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 ) Objective : To examine the efficacy of an interactive multimedia intervention that teaches advocacy skills to people caring for a family member with traumatic brain injury . Participants : A total of 201 individuals ( control , n = 97 ; treatment , n = 104 ) providing support to a family member with traumatic brain injury . Design : R and omized controlled study . Main Measures : Caregiver knowledge , skill application , behavioral intention , and overall life satisfaction . Intervention : The Brain Injury Partners program , a Web site focused on advocacy , communication skills , and re sources for families affected by brain injury . Results : Univariate analyses revealed that compared with the control group , the Brain Injury Partners group reported statistically significant higher adjusted means for application , knowledge , and attitudes scales immediately postintervention and at follow-up . Satisfaction with life , assessed at follow-up but not posttest , was not significant . Discussion : This study demonstrated the effectiveness of a Web-based intervention to teach effective skills to caregivers advocating for a family member with traumatic brain injury Purpose . We hypothesised that carers of stroke survivors who participate in the Web-based intervention , Caring∼Web © , would have higher well-being than non-Web users . We also postulated that those survivors whose carers participated in Caring∼Web would use fewer healthcare services . Method . A r and omised , two-group , repeated measures design was used . Subjects were recruited from four rehabilitation centres from which first-time stroke survivors were discharged to home in two Midwestern states . Of 144 carers screened , 103 carers of these survivors who were novice Internet users were assigned to a Web or non-Web user group . Seventy-three subjects completed the study . Intervention . Caring∼Web was a Web-based intervention of education and support provided to the Web user group for 1 year . A bi-monthly telephone survey collected data on all carers well-being ( perceived depression , life satisfaction ) and survivors healthcare service use ( self-reported provider and emergency department visits , hospital re-admissions , nursing home placement ) . Results . No statistical differences were found between the groups in carers well-being or in the number of provider visits for survivors . There were significant differences in emergency department visits ( p = 0.001 ) and hospital re-admissions ( p = 0.0005 ) related to the health of survivors . Conclusions . This Web-based intervention helped new carers make informed decisions about healthcare needs of stroke survivors , thus reducing service use Background Web-based programs have been developed for informal caregivers of people with Alzheimer ’s disease ( PWAD ) . However , these programs can prove difficult to adopt , especially for older people , who are less familiar with the Internet than other population s. Despite the fundamental role of usability testing in promoting caregivers ’ correct use and adoption of these programs , to our knowledge , this is the first study describing this process before evaluating a program for caregivers of PWAD in a r and omized clinical trial . Objective The objective of the study was to describe the development process of a fully automated Web-based program for caregivers of PWAD , aim ing to reduce caregivers ’ stress , and based on the user-centered design approach . Methods There were 49 participants ( 12 health care professionals , 6 caregivers , and 31 healthy older adults ) that were involved in a double iterative design allowing for the adaptation of program content and for the enhancement of website usability . This process included three component parts : ( 1 ) project team workshops , ( 2 ) a proof of concept , and ( 3 ) two usability tests . The usability tests were based on a mixed methodology using behavioral analysis , semistructured interviews , and a usability question naire . Results The user-centered design approach provided valuable guidelines to adapt the content and design of the program , and to improve website usability . The professionals , caregivers ( mainly spouses ) , and older adults considered that our project met the needs of isolated caregivers . Participants underlined that contact between caregivers would be desirable . During usability observations , the mistakes of users were also due to ergonomics issues from Internet browsers and computer interfaces . Moreover , negative self-stereotyping was evidence d , when comparing interviews and results of behavioral analysis . Conclusions Face-to-face psycho-educational programs may be used as a basis for Web-based programs . Nevertheless , a user-centered design approach involving targeted users ( or their representatives ) remains crucial for their correct use and adoption . For future user-centered design studies , we recommend to involve end-users from preconception stages , using a mixed research method in usability evaluations , and implementing pilot studies to evaluate acceptability and feasibility of programs Objective : Determine if the online iCare Stress Management e-Training Program reduces stress , bother , depression , and poor life quality for dementia family caregivers ( CGs ) . Method : CGs ( N = 150 ) were r and omly assigned to the iCare Condition ( ICC ) or to the Education/Information-Only Condition ( EOC ) for a 3-month period . Change in self-report measures of stress ( PSS ) ( primary outcome ) , caregiver bother(RMBPC ) , depression ( CES-D ) , and quality of life ( PQOL ) ( secondary outcomes ) was determined , along with usage of new information in one 's own caregiving . Results : A mixed ANOVA revealed that change in perceived stress was significant for the ICC but not the EOC ( p = .017 ) . Changes in the other measures were not significant . More caregivers in the ICC used the material s in their own caregiving situation than those in the EOC . Roughly one-third of the caregivers enrolled in the study dropped prior to completion . Conclusion : Results are promising , but the high dropout is a concern . Future efforts to improve dropout rate and increase participant engagement are warranted . To our knowledge , this is the first attempt to present an evidence -based intervention for CGs via the Internet Purpose Family caregivers of persons with dementia ( PWD ) may receive caregiver training because of logistical constraints and privacy concerns . This study evaluated the effectiveness of an online intervention for family caregivers of PWD in improving their self-efficacy in managing behavioral and psychological symptoms of dementia ( BPSD ) , and their emotion well-being . Subjects and methods A total of 36 family caregivers of people with dementia participated in a 9-week online intervention based on the cognitive behavioral therapy model . Outcomes of the intervention were measured by the Chinese version of the Neuropsychiatric Inventory Question naire and two domains of the Revised Scale for Caregiving Self-Efficacy . Wilcoxon signed rank tests were used to compare the change in outcome variables . Results The severity of BPSD of PWD and BPSD-related distress in family caregivers showed a statistically significant reduction after the intervention . Subgroup analysis showed self-efficacy in controlling up setting thoughts significantly improved in caregivers of PWD at moderate to severe stages . Conclusion Online cognitive behavioral therapy for family caregivers reduced BPSD of PWD and the related distress in their caregivers Background : Mobile health services may improve chronic illness care , but interventions rarely support informal caregivers ’ efforts . Objectives : To determine whether automated feedback to caregivers of chronic heart failure patients impacts caregiving burden and assistance with self-management . Research Design : R and omized comparative effectiveness trial . Subjects : A total of 369 heart failure patients were recruited from a Veterans Health Administration health care system . All patients participated with a “ CarePartner ” or informal caregiver outside their household . Intervention : Patients r and omized to “ st and ard mHealth ”  received weekly automated self-care support calls for 12 months with notifications about problems sent to clinicians . “ mobile health+CarePartner ” ( mHealth+CP ) patients received identical services , plus email summaries and suggestions for self-care assistance automatically sent to their CarePartners . Measures : At baseline , 6 , and 12 months , CarePartners completed assessment s of caregiving strain , depressive symptoms , and participation in self-care support . Results : mHealth+CP CarePartners reported less caregiving strain than controls at both 6 and 12 months ( both P⩽0.03 ) . That effect as well as improvements in depressive symptoms were seen primarily among CarePartners reporting greater burden at baseline ( P⩽0.03 for interactions between arm and baseline strain/depression at both endpoints ) . Although most mHealth+CP CarePartners increased the amount of time spent in self-care support , those with the highest time commitment at baseline reported decreases at both follow-ups ( all P<0.05 ) . mHealth+CP CarePartners reported more frequently attending patients ’ medical visits at 6 months ( P=0.049 ) and greater involvement in medication adherence at both endpoints ( both P⩽0.032 ) . Conclusions : When CarePartners experienced significant caregiving strain and depression , systematic feedback about their patient-partner decreased those symptoms . Feedback also increased most CarePartners ’ engagement in self-care OBJECTIVES The E Sibling Project aims to address the needs of siblings of individuals affected by psychosis through provision of a comprehensive online intervention . The online intervention comprises four core elements , including : information on psychosis ; various coping and promoting well-being strategies ; siblings ' blogs and discussion forum with peers ; and an " Ask the Experts " function . After the intervention-prototype was developed , we tested its feasibility , usability and acceptability by siblings . METHODS We evaluated the usability of the intervention-prototype using a non-r and omised usability study with siblings of individuals diagnosed with psychosis . The usability study adapted Poulson et al 's framework to collect subjective feedback from participants on ease of use , perceived usefulness and acceptability , together with objective usage data on the intervention . RESULTS Twenty siblings were recruited to the usability test ; 19 tried out the re source -prototype over a 4-week period and 17 completed the online evaluation after using the intervention . In total , 906 page-views were made by the participants and each spent about two hours using the re source . Participants evaluated the intervention as helpful , relevant and useful in terms of content , design and usability . Developments are needed to improve the navigation and intuitiveness of the re source . CONCLUSIONS Using an internet-based information-giving and peer support intervention to promote wellbeing and coping is feasible and acceptable to siblings of people with psychosis Background To date , there has been very little work investigating behaviour changes induced by interventions that are design ed to increase help seeking . The present paper examines the effects of two Internet depression websites on help seeking . Methods 414 individuals with elevated scores on a depression assessment scale were r and omly allocated to a de 
    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 ) Objective : To examine the efficacy of an interactive multimedia intervention that teaches advocacy skills to people caring for a family member with traumatic brain injury . Participants : A total of 201 individuals ( control , n = 97 ; treatment , n = 104 ) providing support to a family member with traumatic brain injury . Design : R and omized controlled study . Main Measures : Caregiver knowledge , skill application , behavioral intention , and overall life satisfaction . Intervention : The Brain Injury Partners program , a Web site focused on advocacy , communication skills , and re sources for families affected by brain injury . Results : Univariate analyses revealed that compared with the control group , the Brain Injury Partners group reported statistically significant higher adjusted means for application , knowledge , and attitudes scales immediately postintervention and at follow-up . Satisfaction with life , assessed at follow-up but not posttest , was not significant . Discussion : This study demonstrated the effectiveness of a Web-based intervention to teach effective skills to caregivers advocating for a family member with traumatic brain injury Purpose . We hypothesised that carers of stroke survivors who participate in the Web-based intervention , Caring∼Web © , would have higher well-being than non-Web users . We also postulated that those survivors whose carers participated in Caring∼Web would use fewer healthcare services . Method . A r and omised , two-group , repeated measures design was used . Subjects were recruited from four rehabilitation centres from which first-time stroke survivors were discharged to home in two Midwestern states . Of 144 carers screened , 103 carers of these survivors who were novice Internet users were assigned to a Web or non-Web user group . Seventy-three subjects completed the study . Intervention . Caring∼Web was a Web-based intervention of education and support provided to the Web user group for 1 year . A bi-monthly telephone survey collected data on all carers well-being ( perceived depression , life satisfaction ) and survivors healthcare service use ( self-reported provider and emergency department visits , hospital re-admissions , nursing home placement ) . Results . No statistical differences were found between the groups in carers well-being or in the number of provider visits for survivors . There were significant differences in emergency department visits ( p = 0.001 ) and hospital re-admissions ( p = 0.0005 ) related to the health of survivors . Conclusions . This Web-based intervention helped new carers make informed decisions about healthcare needs of stroke survivors , thus reducing service use Background Web-based programs have been developed for informal caregivers of people with Alzheimer ’s disease ( PWAD ) . However , these programs can prove difficult to adopt , especially for older people , who are less familiar with the Internet than other population s. Despite the fundamental role of usability testing in promoting caregivers ’ correct use and adoption of these programs , to our knowledge , this is the first study describing this process before evaluating a program for caregivers of PWAD in a r and omized clinical trial . Objective The objective of the study was to describe the development process of a fully automated Web-based program for caregivers of PWAD , aim ing to reduce caregivers ’ stress , and based on the user-centered design approach . Methods There were 49 participants ( 12 health care professionals , 6 caregivers , and 31 healthy older adults ) that were involved in a double iterative design allowing for the adaptation of program content and for the enhancement of website usability . This process included three component parts : ( 1 ) project team workshops , ( 2 ) a proof of concept , and ( 3 ) two usability tests . The usability tests were based on a mixed methodology using behavioral analysis , semistructured interviews , and a usability question naire . Results The user-centered design approach provided valuable guidelines to adapt the content and design of the program , and to improve website usability . The professionals , caregivers ( mainly spouses ) , and older adults considered that our project met the needs of isolated caregivers . Participants underlined that contact between caregivers would be desirable . During usability observations , the mistakes of users were also due to ergonomics issues from Internet browsers and computer interfaces . Moreover , negative self-stereotyping was evidence d , when comparing interviews and results of behavioral analysis . Conclusions Face-to-face psycho-educational programs may be used as a basis for Web-based programs . Nevertheless , a user-centered design approach involving targeted users ( or their representatives ) remains crucial for their correct use and adoption . For future user-centered design studies , we recommend to involve end-users from preconception stages , using a mixed research method in usability evaluations , and implementing pilot studies to evaluate acceptability and feasibility of programs Objective : Determine if the online iCare Stress Management e-Training Program reduces stress , bother , depression , and poor life quality for dementia family caregivers ( CGs ) . Method : CGs ( N = 150 ) were r and omly assigned to the iCare Condition ( ICC ) or to the Education/Information-Only Condition ( EOC ) for a 3-month period . Change in self-report measures of stress ( PSS ) ( primary outcome ) , caregiver bother(RMBPC ) , depression ( CES-D ) , and quality of life ( PQOL ) ( secondary outcomes ) was determined , along with usage of new information in one 's own caregiving . Results : A mixed ANOVA revealed that change in perceived stress was significant for the ICC but not the EOC ( p = .017 ) . Changes in the other measures were not significant . More caregivers in the ICC used the material s in their own caregiving situation than those in the EOC . Roughly one-third of the caregivers enrolled in the study dropped prior to completion . Conclusion : Results are promising , but the high dropout is a concern . Future efforts to improve dropout rate and increase participant engagement are warranted . To our knowledge , this is the first attempt to present an evidence -based intervention for CGs via the Internet Purpose Family caregivers of persons with dementia ( PWD ) may receive caregiver training because of logistical constraints and privacy concerns . This study evaluated the effectiveness of an online intervention for family caregivers of PWD in improving their self-efficacy in managing behavioral and psychological symptoms of dementia ( BPSD ) , and their emotion well-being . Subjects and methods A total of 36 family caregivers of people with dementia participated in a 9-week online intervention based on the cognitive behavioral therapy model . Outcomes of the intervention were measured by the Chinese version of the Neuropsychiatric Inventory Question naire and two domains of the Revised Scale for Caregiving Self-Efficacy . Wilcoxon signed rank tests were used to compare the change in outcome variables . Results The severity of BPSD of PWD and BPSD-related distress in family caregivers showed a statistically significant reduction after the intervention . Subgroup analysis showed self-efficacy in controlling up setting thoughts significantly improved in caregivers of PWD at moderate to severe stages . Conclusion Online cognitive behavioral therapy for family caregivers reduced BPSD of PWD and the related distress in their caregivers Background : Mobile health services may improve chronic illness care , but interventions rarely support informal caregivers ’ efforts . Objectives : To determine whether automated feedback to caregivers of chronic heart failure patients impacts caregiving burden and assistance with self-management . Research Design : R and omized comparative effectiveness trial . Subjects : A total of 369 heart failure patients were recruited from a Veterans Health Administration health care system . All patients participated with a “ CarePartner ” or informal caregiver outside their household . Intervention : Patients r and omized to “ st and ard mHealth ”  received weekly automated self-care support calls for 12 months with notifications about problems sent to clinicians . “ mobile health+CarePartner ” ( mHealth+CP ) patients received identical services , plus email summaries and suggestions for self-care assistance automatically sent to their CarePartners . Measures : At baseline , 6 , and 12 months , CarePartners completed assessment s of caregiving strain , depressive symptoms , and participation in self-care support . Results : mHealth+CP CarePartners reported less caregiving strain than controls at both 6 and 12 months ( both P⩽0.03 ) . That effect as well as improvements in depressive symptoms were seen primarily among CarePartners reporting greater burden at baseline ( P⩽0.03 for interactions between arm and baseline strain/depression at both endpoints ) . Although most mHealth+CP CarePartners increased the amount of time spent in self-care support , those with the highest time commitment at baseline reported decreases at both follow-ups ( all P<0.05 ) . mHealth+CP CarePartners reported more frequently attending patients ’ medical visits at 6 months ( P=0.049 ) and greater involvement in medication adherence at both endpoints ( both P⩽0.032 ) . Conclusions : When CarePartners experienced significant caregiving strain and depression , systematic feedback about their patient-partner decreased those symptoms . Feedback also increased most CarePartners ’ engagement in self-care OBJECTIVES The E Sibling Project aims to address the needs of siblings of individuals affected by psychosis through provision of a comprehensive online intervention . The online intervention comprises four core elements , including : information on psychosis ; various coping and promoting well-being strategies ; siblings ' blogs and discussion forum with peers ; and an " Ask the Experts " function . After the intervention-prototype was developed , we tested its feasibility , usability and acceptability by siblings . METHODS We evaluated the usability of the intervention-prototype using a non-r and omised usability study with siblings of individuals diagnosed with psychosis . The usability study adapted Poulson et al 's framework to collect subjective feedback from participants on ease of use , perceived usefulness and acceptability , together with objective usage data on the intervention . RESULTS Twenty siblings were recruited to the usability test ; 19 tried out the re source -prototype over a 4-week period and 17 completed the online evaluation after using the intervention . In total , 906 page-views were made by the participants and each spent about two hours using the re source . Participants evaluated the intervention as helpful , relevant and useful in terms of content , design and usability . Developments are needed to improve the navigation and intuitiveness of the re source . CONCLUSIONS Using an internet-based information-giving and peer support intervention to promote wellbeing and coping is feasible and acceptable to siblings of people with psychosis Background To date , there has been very little work investigating behaviour changes induced by interventions that are design ed to increase help seeking . The present paper examines the effects of two Internet depression websites on help seeking . Methods 414 individuals with elevated scores on a depression assessment scale were r and omly allocated to a de 
    Output:
    