***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: BACKGROUND For surgeons familiar with pelvic pouch operation , it is disappointing that the patients , although very satisfied to have a pouch instead of an ileostomy , often have difficulty in specifying exactly how their quality of life really has improved . The present study is an attempt to examine this situation . STUDY DESIGN In 48 patients with ulcerative colitis undergoing pelvic pouch operation  , quality of life ( QOL ) was studied prospect ively when the patients had an ileostomy , and at follow-up evaluation at least one year after restitution of anal defecation . The surgeons ' evaluation of functional outcome was compared with those of three independent evaluators ( the patient , a psychiatrist , and a psychologist ) . The Psychosocial Adjustment to Illness Scale , the Well-being Profile , the Global Assessment of Function Scale , and surgical evaluation scales were used . RESULTS As assessed by surgeons using the surgical evaluation scales , functional outcome correlated significantly with most of the assessment s of QOL done by the three independent evaluators ( the patient , a psychiatrist , and a psychologist ) . Quality of life did not improve with increasing time , either with an ileostomy or with a functioning pelvic pouch . On most evaluations , there was no further significant improvement in QOL after restitution of anal defecation . CONCLUSIONS The findings suggest that QOL is already satisfactory after " cure " of the disease , and restitution of normal defecation does not yield much further improvement BACKGROUND : Total proctocolectomy with IPAA is frequently considered the procedure of choice for surgical patients with ulcerative colitis , presumably owing to an expectation of improved quality of life in comparison with an ileostomy . OBJECTIVE : The goal of our study was to determine whether long-term quality of life among patients with a pelvic pouch is better than those who chose a permanent stoma . DESIGN : This investigation is a cross-sectional observational study using a prospect i ve data base . SETTING : This study was conducted at an academic medical center . PATIENTS : Consecutive patients who had undergone IPAA or a permanent ileostomy for ulcerative colitis by a single surgeon , presenting for their annual follow-up visit from July through September 2011 , were offered participation in the study . A r and omly chosen group of subjects who did not have scheduled appointments during the study period were sent a letter inviting them to participate in the study . MAIN OUTCOME MEASURES : The primary outcome measures used were EQ-5D-3L , the Short Quality of Life in Inflammatory Bowel Disease question naire , the Clevel and Global Quality of Life instrument , the Fecal Incontinence Quality of Life scale , and the Stoma Quality of Life scale . RESULTS : Thirty-five patients with a pelvic pouch and 24 ostomates were accrued and comprehensively studied . Global quality -of-life scores were virtually identical for the 2 groups . Patients with a pelvic pouch had better subscores in current quality of health and energy level , Fazio score , sexuality/body image , and work/social function . LIMITATIONS : This study was limited by its small sample size , and some of our patients were enrolled through mailed surveys and , hence , nonresponse bias may be present . The follow-up time since surgery was longer in the pelvic pouch group than in the ileostomy group . CONCLUSION : Informed patients with ulcerative colitis choosing an ileostomy have a health-related global quality of life very similar to patients with a pelvic pouch . Better outcomes in patients with an ileal pouch were most evident in the areas of sexuality/body image and work/social function The final development of the Sickness Impact Profile ( SIP ) , a behaviorally based measure of health status , is presented . A large field trial on a r and om sample of prepaid group practice enrollees and smaller trials on sample s of patients with hyperthyroidism , rheumatoid arthritis and hip replacements were undertaken to assess reliability and validity of the SIP and provide data for category and item analyses . Test-retest reliability ( r = 0.92 ) and internal consistency ( r = 0.94 ) were high . Convergent and discriminant validity was evaluated using the multitrait – multi method technique . Clinical validity was assessed by determining the relationship between clinical measures of disease and the SIP scores . The relationship between the SIP and criterion measures were moderate to high and in the direction hypotheszed . A technique for describing and assessing similarities and differences among groups was developed using profile and pattern analysis . The final SIP contains 136 items in 12 categories . Overall , category , and dimension scores may be calculated BACKGROUND : Significant concern exists regarding the effect of proctectomy on sexual function in patients with IBD . Little is known about gender-specific differences . OBJECTIVE : This study aim ed to examine sexual function and quality of life in men and women with IBD before and after proctectomy .  DESIGN : This is a prospect i ve cohort study . SETTING : The study was conducted at a colorectal surgery center . PATIENTS : The patients included in this study have IBD and underwent proctectomy or proctocolectomy .  INTERVENTION : The treatment provided was proctectomy or proctocolectomy . MAIN OUTCOME MEASURES : Vali date d question naires were used to assess sexual function , quality of life , bowel habits , and urinary symptoms , and were completed before and 6 months after surgery . RESULTS : Sixty-six participants ( 41 men and 25 women ) were evaluated at baseline and 6 months after proctocolectomy or completion proctectomy . A total of 48 IPAAs ( 31 men and 17 women ) and 18 end ileostomies ( 10 men and 8 women ) were created . Men reported improved scores on the International Index of Erectile Function ( P = .003 ) , a modified Sexual Function Question naire ( P = .001 ) , Inflammatory Bowel Disease Quality of Life ( P < .001 ) , and SF-36 ( Mental Component Summary , P = .003 ; Physical Component Summary , P = .001 ) after surgery . Women had improvement in the desire subscale of the Female Sexual Function Index ( P = .03 ) , Inflammatory Bowel Disease Quality of Life scores ( P = .04 ) , and SF-36 ( Mental Component Summary , P = .02 ; Physical Component Summary , P = .02 ) . There was no gender difference in the magnitude of change in scores before and after surgery for any of the measures . LIMITATIONS : Small sample size and sexually inactivity in 50 % of cohort may have had an impact on our findings . CONCLUSIONS : Both men and women reported improvements in general and IBD-specific quality of life after surgery , but only men demonstrated several areas of improved sexual function . Women reported improved sexual desire but no other sexual function improvement . The postsurgical gender difference in sexual function , despite similar improvements in quality of life , may be accounted for by unexamined aspects of female sexual function OBJECTIVE Health-related quality of life ( HRQOL ) affects outcome in chronic diseases such as inflammatory bowel disease ( IBD ) . The inflammatory bowel disease question naire ( IBDQ ) , a disease-specific HRQOL question naire , can define changes in health status in IBD , but simple instruments are needed for daily application . The present study proposed to develop a short version of the IBDQ , the SIBDQ , for community physicians . METHODS Using data from a clinical trial in 149 patients with Crohn 's disease , 10 items were selected ( by forward stepwise regression ) that best explained the variance of the IBDQ or dimensional scores ( bowel , systemic , social , emotional ) . The validity , reliability , and responsiveness of the SIBDQ were then assessed in 150 different patients with Crohn 's disease and 45 with ulcerative colitis . All scores were reported with a 7-point scale ( 1 = poor HRQOL , 7 = optimum HRQOL ) . RESULTS Mean SIBDQ scores were similar ( p = 0.22 ) in Crohn 's patients among 14 participating centers at study entry . Mean scores were lower in active Crohn 's disease ( range 4.00 - 4.92 ) than inactive disease ( range 4.67 - 5.83 ; p = 0.0015 ) . In active ulcerative colitis , the mean SIBDQ was 4.79 + /- 1.17 compared to 5.90 + /- 0.80 ( p = 0.0006 ) in inactive disease . The SIBDQ explained 92 % and 90 % of the IBDQ variance in Crohn 's disease and ulcerative colitis , respectively . In patients with stable Crohn 's disease , the test-retest reliability coefficient was 0.65 and Crohnbach 's alpha was 0.78 , indicating good reliability . In patients with Crohn 's disease who relapsed during follow-up , the mean SIBDQ decreased by -0.93 + 0.55 ( p = 0.001 ) . CONCLUSION The SIBDQ is valid , reliable , and able to detect meaningful clinical changes in HRQOL that might occur in the office setting OBJECTIVE To evaluate prospect ively long-term quality of life and functional outcome after  restorative proctocolectomy ( RPC ) with ileal pouch-anal anastomosis , and to evaluate and vali date a novel quality -of-life indicator in this group of patients . SUMMARY BACKGROUND DATA Restorative proctocolectomy with ileal pouch-anal anastomosis is now the preferred option when total proctocolectomy is required for ulcerative colitis or familial adenomatous polyposis , but long-term data on functional outcome and quality of life after the procedure are lacking . METHODS Patients ( n = 977 ) who underwent RPC with stapled anastomosis for colitis or polyposis coli and who were followed for > or = 12 months were included .  Quality of life , fecal incontinence , and satisfaction with surgery were prospect ively evaluated by structured interview or question naire for 1 to 12 years after surgery ( median 5.0 ) . Quality of life was scored using the Clevel and Global Quality of Life ( CGQL ) instrument ( Fazio Score ) . This is a novel score developed over the past 15 years by the senior author . Quality of life was also evaluated in a subgroup of patients with the Short Form 36 ( SF-36 ) . The CGQL was vali date d by determining its reliability , responsiveness , and validity as well as its correlation with the SF-36 score . RESULTS Postoperative quality of life as measured by SF-36 was excellent and compared well with published norms for the general U.S. population . The CGQL was found to be reliable , responsive , and valid , and there was a high correlation with the SF-36 scores . Using the CGQL , quality of life was shown to increase after the first 2 years after surgery , and there was no deterioration thereafter . The prevalence of perfect continence increased from 75.5 % before surgery to 82.4 % after surgery , and although this deteriorated somewhat > 2 years after surgery , it was no worse than preoperative values . Ninety-eight percent of patients would recommend the surgery to others . CONCLUSIONS Long-term quality of life after ileal pouch surgery is excellent and the level of continence is satisfactory . This surgery is an excellent long-term option in patients requiring total proctocolectomy . The CGQL is a simple , valid , and reliable measure of quality of life after pelvic pouch surgery and may well be applicable in many other clinical conditions PURPOSE : Ileal pouch-anal anastomosis is widely cl aim ed to have replaced total proctocolectomy with ileostomy as the “ procedure of choice ” for ulcerative colitis , largely on the basis of a perceived improved quality of life . There exists relatively little support for this assertion in the literature . Our aim was to determine if educated patients choosing total proctocolectomy with ileostomy have a similar quality of life as with ileal pouch-anal anastomosis . METHODS : All patients with ulcerative colitis referred to a single surgeon and deemed an appropriate surgical c and i date were educated and then offered ileal pouch-anal anastomosis or total proctocolectomy with ileostomy . Age , gender , and complications ( including pouchitis ) were recorded prospect ively , and all patients were question ed regarding functional outcome and level of satisfaction . They were then asked to complete a slightly modified Inflammatory Bowel Disease Question naire , which was analyzed by categoric and overall scores . RESULTS : Sixty-seven patients underwent elective surgery for ulcerative colitis during the study period . Fifty-five patients chose ileal pouch-anal anastomosis , and 12 had total proctocolectomy with ileostomy . The groups were similar except for younger age and longer follow-up in the ileal pouch-anal anastomosis group . Patients undergoing ileal pouch-anal anastomosis had significantly more short-term or long-term complications ( 49vs . 8 percent ) , with pouchitis being the most frequent complication . There was no difference in level of satisfaction between the two groups , and no patient in either group wishes they had undergone the other procedure . There was no difference in the overall or any categoric Inflammatory Bowel Disease Question naire score . CONCLUSION : Patient satisfaction with both procedures was similarly high . Patients who undergo ileal pouch-anal anastomosis can expect a high level of satisfaction , with a good quality of life . However , educated patients choosing an ileostomy can achieve the same quality of life , without the higher complication rate associated with a pelvic pouch Although an ileoanal pouch is frequently offered to patients with ulcerative colitis , it is still not clear to what extent this operation offers advantages over a permanent ileostomy . The aim of this study was to determine whether patients with a pouch have less morbidity and a better quality of life than a matched group of patients with a Brooke ileostomy . Nineteen patients (  
    Output:
    
Neither procedure was found to be clearly superior with regard to health-related quality of life .
: Despite being limited by poor study quality , both total proctocolectomy with ileostomy and IPAA appear equivalent in terms of overall health-related quality of life .
Most patients are satisfied with their choice regardless of procedure .
Most of the improvement in quality of life after surgery is related to the control of disease-related symptoms .