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 The role of music during surgery has been studied , including its effect on theatre staff , users and patients . However , little attention has been paid to its application especially in our environment . METHODS It was a prospect i ve study , involving theatre staff , users , and patients . Their opinions on acceptability and the role of music in operating theatre were determined . Information was obtained by question naire . RESULTS There were 162 respondents ; age range 25 to 76 years ( median age 39 ) . There were 109 ( 67.2 % ) males and 53 ( 32.7 % ) female . One hundred and forty five ( 89.5 % ) respondents agree that music should be played in the operating theatre . One fifty eight , ( 97.5 % ) considered low tone of music to be most appropriate in the theatre while 3(1.9 % ) , and 1(0.6 % ) considered moderate and high tone respectively to be most appropriate . One hundred and sixteen , ( 71.6 % ) preferred  jazz music while 19(11.7 % ) reggae , 11(6.8 % ) African music , 13 ( 8.0 % ) others ( not specify ) , 2 ( 1.2 % ) classical , and 1(0.6 % ) Irish folk . The majority of the respondents were aware of the role of music in terms of its anxiolytic effect , reduction of stress and enhancement of performance when familiar music is played . CONCLUSION Music in the operating theatre has immeasurable effects . It can prevent distraction , minimize annoyance , reduce stress and diminish the anxiety of patients , staff and users Objective To evaluate and vali date the time of completion and results of a new method of search ing for systematic review s , the exhaustive search method ( ESM ) , using a pragmatic comparison . Methods Single‐line search strategies were prepared in a text document . Term completeness was ensured with a novel optimization technique . Macros in MS Word converted the syntaxes between data bases and interfaces almost automatically . We compared search characteristics , such as number of search terms and data bases , and outcomes , such as number of included and retrieved references and precision , from ESM search es and other Dutch academic hospitals identified by search ing PubMed for systematic review s published between 2014 and 2016 . We compared time to perform the ESM with a secondary comparator of recorded search times from published literature and contact with authors to acquire unpublished data . Results We identified 73 published Erasmus MC systematic review s and 258 published by other Dutch academic hospitals meeting our criteria . We pooled search time data from 204 other systematic review s. The ESM search es differed by using 2 times more data bases , retrieving 44 % more references , including 20 % more studies in the final systematic review , but the time needed for the search was 8 % of that of the control group . Similarities between methods include precision and the number of search terms . Conclusions The evaluated similarities and differences suggest that the ESM is a highly efficient way to locate more references meeting the specified selection criteria in systematic review s than traditional search methods . Further prospect i ve research is required BACKGROUND Effective communication is a critical component of patient care in the operative room ( OR ) . However , the presence of loud equipment , a large number of staff members , and music can contribute to high levels of background noise . In a setting in which crucial tasks are performed continuously , distractions and barriers to communication can result in harm to both patients and OR personnel . The purpose of this investigation was to simulate OR listening conditions and evaluate the effect of operating noise on auditory function . STUDY DESIGN This is a prospect i ve investigation of 15 subjects ranging from 1 to 30 years of operative experience . All surgeons had normal peripheral hearing sensitivity . The surgeons ' ability to underst and and repeat words were tested using the  Speech in Noise Test-Revised  in 4 different conditions chosen to simulate typical OR environments . These included quiet , filtered noise through a mask and background noise both with and without music . They were tested in both a tasked and in an untasked situation . RESULTS It was found that the impact of noise is considerably greater when the participant is tasked . Surgeons demonstrated substantially poorer auditory performance in music than in quiet or OR noise . Performance in both conditions was poorer when the sentences were low in predictability . CONCLUSIONS Operating room noise can cause a decrease in auditory processing function , particularly in the presence of music . This becomes even more difficult when the communication involves conversations that carry critical information that is unpredictable . To avoid possible miscommunication in the OR , attempts should be made to reduce ambient noise levels Objective : To assess the impact of postoperative complications on full in-hospital costs per case . Background : Rising expenses for complex medical procedures combined with constrained re sources represent a major challenge . The severity of postoperative complications reflects surgical outcomes . The magnitude of the cost created by negative outcomes is unclear . Patients and Methods Morbidity of 1200 consecutive patients undergoing major surgery from 2005 to 2008 in a tertiary , high-volume center was assessed by a vali date d , complication score system . Full in-hospital costs were collected for each patient . Statistical analysis was performed using a multivariate linear regression model adjusted for potential confounders . Results : This study population included 393 complex liver/bile duct surgeries , 110 major pancreas operations , 389 colon resections , and 308 Roux-en-Y gastric bypasses .  The overall 30-day mortality rate was 1.8 % , whereas morbidity was 53.8 % . Patients with an uneventful course had mean costs per case of US$ 27,946 ( SD US$ 15,106 ) . Costs increased dramatically with the severity of postoperative complications and reached the mean costs of US$ 159,345 ( SD US$ 151,191 ) for grade IV complications . This increase in costs , up to 5 times the cost of a similar operation without complications , was observed for all types of investigated procedures , although the magnitude of the increase varied , with the highest costs in patients undergoing pancreas surgery . Conclusion : This study demonstrates the dramatic impact of postoperative complications on full in-hospital costs per case and that complications are the strongest indicator of costs . Furthermore , the study highlights a relevant savings capacity for major surgical procedures , and supports all efforts to lower negative events in the postoperative course BACKGROUND Although there is growing evidence that practice on bench model simulators can improve the acquisition of technical skill in surgery , the degree to which these models have to approximate real-world conditions ( model fidelity ) to optimize learning is unclear . Previous research suggests that low-fidelity models may be adequate for novice learners . The purpose of this study was to assess the effect of model fidelity and surgical expertise on the acquisition of vascular anastomosis skill . METHODS Twenty-seven surgical residents participated in this institutional review board-approved study . Junior residents ( postgraduate year 1 and 2 ) and senior residents ( postgraduate year 4 or higher ) were r and omized into two groups : low-fidelity ( n = 13 ) and high-fidelity ( n = 14 ) model training . Both groups were given a 3-hour h and s-on training session : the low-fidelity group used plastic models , and the high-fidelity group used human cadaver arms ( brachial arteries ) to practice graft-to-arterial anastomosis . One week later , all subjects participated in an animal laboratory in which they performed a single vascular anastomosis on a live , anesthetized pig ( femoral artery ) . A blinded vascular surgeon scored c and i date performance in the animal laboratory by using previously vali date d end points , including a checklist and final product analysis score . RESULTS Acquisition of skill was significantly affected by model fidelity and level of training as measured by both the checklist ( P = .03 ) and final product analysis ( P = .01 ; Kruskal-Wallis ) . Specifically , junior residents practicing on high-fidelity models scored better on the checklist ( P = .05 ) and final product analysis ( P = .04 ) . Senior residents practicing on high-fidelity models scored better on final product analysis ( P < .05 ) . CONCLUSIONS Training in the laboratory does improve skill when assessed in a realistic setting . Both expertise groups showed better skill transfer from the bench model to live animals when practicing on high-fidelity models . For vascular anastomosis , it is important to provide appropriate model fidelity for trainees of different abilities to optimize the effectiveness of bench model training Background Music and noise are frequent occurrences in the operating room . To date , the effects of these auditory conditions on the performance of laparoscopic surgery experts have not been evaluated . Methods Eight internationally recognized experts were recruited for a crossover study . The experts were r and omized to perform three simple tasks on a laparoscopic simulator , SurgicalSIM VR . The tasks were equal in difficulty and performed under the following conditions : silence , dichaotic music ( auditory stress ) , classical music ( auditory relaxation ) , and mental loading ( mental arithmetic tasks ) . Permutations of the conditions were created to account for a learning effect . The tasks were performed twice to test for memory consolidation and to accommo date baseline variability . Time until task completion and task accuracy via instrument tip trajectory ( path of the tip through space ) were recorded . Performance was correlated with responses on the Brief Musical Experience Question naire ( MEQ ) . Results The study demonstrated that dichaotic music has a negative impact on time until task completion but not on task accuracy . In addition , memory consolidation of accuracy is negatively influenced . Classical music has a variable effect on experts ’ time until task completion , yet all the experts performed the tasks more accurately . Classical music had no effect on recall of a procedure . Mental loading increased time until completion , but did not affect accuracy or recall . The experience of music varied among experts and influenced how each of the conditions affected their performance . Conclusion The study demonstrated that , contrary to common belief , proficiency in surgery does not protect against stressful auditory influences or the influence of mental preoccupation . Interestingly , relaxing auditory influences such as classical music can even have a positive impact on the accuracy of experts . Previous musical experience could help to identify surgeons whose performance may be specifically affected by music or noise BACKGROUND Clinical outcomes after many complex surgical procedures vary widely across hospitals and surgeons . Although it has been assumed that the proficiency of the operating surgeon is an important factor underlying such variation , empirical data are lacking on the relationships between technical skill and postoperative outcomes . METHODS We conducted a study involving 20 bariatric surgeons in Michigan who participated in a statewide collaborative improvement program . Each surgeon su bmi tted a single representative videotape of himself or herself performing a laparoscopic gastric bypass . Each videotape was rated in various domains of technical skill on a scale of 1 to 5 ( with higher scores indicating more advanced skill ) by at least 10 peer surgeons who were unaware of the identity of the operating surgeon . We then assessed relationships between these skill ratings and risk-adjusted complication rates , using data from a prospect i ve , externally audited , clinical - outcomes registry involving 10,343 patients . RESULTS Mean summary ratings of technical skill ranged from 2.6 to 4.8 across the 20 surgeons . The bottom quartile of surgical skill , as compared with the top quartile , was associated with higher complication rates ( 14.5 % vs. 5.2 % , P<0.001 ) and higher mortality ( 0.26 % vs. 0.05 % , P=0.01 ) . The lowest quartile of skill was also associated with longer operations ( 137 minutes vs. 98 minutes , P<0.001 ) and higher rates of reoperation ( 3.4 % vs. 1.6 % , P=0.01 ) and readmission ( 6.3 % vs. 2.7 % ) ( P<0.001 ) . CONCLUSIONS The technical skill of practicing bariatric surgeons varied widely , and greater skill was associated with fewer postoperative complications and lower rates of reoperation , readmission , and visits to the emergency department . Although these findings are preliminary , they suggest that peer rating of operative skill may be an effective strategy for assessing a surgeon 's proficiency BACKGROUND Music is commonly played in operating theaters . Some surgeons believe music reduces stress and operative time , while others think music is a distraction and should be avoided . There is limited published evidence evaluating the effects of music on surgical performance . OBJECTIVE The goal of this study is to evaluate the effect of music on simple wound closure . METHODS Plastic surgery residents were asked to perform layered closures on pigs ' feet with and without their preferred music playing . Simple r and omization was used to assign residents to the music playing first or music playing second group . The time to complete the repair was measured and repairs were grade d by blinded faculty . Results were analyzed to determine significant differences in time to complete the task and quality of repair . Participants were retested in a second session with music played in the opposite order to evaluate consistency . RESULTS Listening to preferred music decreased repair time by 8 % for all plastic surgery residents ( p = 0.009 ) . Subgroup analysis demonstrated even more significant improvement in speed for senior residents ( PGY 4 - 6 ) , result ing in a 10 % decrease in repair time ( p = 0.006 ) . The quality of repair was also better in the music group , at 3.3 versus 3.1 ( p = 0.047 ) . Retesting revealed results remained significant whether music was played first or second . CONCLUSIONS Playing preferred music made plastic surgery residents faster in completing wound closure with a 10 % improvement in senior residents . Music also improved quality of repair as judged by blinded faculty . Our study showed that music improves efficiency of wound closure , which may translate to healthcare cost savings PURPOSE To investigate the effect of virtual reality proficiency-based training on actual cataract surgery performance . The secondary purpose of the study was to define which surgeons benefit from virtual reality training . DESIGN Multicenter masked clinical trial . PARTICIPANTS Eighteen cataract surgeons with different levels of experience . METHODS Cat 
    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 The role of music during surgery has been studied , including its effect on theatre staff , users and patients . However , little attention has been paid to its application especially in our environment . METHODS It was a prospect i ve study , involving theatre staff , users , and patients . Their opinions on acceptability and the role of music in operating theatre were determined . Information was obtained by question naire . RESULTS There were 162 respondents ; age range 25 to 76 years ( median age 39 ) . There were 109 ( 67.2 % ) males and 53 ( 32.7 % ) female . One hundred and forty five ( 89.5 % ) respondents agree that music should be played in the operating theatre . One fifty eight , ( 97.5 % ) considered low tone of music to be most appropriate in the theatre while 3(1.9 % ) , and 1(0.6 % ) considered moderate and high tone respectively to be most appropriate . One hundred and sixteen , ( 71.6 % ) preferred  jazz music while 19(11.7 % ) reggae , 11(6.8 % ) African music , 13 ( 8.0 % ) others ( not specify ) , 2 ( 1.2 % ) classical , and 1(0.6 % ) Irish folk . The majority of the respondents were aware of the role of music in terms of its anxiolytic effect , reduction of stress and enhancement of performance when familiar music is played . CONCLUSION Music in the operating theatre has immeasurable effects . It can prevent distraction , minimize annoyance , reduce stress and diminish the anxiety of patients , staff and users Objective To evaluate and vali date the time of completion and results of a new method of search ing for systematic review s , the exhaustive search method ( ESM ) , using a pragmatic comparison . Methods Single‐line search strategies were prepared in a text document . Term completeness was ensured with a novel optimization technique . Macros in MS Word converted the syntaxes between data bases and interfaces almost automatically . We compared search characteristics , such as number of search terms and data bases , and outcomes , such as number of included and retrieved references and precision , from ESM search es and other Dutch academic hospitals identified by search ing PubMed for systematic review s published between 2014 and 2016 . We compared time to perform the ESM with a secondary comparator of recorded search times from published literature and contact with authors to acquire unpublished data . Results We identified 73 published Erasmus MC systematic review s and 258 published by other Dutch academic hospitals meeting our criteria . We pooled search time data from 204 other systematic review s. The ESM search es differed by using 2 times more data bases , retrieving 44 % more references , including 20 % more studies in the final systematic review , but the time needed for the search was 8 % of that of the control group . Similarities between methods include precision and the number of search terms . Conclusions The evaluated similarities and differences suggest that the ESM is a highly efficient way to locate more references meeting the specified selection criteria in systematic review s than traditional search methods . Further prospect i ve research is required BACKGROUND Effective communication is a critical component of patient care in the operative room ( OR ) . However , the presence of loud equipment , a large number of staff members , and music can contribute to high levels of background noise . In a setting in which crucial tasks are performed continuously , distractions and barriers to communication can result in harm to both patients and OR personnel . The purpose of this investigation was to simulate OR listening conditions and evaluate the effect of operating noise on auditory function . STUDY DESIGN This is a prospect i ve investigation of 15 subjects ranging from 1 to 30 years of operative experience . All surgeons had normal peripheral hearing sensitivity . The surgeons ' ability to underst and and repeat words were tested using the  Speech in Noise Test-Revised  in 4 different conditions chosen to simulate typical OR environments . These included quiet , filtered noise through a mask and background noise both with and without music . They were tested in both a tasked and in an untasked situation . RESULTS It was found that the impact of noise is considerably greater when the participant is tasked . Surgeons demonstrated substantially poorer auditory performance in music than in quiet or OR noise . Performance in both conditions was poorer when the sentences were low in predictability . CONCLUSIONS Operating room noise can cause a decrease in auditory processing function , particularly in the presence of music . This becomes even more difficult when the communication involves conversations that carry critical information that is unpredictable . To avoid possible miscommunication in the OR , attempts should be made to reduce ambient noise levels Objective : To assess the impact of postoperative complications on full in-hospital costs per case . Background : Rising expenses for complex medical procedures combined with constrained re sources represent a major challenge . The severity of postoperative complications reflects surgical outcomes . The magnitude of the cost created by negative outcomes is unclear . Patients and Methods Morbidity of 1200 consecutive patients undergoing major surgery from 2005 to 2008 in a tertiary , high-volume center was assessed by a vali date d , complication score system . Full in-hospital costs were collected for each patient . Statistical analysis was performed using a multivariate linear regression model adjusted for potential confounders . Results : This study population included 393 complex liver/bile duct surgeries , 110 major pancreas operations , 389 colon resections , and 308 Roux-en-Y gastric bypasses .  The overall 30-day mortality rate was 1.8 % , whereas morbidity was 53.8 % . Patients with an uneventful course had mean costs per case of US$ 27,946 ( SD US$ 15,106 ) . Costs increased dramatically with the severity of postoperative complications and reached the mean costs of US$ 159,345 ( SD US$ 151,191 ) for grade IV complications . This increase in costs , up to 5 times the cost of a similar operation without complications , was observed for all types of investigated procedures , although the magnitude of the increase varied , with the highest costs in patients undergoing pancreas surgery . Conclusion : This study demonstrates the dramatic impact of postoperative complications on full in-hospital costs per case and that complications are the strongest indicator of costs . Furthermore , the study highlights a relevant savings capacity for major surgical procedures , and supports all efforts to lower negative events in the postoperative course BACKGROUND Although there is growing evidence that practice on bench model simulators can improve the acquisition of technical skill in surgery , the degree to which these models have to approximate real-world conditions ( model fidelity ) to optimize learning is unclear . Previous research suggests that low-fidelity models may be adequate for novice learners . The purpose of this study was to assess the effect of model fidelity and surgical expertise on the acquisition of vascular anastomosis skill . METHODS Twenty-seven surgical residents participated in this institutional review board-approved study . Junior residents ( postgraduate year 1 and 2 ) and senior residents ( postgraduate year 4 or higher ) were r and omized into two groups : low-fidelity ( n = 13 ) and high-fidelity ( n = 14 ) model training . Both groups were given a 3-hour h and s-on training session : the low-fidelity group used plastic models , and the high-fidelity group used human cadaver arms ( brachial arteries ) to practice graft-to-arterial anastomosis . One week later , all subjects participated in an animal laboratory in which they performed a single vascular anastomosis on a live , anesthetized pig ( femoral artery ) . A blinded vascular surgeon scored c and i date performance in the animal laboratory by using previously vali date d end points , including a checklist and final product analysis score . RESULTS Acquisition of skill was significantly affected by model fidelity and level of training as measured by both the checklist ( P = .03 ) and final product analysis ( P = .01 ; Kruskal-Wallis ) . Specifically , junior residents practicing on high-fidelity models scored better on the checklist ( P = .05 ) and final product analysis ( P = .04 ) . Senior residents practicing on high-fidelity models scored better on final product analysis ( P < .05 ) . CONCLUSIONS Training in the laboratory does improve skill when assessed in a realistic setting . Both expertise groups showed better skill transfer from the bench model to live animals when practicing on high-fidelity models . For vascular anastomosis , it is important to provide appropriate model fidelity for trainees of different abilities to optimize the effectiveness of bench model training Background Music and noise are frequent occurrences in the operating room . To date , the effects of these auditory conditions on the performance of laparoscopic surgery experts have not been evaluated . Methods Eight internationally recognized experts were recruited for a crossover study . The experts were r and omized to perform three simple tasks on a laparoscopic simulator , SurgicalSIM VR . The tasks were equal in difficulty and performed under the following conditions : silence , dichaotic music ( auditory stress ) , classical music ( auditory relaxation ) , and mental loading ( mental arithmetic tasks ) . Permutations of the conditions were created to account for a learning effect . The tasks were performed twice to test for memory consolidation and to accommo date baseline variability . Time until task completion and task accuracy via instrument tip trajectory ( path of the tip through space ) were recorded . Performance was correlated with responses on the Brief Musical Experience Question naire ( MEQ ) . Results The study demonstrated that dichaotic music has a negative impact on time until task completion but not on task accuracy . In addition , memory consolidation of accuracy is negatively influenced . Classical music has a variable effect on experts ’ time until task completion , yet all the experts performed the tasks more accurately . Classical music had no effect on recall of a procedure . Mental loading increased time until completion , but did not affect accuracy or recall . The experience of music varied among experts and influenced how each of the conditions affected their performance . Conclusion The study demonstrated that , contrary to common belief , proficiency in surgery does not protect against stressful auditory influences or the influence of mental preoccupation . Interestingly , relaxing auditory influences such as classical music can even have a positive impact on the accuracy of experts . Previous musical experience could help to identify surgeons whose performance may be specifically affected by music or noise BACKGROUND Clinical outcomes after many complex surgical procedures vary widely across hospitals and surgeons . Although it has been assumed that the proficiency of the operating surgeon is an important factor underlying such variation , empirical data are lacking on the relationships between technical skill and postoperative outcomes . METHODS We conducted a study involving 20 bariatric surgeons in Michigan who participated in a statewide collaborative improvement program . Each surgeon su bmi tted a single representative videotape of himself or herself performing a laparoscopic gastric bypass . Each videotape was rated in various domains of technical skill on a scale of 1 to 5 ( with higher scores indicating more advanced skill ) by at least 10 peer surgeons who were unaware of the identity of the operating surgeon . We then assessed relationships between these skill ratings and risk-adjusted complication rates , using data from a prospect i ve , externally audited , clinical - outcomes registry involving 10,343 patients . RESULTS Mean summary ratings of technical skill ranged from 2.6 to 4.8 across the 20 surgeons . The bottom quartile of surgical skill , as compared with the top quartile , was associated with higher complication rates ( 14.5 % vs. 5.2 % , P<0.001 ) and higher mortality ( 0.26 % vs. 0.05 % , P=0.01 ) . The lowest quartile of skill was also associated with longer operations ( 137 minutes vs. 98 minutes , P<0.001 ) and higher rates of reoperation ( 3.4 % vs. 1.6 % , P=0.01 ) and readmission ( 6.3 % vs. 2.7 % ) ( P<0.001 ) . CONCLUSIONS The technical skill of practicing bariatric surgeons varied widely , and greater skill was associated with fewer postoperative complications and lower rates of reoperation , readmission , and visits to the emergency department . Although these findings are preliminary , they suggest that peer rating of operative skill may be an effective strategy for assessing a surgeon 's proficiency BACKGROUND Music is commonly played in operating theaters . Some surgeons believe music reduces stress and operative time , while others think music is a distraction and should be avoided . There is limited published evidence evaluating the effects of music on surgical performance . OBJECTIVE The goal of this study is to evaluate the effect of music on simple wound closure . METHODS Plastic surgery residents were asked to perform layered closures on pigs ' feet with and without their preferred music playing . Simple r and omization was used to assign residents to the music playing first or music playing second group . The time to complete the repair was measured and repairs were grade d by blinded faculty . Results were analyzed to determine significant differences in time to complete the task and quality of repair . Participants were retested in a second session with music played in the opposite order to evaluate consistency . RESULTS Listening to preferred music decreased repair time by 8 % for all plastic surgery residents ( p = 0.009 ) . Subgroup analysis demonstrated even more significant improvement in speed for senior residents ( PGY 4 - 6 ) , result ing in a 10 % decrease in repair time ( p = 0.006 ) . The quality of repair was also better in the music group , at 3.3 versus 3.1 ( p = 0.047 ) . Retesting revealed results remained significant whether music was played first or second . CONCLUSIONS Playing preferred music made plastic surgery residents faster in completing wound closure with a 10 % improvement in senior residents . Music also improved quality of repair as judged by blinded faculty . Our study showed that music improves efficiency of wound closure , which may translate to healthcare cost savings PURPOSE To investigate the effect of virtual reality proficiency-based training on actual cataract surgery performance . The secondary purpose of the study was to define which surgeons benefit from virtual reality training . DESIGN Multicenter masked clinical trial . PARTICIPANTS Eighteen cataract surgeons with different levels of experience . METHODS Cat 
    Output:
    