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: Introduction The aim of this prospect i ve study was to analyze the impact of different surgical techniques on patients undergoing intestinal surgery for Crohn ’s disease ( CD ) in terms of recovery , quality of life , and direct and indirect costs . Patients and methods Forty-seven consecutive patients admitted for intestinal surgery for CD were enrolled in this prospect i ve study . Surgical procedures were evaluated as possible predictors of outcome in terms of disability status ( Barthel ’s Index ) , quality of life ( Clevel and Global Quality of Life score ) , body image , disease activity ( Harvey – Bradshaw Activity Index ) , and costs ( calculated in 2008 Euros ) . Univariate and multivariate analyses were performed . Results Significant predictors of a long postoperative hospital stay were the creation of a stoma , postoperative complications , disability status on the third post-operative day , and surgical access ( R2 = 0.59 , p < 0.01 ) . Barthel ’s index at discharge was independently predicted by laparoscopic-assisted approach , ileal CD , and colonic CD ( R2 = 0.53 , p < 0.01 ) . The disability status at admission showed to be an independent predictor of quality of life score at follow-up . The overall cost for intestinal surgery  for CD was 12,037 ( 10,117–15,795 ) euro per patient and stoma creation revealed to be its only predictor ( p = 0.006 ) . Conclusions Laparoscopy was associated with a shorter postoperative length of stay ; stoma creation was associated with a long and expensive postoperative hospital stay , and stricturoplasty was associated with a slower recovery of bowel function BACKGROUND Despite more than three decades of research on iatrogenesis , surgical adverse events have not been subjected to detailed study to identify their characteristics . This information could be invaluable , however , for guiding quality assurance and research efforts aim ed at reducing the occurrence of surgical adverse events . Thus we conducted a retrospective chart review of 15,000 r and omly selected admissions to Colorado and Utah hospitals during 1992 to identify and analyze these events . METHODS We selected a representative sample of hospitals from Utah and Colorado and then r and omly sample d 15,000 nonpsychiatric discharges from 1992 . With use of a 2-stage record- review process modeled on previous adverse event studies , we estimated the incidence , morbidity , and preventability of surgical adverse events that caused death , disability at the time of discharge , or prolonged hospital stay . We characterized their distribution by type of injury and by physician specialty and determined incidence rates by procedure . RESULTS Adverse events were no more likely in surgical care than in nonsurgical care . Nonetheless , 66 % of all adverse events were surgical , and the annual incidence among hospitalized patients who underwent an operation or child delivery was 3.0 % ( confidence interval 2.7 % to 3.4 % ) . Among surgical adverse events 54 % ( confidence interval 48.9 % to 58.9 % ) were preventable . We identified 12 common operations with significantly elevated adverse event incidence rates that ranged from 4.4 % for hysterectomy ( confidence interval 2.9 % to 6.8 % ) to 18.9 % for abdominal aortic aneurysm repair ( confidence interval 8.3 % to 37.5 % ) . Eight operations also carried a significantly higher risk of a preventable adverse event : lower extremity bypass graft ( 11.0 % ) , abdominal aortic aneurysm repair ( 8.1 % ) , colon resection ( 5.9 % ) , coronary artery bypass graft/cardiac valve surgery ( 4.7 % ) , transurethral  resection of the prostate or of a bladder tumor ( 3.9 % ) , cholecystectomy ( 3.0 % ) , hysterectomy ( 2.8 % ) , and appendectomy ( 1.5 % ) . Among all surgical adverse events , 5.6 % ( confidence interval 3.7 % to 8.3 % ) result ed in death , accounting for 12.2 % ( confidence interval 6.9 % to 21.4 % ) of all hospital deaths in Utah and Colorado . Technique-related complications , wound infections , and postoperative bleeding produced nearly half of all surgical adverse events . CONCLUSION These findings provide direction for research to identify the causes of surgical adverse events and for targeted quality improvement efforts The main purpose of the present study was to investigate the association between perceived stress and impaired cutaneous wound healing  in humans using a novel wound assessment technique , and taking into account putative mediating factors such as cortisol levels , health behaviours , and personality factors . The study made use of a prospect i ve , within-subjects design in which 24 male non-smokers participated . Every subject received a st and ard 4mm-punch biopsy , and the healing progress was monitored via high-resolution ultrasound scanning . Participants completed question naires on perceived stress , health behaviours , and personality factors , and sample d saliva for  cortisol assessment after awakening at 2 weeks prior , directly after , and 2 weeks after the biopsy . The overall results showed a significant negative correlation between speed of wound healing , and both Perceived Stress scale ( PSS ) scores ( r=-.59 ; p<.01 ) , and General Health Question naire ( GHQ ) scores ( r=-.59 ; p<.01 ) at the time of the biopsy . The area under the morning cortisol response curve was negatively correlated with speed of wound healing ( r=-.55 ; p<.05 ) , indicating a clear elevation in the morning cortisol slope of those whose wounds were slowest to heal . A median split of the complete sample yielded that the ' slow healing ' group showed higher stress levels ( PSS t=3.93 , p<.01 , GHQ t=2.50 , p<.05 ) , lower trait optimism ( t=3.25 , p<.05 ) , and higher cortisol levels to awakening ( F=5.60 , p<.05 ) compared with the ' fast healing ' group . None of the health behaviours investigated ( i.e. alcohol consumption , exercise , healthy eating , and sleep ) were correlated with healing speed at any time point . Our data hint at a considerable influence of stress on wound healing , and suggests that elevated cortisol levels , rather than altered health behaviours , play a role in this effect Background The project aim ed at testing the feasibility of a quality improvement system based on patient-reported outcomes in short-stay surgery for cholecystectomy . Methods In two centers for short-stay surgery , patients referred for laparoscopic cholecystectomy were surveyed between Aug 1999 and Jan 2002 . Patients reported on health-related quality of life ( SF-36 ) , symptoms ( gallstone symptom checklist , GSCL ) and other indicators preoperatively ( T0 ) , 14 days ( T1 ) and 6 months postoperatively ( T2 ) . The SF-36 subscales physical functioning , bodily pain , and role physical as well as the GSCL and treatment satisfaction at T2 were considered as main outcomes . The main outcomes were analyzed by generalized linear models with regard to predictors . Results At T0 a total of 205 patients were included . The response rate at T2 was 63.4 % ( 74.6 % females , 53.6 years of age ) . The GSCL score at T0 ( 29.4 % preoperatively ) fell slightly to 27.9 % at T1 and decreased to 14.8 % at T2 ( T0–T2 : p < 0.001 ) . The SF-36 subscales showed a different course over time ( decrease of health-related quality of life at T1 and large increase at T2 ) . The level of satisfaction with the outcome of cholecystectomy was 82.3 % . The patient-reported outcomes were mainly influenced by the preoperative level , age and self-reported postoperative complaints . Conclusion The low response rate was mainly due to nondelivery of question naires at T1 during the regular postoperative visit by the operating physician . Though nonresponse occurs under conditions of routine care , meaningful information was gained , which should be used for quality improvement activities . Because the preoperative level is a major determinant of the postoperative health outcomes , the prospect i ve pre – post measurement should be preferred if institutional comparisons are intended We investigated the impact of perioperative complications on patients ' health-related quality of life ( HRQL ) and intermediate-term survival after cardiac surgery . Improved results for cardiac surgery are well demonstrated in low rates of operative mortality and morbidity . However , the association between perioperative morbid events , HRQL at 1 year , and survival is unclear . We performed a prospect i ve study among 836 elective cardiac surgery patients to assess the impact of perioperative outcomes on survival and HRQL at 1 year . Health-related quality of life  was generated using the 20-item short-form question naire . Kaplan-Meier and life-table estimates were used to examine the relationship of HRQL at 1-year and intermediate-term survival . All HRQL domains were statistically improved at 1 year , with the highest gains in general health perception ( + 19.4 % ) and the least gains in social ( + 5.1 % ) and mental ( + 5.1 % ) domains . Patients experiencing 1 or more perioperative complication or increased length of stay reported similar HRQL scores as patients with no complications . Patients with negative changes in social ( 94.5 % vs 99.2 % , P < .001 ) and general health perception ( 99.4 % vs 95.5 % , P < .001 ) domains showed a reduced survival compared with patients with positive HRQL gains at 2 to 5 years after surgery . Perioperative complications had minimal or no effect on HRQL at 1 year after cardiac surgery Aim To evaluate the effects of Lichtenstein tension-free inguinal hernioplasty on sexual function and generic quality of life , testicular volume , and perfusion . Patients and methods In a prospect i ve study , testicular volume , testicular perfusion , sexual function , generic quality of life , chronic inguinal pain , and groin sepsis were investigated before and 3 and 9 months after  surgical hernia repair .  Results Forty male patients completed this study . No differences in testicular volume or in peak systolic velocity were observed between the hernia and healthy sides of the body ( P > 0.05 ) . Preoperatively , there was a significantly higher end diastolic velocity ( P < 0.04 ) and resistive index ( P < 0.001 ) on the hernia side compared with the normal side ; these elevations returned to normal postoperatively . Three months postoperative , the studied sexual function domains , except orgasm domain , and total sexual score presented significant improvement ( Ps < 0.05 and 0.001 respectively ) . By the end of the study , the mean total sexual score and the number of patients with enhanced total score had showed further clinical progress . The total generic quality -of-life score , general health perception and physical function , vitality , and social domains were statistically recovered at 3 months postoperative ( P < 0.05 ) , with further improvement in total score at 9 months . Two patients developed superficial groin sepsis , and seven ( 17.5 % ) experienced chronic inguinal pain . Conclusion Inguinal hernia impaired testicular perfusion that improved postoperatively . Lichtenstein tension-free hernioplasty improved sexual function and generic quality of life without adverse mesh effects on testicular volume or perfusion Few prospect i ve longitudinal studies have used a vali date d  quality of life ( QOL ) instrument in patients undergoing liver resection for hepatobiliary malignancy OBJECTIVE Perioperative myocardial infa rct ion ( PMI ) is a well-described complication of coronary artery bypass grafting ( CABG ) . Data on its effect on patients ' subsequent health-related quality of life ( QOL ) and on other related consequences is deficient . The aim here was to evaluate in a prospect i ve follow-up design the risk factors for and consequences of PMI and especially its possible impact on health-related QOL . METHODS Comprehensive data , including preoperative risk profile , perioperative variables and postoperative morbidity up to discharge were collected of 501 CABG patients in the Heart Center of Tampere University Hospital and in all eighteen postoperative care hospitals . Eighty patients ( 16 % ) fulfilled ECG or cardiac enzyme criteria for PMI and they were compared to patients with no PMI . The  R AND -36 Health Survey ( R AND -36 ) was used as an indicator of QOL . The primary outcomes were change in physical component summary ( PCS ) , mental component summary ( MCS ) and the eight dimensions of health-related QOL from the R AND -36 . Symptomatic status was estimated according to New York Heart Association ( NYHA ) class . Assessment s were made preoperatively and repeated 12 months later . RESULTS Multivariate logistic regression analysis identified long cardiopulmonary bypass time ( P=0.006 ) and high age ( P=0.049 ) as independent predictors for PMI . Thirty-day mortality was adversely affected by PMI ( 6.3 vs 1.0 % , P=0.001 ) . In discharged patients , the occurrence of PMI did not affect 1-year survival adversely ( 98.7 vs 98.6 % ) . The PMI patients showed significant ( P<0.05 ) improvements in six of the eight dimensions of R AND -36 , but they presented with a negative change in their ' general health ' scores at the follow-up . All QOL scores improved significantly ( P<0.001 ) among the patients without PMI . A highly significant ( P<0.001 ) pattern of change was seen in the 
    Output:
    
agent
Two-thirds of the studies found that patients who suffered surgical complications had significantly worse postoperative psychosocial outcomes even after controlling for preoperative psychosocial outcomes , clinical and demographic factors .
Surgical complications appear to be a significant and often long-term predictor of patient postoperative psychosocial outcomes .
The results highlight the importance of attending to patients ' psychological needs in the aftermath of surgical complications
***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: Introduction The aim of this prospect i ve study was to analyze the impact of different surgical techniques on patients undergoing intestinal surgery for Crohn ’s disease ( CD ) in terms of recovery , quality of life , and direct and indirect costs . Patients and methods Forty-seven consecutive patients admitted for intestinal surgery for CD were enrolled in this prospect i ve study . Surgical procedures were evaluated as possible predictors of outcome in terms of disability status ( Barthel ’s Index ) , quality of life ( Clevel and Global Quality of Life score ) , body image , disease activity ( Harvey – Bradshaw Activity Index ) , and costs ( calculated in 2008 Euros ) . Univariate and multivariate analyses were performed . Results Significant predictors of a long postoperative hospital stay were the creation of a stoma , postoperative complications , disability status on the third post-operative day , and surgical access ( R2 = 0.59 , p < 0.01 ) . Barthel ’s index at discharge was independently predicted by laparoscopic-assisted approach , ileal CD , and colonic CD ( R2 = 0.53 , p < 0.01 ) . The disability status at admission showed to be an independent predictor of quality of life score at follow-up . The overall cost for intestinal surgery  for CD was 12,037 ( 10,117–15,795 ) euro per patient and stoma creation revealed to be its only predictor ( p = 0.006 ) . Conclusions Laparoscopy was associated with a shorter postoperative length of stay ; stoma creation was associated with a long and expensive postoperative hospital stay , and stricturoplasty was associated with a slower recovery of bowel function BACKGROUND Despite more than three decades of research on iatrogenesis , surgical adverse events have not been subjected to detailed study to identify their characteristics . This information could be invaluable , however , for guiding quality assurance and research efforts aim ed at reducing the occurrence of surgical adverse events . Thus we conducted a retrospective chart review of 15,000 r and omly selected admissions to Colorado and Utah hospitals during 1992 to identify and analyze these events . METHODS We selected a representative sample of hospitals from Utah and Colorado and then r and omly sample d 15,000 nonpsychiatric discharges from 1992 . With use of a 2-stage record- review process modeled on previous adverse event studies , we estimated the incidence , morbidity , and preventability of surgical adverse events that caused death , disability at the time of discharge , or prolonged hospital stay . We characterized their distribution by type of injury and by physician specialty and determined incidence rates by procedure . RESULTS Adverse events were no more likely in surgical care than in nonsurgical care . Nonetheless , 66 % of all adverse events were surgical , and the annual incidence among hospitalized patients who underwent an operation or child delivery was 3.0 % ( confidence interval 2.7 % to 3.4 % ) . Among surgical adverse events 54 % ( confidence interval 48.9 % to 58.9 % ) were preventable . We identified 12 common operations with significantly elevated adverse event incidence rates that ranged from 4.4 % for hysterectomy ( confidence interval 2.9 % to 6.8 % ) to 18.9 % for abdominal aortic aneurysm repair ( confidence interval 8.3 % to 37.5 % ) . Eight operations also carried a significantly higher risk of a preventable adverse event : lower extremity bypass graft ( 11.0 % ) , abdominal aortic aneurysm repair ( 8.1 % ) , colon resection ( 5.9 % ) , coronary artery bypass graft/cardiac valve surgery ( 4.7 % ) , transurethral  resection of the prostate or of a bladder tumor ( 3.9 % ) , cholecystectomy ( 3.0 % ) , hysterectomy ( 2.8 % ) , and appendectomy ( 1.5 % ) . Among all surgical adverse events , 5.6 % ( confidence interval 3.7 % to 8.3 % ) result ed in death , accounting for 12.2 % ( confidence interval 6.9 % to 21.4 % ) of all hospital deaths in Utah and Colorado . Technique-related complications , wound infections , and postoperative bleeding produced nearly half of all surgical adverse events . CONCLUSION These findings provide direction for research to identify the causes of surgical adverse events and for targeted quality improvement efforts The main purpose of the present study was to investigate the association between perceived stress and impaired cutaneous wound healing  in humans using a novel wound assessment technique , and taking into account putative mediating factors such as cortisol levels , health behaviours , and personality factors . The study made use of a prospect i ve , within-subjects design in which 24 male non-smokers participated . Every subject received a st and ard 4mm-punch biopsy , and the healing progress was monitored via high-resolution ultrasound scanning . Participants completed question naires on perceived stress , health behaviours , and personality factors , and sample d saliva for  cortisol assessment after awakening at 2 weeks prior , directly after , and 2 weeks after the biopsy . The overall results showed a significant negative correlation between speed of wound healing , and both Perceived Stress scale ( PSS ) scores ( r=-.59 ; p<.01 ) , and General Health Question naire ( GHQ ) scores ( r=-.59 ; p<.01 ) at the time of the biopsy . The area under the morning cortisol response curve was negatively correlated with speed of wound healing ( r=-.55 ; p<.05 ) , indicating a clear elevation in the morning cortisol slope of those whose wounds were slowest to heal . A median split of the complete sample yielded that the ' slow healing ' group showed higher stress levels ( PSS t=3.93 , p<.01 , GHQ t=2.50 , p<.05 ) , lower trait optimism ( t=3.25 , p<.05 ) , and higher cortisol levels to awakening ( F=5.60 , p<.05 ) compared with the ' fast healing ' group . None of the health behaviours investigated ( i.e. alcohol consumption , exercise , healthy eating , and sleep ) were correlated with healing speed at any time point . Our data hint at a considerable influence of stress on wound healing , and suggests that elevated cortisol levels , rather than altered health behaviours , play a role in this effect Background The project aim ed at testing the feasibility of a quality improvement system based on patient-reported outcomes in short-stay surgery for cholecystectomy . Methods In two centers for short-stay surgery , patients referred for laparoscopic cholecystectomy were surveyed between Aug 1999 and Jan 2002 . Patients reported on health-related quality of life ( SF-36 ) , symptoms ( gallstone symptom checklist , GSCL ) and other indicators preoperatively ( T0 ) , 14 days ( T1 ) and 6 months postoperatively ( T2 ) . The SF-36 subscales physical functioning , bodily pain , and role physical as well as the GSCL and treatment satisfaction at T2 were considered as main outcomes . The main outcomes were analyzed by generalized linear models with regard to predictors . Results At T0 a total of 205 patients were included . The response rate at T2 was 63.4 % ( 74.6 % females , 53.6 years of age ) . The GSCL score at T0 ( 29.4 % preoperatively ) fell slightly to 27.9 % at T1 and decreased to 14.8 % at T2 ( T0–T2 : p < 0.001 ) . The SF-36 subscales showed a different course over time ( decrease of health-related quality of life at T1 and large increase at T2 ) . The level of satisfaction with the outcome of cholecystectomy was 82.3 % . The patient-reported outcomes were mainly influenced by the preoperative level , age and self-reported postoperative complaints . Conclusion The low response rate was mainly due to nondelivery of question naires at T1 during the regular postoperative visit by the operating physician . Though nonresponse occurs under conditions of routine care , meaningful information was gained , which should be used for quality improvement activities . Because the preoperative level is a major determinant of the postoperative health outcomes , the prospect i ve pre – post measurement should be preferred if institutional comparisons are intended We investigated the impact of perioperative complications on patients ' health-related quality of life ( HRQL ) and intermediate-term survival after cardiac surgery . Improved results for cardiac surgery are well demonstrated in low rates of operative mortality and morbidity . However , the association between perioperative morbid events , HRQL at 1 year , and survival is unclear . We performed a prospect i ve study among 836 elective cardiac surgery patients to assess the impact of perioperative outcomes on survival and HRQL at 1 year . Health-related quality of life  was generated using the 20-item short-form question naire . Kaplan-Meier and life-table estimates were used to examine the relationship of HRQL at 1-year and intermediate-term survival . All HRQL domains were statistically improved at 1 year , with the highest gains in general health perception ( + 19.4 % ) and the least gains in social ( + 5.1 % ) and mental ( + 5.1 % ) domains . Patients experiencing 1 or more perioperative complication or increased length of stay reported similar HRQL scores as patients with no complications . Patients with negative changes in social ( 94.5 % vs 99.2 % , P < .001 ) and general health perception ( 99.4 % vs 95.5 % , P < .001 ) domains showed a reduced survival compared with patients with positive HRQL gains at 2 to 5 years after surgery . Perioperative complications had minimal or no effect on HRQL at 1 year after cardiac surgery Aim To evaluate the effects of Lichtenstein tension-free inguinal hernioplasty on sexual function and generic quality of life , testicular volume , and perfusion . Patients and methods In a prospect i ve study , testicular volume , testicular perfusion , sexual function , generic quality of life , chronic inguinal pain , and groin sepsis were investigated before and 3 and 9 months after  surgical hernia repair .  Results Forty male patients completed this study . No differences in testicular volume or in peak systolic velocity were observed between the hernia and healthy sides of the body ( P > 0.05 ) . Preoperatively , there was a significantly higher end diastolic velocity ( P < 0.04 ) and resistive index ( P < 0.001 ) on the hernia side compared with the normal side ; these elevations returned to normal postoperatively . Three months postoperative , the studied sexual function domains , except orgasm domain , and total sexual score presented significant improvement ( Ps < 0.05 and 0.001 respectively ) . By the end of the study , the mean total sexual score and the number of patients with enhanced total score had showed further clinical progress . The total generic quality -of-life score , general health perception and physical function , vitality , and social domains were statistically recovered at 3 months postoperative ( P < 0.05 ) , with further improvement in total score at 9 months . Two patients developed superficial groin sepsis , and seven ( 17.5 % ) experienced chronic inguinal pain . Conclusion Inguinal hernia impaired testicular perfusion that improved postoperatively . Lichtenstein tension-free hernioplasty improved sexual function and generic quality of life without adverse mesh effects on testicular volume or perfusion Few prospect i ve longitudinal studies have used a vali date d  quality of life ( QOL ) instrument in patients undergoing liver resection for hepatobiliary malignancy OBJECTIVE Perioperative myocardial infa rct ion ( PMI ) is a well-described complication of coronary artery bypass grafting ( CABG ) . Data on its effect on patients ' subsequent health-related quality of life ( QOL ) and on other related consequences is deficient . The aim here was to evaluate in a prospect i ve follow-up design the risk factors for and consequences of PMI and especially its possible impact on health-related QOL . METHODS Comprehensive data , including preoperative risk profile , perioperative variables and postoperative morbidity up to discharge were collected of 501 CABG patients in the Heart Center of Tampere University Hospital and in all eighteen postoperative care hospitals . Eighty patients ( 16 % ) fulfilled ECG or cardiac enzyme criteria for PMI and they were compared to patients with no PMI . The  R AND -36 Health Survey ( R AND -36 ) was used as an indicator of QOL . The primary outcomes were change in physical component summary ( PCS ) , mental component summary ( MCS ) and the eight dimensions of health-related QOL from the R AND -36 . Symptomatic status was estimated according to New York Heart Association ( NYHA ) class . Assessment s were made preoperatively and repeated 12 months later . RESULTS Multivariate logistic regression analysis identified long cardiopulmonary bypass time ( P=0.006 ) and high age ( P=0.049 ) as independent predictors for PMI . Thirty-day mortality was adversely affected by PMI ( 6.3 vs 1.0 % , P=0.001 ) . In discharged patients , the occurrence of PMI did not affect 1-year survival adversely ( 98.7 vs 98.6 % ) . The PMI patients showed significant ( P<0.05 ) improvements in six of the eight dimensions of R AND -36 , but they presented with a negative change in their ' general health ' scores at the follow-up . All QOL scores improved significantly ( P<0.001 ) among the patients without PMI . A highly significant ( P<0.001 ) pattern of change was seen in the 
    Output:
    