***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 : Hemodialysis ( HD ) patients have low self-care knowledge , poor self-care behavior , and powerlessness . Purpose : The authors design ed this study to , first , underst and the current state of first-year HD patients ' self-care knowledge , self-care behavior , and powerlessness and , second , assess the effectiveness of an interactive multimedia CD educational intervention . Method : A quasi-experimental , repeated measures design , with intervention and comparison groups , was used . All subjects for this study were recruited from six dialysis centers in southern Taiwan . The three points for outcome testing included baseline , 4 weeks , and 8 weeks . Research tools included an HD self-care knowledge question naire , an HD self-care behavioral question naire , a powerlessness question naire , and an interactive multimedia CD . Results : Results found that participants possessed insufficient knowledge , were incapable of completely achieving or comprehending routine self-care , and were affected by powerlessness . The interactive multimedia CD intervention effectively enhanced self-care knowledge ( p < .000 ) and self-care behavior ( p < .000 ) and improved powerlessness ( p < .000 ) . Positive results persisted well after the conclusion of the intervention . Conclusions / Implication s for Practice : Participants in the intervention group had better self-care knowledge and behaviors and feeling of control over their lives than those in the control group . This illustrates the positive effects of the interactive multimedia CD . Results demonstrate the potential benefits of using the interactivemultimedia CD with elderly patients in HD and nursing practice education OBJECTIVE To examine the effect of brief disease-specific education delivered in primary care on objective measures of knowledge in individuals recently diagnosed with chronic obstructive pulmonary disease ( COPD ) . METHODS A r and omized control trial was undertaken during which an experimental group received 2h of education delivered by a certified COPD educator and a control group received usual care . The Bristol COPD Knowledge Question naire ( BCKQ ) was self-administered at the time of r and omization and approximately three months later . RESULTS Of the 93 individuals that completed the study , 50 ( forced expiratory volume in 1s [FEV(1)]=60.0+/-14.3 % predicted ; 22 males ) and 43 ( FEV(1)=58.2+/-14.4 % predicted ; 20 males ) participants were r and omized to the experimental and control groups , respectively . The BCKQ increased from 27.6+/-8.7 to 36.5+/-7.7 points ( p<0.001 ) in the experimental group , which was greater than any seen in the control group ( between-group difference 8.3 , 95 % confidence interval 5.5 - 11.2 points ) . CONCLUSION As little as 2h of education delivered in primary care was effective at increasing objective measures of disease-specific knowledge . PRACTICE IMPLICATION S A program of brief education delivered in the primary care setting , represents an important approach for many individuals with COPD who are unlikely to access pulmonary rehabilitation This study explored whether patients ’ preference for particular types of anaesthesia  could be influenced pre‐operatively by giving them the addresses of various relevant websites . Patients at an orthopaedic pre‐ assessment education clinic completed a question naire , which included a short multiple‐choice general knowledge quiz about anaesthesia , and also question ed them as to their choice of anaesthesia ( general or neuraxial ) . Patients were r and omly assigned to intervention or control groups . Intervention group members were given the addresses of three relevant anaesthesia and health related websites to access at home . All patients were asked to complete the question naires on a second occasion , before surgery . Initially , most patients stated a preference for general anaesthesia . Subsequently , the intervention group altered their preference towards neuraxial anaesthesia compared to the control group ( p ≤ 0.0001 ) . The increase in median ( IQR [ range ] ) anaesthesia knowledge test score was greater in the intervention group ( from 10.0 ( 9.0–12.0 [ 5.0–14.0 ] ) to 13.0 ( 11.0–14.0 [ 6.0–14.0 ] ) ) than in the control group ( from 10.0 ( 9.0–11.5 [ 3.0–13.0 ] ) to 11.0 ( 9.0–12.0 [ 4.0–14.0 ] ) ; p = 0.0068 ) Purpose The purpose of this study is to evaluate the impact of a promotores-led diabetes self-management program by comparing the outcomes ( knowledge , beliefs , and HbA1c level ) of Mexican American patients with type 2 diabetes who received usual diabetic care in a wait-list control group  to those who received self-management education and follow-up by promotores in consultation with clinic providers and staff . Methods This r and omized control study compared the results of 63 patients who attended a promotores-led culturally sensitive diabetes self-management course at a commu- nity clinic with 68 patients in a wait-list , usual-care control group . Participants were Mexican Americans with type 2 diabetes who were patients at the clinic and at least 18 years of age . At baseline , 3 months , and 6 months , the Diabetes Knowledge Question naire ( DKQ ) , Health Beliefs Question naire ( HBQ ) , and HbA1c levels ( drawn by the clinic laboratory ) were collected . Results There was a significant improvement in the intervention group 's DKQ scores over time and in treatment by time . The baseline HbA1c level was 7.49 and did not change over time in either group . The DKQ , HBQ , and HbA1c results were significantly affected by age ; the DKQ and HbA1c were affected by years with diabetes . Conclusions The promotores-led diabetes self-management course improved the knowledge of patients with diabetes . Participant baseline HbA1c level was close to therapeutic level ( much lower than reported in previous studies ) , suggesting participants received good medical care within the community clinic OBJECTIVE Although patient education may enhance knowledge , coping with illness , and quality of life among cancer patients , it is uncertain which didactic method is most effective . We compared the impact of an interactive , patient-oriented group program to a lecture-based , information-only program in gastric cancer patients . METHODS In this prospect i ve , controlled trial , 121 gastric cancer patients attending inpatient rehabilitation after surgical treatment received either the interactive intervention or lectures providing information . The outcomes were patients ' disease-related knowledge , active coping with illness , and quality of life ( QoL ) at the end of their stay and 6 and 12 months thereafter . RESULTS Both groups improved their knowledge and QoL during rehabilitation ; however , knowledge was significantly higher in the interactive group compared to the lecture group . This difference was maintained at the 6- and 12-months follow-ups . In addition , the interactive group proved superior to the lecture group regarding active coping with illness and QoL at the end of rehabilitation , but not during follow-up . CONCLUSIONS A structured , interactive patient education program proved superior to lecture-based provision of information in regards to short-term and long-term knowledge as well as short-term coping and QoL. PRACTICE IMPLICATION S In gastric cancer patients , interactive patient education seems preferable over lectures OBJECTIVE To determine whether using the chronic care model ( CCM ) in an underserved community leads to improved clinical and behavioral outcomes for people with diabetes . RESEARCH DESIGN AND METHODS This multilevel , cluster- design , r and omized controlled trial examined the effectiveness of a CCM-based intervention in an underserved urban community . Eleven primary care practice s , along with their patients , were r and omized to three groups : CCM intervention ( n = 30 patients ) , provider education only ( PROV group ) ( n = 38 ) , and usual care ( UC group ) ( n = 51 ) . RESULTS A marked decline in HbA(1c ) was observed in the CCM group ( -0.6 % , P = 0.008 ) but not in the other groups . The magnitude of the association remained strong after adjustment for clustering ( P = 0.01 ) . The same pattern was observed for a decline in non-HDL cholesterol and for the proportion of participants who self-monitor blood glucose in the CCM group ( non-HDL cholesterol : -10.4 mg/dl , P = 0.24 ; self-monitor blood glucose : + 22.2 % , P < 0.0001 ) , with statistically significant between-group differences in improvement ( non-HDL cholesterol : P = 0.05 ; self-monitor blood glucose : P = 0.03 ) after adjustment . The CCM group also showed improvement in HDL cholesterol ( + 5.5 mg/dl , P = 0.0004 ) , diabetes knowledge test scores ( + 6.7 % , P = 0.07 ) , and empowerment scores ( + 2 , P = 0.02 ) . CONCLUSIONS These results suggest that implementing the CCM in the community is effective in improving clinical and behavioral outcomes in patients with diabetes & NA ; The issue of whether nursing instruction efforts could improve asthma knowledge and quality of life among schoolchildren was investigated using a quasi-experimental design . The key instruments were the Asthmatic Knowledge Question naire and the Childhood Asthma Question naire-Form B. Asthmatic knowledge increased among children who received instruction from nurses  ( Mean pre/post= 22.20/31.87 , p < .05 ) . These children also experienced significant improvements in their active quality of life ( Mean pre/post = 27.53/30.20 , p < .05 ) , and decreased distress ( Mean pre/post= 24.04/10.86 , p < .05 ) and asthma severity ( Mean pre/post= 13.27/8.3 , p < .05 ) . This study finds nursing instruction helpful in improving asthma knowledge . However , in terms of quality of life , elevated knowledge has a marked ( negative ) correlation only with levels of distress and severity . It shows no detectable relationship with active or passive life quality . Therefore , though nursing instruction can improve schoolchildren 's knowledge about asthma , the improvement in knowledge only relates to reducing distress and severity and thus improving quality of life . This result can provide guidance for nursing personnel in developing nursing instruction to improve active quality of life in child patients Background : Patient knowledge of correct inhaler technique is essential in the treatment of pulmonary disease . Computer delivery of educational content may augment existing teaching efforts . Objective : To determine whether a computer-based tutorial on inhaler technique could improve patients ' knowledge and ability to correctly demonstrate inhaler technique . Methods : A total of 34 adults with pulmonary disease and experience using inhalers were r and omized into the control or intervention groups . The intervention group viewed the tutorial , after which they demonstrated their inhaler technique and completed an Inhaler Technique Knowledge Test . Control group patients , who did not view the tutorial , were also evaluated on their demonstrated inhaler technique and technique knowledge . Additional information obtained included demographics , illness and treatment history , and patients ' use of computers . Lastly , all patients who viewed the tutorial completed a brief question naire eliciting tutorial feedback . Control group patients were invited to view the tutorial after other data collection was complete . The 2 principal outcomes were the observed inhaler technique score and the inhaler technique knowledge test score . Comparisons between groups were conducted using Student 's t-test and χ2 test , with a p value less than 0.05 considered statistically significant . Results : Eighteen subjects were enrolled in the computer group ; 16 were in the control group . The intervention group demonstrated significantly better inhaler technique , with a mean Observed Inhaler Technique Score of 88.3 ± 12.3 compared with 67.4 ± 19.2 for the control group ( p = 0.001 ) . The intervention group also scored significantly higher on the Inhaler Technique Knowledge Test , with a score of 80.9 ± 17.0 versus 67.4 ± 11.8 for the control group ( p = 0.01 ) . Overall , the program appeared acceptable to patients . Conclusions : Patients in the tutorial group demonstrated better inhaler technique and scored higher on the Inhaler Technique Knowledge Test compared with those in a control group . This tutorial may be a useful educational tool to enhance patient education regarding inhaler technique Knowledge of the warning signs of stroke may reduce the incidence of having a second stroke by receiving medical intervention in a timely manner . The need for stroke education is paramount to empower stroke patients to recognize the signs and symptoms of an impending stroke . The purpose of this pilot study was to develop and to evaluate the effectiveness of an educational method of providing stroke education in an acute care setting . Twenty patients were recruited and r and omized to two groups . Group 1 received the st and ard of care : verbal and written education at the time of discharge by the discharge nurse . Group 2 received individualized protocol -driven verbal and written education with their caregiver present within the context of the Therapeutic Alliance Model using motivational interviewing techniques . Each group was sent a Stroke Knowledge Test and a patient satisfaction survey at 1 month . Results indicate that the enhanced education group received improved scores on the Stroke Knowledge Test and had better patient satisfaction scores regarding stroke education . An enhanced educational method using motivational interviewing and an individualized protocol -driven education intervention given to both the patient and a caregiver enhance stroke knowledge and patient satisfaction after discharge from the acute care setting Background Patient education has proved beneficial in several but not all chronic disease . Inconsistent findings may rely on varying educational effects of various programs and differential effects on subgroups of patients . Patients ' increase in disease knowledge may serve as a feedback to the educator on how well the education program works – but may not be associated to relevant clinical outcomes like quality of life ( QoL ) . This study aim ed to investigate the effects of a group based education program for patients with gastroesoph 
    Output:
    
The outcome measurements for patient-education needs were comprehensive , validating knowledge tests that cover multidimensional aspects of knowledge .