***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: Abstract In March 2002 The Northern Clinical Research Centre , Epping implemented a six week outpatient based pulmonary rehabilitation program for people with COPD . This paper outlines the establishment , underlying philosophy , marketing , coordination and personnel necessary for a successful program , as identified by the research centre . Barriers to program participation were identified and steps to minimize these were implemented . The longitudinal evaluation of this program in a prospect i ve manner enables the duration of the effect of this adjunctive therapy to be examined in the Australian population . One hundred and thirty six participants have graduated from the research centre 's pulmonary rehabilitation program since the program commenced in 2002 . This paper review s the process of implementing a pulmonary rehabilitation program in the northern corridor of Melbourne Aims : The main objective of this study was to investigate whether a comprehensive self-management programme , including self-treatment guidelines for exacerbations and a fitness programme , is an efficient treatment option for chronic obstructive pulmonary disease ( COPD ) patients . Method : We r and omly allocated 248 COPD patients to either self-management  ( 127 ) or usual care ( 121 ) . Data on preference-based utilities ( EuroQol-5D ) , health-related quality of life ( HRQoL ) , health-care re source use and productivity losses associated with exacerbations were prospect ively collected . Quality -adjusted life years ( QALYs ) were calculated . The economic analysis took the societal perspective and the observation period was one year . Results : As we observed that the groups were equally effective in terms of QALYs and HRQoL ( SGRQ ) , we described a cost minimization analysis only . The self-management programme-specific costs amounted to 6642 per patient . In the base-case cost analysis , the incremental cost difference amounted to 838 per patient per year in favour of usual care . When only direct medical costs were included , the incremental annual cost of self-managementrelative to usual care was 179 per person per year . If time costs for the fitness programme were set to zero , the costs for self-management diminished to 542 . Sensitivity analysis showed that these results were robust to changes in the underlying assumptions . Conclusion : We conclude that the COPE self-management programme is not an efficient treatment option for moderate to severe COPD patients who rate their HRQoL relatively high . The programme was twice as expensive as usual care and had no measurable beneficial effects on QALYs or On the basis of the beneficial health effects of self-management in the treatment of other chronic diseases like asthma it might be expected that the active participation of COPD - patients in the management of their disease may reduce the burden of the disease .  Self-management of COPD includes sufficient coping behaviour , compliance with inhaled medication , attention to changes in the severity of the disease , adequate inhalation technique , and self adjustment of the medication in case of exacerbations . The results of a pilot study on the effects of self-management in COPD suggest a reduction of morbidity due to COPD . The definite place of self-management in the treatment of COPD has to established by larger , prospect i ve , controlled trials This study tested the hypothesis that severity of respiratory disability may affect the outcome of pulmonary rehabilitation . In this r and omized , controlled study , 126 patients with chronic obstructive pulmonary disease ( COPD ) were stratified for dyspnoea using the Medical Research Council ( MRC ) dyspnoea score into MRC3/4 ( Moderate ) ( n=66 ) and MRC 5 ( Severe ) dyspnoeic ( n=60 ) groups . The patients were r and omly assigned to an eight week programme of either exercise plus education ( Exercise group ) or education ( Control group ) . Education and exercise programmes for the moderately dyspnoeic patients were carried out in a hospital outpatient setting . Severely dyspnoeic patients were all treated at home . Those in the Exercise group received an individualized training programme . There was a significant improvement in shuttle walking distance in the moderate dyspnoeic group , who received exercise training ; baseline ( mean+/-SEM ) 191+/-22 m , post-rehabilitation 279+/-22 m ( p<0.001 ) . There was no improvement in exercise performance in the severely dyspnoeic patients receiving exercise . Neither group of control patients improved . Health status , assessed by the Total Chronic Respiratory Disease Question naire score , increased in the moderately dyspnoeic patients receiving exercise from 80+/-18 to 95+/-17 ( p<0.0001 ) after rehabilitation . Much smaller changes were seen in the other three groups . Improvement in exercise performance and health status in patients with chronic obstructive pulmonary disease after an exercise programme depends on the initial degree of dyspnoea The aim of the present study was to assess the long-term impact on hospitalisation of a self-management programme for chronic obstructive pulmonary disease ( COPD ) patients . A multicentre , r and omised clinical trial was carried out involving 191 COPD patients from seven hospitals . Patients who had one or more hospitalisations in the year preceding study enrolment were assigned to a self-management programme “ Living Well with COPD TM ” or to st and ard care .  Hospitalisations from all causes were the primary outcome and were documented from the provincial hospitalisation data base ; emergency visits were recorded from the provincial health insurance data base . Most patients were elderly , not highly educated , had advanced COPD ( reflected by a mean forced expiratory volume in one second of 1 L ) , and almost half reported a dyspnoea score of 5/5 ( modified Medical Research Council ) . At 2 years , there was a statistically significant and clinical ly relevant reduction in all-cause hospitalisations of 26.9 % and in all-cause emergency visits of 21.1 % in the intervention group as compared to the st and ard-care group . After adjustment for the self-management intervention effect , the predictive factors for reduced hospitalisations included younger age , sex ( female ) , higher education , increased health status and exercise capacity . In conclusion , in this study , patients with chronic obstructive pulmonary disease who received educational intervention with supervision and support based on disease-specific self-management maintained a significant reduction in hospitalisations after a 2-year period Abstract Objective : To assess whether sharing the uncertainty of the value of antibiotics for acute bronchitis in the form of written and verbal advice affects the likelihood of patients taking antibiotics .  Design : Nested , single blind , r and omised controlled trial . Setting : Three suburban general practice s in Nottingham . Participants : 259 previously well adults presenting with acute bronchitis . Intervention : In group A , 212 patients were judged by their general practitioner not to need antibiotics that day but were given a prescription to use if they got worse and st and ard verbal reassurance . Half of them ( 106 ) were also given an information leaflet . All patients in group B ( 47 ) were judged to need antibiotics and were given a prescription and encouraged to use it . Main outcome measures : Antibiotic use in the next two weeks . Reconsultation for the same symptoms in the next month . Results : In group A fewer patients who received the information leaflet  took antibiotics compared with those who did not receive the leaflet ( 49 v 63 , risk ratio 0.76 , 95 % confidence interval 0.59 to 0.97 , P=0.04 ) . Numbers reconsulting were similar ( 11 v 14 ) . In group B , 44 patients took the antibiotics . Conclusion : Most previously well adults with acute bronchitis were judged not to need antibiotics . Reassuring these patients and sharing the uncertainty about prescribing in a information leaflet supported by verbal advice is a safe strategy and reduces antibiotic use . What is already known on this topic Most adults with acute bronchitis who consult their general practitioner will receive antibiotics For most patients antibiotics do not modify the natural course of the symptoms The widespread belief among patients that infection is the problem and antibiotics the solution has considerable influence on prescribing by general practitioners , even when they judge that antibiotics are not definitely indicated What this study adds General practitioners judged that about four in five adults with acute bronchitis did not definitely need antibiotics on the day they consulted Antibiotic use was reduced by a quarter in such patients , who received verbal and written information and reassurance in addition to a prescription for antibiotics Sharing with the patient the uncertainty about the decision to prescribe seems safe and The aim of this study was to assess the effects of a comprehensive self-management intervention on health-related quality of life ( HRQoL ) , symptoms and walking distance in patients with stable moderately severe chronic obstructive pulmonary disease ( COPD ) . This study was part of the overall COPD study of the Dept of Pulmonary Medicine , Enschede , which consisted of an inhaled corticosteroid ( ICS ) trial and a self-management trial . After the ICS trial , all patients were r and omised again to a self-management and a control group . The self-management intervention consisted of askill-oriented patient education programme and a near-home fitness programme , on top of usual care . The control group received usual care by the treating chest physician . HRQoL was measured by the St George ’s Respiratory Question naire ( SGRQ ) and walking distance by the 6‐min walking test . Patients recorded their symptoms in diaries and grade d their health status from 1–10 in a weekly report . Altogether , 248 COPD patients were r and omly allocated to either an intervention ( 127 ) or control ( 121 ) group . No differences in the SGRQ scores within and between both groups were observed over 1 yr . Similarly , no differences in symptom scores and 6‐min walking distance were found within and between groups . The intervention group reported more exacerbations than the control group . The majority ( 69 % ) of the exacerbations in the intervention group were self-treated at home . This study failed to show positive effects of a self-management programme among moderately severe chronic obstructive pulmonary disease patients This study assessed the long-term efficacy of adding self-treatment guidelines to a self-management programme for adults with asthma . In this prospect i ve r and omized controlled trial , 245 patients with stable , moderate to severe asthma were included . They were r and omized into a self-treatment group ( group S ) and a control group ( group C ) . Both groups received self-management education . Additionally , group S received self-treatment guidelines based on peak expiratory flow ( PEF ) and symptoms . Outcome parameters included : asthma symptoms , quality of life , pulmonary function , and exacerbation rate . The 2-yr study was completed by 174 patients . Both groups showed an improvement in the quality of life of 7 % . PEF variability decreased by 32 % and 29 % , and the number of outpatient visits by 25 % and 18 % in groups S and C , respectively . No significant differences in these parameters were found between the two groups . After 1 yr , patients in both groups perceived better control of asthma and had more self-confidence regarding their asthma . The latter improvements were significantly greater in group S as compared to group C. There were no other differences in outcome parameters between the groups . Individual self-treatment guidelines for exacerbations on top of a general self-management programme does not seem to be of additional benefit in terms of improvements in the clinical outcome of asthma . However , patients in the self-treatment group had better scores in subjective outcome measures such as perceived control of asthma and self-confidence than patients in the control group Seventy five patients with chronic respiratory disability were r and omised to a group visited by a respiratory health worker ( 42 ) or control group  ( 33 ) . The first group was visited monthly by a respiratory nurse , who gave education and support . The effect of the intervention was assessed in terms of quality of life ( by question naires ) , the number and duration of admissions to hospital , and the number of deaths . The question naires on quality of life showed no changes in either group during the study , but nearly all of the group visited by a respiratory health worker said that they valued the visits and wished them to continue . Their knowledge about their condition also improved compared with that of the controls . The duration of stay in hospital for respiratory reasons in the group visited by a respiratory health worker was longer than that of control patients . This was explained by their being scored as more ill than the controls on admission . Fewer patients died in the group visited by a respiratory health worker than in the control group ( p = 0.11 ) . The patients in the group visited by respiratory health workers may have survived longer because they sought help rather than dying at home . If confirmed this could have implication s for the cost of their care By instructing patients in how to deal with their disease financial dem and s on health services may be reduced . 100 consecutive patients ( aged 48 to 89 ) admitted to a general medical ward in Denmark with chronic obstructive pulmonary disease ( COPD ) were allocated r and omly to receive either " personalized hospital practice " ( PHP ) , which includes training in aspects of their disease , or st and ard hospital practice .  Changes in " consumption " of health services per patient from 1 year before until 1 year after the intervention admission were evaluated in 82 ( PHP group 42 , controls 40 ) patients who completed the intervention phase . Each group contained about the same percentage of asthmatics and smokers . The increase in consumption of health services after intervention was on average Kr15,298 per patient per year less in the PHP group than in the control group ( p = 0.048 , Wilcoxon test ) . Consumption of general practitioner services was significantly increased in the control group compared with the PHP group ( mean [ 95 % Cl ] Kr1346 [ 549 to 2143 ] vs -89 [ -423 to 245 ] per patient per year ; p = 0.001 , Wilcoxon test ) . These differences could not be explained by changes in smoking habits 
    Output:
    
It is likely that self-management education is associated with a reduction in hospital admissions with no indications for detrimental effects in other outcome parameters .
This would in itself already be enough reason for recommending self-management education in COPD .
However , because of heterogeneity in interventions , study population s , follow-up time , and outcome measures , data are still insufficient to formulate clear recommendations regarding the form and contents of self-management education programmes in COPD .