{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T07:18:44Z","timestamp":1785223124533,"version":"3.55.0"},"reference-count":20,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2014,11,6]]},"published-print":{"date-parts":[[2014,12]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Antipsychotics are commonly used for management of behavioural symptoms in dementia, among people in residential care. This continues to occur despite their modest effectiveness, potential harms including increased risk of death and stroke, and absence of detrimental effect when people with dementia were randomised to antipsychotic withdrawal. This study aims to test the hypothesis that the multifaceted REducing Anti-Psychotic use in residential care-Huntington Disease (REAP-HD) programme is more effective than standard staff education (SSE) in reducing antipsychotic use for people with HD in residential care facilities (RCF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>this is a cluster randomised controlled trial with blinded outcome assessment. The study population is healthcare professionals looking after people with HD in individual RCF, in the state of New South Wales. Each RCF will be centrally randomised to the REAP-HD programme or the comparator, SSE. Blinded outcome assessment will be performed by examining drug charts and using the Neuropsychiatric Inventory-Q (NPI-Q). Primary outcome is the proportion of people with HD who have had a reduction in antipsychotic use 4\u2005months after the intervention. Secondary outcome measures are (1) change in severity of behavioural symptoms, as measured by the NPI-Q at 4\u2005months (to ensure antipsychotic reduction has not lead to worsening behavioural symptoms), and (2) proportion of people with HD who have had a reduction in antipsychotic dosage at 4\u2005months for each strategy, compared to 4\u2005months prior to enrolment (to capture the possibility that both arms reduced antipsychotic use). Analysis will be by Intention-To-Treat and take into account the clustering. Recruitment is ongoing, as of July 2014.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This protocol has been approved by the Western Sydney Local Health District Human Research Ethics Committee, trial registration ACTRN12614000083695. Study results will be disseminated through peer-reviewed publication in an anonymous manner.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>ACTRN12614000083695, the Australian New Zealand Clinical Trials Registry.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2014-006151","type":"journal-article","created":{"date-parts":[[2014,12,3]],"date-time":"2014-12-03T00:13:01Z","timestamp":1417565581000},"page":"e006151","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Protocol for REducing Anti-Psychotic use in residential care-Huntington Disease (REAP-HD): a pilot cluster randomised controlled trial of a multifaceted intervention for health professionals"],"prefix":"10.1136","volume":"4","author":[{"given":"Clement T","family":"Loy","sequence":"first","affiliation":[{"name":"Huntington Disease Service, Westmead Hospital, Westmead, New South Wales, Australia"},{"name":"The University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Hayen","sequence":"additional","affiliation":[{"name":"The University of New South Wales, Kensington, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen","family":"McKinnon","sequence":"additional","affiliation":[{"name":"Huntington Disease Service, Westmead Hospital, Westmead, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2014,12,2]]},"reference":[{"key":"2025121300010087000_4.12.e006151.1","unstructured":"National Prescribing Service. Role of antipsychotics in managing behavioural and psychological symptoms of dementia. NPS Prescribing Practice Review, 2007."},{"key":"2025121300010087000_4.12.e006151.2","unstructured":"National Institute for Health and Clinical Excellence. Dementia: supporting people with dementia and their carers in health and social care. NICE clinical guidelines, 2006 (amended 2011):35\u20137."},{"key":"2025121300010087000_4.12.e006151.3","unstructured":"American Psychiatric Association. Practice guideline for the treatment of patients with Alzheimer's disease and other dementias. 2nd edn. 2007:31."},{"key":"2025121300010087000_4.12.e006151.4","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s00213-010-1939-z","article-title":"Second-generation antipsychotics in dementia: beyond safety concerns. A clinical, systematic review of efficacy data from randomised controlled trials","volume":"212","author":"Gentile","year":"2010","journal-title":"Psychopharmacology (Berl)"},{"key":"2025121300010087000_4.12.e006151.5","doi-asserted-by":"crossref","unstructured":"Ballard C , Waite J . The effectiveness of atypical antipsychotics for the treatment of aggression and psychosis in Alzheimer's disease. Cochrane Database Syst Rev 2006;(1):CD003476.","DOI":"10.1002\/14651858.CD003476.pub2"},{"key":"2025121300010087000_4.12.e006151.6","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.15.1934"},{"key":"2025121300010087000_4.12.e006151.7","doi-asserted-by":"publisher","DOI":"10.1097\/01.JGP.0000200589.01396.6d"},{"key":"2025121300010087000_4.12.e006151.8","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0050076"},{"key":"2025121300010087000_4.12.e006151.9","unstructured":"US Food and Drug Administration. FDA Requests Boxed Warnings on Older Class of Antipsychotic Drugs. Secondary FDA Requests Boxed Warnings on Older Class of Antipsychotic Drugs. 2008. http:\/\/www.fda.gov\/NewsEvents\/Newsroom\/PressAnnouncements\/2008\/ucm116912.htm"},{"key":"2025121300010087000_4.12.e006151.10","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2010.200"},{"key":"2025121300010087000_4.12.e006151.11","doi-asserted-by":"crossref","first-page":"270","DOI":"10.5694\/j.1326-5377.2011.tb02968.x","article-title":"A 2009 survey of psychotropic medication use in Sydney nursing homes","volume":"194","author":"Snowdon","year":"2011","journal-title":"Med J Aust"},{"key":"2025121300010087000_4.12.e006151.12","unstructured":"Banergee S . The use of antipsychotic medication for people with dementia: time for action. A report for the Minister of State for Care Services, 2009."},{"key":"2025121300010087000_4.12.e006151.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60111-1"},{"key":"2025121300010087000_4.12.e006151.14","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410300314"},{"key":"2025121300010087000_4.12.e006151.15","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psy.48.5.400"},{"key":"2025121300010087000_4.12.e006151.16","unstructured":"Craufurd G , Snowden J . Neuropsychological and neuropsychiatric aspects of Huntington disease. In: Bates G , Harper PS , Jones L , eds. Huntington's disease. 3rd edn. Oxford: Oxford University Press, 2002:62\u201394."},{"key":"2025121300010087000_4.12.e006151.17","unstructured":"YPINH National Alliance. 2011. http:\/\/www.ypinh.org.au\/index.php\/Statistics.htm; Secondary http:\/\/www.ypinh.org.au\/index.php\/Statistics.htm. http:\/\/www.ypinh.org.au\/index.php\/Statistics.htm"},{"key":"2025121300010087000_4.12.e006151.18","doi-asserted-by":"publisher","DOI":"10.1176\/appi.neuropsych.12.2.233"},{"key":"2025121300010087000_4.12.e006151.19","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-7-37"},{"key":"2025121300010087000_4.12.e006151.20","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v64n0607"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2014-006151","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T08:01:14Z","timestamp":1765612874000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2014-006151"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,12]]},"references-count":20,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2014,12,2]]},"published-print":{"date-parts":[[2014,12]]}},"alternative-id":["10.1136\/bmjopen-2014-006151"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2014-006151","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,12]]}}}