***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 Untreated , one third of patients who undergo surgery will have postoperative nausea and vomiting . Although many trials have been conducted , the relative benefits of prophylactic antiemetic interventions given alone or in combination remain unknown . METHODS We enrolled 5199 patients at high risk for postoperative nausea and vomiting in a r and omized , controlled trial of factorial design that was powered to evaluate interactions among as many as three antiemetic interventions . Of these patients , 4123 were r and omly assigned to 1 of 64 possible combinations of six prophylactic interventions : 4 mg of ondansetron or no ondansetron ; 4 mg of dexamethasone or no dexamethasone ; 1.25 mg of droperidol or no droperidol ; propofol or a volatile anesthetic ; nitrogen or nitrous oxide ; and remifentanil or fentanyl . The remaining patients were r and omly assigned with respect to the first four interventions . The primary outcome was nausea and vomiting within 24 hours after surgery , which was evaluated blindly . RESULTS Ondansetron , dexamethasone , and droperidol each reduced the risk of postoperative nausea and vomiting by about 26 percent . Propofol reduced the risk by 19 percent , and nitrogen by 12 percent ; the risk reduction with both of these agents ( i.e. , total intravenous anesthesia ) was thus similar to that observed with each of the antiemetics . All the interventions acted independently of one another and independently of the patients ' baseline risk . Consequently , the relative risks associated with the combined interventions could be estimated by multiplying the relative risks associated with each intervention . Absolute risk reduction , though , was a critical function of patients ' baseline risk . CONCLUSIONS Because antiemetic interventions are similarly effective and act independently , the safest or least expensive should be used first . Prophylaxis is rarely warranted in low-risk patients , moderate-risk patients may benefit from a single intervention , and multiple interventions should be reserved for high-risk patients CONTEXT A prior national survey documented the high prevalence and costs of  alternative medicine use in the United States in 1990 . OBJECTIVE To document trends in alternative medicine use in the United States between 1990 and 1997 . DESIGN Nationally representative r and om household telephone surveys using comparable key questions were conducted in 1991 and 1997 measuring utilization in 1990 and 1997 , respectively . PARTICIPANTS A total of 1539 adults in 1991 and 2055 in 1997 . MAIN OUTCOMES MEASURES Prevalence , estimated costs , and disclosure of alternative therapies to physicians . RESULTS Use of at least 1 of 16 alternative therapies during the previous year increased from 33.8 % in 1990 to 42.1 % in 1997 ( P < or = .001 ) . The therapies increasing the most included herbal medicine , massage , megavitamins , self-help groups , folk remedies , energy healing , and homeopathy . The probability of users visiting an alternative medicine practitioner increased from 36.3 % to 46.3 % ( P = .002 ) . In both surveys alternative therapies were used most frequently for chronic conditions , including back problems , anxiety , depression , and headaches . There was no significant change in disclosure rates between the 2 survey years ; 39.8 % of alternative therapies were disclosed to physicians in 1990 vs 38.5 % in 1997 . The percentage of users paying entirely out-of-pocket for services provided by alternative medicine practitioners did not change significantly between 1990 ( 64.0 % ) and 1997 ( 58.3 % ) ( P=.36 ) . Extrapolations to the US population suggest a 47.3 % increase in total visits to alternative medicine practitioners , from 427 million in 1990 to 629 million in 1997 , thereby exceeding total visits to all US primary care physicians . An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and /or high-dose vitamins ( 18.4 % of all prescription users ) . Estimated expenditures for alternative medicine professional services increased 45.2 % between 1990 and 1997 and were conservatively estimated at $ 21.2 billion in 1997 , with at least $ 12.2 billion paid out-of-pocket . This exceeds the 1997 out-of-pocket expenditures for all US hospitalizations . Total 1997 out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $ 27.0 billion , which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services . CONCLUSIONS  Alternative medicine use and expenditures increased substantially between 1990 and 1997 , attributable primarily to an increase in the proportion of the population seeking alternative therapies , rather than increased visits per patient Postoperative nausea , a common complication in patients receiving general anesthesia , was studied in this r and omized investigation to compare the efficacy of 70 % inhaled isopropyl alcohol and intravenous ondansetron . For the study , 100 healthy women , ASA physical status I or II , scheduled for outpatient gynecologic laparoscopic procedures r and omly received 4 mg of intravenous ondansetron or isopropyl alcohol for the treatment of postoperative nausea . Nausea was measured on arrival to the postanesthesia care unit , at first complaint of nausea , every 5 minutes after initiation of therapy until nausea resolution , and every 15 minutes thereafter using a 0 to 10 verbal numerical rating scale . At 5 , 10 , and 15 minutes , the median verbal numerical rating scores between the ondansetron and alcohol groups were 6.00 and 3.00 , 5.00 and 3.00 , and 5.00 and 2.00 , respectively ( P = .002 , .015 , and .036 , respectively ) . No statistically significant differences were found at any other time interval . Mean times from initiation of therapy to a 50 % reduction in nausea between the ondansetron and alcohol groups were 6.3 minutes and 27.7 minutes , respectively ( P = 0.022 ) . Based on this study , it seems postoperative nausea can be resolved quicker using 70 % inhaled isopropyl alcohol compared with intravenous ondansetron in women undergoing outpatient gynecologic laparoscopic procedures Background The relative efficacy of antiemetics for the treatment of postoperative nausea and vomiting ( PONV ) is poorly understood . Methods Systematic search ( MEDLINE , Embase , Cochrane Library , bibliographies , any language , to 8.2000 ) for r and omised comparisons of antiemetics with any comparator for the treatment of established PONV . Dichotomous data on prevention of further nausea and vomiting , and on side effects were combined using a fixed effect model . Results In seven trials ( 1,267 patients ) , 11 different antiemetics were tested without placebos ; these data were not further analysed . Eighteen trials ( 3,809 ) had placebo  controls . Dolasetron 12.5–100 mg , granisetron 0.1–3 mg , tropisetron 0.5–5 mg , and ondansetron 1–8 mg prevented further vomiting with little evidence of dose-responsiveness ; with all regimens , absolute risk reductions compared with placebo were 20%–30 % . The anti-nausea effect was less pronounced . Headache was dose-dependent . Results on propofol were contradictory . The NK1 antagonist GR205171 , isopropyl alcohol vapor , metoclopramide , domperidone , and midazolam were tested in one trial each with a limited number of patients . Conclusions Of 100 vomiting surgical patients receiving a 5-HT3 receptor antagonist  , 20 to 30 will stop vomiting who would not have done so had they received a placebo ; less will profit from the anti-nausea effect . There is a lack of evidence for a clinical ly relevant dose-response ; minimal effective doses may be used . There is a discrepancy between the plethora of trials on prevention of PONV and the paucity of trials on treatment of established symptoms . Valid data on the therapeutic efficacy of classic antiemetics , which have been used for decades , are needed Background Despite the presence of a plethora of publications on the prevention of postoperative nausea and vomiting ( PONV ) only little is known how to treat established symptoms . Besides the high effort of performing these efficacy trials ( much more patients must give their consent than are actually included in a study ) and ethical concerns , little is known about the rate of re-occurring PONV/vomiting after placebo . As a consequence investigators will have difficulties defining a clinical ly relevant effect for the new treatment which is crucial for any planning . A quantitative systematic review was performed in order to provide more reliable estimates of the incidence of re-occurring PONV/vomiting after placebo and to help investigators defining a clinical ly relevant treatment effect . Methods A systematic search of the literature was performed using an extended search strategy of a previous review . Data on the recurrence of PONV ( any nausea or emetic symptom ) and vomiting ( retching or vomiting ) was extracted from published reports treating PONV with  placebo  and unpublished results from two observational trials where no treatment was given . A nonlinear r and om effects model was used to calculate estimates of the recurrence of symptoms and their 95%-confidence intervals ( 95%-CI ) . Results A total of 29 trials ( including the unpublished data ) were eligible for the calculations . Depending on the length of observation after administering placebo or no treatment the recurrence rate of PONV was between 65 % ( 95%-CI : 53% ... 75 % ) and 84 % ( 95%-CI : 73% ... 91 % ) and that of vomiting was between 65 % ( 95%-CI : 44% ... 81 % ) and 78 % ( 95%-CI : 59% ... 90 % ) . Conclusion Almost all trials showed a considerable and consistently high rate of recurrence of emetic symptoms after placebo highlighting the need for a consequent antiemetic treatment . Future ( placebo ) controlled efficacy trials may use the presented empirical estimates for defining clinical ly relevant effects and for statistical power considerations Background : Indacaterol is a novel , inhaled once-daily ultra-long-acting β2-agonist for the treatment of chronic obstructive pulmonary disease ( COPD ) . Objectives : This study compared the onset of action of single doses of indacaterol 150 and 300 μg with salbutamol 200 μg , salmeterol-fluticasone 50/500 μg , and placebo in moderate-to-severe COPD patients . Methods : This was a multicenter , r and omized , double-blind , placebo-controlled crossover study . The primary variable was forced expiratory volume in one second ( FEV1 ) at five minutes postdose . Results : Out of 89 patients r and omized ( mean age 62 years ) , 86 completed the study . At five minutes postdose , both indacaterol doses were statistically and clinical ly superior to placebo ( P < 0.001 ) , with treatment – placebo differences in FEV1 of 100 ( 95 % confidence interval [ CI ] 70–130 ) mL and 120 ( 95 % CI 90–150 ) mL for indacaterol 150 and 300 μg , respectively . FEV1 at five minutes postdose with both indacaterol doses was numerically higher than for salbutamol ( 10 and 30 mL for indacaterol 150 and 300 μg , respectively ) and significantly higher than for salmeterol-fluticasone ( 50 mL , P = 0.003 ; 70 mL , P < 0.001 , respectively ) . Moreover , both indacaterol doses showed significantly higher FEV1 than placebo ( P < 0.001 ) at all postdose time points . The numbers of patients with an FEV1 increase of at least 12 % and 200 mL at five minutes postdose were 16 ( 18.8 % ) , 24 ( 27.6 % ) , 20 ( 23.3 % ) , 8 ( 9.1 % ) , and 3 ( 3.4 % ) for indacaterol 150 and 300 μg , salbutamol 200 μg , salmeterol-fluticasone 50/500 μg , and placebo , respectively . Conclusions : Single doses of indacaterol 150 and 300 μg demonstrated a fast onset of action similar to that for salbutamol and faster than that for salmeterol-fluticasone BACKGROUND Despite intensive research , the main causes of postoperative nausea and vomiting ( PONV ) remain unclear . We sought to quantify the relative importance of operative , anaesthetic and patient-specific risk factors to the development of PONV . METHODS We conducted a r and omized controlled trial of 1180 children and adults at high risk for 
    Output:
    
Isopropyl alcohol was more effective than saline placebo for reducing postoperative nausea and vomiting but less effective than  st and ard anti-emetic drugs .
There is currently no reliable evidence for the use of peppermint oil