***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: OBJECTIVE To determine whether an asthma coaching program can improve  parent and child asthma-related quality of life ( QOL ) and reduce urgent care events . DESIGN R and omized controlled trial of usual care vs usual care with coaching . Comparisons were made between groups using mixed models . SETTING A Midwest city . PARTICIPANTS A community-based sample of 362 families with a child aged 5 to 12 years with persistent asthma . INTERVENTION A 12-month structured telephone coaching program in which trained coaches provided education and support to parents for 4 key asthma management behaviors . MAIN OUTCOME MEASURES Parental and child QOL measured with a vali date d , interview-administered , 7-point instrument and urgent care events in a year ( unscheduled office visits , after-hours calls , emergency department visits , or hospitalizations ) determined by record audit . RESULTS Parental asthma-related QOL scores improved by an average of 0.67 units ( 95 % confidence interval [ CI ] , 0.49 to 0.84 ) in the intervention group and 0.28 units ( 95 % CI , 0.10 to 0.46 ) in the control group . The difference between study groups was statistically significant ( difference , 0.38 ; 95 % CI , 0.14 to 0.63 ) . No between-group difference was found in the change in the child 's QOL ( difference , -0.17 ; 95 % CI , -0.47 to 0.12 ) or in the mean number of urgent care events per year ( difference , 1.15 ; 95 % CI , 0.82 to 1.61 ) . The proportion of children with very poorly controlled asthma in the intervention group decreased compared with the control group ( difference , 0.34 ; 95 % CI , 0.21 to 0.48 ) . CONCLUSIONS A telephone coaching program can improve parental QOL and can be implemented without additional physician training or practice re design BACKGROUND AND PURPOSE We report the findings of a r and omized controlled trial to determine the effectiveness of a multidisciplinary Stroke Education Program ( SEP ) for patients and their informal carers . METHODS Two hundred four patients admitted with acute stroke and their 176 informal carers were r and omized to receive an invitation to the SEP or to receive conventional stroke unit care . The SEP consisted of one 1-hour small group educational session for in patients followed by six 1-hour sessions after discharge . The primary outcome measure was patient- and carer-perceived health status ( SF-36 ) at 6 months after stroke . Knowledge of stroke , satisfaction with services , emotional outcome , disability , and h and icap and were secondary outcome measures . RESULTS Only 51 of 108 ( 47 % ) surviving patients r and omized to the SEP completed the program , as did 20 of 93 ( 22 % ) informal carers of surviving patients .  Perceived health status ( Short Form 36 [ SF-36 ] health survey ) scores were similar for SEP patients and controls . Informal carers in the control group scored better on the social functioning component of the SF-36 than the SEP group ( P=0.04 ) . Patients and informal carers in the SEP group scored higher on the stroke knowledge scale than controls ( patients , P=0.02 ; carers , P=0 . 01 ) . Patients in the SEP group were more satisfied with the information that they had received about stroke ( P=0.004 ) . There were no differences in emotional or functional outcomes between groups . CONCLUSIONS Although the SEP improved patient and informal carer knowledge about stroke and patient satisfaction with some components of stroke services , this was not associated with an improvement in their perceived health status . Indeed , the social functioning of informal carers r and omized to the SEP was less than in the control group The objective is to test the effectiveness of Partners in Dementia Care ( PDC ) , a care-coordination program that integrates and improves access to medical and nonmedical services , while strengthening the informal care network and providing information , coaching , and emotional support . PDC was delivered via a partnership between Veterans Affairs ( VA ) Medical Centers ( VAMCs ) and Alzheimer 's Association chapters , for caregivers of veterans with dementia living in the community and receiving primary care from the VA . The initial sample was 486 caregivers of 508 veterans with diagnosed dementia . Outcomes were evaluated for 394 and 324 caregivers who completed 6- and 12- month follow-up , respectively . PDC had a st and ardized protocol that included assessment and re assessment , action planning , and ongoing monitoring . It was delivered by telephone and e-mail for cost efficiency and the ability to h and le caseloads of 100 to 125 . Care coordinators from VAMCs and Alzheimer 's Association chapters worked as a team using a shared computerized record . A variety of caregiver outcomes was measured after 6 and 12 months . Intervention group caregivers had significant improvements in outcomes representing unmet needs , three types of caregiver strains , depression , and two support re sources . Most improvements were evident after 6 months , with more-limited improvements from Months 6 to 12 . Some outcomes improved for all caregivers , whereas some improved for caregivers experiencing more initial difficulties or caring for veterans with more-severe impairments . PDC is a promising model that improves linkages between healthcare services and community services , which is a goal of several new national initiatives such as the National Plan to Address Alzheimer 's Disease and a proposed amendment to the Older Americans Act 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 Educational initiatives for informal caregivers have proved efficient at reducing some of their symptoms , consequence of their involvement in care giving . However , more progress must be made in terms of the design of more successful interventions . Aims : R and omized clinical trial to test the efficiency of an Education Program for Primary Informal Caregivers of Hospitalized Dependent Patients in relation to their burden , mental and physical health , and care related knowledge . Methods Design : Cluster R and omized Trial . Sample : 151 participants , primary caregivers of hospitalized , dependent patients , carried out from February 2009 to March 2010 . They were assigned at r and om to two groups : one received an intensive educational program ( n = 78 ) , and the other just a generic speech ( n = 73 ) . The degree of burden of caregivers was recorded ( Zarit Test ) , as well as their physical and mental health ( SF12 ) and their knowledge of caregiving , before , immediately , after and one and a half months after the intervention . These analyses were carried out according to the Generalized Estimated Equations Method , in order to assess any possible improvements . Results Participants ´ burden did not improve , as measured by Zarit Test ( p = 0,338 ) , nor did their physical ( p = 0,917 ) or mental health ( p = 0,345 ) . However there was an improvement in their hygiene caregiving ( p = 0,001 ) and mobility care giving ( p = 0,001 ) . Conclusions Caregivers found useful the education program , providing them with an informal support group . Interventions need to be longer and more customized as well as adapted to specific dem and s. There is a lack of vali date d question naires to assess improvements in care knowledge . There is a need to develop programs that contemplate continuity of care from primary to specialized caregiving . Trial registration Cluster r and omized trial : Dementia care is largely provided in primary care setting s. This article describes a pilot project aim ed at evaluating the effectiveness of an accessible , telephone-based , patient- and caregiver (CG)-centered , collaborative care management program that involves CG education and psychosocial support in improving CG and patient outcomes . CGs ( n = 75 ) of older veterans with dementia receiving care from Veterans Affairs ( VA ) Medical Center primary care practice s were r and omized to receive either dementia care management or usual care ( UC ) . Of interest in this study were the frequency and severity of patients ’ dementia-related symptom , CG distress related to patients ’ behavioral and neuropsychiatric symptoms ( primary outcomes ) , and CG coping and mastery ( secondary outcomes ) . Adjusted , intention-to-treat longitudinal models suggest that CGs receiving care management reported significantly greater reductions in distress due to patients ’ dementia-related ( p = .05 ) and neuropsychiatric ( p = .01 ) symptoms compared with CGs in UC . Additionally , CGs in the intervention reported significantly larger improvements in their ability to cope ( p = .03 ) and caregiving mastery ( p = .03 ) . No significant group differences were found in CG burden or patients ’ dementia-related symptom frequency or severity over time . Findings suggest that CGs of veterans with dementia may benefit from a telephone-delivered , care management program in improving CG-related outcomes . Further research of care management programs for CG of veterans with dementia in addressing barriers to care and reducing CG burden is warranted . These findings highlight the potential for such programs as adjuncts to dementia care offered in primary care practice Background and Purpose — Additional exercise therapy has been shown to have a positive impact on function after acute stroke and research is now focusing on methods to increase the amount of therapy that is delivered . This r and omized controlled trial examined the impact of additional family-mediated exercise ( FAME ) therapy on outcome after acute stroke . Methods — Forty participants with acute stroke were r and omly assigned to either a control group who received routine therapy with no formal input from their family members or a FAME group , who received routine therapy and additional lower limb FAME therapy for 8 weeks . The primary outcome measure used was the lower limb section of the Fugl-Meyer Assessment modified by Lindmark . Other measures of impairment , activity , and participation were completed at baseline , postintervention , and at a 3-month follow-up . Results — Statistically significant differences in favor of the FAME group were noted on all measures of impairment and activity postintervention ( P<0.05 ) . These improvements persisted at the 3-month follow-up but only walking was statistically significant ( P<0.05 ) . Participants in the FAME group were also significantly more integrated into their community at follow-up ( P<0.05 ) . Family members in the FAME group reported a significant decrease in their levels of caregiver strain at the follow-up when compared with those in the control group ( P<0.01 ) . Conclusions — This evidence -based FAME intervention can serve to optimize patient recovery and family involvement after acute stroke at the same time as being mindful of available re sources UNLABELLED Objectives . Implementation and valuation of the  family member participation in the critically ill patient care . Methodology . Experimental , longitudinal and prospect i ve study , temporal series , with a r and om control group . This family implication program will be valued according to three dependent parameters : patient , family carer and nursing staff . PATIENT cognitive state , measured by using the Mini-mental state examination test . Family visitor : family principal carer anxiety state levels , measured using STAI test . Nursing staff : nurses ' beliefs about changes introduced in the ICU , valued using attitude Likert type scale . Hypothesis . A family participation program design and implementation in the basic care in the critic patient has positive and significantly influence in the patient , family career and nursing staff . Results . The sample was of 117 cases ; 49 in control group , 49 in experimental group and 19 no valid . The STAI test obtained in the experimental group a mean of 23.57 against control group of 31.22 ( p < .005 ) . Minimental test was a mean of 
    Output:
    
Patient outcomes ( e.g. , satisfaction ) were most improved by caregiver-mediated interventions that provided condition and treatment education ( e.g. , symptom management information ) and practical condition-management support ( e.g. , practicing medication protocol ) .
Caregiver outcomes ( e.g. , stress-related/psychiatric outcomes ) were most improved by interventions that activated caregiver roles ( e.g. , monitoring blood glucose ) and provided information related to that action ( e.g. , why and how to monitor ) .
Conclusions There is a large body of research , including many RCTs , to support the use of caregiver-mediated interventions that inform and activate caregivers to improve patient and caregiver outcomes .