***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: Many cystic fibrosis patients with Pseudomonas lung infections receive intravenous ( IV ) antibiotics and chest physiotherapy ( CPT ) at home . Previous studies have suggested that home care , in the setting of a clinical study , is as efficacious as hospital care . This report compares the outcomes of home care with minimal supervision to outcomes of hospital care . We compared two groups of similar age and severity of lung impairment . Patients met strict definitions for home or hospital treatment ( 27 home care courses/33 hospital care courses ) . Five patients completed six courses of both home care and hospital treatment .  Treatment in both groups included intravenous antibiotics and CPT . Primary outcome measures included changes in pulmonary function between the start of treatment and after 2 weeks of therapy , duration of treatment , and intervals between antibiotic courses . In hospitalized patients , forced vital capacity ( FVC ) increased by 17.4 + /- 3.1 % ( mean + /- SEM ) , and forced expiratory volume in one second ( FEV1 ) increased by 23.3 + /- 4.1 % , both significant at P < 0.001 . The FVC and FEV1 of patients treated at home increased by 10.2 + /- 2.0 % and 13.7 + /- 2.6 % respectively , neither of which was a significant improvement . Similar results were found in the five patients completing both home and hospital courses . The average duration of treatment was twice as long and time between IV antibiotic courses only two-thirds as long for those treated at home compared with the hospitalized patients . Previous reports have cl aim ed that home care in the setting of a prospect i ve study is as efficacious as hospital care . Our experience indicates that routine home care with minimal supervision of patients is less effective than hospital care . Furthermore , home care as delivered to patients in this report increased the overall cost of care by as much as 30 % because of longer and more frequent courses of antibiotic therapy Purpose : We hypothesized that a single intravenous ( iv ) tobramycine infusion ( treatment B ) would have equivalent anti-infectious efficacy in chronic Pseudomonas aeruginosa ( PA ) infection in cystic fibrosis ( CF ) as the commonly performed treatment of three doses ( treatment A ) . Toxicity and practicability may even be improved in the single-dose regimen . Methods : This was a r and omized crossover study comparing outcome after 14 and 35 days . The primary end-point was a decrease in the leukocyte count , and the secondary end-points were clinical and lung function parameters , Pseudomonas quantification in sputum , and inflammation markers ( immunoglobulin G , C-reactive protein ) in serum . 30 patients ( 20 female , mean age 11.2 years , mean age range 1.7–18.1 years ) received elective 14-day courses of treatments A or B , followed by the alternative treatment after a mean interval of 37 ( ± 21 ) weeks . Results : With the exception of PA density , there were no significant differences between both treatment strategies after 14 days of treatment . After 35 days of treatment , there were no significant changes in the leukocyte count and inflammation markers . Both treatment strategies reduced the bacterial load in the airways , as reflected by a decreased PA density in sputum . Nephrotoxicity was equal in both groups , with a transient slight elevation of urinary N-acetyl-β-glucosaminidase concentrations . St and ard audiometry tests revealed no evidence of a hearing impairment in any patient following therapy . Mean body weight increased during the study period by 0.5 kg . Forced expiratory volume increased by approximately 5 % of the predicted volume , forced vital capacity increased by 2 % of predicted capacity , and forced mid expiratory flow rate increased by 7 % ( A ) or 4 % ( B ) of the predicted normal value , although these changes were not statistically significant . Conclusion : We conclude that tobramycin given in a daily single dose ( with the advantage of being more practical in a home environment ) has an efficacy equal to that of three daily doses in terms of elective antipseudomonal therapy in clinical ly stable patients with CF Abstract . Background : Home intravenous antibiotic treatment has added to therapeutic options against Pseudomonas aeruginosa in cystic fibrosis ( CF ) patients leading to increased flexibility . A prospect i ve clinical study was carried out to compare home and hospital iv antibiotic treatment in CF patients with chronic P. aeruginosa infection . Patients and Methods : Treatment courses were planned selectively , exacerbations were excluded . 28 consecutive hospital courses ( group 1 ) were compared with 30 home care courses ( group 2 ) . Chest physiotherapy and nutrition therapy were carried on in both groups . Antibiotic treatment in both groups consisted of tobramycin and ceftazidime , with equal dosage and application . Groups were compared using clinical , inflammatory and microbiological parameters . Results : There was a significant difference ( p ≤ 0.05 ) in peripheral leukocyte counts before and after therapy in both groups . The same was true for forced expiratory volume in 1 sec ( FEV1 ; p ≤ 0.05 ) , weight for height ( p ≤ 0.005 ) and for Pseudomonas counts ( p ≤ 0.005 ) in sputa . There was no statistical difference between the two groups for any of the parameters tested . Conclusion : It is concluded that , when exacerbations are excluded , home iv therapy is an effective therapeutic option in CF . Long-term comparison is still needed to effectively evaluate the pros and cons of home and hospital antibiotic treatment in CF In this study , we set out to determine if home intravenous ( i.v . ) antibiotic therapy in adult patients with cystic fibrosis ( CF ) is a feasible , effective and less costly alternative to hospitalization , and to assess the impact of home therapy on quality of life . The study was a prospect i ve , r and omized , two-factor mixed design involving adults presenting with respiratory exacerbations of CF . Patients were r and omized such that they were discharged home after 2 - 4 days , or remained in hospital . Seventeen patients had 31 admissions ( 13 home and 18 hospital ) . Following 10 days of therapy , there were no significant differences between home or hospital arms with respect to body weight , 12 minute walking distance , sputum weight , pulse oximetry , or improvement in lung function ( forced expiratory volume in one second ( FEV1 ) , or forced vital capacity ( FVC ) ) . Patients who remained in hospital were less fatigued and noted a greater degree of mastery . Patients discharged early noted less disruption to their family life , personal life and sleeping pattern . The total cost for the home therapy arm was approximately half that of the hospital therapy arm . Home intravenous antibiotic therapy in patients with cystic fibrosis was a feasible , cost-effective alternative to receiving therapy in hospital . Although there was no clinical compromise associated with home therapy , there were advantages and disadvantages in terms of quality of life METHODS 14 patients with cystic fibrosis and chronic pulmonary pseudomonas infection received four courses of two-week intravenous antibiotic therapy at home and during hospitalisation over an 18-month period . Following a controlled , intra-individual cross-over design , two courses of home therapy were followed by two courses of hospital treatment or vice versa . Parameters for inflammation , lung function , and body mass index were obtained at the beginning and end of each intravenous antibiotic therapy .  Health-related quality of life , i.e. physical , emotional , social and functional components as well as happiness and medical care , was assessed at the end of each course . RESULTS There was a trend towards better reduction of infection ( p = 0.20 for leukocyte reduction ) and improvement of lung function ( p = 0.20 for FEV1 improvement ) with hospital intravenous antibiotic therapy , although the differences did not attain statistical significance . Quality of life during therapy was significantly higher with home therapy regarding social ( p < 0.01 ) , functional and emotional subscales and happiness ( all p < 0.05 ) . The necessity for professional help and support from family and /or partner was emphasised . Individual answers showed that home therapy has the advantage of self-determination and continuity of daily life . Parents and partners felt impaired by day and night intravenous therapy at home . CONCLUSION From our data we conclude that home intravenous antibiotic therapy is a useful option for a selected subgroup of patients with cystic fibrosis , but professional support and family aid is important to gain an effect similar to hospital treatment RATIONALE Individuals with cystic fibrosis ( CF ) are subject to recurrent respiratory infections ( exacerbations ) that often require intravenous antibiotic treatment and may result in permanent loss of lung function . The optimal means of delivering therapy remains unclear . OBJECTIVES To determine whether duration or venue of intravenous antibiotic administration affect lung function . METHODS Data were retrospectively collected on 1,535 subjects recruited by the US CF Twin and Sibling Study from US CF care centers between 2000 and 2007 . MEASUREMENTS AND MAIN RESULTS Long-term decline in FEV₁ after exacerbation was observed regardless of whether antibiotics were administered in the hospital ( mean , -3.3 percentage points [ 95 % confidence interval , -3.9 to -2.6 ] ; n = 602 courses of therapy ) or at home ( mean , -3.5 percentage points [ 95 % confidence interval , -4.5 to -2.5 ] ; n = 232 courses of therapy ) ; this decline was not different by venue using t tests ( P = 0.69 ) or regression ( P = 0.91 ) . No difference in intervals between courses of antibiotics was observed between hospital ( median , 119 d [ interquartile range , 166 ] ; n = 602 ) and home ( median , 98 d [ interquartile range , 155 ] ; n = 232 ) ( P = 0.29 ) . Patients with greater drops in FEV₁ with exacerbations had worse long-term decline even if lung function initially recovered with treatment ( P < 0.001 ) . Examination of FEV₁ measures obtained during treatment for exacerbations indicated that improvement in FEV₁ plateaus after 7 - 10 days of therapy . CONCLUSIONS Intravenous antibiotic therapy for CF respiratory exacerbations administered in the hospital and in the home was found to be equivalent in terms of long-term FEV₁ change and interval between courses of antibiotics . Optimal duration of therapy ( 7 - 10 d ) may be shorter than current practice . Large prospect i ve studies are needed to answer these essential questions for CF respiratory management There is a worldwide drive for the home management of chronic respiratory diseases . With the widespread use of home intravenous ( IV ) treatment for cystic fibrosis ( CF ) pulmonary exacerbations ( PExs ) , evidence pointing to an inferior outcome of care for home-treated patients in comparison to hospital-treated patients is a cause of concern . Currently , patients who self-administer IV antibiotics at home are provided with equipment and instructions on the use of antibiotics . Policies vary ; but in most UK centers , these patients are then followed up by the multidisciplinary team only on days 1 , 7 and 14 of the treatment course . We aim ed to review the current published literature in search for evidence for the value and the shortfalls of self-administered IV treatment at home for acute PExs in CF patients in comparison to conventional hospital treatment . We search ed the electronic data base system Medline for published papers regarding studies comparing home- and hospital-based IV antibiotic treatment for both adult and pediatric CF patients . Sixteen studies were identified and grouped into those that showed a similar outcome between home and hospital treatment and those that showed an inferior outcome for home management . Most studies were retrospective or inadequately powered to provide clear answers . Ideally , outcome of care for home treatment should be at least equal to outcome for hospital treatment . Extensive efforts should be made to st and ardize therapies preserving the advantages of home management and addressing the perceived reasons for an inferior outcome . Until further studies provide definitive answers , treatment at home should be reserved for adequately selected patients and individualized depending on the unique setting s of each CF center and specific patients ' requirements . There is great need for a prospect i ve r and omized controlled trial comparing home and hospital treatments in order to clarify this matter In a prospect i ve , r and omised , cross-over study including cystic fibrosis patients with indications for HIVAT ( home intravenous antibiotic treatment ) the prospect of pharmaceutical intervention was investigated . A comparison between the use of disposable infusion devices with antibiotics from the pharmacy and when the patients prepared the drugs themselves was performed . During a first treatment course the patients received either infusion devices during 5 days or reconstituted the drugs themselves during 5 days , or vice versa . During a second treatment course the order was the reversed . Eight patients were included , out of which six completed the original design as a cross-over study , yielding a total of 550 doses of antibiotics . The patients preferred infusion devices from the pharmacy prepared according to GMP ( Good Manufacturing Practice ) as opposed to reconstituting the antibiotics themselves . Points of view presented included no anxiety over the correct dosage of drugs and less disruption of family and social life . In a practical sense , portable devices are more expensive than the preparation of the drugs by the patients themselves . However , when comparing with in-hospital treatment the direct costs for a hospital stay exceed that of the devices . Another part of the study evaluated the quality of life using a modified form of SEIQoL-DW ( Schedule for the Evaluation of Individual Quality of Life - Direct Weighting ) . Twenty patients took part in the study and the overall quality of life scores increased significantly when patients received infusion devices compared to reconstituting the drugs themselves Methods for combining data from several studies exist and appear to be quite useful . None satisfactorily addresses the question of what studies should 
    Output:
    
Home participants underwent fewer investigations than hospital participants ( P < 0.002 ) and general activity was higher in the home group .
No significant differences were found for clinical outcomes , adverse events , complications or change of intravenous lines , or time to next admission .
Home participants received less  low-dose home maintenance antibiotic .
Quality of life measures showed no significant differences for dyspnoea and emotional state , but fatigue and mastery were worse for home participants , possibly due to a higher general activity and need of support .
Personal , family , sleeping and eating disruptions were less important for home than hospital admissions .
Home therapy was cheaper for families and the hospital .
It suggests that , in the short term , home therapy does not harm individuals , entails fewer investigations , reduces social disruptions and can be cost-effective .
There were both advantages and disadvantages in terms of quality of life .