***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: BACKGROUND : We proposed a new chest physiotherapy ( CPT ) secretion clearance method to treat respiratory syncytial virus bronchiolitis in infants . Our new CPT method consists of 15 prolonged slow expirations , then 5 provoked cough maneuvers . METHODS : We r and omized 20 infants ( mean age 4.2 months ) into 2 groups : 8 patients received 27 sessions of nebulization of hypertonic saline ; 12 patients received 31 sessions of nebulization of hypertonic saline followed by our new CPT method . We used the Wang clinical severity scoring system ( which assesses wheezing , respiratory rate , retractions , and general condition ) and measured SpO2 and heart rate before each CPT session ( T0 ) , immediately after the 30-min session ( T30 ) , and 120 min after the session ( T150 ) . RESULTS : Within the groups : in the first group , Wang score was significantly lower at T150 than at T0 : 4.6 vs 5.0 ( P = .008 ) . In the new- method -CPT group , Wang score was significantly lower at T30 ( 3.6 vs 4.3 , P = .001 ) and at T150 ( 3.7 vs 4.3 , P = .002 ) . Wheezing score was significantly lower at T150 than at T0 ( 1.1 vs 1.2 , P = .02 ) in the first group , and in the new- method -CPT group at T30 than at T0 ( 0.8 vs 1.3 , P = .001 ) and at T150 than at T0 ( 0.9 vs 1.3 , P = .001 ) . Between the groups : at T30 the improvement was significantly better in the new- method -CPT group for overall Wang score ( P = .02 ) , retractions ( P = .05 ) , respiratory rate ( P = .001 ) , and heart rate ( P < .001 ) . At T150 the Wang score was not significantly different between the groups . At T30 ( versus T0 ) the difference in percent gain between the groups was significant for Wang score ( P = .004 ) , wheezing ( P = .001 ) , and heart rate ( P = .02 ) . Over 5-hospital days , the daily baseline ( T0 ) Wang score decreased significantly in the new- method -CPT group ( P = .002 ) , whereas it did not in the first group . There were no adverse events . Average hospital stay was not significantly different between the groups . CONCLUSIONS : Our new CPT method showed short-term benefits to some respiratory symptoms of bronchial obstruction in infants with acute respiratory syncytial virus bronchiolitis OBJECTIVE In previously well infants hospitalized with acute viral bronchiolitis , the effectiveness of repeated nebulized therapy with epinephrine ( EPI ) was compared with treatment with albuterol ( ALB ) or saline placebo ( PLAC ) . STUDY DESIGN In this r and omized , double-blind , parallel-group , controlled trial , infants received study nebulizations every 1 to 6 hours and were assessed twice daily by the research team . The primary outcome was length of hospital stay ( LOS ) . Secondary outcomes included the time from admission until the infant had normal hydration , oxygenation , and minimal respiratory distress . RESULTS A total of 149 infants were r and omized ; 50 were allocated to receive racemic EPI , 51 were given ALB , and 48 received PLAC . Baseline characteristics and pre-enrollment symptoms , signs , and therapy were similar between groups . There were no group differences in the primary outcome measure , mean LOS (hours)(+/- SD ) : EPI = 59.8 ( 62 ) , ALB = 61.4 ( 54 ) , and PLAC = 63.3 ( 47 ) ; P = .95 by intent-to-treat analysis . Group differences were not statistically significant in any of the secondary outcomes . CONCLUSIONS There were no group differences in the effectiveness of therapy for infants hospitalized with bronchiolitis . Based on these results , we do not recommend routine use of either nebulized EPI or ALB in this patient group Objective To compare the length of hospital stay ( primary ) and improvement in clinical severity scores ( secondary ) among children with bronchiolitis nebulized with 3 % hypertonic saline or 0.9 % saline .  Design R and omized double blind controlled trial . Setting Tertiary care teaching hospital . Patients Hospitalized children ( 1–24 months ) with acute bronchiolitis of moderate severity . InterventionNebulization of 4 ml of 3 % hypertonic saline or 4 mL of 0.9 % saline , along with 2.5 mg salbutamol , at 4-hourly intervals till the patient was ready for discharge . Results Baseline characteristics were similar in two groups . Median clinical severity score at admission was 6 ( IQR-1 ) in both the groups . Clinical severity scores monitored afterwards 12-hourly till discharge ( 132 h ) did not show statistically significant differences in 3 % and 0.9 % saline groups . Mean length of hospital stay ( time to reach predefined clinical severity score<3 ) was 63.93 ± 22.43 h in 3 % saline group and 63.51 ± 21.27 h in 0.9 % saline group ( P=0.878 ) . No adverse events were reported by the parents , caregivers or treating medical attendants in both groups . Conclusion Nebulized 3 % saline is not superior to 0.9 % saline in infants with clinical ly diagnosed acute bronchiolitis Bronchiolitis is a common disorder in young children that often results in hospitalisation . Except for a possible effect of nebulised hypertonic saline ( sodium chloride ) , no evidence -based therapy is available . This study investigated the efficacy of nebulised 3 % and 6 % hypertonic saline compared with 0.9 % hypertonic saline in children hospitalised with viral bronchiolitis . In this multicentre , double-blind , r and omised , controlled trial , children hospitalised with acute viral bronchiolitis were r and omised to receive either nebulised 3 % , 6 % hypertonic saline or 0.9 % normal saline during their entire hospital stay . Salbutamol was added to counteract possible bronchial constriction . The primary endpoint was the length of hospital stay . Secondary outcomes were need for supplemental oxygen and tube feeding . From the 292 children included in the study ( median age 3.4 months ) , 247 completed the study . The median length of hospital stay did not differ between the groups : 69 h ( interquartile range 57 ) , 70 h ( IQR 69 ) and 53 h ( IQR 52 ) , for 3 % ( n=84 ) and 6 % ( n=83 ) hypertonic saline and 0.9 % ( n=80 ) normal saline , respectively , ( p=0.29 ) . The need for supplemental oxygen or tube feeding did not differ significantly . Adverse effects were similar in the three groups . Nebulisation with hypertonic saline ( 3 % or 6 % sodium chloride ) although safe , did not reduce the length of stay in hospital , duration of supplemental oxygen or tube feeding in children hospitalised with moderate-to-severe viral bronchiolitis . Hypertonic saline nebulisation did not reduce hospital stay for children with viral bronchiolitis OBJECTIVE To determine the utility of inhaled hypertonic saline solution to treat ambulatory infants with viral bronchiolitis . DESIGN R and omized , double-blind , controlled trial . Sixty-five ambulatory infants ( mean + /- SD age , 12.5 + /- 6 months ) with viral bronchiolitis received either of the following : inhalation of 0.5 mL ( 5 mg ) terbutaline added to 2 mL of 0.9 % saline solution as a wet nebulized aerosol ( control ; group 1 ; n = 32 ) or 0.5 mL ( 5 mg ) terbutaline added to 2 mL of 3 % saline solution administered in the same manner as above ( treatment ; group 2 ; n = 33 ) . This therapy was repeated three times every day for 5 days . RESULTS The clinical severity ( CS ) scores at baseline on the first day of treatment were 6.4 + /- 1.8 in group 1 and 6.6 + /- 1.5 in group 2 ( not significant ) . After the first day , the CS score was significantly lower ( better ) in group 2 as compared to group 1 on each of the treatment days ( p < 0.005 ; Fig 1 ) . On the first day , the percentage decrease in the CS score after inhalation therapy was significantly better for group 2 ( 33 % ) than for group 1 ( 13 % ) [ p < 0.005 ; Fig 1 ] . On the second day , the percentage improvement was better in the hypertonic saline solution-treated patients ( group 2 ) as compared to the 0.9 % saline solution-treated patients ( group 1 ) [ p = 0.01 ; Fig 1 ] . CONCLUSIONS We conclude that in nonasthmatic , nonseverely ill ambulatory infants with viral bronchiolitis , aerosolized 3 % saline solution plus 5 mg terbutaline is effective in decreasing symptoms as compared to 0.9 % saline solution plus 5 mg terbutaline OBJECTIVE To determine the utility of inhaled hypertonic saline solution to treat infants hospitalized with viral bronchiolitis . DESIGN R and omized , double-blind , controlled trial . Fifty-two hospitalized infants ( mean + /- SD age , 2.9 + /- 2.1 months ) with viral bronchiolitis received either inhalation of epinephrine , 1.5 mg , in 4 mL of 0.9 % saline solution ( group 1 ; n = 25 ) or inhalation of epinephrine , 1.5 mg , in 4 mL of 3 % saline solution ( group 2 ; n = 27 ) . This therapy was repeated three times every hospitalization day until discharge . RESULTS The percentage improvement in the clinical severity scores after inhalation therapy was not significant in group 1 on the first , second , and third days after hospital admission ( 3.5 % , 2 % , and 4 % , respectively ) . In group 2 , significant improvement was observed on these days ( 7.3 % , 8.9 % , and 10 % , respectively ; p < 0.001 ) . Also , the improvement in clinical severity scores differed significantly on each of these days between the two groups . Using 3 % saline solution decreased the hospitalization stay by 25 % : from 4 + /- 1.9 days in group 1 to 3 + /- 1.2 days in group 2 ( p < 0.05 ) . CONCLUSIONS We conclude that in nonasthmatic , nonseverely ill infants hospitalized with viral bronchiolitis , aerosolized 3 % saline solution/1.5 mg epinephrine decreases symptoms and length of hospitalization as compared to 0.9 % saline solution/1.5 mg epinephrine Background Systematic review s ( SRs ) should be up to date to maintain their importance in informing healthcare policy and practice . However , little guidance is available about when and how to up date SRs . Moreover , the updating policies and practice s of organizations that commission or produce SRs are unclear . Methodology /Principal Findings The objective was to describe the updating practice s and policies of agencies that sponsor or conduct SRs . An Internet-based survey was administered to a purposive non-r and om sample of 195 healthcare organizations within the international SR community . Survey results were analyzed using descriptive statistics . The completed response rate was 58 % ( n = 114 ) from across 26 countries with 70 % ( 75/107 ) of participants identified as producers of SRs . Among responders , 79 % ( 84/107 ) characterized the importance of updating as high or very-high and 57 % ( 60/106 ) of organizations reported to have a formal policy for updating . However , only 29 % ( 35/106 ) of organizations made reference to a written policy document . Several groups ( 62/105 ; 59 % ) reported updating practice s as irregular , and over half ( 53/103 ) of organizational respondents estimated that more than 50 % of their respective SRs were likely out of date . Authors of the original SR ( 42/106 ; 40 % ) were most often deemed responsible for ensuring SRs were current . Barriers to updating included re source constraints , review er motivation , lack of academic credit , and limited publishing formats . Most respondents ( 70/100 ; 70 % ) indicated that they supported central ization of updating efforts across institutions or agencies . Furthermore , 84 % ( 83/99 ) of respondents indicated they favoured the development of a central registry of SRs , analogous to efforts within the clinical trials community . Conclusions / Significance Most organizations that sponsor and /or carry out SRs consider updating important . Despite this recognition , updating practice s are not regular , and many organizations lack a formal written policy for updating SRs . This research marks the first baseline data available on updating from an organizational perspective Aim Acute bronchiolitis is the commonest cause for hospitalisation in infancy . Supportive care remains the cornerstone of current management and no other therapy has been shown to influence the course of the disease . It has been suggested that adding nebulised hypertonic saline to usual care may shorten the duration of hospitalisation . To determine whether hypertonic saline does have beneficial effects we undertook an open , multi-centre parallel-group , pragmatic RCT in ten UK hospitals . Methods Infants admitted 
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Conclusions There is disparity between the overall combined effect on LoS as compared with the negative results from the largest and most precise trials .
Together with high levels of heterogeneity , this means that neither individual trials nor pooled estimates provide a firm evidence -base for routine use of HS in inpatient acute bronchiolitis