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: Background Although several face-to-face programs are dedicated to informal caregivers of persons with dementia , they are not always accessible to overburdened or isolated caregivers . Based on a face-to-face intervention program , we adapted and design ed a Web-based fully automated psychoeducational program ( called Diapason ) inspired by a cognitive approach . Objective This study aim ed to evaluate through a pilot unblinded r and omized controlled trial the efficacy and acceptability of a Web-based psychoeducational program for informal caregivers of persons with Alzheimer ’s disease ( PWAD ) based on a mixed methods research design . Methods We recruited and r and omized offline 49 informal caregivers of a PWAD in a day care center in Paris , France . They either received the Web-based intervention and usual care for 3 months ( experimental group , n=25 ) or only usual care ( control group , n=24 ) . Caregivers ’ perceived stress ( PSS-14 , primary outcome ) , self-efficacy , burden , perceived health status , and depression ( secondary outcomes ) were measured during 3 face-to-face on-site visits : at baseline , at the end of the program ( month 3 ) , and after follow-up ( month 6 ) . Additionally , semistructured interviews were conducted with experimental group caregivers at month 6 and examined with thematic analysis . Results Intention-to-treat analysis did not show significant differences in self-perceived stress between the experimental and control groups ( P=.98 ) . The experimental group significantly improved their knowledge of the illness ( d=.79 , P=.008 ) from baseline to month 3 . Of the 25 participants allocated to the experimental group , 17 ( 71 % ) finished the protocol and entirely viewed at least 10 of 12 online sessions . On average , participants used the website 19.72 times ( SD 12.88 ) and were connected for 262.20 minutes ( SD 270.74 ) . The results of the satisfaction question naire showed that most participants considered the program to be useful ( 95 % , 19/20 ) , clear ( 100 % , 20/20 ) , and comprehensive ( 85 % , 17/20 ) . Significant correlations were found between relationship and caregivers ’ program opinion ( P=.01 ) . Thus , positive opinions were provided by husb and s and sons ( 3/3 ) , whereas qualified opinions were primarily reported by daughters ( 8/11 ) . Female spouses expressed negative ( 2/3 ) or neutral opinions ( 1/3 ) . Caregivers expected more dynamic content and further interaction with staff and peers . Conclusions In this study , quantitative results were inconclusive owing to small sample size . Qualitative results indicated/showed little acceptance of the program and high expectations from caregivers . Caregivers did not rule out their interest in this kind of intervention provided that it met their needs . More dynamic , personalized , and social interventions are desirable . Our recruitment issues pointed out the necessity of in-depth studies about caregivers ’ help-seeking behaviors and readiness factors . Trial Registration Clinical trials.gov NCT01430286 ; http:// clinical trials.gov/ct2/show/NCT01430286 ( Archived by WebCite at http://www.webcitation/6KxHaRspL ) BACKGROUND Well-being and various forms of agitation in people with dementia can be improved in a person-centered long-term care setting . Data obtained during the Person-Centered Dementia Care and Environment ( PerCEN ) r and omized controlled trial shed light on the factors that influenced the adoption and outcomes of person-centered interventions in long-term care from the perspective of study participants . METHODS Data were obtained from PerCEN participants : individual semi-structured interviews with care managers ( 29 ) , nurses and care staff ( 70 ) ; telephone surveys with family members ( 73 ) ; staff reports of care approaches ; and 131 field note entries recorded by the person-centered care and environment facilitators .  Data were interpreted inductively using content analysis , code building , theme development , and synthesis of findings . RESULTS All data sources confirmed that , when adopted , the person-centered model increased the number and variety of opportunities for resident interaction , improved flexibility in care regimens , enhanced staff 's attention to resident needs , reduced resident agitation , and improved their well-being . Barriers and enablers for the person-centered model related to leadership , manager , staff and family appreciation of the model , staff 's capacity , effective communication and team work among direct care staff , care service flexibility , and staff education on how to focus care on the person 's well-being . CONCLUSIONS Successful knowledge translation of the person-centered model starts with managerial leadership and support ; it is sustained when staff are educated and assisted to apply the model , and , along with families , come to appreciate the benefits of flexible care services and teamwork in achieving resident well-being . The Australian New Zeal and Clinical Trials Registry number is ACTRN 12608000095369 PURPOSE This study examined the efficacy of a newly developed intervention , Acquiring New Skills While Enhancing Remaining Strengths ( ANSWERS ) , for family caregivers of individuals with dementia .  ANSWERS was design ed for dyads comprised of an individual with dementia and his/her family caregiver . Using a strength-based approach , ANSWERS combined educational skills ( traditionally used with caregivers ) and cognitive rehabilitation skills training ( traditionally used with individuals with dementia ) into a single protocol for addressing the dyad 's care issues and needs . Key domains addressed by the intervention included : education about dementia and memory loss ; effective communication ; managing memory ; staying active ; and recognizing emotions and behaviors . This analysis focused on outcomes for caregivers . DESIGN & METHODS The Stress Process Model guided the study 's hypotheses and design . Caregiving dyads were r and omly assigned to the control or intervention conditions . Intervention dyads received 6-curriculum guided sessions with an intervention specialist . Data came from in-person baseline interviews with caregivers conducted prior to r and omization and follow-up interviews conducted approximately 14.56 weekspost-baseline . RESULTS Intervention caregivers , compared to controls , had decreased care-related strain as indicated by lower emotional health strain , dyadic relationship strain , role captivity , and higher caregiving mastery . Additionally , intervention caregivers had improved well-being as indicated by fewer symptoms of depression and anxiety . IMPLICATION S ANSWERS was efficacious in improving key strain and psychosocial outcomes for caregivers . Features essential to the success of ANSWERS included a strength-based approach for selecting , developing , and implementing care goals , as well as teaching caregivers educational and cognitive rehabilitation skills for addressing care needs BACKGROUND There is good evidence of the positive effects of person-centered care ( PCC ) on agitation in dementia . We hypothesized that a person-centered environment ( PCE ) would achieve similar outcomes by focusing on positive environmental stimuli , and that there would be enhanced outcomes by combining PCC and PCE . METHODS 38 Australian residential aged care homes with scope for improvement in both PCC and PCE were stratified , then r and omized to one of four intervention groups : ( 1 ) PCC ; ( 2 ) PCE ; ( 3 ) PCC + PCE ; ( 4 ) no intervention .  People with dementia , over 60 years of age and consented were eligible . Co- outcomes assessed pre and four months post-intervention and at 8 months follow-up were resident agitation , emotional responses in care , quality of life and depression , and care interaction quality . RESULTS From 38 homes r and omized , 601 people with dementia were recruited . At follow-up the mean change for quality of life and agitation was significantly different for PCE ( p = 0.02 , p = 0.05 , respectively ) and PCC ( p = 0.0003 , p = 0.002 respectively ) , compared with the non-intervention group ( p = 0.48 , p = 0.93 respectively ) . Quality of life improved non-significantly for PCC+PCE ( p = 0.08 ) , but not for agitation ( p = 0.37 ) . Improvements in care interaction quality ( p = 0.006 ) and in emotional responses to care ( p = 0.01 ) in PCC+PCE were not observed in the other groups . Depression scores did not change in any of the groups . Intervention compliance for PCC was 59 % , for PCE 54 % and for PCC+PCE 66 % . CONCLUSION The hypothesis that PCC+PCE would improve quality of life and agitation even further was not supported , even though there were improvements in the quality of care interactions and resident emotional responses to care for some of this group . The Australian New Zeal and Clinical Trials Registry Number is ACTRN 12608000095369 PURPOSE The current article provides an in-depth description of a dyadic intervention for individuals with dementia and their family caregivers . Using a strength-based approach , caregiving dyads received skills training across 5 key areas : ( a ) education regarding dementia and memory loss , ( b ) effective communication , ( c ) managing memory loss , ( d ) staying active , and ( e ) recognizing emotions and behaviors . Results of the acceptability and feasibility of the intervention protocol s are also presented . DESIGN AND METHODS Caregiving dyads were r and omly assigned to participate in the intervention . Participants in the treatment condition were asked to complete a series of evaluation questions after each intervention session and an overall evaluation of the program . Data were also collected from the intervention specialists who implemented the protocol s. RESULTS Overall , the evaluation data indicated that the content and process of the intervention were viewed as highly acceptable and feasible by both participants and intervention specialists . IMPLICATION S This article highlights the merit of using a strength-based approach for working with caregiving dyads with dementia and how a single intervention protocol can be used to address the goals of both care partners . Furthermore , the intervention program was found to be highly acceptable and feasible , which is an important aspect of developing dyadic protocol Purpose The effects of a multicomponent dyadic intervention on the mood , behavior , and physical health of people with dementia living in the community were evaluated in a r and omized controlled trial . This multicomponent dyadic intervention is a translated and adapted version of an intervention that has been shown to be effective for people with dementia in the US . Patients and methods People with dementia living in the community and their family caregivers ( N=111 caregiver-care recipient dyads ) were r and omly assigned to the intervention and comparison group . The intervention group received home-based physical exercise training , psycho-education , communication skills training , and pleasant activities training during 3 months directed at both the person with dementia and the caregiver .  Mood , behavior , and physical health were measured at baseline , 3 months , and 6 months . The effects of the study were determined by using generalized estimating equations based on an intention-to-treat analysis . Results Analyses showed no beneficial effects over time on any of the outcome measures . Conclusion This study showed no effects . The negative results in this study compared to the study that has been carried out in the US might be explained by the translation , adaptation , and shortening of the intervention used in the US , and a different social context . In addition , the results might be explained by the lack of room for improvement and by experiencing the intervention as too much of a burden . Furthermore , improving physical health might only be effective if the physical exercises are of moderate-to-high-intensity and are tailored in accordance with participants ’ preferences and needs . For future studies , because dyads often commented positively about the pleasure and support they received , it might also be valuable to measure quality of life outcomes such as relationship quality , pleasure , and self-esteem in dyadic focused interventions Objective To assess whether a manual based coping strategy compared with treatment as usual reduces depression and anxiety symptoms in carers of family members with dementia . Design R and omised , parallel group , superiority trial . Setting Three mental health community services and one neurological outpatient dementia service in London and Essex , UK . Participants 260 carers of family members with dementia . Intervention A manual based coping intervention comprising eight sessions and delivered by supervised psychology graduates to carers of family members with dementia . The programme consisted of psychoeducation about dementia , carers ’ stress , and where to get emotional support ; underst and ing behaviours of the family member being cared for , and behavioural management techniques ; changing unhelpful thoughts ; promoting acceptance ; assertive communication ; relaxation ; planning for the future ; increasing pleasant activities ; and maintaining skills learnt . Carers practised these techniques at home , using the manual and relaxation CDs . Main outcome measures Affective symptoms ( hospital anxiety and depression total score ) at four and eight months . Secondary outcomes were depression and anxiety caseness on the hospital anxiety and depression scale ; quality of life of both the carer ( health status question naire , mental health ) and the recipient of care ( quality of life-Alzheimer ’s disease ) ; and potentially abusive behaviour by the carer towards the recipient of care ( modified conflict tactics scale ) . Results 260 carers were recruited ; 173 were r and omised to the intervention and 87 to treatment as usual .  Mean total scores on the hospital anxiety and depression scale were lower in the intervention group than in the treatment as usual group over the eight month evaluation period : adjusted difference in means −1.80 points ( 95 % confidence interval −3.29 to −0.31 ; P=0.02 ) and absolute difference in means −2.0 points . Carers in the intervention group were less likely to have case level depression ( odds ratio 0.24 , 95 % confidence interval 0.07 to 0.76 ) and there was a non-significant trend towards reduced case level anxiety ( 0.30 , 0 
    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: Background Although several face-to-face programs are dedicated to informal caregivers of persons with dementia , they are not always accessible to overburdened or isolated caregivers . Based on a face-to-face intervention program , we adapted and design ed a Web-based fully automated psychoeducational program ( called Diapason ) inspired by a cognitive approach . Objective This study aim ed to evaluate through a pilot unblinded r and omized controlled trial the efficacy and acceptability of a Web-based psychoeducational program for informal caregivers of persons with Alzheimer ’s disease ( PWAD ) based on a mixed methods research design . Methods We recruited and r and omized offline 49 informal caregivers of a PWAD in a day care center in Paris , France . They either received the Web-based intervention and usual care for 3 months ( experimental group , n=25 ) or only usual care ( control group , n=24 ) . Caregivers ’ perceived stress ( PSS-14 , primary outcome ) , self-efficacy , burden , perceived health status , and depression ( secondary outcomes ) were measured during 3 face-to-face on-site visits : at baseline , at the end of the program ( month 3 ) , and after follow-up ( month 6 ) . Additionally , semistructured interviews were conducted with experimental group caregivers at month 6 and examined with thematic analysis . Results Intention-to-treat analysis did not show significant differences in self-perceived stress between the experimental and control groups ( P=.98 ) . The experimental group significantly improved their knowledge of the illness ( d=.79 , P=.008 ) from baseline to month 3 . Of the 25 participants allocated to the experimental group , 17 ( 71 % ) finished the protocol and entirely viewed at least 10 of 12 online sessions . On average , participants used the website 19.72 times ( SD 12.88 ) and were connected for 262.20 minutes ( SD 270.74 ) . The results of the satisfaction question naire showed that most participants considered the program to be useful ( 95 % , 19/20 ) , clear ( 100 % , 20/20 ) , and comprehensive ( 85 % , 17/20 ) . Significant correlations were found between relationship and caregivers ’ program opinion ( P=.01 ) . Thus , positive opinions were provided by husb and s and sons ( 3/3 ) , whereas qualified opinions were primarily reported by daughters ( 8/11 ) . Female spouses expressed negative ( 2/3 ) or neutral opinions ( 1/3 ) . Caregivers expected more dynamic content and further interaction with staff and peers . Conclusions In this study , quantitative results were inconclusive owing to small sample size . Qualitative results indicated/showed little acceptance of the program and high expectations from caregivers . Caregivers did not rule out their interest in this kind of intervention provided that it met their needs . More dynamic , personalized , and social interventions are desirable . Our recruitment issues pointed out the necessity of in-depth studies about caregivers ’ help-seeking behaviors and readiness factors . Trial Registration Clinical trials.gov NCT01430286 ; http:// clinical trials.gov/ct2/show/NCT01430286 ( Archived by WebCite at http://www.webcitation/6KxHaRspL ) BACKGROUND Well-being and various forms of agitation in people with dementia can be improved in a person-centered long-term care setting . Data obtained during the Person-Centered Dementia Care and Environment ( PerCEN ) r and omized controlled trial shed light on the factors that influenced the adoption and outcomes of person-centered interventions in long-term care from the perspective of study participants . METHODS Data were obtained from PerCEN participants : individual semi-structured interviews with care managers ( 29 ) , nurses and care staff ( 70 ) ; telephone surveys with family members ( 73 ) ; staff reports of care approaches ; and 131 field note entries recorded by the person-centered care and environment facilitators .  Data were interpreted inductively using content analysis , code building , theme development , and synthesis of findings . RESULTS All data sources confirmed that , when adopted , the person-centered model increased the number and variety of opportunities for resident interaction , improved flexibility in care regimens , enhanced staff 's attention to resident needs , reduced resident agitation , and improved their well-being . Barriers and enablers for the person-centered model related to leadership , manager , staff and family appreciation of the model , staff 's capacity , effective communication and team work among direct care staff , care service flexibility , and staff education on how to focus care on the person 's well-being . CONCLUSIONS Successful knowledge translation of the person-centered model starts with managerial leadership and support ; it is sustained when staff are educated and assisted to apply the model , and , along with families , come to appreciate the benefits of flexible care services and teamwork in achieving resident well-being . The Australian New Zeal and Clinical Trials Registry number is ACTRN 12608000095369 PURPOSE This study examined the efficacy of a newly developed intervention , Acquiring New Skills While Enhancing Remaining Strengths ( ANSWERS ) , for family caregivers of individuals with dementia .  ANSWERS was design ed for dyads comprised of an individual with dementia and his/her family caregiver . Using a strength-based approach , ANSWERS combined educational skills ( traditionally used with caregivers ) and cognitive rehabilitation skills training ( traditionally used with individuals with dementia ) into a single protocol for addressing the dyad 's care issues and needs . Key domains addressed by the intervention included : education about dementia and memory loss ; effective communication ; managing memory ; staying active ; and recognizing emotions and behaviors . This analysis focused on outcomes for caregivers . DESIGN & METHODS The Stress Process Model guided the study 's hypotheses and design . Caregiving dyads were r and omly assigned to the control or intervention conditions . Intervention dyads received 6-curriculum guided sessions with an intervention specialist . Data came from in-person baseline interviews with caregivers conducted prior to r and omization and follow-up interviews conducted approximately 14.56 weekspost-baseline . RESULTS Intervention caregivers , compared to controls , had decreased care-related strain as indicated by lower emotional health strain , dyadic relationship strain , role captivity , and higher caregiving mastery . Additionally , intervention caregivers had improved well-being as indicated by fewer symptoms of depression and anxiety . IMPLICATION S ANSWERS was efficacious in improving key strain and psychosocial outcomes for caregivers . Features essential to the success of ANSWERS included a strength-based approach for selecting , developing , and implementing care goals , as well as teaching caregivers educational and cognitive rehabilitation skills for addressing care needs BACKGROUND There is good evidence of the positive effects of person-centered care ( PCC ) on agitation in dementia . We hypothesized that a person-centered environment ( PCE ) would achieve similar outcomes by focusing on positive environmental stimuli , and that there would be enhanced outcomes by combining PCC and PCE . METHODS 38 Australian residential aged care homes with scope for improvement in both PCC and PCE were stratified , then r and omized to one of four intervention groups : ( 1 ) PCC ; ( 2 ) PCE ; ( 3 ) PCC + PCE ; ( 4 ) no intervention .  People with dementia , over 60 years of age and consented were eligible . Co- outcomes assessed pre and four months post-intervention and at 8 months follow-up were resident agitation , emotional responses in care , quality of life and depression , and care interaction quality . RESULTS From 38 homes r and omized , 601 people with dementia were recruited . At follow-up the mean change for quality of life and agitation was significantly different for PCE ( p = 0.02 , p = 0.05 , respectively ) and PCC ( p = 0.0003 , p = 0.002 respectively ) , compared with the non-intervention group ( p = 0.48 , p = 0.93 respectively ) . Quality of life improved non-significantly for PCC+PCE ( p = 0.08 ) , but not for agitation ( p = 0.37 ) . Improvements in care interaction quality ( p = 0.006 ) and in emotional responses to care ( p = 0.01 ) in PCC+PCE were not observed in the other groups . Depression scores did not change in any of the groups . Intervention compliance for PCC was 59 % , for PCE 54 % and for PCC+PCE 66 % . CONCLUSION The hypothesis that PCC+PCE would improve quality of life and agitation even further was not supported , even though there were improvements in the quality of care interactions and resident emotional responses to care for some of this group . The Australian New Zeal and Clinical Trials Registry Number is ACTRN 12608000095369 PURPOSE The current article provides an in-depth description of a dyadic intervention for individuals with dementia and their family caregivers . Using a strength-based approach , caregiving dyads received skills training across 5 key areas : ( a ) education regarding dementia and memory loss , ( b ) effective communication , ( c ) managing memory loss , ( d ) staying active , and ( e ) recognizing emotions and behaviors . Results of the acceptability and feasibility of the intervention protocol s are also presented . DESIGN AND METHODS Caregiving dyads were r and omly assigned to participate in the intervention . Participants in the treatment condition were asked to complete a series of evaluation questions after each intervention session and an overall evaluation of the program . Data were also collected from the intervention specialists who implemented the protocol s. RESULTS Overall , the evaluation data indicated that the content and process of the intervention were viewed as highly acceptable and feasible by both participants and intervention specialists . IMPLICATION S This article highlights the merit of using a strength-based approach for working with caregiving dyads with dementia and how a single intervention protocol can be used to address the goals of both care partners . Furthermore , the intervention program was found to be highly acceptable and feasible , which is an important aspect of developing dyadic protocol Purpose The effects of a multicomponent dyadic intervention on the mood , behavior , and physical health of people with dementia living in the community were evaluated in a r and omized controlled trial . This multicomponent dyadic intervention is a translated and adapted version of an intervention that has been shown to be effective for people with dementia in the US . Patients and methods People with dementia living in the community and their family caregivers ( N=111 caregiver-care recipient dyads ) were r and omly assigned to the intervention and comparison group . The intervention group received home-based physical exercise training , psycho-education , communication skills training , and pleasant activities training during 3 months directed at both the person with dementia and the caregiver .  Mood , behavior , and physical health were measured at baseline , 3 months , and 6 months . The effects of the study were determined by using generalized estimating equations based on an intention-to-treat analysis . Results Analyses showed no beneficial effects over time on any of the outcome measures . Conclusion This study showed no effects . The negative results in this study compared to the study that has been carried out in the US might be explained by the translation , adaptation , and shortening of the intervention used in the US , and a different social context . In addition , the results might be explained by the lack of room for improvement and by experiencing the intervention as too much of a burden . Furthermore , improving physical health might only be effective if the physical exercises are of moderate-to-high-intensity and are tailored in accordance with participants ’ preferences and needs . For future studies , because dyads often commented positively about the pleasure and support they received , it might also be valuable to measure quality of life outcomes such as relationship quality , pleasure , and self-esteem in dyadic focused interventions Objective To assess whether a manual based coping strategy compared with treatment as usual reduces depression and anxiety symptoms in carers of family members with dementia . Design R and omised , parallel group , superiority trial . Setting Three mental health community services and one neurological outpatient dementia service in London and Essex , UK . Participants 260 carers of family members with dementia . Intervention A manual based coping intervention comprising eight sessions and delivered by supervised psychology graduates to carers of family members with dementia . The programme consisted of psychoeducation about dementia , carers ’ stress , and where to get emotional support ; underst and ing behaviours of the family member being cared for , and behavioural management techniques ; changing unhelpful thoughts ; promoting acceptance ; assertive communication ; relaxation ; planning for the future ; increasing pleasant activities ; and maintaining skills learnt . Carers practised these techniques at home , using the manual and relaxation CDs . Main outcome measures Affective symptoms ( hospital anxiety and depression total score ) at four and eight months . Secondary outcomes were depression and anxiety caseness on the hospital anxiety and depression scale ; quality of life of both the carer ( health status question naire , mental health ) and the recipient of care ( quality of life-Alzheimer ’s disease ) ; and potentially abusive behaviour by the carer towards the recipient of care ( modified conflict tactics scale ) . Results 260 carers were recruited ; 173 were r and omised to the intervention and 87 to treatment as usual .  Mean total scores on the hospital anxiety and depression scale were lower in the intervention group than in the treatment as usual group over the eight month evaluation period : adjusted difference in means −1.80 points ( 95 % confidence interval −3.29 to −0.31 ; P=0.02 ) and absolute difference in means −2.0 points . Carers in the intervention group were less likely to have case level depression ( odds ratio 0.24 , 95 % confidence interval 0.07 to 0.76 ) and there was a non-significant trend towards reduced case level anxiety ( 0.30 , 0 
    Output:
    