***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 study nausea , vomiting and need for rescue antiemetics  in patients receiving antiemetic acupuncture , sham acupuncture or st and ard care during concomitant chemotherapy during pelvic radiotherapy . METHODS In total , 68 patients participated ( 75 % women , mean age 56 years , 53 % had gynecological , 43 % colorectal , and 4 % other cancer types ) . Fifty-seven of them were blinded r and omized to verum ( n=28 ) or sham ( n=29 ) acupuncture , median 10 sessions . During the study period of four weeks , the patients daily registered their nausea , vomiting and consumption of antiemetics .  They were compared to a reference group ( n=11 ) receiving st and ard care only , who delivered these data once ( after receiving mean 27Gy radiotherapy dose ) . RESULTS More patients in the sham acupuncture group ( 17 of 20 ; 85 % , p=0.019 , RR 1.81 , CI 1.06 - 3.09 ) consumed antiemetics  , compared to the verum acupuncture group ( 8 of 17 ; 47 % ) . In the st and ard care group , 7 of 11 ( 63 % ) consumed  antiemetics . The verum acupuncture treated patients experienced lower intensity of nausea than the other patients ( p=0.049 ) . There was a non-significant tendency that more patients receiving either sham acupuncture or st and ard care experienced nausea ( 21 of 31 ; 68 % ) than patients receiving verum acupuncture ( 9 of 17 ; 53 % : p=0.074 , RR 1.58 , CI 0.91 - 2.74 ) . CONCLUSION Patients treated with verum acupuncture needed less antiemetics and experienced milder nausea than other patients . Our study was small and many analyses lacked statistical power to detect differences ; we welcome further sham-controlled efficacy studies and studies regarding the role of non-specific treatment components for experiencing antiemetic effects of acupuncture Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more BACKGROUND Chemotherapy-induced nausea and vomiting is a common side-effect of many antineoplastic regimens and can occur for several days after treatment . We aim ed to assess the neurokinin-1 receptor antagonist rolapitant , in combination with a serotonin ( 5-HT3 ) receptor antagonist and dexamethasone , for the prevention of chemotherapy-induced nausea and vomiting in patients with cancer after administration of moderately emetogenic chemotherapy or regimens containing an anthracycline and cyclophosphamide .  METHODS We conducted a global , r and omised , double-blind , active-controlled , phase 3 study at 170 cancer centres in 23 countries . We included patients with cancer aged 18 years or older , who had not received moderately or highly emetogenic chemotherapy before , with a Karnofsky performance score of 60 or higher , and a predicted life expectancy of 4 months or longer . We used an interactive web-based r and omisation system to r and omly allocate patients to receive either oral rolapitant ( one 180 mg dose ; rolapitant group ) or a placebo that was identical in appearance ( active control group ) 1 - 2 h before administration of moderately emetogenic chemotherapy . Patients were stratified by sex . All patients also received granisetron ( 2 mg orally ) and dexamethasone ( 20 mg orally ) on day 1 ( except for patients receiving taxanes as part of moderately emetogenic chemotherapy , who received dexamethasone according to the package insert ) and granisetron ( 2 mg orally ) on days 2 - 3 . Every cycle was a minimum of 14 days . In up to five subsequent cycles , patients received the same study drug they were assigned in cycle 1 , unless they chose to leave the study or were removed at the treating clinician 's discretion . Efficacy analysis was done in the modified intention-to-treat population ( comprising all patients who received at least one dose of study drug at a study site compliant with Good Clinical Practice [ GCP ] ) . The primary endpoint was the proportion of patients achieving a complete response ( defined as no emesis or use of rescue medication ) in the delayed phase ( > 24 - 120 h after initiation of chemotherapy ) in cycle 1 . This study is registered with Clinical Trials.gov , number NCT01500226 . The study has been completed . FINDINGS Between March 5 , 2012 , and Sept 6 , 2013 , 1369 patients were r and omised to receive either rolapitant ( n=684 ) or active control ( n=685 ) . 666 patients in each group received at least one dose of study drug at a GCP-compliant site and were included in the modified intention-to-treat population . A significantly greater proportion of patients receiving rolapitant had complete responses in the delayed phase than did those receiving active control ( 475 [ 71 % ] vs 410 [ 62 % ] ; odds ratio 1·6 , 95 % CI 1·2 - 2·0 ; p=0·0002 ) . The incidence of adverse events was similar in the rolapitant and control groups , with the most frequently reported treatment-related treatment-emergent adverse events being fatigue , constipation , and headache . For cycle 1 , the most common grade 3 - 4 adverse event in the rolapitant versus active control groups was neutropenia ( 32 [ 5 % ] vs 23 [ 3 % ] patients ) . No serious adverse event was treatment-related , and no treatment-related treatment-emergent adverse event result ed in death . INTERPRETATION Rolapitant in combination with a 5-HT3 receptor antagonist and dexamethasone is well tolerated and shows superiority over active control for the prevention of chemotherapy-induced nausea and vomiting during the 5-day ( 0 - 120 h ) at-risk period after administration of moderately emetogenic chemotherapy or regimens containing an anthracycline and cyclophosphamide . FUNDING TESARO , OBJECTIVE The aim of this study was to determine the effect of auricular acupressure in relieving nausea and vomiting among the women who received chemotherapy . METHODS 48 women suffering from Breast Cancer and receiving chemotherapy were recruited for the study . The patients were r and omly assigned into two groups of experiment and control . In the initial phase of chemotherapy , the experimental group received st and ard medications to control nausea and vomiting and auricular acupressure for five days . Meanwhile , the control group received only the st and ard medications . RESULTS The use of auricular acupressure led to the decrease in the number and intensity of nausea and vomiting in both the acute and delayed phases in experimental group which were significantly lower than the control group ( P = 0/001 ) . CONCLUSIONS It is suggested that nurses use this pressure technique as a complementary treatment , non - pharmacological , inexpensive , non-invasive approach for the relief of chemotherapy-induced nausea and vomiting OBJECTIVE To compare the efficacy between acupuncture and ondansetron in the prevention of delayed  chemotherapy induced nausea and vomiting ( CINV ) . METHODS 70 patients were r and omized to receive either 1 ) acupuncture at P6 point before chemotherapy infusion or 2 ) ondansetron 8 mg intravenously 30 min before chemotherapy infusion in their first cycle with cross-over of antiemetic regimen in the consecutive cycle . All patients received dexamethasone 5 mg orally twice a day for 3 days . Patients were given additional does of ondansetron 4 mg orally every 12h if they experienced emesis . Emetic episode , severity of nausea score of 0 - 10 and adverse events were recorded . Complete response was defined as no nausea , no vomiting and no requirement of additional antiemetic drugs . FACT-G scale was used to evaluate quality of life ( QOL ) 7 days after each cycle of chemotherapy . RESULTS The acupuncture group had a significantly higher rate of complete response in the prevention of delayed CINV ( 52.8 % and 35.7 % , P = 0.02 ) . Compared to another group , the acupuncture group reported significantly lower delayed nausea ( 45.7 % and 65.7 % , P = 0.004 ) , nausea score ( P < 0.001 ) and fewer dosages of additional oral ondansetron ( P = 0.002 ) . Adverse effects were also significantly lower in the acupuncture group with less frequent constipation ( P = 0.02 ) and insomnia ( P = 0.01 ) . Overall FACT-G scores were significantly higher in the acupuncture group . CONCLUSION Acupuncture is effective in preventing delayed CINV and in promoting better QOL . With fewer adverse effects , it may be used as an alternative treatment option for CINV 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 Purpose This paper describes the incidence of chemotherapy-induced nausea and vomiting ( CINV ) after highly or moderately emetogenic chemotherapy ( HEC or MEC ) for cancer in six Asia Pacific countries . Methods Sequential adult patients naïve to chemotherapy and scheduled to receive at least two cycles of single-day HEC or MEC were enrolled in this prospect i ve observational study . Patients completed the Multinational Association of Supportive Care in Cancer ( MASCC ) Antiemesis Tool on post-chemotherapy days 2 and 6 to record acute-phase ( first 24 h ) and delayed-phase ( days 2–5 ) CINV . Results There were 648 evaluable patients ( 318 HEC , 330 MEC ) from Australia ( n = 74 ) , China ( 153 ) , India ( 88 ) , Singapore ( 57 ) , South Korea ( 151 ) , and Taiwan ( 125 ) . Mean ( SD ) patient age was 56 ( 12 ) and 58 % of patients were women ; the most common primary cancers were breast ( 27 % ) , lung ( 22 % ) , and colon ( 20 % ) . Overall in cycle 1 , complete response ( no emesis or rescue antiemetics ) was recorded by 69 % ( 95 % confidence interval ( CI ) , 66–73 ) of all evaluable patients , with country percentages ranging from 55 to 78 % ( p < 0.001 ) . After HEC , no emesis was recorded by 75 % and no nausea by 38 % of patients . After MEC , 80 % had no emesis and 50 % no nausea . Acute-phase CINV was better controlled than delayed-phase CINV , and the control of nausea was the lowest of any CINV measure in all phases . In a CINV perception survey , physicians tended to overestimate emesis rate and underestimate nausea rate . Conclusions CINV remains a substantial problem , and country-specific information about CINV can be useful in developing strategies to improve outcomes for patients undergoing chemotherapy Objective Netupitant is a novel , selective neurokinin-1 receptor antagonist used for prevention of chemotherapy-induced nausea and vomiting , a distressing side effect of chemotherapy . This double-blind , r and omized , Phase II study investigated the dose-response of oral netupitant in Japanese patients receiving highly emetogenic chemotherapy . Methods Chemotherapy-naïve patients were r and omized ( 1:1:1 ) to a single oral netupitant 30- , 100- or 300-mg dose before chemotherapy initiation . Patients received concomitant palonosetron ( 0.75 mg intravenously [ i.v . ] Day 1 ) and dexamethasone ( 9.9 mg i.v . Day 1 , 8 mg orally Days 2 - 4 ) . Results Overall , 402 patients ( 30 mg : 134 ; 100 mg : 135 ; 300 mg : 133 ) were treated and evaluable for efficacy and safety . The primary endpoint of overall ( 0 - 120 h after chemotherapy administration ) complete response ( CR ) rate ( no emesis , no rescue medication ) was 64.2 % , 60.0 % and 54.9 % in the 30- , 100- and 300-mg arms , 
    Output:
    
RESULTS The results of this review will provide a high- quality synthesis to evaluate the effectiveness and safety of acupoint therapies for CINV .
This review will provide evidence to estimate whether acupoint therapies are effective interventions for CINV .