in 246 patients ≥64 years of age with heart failure and an estimated likelihood of death of > 50 % within 2 years . Intervention participants received a verbal description for goals of care ( life-prolonging care , limited care , and comfort care ) and CPR/intubation plus a 6-minute video depicting the 3 levels of care , CPR/intubation , and an advance care planning checklist . Control subjects received only the verbal description . The primary analysis compared the proportion of patients preferring comfort care between study arms immediately after the intervention . Secondary outcomes were CPR/intubation preferences and knowledge ( 6-item test ; range , 0–6 ) after intervention . Results : In the intervention group , 27 ( 22 % ) chose life-prolonging care , 31 ( 25 % ) chose limited care , 63 ( 51 % ) selected comfort care , and 2 ( 2 % ) were uncertain . In the control group , 50 ( 41 % ) chose life-prolonging care , 27 ( 22 % ) selected limited care , 37 ( 30 % ) chose comfort care , and 8 ( 7 % ) were uncertain ( P<0.001 ) . Intervention participants ( compared with control subjects ) were more likely to forgo CPR ( 68 % versus 35 % ; P<0.001 ) and intubation ( 77 % versus 48 % ; P<0.001 ) and had higher mean knowledge scores ( 4.1 versus 3.0 ; P<0.001 ) . Conclusions : Patients with heart failure who viewed a video were more informed , more likely to select a focus on comfort , and less likely to desire CPR/intubation compared with patients receiving verbal information only . Clinical Trial Registration : URL : http://www . clinical trials.gov . Unique identifier : NCT01589120 PURPOSE To determine whether the use of a goals -of-care video to supplement a verbal description can improve end-of-life decision making for patients with cancer . METHODS Fifty participants with malignant glioma were r and omly assigned to either a verbal narrative of goals -of-care options at the end of life ( control ) , or a video after the same verbal narrative ( intervention ) in this r and omized controlled trial . The video depicts three levels of medical care : life-prolonging care ( cardiopulmonary resuscitation [ CPR ] , ventilation ) , basic care ( hospitalization , no CPR ) , and comfort care ( symptom relief ) . The primary study outcome was participants ' preferences for end-of-life care . The secondary outcome was participants ' uncertainty regarding decision making ( score range , 3 to 15 ; higher score indicating less uncertainty ) . Participants ' comfort level with the video was also measured . RESULTS Fifty participants were r and omly assigned to either the verbal narrative ( n = 27 ) or video ( n = 23 ) . After the verbal description , 25.9 % of participants preferred life-prolonging care , 51.9 % basic care , and 22.2 % comfort care . In the video arm , no participants preferred life-prolonging care , 4.4 % preferred basic care , 91.3 % preferred comfort care , and 4.4 % were uncertain ( P < .0001 ) . The mean uncertainty score was higher in the video group than in the verbal group ( 13.7 v 11.5 , respectively ; P < .002 ) . In the intervention arm , 82.6 % of participants reported being very comfortable watching the video . CONCLUSION Compared with participants who only heard a verbal description , participants who viewed a goals -of-care video were more likely to prefer comfort care and avoid CPR , and were more certain of their end-of-life decision making . Participants reported feeling comfortable watching the video BACKGROUND  Cardiopulmonary resuscitation ( CPR ) is an important advance directive ( AD ) topic in patients with progressive cancer ; however such discussion s are challenging . OBJECTIVE This study investigates whether video educational information about CPR engenders broader advance care planning ( ACP ) discourse . METHODS Patients with progressive pancreas or hepatobiliary cancer were r and omized to an educational CPR video or a similar CPR narrative . The primary end-point was the difference in ACP documentation one month posttest between arms . Secondary end-points included study impressions ; pre- and post-intervention knowledge of and preferences for CPR and mechanical ventilation ; and longitudinal patient outcomes . RESULTS Fifty-six subjects were consented and analyzed . Rates of ACP documentation ( either formal ADs or documented discussion s ) were 40 % in the video arm ( 12/30 ) compared to 15 % in the narrative arm ( 4/26 ) , OR=3.6 [ 95 % CI : 0.9 - 18.0 ] , p=0.07 . Post-intervention knowledge was higher in both arms . Posttest , preferences for CPR had changed in the video arm but not in the narrative arm . Preferences regarding mechanical ventilation did not change in either arm . The majority of subjects in both arms reported the information as helpful and comfortable to discuss , and they recommended it to others . More deaths occurred in the video arm compared to the narrative arm , and more subjects died in hospice setting s in the video arm . CONCLUSIONS This pilot r and omized trial addressing downstream ACP effects of video versus narrative decision tools demonstrated a trend towards more ACP documentation in video subjects . This trend , as well as other video effects , is the subject of ongoing study OBJECTIVE Few studies have evaluated the end-of-life preferences of elderly patients in rural communities and whether preferences are associated with level of health literacy . DESIGN R and omized controlled trial of a goals -of-care video decision aid of advanced dementia . PARTICIPANTS Elderly subjects ( 65 years or older ) at a primary care clinic in rural Louisiana . METHODS Half of subjects heard a verbal description of advanced dementia and the goals of care ; the other half heard the same verbal description and then viewed the video decision aid . End points were the preferred goal of care in advanced dementia : life-prolonging care ( cardiopulmonary resuscitation [ CPR ] , etc . ) , limited care ( hospitalization but not CPR ) , or comfort care ( symptom relief ) . The principal category for analysis was the difference in proportions of subjects preferring comfort care for each characteristic including r and omization group and health literacy level . RESULTS Seventy-six subjects were r and omized to the verbal ( n = 43 ) or video ( n = 33 ) arms of the study . Among subjects receiving the verbal description of advanced dementia and the goals of care , 31 ( 72 % ) preferred comfort ; 5 ( 12 % ) chose limited ; and 7 ( 16 % ) desired life-prolonging . In the video group , 30 ( 91 % ) preferred comfort ; 3 ( 9 % ) chose limited ; and none desired life-prolonging ( χ(2 ) = 6.3 , df = 2 , p = 0.047 ) . Factors associated with greater likelihood of opting for comfort included greater health literacy ( unadjusted odds ratio [ OR ] 12.1 ; 95 % confidence interval [ CI ] , 2.4 - 62.6 ) and r and omization to the video ( unadjusted OR 3.9 ; 95 % CI , 1.0 - 15.1 ) . CONCLUSION Rural subjects with higher health literacy were more likely to want comfort care compared to those with lower levels of health literacy . Furthermore , subjects who viewed a video decision aid were more likely to opt for comfort compared to those who solely listened to a verbal description . These findings suggest that video can help elicit preferences and that interventions to empower such patients need to be design ed in a manner that is sensitive to health literacy INTRODUCTION When patients are unable to make important end-of-life decisions , doctors ask surrogate decision makers to provide insight into patients ' preferences . Unfortunately , multiple studies have shown that surrogates ' knowledge of patient preferences is poor . We hypothesized that a video decision tool would improve concordance between patients and their surrogates for end-of-life preferences .  OBJECTIVE To compare the concordance of preferences among elderly patients and their surrogates listening to only a verbal description of advanced dementia or viewing a video decision support tool of the disease after hearing the verbal description . METHODS This was a r and omized controlled trial of a convenience sample of community-dwelling elderly subjects ( > or = 65 years ) and their surrogates , and was conducted at 2 geriatric clinics affiliated with 2 academic medical centers in Boston . The study was conducted between September 1 , 2007 , and May 30 , 2008 . R and om assignment of patient and surrogate dyads was to either a verbal narrative or a video decision support tool after the verbal narrative . End points were goals of care chosen by the patient and predicted goals of care by the 
    Output:
    