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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
101 to 125 of 197 Research Studies DisplayedKukulka K, Washington KT, Govindarajan R
Stakeholder perspectives on the biopsychosocial and spiritual realities of living with ALS: implications for palliative care teams.
The purpose of this study was to generate a rich description of the realities of living with amyotrophic lateral sclerosis (ALS), equipping palliative care teams with an in-depth understanding of the experiences and needs of patients with ALS and their family caregivers. Study findings illustrated the intricacies of living with ALS and the importance of eliciting individualized values when caring for patients with ALS and their families. The investigators concluded that the complex biopsychosocial needs experienced by patients and family caregivers suggested numerous opportunities for meaningful palliative care involvement.
AHRQ-funded; HS022140.
Citation: Kukulka K, Washington KT, Govindarajan R .
Stakeholder perspectives on the biopsychosocial and spiritual realities of living with ALS: implications for palliative care teams.
Am J Hosp Palliat Care 2019 Oct;36(10):851-57. doi: 10.1177/1049909119834493..
Keywords: Palliative Care, Patient-Centered Outcomes Research, Neurological Disorders, Patient-Centered Healthcare, Patient and Family Engagement, Caregiving
Possin KL, Merrilees JJ, Dulaney S
Effect of collaborative dementia care via telephone and internet on quality of life, caregiver well-being, and health care use: the Care Ecosystem randomized clinical trial.
Few health systems have adopted effective dementia care management programs. The Care Ecosystem is a model for delivering care from centralized hubs across broad geographic areas to caregivers and persons with dementia (PWDs) independently of their health system affiliations. The purpose of this study was to determine whether the Care Ecosystem was effective in improving outcomes important to PWDs, their caregivers, and payers beyond those achieved with usual care.
AHRQ-funded; HS022241.
Citation: Possin KL, Merrilees JJ, Dulaney S .
Effect of collaborative dementia care via telephone and internet on quality of life, caregiver well-being, and health care use: the Care Ecosystem randomized clinical trial.
JAMA Intern Med 2019 Sep 30;179(12):1658-67. doi: 10.1001/jamainternmed.2019.4101..
Keywords: Dementia, Neurological Disorders, Telehealth, Health Information Technology (HIT), Care Management, Healthcare Delivery, Caregiving, Quality of Life
Wissel BD, Greiner HM, Glauser TA
Investigation of bias in an epilepsy machine learning algorithm trained on physician notes.
Racial disparities in the utilization of epilepsy surgery are well documented, but it is unknown whether a natural language processing (NLP) algorithm trained on physician notes would produce biased recommendations for epilepsy presurgical evaluations. To assess this, an NLP algorithm was trained to identify potential surgical candidates using 1097 notes from 175 epilepsy patients with a history of resective epilepsy surgery and 268 patients who achieved seizure freedom without surgery (total N = 443 patients).
AHRQ-funded; HS024977.
Citation: Wissel BD, Greiner HM, Glauser TA .
Investigation of bias in an epilepsy machine learning algorithm trained on physician notes.
Epilepsia 2019 Sep;60(9):e93-e98. doi: 10.1111/epi.16320..
Keywords: Neurological Disorders, Surgery, Clinical Decision Support (CDS), Healthcare Utilization, Health Information Technology (HIT), Decision Making
Bernstein A, Rogers KM, Possin KL
Primary care provider attitudes and practices evaluating and managing patients with neurocognitive disorders.
The prevalence of dementia, a neurocognitive disorder (NCD), is expected to triple in the next 30 years. In this study, the investigators surveyed a national sample of primary care physicians to characterize their attitudes and practices with respect to the evaluation and management of NCDs.
AHRQ-funded; HS022241.
Citation: Bernstein A, Rogers KM, Possin KL .
Primary care provider attitudes and practices evaluating and managing patients with neurocognitive disorders.
J Gen Intern Med 2019 Sep;34(9):1691-92. doi: 10.1007/s11606-019-05013-7..
Keywords: Dementia, Neurological Disorders, Provider: Physician, Provider: Clinician, Provider, Primary Care
Gillespie SM, Wasserman EB, Wood NE
High-intensity telemedicine reduces emergency department use by older adults with dementia in senior living communities.
Individuals with dementia have high rates of emergency department (ED) use for acute illnesses. In this study, the investigators evaluated the effect of a high-intensity telemedicine program that delivered care for acute illnesses on ED use rates for individuals with dementia residing in senior living communities (SLCs; independent and assisted living).
AHRQ-funded; HS018047.
Citation: Gillespie SM, Wasserman EB, Wood NE .
High-intensity telemedicine reduces emergency department use by older adults with dementia in senior living communities.
J Am Med Dir Assoc 2019 Aug;20(8):942-46. doi: 10.1016/j.jamda.2019.03.024..
Keywords: Elderly, Telehealth, Health Information Technology (HIT), Dementia, Neurological Disorders, Healthcare Delivery, Chronic Conditions, Emergency Department, Healthcare Utilization
Newman TB, Wu YW, Kuzniewicz MW
Childhood seizures after phototherapy.
A recent Danish study found an increased risk of childhood epilepsy only in boys after phototherapy; researchers investigated this association in a Kaiser Permanente Northern California cohort of infants born after at least 35 weeks' gestation in 1995-2011. The mean follow-up period was 8.1 years. Primary outcome was at least 1 encounter with a seizure diagnosis plus at least 1 prescription for an antiepileptic drug. Results indicated that boys were at higher risk of seizures overall, and had a higher adjusted hazard ratio for phototherapy than girls, although effect modification by sex was not statistically significant. The researchers conclude that infant phototherapy is associated with a small increased risk of childhood seizures, and the risk is more significant in boys.
AHRQ-funded; HS020618.
Citation: Newman TB, Wu YW, Kuzniewicz MW .
Childhood seizures after phototherapy.
Pediatrics 2018 Oct;142(4):pii: e20180648. doi: 10.1542/peds.2018-0648..
Keywords: Adverse Events, Children/Adolescents, Neurological Disorders, Risk
Spears CC, Besharat A, Monari EH
Causes and outcomes of hospitalization in Lewy body dementia: a retrospective cohort study.
Understanding hospitalization in Lewy body dementia (LBD) is a known knowledge gap. In this study, the authors aimed to identify common causes, medication profiles, complications, and outcomes of hospitalization in LBD. The investigators concluded that the most common reasons for hospitalization in LBD are potentially modifiable. They indicated that opportunities for improved care include increased involvement of neurological and psychiatric services, delirium prevention strategies, and reduced antipsychotic use.
AHRQ-funded; HS024159.
Citation: Spears CC, Besharat A, Monari EH .
Causes and outcomes of hospitalization in Lewy body dementia: a retrospective cohort study.
Parkinsonism Relat Disord 2019 Jul;64:106-11. doi: 10.1016/j.parkreldis.2019.03.014..
Keywords: Dementia, Neurological Disorders, Hospitalization
Armstrong MJ, Gronseth GS, Day GS
Patient stakeholder versus physician preferences regarding amyloid PET testing.
Patient and caregiver perspectives on amyloid positron emission tomography (PET) use are largely unexplored, particularly as compared with clinician views. In this study, the investigators surveyed clinicians, patients, caregivers, and dementia advocates on topics relating to an evidence-based guideline on amyloid PET use. They found that patients and caregivers emphasized the importance of having a dementia diagnosis and placed more value on testing and outcomes for asymptomatic populations than clinicians.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Gronseth GS, Day GS .
Patient stakeholder versus physician preferences regarding amyloid PET testing.
Alzheimer Dis Assoc Disord 2019 Jul-Sep;33(3):246-53. doi: 10.1097/wad.0000000000000311..
Keywords: Decision Making, Dementia, Diagnostic Safety and Quality, Evidence-Based Practice, Guidelines, Imaging, Neurological Disorders, Patient-Centered Outcomes Research, Provider, Provider: Physician
Schiltz NK, Warner DF, Sun J
The influence of multimorbidity on leading causes of death in older adults with cognitive impairment.
The aim of this study was to evaluate the relationship of leading causes of death with gradients of cognitive impairment and multimorbidity. The authors found that multimorbidity was common in the study population. Heart disease was the leading cause in all groups, but with a larger percentage of deaths in the mild and moderate/severe cognitively impaired groups than among the noncognitively impaired. The different "paths" down the regression trees showed that the distribution of causes of death changed with different combinations of multimorbidity.
AHRQ-funded; HS023113.
Citation: Schiltz NK, Warner DF, Sun J .
The influence of multimorbidity on leading causes of death in older adults with cognitive impairment.
J Aging Health 2019 Jul;31(6):1025-42. doi: 10.1177/0898264317751946..
Keywords: Elderly, Dementia, Neurological Disorders, Chronic Conditions, Mortality
Befus DR, Hull S
Nonpharmacological self-management of migraine across social locations: an equity-oriented, qualitative analysis.
The authors conducted focus groups to explore patients’ desires and recommendations for migraine clinicians and researchers. They identified 4 themes: a more holistic, collaborative, long-term treatment approach; medication as a short-term solution; high personal and economic costs of medication; and desire for more information about and access to natural approaches. The authors concluded that holistic and integrative approaches were preferred over medication as long-term migraine management strategies; however, people in marginalized social locations, while disproportionately disabled by migraine, did not feel as comfortable accessing integrative approaches through currently available channels.
AHRQ-funded; HS0224430.
Citation: Befus DR, Hull S .
Nonpharmacological self-management of migraine across social locations: an equity-oriented, qualitative analysis.
Glob Adv Health Med 2019 Jun 13;8:2164956119858034. doi: 10.1177/2164956119858034..
Keywords: Care Management, Chronic Conditions, Complementary and Alternative Medicine, Neurological Disorders, Patient Self-Management
Armstrong MJ, Alliance S, Taylor A
End-of-life experiences in dementia with Lewy bodies: qualitative interviews with former caregivers.
This study examined the knowledge of former caregivers of patients with dementia with Lewy bodies (DLB) and the patients’ end of life (EOL) experiences. Telephone interviews were conducted with a total of 30 caregivers and family members of individuals who died with DLB in the last 5 years. The interviews revealed a lack of knowledge regarding what to expect, EOL time course, advance care planning, medications at the end of life, approaching end of life, and the death experience itself.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Alliance S, Taylor A .
End-of-life experiences in dementia with Lewy bodies: qualitative interviews with former caregivers.
PLoS One 2019 May 30;14(5):e0217039. doi: 10.1371/journal.pone.0217039..
Keywords: Palliative Care, Dementia, Neurological Disorders, Caregiving
Callaghan BC, Reynolds E, Banerjee M
Out-of-pocket costs are on the rise for commonly prescribed neurologic medications.
The purpose of this study was to determine out-of-pocket costs for neurologic medications in 5 common neurologic diseases. The investigators concluded that out-of-pocket costs for neurologic medications have increased considerably over the last 12 years, particularly for those in high-deductible health plans. Out-of-pocket costs vary widely both across and within conditions. They assert that to minimize patient financial burden, neurologists require access to precise cost information when making treatment decisions.
AHRQ-funded; HS022258.
Citation: Callaghan BC, Reynolds E, Banerjee M .
Out-of-pocket costs are on the rise for commonly prescribed neurologic medications.
Neurology 2019 May 28;92(22):e2604-e13. doi: 10.1212/wnl.0000000000007564.
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Keywords: Health Insurance, Healthcare Costs, Medication, Neurological Disorders
Armstrong MJ
Developing the disorders of consciousness guideline and challenges of integrating shared decision-making into clinical practice.
The purpose of this study was to review methodology informing evidence-based guideline development and integration of guidelines into clinical care through shared decision-making (SDM) and to highlight challenges to SDM in disorders of consciousness. Recently published disorders of consciousness guideline recommendations provide strategies for clinicians to enhance quality care for these individuals and also to provide details helping clinicians partner with individuals with disorders of consciousness and their surrogates. Further research is recommended into many aspects of caring for individuals with disorders of consciousness and optimal strategies for partnering with surrogates in decision-making.
AHRQ-funded; HS024159.
Citation: Armstrong MJ .
Developing the disorders of consciousness guideline and challenges of integrating shared decision-making into clinical practice.
J Head Trauma Rehabil 2019 May/Jun;34(3):199-204. doi: 10.1097/htr.0000000000000496.
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Keywords: Decision Making, Guidelines, Evidence-Based Practice, Neurological Disorders, Patient-Centered Outcomes Research
Armstrong MJ, Rastgardani T, Gagliardi AR
Barriers and facilitators of communication about off periods in Parkinson's disease: qualitative analysis of patient, carepartner, and physician Interviews.
This article discusses barriers and facilitators of communication with Parkinson’s disease patients, care partners, and their physicians specifically during off periods. Twenty persons with Parkinson’s and their care partners, and 20 physicians participated in interviews using a semi-structured questionnaire. Communication barrier levels were identified as patient-level, caregiver-level, and physician-level. For patients cognitive impairment and reluctance to discuss symptoms was the largest barrier. Caregiver absence was also a barrier. For physicians barriers were distraction by technology and lack of appreciation of off period burdens. Various tools such as home diaries, questionnaires and mobile phone videos can be used to aid communication regarding off periods. Patients and their caregivers stressed the need for more formal educational materials and improved educational tools.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Rastgardani T, Gagliardi AR .
Barriers and facilitators of communication about off periods in Parkinson's disease: qualitative analysis of patient, carepartner, and physician Interviews.
PLoS One 2019 Apr 18;14(4):e0215384. doi: 10.1371/journal.pone.0215384..
Keywords: Communication, Clinician-Patient Communication, Neurological Disorders, Caregiving, Education: Patient and Caregiver, Health Literacy, Patient and Family Engagement
Albrecht JS, Hanna M, Randall RL
An algorithm to characterize a dementia population by disease subtype.
The purpose of this study was to develop a method of categorizing Alzheimer disease and related dementias (ADRD) cases by subtype and to characterize and compare subtype populations by demographic and other characteristics. Cases of ADRD occurring 2008 to 2014 were identified from the OptumLabs Database a categorization algorithm using temporal sequencing of diagnoses and provider type developed. The algorithm identified six dementia subtypes as well as three additional categories that represent unique diagnostic patterns in the data. The authors conclude that the differences and similarities between these groups provide support for their algorithmic approach and offer a unique insight into ADRD subtype characteristics.
AHRQ-funded; HS024560.
Citation: Albrecht JS, Hanna M, Randall RL .
An algorithm to characterize a dementia population by disease subtype.
An algorithm to characterize a dementia population by disease subtype..
Keywords: Dementia, Neurological Disorders
Hong M, Casado BL, Lee SE
The intention to discuss advance care planning in the context of Alzheimer's disease among Korean Americans.
The authors examined the intention to discuss advance care planning (ACP) for a family member with Alzheimer's disease among Korean Americans. Path analyses were conducted on a cross-sectional convenience sample; age, gender, education, and knowledge about Alzheimer's disease and ACP were included as covariates. From their findings, the authors recommended promoting ACP among this population and designing educational interventions to address positive attitudes and subjective norms toward ACP.
AHRQ-funded; HS022947.
Citation: Hong M, Casado BL, Lee SE .
The intention to discuss advance care planning in the context of Alzheimer's disease among Korean Americans.
Gerontologist 2019 Mar 14;59(2):347-55. doi: 10.1093/geront/gnx211..
Keywords: Elderly, Dementia, Neurological Disorders, Decision Making, Racial and Ethnic Minorities
Simon KC, Yucus C, Castle J
Building of EMR tools to support quality and research in a memory disorders clinic.
This article describes the development of a customized EMR toolkit that standardizes patient data collection with hundreds of discrete fields, supports Best Practices for treating patients with memory disorders, and also supports practice-based research. The toolkit was successfully implemented to support Best Practices in the care of patients with memory disorders. Applications are also discussed. Data collection is ongoing, but the authors anticipate that the toolkit will generate data that allows for descriptive and hypothesis-driven research as well as quality improvement among patients seen in memory clinics.
AHRQ-funded; HS024057.
Citation: Simon KC, Yucus C, Castle J .
Building of EMR tools to support quality and research in a memory disorders clinic.
Front Neurol 2019 Mar 7;10:161. doi: 10.3389/fneur.2019.00161..
Keywords: Dementia, Electronic Health Records (EHRs), Health Information Technology (HIT), Neurological Disorders, Quality of Care, Quality Improvement, Tools & Toolkits
Marcum ZA, Hohl SD, Gray SL
Brain health and dementia prevention: a mixed-method analysis.
This study examined perceptions on the ability to prevent Alzheimer’s disease and related dementias (ADRD) by improving brain health. A web-based survey was conducted on a sample 1661 patients in Washington State from February-March 2018. Most respondents were female, aged 51-70, and white. Most agreed that it may be possible to improve brain health to reduce ADRD risk, one-third lacked confidence that they could take personal action to reduce the risk.
AHRQ-funded; HS022982.
Citation: Marcum ZA, Hohl SD, Gray SL .
Brain health and dementia prevention: a mixed-method analysis.
Am J Health Behav 2019 Mar 1;43(2):300-10. doi: 10.5993/ajhb.43.2.7..
Keywords: Dementia, Neurological Disorders, Prevention
Callaghan BC, Reynolds E, Banerjee M
Longitudinal pattern of pain medication utilization in peripheral neuropathy patients.
The authors of this article investigated the pattern and utilization of neuropathic pain medications in peripheral neuropathy patients. They found that opioid initiation and transition to chronic opioid therapy were frequent in the studied population despite few patients receiving more than one guideline-recommended medication. They concluded that efforts are needed to decrease opioid utilization and to increase guideline-recommended medication use in order to improve current neuropathic pain treatment.
AHRQ-funded; HS017690.
Citation: Callaghan BC, Reynolds E, Banerjee M .
Longitudinal pattern of pain medication utilization in peripheral neuropathy patients.
Pain 2019 Mar;160(3):592-99. doi: 10.1097/j.pain.0000000000001439..
Keywords: Chronic Conditions, Guidelines, Healthcare Utilization, Medication, Neurological Disorders, Opioids, Pain, Practice Patterns
Hill CE, Lin CC, Burke JF
Claims data analyses unable to properly characterize the value of neurologists in epilepsy care.
The authors sought to determine the association of a neurologist visit with health care use and cost outcomes for patients with incident epilepsy using health care claims data for individuals insured by United Healthcare from 2001 to 2016. They found that patients with epilepsy who visited a neurologist had greater subsequent health care use, medical costs, and care escalation than controls. They conclude that their comparison using administrative claims was plausibly confounded by case disease severity, as suggested by higher non-epilepsy care costs, and that linking patient-centered outcomes to claims data may provide the clinical resolution to assess care value within a heterogeneous population.
AHRQ-funded; HS017690; HS022258.
Citation: Hill CE, Lin CC, Burke JF .
Claims data analyses unable to properly characterize the value of neurologists in epilepsy care.
Neurology 2019 Feb 26;92(9):e973-e87. doi: 10.1212/wnl.0000000000007004..
Keywords: Neurological Disorders, Ambulatory Care and Surgery, Healthcare Utilization
Marcum ZA, Walker RL, Jones BL
Patterns of antihypertensive and statin adherence prior to dementia: findings from the adult changes in thought study.
Using the hypothesis that changes in medication adherence might represent an early sign of cognitive impairment, this study examined antihypertensive and statin adherence trajectories in community-dwelling older adults to compare which went on to develop dementia and which did not. Data from Adult Changes in Thought (ACT), a population-based cohort study, was analyzed; 4368 participants aged 65 years or older who had at least one follow-up visit were selected, included on the basis of whether they were prevalent users of either a statin or antihypertensive medication on the first day of follow up. Research-quality dementia diagnoses were used to identify cases. Non-dementia control visits were matched by age, sex, and study cohort that occurred at similar follow-up time as the selected case dementia onset. The authors conclude that the patterns of medication adherence that emerged may be useful to identify people with higher likelihood of developing dementia.
AHRQ-funded; HS022982.
Citation: Marcum ZA, Walker RL, Jones BL .
Patterns of antihypertensive and statin adherence prior to dementia: findings from the adult changes in thought study.
BMC Geriatr 2019 Feb 14;19(1):41. doi: 10.1186/s12877-019-1058-6..
Keywords: Dementia, Elderly, Medication, Neurological Disorders, Patient Adherence/Compliance
Duvall SW, Lindly O, Zuckerman K
Ethical implications for providers regarding cannabis use in children with autism spectrum disorders.
In this paper, the authors present commentary on the ethical implications of cannabis use in children with autism spectrum disorder and severe self-harm behaviors. They discuss ethical analysis that includes harm reduction, health concerns, and information sharing.
AHRQ-funded; HS000063.
Citation: Duvall SW, Lindly O, Zuckerman K .
Ethical implications for providers regarding cannabis use in children with autism spectrum disorders.
Pediatrics 2019 Feb;143(2). doi: 10.1542/peds.2018-0558..
Keywords: Autism, Children/Adolescents, Complementary and Alternative Medicine, Neurological Disorders
Sterling MR, Jannat-Khah D, Bryan J
The prevalence of cognitive impairment among adults with incident heart failure: the "Reasons for Geographic and Racial Differences in Stroke" (REGARDS) study.
The REGARDS study determined the prevalence of cognitive impairment (CI) among adults aged 45 and older with incident heart failure (HF) in order to improve understanding of cognition in HF. Cognitive function was assessed using the Six-Item Screener, and the prevalence of CI among those with incident HF was compared with the prevalence of CI among a matching cohort without HF. The study results indicated that 14.9 percent of the adults with incident HF had CI, suggesting that the majority of cognitive decline occurs after HF diagnosis. The authors suggest that increased awareness of CI among newly diagnosed patients and ways to mitigate it in the context of HF management are warranted.
AHRQ-funded; HS000066.
Citation: Sterling MR, Jannat-Khah D, Bryan J .
The prevalence of cognitive impairment among adults with incident heart failure: the "Reasons for Geographic and Racial Differences in Stroke" (REGARDS) study.
J Card Fail 2019 Feb;25(2):130-36. doi: 10.1016/j.cardfail.2018.12.006..
Keywords: Cardiovascular Conditions, Dementia, Heart Disease and Health, Neurological Disorders
Gaugler JE, Zmora R, Mitchell LL
Six-month effectiveness of remote activity monitoring for persons living with dementia and their family caregivers: an experimental mixed methods study.
This paper describes a pilot study conducted to evaluate the effectiveness of remote activity monitoring (RAM) for persons living with Alzheimer’s disease or a related dementia (ADRD) and their family caregivers. An experimental mixed methods study of 132 persons living with ADRD was conducted for six months. There were mixed results as the early months spent calibrating and modifying the RAM system was challenging for families. For families who care for ADRD patients with less severe cognitive impairment and difficulty navigating around the most there was a statistically significant increase in competence and self-sufficiency. However, it may not be as effective for patients with more severe cognitive impairment.
AHRQ-funded; HS022836.
Citation: Gaugler JE, Zmora R, Mitchell LL .
Six-month effectiveness of remote activity monitoring for persons living with dementia and their family caregivers: an experimental mixed methods study.
Gerontologist 2019 Jan 9;59(1):78-89. doi: 10.1093/geront/gny078..
Keywords: Caregiving, Dementia, Elderly, Health Information Technology (HIT), Neurological Disorders, Quality of Care, Quality Improvement
Carnahan RM, Daly JM, Minion S
A needs assessment of family physicians to inform development of educational resources on antipsychotic use in dementia.
The authors assessed the needs and preferred resources of Iowa physicians to inform the development of educational resources for best practice dementia care and compared the responses of nursing home medical directors with nonmedical directors. They found that medical directors and nonmedical directors had similar preferences for resources used and information needs, with preference for online resources, pocket guides, a handbook, consulting pharmacists, and facility in-services being the most commonly preferred sources of new information. Medical directors were significantly more aware of the FDA warning on antipsychotic use in dementia and treated more nursing home patients. No differences were observed between groups related to confidence in and use of nondrug strategies instead of antipsychotics to manage behavioral symptoms of dementia.
AHRQ-funded; HS019355.
Citation: Carnahan RM, Daly JM, Minion S .
A needs assessment of family physicians to inform development of educational resources on antipsychotic use in dementia.
J Prim Care Community Health 2019 Jan-Dec;10:2150132719840113. doi: 10.1177/2150132719840113..
Keywords: Education: Continuing Medical Education, Medication, Dementia, Neurological Disorders, Elderly, Evidence-Based Practice, Guidelines, Long-Term Care