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: Background Countries in sub-Saharan Africa ( SSA ) are experiencing an epidemic of cardiovascular disease ( CVD ) propelled by rapidly increasing rates of hypertension . Barriers to hypertension control in SSA include poor access to care and high out-of-pocket costs . Although SSA bears 24 % of the global disease burden , it has only 3 % of the global health workforce . Given such limited re sources , cost-effective strategies , such as task shifting , are needed to mitigate the rising CVD epidemic in SSA . Ghana , a country in SSA with an established community health worker program integrated within a national health insurance scheme provides an ideal platform to evaluate implementation of the World Health Organization ( WHO ) task-shifting strategy . This study will evaluate the comparative effectiveness of the implementation of the WHO Package targeted at CV risk assessment versus provision of health insurance coverage , on blood pressure ( BP ) reduction . Methods Using a cluster r and omized design , 32 community health centers ( CHCs ) and district hospitals in Ghana will be r and omized to either the  intervention  group ( 16 CHCs ) or the control group ( 16 CHCs ) . A total of 640 patients with uncomplicated hypertension ( BP 140–179/90–99 mm Hg and absence of target organ damage ) will be enrolled in this study ( 20 patients per CHC ) . The intervention consists of WHO Package of CV risk assessment , patient education , initiation and titration of antihypertensive medications , behavioral counseling on lifestyle behaviors , and medication adherence every three months for 12 months . The primary outcome is the mean change in systolic BP from baseline to 12 months . The secondary outcomes are rates of BP control at 12 months ; levels of physical activity , percent change in weight , and dietary intake of fruits and vegetables at 12 months ; and sustainability of intervention effects at 24 months . All outcomes will be assessed at baseline , six months and 12 months . Trained community health nurses will deliver the intervention as part of Ghana ’s community-based health planning and services ( CHPS ) program . Discussion Findings from this study will provide policy makers and other stakeholders needed information to recommend scalable and cost-effective policy with respect to comprehensive CV risk reduction and hypertension control in re source -poor setting s . Trial registration NCT01802372 Background The high burden of undetected and undertreated hypertension and diabetes mellitus is a major health challenge worldwide . The mPower Heart Project aim ed to develop and test a feasible and scalable intervention for hypertension and diabetes mellitus by task‐sharing with the use of a mobile phone – based clinical decision support system at Community Health Centers in Himachal Pradesh , India . Methods and Results The development of the intervention and mobile phone – based clinical decision support system was carried out using mixed methods in five Community Health Centers . The intervention was subsequently evaluated using pre – post evaluation design . During intervention , a nurse care coordinator screened , examined , and entered patient parameters into mobile phone – based clinical decision support system to generate a prescription , which was vetted by a physician . The change in systolic blood pressure , diastolic blood pressure , and fasting plasma glucose ( FPG ) over 18 months of intervention was quantified using generalized estimating equations models . During intervention , 6797 participants were enrolled . Six thous and sixteen participants had hypertension ( mean systolic blood pressure : 146.1 mm Hg , 95 % CI : 145.7 , 146.5 ; diastolic blood pressure : 89.52 mm Hg , 95 % CI : 89.33 , 89.72 ) , of which 3152 ( 52 % ) subjects were newly detected . Similarly , 1516 participants had diabetes mellitus ( mean FPG : 177.9 mg/dL , 95 % CI : 175.8 , 180.0 ) , of which 450 ( 30 % ) subjects were newly detected . The changes in systolic blood pressure , diastolic blood pressure , and FPG observed at 18 months of follow‐up were −14.6 mm Hg ( 95 % CI : −15.3 , −13.8 ) , −7.6 mm Hg ( CI : −8.0 , −7.2 ) , and −50.0 mg/dL ( 95 % CI : −54.6 , −45.5 ) , respectively , and were statistically significant even after adjusting for age , sex , and Community Health Center . Conclusions A nurse‐facilitated , mobile phone – based clinical decision support system‐enabled intervention in primary care was associated with improvements in blood pressure and blood glucose control and has the potential to scale‐up in re source poor setting s. Clinical Trial Registration URL : https://www . clinical trials.gov . Unique identifiers : NCT01794052 . Clinical Trial Registry — India : CTRI/2013/02/003412 OBJECTIVE To evaluate a simple cardiovascular risk management package for assessing and managing cardiovascular risk using hypertension as an entry point in primary care facilities in low-re source setting s. METHODS Two geographically distant regions in two countries ( China and Nigeria ) were selected and 10 pairs of primary care facilities in each region were r and omly selected and matched . Regions were then r and omly assigned to a control group , which received usual care , or to an intervention group , which applied the cardiovascular risk management package . Each facility enrolled 60 consecutive patients with hypertension . Intervention sites educated patients about risk factors at baseline and initiated treatment with hydrochlorothiazide at 4 months in patients at medium risk of a cardiovascular event , according to a st and ardized treatment algorithm . Systolic blood pressure change from baseline to 12 months was the primary outcome measure . FINDINGS The study included 2397 patients with baseline hypertension : 1191 in 20 intervention facilities and 1206 in 20 control facilities .  Systolic and diastolic blood pressure decreased more in intervention patients than in controls . However , at 12 months more than half of patients still had uncontrolled hypertension ( systolic blood pressure > 140 mmHg and /or diastolic blood pressure > 90 mmHg ) . Behavioural risk factors had improved among intervention patients in Nigeria but not in China . Only about 2 % of hypertensive patients required referral to the next level of care . CONCLUSION Even in low-re source setting s , hypertensive patients can be effectively assessed and managed in primary care facilities BACKGROUND Coronary artery disease is a major cause of morbidity and mortality among adults worldwide , including China . After a hospital stay , transitional care could help to ensure improved patient care and outcomes , and reduce Medicare costs . Nevertheless , the results of the existing transitional care are not always satisfactory and our knowledge of how to perform effective transitional care for patients with coronary artery disease is limited in mainl and China . OBJECTIVES To examine the effectiveness of a nurse-led transitional care program on clinical outcomes , health-related knowledge , and physical and mental health status among Chinese patients with coronary artery disease . DESIGN R and omized controlled trial . METHODS The Omaha system and Pender 's health promoting model were employed in planning and implementing this nurse-led transitional care program . The sample was comprised of 199 Chinese patients with coronary artery disease . The experimental group ( n=100  ) received nurse-led transitional care intervention in addition to routine care . The nurse-led transitional care intervention included a structured assessment and health education , followed by 7 months of individual teaching and coaching ( home visits , telephone follow-up and group activity ) . The  control group ( n=99 ) received a comparable length routine care and follow-up contacts . Evaluations were conducted at baseline and completion of the interventions using the perceived knowledge scale for coronary heart disease , the medical outcomes study 36-item short-form health survey and clinical measures ( blood pressure , blood glucose , lipids , body mass index ) . Data were collected between March and October 2014 . RESULTS Compared with the control group , participants in the experimental group showed significant better clinical outcomes ( systolic blood pressure , t=5.762 , P=0.000 ; diastolic blood pressure , t=4.250 , P=0.000 ; fasting blood glucose , t=2.249 , P=0.027 ; total cholesterol , t=4.362 , P=0.000 ; triglyceride , t=3.147 , P=0.002 ; low density lipoprotein cholesterol , t=2.399 , P=0.018 ; and body mass index , t=3.166 , P=0.002 ) , higher knowledge scores for coronary artery disease ( total knowledge score , t=-7.099 , P=0.000 ) , better physical health status ( t=-2.503 , P=0.014 ) and mental health status ( t=-2.950 , P=0.004 ) . CONCLUSIONS This study provides evidence for the value of a  nurse-led transitional care program  using both the Omaha system and Pender 's health promoting model as its theoretical framework . The structured interventions in this nurse-led transitional care program facilitate the use of this program in other setting Background : Lifestyle factors such as weight , salt intake , and physical activity have shown to be important in treating hypertension . The object of this study was to describe feasibility and to assess the effectiveness of a multicomponent lifestyle intervention on high blood pressure ( BP ) of Iranian women . Material s and Methods : This r and omized controlled trial was conducted in four health centers by recruiting 161 women aged 35 - 65 years with high BP and r and omizing them to a 4-week lifestyle modification ( n = 80 ) or control group ( n = 81 ) . BP level and other health behavioral factors were assessed before and after the 4-week intervention and also after 6 months . Results : The mean systolic BP changed from 158.8 ( ±8.1 ) mmHg to 153.2 ( ±6.4 ) mmHg during 4-week and to 145.5 ( ±4.6 ) ) mmHg after 6 months in the intervention group ( P < 0.001 ) . There was a significant difference between two groups of study after 4-week mean = 5.6 ( confidence interval [ CI ] = 5.1 - 6.6 ) and 6 months follow mean ( CI = 12.3 - 14.6).(P < 0.001 ) A significant correlation was detected between systolic BP ( SBP ) and diastolic BP ( DBP ) with weight , body mass index , waist circumference , salt intake , and physical activity level ( P < 0.001 ) . Stepwise regression analyses indicated that the weight , dietary salt intake , and physical activity level were significant predictors of SBP and DBP . Conclusion : The results of this study suggest that lifestyle modification program is associated with improvements in BP level in Iranian women BACKGROUND Adherence to drugs and healthy lifestyles is low after acute coronary syndrome . We assessed whether trained community health workers could improve adherence to drugs , lifestyle changes , and clinical risk markers in patients with acute coronary syndrome in India . METHODS In this study done at 14 hospitals in India we r and omly assigned ( 1:1 ) patients with acute coronary syndrome 1 or 2 days before discharge from hospital to a community health worker-based intervention group or a st and ard care group . Patients were r and omly assigned with a telephone r and omisation service . In the intervention group , during four in-hospital and two home visits , community health workers used unstructured discussion s , visual methods , and patient diaries to educate patients on healthy lifestyle and drugs , and measures to enhance adherence . The primary outcome was adherence to proven secondary prevention drugs ( antiplatelet drugs , β blockers , angiotensin-converting enzyme inhibitors or angiotensin receptor blockers , and statins )  estimated using a Composite Medication Adherence Scale at 1 year . The secondary outcomes were difference in lifestyle factors ( diet , exercise , and tobacco and alcohol use ) , and clinical risk markers ( blood pressure , bodyweight , BMI , heart rate , and lipids ) . All analyses were by intention to treat . This trial is registered with the Clinical Trial Registry of India , number REF/2013/03/004737 , and Clinical Trials.gov , number NCT01207700 . RESULTS Between Aug 23 , 2011 , and June 25 , 2012 , 806 participants were r and omly assigned ( 405 to a community health worker-based intervention group and 401 to a st and ard care group ) . At 1 year , 40 patients had died and 15 had discontinued or been lost to follow-up , so 750 ( 93 % ) were included in the analyses ( 375 in each group ) . Secondary prevention drugs prescribed at discharge were 98 % ( 786/803 ) for any antiplatelet drug , 79 % ( 638/803 ) for dual antiplatelet drugs , 69 % ( 555/803 ) for β blockers , 69 % ( 552/803 ) for angiotensin-converting enzyme inhibitors and angiotensin receptor blockers , and 95 % ( 762/803 ) for statins  . At one year , overall adherence ( ≥8 
    Output:
    
agent
The overall quality of evidence based on GRADE criteria was moderate for systolic blood pressure , but low for diastolic blood pressure .
INTERPRETATION Task-sharing interventions are effective in reducing blood pressure .
***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 Countries in sub-Saharan Africa ( SSA ) are experiencing an epidemic of cardiovascular disease ( CVD ) propelled by rapidly increasing rates of hypertension . Barriers to hypertension control in SSA include poor access to care and high out-of-pocket costs . Although SSA bears 24 % of the global disease burden , it has only 3 % of the global health workforce . Given such limited re sources , cost-effective strategies , such as task shifting , are needed to mitigate the rising CVD epidemic in SSA . Ghana , a country in SSA with an established community health worker program integrated within a national health insurance scheme provides an ideal platform to evaluate implementation of the World Health Organization ( WHO ) task-shifting strategy . This study will evaluate the comparative effectiveness of the implementation of the WHO Package targeted at CV risk assessment versus provision of health insurance coverage , on blood pressure ( BP ) reduction . Methods Using a cluster r and omized design , 32 community health centers ( CHCs ) and district hospitals in Ghana will be r and omized to either the  intervention  group ( 16 CHCs ) or the control group ( 16 CHCs ) . A total of 640 patients with uncomplicated hypertension ( BP 140–179/90–99 mm Hg and absence of target organ damage ) will be enrolled in this study ( 20 patients per CHC ) . The intervention consists of WHO Package of CV risk assessment , patient education , initiation and titration of antihypertensive medications , behavioral counseling on lifestyle behaviors , and medication adherence every three months for 12 months . The primary outcome is the mean change in systolic BP from baseline to 12 months . The secondary outcomes are rates of BP control at 12 months ; levels of physical activity , percent change in weight , and dietary intake of fruits and vegetables at 12 months ; and sustainability of intervention effects at 24 months . All outcomes will be assessed at baseline , six months and 12 months . Trained community health nurses will deliver the intervention as part of Ghana ’s community-based health planning and services ( CHPS ) program . Discussion Findings from this study will provide policy makers and other stakeholders needed information to recommend scalable and cost-effective policy with respect to comprehensive CV risk reduction and hypertension control in re source -poor setting s . Trial registration NCT01802372 Background The high burden of undetected and undertreated hypertension and diabetes mellitus is a major health challenge worldwide . The mPower Heart Project aim ed to develop and test a feasible and scalable intervention for hypertension and diabetes mellitus by task‐sharing with the use of a mobile phone – based clinical decision support system at Community Health Centers in Himachal Pradesh , India . Methods and Results The development of the intervention and mobile phone – based clinical decision support system was carried out using mixed methods in five Community Health Centers . The intervention was subsequently evaluated using pre – post evaluation design . During intervention , a nurse care coordinator screened , examined , and entered patient parameters into mobile phone – based clinical decision support system to generate a prescription , which was vetted by a physician . The change in systolic blood pressure , diastolic blood pressure , and fasting plasma glucose ( FPG ) over 18 months of intervention was quantified using generalized estimating equations models . During intervention , 6797 participants were enrolled . Six thous and sixteen participants had hypertension ( mean systolic blood pressure : 146.1 mm Hg , 95 % CI : 145.7 , 146.5 ; diastolic blood pressure : 89.52 mm Hg , 95 % CI : 89.33 , 89.72 ) , of which 3152 ( 52 % ) subjects were newly detected . Similarly , 1516 participants had diabetes mellitus ( mean FPG : 177.9 mg/dL , 95 % CI : 175.8 , 180.0 ) , of which 450 ( 30 % ) subjects were newly detected . The changes in systolic blood pressure , diastolic blood pressure , and FPG observed at 18 months of follow‐up were −14.6 mm Hg ( 95 % CI : −15.3 , −13.8 ) , −7.6 mm Hg ( CI : −8.0 , −7.2 ) , and −50.0 mg/dL ( 95 % CI : −54.6 , −45.5 ) , respectively , and were statistically significant even after adjusting for age , sex , and Community Health Center . Conclusions A nurse‐facilitated , mobile phone – based clinical decision support system‐enabled intervention in primary care was associated with improvements in blood pressure and blood glucose control and has the potential to scale‐up in re source poor setting s. Clinical Trial Registration URL : https://www . clinical trials.gov . Unique identifiers : NCT01794052 . Clinical Trial Registry — India : CTRI/2013/02/003412 OBJECTIVE To evaluate a simple cardiovascular risk management package for assessing and managing cardiovascular risk using hypertension as an entry point in primary care facilities in low-re source setting s. METHODS Two geographically distant regions in two countries ( China and Nigeria ) were selected and 10 pairs of primary care facilities in each region were r and omly selected and matched . Regions were then r and omly assigned to a control group , which received usual care , or to an intervention group , which applied the cardiovascular risk management package . Each facility enrolled 60 consecutive patients with hypertension . Intervention sites educated patients about risk factors at baseline and initiated treatment with hydrochlorothiazide at 4 months in patients at medium risk of a cardiovascular event , according to a st and ardized treatment algorithm . Systolic blood pressure change from baseline to 12 months was the primary outcome measure . FINDINGS The study included 2397 patients with baseline hypertension : 1191 in 20 intervention facilities and 1206 in 20 control facilities .  Systolic and diastolic blood pressure decreased more in intervention patients than in controls . However , at 12 months more than half of patients still had uncontrolled hypertension ( systolic blood pressure > 140 mmHg and /or diastolic blood pressure > 90 mmHg ) . Behavioural risk factors had improved among intervention patients in Nigeria but not in China . Only about 2 % of hypertensive patients required referral to the next level of care . CONCLUSION Even in low-re source setting s , hypertensive patients can be effectively assessed and managed in primary care facilities BACKGROUND Coronary artery disease is a major cause of morbidity and mortality among adults worldwide , including China . After a hospital stay , transitional care could help to ensure improved patient care and outcomes , and reduce Medicare costs . Nevertheless , the results of the existing transitional care are not always satisfactory and our knowledge of how to perform effective transitional care for patients with coronary artery disease is limited in mainl and China . OBJECTIVES To examine the effectiveness of a nurse-led transitional care program on clinical outcomes , health-related knowledge , and physical and mental health status among Chinese patients with coronary artery disease . DESIGN R and omized controlled trial . METHODS The Omaha system and Pender 's health promoting model were employed in planning and implementing this nurse-led transitional care program . The sample was comprised of 199 Chinese patients with coronary artery disease . The experimental group ( n=100  ) received nurse-led transitional care intervention in addition to routine care . The nurse-led transitional care intervention included a structured assessment and health education , followed by 7 months of individual teaching and coaching ( home visits , telephone follow-up and group activity ) . The  control group ( n=99 ) received a comparable length routine care and follow-up contacts . Evaluations were conducted at baseline and completion of the interventions using the perceived knowledge scale for coronary heart disease , the medical outcomes study 36-item short-form health survey and clinical measures ( blood pressure , blood glucose , lipids , body mass index ) . Data were collected between March and October 2014 . RESULTS Compared with the control group , participants in the experimental group showed significant better clinical outcomes ( systolic blood pressure , t=5.762 , P=0.000 ; diastolic blood pressure , t=4.250 , P=0.000 ; fasting blood glucose , t=2.249 , P=0.027 ; total cholesterol , t=4.362 , P=0.000 ; triglyceride , t=3.147 , P=0.002 ; low density lipoprotein cholesterol , t=2.399 , P=0.018 ; and body mass index , t=3.166 , P=0.002 ) , higher knowledge scores for coronary artery disease ( total knowledge score , t=-7.099 , P=0.000 ) , better physical health status ( t=-2.503 , P=0.014 ) and mental health status ( t=-2.950 , P=0.004 ) . CONCLUSIONS This study provides evidence for the value of a  nurse-led transitional care program  using both the Omaha system and Pender 's health promoting model as its theoretical framework . The structured interventions in this nurse-led transitional care program facilitate the use of this program in other setting Background : Lifestyle factors such as weight , salt intake , and physical activity have shown to be important in treating hypertension . The object of this study was to describe feasibility and to assess the effectiveness of a multicomponent lifestyle intervention on high blood pressure ( BP ) of Iranian women . Material s and Methods : This r and omized controlled trial was conducted in four health centers by recruiting 161 women aged 35 - 65 years with high BP and r and omizing them to a 4-week lifestyle modification ( n = 80 ) or control group ( n = 81 ) . BP level and other health behavioral factors were assessed before and after the 4-week intervention and also after 6 months . Results : The mean systolic BP changed from 158.8 ( ±8.1 ) mmHg to 153.2 ( ±6.4 ) mmHg during 4-week and to 145.5 ( ±4.6 ) ) mmHg after 6 months in the intervention group ( P < 0.001 ) . There was a significant difference between two groups of study after 4-week mean = 5.6 ( confidence interval [ CI ] = 5.1 - 6.6 ) and 6 months follow mean ( CI = 12.3 - 14.6).(P < 0.001 ) A significant correlation was detected between systolic BP ( SBP ) and diastolic BP ( DBP ) with weight , body mass index , waist circumference , salt intake , and physical activity level ( P < 0.001 ) . Stepwise regression analyses indicated that the weight , dietary salt intake , and physical activity level were significant predictors of SBP and DBP . Conclusion : The results of this study suggest that lifestyle modification program is associated with improvements in BP level in Iranian women BACKGROUND Adherence to drugs and healthy lifestyles is low after acute coronary syndrome . We assessed whether trained community health workers could improve adherence to drugs , lifestyle changes , and clinical risk markers in patients with acute coronary syndrome in India . METHODS In this study done at 14 hospitals in India we r and omly assigned ( 1:1 ) patients with acute coronary syndrome 1 or 2 days before discharge from hospital to a community health worker-based intervention group or a st and ard care group . Patients were r and omly assigned with a telephone r and omisation service . In the intervention group , during four in-hospital and two home visits , community health workers used unstructured discussion s , visual methods , and patient diaries to educate patients on healthy lifestyle and drugs , and measures to enhance adherence . The primary outcome was adherence to proven secondary prevention drugs ( antiplatelet drugs , β blockers , angiotensin-converting enzyme inhibitors or angiotensin receptor blockers , and statins )  estimated using a Composite Medication Adherence Scale at 1 year . The secondary outcomes were difference in lifestyle factors ( diet , exercise , and tobacco and alcohol use ) , and clinical risk markers ( blood pressure , bodyweight , BMI , heart rate , and lipids ) . All analyses were by intention to treat . This trial is registered with the Clinical Trial Registry of India , number REF/2013/03/004737 , and Clinical Trials.gov , number NCT01207700 . RESULTS Between Aug 23 , 2011 , and June 25 , 2012 , 806 participants were r and omly assigned ( 405 to a community health worker-based intervention group and 401 to a st and ard care group ) . At 1 year , 40 patients had died and 15 had discontinued or been lost to follow-up , so 750 ( 93 % ) were included in the analyses ( 375 in each group ) . Secondary prevention drugs prescribed at discharge were 98 % ( 786/803 ) for any antiplatelet drug , 79 % ( 638/803 ) for dual antiplatelet drugs , 69 % ( 555/803 ) for β blockers , 69 % ( 552/803 ) for angiotensin-converting enzyme inhibitors and angiotensin receptor blockers , and 95 % ( 762/803 ) for statins  . At one year , overall adherence ( ≥8 
    Output:
    