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: Cancer patients continue to experience elevated levels of emotional distress , even after cancer treatment . Elevated emotional distress negatively impacts immune and endocrine functions and decreases life quality . This study explored the effectiveness of GIM in alleviating mood disturbance and improving quality of life in cancer patients . Eight volunteers with a cancer history were r and omly assigned to either an experimental or a wait-list control group . Experimental subjects individually participated in 10 weekly GIM sessions . All subjects completed the Profile of Mood States ( POMS ) and Quality of Life-Cancer ( QOL-CA ) question naires pretest , posttest , and at a 6-week follow-up . Individuals who participated in GIM sessions scored better on both mood scores and quality of life scores at posttest than those participating in the control group . Additionally , mood and quality of life scores continued to improve in the experimental group , even after sessions were complete . Results indicate that GIM was effective in improving mood and quality of life in these cancer patients & NA ; Few controlled clinical trials of psychological interventions for cancer pain relief exist in spite of frequent support for their importance as adjuncts to medical treatment . This study compared oral mucositis pain levels in 4 groups of cancer patients receiving bone marrow transplants ( BMT ) : ( 1 ) treatment as usual control , ( 2 ) therapist support , ( 3 ) relaxation and imagery training , and ( 4 ) training in a package of cognitive‐behavioral coping skills which included relaxation and imagery . A total of 94 patients completed the study which involved two training sessions prior to treatment and twice a week ‘ booster ’ sessions during the first 5 weeks of treatment . Results confirmed our hypothesis that patients who received either relaxation and imagery alone or patients who received the package of cognitive‐behavioral coping skills would report less pain than patients in the other 2 groups . The hypothesis that the cognitive‐behavioral skills package would have an additive effect beyond relaxation and imagery alone was not confirmed . Average visual analogue scale ( VAS ) report of pain within the therapist support group was not significantly lower than the control group ( P = 0.103 ) nor significantly higher than the training groups . Patient reports of relative helpfulness of the interventions for managing pain and nausea matched the results of VAS reports . From these results , we conclude that relaxation and imagery training reduces cancer treatment‐related pain ; adding cognitive‐behavioral skills to the relaxation with imagery does not , on average , further improve pain relief The purpose of this study was to determine if the addition of guided imagery to a st and ard antiemetic regimen decreased nausea , vomiting , and retching occurrence and distress in patients receiving cisplatin-based chemotherapy . A convenience sample of patients ( N = 28 ) was selected from an oncologist 's patient population and r and omized into two groups . Both groups received the same st and ard antiemetic regimen , while the experimental group additionally used a chemotherapy-specific guided-imagery audiotape . The Rhodes Index of Nausea and Vomiting Form 2 was used to measure the nausea and vomiting experience . Findings revealed no statistically significant difference in this measurement between the two groups when measured at five different times during chemotherapy administration . The Chemotherapy Experience Survey was used to evaluate the participants ' overall perceptions of the  chemotherapy  experience . The guided-imagery group expressed a significantly more positive experience ( p = 0.0001 ) with chemotherapy . These findings have definite implication s for developing effective nursing interventions to promote patient involvement in self-care practice s and to increase patient coping abilities during symptom occurrence PURPOSE / OBJECTIVES To measure the effectiveness of customized guided imagery for increasing comfort in women with early stage breast cancer . DESIGN Experimental longitudinal , r and om assignment to groups . SETTING Two urban radiation oncology departments . SAMPLE 53 women ( 26 in the experimental group , 27 in the control group ) aged 37 - 81 ; 80 % European and 10 % African American with stage I or II breast cancer about to begin radiation therapy . METHODS The experimental group was to listen to a guided imagery audiotape once a day for the duration of the study . The  Radiation Therapy Comfort Question naire was self-administered at three time points : prior to the introduction of intervention and the beginning of radiation therapy ( Time 1 ) , three weeks later ( Time 2 ) , and three weeks after completing radiation therapy ( Time 3 ) . The  State Anxiety Inventory  was administered at Time 1 only . MAIN RESEARCH VARIABLES The effect of use of guided imagery on comfort with anxiety as a control variable . FINDINGS Pooled data indicated a significant overall increase in differences in comfort between the treatment and control group , with the treatment group having higher comfort over time . The data also revealed a significant linear trend in differences between groups . No significant interaction of group and time existed . CONCLUSIONS Guided imagery is an effective intervention for enhancing comfort of women undergoing radiation therapy for early stage breast cancer . The intervention was especially salient in the first three weeks of therapy . IMPLICATION S FOR NURSING PRACTICE Guided imagery audiotapes specifically design ed for this population were re source effective in terms of cost , personnel , and time Increasing numbers of women with breast cancer are seeking alternatives to st and ard group support in coping with their illness . This study examines outcomes for 181 women with breast cancer r and omized to either a 12-week st and ard group support or a 12-week complementary and alternative medicine ( CAM ) support intervention .  Participants in the CAM group were taught the use of meditation , affirmation , imagery and ritual . The st and ard group combined cognitive-behavioral approaches with group sharing and support . Both interventions were found to be associated with improved quality of life ( CAM , P=0.008 ; St and ard , P=0.006 ) , decreased depression ( CAM , P=0.004 ; St and ard , P=0.02 ) , decreased anxiety ( CAM , P=0.0003 ; St and ard , P=0.02 ) and increased " spiritual well-being " ( CAM , P=002 ; St and ard , P=0.003 ) . Only the CAM group showed increases in measures of Spiritual Integration ( P=0.001 ) which were also significant between groups ( P=0.003 ) . The St and ard group was associated with decreased confusion ( P=0.01 ) and decreased helplessness/hopelessness ( P=0.01 ) , while the CAM group was associated with decreased avoidance ( P=0.01 ) . None of these latter changes were significant between groups . At baseline , very high correlations were noted between measures of quality of life , mood , and spiritual integration . At the end of the intervention , the CAM group showed higher satisfaction ( P=0.006 ) and fewer dropouts ( P=0.006 ) compared to the st and ard group . Better outcomes in quality of life in the CAM group were associated with lower initial fighting spirit ( r=-.39 , P=0.001 ) . No baseline factors predicted better outcomes in the St and ard group . In summary , the study found equivalence on most psychosocial outcomes between the two interventions We examined the long-term effects of a behavioral intervention on the psychological distress of patients recently diagnosed with localized cancer , who were being treated at Hadassah University Hospital . All 116 patients who met the inclusion criteria ( 49 men and 67 women ) were r and omized into an intervention group and a control group on a 3:1 basis . The intervention chosen was Progressive Muscle Relaxation with Guided Imagery , which is intended to decrease psychological distress and increase the patient 's sense of internal control . The Brief Symptom Inventory ( BSI ) and the Impact of Events Scale ( IES ) were used to assess psychological distress within 1 month of diagnosis , 3 months later ( shortly before starting intervention ) , and 6 months after the end of the intervention . At the final assessment , the effect of the  behavioral intervention  on psychological distress was positive . The effect was relatively modest but statistically significant when assessed in terms of the Global Severity Index ( GSI ) ( a decrease of 2.3 points in the GSI of the treatment group as compared to an increase of 1.2 points in the GSI of the control group P=.005 ) . Despite these moderately positive findings , we suggest that the results might be more meaningful if cancer patients are first screened for psychological distress to exclude those with a low distress level that does not justify intervention , and only then r and omized for participation in the study This article reports the results of an 18-month study of immune system and psychological changes in stage 1 breast cancer patients provided with relaxation , guided imagery , and biofeedback training .  Thirteen lymph node negative patients who had recovered from a modified radical mastectomy were r and omly assigned to either an immediate treatment or a delayed treatment control group . Multiple pre-post psychological measures were performed . Significant effects were found in natural killer cell ( NK ) activity ( p<.017 ) , mixed lymphocyte responsiveness ( MLR ) ( p<.001 ) , concanavalin A ( Con-A ) responsiveness ( p<.001 ) , and the number of peripheral blood lymphocytes ( PBL ) ( p<.01 ) . No significant psychological changes were detected ; however , reductions were seen in psychological inventory scales measuring anxiety . The results show that behavioral interventions can be correlated with immune system measures , thereby replicating the results of an earlier pilot study from our Center . Discussion is provided on differential T-cell and B-cell responsiveness to behavioral interventions The value of a brief , preoperative hypnosis experience was explored with a sample of 36 head and neck cancer surgery patients . 15 patients volunteered for the experimental hypnosis intervention . 21 patients who received usual care ( no hypnosis )  were followed through their hospital charts and were used as a comparison group . Hypnotic intervention and usual care groups were comparable in terms of relevant demographic variables . Postoperative hospitalizations for the hypnotic intervention group were significantly shorter than for the usual care group . Within the hypnotic intervention group , hypnotizability was negatively correlated with surgical complications and there was a trend toward a negative correlation between hypnotizability and blood loss during surgery . Findings suggest that imagery-hypnosis may be prophylactic , benefitting patients by reducing the probability of postoperative complications and thereby keeping hospital stay within the expected range . Recommendations are presented for a controlled , r and omized , clinical trial with a sufficiently large sample to provide the opportunity for statistical analysis with appropriate power This psychoneuroimmunological study examined the effects of visualization , or mental imagery , on immune system response , specifically , on depressed  white blood cell ( WBC ) count in 20 medical patients . Subjects were 10 females and 10 males and included medical patients diagnosed with cancer , AIDS , viral infections , and other medical problems associated with depressed WBC count .  Results indicated significant increases in WBC count for all patients over a 90-day period , after a predicted initial decrease in WBC count . No significant age or sex differences were found Sixty cancer chemotherapy patients were r and omly assigned to one of four treatments : ( a ) relaxation training with guided relaxation imagery ( RT ) , ( b ) general coping preparation package ( PREP ) , ( c ) both RT and PREP , or ( d ) routine clinic treatment only . All patients were assessed on self-report , nurse observation , family observation , and physiological measures and were followed for five sequential chemotherapy treatments . Results indicate that the PREP intervention increased patients ' knowledge of the disease and its treatment , reduced anticipatory side effects , reduced negative affect , and improved general coping . RT patients showed some decrease in negative affect and vomiting , but not as great as in past studies . The data suggest that a relatively simple , one-session coping preparation intervention can reduce many different types of distress associated with cancer chemotherapy and may be more effective than often-used behavioral relaxation procedures Cancer patients who had developed negative conditioned responses to their chemotherapy  either did ( relaxation training ) or did not ( no relaxation training ) receive progressive muscle relaxation training and guided relaxation imagery instructions immediately before and during their chemotherapy treatments .  Physiological ( blood pressure and pulse rate ) measures of arousal , frequency of vomiting , and patient-reported and nurse-reported indices of negative affect and nausea were collected during pretraining , training , and posttraining chemotherapy sessions . Results indicated that during both the training and the posttraining sessions , patients in the relaxation training condition reported feeling less emotionally distressed and nauseated , and showed less physiological arousal following the chemotherapy infusion , than patients in the no relaxation training condition . The attending nurses ' observations confirmed the patients ' self-reports . No differences were found in frequency of vomiting between conditions . These data clearly suggest that the use of relaxation procedures may be an effective means of reducing several of the adverse side effects of cancer chemotherapy Patients who undergo surgery usually experience fear and apprehension about their surgical procedures . Guided imagery is a simple , low-cost therapeutic tool that can help counteract surgical patients ' fear and anxiety . The authors r and omly assigned 130 patients undergoing elective colorectal surgical procedures into two groups . Members of one group received routine perioperative care . Members of the other group listened to guided imagery tapes for three days before their surgical procedures , during anesthesia induction , intraoperatively , in the postanesthesia care unit , and for six days after surgery . The authors measured patients ' anxiety levels , pain perceptions , and narcotic medication requirements . The patients in the guided imagery group experienced considerably less preoperative and postoperative anxiety and pain , and they required almost 50 % less narcotic medications after their surgical procedures than patients in the control group A community-based nursing study was conducted in Sydney , Australia , to compare the effects of progressive muscle relaxation and guided imagery on anxiety , depression , and quality of life in people with advanced cancer . In this study , 56 people with advanced cancer who were experiencing anxiety and depression were r and omly assigned to 1 of 4 treatment 
    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: Cancer patients continue to experience elevated levels of emotional distress , even after cancer treatment . Elevated emotional distress negatively impacts immune and endocrine functions and decreases life quality . This study explored the effectiveness of GIM in alleviating mood disturbance and improving quality of life in cancer patients . Eight volunteers with a cancer history were r and omly assigned to either an experimental or a wait-list control group . Experimental subjects individually participated in 10 weekly GIM sessions . All subjects completed the Profile of Mood States ( POMS ) and Quality of Life-Cancer ( QOL-CA ) question naires pretest , posttest , and at a 6-week follow-up . Individuals who participated in GIM sessions scored better on both mood scores and quality of life scores at posttest than those participating in the control group . Additionally , mood and quality of life scores continued to improve in the experimental group , even after sessions were complete . Results indicate that GIM was effective in improving mood and quality of life in these cancer patients & NA ; Few controlled clinical trials of psychological interventions for cancer pain relief exist in spite of frequent support for their importance as adjuncts to medical treatment . This study compared oral mucositis pain levels in 4 groups of cancer patients receiving bone marrow transplants ( BMT ) : ( 1 ) treatment as usual control , ( 2 ) therapist support , ( 3 ) relaxation and imagery training , and ( 4 ) training in a package of cognitive‐behavioral coping skills which included relaxation and imagery . A total of 94 patients completed the study which involved two training sessions prior to treatment and twice a week ‘ booster ’ sessions during the first 5 weeks of treatment . Results confirmed our hypothesis that patients who received either relaxation and imagery alone or patients who received the package of cognitive‐behavioral coping skills would report less pain than patients in the other 2 groups . The hypothesis that the cognitive‐behavioral skills package would have an additive effect beyond relaxation and imagery alone was not confirmed . Average visual analogue scale ( VAS ) report of pain within the therapist support group was not significantly lower than the control group ( P = 0.103 ) nor significantly higher than the training groups . Patient reports of relative helpfulness of the interventions for managing pain and nausea matched the results of VAS reports . From these results , we conclude that relaxation and imagery training reduces cancer treatment‐related pain ; adding cognitive‐behavioral skills to the relaxation with imagery does not , on average , further improve pain relief The purpose of this study was to determine if the addition of guided imagery to a st and ard antiemetic regimen decreased nausea , vomiting , and retching occurrence and distress in patients receiving cisplatin-based chemotherapy . A convenience sample of patients ( N = 28 ) was selected from an oncologist 's patient population and r and omized into two groups . Both groups received the same st and ard antiemetic regimen , while the experimental group additionally used a chemotherapy-specific guided-imagery audiotape . The Rhodes Index of Nausea and Vomiting Form 2 was used to measure the nausea and vomiting experience . Findings revealed no statistically significant difference in this measurement between the two groups when measured at five different times during chemotherapy administration . The Chemotherapy Experience Survey was used to evaluate the participants ' overall perceptions of the  chemotherapy  experience . The guided-imagery group expressed a significantly more positive experience ( p = 0.0001 ) with chemotherapy . These findings have definite implication s for developing effective nursing interventions to promote patient involvement in self-care practice s and to increase patient coping abilities during symptom occurrence PURPOSE / OBJECTIVES To measure the effectiveness of customized guided imagery for increasing comfort in women with early stage breast cancer . DESIGN Experimental longitudinal , r and om assignment to groups . SETTING Two urban radiation oncology departments . SAMPLE 53 women ( 26 in the experimental group , 27 in the control group ) aged 37 - 81 ; 80 % European and 10 % African American with stage I or II breast cancer about to begin radiation therapy . METHODS The experimental group was to listen to a guided imagery audiotape once a day for the duration of the study . The  Radiation Therapy Comfort Question naire was self-administered at three time points : prior to the introduction of intervention and the beginning of radiation therapy ( Time 1 ) , three weeks later ( Time 2 ) , and three weeks after completing radiation therapy ( Time 3 ) . The  State Anxiety Inventory  was administered at Time 1 only . MAIN RESEARCH VARIABLES The effect of use of guided imagery on comfort with anxiety as a control variable . FINDINGS Pooled data indicated a significant overall increase in differences in comfort between the treatment and control group , with the treatment group having higher comfort over time . The data also revealed a significant linear trend in differences between groups . No significant interaction of group and time existed . CONCLUSIONS Guided imagery is an effective intervention for enhancing comfort of women undergoing radiation therapy for early stage breast cancer . The intervention was especially salient in the first three weeks of therapy . IMPLICATION S FOR NURSING PRACTICE Guided imagery audiotapes specifically design ed for this population were re source effective in terms of cost , personnel , and time Increasing numbers of women with breast cancer are seeking alternatives to st and ard group support in coping with their illness . This study examines outcomes for 181 women with breast cancer r and omized to either a 12-week st and ard group support or a 12-week complementary and alternative medicine ( CAM ) support intervention .  Participants in the CAM group were taught the use of meditation , affirmation , imagery and ritual . The st and ard group combined cognitive-behavioral approaches with group sharing and support . Both interventions were found to be associated with improved quality of life ( CAM , P=0.008 ; St and ard , P=0.006 ) , decreased depression ( CAM , P=0.004 ; St and ard , P=0.02 ) , decreased anxiety ( CAM , P=0.0003 ; St and ard , P=0.02 ) and increased " spiritual well-being " ( CAM , P=002 ; St and ard , P=0.003 ) . Only the CAM group showed increases in measures of Spiritual Integration ( P=0.001 ) which were also significant between groups ( P=0.003 ) . The St and ard group was associated with decreased confusion ( P=0.01 ) and decreased helplessness/hopelessness ( P=0.01 ) , while the CAM group was associated with decreased avoidance ( P=0.01 ) . None of these latter changes were significant between groups . At baseline , very high correlations were noted between measures of quality of life , mood , and spiritual integration . At the end of the intervention , the CAM group showed higher satisfaction ( P=0.006 ) and fewer dropouts ( P=0.006 ) compared to the st and ard group . Better outcomes in quality of life in the CAM group were associated with lower initial fighting spirit ( r=-.39 , P=0.001 ) . No baseline factors predicted better outcomes in the St and ard group . In summary , the study found equivalence on most psychosocial outcomes between the two interventions We examined the long-term effects of a behavioral intervention on the psychological distress of patients recently diagnosed with localized cancer , who were being treated at Hadassah University Hospital . All 116 patients who met the inclusion criteria ( 49 men and 67 women ) were r and omized into an intervention group and a control group on a 3:1 basis . The intervention chosen was Progressive Muscle Relaxation with Guided Imagery , which is intended to decrease psychological distress and increase the patient 's sense of internal control . The Brief Symptom Inventory ( BSI ) and the Impact of Events Scale ( IES ) were used to assess psychological distress within 1 month of diagnosis , 3 months later ( shortly before starting intervention ) , and 6 months after the end of the intervention . At the final assessment , the effect of the  behavioral intervention  on psychological distress was positive . The effect was relatively modest but statistically significant when assessed in terms of the Global Severity Index ( GSI ) ( a decrease of 2.3 points in the GSI of the treatment group as compared to an increase of 1.2 points in the GSI of the control group P=.005 ) . Despite these moderately positive findings , we suggest that the results might be more meaningful if cancer patients are first screened for psychological distress to exclude those with a low distress level that does not justify intervention , and only then r and omized for participation in the study This article reports the results of an 18-month study of immune system and psychological changes in stage 1 breast cancer patients provided with relaxation , guided imagery , and biofeedback training .  Thirteen lymph node negative patients who had recovered from a modified radical mastectomy were r and omly assigned to either an immediate treatment or a delayed treatment control group . Multiple pre-post psychological measures were performed . Significant effects were found in natural killer cell ( NK ) activity ( p<.017 ) , mixed lymphocyte responsiveness ( MLR ) ( p<.001 ) , concanavalin A ( Con-A ) responsiveness ( p<.001 ) , and the number of peripheral blood lymphocytes ( PBL ) ( p<.01 ) . No significant psychological changes were detected ; however , reductions were seen in psychological inventory scales measuring anxiety . The results show that behavioral interventions can be correlated with immune system measures , thereby replicating the results of an earlier pilot study from our Center . Discussion is provided on differential T-cell and B-cell responsiveness to behavioral interventions The value of a brief , preoperative hypnosis experience was explored with a sample of 36 head and neck cancer surgery patients . 15 patients volunteered for the experimental hypnosis intervention . 21 patients who received usual care ( no hypnosis )  were followed through their hospital charts and were used as a comparison group . Hypnotic intervention and usual care groups were comparable in terms of relevant demographic variables . Postoperative hospitalizations for the hypnotic intervention group were significantly shorter than for the usual care group . Within the hypnotic intervention group , hypnotizability was negatively correlated with surgical complications and there was a trend toward a negative correlation between hypnotizability and blood loss during surgery . Findings suggest that imagery-hypnosis may be prophylactic , benefitting patients by reducing the probability of postoperative complications and thereby keeping hospital stay within the expected range . Recommendations are presented for a controlled , r and omized , clinical trial with a sufficiently large sample to provide the opportunity for statistical analysis with appropriate power This psychoneuroimmunological study examined the effects of visualization , or mental imagery , on immune system response , specifically , on depressed  white blood cell ( WBC ) count in 20 medical patients . Subjects were 10 females and 10 males and included medical patients diagnosed with cancer , AIDS , viral infections , and other medical problems associated with depressed WBC count .  Results indicated significant increases in WBC count for all patients over a 90-day period , after a predicted initial decrease in WBC count . No significant age or sex differences were found Sixty cancer chemotherapy patients were r and omly assigned to one of four treatments : ( a ) relaxation training with guided relaxation imagery ( RT ) , ( b ) general coping preparation package ( PREP ) , ( c ) both RT and PREP , or ( d ) routine clinic treatment only . All patients were assessed on self-report , nurse observation , family observation , and physiological measures and were followed for five sequential chemotherapy treatments . Results indicate that the PREP intervention increased patients ' knowledge of the disease and its treatment , reduced anticipatory side effects , reduced negative affect , and improved general coping . RT patients showed some decrease in negative affect and vomiting , but not as great as in past studies . The data suggest that a relatively simple , one-session coping preparation intervention can reduce many different types of distress associated with cancer chemotherapy and may be more effective than often-used behavioral relaxation procedures Cancer patients who had developed negative conditioned responses to their chemotherapy  either did ( relaxation training ) or did not ( no relaxation training ) receive progressive muscle relaxation training and guided relaxation imagery instructions immediately before and during their chemotherapy treatments .  Physiological ( blood pressure and pulse rate ) measures of arousal , frequency of vomiting , and patient-reported and nurse-reported indices of negative affect and nausea were collected during pretraining , training , and posttraining chemotherapy sessions . Results indicated that during both the training and the posttraining sessions , patients in the relaxation training condition reported feeling less emotionally distressed and nauseated , and showed less physiological arousal following the chemotherapy infusion , than patients in the no relaxation training condition . The attending nurses ' observations confirmed the patients ' self-reports . No differences were found in frequency of vomiting between conditions . These data clearly suggest that the use of relaxation procedures may be an effective means of reducing several of the adverse side effects of cancer chemotherapy Patients who undergo surgery usually experience fear and apprehension about their surgical procedures . Guided imagery is a simple , low-cost therapeutic tool that can help counteract surgical patients ' fear and anxiety . The authors r and omly assigned 130 patients undergoing elective colorectal surgical procedures into two groups . Members of one group received routine perioperative care . Members of the other group listened to guided imagery tapes for three days before their surgical procedures , during anesthesia induction , intraoperatively , in the postanesthesia care unit , and for six days after surgery . The authors measured patients ' anxiety levels , pain perceptions , and narcotic medication requirements . The patients in the guided imagery group experienced considerably less preoperative and postoperative anxiety and pain , and they required almost 50 % less narcotic medications after their surgical procedures than patients in the control group A community-based nursing study was conducted in Sydney , Australia , to compare the effects of progressive muscle relaxation and guided imagery on anxiety , depression , and quality of life in people with advanced cancer . In this study , 56 people with advanced cancer who were experiencing anxiety and depression were r and omly assigned to 1 of 4 treatment 
    Output:
    