human
***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 Mild perioperative hypothermia , which is common during major surgery , may promote surgical-wound infection by triggering thermoregulatory vasoconstriction , which decreases subcutaneous oxygen tension . Reduced levels of oxygen in tissue impair oxidative killing by neutrophils and decrease the strength of the healing wound by reducing the deposition of collagen . Hypothermia also directly impairs immune function . We tested the hypothesis that hypothermia both increases susceptibility to surgical-wound infection and lengthens hospitalization . METHODS Two hundred patients undergoing colorectal surgery were r and omly assigned to routine intraoperative thermal care ( the hypothermia group ) or additional warming ( the normothermia group ) . The patient 's anesthetic care was st and ardized , and they were all given cefam and ole and metronidazole . In a double-blind protocol , their wounds were evaluated daily until discharge from the hospital and in the clinic after two weeks ; wounds containing culture-positive pus were considered infected . The patients ' surgeons remained unaware of the patients ' group assignments . RESULTS The mean ( + /- SD ) final intraoperative core temperature was 34.7 + /- 0.6 degrees C in the hypothermia group and 36.6 + /- 0.5 degrees C in the normothermia group ( P < 0.001 ) Surgical-wound infections were found in 18 of 96 patients assigned to hypothermia ( 19 percent ) but in only 6 of 104 patients assigned to normothermia ( 6 percent , P = 0.009 ) . The sutures were removed one day later in the patients assigned to hypothermia than in those assigned to normothermia ( P = 0.002 ) , and the duration of hospitalization was prolonged by 2.6 days ( approximately 20 percent ) in hypothermia group ( P = 0.01 ) . CONCLUSIONS Hypothermia itself may delay healing and predispose patients to wound infections . Maintaining normothermia intraoperatively is likely to decrease the incidence of infectious complications in patients undergoing colorectal resection and to shorten their hospitalizations BACKGROUND  Surgical site infections ( SSIs ) are the most frequent health-care-associated infections in developing countries . Specific prevention measures are highly effective , but are often poorly implemented . We aim ed to establish the effect of a multimodal intervention on SSIs in Africa . METHODS We did a before-after cohort study , between July 1 , 2013 , and Dec 31 , 2015 , at five African hospitals . The multimodal intervention consisted of the implementation or strengthening of multiple SSI prevention measures , combined with an adaptive approach aim ed at the improvement of teamwork and the safety climate . The primary outcome was the first occurrence of SSI , and the secondary outcome was death within 30 days post surgery . Data on adherence to SSI prevention measures were prospect ively collected . The intervention effect on SSI risk and death within 30 days post surgery was assessed in a mixed-effects logistic regression model , after adjustment for key confounders . FINDINGS Four hospitals completed the baseline and follow-up ; three provided suitable ( ie , sufficient number and quality ) data for the sustainability period . 4322 operations were followed up ( 1604 at baseline , 1827 at follow-up , and 891 in the sustainability period )  . SSI cumulative incidence significantly decreased post intervention , from 8·0 % ( 95 % CI 6·8 - 9·5 ; n=129 ) to 3·8 % ( 3·0 - 4·8 ; n=70 ; p<0·0001 ) , and this decrease persisted in the sustainability period ( 3·9 % , 2·8 - 5·4 ; n=35 ) . A substantial improvement in compliance with prevention measures was consistently observed in the follow-up and sustainability periods . The likelihood of SSI during follow-up was significantly lower than pre-intervention ( odds ratio [ OR ] 0·40 , 95 % CI 0·29 - 0·54 ; p<0·0001 ) , but the likelihood of death was not significantly reduced ( 0·72 , 0·42 - 1·24 ; p=0·2360 ) . INTERPRETATION Implementation of our intervention is feasible in African hospitals . Improvement was observed across all perioperative prevention practice s. A significant effect on the overall SSI risk was observed , but with some heterogeneity between sites . Further large-scale experimental studies are needed to confirm these results and to improve the sustainability and long-term effect of such complex programmes . FUNDING US Agency for Healthcare Research and Quality , WHO INTRODUCTION The World Health Organization sets a st and ard to maintain patient core temperature greater than 36 ° C throughout the perioperative period . Normothermia ( defined as > 36 ° C ) in the Operating Room ( OR ) is an important factor to preventing complications in patients ( MI , infection , coagulopathy ) . R and omized studies suggests that maintaining at higher temperatures may further reduce complications in surgery ( less complications for group at 36.4 ° C than the control group at 36.0 ° C ) [ 1,2 ] . Perioperative normothermia is an important but often unrecognized element during anesthesia . Early recognition of hypothermia would allow for appropriate interventions and prevent complications . METHODOLOGY Manual validation of the diagnostic performance a clinical tool ( alert ) that would automatically measure changes in core temperature to identify patients who fail to be in range of normothermia during surgery . RESULTS The clinical tool ( alert ) was found to be 97 % sensitive BACKGROUND Currently , no single U.S. surveillance system can provide estimates of the burden of all types of health care-associated infections across acute care patient population s. We conducted a prevalence survey in 10 geographically diverse states to determine the prevalence of health care-associated infections in acute care hospitals and generate up date d estimates of the national burden of such infections . METHODS We defined health care-associated infections with the use of National Healthcare Safety Network criteria .  One-day surveys of r and omly selected in patients were performed in participating hospitals . Hospital personnel collected demographic and limited clinical data . Trained data collectors review ed medical records retrospectively to identify health care-associated infections active at the time of the survey . Survey data and 2010 Nationwide Inpatient Sample data , stratified according to patient age and length of hospital stay , were used to estimate the total numbers of health care-associated infections and of in patients with such infections in U.S. acute care hospitals in 2011 . RESULTS Surveys were conducted in 183 hospitals . Of 11,282 patients , 452 had 1 or more health care-associated infections  ( 4.0 % ; 95 % confidence interval , 3.7 to 4.4 ) . Of 504 such infections , the most common types were pneumonia ( 21.8 % ) , surgical-site infections ( 21.8 % ) , and gastrointestinal infections ( 17.1 % ) . Clostridium difficile was the most commonly reported pathogen ( causing 12.1 % of health care-associated infections ) . Device-associated infections ( i.e. , central -catheter-associated bloodstream infection , catheter-associated urinary tract infection , and ventilator-associated pneumonia ) , which have traditionally been the focus of programs to prevent health care-associated infections , accounted for 25.6 % of such infections . We estimated that there were 648,000 patients with 721,800 health care-associated infections in U.S. acute care hospitals in 2011 . CONCLUSIONS Results of this multistate prevalence survey of health care-associated infections indicate that public health surveillance and prevention activities should continue to address C. difficile infections . As device- and procedure-associated infections decrease , consideration should be given to exp and ing surveillance and prevention activities to include other health care-associated infections BACKGROUND Inadvertent perioperative hypothermia ( IPH ) occurs in many patients because warming techniques are insufficient to counteract thermal redistribution result ing from the ablation of thermoregulatory vasoconstriction associated with anaesthesia . We tested the efficiency of a preoperative forced-air warming ( FAW ) device ( Bair Paws ) in preventing IPH . METHODS Sixty-eight adult patients undergoing spinal surgery under general anaesthesia were r and omized to receive either normal care or prewarming for 60 min , at 38 degrees C , using the Bair Paws system . All patients received routine FAW intraoperatively . RESULTS Thirty-one patients were prewarmed and 37 patients were in the control group . There was a 0.3 degrees C smaller decrease in mean core temperature in the prewarmed group at 40 , 60 , and 80 min post-induction ( P < or = 0.05 ) . Temperature was maintained above the hypothermic threshold of 36 degrees C in 21 ( 68 % ) patients in the prewarmed group , compared with 16 ( 43 % ) patients in the control group ( P<0.05 ) . CONCLUSIONS Preoperative warming using the Bair Paws system results in smaller decreases in core temperature intraoperatively and less IPH in patients undergoing spinal surgery under general anaesthesia Background General anesthesia may induce inadvertent hypothermia and this may be related to perioperative cardiovascular complications . Microvascular reactivity , measured by the recovery slope during a vascular occlusion test , is decreased during surgery and is also related to postoperative clinical outcomes . We hypothesized that microvascular changes during surgery may be related to intraoperative hypothermia . To evaluate this , we conducted a r and omized study in patients undergoing off-pump coronary artery bypass surgery , in which the effect of prewarming on microvascular reactivity was evaluated . Methods Patients scheduled for off-pump coronary artery bypass surgery were screened . Enrolled patients were r and omized to the prewarming group to receive forced-air warming during induction of anesthesia or to the control group . Measurement of core and skin temperatures and vascular occlusion test were conducted before anesthesia induction , 1 , 2 , and 3 h after induction , and at the end of surgery . Results In total , 40 patients were enrolled and finished the study ( n = 20 in the prewarming group and n = 20 in the control group ) . During the first 3 h of anesthesia , core temperature was higher in the prewarming group than the control group ( p < 0.001 ) . The number of patients developing hypothermia was lower in the prewarming group than the control group ( 4/20 vs. 13/20 , p = 0.004 ) . However , tissue oxygen saturation and changes in recovery slope following a vascular occlusion test at 3 h after anesthesia induction did not differ between the groups . There was no difference in clinical outcome , including perioperative transfusion , wound infection , or hospital stay , between the groups . Conclusions Prewarming during induction of anesthesia decreased intraoperative hypothermia , but did not reduce the deterioration in microvascular reactivity in patients undergoing off-pump coronary artery bypass surgery . Trial Registration Clinical Trials.gov Objective : To analyze the association between perioperative normothermia ( temperature ≥36 ° C ) and  surgical site infections ( SSIs ) after gastrointestinal ( GI ) surgery . Summary of Background Data : Although active warming during colorectal surgery reduces SSIs , there is limited evidence that perioperative normothermia is associated with lower rates of SSI . Nonetheless , hospitals participating in the Surgical Care Improvement Project must report normothermia rates during major surgery . Methods : We conducted a nested , matched , case-control study ; cases consisted of GI surgery patients enrolled in our National Surgical Quality Improvement Program data base between March 2006 and March 2009 who developed SSIs . Patient/surgery risk factors for SSI were obtained from the National Surgical Quality Improvement Program data base . Perioperative temperature/antibiotic/glucose data were obtained from medical records . Cases/controls were compared using univariate/r and om effects/logistic regression models . Independent risk factors for SSIs were identified using multivariate/r and om effects/logistic regression models . Results : A total of 146 cases and 323 matched controls were identified ; 82 % of patients underwent noncolorectal surgery . Cases were more likely to have final intraoperative normothermia compared with controls ( 87.6 % vs. 77.8 % , P = 0.015 ) ; rates of immediate postoperative normothermia were similar ( 70.6 % vs. 65.3 % , respectively , P = 0.19 ) . Emergent surgery/higher wound class were associated with higher rates of intraoperative normothermia . Independent risk factors for SSI were diabetes , surgical complexity , small bowel surgery , and nonlaparoscopic surgery . There was no independent association between perioperative normothermia and SSI ( adjusted odds ratio , 1.05 ; 95 % confidence interval , 0.48–2.33 ; P = 0.90 ) . Conclusions : Pay-for-reporting measures focusing on perioperative normothermia may be of limited value in preventing SSI after GI surgery . Studies to define the benefit of active warming after non 
    Output:
    
agent
The results of this study suggest that preoperative warming can reduce rates of SSI after surgery .
***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 Mild perioperative hypothermia , which is common during major surgery , may promote surgical-wound infection by triggering thermoregulatory vasoconstriction , which decreases subcutaneous oxygen tension . Reduced levels of oxygen in tissue impair oxidative killing by neutrophils and decrease the strength of the healing wound by reducing the deposition of collagen . Hypothermia also directly impairs immune function . We tested the hypothesis that hypothermia both increases susceptibility to surgical-wound infection and lengthens hospitalization . METHODS Two hundred patients undergoing colorectal surgery were r and omly assigned to routine intraoperative thermal care ( the hypothermia group ) or additional warming ( the normothermia group ) . The patient 's anesthetic care was st and ardized , and they were all given cefam and ole and metronidazole . In a double-blind protocol , their wounds were evaluated daily until discharge from the hospital and in the clinic after two weeks ; wounds containing culture-positive pus were considered infected . The patients ' surgeons remained unaware of the patients ' group assignments . RESULTS The mean ( + /- SD ) final intraoperative core temperature was 34.7 + /- 0.6 degrees C in the hypothermia group and 36.6 + /- 0.5 degrees C in the normothermia group ( P < 0.001 ) Surgical-wound infections were found in 18 of 96 patients assigned to hypothermia ( 19 percent ) but in only 6 of 104 patients assigned to normothermia ( 6 percent , P = 0.009 ) . The sutures were removed one day later in the patients assigned to hypothermia than in those assigned to normothermia ( P = 0.002 ) , and the duration of hospitalization was prolonged by 2.6 days ( approximately 20 percent ) in hypothermia group ( P = 0.01 ) . CONCLUSIONS Hypothermia itself may delay healing and predispose patients to wound infections . Maintaining normothermia intraoperatively is likely to decrease the incidence of infectious complications in patients undergoing colorectal resection and to shorten their hospitalizations BACKGROUND  Surgical site infections ( SSIs ) are the most frequent health-care-associated infections in developing countries . Specific prevention measures are highly effective , but are often poorly implemented . We aim ed to establish the effect of a multimodal intervention on SSIs in Africa . METHODS We did a before-after cohort study , between July 1 , 2013 , and Dec 31 , 2015 , at five African hospitals . The multimodal intervention consisted of the implementation or strengthening of multiple SSI prevention measures , combined with an adaptive approach aim ed at the improvement of teamwork and the safety climate . The primary outcome was the first occurrence of SSI , and the secondary outcome was death within 30 days post surgery . Data on adherence to SSI prevention measures were prospect ively collected . The intervention effect on SSI risk and death within 30 days post surgery was assessed in a mixed-effects logistic regression model , after adjustment for key confounders . FINDINGS Four hospitals completed the baseline and follow-up ; three provided suitable ( ie , sufficient number and quality ) data for the sustainability period . 4322 operations were followed up ( 1604 at baseline , 1827 at follow-up , and 891 in the sustainability period )  . SSI cumulative incidence significantly decreased post intervention , from 8·0 % ( 95 % CI 6·8 - 9·5 ; n=129 ) to 3·8 % ( 3·0 - 4·8 ; n=70 ; p<0·0001 ) , and this decrease persisted in the sustainability period ( 3·9 % , 2·8 - 5·4 ; n=35 ) . A substantial improvement in compliance with prevention measures was consistently observed in the follow-up and sustainability periods . The likelihood of SSI during follow-up was significantly lower than pre-intervention ( odds ratio [ OR ] 0·40 , 95 % CI 0·29 - 0·54 ; p<0·0001 ) , but the likelihood of death was not significantly reduced ( 0·72 , 0·42 - 1·24 ; p=0·2360 ) . INTERPRETATION Implementation of our intervention is feasible in African hospitals . Improvement was observed across all perioperative prevention practice s. A significant effect on the overall SSI risk was observed , but with some heterogeneity between sites . Further large-scale experimental studies are needed to confirm these results and to improve the sustainability and long-term effect of such complex programmes . FUNDING US Agency for Healthcare Research and Quality , WHO INTRODUCTION The World Health Organization sets a st and ard to maintain patient core temperature greater than 36 ° C throughout the perioperative period . Normothermia ( defined as > 36 ° C ) in the Operating Room ( OR ) is an important factor to preventing complications in patients ( MI , infection , coagulopathy ) . R and omized studies suggests that maintaining at higher temperatures may further reduce complications in surgery ( less complications for group at 36.4 ° C than the control group at 36.0 ° C ) [ 1,2 ] . Perioperative normothermia is an important but often unrecognized element during anesthesia . Early recognition of hypothermia would allow for appropriate interventions and prevent complications . METHODOLOGY Manual validation of the diagnostic performance a clinical tool ( alert ) that would automatically measure changes in core temperature to identify patients who fail to be in range of normothermia during surgery . RESULTS The clinical tool ( alert ) was found to be 97 % sensitive BACKGROUND Currently , no single U.S. surveillance system can provide estimates of the burden of all types of health care-associated infections across acute care patient population s. We conducted a prevalence survey in 10 geographically diverse states to determine the prevalence of health care-associated infections in acute care hospitals and generate up date d estimates of the national burden of such infections . METHODS We defined health care-associated infections with the use of National Healthcare Safety Network criteria .  One-day surveys of r and omly selected in patients were performed in participating hospitals . Hospital personnel collected demographic and limited clinical data . Trained data collectors review ed medical records retrospectively to identify health care-associated infections active at the time of the survey . Survey data and 2010 Nationwide Inpatient Sample data , stratified according to patient age and length of hospital stay , were used to estimate the total numbers of health care-associated infections and of in patients with such infections in U.S. acute care hospitals in 2011 . RESULTS Surveys were conducted in 183 hospitals . Of 11,282 patients , 452 had 1 or more health care-associated infections  ( 4.0 % ; 95 % confidence interval , 3.7 to 4.4 ) . Of 504 such infections , the most common types were pneumonia ( 21.8 % ) , surgical-site infections ( 21.8 % ) , and gastrointestinal infections ( 17.1 % ) . Clostridium difficile was the most commonly reported pathogen ( causing 12.1 % of health care-associated infections ) . Device-associated infections ( i.e. , central -catheter-associated bloodstream infection , catheter-associated urinary tract infection , and ventilator-associated pneumonia ) , which have traditionally been the focus of programs to prevent health care-associated infections , accounted for 25.6 % of such infections . We estimated that there were 648,000 patients with 721,800 health care-associated infections in U.S. acute care hospitals in 2011 . CONCLUSIONS Results of this multistate prevalence survey of health care-associated infections indicate that public health surveillance and prevention activities should continue to address C. difficile infections . As device- and procedure-associated infections decrease , consideration should be given to exp and ing surveillance and prevention activities to include other health care-associated infections BACKGROUND Inadvertent perioperative hypothermia ( IPH ) occurs in many patients because warming techniques are insufficient to counteract thermal redistribution result ing from the ablation of thermoregulatory vasoconstriction associated with anaesthesia . We tested the efficiency of a preoperative forced-air warming ( FAW ) device ( Bair Paws ) in preventing IPH . METHODS Sixty-eight adult patients undergoing spinal surgery under general anaesthesia were r and omized to receive either normal care or prewarming for 60 min , at 38 degrees C , using the Bair Paws system . All patients received routine FAW intraoperatively . RESULTS Thirty-one patients were prewarmed and 37 patients were in the control group . There was a 0.3 degrees C smaller decrease in mean core temperature in the prewarmed group at 40 , 60 , and 80 min post-induction ( P < or = 0.05 ) . Temperature was maintained above the hypothermic threshold of 36 degrees C in 21 ( 68 % ) patients in the prewarmed group , compared with 16 ( 43 % ) patients in the control group ( P<0.05 ) . CONCLUSIONS Preoperative warming using the Bair Paws system results in smaller decreases in core temperature intraoperatively and less IPH in patients undergoing spinal surgery under general anaesthesia Background General anesthesia may induce inadvertent hypothermia and this may be related to perioperative cardiovascular complications . Microvascular reactivity , measured by the recovery slope during a vascular occlusion test , is decreased during surgery and is also related to postoperative clinical outcomes . We hypothesized that microvascular changes during surgery may be related to intraoperative hypothermia . To evaluate this , we conducted a r and omized study in patients undergoing off-pump coronary artery bypass surgery , in which the effect of prewarming on microvascular reactivity was evaluated . Methods Patients scheduled for off-pump coronary artery bypass surgery were screened . Enrolled patients were r and omized to the prewarming group to receive forced-air warming during induction of anesthesia or to the control group . Measurement of core and skin temperatures and vascular occlusion test were conducted before anesthesia induction , 1 , 2 , and 3 h after induction , and at the end of surgery . Results In total , 40 patients were enrolled and finished the study ( n = 20 in the prewarming group and n = 20 in the control group ) . During the first 3 h of anesthesia , core temperature was higher in the prewarming group than the control group ( p < 0.001 ) . The number of patients developing hypothermia was lower in the prewarming group than the control group ( 4/20 vs. 13/20 , p = 0.004 ) . However , tissue oxygen saturation and changes in recovery slope following a vascular occlusion test at 3 h after anesthesia induction did not differ between the groups . There was no difference in clinical outcome , including perioperative transfusion , wound infection , or hospital stay , between the groups . Conclusions Prewarming during induction of anesthesia decreased intraoperative hypothermia , but did not reduce the deterioration in microvascular reactivity in patients undergoing off-pump coronary artery bypass surgery . Trial Registration Clinical Trials.gov Objective : To analyze the association between perioperative normothermia ( temperature ≥36 ° C ) and  surgical site infections ( SSIs ) after gastrointestinal ( GI ) surgery . Summary of Background Data : Although active warming during colorectal surgery reduces SSIs , there is limited evidence that perioperative normothermia is associated with lower rates of SSI . Nonetheless , hospitals participating in the Surgical Care Improvement Project must report normothermia rates during major surgery . Methods : We conducted a nested , matched , case-control study ; cases consisted of GI surgery patients enrolled in our National Surgical Quality Improvement Program data base between March 2006 and March 2009 who developed SSIs . Patient/surgery risk factors for SSI were obtained from the National Surgical Quality Improvement Program data base . Perioperative temperature/antibiotic/glucose data were obtained from medical records . Cases/controls were compared using univariate/r and om effects/logistic regression models . Independent risk factors for SSIs were identified using multivariate/r and om effects/logistic regression models . Results : A total of 146 cases and 323 matched controls were identified ; 82 % of patients underwent noncolorectal surgery . Cases were more likely to have final intraoperative normothermia compared with controls ( 87.6 % vs. 77.8 % , P = 0.015 ) ; rates of immediate postoperative normothermia were similar ( 70.6 % vs. 65.3 % , respectively , P = 0.19 ) . Emergent surgery/higher wound class were associated with higher rates of intraoperative normothermia . Independent risk factors for SSI were diabetes , surgical complexity , small bowel surgery , and nonlaparoscopic surgery . There was no independent association between perioperative normothermia and SSI ( adjusted odds ratio , 1.05 ; 95 % confidence interval , 0.48–2.33 ; P = 0.90 ) . Conclusions : Pay-for-reporting measures focusing on perioperative normothermia may be of limited value in preventing SSI after GI surgery . Studies to define the benefit of active warming after non 
    Output:
    