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: Background : This systematic review evaluated the effectiveness of psychological interventions for reducing vaccination pain and related outcomes in children and adolescents . Design / Methods : Data base search es identified relevant r and omized and quasi-r and omized controlled trials . Data were extracted and pooled using established methods . Pain , fear , and distress were considered critically important outcomes . Results : Twenty-two studies were included ; 2 included adolescents . Findings showed no benefit of false suggestion ( n=240 ) for pain ( st and ardized mean difference [ SMD ] −0.21 [ −0.47 , 0.05 ] ) or distress ( SMD −0.28 [ −0.59 , 0.11 ] ) , or for use of repeated reassurance ( n=82 ) for pain ( SMD −0.18 [ −0.92 , 0.56 ] ) , fear ( SMD −0.18 [ −0.71 , 0.36 ] ) , or distress ( SMD 0.10 [ −0.33 , 0.54 ] ) . Verbal distraction ( n=46 ) showed reduced distress ( SMD −1.22 [ −1.87 , −0.58 ] ) , but not reduced pain ( SMD −0.27 [ −1.02 , 0.47 ] ) . Similarly , video distraction ( n=328 ) showed reduced distress ( SMD −0.58 [ −0.82 , −0.34 ] ) , but not reduced pain ( SMD −0.88 [ −1.78 , 0.02 ] ) or fear ( SMD 0.08 [ −0.25 , 0.41 ] ) . Music distraction demonstrated reduced pain when used with children ( n=417 ) ( SMD −0.45 [ −0.71 , −0.18 ] ) , but not with adolescents ( n=118 ) ( SMD −0.04 [ −0.42 , 0.34 ] ) . Breathing with a toy ( n=368 ) showed benefit for pain ( SMD −0.49 [ −0.85 , −0.13 ] ) , but not fear ( SMD −0.60 [ −1.22 , 0.02 ] ) ; whereas breathing without a toy ( n=136 ) showed no benefit for pain ( SMD −0.27 [ −0.61 , 0.07 ] ) or fear ( SMD −0.36 [ −0.86 , 0.15 ] ) . There was no benefit for a breathing intervention ( cough ) in children and adolescents ( n=136 ) for pain ( SMD −0.17 [ −0.41 , 0.07 ] ) . Conclusions : Psychological interventions with some evidence of benefit in children include : verbal distraction , video distraction , music distraction , and breathing with a toy & NA ; Distraction has been shown to be an effective technique for managing pain in children ; however , few investigations have examined the utility of this technique with infants . The goal of the current study was to investigate the effectiveness of movie distraction in reducing  infants ’ immunization distress .  Participants were 136 infants ( range = 1–21 months ; M = 7.6 months , SD = 5.0 months ) and their parents , all of whom were recruited when presenting for routine vaccinations . The parent – child dyads were r and omly assigned to either a Distraction or Typical Care control condition . Infant and adult behaviors were assessed using a visual analog scale and a behavioral observation rating scale . Results indicated parents in the Distraction group engaged in higher rates of distraction than those in the Typical Care group , whereas there was no difference in the behavior of nurses in the Distraction and Typical Care groups . In addition , infants in the Distraction group displayed fewer distress behaviors than infants in the Typical Care group both prior to and during recovery from the injection . Findings suggest that a simple and practical distraction intervention can provide some distress relief to infants during routine injections Background : This systematic review evaluated the effectiveness of physical and procedural interventions for reducing pain and related outcomes during vaccination . Design / Methods : Data bases were search ed using a broad search strategy to identify relevant r and omized and quasi-r and omized controlled trials . Data were extracted according to procedure phase ( preprocedure , acute , recovery , and combinations of these ) and pooled using established methods . Results : A total of 31 studies were included . Acute infant distress was diminished during  intramuscular injection without  aspiration ( n=313 ) : st and ardized mean difference ( SMD ) −0.82 ( 95 % confidence interval [ CI ] : −1.18 , −0.46 ) . Injecting the most painful vaccine last during vaccinations reduced acute infant distress ( n=196 ) : SMD −0.69 ( 95 % CI : −0.98 , −0.4 ) . Simultaneous injections  reduced acute infant distress compared with sequential injections ( n=172 ) : SMD −0.56 ( 95 % CI : −0.87 , −0.25 ) . There was no benefit of simultaneous injections in children . Less infant distress during the acute and recovery phases combined occurred with vastus lateralis ( vs. deltoid ) injections ( n=185 ) : SMD −0.70 ( 95 % CI : −1.00 , −0.41 ) . Skin-to-skin contact in neonates ( n=736 ) reduced acute distress : SMD −0.65 ( 95 % CI : −1.05 , −0.25 ) . Holding infants reduced acute distress after removal of the data from 1 method ologically diverse study ( n=107 ) : SMD −1.25 ( 95 % CI : −2.05 , −0.46 ) . Holding after vaccination ( n=417 ) reduced infant distress during the acute and recovery phases combined : SMD −0.65 ( 95 % CI : −1.08 , −0.22 ) . Self-reported fear was reduced for children positioned upright ( n=107 ) : SMD −0.39 ( 95 % CI : −0.77 , −0.01 ) . Non-nutritive sucking ( n=186 ) reduced acute distress in infants : SMD −1.88 ( 95 % CI : −2.57 , −1.18 ) . Manual tactile stimulation did not reduce pain across the lifespan . An external vibrating device and cold reduced pain in children ( n=145 ) : SMD −1.23 ( 95 % CI : −1.58 , −0.87 ) . There was no benefit of warming the vaccine in adults . Muscle tension was beneficial in selected indices of fainting in adolescents and adults . Conclusions : Interventions with evidence of benefit in select population s include : no aspiration , injecting most painful vaccine last , simultaneous injections , vastus lateralis injection , positioning interventions , non-nutritive sucking , external vibrating device with cold , and muscle tension BACKGROUND Distraction has recently gained attention as a technique that may help reduce acute pain in infants and toddlers ; however , results remain equivocal . It appears that these mixed results stem from a variety of method ological differences with regard to how distraction is implemented . OBJECTIVES To offer more definitive conclusions regarding the efficacy and mechanisms of distraction for pain management during infancy . Specifically , the goal was to examine whether the agent of distraction ( i.e. , the specific person conducting the distraction ) and preneedle distress behaviours impact the efficacy of distraction when toddlers were held by parents . METHODS A total of 99 toddlers were r and omly assigned to one of three conditions ( typical care , research assistant-directed distraction or parent-directed distraction ) . Toddler distress behaviours were assessed pre- and postneedle . Toddlers were further grouped according to distress behaviours preneedle ( low⁄no distress versus high distress ) . Parental soothing behaviours were also assessed as a manipulation check . RESULTS Toddler postneedle pain did not significantly differ among groups . However , toddlers who were distressed preneedle displayed significantly more pain postneedle , regardless of the treatment group . There were no significant interactions between treatment group and preneedle distress behaviours . CONCLUSIONS These results suggest that , when being held by a parent , distraction using a toy does not result in lower pain scores in the context of immunization , regardless of who offers the distraction . Furthermore , these findings raise the notion that if clinicians ensured toddlers were regulated before attempting an immunization , postneedle pain may be significantly reduced OBJECTIVE To assess the effect of Eutectic Mixture of Local Anaesthetics cream and rattle on soothing the vaccination pain on four-month-infants . METHODS The single blind r and omised clinical trial was conducted from May 2012 to February 2013 at a clinic under the Gonabad University of Medical Sciences , Iran , and comprised four-month infants who were selected r and omly and divided into three groups . In one group , 2 g of eutectic mixture of local anaesthetics cream was rubbed on the injection spot before administration ; for the other group , the rattle was shaken from 30s to 15s before injection . The last group consisted of controls . The infants were filmed after vaccination . Afterward , a pain question naire was filled out by a trained observer . SPSS 11.5 was used for statistical analysis . RESULTS Of the 50 subjects in the study 16 ( 32 % ) each were in the cream and rattle groups , while the rest ( 36 % ) were in the control group . The severity of the pain before intervention in the control , cream and rattle groups was 2.22 + /- 0.88 , 2.12 + /- 0.95 and 2.25 + /- 1.06 respectively , which were not statistically significant ( p < 0.93 ) . Likewise , the mean severity of pain at the moment of intervention in the three above groups were 8.67 + /- 0.77 , 7.12 + /- 0.5 and 7.87 + /- 0.96 respectively , which was significantly different ( p < 0.001 ) . The severity of pain 15seconds after the intervention in the groups was 5.06 + /- 1.51 , 4.87 + /- 1.31 and 4.19 + /- 1.94 respectively , which were not statistically different ( p < 0.27 ) . CONCLUSION The eutectic mixture of local anaesthetics cream and shaking rattle were effective in attenuating pain of vaccination among the infants , but the latter was not as significant as the former Infant procedural distress is largely understudied , and there is a dearth of empirically supported interventions in the child health psychology literature . This study examined nurse-directed distraction for reducing  infant immunization distress . Ninety infants and their parents were r and omly assigned to a distraction condition ( i.e. , nurses used stimuli to divert infants ' attention ) or a typical care condition . Outcome measures were an observational scale , parent and nurse ratings , and infant heart rate . Results indicated that infants engaged in distraction and that distraction reduced their behavioral distress ; however , ratings and heart rate were inconclusive . Analyses of procedural phases indicated that infants exhibited elevated distress immediately prior to and during an injection , but this distress was fleeting Pain and distress during immunisation of toddlers are reasons for non-immunisation of large number of toddlers . The present study was undertaken to assess the comparative effectiveness of distraction techniques  in the process of immunisation i.e. toy and music . ( The third group of study subjects was control group )  . It is concluded that distraction techniques are quite economical and safe in enhancing the magnitude of immunisation 
    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: Background : This systematic review evaluated the effectiveness of psychological interventions for reducing vaccination pain and related outcomes in children and adolescents . Design / Methods : Data base search es identified relevant r and omized and quasi-r and omized controlled trials . Data were extracted and pooled using established methods . Pain , fear , and distress were considered critically important outcomes . Results : Twenty-two studies were included ; 2 included adolescents . Findings showed no benefit of false suggestion ( n=240 ) for pain ( st and ardized mean difference [ SMD ] −0.21 [ −0.47 , 0.05 ] ) or distress ( SMD −0.28 [ −0.59 , 0.11 ] ) , or for use of repeated reassurance ( n=82 ) for pain ( SMD −0.18 [ −0.92 , 0.56 ] ) , fear ( SMD −0.18 [ −0.71 , 0.36 ] ) , or distress ( SMD 0.10 [ −0.33 , 0.54 ] ) . Verbal distraction ( n=46 ) showed reduced distress ( SMD −1.22 [ −1.87 , −0.58 ] ) , but not reduced pain ( SMD −0.27 [ −1.02 , 0.47 ] ) . Similarly , video distraction ( n=328 ) showed reduced distress ( SMD −0.58 [ −0.82 , −0.34 ] ) , but not reduced pain ( SMD −0.88 [ −1.78 , 0.02 ] ) or fear ( SMD 0.08 [ −0.25 , 0.41 ] ) . Music distraction demonstrated reduced pain when used with children ( n=417 ) ( SMD −0.45 [ −0.71 , −0.18 ] ) , but not with adolescents ( n=118 ) ( SMD −0.04 [ −0.42 , 0.34 ] ) . Breathing with a toy ( n=368 ) showed benefit for pain ( SMD −0.49 [ −0.85 , −0.13 ] ) , but not fear ( SMD −0.60 [ −1.22 , 0.02 ] ) ; whereas breathing without a toy ( n=136 ) showed no benefit for pain ( SMD −0.27 [ −0.61 , 0.07 ] ) or fear ( SMD −0.36 [ −0.86 , 0.15 ] ) . There was no benefit for a breathing intervention ( cough ) in children and adolescents ( n=136 ) for pain ( SMD −0.17 [ −0.41 , 0.07 ] ) . Conclusions : Psychological interventions with some evidence of benefit in children include : verbal distraction , video distraction , music distraction , and breathing with a toy & NA ; Distraction has been shown to be an effective technique for managing pain in children ; however , few investigations have examined the utility of this technique with infants . The goal of the current study was to investigate the effectiveness of movie distraction in reducing  infants ’ immunization distress .  Participants were 136 infants ( range = 1–21 months ; M = 7.6 months , SD = 5.0 months ) and their parents , all of whom were recruited when presenting for routine vaccinations . The parent – child dyads were r and omly assigned to either a Distraction or Typical Care control condition . Infant and adult behaviors were assessed using a visual analog scale and a behavioral observation rating scale . Results indicated parents in the Distraction group engaged in higher rates of distraction than those in the Typical Care group , whereas there was no difference in the behavior of nurses in the Distraction and Typical Care groups . In addition , infants in the Distraction group displayed fewer distress behaviors than infants in the Typical Care group both prior to and during recovery from the injection . Findings suggest that a simple and practical distraction intervention can provide some distress relief to infants during routine injections Background : This systematic review evaluated the effectiveness of physical and procedural interventions for reducing pain and related outcomes during vaccination . Design / Methods : Data bases were search ed using a broad search strategy to identify relevant r and omized and quasi-r and omized controlled trials . Data were extracted according to procedure phase ( preprocedure , acute , recovery , and combinations of these ) and pooled using established methods . Results : A total of 31 studies were included . Acute infant distress was diminished during  intramuscular injection without  aspiration ( n=313 ) : st and ardized mean difference ( SMD ) −0.82 ( 95 % confidence interval [ CI ] : −1.18 , −0.46 ) . Injecting the most painful vaccine last during vaccinations reduced acute infant distress ( n=196 ) : SMD −0.69 ( 95 % CI : −0.98 , −0.4 ) . Simultaneous injections  reduced acute infant distress compared with sequential injections ( n=172 ) : SMD −0.56 ( 95 % CI : −0.87 , −0.25 ) . There was no benefit of simultaneous injections in children . Less infant distress during the acute and recovery phases combined occurred with vastus lateralis ( vs. deltoid ) injections ( n=185 ) : SMD −0.70 ( 95 % CI : −1.00 , −0.41 ) . Skin-to-skin contact in neonates ( n=736 ) reduced acute distress : SMD −0.65 ( 95 % CI : −1.05 , −0.25 ) . Holding infants reduced acute distress after removal of the data from 1 method ologically diverse study ( n=107 ) : SMD −1.25 ( 95 % CI : −2.05 , −0.46 ) . Holding after vaccination ( n=417 ) reduced infant distress during the acute and recovery phases combined : SMD −0.65 ( 95 % CI : −1.08 , −0.22 ) . Self-reported fear was reduced for children positioned upright ( n=107 ) : SMD −0.39 ( 95 % CI : −0.77 , −0.01 ) . Non-nutritive sucking ( n=186 ) reduced acute distress in infants : SMD −1.88 ( 95 % CI : −2.57 , −1.18 ) . Manual tactile stimulation did not reduce pain across the lifespan . An external vibrating device and cold reduced pain in children ( n=145 ) : SMD −1.23 ( 95 % CI : −1.58 , −0.87 ) . There was no benefit of warming the vaccine in adults . Muscle tension was beneficial in selected indices of fainting in adolescents and adults . Conclusions : Interventions with evidence of benefit in select population s include : no aspiration , injecting most painful vaccine last , simultaneous injections , vastus lateralis injection , positioning interventions , non-nutritive sucking , external vibrating device with cold , and muscle tension BACKGROUND Distraction has recently gained attention as a technique that may help reduce acute pain in infants and toddlers ; however , results remain equivocal . It appears that these mixed results stem from a variety of method ological differences with regard to how distraction is implemented . OBJECTIVES To offer more definitive conclusions regarding the efficacy and mechanisms of distraction for pain management during infancy . Specifically , the goal was to examine whether the agent of distraction ( i.e. , the specific person conducting the distraction ) and preneedle distress behaviours impact the efficacy of distraction when toddlers were held by parents . METHODS A total of 99 toddlers were r and omly assigned to one of three conditions ( typical care , research assistant-directed distraction or parent-directed distraction ) . Toddler distress behaviours were assessed pre- and postneedle . Toddlers were further grouped according to distress behaviours preneedle ( low⁄no distress versus high distress ) . Parental soothing behaviours were also assessed as a manipulation check . RESULTS Toddler postneedle pain did not significantly differ among groups . However , toddlers who were distressed preneedle displayed significantly more pain postneedle , regardless of the treatment group . There were no significant interactions between treatment group and preneedle distress behaviours . CONCLUSIONS These results suggest that , when being held by a parent , distraction using a toy does not result in lower pain scores in the context of immunization , regardless of who offers the distraction . Furthermore , these findings raise the notion that if clinicians ensured toddlers were regulated before attempting an immunization , postneedle pain may be significantly reduced OBJECTIVE To assess the effect of Eutectic Mixture of Local Anaesthetics cream and rattle on soothing the vaccination pain on four-month-infants . METHODS The single blind r and omised clinical trial was conducted from May 2012 to February 2013 at a clinic under the Gonabad University of Medical Sciences , Iran , and comprised four-month infants who were selected r and omly and divided into three groups . In one group , 2 g of eutectic mixture of local anaesthetics cream was rubbed on the injection spot before administration ; for the other group , the rattle was shaken from 30s to 15s before injection . The last group consisted of controls . The infants were filmed after vaccination . Afterward , a pain question naire was filled out by a trained observer . SPSS 11.5 was used for statistical analysis . RESULTS Of the 50 subjects in the study 16 ( 32 % ) each were in the cream and rattle groups , while the rest ( 36 % ) were in the control group . The severity of the pain before intervention in the control , cream and rattle groups was 2.22 + /- 0.88 , 2.12 + /- 0.95 and 2.25 + /- 1.06 respectively , which were not statistically significant ( p < 0.93 ) . Likewise , the mean severity of pain at the moment of intervention in the three above groups were 8.67 + /- 0.77 , 7.12 + /- 0.5 and 7.87 + /- 0.96 respectively , which was significantly different ( p < 0.001 ) . The severity of pain 15seconds after the intervention in the groups was 5.06 + /- 1.51 , 4.87 + /- 1.31 and 4.19 + /- 1.94 respectively , which were not statistically different ( p < 0.27 ) . CONCLUSION The eutectic mixture of local anaesthetics cream and shaking rattle were effective in attenuating pain of vaccination among the infants , but the latter was not as significant as the former Infant procedural distress is largely understudied , and there is a dearth of empirically supported interventions in the child health psychology literature . This study examined nurse-directed distraction for reducing  infant immunization distress . Ninety infants and their parents were r and omly assigned to a distraction condition ( i.e. , nurses used stimuli to divert infants ' attention ) or a typical care condition . Outcome measures were an observational scale , parent and nurse ratings , and infant heart rate . Results indicated that infants engaged in distraction and that distraction reduced their behavioral distress ; however , ratings and heart rate were inconclusive . Analyses of procedural phases indicated that infants exhibited elevated distress immediately prior to and during an injection , but this distress was fleeting Pain and distress during immunisation of toddlers are reasons for non-immunisation of large number of toddlers . The present study was undertaken to assess the comparative effectiveness of distraction techniques  in the process of immunisation i.e. toy and music . ( The third group of study subjects was control group )  . It is concluded that distraction techniques are quite economical and safe in enhancing the magnitude of immunisation 
    Output:
    