***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: Abstract . Aims : To describe the frequency , timing and outcome from gastrostomy in amyotrophic lateral sclerosis/motor neurone disease ( ALS/MND ) . Methods : The Scottish MND Register , a population based disease register ( 1989–1998 ) , with record linkage to the Scottish Morbidity 1 data set of hospital discharges coded for  gastrostomy procedure  was used . Descriptive statistics of patients undergoing gastrostomy were extracted . Survival analysis used Kaplan Meier and Cox proportional hazards methods . Results : For patients diagnosed between 1989–98 , 142 percutaneous endoscopic gastrostomy ( PEG ) insertion episodes were identified in 1226 patients , 130 of which occurred before the censoring date of 31 December 1999.Annually , on average , 5 % of all revalent patients underwent gastrostomy , and this rate appeared to double between 1989–98 . The cumulative incidence of  gastrostomy  was 11%.Mean age at PEG tube insertion was 66.8 years , with a mean disease duration of 24 months . Median survival from PEG tube insertion was 146 days . The 1 month mortality after gastrostomy was 25 % . Gastrostomy did not confer a survival advantage compared with no gastrostomy . Conclusions : We found that gastrostomy feeding tubes are being inserted more frequently in people with ALS/MND . An unexpectedly high early mortality was detected which probably reflects a lack of selection bias compared with previously published data . It is possible that changes in the practice of gastrostomy placement since 1998 result in better outcomes for patients with ALS/MND . Prospect i ve studies are required to assess the risks and benefits of enteral nutrition in ALS/MND Percutaneous endoscopic gastrostomy ( PEG ) provides a reliable route for nutrition and hydration in ALS patients with dysphagia . We performed a retrospective analysis of the CNTF and BDNF data bases to determine the clinical status of ALS patients within 30 days preceding PEG insertion . This analysis revealed an approximately 50 % reduction of function across multiple measures of ALS disease status . A trend to earlier intervention with PEG was apparent upon review of published studies and the CNTF and BDNF studies . By comparing the rate of decline pre- and post-PEG , nutritional supplementation via PEG stabilized the weight loss experienced by patients . Death within 30 days post-PEG was associated with a marked reduction in forced vital capacity ( FVC ) and identified a group of ALS patients in whom PEG should be cautiously performed . These data emphasize the importance of sequential measurement of FVC in managing ALS patients to guide the timing of nutritional intervention with PEG To underst and palliative care choices among people with ALS , it is important to follow a group of recently diagnosed patients and record when patients reach well-defined palliative care milestones . We began following such a cohort prospect ively in 1996 , when 121 ALS patients were enrolled from a tertiary care clinic . These patients are assessed every 4 months to determine their experience with  ameliorative and palliative care .  Domains include  adjuvant therapies ( e.g. speech therapy ) , adaptive aids  ( e.g. wheelchair use , augmentative communication ) , home health care , PEG placement , pulmonary support , health care directives , psychosocial care  ( e.g. participation in support group , pastoral counseling ) , and  hospitalization .  The median follow-up time for the cohort , to date , was 12 months . In the group that entered the cohort within 1 year of their diagnosis ( n=93 ) , 53.8 % have died , 22.6 % have had PEG , 19.4 % have used Bi-PaP , and 4.3 % have had a tracheostomy . Many patients did not take advantage of palliative care options before death ; for example , 36.6 % used hospice , 48 % had signed a power of attorney form , and 18 % had ' do not resuscitate ' orders in their medical charts . Examining time to such endpoints captures important features of patient and family experience with the disease Amyotrophic lateral sclerosis is a rapidly progressive disease of unknown etiology result ing in tetraparalysis , dysarthria , dysphagia , and ultimately death from respiratory insufficiency . In the course of the disease , recurrent episodes of aspiration , pneumonia , dehydration , and malnutrition may necessitate nasoenteral tube placement , an inconvenient and unattractive arrangement in patients with dribbling and impaired swallowing . A percutaneous endoscopic gastrostomy seemed a better , though potentially hazardous , alternative in view of the often severely restricted pulmonary function of these patients . Therefore , we prospect ively investigated the use of percutaneous endoscopic gastrostomy in 68 consecutive patients with amyotrophic lateral sclerosis .  Minimum required pulmonary function was defined as forced vital capacity ( FVC ) of 1 L or more and CO2 gas exchange capability as pCO2 of 45 mm Hg or less . The methodology of insertion was adapted to facilitate the early removal of gastric air . Fifty-five patients ( median FVC , 1.7 L ; pCO2 , 40 mm Hg ) were eligible for the gastrostomy procedure , and 13 patients ( median FVC , 0.8 L ; pCO2 , 47 mm Hg ) were not . Despite the fact that modification of the method of insertion rendered the procedure more difficult , the success rate was 89 % ( 49/55 ) ; it was 96 % ( 49/51 ) when failures related to distorted anatomy were excluded . The procedure-related mortality rate was 1.8 % and the 24-hour in-hospital mortality rate was 3.6 % , mainly related to respiratory insufficiency . The 30-day out-of-hospital mortality rate was 11.5 % . Major complications ( 3.6 % ) consisted of a spontaneously draining cutaneous abscess in 2 cases . Peristomal redness was present in 6 cases , and 5 patients required analgesics for wound pain . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE : To compare characteristics of ALS patients with and without percutaneous endoscopic gastrostomy ( PEG ) .  METHODS : Using the ALS Patient Care Data base , data from patients with and without PEG with ALS Functional Rating Scale‐bulbar subscale ( ALSFRSb ) scores ≤5 were analyzed ; follow‐up data were also collected . RESULTS : PEG use was markedly increased with declining ALSFRSb scores . Demographics did not differ , but ALSFRS composite scores and bulbar and arm subscale scores were lower ( P<0.0001 ) . PEG patients used significantly more assistive devices , multidisciplinary care , home care nurses and aides , had more frequent physician and emergency department visits and hospital admissions ( P<0.0001 ) , and had lower health status based on the mini‐SIP scale ( P=0.0047 ) . PEG use varied greatly between ALS centers . In the follow‐up study , positive impact of PEG  was noted in 79 % of PEG patients but in only 37.5 % of patients who received PEG later , based on a small number of patients . PEG use showed no survival benefit . CONCLUSION : Patients  did not receive PEG until bulbar function was severely reduced and overall ALS had markedly progressed . PEG may have been performed too late to demonstrate survival benefits . Aggressive proactive nutritional management appears essential in patients with ALS . To determine whether PEG provides benefits , it must be performed at earlier stages of the disease and prospect ively studied 
    Output:
    
There are no r and omized controlled trials to indicate whether enteral tube feeding is beneficial compared to continuation of oral feeding for survival .
Evidence for improved nutrition is also incomplete but tentatively favorable .