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: Aims The ŒDIPE trial examined the safety and efficacy of an abbreviated hospitalization after implantation or replacement of dual-chamber pacemakers ( PM )  using a telecardiology-based ambulatory surveillance programme . Methods and results Patients were r and omly assigned to ( i ) an active group  , discharged from the hospital 24 h after a first PM implant  or 4–6 h after replacement  , and followed for 4 weeks with Home-Monitoring ( HM ) , or ( ii ) a control group followed for 4 weeks according to usual medical practice s. The primary objective was to confirm that the proportion of patients who experienced one or more major adverse events ( MAE ) was not higher in the active than in the control group . The study included 379 patients . At least one treatment-related MAE was observed in 9.2 % of patients ( n = 17 ) assigned to the active group vs. 13.3 % of patients ( n = 26 ) in the control group ( P = 0.21 ) , a 4.1 % absolute risk reduction ( 95 % CI −2.2 to 10.4 ; P = 0.98 ) . By study design , the mean hospitalization duration was 34 % shorter in the active than in the control group ( P < 0.001 ) , and HM facilitated the early detection of technical issues and detectable clinical anomalies . Conclusion Early discharge with HM after PM implantation or replacement was safe and facilitated the monitoring of patients in the month following the procedure A r and omised controlled trial was used to evaluate elective ambulatory orthopaedic surgery patients '  emotions during internet-based patient education or face-to-face education with a nurse .  The internet-based patient education was design ed for this study and patients used websites individually based on their needs . Patients in the control group  participated individually in face-to-face patient education with a nurse in the ambulatory surgery unit . The theoretical basis for both types of education was the same . Ambulatory orthopaedic surgery patients scored their emotions rather low at intervals throughout the whole surgical process , though their scores also changed during the surgical process . Emotion scores did not decrease after patient education . No differences in patients ' emotions were found to result from either of the two different patient education methods BACKGROUND total knee arthroplasty is an effective means for relieving the symptoms associated with degenerative arthritis of the knee . Rehabilitation is a necessary adjunct to surgery and is important in regaining optimum function . Access to high- quality rehabilitation services is not always possible , especially for those who live in rural or remote areas . The aim of this study was to evaluate the equivalence of an Internet-based telerehabilitation program compared with conventional outpatient physical therapy for patients who have had a total knee arthroplasty . METHODS this investigation was a single-blinded , prospect i ve , r and omized , controlled noninferiority trial . Sixty-five participants were r and omized to receive a six-week program of outpatient physical therapy either in the conventional manner or by means of an Internet-based telerehabilitation program . The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) measured at baseline and six weeks by a blinded independent assessor . Secondary outcomes included the Patient-Specific Functional Scale , the timed up- and -go test , pain intensity , knee flexion and extension , quadriceps muscle strength , limb girth measurements , and an assessment of gait . Noninferiority was assessed through the comparison of group differences with a noninferiority margin and with linear mixed model statistics . RESULTS baseline characteristics between groups were similar , and all participants had significant improvement on all outcome measures with the intervention ( p < 0.01 for all ) . After the six-week intervention , participants in the telerehabilitation group achieved outcomes comparable to those of the conventional rehabilitation group with regard to flexion and extension range of motion , muscle strength , limb girth , pain , timed up- and -go test , quality of life , and clinical gait and WOMAC scores . Better outcomes for the Patient-Specific Functional Scale and the stiffness subscale of the WOMAC were found in the telerehabilitation group ( p < 0.05 ) . The telerehabilitation intervention was well received by participants , who reported a high level of satisfaction with this novel technology . CONCLUSIONS the outcomes achieved via telerehabilitation at six weeks following total knee arthroplasty were comparable with those after conventional rehabilitation . LEVEL OF EVIDENCE therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence The purpose of this r and omized trial was to determine whether coronary artery bypass graft surgery patients and their caregivers who received  telehealth follow-up  had greater improvements in anxiety levels from pre-surgery to 3 weeks after discharge than did those who received st and ard care . Secondary outcomes included changes in depressive symptoms and patients ' contacts with physicians . No group differences were noted in changes in patients ' anxiety and depressive symptoms , but patients in the telehealth group had fewer physician contacts ( p = .04 ) . Female caregivers in the telehealth group had greater decreases in anxiety than those in st and ard care ( p < .001 ) , and caregivers of both genders in the telehealth group had greater decreases in depressive symptoms ( p = .03 ) Background Many employers and other stakeholders believe that health examinations of job applicants prevent occupational diseases and sickness absence . Objectives To evaluate the effectiveness of pre-employment examinations of job applicants  in preventing occupational injury , disease and sickness absence compared to no intervention or alternative interventions . Search strategy We search ed CENTRAL ( The Cochrane Library ) , MEDLINE , EMBASE , CINAHL , PsycINFO and PEDro ( to December 2009 ) not restricted by date , language or publication type . Selection criteria We included r and omised controlled trials ( RCTs ) , controlled before-after studies ( CBA ) , and interrupted time-series ( ITS ) of health examinations to prevent occupational diseases and injuries in job applicants . Data collection and analysis Four review authors ( NM , ML , JV , ES ) independently selected studies , extracted data , and determined study quality . The studies were too heterogeneous for statistical pooling of results . Main results We included two RCTs , five CBA studies and two ITS .  Seven studies with 5872 participants evaluated the screening process of pre-employment examinations and two studies with 2164 participants evaluated the measures to mitigate the risks found following the screening process . Of those studies that evaluated the screening process , one study found that a general examination did not reduce sick leave ( Mean Difference -0.1 95 % CI -0.5 to 0.3 ) but another study found that a more task focused examination did ( MD -36 95 % CI -68.3 to -3.8 ) . One study found that incorporation of a bronchial challenge test decreased occupational asthma ( trend change -2.6 95 % CI -3.6 to -1.5 ) . Three studies that included functional capacity evaluation found contradictory effects on injury rates and number of medical visits . The rates of rejecting job applicants varied from 2 % to 35 % . Neither of the two studies that evaluated risk mitigation found an increased injury rate after training or work accommodations had been implemented . We rated the evidence for all outcomes as very low quality . Authors ' conclusions There is very low quality evidence that pre-employment examinations that are specific to certain jobs or health problems could reduce occupational disease , injury , or sickness absence . This supports the current policy to restrict pre-employment examinations to job-specific examinations . More studies are needed that take into account the harms of rejecting job applicants OBJECTIVE To compare the effectiveness of a new interactive virtual telerehabilitation system and a conventional programme following total knee arthroplasty . DESIGN R and omized , controlled , single-blind clinical trial . PARTICIPANTS A total of 142 total knee arthroplasty patients . METHODS Participants were r and omly assigned to receive either : ( i ) conventional out-patient physical therapy ; or ( ii ) interactive virtual telerehabilitation system . The main outcome was function assessed with active range of knee movement . Other variables , such as muscle strength , walk speed , pain and the Western Ontario and McMaster Universities osteoarthritis index , were also collected . Comparisons were made on the basis of data collected routinely before surgery , at the end of the rehabilitation programme , and at 3 months follow-up . Quantitative variables were compared by Mann-Whitney U test . The agreed alpha risk for all hypothesis testing was 0.05 . RESULTS Baseline characteristics between groups were comparable . All participants improved after the 2-week intervention on all outcome variables ( p < 0.05 ) . Patients in the interactive virtual telerehabilitation group achieved improvements in the functional variables similar to those achieved in the conventional therapy group . CONCLUSION A 2-week interactive virtual telerehabilitation programme is at least as effective as conventional therapy . Telerehabilitation is a promising alternative to traditional face-to-face therapies after discharge from total knee arthroplasty , especially for those patients who have difficulty with transportation to rehabilitation centres To test the hypothesis that educational information provided via the web would not only be accessed by our patients , but could also reduce postoperative pain  following ambulatory surgery , we enrolled 195 patients into a r and omized controlled study . Fifty-two percent of our ambulatory surgery patients already knew how to use and had access to the Internet . Eighty-five percent of our study patients accessed the re sources made available to them on the web site . Patients who had access to the pain management information on the ambulatory surgery web site reported significantly less postoperative pain on arrival to their home after surgery ( p < 0.016 ) and into the night after surgery ( p < 0.013 ) . These patients also reported significantly less postoperative pain for the day immediately following surgery ( p < 0.037 ) . We conclude that using the Internet to provide just-in-time patient education can significantly effect the clinical outcome of care PURPOSE : To describe and compare ambulatory orthopaedic surgery patients ' reported cost of care ( out-of-pocket costs , use of time , and consultations with healthcare organizations ) and nurses ' cost of care ( use of time and consultations with other professionals such as other nurses , physicians , and anesthesiologists ) when patients receive 2 different types of patient education ( Internet-based or face-to-face ) .  METHOD : Pretest/posttest design . SAMPLE : R and om assignment of all ambulatory orthopaedic surgery patients in a university hospital in Finl and . INTERVENTION : The experimental group received Web-based patient education and the control group received face-to-face patient education . OUTCOMES OF INTEREST : Financial and time costs . FINDINGS : Pre- , intra- , and postoperative costs did not differ between the groups . However , Internet-based education was more time-consuming for the patient and face-to-face education was more time-consuming for the nurse . There were no differences between the groups in patients ' use of consultations of healthcare professionals . Nurses ' consultations were few and did not differ between the groups . The small number of patients ' and nurses ' consultations indicates that patients in both education methods had enough knowledge to deal with the surgery HYPOTHESIS Patient safety and satisfaction are adversely affected when robotic videoconferencing ( telerounding ) is used in the postoperative setting . DESIGN R and omized controlled trial . SETTING Three academic institutions . PATIENTS A total of 270 adults undergoing a urologic procedure requiring a hospital stay of 24 to 72 hours were r and omized to receive either traditional bedside rounds or robotic telerounds .  MAIN OUTCOME MEASURES The primary outcome measure was postoperative patient morbidity . Secondary outcomes were patient-reported satisfaction and hospital length of stay . Other variables assessed included demographics , procedure , operative time , estimated blood loss , and mortality . Patients also completed a vali date d satisfaction instrument 2 weeks after hospital discharge . RESULTS Patients were equally distributed based on the baseline demographic and operative measures . Morbidity rates were similar between the study arms ( st and ard rounds vs telerounds : 16 % vs 13 % ; P = .64 ) . Length of stay was similar in both arms ( st and ard rounds vs telerounds : 2.8 vs 2.8 days ; P = .94 ) . In addition , patient satisfaction was equivalently high in both arms of the study . CONCLUSIONS Robotic telerounds matched the performance of st and ard bedside rounds after urologic surgical procedures . Virtual visits did not result in missed or increased postoperative complications . Hospital length of stay and ratings of hospital satisfaction were on par with those for traditional rounding OBJECTIVES Telemedicine applications carry the potential to enhance the quality of life of patients , but studies evaluating telemedicine applications are still scarce . The evidence regarding the effectiveness of telemedicine is limited and not yet conclusive . This study investigated whether telemedicine could be beneficial to the quality of life of cancer patients . DESIGN AND MEASUREMENTS Between 1999 and 2002 , we conducted a prospect i ve controlled trial evaluating the effects of a telemedicine application on the quality of life of patients with cancer involving the head and neck , using quality of life question naires that covered 22 quality of life parameters . All patients had undergone surgery for head and neck cancer at the Erasmus MC , a tertiary university hospital in The Netherl and s. Patients in the intervention group were given access to an electronic health information support system for a period of six weeks , starting at discharge from the hospital . RESULTS In total , we included 145 patients in the control group and 39 in the intervention group . At 6 weeks , the end of the intervention , the intervention group had significantly improved QoL in 5 of the 22 studied parameters . Only one of these five quality of life parameters remained significantly different at 12 weeks . CONCLUSIONS This study adds to the sparse evidence that telemedicine may be beneficial for 
    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: Aims The ŒDIPE trial examined the safety and efficacy of an abbreviated hospitalization after implantation or replacement of dual-chamber pacemakers ( PM )  using a telecardiology-based ambulatory surveillance programme . Methods and results Patients were r and omly assigned to ( i ) an active group  , discharged from the hospital 24 h after a first PM implant  or 4–6 h after replacement  , and followed for 4 weeks with Home-Monitoring ( HM ) , or ( ii ) a control group followed for 4 weeks according to usual medical practice s. The primary objective was to confirm that the proportion of patients who experienced one or more major adverse events ( MAE ) was not higher in the active than in the control group . The study included 379 patients . At least one treatment-related MAE was observed in 9.2 % of patients ( n = 17 ) assigned to the active group vs. 13.3 % of patients ( n = 26 ) in the control group ( P = 0.21 ) , a 4.1 % absolute risk reduction ( 95 % CI −2.2 to 10.4 ; P = 0.98 ) . By study design , the mean hospitalization duration was 34 % shorter in the active than in the control group ( P < 0.001 ) , and HM facilitated the early detection of technical issues and detectable clinical anomalies . Conclusion Early discharge with HM after PM implantation or replacement was safe and facilitated the monitoring of patients in the month following the procedure A r and omised controlled trial was used to evaluate elective ambulatory orthopaedic surgery patients '  emotions during internet-based patient education or face-to-face education with a nurse .  The internet-based patient education was design ed for this study and patients used websites individually based on their needs . Patients in the control group  participated individually in face-to-face patient education with a nurse in the ambulatory surgery unit . The theoretical basis for both types of education was the same . Ambulatory orthopaedic surgery patients scored their emotions rather low at intervals throughout the whole surgical process , though their scores also changed during the surgical process . Emotion scores did not decrease after patient education . No differences in patients ' emotions were found to result from either of the two different patient education methods BACKGROUND total knee arthroplasty is an effective means for relieving the symptoms associated with degenerative arthritis of the knee . Rehabilitation is a necessary adjunct to surgery and is important in regaining optimum function . Access to high- quality rehabilitation services is not always possible , especially for those who live in rural or remote areas . The aim of this study was to evaluate the equivalence of an Internet-based telerehabilitation program compared with conventional outpatient physical therapy for patients who have had a total knee arthroplasty . METHODS this investigation was a single-blinded , prospect i ve , r and omized , controlled noninferiority trial . Sixty-five participants were r and omized to receive a six-week program of outpatient physical therapy either in the conventional manner or by means of an Internet-based telerehabilitation program . The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) measured at baseline and six weeks by a blinded independent assessor . Secondary outcomes included the Patient-Specific Functional Scale , the timed up- and -go test , pain intensity , knee flexion and extension , quadriceps muscle strength , limb girth measurements , and an assessment of gait . Noninferiority was assessed through the comparison of group differences with a noninferiority margin and with linear mixed model statistics . RESULTS baseline characteristics between groups were similar , and all participants had significant improvement on all outcome measures with the intervention ( p < 0.01 for all ) . After the six-week intervention , participants in the telerehabilitation group achieved outcomes comparable to those of the conventional rehabilitation group with regard to flexion and extension range of motion , muscle strength , limb girth , pain , timed up- and -go test , quality of life , and clinical gait and WOMAC scores . Better outcomes for the Patient-Specific Functional Scale and the stiffness subscale of the WOMAC were found in the telerehabilitation group ( p < 0.05 ) . The telerehabilitation intervention was well received by participants , who reported a high level of satisfaction with this novel technology . CONCLUSIONS the outcomes achieved via telerehabilitation at six weeks following total knee arthroplasty were comparable with those after conventional rehabilitation . LEVEL OF EVIDENCE therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence The purpose of this r and omized trial was to determine whether coronary artery bypass graft surgery patients and their caregivers who received  telehealth follow-up  had greater improvements in anxiety levels from pre-surgery to 3 weeks after discharge than did those who received st and ard care . Secondary outcomes included changes in depressive symptoms and patients ' contacts with physicians . No group differences were noted in changes in patients ' anxiety and depressive symptoms , but patients in the telehealth group had fewer physician contacts ( p = .04 ) . Female caregivers in the telehealth group had greater decreases in anxiety than those in st and ard care ( p < .001 ) , and caregivers of both genders in the telehealth group had greater decreases in depressive symptoms ( p = .03 ) Background Many employers and other stakeholders believe that health examinations of job applicants prevent occupational diseases and sickness absence . Objectives To evaluate the effectiveness of pre-employment examinations of job applicants  in preventing occupational injury , disease and sickness absence compared to no intervention or alternative interventions . Search strategy We search ed CENTRAL ( The Cochrane Library ) , MEDLINE , EMBASE , CINAHL , PsycINFO and PEDro ( to December 2009 ) not restricted by date , language or publication type . Selection criteria We included r and omised controlled trials ( RCTs ) , controlled before-after studies ( CBA ) , and interrupted time-series ( ITS ) of health examinations to prevent occupational diseases and injuries in job applicants . Data collection and analysis Four review authors ( NM , ML , JV , ES ) independently selected studies , extracted data , and determined study quality . The studies were too heterogeneous for statistical pooling of results . Main results We included two RCTs , five CBA studies and two ITS .  Seven studies with 5872 participants evaluated the screening process of pre-employment examinations and two studies with 2164 participants evaluated the measures to mitigate the risks found following the screening process . Of those studies that evaluated the screening process , one study found that a general examination did not reduce sick leave ( Mean Difference -0.1 95 % CI -0.5 to 0.3 ) but another study found that a more task focused examination did ( MD -36 95 % CI -68.3 to -3.8 ) . One study found that incorporation of a bronchial challenge test decreased occupational asthma ( trend change -2.6 95 % CI -3.6 to -1.5 ) . Three studies that included functional capacity evaluation found contradictory effects on injury rates and number of medical visits . The rates of rejecting job applicants varied from 2 % to 35 % . Neither of the two studies that evaluated risk mitigation found an increased injury rate after training or work accommodations had been implemented . We rated the evidence for all outcomes as very low quality . Authors ' conclusions There is very low quality evidence that pre-employment examinations that are specific to certain jobs or health problems could reduce occupational disease , injury , or sickness absence . This supports the current policy to restrict pre-employment examinations to job-specific examinations . More studies are needed that take into account the harms of rejecting job applicants OBJECTIVE To compare the effectiveness of a new interactive virtual telerehabilitation system and a conventional programme following total knee arthroplasty . DESIGN R and omized , controlled , single-blind clinical trial . PARTICIPANTS A total of 142 total knee arthroplasty patients . METHODS Participants were r and omly assigned to receive either : ( i ) conventional out-patient physical therapy ; or ( ii ) interactive virtual telerehabilitation system . The main outcome was function assessed with active range of knee movement . Other variables , such as muscle strength , walk speed , pain and the Western Ontario and McMaster Universities osteoarthritis index , were also collected . Comparisons were made on the basis of data collected routinely before surgery , at the end of the rehabilitation programme , and at 3 months follow-up . Quantitative variables were compared by Mann-Whitney U test . The agreed alpha risk for all hypothesis testing was 0.05 . RESULTS Baseline characteristics between groups were comparable . All participants improved after the 2-week intervention on all outcome variables ( p < 0.05 ) . Patients in the interactive virtual telerehabilitation group achieved improvements in the functional variables similar to those achieved in the conventional therapy group . CONCLUSION A 2-week interactive virtual telerehabilitation programme is at least as effective as conventional therapy . Telerehabilitation is a promising alternative to traditional face-to-face therapies after discharge from total knee arthroplasty , especially for those patients who have difficulty with transportation to rehabilitation centres To test the hypothesis that educational information provided via the web would not only be accessed by our patients , but could also reduce postoperative pain  following ambulatory surgery , we enrolled 195 patients into a r and omized controlled study . Fifty-two percent of our ambulatory surgery patients already knew how to use and had access to the Internet . Eighty-five percent of our study patients accessed the re sources made available to them on the web site . Patients who had access to the pain management information on the ambulatory surgery web site reported significantly less postoperative pain on arrival to their home after surgery ( p < 0.016 ) and into the night after surgery ( p < 0.013 ) . These patients also reported significantly less postoperative pain for the day immediately following surgery ( p < 0.037 ) . We conclude that using the Internet to provide just-in-time patient education can significantly effect the clinical outcome of care PURPOSE : To describe and compare ambulatory orthopaedic surgery patients ' reported cost of care ( out-of-pocket costs , use of time , and consultations with healthcare organizations ) and nurses ' cost of care ( use of time and consultations with other professionals such as other nurses , physicians , and anesthesiologists ) when patients receive 2 different types of patient education ( Internet-based or face-to-face ) .  METHOD : Pretest/posttest design . SAMPLE : R and om assignment of all ambulatory orthopaedic surgery patients in a university hospital in Finl and . INTERVENTION : The experimental group received Web-based patient education and the control group received face-to-face patient education . OUTCOMES OF INTEREST : Financial and time costs . FINDINGS : Pre- , intra- , and postoperative costs did not differ between the groups . However , Internet-based education was more time-consuming for the patient and face-to-face education was more time-consuming for the nurse . There were no differences between the groups in patients ' use of consultations of healthcare professionals . Nurses ' consultations were few and did not differ between the groups . The small number of patients ' and nurses ' consultations indicates that patients in both education methods had enough knowledge to deal with the surgery HYPOTHESIS Patient safety and satisfaction are adversely affected when robotic videoconferencing ( telerounding ) is used in the postoperative setting . DESIGN R and omized controlled trial . SETTING Three academic institutions . PATIENTS A total of 270 adults undergoing a urologic procedure requiring a hospital stay of 24 to 72 hours were r and omized to receive either traditional bedside rounds or robotic telerounds .  MAIN OUTCOME MEASURES The primary outcome measure was postoperative patient morbidity . Secondary outcomes were patient-reported satisfaction and hospital length of stay . Other variables assessed included demographics , procedure , operative time , estimated blood loss , and mortality . Patients also completed a vali date d satisfaction instrument 2 weeks after hospital discharge . RESULTS Patients were equally distributed based on the baseline demographic and operative measures . Morbidity rates were similar between the study arms ( st and ard rounds vs telerounds : 16 % vs 13 % ; P = .64 ) . Length of stay was similar in both arms ( st and ard rounds vs telerounds : 2.8 vs 2.8 days ; P = .94 ) . In addition , patient satisfaction was equivalently high in both arms of the study . CONCLUSIONS Robotic telerounds matched the performance of st and ard bedside rounds after urologic surgical procedures . Virtual visits did not result in missed or increased postoperative complications . Hospital length of stay and ratings of hospital satisfaction were on par with those for traditional rounding OBJECTIVES Telemedicine applications carry the potential to enhance the quality of life of patients , but studies evaluating telemedicine applications are still scarce . The evidence regarding the effectiveness of telemedicine is limited and not yet conclusive . This study investigated whether telemedicine could be beneficial to the quality of life of cancer patients . DESIGN AND MEASUREMENTS Between 1999 and 2002 , we conducted a prospect i ve controlled trial evaluating the effects of a telemedicine application on the quality of life of patients with cancer involving the head and neck , using quality of life question naires that covered 22 quality of life parameters . All patients had undergone surgery for head and neck cancer at the Erasmus MC , a tertiary university hospital in The Netherl and s. Patients in the intervention group were given access to an electronic health information support system for a period of six weeks , starting at discharge from the hospital . RESULTS In total , we included 145 patients in the control group and 39 in the intervention group . At 6 weeks , the end of the intervention , the intervention group had significantly improved QoL in 5 of the 22 studied parameters . Only one of these five quality of life parameters remained significantly different at 12 weeks . CONCLUSIONS This study adds to the sparse evidence that telemedicine may be beneficial for 
    Output:
    