***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: OBJECTIVES To evaluate the effectiveness of a multifactorial intervention to reduce the use of physical restraints in residents of nursing homes . DESIGN Cluster-r and omized controlled trial . SETTING Forty-five nursing homes in Germany . PARTICIPANTS Three hundred thirty-three residents who were being restrained at the start of the intervention . INTERVENTION Persons responsible for the intervention in the nursing homes attended a 6-hour training course that included education about the reasons restraints are used , the adverse effects , and alternatives to their use . Technical aids , such as hip protectors and sensor mats , were provided . The training was design ed to give the change agents tools for problem-solving to prevent behavioral symptoms and injuries from falls without using physical restraints . MEASUREMENTS The main outcome was the complete cessation of physical restraint use on 3 consecutive days 3 months after the start of the intervention . Secondary outcomes were partial reductions in restraint use , percentage of fallers , number of psychoactive drugs , and occurrence of behavioral symptoms . RESULTS The probability of being unrestrained in the intervention group ( IG ) was more than twice that in the control group ( CG ) at the end of the study ( odds ratio=2.16 , 95 % confidence interval=1.05 - 4.46 ) . A partial reduction of restraint use was also about twice as often achieved in the IG as in the CG . No negative effect was observed regarding medication or behavioral symptoms . The percentage of fallers was higher in the IG . CONCLUSION The intervention reduced restraint use without a significant increase in falling , behavioral symptoms , or medication OBJECTIVES Physical restraints are often used to prevent falls and to secure medical devices in older people in hospitals .  Restraint reduction has been advocated on the grounds that physical restraints have negative psychological effects and are not effective in preventing falls . The potential effect of restraint reduction on length of hospital stay ( LOS ) has not been investigated . This study was undertaken to compare the average length of stay of older patients in a convalescent medical ward setting before and after a restraint reduction program . DESIGN This is a retrospective study . SETTING A convalescent hospital in Hong Kong . PARTICIPANTS This study included 2000 patient episodes . MEASUREMENTS The use of physical restraint , LOS , and clinical outcomes of r and omly selected patient episodes in the year before and after the implementation of a restraint reduction program were compared . The clinical outcomes included Modified Functional Ambulatory Categories and modified Barthel index . Subgroup analysis was performed on those with confusion as defined by dementia diagnosis , low abbreviated mental test score , or abnormal mental domain of Norton Score . RESULTS A total of 958 and 988 patient episodes admitted to 10 medical wards in a convalescent hospital in 2007 and 2009 were examined . There were no significant differences in the baseline characteristics of patients in the 2 years . With the implementation of the restraint reduction scheme , the rate of physical restraint use declined significantly from 13.3 % in 2007 to 4.1 % in 2009 for all patients . The average LOS of patients was significantly lower in the year after the implementation of restraint reduction ( 19.5 ± 20.7 versus 16.8 ± 13.4 days in 2007 and 2009 respectively , P < .001 ) . On subgroup analysis , the reduction in LOS was significant in the cognitively impaired patients ( 23.0 ± 26.5 to 17.8 ± 15.0 days in 2007 and 2009 respectively , P < .001 ) , but not in the cognitively normal patients . There were no significant differences between the 2 years in the incidence of fall , mobility , and activities of daily living on discharge . CONCLUSION Physical restraint reduction was associated with significant reduction in average length of stay in convalescent medical wards , especially in the cognitively impaired patients Background Physical restraints are still frequently used in nursing home residents despite growing evidence for the ineffectiveness and negative consequences of these methods . Therefore , reduction in the use of physical restraints in psycho-geriatric nursing home residents is very important . The aim of this study was to investigate the short-term effects of an educational intervention on the use of physical restraints in psycho-geriatric nursing home residents . Methods A cluster r and omized trial was applied to 5 psycho-geriatric nursing home wards ( n = 167 residents with dementia ) . The wards were assigned at r and om to either educational intervention ( 3 wards ) or control status ( 2 wards ) . The restraint status was observed and residents ' characteristics , such as cognitive status , were determined by using the Minimum Data Set ( MDS ) at baseline and 1 month after intervention . Results Restraint use did not change significantly over time in the experimental group ( 55%–56 % ) , compared to a significant increased use ( P < 0.05 ) in the control group ( 56%–70 % ) . The mean restraint intensity and mean multiple restraint use in residents increased in the control group but no changes were shown in the experimental group . Logistic regression analysis showed that residents in the control group were more likely to experience increased restraint use than residents in the experimental group . Conclusion An educational programme for nurses combined with consultation with a nurse specialist did not decrease the use of physical restraints in psycho-geriatric nursing home residents in the short term . However , the residents in the control group experienced more restraint use during the study period compared to the residents in the experimental group . Whether the intervention will reduce restraint use in the long term could not be inferred from these results . Further research is necessary to gain insight into the long-term effects of this educational intervention OBJECTIVES To investigate the effects of an educational intervention on the use of physical restraints with psychogeriatric nursing home residents . DESIGN Cluster-r and omized trial . SETTING Fifteen psychogeriatric nursing home wards in the Netherl and s. PARTICIPANTS In total , 432 psychogeriatric nursing home residents from 15 psychogeriatric nursing home wards in seven nursing homes were selected for participation ; 404 consented , and 371 of these were available at baseline . Two hundred forty-one from 14 wards had complete data and were included in the data analyses . INTERVENTION The nursing home wards were assigned at r and om to educational intervention or control status . The educational intervention consisted of an educational program for nursing staff combined with consultation with a nurse specialist ( registered nurse ( RN ) level ) . MEASUREMENTS Data were collected at baseline and 1 , 4 , and 8 months postintervention . At each measurement , the use of physical restraints was measured using observations of blinded , trained observers on four separate occasions over a 24-hour period . Other resident characteristics , such as cognitive status , were determined using the Minimum Data Set . RESULTS Logistic and linear regression analyses showed no treatment effect on restraint status , restraint intensity , or multiple restraint use in any of the three postintervention measurements . Furthermore , only small changes occurred in the types of restraints used with residents in the experimental group . CONCLUSION An educational program for nursing staff combined with consultation with a nurse specialist ( RN level ) had no effect on the use of physical restraints with psychogeriatric nursing home residents . In addition to restraint education and consultation , new measures to reduce the use of physical restraints with psychogeriatric nursing home residents should be developed Objective To assess whether a manual based coping strategy compared with treatment as usual reduces depression and anxiety symptoms in carers of family members with dementia . Design R and omised , parallel group , superiority trial . Setting Three mental health community services and one neurological outpatient dementia service in London and Essex , UK . Participants 260 carers of family members with dementia . Intervention A manual based coping intervention comprising eight sessions and delivered by supervised psychology graduates to carers of family members with dementia . The programme consisted of psychoeducation about dementia , carers ’ stress , and where to get emotional support ; underst and ing behaviours of the family member being cared for , and behavioural management techniques ; changing unhelpful thoughts ; promoting acceptance ; assertive communication ; relaxation ; planning for the future ; increasing pleasant activities ; and maintaining skills learnt . Carers practised these techniques at home , using the manual and relaxation CDs . Main outcome measures Affective symptoms ( hospital anxiety and depression total score ) at four and eight months . Secondary outcomes were depression and anxiety caseness on the hospital anxiety and depression scale ; quality of life of both the carer ( health status question naire , mental health ) and the recipient of care ( quality of life-Alzheimer ’s disease ) ; and potentially abusive behaviour by the carer towards the recipient of care ( modified conflict tactics scale ) . Results 260 carers were recruited ; 173 were r and omised to the intervention and 87 to treatment as usual .  Mean total scores on the hospital anxiety and depression scale were lower in the intervention group than in the treatment as usual group over the eight month evaluation period : adjusted difference in means −1.80 points ( 95 % confidence interval −3.29 to −0.31 ; P=0.02 ) and absolute difference in means −2.0 points . Carers in the intervention group were less likely to have case level depression ( odds ratio 0.24 , 95 % confidence interval 0.07 to 0.76 ) and there was a non-significant trend towards reduced case level anxiety ( 0.30 , 0.08 to 1.05 ) . Carers ’ quality of life was higher in the intervention group ( difference in means 4.09 , 95 % confidence interval 0.34 to 7.83 ) but not for the recipient of care ( difference in means 0.59 , −0.72 to 1.89 ) . Carers in the intervention group reported less abusive behaviour towards the recipient of care compared with those in the treatment as usual group ( odds ratio 0.47 , 95 % confidence interval 0.18 to 1.23 ) , although this was not significant . Conclusions A manual based coping strategy was effective in reducing affective symptoms and case level depression in carers of family members with dementia . The carers ’ quality of life also improved . Trial registration Current Controlled Trials ISCTRN70017938 BACKGROUND This study examines the effectiveness of a nursing home staff training program design ed to improve the interaction between residents with dementia and their caregivers . METHODS A three-arm cluster-r and omized and controlled population of 96 caregivers and 210 residents was used . Caregivers of the intervention group ( IG ) received a three-month training program in dementia care . Data were gathered at baseline , immediately after the training and at a six-month follow-up- assessment . Short- and long-term effects of the training program were assessed in comparison with another intervention referred to as the relaxation group ( RG ) and a wait-list control group ( CG ) . RESULTS Results indicated significant positive effects of the training program on caregivers ' knowledge immediately after the training and on the use of physical restraints at the six-month follow-up . Caregivers ' overall competence increased significantly both in the IG and in the RG . No intervention effects were found on caregivers ' level of burnout , their health complaints or on the use of sedative drugs .  Relaxation training was more successful in the reduction of caregivers ' health complaints . CONCLUSIONS Results of the study indicate both the effectiveness and the limitations of a general training program in dementia care . The complexity of the nursing home setting potentially needs more complex interventions . Ongoing and continued support of the caregivers , as well as changes in organization and environment , are more likely to be helpful in the long-term improvement in the quality of care . Future research should focus on studies of specific interventions , such as the interesting effects of relaxation training on the caregivers ' state of health OBJECTIVES To evaluate the effects of a restraint minimization education program on staff knowledge and attitudes and use of physical restraints . DESIGN Cluster-r and omized controlled trial with nursing units as the basis for r and omization . SETTING Forty group dwelling units for people with dementia . PARTICIPANTS At baseline , there were 184 staff and 191 residents in the intervention group and 162 staff and 162 residents in the control group . At the 6-month follow-up , there were 156 staff and 185 residents ( 36 newly admitted ) in the intervention group and 133 staff and 165 residents ( 26 newly admitted ) in the control group . INTERVENTION A 6-month education program for all nursing staff . MEASUREMENTS Staff knowledge and attitudes and physical restraint use were measured before and after the education program . RESULTS In the intervention group , staff knowledge about and attitudes toward restraint use changed , and the overall use of physical restraints decreased . A comparison including only residents present during the whole study period showed that the level of use was similar between the groups at baseline , whereas it was significantly lower in the intervention group at follow-up . Adjusted analyses showed that the odds of being restrained at follow-up were lower in the intervention group than in the control group . There was no significant change in the number of falls or use of psychoactive medication . CONCLUSION The results indicate that staff education can increase knowledge , change attitudes , and reduce the use of physical restraints without any change in the incidence of falls or use of psychoactive drugs OBJECTIVES The Grip on Challenging Behavior care program was developed using the current guidelines and models on managing challenging behavior in dementia in nursing homes . It was hypothesized that the use of the care program would lead to a decrease in challenging behavior and in the prescription of psychoactive drugs without increase in use of restraints . DESIGN A r and omized controlled trial was undertaken using a stepped-wedge design to implement the care program and to evaluate the effects . An assessment of challenging behavior and ps 
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INTERPRETATION the most effective place to intervene at the present time is by directly targeting physical restraint by long-term care paid carers .
Specific areas that are still lacking evidence at the present time are interventions that target ( i ) elder neglect , ( ii ) public awareness , ( iii ) older adults who experience maltreatment , ( iv ) professionals responsible for preventing maltreatment , ( v ) family caregivers who abuse and ( vi ) carers who abuse