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: Australian palliative care is delivered by general practitioners ( GPs ) and specialist palliative care teams . Patient outcomes should improve if they work in formal partnership . We conducted a multi-centred r and omised controlled trial of  specialist- GP case conferences , with the GP participating by teleconference , or usual care and communication methods . Primary outcome measure was global Quality of Life ( QoL ) scores at 3 weeks from intervention . Secondary measures included subscale QoL scores and carer burden . Two a priori intention-to-treat analyses were conducted using recruitment , and time of death , as fixed time points . There was no difference between groups in the magnitude of change in global QoL measures from baseline to any time point up to 9 weeks post-case conference , or at any time before death . The case conference group showed better maintenance of some physical and mental health measures of QoL in the 35 days before death . Case conferences may improve clinical relationships and care plans at referral , which are not implemented until severe symptoms develop . Case conferences between GPs and specialist palliative care services may be warranted for palliative care patients OBJECTIVE This study evaluated the impact of an eight-session training program for aged care staff  in managing dementia-related challenging behaviours .  Participation in the training program with an additional five-session peer support group was compared with both participation in training only and a wait-list control condition . METHODS Outcomes were evaluated for 90 participating staff members and 113 residents with challenging behaviours from six aged care facilities . Measures of staff attitudes and the behaviours of staff and residents were collected pre- and post-intervention , and at six month follow-up . RESULTS Staff members in both dementia training groups reported improved attitudes regarding their knowledge and skills in managing residents with challenging behaviours , immediately after the training and six months later . Facility supervisors rated the nursing performance of trained staff more positively , particularly those who participated in a peer support group . The dementia training programs , whether with or without the inclusion of peer support , did not impact on levels of staff burnout or substantially reduce the level of challenging behaviours among aged care residents . CONCLUSIONS While training programs may impact positively on staff performance , organisational characteristics of aged care facilities , including low levels of management support for staff training initiatives , limit the potential outcomes . Method ological limitations are discussed Behaviours , viewed by nurses as dem and ing , performed by patients with severe dementia were investigated during one year of intervention . Supervised implementation of individually planned care and systematic clinical supervision were implemented on one experimental ward ( EW ) while another ward ( CW ) served as control . Each ward had 11 patients . At baseline and after 6 and 12 months of intervention structured interviews with the patients ' assigned nurses were conducted based on the Dem and ing Behaviour Assessment Scale and Multi Dimensional Dementia Assessment Scale . At the EW there was a decreased frequency ( p=0.000 ) and a reduced occurrence of physical behaviours ( p=0.008 ) , a decreased frequency ( p=0.029 ) and a reduced occurrence of vocal behaviours ( p=0.002 ) . No significant changes were seen at the CW . Bearing the small sample size in mind , the findings indicate that individually planned care and systematic clinical supervision could be a means of reducing the frequency , and /or effect the nurses ' attitude and interpretation of the patients ' behaviour as dem and ing . The findings , however , can only be seen as indications for further research , but point to the importance of including effect variables related to patients when intervening in nursing care Aim of study : This study sought to determine whether multidisciplinary case conference review s improved outcomes for nursing home residents , and the effects of this team approach to resident care on carers , including the h and s-on carers employed by the nursing home , and health professionals . Method : 245 residents of three Canberra nursing homes were enrolled in this non-r and omised controlled trial . The intervention consisted of sessions of three case conference review s held between 10/4sol;96 and 4sol;12sol;96 . These sessions were attended by the General Practitioners ( GPs ) of the residents discussed , the GP project officer from the ACT Division of General Practice , a clinical pharmacist , senior nursing staff , other health professionals eg physiotherapist , and occasionally the resident concerned or their representative . At each review , a case presentation by the resident 's GP was followed by a multidisciplinary discussion of all aspects , medical and non-medical , of the resident 's care . The review concluded with a management plan for the resident . In total 75 residents were review ed . Main outcome measures : Medication use and cost , and mortality . Results : One month after the review s were completed comparisons between those who were review ed and those who were not showed non-significant reductions in medication orders , medication cost , and mortality in the review ed group . Many of the 92 recommendations in the management plans that were carried out benefited the residents ( n=37 ) and /or carers ( n=24 ) . The responses of the GPs and the Directors of Nursing to the review s were overwhelmingly positive . Conclusion : Recommendations arising from multidisciplinary case conferences were carried out to the benefit of patients and carers . Given the support shown by key stakeholders , multidisciplinary conferences should be used more An intervention consisting of individualized planned care for patients and regular clinical systematic supervision for nurses  was carried out on a ward for dementia care ( the experimental ward , EW ) . On a similar control ward ( CW ) , no changes were made . Observations of  nurse-patient  cooperation during morning care were collected at both wards , before and during the intervention . The observations ( N = 107 ) were analyzed blindly and sorted into already-developed categories . The distribution of the cooperation-style categories was then analyzed statistically . The patients who survived throughout the study period ( N = 18 ) were also compared over time . Nurse-patient cooperation at the EW improved significantly during the intervention period , whereas , at the CW , it deteriorated ( p = .02 ) . Status of surviving patients followed the same pattern ( p = .001 ) . The findings indicate that such interventions can improve the quality of nurse-patient cooperation in dementia care BACKGROUND The adverse effects of behavioral and psychological symptoms of dementia ( BPSD ) are well described but treatment remains problematical , including overuse of psychotropic medication . This study aims to compare the outcome of two approaches to BPSD , one focusing on causality and using predominantly psychosocial interventions , the other relying predominantly on psychotropic medication . METHODS Thirty-three residential care clients manifesting BPSD who had been referred to a community psychogeriatric service ( intervention group ) were assessed and treated , with the focus placed on the causes of the behavior and why it was perceived as a problem by nursing staff . Cases were managed primarily by psychosocial means with psychopharmacology as an adjunct . A control group was made up of 22 referrals to an adjacent service , which used primarily psychopharmacology with psychosocial methods as an occasional adjunct . RESULTS Measures of behavior and staff response showed significant improvement in both groups at two- and five-months ' follow-up .  Antipsychotic use in the intervention group decreased over time while in the control group it increased . Service measures showed both groups required approximately the same number of clinical visits but the intervention group experienced fewer medication changes , fewer drug side effects , and all but one case could be treated in situ . Five control group participants spent extended periods as in patients in a psychogeriatric unit . Minor sampling differences did not affect the results , and neither they nor the nature of the behavior explained the difference in clinical approach . CONCLUSION The causality-focused approach appears to be as effective as the more common predominantly pharmacological approach , and appears to involve lower human and financial costs OBJECTIVES To test the premise that individually tailored psychosocial , nursing and medical interventions to nursing home residents with dementia will reduce the frequency and severity of behavioural symptoms . METHODS A four-member team comprising a psychiatrist , psychologist and nurses conducted detailed assessment s of 99 nursing home residents with advanced dementia who were rated by staff as having frequent , severe behavioural disturbances . Residents were then r and omly assigned to an ' early ' or ' late ' intervention group and observed for four weeks . Interventions encompassed psychosocial strategies , nursing approaches , psychotropic medications and management of pain . Outcome measures included the frequency and severity of disruptive behaviours and assessment s of change by senior nursing home staff . RESULTS While improvements in behaviour were noted in both groups from the outset of observations , pointing to a powerful Hawthorne effect , consultancies were associated with a modest but statistically significant decrease in challenging behaviours . Staff assessment s of the interventions were highly favourable . CONCLUSIONS The consultancies were effective and well received by staff . The change-inducing nature of any new endeavour is an integral part of research in a long-term setting AIM The study aims to compare clients using institutions of geriatric day-care to residents in homes for the elderly with regard to functional impairment , dementia disorders , behavior problems and the care situation . METHODS A cross-sectional study of 17 geriatric day-care facilities in eight towns and cities in Baden examined the data for all 257 clients who received care on a given reference date . These clients were compared to a reference population drawn from all residents ( N = 1,387 ) of 15 r and omly selected residential and nursing homes in the city of Mannheim , whereby identical assessment procedures were used by qualified nursing staff . RESULTS The average age of subjects in both groups was around 80 years , over three-fourths of whom were women . Home residents were more limited than the clients of geriatric day-care facilities  with regard to their activities of daily living , above all with regard to their mobility . The percentage of moderate to severe dementia disorders at 58.6 % was equally high in both groups . In addition , symptoms of depression and behavior problems were observed among a substantial number of the day-care clients . While the inpatient sector places greater emphasis on basic care and treatment , day-care institutions focus primarily on measures of social therapy .  CONCLUSIONS The high percentage of demented yet still mobile clients in day-care facilities indicates the particular importance of this target group when it comes to providing at least partial stress relief for family care-givers BACKGROUND efficient strategies are needed to provide specialist advice in nursing homes to ensure quality medical care . We describe a case conference intervention involving a multidisciplinary team of health professionals . OBJECTIVES to evaluate the impact of multidisciplinary case conferences on the appropriateness of medications and on patient behaviours in high-level residential aged care facilities . DESIGN cluster-r and omised controlled trial . SETTING ten high-level aged care facilities . PARTICIPANTS 154 residents with medication problems and /or challenging behaviours were selected for case conference by residential care staff . INTERVENTION two multidisciplinary case conferences involving the resident 's general practitioner , a geriatrician , a pharmacist and residential care staff were held at the nursing home for each resident . MEASUREMENTS outcomes were assessed at baseline and 3 months . The primary outcome was the Medication Appropriateness Index ( MAI ) . The behaviour of each resident was assessed via the Nursing Home Behaviour Problem Scale . RESULTS 45 residents died  before follow-up . Medication appropriateness improved in the intervention group [ MAI mean change 4.1 , 95 % confidence interval ( CI ) 2.1 - 6.1 ] compared with the control group ( MAI mean change 0.4 , 95 % CI -0.4 - 1.2 ; P < 0.001 ) . There was a significant reduction in the MAI for benzodiazepines ( mean change control -0.38 , 95 % CI -1.02 - 0.27 versus intervention 0.73 , 95 % CI 0.16 - 1.30 ; P = 0.017 ) . Resident behaviours were unchanged after the intervention and the improved medication appropriateness did not extend to other residents in the facility . CONCLUSION multidisciplinary case conferences in nursing homes can improve care . Outreach specialist services can be delivered without direct patient contact and achieve improvements in prescribing This study was design ed to investigate the impact of staff education on the behaviour and quality of life of residents with dementia and on staff members ’ attitudes about working with people with dementia and level of burnout .  Staff from three aged care facilities participated in the study ( n = 52 ) . These facilities were r and omly assigned to one of two intervention groups or a control group . Staff assigned to the intervention groups received an eight-week behaviourally-based programme . Staff from one aged care facility also participated in a peer support group design ed to reinforce educational material and facilitate positive changes among staff members . Behavioural symptoms displayed by residents ( n = 76 ) in each of the facilities were also assessed . Assessment s were conducted at pre-intervention , post-intervention , three- and six-month follow-up . The results of this study indicated that education or peer support was not associated with an improvement in resident behaviour or quality of life . Education or peer support also did not impact on staff members ’ level of burnout . There was , however , a change in staff members ’ attitudes about working with people with dementia . Possible explanations for these findings and implication for further research are considered 
    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: Australian palliative care is delivered by general practitioners ( GPs ) and specialist palliative care teams . Patient outcomes should improve if they work in formal partnership . We conducted a multi-centred r and omised controlled trial of  specialist- GP case conferences , with the GP participating by teleconference , or usual care and communication methods . Primary outcome measure was global Quality of Life ( QoL ) scores at 3 weeks from intervention . Secondary measures included subscale QoL scores and carer burden . Two a priori intention-to-treat analyses were conducted using recruitment , and time of death , as fixed time points . There was no difference between groups in the magnitude of change in global QoL measures from baseline to any time point up to 9 weeks post-case conference , or at any time before death . The case conference group showed better maintenance of some physical and mental health measures of QoL in the 35 days before death . Case conferences may improve clinical relationships and care plans at referral , which are not implemented until severe symptoms develop . Case conferences between GPs and specialist palliative care services may be warranted for palliative care patients OBJECTIVE This study evaluated the impact of an eight-session training program for aged care staff  in managing dementia-related challenging behaviours .  Participation in the training program with an additional five-session peer support group was compared with both participation in training only and a wait-list control condition . METHODS Outcomes were evaluated for 90 participating staff members and 113 residents with challenging behaviours from six aged care facilities . Measures of staff attitudes and the behaviours of staff and residents were collected pre- and post-intervention , and at six month follow-up . RESULTS Staff members in both dementia training groups reported improved attitudes regarding their knowledge and skills in managing residents with challenging behaviours , immediately after the training and six months later . Facility supervisors rated the nursing performance of trained staff more positively , particularly those who participated in a peer support group . The dementia training programs , whether with or without the inclusion of peer support , did not impact on levels of staff burnout or substantially reduce the level of challenging behaviours among aged care residents . CONCLUSIONS While training programs may impact positively on staff performance , organisational characteristics of aged care facilities , including low levels of management support for staff training initiatives , limit the potential outcomes . Method ological limitations are discussed Behaviours , viewed by nurses as dem and ing , performed by patients with severe dementia were investigated during one year of intervention . Supervised implementation of individually planned care and systematic clinical supervision were implemented on one experimental ward ( EW ) while another ward ( CW ) served as control . Each ward had 11 patients . At baseline and after 6 and 12 months of intervention structured interviews with the patients ' assigned nurses were conducted based on the Dem and ing Behaviour Assessment Scale and Multi Dimensional Dementia Assessment Scale . At the EW there was a decreased frequency ( p=0.000 ) and a reduced occurrence of physical behaviours ( p=0.008 ) , a decreased frequency ( p=0.029 ) and a reduced occurrence of vocal behaviours ( p=0.002 ) . No significant changes were seen at the CW . Bearing the small sample size in mind , the findings indicate that individually planned care and systematic clinical supervision could be a means of reducing the frequency , and /or effect the nurses ' attitude and interpretation of the patients ' behaviour as dem and ing . The findings , however , can only be seen as indications for further research , but point to the importance of including effect variables related to patients when intervening in nursing care Aim of study : This study sought to determine whether multidisciplinary case conference review s improved outcomes for nursing home residents , and the effects of this team approach to resident care on carers , including the h and s-on carers employed by the nursing home , and health professionals . Method : 245 residents of three Canberra nursing homes were enrolled in this non-r and omised controlled trial . The intervention consisted of sessions of three case conference review s held between 10/4sol;96 and 4sol;12sol;96 . These sessions were attended by the General Practitioners ( GPs ) of the residents discussed , the GP project officer from the ACT Division of General Practice , a clinical pharmacist , senior nursing staff , other health professionals eg physiotherapist , and occasionally the resident concerned or their representative . At each review , a case presentation by the resident 's GP was followed by a multidisciplinary discussion of all aspects , medical and non-medical , of the resident 's care . The review concluded with a management plan for the resident . In total 75 residents were review ed . Main outcome measures : Medication use and cost , and mortality . Results : One month after the review s were completed comparisons between those who were review ed and those who were not showed non-significant reductions in medication orders , medication cost , and mortality in the review ed group . Many of the 92 recommendations in the management plans that were carried out benefited the residents ( n=37 ) and /or carers ( n=24 ) . The responses of the GPs and the Directors of Nursing to the review s were overwhelmingly positive . Conclusion : Recommendations arising from multidisciplinary case conferences were carried out to the benefit of patients and carers . Given the support shown by key stakeholders , multidisciplinary conferences should be used more An intervention consisting of individualized planned care for patients and regular clinical systematic supervision for nurses  was carried out on a ward for dementia care ( the experimental ward , EW ) . On a similar control ward ( CW ) , no changes were made . Observations of  nurse-patient  cooperation during morning care were collected at both wards , before and during the intervention . The observations ( N = 107 ) were analyzed blindly and sorted into already-developed categories . The distribution of the cooperation-style categories was then analyzed statistically . The patients who survived throughout the study period ( N = 18 ) were also compared over time . Nurse-patient cooperation at the EW improved significantly during the intervention period , whereas , at the CW , it deteriorated ( p = .02 ) . Status of surviving patients followed the same pattern ( p = .001 ) . The findings indicate that such interventions can improve the quality of nurse-patient cooperation in dementia care BACKGROUND The adverse effects of behavioral and psychological symptoms of dementia ( BPSD ) are well described but treatment remains problematical , including overuse of psychotropic medication . This study aims to compare the outcome of two approaches to BPSD , one focusing on causality and using predominantly psychosocial interventions , the other relying predominantly on psychotropic medication . METHODS Thirty-three residential care clients manifesting BPSD who had been referred to a community psychogeriatric service ( intervention group ) were assessed and treated , with the focus placed on the causes of the behavior and why it was perceived as a problem by nursing staff . Cases were managed primarily by psychosocial means with psychopharmacology as an adjunct . A control group was made up of 22 referrals to an adjacent service , which used primarily psychopharmacology with psychosocial methods as an occasional adjunct . RESULTS Measures of behavior and staff response showed significant improvement in both groups at two- and five-months ' follow-up .  Antipsychotic use in the intervention group decreased over time while in the control group it increased . Service measures showed both groups required approximately the same number of clinical visits but the intervention group experienced fewer medication changes , fewer drug side effects , and all but one case could be treated in situ . Five control group participants spent extended periods as in patients in a psychogeriatric unit . Minor sampling differences did not affect the results , and neither they nor the nature of the behavior explained the difference in clinical approach . CONCLUSION The causality-focused approach appears to be as effective as the more common predominantly pharmacological approach , and appears to involve lower human and financial costs OBJECTIVES To test the premise that individually tailored psychosocial , nursing and medical interventions to nursing home residents with dementia will reduce the frequency and severity of behavioural symptoms . METHODS A four-member team comprising a psychiatrist , psychologist and nurses conducted detailed assessment s of 99 nursing home residents with advanced dementia who were rated by staff as having frequent , severe behavioural disturbances . Residents were then r and omly assigned to an ' early ' or ' late ' intervention group and observed for four weeks . Interventions encompassed psychosocial strategies , nursing approaches , psychotropic medications and management of pain . Outcome measures included the frequency and severity of disruptive behaviours and assessment s of change by senior nursing home staff . RESULTS While improvements in behaviour were noted in both groups from the outset of observations , pointing to a powerful Hawthorne effect , consultancies were associated with a modest but statistically significant decrease in challenging behaviours . Staff assessment s of the interventions were highly favourable . CONCLUSIONS The consultancies were effective and well received by staff . The change-inducing nature of any new endeavour is an integral part of research in a long-term setting AIM The study aims to compare clients using institutions of geriatric day-care to residents in homes for the elderly with regard to functional impairment , dementia disorders , behavior problems and the care situation . METHODS A cross-sectional study of 17 geriatric day-care facilities in eight towns and cities in Baden examined the data for all 257 clients who received care on a given reference date . These clients were compared to a reference population drawn from all residents ( N = 1,387 ) of 15 r and omly selected residential and nursing homes in the city of Mannheim , whereby identical assessment procedures were used by qualified nursing staff . RESULTS The average age of subjects in both groups was around 80 years , over three-fourths of whom were women . Home residents were more limited than the clients of geriatric day-care facilities  with regard to their activities of daily living , above all with regard to their mobility . The percentage of moderate to severe dementia disorders at 58.6 % was equally high in both groups . In addition , symptoms of depression and behavior problems were observed among a substantial number of the day-care clients . While the inpatient sector places greater emphasis on basic care and treatment , day-care institutions focus primarily on measures of social therapy .  CONCLUSIONS The high percentage of demented yet still mobile clients in day-care facilities indicates the particular importance of this target group when it comes to providing at least partial stress relief for family care-givers BACKGROUND efficient strategies are needed to provide specialist advice in nursing homes to ensure quality medical care . We describe a case conference intervention involving a multidisciplinary team of health professionals . OBJECTIVES to evaluate the impact of multidisciplinary case conferences on the appropriateness of medications and on patient behaviours in high-level residential aged care facilities . DESIGN cluster-r and omised controlled trial . SETTING ten high-level aged care facilities . PARTICIPANTS 154 residents with medication problems and /or challenging behaviours were selected for case conference by residential care staff . INTERVENTION two multidisciplinary case conferences involving the resident 's general practitioner , a geriatrician , a pharmacist and residential care staff were held at the nursing home for each resident . MEASUREMENTS outcomes were assessed at baseline and 3 months . The primary outcome was the Medication Appropriateness Index ( MAI ) . The behaviour of each resident was assessed via the Nursing Home Behaviour Problem Scale . RESULTS 45 residents died  before follow-up . Medication appropriateness improved in the intervention group [ MAI mean change 4.1 , 95 % confidence interval ( CI ) 2.1 - 6.1 ] compared with the control group ( MAI mean change 0.4 , 95 % CI -0.4 - 1.2 ; P < 0.001 ) . There was a significant reduction in the MAI for benzodiazepines ( mean change control -0.38 , 95 % CI -1.02 - 0.27 versus intervention 0.73 , 95 % CI 0.16 - 1.30 ; P = 0.017 ) . Resident behaviours were unchanged after the intervention and the improved medication appropriateness did not extend to other residents in the facility . CONCLUSION multidisciplinary case conferences in nursing homes can improve care . Outreach specialist services can be delivered without direct patient contact and achieve improvements in prescribing This study was design ed to investigate the impact of staff education on the behaviour and quality of life of residents with dementia and on staff members ’ attitudes about working with people with dementia and level of burnout .  Staff from three aged care facilities participated in the study ( n = 52 ) . These facilities were r and omly assigned to one of two intervention groups or a control group . Staff assigned to the intervention groups received an eight-week behaviourally-based programme . Staff from one aged care facility also participated in a peer support group design ed to reinforce educational material and facilitate positive changes among staff members . Behavioural symptoms displayed by residents ( n = 76 ) in each of the facilities were also assessed . Assessment s were conducted at pre-intervention , post-intervention , three- and six-month follow-up . The results of this study indicated that education or peer support was not associated with an improvement in resident behaviour or quality of life . Education or peer support also did not impact on staff members ’ level of burnout . There was , however , a change in staff members ’ attitudes about working with people with dementia . Possible explanations for these findings and implication for further research are considered 
    Output:
    