***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: Pruritus ( itching ) is a common and distressing complaint after injury . The purpose of this study was to investigate self-reported postburn pruritus in a large , multisite cohort study of adult burn survivors . Descriptive statistics , general linear regression , and mixed model repeated measures analyses were employed to test statistical significance . Two cohorts of adult burn survivors were studied . Group 1 participants ( n = 637 ) were injured from 2006 to 2010 and were followed up prospect ively for 2 years from the time of injury .  Prevalence and severity of pruritus were compared across multiple subgroups . Prevalence of pruritus at discharge , 6 , 12 , and 24 months following injury were 93 , 86 , 83 , and 73 % , respectively . Regression results established that % TBSA-burn and % TBSA-grafted were correlated to itch intensity values . Group 2 participants ( n = 336 ) were injured 4 to 10 years before an assessment using the vali date d 5-D Itch Scale . Many patients ( 44.4 % ) reported itching in the area of the burn , graft , or donor site . Within this group , 76 % reported itching for < 6 hours/day , and 52 and 29 % considered itch intensity to be mild or moderate , respectively . This study confirms that the prevalence of burn pruritus is high , initially affecting > 90 % and persisting for > 40 % of long-term burn survivors . New predictors for postburn itch were identified to include younger age , dry skin , and raised/thick scars . Characterization of the impact of postburn pruritus on leisure , vocation , and sleep are quantified for those long-term survivors suffering from postburn pruritus Years after injury , pruritus is a common and severe problem for many burn patients . However , its characteristics and consequences are often only partially described . The authors therefore performed a prospect i ve detailed examination of burn- and individual-related factors and considered those in relation to pruritus severity . Sixty-seven consecutive burn patients were assessed during acute care , and at 3 and 12 months postburn regarding preburn psychiatric disorders , health-related quality of life , post traumatic stress disorder , and personality traits . Postburn pruritus was subsequently assessed 2 to 7 years postburn using the Question naire for Pruritus Assessment . Fifty-one individuals , 76 % of the participants , reported burn pruritus any time after the burn . Thirty-three individuals , 49 % of the participants , reported ongoing pruritus the last 2 months . Information on the characteristics of pruritus was obtained from 32 of these individuals . Most perceived pruritus as bothersome or annoying and as present every day , 16 ( 50 % ) were considered to have severe pruritus , and 11 ( 34 % ) scratched themselves to the point of bleeding . In logistic regressions , this was independently related to TBSA full-thickness burn and health-related quality of life at 3 months , and to TBSA full thickness burn and the personality trait impulsiveness , respectively . About half of the previous burn patients experienced ongoing pruritus on an average of 4.5 years after injury , and half of them had severe pruritus . Scratching oneself to the point of bleeding is linked both to a certain personality and to pruritus . It is suspected that many patients are left without access to the best available treatment Twenty patients with burn injuries were r and omly assigned to a massage therapy or a st and ard treatment control group during the remodeling phase of wound healing . The massage therapy group received a 30-minute massage with cocoa butter to a closed , moderate-sized scar tissue area twice a week for 5 weeks . The massage therapy group reported reduced itching , pain , and anxiety and improved mood immediately after the first and last therapy sessions , and their ratings on these measures improved from the first day to the last day of the study Background We conducted an experimental study to compare the effect of massage using topical agents ( Kelo-cote or Contractubex ) on scar formation by massaging the healed burn wound on the dorsal area of Sprague-Dawley ( SD ) rats . Methods Four areas of second degree contact burn were made on the dorsal area of each of 15 SD rats , using a soldering iron 15 mm in diameter . After gross epithelialization in the defect , 15 SD rats were r and omly divided into four groups : the Kelo-cote group , Contractubex group , Vaseline group , and control group . Rats in three of the groups ( all but the Control group ) were massaged twice per day for 5 minutes each day , while those in the Control group were left unattended . For histologic analysis , we performed a biopsy and evaluated the thickness of scar tissue . Results In the Kelo-cote and Contractubex groups , scar tissue thicknesses showed a significant decrease , compared with the Vaseline and control groups . However , no significant differences were observed between the Kelo-cote and Contractubex groups . In the Vaseline group , scar tissue thicknesses showed a significant decrease , compared with the control groups . Conclusions The findings of this study suggest that massage using a topical agent is helpful in the prevention of scar formation and that massage only with lubricant ( no use of a topical agent ) also has a considerable effect , although not as much as the use of a topical agent . Thus , we recommend massage with a topical agent on the post-burn scar as an effective method for decreasing the scar thickness This study prospect ively examined the incidence and severity of large joint contractures after burn injury and determined predictors of contracture development . Data were collected prospect ively from 1993 to 2002 for consecutive adult burn survivors admitted to a regional burn center . Demographic and medical data were collected on each subject . The primary outcome measures included the presence of contractures , number of contractures per patient , and severity of contractures at each of four joints ( shoulder , elbow , hip , knee ) at time of hospital discharge . Logistic regression analysis was performed to determine predictors of the presence and severity of contractures and a negative binomial regression was performed to determine predictors of the number of contractures . Of the 985 study patients , 381 ( 38.7 % ) developed at least one contracture  at hospital discharge . Among those with at least one contracture , the mean is three contractures per person . The shoulder was the most frequently contracted joint ( 38 % ) , followed by the elbow ( 34 % ) and knee ( 22 % ) . Most contractures were mild ( 60 % ) or moderate ( 32 % ) in severity . Statistically significant predictors of contracture development were length of stay ( P < .005 ) and extent of burn ( P = .033 ) and graft ( P < .005 ) . Predictors of the severity of contracture include graft size ( P < .005 ) , amputation ( P = .034 ) , and inhalation injury ( P = .036 ) . More than one third of the patients with a major burn injury developed a contracture at hospital discharge , which highlights the importance of therapeutic positioning and intensive therapy intervention during acute hospitalization . Furthermore , this challenges the burn care community to find new and better ways of preventing contractures after burn injury PURPOSE Hypertrophic scarring and depression are the principal problems of burn rehabilitation . This study was done to verify the effects of skin rehabilitation massage therapy ( SRMT ) on pruritus , skin status , and depression for Korean burn survivors . METHODS A pretest-posttest design using a nonequivalent control group was applied to examine the effects of SRMT for 3 months in a group of 18 burn survivors . The major dependent variables-including pruritus , objective and subjective scar status , and depression-were measured at the beginning and at the end of the therapy to examine the effects of SRMT . RESULTS Burn survivors receiving SRMT showed reduced pruritus , improved skin status , and depression . The remaining scar also showed improvement in skin pigmentation , pliability , vascularity , and height ( compared to the surrounding skin ) as measured on the Vancouver Scar Scale ( VSS ) . CONCLUSIONS The findings demonstrate that SRMT for burn survivors may improve their scars both objective ly and subjectively , and also reduce pruritus and depression BACKGROUND Psychiatric history has been suggested to have an impact on long-term adjustment in burn survivors . A rigorous , prospect i ve , longitudinal approach was used to study psychiatric history in a population -based burn sample and its impact on symptomatology of depression and posttraumatic stress disorder ( PTSD ) at a 12-month follow-up . METHODS Seventy-three consecutive patients admitted to the Uppsala Burn Unit were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition for psychiatric disorders , of whom 64 were also assessed after 12 months . RESULTS Forty-eight patients ( 66 % ) presented with at least one lifetime psychiatric diagnosis ; major depression ( 41 % ) , alcohol abuse or dependence ( 32 % ) , simple phobia ( 16 % ) , and panic disorder ( 16 % ) were most prevalent . At 12-months postburn , 10 patients ( 16 % ) met criteria for major depression , 6 ( 9 % ) for PTSD , and 11 ( 17 % ) for subsyndromal PTSD . Patients with lifetime anxiety disorder and with lifetime psychiatric comorbidity were more likely to be depressed at 12 months , whereas those with lifetime affective disorder , substance use disorder and psychiatric comorbidity were more likely to have symptoms of PTSD . CONCLUSIONS Two-thirds of burn survivors exhibit a history of lifetime psychiatric disorders . Those with a psychiatric history have a higher risk of postburn psychiatric problems Twenty-eight adult patients with burns were r and omly assigned before debridement to either a massage therapy group or a st and ard treatment control group .  State anxiety and cortisol levels decreased , and behavior ratings of state , activity , vocalizations , and anxiety improved after the massage therapy sessions on the first and last days of treatment . Longer-term effects were also significantly better for the massage therapy group including decreases in depression and anger , and decreased pain on the McGill Pain Question naire , Present Pain Intensity scale , and Visual Analogue Scale . Although the underlying mechanisms are not known , these data suggest that debridement sessions were less painful after the massage therapy sessions due to a reduction in anxiety , and that the clinical course was probably enhanced as the result of a reduction in pain , anger , and depression BACKGROUND A primary focus of hospital treatment following admission for subarachnoid haemorrhage ( SAH ) is a prevention of cerebral artery vasospasm , which may result in ischaemic stroke . Intraventricular catheter ( IVC ) insertion to facilitate cerebral spinal fluid ( CSF ) drainage and intracranial pressure ( ICP ) monitoring may reduce the incidence or severity of vasospasm , but insufficient evidence exists from which clinicians may determine the best practice of CSF management . AIMS The aim of this study was to provide the pilot data to explore the impact of different methods of CSF drainage on outcomes in patients with SAH . METHODS In this non-r and omized observational study , patients diagnosed with SAH who had ICP monitoring in situ were prospect ively enrolled . Group assignment was determined by the method of external ventricular drainage ( EVD ) management prescribed by the attending physician prior to enrollment . RESULTS The 37 subjects were disproportionately divided : open-EVD group ( N = 24 ) and monitor-ICP group ( N = 13 ) . There were no statistically significant differences by group assignment with respect to vasospasm , length of stay ( LOS ) , highest average ICP , total CSF drained and disability upon discharge between groups . CONCLUSIONS Although not significant , our results show that the monitor-ICP group trended towards improved clinical outcomes . These results provide sufficient equipoise to support further research in ICP management in patients with SAH using a r and omized clinical trial . RELEVANCE TO CLINICAL PRACTICE This study provides a solid foundation for the development of a r and omized trial exploring two different methods of ICP monitoring and CSF diversion during the acute phase of care following aneurysm rupture OBJECTIVE To evaluate the effect of burn rehabilitation massage therapy on hypertrophic scar after burn . METHOD One hundred and forty-six burn patients with hypertrophic scar(s ) were r and omly divided into an experimental group and a control group . All patients received st and ard rehabilitation therapy for hypertrophic scars and 76 patients ( massage group ) additionally received burn scar rehabilitation massage therapy .  Both before and after the treatment , we determined the scores of visual analog scale ( VAS ) and itching scale and assessed the scar characteristics of thickness , melanin , erythema , transepidermal water loss ( TEWL ) , sebum , and elasticity by using ultrasonography , Mexameter ( ® ) , Tewameter ( ® ) , Sebumeter ( ® ) , and Cutometer ( ® ) , respectively . RESULTS The scores of both VAS and itching scale decreased significantly in both groups , indicating a significant intragroup difference . With regard to the scar characteristics , the massage group showed a significant decrease after treatment in scar thickness , melanin , erythema , TEWL and a significant intergroup difference . In terms of scar elasticity , a significant intergroup difference was noted in immediate distension and gross skin elasticity , while the massage group significant improvement in skin distensibility , immediate distension , immediate retraction , and delayed distension . CONCLUSION Our results suggest that burn rehabilitation massage therapy is effective in improving pain , pruritus , and scar characteristics in hypertrophic scars after burn RATIONALE AND AI 
    Output:
    
It appears that there is preliminary evidence to suggest that scar massage may be effective to decrease scar height , vascularity , pliability , pain , pruritus and depression in hypertrophic burns scaring .