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 Few interventions have focused on the difficulties that African American women face when managing asthma . OBJECTIVE To evaluate a telephone-based self-regulation intervention that emphasized African American women 's management of asthma in a series of 6 sessions . METHODS A total of 422 African American women with persistent asthma were r and omly assigned to either an intervention or control group receiving usual care .  Behavioral factors , symptoms and asthma control , asthma-related quality of life , and health care use at baseline and 2 years after baseline were assessed . Generalized estimating equations were used to assess the long-term effect of the intervention on outcomes . RESULTS Compared with the control group , those who completed the full intervention ( 6 sessions ) had significant gains in self-regulation of their asthma ( B estimate , 0.73 ; 95 % CI , 0.17 - 1.30 ; P < .01 ) , noticing changes to their asthma during their menstrual cycle ( B estimate , 1.42 ; 95 % CI , 0.69 - 2.15 ; P < .001 ) , and when having premenstrual syndrome ( B estimate , 1.70 ; 95 % CI , 0.67 - 2.72 ; P < .001 ) . They also had significant reductions in daytime symptoms ( B estimate , -0.15 ; 95 % CI , -0.27 to -0.03 ; P < .01 ) , asthma-related hospitalization ( B estimate , 0.51 ; 95 % CI , 0.00 - 1.02 ; P < .05 ) , and improved asthma control ( B estimate , 1.34 ; 95 % CI , 0.57 - 2.12 ; P < .001 ) . However , neither grouped changed over time in outcomes . CONCLUSION Despite high comorbidity , African American women who completed a culturally responsive self-management program had improvements in asthma outcomes compared with the control group . Future work should address significant comorbidities and psychosocial issues alongside asthma management to improve asthma outcomes in the long term . TRIAL REGISTRATION clinical trials.gov Identifier NCT01117805 Background : Despite national disease management plans , optimal asthma management remains a challenge in Australia . Community pharmacists are ideally placed to implement new strategies that aim to ensure asthma care meets current st and ards of best practice . The impact of the Pharmacy Asthma Care Program ( PACP ) on asthma control was assessed using a multi-site r and omised intervention versus control repeated measures study design . Methods : Fifty Australian pharmacies were r and omised into two groups : intervention pharmacies  implemented the PACP ( an ongoing cycle of assessment , goal setting , monitoring and review )  to 191 patients over 6 months , while control pharmacies gave their usual care to 205 control patients . Both groups administered question naires and conducted spirometric testing at baseline and 6 months later . The main outcome measure was asthma severity/control status . Results : 186 of 205 control patients ( 91 % ) and 165 of 191 intervention patients ( 86 % ) completed the study . The intervention result ed in improved asthma control : patients receiving the intervention were 2.7 times more likely to improve from “ severe ” to “ not severe ” than control patients ( OR 2.68 , 95 % CI 1.64 to 4.37 ; p<0.001 ) . The intervention also result ed in improved adherence to preventer medication ( OR 1.89 , 95 % CI 1.08 to 3.30 ; p = 0.03 ) , decreased mean daily dose of reliever medication ( difference −149.11 μg , 95 % CI −283.87 to −14.36 ; p = 0.03 ) , a shift in medication profile from reliever only to a combination of preventer , reliever with or without long-acting β agonist ( OR 3.80 , 95 % CI 1.40 to 10.32 ; p = 0.01 ) and improved scores on risk of non-adherence ( difference −0.44 , 95 % CI −0.69 to −0.18 ; p = 0.04 ) , quality of life ( difference −0.23 , 95 % CI −0.46 to 0.00 ; p = 0.05 ) , asthma knowledge ( difference 1.18 , 95 % CI 0.73 to 1.63 ; p<0.01 ) and perceived control of asthma question naires ( difference −1.39 , 95 % CI −2.44 to −0.35 ; p<0.01 ) . No significant change in spirometric measures occurred in either group . Conclusions : A pharmacist-delivered asthma care programme based on national guidelines improves asthma control . The sustainability and implementation of the programme within the healthcare system remains to be investigated Background Supporting self-management behaviours is recommended guidance for people with asthma . Preliminary work suggests that a brief , intensive , patient-centred intervention may be successful in supporting people with asthma to participate in life roles and activities they value . We seek to assess the feasibility of undertaking a cluster-r and omised controlled trial ( c RCT ) of a brief , goal - setting intervention delivered in the context of an asthma review consultation . Methods / design A two armed , single-blinded , multi-centre , cluster-r and omised controlled feasibility trial will be conducted in UK primary care . R and omisation will take place at the practice level . We aim to recruit a total of 80 primary care patients with active asthma from at least eight practice s across two health boards in Scotl and ( 10 patients per practice result ing in ~40 in each arm ) . Patients in the intervention arm will be asked to complete a novel goal - setting tool immediately prior to an asthma review consultation . This will be used to underpin a focussed discussion about their goals during the asthma review . A tailored management plan will then be negotiated to facilitate achieving their prioritised goals . Patients in the control arm will receive a usual care guideline -based review of asthma . Data on quality of life , asthma control and patient confidence will be collected from both arms at baseline and 3 and 6 months post-intervention . Data on health services re source use will be collected from all patient records 6 months pre- and post-intervention . Semi-structured interviews will be carried out with healthcare staff and a purposive sample of patients to elicit their views and experiences of the trial . The outcomes of interest in this feasibility trial are the ability to recruit patients and healthcare staff , the optimal method of delivering the intervention within routine clinical practice , and acceptability and perceived utility of the intervention among patients and staff . Trial registration IS RCT Optimal use of goal - setting strategies in self-management efforts with high-risk individuals with asthma is not well understood . This study aim ed to describe factors associated with goal attainment in an asthma self-management intervention for African American women with asthma and determine whether goal attainment methods proved beneficial to goal achievement and improved asthma outcomes . Data came from 212 African American women in the intervention arm of a r and omized clinical trial evaluating a telephone-based asthma self-management program . Telephone interview data were collected to assess goals and goal attainment methods identified , asthma symptoms , asthma control , and asthma-related quality of life at baseline and 2-year follow-up . Generalized estimating equations were used to assess the long-term impact of goal setting and goal attainment methods on outcomes .  The average age of the sample was 42.1 years ( SD = 14.8 ) . Factors associated with goal attainment included higher education ( p < .01 ) and fewer depressive symptoms ( p < .01 ) . Using a goal attainment method also result ed in more goals being achieved over the course of the intervention ( Estimate [ SE ] = 1.25 [ 0.18 ] ; p < .001 ) when adjusted for clinical and demographic factors . Use of and types of goal attainment methods and goals were not found to significantly affect asthma control , quality of life , or frequency of nighttime asthma symptoms at follow-up . Using a method to achieve goals led to greater goal attainment . Goal attainment alone did not translate into improved asthma outcomes in our study sample . Further studies are warranted to assess the challenges of self-management in chronic disease patients with complex health needs and how goal setting and goal attainment methods can be strategically integrated into self-management efforts to improve health endpoints Background Despite being a core component of self-management , goal setting is rarely used in routine care . We piloted a primary care , nurse-led intervention called Achieving Good Outcomes for Asthma Living ( GOAL )  for adults with asthma . Patients were invited to identify and prioritise their goals in preparation for discussing and negotiating an action/coping plan with the nurse at a routine asthma review . Methods The 18-month mixed methods feasibility cluster pilot trial stratified and then r and omised practice s to deliver usual care ( UC ) or a goal - setting intervention ( GOAL ) . Practice asthma nurses and adult patients with active asthma were invited to participate . The primary outcome was asthma-specific quality of life . Semi-structured interviews with a purposive patient sample ( n = 14 ) and 10 participating nurses explored GOAL perception . The constructs of normalisation process theory ( NPT ) were used to analyse and interpret data . Results Ten practice s participated ( five in each arm ) , exceeding our target of eight . However , only 48 patients ( target 80 ) were recruited ( 18 in GOAL practice s ) . At 6 months post-intervention , the difference in mean asthma-related quality of life ( mAQLQ ) between intervention and control was 0.1 ( GOAL 6.20 : SD 0.76 ( CI 5.76–6.65 ) versus UC 6.1 : SD 0.81 ( CI 5.63–6.57 ) ) , less than the minimal clinical ly important difference ( MCID ) of 0.5 . However , change from baseline was stronger in the intervention group : at 6 months the change in the emotions sub-score was 0.8 for intervention versus 0.2 for control . Costs were higher in the intervention group by £ 22.17.Routine review with goal setting was considered more holistic , enhancing rapport and enabling patients to become active rather than passive participants in healthcare . However , time was a major barrier for nurses , who admitted to screening out patient goals they believed were unrelated to asthma . Conclusions The difference in AQLQ score from baseline is larger in the intervention arm than the control , indicating the intervention may have impact if appropriately strengthened . The GOAL intervention changed the review dynamic and was well received by patients , but necessitated additional time , which was problematic in the confines of the traditional nurse appointment . Modification to recruitment methods and further development of the intervention are needed before proceeding to a definitive cluster r and omised controlled trial . Trial registration IS RCT N18912042 . Registered on 26 June 2012 OBJECTIVES To evaluate a self-regulation intervention for asthma for older adults . DESIGN A blinded r and omized controlled trial . SETTING Single-center tertiary care academic center . PARTICIPANTS Seventy older adults aged 65 and older with persistent asthma r and omized to an intervention or control group . INTERVENTION Participants participate in a six-session program conducted over the telephone and in group sessions . Participants selected an asthma-specific goal , identified problems , and addressed potential barriers . MEASUREMENTS Outcomes were assessed at 1 , 6 , and 12 months and included the mini-Asthma Quality of Life Question naire ( mAQLQ ) , Asthma Control Question naire ( ACQ ) , healthcare utilization , exhaled nitric oxide ( FENO ) , and percentage of predicted forced expiratory volume in 1 second ( FEV1 % ) . RESULTS The mAQLQ score was significantly higher in the intervention group at 1 , 6 , and 12 months , even after controlling for confounding factors . The between-group difference decreased over time , although at 12 months , it remained greater than 0.5 points . The ACQ was better in the intervention group than in the control group at 1 , 6 , and 12 months . At 12 months , those in the intervention group were 4.2 times as likely as those in the control group to have an ACQ score in the controlled range . Healthcare utilization was lower in the intervention group , although no difference was observed in FENO or predicted FEV1 % . CONCLUSION A self-regulation intervention can improve asthma control , quality of life , and healthcare utilization in older adults Low-income African American children have disproportionately higher asthma morbidity and mortality . Education alone may not address barriers to asthma management due to psychosocial stress . This study evaluated the efficacy of a home-based family intervention integrating asthma education and strategies to address stress using a community-based participatory research model . Children age 8 to 13 with poorly controlled asthma and their caregivers were recruited from an urban hospital and an asthma camp . Caregivers with elevated scores on a stress measure were enrolled . Forty-three families were r and omized to the 4- to 6-session Home Based Family Intervention ( HBFI ) or the single session of Enhanced Treatment as Usual ( ETAU ) . All families received an asthma action plan and dust mite covers ; children performed spirometry and demonstrated MDI/spacer technique at each home visit . The HBFI addressed family-selected goals targeting asthma management and stressors . Asthma management , morbidity , family functioning , and caregiver stress were assessed at baseline , post 
    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 Few interventions have focused on the difficulties that African American women face when managing asthma . OBJECTIVE To evaluate a telephone-based self-regulation intervention that emphasized African American women 's management of asthma in a series of 6 sessions . METHODS A total of 422 African American women with persistent asthma were r and omly assigned to either an intervention or control group receiving usual care .  Behavioral factors , symptoms and asthma control , asthma-related quality of life , and health care use at baseline and 2 years after baseline were assessed . Generalized estimating equations were used to assess the long-term effect of the intervention on outcomes . RESULTS Compared with the control group , those who completed the full intervention ( 6 sessions ) had significant gains in self-regulation of their asthma ( B estimate , 0.73 ; 95 % CI , 0.17 - 1.30 ; P < .01 ) , noticing changes to their asthma during their menstrual cycle ( B estimate , 1.42 ; 95 % CI , 0.69 - 2.15 ; P < .001 ) , and when having premenstrual syndrome ( B estimate , 1.70 ; 95 % CI , 0.67 - 2.72 ; P < .001 ) . They also had significant reductions in daytime symptoms ( B estimate , -0.15 ; 95 % CI , -0.27 to -0.03 ; P < .01 ) , asthma-related hospitalization ( B estimate , 0.51 ; 95 % CI , 0.00 - 1.02 ; P < .05 ) , and improved asthma control ( B estimate , 1.34 ; 95 % CI , 0.57 - 2.12 ; P < .001 ) . However , neither grouped changed over time in outcomes . CONCLUSION Despite high comorbidity , African American women who completed a culturally responsive self-management program had improvements in asthma outcomes compared with the control group . Future work should address significant comorbidities and psychosocial issues alongside asthma management to improve asthma outcomes in the long term . TRIAL REGISTRATION clinical trials.gov Identifier NCT01117805 Background : Despite national disease management plans , optimal asthma management remains a challenge in Australia . Community pharmacists are ideally placed to implement new strategies that aim to ensure asthma care meets current st and ards of best practice . The impact of the Pharmacy Asthma Care Program ( PACP ) on asthma control was assessed using a multi-site r and omised intervention versus control repeated measures study design . Methods : Fifty Australian pharmacies were r and omised into two groups : intervention pharmacies  implemented the PACP ( an ongoing cycle of assessment , goal setting , monitoring and review )  to 191 patients over 6 months , while control pharmacies gave their usual care to 205 control patients . Both groups administered question naires and conducted spirometric testing at baseline and 6 months later . The main outcome measure was asthma severity/control status . Results : 186 of 205 control patients ( 91 % ) and 165 of 191 intervention patients ( 86 % ) completed the study . The intervention result ed in improved asthma control : patients receiving the intervention were 2.7 times more likely to improve from “ severe ” to “ not severe ” than control patients ( OR 2.68 , 95 % CI 1.64 to 4.37 ; p<0.001 ) . The intervention also result ed in improved adherence to preventer medication ( OR 1.89 , 95 % CI 1.08 to 3.30 ; p = 0.03 ) , decreased mean daily dose of reliever medication ( difference −149.11 μg , 95 % CI −283.87 to −14.36 ; p = 0.03 ) , a shift in medication profile from reliever only to a combination of preventer , reliever with or without long-acting β agonist ( OR 3.80 , 95 % CI 1.40 to 10.32 ; p = 0.01 ) and improved scores on risk of non-adherence ( difference −0.44 , 95 % CI −0.69 to −0.18 ; p = 0.04 ) , quality of life ( difference −0.23 , 95 % CI −0.46 to 0.00 ; p = 0.05 ) , asthma knowledge ( difference 1.18 , 95 % CI 0.73 to 1.63 ; p<0.01 ) and perceived control of asthma question naires ( difference −1.39 , 95 % CI −2.44 to −0.35 ; p<0.01 ) . No significant change in spirometric measures occurred in either group . Conclusions : A pharmacist-delivered asthma care programme based on national guidelines improves asthma control . The sustainability and implementation of the programme within the healthcare system remains to be investigated Background Supporting self-management behaviours is recommended guidance for people with asthma . Preliminary work suggests that a brief , intensive , patient-centred intervention may be successful in supporting people with asthma to participate in life roles and activities they value . We seek to assess the feasibility of undertaking a cluster-r and omised controlled trial ( c RCT ) of a brief , goal - setting intervention delivered in the context of an asthma review consultation . Methods / design A two armed , single-blinded , multi-centre , cluster-r and omised controlled feasibility trial will be conducted in UK primary care . R and omisation will take place at the practice level . We aim to recruit a total of 80 primary care patients with active asthma from at least eight practice s across two health boards in Scotl and ( 10 patients per practice result ing in ~40 in each arm ) . Patients in the intervention arm will be asked to complete a novel goal - setting tool immediately prior to an asthma review consultation . This will be used to underpin a focussed discussion about their goals during the asthma review . A tailored management plan will then be negotiated to facilitate achieving their prioritised goals . Patients in the control arm will receive a usual care guideline -based review of asthma . Data on quality of life , asthma control and patient confidence will be collected from both arms at baseline and 3 and 6 months post-intervention . Data on health services re source use will be collected from all patient records 6 months pre- and post-intervention . Semi-structured interviews will be carried out with healthcare staff and a purposive sample of patients to elicit their views and experiences of the trial . The outcomes of interest in this feasibility trial are the ability to recruit patients and healthcare staff , the optimal method of delivering the intervention within routine clinical practice , and acceptability and perceived utility of the intervention among patients and staff . Trial registration IS RCT Optimal use of goal - setting strategies in self-management efforts with high-risk individuals with asthma is not well understood . This study aim ed to describe factors associated with goal attainment in an asthma self-management intervention for African American women with asthma and determine whether goal attainment methods proved beneficial to goal achievement and improved asthma outcomes . Data came from 212 African American women in the intervention arm of a r and omized clinical trial evaluating a telephone-based asthma self-management program . Telephone interview data were collected to assess goals and goal attainment methods identified , asthma symptoms , asthma control , and asthma-related quality of life at baseline and 2-year follow-up . Generalized estimating equations were used to assess the long-term impact of goal setting and goal attainment methods on outcomes .  The average age of the sample was 42.1 years ( SD = 14.8 ) . Factors associated with goal attainment included higher education ( p < .01 ) and fewer depressive symptoms ( p < .01 ) . Using a goal attainment method also result ed in more goals being achieved over the course of the intervention ( Estimate [ SE ] = 1.25 [ 0.18 ] ; p < .001 ) when adjusted for clinical and demographic factors . Use of and types of goal attainment methods and goals were not found to significantly affect asthma control , quality of life , or frequency of nighttime asthma symptoms at follow-up . Using a method to achieve goals led to greater goal attainment . Goal attainment alone did not translate into improved asthma outcomes in our study sample . Further studies are warranted to assess the challenges of self-management in chronic disease patients with complex health needs and how goal setting and goal attainment methods can be strategically integrated into self-management efforts to improve health endpoints Background Despite being a core component of self-management , goal setting is rarely used in routine care . We piloted a primary care , nurse-led intervention called Achieving Good Outcomes for Asthma Living ( GOAL )  for adults with asthma . Patients were invited to identify and prioritise their goals in preparation for discussing and negotiating an action/coping plan with the nurse at a routine asthma review . Methods The 18-month mixed methods feasibility cluster pilot trial stratified and then r and omised practice s to deliver usual care ( UC ) or a goal - setting intervention ( GOAL ) . Practice asthma nurses and adult patients with active asthma were invited to participate . The primary outcome was asthma-specific quality of life . Semi-structured interviews with a purposive patient sample ( n = 14 ) and 10 participating nurses explored GOAL perception . The constructs of normalisation process theory ( NPT ) were used to analyse and interpret data . Results Ten practice s participated ( five in each arm ) , exceeding our target of eight . However , only 48 patients ( target 80 ) were recruited ( 18 in GOAL practice s ) . At 6 months post-intervention , the difference in mean asthma-related quality of life ( mAQLQ ) between intervention and control was 0.1 ( GOAL 6.20 : SD 0.76 ( CI 5.76–6.65 ) versus UC 6.1 : SD 0.81 ( CI 5.63–6.57 ) ) , less than the minimal clinical ly important difference ( MCID ) of 0.5 . However , change from baseline was stronger in the intervention group : at 6 months the change in the emotions sub-score was 0.8 for intervention versus 0.2 for control . Costs were higher in the intervention group by £ 22.17.Routine review with goal setting was considered more holistic , enhancing rapport and enabling patients to become active rather than passive participants in healthcare . However , time was a major barrier for nurses , who admitted to screening out patient goals they believed were unrelated to asthma . Conclusions The difference in AQLQ score from baseline is larger in the intervention arm than the control , indicating the intervention may have impact if appropriately strengthened . The GOAL intervention changed the review dynamic and was well received by patients , but necessitated additional time , which was problematic in the confines of the traditional nurse appointment . Modification to recruitment methods and further development of the intervention are needed before proceeding to a definitive cluster r and omised controlled trial . Trial registration IS RCT N18912042 . Registered on 26 June 2012 OBJECTIVES To evaluate a self-regulation intervention for asthma for older adults . DESIGN A blinded r and omized controlled trial . SETTING Single-center tertiary care academic center . PARTICIPANTS Seventy older adults aged 65 and older with persistent asthma r and omized to an intervention or control group . INTERVENTION Participants participate in a six-session program conducted over the telephone and in group sessions . Participants selected an asthma-specific goal , identified problems , and addressed potential barriers . MEASUREMENTS Outcomes were assessed at 1 , 6 , and 12 months and included the mini-Asthma Quality of Life Question naire ( mAQLQ ) , Asthma Control Question naire ( ACQ ) , healthcare utilization , exhaled nitric oxide ( FENO ) , and percentage of predicted forced expiratory volume in 1 second ( FEV1 % ) . RESULTS The mAQLQ score was significantly higher in the intervention group at 1 , 6 , and 12 months , even after controlling for confounding factors . The between-group difference decreased over time , although at 12 months , it remained greater than 0.5 points . The ACQ was better in the intervention group than in the control group at 1 , 6 , and 12 months . At 12 months , those in the intervention group were 4.2 times as likely as those in the control group to have an ACQ score in the controlled range . Healthcare utilization was lower in the intervention group , although no difference was observed in FENO or predicted FEV1 % . CONCLUSION A self-regulation intervention can improve asthma control , quality of life , and healthcare utilization in older adults Low-income African American children have disproportionately higher asthma morbidity and mortality . Education alone may not address barriers to asthma management due to psychosocial stress . This study evaluated the efficacy of a home-based family intervention integrating asthma education and strategies to address stress using a community-based participatory research model . Children age 8 to 13 with poorly controlled asthma and their caregivers were recruited from an urban hospital and an asthma camp . Caregivers with elevated scores on a stress measure were enrolled . Forty-three families were r and omized to the 4- to 6-session Home Based Family Intervention ( HBFI ) or the single session of Enhanced Treatment as Usual ( ETAU ) . All families received an asthma action plan and dust mite covers ; children performed spirometry and demonstrated MDI/spacer technique at each home visit . The HBFI addressed family-selected goals targeting asthma management and stressors . Asthma management , morbidity , family functioning , and caregiver stress were assessed at baseline , post 
    Output:
    