***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 There has been limited study of yoga training as a complementary exercise strategy to manage the symptom of dyspnea in patients with chronic obstructive pulmonary disease ( COPD ) . PURPOSE The primary purpose of this pilot study was to evaluate a yoga program for its safety , feasibility , and efficacy for decreasing dyspnea intensity ( DI ) and dyspnea-related distress ( DD ) in older adults with COPD . METHODS Clinical ly stable patients with COPD ( n = 29 ; age 69.9 + /- 9.5 ; forced expiratory volume in 1 second ( FEV(1 ) ) 47.7 + /- 15.6 % predicted ; female = 21 ) were r and omized to a 12-week yoga program specifically design ed for people with COPD or usual-care control  ( UC ) . The twice-weekly yoga program included asanas ( yoga postures ) and visama vritti pranayama ( timed breathing ) . Safety measure outcomes included heart rate , oxygen saturation , dyspnea , and pain . Feasibility was measured by patient-reported enjoyment , difficulty , and adherence to yoga sessions . At baseline and at 12 weeks , DI and DD were measured during incremental cycle ergometry and a 6-minute walk ( 6MW ) test . Secondary efficacy outcomes included physical performance , psychologic well-being , and health-related quality of life ( HRQoL ) . RESULTS Yoga training was safe and feasible for patients with COPD . While yoga training had only small effects on DI after the 6MW test ( effect size [ ES ] , 0.20 ; p = 0.60 ) , there were greater reductions in DD in the yoga group compared to UC ( ES , 0.67 ; p = 0.08 ) . Yoga training also improved 6MW distance ( + 71.7 + /- 21.8 feet versus -27.6 + /- 36.2 feet ; ES = 0.78 , p = 0.04 ) and self-reported functional performance ( ES = 0.79 , p = 0.04 ) compared to UC . There were small positive changes in muscle strength and HRQoL. CONCLUSIONS Elderly patients with COPD participated safely in a 12-week yoga program especially design ed for patients with this chronic illness . After the program , the subjects tolerated more activity with less DD and improved their functional performance . These findings need to be confirmed in a larger , more sufficiently powered efficacy study BACKGROUND Heart failure ( HF ) is a major public health problem . Case management by nurses using telephone follow-up has been suggested as a convenient and effective mechanism to promote the self-management of HF . Similarly , a patient empowerment approach to the management of chronic disease has been suggested as one that may nurture self-management in individuals with chronic illness . OBJECTIVE The purpose of this study was to examine the effects of a telephone-delivered empowerment intervention ( EI ) on clinical ly and theoretically relevant outcomes in patients with HF , including purpose ful participation in goal attainment , self-management of HF , and perception of functional health . The EI was guided by Rogers ' Science of Unitary Human Beings person-environment process . METHODS A convenience sample of men and women aged 21 years and older with a clinical diagnosis of HF was obtained from a metropolitan hospital located in the southwestern United States . The participants were r and omly assigned to the control group ( n = 45 ) or EI group ( n = 45 ) . All participants received st and ardized HF patient education ; the intervention group also received an EI delivered through telephone follow-up calls from a registered nurse . Repeated- measures analysis of variance was used to evaluate intervention effects . RESULTS The telephone-delivered EI  facilitated self-management of HF through self-care activities in EI group members . CONCLUSION The knowledge gained from this study provides a beginning underst and ing of strategies to enhance health care providers ' ability to facilitate self-management of HF among patients diagnosed with HF Objectives To assess benefits of telephone-delivered health mentoring in community-based chronic obstructive pulmonary disease ( COPD ) . Design Cluster r and omised controlled trial . Setting Tasmanian general practice s : capital city ( 11 ) , large rural ( 3 ) , medium rural ( 1 ) and small rural ( 16 ) . Participants Patients were invited ( 1207 ) from general practitioner ( GP ) data bases with COPD diagnosis and /or tiotropium prescription , response rate 49 % ( 586 ) , refused ( 176 ) and excluded ( criteria : smoking history or previous study , 68 ) . Spirometry testing ( 342 ) confirmed moderate or severe COPD in 182 ( 53 % ) patients . R and omisation By r and om numbers code , block stratified on location , allocation by sequentially numbered , opaque and sealed envelopes . Intervention Health mentor ( HM ) group received regular calls to manage illness issues and health behaviours from trained community health nurses using negotiated goal setting : problem solving , decision-making and action planning . Control : usual care ( UC ) group received GP care plus non-interventional brief phone calls . Outcomes Measured at 0 , 6 and 12 months , the Short Form 36 ( SF-36 ) and St George ’s Respiratory Question naire ( SGRQ , primary ) ; Partners In Health ( PIH ) Scale for self-management capacity , Hospital Anxiety and Depression Scale ( HADS ) , Center for Epidemiologic Studies -Depression ( CES-D ) question naire , Post-Traumatic Stress Disorder Checklist , Satisfaction with life and hospital admissions ( secondary ) . Results 182 participants with COPD ( age 68±8 years , 62 % moderate COPD and 53 % men ) were r and omised ( HM=90 and UC=92 ) . Mixed model regression analysis accounting for clustering , adjusting for age , gender , smoking status and airflow limitation assessed efficacy ( regression coefficient , β , reported per 6-month visit ) . There was no difference in quality of life between groups , but self-management capacity increased in the HM group ( PIH overall 0.15 , 95 % CI 0.03 to 0.29 ; knowledge domain 0.25 , 95 % CI 0.00 to 0.50 ) . Anxiety decreased in both groups ( HADS A 0.35 ; 95 % CI −0.65 to −0.04 ) and coping capacity improved ( PIH coping 0.15 ; 95 % CI 0.04 to 0.26 ) . Conclusions Health mentoring  improved self-management capacity but not quality of life compared to regular phone contact , which itself had positive effects where decline is generally expected OBJECTIVE Women with gynecological cancers have reported poor health-related quality of life ( QOL ) , with complex physical and psychological needs post-surgery and during chemotherapy treatment . There are no studies reporting interventions addressing these needs post-hospital discharge in this population . METHODS Patients were r and omized into two groups . The intervention group received 6 months of specialized care by an Advanced Practice Nurse ( APN ) ; in addition , women with high distress were evaluated and monitored by a psychiatric consultation-liaison nurse ( PCLN ) . The attention control group was assisted with symptom management by a research assistant . The effects of the 6-month intervention were evaluated using self-report question naires at baseline ( 24 - 48 h after surgery ) , 1 , 3 , and 6 months post- surgery . QOL assessment s included the Center for Epidemiological Studies -Depression Scale , the ambiguity subscale of the Mishel Uncertainty in Illness Scale , the Symptom Distress Scale , and the Short-Form Health Survey ( SF-12 ) . The sample for the longitudinal analysis included 123 who completed QOL outcome measures  across three occasions post-surgery . RESULTS The APN intervention result ed in significantly less uncertainty than the attention control intervention 6 months after surgery . When the sub-group who received the APN plus PCLN intervention was compared with the total attention control group , the sub-group had significantly less uncertainty , less symptom distress , and better SF-12 mental and physical QOL over time . CONCLUSION Nurse tailored interventions that target both physical and psychological aspects of QOL in women recovering from cancer surgery and undergoing chemotherapy produce stronger outcomes than interventions that target solely one QOL aspect Aim To examine the effects of a nurse-led case management programme for hospital-discharged older adults with co-morbidities . Background The most significant chronic conditions today involve diseases of the cardiovascular , respiratory , endocrine and renal systems . Previous studies have suggested that a nurse-led case management approach using either telephone follow-ups or home visits was able to improve clinical and patient outcomes for patients having a single , chronic disease , while the effects for older patients having at least two long-term conditions are unknown . A self-help programme using motivation and empowerment approaches is the framework of care in the study . Design R and omized controlled trial . Method The study was conducted from 2010–2012 . Older patients having at least two chronic diseases were included for analysis . The participants were r and omized into three arms : two study groups and one control group . Data were collected at baseline and at 4 and 12 weeks later . Results Two hundred and eighty-one patients completed the study . The interventions demonstrated significant differences in hospital readmission rates within 84 days post discharge . The two intervention groups had lower readmission rates than the control group . Patients in the two study arms had significantly better self-rated health and self-efficacy . There was significant difference between the groups in the physical composite score , but no significant difference in mental component score in SF-36 scale . Conclusion The postdischarge interventions led by the nurse case managers on self-management of disease using the empowerment approach were able to provide effective clinical and patient outcomes for older patients having co-morbidities Context Few studies have evaluated whether health care assistants can improve care for depressed patients .  Contribution Patients who were r and omly assigned to receive telephone case management by health care assistants  reported slightly greater improvements in depression symptoms , better adherence to antidepressant therapies , and more favorable assessment s of the quality of their care than did patients r and omly assigned to receive usual care .  Implication Telephone case management facilitated by health care assistants may be a feasible mechanism for small primary care practice s to improve care of their patients with depression . The Editors Depression causes a substantial disease burden ( 1 ) and is responsible for annual health care costs of about $ 83.1 billion in the United States ( 2 , 3 ) . Most patients with depression are treated in primary care ( 46 ) . Collaborative care can improve depression outcomes by providing decision support and clinical information for family physicians , as well as self-management support and follow-up for patients . However , evidence regarding collaborative depression care stems mostly from academic or managed care setting s in the United States ( 711 ) . In these trials , family physicians generally relied on mental health case managers and decision support from mental health specialists ( 12 ) . Case management is a patient-centered element of collaborative care that may be effective in primary care ( 13 ) . It comprises systematic tracking of patients , support for continuing the treatment , and taking action in the case of nonadherence or lack of improvement ( 14 ) . Collaborative depression care has generally yielded positive results in diverse primary care setting s ( 7 ) . The IMPACT ( Improving MoodPromoting Access to Collaborative Treatment ) trial found that care managers who were supervised by psychiatrists and who provided education and support for medication adherence reduced depression symptoms in older patients ( 15 ) . Dietrich and colleagues ( 16 ) found that telephone support , provided by a trained , central ly based mental health care manager who was supervised by a psychiatrist , improved depression symptoms . Dobscha and colleagues ( 17 ) evaluated a primary care decision-support team for depression ( comprising a psychiatrist and a mental health nurse ) and found improved care processes but no differences in depression symptoms ( 17 ) , possibly because of less intensive follow-up of patients . Small , isolated primary care setting s often have limited re sources ( 18 ) . In the United States , 26 % of primary care practice s are solo practice s or 2-person partnerships , in which extensive collaborative models would be difficult to implement , and 22 % are located in rural areas with limited access to mental health specialists ( 19 ) . Health care assistants are established professionals in primary care setting s. They have less training than U.S. physician assistants or nurse practitioners , who provide first-contact care , and need not be college graduates ( 20 ) . In Germany , health care assistants have 3 years of on-the-job training . They are mainly responsible for administrative tasks in general practice but provide basic clinical procedures ( 21 ) . Health care assistants are a potentially important re source for enhancing patient care in primary care setting s ( 20 ) . Our aim was to evaluate whether case management by a practice -based health care assistant can reduce depression symptoms and improve the process of care for patients with major depression in small primary care practice s. Methods We design ed a pragmatic , cluster r and omized , controlled trial that used practice as the unit of r and omization to avoid contamination ( 22 ) . The institutional review board of Goethe University Frankfurt am Main , Frankfurt am Main , Germany , approved the study protocol on 25 April 2005 ( 23 ) . We used written consent procedures for family physicians and patients . We recruited practice s between February 2005 and May 2005 and patients between May 2005 and July 2006 . We carried out the intervention between June 2005 and August 2007 . We completed the last follow-up for study patients in September 2007 . Setting and Participants After calculating the sample size ( 24 ) , we informed all 1600 
    Output:
    
This improvement on HRQoL was associated to interventions on " Case Management " and " Treatments and Procedures " , which were based on a theory , were of shorter duration , and had a follow-up period .
Interventions targeting people with chronic diseases result ed in a slight increase in the HRQoL that was not always significant , which suggests that there is a need for their continuous improvement