***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: A prospect i ve study of 110 unselected patients with suspected acute appendicitis comprised ultrasonography and parameters of inflammation -- c-reactive protein , white blood cell count , erythrocyte sedimentation rate and Yersinia antibody titer . The results were compared with the initial clinical diagnosis . Acute appendicitis was confirmed in 28 cases ( prevalence 25.4 % ) . The negative laparotomy rate was 11.4 % and the appendiceal perforation rate 10.7 % Clinical judgment and ultrasonography were statistically highly significant as predictors of acute appendicitis , whereas the indications given by c-reactive protein and white blood cell count did not reach statistical significance Headache following lumbar puncture is a well known and well described complication . Various manoeuvres have been tried to prevent post lumbar puncture headache -- the commonest being bed rest for 4 to 24 hours following lumbar puncture , though its value is question able . R and omised controlled clinical trial was done to evaluate the effect of 24 hours bed rest on the incidence and severity of post lumbar puncture headaches .  Two hundred and eight patients were r and omly allocated to either the ambulant or the bed rest group . Patients were interviewed by a single investigator on days 0 , 1 , 2 and 7 about the presence and nature of headache . Other relevant clinical and laboratory data pertaining to the lumbar puncture was collected . The overall incidence of post lumbar puncture headache was 17 % ; 15 % in the ambulant and 18 % in the bed rest group . Of the patients who had headaches , severe headache was observed in 57 % in the ambulant and 12 % in the bed rest group ( p = 0.02 ) . Other variables did not alter the outcome of headaches . Bed rest does not appear to alter the incidence of post lumbar puncture headaches , but reduces the severity in those who get headaches , after a lumbar puncture The diagnostic value of  C-reactive protein ( CRP ) , total white blood cell ( WBC ) count , total neutrophil count , and neutrophil differential count were evaluated in a prospect i ve blinded study of 204 patients su bmi tted with the tentative diagnosis of acute appendicitis . The laboratory tests were performed on blood sample s obtained at the time of admission , and the results were stored until the patients were discharged . One hundred patients were operated on : 59 had appendicitis , 3 had other surgically correctable diseases , and 38 had a superfluous exploration .  All 104 nonoperated patients recovered spontaneously . The sensitivity , specificity , and predictive values of single tests and test combinations were calculated at different cutoff levels . Using st and ard reference intervals , WBC count demonstrated the best sensitivity ( 83 percent ) and predictive value of a negative result ( 88 percent ) . Combining the tests by an “ or ” rule enhanced the sensitivity to 100 percent , employing WBC count or CRP or neutrophil percentage above the reference range ( triple test ) , but at the expense of the predictive value of a positive test ( 37 percent ) . It was concluded that both single tests and combined tests are of limited value in predicting acute appendicitis . However , the same triple test combination proved a predictive value of a negative result at 100 percent ( 95 percent confidence limits 92 to 100 percent ) , indicating that acute appendicitis is unlikely when these tests are simultaneously negative . The triple test combination was valid in 32 percent of the patients who were free from appendicitis . In the study group , 10 of the patients ( 25 percent ) who had a superfluous exploration had a negative triple test , and they might have avoided surgery if it had been used . Therefore , the triple test is recommended as a help in reducing the significant rate of negative laparotomies in patients suspected of having acute appendicitis The clinical diagnosis of appendicitis needs to be improved , as up to 40 % of explorations for suspected appendicitis are unnecessary . The use of body temperature and laboratory examinations as diagnostic aids in the management of these patients is controversial . The diagnostic power of these variables compared to that of the disease history and clinical findings is not well studied . In this study we prospect ively assessed and compared the diagnostic value of 21 elements of the history , clinical findings , body temperature , and laboratory examinations in 496 patients with suspected appendicitis . The diagnostic value of each variable was compared from the area under the receiver operating characteristic ( ROC ) curve and the likelihood ratios ( LR ) . Logistic regression was used to analyze the diagnostic value of a combination of variables and to analyze independent relations . No single variable had sufficiently high discriminating or predicting power to be used as a true diagnostic test . The inflammatory variables ( temperature , leukocyte and differential white blood cell ( WBC ) counts , C-reactive protein ) had discriminating and predicting powers similar to those of the clinical findings ( direct and rebound abdominal tenderness and guarding ) . Anorexia , nausea , and right-sided rectal tenderness had no diagnostic value . The leukocyte and differential WBC counts , C-reactive protein , rebound tenderness , guarding , and gender were independent predictors of appendicitis with a combined ROC area of 0 . 93 for appendicitis . This showed that inflammatory variables contain important diagnostic information , especially with advanced appendicitis . They should therefore always be included in the diagnostic workup in patients with suspected appendicitis The total leucocyte count ( TLC ) and neutrophil percentage ( NP ) were studied prospect ively in 1032 patients who underwent appendicectomy for suspected acute appendicitis . On histopathological study of the resected appendices , 97 patients had normal appendices , and 935 patients had acutely inflamed , gangrenous or perforated appendicitis . Statistically more patients with appendicitis had either raised TLC or raised NP compared with patients with normal appendices ( P less than 0.001 ) , and also compared with 357 patients who were admitted with right lower quadrant abdominal pain but were not subjected to operation ( P less than 0.001 ) . The sensitivity and specificity of raised TLC in diagnosing appendicitis for patients who underwent appendicectomy  were 81.4 % and 77.3 % , respectively . Sensitivity increased when either raised TLC or raised NP were used , but specificity decreased . In contrast , sensitivity decreased when both raised TLC and raised NP were used together , but specificity increased . Raised TLC , preferably combined with raised NP , is a useful diagnostic aid in acute appendicitis . The TLC and NP , however , should only be interpreted in the light of physical findings in patients with suspected appendicitis because these blood tests have false positive and false negative results In this single-blind , r and omized study of post-lumbar-puncture headache ( PPH )  in 300 neurologic in patients the significance of body posture after lumbar puncture ( LP )  was evaluated . Immediate mobilization was compared with bed rest for 6 h ( 3 h prone followed by 3 h supine posture ) . Contrary to the widely held belief , this investigation did not show significant differences between recumbent and ambulant patients as to frequency of PPH in the total material ( 39 % versus 35 % ) or when men ( 31 % versus 29 % ) and women ( 48 % versus 41 % ) were evaluated separately . Headache associated with nausea was significantly more frequent in the recumbent than in the ambulant patients both in the total material ( 23 % versus 13 % ) and in women ( 35 % versus 16 % ) . Thus , immediate mobilization seems to be preferable after LP A r and omised study was carried out to compare the efficacy of the gum elastic bougie and the stylet in a simulated difficult intubation . A  laryngoscopy assessment , as described by Cormack and Lehane , was made in 100 patients . A Grade 3 view was then simulated . In the Bougie First Group ( 50 patients ) two attempts were made to pass a gum elastic bougie and a tracheal tube into the trachea . If these first two attempts were not successful , two further attempts at intubation were allowed with a stylet placed in the tracheal tube . In the Stylet First Group ( 50 patients ) the order was reversed . After two attempts the tube was correctly placed in the trachea in 96 % of cases in the Bougie First Group compared to only 66 % of cases in the Stylet First Group ( p < 0.001 ) . We recommend that a gum elastic bougie should be readily available and that anaesthetists should use it in preference to a stylet whenever a good view of the glottis is not immediately available Abstract Lumbar puncture was performed on 100 neurological patients by one investigator , using one needle size . 50 patients were kept ambulant and the other 50 , who were comparable in age , sex , and neuroticism , were given 24 hours ' bed rest . The incidence of post-lumbar-puncture headache did not differ significantly between the two groups A r and omized study of 110 patients undergoing their first diagnostic lumbar puncture  was performed to compare the effect of immediate mobilization with 4 hours bed rest on the incidence of post lumbar puncture headache . There was no difference between the mobile ( n = 54 ) and bed rest ( n = 56 ) groups in the incidence of post lumbar puncture headache ( 32 % versus 31 % , respectively ) . We conclude that bed rest following lumbar puncture may be an unnecessary imposition on the patient , as well as on nursing staff 
    Output:
    
Comment(s ) No papers were found that involved physiotherapy treatment of Bell ’s palsy in the acute setting .
The above paper describes significant differences in the outcomes used for patients with long term facial nerve palsy using electrical stimulation , however this was not a rigorous study .
c CLINICAL BOTTOM LINE There is no evidence to suggest that either exercises or electrical stimulation  is beneficial to patients with acute Bell ’s palsy .
Evidence does exist to justify the use of electrical stimulation in patients with long term Bell ’s palsy , although the study could have been more rigorous .
Clinical Rehabilitation 1987;1:265–71 .
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