***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: PURPOSE The purpose of this study was to determine the cost-effectiveness of  knee arthroscopy and anterior cruciate ligament ( ACL ) reconstruction .  METHODS Retrospective analysis of prospect ively collected data from a single-surgeon , institutional review board-approved outcomes registry included 2 cohorts : surgically treated knee arthroscopy and ACL reconstruction patients .  Our outcome measure is cost-effectiveness ( cost of a quality -adjusted life-year [ QALY ] ) . The QALY is calculated by multiplying difference in health-related quality of life , before and after treatment , by life expectancy . Health-related quality of life is measured by use of the Quality of Well-Being scale , which has been vali date d for cost-effectiveness analysis . Costs are facility charges per the facility cost-to-charges ratio plus surgeon fee . Sensitivity analyses are performed to determine the effect of variations in costs or outcomes . RESULTS There were 93 knee arthroscopy and 35 ACL reconstruction patients included at a mean follow-up of 2.1 years .  Cost per QALY was $ 5,783 for arthroscopy and $ 10,326 for ACL reconstruction ( 2009 US dollars ) . Sensitivity analysis shows that our results are robust ( relatively insensitive ) to variations in costs or outcomes . CONCLUSIONS Knee arthroscopy and knee ACL reconstruction are very cost-effective 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 and Purpose — There are limited real-world data comparing the effectiveness and safety of non-vitamin K antagonist oral anticoagulants ( NOACs ) and warfarin in Asians with nonvalvular atrial fibrillation . We aim ed to compare the effectiveness and safety between NOACs and warfarin users in the Korean atrial fibrillation population , with particular focus on high-risk patients . Methods — Using the Korean National Health Insurance Service data base , we analyzed the risk of ischemic stroke , intracranial hemorrhage ( ICH ) events , and all-cause death in  NOAC users ( n=11 611 total , n=5681 taking rivaroxaban , n=3741 taking dabigatran , and n=2189 taking apixaban ) compared with propensity score-matched warfarin users ( n=23 222 ) among patients with high-risk atrial fibrillation ( CHA2DS2-VASc score ≥2 ) between 2014 and 2015 . Results — NOAC treatment was associated with similar risk of ischemic stroke and lower risk of ICH and all-cause mortality compared with warfarin . All 3 NOACs were associated with a similar risk of ischemic stroke and a lower risk of ICH compared with warfarin . Dabigatran and apixaban were associated with a lower risk of total mortality and the composite net clinical outcome ( ischemic stroke , ICH , and all-cause death ) compared with warfarin , whereas this was nonsignificant for rivaroxaban . Among previously oral anticoagulant – naive patients ( n=23 262 ) , dabigatran and apixaban were superior to warfarin  for ICH prevention , whereas rivaroxaban and warfarin were associated with similar risk of ICH . Conclusions — In real-world practice among a high-risk Asian atrial fibrillation population , all 3 NOACs demonstrated similar risk of ischemic stroke and lower risk of ICH  compared with warfarin . All-cause mortality was significantly lower only with dabigatran and apixaban OBJECTIVES Heart transplantation ( HT ) and ventricular assist devices ( VAD ) for the management of end-stage heart failure have not been directly compared . We compare the outcomes and use of re sources with these 2 strategies in 2 European countries with different allocation systems . METHODS We studied 83 patients managed by VAD as the first option in Bad Oeynhausen , Germany ( Group I ) and 141 managed with either HT or medical therapy , as the first option , in Paris , France ( Group II ) . The primary end-point was 2-year survival . Kaplan-Meier analyses were performed after the application of propensity score weights to mitigate the effects of non-r and om group assignment . The secondary end-points were re source utilization and costs . Subgroup analyses were performed for patients undergoing HT and patients treated with inotropes at the enrolment time . RESULTS The Group I patients were more severely ill and haemodynamically compromised , and 28 % subsequently underwent HT vs 55 % primary HT in Group II , P < 0.001 . The adjusted probability of survival was 44 % in Group I vs 70 % in Group II , P < 0.0001 . The mean cumulated 2-year costs were € 281 361 ± 156 223 in Group I and € 47 638 ± 35 061 in Group II , P < 0.0001 . Among patients who underwent HT , the adjusted probability of survival in Group I ( n = 23 ) versus Group II ( n = 78 ) was 76 % versus 68 % , respectively ( 0.09 ) , though it differed in the inotrope-treated subgroups ( 77 % in Group I vs 67 % in Group II , P = 0.04 ) . CONCLUSIONS HT should remain the first option for end-stage heart failure patients , associated with improved outcomes and better cost-effectiveness profile . VAD devices represent an option when transplant is not possible or when patient presentation is not optimal Background Surgical site infections ( SSIs ) lead to increased patient morbidity and healthcare costs . Our objective was to decrease the SSI rate following gynecologic surgery . Methods Adult patients undergoing abdominal surgery for gynecologic malignancy or benign disease received the following : patient education ; preoperative antibacterial soap ; appropriate antibiotic prophylaxis ; change of gloves and use of clean instruments at surgical closure ; surgical dressing for 48 h ; and a post-discharge phone call . The baseline SSI rate was determined retrospectively ( 1 April 2014–30 June 2014 ) , while the post-intervention SSI rate was determined prospect ively ( 16 February 2015–15 October 2015 ) . The main outcome was the overall SSI rate with secondary outcomes , including the rate of superficial , deep , incisional and organ space infection , as well as the cost effectiveness of the bundle . Results A total of 232 baseline and 555 post-intervention patients were included in the study . No differences were observed between the baseline and post-intervention groups with regard to median body mass index ( BMI ) , surgical approach , receipt of preoperative chemotherapy and /or radiation therapy , and cases including bowel surgery . Overall , the SSI rate decreased significantly from baseline [ 12.5 % ] to post-intervention [ 7.4 % ] ( odds ratio [ OR ] 0.56 , 90 % confidence interval [ CI ] 0.37–0.85 ; p = 0.01 ) . A 40 % decrease was noted in the rate of superficial and deep infections ( 9.5 vs. 5.9 % ; OR 0.60 , 90 % CI 0.38–0.97 ; p = 0.04 ) and SSIs after open surgery ( 21.4 vs. 13.2 % ; OR 0.56 , 90 % CI 0.34–0.92 ; p = 0.03 ) . The estimated cost of the intervention was $ 19.26/case and the net total amount saved during the post-intervention period was $ 65,625 month . Conclusions This bundled intervention led to a significant decrease in the overall SSI rate and was cost effective . The largest decreases in SSIs were in incisional infections and following open surgery Purpose and hypothesis The main purpose of the study is to put focus on the costs related to treating posterior cruciate ligament ( PCL ) injuries and the possible implication s of chosen treatment strategy to the respective institutions and society . Methods Costs of treating PCL injuries  nonoperatively and for both single-bundle ( SB ) and double-bundle ( DB ) reconstruction were estimated . These costs were translated into equivalent quality -adjusted life years ( QALY ) given a threshold value of Euro ( € ) 70,000 per QALY . Expected gain in knee osteoarthritis outcome score ( KOOS ) quality of life ( QoL ) following surgery based on KOOS data from 112 patients was used as a basis for calculating the cost efficiency ratio . Results The average calculated cost of nonoperative treatment was € 3382 . Incremental cost for SB PCLR was € 8585 ( 154 % ) and another increment of € 5220 ( 61 % ) for DB PCLR using numbers from a European hospital . This is equivalent to increments of 0.074 ( SB ) and another 0.075 ( DB ) QALYs given the € 70,000 threshold . For DB to be as cost efficient as SB reconstruction , the incremental gain in KOOS QoL has to be at the same level as for SB reconstruction compared to nonoperative treatment . Conclusion Though surgical reconstruction adds a substantial cost to nonoperative treatment alone , it can be considered cost-effective .  Double-bundle reconstruction is less cost efficient  than SB reconstruction , but should probably still be considered the treatment of choice for certain patient categories . R and omized controlled trials looking at outcome following nonoperative , SB and DB PCL reconstruction are needed . The clinical relevance of this is that surgical reconstruction of PCL injuries is a cost-efficient treatment alternative in patients with an isolated PCL injury . This finding should be taken into consideration when deciding on how to treat these injuries . Level of evidence III Objective To complete an economic evaluation within a r and omised controlled trial ( RCT ) comparing the use of an electronic discharge communication tool ( eDCT ) compared with usual care . Setting Patients being discharged from a single tertiary care centre ’s internal medicine Medical Teaching Units . Participants Between January 2012 and December 2013 , 1399 patients were r and omised to a discharge mechanism . Forty-five patients were excluded from the economic evaluation as they did not have data for the index hospitalisation cost ; 1354 patients contributed to the economic evaluation . Intervention eDCT generated at discharge containing structured content on reason for admission , details of the hospital stay , treatments received and follow-up care required . The control group was discharged via traditional dictation methods . Primary and secondary outcome measures The primary economic outcome was the cost per quality -adjusted life year ( QALY ) gained . Secondary outcomes included the cost per death avoided and the cost per readmission avoided . Results The average transcription cost was $ C22.28 per patient , whereas the estimated cost of the eDCT was $ C13.33 per patient . The cost per QALY gained was $ C239 933 in the eDCT arm compared with usual care due to the very small gains in effectiveness and approximately $ C800difference in re source utilisation costs . The bootstrap analyses result ed in eDCT being more effective and more costly in 29.2 % of sample s , less costly and more effective in 29.2 % of sample s , less effective and more costly in 23.9 % of sample s and finally , less costly and less effective in 17.7 % of sample s. Conclusions The eDCT reduced per patient costs of the generation of discharge summaries . The bootstrap estimates demonstrate considerable uncertainty supporting the finding of neutrality reported in the clinical component of the R 
    Output:
    
The most frequently assessed illnesses were neoplasms while the most evaluated interventions were pharmacological .
The main source of costs and effects of RWD were information systems .