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 Despite modest efficacy , unpredictable individual utility , and a high rate of adverse effects , behavioural and psychological symptoms of dementia ( BPSD ) are common determinants for antipsychotic drug therapy in nursing home patients . AIMS To explore the impact on BPSD of stopping long-term antipsychotic treatment in nursing home patients with dementia . METHODS Fifty-five patients ( 43 women ; mean age 84.1 ) taking haloperidol , risperidone , or olanzapine for BPSD were r and omly assigned to cessation ( intervention group , n=27 ) or continued treatment with antipsychotic drugs ( reference group , n=28 ) for 4 consecutive weeks . The Neuropsychiatric Inventory ( NPI ) Question naire was used to examine changes in behavioural and psychological symptoms . RESULTS By study completion , 23 of the 27 intervention group patients were still off antipsychotics . Symptom scores ( NPI ) remained stable or even improved in 42 patients ( intervention group , 18 out of 27 ; reference group , 24 out of 28 ; p=0.18 ) . As compared to patients with stable or improved symptom scores , patients with behavioural deterioration after antipsychotic cessation used higher daily drug doses at baseline ( p=0.42 ) . CONCLUSION A large share of elderly nursing home patients on long-term treatment with antipsychotics for BPSD , do well without this treatment . St and ardized symptom evaluations and drug cessation attempts should therefore be undertaken at regular intervals Background The aim of this project was to assess whether outreach visits would improve the implementation of evidence based clinical practice in the area of falls reduction and stroke prevention in a residential care setting . Methods Twenty facilities took part in a r and omized controlled trial with a seven month follow-up period . Two outreach visits were delivered by a pharmacist . At the first a summary of the relevant evidence was provided and at the second detailed audit information was provided about fall rates , psychotropic drug prescribing and stroke risk reduction practice s ( BP monitoring , aspirin and warfarin use ) for the facility relevant to the physician . The effect of the interventions was determined via pre- and post-intervention case note audit . Outcomes included change in percentage patients at risk of falling who fell in a three month period prior to follow-up and changes in use of psychotropic medications . Chi-square tests , independent sample s t-test , and logistic regression were used in the analysis . Results Data were available from case notes at baseline ( n = 897 ) and seven months follow-up ( n = 902 ) , 452 residential care staff were surveyed and 121 physicians were involved with 61 receiving outreach visits . Pre- and post-intervention data were available for 715 participants . There were no differences between the intervention and control groups for the three month fall rate . We were unable to detect statistically significant differences between groups for the psychotropic drug use of the patients before or after the intervention . The exception was significantly greater use of " as required " antipsychotics in the intervention group compared with the control group after the pharmacy intervention ( RR = 4.95 ; 95%CI 1.69–14.50 ) . There was no statistically significant difference between groups for the numbers of patients " at risk of stroke " on aspirin at follow-up . Conclusions While the strategy was well received by the physicians involved , there was no change in prescribing patterns . Patient care in residential setting s is complex and involves contributions from the patient 's physician , family and residential care staff . The project highlights challenges of delivering evidence based care in a setting in which there is a paucity of well controlled trial evidence but where significant health outcomes can be attained OBJECTIVE To evaluate the efficacy of a dementia care program to reduce behavior disorders in nursing home patients with dementia . DESIGN R and omized controlled clinical trial with 6-month follow-up . SETTING A 250-bed community nursing home . PATIENTS The nursing home was screened to identify patients with dementia and behavior disorders . A total of 118 patients were eligible for r and omization . Of these , 89 ( 75.4 % ) were r and omized , and 81 of these ( 91.0 % ) completed the trial . INTERVENTION The A.G.E. dementia care program consisted of Activities , Guidelines for psychotropic medications , and Educational rounds . The control treatment was usual nursing home care . MEASUREMENTS Behavior disorders , antipsychotic drug and physical restraint use , patient activity levels , and cognitive and functional status . RESULTS After 6 months , 12 of 42 ( 28.6 % ) intervention patients exhibited behavior disorders compared with 20 of 39 ( 51.3 % ) controls ( OR = 0.38 ; 95 % CI [ 0.15 , 0.95 ] ; P = .037 ) . Controls were more than twice as likely to receive antipsychotics ( OR = 2.55 , 95 % CI [ 0.96 , 6.76 ] ; P < .056 ) , to be restrained during activity times ( OR = 2.98 , 95 % CI [ 1.10 , 8.04 ] ; P < .028 ) , and to be restrained on nursing units ( OR = 2.14 , 95 % CI [ 0.9 , 5.3 ] ; P < .10 ) . Intervention patients were much more likely to participate in activities ( OR = 13.71 ; 95 % CI [ 4.51 , 41.73 ] ; P = .001 ) . CONCLUSIONS The A.G.E. program reduces the prevalence of behavior disorders and the use of antipsychotic drugs and restraints . It is practical , feasible , and appears to improve the lives of patients with dementia in nursing homes Abstract Objective To evaluate the effectiveness of a training and support intervention for nursing home staff in reducing the proportion of residents with dementia who are prescribed neuroleptics . Design Cluster r and omised controlled trial with blinded assessment of outcome . Setting 12 specialist nursing homes for people with dementia in London , Newcastle , and Oxford . Participants Residents of the 12 nursing homes ; numbers varied during the study period . Intervention Training and support intervention delivered to nursing home staff over 10 months , focusing on alternatives to drugs for the management of agitated behaviour in dementia . Main outcome measures Proportion of residents in each home who were prescribed neuroleptics and mean levels of agitated and disruptive behaviour ( Cohen-Mansfield agitation inventory ) in each home at 12 months . Results At 12 months the proportion of residents taking neuroleptics in the intervention homes ( 23.0 % ) was significantly lower than that in the control homes ( 42.1 % ) : average reduction in neuroleptic use 19.1 % ( 95 % confidence interval 0.5 % to 37.7 % ) . No significant differences were found in the levels of agitated or disruptive behaviour between intervention and control homes . Conclusions Promotion of person centred care and good practice in the management of patients with dementia with behavioural symptoms provides an effective alternative to neuroleptics OBJECTIVE The study examined the relationship between treatment cultures of nursing homes and their responses to regulations to reduce use of psychotropic drugs m and ated by the 1987 Omnibus Budget Reconciliation ACT : The authors hypothesized that reduction in use of antipsychotic drugs was more likely to occur in homes with a resident-centered culture emphasizing psychosocial care , avoidance of psychotropic drugs , pharmacist feedback , and involvement of mental health workers . The authors also predicted greater reductions in drug use in facilities with a less severe case mix and better capacity for change . METHODS Data were collected in a stratified r and om sample of 16 skilled nursing facilities in Wisconsin . Participants included 1,181 residents in the baseline study and 1,650 residents in the follow-up study . Treatment culture was measured with a question naire for assessing nurses ' beliefs and philosophies of care and their interactions with pharmacists and mental health workers . RESULTS No significant change was observed in the use of benzodiazepines , antidepressants , or polymedicine  ( two or more psychotropic medications ) . However , use of antipsychotic drugs  decreased significantly , from 24 percent to 16 percent . The change in use varied dramatically across facilities , from an 85 percent reduction to a 19 percent increase . Findings also revealed significant variability in treatment cultures . Greater reductions in use of antipsychotic drugs  were found in facilities with a resident-centered culture , a less severe case mix , and a higher nurse-to-resident staffing ratio . CONCLUSIONS Future policy and quality improvement efforts must address treatment cultures , staffing , and other organizational barriers to nursing home reform Background Studies comparing Alzheimer Special Care Units ( ASCUs ) with traditional nursing homes ( NHs ) have reported conflicting results . Objectives To compare the characteristics and the effects on mortality , hospitalization , use of physical restraints , falls , and antipsychotics  among patients admitted to ASCUs or to NHs . Methods A sequential cohort of patients with dementia was recruited and followed for 18 months in a sample of r and omly selected ASCUs and NHs . Data on socio-demographic , cognitive , functional , behavioral , and clinical characteristics , and drug exposure were collected at baseline and at 6-month intervals up to 18 months . Results A total of 349 patients were enrolled in 35 ASCUs and 81 in 9 NHs . Patients admitted to ASCUs were younger , cognitively and functionally less impaired , but had more behavioral disturbances than those in NH . During follow-up , ASCU patients had a lower risk of hospitalization ( odds ratio : 0.67 ; 95 % confidence interval : 0.46 - 0.99 ; P=0.04 ) , and use of physical restraints ( odds ratio : 0.66 ; 95 % confidence interval : 0.51 - 0.86 ; P=0.003 ) , and showed a higher rate of withdrawal of antipsychotics  ( P=0.003 ) . No difference was found in mortality and falls . Propensity score analysis gives similar results . Conclusions This study found that patients with dementia in ASCUs had different baseline clinical and functional characteristics from those in NHs . They had a lower rate of hospitalization and use of physical restraints at 6-month follow-up , and a higher probability of having  antipsychotic agents  withdrawn Context Recent reports suggest that antipsychotics are associated with increased risk for death in patients with dementia . Contribution This large , population -based study from Canada assessed the risk for death after dispensation of antipsychotics in older adults with dementia . New use of antipsychotics compared with nonuse was associated with increased risk for death at 30 days . Conventional agents were associated with higher risks than were atypical agents . Caution Sensitivity analyses showed that unmeasured confounders might diminish or erase observed associations . Implication Both conventional and atypical antipsychotics may be associated with an increased risk for death in elderly persons with dementia . The Editors Various challenging behavioral and psychological symptoms commonly develop in older adults with dementia and predispose them and their caregivers to poor outcomes ( 1 ) . Nonpharmacologic strategies are recommended as first-line management for these symptoms ( 2 ) , but they may be difficult to implement in clinical practice ( 3 ) . For many reasons , antipsychotic medications are routinely prescribed in this setting ( 4 , 5 ) . Conventional antipsychotics , such as haloperidol , have been available since the 1950s . Meta-analyses of clinical trials evaluating conventional antipsychotics to treat agitation in dementia show that these agents have modest efficacy and important adverse effects compared with placebo ( 6 , 7 ) . In the past decade , use of newer atypical antipsychotics has been rapidly increasing in clinical practice because these agents were thought to produce fewer adverse effects than conventional agents ( 2 ) . A Canadian study found that the prevalence of antipsychotic use in older adults increased from 2.2 % in 1993 to 3.0 % at the end of 2002 . In that study , atypical antipsychotics , which were unavailable in 1993 , accounted for 82.5 % of all antipsychotics dispensed in 2002 ( 8) . Short-term r and omized , controlled trials ( RCTs ) have studied the role of atypical antipsychotics in the management of behavioral and psychological symptoms of dementia ( 2 , 9 ) . An RCT involving 421 out patients with Alzheimer disease and psychosis , aggression , or agitation concluded that the adverse effects of these newer drugs offset their advantages ( 10 ) . As a result , improvements in behavioral symptoms with antipsychotic drug treatment do not necessarily lead to improvements in overall quality of life for patients or their caregivers ( 11 ) . In April 2005 , the U.S. Food and Drug Administration ( FDA ) issued a public health advisory that the use of atypical antipsychotics to treat elderly patients with dementia was associated with an increased risk for death compared with placebo ( 12 ) . In June 2005 , Health Canada issued a similar warning and additional data ( 13 ) . These warnings stem from review s of RCTs that involve the atypical agents risperidone , olanzapine , quetiapine , and aripiprazole . The mortality rate was approximately 1.6 to 1.7 times higher than with placebo and was greater with antipsychotics than with placebo in 15 of the 17 trials review ed by the U.S. FDA ( 
    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 Despite modest efficacy , unpredictable individual utility , and a high rate of adverse effects , behavioural and psychological symptoms of dementia ( BPSD ) are common determinants for antipsychotic drug therapy in nursing home patients . AIMS To explore the impact on BPSD of stopping long-term antipsychotic treatment in nursing home patients with dementia . METHODS Fifty-five patients ( 43 women ; mean age 84.1 ) taking haloperidol , risperidone , or olanzapine for BPSD were r and omly assigned to cessation ( intervention group , n=27 ) or continued treatment with antipsychotic drugs ( reference group , n=28 ) for 4 consecutive weeks . The Neuropsychiatric Inventory ( NPI ) Question naire was used to examine changes in behavioural and psychological symptoms . RESULTS By study completion , 23 of the 27 intervention group patients were still off antipsychotics . Symptom scores ( NPI ) remained stable or even improved in 42 patients ( intervention group , 18 out of 27 ; reference group , 24 out of 28 ; p=0.18 ) . As compared to patients with stable or improved symptom scores , patients with behavioural deterioration after antipsychotic cessation used higher daily drug doses at baseline ( p=0.42 ) . CONCLUSION A large share of elderly nursing home patients on long-term treatment with antipsychotics for BPSD , do well without this treatment . St and ardized symptom evaluations and drug cessation attempts should therefore be undertaken at regular intervals Background The aim of this project was to assess whether outreach visits would improve the implementation of evidence based clinical practice in the area of falls reduction and stroke prevention in a residential care setting . Methods Twenty facilities took part in a r and omized controlled trial with a seven month follow-up period . Two outreach visits were delivered by a pharmacist . At the first a summary of the relevant evidence was provided and at the second detailed audit information was provided about fall rates , psychotropic drug prescribing and stroke risk reduction practice s ( BP monitoring , aspirin and warfarin use ) for the facility relevant to the physician . The effect of the interventions was determined via pre- and post-intervention case note audit . Outcomes included change in percentage patients at risk of falling who fell in a three month period prior to follow-up and changes in use of psychotropic medications . Chi-square tests , independent sample s t-test , and logistic regression were used in the analysis . Results Data were available from case notes at baseline ( n = 897 ) and seven months follow-up ( n = 902 ) , 452 residential care staff were surveyed and 121 physicians were involved with 61 receiving outreach visits . Pre- and post-intervention data were available for 715 participants . There were no differences between the intervention and control groups for the three month fall rate . We were unable to detect statistically significant differences between groups for the psychotropic drug use of the patients before or after the intervention . The exception was significantly greater use of " as required " antipsychotics in the intervention group compared with the control group after the pharmacy intervention ( RR = 4.95 ; 95%CI 1.69–14.50 ) . There was no statistically significant difference between groups for the numbers of patients " at risk of stroke " on aspirin at follow-up . Conclusions While the strategy was well received by the physicians involved , there was no change in prescribing patterns . Patient care in residential setting s is complex and involves contributions from the patient 's physician , family and residential care staff . The project highlights challenges of delivering evidence based care in a setting in which there is a paucity of well controlled trial evidence but where significant health outcomes can be attained OBJECTIVE To evaluate the efficacy of a dementia care program to reduce behavior disorders in nursing home patients with dementia . DESIGN R and omized controlled clinical trial with 6-month follow-up . SETTING A 250-bed community nursing home . PATIENTS The nursing home was screened to identify patients with dementia and behavior disorders . A total of 118 patients were eligible for r and omization . Of these , 89 ( 75.4 % ) were r and omized , and 81 of these ( 91.0 % ) completed the trial . INTERVENTION The A.G.E. dementia care program consisted of Activities , Guidelines for psychotropic medications , and Educational rounds . The control treatment was usual nursing home care . MEASUREMENTS Behavior disorders , antipsychotic drug and physical restraint use , patient activity levels , and cognitive and functional status . RESULTS After 6 months , 12 of 42 ( 28.6 % ) intervention patients exhibited behavior disorders compared with 20 of 39 ( 51.3 % ) controls ( OR = 0.38 ; 95 % CI [ 0.15 , 0.95 ] ; P = .037 ) . Controls were more than twice as likely to receive antipsychotics ( OR = 2.55 , 95 % CI [ 0.96 , 6.76 ] ; P < .056 ) , to be restrained during activity times ( OR = 2.98 , 95 % CI [ 1.10 , 8.04 ] ; P < .028 ) , and to be restrained on nursing units ( OR = 2.14 , 95 % CI [ 0.9 , 5.3 ] ; P < .10 ) . Intervention patients were much more likely to participate in activities ( OR = 13.71 ; 95 % CI [ 4.51 , 41.73 ] ; P = .001 ) . CONCLUSIONS The A.G.E. program reduces the prevalence of behavior disorders and the use of antipsychotic drugs and restraints . It is practical , feasible , and appears to improve the lives of patients with dementia in nursing homes Abstract Objective To evaluate the effectiveness of a training and support intervention for nursing home staff in reducing the proportion of residents with dementia who are prescribed neuroleptics . Design Cluster r and omised controlled trial with blinded assessment of outcome . Setting 12 specialist nursing homes for people with dementia in London , Newcastle , and Oxford . Participants Residents of the 12 nursing homes ; numbers varied during the study period . Intervention Training and support intervention delivered to nursing home staff over 10 months , focusing on alternatives to drugs for the management of agitated behaviour in dementia . Main outcome measures Proportion of residents in each home who were prescribed neuroleptics and mean levels of agitated and disruptive behaviour ( Cohen-Mansfield agitation inventory ) in each home at 12 months . Results At 12 months the proportion of residents taking neuroleptics in the intervention homes ( 23.0 % ) was significantly lower than that in the control homes ( 42.1 % ) : average reduction in neuroleptic use 19.1 % ( 95 % confidence interval 0.5 % to 37.7 % ) . No significant differences were found in the levels of agitated or disruptive behaviour between intervention and control homes . Conclusions Promotion of person centred care and good practice in the management of patients with dementia with behavioural symptoms provides an effective alternative to neuroleptics OBJECTIVE The study examined the relationship between treatment cultures of nursing homes and their responses to regulations to reduce use of psychotropic drugs m and ated by the 1987 Omnibus Budget Reconciliation ACT : The authors hypothesized that reduction in use of antipsychotic drugs was more likely to occur in homes with a resident-centered culture emphasizing psychosocial care , avoidance of psychotropic drugs , pharmacist feedback , and involvement of mental health workers . The authors also predicted greater reductions in drug use in facilities with a less severe case mix and better capacity for change . METHODS Data were collected in a stratified r and om sample of 16 skilled nursing facilities in Wisconsin . Participants included 1,181 residents in the baseline study and 1,650 residents in the follow-up study . Treatment culture was measured with a question naire for assessing nurses ' beliefs and philosophies of care and their interactions with pharmacists and mental health workers . RESULTS No significant change was observed in the use of benzodiazepines , antidepressants , or polymedicine  ( two or more psychotropic medications ) . However , use of antipsychotic drugs  decreased significantly , from 24 percent to 16 percent . The change in use varied dramatically across facilities , from an 85 percent reduction to a 19 percent increase . Findings also revealed significant variability in treatment cultures . Greater reductions in use of antipsychotic drugs  were found in facilities with a resident-centered culture , a less severe case mix , and a higher nurse-to-resident staffing ratio . CONCLUSIONS Future policy and quality improvement efforts must address treatment cultures , staffing , and other organizational barriers to nursing home reform Background Studies comparing Alzheimer Special Care Units ( ASCUs ) with traditional nursing homes ( NHs ) have reported conflicting results . Objectives To compare the characteristics and the effects on mortality , hospitalization , use of physical restraints , falls , and antipsychotics  among patients admitted to ASCUs or to NHs . Methods A sequential cohort of patients with dementia was recruited and followed for 18 months in a sample of r and omly selected ASCUs and NHs . Data on socio-demographic , cognitive , functional , behavioral , and clinical characteristics , and drug exposure were collected at baseline and at 6-month intervals up to 18 months . Results A total of 349 patients were enrolled in 35 ASCUs and 81 in 9 NHs . Patients admitted to ASCUs were younger , cognitively and functionally less impaired , but had more behavioral disturbances than those in NH . During follow-up , ASCU patients had a lower risk of hospitalization ( odds ratio : 0.67 ; 95 % confidence interval : 0.46 - 0.99 ; P=0.04 ) , and use of physical restraints ( odds ratio : 0.66 ; 95 % confidence interval : 0.51 - 0.86 ; P=0.003 ) , and showed a higher rate of withdrawal of antipsychotics  ( P=0.003 ) . No difference was found in mortality and falls . Propensity score analysis gives similar results . Conclusions This study found that patients with dementia in ASCUs had different baseline clinical and functional characteristics from those in NHs . They had a lower rate of hospitalization and use of physical restraints at 6-month follow-up , and a higher probability of having  antipsychotic agents  withdrawn Context Recent reports suggest that antipsychotics are associated with increased risk for death in patients with dementia . Contribution This large , population -based study from Canada assessed the risk for death after dispensation of antipsychotics in older adults with dementia . New use of antipsychotics compared with nonuse was associated with increased risk for death at 30 days . Conventional agents were associated with higher risks than were atypical agents . Caution Sensitivity analyses showed that unmeasured confounders might diminish or erase observed associations . Implication Both conventional and atypical antipsychotics may be associated with an increased risk for death in elderly persons with dementia . The Editors Various challenging behavioral and psychological symptoms commonly develop in older adults with dementia and predispose them and their caregivers to poor outcomes ( 1 ) . Nonpharmacologic strategies are recommended as first-line management for these symptoms ( 2 ) , but they may be difficult to implement in clinical practice ( 3 ) . For many reasons , antipsychotic medications are routinely prescribed in this setting ( 4 , 5 ) . Conventional antipsychotics , such as haloperidol , have been available since the 1950s . Meta-analyses of clinical trials evaluating conventional antipsychotics to treat agitation in dementia show that these agents have modest efficacy and important adverse effects compared with placebo ( 6 , 7 ) . In the past decade , use of newer atypical antipsychotics has been rapidly increasing in clinical practice because these agents were thought to produce fewer adverse effects than conventional agents ( 2 ) . A Canadian study found that the prevalence of antipsychotic use in older adults increased from 2.2 % in 1993 to 3.0 % at the end of 2002 . In that study , atypical antipsychotics , which were unavailable in 1993 , accounted for 82.5 % of all antipsychotics dispensed in 2002 ( 8) . Short-term r and omized , controlled trials ( RCTs ) have studied the role of atypical antipsychotics in the management of behavioral and psychological symptoms of dementia ( 2 , 9 ) . An RCT involving 421 out patients with Alzheimer disease and psychosis , aggression , or agitation concluded that the adverse effects of these newer drugs offset their advantages ( 10 ) . As a result , improvements in behavioral symptoms with antipsychotic drug treatment do not necessarily lead to improvements in overall quality of life for patients or their caregivers ( 11 ) . In April 2005 , the U.S. Food and Drug Administration ( FDA ) issued a public health advisory that the use of atypical antipsychotics to treat elderly patients with dementia was associated with an increased risk for death compared with placebo ( 12 ) . In June 2005 , Health Canada issued a similar warning and additional data ( 13 ) . These warnings stem from review s of RCTs that involve the atypical agents risperidone , olanzapine , quetiapine , and aripiprazole . The mortality rate was approximately 1.6 to 1.7 times higher than with placebo and was greater with antipsychotics than with placebo in 15 of the 17 trials review ed by the U.S. FDA ( 
    Output:
    