human
***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: BACKGROUND There is some evidence that quality of life ( QOL ) in patients with chronic obstructive pulmonary disease ( COPD ) may predict clinical outcomes and use of re sources . This study examined whether QOL scores could prospect ively predict re-admission for COPD or death within 12 months of an original admission , and whether QOL scores predicted home nebuliser provision . METHODS The study was carried out in all acute medical wards of Aberdeen Royal Infirmary , Woodend and City Hospitals , Aberdeen over 12 months . A total of 377 patients admitted with an exacerbation of COPD were identified in this time , 111 of whom were not included in the study because they refused the interview or died before discharge . The remaining 266 patients completed the St George 's Respiratory Question naire ( SGRQ ) . Information on spirometric parameters , nebuliser provision at discharge , provision of domiciliary oxygen , and re-admission within 12 months was collected from patient notes . RESULTS The mean age of the patients was 68 years and 53 % were men . The mean ( SD ) forced expiratory volume in one second ( FEV1 ) was 38.8 (18.0)% predicted and forced vital capacity ( FVC ) was 58.9 (23.8)% predicted . Higher ( worse ) scores on the SGRQ were significantly related to re-admission for COPD in the next 12 months ( difference = 4.8 , 95 % CI 1.6 to 8.0 ) . Patients who were re-admitted and died from COPD did not differ in SGRQ scores from those who were re-admitted and survived for more than 12 months . Re-admission was not related to sex , age , or pulmonary function . One hundred and thirty eight patients did not have a home nebuliser before admission . Of these , 14 were provided with a home nebuliser at discharge . Patients provided with nebulisers had significantly worse SGRQ scores and worse FVC . The 41 patients given domiciliary oxygen did not differ in SGRQ or spirometric parameters . Logistic regression analysis of the three SGRQ subscales ( Symptom , Impact and Activity ) , adjusting for lung function , age and sex , showed that all three subscales were significantly related to hospital readmission and that Impact scores were related to nebuliser provision . Women did not differ from men in Symptom scores on the SGRQ but differed markedly on the Activity and Impact scales . CONCLUSIONS It is concluded that poor scores on the SGRQ , a QOL scale which measures patient distress and coping , are associated with re-admission for COPD and use of re sources such as nebulisers , independent of physiological measures of disease severity PURPOSE Self-directed and supervised exercise were compared with usual care in a clinical trial design ed to evaluate the effect of structured exercise on physical functioning and other dimensions of health-related quality of life in women with stages I and II breast cancer . PATIENTS AND METHODS One hundred twenty-three women with stages I and II breast cancer completed baseline evaluations of generic and disease- and site-specific health-related quality of life , aerobic capacity , and body weight . Participants were r and omly allocated to one of three intervention groups : usual care ( control group ) , self-directed exercise , or supervised exercise .  Quality of life , aerobic capacity , and body weight measures were repeated at 26 weeks . The primary outcome was the change in the Short Form-36 physical functioning scale between baseline and 26 weeks . RESULTS Physical functioning in the control group decreased by 4.1 points , whereas it increased by 5.7 points and 2.2 points in the self-directed and supervised exercise groups , respectively ( P = .04 ) . Post hoc analysis showed a moderately large ( and clinical ly important ) difference between the self-directed and control groups ( 9.8 points ; P = .01 ) and a more modest difference between the supervised and control groups ( 6.3 points ; P = .09 ) . No significant differences between groups were observed for changes in quality of life scores . In a secondary analysis of participants stratified by type of adjuvant therapy , supervised exercise improved aerobic capacity ( + 3.5 mL/kg/min ; P = .01 ) and reduced body weight ( -4.8 kg ; P < .05 ) compared with usual care only in participants not receiving chemotherapy . CONCLUSION Physical exercise can blunt some of the negative side effects of breast cancer treatment , including reduced physical functioning .  Self-directed exercise is an effective way to improve physical functioning compared with usual care . In participants not receiving chemotherapy  , supervised exercise may increase aerobic capacity and reduce body weight compared with usual care We have developed a rehabilitation programme at home and have investigated its effects on quality of life ( QOL ) , lung function , and exercise tolerance in patients with chronic obstructive pulmonary disease ( COPD ) . We studied 43 patients with severe airflow obstruction : forced expiratory volume in one second ( FEV1 ) 1.3 + /- 0.4 l ( mean + /- SD ) , FEV1/inspiratory vital capacity ( IVC ) 37 + /- 7.9 % . After stratification , 28 patients were r and omly allocated in a home rehabilitation programme for 12 weeks . Fifteen patients in a control group received no rehabilitation . The rehabilitation group received physiotherapy by the local physiotherapist , and supervision by a nurse and a general practitioner .  Quality of life was assessed by the four dimensions of the Chronic Respiratory Question naire ( CRQ ) . We found a highly significant improvement in the rehabilitation group compared to the control group for the dimensions dyspnoea , emotion , and mastery . Lung function showed no changes in the rehabilitation group . The exercise tolerance improved significantly in the rehabilitation group compared to the control group . The improvement in quality of life was not correlated with the improvement in exercise tolerance . Rehabilitation of COPD patients at home may improve quality of life ; this improvement is not correlated with an improvement in lung function and exercise tolerance PURPOSE We report on a clinical trial developed to compare four different instruments that provide overall quality -of-life ( QOL ) scores , ranging from a simple , one-item instrument to more detailed instruments . Two issues addressed were ( 1 ) Will QOL tools suffer from missing data when used in a community-based cooperative group setting ? , and ( 2 ) Are there additional data generated by a more detailed multiitem instrument over that provided by a single-item global QOL question ? MATERIAL S AND METHODS A four-arm r and omized trial was design ed to compare four instruments that provide overall QOL scores in patients with advanced colorectal cancer . Patients and physicians completed the single-item Spitzer Uniscale ( UNISCALE ) at baseline and monthly . Patients were r and omly assigned to complete , in addition , either the 22-item Functional Living Index-Cancer ( FLIC ) , the five-item Spitzer QOL index ( QLI ) , a picture-face scale ( PICT ) , or nothing else . RESULTS A total of 128 patients were r and omized . Greater than 90 % complete QOL data were obtained . There was strong correlation , concordance , and criterion-related validity among all four patient-completed tools . The UNISCALE had a greater decrease over time than did the FLIC ( P=.005 ) , which suggests a greater sensitivity ; the UNISCALE was similar to the QLI and the PICT in this regard . Physicians provided lower UNISCALE scores than patients . Results supported the hypothesis that QOL is prognostic for survival . CONCLUSION Patients can effectively complete QOL tools in a cooperative group setting with proper education of health care providers and patients . A simple single-item tool ( UNISCALE ) appears to be appropriate to obtain a measure of overall QOL BACKGROUND AND PURPOSE The Rol and -Morris Question naire ( RMQ ) is a self-administered disability measure in which greater levels of disability are reflected by higher numbers on a 24-point scale . The RMQ has been shown to yield reliable measurements , which are valid for inferring the level of disability , and to be sensitive to change over time for groups of patients with low back pain . Little is known about the usefulness of this instrument in aiding decision making regarding individual patients . The purpose of this study was to determine the minimum level of detectable change when the RMQ is applied to individual patients . SUBJECTS The study sample consisted of 60 out patients with low back pain . METHODS The RMQ was administered at the subjects ' initial visit and again 4 to 6 weeks later . Conditional st and ard errors of measurement ( CSEMs ) were computed for initial and follow-up RMQ scores , and these values were used to estimate the minimum level of detectable change . Results . Minimum levels of detectable change at the 90 % confidence level varied from 4 to 5 RMQ points . CONCLUSION AND DISCUSSION The magnitude of CSEMs is sufficiently small to detect change in patients with initial scores in the central portion of the scale ( 4 - 20 RMQ points ) ; however , the magnitude is too large to detect improvement in patients with scores of less than 4 and deterioration in patients who have scores greater than 20 PURPOSE Pulmonary rehabilitation programs are effective in patients with severe chronic obstructive pulmonary disease ( COPD ) in the short term , but their long-term effects are not known . We investigated the short- and long-term effects of a 6-month outpatient rehabilitation program in patients with severe COPD . SUBJECTS AND METHODS One hundred patients were r and omly assigned to receive either an exercise training program that included cycling , walking , and strength training ( n = 50 ) or usual medical care ( n = 50 ) . Thirty-four patients in the training group were evaluated after 6 months ( end of training ) , and 26 were evaluated after 18 months of follow-up . In the control group , 28 patients were evaluated at 6 months and 23 after 18 months . We measured pulmonary function , 6-minute walking distance , maximal exercise capacity , peripheral and respiratory muscle strength , and quality of life ( on a 20 to 140-point scale ) , and estimated the cost-effectiveness of the program . RESULTS At 6 months , the training group showed improvement in 6-minute walking distance [ mean difference ( training - control ) of 52 m ; 95 % confidence interval ( CI ) , 15 to 89 m ] , maximal work load ( 12 W ; 95 % CI , 6 to 19 W ) , maximal oxygen uptake ( 0.26 liters/min ; 95 % CI , 0.07 to 0.45 liters/min ) , quadriceps force ( 18 Nm ; 95 % CI , 7 to 29 Nm ) , inspiratory muscle force ( 11 cm H(2)O ; 95 % CI , 3 to 20 cm H(2)O ) , and quality of life ( 14 points ; 95 % CI , 6 to 21 points ; all P < 0.05 ) . At 18 months all these differences persisted ( P < 0.05 ) , except for inspiratory muscle strength . For 6-minute walking distance and quality of life , the differences between the training group and controls at 18 months exceeded the minimal clinical ly-important difference . CONCLUSION Among patients who completed the 6-month program , outpatient training result ed in significant and clinical ly relevant changes in 6-minute walking distance , maximal exercise performance , peripheral and respiratory muscle strength , and quality of life . Most of these effects persisted 18 months after starting the program In this study , the perceptions of asthmatics to change in their disease was associated with observed changes in clinical asthma measures , in order to identify the threshold where changes in clinical asthma measures are perceivable by patients . The study included 281 asthmatic patients , aged 18 - 63 yrs , in a r and omized , placebo-controlled clinical trial of a leukotriene antagonist .  Changes were related in : 1 ) asthma symptom scores ; 2 ) inhaled beta-agonist use ; 3 ) forced expiratory volume in one second ( FEV1 ) ; and 4 ) peak expiratory flow ( PEF ) to a global question that queried overall change in asthma since starting the study drug . Additional analyses examined differences in the group reporting minimal improvement by treatment ( active treatment versus placebo ) , sex and age groups . The average minimal patient perceivable improvement for each measure was : 1 ) -0.31 points for the symptom score on a scale of 0 - 6 ; 2 ) -0.81 puffs x day(-1 ) for inhaled beta-agonist use ; 3 ) 0.23 L for FEV1 ; and 4 ) 18.79 L x min(-1 ) for PEF . In general placebo-treated patients and older patients , who reported minimal improvement , experienced less mean improvement from baseline than active-treated patients and younger patients , who reported minimal improvement . Determining the minimal patient perceivable improvement value for a measure may be helpful to interpret changes . However , interpretation should be carried out cautiously when reporting a single value as a clinical ly important change OBJECTIVES : Endoscopy-negative gastroesophageal reflux disease ( GERD ) lacks objective markers of disease severity . Evaluation of therapies for GERD must therefore rely on subjective measures , including patient self-report question naires , to measure the clinical effectiveness of therapeutic interventions . We aim ed to evaluate the previously vali date d Gastrointestinal Symptoms Rating Scale ( GSRS ) and the Quality of Life in Reflux and Dyspepsia ( QOLRAD ) question naires for reliability and responsiveness to change over time . METHODS : Patients ( n = 1143 ) with heartburn , but no esophagitis included in a r and omized clinical trial assessing the effectiveness of active treatment with proton pump inhibitors over 4 wk were evaluated . RESULTS : The test-retest reliability of both question naires over time was good to excellent ( GSRS 0.53–0.69 ; QOL 
    Output:
    
agent
There was no consistent relationship with factors such as disease-specific or generic instrument or the number of response options .
Negative changes were not associated with larger ESs .
Population -based estimation procedures and brief follow-up were associated with smaller ESs , and acute conditions with larger ESs .
***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: BACKGROUND There is some evidence that quality of life ( QOL ) in patients with chronic obstructive pulmonary disease ( COPD ) may predict clinical outcomes and use of re sources . This study examined whether QOL scores could prospect ively predict re-admission for COPD or death within 12 months of an original admission , and whether QOL scores predicted home nebuliser provision . METHODS The study was carried out in all acute medical wards of Aberdeen Royal Infirmary , Woodend and City Hospitals , Aberdeen over 12 months . A total of 377 patients admitted with an exacerbation of COPD were identified in this time , 111 of whom were not included in the study because they refused the interview or died before discharge . The remaining 266 patients completed the St George 's Respiratory Question naire ( SGRQ ) . Information on spirometric parameters , nebuliser provision at discharge , provision of domiciliary oxygen , and re-admission within 12 months was collected from patient notes . RESULTS The mean age of the patients was 68 years and 53 % were men . The mean ( SD ) forced expiratory volume in one second ( FEV1 ) was 38.8 (18.0)% predicted and forced vital capacity ( FVC ) was 58.9 (23.8)% predicted . Higher ( worse ) scores on the SGRQ were significantly related to re-admission for COPD in the next 12 months ( difference = 4.8 , 95 % CI 1.6 to 8.0 ) . Patients who were re-admitted and died from COPD did not differ in SGRQ scores from those who were re-admitted and survived for more than 12 months . Re-admission was not related to sex , age , or pulmonary function . One hundred and thirty eight patients did not have a home nebuliser before admission . Of these , 14 were provided with a home nebuliser at discharge . Patients provided with nebulisers had significantly worse SGRQ scores and worse FVC . The 41 patients given domiciliary oxygen did not differ in SGRQ or spirometric parameters . Logistic regression analysis of the three SGRQ subscales ( Symptom , Impact and Activity ) , adjusting for lung function , age and sex , showed that all three subscales were significantly related to hospital readmission and that Impact scores were related to nebuliser provision . Women did not differ from men in Symptom scores on the SGRQ but differed markedly on the Activity and Impact scales . CONCLUSIONS It is concluded that poor scores on the SGRQ , a QOL scale which measures patient distress and coping , are associated with re-admission for COPD and use of re sources such as nebulisers , independent of physiological measures of disease severity PURPOSE Self-directed and supervised exercise were compared with usual care in a clinical trial design ed to evaluate the effect of structured exercise on physical functioning and other dimensions of health-related quality of life in women with stages I and II breast cancer . PATIENTS AND METHODS One hundred twenty-three women with stages I and II breast cancer completed baseline evaluations of generic and disease- and site-specific health-related quality of life , aerobic capacity , and body weight . Participants were r and omly allocated to one of three intervention groups : usual care ( control group ) , self-directed exercise , or supervised exercise .  Quality of life , aerobic capacity , and body weight measures were repeated at 26 weeks . The primary outcome was the change in the Short Form-36 physical functioning scale between baseline and 26 weeks . RESULTS Physical functioning in the control group decreased by 4.1 points , whereas it increased by 5.7 points and 2.2 points in the self-directed and supervised exercise groups , respectively ( P = .04 ) . Post hoc analysis showed a moderately large ( and clinical ly important ) difference between the self-directed and control groups ( 9.8 points ; P = .01 ) and a more modest difference between the supervised and control groups ( 6.3 points ; P = .09 ) . No significant differences between groups were observed for changes in quality of life scores . In a secondary analysis of participants stratified by type of adjuvant therapy , supervised exercise improved aerobic capacity ( + 3.5 mL/kg/min ; P = .01 ) and reduced body weight ( -4.8 kg ; P < .05 ) compared with usual care only in participants not receiving chemotherapy . CONCLUSION Physical exercise can blunt some of the negative side effects of breast cancer treatment , including reduced physical functioning .  Self-directed exercise is an effective way to improve physical functioning compared with usual care . In participants not receiving chemotherapy  , supervised exercise may increase aerobic capacity and reduce body weight compared with usual care We have developed a rehabilitation programme at home and have investigated its effects on quality of life ( QOL ) , lung function , and exercise tolerance in patients with chronic obstructive pulmonary disease ( COPD ) . We studied 43 patients with severe airflow obstruction : forced expiratory volume in one second ( FEV1 ) 1.3 + /- 0.4 l ( mean + /- SD ) , FEV1/inspiratory vital capacity ( IVC ) 37 + /- 7.9 % . After stratification , 28 patients were r and omly allocated in a home rehabilitation programme for 12 weeks . Fifteen patients in a control group received no rehabilitation . The rehabilitation group received physiotherapy by the local physiotherapist , and supervision by a nurse and a general practitioner .  Quality of life was assessed by the four dimensions of the Chronic Respiratory Question naire ( CRQ ) . We found a highly significant improvement in the rehabilitation group compared to the control group for the dimensions dyspnoea , emotion , and mastery . Lung function showed no changes in the rehabilitation group . The exercise tolerance improved significantly in the rehabilitation group compared to the control group . The improvement in quality of life was not correlated with the improvement in exercise tolerance . Rehabilitation of COPD patients at home may improve quality of life ; this improvement is not correlated with an improvement in lung function and exercise tolerance PURPOSE We report on a clinical trial developed to compare four different instruments that provide overall quality -of-life ( QOL ) scores , ranging from a simple , one-item instrument to more detailed instruments . Two issues addressed were ( 1 ) Will QOL tools suffer from missing data when used in a community-based cooperative group setting ? , and ( 2 ) Are there additional data generated by a more detailed multiitem instrument over that provided by a single-item global QOL question ? MATERIAL S AND METHODS A four-arm r and omized trial was design ed to compare four instruments that provide overall QOL scores in patients with advanced colorectal cancer . Patients and physicians completed the single-item Spitzer Uniscale ( UNISCALE ) at baseline and monthly . Patients were r and omly assigned to complete , in addition , either the 22-item Functional Living Index-Cancer ( FLIC ) , the five-item Spitzer QOL index ( QLI ) , a picture-face scale ( PICT ) , or nothing else . RESULTS A total of 128 patients were r and omized . Greater than 90 % complete QOL data were obtained . There was strong correlation , concordance , and criterion-related validity among all four patient-completed tools . The UNISCALE had a greater decrease over time than did the FLIC ( P=.005 ) , which suggests a greater sensitivity ; the UNISCALE was similar to the QLI and the PICT in this regard . Physicians provided lower UNISCALE scores than patients . Results supported the hypothesis that QOL is prognostic for survival . CONCLUSION Patients can effectively complete QOL tools in a cooperative group setting with proper education of health care providers and patients . A simple single-item tool ( UNISCALE ) appears to be appropriate to obtain a measure of overall QOL BACKGROUND AND PURPOSE The Rol and -Morris Question naire ( RMQ ) is a self-administered disability measure in which greater levels of disability are reflected by higher numbers on a 24-point scale . The RMQ has been shown to yield reliable measurements , which are valid for inferring the level of disability , and to be sensitive to change over time for groups of patients with low back pain . Little is known about the usefulness of this instrument in aiding decision making regarding individual patients . The purpose of this study was to determine the minimum level of detectable change when the RMQ is applied to individual patients . SUBJECTS The study sample consisted of 60 out patients with low back pain . METHODS The RMQ was administered at the subjects ' initial visit and again 4 to 6 weeks later . Conditional st and ard errors of measurement ( CSEMs ) were computed for initial and follow-up RMQ scores , and these values were used to estimate the minimum level of detectable change . Results . Minimum levels of detectable change at the 90 % confidence level varied from 4 to 5 RMQ points . CONCLUSION AND DISCUSSION The magnitude of CSEMs is sufficiently small to detect change in patients with initial scores in the central portion of the scale ( 4 - 20 RMQ points ) ; however , the magnitude is too large to detect improvement in patients with scores of less than 4 and deterioration in patients who have scores greater than 20 PURPOSE Pulmonary rehabilitation programs are effective in patients with severe chronic obstructive pulmonary disease ( COPD ) in the short term , but their long-term effects are not known . We investigated the short- and long-term effects of a 6-month outpatient rehabilitation program in patients with severe COPD . SUBJECTS AND METHODS One hundred patients were r and omly assigned to receive either an exercise training program that included cycling , walking , and strength training ( n = 50 ) or usual medical care ( n = 50 ) . Thirty-four patients in the training group were evaluated after 6 months ( end of training ) , and 26 were evaluated after 18 months of follow-up . In the control group , 28 patients were evaluated at 6 months and 23 after 18 months . We measured pulmonary function , 6-minute walking distance , maximal exercise capacity , peripheral and respiratory muscle strength , and quality of life ( on a 20 to 140-point scale ) , and estimated the cost-effectiveness of the program . RESULTS At 6 months , the training group showed improvement in 6-minute walking distance [ mean difference ( training - control ) of 52 m ; 95 % confidence interval ( CI ) , 15 to 89 m ] , maximal work load ( 12 W ; 95 % CI , 6 to 19 W ) , maximal oxygen uptake ( 0.26 liters/min ; 95 % CI , 0.07 to 0.45 liters/min ) , quadriceps force ( 18 Nm ; 95 % CI , 7 to 29 Nm ) , inspiratory muscle force ( 11 cm H(2)O ; 95 % CI , 3 to 20 cm H(2)O ) , and quality of life ( 14 points ; 95 % CI , 6 to 21 points ; all P < 0.05 ) . At 18 months all these differences persisted ( P < 0.05 ) , except for inspiratory muscle strength . For 6-minute walking distance and quality of life , the differences between the training group and controls at 18 months exceeded the minimal clinical ly-important difference . CONCLUSION Among patients who completed the 6-month program , outpatient training result ed in significant and clinical ly relevant changes in 6-minute walking distance , maximal exercise performance , peripheral and respiratory muscle strength , and quality of life . Most of these effects persisted 18 months after starting the program In this study , the perceptions of asthmatics to change in their disease was associated with observed changes in clinical asthma measures , in order to identify the threshold where changes in clinical asthma measures are perceivable by patients . The study included 281 asthmatic patients , aged 18 - 63 yrs , in a r and omized , placebo-controlled clinical trial of a leukotriene antagonist .  Changes were related in : 1 ) asthma symptom scores ; 2 ) inhaled beta-agonist use ; 3 ) forced expiratory volume in one second ( FEV1 ) ; and 4 ) peak expiratory flow ( PEF ) to a global question that queried overall change in asthma since starting the study drug . Additional analyses examined differences in the group reporting minimal improvement by treatment ( active treatment versus placebo ) , sex and age groups . The average minimal patient perceivable improvement for each measure was : 1 ) -0.31 points for the symptom score on a scale of 0 - 6 ; 2 ) -0.81 puffs x day(-1 ) for inhaled beta-agonist use ; 3 ) 0.23 L for FEV1 ; and 4 ) 18.79 L x min(-1 ) for PEF . In general placebo-treated patients and older patients , who reported minimal improvement , experienced less mean improvement from baseline than active-treated patients and younger patients , who reported minimal improvement . Determining the minimal patient perceivable improvement value for a measure may be helpful to interpret changes . However , interpretation should be carried out cautiously when reporting a single value as a clinical ly important change OBJECTIVES : Endoscopy-negative gastroesophageal reflux disease ( GERD ) lacks objective markers of disease severity . Evaluation of therapies for GERD must therefore rely on subjective measures , including patient self-report question naires , to measure the clinical effectiveness of therapeutic interventions . We aim ed to evaluate the previously vali date d Gastrointestinal Symptoms Rating Scale ( GSRS ) and the Quality of Life in Reflux and Dyspepsia ( QOLRAD ) question naires for reliability and responsiveness to change over time . METHODS : Patients ( n = 1143 ) with heartburn , but no esophagitis included in a r and omized clinical trial assessing the effectiveness of active treatment with proton pump inhibitors over 4 wk were evaluated . RESULTS : The test-retest reliability of both question naires over time was good to excellent ( GSRS 0.53–0.69 ; QOL 
    Output:
    