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 : Until now , care provided by asthma nurses has been additional to care provided by paediatricians . A study was undertaken to compare nurse led outpatient management of childhood asthma with follow up by a paediatrician . Methods : Seventy four children referred because of insufficient control of persistent asthma were r and omly allocated to 1 year follow up by a paediatrician or asthma nurse . The main outcome measure was the percentage of symptom-free days . Additional outcome measures were airway hyperresponsiveness , lung function , daily dose of inhaled corticosteroids ( ICS ) , number of exacerbations , number of additional visits to the general practitioner , absence from school , functional health status , and disease specific quality of life . Results : There were no significant differences at the end of the 1 year study period between the two treatment groups in percentage of symptom-free days ( mean difference 2.5 % ; 95 % CI −8.8 to 13.8 ) , airway hyperresponsiveness ( log10 PD20 0.06 ; −0.19 to 0.32 ) , functional health status ( 10.1 ; −0.3 to 19.8 ) , disease specific quality of life of patients ( 0.08 ; −0.9 to 0.7 ) , and disease specific quality of life of caregivers ( 0.09 ; −0.2 to 0.3 ) , nor in any other outcome parameters . Most outcome parameters improved considerably over the 1 year study period . These improvements were achieved although the daily dose of ICS was reduced by a mean of 26 % compared with the dose received by children at referral . All parents were satisfied with the asthma care received . Conclusions : After initial assessment in a multidisciplinary clinic , childhood asthma can be successfully managed by an asthma nurse in close cooperation with a paediatrician . During close follow up by paediatrician or asthma nurse , asthma control improved despite a reduction in ICS dose Background : The effects on morbidity were examined of providing an educational intervention and a written guided self-management plan to the parents of pre-school children following a recent attendance at hospital for asthma or wheeze . Methods : A prospect i ve , r and omised , partially blinded , controlled trial was design ed at two secondary care centres . Over a 13 month period 200 children aged 18 months to 5 years at the time of admission to a children 's ward or attendance at an accident and emergency department or children 's ( emergency ) assessment unit ( A&E/CAU ) with a primary diagnosis of acute severe asthma or wheezing were recruited . 101 children were r and omised into the control group and received usual care and 99 were assigned to the intervention group and received : ( 1 ) a pre-school asthma booklet ; ( 2 ) a written guided self-management plan ; and ( 3 ) two 20 minute structured educational sessions between a specialist respiratory nurse and the parent(s ) and child . Subjects were assessed at 3 , 6 , and 12 months . The main outcomes were GP consultation rates , hospital re-admissions , and attendances at A&E/CAU . Secondary outcomes included disability score , caregivers ' quality of life , and parental knowledge of asthma . Results : There were no statistically significant differences between the two groups during the 12 month follow up period for any of the main or secondary outcome measures . Conclusions : These results do not support the hypothesis that the introduction of an educational package and a written guided self-management plan to the parents of pre-school children with asthma who had recently attended hospital for troublesome asthma or wheeze reduces morbidity over the subsequent 12 months A r and omised controlled study of an educational programme for children with asthma and their families was carried out by community child health nurses . Three hundred and sixty eight children aged 2 to 14 years were enrolled in the study after admission to hospital for asthma . The intervention group was visited monthly by a nurse for six months . The subjects were assessed six months later by a postal , self administered question naire . European children in the intervention group were taking significantly more drugs for the treatment of asthma six months after the index admission to hospital than those in the control group ( mean ( SD ) intake 2.7 ( 1.1 ) v 2.1 ( 1.0 ) , respectively ) . In particular , they were using more  theophylline  ( 56.6 % v 37.0 % ) and  inhaled steroids  ( 34.9 % v 21.0 % ) . There was no difference between the groups for parental reports of improvement , of missed schooling , and in severe attacks of asthma of not responding to the usual treatment at home . European children in the intervention group used the hospital services for severe attacks of asthma more than controls ( 34.2 % v 10.5 % ) . There were more re-admissions in the European intervention group in the subsequent six months after the index admission than in the control group ( mean ( SD ) 0.51 ( 0.97 ) v 0.29 ( 0.65 ) . Re-admission continued to be higher in the 12 months after the nurse had stopped visiting ( 0.81 ( 1.65 ) v 0.25 ( 0.65 ] . There was no difference in the duration of hospital stay between the intervention and control groups . For Polynesian children there was no difference between the groups for any outcome measures BACKGROUND Studies examining the influence of provider behavior and patterns of care delivery on the use of anti-inflammatory asthma therapy have been limited to selected population s or have been unable to assess the appropriateness of therapy for individuals . We have previously reported the influence of sociodemographic variables and asthma severity on reported use of asthma medications in the United States . OBJECTIVE We sought to examine the influence of patterns of care delivery and clinician behavioral factors on the use of anti-inflammatory medication by patients with asthma . METHODS We performed a cross-sectional national r and om digit dial household telephone survey in 1998 of adult patients and parents of children with current asthma . Respondents were classified as having current asthma if they had a physician 's diagnosis of asthma and were either taking medication for asthma or had asthma symptoms during the past year . RESULTS One or more persons met the study criteria for current asthma in 3273 ( 7.8 % ) households in which a screening question naire was completed . Of the 2509 persons ( 721 children < 16 years of age ) with current asthma interviewed , 507 ( 20.1 % ) reported current use of anti-inflammatory  medication  . In a multiple logistic regression model controlling for asthma symptoms , reported anti-inflammatory use was significantly associated with patients reporting their physician having an excellent ability to explain asthma management ( odds ratio [ OR ] , 1.47 ; 95 % CI , 1.09 - 1.98 ) , scheduling regular visits to a physician for asthma ( OR , 1.30 ; 95 % CI , 1.02 - 1.64 ) , having a written asthma action plan ( OR , 1.63 ; 95 % CI , 1.29 - 2.06 ) , and being of white , non-Hispanic ethnicity ( OR , 1.53 ; 95 % CI , 1.19 - 1.98 ) , along with markers of greater asthma morbidity , missing 6 or more days from work or school in the past year ( OR , 1.29 ; 95 % CI , 1.01 - 1.65 ) , and hospitalization for asthma in the past year ( OR , 1.74 ; 95 % CI , 1.19 - 2.53 ) . Anti-inflammatory use was less likely to be reported with younger age ( OR , 0.82 ; 95 % CI , 0.73 - 0.94 ) , lower long-term asthma symptom burden ( OR , 0.82 ; 95 % CI , 0.71 - 0.94 ) , use of 4 or fewer reliever inhaler canisters in the past year ( OR , 0.50 ; 95 % CI , 0.43 - 0.58 ) , and smoking ( OR , 0.50 ; 95 % CI , 0.37 - 0.68 ) . CONCLUSION How asthma care is delivered influences the use of anti-inflammatory medication . Strategies to increase regular evaluation by a physician interested in asthma , particularly for minority patients , and to increase a physician 's ability to communicate asthma management to patients might improve use of anti-inflammatory therapy among patients with asthma BACKGROUND Re-admissions to hospital in childhood asthma are common with studies reporting that 25 % or more of children will be re-admitted within a year . There is a need for strategies to reduce re-admissions . METHODS A prospect i ve r and omised control study of an asthma home management training programme was performed in children aged two years or over admitted with acute asthma . Two hundred and one children were r and omised at admission to either an intervention group ( n = 96 ) which received the teaching programme or a control group ( n = 105 ) . A nurse-led teaching programme used the current attack as a model for the management of future attacks and included discussion , written information , subsequent follow up and telephone advice aim ed at developing and reinforcing individualised asthma management plans . Parents were also provided with a course of oral steroids and guidance on when to start them . RESULTS The groups were similar in degree of social deprivation , length of stay , number of previous admissions , acute asthma treatment , and asthma treatment at discharge . Subsequent re-admissions were significantly reduced in the intervention group from 25 % to 8 % in individual follow up periods that ranged from two to 14 months ( chi 2 = 9.63 ; p = 0.002 ) . This reduction was not accompanied by any increase in subsequent emergency room attendances nor , in the short term , by any increase in urgent community asthma treatment . The intervention group also showed significant reductions in day and night morbidity 3 - 4 weeks after admission to hospital . CONCLUSIONS A nurse-led asthma home management training programme administered during a hospital admission can significantly reduce subsequent admissions to hospital for asthma . Acute hospitalisation may be a particularly effective time to deliver home management training The high burden of asthma on healthcare utilisation and costs warrants economic appraisal of management approaches . The authors previously demonstrated that the efficacy of nurse-led outpatient management of childhood asthma was comparable to management by a paediatrician and now report on the healthcare utilisation and costs of both management approaches . A total of 74 newly referred children with asthma were r and omly assigned to a 1‐yr follow-up by paediatricians or asthma nurse . Healthcare utilisation was recorded and associated costs calculated for both management approaches . There were no significant differences in healthcare utilisation except for the total time spent on patient contact ( 136(n=14 ) versus 187(n=41 ) min , for patients followed-up by paediatrician and an asthma nurse repectively ) . Costs within the healthcare sector were reduced by 7.2 % in favour of nurse-led care . The reduction in costs was solely attributable to a 17.5 % reduction in the costs of outpatient visits . Nurse-led care appeared to be cost-saving even if the duration of follow-up visits would be twice that of doctor 's visits . Overall healthcare costs ( within and outside the healthcare sector ) were 4.1 % lower for nurse-led outpatient management compared to traditional medical care . Nurse-led outpatient management of childhood asthma can be provided at a lower cost than medical care by paediatricians BACKGROUND A study was undertaken to investigate the compliance with and accuracy of peak flow diaries in childhood asthma . METHODS Forty asthmatic children ( 5–16 years ) were asked to perform peak flow measurements twice daily for 4 weeks by means of an electronic peak flow meter and to record values in a written diary . Patients and parents were unaware that the device stored the peak flow values on a microchip . In r and om order , half of the patients were only told that the device allowed for more accurate assessment of peak flow while the other half were told that accurate recording of peak flow was important because the results would be used in guiding adjustments to treatment . Data in the written diary ( reported data ) were compared with those from the electronic diary ( actual data ) . RESULTS In the entire study population the mean ( SD ) actual compliance ( 77.1 (20.5)% ) was much lower than the mean reported compliance ( 95.7 (9.1)% ) ( 95 % CI for difference 12.7 % to 24.4 % ) The percentage of correct peak flow entries decreased from 56 % to < 50 % from the first to the last study week ( p<0.04 ) , mainly as a result of an increase in self-invented peak flow entries . Results were comparable for both groups . For incorrect peak flow entries the mean difference between written and electronically recorded entries ranged from –72 to 34 l/min per patient . CONCLUSIONS Peak flow diaries kept by asthmatic children are unreliable . Electronic peak flow meters should be used if peak flow monitoring is required in children with asthma OBJECTIVES To determine the ability of children and adolescents with acute asthma exacerbations to adhere to national guidelines for proper metered-dose inhaler ( MDI ) and peak flow meter ( PFM ) technique and to define characteristics associated with improper use . DESIGN A prospect i ve study in which the patients were instructed to use a placebo MDI or a PFM in the emergency department exactly as at home . Technique was grade d on the basis of performance of specific steps recommended by national guidelines . SETTING AND PARTICIPANTS Children 
    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 : Until now , care provided by asthma nurses has been additional to care provided by paediatricians . A study was undertaken to compare nurse led outpatient management of childhood asthma with follow up by a paediatrician . Methods : Seventy four children referred because of insufficient control of persistent asthma were r and omly allocated to 1 year follow up by a paediatrician or asthma nurse . The main outcome measure was the percentage of symptom-free days . Additional outcome measures were airway hyperresponsiveness , lung function , daily dose of inhaled corticosteroids ( ICS ) , number of exacerbations , number of additional visits to the general practitioner , absence from school , functional health status , and disease specific quality of life . Results : There were no significant differences at the end of the 1 year study period between the two treatment groups in percentage of symptom-free days ( mean difference 2.5 % ; 95 % CI −8.8 to 13.8 ) , airway hyperresponsiveness ( log10 PD20 0.06 ; −0.19 to 0.32 ) , functional health status ( 10.1 ; −0.3 to 19.8 ) , disease specific quality of life of patients ( 0.08 ; −0.9 to 0.7 ) , and disease specific quality of life of caregivers ( 0.09 ; −0.2 to 0.3 ) , nor in any other outcome parameters . Most outcome parameters improved considerably over the 1 year study period . These improvements were achieved although the daily dose of ICS was reduced by a mean of 26 % compared with the dose received by children at referral . All parents were satisfied with the asthma care received . Conclusions : After initial assessment in a multidisciplinary clinic , childhood asthma can be successfully managed by an asthma nurse in close cooperation with a paediatrician . During close follow up by paediatrician or asthma nurse , asthma control improved despite a reduction in ICS dose Background : The effects on morbidity were examined of providing an educational intervention and a written guided self-management plan to the parents of pre-school children following a recent attendance at hospital for asthma or wheeze . Methods : A prospect i ve , r and omised , partially blinded , controlled trial was design ed at two secondary care centres . Over a 13 month period 200 children aged 18 months to 5 years at the time of admission to a children 's ward or attendance at an accident and emergency department or children 's ( emergency ) assessment unit ( A&E/CAU ) with a primary diagnosis of acute severe asthma or wheezing were recruited . 101 children were r and omised into the control group and received usual care and 99 were assigned to the intervention group and received : ( 1 ) a pre-school asthma booklet ; ( 2 ) a written guided self-management plan ; and ( 3 ) two 20 minute structured educational sessions between a specialist respiratory nurse and the parent(s ) and child . Subjects were assessed at 3 , 6 , and 12 months . The main outcomes were GP consultation rates , hospital re-admissions , and attendances at A&E/CAU . Secondary outcomes included disability score , caregivers ' quality of life , and parental knowledge of asthma . Results : There were no statistically significant differences between the two groups during the 12 month follow up period for any of the main or secondary outcome measures . Conclusions : These results do not support the hypothesis that the introduction of an educational package and a written guided self-management plan to the parents of pre-school children with asthma who had recently attended hospital for troublesome asthma or wheeze reduces morbidity over the subsequent 12 months A r and omised controlled study of an educational programme for children with asthma and their families was carried out by community child health nurses . Three hundred and sixty eight children aged 2 to 14 years were enrolled in the study after admission to hospital for asthma . The intervention group was visited monthly by a nurse for six months . The subjects were assessed six months later by a postal , self administered question naire . European children in the intervention group were taking significantly more drugs for the treatment of asthma six months after the index admission to hospital than those in the control group ( mean ( SD ) intake 2.7 ( 1.1 ) v 2.1 ( 1.0 ) , respectively ) . In particular , they were using more  theophylline  ( 56.6 % v 37.0 % ) and  inhaled steroids  ( 34.9 % v 21.0 % ) . There was no difference between the groups for parental reports of improvement , of missed schooling , and in severe attacks of asthma of not responding to the usual treatment at home . European children in the intervention group used the hospital services for severe attacks of asthma more than controls ( 34.2 % v 10.5 % ) . There were more re-admissions in the European intervention group in the subsequent six months after the index admission than in the control group ( mean ( SD ) 0.51 ( 0.97 ) v 0.29 ( 0.65 ) . Re-admission continued to be higher in the 12 months after the nurse had stopped visiting ( 0.81 ( 1.65 ) v 0.25 ( 0.65 ] . There was no difference in the duration of hospital stay between the intervention and control groups . For Polynesian children there was no difference between the groups for any outcome measures BACKGROUND Studies examining the influence of provider behavior and patterns of care delivery on the use of anti-inflammatory asthma therapy have been limited to selected population s or have been unable to assess the appropriateness of therapy for individuals . We have previously reported the influence of sociodemographic variables and asthma severity on reported use of asthma medications in the United States . OBJECTIVE We sought to examine the influence of patterns of care delivery and clinician behavioral factors on the use of anti-inflammatory medication by patients with asthma . METHODS We performed a cross-sectional national r and om digit dial household telephone survey in 1998 of adult patients and parents of children with current asthma . Respondents were classified as having current asthma if they had a physician 's diagnosis of asthma and were either taking medication for asthma or had asthma symptoms during the past year . RESULTS One or more persons met the study criteria for current asthma in 3273 ( 7.8 % ) households in which a screening question naire was completed . Of the 2509 persons ( 721 children < 16 years of age ) with current asthma interviewed , 507 ( 20.1 % ) reported current use of anti-inflammatory  medication  . In a multiple logistic regression model controlling for asthma symptoms , reported anti-inflammatory use was significantly associated with patients reporting their physician having an excellent ability to explain asthma management ( odds ratio [ OR ] , 1.47 ; 95 % CI , 1.09 - 1.98 ) , scheduling regular visits to a physician for asthma ( OR , 1.30 ; 95 % CI , 1.02 - 1.64 ) , having a written asthma action plan ( OR , 1.63 ; 95 % CI , 1.29 - 2.06 ) , and being of white , non-Hispanic ethnicity ( OR , 1.53 ; 95 % CI , 1.19 - 1.98 ) , along with markers of greater asthma morbidity , missing 6 or more days from work or school in the past year ( OR , 1.29 ; 95 % CI , 1.01 - 1.65 ) , and hospitalization for asthma in the past year ( OR , 1.74 ; 95 % CI , 1.19 - 2.53 ) . Anti-inflammatory use was less likely to be reported with younger age ( OR , 0.82 ; 95 % CI , 0.73 - 0.94 ) , lower long-term asthma symptom burden ( OR , 0.82 ; 95 % CI , 0.71 - 0.94 ) , use of 4 or fewer reliever inhaler canisters in the past year ( OR , 0.50 ; 95 % CI , 0.43 - 0.58 ) , and smoking ( OR , 0.50 ; 95 % CI , 0.37 - 0.68 ) . CONCLUSION How asthma care is delivered influences the use of anti-inflammatory medication . Strategies to increase regular evaluation by a physician interested in asthma , particularly for minority patients , and to increase a physician 's ability to communicate asthma management to patients might improve use of anti-inflammatory therapy among patients with asthma BACKGROUND Re-admissions to hospital in childhood asthma are common with studies reporting that 25 % or more of children will be re-admitted within a year . There is a need for strategies to reduce re-admissions . METHODS A prospect i ve r and omised control study of an asthma home management training programme was performed in children aged two years or over admitted with acute asthma . Two hundred and one children were r and omised at admission to either an intervention group ( n = 96 ) which received the teaching programme or a control group ( n = 105 ) . A nurse-led teaching programme used the current attack as a model for the management of future attacks and included discussion , written information , subsequent follow up and telephone advice aim ed at developing and reinforcing individualised asthma management plans . Parents were also provided with a course of oral steroids and guidance on when to start them . RESULTS The groups were similar in degree of social deprivation , length of stay , number of previous admissions , acute asthma treatment , and asthma treatment at discharge . Subsequent re-admissions were significantly reduced in the intervention group from 25 % to 8 % in individual follow up periods that ranged from two to 14 months ( chi 2 = 9.63 ; p = 0.002 ) . This reduction was not accompanied by any increase in subsequent emergency room attendances nor , in the short term , by any increase in urgent community asthma treatment . The intervention group also showed significant reductions in day and night morbidity 3 - 4 weeks after admission to hospital . CONCLUSIONS A nurse-led asthma home management training programme administered during a hospital admission can significantly reduce subsequent admissions to hospital for asthma . Acute hospitalisation may be a particularly effective time to deliver home management training The high burden of asthma on healthcare utilisation and costs warrants economic appraisal of management approaches . The authors previously demonstrated that the efficacy of nurse-led outpatient management of childhood asthma was comparable to management by a paediatrician and now report on the healthcare utilisation and costs of both management approaches . A total of 74 newly referred children with asthma were r and omly assigned to a 1‐yr follow-up by paediatricians or asthma nurse . Healthcare utilisation was recorded and associated costs calculated for both management approaches . There were no significant differences in healthcare utilisation except for the total time spent on patient contact ( 136(n=14 ) versus 187(n=41 ) min , for patients followed-up by paediatrician and an asthma nurse repectively ) . Costs within the healthcare sector were reduced by 7.2 % in favour of nurse-led care . The reduction in costs was solely attributable to a 17.5 % reduction in the costs of outpatient visits . Nurse-led care appeared to be cost-saving even if the duration of follow-up visits would be twice that of doctor 's visits . Overall healthcare costs ( within and outside the healthcare sector ) were 4.1 % lower for nurse-led outpatient management compared to traditional medical care . Nurse-led outpatient management of childhood asthma can be provided at a lower cost than medical care by paediatricians BACKGROUND A study was undertaken to investigate the compliance with and accuracy of peak flow diaries in childhood asthma . METHODS Forty asthmatic children ( 5–16 years ) were asked to perform peak flow measurements twice daily for 4 weeks by means of an electronic peak flow meter and to record values in a written diary . Patients and parents were unaware that the device stored the peak flow values on a microchip . In r and om order , half of the patients were only told that the device allowed for more accurate assessment of peak flow while the other half were told that accurate recording of peak flow was important because the results would be used in guiding adjustments to treatment . Data in the written diary ( reported data ) were compared with those from the electronic diary ( actual data ) . RESULTS In the entire study population the mean ( SD ) actual compliance ( 77.1 (20.5)% ) was much lower than the mean reported compliance ( 95.7 (9.1)% ) ( 95 % CI for difference 12.7 % to 24.4 % ) The percentage of correct peak flow entries decreased from 56 % to < 50 % from the first to the last study week ( p<0.04 ) , mainly as a result of an increase in self-invented peak flow entries . Results were comparable for both groups . For incorrect peak flow entries the mean difference between written and electronically recorded entries ranged from –72 to 34 l/min per patient . CONCLUSIONS Peak flow diaries kept by asthmatic children are unreliable . Electronic peak flow meters should be used if peak flow monitoring is required in children with asthma OBJECTIVES To determine the ability of children and adolescents with acute asthma exacerbations to adhere to national guidelines for proper metered-dose inhaler ( MDI ) and peak flow meter ( PFM ) technique and to define characteristics associated with improper use . DESIGN A prospect i ve study in which the patients were instructed to use a placebo MDI or a PFM in the emergency department exactly as at home . Technique was grade d on the basis of performance of specific steps recommended by national guidelines . SETTING AND PARTICIPANTS Children 
    Output:
    