***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: Objective : To determine whether listening to music during  transrectal ultrasound (TRUS)-guided 12-core needle prostate biopsy decreases anxiety , pain and dissatisfaction among patients and results in a more comfortable and better tolerated procedure . Patients and Methods : 76 male patients who underwent TRUS-guided prostate biopsy between March 2013 and June 2014 were r and omized into the following groups : no music ( group I , n = 38 ) or classical music ( group II , n = 38 ) during the procedure . Before TRUS-guided prostate biopsy , lidocaine gel was instilled into the rectum . Patient anxiety levels were quantified using the State-Trait Anxiety Inventory . A visual analog scale ( 0 - 10 ) was used for self- assessment of satisfaction , discomfort and willingness among patients to have a repeat TRUS-guided prostate biopsy . Results : Demographic characteristics , mean age , procedure duration and procedure indications did not differ statistically between the two groups . The mean anxiety level and mean pain score of group II were significantly lower than those of group I ( p = 0.001 and p = 0.003 , respectively ) . Group II also had a significantly higher mean satisfaction score than group I ( p = 0.007 ) . Before the procedure , heart rate and systolic blood pressure were similar in groups I and II ; however , after the procedure , levels were lower in group II than in group I ( heart rate , p = 0.014 ; systolic blood pressure , p = 0.011 ) . Conclusion : Listening to music during TRUS-guided prostate biopsy significantly reduced patients ' feelings of pain , discomfort and dissatisfaction . Music can serve as a simple , inexpensive and effective adjunct to sedation during TRUS-guided prostate biopsy . We recommend playing music during TRUS-guided prostate biopsy OBJECTIVE To examine the impact of r and om assignment to music versus usual care on anxiety , perceived pain level and patient satisfaction in patients undergoing bone marrow biopsies . METHOD Patients were r and omized to music or usual care after completing a baseline question naire . All patients completed a post-procedure question naire . RESULTS Study participants ( N=59 ) had a mean age of 50.9 years ( SD = 13.9 ; range 22 - 78 ) . Post-procedure state anxiety ( STAI ) and pain rating ( VAS ) were not significantly different between groups ( STAI p=0.766 ; VAS p=0.771 ) . However , patient satisfaction with music was high ; 66 % of these patients said they very much preferred to listen to music at a future biopsy . CONCLUSIONS While there were no significant group differences for the music intervention compared to st and ard of care for anxiety or perceived pain , additional feedback indicated that patients found the music intervention beneficial and requested use of music during future procedures OBJECTIVE To assess the effect of noise-cancelling headphones with or without music on patient pain and anxiety associated with routine , office-based transrectal ultrasound (TRUS)-guided prostate biopsy in a prospect i ve r and omized study . METHODS Patients scheduled for prostate biopsy as a result of elevated prostate-specific antigen and /or abnormal digital rectal examination were prospect ively enrolled and r and omized into a control , noise-cancelling headphones , or music-headphones group . Patients completed pain and anxiety question naires and had their physiological parameters assessed before and after the procedure and compared across groups . RESULTS Eighty-eight patients were enrolled .  Pain scores increased from baseline across all study groups , with the lowest mean score in the music group . No appreciable change was noted in anxiety scores after the procedure between groups ( P>.05 ) . Although postbiopsy systolic blood pressure values remained comparable with baseline levels in all groups , postbiopsy diastolic blood pressure increased in the control and headphones groups ( P=.062 and .088 , respectively ) but remained stable in the music group ( P=.552 ) after biopsy , indicating lesser physiological response to anxiety and pain in this group . CONCLUSION Music-induced attention shift during prostate biopsy may have a beneficial impact on procedural anxiety and pain perception , but no apparent effect was noted for use of headphones alone . Further studies are necessary to explore strategies to reduce perceived anxiety and pain in men undergoing prostate biopsy BACKGROUND Listening to music as a means of inducing a sense of calm and relaxation has been known for some time . Although these effects are robust , little research has been conducted into exploring the underlying neurochemical changes , which must occur to provide an individual with these objective sensations . MATERIAL / METHODS In the current report we utilize an AB design to explore observed differences in blood plasma signaling molecules in pre- and post music listening groups when compared with controls . We focus chiefly on cytokines , as well as peripheral blood mononuclear cells and polymorphonuclear cells . We utilized reverse transcription followed by real-time polymerase chain reactions to determine relative mRNA expression for the mu opiate receptor gene . Using high pressure liquid chromatography coupled to electrochemical detection as well as nano electrospray ionization double quadrupole orthogonal acceleration time of flight-mass spectrometry we determined opiate alkaloid levels . RESULTS Our findings are two-fold : with regard to mu opiate receptor expression , mononuclear cells showed a statistically significant increase in subjects in the music group compared to the control . Plasma morphine levels were found to be non-significantly lower in subjects after listening to music when compared to control subjects whereas morphine 6 glucuronide levels increased slightly , suggesting morphine 's conversion to morphine 6 glucuronide . IL- 6 levels were significantly lower as well whereas IL-1b , IL-10 and cortisol values were unchanged . CONCLUSIONS Taken together , it appears that music-listeners exhibit plasma signal molecule changes consistent with the physiological changes associated with the reported actions of music , i.e , lower blood pressure BACKGROUND Childbirth is an important experience in a woman 's life , and unfavorable birth experiences have been shown to negatively impact postpartum maternal health . Aim of this study was to evaluate the effects of music therapy on postpartum pain , anxiety level , satisfaction and early pospartum depression rate . METHODS Totally 161 primiparous women were recruited and r and omized either music group ( n=80 ) or a control group ( n=81 ) . Women in the music group listened to self-selected music during labor .  Postpartum pain intensity , anxiety level and satisfaction rate were measured using the visual analog scale ( VAS ) , postpartum depression rate was assessed with Edinburg Postpartum Depression Scale ( EPDS ) at postpartum day one and day eight . RESULTS Mothers in the music therapy group had a lower level of postpartum pain and anxiety than the control group and it was statistically significant at all time intervals ( 1 , 4 , 8 , 16 and 24h , p<0.001 ) . A significant difference was observed between the two groups in terms of satisfaction rate ( p<0.001 ) and postpartum depression rate at postpartum day one and day eight ( p<0.05 ) . LIMITATIONS We only measured the effect of music therapy on early postpartum depression rate . Effect of music on late postpartum depression rate should be investigated in future . CONCLUSIONS Using music therapy during labor decreased postpartum anxiety and pain , increased the satisfaction with childbirth and reduced early postpartum depression rate .  Music therapy can be clinical ly recommended as an alternative , safe , easy and enjoyable nonpharmacological method for postpartum well-being Abstract The authors evaluated the efficacies of audio-recorded hypnosis with background music and music without hypnosis in the reduction of emotional and physical disturbances in patients scheduled for breast biopsy in comparison with a control group . A total of 75 patients were r and omly assigned to 3 different groups and evaluated at baseline and before and after breast biopsy using visual analog scales of stress , pain , depression , anxiety , fatigue , optimism , and general well-being . The results showed that , before breast biopsy , the music group presented less stress and anxiety , whereas the hypnosis with music group presented reduced stress , anxiety , and depression and increased optimism and general well-being . After the biopsy , the music group presented less anxiety and pain , whereas the hypnosis group showed less anxiety and increased optimism BACKGROUND / AIMS Patients who undergo endoscopic biopsy suffer anxiety until results are confirmed . This study assesses the effects of written educational material on the anxiety level of patients following endoscopic biopsy . METHODS This study was a r and omized controlled study trial with 83 patients divided into the following three groups : a biopsy group given written educational material prepared by our institution following the biopsy ( intervention group , n=28 ) , a biopsy group without written material ( biopsy only group , n=25 ) , and a control group without biopsy ( control group , n=30 ) . The anxiety level of each patient was evaluated three times using Spielberger 's State-Trait Anxiety Inventory ( STAI ) : for baseline at the first visit to our institution , at the day of endoscopy , one day later , and one week after the procedure . We compared baseline characteristics , STAI scores at each visit , and differences in STAI scores among the three groups . RESULTS No difference was found in STAI score among groups at baseline and before and after the endoscopic procedure . However , the STAI-state score of the intervention group was slightly lower than biopsy only group one day post-procedure ( 40.3 ± 7.7 vs. 43.9 ± 7.1 , p=0.135 ) . The STAI-state score significantly decreased from pre- to post-procedure only in the intervention group ( -2.75 ± 6.1 vs. 0.92 ± 4.0 , p<0.027 ) . CONCLUSIONS Use of written educational material for patients having biopsy might lessen their anxiety level BACKGROUND Bone marrow aspiration and /or biopsy ( BMAB ) is often an unpleasant and painful procedure in spite of local anaesthetic infiltration . This r and omized placebo-controlled trial compared the pain relieving effect of sublingual fentanyl and placebo during BMAB . METHODS One hundred sixty patients were r and omized to receive either sublingual fentanyl 200 μg , 100 μg ( patients ≥ 70 years old , weight ≤ 50 kg or in poor health )  or placebo before BMAB . The grade of anxiety before the procedure and the grade of pain during local anaesthetic infiltration , aspiration , biopsy and immediately after the BMAB were assessed using the Numeral Rating Scale ( 0 - 10 ) . Possible side effects of the study drugs were recorded . RESULTS Sublingual fentanyl proved inadequate in relieving pain during BMAB as no significant differences in the pain scores of the fentanyl and placebo patients were observed . However , fentanyl caused significantly more dizziness than placebo . CONCLUSIONS The results suggest that sublingual fentanyl in a dose of 200 μg ( 100 μg in infirm patients ) is not a feasible preventive analgesic during BMAB . Pain scores were similar and side effects more frequent in the fentanyl group than in the placebo group A bone marrow biopsy is considered to be painful , often causing anxiety . We observed large differences between patients and wondered which factors cause pain and anxiety . In a prospect i ve study , 202 patients were analyzed . Experienced hematologists and fellows in training ( 17 % of biopsies ) performed bone marrow aspirates and biopsies from the posterior iliac crest . Demographics , disease category , performance score , source of information , number of previous biopsies , experience of the hematologist , and length and quality of the biopsy were recorded . Pain and anxiety were measured using a visual analog scale and verbal rating score . Data were subjected to univariate and multivariate regression . The median pain score was 1.9 ( range 0 - 10 ) ; 21 % did not experience any pain . Anxiety scored 1.8 ( range 0 - 10 ) , and correlated positively with pain ( p = .000 ) . By univariate analysis , young age , poor performance , the physician as source of information , and prolonged procedures were associated with more pain . In multivariate analysis , anxiety , information from the physician , and a prolonged procedure persisted . Length or artifacts of the core biopsy did not correlate with pain . In conclusion , bone marrow biopsies performed in an optimal setting by experienced hematologists cause only mild pain , with , however , some patients experienced serious problems . To reduce pain , not only careful local anesthesia , but also the addition of systemic analgesics and especially anxiety reduction seems to be useful This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence AIM This paper reports a study to test the hypothesis that day surgery patients who listen to music during their preoperative wait will have statistically significantly lower levels of anxiety than patients 
    Output:
    
Clinical study results indicated that music can influence the anxiety and pain caused by invasive procedures .
Music had a tendency towards decreasing systolic blood pressure before the biopsy , State-Trait Anxiety Inventory scores after the biopsy , diastolic blood pressure after the biopsy and heart rate after the biopsy .
Similarly , music also tended to be more effective for controlling pain after the biopsy .
Music can be used for patients before and during the biopsy procedure .
This approach may be performed by nurses to promote the recovery of patients after the biopsy