***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: Objective The aim of the investigation was to study the effects of withdrawing selective serotonin reuptake inhibitor ( SSRI ) drugs in nursing home patients , who had no documented diagnosis or symptoms of depression . Setting The setting of the study was in 11 nursing homes in the county of Stockholm , Sweden . Participants Participants were patients without dementia or history of depression who had received treatment with SSRI drugs for more than 6 months and who had no indications of anxiety disorder or major depression Design The included patients ( n=70 ) were r and omized to either the intervention group  ( withdrawal of SSRI ) or the control group  ( no change in treatment ) , 35 patients to each group . Main outcome measures The patients were subjected to assessment using the following instruments : Montgomery-Åsberg depression rating scale , global assessment for functioning , health index and a symptom assessment form . Assessment was made at the start of the study and at the 3-month and 6-month follow-ups . Results We found no significant difference between the intervention and control groups in any outcome measure . Conclusion Treatment with SSRI drugs in patients without clinical major depression or anxiety disorder is often unjustified and should be discontinued OBJECTIVES To evaluate the effect of pharmaceutical care provided in addition to acute Geriatric Evaluation and Management ( GEM ) care on the appropriateness of prescribing . DESIGN R and omized , controlled trial , with the patient as unit of r and omization . SETTING Acute GEM unit . PARTICIPANTS Two hundred three patients aged 70 and older . INTERVENTION Pharmaceutical care provided from admission to discharge by a specialist clinical pharmacist who had direct contacts with the GEM team and patients . MEASUREMENTS Appropriateness of prescribing on admission , at discharge , and 3 months after discharge , using the Medication Appropriateness Index ( MAI ) , Beers criteria , and Assessing Care of Vulnerable Elders ( ACOVE ) underuse criteria and mortality , readmission , and emergency visits up to 12 months after discharge . RESULTS Intervention patients were significantly more likely than control patients to have an improvement in the MAI and in the ACOVE underuse criteria from admission to discharge ( odds ratio (OR)=9.1 , 95 % confidence interval (CI)=4.2 - 21.6 and OR=6.1 , 95 % CI=2.2 - 17.0 , respectively ) . The control and intervention groups had comparable improvements in the Beers criteria . CONCLUSION Pharmaceutical care provided in the context of acute GEM care improved the appropriate use of medicines during the hospital stay and after discharge . This is an important finding , because only limited data exist on the effect of various strategies to improve medication use in elderly in patients . The present approach has the potential to minimize risk and improve patient outcomes Background Polypharmacy and potentially inappropriate drugs have been associated with negative outcomes in older adults which might be reduced by pharmacist interventions . Objectives Our objective was to evaluate the effect of a pharmacist intervention , consisting of the application of the Rationalization of home medication by an Adjusted STOPP in older Patients ( RASP ) list and a pharmacist-led medication review on polypharmacy , the quality of prescribing , and clinical outcome in geriatric in patients . Methods A monocentric , prospect i ve controlled trial was undertaken at the geriatric wards of a large university hospital . Pharmacists applied the RASP list to the drugs reconciled on admission and additionally performed an expert-based medication review , upon which recommendations were provided to the treating physicians . The primary outcome was the composite endpoint of drug discontinuation and dose reduction of drugs taken on admission . Secondary outcomes included RASP-identified potentially inappropriate medications ( PIMs ) , the number of Emergency Department ( ED ) visits and quality of life ( QOL ) registered up to 3 months after discharge . Results On average , patients ( n = 172 ) took 10 drugs on admission and were 84.5 years ( st and ard deviation 4.8 ) of age . More drugs were discontinued or reduced in dose in the intervention group { control vs. intervention : median ( interquartile range [ IQR ] ) 3 ( 2–5 ) vs. 5 ( 3–7 ) ; p < 0.001}. More PIMs were discontinued in the intervention group , leading to less PIM at discharge [ control vs. intervention : median ( IQR ) 2 ( 1–3 ) vs. 0.5 ( 0–1 ) ; p < 0.001 ] . No signal of harm was seen , and a significant improvement of QOL and less ED visits without hospitalization were observed . Conclusions The combined intervention safely reduced drug use in very old in patients and outperformed usual geriatric care . An increased QOL was seen , as well as a trend towards less ED visits . Clinical Trials.gov Identifier : NCT01513265 AIMS Whether or not beta-blocker therapy should be stopped during acutely decompensated heart failure ( ADHF ) is unsure . METHODS AND RESULTS In a r and omized , controlled , open labelled , non-inferiority trial , we compared beta-blockade continuation vs. discontinuation during ADHF in patients with LVEF below 40 % previously receiving stable beta-blocker therapy . 169 patients were included , among which 147 were evaluable . Mean age was 72 + /- 12 years , 65 % were males . After 3 days , 92.8 % of patients pursuing beta-blockade improved for both dyspnoea and general well-being according to a physician blinded for therapy vs. 92.3 % of patients stopping beta-blocker . This was the main endpoint and the upper limit for unilateral 95 % CI ( 6.6 % ) is lower that of the predefined upper limit ( 12.5 % ) , indicating non-inferiority . Similar findings were obtained at 8 days and when evaluation was made by the patient . Plasma BNP at Day 3 , length of hospital stay , re-hospitalization rate , and death rate after 3 months were also similar . Beta-blocker therapy at 3 months was given to 90 % of patients vs. 76 % ( P < 0.05 ) . CONCLUSION In conclusion , during ADHF , continuation of beta-blocker therapy is not associated with delayed or lesser improvement , but with a higher rate of chronic prescription of beta-blocker therapy after 3 months , the benefit of which is well established ABSTRACT Background : Long-term benzodiazepine use in the elderly population is a significant public health problem that leads to impaired cognitive functioning , medication dependence and increased risks for adverse drug reactions . The aim of this review was to examine r and omized controlled trials ( RCTs ) on the efficacy of different methods for tapering and discontinuing benzodiazepines . Method : We used four data bases ( Ovid , PubMed , Academic Search Complete , Web of Science ) to retrieve r and omized controlled trials published in peer- review ed journals that explored different methods for tapering benzodiazepine use in a primarily geriatric population . Results : Eleven papers met the inclusion criteria . Methods to assist in benzodiazepine tapering included patient education , cognitive behavioural therapy ( CBT ) , and pharmaceutical adjuvants ( SSRIs , melatonin , progesterone ) . Patient education was consistently effective in increasing benzodiazepine discontinuation success while CBT had mixed but promising results . The use of medications to help improve tapering success was inconclusive . Conclusions : Patient education is a successful , time- and cost-effective intervention that can significantly help with benzodiazepine discontinuation success .  CBT may also be an effective approach . However , cost can be an issue since public healthcare coverage in Canada does not cover psychotherapy . More research is needed in looking at pharmaceutical adjuvants and their role in assisting with benzodiazepine discontinuation Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objectives Deprescribing has been proposed as a way to reduce polypharmacy in frail older people . We aim ed to reduce the number of medicines consumed by people living in residential aged care facilities ( RACF ) . Secondary objectives were to explore the effect of deprescribing on survival , falls , fractures , hospital admissions , cognitive , physical , and bowel function , quality of life , and sleep . Methods Ninety-five people aged over 65 years living in four RACF in rural mid-west Western Australia were r and omised in an open study . The intervention group ( n = 47 ) received a deprescribing intervention , the planned cessation of non-beneficial medicines . The control group ( n = 48 ) received usual care . Participants were monitored for twelve months from r and omisation . Primary outcome was change in the mean number of unique regular medicines . All outcomes were assessed at baseline , six , and twelve months . Results Study participants had a mean age of 84.3±6.9 years and 52 % were female . Intervention group participants consumed 9.6±5.0 and control group participants consumed 9.5±3.6 unique regular medicines at baseline . Of the 348 medicines targeted for deprescribing ( 7.4±3.8 per person , 78 % of regular medicines ) , 207 medicines ( 4.4±3.4 per person , 59 % of targeted medicines ) were successfully discontinued . The mean change in number of regular medicines at 12 months was -1.9±4.1 in intervention group participants and + 0.1±3.5 in control group participants ( estimated difference 2.0±0.9 , 95%CI 0.08 , 3.8 , p = 0.04 ) . Twelve intervention participants and 19 control participants died within 12 months of r and omisation ( 26 % versus 40 % mortality , p = 0.16 , HR 0.60 , 95%CI 0.30 to 1.22 ) There were no significant differences between groups in other secondary outcomes . The main limitations of this study were the open design and small participant numbers . Conclusions Deprescribing reduced the number of regular medicines consumed by frail older people living in residential care with no significant adverse effects on survival or other clinical outcomes . Trial Registration Australian New Zeal and Clinical Trials Registry Background The use of Fall-Risk-Increasing-Drugs ( FRIDs ) has been associated with increased risk of falls and associated injuries . This study investigates the effect of withdrawal of FRIDs versus ‘ care as usual ’ on health-related quality of life ( HRQoL ) , costs , and cost-utility in community-dwelling older fallers . Methods In a prospect i ve multicenter r and omized controlled trial FRIDs assessment combined with FRIDs-withdrawal or modification was compared with ‘ care as usual ’ in older persons , who visited the emergency department after experiencing a fall . For the calculation of costs the direct medical costs ( intramural and extramural ) and indirect costs ( travel costs ) were collected for a 12 month period . HRQoL was measured at baseline and at 12 months follow-up using the EuroQol-5D and Short Form-12 version 2 . The change in EuroQol-5D and Short Form-12 scores over 12 months follow-up within the control and intervention groups was compared using the Wilcoxon Signed Rank test for continuous variables and the McNemar test for dichotomous variables . The change in scores between the control and intervention groups were compared using a two-way analysis of variance . Results We included 612 older persons who visited an emergency department because of a fall . The mean cost of the FRIDs intervention was € 120 per patient . The total fall-related healthcare costs ( without the intervention costs ) did not differ significantly between the intervention group and the control group ( € 2204 versus € 2285 ) . However , the withdrawal of FRIDs  reduced medication costs with a mean of € 38 per participant . Furthermore , the control group had a greater decline in EuroQol-5D utility score during the 12-months follow-up than the intervention group ( p = 0.02 ) . The change in the Short Form-12 Physical Component Summary and Mental Component Summary scores did not differ significantly between the two groups . Conclusions Withdrawal of FRID ’s in older persons who visited an emergency department due to a fall , did not lead to reduction of total health-care costs . However , the withdrawal of FRIDs  reduced medication costs with a mean of € 38 per participant in combination with less decline in HRQoL is an important result .Trial registration The trial is registered in the Netherl and s Trial Register ( NTR1593 – October 1st 2008 ) Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies Background Appropriateness of prescribing can be assessed by various measures and screening instruments . The aims of this study were to investigate the effects of pharmacists ' interventions on appropriateness of prescribing in elderly patients , and to explore the relationship between these results and hospital care utilization during a 12-month follow-up period . Methods The study population from a previous r and omized controlled study 
    Output:
    
Based on a limited number of studies with varying method ological rigor , deprescribing may not significantly improve QOL or SWC ; however , it may not contribute to additional ED visits and hospitalizations .