***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: We present a Swedish Health-Related Quality of Life Survey ( SWED-QUAL ) that was adapted from measures used in the Medical Outcomes Study ( MOS ) . The development of these measures spans more than 20 years and their reliability and validity have been extensively tested . The SWED-QUAL consists of 61 items that form 11 multi-item scales tapping aspects of physical , mental , social and general health . The instrument was mailed in 1991 to a r and om stratified sample of 2,366 individuals from the Swedish general population aged 18–84 years and to a stratified r and om sample of 2,349 individuals who had been seriously injured in a traffic accident . The response rates were 61 % and 59 % , respectively . Telephone follow-up of non-responders indicate that most of those tended to have a better health-related quality of life than responders . The SWED-QUAL satisfied all of the psychometric criteria that were evaluated . Multitrait scaling provided strong support for item discrimination . Cronbach 's alpha exceeded 0.78 for all scales . Scores tended to be lower among older than younger people , and among females compared to males . The good response rate indicates that the content of the SWED-QUAL is considered relevant by people at large , that the results from the general population sample could be used for comparisons with other sample s and the instrument used for further studies of the effectiveness of a broad spectrum of medical interventions Australian palliative care is delivered by general practitioners ( GPs ) and specialist palliative care teams . Patient outcomes should improve if they work in formal partnership . We conducted a multi-centred r and omised controlled trial of  specialist- GP case conferences , with the GP participating by teleconference , or usual care and communication methods . Primary outcome measure was global Quality of Life ( QoL ) scores at 3 weeks from intervention . Secondary measures included subscale QoL scores and carer burden . Two a priori intention-to-treat analyses were conducted using recruitment , and time of death , as fixed time points . There was no difference between groups in the magnitude of change in global QoL measures from baseline to any time point up to 9 weeks post-case conference , or at any time before death . The case conference group showed better maintenance of some physical and mental health measures of QoL in the 35 days before death . Case conferences may improve clinical relationships and care plans at referral , which are not implemented until severe symptoms develop . Case conferences between GPs and specialist palliative care services may be warranted for palliative care patients In the study reported here 55 spouses of patients living with end-stage renal disease ( ESRD ) were investigated with respect to coping strategies and health-related quality of life . Findings from the study were compared to two r and om sample s of the Swedish general population ( n = 454 , and n = 1200 ) . The study design was correlational and comparative . Coping was measured by the  Jalowiec Coping Scale  , and quality of life ( QoL ) by the  Swedish Health-Related Quality of Life Survey  ( SWED-QUAL ) . Data were analysed using a number of statistical tests including Pearson 's product moment correlations , Student 's t-test and two way ANOVAs . The combined sample of spouses used significantly more  optimistic and palliative coping  than the general population , but less  confrontative , self-reliant , evasive and emotive coping . In the study fatalistic , evasive and emotive coping was associated with low perceived efficiency in h and ling various aspects of the partners ' situation . The male spouses used significantly less optimistic , supportive and palliative coping than did the female spouses . The spouses of transplant patients had better overall quality of life than the continuous ambulatory peritoneal dialysis and haemodialysis spouse groups , most likely due to the lower age of the former group . The study findings suggest that emotive , evasive and fatalistic coping  are less than optimal ways to deal with problems occasioned by the partner 's treatment CONTEXT Although home-based health care has grown over the past decade , its effectiveness remains controversial . A prior trial of Veterans Affairs ( VA ) Team-Managed Home-Based Primary Care ( TM/HBPC ) found favorable outcomes , but the replicability of the model and generalizability of the findings are unknown . OBJECTIVES To assess the impact of TM/HBPC on functional status , health-related quality of life ( HR-QoL ) , satisfaction with care , and cost of care . DESIGN AND SETTING Multisite r and omized controlled trial conducted from October 1994 to September 1998 in 16 VA medical centers with HBPC programs . PARTICIPANTS A total of 1966 patients with a mean age of 70 years who had 2 or more activities of daily living impairments or a terminal illness , congestive heart failure ( CHF ) , or chronic obstructive pulmonary disease ( COPD ) .  Intervention Home-based primary care ( n=981 ) , including a primary care manager , 24-hour contact for patients , prior approval of hospital readmissions , and HBPC team participation in discharge planning , vs customary VA and private sector care ( n=985 ) . MAIN OUTCOME MEASURES Patient functional status , patient and caregiver HR-QoL and satisfaction , caregiver burden , hospital readmissions , and costs over 12 months . RESULTS Functional status as assessed by the Barthel Index did not differ for terminal ( P=.40 ) or nonterminal ( those with severe disability or who had CHF or COPD ) ( P=.17 ) patients by treatment group . Significant improvements were seen in terminal TM/HBPC patients in HR-QoL scales of emotional role function , social function , bodily pain , mental health , vitality , and general health . Team-Managed HBPC nonterminal patients had significant increases of 5 to 10 points in 5 of 6 satisfaction with care scales . The caregivers of terminal patients in the TM/HBPC group improved significantly in HR-QoL measures except for vitality and general health . Caregivers of nonterminal patients improved significantly in QoL measures and reported reduced caregiver burden ( P=.008 ) . Team-Managed HBPC patients with severe disability experienced a 22 % relative decrease ( 0.7 readmissions/patient for TM/HBPC group vs 0.9 readmissions/patient for control group ) in hospital readmissions ( P=.03 ) at 6 months that was not sustained at 12 months . Total mean per person costs were 6.8 % higher in the TM/HBPC group at 6 months ( $ 19190 vs $ 17971 ) and 12.1 % higher at 12 months ( $ 31401 vs $ 28008 ) . CONCLUSIONS The TM/HBPC intervention improved most HR-QoL measures among terminally ill patients and satisfaction among non-terminally ill patients . It improved caregiver HR-QoL , satisfaction with care , and caregiver burden and reduced hospital readmissions at 6 months , but it did not substitute for other forms of care . The higher costs of TM/HBPC should be weighed against these benefits Multiple sclerosis results in both physical and psychological disability but some patients have needs that are not adequately met by existing services . Our objective was to explore whether a new palliative care service improved outcomes for people severely affected by multiple sclerosis . A delayed intervention r and omized controlled trial was undertaken with multiple sclerosis patients deemed by staff to have palliative care needs . The intervention was a multiprofessional palliative care team assessment and follow-up . The intervention group was offered the team immediately ( fast track , FI ) ; the control group continued best st and ard care and then offered the team after 3 months ( st and ard intervention , SI ) . The main outcome measures were : patient reported issues using the Palliative Care Outcome Scale and Multiple Sclerosis Impact Scale at 12 weeks and caregiver burden using the Zarit Burden Inventory .  Sixty-nine people were referred to the service ; 52 consented or were eligible to be r and omized ( 26 to the FI and 26 to the SI groups ) . At 12 weeks people in the FI group had an improvement ( mean change —1.0 ) in the total score of 5 key symptoms whereas there was deterioration in the SI group ( mean change 1.1 , F = 4.75 , p = 0.035 ) . There was no difference in the change in general Palliative Care Outcome Scale or Multiple Sclerosis Impact Scale scores . There was an improvement in caregiver burden in the FI group and a deterioration in the SI group ( F = 7.60 , p = 0.013 ) . Involvement with the palliative care service appeared to positively affect some key symptoms and reduced informal caregiver burden OBJECTIVES --To gain population norms for the short form 36 health survey question naire ( SF36 ) in a large community sample and to explore the question naire 's internal consistency and validity . DESIGN --Postal survey by using a booklet containing the SF36 and several other items concerned with lifestyles and illness . SETTING --The sample was drawn from computerised registers of the family health services authorities for Berkshire , Buckinghamshire , Northamptonshire , and Oxfordshire . SAMPLE --13,042 r and omly selected subjects aged 18 - 64 years . MAIN OUTCOME MEASURES --Scores for the eight health dimensions of the SF36 . RESULTS --The survey achieved a response rate of 72 % ( n = 9332 ) . Internal consistency of the different dimensions of the question naire was high . Normative data broken down by age , sex , and social class were consistent with those from previous studies . CONCLUSIONS --The SF36 is a potentially valuable tool in medical research . The normative data provided here may further facilitate its validation and use Peritoneal dialysis is the archetypal home-based therapy and is often favoured by patients . However , as patients with end-stage renal failure become more elderly , with more co-morbidity , their dependence on carers to provide physical , emotional and logistical support increases . The effect of this chronic burden has not been systematic ally studied . We have prospect ively studied patients with end-stage renal failure starting peritoneal dialysis and their carers over a 1-year period . We selected a cohort of caregivers that are actively involved with the care of their partners ' dialysis . Quality of Life ( QoL ) assessed by SF-36 question naires showed the patients and carers had impairment of QoL at the start of dialysis . As expected , the baseline QoL Physical Component Scores highly correlated with co-morbidity and assessment of functional capacity . Scores of all QoL domains improved after 1 year and this reached statistical significance for social functioning for both patients and carers . When we compared carers of highly dependent patients ( required to perform daily dialysis ) with carers of less dependent patients , we noted that the former had a statistically significant worsening of their mental health but other parameters were not different . We have shown that despite increasing the burden for caregivers , with careful selection , education and support , we did not adversely impact on the QoL of carers whilst there was some evidence of improvement , especially in social functioning . This gives reassurance that establishing dependent patients on PD is compatible with a holistic approach to the patients and their families PURPOSE OF THE STUDY Problem-solving therapy ( PST ) has been found effective when delivered to informal caregivers of patients with various conditions . In hospice , however , its translation to practice is impeded by the increased re sources needed for its delivery . The study purpose was to compare the effectiveness of a PST intervention delivered face-to-face with one delivered via videophone to hospice primary caregivers . DESIGN AND METHODS The study design was a r and omized noninferiority trial with two groups , Group 1 in which caregivers received PST face-to-face , and Group 2 in which caregivers received PST via videophone .  Family hospice caregivers were recruited from two urban hospice agencies and received the PST intervention ( in three visits for Group 1 or three video-calls in Group 2 ) in an approximate period of 20 days after hospice admission . St and ard caregiver demographic data were collected . Psychometric instruments administered to caregivers at baseline and at study completion included the CQLI-R ( Caregiver Quality of Life Index-Revised ) , the STAI ( State-Trait Anxiety Inventory ) , and the PSI ( Problem-Solving Inventory ) . RESULTS One hundred twenty-six caregivers were recruited in the study ; 77 were r and omly assigned to Group 1 and 49 to Group 2 .  PST delivered via video was not inferior to face-to-face delivery . The observed changes in scores were similar for each group . Caregiver quality of life improved and state anxiety decreased under both conditions . CONCLUSIONS The delivery of PST via videophone was not inferior to face-to-face . Audiovisual feedback captured by technology may be sufficient , providing a solution to the geographic barriers that often inhibit the delivery of these types of interventions to older adults in hospice We do not know to what extent the needs of caregivers involved with patients at the end of life are being met by care providers and whether caregiving at life 's end can be a positive experience . We used the Hospice Experience Model of Care as a framework for underst and ing the effect of transformative tasks on caregiving at life 's end . We compared current and bereaved caregivers  and then , holding background characteristics constant , tested the independent effects of three transformative mediators :  self-acceptance , meaning , and closure  , as well as  comfort  with caregiving on several stressors when explaining differences in caregiver burden and gain . Transformative aspects of caregiving do not mediate the stressors associated with burden but do mediate one stressor associated with caregiver gain . Two mediators reduce caregiver burden and all four of the mediators improve caregiver gain . Caregivers who are able to attend to these transformative aspects find more gain in the caregiving experience The purpose of this study was to examine the effects of music 
    Output:
    
Conclusion : A broad range of outcome measures have been used for informal carers of patients with palliative care needs .