***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 : To determine whether locally developed guidelines on asthma and diabetes disseminated through practice based education improve quality of care in non-training , inner city general practice s. Design : R and omised controlled trial with each practice receiving one set of guidelines but providing data on the management of both conditions . Subjects:24 inner city , non-training general practice s. Setting : East London . Main outcome measures : Recording of key variables in patient records ( asthma : peak flow rate , review of inhaler technique , review of asthma symptoms , prophylaxis , occupation , and smoking habit ; diabetes : blood glucose concentration , glycaemic control , funduscopy , feet examination , weight , and smoking habit ) ; size of practice disease registers ; prescribing in asthma ; and use of structured consultation “ prompts . ” Results : In practice s receiving diabetes guidelines , significant improvements in recording were seen for all seven diabetes variables . Both groups of practice s showed improved recording of review of inhaler technique , smoking habit , and review of asthma symptoms . In practice s receiving asthma guidelines , further improvement was seen only in recording of review of inhaler technique and quality of prescribing in asthma . Sizes of disease registers were unchanged . The use of structured prompts was associated with improved recording of four of seven variables on diabetes and all six variables on asthma . Conclusions : Local guidelines disseminated via practice based education improve the management of diabetes and possibly of asthma in inner city , non-training practice s. The use of simple prompts may enhance this improvement New British guidelines on the treatment of asthma ( 9 ) advocate starting with a higher dose of inhaled corticosteroids in newly detected asthma patients . We investigated whether initiating inhaled steroid treatment with a higher dose is clinical ly more effective than a lower dose in steroid naive patients with asthma . The study had a 13-wk r and omized , double-blind , parallel design : 1-mo treatment with 400 microg budesonide twice a day , or 100 microg budesonide twice a day by dry powder inhaler , and follow-up treatment period of 2 mo with 200 microg budesonide once daily for all patients . Forty patients started with 400 microg budesonide twice daily , 44 with 100 microg budesonide twice daily . Mean age was 32 yr , baseline FEV1 value 84 % predicted , reversibility 9 % from baseline , and mean bronchodilator use 1.6 inhalations/d in the run-in period . After 4 wk of treatment with 400 microg and 100 microg budesonide twice daily mean morning peak expiratory flow ( PEF ) increased 27 L/min ( SD 50 ) , and 38 L/ min ( SD 53 ) , respectively ( p = 0.30 ) ; mean symptom score improved from 1.1 to 0.6 and from 1.1 to 0.5 . These effects were maintained in the 2 mo follow-up . This study suggests that starting inhaled corticosteroids at a higher dose is not superior to a lower dose in the treatment of newly detected asthma BACKGROUND We compared short-term prognosis of active compression-decompression ( ACD ) and st and ard ( STD ) cardiopulmonary resuscitation ( CPR ) in out-of-hospital cardiac arrests . METHODS AND RESULTS We r and omized advanced cardiac life support ( ACLS ) with ACD ACLS CPR on odd days and STD ACLS CPR  on even days . We measured the rates of return of spontaneous circulation ( ROSC ) , survival at 1 hour ( H1 ) , at 24 hours ( H24 ) , and at 1 month ( D30 ) : hospital discharge ( HD ) ; neurological outcome ; and complications . Mean times from collapse to basic cardiac life support CPR was 9 minutes and from collapse to ACLS CPR was 21 minutes . Compared with the STD ACLS patients ( n = 258 ) , ACD ACLS patients ( n = 254 ) had higher survival rates ( ROSC , 44.9 % versus 29.8 % , P = .0004 ; H1 , 36.6 % versus 24.8 % , P = .003 ; H24 , 26 % versus 13.6 % , P = .002 ; HD without neurological impairment , 5.5 % versus 1.9 % , P = .03 ) and a trend for improvement in neurological outcome at D30 ( Glasgow-Pittsburgh Outcome Categories = 1.6 + /- 0.8 versus 2.3 + /- 1.1 . P = .09 ) . Sternal dislodgements ( 2.9 % versus 0.4 % , P = .03 ) and hemoptysis ( 5.4 % versus 1.3 % , P = .01 ) were more frequent in the ACD ACLS group . CONCLUSIONS Despite long time intervals , ACD significantly improved short-term survival rates in out-of-hospital cardiac arrests compared with STD CPR OBJECTIVE To study the effect of a length of stay practice guideline on patient outcomes . DESIGN A prospect i ve , nonr and omized , interventional trial . SETTING Six geographically distributed hospitals . PATIENTS Two hundred forty-two consecutively hospitalized " low-risk " patients with pneumonia . MEASUREMENTS AND RESULTS One hundred fifty-two patients ( 63 % ) completed the mailed postdischarge survey  and were included in the analysis . Data were prospect ively collected for 85 patients from the baseline observation period ( B ) and 67 patients from the intervention period ( I ) . During the I , case managers provided physicians with patient risk information based on guideline recommendations . There was no significant change in guideline compliance ( B vs I : 76.5 % vs 83.6 % ; p=0.32 ) or length of stay ( B vs I : 3.5 days [ 95 % confidence interval , 3.2 to 3.8 ] vs 3.6 days [ 95 % confidence interval , 3.3 to 4.0 ] ) . Also , there were no statistically significant effects of the intervention on patient outcomes , care following hospital discharge , and patient satisfaction scores . CONCLUSION Patients in this study often had shorter lengths of stay than recommended by the practice guideline . This suggests that the external environment may have had a greater effect on physician behavior and length of stay than the practice guideline itself . Moreover , it demonstrates the importance of continuous assessment of physician practice s immediately prior to , during , and after application of the clinical practice guideline Guidelines on asthma management recommend that in patients who still have symptoms on treatment with low-dose inhaled corticosteroids the first step should be an increase in inhaled corticosteroid dose . The addition of long-acting inhaled beta 2-adrenoceptor agonists is another option . We have compared these two strategies in a r and omised , double-blind , parallel-group trial . We studied 429 adult asthmatic patients who still had symptoms despite maintenance treatment with 200 micrograms twice daily inhaled beclomethasone dipropionate ( BDP ) .  3 did not provide verifiable data . Of the others , 220 were assigned salmeterol xinafoate ( 50 micrograms twice daily ) plus BDP and 206 were assigned higher-dose BDP ( 500 micrograms twice daily ) for 6 months . The mean morning peak expiratory flow increased from baseline in both groups , but the increase was greater in the salmeterol/BDP group than in the higher-dose BDP group at all time points ( differences 16 - 21 L/min , p < 0.05 ) . Mean evening PEF also increased with salmeterol/BDP but not with higher-dose BDP . There were significant differences in favour of salmeterol/BDP in diurnal variation of PEF ( all time points ) and in use of rescue bronchodilator ( salbutamol ) and daytime and night-time symptoms ( some time points ) . There was no significant difference between the groups in adverse effects or exacerbations of asthma , indicating that in this group of patients regular beta 2-agonist therapy was not associated with any risk of deteriorating asthma control over 6 months . This study suggests a need for a flexible approach to asthma management BACKGROUND National and international guidelines recommend the use of inhaled antiinflammatory medications in patients with all but the mildest forms of asthma . Twice daily dosing may increase compliance with therapy . OBJECTIVE We sought to evaluate the safety and efficacy of 400 microg twice daily triamcinolone acetonide ( TAA ) compared with placebo in adult patients with mild-to-moderate asthma who were poorly controlled by beta2-agonist therapy . METHODS We performed a multicenter , r and omized , double-blind , placebo-controlled study , including a screening visit , a 7- to 21-day pretreatment baseline phase , and a 6-week double-blind treatment phase . Efficacy was measured by weekly spirometry and daily diary recordings of peak flow rates , asthma symptom scores , and albuterol use .  Eligible patients used albuterol four or more times per day , had total asthma symptom scores of 15 or greater ( possible total , 60 ) over 5 of 7 baseline days , and had FEV1 measurements of 60 % of predicted value or greater . RESULTS One hundred twenty-one patients were r and omized to treatment .  TAA was superior to placebo for all efficacy measures , with significant improvements in asthma symptoms , albuterol use , morning and evening peak flow rates , and forced vital capacity evident at Treatment Week 1 . Significant improvements in other pulmonary function measurements were observed after 2 or more weeks . All efficacy variables improved progressively throughout the study . CONCLUSIONS Twice daily TAA ( 400 microg ) decreased asthma symptoms and improved lung function in patients with mild-to-moderate asthma compared with placebo .  Therapeutic benefit was evident within 1 week and increased throughout treatment BACKGROUND In a previous study , we found that two years of treatment with an inhaled corticosteroid , budesonide , was more effective than treatment with an inhaled beta 2-agonist , terbutaline , in patients with newly diagnosed , generally mild asthma . We continued this study for a third year to investigate whether the steroid dose could be reduced or discontinued and what effect crossover of patients from beta 2-agonist therapy to corticosteroid therapy would have . METHODS A total of 37 patients treated for two years with inhaled budesonide at a dose of 1200 micrograms per day were r and omly assigned to treatment with 400 micrograms of budesonide per day ( 19 patients ) or placebo ( 18 patients ) in a double-blind manner . Another 37 patients , who had received terbutaline during the first two years , were crossed over in an open-label manner to treatment with 1200 micrograms of budesonide per day during the third year . RESULTS Treatment with the reduced dose of budesonide was sufficiently effective in 74 percent of the patients to maintain bronchial responsiveness at a level similar to that achieved with the higher dose . In contrast , improvement was maintained in only 33 percent of the patients receiving placebo , and the differences in pulmonary function between the steroid and placebo groups were significant ( for forced expiratory volume in one second , P = 0.007 ; for bronchial responsiveness to histamine , P = 0.025 ; and for peak expiratory flow in the morning , P = 0.040 ) . The condition of patients who were crossed over from terbutaline therapy to treatment with 1200 micrograms of budesonide per day improved . However , the degree of improvement in these patients appeared to be less than in those who were treated with budesonide at the beginning of the three-year study . CONCLUSIONS Early treatment with inhaled budesonide results in long-lasting control of mild asthma . Maintenance therapy can usually be given at a reduced dose , but discontinuation of treatment is often accompanied by exacerbation of the disease Abstract Objective : To compare outcomes between groups of patients with irreversible chronic airflow limitation given  theophylline  by n of 1 trials or st and ard practice . Design : R and omised controlled study of n of 1 trials versus st and ard practice . Setting : Tertiary care centre outpatient department . Subjects : 31 patients with irreversible chronic airflow limitation who were unsure that theophylline was helpful after an open trial . Interventions : n Of 1 trials ( single patient r and omised multiple crossover comparisons of theophylline against placebo ) followed published guidelines . For st and ard practice patients theophylline was stopped and resumed if their dyspnoea worsened ; if their dyspnoea then improved theophylline was continued . For both groups a decision to continue or stop the drug was made within three months of r and omisation . Main outcome measures : Exercise capacity as measured by six minute walking distance , quality of life as measured by the chronic respiratory disease question naire at baseline and six months after r and omisation , and proportions of patients taking theophylline at six months . Results : 26 patients completed follow up . 47 % fewer n of 1 trial patients than st and ard practice patients were taking theophylline at six months ( 5/14 versus 10/12 ; 95 % confidence interval of difference 14 % to 80 % ) without differences in exercise capacity or quality of life . Conclusions : n Of 1 trials led to less theophylline use without adverse effects on exercise capacity or quality of life in patients with irreversible chronic airflow limitation . These data directly support the presence of a clinical ly important bias towards unnecessary treatment during open prescription of theophylline 
    Output:
    
Pulmonary guidelines are increasingly published in peer- review ed journals , but few are tested clinical ly in RCTs .