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: PURPOSE Decision making regarding cardiopulmonary resuscitation ( CPR ) is challenging . This study examined the effect of a video decision support tool on CPR preferences among patients with advanced cancer . PATIENTS AND METHODS We performed a r and omized controlled trial of 150 patients with advanced cancer from four oncology centers . Participants in the control arm ( n = 80 ) listened to a verbal narrative describing CPR and the likelihood of successful resuscitation . Participants in the intervention arm ( n = 70 ) listened to the identical narrative and viewed a 3-minute video depicting a patient on a ventilator and CPR being performed on a simulated patient . The primary outcome was participants ' preference for or against CPR  measured immediately after exposure to either modality . Secondary outcomes were participants ' knowledge of CPR ( score range of 0 to 4 , with higher score indicating more knowledge ) and comfort with video . RESULTS The mean age of participants was 62 years ( st and ard deviation , 11 years ) ; 49 % were women , 44 % were African American or Latino , and 47 % had lung or colon cancer . After the verbal narrative , in the control arm , 38 participants ( 48 % ) wanted CPR , 41 ( 51 % ) wanted no CPR , and one ( 1 % ) was uncertain . In contrast , in the intervention arm , 14 participants ( 20 % ) wanted CPR , 55 ( 79 % ) wanted no CPR , and 1 ( 1 % ) was uncertain ( unadjusted odds ratio , 3.5 ; 95 % CI , 1.7 to 7.2 ; P < .001 ) . Mean knowledge scores were higher in the intervention arm than in the control arm ( 3.3 ± 1.0 v 2.6 ± 1.3 , respectively ; P < .001 ) , and 65 participants ( 93 % ) in the intervention arm were comfortable watching the video . CONCLUSION Participants with advanced cancer who viewed a video of CPR were less likely to opt for CPR than those who listened to a verbal narrative BACKGROUND  Cardiopulmonary resuscitation ( CPR ) is an important advance directive ( AD ) topic in patients with progressive cancer ; however such discussion s are challenging . OBJECTIVE This study investigates whether video educational information about CPR engenders broader advance care planning ( ACP ) discourse . METHODS Patients with progressive pancreas or hepatobiliary cancer were r and omized to an educational CPR video or a similar CPR narrative . The primary end-point was the difference in ACP documentation one month posttest between arms . Secondary end-points included study impressions ; pre- and post-intervention knowledge of and preferences for CPR and mechanical ventilation ; and longitudinal patient outcomes . RESULTS Fifty-six subjects were consented and analyzed . Rates of ACP documentation ( either formal ADs or documented discussion s ) were 40 % in the video arm ( 12/30 ) compared to 15 % in the narrative arm ( 4/26 ) , OR=3.6 [ 95 % CI : 0.9 - 18.0 ] , p=0.07 . Post-intervention knowledge was higher in both arms . Posttest , preferences for CPR had changed in the video arm but not in the narrative arm . Preferences regarding mechanical ventilation did not change in either arm . The majority of subjects in both arms reported the information as helpful and comfortable to discuss , and they recommended it to others . More deaths occurred in the video arm compared to the narrative arm , and more subjects died in hospice setting s in the video arm . CONCLUSIONS This pilot r and omized trial addressing downstream ACP effects of video versus narrative decision tools demonstrated a trend towards more ACP documentation in video subjects . This trend , as well as other video effects , is the subject of ongoing study OBJECTIVE To determine the impact of a video on preferences for the primary goal of care . DESIGN , SUBJECTS , AND INTERVENTION Consecutive subjects 65 years of age or older ( n=101 ) admitted to two skilled nursing facilities ( SNFs ) were r and omized to a verbal narrative ( control ) or a video ( intervention ) describing goals -of-care options . Options included : life-prolonging ( i.e. , cardiopulmonary resuscitation ) , limited ( i.e. , hospitalization but no cardiopulmonary resuscitation ) , or comfort care ( i.e. , symptom relief ) . MAIN MEASURES Primary outcome was patients ' preferences for comfort versus other options . Concordance of preferences with documentation in the medical record was also examined . RESULTS Fifty-one subjects were r and omized to the verbal arm and 50 to the video arm . In the verbal arm , preferences were : comfort , n=29 ( 57 % ) ; limited , n=4 ( 8 % ) ; life-prolonging , n=17 ( 33 % ) ; and uncertain , n=1 ( 2 % ) . In the video arm , preferences were : comfort , n=40 ( 80 % ) ; limited , n=4 ( 8 % ) ; and life-prolonging , n=6 ( 12 % ) . R and omization to the video was associated with greater likelihood of opting for comfort ( unadjusted rate ratio , 1.4 ; 95 % confidence interval [ CI ] , 1.1 - 1.9 , p=0.02 ) . Among subjects in the verbal arm who chose comfort , 29 % had a do-not-resuscitate ( DNR ) order ( κ statistic 0.18 ; 95 % CI-0.02 to 0.37 ) ; 33 % of subjects in the video arm choosing comfort had a DNR order ( κ statistic 0.06 ; 95 % CI-0.09 to 0.22 ) . CONCLUSION Subjects admitted to SNFs who viewed a video were more likely than those exposed to a verbal narrative to opt for comfort . Concordance between a preference for comfort and a DNR order was low . These findings suggest a need to improve ascertainment of patients ' preferences . TRIAL REGISTRATION Clinical trials.gov Identifier : NCT01233973 Patient attitudes and knowledge regarding cancer pain and strong opioid analgesia can sometimes be a barrier to good pain control . Educational interventions that address these barriers are effective in oncology out patients but have not been evaluated in patients with more advanced disease . We assessed the feasibility of a r and omized , controlled clinical trial evaluating a brief DVD-based educational intervention for cancer pain in palliative care patients . Participants were shown DVD at baseline ( V1 ) and at 1 week ( V2 ) . Outcomes were assessed using Brief Pain Inventory ( BPI ) and Patient Pain Question naire ( PPQ ) before intervention , and at V2 and V3 ( 4 weeks later ) . Fifteen patients and 10 carers were recruited . Between V1 and V2 , total BPI and PPQ scores improved significantly by 9.6 % ( p = 0.02 ) and 17 % ( p = 0.04 ) respectively with no further improvements at V3 . Our findings suggest that this intervention is feasible and potentially effective between 7—30 days follow up . A multicentre clinical trial is now needed to evaluate this intervention further Background : Hospice providers need to ensure that informal , unpaid caregivers can safely manage medications to alleviate pain and distressing symptoms in patients near the end of life . Aim : This study characterizes hospice providers ’ self-reported experiences and approaches to helping caregivers ’ medication management for home hospice patients . Design : Survey with mixed- method analysis . Setting / Participants : Surveys were administered to a convenience sample of 98 hospice providers ( 74 nurses , 6 physicians , 11 social workers , 7 chaplains ) from 5 Chicago-based agencies in the United States . Results : Among respondents , 67 % rated ensuring proper medication management as “ most important ” in hospice care delivery , and 33 % reported frequently encountering caregivers with problems managing medications . To assess if caregivers had problems managing medications , two categories of approaches emerged from the data : prospect i ve approaches and retrospective warning signs when a problem occurred ( e.g. identifying medication nonadherence after observing a sudden patient health decline ) . Overall , 42 % reported using at least one prospect i ve approach , while 38 % reported only retrospective signs . To help caregivers manage medications , three categories of approaches emerged : teaching to increase knowledge , supporting existing or simplifying medication management process , and counseling to overcome attitudinal barriers . Overall , 6 % reported approaches from all three categories . About 28 % frequently experienced difficulty teaching/supporting caregivers with medication management . As much as 47 % believed that they would benefit “ to a great extent ” from additional re sources to help caregivers . Conclusions : Supporting caregivers in medication management is considered important , yet challenging , to hospice providers . Additional re sources may be needed to help providers consistently and effectively teach , support , and assess caregivers ’ medication management Objective Previous studies demonstrate that patients often have difficulty underst and ing their discharge instructions . Video discharge instructions have the potential to mitigate factors such as illiteracy and limited physician time , which may affect comprehension . Our goal is to determine if adding video discharge instructions affects caregivers ’ underst and ing of their child ’s emergency department ( ED ) visit , plan , and follow-up . Methods Caregivers of patients , aged 29 days to 18 years , with a diagnosis of fever , vomiting or diarrhea , and wheezing or asthma were r and omized into written or video discharge instruction groups . In the ED , caregivers read st and ard written discharge instructions or watched a 3-minute video based on their child ’s diagnosis . They were then asked questions regarding information covered in these instructions . After completing the 20-point question naire , st and ard discharge procedure was followed . Caregivers were contacted by phone 2 to 5 days after discharge for a follow-up question naire . Usefulness of the discharge instructions was also assessed . Results Of 436 caregivers enrolled , 220 received written and 216 received video discharge instructions .  The follow-up question naire was completed by 341 caregivers . The group receiving video discharge instructions  scored significantly higher in the ED ( 12.2 vs 8.9 ) and 2 to 5 days after discharge ( 11.1 vs 7.8 ) . At follow-up , 29 % of the written and 42 % of the video groups rated their discharge instructions as being extremely helpful . Conclusions Brief video discharge instructions improved caregiver knowledge both in the ED and 2 to 5 days after discharge compared with written discharge instructions alone . Caregiver satisfaction with video discharge instructions was also greater than with written discharge instructions 
    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: PURPOSE Decision making regarding cardiopulmonary resuscitation ( CPR ) is challenging . This study examined the effect of a video decision support tool on CPR preferences among patients with advanced cancer . PATIENTS AND METHODS We performed a r and omized controlled trial of 150 patients with advanced cancer from four oncology centers . Participants in the control arm ( n = 80 ) listened to a verbal narrative describing CPR and the likelihood of successful resuscitation . Participants in the intervention arm ( n = 70 ) listened to the identical narrative and viewed a 3-minute video depicting a patient on a ventilator and CPR being performed on a simulated patient . The primary outcome was participants ' preference for or against CPR  measured immediately after exposure to either modality . Secondary outcomes were participants ' knowledge of CPR ( score range of 0 to 4 , with higher score indicating more knowledge ) and comfort with video . RESULTS The mean age of participants was 62 years ( st and ard deviation , 11 years ) ; 49 % were women , 44 % were African American or Latino , and 47 % had lung or colon cancer . After the verbal narrative , in the control arm , 38 participants ( 48 % ) wanted CPR , 41 ( 51 % ) wanted no CPR , and one ( 1 % ) was uncertain . In contrast , in the intervention arm , 14 participants ( 20 % ) wanted CPR , 55 ( 79 % ) wanted no CPR , and 1 ( 1 % ) was uncertain ( unadjusted odds ratio , 3.5 ; 95 % CI , 1.7 to 7.2 ; P < .001 ) . Mean knowledge scores were higher in the intervention arm than in the control arm ( 3.3 ± 1.0 v 2.6 ± 1.3 , respectively ; P < .001 ) , and 65 participants ( 93 % ) in the intervention arm were comfortable watching the video . CONCLUSION Participants with advanced cancer who viewed a video of CPR were less likely to opt for CPR than those who listened to a verbal narrative BACKGROUND  Cardiopulmonary resuscitation ( CPR ) is an important advance directive ( AD ) topic in patients with progressive cancer ; however such discussion s are challenging . OBJECTIVE This study investigates whether video educational information about CPR engenders broader advance care planning ( ACP ) discourse . METHODS Patients with progressive pancreas or hepatobiliary cancer were r and omized to an educational CPR video or a similar CPR narrative . The primary end-point was the difference in ACP documentation one month posttest between arms . Secondary end-points included study impressions ; pre- and post-intervention knowledge of and preferences for CPR and mechanical ventilation ; and longitudinal patient outcomes . RESULTS Fifty-six subjects were consented and analyzed . Rates of ACP documentation ( either formal ADs or documented discussion s ) were 40 % in the video arm ( 12/30 ) compared to 15 % in the narrative arm ( 4/26 ) , OR=3.6 [ 95 % CI : 0.9 - 18.0 ] , p=0.07 . Post-intervention knowledge was higher in both arms . Posttest , preferences for CPR had changed in the video arm but not in the narrative arm . Preferences regarding mechanical ventilation did not change in either arm . The majority of subjects in both arms reported the information as helpful and comfortable to discuss , and they recommended it to others . More deaths occurred in the video arm compared to the narrative arm , and more subjects died in hospice setting s in the video arm . CONCLUSIONS This pilot r and omized trial addressing downstream ACP effects of video versus narrative decision tools demonstrated a trend towards more ACP documentation in video subjects . This trend , as well as other video effects , is the subject of ongoing study OBJECTIVE To determine the impact of a video on preferences for the primary goal of care . DESIGN , SUBJECTS , AND INTERVENTION Consecutive subjects 65 years of age or older ( n=101 ) admitted to two skilled nursing facilities ( SNFs ) were r and omized to a verbal narrative ( control ) or a video ( intervention ) describing goals -of-care options . Options included : life-prolonging ( i.e. , cardiopulmonary resuscitation ) , limited ( i.e. , hospitalization but no cardiopulmonary resuscitation ) , or comfort care ( i.e. , symptom relief ) . MAIN MEASURES Primary outcome was patients ' preferences for comfort versus other options . Concordance of preferences with documentation in the medical record was also examined . RESULTS Fifty-one subjects were r and omized to the verbal arm and 50 to the video arm . In the verbal arm , preferences were : comfort , n=29 ( 57 % ) ; limited , n=4 ( 8 % ) ; life-prolonging , n=17 ( 33 % ) ; and uncertain , n=1 ( 2 % ) . In the video arm , preferences were : comfort , n=40 ( 80 % ) ; limited , n=4 ( 8 % ) ; and life-prolonging , n=6 ( 12 % ) . R and omization to the video was associated with greater likelihood of opting for comfort ( unadjusted rate ratio , 1.4 ; 95 % confidence interval [ CI ] , 1.1 - 1.9 , p=0.02 ) . Among subjects in the verbal arm who chose comfort , 29 % had a do-not-resuscitate ( DNR ) order ( κ statistic 0.18 ; 95 % CI-0.02 to 0.37 ) ; 33 % of subjects in the video arm choosing comfort had a DNR order ( κ statistic 0.06 ; 95 % CI-0.09 to 0.22 ) . CONCLUSION Subjects admitted to SNFs who viewed a video were more likely than those exposed to a verbal narrative to opt for comfort . Concordance between a preference for comfort and a DNR order was low . These findings suggest a need to improve ascertainment of patients ' preferences . TRIAL REGISTRATION Clinical trials.gov Identifier : NCT01233973 Patient attitudes and knowledge regarding cancer pain and strong opioid analgesia can sometimes be a barrier to good pain control . Educational interventions that address these barriers are effective in oncology out patients but have not been evaluated in patients with more advanced disease . We assessed the feasibility of a r and omized , controlled clinical trial evaluating a brief DVD-based educational intervention for cancer pain in palliative care patients . Participants were shown DVD at baseline ( V1 ) and at 1 week ( V2 ) . Outcomes were assessed using Brief Pain Inventory ( BPI ) and Patient Pain Question naire ( PPQ ) before intervention , and at V2 and V3 ( 4 weeks later ) . Fifteen patients and 10 carers were recruited . Between V1 and V2 , total BPI and PPQ scores improved significantly by 9.6 % ( p = 0.02 ) and 17 % ( p = 0.04 ) respectively with no further improvements at V3 . Our findings suggest that this intervention is feasible and potentially effective between 7—30 days follow up . A multicentre clinical trial is now needed to evaluate this intervention further Background : Hospice providers need to ensure that informal , unpaid caregivers can safely manage medications to alleviate pain and distressing symptoms in patients near the end of life . Aim : This study characterizes hospice providers ’ self-reported experiences and approaches to helping caregivers ’ medication management for home hospice patients . Design : Survey with mixed- method analysis . Setting / Participants : Surveys were administered to a convenience sample of 98 hospice providers ( 74 nurses , 6 physicians , 11 social workers , 7 chaplains ) from 5 Chicago-based agencies in the United States . Results : Among respondents , 67 % rated ensuring proper medication management as “ most important ” in hospice care delivery , and 33 % reported frequently encountering caregivers with problems managing medications . To assess if caregivers had problems managing medications , two categories of approaches emerged from the data : prospect i ve approaches and retrospective warning signs when a problem occurred ( e.g. identifying medication nonadherence after observing a sudden patient health decline ) . Overall , 42 % reported using at least one prospect i ve approach , while 38 % reported only retrospective signs . To help caregivers manage medications , three categories of approaches emerged : teaching to increase knowledge , supporting existing or simplifying medication management process , and counseling to overcome attitudinal barriers . Overall , 6 % reported approaches from all three categories . About 28 % frequently experienced difficulty teaching/supporting caregivers with medication management . As much as 47 % believed that they would benefit “ to a great extent ” from additional re sources to help caregivers . Conclusions : Supporting caregivers in medication management is considered important , yet challenging , to hospice providers . Additional re sources may be needed to help providers consistently and effectively teach , support , and assess caregivers ’ medication management Objective Previous studies demonstrate that patients often have difficulty underst and ing their discharge instructions . Video discharge instructions have the potential to mitigate factors such as illiteracy and limited physician time , which may affect comprehension . Our goal is to determine if adding video discharge instructions affects caregivers ’ underst and ing of their child ’s emergency department ( ED ) visit , plan , and follow-up . Methods Caregivers of patients , aged 29 days to 18 years , with a diagnosis of fever , vomiting or diarrhea , and wheezing or asthma were r and omized into written or video discharge instruction groups . In the ED , caregivers read st and ard written discharge instructions or watched a 3-minute video based on their child ’s diagnosis . They were then asked questions regarding information covered in these instructions . After completing the 20-point question naire , st and ard discharge procedure was followed . Caregivers were contacted by phone 2 to 5 days after discharge for a follow-up question naire . Usefulness of the discharge instructions was also assessed . Results Of 436 caregivers enrolled , 220 received written and 216 received video discharge instructions .  The follow-up question naire was completed by 341 caregivers . The group receiving video discharge instructions  scored significantly higher in the ED ( 12.2 vs 8.9 ) and 2 to 5 days after discharge ( 11.1 vs 7.8 ) . At follow-up , 29 % of the written and 42 % of the video groups rated their discharge instructions as being extremely helpful . Conclusions Brief video discharge instructions improved caregiver knowledge both in the ED and 2 to 5 days after discharge compared with written discharge instructions alone . Caregiver satisfaction with video discharge instructions was also greater than with written discharge instructions 
    Output:
    