***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 double-blind study of 537 patients evaluated the relative efficacy of four drugs — chlordiazepoxide , chlorpromazine , hydroxyzine , and thiamine — commonly used in treating alcohol withdrawal symptoms , specifically to prevent delirium tremens and convulsions . Of the 55 patients who developed these symptoms , two percent were in the chlordiazepoxide group ; the incidence ranged from ten to 16 percent in the other treatment groups . The authors conclude that chlordiazepoxide appears to be the drug of choice among those tested Zuclopenthixol acetate — a new injectable formulation with a duration of action of 2–3 days — was compared with conventional intramuscular and oral formulations of haloperidol and zuclopenthixol in the initial treatment of acutely disturbed , psychotic patients . The patients were stratified into 3 diagnostic categories : acute psychoses ( 48 patients ) , mania ( 22 patients ) , and exacerbation of chronic psychoses ( 73 patients ) . The patients were rated on the Brief Psychiatric Rating Scale ( BPRS ) , the Bech‐Rafaelsen Mania Rating Scale ( brmas ) ( only manic patients ) and globally on the Clinical Global Impression ( CGI ) . The study was an open , r and omized multicentre trial with a 6‐day treatment period . The zuclopenthixol acetate patients received 1–4 doses , the haloperidol patients 1–26 and the zuclopenthixol patients 1–22 doses . The assessment s on the CGI showed that all 3 treatments caused a clear reduction of the severity of illness scores in all 3 diagnostic categories , with no differences between treatments . The ratings of the acute and chronic psychotic patients on the BPRS also showed significant reductions in scores with no differences between treatments . All 3 treatments caused a rapid remission of symptoms on the BRMAS .  Haloperidol  induced hypokinesia in significantly more patients than zuclopenthixol acetate after 24 h. Later there were no significant differences between treatments . Zuclopenthixol acetate fulfils many desires for an amended neuroleptic formulation for the initial treatment of acutely disturbed psychotic patients In an 18 hospital study , 205 patients hospitalized with a diagnosis of manic-depressive illness , manic type , were treated upon discharge with lithium carbonate or placebo for a two-year period . Lithium carbonate was significantly more effective than placebo in preventing relapses ( ie , affective episodes severe enough to require hospitalization or use of non study drugs ) . The difference in treatment outcome between lithium carbonate and placebo was due mainly to the lower incidence of manic relapses on lithium carbonate . Patients on lithium carbonate also had a lower incidence of depressive relapses than patients on placebo but the limited incidence of severe depression in this sample makes it difficult to draw any conclusions regarding the prophylactic efficacy of lithium carbonate in depressive illness . The results from this trial coupled with those from other studies indicate that lithium carbonate combined with regular clinical appraisal s is a safe and effective treatment for preventing relapse in manic-depressive illness The merits or otherwise of publishing hospital specific death rates are much debated . This article compares the relative sensitivity of measures of process and outcome to differences in quality of care for the hospital treatment of myocardial infa rct ion . Aspects of hospital care that have a proved impact on mortality from myocardial infa rct ion are identified , and the results from meta- analysis and large r and omised controlled trials are used to estimate the impact that optimal use of these interventions would have on mortality in a typical district general hospital . Sample size calculations are then performed to determine how many years of data would be needed to detect significant differences between hospitals . A comparison is then made with the amount of data that would be needed to detect significant differences if information about process of care was being collected . Process measures based on the results of r and omised controlled trials were found to be able to detect relevant differences between hospitals that would not be identified by comparing hospital specific mortality , which is an insensitive indicator of the quality of care Abstract Objectives : To estimate the proportion of interventions in general practice that are based on evidence from clinical trials and to assess the appropriateness of such an evaluation . Design : Retrospective review of case notes . Setting : One suburban training general practice . Subjects : 122 consecutive doctor-patient consultations over two days . Main outcome measures : Proportions of interventions based on r and omised controlled trials  ( from literature search with Medline , pharmaceutical data bases , and st and ard textbooks ) , on  convincing non-experimental evidence , and without substantial evidence . Results : 21 of the 122 consultations recorded were excluded due to insufficient data ; 31 of the interventions were based on r and omised controlled trial evidence and 51 based on convincing non-experimental evidence . Hence 82/101 ( 81 % ) of interventions were based on evidence meeting our criteria . Conclusions : Most interventions within general practice are based on evidence from clinical trials , but the methods used in such trials may not be the most appropriate to apply to this setting . Key messages Key messages 81 % of general practice can be described as evidence based using this method of assessment Evidence derived from different method ologies may be important for the assessment of the evidence base of general The phenylpiperidine derivative paroxetine is a selective serotonin reuptake inhibitor . In a double-blind 6-week trial , paroxetine was compared with amitriptyline in hospitalized patients suffering from major depression ( DSM-III ) . One hundred fifty-three patients were enrolled in the study in seven centers in Austria and Germany . Results showed similar efficacy of both drugs after 6 weeks . The differences between groups in Mont-gomery-Asberg Depression Rating Scale and Clinical Global Impression ratings did not reach statistical significance at any time . Side effects were distributed similarly but with a significantly higher incidence of anticholinergic effects in patients treated with amitriptyline ( p < 0.001 ) , whereas agitation and insomnia were registered more often in the paroxetine group . This study supports the antidepressive efficacy of paroxetine in a sample of severely depressed in patients BACKGROUND This study was design ed to establish whether ( as suggested in a number of open and relatively small controlled trials ) lithium augmentation is more effective than continued antidepressant alone , where response to a st and ard course of antidepressant treatment has been absent or partial . METHOD Lithium or placebo was added on a double-blind basis for six weeks to the drug regime of 62 patients with major depressive illness ( in both hospital and primary care setting s ) who had failed to respond to a controlled trial of fluoxetine or lofepramine .  Response was defined as a final Hamilton Depression Rating Scale ( HDRS ) score of < 10 . RESULTS Response was seen more frequently in patients taking lithium  ( 15/29 ) than in those remaining on antidepressant alone ( 8/32 ; P or = 0.4 mmol/l ) . No differences in the efficacy of  LA  were apparent between fluoxetine and lofepramine . CONCLUSIONS Our results confirm that LA is a useful strategy in the treatment of antidepressant-resistant depression . Partial response was , however , frequently observed with continued antidepressant treatment alone , and the superiority of LA appears to depend on achieving adequate serum lithium levels For many years clinicians have had to cope with the accusation that only 10 - 20 % of the treatments they provide have any scientific foundation . Their interventions , in other words , are seldom " evidence based " . Is the profession guilty as charged ? In April , 1995 , a general medical team at a university-affiliated district hospital in Oxford , UK , studied the treatments given to all 109 patients managed during that month on whom a diagnosis had been reached . Medical sources ( including data bases ) were then search ed for r and omised controlled trial ( RCT ) evidence that the treatments were effective . The 109 primary treatments were then classified : 82 % were evidence based ( ie , there was RCT support [ 53 % ] or unanimity on the team about the existence of convincing non-experimental evidence [ 29 % ] ) . This study , which needs to be repeated in other clinical setting s and for other disciplines , suggests that earlier pessimism over the extent to which evidence -based medicine is already practised is misplaced OBJECTIVE The purpose of this study was to investigate the safety and efficacy of risperidone in the treatment of schizophrenic patients and determine its optimal dose . METHOD This double-blind study included 388 schizophrenic patients drawn from 20 sites in the United States . Patients were r and omly assigned to 8 weeks ' treatment with placebo , one of four doses of risperidone ( 2 , 6 , 10 , or 16 mg ) , or 20 mg of haloperidol daily . RESULTS Clinical improvement ( 20 % reduction in total scores on the Positive and Negative Syndrome Scale for Schizophrenia ) at the study end point was shown by 35 % of the patients receiving 2 mg of risperidone , 57 % receiving 6 mg , 40 % receiving 10 mg , and 51 % receiving 16 mg ; and by 30 % receiving haloperidol and 22 % receiving placebo . Statistically significant differences in clinical improvement were found between 6 and 16 mg of risperidone versus placebo and versus haloperidol .  Positive symptom scores were significantly lower after 6 , 10 , and 16 mg of risperidone and 20 mg of haloperidol than placebo ;  negative symptom scores , however , were reduced significantly , compared with placebo , only after 6 and 16 mg of risperidone . The incidence of extra-pyramidal side effects ( measured by the Extrapyramidal Symptom Rating Scale ) was significantly higher in patients treated with 16 mg of risperidone or 20 mg of haloperidol than placebo . The results indicate that the optimal daily dose of risperidone for most schizophrenic patients in this study was 6 mg ; this dose was as effective as 16 mg , and the incidence of extrapyramidal symptoms in patients receiving 6 mg of risperidone was no higher than that in patients receiving placebo . CONCLUSIONS Risperidone is a safe antipsychotic that is effective against both the positive and negative symptoms of schizophrenia 
    Output:
    
MAIN OUTCOME MEASURES : Primary interventions were classified according to whether or not they were supported by evidence from r and omised controlled trials or systematic review s. RESULTS : The primary interventions received by 26/40 ( 65 % ; 95 % confidence interval ( 95 % CI ) 51 % to 79 % ) of patients admitted during the period were based on r and omised trials or systematic review s. CONCLUSIONS : When patients were used as the denominator , most primary interventions given in acute general psychiatry were based on experimental evidence .