***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: This investigation evaluates effects of care consultation delivered within a partnership between a managed health care system and Alzheimer 's Association chapter .  Care consultation is a multi-component telephone intervention in which Association staff work with patients and caregivers to identify personal strengths and re sources within the family , health plan , and community . The primary hypothesis is that care consultation will decrease utilization of managed care services and improve psychosocial outcomes . A secondary modifying-effects hypothesis posits benefits will be greater for patients with more severe memory impairment . The sample is composed of managed care patients whose medical records indicate a diagnosis of dementia or memory loss . Patients were r and omly assigned to an intervention group , which was offered care consultation in addition to usual managed care services , or to a control group , which was offered only usual managed care services . Data come from two in-person interviews with patients , and medical and administrative records . Results supporting the primary hypothesis show intervention group patients feel less embarrassed and isolated because of their memory problems and report less difficulty coping . Findings consistent with the modifying-effects hypothesis show intervention group patients with more severe impairment have fewer physician visits , are less likely to have an emergency department visit or hospital admission , are more satisfied with managed care services , and have decreased depression and strain Objective Systematic review s can include cluster-r and omised controlled trials ( C- RCTs ) , which require different analysis compared with st and ard individual-r and omised controlled trials . However , it is not known whether review authors follow the method ological and reporting guidance when including these trials . The aim of this study was to assess the method ological and reporting practice of Cochrane review s that included C- RCTs against criteria developed from existing guidance . Methods Criteria were developed , based on method ological literature and personal experience supervising review production and quality . Criteria were grouped into four themes : identifying , reporting , assessing risk of bias , and analysing C- RCTs . The Cochrane Data base of Systematic Review s was search ed ( 2nd December 2013 ) , and the 50 most recent review s that included C- RCTs were retrieved . Each review was then assessed using the criteria . Results The 50 review s we identified were published by 26 Cochrane Review Groups between June 2013 and November 2013 . For identifying C- RCTs , only 56 % identified that C- RCTs were eligible for inclusion in the review in the eligibility criteria . For reporting C- RCTs , only eight ( 24 % ) of the 33 review s reported the method of cluster adjustment for their included C- RCTs . For assessing risk of bias , only one review assessed all five C- RCT -specific risk-of-bias criteria . For analysing C- RCTs , of the 27 review s that presented unadjusted data , only nine ( 33 % ) provided a warning that confidence intervals may be artificially narrow . Of the 34 review s that reported data from unadjusted C- RCTs , only 13 ( 38 % ) excluded the unadjusted results from the meta-analyses . Conclusions The method ological and reporting practice s in Cochrane review s incorporating C- RCTs could be greatly improved , particularly with regard to analyses . Criteria developed as part of the current study could be used by review authors or editors to identify errors and improve the quality of published systematic review s incorporating C- RCTs Background Current guidelines for dementia care recommend the combination of drug therapy with non-pharmaceutical measures like counselling and social support . However , the scientific evidence concerning non-pharmaceutical interventions for dementia patients and their informal caregivers remains inconclusive . Targets of modern comprehensive dementia care are to enable patients to live at home as long and as independent as possible and to reduce the burden of caregivers . The objective of the study is to compare a complex intervention including caregiver support groups and counselling against usual care in terms of time to nursing home placement . In this paper the study protocol is described . Methods / Design The IDA ( Initiative Demenzversorgung in der Allgemeinmedizin ) project is design ed as a three armed cluster-r and omized trial where dementia patients and their informal caregivers are recruited by general practitioners . Patients in the study region of Middle Franconia , Germany , are included if they have mild or moderate dementia , are at least 65 years old , and are members of the German AOK ( Allgemeine Ortskrankenkasse ) sickness fund . In the control group patients receive regular treatment , whereas in the two intervention groups general practitioners participate in a training course in evidence based dementia treatment , recommend support groups and offer counseling to the family caregivers either beginning at baseline or after the 1-year follow-up . The study recruitment and follow-up took place from July 2005 to January 2009 . 303 general practitioners were r and omized of which 129 recruited a total of 390 patients .  Time to nursing home admission within the two year intervention and follow-up period is the primary endpoint . Secondary endpoints are cognitive status , activities of daily living , burden of care giving as well as healthcare costs . For an economic analysis from the societal perspective , data are collected from caregivers as well as by the use of routine data from statutory health insurance and long-term care insurance . Discussion From a public health perspective , the IDA trial is expected to lead to evidence based results on the community effectiveness of non-pharmaceutical support measures for dementia patients and their caregivers in the primary care sector . For health policy makers it is necessary to make their decisions about financing new services based on strong knowledge about the acceptance of measures in the population and their cost-effectiveness . Trial registration IS RCT Background The provision of appropriate medical and nursing care for people with dementia is a major challenge for the healthcare system in Germany . New models of healthcare provision need to be developed , tested and implemented on the population level . Trials in which collaborative care for dementia in the primary care setting were studied have demonstrated its effectiveness . These studies have been conducted in different healthcare systems , however , so it is unclear whether these results extend to the specific context of the German healthcare system . The objective of this population -based intervention trial in the primary care setting is to test the efficacy and efficiency of implementing a subsidiary support system on a population level for persons with dementia who live at home . Methods and study design The study was design ed to assemble a general physician-based epidemiological cohort of people above the age of 70 who live at home ( DelpHi cohort ) . These people are screened for eligibility to participate in a trial of dementia care management ( DelpHi trial ) . The trial is a cluster-r and omised , controlled intervention trial with two arms ( intervention and control ) design ed to test the efficacy and efficiency of implementing a subsidiary support system for persons with dementia who live at home . This subsidiary support system is initiated and coordinated by a dementia care manager : a nurse with dementia-specific qualifications who delivers the intervention according to a systematic , detailed protocol . The primary outcome is quality of life and healthcare for patients with dementia and their caregivers . This is a multidimensional outcome with a focus on four dimensions : ( 1 ) quality of life , ( 2 ) caregiver burden , ( 3 ) behavioural and psychological symptoms of dementia and ( 4 ) pharmacotherapy with an antidementia drug and prevention or suspension of potentially inappropriate medication . Secondary outcomes include the assessment of dementia syndromes , activities of daily living , social support health status , utilisation of health care re sources and medication . Discussion The results will provide evidence for specific needs in ambulatory care for persons with dementia and will show effective ways to meet those needs . Qualification requirements will be evaluated , and the results will help to modify existing guidelines and treatment paths . Trial registration Importance Dementia care management ( DCM ) can increase the quality of care for people with dementia . Method ologically rigorous clinical trials on DCM are lacking . Objective To test the effectiveness and safety of DCM in the treatment and care of people with dementia living at home and caregiver burden ( when available ) . Design , Setting , and Participants This pragmatic , general practitioner – based , cluster-r and omized intervention trial compared the intervention with care as usual at baseline and at 12-month follow-up . Simple 1:1 r and omization of general practice s in Germany was used . Analyses were intent to treat and per protocol . In total , 6838 patients were screened for dementia ( eligibility : 70 years and older and living at home ) from January 1 , 2012 , to March 31 , 2016 . Overall , 1167 ( 17.1 % ) were diagnosed as having dementia , and 634 ( 9.3 % ) provided written informed consent to participate . Interventions Dementia care management was provided for 6 months at the homes of patients with dementia . Dementia care management is a model of collaborative care , defined as a complex intervention aim ing to provide optimal treatment and care for patients with dementia and support caregivers using a computer-assisted assessment determining a personalized array of intervention modules and subsequent success monitoring . Dementia care management was targeted at the individual patient level and was conducted by 6 study nurses with dementia care – specific qualifications . Main Outcomes and Measures Quality of life , caregiver burden , behavioral and psychological symptoms of dementia , pharmacotherapy with antidementia drugs , and use of potentially inappropriate medication . Results The mean age of 634 patients was 80 years . A total of 407 patients received the intended treatment and were available for primary outcome measurement . Of these patients , 248 ( 60.9 % ) were women , and 204 ( 50.1 % ) lived alone . Dementia care management  significantly decreased behavioral and psychological symptoms of dementia ( b = −7.45 ; 95 % CI , −11.08 to −3.81 ; P < .001 ) and caregiver burden ( b = −0.50 ; 95 % CI , −1.09 to 0.08 ; P = .045 ) compared with care as usual . Patients with dementia receiving DCM had an increased chance of receiving antidementia drug treatment ( DCM , 114 of 291 [ 39.2 % ] vs care as usual , 31 of 116 [ 26.7 % ] ) after 12 months ( odds ratio , 1.97 ; 95 % CI , 0.99 to 3.94 ; P = .03 ) . Dementia care management significantly increased quality of life ( b = 0.08 ; 95 % CI , 0 to 0.17 ; P = .03 ) for patients not living alone but did not increase quality of life overall . There was no effect on potentially inappropriate medication ( odds ratio , 1.86 ; 95 % CI , 0.62 to 3.62 ; P = .97 ) . Conclusions and Relevance Dementia care management provided by specifically trained nurses is an effective collaborative care model that improves relevant patient- and caregiver-related outcomes in dementia . Implementing DCM in different health care systems should become an active area of research . Trial Registration clinical trials.gov Identifier : AIM This paper reports a study to examine the effectiveness of a 6-month dementia care programme for Chinese families living with and caring for a relative with dementia , compared with routine family support services in Hong Kong . BACKGROUND Recognizing the adverse psychosocial health effects inherent in dementia care , different psychosocial interventions provided preliminary evidence of their effectiveness in improving family members ' knowledge and skills in caregiving and delaying dementia sufferers ' illness deterioration and institutionalization . Little is known about the effects of such interventions for family caregivers ' psychosocial health conditions , particularly in non-Western population s. METHODS A r and omized controlled trial was conducted with 92 Chinese families of a relative with dementia in two dementia care centres in Hong Kong . They were r and omly selected from a dementia client list and then r and omly assigned to receive either the dementia family care programme ( n=46 ) , or routine care only ( n=46 ) . Clients ' symptoms and institutionalization , and caregivers ' quality of life , burden and social support at recruitment , 1 week , and 12 and 18 months following intervention were measured and compared between the study groups using repeated measures MANOVAS followed by Helmert 's contrast tests . Data was collected over a period of 24 months , between September 2007 and August 2009 . RESULTS Results of the MANOVAS and contrast tests indicated that at 18-month follow-up , participants in the family programme reported significantly greater improvements in clients ' symptoms and institutionalization rates , and caregivers ' quality of life and burden , when compared with their counterparts in the routine care group . CONCLUSION These findings provide evidence that the dementia care family programme can improve the psychosocial functioning of both clients with dementia and their family caregivers in a Chinese population . Further research is recommended to investigate whether this intervention can also apply to families with different socio-economic background s and across cultures OBJECTIVES To underst and the range of symptoms that present to family caregivers of community-dwelling persons with Alzheimer 's disease and related dementias ( ADRD ) . DESIGN Six-month longitudinal prospect i ve study to identify the incidence of new or worsening symptoms and their association with acute care medical service use . SETTING Community-based sample of volunteers from multiple states . PARTICIPANTS A total of 136 patient-caregiver dyads with a range of dementia severity . MEASUREMENTS Forty four symptoms and signs common in older persons and /or persons with dementia ; frequency of emergency department visits , hospitalizations , and death ; and associations between reported symptoms and acute medical care . RESULTS During a mean of 5.7 months ' follow-up , new or worsening organ-specific ( 90 % of participants ) , nonspecific ( 89 % ) , and 
    Output:
    
None of the outcome comparisons provided conclusive evidence supporting the hypothesis that these interventions would lead to a decrease in acute hospital use .
Furthermore , prediction intervals indicated possible and important increased service use associated with these interventions , such as emergency department visits , hospital admissions , and hospital days .
Subgroup analyses did not favour any type of intervention .
Conclusion Despite a comprehensive systematic review and meta- analysis , including predominantly unpublished data , no health service intervention beyond usual care was found to reduce acute hospital use in community-dwelling persons with dementia .
An important increase in service use may be associated with these interventions .