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: A r and omized trial of family caregiver support for the home management of older people suffering from moderate to severe progressive irreversible dementia was conducted in an urban center in southern Ontario . Thirty caregivers were allocated to receive the experimental intervention consisting of : caregiver-focused health care , education about dementia and caregiving , assistance with problem solving , regularly scheduled in-home respite , and a self-help family caregiver support group .  Thirty control subjects received conventional community nursing care . Before completion of the intervention , 18 ( 30 % ) were withdrawn , almost equally from each group . The most frequent reason was long-term institutionalization of the demented relative ( n = 10 ) . At baseline , caregivers in both groups were suffering from above-average levels of depression and anxiety . After the six-month intervention period , we found neither experimental nor control group improved in these areas . However , the experimental group showed a clinical ly important improvement in quality of life , experienced a slightly longer mean time to long-term institutionalization , found the caregiver role less problematic , and had greater satisfaction with nursing care than the control group Family caregivers , the “ second victims ” or hidden patients in dementia care , are at risk for social isolation , stress , depression , and mortality . Telephone-based support ( telesupport groups ) represents a practical , low-burden , low-cost source of emotional support . The present study evaluated the feasibility and effectiveness of professionally led telephone-based support groups for female family caregivers of community-dwelling dementia patients . Recruited through various community sources , 103 female caregivers were r and omized to the telesupport group treatment or a control condition . Effects on caregiver burden , depression , and personal gains were evaluated at 6 months , the main end point . Older care-givers ( ≥65 ) in telesupport  reported lower depression than control group caregivers did OBJECTIVES To develop and vali date a brief screening measure for use in research , healthcare , and community setting s to systematic ally assess well-being and identify needed areas of support for caregivers of patients with dementia . DESIGN This study used data from Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH II ) , a multisite r and omized clinical trial of a behavioral intervention design ed to improve the quality of life of caregivers in multiple domains . SETTING REACH II . PARTICIPANTS Two hundred twelve Hispanic , 211 black , and 219 white family caregivers providing in-home care to patients with dementia . MEASUREMENT Based on conceptual and psychometric analyses , a 16-item measure was developed that assesses six domains linked to caregiver risk and amenable to intervention : depression , burden , self-care and health behaviors , social support , safety , and patient problem behaviors . The reliability and validity of the instrument was evaluated with 642 dementia caregiver dyads from the REACH II program . RESULTS The measure was found to have acceptable internal consistency for a multidimensional scale and similar measurement properties for each of the racial and ethnic groups . Concurrent validity was also demonstrated for the measure . CONCLUSION The REACH Risk Appraisal Measure developed in this study shows promise as an assessment tool that can be used in research , clinical , and community setting s to guide , prioritize , and target needed areas of support for caregivers of patients with dementia 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 Background The World Health Organization stresses the importance of accessible and (cost)effective caregiver support , given the expected increase in the number of people with dementia and the detrimental impact on the mental health of family caregivers . Methods This study assessed the effectiveness of the Internet intervention ‘ Mastery over Dementia ’ . In a RCT , 251 caregivers , of whom six were lost at baseline , were r and omly assigned to two groups . Caregivers in the experimental group ( N = 149 ) were compared to caregivers who received a minimal intervention consisting of e-bulletins ( N = 96 ) . Outcomes were symptoms of depression ( Center for Epidemiologic Studies Depression Scale : CES-D ) and anxiety ( Hospital Anxiety and Depression Scale : HADS-A ) . All data were collected via the Internet , and an intention-to-treat analysis was carried out . Results Almost all caregivers were spouses or children ( in-law ) . They were predominantly female and lived with the care recipient in the same household . Age of the caregivers varied from 26 to 87 years . Level of education varied from primary school to university , with almost half of them holding a bachelor ’s degree or higher . Regression analyses showed that caregivers in the experimental group showed significantly lower symptoms of depression ( p = .034 ) and anxiety ( p = .007 ) post intervention after adjustment for baseline differences in the primary outcome scores and the functional status of the patients with dementia . Effect sizes were moderate for symptoms of anxiety ( .48 ) and small for depressive symptoms ( .26 ) . Conclusions The Internet course ‘ Mastery over Dementia ’ offers an effective treatment for family caregivers of people with dementia reducing symptoms of depression and anxiety . The results of this study justify further development of Internet interventions for family caregivers of people with dementia and suggest that such interventions are promising for keeping support for family caregivers accessible and affordable . The findings are even more promising because future generations of family caregivers will be more familiar with the Internet . Trial Registration Dutch Trial Register NTR-2051 www.trialregister.nl/trialreg/admin/ rct Implementation fidelity , a critical aspect of clinical trials research that establishes adequate delivery of the treatment as prescribed in treatment manuals and protocol s , is also essential to the successful implementation of effective programs into new practice setting s. Although infrequently studied in the drug abuse field , stronger implementation fidelity has been linked to better outcomes in practice but appears to be more difficult to achieve with greater distance from model developers . In the INternational CAnnabis Need for Treatment ( INCANT ) multi-national r and omized clinical trial , investigators tested the effectiveness of  Multidimensional Family Therapy ( MDFT )  in comparison to individual psychotherapy ( IP ) in Brussels , Berlin , Paris , The Hague , and Geneva with 450 adolescents with a cannabis use disorder and their parents . This study reports on the implementation fidelity of MDFT  across these five Western European sites in terms of treatment adherence , dose and program differentiation , and discusses possible implication s for international implementation efforts BACKGROUND It is believed that timely recognition and diagnosis of dementia is a pre-condition for improving care for both older adults with dementia and their informal caregivers . However , diagnosing dementia often occurs late in the disease . This means that a significant number of patients with early symptoms of dementia and their informal caregivers may lack appropriate care . OBJECTIVES To compare the effects of case management and usual care among community-dwelling older adults with early symptoms of dementia and their primary informal caregivers . DESIGN R and omized controlled trial with measurements at baseline and after 6 and 12 months . SETTING Primary care in West-Friesl and , the Netherl and s. PARTICIPANTS 99 pairs of community-dwelling older adults with dementia symptoms ( defined as abnormal screening for symptoms of dementia ) and their primary informal caregivers . INTERVENTION 12 months of case management by district nurses for both older adults and informal caregivers versus usual care . MEASUREMENTS PRIMARY OUTCOME informal caregiver 's sense of competence . SECONDARY OUTCOMES caregiver 's quality of life , depressive symptoms , and burden , and patient 's quality of life . Process measurements : intervention fidelity and caregiver 's satisfaction with the quality of case management . RESULTS Linear mixed model analyses showed no statistically significant and clinical ly relevant differences over time between the two groups . The process evaluation revealed that intervention fidelity could have been better . Meanwhile , informal caregivers were satisfied with the quality of case management . CONCLUSION This study shows no benefits of case management for older adults with dementia symptoms and their primary informal caregivers . One possible explanation is that case management , which has been recommended among diagnosed dementia patients , may not be beneficial if offered too early . However , on the other h and , it is possible that : ( 1 ) case management will be effective in this group if more fully implemented and adapted or aim ed at informal caregivers who experience more severe distress and problems ; ( 2 ) case management is beneficial but that it is not seen in the timeframe studied ; ( 3 ) case management might have undetected small benefits . This has to be established . Trial registration ISCRTN83135728 OBJECTIVES To determine whether community care of people with dementia can be prolonged with a 2-year multicomponent intervention program and to analyze effects of the intervention on total usage and expenses of social and healthcare services . DESIGN R and omized controlled trial . SETTING Community-dwelling couples with one spouse caring for the other spouse with dementia . PARTICIPANTS Couples with dementia ( N=125 ) were allocated at r and om to the intervention ( n=63 ) or control group ( n=62 ) . INTERVENTION Intervention couples were provided with a multicomponent intervention program with a family care coordinator , a geriatrician , support groups for caregivers , and individualized services . MEASUREMENTS Time from enrollment to institutionalization of spouses with dementia and use of services and service expenditure of couples . RESULTS At 1.6 years , a larger proportion in the control group than in the intervention group was in long-term institutional care ( 25.8 % vs 11.1 % , P=.03 ) . At 2 years , the difference was no longer statistically significant . The 2-year adjusted hazard ratio for the intervention group was 0.53 ( 95 % confidence interval (CI)=0.23 - 1.19 , P=.12 ) . Intervention led to reduction in use of community services and expenditures . The difference for the benefit of intervention group was -7,985 Euro ( 95 % CI=-16,081 to -1,499 , P=.03 ) . When the intervention costs were included , the differences between the groups were not significant . CONCLUSION Although the intervention did not result in a significant difference in the need for institutional care after 2 years , individualizing services in collaboration with families may lead to reduction in use of and expenditures on municipal services Most caregiver interventions in a multicultural society are design ed to target caregivers from the mainstream culture and exclude those who are unable to speak English . This study addressed the gap by testing the hypothesis that personalized caregiver support provided by a team led by a care coordinator of the person with dementia would improve competence for caregivers from minority groups in managing dementia . A r and omised controlled trial was utilised to test the hypothesis . Sixty-one family caregivers from 10 minority groups completed the trial . Outcome variables were measured prior to the intervention , at 6 and 12 months after the commencement of trial . A linear mixed effect model was used to estimate the effectiveness of the intervention . The intervention group showed a significant increase in the caregivers ’ sense of competence and mental components of quality of life . There were no significant differences in the caregivers ’ physical components of quality of life BACKGROUND Treatment adherence is a widely recognized problem in health services but understudied in caregiver intervention research . This study examines caregiver sociodemographic and psychological characteristics , patient illness severity , and treatment implementation factors as predictors of caregiver adherence to a skills training intervention to help families manage dementia care problems at home . METHODS The sample consisted of 105 caregivers r and omized to the Home Environmental Skill-Building Program at the Philadelphia site of the National Institutes of Health ( NIH ) Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH I ) . The intervention , implemented by occupational therapists , consisted of education , problem solving , communication , environmental and task simplification techniques , and home modifications . Adherence was measured by a proportion score representing the percentage of strategies used by participants compared to the total number of strategies prescribed during intervention ( Strategy Use ) . RESULTS Regression analysis with intraclass correlation adjustment for interventionist effects revealed that caregivers with better physical health ( p < .001 ) , greater treatment exposure ( p < .001 ) , more problem areas addressed ( p = .012 ) , and for whom more active therapeutic techniques ( role play ) were used ( p = .004 ) demonstrated greater adherence . Other caregiver characteristics , patient cognitive impairment , and troublesome behaviors were not significantly related to caregiver adherence . 
    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: A r and omized trial of family caregiver support for the home management of older people suffering from moderate to severe progressive irreversible dementia was conducted in an urban center in southern Ontario . Thirty caregivers were allocated to receive the experimental intervention consisting of : caregiver-focused health care , education about dementia and caregiving , assistance with problem solving , regularly scheduled in-home respite , and a self-help family caregiver support group .  Thirty control subjects received conventional community nursing care . Before completion of the intervention , 18 ( 30 % ) were withdrawn , almost equally from each group . The most frequent reason was long-term institutionalization of the demented relative ( n = 10 ) . At baseline , caregivers in both groups were suffering from above-average levels of depression and anxiety . After the six-month intervention period , we found neither experimental nor control group improved in these areas . However , the experimental group showed a clinical ly important improvement in quality of life , experienced a slightly longer mean time to long-term institutionalization , found the caregiver role less problematic , and had greater satisfaction with nursing care than the control group Family caregivers , the “ second victims ” or hidden patients in dementia care , are at risk for social isolation , stress , depression , and mortality . Telephone-based support ( telesupport groups ) represents a practical , low-burden , low-cost source of emotional support . The present study evaluated the feasibility and effectiveness of professionally led telephone-based support groups for female family caregivers of community-dwelling dementia patients . Recruited through various community sources , 103 female caregivers were r and omized to the telesupport group treatment or a control condition . Effects on caregiver burden , depression , and personal gains were evaluated at 6 months , the main end point . Older care-givers ( ≥65 ) in telesupport  reported lower depression than control group caregivers did OBJECTIVES To develop and vali date a brief screening measure for use in research , healthcare , and community setting s to systematic ally assess well-being and identify needed areas of support for caregivers of patients with dementia . DESIGN This study used data from Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH II ) , a multisite r and omized clinical trial of a behavioral intervention design ed to improve the quality of life of caregivers in multiple domains . SETTING REACH II . PARTICIPANTS Two hundred twelve Hispanic , 211 black , and 219 white family caregivers providing in-home care to patients with dementia . MEASUREMENT Based on conceptual and psychometric analyses , a 16-item measure was developed that assesses six domains linked to caregiver risk and amenable to intervention : depression , burden , self-care and health behaviors , social support , safety , and patient problem behaviors . The reliability and validity of the instrument was evaluated with 642 dementia caregiver dyads from the REACH II program . RESULTS The measure was found to have acceptable internal consistency for a multidimensional scale and similar measurement properties for each of the racial and ethnic groups . Concurrent validity was also demonstrated for the measure . CONCLUSION The REACH Risk Appraisal Measure developed in this study shows promise as an assessment tool that can be used in research , clinical , and community setting s to guide , prioritize , and target needed areas of support for caregivers of patients with dementia 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 Background The World Health Organization stresses the importance of accessible and (cost)effective caregiver support , given the expected increase in the number of people with dementia and the detrimental impact on the mental health of family caregivers . Methods This study assessed the effectiveness of the Internet intervention ‘ Mastery over Dementia ’ . In a RCT , 251 caregivers , of whom six were lost at baseline , were r and omly assigned to two groups . Caregivers in the experimental group ( N = 149 ) were compared to caregivers who received a minimal intervention consisting of e-bulletins ( N = 96 ) . Outcomes were symptoms of depression ( Center for Epidemiologic Studies Depression Scale : CES-D ) and anxiety ( Hospital Anxiety and Depression Scale : HADS-A ) . All data were collected via the Internet , and an intention-to-treat analysis was carried out . Results Almost all caregivers were spouses or children ( in-law ) . They were predominantly female and lived with the care recipient in the same household . Age of the caregivers varied from 26 to 87 years . Level of education varied from primary school to university , with almost half of them holding a bachelor ’s degree or higher . Regression analyses showed that caregivers in the experimental group showed significantly lower symptoms of depression ( p = .034 ) and anxiety ( p = .007 ) post intervention after adjustment for baseline differences in the primary outcome scores and the functional status of the patients with dementia . Effect sizes were moderate for symptoms of anxiety ( .48 ) and small for depressive symptoms ( .26 ) . Conclusions The Internet course ‘ Mastery over Dementia ’ offers an effective treatment for family caregivers of people with dementia reducing symptoms of depression and anxiety . The results of this study justify further development of Internet interventions for family caregivers of people with dementia and suggest that such interventions are promising for keeping support for family caregivers accessible and affordable . The findings are even more promising because future generations of family caregivers will be more familiar with the Internet . Trial Registration Dutch Trial Register NTR-2051 www.trialregister.nl/trialreg/admin/ rct Implementation fidelity , a critical aspect of clinical trials research that establishes adequate delivery of the treatment as prescribed in treatment manuals and protocol s , is also essential to the successful implementation of effective programs into new practice setting s. Although infrequently studied in the drug abuse field , stronger implementation fidelity has been linked to better outcomes in practice but appears to be more difficult to achieve with greater distance from model developers . In the INternational CAnnabis Need for Treatment ( INCANT ) multi-national r and omized clinical trial , investigators tested the effectiveness of  Multidimensional Family Therapy ( MDFT )  in comparison to individual psychotherapy ( IP ) in Brussels , Berlin , Paris , The Hague , and Geneva with 450 adolescents with a cannabis use disorder and their parents . This study reports on the implementation fidelity of MDFT  across these five Western European sites in terms of treatment adherence , dose and program differentiation , and discusses possible implication s for international implementation efforts BACKGROUND It is believed that timely recognition and diagnosis of dementia is a pre-condition for improving care for both older adults with dementia and their informal caregivers . However , diagnosing dementia often occurs late in the disease . This means that a significant number of patients with early symptoms of dementia and their informal caregivers may lack appropriate care . OBJECTIVES To compare the effects of case management and usual care among community-dwelling older adults with early symptoms of dementia and their primary informal caregivers . DESIGN R and omized controlled trial with measurements at baseline and after 6 and 12 months . SETTING Primary care in West-Friesl and , the Netherl and s. PARTICIPANTS 99 pairs of community-dwelling older adults with dementia symptoms ( defined as abnormal screening for symptoms of dementia ) and their primary informal caregivers . INTERVENTION 12 months of case management by district nurses for both older adults and informal caregivers versus usual care . MEASUREMENTS PRIMARY OUTCOME informal caregiver 's sense of competence . SECONDARY OUTCOMES caregiver 's quality of life , depressive symptoms , and burden , and patient 's quality of life . Process measurements : intervention fidelity and caregiver 's satisfaction with the quality of case management . RESULTS Linear mixed model analyses showed no statistically significant and clinical ly relevant differences over time between the two groups . The process evaluation revealed that intervention fidelity could have been better . Meanwhile , informal caregivers were satisfied with the quality of case management . CONCLUSION This study shows no benefits of case management for older adults with dementia symptoms and their primary informal caregivers . One possible explanation is that case management , which has been recommended among diagnosed dementia patients , may not be beneficial if offered too early . However , on the other h and , it is possible that : ( 1 ) case management will be effective in this group if more fully implemented and adapted or aim ed at informal caregivers who experience more severe distress and problems ; ( 2 ) case management is beneficial but that it is not seen in the timeframe studied ; ( 3 ) case management might have undetected small benefits . This has to be established . Trial registration ISCRTN83135728 OBJECTIVES To determine whether community care of people with dementia can be prolonged with a 2-year multicomponent intervention program and to analyze effects of the intervention on total usage and expenses of social and healthcare services . DESIGN R and omized controlled trial . SETTING Community-dwelling couples with one spouse caring for the other spouse with dementia . PARTICIPANTS Couples with dementia ( N=125 ) were allocated at r and om to the intervention ( n=63 ) or control group ( n=62 ) . INTERVENTION Intervention couples were provided with a multicomponent intervention program with a family care coordinator , a geriatrician , support groups for caregivers , and individualized services . MEASUREMENTS Time from enrollment to institutionalization of spouses with dementia and use of services and service expenditure of couples . RESULTS At 1.6 years , a larger proportion in the control group than in the intervention group was in long-term institutional care ( 25.8 % vs 11.1 % , P=.03 ) . At 2 years , the difference was no longer statistically significant . The 2-year adjusted hazard ratio for the intervention group was 0.53 ( 95 % confidence interval (CI)=0.23 - 1.19 , P=.12 ) . Intervention led to reduction in use of community services and expenditures . The difference for the benefit of intervention group was -7,985 Euro ( 95 % CI=-16,081 to -1,499 , P=.03 ) . When the intervention costs were included , the differences between the groups were not significant . CONCLUSION Although the intervention did not result in a significant difference in the need for institutional care after 2 years , individualizing services in collaboration with families may lead to reduction in use of and expenditures on municipal services Most caregiver interventions in a multicultural society are design ed to target caregivers from the mainstream culture and exclude those who are unable to speak English . This study addressed the gap by testing the hypothesis that personalized caregiver support provided by a team led by a care coordinator of the person with dementia would improve competence for caregivers from minority groups in managing dementia . A r and omised controlled trial was utilised to test the hypothesis . Sixty-one family caregivers from 10 minority groups completed the trial . Outcome variables were measured prior to the intervention , at 6 and 12 months after the commencement of trial . A linear mixed effect model was used to estimate the effectiveness of the intervention . The intervention group showed a significant increase in the caregivers ’ sense of competence and mental components of quality of life . There were no significant differences in the caregivers ’ physical components of quality of life BACKGROUND Treatment adherence is a widely recognized problem in health services but understudied in caregiver intervention research . This study examines caregiver sociodemographic and psychological characteristics , patient illness severity , and treatment implementation factors as predictors of caregiver adherence to a skills training intervention to help families manage dementia care problems at home . METHODS The sample consisted of 105 caregivers r and omized to the Home Environmental Skill-Building Program at the Philadelphia site of the National Institutes of Health ( NIH ) Re sources for Enhancing Alzheimer 's Caregiver Health ( REACH I ) . The intervention , implemented by occupational therapists , consisted of education , problem solving , communication , environmental and task simplification techniques , and home modifications . Adherence was measured by a proportion score representing the percentage of strategies used by participants compared to the total number of strategies prescribed during intervention ( Strategy Use ) . RESULTS Regression analysis with intraclass correlation adjustment for interventionist effects revealed that caregivers with better physical health ( p < .001 ) , greater treatment exposure ( p < .001 ) , more problem areas addressed ( p = .012 ) , and for whom more active therapeutic techniques ( role play ) were used ( p = .004 ) demonstrated greater adherence . Other caregiver characteristics , patient cognitive impairment , and troublesome behaviors were not significantly related to caregiver adherence . 
    Output:
    