***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 
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    Input: Background The aim of this project was to assess whether outreach visits would improve the implementation of evidence based clinical practice in the area of falls reduction and stroke prevention in a residential care setting . Methods Twenty facilities took part in a r and omized controlled trial with a seven month follow-up period . Two outreach visits were delivered by a pharmacist . At the first a summary of the relevant evidence was provided and at the second detailed audit information was provided about fall rates , psychotropic drug prescribing and stroke risk reduction practice s ( BP monitoring , aspirin and warfarin use ) for the facility relevant to the physician . The effect of the interventions was determined via pre- and post-intervention case note audit . Outcomes included change in percentage patients at risk of falling who fell in a three month period prior to follow-up and changes in use of psychotropic medications . Chi-square tests , independent sample s t-test , and logistic regression were used in the analysis . Results Data were available from case notes at baseline ( n = 897 ) and seven months follow-up ( n = 902 ) , 452 residential care staff were surveyed and 121 physicians were involved with 61 receiving outreach visits . Pre- and post-intervention data were available for 715 participants . There were no differences between the intervention and control groups for the three month fall rate . We were unable to detect statistically significant differences between groups for the psychotropic drug use of the patients before or after the intervention . The exception was significantly greater use of " as required " antipsychotics in the intervention group compared with the control group after the pharmacy intervention ( RR = 4.95 ; 95%CI 1.69–14.50 ) . There was no statistically significant difference between groups for the numbers of patients " at risk of stroke " on aspirin at follow-up . Conclusions While the strategy was well received by the physicians involved , there was no change in prescribing patterns . Patient care in residential setting s is complex and involves contributions from the patient 's physician , family and residential care staff . The project highlights challenges of delivering evidence based care in a setting in which there is a paucity of well controlled trial evidence but where significant health outcomes can be attained OBJECTIVE To evaluate the efficacy of a dementia care program to reduce behavior disorders in nursing home patients with dementia . DESIGN R and omized controlled clinical trial with 6-month follow-up . SETTING A 250-bed community nursing home . PATIENTS The nursing home was screened to identify patients with dementia and behavior disorders . A total of 118 patients were eligible for r and omization . Of these , 89 ( 75.4 % ) were r and omized , and 81 of these ( 91.0 % ) completed the trial . INTERVENTION The A.G.E. dementia care program consisted of Activities , Guidelines for psychotropic medications , and Educational rounds . The control treatment was usual nursing home care . MEASUREMENTS Behavior disorders , antipsychotic drug and physical restraint use , patient activity levels , and cognitive and functional status . RESULTS After 6 months , 12 of 42 ( 28.6 % ) intervention patients exhibited behavior disorders compared with 20 of 39 ( 51.3 % ) controls ( OR = 0.38 ; 95 % CI [ 0.15 , 0.95 ] ; P = .037 ) . Controls were more than twice as likely to receive antipsychotics ( OR = 2.55 , 95 % CI [ 0.96 , 6.76 ] ; P < .056 ) , to be restrained during activity times ( OR = 2.98 , 95 % CI [ 1.10 , 8.04 ] ; P < .028 ) , and to be restrained on nursing units ( OR = 2.14 , 95 % CI [ 0.9 , 5.3 ] ; P < .10 ) . Intervention patients were much more likely to participate in activities ( OR = 13.71 ; 95 % CI [ 4.51 , 41.73 ] ; P = .001 ) . CONCLUSIONS The A.G.E. program reduces the prevalence of behavior disorders and the use of antipsychotic drugs and restraints . It is practical , feasible , and appears to improve the lives of patients with dementia in nursing homes Abstract Objective To evaluate the effectiveness of a training and support intervention for nursing home staff in reducing the proportion of residents with dementia who are prescribed neuroleptics . Design Cluster r and omised controlled trial with blinded assessment of outcome . Setting 12 specialist nursing homes for people with dementia in London , Newcastle , and Oxford . Participants Residents of the 12 nursing homes ; numbers varied during the study period . Intervention Training and support intervention delivered to nursing home staff over 10 months , focusing on alternatives to drugs for the management of agitated behaviour in dementia . Main outcome measures Proportion of residents in each home who were prescribed neuroleptics and mean levels of agitated and disruptive behaviour ( Cohen-Mansfield agitation inventory ) in each home at 12 months . Results At 12 months the proportion of residents taking neuroleptics in the intervention homes ( 23.0 % ) was significantly lower than that in the control homes ( 42.1 % ) : average reduction in neuroleptic use 19.1 % ( 95 % confidence interval 0.5 % to 37.7 % ) . No significant differences were found in the levels of agitated or disruptive behaviour between intervention and control homes . Conclusions Promotion of person centred care and good practice in the management of patients with dementia with behavioural symptoms provides an effective alternative to neuroleptics Abstract . Objectives : To describe the drug use in epilepsy and Parkinson 's patients living in nursing homes and to evaluate the impact of multi-speciality team intervention on health-related quality of life , activities of daily living ( ADL ) and confusion state . Methods : Nursing home residents with epilepsy or Parkinson 's disease in the county of Skåne in Sweden were identified . From 119 nursing homes , 262 patients were identified . After obtaining informed consent , 157 patients from 48 nursing homes were included . Of these patients 74 were diagnosed with epilepsy and 84 with Parkinson 's disease ( one patient had both diagnoses ) . The average age of the epilepsy patients was 79 years and of the Parkinson 's patients 81 years . Pharmacists documented the patients ' drug use and any drug-related problems after communication with nursing-home residents , their contact persons at the nursing home and the residents ' physicians . A multi-speciality group consisting of pharmacists , a primary care physician , a neurologist , a neuro-psychiatrist and a clinical pharmacologist evaluated the patients ' medication and , when appropriate , suggested changes . Lists of each resident 's medications were collected together with information about drug-related problems . The use of drugs deemed inappropriate for geriatric nursing-home residents according to Beer 's criteria was documented . Health-related quality of life was evaluated using a generic health-related quality of life instrument , SF-36 . Confusion state was measured using the Behaviour Pathology in Alzheimer 's Disease Rating Scale ( Behave-AD ) , and ability to perform ADL was assessed using the Schwab and Engl and capacity for daily living scale . All measurements were repeated after approximately 6 months . During that period , for the group r and omised to active intervention , the physicians involved in the care of the patients had received the recommendations for changes in drug treatment from the multi-speciality group . Results : Epilepsy patients at nursing homes used on average 8.0 drugs for continuous use whereas Parkinson 's patients used 8.6 drugs . According to Beer 's criteria about 40 % of both patient groups used drugs that are classified as inappropriate to geriatric nursing-home patients . Dopamine receptor-blocking psychotropic drugs were used by 29 % of the Parkinson 's patients . Indication for a patient 's total drug treatment was not documented for 50 % of epilepsy and 40 % of Parkinson 's patients . There were no significant differences between the active and control groups in changes in SF-36 , Behave-AD or ADL for epilepsy patients . For Parkinson 's patients there was a significant decrease in ADL for the active group , whereas there were no differences in SF-36 or Behave-AD . Conclusion : Nursing-home residents with epilepsy or Parkinson 's disease use many drugs and often drugs that are classified as inappropriate . A simple problem-oriented question naire may be helpful in identifying specific drug-related problems in geriatric patients with common neurological diseases . Methods on how to improve the pharmacotherapy of these patients still have to be developed OBJECTIVES To test the effect of an adapted U.S. model of pharmaceutical care on prescribing of inappropriate psychoactive ( anxiolytic , hypnotic , and antipsychotic ) medications and falls in nursing homes for older people in Northern Irel and ( NI ) . DESIGN Cluster r and omized controlled trial . SETTING Nursing homes r and omized to intervention ( receipt of the adapted model of care ; n=11 ) or control ( usual care continued ; n=11 ) . PARTICIPANTS Residents aged 65 and older who provided informed consent ( N=334 ; 173 intervention , 161 control ) . INTERVENTION Specially trained pharmacists visited intervention homes monthly for 12 months and review ed residents ' clinical and prescribing information , applied an algorithm that guided them in assessing the appropriateness of psychoactive medication , and worked with prescribers ( general practitioners ) to improve the prescribing of these drugs . The control homes received usual care . MEASUREMENTS The primary end point was the proportion of residents prescribed one or more inappropriate psychoactive medicine according to st and ardized protocol s ; falls were evaluated using routinely collected falls data m and ated by the regulatory body for nursing homes in NI . RESULTS The proportion of residents taking inappropriate psychoactive medications at 12 months in the intervention homes ( 25/128 , 19.5 % ) was much lower than in the control homes ( 62/124 , 50.0 % ) ( odds ratio=0.26 , 95 % confidence interval=0.14 - 0.49 ) after adjustment for clustering within homes . No differences were observed at 12 months in the falls rate between the intervention and control groups . CONCLUSION Marked reductions in inappropriate psychoactive medication prescribing in residents result ed from pharmacist review of targeted medications , but there was no effect on falls Abstract Objective To assess whether a multifaceted intervention can reduce the number of prescriptions for antimicrobials for suspected urinary tract infections in residents of nursing homes . Design Cluster r and omised controlled trial . Setting 24 nursing homes in Ontario , Canada , and Idaho , United States . Participants 12 nursing homes allocated to a multifaceted intervention and 12 allocated to usual care .  Outcomes were measured in 4217 residents . Interventions Diagnostic and treatment algorithm for urinary tract infections implemented at the nursing home level using a multifaceted approach — small group interactive sessions for nurses , videotapes , written material , outreach visits , and one on one interviews with physicians . Main outcome measures Number of antimicrobials prescribed for suspected urinary tract infections , total use of antimicrobials , admissions to hospital , and deaths . Results Fewer courses of antimicrobials for suspected urinary tract infections per 1000 resident days were prescribed in the intervention nursing homes than in the usual care homes ( 1.17 v 1.59 courses ; weighted mean difference −0.49 , 95 % confidence intervals −0.93 to −0.06 ) . Antimicrobials for suspected urinary tract infection represented 28.4 % of all courses of drugs prescribed in the intervention nursing homes compared with 38.6 % prescribed in the usual care homes ( weighted mean difference −9.6 % , −16.9 % to −2.4 % ) . The difference in total antimicrobial use per 1000 resident days between intervention and usual care groups was not significantly different ( 3.52 v 3.93 ; weighted mean difference −0.37 , −1.17 to 0.44 ) . No significant difference was found in admissions to hospital or mortality between the study arms . Conclusion A multifaceted intervention using algorithms can reduce the number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes BACKGROUND Although psychoactive medications have substantial side effects in the elderly , these drugs are used frequently in nursing homes . Few interventions have succeeded in changing this situation , and little is known about the clinical effects of such interventions . METHODS We studied six matched pairs of nursing homes ; at one r and omly selected nursing home in each pair , physicians , nurses , and aides participated in an educational program in geriatric psychopharmacology .  At base line we determined the type and quantity of drugs received by all residents ( n = 823 ) , and a blinded observer performed st and ardized clinical assessment s of the residents who were taking psychoactive medications .  After the five-month program , drug use and patient status were reassessed . RESULTS Scores on an index of psychoactive-drug use , measuring both the magnitude and the probable inappropriateness of medication use , declined significantly more in the nursing homes in which the program was carried out ( experimental nursing homes ) than in the control nursing homes ( decrease , 27 percent vs. 8 percent ; P = 0.02 ) . The use of  antipsychotic drugs 
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Several review s were identified , but these either concerned elderly in general or did not satisfy all the requirements for systematic review s. Conclusions Interventions using educational outreach , on-site education given alone or as part of an intervention package and pharmacist medication review may under certain circumstances reduce inappropriate drug use , but the evidence is of low quality .
Due to poor quality of the evidence , no conclusions may be drawn about the effect of the other three interventions on drug use , or of either intervention on health-related outcomes