***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 It has been proposed that 50%-75 % of the efficacy of antidepressant medication represents the placebo effect , since many depressed patients improve when treated with either medication or placebo . This study examined brain function in depressed subjects receiving either active medication or placebo  and sought to determine whether quantitative electroencephalography ( QEEG ) could detect differences in brain function between medication and placebo responders . Both QEEG power and cordance , a new measure that reflects cerebral perfusion and is sensitive to the effect of antidepressant medication , were examined . METHOD Fifty-one subjects with major depression were enrolled in one of two independent , 9-week double-blind , placebo-controlled studies in which either fluoxetine ( N=24 ) or venlafaxine ( N=27 ) was the active medication . Serial QEEG recordings were performed during the course of treatment . After 9 weeks , the blind was broken and subjects were classified as medication responders , placebo responders , medication nonresponders , or placebo nonresponders . RESULTS No significant pretreatment differences in clinical or QEEG measures were found among the four outcome groups . Placebo responders , however , showed a significant increase in prefrontal cordance starting early in treatment that was not seen in medication responders ( who showed decreased cordance ) or in medication nonresponders or placebo nonresponders ( who showed no significant change ) . There was no significant change in QEEG power during treatment . CONCLUSIONS These findings suggest that " effective " placebo treatment induces changes in brain function that are distinct from those associated with antidepressant medication . If these results are confirmed , cordance may be useful for differentiating between medication and placebo responders 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 training but without a mantra . Both procedures were compared with a no-treatment control group . The results showed modest reductions in blood pressure in both SRELAX and NSRELAX groups , compared with the no-treatment controls , with diastolic percentage reductions reaching significance ( p<0.05 ) . There was considerable subject variation in response , with overall a mean decline in diastolic blood pressure of 8–10 % on 3-month follow-up . Possible indicators to predict the response of subjects are considered and reasons for the similarity in the effectiveness of the SRELAX and NSRELAX conditions are discussed Twenty‐seven long‐term psychiatric in patients maintained on neuroleptics with concomitant antiparkinsonian medication were entered into a study in which anticholinergic medication was gradually withdrawn in a r and omized double‐blind within‐subjects design . The extrapyramidal symptoms of each patient were compared when taking their usual anticholinergic medication , when taking placebo and when taking no antiparkinsonian drug . The relapse rate on no medication was 14 % , and if patients relapsed on no medication they also relapsed on placebo . The relapse rate was not significantly different on active medication . Nor were there significant differences in ratings of parkinsonism or dyskinesia . The lack of difference between double‐blind and overt withdrawal does not mean that studies that find a much higher relapse rate are necessarily unaffected by nonspecific factors , as significant unblinding may occur in clinical trials A prospect i ve , r and omized , controlled study was carried out to investigate the dilating and softening effect on the cervix of prostagl and in F2-alpha gel administered intracervically and of prostagl and in E2 tablets administered orally . A total of 581 patients were included in the study : 149 received 2.5 mg prostagl and in F2-alpha in gel form intracervically , 150 received 1 mg prostagl and in E2 in tablet form orally , 138 were given placebo gel and 144 no medication at all . In the group given prostagl and in F2-alpha gel intracervically , success was achieved in 85.8 % of patients and partial success in 8.8 % . In the group given prostagl and in E2 tablets orally , the results were successful in 29.4 % and partially successful in 40.6 % . The incidence of side effects in the group given prostagl and in F2-alpha gel was rather high - 53 % . The results show that prostagl and in can bring about a certain softening of the cervix , but side effects can not be ruled out . Nevertheless , priming of the cervix is to be recommended in young primigravidas Studies in smoking cessation have generally failed to adequately control for active treatment effects and have assumed that measures of smoking behaviour ( i.e. , estimated smoking rate , self-monitoring and chemical analysis ) are equally reliable measures . Sixty smokers were r and omly assigned to one of four different smoking cessation treatment groups : hypnosis , focussed smoking , attention placebo and a waiting list control . Subjects were asked to estimate and monitor their own smoking  behaviour . Blood sample s were also taken for thiocyanate analysis before treatment . Smoking rates were similarly measured directly , at 3 months and 6 months after treatment . The results indicate that the three measures of smoking behaviour were all highly correlated . No significant differences were found between treatments , directly after treatment or at the 3- and 6-month follow-ups . These results suggest that active treatment effects may not be responsible for behavioural change in a smoking cessation program . The implication s of these findings are discussed PURPOSE To compare reduced colonic cleansing based on dietary fecal tagging ( FT ) with st and ard ( non-FT ) colonic cleansing with regard to patient acceptance , sensitivity , and specificity . MATERIAL S AND METHODS In 50 patients ( FT group ) , FT was performed by means of diet , magnesium citrate , and a barium suspension . In another 50 patients ( non-FT group ) , preparation was based on polyethylene glycol administration .  All patients underwent conventional colonoscopy after computed tomographic ( CT ) colonography .  Sensitivity and specificity for polyp detection were calculated by using conventional colonography as the reference st and ard . At CT colonography , fecal residue was evaluated . Patients were interviewed to determine discomfort , side effects , sleep quality , final opinion on examination comfort , and whether they would be reluctant to undergo the same examination again . RESULTS FT left more fecal residue but improved differentiation from polyps ( FT specificity , 88 % [ 30 of 34 patients ] ; non-FT , 77 % [ 23 of 30 patients ] ) . Sensitivities were comparable : FT , 88 % ( 14 of 16 patients ) ; non-FT , 85 % ( 17 of 20 patients ) . FT significantly reduced discomfort , side effects , and sleep disturbance , and result ed in an improved final opinion of how comfortable the examination was ( P < .05 ) . Although FT improved patient willingness to repeat the examination , this improvement was not statistically significant ( P > .05 ) . CONCLUSION FT offers the patient a well-tolerated preparation and improves specificity , with improved differentiation of polyps from residual stool & NA ; Post‐herpetic neuralgia ( PHN ) is a common and often intractable neuropathic pain syndrome predominantly affecting the elderly .  Topical local anesthetics have shown promise in both uncontrolled and controlled studies . Thirty‐five subjects with established PHN affecting the torso or extremities completed a four‐session , r and om order , double‐blind , vehicle‐controlled study of the analgesic effects of topically applied 5 % lidocaine in the form of a non‐woven polyethylene adhesive patch .  All subjects had allodynia on examination . Up to 3 patches , covering a maximum of 420 cm2 , were applied to cover the area of greatest pain as fully as possible . Lidocaine containing patches were applied in two of the four 12‐h‐long sessions , in one session vehicle patches were applied , and one session was a no‐treatment observation session . Lidocaine containing patches significantly reduced pain intensity at all time points 30 min to 12 h compared to no‐treatment observation , and at all time points 4–12 h compared to vehicle patches . Lidocaine patches were superior to both no‐treatment observation and vehicle patches in averaged category pain relief scores . The highest blood Lidocaine level measured was 0.1 & mgr;g/ ml , indicating minimal systemic absorption of Lidocaine . Patch application was without systemic side effects and well tolerated when applied on allodynic skin for 12 h. This study demonstrates that topical 5 % Lidocaine in patch form is easy to use and relieves post‐herpetic neuralgia Abstract Objectives : To assess whether and how investigators of placebo controlled r and omised trials inform participants of their treatment allocation at trial closure and to assess barriers to feedback . Design : Postal survey with a semistructured question naire . Participants : All investigators who published a placebo controlled r and omised trial in 2000 in five leading medical journals , and a r and om sample of 120 trials listed in the national research register data base . Main outcome measures : Number of investigators who informed participants of their treatment allocation at trial closure , methods for delivering the information , and barriers to unmasking treatment . Results : 45 % of investigators informed either all or most participants of their treatment allocation , and 55 % did not inform any participant or only informed those who asked . The main reasons for not informing participants were that the investigators never considered this option ( 40 % ) or to avoid biasing results at study follow up ( 24 % ) . Conclusion : Further research is required to examine sensitive ways to communicate treatment information to trial participants HE first placebo-controlled trial was probably conducted in 1931 , when sanocrysin was compared with distilled water for the treatment of tuberculosis . 1 Ever since then , placebo-controlled trials have been controversial , especially when patients r and omly assigned to receive placebo  have forgone effective treatments . 2 - 5 Recently , the debate has become polarized . One view , dubbed " placebo orthodoxy " by its opponents , is that method ologic considerations make placebo-controlled trials necessary . 6 - 11 The other view , which might be called " active-control ortho-doxy , " is that placebo orthodoxy sacrifices ethics and the rights and welfare of patients to presumed scientific rigor . 10 - 14 The latest revision of the Declaration of Helsinki , although controversial , 15,16 embraces the active-control orthodoxy . 17 Both views discount the ethical and method ologic complexities of clinical research . In this essay , we argue that placebo-controlled trials are permissible when proven therapies exist , but only if certain ethical and method ologic criteria are met . Advocates of placebo-controlled studies argue that it is ethical to conduct such trials even in the case of medical conditions for which there are interventions known to be effective , because of the method ologic limitations of trials in which active treatment is used as the control . 6 - 9 Sometimes therapies that are known to be effective are no better than placebo in particular trials because of variable responses to drugs in particular population s , unpredictable and small effects , and high rates of spontaneous improvement in patients . Consequently , without a placebo group to ensure validity , the finding that there is no difference between the investigational and st and ard treatments can be misleading or uninterpretable . 8,9 New treatments that are no better than existing treatments may still be clinical ly valuable if they have fewer side effects or are more effective for particular subgroups of patients . 18 However , no drug should be approved for use in patients unless it is clearly superior to placebo or no treatment . Despite the method ologic rigor of placebo-controlled trials , commentators acknowledge that they are unethical in some circumstances , especially when withholding an effective treatment might be life-threatening or might cause serious morbidity . There are serious problems with placebo orthodoxy . First , in our opinion , the criteria for ethical use of T placebo controls are never precisely stated . In a recent review , for instance , Temple and Ellenberg 8,9 cl aim ed that the use of placebo controls is ethical if the research participants who receive placebo will experience " no permanent adverse consequence , " if there is OBJECTIVE Our purpose was to investigate the efficacy of P6 acupress 
    Output:
    
We found little evidence in general that placebos had powerful clinical effects .
Although placebos had no significant effects on objective or binary outcomes , they had possible small benefits in studies with continuous subjective outcomes and for the treatment of pain .
Outside the setting of clinical trials , there is no justification for the use of placebos