***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: Cumulative exposure to socioeconomic disadvantage across the life course may be inversely associated with coronary heart disease ( CHD ) ; the mechanisms are not fully clear . An objective of this study was to determine whether cumulative life-course socioeconomic position ( SEP ) is associated with CHD incidence in a well-characterized US cohort that had directly assessed childhood and adulthood measures of SEP and prospect ively measured CHD incidence . Furthermore , analyses aim ed to evaluate whether adjustment for CHD risk factors reduces the association between cumulative life-course SEP and CHD . The authors examined 1,835 subjects who participated in the Framingham Heart Study Offspring Cohort from 1971 through 2003 ( mean age , 35.0 years ; 52.4 % women ) .  Childhood SEP  was measured as father 's education ; adulthood SEP  was assessed as own education and occupation .  CHD incidence included myocardial infa rct ion , coronary insufficiency , and coronary death . Cox proportional hazards analyses indicated that cumulative SEP was associated with incident CHD after adjustment for age and sex ( hazard ratio = 1.82 , 95 % confidence interval : 1.17 , 2.85 for low vs. high cumulative SEP score ) . Adjustment for CHD risk factors reduced that magnitude of association ( hazard ratio = 1.29 , 95 % confidence interval : 0.78 , 2.13 ) . These findings underscore the potential importance of CHD prevention and treatment efforts for those whose background s include low SEP throughout life Background : The optimal length of bed rest after femoral coronary angiography is still unknown . Short immobilisation could cause puncture site complications due to the modern antiplatelet therapy used , while long immobilisation time increases the risk of back pain for the patient . Purpose : To assess the safety , as well as perceived comfort , of early mobilisation after coronary angiography with femoral approach . Methods : A r and omised , single centre pilot trial with 104 coronary angiography patients ( including 58 patients with non ST-elevation acute coronary syndrome ) assigned to a post-procedural bed rest time for either 1.5 or 5 h.  The primary endpoint was any incidence of vascular complication . Patients ' discomfort was measured as self-perceived grade of pain in the back . Results : The presence of haematomas ≥ 5 cm was 5.8 % in the short immobilisation group vs. 3.8 % in the control group ( ns ) . There was a significantly lower rate of perceived back pain in the short immobilisation group , compared to the controls , at the time of mobilisation , which remained significant also after 2 h of mobilisation . Conclusion : Early ambulation after coronary angiography is safe , without affecting the incidence of vascular complications , and decreases the patients ' pain , both during and after the bed rest Background : Vascular access complications may be a cause of discomfort , prolonged hospital stay , and impaired outcomes in patients undergoing cardiac catheterisation . Aims : To assess vascular access complication in our patients with/without the use of closure devices as a first local benchmark for subsequent quality improvement . Methods : A nurse-led single-centre prospect i ve survey of all vascular access complications in consecutive patients su bmi tted to cardiac catheterisation during 4 months . Results : The radial and femoral access were used in 78 ( 14 % ) and 470 ( 83 % ) , respectively , of 564 procedures , and a closure device was used in 136 of the latter . A haemathoma ( any size ) was isolated and uneventful in 9.6 % of cases . More severe complications ( haemoglobin loss > 2 g , need for blood transfusion or vascular repair ) occurred in 1.2 % of cases , namely : in none of the procedures with radial access , and in 0.4 % and 2.4 % of femoral diagnostic and interventional coronary procedures , respectively . During complicated ( n = 40 ) vs uncomplicated ( n = 172 ) transfemoral interventions , the activated coagulation time was 309 ± 83 vs 271 ± 71 s ( p = 0.004 ) , but the use of closure devices was similar . Conclusion : Severe vascular access complications in our patients were fewer than in most reports , and virtually absent in radial procedures . Vigorous anticoagulation was associated with increased complications in our patients , but closure devices were not . A new policy including both the use of the radial access whenever possible , and a less aggressive anticoagulation regimen during transfemoral interventions will be tested OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity OBJECTIVE To examine the effects of ambulation at 3 versus 6 hours on delayed bleeding , pain , and anxiety in patients after cardiac angiogram . DESIGN Experimental , pretest posttest , r and om assignment . SETTING Western Canadian University-affiliated tertiary care hospital . PATIENTS Thirty-nine patients who underwent cardiac angiograms . OUTCOME MEASURES Delayed bleeding , pain , and anxiety . INTERVENTION The experimental group ambulated at 3 hours after cardiac angiogram ; the control group ambulated at 6 hours .  Delayed bleeding was evaluated by sanguinous drainage through a st and ard gauze pressure dressing and /or the presence of a palpable hematoma greater than 5 cm in width . Melzack 's Present Pain Intensity Scale and Spielberger 's State Anxiety Inventory were used to evaluate patient comfort at 2 , 4 , and 7 hours after angiogram and the next day . RESULTS None of the patients experienced any delayed bleeding . Student 's t test was used to compare pain levels and anxiety scores . In addition , repeated measures analysis of variance was applied to pain scores taken at 4 hours , 7 hours , and the next day . The 2-hour observation data were used as a covariate and a basis for comparison of pain at the next three observations . Patients ambulating early had significantly less pain overall ( p < 0.005 ) and less back pain at 4 and 7 hours after angiogram ( p < 0.05 ) . There was no significant difference in the mean anxiety scores . CONCLUSION The significant decrease in back pain of patients who ambulated earlier demonstrates the need to consider patient comfort as well as the potential risks and sequelae of delayed bleeding INTRODUCTION After coronary angiography to prevent potential complications , patients are restricted to 4 - 24 hours bed rest in the supine position due to the complications . This study was design ed to assess the effect of changing position and early ambulation on low back pain , urinary retention , bleeding and hematoma  after cardiac catheterization . METHODS In this clinical trial , 140 patients by using a convenience sampling r and omly divided into four 35-individual groups . The patients in the control group were in the supine position for 6 hours without a movement . Change position was applied to the second group ( based on a specific protocol ) , early ambulation was applied to the third group and both early ambulation and change position were applied to the fourth group . Then , severity of bleeding , hematoma , back pain and urinary retention were measured at zero , 1 , 2 , 4 , 6 , and 24 hours after angiography . The data was collected through an individual data question naire , Numerical Rating Scale ( NRS ) of pain and Kristin Swain 's check list was applied to evaluate the severity of bleeding and hematoma . RESULTS None of patients developed vascular complications . Incidence of urinary retention was higher in the control group , although this difference was not significant . The mean of pain intensity in the fourth and sixth hours showed a significant difference . CONCLUSION Based on the findings of this study , changing patients ' position can be safe and they can be ambulated early after angiography The general recommended strategy after arterial invasive procedures is a 4- to 6-hour bed rest that is associated with patient discomfort and increased medical costs . We hypothesized that mobilization of selected patients at the second hour would not increase vascular complications .  Coronary angiography was performed through the femoral route via 6-Fr catheters . Homeostasis was achieved by manual compression and maintained with a compressive b and age . A total of 1446 patients were ambulated at the second hour and 1226 of them were discharged without complication . A total of 220 patients required further follow-up due to blood oozing ;  154 patients were conventionally ambulated due to difficult arterial access , longer ( > 15 minutes ) compression time , hematoma formation within 2 hours , or hypertensive state ( blood pressure > 180/100 mm Hg ) . Twenty-five ( 16 % ) of those patients developed minor bleeding after ambulation . No major bleeding or large hematoma was observed during in-hospital observation . Ecchymosis ( 10 % [ 2-hour group ] vs 21 % [ 4—5 hour group ] ) and small hematomas ( 22 % vs 9 % ) were the most frequent complications after discharge . Early mobilization of selected patients undergoing diagnostic heart catheterization through the femoral artery via 6-Fr catheters is safe and associated with acceptable bleeding complication rates AIM This paper is a report of a study to investigate the effect of three positioning protocol s on back pain , heart rate , blood pressure and vascular complications  after cardiac catheterization . BACKGROUND After cardiac catheterization , bed rest is prescribed in order to minimize vascular complications , but this often leads to back pain and other complications , such as hemodynamic instability . METHODS A three-group quasi-experimental design was used in this study , which was conducted in 2006 . A convenience sample of 105 patients was r and omly assigned to either the control or the two experimental groups ( A and B ) . The control group received routine care . Group B was treated only with modified positioning and group A with modified positioning and a pillow under their body .  Back pain , heart rate , arterial blood pressure , haematoma formation and bleeding were measured at regular time intervals . FINDINGS The control group experienced higher levels of pain after 3 , 6 , 8 hours and the morning after catheterization . The level of pain in group B was also higher than in group A at 3 hours after the procedure . Mean heart rate and blood pressure were lower in the experimental groups compared with the control group at 6 and 8 hours after catheterization . No statistically significant difference between the three groups regarding the amounts of overall bleeding and overall haematoma formation was observed . CONCLUSION Changing position in bed and using a supportive pillow during the early hours after cardiac catheterization can effectively minimize pain and hemodynamic instability without increasing vascular complications BACKGROUND Small trials have suggested that radial access for percutaneous coronary intervention ( PCI ) reduces vascular complications and bleeding compared with femoral access . We aim ed to assess whether radial access was superior to femoral access in patients with acute coronary syndromes ( ACS ) who were undergoing coronary angiography with possible intervention . METHODS The RadIal Vs femorAL access for coronary intervention ( RIVAL ) trial was a r and omised , parallel group , multicentre trial . Patients with ACS were r and omly assigned ( 1:1 ) by a 24 h computerised central automated voice response system to radial or femoral artery access . The primary outcome was a composite of death , myocardial infa rct ion , stroke , or non-coronary artery bypass graft (non-CABG)-related major bleeding at 30 days . Key secondary outcomes were death , myocardial infa rct ion , or stroke ; and non-CABG-related major bleeding at 30 days . A masked central committee adjudicated the primary outcome , components of the primary outcome , and stent thrombosis . All other outcomes were as reported by the investigators . Patients and investigators were not masked to treatment allocation . Analyses were by intention to treat . This trial is registered with Clinical Trials.gov 
    Output:
    
The findings of these studies suggest that early ambulation and modified positioning were effective to reduce back pain in patients undergoing coronary angiography .
The use of early ambulation 2 - 4 hours after angiography and changing the patients ' position along with modified positioning cause a reduction in the back pain of the patients