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 : Behavioral problems may affect individuals with dementia , increasing the cost and burden of care . Pet therapy has been known to be emotionally beneficial for many years . Robotic pets have been shown to have similar positive effects without the negative aspects of traditional pets . Robotic pet therapy offers an alternative to traditional pet therapy . Objective : The study rigorously assesses the effectiveness of the PARO robotic pet , an FDA approved biofeedback device , in treating dementia-related symptoms . Methods : A r and omized block design with repeated measurements guided the study . Before and after measures included reliable , valid tools such as : RAID , CSDD , GDS , pulse rate , pulse oximetry , and GSR .  Participants interacted with the PARO robotic pet , and the control group received st and ard activity programs .  Five urban secure dementia units comprised the setting . Results : 61 patients , with 77 % females , average 83.4 years in age , were r and omized into control and treatment groups . Compared to the control group , RAID , CSDD , GSR , and pulse oximetry were increased in the treatment group , while pulse rate , pain medication , and psychoactive medication use were decreased . The changes in GSR , pulse oximetry , and pulse rate over time were plotted for both groups . The difference between groups was consistent throughout the 12-week study for pulse oximetry and pulse rate , while GSR had several weeks when changes were similar between groups . Conclusions : Treatment with the PARO robot decreased stress and anxiety in the treatment group and result ed in reductions in the use of psychoactive medications and pain medications in elderly clients with dementia Background and Objectives Recent years have seen social robotic pets introduced as a means of treating behavioral and psychological symptoms of dementia , and many show promising potential . In this study , we sought to explore family members ' perceptions of the Japanese-developed baby harp seal , Paro ( version 9 ) , and a look-alike , nonrobotic Plush Toy , when used by their relative with dementia for 15 min , 3 afternoons per week for 10 weeks . Research Design and Method The study employed a descriptive qualitative approach , which was nested within a larger cluster r and omized controlled trial . A convenience sample of 20 family members ( n = 10 each from the Paro and Plush Toy conditions ) with relatives in 9 long-term care facilities in Queensl and , Australia , completed individual semi-structured interviews ( telephone or face-to-face ) . Inductive , data -driven thematic analysis of the data was undertaken with the assistance of the qualitative management software , ATLAS.ti ® . Results Family members of long-term care residents with dementia expressed positive perceptions of the Paro  , perceiving that it improved mood , reduced agitation , and provided opportunity for communication for their relative . Negative perceptions of the Plush Toy were given by family members , primarily because of its lack of movement and engagement . Conclusion Family members were keen for their older relative with dementia to use a social robot that moved and engaged with them , and Plush Toys that were static and unresponsive were perceived as being unimportant in improving quality of life . However , the current cost of Paro was identified by family members as a major limitation to use AIM The aim of this study was to investigate effects of robot-assisted group activity with Paro on quality of life in older people with dementia . BACKGROUND Nursing home residents with severe dementia often experience social withdrawal and lower quality of life , which are suggested to be enhanced by non-pharmacological interventions . DESIGN A cluster-r and omized controlled trial . Ten nursing home units were r and omized to robot-assisted intervention or control group ( treatment as usual ) .  METHODS Data were collected between March 2013-September 2014 . 27 participants participated in group activity for 30 minutes twice a week over 12 weeks , 26 participated in the control group .  Change in quality of life was assessed by local nurses through the Quality of Life in Late-Stage Dementia scale at baseline , after end of intervention and at 3 months follow-up . The scale and regular psychotropic medication were analysed stratified by dementia severity . Analysis using mixed model , one-way anova and linear regression were performed . RESULTS An effect was found among participants with severe dementia from baseline to follow-up showing stable quality of life in the intervention group compared with a decrease in the control group . The intervention explained most of the variance in change in the total scale and in the subscales describing Tension and Well-being for the group with severe dementia . The intervention group used significantly less psychotropic medication compared with the control group after end of intervention . CONCLUSION Pleasant and engaging activities facilitated by nursing staff , such as group activity with Paro , could improve quality of life in people with severe dementia . The trial is in adherence with the CONSORT statement and is registered at www . clinical trials.gov ( study ID number : NCT01998490 ) [ corrected ] OBJECTIVES To investigate the affective , social , behavioral , and physiological effects of the companion robot Paro for people with dementia in both a day care center and a home setting . DESIGN A pilot block r and omized controlled trial over 12 weeks . Participants were r and omized to the intervention ( Paro ) or control condition  ( st and ard care ) . SETTING Two dementia day care centers and participants ' homes in Auckl and , New Zeal and . PARTICIPANTS Thirty dyads ( consisting of a care recipient with dementia and their caregiver ) took part in this study . All care recipients attended dementia day care centers at Selwyn Foundation and had a formal diagnosis of dementia . INTERVENTION Thirty-minute unstructured group sessions with Paro at the day care center were run 2 to 3 times a week for 6 weeks . Participants also had Paro at home for 6 weeks . MEASUREMENTS At the day care centers , observations of the care recipients ' behavior , affect , and social responses were recorded using a time sampling method . Observations of interactions with Paro for participants in the intervention were also recorded . Blood pressure and salivary cortisol were collected from care recipients before and after sessions at day care . In the home setting , level of cognition , depressive symptoms , neuropsychiatric symptoms , behavioral agitation , and blood pressure were measured at baseline , 6 weeks , and 12 weeks . Hair cortisol measures were collected at baseline and at 6 weeks . RESULTS Observations showed that Paro significantly improved facial expressions ( affect ) and communication with staff ( social interaction ) at the day care centers . Subanalyses showed that care recipients with less cognitive impairment responded significantly better to Paro . There were no significant differences in care recipient dementia symptoms , nor physiological measures between the intervention and control group . CONCLUSION Paro shows promise in enhancing affective and social outcomes for certain individuals with dementia in a community context . Larger r and omized controlled trials in community setting s , with longer time frames , are needed to further specify the context s and characteristics for which Paro is most beneficial 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 ( 12 ) . The warnings extend to all currently available atypical antipsychotics . Other publications have provided support for these warnings and have raised further safety concerns about older conventional antipsychotics ( 1416 ) . Important questions remain unanswered . Although RCTs provide the best evidence of treatment efficacy and harm , the individual RCTs in this case had low event rates . Reliable estimates of the mortality risk were generated only when data were combined by meta- analysis ( 14 ) . Furthermore , these RCTs were generally short in duration and could not provide information about the long-term effect of antipsychotics on mortality ( 14 , 17 ) . Finally , these trials provide estimates of harm primarily for atypical antipsychotics . Relatively few data are available on harms associated with older conventional antipsychotics . Studies suggest that important differences may exist in the safety profiles of conventional and atypical agents ( 15 , 16 , 18 , 19 ) . Using population -based data , we sought to determine the risk for all-cause mortality in older adults with dementia who received atypical antipsychotics , conventional antipsychotics , or no antipsychotic .  Because important baseline differences exist among these groups , we used propensity score matching to improve their comparability . We also evaluated the effect of duration of treatment with antipsychotics on the risk for death . Methods Data Sources Ontario is Canada 's most populous province . During our study , Ontario had a population of approximately 12 million people , of whom 1.4 million were 65 years of age or older . A universally funded health program covers nearly all physician services , medications , and hospital services for patients 65 years of age or older in Ontario . Information from 4 administrative health care data bases was linked to develop the study cohort : pharmacy records from the Ontario Drug Benefit program , hospitalization records from the Canadian Institute for Health Information Discharge Abstract Data base , physician billing information for inpatient and outpatient services from the Ontario Health Insurance Plan , and basic demographic information and vital statistics from the Registered Persons Data base . We used encrypted unique identifiers that are common among data bases to link anonymous information on demographic characteristics and health services utilization for patients in our study . Little basic information on patients is missing in these data bases . For example , the coding accuracy of drug cl aims in the Ontario Drug Benefit program data base is excellent , with an error rate of only 0.7 % ( 20 ) . The study was approved by the ethics review board of Sunnybrook and Women 's College Health Sciences Centre , Toronto , Ontario , Canada . Dementia Cohort We identified a cohort of all Ontario residents 66 years of age or older with a diagnosis of dementia ( in the Ontario Health Insurance Plan or Discharge Abstract Data base ) between 1 April 1997 and 31 March 2002 . To focus on antipsychotic drug treatment for behavioral and psychological symptoms of dementia , we excluded patients who had evidence of other psychotic disorders ( such as schizophrenia ) or were receiving palliative care services . To reduce the potential for selection bias , we studied only new users of antipsychotics and excluded those who had received antipsychotics in the year before cohort entry ( 21 ) . Exposure to Antipsychotics We identified new use of antipsychotics if any agent available through the Ontario Drug Benefit program was dispensed after cohort entry . Cohort entry ( that is , the index date ) was defined as the date of the first dispensed antipsychotic drug . Available atypical drugs included olanzapine , quetiapine , and risperidone , and available conventional drugs included chlorpromazine , flupenthixol , fluphenazine , haloperidol , loxapine , pericyazine , perphenazine , pimozide , thioridazine , and trifluoperazine . Clozap 
    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 : Behavioral problems may affect individuals with dementia , increasing the cost and burden of care . Pet therapy has been known to be emotionally beneficial for many years . Robotic pets have been shown to have similar positive effects without the negative aspects of traditional pets . Robotic pet therapy offers an alternative to traditional pet therapy . Objective : The study rigorously assesses the effectiveness of the PARO robotic pet , an FDA approved biofeedback device , in treating dementia-related symptoms . Methods : A r and omized block design with repeated measurements guided the study . Before and after measures included reliable , valid tools such as : RAID , CSDD , GDS , pulse rate , pulse oximetry , and GSR .  Participants interacted with the PARO robotic pet , and the control group received st and ard activity programs .  Five urban secure dementia units comprised the setting . Results : 61 patients , with 77 % females , average 83.4 years in age , were r and omized into control and treatment groups . Compared to the control group , RAID , CSDD , GSR , and pulse oximetry were increased in the treatment group , while pulse rate , pain medication , and psychoactive medication use were decreased . The changes in GSR , pulse oximetry , and pulse rate over time were plotted for both groups . The difference between groups was consistent throughout the 12-week study for pulse oximetry and pulse rate , while GSR had several weeks when changes were similar between groups . Conclusions : Treatment with the PARO robot decreased stress and anxiety in the treatment group and result ed in reductions in the use of psychoactive medications and pain medications in elderly clients with dementia Background and Objectives Recent years have seen social robotic pets introduced as a means of treating behavioral and psychological symptoms of dementia , and many show promising potential . In this study , we sought to explore family members ' perceptions of the Japanese-developed baby harp seal , Paro ( version 9 ) , and a look-alike , nonrobotic Plush Toy , when used by their relative with dementia for 15 min , 3 afternoons per week for 10 weeks . Research Design and Method The study employed a descriptive qualitative approach , which was nested within a larger cluster r and omized controlled trial . A convenience sample of 20 family members ( n = 10 each from the Paro and Plush Toy conditions ) with relatives in 9 long-term care facilities in Queensl and , Australia , completed individual semi-structured interviews ( telephone or face-to-face ) . Inductive , data -driven thematic analysis of the data was undertaken with the assistance of the qualitative management software , ATLAS.ti ® . Results Family members of long-term care residents with dementia expressed positive perceptions of the Paro  , perceiving that it improved mood , reduced agitation , and provided opportunity for communication for their relative . Negative perceptions of the Plush Toy were given by family members , primarily because of its lack of movement and engagement . Conclusion Family members were keen for their older relative with dementia to use a social robot that moved and engaged with them , and Plush Toys that were static and unresponsive were perceived as being unimportant in improving quality of life . However , the current cost of Paro was identified by family members as a major limitation to use AIM The aim of this study was to investigate effects of robot-assisted group activity with Paro on quality of life in older people with dementia . BACKGROUND Nursing home residents with severe dementia often experience social withdrawal and lower quality of life , which are suggested to be enhanced by non-pharmacological interventions . DESIGN A cluster-r and omized controlled trial . Ten nursing home units were r and omized to robot-assisted intervention or control group ( treatment as usual ) .  METHODS Data were collected between March 2013-September 2014 . 27 participants participated in group activity for 30 minutes twice a week over 12 weeks , 26 participated in the control group .  Change in quality of life was assessed by local nurses through the Quality of Life in Late-Stage Dementia scale at baseline , after end of intervention and at 3 months follow-up . The scale and regular psychotropic medication were analysed stratified by dementia severity . Analysis using mixed model , one-way anova and linear regression were performed . RESULTS An effect was found among participants with severe dementia from baseline to follow-up showing stable quality of life in the intervention group compared with a decrease in the control group . The intervention explained most of the variance in change in the total scale and in the subscales describing Tension and Well-being for the group with severe dementia . The intervention group used significantly less psychotropic medication compared with the control group after end of intervention . CONCLUSION Pleasant and engaging activities facilitated by nursing staff , such as group activity with Paro , could improve quality of life in people with severe dementia . The trial is in adherence with the CONSORT statement and is registered at www . clinical trials.gov ( study ID number : NCT01998490 ) [ corrected ] OBJECTIVES To investigate the affective , social , behavioral , and physiological effects of the companion robot Paro for people with dementia in both a day care center and a home setting . DESIGN A pilot block r and omized controlled trial over 12 weeks . Participants were r and omized to the intervention ( Paro ) or control condition  ( st and ard care ) . SETTING Two dementia day care centers and participants ' homes in Auckl and , New Zeal and . PARTICIPANTS Thirty dyads ( consisting of a care recipient with dementia and their caregiver ) took part in this study . All care recipients attended dementia day care centers at Selwyn Foundation and had a formal diagnosis of dementia . INTERVENTION Thirty-minute unstructured group sessions with Paro at the day care center were run 2 to 3 times a week for 6 weeks . Participants also had Paro at home for 6 weeks . MEASUREMENTS At the day care centers , observations of the care recipients ' behavior , affect , and social responses were recorded using a time sampling method . Observations of interactions with Paro for participants in the intervention were also recorded . Blood pressure and salivary cortisol were collected from care recipients before and after sessions at day care . In the home setting , level of cognition , depressive symptoms , neuropsychiatric symptoms , behavioral agitation , and blood pressure were measured at baseline , 6 weeks , and 12 weeks . Hair cortisol measures were collected at baseline and at 6 weeks . RESULTS Observations showed that Paro significantly improved facial expressions ( affect ) and communication with staff ( social interaction ) at the day care centers . Subanalyses showed that care recipients with less cognitive impairment responded significantly better to Paro . There were no significant differences in care recipient dementia symptoms , nor physiological measures between the intervention and control group . CONCLUSION Paro shows promise in enhancing affective and social outcomes for certain individuals with dementia in a community context . Larger r and omized controlled trials in community setting s , with longer time frames , are needed to further specify the context s and characteristics for which Paro is most beneficial 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 ( 12 ) . The warnings extend to all currently available atypical antipsychotics . Other publications have provided support for these warnings and have raised further safety concerns about older conventional antipsychotics ( 1416 ) . Important questions remain unanswered . Although RCTs provide the best evidence of treatment efficacy and harm , the individual RCTs in this case had low event rates . Reliable estimates of the mortality risk were generated only when data were combined by meta- analysis ( 14 ) . Furthermore , these RCTs were generally short in duration and could not provide information about the long-term effect of antipsychotics on mortality ( 14 , 17 ) . Finally , these trials provide estimates of harm primarily for atypical antipsychotics . Relatively few data are available on harms associated with older conventional antipsychotics . Studies suggest that important differences may exist in the safety profiles of conventional and atypical agents ( 15 , 16 , 18 , 19 ) . Using population -based data , we sought to determine the risk for all-cause mortality in older adults with dementia who received atypical antipsychotics , conventional antipsychotics , or no antipsychotic .  Because important baseline differences exist among these groups , we used propensity score matching to improve their comparability . We also evaluated the effect of duration of treatment with antipsychotics on the risk for death . Methods Data Sources Ontario is Canada 's most populous province . During our study , Ontario had a population of approximately 12 million people , of whom 1.4 million were 65 years of age or older . A universally funded health program covers nearly all physician services , medications , and hospital services for patients 65 years of age or older in Ontario . Information from 4 administrative health care data bases was linked to develop the study cohort : pharmacy records from the Ontario Drug Benefit program , hospitalization records from the Canadian Institute for Health Information Discharge Abstract Data base , physician billing information for inpatient and outpatient services from the Ontario Health Insurance Plan , and basic demographic information and vital statistics from the Registered Persons Data base . We used encrypted unique identifiers that are common among data bases to link anonymous information on demographic characteristics and health services utilization for patients in our study . Little basic information on patients is missing in these data bases . For example , the coding accuracy of drug cl aims in the Ontario Drug Benefit program data base is excellent , with an error rate of only 0.7 % ( 20 ) . The study was approved by the ethics review board of Sunnybrook and Women 's College Health Sciences Centre , Toronto , Ontario , Canada . Dementia Cohort We identified a cohort of all Ontario residents 66 years of age or older with a diagnosis of dementia ( in the Ontario Health Insurance Plan or Discharge Abstract Data base ) between 1 April 1997 and 31 March 2002 . To focus on antipsychotic drug treatment for behavioral and psychological symptoms of dementia , we excluded patients who had evidence of other psychotic disorders ( such as schizophrenia ) or were receiving palliative care services . To reduce the potential for selection bias , we studied only new users of antipsychotics and excluded those who had received antipsychotics in the year before cohort entry ( 21 ) . Exposure to Antipsychotics We identified new use of antipsychotics if any agent available through the Ontario Drug Benefit program was dispensed after cohort entry . Cohort entry ( that is , the index date ) was defined as the date of the first dispensed antipsychotic drug . Available atypical drugs included olanzapine , quetiapine , and risperidone , and available conventional drugs included chlorpromazine , flupenthixol , fluphenazine , haloperidol , loxapine , pericyazine , perphenazine , pimozide , thioridazine , and trifluoperazine . Clozap 
    Output:
    