***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 
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    Input: OBJECTIVE To examine the effect of brief disease-specific education delivered in primary care on objective measures of knowledge in individuals recently diagnosed with chronic obstructive pulmonary disease ( COPD ) . METHODS A r and omized control trial was undertaken during which an experimental group received 2h of education delivered by a certified COPD educator and a control group received usual care . The Bristol COPD Knowledge Question naire ( BCKQ ) was self-administered at the time of r and omization and approximately three months later . RESULTS Of the 93 individuals that completed the study , 50 ( forced expiratory volume in 1s [FEV(1)]=60.0+/-14.3 % predicted ; 22 males ) and 43 ( FEV(1)=58.2+/-14.4 % predicted ; 20 males ) participants were r and omized to the experimental and control groups , respectively . The BCKQ increased from 27.6+/-8.7 to 36.5+/-7.7 points ( p<0.001 ) in the experimental group , which was greater than any seen in the control group ( between-group difference 8.3 , 95 % confidence interval 5.5 - 11.2 points ) . CONCLUSION As little as 2h of education delivered in primary care was effective at increasing objective measures of disease-specific knowledge . PRACTICE IMPLICATION S A program of brief education delivered in the primary care setting , represents an important approach for many individuals with COPD who are unlikely to access pulmonary rehabilitation The purpose of this study was to test the effectiveness of a taped relaxation message in reducing dyspnea and anxiety in chronic obstructive pulmonary disease ( COPD ) patients . Twenty-six adult COPD patients with dyspnea were r and omly assigned to two groups . The treatment group was taught relaxation using a prerecorded tape while the control group was instructed to sit quietly .  Skin temperature , heart rate , and respiratory rate were recorded for all subjects during a total of four weekly sessions . Anxiety , dyspnea , and airway obstruction were measured at the beginning and end of the study . The relaxation group achieved the preset relaxation criteria . Dyspnea , anxiety , and airway obstruction were induced in the relaxation group while the control group remained the same or became worse Objective To evaluate an entirely outpatient-based program of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease COPD , using St . George ’s Respiratory question naire ( SGRQ ) , the 6-minutes walking test ( 6-MWT ) and BODE index as the primary outcome measures . Methods A prospect i ve , parallel-group controlled study of an outpatient rehabilitation program in 80 patients with COPD ( 67 men and 13 women ; mean age 64.8 ± 10.6 years ; FEV1 , 42.8 % ± 7.6 % of the predicted value . The active group ( n = 40 ) took part in a 14-week rehabilitation program [ 3 h/wk , 1.5 h of education and exercise and 1.5 h of cycling ] . The control group ( n = 40 ) was review ed routinely as medical out patients . The following evaluations were carried out at study entry and after14 weeks : ( 1 ) pulmonary function studies ; ( 2 ) 6-minutes walking test 6MWT ; ( 3 ) quality of life ; and ( 4 ) BODE index . Results The following patients completed the study : 35 patients ( 87.5 % ) from the active group ( mean age , 63.7 ± 11.9 years ; mean forced expiratory volume in one second ( FEV1 ) , 41.9 ± 2.6 % of the predicted value ) ; and 36 patients ( 88 % ) from the control group ( mean age , 65.9 ± 10.3 years ; mean FEV1 , 43.33 ± 3.6 % of the predicted value ) . We found no changes in pulmonary function parameters in the active group and the control one at 14weeks . On the other h and , there were significant changes within the components of the SGRQ ( 12.3 for the score total ) for the patients of the active group but not for the patients of the control one ( only 1.5 for the score total ) , we observed also a significant increase in the distance of the 6-MWT in the patients of the active group but not for the patients of the control one , and finally a decrease of two points ( from 6 to 4 ) was noted in the score of the active group ’s BODE index without any change in the control group ’s one . Conclusion An outpatient-based of 14-week rehabilitation program  significantly improved the quality of life and exercise tolerance without any change in the pulmonary function in patients with moderate COPD , and there was also a large decrease in the risk of death in rehabilitated patients as measured using the BODE index 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 BACKGROUND Chronic obstructive pulmonary disease ( COPD ) affects 14 to 20 million Americans and is associated with increased prevalence of affective disorders , contributing significantly to disability . This study compared cognitive behavioral therapy ( CBT ) group treatment for anxiety and depression with COPD education for COPD patients with moderate-to-severe anxiety and /or depressive symptoms . METHOD A r and omized controlled trial ( RCT ) was conducted between 11 July 2002 and 30 April 2005 at the Michael E. DeBakey VA Medical Center , Houston , TX . Participants were 238 patients treated for COPD the year before , with forced expiratory value in 1 second (FEV)1/forced vital capacity (FVC)<70 % and FEV1<70 % predicted , and symptoms of moderate anxiety and /or moderate depression , who were being treated by a primary care provider or pulmonologist . Participants attended eight sessions of CBT or COPD education . Assessment s were at baseline , at 4 and 8 weeks , and 4 , 8 and 12 months . Primary outcomes were disease-specific and generic quality of life ( QoL ) [ Chronic Respiratory Question naire ( CRQ ) and Medical Outcomes Survey Short Form-36 ( SF-36 ) respectively ] . Secondary outcomes were anxiety [ Beck Anxiety Inventory ( BAI ) ] , depressive symptoms [ Beck Depression Inventory-II ( BDI-II ) ] , 6-minute walk distance ( 6MWD ) and use of health services . RESULTS Both treatments significantly improved QoL , anxiety and depression ( p<0.005 ) over 8 weeks ; the rate of change did not differ between groups . Improvements were maintained with no significant change during follow-up . Ratios of post- to pretreatment use of health services were equal to 1 for both groups . CONCLUSIONS CBT group treatment and COPD education can achieve sustainable improvements in QoL for COPD patients experiencing moderate-to-severe symptoms of depression or anxiety Aims : The main objective of this study was to investigate whether a comprehensive self-management programme , including self-treatment guidelines for exacerbations and a fitness programme , is an efficient treatment option for chronic obstructive pulmonary disease ( COPD ) patients . Method : We r and omly allocated 248 COPD patients to either self-management  ( 127 ) or usual care ( 121 ) . Data on preference-based utilities ( EuroQol-5D ) , health-related quality of life ( HRQoL ) , health-care re source use and productivity losses associated with exacerbations were prospect ively collected . Quality -adjusted life years ( QALYs ) were calculated . The economic analysis took the societal perspective and the observation period was one year . Results : As we observed that the groups were equally effective in terms of QALYs and HRQoL ( SGRQ ) , we described a cost minimization analysis only . The self-management programme-specific costs amounted to 6642 per patient . In the base-case cost analysis , the incremental cost difference amounted to 838 per patient per year in favour of usual care . When only direct medical costs were included , the incremental annual cost of self-managementrelative to usual care was 179 per person per year . If time costs for the fitness programme were set to zero , the costs for self-management diminished to 542 . Sensitivity analysis showed that these results were robust to changes in the underlying assumptions . Conclusion : We conclude that the COPE self-management programme is not an efficient treatment option for moderate to severe COPD patients who rate their HRQoL relatively high . The programme was twice as expensive as usual care and had no measurable beneficial effects on QALYs or Inhaled medication is important in the treatment of chronic obstructive pulmonary disease ( COPD ) . In this paper a comparison of the long-term efficacy of three instruction-models is presented . A total of 152 COPD - patients were r and omized into one of four groups : Personal- , video- , group-instruction and a control group . Inhalation technique was assessed by means of checklists , on which essential inhalation manoeuvres were identified . Up to 9 months later , 148 patients returned for follow-up assessment . Prior to instruction 61 % of patients in the control group had a perfect score on essential actions , compared to 62 , 65 and 53 % for those receiving group- , personal- and video-instruction respectively . At follow-up these percentages were 49 , 97 , 75 and 76 % . For group-(35 % ) and video-instruction ( 24 % ) the increase from baseline was significant . Examining the different inhalers under investigation , it is striking , that only 24 % of all patients with a Metered Dose Inhaler ( MDI ) performed all essential checklist items correctly , versus 96 % for those using a Diskhaler . The fact that for the MDI this percentage improved to 90 % post-instruction , shows that time spent on instruction , is time well spent . We conclude that group instruction seems superior to personal counselling , and equally effective or even better than video instruction . Personal instruction should not be dismissed and a combination with video instruction might prove to be effective as well It was postulated that home hospitalisation ( HH ) of selected chronic obstructive pulmonary disease ( COPD ) exacerbations admitted at the emergency room ( ER ) could facilitate a better outcome than conventional hospitalisation . To this end , 222 COPD patients ( 3.2 % female ; 71±10 yrs ( mean±sd ) ) were r and omly assigned to HH ( n=121 ) or conventional care ( n=101 ) . During HH , integrated care was delivered by a specialised nurse with the patient 's free-phone access to the nurse ensured for an 8‐week follow-up period . Mortality ( HH : 4.1 % ; controls : 6.9 % ) and hospital readmissions ( HH : 0.24±0.57 ; controls : 0.38±0.70 ) were similar in both groups . However , at the end of the follow-up period , HH patients showed : 1 ) a lower rate of ER visits ( 0.13±0.43 versus 0.31±0.62 ) ; and 2 ) a noticeable improvement of quality of life ( Δ St George 's Respiratory Question naire ( SGRQ ) , −6.9 versus −2.4 ) . Furthermore , a higher percentage of patients had a better knowledge of the disease ( 58 % versus 27 % ) , a better self-management of their condition ( 81 % versus 48 % ) , and the patient 's satisfaction was greater . The average overall direct cost per HH patient was 62 % of the costs of conventional care , essentially due to fewer days of inpatient hospitalisation ( 1.7±2.3 versus 4.2±4.1 days ) . A comprehensive home care intervention in selected chronic obstructive pulmonary disease exacerbations appears as cost effective . The home hospitalisation intervention  generates better outcomes at lower costs than conventional care Chronic obstructive pulmonary disease ( COPD ) is disabling , with symptoms such as chronic cough , phlegm , wheezing , shortness of breath and increased infections of the respiratory passage . The aim was to examine the effects of a structured educational intervention programme at a nurse-led primary health 
    Output:
    
Heterogeneity and wide variation in the content and the method of delivery of educational interventions were present .