***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: High re-attendance rates are common after asthma emergency department ( ED ) care . Inadequate patient education has been cited as a potential cause of re-attendance and the optimal format of education is uncertain . The present study aim ed to compare the effectiveness of patient-centred education ( PCE ) and st and ard asthma patient education on ED re-attendance . A r and omised controlled trial was conducted at two inner-city Australian teaching hospitals ’ EDs , where patients received either st and ard patient education ( SPE ) or PCE . Both groups received a six-topic curriculum . However , PCE patients reordered the topics according to their own priority and thus controlled the order of education . In total , 146 adult patients presenting to EDs with acute asthma were enrolled . After 4 months , ED re-attendance decreased from 22 to 12 % in the PCE group and remained unchanged in the SPE group ( between group odds ratio 0.4 , 95 % confidence interval ( 0.2–1.1 ) ) . In 78 patients discharged after ED care , the PCE group had fewer re-attendances after 4 and 12 months ( 0.3 ( 0.1–0.9 ) and 0.3 ( 0.1–0.8 ) , respectively ) . PCE patients with no general practitioner care in the preceding 7 days had fewer re-attendances after 4 and 12 months ( 0.1 ( 0.0–0.7 ) and 0.2 ( 0.0–0.6 ) , respectively ) . A trend of better asthma control was evident , with a reduction in activity limitation . In conclusion , patient-centred education offers promise as a brief education process in the emergency department . However , a large multicentre trial of patient-centred education is required STUDY OBJECTIVE We determined whether a simple emergency department intervention improves the likelihood of primary care provider ( PCP ) follow-up after ED discharge for an acute asthma exacerbation . METHODS This r and omized , controlled clinical trial was conducted in an urban university-based ED . Participants were patients with asthma between the ages of 16 and 45 years who were treated and discharged from the ED . The study intervention was usual care or an intervention that consisted of a free 5-day course of prednisone , vouchers for transportation to and from their PCP , and a 48-hour telephone reminder to make an appointment with their PCP . The main outcome was whether the patient received follow-up care as determined by PCP contact at 4 weeks . RESULTS One hundred ninety-two patients with asthma were enrolled over 8 months ; 178 ( 93 % ) had complete follow-up . The intervention and control groups were similar with regard to age , sex , ethnicity , or years of education . The 2 groups were also comparable with respect to multiple measures of baseline access/barriers to care and severity of ED exacerbation . Patients receiving the intervention were significantly more likely to follow up with their PCP than control patients ( relative risk 1.6 ; 95 % confidence interval [ CI ] 1.1 , 2.4 ) . When adjusted for other factors influencing PCP follow-up care ( ethnicity , prior PCP relationship , insurance status , regular car access ) , intervention patients were more likely to follow up with their PCP ( odds ratio 3.1 ; 95 % CI 1.5 , 6.3 ) . CONCLUSION Providing medication , transportation vouchers , and a telephone reminder to make an appointment increased the likelihood that discharged patients with asthma obtained PCP follow-up Background : There is still debate over the benefit of self-management programmes for adults with asthma . A brief self-management programme given during a hospital admission for acute asthma was tested to determine whether it would reduce readmission . Method : A r and omised controlled trial was performed in 280 adult patients with acute asthma admitted over 29 months . Patients on the self-management programme ( SMP ) received 40–60 minutes of education supporting a written self-management plan . Control patients received st and ard care ( SC ) . Results : One month after discharge SMP patients were more likely than SC patients to report no daytime wheeze ( OR 2.6 , 95 % CI 1.5 to 5.3 ) , no night disturbance ( OR 2.0 , 95 % CI 1.2 to 3.5 ) , and no activity limitation ( OR 1.5 , 95 % CI 0.9 to 2.7 ) . Over 12 months 17 % of SMP patients were re-admitted compared with 27 % of SC patients ( OR 0.5 , 95 % CI 0.3 to 1.0 ) . Among first admission patients , OR readmission ( SMP v SC ) was 0.2 ( 95 % CI 0.1 to 0.7 ) , p<0.01 . For patients with a previous admission , OR readmission was 0.8 ( 95 % CI 0.4 to 1.6 ) , p=0.6 . SMP patients were more likely than SC patients to be prescribed inhaled steroids at discharge ( 99 % v 92 % , p=0.03 ) , oral steroids ( 98 % v 90 % , p=0.06 ) , and to have hospital follow up ( 98 % v 84 % , p<0.01 ) but adjustment for these differences did not diminish the effect of the self-management programme . Conclusions : A brief self-management programme during hospital admission reduced post discharge morbidity and readmission for adult asthma patients . The benefit of the programme may have been greater for patients admitted for the first time . The programme also had a small but significant effect on medical management at discharge BACKGROUND The " credit card " asthma self-management plan provides the adult asthmatic patient with simple guidelines for the self-management of asthma , which are based on the self- assessment of peak expiratory flow rate recordings and symptoms . OBJECTIVE The study was a trial of the clinical efficacy of the credit card plan in a high-risk group of asthmatic patients . METHODS In this " before- and -after " trial , patients discharged from the emergency department of Wellington Hospital , after treatment for severe asthma were invited to attend a series of hospital outpatient clinics at which the credit card plan was introduced . Question naires were used to compare markers of asthma morbidity , requirement for emergency medical care , and medication use during the 6-month period before and after intervention with the credit card plan . RESULTS Of the 30 patients with asthma who attended the first outpatient clinic , 26 ( 17 women and 9 men ) completed the program . In these 26 participants , there was a reduction in both morbidity and requirement for acute medical services : specifically , the proportion waking with asthma more than once a week decreased from 65 % to 23 % ( p = 0.005 ) and the proportion visiting the emergency department for treatment of severe asthma decreased from 58 % to 15 % ( p = 0.004 ) . The patients attending the clinics commented favorably on the plan , in particular on its usefulness as an educational tool for monitoring and treating their asthma . CONCLUSIONS Although the interpretation of this study is limited by the lack of a r and omized control group , the findings are consistent with other evidence that the credit card asthma self-management plan can be an effective and acceptable system for improving asthma care in a high-risk group of adult patients with asthma A prospect i ve r and omised trial was performed to evaluate the effectiveness of an asthma education programme administered by an asthma nurse specialist in an out-patient setting . Sixty asthmatic patients ( mean age 28.5 years ) were enrolled , 30 to a  usual care control group and 30 to an  education group . The education group underwent an individual education programme lasting at least one hour . The following variables were measured at baseline , one month after the education programme and at one year follow-up : asthma knowledge by MCQ ( 36 point question naire ) , inhaler technique ( 7 point scale ) , peak expiratory flow rate ( PEFR ) and symptomatology by visual analogue score ( 0 to 10 score ) . The education group 's inhaler technique and MCQ score both improved significantly at one month , from 5.4 ( 0.3 ) ( mean [ SEM ] ) to 6.5 ( 0.3 ) , p < 0.001 , and from 7.5 ( 2.4 ) to 22 ( 1.8 ) , p < 0.0001 respectively . Both of these improvements were significantly greater than in the control group , and both were maintained at one year follow-up . The symptom score improved over one year in the education group , from 5.4 ( 0.6 ) to 7.6 ( 0.5 ) , p < 0.05 , and was unchanged in the control group . There was no change in the PEFR in either group . This study shows clear objective benefits to an out-patient asthma education programme conducted by an asthma nurse specialist The purpose was to compare the short-term cost-effectiveness of intensive vs conventional education and supervision for the self-management of mild asthmatic patients . Consecutive newly diagnosed asthmatic patients ( n = 162 ) were r and omized into an intervention group ( IG ) and a control group ( CG ) with 1 yr of treatment and follow-up . Intensive education was given to 77 patients at visits every third month in the outpatient clinic . Eighty CG patients received conventional education and advice at the baseline visit only . All patients received similar inhaled anti-inflammatory treatment . At baseline and at 12 months st and ard clinical lung functions and health-related quality of life ( HRQOL ) were measured , the latter by the disease-specific St George 's Respiratory Question naire and the generic 15D . Furthermore , the use of extra health care services , medication and sickness days were recorded . The IG experienced a significant improvement in all clinical and HRQOL outcome variables . The same applied to the CG except spirometric values . The groups differed significantly only in terms of FEV1 ( P < 0.05 ) in favour of the IG . There was a significant difference between the groups in extra costs . The mean cost was FIM 2351 per patient ( 294 Pounds sterling ) in the CG and FIM 2757 per patient ( 345 Pounds ) in the IG , of which the intervention cost was FIM 1978 per patient ( 247 Pounds ) . In 1 yr follow-up the intensive education programme did not prove to be cost effective but was dominated by the conventional one regardless of what effectiveness measure was used . Also , a purely monetary cost-benefit calculation showed that the intervention result ed in a negative net benefit ( loss ) of FIM 406 per patient ( 51 Pounds ) . A longer follow-up may be needed before definitive conclusions about the cost-effectiveness of this kind of intervention can be drawn BACKGROUND Despite improved underst and ing of the pathophysiology of asthma , morbidity and mortality continue to rise , with disproportionate increases occurring among urban , indigent minorities . New approaches in the management of asthma are therefore necessary to reverse these dramatic and costly trends . OBJECTIVE To determine if patients who are admitted to the hospital with acute asthma and receive inpatient education  will have improved outpatient follow-up and clinical outcome measures compared with those receiving conventional care . METHODS Patients enrolled in the study had a primary admission diagnosis of asthma and were between ages 18 and 45 years . Exclusion criteria included comorbid disease , inability to speak English , absence of a telephone in the primary residence , or pregnancy . Seventy-seven patients admitted from the emergency department with asthma were r and omized to either the inpatient educational program ( IEP ) or routine care ( control group ) . Patients in the IEP received asthma education , bedside spirometry , a telephone call 24 hours after discharge , and scheduled follow-up in an outpatient asthma program within 1 week of discharge . Those individuals r and omized to the routine management group received conventional inpatient asthma care and routine follow-up . RESULTS The patients enrolled in the IEP had a markedly higher follow-up rate compared with outpatient appointments ( 60 % vs. 27 % ; P = .01 ) and significantly fewer emergency department visits ( P = .04 ) and hospitalizations ( P = .04 ) for asthma in the 6 months following IEP intervention , as compared with control patients . This represented a substantial cost savings to the managed care organization . CONCLUSION Our study suggests that an IEP in the treatment of indigent , inner-city patients hospitalized with asthma reduces the need for subsequent emergent care and improves outpatient follow-up in a cost-effective manner OBJECTIVES To test the hypothesis that reinforcement of the advice given at the time of discharge from the emergency department by telephone consultation would improve asthma outcomes . METHODS A r and omized controlled trial of the parents of 310 children who had been discharged from the emergency department with asthma was undertaken . The parents were r and omized to receive either st and ard care ( 155 children ) or st and ard care plus education by telephone ( 155 children ) from a trained asthma educator . Symptoms , parental asthma knowledge , parental quality of life and use of asthma action plans and preventer therapy were collected at baseline and 6 months later . The primary measure was days of wheeze in last 3 months ; intermediate measures were regular use of preventer medications , possession and use of written asthma action plan , parental asthma knowledge scores and parental quality of life scores . RESULTS A total of 266 parents ( 136 intervention ) completed the follow-up question naires after 6 months . Both groups showed similar symptoms and process measures at baseline , apart from more regular use of preventer medication in the control children . At follow up , the intervention group children were significantly more likely than controls to possess ( 87.5 % vs 72.3 % ; P = 0.00 
    Output:
    
If data were restricted to emergency department treatment , education led to lower costs than control .
This review found that educational interventions applied in the emergency department reduce subsequent asthma admissions to hospital .
The interventions did not significantly reduce ED re-presentations ; while the trend in effect favours educational interventions , the pooled results were not statistically significant .
The impact of educational intervention in this context on longer term outcomes relating to asthma morbidity is unclear .