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 In spite of the well-demonstrated benefits for patients with COPD , pulmonary rehabilitation programmes show considerable drop-out and suboptimal attendance rates . The purpose of this prospect i ve study is to examine causes for drop-out and non-attendance during a 12 week multidisciplinary pulmonary rehabilitation programme , and to investigate whether sociodemographic and medical factors as well as patients ' perception of their illness are related to drop-out and non-attendance . METHODS Two hundred and seventeen patients with COPD who were referred to a rehabilitation centre participated in this multicentre study . Prior to treatment , patients received a question naire , which included the Illness Perception Question naire-Revised . Clinical data were drawn from medical records . Drop-out and attendance were recorded during the programme . RESULTS Fifty patients ( 23 % ) did not complete the rehabilitation course , of which half was due to medical reasons ( e.g. exacerbations , hospitalisations ) . Non-completion could not be predicted by baseline sociodemographic , clinical or psychological variables . Patients who declined treatment did not differ from patients who dropped out due to medical reasons . On average , patients attended 92 % of all scheduled appointments . Of all missed appointments , approximately 20 % were accountable to factors beyond patients ' control ( e.g. absent therapists , hospitalisations ) . Smoking , living alone , a lower fat free mass and lower confidence in treatment increased the chance of patients not attending an appointment during rehabilitation . CONCLUSION In general , adherence in rehabilitation is high . However , paying attention to patients ' nutritional status and creating a positive expectation of treatment during referral and intake appear to be important if one aims to optimise patients ' attendance during rehabilitation INTRODUCTION Pulmonary Rehabilitation ( PR ) reduces hospital admissions following an acute exacerbation of Chronic Obstructive Pulmonary Disease ( COPD ) but adherence is known to be poor . Patients ' illness perceptions may affect adherence to disease-management strategies but to date have not been explored following an exacerbation . The study aim is two-fold ; firstly to prospect ively explore acceptance and uptake of post-exacerbation PR and secondly to identify possible clusters of patients ' illness perceptions following hospitalisation for an exacerbation of COPD . METHODS Patients admitted to hospital with an exacerbation of COPD were recruited to a prospect i ve observational study . Self-reported illness perceptions , mood , health status and self-efficacy were assessed . Acceptance and uptake of PR were recorded at six months . Cluster analysis of Illness Perceptions Question naire-Revised data was used to establish groups of patients holding distinct beliefs . RESULTS 128 patients were recruited .  Acceptance and uptake of PR following an acute exacerbation was poor with only 9 % ( n = 11 ) completing the programme . Cluster analysis revealed three distinct groups : Cluster 1 ' in control ' ( n = 52 ) , Cluster 2 ' disengaged ' ( n = 36 ) and Cluster 3 ' distressed ' ( n = 40 ) . Significant between-cluster differences were observed in mood , health status and self-efficacy ( p < 0.01 ) . Acceptance and uptake of PR did not differ between clusters . CONCLUSIONS Acceptance/uptake of post-exacerbation PR was found to be poor . Three distinct illness schema exist in patients following an acute exacerbation . This information may be useful in developing novel psychologically-informed interventions design ed to reduce feelings of distress and perhaps facilitate a PR intervention for this vulnerable population OBJECTIVE Nonadherence to immunosuppressive medication ( IM ) after kidney transplantation is related to poorer patient and graft outcomes ; therefore research into modifiable factors associated with nonadherence is a priority . In this prospect i ve cohort study we investigated whether changes in goal cognitions , illness perceptions , and treatment beliefs were related to self-reported medication adherence six months after kidney transplantation . METHODS Interviews were conducted with patients in the out-patient clinic six weeks ( T1 : n=113 ) and six months ( T2 : n=106 ) after transplantation .  Self-reported adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale ( BAASIS © Interview ) . The  Brief Illness Perceptions Question naire , Beliefs about Medicines Question naire and questions on goal cognitions were also administered at both time points . RESULTS Self-reported nonadherence increased significantly between 6 weeks and 6 months after transplantation from 17 % to 27 % . Importance of medication adherence as a personal goal and self-efficacy to successfully carry out this goal decreased significantly over time . Perceived necessity of immunosuppressive medication was high but significantly decreased over time . Concerns about the medicines were low . There were no significant changes in illness perceptions or concerns over time . An increase in perceived graft longevity ( timeline ) was related to higher likelihood of nonadherence six months post-transplant . Furthermore , younger adult patients were more likely to be nonadherent six months after transplantation . CONCLUSION The self-reported nonadherence levels found in this study so soon after transplantation demonstrate the need for early and continued intervention after kidney transplantation in order to maximise adherence and consequently clinical outcomes . Changes in ( unrealistic ) beliefs regarding the longevity of the graft may offer a potential target for intervention among nonadherent patients Background Illness perceptions have been shown to predict patient activities . Therefore , studies of the effectiveness of a targeted illness-perception intervention on chronic nonspecific low back pain ( CLBP ) are needed . Objective The purpose of this study was to compare the effectiveness of treatment of illness perceptions against a waiting list for patients with CLBP . Design This was a prospect ively registered r and omized controlled trial with an assessor blinded for group allocation . Setting The study was conducted in an outpatient rehabilitation clinic . Participants The participants were 156 patients ( 18–70 years of age ) with CLBP ( > 3 months ) . Intervention Patients were r and omly assigned to either a treatment group or to a waiting list ( control ) group . Trained physical therapists and occupational therapists delivered 10 to 14 one-hour treatment sessions according to the treatment protocol . Measurements The primary outcome measure was change in patient-relevant physical activities ( Patient-Specific Complaints question naire ) . The secondary outcome measures were changes in illness perceptions ( Illness Perceptions Question naire ) and generic physical activity level ( Quebec Back Pain Disability Scale ) . Measurements were taken at baseline ( 0 weeks ) and after treatment ( 18 weeks ) . Results A baseline-adjusted analysis of covariance showed that there were statistically significant differences between intervention and control groups at 18 weeks for the change in patient-relevant physical activities . This was a clinical ly relevant change ( 19.1 mm ) for the intervention group . Statistically significant differences were found for the majority of illness perception scales . There were no significant differences in generic physical activity levels . Limitations Longer-term effectiveness was not studied . Conclusions This first trial evaluating cognitive treatment of illness perceptions concerning CLBP showed statistically significant and clinical ly relevant improvements in patient-relevant physical activities at 18 weeks Background Adherence with therapy could influence the progression of glaucoma and ultimately affect the onset of visual impairment in some individuals . This feasibility study evaluated the measures to be used for a future r and omized controlled trial assessing the effects of group-based education on adherence with eye drops . Methods People diagnosed with glaucoma within the previous 12 months attending a regional ophthalmology clinic in the North West of Engl and were recruited . A two-session education program delivered one week apart had been devised as part of a previous project . A combined adult learning and health needs approach to education was taken . Outcomes measured were knowledge of glaucoma , self-report of adherence , illness perception , beliefs about medicines , patient enablement , and general health ( Short Form-12 ) . Adherence was also measured objective ly using a Medical Events Monitoring System device . Results Twenty-six participants consented to undertake the educational program and 19 produced analyzable data . Knowledge of glaucoma , illness perception , beliefs about medicine , and patient enablement all showed statistically significant improvements after education . Mean adherence with eye drops was maintained above 85 % before and for 3 months after attendance at the educational program . Self-report exaggerated adherence by at least 10 % when compared with the objective Medical Events Monitoring System data , and in fact the kappa agreement was zero . Conclusion All question naires other than the Short Form-12 were considered to be valuable measures and use of a Medical Events Monitoring System device was considered to be an objective surrogate measure for adherence with eye drops . A multicenter , r and omized , controlled equivalence trial of group versus individualized education using adherence as the primary outcome is the next step OBJECTIVE Cardiac rehabilitation remains grossly under-utilized despite its proven benefits . This study prospect ively compared verified cardiac rehabilitation enrollment following automatic vs usual referral , postulating that automatic referral would result in significantly greater enrollment for cardiac rehabilitation . DESIGN Prospect i ve controlled multi-center study . PATIENTS AND METHODS A consecutive sample of 661 patients with acute coronary syndrome treated at 2 acute care centers ( 75 % response rate ) were recruited , one site with automatic referral via a computerized prompt and the other with a usual referral strategy at the physician 's discretion . Cardiac rehabilitation referral was discerned in a mailed survey 9 months later ( n = 506 ; 84 % retention ) , and verified with 24 cardiac rehabilitation sites to which participants were referred . RESULTS A total of 124 ( 52 % ) participants enrolled in cardiac rehabilitation following automatic referral , vs 84 ( 32 % ) following usual referral ( p < 0.001 ) . Automatically referred participants were more likely to be referred from an in- patient unit ( p < 0.01 ) , and to be referred in a shorter time period ( p < 0.001 ) . Logistic regression analyses revealed that , after controlling for sociodemographic characteristics and case-mix , automatically referred participants were significantly more likely to enroll in cardiac rehabilitation ( odds ratio = 2.1 ; 95 % confidence interval 1.4 - 3.3 ) than controls . CONCLUSION Automatic referral result ed in over 50 % verified cardiac rehabilitation enrollment ; 2 times more than usual referral . It also significantly reduced utilization delays to less than one month There is accumulating evidence for the benefits of exercise in Parkinson 's disease ( PD ) , but less is known about group exercise interventions . We evaluated the effect of gym-training programme on people with PD . Thirty-two adults with mild to moderate PD , not currently exercising formally , were r and omised to an immediate 20-week biweekly gym training programme at a local leisure complex , or a 10-week programme starting 10 weeks later . Assessment s at baseline ( T1 ) , 10 weeks ( T2 ) and 20 weeks ( T3 ) included reaction time , motor performance ( UPDRS ) , quality of life and illness perceptions . Experiences of the programme were assessed via question naire and a focus group . Overall UPDRS motor function score did not change over time . However , gym training was associated with significant improvements in reaction times and some timed tests in the immediate training group ( T1-T2 ) . The delayed group showed similar improvements following gym training ( T2-T3 ) . Participants reported enjoyment , obtaining social benefits , and increased confidence . However , the question naire measures did not show improvements in subjective health ratings or illness perceptions . Although benefits were not apparent in the question naire measures or overall UPDRS scores , our findings suggest that a 10-week gym training programme in a community setting can provide some benefits for people with PD BACKGROUND Patients who adhere to medications experience better outcomes than their nonadherent counterparts . However , these observations may be confounded by patient behaviors . The level of adherence necessary for patients to derive benefit and whether adherence to all agents is important for diseases that require multiple drugs remain unclear . This study quantifies the relationship between medication adherence and  post-myocardial infa rct ion (  MI ) adverse coronary events . METHODS This is a secondary analysis of the r and omized MI FREEE trial . Patients who received full prescription coverage  were classified as adherent ( proportion of days covered ≥80 % ) or not based upon achieved adherence in the 6 months after r and omization . First major vascular event or revascularization rates were compared using multivariable Cox models adjusting for comorbidity and health-seeking behavior . RESULTS Compared with patients r and omized to usual care , full coverage patients adherent to statin , β-blocker , or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker were significantly less likely to experience the study 's primary outcome ( hazard ratio [ HR ] range 0.64 - 0.81 ) . In contrast , nonadherent patients derived no benefit ( HR range 0.98 - 1.04 , P ≤ .01 for the difference in HRs between adherent and nonadherent patients ) . Partially adherent patients had no reduction in clinical outcomes for any of the drugs evaluated , although their achieved adherence was higher than that among controls . CONCLUSION Achieving high levels of adherence to each and all guideline -recommended post-MI secondary prevention medication is associated with improved event-free survival . Lower levels of adherence appear less protective BACKGROUND Asthma exacerbations during pregnancy are common and can be associated with substantial maternal and fetal morbidity . Treatment decisions based on s 
    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: BACKGROUND In spite of the well-demonstrated benefits for patients with COPD , pulmonary rehabilitation programmes show considerable drop-out and suboptimal attendance rates . The purpose of this prospect i ve study is to examine causes for drop-out and non-attendance during a 12 week multidisciplinary pulmonary rehabilitation programme , and to investigate whether sociodemographic and medical factors as well as patients ' perception of their illness are related to drop-out and non-attendance . METHODS Two hundred and seventeen patients with COPD who were referred to a rehabilitation centre participated in this multicentre study . Prior to treatment , patients received a question naire , which included the Illness Perception Question naire-Revised . Clinical data were drawn from medical records . Drop-out and attendance were recorded during the programme . RESULTS Fifty patients ( 23 % ) did not complete the rehabilitation course , of which half was due to medical reasons ( e.g. exacerbations , hospitalisations ) . Non-completion could not be predicted by baseline sociodemographic , clinical or psychological variables . Patients who declined treatment did not differ from patients who dropped out due to medical reasons . On average , patients attended 92 % of all scheduled appointments . Of all missed appointments , approximately 20 % were accountable to factors beyond patients ' control ( e.g. absent therapists , hospitalisations ) . Smoking , living alone , a lower fat free mass and lower confidence in treatment increased the chance of patients not attending an appointment during rehabilitation . CONCLUSION In general , adherence in rehabilitation is high . However , paying attention to patients ' nutritional status and creating a positive expectation of treatment during referral and intake appear to be important if one aims to optimise patients ' attendance during rehabilitation INTRODUCTION Pulmonary Rehabilitation ( PR ) reduces hospital admissions following an acute exacerbation of Chronic Obstructive Pulmonary Disease ( COPD ) but adherence is known to be poor . Patients ' illness perceptions may affect adherence to disease-management strategies but to date have not been explored following an exacerbation . The study aim is two-fold ; firstly to prospect ively explore acceptance and uptake of post-exacerbation PR and secondly to identify possible clusters of patients ' illness perceptions following hospitalisation for an exacerbation of COPD . METHODS Patients admitted to hospital with an exacerbation of COPD were recruited to a prospect i ve observational study . Self-reported illness perceptions , mood , health status and self-efficacy were assessed . Acceptance and uptake of PR were recorded at six months . Cluster analysis of Illness Perceptions Question naire-Revised data was used to establish groups of patients holding distinct beliefs . RESULTS 128 patients were recruited .  Acceptance and uptake of PR following an acute exacerbation was poor with only 9 % ( n = 11 ) completing the programme . Cluster analysis revealed three distinct groups : Cluster 1 ' in control ' ( n = 52 ) , Cluster 2 ' disengaged ' ( n = 36 ) and Cluster 3 ' distressed ' ( n = 40 ) . Significant between-cluster differences were observed in mood , health status and self-efficacy ( p < 0.01 ) . Acceptance and uptake of PR did not differ between clusters . CONCLUSIONS Acceptance/uptake of post-exacerbation PR was found to be poor . Three distinct illness schema exist in patients following an acute exacerbation . This information may be useful in developing novel psychologically-informed interventions design ed to reduce feelings of distress and perhaps facilitate a PR intervention for this vulnerable population OBJECTIVE Nonadherence to immunosuppressive medication ( IM ) after kidney transplantation is related to poorer patient and graft outcomes ; therefore research into modifiable factors associated with nonadherence is a priority . In this prospect i ve cohort study we investigated whether changes in goal cognitions , illness perceptions , and treatment beliefs were related to self-reported medication adherence six months after kidney transplantation . METHODS Interviews were conducted with patients in the out-patient clinic six weeks ( T1 : n=113 ) and six months ( T2 : n=106 ) after transplantation .  Self-reported adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale ( BAASIS © Interview ) . The  Brief Illness Perceptions Question naire , Beliefs about Medicines Question naire and questions on goal cognitions were also administered at both time points . RESULTS Self-reported nonadherence increased significantly between 6 weeks and 6 months after transplantation from 17 % to 27 % . Importance of medication adherence as a personal goal and self-efficacy to successfully carry out this goal decreased significantly over time . Perceived necessity of immunosuppressive medication was high but significantly decreased over time . Concerns about the medicines were low . There were no significant changes in illness perceptions or concerns over time . An increase in perceived graft longevity ( timeline ) was related to higher likelihood of nonadherence six months post-transplant . Furthermore , younger adult patients were more likely to be nonadherent six months after transplantation . CONCLUSION The self-reported nonadherence levels found in this study so soon after transplantation demonstrate the need for early and continued intervention after kidney transplantation in order to maximise adherence and consequently clinical outcomes . Changes in ( unrealistic ) beliefs regarding the longevity of the graft may offer a potential target for intervention among nonadherent patients Background Illness perceptions have been shown to predict patient activities . Therefore , studies of the effectiveness of a targeted illness-perception intervention on chronic nonspecific low back pain ( CLBP ) are needed . Objective The purpose of this study was to compare the effectiveness of treatment of illness perceptions against a waiting list for patients with CLBP . Design This was a prospect ively registered r and omized controlled trial with an assessor blinded for group allocation . Setting The study was conducted in an outpatient rehabilitation clinic . Participants The participants were 156 patients ( 18–70 years of age ) with CLBP ( > 3 months ) . Intervention Patients were r and omly assigned to either a treatment group or to a waiting list ( control ) group . Trained physical therapists and occupational therapists delivered 10 to 14 one-hour treatment sessions according to the treatment protocol . Measurements The primary outcome measure was change in patient-relevant physical activities ( Patient-Specific Complaints question naire ) . The secondary outcome measures were changes in illness perceptions ( Illness Perceptions Question naire ) and generic physical activity level ( Quebec Back Pain Disability Scale ) . Measurements were taken at baseline ( 0 weeks ) and after treatment ( 18 weeks ) . Results A baseline-adjusted analysis of covariance showed that there were statistically significant differences between intervention and control groups at 18 weeks for the change in patient-relevant physical activities . This was a clinical ly relevant change ( 19.1 mm ) for the intervention group . Statistically significant differences were found for the majority of illness perception scales . There were no significant differences in generic physical activity levels . Limitations Longer-term effectiveness was not studied . Conclusions This first trial evaluating cognitive treatment of illness perceptions concerning CLBP showed statistically significant and clinical ly relevant improvements in patient-relevant physical activities at 18 weeks Background Adherence with therapy could influence the progression of glaucoma and ultimately affect the onset of visual impairment in some individuals . This feasibility study evaluated the measures to be used for a future r and omized controlled trial assessing the effects of group-based education on adherence with eye drops . Methods People diagnosed with glaucoma within the previous 12 months attending a regional ophthalmology clinic in the North West of Engl and were recruited . A two-session education program delivered one week apart had been devised as part of a previous project . A combined adult learning and health needs approach to education was taken . Outcomes measured were knowledge of glaucoma , self-report of adherence , illness perception , beliefs about medicines , patient enablement , and general health ( Short Form-12 ) . Adherence was also measured objective ly using a Medical Events Monitoring System device . Results Twenty-six participants consented to undertake the educational program and 19 produced analyzable data . Knowledge of glaucoma , illness perception , beliefs about medicine , and patient enablement all showed statistically significant improvements after education . Mean adherence with eye drops was maintained above 85 % before and for 3 months after attendance at the educational program . Self-report exaggerated adherence by at least 10 % when compared with the objective Medical Events Monitoring System data , and in fact the kappa agreement was zero . Conclusion All question naires other than the Short Form-12 were considered to be valuable measures and use of a Medical Events Monitoring System device was considered to be an objective surrogate measure for adherence with eye drops . A multicenter , r and omized , controlled equivalence trial of group versus individualized education using adherence as the primary outcome is the next step OBJECTIVE Cardiac rehabilitation remains grossly under-utilized despite its proven benefits . This study prospect ively compared verified cardiac rehabilitation enrollment following automatic vs usual referral , postulating that automatic referral would result in significantly greater enrollment for cardiac rehabilitation . DESIGN Prospect i ve controlled multi-center study . PATIENTS AND METHODS A consecutive sample of 661 patients with acute coronary syndrome treated at 2 acute care centers ( 75 % response rate ) were recruited , one site with automatic referral via a computerized prompt and the other with a usual referral strategy at the physician 's discretion . Cardiac rehabilitation referral was discerned in a mailed survey 9 months later ( n = 506 ; 84 % retention ) , and verified with 24 cardiac rehabilitation sites to which participants were referred . RESULTS A total of 124 ( 52 % ) participants enrolled in cardiac rehabilitation following automatic referral , vs 84 ( 32 % ) following usual referral ( p < 0.001 ) . Automatically referred participants were more likely to be referred from an in- patient unit ( p < 0.01 ) , and to be referred in a shorter time period ( p < 0.001 ) . Logistic regression analyses revealed that , after controlling for sociodemographic characteristics and case-mix , automatically referred participants were significantly more likely to enroll in cardiac rehabilitation ( odds ratio = 2.1 ; 95 % confidence interval 1.4 - 3.3 ) than controls . CONCLUSION Automatic referral result ed in over 50 % verified cardiac rehabilitation enrollment ; 2 times more than usual referral . It also significantly reduced utilization delays to less than one month There is accumulating evidence for the benefits of exercise in Parkinson 's disease ( PD ) , but less is known about group exercise interventions . We evaluated the effect of gym-training programme on people with PD . Thirty-two adults with mild to moderate PD , not currently exercising formally , were r and omised to an immediate 20-week biweekly gym training programme at a local leisure complex , or a 10-week programme starting 10 weeks later . Assessment s at baseline ( T1 ) , 10 weeks ( T2 ) and 20 weeks ( T3 ) included reaction time , motor performance ( UPDRS ) , quality of life and illness perceptions . Experiences of the programme were assessed via question naire and a focus group . Overall UPDRS motor function score did not change over time . However , gym training was associated with significant improvements in reaction times and some timed tests in the immediate training group ( T1-T2 ) . The delayed group showed similar improvements following gym training ( T2-T3 ) . Participants reported enjoyment , obtaining social benefits , and increased confidence . However , the question naire measures did not show improvements in subjective health ratings or illness perceptions . Although benefits were not apparent in the question naire measures or overall UPDRS scores , our findings suggest that a 10-week gym training programme in a community setting can provide some benefits for people with PD BACKGROUND Patients who adhere to medications experience better outcomes than their nonadherent counterparts . However , these observations may be confounded by patient behaviors . The level of adherence necessary for patients to derive benefit and whether adherence to all agents is important for diseases that require multiple drugs remain unclear . This study quantifies the relationship between medication adherence and  post-myocardial infa rct ion (  MI ) adverse coronary events . METHODS This is a secondary analysis of the r and omized MI FREEE trial . Patients who received full prescription coverage  were classified as adherent ( proportion of days covered ≥80 % ) or not based upon achieved adherence in the 6 months after r and omization . First major vascular event or revascularization rates were compared using multivariable Cox models adjusting for comorbidity and health-seeking behavior . RESULTS Compared with patients r and omized to usual care , full coverage patients adherent to statin , β-blocker , or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker were significantly less likely to experience the study 's primary outcome ( hazard ratio [ HR ] range 0.64 - 0.81 ) . In contrast , nonadherent patients derived no benefit ( HR range 0.98 - 1.04 , P ≤ .01 for the difference in HRs between adherent and nonadherent patients ) . Partially adherent patients had no reduction in clinical outcomes for any of the drugs evaluated , although their achieved adherence was higher than that among controls . CONCLUSION Achieving high levels of adherence to each and all guideline -recommended post-MI secondary prevention medication is associated with improved event-free survival . Lower levels of adherence appear less protective BACKGROUND Asthma exacerbations during pregnancy are common and can be associated with substantial maternal and fetal morbidity . Treatment decisions based on s 
    Output:
    