***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: Objective : To determine the effectiveness of steroids , acyclovir , and surgical facial nerve decompression  in Bell ’s palsy . Methods : The authors identified articles by search ing MEDLINE and selected those that prospect ively compared outcomes in patients treated with steroids , acyclovir , or surgery with patients not receiving these modalities . The authors grade d the quality of each study ( class I to IV ) using a st and ard classification-of- evidence scheme . They compared the proportion of patients recovering facial function in the treated group to the proportion of patients recovering facial function in the control group . Results : The authors identified no adequately powered class I studies for any treatment modality . The pooled results of two class I and two class II studies showed significantly better facial outcomes in steroid-treated patients compared with non – steroid-treated patients ( relative rate good outcome 1.16 , 95 % CI 1.05 to 1.29 ) . One class II study demonstrated a significant benefit from acyclovir in combination with prednisone compared with prednisone alone ( relative rate good outcome 1.22 , 95 % CI 1.02 to 1.45 ) . All studies describing outcomes in patients treated with facial nerve decompression were grade d as class IV . Conclusion : For patients with Bell ’s palsy , a benefit from steroids , acyclovir , or facial nerve decompression has not been definitively established . However , available evidence suggests that steroids are probably effective and acyclovir ( combined with prednisone ) is possibly effective in improving facial functional outcomes . There is insufficient evidence to make recommendations regarding surgical facial nerve decompression for Bell ’s palsy . Well- design ed studies of the effectiveness of treatments for Bell ’s palsy are still needed A prospect i ve , controlled , double-blind study was design ed to evaluate the effect of steroid treatment  on the natural history of Bell 's palsy . Fifty-one patients were included in the study between 1972 and 1974 . The patients were evaluated and started on treatment within two days of onset of Bell 's palsy and followed for six months . Treatment was given in r and omized double-blind fashion and consisted of either vitamins or a total of 410 mg of prednisone plus vitamins in descending doses over 10 days . The recovery of facial motor function was determined by three physicians who had no knowledge of the treatment received by the patients . They examined photographs of the patients taken six months after onset of paralysis in eight positions of facial function and categorized them as to complete fair , or poor recovery of facial function . These results of this evaluation were su bmi tted to the biostatistician who broke the treatment code . The results of this study demonstrate no statistically significant beneficial effect of steroid therapy  upon recovery from Bell 's palsy . Factors considered included the patients ' age , sex , the presence of pain , ageusia , hyperacusis , diabetes , hypertension , the progression and degree of palsy , the results of nerve excitability and salivary flow tests , and the time at which recovery was first noted or became complete . Bell 's palsy remains without a proven efficacious treatment The Quality St and ards Subcommittee of the American Academy of Neurology is charged with developing practice parameters for neurologists for diagnostic procedures , treatment modalities , and clinical disorders . The selection of topics for which practice parameters are used is based on prevalence , frequency of use , economic impact , membership involvement , controversy , urgency , external constraints , and re sources required . This paper addresses the role of thymectomy in the treatment of nonthymomatous autoimmune MG . In 1939 , Blalock et al.1 reported the remission of generalized MG in a 21-year-old woman after removal of a cystic thymic tumor . Subsequently , Blalock et al.2,3 performed thymectomy  on MG patients without thymoma , found hyperplasia in the thymus gl and s , and reported improvement in at least half of their patients . Since these reports , thymectomy , with or without the presence of thymoma , has gained widespread acceptance as a form of treatment for MG . Because a definitive study of the effectiveness of thymectomy has never been done,4,5 the role of thymectomy in the management of MG remains uncertain . Nevertheless , physicians have to advise their patients regarding the benefits of thymectomy based on the existing literature . Our goal is to develop evidence -based recommendations for clinicians considering  thymectomy for patients with nonthymomatous autoimmune MG by performing a systematic review and analysis of the literature . # # # Identification and selection of studies . We search ed the National Library of Medicine ’s Medline data base from 1966 to February 1998 using the medical subject headings “ myasthenia gravis ” ( restricted to the surgery subheading ) and “ thymectomy . ” To identify articles published before 1966 , or missed by our original search strategy , we review ed the references of the identified articles . We classified the result ing articles into the following categories : Class II , controlled but nonr and omized studies describing outcomes in MG patients with and without thymectomy ; and Class III , uncontrolled case series describing outcomes in patients with or without Incomplete recovery from Bell 's palsy was observed in some patients even after the intake of corticosteroids . This prospect i ve study was performed on 160 patients with unilaterial nonrecurrent Bell 's palsy in order to investigate the role of prednisolone on the prognosis of Bell 's palsy . Ninety-three patients were given prednisolone tablets ( 1 mg/kg body wt/day up to 70 mg ) for six successive days , then the dose was reduced gradually over the next four days . The remaining 67 patients were not given prednisolone ( control group ) . Facial nerve recovery was assessed clinical ly and electrophysiologically for up to one year . The results of this study suggested that the most probable contributing factor for the success of prednisolone in improving the prognosis of Bell 's palsy was its early intake ( within the first 24 hours following onset ) 
    Output:
    
Results are mixed on whether educating physicians about evidence -based recommendations is sufficient to change physician behavior .