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: CONTEXT Postoperative enteral nutrition is thought to reduce complications and speed recovery after pancreatic resection . There is little evidence on the best route for delivery of enteral nutrition . Currently we use percutaneous transperitoneal jejunostomy or percutaneous transperitoneal gastrojejunostomy , or the nasojejunal route to deliver enteral nutrition , according to surgeon preference . OBJECTIVE To compare morbidity , efficiency , and safety of these three routes for enteral nutrition following pancreaticoduodenectomy . PATIENTS Data were obtained from a prospect ively maintained data base , for all patients undergoing pancreatic resection between January 2007 and June 2008 . One-hundred pancreatic resected patients underwent enteral nutrition : 93 had Whipple 's operations and 7 had total pancreatectomies . INTERVENTION Enteral nutrition was delivered by agreed protocol , starting within 24 h of operation and increasing over 2 - 3 days to meet full nutritional requirement . RESULTS Delivery route of enteral nutrition was : percutaneous transperitoneal jejunostomy in 25 ( 25 % ) , percutaneous transperitoneal gastrojejunostomy in 32 ( 32 % ) and nasojejunal in 43 ( 43 % ) . The incidence of catheter-related complications was higher in percutaneous techniques : 24 % in percutaneous transperitoneal jejunostomy and 34 % in percutaneous transperitoneal gastrojejunostomy as compared to nasojejunal technique ( 12 % ) . Median time to complete establishment of oral intake was 14 , 14 and 10 days in percutaneous transperitoneal jejunostomy , percutaneous transperitoneal gastrojejunostomy , and nasojejunal groups , respectively .  Nasojejunal tubes were removed at median 11 days ( mean 11.5 days ) compared to 5 - 6 weeks for percutaneous transperitoneal jejunostomy and percutaneous transperitoneal gastrojejunostomy . Commonest catheter-related complication in the percutaneous transperitoneal jejunostomy and percutaneous transperitoneal gastrojejunostomy was blockage ( n=6 ; 10.5 % ) , followed by pain after removal of feeding tube at 5 - 6 weeks ( n=5 ; 8.8 % ) , whereas in the nasojejunal group it was blockage ( n=3 ; 7.0 % ) , followed by displacement ( n=2 ; 4.7 % ) . Two patients died postoperatively in this cohort , however , there were no catheter-related mortalities . CONCLUSION Enteral nutrition following pancreatic resection can be delivered in different ways . Nasojejunal feeding was associated with fewest and less serious complications . On current evidence surgeon preference is a reasonable way to decide enteral nutrition but a r and omized controlled trial is needed to address this issue Background Poor nutrition in the first months after oesophago-gastric resection is a contributing factor to the reduced quality of life seen in these patients . The aim of this pilot and feasibility study was to ascertain the feasibility of conducting a multi-centre r and omised controlled trial to evaluate routine home enteral nutrition in these patients . Methods Patients undergoing oesophagectomy or total gastrectomy were r and omised to either six weeks of home feeding through a jejunostomy ( intervention ) , or treatment as usual ( control ) . Intervention comprised overnight feeding , providing 50 % of energy and protein requirements , in addition to usual oral intake . Primary outcome measures were recruitment and retention rates at six weeks and six months . Nutritional intake , nutritional parameters , quality of life and healthcare costs were also collected . Interviews were conducted with a sample of participants , to ascertain patient and carer experiences . Results Fifty-four of 112 ( 48 % ) eligible patients participated in the study over the 20 months . Study retention at six weeks was 41/54 patients ( 76 % ) and at six months was 36/54 ( 67 % ) . At six weeks , participants in the control group had lost on average 3.9 kg more than participants in the intervention group ( 95 % confidence interval [ CI ] 1.6 to 6.2 ) . These differences remained evident at three months ( mean difference 2.5 kg , 95 % CI −0.5 to 5.6 ) and at six months ( mean difference 2.5 kg , 95 % CI −1.2 to 6.1 ) . The mean values observed in the intervention group for mid arm circumference , mid arm muscle circumference , triceps skin fold thickness and right h and grip strength were greater than for the control group at all post hospital discharge time points . The economic evaluation suggested that it was feasible to collect re source use and EQ-5D data for a full cost-effectiveness analysis . Thematic analysis of 15 interviews identified three main themes related to the intervention and the trial : 1 ) a positive experience , 2 ) the reasons for taking part , and 3 ) uncertainty of the study process . Conclusions This study demonstrated that home enteral feeding by jejunostomy was feasible , safe and acceptable to patients and their carers . Whether home enteral feeding as ’ usual practice ’ is a cost-effective therapy would require confirmation in an appropriately powered , multi-centre study .Trial registration UK Clinical Research Network ID 12447 ( main trial , first registered 30 May 2012 ) ; UK Clinical Research Network ID 13361 ( qualitative sub study , first registered 30 May 2012 ) ; Clinical Trials.gov NCT01870817 ( first registered 28 May 2013 ABSTRACT Objective : To evaluate the change in respiratory function and functional capacity according to the type of preoperative fasting . Methods : R and omized prospect i ve clinical trial , with 92 female patients undergoing cholecystectomy by laparotomy with conventional or 2 hours shortened fasting .  The variables measured were the peak expiratory flow , forced expiratory volume in the first second , forced vital capacity , dominant h and grip strength , and non-dominant h and grip strength . Evaluations were performed 2 hours before induction of anesthesia and 24 hours after the operation . Results : The two groups were similar in preoperative evaluations regarding demographic and clinical characteristics , as well as for all variables . However , postoperatively the group with shortened fasting had higher values than the group with conventional fasting for lung function tests peak expiratory flow ( 128.7±62.5 versus 115.7±59.9 ; p=0.040 ) , forced expiratory volume in the first second ( 1.5±0.6 versus 1.2±0.5 ; p=0.040 ) , forced vital capacity ( 2.3±1.1 versus 1.8±0.9 ; p=0.021 ) , and for muscle function tests dominant h and grip strength ( 24.9±6.8 versus 18.4±7.7 ; p=0.001 ) and non-dominant h and grip strength ( 22.9±6.3 versus 17.0±7.8 ; p=0.0002 ) . In the intragroup evaluation , there was a decrease in preoperative compared with postoperative values , except for dominant h and grip strength ( 25.2±6.7 versus 24.9±6.8 ; p=0.692 ) , in the shortened fasting group . Conclusion : Abbreviation of preoperative fasting time with ingestion of maltodextrin solution is beneficial to pulmonary function and preserves dominant h and grip strength BACKGROUND Patients undergoing upper gastrointestinal surgery often eat poorly post-operatively , despite dietetic input . A pilot study was conducted to examine the benefit of a 6 week nutritional supplementation via a feeding jejunostomy on fatigue , quality of life and independent living . METHODS A feeding jejunostomy was placed routinely at oesophagectomy or total gastrectomy for cancer . At discharge , patients were r and omised to nutritional supplementation ( 600 kcal/day ) via their feeding jejunostomies or no jejunal supplement . Patients were assessed at discharge and 3 , 6 , 12 and 24 weeks following discharge for fatigue ( MFI-20 ) , quality of life ( QLQ-OES18 ) , health economic analysis ( EQ5D ) as well as completing a two-day dietary diary . RESULTS 44 patients ( M : F , 29:15 ) were r and omised , 23 received jejunal supplements . There were no differences between the groups . Percentage of calculated energy requirement received was greater in the supplemented group at weeks 3 and 6 ( p < 0.0001 ) . Oral energy intake was not different between the groups at any time period . After hospital discharge , there were no differences in MFI-20 , EQ5D and QLQ-OES18 scores at any time point . From hospital discharge fatigue improved and plateaued at 6 weeks ( p < 0.05 for both groups ) , independence at 12 weeks ( p < 0.05 for both groups ) . No improvement was seen in quality of life until 24 weeks in the active group alone ( p < 0.02 ) and not at all in the control group . CONCLUSIONS Addition of jejunal feeding is effective in providing patients with an adequate energy intake . Increased energy intake however , produced no obvious improvement in measures of fatigue , quality of life or health economics This document represents the first collaboration between 2 organizations — the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine — to describe best practice s in nutrition therapy in critically ill children . The target of these guidelines is intended to be the pediatric critically ill patient ( > 1 month and 2–3 days in a PICU admitting medical , surgical , and cardiac patients . In total , 2032 citations were scanned for relevance . The PubMed / MEDLINE search result ed in 960 citations for clinical trials and 925 citations for cohort studies . The EMBASE search for clinical trials culled 1661 citations . In total , the search for clinical trials yielded 1107 citations , whereas the cohort search yielded 925 . After careful review , 16 r and omized controlled trials and 37 cohort studies appeared to answer 1 of the 8 preidentified question groups for this guideline . We used the GRADE criteria ( Grading of Recommendations , Assessment , Objective : To determine whether glutamine (GLN)-supplemented parenteral nutrition ( PN ) improves clinical outcomes in surgical intensive care unit ( SICU ) patients . Summary Background Data : GLN requirements may increase with critical illness . GLN-supplemented PN may improve clinical outcomes in SICU patients . Methods : A parallel-group , multicenter , double-blind , r and omized , controlled clinical trial in 150 adults after gastrointestinal , vascular , or cardiac surgery requiring PN and SICU care . Patients were without significant renal or hepatic failure or shock at entry . All received isonitrogenous , isocaloric PN [ 1.5 g/kg/d amino acids ( AAs ) and energy at 1.3 × estimated basal energy expenditure ] . Controls ( n = 75 ) received st and ard GLN-free PN ( STD-PN ) ; the GLN group ( n = 75 ) received PN containing alanyl-GLN dipeptide ( 0.5 g/kg/d ) , proportionally replacing AA in PN ( GLN-PN ) . Enteral nutrition ( EN ) was advanced and PN weaned as indicated . Hospital mortality and infections were primary endpoints . Results : Baseline characteristics , days on study PN and daily macronutrient intakes via PN and EN , were similar between groups . There were 11 hospital deaths ( 14.7 % ) in the GLN-PN group and 13 deaths in the STD-PN group ( 17.3 % ; difference , −2.6 % ; 95 % confidence interval , −14.6 % to 9.3 % ; P = 0.66 ) . The 6-month cumulative mortality was 31.4 % in the GLN-PN group and 29.7 % in the STD-PN group ( P = 0.88 ) . Incident bloodstream infection rate was 9.6 and 8.4 per 1000 hospital days in the GLN-PN and STD-PN groups , respectively ( P = 0.73 ) . Other clinical outcomes and adverse events were similar . Conclusions : PN supplemented with GLN dipeptide was safe , but did not alter clinical outcomes among SICU patients The benefits of early enteral feeding ( EEN ) have been demonstrated in gastrointestinal surgery . But , the impact of EEN has not been eluci date d yet . We assessed the postoperative nutritional status of patients who had undergone pancreaticoduodenectomy ( PD ) according to the postoperative nutritional method and compared the clinical outcomes of two methods . A prospect i ve r and omized trial was undertaken following PD . Patients were r and omly divided into two groups ; the EEN group received the postoperative enteral feed and the control group received the postoperative total parenteral nutrition ( TPN ) management .  Thirty-eight patients were included in our analyses . The first day of bowel movement and time to take a normal soft diet was significantly shorter in EEN group than in TPN group . Prealbumin and transferrin were significantly reduced on post-operative day ( POD ) 7 and were slowly recovered until POD 90 in the TPN group than in the EEN group . EEN group rapidly recovered weight after POD 21 whereas it 
    Output:
    
agent
this guideline reflects the recommendations of the group of specialists of the Brazilian College of Surgeons , the Brazilian Society of Parenteral and Enteral Nutrition and the ACERTO Project for nutritional interventions in the perioperative period of Elective General Surgery .
The prescription of these recommendations can accelerate the postoperative recovery of patients su bmi tted to elective general surgery , with decrease in morbidity , length of stay and rehospitalization , and consequently , of costs
***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: CONTEXT Postoperative enteral nutrition is thought to reduce complications and speed recovery after pancreatic resection . There is little evidence on the best route for delivery of enteral nutrition . Currently we use percutaneous transperitoneal jejunostomy or percutaneous transperitoneal gastrojejunostomy , or the nasojejunal route to deliver enteral nutrition , according to surgeon preference . OBJECTIVE To compare morbidity , efficiency , and safety of these three routes for enteral nutrition following pancreaticoduodenectomy . PATIENTS Data were obtained from a prospect ively maintained data base , for all patients undergoing pancreatic resection between January 2007 and June 2008 . One-hundred pancreatic resected patients underwent enteral nutrition : 93 had Whipple 's operations and 7 had total pancreatectomies . INTERVENTION Enteral nutrition was delivered by agreed protocol , starting within 24 h of operation and increasing over 2 - 3 days to meet full nutritional requirement . RESULTS Delivery route of enteral nutrition was : percutaneous transperitoneal jejunostomy in 25 ( 25 % ) , percutaneous transperitoneal gastrojejunostomy in 32 ( 32 % ) and nasojejunal in 43 ( 43 % ) . The incidence of catheter-related complications was higher in percutaneous techniques : 24 % in percutaneous transperitoneal jejunostomy and 34 % in percutaneous transperitoneal gastrojejunostomy as compared to nasojejunal technique ( 12 % ) . Median time to complete establishment of oral intake was 14 , 14 and 10 days in percutaneous transperitoneal jejunostomy , percutaneous transperitoneal gastrojejunostomy , and nasojejunal groups , respectively .  Nasojejunal tubes were removed at median 11 days ( mean 11.5 days ) compared to 5 - 6 weeks for percutaneous transperitoneal jejunostomy and percutaneous transperitoneal gastrojejunostomy . Commonest catheter-related complication in the percutaneous transperitoneal jejunostomy and percutaneous transperitoneal gastrojejunostomy was blockage ( n=6 ; 10.5 % ) , followed by pain after removal of feeding tube at 5 - 6 weeks ( n=5 ; 8.8 % ) , whereas in the nasojejunal group it was blockage ( n=3 ; 7.0 % ) , followed by displacement ( n=2 ; 4.7 % ) . Two patients died postoperatively in this cohort , however , there were no catheter-related mortalities . CONCLUSION Enteral nutrition following pancreatic resection can be delivered in different ways . Nasojejunal feeding was associated with fewest and less serious complications . On current evidence surgeon preference is a reasonable way to decide enteral nutrition but a r and omized controlled trial is needed to address this issue Background Poor nutrition in the first months after oesophago-gastric resection is a contributing factor to the reduced quality of life seen in these patients . The aim of this pilot and feasibility study was to ascertain the feasibility of conducting a multi-centre r and omised controlled trial to evaluate routine home enteral nutrition in these patients . Methods Patients undergoing oesophagectomy or total gastrectomy were r and omised to either six weeks of home feeding through a jejunostomy ( intervention ) , or treatment as usual ( control ) . Intervention comprised overnight feeding , providing 50 % of energy and protein requirements , in addition to usual oral intake . Primary outcome measures were recruitment and retention rates at six weeks and six months . Nutritional intake , nutritional parameters , quality of life and healthcare costs were also collected . Interviews were conducted with a sample of participants , to ascertain patient and carer experiences . Results Fifty-four of 112 ( 48 % ) eligible patients participated in the study over the 20 months . Study retention at six weeks was 41/54 patients ( 76 % ) and at six months was 36/54 ( 67 % ) . At six weeks , participants in the control group had lost on average 3.9 kg more than participants in the intervention group ( 95 % confidence interval [ CI ] 1.6 to 6.2 ) . These differences remained evident at three months ( mean difference 2.5 kg , 95 % CI −0.5 to 5.6 ) and at six months ( mean difference 2.5 kg , 95 % CI −1.2 to 6.1 ) . The mean values observed in the intervention group for mid arm circumference , mid arm muscle circumference , triceps skin fold thickness and right h and grip strength were greater than for the control group at all post hospital discharge time points . The economic evaluation suggested that it was feasible to collect re source use and EQ-5D data for a full cost-effectiveness analysis . Thematic analysis of 15 interviews identified three main themes related to the intervention and the trial : 1 ) a positive experience , 2 ) the reasons for taking part , and 3 ) uncertainty of the study process . Conclusions This study demonstrated that home enteral feeding by jejunostomy was feasible , safe and acceptable to patients and their carers . Whether home enteral feeding as ’ usual practice ’ is a cost-effective therapy would require confirmation in an appropriately powered , multi-centre study .Trial registration UK Clinical Research Network ID 12447 ( main trial , first registered 30 May 2012 ) ; UK Clinical Research Network ID 13361 ( qualitative sub study , first registered 30 May 2012 ) ; Clinical Trials.gov NCT01870817 ( first registered 28 May 2013 ABSTRACT Objective : To evaluate the change in respiratory function and functional capacity according to the type of preoperative fasting . Methods : R and omized prospect i ve clinical trial , with 92 female patients undergoing cholecystectomy by laparotomy with conventional or 2 hours shortened fasting .  The variables measured were the peak expiratory flow , forced expiratory volume in the first second , forced vital capacity , dominant h and grip strength , and non-dominant h and grip strength . Evaluations were performed 2 hours before induction of anesthesia and 24 hours after the operation . Results : The two groups were similar in preoperative evaluations regarding demographic and clinical characteristics , as well as for all variables . However , postoperatively the group with shortened fasting had higher values than the group with conventional fasting for lung function tests peak expiratory flow ( 128.7±62.5 versus 115.7±59.9 ; p=0.040 ) , forced expiratory volume in the first second ( 1.5±0.6 versus 1.2±0.5 ; p=0.040 ) , forced vital capacity ( 2.3±1.1 versus 1.8±0.9 ; p=0.021 ) , and for muscle function tests dominant h and grip strength ( 24.9±6.8 versus 18.4±7.7 ; p=0.001 ) and non-dominant h and grip strength ( 22.9±6.3 versus 17.0±7.8 ; p=0.0002 ) . In the intragroup evaluation , there was a decrease in preoperative compared with postoperative values , except for dominant h and grip strength ( 25.2±6.7 versus 24.9±6.8 ; p=0.692 ) , in the shortened fasting group . Conclusion : Abbreviation of preoperative fasting time with ingestion of maltodextrin solution is beneficial to pulmonary function and preserves dominant h and grip strength BACKGROUND Patients undergoing upper gastrointestinal surgery often eat poorly post-operatively , despite dietetic input . A pilot study was conducted to examine the benefit of a 6 week nutritional supplementation via a feeding jejunostomy on fatigue , quality of life and independent living . METHODS A feeding jejunostomy was placed routinely at oesophagectomy or total gastrectomy for cancer . At discharge , patients were r and omised to nutritional supplementation ( 600 kcal/day ) via their feeding jejunostomies or no jejunal supplement . Patients were assessed at discharge and 3 , 6 , 12 and 24 weeks following discharge for fatigue ( MFI-20 ) , quality of life ( QLQ-OES18 ) , health economic analysis ( EQ5D ) as well as completing a two-day dietary diary . RESULTS 44 patients ( M : F , 29:15 ) were r and omised , 23 received jejunal supplements . There were no differences between the groups . Percentage of calculated energy requirement received was greater in the supplemented group at weeks 3 and 6 ( p < 0.0001 ) . Oral energy intake was not different between the groups at any time period . After hospital discharge , there were no differences in MFI-20 , EQ5D and QLQ-OES18 scores at any time point . From hospital discharge fatigue improved and plateaued at 6 weeks ( p < 0.05 for both groups ) , independence at 12 weeks ( p < 0.05 for both groups ) . No improvement was seen in quality of life until 24 weeks in the active group alone ( p < 0.02 ) and not at all in the control group . CONCLUSIONS Addition of jejunal feeding is effective in providing patients with an adequate energy intake . Increased energy intake however , produced no obvious improvement in measures of fatigue , quality of life or health economics This document represents the first collaboration between 2 organizations — the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine — to describe best practice s in nutrition therapy in critically ill children . The target of these guidelines is intended to be the pediatric critically ill patient ( > 1 month and 2–3 days in a PICU admitting medical , surgical , and cardiac patients . In total , 2032 citations were scanned for relevance . The PubMed / MEDLINE search result ed in 960 citations for clinical trials and 925 citations for cohort studies . The EMBASE search for clinical trials culled 1661 citations . In total , the search for clinical trials yielded 1107 citations , whereas the cohort search yielded 925 . After careful review , 16 r and omized controlled trials and 37 cohort studies appeared to answer 1 of the 8 preidentified question groups for this guideline . We used the GRADE criteria ( Grading of Recommendations , Assessment , Objective : To determine whether glutamine (GLN)-supplemented parenteral nutrition ( PN ) improves clinical outcomes in surgical intensive care unit ( SICU ) patients . Summary Background Data : GLN requirements may increase with critical illness . GLN-supplemented PN may improve clinical outcomes in SICU patients . Methods : A parallel-group , multicenter , double-blind , r and omized , controlled clinical trial in 150 adults after gastrointestinal , vascular , or cardiac surgery requiring PN and SICU care . Patients were without significant renal or hepatic failure or shock at entry . All received isonitrogenous , isocaloric PN [ 1.5 g/kg/d amino acids ( AAs ) and energy at 1.3 × estimated basal energy expenditure ] . Controls ( n = 75 ) received st and ard GLN-free PN ( STD-PN ) ; the GLN group ( n = 75 ) received PN containing alanyl-GLN dipeptide ( 0.5 g/kg/d ) , proportionally replacing AA in PN ( GLN-PN ) . Enteral nutrition ( EN ) was advanced and PN weaned as indicated . Hospital mortality and infections were primary endpoints . Results : Baseline characteristics , days on study PN and daily macronutrient intakes via PN and EN , were similar between groups . There were 11 hospital deaths ( 14.7 % ) in the GLN-PN group and 13 deaths in the STD-PN group ( 17.3 % ; difference , −2.6 % ; 95 % confidence interval , −14.6 % to 9.3 % ; P = 0.66 ) . The 6-month cumulative mortality was 31.4 % in the GLN-PN group and 29.7 % in the STD-PN group ( P = 0.88 ) . Incident bloodstream infection rate was 9.6 and 8.4 per 1000 hospital days in the GLN-PN and STD-PN groups , respectively ( P = 0.73 ) . Other clinical outcomes and adverse events were similar . Conclusions : PN supplemented with GLN dipeptide was safe , but did not alter clinical outcomes among SICU patients The benefits of early enteral feeding ( EEN ) have been demonstrated in gastrointestinal surgery . But , the impact of EEN has not been eluci date d yet . We assessed the postoperative nutritional status of patients who had undergone pancreaticoduodenectomy ( PD ) according to the postoperative nutritional method and compared the clinical outcomes of two methods . A prospect i ve r and omized trial was undertaken following PD . Patients were r and omly divided into two groups ; the EEN group received the postoperative enteral feed and the control group received the postoperative total parenteral nutrition ( TPN ) management .  Thirty-eight patients were included in our analyses . The first day of bowel movement and time to take a normal soft diet was significantly shorter in EEN group than in TPN group . Prealbumin and transferrin were significantly reduced on post-operative day ( POD ) 7 and were slowly recovered until POD 90 in the TPN group than in the EEN group . EEN group rapidly recovered weight after POD 21 whereas it 
    Output:
    