human
***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: OBJECTIVE Our purpose was to investigate the effects of acupressure on sleep quality in hemodialysis patients . DESIGN R and omized clinical trial . SETTING The setting of the study was dialysis wards located in two university hospitals ( Imam and Golestan ) in Ahvaz , Iran . INTERVENTIONS 48 end-stage renal disease patients on hemodialysis who scored 5 points or higher on the Pittsburgh Sleep Quality Index ( PSQI ) were enrolled to the study .  Acupressure group received acupressure intervention on the Shenmen ( He7 ) and He Gu ( Li4 ) points in the h and s and Sanyingjao ( sp6 ) point in the feet for 4 weeks beside routine care and control group received only routine care . MAIN OUTCOME MEASURES subjective sleep quality , latency and duration , habitual sleep efficiency ; sleep disturbances , daytime functional status , and use of sleeping medications . RESULTS The result indicated significant differences between the acupressure group and the control group after intervention in PSQI global scores ( p<0.001 ) and all sleep quality indices between two groups after intervention : subjective sleep quality ( p<0.001 ) , sleep latency ( p<0.001 ) , sleep duration ( p<0.001 ) , sleep efficiency ( p=0.006 ) , sleep disturbance ( p<0.001 ) , the use of sleeping medication ( p=0.028 ) , and daytime dysfunction ( p<0.001 ) . CONCLUSION This study supports the effectiveness of acupressure in improving sleep quality of end-stage renal disease patients as a noninvasive therapy OBJECTIVE To explore the underlying mechanisms of acupuncture in treating diabetic nephropathy ( DN ) by observing the effect of acupuncture on blood rheology of DN . METHODS A total of 54 cases of DN patients were r and omly divided into control ( n=24 ) and acupuncture group ( n=30 ) . Patients of control group were treated with diet-control , oral administration of Gliguidone ( 30 - 60 mg , t. i. d. ) or subcutaneous injection of insulin , and those of acupuncture group treated with the same medication as those of control group and additional manual acupuncture stimulation of Ganshu ( BL18 ) , Pishu ( BL20 ) , Zusanli ( ST 36 ) , etc . , once daily for 30 days . Hemorheology was detected with LBY-N6A Automatic Hemorheological Analyser . The treatment duration in 2 groups was 30 days . RESULTS After the treatment , of the 24 and 30 cases in control and acupuncture groups , 6 ( 25.0 % ) and 16 ( 53.3 % ) cases experienced remarkable improvement in their symptoms ; 10 ( 41.6 % ) and 12 ( 40.0 % ) had improvement , 8 ( 33.3 % ) and 2 ( 6.7 % ) failed , with the effective rates being 66.7 % and 93.3 % respectively . Self-comparison showed that after the treatment , no significant changes were found in lower shear rate ( LSR ) and higher shear rate ( HSR ) of whole blood viscosity , plasma viscosity ( etap ) , hematocrit ( HCT ) and profibrin in control group ; while LSR of whole blood viscosity , etap and profibrin in acupuncture group decreased significantly ( P<0.05 ) . The therapeutic effect of acupuncture group was significantly superior to that of control group in lowering LSR of whole blood viscosity and profibrin ( P<0.05 ) . CONCLUSION Acupuncture can improve DN patients ' clinical symptoms and blood rheology , and hence , has a certain effect in postponing the development of DN Patients receiving regular hemodialysis sessions have been known to suffer from fatigue and depression . This experiment was design ed to determine the effects of far infrared ray ( FIR ) stimulation on acupoints of patients suffering from renal failure who are receiving regular hemodialysis . Patients receiving long-term and regular hemodialysis who volunteered for this procedure were r and omly selected to undergo either FIR or heat pad ( HP ) therapy to determine the impact of FIR treatment on these patients . Both the activities of the autonomic nervous system and changes in quality of life were measured before and after treatment to determine the effectiveness of the FIR treatment . Results from this study show that FIR therapy decreases both stress and fatigue levels of these patients . It also stimulates autonomic nervous system ( ANS ) activity in patients who are diagnosed with end-stage renal disease ( ESRD ) and are receiving regular hemodialysis ( HD ) . Therefore , benefits of FIR stimulation on these patients are clearly demonstrated in this preliminary study CONTEXT Hemodialysis patients suffer a large symptom burden , and little is known about how effectively symptoms are treated . OBJECTIVES To assess the management of treatable symptoms in hemodialysis patients , we administered a 30-item question naire on physical and emotional symptoms to patients receiving outpatient hemodialysis at the University of Virginia . METHODS We asked patients whether they were prescribed therapy for potentially treatable symptoms and assessed who prescribed the therapy . By means of chart review , we also documented whether medications were prescribed for these symptoms . RESULTS We approached 87 patients and enrolled 62 ( 71 % ) . The most commonly reported , potentially treatable symptoms included bone/joint pain , insomnia , mood disturbance , sexual dysfunction , paresthesia , and nausea . Only 45 % of patients with bone/joint pain reported receiving an  analgesic medication . Twenty-three percent of patients with trouble falling asleep and 53 % of patients with nausea reported receiving a medication to alleviate this symptom . Chart review revealed that 58 % of patients who reported the presence of bone/joint pain were prescribed an  analgesic  , 23 % of patients with trouble falling asleep were prescribed a  sleep aid  , and 42 % of patients with nausea received an  antiemetic .  Primary care providers were more likely than nephrologists to provide for all symptoms except nausea and numbness or tingling in the feet , and this difference was significant for the treatment of worrying ( 3/3 vs. 0/3 , P=0.05 ) and nervousness ( 4/5 vs. 0/5 , P=0.02 ) . CONCLUSION Potentially treatable symptoms in hemodialysis are undertreated . Pharmacologic therapy , particularly for emotional symptoms , was more commonly prescribed by primary care providers than nephrologists . Additional study of the barriers to symptom treatment and interventions that increase nephrologist and primary care provider symptom management are needed Depression is an important target of psychological assessment in patients with end-stage renal disease because it predicts their morbidity , mortality , and quality of life . We assessed the effectiveness of cognitive-behavioral therapy in chronic hemodialysis patients diagnosed with major depression by the Mini International Neuropsychiatric Interview ( MINI ) . In a r and omized trial conducted in Brazil , an intervention group of 41 patients was given 12 weekly sessions of cognitive-behavioral group therapy led by a trained psychologist over 3 months while a control group of 44 patients received the usual treatment offered in the dialysis unit . In both groups , the Beck Depression Inventory , the MINI , and the Kidney Disease and Quality of Life-Short Form question naires were administered at baseline , after 3 months of intervention or usual treatment , and after 9 months of follow-up . The intervention group had significant improvements , compared to the control group , in the average scores of the Beck Depression Inventory overall scale , MINI scores , and in quality -of-life dimensions that included the burden of renal disease , sleep , quality of social interaction , overall health , and the mental component summary . We conclude that cognitive-behavioral group therapy is an effective treatment of depression in chronic hemodialysis patients OBJECTIVE To observe the effect of acupuncture on gastrointestinal responses  after renal transplantation . METHODS Sixty cases with gastrointestinal responses after renal transplantation were r and omly divided into an acupuncture group and a medication group , 30 cases in each group . The acupuncture group were treated with acupuncture at Neiguan ( PC 6 ) , Zusanli ( ST 36 ) , Sanyinjiao ( SP 6 ) , etc . ; the medication group were treated with oral administration of Weilexin . The symptoms of abdominal pain , nausea , gastric distention , and other gastrointestinal responses were observed in the two groups . RESULTS The effective rate was 93.3 % in the acupuncture group and 76.7 % in the medication group with a very significant difference between the two groups ( P < 0.01 ) , the acupuncture group being significantly better than the medication group . CONCLUSION Acupuncture has a good effect of promoting recovery of gastrointestinal function after renal transplantation Objectives To assess the feasibility and acceptability of a r and omized controlled trial compared auricular acupressure ( AA ) on specific acupoints with AA on non-specific acupoints for treating maintenance hemodialysis ( MHD ) patients with insomnia . Methods Sixty three ( 63 ) eligible subjects were r and omly assigned into either AA group received AA on specific acupoints ( n=32 ) , or sham AA ( SAA ) group received AA on points irrelevant to insomnia treatment ( n=31 ) for eight weeks . All participants were followed up for 12 weeks after treatments . The primary outcome was clinical response at eight weeks after r and omization , defined as a reduction of Pittsburgh Sleep Quality Index ( PSQI ) global score by 3 points and more . Results Fifty-eight ( 58 ) participants completed the trial and five dropped out . Twenty participants in AA group ( 62.5 % ) and ten in SAA group ( 32.3 % ) responded to the eight-week interventions ( χ2 = 5.77 , P = 0.02 ) . PSQI global score declined 3.75 ± 4.36 ( 95%CI -5.32 , -2.18 ) and 2.26 ± 3.89 ( 95%CI -3.68 , -0.83 ) in AA group and SAA group respectively . Three participants died during the follow-up period . No evidence supported their deaths were related to the AA intervention . No other adverse event was observed . Conclusion Feasibility and logistics of patient recruitment , r and omization procedure , blinding approach , interventions application and outcome assessment had been tested in this pilot trial . The preliminary data appeared to show a favorable result on AA treatment . A full-scale trial is warranted . Trial Registration Chinese Clinical Trial Registry ChiCTR-TRC-12002272 TITLE Effects of thermal therapy on uremic pruritus and biochemical parameters in patients having haemodialysis . AIM This paper is a report of a trial to identify the effect of thermal therapy with far-infrared rays in comparison with non-thermal therapy on uremic pruritus and biochemical parameters . BACKGROUND Uremic pruritus remains one of the most frustrating , common , and potentially disabling symptoms in patients undergoing haemodialysis . The mechanism underlying uremic pruritus is poorly understood . Although enough is known to determine a reasonable treatment approach , more research is needed to evaluate more reliable treatments . METHODS A r and omized , double-blind , controlled trial was conducted in 2005 using question naires and measurement of blood biochemical parameters . A total of 41 uremic patients on maintenance haemodialysis were r and omly assigned either to the thermal therapy group or the control group . The thermal therapy group was treated with 40 degrees C thermal therapy with far-infrared rays at the Sanyinjiao acupoint for 15 minutes once a day on two days a week for a total of 18 sessions . The control group received a plain adhesive patch placed on the same acupoint . FINDINGS Both groups showed statistically significant improvements but there were no differences between groups , while a relatively large decrease in pruritus scores was found in the thermal therapy group ( P < 0.001 ) as compared with the non-thermal therapy group . Serum calcium level decreased statistically significantly in the thermal therapy group and was statistically significantly different from that of the control group . CONCLUSION The lack of effect does not necessarily demonstrate that thermal therapy is not effective or has no therapeutic benefits for uremic pruritus in patients having haemodialysis . Further investigation is warranted , with larger sample s and longer intervention Background : Fatigue is considered as a major problem in hemodialysis patients and can impair their quality of life . The purpose of this study was to investigate the effectiveness of acupressure on fatigue in hemodialysis patients . Material s and Methods : This is a clinical trial study in which 96 hemodialysis patients participated . Patients were r and omly assigned into acupressure , placebo , and control groups ( 32 subjects fulfilling the inclusion criteria assigned to each group ) . The measures included the form of demographic characteristics , visual analog scale of fatigue , and Piper Fatigue Scale . Patients in the acupressure and placebo groups received acupressure intervention during the early 2 h of dialysis on six acupoints with massage for 20 min/day , 3 days per week for 4 weeks . In the placebo group , acupressure intervention was performed as mentioned above with a distance of 1 cm away from the actual intervention site . Patients in the control group received routine unit care only . Chi- quare test , Kruskal-Wallis , paired t-test , one-way analysis of variance ( ANOVA ) , and Duncan test were used for data analysis . Results : One-way ANOVA tests showed significant differences in the total mean score of fatigue 
    Output:
    
agent
***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: OBJECTIVE Our purpose was to investigate the effects of acupressure on sleep quality in hemodialysis patients . DESIGN R and omized clinical trial . SETTING The setting of the study was dialysis wards located in two university hospitals ( Imam and Golestan ) in Ahvaz , Iran . INTERVENTIONS 48 end-stage renal disease patients on hemodialysis who scored 5 points or higher on the Pittsburgh Sleep Quality Index ( PSQI ) were enrolled to the study .  Acupressure group received acupressure intervention on the Shenmen ( He7 ) and He Gu ( Li4 ) points in the h and s and Sanyingjao ( sp6 ) point in the feet for 4 weeks beside routine care and control group received only routine care . MAIN OUTCOME MEASURES subjective sleep quality , latency and duration , habitual sleep efficiency ; sleep disturbances , daytime functional status , and use of sleeping medications . RESULTS The result indicated significant differences between the acupressure group and the control group after intervention in PSQI global scores ( p<0.001 ) and all sleep quality indices between two groups after intervention : subjective sleep quality ( p<0.001 ) , sleep latency ( p<0.001 ) , sleep duration ( p<0.001 ) , sleep efficiency ( p=0.006 ) , sleep disturbance ( p<0.001 ) , the use of sleeping medication ( p=0.028 ) , and daytime dysfunction ( p<0.001 ) . CONCLUSION This study supports the effectiveness of acupressure in improving sleep quality of end-stage renal disease patients as a noninvasive therapy OBJECTIVE To explore the underlying mechanisms of acupuncture in treating diabetic nephropathy ( DN ) by observing the effect of acupuncture on blood rheology of DN . METHODS A total of 54 cases of DN patients were r and omly divided into control ( n=24 ) and acupuncture group ( n=30 ) . Patients of control group were treated with diet-control , oral administration of Gliguidone ( 30 - 60 mg , t. i. d. ) or subcutaneous injection of insulin , and those of acupuncture group treated with the same medication as those of control group and additional manual acupuncture stimulation of Ganshu ( BL18 ) , Pishu ( BL20 ) , Zusanli ( ST 36 ) , etc . , once daily for 30 days . Hemorheology was detected with LBY-N6A Automatic Hemorheological Analyser . The treatment duration in 2 groups was 30 days . RESULTS After the treatment , of the 24 and 30 cases in control and acupuncture groups , 6 ( 25.0 % ) and 16 ( 53.3 % ) cases experienced remarkable improvement in their symptoms ; 10 ( 41.6 % ) and 12 ( 40.0 % ) had improvement , 8 ( 33.3 % ) and 2 ( 6.7 % ) failed , with the effective rates being 66.7 % and 93.3 % respectively . Self-comparison showed that after the treatment , no significant changes were found in lower shear rate ( LSR ) and higher shear rate ( HSR ) of whole blood viscosity , plasma viscosity ( etap ) , hematocrit ( HCT ) and profibrin in control group ; while LSR of whole blood viscosity , etap and profibrin in acupuncture group decreased significantly ( P<0.05 ) . The therapeutic effect of acupuncture group was significantly superior to that of control group in lowering LSR of whole blood viscosity and profibrin ( P<0.05 ) . CONCLUSION Acupuncture can improve DN patients ' clinical symptoms and blood rheology , and hence , has a certain effect in postponing the development of DN Patients receiving regular hemodialysis sessions have been known to suffer from fatigue and depression . This experiment was design ed to determine the effects of far infrared ray ( FIR ) stimulation on acupoints of patients suffering from renal failure who are receiving regular hemodialysis . Patients receiving long-term and regular hemodialysis who volunteered for this procedure were r and omly selected to undergo either FIR or heat pad ( HP ) therapy to determine the impact of FIR treatment on these patients . Both the activities of the autonomic nervous system and changes in quality of life were measured before and after treatment to determine the effectiveness of the FIR treatment . Results from this study show that FIR therapy decreases both stress and fatigue levels of these patients . It also stimulates autonomic nervous system ( ANS ) activity in patients who are diagnosed with end-stage renal disease ( ESRD ) and are receiving regular hemodialysis ( HD ) . Therefore , benefits of FIR stimulation on these patients are clearly demonstrated in this preliminary study CONTEXT Hemodialysis patients suffer a large symptom burden , and little is known about how effectively symptoms are treated . OBJECTIVES To assess the management of treatable symptoms in hemodialysis patients , we administered a 30-item question naire on physical and emotional symptoms to patients receiving outpatient hemodialysis at the University of Virginia . METHODS We asked patients whether they were prescribed therapy for potentially treatable symptoms and assessed who prescribed the therapy . By means of chart review , we also documented whether medications were prescribed for these symptoms . RESULTS We approached 87 patients and enrolled 62 ( 71 % ) . The most commonly reported , potentially treatable symptoms included bone/joint pain , insomnia , mood disturbance , sexual dysfunction , paresthesia , and nausea . Only 45 % of patients with bone/joint pain reported receiving an  analgesic medication . Twenty-three percent of patients with trouble falling asleep and 53 % of patients with nausea reported receiving a medication to alleviate this symptom . Chart review revealed that 58 % of patients who reported the presence of bone/joint pain were prescribed an  analgesic  , 23 % of patients with trouble falling asleep were prescribed a  sleep aid  , and 42 % of patients with nausea received an  antiemetic .  Primary care providers were more likely than nephrologists to provide for all symptoms except nausea and numbness or tingling in the feet , and this difference was significant for the treatment of worrying ( 3/3 vs. 0/3 , P=0.05 ) and nervousness ( 4/5 vs. 0/5 , P=0.02 ) . CONCLUSION Potentially treatable symptoms in hemodialysis are undertreated . Pharmacologic therapy , particularly for emotional symptoms , was more commonly prescribed by primary care providers than nephrologists . Additional study of the barriers to symptom treatment and interventions that increase nephrologist and primary care provider symptom management are needed Depression is an important target of psychological assessment in patients with end-stage renal disease because it predicts their morbidity , mortality , and quality of life . We assessed the effectiveness of cognitive-behavioral therapy in chronic hemodialysis patients diagnosed with major depression by the Mini International Neuropsychiatric Interview ( MINI ) . In a r and omized trial conducted in Brazil , an intervention group of 41 patients was given 12 weekly sessions of cognitive-behavioral group therapy led by a trained psychologist over 3 months while a control group of 44 patients received the usual treatment offered in the dialysis unit . In both groups , the Beck Depression Inventory , the MINI , and the Kidney Disease and Quality of Life-Short Form question naires were administered at baseline , after 3 months of intervention or usual treatment , and after 9 months of follow-up . The intervention group had significant improvements , compared to the control group , in the average scores of the Beck Depression Inventory overall scale , MINI scores , and in quality -of-life dimensions that included the burden of renal disease , sleep , quality of social interaction , overall health , and the mental component summary . We conclude that cognitive-behavioral group therapy is an effective treatment of depression in chronic hemodialysis patients OBJECTIVE To observe the effect of acupuncture on gastrointestinal responses  after renal transplantation . METHODS Sixty cases with gastrointestinal responses after renal transplantation were r and omly divided into an acupuncture group and a medication group , 30 cases in each group . The acupuncture group were treated with acupuncture at Neiguan ( PC 6 ) , Zusanli ( ST 36 ) , Sanyinjiao ( SP 6 ) , etc . ; the medication group were treated with oral administration of Weilexin . The symptoms of abdominal pain , nausea , gastric distention , and other gastrointestinal responses were observed in the two groups . RESULTS The effective rate was 93.3 % in the acupuncture group and 76.7 % in the medication group with a very significant difference between the two groups ( P < 0.01 ) , the acupuncture group being significantly better than the medication group . CONCLUSION Acupuncture has a good effect of promoting recovery of gastrointestinal function after renal transplantation Objectives To assess the feasibility and acceptability of a r and omized controlled trial compared auricular acupressure ( AA ) on specific acupoints with AA on non-specific acupoints for treating maintenance hemodialysis ( MHD ) patients with insomnia . Methods Sixty three ( 63 ) eligible subjects were r and omly assigned into either AA group received AA on specific acupoints ( n=32 ) , or sham AA ( SAA ) group received AA on points irrelevant to insomnia treatment ( n=31 ) for eight weeks . All participants were followed up for 12 weeks after treatments . The primary outcome was clinical response at eight weeks after r and omization , defined as a reduction of Pittsburgh Sleep Quality Index ( PSQI ) global score by 3 points and more . Results Fifty-eight ( 58 ) participants completed the trial and five dropped out . Twenty participants in AA group ( 62.5 % ) and ten in SAA group ( 32.3 % ) responded to the eight-week interventions ( χ2 = 5.77 , P = 0.02 ) . PSQI global score declined 3.75 ± 4.36 ( 95%CI -5.32 , -2.18 ) and 2.26 ± 3.89 ( 95%CI -3.68 , -0.83 ) in AA group and SAA group respectively . Three participants died during the follow-up period . No evidence supported their deaths were related to the AA intervention . No other adverse event was observed . Conclusion Feasibility and logistics of patient recruitment , r and omization procedure , blinding approach , interventions application and outcome assessment had been tested in this pilot trial . The preliminary data appeared to show a favorable result on AA treatment . A full-scale trial is warranted . Trial Registration Chinese Clinical Trial Registry ChiCTR-TRC-12002272 TITLE Effects of thermal therapy on uremic pruritus and biochemical parameters in patients having haemodialysis . AIM This paper is a report of a trial to identify the effect of thermal therapy with far-infrared rays in comparison with non-thermal therapy on uremic pruritus and biochemical parameters . BACKGROUND Uremic pruritus remains one of the most frustrating , common , and potentially disabling symptoms in patients undergoing haemodialysis . The mechanism underlying uremic pruritus is poorly understood . Although enough is known to determine a reasonable treatment approach , more research is needed to evaluate more reliable treatments . METHODS A r and omized , double-blind , controlled trial was conducted in 2005 using question naires and measurement of blood biochemical parameters . A total of 41 uremic patients on maintenance haemodialysis were r and omly assigned either to the thermal therapy group or the control group . The thermal therapy group was treated with 40 degrees C thermal therapy with far-infrared rays at the Sanyinjiao acupoint for 15 minutes once a day on two days a week for a total of 18 sessions . The control group received a plain adhesive patch placed on the same acupoint . FINDINGS Both groups showed statistically significant improvements but there were no differences between groups , while a relatively large decrease in pruritus scores was found in the thermal therapy group ( P < 0.001 ) as compared with the non-thermal therapy group . Serum calcium level decreased statistically significantly in the thermal therapy group and was statistically significantly different from that of the control group . CONCLUSION The lack of effect does not necessarily demonstrate that thermal therapy is not effective or has no therapeutic benefits for uremic pruritus in patients having haemodialysis . Further investigation is warranted , with larger sample s and longer intervention Background : Fatigue is considered as a major problem in hemodialysis patients and can impair their quality of life . The purpose of this study was to investigate the effectiveness of acupressure on fatigue in hemodialysis patients . Material s and Methods : This is a clinical trial study in which 96 hemodialysis patients participated . Patients were r and omly assigned into acupressure , placebo , and control groups ( 32 subjects fulfilling the inclusion criteria assigned to each group ) . The measures included the form of demographic characteristics , visual analog scale of fatigue , and Piper Fatigue Scale . Patients in the acupressure and placebo groups received acupressure intervention during the early 2 h of dialysis on six acupoints with massage for 20 min/day , 3 days per week for 4 weeks . In the placebo group , acupressure intervention was performed as mentioned above with a distance of 1 cm away from the actual intervention site . Patients in the control group received routine unit care only . Chi- quare test , Kruskal-Wallis , paired t-test , one-way analysis of variance ( ANOVA ) , and Duncan test were used for data analysis . Results : One-way ANOVA tests showed significant differences in the total mean score of fatigue 
    Output:
    