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: Objective . This study was design ed to compare the safety and efficacy of tacrolimus ointment 0.03 % with vehicle ointment for the treatment of mild to moderate atopic dermatitis ( AD ) in pediatric patients . Methods . A total of 317 patients ( 2–15 years of age ) with mild to moderate AD were r and omized to receive tacrolimus ointment or vehicle ointment twice daily in a 6-week , multicenter , double-blind study . Efficacy evaluations , including the Investigators ' Global Atopic Dermatitis Assessment , eczema area and severity index , percentage of total body surface area affected , and patient assessment of itch occurred at baseline , day 4 , and weeks 2 , 4 , and 6 . Cutaneous adverse events were recorded to evaluate safety . Results . At the end of study , 50.6 % ( 80 of 158 ) of the patients were treated successfully with tacrolimus ointment based on Investigators ' Global Atopic Dermatitis Assessment scores , a significant improvement compared with patients treated with vehicle ointment ( 25.8 % [ 41 of 159 ] ) . The percent improvement from baseline in eczema area and severity index scores was also significantly greater in tacrolimus-treated patients ( 54.8 % ) compared with vehicle-treated patients ( 20.8 % ) . There was also a significant improvement in the percentage of total body surface area affected of tacrolimus-treated patients ( 50.5 % reduction from baseline ) compared with vehicle-treated patients ( 16.4 % ) . Patient itch scores were significantly lower in tacrolimus-treated patients ( 2.1 ) versus vehicle-treated patients ( 3.7 ) . Overall , the incidence of cutaneous adverse events reported was similar for both treatment groups . There was no significant difference in the incidence of burning or stinging between treatment groups . Significantly fewer tacrolimus-treated patients prematurely discontinued from the study because of a cutaneous adverse event in the treatment area or experienced increased itching and erythema at the application site . Conclusion . Monotherapy with tacrolimus ointment 0.03 % is a safe and effective treatment alternative for pediatric patients with mild to moderate AD Background : In the published studies on the efficacy of the topical immunomodulator pimecrolimus , different eczema scores were used , and the impact on morphological key signs of eczema was not analysed . Objective : To compare the influence of pimecrolimus cream 1 % on different st and ard eczema scores in infants with atopic dermatitis and to analyse the impact of treatment on the individual morphological key signs of eczema . Methods :  Pimecrolimus cream 1 % ( n = 129 ) or double-blind vehicle control ( n = 66 ) was administered for 4 weeks . The Eczema Area and Severity Index ( EASI ) , Investigators ’ Global Assessment ( IGA ) and Scoring Atopic Dermatitis Index ( SCORAD ) were determined and were correlated with each other . Results : Following treatment with pimecrolimus , the EASI , IGA and SCORAD were significantly reduced on day 29 as compared with the vehicle group ( p < 0.001 , p < 0.001 , p = 0.002 , respectively ) . There was a close correlation between EASI , IGA and SCORAD . The single parameters of the EASI were already significantly decreased by day 4 in the pimecrolimus group as compared to vehicle ( each p < 0.001 ) . Conclusion : Treatment with pimecrolimus 1 % cream leads to a rapid improvement of all morphological signs of eczema . The close correlation of different scores was shown for the first time OBJECTIVE To develop a simple , valid , repeatable , and readily underst and able patient-oriented assessment measure for monitoring disease activity in children and adults with atopic eczema . DESIGN Qualitative semistructured patient interviews identified a list of symptoms of atopic eczema . These symptoms were quantitatively analyzed in a larger patient population to identify which symptoms were important to patients and amenable to monitoring as part of a scoring system . SETTING The outpatient Department of Dermatology at the Queen 's Medical Centre , University Hospital , Nottingham , Engl and , and 5 local general practice s. PATIENTS Four hundred thirty-five patients with atopic eczema . RESULTS Seven symptoms were incorporated into the final patient-oriented eczema measure using a simple 5-point scale of frequency of occurrence during the previous week , with a maximum total score of 28 . Validity testing against the Dermatology Life Quality Index , Children 's Dermatology Life Quality Index , and patients ' global severity assessment s showed good correlation ( r = 0.78 , r = 0.73 , and r = 0.81 , respectively ; P<.001 ) . Internal consistency was high ( Cronbach alpha = 0.88 ) , and test-retest reliability was good , with 95 % of scores falling within 2.6 points on repeat testing ( mean score difference , 0.04 ; SD , 1.32 ) . Individual variables in the measure demonstrated sensitivity to change during a 4-week in-clinic period and an 18-week r and omized controlled clinical trial . CONCLUSION The patient-oriented eczema measure is a practical self-assessed measurement tool for monitoring aspects of atopic eczema that are important to patients in routine clinical practice or in the clinical trial setting Aim : To examine the association between childhood atopic dermatitis ( AD ) severity and family impact at baseline and after an intervention by a physician specialist , using vali date d measures of both severity and family impact . Methods : Cross sectional self administered survey of parent – caregivers of 49 r and omly selected children with AD ; 35 parents were available for follow up .  Family impact was measured using a modified AD Family Impact Scale completed by the parent – caregiver . The child ’s disease severity was measured using both the investigator ’s assessment via the Eczema Area and Severity Index ( EASI ) and the caregiver ’s assessment via the recently vali date d Self Assessment Eczema Area and Severity Index ( SA-EASI ) . Results : The parent – caregiver ’s assessment of severity of the child was the most significant correlate of the family impact of the child ’s AD ( p = 0.65 at baseline and p = 0.38 at follow up ) . In multivariate regression models , the parent – caregiver ’s estimate of severity remained the single strongest predictor of family impact before and after receipt of dermatologist care , as well as the difference in impact between pre and post-dermatologist care . Conclusions : There is evidence to support the ability of parent – caregivers of children with AD to accurately determine severity of their child ’s AD ; perceived severity is the driver of the family impact of this condition . Treatment of a child by a physician specialist is associated with reductions in both perceived severity , as well as family impact of this condition The ETAC ( Early Treatment of the Atopic Child ) study , a multi-national double-blind placebo-controlled r and omized trials , has been in progress since 1994 . Fifty-six centers in Europe and Canada participate in this study . A total of 817 children with atopic dermatitis [ AD ] were recruited . The severity of AD was scored using the SCORAD ( objective criteria ) . Ninety-eight investigators ( mostly pediatricians ) were trained by three members of the European Task Force on Atopic Dermatitis [ ETFAD ] to st and ardize their objective SCORAD scoring ( system developed by the ETFAD ) . The experts selected photographs and prepared a training atlas . The percentages of photographs assessed by the 98 non-expert investigators below , within and above the range of evaluations by the three experts were calculated . Taking over and underscoring together , edema/papulation was the easiest intensity item to score ( 82 % within the range by the experts ) . The global symptom score , as well as lichenification , edema/papulation , oozing and excoriation registered by physicians with dermatological experience were not statistically significantly different from those by other . Erythema was statistically significantly better scored by those with dermatological experience . The results of the Euclidean Distance method showed that the item excoriations gave the largest distance . Erythema and excoriations were scored better by dermatologically experienced physicians ( t-test , p = 0.042 and p = 0.063 respectively ) , but lichenification was better scored by non-dermatologically experienced physicians ( p = 0.013 ) . The extent of surface area involved in the disease was calculated on 3 sets of photographs . Most evaluations by the 98 nonexpert investigators were within the range of the experts . Dermatologically experienced physicians scored significantly better than the others ( t-test , p = 0.006 ) . This training program is useful for st and ardizing the scoring in AD and indicates that SCORAD can be used by investigators from different disciplines Objective To vali date the Eczema Area and Severity Index ( EASI ) by assessing its internal consistency , reliability and sensitivity to change and by correlating it to other efficacy parameters . Both growth and the course of allergic symptoms were evaluated in 79 infants with cow 's milk protein intolerance , aged three months or younger , diagnosed by st and ard elimination/provocation and treated with a whey-hydrolysate based infant formula : Nutrilon Pept or Pepti Junior .  The efficacy of both products , in terms of symptomatology and growth , was compared with each other . The products differ in fat source ( Pepti Junior 50 % of its fat as MCT , Nutrilon Pepti normal LCT fat blend ) and the presence of lactose ( Pepti Junior : lactose free ; Nutrilon Pepti : 40 % of its carbohydrate as lactose ) . The study was part of a large project that aim ed at st and ardising the approach towards cow 's milk protein intolerance in Baby Health Clinics . Nearly 50 Baby Health Clinics participated in this project . In this study , growth and symptomatology ( skin , respiratory tract , gastrointestinal tract ) were monitored during an intervention period of at least 10 weeks . Infants in both feeding groups showed normal growth , and in at least 80 % of the infants an improvement of the overall symptomatology could be seen during the intervention period . Most profound were the decreases in prevalence and severity of eczema and infantile colic . No differences in efficacy were found in this study between the two infant formulas . It was concluded that the exclusive use of either whey hydrolysate based infant formula result ed in an improvement of allergic symptoms and in normal growth in infants diagnosed by elimination/provocation for cow 's milk protein intolerance in a Primary Health Care setting Summary The efficacy of cyclosporin ( S and immun ® ) given in a daily dose of 5 mg/kg for 6 weeks in  severe atopic dermatitis  was confirmed in this double‐blind , placebo‐controlled , short‐term study . Of the 46 patients included in the study , 23 were r and omized to receive cyclosporin and 23 to receive placebo Different scoring systems have been developed to determine the severity of atopic dermatitis .  The SCORAD ( SCORing Atopic Dermatitis ) , one of the best vali date d systems , is suited for clinical trials , but is too complicated and time consuming for routine clinical use . The TIS score  ( Three Item Severity score ) , a simplified system , is based on the evaluation of erythema , oedema/papulation and excoriation on a scale from 0 to 3 . In order to determine the value of the TIS score we conducted a prospect i ve study in 126 children with mild to severe atopic dermatitis . Both the  TIS score and the SCORAD  were assessed by trained investigators . Interobserver agreement was investigated in 20 children by comparing the independently performed scores of three investigators . A positive correlation was found between the TIS score and the SCORAD ( Rank Spearman r(s)=0.86 ; p<0.0005 ) . The item which correlated best with the SCORAD was excoriation ( r(s)=0.72 ; p<0.0005 ) followed by oedema/papulations ( r(s)=0.66 ; p<0.0005 ) . Interobserver agreement which was calculated by Cohen 's kappa ( kappa ) was " excellent " for SCORAD ( kappa=0.82 ; p<0.001 ) and " fair " for TIS score ( kappa=0.58 ; p<0.01 ) . We conclude that the TIS score is a rough , though reliable and simple system for scoring  atopic dermatitis . It is particularly suitable in general practice , for routine clinical use and for screening purpose s in clinical trials . For research purpose s , the objective SCORAD offers a more detailed and comprehensive assessment A few patients remain severely affected by atopic dermatitis into adult life despite treatment with systemic steroids , azathioprine , and photochemotherapy .  33 patients took part in a double-blind ,  placebo-controlled  , crossover study to assess the efficacy and safety of cyclosporin ( 5 mg/kg per day ) in adults with severe refractory atopic dermatitis . Treatments were given for eight weeks each with one group ( n = 16 ) receiving placebo followed by cyclosporin and another ( n = 17 ) receiving cyclosporin and then placebo .  Disease activity , extent of disease , sleep and itch , topical steroid use , and adverse events were assessed every two weeks . Both extent and activity of dermatitis were significantly improved ( p less than 0.001 ) as were subjective measures of disease .  20 patients receiving cyclosporin reported adverse events compared with  
    Output:
    
agent
CLINICAL IMPLICATION S Only SCORAD , EASI , and POEM currently perform adequately .
***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: Objective . This study was design ed to compare the safety and efficacy of tacrolimus ointment 0.03 % with vehicle ointment for the treatment of mild to moderate atopic dermatitis ( AD ) in pediatric patients . Methods . A total of 317 patients ( 2–15 years of age ) with mild to moderate AD were r and omized to receive tacrolimus ointment or vehicle ointment twice daily in a 6-week , multicenter , double-blind study . Efficacy evaluations , including the Investigators ' Global Atopic Dermatitis Assessment , eczema area and severity index , percentage of total body surface area affected , and patient assessment of itch occurred at baseline , day 4 , and weeks 2 , 4 , and 6 . Cutaneous adverse events were recorded to evaluate safety . Results . At the end of study , 50.6 % ( 80 of 158 ) of the patients were treated successfully with tacrolimus ointment based on Investigators ' Global Atopic Dermatitis Assessment scores , a significant improvement compared with patients treated with vehicle ointment ( 25.8 % [ 41 of 159 ] ) . The percent improvement from baseline in eczema area and severity index scores was also significantly greater in tacrolimus-treated patients ( 54.8 % ) compared with vehicle-treated patients ( 20.8 % ) . There was also a significant improvement in the percentage of total body surface area affected of tacrolimus-treated patients ( 50.5 % reduction from baseline ) compared with vehicle-treated patients ( 16.4 % ) . Patient itch scores were significantly lower in tacrolimus-treated patients ( 2.1 ) versus vehicle-treated patients ( 3.7 ) . Overall , the incidence of cutaneous adverse events reported was similar for both treatment groups . There was no significant difference in the incidence of burning or stinging between treatment groups . Significantly fewer tacrolimus-treated patients prematurely discontinued from the study because of a cutaneous adverse event in the treatment area or experienced increased itching and erythema at the application site . Conclusion . Monotherapy with tacrolimus ointment 0.03 % is a safe and effective treatment alternative for pediatric patients with mild to moderate AD Background : In the published studies on the efficacy of the topical immunomodulator pimecrolimus , different eczema scores were used , and the impact on morphological key signs of eczema was not analysed . Objective : To compare the influence of pimecrolimus cream 1 % on different st and ard eczema scores in infants with atopic dermatitis and to analyse the impact of treatment on the individual morphological key signs of eczema . Methods :  Pimecrolimus cream 1 % ( n = 129 ) or double-blind vehicle control ( n = 66 ) was administered for 4 weeks . The Eczema Area and Severity Index ( EASI ) , Investigators ’ Global Assessment ( IGA ) and Scoring Atopic Dermatitis Index ( SCORAD ) were determined and were correlated with each other . Results : Following treatment with pimecrolimus , the EASI , IGA and SCORAD were significantly reduced on day 29 as compared with the vehicle group ( p < 0.001 , p < 0.001 , p = 0.002 , respectively ) . There was a close correlation between EASI , IGA and SCORAD . The single parameters of the EASI were already significantly decreased by day 4 in the pimecrolimus group as compared to vehicle ( each p < 0.001 ) . Conclusion : Treatment with pimecrolimus 1 % cream leads to a rapid improvement of all morphological signs of eczema . The close correlation of different scores was shown for the first time OBJECTIVE To develop a simple , valid , repeatable , and readily underst and able patient-oriented assessment measure for monitoring disease activity in children and adults with atopic eczema . DESIGN Qualitative semistructured patient interviews identified a list of symptoms of atopic eczema . These symptoms were quantitatively analyzed in a larger patient population to identify which symptoms were important to patients and amenable to monitoring as part of a scoring system . SETTING The outpatient Department of Dermatology at the Queen 's Medical Centre , University Hospital , Nottingham , Engl and , and 5 local general practice s. PATIENTS Four hundred thirty-five patients with atopic eczema . RESULTS Seven symptoms were incorporated into the final patient-oriented eczema measure using a simple 5-point scale of frequency of occurrence during the previous week , with a maximum total score of 28 . Validity testing against the Dermatology Life Quality Index , Children 's Dermatology Life Quality Index , and patients ' global severity assessment s showed good correlation ( r = 0.78 , r = 0.73 , and r = 0.81 , respectively ; P<.001 ) . Internal consistency was high ( Cronbach alpha = 0.88 ) , and test-retest reliability was good , with 95 % of scores falling within 2.6 points on repeat testing ( mean score difference , 0.04 ; SD , 1.32 ) . Individual variables in the measure demonstrated sensitivity to change during a 4-week in-clinic period and an 18-week r and omized controlled clinical trial . CONCLUSION The patient-oriented eczema measure is a practical self-assessed measurement tool for monitoring aspects of atopic eczema that are important to patients in routine clinical practice or in the clinical trial setting Aim : To examine the association between childhood atopic dermatitis ( AD ) severity and family impact at baseline and after an intervention by a physician specialist , using vali date d measures of both severity and family impact . Methods : Cross sectional self administered survey of parent – caregivers of 49 r and omly selected children with AD ; 35 parents were available for follow up .  Family impact was measured using a modified AD Family Impact Scale completed by the parent – caregiver . The child ’s disease severity was measured using both the investigator ’s assessment via the Eczema Area and Severity Index ( EASI ) and the caregiver ’s assessment via the recently vali date d Self Assessment Eczema Area and Severity Index ( SA-EASI ) . Results : The parent – caregiver ’s assessment of severity of the child was the most significant correlate of the family impact of the child ’s AD ( p = 0.65 at baseline and p = 0.38 at follow up ) . In multivariate regression models , the parent – caregiver ’s estimate of severity remained the single strongest predictor of family impact before and after receipt of dermatologist care , as well as the difference in impact between pre and post-dermatologist care . Conclusions : There is evidence to support the ability of parent – caregivers of children with AD to accurately determine severity of their child ’s AD ; perceived severity is the driver of the family impact of this condition . Treatment of a child by a physician specialist is associated with reductions in both perceived severity , as well as family impact of this condition The ETAC ( Early Treatment of the Atopic Child ) study , a multi-national double-blind placebo-controlled r and omized trials , has been in progress since 1994 . Fifty-six centers in Europe and Canada participate in this study . A total of 817 children with atopic dermatitis [ AD ] were recruited . The severity of AD was scored using the SCORAD ( objective criteria ) . Ninety-eight investigators ( mostly pediatricians ) were trained by three members of the European Task Force on Atopic Dermatitis [ ETFAD ] to st and ardize their objective SCORAD scoring ( system developed by the ETFAD ) . The experts selected photographs and prepared a training atlas . The percentages of photographs assessed by the 98 non-expert investigators below , within and above the range of evaluations by the three experts were calculated . Taking over and underscoring together , edema/papulation was the easiest intensity item to score ( 82 % within the range by the experts ) . The global symptom score , as well as lichenification , edema/papulation , oozing and excoriation registered by physicians with dermatological experience were not statistically significantly different from those by other . Erythema was statistically significantly better scored by those with dermatological experience . The results of the Euclidean Distance method showed that the item excoriations gave the largest distance . Erythema and excoriations were scored better by dermatologically experienced physicians ( t-test , p = 0.042 and p = 0.063 respectively ) , but lichenification was better scored by non-dermatologically experienced physicians ( p = 0.013 ) . The extent of surface area involved in the disease was calculated on 3 sets of photographs . Most evaluations by the 98 nonexpert investigators were within the range of the experts . Dermatologically experienced physicians scored significantly better than the others ( t-test , p = 0.006 ) . This training program is useful for st and ardizing the scoring in AD and indicates that SCORAD can be used by investigators from different disciplines Objective To vali date the Eczema Area and Severity Index ( EASI ) by assessing its internal consistency , reliability and sensitivity to change and by correlating it to other efficacy parameters . Both growth and the course of allergic symptoms were evaluated in 79 infants with cow 's milk protein intolerance , aged three months or younger , diagnosed by st and ard elimination/provocation and treated with a whey-hydrolysate based infant formula : Nutrilon Pept or Pepti Junior .  The efficacy of both products , in terms of symptomatology and growth , was compared with each other . The products differ in fat source ( Pepti Junior 50 % of its fat as MCT , Nutrilon Pepti normal LCT fat blend ) and the presence of lactose ( Pepti Junior : lactose free ; Nutrilon Pepti : 40 % of its carbohydrate as lactose ) . The study was part of a large project that aim ed at st and ardising the approach towards cow 's milk protein intolerance in Baby Health Clinics . Nearly 50 Baby Health Clinics participated in this project . In this study , growth and symptomatology ( skin , respiratory tract , gastrointestinal tract ) were monitored during an intervention period of at least 10 weeks . Infants in both feeding groups showed normal growth , and in at least 80 % of the infants an improvement of the overall symptomatology could be seen during the intervention period . Most profound were the decreases in prevalence and severity of eczema and infantile colic . No differences in efficacy were found in this study between the two infant formulas . It was concluded that the exclusive use of either whey hydrolysate based infant formula result ed in an improvement of allergic symptoms and in normal growth in infants diagnosed by elimination/provocation for cow 's milk protein intolerance in a Primary Health Care setting Summary The efficacy of cyclosporin ( S and immun ® ) given in a daily dose of 5 mg/kg for 6 weeks in  severe atopic dermatitis  was confirmed in this double‐blind , placebo‐controlled , short‐term study . Of the 46 patients included in the study , 23 were r and omized to receive cyclosporin and 23 to receive placebo Different scoring systems have been developed to determine the severity of atopic dermatitis .  The SCORAD ( SCORing Atopic Dermatitis ) , one of the best vali date d systems , is suited for clinical trials , but is too complicated and time consuming for routine clinical use . The TIS score  ( Three Item Severity score ) , a simplified system , is based on the evaluation of erythema , oedema/papulation and excoriation on a scale from 0 to 3 . In order to determine the value of the TIS score we conducted a prospect i ve study in 126 children with mild to severe atopic dermatitis . Both the  TIS score and the SCORAD  were assessed by trained investigators . Interobserver agreement was investigated in 20 children by comparing the independently performed scores of three investigators . A positive correlation was found between the TIS score and the SCORAD ( Rank Spearman r(s)=0.86 ; p<0.0005 ) . The item which correlated best with the SCORAD was excoriation ( r(s)=0.72 ; p<0.0005 ) followed by oedema/papulations ( r(s)=0.66 ; p<0.0005 ) . Interobserver agreement which was calculated by Cohen 's kappa ( kappa ) was " excellent " for SCORAD ( kappa=0.82 ; p<0.001 ) and " fair " for TIS score ( kappa=0.58 ; p<0.01 ) . We conclude that the TIS score is a rough , though reliable and simple system for scoring  atopic dermatitis . It is particularly suitable in general practice , for routine clinical use and for screening purpose s in clinical trials . For research purpose s , the objective SCORAD offers a more detailed and comprehensive assessment A few patients remain severely affected by atopic dermatitis into adult life despite treatment with systemic steroids , azathioprine , and photochemotherapy .  33 patients took part in a double-blind ,  placebo-controlled  , crossover study to assess the efficacy and safety of cyclosporin ( 5 mg/kg per day ) in adults with severe refractory atopic dermatitis . Treatments were given for eight weeks each with one group ( n = 16 ) receiving placebo followed by cyclosporin and another ( n = 17 ) receiving cyclosporin and then placebo .  Disease activity , extent of disease , sleep and itch , topical steroid use , and adverse events were assessed every two weeks . Both extent and activity of dermatitis were significantly improved ( p less than 0.001 ) as were subjective measures of disease .  20 patients receiving cyclosporin reported adverse events compared with  
    Output:
    