***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: Prevention of relapse following depression is a pressing research problem . The authors tested the efficacy of the tricyclic antidepressant amitriptyline and psychotherapy , alone and in combination , in preventing the relapse of 150 neurotic depressed female patients . They found that patients receiving amitriptyline and little psychotherapy had a 12-percent relapse rate , compared to a 16-percent rate for those receiving more psychotherapy and no medication . There was no significant difference between drug therapy alone or drug therapy in combination with psychotherapy . However ,  psychotherapy was beneficial to patients with problems of social adjustment and interpersonal relations .  The need for further research and implication s for treatment are discussed A group of 200 patients who presented in general practice with symptoms but no abnormal physical signs and in whom no definite diagnosis was made were r and omly selected for one of four consultations : a consultation conducted in a " positive manner , " with and without treatment , and a consultation conducted in a " non-positive manner , " called a negative consultation , with and without treatment . Two weeks after consultation there was a significant difference in patient satisfaction between the positive and negative groups but not between the treated and untreated groups . Similarly , 64 % of those receiving a positive consultation  got better , compared with 39 % of those who received a negative consultation ( p = 0.001 ) and 53 % of those treated got better compared with 50 % of those not treated ( p = 0.5 ) OBJECTIVE To investigate the effects of functional electrical stimulation ( FES ) on the improvement of motor and walking ability of the lower extremities of the patients with acute stroke . METHODS Forty-six patients with stroke ( including cerebral infa rct ion and hemorrhage ) , aged 71 + /- 8 ( 45 - 84 ) , hospitalized within 2 weeks ( 9 + /- 4 days ) after the onset , matched with one another in the baseline measurements before treatment , were assigned r and omly into 3 groups : FES group ( n = 13 ) , receiving st and ard rehabilitation combined with FES 30 minutes per day , 5 days per week for 3 weeks , placebo stimulation group ( n = 15 ) receiving st and ard rehabilitation combined with the installment of the FES apparatus , operated in the same manner as mentioned above , however , without real electric stimulation , and control group ( n = 13 ) , receiving st and ard rehabilitation alone . The score of the composite spasticity scale ( CSS ) was measured , electromyography was conducted to measure the maximum isometric voluntary contraction ( MIVC ) of the ankle dorsi-flexors and plantar-flexors , and walking ability by the test of timed " Up and Go " before treatment , weekly during the 3-week treatment , and 8 weeks after the onset of stroke . RESULTS After 3 weeks of treatment , the percentage of CSS score of the FES group was 31 % + /- 35 % , significantly lower than those of the placebo and control groups ( 50 % + /- 88 % and 65 % + /- 65 % respectively , both P < 0.05 ) ; the ankle dorsiflexion torque of MIVC of the FES group was 9 Nm + /- 5 Nm , significantly higher than those of the placebo and control groups ( 5 Nm + /- 3 Nm and 4 Nm + /- 5 Nm respectively , both P < 0.05 ) , and the electromyogram co-contraction ratio of the FES group was 8 % + /- 5 % , significantly lower than those of the placebo and control groups ( 27 % + /- 26 % and 28 % + /- 19 % respectively , both P < 0.05 ) . The time needed to recover the walking ability after the stroke onset of the FES group was 18 + /- 8 days , shorter by 2 approximately 3 days than those of the placebo and control groups ( 20 + /- 7 and 21 + /- 8 days respectively ) . The percentage of the patients able to walk with the help of a stick 3 weeks after treatment of the FES group was 85 % , significantly higher than those of the placebo and control groups ( 60 % and 46 % respectively , both P < 0.05 ) . 84.6 % of the patients of the FES group returned home , a percentage significantly higher than those of the placebo and control groups ( 53 % and 46 % respectively , both P < 0.05 ) . CONCLUSION FES , plus st and ard rehabilitation , is effective in improving the motor and walking ability of the patients with acute stroke , to the degree that most patients are recovered to be able to return home A prospect i ve , r and omized clinical trial was performed in order to assess the efficacy and side-effects of commonly used topical anaesthesia methods in adults receiving peripheral venous cannulation . The study was double-blinded to the degree that the method ologies allowed . One hundred and fifty healthy adults undergoing elective surgery were allocated at r and om to five groups : EMLA cream , ethyl chloride spray , intracutaneous infiltration with 2 % lidocaine , placebo cream and no treatment . Venipuncture was performed with a 18 G cannula on the dorsal side of the h and . Puncture pain and pain caused by the topical treatment itself were measured using a visual analogue scale ( VAS , range : 0 - 100 mm ) . Haemodynamic response , difficulties in performing the puncture and side-effects were recorded . All analgesic techniques were well tolerated . Haemodynamic response and degree of puncture difficulty showed no differences among the groups . Puncture pain ( median mrnVAS ) following infiltration ( 1.0 ) and EMLA ( 10.0 ) was significantly lower than no treatment ( 30.0 ) or placebo ( 30.0 ) . The benefit of local infiltration was altered by injection pain ( 11.5 ) . Spray did not significantly lower puncture pain ( 26.5 ) and , in addition , was associated with discomfort ( 10.5 ) . In adults , EMLA cream significantly reduces puncture pain and represents an acceptable alternate method for topical anaesthesia in venous cannulation . Local lidocaine infiltration is impaired by applicational pain , whereas spraying the puncture site with ethyl chloride has no analgesic benefit BACKGROUND To our knowledge , verum acupuncture has never been directly compared with sham acupuncture and guideline -based conventional therapy in patients with chronic low back pain . METHODS A patient- and observer-blinded r and omized controlled trial conducted in Germany involving 340 outpatient practice s , including 1162 patients aged 18 to 86 years ( mean + /- SD age , 50 + /- 15 years ) with a history of chronic low back pain for a mean of 8 years . Patients underwent ten 30-minute sessions , generally 2 sessions per week , of verum acupuncture ( n = 387 ) according to principles of traditional Chinese medicine ; sham acupuncture ( n = 387 ) consisting of superficial needling at nonacupuncture points ; or conventional therapy , a combination of drugs , physical therapy , and exercise ( n = 388 ) . Five additional sessions were offered to patients who had a partial response to treatment ( 10%-50 % reduction in pain intensity ) . Primary outcome was response after 6 months , defined as 33 % improvement or better on 3 pain-related items on the Von Korff Chronic Pain Grade Scale question naire or 12 % improvement or better on the back-specific Hanover Functional Ability Question naire . Patients who were unblinded or had recourse to other than permitted concomitant therapies during follow-up were classified as nonresponders regardless of symptom improvement . RESULTS At 6 months , response rate was 47.6 % in the verum acupuncture group , 44.2 % in the sham acupuncture group , and 27.4 % in the conventional therapy group . Differences among groups were as follows : verum vs sham , 3.4 % ( 95 % confidence interval , -3.7 % to 10.3 % ; P = .39 ) ; verum vs conventional therapy , 20.2 % ( 95 % confidence interval , 13.4 % to 26.7 % ; P < .001 ) ; and sham vs conventional therapy , 16.8 % ( 95 % confidence interval , 10.1 % to 23.4 % ; P < .001 . CONCLUSIONS Low back pain improved after acupuncture treatment for at least 6 months . Effectiveness of acupuncture , either verum or sham , was almost twice that of conventional therapy Objective : To assess the efficacy of an orally administered antioxidant dietary supplement for managing marginal dry eye . Design : A prospect i ve , r and omised , placebo controlled trial with cross-over . Setting : Eye Clinic , Department of Vision Sciences , Glasgow Caledonian University . Subjects : Forty marginal dry eye sufferers composed of 30 females and 10 males ( median age 53 y ; range 38–69 y ) . Interventions : Baseline assessment s were made of tear volume sufficiency ( thread test ) , tear quality ( stability ) , ocular surface status ( conjunctival impression cytology ) and dry eye symptoms ( question naire ) . Each subject was administered courses of active treatment , placebo and no treatment , in r and om order for 1 month each and results compared to baseline . Results : Tear stability and ocular surface status were significantly improved following active treatment ( P<0.05 ) . No changes from baseline were detected following administration of placebo and no treatment ( P>0.05 ) . Absolute increase in tear stability correlated with absolute change in goblet cell population density . Tear volume was not improved following any treatment period and dry eye symptom responses were subject to placebo effect . Conclusions : Oral antioxidants improved both tear stability and conjunctival health , although it is not yet understood whether increased ocular surface health mediates increased tear stability or vice versa . Sponsors : This study was supported by a PhD scholarship funded by the Department of Vision Sciences , Glasgow Caledonian University , Scotl and . Antioxidant supplements and placebos were kindly donated by Vitabiotics . European Journal of Clinical Nutrition ( 2001 ) 55 , Background and Purpose — The effectiveness of functional electrical stimulation ( FES ) has been investigated in chronic hemiplegia . The present study examines whether FES , given during acute stroke , was more effective in promoting motor recovery of the lower extremity and walking ability than st and ard rehabilitation alone . Methods — Forty-six subjects , 70.9±8.0 years old and 9.2±4.1 days after stroke , were assigned r and omly to 1 of 3 groups receiving st and ard rehabilitation with FES or placebo stimulation or alone ( control ) . FES was applied 30 minutes and placebo stimulation 60 minutes , 5 days per week for 3 weeks . Outcome measurements included composite spasticity score , maximum isometric voluntary contraction of ankle dorsi-flexors and planter-flexors , and walking ability . They were recorded before treatment , weekly during the 3-week treatment , and at week 8 after stroke . Results — No significant differences were found in the baseline measurements . After 3 weeks of treatment , there was a significant reduction in the percentage of composite spasticity score , and a significant improvement in the ankle dorsiflexion torque , accompanied by an increase in agonist electromyogram and a reduction in electromyogram cocontraction ratio in the FES group , when compared with the other 2 groups ( P<0.05 ) . All subjects in the FES group were able to walk after treatment , and 84.6 % of them returned home , in comparison with the placebo ( 53.3 % ) and control ( 46.2 % , P<0.05 ) groups . Conclusions — Fifteen sessions of FES , applied to subjects with acute stroke plus st and ard rehabilitation , improved their motor and walking ability to the degree that more subjects were able to return to home Auricular acupuncture can be an effective treatment for acute anxiety , but there is a lack of direct comparisons of acupuncture to proven st and ard drug treatments . In this study we compared the efficacy of auricular acupuncture with intranasal midazolam , placebo acupuncture , and no treatment for reducing dental anxiety .  Patients having dental extraction s ( n = 67 ) were r and omized to ( i ) auricular acupuncture , ( ii ) placebo acupuncture , and ( iii ) intranasal midazolam and compared with a no treatment group .  Anxiety was assessed before the interventions , at 30 min , and after the dental extraction . Physiological variables were assessed continuously . With the no treatment group as control , the auricular acupuncture group , and the midazolam group were significantly less anxious at 30 min as compared with patients in the placebo acupuncture group ( Spielberger Stait-Trait Anxiety Inventory X1 , P = 0.012 and < 0.001 , respectively ) . In addition , patient compliance assessed by the dentist was significantly improved if auricular acupuncture or application of intranasal midazolam had been performed ( P = 0.032 and 0.049 , respectively ) . In conclusion , both , auricular acupuncture and intranasal midazolam were similarly effective for the treatment of dental anxiety Meditation training appears to be a promising psychological approach to the control of hypertension . However , most studies to date have had serious deficiencies . This study attempted to correct many of these deficiencies . Forty-one unmedicated hypertensives referred by general practitioners were r and omly allocated to three groups . The treatment group ( SRELAX ) underwent training procedures based on Transcendental Meditation ; a placebo control group ( NSRELAX ) underwent identical 
    Output:
    
Larger effects of placebo were also found in trials that did not inform patients about the possible placebo intervention .
We did not find that placebo interventions have important clinical effects in general .
However , in certain setting s placebo interventions can influence patient-reported outcomes , especially pain and nausea , though it is difficult to distinguish patient-reported effects of placebo from biased reporting .