***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 Publication bias toward studies that favor new therapies has been known to occur for the past 40 years , yet its implication s are not well studied in child health . The increased interest in meta-analyses has highlighted the need to identify the totality of evidence when addressing treatment questions . OBJECTIVES To measure the percentage of r and omized controlled trials  ( RCTs ) presented at a major pediatric scientific meeting that were subsequently published as full-length articles , to investigate factors associated with publication , and to describe the variables that change from abstract to manuscript form . DESIGN The scientific proceedings from the Society for Pediatric Research were h and search ed for RCTs ( 1992 - 1995 ) . Subsequent publication was ascertained through a search of various electronic data bases . Quality of abstract s and manuscripts was measured , and data were extracted using a structured form . RESULTS A total of 264 ( 59.1 % ) of 447 abstract s were subsequently published . Almost 64 % of RCTs that were subsequently published favored new therapy compared with 43.5 % of studies that were never published ( P<.001 ) . Mean effect size for published vs unpublished RCTs was 0.74 vs 0.05 ( P<.001 ) . Median sample size was larger in published ( n = 45 ) vs unpublished ( n = 34 ) RCTs ( P = .02 ) . Quality was significantly lower for abstract s vs published RCTs ( P<.001 ) . For 5 % of abstract s that were subsequently published , the conclusion regarding treatment efficacy changed . CONCLUSIONS Publication bias is a serious threat to assessing the effectiveness of interventions in child health , as little more than half of RCTs presented at a major scientific meeting are subsequently published . There is a need to institute an international registry of RCTs in children so that the totality of evidence can be accessed when assessing treatment effectiveness Background Adolescent idiopathic scoliosis ( AIS ) remains the most common deforming orthopedic condition in children . Increasingly , both adults and children are seeking complementary and alternative therapy , including chiropractic treatment , for a wide variety of health concerns . The scientific evidence supporting the use chiropractic intervention is inadequate . The purpose of this study was to conduct a pilot study and explore issues of safety , patient recruitment and compliance , treatment st and ardization , sham treatment refinement , inter-professional cooperation , quality assurance , and outcome measure selection . Methods Six patients participated in this 6-month study , 5 of whom were female . One female was braced . The mean age of these patients was 14 years , and the mean Cobb angle was 22.2 degrees . The study design was a r and omized controlled clinical trial with two independent and blinded observers . Three patients were treated by st and ard medical care ( observation or brace treatment ) , two were treated with st and ard medical care plus chiropractic manipulation , and one was treated with st and ard medical care plus sham manipulation . The primary outcome measure was Cobb , and the psychosocial measure was Scoliosis Quality of Life Index . Results Orthopedic surgeons and chiropractors were easily recruited and worked cooperatively throughout the trial . Patient recruitment and compliance was good . Chiropractic treatments were safely employed , and research protocol s were successful . Conclusion Overall , our pilot study showed the viability for a larger r and omized trial . This pilot confirms the strength of existing protocol s with amendments for use in a full r and omized controlled trial . Trial registration This trial has been assigned an international st and ard r and omized controlled trial number by Current Controlled Trials , Ltd. http://www.controlled-trials.com/is rct n/. The number is IS RCT N41221647 OBJECTIVE To determine whether there is a short-term effect of spinal manipulation in the treatment of infantile colic . DESIGN A r and omized controlled trial . SETTING A private chiropractic practice and the National Health Service 's health visitor nurses in the suburb Ballerup ( Copenhagen , Denmark ) . SUBJECTS Infants seen by the health visitor nurses , who fulfilled the diagnostic criteria for infantile colic . INTERVENTION One group received spinal manipulation for 2 weeks , the other was treated with the drug dimethicone for 2 weeks . OUTCOME MEASURE Changes in daily hours of crying as registered in a colic diary . RESULTS By trial days 4 to 7 , hours of crying were reduced by 1 hour in the dimethicone group compared with 2.4 hours in the manipulation group ( P = .04 ) . On days 8 through 11 , crying was reduced by 1 hour for the dimethicone group , whereas crying in the manipulation group was reduced by 2.7 hours ( P = .004 ) . From trial day 5 onward the manipulation group did significantly better that the dimethicone group . CONCLUSION Spinal manipulation is effective in relieving infantile colic OBJECTIVE To evaluate chiropractic management of primary nocturnal enuresis in children . DESIGN A controlled clinical trial for 10 wk preceded by and followed by a 2-wk nontreatment period . SETTING Chiropractic clinic of the Palmer Institute of Graduate Studies and Research . PARTICIPANTS Forty-six nocturnal enuretic children ( 31 treatment and 15 control group ) , from a group of 57 children initially included in the study , participated in the trial . INTERVENTION High velocity , short lever adjustments of the spine consistent with the Palmer Package Techniques ; or a sham adjustment using an Activator at a nontension setting administered to the examiner 's underlying contact point . Two 5th-year chiropractic students under the supervision of two clinic faculty performed the adjustments . MAIN OUTCOME MEASURES Frequency of wet nights . RESULTS The post-treatment mean wet night frequency of 7.6 nights/2 wk for the treatment group was significantly less than its baseline mean wet night frequency of 9.1 nights/2 wk ( p = 0.05 ) . For the control group , there was practically no change ( 12.1 to 12.2 nights/2 wk ) in the mean wet night frequency from the baseline to the post-treatment . The mean pre- to post-treatment change in the wet night frequency for the treatment group compared with the control group did not reach statistical significance ( p = 0.067 ) . Twenty-five percent of the treatment-group children had 50 % or more reduction in the wet night frequency from baseline to post-treatment while none among the control group had such reduction . CONCLUSIONS Results of the present study strongly suggest the effectiveness of chiropractic treatment for primary nocturnal enuresis . A larger study of longer duration with a 6-month follow-up is therefore warranted Objective . To compare supination at the wrist followed by flexion at the elbow ( the traditional reduction technique ) to hyperpronation at the wrist in the reduction of radial head subluxations ( nursemaid 's elbow ) . Material s and Methods . This prospect i ve , r and omized study involved a consecutive sampling of children younger than 6 years of age who presented to one of two urban pediatric emergency departments and two suburban pediatric ambulatory care centers with a clinical diagnosis of radial head subluxation . Patients were r and omized to undergo reduction by one of the two methods and were followed every 5 minutes for return of elbow function . The initial procedure was repeated if baseline functioning did not return 15 minutes after the initial reduction attempt . Failure of that technique 30 minutes after the initial reduction attempt result ed in a cross-over to the alternate method of reduction . The alternate procedure was repeated if baseline functioning did not return 15 minutes after the alternate procedure was attempted . If the patient failed both techniques , radio-graphy of the elbow was performed . Results . A total of 90 patients were enrolled in the study . Five patients were removed from further analysis secondary to a final diagnosis of fracture , 84 were reduced successfully , and 1 failed both techniques . Demographic characteristics of each group were similar . Thirty-nine of 41 patients ( 95 % ) r and omized to hyper-pronation were reduced successfully on the first attempt versus 34 of 44 patients ( 77 % ) r and omized to supination . Two patients in the hyperpronation group required two attempts versus 10 patients in the supination group . Hyperpronation was more successful ; 40 of 41 patients ( 97.5 % ) in the hyperpronation group were reduced successfully versus 38 of 44 patients ( 86 % ) in the supination group . Of the 6 patients who crossed over from supination to hyperpronation , 5 were reduced on the first attempt and 1 was reduced on the second attempt . Conclusions . In the reduction of radial head subluxations , the hyperpronation technique required fewer attempts at reduction compared with supination , was successful more often than supination , and was often successful when supination failed OBJECTIVE To review the biomedical literature up to and including 2003 , and determine the extent of the evidence related to the therapeutic application of chiropractic manipulation for paediatric health conditions . No critical appraisal of the evidence is undertaken . DATA SOURCES The indexed manual therapy sector including medical , chiropractic , physiotherapy , naturopathic and osteopathic literature was search ed . This included PubMed ; the Manual , Alternative , and Natural Therapy Index System ; the Cumulative Index to Nursing and Allied Health Literature ; the Index to Chiropractic Literature ; the Paediatric Economic Data base Evaluation Project ; the Cochrane Library ; the Canadian Coordinating Office for Health Technology Assessment data base ; and the Agency for Healthcare Research and Quality data base . Other re sources included research conference and symposium proceedings , and the references of identified studies . RESULT The search identified 1731 articles , of which 166 met the eligibility criteria . Two review ers determined by consensus each citation 's appropriate level on the strength of evidence scale . There was one systematic review , nine r and omized controlled trials , one observational study , 141 descriptive case studies and 14 conference abstract s. SUMMARY Health cl aims made by practitioners regarding the application of chiropractic manipulation as a health care intervention for paediatric health conditions are , for the most part , supported by low levels of scientific evidence . Chiropractors , in particular , employ manipulation for the treatment of a wide variety of paediatric health conditions . The evidence rests primarily with clinical experience , descriptive case studies and a few r and omized controlled trials . There is a need for more rigorous scientific inquiry to examine the value of manipulative therapy in the treatment of paediatric conditions . To advance the health interests of paediatric patients , health care decisions made on the basis of expert opinion or clinical experience must integrate the best research evidence available from high- quality , scientific studies AIMS To investigate the efficacy of chiropractic spinal manipulation in the management of infantile colic . METHODS One hundred infants with typical colicky pain were recruited to a r and omised , blinded , placebo controlled clinical trial . RESULTS Nine infants were excluded because inclusion criteria were not met , and five dropped out , leaving 86 who completed the study . There was no significant effect of chiropractic spinal manipulation . Thirty two of 46 infants in the treatment group ( 69.9 % ) , and 24 of 40 in the control group ( 60.0 % ) , showed some degree of improvement . CONCLUSION Chiropractic spinal manipulation is no more effective than placebo in the treatment of infantile colic . This study emphasises the need for placebo controlled and blinded studies when investigating alternative methods to treat unpredictable conditions such as infantile colic BACKGROUND Pediatric otitis media with effusion is a common and costly condition . Although chiropractors have anecdotally cl aim ed success in treating otitis media , there is little research to support their cl aims . OBJECTIVE A pilot study was undertaken for the purpose of assessing the feasibility of conducting a full-scale r and omized clinical trial investigating the efficacy of chiropractic spinal manipulative therapy ( SMT ) for children with chronic otitis media with effusion . METHODS This study was a prospect i ve , parallel-group , observer-blinded , r and omized feasibility study . Twenty-two patients , ages 6 months to 6 years , received either active chiropractic SMT or placebo chiropractic SMT . Otoscopy and tympanometry were used to create a middle ear status profile , and daily diaries were collected . RESULTS Five newspaper advertisements over 6 months generated 105 responses . Twenty patients subsequently qualified and were r and omized into the study . Collection of tympanometric and otoscopic data proved to be challenging . Compliance with the treatment and evaluation protocol s and daily diaries was excellent . There were no reports of serious side effects as a result of either the active or placebo chiropractic treatments . CONCLUSION Recruitment for a r and omized controlled trial is feasible and could be enhanced by medical collaboration . Patients and parents are able and willing to participate in a study comparing active SMT and placebo SMT . Parents were extremely compliant with the daily diaries , suggesting that similar quality -of-life and functional status measures can be successfully used in a larger trial . We found the objective outcomes assessment involving tympanometry and otoscopy extremely challenging and should be performed by experienced examiners in future studies OBJECTIVE To determine the effect of chiropractic care on jet lag in Finnish junior elite athletes . SUBJECTS Fifteen Finnish junior elite athletes . METHODS Through use of a table of r and om numbers , each athlete was assigned by sex to one of 3 groups : chiropractic adjustment , sham adjustment , or control . As needed , the chiropractic adjustment group athletes ( n = 5 ) were adjusted on a daily basis by licensed chiropractors using a toggle/recoil procedure . The sham adjustment group athletes ( n = 5 ) received sham adjustments on a daily basis by licensed chiropractors . The control group athletes ( n = 5 ) were not adjusted or sham-adjusted but participated in all test protocol s. Sleep 
    Output:
    
Summary There has been no substantive shift in this body of knowledge during the past 3 1/2 years .
The health cl aims made by chiropractors with respect to the application of manipulation as a health care intervention for pediatric health conditions continue to be supported by only low levels of scientific evidence .