***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 Background Asthma is a common disease that affects people of all ages and has significant morbidity and mortality . Poor outcomes and health disparities related to asthma result in part from the difficulty of disseminating new evidence and care delivery methods such as shared decision making ( SDM ) into clinical practice .This 3-year study explores the ideal framework for rapid dissemination of an evidence -based SDM toolkit for asthma management . The study leverages a partnership between the North Carolina ( NC ) statewide Medicaid network and the NC Network Consortium of practice -based research networks ( PBRNs ) . Methods / design This non-blinded study will r and omize 30 primary care clinics in NC stratified by four PBRNs . We will test dissemination across these practice s using a facilitator-led participatory approach to dissemination ( FLOW ) , a novel method of participatory dissemination involving key principles of community-based participatory research , and a more typical " lunch and learn " dissemination method . Specifically , we will use cluster r and omization to assign each of the 30 practice s to one of three arms : ( 1 ) control , no dissemination ; ( 2 ) traditional dissemination , one didactic session a year and distribution of educational material ; and ( 3 ) FLOW dissemination . We hypothesize that at the unit of r and omization , the clinic , patients in the FLOW dissemination arm will be more likely to share in their treatment decisions compared to patients in the traditional dissemination or control arms . All outcomes will be measured at the level of the clinic . Adoption of the SDM approach will be evaluated by 1 ) asthma exacerbations , 2 ) level of patient involvement in the decision making process , and 3 ) qualitative assessment s from patients and providers . The research question is : What dissemination strategy most effectively increases practice level adoption of a shared decision making approach to asthma management ? This study will provide important data to support best practice s in dissemination of an evidence -based toolkit and implementation of shared decision making into primary care practice s . Trial registration The trial was registered on January 27 , 2014 through the United States National Institutes of Health 's Clinical Trials.gov NCT02047929 and funded by the Patient-Centered Outcomes Research Institute ( PCORI ) OBJECTIVES This study was conducted to assess the impact of an interactive seminar based on self-regulation theory on 1 ) the treatment practice s and communications and education behavior of physicians , 2 ) the health status and medical care utilization of their pediatric patients with asthma , and 3 ) the satisfaction with care of the subjects ' parents . METHODS A total of 74 general practice pediatricians were assigned to either a program or a control group in a r and omized controlled study . Data were collected from physicians at baseline , and 69 ( 93 % ) provided follow-up data 5 months after the program . Data were also collected from 637 of their patients at baseline , and in a 22-month window after the intervention , 472 ( 74 % ) of this number provided follow-up data . RESULTS After the seminar , physicians in the program group were more likely than were control group physicians to address patients ' fears about medicines , review written instructions , provide a sequence of educational messages , write down how to adjust the medicines at home when symptoms change , and report that they spent less time with their patients . Parents of the children treated by program physicians were significantly more likely than were  control group parents to report that the physician had been reassuring , described as a goal that the child be fully active , and gave information to relieve specific worries . After a visit with the physician , these parents were also more likely to report that they knew how to make management decisions at home . After the intervention compared to controls , patients of physicians in the program group were more likely to have received a prescription for inhaled antiinflammatory medicine and to have been asked by the physician to demonstrate how to use a metered-dose inhaler . After the intervention , children seen by program physicians made significantly fewer nonemergency office visits and visits for follow-up of an episode of symptoms ; however , there were no differences in emergency department visits and hospitalizations . Among children who were placed on inhaled corticosteroids during this study , however , children treated by physicians who had received education had significantly fewer symptoms and fewer follow-up office visits , nonemergency physician office visits , emergency department visits , and hospitalizations . CONCLUSIONS The interactive seminar based on theories of self-regulation led to patient-physician encounters that were of shorter duration , had significant impact on the prescribing and communications behavior of physicians , led to more favorable patient responses to physicians ' actions , and led to reductions in health care utilization BACKGROUND We assessed the content of an intervention which integrates individual goals in outpatient clinic asthma management  ( based on self management principles ) of children 6 - 12 years of age . METHODS This is a content evaluation study and was part of a r and omized controlled multicenter trial with 9 months follow-up in five Dutch outpatient asthma clinics among children with asthma aged 6 - 12 years . Information on children 's individual problems and their level of impairment ( as indicated by the Pelican instrument ) , asthma management goals , and actions ( as indicated by written action plans ) was collected . Satisfaction of parents , children , and nurses were assessed with question naires and analyzed with descriptive statistics . RESULTS Most frequently identified problems by children ( n = 42 ) were " cough , " " cigarette smoke , " and " shortness of breath . " Eighty-two percent of items that were selected by children showed room for improvement . About 2 - 7 actions were formulated and children had an active role in more than 76 % of the actions . " Using rescue medication prior to activities/triggers , " and " talk to others about your asthma " were most frequently recommended . Children thought the Pelican instrument was easy ( 95 % ) and fun ( 65 % ) and both parents and nurses were positive about the incorporation of the program in asthma management . Following barriers were found : ( 1 ) only 25 % of goals was formulated according to SMART principles ; ( 2 ) traditional management aspects ( such as medication use ) are often treated instead of individual problems of children . CONCLUSION Implementation of patient-centered care based on the Pelican instrument is recommended in specialized care , although more extensive training of nurses in PCC will improve the successful execution of the evaluated treatment . Pediatr Pulmonol . 2016;51:993 - 1003 . © 2016 Wiley Periodicals , Older adults with asthma face numerous barriers to effective self-management and asthma control , and experience worse outcomes than younger asthmatics . Yet , there have been no controlled trials of interventions specifically design ed to improve their care and outcomes . Through a multi-stakeholder collaboration ( patients , academia , community-based organizations , a state department of health , and an advocacy organization ) we developed a multi-component asthma self-management support intervention to address the myriad psychosocial , functional , health status , and cognitive barriers to effective asthma self-management in adults ages 60 and older . We are recruiting 425 New Yorkers in Manhattan and the Bronx for a pragmatic r and omized controlled trial with 3 arms : the intervention delivered in primary care setting s or in their home , or usual care . In the intervention , care coaches use a novel screening tool to identify the specific barriers to asthma control and self-management they experience . Once identified , the coach and patient choose from a menu of actions to address it . The intervention emphasizes efficiency , flexibility , shared decision making and goal setting , communication strategies appropriate for individuals with limited cognition and literacy skills , and ongoing reinforcement and support . Additionally , we introduced asthma-specific enhancements to the electronic health records of all participating clinical practice s , including an asthma severity assessment , clinical decision support , and a patient-tailored asthma action plan . Patients will be followed for 12months and interviewed at baseline , 3 , 6 , and 12months and data on emergency department visits and hospitalizations will be obtained through the New York State Statewide Planning and Research Cooperative System Background Not providing adequate patient education interventions to asthma patients remains a major care gap . To help asthma patients and caregivers discuss inhaled controller medication use , our team has previously developed a decision aid ( DA ) . We sought to assess whether adding this DA to education interventions improved knowledge , decisional conflict , and asthma control among adults with asthma . Methods A parallel clinical trial ( NCT02516449 ) . We recruited adults with asthma , aged 18 to 65 years , prescribed inhaled controller medication to optimize asthma control . Educators r and omly allocated participants either to the education + DA or to the education group . At baseline and two-month follow-up , we measured asthma knowledge ( primary outcome ) with a vali date d self-administered question naire ( score –37 to + 37 ) . Secondary outcomes included decisional conflict and asthma control . Blinded assessors collected data . Between the two time points , the within- and between-group changes were estimated by generalized linear mixed models . Results Fifty-one participants ( response rate : 53 % ; age : 44 ± 13 years ; women : n = 32 ) were r and omized either to the education + DA group ( n = 26 ) or to the education group ( n = 25 ) , and included in statistical analyses . Between baseline and follow-up , mean [ 95 % CI ] knowledge scores increased from 21.5 [ 19.9–23.2 ] to 25.1 [ 23.1–27.0 ] in the education + DA group ( P = 0.0002 ) and from 24.0 [ 22.3–25.7 ] to 26.0 [ 24.0–28.0 ] in the education group ( P = 0.0298 ) . In both of the groups , decisional conflict and asthma control improved . There were no differences between groups . Conclusions Education improved knowledge , decisional conflict , and asthma control whether the DA was added or not Background Supporting self-management behaviours is recommended guidance for people with asthma . Preliminary work suggests that a brief , intensive , patient-centred intervention may be successful in supporting people with asthma to participate in life roles and activities they value . We seek to assess the feasibility of undertaking a cluster-r and omised controlled trial ( c RCT ) of a brief , goal - setting intervention delivered in the context of an asthma review consultation . Methods / design A two armed , single-blinded , multi-centre , cluster-r and omised controlled feasibility trial will be conducted in UK primary care . R and omisation will take place at the practice level . We aim to recruit a total of 80 primary care patients with active asthma from at least eight practice s across two health boards in Scotl and ( 10 patients per practice result ing in ~40 in each arm ) . Patients in the intervention arm will be asked to complete a novel goal - setting tool immediately prior to an asthma review consultation . This will be used to underpin a focussed discussion about their goals during the asthma review . A tailored management plan will then be negotiated to facilitate achieving their prioritised goals . Patients in the control arm will receive a usual care guideline -based review of asthma . Data on quality of life , asthma control and patient confidence will be collected from both arms at baseline and 3 and 6 months post-intervention . Data on health services re source use will be collected from all patient records 6 months pre- and post-intervention . Semi-structured interviews will be carried out with healthcare staff and a purposive sample of patients to elicit their views and experiences of the trial . The outcomes of interest in this feasibility trial are the ability to recruit patients and healthcare staff , the optimal method of delivering the intervention within routine clinical practice , and acceptability and perceived utility of the intervention among patients and staff . Trial registration IS RCT This r and omized clinical trial evaluated the long-term impact of an interactive seminar for physicians  based on principles of self-regulation on clinician behaviour , children 's use of health services for asthma , and parent 's views of physician performance . Seventy-four general practice paediatricians , and 637 of their asthma patients aged 1 - 12 yrs , were r and omized to treatment or control . Children and parents were blind to physicians 
    Output:
    
Individual studies demonstrated some benefits of SDM over control , in terms of quality of life ; patient and parent satisfaction ; adherence to prescribed medication ; reduction in asthma-related healthcare visits ; and improved asthma control .