***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: STUDY OBJECTIVES To evaluate whether the capillary refill test can correctly differentiate between hypovolemic and euvolemic emergency department patients . DESIGN A prospect i ve , nonr and omized , nonblinded time series . SETTING The orthostatic and hypotensive patients were seen in a university hospital ED with 44,000 visits per year . Blood donors were studied in the hospital 's blood donor center . TYPE OF PARTICIPANTS Thirty-two adult ED patients who presented with a history suggestive of hypovolemia and either abnormal orthostatic vital signs ( 19 ) or frank hypotension ( 13 ) , and 47 volunteer blood donors who ranged in age from 19 to 83 participated . INTERVENTIONS  Capillary refill was measured before rehydration in the ED subjects and , in the donor group , before and after a 450-mL blood donation . MEASUREMENTS Sensitivity , specificity , accuracy , and positive and negative predictive values were calculated . Analyses were stratified by age , sex , and study group . MAIN RESULTS For the blood donor group , mean capillary refill time before donation was 1.4 seconds and after donation was 1.1 seconds . Mean capillary refill time for the orthostatic group was 1.9 seconds and for the hypotensive group was 2.8 seconds . When scored with age-sex specific upper limits of normal , the sensitivity of capillary refill in identifying hypovolemic patients was 6 % for the 450-mL blood loss group , 26 % for the orthostatic group , and 46 % for the hypotensive group . The accuracy of capillary refill in a patient with a 50 % prior probability of hypovolemia is 64 % . Orthostatic vital signs were found to be more sensitive and specific than capillary refill in detecting the 450-mL blood loss . CONCLUSION Capillary refill does not appear to be a useful test for detecting mild-to-moderate hypovolemia in adults Background : The research -to- practice gap is at the heart of the problem in the underuse of nondrug complementary methods to manage postoperative pain . Purpose : To show how the six steps of the Collaborative Research Utilization ( CRU ) model can be used to translate research into practice , using an example of nondrug pain management protocol s. Methods : The CRU model was used to translate empirically tested nondrug interventions for surgical pain management enhancement into cost-effective , easy-to-use , best- practice nursing interventions , using tailored patient teaching . Results : The preliminary findings of the sub study in the context of the CRU model are reported . Discussion : The CRU model was successful in changing patients ' knowledge , attitudes , and use of nondrug interventions for pain management . Further research is needed in heterogeneous population s. Organization receptivity to research and a well-integrated computerized documentation system for cueing clinicians ' pain management practice s are key for effectiveness of change It is not uncommon for a decade to pass between the time a research problem is identified and the time that research -based solutions are translated into st and ards for care . This quasi-experimental study demonstrated the effectiveness of a collaborative research utilization model directed towards the transfer of specific research -based knowledge ( pain assessment ) into practice for the purpose of helping to solve pain management problems . At the same time , nurses who participated in the model significantly improved their competency in research utilization and their attitudes towards research when compared to a control group who did not participate in the model Objective Peripheral perfusion in critically ill patients frequently is assessed by use of clinical signs . Recently , the pulse oximetry signal has been suggested to reflect changes in peripheral perfusion . A peripheral perfusion index based on analysis of the pulse oximetry signal has been implemented in monitoring systems as an index of peripheral perfusion . No data on the variation of this index in the normal population are available , and clinical application of this variable in critically ill patients has not been reported . We therefore studied the variation of the peripheral perfusion index in healthy adults and related it to the central -to-toe temperature difference and capillary refill time in critically ill patients after changes in clinical signs of peripheral perfusion . Design Prospect i ve study . Setting University-affiliated teaching hospital . Patients One hundred eight healthy adult volunteers and 37 adult critically ill patients . Interventions None . Measurements and Main Results Capillary refill time , peripheral perfusion index , and arterial oxygen saturation were measured in healthy adults ( group 1 ) . Capillary refill time , peripheral perfusion index , arterial oxygen saturation , central -to-toe temperature difference , and hemodynamic variables were measured in critically ill patients ( group 2 ) during different peripheral perfusion profiles . Poor peripheral perfusion was defined as a capillary refill time > 2 secs and central -to-toe temperature difference ≥7 ° C . Peripheral perfusion index and arterial oxygen saturation were measured by using the Philips Medical Systems Viridia/56S monitor . In group 1 , measurements were made before and after a meal . In group 2 , two measurements were made , with the second measurement taken when the peripheral perfusion profile had changed . A total of 216 measurements were carried out in group 1 . The distribution of the peripheral perfusion index was skewed and values ranged from 0.3 to 10.0 , median 1.4 ( inner quartile range , 0.7–3.0 ) . Seventy-four measurements were carried out in group 2 . A significant correlation between the peripheral perfusion index and the core-to-toe temperature difference was found ( R2= .52;p < .001 ) . A cutoff peripheral perfusion index value of 1.4 ( calculated by constructing a receiver operating characteristic curve ) best reflected the presence of poor peripheral perfusion in critically ill patients . Changes in peripheral perfusion index and changes in core-to-toe temperature difference correlated significantly ( R = .52 , p < .001 ) . Conclusions The peripheral perfusion index distribution in the normal population is highly skewed . Changes in the peripheral perfusion index reflect changes in the core-to-toe temperature difference . Therefore , peripheral perfusion index measurements can be used to monitor peripheral perfusion in critically ill patients The influence of gender , local temperature , and systemic blood pressure on human capillary pressure is unknown . Finger nail fold capillary pressure was therefore directly measured in 74 healthy supine volunteers ( 40 female ) at midaxillary level .  Capillary pressure was lower in women than in men ( 15.9 + /- 3.0 vs. 18.2 + /- 2.3 mmHg ; P = 0.001 ) , particularly in premenopausal women , but was not related to systolic , diastolic , or mean blood pressure . Capillary pulse pressure amplitude was related to skin temperature , an effect more marked in women ( P = 0.003 ) . There was a significant association between skin temperature and the time taken for the systolic pressure rise to reach the capillary , in women only ( r = -0.69 , P < 0.001 ) . Increasing age reduced the high-frequency waves in the pressure waveform [ 2nd harmonic percentage of fundamental : r = -0.52 and P = 0.002 ( women ) , r = -0.52 and P = 0.004 ( men ) ] . Thus mean capillary pressure and the pressure waveform may be influenced by gender , age , and skin temperature , illustrating the necessity to adequately match control groups during assessment s of capillary pressure pathophysiology 
    Output:
    
AND RECOMMENDATIONS Isolated performance of capillary refill assessment is of limited value and no nursing interventions rely solely on this measure .
Future research should be directed toward evaluation and comparative analyses of alternate methods of evaluating peripheral perfusion