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: Abstract Background : Chest physiotherapy is a common practice after open reflux and obesity surgery . It is now possible to perform fundoplication and vertical b and ed gastroplasty ( VBG ) by the laparoscopic technique . The aim of this study was to evaluate in a prospect i ve , r and omized , controlled trial whether chest physiotherapy affects the postoperative course . Method : A series of 40 patients underwent laparoscopic fundoplication ; another 40 underwent laparoscopic VBG .  Twenty patients in each series received prophylactic chest physiotherapy ; the other 20 served as control patients and were not given any information or training . Results : Postoperatively , all patients had a significant reduction in respiratory function , measured as oxygen saturation , forced vital capacity , and peak expiratory flow , but the differences between the groups within each series were not significant . Postoperatively , one patient in the VBG treatment group had hypoxemia ( SaO2 < 92 % ) versus two control patients . One control patient developed postoperative pneumonia . Conclusions : This study indicates that routine chest physiotherapy is not necessary in patients undergoing laparoscopic upper gastrointestinal surgery , such as fundoplication and VBG The role of pre-operative short-term pulmonary rehabilitation in patients with chronic obstructive pulmonary disease who undergo coronary artery bypass graft surgery has been assessed for the first time prospect ively . Forty-five patients posted for coronary artery bypass graft surgery  were r and omised to receive either short-term pulmonary rehabilitation ( group I ) or no such programme ( group II ) . Patients of both the groups were evenly matched with respect to age , sex , body surface area , duration and severity of chronic obstructive pulmonary disease and coronary artery disease . Normal individuals who evenly matched with the study group were assessed for normal respiratory function parameters . Pre-operative and post-operative peak expiratory flow rate , inspiratory capacity , post-operative ventilation time , post-operative pulmonary complication and hospital stay were determined in both the groups . Peak expiratory flow rate ( 220.0 + /- 12.9 and 324.3 + /- 84.3 in group I , 218.0 + /- 16.4 and 260.5 + /- 35.2 in group II ) and inspiratory capacity ( 844.0 + /- 147.4 and 1100.0 + /- 158.1 in group I , 830.0 + /- 117.4 and 1090 + /- 137 in group II ) were significantly lower before and after surgery respectively in both groups compared to normal values . Even though both groups showed a significant rise in post-operative peak expiratory flow rate and inspiratory capacity after surgery , the post-operative peak expiratory flow rate and inspiratory capacity in group I was significantly higher than in group II . In group I , the post-operative ventilation time ( 24.5 + /- 6.00 hours ) , post-operative complications ( n = 4 ) and hospital stay ( 12.4 + /- 3.6 days ) were significantly lower than in group II ( 35.2 + /- 22.3 hours , n = 11 , 18.8 + /- 6.6 days respectively ) . These data suggest that short-term pulmonary rehabilitation is feasible and effective in improving pulmonary functions before and after surgery and in reducing surgical morbidity and cost of medical care significantly CONTEXT Postoperative pulmonary complications ( PPCs ) after coronary artery bypass graft ( CABG ) surgery are a major source of morbidity and mortality , and increase length of hospital stay and re source utilization . The prehospitalization period before CABG surgery may be used to improve a patient 's pulmonary condition . The efficacy of preoperative inspiratory muscle training ( IMT ) in reducing the incidence of PPCs in high-risk patients undergoing CABG surgery has not yet been determined . OBJECTIVE To evaluate the prophylactic efficacy of preoperative IMT on the incidence of PPCs in high-risk patients scheduled for elective CABG surgery . DESIGN , SETTING , AND PATIENTS A single-blind , r and omized clinical trial conducted at the University Medical Center Utrecht , Utrecht , the Netherl and s , with enrollment between July 2002 and August 2005 . Of 655 patients referred for elective CABG surgery , 299 ( 45.6 % ) met criteria for high risk of developing PPCs , of whom 279 were enrolled and followed up until discharge from hospital . INTERVENTION Patients were r and omly assigned to receive either preoperative IMT ( n = 140 ) or usual care ( n = 139 ) . Both groups received the same postoperative physical therapy . MAIN OUTCOME MEASURES Incidence of PPCs , especially pneumonia , and duration of postoperative hospitalization . RESULTS Both groups were comparable at baseline . After CABG surgery , PPCs were present in 25 ( 18.0 % ) of 139 patients in the IMT group and 48 ( 35.0 % ) of 137 patients in the usual care group ( odds ratio [ OR ] , 0.52 ; 95 % confidence interval [ CI ] , 0.30 - 0.92 ) . Pneumonia occurred in 9 ( 6.5 % ) of 139 patients in the IMT group and in 22 ( 16.1 % ) of 137 patients in the usual care group ( OR , 0.40 ; 95 % CI , 0.19 - 0.84 ) . Median duration of postoperative hospitalization was 7 days ( range , 5 - 41 days ) in the IMT group vs 8 days ( range , 6 - 70 days ) in the usual care group by Mann-Whitney U statistic ( z = -2.42 ; P = .02 ) . CONCLUSION Preoperative IMT reduced the incidence of PPCs and duration of postoperative hospitalization in patients at high risk of developing a pulmonary complication undergoing CABG surgery . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N17691887 PURPOSE To evaluate the effects of positive end expiratory pressure and physiotherapy intervention during Phase I of cardiac rehabilitation on the behavior of pulmonary function and inspiratory muscle strength in postoperative cardiac surgery . METHODS A prospect i ve r and omized study , in which 24 patients were divided in 2 groups : a group that performed respiratory exercises with positive airway expiratory pressure associated with physiotherapy intervention ( GEP , n = 8) and a group that received only the physiotherapy intervention ( GPI , n = 16 ) . Pulmonary function was evaluated by spirometry on the preoperative and on the fifth postoperative days ; inspiratory muscle strength was measured by maximal inspiratory pressure on the same days . RESULTS Spirometric variables were significantly reduced from the preoperative to the fifth postoperative day for the GPI , while the GEP had a significant reduction only for vital capacity ( P < .05 ) . When the treatments were compared , smaller values were observed in the GPI for peak flow on the fifth postoperative day . Significant reductions of maximal inspiratory pressure from preoperative to the first postoperative day were found in both groups . However , the reduction in maximal inspiratory pressure from the preoperative to the fifth postoperative day was significant only in the GPI ( P < .05 ) . CONCLUSIONS These data suggest that cardiac surgery produces a reduction in inspiratory muscle strength , pulmonary volume , and flow . The association of positive expiratory pressure with physiotherapy intervention was more efficient in minimizing these changes , in comparison to the physiotherapy intervention alone . However , in both groups , the pulmonary volumes were not completely reestablished by the fifth postoperative day , and it was necessary to continue the treatment after hospital convalescence OBJECTIVE : To determine whether preoperative inspiratory muscle training is able to attenuate the impact of surgical trauma on the respiratory muscle strength , in the lung volumes , and diaphragmatic excursion in obese women undergoing open bariatric surgery . DESIGN : R and omized controlled trial . SETTING : Meridional Hospital , Cariacica/ES , Brazil . SUBJECTS : Thirty-two obese women undergoing elective open bariatric surgery were r and omly assigned to receive preoperative inspiratory muscle training ( inspiratory muscle training group ) or usual care ( control group ) . MAIN MEASURES : Respiratory muscle strength ( maximal static respiratory pressure – maximal inspiratory pressure and maximal expiratory pressure ) , lung volumes , and diaphragmatic excursion . RESULTS : After training , there was a significant increase only in the maximal inspiratory pressure in the inspiratory muscle training group . The maximal expiratory pressure , the lung volumes and the diaphragmatic excursion did not show any significant change with training . In the postoperative period there was a significant decrease in maximal inspiratory pressure in both the groups . However , there was a decrease of 28 % in the inspiratory muscle training group , whereas it was 47 % in the control group . The decrease in maximal expiratory pressure and in lung volumes in the postoperative period was similar between the groups . There was a significant reduction in the measures of diaphragmatic excursion in both the groups . CONCLUSION : The preoperative inspiratory muscle training increased the inspiratory muscle strength ( maximal inspiratory pressure ) and attenuated the negative postoperative effects of open bariatric surgery in obese women for this variable , though not influencing the lung volumes and the diaphragmatic excursion The object of the investigation was to compare the effect of three different physiotherapy masks on the incidence of postoperative complications after thoracic surgery . It was carried out as a prospect i ve , consecutive , r and omized comparison at a Department of Thoracic and Heart Surgery at a University Hospital . The therapy was performed by experienced and specially trained physiotherapists . One hundred and sixty patients were evaluated ; 60 patients undergoing heart surgery , 59 patients having pulmonary resection , and 41 patients with exploratory thoracotomy . In each operative category the patients were treated with one of three face mask systems used in addition to routine chest physiotherapy . These were either continuous positive airway pressure ( CPAP ) , positive expiratory pressure ( PEP ) , or inspiratory resistance -- positive expiratory pressure ( IR-PEP ) . Postoperative pulmonary complications were assessed by forced vital capacity ( FVC ) , arterial oxygen tension ( PaO2 ) , and chest X-ray examination , all parameters were measured preoperatively and on the fourth and ninth postoperative day . The patients filled in a question naire concerning their opinions about their mask treatment . IR-PEP showed a lesser decrease in PaO2 on day nine . Otherwise there was an equal decrease in FVC and PaO2 , and equal frequency of atelectasis in the three mask treatments . It is therefore concluded that any of the three therapies : continuous positive airway pressure ( CPAP ) , positive expiratory pressure ( PEP ) , and inspiratory resistance -- positive expiratory pressure ( IR-PEP ) may be used as supplement to st and ard chest physiotherapy A prospect i ve r and omized controlled trial was conducted in patients undergoing elective cholecystectomy  to assess the value of routine chest physiotherapy .  One hundred and two patients entered the study : 47 patients developed no pulmonary complications , 29 had pulmonary atelectasis and a further 26 developed chest infection . The pattern of changes in arterial oxygen tension in the period after operation supported the clinical allocation of the patients . Of 51 patients not receiving physiotherapy  , 11 developed atelectasis and 19 chest infection . Of 51 treated patients , 18 developed atelectasis and seven chest infection .  Routine prophylactic postoperative chest physiotherapy decreased significantly the frequency of chest infection ( P less than 0.02 ) PURPOSE To determine the relation between cardiac and noncardiac complications and their effects on length of stay in patients undergoing noncardiac surgery . METHODS We collected detailed information from the history , physical examination , and preoperative tests of 3970 patients aged > or = 50 years who were undergoing major noncardiac procedures . Serial electrocardiograms and cardiac enzyme measurements were performed perioperatively , and cardiac and noncardiac complications were recorded prospect ively . Multivariate logistic regression analysis was used to determine the association between cardiac and noncardiac complications , and linear regression was used to assess their effects on length of stay . RESULTS Cardiac complications occurred in 84 patients ( 2 % ) , and noncardiac complications developed in 510 patients ( 13 % ) . Both types of complications occurred in 40 patients ( 1 % ) . The most common cardiac complications were pulmonary edema ( n = 42 ) and myocardial infa rct ion ( n = 41 ) . The most common noncardiac complications were wound infection ( n = 291 ) , confusion ( n = 87 ) , respiratory failure requiring intubation ( n = 62 ) , deep venous thrombosis ( n = 48 ) , and bacterial pneumonia ( n = 46 ) . Patients with cardiac complications were more likely to suffer a noncardiac complication than were those without cardiac complications , even after adjustment for preoperative clinical factors ( odds ratio = 6.4 ; 95 % confidence interval [ CI ] : 3.9 to 10.6 ) . Mean length of stay was markedly increased in patients who experienced cardiac ( 11 days ; 95 % CI : 9 to 12 days ) or noncardiac ( 11 days ; 95 % CI : 10 to 12 days ) complications , or both ( 15 days ; 95 % CI : 12 to 18 days ) , as compared with 
    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: Abstract Background : Chest physiotherapy is a common practice after open reflux and obesity surgery . It is now possible to perform fundoplication and vertical b and ed gastroplasty ( VBG ) by the laparoscopic technique . The aim of this study was to evaluate in a prospect i ve , r and omized , controlled trial whether chest physiotherapy affects the postoperative course . Method : A series of 40 patients underwent laparoscopic fundoplication ; another 40 underwent laparoscopic VBG .  Twenty patients in each series received prophylactic chest physiotherapy ; the other 20 served as control patients and were not given any information or training . Results : Postoperatively , all patients had a significant reduction in respiratory function , measured as oxygen saturation , forced vital capacity , and peak expiratory flow , but the differences between the groups within each series were not significant . Postoperatively , one patient in the VBG treatment group had hypoxemia ( SaO2 < 92 % ) versus two control patients . One control patient developed postoperative pneumonia . Conclusions : This study indicates that routine chest physiotherapy is not necessary in patients undergoing laparoscopic upper gastrointestinal surgery , such as fundoplication and VBG The role of pre-operative short-term pulmonary rehabilitation in patients with chronic obstructive pulmonary disease who undergo coronary artery bypass graft surgery has been assessed for the first time prospect ively . Forty-five patients posted for coronary artery bypass graft surgery  were r and omised to receive either short-term pulmonary rehabilitation ( group I ) or no such programme ( group II ) . Patients of both the groups were evenly matched with respect to age , sex , body surface area , duration and severity of chronic obstructive pulmonary disease and coronary artery disease . Normal individuals who evenly matched with the study group were assessed for normal respiratory function parameters . Pre-operative and post-operative peak expiratory flow rate , inspiratory capacity , post-operative ventilation time , post-operative pulmonary complication and hospital stay were determined in both the groups . Peak expiratory flow rate ( 220.0 + /- 12.9 and 324.3 + /- 84.3 in group I , 218.0 + /- 16.4 and 260.5 + /- 35.2 in group II ) and inspiratory capacity ( 844.0 + /- 147.4 and 1100.0 + /- 158.1 in group I , 830.0 + /- 117.4 and 1090 + /- 137 in group II ) were significantly lower before and after surgery respectively in both groups compared to normal values . Even though both groups showed a significant rise in post-operative peak expiratory flow rate and inspiratory capacity after surgery , the post-operative peak expiratory flow rate and inspiratory capacity in group I was significantly higher than in group II . In group I , the post-operative ventilation time ( 24.5 + /- 6.00 hours ) , post-operative complications ( n = 4 ) and hospital stay ( 12.4 + /- 3.6 days ) were significantly lower than in group II ( 35.2 + /- 22.3 hours , n = 11 , 18.8 + /- 6.6 days respectively ) . These data suggest that short-term pulmonary rehabilitation is feasible and effective in improving pulmonary functions before and after surgery and in reducing surgical morbidity and cost of medical care significantly CONTEXT Postoperative pulmonary complications ( PPCs ) after coronary artery bypass graft ( CABG ) surgery are a major source of morbidity and mortality , and increase length of hospital stay and re source utilization . The prehospitalization period before CABG surgery may be used to improve a patient 's pulmonary condition . The efficacy of preoperative inspiratory muscle training ( IMT ) in reducing the incidence of PPCs in high-risk patients undergoing CABG surgery has not yet been determined . OBJECTIVE To evaluate the prophylactic efficacy of preoperative IMT on the incidence of PPCs in high-risk patients scheduled for elective CABG surgery . DESIGN , SETTING , AND PATIENTS A single-blind , r and omized clinical trial conducted at the University Medical Center Utrecht , Utrecht , the Netherl and s , with enrollment between July 2002 and August 2005 . Of 655 patients referred for elective CABG surgery , 299 ( 45.6 % ) met criteria for high risk of developing PPCs , of whom 279 were enrolled and followed up until discharge from hospital . INTERVENTION Patients were r and omly assigned to receive either preoperative IMT ( n = 140 ) or usual care ( n = 139 ) . Both groups received the same postoperative physical therapy . MAIN OUTCOME MEASURES Incidence of PPCs , especially pneumonia , and duration of postoperative hospitalization . RESULTS Both groups were comparable at baseline . After CABG surgery , PPCs were present in 25 ( 18.0 % ) of 139 patients in the IMT group and 48 ( 35.0 % ) of 137 patients in the usual care group ( odds ratio [ OR ] , 0.52 ; 95 % confidence interval [ CI ] , 0.30 - 0.92 ) . Pneumonia occurred in 9 ( 6.5 % ) of 139 patients in the IMT group and in 22 ( 16.1 % ) of 137 patients in the usual care group ( OR , 0.40 ; 95 % CI , 0.19 - 0.84 ) . Median duration of postoperative hospitalization was 7 days ( range , 5 - 41 days ) in the IMT group vs 8 days ( range , 6 - 70 days ) in the usual care group by Mann-Whitney U statistic ( z = -2.42 ; P = .02 ) . CONCLUSION Preoperative IMT reduced the incidence of PPCs and duration of postoperative hospitalization in patients at high risk of developing a pulmonary complication undergoing CABG surgery . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N17691887 PURPOSE To evaluate the effects of positive end expiratory pressure and physiotherapy intervention during Phase I of cardiac rehabilitation on the behavior of pulmonary function and inspiratory muscle strength in postoperative cardiac surgery . METHODS A prospect i ve r and omized study , in which 24 patients were divided in 2 groups : a group that performed respiratory exercises with positive airway expiratory pressure associated with physiotherapy intervention ( GEP , n = 8) and a group that received only the physiotherapy intervention ( GPI , n = 16 ) . Pulmonary function was evaluated by spirometry on the preoperative and on the fifth postoperative days ; inspiratory muscle strength was measured by maximal inspiratory pressure on the same days . RESULTS Spirometric variables were significantly reduced from the preoperative to the fifth postoperative day for the GPI , while the GEP had a significant reduction only for vital capacity ( P < .05 ) . When the treatments were compared , smaller values were observed in the GPI for peak flow on the fifth postoperative day . Significant reductions of maximal inspiratory pressure from preoperative to the first postoperative day were found in both groups . However , the reduction in maximal inspiratory pressure from the preoperative to the fifth postoperative day was significant only in the GPI ( P < .05 ) . CONCLUSIONS These data suggest that cardiac surgery produces a reduction in inspiratory muscle strength , pulmonary volume , and flow . The association of positive expiratory pressure with physiotherapy intervention was more efficient in minimizing these changes , in comparison to the physiotherapy intervention alone . However , in both groups , the pulmonary volumes were not completely reestablished by the fifth postoperative day , and it was necessary to continue the treatment after hospital convalescence OBJECTIVE : To determine whether preoperative inspiratory muscle training is able to attenuate the impact of surgical trauma on the respiratory muscle strength , in the lung volumes , and diaphragmatic excursion in obese women undergoing open bariatric surgery . DESIGN : R and omized controlled trial . SETTING : Meridional Hospital , Cariacica/ES , Brazil . SUBJECTS : Thirty-two obese women undergoing elective open bariatric surgery were r and omly assigned to receive preoperative inspiratory muscle training ( inspiratory muscle training group ) or usual care ( control group ) . MAIN MEASURES : Respiratory muscle strength ( maximal static respiratory pressure – maximal inspiratory pressure and maximal expiratory pressure ) , lung volumes , and diaphragmatic excursion . RESULTS : After training , there was a significant increase only in the maximal inspiratory pressure in the inspiratory muscle training group . The maximal expiratory pressure , the lung volumes and the diaphragmatic excursion did not show any significant change with training . In the postoperative period there was a significant decrease in maximal inspiratory pressure in both the groups . However , there was a decrease of 28 % in the inspiratory muscle training group , whereas it was 47 % in the control group . The decrease in maximal expiratory pressure and in lung volumes in the postoperative period was similar between the groups . There was a significant reduction in the measures of diaphragmatic excursion in both the groups . CONCLUSION : The preoperative inspiratory muscle training increased the inspiratory muscle strength ( maximal inspiratory pressure ) and attenuated the negative postoperative effects of open bariatric surgery in obese women for this variable , though not influencing the lung volumes and the diaphragmatic excursion The object of the investigation was to compare the effect of three different physiotherapy masks on the incidence of postoperative complications after thoracic surgery . It was carried out as a prospect i ve , consecutive , r and omized comparison at a Department of Thoracic and Heart Surgery at a University Hospital . The therapy was performed by experienced and specially trained physiotherapists . One hundred and sixty patients were evaluated ; 60 patients undergoing heart surgery , 59 patients having pulmonary resection , and 41 patients with exploratory thoracotomy . In each operative category the patients were treated with one of three face mask systems used in addition to routine chest physiotherapy . These were either continuous positive airway pressure ( CPAP ) , positive expiratory pressure ( PEP ) , or inspiratory resistance -- positive expiratory pressure ( IR-PEP ) . Postoperative pulmonary complications were assessed by forced vital capacity ( FVC ) , arterial oxygen tension ( PaO2 ) , and chest X-ray examination , all parameters were measured preoperatively and on the fourth and ninth postoperative day . The patients filled in a question naire concerning their opinions about their mask treatment . IR-PEP showed a lesser decrease in PaO2 on day nine . Otherwise there was an equal decrease in FVC and PaO2 , and equal frequency of atelectasis in the three mask treatments . It is therefore concluded that any of the three therapies : continuous positive airway pressure ( CPAP ) , positive expiratory pressure ( PEP ) , and inspiratory resistance -- positive expiratory pressure ( IR-PEP ) may be used as supplement to st and ard chest physiotherapy A prospect i ve r and omized controlled trial was conducted in patients undergoing elective cholecystectomy  to assess the value of routine chest physiotherapy .  One hundred and two patients entered the study : 47 patients developed no pulmonary complications , 29 had pulmonary atelectasis and a further 26 developed chest infection . The pattern of changes in arterial oxygen tension in the period after operation supported the clinical allocation of the patients . Of 51 patients not receiving physiotherapy  , 11 developed atelectasis and 19 chest infection . Of 51 treated patients , 18 developed atelectasis and seven chest infection .  Routine prophylactic postoperative chest physiotherapy decreased significantly the frequency of chest infection ( P less than 0.02 ) PURPOSE To determine the relation between cardiac and noncardiac complications and their effects on length of stay in patients undergoing noncardiac surgery . METHODS We collected detailed information from the history , physical examination , and preoperative tests of 3970 patients aged > or = 50 years who were undergoing major noncardiac procedures . Serial electrocardiograms and cardiac enzyme measurements were performed perioperatively , and cardiac and noncardiac complications were recorded prospect ively . Multivariate logistic regression analysis was used to determine the association between cardiac and noncardiac complications , and linear regression was used to assess their effects on length of stay . RESULTS Cardiac complications occurred in 84 patients ( 2 % ) , and noncardiac complications developed in 510 patients ( 13 % ) . Both types of complications occurred in 40 patients ( 1 % ) . The most common cardiac complications were pulmonary edema ( n = 42 ) and myocardial infa rct ion ( n = 41 ) . The most common noncardiac complications were wound infection ( n = 291 ) , confusion ( n = 87 ) , respiratory failure requiring intubation ( n = 62 ) , deep venous thrombosis ( n = 48 ) , and bacterial pneumonia ( n = 46 ) . Patients with cardiac complications were more likely to suffer a noncardiac complication than were those without cardiac complications , even after adjustment for preoperative clinical factors ( odds ratio = 6.4 ; 95 % confidence interval [ CI ] : 3.9 to 10.6 ) . Mean length of stay was markedly increased in patients who experienced cardiac ( 11 days ; 95 % CI : 9 to 12 days ) or noncardiac ( 11 days ; 95 % CI : 10 to 12 days ) complications , or both ( 15 days ; 95 % CI : 12 to 18 days ) , as compared with 
    Output:
    