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MS2_fixed_5_shot_test

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MS2_fixed_5_shot1800

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: BACKGROUND Dietary supplements providing physiologic amounts of several micronutrients simultaneously have not been thoroughly tested for combating micronutrient deficiencies . OBJECTIVE We determined whether a beverage fortified with 10 micronutrients at physiologic doses influenced the iron and vitamin A status and growth of rural children ( aged 6 - 11 y ) attending primary schools . DESIGN In this r and omized , double-blind , placebo-controlled efficacy trial , children were assigned to receive the fortified beverage or an unfortified beverage at school for 6 mo . RESULTS There were nonsignificant differences at baseline between children in the fortified and nonfortified groups in iron status , serum retinol , and anthropometry . At the 6-mo follow-up , among children with anemia ( hemoglobin < 110 g/L ) , there was a significantly larger increase in hemoglobin concentration in the fortified group than in the nonfortified group ( 9.2 and 0.2 g/L , respectively ) . Of those who were anemic at baseline , 69.4 % in the nonfortified group and 55.1 % in the fortified group remained anemic at follow-up ( RR : 0.79 ) , a cure rate of 21 % . The prevalence of children with low serum retinol concentrations ( < 200 microg/L ) dropped significantly from 21.4 % to 11.3 % in the fortified group compared with a nonsignificant change ( 20.6 % to 19.7 % ) in the nonfortified group . At follow-up , mean incremental changes in weight ( 1.79 compared with 1.24 kg ) , height ( 3.2 compared with 2.6 cm ) , and BMI ( 0.88 compared with 0.53 ) were significantly higher in the fortified group than in the nonfortified group . CONCLUSION The fortified beverage significantly improved hematologic and anthropometric measurements and significantly lowered the overall prevalence of anemia and vitamin A def OUTPUT:

Synthesized evidence indicates that addition of multiple micronutrients to Fe supplementation may only marginally improve Hb response compared with Fe supplementation alone . However , addition of ' other micronutrients ' may have a negative effect . Routine addition of unselected multiple micronutrients to Fe therefore appears unjustified for nutritional anaemia control programmes

MS2_fixed_5_shot1801

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: The effect of atomoxetine ( ATX ) on executive function has been assessed by means of question naires only . The aim of this study was therefore to evaluate the efficacy of ATX using st and ard variables of a computer-based continuous performance test ( cb-CPT ) combined with an infra-red motion-tracking device at different times of the day . One hundred twenty-eight girls and boys aged 6 to 12 years with a diagnosis of ADHD according to DSM-IV-TR criteria were r and omized in the study . The primary efficacy measures were the q-scores of the cb-CPT combined with an infra-red motion-tracking device . The test comprises 13 neuropsychological variables that can be taken to reflect hyperactivity , inattention , or impulsivity . One hundred five patients completed the study ( ATX group : n=54 ; placebo group : n=51 ) . ATX ( target dose 1.2 mg/kg/day ) over 8 weeks was significantly superior to placebo in reducing hyperactivity , inattention , and impulsivity as measured by q-scores of 10 primary variables of the cb-CPT . Both groups of patients showed a circadian pattern of neuropsychological outcomes across the day as reflected by the cb-CPT combined with an infra-red motion-tracking device . In summary , this study demonstrated a positive effect of ATX on some aspects of executive function , inhibitory control , and hyperactivity compared with placebo Twenty-four-hour motor activity was assessed in a naturalistic setting in 12 hyperactive boys for four weeks ( 672 consecutive hours ) . Dextroamphetamine , 15 mg/day , or placebo was administered on alternate weeks , using a double-blind ABAB design . When the boys received dextroamphetamine , motor activity was significantly decreased for about eight hours after drug administration . This decrease was followed by a period of slight but significant increases in activity ( " rebound " ) . Dextroamphetamine decreased activity most strikingly during structured classroom activity ; during physical education , however , there was a significant drug-induced increase in motor activity Introduction The National OUTPUT:

There were mixed findings with regard to the use of CPTs to assess and manage medication , with contrasting evidence on their ability to support clinical decision-making . There was a strong evidence base for the use of objective measures of activity to aid ADHD/non-ADHD group differentiation , which appears sensitive to medication effects and would also benefit from further research on their clinical utility .

MS2_fixed_5_shot1802

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Clinical research of grade d exposure in vivo with behavioral experiments in patients with chronic low back pain who reported fear of movement/(re)injury shows abrupt changes in self-reported pain-related fears and cognitions . The abrupt changes are more characteristics of insight learning rather than the usual gradual progression of trial and error learning . The educational session at the start of the exposure might have contributed to this insight . The current study examines the contribution of education and grade d exposure versus grade d activity in the reduction of pain-related fear and associated disability and physical activity . Six consecutive patients with chronic low back pain who reported substantial fear of movement/(re)injury were included in the study . After a no-treatment baseline measurement period , all the patients received a single educational session , followed again by a no-treatment period . Patients were then r and omly assigned to either a grade d exposure with behavioral experiments or an operant grade d activity program . A diary was used to assess daily changes in pain intensity , pain-related fear , pain catastrophizing , and activity goal achievement . St and ardized question naires of pain-related fear , pain vigilance , pain intensity , and pain disability were administered before and after each intervention and at the 6-month follow-up . An activity monitor was carried at baseline , during the interventions , and 1 week at 6-month follow-up . R and omization tests of the daily measures showed that improvements in pain-related fear and catastrophizing occurred after the education was introduced . The results also showed a further improvement when exposure in vivo followed the no-treatment period after the education and not during the operant grade d activity program . Performance of relevant daily activities , however , were not affected by the educational session and improved significantly only in the exposure in vivo condition . All improvements remained at half-year follow-up only in patients receiving the exposure in vivo . These patients also reported a significant decrease in pain intensity at follow-up Introduction With the high incidence of knee osteoarthritis ( OA ) in Japan , there is a strong need not only for surgical therapies , but also for vali date d outcome measures . For this study , we completed cross-cultural adaptation , testing and validation OUTPUT:

Results The FreKAQ-J had acceptable internal consistency , unidimensionality , good test-retest reliability , and was functional on the category rating scale . The FreKAQ-J was significantly correlated with pain in motion , disability , pain-related catastrophizing , fear of movement , and anxiety symptomatology . Conclusions We developed FreKAQ-J by modifying the FreBAQ-J. The FreKAQ-J fits the Rasch measurement model well and is suitable for use in people with knee OA .

MS2_fixed_5_shot1803

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Background For total hip arthroplasty ( THA ) , minimally invasive surgery ( MIS ) uses a smaller incision and less muscle dissection than the classic approach ( CLASS ) , and may lead to faster rehabilitation . Questions / purpose sDoes minimally invasive hip arthroplasty result in superior clinical outcomes ? Patients and Methods In this double-blind r and omized controlled trial , 120 consecutive primary noncemented THAs in 120 patients were assigned to one of two groups ( MIS or CLASS ) . The r and omization sequence was stratified for two groups of surgeons , ie , those using a posterolateral approach ( PL-CLASS or PL-MIS ) and those using an anterolateral approach ( AL-CLASS or AL-MIS ) . Length of the incisions was 18 cm for the CLASS procedures . MIS incisions were extended at the skin level to 18 cm at the end of the procedure . The primary end point was the Harris hip score ( HHS ) at 6 weeks postoperatively . Patient-centered question naires were obtained preoperatively and after 6 weeks and 1 year . Results For the patients in the MIS group ( average 7.8 cm incision length ) , statistically significant increased mean HHSs were seen compared with the CLASS group at 6 weeks and 1 year . This difference was small and mainly caused by the favorable results of the PL-MIS . In the MIS group , surgical time was longer . A learning curve was observed based on operation time and complication rate . Although not statistically significant , the perioperative complication rate was rather high in the ( anterolateral ) MIS group . Conclusions The minimal invasive approach in THA did not show a clinical ly relevant superior outcome in the first postoperative year . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence Introduction Minimally invasive total hip arthroplasty ( THA ) is cl aim ed to be superior to the st and ard technique , due to the potential reduction of soft tissue damage via a smaller and tissue-sparing approach OUTPUT:

The posterolateral approach reported the lowest value for the surgical duration . The posterolateral approach reported the shortest hospitalization length . The posterolateral approach reported shorter surgical duration and hospitalization length . Concerning the analysis of total estimated blood loss , no significant result was obtained .

MS2_fixed_5_shot1804

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: The purpose of this study was to assess the effects of music therapy on pain and anxiety in pediatric burn patients during nursing procedures . Nine subjects were r and omly selected to participate in this study . Qualitative and quantitative data was collected on the patients ' pain , anxiety , heart rate , blood oxygenation , and engagement level through measurement tools and interviews . The results from the qualitative and quantitative data indicated that music therapy reduced pain , anxiety , and behavioral distress . The quantitative data were analyzed and an inverse relationship between engagement in music therapy and lower behavioral distress scores was noted . Additionally , a linear relationship between engagement and behavioral distress was noted ; significance was found but was moderated by the age of the child . However , no significant relationship was found between heart rate and behavioral distress . The results from the qualitative data from the interviews with the patients , parents , nurses and music therapist indicated that music therapy reduced pain and anxiety , and that engagement in music therapy enhanced relaxation . In addition , music therapy positively affected patients ' mood , compliance , and the relaxation level . Finally , parents/guardians and nurses involved in the study reported that music therapy helped them to feel more relaxed as well Cancer patients continue to experience elevated levels of emotional distress , even after cancer treatment . Elevated emotional distress negatively impacts immune and endocrine functions and decreases life quality . This study explored the effectiveness of GIM in alleviating mood disturbance and improving quality of life in cancer patients . Eight volunteers with a cancer history were r and omly assigned to either an experimental or a wait-list control group . Experimental subjects individually participated in 10 weekly GIM sessions . All subjects completed the Profile of Mood States ( POMS ) and Quality of Life-Cancer ( QOL-CA ) question naires pretest , posttest , and at a 6-week follow-up . Individuals who participated in GIM sessions scored better on both mood scores and quality of life scores at posttest than those participating in the control group . Additionally , mood and quality of life scores continued to improve in the experimental group , even after sessions were complete . Results indicate that GIM was effective in improving m OUTPUT:

Specifically , the research er studied whether ( a ) there was a significant difference in physiological measures , ( b ) there was a significant difference in quality of life , ( c ) there was a significant difference in satisfaction levels , ( d ) there was a significant difference in pain reduction , ( e ) there was a significant difference in procedural length , ( f ) there was a significant difference in length of stay , and ( g ) whether the overall effect size and 95 % confidence level support the recommendation of music therapy in the health care setting .

MS2_fixed_5_shot1805

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Background PTCA is performed primarily to improve health-related quality of life ( HRQOL ) in patients with symptomatic coronary artery disease . In patients undergoing PTCA , smoking has been shown to increase risks of late myocardial infa rct ion and death . Whether smoking also affects HRQOL after PTCA is currently unknown . Methods and Results We examined the relation between smoking status and HRQOL among 1432 patients who underwent PTCA as part of 2 multicenter clinical trials . HRQOL was assessed with the use of the Medical Outcomes Study SF-36 question naire . Patients were classified as smokers ( n=301 ) , quitters ( n=141 ) , or nonsmokers ( n=990 ) on the basis of their smoking status at the time of their index procedure and during the first year of follow-up . For the overall population , HRQOL improved significantly after PTCA for all scales except general health perception , with improvements ranging from 5.5 points for mental health to 23.2 points for role-physical functioning . After adjustment for baseline characteristics and initial HRQOL , nonsmokers had gains at 6 months that were larger than those of smokers for all health domains : physical function ( 15.4 versus 10.4 points ) , role-physical ( 24.5 versus 13.9 ) , pain ( 18.4 versus 13.3 ) , general health perception ( 1.7 versus −4.5 ) , vitality ( 11.0 versus 4.7 ) , social function ( 12.8 versus 3.5 ) , role-emotional ( 13.5 versus 6.7 ) , and mental health ( 6.8 versus 0.8;P < 0.02 for all comparisons ) . Quitters had 6-month HRQOL improvements that were greater than those in smokers for all domains as well . Findings were similar at 1 year . Conclusions Quality -of-life benefits of PTCA are diminished by continued smoking . Effort OUTPUT:

REVIEW ER 'S CONCLUSIONS Quitting smoking is associated with a substantial reduction in risk of all-cause mortality among patients with CHD . This 36 % risk reduction appears substantial compared with other secondary preventive therapies such as cholesterol lowering which have received greater attention in recent years . The risk reduction associated with quitting smoking seems consistent regardless of differences between the studies in terms of index cardiac events , age , sex , country , and time period .

MS2_fixed_5_shot1806

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: CONTEXT Hallux valgus is a common foot deformation in adults , but evidence for effectiveness of surgical and conservative treatments for this condition is limited . OBJECTIVE To compare the effectiveness of surgical and orthotic treatment with no treatment in patients with hallux valgus . DESIGN AND SETTING R and omized controlled trial conducted in 4 general community hospitals in Finl and in 1997 - 1998 , with a follow-up period of 12 months . PARTICIPANTS Two hundred nine consecutive patients ( mean age , 48 years ; 93 % women ) with a painful bunion and a hallux valgus angle 35 degrees or less . INTERVENTIONS Patients were r and omly assigned to surgery ( distal chevron osteotomy ; n = 71 ) , orthosis ( n = 69 ) , or a 1-year waiting list ( control group , n = 69 ) . MAIN OUTCOME MEASURES Pain intensity during walking on a visual analog scale ( 0 - 100 ) , patient assessment of global improvement , number of painful days , cosmetic disturbance , footwear problems , functional status , and treatment satisfaction , compared among treatment groups . RESULTS Follow-up rates at 6 and 12 months were 99 % and 98 % , respectively . At 6 months , pain intensity decreased more in the surgical group than in the control group ( adjusted mean differences , -20 [ 95 % confidence interval ( CI ) , -28 to -12 ] ) and more in orthosis than in the control groups ( adjusted mean difference , -14 [ 95 % CI , -22 to -6 . At 1 year , pain intensity decreased more in the surgical than in the control groups ( adjusted mean difference , -19 [ 95 % CI , -28 to -10 ] ) and more than in the surgical and orthosis groups ( adjusted mean difference , -14 [ 95 % CI , -22 to -5 ] ) . At 1 year , 83 % , 46 % , and 24 % in the surgery , orthosis , and control groups OUTPUT:

The present review shows that current scientific literature concerning the usability of orthopaedic shoes focuses mainly on effectiveness at the expense of the other domains of usability , i.e. , efficiency , satisfaction and context of use

MS2_fixed_5_shot1807

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: AIMS Elevated natriuretic peptides ( NPs ) are associated with an increased cardiovascular risk following acute coronary syndromes ( ACSs ) . However , the therapeutic implication s are still undefined . We hypothesized that early inhibition of renin-angiotensin-aldosterone system ( RAAS ) in patients with preserved left ventricular function but elevated NPs but following ACS would reduce haemodynamic stress as reflected by a greater reduction NP compared with placebo . METHODS AND RESULTS AVANT GARDE-TIMI 43 trial , a multinational , double-blind trial , r and omized 1101 patients stabilized after ACS without clinical evidence of heart failure or left ventricular function < or=40 % but with an increased level of NP 3 - 10 days after admission to aliskiren , valsartan , their combination , and placebo . The primary endpoint was the change in NT-proBNP from baseline to Week 8 . NT-proBNP declined significantly in each treatment arm , including placebo , by Week 8 , though there were no differences in the reduction between treatment strategies ( 42 % in placebo , 44 % in aliskiren , 39 % in valsartan , and 36 % in combination arm ) . Although several subgroups had higher baseline levels of NP and greater reductions over the study period , there were no differences among treatment groups in any subgroup . There were no differences in clinical outcomes but there were more adverse events , including serious events and adverse events leading to early study drug discontinuation , in patients treated with active therapy . CONCLUSION In this study of a high-risk population with elevated levels of NPs but relatively preserved systolic function and no evidence of heart failure following ACS , there was no evidence for a benefit of early initiation of inhibition of RAAS with valsartan , aliskiren , or their combination compared with placebo with respect to a reduction in NP over 8 weeks of therapy . Moreover , adverse events were reported more frequently in patients assigned to active therapy Aliskiren is a novel OUTPUT:

There was a dose-dependent decrease in blood pressure for aliskiren 75 mg , 150 mg and 300 mg . Aliskiren had no effect on blood pressure variability . Due to very limited information available regarding change in heart rate and pulse pressure , it was not possible to meta-analyze these outcomes .Mortality and non-fatal serious adverse events were not increased . AUTHORS ' CONCLUSIONS Compared to placebo , aliskiren lowered BP and this effect is dose-dependent . This magnitude of BP lowering effect is similar to that for angiotensin-converting enzyme ( ACE ) inhibitors and angiotensin receptor blockers ( ARBs ) . There is no difference in mortality , nonfatal serious adverse events or withdrawal due to adverse effects with short term aliskiren monotherapy .

MS2_fixed_5_shot1808

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: We r and omly allocated 50 total knee replacements to scrub teams wearing body-exhaust suits ( BES ) or Rotecno occlusive clothing . The effectiveness of the clothing was assessed using air and wound bacterial counts . Bacteria were recovered from 62 % of wounds ( 64 % BES , 60 % Rotecno ) . The mean air count was 0.5 CFU/ m3 with BES and 1.0 CFU/m3 with Rotecno ( p = 0.014 ) . The mean wound counts were 14 bacteria/wound with BES and eight bacteria/wound with Rotecno ( p = 0.171 ) . There was no correlation between the air and wound counts ( r = -0.011 , Spearman 's ) . The higher air counts suggest that Rotecno occlusive clothing is less effective than BES , but wounds were equally contaminated with both types of clothing suggesting that at very low levels of air contamination the contribution of bacteria to the wound from the air is irrelevant . Even doubling the air counts from 0.5 to 1.0 CFU/m3 had no detectable effect on the wound . This allows a re assessment to be made of other sources of contamination the effect of which would previously have been overwhelmed by contamination from air An evaluation of the effect of total body exhaust clothing on air and wound contamination was made in an operating theatre with a zonal ventilation system . Sixty-four patients who underwent total hip replacement using the Charnley-Müller prosthesis were studied . The members of the surgical team wore total body exhaust suits ( TBE-suit ) , or conventional theatre clothing ( C-clothing ) at alternate operations . Nearly half of the patients in each group were given prophylactic antibiotics . Both the mean and median values of airborne bacteria in the operating theatre were significantly lower during operations with TBE-suits than with conventional theatre clothing . The lowest number , 4.0 cfu/m3 , was found at the site of the operation wound . Cultures from adhesive OUTPUT:

Newer infection prevention techniques , such as preoperative antiseptic scrubbing , are affected and may help reduce the infection rate , while traditionally accepted methods of prophylaxis such as laminar-flow operating rooms and body exhaust suits may raise the infection rate

MS2_fixed_5_shot1809

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: BACKGROUND Low serum 25-hydroxyvitamin D ( 25-[OH]D ) levels have been associated with lower FEV(1 ) , impaired immunologic control , and increased airway inflammation . Because many patients with chronic obstructive pulmonary disease ( COPD ) have vitamin D deficiency , effects of vitamin D supplementation may extend beyond preventing osteoporosis . OBJECTIVE To explore whether supplementation with high doses of vitamin D could reduce the incidence of COPD exacerbations . DESIGN R and omized , single-center , double-blind , placebo-controlled trial . ( Clinical Trials.gov registration number : NCT00666367 ) SETTING University Hospitals Leuven , Leuven , Belgium . PATIENTS 182 patients with moderate to very severe COPD and a history of recent exacerbations . INTERVENTION 100,000 IU of vitamin D supplementation or placebo every 4 weeks for 1 year . MEASUREMENTS The primary outcome was time to first exacerbation . Secondary outcomes were exacerbation rate , time to first hospitalization , time to second exacerbation , FEV(1 ) , quality of life , and death . RESULTS Mean serum 25-(OH)D levels increased significantly in the vitamin D group compared with the placebo group ( mean between-group difference , 30 ng/mL [ 95 % CI , 27 to 33 ng/mL ] ; P < 0.001 ) . The median time to first exacerbation did not significantly differ between the groups ( hazard ratio , 1.1 [ CI , 0.82 to 1.56 ] ; P = 0.41 ) , nor did exacerbation rates , FEV(1 ) , hospitalization , quality of life , and death . However , a post hoc analysis in 30 participants with severe vitamin D deficiency ( serum 25-[OH]D levels < 10 ng/mL ) at baseline showed a significant OUTPUT:

Subgroup analyses in the observational studies indicated that risk of mortality was significantly higher in studies with lower baseline use of vitamin D supplements . The effects observed for vitamin D3 supplementation remained unchanged when grouped by various characteristics . However , for vitamin D2 supplementation , increased risks of mortality were observed in studies with lower intervention doses and shorter average intervention periods . Conclusions Evidence from observational studies indicates inverse associations of circulating 25-hydroxyvitamin D with risks of death due to cardiovascular disease , cancer , and other causes .

MS2_fixed_5_shot1810

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: BACKGROUND Besides clinical tumour size , other anatomical aspects of the renal tumour are routinely considered when evaluating the feasibility of elective nephron-sparing surgery ( NSS ) . OBJECTIVE To propose an original , st and ardised classification of renal tumours suitable for NSS based on their anatomical features and size and to evaluate the ability of this classification to predict the risk of overall complications result ing from the surgery . DESIGN , SETTING , AND PARTICIPANTS We enrolled prospect ively 164 consecutive patients who underwent NSS for renal tumours at a tertiary academic referral centre from January 2007 to December 2008 . INTERVENTION Open partial nephrectomy without vessel clamping . MEASUREMENTS All tumours were classified by integrating size with the following anatomical features : anterior or posterior face , longitudinal , and rim tumour location ; tumour relationships with renal sinus or urinary collecting system ; and percentage of tumour deepening into the kidney . We generated an algorithm evaluating each anatomical parameter and tumour size ( the preoperative aspects and dimensions used for an anatomical [ PADUA ] score ) to predict the risk of complications . RESULTS AND LIMITATIONS Overall rates of complication were significantly correlated to all the evaluated anatomical aspects , excluding clinical size and anterior or posterior location of the tumour . By multivariate analysis , PADUA scores were independent predictors of the occurrence of any grade complications ( hazard ratio [ HR ] for score 8 - 9 vs 6 - 7 : 14.535 ; HR for score ≥10 vs 6 - 7 : 30.641 ) . Potential limitations were the limited number of patients with T1b tumours included in the study and the lack of laparoscopically treated patients . Further external validation of the PADUA score is needed . CONCLUSIONS The PADUA score is a simple anatomical system that can be used to predict the risk of surgical and medical perioperative complications in patients undergoing open NSS . The use of an appropriate score can help clin OUTPUT:

The 2014 guideline has been up date d by a multidisciplinary panel using the highest method ological st and ards , and provides the best and most reliable contemporary evidence base for RCC management .

MS2_fixed_5_shot1811

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Objectives : To study the effect of Vitamin D3 supplementation on metabolic control in an obese type 2 diabetes Emirati population . Methods : This r and omized double-blind clinical trial was conducted with 87 vitamin D-deficient obese , type 2 diabetic participants . The vitamin D-group ( n=45 ) and the placebo group ( n=42 ) were matched for gender , age , HbA1c and 25-hydroxy vitamin D ( 25(OH ) D ) at the baseline . The study was divided into two phases of 3 months each ; in phase 1 , the vitamin D-group received 6000 IU vitamin D3/day followed by 3000 IU vitamin D3/day in phase 2 , whereas the placebo group ( n=42 ) received matching placebo . Results : After supplementation , serum 25(OH ) D peaked in the vitamin D-group in phase 1 ( 77.2±30.1 nmol/l , P=0.003 ) followed by a decrease in the phase 2 ( 61.4±18.8 nmol/l , P=0.006 ) , although this was higher compared with baseline . In the placebo group , no difference was observed in the serum 25(OH ) D levels throughout the intervention . Relative to baseline serum , parathyroid hormone decreased 24 % ( P=0.003 ) in the vitamin D-group in phase 2 , but remained unchanged in the placebo group . No significant changes were observed in blood pressure , fasting blood glucose , HbA1c , C-peptide , creatinine , phosphorous , alkaline phosphatase , lipids , C-reactive protein or thyroid stimulating hormone concentrations compared with baseline in either group . Conclusions : Six months of vitamin D3 supplementation to vitamin D-deficient obese type 2 diabetes patients in the UAE normalized the vitamin D status and reduced the incidence of eucalcemic parathyroid horm OUTPUT:

Overall , this meta- analysis shows that in diabetic patients , taking vitamin D had significant effects on hs-CRP and MDA levels , and significantly increased NO , TAC and GSH levels

MS2_fixed_5_shot1812

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Background In patients with COPD , both laboratory exercise tests and field walking tests are used to assess physical performance . In laboratory tests , peak exercise capacity in watts ( W peak ) and /or peak oxygen uptake ( VO2 peak ) are assessed , whereas the performance on walking tests usually is expressed as distance walked . The aim of the study was to investigate the relationship between an incremental shuttle walking test ( ISWT ) and two laboratory cycle tests in order to assess whether W peak could be estimated from an ISWT . Methods Ninety-three patients with moderate or severe COPD performed an ISWT , an incremental cycle test ( ICT ) to measure W peak and a semi-steady-state cycle test with breath-by-breath gas exchange analysis ( CPET ) to measure VO2 peak . Routine equations for conversion between cycle tests were used to estimate W peak from measured VO2 peak ( CPET ) . Conversion equation for estimation of W peak from ISWT was found by univariate regression . Results There was a significant correlation between W peak and distance walked on ISWT × body weight ( r = 0.88 , p < 0.0001 ) . The agreement between W peak measured by ICT and estimated from ISWT was similar to the agreement between measured W peak ( ICT ) and W peak estimated from measured VO2 peak by CPET . Conclusion Peak exercise capacity measured by an incremental cycle test could be estimated from an ISWT with similar accuracy as when estimated from peak oxygen uptake in patients with COPD Background : Ambulatory oxygen is frequently prescribed for patients with chronic obstructive pulmonary disease ( COPD ) who have oxygen desaturation ≤88 % during exercise . The 6-min walk test ( 6MWT ) with continuous pulse oximetry monitoring is a common method to document this oxygen desaturation , but the reproducibility of this test in determining the need for ambulatory oxygen in patients with COPD is not well documented . Objective : The aim of this study was to establish the reproducibility of the 6MWT in determining the need for ambulatory oxygen prescription in stable COPD patients using the Centers for Medicare and Medicaid ( CMS ) criteria for ambul OUTPUT:

Good repeatability ( for the 6MWT and ESWT ) and reproducibility ( for the 6MWT , 12-minute walk test , ISWT , ESWT , and incremental cycle ergometer test ) were reported by most studies assessing these tests , providing patients were familiarized with them beforeh and . The 6MWT , ISWT , and particularly the ESWT were reported to be sensitive to therapeutic intervention .

MS2_fixed_5_shot1813

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: The purpose of this study was to compare the effects of aerobic training with a muscle-strengthening program in patients with fibromyalgia . Thirty women with fibromyalgia were r and omized to either an aerobic exercise ( AE ) program or a strengthening exercise ( SE ) program for 8 weeks . Outcome measures included the intensity of fibromyalgia-related symptoms , tender point count , fitness ( 6-min walk distance ) , hospital anxiety and depression ( HAD ) scale , and short-form health survey ( SF-36 ) . There were significant improvements in both groups regarding pain , sleep , fatigue , tender point count , and fitness after treatment . HAD-depression scores improved significantly in both groups while no significant change occurred in HAD-anxiety scores . Bodily pain subscale of SF-36 and physical component summary improved significantly in the AE group , whereas seven subscales of SF-36 , physical component summary , and mental component summary improved significantly in the SE group . When the groups were compared after treatment , there were no significant differences in pain , sleep , fatigue , tender point count , fitness , HAD scores , and SF-36 scores . AE and SE are similarly effective at improving symptoms , tender point count , fitness , depression , and quality of life in fibromyalgia Objective : Assess the efficacy of duloxetine 60/120 mg ( N = 162 ) once daily compared with placebo ( N = 168 ) in the treatment of patients with fibromyalgia , during six months of treatment . Methods : This was a phase-III , r and omized , double-blind , placebo-controlled , parallel-group study assessing the efficacy and safety of duloxetine . Results : There were no significant differences between treatment groups on the co- primary efficacy outcome measures , change in the Brief Pain Inventory ( BPI ) average pain severity from baseline to endpoint ( P = 0.053 ) and the Patient ’s Global Impressions of Improvement ( PGI-I ) at endpoint ( P = 0.073 ) . Duloxetine-treated patients improved significantly more than placebo-treated patients on the OUTPUT:

While no clinical trial to date has specifically targeted fatigue , r and omized controlled trials , systematic review s , and meta-analyses indicate that treatment modalities studied in the context of other fibromyalgia symptoms could also improve fatigue .

MS2_fixed_5_shot1814

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: A r and omized control trial comparing two social-communication interventions in young children with autism examined far-transfer of the use of picture exchange to communicate . Thirty-six children were r and omly assigned to one of two treatment conditions , one of which was the Picture Exchange Communication System ( PECS ) . All children had access to picture symbols during assessment s. Post-treatment measurement of the number of picture exchanges in a far-transfer , assessment context favored the PECS intervention . These findings were interpreted as support for the hypothesis that the PECS curriculum can successfully teach a generalized means of showing coordinated attention to object and person without requiring eye contact to children with ASD BACKGROUND Delays and deficits in joint attention and symbolic play constitute two important developmental problems in young children with autism . These areas of deficit have been well studied in autism but have rarely been the focus of treatment efforts ( see Kasari , Freeman , & Paparella , 2001 ) . In this study , we examine the efficacy of targeted interventions of joint attention and symbolic play . METHODS Participants were 58 children with autism aged 3 and 4 years ( 46 boys ) . Children were r and omized to a joint attention intervention , a symbolic play intervention , or control group . Interventions were conducted 30 minutes daily for 5 - 6 weeks . Both structured assessment s of joint attention and play skills and mother-child interactions were collected pre and post intervention by independent assessors . RESULTS Results indicate that both intervention groups improved significantly over the control group on certain behaviors . Children in the joint attention intervention initiated significantly more showing and responsiveness to joint attention on the structured joint attention assessment and more child-initiated joint attention in the mother-child interaction . The children in the play group showed more diverse types of symbolic play in interaction with their mothers and higher play levels on both the play assessment and in interaction with their mothers . CONCLUSIONS This r and omized controlled trial provides promising data on the specificity and generalizability of joint attention and play interventions for young children with autism . Future studies need to examine the long-term effects of these early interventions OUTPUT:

In particular , there is little evidence that the identified tools would be good at detecting change in intervention studies . The obvious gaps in available outcome measurement include well-being and participation outcomes for children , and family quality -of-life outcomes , domains particularly valued by our informants ( young people with ASD and parents ) . This is the first systematic review of the quality and appropriateness of tools design ed to monitor progress and outcomes of young children with ASD .

MS2_fixed_5_shot1815

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Objectives Pain is a very common symptom of juvenile idiopathic arthritis ( JIA ) . Disease activity alone can not explain symptoms of pain in all children , suggesting other factors may be relevant . The objectives of this study were to describe the different patterns of pain experienced over time in children with JIA and to identify predictors of which children are likely to experience ongoing pain . Methods This study used longitudinal- data from patients ( aged 1–16 years ) with new-onset JIA . Baseline and up to 5-year follow-up pain data from the Childhood Arthritis Prospect i ve Study ( CAPS ) were used . A two-step approach was adopted . First , pain trajectories were modelled using a discrete mixture model . Second , multinomial logistic regression was used to determine the association between variables and trajectories . Results Data from 851 individuals were included ( 4 years , median follow-up ) . A three-group trajectory model was identified : consistently low pain ( n=453 ) , improved pain ( n=254 ) and consistently high pain ( n=144 ) . Children with improved pain or consistently high pain differed on average at baseline from consistently low pain . Older age at onset , poor function/disability and longer disease duration at baseline were associated with consistently high pain compared with consistently low pain . Early increases in pain and poor function/disability were also associated with consistently high pain compared with consistently low pain . Conclusions This study has identified routinely collected clinical factors , which may indicate those individuals with JIA at risk of poor pain outcomes earlier in disease . Identifying those at highest risk of poor pain outcomes at disease onset may enable targeted pain management strategies to be implemented early in disease thus reducing the risk of poor pain outcomes Introduction Prevalence of insulin resistance and the metabolic syndrome has been reported to be high in rheumatoid arthritis ( RA ) patients . Tumor necrosis factor ( TNF ) , a pro-inflammatory cytokine with a major pathogenetic role in RA , may promote insulin resistance by inducing Ser312 phosphorylation ( p-Ser312 ) of OUTPUT:

Results The literature review and meta- analysis identified decreased PA and increased time spent in SB in these population s , which may exacerbate both their lower physical fitness and the symptoms of their health disorders .

MS2_fixed_5_shot1816

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: STUDY DESIGN R and omized clinical trial . OBJECTIVE The aim of this study was to evaluate the effect of ischemic compression therapy in the treatment of chronic carpal tunnel syndrome . METHOD Fifty-five patients suffering from carpal tunnel syndrome were r and omized to two groups . Thirty-seven patients received 15 experimental treatments which consisted of ischemic compressions at trigger points located in the axilla of the shoulder , the length of the biceps muscle , at the bicipital aponeurosis and at the pronator teres muscle in the hollow of the elbow . Eighteen patients received the control treatment involving ischemic compression on trigger points located in the deltoid muscle , supraspinatus muscle and infraspinatus muscle . Of the 18 patients forming the control group , 13 agreed to receive the experimental treatments after the 15 control treatments . Outcome measures included a vali date d 18- question question naire to assess the severity of symptoms and functional status in carpal tunnel syndrome , and a quantification of the patients ' perceived improvement , using a scale from 0 % to 100 % . Outcome measures evaluations were completed at baseline , after 15 treatments , 30 days following the last treatment , and 6 months later . RESULTS For the disability question naire , a significant reduction of symptoms was noted only in the experimental group . In the experimental group the outcome at baseline was 33.5 ( SD , 10.3 ) ; after 15 treatments it was 18.6 ( SD , 7.0 ) . The control group outcome at baseline was 36.3 ( SD , 15.2 ) ; after 15 treatments it was 26.4 ( SD , 9.9 ) and after the crossover ( 15 control treatments plus 15 experimental treatments ) 20.2 ( SD , 12.2 ) . A significant between group difference ( P < 0.021 ) was noted in the patients ' perceived improvement after 15 treatments : 67 ( SD , 26 ) percent and 50 ( SD , OUTPUT:

The strongest evidence supports postsurgical early active motion protocol s and splinting for various conditions . Very few studies have examined occupation-based interventions .

MS2_fixed_5_shot1817

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: This study examined the impact of L-acetylcarnitine treatment on metabolic parameters and body composition in patients with lipodystrophy syndrome secondary to antiretroviral treatment in human immunodeficiency virus ( HIV ) infection . A total of 9 HIV-1 infected patients with lipodystrophy syndrome ( 4F/5 M , age 41+/-5 years , HIV duration 8+/-2 years , BMI 23.7+/-3.4 kg/m(2 ) , on protease inhibitors and nucleoside analogue Reverse Transcriptase inhibitors ) were evaluated before and after 8 months of therapy with L-acetylcarnitine ( 2 g/die ) and 9 matched healthy subjects served as control subjects . In all patients fasting plasma glucose , insulin concentrations ( for evaluation of surrogate indexes of insulin sensitivity ) , lipid profile , lipid oxidation ( by indirect calorimetry ) , body composition ( by DEXA ) , and intramyocellular triglyceride ( IMCL ) content of the calf muscles ( by (1)H NMR spectroscopy ) were assessed . After this therapy , in HIV-1 patients , the IMCL content of the soleus had significantly decreased ( p=0.03 ) . Plasma FFAs ( 0.79+/-0.31 to 0.64+/-0.25 ; p<0.05 ) and Respiratory Quotient ( 0.83+/-0.18 to 0.72+/-0.16 ; p<0.03 ) also decreased . Insulin sensitivity was significantly lower prior ( HOMA-IS 0.56+/-0.30 ) and nonstatistically different than controls after therapy ( 0.72+/-0.49 vs. 0.78+/-0.42 ) whilst the percentage of fat in the legs increased ( p=0.05 ) . Eight months of L-acetylcarnitine treatment increased lipid oxidation , decreased intramyocellular triglyceride content OUTPUT:

No significant effect was seen for waist circumference ( WC ) and body fat percent . A non-linear dose-response association was seen between l-carnitine supplementation and body weight reduction ( P < 0.001 ) suggesting that ingestion of 2000 mg l-carnitine per day provides the maximum effect in adults . This association was not seen for BMI , WC and body fat percent . CONCLUSIONS l-carnitine supplementation provides a modest reducing effect on body weight , BMI and fat mass , especially among adults with overweight/obesity

MS2_fixed_5_shot1818

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: BACKGROUND Long-leg radiographs ( LLR ) are often used in orthopaedics to assess limb alignment in patients undergoing total knee arthroplasty ( TKA ) . However , there are still concerns about the adequacy of measurements performed on LLR . We assessed the reliability and validity of measurements on LLR using three-dimensional computed tomography ( 3D CT)-scan as a gold st and ard . METHODS Six different surgeons measured the mechanical axis and position of the femoral and tibial components individually on 24 LLR . Intraclass correlation coefficients ( ICC ) were calculated to obtain reliability and Bl and -Altman plots were constructed to assess agreement between measurements on LLR and measurements on 3D CT-scan . RESULTS ICC agreement for the six observer measurements on LLR was 0.70 for the femoral component and 0.80 for the tibial component . The mean difference between measurements performed on LLR and 3D CT-scan was 0.3 ° for the femoral component and -1.1 ° for the tibial component . Variation of the difference between LLR and 3D CT-scan for the femoral component was 1.1 ° and 0.9 ° for the tibial component . 95 % of the differences between measurements performed on LLR and 3D CT-scan were between -1.9 and 2.4 ° ( femoral component ) and between -2.9 and 0.7 ( tibial component ) . CONCLUSION Measurements on LLR show moderate to good reliability and , when compared to 3D CT-scan , show good validity . CLINICAL TRIAL REGISTRATION NUMBER institutional review board Atrium-Orbis-Zuyd , number : 11-T-15 . LEVEL OF EVIDENCE Prospect i ve cohort study , Level II Purpose To compare the femoral and tibial components rotational alignment in total knee arthroplasty ( TKA ) performed either with conventional or with patient-specific instrumentation . Methods Forty-five patients underwent primary TKA and were prospect ively r and omized into two groups : 22 patients into the conventional OUTPUT:

There were no significant differences regarding the biomechanical axis or frontal femoral and individual tibial component alignment . Conclusion This systematic review and meta- analysis demonstrate that alignment with MRI-based PSI is at least as good as , if not better than , that with CT-based PSI .

MS2_fixed_5_shot1819

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Objective To compare the efficacy of five probiotic preparations recommended to parents in the treatment of acute diarrhoea in children . Design R and omised controlled clinical trial in collaboration with family paediatricians over 12 months . Setting Primary care . Participants Children aged 3 - 36 months visiting a family paediatrician for acute diarrhoea . Intervention Children 's parents were r and omly assigned to receive written instructions to purchase a specific probiotic product : oral rehydration solution ( control group ) ; Lactobacillus rhamnosus strain GG ; Saccharomyces boulardii ; Bacillus clausii ; mix of L delbrueckii var bulgaricus , Streptococcus thermophilus , L acidophilus , and Bifidobacterium bifidum ; or Enterococcus faecium SF68 . Main outcome measures Primary outcomes were duration of diarrhoea and daily number and consistency of stools . Secondary outcomes were duration of vomiting and fever and rate of admission to hospital . Safety and tolerance were also recorded . Results 571 children were allocated to intervention . Median duration of diarrhoea was significantly shorter ( P<0.001 ) in children who received L rhamnosus strain GG ( 78.5 hours ) and the mix of four bacterial strains ( 70.0 hours ) than in children who received oral rehydration solution alone ( 115.0 hours ) . One day after the first probiotic administration , the daily number of stools was significantly lower ( P<0.001 ) in children who received L rhamnosus strain GG and in those who received the probiotic mix than in the other groups . The remaining preparations did not affect primary outcomes . Secondary outcomes were similar in all groups . Conclusions Not all commercially available probiotic preparations are effective in children with acute diarrhoea . Paediatricians should choose bacterial preparations based on effectiveness data . Trial registration number Current Controlled Trials IS RCT N56067537 In a controlled trial in Petrozavodsk , Kare OUTPUT:

The pooled estimate of efficacy of lactobacillus rhamnosus GG and other probiotics significantly reduced the duration of diarrhea . In conclusion , probiotics exert positive effect in reducing the duration of acute rotavirus diarrhea compared with control

MS2_fixed_5_shot1820

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Introduction The aim of this study was to assess the effects of preoperative pulmonary rehabilitation ( PPR ) on preoperative clinical status changes in patients with chronic obstructive pulmonary disease ( COPD ) and non-small cell lung cancer ( NSCLC ) , and net effects of PPR and cancer resection on residual pulmonary function and functional capacity . Material and methods This prospect i ve single group study included 83 COPD patients ( 62 ±8 years , 85 % males , FEV1 = 1844 ±618 ml , Tiffeneau index = 54 ±9 % ) with NSCLC , on 2–4-week PPR , before resection . Pulmonary function , and functional and symptom status were evaluated by spirometry , 6-minute walking distance ( 6MWD ) and Borg scale , on admission , after PPR and after surgery . Results Following PPR significant improvement was registered in the majority of spirometry parameters ( FEV1 by 374 ml , p < 0.001 ; VLC by 407 ml , p < 0.001 ; FEF50 by 3 % , p = 0.003 ) , 6MWD ( for 56 m , p < 0.001 ) and dyspnoeal symptoms ( by 1.0 Borg unit , p < 0.001 ) . A positive correlation was identified between preoperative increments of FEV1 and 6MWD ( r s = 0.503 , p = 0.001 ) . Negative correlations were found between basal FEV1 and its percentage increment ( r s = –0.479 , p = 0.001 ) and between basal 6MWD and its percentage change ( r s = –0.603 , p < 0.001 ) during PPR . Compared to basal values , after resection a significant reduction of most spirometry parameters and 6MWD were recorded , while Tiffeneau index , FEF25 and dyspnoea severity remained stable ( p = NS ) . Conclusions Preoperative pulmonary re OUTPUT:

In conclusion , preoperative exercise-based training improves pulmonary function before surgery and reduces in-hospital length of stay and postoperative complications after lung resection surgery for lung cancer

MS2_fixed_5_shot1821

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: BACKGROUND AND AIM Some studies recently reported a favourable effect for cis-9 , trans-11 conjugated linoleic acid ( CLA ) on plasma lipoprotein profile of healthy subjects . Aim of this crossover intervention study was to evaluate the influence of a short-term dietary intake of a cheese derived from sheep 's milk naturally rich in CLA on several atherosclerotic biomarkers , in comparison with a commercially available cheese . METHODS AND RESULTS Ten subjects ( 6 F ; 4 M ) with a median age of 51.5 followed for 10 weeks a diet containing 200 g/week of cheese naturally rich in CLA ( intervention period ) and for the same period a diet containing a commercially available cheese of the same quantity ( placebo period ) . Consumption of the dairy product naturally rich in cis-9 , trans-11 CLA determined a significant ( p<0.05 ) reduction in inflammatory parameters such as interleukin-6 ( pre : 8.08+/-1.57 vs. post : 4.58+/-0.94 pg/mL ) , interleukin-8 ( pre : 45.02+/-5.82 vs. post : 28.59+/-2.64 pg/mL ) , and tumour necrosis factor-alpha ( pre : 53.58+/-25.67 vs. post : 32.09+/-17.42 pg/mL ) whereas no significant differences in the placebo period were observed . With regard to haemorheological parameters , the test period significantly ameliorated erythrocytes ' filtration rate ( pre : 7.61+/-0.71 % vs. post : 9.12+/-0.97 % ; p=0.03 ) with respect to the placebo period . Moreover , a reduction in the extent of platelet aggregation , induced by arachidonic acid [ pre : 87.8+/-1.76 % vs. post : 77.7+/-3.56 % ; p= OUTPUT:

There was a significant heterogeneity for the impact of CLA on CRP and IL-6 , but not TNF-α . Conclusions This meta- analysis showed that CLA supplementation may increase inflammatory markers ( CRP and TNF-α ) .

MS2_fixed_5_shot1822

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: AIMS The European cardiac resynchronization therapy ( CRT ) survey is a joint initiative taken by the Heart Failure Association and the European Heart Rhythm Association of the European Society of Cardiology . The primary aim of this survey is to describe current European practice associated with CRT implantations . METHODS AND RESULTS A total of 140 centres from 13 European countries contributed data from consecutive patients successfully implanted with a CRT device with or without an ICD between November 2008 and June 2009 . The total number of patients enrolled was 2438 . The median age of the patients was 70 years ( IQR 62 - 76 ) and 31 % were > or = 75 years . It was found that 78 % were in NYHA functional class III or IV and 22 % in I or II . The mean ejection fraction was 27 % + /- 8 and the mean QRS duration 157 ms + /- 32 . The QRS duration was < 120 ms in 9 % . Atrial fibrillation was reported in 23 % . It was found that 26 % of patients had a previously implanted permanent pacemaker or ICD ; 76 % of procedures were performed by an electrophysiologist ; 82 % had an elective admission for implantation and the median duration of hospitalization was 3 days ( IQR 2 - 7 ) ; and 73 % received a CRT-D device which was more often implanted in men , younger patients , and with ischaemic aetiology . The mean QRS duration was reduced to 133 ms + /- 27 ( P < 0.0001 ) at discharge . Peri-procedural complication rates were comparable to the rates reported in r and omized trials . CONCLUSION This CRT survey provides important information describing current European practice with regard to patient demographics , selection criteria , procedural routines , and status at discharge . These data should be useful for benchmarking individual patient management and national practice against wider experience OBJECTIVES The main objective of this study was to assess if the benefits of biventricular ( BiV ) p OUTPUT:

AV nodal ablation was associated with a substantial reduction in all-cause mortality and cardiovascular mortality and with improvements in New York Heart Association functional class compared with medical therapy in CRT-AF patients .

MS2_fixed_5_shot1823

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: BACKGROUND : Interactive Health Communication Applications ( IHCAs ) are computer-based , usually web-based health information packages for patients that combine information with at least one of social support , decision support , or behaviour change support . These are innovations in health care and their effects on health are uncertain . OBJECTIVES : To assess the effects of IHCAs for people with chronic disease . SEARCH STRATEGY : We design ed a four-part search strategy . First , we search ed electronic bibliographic data bases for published work ; second , we search ed the grey literature and third , we search ed for ongoing and recently completed clinical trials in the appropriate data bases . Finally , research ers of included studies were contacted , and reference lists from relevant primary and review articles were followed up . As IHCAs require relatively new technology , the search commenced at 1990 where possible . SELECTION CRITERIA : R and omised controlled trials ( RCTs ) of Interactive Health Communication Applications for adults and children with chronic disease . DATA COLLECTION AND ANALYSIS : One review er screened abstract s. Two review ers screened all c and i date studies to determine eligibility , apply quality criteria , and extract data from included studies . Authors of included RCTs were contacted for missing data . Results of RCTs were pooled using a r and om effects model and st and ardised mean differences ( SMDs ) were calculated to provide net effect sizes . MAIN RESULTS : We screened 24,757 unique citations and retrieved 958 papers for further assessment , yielding 28 RCTs involving 4042 participants . One of these had an inadequate method of concealment of allocation , and sensitivity analyses were performed to determine the effects of including or excluding these data in the meta-analyses . Results in the abstract are from the meta-analyses excluding data from this study .IHCAs were found to have a positive effect on knowledge ( SMD 0.49 ; 95 % confidence interval ( CI ) 0.14 to 0.84 ) and on social support ( SMD 0.47 ; 95 % CI 0.28 to 0.6 OUTPUT:

There is very limited evidence for the effectiveness of IDIs on PA and HRQoL in RA and JIA and no evidence for their effectiveness in PsA or AS

MS2_fixed_5_shot1824

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Abstract . The prospect ively collected data from 530 cholecystectomies performed in a university clinic from October 1989 to March 1991 were analyzed after 1 to 3 years of follow-up . The aim of this study was to compare the results of laparoscopic cholecystectomy ( LC ) for acute cholecystitis with that for routine symptomatic gallbladders . The preoperative , intraoperative , and postoperative parameters of 424 routine ( noninflamed ) LCs and 54 LCs for acutely inflamed gallbladders were compared under the “ intention to treat ” principle . Operating time was longer in the inflamed group ( median 97 minutes versus 75 minutes;p < 0.0001 ) . Significantly more adhesions ( 20 % versus 8 % ) , more blood loss ( 48 % versus 19 % ) , a higher incidence of bile spillage ( 28 % versus 12 % ) , and lost stones ( 19 % versus 8 % ) were encountered in patients with acute cholecystitis . Common bile duct ( CBD ) injuries were also more frequent in that group ( 5.5 % versus 0.2%;p = 0.005 ) . The rate of conversion to open surgery was higher than with routine LCs ( 13 % versus 4 % ) . There were two deaths in the routine LC group and none in the acutely inflamed group . There was no difference in postoperative pain intensity or postoperative fatigue according to visual analog scale measurements . Patients with acute cholecystitis stayed only 1 day longer ( median 4 days versus 3 days ) in hospital . The quality of life scores indicate return to almost normal values by the 14th postoperative day . Long-term follow-up ( 1–3 years ) did not reveal any delayed clinical adverse effects . In summary , LC for inflamed gallbladders has a higher conversion rate than LC for routine symptomatic gallbladders . If successfully performed , it has definite benefit for the patient in terms of better postoperative recovery . The trade- OUTPUT:

Early laparoscopic cholecystectomy during acute cholecystitis seems safe and shortens the total hospital stay .

MS2_fixed_5_shot1825

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: BACKGROUND Females experience a disproportionate number of anterior cruciate ligament injuries compared to males . Increased estradiol concentration has been suggested to alter ligament properties and strength . Determining whether the knee responds differently to an external load at various hormonal levels may be helpful in further explaining the gender disparity . METHODS Estradiol , progesterone and testosterone were quantified at menses , near ovulation and at the mid-luteal phase . With one knee serving as the control limb and the other as the experimental limb , displacement at 134N and stiffness between 90 and 134N were recorded with a knee ligament arthrometer on both knees before and after a loading protocol . The protocol consisted of three , 3-min , posterior to anterior normalized loads directed to the posterior calf with a ligament testing device . FINDINGS The loading protocol produced a measurable increase in displacement but not stiffness . Neither displacement nor stiffness measures however were affected by day of the menstrual cycle . No consistent relationships between hormonal concentrations and displacement or stiffness were evident . INTERPRETATION Following a controlled , static external load , displacement and stiffness were not affected differently by day of the menstrual cycle Background Ovulatory menstrual cycles are essential for women ’s fertility and needed to prevent bone loss . There is a medical/cultural expectation that clinical ly normal menstrual cycles are inevitably ovulatory . Currently within the general population it is unknown the proportion of regular , normal-length menstrual cycles that are ovulatory . Thus , the objective of this study was to determine the population point prevalence of ovulation in premenopausal , normally menstruating women . The null hypothesis was that such cycles are ovulatory . Methods This is a single-cycle , cross-sectional , population -based study —a sub- study of the HUNT3 health study in the semi-rural county ( Nord Trøndelag ) in mid-Norway . Participants included > 3,700 spontaneously ( no hormonal contraception ) menstruating women , primarily Caucasian , OUTPUT:

Conclusion : The literature suggests an association between hormonal fluctuations and ACL injury . Recent studies have suggested that oral contraceptives may offer up to a 20 % reduction in risk of injury .

MS2_fixed_5_shot1826

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Study Design . A prospect i ve 10-year follow-up study of patients with whiplash-associated disorders ( WAD ) and asymptomatic volunteers . Objective . To clarify long-term impact of whiplash injury on patient 's symptoms and on magnetic resonance imaging ( MRI ) findings of the cervical spine . Summary of Background Data . Long-term prognosis of WAD has not been fully eluci date d. Methods . Between 1993 and 1996 , we conducted cross-sectional comparative study of 508 acute WAD patients and 497 asymptomatic volunteers , all of whom underwent MRI of the cervical spine . For this follow-up study , 133 WAD patients and 223 control subjects were recruited again . All participants underwent follow-up MRI and physical examination , and answered to question naires regarding neck symptoms . Evaluation of MRI included decrease in signal intensity of discs , posterior disc protrusion , disc space narrowing , and foraminal stenosis using 2 to 4 numerical grade s. Increase in the numerical grade s by one or more was considered to be progression of degenerative changes . Results . Progression of decrease in signal intensity was observed in 109 WAD patients ( 82.0 % ) , and 132 control subjects ( 59.2 % ) , ( age , sex adjusted odds ratio [ OR ] : 3.06 ) , posterior disc protrusion in 101 ( 75.9 % ) and in 155 ( 69.5 % ) ( OR = 1.46 ) , disc space narrowing in 33 ( 24.8 % ) and in 59 ( 26.5 % ) ( OR = 0.98 ) , and foraminal stenosis in 6 ( 4.5 % ) , and in 20 ( 9.0 % ) ( OR = 0.52 ) , respectively . Neck pain was observed in 34 WAD patients ( 25.6 % ) and 22 control subjects ( 9.9 % ) ( P < OUTPUT:

CONCLUSIONS There was a consistent positive association among studies that have examined the association between MVC-related neck injury and future NP .

MS2_fixed_5_shot1827

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Background Psychosocial prognostic factors are important in the development of chronic pain , but treatment providers often lack knowledge and skills to assess and address these risk factors . Objective The aim of this study was to examine the effects on outcomes ( pain and disability ) in patients of a course about psychosocial prognostic factors for physical therapists . Design This study was a r and omized , controlled trial . Setting The setting was primary care practice . Participants Forty-two primary care physical therapists attended an 8-day university course ( over 8 weeks ) aim ed at identifying and addressing psychosocial risk factors . Intervention The physical therapists were r and omly assigned to either the course or a waiting list . They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course . Measurements We measured physical therapists ' attitudes and beliefs about psychosocial factors , knowledge , and skills before and after the course . We measured patients ' pain , disability , catastrophizing , and mood at the start of treatment and at a 6-month follow-up . Methods The physical therapists were r and omly assigned to either the course or a waiting list . They treated consecutive patients with acute and subacute musculoskeletal pain both before and after the course . Results Pain and disability outcomes in all patients of physical therapists who had participated in the course or in patients at risk of developing long-term disability who had higher levels of catastrophizing or depression were not significantly different from those outcomes in patients of physical therapists who had not participated in the course . Pain and disability outcomes in patients with a low risk of developing long-term disability— and pain outcomes in patients with a high risk of developing long-term disability — were not dependent upon whether the attitudes and beliefs of their physical therapists changed during the course . However , disability outcomes in patients with a high risk of developing long-term disability may have been influenced by whether the attitudes and beliefs of their physical therapists changed . Limitations A limitation of this study was that actual practice behavior was not measured . Conclusions An 8-day university course for physical therapists did not improve outcomes in a group of patients as a whole or OUTPUT:

Physiotherapists partially recognised cognitive , psychological and social factors in people with LBP . Physiotherapists expressed a preference for dealing with the more mechanical aspects of LBP , and some stigmatised the behaviours suggestive of cognitive , psychological and social contributions to LBP . Physiotherapists perceived that neither their initial training , nor currently available professional development training , instilled them with the requisite skills and confidence to successfully address and treat the multidimensional pain presentations seen in LBP .

MS2_fixed_5_shot1828

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: GH is often used to treat children with idiopathic short stature despite the lack of definitive , long-term studies of efficacy . We performed a r and omized , double-blind , placebo-controlled trial to determine the effect of GH on adult height in peripubertal children . Subjects ( n = 68 ; 53 males and 15 females ) , 9 - 16 yr old , with marked , idiopathic short stature [ height or predicted height < or = -2.5 sd score ( SDS ) ] received either GH ( 0.074 mg/kg ) or placebo sc three times per week until they were near adult height . At study termination , adult height measurements were available for 33 patients after mean treatment duration of 4.4 yr . Adult height was greater in the GH-treated group ( -1.81 + /- 0.11 SDS , least squares mean + /- sem ) than in the placebo-treated group ( -2.32 + /- 0.17 SDS ) by 0.51 SDS ( 3.7 cm ; P < 0.02 ; 95 % confidence interval , 0.10 - 0.92 SDS ) . A similar GH effect was demonstrated in terms of adult height SDS minus baseline height SDS and adult height SDS minus baseline predicted height SDS . Modified intent-to-treat analysis in 62 patients treated for at least 6 months indicated a similar GH effect on last observed height SDS ( 0.52 SDS ; 3.8 cm ; P < 0.001 ; 95 % confidence interval , 0.22 - 0.82 SDS ) and no important dropout bias . In conclusion , GH treatment increases adult height in peripubertal children with marked idiopathic short stature BACKGROUND Short-term studies have demonstrated acceleration of growth rate following administration of biosynthetic human growth hormone ( r-hGH ) to short normal children . We describe the effect of such treatment on final height . METHODS This was an open study of consecutive referrals to a growth disorder clinic from OUTPUT:

CONCLUSIONS Growth hormone therapy in children with idiopathic short stature seems to be effective in partially reducing the deficit in height as adults , although the magnitude of effectiveness is on average less than that achieved in other conditions for which growth hormone is licensed .

MS2_fixed_5_shot1829

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: & NA ; This prospect i ve study was performed to investigate whether postoperative alternate flexion and extension splinting ( daily change in position of immobilization by splinting ) was useful in restoring full range of motion ( ROM ) after total knee arthroplasty as compared with continuous passive motion . The alternate flexion and extension splinting group and the continuous passive motion group were each composed of 34 knees . Final ROM was measured at an average of 3.5 years postoperatively . Squatting was possible in 31 knees ( 45.6 % ) of the alternate flexion and extension splinting group . The postoperative ROM of the osteoarthritic knees ( 131.8 ° ± 12.3 ° ) was significantly greater than that of the rheumatoid knees ( 121.9 ° ± 22.4 ° ) ( p < 0.05 ) . The postoperative ROM of the alternate flexion and extension splinting group ( 135.1 ° ± 11.9 ° ) also was significantly greater than that of the continuous passive motion group ( 120.0 ° ± 19.7 ° ) ( p < 0.01 ) . There was no statistically significant relationship between the posterior slope of tibial cutting and the postoperative ROM . It is suggested that alternate flexion and extension splinting is effective in restoring full ROM after total knee arthroplasty Purpose . Continuous passive motion is frequently used post-operatively to increase knee range of motion after total knee arthroplasty in spite of little conclusive evidence . The aim of this study was to examine whether continuous passive motion ( CPM ) as an adjunct to active exercises had any short time effects ( after one week and three months ) on pain , range of motion , timed walking and stair climbing . Method . A r and omized controlled trial was conducted . A total of 63 patients undergoing primary TKA were r and omly assigned into an experimental group receiving CPM and active exercises and a control group receiving active exercises only . Outcomes were assessed by goniometer , OUTPUT:

The estimates for risk of manipulation and adverse events are very imprecise and the estimate for the risk of adverse events does not distinguish between a clinical ly important increase and decrease in risk . There was insufficient evidence to determine the effect of CPM on participants ' global assessment of treatment effectiveness . CPM does not have clinical ly important effects on active knee flexion ROM , pain , function or quality of life to justify its routine use .

MS2_fixed_5_shot1830

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Buspirone , a new nonbenzodiazepine anxiolytic agent , was compared with clorazepate in a double-blind , multicenter trial conducted with 336 out patients who had moderate to severe anxiety . The two treatments were equally effective for relief of symptoms , including anxiety with associated depression . Although both agents were generally well tolerated , the profile of side effects was dissimilar . Drowsiness and depression occurred significantly ( p less than 0.055 ) more frequently with clorazepate , whereas nausea and headache occurred significantly ( p less than 0.055 ) more frequently with buspirone . Clorazepate-treated patients were significantly ( p less than 0.055 ) more likely to have had an adverse experience that was considered drug related or that interfered with the therapeutic effect . In this study , buspirone was shown to be an effective antianxiety agent , causing significantly less sedation than clorazepate Two groups of 12 out patients each ( six men and six women ) with generalized anxiety disorder , participated in this study . Each patient was treated single-blind with placebo during the first 7 days ( baseline ) , followed by a double-blind drug treatment period of 4 consecutive weeks ( active ) and ending again with 7 days single-blind placebo treatment ( washout ) . One group received buspirone 5 mg three times a day in the first week and continued with 10 mg in the morning , 5 mg in the afternoon , and 5 mg in the evening during the second , third , and fourth weeks . The other group received diazepam 5 mg three times a day in all 4 weeks . On the evening of the seventh day of each treatment week the Hamilton Rating Scale for Anxiety and the Symptom Check List ( 90 items ) were applied to assess the therapeutic effects , followed by an on-the-road driving test that started 1.5 hours after the last drug or placebo intake . The test consisted of operating an instrumented vehicle over a 100 kilometer highway circuit while attempting to maintain a constant speed and a steady lateral position within the right traffic l OUTPUT:

Azapirones may be less effective than benzodiazepines and we were unable to conclude if azapirones were superior to antidepressants , kava kava or psychotherapy . Azapirones appeared to be well tolerated . Azapirones appeared to be useful in the treatment of GAD , particularly for those participants who had not been on a benzodiazepine . Azapirones may not be superior to benzodiazepines and do not appear as acceptable as benzodiazepines . Side effects appeared mild and non serious in the azapirone treated group . Longer term studies are needed to show that azapirones are effective in treating GAD , which is a chronic long-term illness

MS2_fixed_5_shot1831

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: UNLABELLED The aim of the study is to compare the role of killed ( KP ) Lactobacillus acidophilus with living ( LP ) in reducing incidence of sepsis ( NS ) and necrotizing enterocolitis ( NEC ) in neonates . R and omized double blind placebo study , included 150 neonates admitted to NICU at day 1 , sixty received oral ( LP ) and 60 received ( KP ) and 30 received placebo . One gram of stools was collected on admission , at day 7 , at end of the study , as well as on suspected NEC or NS and was sent for culture . RESULTS LP and KP were preventive factors for NEC with absolute risk reduction ( AAR ) 16 , 15 % , respectively and 18 % for NS compared to placebo . Incidence of NEC and NS did not differ significantly between neonates supplemented with LP and those with KP . Preterm neonates supplemented with KP showed significantly lower incidence of NEC compared to placebo , while incidence of NS showed no significant difference between both groups . There is significant reduction in NS and NEC among neonates with positive Lactobacillus colonization of gut compared to those none colonized at day 7 ( 27.9 vs. 85.9 % , 0 vs. 7.8 % ) and at day 14 ( 48.7 vs. 91.7 % for NS and 0 vs. 20.8 % for NEC ) . Overall comparison between the three groups showed statistical significant reduction in the incidence of NEC . Present conclusions are that early gut colonization with beneficial bacteria lowers the incidence of NEC and NS . KP retained similar benefits to live bacteria ABSTRACT The gastrointestinal microbiota of preterm infants in a neonatal intensive care unit differs from that of term infants . In particular , the colonization of preterm infants by bifidobacteria is delayed . A double-blind , placebo-controlled , r and omized clinical study was performed on 69 preterm infants to investigate the role of Bif OUTPUT:

There was no difference in mortality caused by NEC . In premature newborns , the use of probiotics is effective as a prophylaxis for NEC and its complications

MS2_fixed_5_shot1832

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: UNLABELLED Various chemotherapies have been used to treat inoperable gastric cancer . Most combination therapies include cisplatin ( CDDP ) and fluoropyrimidine ( 5-FUs ) , which are thought of as key drugs . In the present study , we r and omly compared mitomycin ( MMC ) and CDDP plus doxifluridine ( 5'-DFUR ) , which is an oral 5-FU and an intermediate metabolite of capecitabine ( Xeloda ) , with CDDP plus 5'-DFUR in advanced unresectable gastric cancer . Regimen A was CDDP ( 70 mg/m2 , by 2-hour intravenous drip infusion on day 1 ) , MMC ( 7 mg/m2 , injected intravenously on day 2 ) , and oral 5'-DFUR ( 1200 mg/m2 , on days 4 to 7 , 11 to 14 , 18 to 21 and 25 to 28 ; 3 days rest and 4 days administration ) . Regimen B was identical to regimen A without MMC . RESULTS The response rate was 25.0 % ( 8/32 patients ) in Regimen A , 17.2 % ( 5/29 ) in Regimen B ( p=0.541 ) . The median survival time was 241 days in Regimen A and 179 days in Regimen B ( p=0.498 ) . In Regimen A , although no significant difference was observed , end points such as response rate and suvival improved . Thus , we concluded that a r and omized controlled phase III study with more subjects should be conducted BACKGROUND Irinotecan , in combination with 5-fluorouracil ( 5-FU ) or cisplatin , has demonstrated efficacy against advanced gastric cancer ( AGC ) . PATIENTS AND METHODS Chemotherapy-naive AGC patients were r and omly assigned to receive irinotecan 150 mg/m(2 ) on day 1 OUTPUT:

Within a combination chemotherapy regimen , oral capecitabine is preferred over intravenous 5-fluorouracil (5fu)-that is , epirubicin-cisplatin-capecitabine is preferred over the prior st and ard regimen , epirubicin-cisplatin-5fu (ecf).Epirubicin-oxaliplatin-capecitabine ( eox ) is a reasonable alternative to ecf .

MS2_fixed_5_shot1833

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: INTRODUCTION High expression of leptin receptors have been observed in the prostate cancer in various clinical studies ; however the association of serum leptin with carcinoma prostate remains unresolved . We studied association , between serum leptin and carcinoma prostate in Asian ( Indian ) population and its association with obesity . MATERIAL AND METHODS 30 prospect i ve cases of cancer prostate and 30 age matched controls were included in this study . Body mass index ( BMI ) was estimated and categorized in 4 groups by WHO criteria . Waist hip ratio ( WHR ) was calculated and divided into three groups . Serum leptin was estimated by s and wich ELISA technique ( DRG leptin ELISA kit , Marburg , Germany ) . RESULTS Both the groups were comparable for age , WHR and BMI . Serum leptin was significantly higher in patients with cancer prostate as compared to controls ( median 14.18 ng/ml vs. 1.63 ng/ml ; p < 0.001 ) . The level of leptin was found to have positive correlation with BMI and WHR in controls ( r=0.485 , p=0.007 ; r=0.314 , p=0.091 , respectively ) however , no correlation was observed in patients with cancer prostate ( r=0.071 , p=0.711 ; r=0.067 , p=0.725 , respectively ) . There was no correlation between leptin and PSA . The serum leptin level was not related to the Gleason 's score and stage of the carcinoma . CONCLUSIONS This study shows that Prostate cancer is associated with raised serum leptin which is independent of obesity and serum PSA . It hints the role of leptin in pathogenesis of this tumor . It may not be a surrogate marker of aggressiveness . For validation , further studies including a large patient population is required Recent studies indicate that adipose tissue and adipocytokines might affect the development of prostate cancer ( PCa ) . Leptin would have a stimulating effect on prostate cancer OUTPUT:

Conclusions The current evidence does not suggest an association between leptin and PCa outcome . However , there may be an inverse association between adiponectin and the incidence of advanced PCa that should be investigated by further studies .

MS2_fixed_5_shot1834

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: INTRODUCTION AND OBJECTIVES Laryngeal electromyography , together with clinical evaluation , is a valuable tool in voice disorder management . It assesses the integrity of laryngeal nerves and muscles , contributing to the diagnosis of many diseases , especially laryngeal movement disorders . Our purpose was to describe the experience of the first Spanish series with laryngeal electromyography in evaluating voice disorders . METHODS A prospect i ve study was design ed to evaluate laryngeal movement disorders with laryngeal electromyography . Both the cricothyroid and thyroarytenoid muscles were tested routinely and , in some cases , the posterior cricoarytenoid muscle . The laryngeal electromyography technique and result interpretation were performed by a laryngologist and a neurophysiologist . RESULTS We included 110 patients , with the most common symptom being dysphonia . Laryngeal electromyography was performed in 85 % of cases . Primary diagnosis before electromyography was laryngeal immobility . Positive predictive value for diagnosis in cases of paralysis was 88 % . CONCLUSIONS Laryngeal electromyography is a useful adjunct , together with clinical evaluation , for diagnosis and management of motion abnormalities in the larynx in patients who present with dysphonia OBJECTIVES Epidemiologic studies of the prevalence and risk factors of voice disorders in the general adult population are rare . The purpose of this investigation was to 1 ) determine the prevalence of voice disorders , 2 ) identify variables associated with increased risk of voice disorders , and 3 ) establish the functional impact of voice disorders on the general population . STUDY DESIGN Cross-sectional telephone survey . METHODS A r and om sample ( n = 1,326 ) of adults in Iowa and Utah was interviewed using a question naire that addressed three areas related to voice disorders : prevalence , potential risk factors , and occupational consequences/effects . RESULTS The lifetime prevalence of a voice disorder was 29.9 % OUTPUT:

Specific " active ingredients " for therapeutic change were not identified .

MS2_fixed_5_shot1835

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Background and Purpose — There is currently no consensus on ( 1 ) the percentage of patients who develop spasticity after ischemic stroke , ( 2 ) the relation between spasticity and initial clinical findings after acute stroke , and ( 3 ) the impact of spasticity on activities of daily living and health-related quality of life . Methods — In a prospect i ve cohort study , 301 consecutive patients with clinical signs of central paresis due to a first-ever ischemic stroke were examined in the acute stage and 6 months later . At both times , the degree and pattern of paresis and muscle tone , the Barthel Index , and the EQ-5D score , a st and ardized instrument of health-related quality of life , were evaluated . Spasticity was assessed on the Modified Ashworth Scale and defined as Modified Ashworth Scale > 1 in any of the examined joints . Results — Two hundred eleven patients ( 70.1 % ) were reassessed after 6 months . Of these , 42.6 % ( n=90 ) had developed spasticity . A more severe degree of spasticity ( Modified Ashworth Scale ≥3 ) was observed in 15.6 % of all patients . The prevalence of spasticity did not differ between upper and lower limbs , but in the upper limb muscles , higher degrees of spasticity ( Modified Ashworth Scale ≥3 ) were more frequently ( 18.9 % ) observed than in the lower limbs ( 5.5 % ) . Regression analysis used to test the differences between upper and lower limbs showed that patients with more severe paresis in the proximal and distal limb muscles had a higher risk for developing spasticity ( P≤0.001 ) . Spasticity of the upper and lower limb was more frequent in patients with hemihypesthesia than in patients without sensory deficits ( P≤0.001 ) . Patients with spasticity showed a lower Barthel Index and EQ-5D score compared with the group without spasticity . Conclusions — Spasticity was present in 42.6 % of patients with initial central paresis . However , severe spasticity was relatively rare OUTPUT:

None of the review ed measurement tools demonstrated satisfactory results for all psychometric properties evaluated , and the majority lacked evidence concerning validity and absolute reliability . This systematic review found limited evidence to support the use of most of clinical measures of spasticity for people post-stroke . This review identified various clinical measures of spasticity that have been investigated in people after stroke .

MS2_fixed_5_shot1836

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: OBJECTIVE To test the feasibility , acceptability , and potential efficacy of after-school dance classes and a family-based intervention to reduce television viewing , thereby reducing weight gain , among African-American girls . DESIGN Twelve-week , 2-arm parallel group , r and omized controlled trial . SETTING Low-income neighborhoods . PARTICIPANTS Sixty-one 8 - 10-year-old African-American girls and their parents/guardians . INTERVENTIONS The treatment intervention consisted of after-school dance classes at 3 community centers , and a 5-lesson intervention , delivered in participants ' homes , and design ed to reduce television , videotape , and video game use . The active control intervention consisted of disseminating newsletters and delivering health education lectures . MAIN OUTCOME MEASURES Implementation and process measures , body mass index , waist circumference , physical activity measured by accelerometry , self-reported media use , and meals eaten with TV . RESULTS Recruitment and retention goals were exceeded . High rates of participation were achieved for assessment s and intervention activities , except where transportation was lacking . All interventions received high satisfaction ratings . At follow up , girls in the treatment group , as compared to the control group , exhibited trends toward lower body mass index ( adjusted difference = -.32 kg/m2 , 95 % confidence interval [ CI ] -.77 , .12 ; Cohen 's d = .38 st and ard deviation units ) and waist circumference ( adjusted difference = -.63 cm , 95 % CI -1.92 , .67 ; d = .25 ) ; increased after-school physical activity ( adjusted difference = 55.1 counts/minute , 95 % CI -115.6 , 225.8 ; d = .21 ) ; and reduced television , videotape , and video game use ( adjusted difference = -4.96 hours/week , 95 % CI -11.41 , 1.49 ; d = .40 ) . The treatment group reported significantly reduced household television viewing ( d = .73 , P = .00 OUTPUT:

There is a large body of evidence from all study design s which suggests that decreasing any type of sedentary time is associated with lower health risk in youth aged 5 - 17 years . In particular , the evidence suggests that daily TV viewing in excess of 2 hours is associated with reduced physical and psychosocial health , and that lowering sedentary time leads to reductions in BMI

MS2_fixed_5_shot1837

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: OBJECTIVE To evaluate gait biomechanics after training with a virtual reality ( VR ) system and to eluci date underlying mechanisms that contributed to the observed functional improvement in gait speed and distance . DESIGN A single blind r and omized control study . SETTING Gait analysis laboratory in a rehabilitation hospital and the community . PARTICIPANTS Fifteen men and three women with hemiparesis caused by stroke . INTERVENTIONS Subjects trained on a six-degree of freedom force-feedback robot interfaced with a VR simulation . Subjects were r and omized to either a VR group ( n=9 ) or non-VR group ( NVR , n=9 ) . Training was performed three times a week for 4 weeks for approximately 1h each visit . MAIN OUTCOME MEASURES Kinematic and kinetic gait parameters . RESULTS Subjects in the VR group demonstrated a significantly larger increase in ankle power generation at push-off as a result of training ( p=0.036 ) . The VR group had greater change in ankle ROM post-training ( 19.5 % ) as compared to the NVR group ( 3.3 % ) . Significant differences were found in knee ROM on the affected side during stance and swing , with greater change in the VR group . No significant changes were observed in kinematics or kinetics of the hip post-training . CONCLUSIONS These findings are encouraging because they support the potential for recovery of force and power of the lower extremity for individuals with chronic hemiparesis . It is likely that the effects of training included improved motor control at the ankle , which enabled the cascade of changes that produced the functional improvements seen after training Background and Purpose — Training of the lower extremity ( LE ) using a robot coupled with virtual environments has shown to transfer to improved overground locomotion . The purpose of this study was to determine whether the transfer of training of LE movements to locomotion was greater using a virtual environment coupled with a robot or with the robot alone . Methods — A single , blind , r and omized clinical trial was conducted . Eighteen individuals poststroke participated in a 4-week training protocol . One group trained with OUTPUT:

Cognitive motor interference is effective for improving gait and balance function for stroke in the short term . However , only little evidence supports assumptions regarding CMI 's long-term benefits

MS2_fixed_5_shot1838

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Microfinance institutions have started to bundle their basic loans with other financial services , such as health insurance . Using a r and omized control trial in Karnataka , India , we evaluate the impact on loan renewal from m and ating the purchase of actuarially-fair health insurance covering hospitalization and maternity expenses . Bundling loans with insurance led to a 16 percentage points ( 23 percent ) increase in drop-out from microfinance , as many clients preferred to give up microfinance than pay higher interest rates and receive insurance . In a Pyrrhic victory , the total absence of dem and for health insurance led to there being no adverse selection in insurance enrollment Objective : To assess effects of a combined microfinance and training intervention on HIV risk behavior among young female participants in rural South Africa . Design : Secondary analysis of quantitative and qualitative data from a cluster r and omized trial , the Intervention with Microfinance for AIDS and Gender Equity study . Methods : Eight villages were pair-matched and r and omly allocated to receive the intervention . At baseline and after 2 years , HIV risk behavior was assessed among female participants aged 14–35 years . Their responses were compared with women of the same age and poverty group from control villages . Intervention effects were calculated using adjusted risk ratios employing village level summaries . Qualitative data collected during the study explored participants ' responses to the intervention including HIV risk behavior . Results : After 2 years of follow-up , when compared with controls , young participants had higher levels of HIV-related communication ( adjusted risk ratio 1.46 , 95 % confidence interval 1.01–2.12 ) , were more likely to have accessed voluntary counseling and testing ( adjusted risk ratio 1.64 , 95 % confidence interval 1.06–2.56 ) , and less likely to have had unprotected sex at last intercourse with a nonspousal partner ( adjusted risk ratio 0.76 , 95 % confidence interval 0.60–0.96 ) . Qualitative data suggest a greater acceptance of intrahousehold communication about HIV and sexuality . Although women noted challeng OUTPUT:

Results Most interventions combined microfinance with health education , which demonstrated positive effects on health knowledge and behaviours , though not health status . Interventions combining multiple health components in a given study demonstrated positive effects , though it was unclear which component was driving the effect . Discussion Integrated microfinance and health education programs were effective , though longer intervention periods are necessary to measure more complex pathways to health status . The effect of microfinance combined with other health components was less clear .

MS2_fixed_5_shot1839

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: In recent years quality of life instruments have been featured as primary outcomes in many r and omized trials . One of the challenges facing the investigator using such measures is determining the significance of any differences observed , and communicating that significance to clinicians who will be applying the trial results . We have developed an approach to elucidating the significance of changes in score in quality of life instruments by comparing them to global ratings of change . Using this approach we have established a plausible range within which the minimal clinical ly important difference ( MCID ) falls . In three studies in which instruments measuring dyspnea , fatigue , and emotional function in patients with chronic heart and lung disease were applied the MCID was represented by mean change in score of approximately 0.5 per item , when responses were presented on a seven point Likert scale . Furthermore , we have established ranges for changes in question naire scores that correspond to moderate and large changes in the domains of interest . This information will be useful in interpreting question naire scores , both in individuals and in groups of patients participating in controlled trials , and in the planning of new trials Background : The increasing use of computerized adaptive tests ( CATs ) to generate outcome measures during rehabilitation has prompted questions concerning score interpretation . Objective : The purpose of this study was to describe meaningful interpretations of functional status ( FS ) outcome measures estimated with a body part – specific CAT developed from the Lower-Extremity Functional Scale ( LEFS ) . Design : This investigation was a prospect i ve cohort study of 8,714 people who had hip impairments and were receiving physical therapy in 257 outpatient clinics in 31 states ( United States ) between January 2005 and June 2007 . Methods : Four approaches were used to clinical ly interpret outcome data . First , the st and ard error of the estimate was used to construct the 90 % confidence interval for each CAT-generated score estimate . Second , percentile ranks were applied to FS scores . Third , 2 threshold approaches were used to define individual subject – level change : statistically reliable change and clinical ly important change . The fourth approach was a functional staging method . Results : The precision of a single score was estimated from the FS score ±4 . On the basis of OUTPUT:

A considerable variety of outcome measurement tools are used in the foot and ankle clinical literature , with a small proportion used consistently . The AOFAS scales continue to be used at a high rate relative to other scales that have been vali date d. Data from the present study underscore the need for a paradigm shift toward the use of consistent , valid , and reliable outcome measures for studies of foot and ankle procedures and disorders . It is not clear which existing vali date d outcome instruments will emerge as widely used and clinical ly meaningful .

MS2_fixed_5_shot1840

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: The efficacy and side effects of topical mupirocin ( Bactroban ) and fusidic acid ( Fucidin ) ointment were compared in a double-blind , r and omized trial in 70 patients who came to the Dermatologic Clinic of L'Enfant Jésus Hospital with primary or secondary ( or both ) skin infections . Thirty-five patients were treated with mupirocin and 35 patients were treated with fusidic acid three times a day for seven days . Clinical and bacteriologic assessment s were conducted before and after treatment . The efficacy of mupirocin , in terms of resolution and improvement of clinical signs and symptoms of infection , as well as of the elimination of infecting organisms , was similar to that of fusidic acid . Of 34 patients ( 1 could not be evaluated ) treated with mupirocin , a clinical cure was achieved in 18 , and significant improvement was demonstrated in 15 . Similarly , of 35 patients treated with fusidic acid , a clinical cure was achieved in 18 and improvement occurred in 15 . Bacteriologic cure rates were 97 % ( 30 of 31 patients evaluated ) in the mupirocin-treated group , compared with 87 % ( 27 of 31 patients evaluated ) in the fusidic acid-treated group . No side effects were observed in either treatment group . Because topical 2 % mupirocin has little or no potential for irritation , systemic side effects , or cross-resistance with other antibiotics , its efficacy is likely to make this new compound a useful agent for the treatment of superficial skin infections Staphylococcus aureus has been consistently isolated from a high proportion of impetiginous lesions , and in several recent studies , it was present in the majority of the cases . Since recently a large proportion of S. aureus strains in our community showed erythromycin resistance , we undertook a prospect i ve double-blind controlled study comparing topical mupirocin with oral erythromycin to determine ( i ) the prevalence of erythromycin-res OUTPUT:

This review found limited high- quality evidence to inform the treatment of impetigo .

MS2_fixed_5_shot1841

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: OBJECTIVE To evaluate specific effects of ovarian hyperstimulation , the in vitro procedure , and a history of subfertility on neuromotor development at 3 months of age . DESIGN Prospect i ve , cohort study . SETTING University Medical Center Groningen , The Netherl and s. PATIENT(S ) Singletons conceived after controlled ovarian hyperstimulation-IVF/intracytoplasmic sperm injection ( COH-IVF ; n = 68 ) or modified natural cycle-IVF/intracytoplasmic sperm injection ( MNC-IVF ; n = 57 ) , and naturally conceived singletons of subfertile couples ( NC ; n = 90 ) . Data from a reference population were available ( n = 450 ) . INTERVENTION(S ) None . MAIN OUTCOME MEASURE(S ) Quality of general movements ( GMs ) , classified as normal-optimal , normal-suboptimal , mildly abnormal , or definitely abnormal . Definitely abnormal GMs indicate brain dysfunction , mildly abnormal GMs normal but non-optimal brain function . RESULT ( S ) Mildly abnormal and definitely abnormal GMs were observed equally frequently in COH-IVF , MNC-IVF , and NC singletons . The three subfertile groups showed a reduction in GM quality , in particular more mildly abnormal GMs , in comparison with the reference population . CONCLUSION ( S ) Singletons born after IVF ( with or without ovarian hyperstimulation ) are not at increased risk for abnormal GMs compared with naturally conceived peers of subfertile parents . Mildly abnormal GMs occur more often in infants of subfertile parents than in the general population , suggesting that factors associated with subfertility rather than those related to IVF procedures may be associated with less-optimal early neurodevelopmental outcome . These results need confirmation through replication and follow-up at older ages The use of a gonodotropin-releasing hormone ( Gn-RH ) agonist in an in vitro fertilization ( IVF ) program raises the OUTPUT:

RESULT ( S ) For infants , studies on psychomotor development showed no deficits , but few investigated cognitive or behavioral development . Studies on toddlers generally reported normal cognitive , behavioral , socio-emotional , and psychomotor development . For children in middle childhood , development seems comparable in children born after assisted reproduction and controls , although fewer studies have been conducted with follow-up to this age . ( S ) It may tentatively be concluded that the neurodevelopment of children born after fertility treatment is overall comparable to that in children born after spontaneous conception

MS2_fixed_5_shot1842

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Of 22 r and omized trials of rehabilitation with exercise after myocardial infa rct ion ( MI ) , one trial had results that achieved conventional statistical significance . To determine whether or not these studies , in the aggregate , show a significant benefit of rehabilitation after myocardial infa rct ion , we performed an overview of all r and omized trials , involving 4,554 patients ; we evaluated total and cardiovascular mortality , sudden death , and fatal and nonfatal reinfa rct ion . For each endpoint , we calculated an odds ratio ( OR ) and 95 % confidence interval ( 95 % CI ) for the trials combined . After an average of 3 years of follow-up , the ORs were significantly lower in the rehabilitation than in the comparison group : specifically , total mortality ( OR = 0.80 [ 0.66 , 0.96 ] ) , cardiovascular mortality ( OR = 0.78 [ 0.63 , 0.96 ] ) , and fatal reinfa rct ion ( OR = 0.75 [ 0.59 , 0.95 ] ) . The OR for sudden death was significantly lower in the rehabilitation than in the comparison group at 1 year ( OR = 0.63 [ 0.41 , 0.97 ] ) . The data were compatible with a benefit at 2 ( OR = 0.76 [ 0.54 , 1.06 ] ) and 3 years ( OR = 0.92 [ 0.69 , 1.23 ] ) , but these findings were not statistically significant . For nonfatal reinfa rct ion , there were no significant differences between the two groups after 1 ( OR = 1.09 [ 0.76 , 1.57 ] ) , 2 ( OR = 1.10 [ 0.82 , 1.47 ] ) , or 3 years ( OR = 1.09 [ 0.88 , 1.34 ] ) of follow-up . The observed 20 % reduction in overall mortality reflects a decreased risk of card OUTPUT:

Available studies show convincingly the health benefits of lifestyle changes in CAD patients . Effect estimates of combined dietary changes look promising .

MS2_fixed_5_shot1843

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: The aim of this study was to evaluate the effects of a proanthocyanidin-rich grape seed extract ( GSE ) on the in vitro demineralization of root dentine . Root fragments were obtained from sound human teeth . The fragments were r and omly assigned to different treatments solutions : GSE , fluoride ( F ) , GSE+F and distilled water ( control ) . Sample s were treated daily for 30 min and subjected to a pH cycling artificial caries protocol using demineralization cycles ( 2.2 mM CaCl2 × H2O , 2.2 mM KH2PO4 , 50 mM acetic acid , pH 4.3 ) for 6 h and remineralization cycles ( 20 mM HEPES , 2.25 mM CaCl2 × H2O , 1.35 mM KH2PO4 , 130 mM KCl , pH 7.0 ) for 17.5 h. Mineral loss ( ΔZ ) and lesion depth ( LD ) were determined after 18 days of treatment/pH cycling , by transverse microradiography . GSE was able to minimize ΔZ and LD compared with the control group ( p < 0.0001 ) . The GSE+F and F groups showed the lowest values of ΔZ and LD ( p < 0.05 ) , with no statistically significant differences between them ( p = 0.554 and p = 0.726 , respectively ) . A biomimetic approach to strengthen root dentine using GSE results in decreased rates of root demineralization and may be used in conjunction with F to prevent root caries Dental caries is considered a disease of high prevalence and a constant problem in public health . Proanthocyanidins ( PAs ) are substances that have been the target of recent studies aim ing to control or treat caries . Objective The aim of this in vitro study was to evaluate the efficacy of a treatment with grape seed extract , under cariogenic challenge , to minimize or even prevent the onset of caries in the enamel and dentin . Material and Methods Blocks of en OUTPUT:

Both synthetic and naturally derived crosslinkers have been found to exhibit significant effects in biomodification of dentine via their multiple interactions with the dentine matrix . A stable matrix network or a durable hybrid layer in dentine bonding could be achieved , where the dentine collagen fibrils show improved biochemical and biomechanical properties and enzymatic biodegradation is reduced .

MS2_fixed_5_shot1844

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: OBJECTIVE The authors examined the efficacy of intramuscular flunitrazepam compared with intramuscular haloperidol for the immediate control of agitated or aggressive behavior in acutely psychotic patients . METHOD Twenty-eight actively psychotic in patients , aged 20 - 60 years , who were under treatment with neuroleptic agents were selected for the study . Each was r and omly assigned on a double-blind basis to receive either 5 mg i.m . of haloperidol ( N=13 ) or 1 mg i.m . of flunitrazepam ( N=15 ) during an aggressive event . Verbal and physical aggression was measured over time with the Overt Aggression Scale . Patients were also rated with the Brief Psychiatric Rating Scale and the Clinical Global Impression scale . RESULTS Both flunitrazepam and haloperidol exhibited acute antiaggressive activity . This beneficial effect , as assessed by the Overt Aggression Scale , was obtained within 30 minutes . CONCLUSIONS Intramuscular flunitrazepam may serve as a convenient , rapid , safe , and effective adjunct to neuroleptics in reducing aggressive behavior in emergency psychiatric setting OBJECTIVES To determine if midazolam is superior to lorazepam or haloperidol in the management of violent and severely agitated patients in the emergency department . Superiority would be determined if midazolam result ed in a significantly shorter time to sedation and shorter time to arousal . METHODS This was a r and omized , prospect i ve , double-blind study of a convenience sample of patients from an urban , county teaching emergency department . Participants included 111 violent and severely agitated patients . Patients were r and omized to receive intramuscular midazolam ( 5 mg ) , lorazepam ( 2 mg ) , or haloperidol ( 5 mg ) . RESULTS The mean ( + /-SD ) age was 40.7 ( + /-13 ) years . The mean ( + /-SD OUTPUT:

When haloperidol and midazolam were compared with olanzapine , there was some evidence the combination was superior in terms of improvement , sedation and behaviour . There were relatively little good data and most trials are too small to highlight differences in either positive or negative effects . Adding a benzodiazepine to other drugs does not seem to confer clear advantage and has potential for adding unnecessary adverse effects . Sole use of older antipsychotics unaccompanied by anticholinergic drugs seems difficult to justify .

MS2_fixed_5_shot1845

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: OBJECTIVE The combination of chronic musculoskeletal pain and depression is associated with worse clinical outcomes than either condition alone . In this study , we report the predictors of pain intensity and activity interference in primary care patients with co-morbid pain and depression . METHODS This is a secondary data analysis of the 250 persons who participated in a r and omized clinical trial design ed to test the effectiveness of 12 weeks of optimized antidepressant therapy for both depression and pain . Using multivariate linear regression analysis , we assessed the predictive value of baseline self-efficacy , fear of movement , pain beliefs , and demographic and clinical factors on 3-month Grade d Chronic Pain Scale pain intensity and activity interference outcomes . RESULTS In the full model , significant sociodemographic predictors of less activity interference included being non-white ( beta-5.8 , P = 0.04 ) and being employed ( beta-13.3 , P < 0.0001 ) . The latter was also predictive of less pain intensity ( beta-5.6 , P = 0.01 ) . As expected , the optimized antidepressant treatment arm was associated with improved outcomes ( pain intensity : beta-3.7 , P = 0.0005 and activity interference : beta-6.4 , P = 0.01 ) . Whereas stronger perceived pain control ( beta 3.6 , P = 0.01 ) was associated with greater activity interference , higher degree of fear of movement ( or fear avoidance ) predicted greater pain intensity ( beta 0.46 , P = 0.04 ) and activity interference ( beta 0.57 , P = 0.05 ) . Neither the location ( low back vs hip/knee ) nor duration of pain were predictive of pain intensity or interference outcomes . CONCLUSION The findings are consistent with a bio-psychosocial model , implicating the need to consider the impact of sociodemographic variables and pain-related beliefs and cognition on pain-related outcomes for patients with co-morbid musculoskeletal pain and depression Objective To OUTPUT:

We found a strong level of evidence for a relationship between depression and knee pain , limited evidence for no relationship between anxiety and knee pain , and minimal evidence for no relationship between poor mental health and knee pain . Conclusions Despite the heterogeneity of the included studies , these data show that depression plays a significant role in knee pain , and that a biopsychosocial approach to the management of this condition is integral to optimising outcomes for knee pain

MS2_fixed_5_shot1846

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: CONTEXT Popular diets , particularly those low in carbohydrates , have challenged current recommendations advising a low-fat , high-carbohydrate diet for weight loss . Potential benefits and risks have not been tested adequately . OBJECTIVE To compare 4 weight-loss diets representing a spectrum of low to high carbohydrate intake for effects on weight loss and related metabolic variables . DESIGN , SETTING , AND PARTICIPANTS Twelve-month r and omized trial conducted in the United States from February 2003 to October 2005 among 311 free-living , overweight/obese ( body mass index , 27 - 40 ) nondiabetic , premenopausal women . INTERVENTION Participants were r and omly assigned to follow the Atkins ( n = 77 ) , Zone ( n = 79 ) , LEARN ( n = 79 ) , or Ornish ( n = 76 ) diets and received weekly instruction for 2 months , then an additional 10-month follow-up . MAIN OUTCOME MEASURES Weight loss at 12 months was the primary outcome . Secondary outcomes included lipid profile ( low-density lipoprotein , high-density lipoprotein , and non-high-density lipoprotein cholesterol , and triglyceride levels ) , percentage of body fat , waist-hip ratio , fasting insulin and glucose levels , and blood pressure . Outcomes were assessed at months 0 , 2 , 6 , and 12 . The Tukey studentized range test was used to adjust for multiple testing . RESULTS Weight loss was greater for women in the Atkins diet group compared with the other diet groups at 12 months , and mean 12-month weight loss was significantly different between the Atkins and Zone diets ( P<.05 ) . Mean 12-month weight loss was as follows : Atkins , -4.7 kg ( 95 % confidence interval [ CI ] , -6.3 to -3.1 kg ) , Zone , -1.6 kg ( 95 % CI OUTPUT:

No significant differences were observed for weight , waist circumference , fat mass , blood lipids ( i.e. total cholesterol , LDL-cholesterol , HDL-cholesterol , triacylglycerols ) , C-reactive protein , diastolic and systolic blood pressure , fasting glucose and glycosylated hemoglobin . Sensitivity analysis of high quality RCTs confirmed the data of the primary analyses , while exclusion of studies with diabetic subjects result ed in an additional benefit of high-protein diets with respect to a more marked increase in HDL-cholesterol . Conclusion According to the present meta- analysis of long-term RCTs , high-protein diets exerted neither specific beneficial nor detrimental effects on outcome markers of obesity , cardiovascular disease or glycemic control .

MS2_fixed_5_shot1847

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: OBJECTIVES To compare the outcomes of the different surgical techniques used in varicocelectomy . METHODS The study included 120 patients with 147 clinical ly palpable varicoceles who underwent varicocelectomy . The patients were r and omly allocated to one of three equal groups according to the varicocelectomy technique , which included the open inguinal approach , a laparoscopic approach , and subinguinal microscopic varicocelectomy . The assessment included operative and postoperative parameters , together with semen analysis and pregnancy rate . The mean follow-up was 18 months ( range 11 to 26 ) . RESULTS The operative time in the microscopic group was significantly longer than that for the other two groups . At follow-up , none of the patients of the microscopic group had developed postoperative hydrocele ; however , it was observed in 7 ( 13 % ) of 52 varicoceles in the open group and 10 ( 20 % ) of 50 in the laparoscopic group . This difference was statistically significant in favor of the microscopic group only . Only 1 patient in the microscopic group experienced recurrence of one varicocele compared with 7 and 9 patients in the open and laparoscopic groups , respectively . This difference was statistically significant in favor of the microscopic group only . Improvement in sperm motility and /or concentration was comparable and observed in 65 % , 67 % , and 76 % of the open , laparoscopic , and microscopic groups , respectively . Also , the pregnancy rate at 1 year was not significantly different and was 28 % , 30 % , and 40 % in three groups , respectively . CONCLUSIONS The findings of our study have demonstrated that , compared with open inguinal and laparoscopic varicocelectomy , subinguinal microsurgical varicocelectomy offers the best outcome OBJECTIVE To compare semen parameters , pregnancy , recurrence , and complication rates after microsurgical and nonmagnified subinguinal varicocelectomy for infertile men OUTPUT:

Taken together , the clinical work to date suggests that the highest fertility rates and the lowest complication rates are associated with the microsurgical subinguinal surgical approach to varicocelectomy .

MS2_fixed_5_shot1848

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: The impact of omega-3 long-chain polyunsaturated fatty acids ( LCPUFAs ) on cognition is heavily debated . In the current study , the possible association between omega-3 LCPUFAs in blood and cognitive performance of 266 typically developing adolescents aged 13–15 years is investigated . Baseline data from Food2Learn , a double-blind and r and omized placebo controlled krill oil supplementation trial in typically developing adolescents , were used for the current study . The Omega-3 Index was determined with blood from a finger prick . At baseline , participants finished a neuropsychological test battery consisting of the Letter Digit Substitution Test ( LDST ) , D2 test of attention , Digit Span Forward and Backward , Concept Shifting Test and Stroop test . Data were analyzed with multiple regression analyses with correction for covariates . The average Omega-3 Index was 3.83 % ( SD 0.60 ) . Regression analyses between the Omega-3 Index and the outcome parameters revealed significant associations with scores on two of the nine parameters . The association between the Omega-3 Index and both scores on the LDST ( β = 0.136 and p = 0.039 ) , and the number of errors of omission on the D2 ( β = −0.053 and p = 0.007 ) . This is a possible indication for a higher information processing speed and less impulsivity in those with a higher Omega-3 Index The macronutrient composition of a breakfast that could facilitate performance after an overnight fast remains unclear . As glucose is the brain 's major energy source , the interest is in investigating meals differing in their blood glucose-raising potential . Findings vary due to unaccounted differences in glucoregulation , arousal and cortisol secretion . We investigated the effects of meals differing in glycaemic index ( GI ) and glycaemic load ( GL ) on cognition and mood in school children . A total of seventy-four school children were matched and r and omly allocated either to the high- OUTPUT:

Taken together , evidence suggests a positive association between healthy dietary consumption and executive functioning .

MS2_fixed_5_shot1849

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Background : Treatment for children with attention deficit/hyperactivity disorder ( ADHD ) today is predominantly pharmacological . While it is the most common treatment , it might not always be the most appropriate one . Moreover , long term effects remain unclear . Behavior therapy ( BT ) and non-pharmacological treatments such as neurofeedback ( NF ) are promising alternatives , though there are no routine outpatient care/effectiveness studies yet that have included children with medication or changes in medication . Methods / design : This paper presents the protocol of a r and omized controlled trial to compare the effectiveness of a Slow Cortical Potential ( SCP ) NF protocol with self-management ( SM ) in a high frequent outpatient care setting . Both groups ( NF/SM ) receive a total of 30 high frequent therapy sessions . Additionally , 6 sessions are reserved for comorbid problems . The primary outcome measure is the reduction of ADHD core symptoms according to parent and teacher ratings . Preliminary Results : Untill now 58 children were included in the study ( 48 males ) , with a mean age of 8.42 ( 1.34 ) years , and a mean IQ of 110 ( 13.37 ) . Conners-3 parent and teacher ratings were used to estimate core symptom change . Since the study is still ongoing , and children are in different study stages , pre-post and follow-up results are not yet available for all children included . Preliminary results suggest overall good pre-post effects , though . For parent and teacher ratings an ANOVA with repeated measures yielded overall satisfying pre-post effects ( η2 0.175–0.513 ) . Differences between groups ( NF vs. SM ) could not yet be established ( p = 0.81 ) . Discussion : This is the first r and omized controlled trial to test the effectiveness of a NF protocol in a high frequent outpatient care setting that does not exclude children on or with changes in medication . First preliminary results show positive effects . The rationale for the trial , the design , and the strengths and limitations of the study are discussed . Trial registration : This trial is registered in www . clinical trials.gov OUTPUT:

Compared to non-active control treatments , NF appears to have more durable treatment effects , for at least 6 months following treatment .

MS2_fixed_5_shot1850

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Background Age‐related endothelial dysfunction and vascular stiffening are associated with increased cardiovascular ( CV ) risk . Many groups have encouraged goals of ≥10 000 steps/day or ≥30 min/day of moderate intensity physical activity ( MPA ) to reduce age‐related CV risk . The impact of MPA on the vasculature of older adults remains unclear . Methods and Results We r and omized 114 sedentary older adults ages ≥50 to 12 weeks of either no intervention ( group 1 ) , a pedometer‐only intervention ( group 2 ) , or a pedometer with an interactive website employing strategies to increase the adoption of habitual physical activity ( PA , group 3 ) . Endothelial function by brachial flow‐mediated dilation ( FMD% ) , vascular stiffness by tonometry , step‐count by pedometer , and PA intensity/distribution by accelerometer were measured . Step‐count increased in groups 2 ( 5136±1554 to 9596±3907 , P<0.001 ) and 3 ( 5474±1512 to 8167±3111 , P<0.001 ) but not in group 1 ( 4931±1667 to 5410±2410 ) . Both groups 2 and 3 increased MPA ≥30 min/day . Only group 3 increased MPA in continuous bouts of ≥10 minutes ( P<0.001 ) and improved FMD% ( P=0.001 ) . Neither achievement of ≥10 000 steps/day nor ≥30 min/day of MPA result ed in improved FMD% . However , achieving ≥20 min/day in MPA bouts result ed in improved FMD% . No changes in vascular stiffness were observed . Conclusions MPA reverses age‐related endothelial dysfunction , but may require MPA to be performed in bouts of ≥10 minutes duration for ≥20 min/day to be effective . Commonly encouraged PA OUTPUT:

R and omized controlled trials found a positive correlation for SB with BMI , neck circumference , fat mass , HbA1C , cholesterol and insulin levels , cohort studies additionally for WC , leptin , C-peptide , ApoA1 and Low density lipoprotein and a negative correlation for HDL . Most studied biomarkers associated with SB were of cardiovascular or metabolic origin .

MS2_fixed_5_shot1851

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: OBJECTIVES The purpose of this study was to test the value of gait speed , a clinical marker for frailty , to improve the prediction of mortality and major morbidity in elderly patients undergoing cardiac surgery . BACKGROUND It is increasingly difficult to predict the elderly patient 's risk posed by cardiac surgery because existing risk assessment tools are incomplete . METHODS A multicenter prospect i ve cohort of elderly patients undergoing cardiac surgery was assembled at 4 tertiary care hospitals between 2008 and 2009 . Patients were eligible if they were 70 years of age or older and were scheduled for coronary artery bypass and /or valve replacement or repair . The primary predictor was slow gait speed , defined as a time taken to walk 5 m of ≥ 6 s. The primary end point was a composite of in-hospital post-operative mortality or major morbidity . RESULTS The cohort consisted of 131 patients with a mean age of 75.8 ± 4.4 years ; 34 % were female patients . Sixty patients ( 46 % ) were classified as slow walkers before cardiac surgery . Slow walkers were more likely to be female ( 43 % vs. 25 % , p = 0.03 ) and diabetic ( 50 % vs. 28 % , p = 0.01 ) . Thirty patients ( 23 % ) experienced the primary composite end point of mortality or major morbidity after cardiac surgery . Slow gait speed was an independent predictor of the composite end point after adjusting for the Society of Thoracic Surgeons risk score ( odds ratio : 3.05 ; 95 % confidence interval : 1.23 to 7.54 ) . CONCLUSIONS Gait speed is a simple and effective test that may identify a subset of vulnerable elderly patients at incrementally higher risk of mortality and major morbidity after cardiac surgery Background When people with stroke recover gait speed , they report improved function and reduced disability . However , the minimal amount of change in gait speed that is clinical ly meaningful and associated OUTPUT:

Changes in gait speed of 0.10 to 0.20 m s(-1 ) may be important across multiple patient groups

MS2_fixed_5_shot1852

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: OBJECTIVE The aim of this study was to investigate the construct validity of 6 physical performance tests that had already been shown to have acceptable repeatability . DESIGN Data were collected in a r and omized controlled multi-centre study . SUBJECTS 126 women and 105 men sick-listed for spinal pain carried out the tests and provided personal and background data at inclusion in the study . METHODS One test measured stepping up onto and down from a stool , 2 measured lifting ability and 3 walking speed . Construct validity was examined by analysing the influence of some variables on test performance . RESULTS High-rated pain behaviour and perceived high pain intensity during testing or during the previous 4 weeks were connected with low test performance . Exercise twice a week was connected with high test performance . The test with the highest ability to detect disability in the women with lumbar pain was a lumbar lifting test , while for the men , it was a cervical lifting test . The test with the highest ability to detect disability in the participants with neck pain was the cervical lifting test in addition to a gait test with burden for the women . CONCLUSION Back pain hampered the test performance more than neck pain . Impairments and activity limitations expressed by the patient should guide the choice of test Background Reproducibility measurements of the range of motion are an important prerequisite for the interpretation of study results . The aim of the study is to assess the intra-rater and inter-rater reproducibility of the measurement of active Range of Motion ( ROM ) in patients with neck pain using the Cybex Electronic Digital Inclinometer-320 ( EDI-320 ) . Methods In an outpatient clinic in a primary care setting 32 patients with at least 2 weeks of pain and /or stiffness in the neck were r and omly assessed , in a test- retest design with blinded raters using a st and ardized measurement protocol . Cervical flexion-extension , lateral flexion and rotation were assessed . Results Reliability expressed by the Intraclass Correlation Coefficient ( ICC ) was 0.93 ( lateral flexion ) or higher for intra-rater reliability and OUTPUT:

Screening protocol s have high predictive values to detect cervical spine fracture in alert , low-risk patients seeking emergency care after blunt neck trauma . Computerized tomography ( CT ) scans had better validity ( in adults and elderly ) than radiographs in assessing high-risk and /or multi-injured blunt trauma neck patients . In the absence of serious pathology , clinical physical examinations are more predictive at excluding than confirming structural lesions causing neurologic compression . One exception is the manual provocation test for cervical radiculopathy , which has high positive predictive value . There was no evidence that specific MRI findings are associated with neck pain , cervicogenic headache , or whiplash exposure . No evidence supports using cervical provocative discography , anesthetic facet , or medial branch blocks in evaluating neck pain . Reliable and valid self-report question naires are useful in assessing pain , function , disability , and psychosocial status in individuals with neck pain . CONCLUSION The scientific evidence supports screening protocol s in emergency care for low-risk patients ; and CT-scans for high-risk patients with blunt trauma to the neck . In nonemergency neck pain without radiculopathy , the validity of most commonly used objective tests is lacking .

MS2_fixed_5_shot1853

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Introduction The aim of this prospect i ve study was to analyze the impact of different surgical techniques on patients undergoing intestinal surgery for Crohn ’s disease ( CD ) in terms of recovery , quality of life , and direct and indirect costs . Patients and methods Forty-seven consecutive patients admitted for intestinal surgery for CD were enrolled in this prospect i ve study . Surgical procedures were evaluated as possible predictors of outcome in terms of disability status ( Barthel ’s Index ) , quality of life ( Clevel and Global Quality of Life score ) , body image , disease activity ( Harvey – Bradshaw Activity Index ) , and costs ( calculated in 2008 Euros ) . Univariate and multivariate analyses were performed . Results Significant predictors of a long postoperative hospital stay were the creation of a stoma , postoperative complications , disability status on the third post-operative day , and surgical access ( R2 = 0.59 , p < 0.01 ) . Barthel ’s index at discharge was independently predicted by laparoscopic-assisted approach , ileal CD , and colonic CD ( R2 = 0.53 , p < 0.01 ) . The disability status at admission showed to be an independent predictor of quality of life score at follow-up . The overall cost for intestinal surgery for CD was 12,037 ( 10,117–15,795 ) euro per patient and stoma creation revealed to be its only predictor ( p = 0.006 ) . Conclusions Laparoscopy was associated with a shorter postoperative length of stay ; stoma creation was associated with a long and expensive postoperative hospital stay , and stricturoplasty was associated with a slower recovery of bowel function Aliment Pharmacol Ther 2010 ; 32 : 1228–1239 One hundred and twenty-two r and omly selected patients with ulcerative colitis ( 28 of whom had undergone colectomy ) were interviewed to obtain data on the quality of their family , emotional , social , and professional lives . They were compared with an age- and sex-matched OUTPUT:

The majority of the studies reported a high burden of work-related outcomes among inflammatory bowel disease patients regardless of the methodology used . Inflammatory bowel disease patients experience a high burden in work-related outcomes .

MS2_fixed_5_shot1854

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: BACKGROUND The results of previous studies indicated that energy density , independent of fat content , influences energy intake . In most studies , however , both fat content and energy density were lower than in typical American diets . OBJECTIVE We examined the influence of energy density on intake when fat content was above , below , or similar to the amount of fat typically consumed and when energy density was closer to that of American diets . DESIGN Lean ( n = 19 ) and obese ( n = 17 ) women consumed all meals daily in our laboratory during 6 experimental sessions . The main entrées , consumed ad libitum , were formulated to vary in fat content ( 25 % , 35 % , and 45 % of energy ) and energy density ( 5.23 kJ/g , or low energy density , and 7.32 kJ/g , or high energy density ) but to have similar palatability . RESULTS Energy density influenced energy intake across all fat contents in both lean and obese women ( P < 0.0001 ) . Women consumed less energy in the low ( 7531 kJ ) than in the high ( 9414 kJ ) energy density condition . Despite this 20 % lower energy intake , there were only small differences in hunger ( 7 % ) and fullness ( 5 % ) . Women consumed a similar volume , but not weight , of food daily across conditions . Differences in intake by weight , but not volume , occurred because for some versions of manipulated foods , weight and volume were not directly proportional . CONCLUSIONS Energy density affected energy intake across different fat contents and at levels of energy density comparable with those in typical diets . Furthermore , our findings suggest that cues related to the amount of food consumed have a greater influence on short-term intake than does the amount of energy consumed BACKGROUND A vegetarian diet may lead to numerous health benefits , including weight loss . OBJECTIVE We examined the joint effects of personal preference of dietary treatment and a calorie-restricted , low-fat lactoovovegetarian diet ( LOV-D ) compared with a st and ard calorie-restricted , low-fat OUTPUT:

Greater weight loss was reported in studies with higher baseline weights , smaller proportions of female participants , older participants , or longer duration s , and in studies in which weight loss was a goal . The prescription of vegetarian diets reduces mean body weight , suggesting potential value for prevention and management of weight-related conditions

MS2_fixed_5_shot1855

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: We have investigated the action of pimozide in tardive dyskinesia induced by prolonged administration of phenothiazines . Improvement was recorded in a double blind study of 18 patients treated with maximum tolerated dosage ( mean 18.8 mg/day ) for 6 weeks . There was no deterioration in the therapeutic action of pimozide over this time . Parkinsonism and sedation were the main adverse effects . They were corrected by reduction of the dose of pimozide , but often recurred so that further adjustments of dosage were necessary . Our findings support the view that tardive dyskinesia is produced by a disturbance in the balance of central transmitters such that dopaminergic transmission is increased OBJECTIVE Despite the frequent use of the Positive and Negative Syndrome Scale ( PANSS ) for rating the symptoms of schizophrenia , the clinical meaning of its total score and of the cut-offs that are used to define treatment response ( e.g. at least 20 % or 50 % reduction of the baseline score ) are as yet unclear . We therefore compared the PANSS with simultaneous ratings of Clinical Global Impressions ( CGI ) . METHOD PANSS and CGI ratings at baseline ( n = 4091 ) , and after one , two , four and six weeks of treatment taken from a pooled data base of seven pivotal , multi-center antipsychotic drug trials on olanzapine or amisulpride in patients with exacerbations of schizophrenia were compared using equipercentile linking . RESULTS Being considered " mildly ill " according to the CGI approximately corresponded to a PANSS total score of 58 , " moderately ill " to a PANSS of 75 , " markedly ill " to a PANSS of 95 and severely ill to a PANSS of 116 . To be " minimally improved " according to the CGI score was associated with a mean percentage PANSS reduction of 19 % , 23 % , 26 % and 28 % at weeks 1 , 2 , 4 and 6 , respectively OUTPUT:

This review suggests that both benzodiazepines work , but that midazolam has a faster onset and thereby reduces the risk of exposure to violence . Most evidence , however , exists for the haloperidol plus promethazine mix , with currently more than 400 people r and omised to the combination . The onset of action is swift and faster than lorazepam . The combination also seems safe with no clear longer term consequences .

MS2_fixed_5_shot1856

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: The mechanism of risk reduction obtained by blood pressure-lowering pharmacological treatment remains unclear . We explored the amount of risk reduction attributable to the apparent effect of antihypertensive medicines on blood pressure by using the capture approach . Five r and omized , placebo or nil controlled trials with a total of 28,997 subjects and 1,935 cardiovascular fatal or non-fatal events from the INDANA data base met the eligibility criteria . Computations were performed on the original individual records using multiple Cox 's proportional hazard regression models design ed for meeting the assumed treatment mode of action and comparing relevant assumptions . For coronary event , the results are inconclusive essentially because the risk reduction is mild . However , for stroke the risk reduction adjusted for baseline risk factors is 34 % ( P<0.0001 ) . The part explained by the effect of treatment on systolic blood pressure is 49 % of this reduction , with 95 % confidence interval not including 100 % . This result suggests that the apparent effect on blood pressure is not the only cause of stroke risk reduction in hypertensive subjects su bmi tted to an antihypertensive medicine CONTEXT The Systolic Hypertension in the Elderly Program ( SHEP ) demonstrated that treating isolated systolic hypertension in older patients decreased incidence of total stroke , but whether all types of stroke were reduced was not evaluated . OBJECTIVE To investigate antihypertensive drug treatment effects on incidence of stroke by type and subtype , timing of strokes , case-fatality rates , stroke residual effects , and relationship of attained systolic blood pressure to stroke incidence . DESIGN The SHEP study , a r and omized , double-blind , placebo-controlled trial began March 1 , 1985 , and had an average follow-up of 4.5 years . SETTING AND PARTICIPANTS A total of 4736 men and women aged 60 years or older with isolated systolic hypertension at 16 clinical centers in the United States . INTERVENTIONS Patients were r and omly assigned to receive treatment with 12.5 mg/d of chlorthalid OUTPUT:

The reduction in cardiovascular mortality and morbidity was primarily due to a reduction in cerebrovascular mortality and morbidity . AUTHORS ' CONCLUSIONS Treating healthy adults 60 years or older with moderate to severe systolic and /or diastolic hypertension with antihypertensive drug therapy reduced all-cause mortality , cardiovascular mortality and morbidity , cerebrovascular mortality and morbidity , and coronary heart disease mortality and morbidity . Most evidence of benefit pertains to a primary prevention population using a thiazide as first-line treatment

MS2_fixed_5_shot1857

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: PURPOSE The purpose of the article was to examine the association of early life growth with age at menarche . METHODS Using data from a prospect i ve birth cohort ( n = 1134 women , 290 sibling sets ) , we assessed the association between postnatal growth at 4 months , 1 year , and 4 years and age at menarche , using generalized estimating equations and generalized linear r and om effects models . RESULTS Overall , 18 % of the cohort experienced early menarche ( < 12 years ) . After accounting for postnatal growth in length , faster postnatal change in weight ( per 10-percentile increase ) in all three periods was associated with an increase ( range 9%-20 % ) in the likelihood of having an early menarche . In adjusted linear models , faster weight gains in infancy and childhood were associated with an average age at menarche that was 1.1 - 1.3 months earlier compared with stable growth . The overall results were consistent for percentile and conditional growth models . Girls who experienced rapid growth ( defined as increasing across two major Centers for Disease Control and Prevention growth percentiles ) in early infancy had an average age at menarche that was 4.6 months earlier than girls whose growth was stable . CONCLUSIONS Faster postnatal weight gains in infancy and early childhood before the age of 4 years are associated with earlier age at menarche Background : Given global trends toward earlier onset of puberty and the adverse psychosocial consequences of early puberty , it is important to underst and the childhood predictors of pubertal timing and tempo . Objective : We examined the association between early growth and the timing and tempo of puberty in adolescents in South Africa . Methods : We analyzed prospect ively collected data from 1060 boys and 1135 girls participating in the Birth-to-Twenty cohort in Soweto , South Africa . Height-for-age z scores ( HAZs ) and body mass index – for-age z scores ( BMI Zs ) were calculated based on height ( centimeters ) and body mass index ( kilograms per meter squared ) at OUTPUT:

There is no consistent result in the relationship between obesity and timing of pubertal onset in boys . Obesity may contribute to early onset of puberty in girls , while in boys , there is insufficient data .

MS2_fixed_5_shot1858

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Background : Calcium absorption is generally considered to be impaired under conditions of vitamin D deficiency , but the vitamin D status that fully normalizes absorption is not known for humans . Objective : To quantify calcium absorption at two levels of vitamin D repletion , using pharmacokinetic methods and commercially marketed calcium supplements . Design : Two experiments performed in the spring of the year , one year apart . In the first , in which participants were pretreated with 25-hydroxyvitamin D ( 25OHD ) , mean serum 25OHD concentration was 86.5 nmol/L ; and in the other , with no pretreatment , mean serum concentration was 50.2 nmol/L. Participants received 500 mg oral calcium loads as a part of a st and ard low calcium breakfast . A low calcium lunch was provided at mid-day . Blood was obtained fasting and at frequent intervals for 10 to 12 hours thereafter . Methods : Relative calcium absorption at the two 25OHD concentrations was estimated from the area under the curve ( AUC ) for the load-induced increment in serum total calcium . Results : AUC9 ( ± SEM ) , was 3.63 mg hr/dL ± 0.234 in participants pretreated with 25OHD and 2.20 ± 0.240 in those not pretreated ( P < 0.001 ) . In brief , absorption was 65 % higher at serum 25OHD levels averaging 86.5 nmol/L than at levels averaging 50 nmol/L ( both values within the nominal reference range for this analyte ) . Conclusions : Despite the fact that the mean serum 25OHD level in the experiment without supplementation was within the current reference ranges , calcium absorptive performance at 50 nmol/L was significantly reduced relative to that at a mean 25OHD level of 86 nmol/L. Thus , individuals with serum 25-hydroxyvitamin OUTPUT:

Children with LRTI were found to have significantly lower mean vitamin D levels as compared to controls There was likewise a correlation between vitamin D levels and incidence and severity of LRTI .

MS2_fixed_5_shot1859

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Abstract Purpose The aim of the study was to investigate the influence of foods enriched with vegetable oils varying in their n-3 polyunsaturated fatty acids profile on cardiovascular risk factors for hypertriglyceridemic subjects . Methods Fifty-nine hypertriglyceridemic subjects ( triglycerides ≥ 1.5 mmol/L ) were included in the r and omized , double-blind , placebo-controlled , crossover study . The placebo group received sunflower oil [ linoleic acid ( LA ) group ; 10 g LA/day ] . The intervention groups received linseed oil [ α-linolenic acid ( ALA ) group ; 7 g ALA/day ] , echium oil [ stearidonic acid ( SDA ) group ; 2 g SDA/day ] or microalgae oil [ docosahexaenoic acid ( DHA ) group ; 2 g DHA/day ] over 10 weeks . Blood sample s were collected at baseline and at the end of each period . Results Total cholesterol ( TC ) and low-density-lipoprotein cholesterol decreased significantly in the LA and ALA groups ( LA : P ≤ 0.01 , ALA : P ≤ 0.05 ) . No changes in blood lipids were observed in the SDA group . Significant increases in TC and high-density-lipoprotein cholesterol occurred in the DHA group ( P ≤ 0.05 ) . In the ALA and SDA groups , the content of eicosapentaenoic acid in erythrocyte lipids increased significantly ( P ≤ 0.05 ) after 10 weeks ( ALA group : 38 ± 37 % , SDA group : 73 ± 59 % ) . Conclusion Foods enriched with different vegetable oils rich in ALA or SDA are able to increase the n-3 long-chain polyunsaturated fatty acids content in erythrocyte lipids ; echium oil is more potent in comparison with linseed oil . Blood lipids were beneficially modified through the consumption of food products en OUTPUT:

Despite limitations in these data , our NMA findings are in line with existing evidence on the metabolic effects of fat and support current recommendations to replace high saturated-fat food with unsaturated oils

MS2_fixed_5_shot1860

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Rationale Seasonal affective disorder ( SAD ) is a relatively common cyclical depressive illness characterized by seasonal depressions during winter . The disorder is commonly responsive to light therapy , but antidepressant drug efficacy has not been definitely established . Serotonin selective re-uptake inhibitors are potentially efficacious treatments for SAD . Objectives The objective of this study was to evaluate the efficacy , tolerability and safety of sertraline treatment for SAD . Methods One hundred and eighty seven out patients with seasonal pattern recurrent winter depression ( DSM-III-R defined ) and a minimum 29-item Hamilton depression scale ( SIGH-SAD version ) score of 22 were r and omized to 8 weeks treatment with either sertraline or placebo in a double-blind , multi-country , multi-center , parallel-group , flexible dose ( 50–200 mg once daily ) study . Efficacy was investigated using physician and patient-rated scales measuring depression , anxiety and symptoms characteristic of seasonal affective disorder . Results Sertraline produced a significantly greater response than placebo at endpoint as measured by changes in the 29-item and 21-item Hamilton depression scales , the clinical global impression ( CGI ) severity scale , the Hamilton anxiety scale , and the hospital anxiety and depression scale . The proportion of sertraline-treated subjects achieving a response on the CGI improvement rating ( ratings of 1 or 2 ) at endpoint ( last observation carried forward ) was significantly greater than that of the placebo group . Overall sertraline was well tolerated with the most frequent placebo adjusted adverse events , being nausea , diarrhea , insomnia and dry mouth . Adverse events were mostly mild to moderate and transient . Conclusions Sertraline pharmacotherapy has been demonstrated to be an effective and well-tolerated therapy for out patients with SAD . As such , sertraline offers an important pharmacological option in the clinical management of this condition OBJECTIVE In DSM-IV , winter seasonal affective disorder ( SAD ) is classified as a seasonal pattern OUTPUT:

Recent systematic review s have shown that light therapy is an efficacious and well-tolerated treatment for SAD . There is also evidence for efficacy of pharmacotherapy to treat and prevent SAD . SAD is a common condition with significant psychosocial impairment .

MS2_fixed_5_shot1861

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Abstract The inability to predict outcome in patients with low back/neck pain leads to inappropriate or unnecessary treatment . The aims of the study were to identify prognostic factors for disability at 1‐year follow‐up in patients with back pain visiting primary care , and to compare the effect of these in two treatment strategies – chiropractic and physiotherapy . Data were taken from a r and omised trial on patients with back/neck pain visiting the general practitioner , in which patients were allocated to chiropractic and physiotherapy as primary management . Three hundred and twenty‐three patients , aged 18–60 years , who had no contraindications to manipulation and who had not been treated within the previous month were included in the study . Multiple regression analysis was used to identify prognostic factors . Dependent variables were mean Oswestry score and mean change in Oswestry score at 12‐month follow‐up . The multiple regression analysis revealed five significant ( P<0.001–0.01 ) prognostic factors ; duration of current episode , Oswestry score at entry , expectations of treatment , number of localisations , and well‐being . Besides , the regression coefficients for the significant factors were compared between the two treatment strategies . No significant difference in effect or regression coefficients for the prognostic factors were seen between the two treatment strategies . Twelve per cent of the patients had poor prognostic factors ( duration ≥1 month , more than one localisation , low expectations of treatment and low well‐being ) at entry . These patients had a mean Oswestry score above 20 % at 1‐year follow‐up . Clinical decision models for the management of patients with back pain visiting primary care that consider prognostic factors need to be implemented and prospect ively evaluated In clinical measurement comparison of a new measurement technique with an established one is often needed to see whether they agree sufficiently for the new to replace the old . Such investigations are often analysed inappropriately , notably by using correlation coefficients . The use of correlation is misleading . An alternative approach , based on graphical techniques and simple calculations , is described , together with the relation between this analysis and the assessment of repeatability In a study that indicates more definitive investigation OUTPUT:

The ODI remains a valid and vigorous measure and has been a worthwhile outcome measure . The behavior of the instrument is incompletely understood , particularly in sensitivity to real change .

MS2_fixed_5_shot1862

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: BACKGROUND Selecting elderly persons who need geriatric interventions and making accurate treatment decisions are recurring challenges in geriatrics . Chronological age , although often used , does not seem to be the best selection criterion . Instead , the concept of frailty , which indicates several concurrent losses in re sources , can be used . METHODS The predictive values of chronological age and frailty were investigated in a large community sample of persons aged 65 years and older , r and omly drawn from the register of six municipalities in the northern regions of the Netherl and s ( 45 % of the original addressees ) . The participants ' generative capacity to sustain well-being ( i.e. , self-management abilities ) was used as the main outcome measure . RESULTS When using chronological age instead of frailty , both too many and too few persons were selected . Furthermore , frailty related more strongly ( with beta values ranging from -.25 to -.39 ) to a decline in the participants ' self-management abilities than did chronological age ( with beta values ranging from -.06 to -.14 ) . Chronological age added very little to the explained variances of all outcomes once frailty was included . CONCLUSIONS Using frailty as the criterion to select older persons at risk for interventions may be better than selecting persons based only on their chronological age Abstract Currently , the association between sarcopenia and long-term prognosis after gastric cancer surgery has not been investigated . Moreover , the association between sarcopenia and postoperative complications remains controversial . This large-scale retrospective study aims to ascertain the prevalence of sarcopenia and assess its impact on postoperative complications and long-term survival in patients undergoing radical gastrectomy for gastric cancer . From December 2008 to April 2013 , the clinical data of all patients who underwent elective radical gastrectomy for gastric cancer were collected prospect ively . Only patients with available preoperative abdominal CT scan within 30 days of surgery were considered for analysis . Skeletal muscle mass was determined by abdominal ( computed tomography ) CT scan , and s OUTPUT:

ConclusionS arcopenia and frailty seem to have significant adverse impacts on the occurrence of postoperative outcomes .

MS2_fixed_5_shot1863

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: CONTEXT To enhance the effectiveness of diet in lowering cholesterol , recommendations of the Adult Treatment Panel III of the National Cholesterol Education Program emphasize diets low in saturated fat together with plant sterols and viscous fibers , and the American Heart Association supports the use of soy protein and nuts . OBJECTIVE To determine whether a diet containing all of these recommended food components leads to cholesterol reduction comparable with that of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors ( statins ) . DESIGN R and omized controlled trial conducted between October and December 2002 . SETTING AND PARTICIPANTS Forty-six healthy , hyperlipidemic adults ( 25 men and 21 postmenopausal women ) with a mean ( SE ) age of 59 ( 1 ) years and body mass index of 27.6 ( 0.5 ) , recruited from a Canadian hospital-affiliated nutrition research center and the community . INTERVENTIONS Participants were r and omly assigned to undergo 1 of 3 interventions on an outpatient basis for 1 month : a diet very low in saturated fat , based on milled whole-wheat cereals and low-fat dairy foods ( n = 16 ; control ) ; the same diet plus lovastatin , 20 mg/d ( n = 14 ) ; or a diet high in plant sterols ( 1.0 g/1000 kcal ) , soy protein ( 21.4 g/1000 kcal ) , viscous fibers ( 9.8 g/1000 kcal ) , and almonds ( 14 g/1000 kcal ) ( n = 16 ; dietary portfolio ) . MAIN OUTCOME MEASURES Lipid and C-reactive protein levels , obtained from fasting blood sample s ; blood pressure ; and body weight ; measured at weeks 0 , 2 , and 4 and compared among the 3 treatment groups . RESULTS The control , statin , and OUTPUT:

Conclusions Plant-based diets are associated with decreased total cholesterol , low-density lipoprotein cholesterol , and high-density lipoprotein cholesterol , but not with decreased triglycerides .

MS2_fixed_5_shot1864

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: A double blind clinical trial was carried out to clarify the effects of oil with medium- and long-chain triglyceride ( MLCT ) on body fat and blood lipid profiles in hypertriglyceridemic subjects . One-hundred- and -twelve subjects were enrolled and divided into two groups ; those that consumed MLCT oil and those that consumed long-chain triglyceride ( LCT ) oil for 8 weeks . All subjects were requested to consume 25 - 30 g of the oils daily and maintain a fixed level of energy intake and exercise . Anthropometric and blood biochemical parameters were measured when the study was initiated and completed . The LCT group consisted of 50 subjects ( 34 men and 16 women ) , while the MLCT group consisted of 51 subjects ( 33 men and 18 women ) who completed the study . Larger decreases in body weight , body mass index , waist circumference , body fat , total fat area and subcutaneous fat area in the abdomen and serum triglycerides , low-density lipoprotein cholesterol , apolipoprotein B , C2 , C3 and E were observed in male subjects in the MLCT group than those in the LCT group . However , no significant differences in these parameters between the female subjects in the two groups were observed . Data from this study indicate that consumption of medium- and long-chain triglycerides can reduce body weight and body fat and improve blood lipid profiles in male hypertriglyceridemic subjects OBJECTIVE The objectives of this study were to compare the effects of diets rich in medium-chain triglycerides ( MCTs ) or long-chain triglycerides ( LCTs ) on body composition , energy expenditure , substrate oxidation , subjective appetite , and ad libitum energy intake in overweight men . RESEARCH METHODS AND PROCEDURES Twenty-four healthy , overweight men with body mass indexes between 25 and 31 kg/m(2 ) consumed diets rich in MCT or LCT for 28 days each in a crossover r and omized controlled trial . At baseline and after 4 weeks of each dietary intervention OUTPUT:

No differences were seen in blood lipid levels . Replacement of LCTs with MCTs in the diet could potentially induce modest reductions in body weight and composition without adversely affecting lipid profiles .

MS2_fixed_5_shot1865

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Glass ionomer orthodontic adhesives cause less enamel demineralization during fixed orthodontic appliance treatment than do traditional resin-based products . An in vivo r and omized clinical trial was performed comparing the clinical performance of a resin-modified glass ionomer ( RMGI ) adhesive with a no-mix , resin-based ( the control ) adhesive over a 12-month period . The split-mouth technique was used to analyze bracket retention , bracket failure causes , and mode of failure for both adhesives in 61 patients . Bracket-failure rates were 10 % for the RMGI and 4 % for the resin-based adhesive . Both adhesives had 4 times more bracket failures when opposing occlusion was present . The resin-based product demonstrated a higher proportion of resin-to-enamel adhesive failures than did the RMGI . Compared with the resin-based adhesive , the RMGI-bracketed teeth showed improved clinical performance , no enamel surface loss , less enamel demineralization , and faster adhesive removal . However , the RMGI had a 2.6 times greater bracket-failure rate than did the resin-based product OBJECTIVE Pumicing of the enamel prior to direct bonding with conventional diacrylate bonding agents has been shown to be unnecessary . It is not known whether this is also the case with resin-modified glass poly(alkenoate ) cements . The aims of this study were two-fold : ( a ) . to determine whether pumicing prior to bonding has an effect on the in vivo failure of brackets bonded with either Right-On or Fuji II LC ; ( b ) . to determine whether there is a difference in the in vivo failure of brackets bonded with either Right-On or Fuji II LC . Design A cross-mouth controlled clinical trial was performed on a total of 60 patients in which the variables under test were pumicing or not pumicing of the enamel prior to bonding using two different bonding agents . MAIN OUTCOME MEASURES The measurement variable was bond failure over OUTPUT:

The current evidence suggests no difference between the types of material s after 12 months but favours composite resin adhesives after a > 14-month period . The clinical relevance of this study is that RM-GIC may have the same clinical debonding ( failure ) rate as composite resin adhesives after 1 year when used for bonding of orthodontic brackets

MS2_fixed_5_shot1866

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: BACKGROUND Patients with transient ischaemic attack ( TIA ) or minor stroke are at high immediate risk of stroke . The optimum early treatment options for these patients are not known . METHODS Within 24 h of symptom onset , we r and omly assigned , in a factorial design , 392 patients with TIA or minor stroke to clopidogrel ( 300 mg loading dose then 75 mg daily ; 198 patients ) or placebo ( 194 patients ) , and simvastatin ( 40 mg daily ; 199 patients ) or placebo ( 193 patients ) . All patients were also given aspirin and were followed for 90 days . Descriptive analyses were done by intention to treat . The primary outcome was total stroke ( ischaemic and haemorrhagic ) within 90 days . Safety outcomes included haemorrhage related to clopidogrel and myositis related to simvastatin . This study is registered as an International St and ard R and omised Controlled Trial ( number 35624812 ) and with Clinical Trials.gov ( NCT00109382 ) . FINDINGS The median time to stroke outcome was 1 day ( range 0 - 62 days ) . The trial was stopped early due to a failure to recruit patients at the prespecified minimum enrolment rate because of increased use of statins . 14 ( 7.1 % ) patients on clopidogrel had a stroke within 90 days compared with 21 ( 10.8 % ) patients on placebo ( risk ratio 0.7 [ 95 % CI 0.3 - 1.2 ] ; absolute risk reduction -3.8 % [ 95 % CI -9.4 to 1.9 ] ; p=0.19 ) . 21 ( 10.6 % ) patients on simvastatin had a stroke within 90 days compared with 14 ( 7.3 % ) patients on placebo ( risk ratio 1.3 [ 0.7 - 2.4 ] ; absolute risk increase 3.3 % OUTPUT:

The available evidence demonstrates that the use of clopidogrel plus aspirin in people at high risk of cardiovascular disease and people with established cardiovascular disease without a coronary stent is associated with a reduction in the risk of myocardial infa rct ion and ischaemic stroke , and an increased risk of major and minor bleeding compared with aspirin alone . According to GRADE criteria , the quality of evidence was moderate for all outcomes except all-cause mortality ( low quality evidence ) and adverse events ( very low quality evidence )

MS2_fixed_5_shot1867

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: OBJECTIVE To test whether a weight loss program promotes greater weight loss , glycemic control , and improved cardiovascular disease risk factors compared with control conditions and whether there is a differential response to higher versus lower carbohydrate intake . RESEARCH DESIGN AND METHODS This r and omized controlled trial at two university medical centers enrolled 227 overweight or obese adults with type 2 diabetes and assigned them to parallel in-person diet and exercise counseling , with prepackaged foods in a planned menu during the initial phase , or to usual care ( UC ; two weight loss counseling sessions and monthly contacts ) . RESULTS Relative weight loss was 7.4 % ( 95 % CI 5.7–9.2 % ) , 9.0 % ( 7.1–10.9 % ) , and 2.5 % ( 1.3–3.8 % ) for the lower fat , lower carbohydrate , and UC groups ( P < 0.001 intervention effect ) . Glycemic control markers and triglyceride levels were lower in the intervention groups compared with UC group at 1 year ( fasting glucose 141 [ 95 % CI 133–149 ] vs. 159 [ 144–174 ] mg/dL , P = 0.023 ; hemoglobin A1c 6.9 % [ 6.6–7.1 % ] vs. 7.5 % [ 7.1–7.9 % ] or 52 [ 49–54 ] vs. 58 [ 54–63 ] mmol/mol , P = 0.001 ; triglycerides 148 [ 134–163 ] vs. 204 [ 173–234 ] mg/dL , P < 0.001 ) . The lower versus higher carbohydrate groups maintained lower hemoglobin A1c ( 6.6 % [ 95 % CI 6.3–6.8 % ] vs. 7.2 % OUTPUT:

This dietary pattern did not significantly affect 2-h post-pr and ial blood glucose and Matsuda index . Conclusions Adherence to the ND might improve serum insulin and HOMA-IR levels ; however , this effect was not confirmed for other markers of blood glucose control .

MS2_fixed_5_shot1868

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: ABSTRACT Despite increased interest among the public in breast cancer genetic risk and genetic testing , there are limited services to help women make informed decisions about genetic testing . This study , conducted with female callers ( N = 279 ) to the National Cancer Institute 's ( NCI 's ) Atlantic Region Cancer Information Service ( CIS ) , developed and evaluated a theory-based , educational intervention design ed to increase callers ' underst and ing of the following : ( a ) the kinds of information required to determine inherited risk ; ( b ) their own personal family history of cancer ; and ( c ) the benefits and limitations of genetic testing . Callers requesting information about breast/ovarian cancer risk , risk assessment services , and genetic testing were r and omized to either : ( 1 ) st and ard care or ( 2 ) an educational intervention . Results show that the educational intervention reduced intention to obtain genetic testing among women at average risk and increased intention among high-risk women at 6 months . In addition , high monitors , who typically attend to and seek information , demonstrated greater increases in knowledge and perceived risk over the 6-month interval than low monitors , who typically are distracted from information . These findings suggest that theoretically design ed interventions can be effective in helping women underst and their cancer risk and appropriate risk assessment options and can be implemented successfully within a service program like the CIS OBJECTIVE --To assess the efficiency , reliability , and ease of use of DNA diagnosis for Duchenne and Becker muscular dystrophies ( DMD/BMD ) using the polymerase chain reaction ( PCR ) . DESIGN --DNA from the patients was screened for deletion mutations using multiplex PCR , and the results were compared with those obtained by Southern blot analysis . The PCR multiplex reaction detects nine specific " hot-spot " exons in the dystrophin gene while the Southern analysis detects 66 specific dystrophin gene restriction fragments . The multiplex reaction requires 50-fold less DNA than Southern analysis and thus is considerably more sensitive . SETTING --Fourteen university-affiliated and private genetic disease diagnostic laboratories . PATIENTS --Male patients with clinical signs of DMD/BMD . Cases were selected OUTPUT:

No single vali date d outcome measure encompassed all potential patient benefits from using a CGS . A variety of different domains were identified , including anxiety and depression , coping , decision-making , distress , family environment , health status , knowledge , mood , perception of risk , perceived personal control , psychological impact , quality of life , satisfaction and expectations , self-esteem , spiritual well-being , and worry . Some important aspects of patient benefit from CGS are not covered by existing outcome measures .

MS2_fixed_5_shot1869

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: OBJECTIVE To test whether a theory-based , literacy , and culturally tailored self-management intervention , Latinos en Control , improves glycemic control among low-income Latinos with type 2 diabetes . RESEARCH DESIGN AND METHODS A total of 252 patients recruited from community health centers were r and omized to the Latinos en Control intervention or to usual care . The primarily group-based intervention consisted of 12 weekly and 8 monthly sessions and targeted knowledge , attitudes , and self-management behaviors . The primary outcome was HbA1c . Secondary outcomes included diet , physical activity , blood glucose self-monitoring , diabetes knowledge and self-efficacy , and other physiological factors ( e.g. , lipids , blood pressure , and weight ) . Measures were collected at baseline and at 4- and 12-month follow-up . Change in outcomes over time between the groups and the association between HbA1c and possible mediators were estimated using mixed-effects models and an intention-to-treat approach . RESULTS A significant difference in HbA1c change between the groups was observed at 4 months ( intervention −0.88 [ −1.15 to −0.60 ] versus control −0.35 [ −0.62 to 0.07 ] , P < 0.01 ) , although this difference decreased and lost statistical significance at 12 months ( intervention −0.46 [ −0.77 to −0.13 ] versus control −0.20 [ −0.53 to 0.13 ] , P = 0.293 ) . The intervention result ed in significant change differences in diabetes knowledge at 12 months ( P = 0.001 ) , self-efficacy ( P = 0.001 ) , blood glucose self-monitoring ( P = 0.02 ) , and diet , including dietary quality ( P = 0.01 ) , kilocalories consumed ( P < 0.001 ) , percentage of fat ( P = 0. OUTPUT:

The pooled main outcomes by r and om-effects model showed significant improvements in HbA1c , self-efficacy , and diabetes knowledge , but not in BMI . As for quality of life , no conclusions can be drawn as the pooled outcome became the opposite with reduced heterogeneity after one study was excluded . No significant publication bias was found in the main outcomes .

MS2_fixed_5_shot1870

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: This paper examines changes in drug utilization following Taiwan 's newly implemented National Health Insurance ( NHI ) outpatient prescription drug cost-sharing program for persons over 65 years old . The study is a hospital outpatient prescription level analysis that adopts a pretest-posttest control group experiment design . Selected measures of outpatient prescription drug utilization are examined for cost-sharing and non cost-sharing groups in cost-sharing periods and pre cost-sharing periods . Additional analyses were conducted comparing older patients with and without chronic diseases and differences for essential and non-essential drugs . Patients over age 65 were drawn from 21 hospitals in the Taipei area using a stratified r and om sampling method . This paper yields several interesting findings . First , average prescription cost and prescription period increased for both the cost-sharing and non cost-sharing groups . However , the rate of increase was significantly less in the cost-sharing group when compared with the non cost-sharing group . Second , the elderly with non-chronic diseases were more sensitive ( i.e. , reducing drug utilization ) to the drug cost-sharing program when compared with those with chronic diseases . Third , for the elderly with non-chronic diseases average drug cost per prescription experienced a smaller decrease in essential drugs but a moderate increase in non-essential drugs for the cost-sharing group . By contrast , for the non cost-sharing group , average drug cost per prescription increased sharply in non-essential drugs as well as essential drugs . Finally , there was a significant increase in the number of prescriptions as well as drug costs above the upper bound of the cost-sharing schedule . The outpatient drug cost-sharing program implemented by the NHI in Taiwan did not reverse the trend of prescription drug cost increases in hospitals . The significant increase in the number of prescriptions above the upper bound of the cost-sharing schedule implies that the NHI should increase the upper bound . Further analysis needs to evaluate any adverse clinical impact for older patients result ing from policy changes CONTEXT Rising costs of medications and inequities in access have sparked calls for drug policy reform in the United States and Canada . Control of drug expendit OUTPUT:

Increasing the amount of money that people pay for medicines may reduce insurers ' medicine expenditures and may reduce patients ' medicine use . These types of interventions may lead to small decreases in or uncertain effects on healthcare utilisation . Cap and co-payment polices may reduce the use of medicines and reduce medicine expenditures for health insurers . However , they may also reduce the use of life-sustaining medicines or medicines that are important in treating chronic , including symptomatic , conditions and , consequently , could increase the use of healthcare services . Fixed co-payment with a ceiling and tiered fixed co-payment may be less likely to reduce the use of essential medicines or to increase the use of healthcare services

MS2_fixed_5_shot1871

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: In a r and omised , double-blind placebo-controlled trial , the effects of the administration of oral L-carnitine ( 2 g/day ) for 28 days were compared in the management of 51 ( carnitine group ) and 50 ( placebo group ) patients with suspected acute myocardial infa rct ion . At study entry , the extent of cardiac disease , cardiac enzymes and lipid peroxides were comparable between the groups , although both groups showed an increase in cardiac enzymes and lipid peroxides . At the end of the 28-day treatment period , the mean infa rct size assessed by cardiac enzymes showed a significant reduction in the carnitine group compared to placebo . Electrocardiographic assessment of infa rct size revealed that the QRS-score was significantly less in the carnitine group compared to placebo ( 7.4 + /- 1.2 vs 10.7 + /- 2.0 ) , while serum aspartate transaminase and lipid peroxides showed significant reduction in the carnitine group . Lactate dehydrogenase measured on the sixth or seventh day following infa rct ion showed a smaller rise in the carnitine group compared to placebo . Angina pectoris ( 17.6 vs 36.0 % ) , New York Heart Association class III and IV heart failure plus left ventricular enlargement ( 23.4 vs 36.0 % ) and total arrhythmias ( 13.7 vs 28.0 % ) were significantly less in the carnitine group compared to placebo . Total cardiac events including cardiac deaths and nonfatal infa rct ion were 15.6 % in the carnitine group vs 26.0 % in the placebo group . It is possible that L-carnitine supplementation in patients with suspected acute myocardial infa rct ion may be protective against cardiac necrosis and complications during the first 28 days Non-alcoholic fatty liver disease ( NAFLD ) consists of a range of complication . The disease describes clinical , para clinical OUTPUT:

However , carnitine supplementation at dosages of ≤ 1000 mg/day ( p = 0.035 ) or equal to 2000 mg/day ( p = 0.013 ) result ed in significant reduction in ALT level , while doses more than 2000 mg/day did not change ALT significantly . Carnitine exerts its reducing effect on serum ALT and AST levels only when these aminotransferases are raised or when the duration of supplementation lasts at least 3 months . Results of the current meta- analysis showed that carnitine supplementation can decrease serum AST and ALT levels significantly , especially when supplementation lasts 3 months or more in patients with elevated serum aminotransferase levels

MS2_fixed_5_shot1872

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: & NA ; A series of health surveys are conducted every sixth to seventh year in Denmark . In the most recent survey of 2000 , a national r and om sample ( > 16 years ) was drawn from the Danish Central Personal Register . Out of the original sample 12,333 ( 74 % ) were interviewed and of these 10,066 returned a completed question naire ( SF‐36 ) . The present study includes only those who both took part in the interview and the postal question naire . Cancer patients were excluded . Persons suffering from chronic pain ( PG ) were identified through the question ‘ Do you have chronic/long lasting pain lasting 6 months or more ’ ? An overall chronic pain prevalence of 19 % was found −16 % for men and 21 % for women . Prevalence of chronic pain increased with increasing age . Persons ≥67 years had 3.9 higher odds of suffering from chronic pain than persons in the age group 16–24 years . Compared with married persons , divorced or separated persons had 1.5 higher odds of chronic pain . Odds for chronic pain were 1.9 higher among those with an education of less than 10 years compared with individuals with an education of 13 years or more . During a 14‐day period reporters of chronic pain had an average of 0.8 days ( range 0–10 ) lost due to illness compared with an average of 0.4 days ( range 0–10 ) for the control group ( CG ) ( Odds Ratio ( OR ) ) 2.0 ) . Persons with a job which required high physical strain were more likely to report chronic pain compared with those with a sedentary job ( OR 2.2 ) . The odds of quitting one 's job because of ill health were seven times higher among people belonging to the PG . A strong association between chronic pain and poor self‐rated health was also demonstrated . The PG had twice as many contacts with various health professionals compared with the CG , and the health care system was , on average , utilised 25 % more ( overall contacts ) by the PG than by the general population . Among the OUTPUT:

On the basis of the limited number of studies available , and significant problems with their design , reporting , statistical integrity , and clinical applicability , physical examination can not currently be recommended as a reliable test for the diagnosis of trigger points .

MS2_fixed_5_shot1873

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Background This prospect i ve study followed patients who underwent breast reductions to determine the influence of smoking and the amount of tissue removed on postoperative wound infections . Methods Patients who had received breast reductions were considered eligible for the study . The study excluded postbariatric patients and those with ongoing clinical infections , a recent antibiotic course , or systemic diseases that could impair tissue oxygenation . Smokers were instructed to quit smoking at least 4 weeks before surgery . Results By March 2004 , the study had enrolled 87 patients . Postoperative infections were present in 24 cases ( 27.9 % ) . Infections included 16 in smokers ( 37.2 % ) , 8 in nonsmokers ( 18.2 % ; p < 0.05 ) , 14 in patients with large resections ( > 0.85 kg ; 70 % ) , and 10 in patients with small resections ( 14.9 % ; p < 0.001 ) . Significant differences were found between the patients who experienced infections and those who were infection free in terms of the overall estimated cigarettes smoked ( mean , 146,000 ; range , 29,200–228,125 vs mean , 10,950 ; range , 9,125–54,750 ; p < 0.001 ) , the number of pack years ( mean , 20 ; range , 4–31 vs mean , 2 ; range , 1–8 ; p < 0.001 ) , and the amount of tissue removed ( mean , 0.9 kg ; range , 0.5–2 kg vs mean , 0.5 kg ; range , 0.2–1.4 kg ; p < 0.001 ) . The analysis for all the patients determined an odds ratio of 2.04 for smoking and 4.7 for the amount of tissue removed . Conclusions Smoking and the amount of tissue removed are important issues in aesth OUTPUT:

Preoperative smoking status was not observed to be associated with postoperative mortality , cardiovascular complications , bleedings , anastomotic leakage , or allograft rejection . CONCLUSIONS Preoperative smoking was found to be associated with an increased risk of the following postoperative complications : general morbidity , wound complications , general infections , pulmonary complications , neurological complications , and admission to the intensive care unit

MS2_fixed_5_shot1874

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: The antihypertensive efficacy of the angiotensin II receptor blocker olmesartan medoxomil has been shown to compare favourably with that of other antihypertensive agents . This r and omized , double-blind study compared the antihypertensive efficacy of the starting dose of olmesartan medoxomil with that of the calcium channel blocker amlodipine besylate ( amlodipine ) in subjects with mild-to-moderate hypertension . Following a 4-week , single-blind , placebo run-in period , 440 subjects aged ⩾18 years were r and omized to the starting dose of olmesartan medoxomil ( 20 mg/day ) , amlodipine ( 5 mg/day ) , or placebo for 8 weeks . Subjects were evaluated by 24-h ambulatory blood pressure monitoring ( ABPM ) and by seated cuff blood pressure ( BP ) measurements at trough . The primary end point was the change from baseline in mean 24-h diastolic blood pressure ( DBP ) by ABPM at Week 8 . Secondary end points included change from baseline in mean 24-h ambulatory systolic blood pressure ( SBP ) at 8 weeks , change from baseline in mean seated trough cuff DBP and SBP measurements , and response and control rates for DBP < 90 and < 85 mmHg . Control rates for SBP < 140 and < 130 mmHg were also calculated . Olmesartan medoxomil and amlodipine produced significantly greater reductions in ambulatory and seated DBP and SBP compared with placebo . Mean reductions in ambulatory and seated BP were similar between the two active agents ; however , in the olmesartan medoxomil group , significantly more patients achieved the SBP goal of < 130 mmHg and the DBP goal of < 85 mmHg . Both drugs were well tolerated at the recommended starting dose . Although amlodipine was associated with a higher incidence of oedema , this did not reach OUTPUT:

Once-daily dihydropyridine calcium channel blockers appeared to lower blood pressure by a relatively constant amount throughout the 24-hour dosing interval . Six dihydropyridine calcium channel blockers studied in this review lowered blood pressure by a relatively similar amount each hour over the course of 24 hours .

MS2_fixed_5_shot1875

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Objective : Despite evidence demonstrating that risk-factor management is effective in reducing recurrent cerebrovascular disease , there are very few structured care programmes for stroke survivors . The aim was to implement and evaluate an integrated care programme in stroke . Methods : 186 patients with stroke were r and omised to either the treatment ( integrated care ) or control ( usual care ) group and were followed up over 12 months . The Integrated Care for the Reduction of Secondary Stroke ( ICARUSS ) model of integrated care involved collaboration between a specialist stroke service , a hospital coordinator and a patient ’s general practitioner . The primary aim was to promote the management of vascular risk factors through ongoing patient contact and education . Results : In the 12 months poststroke , systolic blood pressure ( sBP ) decreased in the treatment group but increased in controls . The group difference was significant , and remained so when age , sex , disability and sBP at discharge were accounted for ( p = 0.04 ) . Treatment patients also exhibited better modification of body mass index ( p = 0.007 ) and number of walks taken ( p<0.001 ) than controls . Rankin scores indicated significantly reduced disability in treatment patients relative to controls in the year poststroke ( p = 0.003 ) . Conclusions : Through an integrated system of education , advice and support to both patient and GP , the ICARUSS model was effective in modifying a variety of vascular risk factors and therefore should decrease the likelihood or recurrent stroke or vascular event Objectives To investigate if repeated verbal instructions about physical activity to patients with ischaemic stroke could increase long term physical activity . Design Multicentre , multinational , r and omised clinical trial with masked outcome assessment . Setting Stroke units in Denmark , China , Pol and , and Estonia . Participants 314 patients with ischaemic stroke aged ≥40 years who were able to walk—157 ( mean age 69.7 years ) r and omised to the intervention , 157 ( mean age 69.4 years ) in the control group . Interventions Patients r and omised to the intervention were instructed in a detailed training OUTPUT:

No significant effect was found on cardiovascular events , mortality , diastolic blood pressure , or cholesterol . Conclusions — We found that lifestyle interventions are effective in lowering systolic blood pressure . About other end points , this systematic review found no effect of lifestyle interventions on cardiovascular event rate mortality , diastolic blood pressure , or total cholesterol

MS2_fixed_5_shot1876

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Objectives To compare collagenase injections and surgery ( fasciectomy ) for Dupuytren 's contracture ( DC ) regarding actual total direct treatment costs and short-term outcomes . Design Retrospective cohort study . Setting Orthopaedic department of a regional hospital in Sweden . Participants Patients aged 65 years or older with previously untreated DC of 30 ° or greater in the metacarpophalangeal ( MCP ) and /or proximal interphalangeal ( PIP ) joints of the small , ring or middle finger . The collagenase group comprised 16 consecutive patients treated during the first 6 months following the introduction of collagenase as treatment for DC at the study centre . The controls were 16 patients r and omly selected among those operated on with fasciectomy at the same centre during the preceding 3 years . Interventions Treatment with collagenase was given during two st and ard outpatient clinic visits ( injection of 0.9 mg , distributed at multiple sites in a palpable cord , and next-day finger extension under local anaesthesia ) followed by night-time splinting . Fasciectomy was carried out in the operating room ( day surgery ) under general or regional anaesthesia using st and ard technique , followed by therapy and splinting . Primary and secondary outcome measures Actual total direct costs ( salaries of all medical personnel involved in care , medications , material s and other relevant costs ) , and total MCP and PIP extension deficit ( degrees ) measured by h and therapists at 6–12 weeks after the treatment . Results Collagenase injection required fewer hospital outpatient visits to a therapist and nurse than fasciectomy . Total treatment cost for collagenase injection was US$ 1418.04 and for fasciectomy US$ 2102.56 . The post-treatment median ( IQR ) total extension deficit was 10 ( 0–30 ) for the collagenase group and 10 ( 0–34 ) for the fasciectomy group . Conclusions Treatment of DC with one collagenase injection costs 33 % less than fasciectomy with OUTPUT:

Outcomes , such as range of motion , recurrence , and clinical success , were frequently defined , however many different definitions were used .

MS2_fixed_5_shot1877

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: The study of the peripheral skeletal muscle function in patients with chronic obstructive pulmonary disease ( COPD ) is of growing interest , but often requires biopsies , usually with the Bergström technique . The current study was design ed to test the validity of a minimally invasive technique : the microbiopsy . In 17 patients with COPD and four normal subjects , two specimens of the vastus lateralis were taken percutaneously under local anaesthesia , one with a 16-gauge needle ( microbiopsy ) and the other with the Bergström needle . The enzymatic activity of citrate synthase ( CS ) and phosphofructokinase ( PFK ) , and the myosin heavy chain ( MyoHC ) composition were measured for both techniques . The subjects reported no pain or much less with the microbiopsy compared with the Bergström biopsy . The microbiopsy sample weight reached 55±17 mg . The two techniques showed excellent agreement for CS activity and MyoHC composition . The PFK activity did not differ statistically between the techniques , but the agreement was moderate . The agreement between both biopsy techniques was stable over time . The median ( range ) fibre number within the microbiopsy specimens was 144 ( 38–286 ) . In conclusion , the current study shows the feasibility and validity of a minimally invasive muscle biopsy technique that appears more comfortable for subjects , compared with the Bergström technique Muscle dysfunction is a major problem in chronic obstructive pulmonary disease ( COPD ) , particularly after exacerbations . We thus asked whether neuromuscular electrostimulation ( NMES ) might be directly useful following an acute exacerbation and if such a therapy decreases muscular oxidative stress and /or alters muscle fibre distribution . A pilot r and omised controlled study of NMES lasting 6 weeks was carried out in 15 in- patients ( n=9 NMES ; n=6 sham ) following a COPD exacerbation . Stimulation was delivered to the quadriceps and hamstring muscles ( OUTPUT:

Our meta analysis of a homogeneous set of studies is the first to provide valuable LLNs for fiber CSA according to fiber type and gender .

MS2_fixed_5_shot1878

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: OBJECTIVES To characterize and compare quality of life ( QOL ) in patients with head and neck cancer shortly before initial treatment and 1 year later and to study the predictors of changes in QOL over 1 year . DESIGN Prospect i ve cohort study . SETTING Three otolaryngology clinics . PATIENTS Three hundred sixteen patients having newly diagnosed squamous cell head and neck cancer . MAIN OUTCOME MEASURE Health-related QOL was assessed using the 36-item Short-Form Health Survey and a head and neck cancer-specific QOL scale . RESULTS Over 1 year , QOL decreased for physical functioning measures and eating but improved for mental health QOL . Depression and smoking were major predictors of poor QOL at baseline . Major predictors of change in QOL from baseline to 1 year were treatment factors , especially feeding tube placement ( 9 scales ) , chemotherapy ( 3 scales ) , and radiation therapy ( 3 scales ) . Baseline smoking and depressive symptoms also remained significant predictors of several QOL scales at 1 year . CONCLUSIONS Health-related physical QOL tended to decline over 1 year and mental health QOL improved . The major predictors of change in QOL were treatment factors , smoking , and depressive symptoms . Physicians should alert patients to the relative effects on QOL one may experience with different treatments BACKGROUND Early discontinuation of adjuvant endocrine therapy may affect the outcome of treatment in breast cancer patients . The aim of this study was to assess age-specific persistence and age-specific survival outcome based on persistence status . METHODS Patients enrolled in the Tamoxifen Exemestane Adjuvant Multinational trial were included . Nonpersistence was defined as discontinuing the assigned endocrine treatment within 1 year of follow-up because of adverse events , intercurrent illness , patient refusal , or other reasons . Endpoints were the breast cancer-specific and overall survival times . Analyses were stratified by age at diagnosis ( < 65 years , 65 - 74 years , ≥75 years ) . RESULTS Overall , 3,14 OUTPUT:

Functional and cognitive impairment , depressive symptoms and social isolation are highly prevalent in head and neck cancer patients and associate with high risk of adverse health outcomes .

MS2_fixed_5_shot1879

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: OBJECTIVE : To assess the acute metabolic and cardiovascular responses to walking exercise at an intensity corresponding to the heart rate of claudication pain onset and to investigate the effects of a 12-week walking training program at this intensity on walking capacity . METHODS : Twenty-nine patients with intermittent claudication were r and omly allocated to the walking training ( n = 17 ) or control ( CO , n = 12 ) group . The walking training group performed an acute exercise session comprising 15 × 2-min bouts of walking at the heart rate of claudication pain onset , with 2-min interpolated rest intervals . The claudication symptoms and cardiovascular and metabolic responses were evaluated . Walking training was then performed at the same intensity twice each week for 12 weeks , while the control group engaged in twice weekly stretching classes . The claudication onset distance and total walking distance were evaluated before and after the interventions . Brazilian Registry Clinical Trials : RBR-7M3D8W . RESULTS : During the acute exercise session , the heart rate was maintained within tight limits . The exercise intensity was above the anaerobic threshold and > 80 % of the heart rate peak and VO2peak . After the exercise training period , the walking exercise group ( n = 13 ) showed increased claudication onset distance ( 309±153 vs. 413±201 m ) and total walking distance ( 784±182 vs. 1,100±236 m ) compared to the control group ( n = 12 ) ( p<0.05 ) . CONCLUSION : Walking exercise prescribed at the heart rate of claudication pain onset enables patients with intermittent claudication to exercise with tolerable levels of pain and improves walking performance This study examined whether a training intervention likely to elicit adaptations in the leg could result in reduced leg pain and increased whole body physical capacity . Twenty-seven peripheral arterial disease ( PAD ) patients were r and omized to either an individual leg plantar flexion training OUTPUT:

Data showed improvements secondary to exercise in ' physical function ' and ' general health ' . The other domains - ' role physical ' , ' bodily pain ' , ' vitality ' , ' social ' , ' role emotional ' , and ' mental health ' - did not show improvement at six months . Although results showed significant heterogeneity between trials , population s and outcomes were comparable overall , with findings relevant to the claudicant population . High- quality evidence shows that exercise programmes provided important benefit compared with placebo or usual care in improving both pain-free and maximum walking distance in people with leg pain from IC who were considered to be fit for exercise intervention . Exercise did not improve ABI , and we found no evidence of an effect of exercise on amputation or mortality . Exercise may improve quality of life when compared with placebo or usual care .

MS2_fixed_5_shot1880

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Objectives : Adult literature supports the elimination of mechanical bowel preparation ( MBP ) for elective colorectal surgical procedures . Prospect i ve data for the pediatric population regarding the utility of MBP are lacking . The primary aim of this study was to compare infectious complications , specifically anastomotic leak , intraabdominal abscess , and wound infection in patients who received MBP with those who did not . Methods : A r and omized pilot study comparing MBP with polyethylene glycol with no MBP was performed . Patients , 0 to 21 years old , undergoing elective colorectal surgery were eligible and r and omized within 4 age strata . Statistical analyses were performed using & khgr;2 or Fisher exact test for categorical data and t test or Wilcoxon 2- sample test for continuous data . Results : Forty-four patients were enrolled in the study from December 2010 to February 2013 , of which 24 ( 55 % ) received MBP and 20 ( 45 % ) did not . Two patients ( 5 % ) had anastomotic leak , 4 ( 9 % ) had intraabdominal infection , and 7 ( 16 % ) had wound infections . The rate of anastomotic leak , intraabdominal abscess , and wound infection did not differ between the 2 groups . Conclusions : MBP for elective colorectal surgery in children does not affect the incidence of infectious complications . A larger multiinstitutional study is necessary to vali date the results of this single-institution pilot study BACKGROUND Surgical site infections ( SSI ) are a common complication after colorectal surgery . An infection prevention bundle ( IPB ) was implemented to improve outcomes . STUDY DESIGN A st and ardized IPB that included the administration of oral antibiotics with a mechanical bowel preparation , preoperative shower with chlorhexidine , hair removal and skin preparation in holding , antibiotic wound irrigation , and a " clean-closure " protocol was implemented OUTPUT:

Conclusion Based on the current literature , there is insufficient evidence to indicate that the use of MBP leads to a significant difference in the risk of developing infectious complications in pediatric colorectal surgery

MS2_fixed_5_shot1881

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: BACKGROUND Antimicrobial prophylaxis in cardiac surgery has been demonstrated to lower the incidence of surgical site infection ( SSI ) . Inappropriate antimicrobial prophylaxis , such as inappropriate selection of the antimicrobial agent or inappropriate dosing regimen , can increase the prevalence of antibiotic resistant strains , prolong hospital stay , cause adverse reactions , and negatively affect an institution 's pharmacy budget for antibiotics . In developing countries such as Jordan , where the role of clinical pharmacists is still in its primary stages , the first step in establishing an organized clinical pharmacy service is the evaluation of current practice to determine the need for improvement . OBJECTIVE To assess the degree of adherence to international guidelines for antimicrobial prophylaxis practice in cardiac surgery performed at Queen Alia Heart Institute ( QAHI ) in Amman , Jordan , as part of an attempt to determine opportunities for clinical pharmacist intervention . METHODS For a total of 236 patients who were admitted for cardiac surgery to QAHI - the only official referral hospital for cardiac patients in Jordan - between November 19 , 2006 , and January 22 , 2007 , the antimicrobial prophylaxis indication , choice , duration , dose , dosing interval , and timing appropriateness were assessed against 3 international guidelines using a pre-tested , structured clinical data collection form that was completed by 2 of the authors who work at QAHI . The study design was prospect i ve . All patients who were scheduled for surgery were monitored daily during their inpatient stay until discharge and then were tracked in the outpatient clinic for 2 months following surgery . Data regarding antimicrobial prophylaxis indication , choice , duration , dose , dosing interval , and timing appropriateness were collected during the patient 's inpatient stay ; data collection was performed periodically thereafter as data became available until the end of the 2-month follow-up . The 3 guidelines agreed that ( a ) antimicrobial prophylaxis should OUTPUT:

There was no advantage of regimens lasting > 48 h post-operation . In the comparison of glycopeptides versus β-lactams , an advantage of glycopeptides was observed when comparators were given for similar duration and for β-lactams when given for a longer duration than the glycopeptides . There was no significant advantage of high antibiotic dosing . Evidence supports second- or third-generation cephalosporins for cardiac surgery prophylaxis and points at a possible advantage of prophylaxis prolongation up to 48 h post-operatively

MS2_fixed_5_shot1882

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: The mechanism of risk reduction obtained by blood pressure-lowering pharmacological treatment remains unclear . We explored the amount of risk reduction attributable to the apparent effect of antihypertensive medicines on blood pressure by using the capture approach . Five r and omized , placebo or nil controlled trials with a total of 28,997 subjects and 1,935 cardiovascular fatal or non-fatal events from the INDANA data base met the eligibility criteria . Computations were performed on the original individual records using multiple Cox 's proportional hazard regression models design ed for meeting the assumed treatment mode of action and comparing relevant assumptions . For coronary event , the results are inconclusive essentially because the risk reduction is mild . However , for stroke the risk reduction adjusted for baseline risk factors is 34 % ( P<0.0001 ) . The part explained by the effect of treatment on systolic blood pressure is 49 % of this reduction , with 95 % confidence interval not including 100 % . This result suggests that the apparent effect on blood pressure is not the only cause of stroke risk reduction in hypertensive subjects su bmi tted to an antihypertensive medicine Although the benefits of antihypertensive treatment in " young " elderly ( under 70 years ) hypertensive patients are well established , the value of treatment in older patients ( 70 - 84 years ) is less clear . The Swedish Trial in Old Patients with Hypertension ( STOP-Hypertension ) was a prospect i ve , r and omised , double-blind , intervention study set up to compare the effects of active antihypertensive therapy ( three beta-blockers and one diuretic ) and placebo on the frequency of fatal and non-fatal stroke and myocardial infa rct ion and other cardiovascular death in hypertensive Swedish men and women aged 70 - 84 years . We recruited 1627 patients at 116 health centres throughout Sweden , who were willing to participate , and who met the entry criteria of three separate recordings during a 1-month placebo run-in period of systolic blood pressure between 180 and 230 mm Hg with a diast OUTPUT:

Antihypertensive drugs used to treat predominantly healthy adults aged 18 to 59 years with mild to moderate primary hypertension have a small absolute effect to reduce cardiovascular mortality and morbidity primarily due to reduction in cerebrovascular mortality and morbidity . All-cause mortality and coronary heart disease were not reduced . There is lack of good evidence on withdrawal due to adverse events .

MS2_fixed_5_shot1883

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: BACKGROUND The aim of the study was to analyse the toxicity and health related quality of life ( HRQoL ) of breast cancer patients treated with FAC ( 5-fluorouracil , doxorubicin , cyclophosphamide ) and TAC ( docetaxel , doxorubicin , cyclophosphamide ) with and without primary prophylactic G-CSF ( PPG ) . PATIENTS AND METHODS This was a phase III study to compare FAC and TAC as adjuvant treatment of high-risk node-negative breast cancer patients . After the entry of the first 237 patients , the protocol was amended to include PPG in the TAC arm due to the high incidence of febrile neutropenia . A total of 1047 evaluable patients from 49 centres in Spain , two in Pol and and four in Germany were included in the trial . Side-effects and the scores of the EORTC QLQ-C30 and QLQ BR-23 question naires were compared in the three groups ( FAC , TAC pre-amendment and TAC post-amendment ) . RESULTS The addition of PPG to TAC significantly reduced the incidence of neutropenic fever , grade 2 - 4 anaemia , asthenia , anorexia , nail disorders , stomatitis , myalgia and dysgeusia . Patient QoL decreased during chemotherapy , more with TAC than FAC , but returned to baseline values afterwards . The addition of PPG to TAC significantly reduced the percentage of patients with clinical ly relevant Global Health Status deterioration ( 10 or more points over baseline value ) at the end of chemotherapy ( 64 % versus 46 % , P<0.03 ) . CONCLUSIONS The addition of PPG significantly reduces the incidence of neutropenic fever associated with TAC chemotherapy as well as that of some TAC-induced haematological and extrahaematological side-effects . The HRQoL of patients treated with TAC is worse than that of those treated with FAC but improves with the addition OUTPUT:

Attempts to prevent dysgeusia through the prophylactic use of zinc sulfate or amifostine have been of limited benefit . Nutritional counseling may be helpful to some patients in minimizing the symptoms of dysgeusia . Conclusions Dysgeusia is a common oral side effect of cancer therapy ( radiotherapy , chemotherapy , or combined modality therapy ) and often impacts negatively on quality of life . From the current literature , there does not appear to be a predictable way of preventing or treating dysgeusia

MS2_fixed_5_shot1884

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: PURPOSE To compare the in vivo short-term post-operative sensitivity of teeth restored with amalgam using a bonded resin liner vs. teeth restored using a copal varnish liner . MATERIAL S AND METHODS 20 patients received Class I or Class II contralaterally paired restorations which were placed at the same appointment . All restorations were placed by the same operator using an identical technique except that , in each r and omized pair , one was lined with an adhesive resin ( Scotchbond Multi- Purpose Plus ) while the other was lined with copal varnish . ( Plastodent ) Patients were provided visual analog scale response forms , instructed in their use , and requested to complete and return a form reporting their degree of sensitivity at baseline and on days 1 , 3 , 7 , 14 , and 30 post-operatively . Data from the response forms were analyzed for differences using a paired t-test . RESULTS A response rate of 90 % ( 18/20 ) was achieved for the complete 30-day assessment . Increases in thermal sensitivity beyond baseline were seen in 13 of the 18 subjects involving 12 restorations lined with copal varnish and 10 lined with adhesive resin . Typically , sensitivity peaked on day 1 or day 3 and diminished to pre-operative levels by day 30 . Only three subjects reported greater sensitivity at day 30 than at baseline . No significant difference in post-operative sensitivity was found between the two cavity lining material s at any post-operative interval AIM The aim of this r and omized , double blind clinical trial was to compare three lining material s ( Adper Prompt L-Pop , VivaSens , and Copalite ) versus unlined restorations on postoperative cold sensitivity of class I amalgam restorations . METHODS AND MATERIAL S Potential subjects were screened for the presence of four initial class I carious lesions on posterior teeth . Each tooth was assigned to treatments according to a r and omized block design . After cavity preparation , teeth were OUTPUT:

Due to the low quality , small sample sizes or lack of adequate reporting of the outcome data , the evidence is inadequate to cl aim or refute a difference in postoperative sensitivity between different dental liners .

MS2_fixed_5_shot1885

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Vitamin D insufficiency and low calcium intake contribute to increase parathyroid function and bone fragility in elderly people . Calcium and vitamin D supplements can reverse secondary hyperparathyroidism thus preventing hip fractures , as proved by Decalyos I. Decalyos II is a 2-year , multicenter , r and omized , double-masked , placebo-controlled confirmatory study . The intention-to-treat population consisted of 583 ambulatory institutionalized women ( mean age 85.2 years , SD = 7.1 ) r and omized to the calcium – vitamin D3 fixed combination group ( n= 199 ) ; the calcium plus vitamin D3 separate combination group ( n= 190 ) and the placebo group ( n= 194 ) . Fixed and separate combination groups received the same daily amount of calcium ( 1200 mg ) and vitamin D3 ( 800 IU ) , which had similar pharmacodynamic effects . Both types of calcium-vitamin D3 regimens increased serum 25-hydroxyvitamin D and decreased serum intact parathyroid hormone to a similar extent , with levels returning within the normal range after 6 months . In a subgroup of 114 patients , femoral neck bone mineral density ( BMD ) decreased in the placebo group ( mean = –2.36 % per year , SD = 4.92 ) , while remaining unchanged in women treated with calcium-vitamin D3 ( mean = 0.29 % per year , SD = 8.63 ) . The difference between the two groups was 2.65 % ( 95 % CI = –0.44 , 5.75 % ) with a trend in favor of the active treatment group . No significant difference between groups was found for changes in distal radius BMD and quantitative ultrasonic parameters at the os calcis . The relative risk ( RR ) of HF in the placebo group compared with the active treatment group was 1.69 ( 95 % CI = 0.96 , 3.0 OUTPUT:

There is high quality evidence that vitamin D plus calcium is associated with a statistically significant reduction in incidence of new non-vertebral fractures . Vitamin D alone is unlikely to prevent fractures in the doses and formulations tested so far in older people . Supplements of vitamin D and calcium may prevent hip or any type of fracture . There was a small but significant increase in gastrointestinal symptoms and renal disease associated with vitamin D and calcium . This review found that there was no increased risk of death from taking calcium and vitamin

MS2_fixed_5_shot1886

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Objective To assess the effect of a governmentally-led center based child care physical activity program ( Youp’là Bouge ) on child motor skills . Patients and methods We conducted a single blinded cluster r and omized controlled trial in 58 Swiss child care centers . Centers were r and omly selected and 1:1 assigned to a control or intervention group . The intervention lasted from September 2009 to June 2010 and included training of the educators , adaptation of the child care built environment , parental involvement and daily physical activity . Motor skill was the primary outcome and body mass index ( BMI ) , physical activity and quality of life secondary outcomes . The intervention implementation was also assessed . Results At baseline , 648 children present on the motor test day were included ( age 3.3 ± 0.6 , BMI 16.3 ± 1.3 kg/m2 , 13.2 % overweight , 49 % girls ) and 313 received the intervention . Relative to children in the control group ( n = 201 ) , children in the intervention group ( n = 187 ) showed no significant increase in motor skills ( delta of mean change ( 95 % confidence interval : -0.2 ( −0.8 to 0.3 ) , p = 0.43 ) or in any of the secondary outcomes . Not all child care centers implemented all the intervention components . Within the intervention group , several predictors were positively associated with trial outcomes : 1 ) free-access to a movement space and parental information session for motor skills 2 ) highly motivated and trained educators for BMI 3 ) free-access to a movement space and purchase of mobile equipment for physical activity ( all p < 0.05 ) . Conclusion This “ real-life ” physical activity program in child care centers confirms the complexity of implementing an intervention outside a study setting and identified potentially relevant predictors that could improve future programs . Trial registration Clinical trials.gov Physical activity is beneficial for children ’s well-being . The effect of dietary supplementation on children ’s physical activity in food-insecure areas remains little studied . We examined the effects of a lipid-based OUTPUT:

Overall , toddlers tend to exceed the total PA recommendation of 180 min/day ; however , very little of this time is spent at higher movement intensities . Even with high PA rates , toddlers still engage in substantial ST .

MS2_fixed_5_shot1887

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: OBJECTIVE To evaluate the feasibility , acceptability , and efficacy of an after-school team sports program for reducing weight gain in low-income overweight children . DESIGN Six-month , 2-arm , parallel-group , pilot r and omized controlled trial . SETTING Low-income , racial/ethnic minority community . PARTICIPANTS Twenty-one children in grade s 4 and 5 with a body mass index at or above the 85th percentile . INTERVENTIONS The treatment intervention consisted of an after-school soccer program . The " active placebo " control intervention consisted of an after-school health education program . MAIN OUTCOME MEASURES Implementation , acceptability , body mass index , physical activity measured using accelerometers , reported television and other screen time , self-esteem , depressive symptoms , and weight concerns . RESULTS All 21 children completed the study . Compared with children receiving health education , children in the soccer group had significant decreases in body mass index z scores at 3 and 6 months and significant increases in total daily , moderate , and vigorous physical activity at 3 months . CONCLUSION An after-school team soccer program for overweight children can be a feasible , acceptable , and efficacious intervention for weight control The present study aim ed at analyzing the efficacy of a 6-month football training program compared with a st and ard exercise program on health and fitness parameters in overweight children . The study design was a 6-month , two-arm , parallel-group r and omized trial . Twenty-two overweight children were r and omly assigned to two groups ( age=10.8+/-1.2 years , height=1.56+/-0.08 m , weight= 65.1+/-11.4 kg ) . One group conducted a football training program , and the other group an established st and ard sports program . Both interventions took place three times per week from mid-May to mid-November . Before , after 3 months and after the training period , comprehensive testing was conducted : anthropometric characteristics , cycling ergometry , psychometric monitoring as well as several motor ability tests . Maximal performance capacity increased and submaximal heart rate during OUTPUT:

Group sports improve body composition , cardiorespiratory endurance , and h and grip strength of overweight/obese youth . Flexibility and neuromotor fitness do not seem to change following group sports

MS2_fixed_5_shot1888

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: The effect of intravenous infusion of labetalol and of dihydralazine in increasing doses was compared in 12 women with severe hypertension in pregnancy . In 5 our of 6 women labetalol produced a smooth , progressive fall in blood pressure to normal levels with minimal side effects . In 2 our of 6 women on dihydralazine the blood pressure control was satisfactory but in the remaining 4 patients treatment had to by discontinued because of unpredictable , sudden falls in blood pressure . One of the 6 infants of mothers treated with labetalol manifested signs of adrenergic blockade . Continuous infusion of labetalol appears to offer significant advantages in the management of severe hypertension in pregnancy and merits further trial Summary : The results of a prospect i ve trial to evaluate the use of diazoxide and labetalol given intravenously in the management of severe hypertensive disease in pregnancy are presented OBJECTIVES The purpose s of this study were to compare the efficacy of sublingual nifedipine with intravenous hydrallazine in the control of acute hypertension of pregnancy and to make a preliminary assessment whether sublingual nifedipine could be recommended for use by midwives faced with severe hypertension in pregnancy in a rural setting . METHODS Subjects were 200 consecutive patients admitted to Kuala Tereng-ganu General Hospital , Malaysia with severe hypertension in pregnancy between August 1989 and June 1990 . Admission criteria were an ongoing viable pregnancy more than 28 weeks and diastolic blood pressure ( DBP ) more than 120 mmHg . The patients were r and omly divided into 2 groups . In group I , sublingual nifedipine 5 mg was administered and repeated after 15 minutes if DBP > 120 mmHg ; and in group II hydrallazine 5 mg was intravenously injected and repeated after 15 minutes if DBP > 120 mmHg . Both groups were put on hydrallazine infusion if DBP > OUTPUT:

Hydralazine was the most common drug for others to be evaluated against . Diazoxide , given as 75 mg bolus injections , appears to be associated with maternal hypotension requiring treatment , and ketanserin is less effective than hydralazine at reducing blood pressure . There is no other clear evidence that any one of the other antihypertensive agents is better than another for women with severe hypertension during pregnancy . Exceptions are diazoxide and ketanserin , which are probably not good choices

MS2_fixed_5_shot1889

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: This study reports results of a r and omized controlled trial aim ed at joint attention ( JA ) and symbolic play ( SP ) in preschool children with autism , with prediction to language outcome 12 months later . Participants were 58 children ( 46 boys ) with autism between 3 and 4 years of age . Children were r and omized to a JA intervention , an SP intervention , or control group . Interventions were conducted 30 min daily for 5 - 6 weeks . Assessment s of JA skills , SP skills , mother-child interactions , and language development were collected at 4 time points : pre- and postintervention and 6 and 12 months postintervention by independent testers . Results indicate that expressive language gains were greater for both treatment groups compared with the control group , and results could not be explained by differences in other interventions in which children participated . For children beginning treatment with the lowest language levels , the JA intervention improved language outcome significantly more than did the SP or control interventions . These findings suggest clinical ly significant benefits of actively treating JA and SP skills in young children with autism The current study is a r and omized clinical trial evaluating the efficacy of Focused Playtime Intervention ( FPI ) in a sample of 70 children with Autism Spectrum Disorder . This parent-mediated intervention has previously been shown to significantly increase responsive parental communication ( Siller et al. in J Autism Dev Disord 43:540–555 , 2013a ) . The current analyses focus on children ’s attachment related outcomes . Results revealed that children who were r and omly assigned to FPI showed bigger increases in attachment-related behaviors , compared to children assigned to the control condition . Significant treatment effects of FPI were found for both an observational measure of attachment-related behaviors elicited during a brief separation-reunion episode and a question naire measure evaluating parental perceptions of child attachment . The theoretical and clinical implication s of these findings are discussed OBJECTIVE : To conduct a r and omized , controlled trial to evaluate the efficacy of the Early Start Denver Model ( ESDM ) , a comprehensive developmental behavioral intervention , for OUTPUT:

The quality of the health care provider , the duration , and the intensity of intervention played an important role in the effectiveness of the intervention . Interpretation Music therapy appears to be an effective tool for improving social interaction in preschool-aged children with ASD .

MS2_fixed_5_shot1890

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Background . There is controversy regarding whether hypersensitivity to food proteins contributes to colic among breastfed infants . Methods . A r and omized , controlled trial of a low-allergen maternal diet was conducted among exclusively breastfed infants presenting with colic . In the active arm , mothers excluded cow 's milk , eggs , peanuts , tree nuts , wheat , soy , and fish from their diet ; mothers in the control group continued to consume these foods . Outcomes were assessed after 7 days , as the change in cry/fuss duration over 48 hours , with vali date d charts . The primary end point was a reduction in cry/fuss duration of ≥25 % from baseline . Mothers also assessed the responses to diet with categorical and visual analog scales . Results . Of 107 infants , 90 completed the trial ( mean age : 5.7 weeks ; range : 2.9–8.6 weeks ; 54 male infants ) . Infants in both groups presented with significant distress ( geometric mean : low-allergen group : 690 minutes per 48 hours ; control group : 631 minutes per 48 hours ) . In follow-up assessment s on days 8 and 9 , there were significantly more responders in the low-allergen group ( 74 % vs 37 % ) , ie , an absolute risk reduction of 37 % ( 95 % confidence interval : 18–56 % ) . Cry/fuss duration per 48 hours was reduced by a substantially greater amount in the low-allergen group ; the adjusted geometric mean ratio was 0.79 ( 95 % confidence interval : 0.63–0.97 ) , ie , an average reduction of 21 % ( 95 % confidence interval : 3–37 % ) . Mothers ' subjective assessment s of the responses to diet indicated little difference between the groups . Conclusion . Exclusion of allergenic foods from the maternal diet was associated with a reduction in distressed behavior among breastfed infants with colic presenting in the first 6 weeks of life Background Probiotics have rarely been studied in OUTPUT:

AUTHORS ' CONCLUSIONS There is no clear evidence that probiotics are more effective than placebo at preventing infantile colic ; however , daily crying time appeared to reduce with probiotic use compared to placebo . There were no clear differences in adverse effects .

MS2_fixed_5_shot1891

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Background Exergaming has been proposed as an innovative method for physical activity promotion . However , large effectiveness studies are rare . In January 2011 , dance mat systems were introduced in secondary schools in two districts in Engl and with the aim of promoting an innovative opportunity for physical activity . The aim of this natural experiment was to examine the effect of introducing the dance mat exergaming systems on physical activity and health-related outcomes in 11–13 year old students using a non-r and omised controlled design and mixed methods . Methods Participants were recruited from five schools in intervention districts ( n = 280 ) and two schools in neighbouring control districts ( n = 217 ) . Data on physical activity ( accelerometer ) , anthropometrics ( weight , BMI and percentage of body fat ) , aerobic fitness ( 20-m multistage shuttle run test ) , health-related quality of life ( Kidscreen question naire ) , self-efficacy ( children ’s physical activity self-efficacy survey ) , school attendance , focus groups with children and interviews with teachers were collected at baseline and approximately 12 months follow-up . Results There was a negative intervention effect on total physical activity ( -65.4 cpm CI : -12.6 to -4.7 ) , and light and sedentary physical activity when represented as a percentage of wear time ( Light : -2.3 % CI : -4.5 to 0.2 ; Sedentary : 3.3 % CI : 0.7 to 5.9 ) . However , compliance with accelerometers at follow-up was poor . There was a significant positive intervention effect on weight ( -1.7 kg , 95 % CI : -2.9 to -0.4 ) , BMI ( -0.9 kg/m2 , 95 % CI : -1.3 to -0.4 ) and percentage of body fat ( -2.2 % , 95 % CI : -4.2 to -0.2 ) . There was also evidence of improvement in some health-related quality of life parameters : psychological well-being ( 2.5 , 95 % CI : 0.1 to 4.8 ) and OUTPUT:

The relative decline in MVPA affects both sexes from an early age ; however , it is greater among girls .

MS2_fixed_5_shot1892

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: STUDY OBJECTIVES To evaluate the cost-effectiveness of an additional 12-week treatment with varenicline for abstainers who had successfully completed an initial 12-week treatment . DESIGN The Benefits of Smoking Cessation on Outcomes simulation model was used to simulate both direct and indirect effects of smoking cessation . All calculations were performed in 2003 Swedish prices . SETTING Sweden in 2003 . PATIENTS OR PARTICIPANTS The modelled cohort consisted of 25 % of adult smokers motivated to quit smoking ( 168,844 males and 208,737 females ) . The age and sex distributions of the cohort reflect that of the Swedish population in 2003 . INTERVENTIONS Smokers who had achieved abstinence for at least 7 days following 12-week open-label treatment with varenicline were r and omized to receive an additional 12-week treatment with either varenicline or placebo . MEASUREMENTS AND RESULTS The incremental costs per quality -adjusted life-year ( QALY ) gained , for abstainers who received an additional 12-week varenicline treatment compared with only 12 weeks , were Euro 7066 for men and Euro 7108 for women , over a 50-year time horizon . ( 1 Euro approximately equal to SEK 9.12 ) . These estimates excluded indirect effects on production and consumption of increased survival . The corresponding incremental costs per QALY including indirect effects were Euro 24,149 and Euro 24,436 , respectively . Sensitivity analysis indicated that the estimated cost-utility ratios are robust , but relatively sensitive to treatment efficiency and intervention costs . CONCLUSIONS An additional 12-week course of varenicline treatment , provided to abstainers after an initial 12-week treatment , produces relatively low incremental cost-utility ratios in the spectrum of life-saving medical treatments Background Smoking is the leading cause of preventable death in the US . While one in five individuals smoke , and 70 % of these indicate a OUTPUT:

All existing economic evaluations in smoking cessation lack in one or more key study attributes necessary to be fully transferable to a new context

MS2_fixed_5_shot1893

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Background : The evidence of benefit for pulmonary rehabilitation ( PR ) programmes is established . However , the optimal duration of a PR programme is not known . A r and omised controlled trial was undertaken in patients with chronic obstructive pulmonary disease ( COPD ) to assess whether a 4 week PR programme was equivalent to our conventional 7 week PR programme at equivalent time points of 7 weeks and 6 months . Methods : One hundred patients ( 56 men ) with stable COPD of mean ( SD ) age 70 ( 8) years and forced expiratory volume in 1 second ( FEV1 ) 1.13 ( 0.50 ) litres were r and omised to either a 7 week ( n = 50 ) or 4 week ( n = 50 ) supervised PR programme . Patients were assessed at baseline , at completion of the supervised PR programme , and 6 months later . Patients r and omised to the 4 week group were also assessed at the 7 week time point . Outcome measures were the Incremental Shuttle Walk Test , Endurance Shuttle Walk Test ( ESWT ) , Chronic Respiratory Question naire-Self Reported , and the Breathing Problems Question naire . Results : Forty one patients in each group completed the PR programme . Patients made significant within group improvements after supervised rehabilitation . There were no statistically significant differences between the groups for any other measure at the 7 week or 6 month time points , except that patients in the 4 week group attained higher ESWT times ( mean difference 124 seconds ( 95 % CI 17.00 to 232.16 ) , p = 0.024 ) at the 7 week time point . Conclusions : A shortened 4 week supervised PR programme is equivalent to a 7 week supervised PR programme at the comparable time points of 7 weeks and 6 months Guidelines for the prescription of long-term oxygen therapy ( LTOT ) in hypoxemic COPD patients are based on two l and mark studies in which survival was the primary outcome . Such patients are importantly symptomatic with poor health-related quality of life ( HRQL ) OUTPUT:

Conclusion Our findings suggest that people with low literacy skills or learning disabilities are left out of the development of PROMs .

MS2_fixed_5_shot1894

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Abstract Aims / Introduction Dipeptidyl peptidase‐4 inhibitors might have pleiotropic protective effects on cardiovascular disease ( CVD ) , in contrast to sulfonylureas . Therefore , we compared various CVD risk factors between vildagliptin and glimepiride . Material s and Methods We carried out a r and omized , prospect i ve and crossover trial . A total of 16 patients with type 2 diabetes whose glycated hemoglobin was > 7 % were r and omized to add vildagliptin or glimepiride . After 12‐week treatment , each drug was replaced with the other for another 12 weeks . Before and after each treatment , glucose homeostasis and CVD risk factors were assessed , and the continuous glucose monitoring system was applied to calculate glycemic variability . Results The mean age of the participants was 60 years , 31 % were men , body mass index 25.5 kg/m2 and HbA1c 8.41 % . Both vildagliptin and glimepiride significantly decreased glycated hemoglobin and glycemic variability indices . Despite the improved glucose homeostasis , favorable change of CVD markers was not prominent in both the arms , along with significant weight gain . Only plasma stromal cell‐derived factor (SDF)‐1α decreased by 30 % in the vildagliptin arm . According to regression analyses , the reduction of SDF‐1α was independently associated with vildagliptin usage and serum interleukin‐6 changes , but white blood cells were not related with the SDF‐1α changes . Conclusion Compared with glimepiride , vildagliptin arrestingly decreased plasma SDF‐1α , and its clinical implication s should be further investigated Background Glycemic variability is associated with the development of diabetic complications through the activation of oxidative stress . This study aim ed to evaluate the effects of a dipeptidyl peptidase 4 inhibitor , vildagliptin , or a thiazolidinedione , pioglitazone , on g OUTPUT:

Initial combination therapy with DPP-IV inhibitors more effectively reduced MAGE than stepwise add-on therapies ( p = 0.006 ) , although no differences in MAGE were found based on HbA1c values . These findings indicate that DPP-IV inhibitors are promising alternatives for reducing GV in type 2 diabetes patients .

MS2_fixed_5_shot1895

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Symptoms during physical activity and physical inactivity are hallmarks of chronic obstructive pulmonary disease ( COPD ) . Our aim was to evaluate the validity and usability of six activity monitors in patients with COPD against the doubly labelled water ( DLW ) indirect calorimetry method . 80 COPD patients ( mean±sd age 68±6 years and forced expiratory volume in 1 s 57±19 % predicted ) recruited in four centres each wore simultaneously three or four out of six commercially available monitors vali date d in chronic conditions for 14 consecutive days . A priori validity criteria were defined . These included the ability to explain total energy expenditure ( TEE ) variance through multiple regression analysis , using TEE as the dependent variable with total body water ( TBW ) plus several physical activity monitor outputs as independent variables ; and correlation with activity energy expenditure ( AEE ) measured by DLW . The Actigraph GT3X ( Actigraph LLC , Pensacola , FL , USA ) , and DynaPort MoveMonitor ( McRoberts BV , The Hague , the Netherl and s ) best explained the majority of the TEE variance not explained by TBW ( 53 % and 70 % , respectively ) and showed the most significant correlations with AEE ( r=0.71 , p<0.001 and r=0.70 , p<0.0001 , respectively ) . The results of this study should guide users in choosing valid activity monitors for research or for clinical use in patients with chronic diseases such as COPD . This study vali date s six activity monitors in the field against indirect calorimetry ( DLW ) in patients with COPD The use of movement registration for daily physical activity assessment was evaluated during a 7-day period in 30 free-living subjects . Body movement was registered with a Tracmor motion sensor consisting of a triaxial accelerometer and a data unit for on-line processing of accelerometer output over 1-min intervals . Average Tracmor output was correlated against four different energy estimates : 1 ) average daily metabolic rate ( ADMR ) , determined with doubly labeled water ; OUTPUT:

Conclusions : We conclude that there is large heterogeneity across studies in the explained variance of AEE when estimated based on accelerometry .

MS2_fixed_5_shot1896

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Objective : Vitamin A and its retinoid derivates play an important role in regulation of normal growth and development . Vitamin A has been shown to regulate thyroid hormone metabolism and inhibit thyroid-stimulating hormone ( TSH ) secretion via down regulation of TSH-β gene expression ; however , the effect of vitamin A on thyroid function in obese individuals who are at higher risk of sub clinical hypothyroidism is still unclear . In the present study we investigate the impact of vitamin A supplementation on thyroid function in obese women . Method : A 4-month r and omized , double blind controlled trial was conducted among 84 healthy women aged 17–50 years old : 56 were obese ( body mass index [ BMI ] 30–35 kg/m2 ) and 28 were nonobese ( BMI 18.5–24.9 kg/m2 ) . Obese women were r and omly allocated to receive either vitamin A ( 25,000 IU/d retinyl palmitate ) or placebo . Nonobese women received vitamin A. At baseline and 4 months after intervention , serum concentrations of TSH , total thyroxine ( T4 ) , total triiodothyronine ( T3 ) , retinol-binding protein ( RBP ) , and transthyretin ( TTR ) were measured . Results : Baseline concentrations of thyroid hormones , RBP and TTR were not significantly different between groups . Vitamin A caused a significant reduction in serum TSH concentrations in obese ( p = 0.004 ) and nonobese ( p = 0.001 ) groups . Serum T3 concentrations also increased in both obese and nonobese vitamin A – treated groups ( p < 0.001 ) . Serum T4 decreased in all 3 groups after treatment . The results showed a significant reduction in serum RBP in the obese group after vitamin A supplementation ( p = 0.007 ) , but no significant change was seen in serum TTR . Conclusions : Serum TSH concentrations in vitamin A – treated subjects OUTPUT:

Although observational evidence suggests that concentrations of selenium , zinc , and iron are positively associated with iodine status , data from r and omized controlled trials fail to confirm this relationship .

MS2_fixed_5_shot1897

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Background : Postfracture care is suboptimal , and strategies to address this major gap in care are necessary . We investigated whether notifications sent by mail to physicians and patients would lead to improved postfracture care . Methods : We conducted a r and omized controlled trial ( Clinical Trials.gov identifier NCT00594789 ) in the province of Manitoba , Canada , from June 2008 to May 2010 . Using medical cl aims data , we identified 4264 men and women age 50 years or older who recently reported major fractures , and who had not undergone recent bone mineral density testing or treatment for osteoporosis . Participants were r and omized to three groups : group 1 received usual care ( n = 1480 ) , patients in group 2 had mailed notification of the fracture sent to their primary care physicians ( n = 1363 ) , and group 3 had notifications sent to both physicians and patients ( n = 1421 ) . Bone mineral density testing and the start of pharmacologic treatment for osteoporosis within the following 12 months were documented . Results : Among participants in group 1 ( usual care ) , 15.8 % of women and 7.6 % of men underwent testing for bone mineral density or started pharmacologic treatment for osteoporosis . Outcome measures improved among participants in group 2 ( 30.3 % of women and 19.0 % of men , both p < 0.001 ) and group 3 ( 34.0 % of women and 19.8 % of men , both p < 0.001 ) . No additional benefit was seen with patient notification in addition to physician notification . Combining groups 2 and 3 , the absolute increase for the combined end point of bone mineral density testing or pharmacologic treatment was 14.9 % ( 16.4 % among women , 11.8 % among men ) . The number needed to notify to change patient care was 7 ( 6 for women , 6 for men ) . The adjusted odds ratio ( OR ) to change patient OUTPUT:

Interventions to improve OP management had a significant positive impact on prescription of BMD measurement but a more limited impact on treatment prescription

MS2_fixed_5_shot1898

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: BACKGROUND Atrial fibrillation ( AF ) is a very common cardiac arrhythmia , and is associated with an increased mortality in patients with hypertension . Whether the best therapeutic approach for these patients is to restore sinus rhythm ( SR ) or to adequately control the ventricular rate is still controversial . The aim of this study is to compare both strategies in patients with hypertension . METHODS AND RESULTS Two hundred and twenty-one patients with hypertension and AF of duration > 48 h were r and omly assigned to either the rhythm ( n=155 ) or rate ( n=66 ) control group . Exercise capacity was improved in the rhythm control group in the 1st year of the study ( p<0.0001 ) . There were no statistically significant differences in the embolic event rate and the total mortality between the 2 groups at the end of the study ( p = NS ) . CONCLUSIONS Although restoring and maintaining SR had a beneficial effect on exercise capacity in patients with hypertension and AF , no significant difference was found in terms of the total mortality and the embolic event rates . Thus , rate control is an acceptable primary strategy in patients with AF and hypertension Recent trials have favoured ventricular rate control in atrial fibrillation ( AF ) management , however the present study investigated whether the restoration and maintenance of sinus rhythm with long-term anticoagulation therapy was superior in terms of embolic events and death in 534 patients with an AF duration > 48 h. Patients were r and omized and received sinus rhythm control with either aspirin ( group 1 ) or warfarin ( group 2 ) , or they were given ventricular rate control ( group 3 ) . Cardioversion to sinus rhythm was attempted in 425 patients and was successful in 387 ( 91.1 % ) of them . After 3 years ' follow-up there were 12 , two and 15 embolic events in groups 1 , 2 and 3 respectively ( significant difference between groups 1 and 2 , and 2 and 3 ) and overall mortalities were four , two and OUTPUT:

Assessment of the comparative effectiveness of individual AADs on CV hospitalization and mortality end points is not possible with the current evidence

MS2_fixed_5_shot1899

***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: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: The interexaminer reliability of noninvasive methods of examining lumbar spinal segments is not well established . In this project the interexaminer reliability of three experienced chiropractic examiners , who evaluated 21 symptomatic and 25 asymptomatic subjects , was explored . Eight noninvasive segmental examination strategies ( dimensions ) were employed at each spinal segment from T11/T12 through L5/S1 . Marginal to good agreement beyond chance was noted for palpatory pain over osseous structures and in paraspinal soft-tissues . Weaker and less frequently , significant concordance between examiners was noted for detection of temperature differences ( greater than or equal to 1.5 degrees F ) between adjacent segments and for visual inspection for segmental abnormality . Little significant agreement between examiner was found for active and passive motion palpation , muscle tension palpation and misalignment palpation . This study suggests that " subjective " findings ( pain ) may be among the most reliable of conservative spinal observations . Weak but significant correlations were found when positive findings for the eight dimensions at each lumbar segment were summed to form a composite joint abnormality index . When the multidimension index was developed using the four most reliable dimensions , slightly stronger correlations were found . The strongest agreement between examiners tended to be found in the lower lumbar spine Study Design This prospect i ve study evaluated the diagnostic utility of historically accepted sacroiliac joint tests . A multidisciplinary expert panel recommended 12 of the “ best ” sacroiliac joint tests to be evaluated against a criterion st and ard of unequivocal pain relief after an intra‐articular injection of local anesthetic into the sacroiliac joint . Objectives To identify a single sacroiliac joint test or ensemble of tests that are sufficiently useful in diagnosing sacroiliac joint disorders to be clinical ly valuable . Summary of Background Data No previous research has been done to evaluate any physical test of sacroiliac joint pain against an accepted criterion st and ard . Methods Historical data was obtained , and the 12 tests were performed by two examiners on 85 patients who subsequently underwent sacroiliac joint blocks OUTPUT:

Based on the upper threshold used ( kappa/ICC > 0.85 ) most procedures demonstrated either conflicting evidence or moderate to strong evidence of low reliability . When the lower threshold was used ( kappa/ICC > 0.70 ) evidence about pain response to repeated movements changed from contradictory to moderate evidence for high reliability . Most procedures commonly used by clinicians in the examination of patients with back pain demonstrate low reliability