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: Caregivers of persons with Alzheimer 's disease ( AD ) are confronted with novel decision-making tasks that leave them at risk for social isolation . Computer Link is a computer network providing information , communication , and decision-support functions for caregivers of persons with AD . One hundred two AD caregivers participated in a r and omized field experiment to evaluate the effects of ComputerLink on confidence in decision making , decision-making skill , and social isolation . During the 1-year study period , AD caregivers averaged two encounters per week with Computer Link for sessions lasting an average of 13 minutes . Access to Computer Link enhanced caregivers'decision-making confidence . Decision-making skill was unaffected . ComputerLink access did not lead to changes in social isolation as measured by st and ard instruments . The decision-support function was used least often . Postings to ComputerLink 's public bulletin board included both information-seeking and supportive messages . These findings are congruent with reports of other community-based interventions for caregivers and consistent with evaluations of computerized decision-support systems ComputerLink was a computer support network for family caregivers of people with Alzheimer 's disease . In a 12-month experiment , 102 caregivers were r and omly assigned to an experimental group that had access to ComputerLink or to a  control group  that did not . This investigation examined whether caregivers in the experimental group had greater reductions in four types of care-related strain by the end of the 1-year study . ComputerLink reduced certain types of strain if caregivers also had larger informal support networks , were spouses , or did not live alone with their care receivers . More frequent use of the communication function was related to significantly reduced strain for caregivers who were initially more stressed and for non-spouse caregivers . Greater use of the information function was related to significantly lower strain among caregivers who lived alone with care receivers . Overall , ComputerLink appeared to be an effective tool for reducing strain for some caregivers 1 . INTRODUCTION . Decision-making dem and s faced by homebound caregivers of persons with Alzheimer 's Disease ( AD ) are numerous and complex . Although caregivers frequently know what to do in caring for the person with AD , they lack confidence in their decisions [ 1 ] . The challenge of caregiving decisions may be compounded by the lack of re sources to aid in decision-making or affirm decisions made . Because many caregivers are homebound , they are unable to avail themselves of traditional health and social services . ComputerLink , computer network , was design ed to address the needs of these homebound caregivers . 2 . DESCRIPTION . The ComputerLink consisted of a set of specialized programs and utilities residing within a public computer network . The three main features of the ComputerLink , which may provide aid to caregivers in decision making , include : the electronic encyclopedia ( EE ) ; a communications utility composed of a question and answer bulletin board ( Q&A ) and public ( Forum ) and private mail services ; and a decision support module ( DSM ) . The EE contained illness-specific information to support decision-making . The Forum and private mail provided caregivers with a means to interact with peers and professionals about their caregiving decisions . Q&A provided the opportunity to ask questions about caregiving and receive feedback from professionals and peers . The DSM could be accessed to gain information about decision-making or to actually work through a decision problem . The DSM was built on a multi-attribute utility model which employed English- language questions to guide users through a decision analysis . The analysis strategy was design ed to help the user focus on the values and trade-offs that occur during difficult choices . The impact of ComputerLink on decision confidence and skill was evaluated as part of a larger r and omized experiment . 102 AD caregivers were recruited : 51 caregivers in the control group and 47 in the experimental group completed the 12-month study . The mean age of the caregivers was 60 years . Thirty-three percent were male and 28 percent were Black . The groups did not differ in demographic characteristics . The ComputerLink interface was menu-driven and the system was available 24 hours .  ComputerLink  use was captured through a passive monitoring system . AD caregivers accessed ComputerLink a total of 3,875 times , with a mean access per individual of 83 ( range : 3 - 590 ) . The mean length of an encounter was 13 minutes ; subjects typically accessed two or more functions during this time . The decision support model was accessed 91 times . The communication functions were most frequently used ( 3,724 Forum accesses and 1,888 private mail ) ; the information utility was accessed 518 times . 3 . RESULTS . Decision confidence was objective ly measured using a modification of the Saunders and Courtney confidence-in-decision making instrument . Caregivers who had access to ComputerLink  experienced greater confidence in decision-making than caregivers in the control group ( t = 2.73 , p < .01 ) . Access to ComputerLink did not alter decision skill as measured by the number of alternative solutions generated for two self-identified decisions problems ( t = .18 , p < .05 ) . Decision-making confidence correlated positively with ComputerLink accesses ( r = .32 , p = < .02 ) and with length of time spent on ComputerLink ( r = .30 , p = < .02 ) . 56 % of the AD caregivers reported that use of ComputerLink increased both their confidence and skill in decision making , though only 38 percent reported using the DSM to make a decision . 4 . DISCUSSION . Access to ComputerLink increased decision-making confidence , but not decision-making skill in AD caregivers . The impact of ComputerLink on decision confidence , and not skill , may be related to the differential use of the utilities . ( abstract truncated OBJECTIVE This study evaluated the effectiveness of a  technology-based psychoeducational intervention for family caregivers of dementia patients . An additional objective was to determine if the intervention could be implemented by a community-based social service agency . METHODS Forty-six caregivers were r and omly assigned to either a technology-based intervention or an information-only control condition . RESULTS Caregivers assigned to the intervention condition reported a significant decrease in burden postintervention and those who evidence d high depression at baseline experienced a significant decline in depression . CONCLUSION This study provides evidence that technology offers a cost-effective and practical method for delivering interventions to caregivers PURPOSE We determine the main outcome effects of a 12-month computer-mediated automated interactive voice response ( IVR ) intervention design ed to assist family caregivers managing persons with disruptive behaviors related to Alzheimer 's disease ( AD ) . DESIGN AND METHODS We conducted a r and omized controlled study of 100 caregivers , 51 in the usual care control group and 49 in the technology intervention group , who received yearlong access to an IVR-mediated system .  The system provided caregiver stress monitoring and counseling information , personal voice-mail linkage to AD experts , a voice-mail telephone support group , and a distraction call for care recipients . We conducted analyses by using a repeated measures approach for longitudinal data and an intention-to-treat analytic approach . Outcomes included the caregiver 's appraisal of the bothersome nature of caregiving , anxiety , depression , and mastery at baseline , 6 , 12 , and 18 months . RESULTS There was a significant intervention effect as hypothesized for participants with lower mastery at baseline on all three outcomes : bother ( p = .04 ) , anxiety ( p = .01 ) , and depression ( p = .007 ) . Additionally , wives exhibited a significant intervention effect in the reduction of the bothersome nature of caregiving ( p = .02 ) . IMPLICATION S Wives who exhibited low mastery and high anxiety benefited the most from the automated telecare intervention . Findings suggest that , to optimize outcome effects , similar interventions should be tailored to match the users ' characteristics and preferences PURPOSE The majority of persons with Alzheimer 's disease ( AD ) are cared for at home by a family member such as a spouse or daughter . Caregiving places enormous dem and s on these caregivers , and the negative consequences associated with caregiving are well documented . This paper reports results from the Miami site of the REACH ( Re sources for Enhancing Alzheimer 's Caregiver Health ) program that examined the efficacy of a family therapy and technology-based intervention in reducing depressive symptoms ( according to the Center for Epidemiological Studies Depression scale ) among family caregivers of AD patients at 6 months and 18 months follow-up . DESIGN AND METHODS There were 225 White American and Cuban American caregivers that were r and omized into a structural ecosystems therapy , structural ecosystems therapy + computer-telephone integrated system , or minimal support control condition .  RESULTS Caregivers in the combined family therapy and technology intervention experienced a significant reduction in depressive symptoms at 6 months . The 18-month follow-up data indicated that the intervention was particularly beneficial for Cuban American husb and and daughter caregivers . IMPLICATION S The results indicate that information technology has a promising role in alleviating distress and depression among groups of AD caregivers . The data also demonstrate that interventions have differential impacts according to ethnic group and the caregiver-patient relationship PURPOSE The aim of this pilot feasibility study was to evaluate the effects of an innovative , Internet-based psychosocial intervention for family caregivers of older adults with neurodegenerative disease . DESIGN AND METHODS After receiving signed informed consent from each participant , we r and omly assigned 66 caregivers to an Internet-based intervention or to a no-intervention control group .  The intervention group received computers and training in order to access a password-protected Web site with links to information , e-mail , and threaded discussion . Unique to the Web site was a video-conferencing link that supported caregivers ' participation in a 10-session , manual-guided psychosocial support group , followed by 12 additional online sessions facilitated by a group member . Participants completed health-status and stress-response measures at baseline and 6-month follow-up . RESULTS Content analysis of archived video sessions showed ( a ) reliable adherence to the manual-guided support-group intervention and ( b ) online group discussion themes similar to those in face-to-face caregiver support groups . Analyses of stress-response outcome data showed significant between-group differences , with the intervention group experiencing a decline in stress compared with an escalation in stress for the control group . IMPLICATION S Despite the limitations of this pilot study in terms of limited sample size and 54 % dropout of control participants at 6-month follow-up , the results provide preliminary supportive evidence for a technology-based psychosocial intervention for family caregivers of individuals with neurodegenerative disease We investigated the usefulness of a computer-mediated interactive voice response ( IVR ) system integrated with voicemail to help family caregivers manage disruptive behaviours in people with Alzheimer 's disease . The r and omization procedure result ed in 49 caregivers being assigned to the intervention group and 51 to the control group . Using their ordinary telephone , the caregivers were linked to the four components of the IVR system : monitoring and counselling , an in-home support group , ' ask the expert ' , and a respite conversation . During an 18-month study , total system usage amounted to 55 min per user ( SD 78 , range 1 - 318 ) . Half the participants used the system for at least 22 min , and 25 % for at least 70 min . Participants made between one and 45 calls over the study period , averaging 11 calls ( SD 12 ) . Approximately half of the intervention group used the system regularly for two or more months . These ' adopters ' were significantly older , more highly educated and reported a greater sense of management of the situation than ' non-adopters ' . Adopters were much more likely than non-adopters to have been rated as highly proficient by the trainer following the technology training session . The IVR approach appealed to a subset of users . However , the overall preference was for human interaction 
    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: Caregivers of persons with Alzheimer 's disease ( AD ) are confronted with novel decision-making tasks that leave them at risk for social isolation . Computer Link is a computer network providing information , communication , and decision-support functions for caregivers of persons with AD . One hundred two AD caregivers participated in a r and omized field experiment to evaluate the effects of ComputerLink on confidence in decision making , decision-making skill , and social isolation . During the 1-year study period , AD caregivers averaged two encounters per week with Computer Link for sessions lasting an average of 13 minutes . Access to Computer Link enhanced caregivers'decision-making confidence . Decision-making skill was unaffected . ComputerLink access did not lead to changes in social isolation as measured by st and ard instruments . The decision-support function was used least often . Postings to ComputerLink 's public bulletin board included both information-seeking and supportive messages . These findings are congruent with reports of other community-based interventions for caregivers and consistent with evaluations of computerized decision-support systems ComputerLink was a computer support network for family caregivers of people with Alzheimer 's disease . In a 12-month experiment , 102 caregivers were r and omly assigned to an experimental group that had access to ComputerLink or to a  control group  that did not . This investigation examined whether caregivers in the experimental group had greater reductions in four types of care-related strain by the end of the 1-year study . ComputerLink reduced certain types of strain if caregivers also had larger informal support networks , were spouses , or did not live alone with their care receivers . More frequent use of the communication function was related to significantly reduced strain for caregivers who were initially more stressed and for non-spouse caregivers . Greater use of the information function was related to significantly lower strain among caregivers who lived alone with care receivers . Overall , ComputerLink appeared to be an effective tool for reducing strain for some caregivers 1 . INTRODUCTION . Decision-making dem and s faced by homebound caregivers of persons with Alzheimer 's Disease ( AD ) are numerous and complex . Although caregivers frequently know what to do in caring for the person with AD , they lack confidence in their decisions [ 1 ] . The challenge of caregiving decisions may be compounded by the lack of re sources to aid in decision-making or affirm decisions made . Because many caregivers are homebound , they are unable to avail themselves of traditional health and social services . ComputerLink , computer network , was design ed to address the needs of these homebound caregivers . 2 . DESCRIPTION . The ComputerLink consisted of a set of specialized programs and utilities residing within a public computer network . The three main features of the ComputerLink , which may provide aid to caregivers in decision making , include : the electronic encyclopedia ( EE ) ; a communications utility composed of a question and answer bulletin board ( Q&A ) and public ( Forum ) and private mail services ; and a decision support module ( DSM ) . The EE contained illness-specific information to support decision-making . The Forum and private mail provided caregivers with a means to interact with peers and professionals about their caregiving decisions . Q&A provided the opportunity to ask questions about caregiving and receive feedback from professionals and peers . The DSM could be accessed to gain information about decision-making or to actually work through a decision problem . The DSM was built on a multi-attribute utility model which employed English- language questions to guide users through a decision analysis . The analysis strategy was design ed to help the user focus on the values and trade-offs that occur during difficult choices . The impact of ComputerLink on decision confidence and skill was evaluated as part of a larger r and omized experiment . 102 AD caregivers were recruited : 51 caregivers in the control group and 47 in the experimental group completed the 12-month study . The mean age of the caregivers was 60 years . Thirty-three percent were male and 28 percent were Black . The groups did not differ in demographic characteristics . The ComputerLink interface was menu-driven and the system was available 24 hours .  ComputerLink  use was captured through a passive monitoring system . AD caregivers accessed ComputerLink a total of 3,875 times , with a mean access per individual of 83 ( range : 3 - 590 ) . The mean length of an encounter was 13 minutes ; subjects typically accessed two or more functions during this time . The decision support model was accessed 91 times . The communication functions were most frequently used ( 3,724 Forum accesses and 1,888 private mail ) ; the information utility was accessed 518 times . 3 . RESULTS . Decision confidence was objective ly measured using a modification of the Saunders and Courtney confidence-in-decision making instrument . Caregivers who had access to ComputerLink  experienced greater confidence in decision-making than caregivers in the control group ( t = 2.73 , p < .01 ) . Access to ComputerLink did not alter decision skill as measured by the number of alternative solutions generated for two self-identified decisions problems ( t = .18 , p < .05 ) . Decision-making confidence correlated positively with ComputerLink accesses ( r = .32 , p = < .02 ) and with length of time spent on ComputerLink ( r = .30 , p = < .02 ) . 56 % of the AD caregivers reported that use of ComputerLink increased both their confidence and skill in decision making , though only 38 percent reported using the DSM to make a decision . 4 . DISCUSSION . Access to ComputerLink increased decision-making confidence , but not decision-making skill in AD caregivers . The impact of ComputerLink on decision confidence , and not skill , may be related to the differential use of the utilities . ( abstract truncated OBJECTIVE This study evaluated the effectiveness of a  technology-based psychoeducational intervention for family caregivers of dementia patients . An additional objective was to determine if the intervention could be implemented by a community-based social service agency . METHODS Forty-six caregivers were r and omly assigned to either a technology-based intervention or an information-only control condition . RESULTS Caregivers assigned to the intervention condition reported a significant decrease in burden postintervention and those who evidence d high depression at baseline experienced a significant decline in depression . CONCLUSION This study provides evidence that technology offers a cost-effective and practical method for delivering interventions to caregivers PURPOSE We determine the main outcome effects of a 12-month computer-mediated automated interactive voice response ( IVR ) intervention design ed to assist family caregivers managing persons with disruptive behaviors related to Alzheimer 's disease ( AD ) . DESIGN AND METHODS We conducted a r and omized controlled study of 100 caregivers , 51 in the usual care control group and 49 in the technology intervention group , who received yearlong access to an IVR-mediated system .  The system provided caregiver stress monitoring and counseling information , personal voice-mail linkage to AD experts , a voice-mail telephone support group , and a distraction call for care recipients . We conducted analyses by using a repeated measures approach for longitudinal data and an intention-to-treat analytic approach . Outcomes included the caregiver 's appraisal of the bothersome nature of caregiving , anxiety , depression , and mastery at baseline , 6 , 12 , and 18 months . RESULTS There was a significant intervention effect as hypothesized for participants with lower mastery at baseline on all three outcomes : bother ( p = .04 ) , anxiety ( p = .01 ) , and depression ( p = .007 ) . Additionally , wives exhibited a significant intervention effect in the reduction of the bothersome nature of caregiving ( p = .02 ) . IMPLICATION S Wives who exhibited low mastery and high anxiety benefited the most from the automated telecare intervention . Findings suggest that , to optimize outcome effects , similar interventions should be tailored to match the users ' characteristics and preferences PURPOSE The majority of persons with Alzheimer 's disease ( AD ) are cared for at home by a family member such as a spouse or daughter . Caregiving places enormous dem and s on these caregivers , and the negative consequences associated with caregiving are well documented . This paper reports results from the Miami site of the REACH ( Re sources for Enhancing Alzheimer 's Caregiver Health ) program that examined the efficacy of a family therapy and technology-based intervention in reducing depressive symptoms ( according to the Center for Epidemiological Studies Depression scale ) among family caregivers of AD patients at 6 months and 18 months follow-up . DESIGN AND METHODS There were 225 White American and Cuban American caregivers that were r and omized into a structural ecosystems therapy , structural ecosystems therapy + computer-telephone integrated system , or minimal support control condition .  RESULTS Caregivers in the combined family therapy and technology intervention experienced a significant reduction in depressive symptoms at 6 months . The 18-month follow-up data indicated that the intervention was particularly beneficial for Cuban American husb and and daughter caregivers . IMPLICATION S The results indicate that information technology has a promising role in alleviating distress and depression among groups of AD caregivers . The data also demonstrate that interventions have differential impacts according to ethnic group and the caregiver-patient relationship PURPOSE The aim of this pilot feasibility study was to evaluate the effects of an innovative , Internet-based psychosocial intervention for family caregivers of older adults with neurodegenerative disease . DESIGN AND METHODS After receiving signed informed consent from each participant , we r and omly assigned 66 caregivers to an Internet-based intervention or to a no-intervention control group .  The intervention group received computers and training in order to access a password-protected Web site with links to information , e-mail , and threaded discussion . Unique to the Web site was a video-conferencing link that supported caregivers ' participation in a 10-session , manual-guided psychosocial support group , followed by 12 additional online sessions facilitated by a group member . Participants completed health-status and stress-response measures at baseline and 6-month follow-up . RESULTS Content analysis of archived video sessions showed ( a ) reliable adherence to the manual-guided support-group intervention and ( b ) online group discussion themes similar to those in face-to-face caregiver support groups . Analyses of stress-response outcome data showed significant between-group differences , with the intervention group experiencing a decline in stress compared with an escalation in stress for the control group . IMPLICATION S Despite the limitations of this pilot study in terms of limited sample size and 54 % dropout of control participants at 6-month follow-up , the results provide preliminary supportive evidence for a technology-based psychosocial intervention for family caregivers of individuals with neurodegenerative disease We investigated the usefulness of a computer-mediated interactive voice response ( IVR ) system integrated with voicemail to help family caregivers manage disruptive behaviours in people with Alzheimer 's disease . The r and omization procedure result ed in 49 caregivers being assigned to the intervention group and 51 to the control group . Using their ordinary telephone , the caregivers were linked to the four components of the IVR system : monitoring and counselling , an in-home support group , ' ask the expert ' , and a respite conversation . During an 18-month study , total system usage amounted to 55 min per user ( SD 78 , range 1 - 318 ) . Half the participants used the system for at least 22 min , and 25 % for at least 70 min . Participants made between one and 45 calls over the study period , averaging 11 calls ( SD 12 ) . Approximately half of the intervention group used the system regularly for two or more months . These ' adopters ' were significantly older , more highly educated and reported a greater sense of management of the situation than ' non-adopters ' . Adopters were much more likely than non-adopters to have been rated as highly proficient by the trainer following the technology training session . The IVR approach appealed to a subset of users . However , the overall preference was for human interaction 
    Output:
    