***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 Peritoneal dialysis ( PD ) requires patients to take an active role in their adherence to fluid restrictions . Although fluid non-adherence had been identified among this patient group , no specific interventions have been research ed or published with in the PD population . The current study sought to investigate whether an applied cognitive behavioural therapy ( CBT-based intervention ) used among haemodialysis patients would improve fluid adherence among PD patients ; utilizing clinical indicators used in practice . METHODS Fifteen PD patients identified as fluid non-adherent were r and omly assigned to an intervention group ( IG ) or a deferred-entry control group ( CG ) . The study ran for a total of 21 weeks , with five data collection points ; at baseline , post-intervention and at three follow-up points ; providing a RCT phase and a combined longitudinal analysis phase . The content of the group intervention encompassed educational , cognitive and behavioural components , aim ed to assist patients ' self-management of fluid . RESULTS No significant differences in weight ( kg ) reduction were found in either phase and undesirable changes in blood pressure ( BP ) were observed . However , in the longitudinal phase , a statistically significant difference in oedematous status was observed at 6-week follow-up ; which may be indicative of fluid adherence . Positive and significant differences were observed in the desired direction for measures of psychological well-being , quality of life and health beliefs ; areas correlated with enhanced fluid adherence in other research . CONCLUSIONS This study reveals encouraging and significant changes in predictors of fluid adherence . Although there were no significant changes in weight as a crude clinical measure of fluid intake , significant reductions in oedematous status were observed as a consequence of this CBT-based group intervention Objective The purpose of this study is to evaluate the efficacy of a behavioral self-regulation intervention vs. active control condition using a parallel-group r and omized clinical trial with a sample of center hemodialysis patients with chronic kidney disease . Method Participants were recruited from 8 hemodialysis treatment centers in the Midwest . Eligible patients were ( a ) fluid nonadherent as defined by an interdialytic weight gain > 2.5 kg over a 4-week period , ( b ) > 18 years of age , ( c ) English-speaking without severe cognitive impairment , ( d ) treated with center-based hemodialysis for > 3 months , and ( e ) not living in a care facility in which meals were managed . Medical records were used to identify eligible patients . Patients were r and omly assigned to either a behavioral self-regulation intervention or active control condition in which groups of 3–8 patients met for hour-long , weekly sessions for 7 weeks at their usual hemodialysis clinic . Primary analyses were intention-to-treat . Results Sixty-one patients were r and omized to the intervention while 58 were assigned to the attention-placebo support and discussion control . Covariate-adjusted between-subjects analyses demonstrated no unique intervention effect for the primary outcome , interdialytic weight gain ( β = 0.13 , p = 0.48 ) . Significant within-subjects improvement over time was observed for the intervention group ( β = −0.32 , p = 0.014 ) . Conclusions The present study found that participation in a behavioral self-regulation intervention result ed in no unique intervention effect on a key indicator of adherence for those with severe chronic kidney disease . There was , however , modest within-subjects improvement in interdialytic weight gain for the intervention group which meshes with other evidence showing the utility of behavioral interventions in this patient population . Clinical Trials.gov Identifier : This research examined the relative efficacies of three intervention strategies design ed to increase compliance to medical regimens in a group of ambulatory hemodialysis patients . The interventions examined included behavioral contracting ( with or without the involvement of a family member or friend ) and weekly telephone contacts with patients . Compliance was assessed with regard to following dietary restrictions and limiting fluid intake . Data were collected from 116 patients drawn from two outpatient clinics . Within clinics , patients were r and omly assigned either to an intervention program or to a control group . The study employed a pretest-posttest control group design . Patients were interviewed before the intervention programs began ( T1 ) , after a 6-week intervention period ( T2 ) , and 3 months after completion of the intervention period ( T3 ) . Results showed that the interventions achieved substantial reductions in patients ' serum potassium levels and in weight gains between dialysis treatments between T1 and T2 . In general , however , these program effects tapered off to preintervention levels between T2 and T3 . The findings thus indicate a need for long-term intervention programs OBJECTIVE This study aim ed to assess the effectiveness of Benson 's relaxation technique in improving the hemodialysis patients '  dietary and fluid adherence and biomedical markers . DESIGN This r and omized controlled trial with a pre-post test design was conducted on 86 hemodialysis patients r and omly divided into an intervention ( receiving Benson 's relaxation technique ) and a control group ( usual care ) .  SETTING The setting of the study was two hemodialysis units affiliated to Shiraz University of Medical Sciences , Shiraz , Iran . INTERVENTION The patients listened to the audiotape of Benson 's relaxation technique twice a day each time for 20min for 8 weeks . MAIN OUTCOME MEASURES Dietary and fluid adherence and some biomedical markers were measured in both the intervention and the control group at baseline and at the 8th week after the intervention . RESULTS The results showed significant differences between the two groups regarding blood urea nitrogen and phosphate as dietary adherence and interdialytic weight gain as fluid adherence in the 8th week of the intervention ( P<0.05 ) . Also , a significant difference was found between the two groups concerning blood glucose level after the intervention ( P<0.05 ) . CONCLUSIONS This study highlighted the importance of Benson 's relaxation technique in improvement of adherence and some biomedical markers in hemodialysis patients . Thus , Benson 's relaxation therapy could be used as a part of the nursing care practice for hemodialysis patients and those suffering from chronic diseases OBJECTIVE To examine the effect of self-management dietary counselling ( SMDC ) on adherence to dietary management of hyperphosphatemia among haemodialysis patients . DESIGN An eight-week cluster based r and omised control trial . PARTICIPANTS 122 stable adult patients were recruited from an HD unit in Sidon , Lebanon . Study groups were : full intervention ( A ) ( n = 41 ) , partial intervention ( B ) ( n = 41 ) and control ( C ) ( n = 40 ) . INTERVENTION Group ( A ) received SMDC , Group ( B ) received educational games only and Group ( C ) did not receive any research intervention . MAIN OUTCOME MEASURES Serum phosphorus ( P ) , Calcium Phosphate product ( Ca × P ) and two question naires : patient knowledge ( PK ) and dietary non-adherence ( PDnA ) to P reduced diet . RESULTS Group A experienced a significant improvement in mean ( ± SD ) P ( 6.54 ± 2.05 - 5.4 ± 1.97 mg/dl ) , Ca × P ( 58 ± 17 - 49 ± 12 ) , PK scores ( 50 ± 17 - 69 ± 25 % ) and PDnA scores ( 21.4 ± 4.0 - 18.3 ± 2.0 ) . Group B experienced a significant improvement in Ca × P ( 52 ± 14 - 45 ± 16 ) . Group C did not experience any significant change post intervention . CONCLUSION Our findings demonstrate the importance of patient-tailored counselling on serum P management Background / Aims . One of the causes of uncontrolled secondary hyperparathyroidism ( sHPT ) is patient 's poor drug adherence . We evaluated the clinical benefits of an integrated care approach on the control of sHPT by cinacalcet . Methods . Prospect i ve , r and omized , controlled , multicenter , open-label study . Fifty hemodialysis patients on a stable dose of cinacalcet were r and omized to an  integrated care approach ( IC ) or usual care approach ( UC ) . In the IC group , cinacalcet adherence was monitored using an electronic system . Results were discussed with the patients in motivational interviews , and drug prescription adapted accordingly . In the UC group , drug adherence was monitored , but results were not available . Results . At six months , 84 % of patients in the IC group achieved recommended iPTH targets versus 55 % in the UC group ( P = 0.04 ) . The mean cinacalcet taking adherence improved by 10.8 % in the IC group and declined by 5.3 % in the UC group ( P = 0.02 ) . Concomitantly , the mean dose of cinacalcet was reduced by 7.2 mg/day in the IC group and increased by 6.4 mg/day in the UC group ( P = 0.03 ) . Conclusions . The use of a drug adherence monitoring program in the management of sHPT in hemodialysis patients receiving cinacalcet improves drug adherence and iPTH control and allows a reduction in the dose of cinacalcet Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE Poor compliance with the dietary prescriptions is quite common in dialysis patients . We believe that most of the noncompliance is caused by the patient 's poor underst and ing of the dietary prescription . Therefore , in the present study , we tried to investigate the role of menu suggestion in improving the patient 's compliance with the dietary prescription . DESIGN AND SETTING A longitudinal cohort study conducted at an outpatient dialysis clinic . PATIENTS Seventy clinical ly stable patients on peritoneal dialysis were included in this prospect i ve study during April 1 , 2004 , to November 31 , 2004 , in a single center . Patients who had significant cognitive impairment and thus did not underst and the food contents during the training course were not eligible for enrollment . INTERVENTION All the patients were r and omly assigned to 1 of 2 groups . Group 1 patients received the traditional patient education method . Group 2 patients additionally received individualized menu suggestions based on their food preferences and education on how to exchange the foods at equivalent amounts according to the exchange list . MAIN OUTCOME MEASURES At present , there are no clear optimal dietary protein intake levels for peritoneal dialysis patients . Our experience is that a dietary protein intake level of 0.8 to 1.2 g/kg/d can maintain our patients in a good nutritional status . Thereafter , in this study we prescribed the  dietary protein intake level at 0.8 to 1.2 g/kg/d and defined compliance as meeting this target protein intake level . RESULTS There were 35 patients in each group . The compliance was 22.9 % in group 1 and 57.1 % in group 2 ( P < .05 ) . CONCLUSIONS Our study suggests that menu suggestion may be an effective way of improving the compliance with the diet in peritoneal dialysis patients . It improves the patient 's underst and ing of the dietary prescription CONTEXT High dietary phosphorus intake has deleterious consequences for renal patients and is possibly harmful for the general public as well . To prevent hyperphosphatemia , patients with end-stage renal disease limit their intake of foods that are naturally high in phosphorus . However , phosphorus-containing additives are increasingly being added to processed and fast foods . The effect of such additives on serum phosphorus levels is unclear . OBJECTIVE To determine the effect of limiting the intake of phosphorus-containing food additives on serum phosphorus levels among patients with end-stage renal disease . DESIGN , SETTING , AND PARTICIPANTS Cluster r and omized controlled trial at 14 long-term hemodialysis facilities in northeast Ohio . Two hundred seventy-nine patients with elevated baseline serum phosphorus levels ( > 5.5 mg/dL ) were recruited between May and October 2007 . Two shifts at each of 12 large facilities and 1 shift at each of 2 small facilities were r and omly assigned to an intervention or control group . INTERVENTION  Intervention participants ( n=145 ) received education on avoiding foods with phosphorus additives when purchasing groceries or visiting fast food restaurants . Control participants ( n=134 )  continued to receive usual care . MAIN OUTCOME MEASURE Change in serum phosphorus level after 3 months . RESULTS At baseline , there was no significant difference in serum phosphorus levels between the 2 groups . After 3 months , the decline in serum phosphorus levels was 0.6 mg/dL larger among intervention vs control participants ( 95 % confidence interval , -1.0 to -0.1 mg/dL ) . Intervention participants also had statistically significant increases in reading ingredient lists ( P<.001 ) and nutrition facts labels ( P = .04 ) but no significant increase in food knowledge scores ( P = .13 ) . CONCLUSION Educating end-stage renal disease patients to avoid phosphorus-containing food additives result ed in modest improvements in hyperphosphatemia . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00583570 CONTEXT Mortality rates among US hemodialysis patients are the highest in the industrialized world at 23 % per year . Measures of dialysis do 
    Output:
    
A majority of ( 28/36 ) RCTs showed improvement in some reported outcomes .
CONCLUSIONS Interventions to improve treatment adherence result in modest short-term benefits in surrogate outcome measures in dialysis patients , but significant improvements in trial design and outcome reporting are warranted to identify strategies that would achieve meaningful and sustainable clinical benefits .