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: Objective This study investigated the relationship between psychological well-being and different voice rehabilitation methods in total laryngectomy patients . Methods The study enrolled 96 patients who underwent total laryngectomy . The patients were divided into three groups according to the voice rehabilitation method used : esophageal speech ( 24 patients ) ; a tracheoesophageal fistula and Provox 2 voice prosthesis ( 57 patients ) ; or an electrolarynx ( 15 patients ) . The participants were asked to complete the  Turkish version of the Voice H and icap Index-10 ( VHI-10 ) to assess voice problems . They were also asked to complete the Turkish version of the Perceived Stress Scale ( PSS ) , and the Hospital Anxiety and Depression Scale ( HADS ) . The test scores of the three groups were compared statistically . Results Patients who used esophageal speech had a mean VHI-10 score of 10.25 ± 3.22 versus 19.42 ± 5.56 and 17.60 ± 1.92 for the tracheoesophageal fistula and Provox 2 and electrolarynx groups respectively , reflecting better perception of their voice . They also had a PSS score of 11.38 ± 3.92 , indicating that they felt less stressed in comparison with the tracheoesophageal fistula and Provox 2 and electrolarynx groups , which scored 18.84 ± 5.50 and 16.20 ± 3.49 respectively . The HADS scores of the groups were not different , indicating that the patients ’ anxiety and depression status did not vary . Conclusion Patients who used esophageal speech perceived less stress and were less h and icapped by their voice . ZusammenfassungZielUntersucht wurde das psychologische Wohlbefinden von Patienten nach totaler Laryngektomie bei unterschiedlichen Verfahren zur Stimmrehabilitation . Method en96 Patienten nach totaler Laryngektomie wurden in drei Gruppen nach dem jeweiligen Verfahren zur Stimmrehabilitation eingeteilt : Ösophagussprache ( 24 ) , tracheoösophageale Fistel und Provox 2‑Stimmprothese ( 57 ) ; bzw . Elektrolarynx ( 15 ) . Die Teilnehmer sollten die türkischen Fassungen des Voice H and icap Index-10 ( VHI-10 ) zur Bewertung von Sprachproblemen , die Perceived Stress Scale ( PSS ) und die Hospital Anxiety and Depression Scale ( HADS ) ausfüllen . Die Testergebnisse der drei Gruppen wurden statistisch verglichen . ErgebnissePatienten mit Ösophagusstimme erzielten i m Durchschnitt ein VHI-10-Ergebnis von f 10,25 ± 3,22 gegenüber 19,42 ± 5,56 und 17,60 ± 1,92 bei den Gruppen mit tracheoösophagealer Fistel und Provox 2 bzw . Elektrolarynx , wo die Stimmwahrnehmung besser war . Ihr PSS Wert von 11,38 ± 3,92 , deutete darauf hin , dass sie gegenüber den Gruppen mit tracheoösophagealer Fistel und Provox 2 sowie Elektrolarynx , die Werte von 18,84 ± 5,50 bzw . 16,20 ± 3,49 erzielten , weniger Stress empf and en . Die HADS-Werte der Gruppen unterschieden sich nicht , was darauf hindeutet , dass Angst und Depression die Patienten gleichermaßen betrafen . SchlussfolgerungPatienten mit Ösophagusstimme waren weniger gestresst und fühlten sich weniger durch ihre Stimme beeinträchtigt als die Patienten der beiden and eren Gruppen PURPOSE The aim of this study was to define the scales and test the validity , reliability , and sensitivity of the European Organization for Research and Treatment of Cancer Quality of Life Question naire ( EORTC QLQ)-H&N35 , a question naire design ed to assess the quality of life of head and neck ( H&N ) cancer patients in conjunction with the general cancer-specific EORTC QLQ-C30 . PATIENTS AND METHODS Question naires were given to 500 H&N cancer patients from Norway , Sweden , and the Netherl and s as part of two prospect i ve studies . The patients completed the question naires before , during ( Norway and Sweden only ) , and after treatment , yielding a total of 2070 completed question naires . RESULTS The compliance rate was high , and the question naires were well accepted by the patients . Seven scales were constructed ( pain , swallowing , senses , speech , social eating , social contact , sexuality ) . Scales and single items were sensitive to differences between patient subgroups with relation to site , stage , or performance status . Most scales and single items were sensitive to changes , with differences of various magnitudes according to the site in question . The internal consistency , as assessed by Cronbach 's alpha coefficient , varied according to assessment point and within sub sample s of patients . A low overall alpha value was found for the speech and the senses scales , but values were higher in assessment s of patients with laryngeal cancer and in patients with nose , sinus , and salivary gl and tumors . Scales and single items in the QLQ-H&N35 seem to be more sensitive to differences between groups and changes over time than do the scales and single items in the core question naire . CONCLUSION The QLQ-H&N35 , in conjunction with the QLQ-C30 , provides a valuable tool for the assessment of health-related quality of life in clinical studies of H&N cancer patients before , during , and after treatment with radiotherapy , surgery , or chemotherapy 
    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: Objective This study investigated the relationship between psychological well-being and different voice rehabilitation methods in total laryngectomy patients . Methods The study enrolled 96 patients who underwent total laryngectomy . The patients were divided into three groups according to the voice rehabilitation method used : esophageal speech ( 24 patients ) ; a tracheoesophageal fistula and Provox 2 voice prosthesis ( 57 patients ) ; or an electrolarynx ( 15 patients ) . The participants were asked to complete the  Turkish version of the Voice H and icap Index-10 ( VHI-10 ) to assess voice problems . They were also asked to complete the Turkish version of the Perceived Stress Scale ( PSS ) , and the Hospital Anxiety and Depression Scale ( HADS ) . The test scores of the three groups were compared statistically . Results Patients who used esophageal speech had a mean VHI-10 score of 10.25 ± 3.22 versus 19.42 ± 5.56 and 17.60 ± 1.92 for the tracheoesophageal fistula and Provox 2 and electrolarynx groups respectively , reflecting better perception of their voice . They also had a PSS score of 11.38 ± 3.92 , indicating that they felt less stressed in comparison with the tracheoesophageal fistula and Provox 2 and electrolarynx groups , which scored 18.84 ± 5.50 and 16.20 ± 3.49 respectively . The HADS scores of the groups were not different , indicating that the patients ’ anxiety and depression status did not vary . Conclusion Patients who used esophageal speech perceived less stress and were less h and icapped by their voice . ZusammenfassungZielUntersucht wurde das psychologische Wohlbefinden von Patienten nach totaler Laryngektomie bei unterschiedlichen Verfahren zur Stimmrehabilitation . Method en96 Patienten nach totaler Laryngektomie wurden in drei Gruppen nach dem jeweiligen Verfahren zur Stimmrehabilitation eingeteilt : Ösophagussprache ( 24 ) , tracheoösophageale Fistel und Provox 2‑Stimmprothese ( 57 ) ; bzw . Elektrolarynx ( 15 ) . Die Teilnehmer sollten die türkischen Fassungen des Voice H and icap Index-10 ( VHI-10 ) zur Bewertung von Sprachproblemen , die Perceived Stress Scale ( PSS ) und die Hospital Anxiety and Depression Scale ( HADS ) ausfüllen . Die Testergebnisse der drei Gruppen wurden statistisch verglichen . ErgebnissePatienten mit Ösophagusstimme erzielten i m Durchschnitt ein VHI-10-Ergebnis von f 10,25 ± 3,22 gegenüber 19,42 ± 5,56 und 17,60 ± 1,92 bei den Gruppen mit tracheoösophagealer Fistel und Provox 2 bzw . Elektrolarynx , wo die Stimmwahrnehmung besser war . Ihr PSS Wert von 11,38 ± 3,92 , deutete darauf hin , dass sie gegenüber den Gruppen mit tracheoösophagealer Fistel und Provox 2 sowie Elektrolarynx , die Werte von 18,84 ± 5,50 bzw . 16,20 ± 3,49 erzielten , weniger Stress empf and en . Die HADS-Werte der Gruppen unterschieden sich nicht , was darauf hindeutet , dass Angst und Depression die Patienten gleichermaßen betrafen . SchlussfolgerungPatienten mit Ösophagusstimme waren weniger gestresst und fühlten sich weniger durch ihre Stimme beeinträchtigt als die Patienten der beiden and eren Gruppen PURPOSE The aim of this study was to define the scales and test the validity , reliability , and sensitivity of the European Organization for Research and Treatment of Cancer Quality of Life Question naire ( EORTC QLQ)-H&N35 , a question naire design ed to assess the quality of life of head and neck ( H&N ) cancer patients in conjunction with the general cancer-specific EORTC QLQ-C30 . PATIENTS AND METHODS Question naires were given to 500 H&N cancer patients from Norway , Sweden , and the Netherl and s as part of two prospect i ve studies . The patients completed the question naires before , during ( Norway and Sweden only ) , and after treatment , yielding a total of 2070 completed question naires . RESULTS The compliance rate was high , and the question naires were well accepted by the patients . Seven scales were constructed ( pain , swallowing , senses , speech , social eating , social contact , sexuality ) . Scales and single items were sensitive to differences between patient subgroups with relation to site , stage , or performance status . Most scales and single items were sensitive to changes , with differences of various magnitudes according to the site in question . The internal consistency , as assessed by Cronbach 's alpha coefficient , varied according to assessment point and within sub sample s of patients . A low overall alpha value was found for the speech and the senses scales , but values were higher in assessment s of patients with laryngeal cancer and in patients with nose , sinus , and salivary gl and tumors . Scales and single items in the QLQ-H&N35 seem to be more sensitive to differences between groups and changes over time than do the scales and single items in the core question naire . CONCLUSION The QLQ-H&N35 , in conjunction with the QLQ-C30 , provides a valuable tool for the assessment of health-related quality of life in clinical studies of H&N cancer patients before , during , and after treatment with radiotherapy , surgery , or chemotherapy 
    Output:
    