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: A prospect i ve , r and omized clinical trial was performed in order to assess the efficacy and side-effects of commonly used topical anaesthesia methods in adults receiving peripheral venous cannulation . The study was double-blinded to the degree that the method ologies allowed . One hundred and fifty healthy adults undergoing elective surgery were allocated at r and om to five groups : EMLA cream , ethyl chloride spray , intracutaneous infiltration with 2 % lidocaine , placebo cream and no treatment . Venipuncture was performed with a 18 G cannula on the dorsal side of the h and . Puncture pain and pain caused by the topical treatment itself were measured using a visual analogue scale ( VAS , range : 0 - 100 mm ) . Haemodynamic response , difficulties in performing the puncture and side-effects were recorded . All analgesic techniques were well tolerated . Haemodynamic response and degree of puncture difficulty showed no differences among the groups . Puncture pain ( median mrnVAS ) following infiltration ( 1.0 ) and EMLA ( 10.0 ) was significantly lower than no treatment ( 30.0 ) or placebo ( 30.0 ) . The benefit of local infiltration was altered by injection pain ( 11.5 ) . Spray did not significantly lower puncture pain ( 26.5 ) and , in addition , was associated with discomfort ( 10.5 ) . In adults , EMLA cream significantly reduces puncture pain and represents an acceptable alternate method for topical anaesthesia in venous cannulation . Local lidocaine infiltration is impaired by applicational pain , whereas spraying the puncture site with ethyl chloride has no analgesic benefit OBJECTIVE To determine whether milk and its components reduce  crying  in newborns during and after blood collection for phenylketonuria evaluation . METHODOLOGY Seventy-two normal newborns ingested 2 mL of milk ( Similac ) , Ross Special Formula , fat , protein , lactose , sucrose , or water for the 2 minutes preceding blood collection via heel lance . Crying duration during and for the 3 minutes after the procedure was determined by scorers who were blind to the ingestive substance . RESULTS Sucrose and Similac each reduced crying during the blood collection procedure . Sucrose , fat , protein , and Ross Special Formula were effective during the 3-minute recovery period . Neither water nor lactose were effective during or after blood collection . CONCLUSION Milk and some of its components are antinociceptive in human newborns . Based on previous studies , reduced crying during and after painful stimulation may be mediated through endogenous opioids . These findings are of potential clinical significance : natural protective mechanisms , normally engaged during suckling , may safely and noninvasively be activated to reduce  newborn crying to painful stimulation OBJECTIVES Children view needle sticks as the worst source of pain and fear in the hospital setting . In an effort to minimize the pain of needle sticks , the use of eutectic mixture of lidocaine and prilocaine ( EMLA ) has become st and ard practice in many children 's hospitals . Unfortunately , EMLA requires at least 60 minutes to be fully effective and reportedly may cause vasoconstriction , leading to difficult vein cannulation . A newly available local anesthetic ( ELA-Max ) may require less time and cause less vasoconstriction . The purpose of this r and omized crossover study was to investigate the anesthetic equivalence of EMLA and ELA-Max . METHODS Thirty well children ( 14 girls and 16 boys ) who were between the ages of 7 and 13 years volunteered to have EMLA  applied to the dorsal aspect of 1 h and for 60 minutes and ELA-Max applied to the other h and for 30 minutes . Right and left h and s were r and omized to treatment type and order of intravenous ( IV ) insertion . Clinical Research Center nurses , blind to the anesthetic r and omization , attempted to insert a 22-gauge Teflon IV catheter into a vein in each h and . The children rated pain during IV insertion on the Oucher scale , and the nurse rated the difficulty of the insertion . RESULTS There was no significant difference in pain ratings for h and s that were treated with EMLA ( mean : 20.5 ) or with ELA-Max ( mean : 24 ) , and there was no difference for the difficulty of vein cannulation .  Children 's preprocedure state anxiety was positively associated with pain ratings . CONCLUSIONS ELA-Max , applied for 30 minutes before IV cannulation , has an anesthetic effectiveness similar to EMLA applied for 60 minutes . Some children rated IV insertion pain fairly high for both h and s ( eg , 60 on a 0- to 100-point scale ) despite anesthetic treatment . Preprocedural anxiety may affect the perception and /or rating of pain . There were no differences between h and s that were treated with EMLA or with ELA-Max for success of IV insertion Objectives . Ametop gel ( 4 % amethocaine ) is a relatively new topical anesthetic that produces anesthesia within 30 to 45 minutes and therefore may be appropriate for use in busy outpatient setting s. The objective of this study was to assess the efficacy and safety of 4 % amethocaine in reducing the pain of subcutaneous measles-mumps-rubella vaccination in 1-year-old infants . Methods .A double-blind , r and omized , placebo-controlled trial was conducted in pediatric outpatient clinics . Results .A total of 120 infants participated in the study ; 60 were followed up for assessment of antibody titers after 1 month . Either 1 g of amethocaine or placebo was applied for 30 minutes before vaccination . The Modified Behavioral Pain Scale was used to assess pain ; the mean ( st and ard deviation ) pain scores for the amethocaine group ( n = 61 ) was 1.5 ( 1.6 ) versus 2.3 ( 2.2 ) for the placebo group ( n = 59 ) . The rate of vaccination success ( 88 % and 87 % ) was not different between treatment groups . Conclusions .4 % Amethocaine significantly reduces the pain of measles-mumps-rubella vaccination in infants when compared with placebo and does not seem to interfere with subsequent development of protective antibody levels . Because of its relatively short application time ( 30 minutes ) , 4 % amethocaine may be suitable for busy clinics and emergency departments Early childhood experiences with painful injections may lead to anxiety and fear . These reactions need not develop if steps are taken to reduce the pain associated with injections . The purpose of this study was to assess the efficacy of a refrigerant topical anesthetic in reducing injection pain in preschool children experiencing routine diphtheria-pertussis-tetanus ( DPT ) immunizations . This double-blind placebo-controlled study was conducted in community health clinics in conjunction with ongoing immunization programs . Ninety subjects , aged 4 - 5.5 years , were r and omly assigned to one of three groups : ( a ) refrigerant topical anesthetic ; ( b ) placebo topical spray ; and ( c ) no-spray control .  Pain was measured subjectively using a four-point visual analogue scale . Both the refrigerant topical anesthetic spray and the placebo spray significantly reduced injection pain . Age was found to be an important factor influencing pain response in this study . Parental anxiety was not a significant factor influencing pain response . In addition , parents were not good at predicting their child 's pain . The results of the study support the use of an intervention , such as refrigerant topical anesthetic , as a practical , simple , and effective treatment strategy for reduction of short-term painful procedures like injections AIM To evaluate oral glucose as an analgesic to reduce  infant distress after immunization during the first year of life and to investigate if these effects change during this period . METHODS A prospect i ve controlled trial of the effectiveness of glucose on crying response to immunizations at 3 , 5 and 12 months of age . A total of 110 infants were r and omized to receive 2 mL of 30 % glucose or water . The same solution was given at 3 , 5 and 12 months . Crying was registered from onset of the injection up to 120 seconds . Infanrix Polio Hib was administered intra-muscular in the thigh . Observation nurse and parents were blind to the nature of the solution . RESULTS Administration of glucose reduced the mean crying time by 22 % at 3 months , 62 % at 5 months and 52 % at 12 months . The difference was significant at 5 and at 12 months . In the water group , there was a significant correlation between the children who cried at 3 months and who subsequently cried at 5 and 12 months . No correlations were found in the glucose group . CONCLUSION Sweet solution can be used as a simple and safe method to reduce the distress following immunization in infants up to 12 months The efficacy of lignocaine‐prilocaine cream ( EMLA ™ ) and amethocaine gel ( Ametop ™ ) in reducing the pain and distress of venepuncture  was compared in a single‐blind r and omized study of 34 children aged 1—14 y. The influences of age , anxiety and past experience were also investigated . Pain was assessed by the research er using the Observation Scale of Behavioural Distress , and by the parent , doctor and child ( if old enough ) using a 10‐cm , 100‐point Visual Analogue Scale ( VAS ) . Doctors also completed a simple rating scale for difficulty of venepuncture . Compared to older children , infants had significantly more anxious parents and were more distressed when being held still . Anticipatory anxiety correlated with higher pain ratings . No differences in the analgesic effect of the two preparations were found . We conclude that whilst EMLA and Ametop are equally effective at reducing the pain of needle puncture , under some circumstances the use of Ametop may be more advantageous . □ Children , local anaesthetic ,  needle pain , The objective of this study was to examine the pain-relieving effect of breast-feeding during immunization injections in healthy neonates . Sixty-six healthy infants returning to a clinic for their second- , third- , or fourth-month immunization with intramuscular diphtheria , tetanus , and pertussis  were r and omized to be breast-fed before , during , and after the injection or to be given the injection according to routine clinic procedure ( no breast-feeding ) . To assess the pain responses of the neonates during and after immunization , we noted their heart rates , oxygen saturation levels , and length of crying . The crying time was shorter in the experimental ( breast-feeding ) group ( M + /- SD duration , 35.85 + /- 40.11 seconds ) than in the control group ( M + /- SD duration , 76.24 + /- 49.61 seconds ; p = .001 ) . The heart rate and oxygen saturation levels were almost the same in both groups . We concluded that breast-feeding , maternal holding , and skin-to-skin contact significantly reduced crying in infants receiving an immunization injection for diphtheria , tetanus , and pertussis Objective : Although intravenous ( IV ) line placement is a common procedure in the emergency department ( ED ) , it is an uncomfortable experience for many patients . Topical analgesic agents are rarely used because they have long onsets of action and thereby cause unacceptable treatment delays . Cryoanaesthesia , the use of cooling agents to reduce pain , has been recognised for many years as a potential pain management strategy . The purpose of this study was to determine whether an instantaneous topical skin coolant spray reduces patient ’s pain during IV cannulation and represents a feasible alternative for cutaneous analgesia in the ED setting . Methods : We conducted an unblinded , r and omised , controlled study , in a convenience sample of ED patients . Utilising a r and om number generator to assign patients to the control or study group , patients over the age of 18 years who required IV cannulation as part of their evaluation were enrolled at two tertiary care hospitals . In both groups , IV lines were placed in accordance with accepted clinical st and ards of practice , with the single addition of the coolant spray delivered to the IV site before needle insertion in the study group . All study participants answered question naires before and after IV placement and rated pain during procedure on a 100 mm visual analogue scale . Results : Of the 92 patients enrolled in the study , 47 ( 51.1 % ) were r and omised to the study group and received the anaesthetic spray , and 45 ( 48.9 % ) were r and omised to the control group and had their IV placed in a st and ard method . 66 patients were female ( 71.8 % ) and 26 ( 28.2 % ) were males . The mean pain score in the study group was 27 mm ( 95 % confidence interval ( CI ) 19.9 to 34.1 mm ) and 28 mm ( 95 % CI 20.4 to 35.6 m ) in the control group ( p = 0.934 ) . Subgroup analysis of female and male patients did not show significance . Conclusions : Our study failed to detect a difference in pain perception result ing from the pre-procedural application of a skin coolant associated with IV placement in the ED setting We have determined the depth and duration of analgesia to needle insertion after topical application of EMLA cream ( Eutectic Mixture of Local Analgesics ) . EMLA was applied for 30 , 60 , 90 and 120 min and the sensory and pain threshold depths were determined before analgesia ( 1.0 and 1.9 mm , respectively ) and up to 4 h after the cream was 
    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: A prospect i ve , r and omized clinical trial was performed in order to assess the efficacy and side-effects of commonly used topical anaesthesia methods in adults receiving peripheral venous cannulation . The study was double-blinded to the degree that the method ologies allowed . One hundred and fifty healthy adults undergoing elective surgery were allocated at r and om to five groups : EMLA cream , ethyl chloride spray , intracutaneous infiltration with 2 % lidocaine , placebo cream and no treatment . Venipuncture was performed with a 18 G cannula on the dorsal side of the h and . Puncture pain and pain caused by the topical treatment itself were measured using a visual analogue scale ( VAS , range : 0 - 100 mm ) . Haemodynamic response , difficulties in performing the puncture and side-effects were recorded . All analgesic techniques were well tolerated . Haemodynamic response and degree of puncture difficulty showed no differences among the groups . Puncture pain ( median mrnVAS ) following infiltration ( 1.0 ) and EMLA ( 10.0 ) was significantly lower than no treatment ( 30.0 ) or placebo ( 30.0 ) . The benefit of local infiltration was altered by injection pain ( 11.5 ) . Spray did not significantly lower puncture pain ( 26.5 ) and , in addition , was associated with discomfort ( 10.5 ) . In adults , EMLA cream significantly reduces puncture pain and represents an acceptable alternate method for topical anaesthesia in venous cannulation . Local lidocaine infiltration is impaired by applicational pain , whereas spraying the puncture site with ethyl chloride has no analgesic benefit OBJECTIVE To determine whether milk and its components reduce  crying  in newborns during and after blood collection for phenylketonuria evaluation . METHODOLOGY Seventy-two normal newborns ingested 2 mL of milk ( Similac ) , Ross Special Formula , fat , protein , lactose , sucrose , or water for the 2 minutes preceding blood collection via heel lance . Crying duration during and for the 3 minutes after the procedure was determined by scorers who were blind to the ingestive substance . RESULTS Sucrose and Similac each reduced crying during the blood collection procedure . Sucrose , fat , protein , and Ross Special Formula were effective during the 3-minute recovery period . Neither water nor lactose were effective during or after blood collection . CONCLUSION Milk and some of its components are antinociceptive in human newborns . Based on previous studies , reduced crying during and after painful stimulation may be mediated through endogenous opioids . These findings are of potential clinical significance : natural protective mechanisms , normally engaged during suckling , may safely and noninvasively be activated to reduce  newborn crying to painful stimulation OBJECTIVES Children view needle sticks as the worst source of pain and fear in the hospital setting . In an effort to minimize the pain of needle sticks , the use of eutectic mixture of lidocaine and prilocaine ( EMLA ) has become st and ard practice in many children 's hospitals . Unfortunately , EMLA requires at least 60 minutes to be fully effective and reportedly may cause vasoconstriction , leading to difficult vein cannulation . A newly available local anesthetic ( ELA-Max ) may require less time and cause less vasoconstriction . The purpose of this r and omized crossover study was to investigate the anesthetic equivalence of EMLA and ELA-Max . METHODS Thirty well children ( 14 girls and 16 boys ) who were between the ages of 7 and 13 years volunteered to have EMLA  applied to the dorsal aspect of 1 h and for 60 minutes and ELA-Max applied to the other h and for 30 minutes . Right and left h and s were r and omized to treatment type and order of intravenous ( IV ) insertion . Clinical Research Center nurses , blind to the anesthetic r and omization , attempted to insert a 22-gauge Teflon IV catheter into a vein in each h and . The children rated pain during IV insertion on the Oucher scale , and the nurse rated the difficulty of the insertion . RESULTS There was no significant difference in pain ratings for h and s that were treated with EMLA ( mean : 20.5 ) or with ELA-Max ( mean : 24 ) , and there was no difference for the difficulty of vein cannulation .  Children 's preprocedure state anxiety was positively associated with pain ratings . CONCLUSIONS ELA-Max , applied for 30 minutes before IV cannulation , has an anesthetic effectiveness similar to EMLA applied for 60 minutes . Some children rated IV insertion pain fairly high for both h and s ( eg , 60 on a 0- to 100-point scale ) despite anesthetic treatment . Preprocedural anxiety may affect the perception and /or rating of pain . There were no differences between h and s that were treated with EMLA or with ELA-Max for success of IV insertion Objectives . Ametop gel ( 4 % amethocaine ) is a relatively new topical anesthetic that produces anesthesia within 30 to 45 minutes and therefore may be appropriate for use in busy outpatient setting s. The objective of this study was to assess the efficacy and safety of 4 % amethocaine in reducing the pain of subcutaneous measles-mumps-rubella vaccination in 1-year-old infants . Methods .A double-blind , r and omized , placebo-controlled trial was conducted in pediatric outpatient clinics . Results .A total of 120 infants participated in the study ; 60 were followed up for assessment of antibody titers after 1 month . Either 1 g of amethocaine or placebo was applied for 30 minutes before vaccination . The Modified Behavioral Pain Scale was used to assess pain ; the mean ( st and ard deviation ) pain scores for the amethocaine group ( n = 61 ) was 1.5 ( 1.6 ) versus 2.3 ( 2.2 ) for the placebo group ( n = 59 ) . The rate of vaccination success ( 88 % and 87 % ) was not different between treatment groups . Conclusions .4 % Amethocaine significantly reduces the pain of measles-mumps-rubella vaccination in infants when compared with placebo and does not seem to interfere with subsequent development of protective antibody levels . Because of its relatively short application time ( 30 minutes ) , 4 % amethocaine may be suitable for busy clinics and emergency departments Early childhood experiences with painful injections may lead to anxiety and fear . These reactions need not develop if steps are taken to reduce the pain associated with injections . The purpose of this study was to assess the efficacy of a refrigerant topical anesthetic in reducing injection pain in preschool children experiencing routine diphtheria-pertussis-tetanus ( DPT ) immunizations . This double-blind placebo-controlled study was conducted in community health clinics in conjunction with ongoing immunization programs . Ninety subjects , aged 4 - 5.5 years , were r and omly assigned to one of three groups : ( a ) refrigerant topical anesthetic ; ( b ) placebo topical spray ; and ( c ) no-spray control .  Pain was measured subjectively using a four-point visual analogue scale . Both the refrigerant topical anesthetic spray and the placebo spray significantly reduced injection pain . Age was found to be an important factor influencing pain response in this study . Parental anxiety was not a significant factor influencing pain response . In addition , parents were not good at predicting their child 's pain . The results of the study support the use of an intervention , such as refrigerant topical anesthetic , as a practical , simple , and effective treatment strategy for reduction of short-term painful procedures like injections AIM To evaluate oral glucose as an analgesic to reduce  infant distress after immunization during the first year of life and to investigate if these effects change during this period . METHODS A prospect i ve controlled trial of the effectiveness of glucose on crying response to immunizations at 3 , 5 and 12 months of age . A total of 110 infants were r and omized to receive 2 mL of 30 % glucose or water . The same solution was given at 3 , 5 and 12 months . Crying was registered from onset of the injection up to 120 seconds . Infanrix Polio Hib was administered intra-muscular in the thigh . Observation nurse and parents were blind to the nature of the solution . RESULTS Administration of glucose reduced the mean crying time by 22 % at 3 months , 62 % at 5 months and 52 % at 12 months . The difference was significant at 5 and at 12 months . In the water group , there was a significant correlation between the children who cried at 3 months and who subsequently cried at 5 and 12 months . No correlations were found in the glucose group . CONCLUSION Sweet solution can be used as a simple and safe method to reduce the distress following immunization in infants up to 12 months The efficacy of lignocaine‐prilocaine cream ( EMLA ™ ) and amethocaine gel ( Ametop ™ ) in reducing the pain and distress of venepuncture  was compared in a single‐blind r and omized study of 34 children aged 1—14 y. The influences of age , anxiety and past experience were also investigated . Pain was assessed by the research er using the Observation Scale of Behavioural Distress , and by the parent , doctor and child ( if old enough ) using a 10‐cm , 100‐point Visual Analogue Scale ( VAS ) . Doctors also completed a simple rating scale for difficulty of venepuncture . Compared to older children , infants had significantly more anxious parents and were more distressed when being held still . Anticipatory anxiety correlated with higher pain ratings . No differences in the analgesic effect of the two preparations were found . We conclude that whilst EMLA and Ametop are equally effective at reducing the pain of needle puncture , under some circumstances the use of Ametop may be more advantageous . □ Children , local anaesthetic ,  needle pain , The objective of this study was to examine the pain-relieving effect of breast-feeding during immunization injections in healthy neonates . Sixty-six healthy infants returning to a clinic for their second- , third- , or fourth-month immunization with intramuscular diphtheria , tetanus , and pertussis  were r and omized to be breast-fed before , during , and after the injection or to be given the injection according to routine clinic procedure ( no breast-feeding ) . To assess the pain responses of the neonates during and after immunization , we noted their heart rates , oxygen saturation levels , and length of crying . The crying time was shorter in the experimental ( breast-feeding ) group ( M + /- SD duration , 35.85 + /- 40.11 seconds ) than in the control group ( M + /- SD duration , 76.24 + /- 49.61 seconds ; p = .001 ) . The heart rate and oxygen saturation levels were almost the same in both groups . We concluded that breast-feeding , maternal holding , and skin-to-skin contact significantly reduced crying in infants receiving an immunization injection for diphtheria , tetanus , and pertussis Objective : Although intravenous ( IV ) line placement is a common procedure in the emergency department ( ED ) , it is an uncomfortable experience for many patients . Topical analgesic agents are rarely used because they have long onsets of action and thereby cause unacceptable treatment delays . Cryoanaesthesia , the use of cooling agents to reduce pain , has been recognised for many years as a potential pain management strategy . The purpose of this study was to determine whether an instantaneous topical skin coolant spray reduces patient ’s pain during IV cannulation and represents a feasible alternative for cutaneous analgesia in the ED setting . Methods : We conducted an unblinded , r and omised , controlled study , in a convenience sample of ED patients . Utilising a r and om number generator to assign patients to the control or study group , patients over the age of 18 years who required IV cannulation as part of their evaluation were enrolled at two tertiary care hospitals . In both groups , IV lines were placed in accordance with accepted clinical st and ards of practice , with the single addition of the coolant spray delivered to the IV site before needle insertion in the study group . All study participants answered question naires before and after IV placement and rated pain during procedure on a 100 mm visual analogue scale . Results : Of the 92 patients enrolled in the study , 47 ( 51.1 % ) were r and omised to the study group and received the anaesthetic spray , and 45 ( 48.9 % ) were r and omised to the control group and had their IV placed in a st and ard method . 66 patients were female ( 71.8 % ) and 26 ( 28.2 % ) were males . The mean pain score in the study group was 27 mm ( 95 % confidence interval ( CI ) 19.9 to 34.1 mm ) and 28 mm ( 95 % CI 20.4 to 35.6 m ) in the control group ( p = 0.934 ) . Subgroup analysis of female and male patients did not show significance . Conclusions : Our study failed to detect a difference in pain perception result ing from the pre-procedural application of a skin coolant associated with IV placement in the ED setting We have determined the depth and duration of analgesia to needle insertion after topical application of EMLA cream ( Eutectic Mixture of Local Analgesics ) . EMLA was applied for 30 , 60 , 90 and 120 min and the sensory and pain threshold depths were determined before analgesia ( 1.0 and 1.9 mm , respectively ) and up to 4 h after the cream was 
    Output:
    