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: Thirty seven children with acute asthma were given nebulised ipratropium or placebo 30 minutes after their first dose of salbutamol and eight hourly thereafter . There were no significant differences between the two groups in clinical scores , peak expiratory flow rates , length of stay in hospital , or the need for oral steroids BACKGROUND Anticholinergic medications such as ipratropium improve the pulmonary function of patients with acute exacerbations of asthma , but their effect on hospitalization rates is uncertain . METHODS We conducted a r and omized , double-blind , placebo-controlled study of 434 children ( 2 to 18 years old ) who had acute exacerbations of moderate or severe asthma treated in the emergency department . All the children received a nebulized solution of albuterol ( 2.5 or 5 mg per dose , depending on body weight ) every 20 minutes for three doses and then as needed . A corticosteroid ( 2 mg of prednisone or prednisolone per kilogram of body weight ) was given orally with the second dose of albuterol . Children in the treatment group received 500 microg ( 2.5 ml ) of ipratropium bromide with the second and third doses of albuterol ; children in the control group received 2.5 ml of normal saline at these times . RESULTS Overall , the rate of hospitalization was lower in the ipratropium group ( 59 of 215 children [ 27.4 percent ] ) than in the control group ( 80 of 219 [ 36.5 percent ] , P=0.05 ) . For patients with moderate asthma ( indicated by a peak expiratory flow rate of 50 to 70 percent of the predicted value or an asthma score of 8 to 11 on a 15-point scale ) , hospitalization rates were similar in the two groups ( ipratropium : 8 of 79 children [ 10.1 percent ] ; control : 9 of 84 [ 10.7 percent ] ) . For patients with severe asthma ( defined as a peak expiratory flow rate of < 50 percent of the predicted value or an asthma score of 12 to 15 ) , the addition of ipratropium significantly reduced the need for hospitalization ( 51 of 136 children [ 37.5 percent ] , as compared with 71 of 135 [ 52.6 percent ] in the control group ; P=0.02 ) . CONCLUSIONS Among children with a severe exacerbation of asthma , the addition of ipratropium bromide to albuterol and corticosteroid therapy significantly decreases the hospitalization rate BACKGROUND Traditional and largely qualitative review s of evidence are now giving way to much more structured systematic overviews that use a quantitative method to calculate the overall effect of treatment . The latter approach is dependent on the quality of primary studies , which may introduce bias if they are of poor method ologic quality . OBJECTIVE To test the hypothesis that the inclusion of poor- quality trials in meta-analyses would bias the conclusions and produce incorrect estimates of treatment effect . METHODS An overview of r and omized trials of antiestrogen therapy in subfertile men with oligospermia was performed to test the hypothesis . Data sources included online search ing of MEDLINE and Science Citation Index data bases between 1966 and 1994 , scanning the bibliography of known primary studies and review articles , and contacting experts in the field . After independent , blind assessment , nine of 149 originally identified studies met the inclusion criteria and were selected . We assessed study quality independently . Outcome data from each study were pooled and statistically summarized . RESULTS There was a marginal improvement in pregnancy rate with antiestrogen treatment ( odds ratio , 1.6 ; 95 % confidence interval , 0.9 to 2.6 ) . Sensitivity analyses on the basis of method ologic quality demonstrated that poor- quality studies produced a positive effect with treatment , whereas no benefit was observed with high- quality studies . CONCLUSION The results of a meta- analysis are influenced by the quality of the primary studies included . Method ologically , poor studies tend to exaggerate the overall estimate of treatment effect and may lead to incorrect inferences STUDY OBJECTIVE To determine the effect of adding the nebulized anticholinergic drug ipratropium bromide to st and ard therapy compared with st and ard therapy alone for acute severe asthma ( peak expiratory flow rate [ PEFR ] < 50 % of predicted ) in children presenting to the emergency department . METHODS Ninety children aged 6 to 18 years were r and omly assigned to two groups in a prospect i ve , double-blind , placebo-controlled study performed in the ED of an urban children 's hospital . All children received nebulized albuterol solution ( .15 mg/kg ) every 30 minutes , and all received oral steroids with the second dose of albuterol . Children in group 1 received ipratropium bromide ( 500 micrograms/dose ) with the first and third dose of albuterol those in group 2 received saline placebo instead of ipratropium .  Pulmonary functions ( PEFR and 1-second forced expiratory volume [ FEV1 ] ) and physiologic measurements were assessed every 30 minutes up to 120 minutes . By chance , the baseline values for percent of predicted PEFR and FEV1 differed between the two groups . Therefore a multivariate model accounting for both time and baseline effects was used to compare the response between groups . RESULTS On average , and adjusting for baseline measures , children in the ipratropium group had a significantly greater improvement in percent of predicted PEFR than did children in the placebo group at 60 minutes ( P = .02 ) , 90 minutes ( P = .002 ) , and 120 minutes ( P < .0001 ) . The improvement in percent predicted FEV1 was significantly greater for children in the ipratropium group only at 120 minutes ( P = .013 ) . Nine children ( 20 % ) from the ipratropium group and 14 ( 31.1 % ) from the control group were admitted ( P = .33 , chi 2 ) . There were no significant adverse effects attributable to the ipratropium , and there was no relation between ipratropium use and changes in pulse , respiratory rate , blood pressure , or oxygen saturation . CONCLUSION We detected significant improvement in pulmonary function studies over 120 minutes in children with severe asthma who were given nebulized ipratropium combined with albuterol and oral steroids , compared with children who received the st and ard therapy . Further study is needed to determine whether early use of ipratropium decreases the need for hospitalization A study was performed to compare the efficacy and safety of two therapeutic regimens for the treatment of children presenting to the emergency department with acute asthma . A regimen of inhaled salbutamol alone was compared to inhaled salbutamol combined with ipratropium bromide .  Twenty-five children ranging in age from 5 to 15 years were enrolled in the study . Children with FEV1 less than or equal to 55 % predicted were eligible to participate in the study . Subjects were r and omized in a double-blind fashion into one of two treatment groups . Both groups received an initial dose of salbutamol by nebulizer of 150 micrograms/kg ( 0.03 cc/kg ) , followed by six consecutive doses of 50 micrograms/kg ( 0.01 cc/kg ) at 20-minute intervals . In one group of subjects , 250 micrograms ( 1.0 ml ) of ipratropium bromide respirator solution was added to the salbutamol administered at the time of the initial inhalation , and at 40 and 80 minutes , whereas the remaining subjects received a placebo with salbutamol at those times . Formal one-way statistical ANOVA with change in percent predicted FEV1 as a response variable confirmed there was a statistically significant difference at all time points caused by drug regimen during the 150-minute observation period . There was no significant difference in side effects reported in the two groups . Significant additional bronchodilation achieved with salbutamol and ipratropium bromide together indicates that there is likely a substantial cholinergic element to the bronchospasm observed in acute exacerbations of asthma in the pediatric age group Isocapnic hyperventilation dose response curves were constructed for 11 asthmatic children before and after pretreatment with placebo or ipratropium bromide , 40 - 1500 micrograms given by inhalation , on three separate days . The response before and after placebo was highly reproducible ( within subject coefficient of variation 7.5 % , 18 % , and 22 % for intervals of two hours , within two weeks , and over two weeks ) . It was independent of baseline lung function . Complete protection against hyperventilation induced asthma was achieved by ipratropium bromide 40 micrograms in six children and by 200 micrograms or more in a further four . The remaining child was unaffected by any dose of ipratropium up to 1500 micrograms . The dose of ipratropium required for protection was better related to the subjects ' requirement for regular medication than to their sensitivity to hyperventilation or baseline lung function Abnormalities of compliance and functional residual capacity were shown in eight young children aged 2 - 8 years with asthma during an acute attack . In a r and omised , placebo controlled study treatment with bronchodilator ( salbutamol ) was associated with a significant improvement in compliance and lessening of hyperinflation as shown by a reduction in functional residual capacity Varying doses of nebulized salbutamol , ipratropium bromide and a combination of both were given to 20 asthmatic children . All therapies produced effective bronchodilation . Ten mg salbutamol caused elevation of pulse rate and finger tremor whilst the duration of action of 0.6 mg salbutamol was too short . Dose-response effects were clearly seen with salbutamol but not with ipratropium bromide . A summation effect was not demonstrated when the medications were combined Objective . To determine if the addition of ipratropium bromide to the emergency department ( ED ) treatment of childhood asthma reduces time to discharge , number of nebulizer treatments before discharge , and the rate of hospitalization . Methods . Patients > 12 months of age were eligible if they were to be treated according to a st and ardized ED protocol for acute asthma with nebulized albuterol ( 2.5 mg/dose if weight < 30 kg , otherwise 5 mg/dose ) and oral prednisone or prednisolone ( 2 mg/kg up to 80 mg ) . Subjects were r and omized to receive either ipratropium ( 250 μg/dose ) or normal saline ( 1 mL/dose ) with each of the first three nebulized albuterol doses . Further treatment after the first hour was determined by physicians blinded to subject group assignment . Records were review ed to determine the length of time to discharge home from the ED , number of doses of albuterol given before discharge , and the number of patients admitted to the hospital . Results . Four hundred twenty-seven patients were r and omized to ipratropium or control groups ; these groups were similar in all baseline measures . Among patients discharged from the ED , ipratropium group subjects had 13 % shorter treatment time ( mean , 185 minutes , vs control , 213 minutes ) and fewer total albuterol doses ( median , three , vs control , four ) . Admission rates did not differ significantly ( 18 % , vs control , 22 % ) . Conclusions . The addition of three doses of ipratropium to an ED treatment protocol for acute asthma was associated with reductions in duration and amount of treatment before discharge Treatment with nebulised salbutamol or a mixture of salbutamol and ipratropium was given to 138 children .  Length of hospital stay and number of nebulised doses required did not differ . In severe asthma response was greater with salbutamol alone . In mild asthma response was greater with combined treatment Inhaled bronchodilator therapy in young asthmatic children reduces symptoms and improves lung function . After a single dose of therapy , however , lung function may still be abnormal , as evidence d by an elevated function residual capacity ( FRC ) . The aims of this study were to assess if a second dose of bronchodilator therapy result ed in further improvement in lung function and to determine whether additional therapy was more effective if given as a second dose of a beta-adrenergic agonist or if instead an anticholinergic was used . Twenty-one asthmatics ( median age 7.5 years ) received in r and om order on two separate occasions , 1 week apart , either two doses of terbutaline ( 500 micrograms ) or terbutaline plus ipratropium bromide ( 20 micrograms ) . FRC and peak expiratory flow rate ( PEFR ) were measured immediately prior to and then 20 min after each dose of bronchodilator therapy . In the group , overall FRC and PEFR improved after the first and second dose of bronchodilator , regardless of regime used , the response to the second dose , however , was smaller than the first dose . There was no significant difference overall between the two regimes in baseline FRC or PEFR , or FRC and PEFR measured after each dose of bronchodilator . Eight children failed to show a significant change in FRC following two doses of terbutaline , but seven of these eight did have a significant change in FRC in response to the combination of terbutaline and ipratropium bromide . We conclude that a second dose of bronchodilator therapy does further improve lung function . Our results suggest the more efficacious regime consists of a combination of single doses of ipratropium bromide 
    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: Thirty seven children with acute asthma were given nebulised ipratropium or placebo 30 minutes after their first dose of salbutamol and eight hourly thereafter . There were no significant differences between the two groups in clinical scores , peak expiratory flow rates , length of stay in hospital , or the need for oral steroids BACKGROUND Anticholinergic medications such as ipratropium improve the pulmonary function of patients with acute exacerbations of asthma , but their effect on hospitalization rates is uncertain . METHODS We conducted a r and omized , double-blind , placebo-controlled study of 434 children ( 2 to 18 years old ) who had acute exacerbations of moderate or severe asthma treated in the emergency department . All the children received a nebulized solution of albuterol ( 2.5 or 5 mg per dose , depending on body weight ) every 20 minutes for three doses and then as needed . A corticosteroid ( 2 mg of prednisone or prednisolone per kilogram of body weight ) was given orally with the second dose of albuterol . Children in the treatment group received 500 microg ( 2.5 ml ) of ipratropium bromide with the second and third doses of albuterol ; children in the control group received 2.5 ml of normal saline at these times . RESULTS Overall , the rate of hospitalization was lower in the ipratropium group ( 59 of 215 children [ 27.4 percent ] ) than in the control group ( 80 of 219 [ 36.5 percent ] , P=0.05 ) . For patients with moderate asthma ( indicated by a peak expiratory flow rate of 50 to 70 percent of the predicted value or an asthma score of 8 to 11 on a 15-point scale ) , hospitalization rates were similar in the two groups ( ipratropium : 8 of 79 children [ 10.1 percent ] ; control : 9 of 84 [ 10.7 percent ] ) . For patients with severe asthma ( defined as a peak expiratory flow rate of < 50 percent of the predicted value or an asthma score of 12 to 15 ) , the addition of ipratropium significantly reduced the need for hospitalization ( 51 of 136 children [ 37.5 percent ] , as compared with 71 of 135 [ 52.6 percent ] in the control group ; P=0.02 ) . CONCLUSIONS Among children with a severe exacerbation of asthma , the addition of ipratropium bromide to albuterol and corticosteroid therapy significantly decreases the hospitalization rate BACKGROUND Traditional and largely qualitative review s of evidence are now giving way to much more structured systematic overviews that use a quantitative method to calculate the overall effect of treatment . The latter approach is dependent on the quality of primary studies , which may introduce bias if they are of poor method ologic quality . OBJECTIVE To test the hypothesis that the inclusion of poor- quality trials in meta-analyses would bias the conclusions and produce incorrect estimates of treatment effect . METHODS An overview of r and omized trials of antiestrogen therapy in subfertile men with oligospermia was performed to test the hypothesis . Data sources included online search ing of MEDLINE and Science Citation Index data bases between 1966 and 1994 , scanning the bibliography of known primary studies and review articles , and contacting experts in the field . After independent , blind assessment , nine of 149 originally identified studies met the inclusion criteria and were selected . We assessed study quality independently . Outcome data from each study were pooled and statistically summarized . RESULTS There was a marginal improvement in pregnancy rate with antiestrogen treatment ( odds ratio , 1.6 ; 95 % confidence interval , 0.9 to 2.6 ) . Sensitivity analyses on the basis of method ologic quality demonstrated that poor- quality studies produced a positive effect with treatment , whereas no benefit was observed with high- quality studies . CONCLUSION The results of a meta- analysis are influenced by the quality of the primary studies included . Method ologically , poor studies tend to exaggerate the overall estimate of treatment effect and may lead to incorrect inferences STUDY OBJECTIVE To determine the effect of adding the nebulized anticholinergic drug ipratropium bromide to st and ard therapy compared with st and ard therapy alone for acute severe asthma ( peak expiratory flow rate [ PEFR ] < 50 % of predicted ) in children presenting to the emergency department . METHODS Ninety children aged 6 to 18 years were r and omly assigned to two groups in a prospect i ve , double-blind , placebo-controlled study performed in the ED of an urban children 's hospital . All children received nebulized albuterol solution ( .15 mg/kg ) every 30 minutes , and all received oral steroids with the second dose of albuterol . Children in group 1 received ipratropium bromide ( 500 micrograms/dose ) with the first and third dose of albuterol those in group 2 received saline placebo instead of ipratropium .  Pulmonary functions ( PEFR and 1-second forced expiratory volume [ FEV1 ] ) and physiologic measurements were assessed every 30 minutes up to 120 minutes . By chance , the baseline values for percent of predicted PEFR and FEV1 differed between the two groups . Therefore a multivariate model accounting for both time and baseline effects was used to compare the response between groups . RESULTS On average , and adjusting for baseline measures , children in the ipratropium group had a significantly greater improvement in percent of predicted PEFR than did children in the placebo group at 60 minutes ( P = .02 ) , 90 minutes ( P = .002 ) , and 120 minutes ( P < .0001 ) . The improvement in percent predicted FEV1 was significantly greater for children in the ipratropium group only at 120 minutes ( P = .013 ) . Nine children ( 20 % ) from the ipratropium group and 14 ( 31.1 % ) from the control group were admitted ( P = .33 , chi 2 ) . There were no significant adverse effects attributable to the ipratropium , and there was no relation between ipratropium use and changes in pulse , respiratory rate , blood pressure , or oxygen saturation . CONCLUSION We detected significant improvement in pulmonary function studies over 120 minutes in children with severe asthma who were given nebulized ipratropium combined with albuterol and oral steroids , compared with children who received the st and ard therapy . Further study is needed to determine whether early use of ipratropium decreases the need for hospitalization A study was performed to compare the efficacy and safety of two therapeutic regimens for the treatment of children presenting to the emergency department with acute asthma . A regimen of inhaled salbutamol alone was compared to inhaled salbutamol combined with ipratropium bromide .  Twenty-five children ranging in age from 5 to 15 years were enrolled in the study . Children with FEV1 less than or equal to 55 % predicted were eligible to participate in the study . Subjects were r and omized in a double-blind fashion into one of two treatment groups . Both groups received an initial dose of salbutamol by nebulizer of 150 micrograms/kg ( 0.03 cc/kg ) , followed by six consecutive doses of 50 micrograms/kg ( 0.01 cc/kg ) at 20-minute intervals . In one group of subjects , 250 micrograms ( 1.0 ml ) of ipratropium bromide respirator solution was added to the salbutamol administered at the time of the initial inhalation , and at 40 and 80 minutes , whereas the remaining subjects received a placebo with salbutamol at those times . Formal one-way statistical ANOVA with change in percent predicted FEV1 as a response variable confirmed there was a statistically significant difference at all time points caused by drug regimen during the 150-minute observation period . There was no significant difference in side effects reported in the two groups . Significant additional bronchodilation achieved with salbutamol and ipratropium bromide together indicates that there is likely a substantial cholinergic element to the bronchospasm observed in acute exacerbations of asthma in the pediatric age group Isocapnic hyperventilation dose response curves were constructed for 11 asthmatic children before and after pretreatment with placebo or ipratropium bromide , 40 - 1500 micrograms given by inhalation , on three separate days . The response before and after placebo was highly reproducible ( within subject coefficient of variation 7.5 % , 18 % , and 22 % for intervals of two hours , within two weeks , and over two weeks ) . It was independent of baseline lung function . Complete protection against hyperventilation induced asthma was achieved by ipratropium bromide 40 micrograms in six children and by 200 micrograms or more in a further four . The remaining child was unaffected by any dose of ipratropium up to 1500 micrograms . The dose of ipratropium required for protection was better related to the subjects ' requirement for regular medication than to their sensitivity to hyperventilation or baseline lung function Abnormalities of compliance and functional residual capacity were shown in eight young children aged 2 - 8 years with asthma during an acute attack . In a r and omised , placebo controlled study treatment with bronchodilator ( salbutamol ) was associated with a significant improvement in compliance and lessening of hyperinflation as shown by a reduction in functional residual capacity Varying doses of nebulized salbutamol , ipratropium bromide and a combination of both were given to 20 asthmatic children . All therapies produced effective bronchodilation . Ten mg salbutamol caused elevation of pulse rate and finger tremor whilst the duration of action of 0.6 mg salbutamol was too short . Dose-response effects were clearly seen with salbutamol but not with ipratropium bromide . A summation effect was not demonstrated when the medications were combined Objective . To determine if the addition of ipratropium bromide to the emergency department ( ED ) treatment of childhood asthma reduces time to discharge , number of nebulizer treatments before discharge , and the rate of hospitalization . Methods . Patients > 12 months of age were eligible if they were to be treated according to a st and ardized ED protocol for acute asthma with nebulized albuterol ( 2.5 mg/dose if weight < 30 kg , otherwise 5 mg/dose ) and oral prednisone or prednisolone ( 2 mg/kg up to 80 mg ) . Subjects were r and omized to receive either ipratropium ( 250 μg/dose ) or normal saline ( 1 mL/dose ) with each of the first three nebulized albuterol doses . Further treatment after the first hour was determined by physicians blinded to subject group assignment . Records were review ed to determine the length of time to discharge home from the ED , number of doses of albuterol given before discharge , and the number of patients admitted to the hospital . Results . Four hundred twenty-seven patients were r and omized to ipratropium or control groups ; these groups were similar in all baseline measures . Among patients discharged from the ED , ipratropium group subjects had 13 % shorter treatment time ( mean , 185 minutes , vs control , 213 minutes ) and fewer total albuterol doses ( median , three , vs control , four ) . Admission rates did not differ significantly ( 18 % , vs control , 22 % ) . Conclusions . The addition of three doses of ipratropium to an ED treatment protocol for acute asthma was associated with reductions in duration and amount of treatment before discharge Treatment with nebulised salbutamol or a mixture of salbutamol and ipratropium was given to 138 children .  Length of hospital stay and number of nebulised doses required did not differ . In severe asthma response was greater with salbutamol alone . In mild asthma response was greater with combined treatment Inhaled bronchodilator therapy in young asthmatic children reduces symptoms and improves lung function . After a single dose of therapy , however , lung function may still be abnormal , as evidence d by an elevated function residual capacity ( FRC ) . The aims of this study were to assess if a second dose of bronchodilator therapy result ed in further improvement in lung function and to determine whether additional therapy was more effective if given as a second dose of a beta-adrenergic agonist or if instead an anticholinergic was used . Twenty-one asthmatics ( median age 7.5 years ) received in r and om order on two separate occasions , 1 week apart , either two doses of terbutaline ( 500 micrograms ) or terbutaline plus ipratropium bromide ( 20 micrograms ) . FRC and peak expiratory flow rate ( PEFR ) were measured immediately prior to and then 20 min after each dose of bronchodilator therapy . In the group , overall FRC and PEFR improved after the first and second dose of bronchodilator , regardless of regime used , the response to the second dose , however , was smaller than the first dose . There was no significant difference overall between the two regimes in baseline FRC or PEFR , or FRC and PEFR measured after each dose of bronchodilator . Eight children failed to show a significant change in FRC following two doses of terbutaline , but seven of these eight did have a significant change in FRC in response to the combination of terbutaline and ipratropium bromide . We conclude that a second dose of bronchodilator therapy does further improve lung function . Our results suggest the more efficacious regime consists of a combination of single doses of ipratropium bromide 
    Output:
    