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: tracheostomy is one of the most frequent procedures done in an intensive care unit ( icu ) . more than 100,000 tracheostomies are performed annually in the us ( healthcare cost and utilization project 2007 ) . the reason for tracheostomies may be diverse , but the patients tend to have a long length of stay . due to large differences between hospital resource consumption and reimbursement , the health care financing administration added new diagnosis - related groups in 1987 , with heavy weights given to tracheostomy patients . surprisingly , there is a paucity of studies addressing the multifaceted care of these difficult patients to minimize length of stay and complications once the patient leaves the icu . as reported in the previous issue of critical care , garrubba and colleagues culled the literature and found only three studies [ 2 - 4 ] assessing the impact of a multidisciplinary team ( mdt ) on outcome of tracheostomy patients on the ward . all studies compared results with historical controls , and despite the problems intrinsic in cohort studies , the consistent observation was decreased time to decannulation [ 2 - 4 ] , and two of the three studies revealed decreased length of stay . specific outcomes and complications pertinent to tracheostomy patients were notably absent in these studies , although the implication is improved patient care . one study reported improvement in nursing compliance of tracheostomy care plan after institution of mdt , and death and code blues were less common ( albeit not statistically significant ) in the other two studies . in regard to tracheostomy patients , there are multiple variables that may impact clinical outcome , complications , or length of stay or all three . some of these considerations are the following : 1 . early versus late timing of tracheostomy 2 . the surgical technique itself : percutaneous versus open surgery 3 . choice of size and type of tube : double versus single cannula and size of tube in relation to the patient to provide the best function with least airway injury 4 . the best practical method to assess swallowing and prevent aspiration 5 . provision of pulse oximetry monitoring for higher - risk patients in a stepdown unit 8 . preventive measures to avoid tube obstruction such as hydration , humidification of airway , and suctioning of secretions 9 . factors leading to inadvertent decannulation ( such as underlying mental status ) and the best way of securing tracheostomy tubes ( suturing versus tie ) 10 . psychosocial well - being of patients with earlier speech therapy and effective swallowing leading to better communication , less isolation , and improved nutritional support 11 . the background of the physician may not be as important as their interest in these patients and the participation of the respiratory therapist , speech pathologist , clinical nurse specialist , physiotherapist , and dietitian . tobin and santamaria reorganized the existing staff to provide coordinated care without additional costs . resource expenditure on more personnel during times of health care cost crisis may be offset by the decreased length of stay and avoidance of catastrophic events . this lesson may be learned from other specialties in which utilization of case managers for a specific group of patients ( such as trauma victims ) may lead to decreased hospital days and improved care and is currently the standard of practice in trauma centers . it is probable that many institutions already have a modification of the mdt or a stepdown unit prompted by some catastrophic event of tracheostomy patients or both . a philosophical question is whether we can ethically design a prospective randomized trial in which the control group does not receive the benefits of multi - disciplinary care . the concept of mdt may be a common sense issue in which patient benefits and decreased length of stay occur due to small increments of coordinated efforts without a large - scale prospective randomized trial to ' prove ' that mdt works . recent studies advocate earlier performance of tracheostomies to decrease icu length of stay , and the number of tracheostomies performed may increase in the future , making this topic even more important .
output:

agent
patients requiring tracheostomies tend to have a longer length of stay due to their underlying disease . after a thorough literature search , garrubba and colleagues found only three studies assessing the impact of multidisciplinary teams ( mdts ) on tracheostomy patients on the ward . one consistent observation was the decreased time to decannulation after institution of mdt care when compared with historical controls . although a large prospective randomized trial is desirable before mdt is recommended , many institutions may have already formed a team approach to provide coordinated care resulting in improved outcome and length of stay .
***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: tracheostomy is one of the most frequent procedures done in an intensive care unit ( icu ) . more than 100,000 tracheostomies are performed annually in the us ( healthcare cost and utilization project 2007 ) . the reason for tracheostomies may be diverse , but the patients tend to have a long length of stay . due to large differences between hospital resource consumption and reimbursement , the health care financing administration added new diagnosis - related groups in 1987 , with heavy weights given to tracheostomy patients . surprisingly , there is a paucity of studies addressing the multifaceted care of these difficult patients to minimize length of stay and complications once the patient leaves the icu . as reported in the previous issue of critical care , garrubba and colleagues culled the literature and found only three studies [ 2 - 4 ] assessing the impact of a multidisciplinary team ( mdt ) on outcome of tracheostomy patients on the ward . all studies compared results with historical controls , and despite the problems intrinsic in cohort studies , the consistent observation was decreased time to decannulation [ 2 - 4 ] , and two of the three studies revealed decreased length of stay . specific outcomes and complications pertinent to tracheostomy patients were notably absent in these studies , although the implication is improved patient care . one study reported improvement in nursing compliance of tracheostomy care plan after institution of mdt , and death and code blues were less common ( albeit not statistically significant ) in the other two studies . in regard to tracheostomy patients , there are multiple variables that may impact clinical outcome , complications , or length of stay or all three . some of these considerations are the following : 1 . early versus late timing of tracheostomy 2 . the surgical technique itself : percutaneous versus open surgery 3 . choice of size and type of tube : double versus single cannula and size of tube in relation to the patient to provide the best function with least airway injury 4 . the best practical method to assess swallowing and prevent aspiration 5 . provision of pulse oximetry monitoring for higher - risk patients in a stepdown unit 8 . preventive measures to avoid tube obstruction such as hydration , humidification of airway , and suctioning of secretions 9 . factors leading to inadvertent decannulation ( such as underlying mental status ) and the best way of securing tracheostomy tubes ( suturing versus tie ) 10 . psychosocial well - being of patients with earlier speech therapy and effective swallowing leading to better communication , less isolation , and improved nutritional support 11 . the background of the physician may not be as important as their interest in these patients and the participation of the respiratory therapist , speech pathologist , clinical nurse specialist , physiotherapist , and dietitian . tobin and santamaria reorganized the existing staff to provide coordinated care without additional costs . resource expenditure on more personnel during times of health care cost crisis may be offset by the decreased length of stay and avoidance of catastrophic events . this lesson may be learned from other specialties in which utilization of case managers for a specific group of patients ( such as trauma victims ) may lead to decreased hospital days and improved care and is currently the standard of practice in trauma centers . it is probable that many institutions already have a modification of the mdt or a stepdown unit prompted by some catastrophic event of tracheostomy patients or both . a philosophical question is whether we can ethically design a prospective randomized trial in which the control group does not receive the benefits of multi - disciplinary care . the concept of mdt may be a common sense issue in which patient benefits and decreased length of stay occur due to small increments of coordinated efforts without a large - scale prospective randomized trial to ' prove ' that mdt works . recent studies advocate earlier performance of tracheostomies to decrease icu length of stay , and the number of tracheostomies performed may increase in the future , making this topic even more important .
output:
