***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: Pulmonary rehabilitation is beneficial for patients with chronic lung disease . However , long-term maintenance has been difficult to achieve after short-term treatment . We evaluated a telephone-based maintenance program after pulmonary rehabilitation in 172 patients with chronic lung disease recruited from pulmonary rehabilitation graduates . Subjects were r and omly assigned to a 12-month maintenance intervention with weekly telephone contacts and monthly supervised reinforcement sessions ( n = 87 ) or st and ard care ( n = 85 ) and followed for 24 months . Except for a slight imbalance between sexes , experimental and control groups were equivalent at baseline and showed similar improvements after rehabilitation . During the 12-month intervention , exercise tolerance ( maximum treadmill workload and 6-minute walk distance ) and overall health status ratings were better maintained in the experimental group together with a reduction in hospital days . There were no group differences for other measures of pulmonary function , dyspnea , self-efficacy , generic and disease-specific quality of life , and health care use . By 24 months , there were no significant group differences . Patients returned to levels close to but above prerehabilitation measures . We conclude that a maintenance program of weekly telephone calls and monthly supervised sessions produced only modest improvements in the maintenance of benefits after pulmonary rehabilitation Background Dyspnea ( SOB ) , dyspnea-related anxiety ( DA ) , and exercise performance have been shown to improve after  exercise training in patients with Chronic Obstructive Pulmonary Disease ( COPD ) . However , there are no published descriptions of the changes in dyspnea intensity or dyspnea-related anxiety during or across the exercise training sessions . Objectives To describe and compare the differences in the patterns of change in SOB , DA , and exercise performance during 12 exercise training sessions with and without nurse coaching . Methods Forty-five dyspnea-limited patients with COPD were r and omly assigned to nurse-monitored ( ME ) or nurse-coached exercise ( CE ) .  SOB and DA were rated on a 200 mm VAS every 2 minutes during each of 12 treadmill training sessions . Results Warm-up , peak , cool-down , mean SOB , and peak SOB/stage remained constant over the exercise sessions , with increasing exercise performance for both groups over the 12 sessions ( p < .001 ) . There was a significant difference in the pattern of mean SOB over time between the ME and CE group ( p < . 05 ) . Mean , peak DA , and peak DA/stage showed a rapid decrease within the first 4 sessions ( p < . 05 ) with no significant differences between the groups . Warm-up and cool-down DA remained constant . There were large intra- and inter-subject variations in the rating of dyspnea and dyspnea-related anxiety within and across sessions . Conclusions As theoretically proposed , both groups significantly decreased their DA over the training sessions . This decrease was early in the sessions and was not accompanied by a decrease in the SOB . In contrast , subjects maintained a nearly constant mean and peak SOB with increasing exercise performance , suggesting that people may have a dyspnea threshold above which they are unable to tolerate greater dyspnea . Description of the changes in dyspnea and the affective response during training need to be exp and ed , while study ing the type and timing of strategies to enhance the improvement in dyspnea and dyspnea-related anxiety 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 care clinic ( PHCC ) on quality of life ( QoL ) , knowledge about COPD and smoking cessation in patients with COPD . This study had an experimental design in which 52 patients with COPD from a Swedish primary care setting were r and omized into two groups ( intervention or control ) . Both groups received st and ard care but patients in the intervention group were also offered two visits to a nurse specialized in COPD care . The purpose of the visits was to increase the patients ' self-care ability and their knowledge about COPD . The study was approved by the local Research Ethics Committee . Data were collected using two question naires , one pertaining to knowledge about COPD and smoking habits and St. George 's Respiratory Question naire , addressing how QoL was affected by the patients ' respiratory symptoms . The intervention and control groups answered both question naires on their first and last visits to the PHCC . A statistically significant increase was noted in the intervention group on QoL , the number of patients who stopped smoking and patients ' knowledge about COPD at the follow-up , 3 - 5 months after intervention . However , a confounding factor may have been that one of the research ers ( Eva Osterlund Efr aims son ) , as a nurse in the PHCC , performed the intervention . This implies that patients were in a dependent relationship which may have affected the responses in a favourable direction . Our findings show that conventional care alone did not have an effect on patients ' QoL and smoking habits . Instead , the evidence suggests that a structured programme with self-care education is needed to motivate patients for life-style changes Objectives : To determine the effects of a nurse led intermediate care programme in patients who have been hospitalised with an acute exacerbation of chronic obstructive pulmonary disease ( AE COPD ) . Design : R and omised controlled trial . Setting : Community and hospital care in west London . Participants : 122 patients with COPD . Intervention : A care package incorporating initial pulmonary rehabilitation and self-management education , provision of a written , personalised COPD action plan , monthly telephone calls and 3 monthly home visits by a specialist nurse for a period of 2 years . Main outcome measure : Hospital readmission rate . Secondary outcomes : Unscheduled primary care consultations and quality of life . Results : There were no differences in hospital admission rates or in exacerbation rates between the two groups . Self-management of exacerbations was significantly different and the intervention group were more likely to be treated with oral steroids alone or oral steroids and antibiotics , and the initiators of treatment for exacerbations were statistically more likely to be the patients themselves . 12 patients in the control group died during the 2 year period , eight as a result of COPD , compared with six patients in the intervention group , of whom one died from COPD . This is a significant difference . When the numbers were adjusted to reflect the numbers still alive at 2 years , in the intervention group patients reported a total of 171 unscheduled contacts with their general practitioner ( GP ) and in the control group , 280 contacts . The number needed to treat was 0.558—ie , for every one COPD patient receiving the intervention and self-management advice , there were 1.79 fewer unscheduled contacts with the GP . Conclusions : An intermediate care package incorporating pulmonary rehabilitation , self-management education and the receipt of a written COPD action plan , together with regular nurse contact , is associated with a reduced need for unscheduled primary care consultations and a reduction in deaths due to COPD but did not affect the hospital readmission rate 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 Objective To assess the long term effects of two different modes of disease management ( comprehensive self management and routine monitoring ) on quality of life ( primary objective ) , frequency and patients ’ management of exacerbations , and self efficacy ( secondary objectives ) in patients with chronic obstructive pulmonary disease ( COPD ) in general practice . Design 24 month , multicentre , investigator blinded , three arm , pragmatic , r and omised controlled trial . Setting 15 general practice s in the eastern part of the Netherl and s. Participants Patients with COPD confirmed by spirometry and treated in general practice . Patients with very severe COPD or treated by a respiratory physician were excluded . Interventions A comprehensive self management programme as an adjunct to usual care , consisting of four tailored sessions with ongoing telephone support by a practice nurse ; routine monitoring as an adjunct to usual care , consisting of 2 - 4 structured consultations a year with a practice nurse ; or usual care alone ( contacts with the general practitioner at the patients ’ own initiative ) . Outcome measures The primary outcome was the change in COPD specific quality of life at 24 months as measured with the chronic respiratory question naire total score . Secondary outcomes were chronic respiratory question naire domain scores , frequency and patients ’ management of exacerbations measured with the Nijmegen telephonic exacerbation assessment system , and self efficacy measured with the COPD self-efficacy scale . Results 165 patients were allocated to self management ( n=55 ) , routine monitoring ( n=55 ) , or usual care alone ( n=55 ) . At 24 months , adjusted treatment differences between the three groups in mean chronic respiratory question naire total score were not significant . Secondary outcomes did not differ , except for exacerbation management . Compared with usual care , more exacerbations in the self management group were managed with bronchodilators ( odds ratio 2.81 , 95 % confidence interval 1.16 to 6.82 ) and with prednisolone , antibiotics , or both ( 3.98 , 1.10 to 15.58 ) . Conclusions Comprehensive self management or routine monitoring did not show long term benefits in terms of quality of life or self efficacy over usual care alone in COPD patients in general practice . Patients in the self management group seemed to be more capable of appropriately managing exacerbations than did those in the usual care group . Trial registration Clinical trials NCT00128765 AIMS AND OBJECTIVES To test the effect of a Health Belief Model-based nursing intervention on healthcare outcomes in Chinese patients with moderate to severe COPD . BACKGROUND The Health Belief Model ( HBM ) has been internationally vali date d in a variety of chronic conditions . However , nursing intervention based on the HBM is less explored in Chinese patients with COPD . DESIGN A r and omised controlled trial . METHODS Enrolled patients were r and omly assigned to the intervention and control groups . Patients in the intervention group received a 20- to 30-minute HBM-based nursing intervention every 2 days during the hospitalisation period after disease conditions were stable , with additional follow-ups after discharge . Patients in the control group received routine nursing care . RESULTS Patients had significantly increased scores of health belief and self-efficacy after receiving the HBM-based nursing intervention . After receiving the 3-month follow-up , patients in the intervention group had significantly higher mean total scores in the Health Belief Scale and the COPD Self-Efficacy Scale , as well as in all the subscales , than those in the control group except the perceived disease seriousness . Results showed that the value of FEV1 /FVC ratio had a significant difference between study groups before and after the intervention . Results also indicated that mean scores of the Dyspnea Scale , 6-minute walking distance and ADL were significantly different between the groups and between the study time-points . CONCLUSIONS Among patients with moderate to severe COPD  , nursing intervention based on the HBM can enhance their health belief and self-efficacy towards the disease management , decrease dyspnoea and improve exercise tolerance and ADL . RELEVANCE TO CLINICAL PRACTICE Nurses can use the HBM-based intervention to enhance patients ' health belief and self-efficacy towards the management of COPD , and subsequently benefit healthcare outcomes Background Breathing programs have been reported to have positive effects in alleviating symptoms and optimizing pulmonary function in patients with chronic obstructive pulmonary disease ( COPD ) . However , patients with stable disease may drop out of such programs if they are not modified to the individual ’s exercise tolerance level , or if they are not easy to perform in the home . Little is known about the effectiveness of web-based home breathing programs for dyspnea . The purpose of this study was to evaluate the effectiveness of an online breathing program which included an animated diagram and video-guided instruction on pulmonary function , exercise capacity , and health-related quality 
    Output:
    
The results are equivocal as to whether nursing interventions performed at home and nursing interventions performed in hospital with follow-up improve breathlessness in people with chronic obstructive pulmonary disease