***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: The optimal strategy to achieve palliation of  malignant pleural effusions ( MPEs )  is unknown . This multi-institutional , prospect i ve , r and omized trial compares 2 established methods for controlling symptomatic unilateral MPEs . Patients with unilateral MPEs were r and omized to either daily tunneled catheter drainage ( TCD ) or bedside talc pleurodesis ( TP ) . This trial is patterned after a previous r and omized trial that showed that bedside TP was equivalent to thoracoscopic TP ( CALGB 9334 ) . The primary end point of the current study was combined success : consistent/reliable drainage/pleurodesis , lung expansion , and 30-day survival . A secondary end point , survival with effusion control , was added retrospectively . This trial r and omized 57 patients who were similar in terms of age ( 62 years ) , active chemotherapy ( 28 % ) , and histologic diagnosis ( lung , 63 % ; breast , 12 % ; other/unknown cancers , 25 % ) to either bedside TP or TCD .  Combined success was higher with TCD ( 62 % ) than with TP ( 46 % ; odds ratio , 5.0 ; P = .064 ) . Multivariate regression analysis revealed that patients treated with TCD had better 30-day activity without dyspnea scores ( 8.7 vs. 5.9 ; P = .036 ) , especially in the subgroup with impaired expansion ( 9.1 vs. 4.6 ; P = .042 ) . Patients who underwent TCD had better survival with effusion control at 30 days compared with those who underwent TP ( 82 % vs. 52 % , respectively ; P = .024 ) . In this prospect i ve r and omized trial , TCD achieved superior palliation of unilateral MPEs than TP , particularly in patients with trapped lungs The purpose of this study was to compare the effectiveness and safety of a chronic indwelling pleural catheter with doxycycline pleurodesis via tube thoracostomy in the treatment of patients with recurrent symptomatic malignant pleural effusions ( MPE ) STUDY OBJECTIVE To demonstrate the efficacy , safety , and appropriate mode of instillation of talc for sclerosis in treatment of malignant pleural effusions ( MPEs ) . DESIGN A prospect i ve , r and omized trial was design ed to compare thoracoscopy with talc insufflation ( TTI ) to thoracostomy and talc slurry ( TS ) for patients with documented MPE . MEASUREMENTS The primary end point was 30-day freedom from radiographic MPE recurrence among surviving patients whose lungs initially re-exp and ed > 90 % . Morbidity , mortality , and quality of life were also assessed . RESULTS Of 501 patients registered , those eligible were r and omized to TTI ( n = 242 ) or TS ( n = 240 ) . Patient demographics and primary malignancies were similar between study arms . Overall , there was no difference between study arms in the percentage of patients with successful 30-day outcomes ( TTI , 78 % ; TS , 71 % ) . However , the subgroup of patients with primary lung or breast cancer had higher success with TTI than with TS ( 82 % vs 67 % ) . Common morbidity included fever , dyspnea , and pain . Treatment-related mortality occurred in nine TTI patients and seven TS patients . Respiratory complications were more common following TTI than TS ( 14 % vs 6 % ) . Respiratory failure was observed in 4 % of TS patients and 8 % of TTI patients , accounting for five toxic deaths and six toxic deaths , respectively . Quality -of-life measurement demonstrated less fatigue with TTI than TS . Patient ratings of comfort and safety were also higher for TTI , but there were no differences on perceived value or convenience of the procedures . CONCLUSIONS Both methods of talc delivery are similar in efficacy ; TTI may be better for patients with either a lung or breast primary . The etiology and incidence of respiratory complications from talc need further exploration BACKGROUND Malignant pleural effusion is associated with short life expectancy and significant morbidity . A r and omized controlled trial comparing indwelling pleural catheters ( IPCs )  with talc pleurodesis found that IPCs reduced in-hospital time and the need for additional procedures but were associated with excess adverse events . METHODS Using data from the clinical trial , we compared costs associated with use of IPCs and with talc pleurodesis . Re source use and adverse events were captured through case report forms over the 1-year trial follow-up . Costs for outpatient and inpatient visits , diagnostic imaging , nursing , and doctor time were obtained from the UK National Health Service reference costs and University of Kent 's Unit Costs of Health and Social Care 2011 and inflated to 2013 using the UK Consumer Price Index . Procedure supply costs were obtained from the manufacturer . Difference in mean costs was compared using nonparametric bootstrapping . All costs were converted to US dollars using the Organisation for Economic Co-operation and Development Purchasing Power Parity Index . RESULTS Overall mean cost ( SD ) for managing patients with IPCs and talc pleurodesis was $ 4,993 ( $ 5,529 ) and $ 4,581 ( $ 4,359 ) , respectively . The incremental mean cost difference was $ 401 , with 95 % CI of -$1,387 to $ 2,261 . The mean cost related to ongoing drainage in the IPC group was $ 1,011 ( $ 732 ) vs $ 57 ( $ 213 ) in the talc pleurodesis group ( P = .001 ) . This included the cost of drainage bottles , dressing changes in the first month , and catheter removal . There was no significant difference in cost of the initial intervention or adverse events between the groups . For patients with survival < 14 weeks , IPC is significantly less costly than talc pleurodesis , with mean cost difference of -$1,719 ( 95 % CI , -$3,376 to -$85 ) . CONCLUSIONS There is no significant difference in the mean cost of managing patients with IPCs  compared with talc pleurodesis . For patients with limited survival , IPC appears less costly . TRIAL REGISTRY is rct n.org ; No. : IS RCT N87514420 ; URL : www.is rct n.org PURPOSE To assess the effectiveness of tunneled pleural catheters ( TPCs ) in the treatment of malignant pleural effusions ( MPEs ) . MATERIAL S AND METHODS Twenty-eight patients with symptomatic MPEs had 31 hemithoraces treated with TPCs placed under image guidance . Chemical sclerotherapy had failed in two patients and two had symptomatic locules . Drainage was accomplished by intermittent connection to vacuum bottles . Pleurodesis was considered achieved when three consecutive outputs were scant and imaging showed no residual fluid . RESULTS All catheters were successfully placed . Dyspnea improved in 94 % ( 29 of 31 hemithoraces ) at 48 hours and 91 % ( 20 of 22 patients ) at 30 days . Control of the MPE was achieved in 90 % of hemithoraces ( 28/31 ) , although five required ancillary procedures . Pleurodesis occurred in 42 % ( 13 of 31 ) of hemithoraces , including both that underwent an earlier attempt at chemical sclerotherapy and one treated locule . Continued drainage without pleurodesis controlled the effusion in 48 % ( 15 of 31 ) . In only 7 % was hospital time necessary for care related to the TPC .  Early , transient catheter-related pain was common , but only three complications ( in two patients ) occurred . Neither of these altered patient care . CONCLUSIONS Regardless of whether pleurodesis is achieved , TPCs provide effective long-term outpatient palliation of MPEs BACKGROUND Patients with malignant pleural effusion ( MPE ) have limited prognoses . They require long-lasting symptom relief with minimal hospitalization . Indwelling pleural catheters ( IPCs ) and talc pleurodesis are approved treatments for MPE . Establishing the implication s of IPC and talc pleurodesis on subsequent hospital stay will influence patient choice of treatment . Therefore , our objective was to compare patients with MPE treated with IPC vs pleurodesis  in terms of hospital bed days ( from procedure to death or end of follow-up ) and safety . METHODS In this prospect i ve , 12-month , multicenter study , patients with MPE were treated with IPC or talc pleurodesis , based on patient choice . Key end points were hospital bed days from procedure to death ( total and effusion-related ) . Complications , including infection and protein depletion , were monitored longitudinally . RESULTS One hundred sixty patients with MPE were recruited , and 65 required definitive fluid control ; 34 chose  IPCs  and 31 pleurodesis .  Total hospital bed days ( from any causes ) were significantly fewer in patients with IPCs ( median , 6.5 days ; interquartile range [ IQR ] = 3.75 - 13.0 vs pleurodesis , mean , 18.0 ; IQR , 8.0 - 26.0 ; P = .002 ) . Effusion-related hospital bed days were significantly fewer with IPCs ( median , 3.0 days ; IQR , 1.8 - 8.3 vs pleurodesis , median , 10.0 days ; IQR , 6.0 - 18.0 ; P < .001 ) . Patients with IPCs spent significantly fewer of their remaining days of life in hospital ( 8.0 % vs 11.2 % , P < .001 , χ(2 ) = 28.25 ) . Fewer patients with IPCs  required further pleural procedures ( 13.5 % vs 32.3 % in pleurodesis group ) . There was no difference in rates of pleural infection ( P = .68 ) and protein ( P = .65 ) or albumin loss ( P = .22 ) . More patients treated with IPC reported immediate ( within 7 days ) improvements in quality of life and dyspnea . CONCLUSIONS Patients treated with IPCs required significantly fewer days in hospital and fewer additional pleural procedures than those who received pleurodesis . Safety profiles and symptom control were comparable CONTEXT Malignant pleural effusion causes disabling dyspnea in patients with a short life expectancy . Palliation is achieved by fluid drainage , but the most effective first-line method has not been determined . OBJECTIVE To determine whether indwelling pleural catheters ( IPCs ) are more effective than chest tube and talc slurry pleurodesis ( talc ) at relieving dyspnea . DESIGN Unblinded r and omized controlled trial ( Second Therapeutic Intervention in Malignant Effusion Trial [ TIME2 ] ) comparing IPC and talc ( 1:1 ) for which 106 patients with malignant pleural effusion who had not previously undergone pleurodesis were recruited from 143 patients who were treated at 7 UK hospitals . Patients were screened from April 2007-February 2011 and were followed up for a year . INTERVENTION Indwelling pleural catheters were inserted on an outpatient basis , followed by initial large volume drainage , education , and subsequent home drainage . The talc group were admitted for chest tube insertion and talc for slurry pleurodesis . MAIN OUTCOME MEASURE Patients completed daily 100-mm line visual analog scale ( VAS ) of dyspnea over 42 days after undergoing the intervention ( 0 mm represents no dyspnea and 100 mm represents maximum dyspnea ; 10 mm represents minimum clinical ly significant difference ) . Mean difference was analyzed using a mixed-effects linear regression model adjusted for minimization variables . RESULTS Dyspnea improved in both groups , with no significant difference in the first 42 days with a mean VAS dyspnea score of 24.7 in the IPC group ( 95 % CI , 19.3 - 30.1 mm ) and 24.4 mm ( 95 % CI , 19.4 - 29.4 mm ) in the talc group , with a difference of 0.16 mm ( 95 % CI , −6.82 to 7.15 ; P = .96 ) . There was a statistically significant improvement in dyspnea in the IPC group at 6 months , with a mean difference in VAS score between the IPC group and the talc group of −14.0 mm ( 95 % CI , −25.2 to −2.8 mm ; P = .01 ) . Length of initial hospitalization was significantly shorter in the IPC group with a median of 0 days ( interquartile range [ IQR ] , 0 - 1 day ) and 4 days ( IQR , 2 - 6 days ) for the talc group , with a difference of −3.5 days ( 95 % CI , −4.8 to −1.5 days ; P < .001 ) . There was no significant difference in quality of life . Twelve patients ( 22 % ) in the talc group required further pleural procedures compared with 3 ( 6 % ) in the IPC group ( odds ratio [ OR ] , 0.21 ; 95 % CI , 0.04 - 0.86 ; P = .03 ) . Twenty-one of the 52 patients in the catheter group experienced adverse events vs 7 of 54 in the talc group ( OR , 4.70 ; 95 % CI , 1 
    Output:
    
Current evidence suggests that TPC and chemical pleurodesis are both effective treatment for recurrent MPE with similar success and complication rate .