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 A r and omized , placebo-controlled clinical trial was undertaken to determine the efficacy of nonpharmacologic individualized interventions ( individualized to address unmet needs such as boredom or pain ) in decreasing agitation in persons with dementia . METHOD Agitated nursing home residents with advanced dementia ( from 9 nursing homes in 5 locations in Maryl and , United States ) were r and omized into an  intervention group ( n = 89 ) and a  placebo control group ( n = 36 ) . On the basis of data from baseline assessment , a systematic methodology for individualizing nonpharmacologic interventions , Treatment Routes for Exploring Agitation ( TREA ) , was used with the intervention group : an unmet need was hypothesized , a corresponding treatment category was identified , and specifics of the treatment were chosen to fit the person 's need , past identity , preferences , and abilities . ( Unmet needs were hypothesized based on physician evaluations , structured staff interviews , relative question naires , direct observations of agitation with the Agitation Behavior Mapping Instrument [ the primary outcome measure ] and affect with Lawton 's Modified Behavior Stream [ the secondary outcome measure ] , and resident assessment s. ) TREA interventions were implemented for 2 weeks , and observations of agitation and affect were recorded . The study was conducted from June 2006 until December 2011 . RESULTS Relative to a control group , TREA interventions for unmet needs produced statistically significant declines in total ( P < .001 ) , physical nonaggressive ( P < .001 ) , and verbal agitation ( P = .004 ) and significant increases in pleasure ( P < .001 ) and interest ( P < .05 ) . CONCLUSIONS This is the first large r and omized controlled trial to demonstrate the efficacy of TREA and one of only a few such trials of nonpharmacologic interventions for agitation in persons with dementia . The translation of these findings into practice is sorely needed and would require structural changes dedicating staff time to observing each agitated resident , determining unmet needs , obtaining appropriate intervention material s , conducting the individualized nonpharmacologic interventions , and evaluating results . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT00820859 OBJECTIVES To describe the patients seen and the clinical activity undertaken by general practitioners during encounters at residential aged-care facilities ( RACFs ) , and to ascertain how these differ from all GP encounters in Australia as a whole . DESIGN AND PARTICIPANTS A secondary analysis of encounter data from the Bettering the Evaluation and Care of Health ( BEACH ) study , April 2004 to March 2006 , comparing RACF consultations ( identified by Medicare item numbers ) with  all BEACH study encounters in Australia . Participants were a r and om sample of GPs who had cl aim ed at least 375 general practice Medicare items in the 3 months prior to the study . MAIN OUTCOME MEASURES Differences in the characteristics of GPs and patients at RACF consultations , morbidities managed , and treatments provided to patients . RESULTS Over the study period there were 2310 RACF encounters out of a total of 197 000 BEACH encounters ; 360/1970 GPs ( 18.4 % ) recorded at least one RACF consultation . GPs aged > or = 45 years were more likely to record at least one RACF consultation than those aged < 45 years . Patients were predominantly women ( 70.7 % ) , and 83.4 % were aged > or = 75 years . At RACF consultations , problems managed significantly more often included chronic problems , as well as psychological , neurological , urological , circulatory , eye and musculoskeletal problems . Dementia was the most common problem managed , at 33 times the usual management rate in everyday practice . Significantly fewer medications , non-pharmacological treatments , referrals , pathology and imaging tests were recorded at RACF consultations . CONCLUSION GP encounters at RACFs involve the management of chronic and complex conditions , including some not frequently seen in everyday general practice . The provision of additional education and re sources where required may assist with workforce shortages in this setting OBJECTIVES To test the main and interactive effects of activities derived from the Need-Driven Dementia-Compromised Behavior model for responding to behavioral symptoms in nursing home residents . DESIGN R and omized double-blind clinical trial . SETTING Nine community-based nursing homes . PARTICIPANTS One hundred twenty-eight cognitively impaired residents r and omly assigned to activities adjusted to functional level ( FL ) ( n=32 ) , personality style of interest ( PSI ) ( n=33 ) ,  functional level and personality style of interest ( FL+PSI ) ( n=31 ) , or active control ( AC ) ( n=32 ) . INTERVENTION Three weeks of activities provided twice daily . MEASUREMENTS Agitation , passivity , engagement , affect , and mood assessed from video recordings and real-time observations during baseline , intervention , r and om times outside of intervention , and 1 week after intervention . RESULTS All treatments improved outcomes during intervention except mood , which worsened under AC . During intervention the PSI group demonstrated greater engagement , alertness , and attention than the other groups ; the FL+PSI group demonstrated greater pleasure . During r and om times , engagement returned to baseline levels except in the FL group in which it decreased . There was also less agitation and passivity in groups with a component adjusted to PSI . One week after the intervention , mood , anxiety , and passivity improved over baseline ; significantly less pleasure was displayed after withdrawal of treatment . CONCLUSION The hypothesis that activities adjusted to FL+PSI would improve behavioral outcomes to a greater extent than partially adjusted or nonadjusted activities was partially supported . PSI is a critical component of individualized activity prescription This cluster r and omized controlled trial sought to determine whether multidisciplinary specialist mental health consultation was more effective than care as usual in treating the depression of aged care residents with dementia OBJECTIVE The objective of this study was to compare the effectiveness of two individualized psychosocial treatments in reducing the frequency of physically and verbally agitated behaviors in nursing home residents whose dementia was complicated by marked behavioral disturbance . METHODS Thirty nursing home residents with frequent , severe behavioral disturbances were observed by research staff before , during , and after multiple , r and omized , single-blind exposures to 15-minute audiotapes of simulated family presence ( a conversation prepared by a family member about positive experiences from the past ) , music preferred by the resident in earlier life , and a placebo condition of a reading from a horticultural text . Selected ( usually multiple ) physical and verbal behaviors were counted as present or absent at regular intervals . All three treatment conditions were compared with usual care . RESULTS Simulated presence and preferred music both proved effective in reducing counts of physically agitated behaviors .  Simulated presence , but not music , result ed in significantly reduced counts of verbally agitated behaviors . The placebo tape proved more effective than expected . Participants ' responses to simulated presence and music varied widely . Behavior counts fell by one-half or more in many cases . Other residents became more agitated . CONCLUSION Participants ' better-than-expected responses to the placebo tape suggest that even the simplest technology can improve the lives of confused , disturbed nursing home residents . Of the two psychosocial treatments , preferred music tapes were easier to make and were clearly helpful in many instances . By contrast , family members often struggled to recall enough happy memories to compile a simulated presence tape . Simulated presence might prove just as effective if relatives speak on topics of their own choosing . Although not all residents were helped by these treatments , adverse effects were mild and shortlived Objective To determine the effect of discontinuing antidepressant treatment in people with dementia and neuropsychiatric symptoms . Design Double blind , r and omised , parallel group , placebo controlled trial . Setting Norwegian nursing homes ; residents recruited by 16 study centres in Norway from August 2008 to June 2010 . Participants 128 patients with Alzheimer ’s disease , dementia or vascular dementia , and neuropsychiatric symptoms ( but no depressive disorder ) , who had been prescribed escitalopram , citalopram , sertraline , or paroxetine for three months or more . We excluded patients with severe somatic disease or terminal illness , or who were unable to take tablets or capsules as prescribed . Interventions Antidepressant treatment was discontinued over one week in 63 patients , and continued in 68 patients . We assessed patients at baseline , four , seven , 13 , and 25 weeks . Main outcome measures Primary outcomes were score differences between study groups in the Cornell scale of depression in dementia and the neuropsychiatric inventory ( 10 item version ) after 25 weeks . Secondary outcomes were score differences in the clinical dementia rating scale , unified Parkinson ’s disease rating scale , quality of life-Alzheimer ’s disease scale , Lawton and Brody ’s physical self maintenance scale , and severe impairment battery . Results Using a linear multilevel model analysis , we found that the discontinued group had significantly higher scores on the Cornell scale after 25 weeks than the continuation group ( difference −2.89 ( 95 % confidence interval −4.76 to −1.02 ) ; P=0.003 ) . We saw a similar result in the mean total score for the neuropsychiatric inventory after 25 weeks , but this difference was non-significant ( −5.96 ( −12.35 to 0.44 ) ; P=0.068 ) . We confirmed these results by non-response analysis ( > 30 % worsening on the Cornell scale)—significantly more patients worsened in the discontinuation group than in the continuation group ( 32 ( 54 % ) v 17 ( 29 % ) ; P=0.006 ) . We found no significant differences between the groups for secondary outcomes . Forty seven ( 37 % ) patients withdrew from the study early . Conclusions Discontinuation of antidepressant treatment in patients with dementia and neuropsychiatric symptoms leads to an increase in depressive symptoms , compared with those patients who continue with treatment . Trial registration Clinical Trial.gov NCT00594269 , EudraCT 2006 - 002790 - 43 BACKGROUND Among patients with Alzheimer 's disease who have had a response to antipsychotic medication for psychosis or agitation-aggression , the risk of a recurrence of symptoms after discontinuation of the medication has not been established . METHODS Patients with Alzheimer 's disease and psychosis or agitation-aggression received open-label treatment with risperidone for 16 weeks . Those who had a response to risperidone therapy were then r and omly assigned , in a double-blind fashion , to one of three regimens : continued risperidone therapy for 32 weeks ( group 1 ) , risperidone therapy for 16 weeks followed by placebo for 16 weeks ( group 2 ) , or placebo for 32 weeks ( group 3 ) . The primary outcome was the time to relapse of psychosis or agitation . RESULTS A total of 180 patients received open-label  risperidone ( mean dose , 0.97 mg daily ) . The severity of psychosis and agitation were reduced , although there was a mild increase in extrapyramidal signs ;  112 patients met the criteria for response to treatment , of whom 110 underwent r and omization . In the first 16 weeks after r and omization , the rate of relapse was higher in the group that received placebo than in the groups that received risperidone ( 60 % [ 24 of 40 patients in group 3 ] vs. 33 % [ 23 of 70 in groups 1 and 2 ] ; P=0.004 ; hazard ratio with placebo , 1.94 ; 95 % confidence interval [ CI ] , 1.09 to 3.45 ; P=0.02 ) . During the next 16 weeks , the rate of relapse was higher in the group that was switched from risperidone to placebo than in the group that continued to receive risperidone ( 48 % [ 13 of 27 patients in group 2 ] vs. 15 % [ 2 of 13 in group 1 ] ; P=0.02 ; hazard ratio , 4.88 ; 95 % CI , 1.08 to 21.98 ; P=0.02 ) . The rates of adverse events and death after r and omization did not differ significantly among the groups , although comparisons were based on small numbers of patients , especially during the final 16 weeks . CONCLUSIONS In patients with Alzheimer 's disease who had psychosis or agitation that had responded to risperidone therapy for 4 to 8 months , discontinuation of risperidone was associated with an increased risk of relapse . ( Funded by the National Institutes of Health and others ; Clinical Trials.gov number , NCT00417482 . ) 
    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 A r and omized , placebo-controlled clinical trial was undertaken to determine the efficacy of nonpharmacologic individualized interventions ( individualized to address unmet needs such as boredom or pain ) in decreasing agitation in persons with dementia . METHOD Agitated nursing home residents with advanced dementia ( from 9 nursing homes in 5 locations in Maryl and , United States ) were r and omized into an  intervention group ( n = 89 ) and a  placebo control group ( n = 36 ) . On the basis of data from baseline assessment , a systematic methodology for individualizing nonpharmacologic interventions , Treatment Routes for Exploring Agitation ( TREA ) , was used with the intervention group : an unmet need was hypothesized , a corresponding treatment category was identified , and specifics of the treatment were chosen to fit the person 's need , past identity , preferences , and abilities . ( Unmet needs were hypothesized based on physician evaluations , structured staff interviews , relative question naires , direct observations of agitation with the Agitation Behavior Mapping Instrument [ the primary outcome measure ] and affect with Lawton 's Modified Behavior Stream [ the secondary outcome measure ] , and resident assessment s. ) TREA interventions were implemented for 2 weeks , and observations of agitation and affect were recorded . The study was conducted from June 2006 until December 2011 . RESULTS Relative to a control group , TREA interventions for unmet needs produced statistically significant declines in total ( P < .001 ) , physical nonaggressive ( P < .001 ) , and verbal agitation ( P = .004 ) and significant increases in pleasure ( P < .001 ) and interest ( P < .05 ) . CONCLUSIONS This is the first large r and omized controlled trial to demonstrate the efficacy of TREA and one of only a few such trials of nonpharmacologic interventions for agitation in persons with dementia . The translation of these findings into practice is sorely needed and would require structural changes dedicating staff time to observing each agitated resident , determining unmet needs , obtaining appropriate intervention material s , conducting the individualized nonpharmacologic interventions , and evaluating results . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT00820859 OBJECTIVES To describe the patients seen and the clinical activity undertaken by general practitioners during encounters at residential aged-care facilities ( RACFs ) , and to ascertain how these differ from all GP encounters in Australia as a whole . DESIGN AND PARTICIPANTS A secondary analysis of encounter data from the Bettering the Evaluation and Care of Health ( BEACH ) study , April 2004 to March 2006 , comparing RACF consultations ( identified by Medicare item numbers ) with  all BEACH study encounters in Australia . Participants were a r and om sample of GPs who had cl aim ed at least 375 general practice Medicare items in the 3 months prior to the study . MAIN OUTCOME MEASURES Differences in the characteristics of GPs and patients at RACF consultations , morbidities managed , and treatments provided to patients . RESULTS Over the study period there were 2310 RACF encounters out of a total of 197 000 BEACH encounters ; 360/1970 GPs ( 18.4 % ) recorded at least one RACF consultation . GPs aged > or = 45 years were more likely to record at least one RACF consultation than those aged < 45 years . Patients were predominantly women ( 70.7 % ) , and 83.4 % were aged > or = 75 years . At RACF consultations , problems managed significantly more often included chronic problems , as well as psychological , neurological , urological , circulatory , eye and musculoskeletal problems . Dementia was the most common problem managed , at 33 times the usual management rate in everyday practice . Significantly fewer medications , non-pharmacological treatments , referrals , pathology and imaging tests were recorded at RACF consultations . CONCLUSION GP encounters at RACFs involve the management of chronic and complex conditions , including some not frequently seen in everyday general practice . The provision of additional education and re sources where required may assist with workforce shortages in this setting OBJECTIVES To test the main and interactive effects of activities derived from the Need-Driven Dementia-Compromised Behavior model for responding to behavioral symptoms in nursing home residents . DESIGN R and omized double-blind clinical trial . SETTING Nine community-based nursing homes . PARTICIPANTS One hundred twenty-eight cognitively impaired residents r and omly assigned to activities adjusted to functional level ( FL ) ( n=32 ) , personality style of interest ( PSI ) ( n=33 ) ,  functional level and personality style of interest ( FL+PSI ) ( n=31 ) , or active control ( AC ) ( n=32 ) . INTERVENTION Three weeks of activities provided twice daily . MEASUREMENTS Agitation , passivity , engagement , affect , and mood assessed from video recordings and real-time observations during baseline , intervention , r and om times outside of intervention , and 1 week after intervention . RESULTS All treatments improved outcomes during intervention except mood , which worsened under AC . During intervention the PSI group demonstrated greater engagement , alertness , and attention than the other groups ; the FL+PSI group demonstrated greater pleasure . During r and om times , engagement returned to baseline levels except in the FL group in which it decreased . There was also less agitation and passivity in groups with a component adjusted to PSI . One week after the intervention , mood , anxiety , and passivity improved over baseline ; significantly less pleasure was displayed after withdrawal of treatment . CONCLUSION The hypothesis that activities adjusted to FL+PSI would improve behavioral outcomes to a greater extent than partially adjusted or nonadjusted activities was partially supported . PSI is a critical component of individualized activity prescription This cluster r and omized controlled trial sought to determine whether multidisciplinary specialist mental health consultation was more effective than care as usual in treating the depression of aged care residents with dementia OBJECTIVE The objective of this study was to compare the effectiveness of two individualized psychosocial treatments in reducing the frequency of physically and verbally agitated behaviors in nursing home residents whose dementia was complicated by marked behavioral disturbance . METHODS Thirty nursing home residents with frequent , severe behavioral disturbances were observed by research staff before , during , and after multiple , r and omized , single-blind exposures to 15-minute audiotapes of simulated family presence ( a conversation prepared by a family member about positive experiences from the past ) , music preferred by the resident in earlier life , and a placebo condition of a reading from a horticultural text . Selected ( usually multiple ) physical and verbal behaviors were counted as present or absent at regular intervals . All three treatment conditions were compared with usual care . RESULTS Simulated presence and preferred music both proved effective in reducing counts of physically agitated behaviors .  Simulated presence , but not music , result ed in significantly reduced counts of verbally agitated behaviors . The placebo tape proved more effective than expected . Participants ' responses to simulated presence and music varied widely . Behavior counts fell by one-half or more in many cases . Other residents became more agitated . CONCLUSION Participants ' better-than-expected responses to the placebo tape suggest that even the simplest technology can improve the lives of confused , disturbed nursing home residents . Of the two psychosocial treatments , preferred music tapes were easier to make and were clearly helpful in many instances . By contrast , family members often struggled to recall enough happy memories to compile a simulated presence tape . Simulated presence might prove just as effective if relatives speak on topics of their own choosing . Although not all residents were helped by these treatments , adverse effects were mild and shortlived Objective To determine the effect of discontinuing antidepressant treatment in people with dementia and neuropsychiatric symptoms . Design Double blind , r and omised , parallel group , placebo controlled trial . Setting Norwegian nursing homes ; residents recruited by 16 study centres in Norway from August 2008 to June 2010 . Participants 128 patients with Alzheimer ’s disease , dementia or vascular dementia , and neuropsychiatric symptoms ( but no depressive disorder ) , who had been prescribed escitalopram , citalopram , sertraline , or paroxetine for three months or more . We excluded patients with severe somatic disease or terminal illness , or who were unable to take tablets or capsules as prescribed . Interventions Antidepressant treatment was discontinued over one week in 63 patients , and continued in 68 patients . We assessed patients at baseline , four , seven , 13 , and 25 weeks . Main outcome measures Primary outcomes were score differences between study groups in the Cornell scale of depression in dementia and the neuropsychiatric inventory ( 10 item version ) after 25 weeks . Secondary outcomes were score differences in the clinical dementia rating scale , unified Parkinson ’s disease rating scale , quality of life-Alzheimer ’s disease scale , Lawton and Brody ’s physical self maintenance scale , and severe impairment battery . Results Using a linear multilevel model analysis , we found that the discontinued group had significantly higher scores on the Cornell scale after 25 weeks than the continuation group ( difference −2.89 ( 95 % confidence interval −4.76 to −1.02 ) ; P=0.003 ) . We saw a similar result in the mean total score for the neuropsychiatric inventory after 25 weeks , but this difference was non-significant ( −5.96 ( −12.35 to 0.44 ) ; P=0.068 ) . We confirmed these results by non-response analysis ( > 30 % worsening on the Cornell scale)—significantly more patients worsened in the discontinuation group than in the continuation group ( 32 ( 54 % ) v 17 ( 29 % ) ; P=0.006 ) . We found no significant differences between the groups for secondary outcomes . Forty seven ( 37 % ) patients withdrew from the study early . Conclusions Discontinuation of antidepressant treatment in patients with dementia and neuropsychiatric symptoms leads to an increase in depressive symptoms , compared with those patients who continue with treatment . Trial registration Clinical Trial.gov NCT00594269 , EudraCT 2006 - 002790 - 43 BACKGROUND Among patients with Alzheimer 's disease who have had a response to antipsychotic medication for psychosis or agitation-aggression , the risk of a recurrence of symptoms after discontinuation of the medication has not been established . METHODS Patients with Alzheimer 's disease and psychosis or agitation-aggression received open-label treatment with risperidone for 16 weeks . Those who had a response to risperidone therapy were then r and omly assigned , in a double-blind fashion , to one of three regimens : continued risperidone therapy for 32 weeks ( group 1 ) , risperidone therapy for 16 weeks followed by placebo for 16 weeks ( group 2 ) , or placebo for 32 weeks ( group 3 ) . The primary outcome was the time to relapse of psychosis or agitation . RESULTS A total of 180 patients received open-label  risperidone ( mean dose , 0.97 mg daily ) . The severity of psychosis and agitation were reduced , although there was a mild increase in extrapyramidal signs ;  112 patients met the criteria for response to treatment , of whom 110 underwent r and omization . In the first 16 weeks after r and omization , the rate of relapse was higher in the group that received placebo than in the groups that received risperidone ( 60 % [ 24 of 40 patients in group 3 ] vs. 33 % [ 23 of 70 in groups 1 and 2 ] ; P=0.004 ; hazard ratio with placebo , 1.94 ; 95 % confidence interval [ CI ] , 1.09 to 3.45 ; P=0.02 ) . During the next 16 weeks , the rate of relapse was higher in the group that was switched from risperidone to placebo than in the group that continued to receive risperidone ( 48 % [ 13 of 27 patients in group 2 ] vs. 15 % [ 2 of 13 in group 1 ] ; P=0.02 ; hazard ratio , 4.88 ; 95 % CI , 1.08 to 21.98 ; P=0.02 ) . The rates of adverse events and death after r and omization did not differ significantly among the groups , although comparisons were based on small numbers of patients , especially during the final 16 weeks . CONCLUSIONS In patients with Alzheimer 's disease who had psychosis or agitation that had responded to risperidone therapy for 4 to 8 months , discontinuation of risperidone was associated with an increased risk of relapse . ( Funded by the National Institutes of Health and others ; Clinical Trials.gov number , NCT00417482 . ) 
    Output:
    