***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background Care management programmes are an effective approach to care for high risk patients with complex care needs result ing from multiple co-occurring medical and non-medical conditions . These patients are likely to be hospitalized for a potentially " avoidable " cause . Nurse-led care management programmes for high risk elderly patients showed promising results . Care management programmes based on health care assistants ( HCAs ) targeting adult patients with a high risk of hospitalisation may be an innovative approach to deliver cost-efficient intensified care to patients most in need . Methods / Design PraCMan is a cluster r and omized controlled trial with primary care practice s as unit of r and omisation . The study evaluates a complex primary care practice -based care management of patients at high risk for future hospitalizations . Eligible patients either suffer from type 2 diabetes mellitus , chronic obstructive pulmonary disease , chronic heart failure or any combination . Patients with a high likelihood of hospitalization within the following 12 months ( based on insurance data ) will be included in the trial . During 12 months of intervention patients of the care management group receive comprehensive assessment of medical and non-medical needs and re sources as well as regular structured monitoring of symptoms . Assessment and monitoring will be performed by trained HCAs from the participating practice s. Additionally , patients will receive written information , symptom diaries , action plans and a medication plan to improve self-management capabilities . This intervention is addition to usual care . Patients from the  control group  receive usual care . Primary outcome is the number of all-cause hospitalizations at 12 months follow-up , assessed by insurance cl aims data . Secondary outcomes are health-related quality of life ( SF12 , EQ5D ) , quality of chronic illness care ( PACIC ) , health care utilisation and costs , medication adherence ( MARS ) , depression status and severity ( PHQ-9 ) , self-management capabilities and clinical parameters . Data collection will be performed at baseline , 12 and 24 months ( 12 months post-intervention ) . Discussion Practice -based care management for high risk individuals involving trained HCAs appears to be a promising approach to face the needs of an aging population with increasing care dem and s . Trial registration Current Controlled Trials IS RCT Fifty patients with severe chronic obstructive pulmonary disease ( FEV1 < 50 % pred . ) were r and omized to a rehabilitation group and a control group . The rehabilitation group took part in an individualized multidisciplinary , outpatient 12-month rehabilitation programme . Exercise training was intensive during the first 6 weeks and was then gradually replaced by an individual home-training programme and booster sessions . Controls received the usual outpatient care . Positive effects were found in terms of maximum symptom-limited exercise tolerance and walking distance ( 13.5 and 12.1 % increase , respectively ) in the rehabilitation group compared with the controls . Quality of life measurements showed minor beneficial effects on the Sickness Impact Profile , indicating a higher level of activity . No effect was seen on the St George 's Respiratory Question naire or the Mood Adjective Check List . Patients expressed their enthusiasm for the rehabilitation programme in a study -specific question naire Background Chronic obstructive pulmonary disease ( COPD ) is a complex condition with pulmonary and extra-pulmonary manifestations . This study describes the heterogeneity of COPD in a large and well characterised and controlled COPD cohort ( ECLIPSE ) . Methods We studied 2164 clinical ly stable COPD patients , 337 smokers with normal lung function and 245 never smokers . In these individuals , we measured clinical parameters , nutritional status , spirometry , exercise tolerance , and amount of emphysema by computed tomography . Results COPD patients were slightly older than controls and had more pack years of smoking than smokers with normal lung function . Co-morbidities were more prevalent in COPD patients than in controls , and occurred to the same extent irrespective of the GOLD stage . The severity of airflow limitation in COPD patients was poorly related to the degree of breathlessness , health status , presence of co-morbidity , exercise capacity and number of exacerbations reported in the year before the study . The distribution of these variables within each GOLD stage was wide . Even in subjects with severe airflow obstruction , a substantial proportion did not report symptoms , exacerbations or exercise limitation . The amount of emphysema increased with GOLD severity . The prevalence of bronchiectasis was low ( 4 % ) but also increased with GOLD stage . Some gender differences were also identified . Conclusions The clinical manifestations of COPD are highly variable and the degree of airflow limitation does not capture the heterogeneity of the disease Pulmonary rehabilitation is beneficial for patients with chronic lung disease . However , long-term maintenance has been difficult to achieve after short-term treatment . We evaluated a telephone-based maintenance program after pulmonary rehabilitation in 172 patients with chronic lung disease recruited from pulmonary rehabilitation graduates . Subjects were r and omly assigned to a 12-month maintenance intervention with weekly telephone contacts and monthly supervised reinforcement sessions ( n = 87 ) or st and ard care ( n = 85 ) and followed for 24 months . Except for a slight imbalance between sexes , experimental and control groups were equivalent at baseline and showed similar improvements after rehabilitation . During the 12-month intervention , exercise tolerance ( maximum treadmill workload and 6-minute walk distance ) and overall health status ratings were better maintained in the experimental group together with a reduction in hospital days . There were no group differences for other measures of pulmonary function , dyspnea , self-efficacy , generic and disease-specific quality of life , and health care use . By 24 months , there were no significant group differences . Patients returned to levels close to but above prerehabilitation measures . We conclude that a maintenance program of weekly telephone calls and monthly supervised sessions produced only modest improvements in the maintenance of benefits after pulmonary rehabilitation Background Chronic obstructive pulmonary disease ( COPD ) is a common cause of morbidity and mortality affecting a large number of individuals in both developed and developing countries and it represents a significant financial burden for patients , families and society . Pulmonary rehabilitation ( PR ) is a multidisciplinary program that integrates components of exercise training , education , nutritional support , psychological support and self-care , result ing in an improvement in dyspnea , fatigue and quality of life . Despite its proven effectiveness and the strong scientific recommendations for its routine use in the care of COPD , PR is generally underutilized and strategies for increasing access to PR are needed . Home-based self-monitored pulmonary rehabilitation is an alternative to outpatient rehabilitation . In the present study , patients with mild , moderate and severe COPD su bmi tted to either an outpatient or at-home PR program for 12 weeks were analyzed . Methods Patients who fulfilled the inclusion criteria were r and omized into three distinct groups : an  outpatient group who performed all activities at the clinic  , a home-based group who performed the activities at home and a control group . PR consisted of a combination of aerobic exercises and strengthening of upper and lower limbs 3 times a week for 12 weeks . Results There was a significant difference in the distance covered on the six-minute walk test ( p < 0.05 ) and BODE index ( p < 0.001 ) in the outpatient and at-home groups after participating in the rehabilitation program compared to baseline . Conclusion A home-based self-monitoring pulmonary rehabilitation program is as effective as outpatient pulmonary rehabilitation and is a valid alternative for the management of patients with COPD .RiassuntoRazionaleLa broncopneumopatia cronica ostruttiva ( BPCO ) è una causa frequente di morbilità e mortalità che colpisce un’ampia quota di popolazione sia nel mondo industrializzato che nei Paesi in via di sviluppo e rappresenta un peso economico di rilievo per pazienti , familiari e collettività . La riabilitazione respiratoria ( PR ) è un programma multidisciplinare che inegra componenti di riallenamento all’esercizio fisico , educazionale , supporto nutrizionale , supporto psicologico ed autoaiuto , che porta ad un miglioramento della dispnea , della affaticabilità e della qualità della vita . Nonostante la provata efficacia e le forti raccom and azioni delle società scientifiche al suo impiego routinario nel trattamento della BPCO , la PR è generalmente sottoutilizzata e si rendono perciò necessarie strategie per aumentarne l’utilizzo . La PR effettuata a domicilio ed auto-monitorata dal paziente stesso è un’alternativa alla classica riabilitazione ambulatoriale . In questo studio sono stati valuati pazienti con BPCO di grado lieve , moderato e grave sottoposti a un programma di PR ambulatoriale o domiciliare . MetodiI pazienti eligibili allo studio sono stati r and omizzati in tre gruppi : un gruppo ambulatoriale che effettuava tutte le attività in ospedale , un gruppo domiciliare che effettuava il programma a domicilio ed un gruppo di controllo . Il programma di PR consisteva in una combinazione di esercizi aerobici e di rafforzamento della muscolatura degli arti superiori e inferiori per 3 volte la settimana per 12 settimane . RisultatiSia nel gruppo che ha partecipato al PR ambulatoriale che in quello domiciliare si sono rilevate differenze significative rispetto alle misure di base nella distanza coperta con il test del cammino di 6 minuti ( p < 0.05 ) che nell’indice BODE ( p < 0.001 ) . Conclusion iUn programma di riabilitazione respiratoria automonitorato eseguito a domicilio ha efficacia sovrapponibile ad un programma ambulatoriale e può perciò essere considerato una valida alternativa nella gestione del paziente con BPCO Exacerbations are an important cause of morbidity and mortality in COPD . We assessed treatment initiation and health care use at exacerbation in patients receiving a self-management education program including an action plan . COPD patients were r and omly assigned to  usual care or to a  comprehensive self-management program “ Living Well with COPD ” including a written action plan and case manager support , and were followed-up for 12 months . Patients in the usual care were managed by their respective practitioners . Patients in the self-management program received , as part of a written action plan , a prescription of antibiotics and prednisone for self-initiation in case of aggravation of 2 or more symptoms ( dyspnea , sputum volume , sputum purulence ) for at least 24 hours , and they had the support of a case-manager for reinforcement and monthly telephone follow-ups . At 12 months , 166 patients presented with at least one exacerbation . Exacerbations ( 606 ) were confirmed by aggravation of at least one symptom ; 403 ( 67.6 % ) presented 2 or more . Antibiotics were used in 61.6 % of exacerbations and prednisone in 47.9 % . In exacerbations presenting aggravation of 2 or more symptoms ,  antibiotics  and prednisone were used together more often in the action plan than in the usual care group ( 54.4 % vs. 34.8 % , p < 0.001 ) . In the action plan , compared to the usual care group , 17.2 % vs. 36.3 % exacerbations result ed in a hospitalization ( p < 0.001 ) . Self-management with the successful use of an action plan for acute exacerbation of COPD holds promise for reducing health care use AIM In this study , the effects of a 12-week hospital-based outpatient pulmonary rehabilitation program ( HRP ) are compared with those of a 12-week home-care rehabilitation program ( HCRP ) in COPD patients . A control group received no rehabilitation therapy . METHODS After r and omization and stratification , effects on lung function , exercise performance ( 4-min walking test and cycle ergometer test ) , dyspnea , and leg effort during exercise , and well-being were assessed in 45 COPD patients with moderate to severe airflow limitation ( mean [ SD ] FEV1 percent predicted , 42.8 [ 8.4 ] ) . RESULTS After HRP and HCRP , at 3 to 6 months after the start of the study , equal improvements were detected in exercise capacity and in Borg dyspnea and leg effort scores at similar work levels during the cycle test . However , whereas after HRP at longer term values tended to return to baseline outcome , after HCRP a further ongoing significant improvement in exercise capacity was observed , while Borg dyspnea scores remained significantly improved over 18 months . Improvements in cycle workload and dyspnea score were significantly better maintained after HCRP as compared with HRP . Lung function , arterial oxygen saturation , and heart frequency during exercise did not change . A significant improvement in well-being was maintained over 18 months in both rehabilitation groups . CONCLUSION Beneficial effects are achieved both after a HRP and a HCRP in COPD patients with moderate to severe airflow limitation . Yet we recommend to initiate HCRPs as improvements are maintained longer and are even further strengthened in this setting Background Patients with long-term conditions are increasingly the focus of quality improvement activities in health services to reduce the impact of these conditions on quality of life and to reduce the burden on care utilisation . There is significant interest in the potential for self-management support to improve health and reduce utilisation in these patient population s , but little consensus concerning the optimal model that would best provide such support . We describe the implementation and evaluation of self-management support through an evidence -based ' whole systems ' model involving patient support , training for primary care teams , and service re-organisation , all integrated into routine delivery within primary care . Methods The evaluation involves a large-scale , multi-site study of the implementation , effectiveness , and cost-effectiveness of this model of self-management support 
    Output:
    
In these COPD participants , IDM not only improved disease-specific QoL and exercise capacity , but also reduced hospital admissions and hospital days per person