***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 Patients with end-stage kidney disease receiving haemodialysis ( HD ) are at risk of cardiovascular disease and bone disorders related to high levels of serum phosphate . We studied the association between medication beliefs and depressive symptoms , with non-adherence to phosphate binding medication in a group of HD patients at risk of complications due to hyperphosphatemia . DESIGN Cross-sectional design . METHODS Baseline data from 112 patients participating in a r and omized controlled trial , evaluating an adherence intervention  , are presented . All patients had serum phosphate levels > 1.6 mmol/l at baseline .  Adherence was measured by ( 1 )  serum phosphate  and ( 2 )  Medication Adherence Report Scales ( MARS ) . Beliefs about Medicines ( BMQ ) and depressive symptoms ( PHQ-9 ) were also evaluated . RESULTS Beliefs about Medicines Question naire necessity , but not concerns , beliefs were found to correlate with serum phosphate ( r = -.23 , p < .05 ) and self-reported adherence ( r = .35 , p < .01 ) . In regression models , controlling for demographic , clinical and psychological variables , necessity beliefs explained the variance of serum phosphate ( β = -.22 , p = .01 ) and self-reported adherence ( β = .30 , p ≤ .01 ) . Both BMQ concerns and depressive symptoms were not related to non-adherence . CONCLUSION Patients ' beliefs about the necessity of their prescribed phosphate binding medications explain variation in non-adherence levels , measured both subjective and objective ly . Dialysis patient 's medication beliefs are potentially modifiable targets for future interventions Background Despite the evidence that phosphate binder ( PB ) is associated with improved outcomes many hemodialysis patients do not adhere to prescribed PB regimen . Therefore , barriers to PB adherence should be identified and eliminated . The purpose of this study was to evaluate PB adherence  among hemodialysis patients and to explore potentially modifiable factors associated with low PB adherence . Methods A cross-sectional study ( 502 patients ) was performed in four dialysis units in Salvador , Brazil , using data from the second phase of the Prospect i ve Study of the Prognosis of Chronic Hemodialysis Patients ( PROHEMO ) . Patients were categorized as adherent or non-adherent to PB based on their responses to a semi-structured question naire . Results Non-adherence to PB  was observed for 65.7 % of the patients . After adjustments for numerous covariates , cerebrovascular disease ( odds ratio ( OR ) , 3.30 ; 95 % confidence interval ( CI ) , 1.03 - 10.61 ) , higher PTH ( OR per each 300 pg/mL , 1.14 ; 95 % CI , 1.01 - 1.28 ) , lack of comprehension of the appropriate time to use PB ( OR , 7.09 ; 95 % CI , 2.10 - 23.95 ) and stopping PB use after feeling better ( OR , 4.54 ; 95 % CI , 1.45 - 14.25 ) or feeling worse ( OR , 11.04 ; 95 % CI , 1.79- 68.03 ) were significantly associated with PB non-adherence . By contrast , the adjusted odds of PB non-adherence were lower for patients with more years on dialysis ( OR by each 2 years , 0.87 ; 95 % CI , 0.80 - 0.95 ) , with serum phosphorus above 5.5 mg/dL ( OR , 0.53 ; 95 % CI 0.34 - 0.82 ) , who referred that were encouraged by the dialysis staff to be independent ( OR , 0.52 ; 95 % CI 0.30 - 0.90 ) , and reported that the nephrologist explained how PB should be used ( OR , 0.20 ; 95 % CI 0.05 - 0.73 ) . Conclusion The results of the present study are encouraging by showing evidence that improvement in the care provided by the dialysis staff and the attending nephrologist may play an important role in reducing the high prevalence of non-adherence to PB in maintenance hemodialysis patients . A new question naire is presented and may help to evaluate systematic ally the patients regarding PB adherence in hemodialysis setting Limited health literacy is common in the United States and associates with poor clinical outcomes . Little is known about the effect of health literacy in patients with advanced kidney disease . In this prospect i ve cohort study we describe the prevalence of limited health literacy and examine its association with the risk for mortality in hemodialysis patients . We enrolled 480 incident chronic hemodialysis patients from 77 dialysis clinics between 2005 and 2007 and followed them until April 2008 . Measured using the Rapid Estimate of Adult Literacy in Medicine , 32 % of patients had limited ( < 9th grade reading level ) and 68 % had adequate health literacy ( ≥9th grade reading level ) . Limited health literacy was more likely in patients who were male and non-white and who had fewer years of education . Compared with adequate literacy , limited health literacy associated with a higher risk for death ( HR 1.54 ; 95 % CI 1.01 to 2.36 ) even after adjustment for age , sex , race , and diabetes . In summary , limited health literacy is common and associates with higher mortality in chronic hemodialysis patients . Addressing health literacy may improve survival for these patients Background Patients with end stage renal disease often fail to follow prescribed dietary and fluid regimen , leading to undesirable outcomes . This study aim ed to examine and identify factors influencing dietary , fluid , medication and dialysis compliance behaviours in patients undergoing hemodialysis . Methods This was a cross-sectional study which employed purposive sampling design . A total of 188 respondents were recruited from 14 dialysis centres in Malaysia between 2008–2011 .  Self-reported compliance behaviours and biochemical measurements were used as evaluation tools . Results Compliance rates  of dietary , fluid , medication and dialysis were 27.7 % , 24.5 % , 66.5 % and 91.0 % , respectively . Younger , male , working patients and those with longer duration on hemodialysis were found more likely to be non-compliant . Lacks of adequate knowledge , inadequate self-efficacy skills , forgetfulness and financial constraints were the major perceived barriers towards better compliance to fluid , dietary , medication and dialysis , respectively . Conclusions Healthcare professionals should recognise the factors hindering compliance from the patients ' perspective while assisting them with appropriate skills in making necessary changes possible Objective To evaluate the effects of pharmacotherapy follow-up ( PF ) on metabolic control and clinical outcomes in type 2 diabetic patients . Setting Six community pharmacies ( 4 intervention and 2 control ) in the Curitiba metropolitan region ( Brazil ) . Main outcome measure Glycosylated Haemoglobin A1 ( HbA1 ) and fasting capillary glycaemia . Methods We conducted a 12-month controlled trial involving a total of 161 patients in six community pharmacies between July 2004 and March 2006 .  Pharmacotherapy follow-up was applied only to patients in the intervention group . Results Of the 161 patients enrolled , 96 completed the study ( 50 intervention and 46 control ) . The administration of 574 consultations with the intervention group patients led to 119 negative clinical outcomes ( 2.3/patient [ SD = 1.6 ] ) . The majority of detected problems were related to the ineffectiveness of pharmacotherapy ( 68.1 % ) . Relative to the control group , the intervention group exhibited greater glycosylated haemoglobin ( HbA1 ) reduction ( −2.2 % [ 95%CI −2.8%:−1.6 % ] vs. −0.3 [ 95 % CI −0.8:0.2 ] ; P < 0.001 ) and greater fasting capillary glycaemia reduction ( −20.1 mg/dl [ 95 % CI −31.9 mg/dl:−8.3 mg/dl ] vs. 4.3 mg/dl [ 95 % CI −13.4 mg/dl:22.2 mg/dl ] ; P = 0.022 ) . These differences persisted after adjustment for baseline values . There were no significant differences in any other clinical measures between the groups . There were also no significant changes in the number of medications and treatment regimens between groups , with the exception of the percentage of patients undergoing lipid lowering treatment , which increased in the intervention group from 16 % to 24 % ( P = 0.018 ) . The initial medication regimen complexity index ( MRCI ) in the intervention group was 15.5 ( SD = 7.8 , range 4–40.5 ) , and it decreased by 1.2 units ( SD = 5.9 ) after 12 months ( P = 0.149 ) . Conclusions PF of type 2 diabetic patients in community pharmacies can improve the glycaemia control of patients through optimisation of medication profiles without significant changes in either the number of drugs used or the regimen complexity OBJECTIVE To assess the utility of Leventhal 's Self-Regulatory Model ( SRM ) to predict self-care behavior with regard to dietary , medication , and fluid regimes in end-stage renal disease ( ESRD ) patients . METHODS In a prospect i ve study , ESRD patients treated via hospital-based haemodialysis ( N=73 ) were screened for cognitive deficits and completed question naires that enquired about illness perceptions , coping strategies , knowledge of kidney disease , and psychological distress at Time 1 . Physiological proxy measures of self-care behaviors regarding  diet ( serum potassium levels ) , fluid intake  ( mean and st and ard deviation of interdialytic weight gain )  , and  medication ( serum phosphate levels ) regimes were collected 3 weeks later at Time 2 . RESULTS Illness representations ( emotional and timeline perceptions ) predicted self-care behaviors with regard to diet and medication . Emotion-focused coping strategies predicted higher levels of variation in adherence to fluid restrictions . Younger males were less likely to adhere to the fluid restrictions . CONCLUSIONS The SRM has predictive utility . Psychological interventions should focus on alleviating disease-specific distress and challenging erroneous timeline perceptions in order to increase adherence to dietary and medication regimes in ESRD patients . A more specific measure of coping for ESRD is required to clarify the role of coping strategies in this population . Younger , male patients should be targeted for extra support with fluid restrictions PURPOSE Patterns of antihypertensive drug use in patients undergoing long-term hemodialysis therapy were studied . METHODS Patients attending seven outpatient hemodialysis units in Ohio were eligible for the study if they had been receiving the treatment for at least three months . Demographic and clinical data were obtained from patient interviews and computerized data bases , and blood pressure ( BP ) measurements were obtained before dialysis . Labeled names and dosages of antihypertensive drugs were recorded from containers the patients brought with them . Patients were asked to describe their adherence to the medications , their ability to afford the drugs , and their knowledge and beliefs about hypertension . Physical impairments in taking medication were also evaluated . RESULTS The frequency of hypertension was 89 % in the 270 participants . Antihypertensive drugs were prescribed for 76 % of the patients ; 25 % required three or more drugs . Hypertensive patients who were not receiving antihypertensive drugs ( 14 % ) had significantly higher BP than patients who were . Calcium-channel blockers were prescribed for 60 % of patients , angiotensin-converting-enzyme inhibitors for 33 % , and beta-blockers for 34 % . Eighty-three percent said the cost of drugs was never a problem , and 23 % said they sometimes forgot to take their medication . Almost all patients said they would not stop taking antihypertensive drugs if they were feeling better and agreed that monitoring BP was important . Twenty-two percent could not read the warning on a st and ard tablet container , and 12 % could not remove one tablet from the container . CONCLUSION Multidrug antihypertensive therapy was common among hemodialysis patients and was associated with significantly lower BP ; calcium-channel blockers were the most frequently prescribed agents . Most patients said they could afford drugs and reported good adherence to antihypertensive drug therapy BACKGROUND The Cochrane Collaboration is strongly encouraging the use of a newly developed tool , the Cochrane Collaboration Risk of Bias Tool ( CCRBT ) , for all review groups . However , the psychometric properties of this tool to date have yet to be described . Thus , the objective of this study was to add information about psychometric properties of the CCRBT including inter-rater reliability and concurrent validity , in comparison with the Effective Public Health Practice Project Quality Assessment Tool ( EPHPP ) . METHODS Both tools were used to assess the method ological quality of 20 r and omized controlled trials included in our systematic review of the effectiveness of knowledge translation interventions  to improve the management of cancer pain . Each study assessment was completed independently by two review ers using each tool . We analysed the inter-rater reliability of each tool 's individual domains , as well as final grade assigned to each study . RESULTS The EPHPP had fair inter-rater agreement for individual domains and excellent agreement for the final grade . In 
    Output:
    
Medication-related factors such as daily tablet count , total pill burden , number of phosphate binders prescribed and complexity of medication regimen were also associated with poor adherence .
A number of patient- , disease- , and medication-related factors are associated with medication nonadherence in haemodialysis patients .