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: PURPOSE / OBJECTIVES To test the hypotheses that the effects of a music intervention are greater than those of simple distraction and that either intervention is better at controlling procedural pain and anxiety than treatment as usual . DESIGN R and omized , controlled experiment . SETTING A midwestern comprehensive cancer center . SAMPLE 60 people with cancer having noxious medical procedures such as tissue biopsy or port placement or removal ; 58 provided usable data . METHODS Participants completed measures of pain and anxiety before and after their medical procedures and provided a rating of perceived control over pain and anxiety after the procedure . MAIN RESEARCH VARIABLES Procedural pain , state anxiety , and perceived control over pain and anxiety . FINDINGS Contrary to hypotheses , outcomes achieved with music did not differ from those achieved with simple distraction . Moreover , outcomes achieved under treatment as usual were not significantly different from those obtained with music or distraction interventions . Some patients found that the interventions were bothersome and reported that they wanted to attend to the activities of the surgeon and the medical procedure itself . CONCLUSIONS The effects of music , distraction , and treatment as usual are equivocal . In addition , patients have individual preferences for use of distraction during painful or anxiety-provoking procedures . IMPLICATION S FOR NURSING Patients having noxious medical procedures should be asked about their desire to be distracted before and during the procedure and offered a strategy that is consistent with their preferences BACKGROUND Patients with advanced cancer receiving palliative care often experience severe physical and psychosocial symptoms . However , there are limited re sources for psychological and emotional support . Expressive writing has shown decreased anxiety level in young and healthy people suffering from a number of stressors . OBJECTIVE The purpose of this study was to determine the feasibility of expressive writing in patients receiving palliative care and the most suitable outcomes of expressive writing in this patient population . DESIGN In this pilot study , patients were r and omly assigned to either the expressive writing group ( EW ) or the neutral writing group ( NW ) . Anxiety level before and after the writing session was compared between the two groups . Writing material s were content analyzed using st and ard qualitative research methods . RESULTS A total of 24 patients ( 12 in EW and 12 in NW ) were enrolled in the study between October 2006 and January 2007 . Although the majority of patients ( 83%-100 % ) were able to complete all baseline assessment s , poor adherence was observed during the follow-ups . Only 8 % of patients completed the 2-week study . There was no significant difference in the State-Trait Anxiety Inventory ( STAI ) State-Anxiety scores at baseline , before and after each writing session between the EW and NW groups . DISCUSSION Our rapid accrual suggests that palliative care patients are interested in participating in studies such as expressive writing . The high level of adherence to the baseline assessment s indicates that these assessment s were not particularly difficult for our patients to complete . Future studies may need to include patients with better performance status , better patient education , means of emotional expression ( i.e. , audio recording , telephone interview ) and improved adherence . CONCLUSION We conclude that clinical trials of expressive writing in the palliative care setting are not feasible unless they undergo major modification in methods compared to those previous reported in other patient population . Our findings will hopefully assist research ers considering similar studies Background : Dance and yoga have been shown to produce improvements in psychological well-being . Purpose : The aim of this study was to examine some of the psychological and neuroendocrine responses to these activities . Methods : Sixty-nine healthy college students participated in one of three 90-min classes : African dance ( n = 21 ) , Hatha yoga ( n = 18 ) , or a biology lecture as a control session ( n = 30 ) . Before and after each condition participants completed the Perceived Stress Scale ( PSS ) , completed the Positive Affect and Negative Affect Schedule , and provided a saliva sample for cortisol . Results : There were significant reductions in PSS and negative affect ( ps < .0001 ) and Time × Treatment interactions ( ps < .0001 ) such that African dance and Hatha yoga showed significant declines , whereas there was no significant change in biology lecture . There was no significant main effect for positive affect ( p = .53 ) , however there was a significant interaction effect ( p < .001 ) such that positive affect increased in African dance , decreased in biology lecture , and did not change significantly in Hatha yoga . There was a significant main effect for salivary cortisol ( p < .05 ) and a significant interaction effect ( p < .0001 ) such that cortisol increased in African dance , decreased in Hatha yoga , and did not change in biology . Changes in cortisol were not significantly related to changes in psychological variables across treatments . There was 1 significant interaction effect ( p = .04 ) such that change in positive affect and change in cortisol were negatively correlated in Hatha yoga but positively correlated in African dance and biology . Conclusions : Both African dance and Hatha yoga reduced perceived stress and negative affect . Cortisol increased in African dance and decreased in Hatha yoga . Therefore , even when these interventions produce similar positive psychological effects , the effects may be very different on physiological stress processes . One factor that may have particular salience is the amount of physiological arousal produced by the intervention OBJECTIVES To examine effects of sedative music on  cancer pain .  DESIGN A r and omized controlled trial . SETTING S Two large medical centers in Kaoshiung City , in southern Taiwan . PARTICIPANTS 126 hospitalized persons with cancer pain . METHODS Participants were r and omly assigned to an experimental ( n=62 ) or a control group ( n=64 ) , with computerized minimization , stratifying on gender , pain , and hospital unit . Music choices included folk songs , Buddhist hymns ( Taiwanese music ) , plus harp , and piano ( American ) . The experimental group listened to music for 30 min ; the control group rested in bed .  Sensation and distress of pain were rated on 100 mm VAS before and after the 30-min test . RESULTS Using MANCOVA , there was significantly less posttest pain in the music versus the control group , p<.001 . Effect sizes were large , Cohen 's d=.64 , sensation , d=.70 , distress , indicating that music was very helpful for pain . Thirty minutes of music provided 50 % relief in 42 % of the music group compared to 8 % of the controls . The number needed to treat ( NNT ) to find one with 50 % sensation relief was three patients . More patients chose Taiwanese music ( 71 % ) than American music ( 29 % ) , but both were liked and effective . CONCLUSIONS Offering a choice of familiar , culturally appropriate music was a key element of the intervention . Findings extend the Good and Moore theory ( 1996 ) to cancer pain . Soft music was safe , effective , and liked by participants . It provided greater relief of cancer pain than analgesics alone . Thus nurses should offer calming , familiar music to supplement analgesic medication for persons with cancer pain BACKGROUND Art therapy has been used to help children cope with chronic illness but has not been specifically tested with children who have asthma . OBJECTIVE To test an art therapy intervention in a r and omized controlled trial in children with asthma . METHODS Twenty-two children with asthma were r and omized to an active art therapy or wait-list control group . Those in the active art therapy group participated in 60-minute art therapy sessions once a week for 7 weeks . Sessions included specific art therapy tasks design ed to encourage expression , discussion , and problem-solving in response to the emotional burden of chronic illness . Measures taken at baseline , immediately after , and 6 months after the final art therapy session included the Formal Elements Art Therapy Scale applied to the Person Picking an Apple from a Tree assessment , the parent and child versions of the Pediatric Quality of Life Asthma Module , and the Beck Youth Inventories . Those children assigned to the wait-list control group completed all evaluations at the same intervals as the children receiving art therapy but did not receive the art therapy interventions . RESULTS Score changes from baseline to completion of art therapy indicated ( 1 ) improved problem-solving and affect drawing scores ; ( 2 ) improved worry , communication , and total quality of life scores ; and ( 3 ) improved Beck anxiety and self concept scores in the active group relative to the control group . At 6 months , the active group maintained some positive changes relative to the control group including ( 1 ) drawing affect scores , ( 2 ) the worry and quality of life scores , and ( 3 ) the Beck anxiety score . Frequency of asthma exacerbations before and after the 6-month study interval did not differ between the 2 groups . CONCLUSION This was the first r and omized trial demonstrating that children with asthma receive benefit from art therapy that includes decreased anxiety and increased quality of life More than 80 % of women with breast cancer are now reported to be using complementary and alternative medicine ( CAM ) therapies during conventional treatment . A r and omized clinical trial ( RCT ) of reflexology with late stage breast cancer patients serves as the data source for this article . The purpose s were to investigate : ( i ) reasons for refusal to participate in a RCT of reflexology ; ( ii ) the differences between those who completed the baseline interview and those who dropped out before baseline ; and ( iii ) the utility of the Palliative Prognostic Score ( PPS ) as a prognostic screening tool in minimizing early attrition ( before baseline ) from the trial . Eligible women ( N = 400 ) approached at 12 cancer centers in the Midwest had advanced breast cancer , were on chemotherapy or hormonal therapy , and had a PPS of 11 or less . Comparisons of those who dropped out early ( N = 33 ) to those who stayed in the trial ( N = 240 ) were carried out using Wilcoxon rank , t- , chi-squared and Fisher 's exact tests . The reasons of being “ too sick ” or “ overwhelmed ” were given by less than 12 % of the women who refused to participate . There was a higher early dropout rate among black women compared to other ( primarily white ) women ( P = .01 ) . Cancer recurrence and metastasis , age , and the PPS were not predictive of early retention of women . Specialized techniques may be needed to ensure black women remain in the trial once consented . Women with advanced disease were likely to enter and remain in the trial despite deterioration in health Women with breast cancer are naturally exposed to strain related to diagnosis and treatment , and this influences their experienced quality of life ( QoL ) . The present paper reports the effect , with regard to QoL aspects , of an art therapy intervention among 41 women undergoing radiotherapy treatment for breast cancer . The women were r and omized to an intervention group with individual art therapy sessions for 1 h/week ( n = 20 ) , or to a control group ( n = 21 ) . The WHOQOL-BREF and EORTC Quality of Life Question naire-BR23 , were used for QoL assessment , and administrated on three measurement occasions , before the start of radiotherapy and 2 and 6 months later . The results indicate an overall improvement in QoL aspects among women in the intervention group . A significant increase in total health , total QoL , physical health and psychological health was observed in the art therapy group . A significant positive difference within the art therapy group was also seen , concerning future perspectives , body image and systemic therapy side effects . The present study provides strong support for the use of art therapy to improve QoL for women undergoing radiotherapy treatment for breast cancer The purpose of this study was to gather data on the efficacy of a newly developed psychosocial group intervention for cancer patients , called mindfulness-based art therapy ( MBAT ) .  One hundred and eleven women with a variety of cancer diagnoses were paired by age and r and omized to either an eight-week MBAT intervention group or a wait-list control group .  Ninety-three participants ( 84 % ) completed both the pre- and post- study measurements . As compared to the control group , the MBAT group demonstrated a significant decrease in symptoms of distress ( as measured by the Symptoms Checklist-90-Revised ) and significant improvements in key aspects of health-related quality of life ( as measured by the Medical Outcomes Study Short-Form Health Survey ) . This investigation of MBAT provides initial encouraging data that support a possible future role for the intervention as a psychosocial treatment option for cancer patients A nonpharmacological method can be an alternative or complement to analgesics . The aim of this study was to evaluate if music medicine influences pain and anxiety in children undergoing lumbar punctures .  A r and omized clinical trial was used in 40 children ( aged 7 - 12 years ) with leukemia , followed by interviews in 20 of these participants . The participants were r and omly assigned to a music group ( n = 20 ) or control group ( n = 20 ) . The primary outcome was pain scores and the secondary was heart rate , blood pressure , respiratory rate , and oxygen saturation measured before , during , and after the procedure . Anxiety scores were measured before and after the procedure . Interviews with open-ended questions were conducted in conjunction with the completed procedures . The results showed lower pain scores and heart and respiratory rates in the music group during and after the lumbar puncture . The anxiety scores were lower in the music group both before and after the procedure . The findings from the interviews confirmed the quantity results through descriptions of a positive experience by the children , including less pain and fear A pilot research study was conducted at 2 cancer centers in Connecticut to determine the effect of a dance and movement program on quality of life and shoulder function in breast cancer survivors treated within the prior 5 years . Thirty-five women completed the trial that included a 12-week intervention , using The Lebed Method , Focus on Healing Through Movement and Dance . The study design was a r and omized control trial with a wait list control group crossover to active treatment in weeks 13 to 25 , with the treatment group receiving the program in weeks 1 to 12 , and no program in weeks 13 to 25 . Outcome measures were the Breast Cancer Quality of Life ( FACT 
    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: PURPOSE / OBJECTIVES To test the hypotheses that the effects of a music intervention are greater than those of simple distraction and that either intervention is better at controlling procedural pain and anxiety than treatment as usual . DESIGN R and omized , controlled experiment . SETTING A midwestern comprehensive cancer center . SAMPLE 60 people with cancer having noxious medical procedures such as tissue biopsy or port placement or removal ; 58 provided usable data . METHODS Participants completed measures of pain and anxiety before and after their medical procedures and provided a rating of perceived control over pain and anxiety after the procedure . MAIN RESEARCH VARIABLES Procedural pain , state anxiety , and perceived control over pain and anxiety . FINDINGS Contrary to hypotheses , outcomes achieved with music did not differ from those achieved with simple distraction . Moreover , outcomes achieved under treatment as usual were not significantly different from those obtained with music or distraction interventions . Some patients found that the interventions were bothersome and reported that they wanted to attend to the activities of the surgeon and the medical procedure itself . CONCLUSIONS The effects of music , distraction , and treatment as usual are equivocal . In addition , patients have individual preferences for use of distraction during painful or anxiety-provoking procedures . IMPLICATION S FOR NURSING Patients having noxious medical procedures should be asked about their desire to be distracted before and during the procedure and offered a strategy that is consistent with their preferences BACKGROUND Patients with advanced cancer receiving palliative care often experience severe physical and psychosocial symptoms . However , there are limited re sources for psychological and emotional support . Expressive writing has shown decreased anxiety level in young and healthy people suffering from a number of stressors . OBJECTIVE The purpose of this study was to determine the feasibility of expressive writing in patients receiving palliative care and the most suitable outcomes of expressive writing in this patient population . DESIGN In this pilot study , patients were r and omly assigned to either the expressive writing group ( EW ) or the neutral writing group ( NW ) . Anxiety level before and after the writing session was compared between the two groups . Writing material s were content analyzed using st and ard qualitative research methods . RESULTS A total of 24 patients ( 12 in EW and 12 in NW ) were enrolled in the study between October 2006 and January 2007 . Although the majority of patients ( 83%-100 % ) were able to complete all baseline assessment s , poor adherence was observed during the follow-ups . Only 8 % of patients completed the 2-week study . There was no significant difference in the State-Trait Anxiety Inventory ( STAI ) State-Anxiety scores at baseline , before and after each writing session between the EW and NW groups . DISCUSSION Our rapid accrual suggests that palliative care patients are interested in participating in studies such as expressive writing . The high level of adherence to the baseline assessment s indicates that these assessment s were not particularly difficult for our patients to complete . Future studies may need to include patients with better performance status , better patient education , means of emotional expression ( i.e. , audio recording , telephone interview ) and improved adherence . CONCLUSION We conclude that clinical trials of expressive writing in the palliative care setting are not feasible unless they undergo major modification in methods compared to those previous reported in other patient population . Our findings will hopefully assist research ers considering similar studies Background : Dance and yoga have been shown to produce improvements in psychological well-being . Purpose : The aim of this study was to examine some of the psychological and neuroendocrine responses to these activities . Methods : Sixty-nine healthy college students participated in one of three 90-min classes : African dance ( n = 21 ) , Hatha yoga ( n = 18 ) , or a biology lecture as a control session ( n = 30 ) . Before and after each condition participants completed the Perceived Stress Scale ( PSS ) , completed the Positive Affect and Negative Affect Schedule , and provided a saliva sample for cortisol . Results : There were significant reductions in PSS and negative affect ( ps < .0001 ) and Time × Treatment interactions ( ps < .0001 ) such that African dance and Hatha yoga showed significant declines , whereas there was no significant change in biology lecture . There was no significant main effect for positive affect ( p = .53 ) , however there was a significant interaction effect ( p < .001 ) such that positive affect increased in African dance , decreased in biology lecture , and did not change significantly in Hatha yoga . There was a significant main effect for salivary cortisol ( p < .05 ) and a significant interaction effect ( p < .0001 ) such that cortisol increased in African dance , decreased in Hatha yoga , and did not change in biology . Changes in cortisol were not significantly related to changes in psychological variables across treatments . There was 1 significant interaction effect ( p = .04 ) such that change in positive affect and change in cortisol were negatively correlated in Hatha yoga but positively correlated in African dance and biology . Conclusions : Both African dance and Hatha yoga reduced perceived stress and negative affect . Cortisol increased in African dance and decreased in Hatha yoga . Therefore , even when these interventions produce similar positive psychological effects , the effects may be very different on physiological stress processes . One factor that may have particular salience is the amount of physiological arousal produced by the intervention OBJECTIVES To examine effects of sedative music on  cancer pain .  DESIGN A r and omized controlled trial . SETTING S Two large medical centers in Kaoshiung City , in southern Taiwan . PARTICIPANTS 126 hospitalized persons with cancer pain . METHODS Participants were r and omly assigned to an experimental ( n=62 ) or a control group ( n=64 ) , with computerized minimization , stratifying on gender , pain , and hospital unit . Music choices included folk songs , Buddhist hymns ( Taiwanese music ) , plus harp , and piano ( American ) . The experimental group listened to music for 30 min ; the control group rested in bed .  Sensation and distress of pain were rated on 100 mm VAS before and after the 30-min test . RESULTS Using MANCOVA , there was significantly less posttest pain in the music versus the control group , p<.001 . Effect sizes were large , Cohen 's d=.64 , sensation , d=.70 , distress , indicating that music was very helpful for pain . Thirty minutes of music provided 50 % relief in 42 % of the music group compared to 8 % of the controls . The number needed to treat ( NNT ) to find one with 50 % sensation relief was three patients . More patients chose Taiwanese music ( 71 % ) than American music ( 29 % ) , but both were liked and effective . CONCLUSIONS Offering a choice of familiar , culturally appropriate music was a key element of the intervention . Findings extend the Good and Moore theory ( 1996 ) to cancer pain . Soft music was safe , effective , and liked by participants . It provided greater relief of cancer pain than analgesics alone . Thus nurses should offer calming , familiar music to supplement analgesic medication for persons with cancer pain BACKGROUND Art therapy has been used to help children cope with chronic illness but has not been specifically tested with children who have asthma . OBJECTIVE To test an art therapy intervention in a r and omized controlled trial in children with asthma . METHODS Twenty-two children with asthma were r and omized to an active art therapy or wait-list control group . Those in the active art therapy group participated in 60-minute art therapy sessions once a week for 7 weeks . Sessions included specific art therapy tasks design ed to encourage expression , discussion , and problem-solving in response to the emotional burden of chronic illness . Measures taken at baseline , immediately after , and 6 months after the final art therapy session included the Formal Elements Art Therapy Scale applied to the Person Picking an Apple from a Tree assessment , the parent and child versions of the Pediatric Quality of Life Asthma Module , and the Beck Youth Inventories . Those children assigned to the wait-list control group completed all evaluations at the same intervals as the children receiving art therapy but did not receive the art therapy interventions . RESULTS Score changes from baseline to completion of art therapy indicated ( 1 ) improved problem-solving and affect drawing scores ; ( 2 ) improved worry , communication , and total quality of life scores ; and ( 3 ) improved Beck anxiety and self concept scores in the active group relative to the control group . At 6 months , the active group maintained some positive changes relative to the control group including ( 1 ) drawing affect scores , ( 2 ) the worry and quality of life scores , and ( 3 ) the Beck anxiety score . Frequency of asthma exacerbations before and after the 6-month study interval did not differ between the 2 groups . CONCLUSION This was the first r and omized trial demonstrating that children with asthma receive benefit from art therapy that includes decreased anxiety and increased quality of life More than 80 % of women with breast cancer are now reported to be using complementary and alternative medicine ( CAM ) therapies during conventional treatment . A r and omized clinical trial ( RCT ) of reflexology with late stage breast cancer patients serves as the data source for this article . The purpose s were to investigate : ( i ) reasons for refusal to participate in a RCT of reflexology ; ( ii ) the differences between those who completed the baseline interview and those who dropped out before baseline ; and ( iii ) the utility of the Palliative Prognostic Score ( PPS ) as a prognostic screening tool in minimizing early attrition ( before baseline ) from the trial . Eligible women ( N = 400 ) approached at 12 cancer centers in the Midwest had advanced breast cancer , were on chemotherapy or hormonal therapy , and had a PPS of 11 or less . Comparisons of those who dropped out early ( N = 33 ) to those who stayed in the trial ( N = 240 ) were carried out using Wilcoxon rank , t- , chi-squared and Fisher 's exact tests . The reasons of being “ too sick ” or “ overwhelmed ” were given by less than 12 % of the women who refused to participate . There was a higher early dropout rate among black women compared to other ( primarily white ) women ( P = .01 ) . Cancer recurrence and metastasis , age , and the PPS were not predictive of early retention of women . Specialized techniques may be needed to ensure black women remain in the trial once consented . Women with advanced disease were likely to enter and remain in the trial despite deterioration in health Women with breast cancer are naturally exposed to strain related to diagnosis and treatment , and this influences their experienced quality of life ( QoL ) . The present paper reports the effect , with regard to QoL aspects , of an art therapy intervention among 41 women undergoing radiotherapy treatment for breast cancer . The women were r and omized to an intervention group with individual art therapy sessions for 1 h/week ( n = 20 ) , or to a control group ( n = 21 ) . The WHOQOL-BREF and EORTC Quality of Life Question naire-BR23 , were used for QoL assessment , and administrated on three measurement occasions , before the start of radiotherapy and 2 and 6 months later . The results indicate an overall improvement in QoL aspects among women in the intervention group . A significant increase in total health , total QoL , physical health and psychological health was observed in the art therapy group . A significant positive difference within the art therapy group was also seen , concerning future perspectives , body image and systemic therapy side effects . The present study provides strong support for the use of art therapy to improve QoL for women undergoing radiotherapy treatment for breast cancer The purpose of this study was to gather data on the efficacy of a newly developed psychosocial group intervention for cancer patients , called mindfulness-based art therapy ( MBAT ) .  One hundred and eleven women with a variety of cancer diagnoses were paired by age and r and omized to either an eight-week MBAT intervention group or a wait-list control group .  Ninety-three participants ( 84 % ) completed both the pre- and post- study measurements . As compared to the control group , the MBAT group demonstrated a significant decrease in symptoms of distress ( as measured by the Symptoms Checklist-90-Revised ) and significant improvements in key aspects of health-related quality of life ( as measured by the Medical Outcomes Study Short-Form Health Survey ) . This investigation of MBAT provides initial encouraging data that support a possible future role for the intervention as a psychosocial treatment option for cancer patients A nonpharmacological method can be an alternative or complement to analgesics . The aim of this study was to evaluate if music medicine influences pain and anxiety in children undergoing lumbar punctures .  A r and omized clinical trial was used in 40 children ( aged 7 - 12 years ) with leukemia , followed by interviews in 20 of these participants . The participants were r and omly assigned to a music group ( n = 20 ) or control group ( n = 20 ) . The primary outcome was pain scores and the secondary was heart rate , blood pressure , respiratory rate , and oxygen saturation measured before , during , and after the procedure . Anxiety scores were measured before and after the procedure . Interviews with open-ended questions were conducted in conjunction with the completed procedures . The results showed lower pain scores and heart and respiratory rates in the music group during and after the lumbar puncture . The anxiety scores were lower in the music group both before and after the procedure . The findings from the interviews confirmed the quantity results through descriptions of a positive experience by the children , including less pain and fear A pilot research study was conducted at 2 cancer centers in Connecticut to determine the effect of a dance and movement program on quality of life and shoulder function in breast cancer survivors treated within the prior 5 years . Thirty-five women completed the trial that included a 12-week intervention , using The Lebed Method , Focus on Healing Through Movement and Dance . The study design was a r and omized control trial with a wait list control group crossover to active treatment in weeks 13 to 25 , with the treatment group receiving the program in weeks 1 to 12 , and no program in weeks 13 to 25 . Outcome measures were the Breast Cancer Quality of Life ( FACT 
    Output:
    