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 : Despite the high frequency , severity , and effects of cancer-related fatigue ( CRF ) on the quality of life ( QoL ) of patients with cancer , limited treatment options are available . The primary objective of this study was to compare the effects of oral Panax ginseng extract ( PG ) and placebo on CRF . Secondary objectives were to determine the effects of PG on QoL , mood , and function . Methods : In this r and omized , double-blind , placebo-controlled study , patients with CRF ≥4/10 on the Edmonton Symptom Assessment System ( ESAS ) were eligible . Based on a pilot study , we r and omized patients to receive either 400 mg of st and ardized PG twice daily or a matching placebo for 28 days . The primary end point was change in the Functional Assessment of Chronic Illness Therapy-Fatigue ( FACIT-F ) subscale from baseline to day 29 . Results : Of 127 patients , 112 ( 88.2 % ) were evaluable . The mean ( SD ) FACIT-F subscale scores at baseline , day 15 , and day 29 were 22.4 ( 10.1 ) , 29.9 ( 10.6 ) , and 30.1 ( 11.6 ) for PG ( P<.001 ) , and 24.0 ( 9.4 ) , 30.0 ( 10.1 ) , and 30.4 ( 11.5 ) for placebo ( P<.001 ) . Mean ( SD ) improvement in the FACIT-F subscale at day 29 was not significantly different in the PG than in the placebo group ( 7.5 [ 12.7 ] vs 6.5 [ 9.9 ] ; P=.67 ) . QoL , anxiety , depression , symptoms , and functional scores were not significantly different between the PG and placebo groups . Improvement in the FACIT-F subscale correlated with baseline scores ( P=.0005 ) , Hospital Anxiety and Depression Scale results ( P=.032 ) , and sex ( P=.023 ) . There were fewer any- grade toxicities in the PG versus placebo group ( 28/63 vs 33/64 ; P=.024 ) . Conclusions : Both PG and placebo result in significant improvement in CRF . PG was not significantly superior to placebo after 4 weeks of treatment . There is no justification to recommend the use of PG for CRF . Further studies are needed . Trial Registration : Clinical Trials.gov identifier : NCT01375114 Background Synthesis of multiple r and omized controlled trials ( RCTs ) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions . Filtering of search es is time consuming , and no single method fulfills the principal requirements of speed with accuracy . Automation of systematic review s is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making . We developed Rayyan ( http://rayyan.qcri.org ) , a free web and mobile app , that helps expedite the initial screening of abstract s and titles using a process of semi-automation while incorporating a high level of usability . For the beta testing phase , we used two published Cochrane review s in which included studies had been selected manually . Their search es , with 1030 records and 273 records , were uploaded to Rayyan . Different features of Rayyan were tested using these two review s. We also conducted a survey of Rayyan ’s users and collected feedback through a built-in feature . Results Pilot testing of Rayyan focused on usability , accuracy against manual methods , and the added value of the prediction feature . The “ taster ” review ( 273 records ) allowed a quick overview of Rayyan for early comments on usability . The second review ( 1030 records ) required several iterations to identify the previously identified 11 trials . The “ suggestions ” and “ hints , ” based on the “ prediction model , ” appeared as testing progressed beyond five included studies . Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements . The survey respondents reported 40 % average time savings when using Rayyan compared to others tools , with 34 % of the respondents reporting more than 50 % time savings . In addition , around 75 % of the respondents mentioned that screening and labeling studies as well as collaborating on review s to be the two most important features of Rayyan . As of November 2016 , Rayyan users exceed 2000 from over 60 countries conducting hundreds of review s totaling more than 1.6 M citations . Feedback from users , obtained mostly through the app web site and a recent survey , has highlighted the ease in exploration of search es , the time saved , and simplicity in sharing and comparing include-exclude decisions . The strongest features of the app , identified and reported in user feedback , were its ability to help in screening and collaboration as well as the time savings it affords to users . Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of review ers Cancer and its treatment can induce subjective and objective evidence of diminished functional capacity encompassing physical fatigue and cognitive impairment . Dexmethylpheni date ( D-MPH ; the D-isomer of methylpheni date ) was evaluated for treatment of chemotherapy-related fatigue and cognitive impairment . A r and omized , double-blind , placebo-controlled , parallel-group study evaluated the potential therapeutic effect and safety of D-MPH in the treatment of patients with chemotherapy-related fatigue . Change from baseline in the Functional Assessment of Chronic Illness Therapy-Fatigue Subscale ( FACIT-F ) total score at Week 8 was the primary outcome measure . One hundred fifty-four patients ( predominantly with breast and ovarian cancers ) were r and omized and treated . Compared with placebo , D-MPH-treated subjects demonstrated a significant improvement in fatigue symptoms at Week 8 in the FACIT-F ( P=0.02 ) and the Clinical Global Impression-Severity scores ( P=0.02 ) , without clinical ly relevant changes in hemoglobin levels . Cognitive function was not significantly improved . There was a higher rate of study drug-related adverse events ( AEs ) ( 48 of 76 [ 63 % ] vs. 22 of 78 [ 28 % ] ) and a higher discontinuation rate because of AEs ( 8 of 76 [ 11 % ] vs. 1 of 78 [ 1.3 % ] ) in D-MPH-treated subjects compared with placebo-treated subjects . The most commonly reported AEs independent of study drug relationship in D-MPH-treated subjects were headache , nausea , and dry mouth , and in placebo-treated subjects were headache , diarrhea , and insomnia .  D-MPH produced significant improvement in fatigue in subjects previously treated with cytotoxic chemotherapy . Further studies with D-MPH or other agents to explore treatment response in chemotherapy-associated fatigue should be considered Background Uncontrolled studies show fatigue , anorexia , depression , and mortality are associated with low testosterone in men with cancer .  Testosterone replacement improves quality of life and diminishes fatigue in patients with non-cancer conditions . The primary objective was to evaluate the effect of testosterone replacement on fatigue in hypogonadal males with advanced cancer , by the Functional Assessment of Chronic Illness Therapy-Fatigue subscale ( FACIT-Fatigue ) at day 29 . Methods This is a r and omized , double-blinded placebo-controlled trial . Out patients with advanced cancer , bioavailable testosterone ( BT ) < 70 ng/dL and fatigue score > 3/10 on the Edmonton Symptom Assessment Scale were eligible .  Intra-muscular testosterone or sesame seed oil placebo was administered every 14 days to achieve BT levels 70–270 ng/dL. Results Sixteen placebo and 13 testosterone-treated subjects were evaluable . No statistically significant difference was found for FACIT-fatigue scores between arms ( −2 ± 12 for placebo , 4 ± 8 for testosterone , p = 0.11 ) . Sexual Desire Inventory score ( p = 0.054 ) and performance status ( p = 0.02 ) improved in the testosterone group . Fatigue subscale scores were significantly better ( p = 0.03 ) in those treated with testosterone by day 72 . Conclusions Four weeks of intramuscular testosterone replacement in hypogonadal male patients with advanced cancer did not significantly improve quality of life . Larger studies of longer duration are warranted Fatigue is the most common symptom negatively affecting the quality of life of patients with cancer . The objective of the current study was to evaluate the preliminary efficacy and safety of 10.6‐μm infrared laser moxibustion for cancer‐related fatigue ( CRF ) PURPOSE This study investigated the efficacy of the botanical-derived drug , PG2 , a partially purified extract of Astragalus membranaceus , as a complementary and palliative medicine for managing  cancer-related fatigue ( CRF ) .  METHODS Patients with advanced cancer and moderate to severe CRF were r and omized to receive either PG2 or a placebo ( normal saline , NS ) in the first treatment cycle ( four weeks ) in a double-blind manner ; thereafter , on the next cycle ( four weeks ) , all patients received open-label treatment with PG2 . RESULTS PG2 significantly improved CRF in the NS-primed group . In the first four week cycle , PG2 administration result ed in a greater fatigue-improvement response rate than seen with NS alone . In addition , approximately 82 % of patients who reported an improvement of fatigue symptoms following the first cycle of PG2 experienced sustained benefits after administration of the second treatment cycle . Among patients treated with PG2 who did not report an improvement in symptoms throughout the first treatment cycle , approximately 71 % showed significant improvement after the second treatment cycle . No major or irreversible toxicities were observed with PG2 treatment . CONCLUSION PG2 might be an effective and safe treatment for relieving CRF among advanced cancer patients PURPOSE Fatigue is a distressing symptom occurring in more than 60 % of patients with cancer . The CNS stimulants modafinil and methylpheni date are recommended for the treatment of cancer-related fatigue , despite a limited evidence base . We aim ed to evaluate the efficacy and tolerability of modafinil in the management of fatigue in patients with non-small-cell lung cancer ( NSCLC ) . PATIENTS AND METHODS Adults with advanced NSCLC and performance status of 0 to 2 , who were not treated with chemotherapy or radiotherapy within the last 4 weeks , were r and omly assigned to daily modafinil ( 100 mg on days 1 to 14 ; 200 mg on days 15 to 28 ) or matched placebo . The primary outcome was change in Functional Assessment of Chronic Illness Therapy ( FACIT ) -Fatigue score from baseline to 28 days , adjusted for baseline fatigue and performance status . Secondary outcomes included safety and patient-reported measures of depression , daytime sleepiness , and quality of life . RESULTS A total of 208 patients were r and omly assigned , and 160 patients ( modafinil , n = 75 ; placebo , n = 85 ) completed question naires at both baseline and day 28 and were included in the modified intention-to-treat analysis . FACIT-Fatigue scores improved from baseline to day 28 ( mean score change : modafinil , 5.29 ; 95 % CI , 2.57 to 8.02 ; placebo , 5.09 ; 95 % CI , 2.54 to 7.65 ) , but there was no difference between treatments ( 0.20 ; 95 % CI , -3.56 to 3.97 ) . There was also no difference between treatments for the secondary outcomes ; 47 % of the modafinil group and 23 % of the placebo group stated that the intervention was not helpful . CONCLUSION Modafinil had no effect on cancer-related fatigue and should not be prescribed outside a clinical trial setting . Its use was associated with a clinical ly significant placebo effect Objective To determine the feasibility and acceptability of acupuncture in managing fatigue and well-being in breast cancer survivors . Methods A r and omised controlled trial compared acupuncture was with sham acupuncture and wait list controls was performed in Sydney , Australia . A total of 30 women with fatigue following breast cancer treatment participated in the trial . Women received six sessions of acupuncture over 8 weeks . Outcomes related to an assessment of interest to participate in the trial and identification of appropriate recruitment strategies , appropriateness of eligibility criteria and compliance with treatment attendance . Clinical outcomes assessed fatigue and well-being . In-depth interviews were undertaken with seven women , who described their experience of acupuncture . Results Our study demonstrated feasibility with appropriate trial entry criteria , good acceptability and treatment compliance with the study interventions , and with the completion of outcome forms . There was a significant reduction in fatigue for women receiving acupuncture compared with control after 2 weeks mean difference ( MD ) 5.3 , 95 % CI 4.5 to 6.2 , p=0.05 , and a significant improvement in well-being at 6 weeks for acupuncture compared with the sham and wait list control , MD 2.7 , 95 % CI 2.1 to 3.2 , p=0.006 . Women described their experience of acupuncture positively , and interview data may also offer explanations for the improved outcomes of well-being , with women reporting an improvement in sleep , mood and relaxation . Conclusions Fatigue is a common symptom experienced by people recovering from treatment , and an appropriately powered trial to evaluate the effect of acupuncture is needed . Clinical Trial Registration Australian New Zeal and Clinical Trials Registry , www. 
    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 : Despite the high frequency , severity , and effects of cancer-related fatigue ( CRF ) on the quality of life ( QoL ) of patients with cancer , limited treatment options are available . The primary objective of this study was to compare the effects of oral Panax ginseng extract ( PG ) and placebo on CRF . Secondary objectives were to determine the effects of PG on QoL , mood , and function . Methods : In this r and omized , double-blind , placebo-controlled study , patients with CRF ≥4/10 on the Edmonton Symptom Assessment System ( ESAS ) were eligible . Based on a pilot study , we r and omized patients to receive either 400 mg of st and ardized PG twice daily or a matching placebo for 28 days . The primary end point was change in the Functional Assessment of Chronic Illness Therapy-Fatigue ( FACIT-F ) subscale from baseline to day 29 . Results : Of 127 patients , 112 ( 88.2 % ) were evaluable . The mean ( SD ) FACIT-F subscale scores at baseline , day 15 , and day 29 were 22.4 ( 10.1 ) , 29.9 ( 10.6 ) , and 30.1 ( 11.6 ) for PG ( P<.001 ) , and 24.0 ( 9.4 ) , 30.0 ( 10.1 ) , and 30.4 ( 11.5 ) for placebo ( P<.001 ) . Mean ( SD ) improvement in the FACIT-F subscale at day 29 was not significantly different in the PG than in the placebo group ( 7.5 [ 12.7 ] vs 6.5 [ 9.9 ] ; P=.67 ) . QoL , anxiety , depression , symptoms , and functional scores were not significantly different between the PG and placebo groups . Improvement in the FACIT-F subscale correlated with baseline scores ( P=.0005 ) , Hospital Anxiety and Depression Scale results ( P=.032 ) , and sex ( P=.023 ) . There were fewer any- grade toxicities in the PG versus placebo group ( 28/63 vs 33/64 ; P=.024 ) . Conclusions : Both PG and placebo result in significant improvement in CRF . PG was not significantly superior to placebo after 4 weeks of treatment . There is no justification to recommend the use of PG for CRF . Further studies are needed . Trial Registration : Clinical Trials.gov identifier : NCT01375114 Background Synthesis of multiple r and omized controlled trials ( RCTs ) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions . Filtering of search es is time consuming , and no single method fulfills the principal requirements of speed with accuracy . Automation of systematic review s is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making . We developed Rayyan ( http://rayyan.qcri.org ) , a free web and mobile app , that helps expedite the initial screening of abstract s and titles using a process of semi-automation while incorporating a high level of usability . For the beta testing phase , we used two published Cochrane review s in which included studies had been selected manually . Their search es , with 1030 records and 273 records , were uploaded to Rayyan . Different features of Rayyan were tested using these two review s. We also conducted a survey of Rayyan ’s users and collected feedback through a built-in feature . Results Pilot testing of Rayyan focused on usability , accuracy against manual methods , and the added value of the prediction feature . The “ taster ” review ( 273 records ) allowed a quick overview of Rayyan for early comments on usability . The second review ( 1030 records ) required several iterations to identify the previously identified 11 trials . The “ suggestions ” and “ hints , ” based on the “ prediction model , ” appeared as testing progressed beyond five included studies . Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements . The survey respondents reported 40 % average time savings when using Rayyan compared to others tools , with 34 % of the respondents reporting more than 50 % time savings . In addition , around 75 % of the respondents mentioned that screening and labeling studies as well as collaborating on review s to be the two most important features of Rayyan . As of November 2016 , Rayyan users exceed 2000 from over 60 countries conducting hundreds of review s totaling more than 1.6 M citations . Feedback from users , obtained mostly through the app web site and a recent survey , has highlighted the ease in exploration of search es , the time saved , and simplicity in sharing and comparing include-exclude decisions . The strongest features of the app , identified and reported in user feedback , were its ability to help in screening and collaboration as well as the time savings it affords to users . Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of review ers Cancer and its treatment can induce subjective and objective evidence of diminished functional capacity encompassing physical fatigue and cognitive impairment . Dexmethylpheni date ( D-MPH ; the D-isomer of methylpheni date ) was evaluated for treatment of chemotherapy-related fatigue and cognitive impairment . A r and omized , double-blind , placebo-controlled , parallel-group study evaluated the potential therapeutic effect and safety of D-MPH in the treatment of patients with chemotherapy-related fatigue . Change from baseline in the Functional Assessment of Chronic Illness Therapy-Fatigue Subscale ( FACIT-F ) total score at Week 8 was the primary outcome measure . One hundred fifty-four patients ( predominantly with breast and ovarian cancers ) were r and omized and treated . Compared with placebo , D-MPH-treated subjects demonstrated a significant improvement in fatigue symptoms at Week 8 in the FACIT-F ( P=0.02 ) and the Clinical Global Impression-Severity scores ( P=0.02 ) , without clinical ly relevant changes in hemoglobin levels . Cognitive function was not significantly improved . There was a higher rate of study drug-related adverse events ( AEs ) ( 48 of 76 [ 63 % ] vs. 22 of 78 [ 28 % ] ) and a higher discontinuation rate because of AEs ( 8 of 76 [ 11 % ] vs. 1 of 78 [ 1.3 % ] ) in D-MPH-treated subjects compared with placebo-treated subjects . The most commonly reported AEs independent of study drug relationship in D-MPH-treated subjects were headache , nausea , and dry mouth , and in placebo-treated subjects were headache , diarrhea , and insomnia .  D-MPH produced significant improvement in fatigue in subjects previously treated with cytotoxic chemotherapy . Further studies with D-MPH or other agents to explore treatment response in chemotherapy-associated fatigue should be considered Background Uncontrolled studies show fatigue , anorexia , depression , and mortality are associated with low testosterone in men with cancer .  Testosterone replacement improves quality of life and diminishes fatigue in patients with non-cancer conditions . The primary objective was to evaluate the effect of testosterone replacement on fatigue in hypogonadal males with advanced cancer , by the Functional Assessment of Chronic Illness Therapy-Fatigue subscale ( FACIT-Fatigue ) at day 29 . Methods This is a r and omized , double-blinded placebo-controlled trial . Out patients with advanced cancer , bioavailable testosterone ( BT ) < 70 ng/dL and fatigue score > 3/10 on the Edmonton Symptom Assessment Scale were eligible .  Intra-muscular testosterone or sesame seed oil placebo was administered every 14 days to achieve BT levels 70–270 ng/dL. Results Sixteen placebo and 13 testosterone-treated subjects were evaluable . No statistically significant difference was found for FACIT-fatigue scores between arms ( −2 ± 12 for placebo , 4 ± 8 for testosterone , p = 0.11 ) . Sexual Desire Inventory score ( p = 0.054 ) and performance status ( p = 0.02 ) improved in the testosterone group . Fatigue subscale scores were significantly better ( p = 0.03 ) in those treated with testosterone by day 72 . Conclusions Four weeks of intramuscular testosterone replacement in hypogonadal male patients with advanced cancer did not significantly improve quality of life . Larger studies of longer duration are warranted Fatigue is the most common symptom negatively affecting the quality of life of patients with cancer . The objective of the current study was to evaluate the preliminary efficacy and safety of 10.6‐μm infrared laser moxibustion for cancer‐related fatigue ( CRF ) PURPOSE This study investigated the efficacy of the botanical-derived drug , PG2 , a partially purified extract of Astragalus membranaceus , as a complementary and palliative medicine for managing  cancer-related fatigue ( CRF ) .  METHODS Patients with advanced cancer and moderate to severe CRF were r and omized to receive either PG2 or a placebo ( normal saline , NS ) in the first treatment cycle ( four weeks ) in a double-blind manner ; thereafter , on the next cycle ( four weeks ) , all patients received open-label treatment with PG2 . RESULTS PG2 significantly improved CRF in the NS-primed group . In the first four week cycle , PG2 administration result ed in a greater fatigue-improvement response rate than seen with NS alone . In addition , approximately 82 % of patients who reported an improvement of fatigue symptoms following the first cycle of PG2 experienced sustained benefits after administration of the second treatment cycle . Among patients treated with PG2 who did not report an improvement in symptoms throughout the first treatment cycle , approximately 71 % showed significant improvement after the second treatment cycle . No major or irreversible toxicities were observed with PG2 treatment . CONCLUSION PG2 might be an effective and safe treatment for relieving CRF among advanced cancer patients PURPOSE Fatigue is a distressing symptom occurring in more than 60 % of patients with cancer . The CNS stimulants modafinil and methylpheni date are recommended for the treatment of cancer-related fatigue , despite a limited evidence base . We aim ed to evaluate the efficacy and tolerability of modafinil in the management of fatigue in patients with non-small-cell lung cancer ( NSCLC ) . PATIENTS AND METHODS Adults with advanced NSCLC and performance status of 0 to 2 , who were not treated with chemotherapy or radiotherapy within the last 4 weeks , were r and omly assigned to daily modafinil ( 100 mg on days 1 to 14 ; 200 mg on days 15 to 28 ) or matched placebo . The primary outcome was change in Functional Assessment of Chronic Illness Therapy ( FACIT ) -Fatigue score from baseline to 28 days , adjusted for baseline fatigue and performance status . Secondary outcomes included safety and patient-reported measures of depression , daytime sleepiness , and quality of life . RESULTS A total of 208 patients were r and omly assigned , and 160 patients ( modafinil , n = 75 ; placebo , n = 85 ) completed question naires at both baseline and day 28 and were included in the modified intention-to-treat analysis . FACIT-Fatigue scores improved from baseline to day 28 ( mean score change : modafinil , 5.29 ; 95 % CI , 2.57 to 8.02 ; placebo , 5.09 ; 95 % CI , 2.54 to 7.65 ) , but there was no difference between treatments ( 0.20 ; 95 % CI , -3.56 to 3.97 ) . There was also no difference between treatments for the secondary outcomes ; 47 % of the modafinil group and 23 % of the placebo group stated that the intervention was not helpful . CONCLUSION Modafinil had no effect on cancer-related fatigue and should not be prescribed outside a clinical trial setting . Its use was associated with a clinical ly significant placebo effect Objective To determine the feasibility and acceptability of acupuncture in managing fatigue and well-being in breast cancer survivors . Methods A r and omised controlled trial compared acupuncture was with sham acupuncture and wait list controls was performed in Sydney , Australia . A total of 30 women with fatigue following breast cancer treatment participated in the trial . Women received six sessions of acupuncture over 8 weeks . Outcomes related to an assessment of interest to participate in the trial and identification of appropriate recruitment strategies , appropriateness of eligibility criteria and compliance with treatment attendance . Clinical outcomes assessed fatigue and well-being . In-depth interviews were undertaken with seven women , who described their experience of acupuncture . Results Our study demonstrated feasibility with appropriate trial entry criteria , good acceptability and treatment compliance with the study interventions , and with the completion of outcome forms . There was a significant reduction in fatigue for women receiving acupuncture compared with control after 2 weeks mean difference ( MD ) 5.3 , 95 % CI 4.5 to 6.2 , p=0.05 , and a significant improvement in well-being at 6 weeks for acupuncture compared with the sham and wait list control , MD 2.7 , 95 % CI 2.1 to 3.2 , p=0.006 . Women described their experience of acupuncture positively , and interview data may also offer explanations for the improved outcomes of well-being , with women reporting an improvement in sleep , mood and relaxation . Conclusions Fatigue is a common symptom experienced by people recovering from treatment , and an appropriately powered trial to evaluate the effect of acupuncture is needed . Clinical Trial Registration Australian New Zeal and Clinical Trials Registry , www. 
    Output:
    