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: High re-attendance rates are common after asthma emergency department ( ED ) care . Inadequate patient education has been cited as a potential cause of re-attendance and the optimal format of education is uncertain . The present study aim ed to compare the effectiveness of patient-centred education ( PCE ) and st and ard asthma patient education on ED re-attendance . A r and omised controlled trial was conducted at two inner-city Australian teaching hospitals ’ EDs , where patients received either st and ard patient education ( SPE ) or PCE . Both groups received a six-topic curriculum . However , PCE patients reordered the topics according to their own priority and thus controlled the order of education . In total , 146 adult patients presenting to EDs with acute asthma were enrolled . After 4 months , ED re-attendance decreased from 22 to 12 % in the PCE group and remained unchanged in the SPE group ( between group odds ratio 0.4 , 95 % confidence interval ( 0.2–1.1 ) ) . In 78 patients discharged after ED care , the PCE group had fewer re-attendances after 4 and 12 months ( 0.3 ( 0.1–0.9 ) and 0.3 ( 0.1–0.8 ) , respectively ) . PCE patients with no general practitioner care in the preceding 7 days had fewer re-attendances after 4 and 12 months ( 0.1 ( 0.0–0.7 ) and 0.2 ( 0.0–0.6 ) , respectively ) . A trend of better asthma control was evident , with a reduction in activity limitation . In conclusion , patient-centred education offers promise as a brief education process in the emergency department . However , a large multicentre trial of patient-centred education is required BACKGROUND Whether asthma morbidity in minority groups can be reduced by preventative health care measures delivered in the relevant ethnic dialects requires further evaluation . This study reports clinical outcomes and quality of life from a community based project investigating white European ( W/E ) and Indian subcontinent ( ISC ) ethnic groups with asthma living in deprived inner city areas of Birmingham , UK . METHODS Six hundred and eighty nine asthmatic subjects ( 345 W/E , 344 ISC ) of mean ( SD ) age 34.5 ( 15 ) years ( range 11–59 ) and mean forced expiratory volume in one second ( FEV1 ) of 80 % predicted were interviewed in English , Punjabi , Hindi , or Urdu . Subjects r and omised to the active limb of a prospect i ve , open , r and omised , controlled , parallel group , 12 month follow up study underwent individually based asthma education and optimisation of drug therapy with four monthly follow up ( active intervention ) . Control groups were seen only at the beginning and end of the study . Urgent or emergency interactions with primary and secondary health care ( clinical outcomes ) and both cross sectional and longitudinal data from an Asthma Quality of Life Question naire ( AQLQ ) were analysed . RESULTS Clinical outcomes were available for 593 subjects . Fewer of the active intervention group consulted their GP ( 41.8 % versus 57.8 % , odds ratio ( OR ) 0.52 ( 95 % CI 0.37 to 0.74 ) ) or were prescribed antibiotics ( 34.9 % versus 51.2 % , OR 0.51 ( 95 % CI 0.36 to 0.72 ) ) , but by ethnicity statistically significant changes occurred only in the W/E group with fewer also attending A&E departments and requiring urgent home visits . Active intervention reduced the number of hospital admissions ( 10 versus 30 ) , GP consultations ( 341 versus 476 ) , prescriptions of rescue oral steroids ( 92 versus 177 ) , and antibiotics ( 220 versus 340 ) , but again significant improvements by ethnicity only occurred in the active W/E group . AQLQ scores were negatively skewed to the higher values ; regression analysis showed that lower values were associated with ISC ethnicity . Longitudinal changes ( for 522 subjects ) in the mean AQLQ scores were small but statistically significant for both ethnic groups , with scores improving in the active and worsening in the control groups . CONCLUSIONS Active intervention only improved clinical outcomes in the W/E group . AQLQ scores , although lower in the ISC group , were improved by active intervention in both ethnic groups Background : In clinical trials of asthma , the outcomes are often good , but when the same treatment regimens are implemented in primary care , equally good results are not obtained . Objective : To investigate if addition of structured patient information and monitoring by an asthma diary in primary care improves asthma control . Methods : 141 patients from 19 primary care centres were studied . The centres were r and omised to a st and ard care group or to an intervention group . The intervention group received structured written and oral information about asthma and asthma medication , and were instructed to keep an asthma diary . The primary outcome was asthma control as assessed by the Asthma Control Question naire . Secondary outcomes were costs of asthma medication , the Mini Asthma Quality of Life Question naire score and lung function . Results : Asthma Control Question naire score changes differed between the study groups ( p < 0.05 ) . In the intervention group , these changes ( M = –0.45 ) in asthma control were close to clinical significance ( minimal important difference ≈0.5 ) . Both groups improved in disease-specific quality of life scores . For the intervention group , which changed the most ( p < 0.05 ) , the change exceeded the threshold for the minimal important difference ( 0.5 ) . The costs of medications increased significantly in the intervention group , where adjustments of medication were made more often than in controls . Conclusion : Disease-specific quality of life of asthma patients could be improved by adding structured information and monitoring by diary to st and ard care Education on optimal medication use is an essential strategy to improve asthma control . The current authors investigated whether pharmacist interventions , focused on appropriate use of asthma medication and tailor-made to the patient 's current asthma control , would improve asthma control in adult patients . A 6-month r and omised , controlled , parallel-group trial was conducted in 66 community pharmacies in Belgium . Patients were r and omly assigned to receive usual pharmacist care ( n = 94 ) or a pre-defined pharmacist intervention ( n = 107 ) . This intervention mainly focused on improving inhalation technique and medication adherence . Primary outcome was the level of asthma control , as assessed by the Asthma Control Test ® ( ACT ) . Mean ACT scores did not change from baseline for both study groups . However , a pre-defined subgroup analysis of patients having insufficiently controlled asthma at baseline showed that the intervention had significantly increased the ACT score after 6 months compared with usual care . The intervention also reduced , for the complete study group , reliever medication use and the frequency of night-time awakenings due to asthma . Inhalation technique and adherence to controller medication were significantly better in the intervention group . In conclusion , pragmatic community pharmacy-based programmes can significantly improve therapeutic outcomes in adult asthma patients OBJECTIVE This study examined the impact of a 6-month , empowerment-based diabetes self-management support ( DSMS ) intervention on clinical outcomes , self-care behaviors , and quality of life ( QOL ) compared to a 6-month control period . METHODS This control-intervention cohort study recruited 77 African-American adults with type 2 diabetes . Baseline , 6-month , and 12-month assessment s measured A1C , weight , body mass index ( BMI ) , blood pressure , lipids , self-care behaviors , and QOL . During the control period , participants received weekly educational newsletters . During the intervention period , participants attended weekly DSMS groups as frequently as they needed . Sessions were guided by participants ' self-management questions and concerns , and also emphasized experiential learning , coping , problem-solving , and goal - setting . RESULTS The control period found significant improvements for diastolic BP ( p<0.05 ) , serum cholesterol ( p<0.001 ) , following a healthy diet ( p<0.01 ) , and monitoring blood glucose ( p<0.01 ) . The intervention period found significant additional improvements for A1C ( p<0.001 ) , weight ( p<0.05 ) , BMI ( p<0.05 ) , and LDL ( p<0.001 ) . Compared to the control period , participation in the intervention led to a significant reduction in A1C ( p<0.01 ) . CONCLUSION Findings suggest that an empowerment-based , DSMS intervention is promising for improving and /or maintaining diabetes-related health , particularly A1C . PRACTICAL IMPLICATION S Incorporating empowerment principles in DSMS interventions may be useful for supporting patients ' self-management efforts in " real-world " setting Background : Morbidity and mortality associated with severe asthma might be reduced by interventions that address psychosocial factors contributing to adverse outcomes . A study was undertaken to assess the effectiveness of a 6 month home based psychoeducational intervention delivered by a respiratory nurse specialist for adults at risk of adverse asthma outcomes . Methods : A pragmatic r and omised controlled trial was performed in 92 adults registered with hospital or primary care asthma clinics . All had previous hospital admissions and /or were on British Thoracic Society step 4–5 treatment and had failed to attend clinic appointments or were considered to have poor adherence to other aspects of their agreed management . Patients were visited in their homes for assessment and , where appropriate , intervention . The main outcomes measured were symptom control , asthma specific quality of life , and generic health status . Results : At the 6 month primary time point there were no significant differences between usual care and intervention groups in mean symptom control , physical functioning , or mental health scores ( differences ( with 95 % CI ) −0.35 ( −1.83 to 1.13 ) , 3.10 ( −11.42 to 17.63 ) , 0.42 ( −10.22 to 11.07 ) , respectively ) . Small effects on asthma specific quality of life up to 12 months ( e.g. adjusted difference at 12 months 0.13 ( 95 % CI 0.02 to 0.25 ) ) and short term effects on generic health status , which mirrored improvements in aspects of self-care observed at the end of the intensive phase of the intervention , were apparent only from fully adjusted analyses . Conclusions : A home based intervention provided by a nurse receiving psychological supervision may have effects on quality of life but is overall of limited long term benefit to adults at risk of adverse asthma outcomes Asthma educational programs have been shown to reduce the use of emergency room , frequency of severe asthma attacks and hospitalization . However , its effectiveness in other morbidity parameters and on quality of life has yet to be fully understood . This prospect i ve r and omized control trial evaluated the effectiveness of a patient education program in 77 asthmatics according to " Teach Your Patients About Asthma : A Clinicians Guide " ( 1992 ) . Forty asthmatic patients were r and omly allocated to Group A ( usual treatment ) and 37 to Group B ( usual treatment plus a patient education program ) . The effectiveness of the educational program was evaluated by comparing morbidity outcomes at baseline and 3 months after initial evaluation . At enrolment , the two groups were not different with regard to age , sex , smoking , asthma severity atopy , FEV1 , symptom-free days , use of rescue salbutamol and quality of life . Three months later , subjects in Group B showed a significant improvement in the overall quality of life ( p < 0.01 ) and in the " Symptoms"domain ( p < 0.01 ) . None of the other parameters ( use of rescue salbutamol , symptom-free days , days absent from work or school , FEV1 ) showed any significant change . After stratification for asthma severity , only subjects with moderate-to-severe asthma showed a significant improvement inthe overall quality of life ( p < 0.05 ) and in the " Symptoms " ( p < 0.01 ) and ' Activities " ( < 0.05 ) domains . Moreover , in subjects with moderate-to-severe asthma FEV1 value at the 3rd month of follow-up was higher in Group B than in Group A ( p < 0.05 ) . In conclusion , the educational program improved the quality of life in asthratic subjects , mainly in patients with moderate-to-severe asthma Background : Functional breathing disorders may complicate asthma and impair quality of life . This study aim ed to determine the effectiveness of physiotherapy based breathing retraining for patients treated for asthma in the community who have symptoms suggestive of dysfunctional breathing . Methods : 33 adult patients aged 17–65 with diagnosed and currently treated asthma and Nijmegen question naire scores ⩾23 were recruited to a r and omised controlled trial comparing short physiotherapy breathing retraining and an asthma nurse education control . The main outcome measures were asthma specific health status ( Asthma Quality of Life question naire ) and Nijmegen question naire scores Results : Of the 33 who entered the study , data were available on 31 after 1 month and 28 at 6 months . The median ( interquartile range ) changes in overall asthma quality of life score at 1 month were 0.6 ( 0.05–1.12 ) and 0.09 ( −0.25–0.26 ) for the breathing retraining and education groups , respectively ( p=0.018 ) , 0.42 ( 0.11–1.17 ) and 0 
    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: High re-attendance rates are common after asthma emergency department ( ED ) care . Inadequate patient education has been cited as a potential cause of re-attendance and the optimal format of education is uncertain . The present study aim ed to compare the effectiveness of patient-centred education ( PCE ) and st and ard asthma patient education on ED re-attendance . A r and omised controlled trial was conducted at two inner-city Australian teaching hospitals ’ EDs , where patients received either st and ard patient education ( SPE ) or PCE . Both groups received a six-topic curriculum . However , PCE patients reordered the topics according to their own priority and thus controlled the order of education . In total , 146 adult patients presenting to EDs with acute asthma were enrolled . After 4 months , ED re-attendance decreased from 22 to 12 % in the PCE group and remained unchanged in the SPE group ( between group odds ratio 0.4 , 95 % confidence interval ( 0.2–1.1 ) ) . In 78 patients discharged after ED care , the PCE group had fewer re-attendances after 4 and 12 months ( 0.3 ( 0.1–0.9 ) and 0.3 ( 0.1–0.8 ) , respectively ) . PCE patients with no general practitioner care in the preceding 7 days had fewer re-attendances after 4 and 12 months ( 0.1 ( 0.0–0.7 ) and 0.2 ( 0.0–0.6 ) , respectively ) . A trend of better asthma control was evident , with a reduction in activity limitation . In conclusion , patient-centred education offers promise as a brief education process in the emergency department . However , a large multicentre trial of patient-centred education is required BACKGROUND Whether asthma morbidity in minority groups can be reduced by preventative health care measures delivered in the relevant ethnic dialects requires further evaluation . This study reports clinical outcomes and quality of life from a community based project investigating white European ( W/E ) and Indian subcontinent ( ISC ) ethnic groups with asthma living in deprived inner city areas of Birmingham , UK . METHODS Six hundred and eighty nine asthmatic subjects ( 345 W/E , 344 ISC ) of mean ( SD ) age 34.5 ( 15 ) years ( range 11–59 ) and mean forced expiratory volume in one second ( FEV1 ) of 80 % predicted were interviewed in English , Punjabi , Hindi , or Urdu . Subjects r and omised to the active limb of a prospect i ve , open , r and omised , controlled , parallel group , 12 month follow up study underwent individually based asthma education and optimisation of drug therapy with four monthly follow up ( active intervention ) . Control groups were seen only at the beginning and end of the study . Urgent or emergency interactions with primary and secondary health care ( clinical outcomes ) and both cross sectional and longitudinal data from an Asthma Quality of Life Question naire ( AQLQ ) were analysed . RESULTS Clinical outcomes were available for 593 subjects . Fewer of the active intervention group consulted their GP ( 41.8 % versus 57.8 % , odds ratio ( OR ) 0.52 ( 95 % CI 0.37 to 0.74 ) ) or were prescribed antibiotics ( 34.9 % versus 51.2 % , OR 0.51 ( 95 % CI 0.36 to 0.72 ) ) , but by ethnicity statistically significant changes occurred only in the W/E group with fewer also attending A&E departments and requiring urgent home visits . Active intervention reduced the number of hospital admissions ( 10 versus 30 ) , GP consultations ( 341 versus 476 ) , prescriptions of rescue oral steroids ( 92 versus 177 ) , and antibiotics ( 220 versus 340 ) , but again significant improvements by ethnicity only occurred in the active W/E group . AQLQ scores were negatively skewed to the higher values ; regression analysis showed that lower values were associated with ISC ethnicity . Longitudinal changes ( for 522 subjects ) in the mean AQLQ scores were small but statistically significant for both ethnic groups , with scores improving in the active and worsening in the control groups . CONCLUSIONS Active intervention only improved clinical outcomes in the W/E group . AQLQ scores , although lower in the ISC group , were improved by active intervention in both ethnic groups Background : In clinical trials of asthma , the outcomes are often good , but when the same treatment regimens are implemented in primary care , equally good results are not obtained . Objective : To investigate if addition of structured patient information and monitoring by an asthma diary in primary care improves asthma control . Methods : 141 patients from 19 primary care centres were studied . The centres were r and omised to a st and ard care group or to an intervention group . The intervention group received structured written and oral information about asthma and asthma medication , and were instructed to keep an asthma diary . The primary outcome was asthma control as assessed by the Asthma Control Question naire . Secondary outcomes were costs of asthma medication , the Mini Asthma Quality of Life Question naire score and lung function . Results : Asthma Control Question naire score changes differed between the study groups ( p < 0.05 ) . In the intervention group , these changes ( M = –0.45 ) in asthma control were close to clinical significance ( minimal important difference ≈0.5 ) . Both groups improved in disease-specific quality of life scores . For the intervention group , which changed the most ( p < 0.05 ) , the change exceeded the threshold for the minimal important difference ( 0.5 ) . The costs of medications increased significantly in the intervention group , where adjustments of medication were made more often than in controls . Conclusion : Disease-specific quality of life of asthma patients could be improved by adding structured information and monitoring by diary to st and ard care Education on optimal medication use is an essential strategy to improve asthma control . The current authors investigated whether pharmacist interventions , focused on appropriate use of asthma medication and tailor-made to the patient 's current asthma control , would improve asthma control in adult patients . A 6-month r and omised , controlled , parallel-group trial was conducted in 66 community pharmacies in Belgium . Patients were r and omly assigned to receive usual pharmacist care ( n = 94 ) or a pre-defined pharmacist intervention ( n = 107 ) . This intervention mainly focused on improving inhalation technique and medication adherence . Primary outcome was the level of asthma control , as assessed by the Asthma Control Test ® ( ACT ) . Mean ACT scores did not change from baseline for both study groups . However , a pre-defined subgroup analysis of patients having insufficiently controlled asthma at baseline showed that the intervention had significantly increased the ACT score after 6 months compared with usual care . The intervention also reduced , for the complete study group , reliever medication use and the frequency of night-time awakenings due to asthma . Inhalation technique and adherence to controller medication were significantly better in the intervention group . In conclusion , pragmatic community pharmacy-based programmes can significantly improve therapeutic outcomes in adult asthma patients OBJECTIVE This study examined the impact of a 6-month , empowerment-based diabetes self-management support ( DSMS ) intervention on clinical outcomes , self-care behaviors , and quality of life ( QOL ) compared to a 6-month control period . METHODS This control-intervention cohort study recruited 77 African-American adults with type 2 diabetes . Baseline , 6-month , and 12-month assessment s measured A1C , weight , body mass index ( BMI ) , blood pressure , lipids , self-care behaviors , and QOL . During the control period , participants received weekly educational newsletters . During the intervention period , participants attended weekly DSMS groups as frequently as they needed . Sessions were guided by participants ' self-management questions and concerns , and also emphasized experiential learning , coping , problem-solving , and goal - setting . RESULTS The control period found significant improvements for diastolic BP ( p<0.05 ) , serum cholesterol ( p<0.001 ) , following a healthy diet ( p<0.01 ) , and monitoring blood glucose ( p<0.01 ) . The intervention period found significant additional improvements for A1C ( p<0.001 ) , weight ( p<0.05 ) , BMI ( p<0.05 ) , and LDL ( p<0.001 ) . Compared to the control period , participation in the intervention led to a significant reduction in A1C ( p<0.01 ) . CONCLUSION Findings suggest that an empowerment-based , DSMS intervention is promising for improving and /or maintaining diabetes-related health , particularly A1C . PRACTICAL IMPLICATION S Incorporating empowerment principles in DSMS interventions may be useful for supporting patients ' self-management efforts in " real-world " setting Background : Morbidity and mortality associated with severe asthma might be reduced by interventions that address psychosocial factors contributing to adverse outcomes . A study was undertaken to assess the effectiveness of a 6 month home based psychoeducational intervention delivered by a respiratory nurse specialist for adults at risk of adverse asthma outcomes . Methods : A pragmatic r and omised controlled trial was performed in 92 adults registered with hospital or primary care asthma clinics . All had previous hospital admissions and /or were on British Thoracic Society step 4–5 treatment and had failed to attend clinic appointments or were considered to have poor adherence to other aspects of their agreed management . Patients were visited in their homes for assessment and , where appropriate , intervention . The main outcomes measured were symptom control , asthma specific quality of life , and generic health status . Results : At the 6 month primary time point there were no significant differences between usual care and intervention groups in mean symptom control , physical functioning , or mental health scores ( differences ( with 95 % CI ) −0.35 ( −1.83 to 1.13 ) , 3.10 ( −11.42 to 17.63 ) , 0.42 ( −10.22 to 11.07 ) , respectively ) . Small effects on asthma specific quality of life up to 12 months ( e.g. adjusted difference at 12 months 0.13 ( 95 % CI 0.02 to 0.25 ) ) and short term effects on generic health status , which mirrored improvements in aspects of self-care observed at the end of the intensive phase of the intervention , were apparent only from fully adjusted analyses . Conclusions : A home based intervention provided by a nurse receiving psychological supervision may have effects on quality of life but is overall of limited long term benefit to adults at risk of adverse asthma outcomes Asthma educational programs have been shown to reduce the use of emergency room , frequency of severe asthma attacks and hospitalization . However , its effectiveness in other morbidity parameters and on quality of life has yet to be fully understood . This prospect i ve r and omized control trial evaluated the effectiveness of a patient education program in 77 asthmatics according to " Teach Your Patients About Asthma : A Clinicians Guide " ( 1992 ) . Forty asthmatic patients were r and omly allocated to Group A ( usual treatment ) and 37 to Group B ( usual treatment plus a patient education program ) . The effectiveness of the educational program was evaluated by comparing morbidity outcomes at baseline and 3 months after initial evaluation . At enrolment , the two groups were not different with regard to age , sex , smoking , asthma severity atopy , FEV1 , symptom-free days , use of rescue salbutamol and quality of life . Three months later , subjects in Group B showed a significant improvement in the overall quality of life ( p < 0.01 ) and in the " Symptoms"domain ( p < 0.01 ) . None of the other parameters ( use of rescue salbutamol , symptom-free days , days absent from work or school , FEV1 ) showed any significant change . After stratification for asthma severity , only subjects with moderate-to-severe asthma showed a significant improvement inthe overall quality of life ( p < 0.05 ) and in the " Symptoms " ( p < 0.01 ) and ' Activities " ( < 0.05 ) domains . Moreover , in subjects with moderate-to-severe asthma FEV1 value at the 3rd month of follow-up was higher in Group B than in Group A ( p < 0.05 ) . In conclusion , the educational program improved the quality of life in asthratic subjects , mainly in patients with moderate-to-severe asthma Background : Functional breathing disorders may complicate asthma and impair quality of life . This study aim ed to determine the effectiveness of physiotherapy based breathing retraining for patients treated for asthma in the community who have symptoms suggestive of dysfunctional breathing . Methods : 33 adult patients aged 17–65 with diagnosed and currently treated asthma and Nijmegen question naire scores ⩾23 were recruited to a r and omised controlled trial comparing short physiotherapy breathing retraining and an asthma nurse education control . The main outcome measures were asthma specific health status ( Asthma Quality of Life question naire ) and Nijmegen question naire scores Results : Of the 33 who entered the study , data were available on 31 after 1 month and 28 at 6 months . The median ( interquartile range ) changes in overall asthma quality of life score at 1 month were 0.6 ( 0.05–1.12 ) and 0.09 ( −0.25–0.26 ) for the breathing retraining and education groups , respectively ( p=0.018 ) , 0.42 ( 0.11–1.17 ) and 0 
    Output:
    