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: OBJECTIVE Our purpose was to investigate the effects of acupressure on sleep quality in hemodialysis patients . DESIGN R and omized clinical trial . SETTING The setting of the study was dialysis wards located in two university hospitals ( Imam and Golestan ) in Ahvaz , Iran . INTERVENTIONS 48 end-stage renal disease patients on hemodialysis who scored 5 points or higher on the Pittsburgh Sleep Quality Index ( PSQI ) were enrolled to the study .  Acupressure group received acupressure intervention on the Shenmen ( He7 ) and He Gu ( Li4 ) points in the h and s and Sanyingjao ( sp6 ) point in the feet for 4 weeks beside routine care and control group received only routine care . MAIN OUTCOME MEASURES subjective sleep quality , latency and duration , habitual sleep efficiency ; sleep disturbances , daytime functional status , and use of sleeping medications . RESULTS The result indicated significant differences between the acupressure group and the control group after intervention in PSQI global scores ( p<0.001 ) and all sleep quality indices between two groups after intervention : subjective sleep quality ( p<0.001 ) , sleep latency ( p<0.001 ) , sleep duration ( p<0.001 ) , sleep efficiency ( p=0.006 ) , sleep disturbance ( p<0.001 ) , the use of sleeping medication ( p=0.028 ) , and daytime dysfunction ( p<0.001 ) . CONCLUSION This study supports the effectiveness of acupressure in improving sleep quality of end-stage renal disease patients as a noninvasive therapy Background Caregiving can be stressful , potentially creating physical and psychological strain . Substantial evidence has shown that family caregivers suffer from significant health problems arising from the dem and s of caregiving . Although there are programs supporting caregivers , there is little evidence regarding their effectiveness . Acupressure is an ancient Chinese healing method design ed to restore the flow of Qi ( vital energy ) by applying external pressure to acupoints . A r and omized , wait-list controlled trial was developed to evaluate the effectiveness of a self-administered acupressure intervention on caregiver stress ( primary objective ) and stress-related symptoms of fatigue , insomnia , depression , and health-related quality of life ( secondary objectives ) in Chinese caregivers of older family members . Methods Two hundred Chinese participants , aged ≥ 21 years , who are the primary caregivers of an older family member and screen positive for caregiver stress and symptoms of fatigue/insomnia/depression will be recruited from a community setting in Hong Kong . Subjects will be r and omized to receive either an immediate treatment condition ( self-administered acupressure intervention ) or a wait-list control condition . The self-administered acupressure intervention will include ( i ) an individual learning and practice session twice a week for 2 weeks , ( ii ) a home follow-up visit once a week for 2 weeks , and ( iii ) 15-min self- practice twice a day for 6 weeks . The wait-list control group will receive the same acupressure training after the intervention group has completed the intervention . We hypothesize that Chinese family caregivers in the intervention group will have lower levels of caregiver stress , fatigue , insomnia , depression , and higher health-related quality of life after completion of the intervention than participants in the wait-list control group . Discussion This study will provide evidence for the effectiveness of self-administered acupressure in reducing stress and improving symptoms of fatigue , insomnia , depression , and health-related quality of life in Chinese family caregivers . The findings will inform the design of interventions to relieve negative health effects of caregiving . Furthermore , the results can raise community awareness and serve as a basis for policymaking , planning , and allocation of re sources regarding empowerment of family caregivers for self-care . Trial registration Current Controlled Trials NCT02526446 . Registered August 10 , 2015 Objectives To assess the feasibility and acceptability of a r and omized controlled trial compared auricular acupressure ( AA ) on specific acupoints with AA on non-specific acupoints for treating maintenance hemodialysis ( MHD ) patients with insomnia . Methods Sixty three ( 63 ) eligible subjects were r and omly assigned into either AA group received AA on specific acupoints ( n=32 ) , or sham AA ( SAA ) group received AA on points irrelevant to insomnia treatment ( n=31 ) for eight weeks . All participants were followed up for 12 weeks after treatments . The primary outcome was clinical response at eight weeks after r and omization , defined as a reduction of Pittsburgh Sleep Quality Index ( PSQI ) global score by 3 points and more . Results Fifty-eight ( 58 ) participants completed the trial and five dropped out . Twenty participants in AA group ( 62.5 % ) and ten in SAA group ( 32.3 % ) responded to the eight-week interventions ( χ2 = 5.77 , P = 0.02 ) . PSQI global score declined 3.75 ± 4.36 ( 95%CI -5.32 , -2.18 ) and 2.26 ± 3.89 ( 95%CI -3.68 , -0.83 ) in AA group and SAA group respectively . Three participants died during the follow-up period . No evidence supported their deaths were related to the AA intervention . No other adverse event was observed . Conclusion Feasibility and logistics of patient recruitment , r and omization procedure , blinding approach , interventions application and outcome assessment had been tested in this pilot trial . The preliminary data appeared to show a favorable result on AA treatment . A full-scale trial is warranted . Trial Registration Chinese Clinical Trial Registry ChiCTR-TRC-12002272 Objectives . To compare the effectiveness of real acupressure versus sham acupressure therapy in improving sleep quality in patients receiving hemodialysis ( HD ) or hemodiafiltration ( HDF ) . Methods . A multicenter , single-blind , r and omized controlled trial was conducted in two Australian dialysis units located in Princess Alex and ra Hospital and Logan Hospital , respectively . Forty-two subjects with self-reported poor sleep quality were r and omly assigned to real ( n = 21 ) or sham ( n = 21 ) acupressure therapy delivered thrice weekly for four consecutive weeks during routine dialysis sessions . The primary outcome was the Pittsburgh Sleep Quality Index ( PSQI ) score measured at week four adjusted for baseline PSQI measurements . Secondary outcomes were quality of life ( QOL ) ( SF-8 ) , adverse events , and patient acceptability ( treatment acceptability question naire , TAQ ) . Results . The two groups were comparable on global PSQI scores ( difference 0.19 , 95 % confidence interval [ CI ] −1.32 to 1.70 ) and on the subscale scores . Similar results were observed for QOL both in the mental ( difference −3.88 , 95 % CI −8.63 to 0.87 ) and the physical scores ( difference 2.45 , 95 % CI −1.69 to 6.58 ) . There were no treatment-related adverse events and acupressure was perceived favorably by participants . Conclusion . Acupressure is a safe , well-tolerated , and highly acceptable therapy in adult hemodialysis patients in a Western healthcare setting with uncertain implication s for therapeutic efficacy Objective : The aim of this study is to examine the relationship between the changes in self-reported sleep symptoms and cardiac sympathovagal activity among women with postmenopausal insomnia ( PI ) who received auricular acupressure ( AA ) therapy .  Methods : A pretest/posttest study design was conducted at Taipei Veterans General Hospital , Taiwan , from August 2008 to July 2009 . Forty-five women ( mean ± SD age , 56.2 ± 5.4 years ) with PI ( 4.9 ± 3.5 years of insomnia ) received an AA therapy course on five auricular points every night before going to sleep for 4 weeks . Heart rate variability ( HRV ) , the Chinese version of the Pittsburgh Sleep Quality Index , and the Menopause Rating Scale were measured before and after AA treatment . Results : The total sleep duration and sleep efficiency were increased , and the sleep latency was shortened significantly ( P < 0.01 ) after AA therapy . The total Menopause Rating Scale and somatovegetative subscale scores were reduced significantly ( P < 0.05 ) after the intervention . A greater percentage change in Pittsburgh Sleep Quality Index was moderately correlated with both a lower percentage change in high-frequency power of HRV ( r = −0.660 , P < 0.001 ) and a greater percentage change in normalized low-frequency power ( nLF ) of HRV ( r = 0.599 , P < 0.001 ) . An elevation of high-frequency power and a reduction of nLF of HRV were observed in the responder group , whereas a raise in nLF of HRV was noted in the nonresponder group . Conclusions : This study suggests that AA intervention leads to more cardiac parasympathetic and less cardiac sympathetic activity , which contributes to the improvement of PI BACKGROUND Elderly people often suffer from disturbed sleep .  Because traditional Chinese medicine indicates that acupressure therapy may induce sedation , testing the effectiveness of acupressure in enhancing the quality of sleep of institutionalized residents with a well- design ed scientific study is needed . METHODS A r and omized block experimental design was used . The Pittsburgh Sleep Quality Index ( PSQI ) question naire was used as a screening tool to select subjects with sleep disturbance . By matching the effects of hypertension , hypnosis , naps , and exercise , subjects were r and omly assigned to an acupressure group , a sham acupressure group , and a control group .  Each group had 28 subjects for a total of 84 subjects . The same massage routine was used in the acupressure group and the sham acupressure group , whereas only conversation was employed in the control group . RESULTS There were significant differences in PSQI subscale scores of the quality , latency , duration , efficiency , disturbances of sleep , and global PSQI scores among subjects in the three groups before and after interventions . Furthermore , there was a significant reduction in the frequencies of nocturnal awakening and night wakeful time in the acupressure group compared to the other two groups . CONCLUSIONS This study confirmed the effectiveness of acupressure in improving the quality of sleep of elderly people and offered a nonpharmacological therapy method for sleep-disturbed elderly people INTRODUCTION Sleep disturbances are very common in elderly people and Traditional Chinese acupressure a noninvasive technique that promotes health and comfort recently has been used in this regard . The purpose of the present study was to evaluate the potential beneficial effects of acupressure on a group of institutionalized elders experiencing sleep disturbances . METHOD A r and omized controlled clinical trial was conducted to test the effectiveness of acupressure on quality of sleep of elderly residing in a Nursing home . The Pittsburgh Sleep Quality index ( PSQI ) question naire was used as a screening tool to select 90 residents with moderate to marked sleep disturbances . The elders were r and omly assigned to an acupressure group , a sham acupressure group and a control group by Balanced r and omization method . RESULTS There were significant differences between the acupressure group and the control group in subjective sleep quality , sleep latency , sleep duration , habitual sleep efficiency and sleep disturbance . But no significant differences were found in sleep indices between the sham acupressure group and the control group . Sleep log data showed a significant decrease in nocturnal awakenings in acupressure group compared to other two groups . CONCLUSION The findings of this study indicated that acupressure has an effect on improvement of sleep quality and endorsed it as a non-pharmacological and complementary therapy for sleep-disturbed elderly people The purpose of this study was to test the effectiveness of acupressure and Transcutaneous Electrical Acupoint Stimulation ( TEAS ) on fatigue , sleep quality and depression in patients who were receiving routine hemodialysis treatment . The study was a r and omized controlled trial ; qualified patients were r and omly assigned to acupressure , TEAS or control groups . Patients in the acupressure and TEAS groups received 15 minutes of treatment 3 times a week for 1 month , whereas patients in the control group only received routine unit care .  A total of 106 patients participated in the study . Methods of measurement included the revised Piper Fatigue Scale ( PFS ) , the Pittsburgh Sleep Quality Index and the Beck Depression Inventory . Data were collected at baseline , during the intervention and post-treatment . The results indicated that patients in the acupressure and TEAS groups had significantly lower levels of fatigue , a better sleep quality and less depressed moods compared with patients in the control group based upon the adjusted baseline differences . However , there were no differences between acupressure and TEAS groups in outcome measures . This study provides an alternative method for health care providers in managing dialysis patients with symptoms of fatigue , poor sleep or depression BACKGROUND Traditional Chinese acupressure is a noninvasive technique that employs pressure and massage to acupoints in order to stimulate the balance of life energy that promotes health and comfort . Sleep disturbance is common in patients with end-stage renal disease but no intervention studies have addressed this problem . Aim . The purpose of the present study was to test the effectiveness of acupoints massage for patients with end-stage renal disease and experiencing sleep disturbances and diminished quality of life .  METHODS The study was a r and omized control trial . A total of 98 end-stage renal disease patients with sleep disturbances  were r and omly assigned into an acupressure group , a sham acupressure group , and a control group . Acupressure and sham acupressure group patients received acupoints or 
    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: OBJECTIVE Our purpose was to investigate the effects of acupressure on sleep quality in hemodialysis patients . DESIGN R and omized clinical trial . SETTING The setting of the study was dialysis wards located in two university hospitals ( Imam and Golestan ) in Ahvaz , Iran . INTERVENTIONS 48 end-stage renal disease patients on hemodialysis who scored 5 points or higher on the Pittsburgh Sleep Quality Index ( PSQI ) were enrolled to the study .  Acupressure group received acupressure intervention on the Shenmen ( He7 ) and He Gu ( Li4 ) points in the h and s and Sanyingjao ( sp6 ) point in the feet for 4 weeks beside routine care and control group received only routine care . MAIN OUTCOME MEASURES subjective sleep quality , latency and duration , habitual sleep efficiency ; sleep disturbances , daytime functional status , and use of sleeping medications . RESULTS The result indicated significant differences between the acupressure group and the control group after intervention in PSQI global scores ( p<0.001 ) and all sleep quality indices between two groups after intervention : subjective sleep quality ( p<0.001 ) , sleep latency ( p<0.001 ) , sleep duration ( p<0.001 ) , sleep efficiency ( p=0.006 ) , sleep disturbance ( p<0.001 ) , the use of sleeping medication ( p=0.028 ) , and daytime dysfunction ( p<0.001 ) . CONCLUSION This study supports the effectiveness of acupressure in improving sleep quality of end-stage renal disease patients as a noninvasive therapy Background Caregiving can be stressful , potentially creating physical and psychological strain . Substantial evidence has shown that family caregivers suffer from significant health problems arising from the dem and s of caregiving . Although there are programs supporting caregivers , there is little evidence regarding their effectiveness . Acupressure is an ancient Chinese healing method design ed to restore the flow of Qi ( vital energy ) by applying external pressure to acupoints . A r and omized , wait-list controlled trial was developed to evaluate the effectiveness of a self-administered acupressure intervention on caregiver stress ( primary objective ) and stress-related symptoms of fatigue , insomnia , depression , and health-related quality of life ( secondary objectives ) in Chinese caregivers of older family members . Methods Two hundred Chinese participants , aged ≥ 21 years , who are the primary caregivers of an older family member and screen positive for caregiver stress and symptoms of fatigue/insomnia/depression will be recruited from a community setting in Hong Kong . Subjects will be r and omized to receive either an immediate treatment condition ( self-administered acupressure intervention ) or a wait-list control condition . The self-administered acupressure intervention will include ( i ) an individual learning and practice session twice a week for 2 weeks , ( ii ) a home follow-up visit once a week for 2 weeks , and ( iii ) 15-min self- practice twice a day for 6 weeks . The wait-list control group will receive the same acupressure training after the intervention group has completed the intervention . We hypothesize that Chinese family caregivers in the intervention group will have lower levels of caregiver stress , fatigue , insomnia , depression , and higher health-related quality of life after completion of the intervention than participants in the wait-list control group . Discussion This study will provide evidence for the effectiveness of self-administered acupressure in reducing stress and improving symptoms of fatigue , insomnia , depression , and health-related quality of life in Chinese family caregivers . The findings will inform the design of interventions to relieve negative health effects of caregiving . Furthermore , the results can raise community awareness and serve as a basis for policymaking , planning , and allocation of re sources regarding empowerment of family caregivers for self-care . Trial registration Current Controlled Trials NCT02526446 . Registered August 10 , 2015 Objectives To assess the feasibility and acceptability of a r and omized controlled trial compared auricular acupressure ( AA ) on specific acupoints with AA on non-specific acupoints for treating maintenance hemodialysis ( MHD ) patients with insomnia . Methods Sixty three ( 63 ) eligible subjects were r and omly assigned into either AA group received AA on specific acupoints ( n=32 ) , or sham AA ( SAA ) group received AA on points irrelevant to insomnia treatment ( n=31 ) for eight weeks . All participants were followed up for 12 weeks after treatments . The primary outcome was clinical response at eight weeks after r and omization , defined as a reduction of Pittsburgh Sleep Quality Index ( PSQI ) global score by 3 points and more . Results Fifty-eight ( 58 ) participants completed the trial and five dropped out . Twenty participants in AA group ( 62.5 % ) and ten in SAA group ( 32.3 % ) responded to the eight-week interventions ( χ2 = 5.77 , P = 0.02 ) . PSQI global score declined 3.75 ± 4.36 ( 95%CI -5.32 , -2.18 ) and 2.26 ± 3.89 ( 95%CI -3.68 , -0.83 ) in AA group and SAA group respectively . Three participants died during the follow-up period . No evidence supported their deaths were related to the AA intervention . No other adverse event was observed . Conclusion Feasibility and logistics of patient recruitment , r and omization procedure , blinding approach , interventions application and outcome assessment had been tested in this pilot trial . The preliminary data appeared to show a favorable result on AA treatment . A full-scale trial is warranted . Trial Registration Chinese Clinical Trial Registry ChiCTR-TRC-12002272 Objectives . To compare the effectiveness of real acupressure versus sham acupressure therapy in improving sleep quality in patients receiving hemodialysis ( HD ) or hemodiafiltration ( HDF ) . Methods . A multicenter , single-blind , r and omized controlled trial was conducted in two Australian dialysis units located in Princess Alex and ra Hospital and Logan Hospital , respectively . Forty-two subjects with self-reported poor sleep quality were r and omly assigned to real ( n = 21 ) or sham ( n = 21 ) acupressure therapy delivered thrice weekly for four consecutive weeks during routine dialysis sessions . The primary outcome was the Pittsburgh Sleep Quality Index ( PSQI ) score measured at week four adjusted for baseline PSQI measurements . Secondary outcomes were quality of life ( QOL ) ( SF-8 ) , adverse events , and patient acceptability ( treatment acceptability question naire , TAQ ) . Results . The two groups were comparable on global PSQI scores ( difference 0.19 , 95 % confidence interval [ CI ] −1.32 to 1.70 ) and on the subscale scores . Similar results were observed for QOL both in the mental ( difference −3.88 , 95 % CI −8.63 to 0.87 ) and the physical scores ( difference 2.45 , 95 % CI −1.69 to 6.58 ) . There were no treatment-related adverse events and acupressure was perceived favorably by participants . Conclusion . Acupressure is a safe , well-tolerated , and highly acceptable therapy in adult hemodialysis patients in a Western healthcare setting with uncertain implication s for therapeutic efficacy Objective : The aim of this study is to examine the relationship between the changes in self-reported sleep symptoms and cardiac sympathovagal activity among women with postmenopausal insomnia ( PI ) who received auricular acupressure ( AA ) therapy .  Methods : A pretest/posttest study design was conducted at Taipei Veterans General Hospital , Taiwan , from August 2008 to July 2009 . Forty-five women ( mean ± SD age , 56.2 ± 5.4 years ) with PI ( 4.9 ± 3.5 years of insomnia ) received an AA therapy course on five auricular points every night before going to sleep for 4 weeks . Heart rate variability ( HRV ) , the Chinese version of the Pittsburgh Sleep Quality Index , and the Menopause Rating Scale were measured before and after AA treatment . Results : The total sleep duration and sleep efficiency were increased , and the sleep latency was shortened significantly ( P < 0.01 ) after AA therapy . The total Menopause Rating Scale and somatovegetative subscale scores were reduced significantly ( P < 0.05 ) after the intervention . A greater percentage change in Pittsburgh Sleep Quality Index was moderately correlated with both a lower percentage change in high-frequency power of HRV ( r = −0.660 , P < 0.001 ) and a greater percentage change in normalized low-frequency power ( nLF ) of HRV ( r = 0.599 , P < 0.001 ) . An elevation of high-frequency power and a reduction of nLF of HRV were observed in the responder group , whereas a raise in nLF of HRV was noted in the nonresponder group . Conclusions : This study suggests that AA intervention leads to more cardiac parasympathetic and less cardiac sympathetic activity , which contributes to the improvement of PI BACKGROUND Elderly people often suffer from disturbed sleep .  Because traditional Chinese medicine indicates that acupressure therapy may induce sedation , testing the effectiveness of acupressure in enhancing the quality of sleep of institutionalized residents with a well- design ed scientific study is needed . METHODS A r and omized block experimental design was used . The Pittsburgh Sleep Quality Index ( PSQI ) question naire was used as a screening tool to select subjects with sleep disturbance . By matching the effects of hypertension , hypnosis , naps , and exercise , subjects were r and omly assigned to an acupressure group , a sham acupressure group , and a control group .  Each group had 28 subjects for a total of 84 subjects . The same massage routine was used in the acupressure group and the sham acupressure group , whereas only conversation was employed in the control group . RESULTS There were significant differences in PSQI subscale scores of the quality , latency , duration , efficiency , disturbances of sleep , and global PSQI scores among subjects in the three groups before and after interventions . Furthermore , there was a significant reduction in the frequencies of nocturnal awakening and night wakeful time in the acupressure group compared to the other two groups . CONCLUSIONS This study confirmed the effectiveness of acupressure in improving the quality of sleep of elderly people and offered a nonpharmacological therapy method for sleep-disturbed elderly people INTRODUCTION Sleep disturbances are very common in elderly people and Traditional Chinese acupressure a noninvasive technique that promotes health and comfort recently has been used in this regard . The purpose of the present study was to evaluate the potential beneficial effects of acupressure on a group of institutionalized elders experiencing sleep disturbances . METHOD A r and omized controlled clinical trial was conducted to test the effectiveness of acupressure on quality of sleep of elderly residing in a Nursing home . The Pittsburgh Sleep Quality index ( PSQI ) question naire was used as a screening tool to select 90 residents with moderate to marked sleep disturbances . The elders were r and omly assigned to an acupressure group , a sham acupressure group and a control group by Balanced r and omization method . RESULTS There were significant differences between the acupressure group and the control group in subjective sleep quality , sleep latency , sleep duration , habitual sleep efficiency and sleep disturbance . But no significant differences were found in sleep indices between the sham acupressure group and the control group . Sleep log data showed a significant decrease in nocturnal awakenings in acupressure group compared to other two groups . CONCLUSION The findings of this study indicated that acupressure has an effect on improvement of sleep quality and endorsed it as a non-pharmacological and complementary therapy for sleep-disturbed elderly people The purpose of this study was to test the effectiveness of acupressure and Transcutaneous Electrical Acupoint Stimulation ( TEAS ) on fatigue , sleep quality and depression in patients who were receiving routine hemodialysis treatment . The study was a r and omized controlled trial ; qualified patients were r and omly assigned to acupressure , TEAS or control groups . Patients in the acupressure and TEAS groups received 15 minutes of treatment 3 times a week for 1 month , whereas patients in the control group only received routine unit care .  A total of 106 patients participated in the study . Methods of measurement included the revised Piper Fatigue Scale ( PFS ) , the Pittsburgh Sleep Quality Index and the Beck Depression Inventory . Data were collected at baseline , during the intervention and post-treatment . The results indicated that patients in the acupressure and TEAS groups had significantly lower levels of fatigue , a better sleep quality and less depressed moods compared with patients in the control group based upon the adjusted baseline differences . However , there were no differences between acupressure and TEAS groups in outcome measures . This study provides an alternative method for health care providers in managing dialysis patients with symptoms of fatigue , poor sleep or depression BACKGROUND Traditional Chinese acupressure is a noninvasive technique that employs pressure and massage to acupoints in order to stimulate the balance of life energy that promotes health and comfort . Sleep disturbance is common in patients with end-stage renal disease but no intervention studies have addressed this problem . Aim . The purpose of the present study was to test the effectiveness of acupoints massage for patients with end-stage renal disease and experiencing sleep disturbances and diminished quality of life .  METHODS The study was a r and omized control trial . A total of 98 end-stage renal disease patients with sleep disturbances  were r and omly assigned into an acupressure group , a sham acupressure group , and a control group . Acupressure and sham acupressure group patients received acupoints or 
    Output:
    