***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: In a multicentre trial 742 patients in 13 hospitals in Wales were r and omly allocated on the fifth day after uncomplicated myocardial infa rct ion to be mobilised on the fifth or the tenth day . The trial shows no difference in first year mortality , nor in morbidity assessed after a median period of 13 months . Follow-up after one year suggests an unexplained lower mortality during the second and third years in the late mobilisation group Abstract The effects of early mobilization after uncomplicated myocardial infa rct ion were investigated in a strictly r and omized controlled study conducted during a period of transition in the therapeutic practice of the Cantonal Hospital in Geneva , Switzerl and . One hundred fifty-four patients under age 70 who were hospitalized for acute myocardial infa rct ion and who had no complications on day 1 or day 2 were r and omly assigned to two treatment groups . In the early mobilization group , patients were treated by a physical therapist with a progressive activity program beginning on day 2 or 3 after infa rct ion . In the control group , patients underwent the traditional hospital regimen of strict bed rest for 3 or more weeks . The mean duration of hospitalization was 21.3 days for treated patients and 32.8 days for the control group . The follow-up period ranged from 6 to 20 ( average 11.2 ) months . There were no statistically significant differences between the two groups with regard to hospital or follow-up mortality , rate of reinfa rct ion , arrhythmias , heart failure , angina pectoris or ventricular aneurysm , or results of an exercise test . There was significantly greater disability in the control than in the treated group on follow-up examination . This controlled trial , based on a rigid experimental design , provides important confirmation of the benefits of early mobilization observed in uncontrolled programs in recent years Long-term follow-up was obtained on 138 patients who participated in a prospect i ve , r and omized study comparing two weeks with three weeks of hospitalization following uncomplicated acute myocardial infa rct ion . Follow-up information was available on 123 ( 89 % ) of all r and omized patients . The mean follow-up period was 35 months for those patients who died and 99 months for those who survived . No differences were found between the two groups with respect to survival , cardiac-related deaths , frequency or severity of angina pectoris , subsequent myocardial infa rct ion , incidence of congestive heart failure , number of ventricular aneurysms , or subsequent medical therapy . A significantly greater number of survivors in both groups stopped smoking and had a normal initial heart size than those who died . This long-term follow-up study further supports the conclusions of earlier short-term studies that two weeks of hospitalization is safe in patients with uncomplicated acute myocardial infa rct ion AIMS To identify , without additional investigation , a large group of myocardial infa rct ion patients at low risk who would qualify for early discharge . METHODS The decision rule was developed in 647 unselected patients with consecutively admitted myocardial infa rct ion , and vali date d in 825 others . Daily event-rates were calculated for major ( death , ventricular fibrillation , recurrent infa rct ion , heart failure , advanced AV-block ) and minor ( unstable angina and rhythm-abnormalities ) cardiac complications . RESULTS Patients free from major complications until day 7 ( 44 % of all patients ) were found to constitute a very low risk group and thus would qualify for discharge at day 7 . Of the 39 % of patients with an uncomplicated infa rct ion ( low risk ) in the validation group , 31 % were discharged at day 7 , while 8 % stayed longer because of non-cardiac co-morbidity , for social reasons or logistic problems . No major adverse event occurred within 7 days after hospital discharge and only 1.8 % developed complications within 1 month . The median duration of hospital stay for all in-hospital survivors was 7 days compared to 10 days in the control group . CONCLUSION Prospect i ve application of the early discharge decision rule , based upon simple clinical variables and without the need for additional non-invasive and /or invasive tests , result ed in a significant reduction of hospital stay . The decision rule correctly classified patients into high and low risk groups and appeared feasible and safe . Its efficacy was demonstrated by its ability to identify a large group of post infa rct ion survivors at low risk for complications during follow-up To compare the results of home and hospital treatment in men aged under 70 years who had suffered acute myocardial infa rct ion within 48 hours 1895 patients were considered for study in four centres in south-west Engl and . Four-hundred- and -fifty patients were r and omly allocated to receive care either at home by their family doctor or in hospital , initially in an intensive care unit . The r and omised treatment groups were similar in age , history of cardiovascular disease , and incidence of hypotension when first examined . They were followed up for up to a year after onset . The mortality rate at 28 days was 12 % for the r and om home group and 14 % for the r and om hospital group ; the corresponding figures at 330 days were 20 % and 27 % . On average , older patients and those without initial hypotension fared rather better under home care . The patients who underwent r and omisation were similar to those whose place of care was not r and omised , except that the non-r and omised group contained a higher proportion of initially hypotensive patients , whose prognosis was poor wherever treated . These results confirm and extend our preliminary findings . Home care is a proper form of treatment for many patients with acute myocardial infa rct ion , particularly those over 60 years and those with an uncomplicated attack seen by general practitioners In a prospect i ve study of patients admitted to a coronary care unit , the incidence of isotopically diagnosed deep venous thrombosis was found to be related to the severity of illness rather than to the duration of bed rest . In addition , no negative correlation was found between cigarette smoking and deep venous thrombosis A total of 189 patients with uncomplicated myocardial infa rct ion were selected at r and om for early or late mobilization and discharge from hospital . Patients were admitted to the study after 48 hours in a coronary care unit if they were free of pain and showed no evidence of heart failure or significant dysrhythmia . R and omization was achieved by monthly cross-over of the three medical wards to which the patients were discharged . One group of patients was mobilized immediately and discharged home after a total of nine days in hospital , and the second group was mobilized on the ninth day and discharged on the 16th day . Out-patient assessment was carried out six weeks after admission . No significant differences were observed between the groups in terms of mortality or morbidity , as reflected by the incidence of recurrent chest pain or myocardial infa rct ion , heart failure , dysrhythmia , or venous thromboembolism detected either clinical ly or by 125I-labelled fibrinogen scanning Home and hospital management of patients with suspected myocardial infa rct ion were compared in a r and omised trial in which a hospital-based team responded to calls from general practitioners . 500 calls were received , and 349 patients ( 70 % ) were suspected of having myocardial infa rct ion . Of these , 24 % were excluded from the trial on predetermined medical and social grounds ; for the remainder ( 76 % ) there was no significant difference in the 6-week mortality between the home group ( 13 % ) and the hospital group ( 11 % ) . For the majority of patients to whom a general practitioner is called because of suspected infa rct ion , hospital admission confers no clear advantage During the years 1968 - 71 203 patients with proved myocardial infa rct ion were admitted to the trial .  Patients were mobilized either on day 10 ( 102 patients ) or on day 20 ( 100 patients ) . All patients were kept in hospital for 30 days in order to ensure a detailed comparison of clinical course and laboratory data . In neither group was there a fatal complication and the differences in clinical outcome or laboratory data were statistically not significant . Half of the patients from each group were re-examined after an average of one- and -a-half years , and again no differences were observed . It is concluded that patients with an uncomplicated myocardial infa rct ion may safely be mobilized after 9 days and discharged after three weeks A Welsh multicentre trial of early ( fifth day ) compared with late ( tenth day ) mobilisation in 742 patients after uncomplicated myocardial infa rct ion , reported previously , found that there were no significant differences in survival during the first year , but a partial follow up beyond the first year survival showed a significantly reduced survival during the second and third years among patients mobilised early . A full 10 year follow up of all patients admitted to the trial was therefore carried out . A small difference in survival was confirmed , which reached about 5 % at four years ; but the difference was not statistically significant . Further analysis suggested the possibility of real differences in survival in certain subgroups , but the present evidence was not sufficient to provide contraindication to mobilisation five days after uncomplicated myocardial infa rct ion To determine the effects of early ambulation on peripheral venous thrombosis in the coronary care unit , 29 patients with acute myocardial infa rct ion had daily 125I-fibrinogen point counting of both legs using a st and ard portable technique in the first 3 to 7 days after admission . Twenty-one patients underwent early ambulation during the initial 3 days , while 8 remained at complete bed rest for 5 days . Only 2 of 21 early ambulated patients had positive fibrinogen point counts , in contrast to 5 of 8 nonambulated patients ( P less than 0.01 ) . With heart failure , only 2 of 9 ambulated patients had positive point counts , compared with 4 of 5 nonambulated patients ( P less than 0.05 ) . In 16 patients undergoing venography  , point counts were confirmed in 6 positive and 10 negative findings . These results show that the high frequency of peripheral venous thrombosis in immobilized acute myocardial infa rct ion patients , particularly those with heart failure , can be effectively reduced by early ambulation Early mobilisation  after acute myocardial infa rct ion is said to increase the risk of ventricular aneurysm and -rupture , reinfa rct ion , sudden death , and heart failure . In order to evaluate these possible negative effects , we run a prospect i ve and controlled study : 2 X 100 consecutive patients with acute myocardial infa rct ion were mobilized conventionally ( A ) and according to an early mobilisation programme ( B ) respectively-the two groups were comparable according to age , sex , CHD-history , infa rct ion transmural/non transmural and coronary prognostic index ( Norris ) . There was a significant reduction in the average hospital stay from 31.4 days in group A to 25.8 in group B. The patients were followed up for 32 ( A ) and 46 days ( B ) respectively . In the early mobilized group we found no increased risk for heart failure , reinfa rct ion , or sudden death . On the other side , early mobilisation has many psychological , oeconomic and social advantages for patients and hospital A prospect i ve , controlled , r and omized study was done to compare the effect of early and late ambulation in hospitalized patients with acute myocardial infa rct ion . All patients surviving longer than the first five days were studied ; 64 patients were mobilized on day six and discharged on day 12 , and 65 were mobilized on day 13 and discharged on day 19 . Follow-up observation lasted from six to 52 weeks . Of patients without complications until day six , eight out of 32 in the early and 16 of 35 in the late groups manifested complications during the follow-up period ( p smaller than 0.05 ) . Of those who had complications before day six , seven of 32 and 26 of 30 still had or acquired new complications until last seen ( p small than 0.0001 ) . The number of serious complications in the two groups was eight and 24 respectively ( p smaller than 0.001 ) . We conclude that early ambulation is beneficial irrespective of complications on admission We report a prospect i ve study of patients with acute myocardial infa rct ion in whom the use offour simple risk factors  allowed the identification of a group of patients who could be safely allowed home on their 7th day in hospital . This group comprised 40 per cent of all admissions with acute myocardial infa rct ion who survived 6 days . Of these , 68 per cent were discharged by the 7th day . No patient in this group died in the ensuing 3month period Assessing the quality of r and omized controlled trials ( RCTs ) is important and relatively new . Quality gives us an estimate of the likelihood that the results are a valid estimate of the truth . We present an annotated bibliography of scales and checklists developed to assess quality . Twenty-five scales and nine checklists have been developed to assess quality . The checklists are most useful in providing investigators with guidelines as to what information should be included in reporting RCTs . The scales give readers a quantitative index of the likelihood that the reported methodology and results are free of bias . There are several shortcomings with these scales . Future scale development is likely to be most beneficial if questions common to all trials are assessed , if the scale is easy to use , and if it is developed with sufficient rigor Abstract In this trial of early mobilisation and discharge patients with uncomplicated myocardial infa rct ion were all given 7 days of bed rest , followed by mobilisation on day 8 and discharge on day 15 ( 95 patients , group E ) or mobilisation on day 21 and discharge on day 28 ( 104 patients , group L ) . On admission patients in the two groups were well matched . Patients were encouraged to return to work 1 month after discharge . Follow-up was done via outpat 
    Output:
    
Bed rest ranging from 2 to 12 days appears to be as safe as longer periods of bed rest .
Current bed rest recommendations are not supported by the existing evidence as the optimal duration of bed rest is unknown .
The lack of adequate trials is surprising , considering the large size of several studies to compare effectiveness of drugs on people with AMI