***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: Abstract Objective This study evaluated the 6-week Chronic Disease Self-Management Program ( CDSMP )  in Hong Kong . Methods A total of 148 subjects with chronic illness were recruited . Subjects were matched on duration of illness and gender , and then r and omly allocated to experimental and comparison groups . The experimental group participated in the CDSMP , while the comparison group joined a Tai-Chi interest class in a mass-activity format . Subjects completed evaluation question naires before beginning their program and 1 week following the program . Results Analysis of covariance showed that the CDSMP participants demonstrated significantly higher self-efficacy in managing their illness , used more cognitive methods to manage pain and symptoms , and felt more energetic than the subjects in the comparison group . The CDSMP participants also demonstrated changes in their profile of coping strategies , having a tendency to adopt the cognitive methods of diverting attention , reinterpreting pain , ignoring sensations , and making positive self-statements . Conclusion The short-term evaluation results showed that the CDSMP primarily increased the self-efficacy , exercise behavior , and application of cognitive coping strategies of the participants . Practice Implication The effect of the CDSMP in a Chinese population is similar to that found in studies in Western cultures , and the CDSMP could be applied effectively in a Chinese population RATIONALE Bronchiectasis is a chronic debilitating disease with few evidence -based long-term treatments . OBJECTIVES A r and omized controlled trial assessing the efficacy of nebulized gentamicin therapy over 1 year in patients with non-cystic fibrosis bronchiectasis . METHODS Sixty-five patients were r and omized to either twice-daily nebulized gentamicin , 80 mg , or nebulized 0.9 % saline , for 12 months . All were review ed at three-monthly intervals during treatment and at 3 months ' follow-up . MEASUREMENTS AND MAIN RESULTS At each review the following were assessed : quantitative and qualitative sputum bacteriology ; sputum purulence and 24-hour volume ; FEV(1 ) , FVC , and forced expiratory flow , midexpiratory phase ; exercise capacity ; Leicester Cough Question naire and St. George 's Respiratory Question naire ; and exacerbation frequency .  Fifty-seven patients completed the study . At the end of 12 months ' treatment , compared with the saline group , in the gentamicin group there was reduced sputum bacterial density with 30.8 % eradication in those infected with Pseudomonas aeruginosa and 92.8 % eradication in those infected with other pathogens ; less sputum purulence ( 8.7 % vs. 38.5 % ; P < 0.0001 ) ; greater exercise capacity ( 510 [ 350 - 690 ] m vs. 415 [ 267.5 - 530 ] m ; P = 0.03 ) ; and fewer exacerbations ( 0 [ 0 - 1 ] vs. 1.5 [ 1 - 2 ] ; P < 0.0001 ) with increased time to first exacerbation ( 120 [ 87 - 161.5 ] d vs. 61.5 [ 20.7 - 122.7 ] d ; P = 0.02 ) . The gentamicin group had greater improvements in Leicester Cough Question naire ( 81.4 % vs. 20 % ; P < 0.01 ) and St. George 's Respiratory Question naire ( 87.5 % vs. 19.2 % ; P < 0.004 ) score . No differences were seen in 24-hour sputum volume , FEV(1 ) , FVC , or forced expiratory flow , midexpiratory phase . No P. aeruginosa isolates developed resistance to gentamicin . At follow-up , all outcome measures were similar to baseline . CONCLUSIONS Regular , long-term nebulized gentamicin is of significant benefit in non-cystic fibrosis bronchiectasis but treatment needs to be continuous for its ongoing efficacy . Clinical trial registered with www . clinical trials.gov ( NCT 00749866 ) The primary goals of long-term disease management in non-cystic fibrosis bronchiectasis ( NCFB ) are to reduce the number of exacerbations , and improve quality of life . However , currently no therapies are licensed for this . Ciprofloxacin Dry Powder for Inhalation ( Ciprofloxacin DPI ) has potential to be the first long-term intermittent therapy approved to reduce exacerbations in NCFB patients . The RESPIRE programme consists of two international phase III prospect i ve , parallel-group , r and omized , double-blinded , multicentre , placebo-controlled trials of the same design . Adult patients with idiopathic or post-infectious NCFB , a history of ≥2 exacerbations in the previous 12months , and positive sputum culture for one of seven pre-specified pathogens , undergo stratified r and omization 2:1 to receive twice-daily Ciprofloxacin DPI 32.5 mg or placebo using a pocket-sized inhaler in one of two regimens : 28days on/off treatment or 14days on/off treatment . The treatment period is 48weeks plus an 8-week follow-up after the last dose . The primary efficacy endpoints are time to first exacerbation after treatment initiation and frequency of exacerbations using a stringent definition of exacerbation . Secondary endpoints , including frequency of events using different exacerbation definitions , microbiology , quality of life and lung function will also be evaluated . The RESPIRE trials will determine the efficacy and safety of Ciprofloxacin DPI . The strict entry criteria and stratified r and omization , the inclusion of two treatment regimens and a stringent definition of exacerbation should clarify the patient population best positioned to benefit from long-term inhaled antibiotic therapy . Additionally RESPIRE will increase underst and ing of NCFB treatment and could lead to an important new therapy for sufferers . TRIAL REGISTRATION The RESPIRE trials are registered in Clinical Trials.gov , ID number NCT01764841 ( RESPIRE 1 ; date of registration January 8 , 2013 ) and NCT02106832 ( RESPIRE 2 ; date of registration April 4 , 2014 ) RATIONALE Chronic infection with Pseudomonas aeruginosa is associated with an increased exacerbation frequency , a more rapid decline in lung function , and increased mortality in patients with bronchiectasis . OBJECTIVES To perform a r and omized placebo-controlled study assessing the efficacy and safety of inhaled colistin in patients with bronchiectasis and chronic P. aeruginosa infection . METHODS Patients with bronchiectasis and chronic P. aeruginosa infection were enrolled within 21 days of completing a course of antipseudomonal antibiotics for an exacerbation . Participants were r and omized to receive colistin ( 1 million IU ; n = 73 ) or placebo ( 0.45 % saline ; n = 71 ) via the I-neb twice a day , for up to 6 months . MEASUREMENTS AND MAIN RESULTS The primary endpoint was time to exacerbation . Secondary endpoints included time to exacerbation based on adherence recorded by the I-neb , P. aeruginosa bacterial density , quality of life , and safety parameters . All analyses were on the intention-to-treat population . Median time ( 25 % quartile ) to exacerbation was 165 ( 42 ) versus 111 ( 52 ) days in the colistin and placebo groups , respectively ( P = 0.11 ) . In adherent patients ( adherence quartiles 2 - 4 ) , the median time to exacerbation was 168 ( 65 ) versus 103 ( 37 ) days in the colistin and placebo groups , respectively ( P = 0.038 ) . P. aeruginosa density was reduced after 4 ( P = 0.001 ) and 12 weeks ( P = 0.008 ) and the St. George 's Respiratory Question naire total score was improved after 26 weeks ( P = 0.006 ) in the colistin versus placebo patients , respectively . There were no safety concerns . CONCLUSIONS Although the primary endpoint was not reached , this study shows that inhaled colistin is a safe and effective treatment in adherent patients with bronchiectasis and chronic P. aeruginosa infection . Clinical trial registered with http://www.is rct n.org/ ( IS RCT N49790596 ) Background Non-cystic fibrosis bronchiectasis is characterised by sputum production , exercise limitation and recurrent infections . Although pulmonary rehabilitation is advocated for this patient group , its effects are unclear . The aims of this study are to determine the short and long term effects of pulmonary rehabilitation on exercise capacity , cough , quality of life and the incidence of acute pulmonary exacerbations . Methods / Design This r and omised controlled trial aims to recruit 64 patients with bronchiectasis from three tertiary institutions . Participants will be r and omly allocated to the intervention group ( supervised , twice weekly exercise training with regular review of airway clearance therapy ) or a control group ( twice weekly telephone support ) . Measurements will be taken at baseline , immediately following the intervention and at six and 12 months following the intervention period by a blinded assessor . Exercise capacity will be measured using the incremental shuttle walk test and the six-minute walk test . Quality of life and health status will be measured using the Chronic Respiratory Question naire , Leicester Cough Question naire , Assessment of Quality of Life Question naire and the Hospital Anxiety and Depression Scale . The rate of hospitalisation will be captured as well as the incidence of acute pulmonary exacerbations using a daily symptom diary . Discussion Results from this study will help to determine the efficacy of supervised twice-weekly pulmonary rehabilitation upon exercise capacity and quality of life in patients with bronchiectasis and will contribute to clinical practice guidelines for physiotherapists in the management of this population .Trial registration This study protocol is registered with Clinical Trials.gov ( NCT00885521 ) Background : Bronchiectasis is a chronic suppurative lung disease often characterised by airflow obstruction and hyperinflation , and leading to decreased exercise tolerance and reduced health status . The role of pulmonary rehabilitation ( PR ) and inspiratory muscle training ( IMT ) has not been investigated in this group of patients . Methods : Thirty two patients with idiopathic bronchiectasis were r and omly allocated to one of three groups : PR plus sham IMT ( PR-SHAM ) , PR plus targeted IMT ( PR-IMT ) , or control . All patients ( except the control group ) underwent an 8 week training programme of either PR or PR plus targeted IMT . Exercise training during PR was performed three times weekly at 80 % of the peak heart rate . IMT was performed at home for 15 minutes twice daily over the 8 week period . Results : PR-SHAM and PR-IMT result ed in significant increases in the incremental shuttle walking test of 96.7 metres ( 95 % confidence interval ( CI ) 59.6 to 133.7 ) and 124.5 metres ( 95 % CI 63.2 to 185.9 ) , respectively , and in endurance exercise capacity of 174.9 % ( 95 % CI 34.7 to 426.1 ) and 205.7 % ( 95 % CI 31.6 to 310.6 ) . There were no statistically significant differences in the improvements in exercise between the two groups . Significant improvements in inspiratory muscle strength were also observed both in the PR-IMT group ( 21.4 cm H2O increase , 95 % CI 9.3 to 33.4 ; p = 0.008 ) and the PR-SHAM group ( 12.0 cm H2O increase , 95 % CI 1.1 to 22.9 ; p = 0.04 ) , the magnitude of which were also similar ( p = 0.220 ) . Improvements in exercise capacity were maintained in the PR-IMT group 3 months after training , but not in the PR-SHAM group . Conclusion : PR is effective in improving exercise tolerance in bronchiectasis but there is no additional advantage of simultaneous IMT . IMT may , however , be important in the longevity of the training effects RATIONALE There are no risk stratification tools for morbidity and mortality in bronchiectasis . Identifying patients at risk of exacerbations , hospital admissions , and mortality is vital for future research . OBJECTIVES This study describes the derivation and validation of the Bronchiectasis Severity Index ( BSI ) . METHODS Derivation of the BSI used data from a prospect i ve cohort study ( Edinburgh , UK , 2008 - 2012 ) enrolling 608 patients .  Cox proportional hazard regression was used to identify independent predictors of mortality and hospitalization over 4-year follow-up . The score was vali date d in independent cohorts from Dundee , UK ( n = 218 ) ; Leuven , Belgium ( n = 253 ) ; Monza , Italy ( n = 105 ) ; and Newcastle , UK ( n = 126 ) . MEASUREMENTS AND MAIN RESULTS Independent predictors of future hospitalization were prior hospital admissions , Medical Research Council dyspnea score greater than or equal to 4 , FEV1 < 30 % predicted , Pseudomonas aeruginosa colonization , colonization with other path 
    Output:
    
For our secondary outcomes , there was no evidence of benefit in terms of frequency of hospital admissions or FEV1 L , based on very low- quality evidence .
All scales showed significant benefit from the intervention but effects were only sustained to study endpoint on the Managing Depression scale .
AUTHORS ' CONCLUSIONS There is insufficient evidence to determine whether self-management interventions benefit people with bronchiectasis .