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: Objective In Australian residential aged care facilities ( RACFs ) , the use of certain classes of high-risk medication such as antipsychotics , potent analgesics , and sedatives is high . Here , we examined the prescribed medications and subsequent changes recommended by geriatricians during comprehensive geriatric consultations provided to residents of RACFs via videoconference .  Design This is a prospect i ve observational study . Setting Four RACFs in Queensl and , Australia , are included . Participants A total of 153 residents referred by general practitioners for comprehensive assessment by geriatricians delivered by video-consultation .  Results Residents ’ mean ( st and ard deviation , SD ) age was 83.0 ( 8.1 ) years and 64.1 % were female . They had multiple comorbidities ( mean 6 ) , high levels of dependency , and were prescribed a mean ( SD ) of 9.6 ( 4.2 ) regular medications . Ninety-one percent of patients were taking five or more medications daily . Of total medications prescribed ( n=1,469 ) , geriatricians recommended withdrawal of 9.8 % ( n=145 ) and dose alteration of 3.5 % ( n=51 ) . New medications were initiated in 47.7 % ( n=73 ) patients . Of the 10.3 % ( n=151 ) medications considered as high risk , 17.2 % were stopped and dose altered in 2.6 % . Conclusion There was a moderate prevalence of potentially inappropriate high-risk medications . However , geriatricians made relatively few changes , suggesting either that , on balance , prescription of these medications was appropriate or , because of other factors , there was a reluctance to adjust medications . A structured medication review using an algorithm for withdrawing medications of high disutility might help optimize medications in frail patients . Further research , including a broader survey , is required to underst and these dynamics Purpose To assess whether comprehensive medication review s conducted by clinical pharmacists as part of a healthcare team reduce drug-related hospital readmission rates among people with dementia or cognitive impairment . Methods This r and omized controlled trial was carried out between January 9 , 2012 , and December 2 , 2014 . Patients aged ≥65 years with dementia or cognitive impairment admitted to three wards at two hospitals located in Northern Sweden were included . Results Of the 473 deemed eligible for participation , 230 were r and omized to intervention and 230 to control group by block r and omization . The primary outcome , risk of drug-related hospital readmissions , was assessed at 180 days of follow-up by intention-to-treat analysis .During the 180 days of follow-up , 18.9 % ( 40/212 ) of patients in the intervention group and 23.0 % ( 50/217 ) of those in the control group were readmitted for drug-related reasons ( HR = 0.80 , 95 % CI = 0.53–1.21 , p = 0.28 , univariable Cox regression ) . Heart failure was significantly more common in the intervention group . After adjustment for heart failure as a potential confounder and an interaction term , multiple Cox regression analysis indicated that pharmacist participation significantly reduced the risk of drug-related readmissions ( HR = 0.49 , 95 % CI = 0.27–0.90 , p = 0.02 ) . A post-hoc analysis showed a significantly reduced risk of 30-day readmissions due to drug-related problems in the total sample ( without adjustment for heart failure ) . Conclusion Participation of clinical pharmacists in healthcare team conducting comprehensive medication review s did not significantly reduce the risk of drug-related readmissions in patients with dementia or cognitive impairment ; however , post-hoc and subgroup analyses indicated significant effects favoring the intervention . More research is needed . Trial registration : Clinical trials NCT01504672 Age-associated physiological changes and extensive drug treatment including use of potentially inappropriate medications ( PIMs ) pose a significant risk of drug – drug interactions and adverse drug events among elderly people with dementia . This study aim ed at analysing the effects of clinical pharmacists ’ interventions on use of PIMs , risk of emergency department visits , and time to institutionalization . Furthermore , a descriptive analysis was conducted of circumstances associated with drug-related readmissions . This is a secondary analysis of data from a r and omized controlled intervention study conducted in two hospitals in Northern Sweden . The study included patients ( n = 460 ) 65 years or older with dementia or cognitive impairment . The intervention consisted of comprehensive medication review s conducted by clinical pharmacists as part of a healthcare team . There was a larger decrease in PIMs in the intervention group compared with the control group ( p = 0.011 ) . No significant difference was found in time to first all-cause emergency department visits ( HR = 0.994 , 95 % CI = 0.755–1.307 p = 0.963 , simple Cox regression ) or time to institutionalization ( HR = 0.761 , 95 % CI = 0.409–1.416 p = 0.389 , simple Cox regression ) within 180 days . Common reasons for drug-related readmissions were negative effects of sedatives , opioids , antidepressants , and anticholinergic agents , result ing in confusion , falling , and sedation . Drug-related readmissions were associated with living at home , heart failure , and diabetes . Pharmacist-provided interventions were able to reduce PIMs among elderly people with dementia and cognitive impairment Background Drug-related problems , including medication errors and adverse drug events , are common among old people . Due to , for example , greater susceptibility to side effects , people with dementia are even more at risk of drug-related problems . The objectives of this study were to assess the occurrence and character of drug-related problems found among old people with dementia or cognitive impairment . Methods Data from a r and omized controlled clinical trial exploring the effects of a pharmacist intervention as part of a hospital ward team in patients 65 years and older with dementia or cognitive impairment were used . The study was conducted between 2012 and 2014 in the orthopedic and medicine wards in two hospitals located in Northern Sweden . Drug-related problems identified in this patient group were classified and described , and associations with different factors were investigated . Results Clinical pharmacists identified at least one DRP in 66 % ( 140/212 ) of participants in the intervention group , for a total of 310 DRPs . Ineffective drug/inappropriate drug and unnecessary drug therapy were the most common drug-related problems . Discontinuation of drug therapy was the most common action carried out . Drug-related problems were more common among people prescribed a larger number of drugs and among people with an earlier stroke . Conclusions Drug-related problems are common among people with dementia and cognitive impairment . Comprehensive medication review s conducted by clinical pharmacists as part of a health care team might be important to prevent , identify and solve these problems 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 BACKGROUND Potentially inappropriate medications and prescription omissions ( PO ) are highly prevalent in older patients with mental comorbidities . OBJECTIVE To evaluate the effect of interdisciplinary geriatric and psychiatric care on the appropriateness of prescribing . DESIGN Prospect i ve and interventional study . SETTING Medical-psychiatric unit in an academic geriatric department . PARTICIPANTS Participants were 150 consecutive acutely ill patients aged on average 80.0 ± 8.1 years suffering from mental comorbidities and hospitalized for any acute somatic condition . INTERVENTION From admission to discharge , daily collaboration provided by senior geriatrician and psychiatrist working in a usual geriatric interdisciplinary care team .  MEASUREMENTS Potentially inappropriate medications and PO were detected and recorded by a trained independent investigator using STOPP/START criteria at admission and discharge . RESULTS Compared with admission , the intervention reduced the total number of medications prescribed at discharge from 1347 to 790 ( P < .0001 ) and incidence rates for potentially inappropriate medications and PO reduced from 77 % to 19 % ( P < .0001 ) and from 65 % to 11 % ( P < .0001 ) , respectively . Independent predictive factors for PIP at discharge were being a faller ( odds ratio [ OR ] 1.85 ; 95 % confidence interval [ CI ] 1.43 - 2.09 ) and for PO , the increased number of medications ( OR 1.54 ; 95 % CI 1.13 - 1.89 ) and a Charlson comorbidity index greater than 2 ( OR 1.85 ; 95 % CI 1.38 - 2.13 ) . Dementia and /or presence of psychiatric comorbidities were predictive factors for both potentially inappropriate medications and PO at discharge . CONCLUSION These findings hold substantial promise for the prevention of IP and OP in such a comorbid and polymedicated population . Further evaluations are , however , still needed to determine if such an intervention reduces potentially inappropriate prescribing medication-related outcomes , such as incidence of adverse drug events , rehospitalization , or mortality 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 Inappropriate medical treatment of co-morbidities in Alzheimer 's disease ( AD ) is an increasing concern in geriatric medicine . The objective of this study was to compare current drug use related to co-morbidity between individuals with a recent diagnosis of AD and a cognitively healthy control group in a population based clinical trial in Northern Norway . Methods Setting : Nine rural municipalities with 70 000 inhabitants in Northern Norway . Participants : Participants with and without AD recruited in general practice and by population based screening.187 participants with a recent diagnosis of AD were recruited among community dwellers . Of 791 respondents without cognitive symptoms , 500 were r and omly selected and invited to further clinical and cognitive testing . The final control group consisted of 200 cognitively healthy individuals from the same municipalities . Demographic characteristics , data on medical history and current medication were included , and a physical and cognitive examination was performed . The statistical analyses were carried out by independent sample t-test , chi-square , ANCOVA and logistic regression . Results A co-morbidity score was significantly higher in AD participants compared to controls . The mean number of drugs was higher for AD participants compared to controls ( 5.1 ± 3.6 and 2.9 ± 2.4 respectively , p < 0.001 age and gender adjusted ) , also when adjusted for co-morbidity . AD participants used significantly more  anticholinergic , sedative and antidepressant drugs . For nursing home residents with AD  the mean number of drugs was significantly higher compared to AD participants living at home ( 6.9 ± 3.9 and 4.5 ± 3.3 , respectively , p < 0.001 ) . Conclusions AD participants were treated with a significantly higher number of drugs as compared to cognitively healthy controls , even after adjustment for co-morbid 
    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: Objective In Australian residential aged care facilities ( RACFs ) , the use of certain classes of high-risk medication such as antipsychotics , potent analgesics , and sedatives is high . Here , we examined the prescribed medications and subsequent changes recommended by geriatricians during comprehensive geriatric consultations provided to residents of RACFs via videoconference .  Design This is a prospect i ve observational study . Setting Four RACFs in Queensl and , Australia , are included . Participants A total of 153 residents referred by general practitioners for comprehensive assessment by geriatricians delivered by video-consultation .  Results Residents ’ mean ( st and ard deviation , SD ) age was 83.0 ( 8.1 ) years and 64.1 % were female . They had multiple comorbidities ( mean 6 ) , high levels of dependency , and were prescribed a mean ( SD ) of 9.6 ( 4.2 ) regular medications . Ninety-one percent of patients were taking five or more medications daily . Of total medications prescribed ( n=1,469 ) , geriatricians recommended withdrawal of 9.8 % ( n=145 ) and dose alteration of 3.5 % ( n=51 ) . New medications were initiated in 47.7 % ( n=73 ) patients . Of the 10.3 % ( n=151 ) medications considered as high risk , 17.2 % were stopped and dose altered in 2.6 % . Conclusion There was a moderate prevalence of potentially inappropriate high-risk medications . However , geriatricians made relatively few changes , suggesting either that , on balance , prescription of these medications was appropriate or , because of other factors , there was a reluctance to adjust medications . A structured medication review using an algorithm for withdrawing medications of high disutility might help optimize medications in frail patients . Further research , including a broader survey , is required to underst and these dynamics Purpose To assess whether comprehensive medication review s conducted by clinical pharmacists as part of a healthcare team reduce drug-related hospital readmission rates among people with dementia or cognitive impairment . Methods This r and omized controlled trial was carried out between January 9 , 2012 , and December 2 , 2014 . Patients aged ≥65 years with dementia or cognitive impairment admitted to three wards at two hospitals located in Northern Sweden were included . Results Of the 473 deemed eligible for participation , 230 were r and omized to intervention and 230 to control group by block r and omization . The primary outcome , risk of drug-related hospital readmissions , was assessed at 180 days of follow-up by intention-to-treat analysis .During the 180 days of follow-up , 18.9 % ( 40/212 ) of patients in the intervention group and 23.0 % ( 50/217 ) of those in the control group were readmitted for drug-related reasons ( HR = 0.80 , 95 % CI = 0.53–1.21 , p = 0.28 , univariable Cox regression ) . Heart failure was significantly more common in the intervention group . After adjustment for heart failure as a potential confounder and an interaction term , multiple Cox regression analysis indicated that pharmacist participation significantly reduced the risk of drug-related readmissions ( HR = 0.49 , 95 % CI = 0.27–0.90 , p = 0.02 ) . A post-hoc analysis showed a significantly reduced risk of 30-day readmissions due to drug-related problems in the total sample ( without adjustment for heart failure ) . Conclusion Participation of clinical pharmacists in healthcare team conducting comprehensive medication review s did not significantly reduce the risk of drug-related readmissions in patients with dementia or cognitive impairment ; however , post-hoc and subgroup analyses indicated significant effects favoring the intervention . More research is needed . Trial registration : Clinical trials NCT01504672 Age-associated physiological changes and extensive drug treatment including use of potentially inappropriate medications ( PIMs ) pose a significant risk of drug – drug interactions and adverse drug events among elderly people with dementia . This study aim ed at analysing the effects of clinical pharmacists ’ interventions on use of PIMs , risk of emergency department visits , and time to institutionalization . Furthermore , a descriptive analysis was conducted of circumstances associated with drug-related readmissions . This is a secondary analysis of data from a r and omized controlled intervention study conducted in two hospitals in Northern Sweden . The study included patients ( n = 460 ) 65 years or older with dementia or cognitive impairment . The intervention consisted of comprehensive medication review s conducted by clinical pharmacists as part of a healthcare team . There was a larger decrease in PIMs in the intervention group compared with the control group ( p = 0.011 ) . No significant difference was found in time to first all-cause emergency department visits ( HR = 0.994 , 95 % CI = 0.755–1.307 p = 0.963 , simple Cox regression ) or time to institutionalization ( HR = 0.761 , 95 % CI = 0.409–1.416 p = 0.389 , simple Cox regression ) within 180 days . Common reasons for drug-related readmissions were negative effects of sedatives , opioids , antidepressants , and anticholinergic agents , result ing in confusion , falling , and sedation . Drug-related readmissions were associated with living at home , heart failure , and diabetes . Pharmacist-provided interventions were able to reduce PIMs among elderly people with dementia and cognitive impairment Background Drug-related problems , including medication errors and adverse drug events , are common among old people . Due to , for example , greater susceptibility to side effects , people with dementia are even more at risk of drug-related problems . The objectives of this study were to assess the occurrence and character of drug-related problems found among old people with dementia or cognitive impairment . Methods Data from a r and omized controlled clinical trial exploring the effects of a pharmacist intervention as part of a hospital ward team in patients 65 years and older with dementia or cognitive impairment were used . The study was conducted between 2012 and 2014 in the orthopedic and medicine wards in two hospitals located in Northern Sweden . Drug-related problems identified in this patient group were classified and described , and associations with different factors were investigated . Results Clinical pharmacists identified at least one DRP in 66 % ( 140/212 ) of participants in the intervention group , for a total of 310 DRPs . Ineffective drug/inappropriate drug and unnecessary drug therapy were the most common drug-related problems . Discontinuation of drug therapy was the most common action carried out . Drug-related problems were more common among people prescribed a larger number of drugs and among people with an earlier stroke . Conclusions Drug-related problems are common among people with dementia and cognitive impairment . Comprehensive medication review s conducted by clinical pharmacists as part of a health care team might be important to prevent , identify and solve these problems 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 BACKGROUND Potentially inappropriate medications and prescription omissions ( PO ) are highly prevalent in older patients with mental comorbidities . OBJECTIVE To evaluate the effect of interdisciplinary geriatric and psychiatric care on the appropriateness of prescribing . DESIGN Prospect i ve and interventional study . SETTING Medical-psychiatric unit in an academic geriatric department . PARTICIPANTS Participants were 150 consecutive acutely ill patients aged on average 80.0 ± 8.1 years suffering from mental comorbidities and hospitalized for any acute somatic condition . INTERVENTION From admission to discharge , daily collaboration provided by senior geriatrician and psychiatrist working in a usual geriatric interdisciplinary care team .  MEASUREMENTS Potentially inappropriate medications and PO were detected and recorded by a trained independent investigator using STOPP/START criteria at admission and discharge . RESULTS Compared with admission , the intervention reduced the total number of medications prescribed at discharge from 1347 to 790 ( P < .0001 ) and incidence rates for potentially inappropriate medications and PO reduced from 77 % to 19 % ( P < .0001 ) and from 65 % to 11 % ( P < .0001 ) , respectively . Independent predictive factors for PIP at discharge were being a faller ( odds ratio [ OR ] 1.85 ; 95 % confidence interval [ CI ] 1.43 - 2.09 ) and for PO , the increased number of medications ( OR 1.54 ; 95 % CI 1.13 - 1.89 ) and a Charlson comorbidity index greater than 2 ( OR 1.85 ; 95 % CI 1.38 - 2.13 ) . Dementia and /or presence of psychiatric comorbidities were predictive factors for both potentially inappropriate medications and PO at discharge . CONCLUSION These findings hold substantial promise for the prevention of IP and OP in such a comorbid and polymedicated population . Further evaluations are , however , still needed to determine if such an intervention reduces potentially inappropriate prescribing medication-related outcomes , such as incidence of adverse drug events , rehospitalization , or mortality 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 Inappropriate medical treatment of co-morbidities in Alzheimer 's disease ( AD ) is an increasing concern in geriatric medicine . The objective of this study was to compare current drug use related to co-morbidity between individuals with a recent diagnosis of AD and a cognitively healthy control group in a population based clinical trial in Northern Norway . Methods Setting : Nine rural municipalities with 70 000 inhabitants in Northern Norway . Participants : Participants with and without AD recruited in general practice and by population based screening.187 participants with a recent diagnosis of AD were recruited among community dwellers . Of 791 respondents without cognitive symptoms , 500 were r and omly selected and invited to further clinical and cognitive testing . The final control group consisted of 200 cognitively healthy individuals from the same municipalities . Demographic characteristics , data on medical history and current medication were included , and a physical and cognitive examination was performed . The statistical analyses were carried out by independent sample t-test , chi-square , ANCOVA and logistic regression . Results A co-morbidity score was significantly higher in AD participants compared to controls . The mean number of drugs was higher for AD participants compared to controls ( 5.1 ± 3.6 and 2.9 ± 2.4 respectively , p < 0.001 age and gender adjusted ) , also when adjusted for co-morbidity . AD participants used significantly more  anticholinergic , sedative and antidepressant drugs . For nursing home residents with AD  the mean number of drugs was significantly higher compared to AD participants living at home ( 6.9 ± 3.9 and 4.5 ± 3.3 , respectively , p < 0.001 ) . Conclusions AD participants were treated with a significantly higher number of drugs as compared to cognitively healthy controls , even after adjustment for co-morbid 
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