***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: OBJECTIVES The second Primary Angioplasty in Myocardial Infa rct ion ( PAMI-II ) study evaluated the hypothesis that primary percutaneous transluminal coronary angioplasty ( PTCA ) , with subsequent discharge from the hospital 3 days later , is safe and cost-effective in low risk patients . BACKGROUND In low risk patients with myocardial infa rct ion ( MI ) , few data exist regarding the need for intensive care and noninvasive testing or the appropriate length of hospital stay . METHODS Patients with acute MI underwent emergency catheterization with primary PTCA  when appropriate . Low risk patients ( age < 70 years , left ventricular ejection fraction > 45 % , one- or two-vessel disease , successful PTCA , no persistent arrhythmias ) were r and omized to receive accelerated care ( admission to a nonintensive care unit and day 3 hospital discharge without noninvasive testing [ n = 237 ] or traditional care [ n = 234 ] ) . RESULTS Patients who received accelerated care had similar in-hospital outcomes but were discharged 3 days earlier ( 4.2+/-2.3 vs. 7.1+/-4.7 days , p = 0.0001 ) and had lower hospital costs ( $ 9,658+/-5,287 vs. $ 11,604+/-6,125 p = 0.002 ) than the patients who received traditional care . At 6 months , accelerated and traditional care groups had a similar rate of mortality ( 0.8 % vs. 0.4 % , p = 1.00 ) , unstable ischemia ( 10.1 % vs. 12.0 % , p = 0.52 ) , reinfa rct ion ( 0.8 % vs. 0.4 % , p = 1.00 ) , stroke ( 0.4 % vs. 2.6 % , p = 0.07 ) , congestive heart failure ( 4.6 % vs. 4.3 % , p = 0.85 ) or their combined occurrence ( 15.2 % vs. 17.5 % , p = 0.49 ) . The study was design ed to detect a 10 % difference in event rates ; at 6 months , only a 2.3 % difference was measured between groups , indicating an actual power of 0.19 . CONCLUSIONS Early identification of low risk patients with MI allowed safe omission of the intensive care phase and noninvasive testing , and a day 3 hospital discharge strategy , result ing in substantial cost savings Although studies have shown that early oral feeding after abdominal surgery is feasible , the optimal dietary schedule has not been established . This study was conducted prospect ively to compare the clinical outcome of patient-controlled dietary schedule with that of conventional dietary schedule after gastric resection for early cancer . Patients in the patient-controlled diet ( PC ) group ( n = 53 ) received a solid diet on dem and ;  patients in the  conventional regimen ( CR ) group ( n = 50 ) received a solid diet from postoperative day ( POD ) 10 . All patients underwent distal gastrectomy for early gastric cancer . A liquid diet was tolerated by the PC group on POD 2 , and a solid diet was taken on POD 6 after gastrectomy , earlier than in the CR group . The postoperative hospital stay was 18.5 ± 5.9 days ( 10–40 ) in the PC group , versus 21.7 ± 8.8 days ( 14–57 ) in the CR group ( p = 0.02 ) . Patients in the PC group had a higher daily oral intake of calories on POD 10 than those in the CR group ( p = 0.02 ) . Changes in body weight and serum albumin during the postoperative period and after discharge , and the incidence of complications and variances from clinical pathways did not show significant differences between the two groups . The PC schedule was feasible after distal gastrectomy for early gastric cancer . It improved the clinical outcome , with a shorter postoperative hospital stay and a higher oral energy intake on early phase , compared with the CR schedule . Moreover , the PC approach was useful for establishing the optimal dietary schedule and improving the clinical pathway Background . It is often difficult to predict the timing and frequency of asthma attacks . In addition to interrupting the daily life of both the affected child and his/her family , asthma can also pose sudden danger to a child . Based on clinical observations , many asthma‐affected children and their parents must constantly adjust themselves to the uncertainty of the disease , which leads to increased stress on the family . The use of care maps has demonstrated increased efficiency and effectiveness in the care of asthma patients from a variety of setting s. Objective . We design ed this study to construct and evaluate a care map for asthmatic children in Taiwan . Specific attention was placed on comparing the study and control subjects by parental knowledge of asthma , medication used for asthma , hospital readmission , and health care re source usage . Subjects and Methods . The care map was constructed by in‐depth interviews with eight sets of parents of children with asthma . Forty‐four parents of 42 asthma children were r and omized into two groups in the Allergic Clinic of the Chang Gung Children 's Hospital . The experimental group of 22 parents received  individual instruction and training sessions in addition to the regular care provided to the control group of 22 parents . Results . Forty‐two children with asthma were surveyed in this study . To examine the reliability and validity of a care map for children with asthma , a quantitative survey was conducted with 42 outpatient parents with asthmatic children . There was less emergency room attending rate in experimental group ( 6/month ; p < 0.05 ) The underst and ing of the disease was much improved in parents of experimental group ( 13.85 ± 1.04 vs. 10.91 ± 2.14 ; p < 0.01 ) . Furthermore , parents acquired a more positive attitude to asthma , and almost all of the control group had irregular follow‐ups by a physician and had irregular use of medication . Conclusion . This study emphasizes that a  care map  in children with asthma ( CACM ) can be used to educate parents in how to provide the best treatment plan for their children . This study also shows how a CACM can help parents train their children in the best behaviors during asthma attacks . Empathetic assessment and elimination of cultural barriers , a well‐ design ed educational program , and a mutually developed treatment plan could significantly improve the quality of life for families and specific asthma outcomes BACKGROUND AND PURPOSE Integrated Care Pathway ( ICP ) is an organized , goal -defined , and time-managed plan that has the potential of facilitating timely interdisciplinary coordination , improving discharge planning , and reducing length of hospital stay . METHODS An ICP for stroke rehabilitation based on evidence of best practice , professional st and ards , and existing infrastructure was developed . Its effectiveness was tested in 152 stroke patients undergoing rehabilitation who were r and omized to receive ICP care coordinated by an experienced nurse ( n=76 ) or conventional multidisciplinary care ( n=76 ) . RESULTS The age , sex , premorbid functional ability , and stroke characteristics of the 2 groups were comparable . There were no differences in mortality rates ( 10 [ 13 % ] versus 6 [ 8 % ] ) , institutionalization ( 10 [ 13 % ] versus 16 [ 21 % ] ) , or length of hospital stay ( 50+/-19 versus 45+/-23 days ) between patients receiving ICP or multidisciplinary care . Patients receiving conventional multidisciplinary care improved significantly faster between 4 and 12 weeks ( median change in Barthel Activities of Daily Living Index 6 versus 2 ; P<0.01 ) and had higher Quality of Life scores at 12 weeks ( 65 versus 59 ; P=0.07 ) and 6 months ( 72 versus 63 ; P<0.005 ) . There were no significant differences in the mean duration of physiotherapy ( 42.8+/-41.2 versus 39.4+/-36.4 hours ) or occupational therapy ( 8.5+/-7.5 versus 8.0+/-7.5 hours ) received between the 2 groups . CONCLUSIONS ICP management offered no benefit over conventional multidisciplinary care on a stroke rehabilitation unit . Functional recovery was faster and Quality of Life outcomes better in patients receiving conventional multidisciplinary care CONTEXT Physicians frequently prescribe respiratory treatments to hospitalized patients , but the influence of such treatments on clinical outcomes is difficult to assess . OBJECTIVE To compare the clinical outcomes of patients receiving respiratory treatments managed by respiratory care practitioner (RCP)-directed treatment protocol s or physician-directed orders .  DESIGN A single center , quasi-r and omized , clinical study . SETTING Three internal medicine firms from an urban teaching hospital . PATIENTS Six hundred ninety-four consecutive hospitalized non-ICU patients ordered to receive respiratory treatments .  MAIN OUTCOME MEASURES Discordant respiratory care orders , respiratory care charges , hospital length of stay , and patient-specific complications . Discordant orders were defined as written orders for respiratory treatments that were not clinical ly indicated as well as orders omitting treatments that were clinical ly indicated according to protocol -based treatment algorithms . RESULTS Firm A patients ( n = 239 ) received RCP-directed treatments and had a statistically lower rate of discordant respiratory care orders ( 24.3 % ) as compared with patients receiving physician-directed treatments  in firms B ( n = 205 ; 58.5 % ) and C ( n = 250 ; 56.8 % ; p < 0.001 ) . No statistically significant differences in patient complications were observed . The average number of respiratory treatments and respiratory care charges were statistically less for firm A patients ( 10.7 + /- 13.7 treatments ; $ 868 + /- 1,519 ) as compared with patients in firms B ( 12.4 + /- 12.7 treatments , $ 1,124 + /- 1,339 ) and C ( 12.3 + /- 13.4 treatments , $ 1 , 054 + /- 1,346 ; p = 0.009 [ treatments ] and p < 0.001 [ respiratory care charges ] ) . CONCLUSIONS Respiratory care managed by RCP-directed treatment protocol s for non-ICU patients is safe and showed greater agreement with institutional treatment algorithms as compared with physician-directed respiratory care . Additionally , the overall utilization of respiratory treatments was significantly less among patients receiving RCP-directed respiratory care OBJECTIVES We tested the hypothesis that an emergency department-based protocol for rapidly ruling out myocardial ischemia would reduce hospital time and expense but maintain diagnostic accuracy . BACKGROUND Patients with a missed diagnosis of myocardial infa rct ion have a high mortality rate ; however , providing routine hospital care to low risk patients may not be time- or cost-effective . METHODS One hundred low risk patients were entered into the study and r and omized either to an  emergency department-based rapid rule-out protocol  ( n = 50 ) or to  routine hospital care  ( n = 50 ) . Patients receiving routine care were managed by their attending physicians . The rapid protocol included serum enzyme testing at 0 , 3 , 6 and 9h , serial electrocardiograms with continuous ST segment monitoring and , if results were negative , a predischarge grade d exercise test . Study patients were also compared with 160 historical control subjects .  RESULTS Myocardial infa rct ion or unstable angina occurred in 6 % of patients within 30 days ; no diagnoses were missed . By intention to treat analysis ( n = 50 in each group ) , the hospital stay was shorter and charges were lower with the rapid protocol than with routine care ( p = 0.001 ) . Among patients in whom ischemia was ruled out , those assigned to the rapid protocol had a shorter hospital stay ( median 11.9 vs. 22.8 h , p = 0.0001 ) and lower initial ( $ 893 vs $ 1,349 , p = 0.0001 ) and 30-day ( $ 898 vs. $ 1,522 , p = 0.0001 ) hospital charges than did patients given routine care . In historical control subjects , the hospital stay was longer ( median 34.5 h , p = 0.001 vs. either group ) and charges greater ( median $ 2,063 , p = 0.001 , vs rapid protocol , p = 0.02 , vs. routine care group ) . CONCLUSIONS In low risk patients who present to the emergency department with chest pain , the rapid protocol ruled out myocardial infa rct ion and unstable angina more quickly and cost-effectively than did routine hospital care CONTEXT Large variations exist among hospitals in the use of treatment re sources for community-acquired pneumonia ( CAP ) . Lack of a common approach to the diagnosis and treatment of CAP has been cited as an explanation for these variations . OBJECTIVE To determine if use of a critical pathway improves the efficiency of treatment for CAP without compromising the well-being of patients . DESIGN Multicenter controlled clinical trial with cluster r and omization and up to 6 weeks of follow-up . SETTING Nineteen teaching and community hospitals in Canada . PATIENTS A total of 1743 patients with CAP presenting to the emergency department at 1 of the participating institutions between January 1 and July 31 , 1998 . INTERVENTION Hospitals were assigned to continue conventional management ( n = 10 ) or implement the critical pathway ( n = 9 ) , which consisted of a clinical prediction rule to guide the admission decision , levofloxacin therapy , and practice guidelines . MA 
    Output:
    
In general , the majority of studies reporting economic data ( LOS and hospital costs ) showed a positive impact .
Furthermore , in a subgroup- analysis , clinical pathways for invasive procedures showed a stronger LOS reduction ( weighted mean difference ( WMD ) -2.5 days versus -0.8 days)).There was no evidence of differences in readmission to hospitals or in-hospital complications .
Conclusion As a result of the relatively small number of studies meeting inclusion criteria , this evidence base is not conclusive enough to provide a replicable framework for all pathway strategies .
Considering the clinical areas for implementation , clinical pathways seem to be effective especially for invasive care .