human
***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: OBJECTIVE To investigate short-term and long-term effects of structured outpatient education for Functional Insulin Treatment  ( FIT : selective insulin dosages for eating , fasting or correcting hyperglycaemia ) on perceived control over diabetes and related health beliefs . FIT was thought to influence the perception of self-efficacy in diabetes , in contrast to conventional treatment , based on scheduled , rigid food intake and insulin delivery -- it allows flexible eating , provided independent control of glycemia . METHODS Structured , comprehensive , outpatient group training in FIT for selective use of insulin either for eating , fasting or correction included practical " insulin games . " The FIT program focused on everyday criteria for choices of insulin dosages and thus on the patient 's ability to execute his/her newly gained flexible treatment to his/her everyday life while preventing acute and late complications . To evaluate effects of FIT on " Perceived Control over Diabetes " and related " Health Beliefs Concerning Diabetes " ( Bradley 's question naires , 1984 ) , a fully r and omized short-term controlled Study 1 ( four weeks , 32 patients ) , and long-term uncontrolled pilot Study 2 ( three years , 68 patients ) were performed . RESULTS The short-term study revealed that FIT induced the feeling of independence from situational control while self-managing diabetes . In the long-term study , the patients were increasingly freed from the feeling of being under the control of physician and treatment-related restrictions , which -- together with higher perceived self-efficacy -- contributed to the feeling of " empowerment . " This was associated with high treatment satisfaction and significant improvement of glycemic control . CONCLUSION Structured out-patient group training for FIT results in measurable improvement of patients ' perceived control over diabetes and self-efficacy OBJECTIVE Inexpensive and st and ardized methods to deliver medical education to primary care physicians ( PCPs ) are desirable . Our objective was to assess the impact of an individualized simulated learning intervention on diabetes care provided by PCPs . RESEARCH DESIGN AND METHODS Eleven clinics with 41 consenting PCPs in a Minnesota medical group were r and omized to receive or not receive the learning intervention . Each intervention PCP was assigned 12 simulated type 2 diabetes cases that took about 15 min each to complete . Cases were design ed to remedy specific physician deficits found in their electronic medical record observed practice patterns . General linear mixed models that accommo date d the cluster r and omized study design were used to assess patient-level change from preintervention to 12-month postintervention of A1C , blood pressure , and LDL cholesterol . The relationship between the study arm and the total of intervention and patient health care costs was also analyzed . RESULTS Intervention clinic patients with baseline A1C ≥7 % significantly improved glycemic control at the last postintervention A1C measurement , intervention effect of −0.19 % mean A1C ( P = 0.034 ) and + 6.7 % in A1C < 7 % goal achievement ( P = 0.0099 ) . Costs trended lower , with the cost per patient −$71 ( SE = 142 , P = 0.63 ) relative to nonintervention clinic patients . The intervention did not significantly improve blood pressure or LDL control . Models adjusting for age , sex , and comorbidity showed similar results . PCPs reported high satisfaction . CONCLUSIONS A brief individualized case-based simulated learning intervention for PCPs led to modest but significant glucose control improvement in adults with type 2 diabetes without increasing costs OBJECTIVE —The purpose of this study was to determine whether implementation of a multicomponent organizational intervention can produce significant change in diabetes care and outcomes in community primary care practice s. RESEARCH DESIGN AND METHODS —This was a group-r and omized , controlled clinical trial evaluating the practical effectiveness of a multicomponent intervention ( TRANSLATE )  in 24 practice s. The intervention included implementation of an electronic diabetes registry , visit reminders , and patient-specific physician alerts . A site coordinator facilitated previsit planning and a monthly review of performance with a local physician champion . The principle outcomes were the percentage of patients achieving target values for the composite of systolic blood pressure ( SBP ) < 130 mmHg , LDL cholesterol < 100 mg/dl , and A1C < 7.0 % at baseline and 12 months . Six process measures were also followed . RESULTS —Over 24 months , 69,965 visits from 8,405 adult patients with type 2 diabetes were recorded from 238 health care providers in 24 practice s from 17 health systems .  Diabetes process measures increased significantly more in intervention than in control practice s , giving net increases as follows : foot examinations 35.0 % ( P < 0.0.001 ) ; annual eye examinations 25.9 % ( P < 0.001 ) ; renal testing 28.5 % ( P < 0.001 ) ; A1C testing 8.1%(P < 0.001 ) ; blood pressure monitoring 3.5 % ( P = 0.05 ) ; and LDL testing 8.6 % ( P < 0.001 ) . Mean A1C adjusted for age , sex , and comorbidity decreased significantly in intervention practice s ( P < 0.02 ) . At 12 months , intervention practice s had significantly greater improvement in achieving recommended clinical values for SBP , A1C , and LDL than control clinics ( P = 0.002 ) . CONCLUSIONS — Introduction of a multicomponent organizational intervention in the primary care setting significantly increases the percentage of type 2 diabetic patients achieving recommended clinical outcomes Background Regular laboratory test monitoring of patient parameters offers a route for improving the quality of chronic disease care . We evaluated the effects of brief educational messages attached to laboratory test reports on diabetes care . Methods A programme of cluster r and omised controlled trials was set in primary care practice s in one primary care trust in Engl and . Participants were the primary care practice s ' constituent healthcare professionals and patients with diabetes . Interventions comprised brief educational messages added to paper and electronic primary care practice laboratory test reports and introduced over two phases . Phase one messages , attached to Haemoglobin A1c ( HbA1c ) reports , targeted glycaemic and cholesterol control . Phase two messages , attached to albumin : creatinine ratio ( ACR ) reports , targeted blood pressure ( BP ) control , and foot inspection . Main outcome measures comprised practice mean HbA1c and cholesterol levels , diastolic and systolic BP , and proportions of patients having undergone foot inspections . Results Initially , 35 out of 37 eligible practice s participated . Outcome data were available for a total of 8,690 patients with diabetes from 32 practice s. The BP message produced a statistically significant reduction in diastolic BP ( -0.62 mmHg ; 95 % confidence interval -0.82 to -0.42 mmHg ) but not systolic BP ( -0.06 mmHg , -0.42 to 0.30 mmHg ) and increased the odds of achieving target BP control ( odds ratio 1.05 ; 1.00 , 1.10 ) . The foot inspection message increased the likelihood of a recorded foot inspection ( incidence rate ratio 1.26 ; 1.18 to 1.36 ) . The glycaemic control message had no effect on mean HbA1c ( increase 0.01 % ; -0.03 to 0.04 ) despite increasing the odds of a change in likelihood of HbA1c tests being ordered ( OR 1.06 ; 1.01 , 1.11 ) . The cholesterol message had no effect ( decrease 0.01 mmol/l , -0.04 to 0.05 ) . Conclusions Three out of four interventions improved intermediate outcomes or process of diabetes care . The diastolic BP reduction approximates to relative reductions in mortality of 3 % to 5 % in stroke and 3 % to 4 % in ischaemic heart disease over 10 years . The lack of effect for other outcomes may , in part , be explained by difficulties in bringing about further improvements beyond certain thresholds of clinical performance . Trial Registration Current Controlled Trials , IS RCT N2186314 Purpose To assess whether VA MEDIC-E ( Veterans Affairs Multi-disciplinary Education and Diabetes Intervention for Cardiac risk reduction[EM DASH ] Extended for 6 months ) , a pharmacist-led shared medical appointments program , could improve attainment of target goals for hypertension , hyperglycemia , hyperlipidemia , and tobacco use in patients with type 2 diabetes compared to st and ard primary care after 6 months of intervention . Methods A r and omized , controlled trial of VA MEDIC-E ( n = 50 ) versus st and ard primary care ( n = 49 ) in veterans with type 2 diabetes , hemoglobin A1c ( A1C ) > 7 % , blood pressure ( BP ) > 130/80 mmHg , and low density lipoprotein cholesterol ( LDL-C ) > 100mg/dl ( 2.59 mmol/l ) in the previous 6 months was conducted . The VA MEDIC-E intervention consisted of 4 weekly group sessions followed by 5 monthly booster group sessions . Each 2-hour session included 1 hour of multidisciplinary diabetes specific healthy lifestyle education and 1 hour of pharmacotherapeutic interventions performed by a clinical pharmacist . Evaluation measures included lab values of A1C , LDL cholesterol , BP , and goal attainment of these values , and diabetes self-care behavior question naires at 6 months . Results The r and omization groups were similar at baseline in all cardiovascular risk factors except for LDL , which was significantly lower in the MEDIC-E arm . At 6 months , significant improvements from baseline were found in the intervention arm for exercise , foot care , and goal attainment of A1C , LDL-C , and BP but not in the control arm . Conclusions The results of this study demonstrate that the pharmacist-led group intervention program for 6 months was an efficacious and sustainable collaborative care approach to managing diabetes and reducing associated cardiovascular risk OBJECTIVE To determine whether using the chronic care model ( CCM ) in an underserved community leads to improved clinical and behavioral outcomes for people with diabetes . RESEARCH DESIGN AND METHODS This multilevel , cluster- design , r and omized controlled trial examined the effectiveness of a CCM-based intervention in an underserved urban community . Eleven primary care practice s , along with their patients , were r and omized to three groups : CCM intervention ( n = 30 patients ) , provider education only ( PROV group ) ( n = 38 ) , and usual care ( UC group ) ( n = 51 ) . RESULTS A marked decline in HbA(1c ) was observed in the CCM group ( -0.6 % , P = 0.008 ) but not in the other groups . The magnitude of the association remained strong after adjustment for clustering ( P = 0.01 ) . The same pattern was observed for a decline in non-HDL cholesterol and for the proportion of participants who self-monitor blood glucose in the CCM group ( non-HDL cholesterol : -10.4 mg/dl , P = 0.24 ; self-monitor blood glucose : + 22.2 % , P < 0.0001 ) , with statistically significant between-group differences in improvement ( non-HDL cholesterol : P = 0.05 ; self-monitor blood glucose : P = 0.03 ) after adjustment . The CCM group also showed improvement in HDL cholesterol ( + 5.5 mg/dl , P = 0.0004 ) , diabetes knowledge test scores ( + 6.7 % , P = 0.07 ) , and empowerment scores ( + 2 , P = 0.02 ) . CONCLUSIONS These results suggest that implementing the CCM in the community is effective in improving clinical and behavioral outcomes in patients with diabetes Abstract Objective : To assess the effect of a multifaceted intervention directed at general practitioners on six year mortality , morbidity , and risk factors of patients with newly diagnosed type 2 diabetes . Design : Pragmatic , open , controlled trial with r and omisation of practice s to structured personal care or routine care ; analysis after 6 years . Setting : 311 Danish practice s with 474 general practitioners ( 243 in intervention group and 231 in comparison group ) . Participants : 874 ( 90.1 % ) of 970 patients aged ≥40 years who had diabetes diagnosed in 1989 - 91 and survived until six year follow up . Intervention : Regular follow up and individualised goal setting supported by prompting of doctors , clinical guidelines , feedback , and continuing medical education . Main outcome measures : Predefined clinical non-fatal outcomes , overall mortality , risk factors , and weight . Results : Predefined non-fatal outcomes and mortality were the same in both groups . The following risk factor levels were lower for intervention patients than for comparison patients ( median values ) : fasting plasma glucose concentration ( 7.9 v 8.7 mmol/l , P=0.0007 ) , glycated haemoglobin ( 8.5 % v 9.0 % , P<0.0001 ; reference range 5.4 - 7.4 % ) , systolic blood pressure ( 145 v 150 mm Hg , P=0.0004 
    Output:
    
agent
Educational interventions did not seem to have a positive impact on HbA1c , systolic blood pressure or lipid profiles .
The use of telemedicine , clinician reminders and feedback showed mixed results but there was a level of consistency in improvement in HbA1c when multifaceted interventions on multidisciplinary teams were implemented .
Targeting general or family physicians was largely ineffective in improving the cardiovascular risk factors considered , except when using a computer application on insulin h and ling of type 2 diabetes or customised simulated cases with feedbacks .
Similarly , interventions targeting nurses did not improve outcomes compared to st and ard care .
Multifaceted professional interventions were more effective than single interventions targeting single primary or community care professionals in improving glycaemic control
***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: OBJECTIVE To investigate short-term and long-term effects of structured outpatient education for Functional Insulin Treatment  ( FIT : selective insulin dosages for eating , fasting or correcting hyperglycaemia ) on perceived control over diabetes and related health beliefs . FIT was thought to influence the perception of self-efficacy in diabetes , in contrast to conventional treatment , based on scheduled , rigid food intake and insulin delivery -- it allows flexible eating , provided independent control of glycemia . METHODS Structured , comprehensive , outpatient group training in FIT for selective use of insulin either for eating , fasting or correction included practical " insulin games . " The FIT program focused on everyday criteria for choices of insulin dosages and thus on the patient 's ability to execute his/her newly gained flexible treatment to his/her everyday life while preventing acute and late complications . To evaluate effects of FIT on " Perceived Control over Diabetes " and related " Health Beliefs Concerning Diabetes " ( Bradley 's question naires , 1984 ) , a fully r and omized short-term controlled Study 1 ( four weeks , 32 patients ) , and long-term uncontrolled pilot Study 2 ( three years , 68 patients ) were performed . RESULTS The short-term study revealed that FIT induced the feeling of independence from situational control while self-managing diabetes . In the long-term study , the patients were increasingly freed from the feeling of being under the control of physician and treatment-related restrictions , which -- together with higher perceived self-efficacy -- contributed to the feeling of " empowerment . " This was associated with high treatment satisfaction and significant improvement of glycemic control . CONCLUSION Structured out-patient group training for FIT results in measurable improvement of patients ' perceived control over diabetes and self-efficacy OBJECTIVE Inexpensive and st and ardized methods to deliver medical education to primary care physicians ( PCPs ) are desirable . Our objective was to assess the impact of an individualized simulated learning intervention on diabetes care provided by PCPs . RESEARCH DESIGN AND METHODS Eleven clinics with 41 consenting PCPs in a Minnesota medical group were r and omized to receive or not receive the learning intervention . Each intervention PCP was assigned 12 simulated type 2 diabetes cases that took about 15 min each to complete . Cases were design ed to remedy specific physician deficits found in their electronic medical record observed practice patterns . General linear mixed models that accommo date d the cluster r and omized study design were used to assess patient-level change from preintervention to 12-month postintervention of A1C , blood pressure , and LDL cholesterol . The relationship between the study arm and the total of intervention and patient health care costs was also analyzed . RESULTS Intervention clinic patients with baseline A1C ≥7 % significantly improved glycemic control at the last postintervention A1C measurement , intervention effect of −0.19 % mean A1C ( P = 0.034 ) and + 6.7 % in A1C < 7 % goal achievement ( P = 0.0099 ) . Costs trended lower , with the cost per patient −$71 ( SE = 142 , P = 0.63 ) relative to nonintervention clinic patients . The intervention did not significantly improve blood pressure or LDL control . Models adjusting for age , sex , and comorbidity showed similar results . PCPs reported high satisfaction . CONCLUSIONS A brief individualized case-based simulated learning intervention for PCPs led to modest but significant glucose control improvement in adults with type 2 diabetes without increasing costs OBJECTIVE —The purpose of this study was to determine whether implementation of a multicomponent organizational intervention can produce significant change in diabetes care and outcomes in community primary care practice s. RESEARCH DESIGN AND METHODS —This was a group-r and omized , controlled clinical trial evaluating the practical effectiveness of a multicomponent intervention ( TRANSLATE )  in 24 practice s. The intervention included implementation of an electronic diabetes registry , visit reminders , and patient-specific physician alerts . A site coordinator facilitated previsit planning and a monthly review of performance with a local physician champion . The principle outcomes were the percentage of patients achieving target values for the composite of systolic blood pressure ( SBP ) < 130 mmHg , LDL cholesterol < 100 mg/dl , and A1C < 7.0 % at baseline and 12 months . Six process measures were also followed . RESULTS —Over 24 months , 69,965 visits from 8,405 adult patients with type 2 diabetes were recorded from 238 health care providers in 24 practice s from 17 health systems .  Diabetes process measures increased significantly more in intervention than in control practice s , giving net increases as follows : foot examinations 35.0 % ( P < 0.0.001 ) ; annual eye examinations 25.9 % ( P < 0.001 ) ; renal testing 28.5 % ( P < 0.001 ) ; A1C testing 8.1%(P < 0.001 ) ; blood pressure monitoring 3.5 % ( P = 0.05 ) ; and LDL testing 8.6 % ( P < 0.001 ) . Mean A1C adjusted for age , sex , and comorbidity decreased significantly in intervention practice s ( P < 0.02 ) . At 12 months , intervention practice s had significantly greater improvement in achieving recommended clinical values for SBP , A1C , and LDL than control clinics ( P = 0.002 ) . CONCLUSIONS — Introduction of a multicomponent organizational intervention in the primary care setting significantly increases the percentage of type 2 diabetic patients achieving recommended clinical outcomes Background Regular laboratory test monitoring of patient parameters offers a route for improving the quality of chronic disease care . We evaluated the effects of brief educational messages attached to laboratory test reports on diabetes care . Methods A programme of cluster r and omised controlled trials was set in primary care practice s in one primary care trust in Engl and . Participants were the primary care practice s ' constituent healthcare professionals and patients with diabetes . Interventions comprised brief educational messages added to paper and electronic primary care practice laboratory test reports and introduced over two phases . Phase one messages , attached to Haemoglobin A1c ( HbA1c ) reports , targeted glycaemic and cholesterol control . Phase two messages , attached to albumin : creatinine ratio ( ACR ) reports , targeted blood pressure ( BP ) control , and foot inspection . Main outcome measures comprised practice mean HbA1c and cholesterol levels , diastolic and systolic BP , and proportions of patients having undergone foot inspections . Results Initially , 35 out of 37 eligible practice s participated . Outcome data were available for a total of 8,690 patients with diabetes from 32 practice s. The BP message produced a statistically significant reduction in diastolic BP ( -0.62 mmHg ; 95 % confidence interval -0.82 to -0.42 mmHg ) but not systolic BP ( -0.06 mmHg , -0.42 to 0.30 mmHg ) and increased the odds of achieving target BP control ( odds ratio 1.05 ; 1.00 , 1.10 ) . The foot inspection message increased the likelihood of a recorded foot inspection ( incidence rate ratio 1.26 ; 1.18 to 1.36 ) . The glycaemic control message had no effect on mean HbA1c ( increase 0.01 % ; -0.03 to 0.04 ) despite increasing the odds of a change in likelihood of HbA1c tests being ordered ( OR 1.06 ; 1.01 , 1.11 ) . The cholesterol message had no effect ( decrease 0.01 mmol/l , -0.04 to 0.05 ) . Conclusions Three out of four interventions improved intermediate outcomes or process of diabetes care . The diastolic BP reduction approximates to relative reductions in mortality of 3 % to 5 % in stroke and 3 % to 4 % in ischaemic heart disease over 10 years . The lack of effect for other outcomes may , in part , be explained by difficulties in bringing about further improvements beyond certain thresholds of clinical performance . Trial Registration Current Controlled Trials , IS RCT N2186314 Purpose To assess whether VA MEDIC-E ( Veterans Affairs Multi-disciplinary Education and Diabetes Intervention for Cardiac risk reduction[EM DASH ] Extended for 6 months ) , a pharmacist-led shared medical appointments program , could improve attainment of target goals for hypertension , hyperglycemia , hyperlipidemia , and tobacco use in patients with type 2 diabetes compared to st and ard primary care after 6 months of intervention . Methods A r and omized , controlled trial of VA MEDIC-E ( n = 50 ) versus st and ard primary care ( n = 49 ) in veterans with type 2 diabetes , hemoglobin A1c ( A1C ) > 7 % , blood pressure ( BP ) > 130/80 mmHg , and low density lipoprotein cholesterol ( LDL-C ) > 100mg/dl ( 2.59 mmol/l ) in the previous 6 months was conducted . The VA MEDIC-E intervention consisted of 4 weekly group sessions followed by 5 monthly booster group sessions . Each 2-hour session included 1 hour of multidisciplinary diabetes specific healthy lifestyle education and 1 hour of pharmacotherapeutic interventions performed by a clinical pharmacist . Evaluation measures included lab values of A1C , LDL cholesterol , BP , and goal attainment of these values , and diabetes self-care behavior question naires at 6 months . Results The r and omization groups were similar at baseline in all cardiovascular risk factors except for LDL , which was significantly lower in the MEDIC-E arm . At 6 months , significant improvements from baseline were found in the intervention arm for exercise , foot care , and goal attainment of A1C , LDL-C , and BP but not in the control arm . Conclusions The results of this study demonstrate that the pharmacist-led group intervention program for 6 months was an efficacious and sustainable collaborative care approach to managing diabetes and reducing associated cardiovascular risk OBJECTIVE To determine whether using the chronic care model ( CCM ) in an underserved community leads to improved clinical and behavioral outcomes for people with diabetes . RESEARCH DESIGN AND METHODS This multilevel , cluster- design , r and omized controlled trial examined the effectiveness of a CCM-based intervention in an underserved urban community . Eleven primary care practice s , along with their patients , were r and omized to three groups : CCM intervention ( n = 30 patients ) , provider education only ( PROV group ) ( n = 38 ) , and usual care ( UC group ) ( n = 51 ) . RESULTS A marked decline in HbA(1c ) was observed in the CCM group ( -0.6 % , P = 0.008 ) but not in the other groups . The magnitude of the association remained strong after adjustment for clustering ( P = 0.01 ) . The same pattern was observed for a decline in non-HDL cholesterol and for the proportion of participants who self-monitor blood glucose in the CCM group ( non-HDL cholesterol : -10.4 mg/dl , P = 0.24 ; self-monitor blood glucose : + 22.2 % , P < 0.0001 ) , with statistically significant between-group differences in improvement ( non-HDL cholesterol : P = 0.05 ; self-monitor blood glucose : P = 0.03 ) after adjustment . The CCM group also showed improvement in HDL cholesterol ( + 5.5 mg/dl , P = 0.0004 ) , diabetes knowledge test scores ( + 6.7 % , P = 0.07 ) , and empowerment scores ( + 2 , P = 0.02 ) . CONCLUSIONS These results suggest that implementing the CCM in the community is effective in improving clinical and behavioral outcomes in patients with diabetes Abstract Objective : To assess the effect of a multifaceted intervention directed at general practitioners on six year mortality , morbidity , and risk factors of patients with newly diagnosed type 2 diabetes . Design : Pragmatic , open , controlled trial with r and omisation of practice s to structured personal care or routine care ; analysis after 6 years . Setting : 311 Danish practice s with 474 general practitioners ( 243 in intervention group and 231 in comparison group ) . Participants : 874 ( 90.1 % ) of 970 patients aged ≥40 years who had diabetes diagnosed in 1989 - 91 and survived until six year follow up . Intervention : Regular follow up and individualised goal setting supported by prompting of doctors , clinical guidelines , feedback , and continuing medical education . Main outcome measures : Predefined clinical non-fatal outcomes , overall mortality , risk factors , and weight . Results : Predefined non-fatal outcomes and mortality were the same in both groups . The following risk factor levels were lower for intervention patients than for comparison patients ( median values ) : fasting plasma glucose concentration ( 7.9 v 8.7 mmol/l , P=0.0007 ) , glycated haemoglobin ( 8.5 % v 9.0 % , P<0.0001 ; reference range 5.4 - 7.4 % ) , systolic blood pressure ( 145 v 150 mm Hg , P=0.0004 
    Output:
    