***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: Asthma self-management programmes have been shown to increase children 's knowledge about asthma and improve their management practice s and health status . However , existing programmes have rarely addressed the unique learning needs of very young children . This study aim ed to develop and assess the effectiveness of a video tape and picture book design ed to teach children about the prevention and management of acute episodes of asthma . The information content of the educational re sources was determined by analysis of relevant medical information and asthma management skills . Social Learning Theory and consideration of the developmental stage of the target population informed the format and style of presentation of the re sources . Eighty children aged between 2 and 5 years who had been diagnosed with asthma by their medical practitioner and who required daily asthma medication participated in a controlled experimental study . The study evaluated the impact of the asthma education re sources on children 's knowledge about asthma , compliance with medication regimens and health status . Children were r and omly allocated to one of three experimental groups . Children in these groups were exposed to either the video tape alone , the book alone or both the video tape and book , or to a control group who viewed material s unrelated to asthma . The results for the three experimental groups were compared with the control group who did not receive exposure to any of the asthma education re sources . The results showed that children in each experimental group had significantly greater gains in asthma-related knowledge than children in the control group and children exposed to both re sources showed the greatest increases in knowledge . Children in each of the three experimental groups also had better compliance and health than children in the control group . These findings indicate that carefully design ed asthma education re sources are useful for providing even the youngest children with information about asthma and its management Background : Until now , care provided by asthma nurses has been additional to care provided by paediatricians . A study was undertaken to compare nurse led outpatient management of childhood asthma with follow up by a paediatrician . Methods : Seventy four children referred because of insufficient control of persistent asthma were r and omly allocated to 1 year follow up by a paediatrician or asthma nurse . The main outcome measure was the percentage of symptom-free days . Additional outcome measures were airway hyperresponsiveness , lung function , daily dose of inhaled corticosteroids ( ICS ) , number of exacerbations , number of additional visits to the general practitioner , absence from school , functional health status , and disease specific quality of life . Results : There were no significant differences at the end of the 1 year study period between the two treatment groups in percentage of symptom-free days ( mean difference 2.5 % ; 95 % CI −8.8 to 13.8 ) , airway hyperresponsiveness ( log10 PD20 0.06 ; −0.19 to 0.32 ) , functional health status ( 10.1 ; −0.3 to 19.8 ) , disease specific quality of life of patients ( 0.08 ; −0.9 to 0.7 ) , and disease specific quality of life of caregivers ( 0.09 ; −0.2 to 0.3 ) , nor in any other outcome parameters . Most outcome parameters improved considerably over the 1 year study period . These improvements were achieved although the daily dose of ICS was reduced by a mean of 26 % compared with the dose received by children at referral . All parents were satisfied with the asthma care received . Conclusions : After initial assessment in a multidisciplinary clinic , childhood asthma can be successfully managed by an asthma nurse in close cooperation with a paediatrician . During close follow up by paediatrician or asthma nurse , asthma control improved despite a reduction in ICS dose BACKGROUND Children with asthma who live in the inner city are exposed to multiple indoor allergens and environmental tobacco smoke in their homes . Reductions in these triggers of asthma have been difficult to achieve and have seldom been associated with decreased morbidity from asthma . The objective of this study was to determine whether an environmental intervention tailored to each child 's allergic sensitization and environmental risk factors could improve asthma-related outcomes . METHODS We enrolled 937 children with atopic asthma ( age , 5 to 11 years ) in seven major U.S. cities in a r and omized , controlled trial of an environmental intervention that lasted one year ( intervention year ) and included education and remediation for exposure to both allergens and environmental tobacco smoke . Home environmental exposures were assessed every six months , and asthma-related complications were assessed every two months during the intervention and for one year after the intervention . RESULTS For every 2-week period , the intervention group had fewer days with symptoms than did the control group both during the intervention year ( 3.39 vs. 4.20 days , P<0.001 ) and the year afterward ( 2.62 vs. 3.21 days , P<0.001 ) , as well as greater declines in the levels of allergens at home , such as Dermatophagoides farinae ( Der f1 ) allergen in the bed ( P<0.001 ) and on the bedroom floor ( P=0.004 ) , D. pteronyssinus in the bed ( P=0.007 ) , and cockroach allergen on the bedroom floor ( P<0.001 ) . Reductions in the levels of cockroach allergen and dust-mite allergen ( Der f1 ) on the bedroom floor were significantly correlated with reduced complications of asthma ( P<0.001 ) . CONCLUSIONS Among inner-city children with atopic asthma , an individualized , home-based , comprehensive environmental intervention decreases exposure to indoor allergens , including cockroach and dust-mite allergens , result ing in reduced asthma-associated morbidity STUDY OBJECTIVE We determined whether a simple emergency department intervention improves the likelihood of primary care provider ( PCP ) follow-up after ED discharge for an acute asthma exacerbation . METHODS This r and omized , controlled clinical trial was conducted in an urban university-based ED . Participants were patients with asthma between the ages of 16 and 45 years who were treated and discharged from the ED . The study intervention was usual care or an intervention that consisted of a free 5-day course of prednisone , vouchers for transportation to and from their PCP , and a 48-hour telephone reminder to make an appointment with their PCP . The main outcome was whether the patient received follow-up care as determined by PCP contact at 4 weeks . RESULTS One hundred ninety-two patients with asthma were enrolled over 8 months ; 178 ( 93 % ) had complete follow-up . The intervention and control groups were similar with regard to age , sex , ethnicity , or years of education . The 2 groups were also comparable with respect to multiple measures of baseline access/barriers to care and severity of ED exacerbation . Patients receiving the intervention were significantly more likely to follow up with their PCP than control patients ( relative risk 1.6 ; 95 % confidence interval [ CI ] 1.1 , 2.4 ) . When adjusted for other factors influencing PCP follow-up care ( ethnicity , prior PCP relationship , insurance status , regular car access ) , intervention patients were more likely to follow up with their PCP ( odds ratio 3.1 ; 95 % CI 1.5 , 6.3 ) . CONCLUSION Providing medication , transportation vouchers , and a telephone reminder to make an appointment increased the likelihood that discharged patients with asthma obtained PCP follow-up BACKGROUND Diagnosis information from existing data sources is used commonly for epidemiologic , administrative , and research purpose s. The quality of such data for emergency department ( ED ) visits is unknown . OBJECTIVES To determine the agreement on final diagnoses between two sources , electronic administrative sources and manually abstract ed medical records , for pediatric ED visits , in a multicenter network . METHODS This was a cross sectional study at 19 EDs nationwide . The authors obtained data from two sources at each ED during a three-month period in 2003 : administrative sources for all visits and abstract ed records for r and omly selected visits during ten days over the study period . Records were matched using unique identifiers and probabilistic linkage . The authors recorded up to three diagnoses from each abstract ed medical record and up to ten for the administrative data source . Diagnoses were grouped into 104 groups using a modification of the Clinical Classification System . RESULTS A total of 8,860 abstract ed records had at least one valid diagnosis code ( with a total of 12,895 diagnoses ) and were successfully matched to records in the administrative source . Overall , 67 % ( 95 % confidence interval = 66 % to 68 % ) of diagnoses from the administrative and abstract ed sources were within the same diagnosis group . Agreement varied by site , ranging from 54 % to 77 % . Agreement varied substantially by diagnosis group ; there was no difference by method of linkage . Clustering clinical ly similar diagnosis groups improved agreement between administrative and abstract ed data sources . CONCLUSIONS ED diagnoses retrieved from electronic administrative sources and manual chart review frequently disagree , even if similar diagnosis codes are grouped . Agreement varies by institution and by diagnosis . Further work is needed to improve the accuracy of diagnosis coding ; development of a grouping system specific to pediatric emergency care may be beneficial The parents of asthmatic children treated in the pediatric respiratory service of Wolfson Hospital were r and omly divided into two groups . One group compromised 26 parents who voluntarily attended a teaching session .  After completion of the course , a question naire was completed by parents who had attended the course and parents who had not . The first group showed greater knowledge of all aspects of the disease and , after a year 's follow up , it was noted that there was a statistically significant lower hospitalization rate of their asthmatic child BACKGROUND Asthma continues to be a substantial cause of morbidity in pediatric population s. New strategies are needed to provide cost-effective educational interventions for children with asthma , particularly those in the inner city . OBJECTIVE To assess the effectiveness of a multimedia educational software program about asthma . SETTING A hospital-based primary care clinic and an affiliated neighborhood health center . DESIGN R and omized , controlled trial . POPULATION Children 3 to 12 years old with physician-diagnosed asthma . INTERVENTION An interactive educational computer program , Asthma Control , design ed to teach children about asthma and its management . Using a graphic display of a child going through simulated daily events , the game emphasizes : 1 ) monitoring ; 2 ) allergen identification ; 3 ) use of medications ; 4 ) use of health services ; and 5 ) maintenance of normal activity . Control group participants review ed printed educational material s with a research assistant . OUTCOMES Acute health care use ( emergency department and outpatient ) was the primary outcome . Secondary outcome measures included maternal report of asthma symptom severity , child functional status and school absences , satisfaction with care , and parental and child knowledge of asthma . RESULTS A total of 137 families were enrolled in the study ( 76 intervention , 61 control ) . Both intervention and control groups showed substantial improvement in all outcomes during the 12-month follow-up period . Aside from improvement in knowledge after use of the computer program , no differences were demonstrated between the 2 groups in primary or secondary outcome measures . Children reported enjoyment of program use . CONCLUSIONS This trial of an educational software program found that it did not produce greater improvement than occurred with review of traditional written material s. Because both groups showed substantial improvement over baseline , computer-based education may be more cost-effective . Alternatively , improvements in illness severity over time may overshadow the effects of such interventions . Rigorous comprehensive evaluations such as this are necessary to assess new interventions intended to improve management and outcomes of asthma Background : The effects on morbidity were examined of providing an educational intervention and a written guided self-management plan to the parents of pre-school children following a recent attendance at hospital for asthma or wheeze . Methods : A prospect i ve , r and omised , partially blinded , controlled trial was design ed at two secondary care centres . Over a 13 month period 200 children aged 18 months to 5 years at the time of admission to a children 's ward or attendance at an accident and emergency department or children 's ( emergency ) assessment unit ( A&E/CAU ) with a primary diagnosis of acute severe asthma or wheezing were recruited . 101 children were r and omised into the control group and received usual care and 99 were assigned to the intervention group and received : ( 1 ) a pre-school asthma booklet ; ( 2 ) a written guided self-management plan ; and ( 3 ) two 20 minute structured educational sessions between a specialist respiratory nurse and the parent(s ) and child . Subjects were assessed at 3 , 6 , and 12 months . The main outcomes were GP consultation rates , hospital re-admissions , and attendances at A&E/CAU . Secondary outcomes included disability score , caregivers ' quality of life , and parental knowledge of asthma . Results : There were no statistically significant differences between the two groups during the 12 month follow up period for any of the main or secondary outcome measures . Conclusions : These results do not support the hypothesis that the introduction of an educational package and a written guided self-management plan to the parents of pre-school children with asthma who had recently attended hospital for troublesome asthma or wheeze reduces morbidity over the subsequent 12 months This study was conducted to test the efficacy of AIR WISE , an individually administered asthma self-management program . Subjects were paired and r and omly assigned to either an experimental group ( N = 7 ) or a  control group ( N = 7 ) . The frequency of experimental group emergency visits , analyzed over a 12-month posttreatment period , was substantially less than those of the control group , supporting the hypothesis that AIR WISE is effective in high-utilizer children through improved self-management This article describes the evaluation of a comprehensive school-based asthma management program in an inner-city , largely African-American school system . All 54 elementary schools ( combined enrollment 13, 
    Output:
    
Asthma education aim ed at children and their carers who present to the emergency department for acute exacerbations can result in lower risk of future emergency department presentation and hospital admission .
There remains uncertainty as to the long-term effect of education on other markers of asthma morbidity such as quality of life , symptoms and lung function .
It remains unclear as to what type , duration and intensity of educational packages are the most effective in reducing acute care utilisation