***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: Abstract Nine VA Medical Centers are participating in a 2-year double-blind placebo controlled study of antioxidant  treatment for tardive dyskinesia ( TD ) conducted by the Department of Veteran Affairs Cooperative Studies Program . One of the principal outcome measures of this study is the score derived from the instrumental assessment of upper extremity dyskinesia . Dyskinetic h and movements are quantified by assessing the variability associated with steady-state isometric force generated by the patient . In the present report , we describe the training procedures and results of a multi-center reliability assessment of this procedure . Data from nine study centers comprising 45 individual patients with six trials each ( three from left h and and three from right h and ) were reanalyzed by an independent investigator and the results were subjected to reliability assessment . For the statistic of interest ( average coefficient of variation over trials 2 and 3 for each h and , then take the larger of these two values ) , we found very high intraclass correlation coefficients for reliability over all patients across sites ( ICC = 0.995 ) . We also calculated the reliability of the measures across trials within patient for each combination of h and ( right , left , dominant ) , rater group ( site , control ) , and trials set ( all three , trials 2 and 3 ) . For a given h and and trial set , the reliability of the site raters was similar to that of the control . This study demonstrates that instrumental measures for the assessment of dyskinesia are reliable and can be implemented in multi-center studies with minimal training The authors estimated components of variance and intraclass correlation coefficients ( ICCs ) to aid in the design of complex surveys and community intervention studies by analyzing data from the Health Survey for Engl and 1994 . This cross-sectional survey of English adults included data on a range of lifestyle risk factors and health outcomes . For the survey , households were sample d in 720 postal code sectors nested within 177 district health authorities and 14 regional health authorities . Study subjects were adults aged 16 years or more .  ICCs and components of variance were estimated from a nested r and om-effects analysis of variance . Results are presented at the district health authority , postal code sector , and household levels . Between-cluster variation was evident at each level of clustering . In these data , ICCs were inversely related to cluster size , but design effects could be substantial when the cluster size was large . Most ICCs were below 0.01 at the district health authority level , and they were mostly below 0.05 at the postal code sector level . At the household level , many ICCs were in the range of 0.0 - 0.3 . These data may provide useful information for the design of epidemiologic studies in which the units sample d or allocated range in size from households to large administrative areas The authors compared vitamin E with placebo in a double-blind r and omized crossover study of 27 patients with tardive dyskinesia . Each treatment period lasted for 6 weeks . Vitamin E showed no differences from placebo in the treatment of tardive dyskinesia One of the major problems associated with long-term neuroleptic treatment is persistent tardive dyskinesia ( TD ) , for which there is no satisfactory treatment . We have recently proposed that some cases of TD are associated with neuronal dysfunction result ing from excess free radical production occurring during catecholamine metabolism . We therefore decided to assess the efficacy of a powerful free radical scavenging agent , alpha-tocopherol ( vitamin E ) , on the clinical signs of TD . We treated 15 patients with persistent TD with alpha-tocopherol and matched placebo in a r and omized crossover design . Patients demonstrated a significant overall reduction in scores on the Abnormal Involuntary Movements Scale ( AIMS ) after treatment with alpha-tocopherol , but not after placebo . The mean reduction in the AIMS score with alpha-tocopherol was 43 percent , with seven patients showing a greater than 50 percent reduction in their dyskinesia . There was also a trend for a decrease in scores on the Brief Psychiatric Rating Scale , but no change was observed in scores on the Simpson-Angus Scale for Extrapyramidal Side Effects . Our findings are consistent with the possibility that alpha-tocopherol is beneficial in the treatment of some patients with TD , but further research is necessary to establish the efficacy of this agent BACKGROUND Several studies have found that alpha-tocopherol ( vitamin E ) can effectively treat  tardive dyskinesia ( TD ) .  A limitation of these trials is their short treatment duration s ( maximum of 12 weeks ) , which do not allow us to address the effects of long-term treatment . METHODS To participate , patients had to have TD and be on stable oral medications . The study enrolled 40 patients who received up to 36 weeks of treatment with d-vitamin E ( 1600 IU per day ) or placebo .  RESULTS Using the Abnormal Involuntary Movements Scale ( AIMS ) score ( sum of items # 1 - 7 ) to measure TD severity , the study found a significant difference ( 3 points ) in mean AIMS scores , in favor of vitamin E , starting at 10 weeks of treatment and continuing through the full 36 weeks . We used linear mixed-effects regression to quantify the impact of several covariates , and found that treatment assignment . TD duration , and chlorpromazine equivalents had significant effects on decreasing the AIMS score . CONCLUSIONS The study 's finding that vitamin E is effective in treating TD agrees with results from prior studies and provides evidence that the effect may extend to treatment of up to 36 weeks . These findings are in direct contrast to those of VA Cooperative Study # 394 , a much larger , long-term , multi-site study , conducted by many of the same investigators , in which Vitamin E was not superior to placebo OBJECTIVE Vitamin E ( alpha-tocopherol ) , a free-radical scavenger , has been reported to improve symptoms of tardive dyskinesia . The authors attempted to replicate this finding under more controlled conditions in a larger study group . METHOD Fifteen in patients and six out patients with tardive dyskinesia received up to 1600 IU/day of vitamin E for 6 weeks in a double-blind , placebo-controlled crossover study . Abnormal Involuntary Movement Scale ( AIMS ) examinations of these patients were videotaped and rated independently by two trained raters . Levels of neuroleptic medication and vitamin E were measured during both treatment periods . Eighteen patients who demonstrated high blood levels of  vitamin E were included in the data analysis . RESULTS  Vitamin E levels were significantly higher while the patients were receiving vitamin E than while they were receiving placebo . For all 18 patients , there were no significant differences between AIMS scores after receiving vitamin E and AIMS scores after receiving placebo . In agreement with previous studies , however , the nine patients who had had tardive dyskinesia for 5 years or less had significantly lower AIMS scores after receiving vitamin E than after receiving placebo . There were no changes in neuroleptic levels during vitamin E treatment . CONCLUSIONS Vitamin E had a minor beneficial effect on tardive dyskinesia ratings in a selected group of patients who had had tardive dyskinesia for 5 years or less . This effect was not due to an increase in blood levels of neuroleptic medications Eleven patients with tardive dyskinesia were treated in a double-blind study of vitamin E or placebo for 12 weeks . Abnormal Involuntary Movement Scale ( AIMS ) ratings were performed before and after treatment . Patients receiving vitamin E showed a significant reduction in their AIMS scale score , but patients receiving placebo showed no significant change . Vitamin E had a helpful effect even for patients whose tardive dyskinesia was mild and long-term Changes in serum creatine phosphokinase have been associated with exacerbation of tardive dyskinesia . Vitamin E , a drug suggested to be effective in the treatment of tardive dyskinesia , has been implicated as a possible cause of increased creatine phosphokinase levels .  Ten patients with long-term tardive dyskinesia were treated with vitamin E in a double-blind , placebo-controlled crossover study .  Vitamin E blood levels and creatine phosphokinase serum levels were monitored at various phases during the study . There were no significant differences between vitamin E and placebo treated patients in their abilities to affect tardive dyskinesia or to influence creatine phosphokinase levels . These data do not support the hypothesis that administration of vitamin E may alter creatine phosphokinase levels in patients with long-term tardive dyskinesia Alpha-tocopherol ( vitamin E ) has been found to be effective in the treatment of  tardive dyskinesia ( TD ) .  Studies to date have been short in duration and have not found long-term carryover effects of vitamin E. The present study examined the persistence of the effects of vitamin E after longer term ( 36-week ) treatment was discontinued . Vitamin E significantly improved TD over this period . However , the effects of vitamin E persisted so that TD scores approached baseline only after 12 weeks of placebo substitution BACKGROUND This study was design ed to determine if vitamin E is effective in reducing the severity of abnormal movements in patients with tardive dyskinesia ( TD ) . METHOD Thirty-five patients completed a double-blind placebo-controlled parallel-group study of vitamin E. Seventeen of the patients were r and omly assigned to receive 800 IU b.i.d . of vitamin E and 18 were assigned to placebo for 2 months . Twenty-nine patients had a diagnosis of schizophrenia and 6 of mood disorder . Patients were assessed using modified versions of the Abnormal Involuntary Movement Scale ( m AIMS ) , Simpson-Angus Scale for extrapyramidal side effects , and Brief Psychiatric Rating Scale . Additionally , a subgroup of 23 patients were assessed using instrumental measurements of dyskinesia . RESULTS There was a significant reduction of dyskinesia in the vitamin E group , but not the placebo group , on both the m AIMS and the instrumental assessment s. The overall reduction in m AIMS in the active group was 24 % , with 5 ( 29 % ) of 17 patients demonstrating greater than 33 % reduction in score . There was a greater reduction in mean m AIMS score ( 35 % ) with vitamin E in the subgroup of patients with TD for 5 years or less compared with the reduction ( 11 % ) in patients with TD for greater than 5 years . No change was observed in parkinsonism . In the patients with schizophrenia , there was a reduction in positive symptoms after vitamin E. CONCLUSION Vitamin E appears to be effective in reducing the severity of TD , especially in patients who have had TD for 5 years or less The aim of our study was to provide further information as to the efficacy of vitamin E for the management of tardive dyskinesia Vitamin E has been suggested to be a promising new treatment for tardive dyskinesia . However , little is known about the optimum dose . Twenty patients with tardive dyskinesia whose medication had been unchanged for at least 1 month were selected and r and omly divided into a treatment group with 11 patients and a control group with nine patients . The treatment group was started on 600 mg of vitamin E per day , and this dose was increased over the 7 months of the trial to 1600 mg per day . The medication for the control group was unchanged . Severity of tardive dyskinesia was rated on the Abnormal Involuntary Movement Scale . Patients in the treatment group initially showed a significant response to the lower dose of 600 mg per day . However , this improvement was not maintained and differences between the two groups reached significant levels only after the dose of vitamin E was increased to 1600 mg per day . At this dose , there was a significant and sustained reduction in the severity of tardive dyskinesia . The results suggest that vitamin E is of value in the treatment of tardive dyskinesia and that the optimum dose for treating tardive dyskinesia is 1600 mg per day . In addition , there may be a dose related therapeutic effect of Vitamin E in tardive dyskinesia OBJECTIVE The authors studied the effects of vitamin E treatment of tardive dyskinesia ; earlier studies have produced contradictory results . METHOD Twenty-eight patients with tardive dyskinesia were treated in a double-blind , parallel-group comparison study of 8 - 12 weeks of treatment with vitamin E ( 1600 IU/day ) or matching placebo capsules . RESULTS The Abnormal Involuntary Movement Scale scores of the patients treated with vitamin E improved significantly compared to the scores of the patients given placebo . CONCLUSIONS These results support earlier findings of the efficacy of vitamin E in treating tardive dyskinesia Eight subjects with persistent tardive dyskinesia were treated with vitamin E and placebo in a r and omized , double-blind crossover study . Their mean score on the Abnormal Involuntary Movement Scale ( AIMS ) was significantly lower after treatment with vitamin E than after placebo administration A modification of an earlier rating scale for extrapyramidal system disturbance is described , and evidence for the validity and reliability of the scale is presented . The usefulness of the scale in studies of neuroleptic drugs is discussed . By its application it is possible to quantify extrapyramidal side effects and to separate them into four principal factors BACKGROUND A recent review suggested an association between using unpublished scales in clinical trials and finding significant results . AIMS To determine whether such an association existed in schizophrenia trials . METHOD Three hundred trials were r and omly selected from the Cochrane Schizophrenia Group 's Register . All comparisons between treatment groups and control groups using rating scales  were identified . The publication status of each scale was determined and cl aims of a significant treatment effect were recorded . RESULTS Trials were more likely to report that a treatment was superior to control when an unpublished scale was used to make the comparison ( relative risk 1.37 ( 95 % CI 1.12 - 1.68 ) ) . This effect increased when a ' gold-st and ard ' definition of treatment superiority 
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No difference could be found regarding the presence of adverse effects or leaving the study early before the end of study .
There is no trial-based information regarding the effect of vitamin E for those with early onset of TD .
REVIEW ER 'S CONCLUSIONS Small trials with uncertain quality of r and omisation , tend to suggest that vitamin E improves the symptoms of TD .