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: Objectives The aim of this prospect i ve investigation was to evaluate child and parental expectancies as a predictor of pain perception in pediatric oncology patients undergoing painful medical procedures . Methods Forty-five children with leukemia or non-Hodgkin lymphoma and their parents rated expected and experienced pain during lumbar punctures at baseline , during intervention ( ie , cognitive-behavior therapy ) administered by a therapist and when children were using cognitive-behavior therapy skills independently . Results Parental and child expectancies were significantly correlated . Parents consistently expected their children to experience more pain than children were expecting themselves . Parental expectancy was found to mediate the relationship between child expected and experienced pain during every phase of the study . Discussion It is concluded that parental expectancies are reliable predictors of pediatric procedure-related pain and possible useful targets for psychologic interventions to manage such pain Objective Children with chronic diseases such as leukemia are subjected to pain during various procedures . Injection pain in children is so important that it is considered as the most stressful aspect of their disease . Distraction is one of the easiest and least costly methods of non-pharmacological pain relief that has not been paid attention to by nurses . In the present study , the effectiveness of regular breathing method ( Hey-Hu ) in reduction of pain of intrathecal injection in leukemic children was evaluated . Methods This study was conducted as a single blind r and omized clinical trial among 100 patients coming to a referral hospital related to Shahid Sadoughi University of Medical Sciences , Yazd , Iran . The patients were 6 - 15 years old children coming to oncology ward suffering from leukemia . They were selected and r and omly allocated to either regular breathing group or control group in equal numbers . The pain of children was assessed by Wong pain face scale and also general behaviors of the sample s were evaluated by the research er . In Pain Rating Scale , face 0 is considered happy because there is no hurt and face 5 denotes maximum pain . Findings Mean pain score in the regular breathing group was significantly lesser than the control group ( 2.98±1.68 and 3.80±1.30 , respectively ; P=0.01 ) . There was no significant difference between the two sexes but in the regular breathing  group , mean pain score was significantly lower in children aged above 10 years . Conclusion This study showed that regular breathing can significantly reduce the pain of intrathecal injection in leukemic children , especially in those aged above 10 years . Considering the key role of nurses in a health care team , the research ers hope that the results of this study can help them learn this method and implement it in hospitalized children who undergo painful procedures The purpose of this study was to examine longitudinally health-related quality of life ( HRQOL ) and related factors in mothers and fathers of children who undergo SCT , before , and 1 and 2 years after SCT .  A total of 84 parents ( 49 mothers/35 fathers ) of patients diagnosed mainly with leukemia completed a HRQOL measure before SCT , 46 at 1 year ( 26 mothers/20 fathers ) and 50 parents ( 31 mothers/19 fathers ) at 2 years post SCT  . Physical and psychosocial HRQOL summary scores are reported . Parents ’ age and gender , child 's diagnosis , radiation history , age , behavior and physical health were examined . Linear mixed models for repeated measures with a covariate structure were used for analysis . Physical HRQOL did not differ between mothers and fathers or over time . Maternal and paternal psychosocial HRQOL scores improved by 2 years post SCT . Child 's behavior problems and poor health , and maternal age ( younger ) predicted poor maternal psychosocial HRQOL 2 years post SCT . Child 's behavior problems , diagnosis and treatment severity predicted poor paternal psychosocial HRQOL . These findings identify similar ( child 's poor behavior ) and differential risk factors ( parental young age , disease and treatment severity , and child 's poor health status ) for poor HRQOL for mothers and fathers . These findings can guide comprehensive family-care interventions before , during and after pediatric SCT OBJECTIVE The delivery of psychological care services to people with cancer and their carers is a key clinical priority that has yet to be broadly implemented . The present study aim ed to provide guidance for service provision by describing a community-based intervention approach ; outlining the characteristics , psychological concerns , and distress outcomes for people who utilise the service . METHODS Over a 3-year period 681 patients and 520 significant others referred from a community-based Cancer Helpline received  tele-based psychosocial interventions . RESULTS In this case series presenting problems varied between patients and significant others , with significant others reporting higher levels of distress ( p<0.001 ) . Both patients and significant others experienced decreases in distress over the period of the intervention ( p<0.001 ) . CONCLUSIONS This study provides level IV evidence that the tele-based intervention for cancer-related distress is an effective approach to service delivery . A r and omised control trial is currently underway to assess the effectiveness of this approach Abstract Objective The aim of the study was to investigate the feasibility and preliminary efficacy of an Internet‐based guided self‐help intervention for posttraumatic stress symptoms ( PTSS ) and related symptoms in parents of children on cancer treatment . Methods Parents of children on cancer treatment , who fulfilled the modified symptom criteria on the PTSD Checklist , were r and omly allocated to the intervention  or to a  wait‐list control condition . The intervention group accessed a 10‐week guided self‐help program via the Internet based on principles from cognitve behavior therapy . The primary outcome PTSS and the secondary outcomes depression and anxiety were assessed by self‐report preintervention and postintervention . Results Seven hundred forty‐seven parents were approached and informed about the study , 92 were assessed for eligibility , and 58 were included and r and omized to the intervention ( n = 31 ) or wait list ( n = 27 ) . Eightteen participants completed the intervention . Intention‐to‐treat analyses indicated a significant effect of the intervention on PTSS with a large between‐group effect size at post assessment ( Cohen 's d = 0.88 ) . The intervention group reported reductions in PTSS with a large within‐group effect size ( d = 1.62 ) compared with a minimal reduction in the wait‐list group ( d = 0.09 ) . There was a significant intervention effect on depression and anxiety and reductions in the intervention group with large within‐group effect sizes ( d = 0.85–1.09 ) . Conclusions Findings indicate a low enrollment rate and considerable attrition but also that Internet‐based guided self‐help shows promise for parents of children on cancer treatment who report a high level of PTSS and would like to take part in an Internet‐based intervention . © 2015 The Authors . Psycho‐Oncology published by John Wiley & Sons , OBJECTIVES ( 1 ) To examine the acceptability and feasibility of a stress management intervention for caregivers of children recently diagnosed with cancer . ( 2 ) To explore whether caregivers with lower baseline perceived social support derive greater benefit from the intervention than those with higher perceived support . METHODS 45 primary caregivers were r and omly assigned to intervention or st and ard care . Of these , 37 completed measures of social support , depression , anxiety , and perceived stress at both pre-intervention ( T1 ; mean = 24 days post-diagnosis ) and post-intervention time points ( T2 ; mean = 165 days post-diagnosis ) . RESULTS Enrollment , retention , and satisfaction data support feasibility and acceptability of the intervention . There was no overall significant impact of participation in the intervention on levels of distress at T2 . However , T1 social support moderated intervention response , with caregivers who perceived lower T1 support showing greater psychological benefit from the intervention . CONCLUSIONS Primary caregivers with lower levels of perceived social support may benefit from preemptive stress management intervention Objective . This review aims to summarize the existing evidence concerning interventions towards reducing stress in parents with a child with leukemia and their effect in child and family wellbeing . Methods . A systematic review strategy was conducted using MEDLINE covering the period January 1980 to June 2010 . Results . Seven r and omized controlled trials met the inclusion criteria including in total 1045 parents participants . A variety of cognitive-behavioral interventions problem-solving skills training programs have been used for managing distress in parents and children . Outcome measures are assessed by self-report , observer report , behavioral/psychological , and physiological measures . The most prominent method ological problems were the marked heterogeneity in stress measurement and the relative absence of proper measurement and adjustment of moderating and mediating factors . The largest effect has been obtained by combined cognitive-behavioral interventions with promising but limited evidence for several other psychological interventions . Conclusions . Recommendations for future RCTs are provided , and particular attention to the quality of trial design and reporting is highlighted Posttraumatic stress symptoms ( PTSS ) , particularly intrusive thoughts , avoidance , and arousal , are among the most common psychological aftereffects of childhood cancer for survivors and their mothers and fathers . We conducted a r and omized wait-list control trial of a newly developed 4-session , 1-day intervention aim ed at reducing PTSS that integrates cognitive-behavioral and family therapy approaches -- the Surviving Cancer Competently Intervention Program ( SCCIP ) . Participants were 150 adolescent survivors and their mothers , fathers , and adolescent siblings . Significant reductions in intrusive thoughts among fathers and in arousal among survivors were found in the treatment group . A multiple imputations approach was used to address nonr and om missing data and indicated that treatment effects would likely have been stronger had more distressed families been retained . The data are supportive of brief interventions to reduce PTSS in this population and provide additional support for the importance of intervention for multiple members of the family PURPOSE / OBJECTIVES To determine the effects of virtual reality ( VR ) glasses on adolescents with cancer undergoing lumbar punctures ( LPs ) . DESIGN Pilot study using an experimental , control group design . SETTING In-hospital oncology clinic . SAMPLE 30 adolescents with cancer ( 17 in the VR and 13 in the control group ) undergoing frequent LPs . METHODS Subjects were r and omly assigned to groups . Both groups received st and ard intervention during the LP , but the experimental group also wore VR glasses and watched a video . Following the LP , both groups rated their pain using a visual analog scale ( VAS ) and were interviewed to evaluate their experience . MAIN RESEARCH VARIABLES Pain , subjective evaluation of experience . FINDINGS Although VAS pain scores were not statistically different between the two groups ( p = 0.77 ) , VAS scores tended to be lower in the VR group ( median VAS of 7.0 , range 0 - 48 ) than in the control group ( median VAS of 9.0 , range 0 - 59 ) . 77 % of subjects in the experimental group said the VR glasses helped to distract them from the LP . CONCLUSIONS VR glasses are a feasible , age-appropriate , nonpharmacologic adjunct to conventional care in managing the pain associated with LPs in adolescents . IMPLICATION S FOR PRACTICE The clinical application of various age-appropriate distracters to reduce pain in adolescents undergoing painful procedures should be explored The present study sought to reduce  children 's distress during aversive medical procedures using a brief , cost-effective intervention aim ed at reframing memory . Fifty children diagnosed with leukemia ( 25 treatment , 25 attention control , aged 3 - 18 ) were observed as they underwent  3 consecutive lumbar punctures ( LPs ; baseline , postintervention , and follow-up ) . Self-report , physiological , and observable distress measures were collected before and after each LP . At posttreatment , children in the intervention group showed reductions in anticipatory physiological and self-report ratings relative to the control group . At follow-up , these effects generalized to reductions in procedural distress . These results suggest that ( a ) a simple memory-based intervention is efficacious at reducing  children 's distress and ( b ) benefits from this intervention are maintained over 1 week even without continued intervention OBJECTIVE To report acceptability , feasibility , and outcome data from a r and omized clinical trial ( RCT ) of a brief intervention for caregivers of children newly diagnosed with cancer . METHOD Eighty-one families were r and omly assigned following collection of baseline data to Intervention or Treatment as Usual ( TAU ) . Recruitment and retention rates and progression through the protocol were tracked . Measures of state anxiety and posttraumatic stress symptoms served as outcomes . RESULTS Difficulties enrolling participants included a high percentage of newly diagnosed families failing to meet inclusion criteria ( 40 % ) and an unexpectedly low participation rate ( 23 % ) . However , movement through the protocol was generally completed in a timely manner and those completing the intervention provided positive feedback . Outcome data showed no significant differences between the arms of the RCT . CONCLUSIONS There are many challenges inherent in conducting a RCT shortly after cancer diagnosis . Consideration of alternative research design s and optimal timing for interventions are essential next steps Adolescent cancer is uncommon and presents an exceptional stress for the young patient and their parents . The emotional needs of adolescents with cancer are a major factor in the recommendation for the establishment of adolescent cancer units in major cancer centres in the U.K. However , there have been no prospect i ve , longitudinal studies assessing the psychological impact of a diagnosis of cancer on the adolescent patient and their family . In 1994 we began a longitudinal study of the emotional impact of the diagnosis of cancer in patients and their families presenting to an adolescent cancer unit and of the coping strategies they employ . This first report presents the results of the study at the time of diagnosis in 42 adolescents , 34 mothers and 2 
    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: Objectives The aim of this prospect i ve investigation was to evaluate child and parental expectancies as a predictor of pain perception in pediatric oncology patients undergoing painful medical procedures . Methods Forty-five children with leukemia or non-Hodgkin lymphoma and their parents rated expected and experienced pain during lumbar punctures at baseline , during intervention ( ie , cognitive-behavior therapy ) administered by a therapist and when children were using cognitive-behavior therapy skills independently . Results Parental and child expectancies were significantly correlated . Parents consistently expected their children to experience more pain than children were expecting themselves . Parental expectancy was found to mediate the relationship between child expected and experienced pain during every phase of the study . Discussion It is concluded that parental expectancies are reliable predictors of pediatric procedure-related pain and possible useful targets for psychologic interventions to manage such pain Objective Children with chronic diseases such as leukemia are subjected to pain during various procedures . Injection pain in children is so important that it is considered as the most stressful aspect of their disease . Distraction is one of the easiest and least costly methods of non-pharmacological pain relief that has not been paid attention to by nurses . In the present study , the effectiveness of regular breathing method ( Hey-Hu ) in reduction of pain of intrathecal injection in leukemic children was evaluated . Methods This study was conducted as a single blind r and omized clinical trial among 100 patients coming to a referral hospital related to Shahid Sadoughi University of Medical Sciences , Yazd , Iran . The patients were 6 - 15 years old children coming to oncology ward suffering from leukemia . They were selected and r and omly allocated to either regular breathing group or control group in equal numbers . The pain of children was assessed by Wong pain face scale and also general behaviors of the sample s were evaluated by the research er . In Pain Rating Scale , face 0 is considered happy because there is no hurt and face 5 denotes maximum pain . Findings Mean pain score in the regular breathing group was significantly lesser than the control group ( 2.98±1.68 and 3.80±1.30 , respectively ; P=0.01 ) . There was no significant difference between the two sexes but in the regular breathing  group , mean pain score was significantly lower in children aged above 10 years . Conclusion This study showed that regular breathing can significantly reduce the pain of intrathecal injection in leukemic children , especially in those aged above 10 years . Considering the key role of nurses in a health care team , the research ers hope that the results of this study can help them learn this method and implement it in hospitalized children who undergo painful procedures The purpose of this study was to examine longitudinally health-related quality of life ( HRQOL ) and related factors in mothers and fathers of children who undergo SCT , before , and 1 and 2 years after SCT .  A total of 84 parents ( 49 mothers/35 fathers ) of patients diagnosed mainly with leukemia completed a HRQOL measure before SCT , 46 at 1 year ( 26 mothers/20 fathers ) and 50 parents ( 31 mothers/19 fathers ) at 2 years post SCT  . Physical and psychosocial HRQOL summary scores are reported . Parents ’ age and gender , child 's diagnosis , radiation history , age , behavior and physical health were examined . Linear mixed models for repeated measures with a covariate structure were used for analysis . Physical HRQOL did not differ between mothers and fathers or over time . Maternal and paternal psychosocial HRQOL scores improved by 2 years post SCT . Child 's behavior problems and poor health , and maternal age ( younger ) predicted poor maternal psychosocial HRQOL 2 years post SCT . Child 's behavior problems , diagnosis and treatment severity predicted poor paternal psychosocial HRQOL . These findings identify similar ( child 's poor behavior ) and differential risk factors ( parental young age , disease and treatment severity , and child 's poor health status ) for poor HRQOL for mothers and fathers . These findings can guide comprehensive family-care interventions before , during and after pediatric SCT OBJECTIVE The delivery of psychological care services to people with cancer and their carers is a key clinical priority that has yet to be broadly implemented . The present study aim ed to provide guidance for service provision by describing a community-based intervention approach ; outlining the characteristics , psychological concerns , and distress outcomes for people who utilise the service . METHODS Over a 3-year period 681 patients and 520 significant others referred from a community-based Cancer Helpline received  tele-based psychosocial interventions . RESULTS In this case series presenting problems varied between patients and significant others , with significant others reporting higher levels of distress ( p<0.001 ) . Both patients and significant others experienced decreases in distress over the period of the intervention ( p<0.001 ) . CONCLUSIONS This study provides level IV evidence that the tele-based intervention for cancer-related distress is an effective approach to service delivery . A r and omised control trial is currently underway to assess the effectiveness of this approach Abstract Objective The aim of the study was to investigate the feasibility and preliminary efficacy of an Internet‐based guided self‐help intervention for posttraumatic stress symptoms ( PTSS ) and related symptoms in parents of children on cancer treatment . Methods Parents of children on cancer treatment , who fulfilled the modified symptom criteria on the PTSD Checklist , were r and omly allocated to the intervention  or to a  wait‐list control condition . The intervention group accessed a 10‐week guided self‐help program via the Internet based on principles from cognitve behavior therapy . The primary outcome PTSS and the secondary outcomes depression and anxiety were assessed by self‐report preintervention and postintervention . Results Seven hundred forty‐seven parents were approached and informed about the study , 92 were assessed for eligibility , and 58 were included and r and omized to the intervention ( n = 31 ) or wait list ( n = 27 ) . Eightteen participants completed the intervention . Intention‐to‐treat analyses indicated a significant effect of the intervention on PTSS with a large between‐group effect size at post assessment ( Cohen 's d = 0.88 ) . The intervention group reported reductions in PTSS with a large within‐group effect size ( d = 1.62 ) compared with a minimal reduction in the wait‐list group ( d = 0.09 ) . There was a significant intervention effect on depression and anxiety and reductions in the intervention group with large within‐group effect sizes ( d = 0.85–1.09 ) . Conclusions Findings indicate a low enrollment rate and considerable attrition but also that Internet‐based guided self‐help shows promise for parents of children on cancer treatment who report a high level of PTSS and would like to take part in an Internet‐based intervention . © 2015 The Authors . Psycho‐Oncology published by John Wiley & Sons , OBJECTIVES ( 1 ) To examine the acceptability and feasibility of a stress management intervention for caregivers of children recently diagnosed with cancer . ( 2 ) To explore whether caregivers with lower baseline perceived social support derive greater benefit from the intervention than those with higher perceived support . METHODS 45 primary caregivers were r and omly assigned to intervention or st and ard care . Of these , 37 completed measures of social support , depression , anxiety , and perceived stress at both pre-intervention ( T1 ; mean = 24 days post-diagnosis ) and post-intervention time points ( T2 ; mean = 165 days post-diagnosis ) . RESULTS Enrollment , retention , and satisfaction data support feasibility and acceptability of the intervention . There was no overall significant impact of participation in the intervention on levels of distress at T2 . However , T1 social support moderated intervention response , with caregivers who perceived lower T1 support showing greater psychological benefit from the intervention . CONCLUSIONS Primary caregivers with lower levels of perceived social support may benefit from preemptive stress management intervention Objective . This review aims to summarize the existing evidence concerning interventions towards reducing stress in parents with a child with leukemia and their effect in child and family wellbeing . Methods . A systematic review strategy was conducted using MEDLINE covering the period January 1980 to June 2010 . Results . Seven r and omized controlled trials met the inclusion criteria including in total 1045 parents participants . A variety of cognitive-behavioral interventions problem-solving skills training programs have been used for managing distress in parents and children . Outcome measures are assessed by self-report , observer report , behavioral/psychological , and physiological measures . The most prominent method ological problems were the marked heterogeneity in stress measurement and the relative absence of proper measurement and adjustment of moderating and mediating factors . The largest effect has been obtained by combined cognitive-behavioral interventions with promising but limited evidence for several other psychological interventions . Conclusions . Recommendations for future RCTs are provided , and particular attention to the quality of trial design and reporting is highlighted Posttraumatic stress symptoms ( PTSS ) , particularly intrusive thoughts , avoidance , and arousal , are among the most common psychological aftereffects of childhood cancer for survivors and their mothers and fathers . We conducted a r and omized wait-list control trial of a newly developed 4-session , 1-day intervention aim ed at reducing PTSS that integrates cognitive-behavioral and family therapy approaches -- the Surviving Cancer Competently Intervention Program ( SCCIP ) . Participants were 150 adolescent survivors and their mothers , fathers , and adolescent siblings . Significant reductions in intrusive thoughts among fathers and in arousal among survivors were found in the treatment group . A multiple imputations approach was used to address nonr and om missing data and indicated that treatment effects would likely have been stronger had more distressed families been retained . The data are supportive of brief interventions to reduce PTSS in this population and provide additional support for the importance of intervention for multiple members of the family PURPOSE / OBJECTIVES To determine the effects of virtual reality ( VR ) glasses on adolescents with cancer undergoing lumbar punctures ( LPs ) . DESIGN Pilot study using an experimental , control group design . SETTING In-hospital oncology clinic . SAMPLE 30 adolescents with cancer ( 17 in the VR and 13 in the control group ) undergoing frequent LPs . METHODS Subjects were r and omly assigned to groups . Both groups received st and ard intervention during the LP , but the experimental group also wore VR glasses and watched a video . Following the LP , both groups rated their pain using a visual analog scale ( VAS ) and were interviewed to evaluate their experience . MAIN RESEARCH VARIABLES Pain , subjective evaluation of experience . FINDINGS Although VAS pain scores were not statistically different between the two groups ( p = 0.77 ) , VAS scores tended to be lower in the VR group ( median VAS of 7.0 , range 0 - 48 ) than in the control group ( median VAS of 9.0 , range 0 - 59 ) . 77 % of subjects in the experimental group said the VR glasses helped to distract them from the LP . CONCLUSIONS VR glasses are a feasible , age-appropriate , nonpharmacologic adjunct to conventional care in managing the pain associated with LPs in adolescents . IMPLICATION S FOR PRACTICE The clinical application of various age-appropriate distracters to reduce pain in adolescents undergoing painful procedures should be explored The present study sought to reduce  children 's distress during aversive medical procedures using a brief , cost-effective intervention aim ed at reframing memory . Fifty children diagnosed with leukemia ( 25 treatment , 25 attention control , aged 3 - 18 ) were observed as they underwent  3 consecutive lumbar punctures ( LPs ; baseline , postintervention , and follow-up ) . Self-report , physiological , and observable distress measures were collected before and after each LP . At posttreatment , children in the intervention group showed reductions in anticipatory physiological and self-report ratings relative to the control group . At follow-up , these effects generalized to reductions in procedural distress . These results suggest that ( a ) a simple memory-based intervention is efficacious at reducing  children 's distress and ( b ) benefits from this intervention are maintained over 1 week even without continued intervention OBJECTIVE To report acceptability , feasibility , and outcome data from a r and omized clinical trial ( RCT ) of a brief intervention for caregivers of children newly diagnosed with cancer . METHOD Eighty-one families were r and omly assigned following collection of baseline data to Intervention or Treatment as Usual ( TAU ) . Recruitment and retention rates and progression through the protocol were tracked . Measures of state anxiety and posttraumatic stress symptoms served as outcomes . RESULTS Difficulties enrolling participants included a high percentage of newly diagnosed families failing to meet inclusion criteria ( 40 % ) and an unexpectedly low participation rate ( 23 % ) . However , movement through the protocol was generally completed in a timely manner and those completing the intervention provided positive feedback . Outcome data showed no significant differences between the arms of the RCT . CONCLUSIONS There are many challenges inherent in conducting a RCT shortly after cancer diagnosis . Consideration of alternative research design s and optimal timing for interventions are essential next steps Adolescent cancer is uncommon and presents an exceptional stress for the young patient and their parents . The emotional needs of adolescents with cancer are a major factor in the recommendation for the establishment of adolescent cancer units in major cancer centres in the U.K. However , there have been no prospect i ve , longitudinal studies assessing the psychological impact of a diagnosis of cancer on the adolescent patient and their family . In 1994 we began a longitudinal study of the emotional impact of the diagnosis of cancer in patients and their families presenting to an adolescent cancer unit and of the coping strategies they employ . This first report presents the results of the study at the time of diagnosis in 42 adolescents , 34 mothers and 2 
    Output:
    