***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 This study determined whether the NYU Caregiver Intervention , adapted in Minnesota for adult child caregivers ( NYUCI-AC ) , prevented or delayed residential care placement for persons with dementia . DESIGN AND METHODS A single-blinded r and omized controlled trial design was used . One hundred and seven adult child caregivers of persons with dementia were r and omly assigned to the NYUCI-AC treatment group who received individual and family counseling , support group referral , and ad hoc consultation or a contact control group . Participants were asked to complete structured assessment s quarterly during Year 1 and every 6 months thereafter for a minimum of 2 years . RESULTS Two thirds ( 66 % ) of adult child caregivers in the control condition admitted their parent to a residential care setting compared with 37 % in the treatment condition . Logistic regression and Cox proportional hazards models found that NYUCI-AC participants were significantly less likely ( p < .05 ) to admit their parents to a residential care setting and delayed their parents ' time to admission significantly longer ( 228.36 days longer on average ) than those in the control group . IMPLICATION S The multicomponent NYUCI-AC offered adult children the psychosocial support required to continue providing care to cognitively impaired parents at home Background Interventions relieving the burden of caregiving may postpone or prevent patient institutionalization . The objective of this study was to determine whether a family meetings intervention was superior to usual care in postponing nursing home placement of patients with dementia . Methods A r and omized multicenter trial was conducted among 192 patients with a clinical diagnosis of dementia living at home at enrolment and their primary family caregiver . Dyads of caregivers and patients were r and omized to the  family meetings intervention  ( n = 96 ) or  usual care ( n = 96 ) condition . The intervention consisted of two individual sessions with the primary caregiver and four family counseling sessions that included family members and friends . The primary outcome measure was the time until institutionalization of the patient . Intention-to-treat as well as per protocol analyses were performed . Survival analyses were carried out to evaluate the effectiveness of the intervention . Results During 18 months follow-up 23 of 96 relatives with dementia of caregivers in the intervention group and 18 of 96 relatives with dementia of caregivers in the usual care group were institutionalized . No significant difference between the intervention and the usual care group was found in time until institutionalization ( adjusted hazard ratio ( HR ) 1.46 , 95 % confidence interval ( CI ) 0.78 to 2.74 ) . The per- protocol analysis revealed no significant effect either ( adjusted HR 0.57 , 95 % CI 0.21 to 1.57 ) , although the number of placements among the adherers was relatively low ( 9.4 % ) . A subgroup effect was found for patients ’ age , with a significantly higher risk of institutionalization for ‘ younger ’ patients in the intervention group compared with the usual care group ( adjusted HR = 4.94 , 95 % CI 1.10 to 22.13 ) . Conclusion This family meetings intervention for primary caregivers of patients with dementia did not postpone patient institutionalization more than usual care . Trial Registration : Controlled-Trials.com IS RCT OBJECTIVE Does psychosocial intervention for caregivers whose spouses with Alzheimer disease ( AD ) are taking donepezil delay nursing home ( NH ) placement or death of patients ? DESIGN R and omized controlled trial with 2 years of active treatment and up to 8.5 years of follow-up ( mean : 5.4 years , SD : 2.4 ) . SETTING Out patients of research clinics in Australia , the United Kingdom , and the United States . PARTICIPANTS One hundred and fifty-five persons with AD and their spouses . INTERVENTION Five sessions of individual and family counseling ( + prn ad hoc counseling ) or usual care . MEASUREMENTS Time to institutionalization and death using Cox proportional hazards methods . RESULTS Over a mean of 5.4 years ( SD : 2.4 ) , there were no differences in NH placement or mortality by intervention group , but there were by country , with Australian patients admitted to NHs earlier than U.S. than U.K. patients . CONCLUSION Earlier NH admission of Australian compared to U.K. and U.S. subjects may be due to differences in health care , NH systems , availability , and affordability Objective : To determine the effectiveness of a counseling and support intervention for spouse caregivers in delaying time to nursing home placement of patients with Alzheimer disease ( AD ) , and identify the mechanisms through which the intervention accomplished this goal . Methods : We conducted a r and omized controlled trial of an enhanced counseling and support intervention compared to usual care . Participants were a referred volunteer sample of 406 spouse caregivers of community-dwelling patients who had enrolled in the study over a 9.5-year period . The intervention consisted of six sessions of individual and family counseling , support group participation , and continuous availability of ad hoc telephone counseling . Structured question naires were administered at baseline and at regular follow-up intervals , every 4 months for the first year and every 6 months thereafter . Cox proportional hazard models were used to test the effects of the intervention on the time to nursing home placement for the patients after controlling for multiple time-invariant and time-dependent predictors of placement . Results : Patients whose spouses received the intervention experienced a 28.3 % reduction in the rate of nursing home placement compared with usual care controls ( hazard ratio = 0.717 after covariate adjustment , p = 0.025 ) . The difference in model-predicted median time to placement was 557 days . Improvements in caregivers ’ satisfaction with social support , response to patient behavior problems , and symptoms of depression collectively accounted for 61.2 % of the intervention ’s beneficial impact on placement . Conclusion : Greater access to effective programs of counseling and support could yield considerable benefits for caregivers , patients with Alzheimer disease , and society Introduction Quality assessment of included studies is an important component of systematic review s. Objective The authors investigated inter-rater and test – retest reliability for quality assessment s conducted by inexperienced student raters . Design Student raters received a training session on quality assessment using the Jadad Scale for r and omised controlled trials and the Newcastle – Ottawa Scale ( NOS ) for observational studies . Raters were r and omly assigned into five pairs and they each independently rated the quality of 13–20 articles . These articles were drawn from a pool of 78 papers examining cognitive impairment following electroconvulsive therapy to treat major depressive disorder . The articles were r and omly distributed to the raters . Two months later , each rater re-assessed the quality of half of their assigned articles . Setting McMaster Integrative Neuroscience Discovery and Study Program . Participants 10 students taking McMaster Integrative Neuroscience Discovery and Study Program courses . Main outcome measures The authors measured inter-rater reliability using κ and the intraclass correlation coefficient type 2,1 or ICC(2,1 ) . The authors measured test – retest reliability using ICC(2,1 ) . Results Inter-rater reliability varied by scale question . For the six-item Jadad Scale , question -specific κs ranged from 0.13 ( 95 % CI −0.11 to 0.37 ) to 0.56 ( 95 % CI 0.29 to 0.83 ) . The ranges were −0.14 ( 95 % CI −0.28 to 0.00 ) to 0.39 ( 95 % CI −0.02 to 0.81 ) for the NOS cohort and −0.20 ( 95 % CI −0.49 to 0.09 ) to 1.00 ( 95 % CI 1.00 to 1.00 ) for the NOS case – control . For overall scores on the six-item Jadad Scale , ICC(2,1)s for inter-rater and test – retest reliability ( accounting for systematic differences between raters ) were 0.32 ( 95 % CI 0.08 to 0.52 ) and 0.55 ( 95 % CI 0.41 to 0.67 ) , respectively . Corresponding ICC(2,1)s for the NOS cohort were −0.19 ( 95 % CI −0.67 to 0.35 ) and 0.62 ( 95 % CI 0.25 to 0.83 ) , and for the NOS case – control , the ICC(2,1)s were 0.46 ( 95 % CI −0.13 to 0.92 ) and 0.83 ( 95 % CI 0.48 to 0.95 ) . Conclusions Inter-rater reliability was generally poor to fair and test – retest reliability was fair to excellent . A pilot rating phase following rater training may be one way to improve agreement CONTEXT The decision to institutionalize a patient with dementia is complex and is based on patient and caregiver characteristics and the sociocultural context of patients and caregivers . Most studies have determined predictors of nursing home placement primarily according to patient or caregiver characteristics alone . OBJECTIVE To develop and vali date a prognostic model to determine the comprehensive predictors of placement among an ethnically diverse population of patients with dementia . DESIGN , SETTING , AND PARTICIPANTS The Medicare Alzheimer 's Disease Demonstration and Evaluation study , a prospect i ve study at 8 sites in the United States , with enrollment between December 1989 and December 1994 of 5788 community-living persons with advanced dementia . MAIN OUTCOME MEASURES Time to nursing home placement throughout a 36-month follow-up period , assessed by interview and review of Medicare records , and its association with patient and caregiver characteristics , obtained by interview at enrollment . RESULTS Patients were divided into a development ( n = 3859 ) and validation ( n = 1929 ) cohort . In the development cohort , the Kaplan-Meier estimates of nursing home placement throughout 1 , 2 , and 3 years were 22 % , 40 % , and 52 % , respectively . After multivariate adjustment , patient characteristics that were associated with nursing home placement were as follows : black ethnicity ( hazard ratio , 0.60 ; 95 % confidence interval [ CI ] , 0.48 - 0.74 ) , Hispanic ethnicity ( HR , 0.40 ; 95 % CI , 0.28 - 0.56 ) ( both ethnicities were inversely associated with placement ) , living alone ( HR , 1.74 ; 95 % CI , 1.49 - 2.02 ) , 1 or more dependencies in activities of daily living ( HR , 1.38 ; 95 % CI , 1.20 - 1.60 ) , high cognitive impairment ( for Mini-Mental Status Examination score < or = 20 : HR , 1.52 ; 95 % CI , 1.33 - 1.73 ) , and 1 or more difficult behaviors ( HR , 1.30 ; 95 % CI , 1.11 - 1.52 ) . Caregiver characteristics associated with patient placement were age 65 to 74 years ( HR , 1.17 ; 95 % CI , 1.01 - 1.37 ) , age 75 years or older ( HR , 1.55 ; 95 % CI , 1.31 - 1.84 ) , and high Zarit Burden Scale score ( for highest quartile : HR , 1.73 ; 95 % CI , 1.49 - 2.00 ) . Patients were assigned to quartiles of risk based on this model . In the development cohort , patients in the first , second , third , and fourth quartile had a 25 % , 42 % , 64 % , and 91 % rate of nursing home placement at 3 years , respectively . In the validation cohort , the respective rates were 21 % , 50 % , 64 % , and 89 % . The C statistic for 3-year nursing home placement was 0.66 in the development cohort and 0.63 in the validation cohort . CONCLUSIONS Patient and caregiver characteristics are both important determinants of long-term care placement for patients with dementia . Interventions directed at delaying placement , such as reduction of caregiver burden  or  difficult patient behaviors  , need to take into account the patient and caregiver as a unit PURPOSE OF THE STUDY To identify risk factors for early nursing home placement ( NHP ) in Alzheimer 's disease ( AD ) , focusing on the impact of longitudinal change in cognition , activities of daily living ( ADL ) , service utilization , and cholinesterase inhibitor treatment ( ChEI ) . DESIGN AND METHODS In an open , 3-year , prospect i ve , multicenter study in a routine clinical setting , 880 AD patients were treated with either donepezil , rivastigmine , or galantamine . At baseline and every 6 months , they were assessed with several rating scales including Mini-Mental State Examination , Instrumental Activities of Daily Living scale ( IADL ) , and Physical Self-Maintenance scale . Moreover , the dose of ChEI , the amount of weekly assistance ( home help service and adult day care ) , and the date of NHP were recorded . Cox regression models were constructed to predict the risk of NHP . RESULTS During the study , 206 patients ( 23 % ) were admitted to nursing homes . Factors that precipitated institutionalization were lower cognitive and functional abilities at 
    Output:
    
Behavioral and psychological symptoms of dementia , the degree of functional impairment , and caregiver burden had a consistent effect on the risk of LTC placement in our descriptive review .
We quantified the predictive effect of several risk factors for LTC placement .