***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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    ***EXAMPLES*** 
    Input: BACKGROUND A r and omised trial was performed on patients presenting to hospital with an exacerbation of chronic obstructive pulmonary disease ( COPD ) to compare outcomes in those managed at home with  support  with those admitted to hospital in the st and ard manner . METHODS Over an 18 month period all patients presenting to the Royal Infirmary of Edinburgh on weekdays ( n=718 ) with a diagnosis of an exacerbation of COPD were assessed for inclusion in the trial . Patients with impaired level of consciousness , acute confusion , acute changes on radiography , or an arterial pH of < 7.35 or with other serious medical or social reasons for admission were excluded . Patients r and omised to home support were discharged with an appropriate treatment package ( antibiotics , corticosteroids , nebulised bronchodilators and , if necessary , home oxygen ) . They were visited by a nurse the following day and thereafter at intervals of 2 - 3 days until recovery when they were discharged from follow up . Parallel observations were made on patients allocated to normal hospital admission up to the point of discharge . Patients in both groups were assessed at home eight weeks after the initial assessment . RESULTS Among weekday patients 353 ( 50 % ) were considered obligatory admissions , 140 ( 19 % ) were admitted because of co-morbidity , 17 ( 2 % ) because of poor social circumstances , and 24 ( 3 % ) did not consent to the trial . The remaining 184 ( 26 % ) were r and omised ( 2:1 ) either to home support or to a st and ard hospital admission . The median time to discharge was 7 days for the home support group and 5 days for the admitted group ( p<0.01 ) ; 25 % of the home support group and 34 % of the admitted group were readmitted before the final assessment at eight weeks ( p>0.05 ) . There were no significant differences between the groups in attendances by GPs and carers or in health status measured eight weeks after the initial assessment . Satisfaction with the service was good . The mean total health service cost per patient was estimated as 877 pounds sterling for the home support group and 1753 pounds sterling for the admitted group . CONCLUSIONS This study shows that home supported discharge is a well tolerated , safe , and economic alternative to hospital admission for a proportion of patients referred to hospital for admission for an exacerbation of COPD The aim of the present prospect i ve multicentric study was to develop a simple rule for the prediction of poor outcome in patients presenting to emergency departments with initially non-life threatening-chronic obstructive pulmonary disease ( COPD ) exacerbations in a real-life setting . All patients with an acute exacerbation of COPD visiting the emergency departments of 103 hospitals during a 3-month period were included , except those who immediately required intensive care unit admission and /or ventilatory support .  The data collected included patient characteristics , in-hospital outcomes ( mortality and length of stay ) and mode of discharge ( unsupported or need for post-hospital assistance ) . The in-hospital mortality rate was 7.4 % ( 59 out of 794 ) . Independent prognostic factors were age , number of clinical signs of severity ( among cyanosis , impaired neurological status , lower limb oedema , asterixis and use of accessory inspiratory or expiratory muscles ) and dyspnoea grade in the stable state . The need for post-hospital support was also predicted by female sex . In order to construct and vali date a prediction score for mortality based on these items , patients were r and omly allocated to a derivation and a validation cohort . The prediction score showed good discrimination , with a c-statistic of 0.79 in the derivation cohort and 0.83 in the validation cohort . Thus simple purely clinical factors can reliably predict the risk of death and requirement for post-hospital support in an initially non-life threatening-acute exacerbation of chronic obstructive pulmonary disease . Their use needs to be prospect ively vali date Background Exacerbations of Chronic Obstructive Pulmonary Disease ( COPD ) are the main cause for hospitalisation . These hospitalisations result in a high pressure on hospital beds and high health care costs . Because of the increasing prevalence of COPD this will only become worse . Hospital at home is one of the alternatives that has been proved to be a safe alternative for hospitalisation in COPD . Most schemes are early assisted discharge schemes with specialised respiratory nurses providing care at home . Whether this type of service is cost-effective depends on the setting in which it is delivered and the way in which it is organised . Methods / Design GO AHEAD ( Assessment Of Going Home under Early Assisted Discharge ) is a 3-months , r and omised controlled , multi-centre clinical trial . Patients admitted to hospital for a COPD exacerbation are either discharged on the fourth day of admission and further treated at home , or receive usual inpatient hospital care . Home treatment is supervised by general nurses . Primary outcome is the effectiveness and cost effectiveness of an early assisted discharge intervention in comparison with  usual inpatient hospital care for patients hospitalised with a COPD exacerbation . Secondary outcomes include effects on quality of life , primary informal caregiver burden and patient and primary caregiver satisfaction . Additionally , a discrete choice experiment is performed to provide insight in patient and informal caregiver preferences for different treatment characteristics . Measurements are performed on the first day of admission and 3 days , 7 days , 1 month and 3 months thereafter . Ethical approval has been obtained and the study has been registered . Discussion This article describes the study protocol of the GO AHEAD study . Early assisted discharge could be an effective and cost-effective method to reduce length of hospital stay in the Netherl and s which is beneficial for patients and society . If effectiveness and cost-effectiveness can be proven , implementation in the Dutch health care system should be considered . Trial registration Netherl and s Trial Register NTR1129 BACKGROUND We have previously reported the use of a hospital based respiratory nurse service ( Acute Respiratory Assessment Service , ARAS ) to support home treatment of patients with exacerbations of chronic obstructive pulmonary disease ( COPD ) . A controlled trial was undertaken to compare early discharge with home treatment supported by respiratory nurses with conventional hospital management of patients admitted with exacerbations of COPD . METHODS Patients with COPD admitted as emergencies were identified the next working day . They were eligible for inclusion in the study if the differential diagnosis included an exacerbation of COPD , but were excluded if other medical conditions or acidotic respiratory failure required inpatient investigation or management . Of 360 patients review ed , 209 were being assessed for other active medical problems and were excluded , 33 potential participants were already involved in research studies and so were ineligible , and 37 did not wish to participate in the study . Eighty one patients were r and omised to receive conventional inpatient care ( n=40 ) or to planned early discharge the next working day  ( n=41 ) . Those discharged early continued treatment at home under the supervision of specialist respiratory nurses . Outcome measures were readmission , additional hospital days , and deaths within 60 days of initial admission . Process measures included number of visits , duration of follow up by the respiratory nurse , and additional treatment provided to support early discharge . RESULTS On an intention to treat basis , a policy of early discharge reduced inpatient stay from a mean of 6.1 ( range 1–13 ) days with conventional management to 3.2 ( 1–16 ) days with an early discharge policy . Twelve patients ( 30 % conventional management , 29.3 % early discharge ) were readmitted in each group giving a mean difference in readmission of 0.7 % ( 95 % CI of the difference –19.2 to 20.6 ) . In the conventional management group readmitted patients spent a mean of 8.75 additional days in hospital compared with 7.83 days in the early discharge group , giving a mean difference of 0.92 days ( 95 % CI of the difference –6.5 to 8.3 ) . There were two deaths ( 5 % ) in the conventional management group and one ( 2.4 % ) in the early discharge group , a mean difference of 2.6 % ( 95 % CI of the difference –5.7 to 10.8 ) . CONCLUSIONS Patients with acute exacerbations of COPD uncomplicated by acidotic respiratory failure or other medical problems can be discharged home earlier than is current practice with support by visiting respiratory nurses . No difference was found in the subsequent need for readmission 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 Objectives To determine the effectiveness of early assisted discharge for chronic obstructive pulmonary disease ( COPD ) exacerbations , with home care provided by generic community nurses , compared with usual hospital care . Design Prospect i ve , r and omised controlled and multicentre trial with 3-month follow-up . Setting Five hospitals and three home care organisations in the Netherl and s. Participants Patients admitted to the hospital with an exacerbation of COPD . Patients with no or limited improvement of respiratory symptoms and patients with severe unstable comorbidities , social problems or those unable to visit the toilet independently were excluded . Intervention Early discharge from hospital after 3 days inpatient treatment . Home visits by generic community nurses . Primary outcome measure was change in health status measured by the Clinical COPD Question naire ( CCQ ) . Treatment failures , readmissions , mortality and change in generic health-related quality of life ( HRQL ) were secondary outcome measures . Results 139 patients were r and omised . No difference between groups was found in change in CCQ score at day 7 ( difference in mean change 0.29 ( 95 % CI −0.03 to 0.61 ) ) or at 3 months ( difference in mean change 0.04 ( 95 % CI –0.40 to 0.49 ) ) . No difference was found in secondary outcomes . At day 7 there was a significant difference in change in generic HRQL , favouring usual hospital care . Conclusions While patients ’ disease-specific health status after 7-day treatment tended to be somewhat better in the usual hospital care group , the difference was small and not clinical ly relevant or statistically significant . After 3 months , the difference had disappeared . A significant difference in generic HRQL at the end of the treatment had disappeared after 3 months and there was no difference in treatment failures , readmissions or mortality .  Early assisted discharge with community nursing is feasible and an alternative to usual hospital care for selected patients with an acute COPD exacerbation . Trial registration : Netherl and sTrialRegister NTR 1129 BACKGROUND The study was conducted to investigate the safety of " hospital at home " versus hospital care . MATERIAL S AND METHODS It was a prospect i ve r and omised controlled trial . Patients with an exacerbation of chronic obstructive pulmonary disease ( COPD ) were included and r and omised  to  supported discharge  ( n = 22 ) or to  conventional in-patient care ( n = 22 ) . Outcome measures were readmissions , complications , mortality within 60 days of initial admission . RESULTS 390 patients ( COPD ) were admitted and 44 patients ( 12 % ) were included in the study . In the home treatment period 2 patients ( 9 % ) were readmitted . One patient ( 4.5 % ) died 2 weeks after discharge from the home treatment . In the follow-up period 3 patients in the home treated group were readmitted 7 times ( 31.8 % ) , and 7 patients in the conventional in-patient group were readmitted 9 times ( 40.9 % ) . There were 14 complications ( 63.6 % ) in the home treated group and 15 complications ( 68.3 % ) in the conventional in-patient group . The length of hospital stays in the supported discharged group were shorter ( 1.3 ( std = 0.5 ) versus 3.7 ( std = 2.8 ) days , p = 0.002 ) . After discharge a respiratory nurse visited supported discharged patients at home during 5.1 days ( min 
    Output:
    
Costs were lower for ESD/HAH than UC .
ESD/HAH is safe in selected patients with an AE COPD .