***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 and objective Tele monitoring ( TM ) of patients with chronic obstructive pulmonary disease ( COPD ) has gained much interest , but studies have produced conflicting results . Our aim was to investigate the effect of TM with the option of video consultations on exacerbations and hospital admissions in patients with severe COPD . Material s and methods Patients with severe COPD at high risk of exacerbations were eligible for the study . Of 560 eligible patients identified , 279 ( 50 % ) declined to participate . The remaining patients were equally r and omized to either TM ( n=141 ) or usual care ( n=140 ) for the 6-month study period . TM comprised recording of symptoms , saturation , spirometry , and weekly video consultations . Algorithms generated alerts if readings breached thresholds . Both groups received st and ard care . The primary outcome was number of hospital admissions for exacerbation of COPD during the study period . Results Most of the enrolled patients had severe COPD ( forced expiratory volume in 1 second < 50%pred in 86 % and ≥hospital admission for COPD in the year prior to enrollment in 45 % , respectively , of the patients ) . No difference in drop-out rate and mortality was found between the groups . With regard to the primary outcome , no significant difference was found in hospital admissions for COPD between the groups ( P=0.74 ) , and likewise , no difference was found in time to first admission or all-cause hospital admissions . Compared with the control group , TM group patients had more moderate exacerbations ( ie , treated with antibiotics/corticosteroid , but not requiring hospital admission ; P<0.001 ) , whereas the control group had more visits to outpatient clinics ( P<0.001 ) . Conclusion Our study of patients with severe COPD showed that TM including video consultations as add-on to st and ard care did not reduce hospital admissions for exacerbated COPD , but TM may be an alternative to visits at respiratory outpatient clinics . Further studies are needed to establish the optimal role of TM in the management of severe COPD Background There is growing evidence that home telemonitoring can be advantageous in societies with increasing prevalence of chronic diseases . The main objective of this study is to evaluate the effect of a primary care-based telemonitoring intervention on the number and length of hospital admissions . Methods A r and omised controlled trial was carried out across 20 health centres in Bilbao ( Basque Country , Spain ) to assess the impact of home telemonitoring on in-home chronic patients compared with st and ard care . The study lasted for one year . Fifty-eight in-home patients , diagnosed with heart failure ( HF ) and /or chronic lung disease ( CLD ) , aged 14 or above and with two or more hospital admissions in the previous year were recruited . The intervention consisted of daily patient self- measurements of respiratory-rate , heart-rate , blood pressure , oxygen saturation , weight , body temperature and the completion of a health status question naire using PDAs . Alerts were generated when pre-established thresholds were crossed . The control group ( CG ) received usual care . The primary outcome measure was the number of hospital admissions that occurred at 12 months post-r and omisation . The impact of telemonitoring on the length of hospital stay , use of other healthcare re sources and mortality was also explored . Results The intervention group ( IG ) included 28 patients and the CG 30 . Patient baseline characteristics were similar in both groups . Of the 21 intervention patients followed-up for a year , 12 had some admissions ( 57.1 % ) , compared to 19 of 22 controls ( 86.4 % ) , being the difference statistically significant ( p = 0.033 , RR 0.66 ; 95%CI 0.44 to 0.99 ) . The mean hospital stay was overall 9 days ( SD 4.3 ) in the IG versus 10.7 ( SD 11.2 ) among controls , and for cause-specific admissions 9 ( SD 4.5 ) vs. 11.2 ( SD 11.8 ) days , both without statistical significance ( p = 0.891 and 0.927 , respectively ) . Four patients need to be telemonitored for a year to prevent one admission ( NNT ) . There were more telephone contacts in the IG than in the CG ( 22.6 -SD 16.1- vs. 8.6 -SD 7.2- , p = 0.001 ) , but fewer home nursing visits ( 15.3 -SD 11.6- vs. 25.4 -SD 26.3- , respectively ) , though the difference was not statistically significant ( p = 0.3603 ) . Conclusions This study shows that telemonitoring of in-home patients with HF and /or CLD notably increases the percentage of patients with no hospital admissions and indicates a trend to reduce total and cause-specific hospitalisations and hospital stay .  Home telemonitoring can constitute a beneficial alternative mode of healthcare provision for medically unstable elderly patients .Trial registration Current Controlled Trials IS RCT Background Frequent exacerbations induce a high burden to Chronic Obstructive Pulmonary Disease ( COPD ) . We investigated the course of exacerbations in the published COSMIC study that investigated the effects of 1-year withdrawal of fluticasone after a 3-month run-in treatment period with salmeterol/fluticasone in patients with COPD . Methods In 373 patients , we evaluated diary cards for symptoms , Peak Expiratory Flow ( PEF ) , and salbutamol use and assessed their course during exacerbations . Results There were 492 exacerbations in 224 patients . The level of symptoms of cough , sputum , dyspnea and nocturnal awakening steadily increased from 2 weeks prior to exacerbation , with a sharp rise during the last week . Symptoms of cough , sputum , and dyspnea reverted to baseline values at different rates ( after 4 , 4 , and 7 weeks respectively ) , whereas symptoms of nocturnal awakening were still increased after eight weeks . The course of symptoms was similar around a first and second exacerbation . Increases in symptoms and salbutamol use and decreases in PEF were associated with a higher risk to develop an exacerbation , but with moderate predictive values , the areas under the receiver operating curves ranging from 0.63 to 0.70 . Conclusions Exacerbations of COPD are associated with increased symptoms that persist for weeks and the course is very similar between a first and second exacerbation . COPD exacerbations are preceded by increased symptoms and salbutamol use and lower PEF , yet predictive values are too low to warrant daily use in clinical practice Background Chronic obstructive pulmonary disease ( COPD ) is a highly prevalent condition associated with a high health care re source consumption and health care expenditures , driven mainly by exacerbations-related hospitalizations . Telemedicine has been proposed as a mean for timely detection of exacerbation , but the available evidence is inadequate to provide conclusive information on its efficacy . The aim of this study is to evaluate the efficacy of a telemonitoring system in reducing COPD -related hospitalizations in an elderly population with COPD . Methods This is a parallel arms , r and omized trial including patients aged 65 or older with COPD in GOLD stages II and III enrolled in a Pulmonary Medicine outpatient facility . Patients were r and omly assigned to receive a non-invasive system able to telemonitor vital signs ( oxygen saturation , heart rate , near-body temperature , overall physical activity ) or st and ard care , and were followed up for 9 months . The outcome measures were the number of exacerbations and exacerbation-related hospitalization . Results Fifty patients were included in the telemonitoring group and 49 in the control group . The incidence rate of respiratory events was 28/100 person/years in the telemonitoring group vs. 42/100 person/years in the control group ( incidence rate ratio : 0.67 , 95 % CI : 0.32 – 1.36 ) . The corresponding figures for hospital admissions where 13/100 person/years and 20/100 person/years , respectively ( IRR : 0.66 , 95 % CI : 0.21 – 1.86 ) . Conclusions In our study , COPD patients followed up with the aid of a multiparametric remote monitoring system experienced a lower rate of exacerbations and COPD -related hospitalizations compared to patients followed up using the st and ard model of care . These results need to be replicated in larger studies before they can be applied to the general COPD population . Trial registration number : NCT01481506 ( clinical trials.gov ) . Funding : co-financed by Lazio Region and Intersistemi BACKGROUND Telehealth interventions for patients with chronic obstructive pulmonary disease ( COPD ) have focused primarily on stable out patients .  Telehealth design ed to h and le the acute exacerbation that normally requires hospitalization could also be of interest . The aim of this study was to compare the effect of home-based telehealth hospitalization with conventional hospitalization for exacerbation in severe COPD . MATERIAL S AND METHODS A two-center , noninferiority , r and omized , controlled effectiveness trial was conducted between June 2010 and December 2011 . Patients with severe COPD admitted because of exacerbation were r and omized 1:1 either to home-based telehealth hospitalization or to continue st and ard treatment and care  at the hospital . The primary outcome was treatment failure defined as re-admission due to exacerbation in COPD within 30 days after initial discharge . The noninferiority margin was set at 20 % of the control group 's risk of re-admission . Secondary outcomes were mortality , need for manual or mechanical ventilation or noninvasive ventilation , length of hospitalization , physiological parameters , health-related quality of life , user satisfaction , healthcare costs , and adverse events . RESULTS In total , 57 patients were r and omized : 29 participants in the  telehealth group and 28 participants in the control group . Testing the incidence of re-admission within 30 days after discharge could not confirm noninferiority ( lower 95 % confidence limit [ CL ] , -24.8 % ; p=0.35 ) . Results were also nonsignificant at 90 days ( lower 95 % CL , -16.2 % ; p=0.33 ) and 180 days ( lower 95 % CL , -16.6 % ; p = 0.33 ) after discharge . Superiority testing on secondary outcomes showed nonsignificant differences between groups . Healthcare costs have not yet been evaluated . CONCLUSIONS Whether home-based telehealth hospitalization is noninferior to conventional hospitalization requires further investigation . The results indicate that a subgroup of patients with severe COPD can be treated for acute exacerbation at home using telehealth , without the physical presence of health professionals and with a proper organizational " back-up . 
    Output:
    
There is currently insufficient information on how physiological parameters vary prior to exacerbation to support routine domiciliary monitoring for the prediction of exacerbations in COPD .