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 AND PURPOSE We report the findings of a r and omized controlled trial to determine the effectiveness of a multidisciplinary Stroke Education Program ( SEP ) for patients and their informal carers . METHODS Two hundred four patients admitted with acute stroke and their 176 informal carers were r and omized to receive an invitation to the SEP or to receive conventional stroke unit care . The SEP consisted of one 1-hour small group educational session for in patients followed by six 1-hour sessions after discharge . The primary outcome measure was patient- and carer-perceived health status ( SF-36 ) at 6 months after stroke . Knowledge of stroke , satisfaction with services , emotional outcome , disability , and h and icap and were secondary outcome measures . RESULTS Only 51 of 108 ( 47 % ) surviving patients r and omized to the SEP completed the program , as did 20 of 93 ( 22 % ) informal carers of surviving patients .  Perceived health status ( Short Form 36 [ SF-36 ] health survey ) scores were similar for SEP patients and controls . Informal carers in the control group scored better on the social functioning component of the SF-36 than the SEP group ( P=0.04 ) . Patients and informal carers in the SEP group scored higher on the stroke knowledge scale than controls ( patients , P=0.02 ; carers , P=0 . 01 ) . Patients in the SEP group were more satisfied with the information that they had received about stroke ( P=0.004 ) . There were no differences in emotional or functional outcomes between groups . CONCLUSIONS Although the SEP improved patient and informal carer knowledge about stroke and patient satisfaction with some components of stroke services , this was not associated with an improvement in their perceived health status . Indeed , the social functioning of informal carers r and omized to the SEP was less than in the control group OBJECTIVE The objective of this study was to evaluate the strengths and weaknesses of a group support program and a home visiting program for family caregivers of stroke patients . It also examined the best fit between intervention variant and family caregiver and patient characteristics . van den Heuvel 's previous effect study showed positive effects of the same intervention program , but unlike our present study differences between the two support variants could not be measured . METHODS Of 257 family caregivers who were included and r and omly assigned to an intervention variant or a control group , 127 family caregivers completed the intervention in either the group program or the home visiting program . RESULTS Evaluation data showed that both intervention variants had been helpful and feasible , but home visit participants missed peer contact and follow-up contacts were missed in both intervention programs . In comparison to the home visiting program , the group program participants showed more benefit especially with respect to informational and emotional components . Caregivers ' preference for type of intervention revealed that both types of intervention had its supporters . Those that preferred the group program could be clearly characterised : they were burdened , lived with a more psychologically h and icapped relative , were using active coping strategies more frequently or lived in a region which is considered to be more sociable . CONCLUSION The present study adds extensively to van den Heuvel 's effect study with respect to discriminative aspects of group and home intervention programs and their respective benefits for specific family caregiver groups . PRACTICE IMPLICATION S In order to suitably match an intervention type with specific caregiver characteristics the intervention provider should utilize caregiver self- selection or undertake professional screening of caregiver burden . Telephone contacts should be offered in addition to the interventions 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 and Purpose — Stroke symptoms can be very stressful for family caregivers , but most knowledge about the prevalence and stressfulness of stroke-related patient problems is derived from convenience sample s. In addition , little is known about perceived benefits of the stroke caregiving experience . The purpose of this study was to determine the prevalence and stressfulness of stroke-related problems , and perceived benefits of caregiving , as reported by an epidemiologically derived sample of caregivers of stroke survivors . Methods — Stroke survivors ( N=75 ) from a prospect i ve epidemiological study of stroke , the REasons for Geographic and Racial Differences in Stroke ( REGARDS ) study , and their family caregivers were followed . Caregivers were given a comprehensive telephone interview 8 to 12 months after the stroke , using measures of stroke patient problems , caregiver appraisal s of the stressfulness of these problems , and perceived benefits of caregiving .  Results — Caregivers rated patient problems with mood ( depression , loneliness and anxiety ) , memory , and physical care ( bowel control ) , as the most stressful , but reported prevalence of these problems was lower than those reported previously in studies using clinical sample s. Caregivers also reported many benefits from caregiving , with over 90 % reporting that caregiving enabled them to appreciate life more . Conclusions — Epidemiologically based studies of stroke caregiving provide a unique picture of caregiver strains and benefits compared with clinical studies , which tend to over-represent more impaired patients . Support for caregivers should include interventions to aid their coping with highly stressful mood , physical care , and cognitive problems of stroke patients , but should also attend to perceived benefits of caregiving BACKGROUND AND PURPOSE [ corrected ] With the ever-increasing pressure on healthcare budgets , we witness a growing dem and for evidence of the economic implication s of care across many therapeutic areas . Stroke is no exception . METHODS Detailed information on healthcare use was collected in conjunction with two 12-week international trials design ed primarily to assess the safety and efficacy of a new potential neuroprotective agent . The information was gathered prospect ively by means of a customized re source use instrument that included both acute and long-term inpatient management as well as community care . In this report , the results pertaining to the 1341 acute ischemic stroke patients are described . RESULTS More than 70 % of the mean cost ( $ 13 668 ) was explained by the initial hospitalization , which averaged 24 days . The total cost and its components varied according to patient age , the presence of comorbidities , and several indicators of disease severity . Pronounced country differences could be observed in the management of this fairly homogeneous patient group . CONCLUSIONS This study provides a comprehensive picture of the healthcare services used for the treatment and rehabilitation of stroke victims , presented with respect to various patient and disease characteristics . It is expected that research ers evaluating the cost-efficiency of specific stroke treatments will benefit from the detailed information presented in this report Abstract Purpose : This study evaluated the effectiveness of telephone groups for older , spousal caregivers of stroke survivors . Method : The 88 caregivers were mostly white females who were 70 years old on average and who had been providing care for an average of 3 years . Participants were r and omized to treatment or control conditions , followed for 6 months , and assessed for depression , burden , loneliness , stress , and competence . Treatment participants engaged in an eight-session psychoeducational telephone group . Results : Treatment participants showed decreased stress over time but were not significantly different from control participants in the amount of change in stress . Control participants showed a significant increase in burden during the study ; treatment participants showed a significant increase in competence Objectives : To determine whether education and counselling after stroke leads to improved family functioning and psychosocial outcomes for stroke patients and their spouses , and better functional and social outcomes for patients . Design : Two-group r and omized controlled trial . Data were collected on admission to and discharge from rehabilitation , and again six months later . Setting : Rehabilitation units at Repatriation General Hospital and Griffith Hospital , in Adelaide , South Australia . Participants : Sixty-two stroke patients and their spouses , 32 in the intervention group and 30 in the control group . Intervention : Stroke information package and three visits from a social worker trained in family counselling . Outcome measures : Family functioning : McMaster Family Assessment Device ( FAD ) ; functional status : Barthel Index ( BI ) ; social recovery : Adelaide Activities Profile ( AAP ) ; depression : Geriatric Depression Scale ( GDS ) ; anxiety : Hospital Anxiety and Depression Scale ( HADS ) ; mastery : Mastery Scale ( MS ) ; health status : SF-36 . Results : At six months the intervention group had better family functioning for both patients ( mean FAD difference 0.19 ) and spouses ( mean difference 0.09 ) . A modest benefit in functional status for intervention patients ( mean BI difference 1.3 ) was related to improved family functioning . Intervention patients reported better social recovery ( mean AAP differences : domestic chores 5.7 , household maintenance 4.6 , social activities 11.5 ) , but there were no significant effects on depression , anxiety , mastery or health status . Conclusions : An education and counselling intervention maintained family functioning , and in turn led to improved functional and social patient outcomes . This approach helps patients and their spouses to make the optimal adjustment to living with stroke Background and Purpose — Social problem-solving therapy shows promise as an intervention to improve the well-being of  family caregivers .  There is some evidence that training in problem solving may be effectively delivered by telephone . The purpose of this study was to quantify the impact of social problem-solving telephone partnerships on primary family caregiver outcomes after stroke survivors are discharged home from a rehabilitation facility . Methods — Using a r and omized 3-group repeated- measures experimental design , 74 stroke survivors with an admitting diagnosis of ischemic stroke and their primary family caregivers were entered into the study . The intervention consisted of an initial 3-hour home visit between a trained nurse and the family caregiver within 1 week after discharge to begin problem-solving skill training . This initial session was followed by weekly ( the first month ) and biweekly ( the second and third month ) telephone contacts . Results — Compared with the sham intervention and control groups , family caregivers who participated in the social problem-solving telephone partnership intervention group had better problem-solving skills ; greater caregiver preparedness ; less depression ; and significant improvement in measures of vitality , social functioning , mental health , and role limitations related to emotional problems . There were no significant differences among the groups in caregiver burden . Satisfaction with healthcare services decreased over time in the control group while remaining comparable in the intervention and sham intervention groups . Conclusion — These results indicate that problem-solving training may be useful for family caregivers of stroke survivors after discharge from rehabilitative facilities This study developed and implemented the Transition Assistance Program ( TAP ) for stroke caregivers . The program is composed of ( 1 ) skill development , ( 2 ) education , and ( 3 ) supportive problem solving .  Sixty-one dyads ( n = 122 ) participated : thirty-nine from Puerto Rico and twenty-two from Texas . Participants were r and omly assigned to the TAP treatment or a control group . As caregiver satisfaction with the TAP increased , strain and depression decreased , and caregivers reported a very high rate of program satisfaction ( 9.5 out of 10 ) . The TAP effectively reduced caregiver strain at the 3-month follow-up . When controlling for baseline differences , we found that the treatment group had lower depression ( p = 0.07 ) than the control group at follow-up and that the TAP may have had a preventative effect on depression for caregivers who had not been depressed at discharge , although this visual trend did not reach statistical significance . Among veterans with low functioning at baseline , veterans whose caregivers had received the TAP improved in functioning more than did veterans whose caregivers had been in the control group , although this visual trend was not significant . Functioning in veterans with stroke was also significantly linked to caregiver satisfaction with the TAP . The findings from the current study warrant further evaluation of the TAP intervention & NA ; Guided by Orem 's self‐care deficit nursing theory , the purpose of this descriptive comparative study was to examine the emotional support , physical help , and health of caregivers of stroke survivors . Seventy‐three caregivers from the Midwest participated in a parent study that examined their experience of caring during the first 12 months after stroke . Caregivers were r and omized to an online intervention of support and education ( n = 36 Web users ) or a control group ( n = 37 non‐Web users ) . A secondary analysis of data collected during telephone interviews at baseline , 3 , 6 , and 12 months after stroke was performed . No significant mean differences were found between Web and non‐Web users in the above variables at these points in time . Consequently , the caregivers were merged into one group , and the relationships among the variables at the different points in time were analyzed . Significant , 
    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 AND PURPOSE We report the findings of a r and omized controlled trial to determine the effectiveness of a multidisciplinary Stroke Education Program ( SEP ) for patients and their informal carers . METHODS Two hundred four patients admitted with acute stroke and their 176 informal carers were r and omized to receive an invitation to the SEP or to receive conventional stroke unit care . The SEP consisted of one 1-hour small group educational session for in patients followed by six 1-hour sessions after discharge . The primary outcome measure was patient- and carer-perceived health status ( SF-36 ) at 6 months after stroke . Knowledge of stroke , satisfaction with services , emotional outcome , disability , and h and icap and were secondary outcome measures . RESULTS Only 51 of 108 ( 47 % ) surviving patients r and omized to the SEP completed the program , as did 20 of 93 ( 22 % ) informal carers of surviving patients .  Perceived health status ( Short Form 36 [ SF-36 ] health survey ) scores were similar for SEP patients and controls . Informal carers in the control group scored better on the social functioning component of the SF-36 than the SEP group ( P=0.04 ) . Patients and informal carers in the SEP group scored higher on the stroke knowledge scale than controls ( patients , P=0.02 ; carers , P=0 . 01 ) . Patients in the SEP group were more satisfied with the information that they had received about stroke ( P=0.004 ) . There were no differences in emotional or functional outcomes between groups . CONCLUSIONS Although the SEP improved patient and informal carer knowledge about stroke and patient satisfaction with some components of stroke services , this was not associated with an improvement in their perceived health status . Indeed , the social functioning of informal carers r and omized to the SEP was less than in the control group OBJECTIVE The objective of this study was to evaluate the strengths and weaknesses of a group support program and a home visiting program for family caregivers of stroke patients . It also examined the best fit between intervention variant and family caregiver and patient characteristics . van den Heuvel 's previous effect study showed positive effects of the same intervention program , but unlike our present study differences between the two support variants could not be measured . METHODS Of 257 family caregivers who were included and r and omly assigned to an intervention variant or a control group , 127 family caregivers completed the intervention in either the group program or the home visiting program . RESULTS Evaluation data showed that both intervention variants had been helpful and feasible , but home visit participants missed peer contact and follow-up contacts were missed in both intervention programs . In comparison to the home visiting program , the group program participants showed more benefit especially with respect to informational and emotional components . Caregivers ' preference for type of intervention revealed that both types of intervention had its supporters . Those that preferred the group program could be clearly characterised : they were burdened , lived with a more psychologically h and icapped relative , were using active coping strategies more frequently or lived in a region which is considered to be more sociable . CONCLUSION The present study adds extensively to van den Heuvel 's effect study with respect to discriminative aspects of group and home intervention programs and their respective benefits for specific family caregiver groups . PRACTICE IMPLICATION S In order to suitably match an intervention type with specific caregiver characteristics the intervention provider should utilize caregiver self- selection or undertake professional screening of caregiver burden . Telephone contacts should be offered in addition to the interventions 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 and Purpose — Stroke symptoms can be very stressful for family caregivers , but most knowledge about the prevalence and stressfulness of stroke-related patient problems is derived from convenience sample s. In addition , little is known about perceived benefits of the stroke caregiving experience . The purpose of this study was to determine the prevalence and stressfulness of stroke-related problems , and perceived benefits of caregiving , as reported by an epidemiologically derived sample of caregivers of stroke survivors . Methods — Stroke survivors ( N=75 ) from a prospect i ve epidemiological study of stroke , the REasons for Geographic and Racial Differences in Stroke ( REGARDS ) study , and their family caregivers were followed . Caregivers were given a comprehensive telephone interview 8 to 12 months after the stroke , using measures of stroke patient problems , caregiver appraisal s of the stressfulness of these problems , and perceived benefits of caregiving .  Results — Caregivers rated patient problems with mood ( depression , loneliness and anxiety ) , memory , and physical care ( bowel control ) , as the most stressful , but reported prevalence of these problems was lower than those reported previously in studies using clinical sample s. Caregivers also reported many benefits from caregiving , with over 90 % reporting that caregiving enabled them to appreciate life more . Conclusions — Epidemiologically based studies of stroke caregiving provide a unique picture of caregiver strains and benefits compared with clinical studies , which tend to over-represent more impaired patients . Support for caregivers should include interventions to aid their coping with highly stressful mood , physical care , and cognitive problems of stroke patients , but should also attend to perceived benefits of caregiving BACKGROUND AND PURPOSE [ corrected ] With the ever-increasing pressure on healthcare budgets , we witness a growing dem and for evidence of the economic implication s of care across many therapeutic areas . Stroke is no exception . METHODS Detailed information on healthcare use was collected in conjunction with two 12-week international trials design ed primarily to assess the safety and efficacy of a new potential neuroprotective agent . The information was gathered prospect ively by means of a customized re source use instrument that included both acute and long-term inpatient management as well as community care . In this report , the results pertaining to the 1341 acute ischemic stroke patients are described . RESULTS More than 70 % of the mean cost ( $ 13 668 ) was explained by the initial hospitalization , which averaged 24 days . The total cost and its components varied according to patient age , the presence of comorbidities , and several indicators of disease severity . Pronounced country differences could be observed in the management of this fairly homogeneous patient group . CONCLUSIONS This study provides a comprehensive picture of the healthcare services used for the treatment and rehabilitation of stroke victims , presented with respect to various patient and disease characteristics . It is expected that research ers evaluating the cost-efficiency of specific stroke treatments will benefit from the detailed information presented in this report Abstract Purpose : This study evaluated the effectiveness of telephone groups for older , spousal caregivers of stroke survivors . Method : The 88 caregivers were mostly white females who were 70 years old on average and who had been providing care for an average of 3 years . Participants were r and omized to treatment or control conditions , followed for 6 months , and assessed for depression , burden , loneliness , stress , and competence . Treatment participants engaged in an eight-session psychoeducational telephone group . Results : Treatment participants showed decreased stress over time but were not significantly different from control participants in the amount of change in stress . Control participants showed a significant increase in burden during the study ; treatment participants showed a significant increase in competence Objectives : To determine whether education and counselling after stroke leads to improved family functioning and psychosocial outcomes for stroke patients and their spouses , and better functional and social outcomes for patients . Design : Two-group r and omized controlled trial . Data were collected on admission to and discharge from rehabilitation , and again six months later . Setting : Rehabilitation units at Repatriation General Hospital and Griffith Hospital , in Adelaide , South Australia . Participants : Sixty-two stroke patients and their spouses , 32 in the intervention group and 30 in the control group . Intervention : Stroke information package and three visits from a social worker trained in family counselling . Outcome measures : Family functioning : McMaster Family Assessment Device ( FAD ) ; functional status : Barthel Index ( BI ) ; social recovery : Adelaide Activities Profile ( AAP ) ; depression : Geriatric Depression Scale ( GDS ) ; anxiety : Hospital Anxiety and Depression Scale ( HADS ) ; mastery : Mastery Scale ( MS ) ; health status : SF-36 . Results : At six months the intervention group had better family functioning for both patients ( mean FAD difference 0.19 ) and spouses ( mean difference 0.09 ) . A modest benefit in functional status for intervention patients ( mean BI difference 1.3 ) was related to improved family functioning . Intervention patients reported better social recovery ( mean AAP differences : domestic chores 5.7 , household maintenance 4.6 , social activities 11.5 ) , but there were no significant effects on depression , anxiety , mastery or health status . Conclusions : An education and counselling intervention maintained family functioning , and in turn led to improved functional and social patient outcomes . This approach helps patients and their spouses to make the optimal adjustment to living with stroke Background and Purpose — Social problem-solving therapy shows promise as an intervention to improve the well-being of  family caregivers .  There is some evidence that training in problem solving may be effectively delivered by telephone . The purpose of this study was to quantify the impact of social problem-solving telephone partnerships on primary family caregiver outcomes after stroke survivors are discharged home from a rehabilitation facility . Methods — Using a r and omized 3-group repeated- measures experimental design , 74 stroke survivors with an admitting diagnosis of ischemic stroke and their primary family caregivers were entered into the study . The intervention consisted of an initial 3-hour home visit between a trained nurse and the family caregiver within 1 week after discharge to begin problem-solving skill training . This initial session was followed by weekly ( the first month ) and biweekly ( the second and third month ) telephone contacts . Results — Compared with the sham intervention and control groups , family caregivers who participated in the social problem-solving telephone partnership intervention group had better problem-solving skills ; greater caregiver preparedness ; less depression ; and significant improvement in measures of vitality , social functioning , mental health , and role limitations related to emotional problems . There were no significant differences among the groups in caregiver burden . Satisfaction with healthcare services decreased over time in the control group while remaining comparable in the intervention and sham intervention groups . Conclusion — These results indicate that problem-solving training may be useful for family caregivers of stroke survivors after discharge from rehabilitative facilities This study developed and implemented the Transition Assistance Program ( TAP ) for stroke caregivers . The program is composed of ( 1 ) skill development , ( 2 ) education , and ( 3 ) supportive problem solving .  Sixty-one dyads ( n = 122 ) participated : thirty-nine from Puerto Rico and twenty-two from Texas . Participants were r and omly assigned to the TAP treatment or a control group . As caregiver satisfaction with the TAP increased , strain and depression decreased , and caregivers reported a very high rate of program satisfaction ( 9.5 out of 10 ) . The TAP effectively reduced caregiver strain at the 3-month follow-up . When controlling for baseline differences , we found that the treatment group had lower depression ( p = 0.07 ) than the control group at follow-up and that the TAP may have had a preventative effect on depression for caregivers who had not been depressed at discharge , although this visual trend did not reach statistical significance . Among veterans with low functioning at baseline , veterans whose caregivers had received the TAP improved in functioning more than did veterans whose caregivers had been in the control group , although this visual trend was not significant . Functioning in veterans with stroke was also significantly linked to caregiver satisfaction with the TAP . The findings from the current study warrant further evaluation of the TAP intervention & NA ; Guided by Orem 's self‐care deficit nursing theory , the purpose of this descriptive comparative study was to examine the emotional support , physical help , and health of caregivers of stroke survivors . Seventy‐three caregivers from the Midwest participated in a parent study that examined their experience of caring during the first 12 months after stroke . Caregivers were r and omized to an online intervention of support and education ( n = 36 Web users ) or a control group ( n = 37 non‐Web users ) . A secondary analysis of data collected during telephone interviews at baseline , 3 , 6 , and 12 months after stroke was performed . No significant mean differences were found between Web and non‐Web users in the above variables at these points in time . Consequently , the caregivers were merged into one group , and the relationships among the variables at the different points in time were analyzed . Significant , 
    Output:
    