***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: BACKGROUND home-based telecare ( TC ) is utilised to manage risks of independent living and provide prompt emergency responses . This study examined the effect of TC on health-related quality of life ( HRQoL ) , anxiety and depressive symptoms over 12 months in patients receiving social care . DESIGN a study of participant-reported outcomes [ the Whole Systems Demonstrator ( WSD ) Telecare Question naire Study ; baseline n = 1,189 ] was nested in a pragmatic cluster-r and omised trial of TC ( the WSD Telecare trial ) , held across three English Local Authorities . General practice ( GP ) was the unit of r and omisation and TC was compared with usual care ( UC ) . METHODS participant-reported outcome measures were collected at baseline , short-term ( 4 months ) and long-term ( 12 months ) follow-up , assessing generic HRQoL , anxiety and depressive symptoms . Primary intention-to-treat analyses tested treatment effectiveness and were conducted using multilevel models to control for GP clustering and covariates for participants who completed question naire measures at baseline assessment plus at least one other assessment ( n = 873 ) . RESULTS analyses found significant differences between TC and UC on Short Form-12 mental component scores ( P < 0.05 ) , with parameter estimates indicating being a member of the TC trial-arm increases mental component scores ( UC-adjusted mean = 40.52 ; TC-adjusted mean = 43.69 ) . Additional significant analyses revealed , time effects on EQ5D ( decreasing over time ) and depressive symptoms ( increasing over time ) . CONCLUSIONS TC potentially contributes to the amelioration in the decline in users ' mental HRQoL over a 12-month period . TC may not transform the lives of its users , but it may afford small relative benefits on some psychological and HRQOL outcomes relative to users who only receive UC . International St and ard R and omised Controlled Trial Number Register : IS RCT N 43002091 BACKGROUND Mild frailty or pre-frailty is common and yet is potentially reversible . Preventing progression to worsening frailty may benefit individuals and lower health/social care costs . However , we know little about effective approaches to preventing frailty progression . OBJECTIVES ( 1 ) To develop an evidence - and theory-based home-based health promotion intervention for older people with mild frailty . ( 2 ) To assess feasibility , costs and acceptability of ( i ) the intervention and ( ii ) a full-scale clinical effectiveness and cost-effectiveness r and omised controlled trial ( RCT ) . DESIGN Evidence review s , qualitative studies , intervention development and a feasibility RCT with process evaluation . INTERVENTION DEVELOPMENT Two systematic review s ( including systematic search es of 14 data bases and registries , 1990 - 2016 and 1980 - 2014 ) , a state-of-the-art review ( from inception to 2015 ) and policy review identified effective components for our intervention . We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people ( aged 65 - 94 years ) ( n = 44 ) , carers ( n = 12 ) and health/social care professionals ( n = 27 ) . These data , and our evidence review s , fed into development of the ' HomeHealth ' intervention in collaboration with older people and multidisciplinary stakeholders . ' HomeHealth ' comprised 3 - 6 sessions with a support worker trained in behaviour change techniques , communication skills , exercise , nutrition and mood . Participants addressed self-directed independence and well-being goals , supported through education , skills training , enabling individuals to overcome barriers , providing feedback , maximising motivation and promoting habit formation . FEASIBILITY RCT Single-blind RCT , individually r and omised to ' HomeHealth ' or treatment as usual ( TAU ) . SETTING Community setting s in London and Hertfordshire , UK . PARTICIPANTS A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty . MAIN OUTCOME MEASURES Feasibility - recruitment , retention , acceptability and intervention costs . Clinical and health economic outcome data at 6 months included functioning , frailty status , well-being , psychological distress , quality of life , capability and NHS and societal service utilisation/costs . RESULTS We successfully recruited to target , with good 6-month retention ( 94 % ) . Trial procedures were acceptable with minimal missing data . Individual r and omisation was feasible . The intervention was acceptable , with good fidelity and modest delivery costs ( £ 307 per patient ) . A total of 96 % of participants identified at least one goal , which were mostly exercise related ( 73 % ) . We found significantly better functioning ( Barthel Index + 1.68 ; p = 0.004 ) , better grip strength ( + 6.48 kg ; p = 0.02 ) , reduced psychological distress ( 12-item General Health Question naire -3.92 ; p = 0.01 ) and increased capability-adjusted life-years [ + 0.017 ; 95 % confidence interval ( CI ) 0.001 to 0.031 ] at 6 months in the intervention arm than the TAU arm , with no differences in other outcomes . NHS and carer support costs were variable but , overall , were lower in the intervention arm than the TAU arm . The main limitation was difficulty maintaining outcome assessor blinding . CONCLUSIONS Evidence is lacking to inform frailty prevention service design , with no large-scale trials of multidomain interventions . From stakeholder/public perspectives , new frailty prevention services should be personalised and encompass multiple domains , particularly socialising and mobility , and can be delivered by trained non-specialists . Our multicomponent health promotion intervention was acceptable and delivered at modest cost . Our small study shows promise for improving clinical outcomes , including functioning and independence . A full-scale individually RCT is feasible . FUTURE WORK A large , definitive RCT of the HomeHealth service is warranted . STUDY REGISTRATION This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials IS RCT N11986672 . FUNDING This project was funded by the National Institute for Health Research ( NIHR ) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 21 , No. 73 . See the NIHR Journals Library website for further project information Background : Achieving earlier stage diagnosis is one option for improving lung cancer outcomes in the United Kingdom . Patients with lung cancer typically present with symptoms to general practitioners several times before referral or investigation . Methods : We undertook a mixed methods feasibility individually r and omised controlled trial ( the ELCID trial ) to assess the feasibility and inform the design of a definitive , fully powered , UK-wide , Phase III trial of lowering the threshold for urgent investigation of suspected lung cancer . Patients over 60 , with a smoking history , presenting with new chest symptoms to primary care , were eligible to be r and omised  to  intervention ( urgent chest X-ray ) or usual care . Results : The trial design and material s were acceptable to GPs and patients . We r and omised 255 patients from 22 practice s , although the proportion of eligible patients who participated was lower than expected . Survey responses ( 89 % ) , and the fidelity of the intervention ( 82 % patients X-rayed within 3 weeks ) were good . There was slightly higher anxiety and depression in the control arm in participants aged > 75 . Three patients ( 1.2 % ) were diagnosed with lung cancer . Conclusions : We have demonstrated the feasibility of individually r and omising patients at higher risk of lung cancer , to a trial offering urgent investigation or usual care Background This study explored the effectiveness of a pro-active , integrated care model for community-dwelling frail older people compared to care as usual by evaluating the effects on a comprehensive set of outcomes : health outcomes ( experienced health , mental health and social functioning ) ; functional abilities ; and quality of life ( general , health-related and well-being ) . Methods The design of this study was quasi-experimental . In this study , 184 frail older patients of three GP practice s that implemented the Walcheren Integrated Care Model were compared with 193 frail older patients of five GP practice s that provided care as usual .  In the Walcheren Integrated Care Model , community-dwelling elderly were pro-actively screened for frailty from the GP practice using the Groningen Frailty Indicator , and care needs were assessed with the EASYcare instrument . The GP practice functioned as single entry point from which case management was provided , and the GP was the coordinator of care . The entire process was supported by multidisciplinary meetings , multidisciplinary protocol s and web-based patient files . The outcomes of this study were obtained at baseline , after 3 months and after 12 months and analyzed with linear mixed models of repeated measures . Results The Walcheren Integrated Care Model had a positive effect on love and friendship and a moderately positive effect on general quality of life . The ability to receive love and friendship and general quality of life decreased in the control group but was preserved in the experimental group . No significant differences were found on health outcomes such as experienced health , mental health , social functioning and functional abilities . Conclusions The results indicated that pro-active , integrated care can be beneficial for frail older people in terms of quality of life and love and friendship but not in terms of health outcomes and functional abilities . Recommendations for future research are to gain greater insight into what specific outcomes can be achieved with proactive and integrated care , considering the specific content of this care , and to allow for the heterogeneity of frail older people in evaluation research .Trial registration Current Controlled Trials IS RCT N05748494 . Registration date : 14/03/2013 Background Lifestyle factors represent prime targets for behaviour change interventions to promote healthy ageing and reduce dementia risk . We evaluated a goal - setting intervention aim ed at promoting increased cognitive and physical activity and improving mental and physical fitness , diet and health . Methods This was a pilot r and omised controlled trial design ed to guide planning for a larger-scale investigation , provide preliminary evidence regarding efficacy , and explore feasibility and acceptability . Primary outcomes were engagement in physical and cognitive activity .  Participants aged over 50 living independently in the community were recruited through a community Agewell Centre . Following baseline assessment participants were r and omly allocated to one of three conditions : control ( IC ) had an interview in which information about activities and health was discussed ; goal - setting ( GS n = 24 ) had an interview in which they set behaviour change goals relating to physical , cognitive and social activity , health and nutrition ; and goal - setting with mentoring ( GM , n = 24 ) had the goal - setting interview followed by bi-monthly telephone mentoring . Participants and research ers were blinded to group assignment . Participants were reassessed after 12 months . Results Seventy-five participants were r and omised ( IC n = 27 , GS n = 24 , GM n = 24 ) . At 12-month follow-up , the two goal - setting groups , taken together ( GS n = 21 , GM n = 22 ) , increased their level of physical ( effect size 0.37 ) and cognitive ( effect size 0.15 ) activity relative to controls ( IC n = 27 ) . In secondary outcomes , the two goal - setting groups taken together achieved additional benefits compared to control ( effect sizes ≥ 0.2 ) in memory , executive function , cholesterol level , aerobic capacity , flexibility , balance , grip strength , and agility . Adding follow-up mentoring produced further benefits compared to goal - setting alone ( effect sizes ≥ 0.2 ) in physical activity , body composition , global cognition and memory , but not in other domains . Implementation of the recruitment procedure , assessment and intervention was found to be feasible and the approach taken was acceptable to participants , with no adverse effects . Conclusions A brief , low-cost goal - setting intervention is feasible and acceptable , and has the potential to achieve increased activity engagement . Trial registration Current Controlled Trials IS RCT Abstract Purpose : To evaluate the impact of a person-centred , community rehabilitation service on outcomes for people with a neurological condition , in the first year of service . Method : A prospect i ve , observational , pre-post study was conducted with 206 people who had a neurological condition and attended the rehabilitation service  to restore function ( e.g. , Stroke ) ; maximize recovery in an ongoing situation ( e.g. , Spina Bifida ) ; or maximize function and independence while preparing for inevitable decline ( e.g. , Parkinson ’s Disease ) . Outcomes were measured via self-report question naires , prior to , and following three months of rehabilitation . The primary outcome was achievement of self-identified goals , measured by the Patient-Specific Functional scale . Secondary outcomes included the Lawton Instrumental Activities of Daily Living ( IADL ) scale , EQ-5D-5L European Quality of Life scale , and ICECAP-O – Index of Capability for Older Adults and health and medical re source use . Results : Participants demonstrated significant goal achievement and a significant reduction in health and medical re source use . There were small positive changes in the Lawton IADL , EQ-5D-5L , and ICECAP-O however these changes were not significant . Conclusions : In the first year of operation , the community rehabilitation service made a significant impact on outcomes for individuals with a neurological condition . Further research is required to identify appropriate measures of activities of daily living and quality of life that reflect person-centred rehabilitation outcomes for restoring function , maximizing function , or preparing for functional decline . Implication s for Rehabilitation Self-identified goals are an important guide for achievement of meaningful outcomes for individuals with a neurological condition . Person-centred outcome measures are required to evaluate the benefits of a 
    Output:
    
The ICECAP-O has good construct validity and responsiveness , but there is evidence of some issues relating to content validity .
Conclusion Focus , in terms of publications , appears to have shifted now from assessment of psychometric properties to the utilisation of the ICECAP-O within economic evaluation .