human
***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: BACKGROUND Acute extrapyramidal side effects ( EPS ) are a common phenomenon of treatment with conventional antipsychotics . Previous studies found that clozapine has little propensity to cause EPS , while risperidone produces some EPS , but at levels lower than those of conventional antipsychotics . METHOD We compared the prevalence and severity of EPS in patients treated with clozapine , risperidone , or conventional antipsychotics for at least 3 months . Our main hypothesis was that there would be differences between the three treatment groups with regard to akathisia , measured with the Barnes Akathisia Scale , and extrapyramidal motor side effects ( rigidity , rigidity factor , tremor , salivation ) , measured with the Simpson-Angus scale . Secondarily , we were interested in possible differences between the three groups with respect to the anticholinergic comedication and the subjective impression of the patients , measured with the van Putten scale . RESULTS We studied 106 patients ( 41 patients treated with clozapine , 23 patients with risperidone , and 42 patients treated with conventional antipsychotics ) . The sample was 57.5 % male and had a mean + /- SD age of 36.6 + /- 9.3 years . The mean dose of antipsychotics  calculated in chlorpromazine equivalents was 425.6 + /- 197.1 mg/day in the clozapine group , 4.7 + /- 2.1 mg/day in the risperidone group , and 476.5 + /- 476.9 mg/day in the group treated with conventional antipsychotics . The point-prevalence of akathisia was 7.3 % in the clozapine group , 13 % in the risperidone group , and 23.8 % in the group treated with conventional antipsychotics . The point-prevalence of rigidity and cogwheeling respectively was 4.9 % and 2.4 % in the clozapine group , 17.4 % and 17.4 % in the risperidone group , and 35.7 % and 26.2 % in the group treated with conventional antipsychotics . CONCLUSION Our results indicate that risperidone is superior to conventional neuroleptics in that it causes fewer EPS . In comparison to clozapine , risperidone produces EPS levels that are intermediate between clozapine and conventional antipsychotic drugs Abstract The descriptive term behavioral and psychological symptoms of dementia ( BPSD ) is used to cover a range of noncognitive disturbances including anxiety , depression , irritability , aggression , agitation , eating disorders , and inappropriate social or sexual behaviors . Behavioral and psychological symptoms of dementia are seen in about 90 % of patients with dementia . We aim ed to compare the efficacy and tolerability of risperidone , yokukansan , and fluvoxamine used for BPSD in elderly patients with dementia . Ninety in patients with dementia according to the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition criteria were investigated in Sato Hospital , Koutokukai . We conducted an 8-week , rater-blinded , r and omized trial , administering flexibly dosed risperidone , yokukansan , or fluvoxamine . Primary outcome measures were Neuropsychiatric Inventory in Nursing Home Version total score and its items . Secondary outcome measures were cognitive function measured by Mini-Mental State Examination and daily life function measured by Functional Independence Measure ( FIM ) . Neurological adverse effects were measured by the Drug-Induced Extra-Pyramidal Symptoms Scale . At the end of the study , we analyzed 76 patients ( 92.7 % ) .  Mean Neuropsychiatric Inventory in Nursing Home Version total score decreased in all 3 drug groups , with no significant between-group differences . Mini-Mental State Examination and Functional Independence Measure scores did not change significantly . Drug-Induced Extra-Pyramidal Symptoms Scale scores did not change in the yokukansan and fluvoxamine groups , but increased significantly in the risperidone group . Risperidone , yokukansan , and fluvoxamine were equally effective in the treatment of BPSD in elderly patients . However , yokukansan or fluvoxamine for BPSD showed a more favorable profile in tolerability compared with risperidone . This trial is registered at UMIN Clinical Trials Registry ( identifier : UMIN000006146 ) Traditional clinical review articles , also known as up date s , differ from systematic review s and meta-analyses . Up date s selectively review the medical literature while discussing a topic broadly . Non-quantitative systematic review s comprehensively examine the medical literature , seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment . Meta-analyses ( quantitative systematic review s ) seek to answer a focused clinical question , using rigorous statistical analysis of pooled research studies . This article presents guidelines for writing an evidence -based clinical review article for American Family Physician . First , the topic should be of common interest and relevance to family practice . Include a table of the continuing medical education objectives of the review . State how the literature search was done and include several sources of evidence -based review s , such as the Cochrane Collaboration , BMJ 's Clinical Evidence , or the InfoRetriever Web site . Where possible , use evidence based on clinical outcomes relating to morbidity , mortality , or quality of life , and studies of primary care population s. In articles su bmi tted to American Family Physician , rate the level of evidence for key recommendations according to the following scale : level A ( r and omized controlled trial [ RCT ] , meta- analysis ) ; level B ( other evidence ) ; level C ( consensus/expert opinion ) . Finally , provide a table of key summary points BACKGROUND To determine whether oropharyngeal dysphagia is a risk factor for readmission for pneumonia in elderly persons discharged from an acute geriatric unit . METHODS Observational prospect i ve cohort study with data collection based on clinical data bases and electronic clinical notes . All elderly individuals discharged from an acute geriatric unit from June 2002 to December 2009 were recruited and followed until death or December 31 , 2010 . All individuals were initially classified according to the presence of oropharyngeal dysphagia assessed by bedside clinical examination . Main outcome measure was readmission for pneumonia . Clinical notes were review ed by an expert clinician to verify diagnosis and classify pneumonia as aspiration or nonaspiration pneumonia . RESULTS A total of 2,359 patients ( 61.9 % women , mean age 84.9 y ) were recruited and followed for a mean of 24 months . Dysphagia was diagnosed in 47.5 % of cases . Overall , 7.9 % of individuals were readmitted for pneumonia during follow-up , 24.2 % of these had aspiration pneumonia . The incidence rate of hospital readmission for pneumonia was 3.67 readmissions per 100 person-years ( 95 % CI 3.0 - 4.4 ) in individuals without dysphagia and 6.7 ( 5.5 - 7.8 ) in those with dysphagia , with an attributable risk of 3.02 readmissions per 100 person-years ( 1.66 - 4.38 ) and a rate ratio of 1.82 ( 1.41 - 2.36 ) . Multivariate Cox regression showed an independent effect of oropharyngeal dysphagia , with a hazard ratio of 1.6 ( 1.15 - 2.2 ) for hospitalization for pneumonia , 4.48 ( 2.01 - 10.0 ) for aspiration pneumonia , and 1.44 ( 1.02 - 2.03 ) for nonaspiration pneumonia . CONCLUSION Oropharyngeal dysphagia is a very prevalent and relevant risk factor associated with hospital readmission for both aspiration and nonaspiration pneumonia in the very elderly persons Patients with treatment-resistant schizophrenia pose a major challenge to caregivers since only clozapine is documented as having superior efficacy in this population . Although olanzapine is similar to clozapine in structure and receptor profile , it has not been proven to have superior efficacy for this patient group . Nonetheless , olanzapine is being increasingly used in higher doses as clinicians attempt to find a more effective and tolerable therapy for refractory patients . Furthermore , there are little data comparing olanzapine and clozapine in this population . Thirteen patients participated in a r and omized double-blind 16-week crossover study of  clozapine therapy ( 450 mg/day ) compared to high doses of olanzapine ( 50 mg/day ) . No patients on olanzapine responded while 20 % responded to clozapine treatment . Olanzapine patients tended to experience higher rates of anticholinergic effects such as dry mouth ( 80 vs. 20 % ) and blurry vision ( 40 vs. 0 % ) . Clozapine-treated patients had higher rates of sialorrhea ( 80 vs. 10 % ) , sweating ( 50 vs. 10 % ) , dyspepsia ( 70 vs. 30 % ) , and lethargy ( 90 vs. 60 % ) . Neither treatment was associated with significant akathisia . Liver enzyme elevation and lipids were higher with clozapine treatment . Mean weight gain in the initial 8 weeks was 3.4 kg for olanzapine and 1.2 kg for clozapine . High doses of olanzapine during 8 weeks of treatment did not increase lipids and liver enzymes like clozapine did . Olanzapine at 50 mg/day may be associated with more anticholinergic effects and weight gain than clozapine The results are reported of a double-blind controlled trial of a recently introduced major tranquilizer thiothixene ( Navane , Pfizer ) against chlorpromazine in 24 chronic schizophrenics in the Royal Edinburgh Hospital , Edinburgh , Scotl and . Additionally , a limited experiment in withdrawal of routine  tranquilizers in these patients ( one month ) was carried out prior to the trial . Changes in manifest psychosis ( symptoms ) and social disability were assessed by the use of the Lorr scale ( IMPS ) and the Nurses ' Observation Scale for Inpatient Evaluation ( NOSIE ) at suitable intervals . The results indicated that thiothixene conferred no advantage over chlorpromazine in symptom relief or social improvement . Serial measures showed no significant change in these patients as a group when on active drugs as opposed to placebo , or with the course of time . 12.5 % of patients relapsed during the placebo period : these patients were younger than the non-relapsers and had received larger daily doses of phenothiazines prior to the trial 
    Output:
    
agent
***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: BACKGROUND Acute extrapyramidal side effects ( EPS ) are a common phenomenon of treatment with conventional antipsychotics . Previous studies found that clozapine has little propensity to cause EPS , while risperidone produces some EPS , but at levels lower than those of conventional antipsychotics . METHOD We compared the prevalence and severity of EPS in patients treated with clozapine , risperidone , or conventional antipsychotics for at least 3 months . Our main hypothesis was that there would be differences between the three treatment groups with regard to akathisia , measured with the Barnes Akathisia Scale , and extrapyramidal motor side effects ( rigidity , rigidity factor , tremor , salivation ) , measured with the Simpson-Angus scale . Secondarily , we were interested in possible differences between the three groups with respect to the anticholinergic comedication and the subjective impression of the patients , measured with the van Putten scale . RESULTS We studied 106 patients ( 41 patients treated with clozapine , 23 patients with risperidone , and 42 patients treated with conventional antipsychotics ) . The sample was 57.5 % male and had a mean + /- SD age of 36.6 + /- 9.3 years . The mean dose of antipsychotics  calculated in chlorpromazine equivalents was 425.6 + /- 197.1 mg/day in the clozapine group , 4.7 + /- 2.1 mg/day in the risperidone group , and 476.5 + /- 476.9 mg/day in the group treated with conventional antipsychotics . The point-prevalence of akathisia was 7.3 % in the clozapine group , 13 % in the risperidone group , and 23.8 % in the group treated with conventional antipsychotics . The point-prevalence of rigidity and cogwheeling respectively was 4.9 % and 2.4 % in the clozapine group , 17.4 % and 17.4 % in the risperidone group , and 35.7 % and 26.2 % in the group treated with conventional antipsychotics . CONCLUSION Our results indicate that risperidone is superior to conventional neuroleptics in that it causes fewer EPS . In comparison to clozapine , risperidone produces EPS levels that are intermediate between clozapine and conventional antipsychotic drugs Abstract The descriptive term behavioral and psychological symptoms of dementia ( BPSD ) is used to cover a range of noncognitive disturbances including anxiety , depression , irritability , aggression , agitation , eating disorders , and inappropriate social or sexual behaviors . Behavioral and psychological symptoms of dementia are seen in about 90 % of patients with dementia . We aim ed to compare the efficacy and tolerability of risperidone , yokukansan , and fluvoxamine used for BPSD in elderly patients with dementia . Ninety in patients with dementia according to the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition criteria were investigated in Sato Hospital , Koutokukai . We conducted an 8-week , rater-blinded , r and omized trial , administering flexibly dosed risperidone , yokukansan , or fluvoxamine . Primary outcome measures were Neuropsychiatric Inventory in Nursing Home Version total score and its items . Secondary outcome measures were cognitive function measured by Mini-Mental State Examination and daily life function measured by Functional Independence Measure ( FIM ) . Neurological adverse effects were measured by the Drug-Induced Extra-Pyramidal Symptoms Scale . At the end of the study , we analyzed 76 patients ( 92.7 % ) .  Mean Neuropsychiatric Inventory in Nursing Home Version total score decreased in all 3 drug groups , with no significant between-group differences . Mini-Mental State Examination and Functional Independence Measure scores did not change significantly . Drug-Induced Extra-Pyramidal Symptoms Scale scores did not change in the yokukansan and fluvoxamine groups , but increased significantly in the risperidone group . Risperidone , yokukansan , and fluvoxamine were equally effective in the treatment of BPSD in elderly patients . However , yokukansan or fluvoxamine for BPSD showed a more favorable profile in tolerability compared with risperidone . This trial is registered at UMIN Clinical Trials Registry ( identifier : UMIN000006146 ) Traditional clinical review articles , also known as up date s , differ from systematic review s and meta-analyses . Up date s selectively review the medical literature while discussing a topic broadly . Non-quantitative systematic review s comprehensively examine the medical literature , seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment . Meta-analyses ( quantitative systematic review s ) seek to answer a focused clinical question , using rigorous statistical analysis of pooled research studies . This article presents guidelines for writing an evidence -based clinical review article for American Family Physician . First , the topic should be of common interest and relevance to family practice . Include a table of the continuing medical education objectives of the review . State how the literature search was done and include several sources of evidence -based review s , such as the Cochrane Collaboration , BMJ 's Clinical Evidence , or the InfoRetriever Web site . Where possible , use evidence based on clinical outcomes relating to morbidity , mortality , or quality of life , and studies of primary care population s. In articles su bmi tted to American Family Physician , rate the level of evidence for key recommendations according to the following scale : level A ( r and omized controlled trial [ RCT ] , meta- analysis ) ; level B ( other evidence ) ; level C ( consensus/expert opinion ) . Finally , provide a table of key summary points BACKGROUND To determine whether oropharyngeal dysphagia is a risk factor for readmission for pneumonia in elderly persons discharged from an acute geriatric unit . METHODS Observational prospect i ve cohort study with data collection based on clinical data bases and electronic clinical notes . All elderly individuals discharged from an acute geriatric unit from June 2002 to December 2009 were recruited and followed until death or December 31 , 2010 . All individuals were initially classified according to the presence of oropharyngeal dysphagia assessed by bedside clinical examination . Main outcome measure was readmission for pneumonia . Clinical notes were review ed by an expert clinician to verify diagnosis and classify pneumonia as aspiration or nonaspiration pneumonia . RESULTS A total of 2,359 patients ( 61.9 % women , mean age 84.9 y ) were recruited and followed for a mean of 24 months . Dysphagia was diagnosed in 47.5 % of cases . Overall , 7.9 % of individuals were readmitted for pneumonia during follow-up , 24.2 % of these had aspiration pneumonia . The incidence rate of hospital readmission for pneumonia was 3.67 readmissions per 100 person-years ( 95 % CI 3.0 - 4.4 ) in individuals without dysphagia and 6.7 ( 5.5 - 7.8 ) in those with dysphagia , with an attributable risk of 3.02 readmissions per 100 person-years ( 1.66 - 4.38 ) and a rate ratio of 1.82 ( 1.41 - 2.36 ) . Multivariate Cox regression showed an independent effect of oropharyngeal dysphagia , with a hazard ratio of 1.6 ( 1.15 - 2.2 ) for hospitalization for pneumonia , 4.48 ( 2.01 - 10.0 ) for aspiration pneumonia , and 1.44 ( 1.02 - 2.03 ) for nonaspiration pneumonia . CONCLUSION Oropharyngeal dysphagia is a very prevalent and relevant risk factor associated with hospital readmission for both aspiration and nonaspiration pneumonia in the very elderly persons Patients with treatment-resistant schizophrenia pose a major challenge to caregivers since only clozapine is documented as having superior efficacy in this population . Although olanzapine is similar to clozapine in structure and receptor profile , it has not been proven to have superior efficacy for this patient group . Nonetheless , olanzapine is being increasingly used in higher doses as clinicians attempt to find a more effective and tolerable therapy for refractory patients . Furthermore , there are little data comparing olanzapine and clozapine in this population . Thirteen patients participated in a r and omized double-blind 16-week crossover study of  clozapine therapy ( 450 mg/day ) compared to high doses of olanzapine ( 50 mg/day ) . No patients on olanzapine responded while 20 % responded to clozapine treatment . Olanzapine patients tended to experience higher rates of anticholinergic effects such as dry mouth ( 80 vs. 20 % ) and blurry vision ( 40 vs. 0 % ) . Clozapine-treated patients had higher rates of sialorrhea ( 80 vs. 10 % ) , sweating ( 50 vs. 10 % ) , dyspepsia ( 70 vs. 30 % ) , and lethargy ( 90 vs. 60 % ) . Neither treatment was associated with significant akathisia . Liver enzyme elevation and lipids were higher with clozapine treatment . Mean weight gain in the initial 8 weeks was 3.4 kg for olanzapine and 1.2 kg for clozapine . High doses of olanzapine during 8 weeks of treatment did not increase lipids and liver enzymes like clozapine did . Olanzapine at 50 mg/day may be associated with more anticholinergic effects and weight gain than clozapine The results are reported of a double-blind controlled trial of a recently introduced major tranquilizer thiothixene ( Navane , Pfizer ) against chlorpromazine in 24 chronic schizophrenics in the Royal Edinburgh Hospital , Edinburgh , Scotl and . Additionally , a limited experiment in withdrawal of routine  tranquilizers in these patients ( one month ) was carried out prior to the trial . Changes in manifest psychosis ( symptoms ) and social disability were assessed by the use of the Lorr scale ( IMPS ) and the Nurses ' Observation Scale for Inpatient Evaluation ( NOSIE ) at suitable intervals . The results indicated that thiothixene conferred no advantage over chlorpromazine in symptom relief or social improvement . Serial measures showed no significant change in these patients as a group when on active drugs as opposed to placebo , or with the course of time . 12.5 % of patients relapsed during the placebo period : these patients were younger than the non-relapsers and had received larger daily doses of phenothiazines prior to the trial 
    Output:
    