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 The Dialysis Outcomes and Practice Patterns Study ( DOPPS ) is a prospect i ve , observational study design ed to evaluate practice patterns in r and om sample s of haemodialysis facilities and patients across three continents . Participating countries include France , Germany , Italy , Spain and the UK ( Euro-DOPPS ) , Japan and the USA . DOPPS data collection has used the same question naires and protocol s across all participating countries to assess components of dialysis therapy and outcomes . This study focuses on dialysis prescription , adherence and nutrition among the Euro-DOPPS countries . METHODS In each Euro-DOPPS country , patients were selected r and omly from 20 - 21 representative facilities . Simple means and frequencies were calculated to compare relevant data elements to gain insights into differences in therapeutic aspects among nationally representative patients . Participants entering the study within 90 days of beginning dialysis therapy were excluded from these analyses . RESULTS Among the five countries , mean delivered dose as measured by normalized urea clearance ( Kt/V ) varied from 1.28 to 1.50 and was accompanied by differences in dialysis prescription components , including blood flow rates , treatment times , and dialyser membrane and flux characteristics . By country , a nearly 2-fold difference was observed in indicators of patient adherence and management ( skipping and shortening dialysis , hyperkalaemia , hyperphosphataemia and high interdialytic weight gain ) . Indicators of malnutrition varied substantially . CONCLUSIONS This study demonstrates differences in the management of haemodialysis patients across Euro-DOPPS and offers opportunities for improving dialysis dose , adherence and nutrition . Correlation of differences in practice patterns at the dialysis unit level with patient outcomes will offer new insights into improving dialysis therapy The present study examined the efficacy of a behavioral intervention design ed to increase adherence to fluid-intake restrictions among hemodialysis patients . Twenty intervention-group patients were compared with 20 matched control patients on an indicator of fluid-intake adherence at 3 time points . The Group x Time interaction was significant , indicating that patients in the 2 groups exhibited a differential pattern of change in fluid-intake adherence across the follow-up period . The intervention and control groups did not differ significantly in terms of adherence at the initial postintervention period but did differ at the 8-week follow-up . The observed group differences were , in part , due to a trend toward increasingly better adherence in the intervention group and poorer adherence in the control group across the follow-up period This research examined the relative efficacies of three intervention strategies design ed to increase compliance to medical regimens in a group of ambulatory hemodialysis patients . The interventions examined included behavioral contracting ( with or without the involvement of a family member or friend ) and weekly telephone contacts with patients . Compliance was assessed with regard to following dietary restrictions and limiting fluid intake . Data were collected from 116 patients drawn from two outpatient clinics . Within clinics , patients were r and omly assigned either to an intervention program or to a control group . The study employed a pretest-posttest control group design . Patients were interviewed before the intervention programs began ( T1 ) , after a 6-week intervention period ( T2 ) , and 3 months after completion of the intervention period ( T3 ) . Results showed that the interventions achieved substantial reductions in patients ' serum potassium levels and in weight gains between dialysis treatments between T1 and T2 . In general , however , these program effects tapered off to preintervention levels between T2 and T3 . The findings thus indicate a need for long-term intervention programs A nurse-delivered haemodialysis patient education programme incorporating cognitive behavioural therapy ( CBT ) was developed . The effects of the CBT programme were compared with those of a st and ard patient education ( SPE ) programme on patients ' salt intake and weight gain using a quasi-experimental design . There were 22 participants ( 11 CBT , 11 SPE ) undergoing outpatient haemodialysis therapy at one clinic .  Daily weight gain rates decreased in the intervention period compared with the baseline period in both the CBT and SPE groups . This effect lasted for 12 weeks in the CBT group but for only eight weeks in the SPE group . In addition , daily salt intake decreased in the intervention period compared with the baseline period in both the CBT and SPE groups , persisting for 12 weeks . From these results , both programmes were shown to be effective , but CBT had a longer effect CONTEXT International differences in compliance of patients undergoing hemodialysis  are poorly characterized and could contribute to international survival differences . OBJECTIVE To compare international differences in patient compliance with hemodialysis treatments . DESIGN A prospect i ve observational study of patients undergoing hemodialysis in 1995 and a cross-sectional survey of health care professionals caring for hemodialyzed patients in 1996 . SETTING AND PATIENTS Four dialysis centers in the southeastern United States with 415 patients undergoing hemodialysis , 1 center in Sweden with 84 patients , and 4 centers in Japan with 194 patients participated in the prospect i ve observational study . In the cross-sectional survey , nurses and nephrologists from the United States ( n = 49 ) , Japan ( n = 21 ) , and Sweden ( n = 16 ) responded to questions regarding the compliance of their patients undergoing hemodialysis . MAIN OUTCOME MEASURES Percentage of patients who miss a dialysis treatment and number of missed dialysis treatments . RESULTS Of 415 US patients , 147 missed 699 treatments over a 6-month period ( 28.1 missed treatments per 100 patient-months or 2.3 % of all prescribed treatments ) . During a 3-month period , there were 0 missed treatments per 100 patient-months for patients from Japan and 0 missed treatments per 100 patient-months for patients from Sweden ( P<.001 ) . In the cross-sectional survey , the mean ( SD ) estimated percentage of patients missing a treatment per month was 4 % ( 3 % ) for the United States , 0 % for Japan , and 0.1 % ( 3 % ) for Sweden ( P<.001 ) . CONCLUSIONS Noncompliance is much more common in US patients undergoing hemodialysis than Swedish and Japanese patients . The implication s of these results for international differences in survival deserve further study AIM AND OBJECTIVE The purpose of this study was to investigate the effects of group intervention on depression , self-efficacy and quality of life in haemodialysis patients . BACKGROUND Chronic renal failure and haemodialysis treatment is a long-term process ; patients need to have an appropriate adaptive strategy to confront the stress stemming from the disease and subsequent haemodialysis treatment . The application of group intervention for haemodialysis patients has been limited . DESIGN This study applied an experimental design methodology . Patients were selected at two haemodialysis units of major medical centres in northern Taiwan . METHODS Out of 60 original patients r and omly assigned into experimental or control groups , 48 completed the study . Twenty patients in the experimental group received group psychosocial intervention . The therapy ran for two hours per week for two months . Twenty-eight patients in the comparison group received routine unit care and a self-care booklet . Instruments included the Strategies Used by People to Promote Health , the Beck Depression Inventory and the Short Form-36 . Data were collected at pretest and one month following the therapy . RESULTS The findings demonstrated that self-care self-efficacy , depression and quality of life significantly improved statistically for patients in the therapy group , compared with patients in the comparison group . CONCLUSIONS The study indicated that group psychosocial intervention significantly reduced depression , improved self-care self-efficacy and quality of life in haemodialysis patients . RELEVANCE TO CLINICAL PRACTICE The present study was conducted with a group of out patients , did not require expensive re sources and was not time intensive , making it a viable therapy , clinical ly suitable for haemodialysis patients AIMS This paper reports a study investigating the effectiveness of an adaptation training programme ( ATP ) to help patients with end-stage renal disease ( ESRD ) to cope with illness-related stresses and , thus , to alleviate depression and improve quality of life . BACKGROUND Patients with ESRD who receive dialysis must confront the burdens of long-term illness and numerous treatment-associated stressors . The ability of these patients to cope with and adapt to these stresses , whether related to their medical regimen or to the dem and s of daily life , has an important influence on physical and psychological well-being . METHODS The study was a r and omized controlled trial using a convenience sample of 57 eligible , fully informed and consenting patients with ESRD who were assigned to experimental ( ATP plus usual care ) or control ( usual care ) groups . Participants in the ATP took part in weekly small group sessions over an 8-week period and monthly follow-up to help them to cope with stressors . A clinical nurse specialist and an experienced psychotherapist led them in three small groups ( 8 - 10 per group ) . Participants in the usual care group received routine care . Instruments comprised the Haemodialysis Stressor Scale , Beck Depression Inventory and Medical Outcomes Study SF-36 . Data were collected at baseline and at three months following the intervention . RESULTS The major stressors for these patients were limitations on time and place related to employment , limitations on fluid intake , transport difficulties , loss of bodily function , length of dialysis treatment , and limitation of physical activities . The ATP had a beneficial effect on perceived stress ( P = 0.005 ) , depression ( P = 0.001 ) and quality of life ( P = 0.02 ) 3 months after the intervention . CONCLUSIONS This study supports the effectiveness of an ATP to decrease stress and depression levels , and to improve the quality of life of ATP patients receiving haemodialysis OBJECTIVE The purpose of this study was to evaluate the effectiveness of 20 to 30 minutes per month of additional diet education on monthly laboratory values ( phosphorus , calcium , parathyroid hormone , and calcium/phosphorus product ) and knowledge of dietary phosphorus management in hemodialysis patients with hyperphosphatemia . DESIGN A quasi-experimental design . SETTING Three outpatient dialysis centers owned by the same corporation in 1 southern state . PATIENTS Based on a 3-month average serum phosphorus > 6.0 mg/dL , 70 patients were selected for participation ; 63 dialysis patients completed the study , 32 in the experimental group and 31 in the control group . INTERVENTION All patients completed a before- and -after knowledge test and had monthly blood sample s drawn . Each month , the same registered dietitian provided the routine laboratory results review with control group . The experimental group received the routine laboratory review plus 20 to 30 minutes of additional diet education specifically targeting phosphorus . Main outcome measures Before- and -after knowledge test results and baseline and final serum calcium , phosphorus , parathyroid hormone , and calcium/phosphorus product levels . RESULTS At baseline , there were no significant differences in any of the laboratory values , but the knowledge level of the experimental group was greater ( P < .05 ) After 6 months , gains in knowledge were significantly higher in the intervention group , and the serum phosphorus and calcium/phosphorus product levels were significantly lower ( P < .01 ) than in the control group . CONCLUSION Based on this research , those patients who received extra education monthly showed positive changes , which may be beneficial in reducing hyperphosphatemia OBJECTIVE To determine the effect of a tailored intervention on albumin levels among hemodialysis patients . DESIGN R and omized controlled trial . SETTING Eight freest and ing chronic hemodialysis units in northeast Ohio . SUBJECTS Eighty-three r and omly selected adult patients who had been on dialysis for at least 6 months and had a mean albumin < 3.7 g/dL ( bromcresol green method ) or < 3.4 g/dL ( bromcresol purple method ) for the last 3 months . To better eluci date the feasibility and outcomes of the intervention , we selected more intervention than control patients . INTERVENTION Dietitians of the 52 intervention patients determined whether any of the following potential barriers to adequate protein nutrition were present for each patient : ( 1 ) poor knowledge of protein-containing foods , ( 2 ) poor appetite , ( 3 ) needing help shopping or cooking , ( 4 ) low fluid intake , and ( 5 ) inadequate dialysis . Depending on the specific barriers present , the dietitians ( 1 ) educated patients on protein-containing foods , ( 2 ) recommended snacks for which patients had preserved appetite , ( 3 ) helped set up social supports , ( 4 ) provided recommendations on fluid intake , and /or ( 5 ) arranged for improved dialysis . Dietitians of the 31 control patients continued to provide usual care . MAIN OUTCOME MEASURES Change in albumin after 6 months , stratified as minimal change ( less than.25 g/dL increase or decrease ) , moderate improvement ( .25 to.49 g/dL increase ) , and large improvement ( increase of .50 g/dL or more ) . To examine the role of inflammatory states , we also determined serum C-reactive protein levels at the beginning and end of the trial . RESULTS Among intervention patients , 29 % had a minimal change in albumin , 44 % had a moderate improvement , and 27 % had a large improvement . Among control patients , 74 % had a minimal change in albumin , 19 % had a moderate improvement , and 6 % had a large improvement ( P < .001 for comparison of intervention and control subjects ) . About 60 % of subjects had high baseline C-reactive protein levels ( > 10 mg/L ) . However , there was little relationship between change in albumin 
    Output:
    
agent
***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 The Dialysis Outcomes and Practice Patterns Study ( DOPPS ) is a prospect i ve , observational study design ed to evaluate practice patterns in r and om sample s of haemodialysis facilities and patients across three continents . Participating countries include France , Germany , Italy , Spain and the UK ( Euro-DOPPS ) , Japan and the USA . DOPPS data collection has used the same question naires and protocol s across all participating countries to assess components of dialysis therapy and outcomes . This study focuses on dialysis prescription , adherence and nutrition among the Euro-DOPPS countries . METHODS In each Euro-DOPPS country , patients were selected r and omly from 20 - 21 representative facilities . Simple means and frequencies were calculated to compare relevant data elements to gain insights into differences in therapeutic aspects among nationally representative patients . Participants entering the study within 90 days of beginning dialysis therapy were excluded from these analyses . RESULTS Among the five countries , mean delivered dose as measured by normalized urea clearance ( Kt/V ) varied from 1.28 to 1.50 and was accompanied by differences in dialysis prescription components , including blood flow rates , treatment times , and dialyser membrane and flux characteristics . By country , a nearly 2-fold difference was observed in indicators of patient adherence and management ( skipping and shortening dialysis , hyperkalaemia , hyperphosphataemia and high interdialytic weight gain ) . Indicators of malnutrition varied substantially . CONCLUSIONS This study demonstrates differences in the management of haemodialysis patients across Euro-DOPPS and offers opportunities for improving dialysis dose , adherence and nutrition . Correlation of differences in practice patterns at the dialysis unit level with patient outcomes will offer new insights into improving dialysis therapy The present study examined the efficacy of a behavioral intervention design ed to increase adherence to fluid-intake restrictions among hemodialysis patients . Twenty intervention-group patients were compared with 20 matched control patients on an indicator of fluid-intake adherence at 3 time points . The Group x Time interaction was significant , indicating that patients in the 2 groups exhibited a differential pattern of change in fluid-intake adherence across the follow-up period . The intervention and control groups did not differ significantly in terms of adherence at the initial postintervention period but did differ at the 8-week follow-up . The observed group differences were , in part , due to a trend toward increasingly better adherence in the intervention group and poorer adherence in the control group across the follow-up period This research examined the relative efficacies of three intervention strategies design ed to increase compliance to medical regimens in a group of ambulatory hemodialysis patients . The interventions examined included behavioral contracting ( with or without the involvement of a family member or friend ) and weekly telephone contacts with patients . Compliance was assessed with regard to following dietary restrictions and limiting fluid intake . Data were collected from 116 patients drawn from two outpatient clinics . Within clinics , patients were r and omly assigned either to an intervention program or to a control group . The study employed a pretest-posttest control group design . Patients were interviewed before the intervention programs began ( T1 ) , after a 6-week intervention period ( T2 ) , and 3 months after completion of the intervention period ( T3 ) . Results showed that the interventions achieved substantial reductions in patients ' serum potassium levels and in weight gains between dialysis treatments between T1 and T2 . In general , however , these program effects tapered off to preintervention levels between T2 and T3 . The findings thus indicate a need for long-term intervention programs A nurse-delivered haemodialysis patient education programme incorporating cognitive behavioural therapy ( CBT ) was developed . The effects of the CBT programme were compared with those of a st and ard patient education ( SPE ) programme on patients ' salt intake and weight gain using a quasi-experimental design . There were 22 participants ( 11 CBT , 11 SPE ) undergoing outpatient haemodialysis therapy at one clinic .  Daily weight gain rates decreased in the intervention period compared with the baseline period in both the CBT and SPE groups . This effect lasted for 12 weeks in the CBT group but for only eight weeks in the SPE group . In addition , daily salt intake decreased in the intervention period compared with the baseline period in both the CBT and SPE groups , persisting for 12 weeks . From these results , both programmes were shown to be effective , but CBT had a longer effect CONTEXT International differences in compliance of patients undergoing hemodialysis  are poorly characterized and could contribute to international survival differences . OBJECTIVE To compare international differences in patient compliance with hemodialysis treatments . DESIGN A prospect i ve observational study of patients undergoing hemodialysis in 1995 and a cross-sectional survey of health care professionals caring for hemodialyzed patients in 1996 . SETTING AND PATIENTS Four dialysis centers in the southeastern United States with 415 patients undergoing hemodialysis , 1 center in Sweden with 84 patients , and 4 centers in Japan with 194 patients participated in the prospect i ve observational study . In the cross-sectional survey , nurses and nephrologists from the United States ( n = 49 ) , Japan ( n = 21 ) , and Sweden ( n = 16 ) responded to questions regarding the compliance of their patients undergoing hemodialysis . MAIN OUTCOME MEASURES Percentage of patients who miss a dialysis treatment and number of missed dialysis treatments . RESULTS Of 415 US patients , 147 missed 699 treatments over a 6-month period ( 28.1 missed treatments per 100 patient-months or 2.3 % of all prescribed treatments ) . During a 3-month period , there were 0 missed treatments per 100 patient-months for patients from Japan and 0 missed treatments per 100 patient-months for patients from Sweden ( P<.001 ) . In the cross-sectional survey , the mean ( SD ) estimated percentage of patients missing a treatment per month was 4 % ( 3 % ) for the United States , 0 % for Japan , and 0.1 % ( 3 % ) for Sweden ( P<.001 ) . CONCLUSIONS Noncompliance is much more common in US patients undergoing hemodialysis than Swedish and Japanese patients . The implication s of these results for international differences in survival deserve further study AIM AND OBJECTIVE The purpose of this study was to investigate the effects of group intervention on depression , self-efficacy and quality of life in haemodialysis patients . BACKGROUND Chronic renal failure and haemodialysis treatment is a long-term process ; patients need to have an appropriate adaptive strategy to confront the stress stemming from the disease and subsequent haemodialysis treatment . The application of group intervention for haemodialysis patients has been limited . DESIGN This study applied an experimental design methodology . Patients were selected at two haemodialysis units of major medical centres in northern Taiwan . METHODS Out of 60 original patients r and omly assigned into experimental or control groups , 48 completed the study . Twenty patients in the experimental group received group psychosocial intervention . The therapy ran for two hours per week for two months . Twenty-eight patients in the comparison group received routine unit care and a self-care booklet . Instruments included the Strategies Used by People to Promote Health , the Beck Depression Inventory and the Short Form-36 . Data were collected at pretest and one month following the therapy . RESULTS The findings demonstrated that self-care self-efficacy , depression and quality of life significantly improved statistically for patients in the therapy group , compared with patients in the comparison group . CONCLUSIONS The study indicated that group psychosocial intervention significantly reduced depression , improved self-care self-efficacy and quality of life in haemodialysis patients . RELEVANCE TO CLINICAL PRACTICE The present study was conducted with a group of out patients , did not require expensive re sources and was not time intensive , making it a viable therapy , clinical ly suitable for haemodialysis patients AIMS This paper reports a study investigating the effectiveness of an adaptation training programme ( ATP ) to help patients with end-stage renal disease ( ESRD ) to cope with illness-related stresses and , thus , to alleviate depression and improve quality of life . BACKGROUND Patients with ESRD who receive dialysis must confront the burdens of long-term illness and numerous treatment-associated stressors . The ability of these patients to cope with and adapt to these stresses , whether related to their medical regimen or to the dem and s of daily life , has an important influence on physical and psychological well-being . METHODS The study was a r and omized controlled trial using a convenience sample of 57 eligible , fully informed and consenting patients with ESRD who were assigned to experimental ( ATP plus usual care ) or control ( usual care ) groups . Participants in the ATP took part in weekly small group sessions over an 8-week period and monthly follow-up to help them to cope with stressors . A clinical nurse specialist and an experienced psychotherapist led them in three small groups ( 8 - 10 per group ) . Participants in the usual care group received routine care . Instruments comprised the Haemodialysis Stressor Scale , Beck Depression Inventory and Medical Outcomes Study SF-36 . Data were collected at baseline and at three months following the intervention . RESULTS The major stressors for these patients were limitations on time and place related to employment , limitations on fluid intake , transport difficulties , loss of bodily function , length of dialysis treatment , and limitation of physical activities . The ATP had a beneficial effect on perceived stress ( P = 0.005 ) , depression ( P = 0.001 ) and quality of life ( P = 0.02 ) 3 months after the intervention . CONCLUSIONS This study supports the effectiveness of an ATP to decrease stress and depression levels , and to improve the quality of life of ATP patients receiving haemodialysis OBJECTIVE The purpose of this study was to evaluate the effectiveness of 20 to 30 minutes per month of additional diet education on monthly laboratory values ( phosphorus , calcium , parathyroid hormone , and calcium/phosphorus product ) and knowledge of dietary phosphorus management in hemodialysis patients with hyperphosphatemia . DESIGN A quasi-experimental design . SETTING Three outpatient dialysis centers owned by the same corporation in 1 southern state . PATIENTS Based on a 3-month average serum phosphorus > 6.0 mg/dL , 70 patients were selected for participation ; 63 dialysis patients completed the study , 32 in the experimental group and 31 in the control group . INTERVENTION All patients completed a before- and -after knowledge test and had monthly blood sample s drawn . Each month , the same registered dietitian provided the routine laboratory results review with control group . The experimental group received the routine laboratory review plus 20 to 30 minutes of additional diet education specifically targeting phosphorus . Main outcome measures Before- and -after knowledge test results and baseline and final serum calcium , phosphorus , parathyroid hormone , and calcium/phosphorus product levels . RESULTS At baseline , there were no significant differences in any of the laboratory values , but the knowledge level of the experimental group was greater ( P < .05 ) After 6 months , gains in knowledge were significantly higher in the intervention group , and the serum phosphorus and calcium/phosphorus product levels were significantly lower ( P < .01 ) than in the control group . CONCLUSION Based on this research , those patients who received extra education monthly showed positive changes , which may be beneficial in reducing hyperphosphatemia OBJECTIVE To determine the effect of a tailored intervention on albumin levels among hemodialysis patients . DESIGN R and omized controlled trial . SETTING Eight freest and ing chronic hemodialysis units in northeast Ohio . SUBJECTS Eighty-three r and omly selected adult patients who had been on dialysis for at least 6 months and had a mean albumin < 3.7 g/dL ( bromcresol green method ) or < 3.4 g/dL ( bromcresol purple method ) for the last 3 months . To better eluci date the feasibility and outcomes of the intervention , we selected more intervention than control patients . INTERVENTION Dietitians of the 52 intervention patients determined whether any of the following potential barriers to adequate protein nutrition were present for each patient : ( 1 ) poor knowledge of protein-containing foods , ( 2 ) poor appetite , ( 3 ) needing help shopping or cooking , ( 4 ) low fluid intake , and ( 5 ) inadequate dialysis . Depending on the specific barriers present , the dietitians ( 1 ) educated patients on protein-containing foods , ( 2 ) recommended snacks for which patients had preserved appetite , ( 3 ) helped set up social supports , ( 4 ) provided recommendations on fluid intake , and /or ( 5 ) arranged for improved dialysis . Dietitians of the 31 control patients continued to provide usual care . MAIN OUTCOME MEASURES Change in albumin after 6 months , stratified as minimal change ( less than.25 g/dL increase or decrease ) , moderate improvement ( .25 to.49 g/dL increase ) , and large improvement ( increase of .50 g/dL or more ) . To examine the role of inflammatory states , we also determined serum C-reactive protein levels at the beginning and end of the trial . RESULTS Among intervention patients , 29 % had a minimal change in albumin , 44 % had a moderate improvement , and 27 % had a large improvement . Among control patients , 74 % had a minimal change in albumin , 19 % had a moderate improvement , and 6 % had a large improvement ( P < .001 for comparison of intervention and control subjects ) . About 60 % of subjects had high baseline C-reactive protein levels ( > 10 mg/L ) . However , there was little relationship between change in albumin 
    Output:
    