***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: The aim of this study was to compare the effectiveness of  subcutaneous and intravenous fluid therapy  in hydrating , elderly acute stroke patients . Thirty-four such patients , needing parenteral fluids because of impaired consciousness or dysphagia , were r and omly allocated to receive either subcutaneous or intravenous fluids ( 2 litres of dextrose-saline/24 hours ) . Serum osmolality was measured before starting fluid therapy ( Day 1 ) and on Days 2 and 3 . An analysis of covariance of the osmolalities showed no statistical difference between the two groups ( P = 0.12 ) . The total cost of cannulae used over the 3 days for the subcutaneous route was approximately a third of that for the intravenous route . Complication rates were similar for the two groups . The results suggest that subcutaneous fluid therapy is an effective alternative to the intravenous route BACKGROUND Subcutaneous trastuzumab has shown non-inferior efficacy and a similar pharmacokinetic and safety profile when compared with intravenous trastuzumab in patients with HER2-positive early breast cancer . We assessed patient preference for either  subcutaneous or intravenous trastuzumab in the international , r and omised PrefHer study . METHODS Eligible patients were women aged 18 years or older with HER2-positive , histologically confirmed primary invasive breast adenocarcinoma , no evidence of residual , locally recurrent , or metastatic disease after completion of surgery and chemotherapy ( neoadjuvant or adjuvant ) , an Eastern Cooperative Oncology Group performance status of 0 or 1 , and a baseline left-ventricular ejection fraction of 55 % or more before the first dose of trastuzumab . Radiotherapy or hormone therapy was allowed . Patients were r and omised ( r and omly permuted blocks of four ) to receive four cycles of 600 mg fixed-dose subcutaneous adjuvant trastuzumab via a single-use injection device or h and -held syringe followed by four cycles of st and ard intravenous trastuzumab , or the reverse sequence . R and omisation was stratified by de-novo versus non-de-novo use of intravenous trastuzumab . The primary endpoint was the proportion of patients indicating an overall preference for subcutaneous or intravenous trastuzumab  , assessed by patient interview in the evaluable intention-to-treat ( ITT ) population ( patients who completed both interviews and had at least one administration of both subcutaneous and intravenous trastuzumab ) . Data collection for PrefHer is ongoing . This study is registered with Clinical Trials.gov , number NCT01401166 . FINDINGS 124 patients were r and omly allocated to receive subcutaneous followed by intravenous trastuzumab , and 124 to receive the reverse sequence . 117 patients in the subcutaneous first group and 119 in the intravenous first group were included in the evaluable ITT population . Subcutaneous trastuzumab  via the single-use injection device was preferred by 216 patients ( 91·5 % , 95 % CI 87·2 - 94·7 ; p<0·0001 ) . Only 16 patients  preferred intravenous trastuzumab ( 6·8 % , 3·9 - 10·8 ) , and four had no preference ( 1·7 % , 0·5 - 4·3 ) . Clinician-reported adverse events occurred in 141 of 242 ( 58 % ) patients during the pooled subcutaneous periods and 105 of 241 ( 44 % ) patients during the pooled intravenous periods ; seven ( 3 % ) and five ( 2 % ) were grade 3 , no patients had a grade 4 or 5 event . The most common grade 3 adverse event was influenza ( two [ 0·8 % ] patients ) . INTERPRETATION Patient preference and safety results from PrefHer , combined with the known non-inferior efficacy and pharmacokinetic and safety profile data , suggest that a fixed dose of 600 mg trastuzumab administered subcutaneously every 3 weeks is a vali date d , well tolerated treatment option for HER2-positive breast cancer , and is the preferred treatment of patients WHAT IS KNOWN AND OBJECTIVE Hyperglycaemia in trauma patients admitted to the intensive care unit ( ICU ) is associated with increased morbidity and mortality . Our pilot study is a prospect i ve r and omized controlled trial comparing the impact of two glucose control regimens on outcomes in non-diabetic trauma patients admitted with hyperglycaemia to the ICU . METHODS Trauma patients with blood glucose levels ( BGLs ) ≥7·8 mm within the first 48 h of the hospital admission were r and omized to receive intermittent SQ or continuous IV insulin to maintain BGLs between 4·4 and 6·1 mm . We excluded diabetics on the basis of history , or a glycosylated haemoglobin ≥6 % on admission . We compared the effect of SQ vs. IV insulin therapy on the ICU length of stay ( ILOS ) . RESULTS AND DISCUSSION A total of 58 patients were included in the study . The SQ and IV groups were comparable in terms of age , gender , injury severity , revised trauma , Glasgow coma scores and type of trauma ( blunt vs. penetrating ) . There was no significant difference between the two treatment groups in the ILOS ( 3 vs. 2 days , P = 0·084 ) , hospital length of stay ( 8 vs. 6 , P = 0·09 ) , ventilator support days ( 6 vs. 3 , P = 0·98 ) , requirement for blood transfusion ( P = 0·66 ) , rates of infections ( P = 0·70 ) , acute kidney injury ( P = 0·99 ) and mortality ( P = 0·61 ) . WHAT IS NEW AND CONCLUSION There was no difference between SQ and IV insulin therapy in the ILOS in non-diabetic trauma patients To compare the efficacy of immunoglobulin replacement therapy given intravenously versus subcutaneously to prevent infections in patients with primary antibody deficiency syndromes , an international , multicenter , open label , crossover study was design ed . Forty patients were r and omized to receive either subcutaneous or intravenous immunoglobulin replacement therapy for 1 year . In the second year , patients were switched to the alternative treatment , enabling patients to act as their own controls . Equivalent doses were given by both routes . Ethical approval was obtained from the review boards of the hospitals in which the patients were seen and written consent obtained from each patient . Patients with a primary antibody deficiency syndrome , either common variable immunodeficiency or IgG subclass deficiency or specific antibody deficiency , who required immunoglobulin replacement therapy were included in the study . Patients were excluded if they had significant thrombocytopenia ( defined as platelets less than 50 × 109/liter ) , had high levels of anti-IgA antibodies ( defined as greater than 1:8192 ) , or had severe adverse reactions to a blood product within the last 2 years . The primary end point was the number of infections and their severity ( moderate and major ) during the two treatment periods . Secondary end points were adverse reactions , length of infections , days lost from school or work due to infections , and acceptability of treatment regimens to the patients . Based on the assumption that it was difficult to prove equivalence of therapies statistically in crossover studies , an arbitrary number of 40 patients was selected on the basis that this might be achievable in 2 years . There are no significant differences in efficacy or adverse reaction rates between immunoglobulin replacement therapy given subcutaneously or intravenously Background : Rituximab and trastuzumab were the first therapeutic monoclonal antibodies ( mAbs ) approved in oncology . Both antibodies are delivered by the intravenous ( IV ) route , but recently subcutaneous ( SC ) formulations have been developed . Subcutaneous administration of mAbs can offer substantial patient and re source benefits compared with IV , but SC administration of some mAbs can be limited by drug volume . Recombinant human hyaluronidase ( rHuPH20 ) temporarily de grade s hyaluronan , allowing SC delivery of drug volumes that might not otherwise be feasible . Methods : Clinical trials assessing coformulation of rituximab or trastuzumab with rHuPH20 for SC administration were review ed . Results : Phase I trials of rituximab SC maintenance therapy in patients with follicular lymphoma and trastuzumab SC in healthy volunteers and patients with early breast cancer have demonstrated substantially shorter administration times and comparable tolerability and pharmacokinetics compared with IV formulations . Rituximab SC 1400-mg and trastuzumab SC 600-mg doses were identified for further study . Phase III clinical data for rituximab SC 1400 mg have shown comparable efficacy to rituximab IV , and initial clinical data suggest comparable efficacy of trastuzumab SC 600 mg and the IV formulation . Conclusion : Coformulation with rHuPH20 may enable effective , well-tolerated , cost-effective , and convenient SC administration of rituximab and trastuzumab . Additional studies are ongoing BACKGROUND 5-HT3-receptor antagonists are one of the mainstays of antiemetic treatment , and they are administered either i.v . or orally . Nevertheless , sometimes neither administration route is feasible , such as in patients unable to admit oral intake managed in an outpatient setting . Our objective was to evaluate the bioavailability of s.c . granisetron . PATIENTS AND METHODS Patients receiving platinum-based chemotherapy were r and omized to receive 3 mg of granisetron either s.c . or i.v . in a crossover manner during two cycles . Blood and urine sample s were collected after each cycle . Pharmacokinetic parameters observed with each administration route were compared by analysis of variance . RESULTS From May to November 2005 , 31 patients were included and 25 were evaluable .  Subcutaneous granisetron  result ed in a 27 % higher area under the concentration-time curve for 0 - 12 hours ( AUC(0 - 12h ) ) and higher levels at 12 hours , with similar values for AUC(0 - 24h ) . The maximum concentration was lower with the s.c . than with the i.v . route and was observed 30 minutes following s.c . administration . CONCLUSION Granisetron administered s.c . achieves complete bioavailability . This is the first study that shows that s.c . granisetron might be a valid alternative to i.v . delivery . Further trials to confirm clinical equivalence are warranted . This new route of administration might be especially relevant for outpatient management of emesis in cancer patients BACKGROUND Enzyme-assisted subcutaneous infusion ( EASI ) , with subcutaneous human recombinant hyaluronidase pretreatment , may offer an alternative to st and ard intravenous ( IV ) access . OBJECTIVES This study 's objectives were to assess paramedic ( Emergency Medical Technician-Paramedic [EMTP])-placed EASI access in volunteers to determine ( 1 ) feasibility of EMTP EASI access placement ; ( 2 ) subject/EMTP ratings of placement ease , discomfort , and overall EASI vs IV preference ; and ( 3 ) speed of intravascular uptake of EASI infusate . METHODS Twenty adults underwent 20-gauge IV placement by 4 EMTPs  , receiving a 250-mL maximal-rate IV bolus of normal saline . Next , each subject received in the other arm a 20-gauge EASI access line ( with 1-mL injection of 150 U of human recombinant hyaluronidase ) , through which was infused 250 mL D5NS ( 1 g glucose was labeled with stable tracer 13C ) . Blood draws enabled gas chromatography/mass spectrometry ( GC/MS ) assessment of 13C-glucose uptake . Intravenous access and EASI access were compared for time parameters and subject/EMTP ratings . Data were analyzed with median and interquartile range , Kruskal-Wallis testing , Fisher exact test , and regression ( GC/MS data ) . RESULTS Intravenous access and EASI access were successful in all 20 subjects . Compared with EASI access ( all placed in < 15 seconds ) , IV access took longer ; but the 250-mL bolus was given more quickly via IV access . EMTPs rated EASI easier to place than IV ; pain ratings were similar for IV and EASI . The GC/MS showed intravascular uptake at all time points . CONCLUSIONS Enzyme-assisted subcutaneous infusion is faster and easier to initiate than IV access ; intravascular absorption of EASI-administered fluids begins within minutes BACKGROUND AND PURPOSE For treatment of multifocal motor neuropathy ( MMN ) , we hypothesized that ( i ) infusion of equivalent dosages of subcutaneous immunoglobulin ( SCIG ) is as effective as intravenous immunoglobulin ( IVIG ) and that ( ii ) subcutaneous infusion at home is associated with a better quality of life . METHODS In a r and omized single-blinded cross-over study , nine IVIG responsive patients were allocated to receive either SCIG or IVIG for a period equivalent to three IVIG treatment intervals and , subsequently , crossed over to the other treatment . Primary end-points were ( i ) dynamometric strength of affected muscles and ( ii ) the SF- 
    Output:
    
Main factors associated with SC preference were time saving and the ability to have treatment at home .
Conclusions Results suggest that patients prefer SC over IV delivery .
If the safety and efficacy of both administration routes are equivalent , then the most important factor should be patient preference as this will ensure optimal treatment adherence and ultimately improve patient experience or satisfaction .