***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 Low albumin level is a strong predictor of mortality and morbidity among hemodialysis patients , yet few interventions are available to improve albumin levels . Moreover , the relative importance of nutritional barriers versus inflammation in contributing to hypoalbuminemia is unclear . We sought to determine whether targeting specific nutritional barriers will improve albumin levels . METHODS We conducted a r and omized controlled trial involving 180 patients with baseline albumin levels less than 3.7 g/dL ( < 37 g/L ) at 44 long-term hemodialysis facilities . Study coordinators identified and intervened on specific barriers present among intervention patients , whereas control patients continued to receive the usual care . Barriers targeted included poor nutritional knowledge , poor appetite , help needed with shopping or cooking , low fluid intake , inadequate dialysis dose , depression , difficulty chewing , difficulty swallowing , gastrointestinal symptoms , and acidosis . RESULTS At baseline , intervention and control patients had similar albumin levels , dietary intakes , levels of inflammatory markers , and numbers of nutritional barriers . After 12 months , intervention patients had greater increases in albumin levels compared with control patients ( + 0.21 versus + 0.06 g/dL [ + 2.1 versus + 0.6 g/L ] ; P < 0.01 ) , as well as greater increases in energy intake ( + 4.1 versus -0.6 Kcal/d/kg ; P < 0.001 ) and protein intake ( + 0.13 versus -0.06 g/d/kg ; P < 0.001 ) . The intervention appeared most effective for barriers related to poor nutritional knowledge , help needed with shopping or cooking , and difficulty swallowing . About half the subjects had elevated levels of inflammatory markers , but there was no relationship between change in levels of albumin and inflammatory markers . CONCLUSION A nutrition intervention tailored to patient-specific barriers result ed in modest improvements in albumin levels regardless of levels of inflammatory markers BACKGROUND Compared with in-center hemodialysis , self-care dialysis ( including home and self-care hemodialysis and peritoneal dialysis ) is less re source intensive and associated with similar clinical outcomes . However , utilization of self-care dialysis has been very low . We performed a r and omized controlled trial in predialysis patients with chronic kidney disease ( CKD ) ( GFR < 30 mL/min ) to determine the impact of a patient-centered educational intervention on patients ' intention to initiate dialysis with self-care dialysis . METHODS Seventy patients with CKD who were receiving care in a multidisciplinary predialysis clinic were r and omized to receive either ( 1 ) a two-phase patient-centered educational intervention ( phase 1 included educational booklets and a 15-minute video on self-care dialysis ; phase 2 included a 90-minute small group interactive educational session on self-care dialysis ) in addition to their regular multidisciplinary care , or ( 2 ) ongoing st and ard care and education in the multidisciplinary predialysis clinic . The primary outcome was patients ' intention to initiate dialysis with self-care dialysis , assessed by question naire . RESULTS Thirty-five patients were r and omized to st and ard care ; 34 completed the study . Thirty-five patients were r and omized to the educational intervention ; 30 completed phase 1 and 28 completed phase 2 . By study end , significantly more patients in the intervention group ( 82.1 % ) intended to start dialysis with self-care dialysis  compared with the st and ard care group ( 50 % , P= 0.015 ) . This difference persisted after controlling for the small baseline differences among patients in the two study groups ( P= 0.004 ) . CONCLUSION A two-phase educational intervention can increase the proportion of patients who intend to initiate dialysis with self-care dialysis Purpose The purpose of the study is to investigate the effect of an emotional intelligence program on the health-related quality of life and well-being of individuals with type 2 diabetes . Methods The BarOn Emotional Intelligence Scale ( EQ-I ) , WHO Well-Being Question naire ( WHO-WBQ-22 ) , WHO Quality of Life Measure ( WHOQOL-Bref ) , and the Medical Outcomes Study 36-Item Health Survey ( SF-36 ) were administered to 184 patients with type 2 diabetes who volunteered to participate . Thirty-six patients with the lowest test scores on the WHO-WBQ-22 , WHOQOL-Bref , and SF-36 were r and omized into study and control groups ( 18 patients each ) . A 12-week emotional intelligence program was administered to the study group . At the end of the program , scales were readministered to both groups and again at 3 and 6 months . Results There were no differences between the quality of life , well-being , and emotional intelligence levels of the study and control groups before the commencement of the program ( P > .05 ) . At the conclusion of the program , quality of life , well-being , and emotional intelligence levels of study group patients increased in comparison with those in the control group ( P < .001 ) . The positive effect of the program on study groups ' quality of life , wellbeing , and emotional intelligence persisted at the 3- and 6-month follow-up . Conclusion The emotional intelligence program may have positive effects on quality of life and well-being of individuals with type 2 diabetes A nurse-delivered haemodialysis patient education programme incorporating cognitive behavioural therapy ( CBT ) was developed . The effects of the CBT programme were compared with those of a st and ard patient education ( SPE ) programme on patients ' salt intake and weight gain using a quasi-experimental design . There were 22 participants ( 11 CBT , 11 SPE ) undergoing outpatient haemodialysis therapy at one clinic .  Daily weight gain rates decreased in the intervention period compared with the baseline period in both the CBT and SPE groups . This effect lasted for 12 weeks in the CBT group but for only eight weeks in the SPE group . In addition , daily salt intake decreased in the intervention period compared with the baseline period in both the CBT and SPE groups , persisting for 12 weeks . From these results , both programmes were shown to be effective , but CBT had a longer effect OBJECTIVES We investigated the effect of achieved continuous tight blood pressure control and intensified insulin therapy on the rate of progression of renal failure in patients with overt diabetic nephropathy and already impaired renal function . DESIGN AND SETTING Prospect i ve , r and omized , multicentre , follow-up study . PATIENTS AND INTERVENTIONS From a screened group of the 66 hypertensive type 1 diabetic patients ( IDDM ) with overt diabetic nephropathy and reduced glomerular filtration rate who participated in two intensified treatment programmes , 39 patients fulfilled the study inclusion criteria and were enrolled into the 2-year follow-up period . The choice of antihypertensive drugs was based on a r and omized allocation to open antihypertensive treatments starting with felodipine , metoprolol , or ramipril . OUTCOME MEASURES Progression of renal failure was assessed by measurement of glomerular filtration rate ( GFR ) on insulin clearance every 6 months . MAIN RESULTS During the study period mean HbA1c was 8.1 + /- 1.6 % and the office blood pressure 143 + /- 14/88 + /- 8 mmHg . The change in GFRinulin ( mean and 95 % CI ) was + 1.9 ( -2.2 ; + 6.1 ) ml/min/year . GFR improved in 51 % , deteriorated in 39 % , and remained stable in 10 % of the patients . CONCLUSION This study shows that stabilization of glomerular filtration rate , as assessed by inulin clearance , is possible in patients with overt diabetic nephropathy who reach the goals of intensified antihypertensive treatment even if kidney function is already impaired Aims To examine whether motivating patients to gain expertise and closely follow their risk parameters will attenuate the course of microvascular and cardiovascular sequelae of diabetes AIMS This paper reports a study investigating the effectiveness of an adaptation training programme ( ATP ) to help patients with end-stage renal disease ( ESRD ) to cope with illness-related stresses and , thus , to alleviate depression and improve quality of life . BACKGROUND Patients with ESRD who receive dialysis must confront the burdens of long-term illness and numerous treatment-associated stressors . The ability of these patients to cope with and adapt to these stresses , whether related to their medical regimen or to the dem and s of daily life , has an important influence on physical and psychological well-being . METHODS The study was a r and omized controlled trial using a convenience sample of 57 eligible , fully informed and consenting patients with ESRD who were assigned to experimental ( ATP plus usual care ) or control ( usual care ) groups . Participants in the ATP took part in weekly small group sessions over an 8-week period and monthly follow-up to help them to cope with stressors . A clinical nurse specialist and an experienced psychotherapist led them in three small groups ( 8 - 10 per group ) . Participants in the usual care group received routine care . Instruments comprised the Haemodialysis Stressor Scale , Beck Depression Inventory and Medical Outcomes Study SF-36 . Data were collected at baseline and at three months following the intervention . RESULTS The major stressors for these patients were limitations on time and place related to employment , limitations on fluid intake , transport difficulties , loss of bodily function , length of dialysis treatment , and limitation of physical activities . The ATP had a beneficial effect on perceived stress ( P = 0.005 ) , depression ( P = 0.001 ) and quality of life ( P = 0.02 ) 3 months after the intervention . CONCLUSIONS This study supports the effectiveness of an ATP to decrease stress and depression levels , and to improve the quality of life of ATP patients receiving haemodialysis BACKGROUND Self-care dialysis ( SCD ) is associated with cost savings and possibly improved quality of life compared to in-centre haemodialysis . Despite this , less than one in four dialysis patients are currently treated with SCD . Our objectives were to identify perceived advantages of SCD associated with increased odds of selecting SCD , and to evaluate the effect of an educational intervention on patients ' perceptions of these advantages . METHODS We r and omized patients with GFR<30 ml/min to st and ard pre-dialysis education or a multifaceted educational intervention .  After each component of the intervention , participants completed a question naire on which they identified advantages of SCD and indicated their preferred dialysis modality . We used inductive coding to identify perceived advantages of SCD . RESULTS Seventy patients participated in the study . We identified three advantages of SCD : freedom , lifestyle and control . Of these , freedom and lifestyle were associated with increased odds of selecting SCD [ OR 9.1 ( 2.0 , 41.3 ) and 7.0 ( 1.6 , 29.7 ) , respectively ] . We combined these advantages for receiver-operating characteristic ( ROC ) analysis to assess accuracy in predicting patients ' intended choice of dialysis . The area under the ROC curve was 0.82 ( 0.70 , 0.93 ) . Patients who received the educational intervention were more likely to perceive freedom and control as advantages , and were less likely to identify no advantages of SCD . CONCLUSION Patients who identify freedom and lifestyle advantages of SCD are more likely to choose SCD . Providing additional education on dialysis modalities increases patients ' perceptions of the advantages of SCD and the odds of them selecting SCD BACKGROUND Intensified multifactorial intervention - with tight glucose regulation and the use of renin-angiotensin system blockers , aspirin , and lipid-lowering agents - has been shown to reduce the risk of nonfatal cardiovascular disease among patients with type 2 diabetes mellitus and microalbuminuria . We evaluated whether this approach would have an effect on the rates of death from any cause and from cardiovascular causes . METHODS In the Steno-2 Study , we r and omly assigned 160 patients with type 2 diabetes and persistent microalbuminuria to receive either intensive therapy or conventional therapy ;  the mean treatment period was 7.8 years . Patients were subsequently followed observationally for a mean of 5.5 years , until December 31 , 2006 . The primary end point at 13.3 years of follow-up was the time to death from any cause . RESULTS Twenty-four patients in the intensive-therapy group died , as compared with 40 in the conventional-therapy group ( hazard ratio , 0.54 ; 95 % confidence interval [ CI ] , 0.32 to 0.89 ; P=0.02 ) . Intensive therapy was associated with a lower risk of death from cardiovascular causes ( hazard ratio , 0.43 ; 95 % CI , 0.19 to 0.94 ; P=0.04 ) and of cardiovascular events ( hazard ratio , 0.41 ; 95 % CI , 0.25 to 0.67 ; P<0.001 ) . One patient in the intensive-therapy group had progression to end-stage renal disease , as compared with six patients in the conventional-therapy group ( P=0.04 ) . Fewer patients in the intensive-therapy group required retinal photocoagulation ( relative risk , 0.45 ; 95 % CI , 0.23 to 0.86 ; P=0.02 ) . Few 
    Output:
    
AUTHORS ' CONCLUSIONS Education programmes appear to have beneficial effects on improving patients ' knowledge of diabetes and some self-management behavioural changes for patients with diabetes on dialysis or with microalbuminuria .
Educational programmes appear to have beneficial effects on improving patients ' self-efficacy and result in some beliefs changes for patients with diabetes and microalbuminuria .
There is , therefore , inadequate evidence to support the beneficial effects of education programmes for people with DKD