***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: One hundred patients ( aged 48 to 89 ) with chronic obstructive pulmonary disease were allocated to receive either " personalized hospital practice " ( PHP ) , which includes training in aspects of their disease , or st and ard hospital practice . Changes in " consumption " of health services per patient from one year before until one year after the intervention admission were evaluated in 82 ( PHP group 42 , controls 40 ) . The increase in consumption of health services after intervention was on average kr 15.298 per patient per year less in the PHP group than in the control group ( p = 0.048 ) . Consumption of general practitioner services was significantly increased in the control group compared with the PHP group ( mean 95 % confidence limits ) kr 1346 ( 549 - 2143 ) versus -89 ( -423 - 245 ) per patient per year , p = 0.001 ) . PHP reduces the consumption of health services by patients with chronic obstructive pulmonary disease , probably by increasing patients knowledge of disease and their ability to manage themselves On the basis of the beneficial health effects of self-management in the treatment of other chronic diseases like asthma it might be expected that the active participation of COPD - patients in the management of their disease may reduce the burden of the disease .  Self-management of COPD includes sufficient coping behaviour , compliance with inhaled medication , attention to changes in the severity of the disease , adequate inhalation technique , and self adjustment of the medication in case of exacerbations . The results of a pilot study on the effects of self-management in COPD suggest a reduction of morbidity due to COPD . The definite place of self-management in the treatment of COPD has to established by larger , prospect i ve , controlled trials This study tested the hypothesis that severity of respiratory disability may affect the outcome of pulmonary rehabilitation . In this r and omized , controlled study , 126 patients with chronic obstructive pulmonary disease ( COPD ) were stratified for dyspnoea using the Medical Research Council ( MRC ) dyspnoea score into MRC3/4 ( Moderate ) ( n=66 ) and MRC 5 ( Severe ) dyspnoeic ( n=60 ) groups . The patients were r and omly assigned to an eight week programme of either exercise plus education ( Exercise group ) or education ( Control group ) . Education and exercise programmes for the moderately dyspnoeic patients were carried out in a hospital outpatient setting . Severely dyspnoeic patients were all treated at home . Those in the Exercise group received an individualized training programme . There was a significant improvement in shuttle walking distance in the moderate dyspnoeic group , who received exercise training ; baseline ( mean+/-SEM ) 191+/-22 m , post-rehabilitation 279+/-22 m ( p<0.001 ) . There was no improvement in exercise performance in the severely dyspnoeic patients receiving exercise . Neither group of control patients improved . Health status , assessed by the Total Chronic Respiratory Disease Question naire score , increased in the moderately dyspnoeic patients receiving exercise from 80+/-18 to 95+/-17 ( p<0.0001 ) after rehabilitation . Much smaller changes were seen in the other three groups . Improvement in exercise performance and health status in patients with chronic obstructive pulmonary disease after an exercise programme depends on the initial degree of dyspnoea R and omly assigned 119 adults with chronic obstructive pulmonary disease to an 8-week comprehensive rehabilitation program or to an 8-week education control program . Comprehensive pulmonary rehabilitation included education , physical and respiratory therapy instruction , psychosocial support , and supervised exercise training ; education control included biweekly classroom instruction and discussion s on respiratory therapy , medical aspects of lung disease , clinical pharmacology , and diet , but no exercise training . Both groups received extensive physiological and psychosocial evaluation before and after the intervention . Six months after enrollment , patients r and omly assigned to the rehabilitation program showed significant increases in exercise endurance , whereas patients r and omly assigned to control program showed nonsignificant increases . Improvement in self-efficacy was correlated with improvements in exercise endurance This study assessed the long-term efficacy of adding self-treatment guidelines to a self-management programme for adults with asthma . In this prospect i ve r and omized controlled trial , 245 patients with stable , moderate to severe asthma were included . They were r and omized into a self-treatment group ( group S ) and a control group ( group C ) . Both groups received self-management education . Additionally , group S received self-treatment guidelines based on peak expiratory flow ( PEF ) and symptoms . Outcome parameters included : asthma symptoms , quality of life , pulmonary function , and exacerbation rate . The 2-yr study was completed by 174 patients . Both groups showed an improvement in the quality of life of 7 % . PEF variability decreased by 32 % and 29 % , and the number of outpatient visits by 25 % and 18 % in groups S and C , respectively . No significant differences in these parameters were found between the two groups . After 1 yr , patients in both groups perceived better control of asthma and had more self-confidence regarding their asthma . The latter improvements were significantly greater in group S as compared to group C. There were no other differences in outcome parameters between the groups . Individual self-treatment guidelines for exacerbations on top of a general self-management programme does not seem to be of additional benefit in terms of improvements in the clinical outcome of asthma . However , patients in the self-treatment group had better scores in subjective outcome measures such as perceived control of asthma and self-confidence than patients in the control group Seventy five patients with chronic respiratory disability were r and omised to a group visited by a respiratory health worker ( 42 ) or control group  ( 33 ) . The first group was visited monthly by a respiratory nurse , who gave education and support . The effect of the intervention was assessed in terms of quality of life ( by question naires ) , the number and duration of admissions to hospital , and the number of deaths . The question naires on quality of life showed no changes in either group during the study , but nearly all of the group visited by a respiratory health worker said that they valued the visits and wished them to continue . Their knowledge about their condition also improved compared with that of the controls . The duration of stay in hospital for respiratory reasons in the group visited by a respiratory health worker was longer than that of control patients . This was explained by their being scored as more ill than the controls on admission . Fewer patients died in the group visited by a respiratory health worker than in the control group ( p = 0.11 ) . The patients in the group visited by respiratory health workers may have survived longer because they sought help rather than dying at home . If confirmed this could have implication s for the cost of their care By instructing patients in how to deal with their disease financial dem and s on health services may be reduced . 100 consecutive patients ( aged 48 to 89 ) admitted to a general medical ward in Denmark with chronic obstructive pulmonary disease ( COPD ) were allocated r and omly to receive either " personalized hospital practice " ( PHP ) , which includes training in aspects of their disease , or st and ard hospital practice .  Changes in " consumption " of health services per patient from 1 year before until 1 year after the intervention admission were evaluated in 82 ( PHP group 42 , controls 40 ) patients who completed the intervention phase . Each group contained about the same percentage of asthmatics and smokers . The increase in consumption of health services after intervention was on average Kr15,298 per patient per year less in the PHP group than in the control group ( p = 0.048 , Wilcoxon test ) . Consumption of general practitioner services was significantly increased in the control group compared with the PHP group ( mean [ 95 % Cl ] Kr1346 [ 549 to 2143 ] vs -89 [ -423 to 245 ] per patient per year ; p = 0.001 , Wilcoxon test ) . These differences could not be explained by changes in smoking habits .  PHP reduces the consumption of health services by patients with COPD , probably by increasing patients ' knowledge of disease and hence their ability to manage themselves This study compared the effects on self-efficacy of participation by patients with chronic obstructive pulmonary disease ( COPD ) in a pulmonary rehabilitation program that combined education and supervised exercise training with the results demonstrated by participation in a program that provided education alone .  Thirty-seven patients participated in the pulmonary rehabilitation program , and 22 patients participated in the education-only program .  Self-efficacy , as it effects managing or avoiding breathing difficulty , was measured before and after the programs . Patients ' self-efficacy scores significantly improved after the pulmonary rehabilitation program and remained significantly improved 6 months later . Education alone was also effective in significantly improving self-efficacy scores , but patients ' scores 6 months later were not significantly better than preprogram scores . This study indicates that a rehabilitation program that combines education and exercise training is more effective in improving long-term self-efficacy in patients with COPD We hypothesized that the use of an Action Plan might assist self-management for patients with chronic obstructive pulmonary disease ( COPD ) . A pilot process and r and omized , controlled study were undertaken to evaluate an Action Plan that provided advice on management of usual care and exacerbations , together with a booklet on self-management . Fifty six subjects with COPD recruited through general practitioners ( GPs ) completed the 6 month study , 27 in the control group and 29 in the intervention group . The control group received usual care from their GP , and the intervention group received a booklet and Action Plan from their practice nurse plus a supply of prednisone and antibiotic from their GP . The two groups were demographically similar with a mean age of 68 yrs . The re sources were well received by GPs , practice nurses and intervention group subjects . After 6 months , there were no differences in quality of life scores or pulmonary function . There were significant changes in self-management behaviour in the intervention group compared to controls . In response to deteriorating symptoms , 34 versus 7 % ( p=0.014 ) initiated prednisone treatment and 44 versus 7 % ( p=0.002 ) initiated antibiotics . Subjects in the intervention group readily adopted self-management skills but did not show any difference in quality of life or lung function parameters . A larger , prospect i ve , controlled , clinical trial of this approach is warranted The chronic obstructive pulmonary diseases are major causes of disability and death [ 1 - 3 ] . Health statistics underestimate the prevalence of these diseases because of difficulties in definition and recognition and because of misclassification [ 4 ] . Although st and ard medical therapy can alleviate symptoms , many patients with these diseases must cope with the distressing symptom of breathlessness that results from a chronic , irreversible , and disabling disease . These patients may use services in physician offices , emergency departments , hospitals , and intensive care units , in part because of a lack of underst and ing and inability to cope with frightening and disabling symptoms . Since a comprehensive care program for patients with chronic obstructive pulmonary disease was first described [ 5 ] , pulmonary rehabilitation has become an established way to enhance st and ard therapy to control symptoms , optimize functional capacity , and reduce the medical and economic burdens of patients with disabling chronic lung diseases [ 6 - 12 ] . Comprehensive programs usually include education , instruction in respiratory and chest physiotherapy techniques , psychosocial support , and exercise training [ 13 ] . The primary goal of rehabilitation is to restore the patient to the highest possible level of independent function . This is accomplished by helping patients to become more knowledgeable about their disease , more actively involved in their own health care , more independent in performing daily activities , and less dependent on others , including health professionals . Previous studies have shown important benefits of pulmonary rehabilitation , including increased exercise tolerance and quality of life and a decreased number of symptoms and use of health care services [ 7 ] . However , many of these findings are based on small numbers of patients and on observational , nonr and omized studies . We compared the effects of comprehensive pulmonary rehabilitation on both physiologic and psychosocial outcomes with the effects of education alone . Our study featured r and om assignment and long-term , 6-year follow-up . Methods Patients For 18 months , 352 patients with chronic obstructive pulmonary disease were screened for the study ; 128 met entry criteria and were r and omly assigned to either the comprehensive pulmonary rehabilitation program or an education program ( control group ) . Patients were recruited through mechanisms similar to those used in regular clinical pulmonary rehabilitation , including written and personal contact with physicians and direct advertisement to the general public for persons with breathlessness . Nine patients who initially agreed to participate ( 6 in the rehabilitation group and 3 in the education group ) but who withdrew from the study before completing 2 weeks of the interventions were considered to be pretreatment drop-outs . Reasons for dropping out included concurrent illness ( four patients ) , a too-large time commitment ( 2 patients ) , and no clear explanation ( 3 patients ) . Patients who dropped out and those who remained in the study did not differ . The remaining 119 patients comprised 32 women and 87 men . The following were the inclusion criteria : 1 . Clinical diagnosis of mild to severe chronic obstructive pulmonary disease that was confirmed by history , physical examination , spirometry , measurement of arterial blood gases , and chest roentgenograms . Patients with diagnoses of emphysema , chronic bronchitis , or asthmatic bronchitis were accepted . Patients with primarily acute , reversible airway disease ( asthma ) but no chronic airflow obstruction were excluded . 2 . Stable condition while the patient was receiving an acceptable medical regimen and was under the care of a primary care provider . Patients without a primary care physician who presented for evaluation were 
    Output:
    
The studies showed no effect of  self-management education  on hospital admissions , emergency room visits , days lost from work and lung function .
Inconclusive results were observed on health-related quality of life ( HRQoL ) : studies using the disease specific SGRQ showed a better quality of life in the patients in the intervention group , but only in the activity component where there was heterogeneity between the results of the two included studies .
A potential reason for the absence of convincing effects on HRQoL is the limited use of COPD -specific instruments .
Inconclusive results were observed on COPD -symptoms and use of other health care re sources such as doctor and nurse visits .
Self-management education reduced the need for rescue medication , and led to an increased use of courses of oral steroids and antibiotics for respiratory symptoms .