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: A series of 80 patients with cervical , trochanteric or subtrochanteric hip fractures were r and omized to either treatment without traction , skin traction , or skeletal traction during the 1883 h between admission and operation . The institution of skin or skeletal traction was not particularly painful for the patient , but we found no indication that either was of discernible benefit . The number of analgesic medications needed was no higher in patients without traction . We conclude that traction should not be administered routinely to patients awaiting operation for hip fracture We r and omised 50 patients with extracapsular fractures of the femoral neck to receive either a bupivacaine femoral nerve block or systemic analgesia alone . A femoral nerve block was found to be an easy and effective procedure which significantly reduced perioperative analgesic requirements and postoperative morbidity Background : Hip fracture surgery usually carries a high dem and for rehabilitation and a significant risk of perioperative morbidity and mortality . Postoperative epidural analgesia may reduce morbidity and has been shown to facilitate rehabilitation in elective orthopedic procedures . No studies exist on the effect of postoperative epidural analgesia on pain and rehabilitation after hip fracture surgery . Methods : Sixty elderly patients were included in a r and omized , double-blind study comparing 4 days of continuous postoperative epidural infusion of 4 ml/h bupivacaine , 0.125 % , and 50 & mgr;g/ml morphine versus placebo . Both patient groups received balanced analgesia and intravenous nurse-controlled analgesia with morphine . All patients followed a well-defined multimodal rehabilitation program . Pain , ability to participate in four basic physical functions , and any factors restricting participation were assessed on the first 4 postoperative days during physiotherapy . Results : Epidural analgesia provided superior dynamic analgesia during all basic physical functions , and patients were significantly less restricted by pain , which was the dominating restricting factor in the placebo group . Motor blockade was not a restricting factor during epidural analgesia . Despite improved pain relief , scores for recovery of physical independence were not different between groups . Conclusion : Postoperative epidural analgesia after hip fracture surgery provides superior analgesia attenuating pain as a restricting factor during rehabilitation without motor dysfunction . However , superior analgesia did not translate into enhanced rehabilitation . Future studies with multimodal rehabilitation are required to establish whether superior analgesia can be translated into enhanced rehabilitation and reduced morbidity in hip fracture patients Background Recent studies have indicated that unmanaged pain , both acute and chronic , can affect mental status and might precipitate delirium , especially in elderly patients with hip fractures . The aim of this study was to assess the effectiveness of fascia iliaca compartment block ( FICB ) for prevention of perioperative delirium in hip surgery patients who were at intermediate or high risk for this complication . Material s and methods On admission , all included patients were divided into three groups according to low , intermediate or high risk for perioperative delirium . Eligible patients ( those classified as at intermediate or high risk for developing delirium ) were sequentially r and omly assigned to study treatment ( FICB prophylaxis or placebo ) according to a computer-generated r and omization code . The primary outcome was perioperative delirium . Diagnosis of the syndrome was defined using the Diagnostic and Statistical Manual of Mental Disorders , 4th edition ( DSM-IV ) and Confusion Assessment Method ( CAM ) criteria . Secondary outcome variables were severity of delirium and delirium duration . Results Delirium occurred in 33 ( 15.94 % ) out of 207 patients r and omized to FICB prophylaxis or the placebo group . Incidence of delirium in the FICB prophylaxis group was 10.78 % ( 11/102 ) , significantly different from the incidence ( 23.8 % , 25/105 ) in the placebo group [ relative risk 0.45 , 95 % confidence interval ( CI ) 0.23–0.87 ] . Nine of 17 patients with high risk for delirium and included in the FICB prophylaxis group developed delirium , whereas 10 of 16 high-risk patients included in the placebo group became delirious ( relative risk 0.84 , CI 0.47–1.52 ) . Two of 85 patients with intermediate risk for delirium and included in the FICB prophylaxis group developed delirium , whereas 15 of 89 intermediate-risk patients included in the placebo group became delirious ( relative risk 0.13 , CI 0.03–0.53 ) . Severity of delirium according to the highest value of the DRSR-98 during an episode with delirium in patients in the FICB prophylaxis group was on average 14.34 , versus 18.61 in the placebo group ( mean difference 4.27 , 95 % CI 1.8–5.64 , P < 0.001 ) . Mean duration of delirium in the FICB prophylaxis group was significantly shorter than in the placebo group ( FICB 5.22 days versus placebo 10.97 days , 95 % CI 3.87–7.62 , P < 0.001 ) . Conclusion No significant difference was found among high-risk patients between FICB prophylaxis and placebo groups in terms of delirium incidence . However , FICB prophylaxis significantly prevented delirium occurrence in intermediate-risk patients . Thus FICB prophylaxis could be beneficial , particularly for intermediate-risk patients The purpose of this prospect i ve , r and omized , double-blinded study was to evaluate the sensory onset time and the quality of sensory block of ropivacaine , a new long-acting local anesthetic , compared with bupivacaine , for 3-in-1 blocks . Fifty ASA physical status I – III patients undergoing hip surgery after trauma were r and omly assigned to two study groups of 25 patients each . The two study groups received a 3-in-1 block with either 20 mL of ropivacaine 0.5 % or 20 mL of bupivacaine 0.5 % . Blocks in both groups were performed using a nerve stimulator .  The sensory onset time and the quality of sensory block was assessed by pinprick test in the central sensory region of each of the three nerves and compared with the same stimulation in the contralateral leg . We used a scale from 100 % ( normal sensation ) to 0 % ( no sensory sensation ) . We did not find significant differences in sensory onset times between the ropivacaine group and the bupivacaine group ( 30 ± 11 vs 32 ± 10 min ) . The quality of sensory blocks was also comparable between the study groups ( 19 % ± 20 % vs 21 % ± 15 % ) . We conclude that the sensory onset time and quality of sensory block during 3-in-1 blocks performed with ropivacaine are comparable to those with bupivacaine . Ropivacaine is described as being less potent than bupivacaine , making this local anesthetic promising for 3-in-1 blocks because of its reportedly lower incidence of cardiovascular and central nervous system complications . Implication s Ropivacaine 0.5 % has a sensory onset time and quality of sensory block during 3-in-1 blocks similar to that of bupivacaine 0.5 % . Ropivacaine is described as being less potent than bupivacaine , making it a promising local anesthetic for 3-in-1 blocks because of its reportedly lower cardiovascular and central nervous system toxicity OBJECTIVES Auricular acupressure is known to decrease the level of anxiety in patients during ambulance transport . The purpose of this r and omized , double-blind , sham control study was to determine whether auricular acupressure can decrease not only the level of anxiety but also the level of pain in a group of elder patients with acute hip fracture . METHODS With the assistance of the Vienna Red Cross , 38 patients with acute hip fracture were enrolled into this study . Patients were r and omized into two study groups : the true intervention group and the sham control group . Subjects in the true intervention group ( n = 18 ) received bilateral auricular acupressure at three auricular acupressure points for hip pain . Patients in the sham group ( n = 20 ) received bilateral auricular acupressure at sham points . Baseline demographic information , anxiety level , pain level , blood pressure , and heart rate were obtained before the administration of the appropriate acupressure intervention . The level of anxiety , level of pain , hemodynamic profiles , and level of satisfaction were reassessed once the patients arrived at the hospital . RESULTS Patients in the true intervention groups had less pain ( F = 28 , p = 0.0001 ) and anxiety ( F = 4.3 , p = 0.018 ) and lower heart rate ( F = 18 , p = 0.0001 ) on arrival at the hospital than did patients in the sham control group . As a result , the patients in the true intervention group reported higher satisfaction in the care they received during the ride to the hospital . CONCLUSIONS The authors encourage physicians , health care providers , and emergency rescuers to learn this easy , noninvasive , and inexpensive technique for its effects in decreasing anxiety and pain during emergency transportation A consecutive series of 100 patients with femoral neck fractures were assessed by a mental test score on admission . The 67 scoring within the normal range were r and omly assigned to skin traction or no traction between admission and operation . Using pain assessment scales and records of analgesic consumption , there was found to be little difference between the two groups . The conclusion was that skin traction offered no benefits in pain control for the patient and therefore should not be used routinely OBJECTIVES To evaluate the rate of postoperative complications , length of stay , and 1-year mortality before and after introduction of a comprehensive multidisciplinary fast-track treatment and care program for hip fracture patients ( the optimized program ) . DESIGN Retrospective chart review with historical control . SETTING Orthopedic ward ( 110 beds ) at a university hospital ( 700 beds ) . PARTICIPANTS Five hundred thirty-five consecutive patients aged 40 and older ( 94%>or=60 ) hospitalized for hip fracture between January 1 , 2003 , and March 31 , 2004 . Three hundred and thirty-six patients ( 70.3 % ) were community dwellers before the fracture and 159 ( 29.7 % ) were admitted from nursing homes . INTERVENTION The fast-track treatment and care program included a switch from systemic opiates to a local femoral nerve catheter block ; an earlier assessment by the anesthesiologist ; and a more- systematic approach to nutrition , fluid and oxygen therapy , and urinary retention . RESULTS In the intervention group , the rate of any in-hospital postoperative complication was reduced from 33 % to 20 % ( odds ratio=0.61 , 95 % confidence interval=0.4 - 0.9 ; P=.002 ) . Rates of confusion ( P=.02 ) , pneumonia ( P=.03 ) , and urinary tract infection ( P<.001 ) were lower in the intervention group than in the control group , and length of stay was 15.8 days in the control group , versus 9.7 days in the intervention group ( P<.001 ) . For community dwellers , 12-month mortality was 23 % in the control group versus 12 % in the intervention group ( P=.02 ) . Overall 12-month mortality was 29 % in the control group and 23 % in the intervention group ( P=.2 ) . CONCLUSION The optimized hip fracture program reduced the rate of in-hospital postoperative complications and mortality . R and omized clinical trials are needed to confirm these results and eluci date the elements of the program that have the greatest effect on clinical outcomes and mortality OBJECTIVES To compare the intraoperative hemodynamic effects and ephedrine requirements in elderly patients undergoing orthopedic surgery under subarachnoid anesthesia with hyperbaric bupivacaine with or without fentanyl .  MATERIAL AND METHODS Sixty patients over 75 years of age and scheduled for semi-urgent surgical repair of a fractured femur were r and omized to two groups . Group F received subarachnoid surgery with 5 mg of bupivacaine and 15 micrograms of fentanyl . Group B received 7.5 mg bupivacaine . We recorded blood pressure , heart rate and oxygen saturation every 5 minutes and extension of anesthesia . Hemodynamic changes and ephedrine  required by each patient were analyzed , along with side effects . RESULTS Group F patients were more hemodynamically stable 10 and 20 minutes after infusion of the anesthetic , and more hypotensive episodes occurred in group B. Group B consumed significantly more  ephedrine  ( p < 0.05 ) , administered to 22 patients in group B and 6 in group F. The total dose of ephedrine  administered was greater in group B ( 190 mg ) than in group F ( 40 mg ) . The extension of anesthetic block was sufficient for surgery in all cases . No side effects from fentanyl administration were observed . CONCLUSION Adding fentanyl to the local anesthetic used for subarachnoid anesthesia in elderly patients is effective for maintaining greater hemodynamic stability , allowing use of a lower dose of hyperbaric bupivacaine and reducing the need 
    Output:
    
agent
Overall , moderate evidence suggests that nerve blockades are effective for relieving acute pain and reducing delirium .
Low-level evidence suggests that preoperative traction does not reduce acute pain .
Nerve blockade seems to be effective in reducing acute pain after hip fracture .
Sparse data preclude firm conclusions about the relative benefits or harms of many other pain management interventions for patients with hip fracture .
***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: A series of 80 patients with cervical , trochanteric or subtrochanteric hip fractures were r and omized to either treatment without traction , skin traction , or skeletal traction during the 1883 h between admission and operation . The institution of skin or skeletal traction was not particularly painful for the patient , but we found no indication that either was of discernible benefit . The number of analgesic medications needed was no higher in patients without traction . We conclude that traction should not be administered routinely to patients awaiting operation for hip fracture We r and omised 50 patients with extracapsular fractures of the femoral neck to receive either a bupivacaine femoral nerve block or systemic analgesia alone . A femoral nerve block was found to be an easy and effective procedure which significantly reduced perioperative analgesic requirements and postoperative morbidity Background : Hip fracture surgery usually carries a high dem and for rehabilitation and a significant risk of perioperative morbidity and mortality . Postoperative epidural analgesia may reduce morbidity and has been shown to facilitate rehabilitation in elective orthopedic procedures . No studies exist on the effect of postoperative epidural analgesia on pain and rehabilitation after hip fracture surgery . Methods : Sixty elderly patients were included in a r and omized , double-blind study comparing 4 days of continuous postoperative epidural infusion of 4 ml/h bupivacaine , 0.125 % , and 50 & mgr;g/ml morphine versus placebo . Both patient groups received balanced analgesia and intravenous nurse-controlled analgesia with morphine . All patients followed a well-defined multimodal rehabilitation program . Pain , ability to participate in four basic physical functions , and any factors restricting participation were assessed on the first 4 postoperative days during physiotherapy . Results : Epidural analgesia provided superior dynamic analgesia during all basic physical functions , and patients were significantly less restricted by pain , which was the dominating restricting factor in the placebo group . Motor blockade was not a restricting factor during epidural analgesia . Despite improved pain relief , scores for recovery of physical independence were not different between groups . Conclusion : Postoperative epidural analgesia after hip fracture surgery provides superior analgesia attenuating pain as a restricting factor during rehabilitation without motor dysfunction . However , superior analgesia did not translate into enhanced rehabilitation . Future studies with multimodal rehabilitation are required to establish whether superior analgesia can be translated into enhanced rehabilitation and reduced morbidity in hip fracture patients Background Recent studies have indicated that unmanaged pain , both acute and chronic , can affect mental status and might precipitate delirium , especially in elderly patients with hip fractures . The aim of this study was to assess the effectiveness of fascia iliaca compartment block ( FICB ) for prevention of perioperative delirium in hip surgery patients who were at intermediate or high risk for this complication . Material s and methods On admission , all included patients were divided into three groups according to low , intermediate or high risk for perioperative delirium . Eligible patients ( those classified as at intermediate or high risk for developing delirium ) were sequentially r and omly assigned to study treatment ( FICB prophylaxis or placebo ) according to a computer-generated r and omization code . The primary outcome was perioperative delirium . Diagnosis of the syndrome was defined using the Diagnostic and Statistical Manual of Mental Disorders , 4th edition ( DSM-IV ) and Confusion Assessment Method ( CAM ) criteria . Secondary outcome variables were severity of delirium and delirium duration . Results Delirium occurred in 33 ( 15.94 % ) out of 207 patients r and omized to FICB prophylaxis or the placebo group . Incidence of delirium in the FICB prophylaxis group was 10.78 % ( 11/102 ) , significantly different from the incidence ( 23.8 % , 25/105 ) in the placebo group [ relative risk 0.45 , 95 % confidence interval ( CI ) 0.23–0.87 ] . Nine of 17 patients with high risk for delirium and included in the FICB prophylaxis group developed delirium , whereas 10 of 16 high-risk patients included in the placebo group became delirious ( relative risk 0.84 , CI 0.47–1.52 ) . Two of 85 patients with intermediate risk for delirium and included in the FICB prophylaxis group developed delirium , whereas 15 of 89 intermediate-risk patients included in the placebo group became delirious ( relative risk 0.13 , CI 0.03–0.53 ) . Severity of delirium according to the highest value of the DRSR-98 during an episode with delirium in patients in the FICB prophylaxis group was on average 14.34 , versus 18.61 in the placebo group ( mean difference 4.27 , 95 % CI 1.8–5.64 , P < 0.001 ) . Mean duration of delirium in the FICB prophylaxis group was significantly shorter than in the placebo group ( FICB 5.22 days versus placebo 10.97 days , 95 % CI 3.87–7.62 , P < 0.001 ) . Conclusion No significant difference was found among high-risk patients between FICB prophylaxis and placebo groups in terms of delirium incidence . However , FICB prophylaxis significantly prevented delirium occurrence in intermediate-risk patients . Thus FICB prophylaxis could be beneficial , particularly for intermediate-risk patients The purpose of this prospect i ve , r and omized , double-blinded study was to evaluate the sensory onset time and the quality of sensory block of ropivacaine , a new long-acting local anesthetic , compared with bupivacaine , for 3-in-1 blocks . Fifty ASA physical status I – III patients undergoing hip surgery after trauma were r and omly assigned to two study groups of 25 patients each . The two study groups received a 3-in-1 block with either 20 mL of ropivacaine 0.5 % or 20 mL of bupivacaine 0.5 % . Blocks in both groups were performed using a nerve stimulator .  The sensory onset time and the quality of sensory block was assessed by pinprick test in the central sensory region of each of the three nerves and compared with the same stimulation in the contralateral leg . We used a scale from 100 % ( normal sensation ) to 0 % ( no sensory sensation ) . We did not find significant differences in sensory onset times between the ropivacaine group and the bupivacaine group ( 30 ± 11 vs 32 ± 10 min ) . The quality of sensory blocks was also comparable between the study groups ( 19 % ± 20 % vs 21 % ± 15 % ) . We conclude that the sensory onset time and quality of sensory block during 3-in-1 blocks performed with ropivacaine are comparable to those with bupivacaine . Ropivacaine is described as being less potent than bupivacaine , making this local anesthetic promising for 3-in-1 blocks because of its reportedly lower incidence of cardiovascular and central nervous system complications . Implication s Ropivacaine 0.5 % has a sensory onset time and quality of sensory block during 3-in-1 blocks similar to that of bupivacaine 0.5 % . Ropivacaine is described as being less potent than bupivacaine , making it a promising local anesthetic for 3-in-1 blocks because of its reportedly lower cardiovascular and central nervous system toxicity OBJECTIVES Auricular acupressure is known to decrease the level of anxiety in patients during ambulance transport . The purpose of this r and omized , double-blind , sham control study was to determine whether auricular acupressure can decrease not only the level of anxiety but also the level of pain in a group of elder patients with acute hip fracture . METHODS With the assistance of the Vienna Red Cross , 38 patients with acute hip fracture were enrolled into this study . Patients were r and omized into two study groups : the true intervention group and the sham control group . Subjects in the true intervention group ( n = 18 ) received bilateral auricular acupressure at three auricular acupressure points for hip pain . Patients in the sham group ( n = 20 ) received bilateral auricular acupressure at sham points . Baseline demographic information , anxiety level , pain level , blood pressure , and heart rate were obtained before the administration of the appropriate acupressure intervention . The level of anxiety , level of pain , hemodynamic profiles , and level of satisfaction were reassessed once the patients arrived at the hospital . RESULTS Patients in the true intervention groups had less pain ( F = 28 , p = 0.0001 ) and anxiety ( F = 4.3 , p = 0.018 ) and lower heart rate ( F = 18 , p = 0.0001 ) on arrival at the hospital than did patients in the sham control group . As a result , the patients in the true intervention group reported higher satisfaction in the care they received during the ride to the hospital . CONCLUSIONS The authors encourage physicians , health care providers , and emergency rescuers to learn this easy , noninvasive , and inexpensive technique for its effects in decreasing anxiety and pain during emergency transportation A consecutive series of 100 patients with femoral neck fractures were assessed by a mental test score on admission . The 67 scoring within the normal range were r and omly assigned to skin traction or no traction between admission and operation . Using pain assessment scales and records of analgesic consumption , there was found to be little difference between the two groups . The conclusion was that skin traction offered no benefits in pain control for the patient and therefore should not be used routinely OBJECTIVES To evaluate the rate of postoperative complications , length of stay , and 1-year mortality before and after introduction of a comprehensive multidisciplinary fast-track treatment and care program for hip fracture patients ( the optimized program ) . DESIGN Retrospective chart review with historical control . SETTING Orthopedic ward ( 110 beds ) at a university hospital ( 700 beds ) . PARTICIPANTS Five hundred thirty-five consecutive patients aged 40 and older ( 94%>or=60 ) hospitalized for hip fracture between January 1 , 2003 , and March 31 , 2004 . Three hundred and thirty-six patients ( 70.3 % ) were community dwellers before the fracture and 159 ( 29.7 % ) were admitted from nursing homes . INTERVENTION The fast-track treatment and care program included a switch from systemic opiates to a local femoral nerve catheter block ; an earlier assessment by the anesthesiologist ; and a more- systematic approach to nutrition , fluid and oxygen therapy , and urinary retention . RESULTS In the intervention group , the rate of any in-hospital postoperative complication was reduced from 33 % to 20 % ( odds ratio=0.61 , 95 % confidence interval=0.4 - 0.9 ; P=.002 ) . Rates of confusion ( P=.02 ) , pneumonia ( P=.03 ) , and urinary tract infection ( P<.001 ) were lower in the intervention group than in the control group , and length of stay was 15.8 days in the control group , versus 9.7 days in the intervention group ( P<.001 ) . For community dwellers , 12-month mortality was 23 % in the control group versus 12 % in the intervention group ( P=.02 ) . Overall 12-month mortality was 29 % in the control group and 23 % in the intervention group ( P=.2 ) . CONCLUSION The optimized hip fracture program reduced the rate of in-hospital postoperative complications and mortality . R and omized clinical trials are needed to confirm these results and eluci date the elements of the program that have the greatest effect on clinical outcomes and mortality OBJECTIVES To compare the intraoperative hemodynamic effects and ephedrine requirements in elderly patients undergoing orthopedic surgery under subarachnoid anesthesia with hyperbaric bupivacaine with or without fentanyl .  MATERIAL AND METHODS Sixty patients over 75 years of age and scheduled for semi-urgent surgical repair of a fractured femur were r and omized to two groups . Group F received subarachnoid surgery with 5 mg of bupivacaine and 15 micrograms of fentanyl . Group B received 7.5 mg bupivacaine . We recorded blood pressure , heart rate and oxygen saturation every 5 minutes and extension of anesthesia . Hemodynamic changes and ephedrine  required by each patient were analyzed , along with side effects . RESULTS Group F patients were more hemodynamically stable 10 and 20 minutes after infusion of the anesthetic , and more hypotensive episodes occurred in group B. Group B consumed significantly more  ephedrine  ( p < 0.05 ) , administered to 22 patients in group B and 6 in group F. The total dose of ephedrine  administered was greater in group B ( 190 mg ) than in group F ( 40 mg ) . The extension of anesthetic block was sufficient for surgery in all cases . No side effects from fentanyl administration were observed . CONCLUSION Adding fentanyl to the local anesthetic used for subarachnoid anesthesia in elderly patients is effective for maintaining greater hemodynamic stability , allowing use of a lower dose of hyperbaric bupivacaine and reducing the need 
    Output:
    