***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: Introduction : Hip fractures are common in the elderly patients with an incidence of 320 000 fractures/year in the United States , representing a health-care cost of US$ 9 to 20 billion . Hip fracture incidence is projected to increase dramatically . Hospitals must modify clinical models to accommo date this growing burden . Comanagement strategies are reported in the literature , but few have addressed orthopedic-hospitalist models . An orthopedic-hospitalist comanagement ( OHC ) service was established at our hospital to manage hip fracture patients . We sought to determine whether the OHC ( 1 ) improves the efficiency of hip fracture management as measured by inpatient length of stay ( LOS ) and time to surgery ( TTS ) and ( 2 ) whether our results are comparable to those reported in hip fracture comanagement literature . Methods : A comparative retrospective– prospect i ve cohort study of patients older than 60 years with an admitting diagnosis of hip fracture was conducted to compare inpatient LOS and TTS for hip fracture patients admitted 10 months before ( n = 45 ) and 10 months after implementation ( n = 54 ) of the OHC  at a single academic hospital . Secondary outcome measures included percentage of patients taken to surgery within 24 or 48 hours , 30-day readmission rates , and mortality . Outcomes were compared to comanagement study results published in MEDLINE -indexed journals . Results : Patient cohort demographics and comorbidities were similar . Inpatient LOS was reduced by 1.6 days after implementation of the OHC ( P = .01 ) without an increase in 30-day readmission rates or mortality . Time to surgery was insignificantly reduced from 27.4 to 21.9 hours ( P = .27 ) and surgery within 48 hours increased from 86 % to 96 % ( P = .15 ) . Discussion : The OHC has improved efficiency of hip fracture management as judged by significant reductions in LOS with a trend toward reduced TTS at our institution . Conclusion : Orthopedic-hospitalist comanagement may represent an effective strategy to improve hip fracture management in the setting of a rapidly exp and ing patient population Background Synthesis of multiple r and omized controlled trials ( RCTs ) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions . Filtering of search es is time consuming , and no single method fulfills the principal requirements of speed with accuracy . Automation of systematic review s is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making . We developed Rayyan ( http://rayyan.qcri.org ) , a free web and mobile app , that helps expedite the initial screening of abstract s and titles using a process of semi-automation while incorporating a high level of usability . For the beta testing phase , we used two published Cochrane review s in which included studies had been selected manually . Their search es , with 1030 records and 273 records , were uploaded to Rayyan . Different features of Rayyan were tested using these two review s. We also conducted a survey of Rayyan ’s users and collected feedback through a built-in feature . Results Pilot testing of Rayyan focused on usability , accuracy against manual methods , and the added value of the prediction feature . The “ taster ” review ( 273 records ) allowed a quick overview of Rayyan for early comments on usability . The second review ( 1030 records ) required several iterations to identify the previously identified 11 trials . The “ suggestions ” and “ hints , ” based on the “ prediction model , ” appeared as testing progressed beyond five included studies . Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements . The survey respondents reported 40 % average time savings when using Rayyan compared to others tools , with 34 % of the respondents reporting more than 50 % time savings . In addition , around 75 % of the respondents mentioned that screening and labeling studies as well as collaborating on review s to be the two most important features of Rayyan . As of November 2016 , Rayyan users exceed 2000 from over 60 countries conducting hundreds of review s totaling more than 1.6 M citations . Feedback from users , obtained mostly through the app web site and a recent survey , has highlighted the ease in exploration of search es , the time saved , and simplicity in sharing and comparing include-exclude decisions . The strongest features of the app , identified and reported in user feedback , were its ability to help in screening and collaboration as well as the time savings it affords to users . Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of review ers BACKGROUND / PURPOSE Elimination of unnecessary practice variation through st and ardization creates opportunities for improved outcomes and cost-effectiveness . A quality improvement ( QI ) initiative at our institution used evidence and consensus to st and ardize management of gastroschisis ( GS ) from birth to discharge . METHODS An interdisciplinary team utilized best practice evidence and expert opinion to st and ardize GS care . Following stakeholder engagement and education , care st and ardization was implemented in September 2014 . A comparative cohort study was conducted on consecutive patients treated before ( n=33 ) and after ( n=24 ) st and ardization . Demographic , treatment , and outcome measures were collected from a prospect i ve GS registry . Direct costs were estimated , and protocol compliance was audited . RESULTS BW , GA , and bowel injury severity were comparable between groups . Key practice changes were : closure technique ( pre-88 % primary fascial , post-83 % umbilical cord flap ; p<0.001 ) , closure location ( pre-97 % OR , post-67 % NICU ; p<0.001 ) , and GA avoidance ( pre-0 % , post-48 % ; p<0.001 ) . Median post-closure ventilation days were shorter ( pre-4 , post-1 ; p<0.001 ) , and SSI rates trended lower ( pre-21 % , post-8 % ; p=0.3 ) in the post-implementation group with no differences in TPN days or LOS . No significant difference was seen in average per-patient costs : pre-$85,725 ( $ 29,974 - 221,061 ) , post-$76,329 ( $ 14,205 - 176,856 ) . CONCLUSION Care st and ardization for GS enables practice transformation , cost-effective outcome improvement , and supports an organizational culture dedicated to continuous improvement . LEVEL OF EVIDENCE III A fast-track clinical pathway is design ed to streamline patient care delivery and maximize cost effectiveness . It has decreased postoperative length of stay ( LOS ) and hospital charges for many surgical procedures . However , data on clinical pathways after liver surgery are sparse . This study examined whether use of a fast-track clinical pathway for patients undergoing elective liver resection affected postoperative LOS and hospital charges . A fast-track clinical pathway was developed and implemented by a multidisciplinary team for patients undergoing liver resection . Between July , 2007 and May , 2008 , a total of 117 patients underwent elective liver resection :  the fast-track clinical pathway ( education of patients and families , earlier oral feeding , earlier discontinuation of intravenous fluid , no drains or nasogastric tubes , early ambulation , use of a urinary catheter for less than 24 h and planned discharge 6 days after surgery ) was studied prospect ively in 56 patients ( postpathway group ) . These patients were compared with the remainder who had usual care ( prepathway group ) . Outcome measures were postoperative LOS , perioperative hospital charges , intraoperative and postoperative complications , mortality , and readmission rate .  Among all patients , 69 ( 59 % ) had complicating diseases and /or a history of surgery and 24 patients belonged to American Society of Anesthesiologists grade III – IV . Compared with the prepathway group , the postpathway group had a significantly shorter postoperative LOS ( 7 vs. 11 days , P < 0.01 ) . The average perioperative hospital charges were RMB 26,626 for patients in the prepathway group and only RMB 21,004 for those in the postpathway group ( P < 0.05 ) , with no differences in intraoperative and postoperative complications ( P = 0.814 ) , mortality ( P = 0.606 ) , and readmission rate ( P = 0.424 ) . Implementation of the fast-track clinical pathway is an effective and safe method for reducing postoperative LOS and hospital charges for high-risk patients undergoing elective liver resection . The result supports the further development of fast-track clinical pathways for liver surgical procedures BACKGROUND  Carotid endarterectomy ( CEA )  is one of the top-five surgical diagnosis-related groups at Keesler Medical Center . The geometric mean length of stay for CEA during fiscal year ( FY ) 1996 was 5.84 days ( N = 41 ) , compared with 1.79 for a benchmark facility . OBJECTIVE Create a critical pathway to st and ardize care , maintain/improve patient outcomes , reduce lengths of stay , and decrease costs . METHODS A multidisciplinary team was formed to evaluate four patient-flow options . The team decided to discharge patients directly from the intensive care unit to meet both patient and staff needs . RESULTS The geometric mean length of stay decreased to 1.70 days ( N = 54 ) in FY 1998 , compared with 2.42 days ( N = 40 ) in FY 1997 . The cost savings ws $ 5,841 per case , compared with $ 1,684 before creation of the pathway . This represents an annual savings of more than $ 224,000 and a 30 % reduction in length of stay . CONCLUSIONS The CEA pathway has st and ardized the care received by this group of patients . By decreasing variation , processes have become routine and more efficient IMPORTANCE Enhanced recovery after surgery ( ERAS ) colorectal programs have shown to be successful at reducing length of stay in many international and academic centers ; however , their efficacy in a community hospital setting remains unclear . OBJECTIVE To determine if favorable results could be reproduced in a community hospital setting using our ERAS program , which was developed using core ERAS guidelines with the goal of accelerated recovery while also addressing other important outcomes affecting patient experience and safety . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve study of ERAS program , a multidisciplinary effort involving anesthesia , preadmission staff , nursing , and surgery staff at a community hospital . The program was initiated in 2010 and was in full practice by 2011 . We assessed practice patterns and patient outcomes for all elective colon and rectal resection cases performed in 2009 ( prior to ERAS implementation ) , 2011 , and 2012 . MAIN OUTCOMES AND MEASURES Laparoscopic approach , narcotic use , length of stay , 30-day readmission , ileus ( defined as reinsertion of nasogastric tube ) , and intra-abdominal infection and association between colorectal cancer ( CRC ) diagnosis and these outcomes . RESULTS From 2009 to 2012 , the use of laparoscopy increased from 57.4 % to 88.8 % ( P < .001 ) . Length of stay decreased significantly ( 6.7 days vs 3.7 days , P < .001 ) , without an increase in 30-day readmission rate ( 17.6 % vs 12.5 % , P = .49 ) . Use of patient-controlled narcotic analgesia and duration of use decreased ( 63.2 % of patients vs 15 % , P < .001 ; 67.8 hours vs 47.1 hours , P = .02 ) . Ileus rate decreased from 13.2 % to 2.5 % ( P = .02 ) . Intra-abdominal infection decreased from 7.4 % to 2.5 % ( P = .24 ) . When comparing laparoscopic cases alone , similar results were observed . Following regression analysis , there were no statistically significant differences between CRC diagnosis and LOS , 30-day readmission rates , ileus , and intra-abdominal infection ( all P 's > .05 ) . Length of stay reductions result ed in an estimated cost savings of $ 3202 per patient ( 2011 ) and $ 4803 per patient ( 2012 ) . CONCLUSIONS AND RELEVANCE Implementation of this patient care-directed enhanced recovery program is feasible in a community hospital setting , and it is associated with decreased LOS without increased readmission or morbidity , as well as significant decreases in narcotic use and cost . Improved outcomes are independent of the laparoscopic approach and CRC diagnosis Introduction Inefficient patient throughput in a surgery practice can result in extended new patient backlogs , excessively long cycle times in the outpatient clinics , poor patient satisfaction , decreased physician productivity , and loss of potential revenue . This project assesses the efficacy of multiple throughput interventions in an academic , plastic surgery practice at a public university . Methods We implemented a Patient Access and Efficiency ( PAcE ) initiative , funded and sponsored by our health care system , to improve patient throughput in the outpatient surgery clinic . Interventions included : ( 1 ) creation of a multidisciplinary team , led by a project re design manager , that met weekly ; ( 2 ) definition of goals , metrics , and target outcomes ; 3 ) revision of clinic templates to reflect actual dem and ; 4 ) working down patient backlog through group visits ; 5 ) booking new patients across entire practice ; 6 ) assigning a physician ’s assistant to the preoperative clinic ; and 7 ) design ating a central 
    Output:
    
Multidisciplinary surgical care is beneficial not only in terms of patient and provider outcomes , but also in reference to its cost-effectiveness .
Well- design ed multidisciplinary teams tend to optimize perioperative care for all involved parties .