***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: BACKGROUND Although guidelines advise against massage , it is one of the methods widely regarded and used by nurses to prevent pressure ulcers ( PU ) . OBJECTIVES The purpose of this study was to examine the effectiveness of different variations of massage in preventing pressure ulcers . METHODS A r and omized , double-blind cross-over design , in which patients of nursing homes who are prone to PU underwent two of the three possible interventions ; ' position changes only ' , ' massaging with an indifferent cream ' and ' massaging with a dimethyl sulfoxide ( DMSO ) cream ' . RESULTS The results of three interventions did not differ significantly . DMSO did not fulfil the expectations raised by literature and a previous pilot- study Twenty-nine gay men ( 20 HIV+ , 9 HIV- ) received daily massages for one month . A subset of 11 of the HIV+ subjects served as a within subject control group ( one month with and without massages ) . Major immune findings for the effects of the month of massage included a significant increase in Natural Killer Cell number , Natural Killer Cell Cytotoxicity , soluble CD8 , and the cytotoxic subset of CD8 cells . There were no changes in HIV disease progression markers ( CD4 , CD4/CD8 ratio , Beta-2 microglobulin , neopterin ) . Major neuroendocrine findings , measured via 24 hour urines included a significant decrease in cortisol , and nonsignificant trends toward decrease of catecholamines . There were also significant decreases in anxiety and increases in relaxation which were significantly correlated with increases in NK cell number . Thus , there appears to be an increase in cytotoxic capacity associated with massage . Implication s for HIV+ men as those with other illnesses , particularly cancer , are discussed The purpose of this article was to describe the protocol by which predictive instruments can be tested for validity and to evaluate the usefulness of an instrument for predicting pressure sore risk in an AICU . The Braden Scale for Predicting Pressure Sore Risk was described . Methods for measuring predictive validity and for calculating sensitivity , specificity , and per cent predictive value of positive and negative tests were discussed . Sixty consecutively admitted AICU patients who were pressure sore free were rated for pressure sore risk within 24 to 72 hours after admission . The skin condition of each patient was systematic ally assessed every 2 days . Twenty-four subjects developed pressure sores during the study period . The critical cut-off point at which the patient could be judged to be at risk for pressure sore formation was a  Braden Scale score equal to or less than 16 . The sensitivity and specificity of the scale at this score were 83 to 64 per cent , respectively . The per cent predictive value of a positive and negative test were 61 and 85 per cent , respectively . The  Braden Scale  compared favorably with the Norton Scale  in respect to sensitivity . The specificity , or the tendency of a scale to overpredict , was greater for the Norton than for the Braden Scale . The Norton Scale overpredicted by 64 per cent , whereas the Braden Scale overpredicted by 36 per cent . This difference may be important clinical ly if all patients who were judged to be at risk received additional nursing care or protective devices . A greater number of patients may receive unnecessary and expensive treatments using the Norton Scale The purpose of this study was to determine whether st and ard massage ( 30 seconds ) and extended massage ( 60 seconds ) affected skin temperature of patients who had undergone fractured hip surgery . A convenience sample of 20 patients between 66 and 97 years of age who had fractured hip surgery were r and omly assigned to one of the two treatment groups . Evaluation of the effects of massage were made through measures of daily skin temperatures taken at the sacral site of each patient postoperatively for four days . A repeated measures analysis of variance showed a main effect for day ( F [ 3 , 53 ] = 7.26 , p = .01 ) , location ( F [ 1 , 53 ] = 8.83 , p = .01 ) , and an interaction between group and day ( F [ 3 , 53 ] = 5.83 , p less than .01 ) . Orthogonal contrasts of means showed that skin temperature on day 1 was significantly higher than days 2 , 3 , and 4 ( T = [ J , J ( n-1 ) ] = 4.21 , p less than .001 ) . Subjects who received extended massage had a significant decrease in skin temperature as opposed to those who received st and ard massage 
    Output:
    
It is , therefore , unclear whether massage therapy can prevent pressure ulcers