***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 .

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