***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: Treatment goals for patients with CKD are often unrealized for many reasons , but support by nurse practitioners may improve risk factor levels in these patients . Here , we analyzed renal endpoints of the Multifactorial Approach and Superior Treatment Efficacy in Renal Patients with the Aid of Nurse Practitioners ( MASTERPLAN ) study after extended follow-up to determine whether strict implementation of current CKD guidelines through the aid of nurse practitioners improves renal outcome . In total , 788 patients with moderate to severe CKD were r and omized to receive nurse practitioner support added to physician care ( intervention group ) or physician care alone ( control group ) . Median follow-up was 5.7 years . Renal outcome was a secondary endpoint of the MASTERPLAN study . We used a composite renal endpoint of death , ESRD , and 50 % increase in serum creatinine . Event rates were compared with adjustment for baseline serum creatinine concentration and changes in estimated GFR were determined . During the r and omized phase , there were small but significant differences between the groups in BP , proteinuria , LDL cholesterol , and use of aspirin , statins , active vitamin D , and antihypertensive medications  , in favor of the intervention group . The intervention reduced the incidence of the composite renal endpoint by 20 % ( hazard ratio , 0.80 ; 95 % confidence interval , 0.66 to 0.98 ; P=0.03 ) . In the intervention group , the decrease in estimated GFR was 0.45 ml/min per 1.73 m(2 ) per year less than in the control group ( P=0.01 ) . In conclusion , additional support by nurse practitioners attenuated the decline of kidney function and improved renal outcome in patients with CKD BACKGROUND AND OBJECTIVES It is unclear how to optimally care for chronic kidney disease ( CKD ) . This study compares a new coordinated model to usual care for CKD . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS A r and omized trial in nephrology clinics and the community included 474 patients with median estimated GFR ( eGFR ) 42 ml/min per 1.73 m(2 ) identified by laboratory-based case finding compared care coordinated by a general practitioner ( controls ) with care by a nurse-coordinated team including a nephrologist ( intervention ) for a median ( interquartile range [ IQR ] ) of 742 days . 32 % were diabetic , 60 % had cardiovascular disease , and proteinuria was minimal . Guided by protocol s , the intervention team targeted risk factors for adverse kidney and cardiovascular outcomes . Serial eGFR and clinical events were tracked . RESULTS The average decline in eGFR over 20 months was -1.9 ml/min per 1.73 m(2 ) . eGFR declined by ≥4 ml/min per 1.73 m(2 ) within 20 months in 28 ( 17 % ) intervention patients versus 23 ( 13.9 % ) control patients . Control of BP , LDL , and diabetes were comparable across groups . In the intervention group there was a trend to greater use of renin-angiotensin blockers  and more use of statins  in those with initial LDL > 2.5 mmol/L. Treatment was rarely required for anemia , acidosis , or disordered mineral metabolism . Clinical events occurred in 5.2 % per year . CONCLUSIONS Patients with stage 3/4 CKD identified through community laboratories largely had nonprogressive kidney disease but had cardiovascular risk . Over a median of 24 months , the nurse-coordinated team did not affect rate of GFR decline or control of most risk factors compared with usual care & NA ; Cross‐sectional research in clinical sample s , as well as experimental studies in healthy adults , suggests that the experiences of pain and sleep are bi‐directionally connected . However , whether sleep and pain experiences are prospect ively linked to one another on a day‐to‐day basis in the general population has not previously been reported . This study utilizes data from a naturalistic , micro‐longitudinal , telephone study using a representative national sample of 971 adults . Participants underwent daily assessment of hours slept and the reported frequency of pain symptoms over the course of one week . Sleep duration on most nights ( 78.0 % ) was between 6 and 9 h , and on average , daily pain was reported with mild frequency . Results suggested that hours of reported sleep on the previous night was a highly significant predictor of the current day ’s pain frequency ( Z = −7.9 , p < .0001 , in the structural equation model ) ; obtaining either less than 6 or more than 9 h of sleep was associated with greater next‐day pain . In addition , pain prospect ively predicted sleep duration , though the magnitude of the association in this direction was somewhat less strong ( Z = −3.1 , p = .002 , in the structural equation model ) . Collectively , these findings indicate that night‐to‐night changes in sleep affect pain report , illuminating the importance of considering sleep when assessing and treating pain BACKGROUND Chronic kidney disease ( CKD ) is highly prevalent in patients with diabetes or hypertension in primary care . A shared care model could improve quality of care in these patients AIM To assess the effect of a shared care model in managing patients with CKD who also have diabetes or hypertension . Design and setting A cluster r and omised controlled trial in nine general practice s in The Netherl and s. METHOD Five practice s were allocated to the shared care model and four practice s to usual care for 1 year . Primary outcome was the achievement of blood pressure targets ( 130/80 mmHg ) and lowering of blood pressure in patients with diabetes mellitus or hypertension and an estimated glomerular filtration rate (eGFR)<60 ml/min/1.73 m(2 ) . RESULTS Data of 90 intervention and 74 control patients could be analysed . Blood pressure in the intervention group decreased with 8.1 ( 95 % CI = 4.8 to 11.3)/1.1 ( 95 % CI = -1.0 to 3.2 ) compared to -0.2 ( 95 % CI = -3.8 to 3.3)/-0.5 ( 95 % CI = -2.9 to 1.8 ) in the control group . Use of lipid-lowering drugs , angiotensin-system inhibitors and vitamin D was higher in the intervention group than in the control group ( 73 % versus 51 % , 81 % versus 64 % , and 15 % versus 1 % , respectively , [ P = 0.004 , P = 0.01 , and P = 0.002 ] ) . CONCLUSION A shared care model between GP , nurse practitioner and nephrologist is beneficial in reducing systolic blood pressure in patients with CKD in primary care BACKGROUND Patients on maintenance hemodialysis suffer from diminished physical health . Directly supervised exercise programs have been shown to be effective at improving physical function and optimizing well-being . However , nurses seldom include an exercise intervention in the care plan for hemodialysis patients . OBJECTIVES The purpose of this study was to examine the effects of a 12-week nurse-led case management program on home exercise training for hemodialysis patients . DESIGN The study was a r and omized , two-parallel group trial . SETTING S Hemodialysis units in two tertiary hospitals in Nanjing , mainl and China . PARTICIPANTS One hundred and thirteen adult patients who have been in stable condition while on dialysis treatment for more than 3 months were recruited and r and omly assigned to either the study group ( n=57 ) or the control group ( n=56 ) . METHODS Both groups underwent a brief weekly in-center exercise training session before their dialysis sessions for the first 6 weeks . The study group received additional nurse case management weekly for the first 6 weeks and biweekly for the following 6 weeks . The intervention was to facilitate patients in performing regular exercise at home . Outcome measures , including gait speed , 10-repetition sit-to-st and performance , and quality of life were collected at baseline , and at 6 and 12 weeks into the program . RESULTS The results revealed that patients in the study group demonstrated greater increases in normal gait speed [ F(1,111)=4.42 , p=0.038 ] than the control group . For the study group , a mean increase of 12.02 (±3.03)centimeters/second from baseline to week 12 was found . With regard to the fast gait speed , there was a marginally significant between-group effect [ F(1,111)=3.93 , p=0.050 ] . The study group showed a mean improvement of 11.08 (±3.32)cm/s , from baseline to week 12 . Patients from both groups showed improvements in their 10-repetition sit-to-st and performance . The between-group differences approached significance [ F(1,111)=3.92 , p=0.050 ] , with the study group showed greater improvement than the control group . The time taken by the patients in the study group to complete the 10-STS test increased by 5.75 (±3.88)s from baseline to week 12 . Significant improvements in quality of life across three time points were found only in the study group . CONCLUSIONS Home exercise using a nurse-led case management approach is practical and effective in improving the physical function and self-perceived health of stable hemodialysis patients AIM AND OBJECTIVE The purpose of this study was to investigate the effects of group intervention on depression , self-efficacy and quality of life in haemodialysis patients . BACKGROUND Chronic renal failure and haemodialysis treatment is a long-term process ; patients need to have an appropriate adaptive strategy to confront the stress stemming from the disease and subsequent haemodialysis treatment . The application of group intervention for haemodialysis patients has been limited . DESIGN This study applied an experimental design methodology . Patients were selected at two haemodialysis units of major medical centres in northern Taiwan . METHODS Out of 60 original patients r and omly assigned into experimental or control groups , 48 completed the study . Twenty patients in the experimental group received group psychosocial intervention . The therapy ran for two hours per week for two months . Twenty-eight patients in the comparison group received routine unit care and a self-care booklet . Instruments included the Strategies Used by People to Promote Health , the Beck Depression Inventory and the Short Form-36 . Data were collected at pretest and one month following the therapy . RESULTS The findings demonstrated that self-care self-efficacy , depression and quality of life significantly improved statistically for patients in the therapy group , compared with patients in the comparison group . CONCLUSIONS The study indicated that group psychosocial intervention significantly reduced depression , improved self-care self-efficacy and quality of life in haemodialysis patients . RELEVANCE TO CLINICAL PRACTICE The present study was conducted with a group of out patients , did not require expensive re sources and was not time intensive , making it a viable therapy , clinical ly suitable for haemodialysis patients INTRODUCTION Sleep disorders are common in hemodialysis patients . They can affect their quality of life . The purpose of this study was to evaluate the effects of aerobic training on sleep quality , inflammatory status , and serum leptin levels in hemodialysis patients . MATERIAL S AND METHODS Twenty-eight men in the age range of 28 to 74 years who were on maintenance hemodialysis and had sleep problems were enrolled in this study . They were r and omly assigned into control and training groups ( 14 patients in each group ) . Patients in the training group performed a 10- to 30-minute stationary cycling , 3 times a week , during the 1st two hours of every dialysis session , for 8 weeks . The  Pittsburgh Sleep Quality Index and the Baecke question naire on physical activity  were filled out for all participants . To assess serum leptin and C-reactive protein levels , blood sample s were drawn before the beginning and at the end of the eighth week . RESULTS At the end of the study , serum leptin and C-reactive protein levels were significantly reduced ( P < .001 and P < .001 , respectively ) . Furthermore , the Pittsburgh Sleep Quality Index scores of the training group declined significantly after 8 weeks ( P < .001 ) . There was a positive correlation between sleep quality and serum levels of leptin and C-reactive protein ( P = .03 and P = .04 , respectively ) . CONCLUSIONS Aerobic exercise with moderate intensity during the first two hours of a dialysis session could improve sleep quality and inflammatory status of hemodialysis patients , which predicts morbidity , mortality , and quality of life . However , additional research is needed to confirm these effects INTRODUCTION Fatigue and quality of sleep are the main factors that contribute to a poor quality of life among patients on long-term haemodialysis . Studies have also emphasised the importance of exercise for improving the wellbeing of dialysis patients . This study aim ed to determine the effectiveness of a predialysis low-to-moderate-intensity exercise programme for reducing fatigue and improving sleep disorders among long-term haemodialysis patients . METHODS In this quasi-experimental study , an exercise programme was conducted three times a week for 12 weeks before long-term haemodialysis patients underwent dialysis at two centres . The patients were categorised into either the  exercise group ( n = 28 ) or control group ( n = 27 ) . The latter was asked to maintain their current lifestyles . Assessment s of fatigue and sleep disorder levels were performed for both groups using self-reported question naires at baseline and after intervention . The patients ' perception of the exercise programme was also determined using self-reported question na 
    Output:
    
Conclusion Nurse-led disease management program seems effective to improve some parameters of quality of life for patients with chronic kidney disease .