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: AIMS To investigate the incidence , risk factors and natural history of gallstone disease , a r and om sample of females belonging to a rural population was enrolled in a ten-year longitudinal study . METHODS The study has been performed in a small town on the hills south of Rome . In 1985 , a r and om sample of 426 females , aged 20 - 69 years , was screened by real-time ultrasonography for gallstones and previous cholecystectomy .  Screening methods included anthropometry , collection of a blood sample and a question naire on the occurrence of abdominal symptoms . During 1995 , all these subjects were invited for a 10-year follow-up examination . RESULTS The overall 10-year incidence of gallstone disease was 6.3 % ( 5.5 % of new gallstones and 0.8 % of cholecystectomies ) . Only 23.1 % of the women with gallstones were aware of their condition . More than three quarters ( 76.9 % ) had not suffered biliary pain . Univariate and multivariate analyses demonstrated a positive independent association of new gallstone disease with body mass index and parity . Out of the initially asymptomatic gallstone women , 15.4 % experienced at least one episode of biliary pain , 23.1 % were su bmi tted to elective cholecystectomy and 61.5 % remained asymptomatic . CONCLUSIONS The study demonstrates a high incidence of gallstone disease in women belonging to a rural free-living population in Italy and suggests body mass index and parity as possible true risk factors . Moreover , it confirms that a remarkable proportion of asymptomatic patients become symptomatic and eventually undergo cholecystectomy Aim of this study is the evaluation of the impact of preoperative informative session using a Multimedia Health Educational Program ( MHEP ) on patients undergoing elective Laparoscopic Cholecystectomy ( LC ) for cholelithiasis , preoperative anxiety and postoperative pain and nausea . Sixty consecutive patients scheduled for elective LC were considered for enrollment in the trial . Patients were assigned r and omly to four groups : Group A included 15 patients , preoperatively informed regarding LC through the MHEP presented by a Registered Nurse ( RN ) . Group B included 15 patients  preoperatively informed through a leaflet ( design ed and developed using the exact contents of the MHEP ) . In Group C , there were 15 patients who were being informed verbally from the RN . Finally , the control Group D included 15 patients , who had the conventional preoperative information about the operation and postoperative course by the attending surgeon and anesthesiologist , as every other patient included in groups A , B , C. Preoperative assessment of patient 's knowledge about cholelithiasis and LC was performed after informative session , and was based on a specifically developed " closed , true-false " question naire . Preliminary results suggest that conventional information provided by the attending surgeon ( Group D ) is inadequate . Specifically developed informative sessions with the contribution of MHEP seems to be effective on reducing preoperative anxiety and postoperative pain , in patients undergoing elective LC OBJECTIVES To analyze sources search ed in Cochrane review s , to determine the proportion of trials included in review s that are indexed in major data bases , and to compare the quality of these trials with those from other sources . METHODS All new systematic review s in the Cochrane Library , Issue1 2001 , that were restricted to r and omized controlled trials ( RCTs ) or quasi- RCTs were selected . The sources search ed in the review s were recorded , and the trials included were checked to see whether they were indexed in four major data bases . Trials not indexed were checked to determine how they could be identified . The quality of trials found in major data bases was compared with those found from other sources . RESULTS The range in the number of data bases search ed per review ranged between one and twenty-seven . The proportion of the trials in the four data bases were Cochrane Controlled Trials Register = 78.5 % , MEDLINE = 68.8 % , Embase = 65.0 % , and Science/Social Sciences Citation Index = 60.7 % . Search ing another twenty-six data bases after Cochrane Controlled Trials Register ( CCTR ) , MEDLINE , and Embase only found 2.4 % additional trials . There was no significant difference between trials found in the CCTR , MEDLINE , and Embase compared with other trials , with respect to adequate allocation concealment or sample size . CONCLUSIONS There was a large variation between review s in the exhaustiveness of the literature search es . CCTR was the single best source of RCTs . Additional data base search ing retrieved only a small percentage of extra trials . Contacting authors and manufacturers to find unpublished trials appeared to be a more effective method of obtaining the additional better quality trials A r and om sample of 4,807 men and women , aged 30 , 40 , 50 , and 60 years , who lived in the western part of Copenhagen County , was drawn from the National Central Person Registry . A total of 226 subjects who were not of Danish origin were omitted . The response rate was 78.8 % ( 3,608/4,581 ) . Each person had his or her gallbladder examined by ultrasonography . The examinations took place between November 1982 and February 1984 . The overall prevalence of gallstone disease ( cases with stones and cholecystectomized cases ) in males aged 30 , 40 , 50 , and 60 years was 1.8 % , 1.5 % , 6.7 % , and 12.9 % , respectively . The corresponding prevalence in females was 4.8 % , 6.1 % , 14.4 % , and 22.4 % , respectively . Differences according to sex were significant in all age groups . Differences between the 40- and 50-year and 50- and 60-year age groups were significant in both sexes . Among subjects with gallstone disease , the disease was unknown to the prob and in the majority of males and in the 30-year-old females , but only in half of the women aged 40 , 50 , and 60 years . The prevalence of clinical ly diagnosed gallstones was not significantly different between respondents and nonrespondents A prospect i ve study of the prevalence of gall stone disease at necropsy in a stable population has been undertaken over a 10 year period up to June 1988 . In women , the prevalence of gall stone disease remained static but in men aged 50 - 59 years it rose from 7 % ( n = 148 ) in the first three years to 18 % ( n = 138 ) in the last three years ( p less than 0.01 ) and in men aged 60 - 69 it rose from 12 % ( n = 370 ) to 20 % ( n = 366 , p less than 0.01 ) . In the latter age group the female : male ratio fell from 2:1 to 0.8:1 . The proportion of deaths from coronary heart disease in men fell slightly in those over 70 during the study period . There was a fall in deaths from coronary heart disease in all age groups in women . Men with gall stones were less likely to have had a  cholecystectomy  than women , and overall 88 % of gall stones remained in situ . In a parallel clinical study , the number of cholecystectomies  carried out in the same district fell by 18 % over the 10 years without any apparent change in the provision of re sources .  Cholecystectomy  remained almost three times more frequent in women . National data indicate that there have been major changes in the average diet before and during the period of study in favour of reducing coronary heart disease . There has been no change in mortality from coronary heart disease in young men but if the observed increase in the prevalence of gall stones in men and the decrease in deaths from coronary heart disease in women are real phenomena , it seems likely that they are diet related OBJECTIVE Occupational violence as experienced by professional nurses has been extensively research ed . However , the majority of studies have focused primarily on psychological and emotional outcomes and have not identified any interventions that may reduce the impact of aggressive behaviour on professional competence . The purpose of this study was to investigate the relationship between organisational support , occupational violence and perceived professional competence of professional nurses in Australia . DESIGN A model testing research design was used to test the hypothesis that organisational support , as experienced by nurses , would moderate the relationship between occupational violence and perceived professional competence . SETTING Nurses registered in Division 1 of the Nurses Board ( Victoria , Australia ) . PARTICIPANTS A systematic r and om sample of 380 registered nurses from the target population of nurses in Victoria was identified . MAIN OUTCOME MEASURE The relationship between organisational support , occupational violence and perceived professional competence of professional nurses in Australia . RESULTS The result showed that there was a significant effect of occupational violence on perceived competence . Analysis of the moderating effect of organisational support on the relationship between occupational violence and professional competence showed there was significant  organisational support  and  occupational violence  interaction . Overall , the data analysis demonstrated the hypothesis was upheld that the negative effects of occupational violence on perceived professional competence will be moderated by perceived organisational support . CONCLUSIONS The failure to receive appropriate organisational support may result in lowering  professional nurses ' competence levels , causing a significant problem for the profession in that a reduction in professional competence has significant implication s for patient care . The findings heighten the responsibility of the nursing profession to become more aware of the needs of professional nurses OBJECTIVES The objectives of this r and omised controlled study were to determine if pre-admission patient education affects post-operative pain levels , domiciliary self-care capacity and patient recall following a laparoscopic cholecystectomy ( LC ) . Participants were r and omised to receive the st and ard preadmission program ( SP ) or an individualised , education intervention ( El ) . DESIGN A pre-operative question naire was administered in the pre-admission clinic to determine participants ' knowledge of LC and post-operative management . Telephone follow-up and post-operative question naire were conducted approximately 14 days post discharge . SETTING Preadmission clinic of a Sydney , Australia , tertiary referral hospital . SAMPLE Ninety-three elective LC patients . RESULTS EI participants experienced lower pain levels and had significantly greater recall of provided information . However , no significant differences were found between the control and intervention groups for domiciliary self-care . CONCLUSION Pre-admission education intervention helps reduce post-operative pain levels following LC and significantly increases patients ' knowledge of self-care and complication management Purpose The informed consent is a legal requirement prior to surgery and should be based on an extensive preoperative interview . Multimedia productions can therefore be utilised as supporting tool . In a prospect i ve r and omised trial , we evaluated the impact of an extended education on patients undergoing cholecystectomy . Material s and methods For extended patient information , a professionally built DVD was used . After r and omisation to either the DVD or the control group , patients were informed with or without additional presentation of the DVD . The quality of education was evaluated using a purpose -built question naire . Results One hundred fourteen patients were included in the DVD and 98 in the control group .  Patient characteristics did not differ significantly despite a higher educational level in the DVD group . The score of correctly answered questions was higher in the DVD group ( 19.88 vs. 17.58 points , p < 0.001 ) . As subgroup analysis revealed , particular patient characteristics additionally impacted on results . Conclusion Patients should be informed the most extensively prior to any surgical procedure . Multimedia productions therefore offer a suitable instrument . In the presented study , we could prove the positive impact of an information DVD on patients knowledge . Nevertheless , multimedia tools can not replace personal interaction and should only be used to support daily work Methods for combining data from several studies exist and appear to be quite useful . None satisfactorily addresses the question of what studies should be combined . This issue is the most serious method ological limitation . Even studies with statistically significant interaction might still be combined if the effect were in the same direction . Thus , substantial scientific input is required as to what criteria must be met by each potential study . Much can be learned from combining or pooling data but it must be done cautiously . Pooling exercises do not replace well design ed prospect i ve clinical trials . Efforts for establishing basic design criteria to allow for multicentre and multicountry trials to be more easily combined might be useful . Psychological stress has been shown to impair wound healing , but experimental research in surgical patients is lacking . This study investigated whether a brief psychological intervention could reduce stress and improve wound healing in surgical patients . This r and omised controlled trial was conducted at a surgical centre . Inclusion criteria were English-speaking patients over 18 years booked to undergo elective laparoscopic cholecystectomy ; exclusion criteria were cancellation of surgery , medical complications , and refusal of consent . Seventy five patients were r and omised and 15 patients were excluded ; 60 patients completed the study ( 15 male , 45 female ) . Participants were r and omised to receive st and ard care or st and ard care plus a 45-min psychological intervention that included relaxation and guided imagery with take-home relaxation CDs for listening to for 3 days before and 7 days after surgery . In both groups ePTFE tubes were inserted during surgery and removed at 7 days after surgery and analysed for hydroxyproline as a measure of collagen deposition and wound healing . Change in perceived stress from before surgery to 7-day follow-up was assessed using question naires . Intervention group patients showed a reduction in perceived stress compared with the control group , controlling for age . Patients in the intervention group had higher hydroxyproline deposition in the wound than did control group patients ( difference in means 0.35 , 95 % CI 0.66 - 0.03 ; t(43)=2.23 , p=0.03 ) . Changes in perceived stress were not associated with hydroxyproline deposition . A brief relaxation inter 
    Output:
    
agent
Due to the very low quality of the current evidence , the effects of formal patient education provided in addition to the st and ard information provided by doctors to patients compared with st and ard care remain uncertain .
***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: AIMS To investigate the incidence , risk factors and natural history of gallstone disease , a r and om sample of females belonging to a rural population was enrolled in a ten-year longitudinal study . METHODS The study has been performed in a small town on the hills south of Rome . In 1985 , a r and om sample of 426 females , aged 20 - 69 years , was screened by real-time ultrasonography for gallstones and previous cholecystectomy .  Screening methods included anthropometry , collection of a blood sample and a question naire on the occurrence of abdominal symptoms . During 1995 , all these subjects were invited for a 10-year follow-up examination . RESULTS The overall 10-year incidence of gallstone disease was 6.3 % ( 5.5 % of new gallstones and 0.8 % of cholecystectomies ) . Only 23.1 % of the women with gallstones were aware of their condition . More than three quarters ( 76.9 % ) had not suffered biliary pain . Univariate and multivariate analyses demonstrated a positive independent association of new gallstone disease with body mass index and parity . Out of the initially asymptomatic gallstone women , 15.4 % experienced at least one episode of biliary pain , 23.1 % were su bmi tted to elective cholecystectomy and 61.5 % remained asymptomatic . CONCLUSIONS The study demonstrates a high incidence of gallstone disease in women belonging to a rural free-living population in Italy and suggests body mass index and parity as possible true risk factors . Moreover , it confirms that a remarkable proportion of asymptomatic patients become symptomatic and eventually undergo cholecystectomy Aim of this study is the evaluation of the impact of preoperative informative session using a Multimedia Health Educational Program ( MHEP ) on patients undergoing elective Laparoscopic Cholecystectomy ( LC ) for cholelithiasis , preoperative anxiety and postoperative pain and nausea . Sixty consecutive patients scheduled for elective LC were considered for enrollment in the trial . Patients were assigned r and omly to four groups : Group A included 15 patients , preoperatively informed regarding LC through the MHEP presented by a Registered Nurse ( RN ) . Group B included 15 patients  preoperatively informed through a leaflet ( design ed and developed using the exact contents of the MHEP ) . In Group C , there were 15 patients who were being informed verbally from the RN . Finally , the control Group D included 15 patients , who had the conventional preoperative information about the operation and postoperative course by the attending surgeon and anesthesiologist , as every other patient included in groups A , B , C. Preoperative assessment of patient 's knowledge about cholelithiasis and LC was performed after informative session , and was based on a specifically developed " closed , true-false " question naire . Preliminary results suggest that conventional information provided by the attending surgeon ( Group D ) is inadequate . Specifically developed informative sessions with the contribution of MHEP seems to be effective on reducing preoperative anxiety and postoperative pain , in patients undergoing elective LC OBJECTIVES To analyze sources search ed in Cochrane review s , to determine the proportion of trials included in review s that are indexed in major data bases , and to compare the quality of these trials with those from other sources . METHODS All new systematic review s in the Cochrane Library , Issue1 2001 , that were restricted to r and omized controlled trials ( RCTs ) or quasi- RCTs were selected . The sources search ed in the review s were recorded , and the trials included were checked to see whether they were indexed in four major data bases . Trials not indexed were checked to determine how they could be identified . The quality of trials found in major data bases was compared with those found from other sources . RESULTS The range in the number of data bases search ed per review ranged between one and twenty-seven . The proportion of the trials in the four data bases were Cochrane Controlled Trials Register = 78.5 % , MEDLINE = 68.8 % , Embase = 65.0 % , and Science/Social Sciences Citation Index = 60.7 % . Search ing another twenty-six data bases after Cochrane Controlled Trials Register ( CCTR ) , MEDLINE , and Embase only found 2.4 % additional trials . There was no significant difference between trials found in the CCTR , MEDLINE , and Embase compared with other trials , with respect to adequate allocation concealment or sample size . CONCLUSIONS There was a large variation between review s in the exhaustiveness of the literature search es . CCTR was the single best source of RCTs . Additional data base search ing retrieved only a small percentage of extra trials . Contacting authors and manufacturers to find unpublished trials appeared to be a more effective method of obtaining the additional better quality trials A r and om sample of 4,807 men and women , aged 30 , 40 , 50 , and 60 years , who lived in the western part of Copenhagen County , was drawn from the National Central Person Registry . A total of 226 subjects who were not of Danish origin were omitted . The response rate was 78.8 % ( 3,608/4,581 ) . Each person had his or her gallbladder examined by ultrasonography . The examinations took place between November 1982 and February 1984 . The overall prevalence of gallstone disease ( cases with stones and cholecystectomized cases ) in males aged 30 , 40 , 50 , and 60 years was 1.8 % , 1.5 % , 6.7 % , and 12.9 % , respectively . The corresponding prevalence in females was 4.8 % , 6.1 % , 14.4 % , and 22.4 % , respectively . Differences according to sex were significant in all age groups . Differences between the 40- and 50-year and 50- and 60-year age groups were significant in both sexes . Among subjects with gallstone disease , the disease was unknown to the prob and in the majority of males and in the 30-year-old females , but only in half of the women aged 40 , 50 , and 60 years . The prevalence of clinical ly diagnosed gallstones was not significantly different between respondents and nonrespondents A prospect i ve study of the prevalence of gall stone disease at necropsy in a stable population has been undertaken over a 10 year period up to June 1988 . In women , the prevalence of gall stone disease remained static but in men aged 50 - 59 years it rose from 7 % ( n = 148 ) in the first three years to 18 % ( n = 138 ) in the last three years ( p less than 0.01 ) and in men aged 60 - 69 it rose from 12 % ( n = 370 ) to 20 % ( n = 366 , p less than 0.01 ) . In the latter age group the female : male ratio fell from 2:1 to 0.8:1 . The proportion of deaths from coronary heart disease in men fell slightly in those over 70 during the study period . There was a fall in deaths from coronary heart disease in all age groups in women . Men with gall stones were less likely to have had a  cholecystectomy  than women , and overall 88 % of gall stones remained in situ . In a parallel clinical study , the number of cholecystectomies  carried out in the same district fell by 18 % over the 10 years without any apparent change in the provision of re sources .  Cholecystectomy  remained almost three times more frequent in women . National data indicate that there have been major changes in the average diet before and during the period of study in favour of reducing coronary heart disease . There has been no change in mortality from coronary heart disease in young men but if the observed increase in the prevalence of gall stones in men and the decrease in deaths from coronary heart disease in women are real phenomena , it seems likely that they are diet related OBJECTIVE Occupational violence as experienced by professional nurses has been extensively research ed . However , the majority of studies have focused primarily on psychological and emotional outcomes and have not identified any interventions that may reduce the impact of aggressive behaviour on professional competence . The purpose of this study was to investigate the relationship between organisational support , occupational violence and perceived professional competence of professional nurses in Australia . DESIGN A model testing research design was used to test the hypothesis that organisational support , as experienced by nurses , would moderate the relationship between occupational violence and perceived professional competence . SETTING Nurses registered in Division 1 of the Nurses Board ( Victoria , Australia ) . PARTICIPANTS A systematic r and om sample of 380 registered nurses from the target population of nurses in Victoria was identified . MAIN OUTCOME MEASURE The relationship between organisational support , occupational violence and perceived professional competence of professional nurses in Australia . RESULTS The result showed that there was a significant effect of occupational violence on perceived competence . Analysis of the moderating effect of organisational support on the relationship between occupational violence and professional competence showed there was significant  organisational support  and  occupational violence  interaction . Overall , the data analysis demonstrated the hypothesis was upheld that the negative effects of occupational violence on perceived professional competence will be moderated by perceived organisational support . CONCLUSIONS The failure to receive appropriate organisational support may result in lowering  professional nurses ' competence levels , causing a significant problem for the profession in that a reduction in professional competence has significant implication s for patient care . The findings heighten the responsibility of the nursing profession to become more aware of the needs of professional nurses OBJECTIVES The objectives of this r and omised controlled study were to determine if pre-admission patient education affects post-operative pain levels , domiciliary self-care capacity and patient recall following a laparoscopic cholecystectomy ( LC ) . Participants were r and omised to receive the st and ard preadmission program ( SP ) or an individualised , education intervention ( El ) . DESIGN A pre-operative question naire was administered in the pre-admission clinic to determine participants ' knowledge of LC and post-operative management . Telephone follow-up and post-operative question naire were conducted approximately 14 days post discharge . SETTING Preadmission clinic of a Sydney , Australia , tertiary referral hospital . SAMPLE Ninety-three elective LC patients . RESULTS EI participants experienced lower pain levels and had significantly greater recall of provided information . However , no significant differences were found between the control and intervention groups for domiciliary self-care . CONCLUSION Pre-admission education intervention helps reduce post-operative pain levels following LC and significantly increases patients ' knowledge of self-care and complication management Purpose The informed consent is a legal requirement prior to surgery and should be based on an extensive preoperative interview . Multimedia productions can therefore be utilised as supporting tool . In a prospect i ve r and omised trial , we evaluated the impact of an extended education on patients undergoing cholecystectomy . Material s and methods For extended patient information , a professionally built DVD was used . After r and omisation to either the DVD or the control group , patients were informed with or without additional presentation of the DVD . The quality of education was evaluated using a purpose -built question naire . Results One hundred fourteen patients were included in the DVD and 98 in the control group .  Patient characteristics did not differ significantly despite a higher educational level in the DVD group . The score of correctly answered questions was higher in the DVD group ( 19.88 vs. 17.58 points , p < 0.001 ) . As subgroup analysis revealed , particular patient characteristics additionally impacted on results . Conclusion Patients should be informed the most extensively prior to any surgical procedure . Multimedia productions therefore offer a suitable instrument . In the presented study , we could prove the positive impact of an information DVD on patients knowledge . Nevertheless , multimedia tools can not replace personal interaction and should only be used to support daily work Methods for combining data from several studies exist and appear to be quite useful . None satisfactorily addresses the question of what studies should be combined . This issue is the most serious method ological limitation . Even studies with statistically significant interaction might still be combined if the effect were in the same direction . Thus , substantial scientific input is required as to what criteria must be met by each potential study . Much can be learned from combining or pooling data but it must be done cautiously . Pooling exercises do not replace well design ed prospect i ve clinical trials . Efforts for establishing basic design criteria to allow for multicentre and multicountry trials to be more easily combined might be useful . Psychological stress has been shown to impair wound healing , but experimental research in surgical patients is lacking . This study investigated whether a brief psychological intervention could reduce stress and improve wound healing in surgical patients . This r and omised controlled trial was conducted at a surgical centre . Inclusion criteria were English-speaking patients over 18 years booked to undergo elective laparoscopic cholecystectomy ; exclusion criteria were cancellation of surgery , medical complications , and refusal of consent . Seventy five patients were r and omised and 15 patients were excluded ; 60 patients completed the study ( 15 male , 45 female ) . Participants were r and omised to receive st and ard care or st and ard care plus a 45-min psychological intervention that included relaxation and guided imagery with take-home relaxation CDs for listening to for 3 days before and 7 days after surgery . In both groups ePTFE tubes were inserted during surgery and removed at 7 days after surgery and analysed for hydroxyproline as a measure of collagen deposition and wound healing . Change in perceived stress from before surgery to 7-day follow-up was assessed using question naires . Intervention group patients showed a reduction in perceived stress compared with the control group , controlling for age . Patients in the intervention group had higher hydroxyproline deposition in the wound than did control group patients ( difference in means 0.35 , 95 % CI 0.66 - 0.03 ; t(43)=2.23 , p=0.03 ) . Changes in perceived stress were not associated with hydroxyproline deposition . A brief relaxation inter 
    Output:
    