***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 Better self management could improve quality of life ( QoL ) and reduce hospital admissions in chronic obstructive pulmonary disease ( COPD ) , but the best way to promote it remains unclear . AIM To explore the feasibility , effectiveness and cost effectiveness of a novel , layperson-led , theoretically driven COPD self-management support programme . DESIGN AND SETTING Pilot r and omised controlled trial in one UK primary care trust area . METHOD Patients with moderate to severe COPD were identified through primary care and r and omised 2:1 to the 7-week-long , group intervention or usual care . Outcomes at baseline , 2 , and 6 months included self-reported health , St George 's Respiratory Question naire ( SGRQ ) , EuroQol , and exercise . RESULTS Forty-four per cent responded to GP invitation , 116 were r and omised : mean ( st and ard deviation [ SD ] ) age 69.5 ( 9.8 ) years , 46 % male , 78 % had unscheduled COPD care in the previous year . Forty per cent of intervention patients completed the course ; 35 % attended no sessions ; and 78 % participants completed the 6-month follow-up question naire . Results suggest that the intervention may increase both QoL ( mean EQ-5D change 0.12 ( 95 % confidence interval [ CI ] = -0.02 to 0.26 ) higher , intervention versus control ) and exercise levels , but not SGRQ score . Economic analyses suggested that with thresholds of £ 20 000 per quality -adjusted life-year gained , the intervention is likely to be cost-effective . CONCLUSION This intervention has good potential to meet the UK National Institute for Health and Clinical Excellence criteria for cost effectiveness , and further research is warranted . However , to make a substantial impact on COPD self-management , it will also be necessary to explore other ways to enable patients to access self-management education The new COPD -GRIP ( Chronic Obstructive Pulmonary Disease – Guidance , Research on Illness Perception ) intervention translates evidence regarding illness perceptions and health-related quality of life ( HRQoL ) into a nurse intervention to guide COPD patients and to improve health outcomes . It describes how to assess and discuss illness perceptions in a structured way . This study aim ed to assess the effectiveness of the intervention in primary care . A cluster r and omised controlled trial was conducted within 30 general practice s and five home-care centres , including 204 COPD patients . 103 patients were r and omly assigned to the intervention group and 101 patients to the usual-care group .  To assess differences , repeated multilevel linear mixed modelling analyses were used . Primary outcome was change in health status on the Clinical COPD Question naire ( CCQ ) at 9 months . Secondary outcomes were HRQoL , daily activities , health education impact and changes in illness perceptions . There was no significant difference between the groups in the CCQ at 9 months . We found a significant increase in health-directed behaviour at 6 weeks ( p=0.024 ) and in personal control ( p=0.005 ) at 9 months in favour of the intervention group . The COPD -GRIP intervention , practised by nurses , did not improve health status in COPD patients in primary care . However , the intervention has benefits in improving the ability to control the disease and health-related behaviours in the short term . Therefore , taking illness perceptions into account when stimulating healthy behaviours in COPD patients should be considered . Further study on influencing the health status and HRQoL is needed . COPD illness perception intervention improved health behaviours in the short term , but did not improve health status Objectives Pulmonary rehabilitation ( PR ) provides benefit for patients with chronic obstructive pulmonary disease ( COPD ) in terms of quality of life ( QoL ) and exercise capacity ; however , the effects diminish over time . Our aim was to evaluate a maintenance programme for patients who had completed PR . Setting Primary and secondary care PR programmes in Norfolk . Participants 148 patients with COPD who had completed at least 60 % of a st and ard PR programme were r and omised and data are available for 110 patients . Patients had greater than 20 pack year smoking history and less than 80 % predicted forced expiratory volume in 1 s but no other significant disease or recent respiratory tract infection . Interventions Patients were r and omised to receive a maintenance programme or st and ard care . The maintenance programme consisted of 2 h ( 1 h individually tailored exercise training and 1 h education programme ) every 3 months for 1 year . Primary and secondary outcome measures The Chronic Respiratory Question naire ( CRQ ) ( primary outcome ) , endurance shuttle walk test ( ESWT ) , EuroQol ( EQ5D ) , hospital anxiety and depression score ( HADS ) , body mass index ( BMI ) , body fat , activity levels ( overall score and activity diary ) and exacerbations were assessed before and after 12 months . Results There was no statistically significant difference between the groups for the change in CRQ dyspnoea score ( primary end point ) at 12 months which amounted to 0.19 ( −0.26 to 0.64 ) units or other domains of the CRQ . There was no difference in the ESWT duration ( −10.06 ( −191.16 to 171.03 ) seconds ) , BMI , body fat , EQ5D , MET-minutes , activity rating , HADS , exacerbations or admissions . Conclusions A maintenance programme of three monthly 2 h sessions does not improve outcomes in patients with COPD after 12 months . We do not recommend that our maintenance programme is adopted . Other methods of sustaining the benefits of PR are required . Trial registration number NCT00925171 The pivotal objective of chronic obstructive pulmonary disease ( COPD ) self-management programmes is behaviour change to avoid moderate and severe exacerbations and improve health related quality of life . In a prospect ively planned , controlled study , COPD patients who participated in the “ Living well with COPD ” ( LWW COPD ) self-management intervention  were compared with  usual care patients from the primary care COPD Cohort ICE COLD ERIC , who did not receive self-management intervention ( NCT00706602 ) The primary outcome was behaviour change and disease-specific health related quality of life after 1 year . Secondary end-points included exacerbation rates . We calculated mixed linear , zero-inflated negative binomial and logistic regression models and used propensity scores to counteract confounding . 467 patients , 71 from the LWW COPD and 396 from the usual care cohort , were included . The differences between intervention and control were 0.54 ( 95 % CI 0.13−0.94 ) on the Chronic Respiratory Question naire domain “ mastery ” , 0.55 ( 95 % CI 0.11−0.99 ) on “ fatigue ” , 0.54 ( 0.14−0.93 ) on “ emotional function ” and 0.64 ( 95 % CI 0.14−1.14 ) on “ dyspnoea ” . The intervention considerably reduced the risk of moderate and severe exacerbations ( incidence rate ratio 0.36 , 95 % CI 0.25−0.52 ) . Self-management coaching in primary care improves health-related quality of life and lowers exacerbation rates and health care use  . COPD self-management coaching  improves health-status and lowers exacerbation rates among patients in primary care Background Frequent users of healthcare services are a vulnerable population that deserves attention due to high costs and negative outcomes such as lower quality of life and higher mortality . Healthcare systems should offer interventions tailored to their needs and to their level of health literacy , including strategies to promote activation . The relationship between health literacy and patient activation remains to be explored . The aim of this study was to examine the association between health literacy and patient activation in a population of frequent users of healthcare services with chronic diseases . Methods Cross-sectional data were collected ( before r and omization ) through a clinical trial evaluating a case management intervention in primary care . Participants ( n = 247 ) were recruited from the list of frequent users of 4 Family Medicine Groups ( FMG ) in the Saguenay-Lac-St-Jean region of Québec ( Canada ) . They completed question naires by self-report during an encounter with a research assistant : ( 1 ) the Newest Vital Sign ( NVS ) to evaluate health literacy  ( independent variable ) ; and ( 2 ) the Patient Activation Measure-13 ( PAM-13 ) to evaluate patient activation ( dependent variable ) . The relationship between health literacy and activation was examined using biserial correlations . Results No association was found between health literacy ( independent variable ) and patient activation ( rb = 0.075 , ρ = 0.07 ) for this population of frequent users of healthcare services . Conclusions This study suggests that there is no relationship between health literacy and patient activation among frequent users of healthcare services . Trial registration NCT01719991 . Registered October 25 , 2012 Background Self-management education programs ( SMEPs ) are potentially effective in the symptomatic management of COPD . Little is presently known about the effectiveness of these programs in Chinese COPD patients . The objective of this study was to evaluate the effectiveness of a specifically design ed SMEP on levels of self-efficacy in Chinese patients with COPD . Material s and methods Based on the Medical Research Council framework for evaluating complex interventions , an exploratory phase r and omized controlled trial was employed to examine the effects of an SMEP .  Self-efficacy was the primary outcome using the COPD Self-efficacy Scale , measured at baseline and 6 months after the program . Qualitative data were sequentially collected from these patients via three focus groups to supplement the quantitative findings . Results The experimental group displayed significant improvement in their general self-efficacy ( Z = −2.44 , P=0.015 ) and specifically in confronting 1 ) physical exertion ( Z = −2.57 , P=0.01 ) , 2 ) weather/environment effects ( Z = −2.63 , P<0.001 ) and 3 ) intense emotions ( Z = −2.54 , P=0.01 ) . Three themes emerged from the focus groups : greater disease control , improved psychosocial well-being and perceived incapability and individuality . The connection of the quantitative and qualitative data demonstrated that individual perceptual constancy of patients could be a determining factor modulating the effectiveness of this type of intervention . Conclusion These findings highlight the potential putative benefits of an SMEP  in Chinese patients with COPD . Further attention should be given to cultural considerations when developing this type of intervention in Chinese population s with COPD and other chronic diseases Background Patient education is a key component in the management of chronic obstructive pulmonary disease ( COPD ) . Delivering effective education to ethnic groups with COPD is a challenge . The objective of this study was to develop and assess the effectiveness of culturally and linguistically specific audiovisual educational material s in supporting self-management practice s in M and arin- and Cantonese-speaking patients . Methods Educational material s were developed using participatory approach ( patients involved in the development and pilot test of educational material s ) , followed by a r and omized controlled trial that assigned 91 patients to three intervention groups with audiovisual educational interventions and one control group ( pamphlet ) .  The patients were recruited from outpatient clinics . The primary outcomes were improved inhaler technique and perceived self-efficacy to manage COPD . The secondary outcome was improved patient underst and ing of pulmonary rehabilitation procedures . Results Subjects in all three intervention groups , compared with control subjects , demonstrated postintervention improvements in inhaler technique ( P<0.001 ) , preparedness to manage a COPD exacerbation ( P<0.01 ) , ability to achieve goals in managing COPD ( P<0.01 ) , and underst and ing pulmonary rehabilitation procedures ( P<0.05 ) . Conclusion Culturally appropriate educational interventions design ed specifically to meet the needs of M and arin and Cantonese COPD patients are associated with significantly better underst and ing of self-management practice s. Self-management education led to improved proper use of medications , ability to manage COPD exacerbations , and ability to achieve goals in managing COPD . Clinical implication A relatively simple culturally appropriate disease management education intervention improved inhaler techniques and self-management practice s. Further research is needed to assess the effectiveness of self-management education on behavioral change and patient empowerment strategies BACKGROUND New care modes in primary care may affect patients ' experienced continuity of care .  AIM To analyse whether experienced continuity for patients with chronic obstructive pulmonary disease ( COPD ) changes after different care modes are introduced , and to analyse the relationship between continuity of care and patients ' quality of life . DESIGN AND SETTING R and omised controlled trial with 2-year follow-up in general practice in the Netherl and s. METHOD A total of 180 patients with COPD were r and omly assigned to three different care modes : self-management , regular monitoring by a practice nurse , and care provided by the GP at the patient 's own initiative ( usual care ) . Experienced continuity of care as personal continuity ( proportion of visits with patient 's own GP ) and team continuity ( continuity by the primary healthcare team ) was measured using a self-administered patient question naire . Quality of life was measured using the Chronic Respiratory Question naire . RESULTS Of the final sample ( n = 148 ) , those patients receiving usual care experienced the highest personal continuity , although the chance of not contacting any care provider was also highest in this group ( 29 % versus 2 % receiving self-management , and 5 % receiving regular monitoring ) . There were no differences in experienced team continuity in the three care modes . No relationship was found between continuity and changes in quality of life . CONCLUSION Although personal continu 
    Output:
    
Most self-management interventions did not measure health literacy or patient activation as an outcome .
Successful interventions were multicomponent and comprehensive in addressing self-management .
There is a need to evaluate the impact of comprehensive self-management interventions that address and measure both health literacy and patient activation on health outcomes for COPD patients