***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: To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results Background : A phase-III trial that included fifty-three patients undergoing unilateral primary total knee arthroplasty with cement was conducted to investigate the hemostatic efficacy of fibrin sealant . Methods : Following cementing of the joint , 10 mL of fibrin sealant was sprayed onto the wound before tourniquet deflation and wound closure . No placebo was used in the control group . All patients received drains . Results : Within twelve hours after the surgery , the amount of bloody drainage was 184.5 ± 28.9 mL ( mean and st and ard error ) in the fibrin-sealant group ( information available for twenty-three patients ) and 408.3 ± 54.6 mL in the control group ( information available for twenty-three patients ) ( p = 0.002 , after adjustment for variance in the time that the drainage was measured ) . On the first postoperative day , the hemoglobin level had decreased by 20.1 ± 2.1 g/L in the fibrin-sealant group ( information available for twenty-two patients ) and by 27.3 ± 2.1 g/L in the control group ( information available for twenty-four patients ) . After adjustment for baseline values , the decrease in the hemoglobin level was 28.9 % less in the fibrin-sealant group than in the control group ( p = 0.005 , 95 % confidence limits = 10.2 , 43.7 ) . There were no seroconversions in the fibrin-sealant group . Conclusion : These results suggest that fibrin sealant can safely reduce bloody drainage following total knee arthroplasty while maintaining higher hemoglobin levels In a prospect i ve , r and omized study , 58 patients with primary cemented hip arthroplasty and 39 patients with primary cemented knee arthroplasty were divided into groups with postoperative closed-suction drainage and without drainage . There was no difference in healing of the wounds , postoperative blood transfusions , complications , or range of motion . Although there was more soaked dressing requiring reinforcements in the groups without drainage , as a result of this study , we no longer use drains in uncomplicated cemented primary hip and knee arthroplasties for osteoarthritis Closed suction drains reduce postoperative hematoma formation , but create an entry portal for bacteria and thus increase the risk of infection . This study attempts to establish when the risks of wound drainage outweigh the benefits . In a prospect i ve clinical trial , wound drains were used in all patients having a total knee or total hip arthroplasty . Timing of drain removal and amount drained were recorded . Drain-site swabs were sent with drain tips for bacteriology . Results suggest that the likelihood of bacterial colonization increases while wound drainage decreases with time . The authors conclude that the optimal time to remove drains is 24 hours after total joint arthroplasty Sixty patients undergoing total knee replacement were r and omized to receive either a cold compression dressing ( Cryo/Cuff , Aircast , UK ) or a modified Robert Jones b and age immediately after surgery . The cold compression dressing was used for a minimum of 6 h per day throughout the hospital stay , and the modified Robert Jones b and age remained in place for 48 h from the time of operation . The 2 groups of patients were compared during their hospital stay for blood loss , range of movement , pain scores and need for analgesia . No difference was found between the 2 groups except for less blood loss in the surgical drains in the cold compression group ( P<0.05 ) . Postoperative complications were seen in both groups , but no complication was associated with either the cold compression dressing or the modified Robert Jones b and age . RésuméEtude r and omisée de 60 patients qui , immédiatement après une arthroplastie totale du genou ont eu soit un pansement compressif froid de type “ Cryocuff ” soit un pansement compressif de type Robert Jones . Le pansement froid a été utilisé 6 heures par jour pendant la durée de l'hospitalisation t and is que le pansement compressif de type Robert Jones a été laisse en place pendant 48 heures après l'opération . Aucune différence statistiquement significative n'a pu être mise en évidence entre les deux groupes , à l'exception des pertes sanguines dans le drainage , moins importantes dans le premier groupe de patients . Nous avons eu des complications post opératoires dans les deux groupes mais aucune corrélation n'a pu être établie entre ces complications et le type de b and age appliqué Abstract A prospect i ve evaluation of 98 patients who had undergone a total hip or knee arthroplasty was conducted to assess the effect of postoperative suction drainage . Sixty-six patients undergoing elective total hip arthroplasty and 32 patients undergoing total knee replacement were r and omly allocated to undergo either suction drainage or no drainage of the wound . Statistical analysis of the results showed no difference in wound healing , severity of wound haematoma , postoperative blood transfusion requirement , range of motion and duration of the hospitalization between the two groups . We conclude that the use of closed suction drainage provides no apparent advantage after uncomplicated total hip or knee arthroplasty Background : The purpose of this study was to determine whether repeated clamping of a suction drainage system will result in less external blood loss , blood transfusion and no increase in complications compared to a routine continuous suction drainage system . This was a r and omized prospect i ve study on patients undergoing total knee arthroplasty Introduction To study the clinical outcome of two methods of drain clamping after total knee arthroplasty and to determine the effect on blood loss and blood transfusion . Patients and methods A prospect i ve study involving 73 patients , r and omized into two groups . Group 1 included patients in whom the drain was clamped for 1 h postoperatively , after which it was released and kept open for 48 h. Group 2 included patients in whom the drain was clamped and released for 10 min every 2 h for 24 h. The drain was removed at 48 h in both groups . Patient ’s demographic details , intraoperative and postoperative blood loss , and haemoglobin values on the preoperative and postoperative days ( 1 , 4 , 7 , 14 ) were recorded . Results The mean postoperative drainage in group 1 was 520.65±170 ml , which was significantly higher than that of group 2 , 367.62±141.1 ml ( p<0.05 , Student ’s t-test ) . The drain charting shows 65 % of drainage volume occurs in the first 8 h in both groups . The study suggests a reduction in the incidence of blood transfusion in the 2-hourly groups , although it was not statistically significant . There was a difference in the haemoglobin drop between both groups , but statistically the p value was marginally above 0.05 ( p=0.086 ) and hence not significant . Conclusion The method of 2-hourly clamping of drain and release for 10 min significantly reduces postoperative blood loss , without any added increase of complication , after total knee arthroplasty Total knee arthroplasty is sometimes associated with major post-operative bleeding , often requiring transfusion . A prospect i ve , r and omised study was undertaken to assess the effect on post-operative bleeding of delaying release of the clamp on the suction drains . One hundred patients were allocated into two groups : Group A- immediate release of drain following release of tourniquet , and Group B- delayed release of the drain clamp by one hour . There was a statistically significant reduction ( p = < 0.001 ) in postoperative bleeding between group A ( 1050 ml ; 95%CI 728 - 1172 ml ) compared to group B ( 732 ml ; 95 % CI 620- 845 ml ) . Average drop in corrected haemoglobin and postoperative transfusion requirement were also less in the delayed group . The results show that delaying release of the drains by one hour reduces postoperative blood loss and transfusion requirement following total knee arthroplasty In this study we describe the potential role of autologous platelet gel and fibrin sealant in unilateral total knee arthroplasty to improve the postoperative range of motion and to reduce the incidence of arthrofibrosis . Total knee arthroplasty is often associated with a considerable amount of post-operative blood loss . Persistent limited motion directly after surgery may ultimately result in arthrofibrosis . To counteract these effects we investigated whether the use of autologous derived platelet gel and fibrin sealant would reduce postoperative blood loss , decrease the impaired range of motion and the incidence of arthrofibrosis .  All patients were consecutively operated and assigned to the study or control groups . Study group patients ( n = 85 ) were treated with the application of autologous platelet gel and fibrin sealant at the end of surgery . Eighty patients were operated without the use of platelet gel and fibrin sealant , and served as the control group . The postoperative hemoglobin decrease , range of motion and length of hospitalization were recorded . During a 5-month postoperative period patients were followed to observe the incidence of arthrofibrosis . In patients in the treatment group the hemoglobin concentration in blood decreased significantly less when compared to the control group . They also showed a superior postoperative range of motion when compared to those of the control group ( P < 0.001 ) . The incidence of arthrofibrosis and subsequent forced manipulation was significantly less ( P < 0.001 ) in patients managed with platelet gel and fibrin sealant . We conclude that peri-operatively applied platelet gel and fibrin sealant may improve the range of motion after total knee arthroplasty , decreases the length of stay and may reduce the incidence of arthrofibrosis We attempted to decrease the amount of postoperative bleeding after total knee arthroplasty ( TKA ) by clamping the suction drain and through retro grade infusion of saline containing a low concentration of epinephrine . When TKA was completed and the sutured wound was b and aged , 50 ml of saline containing epinephrine diluted to 1:200,000 and 0.5 g of antibiotic was injected into the knee joint via the inserted suction drain . The drain was clamped for 20 hours and then unclamped to begin aspiration until 48 hours after surgery . To clarify the effectiveness of this method , patients were divided into three groups . Group I consisted of 116 knees ( in 95 patients ) infused with 50 ml saline containing a low dose of epinephrine : Group II was composed of 70 knees ( 42 patients ) infused with 50 ml saline only ; and Group III included 97 knees ( 78 patients ) who did not undergo this drain-clamp method . The average amount of postoperative bleeding was 207 ml in Group I , 255 ml in Group II ( p < 0.01 ) , and 501 ml in Group III ( p < 0.001 ) . With this method of using saline with a low dose of epinephrine and sustained clamping of up to 20 hours , we have been able to operate on elderly patients with rheumatoid arthritis without blood transfusion , even in cases of simultaneous bilateral TKA . Drain-clamping with saline infusion effectively controlled postoperative bleeding after TKA , and when epinephrine was added to the saline , the hemostatic effect was even greater than that of saline alone A prospect i ve study was conducted to determine the optimal clamping time in the drain-clamping method after total knee arthroplasty . In a r and omized trial , 44 primary total knee arthroplasties were studied after the drain-clamping method using diluted epinephrine solution was applied for 1 hour or 24 hours . The mean blood loss into the drains was less in the 24-hour group compared with the 1-hour group ( 35 mL in the 24-hour group and 247 mL in the 1-hour group ) . No statistically significant difference was found in hemoglobin or hematocrit levels between the 2 groups after surgery . Only 1 patient ( 4.5 % ) in the 1-hour group and 2 
    Output:
    
The results demonstrated that drainage clamping could decrease the volume of drainage , but only clamping for no less than 4 hours could reduce the true blood loss .
There was no significant difference between the 2 groups regarding blood transfusion , postoperative range of motion , incidence of thromboembolic events , and wound complications .
The current evidence can not confirm the advantage of clamping drainage after TKA