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: Effective , cost-effective , safe , and feasible interventions to improve lifestyle behavior in at-risk population s are needed in primary care . In the Hoorn Prevention Study , the authors implemented a theory-based lifestyle intervention in which trained practice nurses used an innovative combination of motivational interviewing ( MI ) and problem-solving treatment ( PST ) . This article presents the intervention ’s reach , effectiveness in terms of process outcomes , adoption , and implementation . Recruitment strategy and participant flow were documented accurately . The effectiveness in terms of determinants of behavioral change was measured using a vali date d question naire . Question naires were also used to assess participant satisfaction and compliance , as well as practice nurses ’ confidence in providing the intervention . Counseling sessions were tape recorded to assess MI , PST , and general counseling competence . The findings indicate that the recruitment strategy was adequate and result ed in a reasonably extensive reach of the target population . Practice nurses were competent and confident in their provision of  MI and PST  , and participant satisfaction was high . Nevertheless , the number of sessions attended was low , and almost no effects were seen on determinants of behavioral change . The authors conclude that implementing this type of intervention in primary care is feasible , but more is needed to effectively facilitate changes in determinants of lifestyle behavior in this population Current methodology has made popular the pragmatic r and omized trial ( Foster & Little , 2012 ) and has led to an acknowledged growth of high- quality research in the ‘ new generation ’ of psychosocial interventions in dementia care ( Orrell , 2012 ) . However , many trials of psychosocial interventions in dementia lack impact . It is not clear whether this reflects a genuine ineffectiveness , since the methodology used in dementia care research is at present weak in addressing the important distinction between genuine ineffectiveness and an implementation error . Therefore , potentially effective dementia care interventions that may have a positive impact on patient experience can fail to show effectiveness , thereby reducing treatment options and wasting research money . Method ological discussion s about the success and failure of interventions in dementia care within the European INTERDEM group of multi-professional research ers on psychosocial dementia care ( www.interdem.org/ ) led to a critical analysis of the suitability of the current methodology . This has often relied on the Medical Research Council ’s ( MRC ) Framework for complex interventions and its iterations ( Campbell et al. , 2000 ; Craig et al. , 2008 ; Craig & Petticrew , 2013 ) . Foster and Little ( 2012 ) pinpoint an important obstacle to improving clinical practice as the legacy of ‘ simple ’ drug therapy evaluations which are engrained in the design and conduct of the pragmatic trial , a view that can also be extended more generally to the interpretation and conduct of the MRC framework for complex interventions and its method ologies . The advantage of pragmatic trials is their proximity to daily practice in routine health care setting s. This has particular implication s for the design and conduct of psychosocial intervention research in dementia , where the important distinction between poor attention to implementation and genuine ineffectiveness is often overlooked . Furthermore , better attention to the implication s of this proximity in the design and conduct of psychosocial intervention research trials may reduce the need for a separate large-scale implementation study phase in the way that this is currently conceived within the MRC approach to complex interventions ( Craig et al. , 2008 ; Craig & Petticrew , 2013 ) . This is an urgent issue for psychosocial intervention research in dementia care as today 35.6 million people and families worldwide live with dementia ( Prince et al. , 2013 ) , whilst major pharmaceutical advances in prevention and cure remain elusive ( Miller , 2012 ) . The predicted future growth of dementia cases over the next decade will undoubtedly raise the already high costs of care , estimated at US$ 604 billion in 2010 ( Wimo et al. , 2013 ) , in an illness that is most feared people over the age of 55 years ( Le Couteur , Doust , Creasey , & Brayne , 2013 ) , since it can undermine core human capacities result ing in decline in quality of life ( Selkoe , 2012 ) . Although cure for dementia is not available for dementia patients , we are not empty h and ed . Psychosocial intervention research has emerged as today ’s forerunner , given its aim to improve daily practice among professionals who provide support to people and families living with dementia .  Psychosocial interventions in dementia involve interactions between people to improve psychological and social functioning ( Moniz-Cook , Vernooij-Dassen , Woods , & Orrell , 2011 ; Rabins et al. , 2007 ) , such as cognitive stimulation therapy ( Woods , Aguirre , Spector , & Orrell , 2012 ) , occupational therapy ( Graff et al. , 2006 ) and support programmes for family carers ( Vernooij-Dassen , Draskovic , McCleery , & Downs , 2011 ) . This paper outlines the rationale for a paradigm shift in the design and methodology for evaluation of complex interventions in applied dementia care research . We use  psychosocial intervention research as an exemplar of how research ers and their funders may achieve better value for money Many intervention studies lack an investigation of the extent to which the intervention was implemented as intended , which makes outcome measures difficult to interpret . The aim of the present study was to gain insight into the implementation process of snoezelen in 24-h dementia care . The intervention in each of six experimental wards comprised  training sessions in ' snoezelen for caregivers '  , evaluated using a question naire . To study experience with implementation , the follow-up and general meetings ( 20 in total ) were attended and semi-structured interviews ( six in total ) were conducted . The results indicated that the implementation of snoezelen effected a change from task-oriented care to resident-oriented care . The nursing assistants also experienced changes at the resident level and organisational changes . However , the lack of intervention in the organisational structure and obstructive factors such as under-staffing seemed to get in the way of the integration of multi-sensory stimulation in the daily care in two of the six wards PURPOSE We examined the effects of communication skills training and the use of memory books by certified nursing assistants ( CNAs )  on verbal interactions between CNAs ( n = 64 ) and nursing home residents ( n = 67 ) during care routines . DESIGN AND METHODS  CNAs  were taught to use communication skills and memory books during their interactions with residents with moderate cognitive impairments and intact communication abilities . A staff motivational system was used to encourage performance and maintenance of these skills . Formal measures of treatment implementation were included . RESULTS Results were compared with those for participants on no-treatment control units . Trained CNAs talked more , used positive statements more frequently , and tended to increase the number of specific instructions given to residents . Changes in staff behavior did not result in an increase in total time giving care to residents . Maintenance of CNA behavior change was found 2 months after research staff exited the facility . Although an increase was found in positive verbal interactions between CNAs and residents on intervention units , other changes in resident communication were absent . IMPLICATION S Nursing staff can be trained to improve and maintain communication skills during care without increasing the amount of time delivering care . The method ological advantages of including measures to assess treatment implementation are discussed This study was design ed to investigate the impact of staff education on the behaviour and quality of life of residents with dementia and on staff members ’ attitudes about working with people with dementia and level of burnout .  Staff from three aged care facilities participated in the study ( n = 52 ) . These facilities were r and omly assigned to one of two intervention groups or a control group . Staff assigned to the intervention groups received an eight-week behaviourally-based programme . Staff from one aged care facility also participated in a peer support group design ed to reinforce educational material and facilitate positive changes among staff members . Behavioural symptoms displayed by residents ( n = 76 ) in each of the facilities were also assessed . Assessment s were conducted at pre-intervention , post-intervention , three- and six-month follow-up . The results of this study indicated that education or peer support was not associated with an improvement in resident behaviour or quality of life . Education or peer support also did not impact on staff members ’ level of burnout . There was , however , a change in staff members ’ attitudes about working with people with dementia . Possible explanations for these findings and implication for further research are considered AIM The aim of this study was to gain insight into compliance with the introduction of a new care model [ emotion-orientated care ( EOC ) ] as part of an intervention study ( RCT ) in psycho-geriatric care . The success of the implementation ( compliance ) , as well as the expectations and experiences concerning the training were studied . METHODS Observations were conducted in four intervention homes and four control homes , and care-plans of residents were also analysed to see whether the implementation had succeeded . Semi-structured interviews were conducted with four persons in each of the four intervention sites ( a total of 16 interviews ) to study the experiences with the training and implementation . FINDINGS The observations showed no clear differences between intervention and control homes with regard to the interactions between residents and professional caregivers . Analysis of the reporting systems revealed differences within , as well as between , the intervention and control homes . The content of the reports showed no differences between the intervention and control homes . The interviewees had different expectations of the EOC training , depending on their disciplinary background . The caregivers regarded the training as a confirmation of their current practice . They experienced some changes at the individual level and some of them reported that the co-operation between units had become better . At the home-level no changes were reported . Every interviewee indicated that the implementation of EOC was difficult and laborious and that there were ( mainly organizational ) obstacles that could hinder the implementation of the EOC training . CONCLUSIONS Observations and the analysis of the reporting systems indicated that there was no clear difference between intervention homes and control homes as to the actual implementation of the intervention , indicating that the compliance with the new care model was not optimal . The interviews gave some insight into factors that caused lack of compliance OBJECTIVE To investigate the effectiveness of snoezelen , integrated in 24-hour care , on the communication of Certified Nursing Assistants ( CNAs ) and demented nursing home residents during morning care . METHODS A quasi-experimental pre- and post-test design was conducted , comparing sic psychogeriatric wards , that implemented snoezelen , to six control wards , that continued in giving usual care . Measurements were performed at baseline and 18 months after a training ' snoezelen for caregivers ' . Independent assessors analysed 250 video-recordings directly from the computer , using an adapted version of the  Roter Interaction Analysis System ( RIAS ) and non-verbal measurements . RESULTS Trained CNAs showed a significant increase of resident-directed gaze , affective touch and smiling . The total number of verbal utterances also increased ( more social conversation , agreement , talking about sensory stimuli , information and autonomy ) . Regarding residents , a significant treatment effect was found for smiling , CNA-directed gaze , negative verbal behaviours ( less disapproval and anger ) and verbal expressed autonomy . CONCLUSION The implementation of snoezelen improved the actual communication during morning care . PRACTICE IMPLICATION S Teaching CNAs to provide snoezelen has added value for the quality of care . Morning care by trained CNAs appeared to take more time . This suggests that ( some ) time investment might be required to achieve positive effects on CNA- resident communication 
    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: Effective , cost-effective , safe , and feasible interventions to improve lifestyle behavior in at-risk population s are needed in primary care . In the Hoorn Prevention Study , the authors implemented a theory-based lifestyle intervention in which trained practice nurses used an innovative combination of motivational interviewing ( MI ) and problem-solving treatment ( PST ) . This article presents the intervention ’s reach , effectiveness in terms of process outcomes , adoption , and implementation . Recruitment strategy and participant flow were documented accurately . The effectiveness in terms of determinants of behavioral change was measured using a vali date d question naire . Question naires were also used to assess participant satisfaction and compliance , as well as practice nurses ’ confidence in providing the intervention . Counseling sessions were tape recorded to assess MI , PST , and general counseling competence . The findings indicate that the recruitment strategy was adequate and result ed in a reasonably extensive reach of the target population . Practice nurses were competent and confident in their provision of  MI and PST  , and participant satisfaction was high . Nevertheless , the number of sessions attended was low , and almost no effects were seen on determinants of behavioral change . The authors conclude that implementing this type of intervention in primary care is feasible , but more is needed to effectively facilitate changes in determinants of lifestyle behavior in this population Current methodology has made popular the pragmatic r and omized trial ( Foster & Little , 2012 ) and has led to an acknowledged growth of high- quality research in the ‘ new generation ’ of psychosocial interventions in dementia care ( Orrell , 2012 ) . However , many trials of psychosocial interventions in dementia lack impact . It is not clear whether this reflects a genuine ineffectiveness , since the methodology used in dementia care research is at present weak in addressing the important distinction between genuine ineffectiveness and an implementation error . Therefore , potentially effective dementia care interventions that may have a positive impact on patient experience can fail to show effectiveness , thereby reducing treatment options and wasting research money . Method ological discussion s about the success and failure of interventions in dementia care within the European INTERDEM group of multi-professional research ers on psychosocial dementia care ( www.interdem.org/ ) led to a critical analysis of the suitability of the current methodology . This has often relied on the Medical Research Council ’s ( MRC ) Framework for complex interventions and its iterations ( Campbell et al. , 2000 ; Craig et al. , 2008 ; Craig & Petticrew , 2013 ) . Foster and Little ( 2012 ) pinpoint an important obstacle to improving clinical practice as the legacy of ‘ simple ’ drug therapy evaluations which are engrained in the design and conduct of the pragmatic trial , a view that can also be extended more generally to the interpretation and conduct of the MRC framework for complex interventions and its method ologies . The advantage of pragmatic trials is their proximity to daily practice in routine health care setting s. This has particular implication s for the design and conduct of psychosocial intervention research in dementia , where the important distinction between poor attention to implementation and genuine ineffectiveness is often overlooked . Furthermore , better attention to the implication s of this proximity in the design and conduct of psychosocial intervention research trials may reduce the need for a separate large-scale implementation study phase in the way that this is currently conceived within the MRC approach to complex interventions ( Craig et al. , 2008 ; Craig & Petticrew , 2013 ) . This is an urgent issue for psychosocial intervention research in dementia care as today 35.6 million people and families worldwide live with dementia ( Prince et al. , 2013 ) , whilst major pharmaceutical advances in prevention and cure remain elusive ( Miller , 2012 ) . The predicted future growth of dementia cases over the next decade will undoubtedly raise the already high costs of care , estimated at US$ 604 billion in 2010 ( Wimo et al. , 2013 ) , in an illness that is most feared people over the age of 55 years ( Le Couteur , Doust , Creasey , & Brayne , 2013 ) , since it can undermine core human capacities result ing in decline in quality of life ( Selkoe , 2012 ) . Although cure for dementia is not available for dementia patients , we are not empty h and ed . Psychosocial intervention research has emerged as today ’s forerunner , given its aim to improve daily practice among professionals who provide support to people and families living with dementia .  Psychosocial interventions in dementia involve interactions between people to improve psychological and social functioning ( Moniz-Cook , Vernooij-Dassen , Woods , & Orrell , 2011 ; Rabins et al. , 2007 ) , such as cognitive stimulation therapy ( Woods , Aguirre , Spector , & Orrell , 2012 ) , occupational therapy ( Graff et al. , 2006 ) and support programmes for family carers ( Vernooij-Dassen , Draskovic , McCleery , & Downs , 2011 ) . This paper outlines the rationale for a paradigm shift in the design and methodology for evaluation of complex interventions in applied dementia care research . We use  psychosocial intervention research as an exemplar of how research ers and their funders may achieve better value for money Many intervention studies lack an investigation of the extent to which the intervention was implemented as intended , which makes outcome measures difficult to interpret . The aim of the present study was to gain insight into the implementation process of snoezelen in 24-h dementia care . The intervention in each of six experimental wards comprised  training sessions in ' snoezelen for caregivers '  , evaluated using a question naire . To study experience with implementation , the follow-up and general meetings ( 20 in total ) were attended and semi-structured interviews ( six in total ) were conducted . The results indicated that the implementation of snoezelen effected a change from task-oriented care to resident-oriented care . The nursing assistants also experienced changes at the resident level and organisational changes . However , the lack of intervention in the organisational structure and obstructive factors such as under-staffing seemed to get in the way of the integration of multi-sensory stimulation in the daily care in two of the six wards PURPOSE We examined the effects of communication skills training and the use of memory books by certified nursing assistants ( CNAs )  on verbal interactions between CNAs ( n = 64 ) and nursing home residents ( n = 67 ) during care routines . DESIGN AND METHODS  CNAs  were taught to use communication skills and memory books during their interactions with residents with moderate cognitive impairments and intact communication abilities . A staff motivational system was used to encourage performance and maintenance of these skills . Formal measures of treatment implementation were included . RESULTS Results were compared with those for participants on no-treatment control units . Trained CNAs talked more , used positive statements more frequently , and tended to increase the number of specific instructions given to residents . Changes in staff behavior did not result in an increase in total time giving care to residents . Maintenance of CNA behavior change was found 2 months after research staff exited the facility . Although an increase was found in positive verbal interactions between CNAs and residents on intervention units , other changes in resident communication were absent . IMPLICATION S Nursing staff can be trained to improve and maintain communication skills during care without increasing the amount of time delivering care . The method ological advantages of including measures to assess treatment implementation are discussed This study was design ed to investigate the impact of staff education on the behaviour and quality of life of residents with dementia and on staff members ’ attitudes about working with people with dementia and level of burnout .  Staff from three aged care facilities participated in the study ( n = 52 ) . These facilities were r and omly assigned to one of two intervention groups or a control group . Staff assigned to the intervention groups received an eight-week behaviourally-based programme . Staff from one aged care facility also participated in a peer support group design ed to reinforce educational material and facilitate positive changes among staff members . Behavioural symptoms displayed by residents ( n = 76 ) in each of the facilities were also assessed . Assessment s were conducted at pre-intervention , post-intervention , three- and six-month follow-up . The results of this study indicated that education or peer support was not associated with an improvement in resident behaviour or quality of life . Education or peer support also did not impact on staff members ’ level of burnout . There was , however , a change in staff members ’ attitudes about working with people with dementia . Possible explanations for these findings and implication for further research are considered AIM The aim of this study was to gain insight into compliance with the introduction of a new care model [ emotion-orientated care ( EOC ) ] as part of an intervention study ( RCT ) in psycho-geriatric care . The success of the implementation ( compliance ) , as well as the expectations and experiences concerning the training were studied . METHODS Observations were conducted in four intervention homes and four control homes , and care-plans of residents were also analysed to see whether the implementation had succeeded . Semi-structured interviews were conducted with four persons in each of the four intervention sites ( a total of 16 interviews ) to study the experiences with the training and implementation . FINDINGS The observations showed no clear differences between intervention and control homes with regard to the interactions between residents and professional caregivers . Analysis of the reporting systems revealed differences within , as well as between , the intervention and control homes . The content of the reports showed no differences between the intervention and control homes . The interviewees had different expectations of the EOC training , depending on their disciplinary background . The caregivers regarded the training as a confirmation of their current practice . They experienced some changes at the individual level and some of them reported that the co-operation between units had become better . At the home-level no changes were reported . Every interviewee indicated that the implementation of EOC was difficult and laborious and that there were ( mainly organizational ) obstacles that could hinder the implementation of the EOC training . CONCLUSIONS Observations and the analysis of the reporting systems indicated that there was no clear difference between intervention homes and control homes as to the actual implementation of the intervention , indicating that the compliance with the new care model was not optimal . The interviews gave some insight into factors that caused lack of compliance OBJECTIVE To investigate the effectiveness of snoezelen , integrated in 24-hour care , on the communication of Certified Nursing Assistants ( CNAs ) and demented nursing home residents during morning care . METHODS A quasi-experimental pre- and post-test design was conducted , comparing sic psychogeriatric wards , that implemented snoezelen , to six control wards , that continued in giving usual care . Measurements were performed at baseline and 18 months after a training ' snoezelen for caregivers ' . Independent assessors analysed 250 video-recordings directly from the computer , using an adapted version of the  Roter Interaction Analysis System ( RIAS ) and non-verbal measurements . RESULTS Trained CNAs showed a significant increase of resident-directed gaze , affective touch and smiling . The total number of verbal utterances also increased ( more social conversation , agreement , talking about sensory stimuli , information and autonomy ) . Regarding residents , a significant treatment effect was found for smiling , CNA-directed gaze , negative verbal behaviours ( less disapproval and anger ) and verbal expressed autonomy . CONCLUSION The implementation of snoezelen improved the actual communication during morning care . PRACTICE IMPLICATION S Teaching CNAs to provide snoezelen has added value for the quality of care . Morning care by trained CNAs appeared to take more time . This suggests that ( some ) time investment might be required to achieve positive effects on CNA- resident communication 
    Output:
    