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: 187 1 . The FOOD Trial Collaboration . Routine oral nutritional supplementation for stroke patients in hospital ( FOOD ) : a multicentre r and omised controlled trial . Lancet 2005 ; 365 : 755–63 . 2 . The FOOD Trial Collaboration . Effect of timing and method of  enteral tube feeding for  dysphagic stroke patients ( FOOD ) : a multicentre r and omised controlled trial . Lancet 2005 ; 365 : 764–72 . 3 . Spiegelhalter DJ , Abrams KR , Myles JP . Prior Distributions in Bayesian Approaches to Clinical Trials and Health-Care Interventions . Chichester : John Wiley & Sons Ltd , 2004 , 139–80 OBJECTIVE To examine the effects of an advance directive videotape on patient comprehension of advance directive concepts and preferences for resuscitation . DESIGN Pilot study , r and omized cohort trial . SETTING Extended Care and Rehabilitation Center , Veterans Affairs Medical Center , Durham , NC . PARTICIPANTS Thirty-six residents of the center ; mean age , 69 years . INTERVENTIONS Sixteen subjects observed an advance directive videotape , and 20 subjects observed a health-relative videotape . All subjects received written material and counseling on advance directives . MEASUREMENT Structured interviews were conducted at three time points relative to the educational program ( pretest , posttest , delayed posttest ) , measuring comprehension of two advance directive concepts ( living will and cardiopulmonary resuscitation ) and resuscitation preferences based on hypothetical clinical vignettes . Mean comprehension and mean resuscitation preference scores were derived for each time point . RESULTS The mean comprehension score improved an average of 1.6 points for all subjects from pretest to delayed posttest ( P < .001 ) ; however , score changes were not significantly different between the two video groups ( P = .39 ) . Mean resuscitation preference scores were stable over time , and there were no significant score differences between the two video groups . CONCLUSION The advance directive videotape did not significantly affect resuscitation preferences or comprehension of selected advance directive concepts OBJECTIVES To assess the effect of a multicomponent advance care planning intervention directed at nursing home social workers on identification and documentation of preferences for medical treatments and on patient outcomes . DESIGN Controlled clinical trial . SETTING New York City nursing home . PARTICIPANTS One hundred thirty-nine newly admitted long-term care residents . INTERVENTION Nursing home social workers were r and omized to the intervention or control groups . The intervention consisted of baseline education in advance care planning that incorporated small-group workshops and role play/ practice sessions for intervention social workers ; structured advance care planning discussion s with residents and their proxies at admission , after any change in clinical status , and at yearly intervals ; formal structured review of residents ' goals of care at preexisting regular team meetings ; " flagging " of advance directives on nursing home charts ; and feedback to individual healthcare providers of the congruence of care they provided and the preferences specified in the advance care planning process . Control social workers received an educational training session on New York State law regarding advance directives but no additional training or interventions . Subjects were enrolled from January 9 , 2001 through May 25 , 2003 and followed for 6 months after enrollment . MEASUREMENTS Nursing home chart documentation of advance directives ( healthcare proxies , living wills ) and do-not-resuscitate orders ; preferences for artificial nutrition and hydration , intravenous antibiotics , and hospitalization ; and concordance of treatments received with documented preferences were compared for residents assigned to intervention and control social workers . RESULTS Intervention residents were significantly more likely than residents in the control group to have their preferences regarding cardiopulmonary resuscitation ( 40 % vs 20 % , P=.005 ) , artificial nutrition and hydration ( 47 % vs 9 % , P<.01 ) , intravenous antibiotics ( 44 % vs 9 % , P<.01 ) , and hospitalization ( 49 % vs 16 % , P<.01 ) documented in the nursing home chart . Control residents were significantly more likely than intervention residents to receive treatments discordant with their prior stated wishes . Two of 49 ( 5 % ) intervention residents received a treatment in conflict with their prior stated wishes ( one hospitalization , one episode of intravenous antibiotics ) , compared with 17 of 96 ( 18 % ) control patients ( P=.04 ) . CONCLUSION This generalizable intervention directed at nursing home social workers significantly improved the documentation and identification of patients ' wishes regarding common life-sustaining treatments and result ed in a higher concordance between patients ' prior stated wishes and treatments received CONTEXT Death is common in nursing homes , but access to palliative care is limited . OBJECTIVE To test whether a quality improvement ( QI ) intervention in nursing homes increases hospice , pain management , and advance care planning . DESIGN AND SETTING The QI intervention was tested in seven nursing homes using a prepost study design . Two additional nursing homes served as control sites . PARTICIPANTS Nine nursing homes serving 1169 residents . INTERVENTION The intervention included recruitment and training of Palliative Care Leadership Teams in each facility , followed by six technical assistance meetings for team members . Hospice providers delivered six educational sessions for all nursing home staff using a structured curriculum . Teams received feedback of performance data on hospice enrollment , pain management , and advance care planning at 0 , 3 , and 6 months . MAIN OUTCOME MEASURES Percentage of residents receiving hospice or palliative services , pain assessment , pain treatment among residents in pain , and documented advance care planning discussion s. RESULTS Intervention facilities increased hospice enrollment from 4.0 % of residents at baseline to 6.8 % postintervention ( p = .01 ) and increased pain assessment s from 18 % to 60 % ( p < .001 ) . Among resident in pain , orders for nonpharmacologic pain treatments increased from 15 % to 35 % ( p < .001 ) , but pain medication use did not change . Residents with in-depth discussion s about end-of-life care increased from 4 % to 17 % ( p < .001 ) . There were no significant changes in control sites . CONCLUSIONS A quality improvement intervention was effective in increasing hospice enrollment , pain assessment , nonpharmacologic pain treatment , and advance care planning discussion CONTEXT Although advance directives are commonly used in the community , little is known about the effects of their systematic implementation . OBJECTIVES To examine the effect of systematic ally implementing an advance directive in nursing homes on patient and family satisfaction with involvement in decision making and on health care costs . DESIGN R and omized controlled trial conducted June 1 , 1994 , to August 31 , 1998 . SETTING AND PARTICIPANTS A total of 1292 residents in 6 Ontario nursing homes with more than 100 residents each . INTERVENTION The Let Me Decide advance directive program included educating staff in local hospitals and nursing homes , residents , and families about advance directives and offering competent residents or next-of-kin of mentally incompetent residents an advance directive that provided a range of health care choices for life-threatening illness , cardiac arrest , and nutrition . The 6 nursing homes were pair-matched on key characteristics , and 1 home per pair was r and omized to take part in the program . Control nursing homes continued with prior policies concerning advance directives . MAIN OUTCOME MEASURES Residents ' and families ' satisfaction with health care and health care services utilization over 18 months , compared between intervention and control nursing homes . RESULTS Of 527 participating residents in intervention nursing homes , 49 % of competent residents and 78 % of families of incompetent residents completed advance directives .  Satisfaction was not significantly different in intervention and control nursing homes . The mean difference ( scale , 1 - 7 ) between intervention and control homes was -0.16 ( 95 % confidence interval [ CI ] , -0.41 to 0.10 ) for competent residents and 0.07 ( 95 % CI , -0.08 to 0.23 ) for families of incompetent residents . Intervention nursing homes reported fewer hospitalizations per resident ( mean , 0.27 vs 0.48 ; P = .001 ) and less re source use ( average total cost per patient , Can $ 3490 vs Can $ 5239 ; P = .01 ) than control nursing homes . Proportion of deaths in intervention ( 24 % ) and control ( 28 % ) nursing homes were similar ( P = .20 ) . CONCLUSION Our data suggest that systematic implementation of a program to increase use of advance directives reduces health care services utilization without affecting satisfaction or mortality OBJECTIVE To vali date reference st and ards for the assessment of capacity to complete an advance directive and to develop and test three simple screening instruments . METHODS We administered five measures of capacity to 96 older subjects from nursing homes , retirement homes , and homes for the aged . The measures included two reference st and ard evaluations : an assessment by a specially trained nurse in collaboration with a multidisciplinary team ( Competency Clinic assessment ) and geriatrician assessment using a decisional aid . Three screening instruments were also included : a Generic Instrument design ed for any advance directive , a Specific Instrument design ed for the " Let Me Decide " advance directive , and the St and ardized Mini-Mental Status Examination ( SMMSE ) . The screening instruments and the geriatrician 's assessment were administered twice to half of the respondents to determine interrater agreement . RESULTS The chance-corrected agreement for the assessment by two geriatricians was 0.78 , and for agreement between the geriatricians and Competency Clinic assessment s it was 0.82 . Agreement for the Generic and Specific screening instrument assessment s by two observers was 0.77 and 0.90 , respectively . The areas under the Receiver Operating Characteristic curve relating the results of the three screening instruments to the Competency Clinic assessment were 0.82 for the Generic Instrument , 0.90 for the Specific Instrument , and 0.94 for the SMMSE ; chance is an unlikely explanation for the difference between these three values ( P < or = .01 ) . CONCLUSIONS Using rigorous methods , health workers can make reproducible and valid assessment s of capacity to complete an advance directive . The SMMSE accurately differentiates people who can learn about and ultimately complete advance directives from those who can not 
    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: 187 1 . The FOOD Trial Collaboration . Routine oral nutritional supplementation for stroke patients in hospital ( FOOD ) : a multicentre r and omised controlled trial . Lancet 2005 ; 365 : 755–63 . 2 . The FOOD Trial Collaboration . Effect of timing and method of  enteral tube feeding for  dysphagic stroke patients ( FOOD ) : a multicentre r and omised controlled trial . Lancet 2005 ; 365 : 764–72 . 3 . Spiegelhalter DJ , Abrams KR , Myles JP . Prior Distributions in Bayesian Approaches to Clinical Trials and Health-Care Interventions . Chichester : John Wiley & Sons Ltd , 2004 , 139–80 OBJECTIVE To examine the effects of an advance directive videotape on patient comprehension of advance directive concepts and preferences for resuscitation . DESIGN Pilot study , r and omized cohort trial . SETTING Extended Care and Rehabilitation Center , Veterans Affairs Medical Center , Durham , NC . PARTICIPANTS Thirty-six residents of the center ; mean age , 69 years . INTERVENTIONS Sixteen subjects observed an advance directive videotape , and 20 subjects observed a health-relative videotape . All subjects received written material and counseling on advance directives . MEASUREMENT Structured interviews were conducted at three time points relative to the educational program ( pretest , posttest , delayed posttest ) , measuring comprehension of two advance directive concepts ( living will and cardiopulmonary resuscitation ) and resuscitation preferences based on hypothetical clinical vignettes . Mean comprehension and mean resuscitation preference scores were derived for each time point . RESULTS The mean comprehension score improved an average of 1.6 points for all subjects from pretest to delayed posttest ( P < .001 ) ; however , score changes were not significantly different between the two video groups ( P = .39 ) . Mean resuscitation preference scores were stable over time , and there were no significant score differences between the two video groups . CONCLUSION The advance directive videotape did not significantly affect resuscitation preferences or comprehension of selected advance directive concepts OBJECTIVES To assess the effect of a multicomponent advance care planning intervention directed at nursing home social workers on identification and documentation of preferences for medical treatments and on patient outcomes . DESIGN Controlled clinical trial . SETTING New York City nursing home . PARTICIPANTS One hundred thirty-nine newly admitted long-term care residents . INTERVENTION Nursing home social workers were r and omized to the intervention or control groups . The intervention consisted of baseline education in advance care planning that incorporated small-group workshops and role play/ practice sessions for intervention social workers ; structured advance care planning discussion s with residents and their proxies at admission , after any change in clinical status , and at yearly intervals ; formal structured review of residents ' goals of care at preexisting regular team meetings ; " flagging " of advance directives on nursing home charts ; and feedback to individual healthcare providers of the congruence of care they provided and the preferences specified in the advance care planning process . Control social workers received an educational training session on New York State law regarding advance directives but no additional training or interventions . Subjects were enrolled from January 9 , 2001 through May 25 , 2003 and followed for 6 months after enrollment . MEASUREMENTS Nursing home chart documentation of advance directives ( healthcare proxies , living wills ) and do-not-resuscitate orders ; preferences for artificial nutrition and hydration , intravenous antibiotics , and hospitalization ; and concordance of treatments received with documented preferences were compared for residents assigned to intervention and control social workers . RESULTS Intervention residents were significantly more likely than residents in the control group to have their preferences regarding cardiopulmonary resuscitation ( 40 % vs 20 % , P=.005 ) , artificial nutrition and hydration ( 47 % vs 9 % , P<.01 ) , intravenous antibiotics ( 44 % vs 9 % , P<.01 ) , and hospitalization ( 49 % vs 16 % , P<.01 ) documented in the nursing home chart . Control residents were significantly more likely than intervention residents to receive treatments discordant with their prior stated wishes . Two of 49 ( 5 % ) intervention residents received a treatment in conflict with their prior stated wishes ( one hospitalization , one episode of intravenous antibiotics ) , compared with 17 of 96 ( 18 % ) control patients ( P=.04 ) . CONCLUSION This generalizable intervention directed at nursing home social workers significantly improved the documentation and identification of patients ' wishes regarding common life-sustaining treatments and result ed in a higher concordance between patients ' prior stated wishes and treatments received CONTEXT Death is common in nursing homes , but access to palliative care is limited . OBJECTIVE To test whether a quality improvement ( QI ) intervention in nursing homes increases hospice , pain management , and advance care planning . DESIGN AND SETTING The QI intervention was tested in seven nursing homes using a prepost study design . Two additional nursing homes served as control sites . PARTICIPANTS Nine nursing homes serving 1169 residents . INTERVENTION The intervention included recruitment and training of Palliative Care Leadership Teams in each facility , followed by six technical assistance meetings for team members . Hospice providers delivered six educational sessions for all nursing home staff using a structured curriculum . Teams received feedback of performance data on hospice enrollment , pain management , and advance care planning at 0 , 3 , and 6 months . MAIN OUTCOME MEASURES Percentage of residents receiving hospice or palliative services , pain assessment , pain treatment among residents in pain , and documented advance care planning discussion s. RESULTS Intervention facilities increased hospice enrollment from 4.0 % of residents at baseline to 6.8 % postintervention ( p = .01 ) and increased pain assessment s from 18 % to 60 % ( p < .001 ) . Among resident in pain , orders for nonpharmacologic pain treatments increased from 15 % to 35 % ( p < .001 ) , but pain medication use did not change . Residents with in-depth discussion s about end-of-life care increased from 4 % to 17 % ( p < .001 ) . There were no significant changes in control sites . CONCLUSIONS A quality improvement intervention was effective in increasing hospice enrollment , pain assessment , nonpharmacologic pain treatment , and advance care planning discussion CONTEXT Although advance directives are commonly used in the community , little is known about the effects of their systematic implementation . OBJECTIVES To examine the effect of systematic ally implementing an advance directive in nursing homes on patient and family satisfaction with involvement in decision making and on health care costs . DESIGN R and omized controlled trial conducted June 1 , 1994 , to August 31 , 1998 . SETTING AND PARTICIPANTS A total of 1292 residents in 6 Ontario nursing homes with more than 100 residents each . INTERVENTION The Let Me Decide advance directive program included educating staff in local hospitals and nursing homes , residents , and families about advance directives and offering competent residents or next-of-kin of mentally incompetent residents an advance directive that provided a range of health care choices for life-threatening illness , cardiac arrest , and nutrition . The 6 nursing homes were pair-matched on key characteristics , and 1 home per pair was r and omized to take part in the program . Control nursing homes continued with prior policies concerning advance directives . MAIN OUTCOME MEASURES Residents ' and families ' satisfaction with health care and health care services utilization over 18 months , compared between intervention and control nursing homes . RESULTS Of 527 participating residents in intervention nursing homes , 49 % of competent residents and 78 % of families of incompetent residents completed advance directives .  Satisfaction was not significantly different in intervention and control nursing homes . The mean difference ( scale , 1 - 7 ) between intervention and control homes was -0.16 ( 95 % confidence interval [ CI ] , -0.41 to 0.10 ) for competent residents and 0.07 ( 95 % CI , -0.08 to 0.23 ) for families of incompetent residents . Intervention nursing homes reported fewer hospitalizations per resident ( mean , 0.27 vs 0.48 ; P = .001 ) and less re source use ( average total cost per patient , Can $ 3490 vs Can $ 5239 ; P = .01 ) than control nursing homes . Proportion of deaths in intervention ( 24 % ) and control ( 28 % ) nursing homes were similar ( P = .20 ) . CONCLUSION Our data suggest that systematic implementation of a program to increase use of advance directives reduces health care services utilization without affecting satisfaction or mortality OBJECTIVE To vali date reference st and ards for the assessment of capacity to complete an advance directive and to develop and test three simple screening instruments . METHODS We administered five measures of capacity to 96 older subjects from nursing homes , retirement homes , and homes for the aged . The measures included two reference st and ard evaluations : an assessment by a specially trained nurse in collaboration with a multidisciplinary team ( Competency Clinic assessment ) and geriatrician assessment using a decisional aid . Three screening instruments were also included : a Generic Instrument design ed for any advance directive , a Specific Instrument design ed for the " Let Me Decide " advance directive , and the St and ardized Mini-Mental Status Examination ( SMMSE ) . The screening instruments and the geriatrician 's assessment were administered twice to half of the respondents to determine interrater agreement . RESULTS The chance-corrected agreement for the assessment by two geriatricians was 0.78 , and for agreement between the geriatricians and Competency Clinic assessment s it was 0.82 . Agreement for the Generic and Specific screening instrument assessment s by two observers was 0.77 and 0.90 , respectively . The areas under the Receiver Operating Characteristic curve relating the results of the three screening instruments to the Competency Clinic assessment were 0.82 for the Generic Instrument , 0.90 for the Specific Instrument , and 0.94 for the SMMSE ; chance is an unlikely explanation for the difference between these three values ( P < or = .01 ) . CONCLUSIONS Using rigorous methods , health workers can make reproducible and valid assessment s of capacity to complete an advance directive . The SMMSE accurately differentiates people who can learn about and ultimately complete advance directives from those who can not 
    Output:
    