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 and objectives : Postoperative confusion and delirium is a common complication in the elderly with a poorly understood pathophysiology . The aim of this study was to examine whether the type of anaesthesia ( general or regional ) plays a role in the development of cognitive impairment in elderly patients during the immediate postoperative period . Methods : Forty‐seven patients > 60 yr of age and undergoing major surgery were r and omly allocated to receive either regional or general anaesthesia .  The mental status of the patients was assessed preoperatively and during the first three postoperative days with the Mini Mental State Examination . The incidence of delirium was also examined during the same period with the use of DSM III criteria . Results : Overall , during the first three postoperative days , the mean Mini Mental State Examination score decreased significantly ( P < 0.001 ) . However , this decline was very significant only in patients assigned to receive general anaesthesia ( P < 0.001 ) compared to regional anaesthesia . Nine patients developed delirium but the type of anaesthesia did not affect its incidence . The only important factor for the development of delirium was pre‐existing cardiovascular disease irrespective of anaesthesia type ( P < 0.025 ) . Conclusions : Elderly patients subjected to general anaesthesia  displayed more frequent cognitive impairment during the immediate postoperative period in comparison to those who received a regional technique Background : There is no single generally accepted clinical definition of frailty . Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians . We aim ed to develop a tool that would be both predictive and easy to use . Methods : We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging ( CSHA ) . We followed this cohort prospect ively ; after 5 years , we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care , and correlated the results with those obtained from other established tools . Results : The CSHA Clinical Frailty Scale was highly correlated ( r = 0.80 ) with the Frailty Index . Each 1-category increment of our scale significantly increased the medium-term risks of death ( 21.2 % within about 70 mo , 95 % confidence interval [ CI ] 12.5%–30.6 % ) and entry into an institution ( 23.9 % , 95 % CI 8.8%–41.2 % ) in multivariable models that adjusted for age , sex and education . Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition , function or comorbidity in assessing risk for death ( area under the curve 0.77 for 18-month and 0.70 for 70-month mortality ) . Interpretation : Frailty is a valid and clinical ly important construct that is recognizable by physicians . Clinical judgments about frailty can yield useful predictive information BACKGROUND Preoperative risk assessment is important yet inexact in older patients because physiologic reserves are difficult to measure . Frailty is thought to estimate physiologic reserves , although its use has not been evaluated in surgical patients . We design ed a study to determine if frailty predicts surgical complications and enhances current perioperative risk models . STUDY DESIGN We prospect ively measured frailty in 594 patients ( age 65 years or older ) presenting to a university hospital for elective surgery between July 2005 and July 2006 . Frailty was classified using a vali date d scale ( 0 to 5 ) that included weakness , weight loss , exhaustion , low physical activity , and slowed walking speed . Patients scoring 4 to 5 were classified as frail , 2 to 3 were intermediately frail , and 0 to 1 were nonfrail . Main outcomes measures were 30-day surgical complications , length of stay , and discharge disposition . Multiple logistic regression ( complications and discharge ) and negative binomial regression ( length of stay ) were done to analyze frailty and postoperative outcomes associations . RESULTS Preoperative frailty was associated with an increased risk for postoperative complications ( intermediately frail : odds ratio [ OR ] 2.06 ; 95 % CI 1.18 - 3.60 ; frail : OR 2.54 ; 95 % CI 1.12 - 5.77 ) , length of stay ( intermediately frail : incidence rate ratio 1.49 ; 95 % CI 1.24 - 1.80 ; frail : incidence rate ratio 1.69 ; 95 % CI 1.28 - 2.23 ) , and discharge to a skilled or assisted-living facility after previously living at home ( intermediately frail : OR 3.16 ; 95 % CI 1.0 - 9.99 ; frail : OR 20.48 ; 95 % CI 5.54 - 75.68 ) . Frailty improved predictive power ( p < 0.01 ) of each risk index ( ie , American Society of Anesthesiologists , Lee , and Eagle scores ) . CONCLUSIONS Frailty independently predicts postoperative complications , length of stay , and discharge to a skilled or assisted-living facility in older surgical patients and enhances conventional risk models . Assessing frailty using a st and ardized definition can help patients and physicians make more informed decisions BACKGROUND Elders undergo approximately 40 % of more than 1 million major abdominal operations annually . Yet evidence about recovery to preoperative levels of functional independence is limited . This study details course and predictors of functional recovery after  elective major abdominal operations in the elderly . STUDY DESIGN This was a prospect i ve cohort of 372 consecutive patients , 60 years old or more , enrolled from surgeons in private practice and two university-affiliated hospitals , assessed preoperatively and postoperatively at 1 , 3 , and 6 weeks , 3 and 6 months , using self-report and performance-based measures ( Activities of Daily Living [ ADL ] , Instrumental Activities of Daily Living [ IADL ] , Medical Outcomes Study Short Form-36 Physical Component and Mental Component Scales [ PCS , MCS ] , Geriatric Depression Scale [ GDS ] , Folstein Mini-Mental State Exam [ MMSE ] , timed walk , functional reach , h and grip strength ) . RESULTS Mean age was 69 + /- 6 years with 56 % men , 47 % nonHispanic Caucasian , and 42 % Mexican American ; hospital distribution was 49 % private , 51 % university-affiliated . Maximum functional declines ( 95 % CI ) occurred 1 week postoperatively : ADL , 2.8 points ( 2.4 to 3.2 ) ; IADL , 7.6 points ( 7 to 8.3 ) ; SF-36 PCS , 6.5 points ( 5.4 to 7.6 ) ; Mini-Mental State Exam , 0.5 points ( 0.2 to 0.7 ) ; timed walk , 6.8 seconds ( 5.2 to 8.4 ) ; functional reach , 1.7 inches ( 1.2 to 2.2 ) ; grip strength , 2 kilograms ( 1.3 to 2.7 ) ( p < 0.001 for all ) . SF-36 mental component scale and Geriatric Depression Scale scores did not worsen . Mean recovery times were : Mini-Mental State Exam , 3 weeks ; timed walk , 6 weeks ; ADL , SF-36 PCS , and functional reach , 3 months ; and IADL , 6 months . Mean grip strength did not return to preoperative status by 6 months . The incidence of persistent disability at 6 months , compared with preoperative status , was : ADL , 9 % ; IADL , 19 % ; PCS , 16 % ; mental component scale , 17 % ; timed walk , 39 % ; functional reach , 58 % ; and grip strength , 52 % . Potentially modifiable independent predictors of ADL and IADL recovery were preoperative physical conditioning and depression plus serious postoperative complications . CONCLUSIONS The clinical course of functional recovery varied across different measures . Protracted disability at 6 months after operation was substantial . Several potentially modifiable factors consistently predicted recovery Objective To determine the predictive value of the “ Timed Up & Go ” ( TUG ) , a vali date d assessment tool , on a prospect i ve cohort study and to compare these findings to the ASA classification , an instrument commonly used for quantifying patients ’ physical status and anesthetic risk . Background In the onco-geriatric surgical population it is important to identify patients at increased risk of adverse post-operative outcome to minimize the risk of over- and under-treatment and improve outcome in this population . Methods 263 patients ≥70 years undergoing elective surgery for solid tumors were prospect ively recruited . Primary endpoint was 30-day morbidity . Pre-operatively TUG was administered and ASA-classification was registered . Data were analyzed using multivariable logistic regression analyses to estimate odds ratios ( OR ) and 95 % confidence intervals ( 95%-CI ) . Absolute risks and area under the receiver operating characteristic curves ( AUC ’s ) were calculated . Results 164 ( 62.4 % ) patients ( median age : 76 ) underwent major surgery . 50 ( 19.5 % ) patients experienced major complications . 50.0 % of patients with high TUG and 24.8 % of patients with ASA≥3 experienced major complications ( absolute risks ) . TUG and ASA were independent predictors of the occurrence of major complications ( TUG : OR 3.43 ; 95%-CI = 1.13–10.36 . ASA1 vs. 2:OR 5.67 ; 95%-CI = 0.86–37.32 . ASA1 vs. 3&4:OR 11.75 ; 95%-CI = 1.62–85.11 ) . AUCTUG was 0.66 ( 95%-CI = 0.57–0.75 , p<0.001 ) and AUCASA was 0.58 ( 95%-CI = 0.49–0.67 , p = 0.09 ) . Conclusions Twice as many onco-geriatric patients at risk of post-operative complications , who might benefit from pre-operative interventions , are identified using TUG than when using ASA Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more This prospect i ve cohort study sought to identify predictors of functional decline in patients aged 65 years or older who underwent major , nonemergent abdominal or thoracic surgery in our tertiary hospital from 2006 to 2008 . We used the  Stanford Health Assessment Question naire – Disability Index ( HAQ-DI ) to evaluate functional decline ; a 0.1 or greater increase was used to indicate a clinical ly significant decline . The preoperative Duke Activity Status Index ( DASI ) and a physical function score ( PFS ) , assessing gait speed , grip strength , balance , and st and ing speed , were evaluated as predictors of decline . We enrolled 215 patients ( 71.2 ± 5.2 years ; 56.7 % female ) ; 204 completed follow-up HAQ assessment s ( 71.1 ± 5.3 years ; 57.8 % female ) . A significant number of patients had functional decline out to 1 year . Postoperative HAQ-DI increases of 0.1 or greater occurred in 45.3 per cent at 1 month , 30.1 per cent at 3 months , and 28.3 per cent at 1 year . Pre-operative DASI and PFS scores were not predictors of functional decline . Male sex at 1 month ( odds ratio [ OR ] , 3.05 ; 95 % confidence interval [ CI ] , 1.41 to 6.85 ) ; American Society of Anesthesiologists class ( OR , 3.41 ; 95 % CI , 1.31 to 8.86 ) , smoking ( OR , 3.15 ; 95 % CI , 1.27 to 7.85 ) , and length of stay ( OR , 1.09 ; 95 % CI , 1.01 to 1.16 ) at 3 months ; and cancer diagnosis at 1 year ( OR , 2.6 ; 95 % CI , 1.14 to 5.96 ) were associated with functional decline OBJECTIVES Delirium is a common complication in elderly patients after cardiac surgery and is associated with adverse outcomes including prolonged hospital stay and increased mortality . Therefore , prevention or early detection of delirium is indicated . Our objective was to identify preoperative and operative characteristics that could predict delirium after cardiac surgery in elderly patients . METHODS We conducted a prospect i ve cohort study in which we analysed 201 patients of 70 years and older who underwent cardiac surgery , for developing a delirium . Patients were assessed daily using the Confusion Assessment Method -Intensive Care Unit . RESULTS Sixty-three patients ( 31 % ) developed a delirium after cardiac surgery . The Mini-Mental State Examination ( MMSE ) score prior to surgery was lower in the delirious patients when compared with the non-delirious patients ( 27 vs. 28 , P = 0.0 
    Output:
    
agent
Conclusion Geriatric syndromes are important prognostic factors for postoperative 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: Background and objectives : Postoperative confusion and delirium is a common complication in the elderly with a poorly understood pathophysiology . The aim of this study was to examine whether the type of anaesthesia ( general or regional ) plays a role in the development of cognitive impairment in elderly patients during the immediate postoperative period . Methods : Forty‐seven patients > 60 yr of age and undergoing major surgery were r and omly allocated to receive either regional or general anaesthesia .  The mental status of the patients was assessed preoperatively and during the first three postoperative days with the Mini Mental State Examination . The incidence of delirium was also examined during the same period with the use of DSM III criteria . Results : Overall , during the first three postoperative days , the mean Mini Mental State Examination score decreased significantly ( P < 0.001 ) . However , this decline was very significant only in patients assigned to receive general anaesthesia ( P < 0.001 ) compared to regional anaesthesia . Nine patients developed delirium but the type of anaesthesia did not affect its incidence . The only important factor for the development of delirium was pre‐existing cardiovascular disease irrespective of anaesthesia type ( P < 0.025 ) . Conclusions : Elderly patients subjected to general anaesthesia  displayed more frequent cognitive impairment during the immediate postoperative period in comparison to those who received a regional technique Background : There is no single generally accepted clinical definition of frailty . Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians . We aim ed to develop a tool that would be both predictive and easy to use . Methods : We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging ( CSHA ) . We followed this cohort prospect ively ; after 5 years , we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care , and correlated the results with those obtained from other established tools . Results : The CSHA Clinical Frailty Scale was highly correlated ( r = 0.80 ) with the Frailty Index . Each 1-category increment of our scale significantly increased the medium-term risks of death ( 21.2 % within about 70 mo , 95 % confidence interval [ CI ] 12.5%–30.6 % ) and entry into an institution ( 23.9 % , 95 % CI 8.8%–41.2 % ) in multivariable models that adjusted for age , sex and education . Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition , function or comorbidity in assessing risk for death ( area under the curve 0.77 for 18-month and 0.70 for 70-month mortality ) . Interpretation : Frailty is a valid and clinical ly important construct that is recognizable by physicians . Clinical judgments about frailty can yield useful predictive information BACKGROUND Preoperative risk assessment is important yet inexact in older patients because physiologic reserves are difficult to measure . Frailty is thought to estimate physiologic reserves , although its use has not been evaluated in surgical patients . We design ed a study to determine if frailty predicts surgical complications and enhances current perioperative risk models . STUDY DESIGN We prospect ively measured frailty in 594 patients ( age 65 years or older ) presenting to a university hospital for elective surgery between July 2005 and July 2006 . Frailty was classified using a vali date d scale ( 0 to 5 ) that included weakness , weight loss , exhaustion , low physical activity , and slowed walking speed . Patients scoring 4 to 5 were classified as frail , 2 to 3 were intermediately frail , and 0 to 1 were nonfrail . Main outcomes measures were 30-day surgical complications , length of stay , and discharge disposition . Multiple logistic regression ( complications and discharge ) and negative binomial regression ( length of stay ) were done to analyze frailty and postoperative outcomes associations . RESULTS Preoperative frailty was associated with an increased risk for postoperative complications ( intermediately frail : odds ratio [ OR ] 2.06 ; 95 % CI 1.18 - 3.60 ; frail : OR 2.54 ; 95 % CI 1.12 - 5.77 ) , length of stay ( intermediately frail : incidence rate ratio 1.49 ; 95 % CI 1.24 - 1.80 ; frail : incidence rate ratio 1.69 ; 95 % CI 1.28 - 2.23 ) , and discharge to a skilled or assisted-living facility after previously living at home ( intermediately frail : OR 3.16 ; 95 % CI 1.0 - 9.99 ; frail : OR 20.48 ; 95 % CI 5.54 - 75.68 ) . Frailty improved predictive power ( p < 0.01 ) of each risk index ( ie , American Society of Anesthesiologists , Lee , and Eagle scores ) . CONCLUSIONS Frailty independently predicts postoperative complications , length of stay , and discharge to a skilled or assisted-living facility in older surgical patients and enhances conventional risk models . Assessing frailty using a st and ardized definition can help patients and physicians make more informed decisions BACKGROUND Elders undergo approximately 40 % of more than 1 million major abdominal operations annually . Yet evidence about recovery to preoperative levels of functional independence is limited . This study details course and predictors of functional recovery after  elective major abdominal operations in the elderly . STUDY DESIGN This was a prospect i ve cohort of 372 consecutive patients , 60 years old or more , enrolled from surgeons in private practice and two university-affiliated hospitals , assessed preoperatively and postoperatively at 1 , 3 , and 6 weeks , 3 and 6 months , using self-report and performance-based measures ( Activities of Daily Living [ ADL ] , Instrumental Activities of Daily Living [ IADL ] , Medical Outcomes Study Short Form-36 Physical Component and Mental Component Scales [ PCS , MCS ] , Geriatric Depression Scale [ GDS ] , Folstein Mini-Mental State Exam [ MMSE ] , timed walk , functional reach , h and grip strength ) . RESULTS Mean age was 69 + /- 6 years with 56 % men , 47 % nonHispanic Caucasian , and 42 % Mexican American ; hospital distribution was 49 % private , 51 % university-affiliated . Maximum functional declines ( 95 % CI ) occurred 1 week postoperatively : ADL , 2.8 points ( 2.4 to 3.2 ) ; IADL , 7.6 points ( 7 to 8.3 ) ; SF-36 PCS , 6.5 points ( 5.4 to 7.6 ) ; Mini-Mental State Exam , 0.5 points ( 0.2 to 0.7 ) ; timed walk , 6.8 seconds ( 5.2 to 8.4 ) ; functional reach , 1.7 inches ( 1.2 to 2.2 ) ; grip strength , 2 kilograms ( 1.3 to 2.7 ) ( p < 0.001 for all ) . SF-36 mental component scale and Geriatric Depression Scale scores did not worsen . Mean recovery times were : Mini-Mental State Exam , 3 weeks ; timed walk , 6 weeks ; ADL , SF-36 PCS , and functional reach , 3 months ; and IADL , 6 months . Mean grip strength did not return to preoperative status by 6 months . The incidence of persistent disability at 6 months , compared with preoperative status , was : ADL , 9 % ; IADL , 19 % ; PCS , 16 % ; mental component scale , 17 % ; timed walk , 39 % ; functional reach , 58 % ; and grip strength , 52 % . Potentially modifiable independent predictors of ADL and IADL recovery were preoperative physical conditioning and depression plus serious postoperative complications . CONCLUSIONS The clinical course of functional recovery varied across different measures . Protracted disability at 6 months after operation was substantial . Several potentially modifiable factors consistently predicted recovery Objective To determine the predictive value of the “ Timed Up & Go ” ( TUG ) , a vali date d assessment tool , on a prospect i ve cohort study and to compare these findings to the ASA classification , an instrument commonly used for quantifying patients ’ physical status and anesthetic risk . Background In the onco-geriatric surgical population it is important to identify patients at increased risk of adverse post-operative outcome to minimize the risk of over- and under-treatment and improve outcome in this population . Methods 263 patients ≥70 years undergoing elective surgery for solid tumors were prospect ively recruited . Primary endpoint was 30-day morbidity . Pre-operatively TUG was administered and ASA-classification was registered . Data were analyzed using multivariable logistic regression analyses to estimate odds ratios ( OR ) and 95 % confidence intervals ( 95%-CI ) . Absolute risks and area under the receiver operating characteristic curves ( AUC ’s ) were calculated . Results 164 ( 62.4 % ) patients ( median age : 76 ) underwent major surgery . 50 ( 19.5 % ) patients experienced major complications . 50.0 % of patients with high TUG and 24.8 % of patients with ASA≥3 experienced major complications ( absolute risks ) . TUG and ASA were independent predictors of the occurrence of major complications ( TUG : OR 3.43 ; 95%-CI = 1.13–10.36 . ASA1 vs. 2:OR 5.67 ; 95%-CI = 0.86–37.32 . ASA1 vs. 3&4:OR 11.75 ; 95%-CI = 1.62–85.11 ) . AUCTUG was 0.66 ( 95%-CI = 0.57–0.75 , p<0.001 ) and AUCASA was 0.58 ( 95%-CI = 0.49–0.67 , p = 0.09 ) . Conclusions Twice as many onco-geriatric patients at risk of post-operative complications , who might benefit from pre-operative interventions , are identified using TUG than when using ASA Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more This prospect i ve cohort study sought to identify predictors of functional decline in patients aged 65 years or older who underwent major , nonemergent abdominal or thoracic surgery in our tertiary hospital from 2006 to 2008 . We used the  Stanford Health Assessment Question naire – Disability Index ( HAQ-DI ) to evaluate functional decline ; a 0.1 or greater increase was used to indicate a clinical ly significant decline . The preoperative Duke Activity Status Index ( DASI ) and a physical function score ( PFS ) , assessing gait speed , grip strength , balance , and st and ing speed , were evaluated as predictors of decline . We enrolled 215 patients ( 71.2 ± 5.2 years ; 56.7 % female ) ; 204 completed follow-up HAQ assessment s ( 71.1 ± 5.3 years ; 57.8 % female ) . A significant number of patients had functional decline out to 1 year . Postoperative HAQ-DI increases of 0.1 or greater occurred in 45.3 per cent at 1 month , 30.1 per cent at 3 months , and 28.3 per cent at 1 year . Pre-operative DASI and PFS scores were not predictors of functional decline . Male sex at 1 month ( odds ratio [ OR ] , 3.05 ; 95 % confidence interval [ CI ] , 1.41 to 6.85 ) ; American Society of Anesthesiologists class ( OR , 3.41 ; 95 % CI , 1.31 to 8.86 ) , smoking ( OR , 3.15 ; 95 % CI , 1.27 to 7.85 ) , and length of stay ( OR , 1.09 ; 95 % CI , 1.01 to 1.16 ) at 3 months ; and cancer diagnosis at 1 year ( OR , 2.6 ; 95 % CI , 1.14 to 5.96 ) were associated with functional decline OBJECTIVES Delirium is a common complication in elderly patients after cardiac surgery and is associated with adverse outcomes including prolonged hospital stay and increased mortality . Therefore , prevention or early detection of delirium is indicated . Our objective was to identify preoperative and operative characteristics that could predict delirium after cardiac surgery in elderly patients . METHODS We conducted a prospect i ve cohort study in which we analysed 201 patients of 70 years and older who underwent cardiac surgery , for developing a delirium . Patients were assessed daily using the Confusion Assessment Method -Intensive Care Unit . RESULTS Sixty-three patients ( 31 % ) developed a delirium after cardiac surgery . The Mini-Mental State Examination ( MMSE ) score prior to surgery was lower in the delirious patients when compared with the non-delirious patients ( 27 vs. 28 , P = 0.0 
    Output:
    