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: UNLABELLED The aim of this paper was to quantify the influence of the physician 's training and experience in the field of acupuncture on the outcome in patients with chronic pain . Patients visiting their physician because of chronic low back pain , headache , pain due to osteoarthritis of the knee or hip , or neck pain , were included in 4 multicenter , r and omized , controlled studies . All patients received routine care ; patients in the acupuncture groups received additional acupuncture treatment ( on average 10 sessions ) . The data was pooled , and the 3-month change from baseline of the SF-36 bodily pain subscale as the main outcome defined . A total of 9,990 patients ( mean age 49.6 + /- 13.6 years , 68 % female ) treated by 2,781 physicians ( mean age 46.3 + /- 7 years , 37 % female ) were analyzed . The physicians had 7.3 + /- 5.2 ( mean + /- sd ) years of experience in acupuncture  and their mean duration of formal acupuncture training had been 287 + /- 321 hours . The outcome was markedly improved in the acupuncture group . We identified only 1 physician characteristic with a significant influence on the outcome : Internists performed better ( odds ratio OR = 1.49 , confidence interval CI : 1.01;2.18 ; P = .043 ) ; orthopedists worse ( OR = .79 , CI : .62;1 ; P = .043 ) than the average physician . Neither the duration of training nor the duration of experience had any impact on the extent of the  acupuncture effect . PERSPECTIVE In this analysis , physician characteristics such as training did not influence patients ' outcome after acupuncture , suggesting that formal training parameters have only a limited influence on treatment effect . Other skills such as the therapeutic relationship , which are difficult to measure , may probably play a more important role and should be taken into consideration AIMS To assess the quality of r and omized controlled trials ( RCTs ) published in Neurourology and Urodynamics ( NAU ) by using three types of analytical tools . METHODS MEDLINE was used to extract RCTs from original articles published in the NAU from 1993 to 2012 . The relationship between the number of articles and RCTs with time and that between various factors and the quality of RCTs were analyzed . To analyze the quality of the RCTs , the time period was divided into four sections and three tools were applied ( e.g. , the Jadad scale , van Tulder scale , and Cochrane Collaboration Risk of Bias Tool [ CCRBT ] ) . RESULTS Among the 1,957 original articles , 93 ( 4.75 % ) were RCTs . The ratio between the number of NAU and RCTs over time increased . The Jadad score for years 1993 - 1997 was 3.25 ± 1.71 , 1998 - 2002 was 2.10 ± 0.74 , 2003 - 2007 was 2.09 ± 1.12 , and 2008 - 2012 was 2.80 ± 1.09 ( P = 0.014 ) . The van Tulder scales were 6.25 ± 3.10 , 4.40 ± 1.65 , 4.97 ± 1.99 , and 5.93 ± 1.98 , respectively ( P = 0.055 ) . The CCRBT identified a low risk of bias in 1 ( 25 % ) , 0 ( 0 % ) , 1 ( 2.86 % ) , and 5 ( 11.36 % ) articles , respectively . Trials with allocation concealment , Institutional review board ( IRB ) approval , and blinded studies had significantly higher quality than others . CONCLUSIONS The quantitative increase of RCT presented in NAU over time was observed but there was no definite qualitative improvement . Effort is required to improve the quality of RCTs published in NAU from the design step Background We investigated whether there had been an improvement in quality of reporting for r and omised controlled trials of acupuncture since the publication of the STRICTA and CONSORT statements . We conducted a before- and -after study , comparing ratings for quality of reporting following the publication of both STRICTA and CONSORT recommendations . Methodology and Principal Findings Ninety peer review ed journal articles reporting the results of acupuncture trials were selected at r and om from a wider sample frame of 266 papers . Papers published in three distinct time periods ( 1994–1995 , 1999–2000 and 2004–2005 ) were compared . Assessment criteria were developed directly from CONSORT and STRICTA checklists . Papers were independently assessed for quality of reporting by two assessors , one of whom was blind to information which could have introduced systematic bias ( e.g. date of publication ) . We detected a statistically significant increase in the reporting of CONSORT items for papers published in each time period measured . We did not , however , find a difference between the number of STRICTA items reported in journal articles published before and 3 to 4 years following the introduction of STRICTA recommendations . Conclusions and Significance The results of this study suggest that general st and ards of reporting for acupuncture trials have significantly improved since the introduction of the CONSORT statement in 1996 , but that quality in reporting details specific to acupuncture interventions has yet to change following the more recent introduction of STRICTA recommendations . Wider targeting and revision of the guidelines is recommended The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . BACKGROUND Despite growing popularity of complementary and alternative medical ( CAM ) therapies , little is known about the patients seen by CAM practitioners .  Our objective was to describe the patients and problems seen by CAM practitioners .  METHODS We collected data on 20 consecutive visits to r and omly sample d licensed acupuncturists , chiropractors , massage therapists , and naturopathic physicians practicing in Arizona , Connecticut , Massachusetts , and Washington . Data were collected on patient demographics , smoking status , referral source , reasons for visit , concurrent medical care , payment source , and visit duration . Comparative data for conventional physicians were drawn from the National Ambulatory Medical Care Survey . RESULTS In each profession , at least 99 practitioners collected data on more than 1,800 visits . More than 80 % of visits to CAM providers were by young and middle-aged adults , and roughly two thirds were by women . Children comprised 10 % of visits to naturopathic physicians but only 1 % to 4 % of all visits to other CAM providers . At least two thirds of visits result ed from self-referrals , and only 4 % to 12 % of visits were from conventional physician referrals . Chiropractors and massage therapists primarily saw musculoskeletal problems , while acupuncturists and naturopathic physicians saw a broader range of conditions . Visits to acupuncturists and massage therapists lasted about 60 minutes compared with 40 minutes for naturopathic physicians and less than 20 minutes for chiropractors . Most visits to chiropractors and naturopathic physicians , but less than one third of visits to acupuncturists and massage therapists , were covered by insurance . CONCLUSIONS This information will help inform discussion s of the roles CAM practitioners will play in the health care system of the future OBJECTIVE To compare therapeutic effects of electroacupuncture at Houxi ( SI 3 ) and medicine on acute lumbar sprain . METHODS Three hundred cases of acute lumbar sprain were r and omly divided into two groups , a electroacupuncture ( EA ) group and a medication group , 150 cases in each group . The EA group were treated with EA at Houxi ( SI 3 ) , once each day , 3 sessions constituting one course , and the medication group with Mobike , once daily , 7 . 5 mg each time . Their therapeutic effects were evaluated after treatment for 7 days and one month respectively . RESULTS For the short-term therapeutic effect , the effective rate was 97 . 3 % in the EA group and 89 . 2 % in the medication group with a very significant difference between the two groups ( P<0 . 01 ) ; for the long-term therapeutic effect , the effective rate was 99 . 3 % in the EA group and 93 . 2 % in the medication group with a very significant difference between the two groups ( P<0 . 01 ) . CONCLUSION Both the short-term and the long-term therapeutic effects of EA at Houxi ( SI 3 ) on acute lumbar sprain are better than those in the medication group OBJECTIVE To inform the potential revision of St and ards for Reporting Interventions in Controlled Trials of Acupuncture ( STRICTA ) , we sought the opinion of acupuncture trial authors and systematic review ers to rank the utility of the guidelines and asked trial authors about their experiences using them . DESIGN Question naires ranking STRICTA items and qualitative responses about experience using the guidelines . SAMPLE The authors of 38 r and omized controlled acupuncture trials r and omly selected from a systematic search of those published in 2004 and 2005 were contacted with a question naire . Authors of 14 Cochrane acupuncture systematic review s or protocol s published in the same time frame were also sent a question naire . RESULTS Fifty-four percent ( 54 % ) ( 28/52 ) of the sample responded . Among the trial authors , 58 % ( 11/19 ) used STRICTA to help guide their writing , but more than half of these reported that the editing process had removed some or all of the STRICTA-specific items . STRICTA was seen as a helpful reference , but authors requested that some items be clarified . Respondents tended to rank the utility of STRICTA  highly overall , but five items in particular were not highly valued ; three of these pertained to details on the trial acupuncturists ' background . Authors flagged potential difficulties of reporting unusual trial design s in the current format of STRICTA . CONCLUSIONS Authors of acupuncture trials and systematic review s believe that STRICTA contributes to the reporting of acupuncture interventions and rate it highly . Because very few acupuncture studies are published in STRICTA-adopting journals , the editing process for journals unaware of the guidelines may be responsible for deleting acupuncture intervention-specific items . Several items remain unclear , and the relevance of STRICTA to some trial design s is question ed . A review of STRICTA is warranted to clarify and reconsider items , and targeted promotion to non-complementary and alternative medicine journals should be considered In a pilot study , we evaluated the clinical and mechanistic effects of two styles of acupuncture , Traditional Chinese Medicine ( TCM ) and Japanese acupuncture , for the treatment of painful diabetic neuropathy . Out of seven patients enrolled , three received Traditional Chinese acupuncture while four received Japanese style acupuncture . Treatments were delivered once a week for 10 weeks . Acupuncturists were permitted to select the needle interventions . Substantial differences in diagnostic techniques , choice of acupuncture points , and needle manipulation were observed between TCM and Japanese acupuncturists . Clinical ly , patients allocated to Japanese acupuncture reported decreased neuropathy-associated pain according to the daily pain severity score , while the group allocated to the TCM acupuncture reported minimal effects . Both acupuncture styles , however , lowered pain according to the McGill Short Form Pain Score . The TCM style improved nerve sensation according to quantitative sensory testing while the Japanese style had a more equivocal effect . No evident changes were observed in glucose control or heart rate variability in either group OBJECTIVE A pilot study to assess the feasibility of a trial to investigate the efficacy of acupuncture compared to placebo needling for the treatment of acute low back pain ( LBP ) . As part of this , the study was design ed to establish the credibility of the placebo control , and to provide data to inform a power analysis to determine numbers for a future trial . STUDY DESIGN A pilot patient and assessor blinded r and omized controlled trial . SETTING Primary care health centre facility , South and East Belfast Trust , Northern Irel and . PATIENTS Patients from the physiotherapy waiting list ( n=48 ) with LBP of less than 12 weeks duration . OUTCOME MEASURES Rol and and Morris Disability Question naire ( RMDQ ) , Visual Analogue Scale ( VAS ) , medication use and an exit question naire were completed at baseline , end of treatment , and at 3 months follow up . RESULTS Ninety-four percent ( 45/48 ) of patients completed assigned treatment , 83 % ( 40/48 ) completed 3 months follow-up . The sham needle used here proved to be credible : 91.7 % in the placebo group believed they had received acupuncture , compared to 95.8 % in the verum acupuncture group . Differences in baseline characteristics were accounted for using ANCOVA . There was no significant difference between groups on the RMDQ over time . For pain , the only statistically significant difference was at the 3 months follow up ( worst VAS , point estimate , 18.7 , 95 % CI 1.5 - 36.0 , p=0.034 ) . The majority of patients were taking some form of analgesic medication for LBP at the start of treatment ( n=44 ; 92 % ) , and at the end of treatment the verum acupunct 
    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: UNLABELLED The aim of this paper was to quantify the influence of the physician 's training and experience in the field of acupuncture on the outcome in patients with chronic pain . Patients visiting their physician because of chronic low back pain , headache , pain due to osteoarthritis of the knee or hip , or neck pain , were included in 4 multicenter , r and omized , controlled studies . All patients received routine care ; patients in the acupuncture groups received additional acupuncture treatment ( on average 10 sessions ) . The data was pooled , and the 3-month change from baseline of the SF-36 bodily pain subscale as the main outcome defined . A total of 9,990 patients ( mean age 49.6 + /- 13.6 years , 68 % female ) treated by 2,781 physicians ( mean age 46.3 + /- 7 years , 37 % female ) were analyzed . The physicians had 7.3 + /- 5.2 ( mean + /- sd ) years of experience in acupuncture  and their mean duration of formal acupuncture training had been 287 + /- 321 hours . The outcome was markedly improved in the acupuncture group . We identified only 1 physician characteristic with a significant influence on the outcome : Internists performed better ( odds ratio OR = 1.49 , confidence interval CI : 1.01;2.18 ; P = .043 ) ; orthopedists worse ( OR = .79 , CI : .62;1 ; P = .043 ) than the average physician . Neither the duration of training nor the duration of experience had any impact on the extent of the  acupuncture effect . PERSPECTIVE In this analysis , physician characteristics such as training did not influence patients ' outcome after acupuncture , suggesting that formal training parameters have only a limited influence on treatment effect . Other skills such as the therapeutic relationship , which are difficult to measure , may probably play a more important role and should be taken into consideration AIMS To assess the quality of r and omized controlled trials ( RCTs ) published in Neurourology and Urodynamics ( NAU ) by using three types of analytical tools . METHODS MEDLINE was used to extract RCTs from original articles published in the NAU from 1993 to 2012 . The relationship between the number of articles and RCTs with time and that between various factors and the quality of RCTs were analyzed . To analyze the quality of the RCTs , the time period was divided into four sections and three tools were applied ( e.g. , the Jadad scale , van Tulder scale , and Cochrane Collaboration Risk of Bias Tool [ CCRBT ] ) . RESULTS Among the 1,957 original articles , 93 ( 4.75 % ) were RCTs . The ratio between the number of NAU and RCTs over time increased . The Jadad score for years 1993 - 1997 was 3.25 ± 1.71 , 1998 - 2002 was 2.10 ± 0.74 , 2003 - 2007 was 2.09 ± 1.12 , and 2008 - 2012 was 2.80 ± 1.09 ( P = 0.014 ) . The van Tulder scales were 6.25 ± 3.10 , 4.40 ± 1.65 , 4.97 ± 1.99 , and 5.93 ± 1.98 , respectively ( P = 0.055 ) . The CCRBT identified a low risk of bias in 1 ( 25 % ) , 0 ( 0 % ) , 1 ( 2.86 % ) , and 5 ( 11.36 % ) articles , respectively . Trials with allocation concealment , Institutional review board ( IRB ) approval , and blinded studies had significantly higher quality than others . CONCLUSIONS The quantitative increase of RCT presented in NAU over time was observed but there was no definite qualitative improvement . Effort is required to improve the quality of RCTs published in NAU from the design step Background We investigated whether there had been an improvement in quality of reporting for r and omised controlled trials of acupuncture since the publication of the STRICTA and CONSORT statements . We conducted a before- and -after study , comparing ratings for quality of reporting following the publication of both STRICTA and CONSORT recommendations . Methodology and Principal Findings Ninety peer review ed journal articles reporting the results of acupuncture trials were selected at r and om from a wider sample frame of 266 papers . Papers published in three distinct time periods ( 1994–1995 , 1999–2000 and 2004–2005 ) were compared . Assessment criteria were developed directly from CONSORT and STRICTA checklists . Papers were independently assessed for quality of reporting by two assessors , one of whom was blind to information which could have introduced systematic bias ( e.g. date of publication ) . We detected a statistically significant increase in the reporting of CONSORT items for papers published in each time period measured . We did not , however , find a difference between the number of STRICTA items reported in journal articles published before and 3 to 4 years following the introduction of STRICTA recommendations . Conclusions and Significance The results of this study suggest that general st and ards of reporting for acupuncture trials have significantly improved since the introduction of the CONSORT statement in 1996 , but that quality in reporting details specific to acupuncture interventions has yet to change following the more recent introduction of STRICTA recommendations . Wider targeting and revision of the guidelines is recommended The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . BACKGROUND Despite growing popularity of complementary and alternative medical ( CAM ) therapies , little is known about the patients seen by CAM practitioners .  Our objective was to describe the patients and problems seen by CAM practitioners .  METHODS We collected data on 20 consecutive visits to r and omly sample d licensed acupuncturists , chiropractors , massage therapists , and naturopathic physicians practicing in Arizona , Connecticut , Massachusetts , and Washington . Data were collected on patient demographics , smoking status , referral source , reasons for visit , concurrent medical care , payment source , and visit duration . Comparative data for conventional physicians were drawn from the National Ambulatory Medical Care Survey . RESULTS In each profession , at least 99 practitioners collected data on more than 1,800 visits . More than 80 % of visits to CAM providers were by young and middle-aged adults , and roughly two thirds were by women . Children comprised 10 % of visits to naturopathic physicians but only 1 % to 4 % of all visits to other CAM providers . At least two thirds of visits result ed from self-referrals , and only 4 % to 12 % of visits were from conventional physician referrals . Chiropractors and massage therapists primarily saw musculoskeletal problems , while acupuncturists and naturopathic physicians saw a broader range of conditions . Visits to acupuncturists and massage therapists lasted about 60 minutes compared with 40 minutes for naturopathic physicians and less than 20 minutes for chiropractors . Most visits to chiropractors and naturopathic physicians , but less than one third of visits to acupuncturists and massage therapists , were covered by insurance . CONCLUSIONS This information will help inform discussion s of the roles CAM practitioners will play in the health care system of the future OBJECTIVE To compare therapeutic effects of electroacupuncture at Houxi ( SI 3 ) and medicine on acute lumbar sprain . METHODS Three hundred cases of acute lumbar sprain were r and omly divided into two groups , a electroacupuncture ( EA ) group and a medication group , 150 cases in each group . The EA group were treated with EA at Houxi ( SI 3 ) , once each day , 3 sessions constituting one course , and the medication group with Mobike , once daily , 7 . 5 mg each time . Their therapeutic effects were evaluated after treatment for 7 days and one month respectively . RESULTS For the short-term therapeutic effect , the effective rate was 97 . 3 % in the EA group and 89 . 2 % in the medication group with a very significant difference between the two groups ( P<0 . 01 ) ; for the long-term therapeutic effect , the effective rate was 99 . 3 % in the EA group and 93 . 2 % in the medication group with a very significant difference between the two groups ( P<0 . 01 ) . CONCLUSION Both the short-term and the long-term therapeutic effects of EA at Houxi ( SI 3 ) on acute lumbar sprain are better than those in the medication group OBJECTIVE To inform the potential revision of St and ards for Reporting Interventions in Controlled Trials of Acupuncture ( STRICTA ) , we sought the opinion of acupuncture trial authors and systematic review ers to rank the utility of the guidelines and asked trial authors about their experiences using them . DESIGN Question naires ranking STRICTA items and qualitative responses about experience using the guidelines . SAMPLE The authors of 38 r and omized controlled acupuncture trials r and omly selected from a systematic search of those published in 2004 and 2005 were contacted with a question naire . Authors of 14 Cochrane acupuncture systematic review s or protocol s published in the same time frame were also sent a question naire . RESULTS Fifty-four percent ( 54 % ) ( 28/52 ) of the sample responded . Among the trial authors , 58 % ( 11/19 ) used STRICTA to help guide their writing , but more than half of these reported that the editing process had removed some or all of the STRICTA-specific items . STRICTA was seen as a helpful reference , but authors requested that some items be clarified . Respondents tended to rank the utility of STRICTA  highly overall , but five items in particular were not highly valued ; three of these pertained to details on the trial acupuncturists ' background . Authors flagged potential difficulties of reporting unusual trial design s in the current format of STRICTA . CONCLUSIONS Authors of acupuncture trials and systematic review s believe that STRICTA contributes to the reporting of acupuncture interventions and rate it highly . Because very few acupuncture studies are published in STRICTA-adopting journals , the editing process for journals unaware of the guidelines may be responsible for deleting acupuncture intervention-specific items . Several items remain unclear , and the relevance of STRICTA to some trial design s is question ed . A review of STRICTA is warranted to clarify and reconsider items , and targeted promotion to non-complementary and alternative medicine journals should be considered In a pilot study , we evaluated the clinical and mechanistic effects of two styles of acupuncture , Traditional Chinese Medicine ( TCM ) and Japanese acupuncture , for the treatment of painful diabetic neuropathy . Out of seven patients enrolled , three received Traditional Chinese acupuncture while four received Japanese style acupuncture . Treatments were delivered once a week for 10 weeks . Acupuncturists were permitted to select the needle interventions . Substantial differences in diagnostic techniques , choice of acupuncture points , and needle manipulation were observed between TCM and Japanese acupuncturists . Clinical ly , patients allocated to Japanese acupuncture reported decreased neuropathy-associated pain according to the daily pain severity score , while the group allocated to the TCM acupuncture reported minimal effects . Both acupuncture styles , however , lowered pain according to the McGill Short Form Pain Score . The TCM style improved nerve sensation according to quantitative sensory testing while the Japanese style had a more equivocal effect . No evident changes were observed in glucose control or heart rate variability in either group OBJECTIVE A pilot study to assess the feasibility of a trial to investigate the efficacy of acupuncture compared to placebo needling for the treatment of acute low back pain ( LBP ) . As part of this , the study was design ed to establish the credibility of the placebo control , and to provide data to inform a power analysis to determine numbers for a future trial . STUDY DESIGN A pilot patient and assessor blinded r and omized controlled trial . SETTING Primary care health centre facility , South and East Belfast Trust , Northern Irel and . PATIENTS Patients from the physiotherapy waiting list ( n=48 ) with LBP of less than 12 weeks duration . OUTCOME MEASURES Rol and and Morris Disability Question naire ( RMDQ ) , Visual Analogue Scale ( VAS ) , medication use and an exit question naire were completed at baseline , end of treatment , and at 3 months follow up . RESULTS Ninety-four percent ( 45/48 ) of patients completed assigned treatment , 83 % ( 40/48 ) completed 3 months follow-up . The sham needle used here proved to be credible : 91.7 % in the placebo group believed they had received acupuncture , compared to 95.8 % in the verum acupuncture group . Differences in baseline characteristics were accounted for using ANCOVA . There was no significant difference between groups on the RMDQ over time . For pain , the only statistically significant difference was at the 3 months follow up ( worst VAS , point estimate , 18.7 , 95 % CI 1.5 - 36.0 , p=0.034 ) . The majority of patients were taking some form of analgesic medication for LBP at the start of treatment ( n=44 ; 92 % ) , and at the end of treatment the verum acupunct 
    Output:
    