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: Objectives : To assess the state of the neurological bowel in spinal cord injured ( SCI ) patients , design and apply a program for the comprehensive management of neurogenic bowel and evaluate outcome . Setting : Out-patient in a Rehabilitation Service . Subjects : Thirty-eight SCI patients , 12 ( 32 % ) with complete lesions of more than 5 years duration . Design : Observational , longitudinal and prospect i ve . Pre and post intervention . Method : Pre and post SCI intestinal function was evaluated clinical ly prior to beginning program . The presence of GI symptoms were studied . Laboratory work-up included colonic transit time ( CTT ) ,  anorectal manometry  and  recto-colonoscopy .  An intestinal program was design ed , in order to achieve an effective and efficient evacuation in a predictable and socially acceptable time , to avoid short and long term complications and eliminate inadequate intestinal evacuation habits . Outcome measures : Pre and post SCI difficulty in intestinal evacuation ( DIE ) was increased ( from 2.6 % to 26.3 % ) . The most frequent GI symptom was abdominal distention ( 53 % ) . Colonic inertia was present in 49 % of CTT , internal anal sphincter pressure was normal or increased in 77 % and rectoanal inhibitory reflex was present in 88 % . With the intestinal program , the incidence of DIE was reduced to 8.8 % , manual extraction ( ME ) was reduced from 53 % to 37 % . Excellent and good results were obtained in 56 % of the patients . Conclusion : The proposed intestinal program is effective in the rehabilitation of SCI patients with neurogenic bowel . It is essential to initiate these physiological and safe procedures as soon as possible after sustaining the injury ; this will lead to better results and to the elimination of inadequate intestinal maneuvering in the future Spinal Cord ( 2000 ) 38 , 301–308 Background : Chronic constipation ( CC ) is common and there is a need for more effective and better-tolerated agents that normalize bowel function without affecting secretion . Prucalopride is a novel , selective serotonin4 receptor agonist with enterokinetic properties . Aims : Pilot study to compare the efficacy and tolerability of prucalopride and placebo in patients with severe CC referred to a tertiary centre . Methods : After 4-weeks ’ run in , patients were r and omized to 4 weeks ’ once daily , double-blind treatment with either prucalopride 4 mg ( n = 27 ) or placebo  ( n = 26 ) . A 50 % dose reduction after 2 weeks ’ treatment was possible for patients with an excessive gastrointestinal response to the study medication ( severe cramps , abdominal pain , and diarrhea ) . Patients assessed efficacy using a visual analogue scale ( VAS ) and recorded bowel function in daily diaries . The investigator assessed efficacy and total gut transit time ( marker study ) . Results : Patient VAS assessment demonstrated that prucalopride was significantly more effective than placebo in softening stools , and decreasing straining and time to first stool . Prucalopride also had a positive effect on stool frequency , feeling of complete evacuation and total gut transit time , although these differences were not statistically significant compared with placebo . The most common adverse events were gastrointestinal symptoms and headache ; most were mild to moderate . There were no clinical ly relevant effects on cardiovascular or laboratory parameters . Conclusions : Once-daily prucalopride 4 mg for 4 weeks is effective and well tolerated in patients with severe CC . It improves whole gut transit , reducing straining , softening stools and reducing time to first bowel movement Study design : Cross-sectional study . Objectives : To study the prevalence of incontinence , problem perception and determinants of urinary and faecal incontinence  in young adults with spina bifida . Setting : Nation-wide study in the Netherl and s. Participants : A total of 179 of 350 invited patients participated , including 37 patients with spina bifida occulta and 142 with spina bifida aperta , of whom 119 had hydrocephalus ; 41 % were male and mean age was 20.4 ( range 16–25 years ) . Methods : Data were collected from interviews , physical examination , neuropsychological tests and medical records . Results : Urinary and faecal incontinence was common in young adults with spina bifida ( 60.9 and 34.1 % , respectively ) , regardless of the bladder and bowel management they used . The majority of urinary and faecal incontinent patients perceived this as a problem ( 69.7 and 77.0 % , respectively ) . Spina bifida aperta , hydrocephalus and a level of lesion of L5 or above were associated with patients suffering from urinary and /or faecal incontinence . Predictors of perceiving urinary incontinence as a problem were , in addition to being incontinent , not having hydrocephalus and having a level of lesion of L5 or above . The only predictor of perceiving faecal incontinence as a problem was the frequency of incontinence . Conclusion : A majority of young adults with spina bifida suffer from urinary and faecal incontinence and most of them perceive their incontinence as a problem . Therefore , further efforts are important to improve urinary and faecal continence Study design : Cost-effectiveness analysis following international guidelines and taking the societal viewpoint . Objectives : To estimate the cost-effectiveness of transanal irrigation using a self-administered irrigation system when compared with conservative bowel management . Setting : A r and omized clinical trial was conducted at five spinal centres situated in Denmark , Germany , Italy , United Kingdom and Sweden . Estimates of re sources and unit costs were made for the German health care system . Methods : Efficacy outcomes were drawn from a r and omized controlled trial conducted in 2003–2005 . Adult spinal cord-injured patients with neurogenic bowel dysfunction were r and omized to 10 weeks with either transanal irrigation using Peristeen Anal Irrigation or to conservative bowel management .  Costs were calculated based on results from the clinical trial and on 24 interviews conducted in Germany . Unit costs were obtained from the Federal Statistical Office Germany and product list prices . Results : When comparing outcome measures at termination , transanal irrigation significantly reduced symptoms of neurogenic bowel dysfunction . Product-related costs were higher for transanal irrigation using the self-administered system ; however , costs for a carer to help with bowel management and changes/washing due to leakage were lower . For transanal irrigation , costs associated with urinary tract infections and patient time spent were reduced . Thus , the total cost to society is lower when patients use transanal irrigation . The results were shown to be robust in the sensitivity analysis . Conclusion : Transanal irrigation using a self-administered system reduces symptoms of neurogenic bowel dysfunction and results in a lower total cost to society than conservative bowel management . Sponsorship : The study was supported by Coloplast From a question naire sent to 90 spinal cord injury ( SCI ) patients it is concluded that 58 % of patients with a complete SCI above L2 suffer from constipation , defined as two or fewer bowel movements per week , or the use of aids such as laxatives , manual evacuation or enemas . Tetraplegic patients had the highest prevalence of constipation , while patients with low paraplegia were less prone to constipation . The use of anticholinergic drugs was found to predispose to constipation . Preserved rectal sensation did not influence the presence of constipation . Faecal incontinence was rare . Regular abdominal pain was present in one third of SCI patients and might be caused by an irritable bowel syndrome in 62 % of these OBJECTIVES To determine whether gut focused behavioural treatment ( biofeedback ) is a useful therapy in multiple sclerosis patients referred for constipation , incontinence , or a combination of these symptoms . Most patients with multiple sclerosis complain of constipation , faecal incontinence , or a combination of the two . Patients rate these bowel symptoms as having a major impact on their life . Until now the management of these problems has been empirical , with a lack of evaluated therapeutic regimes . METHODS Thirteen patients ( eight women , median age 38 years , median duration of multiple sclerosis 10 years ) complaining of constipation , with or without faecal incontinence underwent a median of four sessions of behavioural treatment .  Anorectal physiological tests were performed before therapy . Impairment and disability were rated with the Kurtzke score and the Cambridge multiple sclerosis basic score ( CAMBS ) . Patients were contacted a median of 14 months after completion of treatment . RESULTS A beneficial effect was attributed to biofeedback in five patients . Mild to moderate disability , quiescent and non-relapsing disease , and absence of progression of multiple sclerosis over the year before biofeedback were predictive of symptom improvement . No physiological test predicted the response to therapy . CONCLUSION Biofeedback retraining is an effective treatment in some patients with multiple sclerosis complaining of constipation or faecal incontinence . A response is more likely in patients with limited disability and a non-progressive disease course Frequency of defaecation , faecal form , straining at the start and end of defaecation , feelings of incomplete evacuation of faeces and urgency of defaecation were recorded in 69 healthy volunteers during three distinct 28-day study phases : pre-treatment , treatment with ispaghula husk and post-treatment . During treatment there was a significant increase ( P<0.001 ) in stool frequency and significant decreases in straining at the start ( P<0.001 ) and end ( P<0.001 ) of defaecation and in feelings of incomplete evacuation ( P<0.001 ) . There was evidence of a beneficial residual effect after treatment had stopped . There are indications that ispaghula husk ( Fybogel ® Orange ) is of benefit in relieving  constipation symptoms in apparently healthy people PURPOSE : This study evaluated the effect of anterior sacral roots stimulator implants on bowel function of patients with spinal cord trauma . METHOD : Eight patients with spinal cord injury and constipation had anterior sacral roots stimulator implants inserted for concomitant bladder dysfunction . Question naires on bowel function and anorectal manometry tests were given before and after insertion of the implants . RESULTS : Six patients achieved improvement in bowel function . Four of these patients could defecate spontaneously following stimulation . Two patients had no improvement in bowel function . Anorectal manometry studies showed a negative rectoanal pressure difference at the time of stimulation . All patients were unable to defecate during stimulation . Positive rectoanal pressure difference was recorded in the six patients who had improved bowel function . This may be attributable to the slower relaxation of the smooth rectal muscle compared with the easily fatigable striated external anal sphincter . CONCLUSION : Anterior sacral roots stimulator implants can improve bowel function in patients with spinal cord trauma 
    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: Objectives : To assess the state of the neurological bowel in spinal cord injured ( SCI ) patients , design and apply a program for the comprehensive management of neurogenic bowel and evaluate outcome . Setting : Out-patient in a Rehabilitation Service . Subjects : Thirty-eight SCI patients , 12 ( 32 % ) with complete lesions of more than 5 years duration . Design : Observational , longitudinal and prospect i ve . Pre and post intervention . Method : Pre and post SCI intestinal function was evaluated clinical ly prior to beginning program . The presence of GI symptoms were studied . Laboratory work-up included colonic transit time ( CTT ) ,  anorectal manometry  and  recto-colonoscopy .  An intestinal program was design ed , in order to achieve an effective and efficient evacuation in a predictable and socially acceptable time , to avoid short and long term complications and eliminate inadequate intestinal evacuation habits . Outcome measures : Pre and post SCI difficulty in intestinal evacuation ( DIE ) was increased ( from 2.6 % to 26.3 % ) . The most frequent GI symptom was abdominal distention ( 53 % ) . Colonic inertia was present in 49 % of CTT , internal anal sphincter pressure was normal or increased in 77 % and rectoanal inhibitory reflex was present in 88 % . With the intestinal program , the incidence of DIE was reduced to 8.8 % , manual extraction ( ME ) was reduced from 53 % to 37 % . Excellent and good results were obtained in 56 % of the patients . Conclusion : The proposed intestinal program is effective in the rehabilitation of SCI patients with neurogenic bowel . It is essential to initiate these physiological and safe procedures as soon as possible after sustaining the injury ; this will lead to better results and to the elimination of inadequate intestinal maneuvering in the future Spinal Cord ( 2000 ) 38 , 301–308 Background : Chronic constipation ( CC ) is common and there is a need for more effective and better-tolerated agents that normalize bowel function without affecting secretion . Prucalopride is a novel , selective serotonin4 receptor agonist with enterokinetic properties . Aims : Pilot study to compare the efficacy and tolerability of prucalopride and placebo in patients with severe CC referred to a tertiary centre . Methods : After 4-weeks ’ run in , patients were r and omized to 4 weeks ’ once daily , double-blind treatment with either prucalopride 4 mg ( n = 27 ) or placebo  ( n = 26 ) . A 50 % dose reduction after 2 weeks ’ treatment was possible for patients with an excessive gastrointestinal response to the study medication ( severe cramps , abdominal pain , and diarrhea ) . Patients assessed efficacy using a visual analogue scale ( VAS ) and recorded bowel function in daily diaries . The investigator assessed efficacy and total gut transit time ( marker study ) . Results : Patient VAS assessment demonstrated that prucalopride was significantly more effective than placebo in softening stools , and decreasing straining and time to first stool . Prucalopride also had a positive effect on stool frequency , feeling of complete evacuation and total gut transit time , although these differences were not statistically significant compared with placebo . The most common adverse events were gastrointestinal symptoms and headache ; most were mild to moderate . There were no clinical ly relevant effects on cardiovascular or laboratory parameters . Conclusions : Once-daily prucalopride 4 mg for 4 weeks is effective and well tolerated in patients with severe CC . It improves whole gut transit , reducing straining , softening stools and reducing time to first bowel movement Study design : Cross-sectional study . Objectives : To study the prevalence of incontinence , problem perception and determinants of urinary and faecal incontinence  in young adults with spina bifida . Setting : Nation-wide study in the Netherl and s. Participants : A total of 179 of 350 invited patients participated , including 37 patients with spina bifida occulta and 142 with spina bifida aperta , of whom 119 had hydrocephalus ; 41 % were male and mean age was 20.4 ( range 16–25 years ) . Methods : Data were collected from interviews , physical examination , neuropsychological tests and medical records . Results : Urinary and faecal incontinence was common in young adults with spina bifida ( 60.9 and 34.1 % , respectively ) , regardless of the bladder and bowel management they used . The majority of urinary and faecal incontinent patients perceived this as a problem ( 69.7 and 77.0 % , respectively ) . Spina bifida aperta , hydrocephalus and a level of lesion of L5 or above were associated with patients suffering from urinary and /or faecal incontinence . Predictors of perceiving urinary incontinence as a problem were , in addition to being incontinent , not having hydrocephalus and having a level of lesion of L5 or above . The only predictor of perceiving faecal incontinence as a problem was the frequency of incontinence . Conclusion : A majority of young adults with spina bifida suffer from urinary and faecal incontinence and most of them perceive their incontinence as a problem . Therefore , further efforts are important to improve urinary and faecal continence Study design : Cost-effectiveness analysis following international guidelines and taking the societal viewpoint . Objectives : To estimate the cost-effectiveness of transanal irrigation using a self-administered irrigation system when compared with conservative bowel management . Setting : A r and omized clinical trial was conducted at five spinal centres situated in Denmark , Germany , Italy , United Kingdom and Sweden . Estimates of re sources and unit costs were made for the German health care system . Methods : Efficacy outcomes were drawn from a r and omized controlled trial conducted in 2003–2005 . Adult spinal cord-injured patients with neurogenic bowel dysfunction were r and omized to 10 weeks with either transanal irrigation using Peristeen Anal Irrigation or to conservative bowel management .  Costs were calculated based on results from the clinical trial and on 24 interviews conducted in Germany . Unit costs were obtained from the Federal Statistical Office Germany and product list prices . Results : When comparing outcome measures at termination , transanal irrigation significantly reduced symptoms of neurogenic bowel dysfunction . Product-related costs were higher for transanal irrigation using the self-administered system ; however , costs for a carer to help with bowel management and changes/washing due to leakage were lower . For transanal irrigation , costs associated with urinary tract infections and patient time spent were reduced . Thus , the total cost to society is lower when patients use transanal irrigation . The results were shown to be robust in the sensitivity analysis . Conclusion : Transanal irrigation using a self-administered system reduces symptoms of neurogenic bowel dysfunction and results in a lower total cost to society than conservative bowel management . Sponsorship : The study was supported by Coloplast From a question naire sent to 90 spinal cord injury ( SCI ) patients it is concluded that 58 % of patients with a complete SCI above L2 suffer from constipation , defined as two or fewer bowel movements per week , or the use of aids such as laxatives , manual evacuation or enemas . Tetraplegic patients had the highest prevalence of constipation , while patients with low paraplegia were less prone to constipation . The use of anticholinergic drugs was found to predispose to constipation . Preserved rectal sensation did not influence the presence of constipation . Faecal incontinence was rare . Regular abdominal pain was present in one third of SCI patients and might be caused by an irritable bowel syndrome in 62 % of these OBJECTIVES To determine whether gut focused behavioural treatment ( biofeedback ) is a useful therapy in multiple sclerosis patients referred for constipation , incontinence , or a combination of these symptoms . Most patients with multiple sclerosis complain of constipation , faecal incontinence , or a combination of the two . Patients rate these bowel symptoms as having a major impact on their life . Until now the management of these problems has been empirical , with a lack of evaluated therapeutic regimes . METHODS Thirteen patients ( eight women , median age 38 years , median duration of multiple sclerosis 10 years ) complaining of constipation , with or without faecal incontinence underwent a median of four sessions of behavioural treatment .  Anorectal physiological tests were performed before therapy . Impairment and disability were rated with the Kurtzke score and the Cambridge multiple sclerosis basic score ( CAMBS ) . Patients were contacted a median of 14 months after completion of treatment . RESULTS A beneficial effect was attributed to biofeedback in five patients . Mild to moderate disability , quiescent and non-relapsing disease , and absence of progression of multiple sclerosis over the year before biofeedback were predictive of symptom improvement . No physiological test predicted the response to therapy . CONCLUSION Biofeedback retraining is an effective treatment in some patients with multiple sclerosis complaining of constipation or faecal incontinence . A response is more likely in patients with limited disability and a non-progressive disease course Frequency of defaecation , faecal form , straining at the start and end of defaecation , feelings of incomplete evacuation of faeces and urgency of defaecation were recorded in 69 healthy volunteers during three distinct 28-day study phases : pre-treatment , treatment with ispaghula husk and post-treatment . During treatment there was a significant increase ( P<0.001 ) in stool frequency and significant decreases in straining at the start ( P<0.001 ) and end ( P<0.001 ) of defaecation and in feelings of incomplete evacuation ( P<0.001 ) . There was evidence of a beneficial residual effect after treatment had stopped . There are indications that ispaghula husk ( Fybogel ® Orange ) is of benefit in relieving  constipation symptoms in apparently healthy people PURPOSE : This study evaluated the effect of anterior sacral roots stimulator implants on bowel function of patients with spinal cord trauma . METHOD : Eight patients with spinal cord injury and constipation had anterior sacral roots stimulator implants inserted for concomitant bladder dysfunction . Question naires on bowel function and anorectal manometry tests were given before and after insertion of the implants . RESULTS : Six patients achieved improvement in bowel function . Four of these patients could defecate spontaneously following stimulation . Two patients had no improvement in bowel function . Anorectal manometry studies showed a negative rectoanal pressure difference at the time of stimulation . All patients were unable to defecate during stimulation . Positive rectoanal pressure difference was recorded in the six patients who had improved bowel function . This may be attributable to the slower relaxation of the smooth rectal muscle compared with the easily fatigable striated external anal sphincter . CONCLUSION : Anterior sacral roots stimulator implants can improve bowel function in patients with spinal cord trauma 
    Output:
    