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 Diabetic patients taking insulin  often have suboptimal glucose control , and st and ard methods of health care delivery are ineffective in improving such control . This study was undertaken to determine if insulin adjustment according to advice provided by telephone by a diabetes nurse educator could lead to better glucose control , as indicated by level of glycated hemoglobin ( HbA1c ) . METHODS The authors conducted a prospect i ve r and omized trial involving 46 insulin-requiring diabetic patients who had poor glucose control ( HbA1c of 0.085 or more ) . Eligible patients were those already taking insulin and receiving endocrinologist-directed care through a diabetes centre and whose most recent HbA1c level was 0.085 or higher . The patients were r and omly assigned to receive st and ard care or to have regular telephone contact with a diabetes nurse educator for advice about adjustment of insulin therapy . RESULTS At baseline there was no statistically significant difference between the 2 groups in terms of HbA1c level ( mean [ and st and ard deviation ] for st and ard-care group 0.094 [ 0.008 ] and for intervention group 0.096 [ 0.010 ] ) , age , sex , type or duration of diabetes , duration of insulin therapy or complications . After 6 months , the mean HbA1c level in the st and ard-care group was 0.089 ( 0.010 ) , which was not significantly different from the mean level at baseline . However , the mean HbA1c level in the intervention group had fallen to 0.078 ( 0.008 ) , which was significantly lower than both the level at baseline for that group ( p < 0.001 ) and the level for the st and ard-care group at 6 months ( p < 0.01 ) . INTERPRETATION Insulin adjustment according to advice from a diabetes nurse educator is an effective method of improving glucose control in insulin-requiring diabetic patients OBJECTIVE To investigate whether monitoring and discussing psychological well-being in out patients with diabetes improves mood , glycemic control , and the patient 's evaluation of the quality of diabetes care . RESEARCH DESIGN AND METHODS This study was a r and omized controlled trial of 461 out patients with diabetes who were r and omly assigned to st and ard care or to the monitoring condition .  In the latter group , the diabetes nurse specialist assessed and discussed psychological well-being with the patient ( with an interval of 6 months ) in addition to st and ard care . The computerized Well-being Question naire was used for this purpose . Primary outcomes were mood , HbA(1c ) , and the patient 's evaluation of the quality of diabetes care at 1-year follow-up . The number of referrals to the psychologist was analyzed as a secondary outcome . Intention-to-treat analysis was used . RESULTS The monitoring group reported better mood compared with the st and ard care group , as indicated by significantly lower negative well-being and significantly higher levels of energy , higher general well-being , better mental health , and a more positive evaluation of the quality of the emotional support received from the diabetes nurse . The two groups did not differ for HbA(1c ) or in their overall evaluation of the quality of diabetes care . In the monitoring condition , significantly more subjects were referred to the psychologist . CONCLUSIONS Monitoring and discussing psychological well-being as part of routine diabetes outpatient care had favorable effects on the mood of patients but did not affect their HbA(1c ) . Our results support the recommendation to monitor psychological well-being in patients with diabetes The aim of the present study was to examine the effect of participation in a support group on self-assessed quality of life . Based on an initial self-report assessment of  quality of life 25 people were allocated to 5 groups comprising 4 - 6 participants ( intervention group ) and 36 controls .  The support groups met fort-nightly for 6 months and were facilitated by the investigator and a diabetic nurse specialist . Group processes were aim ed at alleviating distress and improve satisfaction with life and included installation of hope , imparting information and group cohesiveness . Both the intervention and control group completed the quality of life measure at the end of 6 months . There were no significant differences between the intervention and control group on background characteristics or quality of life pre-test scores . No significant differences were found between the intervention and control group on difference in pre and post-test scores , indicating that support group participation did not effect self-assessed quality of life . This finding may be due to method ological issues i.e. selection , sample size and the instrument used , the implementation of the intervention and /or the concept of quality of life as an outcome variable PURPOSE The purpose of this study was to evaluate an intensive diabetes foot education program for veterans at high risk for foot ulcer . METHODS We invited 100 consecutive patients with diabetes from a Department of Veterans Affairs Medical Center clinic who were insensate to the Semmes-Weinstein 5.07 monofilament to participate in a foot care education program . Two sessions were conducted by a nurse diabetes educator 3 months apart . Multiple educational approaches were used to teach patients foot self-examination , foot washing , proper footwear , and encouragement in enlisting proper physician foot care . Knowledge and satisfaction with care was measured before and after each visit . RESULTS The 34 patients who attended both education sessions improved their foot care knowledge over the course of the program . After the second session , the mean improvement over baseline was 14 % . These patients also reported improved satisfaction with foot care ; mean improvement was 33 % . CONCLUSIONS An intensive education program improved the foot care knowledge and behavior of high-risk patients . Those who adhered to a foot care education program were more satisfied with their foot care than prior to the program . Ways to improve accessibility of education sessions must be explored OBJECTIVE Hospitalized patients with diabetes have a prolonged length of stay  in the hospital . We conducted a controlled prospect i ve r and omized feasibility study of the effects of a diabetes team ( a diabetes nurse educator and an endocrinologist ) on the length of stay and other outcomes of hospitalization in these patients . RESEARCH DESIGN AND METHODS A total of 179 hospitalized patients with diabetes were r and omly assigned to receive usual care supplemented with ( 85 patients ) or without ( 94 control patients ) a diabetes team intervention . Outcome measures included the length of stay , blood glucose control , and rates of readmission . RESULTS For the primary diagnosis of diabetes , the median length of stay was 5.5 days ( 95 % CI 4 - 8 days ) for patients who received diabetes team intervention and 7.5 days ( 5–11 days ) for the control patients ( NS ) . For the secondary diagnosis of diabetes , the median length of stay was 10.0 days ( 8–13 days ) in the intervention group and 10.5 days ( 8–13 days ) in the control group ( NS ) . One month after the team intervention was initiated , 75 % of patients in the intervention group were in good glycemic control , compared with 46 % in the control group . Readmissions at 3 months after discharge included 13 ( 15 % ) patients from the intervention group and 30 ( 32 % ) patients in the control group ( P = 0.01 ) . CONCLUSIONS R and omized controlled prospect i ve trials of clinical interventions in hospitalized patients with diabetes are feasible . Diabetes team intervention appears to reduce the hospital length of stay and to improve glycemic control . Team intervention significantly reduces the rate of recurrent hospitalization This paper describes the development and evaluation of a computer-aided learning ( CAL ) program . The program was tested in a trial that involved 36 people with diabetes ; 20 received CAL lessons in diabetes management and 16 attended conventional diabetes classes conducted by diabetes educators . When measurements taken before and three months after the education were compared , both groups showed significant improvement in their knowledge ; the blood glucose levels of the CAL group were significantly lower but those of the conventional education group were higher . This means that the CAL program was as effective as conventional education in imparting knowledge but it was more likely to motivate people to control their glucose levels . The CAL program allows diabetes educators to spend less time on education in basic knowledge and to concentrate more on motivational and social factors that are important determinants of patient compliance . It can also benefit people with diabetes whose access to health professionals and /or conventional diabetes education is restricted AIMS To evaluate the effectiveness and cost implication s of a  hospital diabetes specialist nursing service . METHODS We conducted a prospect i ve , open , r and omized , controlled trial of st and ard in-patient care for adults with diabetes , with and without the intervention of a diabetes specialist nursing ( DSN ) service . The setting was a single UK university hospital . SUBJECTS were unselected patients referred to the hospital DSN service . Primary outcome measures were length of hospital stay and patterns of readmission ( frequency and time to first readmission ) . Secondary outcome measures were subjects ' diabetes-related quality of life , diabetes knowledge score , satisfaction with treatment , and GP and community care contacts following discharge . Costs were estimated from the hospital and published sources . RESULTS Median length of stay was lower in the intervention group ( 11.0 vs. 8.0 days , P < 0.01 ) . Readmission rates were the same in the two groups ( 25 % ) , and mean time to readmission was similar in the two groups , although slightly less in the control group ( 278 vs. 283 days , P = 0.80 ) . The cost per patient for nursing input was 38.94 pounds sterling . However , when the reduced length of stay was accounted for , the intervention produced a mean cost per admission of 436 ponds sterling lower than that of the control group ( P = 0.19 ) . Patients in the intervention group were more knowledgeable regarding their diabetes and more satisfied with their care . CONCLUSIONS Diabetes specialist nurses are potentially cost saving by reducing hospital length of stay ( LOS ) . There was no evidence of an adverse effect of reduced LOS on re-admissions , use of community re sources , or patient perception of quality of care OBJECTIVE We evaluated automated telephone disease management ( ATDM ) with telephone nurse follow-up as a strategy for improving diabetes treatment processes and outcomes in Department of Veterans Affairs ( VA ) clinics . We also compared the results with those of a prior ATDM trial conducted in a county health care system . RESEARCH DESIGN AND METHODS A total of 272 VA patients with diabetes using hypoglycemic medications were r and omized . During the 1-year study period , intervention patients received biweekly ATDM health assessment and self-care education calls , and a nurse educator followed up with patients based on their ATDM assessment reports . Telephone surveys were used to measure patients ' self-care , symptoms , and satisfaction with care . Outpatient service use was evaluated using electronic data bases and self-reports , and glycemic control was measured by HbA1c and serum glucose testing . RESULTS At 12 months , intervention patients reported more frequent glucose self-monitoring and foot inspections than patients receiving usual care and were more likely to be seen in podiatry and diabetes specialty clinics . Intervention patients also were more likely than control patients to have had a cholesterol test . Among patients with baseline HbA1c levels > or = 8 % , mean end-point values were lower among intervention patients than control patients ( 8.7 vs. 9.2 % , respectively ; P = 0.04 ) . Among intervention and control patients with baseline values > or = 9 % , mean end-point values were 9.1 and 10.2 % , respectively ( P = 0.04 ) . At follow-up , intervention patients reported fewer symptoms of poor glycemic control than control patients and greater satisfaction with their health care . CONCLUSIONS This intervention improved the quality of VA diabetes care . Intervention effects for most end points replicated findings from the prior county clinic trial , although intervention-control differences in the current study were smaller because of the relatively good self-care and health status among the current study 's enrollees In patients with non-insulin-dependent diabetes mellitus ( NIDDM ) , the influence of knowledge about their disease on the treatment and control of the disease is not clear . We evaluated the efficacy of educational group meetings with NIDDM patients on improving their knowledge of the disease and on disease management .  Fifty-one NIDDM patients were r and omly assigned to either intervention or control groups . The intervention group participated in courses of three weekly lessons presented by a physician , nurse , and dietitian once every 4 mo . The intervention and control groups were also followed once every 2 mo in the clinic by the same staff . Medical treatment remained unchanged during the study . After a 12-mo follow-up of the intervention group , no significant improvement in their knowledge of diabetes could be demonstrated . However , mean fasting and postpr and ial blood glucose levels and HbA1c improved significantly in comparison with the control goup . The same tendency was evident with the weight and lipoprotein profile . We conclude that educational group therapy can improve diabetes control in patients with NIDDM OBJECTIVE To assess the quality of r and omization  from reports of trials in a sample of specialist journals , and to compare those results with a similar assessment from a sample of general medical journals . DESIGN Evaluation of all 206 reports of parallel-group r and omized trials published in the 1990 and 1991 volumes of four journals of obstetrics and gynecology and of 81 reports of trials published during 1987 in four general medical journals . RESULTS Of the reports published in the specialist and in the general medical journals , only 32 % and 48 % , respectively , reported having used an adequate method to generate r and om numbers ; only  
    Output:
    
agent
Where reported , emergency admissions and quality of life were not found to be significantly different between groups .
No information was found regarding BMI , mortality , long term diabetic complications , adverse effects , or costs .
REVIEW ER 'S CONCLUSIONS The presence of a diabetes specialist nurse / nurse case manager may improve patients ' diabetic control over short time periods , but from currently available trials the effects over longer periods of time are not evident .
There were no significant differences overall in hypoglycaemic episodes , hyperglycaemic incidents , or hospital admissions .
Quality of life was not shown to be affected by input from a diabetes specialist nurse/nurse case manager
***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 Diabetic patients taking insulin  often have suboptimal glucose control , and st and ard methods of health care delivery are ineffective in improving such control . This study was undertaken to determine if insulin adjustment according to advice provided by telephone by a diabetes nurse educator could lead to better glucose control , as indicated by level of glycated hemoglobin ( HbA1c ) . METHODS The authors conducted a prospect i ve r and omized trial involving 46 insulin-requiring diabetic patients who had poor glucose control ( HbA1c of 0.085 or more ) . Eligible patients were those already taking insulin and receiving endocrinologist-directed care through a diabetes centre and whose most recent HbA1c level was 0.085 or higher . The patients were r and omly assigned to receive st and ard care or to have regular telephone contact with a diabetes nurse educator for advice about adjustment of insulin therapy . RESULTS At baseline there was no statistically significant difference between the 2 groups in terms of HbA1c level ( mean [ and st and ard deviation ] for st and ard-care group 0.094 [ 0.008 ] and for intervention group 0.096 [ 0.010 ] ) , age , sex , type or duration of diabetes , duration of insulin therapy or complications . After 6 months , the mean HbA1c level in the st and ard-care group was 0.089 ( 0.010 ) , which was not significantly different from the mean level at baseline . However , the mean HbA1c level in the intervention group had fallen to 0.078 ( 0.008 ) , which was significantly lower than both the level at baseline for that group ( p < 0.001 ) and the level for the st and ard-care group at 6 months ( p < 0.01 ) . INTERPRETATION Insulin adjustment according to advice from a diabetes nurse educator is an effective method of improving glucose control in insulin-requiring diabetic patients OBJECTIVE To investigate whether monitoring and discussing psychological well-being in out patients with diabetes improves mood , glycemic control , and the patient 's evaluation of the quality of diabetes care . RESEARCH DESIGN AND METHODS This study was a r and omized controlled trial of 461 out patients with diabetes who were r and omly assigned to st and ard care or to the monitoring condition .  In the latter group , the diabetes nurse specialist assessed and discussed psychological well-being with the patient ( with an interval of 6 months ) in addition to st and ard care . The computerized Well-being Question naire was used for this purpose . Primary outcomes were mood , HbA(1c ) , and the patient 's evaluation of the quality of diabetes care at 1-year follow-up . The number of referrals to the psychologist was analyzed as a secondary outcome . Intention-to-treat analysis was used . RESULTS The monitoring group reported better mood compared with the st and ard care group , as indicated by significantly lower negative well-being and significantly higher levels of energy , higher general well-being , better mental health , and a more positive evaluation of the quality of the emotional support received from the diabetes nurse . The two groups did not differ for HbA(1c ) or in their overall evaluation of the quality of diabetes care . In the monitoring condition , significantly more subjects were referred to the psychologist . CONCLUSIONS Monitoring and discussing psychological well-being as part of routine diabetes outpatient care had favorable effects on the mood of patients but did not affect their HbA(1c ) . Our results support the recommendation to monitor psychological well-being in patients with diabetes The aim of the present study was to examine the effect of participation in a support group on self-assessed quality of life . Based on an initial self-report assessment of  quality of life 25 people were allocated to 5 groups comprising 4 - 6 participants ( intervention group ) and 36 controls .  The support groups met fort-nightly for 6 months and were facilitated by the investigator and a diabetic nurse specialist . Group processes were aim ed at alleviating distress and improve satisfaction with life and included installation of hope , imparting information and group cohesiveness . Both the intervention and control group completed the quality of life measure at the end of 6 months . There were no significant differences between the intervention and control group on background characteristics or quality of life pre-test scores . No significant differences were found between the intervention and control group on difference in pre and post-test scores , indicating that support group participation did not effect self-assessed quality of life . This finding may be due to method ological issues i.e. selection , sample size and the instrument used , the implementation of the intervention and /or the concept of quality of life as an outcome variable PURPOSE The purpose of this study was to evaluate an intensive diabetes foot education program for veterans at high risk for foot ulcer . METHODS We invited 100 consecutive patients with diabetes from a Department of Veterans Affairs Medical Center clinic who were insensate to the Semmes-Weinstein 5.07 monofilament to participate in a foot care education program . Two sessions were conducted by a nurse diabetes educator 3 months apart . Multiple educational approaches were used to teach patients foot self-examination , foot washing , proper footwear , and encouragement in enlisting proper physician foot care . Knowledge and satisfaction with care was measured before and after each visit . RESULTS The 34 patients who attended both education sessions improved their foot care knowledge over the course of the program . After the second session , the mean improvement over baseline was 14 % . These patients also reported improved satisfaction with foot care ; mean improvement was 33 % . CONCLUSIONS An intensive education program improved the foot care knowledge and behavior of high-risk patients . Those who adhered to a foot care education program were more satisfied with their foot care than prior to the program . Ways to improve accessibility of education sessions must be explored OBJECTIVE Hospitalized patients with diabetes have a prolonged length of stay  in the hospital . We conducted a controlled prospect i ve r and omized feasibility study of the effects of a diabetes team ( a diabetes nurse educator and an endocrinologist ) on the length of stay and other outcomes of hospitalization in these patients . RESEARCH DESIGN AND METHODS A total of 179 hospitalized patients with diabetes were r and omly assigned to receive usual care supplemented with ( 85 patients ) or without ( 94 control patients ) a diabetes team intervention . Outcome measures included the length of stay , blood glucose control , and rates of readmission . RESULTS For the primary diagnosis of diabetes , the median length of stay was 5.5 days ( 95 % CI 4 - 8 days ) for patients who received diabetes team intervention and 7.5 days ( 5–11 days ) for the control patients ( NS ) . For the secondary diagnosis of diabetes , the median length of stay was 10.0 days ( 8–13 days ) in the intervention group and 10.5 days ( 8–13 days ) in the control group ( NS ) . One month after the team intervention was initiated , 75 % of patients in the intervention group were in good glycemic control , compared with 46 % in the control group . Readmissions at 3 months after discharge included 13 ( 15 % ) patients from the intervention group and 30 ( 32 % ) patients in the control group ( P = 0.01 ) . CONCLUSIONS R and omized controlled prospect i ve trials of clinical interventions in hospitalized patients with diabetes are feasible . Diabetes team intervention appears to reduce the hospital length of stay and to improve glycemic control . Team intervention significantly reduces the rate of recurrent hospitalization This paper describes the development and evaluation of a computer-aided learning ( CAL ) program . The program was tested in a trial that involved 36 people with diabetes ; 20 received CAL lessons in diabetes management and 16 attended conventional diabetes classes conducted by diabetes educators . When measurements taken before and three months after the education were compared , both groups showed significant improvement in their knowledge ; the blood glucose levels of the CAL group were significantly lower but those of the conventional education group were higher . This means that the CAL program was as effective as conventional education in imparting knowledge but it was more likely to motivate people to control their glucose levels . The CAL program allows diabetes educators to spend less time on education in basic knowledge and to concentrate more on motivational and social factors that are important determinants of patient compliance . It can also benefit people with diabetes whose access to health professionals and /or conventional diabetes education is restricted AIMS To evaluate the effectiveness and cost implication s of a  hospital diabetes specialist nursing service . METHODS We conducted a prospect i ve , open , r and omized , controlled trial of st and ard in-patient care for adults with diabetes , with and without the intervention of a diabetes specialist nursing ( DSN ) service . The setting was a single UK university hospital . SUBJECTS were unselected patients referred to the hospital DSN service . Primary outcome measures were length of hospital stay and patterns of readmission ( frequency and time to first readmission ) . Secondary outcome measures were subjects ' diabetes-related quality of life , diabetes knowledge score , satisfaction with treatment , and GP and community care contacts following discharge . Costs were estimated from the hospital and published sources . RESULTS Median length of stay was lower in the intervention group ( 11.0 vs. 8.0 days , P < 0.01 ) . Readmission rates were the same in the two groups ( 25 % ) , and mean time to readmission was similar in the two groups , although slightly less in the control group ( 278 vs. 283 days , P = 0.80 ) . The cost per patient for nursing input was 38.94 pounds sterling . However , when the reduced length of stay was accounted for , the intervention produced a mean cost per admission of 436 ponds sterling lower than that of the control group ( P = 0.19 ) . Patients in the intervention group were more knowledgeable regarding their diabetes and more satisfied with their care . CONCLUSIONS Diabetes specialist nurses are potentially cost saving by reducing hospital length of stay ( LOS ) . There was no evidence of an adverse effect of reduced LOS on re-admissions , use of community re sources , or patient perception of quality of care OBJECTIVE We evaluated automated telephone disease management ( ATDM ) with telephone nurse follow-up as a strategy for improving diabetes treatment processes and outcomes in Department of Veterans Affairs ( VA ) clinics . We also compared the results with those of a prior ATDM trial conducted in a county health care system . RESEARCH DESIGN AND METHODS A total of 272 VA patients with diabetes using hypoglycemic medications were r and omized . During the 1-year study period , intervention patients received biweekly ATDM health assessment and self-care education calls , and a nurse educator followed up with patients based on their ATDM assessment reports . Telephone surveys were used to measure patients ' self-care , symptoms , and satisfaction with care . Outpatient service use was evaluated using electronic data bases and self-reports , and glycemic control was measured by HbA1c and serum glucose testing . RESULTS At 12 months , intervention patients reported more frequent glucose self-monitoring and foot inspections than patients receiving usual care and were more likely to be seen in podiatry and diabetes specialty clinics . Intervention patients also were more likely than control patients to have had a cholesterol test . Among patients with baseline HbA1c levels > or = 8 % , mean end-point values were lower among intervention patients than control patients ( 8.7 vs. 9.2 % , respectively ; P = 0.04 ) . Among intervention and control patients with baseline values > or = 9 % , mean end-point values were 9.1 and 10.2 % , respectively ( P = 0.04 ) . At follow-up , intervention patients reported fewer symptoms of poor glycemic control than control patients and greater satisfaction with their health care . CONCLUSIONS This intervention improved the quality of VA diabetes care . Intervention effects for most end points replicated findings from the prior county clinic trial , although intervention-control differences in the current study were smaller because of the relatively good self-care and health status among the current study 's enrollees In patients with non-insulin-dependent diabetes mellitus ( NIDDM ) , the influence of knowledge about their disease on the treatment and control of the disease is not clear . We evaluated the efficacy of educational group meetings with NIDDM patients on improving their knowledge of the disease and on disease management .  Fifty-one NIDDM patients were r and omly assigned to either intervention or control groups . The intervention group participated in courses of three weekly lessons presented by a physician , nurse , and dietitian once every 4 mo . The intervention and control groups were also followed once every 2 mo in the clinic by the same staff . Medical treatment remained unchanged during the study . After a 12-mo follow-up of the intervention group , no significant improvement in their knowledge of diabetes could be demonstrated . However , mean fasting and postpr and ial blood glucose levels and HbA1c improved significantly in comparison with the control goup . The same tendency was evident with the weight and lipoprotein profile . We conclude that educational group therapy can improve diabetes control in patients with NIDDM OBJECTIVE To assess the quality of r and omization  from reports of trials in a sample of specialist journals , and to compare those results with a similar assessment from a sample of general medical journals . DESIGN Evaluation of all 206 reports of parallel-group r and omized trials published in the 1990 and 1991 volumes of four journals of obstetrics and gynecology and of 81 reports of trials published during 1987 in four general medical journals . RESULTS Of the reports published in the specialist and in the general medical journals , only 32 % and 48 % , respectively , reported having used an adequate method to generate r and om numbers ; only  
    Output:
    