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 patients with dementia are almost invariably unable to use any form of inhaler . Some elderly patients are unable to learn to use a metered dose inhaler or Turbohaler despite a normal abbreviated mental test score . Studies have shown that in many people this is due to unrecognised cognitive impairment and /or dyspraxia . The executive domains of cognition are particularly important in planning and sequencing ; it might be expected therefore that disordered frontal ( executive ) function could be a predictor of poor inhaler technique in subjects with no overt features of dementia . OBJECTIVE to explore the relationship between cognitive , and executive , function and the ability to acquire metered dose inhaler and Turbohaler technique in old age . DESIGN a prospect i ve r and omised observational study with blinded evaluation . SUBJECTS 30 inhaler-naive in patients ( 21 female ) with a mean age of 85 ( range 75 - 94 ) and having a normal ( 8 - 10 ) abbreviated mental test score . METHODS subjects received st and ardised metered dose inhaler and Turbohaler training and were scored on an analogue scale ( for metered dose inhaler ) or for competence ( Turbohaler ) the following day . The Mini-Mental State Examination and EXIT25 ( for executive function ) were performed by separate observers . RESULTS significant correlation was found between the metered dose inhaler score and Mini-Mental State Examination ( r 0.540 , P<0.002 ) and EXIT25 ( r -0.702 , P<0.0001 ) . Threshold effects emerged for the metered dose inhaler in that 18/19 with a competent score compared to 2/11 scored as incompetent had a Mini-Mental State Examination of > 23 ( P<0.01 ) and 19/19 compared to 0/11 had an EXIT25 of < 15 ( P<0.01 ) . Similarly , for the Turbohaler 21/21 of the competent subjects had a Mini-Mental State Examination of > 23 compared with 3/9 incompetent subjects ( P<0.01 ) , with 21/21 competent compared with 0/9 incompetent having an EXIT25 < 15 ( P<0.01 ) . CONCLUSION acquisition and short-term retention of metered dose inhaler and Turbohaler techniques is unlikely to be successful in frail elderly people who have an abnormal Mini-Mental State Examination and /or EXIT25 test . The latter test , when abnormal , is probably the superior predictor of inability to learn inhaler techniques OBJECTIVES To improve the asthma control and adherence to asthma preventer medication of older people using the Patient Asthma Concerns Tool ( PACT ) to identify and address unmet needs and patient concerns . METHODS Community dwelling adults over 55 years , living in Victoria or New South Wales were recruited into a single-blind , parallel design , r and omised-controlled trial comparing person-centred education including device technique , versus written information-only education .  Fifty-eight participants r and omised to the intervention group and 56 to the control completed participation . OUTCOME MEASURES asthma control , adherence to preventer medication , asthma related quality of life , asthma exacerbations and written action plan ownership were assessed at baseline , and 3 and 12 months post intervention . RESULTS Intervention participants experienced improvements in asthma control , adherence to asthma preventer medication , reduced exacerbations , improved quality of life and an increase in asthma action plan ownership at 3 and 12 months . CONCLUSION Asthma outcomes in older people can be significantly improved by delivering tailored education that identifies specific patient concerns and unmet needs . PRACTICAL IMPLICATION S Use of the PACT to identify patient concerns and unmet needs will assist health professionals to improve the health literacy of patients by addressing gaps in their knowledge and perceptions of asthma control BACKGROUND Good inhaler technique and medication concordance is important for symptom and disease control in chronic airways disease . OBJECTIVES Establish the prevalence of inhaler use ; the main inhaler devices used by older people at home ; their ability to use the inhalers they have been prescribed ; and the relationship between perceived ease of use and actual performance . DESIGN Cross-sectional population based study . SUBJECTS Subjects aged 70 years and over living at home . METHODS 500 subjects were r and omly selected from 5002 subjects aged 70 years and over living at home . Inhalers used over the previous 24 hours were identified by a nurse on home visit . Those with cognitive impairment were excluded .  Inhaler system  was assessed and grade d by a doctor as acceptable ( perfect or minor errors ) or unacceptable ( major errors ) , using previously published criteria . Perceived ease of use of the device was rated as easy , moderate or difficult . RESULTS 423 subjects participated in the study . The population prevalence of inhaler use was 15.8 % ( 12.0 , 19.7 ) . Of the 91 inhaler devices used , 39 ( 42.8 % ) were metered dose inhalers , 34 ( 37.4 % ) were metered dose inhalers with large volume spacers , and 18 ( 19.8 % ) were breath-actuated devices . Thirty-two subjects ( 82.1 % ) using metered dose inhalers had an acceptable technique compared with 33 ( 97.1 % ) of those using metered dose inhalers with large volume spacers and 13 ( 72.2 % ) of those using breath-actuated devices ( P < 0.05 ) . Up to three quarters of inhalers were considered easy to use but 12 % of subjects who rated their inhaler device as being easy to use made major errors . CONCLUSION Metered dose inhaler was the most frequently prescribed inhaler and was used correctly by most subjects especially in combination with large volume spacers . Major errors were more common with breath-actuated devices . Inhaler technique should be checked as patients ' perception of their inhaler skills correlates poorly with actual performance OBJECTIVE chronic obstructive pulmonary disease ( COPD ) prevalence steadily increases with age . However , the effectiveness of inhaled therapy in the elderly COPD population has rarely been formally evaluated . We studied a group of elderly patients with COPD with a range of severity , selected from one General Practice register to measure peak inspiratory flow ( PIF ) and assess patient perceived benefit . METHODS we recruited 53 r and omly selected elderly patients with COPD ( 36 males ) with a mean age of 73.5 years ( range 65 - 89 years ) . The evaluation consisted of ( i ) information obtained from directed questions and ( ii ) objective measurements of the ability to generate adequate PIF for a variety of inhalers . Patients answered questions regarding ease of use , perceived benefit from and specific problems encountered with their inhaler . Three recordings of PIF were measured at varying inhaled resistances using the ' In-Check Dial ' . RESULTS thirty-five were classified as mild , 17 moderate and 1 severe COPD . All patients used a metered dose inhaler ( pMDI ) , and 12 of the patients also used a dry powder inhaler ( DPI ) . Forty six per cent of patients using a pMDI and 17 % of those using a DPI rated their device difficult to use . No patient used a nebuliser . Thirty-one of the 53 patients using just a pMDI felt they were able to perceive benefit in comparison to 4 of the 12 DPI users . Even though most DPI users ( 10/12 ) had rated their inhaler as easy to use , 50 % were ' unsure ' as to whether they received any clinical benefit . Most patients were unable to generate sufficient inspiratory flow to use the higher resistance DPI 's and patients with COPD who were able to generate adequate PIF were invariably mild . A significant negative correlation was found between age and the PIF achieved when assessed using the high resistance device setting ( R = 0.84 , P<0.0001 ) . Multivariate analysis showed the effect of age on PIF was independent of the disease grade . CONCLUSIONS elderly patients with COPD , even when in a stable clinical condition , may be unable to gain optimum benefit from their inhaler UNLABELLED Twenty-five COPD patients , aged 65years or above , were recruited to test their ability to use dry powder inhaler H and ihaler ( Boeringher-Ingelheim ) and Aerolizer ( Novartis ) . The results of a score created to evaluate the inhalation technique were compared with age , MMSE , Barthel Index , FEV(1 ) , maximum inspiratory and expiratory pressures , and peak inspiratory flow ( PIF ) . RESULTS Dry powder inhalers were correctly used by 60 % of the patients ( 15 out of 25 ) . Among the capable ones , 13 out of 15 were aged less than 80 years ( p < or = 0.02 ) , 13 out of 15 had a maximum inspiratory pressure greater or equal to 53 cm H(2)O ( p < or = 0.001 ) and a PIF greater or equal to 120l/min ( p < or = 0.05 ) . All skilled patients had a minimum MMSE of 25 ( p < or = 0.001 ) . CONCLUSION In a geriatric population , age , the decrease of maximum inspiratory pressure and PIF as well as cognitive functions , limit the use of dry powder inhalers Poor inhaler technique is frequent in asthma , but its long-term consequences have been seldom assessed . Pharmacists are ideally positioned to teach inhaler technique . This prospect i ve observational study evaluated the feasibility of inhaler training by pharmacists in patients receiving inhaled corticosteroids by pressurised metered-dose inhaler ( pMDI ) or breath-actuated MDI . In parallel , the relationships between inhaler technique , adherence , and asthma control , and their modulation one month after training were assessed . Of 727 patients receiving training at pharmacies ( n=123 ) , 61 % were prescribed a pMDI ; 35 % , an Autohaler ( ® ) ; and 5 % , an Easi-Breathe ( ® ) inhaler .  Poor asthma control ( Asthma Control Question naire score ≥ 1.5 ) at baseline was significantly ( p<0.05 ) and independently associated with poor inhaler technique and poor self-reported adherence ( Morisky score ≥ 3 ) . The percentage of patients with optimal inhaler technique rose from 24 % before to 79 % after training ( p<0.001 ) . Median training session length was 6 min . At 1 month , mean ( SD ) ACQ score had improved from a baseline score of 1.8 ( 1.2 ) to 1.4 ( 1.1 ) , ( p<0.001 ) . Importantly , greater change was observed in patients with improved inhaler technique versus those without . Similar results were observed for Morisky score . Inhaler technique is associated with adherence and influences asthma control  . Inhaler training by pharmacists is feasible and seams to improve inhaler technique , asthma control and adherence The inhalation rate is important when patients use an inhaler . Dry powder inhalers ( DPIs ) require an inhalation rate > 30 L min(-1 ) whereas metered dose inhalers ( MDIs ) should be used at < 90 L min(-1 ) . Within the setting of a routine clinic , we have measured peak inhalation flows ( PIF ) of COPD patients when they used a Diskus ( SDSK ) , Turbuhaler ( STBH ) , H and ihaler ( SH AND ) and MDI . Subjects were then r and omised into trained ( VT ) and non-trained ( NT ) groups . One hundred and sixty-three patients with a mean ( S.D. ) age and % predicted FEV(1 ) of 72.5 ( 9.9 ) years and 47.8 (22.2)% completed the study . Of the patients , 4.9 % , 14.2 % and 57.0 % inhaled < 30 L min(-1 ) through SDSK , STHB and SH AND , respectively and 59.5 % inhaled > 90 L min(-1 ) with the MDI . Generally , the more severe the COPD , the slower was their PIF with all inhalers . The MDI PIF values in the VT group ( n=84 ) post-training were significantly ( p<0.001 ) slower but there was no change for the DPIs . Of the 55 VT patients inhaling > 90 L min(-1 ) through the MDI only 7 ( p<0.001 ) inhaled too fast post-training . Pre-training 3 , 15 and 46 VT subjects inhaled < 30 L min(-1 ) through the SDSK , STBH and SH AND and after training none , 5 and 26 did not inhale faster than this minimum required rate . Some COPD patients have problems achieving required PIFs through DPIs but training is useful to help some exceed the minimum required rate despite only small improvements . The patients found it easier to slow their PIF through the MDI The H and iHaler is a novel breath-actuated dry powder system design ed for the delivery of tiotropium 18microg daily in the treatment of COPD . We compared patient ability to use the H and iHaler or metered dose inhaler ( MDI ) device correctly 4 weeks after receiving brief instructions and device demonstration . A single-blind study was conducted in COPD patients in two centers in Denmark . ALL patients ( n = 151 ) received one placebo capsule via 
    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 patients with dementia are almost invariably unable to use any form of inhaler . Some elderly patients are unable to learn to use a metered dose inhaler or Turbohaler despite a normal abbreviated mental test score . Studies have shown that in many people this is due to unrecognised cognitive impairment and /or dyspraxia . The executive domains of cognition are particularly important in planning and sequencing ; it might be expected therefore that disordered frontal ( executive ) function could be a predictor of poor inhaler technique in subjects with no overt features of dementia . OBJECTIVE to explore the relationship between cognitive , and executive , function and the ability to acquire metered dose inhaler and Turbohaler technique in old age . DESIGN a prospect i ve r and omised observational study with blinded evaluation . SUBJECTS 30 inhaler-naive in patients ( 21 female ) with a mean age of 85 ( range 75 - 94 ) and having a normal ( 8 - 10 ) abbreviated mental test score . METHODS subjects received st and ardised metered dose inhaler and Turbohaler training and were scored on an analogue scale ( for metered dose inhaler ) or for competence ( Turbohaler ) the following day . The Mini-Mental State Examination and EXIT25 ( for executive function ) were performed by separate observers . RESULTS significant correlation was found between the metered dose inhaler score and Mini-Mental State Examination ( r 0.540 , P<0.002 ) and EXIT25 ( r -0.702 , P<0.0001 ) . Threshold effects emerged for the metered dose inhaler in that 18/19 with a competent score compared to 2/11 scored as incompetent had a Mini-Mental State Examination of > 23 ( P<0.01 ) and 19/19 compared to 0/11 had an EXIT25 of < 15 ( P<0.01 ) . Similarly , for the Turbohaler 21/21 of the competent subjects had a Mini-Mental State Examination of > 23 compared with 3/9 incompetent subjects ( P<0.01 ) , with 21/21 competent compared with 0/9 incompetent having an EXIT25 < 15 ( P<0.01 ) . CONCLUSION acquisition and short-term retention of metered dose inhaler and Turbohaler techniques is unlikely to be successful in frail elderly people who have an abnormal Mini-Mental State Examination and /or EXIT25 test . The latter test , when abnormal , is probably the superior predictor of inability to learn inhaler techniques OBJECTIVES To improve the asthma control and adherence to asthma preventer medication of older people using the Patient Asthma Concerns Tool ( PACT ) to identify and address unmet needs and patient concerns . METHODS Community dwelling adults over 55 years , living in Victoria or New South Wales were recruited into a single-blind , parallel design , r and omised-controlled trial comparing person-centred education including device technique , versus written information-only education .  Fifty-eight participants r and omised to the intervention group and 56 to the control completed participation . OUTCOME MEASURES asthma control , adherence to preventer medication , asthma related quality of life , asthma exacerbations and written action plan ownership were assessed at baseline , and 3 and 12 months post intervention . RESULTS Intervention participants experienced improvements in asthma control , adherence to asthma preventer medication , reduced exacerbations , improved quality of life and an increase in asthma action plan ownership at 3 and 12 months . CONCLUSION Asthma outcomes in older people can be significantly improved by delivering tailored education that identifies specific patient concerns and unmet needs . PRACTICAL IMPLICATION S Use of the PACT to identify patient concerns and unmet needs will assist health professionals to improve the health literacy of patients by addressing gaps in their knowledge and perceptions of asthma control BACKGROUND Good inhaler technique and medication concordance is important for symptom and disease control in chronic airways disease . OBJECTIVES Establish the prevalence of inhaler use ; the main inhaler devices used by older people at home ; their ability to use the inhalers they have been prescribed ; and the relationship between perceived ease of use and actual performance . DESIGN Cross-sectional population based study . SUBJECTS Subjects aged 70 years and over living at home . METHODS 500 subjects were r and omly selected from 5002 subjects aged 70 years and over living at home . Inhalers used over the previous 24 hours were identified by a nurse on home visit . Those with cognitive impairment were excluded .  Inhaler system  was assessed and grade d by a doctor as acceptable ( perfect or minor errors ) or unacceptable ( major errors ) , using previously published criteria . Perceived ease of use of the device was rated as easy , moderate or difficult . RESULTS 423 subjects participated in the study . The population prevalence of inhaler use was 15.8 % ( 12.0 , 19.7 ) . Of the 91 inhaler devices used , 39 ( 42.8 % ) were metered dose inhalers , 34 ( 37.4 % ) were metered dose inhalers with large volume spacers , and 18 ( 19.8 % ) were breath-actuated devices . Thirty-two subjects ( 82.1 % ) using metered dose inhalers had an acceptable technique compared with 33 ( 97.1 % ) of those using metered dose inhalers with large volume spacers and 13 ( 72.2 % ) of those using breath-actuated devices ( P < 0.05 ) . Up to three quarters of inhalers were considered easy to use but 12 % of subjects who rated their inhaler device as being easy to use made major errors . CONCLUSION Metered dose inhaler was the most frequently prescribed inhaler and was used correctly by most subjects especially in combination with large volume spacers . Major errors were more common with breath-actuated devices . Inhaler technique should be checked as patients ' perception of their inhaler skills correlates poorly with actual performance OBJECTIVE chronic obstructive pulmonary disease ( COPD ) prevalence steadily increases with age . However , the effectiveness of inhaled therapy in the elderly COPD population has rarely been formally evaluated . We studied a group of elderly patients with COPD with a range of severity , selected from one General Practice register to measure peak inspiratory flow ( PIF ) and assess patient perceived benefit . METHODS we recruited 53 r and omly selected elderly patients with COPD ( 36 males ) with a mean age of 73.5 years ( range 65 - 89 years ) . The evaluation consisted of ( i ) information obtained from directed questions and ( ii ) objective measurements of the ability to generate adequate PIF for a variety of inhalers . Patients answered questions regarding ease of use , perceived benefit from and specific problems encountered with their inhaler . Three recordings of PIF were measured at varying inhaled resistances using the ' In-Check Dial ' . RESULTS thirty-five were classified as mild , 17 moderate and 1 severe COPD . All patients used a metered dose inhaler ( pMDI ) , and 12 of the patients also used a dry powder inhaler ( DPI ) . Forty six per cent of patients using a pMDI and 17 % of those using a DPI rated their device difficult to use . No patient used a nebuliser . Thirty-one of the 53 patients using just a pMDI felt they were able to perceive benefit in comparison to 4 of the 12 DPI users . Even though most DPI users ( 10/12 ) had rated their inhaler as easy to use , 50 % were ' unsure ' as to whether they received any clinical benefit . Most patients were unable to generate sufficient inspiratory flow to use the higher resistance DPI 's and patients with COPD who were able to generate adequate PIF were invariably mild . A significant negative correlation was found between age and the PIF achieved when assessed using the high resistance device setting ( R = 0.84 , P<0.0001 ) . Multivariate analysis showed the effect of age on PIF was independent of the disease grade . CONCLUSIONS elderly patients with COPD , even when in a stable clinical condition , may be unable to gain optimum benefit from their inhaler UNLABELLED Twenty-five COPD patients , aged 65years or above , were recruited to test their ability to use dry powder inhaler H and ihaler ( Boeringher-Ingelheim ) and Aerolizer ( Novartis ) . The results of a score created to evaluate the inhalation technique were compared with age , MMSE , Barthel Index , FEV(1 ) , maximum inspiratory and expiratory pressures , and peak inspiratory flow ( PIF ) . RESULTS Dry powder inhalers were correctly used by 60 % of the patients ( 15 out of 25 ) . Among the capable ones , 13 out of 15 were aged less than 80 years ( p < or = 0.02 ) , 13 out of 15 had a maximum inspiratory pressure greater or equal to 53 cm H(2)O ( p < or = 0.001 ) and a PIF greater or equal to 120l/min ( p < or = 0.05 ) . All skilled patients had a minimum MMSE of 25 ( p < or = 0.001 ) . CONCLUSION In a geriatric population , age , the decrease of maximum inspiratory pressure and PIF as well as cognitive functions , limit the use of dry powder inhalers Poor inhaler technique is frequent in asthma , but its long-term consequences have been seldom assessed . Pharmacists are ideally positioned to teach inhaler technique . This prospect i ve observational study evaluated the feasibility of inhaler training by pharmacists in patients receiving inhaled corticosteroids by pressurised metered-dose inhaler ( pMDI ) or breath-actuated MDI . In parallel , the relationships between inhaler technique , adherence , and asthma control , and their modulation one month after training were assessed . Of 727 patients receiving training at pharmacies ( n=123 ) , 61 % were prescribed a pMDI ; 35 % , an Autohaler ( ® ) ; and 5 % , an Easi-Breathe ( ® ) inhaler .  Poor asthma control ( Asthma Control Question naire score ≥ 1.5 ) at baseline was significantly ( p<0.05 ) and independently associated with poor inhaler technique and poor self-reported adherence ( Morisky score ≥ 3 ) . The percentage of patients with optimal inhaler technique rose from 24 % before to 79 % after training ( p<0.001 ) . Median training session length was 6 min . At 1 month , mean ( SD ) ACQ score had improved from a baseline score of 1.8 ( 1.2 ) to 1.4 ( 1.1 ) , ( p<0.001 ) . Importantly , greater change was observed in patients with improved inhaler technique versus those without . Similar results were observed for Morisky score . Inhaler technique is associated with adherence and influences asthma control  . Inhaler training by pharmacists is feasible and seams to improve inhaler technique , asthma control and adherence The inhalation rate is important when patients use an inhaler . Dry powder inhalers ( DPIs ) require an inhalation rate > 30 L min(-1 ) whereas metered dose inhalers ( MDIs ) should be used at < 90 L min(-1 ) . Within the setting of a routine clinic , we have measured peak inhalation flows ( PIF ) of COPD patients when they used a Diskus ( SDSK ) , Turbuhaler ( STBH ) , H and ihaler ( SH AND ) and MDI . Subjects were then r and omised into trained ( VT ) and non-trained ( NT ) groups . One hundred and sixty-three patients with a mean ( S.D. ) age and % predicted FEV(1 ) of 72.5 ( 9.9 ) years and 47.8 (22.2)% completed the study . Of the patients , 4.9 % , 14.2 % and 57.0 % inhaled < 30 L min(-1 ) through SDSK , STHB and SH AND , respectively and 59.5 % inhaled > 90 L min(-1 ) with the MDI . Generally , the more severe the COPD , the slower was their PIF with all inhalers . The MDI PIF values in the VT group ( n=84 ) post-training were significantly ( p<0.001 ) slower but there was no change for the DPIs . Of the 55 VT patients inhaling > 90 L min(-1 ) through the MDI only 7 ( p<0.001 ) inhaled too fast post-training . Pre-training 3 , 15 and 46 VT subjects inhaled < 30 L min(-1 ) through the SDSK , STBH and SH AND and after training none , 5 and 26 did not inhale faster than this minimum required rate . Some COPD patients have problems achieving required PIFs through DPIs but training is useful to help some exceed the minimum required rate despite only small improvements . The patients found it easier to slow their PIF through the MDI The H and iHaler is a novel breath-actuated dry powder system design ed for the delivery of tiotropium 18microg daily in the treatment of COPD . We compared patient ability to use the H and iHaler or metered dose inhaler ( MDI ) device correctly 4 weeks after receiving brief instructions and device demonstration . A single-blind study was conducted in COPD patients in two centers in Denmark . ALL patients ( n = 151 ) received one placebo capsule via 
    Output:
    