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 Low albumin level is a strong predictor of mortality and morbidity among hemodialysis patients , yet few interventions are available to improve albumin levels . Moreover , the relative importance of nutritional barriers versus inflammation in contributing to hypoalbuminemia is unclear . We sought to determine whether targeting specific nutritional barriers will improve albumin levels . METHODS We conducted a r and omized controlled trial involving 180 patients with baseline albumin levels less than 3.7 g/dL ( < 37 g/L ) at 44 long-term hemodialysis facilities . Study coordinators identified and intervened on specific barriers present among intervention patients , whereas control patients continued to receive the usual care . Barriers targeted included poor nutritional knowledge , poor appetite , help needed with shopping or cooking , low fluid intake , inadequate dialysis dose , depression , difficulty chewing , difficulty swallowing , gastrointestinal symptoms , and acidosis . RESULTS At baseline , intervention and control patients had similar albumin levels , dietary intakes , levels of inflammatory markers , and numbers of nutritional barriers . After 12 months , intervention patients had greater increases in albumin levels compared with control patients ( + 0.21 versus + 0.06 g/dL [ + 2.1 versus + 0.6 g/L ] ; P < 0.01 ) , as well as greater increases in energy intake ( + 4.1 versus -0.6 Kcal/d/kg ; P < 0.001 ) and protein intake ( + 0.13 versus -0.06 g/d/kg ; P < 0.001 ) . The intervention appeared most effective for barriers related to poor nutritional knowledge , help needed with shopping or cooking , and difficulty swallowing . About half the subjects had elevated levels of inflammatory markers , but there was no relationship between change in levels of albumin and inflammatory markers . CONCLUSION A nutrition intervention tailored to patient-specific barriers result ed in modest improvements in albumin levels regardless of levels of inflammatory markers 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 Chile is currently undergoing a period of rapid demographic transition which has led to an increase in the proportion of older people in the population ; the proportion aged 60 years and over , for example , increased from 8 % of the population in 1980 to 12 % in 2005 . In an effort to promote healthy ageing and preserve function , the government of Chile has formulated a package of actions into the Programme of Complementary Feeding for the Older Population ( PACAM ) which has been providing a nutritional supplement to older people since 1998 . PACAM distributes micronutrient fortified foods to individuals aged 70 years and over registered at Primary Health Centres and enrolled in the programme . The recommended serving size ( 50 g/day ) of these supplements provides 50 % of daily micronutrient requirements and 20 % of daily energy requirements of older people . No information is currently available on the cost-effectiveness of the supplementation programme . Aim The aim of the CENEX cluster r and omised controlled trial is to evaluate the cost-effectiveness of an ongoing nutrition supplementation programme , and a specially design ed physical exercise intervention for older people of low to medium socio-economic status living in Santiago , Chile . Methods The study has been conceptualised as a public health programme effectiveness study and has been design ed as a 24-month factorial cluster-r and omised controlled trial conducted among 2800 individuals aged 65.0–67.9 years at baseline attending 28 health centres in Santiago . The main outcomes are incidence of pneumonia , walking capacity and change in body mass index over 24 months of intervention . Costing data ( user and provider ) , collected at all levels , will enable the determination of the cost-effectiveness of the two interventions individually and in combination . The study is supported by the Ministry of Health in Chile , which is keen to exp and and improve its national programme of nutrition for older people based on sound science-base and evidence for cost-effectiveness . Trial registration IS RCT 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 Weight loss in patients with Alzheimer 's disease ( AD ) is a common clinical manifestation that may have clinical significance . Objectives To evaluate if there is a difference between nutrition education and oral nutritional supplementation on nutritional status in patients with AD . Methods A r and omized , prospect i ve 6-month study which enrolled 90 subjects with probable AD aged 65 years or older divided into 3 groups : Control Group ( CG ) [ n = 27 ] , Education Group ( EG ) [ n = 25 ] , which participated in an education program and Supplementation Group ( SG ) [ n = 26 ] , which received two daily servings of oral nutritional supplementation . Subjects were assessed for anthropometric data ( weight , height , BMI , TSF , AC and AMC ) , biochemical data ( total protein , albumin , and total lymphocyte count ) , CDR ( Clinical Dementia Rating ) , MMSE ( Mini-mental state examination ) , as well as dependence during meals . Results The SG showed a significant improvement in the following anthropometric measurements : weight ( H calc = 22.12 , p = < 0.001 ) , BMI ( H calc = 22.12 , p = < 0.001 ) , AC ( H calc = 12.99 , p = < 0.002 ) , and AMC ( H calc = 8.67 , p = < 0.013 ) compared to the CG and EG . BMI of the EG was significantly greater compared to the CG . There were significant changes in total protein ( H calc = 6.17 , p = < 0.046 ) , and total lymphocyte count in the SG compared to the other groups ( H cal = 7.94 , p = 0.019 ) . Conclusion Oral nutritional supplementation is more effective compared to nutrition education in improving nutritional status Objective To examine the prevalence of outcome reporting bias — the selection for publication of a subset of the original recorded outcome variables on the basis of the results — and its impact on Cochrane review s. Design A nine point classification system for missing outcome data in r and omised trials was developed and applied to the trials assessed in a large , unselected cohort of Cochrane systematic review s. Research ers who conducted the trials were contacted and the reason sought for the non-reporting of data . A sensitivity analysis was undertaken to assess the impact of outcome reporting bias on review s that included a single meta- analysis of the review primary outcome . Results More than half ( 157/283 ( 55 % ) ) the review s did not include full data for the review primary outcome of interest from all eligible trials . The median amount of review outcome data missing for any reason was 10 % , whereas 50 % or more of the potential data were missing in 70 ( 25 % ) review s. It was clear from the publications for 155 ( 6 % ) of the 2486 assessable trials that the research ers had measured and analysed the review primary outcome but did not report or only partially reported the results . For reports that did not mention the review primary outcome , our classification regarding the presence of outcome reporting bias was shown to have a sensitivity of 88 % ( 95 % CI 65 % to 100 % ) and specificity of 80 % ( 95 % CI 69 % to 90 % ) on the basis of responses from 62 trialists . A third of Cochrane review s ( 96/283 ( 34 % ) ) contained at least one trial with high suspicion of outcome reporting bias for the review primary outcome . In a sensitivity analysis undertaken for 81 review s with a single meta- analysis of the primary outcome of interest , the treatment effect estimate was reduced by 20 % or more in 19 ( 23 % ) . Of the 42 meta-analyses with a statistically significant result only , eight ( 19 % ) became non-significant after adjustment for outcome reporting bias and 11 ( 26 % ) would have overestimated the treatment effect by 20 % or more . Conclusions Outcome reporting bias is an under-recognised problem that affects the conclusions in a substantial proportion of Cochrane review s. Individuals conducting systematic review s need to address explicitly the issue of missing outcome data for their review to be considered a reliable source of evidence . Extra care is required during data extraction , review ers should identify when a trial reports that an outcome was measured but no results were reported or events observed , and contact with trialists should be encouraged The aims of this r and omised controlled trial were to determine if a high-intensity functional exercise program improves balance , gait ability , and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training . One hundred and ninety-one older persons dependent in activities of daily living , living in residential care facilities , and with a Mini-Mental State Examination ( MMSE ) score of ? 10 participated . They were r and omised to a high-intensity functional exercise program or a control activity , which included 29 sessions over 3 months , as well as to protein-enriched energy supplement or placebo .  Berg Balance Scale , self-paced and maximum gait speed , and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA , using the intention-to-treat principle . At three months , 
    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 Low albumin level is a strong predictor of mortality and morbidity among hemodialysis patients , yet few interventions are available to improve albumin levels . Moreover , the relative importance of nutritional barriers versus inflammation in contributing to hypoalbuminemia is unclear . We sought to determine whether targeting specific nutritional barriers will improve albumin levels . METHODS We conducted a r and omized controlled trial involving 180 patients with baseline albumin levels less than 3.7 g/dL ( < 37 g/L ) at 44 long-term hemodialysis facilities . Study coordinators identified and intervened on specific barriers present among intervention patients , whereas control patients continued to receive the usual care . Barriers targeted included poor nutritional knowledge , poor appetite , help needed with shopping or cooking , low fluid intake , inadequate dialysis dose , depression , difficulty chewing , difficulty swallowing , gastrointestinal symptoms , and acidosis . RESULTS At baseline , intervention and control patients had similar albumin levels , dietary intakes , levels of inflammatory markers , and numbers of nutritional barriers . After 12 months , intervention patients had greater increases in albumin levels compared with control patients ( + 0.21 versus + 0.06 g/dL [ + 2.1 versus + 0.6 g/L ] ; P < 0.01 ) , as well as greater increases in energy intake ( + 4.1 versus -0.6 Kcal/d/kg ; P < 0.001 ) and protein intake ( + 0.13 versus -0.06 g/d/kg ; P < 0.001 ) . The intervention appeared most effective for barriers related to poor nutritional knowledge , help needed with shopping or cooking , and difficulty swallowing . About half the subjects had elevated levels of inflammatory markers , but there was no relationship between change in levels of albumin and inflammatory markers . CONCLUSION A nutrition intervention tailored to patient-specific barriers result ed in modest improvements in albumin levels regardless of levels of inflammatory markers 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 Chile is currently undergoing a period of rapid demographic transition which has led to an increase in the proportion of older people in the population ; the proportion aged 60 years and over , for example , increased from 8 % of the population in 1980 to 12 % in 2005 . In an effort to promote healthy ageing and preserve function , the government of Chile has formulated a package of actions into the Programme of Complementary Feeding for the Older Population ( PACAM ) which has been providing a nutritional supplement to older people since 1998 . PACAM distributes micronutrient fortified foods to individuals aged 70 years and over registered at Primary Health Centres and enrolled in the programme . The recommended serving size ( 50 g/day ) of these supplements provides 50 % of daily micronutrient requirements and 20 % of daily energy requirements of older people . No information is currently available on the cost-effectiveness of the supplementation programme . Aim The aim of the CENEX cluster r and omised controlled trial is to evaluate the cost-effectiveness of an ongoing nutrition supplementation programme , and a specially design ed physical exercise intervention for older people of low to medium socio-economic status living in Santiago , Chile . Methods The study has been conceptualised as a public health programme effectiveness study and has been design ed as a 24-month factorial cluster-r and omised controlled trial conducted among 2800 individuals aged 65.0–67.9 years at baseline attending 28 health centres in Santiago . The main outcomes are incidence of pneumonia , walking capacity and change in body mass index over 24 months of intervention . Costing data ( user and provider ) , collected at all levels , will enable the determination of the cost-effectiveness of the two interventions individually and in combination . The study is supported by the Ministry of Health in Chile , which is keen to exp and and improve its national programme of nutrition for older people based on sound science-base and evidence for cost-effectiveness . Trial registration IS RCT 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 Weight loss in patients with Alzheimer 's disease ( AD ) is a common clinical manifestation that may have clinical significance . Objectives To evaluate if there is a difference between nutrition education and oral nutritional supplementation on nutritional status in patients with AD . Methods A r and omized , prospect i ve 6-month study which enrolled 90 subjects with probable AD aged 65 years or older divided into 3 groups : Control Group ( CG ) [ n = 27 ] , Education Group ( EG ) [ n = 25 ] , which participated in an education program and Supplementation Group ( SG ) [ n = 26 ] , which received two daily servings of oral nutritional supplementation . Subjects were assessed for anthropometric data ( weight , height , BMI , TSF , AC and AMC ) , biochemical data ( total protein , albumin , and total lymphocyte count ) , CDR ( Clinical Dementia Rating ) , MMSE ( Mini-mental state examination ) , as well as dependence during meals . Results The SG showed a significant improvement in the following anthropometric measurements : weight ( H calc = 22.12 , p = < 0.001 ) , BMI ( H calc = 22.12 , p = < 0.001 ) , AC ( H calc = 12.99 , p = < 0.002 ) , and AMC ( H calc = 8.67 , p = < 0.013 ) compared to the CG and EG . BMI of the EG was significantly greater compared to the CG . There were significant changes in total protein ( H calc = 6.17 , p = < 0.046 ) , and total lymphocyte count in the SG compared to the other groups ( H cal = 7.94 , p = 0.019 ) . Conclusion Oral nutritional supplementation is more effective compared to nutrition education in improving nutritional status Objective To examine the prevalence of outcome reporting bias — the selection for publication of a subset of the original recorded outcome variables on the basis of the results — and its impact on Cochrane review s. Design A nine point classification system for missing outcome data in r and omised trials was developed and applied to the trials assessed in a large , unselected cohort of Cochrane systematic review s. Research ers who conducted the trials were contacted and the reason sought for the non-reporting of data . A sensitivity analysis was undertaken to assess the impact of outcome reporting bias on review s that included a single meta- analysis of the review primary outcome . Results More than half ( 157/283 ( 55 % ) ) the review s did not include full data for the review primary outcome of interest from all eligible trials . The median amount of review outcome data missing for any reason was 10 % , whereas 50 % or more of the potential data were missing in 70 ( 25 % ) review s. It was clear from the publications for 155 ( 6 % ) of the 2486 assessable trials that the research ers had measured and analysed the review primary outcome but did not report or only partially reported the results . For reports that did not mention the review primary outcome , our classification regarding the presence of outcome reporting bias was shown to have a sensitivity of 88 % ( 95 % CI 65 % to 100 % ) and specificity of 80 % ( 95 % CI 69 % to 90 % ) on the basis of responses from 62 trialists . A third of Cochrane review s ( 96/283 ( 34 % ) ) contained at least one trial with high suspicion of outcome reporting bias for the review primary outcome . In a sensitivity analysis undertaken for 81 review s with a single meta- analysis of the primary outcome of interest , the treatment effect estimate was reduced by 20 % or more in 19 ( 23 % ) . Of the 42 meta-analyses with a statistically significant result only , eight ( 19 % ) became non-significant after adjustment for outcome reporting bias and 11 ( 26 % ) would have overestimated the treatment effect by 20 % or more . Conclusions Outcome reporting bias is an under-recognised problem that affects the conclusions in a substantial proportion of Cochrane review s. Individuals conducting systematic review s need to address explicitly the issue of missing outcome data for their review to be considered a reliable source of evidence . Extra care is required during data extraction , review ers should identify when a trial reports that an outcome was measured but no results were reported or events observed , and contact with trialists should be encouraged The aims of this r and omised controlled trial were to determine if a high-intensity functional exercise program improves balance , gait ability , and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training . One hundred and ninety-one older persons dependent in activities of daily living , living in residential care facilities , and with a Mini-Mental State Examination ( MMSE ) score of ? 10 participated . They were r and omised to a high-intensity functional exercise program or a control activity , which included 29 sessions over 3 months , as well as to protein-enriched energy supplement or placebo .  Berg Balance Scale , self-paced and maximum gait speed , and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA , using the intention-to-treat principle . At three months , 
    Output:
    