***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 Information technology has potential to improve health care delivery particularly among individuals with chronic diseases such as diabetes in low and middle-income countries ( LMIC ) . Research on the usefulness of information technology to manage persons living with chronic diseases is scarce in LMIC . We sought to evaluate the effect of an electronic reminder system on cardiovascular risk factors ( blood pressure , heart rate , and fasting plasma glucose ) and adherence to clinical appointments among persons living with diabetes . RESEARCH DESIGN AND METHODS A r and omized controlled design was used to recruit 200 diabetic patients ( intervention n=100 , control n=100 ) from the National Diabetes Management Research Centre , Accra . All patients received usual diabetes care . The intervention group was given electronic reminders for their clinical appointments and their physicians were prompted with abnormal laboratory results for six months . RESULTS Baseline characteristics were largely similar for both groups . At six months follow up , the mean reductions of all the cardiovascular risk factors in the intervention group were significantly greater than in the control group : -1.7 kg/m(2 ) versus -1.1 kg/m(2)(p=0.002 ) for BMI ; -4.7 mmHg versus -2.8 mmHg ( p=0.002 ) for SBP ; -5.3 mmH versus -3.1 mmHg ( p=0.001 ) for DBP ; -1.7 bpm versus -0.1 bpm ( p=0.001 ) for heart rate and -2.3 mmol/L versus -1.6 mmol/L ( p=0.001 ) for fasting plasma glucose , respectively . Adherence to appointment schedules was also significantly higher in the intervention group compared with the control group ( 97.8 % versus 89.4 % , p=0.010 ) . CONCLUSIONS Locally developed electronic initiatives such as this result ed in improved cardiovascular risk factors and effective compliance to clinical practice s and improved quality of care for persons living with diabetes Background and objectives Many clinical management guidelines for chronic diseases have been published , but they have not been put into practice by busy clinicians at primary care levels . This study evaluates the implementation of national guidelines incorporated within a structured diabetes and hypertension clinical record ( SR ) in Cape Town in a r and omised controlled trial ( RCT ) . Methods Eighteen public sector community health centres ( CHC ) were r and omly selected and allocated as intervention or control CHC . At each clinic , 25 patients with diabetes and 35 patients with hypertension were enrolled at baseline . Question naires were completed , blood sample s were collected , blood pressure ( BP ) and anthropometric measures were taken and patient records were audited . SR with clinical guideline prompts were introduced at the intervention clinics after training doctors in their use and suggestions to incorporate them in regular patient records . Contact was maintained during the year of intervention with the clinic staff . A follow-up survey was conducted 1 year later to assess BP and HbA1c , and the patient records were examined to ascertain the extent of use of the SR in the intervention clinics . In-depth interviews were conducted with doctors and nurses to record their response to the intervention . Results The intervention evaluated in this RCT had no impact on either diabetes or hypertension control . In the intervention clinics , less than 60 % of the patient folders contained the SR and when present was seldom used . Although the staff were well disposed to the research team , their workload prohibited them from undertaking a true evaluation of the SR , and overall they did not perceive the SR as supporting their current process of patient care . Conclusions No benefit to diabetes of hypertension care by introducing and availability of the staff in the use of the SR was shown in this RCT . The process measures suggest that the SR was not widely used by the healthcare provided in the primary care clinics Abstract Objective Traditionally , health systems in sub‐Saharan Africa have focused on acute conditions . Few data exist on the readiness of African health facilities ( HFs ) to address the growing burden of chronic diseases ( CDs ) , specifically chronic , non‐communicable diseases ( NCDs ) . Methods A stratified r and om sample of 28 urban and rural Ug and an HFs was surveyed to document the burden of selected CDs by analysing the service statistics , service availability and service readiness using a modified WHO Service Availability and Readiness Assessment question naire . Knowledge , skills and practice in the management of CDs of 222 health workers were assessed through a self‐completed question naire . Results Among adult outpatient visits at hospitals , 33 % were for CDs including HIV vs. 14 % and 4 % at medium‐sized and small health centres , respectively . Many HFs lacked guidelines , diagnostic equipment and essential medicines for the primary management of CDs ; training and reporting systems were weak . Lower‐level facilities routinely referred patients with hypertension and diabetes . HIV services accounted for most CD visits and were stronger than NCD services . Systems were weaker in lower‐level HFs . Non‐doctor clinicians and nurses lacked knowledge and experience in NCD care . Conclusion Compared with higher level HFs , lower‐level ones are less prepared and little used for CD care . Health systems in Ug and a , particularly lower‐level HFs , urgently need improvement in managing common NCDs to cope with the growing burden . This should include the provision of st and ard guidelines , essential diagnostic equipment and drugs , training of health workers , supportive supervision and improved referral systems . Substantially better HIV basic service readiness demonstrates that improved NCD care is feasible Abstract Introduction : Multi-disease community health campaigns can be effective for population -wide HIV testing in a research setting ( SEARCH : NCT01864603 ) . We sought to evaluate feasibility and uptake of a community-led health campaign ( CLHC ) planned and implemented by village leaders and local clinic workers in Ug and a. Methods : Over five months in 2014 , locally elected village leaders and Ministry of Health ( MoH ) clinic staff in a rural parish in Ug and a planned a census followed by a CLHC  , after training by two SEARCH trial consultants and by leaders from a neighbouring parish that had previously participated in a SEARCH health campaign . We defined feasibility as : ( 1 ) elected leaders ’ participation in training and implementation of pre-campaign census and mobilization activities ; ( 2 ) implementation of all campaign activities by MoH-funded , local clinic staff ; and ( 3 ) community participation in the campaign , including point-of-care screening for HIV , malaria , hypertension and diabetes , and same-day referral for male circumcision and family planning ( FP ) . Costing of all salaries and supplies was conducted . Results : Elected leaders from all eight villages in the parish participated in CLHC training . They and local clinic staff met monthly to select and plan CLHC services . Village leaders then leveraged existing volunteer health teams to perform a door-to-door census , enumerating 5,202 parish residents over 2 weeks . 2,753 ( 53 % ) residents participated in the 6-day CLHC . Of 1,584 adult participants , 1,474 ( 93 % ) tested for HIV : 105/1,474 ( 7.1 % ) tested HIV positive . 27 % ( 751/2,753 ) of participants reported fever and underwent malaria rapid diagnostic testing : 5.3 % ( 40/751 ) tested positive . Among adults screened , 19 % ( 271/1,452 ) were hypertensive , and 3 % ( 18/637 ) had a r and om blood sugar > 11.1 mmol/L. Of 805 men and boys ( > 10 years ) , 91 ( 11 % ) accepted same-day clinic referral and underwent medical circumcision . Of 900 women offered same-day long-term FP referrals , 25 accepted . The CLHC cost , including census , mobilization and testing services , was $ 23,597 ( $ 8.57/participant ) . Conclusions : Elected village leaders successfully planned and conducted a 6-day multi-disease health campaign with service provision by local clinic staff that reached over half of a rural Ug and an community . These data suggest it is feasible for local leaders and clinics to adopt a multi-disease health campaign approach to scale-up HIV testing in rural Africa Background Rural setting s in Sub-Saharan Africa ( SSA ) consistently report low participation in non-communicable disease ( NCD ) treatment programs and poor outcomes . Objective The objective of this study is to assess the impact of the implementation of a patient-centered rural NCD care delivery model called Bridging Income Generation through grouP Integrated Care ( BIGPIC ) . Design The study prospect ively tracked participation and health outcomes for participants in a screening event and compared linkage frequencies to a historical comparison group . Participants Rural Kenyan participants attending a voluntary NCD screening event were included within the BIGPIC model of care . Interventions The BIGPIC model utilizes a context ualized care delivery model design ed to address the unique barriers faced in rural setting s. This model emphasizes the following steps : ( 1 ) find patients in the community , ( 2 ) link to peer/microfinance groups , ( 3 ) integrate education , ( 4 ) treat in the community , ( 5 ) enhance economic sustainability and ( 6 ) generate dem and for care through incentives . Main Measures The primary outcome is the linkage frequency , which measures the percentage of patients who return for care after screening positive for either hypertension and /or diabetes . Secondary measures include retention frequencies defined as the percentage of patients remaining engaged in care throughout the 9-month follow-up period and changes in systolic ( SBP ) and diastolic blood pressure ( DBP ) and blood sugar over 12 months . Key Results Of the 879 individuals who were screened , 14.2 % were confirmed to have hypertension , while only 1.4 % were confirmed to have diabetes . The implementation of a comprehensive microfinance-linked , community-based , group care model result ed in 72.4 % of screen-positive participants returning for subsequent care , of which 70.3 % remained in care through the 12 months of the evaluation period . Patients remaining in care demonstrated a statistically significant mean decline of 21 mmHg in SBP [ 95 % CI ( 13.9 to 28.4 ) , P < 0.01 ] and 5 mmHg drop in DBP [ 95 % CI ( 1.4 to 7.6 ) , P < 0.01 ] . Conclusions The implementation of a context ualized care delivery model built around the unique needs of rural SSA participants led to statistically significant improvements in linkage to care and blood pressure reduction Background In many low-income countries , care for patients with non-communicable diseases ( NCDs ) and mental health conditions is provided by nurses . The benefits of nurse substitution and supplementation in NCD care in high-income setting s are well recognised , but evidence from low- and middle-income countries is limited . Primary Care 101 ( PC101 ) is a programme design ed to support and exp and nurses ’ role in NCD care , comprising educational outreach to nurses and a clinical management tool with enhanced prescribing provisions . We evaluated the effect of the programme on primary care nurses ’ capacity to manage NCDs . Methods and Findings In a cluster r and omised controlled trial design , 38 public sector primary care clinics in the Western Cape Province , South Africa , were r and omised . Nurses in the intervention clinics were trained to use the PC101 management tool during educational outreach sessions delivered by health department trainers and were authorised to prescribe an exp and ed range of drugs for several NCDs . Control clinics continued use of the Practical Approach to Lung Health and HIV/AIDS in South Africa ( PALSA PLUS ) management tool and usual training . Patients attending these clinics with one or more of hypertension ( 3,227 ) , diabetes ( 1,842 ) , chronic respiratory disease ( 1,157 ) or who screened positive for depression ( 2,466 ) , totalling 4,393 patients , were enrolled between 28 March 2011 and 10 November 2011 . Primary outcomes were treatment intensification in the hypertension , diabetes , and chronic respiratory disease cohorts , defined as the proportion of patients in whom treatment was escalated during follow-up over 14 mo , and case detection in the depression cohort . Primary outcome data were analysed for 2,110 ( 97 % ) intervention and 2,170 ( 97 % ) control group patients . Treatment intensification rates in intervention clinics were not superior to those in the control clinics ( hypertension : 44 % in the intervention group versus 40 % in the control group , risk ratio [ RR ] 1.08 [ 95 % CI 0.94 to 1.24 ; p = 0.252 ] ; diabetes : 57 % versus 50 % , RR 1.10 [ 0.97 to 1.24 ; p = 0.126 ] ; chronic respiratory disease : 14 % versus 12 % , RR 1.08 [ 0.75 to 1.55 ; p = 0.674 ] ) , nor was case detection of depression ( 18 % versus 24 % , RR 0.76 [ 0.53 to 1.10 ; p = 0.142 ] ) . No adverse effects of the nurses ’ exp and ed scope of practice were observed . Limitations of the study include dependence on self-reported diagnoses for inclusion in the patient cohorts , limited data on uptake of PC101 by users , reliance on process outcomes , and insufficient re sources to measure important health outcomes , such as HbA1c , at follow-up . Conclusions Educational outreach to primary care nurses to 
    Output:
    
The scale-up of these pilot interventions and the integration of diabetes care into existing robust chronic disease platforms may be a feasible approach to begin to tackle the upcoming p and emic in diabetes .