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: Background Protein energy malnutrition ( PEM ) predisposes individuals to disease , delays recovery from illness and reduces quality of life . Care home residents in the United Kingdom are especially vulnerable , with an estimated 30 to 42 % at risk . Evidence for nutritional interventions to address PEM in the care home setting is lacking . Widely used techniques include food-based intervention and /or the use of prescribed oral nutritional supplements . To define outcomes and optimise the design for an adequately powered definitive trial to compare the efficacy of established nutritional interventions in this setting , a cluster r and omised feasibility trial with a 6-month intervention was undertaken . Methods Care home residents with or at risk of malnutrition were identified across six UK care home sites from September to December 2013 . Homes were cluster r and omised to st and ard care ( SC ) , food-based intervention ( FB ) or oral nutritional supplement intervention ( ONS ) , for 6 months . Key outcomes were trial feasibility and the acceptability of design , allocated interventions and outcome assessment s. Anthropometry , dietary intake , healthcare re source usage and participant-reported outcome measures were assessed at baseline and at 3 and 6 months . Results All six care homes approached were recruited and retained . Of the 110 residents at risk of malnutrition , 85 % entered the trial , and 68 % completed the 6-month intervention . Pre-specified success criteria for feasibility were met for recruitment and retention , intervention acceptability ( resident compliance ≥60 % ) and measurement of weight , body mass index ( BMI ) , mid-upper arm circumference and dietary intake ( data completeness > 80 % ) . Measurement of h and grip strength and triceps skinfold thickness was not found to be feasible in this population . The 95 % confidence interval ( CI ) data suggested sensitivity to change in dietary intake for weight , BMI and energy intake between baseline and 3 months when each intervention ( FB and ONS ) was compared with SC . Conclusions A definitive trial comparing the efficacy of nutritional support interventions in increasing weight and BMI in malnourished care home residents can be conducted . However , whilst the design was feasible , this trial has highlighted the lack of clinical ly and patient-relevant outcome measures that are appropriate for use in this setting for both research and clinical practice . In particular , this trial identified a need for a more simple measure of functional status , which considers the limitations of functional tests in the care home population .Trial registration Current Controlled Trials IS RCT N38047922 , Date assigned : 22 April 2014 Background and Purpose Abnormal physiological parameters after acute stroke may induce early neurological deterioration . Studies of the effect of dehydration on stroke outcome are limited . We examined the association of raised plasma osmolality on stroke outcome at 3 months and the change of plasma osmolality with hydration during the first week after stroke . Methods Acute stroke patients had their plasma osmolality measured at admission and at days 1 , 3 , and 7 . Maximum plasma osmolality and the area under curve ( AUC ) were also calculated during the first week . Patients were stratified according to how they were hydrated : orally , intravenously , or both . Outcome included survival at 3 months after stroke . Logistic regression was performed to examine the association between raised plasma osmolality ( > 296 mOsm/kg ) and survival , adjusting for stroke severity . Linear regression was performed to examine the pattern of plasma osmolality across hydration groups . Results One hundred sixty-seven patients were included . Mean admission ( 300 mOsm/kg , SD 11.4 ) , maximum ( 308.1 mOsm/kg , SD 17.1 ) , and AUC ( 298.3 mOsm/kg , SD 11.7 ) plasma osmolality were significantly higher in those who died compared with survivors ( 293.1 mOsm/kg [ SD 8.2 ] , 297.7 mOsm/kg [ SD 8.7 ] , and 291.7 mOsm/kg [ SD 8.1 ] , respectively;P < 0.0001 ) . Admission plasma osmolality > 296 mOsm/kg was significantly associated with mortality ( OR 2.4 , 95 % CI 1.0 to 5.9 ) . In patients hydrated intravenously , there was no significant fall in plasma osmolality compared with patients hydrated orally ( P = 0.68 ) . Conclusions Raised plasma osmolality on admission is associated with stroke mortality , after correcting for case mix . Correction of dehydration after stroke requires a more systematic approach . Trials are required to determine whether correcting dehydration after stroke improves outcome AIMS To investigate whether a nutritional intervention in older women and men with femoral neck fracture had an effect on postoperative complications during hospitalization and on nutritional status at a four-month follow-up . METHODS The design was a r and omized controlled trial . The present study sample consisted of 157 patients aged 70 years and above with femoral neck fracture . The nutritional intervention included , among other things , a nutritional journal to detect nutrition deficiencies and protein-enriched meals for at least four days postoperatively . Further , at least two nutritional and protein drinks were served each day during the whole hospitalization and other factors that would influence the patient 's nutrition were also considered and dealt with . Postoperative complications were registered and patients were assessed using the Mini Nutritional Assessment ( MNA ) scale , including body mass index ( BMI ) , on admission and at a four-month follow-up . RESULTS Malnutrition was common and low MNA scores were associated with postoperative complications such as delirium and decubitus ulcers . There were significantly fewer days of delirium in the intervention group , seven patients in the intervention group developed decubitus ulcers vs. 14 patients in the control group and the total length of hospitalization was shorter . There were no detectable significant improvements regarding nutritional parameters between the intervention and the control group at the four-month follow-up but men improved their mean BMI , body weight and MNA scores in both the intervention and the control groups while women deteriorated in both groups . CONCLUSIONS Malnutrition was common among older people with hip fractures admitted to hospital . The nutritional intervention might have contributed to the patients suffering fewer days with delirium , fewer decubitus ulcers and shorter hospitalization but did not improve the long-term nutritional status , at least not in women . RELEVANCE TO CLINICAL PRACTICE This nutritional intervention , which was included in a multifactorial multidisciplinary intervention , is inexpensive and relatively easy to implement . It has significant effects on complications but no long-term effect on nutritional parameters , at least not in women BACKGROUND Obesity exacerbates the age-related decline in physical function and causes frailty in older adults ; however , the appropriate treatment for obese older adults is controversial . METHODS In this 1-year , r and omized , controlled trial , we evaluated the independent and combined effects of weight loss and exercise in 107 adults who were 65 years of age or older and obese . Participants were r and omly assigned to a control group , a weight-management ( diet ) group , an exercise group , or a weight-management-plus-exercise ( diet-exercise ) group . The primary outcome was the change in score on the modified Physical Performance Test . Secondary outcomes included other measures of frailty , body composition , bone mineral density , specific physical functions , and quality of life . RESULTS A total of 93 participants ( 87 % ) completed the study . In the intention-to-treat analysis , the score on the Physical Performance Test , in which higher scores indicate better physical status , increased more in the diet-exercise group than in the diet group or the exercise group ( increases from baseline of 21 % vs. 12 % and 15 % , respectively ) ; the scores in all three of those groups increased more than the scores in the control group ( in which the score increased by 1 % ) ( P<0.001 for the between-group differences ) . Moreover , the peak oxygen consumption improved more in the diet-exercise group than in the diet group or the exercise group ( increases of 17 % vs. 10 % and 8 % , respectively ; P<0.001 ) ; the score on the Functional Status Question naire , in which higher scores indicate better physical function , increased more in the diet-exercise group than in the diet group ( increase of 10 % vs. 4 % , P<0.001 ) . Body weight decreased by 10 % in the diet group and by 9 % in the diet-exercise group , but did not decrease in the exercise group or the control group ( P<0.001 ) . Lean body mass and bone mineral density at the hip decreased less in the diet-exercise group than in the diet group ( reductions of 3 % and 1 % , respectively , in the diet-exercise group vs. reductions of 5 % and 3 % , respectively , in the diet group ; P<0.05 for both comparisons ) . Strength , balance , and gait improved consistently in the diet-exercise group ( P<0.05 for all comparisons ) . Adverse events included a small number of exercise-associated musculoskeletal injuries . CONCLUSIONS These findings suggest that a combination of weight loss and exercise provides greater improvement in physical function than either intervention alone . ( Funded by the National Institutes of Health ; Clinical Trials.gov number , NCT00146107 . ) UNLABELLED James R , Gines D , Menlove A , Horn SD , Gassaway J , Smout RJ . Nutrition support ( tube feeding ) as a rehabilitation intervention . OBJECTIVE To describe site variation in use of enteral feeding and its association with stroke rehabilitation outcomes , controlling for a variety of confounding variables . DESIGN Prospect i ve observational cohort study . SETTING Six inpatient rehabilitation facilities in the United States . PARTICIPANTS Patients ( N=919 ) from the Post-Stroke Rehabilitation Outcomes Project data base with moderate or severe stroke who were discharged to home , community , or skilled nursing facility . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Change in total , motor , and cognitive FIM instrument scores and change in severity of illness . RESULTS Monitoring of nutritional status and the frequency of tube-feeding interventions for patients with moderate and severe stroke varied significantly among sites . Patients with tube feeding had higher severity of illness and lower functioning on admission compared with patients who did not receive tube feeding . However , when we controlled for severity of illness , admission FIM score , and other important covariates , we found that patients with severe strokes who were tube fed for more than 25 % of their stay had greater increases in total , motor , and cognitive FIM scores and greater improvement in severity of illness by discharge . CONCLUSIONS Nutrition support ( tube feeding ) is an effective therapy in rehabilitation service for patients with severe strokes and is associated with greater motor and cognitive improvements , even in patients with the most severe strokes OBJECTIVES Multi-Frequency Bioelectrical Impedance Analysis ( MFBIA ) is a quick , simple , and inexpensive method to assess body fluid compartments . This study aim ed at determining the validity of MFBIA in detecting clinical ly relevant changes of fluid balance in geriatric patients . DESIGN A prospect i ve , observational study . SETTING The 22-bed Geriatric Department of the University Hospital Nijmegen . PARTICIPANTS Hospitalized patients were eligible if they did not have a pacemaker , were not suffering from terminal illnesses , and did not have psychogeriatric diseases likely to interfere with capacity to consent or comply . During a 16-months period , 218 patients were admitted , of whom 78 patients were eligible and 53 consented to participate . MEASUREMENTS Each subject 's fluid balance was diagnosed twice a week as dehydrated , overhydrated , or euvolemic , based on st and ardized physical examination , laboratory tests , and weight evaluation . Changes in fluid balance were quantified by measuring total body water ( TBW ) and extracellular fluid ( ECF ) applying deuterium- and bromide-dilution techniques . Impedance at 1 , 5 , 50 , and 100 kHz and body weight were measured daily . Sensitivity and Guyatt 's responsiveness indexes of MFBIA in detecting dehydration and overhydration were determined . RESULTS In total , 1071 MFBIA measurements were performed , during which 14 transitions from dehydration to euvolemia and 13 transitions from overhydration to euvolemia were monitored . Rehydration of dehydrated patients caused an increase in TBW and ECF of 3.4 + /- 1.8 L and 1.9 + /- 1.9 L , respectively , which result ed in significant decreases in impedance of 133 + /- 67 omega at 1 kHz and 93 + /- 61 omega at 100 kHz ( P = .001 ) . Treatment of overhydrated patients caused a TBW and ECF loss of 3.8 + /- 4.2 L and 3.1 + /- 3.8 L , respectively , which result ed in significant increases in impedance of 104 + /- 72 omega at 1 kHz and 81 + /- 68 omega at 100 kHz ( P < .001 ) . Sensitivity of a single MFBIA in diagnosing dehydration and overhydration was 14 % and 17 % , respectively . Responsiveness indexes of weighing and 
    Output:
    
agent
***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: Background Protein energy malnutrition ( PEM ) predisposes individuals to disease , delays recovery from illness and reduces quality of life . Care home residents in the United Kingdom are especially vulnerable , with an estimated 30 to 42 % at risk . Evidence for nutritional interventions to address PEM in the care home setting is lacking . Widely used techniques include food-based intervention and /or the use of prescribed oral nutritional supplements . To define outcomes and optimise the design for an adequately powered definitive trial to compare the efficacy of established nutritional interventions in this setting , a cluster r and omised feasibility trial with a 6-month intervention was undertaken . Methods Care home residents with or at risk of malnutrition were identified across six UK care home sites from September to December 2013 . Homes were cluster r and omised to st and ard care ( SC ) , food-based intervention ( FB ) or oral nutritional supplement intervention ( ONS ) , for 6 months . Key outcomes were trial feasibility and the acceptability of design , allocated interventions and outcome assessment s. Anthropometry , dietary intake , healthcare re source usage and participant-reported outcome measures were assessed at baseline and at 3 and 6 months . Results All six care homes approached were recruited and retained . Of the 110 residents at risk of malnutrition , 85 % entered the trial , and 68 % completed the 6-month intervention . Pre-specified success criteria for feasibility were met for recruitment and retention , intervention acceptability ( resident compliance ≥60 % ) and measurement of weight , body mass index ( BMI ) , mid-upper arm circumference and dietary intake ( data completeness > 80 % ) . Measurement of h and grip strength and triceps skinfold thickness was not found to be feasible in this population . The 95 % confidence interval ( CI ) data suggested sensitivity to change in dietary intake for weight , BMI and energy intake between baseline and 3 months when each intervention ( FB and ONS ) was compared with SC . Conclusions A definitive trial comparing the efficacy of nutritional support interventions in increasing weight and BMI in malnourished care home residents can be conducted . However , whilst the design was feasible , this trial has highlighted the lack of clinical ly and patient-relevant outcome measures that are appropriate for use in this setting for both research and clinical practice . In particular , this trial identified a need for a more simple measure of functional status , which considers the limitations of functional tests in the care home population .Trial registration Current Controlled Trials IS RCT N38047922 , Date assigned : 22 April 2014 Background and Purpose Abnormal physiological parameters after acute stroke may induce early neurological deterioration . Studies of the effect of dehydration on stroke outcome are limited . We examined the association of raised plasma osmolality on stroke outcome at 3 months and the change of plasma osmolality with hydration during the first week after stroke . Methods Acute stroke patients had their plasma osmolality measured at admission and at days 1 , 3 , and 7 . Maximum plasma osmolality and the area under curve ( AUC ) were also calculated during the first week . Patients were stratified according to how they were hydrated : orally , intravenously , or both . Outcome included survival at 3 months after stroke . Logistic regression was performed to examine the association between raised plasma osmolality ( > 296 mOsm/kg ) and survival , adjusting for stroke severity . Linear regression was performed to examine the pattern of plasma osmolality across hydration groups . Results One hundred sixty-seven patients were included . Mean admission ( 300 mOsm/kg , SD 11.4 ) , maximum ( 308.1 mOsm/kg , SD 17.1 ) , and AUC ( 298.3 mOsm/kg , SD 11.7 ) plasma osmolality were significantly higher in those who died compared with survivors ( 293.1 mOsm/kg [ SD 8.2 ] , 297.7 mOsm/kg [ SD 8.7 ] , and 291.7 mOsm/kg [ SD 8.1 ] , respectively;P < 0.0001 ) . Admission plasma osmolality > 296 mOsm/kg was significantly associated with mortality ( OR 2.4 , 95 % CI 1.0 to 5.9 ) . In patients hydrated intravenously , there was no significant fall in plasma osmolality compared with patients hydrated orally ( P = 0.68 ) . Conclusions Raised plasma osmolality on admission is associated with stroke mortality , after correcting for case mix . Correction of dehydration after stroke requires a more systematic approach . Trials are required to determine whether correcting dehydration after stroke improves outcome AIMS To investigate whether a nutritional intervention in older women and men with femoral neck fracture had an effect on postoperative complications during hospitalization and on nutritional status at a four-month follow-up . METHODS The design was a r and omized controlled trial . The present study sample consisted of 157 patients aged 70 years and above with femoral neck fracture . The nutritional intervention included , among other things , a nutritional journal to detect nutrition deficiencies and protein-enriched meals for at least four days postoperatively . Further , at least two nutritional and protein drinks were served each day during the whole hospitalization and other factors that would influence the patient 's nutrition were also considered and dealt with . Postoperative complications were registered and patients were assessed using the Mini Nutritional Assessment ( MNA ) scale , including body mass index ( BMI ) , on admission and at a four-month follow-up . RESULTS Malnutrition was common and low MNA scores were associated with postoperative complications such as delirium and decubitus ulcers . There were significantly fewer days of delirium in the intervention group , seven patients in the intervention group developed decubitus ulcers vs. 14 patients in the control group and the total length of hospitalization was shorter . There were no detectable significant improvements regarding nutritional parameters between the intervention and the control group at the four-month follow-up but men improved their mean BMI , body weight and MNA scores in both the intervention and the control groups while women deteriorated in both groups . CONCLUSIONS Malnutrition was common among older people with hip fractures admitted to hospital . The nutritional intervention might have contributed to the patients suffering fewer days with delirium , fewer decubitus ulcers and shorter hospitalization but did not improve the long-term nutritional status , at least not in women . RELEVANCE TO CLINICAL PRACTICE This nutritional intervention , which was included in a multifactorial multidisciplinary intervention , is inexpensive and relatively easy to implement . It has significant effects on complications but no long-term effect on nutritional parameters , at least not in women BACKGROUND Obesity exacerbates the age-related decline in physical function and causes frailty in older adults ; however , the appropriate treatment for obese older adults is controversial . METHODS In this 1-year , r and omized , controlled trial , we evaluated the independent and combined effects of weight loss and exercise in 107 adults who were 65 years of age or older and obese . Participants were r and omly assigned to a control group , a weight-management ( diet ) group , an exercise group , or a weight-management-plus-exercise ( diet-exercise ) group . The primary outcome was the change in score on the modified Physical Performance Test . Secondary outcomes included other measures of frailty , body composition , bone mineral density , specific physical functions , and quality of life . RESULTS A total of 93 participants ( 87 % ) completed the study . In the intention-to-treat analysis , the score on the Physical Performance Test , in which higher scores indicate better physical status , increased more in the diet-exercise group than in the diet group or the exercise group ( increases from baseline of 21 % vs. 12 % and 15 % , respectively ) ; the scores in all three of those groups increased more than the scores in the control group ( in which the score increased by 1 % ) ( P<0.001 for the between-group differences ) . Moreover , the peak oxygen consumption improved more in the diet-exercise group than in the diet group or the exercise group ( increases of 17 % vs. 10 % and 8 % , respectively ; P<0.001 ) ; the score on the Functional Status Question naire , in which higher scores indicate better physical function , increased more in the diet-exercise group than in the diet group ( increase of 10 % vs. 4 % , P<0.001 ) . Body weight decreased by 10 % in the diet group and by 9 % in the diet-exercise group , but did not decrease in the exercise group or the control group ( P<0.001 ) . Lean body mass and bone mineral density at the hip decreased less in the diet-exercise group than in the diet group ( reductions of 3 % and 1 % , respectively , in the diet-exercise group vs. reductions of 5 % and 3 % , respectively , in the diet group ; P<0.05 for both comparisons ) . Strength , balance , and gait improved consistently in the diet-exercise group ( P<0.05 for all comparisons ) . Adverse events included a small number of exercise-associated musculoskeletal injuries . CONCLUSIONS These findings suggest that a combination of weight loss and exercise provides greater improvement in physical function than either intervention alone . ( Funded by the National Institutes of Health ; Clinical Trials.gov number , NCT00146107 . ) UNLABELLED James R , Gines D , Menlove A , Horn SD , Gassaway J , Smout RJ . Nutrition support ( tube feeding ) as a rehabilitation intervention . OBJECTIVE To describe site variation in use of enteral feeding and its association with stroke rehabilitation outcomes , controlling for a variety of confounding variables . DESIGN Prospect i ve observational cohort study . SETTING Six inpatient rehabilitation facilities in the United States . PARTICIPANTS Patients ( N=919 ) from the Post-Stroke Rehabilitation Outcomes Project data base with moderate or severe stroke who were discharged to home , community , or skilled nursing facility . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Change in total , motor , and cognitive FIM instrument scores and change in severity of illness . RESULTS Monitoring of nutritional status and the frequency of tube-feeding interventions for patients with moderate and severe stroke varied significantly among sites . Patients with tube feeding had higher severity of illness and lower functioning on admission compared with patients who did not receive tube feeding . However , when we controlled for severity of illness , admission FIM score , and other important covariates , we found that patients with severe strokes who were tube fed for more than 25 % of their stay had greater increases in total , motor , and cognitive FIM scores and greater improvement in severity of illness by discharge . CONCLUSIONS Nutrition support ( tube feeding ) is an effective therapy in rehabilitation service for patients with severe strokes and is associated with greater motor and cognitive improvements , even in patients with the most severe strokes OBJECTIVES Multi-Frequency Bioelectrical Impedance Analysis ( MFBIA ) is a quick , simple , and inexpensive method to assess body fluid compartments . This study aim ed at determining the validity of MFBIA in detecting clinical ly relevant changes of fluid balance in geriatric patients . DESIGN A prospect i ve , observational study . SETTING The 22-bed Geriatric Department of the University Hospital Nijmegen . PARTICIPANTS Hospitalized patients were eligible if they did not have a pacemaker , were not suffering from terminal illnesses , and did not have psychogeriatric diseases likely to interfere with capacity to consent or comply . During a 16-months period , 218 patients were admitted , of whom 78 patients were eligible and 53 consented to participate . MEASUREMENTS Each subject 's fluid balance was diagnosed twice a week as dehydrated , overhydrated , or euvolemic , based on st and ardized physical examination , laboratory tests , and weight evaluation . Changes in fluid balance were quantified by measuring total body water ( TBW ) and extracellular fluid ( ECF ) applying deuterium- and bromide-dilution techniques . Impedance at 1 , 5 , 50 , and 100 kHz and body weight were measured daily . Sensitivity and Guyatt 's responsiveness indexes of MFBIA in detecting dehydration and overhydration were determined . RESULTS In total , 1071 MFBIA measurements were performed , during which 14 transitions from dehydration to euvolemia and 13 transitions from overhydration to euvolemia were monitored . Rehydration of dehydrated patients caused an increase in TBW and ECF of 3.4 + /- 1.8 L and 1.9 + /- 1.9 L , respectively , which result ed in significant decreases in impedance of 133 + /- 67 omega at 1 kHz and 93 + /- 61 omega at 100 kHz ( P = .001 ) . Treatment of overhydrated patients caused a TBW and ECF loss of 3.8 + /- 4.2 L and 3.1 + /- 3.8 L , respectively , which result ed in significant increases in impedance of 104 + /- 72 omega at 1 kHz and 81 + /- 68 omega at 100 kHz ( P < .001 ) . Sensitivity of a single MFBIA in diagnosing dehydration and overhydration was 14 % and 17 % , respectively . Responsiveness indexes of weighing and 
    Output:
    