***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: Purpose Survivors of acute lung injury ( ALI ) and their informal caregivers have difficulty coping with the physical and emotional challenges of recovery from critical illness . We aim ed to develop and pilot test a telephone-based coping skills training intervention for this population . Methods Fifty-eight participants were enrolled overall . A total of 21 patients and 23 caregivers participated in a cross-sectional study to assess coping and its association with psychological distress . This also informed the development of an ALI coping skills training intervention in an iterative process involving content and method ological experts . The intervention was then evaluated in seven patients and seven caregivers in an uncontrolled , prospect i ve , pre-post study . Outcomes included acceptability , feasibility , and symptoms of psychological distress measured with the Hospital Anxiety and Depression Scale ( HADS ) and Post-Traumatic Symptom Scale ( PTSS ) . Results Survivors and their caregivers used adaptive coping infrequently , a pattern that was strongly associated with psychological distress . These findings informed the development of a 12-session intervention for acquiring , applying , and maintaining coping skills . In the evaluation phase , participants completed 77 ( 92 % ) of a possible 84 telephone sessions and all ( 100 % ) reported the intervention ’s usefulness in their daily routine . Mean change scores reflecting improvements in the HADS ( 7.8 U ) and PTSS ( 10.3 U ) were associated with adaptive coping ( r = 0.50–0.70 ) and high self-efficacy ( r = 0.67–0.79 ) . Conclusions A novel telephone-based coping skills training intervention was acceptable , feasible , and may have been associated with a reduction in psychological distress among survivors of ALI and their informal caregivers . A r and omized trial is needed to evaluate the intervention OBJECTIVE The objective of this study was to evaluate the strengths and weaknesses of a group support program and a home visiting program for family caregivers of stroke patients . It also examined the best fit between intervention variant and family caregiver and patient characteristics . van den Heuvel 's previous effect study showed positive effects of the same intervention program , but unlike our present study differences between the two support variants could not be measured . METHODS Of 257 family caregivers who were included and r and omly assigned to an intervention variant or a control group , 127 family caregivers completed the intervention in either the group program or the home visiting program . RESULTS Evaluation data showed that both intervention variants had been helpful and feasible , but home visit participants missed peer contact and follow-up contacts were missed in both intervention programs . In comparison to the home visiting program , the group program participants showed more benefit especially with respect to informational and emotional components . Caregivers ' preference for type of intervention revealed that both types of intervention had its supporters . Those that preferred the group program could be clearly characterised : they were burdened , lived with a more psychologically h and icapped relative , were using active coping strategies more frequently or lived in a region which is considered to be more sociable . CONCLUSION The present study adds extensively to van den Heuvel 's effect study with respect to discriminative aspects of group and home intervention programs and their respective benefits for specific family caregiver groups . PRACTICE IMPLICATION S In order to suitably match an intervention type with specific caregiver characteristics the intervention provider should utilize caregiver self- selection or undertake professional screening of caregiver burden . Telephone contacts should be offered in addition to the interventions OBJECTIVE To determine the long-term effectiveness of comprehensive support and counseling for spouse-caregivers and families  in postponing or preventing nursing home placement of patients with Alzheimer disease ( AD ) . DESIGN R and omized controlled intervention study . SETTING Outpatient research clinic in the New York City metropolitan area . PARTICIPANTS Referred , volunteer sample of 206 spouse-caregivers of AD patients who enrolled in the study during a 3 1/2-year period . All patients were living at home at baseline and had at least 1 relative living in the area . INTERVENTION Caregivers in the treatment group were provided with 6 sessions of individual and family counseling within 4 months of enrollment in the study and were required to join support groups . In addition , counselors were available for further counseling at any time . MAIN OUTCOME MEASURE Time from enrollment of caregivers in the study to placement of the AD patients in a nursing home . RESULTS Using Kaplan-Meier survival analysis , we estimated that the median time ( weighted average of estimates for male and female caregivers ) from baseline to nursing home placement of AD patients was 329 days longer in the treatment group than in the control group ( z=2.29 ; P=.02 ) . The relative risk ( RR ) from a Cox proportional hazard model of nursing home placement ( intent-to-treat estimate ) after adjusting for caregiver sex , patient age , and patient income was 0.65 ( 95 % confidence interval [ CI ] , 0.45 to 0.94 ; P=.02 ) , indicating that caregivers were approximately two thirds as likely to place their spouses in nursing homes at any point in time if they were in the treatment group than if they were in the control group . Treatment had the greatest effect on risk of placement for patients who were mildly demented ( RR , 0.18 ; 95 % CI , 0.04 to 0.77 ) or moderately demented ( RR , 0.38 ; 95 % CI , 0.17 to 0.82 ) . CONCLUSIONS A program of counseling and support can substantially increase the time  spouse-caregivers are able to care for AD patients at home , particularly during the early to middle stages of dementia when nursing home placement is generally least appropriate BACKGROUND : Few studies have examined the factors associated with depression in informal caregivers of HIV-infected persons . OBJECTIVE : To investigate the relationship between depression and caregiver burden among informal caregivers of HIV-infected individuals . DESIGN : Cross-sectional study using baseline data from an ongoing r and omized trial of a supportive telephone intervention . PARTICIPANTS : One hundred seventy-six dyads of HIV patients and their informal caregiver . MEASUREMENTS : Depression was defined as a Beck Depression Inventory > 10 . A Caregiver Strain Index > 6 identified informal caregivers with a high caregiver burden . We used logistic regression to identify characteristics that were associated with depression in the informal caregiver . RESULTS : Informal caregivers were 42 years old ( SD , 13 ) , 53 % female , 59 % nonwhite , and 30 % had education beyond high school . Forty-seven percent of informal caregivers were the patient ’s partner , 18 % a friend , and 35 % a family member . Twenty-seven percent of informal caregivers had a high caregiver burden , and 50 % were depressed . We found significantly greater odds of informal caregiver depression with high caregiver burden ( OR , 6.08 ; 95 % CI , 2.40 to 15.4 ) , informal caregiver medical comorbidity besides HIV ( OR , 2.32 ; 95 % CI , 1.09 to 4.92 ) , spending all day together ( OR , 3.92 ; 95 % CI , 1.59 to 9.69 ) , having to help others besides the HIV patient ( OR , 2.55 ; 95 % CI , 1.14 to 5.74 ) , and duration of the HIV patient ’s diagnosis ( OR , 1.01 per month ; 95 % CI , 1.00 to 1.01 ) . CONCLUSIONS : High caregiver burden was strongly associated with depression  among HIV-infected individuals ’ informal caregivers , who themselves had difficult life circumstances . Informal caregivers of HIV patients may be in need of both mental health services and assistance in caregiving Background Behavioral symptoms accompanying dementia are associated with increased health care costs , reduced quality of life and daily functioning , heightened family caregiver burden , and nursing home placement . St and ard care typically involves pharmacologic agents , but these are , at best , modestly effective , carry serious risks , including mortality , and do not address behavioral symptoms families consider most distressful and which may prompt nursing home placement . Given dementia ’s devastating effects and the absence of an imminent cure , the Veterans Administration has supported the development and testing of new approaches to manage challenging behaviors at home . Methods / Design The Tailored Activity Program – Veterans Administration is a Phase III efficacy trial design ed to reduce behavioral symptoms in Veterans with dementia living with their caregivers in the community . The study uses a r and omized two-group parallel design with 160 diverse Veterans and caregivers . The experimental group receives a transformative patient-centric intervention design ed to reduce the burden of behavioral symptoms in Veterans with dementia . An occupational therapist conducts an assessment to identify a Veteran ’s preserved capabilities , deficit areas , previous roles , habits , and interests to develop activities tailored to the Veteran . Family caregivers are then trained to incorporate activities into daily care . The attention-control group receives bi-monthly telephone contact where education on topics relevant to dementia is provided to caregivers . Key outcomes include reduced frequency and severity of behavioral symptoms using the 12-item Neuropsychiatric Inventory ( primary endpoint ) , reduced caregiver burden , enhanced skill acquisition , efficacy using activities , and time spent providing care at 4 months ; and long-term effects ( 8 months ) on the Veteran ’s quality of life and frequency and severity of behavioral symptoms , and caregiver use of activities . The programs ’ impact of Veterans Administration cost is also examined . Study precision will be increased through face-to-face research team trainings with procedural manuals and review of audio-taped interviews and intervention sessions . Discussion The Tailored Activity Program – Veterans Administration is design ed to improve the quality of life of Veterans with dementia and lessen the burden of care on caregivers . Activities are tailored to reflect the Veteran ’s preserved capabilities and interests to enhance active engagement , while not taxing areas of cognition that are most impaired . Trial registration Clinical Trials.gov , Background Early palliative care ( EPC ) is recommended but rarely integrated with advanced heart failure ( HF ) care . We engaged patients and family caregivers to study the feasibility and site differences in a two-site EPC trial , ENABLE CHF-PC ( Educate , Nurture , Advise , Before Life Ends Comprehensive Heartcare for Patients and Caregivers ) . Methods We conducted an EPC feasibility study ( 4/1/14–8/31/15 ) for patients with NYHA Class III/IV HF and their caregivers in academic medical centers in the northeast and southeast U.S. The EPC intervention comprised : 1 ) an in-person outpatient palliative care consultation ; and 2 ) telephonic nurse coach sessions and monthly calls . We collected patient- and caregiver-reported outcomes of quality of life ( QOL ) , symptom , health , anxiety , and depression at baseline , 12- and 24-weeks . We used linear mixed-models to assess baseline to week 24 longitudinal changes . Results We enrolled 61 patients and 48 caregivers ; between-site demographic differences included age , race , religion , marital , and work status . Most patients ( 69 % ) and caregivers ( 79 % ) completed all intervention sessions ; however , we noted large between-site differences in measurement completion ( 38 % southeast vs. 72 % northeast ) . Patients experienced moderate effect size improvements in QOL , symptoms , physical , and mental health ; caregivers experienced moderate effect size improvements in QOL , depression , mental health , and burden . Small-to-moderate effect size improvements were noted in patients ’ hospital and ICU days and emergency visits . Conclusions Between-site demographic , attrition , and participant-reported outcomes highlight the importance of intervention pilot-testing in culturally diverse population s. Observations from this pilot feasibility trial allowed us to refine the methodology of an in-progress , full-scale r and omized clinical efficacy trial . Trial registration Clinical trials.gov NCT03177447 ( retrospectively registered , June 2017 ) ABSTRACT Background : Breast cancer is the most common form of malignancy among females . Family history is a key risk factor for breast cancer . Breast cancer screening practice s are vital in patients with family history of breast cancer .  Telephone counseling and education may be appropriate for improved breast cancer screening . This study was done to determine family caregiver patients ’ knowledge of risk factors for breast cancer and practice of breast cancer screening and also to assess the effect of telephone counseling and education on mammography screening . Methods : This study was a community-based trial . The participants of the study were 90 caregivers who were r and omly divided into an experimental group , telephone counseling and education , and a control group . The intervention group received counseling and education phone calls . A three-section question naire was responded and filled out through telephone interviews with the participants . The collected data were analyzed with SPSS18 , using descriptive and inferential statistics . Results : The results showed that 88.9 % of the participants did not know when to do breast self-exam ( BSE ) . Mammography was performed by the participants before and after the telephone counseling in intervention group ( P<0.00 ) , which were 13.3 % and 77.8 % respectively ) . Moreover , the major cause of failure to participate in mammography was lack of enough knowledge in 73.3 % of the participants . Conclusion : This study concluded that knowledge and practice on breast cancer screening in family caregiver of breast cancer patients was low . Telephone counseling 
    Output:
    
For one study where quality of life at the end of intervention was reported narratively , the findings indicated that a telephone support intervention may result in slightly higher quality of life , compared with usual care .
There may also be little or no effect of telephone support interventions for quality of life and burden at short-term follow-up or for burden and depression at medium-term follow-up .
Litttle or no difference was found between groups for any of the reported outcomes in studies comparing telephone and non-telephone professional support interventions .
We are uncertain as to the effects of telephone support interventions compared to non-telephone support interventions for caregiver burden and depression at the end of intervention .
Although our review indicated slight benefit may exist for telephone support interventions on some outcomes ( e.g. anxiety and preparedness to care at the end of intervention ) , for most outcomes , including the primary outcomes , telephone-only interventions may have little or no effect on caregiver outcomes compared to usual care .