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: The PREP system of nursing interventions , design ed to increase preparedness ( PR ) , enrichment ( E ) , and predictability ( P ) in families providing care to older people , was pilot tested for acceptability and preliminary effectiveness . Eleven family units were assigned to the PREP group and 11 to a st and ard home health control group .  The PREP group scored approximately one SD higher than the control group ( p < .05 ) on the Care Effectiveness Scale , indicating greater preparedness , enrichment , and predictability . Further , on a rating of overall usefulness , the PREP group rated their assistance from PREP nurses ( M = 9.75 ) as significantly higher ( p < .01 ) than the control group rated assistance from the home health nurse or physical therapist ( M = 6.57 ) . Although not statistically significant , mean hospital costs for the PREP group ( $ 2,775 ) were lower than for the control group ( $ 6,929 ) . Results provided support for a full intervention trial PURPOSE Our goal was to evaluate the efficacy of a multimedia support program delivered over the Internet to employed family caregivers of persons with dementia . DESIGN AND METHODS The evaluation of this program involved 299 employed family caregivers participating in a pretest-posttest r and omized clinical trial with a 30-day follow-up and a waitlist control condition . Vali date d instruments include the Center for Epidemiologic Studies -Depression scale , the State-Trait Anxiety Inventory , the Caregiver Strain scale from Benjamin Rose , and Positive Aspects of Caregiving used in the nationwide REACH study . RESULTS Those who viewed Caregiver 's Friend : Dealing with Dementia 30 days postexposure demonstrated significant improvements in depression , anxiety , level and frequency of stress , caregiver strain , self-efficacy , and intention to seek help , as well as perceptions of positive aspects of caregiving . IMPLICATION S Interactive multimedia interventions delivered over the Internet appear to be uniquely suited to provide low-cost , effective , convenient , individually tailored programs that present educational information , cognitive and behavioral skills , and affective learning opportunities . This makes Web-based multimedia a promising avenue for work-life balance programs , employee-assistance providers , and organizations interested in improving family caregiver health and well-being 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 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 OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity OBJECTIVES The Nutrition Screening Initiative is a national collaborative effort committed to the identification and treatment of nutritional problems in older persons . METHODS A 14-item checklist of characteristics associated with nutritional status was administered to a r and om sample of Medicare beneficiaries , aged 70 years and older , in New Engl and . Regression analysis was used to derive item weights that would predict poor nutrient intakes and low perceived health status . Sensitivity and specificity values were review ed to define low , moderate , and high nutritional risk scores . RESULTS A revised checklist containing 10 yes/no items was adopted . Scores of 6 or more points defined persons at high nutritional risk . Twenty-four percent of the Medicare population was estimated to be at high nutritional risk according to the checklist . Among those in the high-risk group , 56 % perceived their health to be " fair " or " poor " and 38 % had dietary intakes below 75 % of the recommended dietary allowances for three or more nutrients . CONCLUSIONS The Nutrition Screening Initiative Checklist is a brief , easily scored instrument that can accurately identify noninstitutionalized older persons at risk for low nutrient intake and health problems Prior research ( Gallagher-Thompson , D. , Gray , H. , Tang , P. , Pu , C.-Y. , Tse , C. , Hsu , S. , et al. ( 2007 ) . Impact of in-home intervention versus telephone support in reducing  depression and stress of Chinese caregivers : Results of a pilot study . American Journal of Geriatric Psychiatry , 15 , 425–434 . ) found that an in-home behavioral management program , derived conceptually from cognitive behavioral theories ( CBT ) , was effective in reducing caregiver related stress and depressive symptoms in Chinese American dementia caregivers ( CGs ) . Results were promising , but a more cost-effective intervention is needed to serve this growing population . Past work also found that a psychoeducational videotaped training program based on CBT was effective in reducing stress due to caregiving in Caucasian and African American dementia family CGs ( Steffen , 2000 , Anger management for dementia caregivers : A preliminary study using video and telephone interventions . Behavior Therapy , 31 , 281–299 . ) . To date no research has been conducted using a technological medium to deliver a similar kind of intervention to Chinese American caregivers . The present study evaluated the effectiveness of a similar but culturally “ tailored ” program in which 70 CGs were r and omly assigned to a 12-week CBT skill training program delivered on a DVD , or to a general educational DVD program on dementia . Both were available in M and arin Chinese or English as preferred . Pre post change analyses indicated that CGs did not differ on change in level of negative depressive symptoms , but positive affect was higher , and patient behaviors were appraised as less stressful and bothersome , for CGs in the CBT skill training program . They were also more satisfied with the program overall and reported that they believed they were able to give care more effectively . Results encourage further development of theoretically based interventions , delivered using modern technology , for this ever increasing group of CGs Data are presented on a preliminary study investigating the efficacy of 2 distance-based psychosocial interventions ( N = 32 ) for male family dementia caregivers . Male caregivers were r and omly assigned to either a basic education intervention ( ie , educational booklet and biweekly check-in telephone calls ) or a video intervention ( ie , set of 10 videos , an accompanying workbook , and weekly telephone coaching sessions using behavioral strategies to manage challenging caregiving situations ) . Results did not support the greater efficacy of the video condition in reducing psychosocial distress ( eg , negative affect , upset and annoyance following behavior problems ) or increasing positive affect or caregiving self-efficacy . There was , however , a statistically significant effect for postintervention improvement in both the video/coaching and the educational booklet/check-in conditions . Potential reasons for the lack of differential treatment effects are discussed , along with implication s for recruitment of male dementia caregivers 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 
    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: The PREP system of nursing interventions , design ed to increase preparedness ( PR ) , enrichment ( E ) , and predictability ( P ) in families providing care to older people , was pilot tested for acceptability and preliminary effectiveness . Eleven family units were assigned to the PREP group and 11 to a st and ard home health control group .  The PREP group scored approximately one SD higher than the control group ( p < .05 ) on the Care Effectiveness Scale , indicating greater preparedness , enrichment , and predictability . Further , on a rating of overall usefulness , the PREP group rated their assistance from PREP nurses ( M = 9.75 ) as significantly higher ( p < .01 ) than the control group rated assistance from the home health nurse or physical therapist ( M = 6.57 ) . Although not statistically significant , mean hospital costs for the PREP group ( $ 2,775 ) were lower than for the control group ( $ 6,929 ) . Results provided support for a full intervention trial PURPOSE Our goal was to evaluate the efficacy of a multimedia support program delivered over the Internet to employed family caregivers of persons with dementia . DESIGN AND METHODS The evaluation of this program involved 299 employed family caregivers participating in a pretest-posttest r and omized clinical trial with a 30-day follow-up and a waitlist control condition . Vali date d instruments include the Center for Epidemiologic Studies -Depression scale , the State-Trait Anxiety Inventory , the Caregiver Strain scale from Benjamin Rose , and Positive Aspects of Caregiving used in the nationwide REACH study . RESULTS Those who viewed Caregiver 's Friend : Dealing with Dementia 30 days postexposure demonstrated significant improvements in depression , anxiety , level and frequency of stress , caregiver strain , self-efficacy , and intention to seek help , as well as perceptions of positive aspects of caregiving . IMPLICATION S Interactive multimedia interventions delivered over the Internet appear to be uniquely suited to provide low-cost , effective , convenient , individually tailored programs that present educational information , cognitive and behavioral skills , and affective learning opportunities . This makes Web-based multimedia a promising avenue for work-life balance programs , employee-assistance providers , and organizations interested in improving family caregiver health and well-being 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 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 OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity OBJECTIVES The Nutrition Screening Initiative is a national collaborative effort committed to the identification and treatment of nutritional problems in older persons . METHODS A 14-item checklist of characteristics associated with nutritional status was administered to a r and om sample of Medicare beneficiaries , aged 70 years and older , in New Engl and . Regression analysis was used to derive item weights that would predict poor nutrient intakes and low perceived health status . Sensitivity and specificity values were review ed to define low , moderate , and high nutritional risk scores . RESULTS A revised checklist containing 10 yes/no items was adopted . Scores of 6 or more points defined persons at high nutritional risk . Twenty-four percent of the Medicare population was estimated to be at high nutritional risk according to the checklist . Among those in the high-risk group , 56 % perceived their health to be " fair " or " poor " and 38 % had dietary intakes below 75 % of the recommended dietary allowances for three or more nutrients . CONCLUSIONS The Nutrition Screening Initiative Checklist is a brief , easily scored instrument that can accurately identify noninstitutionalized older persons at risk for low nutrient intake and health problems Prior research ( Gallagher-Thompson , D. , Gray , H. , Tang , P. , Pu , C.-Y. , Tse , C. , Hsu , S. , et al. ( 2007 ) . Impact of in-home intervention versus telephone support in reducing  depression and stress of Chinese caregivers : Results of a pilot study . American Journal of Geriatric Psychiatry , 15 , 425–434 . ) found that an in-home behavioral management program , derived conceptually from cognitive behavioral theories ( CBT ) , was effective in reducing caregiver related stress and depressive symptoms in Chinese American dementia caregivers ( CGs ) . Results were promising , but a more cost-effective intervention is needed to serve this growing population . Past work also found that a psychoeducational videotaped training program based on CBT was effective in reducing stress due to caregiving in Caucasian and African American dementia family CGs ( Steffen , 2000 , Anger management for dementia caregivers : A preliminary study using video and telephone interventions . Behavior Therapy , 31 , 281–299 . ) . To date no research has been conducted using a technological medium to deliver a similar kind of intervention to Chinese American caregivers . The present study evaluated the effectiveness of a similar but culturally “ tailored ” program in which 70 CGs were r and omly assigned to a 12-week CBT skill training program delivered on a DVD , or to a general educational DVD program on dementia . Both were available in M and arin Chinese or English as preferred . Pre post change analyses indicated that CGs did not differ on change in level of negative depressive symptoms , but positive affect was higher , and patient behaviors were appraised as less stressful and bothersome , for CGs in the CBT skill training program . They were also more satisfied with the program overall and reported that they believed they were able to give care more effectively . Results encourage further development of theoretically based interventions , delivered using modern technology , for this ever increasing group of CGs Data are presented on a preliminary study investigating the efficacy of 2 distance-based psychosocial interventions ( N = 32 ) for male family dementia caregivers . Male caregivers were r and omly assigned to either a basic education intervention ( ie , educational booklet and biweekly check-in telephone calls ) or a video intervention ( ie , set of 10 videos , an accompanying workbook , and weekly telephone coaching sessions using behavioral strategies to manage challenging caregiving situations ) . Results did not support the greater efficacy of the video condition in reducing psychosocial distress ( eg , negative affect , upset and annoyance following behavior problems ) or increasing positive affect or caregiving self-efficacy . There was , however , a statistically significant effect for postintervention improvement in both the video/coaching and the educational booklet/check-in conditions . Potential reasons for the lack of differential treatment effects are discussed , along with implication s for recruitment of male dementia caregivers 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 
    Output:
    