***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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    Input: BACKGROUND & AIMS A system for screening of nutritional risk is described . It is based on the concept that nutritional support is indicated in patients who are severely ill with increased nutritional requirements , or who are severely undernourished , or who have certain degrees of severity of disease in combination with certain degrees of undernutrition . Degrees of severity of disease and undernutrition were defined as absent , mild , moderate or severe from data sets in a selected number of r and omized controlled trials ( RCTs ) and converted to a numeric score . After completion , the screening system was vali date d against all published RCTs known to us of nutritional support vs spontaneous intake to investigate whether the screening system could distinguish between trials with a positive outcome and trials with no effect on outcome . METHODS The total number of r and omized trials identified was 128 . In each trial , the group of patients was classified with respect to nutritional status and severity of disease , and it was determined whether the effect of nutritional intervention on clinical outcome was positive or absent . RESULTS Among 75 studies of patients classified as being nutritionally at-risk , 43 showed a positive effect of nutritional support on clinical outcome . Among 53 studies of patients not considered to be nutritionally at-risk , 14 showed a positive effect ( P=0.0006 ) . This corresponded to a likelihood ratio ( true positive/false positive ) of 1.7 ( 95 % CI : 2.3 - 1.2 ) . For 71 studies of parenteral nutrition , the likelihood ratio was 1.4 ( 1.9 - 1.0 ) , and for 56 studies of enteral or oral nutrition the likelihood ratio was 2.9 ( 5.9 - 1.4 ) . CONCLUSION The screening system appears to be able to distinguish between trials with a positive effect vs no effect , and it can therefore probably also identify patients who are likely to benefit from nutritional support Abstract Wasting is a major complication of advanced head and neck cancer and the aim of this study was to compare nasogastric tube feeding ( NG ) and percutaneous fluoroscopic gastrostomy ( PFG ) in these patients . The goal of these two methods of nutritional support was to improve or maintain the initial nutritional status during treatment . A total of 90 patients , all stage IV oropharynx or hypopharynx tumor , were review ed from a prospect i ve data bank . All these patients were treated by concomitant chemotherapy and twice-daily continuous radiotherapy with no acceleration .  Fifty patients were managed by PFG , and the rest by NG .  Mechanical failure , duration of feeding , complications , nutritonal evaluation and quality of life were analysed . Mechanical failure occurred in 32 of the 40 NG patients and in seven of the gastrostomy group . In the PFG group , 80 % of patients conserved their nutritional support after the end of the radiotherapy , none patient in the NG group . In the PFG group , two presented a wound infection and six had aspiration pneumonia while in the NG group , 21 had aspiration pneumonia probably due to the NG tube ( gastroesophageal reflux ) . The feeding methods were found to be equally effective at maintaining body weight and body mass index at time 1 ( 3 weeks ) and at time 2 ( 6 weeks ) . Advantages were associated with PFG  cosmesis , mobility and quality of life .  PFG is a safe and effective method of providing enteral nutrition during treatment to patients with advanced head and neck cancer and offers important advantages over NG Malnutrition occurs frequently in patients with cancer of the gastrointestinal ( GI ) or head and neck area and can lead to negative outcomes . The aim of this study is to determine the impact of early and intensive nutrition intervention ( NI ) on body weight , body composition , nutritional status , global quality of life ( QoL ) and physical function compared to usual practice in oncology out patients receiving radiotherapy to the GI or head and neck area . Out patients commencing at least 20 fractions of radiotherapy to the GI or head and neck area were  r  and omised to receive intensive , individualised nutrition counselling by a dietitian using a st and ard protocol and oral supplements if required , or the usual practice of the centre ( general advice and nutrition booklet ) . Outcome parameters were measured at baseline and 4 , 8 and 12 weeks after commencing radiotherapy using valid and reliable tools . A total of 60 patients ( 51 M : 9F ; mean age 61.9±14.0 years ) were r and omised to receive either NI ( n=29 ) or usual care ( UC ) ( n=31 ) . The NI group had statistically smaller deteriorations in weight ( P<0.001 ) , nutritional status ( P=0.020 ) and global QoL ( P=0.009 ) compared with those receiving UC . Clinical ly , but not statistically significant differences in fat-free mass were observed between the groups ( P=0.195 ) . Early and intensive NI appears beneficial in terms of minimising weight loss , deterioration in nutritional status , global QoL and physical function in oncology out patients receiving radiotherapy to the GI or head and neck area . Weight maintenance in this population leads to beneficial outcomes and suggests that this , rather than weight gain , may be a more appropriate aim of NI Background Dysphagia occurs in up to 50 % of patients admitted to hospital with acute strokes with up to 27 % remaining by seven days . Up to 8 % continue to have swallowing problems six months after their stroke with 1.7 % still requiring enteral feeding . Nasogastric tubes ( NGT ) are the most commonly used method for providing enteral nutrition in early stroke , however they are easily and frequently removed leading to inadequate nutrition , early PEG ( Percutaneous Endoscopic Gastrostomy ) insertion or ab and oning of feeding attempts . Looped nasogastric tube feeding may improve the delivery of nutrition to such patients . Methods Three centre , two arm r and omised controlled trial , with 50 participants in each arm comparing loop ( the intervention ) versus conventional nasogastric tube feeding . The primary outcome measure is proportion of intended feed delivered in the first 2 weeks . The study is design ed to show a mean increase of feed delivery of 16 % in the intervention group as compared with the control group , with 90 % power at a 5 % significance level . Secondary outcomes are treatment failures , mean volume of feed received , adverse events , cost-effectiveness , number of chest x-rays , number of nasogastric tubes and tolerability . Trial Registration IS RCT N Number : IS RCT This is a prospect i ve case-control study to assess nutritional supplementation in limiting weight loss and its impact on daily set-up variations and planning target volume ( PTV ) margins in head and neck ( H&N ) radiotherapy ( RT ) . Twenty sequential H&N patients were recruited for this study . Ten patients had a percutaneous endoscopic gastrostomy ( PEG ) tube inserted prior to RT and 10 did not .  PEG use was determined by departmental guidelines for patients considered at high risk for weight loss . Daily 2D electronic portal images were taken for orthogonal verification . Set-up variations were determined for both PEG and non-PEG patients by calculating systematic ( Sigma ) and r and om ( sigma ) errors , and PTV margins were derived . PEG patients lost less weight ( P = 0.04 ) over the course of RT and had a reduction in set-up variation in the superior-inferior ( SI ) and anterior-posterior ( AP ) planes compared to those without . Mean correctional shifts in mm ( range ) for PEG patients were : Right-Left ( RL ) 0.1 ( -1.9 - 2.1 ) , SI -1.7 ( -2.9 - 0.0 ) , AP -0.4 ( -2.0 - 0.8 ) , and for non-PEG patients were : RL -0.2 ( -2.7 - 1.3 ) , SI -1.3 ( -3.1 - 1.0 ) , AP 0.4 ( -1.5 - 2.8 ) . The adapted PTV margins ( mm ) in the RL , SI and AP planes , respectively , for PEG patients were 4.1 , 3.3 and 3.6 , and for non-PEG were 3.9 , 4.9 and 4.8 . Intensive enteral support maintained weight stability in H&N patients considered at risk of weight loss during RT and this was associated with reduced set-up variation OBJECTIVES /HYPOTHESIS Percutaneous endoscopic gastrostomy tube ( PEG ) placement by means of the " pull " method has been reported to result in a significantly higher complication rate when compared with " push " PEG placement . These findings have led to a renewed interest in the push , or Russell introducer , method of PEG placement at the authors ' institution when PEG is required before definitive treatment of advanced head and neck cancer . The authors sought to determine whether the push method of PEG placement is associated with a lower incidence of complications in this patient population . STUDY DESIGN Nonr and omized , retrospective patient analysis . METHODS The medical records of all patients presenting to the Medical College of Georgia ( Augusta , GA ) who received a diagnosis of squamous cell carcinoma of the head and neck between 1999 to 2001 were retrospectively review ed . Patients who required PEG placement as part of their treatment comprised the study population . RESULTS The push PEG technique was used in 29 patients , and the  pull technique was used in 50 patients . There was a statistically significant difference in the complication rate between the two techniques . Patients who underwent placement by means of the pull technique had an overall complication rate of 30 % ( 15 of 50 ) versus a 0 % ( 0 of 29 ) complication rate in patients undergoing the push technique ( P = .0006 , Fisher 's Exact test ) . CONCLUSION The push PEG technique appears to have a significantly lower risk of complications compared with the pull technique in patients with advanced head and neck cancer . The authors recommend considering the use of the push method when PEG placement is required ABSTRACT To compare the efficacy of percutaneous endoscopic gastrostomy ( PEG ) and nasogastric ( NGT ) tube administration of enteral nutrition in head and neck cancer patients undergoing curative treatment , the authors conducted a prospect i ve study to compare nutritional outcomes , complications , and patient satisfaction .  PEG patients sustained significantly less reduction in nutritional parameters , measured at 6 weeks post insertion , as compared with NGT patients . There was also a statistically significant difference between the two groups in patient 's quality of life scores and complications . Comparison could not be done at 6 months because all patients were converted to PEG feeding due to the earlier findings . The authors conclude that PEG is more efficacious than NGT as a channel for nutrition in advanced head and neck cancer patients over a short duration The aim of this prospect i ve two year study was to compare the outcome of two methods of nutritional support , namely nasogastric [ NG ] and percutaneous endoscopic gastrostomy [ PEG ] feeding implemented for head and neck cancer patients unable to maintain their nutritional status whilst receiving radiotherapy treatment at a regional oncology unit . The nutritional requirements of the 100 patients included in the study were calculated and an enteral feeding regime implemented to ensure the nutritional requirements of each individual patient were met . Any changes in the weight and body mass index [ BMI ] of each patient during the study period were documented . The method of delivery , composition of feed and duration of nutritional support of each feeding method were determined . The feeding methods were found to be equally effective at maintaining body weight . Patients with NG tubes in situ were more frequently prescribed a st and ard 1 kcal/ml feed administered via an enteral feeding pump , whereas patients with PEG tubes in situ were more frequently prescribed a high energy 1.5 Kcal/ ml feed administered by the bolus method . A number of advantages are associated with PEG feeding including greater mobility , cosmesis and quality of life . Evidence indicates the outcome of radiotherapy treatment is not as favourable if interrupted , therefore , it is essential PEG tubes are sited prior to commencing treatment , illustrating the necessity for dietetic intervention for every patient to be addressed and incorporated into the treatment plan on diagnosis of head and neck cancer before definitive management commences BACKGROUND Percutaneous endoscopic gastrostomy ( PEG ) tubes have largely replaced nasogastric tubes ( NGTs ) for nutritional support of patients with head and neck cancer undergoing curative ( chemo ) radiotherapy without any good scientific basis . METHODS A prospect i ve study was conducted to compare PEG tubes and NGTs in terms of nutritional outcomes , complications , patient satisfaction , and cost . RESULTS There were 32 PEG and 73 NGT patients .  PEG patients sustained significantly less weight loss at 6 weeks post-treatment ( median 0.8 kg gain vs 3.7 kg loss , p < .001 ) , but had a high insertion site infection rate ( 41 % ) , longer median duration of use ( 146 vs 57 days , p < .001 ) , and more grade 3 dysphagia in disease-free survivors at 6 months ( 25 % vs 8 % , p = .07 ) . Patient self-assessed general physical condition and overall quality of life scores were similar in both groups . Overall costs were significantly higher for PEG patients . CONCLUSION PEG tube use should be selective , not routine , in this patient population BACKGROUND AND STUDY AIMS Infection of the gastrostomy opening after placement of a  percutaneous endoscopic gastrostomy ( PEG ) catheter  has been reported to occur quite often , especially when the pull method is used . We therefore compared complications occurring with the pull and push methods , and evaluated the role of antibiotic prophylaxis . PATIENTS AND METHODS In a prospect i ve study , 100 consecutive patients 
    Output:
    
It became apparent from our studies that both feeding strategies have advantages and disadvantages