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 Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results Purpose This study aim ed to evaluate the long-term survival of all patients who participated in a pilot r and omised trial of an early nutritional intervention for adults with upper gastrointestinal cancer . It also sought to identify factors that predicted patient mortality . Methods All participants ( n = 21 ) who were r and omised into the original study were followed for a maximum of 5 years and 2 months ( final follow-up April 2016 ) . The primary outcome measure was time from date of recruitment until date of death , ascertained by the Victorian Cancer Registry and /or Monash Health Scanned Medical Records . Secondary analyses were conducted to identify factors that adversely affected survival . Results At the end of the follow-up period , three patients were alive in the nutrition intervention group whilst only two patients were living from the st and ard care group . Visual evaluation of the Kaplan-Meier survival curves demonstrated a possible survival benefit from being exposed to the intervention between 6 months and 1.4 years post-recruitment , though this benefit dissipated soon after . The intervention was not associated with increased survival in univariate analyses , but was after adjustment for other factors found to adversely impact on survival ( adjusted hazard ratio 0.12 ( 95 % CI 0.02–0.72 ) p = 0.02 ) . These factors were being a smoker ( 14.2 ( 1.43 to 140.67 ) , p = 0.02 ) ; low baseline physical functioning ( 1.11 ( 1.01 to 1.21 ) , p = 0.03 ) ; high baseline fatigue ( 1.09 ( 1.02–1.16 ) , p = 0.007 ) ; and high baseline dyspnoea ( 1.08 ( 1.02–1.13 ) , p = 0.003 ) . Conclusion Early and intensive nutrition intervention may increase the survival of people with upper gastrointestinal cancer We studied the effects of enteral nutrition ( EN ) support initiated 1 week before surgery on postoperative nutritional status , immune function , and inflammatory response in gastric cancer patients . A total of 200 gastric cancer patients were r and omly divided into two groups : EN starting 1 week before surgery ( study group ) and EN starting early after surgery ( control group ) . The two groups received EN support , following different therapeutic schedules , until the 9th day after operation . In the patients , body weight , skinfold thickness , upper-arm circumference , white blood cell count , albumin , prealbumin , C-reactive protein , peripheral immunoglobulins ( IgA , IgG , and IgM ) , T lymphocyte subsets , interleukin-6 , and tumor necrosis factor-α were measured 10 days before and after surgery and on the first day after surgery . There was no statistically significant difference in the results of recovery time of passage of gas by anus , abdominal distension , stomachache , blood glucose , hepatic and renal functions , and electrolytes between the two groups of patients ( P > 0 . 05 ) . Adverse reactions occurred to both groups at 1 and 2 days after operation . Such conditions was improved after the intravenous drip rate was adjusted . The albumin and prealbumin levels of the patients in both groups decreased at 1 day after operation ( P < 0 . 05 ) . The levels rose when the research was finished ( P < 0 . 05 ) . The prealbumin level of the study group was higher than that of the control group at 10 days after operation ( P < 0 . 05 ) . The IgG level of the study group was higher than that of the control group at 10 days after operation ( P < 0 . 05 ) . The two groups of inflammatory reaction indicators of the study group were lower than those of the control group at 10 days after operation ( P < 0 . 05 ) . This study indicates that appropriate preoperative EN support for gastric cancer patients can improve their postoperative nutritional status and immune function , can reduce inflammatory response , and is more conducive to the recovery of patients Purpose This study aim ed to test whether a very early nutrition intervention delivered over the telephone was feasible and could improve outcomes amongst patients with upper gastrointestinal cancer . Methods Participants with a histologically proven new diagnosis of primary oesophageal or stomach cancer and who were to undergo surgery and /or chemotherapy were r and omised to receive either st and ard nutrition care ( SC ) or early and intensive nutrition intervention ( NI ) over the telephone/face-to-face . Participants were followed for 6 months . The primary outcome was quality of life ( QoL ) , assessed using the European Organization for Research and Treatment of Cancer Global Quality of Life question naire C30 ( EORTC QLQ-C30 ) and the European Quality of Life Instrument ( EQ-5D ) tool ; secondary outcomes were nutritional status and survival . Results Twenty-one participants were recruited ( 11 SC and 10 NI ) . At baseline , the prevalence of malnutrition was 90 % . Compared with SC , the NI group had a significantly higher EORTC global QoL score at the first mid- study follow-up ( coefficient ( 95 % CI ) 21.0 ( 12.1 , 29.9 ) adjusted for baseline , p < 0.001 ) and at 26 weeks ( 28.4 ( 21.3 , 35.4 ) adjusted for baseline , p < 0.001 ) . Nutritional risk score was lower ( p < 0.001 ) , and loss of body weight attenuated ( p < 0.001 ) in the NI group compared with SC . Six deaths occurred during the study , five in the SC group and one in the NI group ( p = 0.06 ) . The mean time spent with a dietitian per contact was significantly less for the NI group compared with SC ( 16(3 ) vs 40(6 ) min per dietetic contact , p < 0.001 ) . Conclusions This pilot study has shown the potential of a novel telephone-based early and intensive dietetic model of care for newly diagnosed upper gastrointestinal cancer patients OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Abstract Background Neoadjuvant chemotherapy is an accepted st and ard for locally advanced esophagogastric junction adenocarcinoma . However , the dysphagia frequently associated with this condition may interfere with patient tolerance of this treatment . In many centers , invasive tube feeding , placed either endoscopically , radiographically , or surgically , is used to address this issue , but it can cause significant morbidity . We sought to determine if an approach of goal -directed dietary counseling and appropriately timed neoadjuvant chemotherapy could obviate the need for invasive tube feeding . Methods Patients with locally advanced ( cT3 or N+ ) esophageal and esophagogastric junction adenocarcinoma undergoing neoadjuvant TCF [ Taxotere , cisplatin 5-fluorouracil ( 5-FU ) ] , ECF ( epirubicin , cisplatin , 5-FU ) , or FLOT ( docetaxel , oxaliplatin , leucovorin , and 5-FU ) at the McGill University Health Center from March 2007 to September 2012 were identified from a prospect i ve data base . All received individualized goal -directed dietary counseling , were monitored for signs/symptoms of malnutrition with serial ( baseline/presurgery ) body mass index , albumin , and completed serial symptom scores ( dysphagia ) , and quality -of-life question naires ( Functional Assessment in Cancer Therapy with the esophageal subset , FACT-E ) . We assessed the response of dysphagia and nutritional status to neoadjuvant chemotherapy and the need for invasive tube feeding . Results Of 130 patients undergoing neoadjuvant chemotherapy  , 78 had severe dysphagia ( defined as dysphagia score ≥2 on a 5-point Likert scale ) , most of whom received TCF ( 91 % ) . Overall dysphagia scores improved in 75 ( 96 % ) of 78 patients from a dysphagia score of 3 - 0 , most of which improved after the first cycle of therapy . This was associated with an increase in quality of life ( FACT-E scores 117 ± 23 to 140 ± 20 ) . With maintenance of weight ( 70 ± 22 to 69 ± 24 kg ) , body mass index ( 24.5 ± 8 to 23.9 ± 7 kg/m2 ) , and serum albumin ( 40 ± 5 to 37 ± 4 g/L ) . Only one patient required a stent , and none required jejunostomy or gastrostomy . Conclusions Appropriately timed neoadjuvant chemotherapy with a highly effective regimen rapidly restores normal swallowing , maintains nutritional status , and obviates the need for invasive tube feeding in patients with significant dysphagia from esophageal adenocarcinoma BACKGROUND & AIMS Malnourished surgical patients are supposed to benefit from perioperative nutrition . It is unclear , however , whether enteral intervention really surpasses the parenteral one , and whether the modification of st and ard formula matters . The aim of the study was to evaluate the clinical value of the route and type of perioperative nutritional support . METHODS A group of 167 malnourished patients ( 91 M , 76 F , mean age 61.4 years ) operated between June 2001 
    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 Supporting 21st century health care and the practice of evidence -based medicine ( EBM ) requires ubiquitous access to clinical information and to knowledge-based re sources to answer clinical questions . Many questions go unanswered , however , due to lack of skills in formulating questions , crafting effective search strategies , and accessing data bases to identify best levels of evidence . Methods This r and omized trial was design ed as a pilot study to measure the relevancy of search results using three different interfaces for the PubMed search system . Two of the search interfaces utilized a specific framework called PICO , which was design ed to focus clinical questions and to prompt for publication type or type of question asked . The third interface was the st and ard PubMed interface readily available on the Web . Study subjects were recruited from interns and residents on an inpatient general medicine rotation at an academic medical center in the US . Thirty-one subjects were r and omized to one of the three interfaces , given 3 clinical questions , and asked to search PubMed for a set of relevant articles that would provide an answer for each question . The success of the search results was determined by a precision score , which compared the number of relevant or gold st and ard articles retrieved in a result set to the total number of articles retrieved in that set . Results Participants using the PICO templates ( Protocol A or Protocol B ) had higher precision scores for each question than the participants who used Protocol C , the st and ard PubMed Web interface . ( Question 1 : A = 35 % , B = 28 % , C = 20 % ; Question 2 : A = 5 % , B = 6 % , C = 4 % ; Question 3 : A = 1 % , B = 0 % , C = 0 % ) 95 % confidence intervals were calculated for the precision for each question using a lower boundary of zero . However , the 95 % confidence limits were overlapping , suggesting no statistical difference between the groups . Conclusion Due to the small number of search es for each arm , this pilot study could not demonstrate a statistically significant difference between the search protocol s. However there was a trend towards higher precision that needs to be investigated in a larger study to determine if PICO can improve the relevancy of search results Purpose This study aim ed to evaluate the long-term survival of all patients who participated in a pilot r and omised trial of an early nutritional intervention for adults with upper gastrointestinal cancer . It also sought to identify factors that predicted patient mortality . Methods All participants ( n = 21 ) who were r and omised into the original study were followed for a maximum of 5 years and 2 months ( final follow-up April 2016 ) . The primary outcome measure was time from date of recruitment until date of death , ascertained by the Victorian Cancer Registry and /or Monash Health Scanned Medical Records . Secondary analyses were conducted to identify factors that adversely affected survival . Results At the end of the follow-up period , three patients were alive in the nutrition intervention group whilst only two patients were living from the st and ard care group . Visual evaluation of the Kaplan-Meier survival curves demonstrated a possible survival benefit from being exposed to the intervention between 6 months and 1.4 years post-recruitment , though this benefit dissipated soon after . The intervention was not associated with increased survival in univariate analyses , but was after adjustment for other factors found to adversely impact on survival ( adjusted hazard ratio 0.12 ( 95 % CI 0.02–0.72 ) p = 0.02 ) . These factors were being a smoker ( 14.2 ( 1.43 to 140.67 ) , p = 0.02 ) ; low baseline physical functioning ( 1.11 ( 1.01 to 1.21 ) , p = 0.03 ) ; high baseline fatigue ( 1.09 ( 1.02–1.16 ) , p = 0.007 ) ; and high baseline dyspnoea ( 1.08 ( 1.02–1.13 ) , p = 0.003 ) . Conclusion Early and intensive nutrition intervention may increase the survival of people with upper gastrointestinal cancer We studied the effects of enteral nutrition ( EN ) support initiated 1 week before surgery on postoperative nutritional status , immune function , and inflammatory response in gastric cancer patients . A total of 200 gastric cancer patients were r and omly divided into two groups : EN starting 1 week before surgery ( study group ) and EN starting early after surgery ( control group ) . The two groups received EN support , following different therapeutic schedules , until the 9th day after operation . In the patients , body weight , skinfold thickness , upper-arm circumference , white blood cell count , albumin , prealbumin , C-reactive protein , peripheral immunoglobulins ( IgA , IgG , and IgM ) , T lymphocyte subsets , interleukin-6 , and tumor necrosis factor-α were measured 10 days before and after surgery and on the first day after surgery . There was no statistically significant difference in the results of recovery time of passage of gas by anus , abdominal distension , stomachache , blood glucose , hepatic and renal functions , and electrolytes between the two groups of patients ( P > 0 . 05 ) . Adverse reactions occurred to both groups at 1 and 2 days after operation . Such conditions was improved after the intravenous drip rate was adjusted . The albumin and prealbumin levels of the patients in both groups decreased at 1 day after operation ( P < 0 . 05 ) . The levels rose when the research was finished ( P < 0 . 05 ) . The prealbumin level of the study group was higher than that of the control group at 10 days after operation ( P < 0 . 05 ) . The IgG level of the study group was higher than that of the control group at 10 days after operation ( P < 0 . 05 ) . The two groups of inflammatory reaction indicators of the study group were lower than those of the control group at 10 days after operation ( P < 0 . 05 ) . This study indicates that appropriate preoperative EN support for gastric cancer patients can improve their postoperative nutritional status and immune function , can reduce inflammatory response , and is more conducive to the recovery of patients Purpose This study aim ed to test whether a very early nutrition intervention delivered over the telephone was feasible and could improve outcomes amongst patients with upper gastrointestinal cancer . Methods Participants with a histologically proven new diagnosis of primary oesophageal or stomach cancer and who were to undergo surgery and /or chemotherapy were r and omised to receive either st and ard nutrition care ( SC ) or early and intensive nutrition intervention ( NI ) over the telephone/face-to-face . Participants were followed for 6 months . The primary outcome was quality of life ( QoL ) , assessed using the European Organization for Research and Treatment of Cancer Global Quality of Life question naire C30 ( EORTC QLQ-C30 ) and the European Quality of Life Instrument ( EQ-5D ) tool ; secondary outcomes were nutritional status and survival . Results Twenty-one participants were recruited ( 11 SC and 10 NI ) . At baseline , the prevalence of malnutrition was 90 % . Compared with SC , the NI group had a significantly higher EORTC global QoL score at the first mid- study follow-up ( coefficient ( 95 % CI ) 21.0 ( 12.1 , 29.9 ) adjusted for baseline , p < 0.001 ) and at 26 weeks ( 28.4 ( 21.3 , 35.4 ) adjusted for baseline , p < 0.001 ) . Nutritional risk score was lower ( p < 0.001 ) , and loss of body weight attenuated ( p < 0.001 ) in the NI group compared with SC . Six deaths occurred during the study , five in the SC group and one in the NI group ( p = 0.06 ) . The mean time spent with a dietitian per contact was significantly less for the NI group compared with SC ( 16(3 ) vs 40(6 ) min per dietetic contact , p < 0.001 ) . Conclusions This pilot study has shown the potential of a novel telephone-based early and intensive dietetic model of care for newly diagnosed upper gastrointestinal cancer patients OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity Abstract Background Neoadjuvant chemotherapy is an accepted st and ard for locally advanced esophagogastric junction adenocarcinoma . However , the dysphagia frequently associated with this condition may interfere with patient tolerance of this treatment . In many centers , invasive tube feeding , placed either endoscopically , radiographically , or surgically , is used to address this issue , but it can cause significant morbidity . We sought to determine if an approach of goal -directed dietary counseling and appropriately timed neoadjuvant chemotherapy could obviate the need for invasive tube feeding . Methods Patients with locally advanced ( cT3 or N+ ) esophageal and esophagogastric junction adenocarcinoma undergoing neoadjuvant TCF [ Taxotere , cisplatin 5-fluorouracil ( 5-FU ) ] , ECF ( epirubicin , cisplatin , 5-FU ) , or FLOT ( docetaxel , oxaliplatin , leucovorin , and 5-FU ) at the McGill University Health Center from March 2007 to September 2012 were identified from a prospect i ve data base . All received individualized goal -directed dietary counseling , were monitored for signs/symptoms of malnutrition with serial ( baseline/presurgery ) body mass index , albumin , and completed serial symptom scores ( dysphagia ) , and quality -of-life question naires ( Functional Assessment in Cancer Therapy with the esophageal subset , FACT-E ) . We assessed the response of dysphagia and nutritional status to neoadjuvant chemotherapy and the need for invasive tube feeding . Results Of 130 patients undergoing neoadjuvant chemotherapy  , 78 had severe dysphagia ( defined as dysphagia score ≥2 on a 5-point Likert scale ) , most of whom received TCF ( 91 % ) . Overall dysphagia scores improved in 75 ( 96 % ) of 78 patients from a dysphagia score of 3 - 0 , most of which improved after the first cycle of therapy . This was associated with an increase in quality of life ( FACT-E scores 117 ± 23 to 140 ± 20 ) . With maintenance of weight ( 70 ± 22 to 69 ± 24 kg ) , body mass index ( 24.5 ± 8 to 23.9 ± 7 kg/m2 ) , and serum albumin ( 40 ± 5 to 37 ± 4 g/L ) . Only one patient required a stent , and none required jejunostomy or gastrostomy . Conclusions Appropriately timed neoadjuvant chemotherapy with a highly effective regimen rapidly restores normal swallowing , maintains nutritional status , and obviates the need for invasive tube feeding in patients with significant dysphagia from esophageal adenocarcinoma BACKGROUND & AIMS Malnourished surgical patients are supposed to benefit from perioperative nutrition . It is unclear , however , whether enteral intervention really surpasses the parenteral one , and whether the modification of st and ard formula matters . The aim of the study was to evaluate the clinical value of the route and type of perioperative nutritional support . METHODS A group of 167 malnourished patients ( 91 M , 76 F , mean age 61.4 years ) operated between June 2001 
    Output:
    