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: BACKGROUND --Bacterial infections of the lower airways during an exacerbation in patients with asthma or chronic obstructive pulmonary disease ( COPD ) may be the cause of an exacerbation or the consequence of a viral infection or an increase in airways limitation . To determine whether bacterial infection is an important component in the pathogenesis of an exacerbation , the effects of antimicrobial treatment must be studied . METHODS -- Patients with asthma or COPD seen in general practice were studied in a double blind r and omised manner to investigate whether the antimicrobial drugs amoxicillin ( 500 mg three times daily ) , cotrimoxazole ( 960 mg twice daily ) , or a placebo , each when added to a short course of oral corticosteroids , can accelerate recovery from exacerbations . Patients were instructed to contact their own physician early in the morning when complaints of increased shortness of breath , wheezing , or exacerbations of cough with or without sputum production occurred . Treatment effects were evaluated over the next 14 days by study ing symptom scores ( wheeze , dyspnoea , cough with and without mucus production , and awakening with dyspnoea ) , peak expiratory flow values ( PEF , expressed as % predicted ) , and sublingual temperature . Bacteriological study of the sputum was made at the onset of an exacerbation and 7 , 21 and 35 days afterwards . RESULTS --Of 195 patients enrolled 71 ( 36 % ) contacted their physician for symptoms of an exacerbation . Symptoms improved in all three groups , improvements ranging from 0.54 to 0.75 points per day on a four point scale . PEF% predicted showed improvements in the three groups after the exacerbation , ranging from 0.34 % to 0.78 % predicted per day , finally returning to baseline values . Sublingual temperature did not change . Six of 71 patients consulted their physician because of a relapse between four and 24 days after the start of treatment . In only two of the 50 sputum sample s , collected during an exacerbation , and which contained > or = 10(5 ) bacteria in culture sensitive to the chosen antibiotic given , did any benefit from antimicrobial treatment occur . During the recovery period sputum purulence improved irrespective of antibiotic treatment . CONCLUSIONS --Antibiotics given with a short course of oral prednisolone during an exacerbation do not accelerate recovery as measured by changes in peak flow and symptom scores in ambulatory patients with mild to moderate asthma or COPD when treated by their general practitioners . Moreover , antibiotics do not reduce the number of relapses after treating an exacerbation OBJECTIVE Scientific and ethical justification for new clinical trials requires them to have been design ed in the light of scientifically defensible assessment s of relevant previous research . Reliable interpretation of the results of new clinical trials entails setting them in the context of up date s of the review s upon which they were deemed scientifically and ethically justifiable . We have shown previously that most reports of r and omized trials published in five general medical journals in May 1997 and in May 2001 failed to set their results in the context of the findings from similar research . In the current study , we assess whether there had been progress in this respect in 2005 and also investigate the extent to which reports begin by referring to systematic review s providing the justification for the new research reported . DESIGN Assessment of the Introduction and Discussion sections in all reports of r and omized trials published during May 2005 in five general medical journals . SETTING Reports of r and omized trials in five general medical journals . PARTICIPANTS Annals of Internal Medicine , BMJ , JAMA , Lancet and New Engl and Journal of Medicine . INTERVENTIONS None . MAIN OUTCOME MEASURES The inclusion or mention of one or more systematic review s in the Introduction or Discussion section of each report assessed . RESULTS We found 18 reports of r and omized trials . The Introduction sections referred to systematic review s in five ( 27 % ) of these reports . None of the discussion sections of the 15 reports of trials that were not the first published trials to address the question studied placed the results of the new trial in the context of an up date d systematic review of other research . Although reference was made to relevant systematic review s in five of these 15 reports , there was no integration - quantitative or qualitative - of the results of the new trials in an up date of these review s. In the remaining ten reports there was no evidence that any systematic attempt had been made to set the new results in the context of previous trials . CONCLUSIONS There is no evidence of progress between 1997 and 2005 in the proportion of reports of trials published in general medical journals which discussed new results within the context of up-to- date systematic review s of relevant evidence from other controlled trials . Although the proportion of trials referring to systematic review s in Discussion sections has increased , the majority of reports continued to fail even to do this . Similarly , most research ers appear not to have considered a systematic review when design ing their trial . Research ers and journal editors do a disservice to the interests of the public and others involved in healthcare decision-making by acquiescing in this situation The aim of the study was to evaluate whether a broad-spectrum penicillin , amoxicillin , was superior to placebo in resolving symptoms of acute exacerbations of chronic bronchitis in patients from general practice . 131 general practitioners included 278 patients over a period of 30 months . The patients were r and omly assigned to treatment with amoxicillin 750 mg b.i.d . or corresponding placebo for 7 days . Patients with pneumonia , a temperature above 38.5 degrees C or heart rate over 100 were excluded for safety reasons . The main effect parameter -- the doctors ' overall evaluation of the treatment -- did not demonstrate any statistically significant difference between amoxicillin or placebo , 63 % versus 64 % of the patients . Resolution of symptoms was obtained by 19 % ( 25/132 ) of the patients in the amoxicillin group compared with 10 % ( 13/136 ) of the patients in the placebo group , P = 0.03 . The present findings do not favour routine use of antibiotics in an attempt to improve the course of acute exacerbations as defined in this study in patients with chronic bronchitis A comparative study of ampicillin ( 500 mg four times daily ) , erythromycin ( 500 mg four times daily ) and sulphametopyrazine ( 1 g at start of exacerbation ) followed by erythromycin ( 500 mg four times daily ) was carried out in infective exacerbations of chronic bronchitis .  Ampicillin and erythromycin were found to be equally effective , but the combination of erythromycin and sulphametopyrazine was significantly less effective . Unwanted effects were more frequent with ampicillin and with erythromycin plus sulphametopyrazine than with erythromycin alone Background Aprotinin is a serine protease inhibitor used to limit perioperative bleeding and reduce the need for donated blood transfusions during cardiac surgery . R and omized controlled trials of aprotinin evaluating its effect on the outcome of perioperative transfusion have been published since 1987 , and systematic review s were conducted in 1992 and 1997 . Methods A systematic search was conducted for all RCTs of aprotinin  that used placebo controls or were open-label with no active control treatment . Data collected included the primary outcome , objective of each study , whether a systematic review was cited or conducted as part of the background and /or rationale for the study and the number of previously published RCTs cited . Cumulative meta-analyses were performed . Results Sixty-four r and omized , controlled trials of aprotinin were found , conducted between 1987 and 2002 , reporting an endpoint of perioperative transfusion .  Median trial size was 64 subjects , with a range of 20 to 1784 . A cumulative meta- analysis indicated that aprotinin greatly decreased the need for perioperative transfusion , stabilizing at an odds ratio of 0.25 ( p , 10 2 6 ) by the 12th study , published in June of 1992 . The upper limit of the confidence interval never exceeded 0.65 and results were similar in all subgroups . Citation of previous RCTs was extremely low , with a median of 20 % of prior trials cited . Only 7 of 44 ( 15 % ) of subsequent reports referenced the largest trial ( N 1/4 1784 ) , which was 28 times larger than the median trial size . Conclusions This study demonstrates that investigators evaluating aprotinin were not adequately citing previous research , result ing in a large number of RCTs being conducted to address efficacy questions that prior trials had already definitively answered . Institutional review boards and journals could reduce the number of redundant trials by requiring investigators to conduct adequate search es for prior evidence and conducting systematic review Campbell , M. ( 1949 ) . Quart . 7 . Med . , 18 , 379 . ( 1955 ) . Brit . Heart Y. , 17 , 511 . ( 1959 ) . Ibid . , 21 , 65 . ( 1961a ) . Brit . med 7 . , 1 , 691 . ( 1961b ) . Acta Genet . med . ( Roma ) , 10 , 443 . ( 1962 ) . Brit . Heart 7 . , 24 , 625 . ( 1963 ) . Ibid . , 25 , 803 . ( 1966 ) . In A Textbook of Paediatric Cardiology , edited by Hamish Watson . Lloyd-Luke , London . In preparation . and Baylis , J. H. ( 1956 ) . Brit . Heart 7 . , 18 , 475 . and Goodwin , J. F. ( 1965 ) . Progr . cardiovasc . Dis . , 7 , 417 . and Polani , P. E. ( 1961a ) . Lancet , 1 , 463 . ( 1961b ) . Brit . Heart 7 . , 23 , 477 . Carlgren , L.-E. ( 1959 ) . Ibid . , 21 , 40 . Carter , C. 0 . ( 1961 ) . In Conference on Clinical Aspects of Genetics ( 1961 ) , p. 30 . Cockayne , E. A. ( 1938 ) . Quart . 7 . Med . , 7 , 479 . Conference on Clinical Aspects of Genetics held at the Royal College of Phybicians of London ( 1961 ) . Pitman Medical Publishing Co. , Ltd. , London . Edited by F. A. Jones . Conte , W. R. , McCammon , C. S. , and Christie , A. ( 1945 ) . Amer . 7 . Dis . Child . , 70 , 301 . Cox , Diane W. ( 1964 ) . Amer . 7 . hum . Genet . , 16 , 214 . Edwards , J. H. ( 1958 ) . Brit . 7 . prev . soc . Med . , 12 , 115 . Evans , W. ( 1949 ) . Brit Heart 7 . , 11 , 68 . First International Conference on Congenital Malformations , London , 18 - 22 July 1960 . Lippincott , Philadelphia and Montreal , 1961 , and Pitman , London , 1962 . Ford , E. B. , and Huxley , J. S. 1927 . Brit . 7 . exp . Biol . , 5 , 112 . Foxon , G. E. H. ( 1959 ) BIrt . Heart 7 . , 21 , 51 . Fraser , F. C. ( 1959 ) . 7 . chron . Dis . , 10 , 97 . Fuhrmann , W. ( 1958 ) . Z. menshl . Vererb.-u Konstit.-Lehre , 34 , 563 . ( 1961 ) . Acta genet . ( Basel ) , 11 , 289 . ( 1962 ) . Ergebn . inn . Med . Kinderhel ~ k . , 18 , 47 . Gibson , S. , and Lewis , K. C. ( 1952 ) . Amer . 7 . Dis . Child . , 83 , 317 . Harris , L. E. , and Steinberg , A. G. ( 1954 ) . Pediatrics , 14 , 314 . Ingalls , T. H. , Avis . F. R. , Curley , F. J. , and Temin , H. M. ( 1953 ) . 7 . Hered . , 44 , 185 . Kalter , H. ( 1954a ) . Genetics , 39 , 185 . ( 1954b ) . Ibid . , 39 , 975 . and Warkany , J. ( 1957 ) . 7 . exp . Zool . , 136 , 531 . Keith , J. D. , Rowe , R. D. , and Vlad , P. ( 1958 ) . Heart Disease in Infancy and Childhood . MacMillan , New York . Lamy , M. , de Grouchy , J. , and Schweisguth , 0 . ( 1957 ) . Amer . 7 . hum . Genet . , 9 , 17 . L and auer , W. ( 
    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: BACKGROUND --Bacterial infections of the lower airways during an exacerbation in patients with asthma or chronic obstructive pulmonary disease ( COPD ) may be the cause of an exacerbation or the consequence of a viral infection or an increase in airways limitation . To determine whether bacterial infection is an important component in the pathogenesis of an exacerbation , the effects of antimicrobial treatment must be studied . METHODS -- Patients with asthma or COPD seen in general practice were studied in a double blind r and omised manner to investigate whether the antimicrobial drugs amoxicillin ( 500 mg three times daily ) , cotrimoxazole ( 960 mg twice daily ) , or a placebo , each when added to a short course of oral corticosteroids , can accelerate recovery from exacerbations . Patients were instructed to contact their own physician early in the morning when complaints of increased shortness of breath , wheezing , or exacerbations of cough with or without sputum production occurred . Treatment effects were evaluated over the next 14 days by study ing symptom scores ( wheeze , dyspnoea , cough with and without mucus production , and awakening with dyspnoea ) , peak expiratory flow values ( PEF , expressed as % predicted ) , and sublingual temperature . Bacteriological study of the sputum was made at the onset of an exacerbation and 7 , 21 and 35 days afterwards . RESULTS --Of 195 patients enrolled 71 ( 36 % ) contacted their physician for symptoms of an exacerbation . Symptoms improved in all three groups , improvements ranging from 0.54 to 0.75 points per day on a four point scale . PEF% predicted showed improvements in the three groups after the exacerbation , ranging from 0.34 % to 0.78 % predicted per day , finally returning to baseline values . Sublingual temperature did not change . Six of 71 patients consulted their physician because of a relapse between four and 24 days after the start of treatment . In only two of the 50 sputum sample s , collected during an exacerbation , and which contained > or = 10(5 ) bacteria in culture sensitive to the chosen antibiotic given , did any benefit from antimicrobial treatment occur . During the recovery period sputum purulence improved irrespective of antibiotic treatment . CONCLUSIONS --Antibiotics given with a short course of oral prednisolone during an exacerbation do not accelerate recovery as measured by changes in peak flow and symptom scores in ambulatory patients with mild to moderate asthma or COPD when treated by their general practitioners . Moreover , antibiotics do not reduce the number of relapses after treating an exacerbation OBJECTIVE Scientific and ethical justification for new clinical trials requires them to have been design ed in the light of scientifically defensible assessment s of relevant previous research . Reliable interpretation of the results of new clinical trials entails setting them in the context of up date s of the review s upon which they were deemed scientifically and ethically justifiable . We have shown previously that most reports of r and omized trials published in five general medical journals in May 1997 and in May 2001 failed to set their results in the context of the findings from similar research . In the current study , we assess whether there had been progress in this respect in 2005 and also investigate the extent to which reports begin by referring to systematic review s providing the justification for the new research reported . DESIGN Assessment of the Introduction and Discussion sections in all reports of r and omized trials published during May 2005 in five general medical journals . SETTING Reports of r and omized trials in five general medical journals . PARTICIPANTS Annals of Internal Medicine , BMJ , JAMA , Lancet and New Engl and Journal of Medicine . INTERVENTIONS None . MAIN OUTCOME MEASURES The inclusion or mention of one or more systematic review s in the Introduction or Discussion section of each report assessed . RESULTS We found 18 reports of r and omized trials . The Introduction sections referred to systematic review s in five ( 27 % ) of these reports . None of the discussion sections of the 15 reports of trials that were not the first published trials to address the question studied placed the results of the new trial in the context of an up date d systematic review of other research . Although reference was made to relevant systematic review s in five of these 15 reports , there was no integration - quantitative or qualitative - of the results of the new trials in an up date of these review s. In the remaining ten reports there was no evidence that any systematic attempt had been made to set the new results in the context of previous trials . CONCLUSIONS There is no evidence of progress between 1997 and 2005 in the proportion of reports of trials published in general medical journals which discussed new results within the context of up-to- date systematic review s of relevant evidence from other controlled trials . Although the proportion of trials referring to systematic review s in Discussion sections has increased , the majority of reports continued to fail even to do this . Similarly , most research ers appear not to have considered a systematic review when design ing their trial . Research ers and journal editors do a disservice to the interests of the public and others involved in healthcare decision-making by acquiescing in this situation The aim of the study was to evaluate whether a broad-spectrum penicillin , amoxicillin , was superior to placebo in resolving symptoms of acute exacerbations of chronic bronchitis in patients from general practice . 131 general practitioners included 278 patients over a period of 30 months . The patients were r and omly assigned to treatment with amoxicillin 750 mg b.i.d . or corresponding placebo for 7 days . Patients with pneumonia , a temperature above 38.5 degrees C or heart rate over 100 were excluded for safety reasons . The main effect parameter -- the doctors ' overall evaluation of the treatment -- did not demonstrate any statistically significant difference between amoxicillin or placebo , 63 % versus 64 % of the patients . Resolution of symptoms was obtained by 19 % ( 25/132 ) of the patients in the amoxicillin group compared with 10 % ( 13/136 ) of the patients in the placebo group , P = 0.03 . The present findings do not favour routine use of antibiotics in an attempt to improve the course of acute exacerbations as defined in this study in patients with chronic bronchitis A comparative study of ampicillin ( 500 mg four times daily ) , erythromycin ( 500 mg four times daily ) and sulphametopyrazine ( 1 g at start of exacerbation ) followed by erythromycin ( 500 mg four times daily ) was carried out in infective exacerbations of chronic bronchitis .  Ampicillin and erythromycin were found to be equally effective , but the combination of erythromycin and sulphametopyrazine was significantly less effective . Unwanted effects were more frequent with ampicillin and with erythromycin plus sulphametopyrazine than with erythromycin alone Background Aprotinin is a serine protease inhibitor used to limit perioperative bleeding and reduce the need for donated blood transfusions during cardiac surgery . R and omized controlled trials of aprotinin evaluating its effect on the outcome of perioperative transfusion have been published since 1987 , and systematic review s were conducted in 1992 and 1997 . Methods A systematic search was conducted for all RCTs of aprotinin  that used placebo controls or were open-label with no active control treatment . Data collected included the primary outcome , objective of each study , whether a systematic review was cited or conducted as part of the background and /or rationale for the study and the number of previously published RCTs cited . Cumulative meta-analyses were performed . Results Sixty-four r and omized , controlled trials of aprotinin were found , conducted between 1987 and 2002 , reporting an endpoint of perioperative transfusion .  Median trial size was 64 subjects , with a range of 20 to 1784 . A cumulative meta- analysis indicated that aprotinin greatly decreased the need for perioperative transfusion , stabilizing at an odds ratio of 0.25 ( p , 10 2 6 ) by the 12th study , published in June of 1992 . The upper limit of the confidence interval never exceeded 0.65 and results were similar in all subgroups . Citation of previous RCTs was extremely low , with a median of 20 % of prior trials cited . Only 7 of 44 ( 15 % ) of subsequent reports referenced the largest trial ( N 1/4 1784 ) , which was 28 times larger than the median trial size . Conclusions This study demonstrates that investigators evaluating aprotinin were not adequately citing previous research , result ing in a large number of RCTs being conducted to address efficacy questions that prior trials had already definitively answered . Institutional review boards and journals could reduce the number of redundant trials by requiring investigators to conduct adequate search es for prior evidence and conducting systematic review Campbell , M. ( 1949 ) . Quart . 7 . Med . , 18 , 379 . ( 1955 ) . Brit . Heart Y. , 17 , 511 . ( 1959 ) . Ibid . , 21 , 65 . ( 1961a ) . Brit . med 7 . , 1 , 691 . ( 1961b ) . Acta Genet . med . ( Roma ) , 10 , 443 . ( 1962 ) . Brit . Heart 7 . , 24 , 625 . ( 1963 ) . Ibid . , 25 , 803 . ( 1966 ) . In A Textbook of Paediatric Cardiology , edited by Hamish Watson . Lloyd-Luke , London . In preparation . and Baylis , J. H. ( 1956 ) . Brit . Heart 7 . , 18 , 475 . and Goodwin , J. F. ( 1965 ) . Progr . cardiovasc . Dis . , 7 , 417 . and Polani , P. E. ( 1961a ) . Lancet , 1 , 463 . ( 1961b ) . Brit . Heart 7 . , 23 , 477 . Carlgren , L.-E. ( 1959 ) . Ibid . , 21 , 40 . Carter , C. 0 . ( 1961 ) . In Conference on Clinical Aspects of Genetics ( 1961 ) , p. 30 . Cockayne , E. A. ( 1938 ) . Quart . 7 . Med . , 7 , 479 . Conference on Clinical Aspects of Genetics held at the Royal College of Phybicians of London ( 1961 ) . Pitman Medical Publishing Co. , Ltd. , London . Edited by F. A. Jones . Conte , W. R. , McCammon , C. S. , and Christie , A. ( 1945 ) . Amer . 7 . Dis . Child . , 70 , 301 . Cox , Diane W. ( 1964 ) . Amer . 7 . hum . Genet . , 16 , 214 . Edwards , J. H. ( 1958 ) . Brit . 7 . prev . soc . Med . , 12 , 115 . Evans , W. ( 1949 ) . Brit Heart 7 . , 11 , 68 . First International Conference on Congenital Malformations , London , 18 - 22 July 1960 . Lippincott , Philadelphia and Montreal , 1961 , and Pitman , London , 1962 . Ford , E. B. , and Huxley , J. S. 1927 . Brit . 7 . exp . Biol . , 5 , 112 . Foxon , G. E. H. ( 1959 ) BIrt . Heart 7 . , 21 , 51 . Fraser , F. C. ( 1959 ) . 7 . chron . Dis . , 10 , 97 . Fuhrmann , W. ( 1958 ) . Z. menshl . Vererb.-u Konstit.-Lehre , 34 , 563 . ( 1961 ) . Acta genet . ( Basel ) , 11 , 289 . ( 1962 ) . Ergebn . inn . Med . Kinderhel ~ k . , 18 , 47 . Gibson , S. , and Lewis , K. C. ( 1952 ) . Amer . 7 . Dis . Child . , 83 , 317 . Harris , L. E. , and Steinberg , A. G. ( 1954 ) . Pediatrics , 14 , 314 . Ingalls , T. H. , Avis . F. R. , Curley , F. J. , and Temin , H. M. ( 1953 ) . 7 . Hered . , 44 , 185 . Kalter , H. ( 1954a ) . Genetics , 39 , 185 . ( 1954b ) . Ibid . , 39 , 975 . and Warkany , J. ( 1957 ) . 7 . exp . Zool . , 136 , 531 . Keith , J. D. , Rowe , R. D. , and Vlad , P. ( 1958 ) . Heart Disease in Infancy and Childhood . MacMillan , New York . Lamy , M. , de Grouchy , J. , and Schweisguth , 0 . ( 1957 ) . Amer . 7 . hum . Genet . , 9 , 17 . L and auer , W. ( 
    Output:
    