***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: A system has been constructed to evaluate the design , implementation , and analysis of  r and omized control trials ( RCT ) . The degree of quadruple blinding ( the r and omization process , the physicians and patients as to therapy , and the physicians as to ongoing results ) is considered to be the most important aspect of any trial . The analytic techniques are scored with the same emphasis as is placed on the control of bias in the planning and implementation of the studies . Description of the patient and treatment material s and the measurement of various controls of quality have less weight . An index of quality of a RCT is proposed with its pros and cons . If published papers were to approximate these principles , there would be a marked improvement in the quality of r and omized control trials . Finally , a reasonable st and ard design and conduct of trials will facilitate the interpretation of those with conflicting results and help in making valid combinations of undersized trials Meta-analytic investigations sometimes use assessment s of research quality according to a formal protocol as a tool for improving research synthesis . We asked whether a particular  quality scoring system could have a direct use in adjusting the summary estimates of a treatment difference . In an empirical study of the relation of quality scores to treatment differences in published meta-analyses of 7 groups of controlled r and omized clinical trials comprising 107 primary studies , we found no relation between treatment difference and overall quality score . We also found no relation between quality score and variation in treatment difference . The level of quality scores has increased at a rate of 9 % per decade for three decades , averaging 0.51 on a scale of 0 to 1 for the 1980s , and leaving much room for improvement . Nevertheless , attention to quality of studies by editors , review ers , and authors may be raising both the level of research done and quality of the reports A clinical trial can not be adequately interpreted without information about the methods used in the design of the study and the analysis of the results . To determine the frequency of reporting what we consider 11 important aspects of design and analysis , we surveyed all 67 clinical trials published in the New Engl and Journal of Medicine , the Lancet , and the British Medical Journal from July through December 1979 and in the Journal of the American Medical Association from July 1979 through June 1980 . Of all 11 items in the 67 trials published in all four journals , 56 per cent were clearly reported , 10 per cent were ambiguously mentioned , and 34 per cent were not reported at all . At least 80 per cent of the 67 trials reported information about  statistical analyses , statistical methods used , and  r  and  om allocation  of subjects , yet only 19 per cent reported the method of r and omization . Loss to follow-up was discussed in 79 per cent of the articles , treatment complications in 64 per cent , and admission of subjects before allocation in 57 per cent , but eligibility criteria for admission to the trial appeared in only 37 per cent . Although information about whether patients were blind to treatment was given in 55 per cent , information about whether there was blind assessment of outcome was reported in only 30 per cent . The statistical power of the trial to detect treatment effects was discussed in only 12 per cent of the articles . The clinical trials published in The New Engl and Journal of Medicine reported 71 per cent of the 11 items , those in the Journal of the American Medical Association 63 per cent , those in the British Medical Journal 52 per cent , and those in the Lancet 46 per cent . These rates are significantly different ( P less than 0.001 ) . We recommend that editors improve the reporting of clinical trials by giving authors a list of the important items to be reported A study was made at r and om on 70 female patients with advanced mamma carcinoma to find out whether an additional treatment with Esberitox N prevents or diminishes the sideeffects of a combined chemo-radiation therapy . As it could not be excluded that the efficacy of Esberitox N on previous affliction by haematotoxic therapy would probably differ , the study was made on various groups of risk . The parameter to form an opinion were either the peripheral hematosis or the appearance of infections . It turned out , however , that Esberitox N proved only effective if there was only a minor damage of the bonemarrow . The efficacy seems to promote the recuperation of the haemapoetic system . There was no significant frequency of infections by the additional Esberitox N treatment , yet in tendency favourably influenced 
    Output:
    
Existing controlled clinical trials indicate that preparations containing extracts of Echinacea can be efficacious immunomodulators .
However , the evidence is still insufficient for clear therapeutic recommendations as to which preparation to use and which dose to employ for a specific indication .