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: Introduction Since hormone replacement therapy given for long periods is now recognised to produce serious side effects , patients with troublesome vasomotor symptoms  are increasingly using non-hormonal treatment including acupuncture . Several r and omised controlled trials have shown that acupuncture reduces menopausal symptoms in patients experiencing the normal climacteric . It may have this effect by raising serotonin levels which alter the temperature set point in the hypothalamus . Vasomotor symptoms can be extreme in breast cancer patients and patients with prostate cancer who are undergoing anticancer therapy . The safety of some herbal medicines and phytoestrogens has been question ed , as they could potentially interfere adversely with the bioavailability of tumouricidal drugs . A previous study reports short term benefit from acupuncture , and the aim of this report is to describe our approach to long term treatment . Acupuncture Approach After piloting several approaches , six weekly treatments were given initially at LI4 , TE5 , LR3 and SP6 and two upper sternal points , but avoiding any limb with existing lymphoedema or prone to developing it . If there were no contraindications , patients were given clear instructions on how to perform self acupuncture using either semi-permanent needles or conventional needling at SP6 , weekly for up to six years , for long term maintenance . Audit Methods and Results A retrospective audit of electronic records was carried out by a doctor not involved in treatment . A total of 194 patients were treated , predominantly with breast and prostate cancer . One hundred and eighty two patients were female . The number of pre-treatment hot flushes per day was estimated by the patient : in the 159 cases providing adequate records , the mean was 16 flushes per day . Following treatment , 114 ( 79 % ) gained a 50 % or greater reduction in hot flushes and 30 ( 21 % ) a less than 50 % reduction . Treatment was ab and oned in those who responded poorly or not at all . The duration of treatment varied from one month to over six years with a mean duration of nine months . Seventeen patients ( 9 % ) experienced minor side effects over the six year period , mostly minor rashes ; one patient described leg swelling but this was likely to be due to a concurrent fracture . Conclusion Acupuncture including self acupuncture is associated with long term relief of vasomotor symptoms in cancer patients . Treatment is safe and costs appear to be low . An algorithm is presented to guide clinical use . We recommend the use of self acupuncture with needles at SP6 in preference to semi-permanent needles in the first instance , but poor responders use indwelling studs if they fail to respond adequately to self acupuncture with regular needles . Point location may be of less importance than the overall ‘ dose ’ , and an appropriate minimum dose may be required to initiate the effect This study examined the relationship between objective ly measured nocturnal hot flashes and objective ly measured sleep in breast cancer survivors with insomnia . Twenty-four women who had completed treatment for non-metastatic breast cancer participated . All were enrolled in a study of cognitive-behavioral treatment for chronic insomnia .  Nocturnal hot flashes and sleep  were measured by skin conductance and polysomnography  , respectively . The 10-minute periods around hot flashes were found to have significantly more wake time , and more stage changes to lighter sleep , than other 10-minute periods during the night . Nights with hot flashes had a significantly higher percentage of wake time , a lower percentage of Stage 2 sleep , and a longer REM latency compared to nights without hot flashes . Overall , hot flashes were found to be associated with less efficient , more disrupted sleep . Nocturnal hot flashes , or their underlying mechanisms , should be considered as potential contributors to sleep disruption in women with breast cancer who report poor sleep PURPOSE To determine the immediate and long-term effects of true acupuncture versus sham acupuncture on hot flash frequency in women with breast cancer . PATIENTS AND METHODS Seventy-two women with breast cancer experiencing three or more hot flashes per day were r and omly assigned to receive either true or sham acupuncture . Interventions were given twice weekly for 4 consecutive weeks . Hot flash frequency was evaluated at baseline , at 6 weeks , and at 6 months after initiation of treatment . Patients initially r and omly assigned to the sham group were crossed over to true acupuncture starting at week 7 . RESULTS The mean number of hot flashes per day was reduced from 8.7 ( st and ard deviation [ SD ] , 3.9 ) to 6.2 ( SD , 4.2 ) in the true acupuncture group and from 10.0 ( SD , 6.1 ) to 7.6 ( SD , 5.7 ) in the sham group . True acupuncture was associated with 0.8 fewer hot flashes per day than sham at 6 weeks , but the difference did not reach statistical significance ( 95 % CI , -0.7 to 2.4 ; P = .3 ) . When participants in the sham acupuncture group were crossed over to true acupuncture , a further reduction in the frequency of hot flashes was seen . This reduction in hot flash frequency persisted for up to 6 months after the completion of treatment . CONCLUSION Hot flash frequency in breast cancer patients was reduced following acupuncture . However , when compared with sham acupuncture , the reduction by the acupuncture regimen as provided in the current study did not reach statistical significance . We can not exclude the possibility that a longer and more intense acupuncture intervention could produce a larger reduction of these symptoms To evaluate true acupuncture to control acupuncture ( CTRL ) ( non-insertive stimulation at non-acupuncture points ) in breast cancer patients treated with adjuvant tamoxifen suffering from hot flushes and sweatings . Eighty-four patients were r and omized to receive either true acupuncture or CTRL twice a week for 5 weeks . Seventy-four patients were treated according to the protocol . In the true acupuncture group 42 % ( 16/38 ) reported improvements in hot flushes after 6 weeks compared to 47 % ( 17/36 ) in the CTRL group ( 95 % CI , −28 to 18 % ) . Both groups reported improvement regarding severity and frequencies in hot flushes and sweatings but no statistical difference was found between the groups . In a sub analysis regarding the severity of sweatings at night a statistically significant difference P = 0.03 was found in the true acupuncture group . Former experience of true acupuncture did not influence the perception of true acupuncture or CTRL . No significant differences in hormonal levels were found before and after treatment . In conclusion , convincing data that true acupuncture is more effective than CTRL  in reducing vasomotor symptoms is still lacking . Our study shows that both true and CTRL  reduce vasomotor symptoms in breast cancer patients treated with adjuvant tamoxifen Purpose Evaluate effects of electro-acupuncture ( EA ) and hormone therapy ( HT ) on health-related quality -of-life ( HRQoL ) and sleep in breast cancer survivors with vasomotor symptoms . Methods Forty-five women , r and omized to EA ( n = 27 ) for 12 weeks or HT ( n = 18 ) for 24 months , were followed for up to 2 years . Distress caused by , and numbers of , hot flushes , hours slept and times woken up/night , Psychological and General Well-being Index ( PGWB ) and Women ’s Health Question naire ( WHQ ) were registered before and during treatment and at 6 , 9 , 12 , 18 and 24 months after start of treatment . Results After 12 weeks of EA ( n = 19 ) , WHQ improved from 0.32 ( IQR 0.23–0.53 ) at baseline to 0.24 ( IQR 0.12–0.39 ; p < 0.001 ) and PGWB from 78 ( IQR 53–89 ) to 79 ( IQR 68–93 ; p = 0.002 ) . All sleep parameters improved and Hot Flush Score ( HFS ) decreased by 80 % . At 12 months , WHQ , PGWB and all sleep parameters remained significantly improved ( n = 14 ) and HFS decreased by 65 % . After 12 weeks of HT ( n = 18 ) , WHQ improved from 0.29 ( IQR 0.15–0.44 ) at baseline to 0.15 ( IQR 0.05–0.22 ; p = 0.001 ) , PGWB from 75 ( IQR 59–88 ) to 90 ( 62–97 ; p = 0.102 ) and three of five sleep parameters improved . Conclusion Both EA and HT  increased HRQoL and sleep , probably through decreasing numbers of and distress by hot flushes . Although flushes decreased less in the EA group than in the HT group , HRQoL improved at least to the same extent maybe due to other effects of EA , not induced by HT , e.g. on anxiety , vitality and sleep , supported by subscale analyses . EA should be further evaluated as treatment for women with breast cancer and climacteric complaints , since HT no longer can be recommended for these women BACKGROUND This study evaluates the effect of acupuncture on hot flashes and disturbed night sleep in patients treated for breast cancer . The effect of acupuncture was tested against a sham-acupuncture group and a no-treatment control group . Plasma estradiol was measured to rule out this as cause of effect . Side effects of the treatment were registered . METHODS We r and omized 94 women into the study : 31 had acupuncture , 29 had sham acupuncture and 34 had no treatment .  FINDINGS In the acupuncture group , 16 patients ( 52 % ) experienced a significant effect on hot flashes compared with seven patients ( 24 % ) in the sham group ( p < 0.05 ) . The effect came after the second acupuncture session and lasted for at least 12 weeks after last treatment . A statistically significant positive effect was seen on sleep in the acupuncture group compared with the sham-acupuncture and no-treatment groups . The effect was not correlated with increased levels of plasma estradiol . No side effects of acupuncture were registered . INTERPRETATION We find that acupuncture significantly relieves hot flashes and sleep disturbances and is a good and safe treatment in women treated for breast cancer Objectives : The present study was a feasibility study of a tailored acupuncture intervention in postmenopausal breast cancer survivors ( BCSs ) reporting sleep disturbances and hot flashes . Objectives were ( 1 ) to describe patterns of acupuncture point use ; ( 2 ) evaluate outcome expectancy , credibility , and acceptability relative to the intervention ; and ( 3 ) evaluate patterns of symptom change over time . Design : This was a single-group , nonr and omized , quasi-experimental 8-week study . Sample / Setting : Ten BCSs with both sleep disturbances and hot flashes were referred to any of 4 Midwestern community acupuncturists . Methods : Assessment s were done at baseline ( weeks 1 , 2 ) , during treatment ( weeks 3 , 4 ) , and after treatment ( weeks 5 , 8) . Acupuncture treatment was tailored to the individual by community acupuncturists and provided as 3 sessions within a 2-week period ( weeks 3 , 4 ) . Patients wore a wrist actigraph during weeks 1 , 2 , 3 , 4 , 5 , and 8 and a sternal skin conductance monitor for 24 consecutive hours during weeks 1 , 2 , 3 , 4 , 5 , and 8 . Subjective data were obtained by question naire at weeks 1 , 2 , 3 , 4 , 5 , and 8 . Findings : Women were a mean age of 53 years , with an average 6.75 years since diagnosis . A mean of 10 needles were used per session , with the most common points located in the lung or lung meridian . Breast cancer survivors had high expectancy that acupuncture would decrease their symptoms , believed it was a credible treatment , and felt it an acceptable form of treatment . Three significant patterns of symptom change were noted from baseline : an increase in the number of minutes it took to fall asleep after treatment ( from week 5 to 8 ; P = .04 ) , a decrease in the percentage of time awake after sleep onset from baseline to follow-up 2 ( week 8 ; P = .05 ) , and a decrease in the number of hot flashes from baseline to follow-up 1 ( week 5 ; P = .02 ) . Implication s for Nursing : Findings may be used by clinical nurse specialists to consider recommending acupuncture to improve sleep and reduce hot flashes in BCSs . Conclusions : Acupuncture treatment seems to be a feasible treatment option for highly motivated BCSs with sleep disturbances and hot flashes but needs to be further evaluated in a larger , r and omized , controlled clinical trial PURPOSE Women with breast cancer ( BC ) treated with aromatase inhibitors ( AIs ) may experience joint symptoms that can lead to discontinuation of effective therapy . We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC . METHODS We conducted a r and omized , controlled , blinded study comparing true acupuncture ( TA ) versus sham acupuncture ( SA ) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs .  TA included full body/auricular acupuncture and joint-specific point prescriptions , whereas SA involved superficial needle insertion at nonacupoint locations . Outcome measures included the Brief Pain Inventory-Short Form ( BPI-SF ) , Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , and Modified Score for the Assessment of Chronic Rheumatoid Affections of the H and s ( 
    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: Introduction Since hormone replacement therapy given for long periods is now recognised to produce serious side effects , patients with troublesome vasomotor symptoms  are increasingly using non-hormonal treatment including acupuncture . Several r and omised controlled trials have shown that acupuncture reduces menopausal symptoms in patients experiencing the normal climacteric . It may have this effect by raising serotonin levels which alter the temperature set point in the hypothalamus . Vasomotor symptoms can be extreme in breast cancer patients and patients with prostate cancer who are undergoing anticancer therapy . The safety of some herbal medicines and phytoestrogens has been question ed , as they could potentially interfere adversely with the bioavailability of tumouricidal drugs . A previous study reports short term benefit from acupuncture , and the aim of this report is to describe our approach to long term treatment . Acupuncture Approach After piloting several approaches , six weekly treatments were given initially at LI4 , TE5 , LR3 and SP6 and two upper sternal points , but avoiding any limb with existing lymphoedema or prone to developing it . If there were no contraindications , patients were given clear instructions on how to perform self acupuncture using either semi-permanent needles or conventional needling at SP6 , weekly for up to six years , for long term maintenance . Audit Methods and Results A retrospective audit of electronic records was carried out by a doctor not involved in treatment . A total of 194 patients were treated , predominantly with breast and prostate cancer . One hundred and eighty two patients were female . The number of pre-treatment hot flushes per day was estimated by the patient : in the 159 cases providing adequate records , the mean was 16 flushes per day . Following treatment , 114 ( 79 % ) gained a 50 % or greater reduction in hot flushes and 30 ( 21 % ) a less than 50 % reduction . Treatment was ab and oned in those who responded poorly or not at all . The duration of treatment varied from one month to over six years with a mean duration of nine months . Seventeen patients ( 9 % ) experienced minor side effects over the six year period , mostly minor rashes ; one patient described leg swelling but this was likely to be due to a concurrent fracture . Conclusion Acupuncture including self acupuncture is associated with long term relief of vasomotor symptoms in cancer patients . Treatment is safe and costs appear to be low . An algorithm is presented to guide clinical use . We recommend the use of self acupuncture with needles at SP6 in preference to semi-permanent needles in the first instance , but poor responders use indwelling studs if they fail to respond adequately to self acupuncture with regular needles . Point location may be of less importance than the overall ‘ dose ’ , and an appropriate minimum dose may be required to initiate the effect This study examined the relationship between objective ly measured nocturnal hot flashes and objective ly measured sleep in breast cancer survivors with insomnia . Twenty-four women who had completed treatment for non-metastatic breast cancer participated . All were enrolled in a study of cognitive-behavioral treatment for chronic insomnia .  Nocturnal hot flashes and sleep  were measured by skin conductance and polysomnography  , respectively . The 10-minute periods around hot flashes were found to have significantly more wake time , and more stage changes to lighter sleep , than other 10-minute periods during the night . Nights with hot flashes had a significantly higher percentage of wake time , a lower percentage of Stage 2 sleep , and a longer REM latency compared to nights without hot flashes . Overall , hot flashes were found to be associated with less efficient , more disrupted sleep . Nocturnal hot flashes , or their underlying mechanisms , should be considered as potential contributors to sleep disruption in women with breast cancer who report poor sleep PURPOSE To determine the immediate and long-term effects of true acupuncture versus sham acupuncture on hot flash frequency in women with breast cancer . PATIENTS AND METHODS Seventy-two women with breast cancer experiencing three or more hot flashes per day were r and omly assigned to receive either true or sham acupuncture . Interventions were given twice weekly for 4 consecutive weeks . Hot flash frequency was evaluated at baseline , at 6 weeks , and at 6 months after initiation of treatment . Patients initially r and omly assigned to the sham group were crossed over to true acupuncture starting at week 7 . RESULTS The mean number of hot flashes per day was reduced from 8.7 ( st and ard deviation [ SD ] , 3.9 ) to 6.2 ( SD , 4.2 ) in the true acupuncture group and from 10.0 ( SD , 6.1 ) to 7.6 ( SD , 5.7 ) in the sham group . True acupuncture was associated with 0.8 fewer hot flashes per day than sham at 6 weeks , but the difference did not reach statistical significance ( 95 % CI , -0.7 to 2.4 ; P = .3 ) . When participants in the sham acupuncture group were crossed over to true acupuncture , a further reduction in the frequency of hot flashes was seen . This reduction in hot flash frequency persisted for up to 6 months after the completion of treatment . CONCLUSION Hot flash frequency in breast cancer patients was reduced following acupuncture . However , when compared with sham acupuncture , the reduction by the acupuncture regimen as provided in the current study did not reach statistical significance . We can not exclude the possibility that a longer and more intense acupuncture intervention could produce a larger reduction of these symptoms To evaluate true acupuncture to control acupuncture ( CTRL ) ( non-insertive stimulation at non-acupuncture points ) in breast cancer patients treated with adjuvant tamoxifen suffering from hot flushes and sweatings . Eighty-four patients were r and omized to receive either true acupuncture or CTRL twice a week for 5 weeks . Seventy-four patients were treated according to the protocol . In the true acupuncture group 42 % ( 16/38 ) reported improvements in hot flushes after 6 weeks compared to 47 % ( 17/36 ) in the CTRL group ( 95 % CI , −28 to 18 % ) . Both groups reported improvement regarding severity and frequencies in hot flushes and sweatings but no statistical difference was found between the groups . In a sub analysis regarding the severity of sweatings at night a statistically significant difference P = 0.03 was found in the true acupuncture group . Former experience of true acupuncture did not influence the perception of true acupuncture or CTRL . No significant differences in hormonal levels were found before and after treatment . In conclusion , convincing data that true acupuncture is more effective than CTRL  in reducing vasomotor symptoms is still lacking . Our study shows that both true and CTRL  reduce vasomotor symptoms in breast cancer patients treated with adjuvant tamoxifen Purpose Evaluate effects of electro-acupuncture ( EA ) and hormone therapy ( HT ) on health-related quality -of-life ( HRQoL ) and sleep in breast cancer survivors with vasomotor symptoms . Methods Forty-five women , r and omized to EA ( n = 27 ) for 12 weeks or HT ( n = 18 ) for 24 months , were followed for up to 2 years . Distress caused by , and numbers of , hot flushes , hours slept and times woken up/night , Psychological and General Well-being Index ( PGWB ) and Women ’s Health Question naire ( WHQ ) were registered before and during treatment and at 6 , 9 , 12 , 18 and 24 months after start of treatment . Results After 12 weeks of EA ( n = 19 ) , WHQ improved from 0.32 ( IQR 0.23–0.53 ) at baseline to 0.24 ( IQR 0.12–0.39 ; p < 0.001 ) and PGWB from 78 ( IQR 53–89 ) to 79 ( IQR 68–93 ; p = 0.002 ) . All sleep parameters improved and Hot Flush Score ( HFS ) decreased by 80 % . At 12 months , WHQ , PGWB and all sleep parameters remained significantly improved ( n = 14 ) and HFS decreased by 65 % . After 12 weeks of HT ( n = 18 ) , WHQ improved from 0.29 ( IQR 0.15–0.44 ) at baseline to 0.15 ( IQR 0.05–0.22 ; p = 0.001 ) , PGWB from 75 ( IQR 59–88 ) to 90 ( 62–97 ; p = 0.102 ) and three of five sleep parameters improved . Conclusion Both EA and HT  increased HRQoL and sleep , probably through decreasing numbers of and distress by hot flushes . Although flushes decreased less in the EA group than in the HT group , HRQoL improved at least to the same extent maybe due to other effects of EA , not induced by HT , e.g. on anxiety , vitality and sleep , supported by subscale analyses . EA should be further evaluated as treatment for women with breast cancer and climacteric complaints , since HT no longer can be recommended for these women BACKGROUND This study evaluates the effect of acupuncture on hot flashes and disturbed night sleep in patients treated for breast cancer . The effect of acupuncture was tested against a sham-acupuncture group and a no-treatment control group . Plasma estradiol was measured to rule out this as cause of effect . Side effects of the treatment were registered . METHODS We r and omized 94 women into the study : 31 had acupuncture , 29 had sham acupuncture and 34 had no treatment .  FINDINGS In the acupuncture group , 16 patients ( 52 % ) experienced a significant effect on hot flashes compared with seven patients ( 24 % ) in the sham group ( p < 0.05 ) . The effect came after the second acupuncture session and lasted for at least 12 weeks after last treatment . A statistically significant positive effect was seen on sleep in the acupuncture group compared with the sham-acupuncture and no-treatment groups . The effect was not correlated with increased levels of plasma estradiol . No side effects of acupuncture were registered . INTERPRETATION We find that acupuncture significantly relieves hot flashes and sleep disturbances and is a good and safe treatment in women treated for breast cancer Objectives : The present study was a feasibility study of a tailored acupuncture intervention in postmenopausal breast cancer survivors ( BCSs ) reporting sleep disturbances and hot flashes . Objectives were ( 1 ) to describe patterns of acupuncture point use ; ( 2 ) evaluate outcome expectancy , credibility , and acceptability relative to the intervention ; and ( 3 ) evaluate patterns of symptom change over time . Design : This was a single-group , nonr and omized , quasi-experimental 8-week study . Sample / Setting : Ten BCSs with both sleep disturbances and hot flashes were referred to any of 4 Midwestern community acupuncturists . Methods : Assessment s were done at baseline ( weeks 1 , 2 ) , during treatment ( weeks 3 , 4 ) , and after treatment ( weeks 5 , 8) . Acupuncture treatment was tailored to the individual by community acupuncturists and provided as 3 sessions within a 2-week period ( weeks 3 , 4 ) . Patients wore a wrist actigraph during weeks 1 , 2 , 3 , 4 , 5 , and 8 and a sternal skin conductance monitor for 24 consecutive hours during weeks 1 , 2 , 3 , 4 , 5 , and 8 . Subjective data were obtained by question naire at weeks 1 , 2 , 3 , 4 , 5 , and 8 . Findings : Women were a mean age of 53 years , with an average 6.75 years since diagnosis . A mean of 10 needles were used per session , with the most common points located in the lung or lung meridian . Breast cancer survivors had high expectancy that acupuncture would decrease their symptoms , believed it was a credible treatment , and felt it an acceptable form of treatment . Three significant patterns of symptom change were noted from baseline : an increase in the number of minutes it took to fall asleep after treatment ( from week 5 to 8 ; P = .04 ) , a decrease in the percentage of time awake after sleep onset from baseline to follow-up 2 ( week 8 ; P = .05 ) , and a decrease in the number of hot flashes from baseline to follow-up 1 ( week 5 ; P = .02 ) . Implication s for Nursing : Findings may be used by clinical nurse specialists to consider recommending acupuncture to improve sleep and reduce hot flashes in BCSs . Conclusions : Acupuncture treatment seems to be a feasible treatment option for highly motivated BCSs with sleep disturbances and hot flashes but needs to be further evaluated in a larger , r and omized , controlled clinical trial PURPOSE Women with breast cancer ( BC ) treated with aromatase inhibitors ( AIs ) may experience joint symptoms that can lead to discontinuation of effective therapy . We examined whether acupuncture improves AI-induced arthralgias in women with early-stage BC . METHODS We conducted a r and omized , controlled , blinded study comparing true acupuncture ( TA ) versus sham acupuncture ( SA ) twice weekly for 6 weeks in postmenopuasal women with BC who had self-reported musculoskeletal pain related to AIs .  TA included full body/auricular acupuncture and joint-specific point prescriptions , whereas SA involved superficial needle insertion at nonacupoint locations . Outcome measures included the Brief Pain Inventory-Short Form ( BPI-SF ) , Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) , and Modified Score for the Assessment of Chronic Rheumatoid Affections of the H and s ( 
    Output:
    