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: PURPOSE / OBJECTIVES To test the hypotheses that the effects of a music intervention are greater than those of simple distraction and that either intervention is better at controlling procedural pain and anxiety than treatment as usual . DESIGN R and omized , controlled experiment . SETTING A midwestern comprehensive cancer center . SAMPLE 60 people with cancer having noxious medical procedures such as tissue biopsy or port placement or removal ; 58 provided usable data . METHODS Participants completed measures of pain and anxiety before and after their medical procedures and provided a rating of perceived control over pain and anxiety after the procedure . MAIN RESEARCH VARIABLES Procedural pain , state anxiety , and perceived control over pain and anxiety . FINDINGS Contrary to hypotheses , outcomes achieved with music did not differ from those achieved with simple distraction . Moreover , outcomes achieved under treatment as usual were not significantly different from those obtained with music or distraction interventions . Some patients found that the interventions were bothersome and reported that they wanted to attend to the activities of the surgeon and the medical procedure itself . CONCLUSIONS The effects of music , distraction , and treatment as usual are equivocal . In addition , patients have individual preferences for use of distraction during painful or anxiety-provoking procedures . IMPLICATION S FOR NURSING Patients having noxious medical procedures should be asked about their desire to be distracted before and during the procedure and offered a strategy that is consistent with their preferences Purpose Intravenous cannulation is a painful and stressful procedure . The objective of this study was to compare the analgesic efficacy of the eutectic mixture of local anesthetics ( EMLA ® ) with that of the Valsalva maneuver in adult patients during i.v . cannulation . Methods One hundred ninety-five patients were r and omized prospect ively to three groups . The dorsum of the nondominant h and was covered with a thick paste of 2.5 g of EMLA ® cream in the EMLA ® group ( group E ) and left for a minimum of 30 min before venipuncture . In the control group ( group C ) , the same procedure was applied except that Vaseline ® was used instead of the EMLA ® . The Valsalva group ( group V ) were punctured during a Valsalva maneuver . The patients were placed in the supine position during venipuncture . The patients then scored the amount of pain on cannulation using an 11-point numerical rating scale ( NRS ; 0 = no pain , 10 = extreme pain ) . Results Thirteen patients were excluded from the analysis due to failed cannulation . There was no difference in the demographic profiles of the groups ( p > 0.05 ) . The success of VP was significantly higher in group V than in groups E and C ( p < 0.001 ) . The median pain score as assessed by the NRS after venipuncture in group C was 3 ( range 0–9 ) , whereas the median pain values in groups E and V were 2 ( range 0–7 ) and 2 ( range 1–8 ) . Conclusions The Valsalva maneuver yields similar results to the EMLA ® in terms of pain reduction during venipuncture Background : This systematic review evaluated the effectiveness of psychological interventions for reducing vaccination pain and related outcomes in children and adolescents . Design / Methods : Data base search es identified relevant r and omized and quasi-r and omized controlled trials . Data were extracted and pooled using established methods . Pain , fear , and distress were considered critically important outcomes . Results : Twenty-two studies were included ; 2 included adolescents . Findings showed no benefit of false suggestion ( n=240 ) for pain ( st and ardized mean difference [ SMD ] −0.21 [ −0.47 , 0.05 ] ) or distress ( SMD −0.28 [ −0.59 , 0.11 ] ) , or for use of repeated reassurance ( n=82 ) for pain ( SMD −0.18 [ −0.92 , 0.56 ] ) , fear ( SMD −0.18 [ −0.71 , 0.36 ] ) , or distress ( SMD 0.10 [ −0.33 , 0.54 ] ) . Verbal distraction ( n=46 ) showed reduced distress ( SMD −1.22 [ −1.87 , −0.58 ] ) , but not reduced pain ( SMD −0.27 [ −1.02 , 0.47 ] ) . Similarly , video distraction ( n=328 ) showed reduced distress ( SMD −0.58 [ −0.82 , −0.34 ] ) , but not reduced pain ( SMD −0.88 [ −1.78 , 0.02 ] ) or fear ( SMD 0.08 [ −0.25 , 0.41 ] ) . Music distraction demonstrated reduced pain when used with children ( n=417 ) ( SMD −0.45 [ −0.71 , −0.18 ] ) , but not with adolescents ( n=118 ) ( SMD −0.04 [ −0.42 , 0.34 ] ) . Breathing with a toy ( n=368 ) showed benefit for pain ( SMD −0.49 [ −0.85 , −0.13 ] ) , but not fear ( SMD −0.60 [ −1.22 , 0.02 ] ) ; whereas breathing without a toy ( n=136 ) showed no benefit for pain ( SMD −0.27 [ −0.61 , 0.07 ] ) or fear ( SMD −0.36 [ −0.86 , 0.15 ] ) . There was no benefit for a breathing intervention ( cough ) in children and adolescents ( n=136 ) for pain ( SMD −0.17 [ −0.41 , 0.07 ] ) . Conclusions : Psychological interventions with some evidence of benefit in children include : verbal distraction , video distraction , music distraction , and breathing with a toy & NA ; Patients are often prepared for procedural discomforts with descriptions of pain or undesirable experiences . This practice is thought to be compassionate and helpful , but there is little data on the effect of such communicative behavior . This study assesses how such descriptions affect patients ' pain and anxiety during medical procedures . The interactions of patients with their healthcare providers during interventional radiological procedures were videotaped during a previously reported 3‐arm prospect i ve r and omized trial assessing the efficacy of self‐hypnotic relaxation .  One hundred and fifty‐nine videos of the st and ard care and attention control arms were review ed . All statements that described painful or undesirable experiences as warning before potentially noxious stimuli or as expression of sympathy afterwards were recorded . Patients ' ratings of pain and anxiety on 0–10 numerical scales ( 0=No Pain , No Anxiety at All and 10=Worst Pain Possible , Terrified ) after the painful event and /or sympathizing statement were the basis for this study . Warning the patient in terms of pain or undesirable experiences result ed in greater pain ( P<0.05 ) and greater anxiety ( P<0.001 ) than not doing so . Sympathizing with the patient in such terms after a painful event did not increase reported pain , but result ed in greater anxiety ( P<0.05 ) . Contrary to common belief , warning or sympathizing using language that refers to negative experiences may not make patients feel better . This conclusion has implication s for the training in medical communication skills and suggests the need for r and omized trials testing different patient – practioner interactions OBJECTIVE : The goal was to investigate the effect of a “ cough trick ” technique on self-reported pain of children receiving routine immunizations . The strategy requires minimal equipment , time , or training for parents , children , and nursing staff members . METHODS : A r and omized , controlled , unblinded , within-subject study of 68 children receiving prekindergarten ( ages 4–5 ) or pre – junior high school ( ages 11–13 ) immunizations was performed . Participants were recruited from an outpatient pediatric clinic at a large public hospital in the Midwest . The strategy required a single “ warm-up ” cough of moderate force , followed by a second cough that coincided with needle puncture . The principle outcome was self-reported pain , although parent and nurse report of pain was used to support the accuracy of self-report . Older participants and all nurses completed a measure of their satisfaction with the procedure . RESULTS : In the initial analysis , the procedure was found not to be effective . However , post hoc tests revealed that the procedure was effective at a statistically and clinical ly significant level for participants identified as Hispanic white or non-Hispanic white but not for those identified as non-Hispanic black . Participants and clinic nurses found the procedure acceptable and effective . CONCLUSIONS : The results of this study suggest that the cough trick can be an effective strategy for the reduction of pain for some children undergoing routine immunizations . However , additional research is needed to clarify the observed moderation by self-identified race For the current issue of the Journal , we asked Drs Anna Taddio and C Meghan McMurtry to comment on and put into context the Cochrane Review on psychological interventions for needle-related procedural pain and distress in children and adolescents ( 1 ) . Background This review is an up date d version of the original Cochrane review published in Issue 4 , 2006 . Needle-related procedures are a common source of pain and distress for children . Our previous review on this topic indicated that several psychological interventions were efficacious in managing paediatric needle pain including distraction , hypnosis and combined cognitive behavioural interventions . Considerable additional research in the area has been published since that time . Methods Search strategy Search es of the following data bases were conducted for relevant r and omized controlled trials ( RCTs ): Cochrane Central Register of Controlled Trials ( CENTRAL ) ; MEDLINE ; EMBASE ; PsycINFO ; the Cumulative Index to Nursing and Allied Health Literature ( CINAHL ) ; and Web of Science . Requests for relevant studies were also posted on various electronic list servers . An up date d search was conducted in March 2012 and again in March 2013 . Selection criteria Participants included children and adolescents two to 19 years of age undergoing needle-related procedures . Only RCTs with ≥5 participants in each study arm comparing a psychological intervention group with a control or comparison group were eligible for inclusion . Data analysis Two review authors extracted data and assessed trial quality , and a third author helped with data extraction and coding for one non-English study . Included studies were coded for quality using the Cochrane Risk of bias tool . St and ardized mean differences with 95 % CIs were calculated for all analyses using Review Manager version 5.2 . Results Thirty-nine trials with a total of 3394 participants were included . The most commonly studied needle-related procedures were veni-puncture , intravenous line insertion and immunization .  Studies included children two to 19 years of age , with the most evidence available for children < 12 years of age . Consistent with the original review , the most commonly studied psychological interventions for needle procedures were distraction , hypnosis and cognitive behavioural therapy ( CBT ) . The majority of included studies ( 19 of 39 ) examined distraction only . The additional studies from this review up date continued to provide strong evidence for the efficacy  of distraction and hypnosis . No evidence was available to support the efficacy of preparation and information , combined CBT ( ≥2 cognitive or behavioural strategies combined ) , parent coaching plus distraction , suggestion or virtual reality for reducing children ’s pain and distress . No conclusions could be drawn about interventions of memory alteration , parent positioning plus distraction , blowing out air or distraction plus suggestion because evidence was available from single studies only . In addition , the risk of bias scores indicated several domains with high or unclear bias scores ( eg , selection , detection and performance bias ) , suggesting that the method ological rigour and reporting of RCTs of psychological interventions continue to exhibit considerable room for improvement . Conclusions Overall , there is strong evidence supporting the efficacy of distraction and hypnosis for needle-related pain and distress in children and adolescents , with no evidence currently available for preparation and information or both , combined CBT , parent coaching plus distraction , suggestion or virtual reality . Additional research is needed to further assess interventions that have only been investigated in one RCT to date ( ie , memory alteration , parent positioning plus distraction , blowing out air and distraction plus suggestion ) . There are continuing issues with the quality of trials examining psychological interventions for needle-related pain and distress . The full text of the Cochrane Review is available in The Cochrane Library ( 1 ) BACKGROUND Clinicians frequently warn patients of discomfort before potentially painful procedures , despite the lack of evidence that such communications are helpful . We aim ed to compare two communications ( one with , and the other without , a warning of a ' sting ' ) immediately before i.v . cannulation in order to measure differences in perceived pain by patients during the procedure . METHODS R and omly assigned patients awaiting elective surgery received a communication immediately before i.v . cannulation consisting of either ' I am going to apply the tourniquet and insert the needle in a few moments . It 's a sharp scratch and it may sting a little ' ( Group S ) or ' I am going to apply the tourniquet on the arm . As I do this many people find the arm becomes heavy , numb and tingly . This allows the drip to be placed more comfortably ' ( Group NS ) . Cannulation pain was measured by a 0 - 10 verbal numerical rating score ( VNRS ) and five-point Likert scale . RESULTS Of 101 participants , 49 were allocated to Group S and 52 to Group NS .  Median VNRS pain scores with inter-quartile ranges ( IQR ) were 1 and 2 , respectively , for both groups . Median Likert scores were 3 in Group S and 2 in Group NS with an IQR of 1 for both groups ( P = 0.13 ) . Six participants vocalized pain in Group S and none in 
    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: PURPOSE / OBJECTIVES To test the hypotheses that the effects of a music intervention are greater than those of simple distraction and that either intervention is better at controlling procedural pain and anxiety than treatment as usual . DESIGN R and omized , controlled experiment . SETTING A midwestern comprehensive cancer center . SAMPLE 60 people with cancer having noxious medical procedures such as tissue biopsy or port placement or removal ; 58 provided usable data . METHODS Participants completed measures of pain and anxiety before and after their medical procedures and provided a rating of perceived control over pain and anxiety after the procedure . MAIN RESEARCH VARIABLES Procedural pain , state anxiety , and perceived control over pain and anxiety . FINDINGS Contrary to hypotheses , outcomes achieved with music did not differ from those achieved with simple distraction . Moreover , outcomes achieved under treatment as usual were not significantly different from those obtained with music or distraction interventions . Some patients found that the interventions were bothersome and reported that they wanted to attend to the activities of the surgeon and the medical procedure itself . CONCLUSIONS The effects of music , distraction , and treatment as usual are equivocal . In addition , patients have individual preferences for use of distraction during painful or anxiety-provoking procedures . IMPLICATION S FOR NURSING Patients having noxious medical procedures should be asked about their desire to be distracted before and during the procedure and offered a strategy that is consistent with their preferences Purpose Intravenous cannulation is a painful and stressful procedure . The objective of this study was to compare the analgesic efficacy of the eutectic mixture of local anesthetics ( EMLA ® ) with that of the Valsalva maneuver in adult patients during i.v . cannulation . Methods One hundred ninety-five patients were r and omized prospect ively to three groups . The dorsum of the nondominant h and was covered with a thick paste of 2.5 g of EMLA ® cream in the EMLA ® group ( group E ) and left for a minimum of 30 min before venipuncture . In the control group ( group C ) , the same procedure was applied except that Vaseline ® was used instead of the EMLA ® . The Valsalva group ( group V ) were punctured during a Valsalva maneuver . The patients were placed in the supine position during venipuncture . The patients then scored the amount of pain on cannulation using an 11-point numerical rating scale ( NRS ; 0 = no pain , 10 = extreme pain ) . Results Thirteen patients were excluded from the analysis due to failed cannulation . There was no difference in the demographic profiles of the groups ( p > 0.05 ) . The success of VP was significantly higher in group V than in groups E and C ( p < 0.001 ) . The median pain score as assessed by the NRS after venipuncture in group C was 3 ( range 0–9 ) , whereas the median pain values in groups E and V were 2 ( range 0–7 ) and 2 ( range 1–8 ) . Conclusions The Valsalva maneuver yields similar results to the EMLA ® in terms of pain reduction during venipuncture Background : This systematic review evaluated the effectiveness of psychological interventions for reducing vaccination pain and related outcomes in children and adolescents . Design / Methods : Data base search es identified relevant r and omized and quasi-r and omized controlled trials . Data were extracted and pooled using established methods . Pain , fear , and distress were considered critically important outcomes . Results : Twenty-two studies were included ; 2 included adolescents . Findings showed no benefit of false suggestion ( n=240 ) for pain ( st and ardized mean difference [ SMD ] −0.21 [ −0.47 , 0.05 ] ) or distress ( SMD −0.28 [ −0.59 , 0.11 ] ) , or for use of repeated reassurance ( n=82 ) for pain ( SMD −0.18 [ −0.92 , 0.56 ] ) , fear ( SMD −0.18 [ −0.71 , 0.36 ] ) , or distress ( SMD 0.10 [ −0.33 , 0.54 ] ) . Verbal distraction ( n=46 ) showed reduced distress ( SMD −1.22 [ −1.87 , −0.58 ] ) , but not reduced pain ( SMD −0.27 [ −1.02 , 0.47 ] ) . Similarly , video distraction ( n=328 ) showed reduced distress ( SMD −0.58 [ −0.82 , −0.34 ] ) , but not reduced pain ( SMD −0.88 [ −1.78 , 0.02 ] ) or fear ( SMD 0.08 [ −0.25 , 0.41 ] ) . Music distraction demonstrated reduced pain when used with children ( n=417 ) ( SMD −0.45 [ −0.71 , −0.18 ] ) , but not with adolescents ( n=118 ) ( SMD −0.04 [ −0.42 , 0.34 ] ) . Breathing with a toy ( n=368 ) showed benefit for pain ( SMD −0.49 [ −0.85 , −0.13 ] ) , but not fear ( SMD −0.60 [ −1.22 , 0.02 ] ) ; whereas breathing without a toy ( n=136 ) showed no benefit for pain ( SMD −0.27 [ −0.61 , 0.07 ] ) or fear ( SMD −0.36 [ −0.86 , 0.15 ] ) . There was no benefit for a breathing intervention ( cough ) in children and adolescents ( n=136 ) for pain ( SMD −0.17 [ −0.41 , 0.07 ] ) . Conclusions : Psychological interventions with some evidence of benefit in children include : verbal distraction , video distraction , music distraction , and breathing with a toy & NA ; Patients are often prepared for procedural discomforts with descriptions of pain or undesirable experiences . This practice is thought to be compassionate and helpful , but there is little data on the effect of such communicative behavior . This study assesses how such descriptions affect patients ' pain and anxiety during medical procedures . The interactions of patients with their healthcare providers during interventional radiological procedures were videotaped during a previously reported 3‐arm prospect i ve r and omized trial assessing the efficacy of self‐hypnotic relaxation .  One hundred and fifty‐nine videos of the st and ard care and attention control arms were review ed . All statements that described painful or undesirable experiences as warning before potentially noxious stimuli or as expression of sympathy afterwards were recorded . Patients ' ratings of pain and anxiety on 0–10 numerical scales ( 0=No Pain , No Anxiety at All and 10=Worst Pain Possible , Terrified ) after the painful event and /or sympathizing statement were the basis for this study . Warning the patient in terms of pain or undesirable experiences result ed in greater pain ( P<0.05 ) and greater anxiety ( P<0.001 ) than not doing so . Sympathizing with the patient in such terms after a painful event did not increase reported pain , but result ed in greater anxiety ( P<0.05 ) . Contrary to common belief , warning or sympathizing using language that refers to negative experiences may not make patients feel better . This conclusion has implication s for the training in medical communication skills and suggests the need for r and omized trials testing different patient – practioner interactions OBJECTIVE : The goal was to investigate the effect of a “ cough trick ” technique on self-reported pain of children receiving routine immunizations . The strategy requires minimal equipment , time , or training for parents , children , and nursing staff members . METHODS : A r and omized , controlled , unblinded , within-subject study of 68 children receiving prekindergarten ( ages 4–5 ) or pre – junior high school ( ages 11–13 ) immunizations was performed . Participants were recruited from an outpatient pediatric clinic at a large public hospital in the Midwest . The strategy required a single “ warm-up ” cough of moderate force , followed by a second cough that coincided with needle puncture . The principle outcome was self-reported pain , although parent and nurse report of pain was used to support the accuracy of self-report . Older participants and all nurses completed a measure of their satisfaction with the procedure . RESULTS : In the initial analysis , the procedure was found not to be effective . However , post hoc tests revealed that the procedure was effective at a statistically and clinical ly significant level for participants identified as Hispanic white or non-Hispanic white but not for those identified as non-Hispanic black . Participants and clinic nurses found the procedure acceptable and effective . CONCLUSIONS : The results of this study suggest that the cough trick can be an effective strategy for the reduction of pain for some children undergoing routine immunizations . However , additional research is needed to clarify the observed moderation by self-identified race For the current issue of the Journal , we asked Drs Anna Taddio and C Meghan McMurtry to comment on and put into context the Cochrane Review on psychological interventions for needle-related procedural pain and distress in children and adolescents ( 1 ) . Background This review is an up date d version of the original Cochrane review published in Issue 4 , 2006 . Needle-related procedures are a common source of pain and distress for children . Our previous review on this topic indicated that several psychological interventions were efficacious in managing paediatric needle pain including distraction , hypnosis and combined cognitive behavioural interventions . Considerable additional research in the area has been published since that time . Methods Search strategy Search es of the following data bases were conducted for relevant r and omized controlled trials ( RCTs ): Cochrane Central Register of Controlled Trials ( CENTRAL ) ; MEDLINE ; EMBASE ; PsycINFO ; the Cumulative Index to Nursing and Allied Health Literature ( CINAHL ) ; and Web of Science . Requests for relevant studies were also posted on various electronic list servers . An up date d search was conducted in March 2012 and again in March 2013 . Selection criteria Participants included children and adolescents two to 19 years of age undergoing needle-related procedures . Only RCTs with ≥5 participants in each study arm comparing a psychological intervention group with a control or comparison group were eligible for inclusion . Data analysis Two review authors extracted data and assessed trial quality , and a third author helped with data extraction and coding for one non-English study . Included studies were coded for quality using the Cochrane Risk of bias tool . St and ardized mean differences with 95 % CIs were calculated for all analyses using Review Manager version 5.2 . Results Thirty-nine trials with a total of 3394 participants were included . The most commonly studied needle-related procedures were veni-puncture , intravenous line insertion and immunization .  Studies included children two to 19 years of age , with the most evidence available for children < 12 years of age . Consistent with the original review , the most commonly studied psychological interventions for needle procedures were distraction , hypnosis and cognitive behavioural therapy ( CBT ) . The majority of included studies ( 19 of 39 ) examined distraction only . The additional studies from this review up date continued to provide strong evidence for the efficacy  of distraction and hypnosis . No evidence was available to support the efficacy of preparation and information , combined CBT ( ≥2 cognitive or behavioural strategies combined ) , parent coaching plus distraction , suggestion or virtual reality for reducing children ’s pain and distress . No conclusions could be drawn about interventions of memory alteration , parent positioning plus distraction , blowing out air or distraction plus suggestion because evidence was available from single studies only . In addition , the risk of bias scores indicated several domains with high or unclear bias scores ( eg , selection , detection and performance bias ) , suggesting that the method ological rigour and reporting of RCTs of psychological interventions continue to exhibit considerable room for improvement . Conclusions Overall , there is strong evidence supporting the efficacy of distraction and hypnosis for needle-related pain and distress in children and adolescents , with no evidence currently available for preparation and information or both , combined CBT , parent coaching plus distraction , suggestion or virtual reality . Additional research is needed to further assess interventions that have only been investigated in one RCT to date ( ie , memory alteration , parent positioning plus distraction , blowing out air and distraction plus suggestion ) . There are continuing issues with the quality of trials examining psychological interventions for needle-related pain and distress . The full text of the Cochrane Review is available in The Cochrane Library ( 1 ) BACKGROUND Clinicians frequently warn patients of discomfort before potentially painful procedures , despite the lack of evidence that such communications are helpful . We aim ed to compare two communications ( one with , and the other without , a warning of a ' sting ' ) immediately before i.v . cannulation in order to measure differences in perceived pain by patients during the procedure . METHODS R and omly assigned patients awaiting elective surgery received a communication immediately before i.v . cannulation consisting of either ' I am going to apply the tourniquet and insert the needle in a few moments . It 's a sharp scratch and it may sting a little ' ( Group S ) or ' I am going to apply the tourniquet on the arm . As I do this many people find the arm becomes heavy , numb and tingly . This allows the drip to be placed more comfortably ' ( Group NS ) . Cannulation pain was measured by a 0 - 10 verbal numerical rating score ( VNRS ) and five-point Likert scale . RESULTS Of 101 participants , 49 were allocated to Group S and 52 to Group NS .  Median VNRS pain scores with inter-quartile ranges ( IQR ) were 1 and 2 , respectively , for both groups . Median Likert scores were 3 in Group S and 2 in Group NS with an IQR of 1 for both groups ( P = 0.13 ) . Six participants vocalized pain in Group S and none in 
    Output:
    