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 examine the effect of self-management dietary counselling ( SMDC ) on adherence to dietary management of hyperphosphatemia among haemodialysis patients . DESIGN An eight-week cluster based r and omised control trial . PARTICIPANTS 122 stable adult patients were recruited from an HD unit in Sidon , Lebanon . Study groups were : full intervention ( A ) ( n = 41 ) , partial intervention ( B ) ( n = 41 ) and control ( C ) ( n = 40 ) . INTERVENTION Group ( A ) received SMDC , Group ( B ) received educational games only and Group ( C ) did not receive any research intervention . MAIN OUTCOME MEASURES Serum phosphorus ( P ) , Calcium Phosphate product ( Ca × P ) and two question naires : patient knowledge ( PK ) and dietary non-adherence ( PDnA ) to P reduced diet . RESULTS Group A experienced a significant improvement in mean ( ± SD ) P ( 6.54 ± 2.05 - 5.4 ± 1.97 mg/dl ) , Ca × P ( 58 ± 17 - 49 ± 12 ) , PK scores ( 50 ± 17 - 69 ± 25 % ) and PDnA scores ( 21.4 ± 4.0 - 18.3 ± 2.0 ) . Group B experienced a significant improvement in Ca × P ( 52 ± 14 - 45 ± 16 ) . Group C did not experience any significant change post intervention . CONCLUSION Our findings demonstrate the importance of patient-tailored counselling on serum P management Background Patients with end stage renal disease often fail to follow prescribed dietary and fluid regimen , leading to undesirable outcomes . This study aim ed to examine and identify factors influencing dietary , fluid , medication and dialysis compliance behaviours in patients undergoing hemodialysis . Methods This was a cross-sectional study which employed purposive sampling design . A total of 188 respondents were recruited from 14 dialysis centres in Malaysia between 2008–2011 .  Self-reported compliance behaviours and biochemical measurements were used as evaluation tools . Results Compliance rates  of dietary , fluid , medication and dialysis were 27.7 % , 24.5 % , 66.5 % and 91.0 % , respectively . Younger , male , working patients and those with longer duration on hemodialysis were found more likely to be non-compliant . Lacks of adequate knowledge , inadequate self-efficacy skills , forgetfulness and financial constraints were the major perceived barriers towards better compliance to fluid , dietary , medication and dialysis , respectively . Conclusions Healthcare professionals should recognise the factors hindering compliance from the patients ' perspective while assisting them with appropriate skills in making necessary changes possible CONTEXT High dietary phosphorus intake has deleterious consequences for renal patients and is possibly harmful for the general public as well . To prevent hyperphosphatemia , patients with end-stage renal disease limit their intake of foods that are naturally high in phosphorus . However , phosphorus-containing additives are increasingly being added to processed and fast foods . The effect of such additives on serum phosphorus levels is unclear . OBJECTIVE To determine the effect of limiting the intake of phosphorus-containing food additives on serum phosphorus levels among patients with end-stage renal disease . DESIGN , SETTING , AND PARTICIPANTS Cluster r and omized controlled trial at 14 long-term hemodialysis facilities in northeast Ohio . Two hundred seventy-nine patients with elevated baseline serum phosphorus levels ( > 5.5 mg/dL ) were recruited between May and October 2007 . Two shifts at each of 12 large facilities and 1 shift at each of 2 small facilities were r and omly assigned to an intervention or control group . INTERVENTION  Intervention participants ( n=145 ) received education on avoiding foods with phosphorus additives when purchasing groceries or visiting fast food restaurants . Control participants ( n=134 )  continued to receive usual care . MAIN OUTCOME MEASURE Change in serum phosphorus level after 3 months . RESULTS At baseline , there was no significant difference in serum phosphorus levels between the 2 groups . After 3 months , the decline in serum phosphorus levels was 0.6 mg/dL larger among intervention vs control participants ( 95 % confidence interval , -1.0 to -0.1 mg/dL ) . Intervention participants also had statistically significant increases in reading ingredient lists ( P<.001 ) and nutrition facts labels ( P = .04 ) but no significant increase in food knowledge scores ( P = .13 ) . CONCLUSION Educating end-stage renal disease patients to avoid phosphorus-containing food additives result ed in modest improvements in hyperphosphatemia . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00583570 OBJECTIVE To determine the most effective time to administer nutrition education to hemodialysis patients by evaluating memory recall scores before , during , and after treatment . DESIGN Prospect i ve , quasi experimental cohort . SUBJECTS Sixty-two adult Hispanic hemodialysis patients ( 38 men and 24 women , 29 < 65 years of age and 32 > 65 years of age ) . Patients , between 18 and 85 years of age , who have been on hemodialysis at least one month . Patients were literate and able to see and hear without impairment . SETTING Hemodialysis clinic . INTERVENTION Fifteen simple words ( English and Spanish ) in large print on 5 x 8 laminated 2-sided cards that were shown to the patient before , during , and after dialysis . METHODS Patients were shown 5 different words before going on dialysis , 5 more words during dialysis , and 5 more words after dialysis . Each time , the patient was asked for immediate recall to assess short-term memory recall . Patients were then asked 5 to 10 minutes later ( before , during , and after dialysis ) what words were seen to assess long-term memory recall . MAIN OUTCOME MEASURE Did patients remember more before , during , or after dialysis ? RESULTS There were no significant differences in memory recall scores between diabetic and nondiabetic subjects or by gender with respect to memory recall scores . Results imply that time of recall in relation to dialysis treatment may be important for those above 65 years of age . A significant difference was found when comparing those subjects completing elementary school to those subjects completing high school and college . The evidence found in this study was in accordance with the findings of Smith and Winslow in their 1990 study showing subjects required less time to complete a task measuring cognitive function when it was given before hemodialysis treatment , as compared with during the treatment . CONCLUSION As age increases , recall ability likely will decrease . As education level increases , recall ability will likely increase . Providing nutrition education before the hemodialysis treatment occurs may be more beneficial than during and after the treatment . The educational information that a hemodialysis patient retains after treatment may be seriously impacted by the patient 's education level and age Background / Aim : A r and omized controlled trial was conducted involving 67 stable adult haemodialysis patients with hyperphosphataemia . The objective was to determine the effect of monthly dietetic consultations on patients ’ serum phosphate concentrations and calcium × phosphate product . Methods : The intervention group received monthly dietetic consultations for 6 months using advanced counselling skills aim ed at limiting phosphate intake in the diet and improving compliance with phosphate binders , whereas st and ard care with dietetic consultations every 6 months was provided to the control group .  Results : Serum phosphate concentrations decreased in the intervention group from 2.05 ± 0.48 to 1.80 ± 0.48 mmol/l by month 3 ( p < 0.05 ) . However , this subsequently increased and by month 6 there was no significant difference from baseline . After controlling for confounding variables , the difference between the groups was approaching significance at month 3 , but there was no difference by month 6 , or following conclusion of the study . The calcium × phosphate product similarly decreased in both groups , achieving K/DOQI st and ards , but was not sustained either during the remainder of the study but decreased further by the 12-month follow-up and , although it was not significantly different , it did improve significantly from baseline in both the intervention and control groups . Conclusion : Increased frequency of dietetic consultations can result in improved phosphate control in the short term , and therefore more innovative strategies appear necessary to sustain longer-term control 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 evaluate the dietary habits of hemodialysis patients with hyperphosphatemia and the effects of a dietetic intervention focused on limiting dietary phosphate load . DESIGN Cross-sectional dietary evaluation and prospect i ve intervention study . SETTING Hospital hemodialysis units of Pisa and Pistoia , Italy . Subjects Forty-three stable adult hemodialysis patients , 20 of whom had phosphorus serum levels > 5.5 mg/dL. INTERVENTION Analysis of dietary composition and of the effects of individual dietetic counseling in an attempt to reduce phosphorus intake while preserving the same protein intake . MAIN OUTCOME MEASURES Differences in nutrient intake between normophosphatemic and hyperphosphatemic patients , and changes in dietary phosphorus and phosphorus-protein ratio , serum phosphate , and calcium-phosphate product after dietetic intervention . RESULTS No major differences in nutrient intake were detected between hyperphosphatemia and normophosphatemia patients , apart from a lower phosphorus-protein ratio ( 13.1 + /- 1.7 versus 14.1 + /- 2.1 mg/g , P < .05 ) in the former . After dietetic intervention in the hyperphosphatemia patients , phosphate and calcium intake decreased significantly ( by 100 mg on average ) , whereas dietary protein did not change . A further decrease of the dietary phosphate-protein ratio ( 12.5 + /- 1.8 mg/g , P < .05 ) also occurred . Serum phosphate showed a trend to decrease in the intervention group , whereas the serum calcium-phosphate product decreased significantly ( from 66.8 + /- 13.1 to 61.0 + /- 13.8 mg2 /dL2 , P < .05 ) . CONCLUSIONS In compliant and motivated patients , individual dietetic counseling may be useful in reducing phosphate load and in limiting the phosphate burden related to an adequate protein intake , with a potentially favorable impact on calcium-phosphate retention . A phosphate-controlled diet has a role in an integrated therapeutic approach to hyperphosphatemia and positive calcium-phosphorus balance in hemodialysis patients OBJECTIVE To evaluate the effectiveness of a protocol design ed to optimize serum phosphate levels in patients undergoing regular hemodialysis ( HD ) . DESIGN R and omized , controlled trial . SETTING Hemodialysis units at Barts and the London NHS Trust and satellite units . PATIENTS Thirty-four clinical ly stable adults undergoing regular HD with a serum phosphate level > 1.8 mmol/L on at least one occasion within 4 months of starting the study . INTERVENTION Management of serum phosphate using a specially design ed phosphate management protocol during a 4-month study period implemented by a renal dietitian and renal pharmacist compared with st and ard practice . MAIN OUTCOME MEASURE Change in serum phosphate levels in both groups after 4 months . RESULTS Patients managed using the phosphate management protocol had a significantly greater reduction in serum phosphate levels compared with patients receiving st and ard practice ( -0.22 + /- 0.67 mmol/L vs. + 0.19 + /- 0.32 mmol/L , P = 0.03 ) . CONCLUSION The phosphate management protocol was effective , and its implementation was associated with significantly 
    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: OBJECTIVE To examine the effect of self-management dietary counselling ( SMDC ) on adherence to dietary management of hyperphosphatemia among haemodialysis patients . DESIGN An eight-week cluster based r and omised control trial . PARTICIPANTS 122 stable adult patients were recruited from an HD unit in Sidon , Lebanon . Study groups were : full intervention ( A ) ( n = 41 ) , partial intervention ( B ) ( n = 41 ) and control ( C ) ( n = 40 ) . INTERVENTION Group ( A ) received SMDC , Group ( B ) received educational games only and Group ( C ) did not receive any research intervention . MAIN OUTCOME MEASURES Serum phosphorus ( P ) , Calcium Phosphate product ( Ca × P ) and two question naires : patient knowledge ( PK ) and dietary non-adherence ( PDnA ) to P reduced diet . RESULTS Group A experienced a significant improvement in mean ( ± SD ) P ( 6.54 ± 2.05 - 5.4 ± 1.97 mg/dl ) , Ca × P ( 58 ± 17 - 49 ± 12 ) , PK scores ( 50 ± 17 - 69 ± 25 % ) and PDnA scores ( 21.4 ± 4.0 - 18.3 ± 2.0 ) . Group B experienced a significant improvement in Ca × P ( 52 ± 14 - 45 ± 16 ) . Group C did not experience any significant change post intervention . CONCLUSION Our findings demonstrate the importance of patient-tailored counselling on serum P management Background Patients with end stage renal disease often fail to follow prescribed dietary and fluid regimen , leading to undesirable outcomes . This study aim ed to examine and identify factors influencing dietary , fluid , medication and dialysis compliance behaviours in patients undergoing hemodialysis . Methods This was a cross-sectional study which employed purposive sampling design . A total of 188 respondents were recruited from 14 dialysis centres in Malaysia between 2008–2011 .  Self-reported compliance behaviours and biochemical measurements were used as evaluation tools . Results Compliance rates  of dietary , fluid , medication and dialysis were 27.7 % , 24.5 % , 66.5 % and 91.0 % , respectively . Younger , male , working patients and those with longer duration on hemodialysis were found more likely to be non-compliant . Lacks of adequate knowledge , inadequate self-efficacy skills , forgetfulness and financial constraints were the major perceived barriers towards better compliance to fluid , dietary , medication and dialysis , respectively . Conclusions Healthcare professionals should recognise the factors hindering compliance from the patients ' perspective while assisting them with appropriate skills in making necessary changes possible CONTEXT High dietary phosphorus intake has deleterious consequences for renal patients and is possibly harmful for the general public as well . To prevent hyperphosphatemia , patients with end-stage renal disease limit their intake of foods that are naturally high in phosphorus . However , phosphorus-containing additives are increasingly being added to processed and fast foods . The effect of such additives on serum phosphorus levels is unclear . OBJECTIVE To determine the effect of limiting the intake of phosphorus-containing food additives on serum phosphorus levels among patients with end-stage renal disease . DESIGN , SETTING , AND PARTICIPANTS Cluster r and omized controlled trial at 14 long-term hemodialysis facilities in northeast Ohio . Two hundred seventy-nine patients with elevated baseline serum phosphorus levels ( > 5.5 mg/dL ) were recruited between May and October 2007 . Two shifts at each of 12 large facilities and 1 shift at each of 2 small facilities were r and omly assigned to an intervention or control group . INTERVENTION  Intervention participants ( n=145 ) received education on avoiding foods with phosphorus additives when purchasing groceries or visiting fast food restaurants . Control participants ( n=134 )  continued to receive usual care . MAIN OUTCOME MEASURE Change in serum phosphorus level after 3 months . RESULTS At baseline , there was no significant difference in serum phosphorus levels between the 2 groups . After 3 months , the decline in serum phosphorus levels was 0.6 mg/dL larger among intervention vs control participants ( 95 % confidence interval , -1.0 to -0.1 mg/dL ) . Intervention participants also had statistically significant increases in reading ingredient lists ( P<.001 ) and nutrition facts labels ( P = .04 ) but no significant increase in food knowledge scores ( P = .13 ) . CONCLUSION Educating end-stage renal disease patients to avoid phosphorus-containing food additives result ed in modest improvements in hyperphosphatemia . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00583570 OBJECTIVE To determine the most effective time to administer nutrition education to hemodialysis patients by evaluating memory recall scores before , during , and after treatment . DESIGN Prospect i ve , quasi experimental cohort . SUBJECTS Sixty-two adult Hispanic hemodialysis patients ( 38 men and 24 women , 29 < 65 years of age and 32 > 65 years of age ) . Patients , between 18 and 85 years of age , who have been on hemodialysis at least one month . Patients were literate and able to see and hear without impairment . SETTING Hemodialysis clinic . INTERVENTION Fifteen simple words ( English and Spanish ) in large print on 5 x 8 laminated 2-sided cards that were shown to the patient before , during , and after dialysis . METHODS Patients were shown 5 different words before going on dialysis , 5 more words during dialysis , and 5 more words after dialysis . Each time , the patient was asked for immediate recall to assess short-term memory recall . Patients were then asked 5 to 10 minutes later ( before , during , and after dialysis ) what words were seen to assess long-term memory recall . MAIN OUTCOME MEASURE Did patients remember more before , during , or after dialysis ? RESULTS There were no significant differences in memory recall scores between diabetic and nondiabetic subjects or by gender with respect to memory recall scores . Results imply that time of recall in relation to dialysis treatment may be important for those above 65 years of age . A significant difference was found when comparing those subjects completing elementary school to those subjects completing high school and college . The evidence found in this study was in accordance with the findings of Smith and Winslow in their 1990 study showing subjects required less time to complete a task measuring cognitive function when it was given before hemodialysis treatment , as compared with during the treatment . CONCLUSION As age increases , recall ability likely will decrease . As education level increases , recall ability will likely increase . Providing nutrition education before the hemodialysis treatment occurs may be more beneficial than during and after the treatment . The educational information that a hemodialysis patient retains after treatment may be seriously impacted by the patient 's education level and age Background / Aim : A r and omized controlled trial was conducted involving 67 stable adult haemodialysis patients with hyperphosphataemia . The objective was to determine the effect of monthly dietetic consultations on patients ’ serum phosphate concentrations and calcium × phosphate product . Methods : The intervention group received monthly dietetic consultations for 6 months using advanced counselling skills aim ed at limiting phosphate intake in the diet and improving compliance with phosphate binders , whereas st and ard care with dietetic consultations every 6 months was provided to the control group .  Results : Serum phosphate concentrations decreased in the intervention group from 2.05 ± 0.48 to 1.80 ± 0.48 mmol/l by month 3 ( p < 0.05 ) . However , this subsequently increased and by month 6 there was no significant difference from baseline . After controlling for confounding variables , the difference between the groups was approaching significance at month 3 , but there was no difference by month 6 , or following conclusion of the study . The calcium × phosphate product similarly decreased in both groups , achieving K/DOQI st and ards , but was not sustained either during the remainder of the study but decreased further by the 12-month follow-up and , although it was not significantly different , it did improve significantly from baseline in both the intervention and control groups . Conclusion : Increased frequency of dietetic consultations can result in improved phosphate control in the short term , and therefore more innovative strategies appear necessary to sustain longer-term control 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 evaluate the dietary habits of hemodialysis patients with hyperphosphatemia and the effects of a dietetic intervention focused on limiting dietary phosphate load . DESIGN Cross-sectional dietary evaluation and prospect i ve intervention study . SETTING Hospital hemodialysis units of Pisa and Pistoia , Italy . Subjects Forty-three stable adult hemodialysis patients , 20 of whom had phosphorus serum levels > 5.5 mg/dL. INTERVENTION Analysis of dietary composition and of the effects of individual dietetic counseling in an attempt to reduce phosphorus intake while preserving the same protein intake . MAIN OUTCOME MEASURES Differences in nutrient intake between normophosphatemic and hyperphosphatemic patients , and changes in dietary phosphorus and phosphorus-protein ratio , serum phosphate , and calcium-phosphate product after dietetic intervention . RESULTS No major differences in nutrient intake were detected between hyperphosphatemia and normophosphatemia patients , apart from a lower phosphorus-protein ratio ( 13.1 + /- 1.7 versus 14.1 + /- 2.1 mg/g , P < .05 ) in the former . After dietetic intervention in the hyperphosphatemia patients , phosphate and calcium intake decreased significantly ( by 100 mg on average ) , whereas dietary protein did not change . A further decrease of the dietary phosphate-protein ratio ( 12.5 + /- 1.8 mg/g , P < .05 ) also occurred . Serum phosphate showed a trend to decrease in the intervention group , whereas the serum calcium-phosphate product decreased significantly ( from 66.8 + /- 13.1 to 61.0 + /- 13.8 mg2 /dL2 , P < .05 ) . CONCLUSIONS In compliant and motivated patients , individual dietetic counseling may be useful in reducing phosphate load and in limiting the phosphate burden related to an adequate protein intake , with a potentially favorable impact on calcium-phosphate retention . A phosphate-controlled diet has a role in an integrated therapeutic approach to hyperphosphatemia and positive calcium-phosphorus balance in hemodialysis patients OBJECTIVE To evaluate the effectiveness of a protocol design ed to optimize serum phosphate levels in patients undergoing regular hemodialysis ( HD ) . DESIGN R and omized , controlled trial . SETTING Hemodialysis units at Barts and the London NHS Trust and satellite units . PATIENTS Thirty-four clinical ly stable adults undergoing regular HD with a serum phosphate level > 1.8 mmol/L on at least one occasion within 4 months of starting the study . INTERVENTION Management of serum phosphate using a specially design ed phosphate management protocol during a 4-month study period implemented by a renal dietitian and renal pharmacist compared with st and ard practice . MAIN OUTCOME MEASURE Change in serum phosphate levels in both groups after 4 months . RESULTS Patients managed using the phosphate management protocol had a significantly greater reduction in serum phosphate levels compared with patients receiving st and ard practice ( -0.22 + /- 0.67 mmol/L vs. + 0.19 + /- 0.32 mmol/L , P = 0.03 ) . CONCLUSION The phosphate management protocol was effective , and its implementation was associated with significantly 
    Output:
    