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: A prospect i ve r and omised trial was performed to evaluate the effectiveness of an asthma education programme administered by an asthma nurse specialist in an out-patient setting . Sixty asthmatic patients ( mean age 28.5 years ) were enrolled , 30 to a  usual care control group and 30 to an  education group . The education group underwent an individual education programme lasting at least one hour . The following variables were measured at baseline , one month after the education programme and at one year follow-up : asthma knowledge by MCQ ( 36 point question naire ) , inhaler technique ( 7 point scale ) , peak expiratory flow rate ( PEFR ) and symptomatology by visual analogue score ( 0 to 10 score ) . The education group 's inhaler technique and MCQ score both improved significantly at one month , from 5.4 ( 0.3 ) ( mean [ SEM ] ) to 6.5 ( 0.3 ) , p < 0.001 , and from 7.5 ( 2.4 ) to 22 ( 1.8 ) , p < 0.0001 respectively . Both of these improvements were significantly greater than in the control group , and both were maintained at one year follow-up . The symptom score improved over one year in the education group , from 5.4 ( 0.6 ) to 7.6 ( 0.5 ) , p < 0.05 , and was unchanged in the control group . There was no change in the PEFR in either group . This study shows clear objective benefits to an out-patient asthma education programme conducted by an asthma nurse specialist Optimal effects of asthma medications are dependent on correct inhaler technique . In a telephone survey , 77/87 patients reported that their Turbuhaler technique had not been checked by a health care professional . In a subsequent pilot study , 26 patients were r and omized to receive one of 3 Turbuhaler counseling techniques , administered in the community pharmacy .  Turbuhaler technique was scored before and 2 weeks after counseling ( optimal technique = score 9/9 ) . At baseline , 0/26 patients had optimal technique . After 2 weeks , optimal technique was achieved by 0/7 patients receiving st and ard verbal counseling ( A ) , 2/8 receiving verbal counseling augmented with emphasis on Turbuhaler position during priming ( B ) , and 7/9 receiving augmented verbal counseling plus physical demonstration ( C ) ( Fisher 's exact test for A vs C , p = 0.006 ) . Satisfactory technique ( 4 essential steps correct ) also improved ( A : 3/8 to 4/7 ; B : 2/9 to 5/8 ; and C : 1/9 to 9/9 patients ) ( A vs C , p = 0.1 ) . Counseling in Turbuhaler use represents an important opportunity for community pharmacists to improve asthma management , but physical demonstration appears to be an important component to effective Turbuhaler training for educating patients toward optimal Turbuhaler technique BACKGROUND Many patients with asthma or chronic obstructive pulmonary disease use their medication inhalers incorrectly . General practitioners , pharmacists and other health care providers do not always have the opportunity to instruct patients in correct inhaler technique . OBJECTIVE To find out whether the inhaler technique and respiratory symptoms of patients can be improved after instruction by practice assistants . METHODS Single blind , r and omized intervention study in which 48 patients who had been using a dry powder inhaler for at least one month took part . Their inhaler technique was videotaped on two visits with a two-week interval between visits . The inhaler technique on the videos was subsequently scored by two experts on nine criteria . At both visits the patients completed a question naire about their respiratory symptoms . After the first video , 25 patients were r and omly chosen to receive instruction from one of six practice assistants who had followed a one evening course about inhaler instruction , and who had been issued an instruction-set . RESULTS The patients who received instruction had a significantly greater reduction in number of mistakes at the second visit than the patients who did not ( P = 0.01 ) . The instructed patients also reported less dyspnoea at the second visit ( P = 0.03 ) . No effect of instruction was found on wheezing , cough and sputum production . CONCLUSION The inhaler technique of patients can be improved significantly by the instruction of patients by trained practice assistants , possibly result ing in less dyspnoea Inhaled medication is important in the treatment of chronic obstructive pulmonary disease ( COPD ) . In this paper a comparison of the long-term efficacy of three instruction-models is presented . A total of 152 COPD - patients were r and omized into one of four groups : Personal- , video- , group-instruction and a control group . Inhalation technique was assessed by means of checklists , on which essential inhalation manoeuvres were identified . Up to 9 months later , 148 patients returned for follow-up assessment . Prior to instruction 61 % of patients in the control group had a perfect score on essential actions , compared to 62 , 65 and 53 % for those receiving group- , personal- and video-instruction respectively . At follow-up these percentages were 49 , 97 , 75 and 76 % . For group-(35 % ) and video-instruction ( 24 % ) the increase from baseline was significant . Examining the different inhalers under investigation , it is striking , that only 24 % of all patients with a Metered Dose Inhaler ( MDI ) performed all essential checklist items correctly , versus 96 % for those using a Diskhaler . The fact that for the MDI this percentage improved to 90 % post-instruction , shows that time spent on instruction , is time well spent . We conclude that group instruction seems superior to personal counselling , and equally effective or even better than video instruction . Personal instruction should not be dismissed and a combination with video instruction might prove to be effective as well Education on optimal medication use is an essential strategy to improve asthma control . The current authors investigated whether pharmacist interventions , focused on appropriate use of asthma medication and tailor-made to the patient 's current asthma control , would improve asthma control in adult patients . A 6-month r and omised , controlled , parallel-group trial was conducted in 66 community pharmacies in Belgium . Patients were r and omly assigned to receive usual pharmacist care ( n = 94 ) or a pre-defined pharmacist intervention ( n = 107 ) . This intervention mainly focused on improving inhalation technique and medication adherence . Primary outcome was the level of asthma control , as assessed by the Asthma Control Test ® ( ACT ) . Mean ACT scores did not change from baseline for both study groups . However , a pre-defined subgroup analysis of patients having insufficiently controlled asthma at baseline showed that the intervention had significantly increased the ACT score after 6 months compared with usual care . The intervention also reduced , for the complete study group , reliever medication use and the frequency of night-time awakenings due to asthma . Inhalation technique and adherence to controller medication were significantly better in the intervention group . In conclusion , pragmatic community pharmacy-based programmes can significantly improve therapeutic outcomes in adult asthma patients Background : The most common treatment for asthma is transferring the drug into the lungs by inhaler devices . Besides , correct use of inhaled medication is required for effectiveness of pharmacotherapy . Thus , it is necessary to train the patients how to use Metered Dose Inhaler ( MDI ) . This study aim ed to determine the effect of training about MDI usage with or without spacer on maximum expiratory flow rate and inhaler usage skills in asthmatic patients . Methods : This r and omized clinical trial was conducted on 90 asthmatic patients who were r and omly divided into inhalation technique group with spacer , inhalation technique group without spacer , and a control group . Then , the Peak Expiratory Flow Rate ( PEFR ) was measured using a peak flow meter , as a basic test . In addition , the patients ’ functional skills of inhalation technique were assessed using two checklists . Afterwards , 3 sessions of training were arranged for both groups . PEFR and the ability to use the MDI were evaluated immediately and 1 month after the intervention . Finally , the data were entered into the SPSS statistical software ( v. 18 ) and analyzed using independent t-test and repeated measures ANOVA . Results : After the intervention , MDI usage skills improved in the two intervention groups compared to the control group ( P<0.001 ) . In addition , a significant difference was found between the intervention groups and the control group regarding the mean of PEFR after the intervention ( P<0.001 ) . However , no significant difference was observed between the two intervention groups ( P=0.556 ) . Conclusion : According to the results , providing appropriate training for asthmatic patients increased MDI usage skills , and both methods of inhalation ( with or without spacer ) could improve the PEFR among the patients . Trial Registration Number : I RCT Background Drugs for inhalation are the cornerstone of therapy in obstructive lung disease . We have observed that up to 75 % of patients do not perform a correct inhalation technique . The inability of patients to correctly use their inhaler device may be a direct consequence of insufficient or poor inhaler technique instruction . The objective of this study is to test the efficacy of two educational interventions to improve the inhalation techniques in patients with Chronic Obstructive Pulmonary Disease ( COPD ) . Methods This study uses both a multicenter patients ´ preference trial and a comprehensive cohort design with 495 COPD -diagnosed patients selected by a non-probabilistic method of sampling from seven Primary Care Centers . The participants will be divided into two groups and five arms . The two groups are : 1 ) the patients ´ preference group with two arms and 2 ) the r and omized group with three arms . In the preference group , the two arms correspond to the two educational interventions ( Intervention A and Intervention B ) design ed for this study . In the r and omized group the three arms comprise : intervention A , intervention B and a control arm . Intervention A is written information ( a leaflet describing the correct inhalation techniques ) . Intervention B is written information about inhalation techniques plus training by an instructor . Every patient in each group will be visited six times during the year of the study at health care center . Discussion Our hypothesis is that the application of two educational interventions in patients with COPD who are treated with inhaled therapy will increase the number of patients who perform a correct inhalation technique by at least 25 % . We will evaluate the effectiveness of these interventions on patient inhalation technique improvement , considering that it will be adequate and feasible within the context of clinical practice .Trial registration Current Controlled Trials Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objectives ( a ) To compare metered dose inhaler ( MDI ) technique in users with poor English and fluent English , ( b ) to evaluate two interventions : a translated patient information leaflet ( PIL ) plus support from an translator ( PIL + verbal ) and a multimedia touch screen system ( MTS ) using video clips and own- language instruction . Methods ( a ) Inhaler technique was videotaped and key steps rated blind for 105 fluent English-speakers ( FE ) and 69 Turkish-speakers with poor English ( EP ) . ( b ) The EP group was r and omised to receive information by MTS ( n = 34 ) or PIL + verbal ( n = 35 ) . Inhaler technique was videotaped before and after information . Main outcome measures ( a ) Global inhaler technique ; ( b ) breathing-in time ; ( c ) co-ordination of inspiration and inhaler actuation . Results Global technique , co-ordination and breath-holding were all significantly worse in MDI users with poor English . Only 17 % of that group had adequate technique compared to over half ( 62 % ) of FE . The EP group were significantly less likely than the FE group to report ever seeing the practice nurse about their asthma . After information , global technique was rated as improved in 50 % of the MTS group compared to 28 % of those given a translated PIL . A further six people ( 17 % ) in the PIL group improved after subsequent verbal advice in their own language . Both information methods significantly increased inhaler shaking and mouthpiece checking , but co-ordination only improved in a small number of people . Conclusions : The study suggests that Turkish-speaking MDI users with poor English may be disadvantaged in terms of access to medicines information in the UK . The acceptability of pharmacy-based support services for this , and other specific language groups should be explored . Multimedia offers an alternative to a translator for brief explanations , particularly for first-time users , but improving poor co-ordination requires individualised “ h and s on ” teaching from health professionals Aim : To investigate the effects of inhaler device technique education on improving inhaler technique in older people with asthma . Methods : In a r and omised controlled trial , device technique education was provided to a sample of 123 adults aged > 55 years who had a doctor diagnosis of asthma . The active education group received one-on-one technique coaching , including observation , verbal instruction and physical demonstration at baseline . The passive group received a device-specific instruction pamphlet only . Inhaler technique , including the critical steps for each device type , was assessed and scored according to Australian National Asthma Council ( NAC ) guidelines . Device technique was scored objective ly at baseline and again at 3 and 12 months post education . Results : The majority of participants demonstrated poor technique at baseline . Only 11 ( 21 % ) of the active intervention group and 7 ( 16 % ) of the passive group demonstrated 100 % correct technique . By 3 months 26 ( 48 % ) of the active group achieved adequate technique . Improvement in technique was observed in the active group at 3 months ( P<0.001 ) and remained significant at 12 months ( P<0.001 ) . No statist 
    Output:
    
agent
***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: A prospect i ve r and omised trial was performed to evaluate the effectiveness of an asthma education programme administered by an asthma nurse specialist in an out-patient setting . Sixty asthmatic patients ( mean age 28.5 years ) were enrolled , 30 to a  usual care control group and 30 to an  education group . The education group underwent an individual education programme lasting at least one hour . The following variables were measured at baseline , one month after the education programme and at one year follow-up : asthma knowledge by MCQ ( 36 point question naire ) , inhaler technique ( 7 point scale ) , peak expiratory flow rate ( PEFR ) and symptomatology by visual analogue score ( 0 to 10 score ) . The education group 's inhaler technique and MCQ score both improved significantly at one month , from 5.4 ( 0.3 ) ( mean [ SEM ] ) to 6.5 ( 0.3 ) , p < 0.001 , and from 7.5 ( 2.4 ) to 22 ( 1.8 ) , p < 0.0001 respectively . Both of these improvements were significantly greater than in the control group , and both were maintained at one year follow-up . The symptom score improved over one year in the education group , from 5.4 ( 0.6 ) to 7.6 ( 0.5 ) , p < 0.05 , and was unchanged in the control group . There was no change in the PEFR in either group . This study shows clear objective benefits to an out-patient asthma education programme conducted by an asthma nurse specialist Optimal effects of asthma medications are dependent on correct inhaler technique . In a telephone survey , 77/87 patients reported that their Turbuhaler technique had not been checked by a health care professional . In a subsequent pilot study , 26 patients were r and omized to receive one of 3 Turbuhaler counseling techniques , administered in the community pharmacy .  Turbuhaler technique was scored before and 2 weeks after counseling ( optimal technique = score 9/9 ) . At baseline , 0/26 patients had optimal technique . After 2 weeks , optimal technique was achieved by 0/7 patients receiving st and ard verbal counseling ( A ) , 2/8 receiving verbal counseling augmented with emphasis on Turbuhaler position during priming ( B ) , and 7/9 receiving augmented verbal counseling plus physical demonstration ( C ) ( Fisher 's exact test for A vs C , p = 0.006 ) . Satisfactory technique ( 4 essential steps correct ) also improved ( A : 3/8 to 4/7 ; B : 2/9 to 5/8 ; and C : 1/9 to 9/9 patients ) ( A vs C , p = 0.1 ) . Counseling in Turbuhaler use represents an important opportunity for community pharmacists to improve asthma management , but physical demonstration appears to be an important component to effective Turbuhaler training for educating patients toward optimal Turbuhaler technique BACKGROUND Many patients with asthma or chronic obstructive pulmonary disease use their medication inhalers incorrectly . General practitioners , pharmacists and other health care providers do not always have the opportunity to instruct patients in correct inhaler technique . OBJECTIVE To find out whether the inhaler technique and respiratory symptoms of patients can be improved after instruction by practice assistants . METHODS Single blind , r and omized intervention study in which 48 patients who had been using a dry powder inhaler for at least one month took part . Their inhaler technique was videotaped on two visits with a two-week interval between visits . The inhaler technique on the videos was subsequently scored by two experts on nine criteria . At both visits the patients completed a question naire about their respiratory symptoms . After the first video , 25 patients were r and omly chosen to receive instruction from one of six practice assistants who had followed a one evening course about inhaler instruction , and who had been issued an instruction-set . RESULTS The patients who received instruction had a significantly greater reduction in number of mistakes at the second visit than the patients who did not ( P = 0.01 ) . The instructed patients also reported less dyspnoea at the second visit ( P = 0.03 ) . No effect of instruction was found on wheezing , cough and sputum production . CONCLUSION The inhaler technique of patients can be improved significantly by the instruction of patients by trained practice assistants , possibly result ing in less dyspnoea Inhaled medication is important in the treatment of chronic obstructive pulmonary disease ( COPD ) . In this paper a comparison of the long-term efficacy of three instruction-models is presented . A total of 152 COPD - patients were r and omized into one of four groups : Personal- , video- , group-instruction and a control group . Inhalation technique was assessed by means of checklists , on which essential inhalation manoeuvres were identified . Up to 9 months later , 148 patients returned for follow-up assessment . Prior to instruction 61 % of patients in the control group had a perfect score on essential actions , compared to 62 , 65 and 53 % for those receiving group- , personal- and video-instruction respectively . At follow-up these percentages were 49 , 97 , 75 and 76 % . For group-(35 % ) and video-instruction ( 24 % ) the increase from baseline was significant . Examining the different inhalers under investigation , it is striking , that only 24 % of all patients with a Metered Dose Inhaler ( MDI ) performed all essential checklist items correctly , versus 96 % for those using a Diskhaler . The fact that for the MDI this percentage improved to 90 % post-instruction , shows that time spent on instruction , is time well spent . We conclude that group instruction seems superior to personal counselling , and equally effective or even better than video instruction . Personal instruction should not be dismissed and a combination with video instruction might prove to be effective as well Education on optimal medication use is an essential strategy to improve asthma control . The current authors investigated whether pharmacist interventions , focused on appropriate use of asthma medication and tailor-made to the patient 's current asthma control , would improve asthma control in adult patients . A 6-month r and omised , controlled , parallel-group trial was conducted in 66 community pharmacies in Belgium . Patients were r and omly assigned to receive usual pharmacist care ( n = 94 ) or a pre-defined pharmacist intervention ( n = 107 ) . This intervention mainly focused on improving inhalation technique and medication adherence . Primary outcome was the level of asthma control , as assessed by the Asthma Control Test ® ( ACT ) . Mean ACT scores did not change from baseline for both study groups . However , a pre-defined subgroup analysis of patients having insufficiently controlled asthma at baseline showed that the intervention had significantly increased the ACT score after 6 months compared with usual care . The intervention also reduced , for the complete study group , reliever medication use and the frequency of night-time awakenings due to asthma . Inhalation technique and adherence to controller medication were significantly better in the intervention group . In conclusion , pragmatic community pharmacy-based programmes can significantly improve therapeutic outcomes in adult asthma patients Background : The most common treatment for asthma is transferring the drug into the lungs by inhaler devices . Besides , correct use of inhaled medication is required for effectiveness of pharmacotherapy . Thus , it is necessary to train the patients how to use Metered Dose Inhaler ( MDI ) . This study aim ed to determine the effect of training about MDI usage with or without spacer on maximum expiratory flow rate and inhaler usage skills in asthmatic patients . Methods : This r and omized clinical trial was conducted on 90 asthmatic patients who were r and omly divided into inhalation technique group with spacer , inhalation technique group without spacer , and a control group . Then , the Peak Expiratory Flow Rate ( PEFR ) was measured using a peak flow meter , as a basic test . In addition , the patients ’ functional skills of inhalation technique were assessed using two checklists . Afterwards , 3 sessions of training were arranged for both groups . PEFR and the ability to use the MDI were evaluated immediately and 1 month after the intervention . Finally , the data were entered into the SPSS statistical software ( v. 18 ) and analyzed using independent t-test and repeated measures ANOVA . Results : After the intervention , MDI usage skills improved in the two intervention groups compared to the control group ( P<0.001 ) . In addition , a significant difference was found between the intervention groups and the control group regarding the mean of PEFR after the intervention ( P<0.001 ) . However , no significant difference was observed between the two intervention groups ( P=0.556 ) . Conclusion : According to the results , providing appropriate training for asthmatic patients increased MDI usage skills , and both methods of inhalation ( with or without spacer ) could improve the PEFR among the patients . Trial Registration Number : I RCT Background Drugs for inhalation are the cornerstone of therapy in obstructive lung disease . We have observed that up to 75 % of patients do not perform a correct inhalation technique . The inability of patients to correctly use their inhaler device may be a direct consequence of insufficient or poor inhaler technique instruction . The objective of this study is to test the efficacy of two educational interventions to improve the inhalation techniques in patients with Chronic Obstructive Pulmonary Disease ( COPD ) . Methods This study uses both a multicenter patients ´ preference trial and a comprehensive cohort design with 495 COPD -diagnosed patients selected by a non-probabilistic method of sampling from seven Primary Care Centers . The participants will be divided into two groups and five arms . The two groups are : 1 ) the patients ´ preference group with two arms and 2 ) the r and omized group with three arms . In the preference group , the two arms correspond to the two educational interventions ( Intervention A and Intervention B ) design ed for this study . In the r and omized group the three arms comprise : intervention A , intervention B and a control arm . Intervention A is written information ( a leaflet describing the correct inhalation techniques ) . Intervention B is written information about inhalation techniques plus training by an instructor . Every patient in each group will be visited six times during the year of the study at health care center . Discussion Our hypothesis is that the application of two educational interventions in patients with COPD who are treated with inhaled therapy will increase the number of patients who perform a correct inhalation technique by at least 25 % . We will evaluate the effectiveness of these interventions on patient inhalation technique improvement , considering that it will be adequate and feasible within the context of clinical practice .Trial registration Current Controlled Trials Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objectives ( a ) To compare metered dose inhaler ( MDI ) technique in users with poor English and fluent English , ( b ) to evaluate two interventions : a translated patient information leaflet ( PIL ) plus support from an translator ( PIL + verbal ) and a multimedia touch screen system ( MTS ) using video clips and own- language instruction . Methods ( a ) Inhaler technique was videotaped and key steps rated blind for 105 fluent English-speakers ( FE ) and 69 Turkish-speakers with poor English ( EP ) . ( b ) The EP group was r and omised to receive information by MTS ( n = 34 ) or PIL + verbal ( n = 35 ) . Inhaler technique was videotaped before and after information . Main outcome measures ( a ) Global inhaler technique ; ( b ) breathing-in time ; ( c ) co-ordination of inspiration and inhaler actuation . Results Global technique , co-ordination and breath-holding were all significantly worse in MDI users with poor English . Only 17 % of that group had adequate technique compared to over half ( 62 % ) of FE . The EP group were significantly less likely than the FE group to report ever seeing the practice nurse about their asthma . After information , global technique was rated as improved in 50 % of the MTS group compared to 28 % of those given a translated PIL . A further six people ( 17 % ) in the PIL group improved after subsequent verbal advice in their own language . Both information methods significantly increased inhaler shaking and mouthpiece checking , but co-ordination only improved in a small number of people . Conclusions : The study suggests that Turkish-speaking MDI users with poor English may be disadvantaged in terms of access to medicines information in the UK . The acceptability of pharmacy-based support services for this , and other specific language groups should be explored . Multimedia offers an alternative to a translator for brief explanations , particularly for first-time users , but improving poor co-ordination requires individualised “ h and s on ” teaching from health professionals Aim : To investigate the effects of inhaler device technique education on improving inhaler technique in older people with asthma . Methods : In a r and omised controlled trial , device technique education was provided to a sample of 123 adults aged > 55 years who had a doctor diagnosis of asthma . The active education group received one-on-one technique coaching , including observation , verbal instruction and physical demonstration at baseline . The passive group received a device-specific instruction pamphlet only . Inhaler technique , including the critical steps for each device type , was assessed and scored according to Australian National Asthma Council ( NAC ) guidelines . Device technique was scored objective ly at baseline and again at 3 and 12 months post education . Results : The majority of participants demonstrated poor technique at baseline . Only 11 ( 21 % ) of the active intervention group and 7 ( 16 % ) of the passive group demonstrated 100 % correct technique . By 3 months 26 ( 48 % ) of the active group achieved adequate technique . Improvement in technique was observed in the active group at 3 months ( P<0.001 ) and remained significant at 12 months ( P<0.001 ) . No statist 
    Output:
    