***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 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 ) Summary This multifactorial mixed‐ methods r and omized controlled trial quantified the specific and nonspecific factors of acupuncture , and found that the practitioner , not the treatment , has the strongest effect on outcome . Abstract The nonspecific effects of acupuncture are well documented ; we wished to quantify these factors in osteoarthritic ( OA ) pain , examining needling , the consultation , and the practitioner . In a prospect i ve r and omised , single‐blind , placebo‐controlled , multifactorial , mixed‐ methods trial , 221 patients with OA awaiting joint replacement surgery were recruited . Interventions were acupuncture , Streitberger placebo acupuncture , and mock electrical stimulation , each with empathic or nonempathic consultations . Interventions involved eight 30‐minute treatments over 4 weeks . The primary outcome was pain ( VAS ) at 1 week posttreatment . Face‐to‐face qualitative interviews were conducted ( purposive sample , 27 participants ) . Improvements occurred from baseline for all interventions with no significant differences between real and placebo acupuncture ( mean difference −2.7 mm , 95 % confidence intervals −9.0 to 3.6 ; P = .40 ) or mock stimulation ( −3.9 , −10.4 to 2.7 ; P = .25 ) . Empathic consultations did not affect pain ( 3.0 mm , −2.2 to 8.2 ; P = .26 ) but practitioner 3 achieved greater analgesia than practitioner 2 ( 10.9 , 3.9 to 18.0 ; P = .002 ) . Qualitative analysis indicated that patients ’ beliefs about treatment veracity and confidence in outcomes were reciprocally linked . The supportive nature of the trial attenuated differences between the different consultation styles . Improvements occurred from baseline , but acupuncture has no specific efficacy over either placebo . The individual practitioner and the patient ’s belief had a significant effect on outcome . The 2 placebos  were equally as effective and credible as acupuncture . Needle and nonneedle placebos are equivalent . An unknown characteristic of the treating practitioner predicts outcome , as does the patient ’s belief ( independently ) . Beliefs about treatment veracity shape how patients self‐report outcome , complicating and confounding study interpretation The neurocognitive pathways by which placebo effects operate are poorly understood . Positron emission tomography ( PET ) imaging was used to assess the brain response of patients with chronic abdominal pain ( irritable bowel syndrome ; IBS ) to induced intestinal discomfort both before and after a 3-week placebo regimen .  A daily symptom diary was used to measure symptom improvement . Increases in right ventrolateral prefrontal cortex ( RVLPFC ) activity from pre- to post-placebo predicted self-reported symptom improvement , and this relationship was mediated by changes in dorsal anterior cingulate ( dACC ) , typically associated with pain unpleasantness . These results are consistent with disruption theory [ Lieberman , M.D. , 2003 . Reflective and reflexive judgment processes : a social cognitive neuroscience approach . In : Forgas , J.P. , Williams , K.R. , von Hippel , W. ( Eds . ) , Social Judgments : Explicit and Implicit Processes . Cambridge Univ . Press , New York , pp . 44 - 67 ] , which proposes that activation of prefrontal regions associated with thinking about negative affect can diminish dACC and amygdala reactivity to negative affect stimuli . This is the first study to identify a neural pathway from a region of the brain associated with placebos and affective thought to a region closely linked to the placebo-related outcome of diminished pain unpleasantness Behavioral conditioned immunosuppression has been described in rodents as the most impressive demonstration of brain-to-immune system interaction . To analyze whether behavioral conditioned immunosuppression is possible in humans , healthy subjects in this double-blind , placebo-controlled study were conditioned in four sessions over 3 consecutive days , receiving the immunosuppressive drug cyclosporin A as an unconditioned stimulus paired with a distinctively flavored drink ( conditioned stimulus ) each 12 h. In the next week , re-exposure to the conditioned stimulus ( drink ) , but now paired with placebo capsules , induced a suppression of immune functions as analyzed by the IL-2 and IFN-gamma mRNA expression , intracellular production , and in vitro release of IL-2 and IFN-gamma , as well as lymphocyte proliferation . These data demonstrate for the first time that immunosuppression can be behaviorally conditioned in humans Objectives To evaluate the completeness of descriptions of non-pharmacological interventions in r and omised trials , identify which elements are most frequently missing , and assess whether authors can provide missing details . Design Analysis of consecutive sample of r and omised trials of non-pharmacological interventions . Data sources and study selection All reports of r and omised trials of non-pharmacological interventions published in 2009 in six leading general medical journals ; 133 trial reports , with 137 interventions , met the inclusion criteria . Data collection Using an eight item checklist , two raters assessed the primary full trial report , plus any reference material s , appendices , or websites . Questions about missing details were emailed to corresponding authors , and relevant items were then reassessed . Results Of 137 interventions , only 53 ( 39 % ) were adequately described ; this was increased to 81 ( 59 % ) by using 63 responses from 88 contacted authors . The most frequently missing item was the “ intervention material s ” ( 47 % complete ) , but it also improved the most after author response ( 92 % complete ) . Whereas some authors ( 27/70 ) provided material s or further information , other authors ( 21/70 ) could not ; their reasons included copyright or intellectual property concerns , not having the material s or intervention details , or being unaware of their importance . Although 46 ( 34 % ) trial interventions had further information or material s readily available on a website , many were not mentioned in the report , were not freely accessible , or the URL was no longer functioning . Conclusions Missing essential information about interventions is a frequent , yet remediable , contributor to the worldwide waste in research funding . If trial reports do not have a sufficient description of interventions , other research ers can not build on the findings , and clinicians and patients can not reliably implement useful interventions . Improvement will require action by funders , research ers , and publishers , aided by long term repositories of material s linked to publications & NA ; Patients are often prepared for procedural discomforts with descriptions of pain or undesirable experiences . This practice is thought to be compassionate and helpful , but there is little data on the effect of such communicative behavior . This study assesses how such descriptions affect patients ' pain and anxiety during medical procedures . The interactions of patients with their healthcare providers during interventional radiological procedures were videotaped during a previously reported 3‐arm prospect i ve r and omized trial assessing the efficacy of self‐hypnotic relaxation .  One hundred and fifty‐nine videos of the st and ard care and attention control arms were review ed . All statements that described painful or undesirable experiences as warning before potentially noxious stimuli or as expression of sympathy afterwards were recorded . Patients ' ratings of pain and anxiety on 0–10 numerical scales ( 0=No Pain , No Anxiety at All and 10=Worst Pain Possible , Terrified ) after the painful event and /or sympathizing statement were the basis for this study . Warning the patient in terms of pain or undesirable experiences result ed in greater pain ( P<0.05 ) and greater anxiety ( P<0.001 ) than not doing so . Sympathizing with the patient in such terms after a painful event did not increase reported pain , but result ed in greater anxiety ( P<0.05 ) . Contrary to common belief , warning or sympathizing using language that refers to negative experiences may not make patients feel better . This conclusion has implication s for the training in medical communication skills and suggests the need for r and omized trials testing different patient – practioner interactions PURPOSE To use a st and ardized videotape stimulus to assess the effect of physician compassion on viewers ' anxiety , information recall , treatment decisions , and assessment of physician characteristics . PARTICIPANTS AND METHODS One hundred twenty-three healthy female breast cancer survivors and 87 women without cancer were recruited for this study . A r and omized pretest/posttest control group design with a st and ardized videotape intervention was used . Participants completed the State-Trait Anxiety Inventory ( STAI ) , an information recall test , a compassion rating , and physician attribute rating scales . RESULTS Women who saw an " enhanced compassion " videotape rated the physician as warmer and more caring , sensitive , and compassionate than did women who watched the " st and ard " videotape . Women who saw the enhanced compassion videotape were significantly less anxious after watching it than the women in the other group . Nevertheless , information recall was relatively low for both groups , and enhanced compassion did not influence patient decisions . Those who saw the enhanced compassion videotape rated the doctor significantly higher on other positive attributes , such as wanting what was best for the patient and encouraging the patient 's questions and involvement in decisions . CONCLUSION The enhanced compassion segment was short , simple , and effective in decreasing viewers ' anxiety . Further research is needed to translate these findings to the clinical setting , where reducing patient anxiety is a therapeutic goal Background A significant proportion of trial participants respond to placebos for a variety of conditions . Despite the common conduct of these trials and the strong emphasis placed on informed consent , very little is known about informing participants about their individual treatment allocation at trial closure . This study aims to address this gap in the literature by exploring treatment beliefs and reactions to feedback about treatment allocation in the participants of a placebo-controlled r and omized clinical trial ( RCT ) . Methods Survey of trial participants using a semi-structured question naire including close and open-ended questions administered as telephone interviews and postal question naires . Trial participants were enrolled in a double-blind placebo-controlled RCT evaluating the effectiveness of corticosteroid for heel pain ( IS RCT N36539116 ) . The trial had closed and participants remained blind to treatment allocation . We assessed treatment expectations , the percentage of participants who wanted to be informed about their treatment allocation , their ability to guess and reactions to debriefing . Results Forty-six ( 73 % ) contactable participants responded to our survey . Forty-two were eligible ( four participants with bilateral disease were excluded as they had received both treatments ) . Most ( 79 % ) participants did not have any expectations prior to receiving treatment , but many ' hoped ' that something would help . Reasons for not having high expectations included the experimental nature of their care and possibility that they may get a placebo . Participants were hopeful because their pain was so severe and because they trusted the staff and services . Most ( 83 % ) wanted to be informed about their treatment allocation and study results . Over half ( 55 % ) said they could not guess which treatment they had been r and omized to , and many of those who attempted a guess were incorrect . Reactions to treatment debriefing were generally positive , including in placebo responders . Conclusion Our study suggests that most trial participants want to be informed about their treatment allocation and trial results . Further research is required to develop measure of hope and expectancy and to rigorously evaluate the effects of debriefing prospect ively The placebo and nocebo effect is believed to be mediated by both cognitive and conditioning mechanisms , although little is known about their role in different circumstances . In this study , we first analyzed the effects of opposing verbal suggestions on experimental ischemic arm pain in healthy volunteers and on motor performance in Parkinsonian patients and found that verbally induced expectations of analgesia/hyperalgesia and motor improvement/worsening antagonized completely the effects of a conditioning procedure . We also measured the effects of opposing verbal suggestions on hormonal secretion and found that verbally induced expectations of increase/decrease of growth hormone ( GH ) and cortisol did not have any effect on the secretion of these hormones . However , if a preconditioning was performed with sumatriptan , a 5-HT1B/1D agonist that stimulates GH and inhibits cortisol secretion , a significant increase of GH and decrease of cortisol plasma concentrations were found after placebo administration , although opposite verbal suggestions were given . These findings indicate that verbally induced expectations have no effect on hormonal secretion , whereas they affect pain and motor performance . This suggests that placebo responses are mediated by conditioning when unconscious physiological functions such as hormonal secretion are involved , whereas they are mediated by expectation when conscious physiological processes such as pain and motor performance come into play , even though a conditioning procedure is performed OBJECTIVE The goal of this study was to show that physician communication style of breaking bad news affects how the physician is perceived , how satisfied recipients of bad news are with the consultation , and how they feel after the consultation . METHOD Female participants ( students , N=159 ) were asked to put themselves in the shoes of a patient receiving the bad news of a breast cancer diagnosis . Participants were r and omly assigned to watch one of three prototypical physician communication styles of breaking bad news on videotape : patient- , disease- , or emotion-centered communication . R 
    Output:
    
We found that , in general , communication has a small effect on ( acute ) pain .
Some of the 23 procedural preparation interventions showed a weak to moderate effect on lowering pain .
CONCLUSIONS Different types of communication have a significant but small effect on ( acute ) pain .
Positive suggestions and informational preparation seem to lower patients ' pain .