Datasets:

YBXL

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MS2_fixed_5_shot_test

like 0

MS2_fixed_5_shot2000

***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 use two different exercise programs over a 2-year period to reduce falls and their sequelae among residents of two long-term care facilities . DESIGN R and omized , controlled trial . SETTING The study took place at two long-term care facilities with services ranging from independent living to skilled nursing . PARTICIPANTS One hundred and ten participants whose average age was 84 and who were capable of ambulating with or without assistive devices and could follow simple directions . INTERVENTION Participants were r and omized to one of two exercise groups ( resistance/endurance plus basic enhanced programming or tai chi plus basic enhanced programming ) or to a control group ( basic enhanced programming only ) . Exercise classes were held three times per week throughout the study . MEASUREMENTS Participants were evaluated for cognitive and physical functioning at baseline and 6 , 12 , and 24 months . Falls were determined from incident reports filed by the nursing staffs at the facilities . RESULTS Time to first fall , time to death , number of days hospitalized , and incidence of falls did not differ among the treatment and control groups ( P>.05 ) . Among all participants , those who fell had significantly lower baseline Folstein Mini-Mental State Examination and instrumental activities of daily living scores and experienced significantly greater declines in these measures over the 2-year program . CONCLUSION There were no significant differences in falls among the two exercise groups and the control group . Lack of treatment differences and low adherence rates suggest that residents of long-term care facilities may require individualized exercise interventions that can be adapted to their changing needs OBJECTIVES To establish the effectiveness of a fall-prevention program in reducing falls and injurious falls in older residential care residents . DESIGN Cluster , r and omized , controlled trial . SETTING Fourteen r and omly selected residential care homes in Auckl and , New Zeal and . PARTICIPANTS All older residents ( n=628 , 95 % participation rate ) . INTERVENTION Residential care staff , using existing re sources , implemented systematic individualized fall-risk management for all residents using a fall-risk assessment tool , high-ris OUTPUT:

The conclusion is that there is firm evidence for training effects on physical fitness , functional performance , activity of daily living performance , and quality -of-life .

MS2_fixed_5_shot2001

***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 & AIMS The Rome III criteria for functional dyspepsia have been changed to include 2 distinct syndromes : postpr and ial distress syndrome and epigastric pain syndrome . We investigated risk factors for functional dyspepsia among the functional dyspepsia subgroups defined by the Rome III criteria . METHODS We performed a cross-sectional population -based study in a primary care setting ( the Kalix and a study ) . A r and om sample ( n = 2860 ) of the adult population from 2 northern Swedish municipalities ( n = 21,610 ) was surveyed using a vali date d postal question naire to assess gastrointestinal symptoms ( response rate , 74.2 % ; n = 2122 ) . A r and omly selected subgroup ( n = 1001 ) of responders was invited to undergo an esophagogastroduodenoscopy ( participation rate , 73.3 % ) including biopsy specimen collection , Helicobacter pylori culture and serology , and symptom assessment s. RESULTS Of the 1001 subjects examined by endoscopy , 202 ( 20.2 % ; 95 % confidence interval [ CI ] , 17.7 - 22.7 ) were classified as having uninvestigated dyspepsia and 157 ( 15.7 % ; 95 % CI , 13.4 - 18.0 ) as having functional dyspepsia . Major anxiety ( Hospital Anxiety and Depression Scale score > or = 11 ) was associated with uninvestigated dyspepsia ( odds ratio [ OR ] , 3.01 ; 95 % CI , 1.39 - 6.54 ) , as was obesity ( body mass index > or = 30 kg/m(2 ) ) ( OR , 1.86 ; 95 % CI , 1.15 - 3.01 ) . Major anxiety was associated with functional dyspepsia and postpr and ial distress syndrome ( OR of 2.56 [ OUTPUT:

However , benefit was limited to antipsychotics and tricyclic antidepressants . Conclusions Psychotropic drugs may be an effective treatment for FD , but the effect appears to be limited to antipsychotics and tricyclic antidepressants with fewer trials for other agents , meaning that firm conclusions for efficacy can not be made .

MS2_fixed_5_shot2002

***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 As a continuation of two large-scale , multicentre studies on the development of 5-year-old ICSI children , we present results of the follow-up study undertaken on the cognitive and motor development of 8-year-old ICSI children . METHODS Developmental outcomes of 151 8-year-old singletons born through ICSI after 32 weeks of gestation were compared with those of 153 singletons of the same age born after spontaneous conception ( SC ) . Part of this population was seen in a cohort at the age 5 years . Outcome measures include Wechsler Intelligence Scale for Children-Revised ( WISC-R ) and Movement Assessment Battery for Children ( ABC ) . RESULTS Regarding intellectual functioning , ICSI children tend to obtain significantly higher total ( P < 0.01 ) , verbal ( P < 0.01 ) and performance ( P < 0.05 ) intelligence scores than SC children , nevertheless remaining in similar ranges . These effects are small ( Cohen 's d < 0.50 ) . High maternal educational level stayed in the regression as a factor accounting for some of the variance in total IQ between the groups . In terms of motor development , no significant differences were found between ICSI and SC children regarding overall motor skills , manual , balance and ball skills . CONCLUSION In this follow-up study , ICSI and SC children show a comparable cognitive and motor development until the age of 8 years STUDY QUESTION Do children born after assisted reproductive techniques ( ART ; IVF/ICSI ) display more mental health issues or social and cognitive developmental problems at 7 - 8 years than naturally conceived ( NC ) controls , and does child gender play a role ? SUMMARY ANSWER ART children do not differ with regard to mental health or social and cognitive developmental problems when compared with controls , but some gender-specific differences do exist . WHAT IS KNOWN ALREADY Systematic review s have not found any evidence of delays in neurocognitive or sensorimotor development in ART children . However findings on the effect of the type of ART treatment ( IVF versus ICSI ) on the OUTPUT:

SUMMARY ANSWER The available high- quality evidence indicates that specific treatments may give rise to different effects on cognitive development , with certain treatments , including ICSI , associated with cognitive impairment .

MS2_fixed_5_shot2003

***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 Outcome measurement following surgery is increasingly the focus of attention in current health-care debates because of the rising costs of medical care and the large variety of operative options . The purpose of the present study was to correlate quality of life after volar locked plate fixation of unstable intra-articular distal radial fractures with functional and radiographic results as well as with quality -of-life data from population norms . METHODS Fifty-four consecutive patients with intra-articular distal radial fractures and a mean age of sixty-three years were managed with a volar locked plate system . Range of motion , grip strength , and radiographs were assessed at a mean of six years postoperatively . The wrist-scoring systems of Gartl and and Werley and Castaing were adopted for the assessment of objective outcomes . The Disabilities of the Arm , Shoulder and H and and Short Form-36 question naires were completed as subjective outcome measures , and the results were compared with United States and Austrian population norms . RESULTS Functional improvement continued for two years postoperatively . At the time of the latest follow-up , > 90 % of all patients had achieved good or excellent results according to the scoring systems of Gartl and and Werley and Castaing . The results of the Short Form-36 question naire were similar to the United States and Austrian population norms . The mean Disabilities of the Arm , Shoulder and H and score was 5 points at two years , and it increased to 13 points at six years . The twenty patients with radiocarpal arthritis had significantly poorer results in the physical component summary measure of the Short Form-36 question naire ( p = 0.012 ) . CONCLUSIONS The results of the present single-center study show that , following distal radial fracture fixation , wrist arthritis may affect the patient 's subjective well-being , as documented with the Short Form-36 , without influencing the functional outcome . Well- design ed longitudinal clinical trials are needed to confirm the findings of the present investigation in terms of quality of life after surgical treatment of intra-articular distal radial fractures Background At present , there is no conclus OUTPUT:

Only the DASH and PRWE have evidence of reliability , validity , and responsiveness in patients with traumatic injuries to the h and and wrist ; other measures either have incomplete evidence or evidence gathered in a nontraumatic population . Conclusions : The DASH and PRWE both have evidence of reliability , validity , and responsiveness in a h and and wrist trauma population . Other PROMs used to assess h and and wrist trauma patients do not .

MS2_fixed_5_shot2004

***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 While physical therapy is an effective element in the rehabilitation of rotator cuff ( RC ) disease , the most effective sequence of exercise training interventions has not been defined . HYPOTHESIS/ PURPOSE The purpose of this study is to determine if there is a difference in pain or function in patients who are given RC strengthening prior to or after initiating scapular stabilization exercises . STUDY DESIGN Level I r and omized crossover trial . METHODS This was a prospect i ve study of 26 men and 14 women with a mean age 51 who were diagnosed with subacromial impingement syndrome ( SAIS ) . They were r and omly assigned to one of two groups for a comprehensive and st and ardized rehabilitation program over six visits at an orthopedic outpatient clinic . One group was prescribed a 4-week program of scapular stabilization exercises while the other group began with RC strengthening exercises . The crossover design had each group add the previously excluded four exercises to their second month of rehabilitation . RESULTS The results showed significant improvements in pain ( p < 0.001 ) , function ( p < 0.001 ) , and patient satisfaction ( p < 0.001 ) at all follow-up times for both groups . There was not a statistically significant difference in pain or function at any follow-up period for initiating one group of exercise before the other ( p > 0.05 ) . There was a statistically significant interaction between the patient 's global rating of change at the 4 week follow-up as compared to 8 weeks ( p = 0.04 ) or 16 ( p < 0.001 ) . CONCLUSION Patients with SAIS demonstrate improvement in pain and function with a st and ardized program of physical therapy regardless of group exercise sequencing . LEVEL OF EVIDENCE 1b Background and purpose A programme based on eccentric exercises for treating subacromial pain was in a previous study found effective at 3-month follow-up . The purpose s of the present study were to investigate whether the results were maintained after OUTPUT:

In many instances , no or minimal attempts to screen were undertaken or reported .

MS2_fixed_5_shot2005

***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 Web-based and mobile health interventions ( also called “ Internet interventions ” or " eHealth/mHealth interventions ") are tools or treatments , typically behaviorally based , that are operationalized and transformed for delivery via the Internet or mobile platforms . These include electronic tools for patients , informal caregivers , healthy consumers , and health care providers . The Consoli date d St and ards of Reporting Trials ( CONSORT ) statement was developed to improve the suboptimal reporting of r and omized controlled trials ( RCTs ) . While the CONSORT statement can be applied to provide broad guidance on how eHealth and mHealth trials should be reported , RCTs of web-based interventions pose very specific issues and challenges , in particular related to reporting sufficient details of the intervention to allow replication and theory-building . Objective To develop a checklist , dubbed CONSORT-EHEALTH ( Consoli date d St and ards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth ) , as an extension of the CONSORT statement that provides guidance for authors of eHealth and mHealth interventions . Methods A literature review was conducted , followed by a survey among eHealth experts and a workshop . Results A checklist instrument was constructed as an extension of the CONSORT statement . The instrument has been adopted by the Journal of Medical Internet Research ( JMIR ) and authors of eHealth RCTs are required to su bmi t an electronic checklist explaining how they addressed each subitem . Conclusions CONSORT-EHEALTH has the potential to improve reporting and provides a basis for evaluating the validity and applicability of eHealth trials . Subitems describing how the intervention should be reported can also be used for non- RCT evaluation reports . As part of the development process , an evaluation component is essential ; therefore , feedback from authors will be solicited , and a before-after study will evaluate whether reporting has been improved BACKGROUND Technology-based interventions for Autism Spectrum Disorder ( ASD ) have proliferated , but few have been evaluated within the context of a r and omised controlled trial ( RCT ) . This RCT evaluated the efficacy of one technology-based early intervention OUTPUT:

Although it is still early to draw a conclusion , available studies are showing promise for use of mobile device apps for treatment of individuals with ASD .

MS2_fixed_5_shot2006

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** INPUT: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: INTRODUCTION On average 40 % of all patients suffering from Parkinson s disease ( PD ) undergo bouts of depression . It is thought that this is due to a dysfunction in the orbitofrontal and dorsolateral circuits , together with hypometabolism in the orbital , cau date nucleus and frontal dorsolateral tract regions . AIMS The aim of this study is to compare the effectiveness of low doses of fluoxetin with that of low doses of amitriptyline in controlling depression in patients with PD . PATIENTS AND METHODS The study examined a total of 77 patients ( 34 females and 43 males ) , with an average age of 68.2 years , who had been suffering from PD ( according to the diagnostic criteria of Calne et al , in stage II of Hoehn and Yahr ) for an average of 6.9 years . They were divided r and omly into two groups which received fluoxetin ( 37 patients , dosage : 20 40 mg/day ) or amitriptyline ( 40 patients , dosage : between 25 and 75 mg/day ) . A basal evaluation and four others ( at 3 , 6 , 9 and 12 months of treatment ) were performed , including the STMS ( Short test of mental status ) , the Hamilton scale , and extent of functional disability using the UPDRS . A statistical analysis was performed by comparing the variance of the above mentioned parameters and the c2 test with Yates correction or the Fisher exact two tailed test , to evaluate the reasons for dropping out . In both cases a value of p < 0.05 was accepted as significant . RESULTS 58 patients finished the study . Drop out because of side effects only took place in the group that received amitriptyline ( p < 0.02 ) , which was better than fluoxetin at controlling the depression ( p < 0.009 , 0.001 , 0.002 and 0.00006 ) at 3 , 6 , 9 and 12 months , respectively . CONCLUSIONS At an average dos OUTPUT:

An acceptability analysis showed that SSRIs were generally well tolerated . Conclusions These results suggest that there is insufficient evidence to reject the null hypothesis of no differences in efficacy between SSRIs and placebo in the treatment of depression in PD .

MS2_fixed_5_shot2007

***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: Head impacts are common in contact sports , but only recently has there been a rising awareness of the effects of subconcussive impacts in adolescent athletes . A better underst and ing of how to attenuate head impacts is needed and therefore , this study investigated the relationship between neck strength , impact , and neurocognitive function in an acute bout of soccer heading in a sample of female high school varsity soccer players . Seventeen participants completed the ImPACT neurocognitive test and had their isometric neck strength tested ( flexion , extension , and bilateral flexion ) before heading drills . Each participant was outfitted with custom headgear with timing switches and a three-dimensional accelerometer affixed to the back of the head , which allowed for measurement of impact during heading . Participants performed a series of 15 directional headers , including 5 forward , 5 left and 5 right headers in a r and om order , then completed the ImPACT test again . Neurocognitive tests revealed no significant changes following heading . However , there were statistically significant , moderate , negative correlations ( r = -0.500:-0.757 , p < .05 ) between neck strength and result ant header acceleration , indicating that those with weaker necks sustained greater impacts . This suggests neck strengthening may be an important component of any head injury prevention/reduction program Our purpose was to determine if an acute bout of heading soccer balls adversely affected postural control and self-reported symptoms of cerebral concussion . Thirty-one college-aged soccer players were r and omly placed into either a kicking group or a heading group . Subjects either kicked or headed 18 soccer balls over the course of 40 minutes . Subjects had their postural control assessed while st and ing on a force plate and completed a concussion symptoms checklist on three separate occasions : prior to , immediately following , and 24 hours after kicking or heading . There were no significant differences between the heading and kicking groups on the postural control measures prior to , immediately following , and 24 hours after kicking/heading . The heading group did , however , report significantly more concussion symptoms than the kick OUTPUT:

The overall results of r and om effects modelling of football heading were found to be inconclusive across all outcomes , groups and time points . No moderating variables related to method ological , sample or study characteristics were supported in the analysis ; age was a potential moderating variable . Summary / conclusions We provide the first meta-analytical review of football heading effects aggregated from multiple studies and extended findings from a recent systematic review of the effects of football heading . Our analysis indicates no overall effect for heading a football on adverse outcomes

MS2_fixed_5_shot2008

***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 — Prior primary prevention trials of statin therapy that used cholesterol criteria for enrollment have not reported significant decreases in stroke risk . We evaluated whether statin therapy might reduce stroke rates among individuals with low levels of cholesterol but elevated levels of high-sensitivity C-reactive protein . Methods and Results — In Justification for the Use of statins in Prevention : an Intervention Trial Evaluating Rosuvastatin ( JUPITER ) , 17 802 apparently healthy men and women with low-density lipoprotein cholesterol levels < 130 mg/dL and high-sensitivity C-reactive protein levels ≥2.0 mg/L were r and omly allocated to rosuvastatin 20 mg daily or placebo and then followed up for the occurrence of a first stroke . After a median follow-up of 1.9 years ( maximum , 5.0 years ) , rosuvastatin result ed in a 48 % reduction in the hazard of fatal and nonfatal stroke as compared with placebo ( incidence rate , 0.18 and 0.34 per 100 person-years of observation , respectively ; hazard ratio 0.52 ; 95 % confidence interval , 0.34 to 0.79 ; P=0.002 ) , a finding that was consistent across all examined subgroups . This finding was due to a 51 % reduction in the rate of ischemic stroke ( hazard ratio , 0.49 ; 95 % confidence interval , 0.30 to 0.81 ; P=0.004 ) , with no difference in the rates of hemorrhagic stroke between the active and placebo arms ( hazard ratio , 0.67 ; 95 % confidence interval , 0.24 to 1.88 ; P=0.44 ) . Conclusion — Rosuvastatin reduces by more than half the incidence of ischemic stroke among men and women with low levels of low-density lipoprotein cholesterol levels who are at risk because of elevated levels of high-sensitivity C-reactive protein . Clin OUTPUT:

Total cholesterol and LDL cholesterol were reduced in all trials but there was evidence of heterogeneity of effects . There was no evidence of any serious harm caused by statin prescription . Evidence available to date showed that primary prevention with statins is likely to be cost-effective and may improve patient quality of life . Recent findings from the Cholesterol Treatment Trialists study using individual patient data meta- analysis indicate that these benefits are similar in people at lower ( < 1 % per year ) risk of a major cardiovascular event . AUTHORS ' CONCLUSIONS Reductions in all-cause mortality , major vascular events and revascularisations were found with no excess of adverse events among people without evidence of CVD treated with statins

MS2_fixed_5_shot2009

***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 Effects of diet on blood lipids are best known in white men , and effects of type of carbohydrate on triacylglycerol concentrations are not well defined . OBJECTIVE Our goal was to determine the effects of diet on plasma lipids , focusing on subgroups by sex , race , and baseline lipid concentrations . DESIGN This was a r and omized controlled outpatient feeding trial conducted in 4 field centers . The subjects were 436 participants of the Dietary Approaches to Stop Hypertension ( DASH ) Trial [ mean age : 44.6 y ; 60 % African American ; baseline total cholesterol : < or = 6.7 mmol/L ( < or = 260 mg/dL ) ] . The intervention consisted of 8 wk of a control diet , a diet increased in fruit and vegetables , or a diet increased in fruit , vegetables , and low-fat dairy products and reduced in saturated fat , total fat , and cholesterol ( DASH diet ) , during which time subjects remained weight stable . The main outcome measures were fasting total cholesterol , LDL cholesterol , HDL cholesterol , and triacylglycerol . RESULTS Relative to the control diet , the DASH diet result ed in lower total ( -0.35 mmol/L , or -13.7 mg/dL ) , LDL- ( -0.28 mmol/L , or -10.7 mg/dL ) , and HDL- ( -0.09 mmol/L , or -3.7 mg/dL ) cholesterol concentrations ( all P < 0.0001 ) , without significant effects on triacylglycerol . The net reductions in total and LDL cholesterol in men were greater than those in women by 0.27 mmol/L , or 10.3 mg/dL ( P = 0.052 ) , and by 0.29 mmol/L , or 11.2 mg/dL ( P < 0.02 ) , OUTPUT:

Conclusion The Nordic dietary pattern improves blood pressure and also some of blood lipid markers and it should be considered as a healthy dietary pattern

MS2_fixed_5_shot2010

***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: Thirty-nine U.S. Air Force enlisted men participated in a r and omized controlled study that evaluated an experimental program design ed to enhance fitness . Subjects were assigned to either a treatment ( access to the program ) or control ( no access to program ) group for 6 months . To improve treatment group fitness ( as measured by VO2 , subjects received individually tailored information ( based on a behavior change model ) via the Internet to encourage adoption of positive diet and exercise behaviors . Results showed no significant effect in improving fitness in treatment . However , significant effects were observed for secondary outcomes such as weight ( controls , + 1.0 kg vs. treatment , -2.2 kg , p < 0.05 ) , body mass index ( + 0.3 kg/m2 vs. -0.7 kg/m2 , p < 0.05 ) , and percent body fat ( + 0.6 % vs. -1.5 % , p < 0.001 ) . The data suggest that the individually tailored exercise information was not effective in encouraging sufficient exercise intensity to impact fitness . However , the dietary tailored information appears to have encouraged the adoption of more positive nutritional practice s as demonstrated by the beneficial effects reflected in secondary outcomes Excess weight is associated with negative health outcomes . Meal replacements are effective in promoting favorable body composition changes in civilian population s ; however , their efficacy with military service members who have unique lifestyles is unknown . The objective of this r and omized controlled trial was to determine the efficacy of the Army 's education-based weight-management program , " Weigh to Stay , " with and without meal replacements for improving blood lipids , and to promote weight and body fat loss in overweight US Army soldiers . Soldiers ( n=113 ; 76 males/37 females ) attending Weigh to Stay at Fort Bragg , NC , in 2006/2007 were r and omized to Weigh to Stay only or a commercially available meal-replacement program ( two meal replacements per day ) in conjunction with Weigh to Stay , and followed until Army body fat st and ards were met or for 6 months if st OUTPUT:

Results Based on consistent evidence from studies that were rated as moderate or strong , there is good evidence that military weight management interventions are effective in improving body composition for duration s of up to 12 months . Effective interventions are more likely to be high intensity ( have a greater number of sessions ) , are more often delivered by specialists , and use theoretical base/behavioral change techniques and a st and ardized guideline . Dietary interventions can potentially reduce total fat and saturated fat intake . Dietary interventions that target the kitchen staff and /or increase the availability of healthy food are more likely to be effective in the short term . The results regarding military physical fitness interventions were inconclusive . Conclusion Despite limitations such as the diversity and heterogeneity of the included interventions , outcome measurements , and follow-up duration , this systematic review found good evidence that weight management interventions are effective , especially in terms of weight loss .

MS2_fixed_5_shot2011

***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 Chronic low back pain remains a major health problem in Australia and around the world . Unfortunately the majority of treatments for this condition produce small effects because not all patients respond to each treatment . It appears that only 25–50 % of patients respond to exercise . The two most popular types of exercise for low back pain are grade d activity and motor control exercises . At present however , there are no guidelines to help clinicians select the best treatment for a patient . As a result , time and money are wasted on treatments which ultimately fail to help the patient . Methods This paper describes the protocol of a r and omised clinical trial comparing the effects of motor control exercises with a grade d activity program in the treatment of chronic non specific low back pain . Further analysis will identify clinical features that may predict a patient 's response to each treatment . One hundred and seventy two participants will be r and omly allocated to receive either a program of motor control exercises or grade d activity . Measures of outcome will be obtained at 2 , 6 and 12 months after r and omisation . The primary outcomes are : pain ( average pain intensity over the last week ) and function ( patient-specific functional scale ) at 2 and 6 months . Potential treatment effect modifiers will be measured at baseline . Discussion This trial will not only evaluate which exercise approach is more effective in general for patients will chronic low back pain , but will also determine which exercise approach is best for an individual patient . Trial registration Proper psychomotor performance is needed in work and in activities of daily living , but among subjects with low back pain this area has been studied Little . The present purpose was to evaluate the effect and permanence of a 3-mo . physical exercise program on the psychomotor performance of lower limbs in subjects with low back pain . The associations between psychomotor performance and intensity of low back pain and subjective disability were also evaluated . 90 subjects with nonspecific , subacute low back pain were assigned to one of the three groups : one given three months intensive training , one home exercise , or the control group . Four measurement sessions were made during the 1-yr . study . Psychomotor speed of lower limbs was analyzed with Choice Reaction Time , Movement Time , and Total Response Time . Flight Time of a vertical static OUTPUT:

That is , persons with acute or subacute LBP appear to vary in the levels of physical activity independent of their pain-related disability . Persons with chronic LBP with high levels of disability are also likely to have low levels of physical activity . Persons with acute or subacute back pain appear to vary in the levels of physical activity independent of disability . Persons with chronic back pain with high levels of disability will likely have low levels of physical activity

MS2_fixed_5_shot2012

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** INPUT: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: Background and Purpose — Cardioembolism in paroxysmal atrial fibrillation ( pxAF ) is a frequent cause of ischemic stroke . Sensitive detection of pxAF after stroke is crucial for adequate secondary stroke prevention ; the optimal diagnostic modality to detect pxAF on stroke units is unknown . We compared 24-hour Holter electrocardiography ( ECG ) with continuous stroke unit ECG monitoring ( CEM ) for pxAF detection . Methods — Patients with acute ischemic stroke or transient ischemic attack were prospect ively enrolled . After a 12-channel ECG on admission , all patients received 24-hour Holter ECG and CEM . Additionally , ECG monitoring data underwent automated analysis using dedicated software to identify pxAF . Patients with a history of atrial fibrillation or with atrial fibrillation on the admission ECG were excluded . Results — Four hundred ninety-six patients ( median age , 69 years ; 61.5 % male ) fulfilled all inclusion criteria ( ischemic stroke : 80.4 % ; transient ischemic attack : 19.6 % ) . Median stroke unit stay lasted 88.8 hours ( interquartile range , 65.0–122.0 ) . ECG data for automated CEM analysis were available for a median time of 64.0 hours ( 43.0–89.8 ) . Paroxysmal AF was documented in 41 of 496 patients ( 8.3 % ) . Of these , Holter detected pxAF in 34.1 % ; CEM in 65.9 % ; and automated CEM in 92.7 % . CEM and automated CEM detected significantly more patients with pxAF than Holter ( P<0.001 ) , and automated CEM detected more patients than CEM ( P<0.001 ) . Conclusions — Automated analysis of CEM improves pxAF detection in patients with stroke on stroke units compared with 24-hour Holter ECG . The comparative usefulness of prolonged or repetitive Holter ECG recordings requires OUTPUT:

Longer duration of electrocardiographic monitoring after cryptogenic stroke is associated with a greater detection of AF .

MS2_fixed_5_shot2013

***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 potential body weight-lowering effects of dietary supplementation with eicosapentaenoic acid ( EPA ) and α-lipoic acid separately or combined in healthy overweight/obese women following a hypocaloric diet . METHODS This is a short-term double-blind placebo-controlled study with parallel design that lasted 10 weeks . Of the r and omized participants , 97 women received the allocated treatment [ Control , EPA ( 1.3 g/d ) , α-lipoic acid ( 0.3 g/d ) , and EPA+α-lipoic acid ( 1.3 g/d+0.3 g/d ) ] , and 77 volunteers completed the study . All groups followed an energy-restricted diet of 30 % less than total energy expenditure . Body weight , anthropometric measurements , body composition , resting energy expenditure , blood pressure , serum glucose , and insulin and lipid profile , as well as leptin and ghrelin levels , were assessed at baseline and after nutritional intervention . RESULTS Body weight loss was significantly higher ( P<0.05 ) in those groups supplemented with α-lipoic acid . EPA supplementation significantly attenuated ( P<0.001 ) the decrease in leptin levels that occurs during weight loss . Body weight loss improved lipid and glucose metabolism parameters but without significant differences between groups . CONCLUSIONS The intervention suggests that α-lipoic acid supplementation alone or in combination with EPA may help to promote body weight loss in healthy overweight/obese women following energy-restricted diets AIM To determine an influence of alpha-lipoic acid to reduction of body weight and regulation of total cholesterol concentration , triglycerides and glucose serum levels in obese patients with diabetes mellitus type 2 . METHODS A prospect i ve study includes two groups of obese patients with diabetes mellitus and signs of peripheral polyneuropathia : examined group ( 30 patients ; 15 females and 15 males ) , and OUTPUT:

The present study revealed that supplementation with ALA slightly but significantly decreased body weight and BMI . Safe dosage for ALA is up to 1200 mg/day . However , it seems that ALA can not be cost-effective .

MS2_fixed_5_shot2014

***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 Neurocognitive testing has been endorsed as a “ cornerstone ’ of concussion management by recent Vienna and Prague meetings of the Concussion in Sport Group . Neurocognitive testing is important given the potential unreliability of athlete self-report after injury . Relying only on athletes'ormalities after injury . Study Design Case control study ; Level of evidence , 3 . Methods High school and college athletes with a diagnosed concussion were tested 2 days after injury . Postinjury neurocognitive performance ( Immediate Postconcussion Assessment and Cognitive Testing ) and symptom ( postconcussion symptom ) scores were compared with preinjury ( baseline ) scores and with those of an agex and education-matched noninjured athlete control group . “ Abnormal ” test performance was determined statistically with Reliable Change Index scores . Results Sixty-four percent of concussed athletes reported a significant increase in symptoms , as judged by postconcussion symptom scores , compared with preinjury baseline at 2 days after injury . Eighty-three percent of the concussed sample demonstrated significantly poorer neurocognitive test results relative to their own baseline performance . The addition of neurocognitive testing result ed in a net increase in sensitivity of 19 % . Ninety-three percent of the sample had either abnormal neurocognitive test results or a significant increase in symptoms , relative to their own baseline ; 30 % of a control group demonstrated either abnormalities in neurocognitive testing or elevated symptoms , as judged by postconcussion symptom scores . For the concussed group , use of symptom and neurocognitive test results result ed in an increased yield of 29 % overreliance on symptoms alone . In contrast , 0 % of the control group had both symptoms and abnormal neurocognitive testing . Conclusion Reliance on patients ’ self-reported symptoms after concussion is likely to result in underdiagnosis of concussion and may result in premature return to play . Neurocognitive testing increases diagnostic accuracy when used in conjunction with self-reported symptoms Objective Compare the visuomotor response times of children after OUTPUT:

The results of this systematic review identify the consistent and prevalent indicators of concussion and their associations , derived from the strongest evidence in the published literature .

MS2_fixed_5_shot2015

***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 role of postoperative radiotherapy in breast-conserving therapy is undisputed . However , optimal timing of adjuvant radiotherapy is an issue of ongoing debate . This retrospective clinical cohort study was performed to investigate the impact of a delay in surgery – radiotherapy intervals on local control and overall survival . Patients and methods Data from an unselected cohort of 1393 patients treated at a single institution over a 17-year period ( 1990–2006 ) were analyzed . Patients were assigned to two groups ( CT+/CT− ) according to chemotherapy status . A delay in the initiation of radiotherapy was defined as > 7 weeks ( CT− group ) and > 24 weeks ( CT+ group ) . Results The 10-year regional recurrence-free survival for the CT− and CT+ groups were 95.6 and 86.0 % , respectively . A significant increase in the median surgery – radiotherapy interval was observed over time ( CT− patients : median of 5 weeks in 1990–1992 to a median of 6 weeks in 2005–2006 ; CT+ patients : median of 5 weeks in 1990–1992 to a median of 21 weeks in 2005–2006 ) . There was no association between a delay in radiotherapy and an increased local recurrence rate ( CT− group : p = 0.990 for intervals 0–6 weeks vs. ≥ 7 weeks ; CT+ group : p = 0.644 for intervals 0–15 weeks vs. ≥ 24 weeks ) or decreased overall survival ( CT− group : p = 0.386 for intervals 0–6 weeks vs. ≥ 7 weeks ; CT+ group : p = 0.305 for intervals 0–15 weeks vs. ≥ 24 weeks ) . Conclusion In the present cohort , a delay of radiotherapy was not associated with decreased local control or overall survival in the two groups ( CT−/CT+ ) . However , in the absence of r and omized evidence , delays in the initiation of OUTPUT:

In patients with a de novo diagnosis of breast cancer with synchronous distant metastases , surgery and radiotherapy result in considerably better locoregional tumor control . An improvement in survival has not been consistently proven , but may exist in subgroups of patients . Bei Patientinnen mit primärer Fernmetastasierung führt die lokale Beh and lung mittels Operation und/oder Strahlentherapie zur besseren lokalen Tumorkontrolle .

MS2_fixed_5_shot2016

***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 compare intraindividually a type III fissure-sealant , glass ionomer cement with a resin-based sealant . One hundred and forty-eight first permanent molars were sealed in forty-seven children . After three years 20.8 percent of the resin and 34.7 percent of the glass ionomer cement sealants were partially lost , and 0 percent and 37.5 percent , respectively , were totally lost . One tooth ( 1.4 percent ) in the glass ionomer cement group and three teeth ( 4.2 percent ) in the resin group developed caries The aim of the present trial was to ( 1 ) compare the caries-preventive effect of glass ionomer sealants , placed according to the atraumatic restorative treatment ( ART ) procedure , with composite resin sealants over time and ( 2 ) investigate the caries-preventive effect after complete disappearance of sealant material . Forty-six boys and 57 girls , mean age 7.8 years , were r and omly divided into two treatment groups in a parallel-group study design . A light-polymerized composite resin sealant material and a high-viscosity glass ionomer were each placed in 180 fully erupted first molars in their respective treatment groups . Evaluation took place annually for 5 years by calibrated examiners . After 5 years , 86 % composite resin and 88 % glass ionomer sealants did not survive . Three categories of re-exposure periods for caries development in pits and fissures after complete loss of sealants were distinguished : 0–1 , 1–2 and 2–3 years . In the 2- to 3-year group , 13 and 3 % of pits and fissures previously sealed with composite resin and glass ionomer , respectively , were diagnosed as having developed a dentine lesion . The relative risks ( 95 % CI ) of dentine lesion development in surfaces sealed with glass ionomer compared to those sealed with composite resin after 3 , 4 and 5 years were 0.22 ( 0.06– OUTPUT:

This systematic review with meta- analysis found no evidence that either material was superior to the other in the prevention of dental caries . Thus , both material s appear equally suitable for clinical application as a fissure sealant material

MS2_fixed_5_shot2017

***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 majority of adults in the UK and US are overweight or obese due to multiple factors including excess energy intake . Training people to inhibit simple motor responses ( key presses ) to high-energy density food pictures reduces intake in laboratory studies . We examined whether online response inhibition training reduced real-world food consumption and weight in a community sample of adults who were predominantly overweight or obese ( N = 83 ) . Participants were allocated in a r and omised , double-blind design to receive four 10-min sessions of either active or control go/no-go training in which either high-energy density snack foods ( active ) or non-food stimuli ( control ) were associated with no-go signals . Participants ' weight , energy intake ( calculated from 24-h food diaries ) , daily snacking frequency and subjective food evaluations were measured for one week pre- and post-intervention . Participants also provided self-reported weight and monthly snacking frequency at pre-intervention screening , and one month and six months after completing the study . Participants in the active relative to control condition showed significant weight loss , reductions in daily energy intake and a reduction in rated liking of high-energy density ( no-go ) foods from the pre-to post-intervention week . There were no changes in self-reported daily snacking frequency . At longer-term follow-up , the active group showed significant reductions in self-reported weight at six months , whilst both groups reported significantly less snacking at one- and six-months . Excellent rates of adherence ( 97 % ) and positive feedback about the training suggest that this intervention is acceptable and has the potential to improve public health by reducing energy intake and overweight The present study investigated the effects of hunger and visuo-spatial interference on imagery-induced food cravings . Forty-two women were r and omly assigned to a hungry ( no food for prior 4h ) or not hungry condition . Participants were asked to form and maintain images of desired foods while looking at a blank computer screen ( control condition ) or performing a task design ed to load the visuo-spatial sketchpad of working memory ( dynamic visual OUTPUT:

A wide range of techniques have been evaluated and some show promise for use in weight management interventions .

MS2_fixed_5_shot2018

***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 / Objectives : Restrictive Anorexia nervosa ( ANR ) is an eating disorder ( ED ) characterized by a low bone mineral content ( BMC ) and by an alteration in body composition ( reduction and abnormal distribution of fat mass — FM and lean mass — LM ) . The aim of our study was to address whether bone and body composition changes could be influenced by hormonal status and sport in female adolescents with restrictive anorexia nervosa-ANR.Subjects/ Methods : Prospect i ve study on 79 adolescents with ANR su bmi tted to Dual Energy X-Ray Absorptiometry — DXA at baseline-T0 and after 12 months-T12 . Among the 46/79—58.2 % patients that completed the study , we evaluated total and regional FM and LM% , as well as lumbar bone mineral density ( BMD ) and Z-score , linking them to clinical variables : menarche/amenorrhea/hormonal therapy and physical activity . Results : At T0 : body mass index ( BMI ) = 16.4±1.4 kg/m2 with low levels of FM% ( 21.7±5.7 ) low BMC in 12/46—26.0 % ( mean Z-score : −1.21±1.27 , with higher values related to physical activity — P=0.001 ) . At T12 : a significant increase in BMI —P=0.001 , with LM reduction and FM increase ( more evident in the trunk — P<0.001 ) ; regarding bone , no significant changes were observed , though a tendency in terms of improvement associated with resumption of menses . Conclusions : After 1 year , weight recovery was not associated with a reestablishment of bone values ; by contrast , it was associated with an increase and a distortion in FM distribution , more evident in trunk region ( potential and adjunctive risk factor for the relapse of the psychiatric condition ) . The complexity of these clinical findings suggested DXA , a low-dose and low-cost technique , in long-term OUTPUT:

First , during anorexia nervosa adolescent females lose more central body fat , while adult females more peripheral fat . Second , partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females . Third , after short-term weight restoration , whether partial or complete , adults show a central adiposity phenotype with respect to healthy age-matched controls . Fourth , central fat distribution is associated with increased insulin resistance , but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults . Fifth , the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration , indicating that preferential central distribution of body fat is a transitory phenomenon .

MS2_fixed_5_shot2019

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** INPUT: OBJECTIVE To determine if an evidence -based practice bundle would result in a significantly lower rate of surgical site infections ( SSIs ) when compared with st and ard practice . DESIGN Single-institution , r and omized controlled trial with blinded assessment of main outcome . The trial opened in April 2007 and was closed in January 2010 . SETTING Veterans Administration teaching hospital . PATIENTS Patients who required elective transabdominal colorectal surgery were eligible . A total of 241 subjects were approached , 211 subjects were r and omly allocated to 1 of 2 interventions , and 197 were included in an intention-to-treat analysis . INTERVENTIONS Subjects received either a combination of 5 evidence d-based practice s ( extended arm ) or were treated according to our current practice ( st and ard arm ) . The interventions in the extended arm included ( 1 ) omission of mechanical bowel preparation ; ( 2 ) preoperative and intraoperative warming ; ( 3 ) supplemental oxygen during and immediately after surgery ; ( 4 ) intraoperative intravenous fluid restriction ; and ( 5 ) use of a surgical wound protector . MAIN OUTCOME MEASURE Overall SSI rate at 30 days assessed by blinded infection control coordinators using st and ardized definitions . RESULTS The overall rate of SSI was 45 % in the extended arm of the study and 24 % in the st and ard arm ( P = .003 ) . Most of the increased number of infections in the extended arm were superficial incisional SSIs ( 36 % extended OUTPUT: Our results suggest that wound protectors reduce rates of SSI after gastrointestinal and biliary surgery INPUT: Chronic Obstructive Pulmonary Disease ( COPD ) is the fourth-leading cause of chronic morbidity and mortality in North America and its burden continues to increase . Tiotropium has been shown to reduce exacerbations , hospitalizations , symptoms , and improve health-related quality of life in patients with COPD . Its effect on mortality and its effects relative to long-acting beta-agonists ( LABAs ) , however , remain unknown . To examine the association between tiotropium use compared to LABA use on all-cause mortality in older patients with COPD , a longitudinal , population -based cohort study was conducted in Ontario , Canada . Subjects were individuals 65 years and older discharged from hospital with a diagnosis of COPD between January 1 , 2003 and March 31 , 2006 . The hazard of receiving a prescription for tiotropium compared to a long-acting beta-agonist on all-cause mortality at 180 days post-hospital discharge , controlling for a number of potential confounders , was eliminated . Data from 7218 eligible patients were analyzed . Of these , 1046 ( 14.5 % ) died in the follow-up period . Patients who received tiotropium were 20 % less likely to die than those receiving a long-acting beta-agonist ( hazard ratio 0.80 , 95 % confidence interval 0.70 to 0.93 ) . In conclusion , in older patients recently discharged from hospital for COPD , receiving tiotropium was found to be associated with reduced mortality at 6 months compared to receiving a long-acting beta-agon OUTPUT: The majority of the studies showed that the medications evaluated provided symptom relief ; improved the quality of life and pulmonary function of patients ; and prevented exacerbations . The medications studied are safe to use in the management of COPD and have few adverse effects INPUT: & NA ; The purpose of the present study was to determine whether gender differences exist in the forebrain cerebral activation patterns of the brain during pain perception . Accordingly , positron emission tomography ( PET ) with intravenous injection of H2 15O was used to detect increases in regional cerebral blood flow ( rCBF ) in normal right‐h and ed male and female subjects as they discriminated differences in the intensity of innocuous and noxious heat stimuli applied to the left forearm . Each subject was instructed in magnitude estimation based on a scale for which 0 indicated ‘ no heat sensation ’ ; 7 , ‘ just barely painful ’ and 10 , ‘ just barely tolerable ’ . Thermal stimuli were 40 ° C or 50 ° C heat , applied with a thermode as repetitive 5‐s contacts to the volar forearm . Both male and female subjects rated the 40 ° C stimuli as warm but not painful and the 50 ° C stimuli as painful but females rated the 50 ° C stimuli as significantly more intense than did the males ( P=0.0052 ) . Both genders showed a bilateral activation of premotor cortex in addition to the activation of a number of contralateral structures , including the posterior insula , anterior cingulate cortex and the cerebellar vermis , during heat pain . However , females had significantly greater activation of the contralateral prefrontal cortex when compared to the males by direct image subtraction . Volume of interest comparison ( t‐statistic ) also suggested greater activation of the contralateral insula and thalamus in the females ( P<0.05 ) . These pain‐related differences in brain OUTPUT: Studies evaluating pain thresholds and nociceptive flexion reflex indicated the opposite when simply averaged across studies ; however , weighted analyses of threshold found more efficient DNIC in males . Gender differences in DNIC effect depend on both the experimental methodology and the modes of measurement of the effect INPUT: Future Care Planning ( FCP ) rarely occurs in patients with heart disease until close to death by which time the potential benefits are lost . We assessed the feasibility , acceptability and tested a design of a r and omised trial evaluating the impact of FCP in patients and carers . 50 patients hospitalised with acute heart failure or acute coronary syndrome and with predicted 12 month mortality risk of > 20 % were r and omly allocated to FCP or usual care for 12 weeks upon discharge and then crossed-over for the next 12 weeks . Quality of life , symptoms and anxiety/distress were assessed by question naire . Hospitalisation and mortality events were documented for 6 months post-discharge . FCP increased implementation and documentation of key decisions linked to end-of-life care . FCP did not increase anxiety/distress ( Kessler score -E 16.7 ( 7.0 ) vs D 16.8 ( 7.3 ) , p = 0.94 ) . Quality of life was unchanged ( EQ5D : E 0.54(0.29 ) vs D 0.56(0.24 ) , p = 0.86 ) while unadjusted hospitalised nights was lower ( E 8.6 ( 15.3 ) vs D 11.8 ( 17.1 ) , p = 0.01 ) . Qualitative interviews indicated that FCP was highly valued by patients , carers and family physicians . FCP is feasible in a r and omised clinical trial in patients with acute high risk cardiac conditions . A Phase 3 trial is needed urgently Objective To examine the effects of OUTPUT: There was no clear adverse impact on mortality . Compared to usual care , palliative care interventions substantially reduce hospitalizations , with no clear adverse effect on survival . INPUT: OBJECTIVE To test the hypothesis that many nursing home residents with an apparently blunted fever response ( maximum temperature less than 101 degrees F ) may actually have a significant change in temperature ( delta T greater than or equal to 2.4 degrees F ) which is not recognized because of a low baseline temperature . DESIGN Retrospective chart review for cases of infection that met specific criteria and for chart-recorded baseline and infection temperatures . Chart-recorded baseline temperatures were prospect ively compared with re-measurement of morning temperatures . SETTING Nursing Home Care Unit of the VAMC West Los Angeles . PATIENTS R and om review of 40 residents ' charts result ed in the detection of 69 infections among 26 residents over a 20-month period . Fifty r and omly selected residents prospect ively underwent comparison of chart-determined and actual re-measurement of baseline temperatures . RESULTS In 50 r and omly selected residents , the mean oral baseline temperature of 97.4 + /- 0.2 ( degrees F + /- SEM ) closely approximated the mean nurse-recorded measures in the charts ( 97.6 + /- 0.1 ) . Chart review detected 69 infections among 26 residents , with 53 episodes having a temperature recorded during the infection . The mean maximum temperature ( Tmax ) during an infection was 101.3 + /- 0.3 ( degrees F + /- SEM ) but 47 % ( 25/53 ) of the episodes had a " blunted " fever response ( Tmax less than 101 degrees F ) . Of the 25 " OUTPUT: Synthesis of data indicated that normal body temperature values in older people by sites were rectal 0.7 degrees F/0.4 degrees C , ear-based 0.3 degrees F/0.2 degrees C , oral 1.2 degrees F/0.7 degrees C , axillary 0.6 degrees F/0.3 degrees C lower than adults ' acceptable value from those traditionally found in nursing textbooks . INPUT: BACKGROUND Low birth weight infants have been noted to have low zinc concentrations in cord blood , and zinc deficiency in childhood is associated with reduced immunocompetence and increased infectious disease morbidity . This study investigates whether zinc supplementation of infants born full term and small for gestational age affects mortality . METHODS A r and omized , double-blind , controlled trial with 2-by-2 factorial design enrolled 1154 full-term small for gestational age infants to receive in syrup 1 of the following : riboflavin ; riboflavin and zinc ( 5 mg as sulfate ) ; riboflavin , calcium , phosphorus , folate , and iron ; or riboflavin , zinc , calcium , phosphorus , folate , and iron . A fixed dosage of 5 mL per child was given daily from 30 to 284 days of age . Household visits were made 6 days per week to provide the syrup and conduct surveillance for illness and death . When a child 's death was reported , parental reports and medical records were used to ascertain the cause . The effects of zinc and of the combination of iron , folate , calcium , and phosphorus were analyzed by intent to treat . The mortality analysis was performed using a survival analytic approach that models time until death as the dependent variable ; all models had 2 terms as independent variables : 1 for the zinc effect and 1 for the vitamin and mineral ( calcium and phosphorus , folate and iron ) effect . RESULTS Zinc supplementation was associated with significantly lower mortality , with a rate ratio of 0.32 ( 95 % confidence interval : 0.12 - 0.89 ) . Calcium , phosphorus , folate , and iron supplementation was not associated with a mortality reduction , although a statistically nonsignificant trend toward reduction was observed with a rate ratio of 0.88 ( 95 % confidence interval : 0.36 - 2.15 ) . CONCLUSIONS Zinc supplementation in small for gestational age infants can result in a substantial OUTPUT:

There is no convincing evidence that zinc supplementation to infants or children results in improved motor or mental development

MS2_fixed_5_shot2020

***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: Associations between modifiable exposures and disease seen in observational epidemiology are sometimes confounded and thus misleading , despite our best efforts to improve the design and analysis of studies . Mendelian r and omization-the r and om assortment of genes from parents to offspring that occurs during gamete formation and conception-provides one method for assessing the causal nature of some environmental exposures . The association between a disease and a polymorphism that mimics the biological link between a proposed exposure and disease is not generally susceptible to the reverse causation or confounding that may distort interpretations of conventional observational studies . Several examples where the phenotypic effects of polymorphisms are well documented provide encouraging evidence of the explanatory power of Mendelian r and omization and are described . The limitations of the approach include confounding by polymorphisms in linkage disequilibrium with the polymorphism under study , that polymorphisms may have several phenotypic effects associated with disease , the lack of suitable polymorphisms for study ing modifiable exposures of interest , and canalization-the buffering of the effects of genetic variation during development . Nevertheless , Mendelian r and omization provides new opportunities to test causality and demonstrates how investment in the human genome project may contribute to underst and ing and preventing the adverse effects on human health of modifiable exposures Background — Whether physical activity reduces the impact of obesity on the risk of acute coronary events is much debated . However , little is known about the role of other potentially modifiable lifestyle factors in combination with obesity . Methods and Results — We followed up 54 783 women and men from the prospect i ve Danish Diet , Cancer and Health study who were 50 to 64 years at baseline ( 1993 to 1997 ) and free of coronary artery disease and cancer . During a median of 7.7 years , 1127 incident cases of acute coronary syndrome ( ACS ) occurred . After multivariable adjustments , each unit of body mass index was associated with a 5 % and 7 % higher risk of ACS among women and men , respectively ( both P<0.0001 for trend ) . Overweight ( body mass index , 25 OUTPUT:

We argue that despite inconsistencies in the definition , patterns across studies clearly show that healthy obesity is a state of intermediate disease risk . Expert commentary : Given the current state of population -level evidence , we conclude that obesity and metabolic dysfunction are inseparable and that healthy obesity is best viewed only as a state of relative health but not of absolute health .