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: Purpose : The purpose of this review is to evaluate the literature related to mobilization of the critically ill patient with an emphasis on functional outcomes and patient safety . Methods : We search ed the electronic data bases of PubMed , CINAHL , Medline ( Ovid ) , and The Cochrane Library for a period spanning 2000‐2011 . Articles used in this review included r and omized and nonr and omized clinical trials , prospect i ve and retrospective analyses , and case series in peer review ed journals . Sackett 's Levels of Evidence were used to classify the current literature to evaluate the strength of the outcomes reported . Results : Fifteen studies met inclusion criteria and were review ed . According to Sackett 's Levels of Evidence , 9 studies were level 4 evidence , one study was level 3 , 4 studies were level 2 , and one study was level one evidence . Ten studies pertained to patient safety/feasibility and 10 studies pertained to functional outcomes with 5 fitting into both categories . Conclusion : A search of the scientific literature revealed a limited number of studies that examined the mobilization of critically ill patients in the intensive care unit . However , literature that does exist supports early mobilization and physical therapy as a safe and effective intervention that can have a significant impact on functional outcomes Introduction The purpose of this trial was to investigate the effectiveness of an exercise rehabilitation program commencing during ICU admission and continuing into the outpatient setting compared with usual care on physical function and health-related quality of life in ICU survivors . Methods We conducted a single-center , assessor-blinded , r and omized controlled trial . One hundred and fifty participants were stratified and r and omized to receive usual care or intervention if they were in the ICU for 5 days or more and had no permanent neurological insult . The intervention group received intensive exercises in the ICU and the ward and as out patients . Participants were assessed at recruitment , ICU admission , hospital discharge and at 3- , 6- and 12-month follow-up . Physical function was evaluated using the Six-Minute Walk Test ( 6MWT ) ( primary outcome ) , the Timed Up and Go Test and the Physical Function in ICU Test . Patient-reported outcomes were measured using the Short Form 36 Health Survey , version 2 ( SF-36v2 ) and Assessment of Quality of Life ( AQoL ) Instrument . Data were analyzed using mixed models . Results The a priori enrollment goal was not reached . There were no between-group differences in demographic and hospital data , including acuity and length of acute hospital stay ( LOS ) ( Acute Physiology and Chronic Health Evaluation II score : 21 vs 19 ; hospital LOS : 20 vs 24 days ) . No significant differences were found for the primary outcome of 6MWT or any other outcomes at 12 months after ICU discharge . However , exploratory analyses showed the rate of change over time and mean between-group differences in 6MWT from first assessment were greater in the intervention group . Conclusions Further research examining the trajectory of improvement with rehabilitation is warranted in this population .Trial registration The trial was registered with the Australian New Zeal and Clinical Trials Registry ACTRN12605000776606 Background The purpose of this study was to identify predictors of 3-month mortality in critically ill older persons under medical care and to assess the clinical impact of an ICU stay on physical and cognitive dependence and subjective health status in survivors . Methods We conducted a prospect i ve observational cohort study including all older persons 75 years and older consecutively admitted into ICU during a one-year period , except those admitted after cardiac arrest , All patients were followed for 3 months or until death . Comorbidities were assessed using the Charlson index and physical dependence was evaluated using the  Katz index of Activity of Daily Living ( ADL ) .  Cognitive dependence was determined by a score based on the individual components of the Lawton index of Daily Living and subjective health status was evaluated using the Nottingham  Health Profile ( NHP ) score . Results One hundred patients were included in the analysis . The mean age was 79.3 ± 3.4 years .  The median Charlson index was 6 [ IQR , 4 to 7 ] and the mean ADL and cognitive scores were 5.4 ± 1.1 and 1.2 ± 1.4 , respectively , corresponding to a population with a high level of comorbidities but low physical and cognitive dependence . Mortality was 61/100 ( 61 % ) at 3 months . In multivariate analysis only comorbidities assessed by the Charlson index [ Adjusted Odds Ratio , 1.6 ; 95 % CI , 1.2 - 2.2 ; p < 0.003 ] and the number of organ failures assessed by the SOFA score [ Adjusted Odds Ratio , 2.5 ; 95 % CI , 1.1 - 5.2 ; p < 0.02 ] were independently associated with 3-month mortality . All 22 patients needing renal support after Day 3 died . Compared with pre-admission , physical ( p = 0.04 ) , and cognitive ( p = 0.62 ) dependence in survivors had changed very little at 3 months . In addition , the mean NHP score was 213.1 ± 132.8 at 3 months , suggesting an acceptable perception of their quality of life . Conclusions In a selected population of non surgical patients 75 years and older , admission into the ICU is associated with a 3-month survival rate of 38 % with little impact on physical and cognitive dependence and subjective health status . Nevertheless , a high comorbidity level ( ie , Charlson index ) , multi-organ failure , and the need for extra-renal support at the early phase of intensive care could be considered as predictors of death Multiple organ failure ( MOF ) is accompanied by muscle wasting , but changes in body composition are frequently obscured by fluid retention ( edema ) , mainly in superficial and visceral tissue . There is a need to assess body composition and changes in body composition in these circumstances independently of edema . A relation was sought between fat-free ( lean tissue ) mass [ calculated from body weight and skinfold thicknesses and measured by using dual-energy X-ray absorptiometry ( DXA ) ] and muscle thickness ( measured using ultrasound at a variety of sites accessible in an unconscious supine subject ) to determine which sites correlated best with lean body mass . The three best sites were midbiceps , midforearm anteriorly , and midthigh anteriorly : R2 for the simple sum of the three sites correlated with fat-free mass from skinfold thicknesses was 71.1 % , and with lean tissue mass from DXA was 76.1 % . Serial measurements of both muscle thickness and midupper-arm circumference in nine patients with MOF showed a complete dissociation ; in all nine there was a significant negative correlation of muscle thickness with time ( P < 0.05 ) but changes in arm circumference were r and om . Only one patient showed a significant negative correlation with time , seven showed no change , and one other showed a significant increase . The muscle thicknesses that correlate best with lean body mass are measured over the biceps , anterior forearm , and anterior thigh . Monitoring muscle thicknesses at these three sites identifies wasting in edematous patients as it is happening The objective of this study was to assess the utility of bioelectrical impedance analysis ( BIA ) in determining nutritional status in critically ill patients in the intensive care unit ( ICU ) . Data were collected prospect ively in 33 mechanically ventilated medical and surgical ICU patients requiring nutrition as part of their care .  BIA , with subsequent calculation of body-composition indexes , was performed every other day for the duration of ICU stay . Body cell mass ( BCM ) changes correlated with energy and protein intakes ( r2 = 0.87 , P < 0.001 and r2 = 0.67 , P < 0.001 , respectively ) . Maintenance of BCM was achieved by a daily provision of 125.5 kJ.kg-1.d-1 ( 30 kcal.kg-1.d-1 ) and 1.5 g protein/kg whereas greater intakes allowed restoration of BCM . The mean ratios of exchangeable sodium to potassium ( Nae : Ke ) improved only in patients achieving positive nitrogen balance ( P = 0.013 ) . Body-composition changes determined by BIA represent a feasible adjunctive method for evaluating and monitoring nutritional status in ICU patients OBJECTIVES To determine whether routine nutrition assessment parameters and body composition change after nutritional support in intensive care unit ( ICU ) patients and whether the changes , if any , are related to cumulative energy and fluid balances . DESIGN A prospect i ve study . SETTING A university teaching hospital . PATIENTS Forty-five mechanically ventilated medical and surgical patients admitted to the ICU who received nutritional support for 7 days ( group 1 ) and 9 patients of this group who received nutritional support for 3 weeks or longer ( group 2 ) . INTERVENTIONS Enteral and parenteral nutritional support prescribed on the basis of metabolic cart measurements of energy expenditure . OUTCOME MEASURES Routine nutrition assessment , including determinations of weight , serum albumin and prealbumin , and lymphocyte count and body composition , including measurements of body cell mass , extracellular fluid and body fat , determined from bioelectric impedance analysis . RESULTS In group 1 patients , weight , albumin and prealbumin levels , and extracellular mass changed , but there was no change in lymphocyte count , body cell mass or body fat . Changes in weight and extracellular mass were slightly related to cumulative fluid balance ; changes in albumin and prealbumin levels were not related to cumulative energy or fluid balance . The findings were similar for group 2 patients . CONCLUSIONS Changes in routine nutrition assessment parameters and body composition are slightly affected by fluid balance but not by energy balance ; thus , they are not specific indicators of the adequacy of nutritional support in ICU patients . Improved nutrition assessment parameters are required to better monitor the response to nutritional support in critically ill patients PURPOSE To study the mortality and outcome of critically ill elderly patients in a developing country with focus on nutritional and socioeconomic status . METHODS A prospect i ve study of 109 patients ( 215 screened ) admitted consecutively to the intensive care unit from 2011 to 2012 .  Demographics , Acute Physiology and Chronic Health Evaluation ( APACHE ) II score , mechanical ventilation , Malnutrition Universal Screening Tool score , socioeconomic category , functional status , delirium , and length of stay were recorded . Telephonic assessment of outcome was done at 1 year . Appropriate statistical tests compared differences between subgroups . Multivariate analysis was performed on significant variables ( P<.1 ) affecting mortality . RESULTS At 12 months after discharge , 46.8 % of patients ( mean age , 76.5±9.6 years ; APACHEII , 22.7±6.4 ; and intensive care unit stay , 7.8±3.4 days ) had died . Risk factors for mortality at 12 months were APACHE II score ( P<.001 ; odds ratio [ OR ] , 1.2 ; 95 % confidence interval [ CI ] , 1.1 - 1.3 ) , severe malnutrition ( P=.006 ; OR , 0.08 ; 95 % CI , 0.01 - 0.48 ) , and delirium ( P=.03 ; OR , 0.32 ; 95 % CI , 0.11 - 0.9 ) . Risk factors for short-term mortality ( at 28 days ) were APACHE II score ( P=.02 ; OR , 1.1 [ 1.0 - 1.2 ] ) and premorbid functional status ( P=.03 ; OR , 0.2 [ 0.1 - 0.8 ] ) . Kaplan-Meier survival analysis showed a significant association with malnutrition ( log-rank test , P=.012 ) but not with socioeconomic category . Most ( 72 % ) of the survivors had a favorable functional status . CONCLUSIONS Malnutrition , delirium , and APACHEII were risk factors for long-term mortality . Survivors had a good functional outcome . Appropriate quality of life tools for this population need to be developed Objective The goal of the paper is to determine inter-rater reliability of trained examiners performing st and ardized strength assessment s using manual muscle testing ( MMT ) .  Design , subjects , and setting The authors report on 19 trainees undergoing quality assurance within a multi-site prospect i ve cohort study .InterventionInter-rater  reliability for specially trained evaluators ( “ trainees ” ) and a reference rater , performing MMT using both simulated and actual patients recovering from critical illness was evaluated . Measurements and results Across 26 muscle groups tested by 19 trainee-reference rater pairs , the median ( interquartile range ) percent agreement and intraclass correlation coefficient ( ICC ; 95 % CI ) were : 96 % ( 91 , 98 % ) and 0.98 ( 0.95 , 1.00 ) , respectively . Across all 19 pairs , the ICC ( 95 % CI ) for the overall composite MMT score was 0.99 ( 0.98–1.00 ) . When limited to actual patients , the ICC was 1.00 ( 95 % CI 0.99–1.00 ) . The agreement ( kappa ; 95 % CI ) in detecting clinical ly significant weakness was 0.88 ( 0.44–1.00 ) . Conclusions MMT has excellent inter-rater reliability in trained examiners and is a reliable method of comprehensively assessing muscle strength OBJECTIVE Patients in intensive care exhibit a high degree of loss of muscle mass . Appropriate instruments are needed to document muscle wasting in these patients . The aim of this pilot study was to describe muscle was 
    Output:
    
agent
Conclusions There is considerable variability in the type of measures utilized to measure physical impairments and limitations in survivors of critical illness .
***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: Purpose : The purpose of this review is to evaluate the literature related to mobilization of the critically ill patient with an emphasis on functional outcomes and patient safety . Methods : We search ed the electronic data bases of PubMed , CINAHL , Medline ( Ovid ) , and The Cochrane Library for a period spanning 2000‐2011 . Articles used in this review included r and omized and nonr and omized clinical trials , prospect i ve and retrospective analyses , and case series in peer review ed journals . Sackett 's Levels of Evidence were used to classify the current literature to evaluate the strength of the outcomes reported . Results : Fifteen studies met inclusion criteria and were review ed . According to Sackett 's Levels of Evidence , 9 studies were level 4 evidence , one study was level 3 , 4 studies were level 2 , and one study was level one evidence . Ten studies pertained to patient safety/feasibility and 10 studies pertained to functional outcomes with 5 fitting into both categories . Conclusion : A search of the scientific literature revealed a limited number of studies that examined the mobilization of critically ill patients in the intensive care unit . However , literature that does exist supports early mobilization and physical therapy as a safe and effective intervention that can have a significant impact on functional outcomes Introduction The purpose of this trial was to investigate the effectiveness of an exercise rehabilitation program commencing during ICU admission and continuing into the outpatient setting compared with usual care on physical function and health-related quality of life in ICU survivors . Methods We conducted a single-center , assessor-blinded , r and omized controlled trial . One hundred and fifty participants were stratified and r and omized to receive usual care or intervention if they were in the ICU for 5 days or more and had no permanent neurological insult . The intervention group received intensive exercises in the ICU and the ward and as out patients . Participants were assessed at recruitment , ICU admission , hospital discharge and at 3- , 6- and 12-month follow-up . Physical function was evaluated using the Six-Minute Walk Test ( 6MWT ) ( primary outcome ) , the Timed Up and Go Test and the Physical Function in ICU Test . Patient-reported outcomes were measured using the Short Form 36 Health Survey , version 2 ( SF-36v2 ) and Assessment of Quality of Life ( AQoL ) Instrument . Data were analyzed using mixed models . Results The a priori enrollment goal was not reached . There were no between-group differences in demographic and hospital data , including acuity and length of acute hospital stay ( LOS ) ( Acute Physiology and Chronic Health Evaluation II score : 21 vs 19 ; hospital LOS : 20 vs 24 days ) . No significant differences were found for the primary outcome of 6MWT or any other outcomes at 12 months after ICU discharge . However , exploratory analyses showed the rate of change over time and mean between-group differences in 6MWT from first assessment were greater in the intervention group . Conclusions Further research examining the trajectory of improvement with rehabilitation is warranted in this population .Trial registration The trial was registered with the Australian New Zeal and Clinical Trials Registry ACTRN12605000776606 Background The purpose of this study was to identify predictors of 3-month mortality in critically ill older persons under medical care and to assess the clinical impact of an ICU stay on physical and cognitive dependence and subjective health status in survivors . Methods We conducted a prospect i ve observational cohort study including all older persons 75 years and older consecutively admitted into ICU during a one-year period , except those admitted after cardiac arrest , All patients were followed for 3 months or until death . Comorbidities were assessed using the Charlson index and physical dependence was evaluated using the  Katz index of Activity of Daily Living ( ADL ) .  Cognitive dependence was determined by a score based on the individual components of the Lawton index of Daily Living and subjective health status was evaluated using the Nottingham  Health Profile ( NHP ) score . Results One hundred patients were included in the analysis . The mean age was 79.3 ± 3.4 years .  The median Charlson index was 6 [ IQR , 4 to 7 ] and the mean ADL and cognitive scores were 5.4 ± 1.1 and 1.2 ± 1.4 , respectively , corresponding to a population with a high level of comorbidities but low physical and cognitive dependence . Mortality was 61/100 ( 61 % ) at 3 months . In multivariate analysis only comorbidities assessed by the Charlson index [ Adjusted Odds Ratio , 1.6 ; 95 % CI , 1.2 - 2.2 ; p < 0.003 ] and the number of organ failures assessed by the SOFA score [ Adjusted Odds Ratio , 2.5 ; 95 % CI , 1.1 - 5.2 ; p < 0.02 ] were independently associated with 3-month mortality . All 22 patients needing renal support after Day 3 died . Compared with pre-admission , physical ( p = 0.04 ) , and cognitive ( p = 0.62 ) dependence in survivors had changed very little at 3 months . In addition , the mean NHP score was 213.1 ± 132.8 at 3 months , suggesting an acceptable perception of their quality of life . Conclusions In a selected population of non surgical patients 75 years and older , admission into the ICU is associated with a 3-month survival rate of 38 % with little impact on physical and cognitive dependence and subjective health status . Nevertheless , a high comorbidity level ( ie , Charlson index ) , multi-organ failure , and the need for extra-renal support at the early phase of intensive care could be considered as predictors of death Multiple organ failure ( MOF ) is accompanied by muscle wasting , but changes in body composition are frequently obscured by fluid retention ( edema ) , mainly in superficial and visceral tissue . There is a need to assess body composition and changes in body composition in these circumstances independently of edema . A relation was sought between fat-free ( lean tissue ) mass [ calculated from body weight and skinfold thicknesses and measured by using dual-energy X-ray absorptiometry ( DXA ) ] and muscle thickness ( measured using ultrasound at a variety of sites accessible in an unconscious supine subject ) to determine which sites correlated best with lean body mass . The three best sites were midbiceps , midforearm anteriorly , and midthigh anteriorly : R2 for the simple sum of the three sites correlated with fat-free mass from skinfold thicknesses was 71.1 % , and with lean tissue mass from DXA was 76.1 % . Serial measurements of both muscle thickness and midupper-arm circumference in nine patients with MOF showed a complete dissociation ; in all nine there was a significant negative correlation of muscle thickness with time ( P < 0.05 ) but changes in arm circumference were r and om . Only one patient showed a significant negative correlation with time , seven showed no change , and one other showed a significant increase . The muscle thicknesses that correlate best with lean body mass are measured over the biceps , anterior forearm , and anterior thigh . Monitoring muscle thicknesses at these three sites identifies wasting in edematous patients as it is happening The objective of this study was to assess the utility of bioelectrical impedance analysis ( BIA ) in determining nutritional status in critically ill patients in the intensive care unit ( ICU ) . Data were collected prospect ively in 33 mechanically ventilated medical and surgical ICU patients requiring nutrition as part of their care .  BIA , with subsequent calculation of body-composition indexes , was performed every other day for the duration of ICU stay . Body cell mass ( BCM ) changes correlated with energy and protein intakes ( r2 = 0.87 , P < 0.001 and r2 = 0.67 , P < 0.001 , respectively ) . Maintenance of BCM was achieved by a daily provision of 125.5 kJ.kg-1.d-1 ( 30 kcal.kg-1.d-1 ) and 1.5 g protein/kg whereas greater intakes allowed restoration of BCM . The mean ratios of exchangeable sodium to potassium ( Nae : Ke ) improved only in patients achieving positive nitrogen balance ( P = 0.013 ) . Body-composition changes determined by BIA represent a feasible adjunctive method for evaluating and monitoring nutritional status in ICU patients OBJECTIVES To determine whether routine nutrition assessment parameters and body composition change after nutritional support in intensive care unit ( ICU ) patients and whether the changes , if any , are related to cumulative energy and fluid balances . DESIGN A prospect i ve study . SETTING A university teaching hospital . PATIENTS Forty-five mechanically ventilated medical and surgical patients admitted to the ICU who received nutritional support for 7 days ( group 1 ) and 9 patients of this group who received nutritional support for 3 weeks or longer ( group 2 ) . INTERVENTIONS Enteral and parenteral nutritional support prescribed on the basis of metabolic cart measurements of energy expenditure . OUTCOME MEASURES Routine nutrition assessment , including determinations of weight , serum albumin and prealbumin , and lymphocyte count and body composition , including measurements of body cell mass , extracellular fluid and body fat , determined from bioelectric impedance analysis . RESULTS In group 1 patients , weight , albumin and prealbumin levels , and extracellular mass changed , but there was no change in lymphocyte count , body cell mass or body fat . Changes in weight and extracellular mass were slightly related to cumulative fluid balance ; changes in albumin and prealbumin levels were not related to cumulative energy or fluid balance . The findings were similar for group 2 patients . CONCLUSIONS Changes in routine nutrition assessment parameters and body composition are slightly affected by fluid balance but not by energy balance ; thus , they are not specific indicators of the adequacy of nutritional support in ICU patients . Improved nutrition assessment parameters are required to better monitor the response to nutritional support in critically ill patients PURPOSE To study the mortality and outcome of critically ill elderly patients in a developing country with focus on nutritional and socioeconomic status . METHODS A prospect i ve study of 109 patients ( 215 screened ) admitted consecutively to the intensive care unit from 2011 to 2012 .  Demographics , Acute Physiology and Chronic Health Evaluation ( APACHE ) II score , mechanical ventilation , Malnutrition Universal Screening Tool score , socioeconomic category , functional status , delirium , and length of stay were recorded . Telephonic assessment of outcome was done at 1 year . Appropriate statistical tests compared differences between subgroups . Multivariate analysis was performed on significant variables ( P<.1 ) affecting mortality . RESULTS At 12 months after discharge , 46.8 % of patients ( mean age , 76.5±9.6 years ; APACHEII , 22.7±6.4 ; and intensive care unit stay , 7.8±3.4 days ) had died . Risk factors for mortality at 12 months were APACHE II score ( P<.001 ; odds ratio [ OR ] , 1.2 ; 95 % confidence interval [ CI ] , 1.1 - 1.3 ) , severe malnutrition ( P=.006 ; OR , 0.08 ; 95 % CI , 0.01 - 0.48 ) , and delirium ( P=.03 ; OR , 0.32 ; 95 % CI , 0.11 - 0.9 ) . Risk factors for short-term mortality ( at 28 days ) were APACHE II score ( P=.02 ; OR , 1.1 [ 1.0 - 1.2 ] ) and premorbid functional status ( P=.03 ; OR , 0.2 [ 0.1 - 0.8 ] ) . Kaplan-Meier survival analysis showed a significant association with malnutrition ( log-rank test , P=.012 ) but not with socioeconomic category . Most ( 72 % ) of the survivors had a favorable functional status . CONCLUSIONS Malnutrition , delirium , and APACHEII were risk factors for long-term mortality . Survivors had a good functional outcome . Appropriate quality of life tools for this population need to be developed Objective The goal of the paper is to determine inter-rater reliability of trained examiners performing st and ardized strength assessment s using manual muscle testing ( MMT ) .  Design , subjects , and setting The authors report on 19 trainees undergoing quality assurance within a multi-site prospect i ve cohort study .InterventionInter-rater  reliability for specially trained evaluators ( “ trainees ” ) and a reference rater , performing MMT using both simulated and actual patients recovering from critical illness was evaluated . Measurements and results Across 26 muscle groups tested by 19 trainee-reference rater pairs , the median ( interquartile range ) percent agreement and intraclass correlation coefficient ( ICC ; 95 % CI ) were : 96 % ( 91 , 98 % ) and 0.98 ( 0.95 , 1.00 ) , respectively . Across all 19 pairs , the ICC ( 95 % CI ) for the overall composite MMT score was 0.99 ( 0.98–1.00 ) . When limited to actual patients , the ICC was 1.00 ( 95 % CI 0.99–1.00 ) . The agreement ( kappa ; 95 % CI ) in detecting clinical ly significant weakness was 0.88 ( 0.44–1.00 ) . Conclusions MMT has excellent inter-rater reliability in trained examiners and is a reliable method of comprehensively assessing muscle strength OBJECTIVE Patients in intensive care exhibit a high degree of loss of muscle mass . Appropriate instruments are needed to document muscle wasting in these patients . The aim of this pilot study was to describe muscle was 
    Output:
    