human
***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 assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint . Design Cost effectiveness study alongside a single blind r and omised controlled trial . Setting Memory clinic , day clinic of a geriatrics department , and participants ’ homes . Patients 135 patients aged ≥65 with mild to moderate dementia living in the community and their primary care givers . Intervention 10 sessions of occupational therapy over five weeks , including cognitive and behavioural interventions , to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision . Main outcome measures Incremental cost effectiveness ratio expressed as the difference in mean total care costs per successful treatment ( that is , a combined patient and care giver outcome measure of clinical ly relevant improvement on process , performance , and competence scales ) at three months after r and omisation . Bootstrap methods used to determine confidence intervals for these measures . Results The intervention cost € 1183 ( £ 848 , $ 1738 ) ( 95 % confidence interval € 1128 ( £ 808 , $ 1657 ) to € 1239 ( £ 888 , $ 1820 ) ) per patient and primary care giver unit at three months . Visits to general practitioners and hospital doctors cost the same in both groups but total mean costs were € 1748 ( £ 1279 , $ 2621 ) lower in the intervention group , with the main cost savings in informal care . There was a significant difference in proportions of successful treatments of 36 % at three months . The number needed to treat for successful treatment at three months was 2.8 ( 2.7 to 2.9 ) . Conclusions Community occupational therapy intervention for patients with dementia and their care givers is successful and cost effective , especially in terms of informal care giving BACKGROUND Cognitive Stimulation Therapy ( CST ) is effective and cost-effective for people with mild-to-moderate dementia when delivered biweekly over 7 weeks . AIMS To examine whether longer-term ( maintenance ) CST is cost-effective when added to usual care . METHODS Cost-effectiveness analysis within multicenter , single-blind , pragmatic r and omized controlled trial ; subgroup analysis for people taking acetylcholinesterase inhibitors ( ACHEIs ) . A total of 236 participants with mild-to-moderate dementia received CST for 7 weeks . They were r and omized to either weekly maintenance CST added to usual care or usual care alone for 24 weeks . RESULTS Although outcome gains were modest over 6 months , maintenance CST appeared cost-effective when looking at self-rated quality of life as primary outcome , and cognition ( MMSE ) and proxy-rated quality -adjusted life years as secondary outcomes . CST in combination with ACHEIs  offered cost-effectiveness gains when outcome was measured as cognition . CONCLUSIONS Continuation of CST is likely to be cost-effective for people with mild-to-moderate dementia BACKGROUND Individualized problem-solving counseling for caregivers of cognitively impaired relatives is thought to help caregivers cope with the stress and burden of caregiving . Few studies have shown the effectiveness of counseling for these caregivers . OBJECTIVES To determine the effectiveness of individualized problem-solving counseling by nurses for caregivers and the expenditures of health care utilization . METHOD Caregivers ( n = 77 ) of the cognitively impaired living at home were r and omized to receive nurse counseling or not .  Psychosocial adjustment to their relative 's illness , psychological distress , burden , coping skills , and expenditures were measured after 6 months and 1 year . RESULTS Although on average , all caregivers receiving nurse counseling indicated no improvement in psychosocial adjustment to their relative 's illness , psychological distress , or caregiver burden , they found counseling very helpful and it was effective for a subgroup of caregivers . Those with poor logical analysis coping skills at baseline had decreased psychological distress ( F(1,53 ) = 9.7 , p = .003 ) and improved psychosocial adjustment ( F(1,53 ) = 4.7 , p = .035 ) after 1 year . Caregivers in control and counseling groups whose relatives entered a nursing home improved their psychosocial adjustment 23 % on average whereas those continuing to live in the community decreased by 8 % . Almost half as many relatives entered nursing homes in the counseling group ( n = 9 vs. n = 5 ) but these compared to control group relatives had greater annualized per person expenditures for health and social services ( Cdn$23,437 vs. Cdn$15,151 ) . CONCLUSIONS Caregivers found nurse counseling most helpful . Those indicating infrequent use of logical analysis coping skills showed benefits BACKGROUND Two-thirds of people with dementia live at home , receiving most care from family carers , about 40 % of whom have clinical ly significant depression or anxiety . This impacts on the person with dementia , families and society , predicting care breakdown . There are currently no clinical ly effective and cost-effective NHS family carer interventions . OBJECTIVES To assess the STrAtegies for RelaTives ( START ) intervention in the short ( 4 and 8 months ) and long term ( 1 and 2 years ) compared with treatment as usual ( TAU ) . DESIGN R and omised , parallel-group , superiority trial with blinded assessment recruiting participants 2:1 ( intervention to TAU ) to allow for therapist clustering . SETTING Three UK mental health services and one neurological service . PARTICIPANTS Family carers of people with dementia . INTERVENTION Eight-session manual-based coping intervention delivered by supervised psychology graduates to individuals . MAIN OUTCOME MEASURES Affective symptoms [ Hospital Anxiety and Depression Scale-total ( HADS-T ) ] and cost-effectiveness . Secondary measures : anxiety and depression symptoms and caseness , quality of life ( QoL ) , abusive behaviour and long-term care home admission . RESULTS Two hundred and sixty participants were r and omised ( 173 intervention , 87 TAU ) . We used intention-to-treat analysis in the short term ( 152 intervention , 77 TAU ) and in the long term ( 140 intervention , 69 TAU ) . In the short term , the intervention group had lower HADS-T [ mean difference -1.80 , 95 % confidence interval ( CI ) -3.29 to -0.31 ; p=0.02 ] and higher quality -adjusted life-years ( QALYs ) ( mean difference 0.03 , 95 % CI -0.01 to 0.08 ) . Costs were no different between groups [ mean £ 252 ( 95 % CI -£ 28 to £ 565 ) for intervention group ] . The cost-effectiveness acceptability curve showed a greater than 99 % chance of being cost-effectiveness at a £ 30,000/QALY willingness-to-pay threshold and a high probability of cost-effectiveness based on the HADS-T score . Carers in the intervention group had less case-level depression [ odds ratio ( OR ) 0.24 , 95 % CI 0.07 to 0.76 ] , a trend towards reduced case-level anxiety ( OR 0.30 , 95 % CI 0.08 to 1.05 ) , lower Hospital Anxiety and Depression Scale-anxiety ( HADS-A ) ( -0.91 , 95 % CI -1.76 to -0.07 ; p = 0.03 ) and Hospital Anxiety and Depression Scale-depression ( HADS-D ) ( -0.91 , 95 % CI -1.71 to -0.10 ; p = 0.03 ) and higher Health Status Question naire ( HSQ ) QoL ( mean difference 4.09 , 95 % CI 0.34 to 7.83 ) . Group differences in abusive behaviour ( OR 0.48 , 95 % CI 0.18 to 1.27 ) and the person with dementia 's quality of life-Alzheimer 's disease ( QoL-AD ) ( mean increase 0.59 , 95 % CI -0.72 to 1.89 ) were not significant . In the long term , the intervention group had lower HADS-T ( mean difference -2.58 , 95 % CI -4.26 to -0.90 ; p = 0.03 ) and higher QALYs ( mean difference 0.03 , 95 % CI -0.01 to 0.06 ) . Carers in the intervention group had less case-level depression ( OR 0.14 , 95 % CI 0.04 to 0.53 ) , a trend towards reduced case-level anxiety ( OR 0.57 , 95 % CI 0.26 to 1.24 ) , lower HADS-A ( -1.16 , 95 % CI -2.15 to -0.18 ) and HADS-D ( 1.45 , 95 % CI -2.32 to -0.57 ) , and higher HSQ ( mean difference 7.47 , 95 % CI 2.87 to 12.08 ) . Thirty-two ( 18.7 % ) people with dementia in the intervention group and 17 ( 20.2 % ) in TAU were admitted to a care home ( hazard ratio 0.83 , 95 % CI 0.44 to 1.56 ; p = 0.56 ) . There were no significant differences between groups in abusive behaviour ( OR 0.83 , 95 % CI 0.36 to 1.94 ) , the person with dementia 's QoL-AD ( 0.17 , 95 % CI -1.37 to 1.70 ) or costs ( £ 336 , 95 % CI -£ 223 to £ 895 ) for intervention group . The probability that the intervention would be seen as cost-effective at £ 30,000/QALY threshold and cost-effectiveness on the HADS-T remained high . CONCLUSIONS The START intervention was clinical ly effective and cost-effective in the short and longer term . The results are robust to the sensitivity analyses performed . Future work is needed to consider mechanism of action ; the effects on people with dementia in clinical terms ( cognition , neuropsychiatric symptoms , longer-term care home admission ) ; and on health and social care costs . In addition , we will explore the effects of carer abusive behaviour on the care recipient 's care home admission and if this then reduces abusive behaviour . We would also like to implement START and evaluate this implementation in clinical practice . TRIAL REGISTRATION Current Controlled Trials ISCTRN70017938 BACKGROUND There is good evidence for the benefits of short-term cognitive stimulation therapy for dementia but little is known about possible long-term effects . AIMS To evaluate the effectiveness of maintenance cognitive stimulation therapy ( CST ) for people with dementia in a single-blind , pragmatic r and omised controlled trial including a sub study with participants taking acetylcholinesterase inhibitors ( AChEIs ) . METHOD The participants were 236 people with dementia from 9 care homes and 9 community services . Prior to r and omisation all participants received the 7-week , 14-session CST programme . The intervention group received the weekly maintenance CST group programme for 24 weeks . The control group received usual care . Primary outcomes were cognition and quality of life ( clinical trial registration : IS RCT N26286067 ) . RESULTS For the intervention group at the 6-month primary end-point there were significant benefits for self-rated quality of life ( Quality of Life in Alzheimer 's Disease ( QoL-AD ) P = 0.03 ) . At 3 months there were improvements for proxy-rated quality of life ( QoL-AD P = 0.01 , Dementia Quality of Life scale ( DEMQOL ) P = 0.03 ) and activities of daily living ( P = 0.04 ) . The intervention subgroup taking AChEIs showed cognitive benefits ( on the Mini-Mental State Examination ) at 3 ( P = 0.03 ) and 6 months ( P = 0.03 ) . CONCLUSIONS Continuing CST improves quality of life ; and improves cognition for those taking AChEIs PURPOSE OF THE STUDY This paper is a report of a study of the Assistance , Support , and Self-health Initiated through Skill Training ( ASSIST ) r and omized control trial . The aim of this paper is to underst and whether participating in ASSIST significantly changed the out-of-pocket ( OOP ) costs for family caregivers of Alzheimer 's disease ( AD ) or Parkinson 's disease ( PD ) patients . DESIGN AND METHODS Secondary analysis of r and omized control trial data , calculating average treatment effects of the intervention on OOP costs .  Enrollment in the ASSIST trial occurred between 2002 and 2007 at 2 sites : Durham , North Carolina , and Birmingham , Alabama . We profile OOP costs for caregivers who participated in the ASSIST study and use 2-part expenditure models to examine the average treatment effect of the intervention on caregiver OOP expenditures . RESULTS ASSIST-trained AD and PD caregivers reported monthly OOP expenditures that averaged $ 500-$600 . The intervention increased the likelihood of caregivers spending 
    Output:
    
agent
***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 assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint . Design Cost effectiveness study alongside a single blind r and omised controlled trial . Setting Memory clinic , day clinic of a geriatrics department , and participants ’ homes . Patients 135 patients aged ≥65 with mild to moderate dementia living in the community and their primary care givers . Intervention 10 sessions of occupational therapy over five weeks , including cognitive and behavioural interventions , to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision . Main outcome measures Incremental cost effectiveness ratio expressed as the difference in mean total care costs per successful treatment ( that is , a combined patient and care giver outcome measure of clinical ly relevant improvement on process , performance , and competence scales ) at three months after r and omisation . Bootstrap methods used to determine confidence intervals for these measures . Results The intervention cost € 1183 ( £ 848 , $ 1738 ) ( 95 % confidence interval € 1128 ( £ 808 , $ 1657 ) to € 1239 ( £ 888 , $ 1820 ) ) per patient and primary care giver unit at three months . Visits to general practitioners and hospital doctors cost the same in both groups but total mean costs were € 1748 ( £ 1279 , $ 2621 ) lower in the intervention group , with the main cost savings in informal care . There was a significant difference in proportions of successful treatments of 36 % at three months . The number needed to treat for successful treatment at three months was 2.8 ( 2.7 to 2.9 ) . Conclusions Community occupational therapy intervention for patients with dementia and their care givers is successful and cost effective , especially in terms of informal care giving BACKGROUND Cognitive Stimulation Therapy ( CST ) is effective and cost-effective for people with mild-to-moderate dementia when delivered biweekly over 7 weeks . AIMS To examine whether longer-term ( maintenance ) CST is cost-effective when added to usual care . METHODS Cost-effectiveness analysis within multicenter , single-blind , pragmatic r and omized controlled trial ; subgroup analysis for people taking acetylcholinesterase inhibitors ( ACHEIs ) . A total of 236 participants with mild-to-moderate dementia received CST for 7 weeks . They were r and omized to either weekly maintenance CST added to usual care or usual care alone for 24 weeks . RESULTS Although outcome gains were modest over 6 months , maintenance CST appeared cost-effective when looking at self-rated quality of life as primary outcome , and cognition ( MMSE ) and proxy-rated quality -adjusted life years as secondary outcomes . CST in combination with ACHEIs  offered cost-effectiveness gains when outcome was measured as cognition . CONCLUSIONS Continuation of CST is likely to be cost-effective for people with mild-to-moderate dementia BACKGROUND Individualized problem-solving counseling for caregivers of cognitively impaired relatives is thought to help caregivers cope with the stress and burden of caregiving . Few studies have shown the effectiveness of counseling for these caregivers . OBJECTIVES To determine the effectiveness of individualized problem-solving counseling by nurses for caregivers and the expenditures of health care utilization . METHOD Caregivers ( n = 77 ) of the cognitively impaired living at home were r and omized to receive nurse counseling or not .  Psychosocial adjustment to their relative 's illness , psychological distress , burden , coping skills , and expenditures were measured after 6 months and 1 year . RESULTS Although on average , all caregivers receiving nurse counseling indicated no improvement in psychosocial adjustment to their relative 's illness , psychological distress , or caregiver burden , they found counseling very helpful and it was effective for a subgroup of caregivers . Those with poor logical analysis coping skills at baseline had decreased psychological distress ( F(1,53 ) = 9.7 , p = .003 ) and improved psychosocial adjustment ( F(1,53 ) = 4.7 , p = .035 ) after 1 year . Caregivers in control and counseling groups whose relatives entered a nursing home improved their psychosocial adjustment 23 % on average whereas those continuing to live in the community decreased by 8 % . Almost half as many relatives entered nursing homes in the counseling group ( n = 9 vs. n = 5 ) but these compared to control group relatives had greater annualized per person expenditures for health and social services ( Cdn$23,437 vs. Cdn$15,151 ) . CONCLUSIONS Caregivers found nurse counseling most helpful . Those indicating infrequent use of logical analysis coping skills showed benefits BACKGROUND Two-thirds of people with dementia live at home , receiving most care from family carers , about 40 % of whom have clinical ly significant depression or anxiety . This impacts on the person with dementia , families and society , predicting care breakdown . There are currently no clinical ly effective and cost-effective NHS family carer interventions . OBJECTIVES To assess the STrAtegies for RelaTives ( START ) intervention in the short ( 4 and 8 months ) and long term ( 1 and 2 years ) compared with treatment as usual ( TAU ) . DESIGN R and omised , parallel-group , superiority trial with blinded assessment recruiting participants 2:1 ( intervention to TAU ) to allow for therapist clustering . SETTING Three UK mental health services and one neurological service . PARTICIPANTS Family carers of people with dementia . INTERVENTION Eight-session manual-based coping intervention delivered by supervised psychology graduates to individuals . MAIN OUTCOME MEASURES Affective symptoms [ Hospital Anxiety and Depression Scale-total ( HADS-T ) ] and cost-effectiveness . Secondary measures : anxiety and depression symptoms and caseness , quality of life ( QoL ) , abusive behaviour and long-term care home admission . RESULTS Two hundred and sixty participants were r and omised ( 173 intervention , 87 TAU ) . We used intention-to-treat analysis in the short term ( 152 intervention , 77 TAU ) and in the long term ( 140 intervention , 69 TAU ) . In the short term , the intervention group had lower HADS-T [ mean difference -1.80 , 95 % confidence interval ( CI ) -3.29 to -0.31 ; p=0.02 ] and higher quality -adjusted life-years ( QALYs ) ( mean difference 0.03 , 95 % CI -0.01 to 0.08 ) . Costs were no different between groups [ mean £ 252 ( 95 % CI -£ 28 to £ 565 ) for intervention group ] . The cost-effectiveness acceptability curve showed a greater than 99 % chance of being cost-effectiveness at a £ 30,000/QALY willingness-to-pay threshold and a high probability of cost-effectiveness based on the HADS-T score . Carers in the intervention group had less case-level depression [ odds ratio ( OR ) 0.24 , 95 % CI 0.07 to 0.76 ] , a trend towards reduced case-level anxiety ( OR 0.30 , 95 % CI 0.08 to 1.05 ) , lower Hospital Anxiety and Depression Scale-anxiety ( HADS-A ) ( -0.91 , 95 % CI -1.76 to -0.07 ; p = 0.03 ) and Hospital Anxiety and Depression Scale-depression ( HADS-D ) ( -0.91 , 95 % CI -1.71 to -0.10 ; p = 0.03 ) and higher Health Status Question naire ( HSQ ) QoL ( mean difference 4.09 , 95 % CI 0.34 to 7.83 ) . Group differences in abusive behaviour ( OR 0.48 , 95 % CI 0.18 to 1.27 ) and the person with dementia 's quality of life-Alzheimer 's disease ( QoL-AD ) ( mean increase 0.59 , 95 % CI -0.72 to 1.89 ) were not significant . In the long term , the intervention group had lower HADS-T ( mean difference -2.58 , 95 % CI -4.26 to -0.90 ; p = 0.03 ) and higher QALYs ( mean difference 0.03 , 95 % CI -0.01 to 0.06 ) . Carers in the intervention group had less case-level depression ( OR 0.14 , 95 % CI 0.04 to 0.53 ) , a trend towards reduced case-level anxiety ( OR 0.57 , 95 % CI 0.26 to 1.24 ) , lower HADS-A ( -1.16 , 95 % CI -2.15 to -0.18 ) and HADS-D ( 1.45 , 95 % CI -2.32 to -0.57 ) , and higher HSQ ( mean difference 7.47 , 95 % CI 2.87 to 12.08 ) . Thirty-two ( 18.7 % ) people with dementia in the intervention group and 17 ( 20.2 % ) in TAU were admitted to a care home ( hazard ratio 0.83 , 95 % CI 0.44 to 1.56 ; p = 0.56 ) . There were no significant differences between groups in abusive behaviour ( OR 0.83 , 95 % CI 0.36 to 1.94 ) , the person with dementia 's QoL-AD ( 0.17 , 95 % CI -1.37 to 1.70 ) or costs ( £ 336 , 95 % CI -£ 223 to £ 895 ) for intervention group . The probability that the intervention would be seen as cost-effective at £ 30,000/QALY threshold and cost-effectiveness on the HADS-T remained high . CONCLUSIONS The START intervention was clinical ly effective and cost-effective in the short and longer term . The results are robust to the sensitivity analyses performed . Future work is needed to consider mechanism of action ; the effects on people with dementia in clinical terms ( cognition , neuropsychiatric symptoms , longer-term care home admission ) ; and on health and social care costs . In addition , we will explore the effects of carer abusive behaviour on the care recipient 's care home admission and if this then reduces abusive behaviour . We would also like to implement START and evaluate this implementation in clinical practice . TRIAL REGISTRATION Current Controlled Trials ISCTRN70017938 BACKGROUND There is good evidence for the benefits of short-term cognitive stimulation therapy for dementia but little is known about possible long-term effects . AIMS To evaluate the effectiveness of maintenance cognitive stimulation therapy ( CST ) for people with dementia in a single-blind , pragmatic r and omised controlled trial including a sub study with participants taking acetylcholinesterase inhibitors ( AChEIs ) . METHOD The participants were 236 people with dementia from 9 care homes and 9 community services . Prior to r and omisation all participants received the 7-week , 14-session CST programme . The intervention group received the weekly maintenance CST group programme for 24 weeks . The control group received usual care . Primary outcomes were cognition and quality of life ( clinical trial registration : IS RCT N26286067 ) . RESULTS For the intervention group at the 6-month primary end-point there were significant benefits for self-rated quality of life ( Quality of Life in Alzheimer 's Disease ( QoL-AD ) P = 0.03 ) . At 3 months there were improvements for proxy-rated quality of life ( QoL-AD P = 0.01 , Dementia Quality of Life scale ( DEMQOL ) P = 0.03 ) and activities of daily living ( P = 0.04 ) . The intervention subgroup taking AChEIs showed cognitive benefits ( on the Mini-Mental State Examination ) at 3 ( P = 0.03 ) and 6 months ( P = 0.03 ) . CONCLUSIONS Continuing CST improves quality of life ; and improves cognition for those taking AChEIs PURPOSE OF THE STUDY This paper is a report of a study of the Assistance , Support , and Self-health Initiated through Skill Training ( ASSIST ) r and omized control trial . The aim of this paper is to underst and whether participating in ASSIST significantly changed the out-of-pocket ( OOP ) costs for family caregivers of Alzheimer 's disease ( AD ) or Parkinson 's disease ( PD ) patients . DESIGN AND METHODS Secondary analysis of r and omized control trial data , calculating average treatment effects of the intervention on OOP costs .  Enrollment in the ASSIST trial occurred between 2002 and 2007 at 2 sites : Durham , North Carolina , and Birmingham , Alabama . We profile OOP costs for caregivers who participated in the ASSIST study and use 2-part expenditure models to examine the average treatment effect of the intervention on caregiver OOP expenditures . RESULTS ASSIST-trained AD and PD caregivers reported monthly OOP expenditures that averaged $ 500-$600 . The intervention increased the likelihood of caregivers spending 
    Output:
    