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: Spontaneous pneumothorax ( SP ) is a disabling condition mostly affecting young , thin and otherwise healthy males . It is usually caused by ruptured pleural blebs . The first treatment is the insertion of a chest tube ( ICT ) but in a great number of patients there is recurrence of the disease . We believe that the video assisted thoracoscopy ( VATS ) is the best treatment possible because it allows us to treat the ruptured bleb radically avoiding any recurrence . In order to prove it , 40 patients admitted in a five-year period , with a SP , were r and omly assigned to be treated by ICT or VATS . The ICT patients were in the hospital a mean time of 7.5 ( 4 to 15 ) days and the VATS patients , 5.3 ( 2 to 7 ) days ( P < .05 ) . ICT patients required analgesic drugs during 76.8 + /- 31 hours and VATS patients 38.4 + /- 13 hours ( p < .05 ) . From the ICT group , 8 ( 53 % ) patients had recurrence of the disease and 6 ( 40 % ) had a prolonged air leak , while none of the patients of the VATS group had any complication ( < .001 ) . Cost of ICT and VATS  were $ 850 and $ 1730 , respectively . According to these results , VATS should be the treatment of choice in SP patients . It treats the cause of the disease . It also reduces the hospitalization time , the use of analgesic drugs post surgery , decreases recurrence of the disease and the cost of the treatment . Moreover , the patients were back to work in less than 10 days BACKGROUND The recent recognition that coronary-artery stenting has improved the short- and long-term outcomes of patients treated with angioplasty has made it necessary to reevaluate the relative benefits of bypass surgery and percutaneous interventions in patients with multivessel disease . METHODS A total of 1205 patients were r and omly assigned to undergo stent implantation or bypass surgery when a cardiac surgeon and an interventional cardiologist agreed that the same extent of revascularization could be achieved by either technique . The primary clinical end point was freedom from major adverse cardiac and cerebrovascular events at one year . The costs of hospital re sources used were also determined . RESULTS At one year , there was no significant difference between the two groups in terms of the rates of death , stroke , or myocardial infa rct ion . Among patients who survived without a stroke or a myocardial infa rct ion , 16.8 percent of those in the stenting group underwent a second revascularization , as compared with 3.5 percent of those in the surgery group . The rate of event-free survival at one year was 73.8 percent among the patients who received stents and 87.8 percent among those who underwent bypass surgery ( P<0.001 by the log-rank test ) . The costs for the initial procedure were $ 4,212 less for patients assigned to stenting than for those assigned to bypass surgery , but this difference was reduced during follow-up because of the increased need for repeated revascularization ; after one year , the net difference in favor of stenting was estimated to be $ 2,973 per patient . CONCLUSION As measured one year after the procedure , coronary stenting for multivessel disease is less expensive than bypass surgery and offers the same degree of protection against death , stroke , and myocardial infa rct ion . However , stenting is associated with a greater need for repeated revascularization BACKGROUND The combination of ceftazidime plus aminoglycoside is widely used for the treatment of febrile neutropenic patients but requires multiple daily administration . Because the frequency of Pseudomonas aeruginosa is low in many centers , there is a rationale to test other antibiotic regimens that provide appropriate antibacterial coverage with the advantage of reduced dosing frequency , such as once daily ceftriaxone plus amikacin . METHODS Febrile neutropenic children with leukemia , lymphoma or solid tumors after chemotherapy were included in an open , prospect i ve , r and omized , multinational study comparing once daily ceftriaxone plus amikacin vs. 8-hourly ceftazidime and amikacin . The response to antimicrobial therapy was defined as complete response , improvement or failure . Assessment of adverse events was supplemented by specific definitions of nephrotoxicity , ototoxicity , hepatotoxicity and hypokalemia . Costs were estimated from published values of acquisition costs , delivery costs and hospitalization costs . RESULTS Efficacy was evaluable in 364 of 468 episodes in 265 children .  Response rates in ceftriaxone and amikacin vs. ceftazidime and amikacin-treated episodes were 119 of 181 ( 66 % ) vs. 121 of 183 ( 66 % ) , 7 of 181 ( 4 % ) vs. 9 of 183 ( 5 % ) and 55 of 181 ( 30 % ) vs. 53 of 181 ( 29 % ) for complete response , improvement and failure , respectively . Safety profiles were similar with both treatment regimens . The acquisition and administration costs were lower for the ceftriaxone and amikacin regimen . CONCLUSIONS A once daily regimen of ceftriaxone and amikacin is as safe and clinical ly effective as that of three times daily ceftazidime and amikacin for the treatment of febrile neutropenic children with cancer and is more cost-effective . The once daily regimen of ceftriaxone and amikacin is suitable for outpatient treatment Background —Our aims were to compare coronary artery bypass grafting ( CABG ) and stenting for the treatment of diabetic patients with multivessel coronary disease enrolled in the Arterial Revascularization Therapy Study ( ARTS ) trial and to determine the costs of these 2 treatment strategies . Methods and Results — Patients ( n=1205 ) were r and omly assigned to stent implantation  ( n=600 ; diabetic , 112 ) or CABG ( n=605 ; diabetic , 96 ) . Costs per patient were calculated as the product of each patient ’s use of re sources and the corresponding unit costs . Baseline characteristics were similar between the groups . At 1 year , diabetic patients treated with stenting had the lowest event-free survival rate ( 63.4 % ) because of a higher incidence of repeat revascularization compared with both diabetic patients treated with CABG ( 84.4 % , P < 0.001 ) and nondiabetic patients treated with stents ( 76.2 % , P = 0.04 ) . Conversely , diabetic and nondiabetic patients experienced similar 1-year event-free survival rates when treated with CABG ( 84.4 % and 88.4 % ) . The total 1-year costs for stenting and CABG in diabetic patients were $ 12 855 and $ 16 585 ( P < 0.001 ) and in the nondiabetic groups , $ 10 164 for stenting and $ 13 082 for surgery . Conclusions —Multivessel diabetic patients treated with stenting  had a worse 1-year outcome than patients assigned to CABG or nondiabetics treated with stenting . The strategy of stenting was less costly than CABG , however , regardless of diabetic status The escalating role played by managed care organizations in the health-care system is reflected in the increased dem and for cost-effectiveness analyses ( CEAs ) to assess the balance between economic impact and clinical efficacy . For example , the high incidence and costs associated with colorectal cancer in Latin America calls for a comprehensive economic evaluation to ensure appropriate allocation of limited health-care funds . In addition , the current call for a " societal " perspective of such analyses indicates the need for increased consideration of the concerns of both patient and health-care provider . The introduction of oral tegafur and uracil ( UFT ) provided the opportunity to evaluate the pharmacoeconomic advantage of the new agent compared with the st and ard fluorouracil ( 5-FU ) . Results of this study indicated an economic advantage for oral UFT vs a 5-FU-based regimen in the treatment of colorectal cancer in Brazil and Argentina . It was further noted that the mild toxicity profile of UFT reduced both the number of clinic visits and the need for venipuncture procedures . Noting that oral UFT may have a positive impact on quality of life in addition to its estimated economic benefit , it was concluded that prospect i ve economic research and quality -of-life evaluations are needed to fully assess the pharmacoeconomic impact of oral UFT OBJECTIVES The second Primary Angioplasty in Myocardial Infa rct ion ( PAMI-II ) study evaluated the hypothesis that primary percutaneous transluminal coronary angioplasty ( PTCA ) , with subsequent discharge from the hospital 3 days later , is safe and cost-effective in low risk patients . BACKGROUND In low risk patients with myocardial infa rct ion ( MI ) , few data exist regarding the need for intensive care and noninvasive testing or the appropriate length of hospital stay . METHODS Patients with acute MI underwent emergency catheterization with primary PTCA  when appropriate . Low risk patients ( age < 70 years , left ventricular ejection fraction > 45 % , one- or two-vessel disease , successful PTCA , no persistent arrhythmias ) were r and omized to receive accelerated care ( admission to a nonintensive care unit and day 3 hospital discharge without noninvasive testing [ n = 237 ] or traditional care [ n = 234 ] ) . RESULTS Patients who received accelerated care had similar in-hospital outcomes but were discharged 3 days earlier ( 4.2+/-2.3 vs. 7.1+/-4.7 days , p = 0.0001 ) and had lower hospital costs ( $ 9,658+/-5,287 vs. $ 11,604+/-6,125 p = 0.002 ) than the patients who received traditional care . At 6 months , accelerated and traditional care groups had a similar rate of mortality ( 0.8 % vs. 0.4 % , p = 1.00 ) , unstable ischemia ( 10.1 % vs. 12.0 % , p = 0.52 ) , reinfa rct ion ( 0.8 % vs. 0.4 % , p = 1.00 ) , stroke ( 0.4 % vs. 2.6 % , p = 0.07 ) , congestive heart failure ( 4.6 % vs. 4.3 % , p = 0.85 ) or their combined occurrence ( 15.2 % vs. 17.5 % , p = 0.49 ) . The study was design ed to detect a 10 % difference in event rates ; at 6 months , only a 2.3 % difference was measured between groups , indicating an actual power of 0.19 . CONCLUSIONS Early identification of low risk patients with MI allowed safe omission of the intensive care phase and noninvasive testing , and a day 3 hospital discharge strategy , result ing in substantial cost savings OBJECTIVES This study was design ed to compare freedom from combined cardiac events ( death , angina , myocardial infa rct ion ) at 1- , 3- and 5-year follow-up in patients with multivessel disease r and omized to either percutaneous transluminal coronary angioplasty or coronary artery bypass graft surgery .  BACKGROUND Percutaneous transluminal coronary angioplasty has been an effective approach in patients with coronary artery disease , but its role in patients with multivessel coronary artery disease is still controversial . METHODS One-hundred twenty-seven patients with multivessel disease and lesions suitable for either form of therapy were r and omized to either coronary artery bypass grafting ( n = 64 ) or coronary angioplasty ( n = 63 ) . In this study we report the immediate results and freedom from combined cardiac events at 1-year follow-up . RESULTS Demographic , clinical and angiographic characteristics were similar in both groups . There were no differences in in-hospital deaths , frequency of periprocedure myocardial infa rct ion or need for emergency revascularization procedures between the two groups . At 1-year follow-up , there were no differences in mortality or in the incidence of myocardial infa rct ion between the groups . However , patients treated with coronary artery bypass grafting were more frequently free of angina , re interventions and combined cardiac events than were patients treated with coronary angioplasty ( 83.5 % vs. 63.7 % , p < 0.005 ) . In-hospital cost and cumulative cost at 1-year follow-up were greater for the coronary artery bypass grafting than for the coronary angioplasty group . CONCLUSIONS No significant differences were found in major in-hospital complications between patients treated with coronary artery bypass grafting or coronary angioplasty . Although at 1-year follow-up there were no differences in survival and freedom from myocardial infa rct ion , patients in the coronary artery bypass grafting group were more frequently free from angina , re interventions and combined events than were patients in the coronary angioplasty group Study sample 263 cyst carriers were identified from a sample population of 12,000 ( 2.1 % ) . From these , two groups each totalling 100 , were assigned to either a treatment ( receiving metronidazole ) or control ( receiving placebo ) group . Power calculations ( no details provided ) determined a minimum sample size of 79 . A loss rate of 20 % was estimated by the authors and this determined the two sample size totals , explaining the loss of 63 
    Output:
    
agent
While we found relatively good st and ards of reporting the study ’s question , population , interventions , comparators and conclusions , the overall reporting was poor , and evidence of unfamiliarity with international guidelines was evident ( i.e. absence of incremental analysis , of discounting long-term costs and effects ) .
Analysis or description of place-to-place variability was infrequent .
***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: Spontaneous pneumothorax ( SP ) is a disabling condition mostly affecting young , thin and otherwise healthy males . It is usually caused by ruptured pleural blebs . The first treatment is the insertion of a chest tube ( ICT ) but in a great number of patients there is recurrence of the disease . We believe that the video assisted thoracoscopy ( VATS ) is the best treatment possible because it allows us to treat the ruptured bleb radically avoiding any recurrence . In order to prove it , 40 patients admitted in a five-year period , with a SP , were r and omly assigned to be treated by ICT or VATS . The ICT patients were in the hospital a mean time of 7.5 ( 4 to 15 ) days and the VATS patients , 5.3 ( 2 to 7 ) days ( P < .05 ) . ICT patients required analgesic drugs during 76.8 + /- 31 hours and VATS patients 38.4 + /- 13 hours ( p < .05 ) . From the ICT group , 8 ( 53 % ) patients had recurrence of the disease and 6 ( 40 % ) had a prolonged air leak , while none of the patients of the VATS group had any complication ( < .001 ) . Cost of ICT and VATS  were $ 850 and $ 1730 , respectively . According to these results , VATS should be the treatment of choice in SP patients . It treats the cause of the disease . It also reduces the hospitalization time , the use of analgesic drugs post surgery , decreases recurrence of the disease and the cost of the treatment . Moreover , the patients were back to work in less than 10 days BACKGROUND The recent recognition that coronary-artery stenting has improved the short- and long-term outcomes of patients treated with angioplasty has made it necessary to reevaluate the relative benefits of bypass surgery and percutaneous interventions in patients with multivessel disease . METHODS A total of 1205 patients were r and omly assigned to undergo stent implantation or bypass surgery when a cardiac surgeon and an interventional cardiologist agreed that the same extent of revascularization could be achieved by either technique . The primary clinical end point was freedom from major adverse cardiac and cerebrovascular events at one year . The costs of hospital re sources used were also determined . RESULTS At one year , there was no significant difference between the two groups in terms of the rates of death , stroke , or myocardial infa rct ion . Among patients who survived without a stroke or a myocardial infa rct ion , 16.8 percent of those in the stenting group underwent a second revascularization , as compared with 3.5 percent of those in the surgery group . The rate of event-free survival at one year was 73.8 percent among the patients who received stents and 87.8 percent among those who underwent bypass surgery ( P<0.001 by the log-rank test ) . The costs for the initial procedure were $ 4,212 less for patients assigned to stenting than for those assigned to bypass surgery , but this difference was reduced during follow-up because of the increased need for repeated revascularization ; after one year , the net difference in favor of stenting was estimated to be $ 2,973 per patient . CONCLUSION As measured one year after the procedure , coronary stenting for multivessel disease is less expensive than bypass surgery and offers the same degree of protection against death , stroke , and myocardial infa rct ion . However , stenting is associated with a greater need for repeated revascularization BACKGROUND The combination of ceftazidime plus aminoglycoside is widely used for the treatment of febrile neutropenic patients but requires multiple daily administration . Because the frequency of Pseudomonas aeruginosa is low in many centers , there is a rationale to test other antibiotic regimens that provide appropriate antibacterial coverage with the advantage of reduced dosing frequency , such as once daily ceftriaxone plus amikacin . METHODS Febrile neutropenic children with leukemia , lymphoma or solid tumors after chemotherapy were included in an open , prospect i ve , r and omized , multinational study comparing once daily ceftriaxone plus amikacin vs. 8-hourly ceftazidime and amikacin . The response to antimicrobial therapy was defined as complete response , improvement or failure . Assessment of adverse events was supplemented by specific definitions of nephrotoxicity , ototoxicity , hepatotoxicity and hypokalemia . Costs were estimated from published values of acquisition costs , delivery costs and hospitalization costs . RESULTS Efficacy was evaluable in 364 of 468 episodes in 265 children .  Response rates in ceftriaxone and amikacin vs. ceftazidime and amikacin-treated episodes were 119 of 181 ( 66 % ) vs. 121 of 183 ( 66 % ) , 7 of 181 ( 4 % ) vs. 9 of 183 ( 5 % ) and 55 of 181 ( 30 % ) vs. 53 of 181 ( 29 % ) for complete response , improvement and failure , respectively . Safety profiles were similar with both treatment regimens . The acquisition and administration costs were lower for the ceftriaxone and amikacin regimen . CONCLUSIONS A once daily regimen of ceftriaxone and amikacin is as safe and clinical ly effective as that of three times daily ceftazidime and amikacin for the treatment of febrile neutropenic children with cancer and is more cost-effective . The once daily regimen of ceftriaxone and amikacin is suitable for outpatient treatment Background —Our aims were to compare coronary artery bypass grafting ( CABG ) and stenting for the treatment of diabetic patients with multivessel coronary disease enrolled in the Arterial Revascularization Therapy Study ( ARTS ) trial and to determine the costs of these 2 treatment strategies . Methods and Results — Patients ( n=1205 ) were r and omly assigned to stent implantation  ( n=600 ; diabetic , 112 ) or CABG ( n=605 ; diabetic , 96 ) . Costs per patient were calculated as the product of each patient ’s use of re sources and the corresponding unit costs . Baseline characteristics were similar between the groups . At 1 year , diabetic patients treated with stenting had the lowest event-free survival rate ( 63.4 % ) because of a higher incidence of repeat revascularization compared with both diabetic patients treated with CABG ( 84.4 % , P < 0.001 ) and nondiabetic patients treated with stents ( 76.2 % , P = 0.04 ) . Conversely , diabetic and nondiabetic patients experienced similar 1-year event-free survival rates when treated with CABG ( 84.4 % and 88.4 % ) . The total 1-year costs for stenting and CABG in diabetic patients were $ 12 855 and $ 16 585 ( P < 0.001 ) and in the nondiabetic groups , $ 10 164 for stenting and $ 13 082 for surgery . Conclusions —Multivessel diabetic patients treated with stenting  had a worse 1-year outcome than patients assigned to CABG or nondiabetics treated with stenting . The strategy of stenting was less costly than CABG , however , regardless of diabetic status The escalating role played by managed care organizations in the health-care system is reflected in the increased dem and for cost-effectiveness analyses ( CEAs ) to assess the balance between economic impact and clinical efficacy . For example , the high incidence and costs associated with colorectal cancer in Latin America calls for a comprehensive economic evaluation to ensure appropriate allocation of limited health-care funds . In addition , the current call for a " societal " perspective of such analyses indicates the need for increased consideration of the concerns of both patient and health-care provider . The introduction of oral tegafur and uracil ( UFT ) provided the opportunity to evaluate the pharmacoeconomic advantage of the new agent compared with the st and ard fluorouracil ( 5-FU ) . Results of this study indicated an economic advantage for oral UFT vs a 5-FU-based regimen in the treatment of colorectal cancer in Brazil and Argentina . It was further noted that the mild toxicity profile of UFT reduced both the number of clinic visits and the need for venipuncture procedures . Noting that oral UFT may have a positive impact on quality of life in addition to its estimated economic benefit , it was concluded that prospect i ve economic research and quality -of-life evaluations are needed to fully assess the pharmacoeconomic impact of oral UFT OBJECTIVES The second Primary Angioplasty in Myocardial Infa rct ion ( PAMI-II ) study evaluated the hypothesis that primary percutaneous transluminal coronary angioplasty ( PTCA ) , with subsequent discharge from the hospital 3 days later , is safe and cost-effective in low risk patients . BACKGROUND In low risk patients with myocardial infa rct ion ( MI ) , few data exist regarding the need for intensive care and noninvasive testing or the appropriate length of hospital stay . METHODS Patients with acute MI underwent emergency catheterization with primary PTCA  when appropriate . Low risk patients ( age < 70 years , left ventricular ejection fraction > 45 % , one- or two-vessel disease , successful PTCA , no persistent arrhythmias ) were r and omized to receive accelerated care ( admission to a nonintensive care unit and day 3 hospital discharge without noninvasive testing [ n = 237 ] or traditional care [ n = 234 ] ) . RESULTS Patients who received accelerated care had similar in-hospital outcomes but were discharged 3 days earlier ( 4.2+/-2.3 vs. 7.1+/-4.7 days , p = 0.0001 ) and had lower hospital costs ( $ 9,658+/-5,287 vs. $ 11,604+/-6,125 p = 0.002 ) than the patients who received traditional care . At 6 months , accelerated and traditional care groups had a similar rate of mortality ( 0.8 % vs. 0.4 % , p = 1.00 ) , unstable ischemia ( 10.1 % vs. 12.0 % , p = 0.52 ) , reinfa rct ion ( 0.8 % vs. 0.4 % , p = 1.00 ) , stroke ( 0.4 % vs. 2.6 % , p = 0.07 ) , congestive heart failure ( 4.6 % vs. 4.3 % , p = 0.85 ) or their combined occurrence ( 15.2 % vs. 17.5 % , p = 0.49 ) . The study was design ed to detect a 10 % difference in event rates ; at 6 months , only a 2.3 % difference was measured between groups , indicating an actual power of 0.19 . CONCLUSIONS Early identification of low risk patients with MI allowed safe omission of the intensive care phase and noninvasive testing , and a day 3 hospital discharge strategy , result ing in substantial cost savings OBJECTIVES This study was design ed to compare freedom from combined cardiac events ( death , angina , myocardial infa rct ion ) at 1- , 3- and 5-year follow-up in patients with multivessel disease r and omized to either percutaneous transluminal coronary angioplasty or coronary artery bypass graft surgery .  BACKGROUND Percutaneous transluminal coronary angioplasty has been an effective approach in patients with coronary artery disease , but its role in patients with multivessel coronary artery disease is still controversial . METHODS One-hundred twenty-seven patients with multivessel disease and lesions suitable for either form of therapy were r and omized to either coronary artery bypass grafting ( n = 64 ) or coronary angioplasty ( n = 63 ) . In this study we report the immediate results and freedom from combined cardiac events at 1-year follow-up . RESULTS Demographic , clinical and angiographic characteristics were similar in both groups . There were no differences in in-hospital deaths , frequency of periprocedure myocardial infa rct ion or need for emergency revascularization procedures between the two groups . At 1-year follow-up , there were no differences in mortality or in the incidence of myocardial infa rct ion between the groups . However , patients treated with coronary artery bypass grafting were more frequently free of angina , re interventions and combined cardiac events than were patients treated with coronary angioplasty ( 83.5 % vs. 63.7 % , p < 0.005 ) . In-hospital cost and cumulative cost at 1-year follow-up were greater for the coronary artery bypass grafting than for the coronary angioplasty group . CONCLUSIONS No significant differences were found in major in-hospital complications between patients treated with coronary artery bypass grafting or coronary angioplasty . Although at 1-year follow-up there were no differences in survival and freedom from myocardial infa rct ion , patients in the coronary artery bypass grafting group were more frequently free from angina , re interventions and combined events than were patients in the coronary angioplasty group Study sample 263 cyst carriers were identified from a sample population of 12,000 ( 2.1 % ) . From these , two groups each totalling 100 , were assigned to either a treatment ( receiving metronidazole ) or control ( receiving placebo ) group . Power calculations ( no details provided ) determined a minimum sample size of 79 . A loss rate of 20 % was estimated by the authors and this determined the two sample size totals , explaining the loss of 63 
    Output:
    