***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: The purpose of this study was to investigate the effects of offering Therapeutic Touch ( TT ) as an adjunct to cognitive behavioral therapy ( CBT ) for people with chronic pain . Patients were r and omized to relaxation training ( control group ) or TT plus relaxation ( experimental ) . Subsequently , all participants attended a CBT program . Preprogram and postprogram data were examined to identify patterns of change in pain intensity , self-efficacy , unitary power , disability , and perceived distress . In addition , patterns of attrition were examined . Patients in this study who were r and omized to receive TT fared better in terms of enhanced self-efficacy and unitary power , as well as having lower attrition rates . Trends associated TT with less distress and disability . This pilot study suggests that offering TT as an adjunct to CBT may help to improve clinical outcomes , reduce program attrition , and promote unitary power in those who suffer with chronic pain OBJECTIVE Fibromyalgia is a common , chronic pain condition for which patients frequently use complementary and alternative medicine , including Reiki . Our objective was to determine whether Reiki is beneficial as an adjunctive fibromyalgia treatment . DESIGN This was a factorial design ed , r and omized , sham-controlled trial in which participants , data collection staff , and data analysts were blinded to treatment group . SETTING /LOCATION The study setting was private medical offices in the Seattle , Washington metropolitan area . SUBJECTS The subjects were comprised 100 adults with fibromyalgia . INTERVENTION Four ( 4 ) groups received twice-weekly treatment for 8 weeks by either a Reiki master or actor r and omized to use direct touch or no touch ( distant therapy ) . OUTCOME MEASURES The primary outcome was subjective pain as measured by visual analog scale at weeks 4 , 8 , and 20 ( 3 months following end of treatment ) . Secondary outcomes were physical and mental functioning , medication use , and health provider visits . Participant blinding and adverse effects were ascertained by self-report . Improvement between groups was examined in an intention-to-treat analysis . RESULTS Neither Reiki nor touch had any effect on pain or any of the secondary outcomes . All outcome measures were nearly identical among the 4 treatment groups during the course of the trial . CONCLUSION Neither Reiki nor touch improved the symptoms of fibromyalgia . Energy medicine modalities such as Reiki should be rigorously studied before being recommended to patients with chronic pain symptoms Fatigue is an extremely common side effect experienced during cancer treatment and recovery . Limited research has investigated strategies stemming from complementary and alternative medicine to reduce cancer-related fatigue . This research examined the effects of Reiki , a type of energy touch therapy , on fatigue , pain , anxiety , and overall quality of life . This study was a counterbalanced crossover trial of 2 conditions : ( 1 ) in the Reiki condition , participants received Reiki for 5 consecutive daily sessions , followed by a 1-week washout monitoring period of no treatments , then 2 additional Reiki sessions , and finally 2 weeks of no treatments , and ( 2 ) in the rest condition , participants rested for approximately 1 hour each day for 5 consecutive days , followed by a 1-week washout monitoring period of no scheduled resting and an additional week of no treatments . In both conditions , participants completed question naires investigating cancer-related fatigue ( Functional Assessment of Cancer Therapy Fatigue subscale [ FACT-F ] ) and overall quality of life ( Functional Assessment of Cancer Therapy , General Version [ FACT-G ] ) before and after all Reiki or resting sessions . They also completed a visual analog scale ( Edmonton Symptom Assessment System [ ESAS ] ) assessing daily tiredness , pain , and anxiety before and after each session of Reiki or rest . Sixteen patients ( 13 women ) participated in the trial : 8 were r and omized to each order of conditions ( Reiki then rest ; rest then Reiki ) . They were screened for fatigue on the ESAS tiredness item , and those scoring greater than 3 on the 0 to 10 scale were eligible for the study . They were diagnosed with a variety of cancers , most commonly colorectal ( 62.5 % ) cancer , and had a median age of 59 years .  Fatigue on the FACT-F decreased within the Reiki condition ( P=.05 ) over the course of all 7 treatments . In addition , participants in the Reiki condition experienced significant improvements in quality of life ( FACT-G ) compared to those in the resting condition ( P < .05 ) . On daily assessment s ( ESAS ) in the Reiki condition , presession 1 versus postsession 5 scores indicated significant decreases in tiredness ( P < .001 ) , pain ( P < .005 ) , and anxiety ( P<.01 ) , which were not seen in the resting condition . Future research should further investigate the impact of Reiki using more highly controlled design s that include a sham Reiki condition and larger sample sizes The purpose of this study was to evaluate the effect of Reiki as an alternative and complementary approach to treating community-dwelling older adults who experience pain , depression , and /or anxiety . Participants ( N = 20 ) were r and omly assigned to either an experimental or wait list control group . The pre- and posttest measures included the Hamilton Anxiety Scale , Geriatric Depression Scale-Short Form , Faces Pain Scale , and heart rate and blood pressure . The research design included an experimental component to examine changes in these measures and a descriptive component ( semi-structured interview ) to elicit information about the experience of having Reiki treatments . Significant differences were observed between the experimental and treatment groups on measures of pain , depression , and anxiety ; no changes in heart rate and blood pressure were noted . Content analysis of treatment notes and interviews revealed five broad categories of responses : Relaxation ; Improved Physical Symptoms , Mood , and Well-Being ; Curiosity and a Desire to Learn More ; Enhanced Self-Care ; and Sensory and Cognitive Responses to Reiki Purpose . This is a pilot study investigating the effect of healing touch ( HT ) on fatigue in breast cancer patients undergoing radiation therapy ( RT ) . Methods / Design . This study presents the results of a within-subjects design r and omized clinical trial where the treatment group was treated with HT , whereas the control group experienced sham therapy . The setting was a university RT clinic . The participants were breast cancer patients treated with lumpectomy or mastectomy , 21 to 75 years old with an Eastern Cooperative Oncology Group ( ECOG ) score of 0 to 2 . The intervention was a 45-minute session of HT or sham therapy once a week during RT . Outcome measures included fatigue , quality of life ( QOL ) , and anxiety/depression . Results . A total of 70 patients were approached , with 41 completing the study . At completion , the HT participants tended to report higher levels of fatigue , statistically significant for interference ( P = .010 ) and usual fatigue ( P = .024 ) . The control group tended to report greater reductions in fatigue relative to their own means than the HT group ( Cohen ’s d = 0.30 to 0.49 vs 0.06 to 0.18 , respectively ) . There were no statistically significant differences between the groups for QOL . Conclusions . Our enrollment and retention indicate that HT is feasible for women during RT . Our pilot findings do not support a beneficial effect of HT on fatigue or QOL . Future research may explore increasing dose and teasing out therapist effect PURPOSE / OBJECTIVES To determine whether provision of Reiki therapy during outpatient chemotherapy is associated with increased comfort and well-being . DESIGN Double-blind , r and omized clinical controlled trial . SETTING Outpatient chemotherapy center . SAMPLE 189 participants were r and omized to actual Reiki , sham Reiki placebo , or st and ard care . METHODS Patients receiving chemotherapy were r and omly placed into one of three groups . Patients received either st and ard care , a placebo , or an actual Reiki therapy treatment . A demographic tool and pre- and post-tests were given before and after chemotherapy infusion . MAIN RESEARCH VARIABLES Reiki therapy , sham Reiki placebo therapy , st and ard care  , and self-reported levels of comfort and well-being pre- and postintervention . FINDINGS Although Reiki therapy was statistically significant in raising the comfort and well-being of patients post-therapy , the sham Reiki placebo also was statistically significant . Patients in the st and ard care group did not experience changes in comfort and well-being during their infusion session . CONCLUSIONS The findings indicate that the presence of an RN providing one-on-one support during chemotherapy was influential in raising comfort and well-being levels , with or without an attempted healing energy field . IMPLICATION S FOR NURSING An attempt by clinic nurses to provide more design ated one-to-one presence and support for patients while receiving their chemotherapy infusions could increase patient comfort and well-being Each therapeutic act may be seen as a result of multiple ingredients that may be specific or nonspecific [ 6 ] . Expectations , preferences , motivation , and patient-doctor interactions are examples of variables that may affect treatment outcome [ 6 , 7 ] . The changed spectrum of medical disorders ( shifted toward aging and chronicity ) and the interindividual differences in health priorities make the focus on single diseases potentially misleading , whereas there is growing awareness that the aim of the treatment should refer to personal goals ( from attainment of cure to prevention of recurrence , from removal of functional impairment to alleviation of symptoms ) [ 8 ] . EBM does not do justice to the importance of these interactions and provides an oversimplified and reductionistic view of treatment . Finally , the presence of investigators with substantial financial conflicts of interest in panels concerned with clinical guidelines and the excessive reliance of metaanalyses on industry-funded studies constitute two major sources of bias in literature interpretation [ 1 , 9 ] . Horwitz et al. [ 10 ] developed a method of clinical inquiry within RCT that can enhance the applicability of results to clinical decision making . Reanalyzing the BetaBlocker Heart Attack Trial , they found that propranolol reduced the risk of dying for the ‘ average ’ patient who survived an acute myocardial infa rct ion , whereas it was harmful in a subgroup characterized by specific cotherapy histories . If we accept the possibility that a treatment The gap between clinical guidelines developed by evidence -based medicine ( EBM ) and the real world of clinicians and patients has been widely recognized . There is currently little evidence that EBM has actually improved patient care [ 1 ] . It is thus not surprising that most of the time clinicians rely more on their own experience and that of their colleagues ( tacit knowledge or ‘ mindlines ’ ) than on explicit evidence from research [ 2 ] . Feinstein and Horwitz [ 3 ] were among the first to warn about excessive reliance on r and omized controlled trials ( RCT ) and meta-analyses that were not intended to answer questions about the treatment of individual patients . The results of these types of trials may show comparative efficacy of treatments for the average r and omized patient but not for those whose characteristics , such as severity of symptoms , comorbidity and other clinical features , depart from st and ard presentations [ 3 ] . In addition , meta-analyses often include highly heterogeneous studies and ascribe conflicting results to r and om variability , whereas different outcomes may reflect different patient population s , enrollment and protocol characteristics [ 4 ] . Even though personalized medicine , described as genomicsbased knowledge , has promised to approach each patient as the biological individual he/she is , the practical applications still have a long way to go and neglect of social and behavioral features may actually lead to ‘ depersonalized ’ medicine [ 5 ] . Other limitations have emerged over time . Received : July 11 , 2014 Accepted after revision : July 21 , 2014 Published online : December 24 , Background : Distant healing , a form of spiritual healing , is widely used for many conditions but little is known about its effectiveness . Methods : In order to evaluate distant healing in patients with a stable chronic condition , we r and omised 409 patients with chronic fatigue syndrome ( CFS ) from 14 private practice s for environmental medicine in Germany and Austria in a two by two factorial design to immediate versus deferred ( waiting for 6 months ) distant healing . Half the patients were blinded and half knew their treatment allocation . Patients were treated for 6 months and allocated to groups of 3 healers from a pool of 462 healers in 21 European countries with different healing traditions .  Change in Mental Health Component Summary ( MHCS ) score ( SF-36 ) was the primary outcome and Physical Health Component Summary score ( PHCS ) the secondary outcome . Results : This trial population had very low quality of life and symptom scores at entry . There were no differences over 6 months in post-treatment MHCS scores between the treated and untreated groups . There was a non-significant outcome ( p = 0.11 ) for healing with PHCS ( 1.11 ; 95 % CI –0.255 to 2.473 at 6 months ) and a significant effect ( p = 0.027 ) for blinding ; patients who were unblinded became worse during the trial ( –1.544 ; 95 % CI –2.913 to –0.176 ) . We found no relevant interaction for blinding among treated patients in MHCS and PHCS . Expectation of treatment and duration of CFS added significantly to the model . Conclusions : In patients with CFS , distant healing appears to have no statistically significant effect on mental and physical health but the expectation of improvement did improve outcome OBJECTIVE Little is known about the effects of distant healing in chronically ill patients , the population most likely to see a healer in practice . This study investigated whether distant healing as found in normal practice with patients representative of those seeking treatment from healers changes patients ' quality of life substantially . METHOD R and omized , waiting-list controlled study of distant healing ( anonymous , amulet , and allowing for personal contact ) in chronically ill patients . OUTCOME MEASURE Patient-reported quality of life as expressed by the sum of all M 
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CONCLUSIONS Energy healing has demonstrated some improvement in illness symptoms , however high level evidence consistently demonstrating efficacy is lacking .