***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 Tobacco use continues to be a global public health problem . Helping patients to quit is part of the preventive role of all health professionals . There is now increasing interest in the role that the dental team can play in helping their patients to quit smoking . The aim of this study was to determine the feasibility of undertaking a r and omised controlled smoking cessation intervention , utilising dental hygienists to deliver tobacco cessation advice to a cohort of periodontal patients . Methods One hundred and eighteen patients who attended consultant clinics in an outpatient dental hospital department ( Periodontology ) were recruited into a trial . Data were available for 116 participants , 59 intervention and 57 control , and were analysed on an intention-to-treat basis . The intervention group received smoking cessation advice based on the 5As ( ask , advise , assess , assist , arrange follow-up ) and were offered nicotine replacement therapy ( NRT ) , whereas the control group received ' usual care ' . Outcome measures included self-reported smoking cessation , verified by salivary cotinine measurement and CO measurements . Self-reported measures in those trial participants who did not quit included number and length of quit attempts and reduction in smoking . Results At 3 months , 9/59 ( 15 % ) of the intervention group had quit compared to 5/57 ( 9 % ) of the controls . At 6 months , 6/59 ( 10 % ) of the intervention group quit compared to 3/57 ( 5 % ) of the controls . At one year , there were 4/59 ( 7 % ) intervention quitters , compared to 2/59 ( 4 % ) control quitters . In participants who described themselves as smokers , at 3 and 6 months , a statistically higher percentage of intervention participants reported that they had had a quit attempt of at least one week in the preceding 3 months ( 37 % and 47 % , for the intervention group respectively , compared with 18 % and 16 % for the control group ) . Conclusion This study has shown the potential that trained dental hygienists could have in delivering smoking cessation advice . While success may be modest , public health gain would indicate that the dental team should participate in this activity . However , to add to the knowledge-base , a multi-centred r and omised controlled trial , utilising biochemical verification would be required to be undertaken CONTEXT Dental ( silver ) amalgam is a widely used restorative material containing 50 % elemental mercury that emits small amounts of mercury vapor . No r and omized clinical trials have determined whether there are significant health risks associated with this low-level mercury exposure . OBJECTIVE To assess the safety of  dental amalgam restorations in children . DESIGN A r and omized clinical trial in which children requiring dental restorative treatment were r and omized to either amalgam for posterior restorations or resin composite instead of amalgam . Enrollment commenced February 1997 , with annual follow-up for 7 years concluding in July 2005 . SETTING AND PARTICIPANTS A total of 507 children in Lisbon , Portugal , aged 8 to 10 years with at least 1 carious lesion on a permanent tooth , no previous exposure to amalgam , urinary mercury level < 10 microg/L , blood lead level < 15 microg/dL , Comprehensive Test of Nonverbal Intelligence IQ > or = 67 , and with no interfering health conditions . INTERVENTION Routine , st and ard-of-care dental treatment , with one group receiving amalgam restorations for posterior lesions ( n = 253 ) and the other group receiving resin composite restorations instead of amalgam ( n = 254 ) . MAIN OUTCOME MEASURES Neurobehavioral assessment s of memory , attention/concentration , and motor/visuomotor domains , as well as nerve conduction velocities . RESULTS During the 7-year trial period , children had a mean of 18.7 tooth surfaces ( median , 16 ) restored in the amalgam group and 21.3 ( median , 18 ) restored in the composite group . Baseline mean creatinine-adjusted urinary mercury levels were 1.8 microg/g in the amalgam group and 1.9 microg/g in the composite group , but during follow-up were 1.0 to 1.5 microg/g higher in the amalgam group than in the composite group ( P<.001 ) . There were no statistically significant differences in measures of memory , attention , visuomotor function , or nerve conduction velocities ( average z scores were very similar , near zero ) for the amalgam and composite groups over all 7 years of follow-up , with no statistically significant differences observed at any time point ( P values from .29 to .91 ) . Starting at 5 years after initial treatment , the need for additional restorative treatment was approximately 50 % higher in the composite group . CONCLUSIONS In this study , children who received dental restorative treatment with amalgam  did not , on average , have statistically significant differences in neurobehavioral assessment s or in nerve conduction velocity when compared with children who received resin composite material s without amalgam . These findings , combined with the trend of higher treatment need later among those receiving composite , suggest that amalgam should remain a viable dental restorative option for children . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00066118 Two methods are presented for the data analysis of signals derived by subtracting conditioned from control reflex data in full-wave rectified and averaged electromyographic ( EMG ) signals . The first method uses the ratios of the mean amplitudes and st and ard errors of the mean ( S.E.M.s ) ( i.e. Student 's t values ) of a series of data points in such a difference signal , and deals with the detection of latencies of reflex components which are susceptible to a conditioning stimulus or experimental situation . The second method applies a modified cumulative sum ( CUSUM ) technique to full-wave rectified difference signals . This modified CUSUM technique determines the magnitude of the effects of the conditioning situation above that expected due to chance fluctuations , taking into account the effect of reflex modulations on such chance fluctuations in a post-stimulus period . The modified CUSUM technique proved particularly useful when various subtle but consistent , opposing changes occurred sequentially in the conditioned series thus yielding a complicated pattern of effects in a difference signal , with a low signal-to-noise ratio R and omization in r and omized controlled trials involves more than generation of a r and om sequence by which to assign subjects . For r and omization to be successfully implemented , the r and omization sequence must be adequately protected ( concealed ) so that investigators , involved health care providers , and subjects are not aware of the upcoming assignment . The absence of adequate allocation concealment can lead to selection bias , one of the very problems that r and omization was supposed to eliminate . Authors of reports of r and omized trials should provide enough details on how allocation concealment was achieved so the reader can determine the likelihood of success . Fortunately , a plan of allocation concealment can always be incorporated into the design of a r and omized trial . Certain methods minimize the risk of concealment failing more than others . Keeping knowledge of subjects ' assignment after allocation from subjects , investigators/health care providers , or those assessing outcomes is referred to as masking ( also known as blinding ) . The goal of masking is to prevent ascertainment bias . In contrast to allocation concealment , masking can not always be incorporated into a r and omized controlled trial . Both allocation concealment and masking add to the elimination of bias in r and omized controlled trials We analysed 113 reports published in 1980 in a sample of medical journals to relate features of study design to the magnitude of gains attributed to new therapies over old . Overall we rated 87 per cent of new therapies as improvements over st and ard therapies . The mean gain ( measured by the Mann-Whitney statistic ) was relatively constant across study design s , except for non-r and omized controlled trials with sequential assignment to therapy , which showed a significantly higher likelihood that a patient would do better on the innovation than on st and ard therapy ( p = 0.004 ) . R and omized controlled trials that did not use a double-blind design had a higher likelihood of showing a gain for the innovation than did double-blind trials ( p = 0.02 ) . Any evaluation of an innovation may include both bias and the true efficacy of the new therapy , therefore we may consider making adjustments for the average bias associated with a study design . When interpreting an evaluation of a new therapy , readers should consider the impact of the following average adjustments to the Mann-Whitney statistic : for trials with non-r and om sequential assignment a decrease of 0.15 , for non-double-blind r and omized controlled trials a decrease of 0.11 The principles which underlie a well- design ed clinical trial were introduced in a previous paper . The trial should be controlled ( to ensure that the appropriate comparisons are made ) , r and omised ( to avoid allocation bias ) and , preferably , blinded ( to obviate assessment bias ) . However , taken in isolation , these concepts will not necessarily ensure that meaningful conclusions can be drawn from the study . It is essential that the sample size is large enough to enable the effects of interest to be estimated precisely , and to detect any real treatment differences . Purpose : Nonselective cyclooxygenase ( COX ) inhibitors have been reported to decrease the frequency of upper aerodigestive cancers . Ketorolac tromethamine oral rinse has been shown to resolve another COX-dependent process , periodontal disease , without incurring gastrointestinal side effects . This trial evaluated if a topically delivered oral rinse containing ketorolac was as safe as and more effective than oral rinse alone in reducing the area of oral leukoplakia . Experimental Design : 57 patients were r and omized ( 2:1 ratio ) in a double-blind , placebo-controlled study of ketorolac ( 10 ml of a 0.1 % ketorolac rinse solution ; n = 38 ) or placebo ( 10 ml of rinse solution ; n = 19 ) given twice daily for 30 s over 90 days . Primary end point was evaluated visually obtaining bidimensional measurement of the size of leukoplakia lesion(s ) at entry and at 90 days . Secondary end point was histological assessment of the leukoplakia as sample d by serial punch biopsy and independently review ed by three pathologists . Results : The patients included 67 % males , 11 % non-Caucasian , and 86 % used tobacco with no significant differences between the two arms . Both rinses were well tolerated with good compliance , and there was no significant difference in adverse events ( P = 0.27 ) . Major response rate ( complete response and partial response ) was 30 % for ketorolac and 32 % for the placebo arm . There was no significant difference in change in histology between the two arms . Conclusion : Local delivery of a COX-containing oral rinse was well tolerated but produced no significant reduction in the extent of leukoplakia compared with the placebo . However , the favorable response rate to placebo arm remains unexplained and additional investigation of the tissue penetration with ketorolac is warranted The antimicrobial efficacy of endodontic procedures performed in one-visit ( including a 10-min intraappointment dressing with 5 % iodine-potassium-iodide ) was compared with a two-visit procedure ( including an interappointment dressing with calcium-hydroxide paste ) . Teeth with apical periodontitis ( n = 96 ) were r and omly assigned to either group .  Root canal sampling and culturing  were performed before and immediately after instrumentation , and after medication . Initial sampling demonstrated the presence of microorganisms in 98 % of the teeth . Postinstrumentation sampling showed reduction of cultivable microbiota . Antibacterial dressing further reduced the number of teeth with surviving microbes . In the postmedication sample s , residual microorganisms were recovered in 29 % of the one-visit teeth and in 36 % of the two-visit treated teeth . No statistically significant differences between the groups were discerned . It was concluded that from a microbiological point of view , treatment of teeth with apical periodontitis performed in two appointments was not more effective than the investigated one-visit procedure A clinical trial of 201 posterior resin-bonded bridges ( PRBBs ) was conducted partially in a University clinic and partially in general dental practice s , for study of the influence of some experimental variables on the survival of these restorations . This report contains the results of an interim analysis which was done after 2.5 years ' follow-up . No significant differences were found among the bonding systems used to adhere the PRBBs ( Clearfil F2/etching , Panavia EX/s and blasting , and Microfill Pontic C/silicate-coating ) , or among the different preparation forms . PRBBs made in general dental practice s were as retentive as those made in the University clinic . The " location " factor was found to be highly significant ( p = 0.0001 ) . The survival rates were 81 % for maxillary PRBBs and 56 % for m and ibular PRBBs We studied the efficacy of curcuminoids in the treatment of oral lichen planus ( OLP ) , a chronic , mucocutaneous , immunological disease . Curcuminoids are components of turmeric ( Curcuma longa ) that have anti-inflammatory activity . Turmeric has been used in Ayurveda ( Indian traditional medicine ) for centuries . A r and omized , double-blind , placebo-controlled trial was conducted . In all , 100 consecutive , eligible patients with OLP presenting to the oral medicine clinic at the University of California , San Francisco , were to be selected . Two interim analyses were to be conducted during the trial . The trial was conducted between February 2003 and September 2004 . The first interim analysis was conducted in October 2004 using data from the first  
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We conclude that sequential analysis  seems to be underused in this field but that there are sufficient method ological re sources in place for future applications