***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: Rapid kidney function decline ( RKFD ) predicts cardiovascular morbidity and mortality , but serial assessment of estimated GFR ( eGFR ) is not cost-effective for the general population . Here , we evaluated the predictive value of albuminuria and three thresholds of dipstick proteinuria to identify RKFD in 2,574 participants in a community-based prospect i ve cohort study with a median of 7 years follow-up .  Median change in eGFR was -0.78 ml/min per 1.73 m(2 ) per year ; with 8.5 % experiencing RKFD , defined as a > 5 % annual eGFR decline from baseline . Of those with RKFD , 65 % advanced to a new CKD stage compared with 19 % of those without RKFD . Dipstick protein ≥ 1 g/L was a stronger predictor of RKFD than albuminuria . Overall , 2.5 % screened positive for dipstick protein ≥ 1 g/L at baseline ; one of every 2.6 patients would have RKFD if all were followed with serial eGFR measurement . Overall , the screening strategy correctly identified progression status for 90.8 % of patients , mislabeled 1.5 % as RKFD , and missed 7.7 % with eventual RKFD . Among those with risk factors ( cardiovascular disease , age > 60 , diabetes , or hypertension ) , the probability of identifying RKFD from serial eGFR measurements increased from 13 to 44 % after incorporating dipstick protein ( ≥ 1 g/L threshold ) . In summary , inexpensive screening with urine dipstick should allow primary care physicians to follow fewer patients with serial eGFR assessment but still identify those with rapid decline of kidney function Summary Background The increasing prevalence of type 2 diabetes poses a major public health challenge . Population -based screening and early treatment for type 2 diabetes could reduce this growing burden . However , uncertainty persists around the benefits of screening for type 2 diabetes . We assessed the effect of a population -based stepwise screening programme on mortality . Methods In a pragmatic parallel group , cluster-r and omised trial , 33 general practice s in eastern Engl and were r and omly assigned by the method of minimisation in an unbalanced design to : screening followed by intensive multifactorial treatment for people diagnosed with diabetes ( n=15 ) ; screening plus routine care of diabetes according to national guidelines ( n=13 ) ; and a no-screening control group ( n=5 ) . The study population consisted of 20 184 individuals aged 40–69 years ( mean 58 years ) , at high risk of prevalent undiagnosed diabetes , on the basis of a previously vali date d risk score . In screening practice s , individuals were invited to a stepwise programme including r and om capillary blood glucose and glycated haemoglobin ( HbA1c ) tests , a fasting capillary blood glucose test , and a confirmatory oral glucose tolerance test . The primary outcome was all-cause mortality . All participants were flagged for mortality surveillance by the Engl and and Wales Office of National Statistics . Analysis was by intention-to-screen and compared all-cause mortality rates between screening and control groups . This study is registered , number IS RCT N86769081 . Findings Of 16 047 high-risk individuals in screening practice s , 15 089 ( 94 % ) were invited for screening during 2001–06 , 11 737 ( 73 % ) attended , and 466 ( 3 % ) were diagnosed with diabetes . 4137 control individuals were followed up . During 184 057 person-years of follow up ( median duration 9·6 years [ IQR 8·9–9·9 ] ) , there were 1532 deaths in the screening practice s and 377 in control practice s ( mortality hazard ratio [ HR ] 1·06 , 95 % CI 0·90–1·25 ) . We noted no significant reduction in cardiovascular ( HR 1·02 , 95 % CI 0·75–1·38 ) , cancer ( 1·08 , 0·90–1·30 ) , or diabetes-related mortality ( 1·26 , 0·75–2·10 ) associated with invitation to screening . Interpretation In this large UK sample , screening for type 2 diabetes in patients at increased risk was not associated with a reduction in all-cause , cardiovascular , or diabetes-related mortality within 10 years . The benefits of screening might be smaller than expected and restricted to individuals with detectable disease . Funding Wellcome Trust ; UK Medical Research Council ; National Health Service research and development support ; UK National Institute for Health Research ; University of Aarhus , Denmark ; Bio-Rad Background The benefit of self-monitoring of blood glucose ( SMBG ) in people with type 2 diabetes on diet or oral agents other than sulphonylureas  remains uncertain . Trials of interventions incorporating education about self-monitoring of blood glucose have reported mixed results . A recent systematic review concluded that SMBG was not cost-effective . However , what was unclear was whether a cheaper method of self-monitoring ( such as urine glucose monitoring ) could produce comparable benefit and patient acceptability for less cost . Methods / Design The DESMOND SMBG trial is comparing two monitoring strategies ( blood glucose monitoring and urine testing ) over 18 months when incorporated into a comprehensive self-management structured education programme . It is a multi-site cluster r and omised controlled trial , conducted across 8 sites ( 7 primary care trusts ) in Engl and , UK involving individuals with newly diagnosed Type 2 diabetes . The trial has 80 % power to demonstrate equivalence in mean HbA1c ( the primary end-point ) at 18 months of within ± 0.5 % assuming 20 % drop out and 20 % non-consent . Secondary end-points include blood pressure , lipids , body weight and psychosocial measures as well as a qualitative sub- study . Practice s were r and omised to one of two arms : participants attend a  DESMOND programme incorporating a module on self-monitoring of either urine or blood glucose . The programme is delivered by accredited educators who received specific training about equipoise . Biomedical data are collected and psychosocial scales completed at baseline , and 6 , 12 , and 18 months post programme . Qualitative research with participants and educators will explore views and experiences of the trial and preferences for methods of monitoring . Discussion The DESMOND SMBG trial is design ed to provide evidence to inform the debate about the value of self-monitoring of blood glucose in people with newly diagnosed type 2 diabetes . Strengths include a setting in primary care , a cluster design , a health economic analysis , a comparison of different methods of monitoring while controlling for other components of training within the context of a quality assured structured education programme and a qualitative sub- study .Trial registration IS RCT N : IS RCT N95696668 Background . This study was done to determine whether emergency department ( ED ) patient management decisions made on the basis of dipstick urinalysis are altered when results of urine microscopy become available . Methods . The study population was a prospect i ve r and om sample of adult ED patients who had urinalysis ordered for detection of possible urinary tract infection ( UTI ) or hematuria . Clinicians were given the result of the dipstick urinalysis and were asked to formulate a management plan . Urine microscopy of the same specimen was obtained later , and the clinicians were asked if management was changed after results were known . Results . Of 166 urinalyses , 118 ( 71 % ) were ordered for suspected UTI , 32 ( 19 % ) for suspected hematuria , and 16 ( 10 % ) for both . Of 134 urinalyses , 58 ( 43 % ) were positive for leukocyte esterase or nitrites , and 15 of 48 ( 31 % ) were positive for blood . Microscopy prompted a management change in only 9 of 166 patients . Six changes result ed in therapy for UTI , one result ed in withholding of therapy for UTI , and two result ed in cancellation of plans for diagnostic imaging . When urinalysis was done only to detect hematuria , none of the 32 patients had a management change after microscopy . Conclusion . Dipstick urinalysis for blood or UTI is a reliable diagnostic test in ED patients . In 94 % of patients , subsequent findings on urine microscopy did not prompt a change in management . Microscopy added nothing to dipstick results when clinicians suspected conditions causing hematuria alone . Primary use of dipstick urinalysis , with microscopy in selected cases , would likely result in considerable cost and time saving without compromising patient care PURPOSE the purpose of this study was to compare selected diabetes care processes and outcomes of nurse practitioners ( NPs ) and physicians ( MDs ) in the primary care of adults with type 2 diabetes . METHODS Adults with type 2 diabetes and no regular source of primary care were enrolled from the emergency room and r and omized to an NP or MD practice .  Chart review s were conducted to assess processes of care ; patient interviews and hemoglobin Al C ( Al C ) testing were performed to measure patient outcomes . RESULTS NPs were more likely than MDs to document provision of general diabetes education and education about nutrition , weight , exercise , and medications . They were more likely to document patient height , urinalyses results , and Al C values . No differences were found in documenting current medications ; alcohol , illicit drug , or tobacco use ; depression ; weight and blood pressure ; foot and cardiovascular exams ; blood glucose and creatinine testing ; or referral to ophthalmologists . No differences were found in patient outcomes . CONCLUSIONS This study provides preliminary evidence of interdisciplinary differences in the processes of care employed by primary care NPs and MDs in caring for patients with type 2 diabetes . NPs documented the provision of diabetes education and selected monitoring tests more frequently than MDs ; however , these differences were not reflected in 6-month patient outcomes AIMS Type 2 diabetes mellitus ( DM ) has a high prevalence in Asian subjects . A simple method of screening using self-testing for postpr and ial glycosuria achieved a good response rate and a sensitivity which compared favourably to more expensive and invasive methods in a semirural Caucasian population . We examined its effectiveness in Asian subjects . METHODS Caucasian and Indo-Asian subjects aged 35 - 70 years in two general practice s in Leicester ( n=9896 ( 6198=Asian subjects , 3698=Caucasian ) ) were screened . Those known to have diabetes were excluded . Subjects were asked to self-test for glycosuria 1 h after their main meal . Instruction and response cards were translated in Punjabi and Gujarati and sent to the Asian subjects , depending on age and surname . RESULTS Response rate was 34.4 % in Asian subjects compared to 54.0 % in Caucasian subjects . Prevalence of glycosuria was 8.2 % in Asian subjects and 3.2 % in Caucasian subjects . Two hundred and thirty-nine subjects recorded glycosuria and 202 ( 84.5 % of the total , 86.9 % of Asian subjects , 78.1 % of Caucasian ) attended for oral glucose tolerance test ( OGTT ) . Sixty-three ( 31.2 % ) were found to have diabetes ( 46 , 73 % Asian ) , 29 ( 14.4 % ) impaired glucose tolerance ( 24 , 82.8 % Asian ) and 110 ( 54.4 % ) normal glucose tolerance ( 82 , 74.6 % Asian ) . Thus 30 % of Asian subjects and 34 % of Caucasian subjects had diabetes on OGTT . The prevalence of diabetes in 35 - 70 years in the total population after screening was 5.6 % ( 6.8 % in Asian subjects , 3.6 % in Caucasian ) and in the screened population was 12.7 % ( 17.9 % in Asian subjects , 6.3 % in Caucasian ) . CONCLUSIONS Screening for diabetes using this method , in terms of response rate , is not as effective in a large city setting , particularly in the Asian population . However , the yield of diabetes in the age group 35 - 64 years compares well to much more expensive and labour intensive approaches and its use in this population in a primary care setting is justified OBJECTIVES To investigate the impact of general health screenings and discussion s with general practitioners on the cardiovascular risk profile of a r and om population of patients . STUDY DESIGN A population -based , r and omized , controlled , 5-year follow-up trial conducted in a primary care setting . POPULATION The study group consisted of 2000 patients , r and omly selected middle-aged men and women aged 30 to 50 years from family practice s in the district of Ebeltoft , Denmark . Of these patients , 1507 ( 75.4 % ) agreed to participate . Patients were r and omized into ( 1 ) a control group who did not receive health screenings , ( 2 ) an intervention group that received 2 health screenings , ( 3 ) an intervention group that received both the 2 screenings and a 45-minute follow-up consultation annually with their general practitioner . OUTCOMES MEASURED Cardiovascular risk score ( CRS ) , body mass index ( BMI ) , blood pressure , serum cholesterol , carbon monoxide in expiratory air , and tobacco use . RESULTS After 5 years , the CRS , BMI , and serum 
    Output:
    
We found no evidence to assess the benefits and harms of screening with urinary dipsticks , which remain unknown