***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 and Purpose — Integrated care pathways ( ICP ) may not reduce disability , institutionalization , or duration of hospitalization compared with conventional multidisciplinary team ( MDT ) care in organized stroke rehabilitation . Their potential to improve patient heath status or satisfaction with care is not known . Methods — A comparison of quality of life , caregiver strain , and patient/caregiver satisfaction at 6 months after stroke was undertaken in 152 stroke patients r and omized to receive ICP or MDT care .  Differences in processes of care were recorded with the use of a predefined schedule . Multivariate analyses were undertaken to identify the effect of age , sex , stroke severity , functional status , mood , and use of care pathway on quality of life score . Results — The 2 groups were comparable for baseline characteristics of age , sex , stroke severity , and initial disability . MDT care was characterized by greater emphasis on return of higher function and caregiver needs compared with ICP . EuroQol Visual Analogue Scale ( EQ-VAS ) scores were higher in the MDT group ( median , 72 versus 63;P < 0.005 ) , who also had higher scores for EuroQol dimension of social functioning ( P = 0.014 ) . Higher EQ-VAS scores were independently related to MDT care ( P = 0.04 ) , Rankin score ( P = 0.01 ) , and psychological function ( P < 0.0001 ) but not to age , sex , or stroke severity . There were no significant differences in patient or caregiver satisfaction between the 2 setting s. Conclusions — Better quality of life in patients receiving conventional MDT care may be attributable to improved social functioning and greater attention to higher function and caregiver needs during rehabilitation BACKGROUND AND PURPOSE We report the findings of a r and omized controlled trial to determine the effectiveness of a multidisciplinary Stroke Education Program ( SEP ) for patients and their informal carers . METHODS Two hundred four patients admitted with acute stroke and their 176 informal carers were r and omized to receive an invitation to the SEP or to receive conventional stroke unit care . The SEP consisted of one 1-hour small group educational session for in patients followed by six 1-hour sessions after discharge . The primary outcome measure was patient- and carer-perceived health status ( SF-36 ) at 6 months after stroke . Knowledge of stroke , satisfaction with services , emotional outcome , disability , and h and icap and were secondary outcome measures . RESULTS Only 51 of 108 ( 47 % ) surviving patients r and omized to the SEP completed the program , as did 20 of 93 ( 22 % ) informal carers of surviving patients .  Perceived health status ( Short Form 36 [ SF-36 ] health survey ) scores were similar for SEP patients and controls . Informal carers in the control group scored better on the social functioning component of the SF-36 than the SEP group ( P=0.04 ) . Patients and informal carers in the SEP group scored higher on the stroke knowledge scale than controls ( patients , P=0.02 ; carers , P=0 . 01 ) . Patients in the SEP group were more satisfied with the information that they had received about stroke ( P=0.004 ) . There were no differences in emotional or functional outcomes between groups . CONCLUSIONS Although the SEP improved patient and informal carer knowledge about stroke and patient satisfaction with some components of stroke services , this was not associated with an improvement in their perceived health status . Indeed , the social functioning of informal carers r and omized to the SEP was less than in the control group The impact of clinical ly diagnosed depression on recovery in activities of daily living over a 2-year follow-up was examined in a prospect i ve study of 63 stroke patients . Although impairment in activities of daily living , neurologic diagnoses and findings , lesion location and volume as measured on computed tomographic scan , demographic variables , cognitive impairment , and social functioning were comparable between depressed ( n = 25 ) and nondepressed ( n = 38 ) patients during their acute hospitalization , the two groups had different patterns of recovery in activities of daily living . At 2 years after suffering a stroke , patients with an in-hospital diagnosis of depression ( either major or minor depression ) were significantly more impaired in both physical activities and language functioning than were non-depressed patients . Among patients with major depression , this disparity in the recovery profile was present even after the depression had remitted . This study emphasizes the need for early recognition and treatment of poststroke depression BACKGROUND Attention is currently focused on family care of stroke survivors , but the effectiveness of support services is unclear . We did a single-blind , r and omised , controlled trial to assess the impact of family support  on stroke patients and their carers . METHODS Patients with acute stroke admitted to hospitals in Oxford , UK , were assigned family support or normal care within 6 weeks of stroke . After 6 months , we assessed , for carers , knowledge about stroke , Frenchay activities index , general health question naire-28 scores , caregiver strain index , Dartmouth co-op charts , short form 36 ( SF-36 ) , and satisfaction scores , and , for patients , knowledge about stroke and use of services , Barthel index , Rivermead mobility index , Frenchay activities index , London h and icap scale , hospital anxiety and depression scales , Dartmouth co-op charts , and satisfaction . FINDINGS 323 patients and 267 carers were followed up . Carers in the intervention group had significantly better Frenchay activities indices ( p=0.03 ) , SF-36 scores ( energy p=0.02 , mental health p=0.004 , pain p=0.03 , physical function p=0.025 , and general health perception p=0.02 ) , quality of life on the Dartmouth co-op chart ( p=0.01 ) , and satisfaction with underst and ing of stroke ( 82 vs 71 % , p=0.04 ) than those in the control group . Patients ' knowledge about stroke , disability , h and icap , quality of life , and satisfaction with services and underst and ing of stroke did not differ between groups . Fewer patients in the intervention group than in the control group saw a physiotherapist after discharge ( 44 vs 56 % , p=0.04 ) , but use of other services was similar . INTERPRETATION Family support significantly increased social activities and improved quality of life for carers , with no significant effects on patients Background and Purpose — The efficacy and safety of the selective serotonin reuptake inhibitor fluoxetine have rarely been studied in the treatment of poststroke emotional disturbances . Methods — Stroke patients ( 152 ) who had poststroke depression ( PSD ) , emotional incontinence ( PSEI ) , or anger proneness ( PSAP ) were studied . PSD was evaluated by Beck Depression Inventory and Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , PSEI by Kim ’s criteria , and PSAP was assessed by Spielberger Trait Anger Scale . Subjects were r and omly given either fluoxetine 20 mg/day ( n=76 ) or placebo ( n=76 ) for 3 months . Follow-up evaluations were done 1 , 3 , and 6 months after the beginning of the treatment . The primary outcome measurement was the scores of emotional disturbances at each follow-up assessment . The secondary outcome measurements were the percentage changes of the scores and the subjective responses of the patients . Results — Although patients in the fluoxetine group more often dropped out because of adverse effects , fluoxetine administration was generally safe . Fluoxetine significantly improved PSEI and PSAP , whereas no definitive improvement of PSD was found . Improvement of PSAP was noted even at 3 months after the discontinuation of the treatment . Conclusions — Fluoxetine is efficacious in the treatment of PSEI and PSAP . Its effect on PSD is not solidly confirmed Background and Purpose — The purpose of this study was to determine whether motivational interviewing , a patient-centered counseling technique , can benefit patients ' mood 3 months after stroke . Methods — A single-center , open , r and omized , controlled trial was conducted at a single hospital with a stroke unit . Subjects consisted of 411 consecutive patients on the stroke register who were over 18 years of age and who did not have severe cognitive and communication problems that would prevent them from taking part in an interview ; were not known to be moving out of the area after discharge ; and were not already receiving psychiatric or clinical psychology intervention . All patients received usual stroke care . Patients in the intervention group received 4 individual , weekly sessions of motivational interviewing with a trained therapist in addition to usual stroke care . The primary outcome was the proportion of patients with normal mood at 3 months poststroke measured by the 28-item General Health Question naire ( normal , < 5 ; low ≥5 ) using a mailed question naire . Results — Eighty-one of 207 ( 39.1 % ) patients in the control group and 100 of 204 ( 49.0 % ) patients in the intervention group had normal mood at follow up . A significant benefit of motivational interviewing over usual stroke care ( OR : 1.60 , 95 % CI : 1.04 to 2.46 , P=0.03 ) was found . Conclusion — Our results suggest motivational interviewing leads to an improvement in  patients ' mood 3 months after stroke Background : The involvement of  five specialist nurses  in providing a stroke support service  was evaluated quantitatively in a recent r and omized controlled trial . This complementary study used qualitative methods to evaluate trial outcomes more comprehensively . Aims : To identify whether the nurses ' intervention may have influenced the process of stroke recovery . Method : A purpose fully selected sub sample of 30 patients and 15 care-givers were interviewed within 1 - 3 months of their final quantitative assessment ( 12 months after recruitment to the r and omized trial ) . Fifteen of the patients and eight of the care-givers had received visits from a specialist nurse .  A semi- structured interview was design ed to include questions on perceptions of the recovery process and evaluation of services received . Results : Some differences were evident between the accounts of control and intervention group subjects . The less tangible aspects of nurses ' interventions - concern , attention , empathy and interest , when combined with sound professional knowledge , had identifiable value to the patients and care-givers . It appeared that the nurses had employed considerable sensitivity and skill in identifying and responding to particular needs at appropriate times . Conclusion : The qualitative evaluation offers a different picture to the quantitative results of the r and omized controlled trial . In general , the findings of the qualitative study are more positive and encouraging than the quantitative results . The majority of patients and care-givers in the intervention group believed that they had benefited from the specialist nurse 's visits Purpose : To evaluate the feasibility and effectiveness of early supported discharge ( ESD ) following acute stroke . Method : An ESD scheme was compared to conventional rehabilitation in a r and omized controlled trial . All patients admitted with acute stroke were considered for inclusion . Eighty-eight ( 20.2 % ) were found to be eligible and 82 were r and omized either to early supported discharge ( n=42 ) or conventional rehabilitation ( n=40 ) . The primary outcome measure was the Nottingham Extended Activities of Daily Living Scale . The General Health Question naire , the Montgomery Aasberg Depression Rating Scale , mortality , placement and patient and carer satisfaction served as secondary outcome measures . Results : Median length of stay was reduced from 31 days in the conventional hospital rehabilitation group to 22 days in the early supported discharge group ( p=0.09 ) . No differences were found regarding primary outcome . The General Health Question naire score showed a significant difference in favour of the early supported discharge group at three months ( 19.5/24 , p = 0.02 ) , but not at six . At six months , the proportion of patients being dead or in institution showed a trend of being higher in the conventional rehabilitation group ( OR 3.8 , 95 % CI 0.8 - 23 ) . Conclusions : Early supported discharge after stroke is feasible and it is possible that it has benefits compared with conventional rehabilitation Background and Purpose — There is inconclusive evidence of the effectiveness of the Stroke Family Support Organiser ( FSO ) service . We report the results from a r and omized controlled trial of the service . Methods — Stroke patients admitted to hospital and their informal caregivers were r and omly allocated to receive the FSO service ( n=126 ) or st and ard care ( n=124 ) . Outcome assessment s were undertaken 4 and 9 months after recruitment with the General Health Question naire 12 , Carer Strain Index , Barthel Index , Extended Activities of Daily Living scale , and a specially design ed question naire to determine knowledge of stroke and satisfaction with services . Results — There were no significant differences between groups in patients ’ mood and independence in personal or instrumental activities of daily living or caregivers ’ mood , strain , or independence . Patients in the intervention group were significantly more knowledgeable about whom to contact for stroke information , reducing the risk of stroke , practical help , community services , and emotional support . Patients in the intervention group were also significantly more satisfied with the stroke information received . Caregivers in the intervention group were significantly more knowledgeable about whom to contact for information on stroke , reducing the risk of stroke , community services , and emotional support . Caregivers in the intervention group were also significantly more satisfied with stroke information . Conclusions — The FSO service had no significant effect on mood , independence in activities of daily living , or reduction in caregiver strain , but it did increase knowledge of stroke and satisfaction with that knowledge . The results may not be representative of all FSO services , and the sample was small relative to the heterogeneity of the participants . However , results suggest that the policies and training procedures of FSOs need to be evaluated to ensure that a cost-effective service is being provided to stroke patients and their caregivers BACKGROUND AND PURPOSE Patients with poststroke major depression have a greater severity of cognitive impairment than nondepressed patients even when matched for size and location of stroke lesion . Prior treatment studies have consistently failed to show an improvement in cognitive function even when poststroke mood 
    Output:
    
There was no clear effect of pharmacological therapy on the prevention of depression or other endpoints .
A significant improvement in mood and the prevention of depression was evident for psychotherapy , but the treatment effects were small .
A small but significant effect of psychotherapy on improving mood and preventing depression was identified .