***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 research and development costs of 68 r and omly selected new drugs were obtained from a survey of 10 pharmaceutical firms . These data were used to estimate the average pre-tax cost of new drug development . The costs of compounds ab and oned during testing were linked to the costs of compounds that obtained marketing approval . The estimated average out-of-pocket cost per new drug is 403 million US dollars ( 2000 dollars ) . Capitalizing out-of-pocket costs to the point of marketing approval at a real discount rate of 11 % yields a total pre-approval cost estimate of 802 million US dollars ( 2000 dollars ) . When compared to the results of an earlier study with a similar methodology , total capitalized costs were shown to have increased at an annual rate of 7.4 % above general price inflation Background . Acupuncture might have effectiveness in relieving the symptoms of  chronic urticaria . There are currently no systematic review s of acupuncture for chronic urticaria published in English . Objective . We conducted a systematic review to assess the effectiveness and safety of acupuncture for chronic urticaria . Methods . A systematic review and meta- analysis of r and omized , controlled trials were performed . The primary outcome was global symptom improvement . Results . We included 6 studies with 406 participants . Three trials showed significant difference between acupuncture and drugs in global symptom improvement ( relative risk 1.37 ; 95 % CI 1.11–1.70 ; P = 0.003 ) . As an adjuvant to medication , acupuncture was also beneficial for global symptom improvement ( relative risk 1.77 ; 95 % CI 1.41–2.22 ; P < 0.01 ) . There were no severe adverse events related to acupuncture . Limitations . Some method ological limitations were observed . The overall risk of bias in the 6 included trials was high and all included RCTs were conducted in China and published in Chinese . Besides , the lack of proper control groups and the use of different rating methods and cut-offs in the included trials also made the evidence of this review limited . Conclusions . Acupuncture might be effective and safe for chronic urticaria in relieving symptoms , based on a low level of evidence . To draw a reliable conclusion , more high quality trials are needed in the future . This trial is registered with PROSPERO CRD42015015702 OBJECTIVE Our purpose was to measure the agreement , reliability , construct validity , and feasibility of a measurement tool to assess  systematic review s ( AMSTAR ) . STUDY DESIGN AND SETTING We r and omly selected 30 systematic review s from a data base . Each was assessed by two review ers using : ( 1 ) the enhanced quality assessment question naire ( Overview of Quality Assessment Question naire [ OQAQ ] ) ; ( 2 ) Sacks ' instrument ; and ( 3 ) our newly developed measurement tool ( AMSTAR ) . We report on reliability ( interobserver kappas of the 11 AMSTAR items ) , intraclass correlation coefficients ( ICCs ) of the sum scores , construct validity ( ICCs of the sum scores of AMSTAR compared with those of other instruments ) , and completion times . RESULTS The interrater agreement of the individual items of AMSTAR was substantial with a mean kappa of 0.70 ( 95 % confidence interval [ CI ] : 0.57 , 0.83 ) ( range : 0.38 - 1.0 ) . Kappas recorded for the other instruments were 0.63 ( 95 % CI : 0.38 , 0.78 ) for enhanced OQAQ and 0.40 ( 95 % CI : 0.29 , 0.50 ) for the Sacks ' instrument . The ICC of the total score for AMSTAR was 0.84 ( 95 % CI : 0.65 , 0.92 ) compared with 0.91 ( 95 % CI : 0.82 , 0.96 ) for OQAQ and 0.86 ( 95 % CI : 0.71 , 0.94 ) for the Sacks ' instrument . AMSTAR proved easy to apply , each review taking about 15 minutes to complete . CONCLUSIONS AMSTAR has good agreement , reliability , construct validity , and feasibility . These findings need confirmation by a broader range of assessors and a more diverse range of review Objectives To examine the evidence derived from r and omized controlled clinical trials on the efficacy and safety of omalizumab compared to placebo in controlling symptoms of  chronic idiopathic urticaria/chronic spontaneous urticaria ( CIU/CSU ) . Data source The electronic data bases PubMed , Medline , EMBASE , Biomed Central , The Cochrane Central Register of Controlled Trials ( CENTRAL ) , Wiley , OVID , and HighwirePress were review ed . The date limit was set to May 31th , but it was extended to September 30th of 2014 due to a new publication . No language restriction was used . The articles included were r and omized trials controlled with placebo  in individuals older than 12 years diagnosed with CIU/CSU refractory to conventional treatment , the intervention being , omalizumab at different doses , and the comparison , placebo . The primary outcome was symptom improvement according to the weekly score of urticaria severity ( UAS7 ) , the itch severity score ( ISS ) , the weekly score of number of urticarial lesions , the dermatology life quality index , and the chronic urticaria quality of life question naire ( CU-QoL ) . Data bases were search ed using the following Mesh or EMTREE key words including as intervention “ omalizumab ” or “ humanized monoclonal antibody , ” compared to placebo and the disease of interest “ urticaria ” or “ angioedema ” . The title , abstract and article were review ed by two independent investigators , according to the selection criteria in each of the data bases . An assessment of the quality of the articles was performed according to the bias tool from the studies of the Cochrane Collaboration . Information such as author data , date of study , number of participants , interventions , dose and frequency of administration , comparison , time of follow-up , measurements of weekly score of urticaria activity , pruritus severity score , weekly urticarial lesions , percentage of angioedema and post-treatment change were extracted . Frequency of adverse events and the ones suspected to be caused by the intervention drug were included . Results 770 records were identified in all data bases described . 720 were eliminated for failing to meet the inclusion criteria in the first review or for duplicate records . 24 articles were review ed by abstract , 18 additional articles were further removed , leaving 6 records for inclusion . An experimental study was excluded because it was n’t r and omized . Five studies were finally included , with 1117 patients , of these 831 received a dose of omalizumab of 75 mg ( 183 patients , 16.38 % ) , 150 mg ( 163 patients , 14.59 % ) , 300 mg ( 437 patients , 39.12 % ) or 600 mg ( 21 patients , 1.8 % ) , as a single dose , or every 4 weeks until 24 weeks maximum . The average age was 42.07 years , predominantly female gender and white ethnicity . It was observed that the use of omalizumab 300 mg lowered the weekly scores of urticarial activity in 19.9 vs. 6.9 on placebo ( p < 0.01 ) , 19 vs 8.5 and 20.7 vs 8.01 in three studies , the weekly ISS ( −9.2 vs. - 3.5 , p < 0.001 , −9.8 vs −5.1 p < 0.01 , −8.6 vs −4.0 and −9.4 vs −3.63 p < 0.001 in four studies ) , and the percentage of angioedema-free days  ( omalizumab 95.5 % vs. placebo 89.2 % p < 0.001 , and 91.95 % vs. 88.1 % p < 0.001 in two of the studies respectively ) . Limitations The different doses used throughout the study , time of administration and follow-up periods ranged from single dose to monthly dose for 24 weeks . Therefore no meta- analysis of the review was conducted . Conclusions and implication s of the main findings Despite the limitations , it is considered that omalizumab 300 mg is effective in treating chronic idiopathic urticaria  refractory to H1 antihistamines . Further studies are required to determine the duration of effective treatment . Registration number of the systematic review http://www.crd.york.ac.uk/ PROSPERO /display_record.asp?ID = CRD42014010029#.VJDr1vl5PpM ( PROSPERO . International Prospect i ve Register of Systematic Review s ) Aims : With the increase in the number of systematic review s available , a logical next step to provide decision makers in healthcare with the evidence they require has been the conduct of review s of existing systematic review s. Syntheses of existing systematic review s are referred to by many different names , one of which is an umbrella review . An umbrella review allows the findings of review s relevant to a review question to be compared and contrasted . An umbrella review 's most characteristic feature is that this type of evidence synthesis only considers for inclusion the highest level of evidence , namely other systematic review s and meta-analyses . A methodology working group was formed by the Joanna Briggs Institute to develop method ological guidance for the conduct of an umbrella review , including diverse types of evidence , both quantitative and qualitative . The aim of this study is to describe the development and guidance for the conduct of an umbrella review . Methods : Discussion and testing of the elements of methods for the conduct of an umbrella review were held over a 6-month period by members of a methodology working group . The working group comprised six participants who corresponded via teleconference , e-mail and face-to-face meeting during this development period . In October 2013 , the methodology was presented in a workshop at the Joanna Briggs Institute Convention . Workshop participants , review authors and method ologists provided further testing , critique and feedback on the proposed methodology . Results : This study describes the methodology and methods developed for the conduct of an umbrella review that includes published systematic review s and meta-analyses as the analytical unit of the review . Details are provided regarding the essential elements of an umbrella review , including presentation of the review question in a Population , Intervention , Comparator , Outcome format , nuances of the inclusion criteria and search strategy . A critical appraisal tool with 10 questions to help assess risk of bias in systematic review s and meta-analyses was also developed and tested . Relevant details to extract from included review s and how to best present the findings of both quantitative and qualitative systematic review s in a reader friendly format are provided . Conclusions : Umbrella review s provide a ready means for decision makers in healthcare to gain a clear underst and ing of a broad topic area . The umbrella review methodology described here is the first to consider review s that report other than quantitative evidence derived from r and omized controlled trials . The methodology includes an easy to use and informative summary of evidence table to readily provide decision makers with the available , highest level of evidence relevant to the question posed The effect of 60 mg twice-daily fexofenadine HCl on health-related quality of life and productivity at work , in the classroom , and during daily activities in patients with moderate to severe chronic idiopathic urticaria symptoms was studied in two identical , 4-week , placebo-controlled , multicenter clinical trials . Patients self-administered the Dermatology Life Quality Index ( score , 0 - 30 ) and the Work Productivity and Activity Impairment instrument ( 0%-100 % ) . In both trials , improvements in Dermatology Life Quality Index scores in  fexofenadine-treated patients ( N = 169 ) were statistically significant compared with placebo ( P < or = .0002 ) . Similarly , improvements in productivity scores with fexofenadine 60 mg twice daily were statistically superior to placebo at work ( n = 120 , P < or = .0152 ) and in performance of daily activities ( n = 166 , P < or = .0002 ) . There was a trend toward improved classroom productivity ( n = 26 ) with fexofenadine . We conclude fexofenadine 60 mg twice daily improves health-related quality of life , increases work productivity , and improves performance of daily activities in patients with moderate to severe chronic idiopathic urticaria INTRODUCTION Chronic Urticaria is a difficult to define condition from the nosographic st and point , with complex pharmacological management , that heavily impacts the life of the patient . Some forms show not to be responsive to anti H1 anti-histaminic and require other treatments . One of these can be the treatment with Cyclosporine A ( CsA ) . MATERIAL S AND METHODS This study , open and sequential , reports the results of short-term treatment over a sample of adults ( 21 patients ) of both sexes , all suffering from chronic urticaria with IgE levels higher than 200 mU/ml treated with 4 mg/kg/die of CsA.  RESULTS The results obtained show a reduction in the levels of total IgE and a significant improvement in symptoms ; there were no adverse effects . CONCLUSIONS Cyclosporine is an excellent treatment for chronic urticaria because it reduces the activity of T lymphocytes and reduction of the histamine release from the mast cells and basophils Background : Omalizumab , a recombinant anti‐IgE antibody , effectively treats chronic spontaneous urticaria . Evidence is lacking in patients with chronic inducible urticarias ( CInd 
    Output:
    
There is some evidence to support a variety of interventions for CU .
Moreover , there remained little information on the relative effectiveness of one intervention compared with another .