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MS2_fixed_5_shot_test

like 0

MS2_fixed_5_shot1900

***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: Laparoscopic Nd-YAG laser photocoagulation of the ovaries was performed in 40 anovulatory women with clomiphene citrate-resistant polycystic ovary disease . Following this procedure , the subjects were r and omly assigned to have either a second-look laparoscopy with lysis of adhesions within 3 - 4 weeks of the initial laparoscopy ( N=19 ) or expectant management ( N=20 ) . One patient assigned to the laparoscopy group refused the procedure . Minimal and mild adhesions that did not distort the normal tubo-ovarian relationship were encountered in 13 patients ( 68 % ) in the second-look laparoscopy group ; these adhesions were easily lysed using sharp or blunt dissection . The pregnancy rates over 6 months were similar in the two groups ( 47 % in the second-look group and 55 % in the expectant-management group ; P>.05 ) . These data suggest that early laparoscopic lysis of adhesions does not improve short-term conception rates following laparoscopic Nd-YAG laser photocoagulation of polycystic ovaries This study describes a prospect i ve r and omized controlled trial to evaluate whether suture of the peritoneal layer is necessary as a separate step in the closure of midline abdominal surgical wounds . Consecutive patients undergoing abdominal operation — elective and emergency surgery — through a midline abdominal wound were r and omized to have the peritoneal layer closed with continuous catgut , or to have this step omitted . The linea alba was closed with interrupted stainless steel sutures , and the skin approximated with staples . Patients were evaluated for wound sepsis , wound dehiscence , and subsequent incisional hernia development . Postoperative pain was assessed by a self-administered visual analogue score , and by measuring narcotic requirements . There was no significant difference in narcotic requirements , pain scores , or wound complications between the 2 groups . Single-layer closure of the abdominal wall is quicker , less costly , and theoretically safer OUTPUT:

None of the techniques that were compared significantly reduced the incidence of adhesive small bowel obstruction . None of the specific techniques that were compared reduced the two main adhesion-related clinical outcomes , small bowel obstruction and infertility . The meta- analysis provides little evidence for the surgical principle that using less invasive techniques , introducing less foreign bodies or causing less ischaemia reduces the extent and severity of adhesions

MS2_fixed_5_shot1901

***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 Escitalopram , the therapeutically active isomer of the racemic selective serotonin reuptake inhibitor antidepressant citalopram , has shown significant anxiolytic effects in placebo-controlled clinical trials of social anxiety disorder , generalized anxiety disorder , and anxiety symptoms associated with major depression . This study evaluated the safety and efficacy of escitalopram in out patients diagnosed with panic disorder . METHOD Male and female out patients between 18 and 80 years of age meeting DSM-IV criteria for panic disorder , with or without agoraphobia , were r and omly assigned to 10 weeks of double-blind treatment with escitalopram , citalopram , or placebo in a study conducted from September 1999 to July 2001 . The primary measure of efficacy was panic attack frequency at week 10 relative to baseline , as assessed by the Modified Sheehan Panic and Anticipatory Anxiety Scale . RESULTS A total of 366 subjects ( 128 escitalopram patients , 119 citalopram patients , and 119 placebo patients ) received at least 1 dose of double-blind treatment . The frequency of panic attacks was statistically significantly improved ( p = .04 ) , and the increase in percentage of patients with zero panic attacks reached borderline significance ( p = .051 ) , in the escitalopram-treated group relative to the placebo-treated group . Both escitalopram and citalopram statistically significantly reduced panic disorder symptoms and severity versus placebo at endpoint ( p < /=.05 ) , as measured by the Panic and Agoraphobia Scale total score , the Clinical Global Impressions scale , the Patient Global Evaluation , and the Quality of Life Enjoyment and Satisfaction Question naire . Treatment with escitalopram was safe and well tolerated , with a similar incidence of the most common adverse events for the escitalopram and placebo groups . The rate of discontinuation for adverse events was 6.3 % for OUTPUT:

These drugs were better tolerated than tricyclics and benzodiazepines as they had a low risk of dependence and overdosing complications . The serotonergic , noradrenergic and GABAergic pathways play a major role in the fear network and in the physiopathology of PD .

MS2_fixed_5_shot1902

***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 efficacy of prophylactic antibiotics in fracture surgery remains controversial for lack of well-documented prospect i ve studies . We report here the findings of the Dutch Trauma Trial , a prospect i ve , r and omised , double-blind , placebo-controlled study of antibiotic prophylaxis in the primary operative treatment of limb fractures . Ceftriaxone was chosen because of its pharmacokinetic profile , including high serum levels , high tissue penetration , and long elimination half-life , makes it suitable for single-dose prophylaxis . METHODS Patients aged 18 years or more , attending one of fourteen Dutch centres for acute treatment of closed fractures , were r and omly allocated to a single preoperative dose of ceftriaxone 2 g or placebo , and evaluated for development of wound infection and nosocomial infection at 10 days , 30 days , and 120 days . To assess the effects of drop-outs and withdrawals , best-case and worst-case analyses were performed . FINDINGS A total of 2195 patients were included . The incidence of superficial and deep wound infections after placebo was 8.3 % , compared with 3.6 % in the ceftriaxone group ( p < 0.001 , Pearson chi 2-test ) . The rate of nosocomial infection in the first month was 10.2 % with placebo and 2.3 % with ceftriaxone ( p < 0.001 , Pearson chi 2-test ) . Gram-positive bacteria were found in 74.5 % of wound infections and 13.4 % of nosocomial infections . INTERPRETATION Adequate single-dose prophylaxis with a long-acting broad-spectrum antibiotic substantially reduces the incidence of wound infection and early nosocomial infection after surgery for closed fractures Every word to utter from the writer involves the element of this life . The writer really shows how the OUTPUT:

However , there was no real evidence supporting the second hypothesis that the relative risk of wound infection would substantially vary over different levels of surgery cleanliness . : As well as antibiotic prophylaxis being a generally effective intervention for preventing postoperative wound infection , the level of this effectiveness would appear to be reasonably independent of what type of surgery is being considered . In particular , perhaps a sensible philosophy would be to assume that antibiotic prophylaxis is effective in reducing the risk of wound infection for all types of surgery , even ones where no clinical trial data exists and make exceptions to this rule if , for certain types of surgery , it can be proved to the contrary

MS2_fixed_5_shot1903

***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 This controlled clinical trial evaluated the 5-year clinical performance of a self-etching primer system including selective enamel-etching with phosphoric acid and a one-bottle adhesive system . METHODS Seventy-two non-carious cervical lesions in 8 patients ( 4 male and 4 female ) with a mean age of 61.3 years ( range 45 - 78 ) participated in the study . An enamel bevel was placed and dentin lightly ground , and cavities restored with clearfil liner bond II ( LB ) or single bond ( SB ) in conjunction with a hybrid resin composite ( Clearfil AP-X ) . In the case of 27 cavities for LB , the enamel was pretreated with 37 % phosphoric acid for 10 s. Each patient received both types of restoration , which were distributed on a r and om basis . All restorations ( 37 restorations for LB and 35 restorations for SB ) were placed by one dentist . The restorations were evaluated blind after 5 years using modified USPHS criteria . The data were statistically analyzed using the Fisher 's exact test . RESULTS All but one restoration ( which was replaced by a crown after the 2-year recall ) were evaluated after 5 years . 100 % retention rates were recorded for both restorative groups . No caries was detected in association with any restorations . The only minor problem was marginal discoloration ; superficial and localized marginal discoloration occurred around 18 % of the restorations , and mainly at the dentin margin . There were no significant differences in the marginal integrity between the LB and SB groups . CONCLUSIONS Restorative material s used in this study demonstrated a good clinical effectiveness in the restoration of non-carious cervical lesions for 5 years This study evaluated the effect of the thickness of the adhesive resin layer of two commercially available resin bonding systems on bond strengths ( Single Bond and Liner Bond 2V ) . The adhesive of Single Bond contains ethanol and water as solvents and is OUTPUT:

RESULTS Comparison of retention of class-V adhesive restorations as a measure to determine clinical bonding effectiveness of adhesives revealed that glass-ionomers most effectively and durably bond to tooth tissue . Three-step etch- and -rinse adhesives and two-step self-etch adhesives showed a clinical ly reliable and predictably good clinical performance . The clinical effectiveness of two-step etch- and -rinse adhesives was less favourable , while an inefficient clinical performance was noted for the one-step self-etch adhesives . SIGNIFICANCE Although there is a tendency towards adhesives with simplified application procedures , simplification so far appears to induce loss of effectiveness .

MS2_fixed_5_shot1904

***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 Green tea consumption has been associated with favorable changes in body weight and obesity-related hormones , although it is not known whether these changes result from green tea polyphenols or caffeine . OBJECTIVE We examined the impact of decaffeinated green tea extract ( GTE ) containing 843 mg of (-)-epigallocatechin-3-gallate on anthropometric variables , obesity-associated hormones , and glucose homeostasis . METHODS The Minnesota Green Tea Trial was a 12-mo r and omized , double-blind , placebo-controlled clinical trial of 937 healthy postmenopausal women assigned to either decaffeinated GTE ( 1315 mg total catechins/d ) or a placebo , stratified by catechol-O-methyltransferase ( COMT ) genotype . This study was conducted in a subset of 237 overweight and obese participants [ body mass index ( BMI ) ≥25 kg/m(2 ) ] . RESULTS No changes in energy intake , body weight , BMI , or waist circumference ( WC ) were observed over 12 mo in women taking GTE ( n = 117 ) or placebo ( n = 120 ) . No differences were seen in circulating leptin , ghrelin , adiponectin , or glucose concentrations at month 12 . Participants r and omly assigned to GTE with baseline insulin ≥10 μIU/mL ( n = 23 ) had a decrease in fasting serum insulin from baseline to month 12 ( -1.43 ± 0.59 μIU/mL ) , whereas those r and omly assigned to placebo with baseline insulin ≥10 μIU/mL ( n = 19 ) had an increase in insulin over 12 mo ( 0.55 ± 0.64 μIU/mL , P < 0.01 ) . Participants with the homozyg OUTPUT:

Resveratrol significantly improves adiponectin but does not affect leptin concentrations .

MS2_fixed_5_shot1905

***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: Implant malposition and poor fixation are potential risks of compromising long-term results after total hip arthroplasty performed with a minimally invasive technique . Between September 2000 and February 2002 , 120 cemented primary total hip arthroplasties were performed at the authors ' institutions in patients with primary osteoarthritis of the hip and with BMI lower than 35 . In 60 of these cases selected at r and om , a posterolateral incision no longer than 10 cm was used . The other 60 THA 's were performed through a st and ard posterolateral approach . The inclination and anteversion of the cup and the position of the femoral stem were assessed on radiographs and statistically evaluated . In the miniinvasive group , the average inclination angle of the cup was 42.3 degrees ( range : 36 to 52 degrees ) and the anteversion angle 13.6 degrees ( range : 6 to 29 degrees ) . The coronal alignment of the femoral component was within 3 degrees of neutral in 54 cases ( 90.0 % ) . Following conventional implantation in the other group , the average cup inclination angle was 42.4 degrees ( range : 35 to 50 degrees ) and the anteversion angle 13.6 degrees ( range : 8 to 24 degrees . A total of 53 stems ( 88.3 % ) were implanted optimally . Statistical analysis found no significant difference between the two groups regarding components position . These findings suggest that using a smaller posterolateral incision as was done in this study does not introduce a potential risk of compromising long-term results BACKGROUND AIMS Evaluation of : 1 . early clinical and radiographic results of total hip arthroplasty ( THA ) through a st and ard lateral direct approach , 2 . early clinical and radiographic results of THA through a minimal lateral approach , 3 . comparison of the results of THA in these two groups . MATERIAL AND METHODS 120 THAs ( 60 cementless and 60 cemented ) done in OUTPUT:

Compared with st and ard total hip replacement , mini-incision procedures may have small perioperative advantages in terms of less blood loss , shorter operative time , and shorter inpatient stay , but the differences were not clinical ly important . Few complications were reported , and the complication rate did not differ significantly between groups . There was insufficient evidence to suggest any major difference in the short-term revision rate , and confidence intervals for surrogate measures for long-term outcome were broad enough to include clinical ly important differences in favor of either approach . Although there were marginal short-term advantages and disadvantages for each of the surgical techniques , there was no strong evidence either for or against mini-incision compared with st and ard-incision total hip replacement . Importantly , evidence on longer-term performance , especially the risk of revision arthroplasty , for mini-incision hip arthroplasty is very limited

MS2_fixed_5_shot1906

***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 investigate the association between distance to the closest supermarket and a composite measure of diet , the diet quality index for pregnancy ( DQI-P ) was constructed . METHODS Data from the Pregnancy , Infection and Nutrition ( PIN ) cohort , a prospect i ve study of determinants of preterm birth , were analyzed . Food frequency question naires were used to construct DQI-P which includes : servings of grains , vegetables , fruits , folate , iron and calcium intake , percentage of calories from fat , and meal pattern score . Street address of residence , supermarkets , grocery and convenience stores were geocoded . Participants with complete food frequency and address data were included ( n = 918 ) . Multinomial logistic regression was used to estimate the conditional association of food outlets on diet quality , controlling for confounders and using a robust variance estimator to account for clustering of neighborhood characteristics . RESULTS Women living greater than 4 miles from a supermarket were more than twice the odds ( adjusted odds ratio = 2.16 ; 95 % confidence interval = 1.2 , 4.0 ) of falling into the lowest compared to highest DQI-P tertile compared to women living within 2 miles of a supermarket , after controlling for individual characteristics , other food retail outlets . CONCLUSION These findings suggest that proximity of food retail outlets influences the diet quality of pregnant women OBJECTIVE To evaluate the effectiveness of a worksite health promotion program on improving cardiovascular disease risk factors . METHODS In St Louis , Missouri from 2005 to 2006 , 151 employees ( 134 F , 17 M , 81 % overweight/obese ) participated in a cohort-r and omized trial comparing assessment s + intervention ( worksite A ) with assessment s only ( worksite B ) for 1 year . All participants received personal health reports containing their assessment results . The intervention was design ed to promote physical activity and favorable dietary patterns using pedometers , healthy snack cart , WeightWatchers(R ) meetings OUTPUT:

Several specific population interventions that achieved a Class I or IIa recommendation with grade A or B evidence were identified , providing a set of specific evidence -based strategies that deserve close attention and prioritization for wider implementation . Effective interventions included specific approaches in all 6 domains evaluated for improving diet , increasing activity , and reducing tobacco use . The writing group also identified several specific interventions in each of these domains for which current evidence was less robust , as well as other inconsistencies and evidence gaps , informing the need for further rigorous and interdisciplinary approaches to evaluate population programs and policies . This systematic review identified and grade d the evidence for a range of population -based strategies to promote lifestyle change .

MS2_fixed_5_shot1907

***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 Adverse effects of hypercaloric , high-fructose diets on insulin sensitivity and lipids in human subjects have been shown repeatedly . The implication s of fructose in amounts close to usual daily consumption , however , have not been well studied . This study assessed the effect of moderate amounts of fructose and sucrose compared with glucose on glucose and lipid metabolism . RESEARCH DESIGN AND METHODS Nine healthy , normal-weight male volunteers ( aged 21–25 years ) were studied in this double-blind , r and omized , cross-over trial . All subjects consumed four different sweetened beverages ( 600 mL/day ) for 3 weeks each : medium fructose ( MF ) at 40 g/day , and high fructose ( HF ) , high glucose ( HG ) , and high sucrose ( HS ) each at 80 g/day . Euglycemic-hyperinsulinemic clamps with [6,6]-2H2 glucose labeling were used to measure endogenous glucose production . Lipid profile , glucose , and insulin were measured in fasting sample s. RESULTS Hepatic suppression of glucose production during the clamp was significantly lower after HF ( 59.4 ± 11.0 % ) than HG ( 70.3 ± 10.5 % , P < 0.05 ) , whereas fasting glucose , insulin , and C-peptide did not differ between the interventions . Compared with HG , LDL cholesterol and total cholesterol were significantly higher after MF , HF , and HS , and free fatty acids were significantly increased after MF , but not after the two other interventions ( P < 0.05 ) . Subjects ’ energy intake during the interventions did not differ significantly from baseline intake . CONCLUSIONS This study clearly shows that moderate amounts of fructose and sucrose significantly alter hepatic insulin sensitivity and lipid metabolism compared with similar amounts of glucose OBJECTIVE To OUTPUT:

We conclude based on high quality evidence from r and omized controlled trials ( RCT ) , systematic review s and meta-analyses of cohort studies that singling out added sugars as unique culprits for metabolically based diseases such as obesity , diabetes and cardiovascular disease appears inconsistent with modern , high quality evidence and is very unlikely to yield health benefits . While it is prudent to consume added sugars in moderation , the reduction of these components of the diet without other reductions of caloric sources seems unlikely to achieve any meaningful benefit

MS2_fixed_5_shot1908

***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 analyze socioeconomic indicators , physical activity ( PA ) opportunities , and behavioral correlates of cardiorespiratory and muscular fitness among Brazilian boys and girls . METHODS A sample of 1555 adolescents was r and omly selected . Age- and sex-specific st and ard scores were calculated for each fitness component . RESULTS Among boys , head of household 's schooling , involvement in organized PA , meeting the PA recommendations , and computer/games use were associated with cardiorespiratory fitness . Involvement in organized PA and active time in Physical Education ( PE ) classes were predictors of muscular fitness . Among girls , active time in PE classes and TV watching were predictors of cardiorespiratory fitness . Meeting the PA recommendations was associated with muscular fitness . CONCLUSION PA variables and sedentary behaviors should be independently considered for physical fitness promotion in youth Overwhelming evidence shows the quality of reporting of r and omised controlled trials ( RCTs ) is not optimal . Without transparent reporting , readers can not judge the reliability and validity of trial findings nor extract information for systematic review s. Recent method ological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects . Such systematic error is seriously damaging to RCTs , which are considered the gold st and ard for evaluating interventions because of their ability to minimise or avoid bias . A group of scientists and editors developed the CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to improve the quality of reporting of RCTs . It was first published in 1996 and up date d in 2001 . The statement consists of a checklist and flow diagram that authors can use for reporting an RCT . Many leading medical journals and major international editorial groups have endorsed the CONSORT statement . The statement facilitates critical appraisal and interpretation of RCTs . During the 2001 CONSORT revision , it became clear that explanation and elaboration of the principles underlying the CONSORT statement would help investigators and others to write or appraise trial reports . A CONSORT explanation and elaboration article was OUTPUT:

Results There was consistent evidence for a positive association between MF and physical activity . For both MF components , there was support for objective ly measured physical activity , particularly for activity of vigorous intensity . Sports participation was also consistently linked with both MF components , whereas the association with active transport was inconsistent . For both MF components , associations with sedentary behaviors were inconsistent irrespective of measurement method , and the association between MF and sleep was considered uncertain . Conclusions The available evidence supports a link between MF and physical activity , particularly for vigorous intensity activity and organized sports participation .

MS2_fixed_5_shot1909

***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 benefits of preoperative biliary drainage , which was introduced to improve the postoperative outcome in patients with obstructive jaundice caused by a tumor of the pancreatic head , are unclear . METHODS In this multicenter , r and omized trial , we compared preoperative biliary drainage with surgery alone for patients with cancer of the pancreatic head . Patients with obstructive jaundice and a bilirubin level of 40 to 250 micromol per liter ( 2.3 to 14.6 mg per deciliter ) were r and omly assigned to undergo either preoperative biliary drainage for 4 to 6 weeks , followed by surgery , or surgery alone within 1 week after diagnosis . Preoperative biliary drainage was attempted primarily with the placement of an endoprosthesis by means of endoscopic retro grade cholangiopancreatography . The primary outcome was the rate of serious complications within 120 days after r and omization . RESULTS We enrolled 202 patients ; 96 were assigned to undergo early surgery and 106 to undergo preoperative biliary drainage ; 6 patients were excluded from the analysis . The rates of serious complications were 39 % ( 37 patients ) in the early-surgery group and 74 % ( 75 patients ) in the biliary-drainage group ( relative risk in the early-surgery group , 0.54 ; 95 % confidence interval [ CI ] , 0.41 to 0.71 ; P<0.001 ) . Preoperative biliary drainage was successful in 96 patients ( 94 % ) after one or more attempts , with complications in 47 patients ( 46 % ) . Surgery-related complications occurred in 35 patients ( 37 % ) in the early-surgery group and in 48 patients ( 47 % ) in the biliary-drainage group ( relative risk , 0.79 ; 95 % CI , 0.57 OUTPUT:

A well-implemented ERAS protocol with good compliance is associated with a reduction in medical complications and length of hospital stay .

MS2_fixed_5_shot1910

***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: Summary Fall prevention is a key strategy for reducing osteoporotic fractures . We investigated the association between vitamin D receptor ( VDR ) polymorphisms and reported falls in postmenopausal women . Bsm1 polymorphisms were associated with falls , balance and muscle power measurements . These results may explain some of the excess fracture risk associated with VDR in some studies . Introduction Fall prevention is a key strategy for reducing osteoporotic fractures . It has been suggested that vitamin D supplementation may reduce the incidence of falls by reducing body sway and increasing muscle power . The vitamin D receptor gene is a well-studied c and i date gene for osteoporosis . We investigated the association between VDR polymorphisms and reported falls in postmenopausal women . Methods Falls data were collected in two separate population cohorts . Five polymorphisms of the VDR gene were analysed ( Cdx-2 , Fok-1 , BsmI , Taq1 and Apa1 ) in the Aberdeen Prospect i ve Osteoporosis Screening Study ( APOSS ) cohort . Results found in APOSS were then vali date d in an independent cohort — the Osteoporosis and Ultrasound ( OPUS ) study ( Bsm1 and Fok1 only ) , where muscle power and balance were also measured . Results Carriers of the ‘ B ’ allele ( Bsm1 ) showed an increased risk for falls . In APOSS , this was statistically significant for visit 3 multiple falls ( p = 0.047 ) and for recurrent falls ( p = 0.043 ) . Similar results were found in OPUS for visit 1 falls ( p = 0.025 ) and visit 1 multiple falls ( p = 0.015 ) . Bsm1 polymorphisms were also associated with balance and muscle power measurements . Conclusions In conclusion , these results demonstrate an association between the Bsm1 polymorphism and risk of falling that may explain some of the excess fracture risk associated with VDR in some studies OBJECTIVE To test the efficacy of high-velocity training in healthy older persons . DESIGN A 12-week r and omized trial , with OUTPUT:

Finally , muscle power testing was found to be safe in older people with a broad range of health and functional states

MS2_fixed_5_shot1911

***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 whether weight-related teasing predicts the development of binge eating , unhealthy weight control behaviors , and frequent dieting among male and female adolescents . METHODS . A prospect i ve study was conducted with an ethnically and socioeconomically diverse sample of 2516 adolescents who completed surveys at both time 1 ( 1998–1999 ) and time 2 ( 2003–2004 ) of the Project EAT ( Eating Among Teens ) study . RESULTS . In 1998–1999 , approximately one fourth of participants reported being teased about their weight at least a few times a year . After adjustment for age , race/ethnicity , socioeconomic status ( SES ) , and BMI , boys who were teased about their weight were more likely than their peers to initiate binge eating with loss of control and unhealthy weight control behaviors 5 years later . The predicted prevalence for incident binge eating behaviors with loss of control among boys who were teased was 4.1 % as compared with 1.4 % for those who were not teased , after adjustment for age , race/ethnicity , SES , and BMI . For unhealthy weight control behaviors at time 2 , the predicted prevalence was 27.5 % among boys who were teased and 19.3 % for boys who were not teased , after adjustment for age , race/ethnicity , SES , and BMI . Girls who were teased were more likely than their peers to become frequent dieters . The predicted prevalence for incident frequent dieting among girls who were teased was 18.2 % as compared with 11.0 % for those who were not teased , after adjustment for age , race/ethnicity , SES , and BMI . CONCLUSIONS . Weight teasing in adolescence predicts disordered eating behaviors at 5-year follow-up . The patterns of these associations differ by gender . Reducing teasing through educational interventions and policies may reduce the level of disordered eating behaviors among youths O OUTPUT:

RESULTS Non-diet interventions result ed in statistically significant improvements in disordered eating patterns , self-esteem , and depression .

MS2_fixed_5_shot1912

***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 heuristic value in underst and ing the neurochemistry of major depression is whether the hypothalamo-pituitary-adrenocortical ( HPA ) axis hyperactivity that occurs in this illness can be related to putative neurotransmitter dysfunction(s ) . Cholinergic neurotransmission stimulates hypothalamic corticotropin releasing hormone ( CRH ) and arginine vasopressin ( AVP ) secretion , both of which stimulate pituitary corticotropin ( ACTH ) secretion , but whether the HPA axis in humans is activated only by doses of cholinergic agonists that produce noxious side effects remains controversial . To test the hypothesis of increased cholinergic sensitivity in major depression , physostigmine ( PHYSO ) , a reversible cholinesterase inhibitor , was administered to patients and control subjects at a dose that elevated plasma ACTH , cortisol , and AVP concentrations but produced few or no side effects . Exogenous AVP also was administered to determine if it would augment the effect of low-dose PHYSO on the HPA axis . Twelve premenopausal or estrogen-replaced female major depressives , 12 individually matched female control subjects , eight male major depressives , and eight matched male control subjects underwent four test sessions 5 - 7 days apart : PHYSO ( 8 microg/kg IV ) , AVP ( 0.08 U/kg IM ) , PHYSO + AVP , and saline control . Serial blood sample s were taken before and after pharmacologic challenge and analyzed for ACTH1 - 39 , cortisol , and AVP . Estradiol and testosterone were also measured at each test session . PHYSO ( 8 microg/kg ) significantly increased plasma ACTH , cortisol , and AVP , while producing no side effects in approximately half the subjects and predominantly mild side effects in the other half . These hormone increases following PHYSO occurred primarily in the female depressives and the male control subjects and were not significantly related to the OUTPUT:

Scopolamine is an effective and rapid antidepressant in both unipolar and bipolar depression , working as quickly as 3 days after initial infusion .

MS2_fixed_5_shot1913

***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: It is generally assumed that the oral contraceptives cause the carrier proteins to change . Notoriously this effect is used to evaluate indirectly their estrogenicity/gestagenicity ratio . In order to assess the residual intrinsic and rogenic activity of two new 19-nor-derivative components , Desogestrel ( DG ) 150 micrograms and Gestodene ( GD ) 75 micrograms , both in association with Ethinylestradiol ( EE ) 30 micrograms , Sex Hormone Binding Globulin , Thyroxine Binding Globulin , Ceruloplasmin and Free And rogen Index ( FAI ) , were studied in 40 young normally cycling healthy volunteers , matched for body mass index and age . The participants were r and omly assigned to either EE-DG or EE-GD treatment . A marked significant increase in all the carrier proteins was found . Conversely , the values for FAI decreased significantly . The changes in the two groups were substantially of the same magnitude . These results are an indirect confirmation of the well-known negligible receptor binding affinity of the two progestogen in vitro , also supporting for these compounds the lack of relevant and rogenic effects The effect of two oral contraceptive ( OC ) pills , both containing 150 micrograms of desogestrel , but with 20 ( Mercilon ) or 30 micrograms ( Marvelon/Desolett ) of ethinyl estradiol on plasma levels of lipids , lipoproteins and sex hormone binding globulin ( SHBG ) , total and free testosterone were compared in a double-blind , r and omized , two-center study in a total of 60 women over one year . A significant rise with Marvelon but not with Mercilon was seen in total cholesterol , HDL cholesterol , HDL-3 and apolipoprotein B , whereas LDL cholesterol decreased with Mercilon only . These effects result ed in significant differences between the two groups in the magnitude of responses in all these parameters except HDL-3 . HDL-2 , apolipoprotein OUTPUT:

However , subgroup analyses for the estrogen dose and the progestin type in relation to changes in SHBG levels did show significant differences : COCs containing second generation progestins and /or the lower estrogen doses ( 20–25 µg EE ) were found to have less impact on SHBG concentrations . The current literature review and meta- analysis demonstrates that COCs decrease circulating levels of total T and free T and increase SBHG concentrations . Due to the SHBG increase , free T levels decrease twice as much as total T. The estrogen dose and progestin type of the COC do not influence the decline of total and free T , but both affect SHBG .

MS2_fixed_5_shot1914

***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: Measuring salivary flow rates among the frail elderly is a challenge . The currently used spit collection method requires levels of time and cooperation that often may exclude the frail elderly who are at high risk for salivary compromise . A measurement method that is not only valid and reliable , but also feasible and acceptable is needed for use in population studies of compromised adults . This study compared two salivary flow rate assessment methods using a suction machine against the currently accepted spit collection method in an elderly population aged 75 and older . Three methods of flow rate ( g/min ) assessment were compared at three time periods among 16 elders ( mean age 86.6 years ) . Flow rates using the 2-min open suction method compared well with the 10-min spit method ( r=0.778 ) but the 2-min closed suction method did not ( r=0.158 ) . Reliability evaluation of the open suction method and the spit method was assessed using a test/retest with a 1-week interval . Both methods demonstrated good comparable reliability ( spit method r=0.566 , P=0.01 ) ; open suction method , ( r= 0.861 , P<0.01 ) . Based on a short survey question naire about the three methods , 11 of the 16 elderly subjects preferred the use of the suction machine to the spit method . These results indicate that the 2-min open suction method technique is a valid and reliable means of measuring salivary flow . The lower level of patient cooperation needed , the shorter time period required , and this preliminary report of its acceptability support the use of this method in future population studies of frail elders The aim of this study was to develop a valid and reproducible index of orthodontic treatment priority . After review ing the available literature , it was felt that this could be best achieved by using two separate components to record firstly the dental health and functional indications for treatment , and secondly the aesthetic impairment caused by the malocclusion . A modification of the index used by the Swedish Dental Health Board was used to record the need for orthodontic treatment on dental health and functional grounds . OUTPUT:

Even though some instruments and methods exhibited good to excellent reliability and validity and can be recommended for research and clinical practice , they do not allow assessing all components of physical oral health .

MS2_fixed_5_shot1915

***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 OBJECTIVE Cycle ergometer training is an important component of pulmonary rehabilitation for patients with COPD . However , incremental cycle tests from which individualized cycle training intensity can be prescribed may not be readily available to clinicians . The aims of the study were to ( i ) investigate the physiological and psychophysical responses to the 6-min walk test ( 6MWT ) , incremental shuttle walk test ( ISWT ) and cycle ergometer test ( CET ) ; and ( ii ) determine whether the distance walked in either the 6MWT or the ISWT could be used to estimate peak work rate on a cycle ergometer . METHODS A repeated measures study was undertaken in COPD patients in a stable condition . The 6MWT , ISWT and CET were performed in r and om order , and physiological responses , rate of perceived exertion and dyspnoea were measured . RESULTS Twenty-two patients with COPD completed the study . There was no significant difference in peak oxygen uptake between the 6MWT , ISWT and CET . The significant correlation between the 6MWD and incremental shuttle walk distance with peak watts on the CET ( r = 0.63 , P = 0.002 and r = 0.75 , P < 0.001 , respectively ) was strengthened by the inclusion of weight , age and gender ( r = 0.89 P = 0.001 and r = 0.91 , P < 0.001 ) . Bl and -Altman analysis demonstrated a strong agreement between peak work rate measured on the CET and that estimated from either the 6MWT or the ISWT . CONCLUSIONS The significant relationships found between the three exercise tests , and the regression equations predicting peak work rate on the CET from the 6MWT or the ISWT , may allow for the estimation of intensity of cycle exercise training from walk tests in COPD patients 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 OUTPUT:

Method ological factors affecting 6MWD include track length , encouragement , supplemental oxygen and walking aids . Supplemental oxygen also affects ISWT and ESWT performance . Responsiveness was moderate to high for all tests , with greater responsiveness to interventions that included exercise training . The findings of this review demonstrate that the 6MWT , ISWT and ESWT are robust tests of functional exercise capacity in adults with chronic respiratory disease

MS2_fixed_5_shot1916

***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 a prospect i ve clinical trial comparing a carbon fibre reinforced carbon ( CFRC ) endodontic post with a conventional prefabricated post . Twenty-seven single rooted maxillary anterior teeth in 18 patients ( nine males and nine females ; age range 18 - 60 years ) were restored either with a CFRC post or a wrought precious alloy control . Cast type III gold alloy cores were used in conjunction with both post groups . The CRFC posts ( n = 16 ) were cemented with a composite luting agent and the conventional posts ( control ) were cemented with zinc phosphate . Four failures were recorded in the CFRC post group at 24 , 29 , 56 and 87 months , compared with one failure in the control group at 84 months . These results suggest that post-retained crowns utilizing a CFRC material and a composite resin luting agent do not perform as well as conventional wrought precious alloy posts Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES This retrospective study investigated the clinical effectiveness over up to 8 years of parallel-sided and of tapered glass-fiber posts , in combination with either hybrid composite or dual-cure composite resin core material , in endodontically treated , maxillary anterior teeth covered with full-ceramic crowns . METHODS The study population comprised 192 patients and 526 endodontically treated teeth , with various degrees of hard-tissue loss , restored by the post- and -core technique . Four groups were defined based on post shape and core build-up material s , and within each group post- and -core restorations were assigned r and omly with respect to root morphology . Inclusion criteria were symptom-free endodontic therapy , root-canal treatment with a minimum apical seal of 4 mm , application of rubber dam , need for post- and -core complex because of coronal OUTPUT:

The results of this study did not show significant differences for root fracture incidence between metal- and fiber posts .

MS2_fixed_5_shot1917

***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 Bariatric surgery is a powerful treatment of severe obesity . During the past several years , a greater appreciation for the need for multidisciplinary care to optimize outcomes has developed , and a number of studies have been started to examine the role of postoperative interventions used in combination with surgery . The purpose of the present study was to investigate the hypothesis that the provision of postoperative dietary counseling , delivered by a registered dietitian , would lead to greater weight loss and more positive improvements in dietary intake and eating behavior compared with st and ard postoperative care . The study was performed at an academic medical center . METHODS Eighty-four individuals who underwent bariatric surgery were r and omly assigned to receive either dietary counseling or st and ard postoperative care for the first 4 months after surgery . The participants completed measures of macronutrient intake and eating behavior at baseline and 2 , 4 , 6 , 12 , 18 , and 24 months after surgery . RESULTS The patients who received dietary counseling achieved greater weight loss than those who received st and ard postoperative care that did not involve this counseling , although this difference did not reach statistical significance . Patients in the dietary counseling arm did report significant changes in several eating behaviors believed to be important to successful long-term weight maintenance . CONCLUSION The results of our pilot study provide some support for the efficacy of early postoperative dietary counseling to improve outcomes after bariatric surgery BACKGROUND Many comprehensive bariatric surgery programs have implemented preoperative behavioral interventions for patients presenting with problematic eating behaviors in an effort to enhance postoperative weight loss and improve psychosocial adjustment . However , it is unknown whether these interventions are best delivered pre- or postoperatively . The purpose of this study was to determine when bariatric surgery patients are most receptive to a behavioral intervention , before or after surgery . METHODS A total of 32 pre- and postoperative patients were referred to a 10-week intervention design ed to reduce eating behaviors associated with OUTPUT:

Behavioural interventions appear to improve weight loss at 12 months after bariatric surgery .

MS2_fixed_5_shot1918

***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 evaluated a two-year multidisciplinary early intervention pilot programme for back-injured nurses employed at a large teaching hospital , using a pre- versus post-programme analysis . The purpose was to ascertain whether this programme could reduce the incidence , morbidity , time lost and cost due to back injuries in the 250 nurses employed on ten targeted high-risk wards . Injuries in the remaining 1395 nurses employed on the other 45 wards were monitored concurrently for comparison . The programme consisted of prompt assessment , treatment and rehabilitation through modified work . Evaluative data were gathered by one research nurse on st and ardized forms at the time of injury , weekly until return to work , and at a six-month follow-up . Time lost and cost data for up to one-year post-injury were derived from workers ' compensation statements . Compared to the two years prior to introduction of the programme , the rates of back injuries and lost-time back injuries decreased by 23 % and 43 % , respectively , on the targeted wards , while these increased on the control wards . Combined expenditure was 32 % lower per injury and 34 % lower per lost-time injury for those in the targeted group who consented to take part in the programme compared to their counterparts on the control wards , as the increased assessment and treatment costs per case attributable to the programme were more than offset by the savings in lower compensation ( wage loss ) costs . This programme thus reduced the incidence and time lost due to back injuries and was cost-beneficial Aims : To identify the work factors that predict intense low back pain ( LBP ) and LBP related sick leaves in nurses ’ aides . Methods : The sample comprised 4266 r and omly selected Norwegian nurses ’ aides , not bothered or only a little bothered by LBP during the previous three months , and not on sick leave when completing a mailed question naire in 1999 . Of these , 3808 ( 89.3 % ) completed a second question naire 3 months later and 3651 ( 8 OUTPUT:

Overall studies showed that nursing activities conferred increased risk for , and were associated with back disorders regardless of nursing technique , personal characteristics , and non-work-related factors . Patient h and ling appears to confer the highest risk , but other nursing duties are also associated with elevated risk , and confound dose – response assessment s related to patient h and ling alone . A threshold of nursing activities below which the risk of back disorders is not elevated has not been established .

MS2_fixed_5_shot1919

***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 the present study was to investigate the effects of nabilone on capsaicin‐induced pain and hyperalgesia , as well as on biomarkers of cannabinoid central nervous system ( CNS ) effects . A r and omized , double‐blind , placebo‐controlled , crossover study was conducted in 30 healthy male volunteers receiving single doses of nabilone ( 1 , 2 or 3 mg ) . Pain intensity after intradermal capsaicin injections in the forearm was assessed by continuous visual analogue scale ( 0–100 mm ) . Capsaicin cream was applied to the calf to induce hyperalgesia . Primary hyperalgesia was assessed by measuring heat pain thresholds , whereas secondary hyperalgesia was assessed by measuring the area where light tactile stimulation was felt to be painful . Pain and hyperalgesia were measured at baseline and 2–3.5 h after dosing . The CNS effects were assessed at baseline and up to 24 h after dosing using visual analogue mood scales for feeling ‘ stimulated ’ , ‘ anxious ’ , ‘ se date d ’ and ‘ down ’ . Plasma sample s for pharmacokinetic analysis were obtained up to 24 h after drug administration . Nabilone did not significantly attenuate either ongoing pain or primary or secondary hyperalgesia , whereas dose‐dependent CNS effects were observed from 1.5 to 6 h after dosing , being maximal at 4–6 h. Plasma concentrations of nabilone and its metabolite carbinol were maximal 1–2 h after dosing . Adverse events ( AE ) were common on nabilone treatment . Four subjects withdrew due to pronounced CNS AE ( anxiety , agitation , altered perception , impaired consciousness ) . Although nabilone had marked CNS effects , no analgesic or antihyperalgesic effects were observed Medicinal cannabis has already entered mainstream medicine in some countries . This systematic review ( SR ) aim ed at evaluating the efficacy , acceptability and safety of cannabis-based medicines for chronic pain management . Qualitative systematic OUTPUT:

Conclusions and Relevance Cannabinoid drugs may prevent the onset of pain by producing small increases in pain thresholds but may not reduce the intensity of experimental pain already being experienced ; instead , cannabinoids may make experimental pain feel less unpleasant and more tolerable , suggesting an influence on affective processes . Cannabis-induced improvements in pain-related negative affect may underlie the widely held belief that cannabis relieves pain

MS2_fixed_5_shot1920

***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 make a longitudinal study of antibodies to Klebsiella pneumoniae in patients with ankylosing spondylitis ( AS ) and to assess treatment effects . As a comparison we measured antibodies of 2 other gut associated bacteria , Escherichia coli and Proteus mirabilis . METHODS In a double blind study in 84 Finnish out patients with AS before and after 26 weeks ' treatment with sulfasalazine or placebo we measured serum antibodies to Klebsiella pneumoniae , E. coli and Proteus mirabilis with ELISA : Serum sample s of 100 healthy blood donors served as controls . RESULTS The levels of IgA class antibodies to all 3 bacteria were statistically significantly higher in the sera of the patients compared to the controls . During sulfasalazine treatment significant decreases were observed in concentrations of the IgA class antibodies to Klebsiella and E. coli whereas only a slight decrease was observed in the concentrations of IgA antibodies to Proteus mirabilis . There were no correlations between the clinical and laboratory results observed with sulfasalazine and decrease in concentrations of IgA class antibodies . CONCLUSION Our results agree with the role of gut associated lymphoid tissue in the pathogenesis of AS , but do not totally exclude Klebsiella pneumoniae as a specific agent contributing to the development of AS In recent years sulphasalazine has gained acceptance as an effective agent for the treatment of rheumatoid arthritis . Ankylosing spondylitis is a disease where remission inducing drugs so far have been lacking . In this double blind trial sulphasalazine was compared with placebo in 37 patients with ankylosing spondylitis . Evaluation after three months ' treatment showed reduction of inflammatory activity and improvement of clinical variables . The side effects were mild . The results suggest that sulphasalazine is a potentially effective and safe drug in the treatment of ankylosing spondylitis OBJECTIVE To compare the efficacy of sulfasalazine ( SSZ ) with its two moieties , 5-am OUTPUT:

There is not enough evidence to support any benefit of sulfasalazine in reducing pain , disease activity , radiographic progression , or improving physical function and spinal mobility in the treatment of AS . A statistically significant benefit in reducing the erythrocyte sedimentation rate and easing spinal stiffness was mentioned in the previous version . More withdrawals because of side effects occurred with sulfasalazine .

MS2_fixed_5_shot1921

***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: Low back pain ( LBP ) is the second greatest cause of disability in the USA.1 USA data supports that in spite of an enormous increase in the health re sources spent on LBP disorders , the disability relating to them continues to increase.2 The management of LBP is underpinned by the exponential increase in the use of physical therapies , opiod medications , spinal injections as well as disc replacement and fusion surgery.2 This is maintained by the underlying belief that LBP is fundamentally a patho-anatomical disorder and should be treated within a biomedical model.1 This is in spite of calls over a number of years to adopt a bio-psycho-social approach , and evidence that only 8–15 % of patients with LBP have an identified patho-anatomical diagnosis , result ing in the majority being diagnosed as having non-specific LBP.3 Of this population , a small but significant group becomes chronic and disabled , labelled non-specific chronic low back pain ( NSCLBP ) , consuming a disproportionate amount of healthcare re sources .4 1 . Over the past decade , the traditional biomedical view of LBP has been greatly challenged . This is a result of : the failure of simplistic single-dimensional therapies to show large effects in patients with NSCLBP5–8 ; 2 . the results of clinical trials testing commonly prescribed interventions demonstrating that no management approaches are clearly superior5–7 9 ; 3 . the stories of NSCLBP patients relating their own ongoing pain experiences of multiple failed treatments , conflicting diagnoses , lost hope and ongoing suffering10 ; 4 . the indisputable evidence supporting the multidimensional nature of NSCLBP as a disorder , where disability levels are more closely associated with cognitive and behavioural aspects of pain rather than sensory and biomedical ones11 12 ; 5 . positive outcomes in r and omised controlled trials ( RCTs ) are best predicted by changes in psychological distress , fear avoidance beliefs , self-efficacy in Seated work has been shown to constitute a risk factor for low-back pain . This is attributed to the prolonged and monoton OUTPUT:

The results suggest there is currently no evidence to support the use of dynamic sitting as a st and -alone approach in the management of LBP . Overall , the evidence suggests that dynamic sitting approaches are not effective as a st and -alone management approach for LBP

MS2_fixed_5_shot1922

***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 aims to evaluate the cost-effectiveness of a long-term workplace health promotion programme on physical activity ( PA ) and nutrition . In total , 924 participants enrolled in a 2-year cluster r and omized controlled trial , with departments ( n = 74 ) within companies ( n = 6 ) as the unit of r and omization . The intervention was compared with a st and ard programme consisting of a physical health check with face-to-face advice and personal feedback on a website . The intervention consisted of several additional website functionalities : action-oriented feedback , self-monitoring , possibility to ask questions and monthly e-mail messages . Primary outcomes were meeting the guidelines for PA and fruit and vegetable intake . Secondary outcomes were self-perceived health , obesity , elevated blood pressure , elevated cholesterol level and maximum oxygen uptake . Direct and indirect costs were calculated from a societal perspective , and a process evaluation was performed . Of the 924 participants , 72 % participated in the first and 60 % in the second follow-up . No statistically significant differences were found on primary and secondary outcomes , nor on costs . Average direct costs per participant over the 2-year period were € 376 , and average indirect costs were € 9476 . In conclusion , no additional benefits were found in effects or cost savings . Therefore , the programme in its current form can not be recommended for implementation OBJECTIVES We assessed the effects of a worksite multiple-component intervention addressing diet and physical activity on employees ' mean body mass index ( BMI ) and the percentage of employees who were overweight or obese . METHODS This group-r and omized trial ( n = 3799 ) was conducted at 10 worksites in the northeastern United States . Worksites were paired and allocated into intervention and control conditions . Within- and between-groups changes in mean BMI s and in the percentage of overweight or obese employees were examined in a volunteer sample . RESULTS Within-group mean BMI s decreased by 0.54 kilograms per meter squared ( P = .02 ) and 0.12 kilograms per meter OUTPUT:

Programs that had professionals frequently interact with participants , regardless if the interactions were done daily , weekly , or monthly , led to a change in body composition . Additionally , programs that incorporated a motivation theory and provided content relevant to participants ' needs result ed in a change in body composition . Conclusion Evidence supports that future worksite wellness programs that are design ed using a motivational theory and content that is created relevant to participants ' needs and that has frequent interactions with participants may result in a change in body composition

MS2_fixed_5_shot1923

***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: Few r and omized controlled trials have included panic disorder patients with moderate to severe agoraphobia . Therefore , this population was studied using pharmacotherapy as well as psychotherapy . At the time of the study , imipramine was widely used as a pharmacological treatment . Also , current practice guidelines for patients with panic disorder find selective serotonin reuptake inhibitors and tricyclic antidepressants roughly comparable in terms of efficacy . Therefore , the main objective of this study is to compare four psychosocial treatments — cognitive and grade d in vivo exposure treatments , grade d in vivo exposure , cognitive treatment , and supportive therapy — to evaluate the benefits of combining cognitive therapy with exposure in vivo . These treatments were combined with imipramine or placebo for a total of eight experimental conditions . Participants presented moderate to severe agoraphobia . The method involved a r and omized , double‐blind , placebo‐controlled trial with 137 participants who completed a 14‐session protocol involving the treatments just mentioned . Measures were taken at baseline and posttreatment and at 3‐ , 6‐ , and 12‐month follow‐up . All treatment conditions were statistically and clinical ly effective in reducing self‐reported panic – agoraphobia symptoms over the 1‐year follow‐up . No statistical differences were observed between imipramine and placebo conditions . This study found that all treatment modalities helped reduce panic and agoraphobic symptomatology over a 1‐year follow‐up period . These surprising results support the need to document the relations among the various components of an intervention . This would make it possible to assess the relative efficacy of the treatment components rather than of the intervention as a whole BACKGROUND Traditional pharmacological approaches to treating psychiatric disorders focus on correcting presumed biochemical abnormalities . However , some disorders , particularly the anxiety-related disorders exemplified by specific phobia , have an emotional learning component to them that can be facilitated with psychotherapy . OBJECTIVE To determine whether D-cycloserine ( DCS ) , a partial OUTPUT:

Paroxetine , sertraline , citalopram , escitalopram , and clomipramine showed the most consistent results , while fluvoxamine , fluoxetine , and imipramine showed limited efficacy . Preliminary results suggested the potential efficacy of inositol ; D-cycloserine showed mixed results for its ability to improve the outcome of exposure-based cognitive behavioral therapy . No studies have been specifically oriented toward evaluating the effect of drugs on AG ; in the available studies , the improvement of AG might have been the consequence of the reduction of panic attacks .

MS2_fixed_5_shot1924

***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 Recent clinical trials have shown that modification of plasma lipoprotein concentrations can favorably alter progression of coronary atherosclerosis , but no data exist on the effects of a comprehensive program of risk reduction involving both changes in lifestyle and medications . This study tested the hypothesis that intensive multiple risk factor reduction over 4 years would significantly reduce the rate of progression of atherosclerosis in the coronary arteries of men and women compared with subjects r and omly assigned to the usual care of their physician . METHODS AND RESULTS Three hundred men ( n = 259 ) and women ( n = 41 ) ( mean age , 56 + /- 7.4 years ) with angiographically defined coronary atherosclerosis were r and omly assigned to usual care ( n = 155 ) or multifactor risk reduction ( n = 145 ) . Patients assigned to risk reduction were provided individualized programs involving a low-fat and -cholesterol diet , exercise , weight loss , smoking cessation , and medications to favorably alter lipoprotein profiles . Computer-assisted quantitative coronary arteriography was performed at baseline and after 4 years . The main angiographic outcome was the rate of change in the minimal diameter of diseased segments . All subjects underwent medical and risk factor evaluations at baseline and yearly for 4 years , and reasons for all hospitalizations and deaths were documented . Of the 300 subjects r and omized , 274 ( 91.3 % ) completed a follow-up arteriogram , and 246 ( 82 % ) had comparative measurements of segments with visible disease at baseline and follow-up . Intensive risk reduction result ed in highly significant improvements in various risk factors , including low-density lipoprotein cholesterol and apolipoprotein B ( both , 22 % ) , high-density lipoprotein cholesterol ( + 12 % ) , plasma triglycerides ( -20 % ) , body weight ( -4 % ) , exercise capacity ( + 20 % ) , and intake of dietary fat ( OUTPUT:

NCC demonstrated to have an effect on a small number of outcomes . NCC that incorporated blood pressure monitoring , cholesterol control and smoking cessation has an impact on the improvement of secondary prevention .

MS2_fixed_5_shot1925

***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 — Data regarding the long-term efficacy of atrial fibrillation ( AF ) ablation are still lacking . Methods and Results —Two hundred four consecutive patients symptomatic for paroxysmal or persistent/permanent AF were r and omly assigned to 2 different ablation schemes : pulmonary vein isolation ( PVI ) and PVI plus left linear lesions ( LL ) . Primary end point was to assess the maintenance of sinus rhythm ( SR ) after procedures 1 and 2 in the absence of antiarrhythmic drugs in a long-term follow-up of at least 3 years . Paroxysmal AF — With a single procedure at 12-month follow-up , 46 % of patients treated with PVI maintained SR , whereas at 3-year follow-up , 29 % were in SR ; using the “ PVI plus LL ” at the 12-month follow-up , 57 % of patients were in SR , whereas at the 3-year follow-up , 53 % remained in SR . After a second procedure , the long-term overall success rate without antiarrhythmic drugs was 62 % with PVI and 85 % with PVI plus LL . Persistent/Permanent AF — With a single procedure at the 12-month follow-up , 27 % of patients treated with PVI were in SR , whereas at the 3-year follow-up , 19 % maintained SR ; using the PVI plus LL with a single procedure at the 12-month follow-up 45 % of patients were in SR , whereas at the 3-year follow-up , 41 % remained in SR . After a second procedure , the long-term overall success rate without antiarrhythmic drugs was 39 % with PVI and 75 % with PVI plus LL . Conclusions —A long-term follow-up of AF ablation shows that short-term results can not be considered permanent because AF recurrences are still present after the first year especially in patients who have had “ PVI ” strategy . PVI isolation plus LL is superior to the PVI strategy in maintaining SR without antiarrhythmic drugs after procedures 1 and 2 both in paroxysmal and persistent AF OUTPUT:

In people with non-paroxysmal atrial fibrillation , evidence suggests a superiority of RFCA to antiarrhythmic drugs in achieving freedom from atrial arrhythmias , reducing the need for cardioversion , and reducing cardiac-related hospitalisations .

MS2_fixed_5_shot1926

***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 report evaluates whether a program for older volunteers , design ed for both benerativity and health promotion , leads to short-term improvements inmultiple behavioral risk factors and positive effects on intermediary risk factors for disability and other morbidities . The Experience Corps ® places older volunteers in public elementary schools in roles design ed to meet schools ’ needs and increase the social , physical , and cognitive activity of the volunteers . This article reports on a pilot r and omized trial in Baltimore , Maryl and . The 128 volunteers were 60–86 years old ; 95 % were African American . At follow-up of 4–8 months , physical activity , strength , people one could turn to for help , and cognitive activity increased significantly , and walking speed decreased significantly less , in participants compared to controls . In this pilot trial , physical , cognitive , and social activity increased , suggesting the potential for the Experience Corps to improve health for an aging population and simultaneously improve educational outcomes for children Family caregivers , the “ second victims ” or hidden patients in dementia care , are at risk for social isolation , stress , depression , and mortality . Telephone-based support ( telesupport groups ) represents a practical , low-burden , low-cost source of emotional support . The present study evaluated the feasibility and effectiveness of professionally led telephone-based support groups for female family caregivers of community-dwelling dementia patients . Recruited through various community sources , 103 female caregivers were r and omized to the telesupport group treatment or a control condition . Effects on caregiver burden , depression , and personal gains were evaluated at 6 months , the main end point . Older care-givers ( ≥65 ) in telesupport reported lower depression than control group caregivers did AIM This paper is a report of a study to explore the effects of psychosocial group nursing intervention on older people 's feelings of loneliness , social activity and psychological well-being . BACKGROUND Older people 's loneliness is associated with low quality of life , and impaired health , increased use of health and social services and increased mortality . Previous intervention studies have achieved quite modest results . M OUTPUT:

According to sufficiently reported outcomes , social capital interventions showed mixed effects on quality of life , well-being and self-perceived health and were generally ineffective on loneliness , mood and mortality . Conclusions Our review highlights the lack of evidence and the diversity among trials , while supporting the potential of social capital interventions to reach comprehensive health effects in older adults

MS2_fixed_5_shot1927

***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 efficacy of a loading dose of α1-adrenoreceptor antagonist for patients with benign prostate hyperplasia who did not improve at a low dose has not been determined . We performed a prospect i ve study to estimate the efficacy of incremental naftopidil administration . Methods The efficacy of naftopidil was examined based on changes in the International Prostate Symptom Score ( IPSS ) . We defined a “ responder ” as a patient who improved by ≥5 points in IPSS total score . All patients were administered naftopidil at 50 mg/day for 12 weeks , and nonresponders at 50 mg/day were increased to 75 mg/day . Efficacy was finally evaluated after an additional 12 weeks of administration at 75 mg/day . Results Among 122 patients whose data could be analyzed , the efficacy rate after administration at 50 mg/day was 52.5 % . In all IPSS items except urgency score , the responders had significantly higher ( poorer ) values than nonresponders before the start of treatment . Of 40 patients whose dose was increased to 75 mg/day and whose data could be analyzed , prostate volume in the responder group ( 9 patients ) was significantly smaller than that in the nonresponder group ( 31 patients ) . Multivariate analysis showed that patients with improved IPSS total score , voiding symptoms , urgency , and weak stream after administration of 50 mg/day naftopidil were more likely to improve after a dose increase . Conclusions A dose increment of naftopidil to 75 mg/day may be useful in patients with BPH who did not improve at 50 mg/day OBJECTIVES To examine the effect of alpha 1D/A adrenoceptor inhibitor naftopidil on health-related quality of life ( QOL ) in men with benign prostatic hyperplasia ( BPH ) . METHODS A total of 56 newly diagnosed patients with symptomatic BPH were prospect ively enrolled and treated with 50 mg naftopidil daily for more than 12 weeks OUTPUT:

Although additional well design ed , worldwide , placebo-controlled and r and omized studies are necessary to confirm the long-term outcomes of naftopidil pharmacotherapy , current data suggest that naftopidil administration in BPH patients provides comparable improvements in total IPSS , QoL , and urinary symptoms from baseline relative to 0.2 mg/d tamsulosin and 8 mg/d silodosin . However , improvements in Qmax are generally less with naftopidil than with tamsulosin . Reported adverse effects related to naftopidil administration are negligible and usually mild .

MS2_fixed_5_shot1928

***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: Spontaneous pneumothorax ( SP ) is a disabling condition mostly affecting young , thin and otherwise healthy males . It is usually caused by ruptured pleural blebs . The first treatment is the insertion of a chest tube ( ICT ) but in a great number of patients there is recurrence of the disease . We believe that the video assisted thoracoscopy ( VATS ) is the best treatment possible because it allows us to treat the ruptured bleb radically avoiding any recurrence . In order to prove it , 40 patients admitted in a five-year period , with a SP , were r and omly assigned to be treated by ICT or VATS . The ICT patients were in the hospital a mean time of 7.5 ( 4 to 15 ) days and the VATS patients , 5.3 ( 2 to 7 ) days ( P < .05 ) . ICT patients required analgesic drugs during 76.8 + /- 31 hours and VATS patients 38.4 + /- 13 hours ( p < .05 ) . From the ICT group , 8 ( 53 % ) patients had recurrence of the disease and 6 ( 40 % ) had a prolonged air leak , while none of the patients of the VATS group had any complication ( < .001 ) . Cost of ICT and VATS were $ 850 and $ 1730 , respectively . According to these results , VATS should be the treatment of choice in SP patients . It treats the cause of the disease . It also reduces the hospitalization time , the use of analgesic drugs post surgery , decreases recurrence of the disease and the cost of the treatment . Moreover , the patients were back to work in less than 10 days BACKGROUND The recent recognition that coronary-artery stenting has improved the short- and long-term outcomes of patients treated with angioplasty has made it necessary to reevaluate the relative benefits of bypass surgery and percutaneous interventions in patients with multivessel disease . METHODS A total of 1205 patients were r and omly assigned to undergo stent implantation or bypass surg OUTPUT:

While we found relatively good st and ards of reporting the study ’s question , population , interventions , comparators and conclusions , the overall reporting was poor , and evidence of unfamiliarity with international guidelines was evident ( i.e. absence of incremental analysis , of discounting long-term costs and effects ) . Analysis or description of place-to-place variability was infrequent .

MS2_fixed_5_shot1929

***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: Improvement in type 2 diabetes after Roux-en-Y gastric bypass ( RYGB ) has been attributed partly to weight loss , but mechanisms beyond weight loss remain unclear . We performed an ancillary study to the Diabetes Surgery Study to assess changes in incretins , insulin sensitivity , and secretion 1 year after r and omization to lifestyle modification and intensive medical management ( LS/IMM ) alone ( n = 34 ) or in conjunction with RYGB ( n = 34 ) . The RYGB group lost more weight and had greater improvement in HbA1c . Fasting glucose was lower after RYGB than after LS/IMM , although the glucose area under the curve decreased comparably for both groups . Insulin sensitivity increased in both groups . Insulin secretion was unchanged after LS/IMM but decreased after RYGB , except for a rapid increase during the first 30 min after meal ingestion . Glucagon-like peptide 1 ( GLP-1 ) was substantially increased after RYGB , while gastric inhibitory polypeptide and glucagon decreased . Lower HbA1c was most strongly correlated with the percentage of weight loss for both groups . At baseline , a greater C-peptide index and 90-min postpr and ial C-peptide level were predictive of lower HbA1c at 1 year after RYGB . β-Cell glucose sensitivity , which improved only after RYGB , and improved disposition index were associated with lower HbA1c in both groups , independent of weight loss . Weight loss and preserved β-cell function both predominantly determine the greatest glycemic benefit after RYGB Objective : To compare bariatric surgery versus intensive medical weight management ( MWM ) in patients with type 2 diabetes mellitus ( T2DM ) who do not meet current National Institutes of Health criteria for bariatric surgery and to assess whether the soluble form of receptor for advanced glycation end products ( sRAGE ) is a biomarker to identify patients most likely to benefit from surgery . Background : OUTPUT:

Furthermore , except for certain cardiovascular indicators , bariatric surgery was superior to conventional arms in terms of metabolic secondary parameters ( P < 0.05 ) . Bariatric surgery is a better therapeutic option for weight loss , irrespective of follow-up duration , surgical techniques and obesity levels

MS2_fixed_5_shot1930

***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 repeated- measures design was applied . Objectives . To examine the measurement properties of the Back Pain Functional Scale ( BPFS ) and the Rol and –Morris Question naire ( RMQ ) and to formulate hypotheses and sample size estimates for a subsequent comparison study . Summary of Background Data . Although there are numerous functional status measures for patients with low back pain , most have been conceived of and vali date d with a group rather than an individual patient as the unit of interest . Also , little has been done to formally compare — this includes the generation of a priori hypotheses , followed by statistical hypotheses testing — the many competing measures . Methods . Subjects were 77 patients with low back pain who were referred by physicians to 10 outpatient physical therapy clinics located in Canada and the United States . The question naires were administered at patients ’ initial visits , within 48 hours of the initial visit , and at 1- , 2- , and 3-week follow-up visits . Reliability , cross-sectional validity , and longitudinal validity ( sensitivity to change ) coefficients were calculated . Results . Test – retest reliability estimates of 0.81 and 0.88 were obtained for the RMQ and BPFS , respectively . The measures demonstrated similar levels of cross-sectional validity . Correlations of 0.56 and 0.65 were noted between a prognostic rating of change and the RMQ and BPFS , respectively . The RMQ demonstrated a ceiling effect . Approximately 180 patients are needed for a subsequent head-to-head comparison study of the measures . Conclusions . The BPFS appears to have sound measurement properties , and a formal head-to-head comparison study with the RMQ is warranted Study Design . Prospect i ve study of two sample s of patients with acute and chronic low back pain , respectively . Objectives . To compare the responsiveness of four functional status question naires , Rol and Morris Disability Question naire ( RMDQ ) , Oswestry Disability Index ( ODI ) , Disability Rating Index ( DRI ) , and Physical Functioning scale of the SF-36 ( PFSF-36 ) OUTPUT:

Most of the outcome question naires had a mixed content reflecting various constructs such as pain and symptoms , sleep disturbances , psychological dysfunctions , physical impairments , and social functions .

MS2_fixed_5_shot1931

***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: Prognosis studies are investigations of future events or the evaluation of associations between risk factors and health outcomes in population s of patients ( 1 ) . The results of such studies improve our underst and ing of the clinical course of a disease and assist clinicians in making informed decisions about how best to manage patients . Prognostic research also informs the design of intervention studies by helping define subgroups of patients who may benefit from a new treatment and by providing necessary information about the natural history of a disorder ( 2 ) . There has recently been a rapid increase in the use of systematic review methods to synthesize the evidence on research questions related to prognosis . It is essential that investigators conducting systematic review s thoroughly appraise the method ologic quality of included studies to be confident that a study 's design , conduct , analysis , and interpretation have adequately reduced the opportunity for bias ( 3 , 4 ) . Caution is warranted , however , because inclusion of method ologically weak studies can threaten the internal validity of a systematic review ( 4 ) . This follows abundant empirical evidence that inadequate attention to biases can cause invalid results and inferences ( 5 - 9 ) . However , there is limited consensus on how to appraise the quality of prognosis studies ( 1 ) . A useful framework to assess bias in such studies follows the basic principles of epidemiologic research ( 10 , 11 ) . We focus on 6 areas of potential bias : study participation , study attrition , prognostic factor measurement , confounding measurement and account , outcome measurement , and analysis . The main objectives of our review of review s are to describe methods used to assess the quality of prognosis studies and to describe how well current practice s assess potential biases . Our secondary objective is to develop recommendations to guide future quality appraisal , both within single studies of prognostic factors and within systematic review s of the evidence . We hope this work facilitates future discussion and research on biases in prognosis studies and systematic review s. Methods Literature Search and Study Selection We identified systematic review s of prognosis studies by search ing MEDLINE ( 1966 to October 2005 ) using the search strategy recommended by McKibbon and colleagues ( 12 ) . This strategy OUTPUT:

Conclusion Most interventions did not report key outcomes .

MS2_fixed_5_shot1932

***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 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 group ( TG ) training 4 × 4 min intervals at 80 % of maximal work rate three times per week for 8 weeks or a control group . The TG significantly increased plantar flexion peak oxygen uptake and power output by 23.5 and 43.9 % , respectively . Treadmill peak oxygen uptake ( VO2peak ) significantly increased 12.3 % in the TG and was associated with a significant increased time to exhaustion of 20.0 % when treadmill walking . Eleven of 14 patients no longer reported leg pain limitations at VO2peak . No differences in cardiac output measured at VO2peak , or walking economy were observed . Plantar flexion training was effective in increasing VO2peak and walking performance , and may be a useful strategy in treatment of PAD 1 . The activities of phosphofructokinase ( PFK ) , citrate synthetase ( CS ) , lactate dehydrogenase ( LDH ) , 3-hydroxyacyl-CoA dehydrogenase ( ACDH ) and cytochrome-c oxidase(Cyt-ox ) in the calf muscle tissue were compared in subjects with intermittent claudication ( n = 38 ) and controls ( n = 20 ) . The activities of CS , ACDH and Cyt-ox were increased and the activity of Cytox was positively correlated to the maximal walking distance ( MWD ) in the patients . 2 . Thirty-three patients with intermittent claudication were r and omized to three treatment groups : ( 1 ) operative surgery , ( 2 ) operative surgery supplemented with physical training and ( 3 ) physical training alone . Before and after 6 - 12 months of treatment , symptom-free walking distance ( SFWD ) , MWD , ankle-brachial blood pressure quotient ( ankle OUTPUT:

Conclusion Although data are limited , there is a strong significant relationship between plantar flexor muscle strength and treadmill walking ability .

MS2_fixed_5_shot1933

***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 heterogeneity statistic I2 , interpreted as the percentage of variability due to heterogeneity between studies rather than sampling error , depends on precision , that is , the size of the studies included . Methods Based on a real meta- analysis , we simulate artificially ' inflating ' the sample size under the r and om effects model . For a given inflation factor M = 1 , 2 , 3 , ... and for each trial i , we create a M-inflated trial by drawing a treatment effect estimate from the r and om effects model , using si2MathType@MTEF@5@5@+=feaagaart1ev2aaatCvAUfKttLearuWrP9MDH5MBPbIqV92AaeXatLxBI9gBaebbnrfifHhDYfgasaacPC6xNi = xH8viVGI8Gi = hEeeu0xXdbba9frFj0xb9qqpG0dXdb9aspeI8k8fiI+fsY = rqGqVepae9pg0db9vqaiVgFr0xfr = xfr = xc9adbaqaaeGaciGaaiaabeqaaeqabiWaaaGcbaGaem4Cam3aa0baaSqaaiabdMgaPbqaaiabikdaYaaaaaa@2FBE@/M as within-trial sampling variance . Results As precision increases , while estimates of the heterogeneity variance τ2 remain unchanged on average , estimates of I2 increase rapidly to nearly 100 % . A similar phenomenon is apparent in a sample of 157 meta-analyses . Conclusion When deciding whether or not to pool treatment estimates in a meta- analysis , the yard-stick should be the clinical relevance of any heterogeneity present . τ2 , rather than I2 , is the appropriate measure for this purpose OBJECTIVE It is unknown if aerobic exercise overloads or improves the cardiovascular system among workers with high occupational physical activity . This was investigated in a worksite r and omized controlled trial ( RCT ) of aerobic exercise among cleaners . METHODS We r and omized OUTPUT:

Conclusions Workplace-based physical activity interventions consisting of at least moderate-intensity activity improve cardiorespiratory fitness . At the present time , we surmise that no single group of employees ( e.g. older employees or less fit individuals ) can be definitively identified as st and ing to benefit more from workplace physical activity interventions than others . This demonstrates the potential utility of workplace physical activity interventions for improving cardiorespiratory fitness in a broad range of healthy employees .

MS2_fixed_5_shot1934

***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: An unexplained loss of muscle strength occurs with aging . Vitamin D deficiency can cause myopathy and administration of 1,25-dihydroxyvitamin D3 [ 1,25-(OH2)D3 ] to persons with low serum concentrations can improve strength . To test the hypothesis that the weakness associated with aging is in part due to inadequate serum concentrations of [ 1,25-(OH2)D3 ] , we conducted a r and omized , controlled , double blinded trial in 98 men and women volunteers over 69 yr old . Treatment consisted of 0.25 micrograms 1,25-(OH)2D3 , orally , twice per day or identical placebo for 6 months . Leg muscle strength of the quadriceps was measured with an isokinetic dynamometer . There was no difference between the two groups at 1 week , 1 month , or 6 months of treatment in any of the measures of muscle strength . We conclude that oral administration of 0.5 micrograms 1,25-(OH)2D3/day does not improve muscle strength in older persons . Further research is needed to determine the etiology of the decline in muscle strength associated with aging The Cohort Consortium Vitamin D Pooling Project of Rarer Cancers ( VDPP ) brought together 10 cohorts to conduct a prospect i ve study of the association between vitamin D status , measured as serum concentrations of 25-hydroxyvitamin D ( 25(OH)D ) , and the development of 7 rarer cancer sites : endometrial , esophageal , gastric , kidney , non-Hodgkin lymphoma , ovarian , and pancreatic cancers . The cohorts come from 3 continents , with participants from a wide range of latitude who are racially diverse . Across each cancer site , there was no evidence of a protective association between higher concentrations of 25-hydroxyvitamin D ( > 75 nmol/L ) and cancer outcome . An increased risk at very high levels ( ≥100 nmol/L ) was OUTPUT:

There is currently no firm evidence that vitamin D supplementation decreases or increases cancer occurrence in predominantly elderly community-dwelling women . Vitamin D₃ supplementation decreased cancer mortality and vitamin D supplementation decreased all-cause mortality , but these estimates are at risk of type I errors due to the fact that too few participants were examined , and to risks of attrition bias originating from substantial dropout of participants . Combined vitamin D₃ and calcium supplements increased nephrolithiasis , whereas it remains unclear from the included trials whether vitamin D₃ , calcium , or both were responsible for this effect .

MS2_fixed_5_shot1935

***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 Perioperative oral carbohydrate intake is beneficial to general surgery patients . Total hip arthroplasty is a common surgical procedure , and even a moderate improvement in patient outcome could have a significant effect on the re sources needed for these patients . However , few studies have focused on the effects of carbohydrate intake on orthopaedic patients . Objective The purpose of this study was to investigate if perioperative oral carbohydrate intake alters the postoperative course for patients undergoing total hip arthroplasty . The primary hypothesis was that pain scores would be lower in patients treated with carbohydrate . Design A r and omised , double-blind , controlled trial . Setting This study was carried out between September 2009 and April 2011 at a district Swedish hospital that specialises in orthopaedic surgery . Patients Sixty ASA physical status I – III patients scheduled for elective total hip arthroplasty were included . Exclusion criteria were obesity , diabetes , prior hip surgery to the same hip , ongoing infection , immunological deficiency or age less than 50 or more than 80 years . Interventions Patients were given 400 ml of either an oral 12.5 % carbohydrate solution or a placebo beverage ( flavoured water ) 1.5 h before and 2 h after surgery . Main outcome measures Visual analogue scales were used to score six discomfort parameters . Results Immediately prior to surgery , the carbohydrate-treated patients were less hungry ( median score 9.5 vs. 22 mm ) and experienced less nausea ( 0 vs. 1.5 mm ) ( P < 0.05 ) . Postoperatively , patients in the carbohydrate group experienced less pain at 12 , 16 and 20 h ( median scores 20 , 30 and 34 vs. 7 , 5 and 0 mm ; P < 0.05 ) . Conclusion This study shows that there is limited benefit from administering oral carbohydatre prior to total hip arthroplasty Postoperative insulin resistance OUTPUT:

Intake of a carbohydrate-containing fluid is reported to improve insulin-like growth factor levels , reduce hunger , nausea , and length of stay , and attenuate the decrease in whole-body insulin sensitivity and endogenous glucose release . Amino acid supplementation is reported to reduce muscle atrophy and accelerate return of functional mobility . There is limited evidence for nutritional supplementation in THR and TKR pathways ; however , the low risk profile and potential benefits to adjunctive treatment methods , such as exercise programs , suggest nutritional supplements may have a role . Optimizing nutritional status pre-operatively may help manage the surgical stress response , with a particular benefit for undernourished , frail , or elderly individuals

MS2_fixed_5_shot1936

***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 examine the effect of an equivalent weight loss , by gastric bypass surgery ( GBP ) or by diet , on peptide YY3–36 ( PYY3–36 ) , ghrelin , and leptin levels and to determine the effect of diabetes status on PYY3–36 levels . Summary Background Data : The increased PYY3–36 levels after GBP may be involved in the magnitude and the sustainability of weight loss after surgery . Methods : Of the 30 morbidly obese women who participated in the study , 21 had type 2 diabetes mellitus , and were studied before and after equivalent weight loss of 10 kg by either GBP ( n = 11 ) or by diet ( n = 10 ) . Results : PYY3–36 levels were higher in obese diabetic as compared with nondiabetic individuals ( 64.1 ± 34.4 pg/mL vs. 39.9 ± 21.1 pg/mL ; P < 0.05 ) . PYY3–36 levels increased markedly in response to oral glucose after GBP ( peak : 72.3 ± 20.5 pg/mL–132.7 ± 49.7 pg/mL ; P < 0.001 ; AUC0–180 : 51.5 ± 23.3 pg/mL.min−1–91.1 ± 32.2 pg/mL.min−1 P < 0.001 ) , but not after diet ( peak : 85.5 ± 51.9 pg/mL–84.8 ± 41.13 pg/mL ; P = NS ; AUC0–180 : 68.3 ± 38.5 pg/mL.min−1–61.1 ± 42.2 pg/mL.min−1 P = NS ) . Fasting ghrelin levels increased after diet ( 425 ± 91 pg/mL–519 ± 1 OUTPUT:

Meta-regression showed that gastric pouch volume , alimentary limb length and biliopancreatic limb length were not associated with changes in ghrelin levels . Conclusion Fasting total ghrelin levels decreased in the short term ( ≤ 3 months ) and increased in the long term ( > 3 months ) after RYGB

MS2_fixed_5_shot1937

***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 Flexible sigmoidoscopy ( FS ) has been recommended as a screening method to reduce mortality from colorectal cancer ( CRC ) . The present study evaluates the effect of adding FS to the fecal occult blood test Hemoccult-II ( H-II ) on diagnostic yield of colorectal neoplasia . METHODS A total of 10,978 normal persons aged 50 - 75 years were invited to participate , 5495 persons being allocated at r and om to H-II and FS and 5483 to H-II alone . RESULTS In spite of a lower compliance ( 40 % versus 56 % ) for the combined procedure , the diagnostic yield of colorectal neoplasia was higher than for H-II alone ( 12 CRC versus 4 CRC , and 72 large adenomas versus 14 ) . Within 24 - 62 months after screening there were fewer CRCs detected after H-II + FS than after H-II alone . The stage distribution was less favorable than in screen-detected cases . CONCLUSION One FS may not be an optimal way of screening , but FS deserves to be evaluated in r and omized population studies including repeated H-II tests in the control arm Osteoarthritis is a common , chronic , progressive , skeletal , degenerative disorder , which commonly affects the knee joint . Boswellia serrata tree is commonly found in India . The therapeutic value of its gum ( guggulu ) has been known . It posses good anti-inflammatory , anti-arthritic and analgesic activity . A r and omized double blind placebo controlled crossover study was conducted to assess the efficacy , safety and tolerability of Boswellia serrata Extract ( BSE ) in 30 patients of osteoarthritis of knee , 15 each receiving active drug or placebo for eight weeks . After the first intervention , washout was given and then the groups were crossed over to receive the opposite intervention for eight weeks . All patients receiving drug treatment reported decrease in knee pain OUTPUT:

The evidence for the effectiveness of B serrata extracts is encouraging but not compelling

MS2_fixed_5_shot1938

***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 Preterm infants are immunologically immature at birth . Previous studies have demonstrated that human milk protects against infection in full-term infants , but there are few studies of its effect for preterm infants . OBJECTIVE To examine the effect of human milk feedings on infection incidence among very low birth weight ( VLBW ) infants during their initial hospitalization . STUDY DESIGN The sample consisted of 212 consecutive VLBW infants admitted to the Georgetown University Medical Center neonatal intensive care unit ( NICU ) during 1992 - 1993 and surviving to receive enteral feeding . Type of feeding ( human milk vs formula ) , presence of infection and sepsis/meningitis ( clinical signs and positive cultures for pathogenic organisms ) , and potential confounding variables were abstract ed from medical records . Multiple logistic regression was used to control for confounders . RESULTS The incidence of infection ( human milk [ 29.3 % ] vs formula [ 47.2 % ] ) and sepsis/meningitis ( human milk [ 19.5 % ] vs formula [ 32.6 % ] ) differed significantly by type of feeding . Major risk factors for infection were similar in both groups . Human milk feeding was independently correlated with a reduced odds of infection ( odds ratio [ OR ] = 0.43 ; 95 % confidence interval [ CI ] : 0.23 - 0.81 ) , controlling for gestational age , 5-minute Apgar score , mechanical ventilation days , and days without enteral feedings ; and was independently correlated with a reduced odds of sepsis/meningitis ( OR = 0.47 , 95 % CI:0.23 - 0 . 95 ) , controlling for gestational age , mechanical ventilation days , and days without enteral feedings . CONCLUSIONS The incidence of any infection and sepsis/meningitis are significantly reduced in human milk-fed VLBW infants compared with exclusively formula-fed VLBW infants BACKGROUND . We previously reported beneficial OUTPUT:

HM provided a clear protective effect against NEC , with an approximate 4 % reduction in incidence . HM also provided a possible reduction in LOS , severe ROP and severe NEC . Particularly for NEC , any volume of HM is better than EPTF , and the higher the dose the greater the protection . Evidence regarding pasteurisation is inconclusive , but it appears to have no effect on some outcomes . Improving the intake of mother ’s own milk ( MOM ) and /or donor HM results in small improvements in morbidity in this population

MS2_fixed_5_shot1939

***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: Some studies focused on the effect of the dietary glycemic index on lipoproteins and apolipoproteins in adults ; however , little evidence exists among adolescents regarding the effect of a low glycemic index ( LGI ) diet on apolipoproteins and lipoprotein ( a ) ( Lpa ) . This study was conducted to evaluate the effect of an LGI diet on the lipid profile , apolipoproteins and Lpa among overweight and obese adolescent girls . For this parallel design ed r and omized clinical trial , 50 healthy overweight/obese girls at pubertal ages were r and omly allocated to an LGI or a healthy nutritional recommendations ( HNR ) based diet . Equal macronutrient distributed diets were prescribed to both groups . Biochemical measurements included lipid profile , apolipoprotein A , apolipoprotein B and Lpa were conducted before and after 10 weeks of intervention . Forty one adolescent girls completed the study . The dietary glycemic index in the LGI group was 42.67 ± 0.067 . There were no differences in the mean of blood lipid indices baseline and after intervention between two groups . There were no significant differences between the two groups regarding lipid profiles , apolipoproteins and Lpa . There were no significant differences in lipid profiles , apolipoproteins and Lpa between the LGI diet and the HNR-based diet and the impact of these two diets on lipid profile was equal in this trial . Trial registry code : I RCT 201109272839N4 The determine the effect of different foods on the blood glucose , 62 commonly eaten foods and sugars were fed individually to groups of 5 to 10 healthy fasting volunteers . Blood glucose levels were measured over 2 h , and expressed as a percentage of the area under the glucose response curve when the same amount of carbohydrate was taken as glucose . The largest rises were seen with vegetables ( 70 + /- 5 % ) , followed OUTPUT:

Other parameters under investigation were not affected by either low or high glycaemic indices . The present systematic review and meta- analysis provides evidence of a beneficial effect of a low glycaemic index/load diet in children and adolescents being either overweight or obese .

MS2_fixed_5_shot1940

***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 : To evaluate the effects of zinc with or without other antioxidants on blood glucose , lipid profile , and serum creatinine in adult diabetics on long-term follow-up . Material s and methods : Patients ( n = 96 ) were r and omly allocated to three groups : group A ( n = 29 ) was supplemented with oral zinc sulfate ( 22 mg/day ) and multivitamin/mineral ( zinc+MVM ) preparation ; group B ( n = 31 ) was given the same preparation without zinc ( MVM ) ; and group C ( n = 36 ) was given a matching placebo for a period of 4 months in a single-blinded study . Blood sample s were taken at baseline and after 4 months of supplementation to assess blood glucose ( fasting and postpr and ial ) and glycosylated hemoglobin ( HbA1C% ) and serum levels of zinc , creatinine , and lipids . Results : The zinc+MVM group had a mean change of fasting blood sugar −0.33 mmol/L ( st and ard error of the mean 0.21 mmol/L ) and was significant ( P = 0.05 ) when compared with the other two groups ( mean change in the MVM group + 0.19 ( 0.31 ) mmol/L and + 0.43 ( 0.23 ) mmol/L in the control group , respectively ) . The HbA1C% level reduced significantly , irrespective of the baseline level , in zinc+MVM-supplemented individuals . In the other two groups , the change of HbA1C% level was not significant . Serum lipid levels reduced significantly in the zinc+MVM and MVM groups . Conclusions : Zinc+MVM supplementation showed beneficial effects in the metabolic control of adult diabetics in addition to elevating their serum zinc level . Zinc supplementation improved glycemic control measured by HbA1C% and fasting and postpr and ial glucose . Furthermore , zinc supplementation lowered OUTPUT:

In conclusion , Zinc supplementation has favourable effects on plasma lipid parameters . Zinc supplementation significantly reduced total cholesterol , LDL cholesterol and triglycerides . Therefore it may have the potential to reduce the incidence of atherosclerosis related morbidity and mortality

MS2_fixed_5_shot1941

***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 efficacy and safety of lixisenatide versus placebo on glycemic control in older patients with type 2 diabetes uncontrolled on their current antidiabetic treatment . RESEARCH DESIGN AND METHODS In this phase III , double-blind , r and omized , placebo-controlled , two-arm , parallel-group , multicenter trial , patients aged ≥70 years were r and omized to receive once-daily lixisenatide 20 μg or placebo before breakfast concomitantly with their existing antidiabetic therapy ( including insulin ) for 24 weeks . Patients at risk for malnutrition or with moderate to severe cognitive impairment were excluded . The primary end point was absolute change in HbA1c from baseline to week 24 . Secondary end points included change from baseline to week 24 in 2-h postpr and ial plasma glucose ( PPG ) and body weight . RESULTS A total of 350 patients were r and omized . HbA1c decreased substantially with lixisenatide ( −0.57 % [ 6.2 mmol/mol ] ) compared with placebo ( + 0.06 % [ 0.7 mmol/mol ] ) from baseline to week 24 ( P < 0.0001 ) . Mean reduction in 2-h PPG was significantly greater with lixisenatide ( −5.12 mmol/L ) than with placebo ( −0.07 mmol/L ; P < 0.0001 ) . A greater decrease in body weight was observed with lixisenatide ( −1.47 kg ) versus placebo ( −0.16 kg ; P < 0.0001 ) . The safety profile of lixisenatide in this older population , including rates of nausea and vomiting , was consistent with that observed in other lixisenatide studies . Hypoglycemia was reported in 17.6 % of patients with lixisenatide versus 10.3 % with placebo . CONCLUSIONS In nonfrail older patients OUTPUT:

Telemedicine interventions can improve communication and connection between older patients and their providers , and improve glycemic control . Summary A systematic review confirmed the efficacy and safety of metformin as first-line therapy of type 2 diabetes in the older adult , but multiple reports highlighted the risk for vitamin B12 deficiency . R and omized controlled trials showed the efficacy and safety of antihyperglycemic agents in the elderly , including some with longer duration and lesser risk for hypoglycemia . R and omized clinical trials showed cardiovascular protection with SGLT-2i ( empagliflozin , canagliflozin ) and GLP-1RA ( liraglutide , semaglutide ) .

MS2_fixed_5_shot1942

***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 This study investigated whether fitness changes result ing from lifestyle interventions for weight loss may independently contribute to the improvement of low adiponectin levels in obese individuals with diabetes . RESEARCH DESIGN AND METHODS Look AHEAD ( Action for Health in Diabetes ) r and omized overweight/obese individuals with type 2 diabetes to intensive lifestyle intervention ( ILI ) for weight loss or to diabetes support and education ( DSE ) . Total and high – molecular weight adiponectin ( adiponectins ) , weight , and cardiorespiratory fitness ( submaximal exercise stress test ) were measured in 1,397 participants at baseline and at 1 year , when ILI was most intense . Regression analyses examined the associations of 1-year weight and fitness changes with change in adiponectins . RESULTS ILI result ed in greater improvements in weight , fitness , and adiponectins at 1 year compared with DSE ( P < 0.0001 ) . Weight loss and improved fitness were each associated with changes in adiponectins in men and women ( P < 0.001 for all ) , after adjusting for baseline adiponectins , demographics , clinical variables , and treatment arm . Weight loss contributed an additional 4–5 % to the variance of change in adiponectins than did increased fitness in men ; in women , the contributions of improved fitness ( 1 % greater ) and of weight loss were similar . When weight and fitness changes were both accounted for , weight loss in men and increased fitness in women retained their strong associations ( P < 0.0001 ) with adiponectin change . CONCLUSIONS Improvements in fitness and weight with ILI were favorably but distinctly associated with changes in adiponectin levels in overweight/obese men and women with diabetes . Future studies need to investigate whether sex-specific biological determinants contribute to the observed associations Recent guidelines on exercise for weight loss and weight maintenance include resistance training as part of the exercise prescription . Yet few studies have compared the effects of similar amounts of aerobic and OUTPUT:

As for physical exercise modalities , aerobic exercise , but not other modalities , increased adiponectin and reduced leptin levels . In conclusion , physical exercise and , specifically , aerobic exercise , leads to higher adiponectin and lower leptin levels in prediabetic and diabetic adults .

MS2_fixed_5_shot1943

***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 Background . The lowering of cholesterol concentrations in individuals at high risk for cardiovascular disease improves clinical outcome . Xuezhikang has a marked impact on lipids . Methods . In this r and omized , double-blinded , placebo-controlled , parallel-group clinical trial , a total of 2704 hypertensive patients with previous myocardial infa rct ion ( MI ) were assigned either to placebo ( n = 1341 ) or to Xuezhikang ( 0.6 g twice daily , n = 1363 ) for an average of 4.5 years . The primary end-point was recurrent coronary events ; the secondary end-point was all-cause mortality and other clinical events , including adverse effects . Results . There were no differences between the Xuezhikang and placebo group in base-line characteristics . However , Xuezhikang treatment reduced the incidence of coronary events by 43.0 % ( P = 0.02 ) , deaths from coronary heart disease ( CHD ) by 30.0 % ( P < 0.01 ) , and all-cause mortality by 35.8 % ( P = 0.001 ) . Conclusions . This study , for the first time , demonstrated that long-term Xuezhikang therapy result ed in significant reduction in cardiovascular events and death in Chinese hypertensive patients with previous MI in a safe manner Lipid-lowering therapy in individuals with high risk of cardiovascular disease reduces the incidence of coronary heart disease . However , few studies have assessed the benefits of cholesterol lowering for primary prevention of coronary heart disease in hypertensive patients with mild dyslipidemia or without conventional dyslipidemia . The large , r and omized Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese Study showed a 33 % reduction in coronary heart disease incidence with pravastatin as the primary prevention in Japanese patients . We conducted an exploratory analysis of the effect of diet plus pravastatin therapy on the primary prevention of cardiovascular events ( coronary OUTPUT:

“ RYR plus conventional therapy ” exhibited significant lowering effects on serum total cholesterol ( TC ) , low-density lipoprotein cholesterol ( LDL-C ) , and CRP but exhibited no significant effect on systolic BP , diastolic BP , triglycerides ( TG ) , and high-density lipoprotein cholesterol ( HDL-C ) compared with “ placebo plus conventional therapy . ” “ RYR plus conventional therapy ” showed significant lowering effects on systolic BP , TC , LDL-C , and CRP but no effect on diastolic BP , TG , and HDL-C compared with “ placebo plus conventional therapy . ” No significant difference in BP and lipid profile between “ RYR plus conventional therapy ” and “ statins plus conventional therapy ” was observed . “ RYR plus statins ” appeared to be more effective in lowering BP , TC , TG , and LDL-C but without a significant difference in HDL-C compared to statins . No serious adverse events were reported . The results of this meta- analysis suggested some supportive but limited evidence regarding RYR for hypertension .

MS2_fixed_5_shot1944

***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 impact of risk management activities on patient risk of glucocorticoid-induced osteoporosis . METHODS Ninety-six adult patients taking chronic glucocorticoid therapy in 15 community pharmacies . Patients in the control group received usual and customary care . Patients in the treatment pharmacies received education and an educational pamphlet about the risks of glucocorticoid-induced osteoporosis . In addition , the treatment group pharmacists monitored the patients ' drug therapy , to identify and address drug-related problems . Data including the glucocorticoid taken by the patient , medications , and osteoporosis risk factors were collected at baseline and after 9 months of monitoring , via Web-based survey completed in the pharmacy . Using an intent to treat approach , the pre-post frequency changes were compared with contrasts for presence of bisphosphonate therapy , presence of estrogen therapy , presence of calcium supplement , discussion of glucocorticoid-induced osteoporosis risk , discussion of bone density test , presence of bone mineral density test , reported inactivity , and reported low calcium diet . RESULTS The contrast was significant in favor of the treatment pharmacies for the frequency of patients taking a calcium supplement ( Control [ -6.9 % ] vs. Treatment [ 17.1 % ] , P < 0.05 ) . No other contrast was significant . CONCLUSIONS Community pharmacists are capable of increasing calcium supplementation among patients at risk for glucocorticoid-induced osteoporosis . Pharmacists who educate at-risk patients can impact the self-care of these patients Background Despite recommendations , osteoporosis screening rates among women aged 65 years and older remain low . We present results from a clustered , r and omized trial evaluating patient mailed reminders , alone and in combination with physician prompts , to improve osteoporosis screening and treatment . Methods Primary care clinics ( n = 15 ) were r and omized to usual care , mailed reminders alone , or mailed reminders with physician prompt OUTPUT:

Multifaceted interventions targeting high-risk patients and their primary care providers may improve the management of osteoporosis , but improvements are often clinical ly modest

MS2_fixed_5_shot1945

***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 Single-site studies suggest that a 2-week program of constraint-induced movement therapy ( CIMT ) for patients more than 1 year after stroke who maintain some h and and wrist movement can improve upper extremity function that persists for at least 1 year . OBJECTIVE To compare the effects of a 2-week multisite program of CIMT vs usual and customary care on improvement in upper extremity function among patients who had a first stroke within the previous 3 to 9 months . DESIGN AND SETTING The Extremity Constraint Induced Therapy Evaluation ( EXCITE ) trial , a prospect i ve , single-blind , r and omized , multisite clinical trial conducted at 7 US academic institutions between January 2001 and January 2003 . PARTICIPANTS Two hundred twenty-two individuals with predominantly ischemic stroke . INTERVENTIONS Participants were assigned to receive either CIMT ( n = 106 ; wearing a restraining mitt on the less-affected h and while engaging in repetitive task practice and behavioral shaping with the hemiplegic h and ) or usual and customary care ( n = 116 ; ranging from no treatment after concluding formal rehabilitation to pharmacologic or physiotherapeutic interventions ) ; patients were stratified by sex , prestroke dominant side , side of stroke , and level of paretic arm function . MAIN OUTCOME MEASURES The Wolf Motor Function Test ( WMFT ) , a measure of laboratory time and strength-based ability and quality of movement ( functional ability ) , and the Motor Activity Log ( MAL ) , a measure of how well and how often 30 common daily activities are performed . RESULTS From baseline to 12 months , the CIMT group showed greater improvements than the control group in both the WMFT Performance Time ( decrease in mean time from 19.3 seconds to 9.3 seconds [ 52 % reduction ] vs from 24.0 seconds to 17.7 seconds [ 26 % reduction ] ; between-group difference , 34 % [ 95 % confidence interval { CI } , 12%-51 % OUTPUT:

RESULTS Studies of task-related training showed benefits for functional outcome compared with traditional therapies . Active use of task-oriented training with stroke survivors will lead to improvements in functional outcomes and overall health-related quality of life . CONCLUSION Generally , task-oriented rehabilitation proved to be more effective . Many interventions are feasible for nurses and can be performed in a ward or at home .

MS2_fixed_5_shot1946

***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: AIM Telemonitoring ( TM ) is a safe and efficient monitoring system for internal cardioverter defibrillator device ( ICD ) recipients . TM has been used to track info on the clinical status of heart failure patients treated by ICD and /or cardiac resynchronisation therapy defibrillator ( CRT-D ) . The aim of this study was to investigate the impact of TM on clinical outcomes in a population of CRT-D patients with heart failure . METHODS In a multicentre , r and omised study , patients with chronic heart failure , New York Heart Association ( NYHA ) functional class II or III , left bundle branch block , severe left ventricle ejection fraction reduction ( LVEF < 35 % ) have been identified and screened . RESULTS One hundred and ninety-one patients have been r and omised to receive either a CRT-D with TM or a CRT-D with traditional ambulatory monitoring ( control group ) and completed the 12-month study follow-up . Primary endpoints were all cause death , cardiac death and hospital admission for heart failure . Secondary endpoints were atrial fibrillation , sustained episodes , non-sustained and self terminated ventricular tachyarrhythmia , sustained ventricular tachycardia , and ventricular fibrillation , ICD shocks and percentage of CRT-D responder patients . Univariate analysis identified the following factors predicting hospitalisation : TM , age , chronic kidney disease , hypercholesterolaemia , LVEF and NYHA class . At multivariate analysis , TM was the only factor predicting heart failure hospitalisation ( hazard ratio 0.6 , 0.42 - 0.79 , 95 % CI , p = 0.002 ) , without affecting overall mortality and cardiac deaths events . CONCLUSIONS Taken together , our data indicate the importance of TM in predicting heart failure hospitalisation in patients treated with Aims The ESC-EHRA Atrial Fibrillation Ablation Long-Term registry is a prospect i ve , multinational study that aims at providing an accurate picture of contemporary real-world ablation for atrial fibrill OUTPUT:

No death or myocardial infa rct ion was reported . CONCLUSION ' PVI-plus ' involving 2G-CB seems to be safe and effective for treating PerAF

MS2_fixed_5_shot1947

***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: It is hypothesized that vitamin D insufficiency in athletes might negatively affect sport performance . The objective of this study was to examine the effect of vitamin D3 supplementation on physical performance of adolescent swimmers with vitamin D insufficiency . Fifty-three adolescent competitive swimmers with vitamin D insufficiency ( serum 25-hydroxyvitamin-D concentrations ( 25(OH)D ) < 30 ng/ml , mean 24.2 ± 4.8 ng/ml ) were r and omized to receive 2,000 IU/day of vitamin D3 or placebo for 12 weeks . Swimming performance at several speeds , arm-grip strength , and one-legged balance , were measured before and after supplementation . The age-adjusted changes in performance variables during the study were compared between groups . 25(OH ) D concentrations at study end were significantly higher in the vitamin group compared with the placebo group ( 29.6 ± 6.5 ng/ml vs. 20.3 ± 4.2 ng/ml , p < .001 ) , yet only 48 % of the vitamin group became vitamin D sufficient with this dosing . No between-group differences were found in the changes of the performance variables tested . No significant differences in performance were found between participants that became vitamin D sufficient , and those who did not . No significant correlation was found between the change in serum 25(OH)D and age-adjusted balance , strength or swimming performance at study end . Vitamin D3 supplementation that raised serum 25(OH)D concentrations by a mean of 9.3 ng/ml above placebo in adolescent swimmers with vitamin D insufficiency , did not improve physical performance more than placebo IMPORTANCE Vitamin D deficiency has been associated with poor physical performance . OBJECTIVE To determine the effectiveness of high-dose vitamin D in lowering the risk of functional decline . DESIGN , SETTING , AND PARTICIPANTS One-year , double-blind , r and omized clinical trial conducted in Zurich , Switzerl and OUTPUT:

CONCLUSIONS Vitamin D supplementation positively affected lower limb muscle strength in athletes , but not upper limb muscle strength or muscle power . Different muscle groups and functions may respond differently to vitamin D supplementation .

MS2_fixed_5_shot1948

***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: Dietary data from a prospect i ve study were used to relate factors influencing calcium balance ( estimates of dietary calcium intake , protein intake from nondairy animal sources ( meat , fish , and eggs ) , and coffee consumption ) to the incidence of hip fracture . During the years 1977 - 1983 , women and men born between 1925 and 1940 and living in one of three Norwegian counties were invited to a cardiovascular screening that included a dietary survey . The attendance rate at screening was 91.1 % , and 90.7 % of these persons ( 19,752 women and 20,035 men ) filled in and returned a semiquantitative dietary question naire . This cohort was followed for an average of 11.4 years ( range , 0.01 - 13.8 years ) with respect to hip fracture , defined as cervical or trochanteric fracture . During follow-up , 213 hip fractures were identified , excluding fractures associated with high-energy trauma and metastatic bone disease . There was no clear association between calcium intake or nondairy animal protein intake and hip fracture in this cohort . However , an elevated risk of fracture was found in women with a high intake of protein from nondairy animal sources in the presence of low calcium intake ( relative risk = 1.96 ( 95 % confidence interval 1.09 - 3.56 ) for the highest quarter of nondairy protein intake and the lowest quarter of calcium intake vs. the three lower quarters of protein intake and the three higher quarters of calcium intake ) . Women who drank nine or more cups of coffee per day also had an increased risk of fracture , while there was no association between coffee consumption and hip fracture in men . Although these findings do not necessarily imply causal relations , they suggest the presence of risk factors for hip fracture that act through a negative calcium balance in this population BACKGROUND The effect of meat protein on calcium retention at different calcium intakes is un OUTPUT:

In the present meta- analysis , reductions in the risk of hip fracture with milk consumption were only observed among American adults , but not among Sc and inavian adults , possibly because milk products are more commonly fortified with vitamin D in the former population than in Sc and inavian countries . The reduction in the risk of hip fracture was also observed with yogurt consumption , which is often associated with healthy lifestyles and dietary patterns that contribute to improved bone health . Fueling this uncertainty , the elevated risk of hip fracture in association with milk consumption was observed in a cohort of Swedish women . The cumulative evidence from prospect i ve cohort studies reassuringly suggests that the risk of hip fracture may not be elevated among people who consume milk , yogurt , and cheese , and that a greater consumption of milk or yogurt may even be associated with a lower risk of hip fracture depending on the factors that may differ across the population of interest

MS2_fixed_5_shot1949

***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: Proton pump inhibitors ( PPIs ) increase osteoporotic fracture risk presumably via hypochlorhydria and consequent reduced fractional calcium absorption ( FCA ) . Existing studies provide conflicting information regarding the direct effects of PPIs on FCA . We evaluated the effect of PPI therapy on FCA . We recruited women at least 5 years past menopause who were not taking acid suppressants . Participants underwent three 24-hour inpatient FCA studies using the dual stable isotope method . Two FCA studies were performed 1 month apart to establish baseline calcium absorption . The third study occurred after taking omeprazole ( 40 mg/day ) for 30 days . Each participant consumed the same foods during all FCA studies ; study meals replicated subjects ' dietary habits based on 7-day diet diaries . Twenty-one postmenopausal women ages 58 ± 7 years ( mean ± SD ) completed all study visits . Seventeen women were white , and 2 each were black and Hispanic . FCA ( mean ± SD ) was 20 % ± 10 % at visit 1 , 18 % ± 10 % at visit 2 , and 23 % ± 10 % following 30 ± 3 days of daily omeprazole ( p = .07 , ANOVA ) . Multiple linear regression revealed that age , gastric pH , serum omeprazole levels , adherence to omeprazole , and 25-hydroxyvitamin D levels were unrelated to changes in FCA between study visits 2 and 3 . The 1,25-dihydroxyvitamin D3 level at visit 2 was the only variable ( p = .049 ) associated with the change in FCA between visits 2 and 3 . PPI-associated hypochlorhydria does not decrease FCA following 30 days of continuous use . Future studies should focus on identifying mechanisms by which PPIs increase the risk of osteoporotic fracture . © 201 OUTPUT:

The magnitude of the association is modest and is most likely due to confounding factors as patients prescribed PPI therapy tend to be more frail with more risk factors for fractures than those not given these drugs . There is no clear dose – response relationship and there is no association between PPI therapy and risk of fracture in those at highest risk . Finally , there is no clear mechanism through which PPI therapy increases the risk of fracture , as recent r and omized trials show no impact of PPI therapy on calcium absorption and there is no association between PPI therapy and risk of osteoporosis . We therefore feel there is insufficient evidence to change PPI prescribing habits based on risk of fracture . There is no evidence to support prescription of calcium and /or vitamin D in patients simply because they are taking PPI therapy .

MS2_fixed_5_shot1950

***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 modulating effects of serotonin on dopamine neurotransmission are not well understood , particularly in acute psychotic states . Positron emission tomography was used to examine the effect of psilocybin on the in vivo binding of [11C]raclopride to D2-dopamine receptors in the striatum in healthy volunteers after placebo and a psychotomimetic dose of psilocybin ( n = 7 ) . Psilocybin is a potent indoleamine hallucinogen and a mixed 5-HT2A and 5-HT1A receptor agonist . Psilocybin administration ( 0.25 mg/kg p.o . ) produced changes in mood , disturbances in thinking , illusions , elementary and complex visual hallucinations and impaired ego-functioning . Psilocybin significantly decreased [11C]raclopride receptor binding potential ( BP ) bilaterally in the cau date nucleus ( 19 % ) and putamen ( 20 % ) consistent with an increase in endogenous dopamine . Changes in [11C]raclopride BP in the ventral striatum correlated with depersonalization associated with euphoria . Together with previous reports of 5-HT receptor involvement in striatal dopamine release , it is concluded that stimulation of both 5-HT2A and 5-HT1A receptors may be important for the modulation of striatal dopamine release in acute psychoses . The present results indirectly support the hypothesis of a serotonin-dopamine dysbalance in schizophrenia and suggest that psilocybin is a valuable tool in the analysis of serotonin-dopamine interactions in acute psychotic states A recent large population study of 130,000 adults in the United States failed to find evidence for a link between psychedelic use ( lysergic acid diethylamide , psilocybin or mescaline ) and mental health problems . Using a new data set consisting of 135,095 r and omly selected United States adults , including 19, OUTPUT:

Long-term use was associated with thinning of the posterior cingulate cortex , thickening of the anterior cingulate cortex , and decreased neocortical 5-HT2A receptor binding . Despite the high method ological heterogeneity and the small sample sizes , the results suggest that hallucinogens increase introspection and positive mood by modulating brain activity in the fronto-temporo-parieto-occipital cortex

MS2_fixed_5_shot1951

***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 the current work we asked whether executive function , as measured by tests of working memory capacity , might benefit from an acute bout of exercise and , more specifically , whether individuals who are lower or higher in working memory to begin with would be more or less affected by an exercise manipulation . Healthy adults completed working memory measures in a nonexercise ( baseline ) session and immediately following a 30-min self-paced bout of exercise on a treadmill ( exercise session ) . Sessions were conducted 1 week apart and session order was counterbalanced across participants . A significant Session x Working Memory interaction was obtained such that only those individuals lowest in working memory benefited from the exercise manipulation . This work suggests that acute bouts of exercise may be most beneficial for healthy adults whose cognitive performance is generally the lowest , and it demonstrates that the impact of exercise on cognition is not uniform across all individuals Background Although basic research has uncovered biological mechanisms by which exercise could maintain and enhance adult brain health , experimental human studies with older adults have produced equivocal results . Purpose This r and omized clinical trial aim ed to investigate the hypotheses that ( a ) the effects of exercise training on the performance of neurocognitive tasks in older adults is selective , influencing mainly tasks with a substantial executive control component and ( b ) performance in neurocognitive tasks is related to cardiorespiratory fitness . Methods Fifty-seven older adults ( 65–79 years ) participated in aerobic or strength- and -flexibility exercise training for 10 months . Neurocognitive tasks were selected to reflect a range from little ( e.g. , simple reaction time ) to substantial ( i.e. , Stroop Word – Color conflict ) executive control . Results Performance in tasks requiring little executive control was unaffected by participating in aerobic exercise . Improvements in Stroop Word – Color task performance were found only for the aerobic exercise group . Changes in aerobic fitness were unrelated to changes in neurocognitive function . Conclusions Aerobic exercise in older adults can have a beneficial effect on the performance of speeded tasks that rely heavily on executive control . Improvements in aerobic fitness do not appear to be a prerequisite for this benef OUTPUT:

Conclusion : These data suggest that sedentary behavior is not associated with changes in cognitive performance in interventions that intend to reduce sedentary behavior .

MS2_fixed_5_shot1952

***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 examine if a cognitive remediation program could be a positive supplement to a psychoeducational treatment program for adolescents with early onset psychosis The first double-blind placebo-controlled clinical trial of an atypical neuroleptic medication is being conducted in symptomatic treatment-seeking patients meeting new diagnostic criteria for a putative prodromal syndrome . This identifies them as being at high risk for developing psychosis in the near future . The study aims include prevention of psychosis onset and disability , as well as palliation of ongoing symptomatology . This report presents the study rationale and design . Recent studies will be review ed that have advanced our knowledge about the early course of schizophrenia and our ability to predict onset prospect ively , advances that have rendered prodromal intervention research feasible and ethical . The study design has many novel features . It tests for prevention versus delay in psychosis onset , as well as for efficacy and safety in a newly defined clinical population . This has required the development of innovative clinical research assessment instruments and a new operational definition of psychosis onset . The integration of these novel elements into an otherwise typical clinical trial design is detailed . The companion report will address sample recruitment and the clinical phenomenology at baseline of this putative " prodromal " entity Atendency to extract spurious , message-like meaning from meaningless noise was assessed as a risk factor leading to schizophrenia-spectrum disorders by assessing word length of speech illusions elicited by multispeaker babble in 43 people with prodromal symptoms . These individuals were r and omised to olanzapine v. placebo groups during year 1 followed by no pharmacological treatment for those with no disorder conversion during year 2 . A time-dependent Cox regression analysis of conversion to schizophrenia-spectrum disorder revealed a significant interaction between condition ( olanzapine v. no drug ) and length of speech illusion , with the latter strongly predicting subsequent conversion during medication-free intervals but not during olanzapine treatment OBJECTIVE Despite the frequent use of the Positive and Negative Syndrome Scale ( PANSS ) for rating OUTPUT:

No convincing evidence suggests that atypical antipsychotic medications are superior to typical medications for the treatment of adolescents with psychosis . However , atypical antipsychotic medications may be more acceptable to young people because fewer symptomatic adverse effects are seen in the short term . Little evidence is available to support the superiority of one atypical antipsychotic medication over another , but side effect profiles are different for different medications . Treatment with olanzapine , risperidone and clozapine is often associated with weight gain . Aripiprazole is not associated with increased prolactin or with dyslipidaemia . Adolescents may respond better to st and ard-dose as opposed to lower-dose risperidone , but for aripiprazole and ziprasidone , lower doses may be equally effective .

MS2_fixed_5_shot1953

***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 Attentional bias towards smoking-related cues is increased during abstinence and can predict relapse after quitting . Exercise has been found to reduce cigarette cravings and desire to smoke during temporary abstinence and attenuate increased cravings in response to smoking cues . OBJECTIVE To assess the acute effects of exercise on attentional bias to smoking-related cues during temporary abstinence from smoking . METHOD In a r and omized cross-over design , on separate days regular smokers ( n = 20 ) undertook 15 minutes of exercise ( moderate intensity stationary cycling ) or passive seating following 15 hours of nicotine abstinence . Attentional bias was measured at baseline and post-treatment . The percentage of dwell time and direction of initial fixation was assessed during the passive viewing of a series of paired smoking and neutral images using an Eyelink II eye-tracking system . Self-reported desire to smoke was recorded at baseline , mid- and post-treatment and post-eye-tracking task . RESULTS There was a significant condition x time interaction for desire to smoke , F((1,18 ) ) = 10.67 , P = 0.004 , eta(2 ) = 0.36 , with significantly lower desire to smoke at mid- and post-treatment following the exercise condition . The percentage of dwell time and direction of initial fixations towards smoking images were also reduced significantly following the exercise condition compared with the passive control . CONCLUSION Findings support previous research that acute exercise reduces desire to smoke . This is the first study to show that exercise appears to also influence the salience and attentional biases towards cigarettes The urges to smoke reported by 215 former smokers were measured 1 day , 7 days , 14 days and 30 days after they quit to examine : ( a ) the time course of smoking urges , ( b ) the relationship of urges to relapse , and ( c ) predictors of urges to smoke . Urges to smoke were strongest 1 day after quitting , and decreased at each subsequent measurement OUTPUT:

There is strong evidence that physical activity acutely reduces cigarette craving

MS2_fixed_5_shot1954

***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: Bladder cancer is the fourth most common cancer among European males . Once diagnosed with muscle invasive bladder cancer , a radical cystectomy is the first line treatment , which results in a urostomy . The placement of a urostomy and the care required impacts the patient 's life . Previous research vali date d the Urostomy Education Scale as the first st and ardized tool capable of documenting the patients ' level of stoma self-care skills and useful to guide patient education interventions . A Danish-Dutch Fellowship was established to support and provide further evidence of applicability of the Urostomy Education Scale PURPOSE : Colorectal surgery is associated with postoperative ileus , which contributes to delayed discharge . This study was design ed to investigate the effect of thoracic epidural anesthesia and analgesia on gastrointestinal function after colorectal surgery under st and ardized controlled postoperative care . METHODS : Forty-two patients diagnosed with either colonic cancer , diverticulitis , polyps , or adenoma , and scheduled for elective colorectal surgery , were r and omly assigned to either postoperative patient-controlled analgesia ( PCA ) with intravenous morphine ( n=21 ) or epidural analgesia with a mixture of bupivacaine and fentanyl ( n=21 ) . Postoperative early oral feeding and assistance to mobilization were offered to all patients . Pain visual analog scale ( 1–100 mm ) , passage of flatus and bowel movements , length of hospital stay , and readiness for discharge were recorded . RESULTS : Pain visual analog scale ( visual analog scale , 1–100 mm ) at rest , on coughing , and daily on mobilization was significantly lower in the epidural group compared with the patient-controlled analgesia group . Median values for the visual analog scale group were 7 ( 95 percent confidence interval , 2–18 ) mm , 19 ( 95 percent confidence interval , 4–38 ) mm , and 10 ( 95 percent confidence interval , 5–33 ) mm , respectively , OUTPUT:

Intraoperatively , a fluid and opioid sparing protocol may reduce fluid shifts and avoid complications from paralytic ileus . Finally , enhanced recovery protocol s including novel medications , early feeding , and multi-modal analgesia approaches are associated with earlier postoperative convalescence . CONCLUSION RC is a complex and morbid procedure that may benefit from care re design .

MS2_fixed_5_shot1955

***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 prospect ively examine the effects of a r and omized school-based intervention on nutrition and physical activity knowledge and preferences , anthropometric measures , and fitness in low socioeconomic kindergarten children . STUDY DESIGN A total of 376 children completed a school-year combined dietary-behavioral-physical activity intervention and were compared with 349 control subjects ( age 3.8 to 6.8 years ) . RESULTS The prevalence of overweight and obesity among the kindergarten children was 27.7 % . Even though the intervention was not associated with between group differences in body mass index changes , it was associated with significantly ( P < .05 ) greater increase in nutrition knowledge and preferences , physical activity knowledge and preferences , and improvement in fitness . There was a greater ( P < .05 ) decrease in the number of overweight children in the intervention group ( -31.9 % ) compared with the controls ( -17.5 % ) . CONCLUSIONS A kindergarten dietary-physical activity intervention applied by the kindergarten teachers , had no effect on body mass index changes between the groups , but improved nutrition and physical activity knowledge and preferences , improved fitness , and decreased the percent of overweight children . This intervention may play an important role in health promotion , prevention and treatment of childhood obesity Objective To test the effect of a multidimensional lifestyle intervention on aerobic fitness and adiposity in predominantly migrant preschool children . Design Cluster r and omised controlled single blinded trial ( Ballabeina study ) over one school year ; r and omisation was performed after stratification for linguistic region . Setting 40 preschool classes in areas with a high migrant population in the German and French speaking regions of Switzerl and . Participants 652 of the 727 preschool children had informed consent and were present for baseline measures ( mean age 5.1 years ( SD 0.7 ) , 72 % migrants of multicultural origins ) . No children withdrew , but 26 moved away . Intervention The multidimensional culturally tail OUTPUT:

Motor fitness , particularly balance , was the most studied fitness component , while cardiorespiratory fitness was the least studied . While we wait for more evidence to be accumulated in preschool children , the PREFIT battery hereby proposed is a useful tool for assessing physical fitness in children aged 3–5 years

MS2_fixed_5_shot1956

***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 address the lack of a simple and st and ardized instrument to assess overall panic disorder severity , the authors developed a scale for the measurement of panic disorder severity . METHOD Ten independent evaluators used the seven-item Panic Disorder Severity Scale to assess 186 patients with principal DSM-III-R diagnoses of panic disorder ( with no or mild agoraphobia ) who were participating in the Multicenter Collaborative Treatment Study of Panic Disorder . In addition , 89 of these patients were reevaluated with the same scale after short-term treatment . A subset of 24 patients underwent two independent assessment s to establish interrater reliability . Internal consistency , convergent and discriminant validity , and sensitivity to change were also determined . RESULTS The Panic Disorder Severity Scale was associated with excellent interrater reliability , moderate internal consistency , and favorable levels of validity and sensitivity to change . Individual items showed good convergent and discriminant validity . Analysis suggested a two-factor model fit the data best . CONCLUSIONS The Panic Disorder Severity Scale is a simple , efficient way for clinicians to rate severity in patients with established diagnoses of panic disorder . However , further research with more diverse groups of panic disorder patients and with a broader range of convergent and discriminant validity measures is needed Studies to date on the effects of benzodiazepines on neuropsychologic function have yielded conflicting data with respect to the type , severity , and duration of deficits that may be induced by these agents . As part of a placebo-controlled trial of alprazolam-XR ( extended release ) administered in combination with cognitive-behavioral therapy in patients with panic disorder , a battery of tests was used to measure neuropsychologic function . Thirty-eight out patients were r and omly assigned to receive either alprazolam-XR or placebo . Dosages were titrated up so that the alprazolam group ( N = 18 ) received a mean dose of 4 mg/day ( reduced in two patients because of OUTPUT:

The review established the paucity of high quality evidence investigating the efficacy of psychotherapy combined with benzodiazepines for panic disorder . Currently , there is inadequate evidence to assess the clinical effects of psychotherapy combined with benzodiazepines for patients who are diagnosed with panic disorder

MS2_fixed_5_shot1957

***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 followed workers over an extended period of time to identify factors which may influence the onset of Carpal Tunnel Syndrome ( CTS ) . The purpose was to evaluate incidence of CTS and to create a predictive model of factors that play a role in the development of CTS . This prospect i ve study followed 432 industrial and clerical workers over 5.4 years . Incident cases were defined as workers who had no prior history of CTS at baseline testing and were diagnosed with CTS during the follow-up period or at the follow-up screening . On the basis of logistic regression , significant predictors for CTS include baseline median-ulnar peak latency difference , a history of wrist/h and /finger tendonitis , a history of numbness , tingling , burning , and /or pain in the h and , and work above the action level of the peak force and h and activity level threshold limit value . This longitudinal study supports findings from previous cross-sectional studies identifying both work related ergonomic stressors and physical factors as independent risk factors for CTS BACKGROUND A prospect i ve study of computer users was performed to determine the occurrence of and evaluate risk factors for neck or shoulder ( N/S ) and h and or arm ( H/A ) musculoskeletal symptoms ( MSS ) and disorders ( MSD ) . METHODS Individuals ( n = 632 ) newly hired into jobs requiring > or = 15 hr/week of computer use were followed for up to 3 years . At study entry , workstation dimensions and worker postures were measured and medical and psychosocial risk factors were assessed . Daily diaries were used to document work practice s and incident MSS . Those reporting MSS were examined for specific MSD . Incidence rates of MSS and MSD were estimated with survival analysis . Cox regression models were used to evaluate associations between participant characteristics at entry and MSS and MSD . RESULTS The annual incidence of N/S MSS was 58 cases/100 person-years and of N/S MSD was 35 cases/100 person-years . The most common N/S MSD was somatic pain syndrome . The annual incidence of H/A MSS OUTPUT:

Conclusion There is insufficient epidemiological evidence that computer work causes CTS

MS2_fixed_5_shot1958

***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 study was made of the effect of high or low intake of sucrose for periods of 14 days in a group of nineteen apparently healthy men . The high sucrose diet produced no change in blood levels of cholesterol or phospholipids , or in glucose tolerance , but it produced a significant rise in triglycerides in all nineteen men . In six of them , there was in addition a rise in serum immunoreactive insulin , especially during the glucose tolerance test , and these same six subjects also showed a considerable increase in weight and a significant increase in platelet adhesiveness . There was no difference between the six subjects and the remaining thirteen in any of the other measurements , or in the diets they consumed during the experiment . The changes produced by sucrose had disappeared , or nearly so , after 14 days of normal diet . It is suggested that the effect of sucrose in producing hyperinsulinism may be more relevant to its possible role in the aetiology of ischaemic heart disease than its effect on blood lipids . It is further suggested that only some individuals are susceptible to the development of ischaemic heart disease by dietary sucrose , and that these may be identified as those that show ‘ sucrose-induced hyperinsulinism ’ BACKGROUND This study assessed if walking at a self-selected pace could improve postpr and ial glucose and insulin concentrations in obese adolescents consuming high-fructose ( HF ) or high-glucose ( HG ) diets . METHODS Seven obese male and female adolescents ( 18 ± 1 yr ) performed 4 , 15-day trials in a r and om order , including 1 ) HF-diet ( 50 g fructose/d added to normal diet ) while being sedentary , 2 ) HG-diet ( 50 g glucose/d ) while sedentary , 3 ) HF-diet with additional walking , and 4 ) HG-diet with additional walking . On the 15th day of each trial , the participants performed mixed meal testing in the laboratory in which they consumed three liquid shakes ( either OUTPUT:

There was interaction by food source , with specific food sources showing beneficial effects ( fruit and fruit juice ) or harmful effects ( sweetened milk and mixed sources ) in substitution studies and harmful effects ( sugars‐sweetened beverages and fruit juice ) in addition studies on at least one outcome . Conclusions Energy control and food source appear to mediate the effect of fructose‐containing sugars on glycaemic control . Although most food sources of these sugars ( especially fruit ) do not have a harmful effect in energy matched substitutions with other macronutrients , several food sources of fructose‐containing sugars ( especially sugars‐sweetened beverages ) adding excess energy to diets have harmful effects .

MS2_fixed_5_shot1959

***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 Comparison of self-management of oral anticoagulant therapy versus conventional management has been hindered by use of different methods . We tested the hypothesis that there is no difference in the International Normalized Ratio ( INR ) variability , INR level , and coumarin dose among patients r and omized to conventional management versus self-management . Methods The study design included uniform analysis of blinded control blood sample s in both treatment arms . Ninety-two patients were r and omly assigned to either self-management of oral anticoagulant therapy ( including a teaching program for self-management followed by 6 months of independent self-management ) or 6 months of conventional management . The endpoints were the variance ( median square of the st and ard deviation ) of the INR value , the median INR-value ( using a blinded control sample analyzed monthly by a reference laboratory ) , and the coumarin dose . Results Self-management was associated with a statistically significant smaller variance in INR values , a higher median INR value , and a higher dose of warfarin compared with conventional management . No difference was found in the group of patients using phenprocoumon . Conclusion Training and implementation of patient self-management leads to a smaller variance in INR values , a higher median INR value and a higher dose of coumarin compared with results obtained for conventionally managed patients BACKGROUND There is increased pressure on primary care physicians to monitor oral anticoagulation . OBJECTIVE To test the null hypothesis that oral anticoagulation care can be provided at least as well in primary care through a nurse-led clinic , involving near-patient testing and computerized decision support software , compared with routine hospital management based on a variety of clinical outcome measures . METHODS A r and omized , controlled trial in 12 primary care practice s in Birmingham , Engl and ( 9 intervention and 3 control ) . Two control population s were used : patients individually r and omly allocated as controls in the intervention practice s ( intra practice controls ) and all patients in control practice s ( inter practice controls ) . Intervention practice s ' patients were r and omized to the intervention ( practice -based anticoagulation clinic ) or control ( hospital clinic ) group . The main outcome OUTPUT:

Experts , however , have commented that there may be under-utilization of OAT due to patient factors , physician factors , or regional practice variations and that sub-optimal patient management may also occur . These models are not suitable for all patients and require the identification and education of suitable c and i date s. Potential advantages of POC devices include improved convenience to patients , better treatment compliance and satisfaction , more frequent monitoring and fewer thromboembolic and hemorrhagic complications . Potential disadvantages of the device include the tendency to underestimate high INR values and overestimate low INR values , low thromboplastin sensitivity , inability to calculate a mean normal PT , and errors in INR determination in patients with antiphospholipid antibodies with certain instruments . Although treatment satisfaction and quality of life ( QoL ) may improve with POC INR monitoring , some patients may experience increased anxiety or preoccupation with their disease with these strategies . The majority of studies reported favourable impacts of POC INR monitoring on QoL and found better treatment satisfaction with POC monitoring .

MS2_fixed_5_shot1960

***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: Importance Sleeve gastrectomy is increasingly used in the treatment of morbid obesity , but its long-term outcome vs the st and ard Roux-en-Y gastric bypass procedure is unknown . Objective To determine whether there are differences between sleeve gastrectomy and Roux-en-Y gastric bypass in terms of weight loss , changes in comorbidities , increase in quality of life , and adverse events . Design , Setting , and Participants The Swiss Multicenter Bypass or Sleeve Study ( SM-BOSS ) , a 2-group r and omized trial , was conducted from January 2007 until November 2011 ( last follow-up in March 2017 ) . Of 3971 morbidly obese patients evaluated for bariatric surgery at 4 Swiss bariatric centers , 217 patients were enrolled and r and omly assigned to sleeve gastrectomy or Roux-en-Y gastric bypass with a 5-year follow-up period . Interventions Patients were r and omly assigned to undergo laparoscopic sleeve gastrectomy ( n = 107 ) or laparoscopic Roux-en-Y gastric bypass ( n = 110 ) . Main Outcomes and Measures The primary end point was weight loss , expressed as percentage excess body mass index ( BMI ) loss . Exploratory end points were changes in comorbidities and adverse events . Results Among the 217 patients ( mean age , 45.5 years ; 72 % women ; mean BMI , 43.9 ) 205 ( 94.5 % ) completed the trial . Excess BMI loss was not significantly different at 5 years : for sleeve gastrectomy , 61.1 % , vs Roux-en-Y gastric bypass , 68.3 % ( absolute difference , −7.18 % ; 95 % CI , −14.30 % to −0.06 % ; P = .22 after adjustment for multiple comparisons ) . Gastric reflux remission was observed more frequently after Roux OUTPUT:

Reoperations were common in all groups . Reoperation rate was initially high but reduced markedly with improved b and and surgical and aftercare techniques . Conclusion All current procedures are associated with substantial and durable weight loss . More long-term data are needed for one-anastomosis gastric bypass and sleeve gastrectomy . Reoperation is likely to remain common across all procedures

MS2_fixed_5_shot1961

***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 Recent findings suggest that executive function ( EF ) plays a critical role in the regulation of gait in older adults , especially under complex and challenging conditions , and that EF deficits may , therefore , contribute to fall risk . The objective of this study was to evaluate if reduced EF is a risk factor for future falls over the course of 5 years of follow-up . Secondary objectives were to assess whether single and dual task walking abilities , an alternative window into EF , were associated with fall risk . Methodology /Main Results We longitudinally followed 256 community-living older adults ( age : 76.4±4.5 yrs ; 61 % women ) who were dementia free and had good mobility upon entrance into the study . At baseline , a computerized cognitive battery generated an index of EF , attention , a closely related construct , and other cognitive domains . Gait was assessed during single and dual task conditions . Falls data were collected prospect ively using monthly calendars . Negative binomial regression quantified risk ratios ( RR ) . After adjusting for age , gender and the number of falls in the year prior to the study , only the EF index ( RR : .85 ; CI : .74–.98 , p = .021 ) , the attention index ( RR : .84 ; CI : .75–.94 , p = .002 ) and dual tasking gait variability ( RR : 1.11 ; CI : 1.01–1.23 ; p = .027 ) were associated with future fall risk . Other cognitive function measures were not related to falls . Survival analyses indicated that subjects with the lowest EF scores were more likely to fall sooner and more likely to experience multiple falls during the 66 months of follow-up ( p<0.02 ) . Conclusions / Significance These findings demonstrate that among community-living older adults , the risk of future falls was predicted by performance on EF and attention tests conducted 5 years earlier . The present results link falls among older adults to cognition , indicating that screening EF will likely enhance fall risk assessment , and that treatment of EF may reduce fall risk In developed countries , falls in older people represent a OUTPUT:

Gait speed significantly reduced with the addition of a dual task , with increasing complexity showing greater decrements . Cadence , stride time , and measures of gait variability were all negatively affected under the dual-task condition . In older adults , the addition of a dual task significantly reduces gait speed and cadence , with possible implication s for the assessment of older people , as the addition of a dual task may expose deficits not observed under single-task assessment

MS2_fixed_5_shot1962

***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 prospect i ve , r and omized , multicenter study was conducted on the efficacy and safety of two prophylactic antibiotic regimens in both abdominal and vaginal hysterectomy . Patients received three intravenous doses of clindamycin ( 900 mg ) plus either aztreonam ( 1 g ) or cefotaxime ( 1 g ) ; the doses were given at the induction of anesthesia and 8 and 16 hours later . A total of 170 patients undergoing abdominal hysterectomy and 142 patients undergoing vaginal hysterectomy completed the trial and were evaluated . Following abdominal hysterectomy infections occurred at the operative site in 1.2 % of patients given a regimen including aztreonam and in 4.7 % of those given a regimen including cefotaxime ; the difference between the two groups was not significant . Neither were significant differences observed in the incidence of fever , the incidence of bacteriuria , the need for postoperative antibiotics , or the duration of postoperative hospitalization , although results were slightly better for patients receiving clindamycin plus aztreonam . Following vaginal hysterectomy , slightly but not significantly better results for the same parameters were obtained in the group given clindamycin plus cefotaxime . Diarrhea was the only adverse reaction attributable to antibiotic treatment and occurred more frequently in patients given cefotaxime . It was concluded that the two regimens were similarly effective and safe in preventing infections following hysterectomy Abstract .Fram KM . Laparoscopically assisted vaginal hysterectomy versus abdominal hysterectomy in stage I endometrial cancer . The purpose of this study was to evaluate and compare laparoscopic treatment for stage I endometrial cancer with the traditional transabdominal approach . From July 1996 to July 1998 , 61 patients with clinical stage I endometrial cancer were treated at the Gynaecology Oncology Unit at the Royal North Shore of Sydney , Australia . OUTPUT:

Results Prophylactic antibiotics prevent inflammatory complications after gynaecological surgery . Prophylactic antibiotics are more effective in surgery requiring access to the peritoneal cavity or the vagina . Cefotetan appears to be more capable in preventing the overall inflammatory complication rate than cefoxitin or cefazolin . No benefit has been shown for the combination of antibiotics as prophylaxis . No difference has been shown between the long-term and short-term use of antibiotics . There is no need for the primary use of an anaerobic antibacterial agent . Conclusion Antibiotics help to prevent postoperative inflammatory complications after major gynecologic surgeries

MS2_fixed_5_shot1963

***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 — Data regarding the long-term efficacy of atrial fibrillation ( AF ) ablation are still lacking . Methods and Results —Two hundred four consecutive patients symptomatic for paroxysmal or persistent/permanent AF were r and omly assigned to 2 different ablation schemes : pulmonary vein isolation ( PVI ) and PVI plus left linear lesions ( LL ) . Primary end point was to assess the maintenance of sinus rhythm ( SR ) after procedures 1 and 2 in the absence of antiarrhythmic drugs in a long-term follow-up of at least 3 years . Paroxysmal AF — With a single procedure at 12-month follow-up , 46 % of patients treated with PVI maintained SR , whereas at 3-year follow-up , 29 % were in SR ; using the “ PVI plus LL ” at the 12-month follow-up , 57 % of patients were in SR , whereas at the 3-year follow-up , 53 % remained in SR . After a second procedure , the long-term overall success rate without antiarrhythmic drugs was 62 % with PVI and 85 % with PVI plus LL . Persistent/Permanent AF — With a single procedure at the 12-month follow-up , 27 % of patients treated with PVI were in SR , whereas at the 3-year follow-up , 19 % maintained SR ; using the PVI plus LL with a single procedure at the 12-month follow-up 45 % of patients were in SR , whereas at the 3-year follow-up , 41 % remained in SR . After a second procedure , the long-term overall success rate without antiarrhythmic drugs was 39 % with PVI and 75 % with PVI plus LL . Conclusions —A long-term follow-up of AF ablation shows that short-term results can not be considered permanent because AF recurrences are still present after the first year especially in patients who have had “ PVI ” strategy . PVI isolation plus LL is superior to the PVI strategy in maintaining SR without antiarrhythmic drugs after procedures 1 and 2 both in paroxysmal and persistent AF OUTPUT:

Catheter ablation of AF safety and efficacy in DM patients is similar to general population , especially when performed in younger patients with satisfactory glycemic control . Catheter ablation of AF reduces the amount of patients requiring AADs , an additional benefit in this population commonly exposed to adverse effects of AF pharmacological treatments

MS2_fixed_5_shot1964

***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 Blood pressure control can reduce the risk of coronary heart disease ( CHD ) among diabetic patients ; however , it is not known whether the lowest risk of CHD is among diabetic patients with the lowest blood pressure level . RESEARCH DESIGN AND METHODS We performed a prospect i ve cohort study ( 2000–2009 ) on diabetic patients including 17,536 African Americans and 12,618 whites . Cox proportional hazards regression models were used to estimate the association of blood pressure with CHD risk . RESULTS During a mean follow-up of 6.0 years , 7,260 CHD incident cases were identified . The multivariable-adjusted hazard ratios of CHD associated with different levels of systolic/diastolic blood pressure at baseline ( < 110/65 , 110–119/65–69 , 120–129/70–80 , and 130–139/80–90 mmHg [ reference group ] ; 140–159/90–100 ; and ≥160/100 mmHg ) were 1.73 , 1.16 , 1.04 , 1.00 , 1.06 , and 1.11 ( P trend < 0.001 ) , respectively , for African American diabetic patients , and 1.60 , 1.27 , 1.08 , 1.00 , 0.95 , and 0.99 ( P trend<0.001 ) for white diabetic patients , respectively . A U-shaped association of isolated systolic and diastolic blood pressure at baseline as well as blood pressure during follow-up with CHD risk was observed among both African American and white diabetic patients ( all Ptrend < 0.001 ) . The U-shaped association was present in the younger age-group ( 30–49 years ) , and this U-shaped association changed to an inverse association in the older age-group ( OUTPUT:

CONCLUSIONS Antihypertensive treatment reduces the risk of mortality and cardiovascular morbidity in people with diabetes mellitus and a systolic blood pressure more than 140 mm Hg . If systolic blood pressure is less than 140 mm Hg , however , further treatment is associated with an increased risk of cardiovascular death , with no observed benefit

MS2_fixed_5_shot1965

***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 examine whether cycled lighting ( CL ) conditions during neonatal care in very preterm infants ( < 32 weeks ’ gestational age [ GA ] ) decrease crying and fussing behavior , improve the consolidation of sleep , and influence activity behavior at 5 and 11 weeks ’ postterm corrected age ( CA ) compared with preterm infants cared for in dim lighting ( DL ) conditions . METHODS : Thirty-seven preterm infants were r and omly assigned to CL ( 7 am–7 pm lights on , 7 pm–7 am lights off [ n = 17 ; mean GA : 30.6 ± 0.95 weeks ; 9 girls ] ) or DL ( lights off whenever the child is asleep [ n = 20 ; GA : 29.5 ± 2.1 weeks ; 8 girls ] ) conditions . Sleeping , crying , and activity behavior was recorded by using parental diaries and actigraphy at 5 and 11 weeks ’ CA . RESULTS : A significant reduction of fussing ( 59.4 minutes/24 hours [ ±25.8 minutes ] ) and crying ( 31.2 minutes/24 hours [ ±14.4 minutes ] ) behavior and a trend to higher motor activity during daytime was found in CL-exposed infants at 5 and 11 weeks ’ CA compared with infants cared for in DL conditions . No significant difference between groups was observed for sleep behavior at 5 and 11 weeks ’ CA . Infants in CL conditions showed a trend to improved daily weight gain ( average : 3.6 g/d ) during neonatal care compared with DL conditions . CONCLUSIONS : CL conditions in neonatal care have beneficial effects on infant ’s fussing and crying behavior and growth in the first weeks of life . This study supports the introduction of CL care in clinical neonatal practice Day-night cycled light improves health outcomes in preterm infants , yet the best time to institute cycled light is unclear . The hypothesis of this study was that extremely preterm infants receiving early cycled light would have better health and OUTPUT:

Conclusion Current evidence suggests that developmental care in only NICU setting could have significant effect on mental and motor development of preterm infants , especially at 12 months of age .

MS2_fixed_5_shot1966

***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 Nonalcoholic fatty liver disease ( NAFLD ) is one of the most common reasons of enzyme increase in liver . In About 10 percent of patients with NAFLD , the disease progresses toward Non Alcoholic Steatohepatitis ( NASH ) and about one third of them may progress toward cirrhosis , liver dysfunction , and even hepatocellular carcinoma . Objectives According to high prevalence of NAFLD and the fact that there is no consensus on treatment of this disease , the aim of this study was to assess the effects of metformin , pioglitazone , and silymarin on treatment of NAFLD . Patients and Methods Sixty six patients with NAFLD who were presented in the Endocrinology and Metabolism clinic of Boo’ali Hospital , Qazvin , Iran , were assigned r and omly into three groups ( n = 22 ) . First group was treated by pioglitazone 15 mg/d , second group by metformin 500 mg/d , and third group by silymarin 140 mg/d . All patients underwent clinical and biochemical evaluations including weight , fasting blood sugar ( FBS ) , lipid profiles , body mass index ( BMI ) , aspartate aminotransferase ( AST ) , alanine aminotransferase ( ALT ) , and serum insulin levels in pre- and post-intervention after eight-week follow up . Results Before the treatment there was no significant difference between three groups with respect to average age , BMI and gender , FBS , lipid profile , AST , ALT , serum insulin level , and Homeostasis Model Assessment ( HOMA ) index for insulin resistance . After the intervention , a significant reduction was observed in average amount of FBS , lipid profile , ALT , AST , serum insulin level and HOMA index in three groups ( P < 0.01 ) . The most reduction in average FBS , TG , serum insulin level , and HOMA index was observed in pioglitazone group , the most reduction in average amount of cholesterol was seen in metformin group , OUTPUT:

There was no significant change in the γGT levels . Significant differences were not found . CONCLUSION Silymarin minimally reduced , but without clinical relevance , the serum levels of ALT and AST .

MS2_fixed_5_shot1967

***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: Cancer patients are commonly associated with various physical and psychological symptoms . In palliative setting , the aims are to relieve those symptoms , improve quality of life , and increase medication adherence among cancer patients . Antidepressants are generally accepted for the treatment of depression among patients with or without cancer . Some other potential benefits of the antidepressants have been reported in cancer patients . OBJECTIVE This study aims to review the use of antidepressants for physical and psychological symptoms in cancer patients . RESULTS Our findings showed the mixed result of positive and negative findings in various symptoms associated with cancer patients . These studies are categorised according to the hierarchy of evidence from high to low level , namely r and omised controlled trials , cohort studies , case-control studies , case series , case reports , as well as other type of publications . The majority of antidepressants used in cancer patients seem to be beneficial for the treatment of depression , anxiety , hot flashes and other symptoms such as sexual dysfunction , fatigue , nicotine dependence , vasomotor symptoms , executive functions , sleep problems , pruritus , as well as for hypochondriasis . While fluoxetine was found to be associated with the reduction of antiemetic property in ondansetron , mirtazapine was identified to be a good alternative in treating nausea and cachexia among cancer patients . CONCLUSION More research studies with adequate statistical power are warranted to vali date the use of antidepressants among cancer patients in treating these physical and psychological symptoms & NA ; Pain intensity is frequently measured on an 11‐point pain intensity numerical rating scale ( PI‐NRS ) , where 0=no pain and 10=worst possible pain . However , it is difficult to interpret the clinical importance of changes from baseline on this scale ( such as a 1‐ or 2‐point change ) . To date , there are no data driven estimates for clinical ly important differences in pain intensity scales used for chronic pain studies . We have estimated a clinical ly important difference on this scale by relating it to global assessment s of change in multiple studies of chronic pain . Data on 2724 subjects from 10 recently completed placebo OUTPUT:

However , mirtazapine showed effectiveness in treating depression , anxiety , sleep disorders , emesis and neuropathic pain . Across all studies , mirtazapine is safe to use , with drowsiness and dizziness the most common side-effects .

MS2_fixed_5_shot1968

***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: Positive psychotic symptoms , such as threat/"control-override " delusions or comm and hallucinations , have been related to aggression in patients with schizophrenia . However , retrospective data collection has hampered evaluation of the direct influence of psychopathology on aggressive behavior . In this study , we monitored aggressive behavior and psychopathology prospect ively and in close temporal proximity in 157 treatment-resistant in patients diagnosed with chronic schizophrenia or schizoaffective disorder participating in a 14-week double-blind clinical trial . Aggressive behavior was rated with the overt aggression scale ( OAS ) . Psychopathology was assessed using the positive and negative syndrome scale ( PANSS ) . At baseline , subjects who would be aggressive during the study had higher scores on only two PANSS items : hostility and poor impulse control . During the study PANSS positive subscale scores were significantly higher in aggressive subjects . Total PANSS scores were higher within 3 days of an aggressive incident , as were positive and general psychopathology subscale scores . However , in a smaller sub sample for whom PANSS ratings were available within 3 days before aggressive incidents , only scores on the PANSS positive subscale were significantly higher . These findings in chronic , treatment resistant in patients support the view that positive symptoms may lead to aggression 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 exac OUTPUT:

MAIN RESULTS We have no good- quality evidence of the absolute effectiveness of haloperidol for people with long-term aggression . When haloperidol was compared with olanzapine or clozapine , skewed data ( n=83 ) at high risk of bias suggested some advantage in terms of scale scores of unclear clinical meaning for olanzapine/clozapine for ' total aggression ' . Although there were some data for the outcomes listed above , there were no data on most of the binary outcomes and none on service outcomes ( use of hospital/police ) , satisfaction with treatment , acceptance of treatment , quality of life or economics .

MS2_fixed_5_shot1969

***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 Increased levels of the inflammatory biomarker high-sensitivity C-reactive protein predict cardiovascular events . Since statins lower levels of high-sensitivity C-reactive protein as well as cholesterol , we hypothesized that people with elevated high-sensitivity C-reactive protein levels but without hyperlipidemia might benefit from statin treatment . METHODS We r and omly assigned 17,802 apparently healthy men and women with low-density lipoprotein ( LDL ) cholesterol levels of less than 130 mg per deciliter ( 3.4 mmol per liter ) and high-sensitivity C-reactive protein levels of 2.0 mg per liter or higher to rosuvastatin , 20 mg daily , or placebo and followed them for the occurrence of the combined primary end point of myocardial infa rct ion , stroke , arterial revascularization , hospitalization for unstable angina , or death from cardiovascular causes . RESULTS The trial was stopped after a median follow-up of 1.9 years ( maximum , 5.0 ) . Rosuvastatin reduced LDL cholesterol levels by 50 % and high-sensitivity C-reactive protein levels by 37 % . The rates of the primary end point were 0.77 and 1.36 per 100 person-years of follow-up in the rosuvastatin and placebo groups , respectively ( hazard ratio for rosuvastatin , 0.56 ; 95 % confidence interval [ CI ] , 0.46 to 0.69 ; P<0.00001 ) , with corresponding rates of 0.17 and 0.37 for myocardial infa rct ion ( hazard ratio , 0.46 ; 95 % CI , 0.30 to 0.70 ; P=0.0002 ) , 0.18 and 0.34 for stroke ( hazard ratio , 0.52 ; 95 % CI , 0.34 to 0.7 OUTPUT:

Considering a reasonable WTP threshold , intermediate dose statin therapy is economically attractive , and should be a priority intervention in prevention of cardiovascular events in Brazil

MS2_fixed_5_shot1970

***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 —Arterial distensibility measures , generally from pulse-wave velocity ( PWV ) , are widely used with little knowledge of relationships to patient outcome . We tested whether aortic PWV predicts cardiovascular and all-cause mortality in type 2 diabetes and glucose-tolerance – tested ( GTT ) multiethnic population sample s. Methods and Results — Participants were r and omly sample d from ( 1 ) a type 2 diabetes outpatient clinic and ( 2 ) primary care population registers , from which nondiabetic control subjects were given a GTT . Brachial blood pressures and Doppler-derived aortic PWV were measured . Mortality data over 10 years ’ follow-up were obtained . At any level of systolic blood pressure ( SBP ) , aortic PWV was greater in subjects with diabetes than in controls . Mortality risk doubled in subjects with diabetes ( hazard ratio 2.34 , 95 % CI 1.5 to 3.74 ) and in those with glucose intolerance ( 2.12 , 95 % CI 1.11 to 4.0 ) compared with controls . For all groups combined , age , sex , and SBP predicted mortality ; the addition of PWV independently predicted all-cause and cardiovascular mortality ( hazard ratio 1.08 , 95 % CI 1.03 to 1.14 for each 1 m/s increase ) but displaced SBP . Glucose tolerance status and smoking were other independent contributors , with African-Caribbeans experiencing reduced mortality risk ( hazard ratio 0.41 , 95 % CI 0.25 to 0.69 ) . Conclusions —Aortic PWV is a powerful independent predictor of mortality in both diabetes and GTT population sample s. In displacing SBP as a prognostic factor , aortic PWV is probably further along the causal pathway for arterial disease and may represent a useful integrated index of vascular status and hence cardi OUTPUT:

Identified evidence suggests that cardiovascular disease ( CVD ) prevention services should consider regulation of blood glucose as a key target for intervention .

MS2_fixed_5_shot1971

***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: Reports in the surgical literature are conflicting as to whether appendectomy " in passing " during laparotomy for trauma or for some other disease state does or does not significantly increase patient morbidity or mortality . A chart survey of all appendectomies ( 342 for acute appendicitis and 146 as incidental procedures ) performed on the trauma service of Grady Memorial Hospital over a 40 month period appeared to indicate that the wound infection rate ( 6.8 percent ) was the same as that for acute simple or suppurative appendicitis ( 6.7 percent ) , whereas the intraabdominal sepsis rate ( 17.5 percent ) paralleled that for more advanced gangrenous or perforative appendicitis ( 18.6 percent ) . Since the validity of a retrospective review is always open to question , a prospect i ve , r and omized trial was carried out only on patients with a negative abdominal exploration for trauma over a 22 month interval at the same trauma service . An odd second from the last digit hospital number dictated appendectomy , provided the appendix was readily accessible ; an even digit in the same locus dictated retention of the appendix . In no patient did intraperitoneal sepsis develop , regardless of the procedure chosen . Wound infection rates were 1.8 percent for appendectomy ( 1 of 56 ) , if local anatomic considerations precluded an easy appendectomy ( 0 of 45 ) , and 3.6 percent for the control subjects without appendectomy ( 3 of 83 ) . There were no deaths . These data cast considerable doubt on the reliability of retrospective review s and support the generally accepted dictum that incidental appendectomy , especially in the trauma patient , can be a relatively innocuous procedure We undertook a prospect i ve study of the effect of incidental appendectomy on the safety of cholecystectomy in patients under the age of 50 years . One hundred twenty patients were r and omized to have either cholecystectomy alone or cholecystectomy and appendectomy . All patients received preoperative antibiotic cover . OUTPUT:

Morbidity was minimal at all ages . : The data from the current survey and literature review support incidental removal of the appendix in the young patient ( < 35 years old ) . However , routine incidental appendectomy can not be justified in patients greater than age 50

MS2_fixed_5_shot1972

***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 : Follow-up study of seven individuals with spinal cord injury ( SCI ) who completed a 9-month r and omized control trial ( RCT ) of exercise training . Objective : In a 9-month RCT conducted in our lab , individuals with SCI who participated in a twice-weekly supervised exercise training reported greater perceived quality of life ( PQOL ) , and less stress and pain than a nonexercising control cohort . The present follow-up study examined the voluntary continuation of exercise training after the study ended and the persistence of the accrued psychosocial benefits . Setting : Centre for Health Promotion and Rehabilitation , McMaster University , Hamilton , Ontario , Canada . Methods : Five men and two women ( age 42.3±3.6 years ) with SCI ( C5–T12 ; ASIA A – D 12.7±8.2 years postinjury ) were invited to continue supervised exercise training twice weekly at the completion of the 9-month RCT . Exercise adherence , PQOL , stress and bodily pain were measured at a 3-month follow-up and were compared to values obtained at baseline , and at 3 , 6 and 9 months during the intervention . Results : There was a significant decrease in adherence at the 3-month follow-up compared to the overall 9-month adherence rate ( 42.7 versus 80.6 % , respectively ; P<0.01 ) . There was also a significant decrease in PQOL ( P<0.05 ) and a trend for increased pain ( P=0.07 ) and stress ( P=0.12 ) , at follow-up compared to the end of the 9-month trial . Finally , there was a significant negative correlation between pain at the conclusion of the RCT and exercise adherence over the 3-month follow-up period ( r=−0.91 ; P<0.01 ) . Conclusions : These findings emphasize the importance of continued exercise adherence to the maintenance of exercise-related increases in psychological well-being among individuals with SCI The purpose of this study is to assess satisfaction with life domains in people with spinal cord injuries ( S OUTPUT:

Although there was a lack of consensus among the selected studies , the majority of them presented a strong correlation between physical activity and variables of quality of life and /or functional independence . Thus , physical activity appears to have an important influence on social relationships , functional independence , psychological factors , and physical aspects , which can enhance quality of life and independence in the performance of daily activities

MS2_fixed_5_shot1973

***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 analysed self-reported cold data for 95 pairs of identical twins who took part in a double-blind trial of vitamin C tablets . One member of each twin pair took vitamin C and the other took a well matched placebo each day for 100 days . Vitamin C had no significant effect except for shortening the average duration of cold episodes by 19 % Three hundred eleven employees of the National Institutes of Health volunteered to take 1 gm of ascorbic acid or lactose placebo in capsules three times a day for nine months . At the onset of a cold , the volunteers were given an additional 3 gm daily of either a placebo or ascorbic acid . One hundred ninety volunteers completed the study . Dropouts were defined as those who missed at least one month of drug ingestion . They represented 44 % of the placebo group and 34 % of those taking ascorbic acid . Analysis of these data showed that ascorbic acid had at best only a minor influence on the duration and severity of colds , and that the effects demonstrated might be explained equally well by a break in the double blind During 7 weeks in the spring of 1973 a double-blind pilot study on 172 children in the age group 8 - 9 was carried out to test the possible effect of 1000 mg vitamin C daily as a prophylactic agent against common colds . During the autumn of 1973 , a main study was carried out on 642 children of the same age . The investigations had the same pattern and lasted for 3 months . Both studies have been processed on the same principles . The results were somewhat divergent but , like previously published studies on children , seemed to indicate that the duration and severity of the cold were reduced while , on the other h and , the incidence remained unaltered or indeed increased . The total number of days of upper respiratory tract infection was smaller for the vitamin C group only in the pilot study ( not in the main study ) . No proven biochemical effects were obtained . Preventive treatment of healthy children with vitamin C in large doses this had no definitely proved effect against colds METHOD A large number of women living in two towns in South OUTPUT:

Vitamin C in doses as high as one gram daily for several winter months , had no consistent beneficial effect on incidence of the common cold . For both preventive and therapeutic trials , there was a consistently beneficial but generally modest therapeutic effect on duration of cold symptoms . There was no clear indication of the relative benefits of different regimes or vitamin C doses . However in trials that tested vitamin C after cold symptoms occurred , there was some evidence that a large dose produced greater benefits than lower doses . REVIEW ER 'S CONCLUSIONS Long term daily supplementation with vitamin C in large doses daily does not appear to prevent colds .

MS2_fixed_5_shot1974

***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 This study evaluated the effect of a atorvastatin-fenofibrate combination on lipid profile , in comparison to each drug alone , in patients with type 2 diabetes and combined hyperlipidemia ( CHL ) . RESEARCH DESIGN AND METHODS A total of 120 consecutive patients , who were free of coronary artery disease ( CAD ) at entry , were studied for a period of 24 weeks . These patients were r and omly assigned to atorvastatin ( 20 mg/day , n = 40 ) , micronized fenofibrate ( 200 mg/day , n = 40 ) , or a combination of both ( atorvastatin 20 mg/day plus fenofibrate 200 mg/day , n = 40 ) . The effect of treatment on LDL cholesterol , triglycerides ( TGs ) , HDL cholesterol , apolipoprotein A-I and B , lipoprotein(a ) , and plasma fibrinogen ( PF ) was recorded . Moreover , the percentage of patients that reached the American Diabetes Association treatment goals and the estimated CAD risk status were calculated . RESULTS No patient was withdrawn from the study because of side effects . The atorvastatin-fenofibrate combination reduced total cholesterol by 37 % , LDL cholesterol by 46 % , TGs by 50 % , and PF by 20 % , whereas it increased HDL cholesterol by 22 % ( P < 0.0001 for all ) . These changes were significantly better than those of both monotherapies . Of the patients on drug combination , 97.5 % reached the LDL cholesterol treatment goal of < 100 mg/dl , 100 % reached the desirable TG levels of < 200 mg/dl , and 60 % reached the optimal HDL cholesterol levels of > 45 mg/dl . These rates were significantly higher than those of both monotherapies . Combined treatment reduced the 10-year probability for myocard OUTPUT:

Monotherapy with either fibrates or statins suggested a significantly greater effect of fibrates in lowering plasma Fib concentrations . According to these findings , mechanisms associated with fibrinogen metabolism might be responsible for the distinct effects of statins and fibrates in reducing cardiovascular endpoints

MS2_fixed_5_shot1975

***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 Both low back pain ( LBP ) and neck pain ( NP ) are major occupational health problems . In the workplace , participatory ergonomics ( PE ) is frequently used on musculoskeletal disorders . However , evidence on the effectiveness of PE to prevent LBP and NP obtained from r and omised controlled trials ( RCTs ) is scarce . This study evaluates the process of the Stay@Work participatory ergonomics programme , including the perceived implementation of the prioritised ergonomic measures . Methods This cluster- RCT was conducted at the departments of four Dutch companies ( a railway transportation company , an airline company , a steel company , and a university including its university medical hospital ) . Directly after the r and omisation outcome , intervention departments formed a working group that followed the steps of PE during a six-hour working group meeting . Guided by an ergonomist , working groups identified and prioritised risk factors for LBP and NP , and composed and prioritised ergonomic measures . Within three months after the meeting , working groups had to implement the prioritised ergonomic measures at their department . Data on various process components ( recruitment , reach , fidelity , satisfaction , and implementation components , i.e. , dose delivered and dose received ) were collected and analysed on two levels : department ( i.e. , working group members from intervention departments ) and participant ( i.e. , workers from intervention departments ) . Results A total of 19 intervention departments ( n = 10 with mental workloads , n = 1 with a light physical workload , n = 4 departments with physical and mental workloads , and n = 4 with heavy physical workloads ) were recruited for participation , and the reach among working group members who participated was high ( 87 % ) . Fidelity and satisfaction towards the PE programme rated by the working group members was good ( 7.3 or higher ) . The same was found for the Stay@Work ergocoach training ( 7.5 or higher ) . In total , 66 ergonomic measures were prioritised by the working groups . Altogether , 34 % of all prioritised ergonomic measures were perceived as implemented ( do OUTPUT:

We found inconsistent evidence that the use of an arm support or an alternative mouse may or may not reduce the incidence of neck or shoulder MSDs . For other physical ergonomic interventions there is no evidence of an effect . For organisational interventions , in the form of supplementary breaks , there is very low- quality evidence of an effect on upper limb discomfort . For training and multifaceted interventions there is no evidence of an effect on upper limb pain or discomfort .

MS2_fixed_5_shot1976

***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 safety of 4-g 5-aminosalicylic acid enemas were assessed in 153 patients with ulcerative colitis involving up to 50 cm of distal colon . Seventy-six patients received active medication and 77 received a placebo . There were 20 dropouts ( 6 in the active group and 14 in the placebo group ) during the study because of insufficient efficacy . After 6 wk of therapy , 48 of the 76 patients ( 63 % ) receiving 5-aminosalicylic acid were considered to be " much improved " by the study physician compared to 22 of the 77 patients ( 29 % ) on placebo ( p = 0.001 ) . A disease activity index based on patient symptoms and sigmoidoscopic appearance was used to assess efficacy . Mean disease activity index declined 55 % for patients on 5-aminosalicylic acid and 24 % for patients on placebo ( p = 0.0001 ) . Analysis of subgroups indicated that patients most likely to respond were those with disease confined to the 20 - 40 cm from the anus . Response was not affected by concurrent sulfasalazine , but patients requiring concurrent oral steroids had a diminished response . Rapid onset of efficacy was shown by a significant reduction in rectal bleeding within 3 days of treatment initiation . 5-Aminosalicylic acid enemas are well tolerated and are of benefit in the treatment of ulcerative colitis confined to the distal colon Purpose Ulcerative colitis ( UC ) is associated with impaired health-related quality of life ( HRQL ) and work-related outcomes ( WRO ) . This analysis examined correspondences among measures of HRQL and WRO in patients with UC , as well as the magnitude of each measure ’s responsiveness to disease activity and treatment . Methods An open-label , prospect i ve trial of delayed-release mesalamine tablets formulated with MMX ® technology included 8 weeks of treatment for patients with active mild-to-moderate UC ( n = 137 ) and 12 months of OUTPUT:

The evidence supports the WPAI as having test-retest reliability ( reproducibility ) over time ; convergent validity , as indicated by moderate correlations with measures of quality of life and moderate-to-strong correlations with measures of disease activity ; known-groups validity , as indicated by differences in WPAI scores between patients with active and inactive disease ; ability ( sensitivity ) to detect change , as indicated by substantial improvement in scores for patients who achieve remission , accompanied by substantial worsening of scores for patients who relapse ; and , responsiveness to treatment , with improvements in scores following treatments that reduce disease activity .

MS2_fixed_5_shot1977

***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 Only a few prospect i ve studies have examined the relationship between the frequency of cigarette smoking and the incidence of diabetes mellitus . The purpose of this study was to determine whether greater frequency of cigarette smoking accelerated the development of diabetes mellitus , and whether quitting reversed the effect . METHODS Data were collected in the Cancer Prevention Study I , a prospect i ve cohort study conducted from 1959 through 1972 by the American Cancer Society where volunteers recruited more than one million acquaintances in 25 US states . From these over one million original participants , 275,190 men and 434,637 women aged > or = 30 years were selected for the primary analysis using predetermined criteria . RESULTS As smoking increased , the rate of diabetes increased for both men and women . Among those who smoked > or = 2 packs per day at baseline , men had a 45 % higher diabetes rate than men who had never smoked ; the comparable increase for women was 74 % . Quitting smoking reduced the rate of diabetes to that of non-smokers after 5 years in women and after 10 years in men . CONCLUSIONS A dose-response relationship seems likely between smoking and incidence of diabetes . Smokers who quit may derive substantial benefit from doing so . Confirmation of these observations is needed through additional epidemiological and biological research Puerto Ricans living in the United States mainl and present multiple disparities in prevalence of chronic diseases , relative to other racial and ethnic groups . Allostatic load ( AL ) , or the cumulative wear and tear of physiological responses to stressors such as major life events , social and environmental burden , has been proposed as a possible mechanism for the inequalities observed in minority groups , but has not been studied in Puerto Ricans . The aim of this study was to determine the association of AL to six chronic diseases ( abdominal obesity , hypertension , diabetes , and self-reported cardiovascular disease ( CVD ) , arthritis and cancer ) in Puerto Ricans , and to contrast OUTPUT:

Lifestyle coping behaviours therefore have a significant contribution to AL . This study is among the first to explore multiple domains of HRB in relation to AL .

MS2_fixed_5_shot1978

***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 BACKGROUND AND PURPOSE Limited evidence exists on the benefits of organized care for improving risk factor control in patients with stroke or transient ischaemic attack . The effectiveness of an individualized management programme in reducing absolute cardiovascular disease risk in this high-risk population was determined . METHODS This was a prospect i ve , multicentre , cluster-r and omized controlled trial with blinded assessment of outcomes and intention-to-treat analysis . Patients hospitalized for stroke/transient ischaemic attack and aged ≥18 years were recruited from four hospitals . General practice s treating recruited patients were r and omized to provide OUTPUT:

The overall best evidence syntheses showed moderate quality evidence that lifestyle interventions do not lead to significant improvements in the physical activity level of people with stroke or TIA . There is low quality evidence that lifestyle interventions that specifically target physical activity are effective at improving the levels of physical activity of people with stroke or TIA . Based on the results of this review , general lifestyle interventions on their own seem insufficient in improving physical activity levels after stroke or TIA . Lifestyle interventions that specifically encourage increasing physical activity may be more effective .

MS2_fixed_5_shot1979

***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 Background There has been increasing interest in performing total hip arthroplasty ( THA ) with minimally invasive surgery ( MIS ) . This study was conducted to examine the effectiveness of MIS-THA using the new two-incision OUTPUT:

The meta- analysis of the current evidence base showed that minimally invasive THA is associated with a significantly increased risk of transient lateral femoral cutaneous nerve palsy ( p = 0.006 ) with no significantly better outcome

MS2_fixed_5_shot1980

***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 Daily injections are required for growth hormone ( GH ) replacement therapy , which may cause low compliance as a result of inconvenience and distress in patients . Objective C-terminal peptide-modified human GH ( MOD-4023 ) is developed for once-a-week dosing regimen in GH-deficient ( GHD ) adults and children . The present trial was a safety and dose-finding study for weekly MOD-4023 in GHD children . Design A multicenter , open-label , r and omized , controlled phase 2 study in children with GHD , evaluating the safety , tolerability , pharmacokinetics/pharmacodynamics , and efficacy of three different weekly MOD-4023 doses , compared with daily recombinant human GH ( r-hGH ) . Setting The trial was conducted in 14 endocrinology centers in Europe . Patients Fifty-three prepubertal children with GHD completed 12 months of treatment with either MOD-4023 ( N = 42 ) or r-hGH ( N = 11 ) . Interventions C-terminal peptide-modified hGH ( MOD-4023 ) was administered weekly at a dose of either 0.25 , 0.48 , or 0.66 mg/kg/wk and compared with daily hGH at a dose of 0.24 mg/kg/wk . Results MOD-4023 showed an estimated half-life approximately fivefold to 10-fold longer when compared with daily r-hGH . Insulin-like growth factor (IGF)-I and IGF-binding peptide 3 showed a dose-dependent increase during MOD-4023 treatment . IGF-I st and ard deviation score for MOD-4023 did not exceed + 2 . All MOD-4023 cohorts demonstrated adequate catch-up growth . The 0.66 mg/kg/wk dose demonstrated efficacy closest to daily r-hGH . No serious adverse events were observed OUTPUT:

Conclusions There is no evidence to support differences in the effects of long-acting GH compared with those of daily GH .

MS2_fixed_5_shot1981

***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 series of 80 patients with cervical , trochanteric or subtrochanteric hip fractures were r and omized to either treatment without traction , skin traction , or skeletal traction during the 1883 h between admission and operation . The institution of skin or skeletal traction was not particularly painful for the patient , but we found no indication that either was of discernible benefit . The number of analgesic medications needed was no higher in patients without traction . We conclude that traction should not be administered routinely to patients awaiting operation for hip fracture We r and omised 50 patients with extracapsular fractures of the femoral neck to receive either a bupivacaine femoral nerve block or systemic analgesia alone . A femoral nerve block was found to be an easy and effective procedure which significantly reduced perioperative analgesic requirements and postoperative morbidity Background : Hip fracture surgery usually carries a high dem and for rehabilitation and a significant risk of perioperative morbidity and mortality . Postoperative epidural analgesia may reduce morbidity and has been shown to facilitate rehabilitation in elective orthopedic procedures . No studies exist on the effect of postoperative epidural analgesia on pain and rehabilitation after hip fracture surgery . Methods : Sixty elderly patients were included in a r and omized , double-blind study comparing 4 days of continuous postoperative epidural infusion of 4 ml/h bupivacaine , 0.125 % , and 50 & mgr;g/ml morphine versus placebo . Both patient groups received balanced analgesia and intravenous nurse-controlled analgesia with morphine . All patients followed a well-defined multimodal rehabilitation program . Pain , ability to participate in four basic physical functions , and any factors restricting participation were assessed on the first 4 postoperative days during physiotherapy . Results : Epidural analgesia provided superior dynamic analgesia during all basic physical functions , and patients were significantly less restricted by pain , which was the dominating restricting factor in the placebo group . OUTPUT:

Overall , moderate evidence suggests that nerve blockades are effective for relieving acute pain and reducing delirium . Low-level evidence suggests that preoperative traction does not reduce acute pain . Nerve blockade seems to be effective in reducing acute pain after hip fracture . Sparse data preclude firm conclusions about the relative benefits or harms of many other pain management interventions for patients with hip fracture .

MS2_fixed_5_shot1982

***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 According to previous studies , probiotic and prebiotic supplementation have desirable effects on glycemic parameters . Thus far , the effect of supplementation on the glycemic parameters and adipokines in non-alcoholic fatty liver disease ( NAFLD ) has not been assessed . Therefore , the aim of this study was to determine the effects of supplementation with probiotic and prebiotic on adiokines and glycemic parameters in the patients with NAFLD . METHODS In the present r and omized , double-blind , placebo-controlled trial , 89 patients with NAFLD were r and omly divided into three groups to receive one probiotic capsule + 16 g/d maltodextrin ( probiotic group ) or 16 g/d oligofructose powder + one placebo capsule ( prebiotic group ) , and one placebo capsule + 16 g/d maltodextrin ( control group ) for 12 weeks . All the subjects in the study were advised to follow the weight loss diet and physical activity recommendations during the intervention . Fasting blood sample s were taken at baseline and after the intervention to measure leptin , adiponectin , insulin , and fasting blood sugar . RESULTS At the end of the study , serum concentrations of leptin , insulin , and HOMA-IR decreased significantly in the probiotic and prebiotic groups compared with the control group . Despite the changes within the groups , serum concentrations of adiponectin did not change significantly between the three groups . Also , fasting blood sugar did not change between the groups , but decreased in the prebiotic group . Quantitative insulin-sensitivity check index ( QUICKI ) increased significantly in probiotic and prebiotic groups compared with the control group . CONCLUSION Probiotic and prebiotic supplementation along with lifestyle intervention has a favorable impact on glycemic parameters and leptin levels compared with lifestyle intervention alone Objective : To study the clinical effect of probiotics in the treatment of non-alcoholic fatty liver disease ( NAFLD OUTPUT:

Conclusion : Probiotic treatment or supplementation is a promising therapeutic method for NAFLD

MS2_fixed_5_shot1983

***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 Sedentary activities , such as watching television , may disrupt habituation to food cues , thereby increasing motivation to eat and energy intake . OBJECTIVE These experiments were design ed to examine the effect of television watching on habituation of ingestive behavior in children . DESIGN In experiment 1 , all children worked for access to cheeseburgers in trials 1 - 7 ( habituating stimulus ) . In trials 8 - 10 , children in the control group continued to work for cheeseburgers without any dishabituating stimuli , whereas children in the other groups received either a novel food ( French fries ) or television as dishabituating stimuli . Responding for food and amount of food eaten were measured . In experiment 2 , all children had access to 1000 kcal of a preferred snack food . One group watched a continuous television show , and the control groups either watched no television or watched a repeated segment of a television show , which controls for the television stimulus but requires reduced allocation of attention . RESULTS In experiment 1 , both the novel food and the television watching groups reinstated responding for food ( P = 0.009 ) and increased the amount of energy earned ( P = 0.018 ) above the level of the control subjects . In experiment 2 , the continuous television group spent more time eating ( P < 0.0001 ) and consumed more energy than the no television and the repeated segment groups ( P = 0.007 ) . CONCLUSION These experiments show that television watching can dishabituate eating or disrupt the development of habituation , which may provide a mechanism for increased energy intake associated with watching television PURPOSE Although moderate-to-vigorous physical activity is related to premature mortality , the relationship between sedentary behaviors and mortality has not been fully explored and may represent a different paradigm than that associated with lack of exercise . We prospect ively examined sitting time and mortality in a representative sample of 17,013 Canadians 18 - 90 yr of age . METHODS Evaluation of daily sitting time ( almost none of the time , one fourth of the time , OUTPUT:

Sedentary behaviour continues to be associated with unhealthy diet in young people in mostly cross-sectional studies .

MS2_fixed_5_shot1984

***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: Almonds , together with other nuts , reduce serum cholesterol levels and may reduce the risk of coronary heart disease . There is much current interest in the relation of coronary heart disease to postpr and ial events . We have therefore assessed the effects of varying amounts of almonds on the postpr and ial blood glucose response to a carbohydrate meal . Our aim was to assess the effect of adding almonds to a bread meal . Nine healthy volunteers ( 2 women , 7 men ; mean age , 27.8 years ; mean body mass index , 22.9 kg/m2 ) were r and omly fed with 3 test meals and 2 white bread control meals on separate days . Subjects were fed the meals after a 10- to 12-hour overnight fast . Each meal contained 50 g of available carbohydrate from white bread eaten alone or with 30 , 60 , or 90 g ( approximately 1 , 2 , or 3 oz ) of almonds . Capillary finger-prick blood sample s for glucose analysis were obtained at 0 , 15 , 30 , 45 , 60 , 90 , and 120 minutes . Glycemic responses were assessed by calculating the incremental area under the 2-hour blood glucose curve . The addition of almonds to white bread result ed in a progressive reduction in the glycemic index of the composite meal in a dose-dependent manner for the 30-g ( 105.8 + /- 23.3 ) , 60-g ( 63.0 + /- 9.0 ) , and 90-g ( 45.2 + /- 5.8 ) doses of almonds ( r = -0.524 , n = 36 , P = .001 ) . We conclude that , in addition to lowering serum cholesterol levels , almonds may also reduce the glycemic impact of carbohydrate foods with which they are eaten Nut consumption reduces cardiovascular risk , and reductions in blood OUTPUT:

There was no effect on waist circumference , high-density lipoprotein cholesterol or blood pressure with the direction of effect favouring tree nuts for waist circumference . Pooled analyses show a MetS benefit of tree nuts through modest decreases in triglycerides and fasting blood glucose with no adverse effects on other criteria across nut types .

MS2_fixed_5_shot1985

***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 identify the most responsive method of measuring gait speed , to estimate the responsiveness of other outcome measures , and to determine whether gait speed predicts discharge destination in acute stroke . DESIGN A prospect i ve cohort study . SETTING Five acute-care hospitals . PATIENTS Fifty subjects with residual gait deficits after a first-time stroke . INTERVENTIONS Five- ( 5mWT ) and 10-meter walk tests ( 10mWT ) at comfortable and maximum speeds , with 2 evaluations conducted an average + /- st and ard deviation ( SD ) of 8 + /- 3 and 38 + /- 5 days poststroke . MAIN OUTCOME MEASURE St and ardized response mean ( SRM = mean change/SD of change ) was used to estimate responsiveness for each walk test , the Berg Balance Scale , the Barthel Index , the Stroke Rehabilitation Assessment of Movement ( STREAM ) , and the Timed Up and Go ( TUG ) . RESULTS The SRMs were 1.22 and 1.00 for the 5mWT , and .92 and .83 for the 10mWT performed at a comfortable and maximum pace , respectively . The SRMs for the Berg Balance Scale , the Barthel Index , the STREAM , and the TUG were 1.04,.99,.89 , and .73 , respectively . The probability of discharge to a rehabilitation center for persons walking at < or = 0.3 m/s or > 0.6 m/s at the first evaluation was.95 and .22 , respectively . CONCLUSIONS The 5mWT at a comfortable pace is recommended as the measure of choice for clinicians and research ers who need to detect longitudinal change in walking disability in the first 5 weeks poststroke Background Frailty is a term commonly used to describe the condition of an older person who has chronic health problems , has lost functional abilities and is likely to deteriorate further . However , despite its common use , only a small number of studies have attempted to define the syndrome of frailty and measure its prevalence . The criteria OUTPUT:

Gait speed at usual pace in acute care setting s was 0.46 m/s ( 95 % CI : 0.34 - 0.57 ) , which was significantly slower than the gait speed of 0.74 m/s ( 95 % CI : 0.65 - 0.83 ) recorded in outpatient setting s. CONCLUSIONS Gait speed is an important measure in comprehensive geriatric assessment . The consolidation of data from multiple studies reported in this meta- analysis highlights the mobility limitations experienced by older people in clinical setting s and the need for ongoing rehabilitation to attain levels sufficient for reintegration in the community

MS2_fixed_5_shot1986

***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 —Recent clinical trials have demonstrated that aggressive lipid lowering by statins could prevent recurrent events after acute coronary syndrome ( ACS ) . We hypothesized that this efficacy was caused by a significant reduction in plaque volume by aggressive LDL cholesterol ( LCL-C ) lowering . The present study investigated the effect of early statin treatment on plaque volume of a nonculprit lesion by serial volumetric intravascular ultrasound in patients with ACS . Methods and Results —Seventy patients with ACS were enrolled . All patients underwent emergency coronary angiography and percutaneous coronary intervention ( PCI ) . They were r and omized to intensive lipid-lowering therapy ( n=35 ; atorvastatin 20 mg/d ) or control ( n=35 ) groups after PCI . Volumetric intravascular ultrasound analyses were performed at baseline and 6-month follow-up for a non-PCI site in 48 patients ( atorvastatin , n=24 ; control , n=24 ) . LDL-C level was significantly decreased by 41.7 % in the atorvastatin group compared with the control group , in which LDL-C was increased by 0.7 % ( P<0.0001 ) . Plaque volume was significantly reduced in the atorvastatin group ( 13.1±12.8 % decrease ) compared with the control group ( 8.7±14.9 % increase ; P<0.0001 ) . Percent change in plaque volume showed a significant positive correlation with follow-up LDL-C level ( R=0.456 , P=0.0011 ) and percent LDL-C reduction ( R=0.612 , P<0.0001 ) , even in patients with baseline LDL-C < 125 mg/dL. Conclusions —Early aggressive lipid-lowering therapy by atorvastatin for 6 months significantly reduced the plaque volume in patients with ACS . Percent change in plaque volume showed a OUTPUT:

Conclusions RYGB surgery reverses the dyslipidaemia of obesity . These findings support the use of RYGB in the management of high cardiovascular risk lipid profiles in morbid obesity

MS2_fixed_5_shot1987

***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 OBJECTIVE Cycle ergometer training is an important component of pulmonary rehabilitation for patients with COPD . However , incremental cycle tests from which individualized cycle training intensity can be prescribed may not be readily available to clinicians . The aims of the study were to ( i ) investigate the physiological and psychophysical responses to the 6-min walk test ( 6MWT ) , incremental shuttle walk test ( ISWT ) and cycle ergometer test ( CET ) ; and ( ii ) determine whether the distance walked in either the 6MWT or the ISWT could be used to estimate peak work rate on a cycle ergometer . METHODS A repeated measures study was undertaken in COPD patients in a stable condition . The 6MWT , ISWT and CET were performed in r and om order , and physiological responses , rate of perceived exertion and dyspnoea were measured . RESULTS Twenty-two patients with COPD completed the study . There was no significant difference in peak oxygen uptake between the 6MWT , ISWT and CET . The significant correlation between the 6MWD and incremental shuttle walk distance with peak watts on the CET ( r = 0.63 , P = 0.002 and r = 0.75 , P < 0.001 , respectively ) was strengthened by the inclusion of weight , age and gender ( r = 0.89 P = 0.001 and r = 0.91 , P < 0.001 ) . Bl and -Altman analysis demonstrated a strong agreement between peak work rate measured on the CET and that estimated from either the 6MWT or the ISWT . CONCLUSIONS The significant relationships found between the three exercise tests , and the regression equations predicting peak work rate on the CET from the 6MWT or the ISWT , may allow for the estimation of intensity of cycle exercise training from walk tests in COPD patients BACKGROUND The protocol used for the 6-min walk test ( 6MWT ) influences its results . The only study to examine the effect of modifying track layout performed a retrospective analysis and concluded that institutions using continuous tracks yield greater distances OUTPUT:

Current data confirm that the 6MWT , ISWT and ESWT are valid , reliable and responsive to change with some interventions . However , results are sensitive to small changes in methodology .

MS2_fixed_5_shot1988

***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: Goals of workProstate cancer patients receiving and rogen deprivation therapy ( ADT ) are vulnerable to a number of potentially debilitating side effects , which can significantly impact quality of life . The role of alternate therapies , such as physical activity ( PA ) , in attenuating these side effects is largely understudied for such a large population . Thus , the purpose of this study was to investigate the effects of PA intervention for men receiving ADT on PA behavior , quality of life , and fitness measures . Patients and methods One hundred participants were r and omized into an intervention ( n = 53 ) or a wait-list control group ( n = 47 ) , with 11 dropping out of the intervention group and 23 dropping out of the wait-list control group prior to post-testing . The intervention consisted of both an individually tailored home-based aerobic and light resistant training program and weekly group sessions . PA , quality of life , fitness , and physiological outcomes were assessed pre and post the 16-week intervention . Results Significant increases in PA , supported by changes in girth measures and blood pressure , support the beneficial impact of the intervention . Positive trends were also evident for depression and fatigue . However , due to the high dropout rate , these results must be interpreted with caution . Conclusions PA effectively attenuates many of the side effects of ADT and should be recommended to prostate survivors as an alternate therapy . Determining the maintenance of this behavior change will be important for underst and ing how the long-term benefits of increased activity levels may alleviate the late effects of ADT BACKGROUND AND PURPOSE The interpretation of patient scores on clinical tests of physical mobility is limited by a lack of data describing the range of performance among people without disabilities . The purpose of this study was to provide data for 4 common clinical tests in a sample of community-dwelling older adults . SUBJECTS Ninety-six community-dwelling elderly people ( 61 - 89 years of age ) with independent functioning performed 4 clinical tests . METHODS Data were collected on the Six-Minute Walk Test ( 6MW ) , Berg Balance Scale ( OUTPUT:

Grade B evidence also suggested that exercise may improve prostate cancer patients ' muscle mass , muscular strength , functional performance ( walking and sit to st and speed ) , as well as health-related , social and physical quality of life . These effects appeared greater for group-rather than home-based-exercise , especially if these programs included resistance training .

MS2_fixed_5_shot1989

***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 Hypothetically , topiramate can improve drinking outcomes among alcohol-dependent individuals by reducing alcohol 's reinforcing effects through facilitation of gamma-aminobutyric acid function and inhibition of glutaminergic pathways in the corticomesolimbic system . OBJECTIVE To determine if topiramate is a safe and efficacious treatment for alcohol dependence . DESIGN , SETTING , AND PARTICIPANTS Double-blind , r and omized , placebo-controlled , 14-week trial of 371 men and women aged 18 to 65 years diagnosed with alcohol dependence , conducted between January 27 , 2004 , and August 4 , 2006 , at 17 US sites . INTERVENTIONS Up to 300 mg/d of topiramate ( n = 183 ) or placebo ( n = 188 ) , along with a weekly compliance enhancement intervention . MAIN OUTCOME MEASURES Primary efficacy variable was self-reported percentage of heavy drinking days . Secondary outcomes included other self-reported drinking measures ( percentage of days abstinent and drinks per drinking day ) along with the laboratory measure of alcohol consumption ( plasma gamma-glutamyltransferase ) . RESULTS Treating all dropouts as relapse to baseline , topiramate was more efficacious than placebo at reducing the percentage of heavy drinking days from baseline to week 14 ( mean difference , 8.44 % ; 95 % confidence interval , 3.07%-13.80 % ; P = .002 ) . Prespecified mixed-model analysis also showed that topiramate compared with placebo decreased the percentage of heavy drinking days ( mean difference , 16.19 % ; 95 % confidence interval , 10.79%-21.60 % ; P < .001 ) and all other drinking outcomes ( P < .001 for all comparisons ) . Adverse events that were more common with topiramate vs placebo , respectively , included paresthes OUTPUT:

In both rodent and cell culture models , CBD was found to exert a neuroprotective effect against adverse alcohol consequences on the hippocampus . In rodent models , CBD was found to attenuate alcohol-induced hepatotoxicity , specifically , alcohol-induced steatosis . Finally , findings from pre clinical rodent models also indicate that CBD attenuates cue-elicited and stress-elicited alcohol seeking , alcohol self-administration , withdrawal-induced convulsions , and impulsive discounting of delayed rewards . In human studies , CBD was well tolerated and did not interact with the subjective effects of alcohol . Collectively , given its favorable effects on alcohol-related harms and addiction phenotypes in pre clinical models , CBD appears to have promise as a c and i date AUD pharmacotherapy . This is further bolstered by the absence of abuse liability and its general tolerability .

MS2_fixed_5_shot1990

***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 compared the effects of three different margarines , one based on palm oil ( PALM-margarine ) , one based on partially hydrogenated soybean oil ( TRANS-margarine ) and one with a high content of polyunsaturated fatty acids ( PUFA-margarine ) , on serum lipids in 27 young women . The main purpose of the study was to test if replacement of trans fatty acids in margarine by palmitic acid results in unfavorable effects on serum lipids . The sum of saturated fatty acids ( 12∶0 , 14∶0 , 16∶0 ) was 36.3 % of total fatty acids in the PALM-diet , the same as the sum of saturated ( 12∶0 , 14∶0 , 16∶0 ) ( 12.5 % ) and trans ( 23.1 % ) fatty acids in the TRANS-diet . This sum was 20.7 % in the PUFA-diet . The content of oleic acid was 37.9 , 35.2 , and 38.6 % , respectively , in the three diets , whereas linoleic acid amounted to 16 , 13.5 , and 27.3 % , respectively . Total fat provided 30–31 % and the test margarines 26 % of total energy in all three diets . The subjects consumed each of the diets for 17 d in a Latin-square crossover design . There were no significant differences in total cholesterol , low density lipoprotein (LDL)-cholesterol and apolipoprotein B ( apoB ) between the TRANS- and the PALM-diets . High density lipoprotein (HDL)-cholesterol and apoA-I were significantly higher on the PALM-diet compared to the TRANS-diet whereas the ratio of LDL-cholesterol to HDL-cholesterol was lower , although not significantly ( P=0.077 ) on OUTPUT:

CONCLUSIONS Palm oil consumption results in higher LDL cholesterol than do vegetable oils low in saturated fat and higher HDL cholesterol than do trans fat-containing oils in humans . The effects of palm oil on blood lipids are as expected on the basis of its high saturated fat content , which supports the reduction in palm oil use by replacement with vegetable oils low in saturated and trans fat .

MS2_fixed_5_shot1991

***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 conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI BACKGROUND This study aim ed to index the prevalence of posttraumatic stress disorder ( PTSD ) after injury requiring OUTPUT:

Conclusion : Combinations of peri- and post-injury factors appear to be influential in the development of PTSD among persons with SCI .

MS2_fixed_5_shot1992

***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 OBJECTIVES Red cell transfusion is commonly used in orthopaedic surgery . Evidence suggests that a restrictive transfusion strategy may be safe for most patients . However , concern has been raised over the risks of anaemia in those with ischaemic cardiac disease . Perioperative silent myocardial ischaemia ( SMI ) has a relatively high incidence in the elderly population undergoing elective surgery . This study used Holter monitoring to compare the effect of a restrictive and a liberal red cell transfusion strategy on the incidence of SMI in patients without signs or symptoms of ischaemic heart disease who were undergoing lower limb arthroplasty . MATERIAL S AND METHODS We performed a multicentre , controlled trial in which 260 patients undergoing elective hip and knee replacement surgery were enrolled and r and omized to transfusion triggers that were either restrictive ( 8 g/dl ) or liberal ( 10 g/dl ) . Participants were monitored with continuous ambulatory electrocardiogram ( ECG ) ( Holter monitoring ) , preoperatively for 12 h and postoperatively for 72 h. The tapes were analysed for new ischaemia by technicians blinded to treatment . The total ischaemia time in minutes was divided by the recording time in hours and an ischaemic load in min/h was calculated . Haemoglobin levels were measured preoperatively , postoperatively in the recovery room , and on days one , three and five after surgery . RESULTS The mean postoperative haemoglobin concentration was 9.87 g/dl in the restrictive group and 11.09 g/dl in the liberal group . In the restrictive group , 34 % were transfused a total of 89 red cell units , and in the liberal group 43 % were given a total of 119 red cell units . A postoperative episode of silent ischaemia was experienced by 21/109 ( 19 % ) patients in the restrictive group and by 26/109 ( 24 % ) patients in the liberal group [ mean difference -4.6 OUTPUT:

Findings and Conclusion To our knowledge , this is the first meta- analysis to compare the clinical results between PAT and a control in joint replacement patients . This meta- analysis has proven that the use of a PAT reinfusion system reduced significantly the dem and for ABT , the number of patients who require ABT and the cost of hospitalization after total knee and hip arthroplasty . This study , together with other previously published data , suggests that PAT drains are beneficial .

MS2_fixed_5_shot1993

***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: To evaluate the effects of filtering short wavelength light on visual performance under intense light conditions among pseudophakic patients previously implanted with a clear intraocular lens ( IOL ) . This was a patient-masked , r and omized crossover study conducted at 6 clinical sites in the United States between September 2013 and January 2014 . One hundred fifty-four bilaterally pseudophakic patients were recruited . Photostress recovery time and glare disability thresholds were measured with clip-on blue-light-filtering and placebo ( clear ; no blue-light filtration ) glasses worn over patients ' habitual correction . Photostress recovery time was quantified as the time necessary to regain sight of a grating target after intense light exposure . Glare disability threshold was assessed as the intensity of a white-light annulus necessary to obscure a central target . The order of filter used and test eye were r and omized across patients . Photostress recovery time and glare disability thresholds were significantly improved ( both P < 0.0001 ) when patients used blue-light-filtering glasses compared with clear , nonfiltering glasses . Compared with a nonfiltering placebo , adding a clip-on blue-absorbing filter to the glasses of pseudophakic patients implanted with clear IOLs significantly increased their ability to cope with glare and to recover normal viewing after an intensive photostress . This result implies that IOL design s with blue-light-filtering characteristics may be beneficial under intense light conditions Purpose This study aims to evaluate the effect of blocking short-wavelength light on critical flicker frequency ( CFF ) . Design This study is a prospect i ve clinical study . Methods Thirty-three participants ( 17 men and 16 women ; age range , 28–39 years ) were divided into 3 groups . Each group wore 1 of 3 types of lenses while performing an intensive computer task for 2 hours . To evaluate the effect of blocking short-wavelength light before and after the task , we measured the CFF and evaluated subjective question naires . We used the analysis of variance test to examine whether the type of lenses tested affected any of OUTPUT:

A study involving normal participants found no observed difference in sleep quality . We found no studies investigating effects on macular structure or function . We find a lack of high quality evidence to support using BB spectacle lenses for the general population to improve visual performance or sleep quality , alleviate eye fatigue or conserve macular health

MS2_fixed_5_shot1994

***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 Vitamin B6 , or pyridoxine , plays an intrinsic role in the synthesis of certain neurotransmitters that take part in development of psychotic states . Several reports indicate that vitamin B6 may be a factor in a number of psychiatric disorders and related conditions , such as autism , Alzheimer 's disease , hyperactivity , learning disability , anxiety disorder , and depression . Moreover , there are anecdotal reports of a reduction in psychotic symptoms after vitamin B6 supplementation of psychopharmacologic treatment of patients suffering from schizophrenia or organic mental disorder . The aim of this study was to examine whether vitamin B6 therapy influences psychotic symptoms in patients suffering from schizophrenia and schizoaffective disorder . METHOD The effects of the supplementation of vitamin B6 to antipsychotic treatment on positive and negative symptoms in 15 schizophrenic and schizoaffective patients ( DSM-IV criteria ) were examined in a double-blind , placebo-controlled , crossover study spanning 9 weeks . All patients had stable psychopathology for at least 1 month before entry into the study and were maintained on treatment with their pre study psychoactive and antiparkinsonian medications throughout the study . All patients were assessed using the Positive and Negative Syndrome Scale ( PANSS ) for schizophrenia on a weekly basis . Patients r and omly received placebo or vitamin B6 , starting at 100 mg/day in the first week and increasing to 400 mg/day in the fourth week by 100-mg increments each week . RESULTS PANSS scores revealed no differences between vitamin B6- and placebo-treated patients in amelioration of their mental state . CONCLUSION Further studies with larger population s and shorter duration of illness are needed to clarify the question of the possible efficacy of vitamin B6 in treatment of psychotic symptoms in schizophrenia IMPORTANCE More effective treatments are needed for negative symptoms of schizophrenia , which are typically chronic , disabling , and costly OUTPUT:

There were no overall effects from antioxidant vitamins , inositol or dietary minerals on psychiatric symptoms . There is preliminary evidence that certain vitamin and mineral supplements may reduce psychiatric symptoms in some people with schizophrenia .

MS2_fixed_5_shot1995

***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 Patient aggression is a common problem in acute psychiatric wards and calls for preventive measures . The timely use of preventive measures presupposes a preceded risk assessment . The Norwegian Brøset-Violence-Checklist ( BVC ) is one of the few instruments suited for short-time prediction of violence of psychiatric in patients in routine care . Aims of our study were to improve the accuracy of the short-term prediction of violence in acute inpatient setting s by combining the Brøset-Violence-Checklist ( BVC ) with an overall subjective clinical risk- assessment and to test the application of the combined measure in daily practice . Method We conducted a prospect i ve cohort study with two sample s of newly admitted psychiatric patients for instrument development ( 219 patients ) and clinical application ( 300 patients ) . Risk of physical attacks was assessed by combining the 6-item BVC and a 6-point score derived from a Visual Analog Scale . Incidents were registered with the Staff Observation of Aggression Scale-Revised SOAS-R. Test accuracy was described as the area under the receiver operating characteristic curve ( AUCROC ) . Results The AUCROC of the new VAS-complemented BVC-version ( BVC-VAS ) was 0.95 in and 0.89 in the derivation and validation study respectively . Conclusion The BVC-VAS is an easy to use and accurate instrument for systematic short-term prediction of violent attacks in acute psychiatric wards . The inclusion of the VAS-derived data did not change the accuracy of the original BVC OBJECTIVE To examine factors associated with physical restraint in psychiatric emergency rooms . METHOD We extracted variables likely to predict use of physical restraints from a large r and omised trial undertaken in three psychiatric emergency rooms in Rio de Janeiro . We fitted a Bayesian binary multivariate model using only variables clearly preceding the restraints . RESULTS Of 301 agitated , aggressive people admitted to emergency rooms , 73 ( 24 % ) were restrained during the first 2 h of admission . In Rio , younger people ( OR=1.03 for OUTPUT:

Verbal de-escalation techniques have been shown to decrease agitation and reduce the potential for associated violence in the emergency setting .

MS2_fixed_5_shot1996

***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 effects of intravenous 1,25 dihydroxycholecalciferol [ (OH)2D3 ] on glucose tolerance and insulin secretion were studied in eleven uremic patients on regular hemodialysis and compared with eleven healthy controls . Intravenous glucose tolerance tests ( IVGTT ) were used to assess glucose tolerance , and the hyperglycemic clamp technique was used to quantitate endogenous insulin secretion . Three days after they had discontinued oral 1,25(OH)2D3 , the dialysis patients were then studied with ( + D ) and without ( -D ) a single intravenous dose of 1,25(OH)2D3 at 2 micrograms/m2 , given two hours before the IVGTT or clamp studies . During the -D studies , the uremic patients were glucose intolerant but not hyperinsulinemic . Intravenous 1,25(OH)2D3 in dialysis patients increased glucose uptake ( K values ) during IVGTT by 38 % ( P less than 0.02 ) and increased early component of insulin secretion during hyperglycemic clamps by 48 % ( P less than 0.01 ) and the late component by 32 % ( P less than 0.01 ) . After intravenous 1,25(OH)2D3 , the dialysis patients became hyperinsulinemic and regained glucose tolerance . Intravenous 1,25(OH)2D3 did not change the K values during IVGTT nor the insulin secretion during hyperglycemic clamps in the control subjects . During the -D studies , serum concentrations of 1,25(OH)2D3 were significantly lower in uremic patients compared with controls . Serum 1,25(OH)2D3 during the + D studies increased to supraphysiological levels in both uremic patients and controls . Serum concentrations of intact parathyroid hormone , total and ionized calcium , magnesium , potassium , urea nitro OUTPUT:

Conclusions Short-term ( 4–12 weeks ) supplementation with vitamin D is associated with lower fasting glucose levels in ESRD with no change in fasting insulin levels .

MS2_fixed_5_shot1997

***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 : To identify the work factors that predict intense low back pain ( LBP ) and LBP related sick leaves in nurses ’ aides . Methods : The sample comprised 4266 r and omly selected Norwegian nurses ’ aides , not bothered or only a little bothered by LBP during the previous three months , and not on sick leave when completing a mailed question naire in 1999 . Of these , 3808 ( 89.3 % ) completed a second question naire 3 months later and 3651 ( 85.6 % ) completed a third question naire 15 months later . Intensity of low back symptoms and certified sick leaves attributed to LBP during the observation period were assessed by self reports at the follow ups . Results : After adjustments for LBP during the three months prior to baseline , baseline health complaints , demographic and familial factors , and a series of physical , psychological , and social work factors , logistic regression analyses revealed the following associations : intense low back symptoms were predicted by frequent positioning of patients in bed , perceived lack of support from immediate superior , and perceived lack of pleasant and relaxing culture in the work unit . LBP related sick leaves were predicted by frequent h and ling of heavy objects , medium level of work dem and s , perceived lack of supportive and encouraging culture in the work unit , working night shifts , and working in a nursing home . Long term LBP related sick leaves were associated with changes of work or work tasks during the observation period that result ed in a perceived reduction of support and encouragement at work . Conclusions : Not only frequent mechanical exposures , but also organisational , psychological , and social work factors , such as night shift work , perceived lack of support from superior , and perceived lack of a pleasant and relaxing or supporting and encouraging culture in the work unit , are associated with an increased risk of intense low back symptoms and LBP related sick leaves in nurses ’ aides To investigate the associations between psychosocial factors and the development of chronic disabling low back pain ( LBP ) in Japanese workers . A 1 yr prospect i ve cohort of the Japan Epidemiological Research of Occup OUTPUT:

The two eligible studies for this review provide moderate evidence that saddle seats provided lower ergonomic risk than conventional seats in the examined population of dental students

MS2_fixed_5_shot1998

***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 ; The feasibility of altering a Type A style of life was investigated in 1012 nonsmoking predominantly male postinfa rct ion volunteers in the San Francisco Bay area . A total of 862 were r and omly allocated into an experimental section receiving a combination of Type A and cardiac counseling , or a control section receiving cardiac counseling alone . The remaining 150 formed a nonr and om but statistically equivalent comparison section . Assessment s of change in Type A behavior were made by the participant , his or her spouse , a work colleague , and an independent rater of a videotaped structured interview . Psychometric analyses indicated that these instruments were valid and reliable measures of Type A behavior . After 24 months , participants receiving Type A/cardiac counseling exhibited a significantly greater reduction in Type A behavior than the other two sections , and had a lower cardiovascular recurrence rate than the comparison section only . No differences among the three sections were observed in total cholesterol or resting blood pressure . The results suggest that Type A behavior can be altered by group counseling in postinfa rct ion volunteers and that such alteration is superior to no group counseling at all in the secondary prevention of coronary heart disease OBJECTIVE Although the Enhancing Recovery in Coronary Heart Disease ( ENRICHD ) treatment was design ed to include individual therapy and cognitive behavioral group training for patients with depression and /or low perceived social support , only 31 % of treated participants received group training . Secondary analyses classified intervention participants into two subgroups , ( 1 ) individual therapy only or ( 2 ) group training ( i.e. , coping skills training ) plus individual therapy , to determine whether medical outcomes differed in participants who received the combination of group training and individual therapy compared to participants who received individual therapy only or usual care . METHODS Secondary analyses of 1243 usual care , 781 individual therapy only , and 356 group plus individual therapy myocardial infa rct ion ( MI ) patients were performed . Depression was diagnosed using modified Diagnostic and Statistical Manual of Mental Disorders , OUTPUT:

Conclusions We found that psychological intervention improved psychological symptoms and reduced cardiac mortality for people with CHD . However , there remains considerable uncertainty regarding the magnitude of these effects and the specific techniques most likely to benefit people with different presentations of CHD

MS2_fixed_5_shot1999

***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 effects of a stabilized 0.454 % stannous fluoride dentifrice , currently marketed as Crest Gum Care , on supragingival plaque , gingivitis , gingival bleeding and oral soft tissue condition were studied in 328 adult male and female subjects who completed a six-month , double blind clinical study . Following initial examinations , subjects presenting with a minimum of five gingival bleeding sites received a thorough dental prophylaxis and were instructed to brush at least twice a day for three months with a commercially available fluoride dentifrice , packaged in such a way as to blind its identity to the study subjects . This constituted the three-month pre-test period . At the end of this period , subjects were again examined , given a second oral prophylaxis , and r and omly assigned to brush with one of the following dentifrices : 1 ) stabilized 0.454 % stannous fluoride , 2 ) 0.243 % sodium fluoride control , or 3 ) one of three experimental dentifrices . Subjects were instructed to brush their teeth as they normally would , at least twice a day for one minute per brushing . Follow-up examinations after three and six months of dentifrice use evaluated supragingival plaque , gingivitis , gingival bleeding , extrinsic tooth stain and oral soft tissue status . After six months , the stabilized stannous fluoride dentifrice significantly reduced gingivitis and gingival bleeding by 20.5 % and 33.4 % compared to the sodium fluoride control group . However , the stabilized stannous fluoride dentifrice group was not significantly different from the control dentifrice group with respect to supragingival plaque scores . As expected , accumulation of extrinsic tooth stain was greater in the stabilized stannous fluoride group than the control group . No unexpected nor clinical ly significant oral soft tissue health effects were associated with the use of the test dentifrices . The results from this clinical study demonstrate that over a six-month period , twice-daily use of a dentifrice containing 0.454 % stabilized stannous OUTPUT:

The studies in this systematic review provide strong evidence of the antiplaque , antigingivitis effects of multiple agents .