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: This guideline presents recommendations for the evaluation and management of patients with gastroparesis . Gastroparesis is identified in clinical practice through the recognition of the clinical symptoms and documentation of delayed gastric emptying . Symptoms from gastroparesis include nausea , vomiting , early satiety , postpr and ial fullness , bloating , and upper abdominal pain . Management of gastroparesis should include assessment and correction of nutritional state , relief of symptoms , improvement of gastric emptying and , in diabetics , glycemic control . Patient nutritional state should be managed by oral dietary modifications . If oral intake is not adequate , then enteral nutrition via jejunostomy tube needs to be considered . Parenteral nutrition is rarely required when hydration and nutritional state can not be maintained . Medical treatment entails use of prokinetic and antiemetic therapies . Current approved treatment options , including metoclopramide and gastric electrical stimulation ( GES , approved on a humanitarian device exemption ) , do not adequately address clinical need . Antiemetics have not been specifically tested in gastroparesis , but they may relieve nausea and vomiting . Other medications aim ed at symptom relief include unapproved medications or off-label indications , and include domperidone , erythromycin ( primarily over a short term ) , and central ly acting antidepressants used as symptom modulators . GES may relieve symptoms , including weekly vomiting frequency , and the need for nutritional supplementation , based on open-label studies . Second-line approaches include venting gastrostomy or feeding jejunostomy ; intrapyloric botulinum toxin injection was not effective in r and omized controlled trials . Most of these treatments are based on open-label treatment trials and small numbers . Partial gastrectomy and pyloroplasty should be used rarely , only in carefully selected patients . Attention should be given to the development of new effective therapies for symptomatic control BACKGROUND AND OBJECTIVES The current pharmacological management of diabetic gastroparesis remains difficult . Acupuncture has been widely used for gastrointestinal symptoms . The aim of this study was to investigate the effects of electroacupuncture ( EA ) on solid gastric emptying time , serum gastrin , motilin , pancreatic polypeptide ( PP ) , fasting and postpr and ial blood glucose , and symptoms in patients with diabetic gastroparesis . INTERVENTIONS EA at the Zusanli ( ST 36 ) and Hegu ( LI 4 ) points and sham EA as control were administered by an experienced and licensed acupuncturist . DESIGN This was a pilot study with a r and omized , single-blinded design . SUBJECTS AND SETTING Nineteen ( 19 ) patients with type 2 diabetes who had had symptoms of gastroparesis for more than 3 months were included in the trial and r and omized into two groups . Each group received EA ( n = 9 ) or sham EA ( n = 10 ) consisting of 4 sessions over 2 weeks . OUTCOME MEASURES Symptom severity was evaluated using the Gastroparesis Cardinal Symptom Index ( GCSI ) at baseline , at the end of treatment , and 2 weeks after the end of the trial ; solid-phase gastric half-emptying time was measured by scintigraphy ; in addition , serum gastrin , motilin , PP , fasting , and postpr and ial blood glucose levels were also measured . RESULTS Gastric half-emptying time in 9 patients with diabetic gastroparesis was significantly shortened by EA treatment ( 143.8 + /- 55.9 minutes versus 98.8 + /- 28.6 minutes , p < 0.03 ) . Half-emptying time did not change ( 98.9 + /- 26.4 minutes versus 90.9 + /- 24.8 minutes , p > 0.05 ) in the sham EA group . Symptom severity , as measured by GCSI total score , improved significantly both at the end of treatment ( 2.38 + /- 0.56 versus 1.48 + /- 0.19 , p < 0.001 ) and 2 weeks after the end of the trial ( 2.38 + /- 0.56 versus 1.65 + /- 0.44 , p < 0.01 ) when compared with the baseline in the EA group , but did not change from baseline with sham EA treatment . There were no significant changes in fasting and postpr and ial blood glucose , serum gastrin , motilin , and PP in both groups . No significant adverse events occurred . CONCLUSIONS This study demonstrates that short-term EA at the Zusanli and Hegu points effectively reduces the dyspeptic symptoms  of diabetic gastroparesis and accelerates solid gastric emptying . Sustained improvement in dyspeptic symptoms was observed at 2 weeks after the end of the trial . Its potential for treating gastroparesis may be explored , and a larger trial is required to draw definitive conclusions OBJECTIVE To determine whether clinical trials originating in certain countries always have positive results . DATA SOURCES Abstract s of trials from Medline ( January 1966-June 1995 ) . STUDY SELECTION Two separate studies were conducted . The first included trials in which the clinical outcome of a group of subjects receiving acupuncture  was compared to that of a group receiving placebo , no treatment , or a nonacupuncture intervention . In the second study , r and omized or controlled trials of interventions other than  acupuncture  that were published in China , Japan , Russia/USSR , or Taiwan were compared to those published in Engl and . DATA EXTRACTION Blinded review ers determined inclusion and outcome and separately classified each trial by country of origin . DATA SYNTHESIS In the study of acupuncture  trials , 252 of 1085 abstract s met the inclusion criteria . Research conducted in certain countries was uniformly favorable to acupuncture ; all trials originating in China , Japan , Hong Kong , and Taiwan were positive , as were 10 out of 11 of those published in Russia/USSR . In studies that examined interventions other than acupuncture , 405 of 1100 abstract s met the inclusion criteria . Of trials published in Engl and , 75 % gave the test treatment as superior to control . The results for China , Japan , Russia/USSR , and Taiwan were 99 % , 89 % , 97 % , and 95 % , respectively . No trial published in China or Russia/USSR found a test treatment to be ineffective . CONCLUSIONS Some countries publish unusually high proportions of positive results . Publication bias is a possible explanation . Research ers undertaking systematic review s should consider carefully how to manage data from these countries BACKGROUND Gastrointestinal ( GI ) tract symptoms are common among patients with diabetes mellitus ( DM ) seen in tertiary care centers . The degree to which this reflects referral bias is unclear . OBJECTIVES To determine whether GI tract symptoms are more prevalent in unselected patients with DM from the general community compared with their age- and sex-matched counterparts without DM and to assess the association of GI tract symptoms in persons with DM with psychosomatic symptoms , medication use , and symptoms of autonomic neuropathy . METHODS In this population -based , cross-sectional study , Olmsted County , Minnesota , residents with type 1 DM , a r and om sample of residents with type 2 DM , and 2 age- and sex-stratified r and om sample s of nondiabetic residents ( total of 1262 person for the 4 groups ) were mailed a previously vali date d symptom question naire . RESULTS Heartburn was less common in residents with type 1 DM vs controls ( 12 % vs 23 % ; P<.05 ) . No significant difference in prevalence was detected ( residents with type 1 DM vs controls ; residents with type 2 DM vs controls ) for nausea or vomiting ( 12 % vs 11 % ; 6 % vs 6 % ) , dyspepsia ( 19 % vs 21 % ; 13 % vs 17 % ) , or constipation ( 17 % vs 14 % ; 10 % vs 12 % ) . However , constipation and /or laxative use was slightly more common in residents with type 1 DM ( 27 % vs 19 % ; P<.15 ) , particularly in men , and was associated with the intake of calcium channel blockers . CONCLUSIONS In the community , the prevalence of most GI tract symptoms is similar in persons with or without DM , except for a lower prevalence of heartburn and an increased prevalence of constipation or laxative use in residents with type 1 DM , especially in men . This difference is associated with calcium channel blocker use rather than symptoms of autonomic neuropathy . In community-based practice s , physicians should not immediately assume that GI tract symptoms in patients with DM represent a complication of DM The aims of this study were to investigate the effects of electroacupuncture ( EA ) at ST36 and PC6 points on solid gastric emptying and dyspeptic symptoms in patients with functional dyspepsia . Nineteen patients with functional dyspepsia ( FD ) were involved in the study , consisting of two parts : ( 1 ) acute effects of EA on solid gastric emptying in FD patients with delayed gastric emptying and ( 2 ) short-term ( 2-week ) effects of EA on symptoms in FD patients with normal gastric emptying . Results were as follows . ( 1 ) Ten of the19 patients showed delayed gastric emptying of solids , and acute EA significantly improved delayed gastric emptying ; the halftime for gastric emptying was reduced from 150.3±48.4 to 118.9±29.6 min ( P=0.007 ) . ( 2 ) In the nine patients with normal gastric emptying , 2-week EA significantly decreased the symptom score , from 8.2±3.3 at baseline to 1.6±1.1 ( P < 0.001 ) at the end of treatment . We conclude that EA at the ST36 and PC6 points accelerates solid gastric emptying in FD patients with delayed gastric emptying and relieves dyspeptic symptoms in FD patients with normal gastric emptying Background : Patient-rated symptom assessment s are needed for evaluating the effectiveness of medical treatments and for monitoring outcomes in gastroparesis . Objective : This paper summarizes the development and psychometric evaluation of a new instrument , the Gastroparesis Cardinal Symptom Index ( GCSI ) , for assessing severity of symptoms associated with gastroparesis . Methods : The GCSI was based on review s of the medical literature , patient focus groups , and interviews with clinicians . A sample of 169 patients with a documented diagnosis of gastroparesis participated in the psychometric evaluation study . Patients completed the GCSI , the SF-36 Health Survey , and disability days questions at baseline and after 8 weeks . A r and omly selected sub- sample of 30 subjects returned at 2 weeks to assess test – retest reliability . Clinicians rated severity of symptoms , and both clinicians and patients rated change in gastroparesis-related symptoms over the 8 week study . Results : The GCSI is based on three subscales : post-pr and ial fullness/early satiety ( 4 items ) ; nausea/vomiting ( 3 items ) , and bloating ( 2 items ) . Internal consistency reliability was 0.84 for the GCSI total score and ranged from 0.83 to 0.85 for the subscale scores . Two week test – retest reliability was 0.76 for the total score and ranged from 0.68 to 0.81 for subscale scores . Construct validity was supported , given that we observed significant relationships between clinician assessed symptom severity and GCSI total score , significant differences between gastroparesis and dyspepsia patients ( n = 760 ) on GCSI total ( p < 0.0001 ) and subscale scores ( p < 0.03 to p < 0.0001 ) , moderate and significant relationships between GCSI total and SF-36 scores , and significant associations between GCSI total score and reports of restricted activity and bed disability days . Patients with greater symptom severity , as rated by clinicians , reported more symptom severity on GCSI total score . GSCI total scores were responsive to changes in overall gastroparesis symptoms as assessed by clinicians ( p < 0.0001 ) and patients ( p= 0.0004 ) . Conclusion : The findings of this study indicate that the GCSI is a reliable and valid instrument for measuring symptom severity in patients with gastroparesis BACKGROUND Dyspepsia and irritable bowel syndrome are suitable conditions for assessment of quality of life . Their similarities justify the elaboration of a single specific question naire for the two conditions . AIMS To examine the process leading to the validation of the psychometric properties of the functional digestive disorders  quality of life question naire ( FDDQL ) . METHODS Initially , the question naire was given to 154 patients , to assess its acceptability and reproducibility , analyse its content , and reduce the number of items . Its responsiveness was tested during two therapeutic trials which included 428 patients . The question naire has been translated into French , English , and German . The psychometric validation study was conducted in France , United Kingdom , and Germany by 187 practitioners . A total of 401 patients with dyspepsia or irritable bowel syndrome , defined by the Rome criteria , filled in the FDDQL and generic SF-36 question naires . RESULTS The structure of the FDDQL scales was checked by factorial analysis . Its reliability was expressed by a Cronbach ’s α coefficient of 0.94 . Assessment of its discriminant validity showed that the more severe the functional digestive disorders , the more imp 
    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: This guideline presents recommendations for the evaluation and management of patients with gastroparesis . Gastroparesis is identified in clinical practice through the recognition of the clinical symptoms and documentation of delayed gastric emptying . Symptoms from gastroparesis include nausea , vomiting , early satiety , postpr and ial fullness , bloating , and upper abdominal pain . Management of gastroparesis should include assessment and correction of nutritional state , relief of symptoms , improvement of gastric emptying and , in diabetics , glycemic control . Patient nutritional state should be managed by oral dietary modifications . If oral intake is not adequate , then enteral nutrition via jejunostomy tube needs to be considered . Parenteral nutrition is rarely required when hydration and nutritional state can not be maintained . Medical treatment entails use of prokinetic and antiemetic therapies . Current approved treatment options , including metoclopramide and gastric electrical stimulation ( GES , approved on a humanitarian device exemption ) , do not adequately address clinical need . Antiemetics have not been specifically tested in gastroparesis , but they may relieve nausea and vomiting . Other medications aim ed at symptom relief include unapproved medications or off-label indications , and include domperidone , erythromycin ( primarily over a short term ) , and central ly acting antidepressants used as symptom modulators . GES may relieve symptoms , including weekly vomiting frequency , and the need for nutritional supplementation , based on open-label studies . Second-line approaches include venting gastrostomy or feeding jejunostomy ; intrapyloric botulinum toxin injection was not effective in r and omized controlled trials . Most of these treatments are based on open-label treatment trials and small numbers . Partial gastrectomy and pyloroplasty should be used rarely , only in carefully selected patients . Attention should be given to the development of new effective therapies for symptomatic control BACKGROUND AND OBJECTIVES The current pharmacological management of diabetic gastroparesis remains difficult . Acupuncture has been widely used for gastrointestinal symptoms . The aim of this study was to investigate the effects of electroacupuncture ( EA ) on solid gastric emptying time , serum gastrin , motilin , pancreatic polypeptide ( PP ) , fasting and postpr and ial blood glucose , and symptoms in patients with diabetic gastroparesis . INTERVENTIONS EA at the Zusanli ( ST 36 ) and Hegu ( LI 4 ) points and sham EA as control were administered by an experienced and licensed acupuncturist . DESIGN This was a pilot study with a r and omized , single-blinded design . SUBJECTS AND SETTING Nineteen ( 19 ) patients with type 2 diabetes who had had symptoms of gastroparesis for more than 3 months were included in the trial and r and omized into two groups . Each group received EA ( n = 9 ) or sham EA ( n = 10 ) consisting of 4 sessions over 2 weeks . OUTCOME MEASURES Symptom severity was evaluated using the Gastroparesis Cardinal Symptom Index ( GCSI ) at baseline , at the end of treatment , and 2 weeks after the end of the trial ; solid-phase gastric half-emptying time was measured by scintigraphy ; in addition , serum gastrin , motilin , PP , fasting , and postpr and ial blood glucose levels were also measured . RESULTS Gastric half-emptying time in 9 patients with diabetic gastroparesis was significantly shortened by EA treatment ( 143.8 + /- 55.9 minutes versus 98.8 + /- 28.6 minutes , p < 0.03 ) . Half-emptying time did not change ( 98.9 + /- 26.4 minutes versus 90.9 + /- 24.8 minutes , p > 0.05 ) in the sham EA group . Symptom severity , as measured by GCSI total score , improved significantly both at the end of treatment ( 2.38 + /- 0.56 versus 1.48 + /- 0.19 , p < 0.001 ) and 2 weeks after the end of the trial ( 2.38 + /- 0.56 versus 1.65 + /- 0.44 , p < 0.01 ) when compared with the baseline in the EA group , but did not change from baseline with sham EA treatment . There were no significant changes in fasting and postpr and ial blood glucose , serum gastrin , motilin , and PP in both groups . No significant adverse events occurred . CONCLUSIONS This study demonstrates that short-term EA at the Zusanli and Hegu points effectively reduces the dyspeptic symptoms  of diabetic gastroparesis and accelerates solid gastric emptying . Sustained improvement in dyspeptic symptoms was observed at 2 weeks after the end of the trial . Its potential for treating gastroparesis may be explored , and a larger trial is required to draw definitive conclusions OBJECTIVE To determine whether clinical trials originating in certain countries always have positive results . DATA SOURCES Abstract s of trials from Medline ( January 1966-June 1995 ) . STUDY SELECTION Two separate studies were conducted . The first included trials in which the clinical outcome of a group of subjects receiving acupuncture  was compared to that of a group receiving placebo , no treatment , or a nonacupuncture intervention . In the second study , r and omized or controlled trials of interventions other than  acupuncture  that were published in China , Japan , Russia/USSR , or Taiwan were compared to those published in Engl and . DATA EXTRACTION Blinded review ers determined inclusion and outcome and separately classified each trial by country of origin . DATA SYNTHESIS In the study of acupuncture  trials , 252 of 1085 abstract s met the inclusion criteria . Research conducted in certain countries was uniformly favorable to acupuncture ; all trials originating in China , Japan , Hong Kong , and Taiwan were positive , as were 10 out of 11 of those published in Russia/USSR . In studies that examined interventions other than acupuncture , 405 of 1100 abstract s met the inclusion criteria . Of trials published in Engl and , 75 % gave the test treatment as superior to control . The results for China , Japan , Russia/USSR , and Taiwan were 99 % , 89 % , 97 % , and 95 % , respectively . No trial published in China or Russia/USSR found a test treatment to be ineffective . CONCLUSIONS Some countries publish unusually high proportions of positive results . Publication bias is a possible explanation . Research ers undertaking systematic review s should consider carefully how to manage data from these countries BACKGROUND Gastrointestinal ( GI ) tract symptoms are common among patients with diabetes mellitus ( DM ) seen in tertiary care centers . The degree to which this reflects referral bias is unclear . OBJECTIVES To determine whether GI tract symptoms are more prevalent in unselected patients with DM from the general community compared with their age- and sex-matched counterparts without DM and to assess the association of GI tract symptoms in persons with DM with psychosomatic symptoms , medication use , and symptoms of autonomic neuropathy . METHODS In this population -based , cross-sectional study , Olmsted County , Minnesota , residents with type 1 DM , a r and om sample of residents with type 2 DM , and 2 age- and sex-stratified r and om sample s of nondiabetic residents ( total of 1262 person for the 4 groups ) were mailed a previously vali date d symptom question naire . RESULTS Heartburn was less common in residents with type 1 DM vs controls ( 12 % vs 23 % ; P<.05 ) . No significant difference in prevalence was detected ( residents with type 1 DM vs controls ; residents with type 2 DM vs controls ) for nausea or vomiting ( 12 % vs 11 % ; 6 % vs 6 % ) , dyspepsia ( 19 % vs 21 % ; 13 % vs 17 % ) , or constipation ( 17 % vs 14 % ; 10 % vs 12 % ) . However , constipation and /or laxative use was slightly more common in residents with type 1 DM ( 27 % vs 19 % ; P<.15 ) , particularly in men , and was associated with the intake of calcium channel blockers . CONCLUSIONS In the community , the prevalence of most GI tract symptoms is similar in persons with or without DM , except for a lower prevalence of heartburn and an increased prevalence of constipation or laxative use in residents with type 1 DM , especially in men . This difference is associated with calcium channel blocker use rather than symptoms of autonomic neuropathy . In community-based practice s , physicians should not immediately assume that GI tract symptoms in patients with DM represent a complication of DM The aims of this study were to investigate the effects of electroacupuncture ( EA ) at ST36 and PC6 points on solid gastric emptying and dyspeptic symptoms in patients with functional dyspepsia . Nineteen patients with functional dyspepsia ( FD ) were involved in the study , consisting of two parts : ( 1 ) acute effects of EA on solid gastric emptying in FD patients with delayed gastric emptying and ( 2 ) short-term ( 2-week ) effects of EA on symptoms in FD patients with normal gastric emptying . Results were as follows . ( 1 ) Ten of the19 patients showed delayed gastric emptying of solids , and acute EA significantly improved delayed gastric emptying ; the halftime for gastric emptying was reduced from 150.3±48.4 to 118.9±29.6 min ( P=0.007 ) . ( 2 ) In the nine patients with normal gastric emptying , 2-week EA significantly decreased the symptom score , from 8.2±3.3 at baseline to 1.6±1.1 ( P < 0.001 ) at the end of treatment . We conclude that EA at the ST36 and PC6 points accelerates solid gastric emptying in FD patients with delayed gastric emptying and relieves dyspeptic symptoms in FD patients with normal gastric emptying Background : Patient-rated symptom assessment s are needed for evaluating the effectiveness of medical treatments and for monitoring outcomes in gastroparesis . Objective : This paper summarizes the development and psychometric evaluation of a new instrument , the Gastroparesis Cardinal Symptom Index ( GCSI ) , for assessing severity of symptoms associated with gastroparesis . Methods : The GCSI was based on review s of the medical literature , patient focus groups , and interviews with clinicians . A sample of 169 patients with a documented diagnosis of gastroparesis participated in the psychometric evaluation study . Patients completed the GCSI , the SF-36 Health Survey , and disability days questions at baseline and after 8 weeks . A r and omly selected sub- sample of 30 subjects returned at 2 weeks to assess test – retest reliability . Clinicians rated severity of symptoms , and both clinicians and patients rated change in gastroparesis-related symptoms over the 8 week study . Results : The GCSI is based on three subscales : post-pr and ial fullness/early satiety ( 4 items ) ; nausea/vomiting ( 3 items ) , and bloating ( 2 items ) . Internal consistency reliability was 0.84 for the GCSI total score and ranged from 0.83 to 0.85 for the subscale scores . Two week test – retest reliability was 0.76 for the total score and ranged from 0.68 to 0.81 for subscale scores . Construct validity was supported , given that we observed significant relationships between clinician assessed symptom severity and GCSI total score , significant differences between gastroparesis and dyspepsia patients ( n = 760 ) on GCSI total ( p < 0.0001 ) and subscale scores ( p < 0.03 to p < 0.0001 ) , moderate and significant relationships between GCSI total and SF-36 scores , and significant associations between GCSI total score and reports of restricted activity and bed disability days . Patients with greater symptom severity , as rated by clinicians , reported more symptom severity on GCSI total score . GSCI total scores were responsive to changes in overall gastroparesis symptoms as assessed by clinicians ( p < 0.0001 ) and patients ( p= 0.0004 ) . Conclusion : The findings of this study indicate that the GCSI is a reliable and valid instrument for measuring symptom severity in patients with gastroparesis BACKGROUND Dyspepsia and irritable bowel syndrome are suitable conditions for assessment of quality of life . Their similarities justify the elaboration of a single specific question naire for the two conditions . AIMS To examine the process leading to the validation of the psychometric properties of the functional digestive disorders  quality of life question naire ( FDDQL ) . METHODS Initially , the question naire was given to 154 patients , to assess its acceptability and reproducibility , analyse its content , and reduce the number of items . Its responsiveness was tested during two therapeutic trials which included 428 patients . The question naire has been translated into French , English , and German . The psychometric validation study was conducted in France , United Kingdom , and Germany by 187 practitioners . A total of 401 patients with dyspepsia or irritable bowel syndrome , defined by the Rome criteria , filled in the FDDQL and generic SF-36 question naires . RESULTS The structure of the FDDQL scales was checked by factorial analysis . Its reliability was expressed by a Cronbach ’s α coefficient of 0.94 . Assessment of its discriminant validity showed that the more severe the functional digestive disorders , the more imp 
    Output:
    