***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 . Voiding cystourethrography ( VCUG ) is a commonly performed radiologic procedure in children that can be both painful and frightening . Given the distress that some children experience during the VCUG and the need for children to be alert and cooperative during the procedure , finding a psychological intervention that helps children to manage anxiety , distress , and pain is clearly desirable . This study was design ed to examine whether relaxation and analgesia facilitated with hypnosis could reduce distress and procedure time for children who undergo this procedure . Methods . Forty-four children who were scheduled for an upcoming VCUG were r and omized  to receive hypnosis ( n = 21 ) or routine care ( n = 23 ) while undergoing the procedure . The sample consisted of 29 ( 66 % ) girls and 15 ( 34 % ) boys with a mean age of 7.6 years ( SD : 2.5 ; range : 4–15 years ) . Ethnic/racial background s were 72.7 % white , 18.2 % Asian , 4.5 % Latino , 2.3 % black , and 2.3 % Filipino . The mean number of previous VCUGs  was 2.95 ( SD : 2.51 ; mode : 2 ; range : 1–15 ) . Potential participants were identified through computerized hospital records of upcoming VCUGs . Parents were contacted by telephone and invited to participate if their child was eligible . To be eligible for the study , the child must have undergone at least 1 previous VCUG , been at least 4 years of age at that time , and experienced distress during that procedure , and both the child and the participating parent had to be English speaking . Each eligible child and parent met with the research assistant ( RA ) before the day of the scheduled procedure for an initial assessment . Children were queried regarding the degree of crying , fear , and pain that they had experienced during their most recent VCUG . Parents completed a series of parallel questions . Immediately after this assessment , those who were r and omized to the hypnosis condition were given a 1-hour training session in self-hypnotic visual imagery by a trained therapist . Parents and children were instructed to practice using the imaginative self-hypnosis procedure several times a day in preparation for the upcoming procedure . The therapist was also present during the procedure to conduct similar exercises with the child . The majority ( 83 % ) of those who were r and omized to the routine care control group chose to participate in a hospital-provided recreation therapy program ( offered as part of routine care ) . The program includes demonstration of the procedure with dolls , relaxation and breath work training , and assistance during the procedure . On the day of the VCUG , the RA met the family at the clinic before the procedure , and both the child and the parent rated the child 's present level of fearfulness . During the procedure , the RA recorded observational ratings of the child 's emotional tone and behavior and timed the overall procedure and its phases . Immediately after the VCUG , the child was asked how much crying , fear , and pain he or she had experienced during the procedure ; the parent rated the child 's experience on the same dimensions and also how traumatic the procedure had been ( both generally and compared with their previous one ) , and the medical staff rated the degree of procedural difficulty . Outcomes included child reports of distress during the procedure , parent reports of how traumatic the present VCUG was compared with the previous one , observer ratings of distress during the procedure , medical staff reports of the difficulty of the procedure overall , and total procedural time . Results . Results indicate significant benefits for the hypnosis group compared with the routine care group in the following 4 areas : ( 1 ) parents of children in the hypnosis group compared with those in the routine care group reported that the procedure was significantly less traumatic for their children compared with their previous VCUG procedure ; ( 2 ) observational ratings of typical distress levels during the procedure were significantly lower for children in the hypnosis condition compared with those in the routine care condition ; ( 3 ) medical staff reported a significant difference between groups in the overall difficulty of conducting the procedure , with less difficulty reported for the hypnosis group ; and ( 4 ) total procedural time was significantly shorter — by almost 14 minutes — for the hypnosis group compared with the routine care group . Moderate to large effect sizes were obtained on each of these 4 outcomes . Conclusions . Hypnotic relaxation may provide a systematic method for improving the overall medical care of children with urinary tract abnormalities and may be beneficial for children who undergo other invasive medical procedures . Because the VCUG is an essential part of the evaluation of urinary tract infections and vesicoureteral reflux in children , lower distress during the procedure may improve patient and family compliance with initial as well as follow-up evaluations . These findings augment the accumulating literature demonstrating the benefits of using hypnosis to reduce distress in the pediatric setting . The present findings are noteworthy in that this study was a controlled , r and omized trial conducted in a naturalistic medical setting . In this context , we achieved a convergence of subjective and objective outcomes with moderate to large effect sizes , including those that may have an impact on patient care and procedure cost , that were consistently supportive of the beneficial effects of hypnosis — a noninvasive intervention with minimal risk . The findings , therefore , have immediate implication s for pediatric care . Limitations of this study include the lack of participant and staff blindness to the child 's condition assignment , which could have introduced bias into reports . However , the objective procedural time differences between groups were consistent with the other , more subjective outcome findings . The sample was also small and primarily white in ethnic/racial makeup , which may have restricted our ability to detect some differences and may limit the generalizability of findings to more representative sample s. In addition , the sample comprised children who had already undergone at least 1 VCUG during which they had had difficulty . Consequently , additional research is needed to determine whether hypnosis would be helpful to those who are undergoing their first VCUG . Additional limitations , clinical observations , and directions for future research are also discussed Background Sedation with midazolam facilitates the performance of diagnostic procedures in children , including voiding cystourethrography ( VCUG ) . However , the influence of sedation on voiding and imaging results have not been adequately evaluated . Objective Midazolam and placebo were compared to assess discomfort during VCUG and to evaluate if sedation influenced the outcome of the examination . Material s and methods The study was prospect i ve , r and omised and double-blind , and included 95 children , 48 in the midazolam group ( median age 2.2 years ) and 47 in the placebo group ( median age 3.2 years ) . The evaluation included the child's/parent 's experience of the VCUG , as well as the examination results . Results The children/parents in the midazolam group experienced the VCUG as less distressing compared to those in the placebo group ( P<0.001 ) . Forty-six of 48 children se date d with midazolam could void during the imaging procedure compared to 38 of 47 children given placebo ( NS ) . There was no difference in frequency or grade of vesicoureteric reflux or bladder emptying between the groups . Conclusions When sedation is required to perform VCUG in children , midazolam can be used without negative effect on the outcome of the examination Micturating cystourethrogram ( MCUG ) is an imaging technique indicated in the diagnosis and follow-up of many diseases . We investigated the reliability and the efficacy of midazolam and chloral hydrate in sedation and anxiolysis during micturating cystourethrogram . Fifty-three children of similar ages ( 39 girls , 14 boys , mean age of 5.8±3.5 years ) were r and omized to midazolam ( n=17 ) , chloral hydrate ( n=18 ) and control groups ( n=18 ) . Oral midazolam 0.6 mg/kg or chloral hydrate 25 mg/kg or saline were administered to the study groups 15–30 min prior to the urinary catheterization . Brietkopf and Buttner , Frankl and Houpt scales and Spielberger ’s State Anxiety Inventory and parent ’s impressions were used to assess the level of sedation and anxiety . The Brietkopf and Buttner classification of emotional status and Houpt behavior rating scale demonstrated a significantly better emotional status and sedation in the midazolam group when compared to controls ( P=0.01 and P=0.018 , respectively ) . The catheterization was described as a more unpleasant and distressing event by the parents of the control and the chloral hydrate groups when compared to the parents of the midazolam group ( P<0.05 ) . Bladder capacity and frequency of detection of residual urine were not statistically different between the three study groups ( P>0.05 ) . Vital signs did not change significantly in any child . Sedation with midazolam does not have adverse effects on the results of micturating cystourethrogram , while it reduces the discomfort in children undergoing this radiological technique Background . Voiding cystourethrograms are distressing for children and parents .  Nonpharmacological methods reduce distress . Pharmacological interventions for VCUG focus on sedation as well as analgesia , anxiolysis , and amnesia . Sedation has cost , time , and safety issues . Which agents and route should we use ? Are we sure that sedation does not influence the ability to diagnose vesicoureteric reflux ? Methods . Literature search of Medline , EMBASE , and the Cochrane Data base . Review of comparative studies found . Results . Seven comparative studies including two r and omised controlled trials were review ed . Midazolam given orally ( 0.5 - 0.6 mg/kg ) or intranasally ( 0.2 mg/kg ) is effective with no apparent effect on voiding dynamics . Insufficient evidence to recommend other sedating agents was found . Deeper sedating agents may interfere with voiding dynamics . Conclusion . Midazolam reduces the VCUG distress , causes amnesia , and does not appear to interfere with voiding dynamics .  Midazolam combined with simple analgesia is an effective method to reduce distress to children undergoing VCUG OBJECTIVE To reduce young children 's distress and increase coping behavior among children undergoing a voiding cystourethrogram ( VCU ) . METHODS Three- to seven-year-old children were stratified based on prior VCU experience and r and omly assigned to an intervention ( n = 20 ) or a st and ard care  ( n = 20 ) condition . The intervention included provision of information , coping skills training , and parent coaching . We hypothesized that the intervention would reduce children 's distress as assessed by child report , parent and technician ratings , and behavioral observations . RESULTS Children in the intervention displayed fewer distress behaviors and greater coping behaviors and were rated as more cooperative than children receiving st and ard care .  Children 's fear and pain ratings did not differ significantly between groups . CONCLUSIONS A cognitive-behavioral treatment package effectively reduced children 's  distress , increased coping , and increased cooperation during voiding cystourethrogram procedures . This type of an intervention should be integrated into routine pediatric radiological procedures Background Voiding cystourethrogram ( VCUG ) is a common procedure at pediatric tertiary care centres that can be painful as it involves a urinary catheter . Currently there are no widely utilized protocol s for non-topical medications to decrease pain that children feel during catheterization . Objective To determine if intranasal ( IN ) fentanyl is effective at decreasing pain that children feel during catheterization of VCUG when compared with sterile water . Material s and methods We performed a double-blind r and omized controlled trial , using IN fentanyl ( 2 μg/kg ) compared to placebo ( sterile water , ) in children 4–8 years of age scheduled for elective VCUG in one urban pediatric tertiary center . Results Using the Face Pain Score-Revised , children receiving IN fentanyl scored 2.58 ( 1.93–3.25 95 % CI ) while those receiving sterile water scored 2.86 ( 2.20–3.51 95 % CI ) showing no statistically significant difference . There were no adverse events . Conclusions Although we were unable to show a statistically significant difference between our study and control groups , we believe that this may be due to technique ( positioning , delivery device ) and timing of administration of IN fentanyl as well as multi-factorial causes of distress during VCUG . Future studies investigating alternative delivery techniques of IN fentanyl for analgesia during VCUG may yield more promising results AIM The purpose of this study was to determine what difference using room temperature ( " cold " ) or body temperature ( " warm " ) contrast medium had on the outcome of MCUG examinations in infants under 1 year of age . MATERIAL S AND METHODS One hundred infants ( 50 males and 50 females ) referred for an MCUG were identified . Individuals with known bladder neuropathy were excluded . Each was r and omized to receive either warm or cold contrast medium . The screening time , volume of contrast instilled , number of attempts at voiding , patient distress , completeness of bladder emptying and incidence of reflux were measured and the results between the two groups compared . RESULTS No difference was found between the two groups with regards to screening time , volume of contrast instilled or number of attempts at voiding . There was a statistically significant ( p<0.05 , chi square ) difference in distress levels , with more children crying during instillation of cold contrast medium than warm . Bladder emptying was more often to completion when using cold contrast medium ( 32 compared with 16 % ) , and vesicoureteric reflux ( VUR ) was more commonly demonstrated when using warm contrast medium ( 16 compared with 6 % ) , although these values did not reach statistical significance . CONCLUSION Warm contrast medium causes significantly less distress than cold contrast medium , but does not prolong screening time or increase the volume of contrast required OBJECTIVE Midazolam is a relatively short-acting water-soluble benzodiazepine that provides anxiolysis and antero grade amnesia 
    Output:
    
Conscious sedation with midazolam effectively alleviates the distress of VCUG in children older than 1 year of age .
Psychological preparation and warmed contrast medium may also be effective .