***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: 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 CONTEXT Most older adults with dementia will be cared for by primary care physicians , but the primary care practice environment presents important challenges to providing quality care . OBJECTIVE To test the effectiveness of a collaborative care model to improve the quality of care for patients with Alzheimer disease . DESIGN , SETTING , AND PATIENTS Controlled clinical trial of 153 older adults with Alzheimer disease and their caregivers who were r and omized by physician to receive collaborative care management ( n = 84 ) or augmented usual care ( n = 69 ) at primary care practice s within 2 US university-affiliated health care systems from January 2002 through August 2004 . Eligible patients ( identified via screening or medical record ) met diagnostic criteria for Alzheimer disease and had a self-identified caregiver . INTERVENTION Intervention patients received 1 year of care management by an interdisciplinary team led by an advanced practice nurse working with the patient 's family caregiver and integrated within primary care . The team used st and ard protocol s to initiate treatment and identify , monitor , and treat behavioral and psychological symptoms of dementia , stressing nonpharmacological management . MAIN OUTCOME MEASURES Neuropsychiatric Inventory ( NPI ) administered at baseline and at 6 , 12 , and 18 months . Secondary outcomes included the Cornell Scale for Depression in Dementia ( CSDD ) , cognition , activities of daily living , re source use , and caregiver 's depression severity . RESULTS Initiated by caregivers ' reports , 89 % of intervention patients triggered at least 1 protocol for behavioral and psychological symptoms of dementia with a mean of 4 per patient from a total of 8 possible protocol s. Intervention patients were more likely to receive  cholinesterase inhibitors  ( 79.8 % vs 55.1 % ; P = .002 ) and  antidepressants  ( 45.2 % vs 27.5 % ; P = .03 ) . Intervention patients had significantly fewer behavioral and psychological symptoms of dementia as measured by the total NPI score at 12 months ( mean difference , -5.6 ; P = .01 ) and at 18 months ( mean difference , -5.4 ; P = .01 ) . Intervention caregivers also reported significant improvements in distress as measured by the caregiver NPI at 12 months ; at 18 months , caregivers showed improvement in depression as measured by the Patient Health Question naire-9 . No group differences were found on the CSDD , cognition , activities of daily living , or on rates of hospitalization , nursing home placement , or death . CONCLUSIONS Collaborative care for the treatment of Alzheimer disease result ed in significant improvement in the quality of care and in behavioral and psychological symptoms of dementia among primary care patients and their caregivers . These improvements were achieved without significantly increasing the use of antipsychotics or sedative-hypnotics . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00246896 BACKGROUND It is believed that timely recognition and diagnosis of dementia is a pre-condition for improving care for both older adults with dementia and their informal caregivers . However , diagnosing dementia often occurs late in the disease . This means that a significant number of patients with early symptoms of dementia and their informal caregivers may lack appropriate care . OBJECTIVES To compare the effects of case management and usual care among community-dwelling older adults with early symptoms of dementia and their primary informal caregivers . DESIGN R and omized controlled trial with measurements at baseline and after 6 and 12 months . SETTING Primary care in West-Friesl and , the Netherl and s. PARTICIPANTS 99 pairs of community-dwelling older adults with dementia symptoms ( defined as abnormal screening for symptoms of dementia ) and their primary informal caregivers . INTERVENTION 12 months of case management by district nurses for both older adults and informal caregivers versus usual care . MEASUREMENTS PRIMARY OUTCOME informal caregiver 's sense of competence . SECONDARY OUTCOMES caregiver 's quality of life , depressive symptoms , and burden , and patient 's quality of life . Process measurements : intervention fidelity and caregiver 's satisfaction with the quality of case management . RESULTS Linear mixed model analyses showed no statistically significant and clinical ly relevant differences over time between the two groups . The process evaluation revealed that intervention fidelity could have been better . Meanwhile , informal caregivers were satisfied with the quality of case management . CONCLUSION This study shows no benefits of case management for older adults with dementia symptoms and their primary informal caregivers . One possible explanation is that case management , which has been recommended among diagnosed dementia patients , may not be beneficial if offered too early . However , on the other h and , it is possible that : ( 1 ) case management will be effective in this group if more fully implemented and adapted or aim ed at informal caregivers who experience more severe distress and problems ; ( 2 ) case management is beneficial but that it is not seen in the timeframe studied ; ( 3 ) case management might have undetected small benefits . This has to be established . Trial registration ISCRTN83135728 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Adequate reporting of r and omized , controlled trials ( RCTs ) is necessary to allow accurate critical appraisal of the validity and applicability of the results . The CONSORT ( Consoli date d St and ards of Reporting Trials ) Statement , a 22-item checklist and flow diagram , is intended to address this problem by improving the reporting of RCTs . However , some specific issues that apply to trials of nonpharmacologic treatments ( for example , surgery , technical interventions , devices , rehabilitation , psychotherapy , and behavioral intervention ) are not specifically addressed in the CONSORT Statement . Furthermore , considerable evidence suggests that the reporting of nonpharmacologic trials still needs improvement . Therefore , the CONSORT group developed an extension of the CONSORT Statement for trials assessing nonpharmacologic treatments . A consensus meeting of 33 experts was organized in Paris , France , in February 2006 , to develop an extension of the CONSORT Statement for trials of nonpharmacologic treatments . The participants extended 11 items from the CONSORT Statement , added 1 item , and developed a modified flow diagram . To allow adequate underst and ing and implementation of the CONSORT extension , the CONSORT group developed this elaboration and explanation document from a review of the literature to provide examples of adequate reporting . This extension , in conjunction with the main CONSORT Statement and other CONSORT extensions , should help to improve the reporting of RCTs performed in this field BACKGROUND Care for elderly persons with disabilities is usually characterized by fragmentation , often leading to more intrusive and expensive forms of care such as hospitalization and institutionalization . There has been increasing interest in the ability of integrated models to improve health , satisfaction , and service utilization outcomes . METHODS A program of integrated care for vulnerable community-dwelling elderly persons ( SIPA [ French acronym for System of Integrated Care for Older Persons ] )  was compared to usual care with a r and omized control trial . SIPA offered community-based care with local agencies responsible for the full range and coordination of community and institutional ( acute and long-term ) health and social services . Primary outcomes were utilization and public costs of institutional and community care . Secondary outcomes included health status , satisfaction with care , caregiver burden , and out-of-pocket expenses . RESULTS Accessibility was increased for health and social home care with increased intensification of home health care . There was a 50 % reduction in hospital alternate level inpatient stays ( " bed blockers " ) but no significant differences in utilization and costs of emergency department , hospital acute inpatient , and nursing home stays . For all study participants , average community costs per person were C dollar 3390 higher in the SIPA group but institutional costs were C dollar 3770 lower with , as hypothesized , no difference in total overall costs per person in the two groups . Satisfaction was increased for SIPA caregivers with no increase in caregiver burden or out-of-pocket costs . As expected , there was no difference in health outcomes . CONCLUSIONS Integrated systems appear to be feasible and have the potential to reduce hospital and nursing home utilization without increasing costs Background Dem and for home care services has increased considerably , along with the growing complexity of cases and variability among re sources and providers . Design ing services that guarantee co-ordination and integration for providers and levels of care is of paramount importance . The aim of this study is to determine the effectiveness of a new case-management based , home care delivery model which has been implemented in And alusia ( Spain ) . Methods Quasi-experimental , controlled , non-r and omised , multi-centre study on the population receiving home care services comparing the outcomes of the new model , which included nurse-led case management , versus the conventional one . Primary endpoints : functional status , satisfaction and use of healthcare re sources . Secondary endpoints : recruitment and caregiver burden , mortality , institutionalisation , quality of life and family function . Analyses were performed at base-line , and at two , six and twelve months . A bivariate analysis was conducted with the Student 's t-test , Mann-Whitney 's U , and the chi squared test . Kaplan-Meier and log-rank tests were performed to compare survival and institutionalisation . A multivariate analysis was performed to pinpoint factors that impact on improvement of functional ability . Results Base-line differences in functional capacity – significantly lower in the intervention group ( RR : 1.52 95%CI : 1.05–2.21 ; p = 0.0016 ) – disappeared at six months ( RR : 1.31 95%CI : 0.87–1.98 ; p = 0.178 ) . At six months , caregiver burden showed a slight reduction in the intervention group , whereas it increased notably in the control group ( base-line Zarit Test : 57.06 95%CI : 54.77–59.34 vs. 60.50 95%CI : 53.63–67.37 ; p = 0.264 ) , ( Zarit Test at six months : 53.79 95%CI : 49.67–57.92 vs. 66.26 95%CI : 60.66–71.86 p = 0.002 ) . Patients in the intervention group received more physiotherapy ( 7.92 CI95 % : 5.22–10.62 vs. 3.24 95%CI : 1.37–5.310 ; p = 0.0001 ) and , on average , required fewer home care visits ( 9.40 95%CI : 7.89–10.92 vs.11.30 95%CI : 9.10–14.54 ) . No differences were found in terms of frequency of visits to A&E or hospital re-admissions . Furthermore , patients in the control group perceived higher levels of satisfaction ( 16.88 ; 95%CI : 16.32–17.43 ; range : 0–21 , vs. 14.65 95%CI : 13.61–15.68 ; p = 0,001 ) . Conclusion A home care service model that includes nurse-led case management streamlines access to healthcare services and re sources , while impacting positively on patients ' functional ability and caregiver burden , with increased levels of satisfaction . Trial registration IS RCT Background The ' Hawthorne Effect ' may be an important factor affecting the generalisability of clinical research to routine practice , but has been little studied . Hawthorne Effects have been reported in previous clin 
    Output:
    
Characteristics associated with positive results for caregivers were a high intensity of case management and programs specifically addressed to dementia patients .
Despite the numerous method ological challenges in the assessment of such complex social interventions , our results show that case management programs can be beneficial for caregivers of dementia patients and that positive results for patients are achieved without increasing caregivers ' burden .
Copyright © 2017 John Wiley & Sons ,