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 Colonoscopy is a procedure often experienced as uncomfortable and worrying . Music has been reported to reduce discomfort during colonoscopy ; however , no study in a Swedish setting has been found . The purpose of this r and omized controlled trial was to analyze the effects of sedative music on patients ' experience of anxiety , pain , relaxation , and well-being during colonoscopy . Prior to colonoscopy , adult patients ( n = 120 ) , aged 18–80 years , were r and omly assigned to either an intervention group ( n = 60 ) who listened to sedative instrumental music with 60–80 beats per minute during the colonoscopy or a control group . After the colonoscopy , both groups completed a question naire on anxiety , the State Trait Anxiety Inventory  , and an anxiety Visual Analogue Scale . Pain , relaxation , and well-being were also measured with Visual Analogue Scales . Women in the intervention group had a lower level of anxiety during the colonoscopy than those in the control group ( p = .007 ) and well-being was significantly higher in the intervention group , especially among men , than in the controls ( p = .006 and p = .025 , respectively ) . Men in the intervention group were more relaxed during the colonoscopy than those in the control group ( p = .065 ) . Listening to sedative music  decreased anxiety among women and increased well-being among men during colonoscopy Objectives To test the inter-rater reliability of the RoB tool applied to Physical Therapy ( PT ) trials by comparing ratings from Cochrane review authors with those of blinded external review ers . Methods R and omized controlled trials ( RCTs ) in PT were identified by search ing the Cochrane Data base of Systematic Review s for meta- analysis of PT interventions .  RoB assessment s were conducted independently by 2 review ers blinded to the RoB ratings reported in the Cochrane review s. Data on RoB assessment s from Cochrane review s and other characteristics of review s and trials were extracted . Consensus assessment s between the two review ers were then compared with the RoB ratings from the Cochrane review s. Agreement between Cochrane and blinded external review ers was assessed using weighted kappa ( κ ) . Results In total , 109 trials included in 17 Cochrane review s were assessed . Inter-rater reliability on the overall RoB assessment between Cochrane review authors and blinded external review ers was poor ( κ = 0.02 , 95%CI : −0.06 , 0.06 ] ) . Inter-rater reliability on individual domains of the RoB tool was poor ( median κ = 0.19 ) , ranging from κ = −0.04 ( “ Other bias ” ) to κ = 0.62 ( “ Sequence generation ” ) . There was also no agreement ( κ = −0.29 , 95%CI : −0.81 , 0.35 ] ) in the overall RoB assessment at the meta- analysis level . Conclusions Risk of bias assessment s of RCTs using the RoB tool are not consistent across different research groups . Poor agreement was not only demonstrated at the trial level but also at the meta- analysis level . Results have implication s for decision making since different recommendations can be reached depending on the group analyzing the evidence . Improved guidelines to consistently apply the RoB tool and revisions to the tool for different health areas are needed Abstract Objectives To evaluate the heart rate lowering effect of relaxation music in patients undergoing coronary CT angiography ( CCTA ) , pulmonary vein CT ( PVCT ) and coronary calcium score CT ( CCS ) . Methods Patients were r and omised to a control group ( i.e. st and ard of care protocol ) or to a relaxation music group ( ie . st and ard of care protocol with music ) . The groups were compared for heart rate , radiation dose , image quality and dose of IV metoprolol . Both groups completed State-Trait Anxiety Inventory anxiety question naires to assess patient experience . Results One hundred and ninety-seven patients were recruited ( 61.9 % males ) ; mean age 56y ( 19 - 86 y ) ; 127 CCTA , 17 PVCT , 53 CCS . No significant difference in heart rate , radiation dose , image quality , metoprolol dose and anxiety scores . 86 % of patients enjoyed the music . 90 % of patients in the music group expressed a strong preference to have music for future examinations . The patient cohort demonstrated low anxiety levels prior to CT . Conclusion Relaxation music in CCTA , PVCT and CCS does not reduce heart rate or IV metoprolol use . Patients showed low levels of anxiety indicating that anxiolytics may not have a significant role in lowering heart rate . Music can be used in cardiac CT to improve patient experience . Key Points• Relaxation music does not reduce heart rate in cardiac CT • Relaxation music does not reduce beta-blocker use in cardiac CT • Relaxation music has no effect on cardiac CT image quality • Low levels of anxiety are present in patients prior to cardiac CT • Patients enjoyed the relaxation music and this results in improved patient BACKGROUND AND PURPOSE Optimizing communication between radiotherapy team members and patients and between colleagues requires training . This study applies a r and omized controlled design to assess the efficacy of a 38-h communication skills training program . MATERIAL AND METHODS Four radiotherapy teams were r and omly assigned either to a training program or to a waiting list . Team members ' communication skills and their self-efficacy to communicate in the context of an encounter with a simulated patient were the primary endpoints . These encounters were scheduled at the baseline and after training for the training group , and at the baseline and four months later for the waiting list group . Encounters were audiotaped and transcribed . Transcripts were analyzed with content analysis software ( LaComm ) and by an independent rater . RESULTS Eighty team members were included in the study . Compared to untrained team members , trained team members used more turns of speech with content oriented toward available re sources in the team ( relative rate [RR]=1.38 ; p=0.023 ) , more assessment utterances ( RR=1.69 ; p<0.001 ) , more empathy ( RR=4.05 ; p=0.037 ) , more negotiation ( RR=2.34 ; p=0.021 ) and more emotional words ( RR=1.32 ; p=0.030 ) , and their self-efficacy to communicate increased ( p=0.024 and p=0.008 , respectively ) . CONCLUSIONS The training program was effective in improving team members ' communication skills and their self-efficacy to communicate in the context of an encounter with a simulated patient . Future study should assess the effect of this training program on communication with actual patients and their satisfaction . Moreover a cost-benefit analysis is needed , before implementing such an intensive training program on a broader scale Breast cancer radiotherapy can be an emotionally difficult experience . Despite this , few studies have examined the effectiveness of psychological interventions to reduce negative affect , and none to date have explicitly examined interventions to improve positive affect among breast cancer radiotherapy patients . The present study examined the effectiveness of a multimodal psychotherapeutic approach , combining cognitive-behavioral therapy and hypnosis ( CBTH ) , to reduce negative affect and increase positive affect in 40 women undergoing breast cancer radiotherapy . Participants were r and omly assigned to receive either CBTH or st and ard care . Participants completed weekly self-report measures of positive and negative affect . Repeated and univariate analyses of variance revealed that the CBTH approach reduced levels of negative affect [ F(1 , 38)=13.49 ; p=.0007 , omega(2)=.56 ] , and increased levels of positive affect [ F(1 , 38)=9.67 ; p=.0035 , omega(2)=.48 ] , during the course of radiotherapy . Additionally , relative to the control group , the CBTH group demonstrated significantly more intense positive affect [ F(1 , 38)=7.09 ; p=.0113 , d=.71 ] and significantly less intense negative affect [ F(1 , 38)=10.30 ; p=.0027 , d=.90 ] during radiotherapy . The CBTH group also had a significantly higher frequency of days where positive affect was greater than negative affect ( 85 % of days assessed for the CBTH group versus 43 % of the Control group ) [ F(1 , 38)=18.16 ; p=.0001 , d=1.16 ] . Therefore , the CBTH intervention has the potential to improve the affective experience of women undergoing breast cancer radiotherapy The objective of this study was to evaluate the effect of immersive virtual reality ( IVR ) distraction therapy during painful wound care procedures in adults on the amount of opioid medications required to manage pain . A convenience sample of consenting , adult in patients requiring recurrent painful wound care procedures was studied . Using a within-subject , r and omized controlled trial study design , 2 sequential wound procedures were compared , 1 with IVR distraction therapy and 1 without IVR .  Total opioid medications administered before and during the wound procedures were recorded and pain and anxiety were rated before and after the 2 wound procedures . The IVR intervention included the wearing of virtual reality goggles and participation in an immersive , computer generated , interactive , 3-dimensional virtual world program . Data were analyzed with Student 's t test and chi-square analysis , with P < 0.05 considered significant . A total of 18 patients were studied , with 12 completing both study wound procedures and 6 completing a single wound procedure . The amount of opioid administered before each of the 2 wound procedures was similar with and without IVR . Total opioid administration during the dressing procedures with IVR was significantly less than when no IVR was used , 17.9 ± 6.0 and 29.2 ± 4.5 mcg/kg fentanyl , respectively ( t = -2.7 ; df = 14 ; P = 0.02 ) . Two of 15 patients ( 11 % ) requested more than 1 opioid rescue dose with IVR and 9 of 15 patients ( 60 % ) requested more than 1 rescue dose without IVR . Seventy-five percentage of participants stated that they would want to use IVR with future dressing changes . Pain and anxiety scores were similar for the wound procedures with and without IVR ( P > 0.05 ) . IVR significantly reduced the amount of opioid medication administered during painful wound care procedures when IVR was used compared with no IVR . Since pain scores were similar before and after the wound procedures with IVR and without IVR , the 39 % reduction in opioid medication during IVR supports its use as a pain distraction therapy during painful procedures AIMS AND OBJECTIVES To evaluate the effect of video information given before cardiovascular magnetic resonance imaging on  patient anxiety  and to compare patient experiences of cardiovascular magnetic resonance imaging versus myocardial perfusion scintigraphy . To evaluate whether additional information has an impact on motion artefacts . BACKGROUND Cardiovascular magnetic resonance imaging and myocardial perfusion scintigraphy are technically advanced methods for the evaluation of heart diseases . Although cardiovascular magnetic resonance imaging is considered to be painless , patients may experience anxiety due to the closed environment . DESIGN A prospect i ve r and omised intervention study , not registered . METHODS The sample ( n = 148 ) consisted of 97 patients referred for cardiovascular magnetic resonance imaging , r and omised to receive either video information in addition to st and ard text-information ( CMR-video/n = 49 ) or st and ard text-information alone ( CMR-st and ard/n = 48 ) . A third group undergoing myocardial perfusion scintigraphy ( n = 51 ) was compared with the cardiovascular magnetic resonance imaging-st and ard group . Anxiety was evaluated before , immediately after the procedure and 1 week later . Five question naires were used : Cardiac Anxiety Question naire , State-Trait Anxiety Inventory , Hospital Anxiety and Depression scale , MRI Fear Survey Schedule and the MRI-Anxiety Question naire . Motion artefacts were evaluated by three observers , blinded to the information given . Data were collected between April 2015-April 2016 . The study followed the CONSORT guidelines . RESULT The CMR-video group scored lower ( better ) than the cardiovascular magnetic resonance imaging-st and ard group in the factor Relaxation ( p = . 
    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 Colonoscopy is a procedure often experienced as uncomfortable and worrying . Music has been reported to reduce discomfort during colonoscopy ; however , no study in a Swedish setting has been found . The purpose of this r and omized controlled trial was to analyze the effects of sedative music on patients ' experience of anxiety , pain , relaxation , and well-being during colonoscopy . Prior to colonoscopy , adult patients ( n = 120 ) , aged 18–80 years , were r and omly assigned to either an intervention group ( n = 60 ) who listened to sedative instrumental music with 60–80 beats per minute during the colonoscopy or a control group . After the colonoscopy , both groups completed a question naire on anxiety , the State Trait Anxiety Inventory  , and an anxiety Visual Analogue Scale . Pain , relaxation , and well-being were also measured with Visual Analogue Scales . Women in the intervention group had a lower level of anxiety during the colonoscopy than those in the control group ( p = .007 ) and well-being was significantly higher in the intervention group , especially among men , than in the controls ( p = .006 and p = .025 , respectively ) . Men in the intervention group were more relaxed during the colonoscopy than those in the control group ( p = .065 ) . Listening to sedative music  decreased anxiety among women and increased well-being among men during colonoscopy Objectives To test the inter-rater reliability of the RoB tool applied to Physical Therapy ( PT ) trials by comparing ratings from Cochrane review authors with those of blinded external review ers . Methods R and omized controlled trials ( RCTs ) in PT were identified by search ing the Cochrane Data base of Systematic Review s for meta- analysis of PT interventions .  RoB assessment s were conducted independently by 2 review ers blinded to the RoB ratings reported in the Cochrane review s. Data on RoB assessment s from Cochrane review s and other characteristics of review s and trials were extracted . Consensus assessment s between the two review ers were then compared with the RoB ratings from the Cochrane review s. Agreement between Cochrane and blinded external review ers was assessed using weighted kappa ( κ ) . Results In total , 109 trials included in 17 Cochrane review s were assessed . Inter-rater reliability on the overall RoB assessment between Cochrane review authors and blinded external review ers was poor ( κ = 0.02 , 95%CI : −0.06 , 0.06 ] ) . Inter-rater reliability on individual domains of the RoB tool was poor ( median κ = 0.19 ) , ranging from κ = −0.04 ( “ Other bias ” ) to κ = 0.62 ( “ Sequence generation ” ) . There was also no agreement ( κ = −0.29 , 95%CI : −0.81 , 0.35 ] ) in the overall RoB assessment at the meta- analysis level . Conclusions Risk of bias assessment s of RCTs using the RoB tool are not consistent across different research groups . Poor agreement was not only demonstrated at the trial level but also at the meta- analysis level . Results have implication s for decision making since different recommendations can be reached depending on the group analyzing the evidence . Improved guidelines to consistently apply the RoB tool and revisions to the tool for different health areas are needed Abstract Objectives To evaluate the heart rate lowering effect of relaxation music in patients undergoing coronary CT angiography ( CCTA ) , pulmonary vein CT ( PVCT ) and coronary calcium score CT ( CCS ) . Methods Patients were r and omised to a control group ( i.e. st and ard of care protocol ) or to a relaxation music group ( ie . st and ard of care protocol with music ) . The groups were compared for heart rate , radiation dose , image quality and dose of IV metoprolol . Both groups completed State-Trait Anxiety Inventory anxiety question naires to assess patient experience . Results One hundred and ninety-seven patients were recruited ( 61.9 % males ) ; mean age 56y ( 19 - 86 y ) ; 127 CCTA , 17 PVCT , 53 CCS . No significant difference in heart rate , radiation dose , image quality , metoprolol dose and anxiety scores . 86 % of patients enjoyed the music . 90 % of patients in the music group expressed a strong preference to have music for future examinations . The patient cohort demonstrated low anxiety levels prior to CT . Conclusion Relaxation music in CCTA , PVCT and CCS does not reduce heart rate or IV metoprolol use . Patients showed low levels of anxiety indicating that anxiolytics may not have a significant role in lowering heart rate . Music can be used in cardiac CT to improve patient experience . Key Points• Relaxation music does not reduce heart rate in cardiac CT • Relaxation music does not reduce beta-blocker use in cardiac CT • Relaxation music has no effect on cardiac CT image quality • Low levels of anxiety are present in patients prior to cardiac CT • Patients enjoyed the relaxation music and this results in improved patient BACKGROUND AND PURPOSE Optimizing communication between radiotherapy team members and patients and between colleagues requires training . This study applies a r and omized controlled design to assess the efficacy of a 38-h communication skills training program . MATERIAL AND METHODS Four radiotherapy teams were r and omly assigned either to a training program or to a waiting list . Team members ' communication skills and their self-efficacy to communicate in the context of an encounter with a simulated patient were the primary endpoints . These encounters were scheduled at the baseline and after training for the training group , and at the baseline and four months later for the waiting list group . Encounters were audiotaped and transcribed . Transcripts were analyzed with content analysis software ( LaComm ) and by an independent rater . RESULTS Eighty team members were included in the study . Compared to untrained team members , trained team members used more turns of speech with content oriented toward available re sources in the team ( relative rate [RR]=1.38 ; p=0.023 ) , more assessment utterances ( RR=1.69 ; p<0.001 ) , more empathy ( RR=4.05 ; p=0.037 ) , more negotiation ( RR=2.34 ; p=0.021 ) and more emotional words ( RR=1.32 ; p=0.030 ) , and their self-efficacy to communicate increased ( p=0.024 and p=0.008 , respectively ) . CONCLUSIONS The training program was effective in improving team members ' communication skills and their self-efficacy to communicate in the context of an encounter with a simulated patient . Future study should assess the effect of this training program on communication with actual patients and their satisfaction . Moreover a cost-benefit analysis is needed , before implementing such an intensive training program on a broader scale Breast cancer radiotherapy can be an emotionally difficult experience . Despite this , few studies have examined the effectiveness of psychological interventions to reduce negative affect , and none to date have explicitly examined interventions to improve positive affect among breast cancer radiotherapy patients . The present study examined the effectiveness of a multimodal psychotherapeutic approach , combining cognitive-behavioral therapy and hypnosis ( CBTH ) , to reduce negative affect and increase positive affect in 40 women undergoing breast cancer radiotherapy . Participants were r and omly assigned to receive either CBTH or st and ard care . Participants completed weekly self-report measures of positive and negative affect . Repeated and univariate analyses of variance revealed that the CBTH approach reduced levels of negative affect [ F(1 , 38)=13.49 ; p=.0007 , omega(2)=.56 ] , and increased levels of positive affect [ F(1 , 38)=9.67 ; p=.0035 , omega(2)=.48 ] , during the course of radiotherapy . Additionally , relative to the control group , the CBTH group demonstrated significantly more intense positive affect [ F(1 , 38)=7.09 ; p=.0113 , d=.71 ] and significantly less intense negative affect [ F(1 , 38)=10.30 ; p=.0027 , d=.90 ] during radiotherapy . The CBTH group also had a significantly higher frequency of days where positive affect was greater than negative affect ( 85 % of days assessed for the CBTH group versus 43 % of the Control group ) [ F(1 , 38)=18.16 ; p=.0001 , d=1.16 ] . Therefore , the CBTH intervention has the potential to improve the affective experience of women undergoing breast cancer radiotherapy The objective of this study was to evaluate the effect of immersive virtual reality ( IVR ) distraction therapy during painful wound care procedures in adults on the amount of opioid medications required to manage pain . A convenience sample of consenting , adult in patients requiring recurrent painful wound care procedures was studied . Using a within-subject , r and omized controlled trial study design , 2 sequential wound procedures were compared , 1 with IVR distraction therapy and 1 without IVR .  Total opioid medications administered before and during the wound procedures were recorded and pain and anxiety were rated before and after the 2 wound procedures . The IVR intervention included the wearing of virtual reality goggles and participation in an immersive , computer generated , interactive , 3-dimensional virtual world program . Data were analyzed with Student 's t test and chi-square analysis , with P < 0.05 considered significant . A total of 18 patients were studied , with 12 completing both study wound procedures and 6 completing a single wound procedure . The amount of opioid administered before each of the 2 wound procedures was similar with and without IVR . Total opioid administration during the dressing procedures with IVR was significantly less than when no IVR was used , 17.9 ± 6.0 and 29.2 ± 4.5 mcg/kg fentanyl , respectively ( t = -2.7 ; df = 14 ; P = 0.02 ) . Two of 15 patients ( 11 % ) requested more than 1 opioid rescue dose with IVR and 9 of 15 patients ( 60 % ) requested more than 1 rescue dose without IVR . Seventy-five percentage of participants stated that they would want to use IVR with future dressing changes . Pain and anxiety scores were similar for the wound procedures with and without IVR ( P > 0.05 ) . IVR significantly reduced the amount of opioid medication administered during painful wound care procedures when IVR was used compared with no IVR . Since pain scores were similar before and after the wound procedures with IVR and without IVR , the 39 % reduction in opioid medication during IVR supports its use as a pain distraction therapy during painful procedures AIMS AND OBJECTIVES To evaluate the effect of video information given before cardiovascular magnetic resonance imaging on  patient anxiety  and to compare patient experiences of cardiovascular magnetic resonance imaging versus myocardial perfusion scintigraphy . To evaluate whether additional information has an impact on motion artefacts . BACKGROUND Cardiovascular magnetic resonance imaging and myocardial perfusion scintigraphy are technically advanced methods for the evaluation of heart diseases . Although cardiovascular magnetic resonance imaging is considered to be painless , patients may experience anxiety due to the closed environment . DESIGN A prospect i ve r and omised intervention study , not registered . METHODS The sample ( n = 148 ) consisted of 97 patients referred for cardiovascular magnetic resonance imaging , r and omised to receive either video information in addition to st and ard text-information ( CMR-video/n = 49 ) or st and ard text-information alone ( CMR-st and ard/n = 48 ) . A third group undergoing myocardial perfusion scintigraphy ( n = 51 ) was compared with the cardiovascular magnetic resonance imaging-st and ard group . Anxiety was evaluated before , immediately after the procedure and 1 week later . Five question naires were used : Cardiac Anxiety Question naire , State-Trait Anxiety Inventory , Hospital Anxiety and Depression scale , MRI Fear Survey Schedule and the MRI-Anxiety Question naire . Motion artefacts were evaluated by three observers , blinded to the information given . Data were collected between April 2015-April 2016 . The study followed the CONSORT guidelines . RESULT The CMR-video group scored lower ( better ) than the cardiovascular magnetic resonance imaging-st and ard group in the factor Relaxation ( p = . 
    Output:
    