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1.  Is melatonin helpful in stopping the long-term use of hypnotics? A discontinuation trial 
Pharmacy World & Science   2007;29(6):641-646.
Objective
To find out if administration of melatonin facilitates discontinuation of benzodiazepine (BD) therapy in patients with insomnia.
Method
A placebo controlled trial in nine general practices in the Netherlands. Long-term users of benzodiazepines were asked by their GP to participate in a discontinuation program in combination with melatonin or placebo. The intervention and follow-up period lasted one year. During this period participants received four questionnaires about their use of sleeping medication and several health instruments. The urine of all participants was tested for the presence of benzodiazepines, as proof of the discontinuation.
Main outcome measure
The discontinuation of benzodiazepine use measured by questionnaires and urine samples at three assessment points.
Results
A total of 503 long-term users were selected by the GPs, of whom 38 patients (16M/22F) participated. After one year 40% had stopped their benzodiazepine use, both in the intervention group on melatonin and in the placebo control group. Comparing stoppers and non-stoppers did not reveal significant differences in benzodiazepine use, or awareness of problematic use.
Conclusion
Our findings do not conclusively indicate that melatonin is helpful for the discontinuation of the use of benzodiazepines, but the average dose of benzodiazepines in the group was low. Further investigation is necessary, with special attention to the possible influence of the daily dose on the facilitation effect of melatonin.
doi:10.1007/s11096-007-9118-y
PMCID: PMC2039831  PMID: 17610043
Discontinuation; Hypnotics; Long-term benzodiazepine use; Melatonin; Primary care; The Netherlands
2.  Effects of a programme of multifactorial home visits on falls and mobility impairments in elderly people at risk: randomised controlled trial 
BMJ : British Medical Journal  2000;321(7267):994-998.
Objective
To evaluate whether a programme of multifactorial home visits reduces falls and impairments in mobility in elderly people living in the community.
Design
Randomised controlled trial with 18 months of follow up.
Setting
Six general practices in Hoensbroek, the Netherlands.
Participants
316 people aged 70 and over living in the community, with moderate impairments in mobility or a history of recent falls.
Intervention
Five home visits by a community nurse over a period of one year. Visits consisted of screening for medical, environmental, and behavioural factors causing falls and impairments in mobility, followed by specific advice, referrals, and other actions aimed at dealing with the observed hazards.
Main outcome measures
Falls and impairments in mobility.
Results
No differences were found in falls and mobility outcomes between the intervention and usual care groups.
Conclusion
Multifactorial home visits had no effects on falls and impairments in mobility in elderly people at risk who were living in the community. Because falls and impairments in mobility remain a serious problem among elderly people, alternative strategies should be developed and evaluated.
PMCID: PMC27508  PMID: 11039967
3.  Effects of preventive home visits to elderly people living in the community: systematic review 
BMJ : British Medical Journal  2000;320(7237):754-758.
Objective
To assess the effects of preventive home visits to elderly people living in the community.
Design
Systematic review.
Setting
15 trials retrieved from Medline, Embase, and the Cochrane controlled trial register.
Main outcome measures
Physical function, psychosocial function, falls, admissions to institutions, and mortality.
Results
Considerable differences in the methodological quality of the 15 trials were found, but in general the quality was considered adequate. Favourable effects of the home visits were observed in 5 out of 12 trials measuring physical functioning, 1 out of 8 measuring psychosocial function, 2 out of 6 measuring falls, 2 out of 7 measuring admissions to institutions, and 3 of 13 measuring mortality. None of the trials reported negative effects.
Conclusions
No clear evidence was found in favour of the effectiveness of preventive home visits to elderly people living in the community. It seems essential that the effectiveness of such visits is improved, but if this cannot be achieved consideration should be given to discontinuing these visits.
PMCID: PMC27318  PMID: 10720360
4.  Effectiveness of home care programmes for patients with incurable cancer on their quality of life and time spent in hospital: systematic review 
BMJ : British Medical Journal  1998;316(7149):1939-1944.
Objective: To investigate whether for patients with incurable cancer comprehensive home care programmes are more effective than standard care in maintaining the patients’ quality of life and reducing their “readmission time” (percentage of days spent in hospital from start of care till death).
Design: Systematic review.
Methods: A computer aided search was conducted using the databases of Medline, Embase, CancerLit, and PsychLit. The search for studies and the assessment of the methodological quality of the relevant studies were performed by two investigators, blinded from each other. Prospective, controlled studies investigating the effects of a home care intervention programme on patients’ quality of life or on readmission time were included in the analyses.
Results: Only 9 prospective controlled studies were found; eight were performed in the United States and 1 in the United Kingdom. Their methodological quality was judged to be moderate (median rating 62 on a 100 point scale). None of the studies showed a negative influence of home care interventions on quality of life. A significantly positive influence on the outcome measures was seen in 2 out of the 5 studies measuring patients’ satisfaction with care, in 3/7 studies measuring physical dimensions of quality of life, in 1/6 studies measuring psychosocial dimensions, and in 2/5 studies measuring readmission time. The incorporation of team members’ visits to patients at home or regular multidisciplinary team meetings into the intervention programme seemed to be related to positive results.
Conclusions: The effectiveness of comprehensive home care programmes remains unclear. Given the enormity of the problems faced by society in caring for patients with terminal cancer, further research is urgently needed.
Key messages Only nine controlled prospective studies have compared the effects of home care intervention programmes for patients with terminal cancer with those of standard care, in relation to patients’ quality of life and time spent in hospital between start of care and death The methodological quality of these studies seemed to be moderate Home care programmes did not have a negative influence on quality of life or time spent in hospital; some studies observed positive effects on these outcome measures Enabling team members to visit patients at home and holding regular multidisciplinary team meetings seem important elements for obtaining favourable results The general belief that home care programmes are effective for patients with terminal cancer is not supported scientifically
PMCID: PMC28590  PMID: 9641929

Results 1-4 (4)