***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 
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    ***EXAMPLES*** 
    Input: This study sought to contrast mailing a booklet to accomplish preoperative instruction with teaching performed by nurses after hospital admission . Sixty-six patients were studied in a 700-bed medical center and were assigned to three teaching groups and a control group which did not receive teaching . The research er compared the four groups preoperatively after admission to determine the patients ' knowledge and ability to perform surgical exercises , as well as their anxiety levels . Findings were that patients who received a booklet by mail preadmission learned surgical exercises equally well compared to patients taught postadmission , and mastered significantly more exercise behaviors than those receiving no instruction . No statistical difference in anxiety level was found among groups . One may infer that mailing preadmission material should be considered as an effective teaching mode and alternative to postadmission instruction Backround . The purpose of the trial was to evaluate the effect on length of stay of individually tailored rehabilitation for clients who were undergoing hip or knee arthroplasty . Method . Clients ( n = 133 ) with complex needs ( comorbid conditions or limited social support ) were r and omly assigned to receive  preoperative usual care ( UC ) or rehabilitation ( R ) . Usual care clients received a single preoperative clinic visit . Rehabilitation clients were individually assessed and received multi disciplinary rehabilitation to optimize functional capacity , education about the in-hospital phase and early discharge planning . All rehabilitation subjects received interdisciplinary counseling/education focused on preparation for discharge home  . The intervention for approximately half the rehabilitation clients was a single ,  cost-effective session , while others received physical conditioning . Results . Clients receiving rehabilitation achieved discharge criteria earlier ( R = 5.4 , UC = 8 days ) and had a shorter actual length of stay ( R = 6.5 , UC = 10.5 days ) . Clinical Implication s. This preoperative , individually tailored , rehabilitation program reduced length of stay An anaesthetic nurse intervention was performed in order to evaluate the effects of extended preoperative information , given by anaesthetic nurses , on perioperative stress in patients operated on for breast cancer or total hip replacement ( THR ) . Forty-six consecutive patients scheduled for surgery for breast cancer , and 55 for THR , were r and omized into two groups which were given different modes of preoperative information . Patients in the control group were informed about pre- and postoperative routines by a ward nurse . Patients in the intervention group were given extended formalized information by an anaesthetic nurse .  Wilcoxon rank sum test was used to show relations between variables . There were no significant differences between the intervention group and control group for patients with breast cancer or for patients with THR . Breast cancer patients in the intervention group were significantly more anxious than THR patients in the intervention group ( P < 0.01 ) . Breast cancer patients in the intervention group showed the highest anxiety scores on the Hospital Anxiety and Depression Scale ( HADS ) scale on the day of surgery . This information may reflect an increased level of anxiety due to the extended information given preoperatively . The information may thus have had a negative effect on breast cancer patients , result ing in an increased state of anxiety . The result indicates a need for individualized modes of information to provide a proper balance between enough and too much information The aim of the study was to evaluate the effect of preparatory information on a patient 's post-operative physical coping outcomes  following a Total Hip Replacement ( THR ) . The research design was quasi-experimental . Eighty-two healthy individuals , scheduled for an elective THR were used and selected using non-r and om techniques , and placed into one of two groups on an alternating basis . The subjects in the experimental group were given procedural , sensory and coping information relating to the whole surgical procedure of a THR . In addition , written information was provided for each experimental subject to support the verbal information . Subjects in the control group only received the advice and support that would routinely be given to THR patients by ward , medical and nursing staff . The study measured a number of physical outcomes using a " Physical Indicators of Coping Question naire " developed to measure physiological and physical outcomes post-operatively . In addition , a Linear Analogue Coping Scale was developed to assess a patient 's personal perception of their overall coping ability with the THR . The study demonstrated that preparatory information , given pre-operatively , post-operatively and pre-discharge had positive effects on the physical recovery and coping outcomes measured . Subjects in the experimental group had significantly less post-operative intramuscular analgesia , mobilized sooner with a Zimmer frame and walking sticks and lastly , their length of stay was on average , 2 days less than the control group . The Linear Analogue Coping Scale demonstrated that patients in the experimental group did perceive they were coping more effectively post-operatively . Preparatory information of various types and in different forms appear to have positive effects on the ability of patients to cope with and recover physically from a THR in the immediate post-operative period Acupuncture is becoming a common technique within the physiotherapy profession as a treatment modality for pain relief ; however , few r and omised controlled trials have been undertaken to assess the effectiveness of acupuncture , particularly in the treatment of osteoarthritis ( OA ) of the hip . Therefore , a r and omised trial to compare the effectiveness of acupuncture with advice and exercises on the symptomatic treatment of OA of the hip was carried out . Thirty-two patients awaiting a total hip arthroplasty were r and omly allocated to either the experimental group , ( A ) , to have six sessions of acupuncture each lasting up to 25 minutes , or the control group , ( B ) , to be given advice and exercises for their hip over a six week period . Group A consisted of three men and 13 women , and group B consisted of four men and eight women . The average age in group A was 66 years and in group B it was 68 years . Patients were assessed for pain and functional ability , using a modified version of the WOMAC question naire , pre-treatment , immediately post-treatment and at eight weeks post-treatment . The pre-treatment WOMAC scores in the two groups were similar ( p=0.85 ) . There was a significant improvement in group A ( decrease in WOMAC score ) immediately post-treatment ( p=0.002 ) and this was maintained at the eight-week follow-up ( p=0.03 ) . There were no significant changes in group B. When the changes in WOMAC scores were compared between groups , a significantly greater improvement was found between pre-treatment and immediately post-treatment in group A , compared with group B ( p=0.02 ) . The changes between pre-treatment and the eight-week follow-up also showed a significant improvement in group A compared with group B ( p=0.03 ) . In conclusion , this trial supports the hypothesis that acupuncture is more effective than advice and exercises in the symptomatic treatment of OA of the hip Objective Elective surgery represents a considerable source of stress for the patient . Many attempts have been made to prepare patients before surgery with the aim of reducing stress and improving outcome . This study used a novel approach to fulfill this aim by showing a videotape of a patient undergoing total hip replacement surgery , covering the time period from hospital admission to discharge , that strictly keeps to the patient ’s perspective . Methods Before elective total hip replacement surgery , 100 patients were r and omly assigned to a  control group or a  preparation group ;  the latter group was shown the videotape on the evening before surgery . Anxiety and pain were evaluated daily for 5 days , beginning with the preoperative day , by means of the State-Trait Anxiety Inventory and a visual analog scale . Intraoperative heart rate and blood pressure , as well as postoperative intake of analgesics and sedatives , were recorded . Urinary levels of cortisol , epinephrine , and norepinephrine were determined in 12-hour sample s collected at night for 5 nights , beginning with the preoperative night . Results Compared with the control group , the preparation group showed significantly less anxiety on the morning before surgery and the mornings of the first 2 postoperative days , and significantly fewer of them had an intraoperative systolic blood pressure increase of more than 15 % . The pain ratings did not differ significantly between the two groups , but the prepared patients needed less analgesic medication after surgery . Prepared patients had significantly lower cortisol excretion during the preoperative night and the first 2 postoperative nights . Excretion of catecholamines did not differ significantly between groups . Conclusions We conclude that use of the videotape decreased anxiety and stress , measured in terms of urinary cortisol excretion and intraoperative systolic blood pressure increase , in patients undergoing hip replacement surgery and prepared them to cope better with postoperative pain The objective of this study was to evaluate the effects of preparatory information on psychological coping outcomes among total hip replacement ( THR ) patients . A quasi-experimental design within an ethnographic clinical context was used . Eighty-two healthy individuals , scheduled for elective THR were recruited for the study and nonr and om selection techniques were used . The subjects in the experimental group were given procedural , sensory and coping information relating to the whole surgical procedure of a THR . In addition , written information was given to support the verbal information . Subjects in the control group received only the advice and support that would routinely be given to THR patients by ward , medical and nursing staff . The main outcomes were measured using st and ard question naires , Hospital Anxiety and Depression Scale ( HADS ) measuring anxiety and depression , Rosenburg Self-Esteem Scale measuring self-esteem , and Health Illness Question naire measuring sense of control . Lastly , a Linear Analogue Coping Scale was developed and applied to assess a subject 's personal perception of coping with a THR . Providing information had positive effects on the psychological coping outcomes measured . Subjects in the experimental group had significantly less anxiety and depression with a high self-esteem and sense of control . The Linear Analogue Coping Scale demonstrated a strong correlation between how subjects believed they were coping and that measured using the st and ard question naires . The study concluded that preparatory information of various types and in different forms appears to have positive effects on psychological coping outcomes for THR patients , which may have influenced postoperative recovery OBJECTIVE Psychoeducational preparation is known to improve postoperative outcome . We tested two common psychoeducational procedures in elderly orthopedic patients , examining how best to match interventions to patients by psychological type . METHODS Two hundred twenty-two elderly patients undergoing total hip or knee replacement were r and omly assigned to 1 ) a slide-tape with information on the postoperative , in-hospital rehabilitation experience , or 2 ) training in Benson 's Relaxation Response with a bedside audiotape , in a 2 x 2 factorial design . RESULTS The relaxation response did not influence postoperative outcomes . The educational intervention reduced length of stay and pain medication use for patients who exhibited most denial ( tendency to avoid thinking about unpleasant events ) , and reduced postoperative anxiety and cognitive errors on the Mini-Mental State Exam for patients with most baseline anxiety . There was no effect on postoperative pain . CONCLUSIONS The importance of attending to the patient 's psychological state and level of preparation before orthopedic surgery is reinforced . Patients who exhibit most denial and highest anxiety may benefit from educational interventions , but patients ' directly expressing desire for information may be a poor guide in deciding which patients would benefit , compared with more formal psychological testing for denial and anxiety Long-term follow-up investigations of the effect of psychological preparation on postoperative physical outcome measures have very rarely been done . In this study a three-month follow-up of a previous investigation of videotape preparation before hip replacement surgery is reported . 100 patients who previously participated in a r and omized controlled study received physical examination and x-ray of the hip joint three months after the operation . The mobility of the replaced hip joint was recorded as well as ossifications of the joint . Prepared patients showed a significantly higher improvement of internal rotation , rotational range of motion , and abduction , compared to the controls . The effect sizes ranged between 21 % and 32 % and , thus , were of clinical relevance . Prepared patients showed less ossifications ( 15 % ) that controls ( 22 % ) , this difference was not significant . For the first time it could be demonstrated that psychological preparation before surgery can not only improve short-term and psychosocial outcome parameters , but also long-term physical measures . The reason for this effect remains to be investigated In-hospital education can reduce anxiety , improve coping and shorten hospital stays of surgical patients . However , hospitals are containing costs by shortening pre- and postoperative stays and reducing the time available for in-hospital teaching . This study evaluated prehospital education for total hip replacement ( THR ) surgery . Half of the patients waiting for admission for THR surgery were r and omly selected to receive a THR education booklet  in the mail 4 - 6 weeks before their scheduled THR surgery . Compared to the No-Booklet patients , patients who had received the booklet were less anxious at the time of hospital admission and at discharge , were more likely to have practised physiotherapy exercises prior to hospitalization , and required significantly less occupational therapy and physiotherapy while in hospital . There were no group differences for length of hospital stay We studied the effect of patient teaching in 60 patients who underwent primary total hip replacement surgery . All the patients received an illustrated patient guide . In addition to the general patient teaching given by doctors , nurses and physiotherapists , a r and omly chosen group of 27 patients received a session of intensified patient teaching .  At the follow-up , 2 - 3 months postoperatively , 61 % of patients thought that they had received the main part of their information from the physiotherapists , 9 % from their doctors and 4 % from the nursing staff . The importance of a well-illustrated guide was pointed out . The knowledge of potential complications , such as infection , remained poor ; 37 % could not name one single relevant complication . At the follow-up , the younger or better educated patients did not score any better . The experimental group who had received intensified teaching differed only slightly from the controls , but they knew significantly better when to inform their doctor of 
    Output:
    
The four studies reporting length of stay did not find any significant effect of preoperative education on days to st and ing and days to climb stairs .
REVIEW ER 'S CONCLUSIONS There is little evidence to support the use of pre-operative education over and above st and ard care to improve postoperative outcomes in patients undergoing hip or knee replacement surgery , especially with respect to pain , functioning and length of hospital stay .
There is evidence that preoperative education has a modest beneficial effect on preoperative anxiety .
There may also be beneficial effects when preoperative education is tailored according to anxiety , or targeted at those most in need of support ( e.g. those who are particularly disabled , or have limited social support structures )