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 Before completion of the intervention , 18 ( 30 % ) were withdrawn , almost equally from each group .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 OBJECTIVES To evaluate the sleep-wake patterns of community-dwelling patients with dementia and their primary caregivers before , during , and after 2-week periods of institutional respite care .  DESIGN Prospect i ve case series . SETTING Four community hospital units in East Midl and s , United Kingdom . PARTICIPANTS Thirty-nine patients meeting Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , criteria for dementia and caregivers completed baseline assessment s ; 33 of these dyads completed the full protocol . INTERVENTION A 2-week period of institutional respite care during which patients were admitted to community hospitals ( and received routine care ) while caregivers remained at home . MEASUREMENTS For patients and caregivers , primary sleep outcomes were derived from 6 weeks of continuous wrist actigraphy ( 2 weeks baseline ; 2 weeks respite ; 2 weeks follow-up ) using the Actiwatch system . For caregivers , actigraphic measures were augmented with assessment s of quality of life ( using the Medical Outcomes Study 36-item Short Form survey ) and quality of sleep ( using the Pittsburgh Sleep Quality Index ) at baseline and by daily sleep diaries and weekly Epworth Sleepiness Scale ratings throughout the study . RESULTS At baseline , caregivers and patients showed profiles of clinical ly significant sleep disturbance . For caregivers , respite periods were associated with significant ( P<.05 ) increases in total sleep time per night , total time in bed per night , and improvements in subjective sleep quality . The benefits of respite were most evident for caregivers who did not share a bedroom with the patient . For patients , respite was associated with significant ( P<.05 ) increases in sleep onset latency , reductions in total sleep time per night , and weakening of the circadian activity rhythm . All measures shifted in the direction of baseline levels at follow-up . CONCLUSION Dementia caregivers show a profile of sleep disturbance consistent with adjustment insomnia , with sleep disturbances partially reversed during periods of institutional respite care . Nevertheless , for patients , respite care worsens already disturbed sleep patterns . To optimize benefits for caregivers and patients , respite care should target sleep management Two groups of care-givers to dementia sufferers were interviewed to assess their psychological symptoms and the behaviour problems of the dementia sufferers . The first group were using  special dementia day care while the second group were about to begin using it . The second group were re-interviewed three months later . Therefore two comparisons could be made ; a with/without day care comparison and a before/after admission to day care comparison . Care-givers had a high level of psychological symptoms which were not significantly reduced by using day care . Full-time institutional care did reduce distress . Day centre clients continued to deteriorate as would be expected with a degenerative condition . While special dementia day care centres appear to play a useful role for many care-givers , they may provide too few hours relief per week to markedly reduce the care-givers ' psychological symptoms . Family care-givers currently take the major role in caring for dementia sufferers in the community and the burden of care needs to be shared more equitably Purpose Caregivers of individuals with dementia experience elevated stress that places them at increased risk for health problems . The purpose of this study was to compare a complementary/alternative medicine ( CAM ) method , Polarity therapy ( PT ) , to an enhanced respite control condition ( ERC ) to reduce stress , depression and pain for American Indian and Alaskan Native ( AI ) family caregivers . A mixed methods , community participatory , indigenous values approach was combined with a r and omized controlled clinical trial to assure both ecological validity and scientific rigor of the investigation STUDY QUESTION Did the  Medicare Alzheimer 's Disease Demonstration with its case management and community service waivers affect the use of community-based long-term care services among people with dementia and their primary caregivers ? DATA SOURCES Baseline and periodic caregiver interviews . Measures include client and caregiver attributes and self-reported service use . STUDY DESIGN The demonstration r and omly assigned voluntary applicants into treatment and control groups . Treatment group cases were eligible for case management  and for up to $ 699 per month in community care benefits . The actual monthly entitlement varied among the eight demonstration communities due to regional cost and inflation adjustments over time . Analyses are for the year after enrollment . DATA COLLECTION Analyses are of cases surviving six months or more in the community after enrollment ( n = 5,209 ) . Cases received baseline and semi-annual assessment s. PRINCIPAL FINDINGS The intervention of case management and community service reimbursement had a strong , consistent , and positive effect on the likelihood of using home care ( including homemaker/chore services , personal care services , companion services ) and adult day care . Treatment group clients were at least twice as likely as control group clients to be using any of the four community-based services . A similar , but less pervasive effect was achieved with caregiver training and support group participation . Reimbursement provided by the demonstration 's Medicare waiver was generally not sufficient to exceed the level of control group service acquired through private payment . CONCLUSIONS Reimbursement levels within the demonstration may have enabled more individuals to purchase some services , but they were not sufficient to increase the average level of use over those in the control group . No consistent differences between demonstration models were found in service use likelihood or average use among users Background Decision aids are often used to assist individuals confronted with a diagnosis of a serious illness to make decisions about treatment options . However , they are rarely utilised to help those with chronic or age related conditions to make decisions about care services . Decision aids should also be useful for carers of people with decreased decisional capacity . These carers ' choices must balance health outcomes for themselves and for salient others with relational and value-based concerns , while relying on information from health professionals . This paper reports on a study that both developed and pilot tested a decision aid aim ed at assisting carers to make evaluative judgements of community services , particularly respite care . Methods A mixed method sequential study , involving qualitative development and a pilot r and omised controlled trial , was conducted in Tasmania , Australia . We undertook 13 semi-structured interviews and three focus groups to inform the development of the decision aid . For the r and omised control trial we r and omly assigned 31 carers of people with dementia to either receive the service decision aid  at the start or end of the study . The primary outcome was measured by comparing the difference in carer burden between the two groups three months after the intervention group received the decision aid . Pilot data was collected from carers using interviewer-administered question naires at the commencement of the project , two weeks and 12 weeks later . Results The qualitative data strongly suggest that the intervention provides carers with needed decision support . Most carers felt that the decision aid was useful . The trial data demonstrated that , using the mean change between baseline and three month follow-up , the intervention group had less increase in burden , a decrease in decisional conflict and increased knowledge compared to control group participants . Conclusions While these results must be interpreted with caution due to the small sample size , all intervention results trend in a direction that is beneficial for carers and their decisional ability . Mixed method data suggest the decision aid provides decisional support that carers do not otherwise receive . Decision aids may prove useful in a community health services context .Trial registration numberIS RCT N : IS RCT OBJECTIVE --To reduce the psychological stress and improve the skills in coping of people who care for relatives with dementia . DESIGN -- Assessment and suitability of carers by question naire ; assessment of patients and carers in a hospital outpatient clinic ; allocation to groups according to date of application to study . Linkage of groups of four carers and programme coordinator by telephone conference calls over 12 months after programmes . Re assessment at three , six , 12 , and , for those in the " wait list " group , 18 months . SETTING --The programmes were conducted in the psychiatry unit of a Sydney teaching hospital . SUBJECTS -- Eligible patients were less than 80 years old , had mild to moderate dementia , and lived at home with their carer . Of the 96 patient-carer pairs in the study , 33 were in the dementia carers ' programme group  , 31 were in the memory retraining group , and 32 were in the wait list group . INTERVENTIONS --Carers in the dementia carers ' programme received training in coping with the difficulties of looking after patients with dementia while the patients had sessions in subjects such as memory retraining . In the memory retraining programme  patients were admitted and received the patient component of the carers ' programme while their carers had 10 days ' respite . In the wait list group carers waited six months before undertaking the carers ' programme . MAIN OUTCOME MEASURES --Effect of the programmes on carers ' general health question naire scores and the rate of placement of patients in institutions . RESULTS --At 12 months ' follow up the carers ' programme had result ed in significantly lower psychological stress among carers than the memory retraining programme ( mean ( SD ) general health question naire scores at 0 months were 6.31 ( 6.23 ) and 3.60 ( 6.25 ) respectively , and at 12 months were 4.69 ( 5.58 ) and 7.40 ( 9.39 ) ; p less than 0.05 . ) In the wait list group distress scores remained stable , even after the carers and patients had undertaken the carers ' programme . Patients deteriorated over 12 months regardless of group allocation , but at 30 months , allowing for patients who died and could not be included in the analysis , 65 % of patients in the carers ' programme group were still living at home compared with 26 % in the memory retraining programme group . CONCLUSION --The intensive intervention programme described for carers of patients with dementia can reduce the psychological morbidity of the carer and delay the placement of the patient in an institution without increasing the use of health services by either patient or carer To evaluate nonpharmacologic interventions , caregivers ( 65 women , 38 men ) and their dementia-diagnosed spouses ( patients ) were r and omized to one of four treatment programs ( cognitive stimulation , dyadic counseling , dual supportive seminar , and early-stage day care ) or to a wait-list control group . Assessment s occurred initially and at postintervention ( 3 months ) . Patients were evaluated on memory , verbal fluency , and problem-solving ability , and caregivers were assessed on marital interaction , emotional status , and physical health , along with stress , coping , and social support .  Caregivers also completed a program evaluation . Repeated measures procedures showed that patients in the cognitive stimulation group demonstrated more improvement over time in cognitive outcomes , and caregivers decreased in depressive symptoms . Early-stage day-care and dual supportive seminar group caregivers reported a decrease in hostility and a decrease in use of negative coping strategies , respectively . Although qualitatively derived benefits differed across groups , similarities in program content reduced the potential for quantitative differentiation among the groups OBJECTIVE To examine the effects of Day Care ( DC ) on demented patients . DESIGN A prospect i ve non-r and omized concurrent-control study . PARTICIPANTS 55 demented patients in DC and 44 controls . SETTING Sundsvall , an industrial community in northern Sweden . MAIN OUTCOME MEASURE Cognition , ADL-functions , behaviour and institutionalization . RESULTS Measurements of cognition , ADL-functions , and behaviour showed no or only small differences between the groups . After one year , 24 % of the patients in the DC-group were institutionalized , compared with 44 % of the controls . In the control group , the exhaustion of spouse and supervision need were highly correlated to institutionalization ( p < 0.001 ) , while high physical nursing load was correlated to institutionalization in the DC-group ( p < 0.01 ) . CONCLUSION DC postpones institutionalization , probably because of less exhaustion of spouses and decreased supervision need A 14-item , self-administered , multidimensional , functional social support question naire was design ed and evaluated on 401 patients attending a family medicine clinic . Patients were selected from r and omized time-frame sampling blocks during regular office hours . The population was predominantly white , female , married , and under age 45 . Eleven items remained after test-retest reliability was assessed over a 1- to 4-week follow-up period . Factor analysis and item remainder analysis reduced the remaining 11 items to a brief and easy-to-complete two-scale , eight-item functional social support instrument . Construct validity , concurrent validity , and discriminant validity are demonstrated for the two scales ( confidant support — five items and affective support —three items ) . Factor analysis and correlations with other measures of social support suggest that the three remaining items ( visits , instrumental support , and praise ) are distinct entities that may need further study Applicants for a newly opened special unit for dementia sufferers were r and omly allocated to full-time care in the unit or placed on a waiting list and offered periodic respite care in the 
    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 OBJECTIVES To evaluate the sleep-wake patterns of community-dwelling patients with dementia and their primary caregivers before , during , and after 2-week periods of institutional respite care .  DESIGN Prospect i ve case series . SETTING Four community hospital units in East Midl and s , United Kingdom . PARTICIPANTS Thirty-nine patients meeting Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , criteria for dementia and caregivers completed baseline assessment s ; 33 of these dyads completed the full protocol . INTERVENTION A 2-week period of institutional respite care during which patients were admitted to community hospitals ( and received routine care ) while caregivers remained at home . MEASUREMENTS For patients and caregivers , primary sleep outcomes were derived from 6 weeks of continuous wrist actigraphy ( 2 weeks baseline ; 2 weeks respite ; 2 weeks follow-up ) using the Actiwatch system . For caregivers , actigraphic measures were augmented with assessment s of quality of life ( using the Medical Outcomes Study 36-item Short Form survey ) and quality of sleep ( using the Pittsburgh Sleep Quality Index ) at baseline and by daily sleep diaries and weekly Epworth Sleepiness Scale ratings throughout the study . RESULTS At baseline , caregivers and patients showed profiles of clinical ly significant sleep disturbance . For caregivers , respite periods were associated with significant ( P<.05 ) increases in total sleep time per night , total time in bed per night , and improvements in subjective sleep quality . The benefits of respite were most evident for caregivers who did not share a bedroom with the patient . For patients , respite was associated with significant ( P<.05 ) increases in sleep onset latency , reductions in total sleep time per night , and weakening of the circadian activity rhythm . All measures shifted in the direction of baseline levels at follow-up . CONCLUSION Dementia caregivers show a profile of sleep disturbance consistent with adjustment insomnia , with sleep disturbances partially reversed during periods of institutional respite care . Nevertheless , for patients , respite care worsens already disturbed sleep patterns . To optimize benefits for caregivers and patients , respite care should target sleep management Two groups of care-givers to dementia sufferers were interviewed to assess their psychological symptoms and the behaviour problems of the dementia sufferers . The first group were using  special dementia day care while the second group were about to begin using it . The second group were re-interviewed three months later . Therefore two comparisons could be made ; a with/without day care comparison and a before/after admission to day care comparison . Care-givers had a high level of psychological symptoms which were not significantly reduced by using day care . Full-time institutional care did reduce distress . Day centre clients continued to deteriorate as would be expected with a degenerative condition . While special dementia day care centres appear to play a useful role for many care-givers , they may provide too few hours relief per week to markedly reduce the care-givers ' psychological symptoms . Family care-givers currently take the major role in caring for dementia sufferers in the community and the burden of care needs to be shared more equitably Purpose Caregivers of individuals with dementia experience elevated stress that places them at increased risk for health problems . The purpose of this study was to compare a complementary/alternative medicine ( CAM ) method , Polarity therapy ( PT ) , to an enhanced respite control condition ( ERC ) to reduce stress , depression and pain for American Indian and Alaskan Native ( AI ) family caregivers . A mixed methods , community participatory , indigenous values approach was combined with a r and omized controlled clinical trial to assure both ecological validity and scientific rigor of the investigation STUDY QUESTION Did the  Medicare Alzheimer 's Disease Demonstration with its case management and community service waivers affect the use of community-based long-term care services among people with dementia and their primary caregivers ? DATA SOURCES Baseline and periodic caregiver interviews . Measures include client and caregiver attributes and self-reported service use . STUDY DESIGN The demonstration r and omly assigned voluntary applicants into treatment and control groups . Treatment group cases were eligible for case management  and for up to $ 699 per month in community care benefits . The actual monthly entitlement varied among the eight demonstration communities due to regional cost and inflation adjustments over time . Analyses are for the year after enrollment . DATA COLLECTION Analyses are of cases surviving six months or more in the community after enrollment ( n = 5,209 ) . Cases received baseline and semi-annual assessment s. PRINCIPAL FINDINGS The intervention of case management and community service reimbursement had a strong , consistent , and positive effect on the likelihood of using home care ( including homemaker/chore services , personal care services , companion services ) and adult day care . Treatment group clients were at least twice as likely as control group clients to be using any of the four community-based services . A similar , but less pervasive effect was achieved with caregiver training and support group participation . Reimbursement provided by the demonstration 's Medicare waiver was generally not sufficient to exceed the level of control group service acquired through private payment . CONCLUSIONS Reimbursement levels within the demonstration may have enabled more individuals to purchase some services , but they were not sufficient to increase the average level of use over those in the control group . No consistent differences between demonstration models were found in service use likelihood or average use among users Background Decision aids are often used to assist individuals confronted with a diagnosis of a serious illness to make decisions about treatment options . However , they are rarely utilised to help those with chronic or age related conditions to make decisions about care services . Decision aids should also be useful for carers of people with decreased decisional capacity . These carers ' choices must balance health outcomes for themselves and for salient others with relational and value-based concerns , while relying on information from health professionals . This paper reports on a study that both developed and pilot tested a decision aid aim ed at assisting carers to make evaluative judgements of community services , particularly respite care . Methods A mixed method sequential study , involving qualitative development and a pilot r and omised controlled trial , was conducted in Tasmania , Australia . We undertook 13 semi-structured interviews and three focus groups to inform the development of the decision aid . For the r and omised control trial we r and omly assigned 31 carers of people with dementia to either receive the service decision aid  at the start or end of the study . The primary outcome was measured by comparing the difference in carer burden between the two groups three months after the intervention group received the decision aid . Pilot data was collected from carers using interviewer-administered question naires at the commencement of the project , two weeks and 12 weeks later . Results The qualitative data strongly suggest that the intervention provides carers with needed decision support . Most carers felt that the decision aid was useful . The trial data demonstrated that , using the mean change between baseline and three month follow-up , the intervention group had less increase in burden , a decrease in decisional conflict and increased knowledge compared to control group participants . Conclusions While these results must be interpreted with caution due to the small sample size , all intervention results trend in a direction that is beneficial for carers and their decisional ability . Mixed method data suggest the decision aid provides decisional support that carers do not otherwise receive . Decision aids may prove useful in a community health services context .Trial registration numberIS RCT N : IS RCT OBJECTIVE --To reduce the psychological stress and improve the skills in coping of people who care for relatives with dementia . DESIGN -- Assessment and suitability of carers by question naire ; assessment of patients and carers in a hospital outpatient clinic ; allocation to groups according to date of application to study . Linkage of groups of four carers and programme coordinator by telephone conference calls over 12 months after programmes . Re assessment at three , six , 12 , and , for those in the " wait list " group , 18 months . SETTING --The programmes were conducted in the psychiatry unit of a Sydney teaching hospital . SUBJECTS -- Eligible patients were less than 80 years old , had mild to moderate dementia , and lived at home with their carer . Of the 96 patient-carer pairs in the study , 33 were in the dementia carers ' programme group  , 31 were in the memory retraining group , and 32 were in the wait list group . INTERVENTIONS --Carers in the dementia carers ' programme received training in coping with the difficulties of looking after patients with dementia while the patients had sessions in subjects such as memory retraining . In the memory retraining programme  patients were admitted and received the patient component of the carers ' programme while their carers had 10 days ' respite . In the wait list group carers waited six months before undertaking the carers ' programme . MAIN OUTCOME MEASURES --Effect of the programmes on carers ' general health question naire scores and the rate of placement of patients in institutions . RESULTS --At 12 months ' follow up the carers ' programme had result ed in significantly lower psychological stress among carers than the memory retraining programme ( mean ( SD ) general health question naire scores at 0 months were 6.31 ( 6.23 ) and 3.60 ( 6.25 ) respectively , and at 12 months were 4.69 ( 5.58 ) and 7.40 ( 9.39 ) ; p less than 0.05 . ) In the wait list group distress scores remained stable , even after the carers and patients had undertaken the carers ' programme . Patients deteriorated over 12 months regardless of group allocation , but at 30 months , allowing for patients who died and could not be included in the analysis , 65 % of patients in the carers ' programme group were still living at home compared with 26 % in the memory retraining programme group . CONCLUSION --The intensive intervention programme described for carers of patients with dementia can reduce the psychological morbidity of the carer and delay the placement of the patient in an institution without increasing the use of health services by either patient or carer To evaluate nonpharmacologic interventions , caregivers ( 65 women , 38 men ) and their dementia-diagnosed spouses ( patients ) were r and omized to one of four treatment programs ( cognitive stimulation , dyadic counseling , dual supportive seminar , and early-stage day care ) or to a wait-list control group . Assessment s occurred initially and at postintervention ( 3 months ) . Patients were evaluated on memory , verbal fluency , and problem-solving ability , and caregivers were assessed on marital interaction , emotional status , and physical health , along with stress , coping , and social support .  Caregivers also completed a program evaluation . Repeated measures procedures showed that patients in the cognitive stimulation group demonstrated more improvement over time in cognitive outcomes , and caregivers decreased in depressive symptoms . Early-stage day-care and dual supportive seminar group caregivers reported a decrease in hostility and a decrease in use of negative coping strategies , respectively . Although qualitatively derived benefits differed across groups , similarities in program content reduced the potential for quantitative differentiation among the groups OBJECTIVE To examine the effects of Day Care ( DC ) on demented patients . DESIGN A prospect i ve non-r and omized concurrent-control study . PARTICIPANTS 55 demented patients in DC and 44 controls . SETTING Sundsvall , an industrial community in northern Sweden . MAIN OUTCOME MEASURE Cognition , ADL-functions , behaviour and institutionalization . RESULTS Measurements of cognition , ADL-functions , and behaviour showed no or only small differences between the groups . After one year , 24 % of the patients in the DC-group were institutionalized , compared with 44 % of the controls . In the control group , the exhaustion of spouse and supervision need were highly correlated to institutionalization ( p < 0.001 ) , while high physical nursing load was correlated to institutionalization in the DC-group ( p < 0.01 ) . CONCLUSION DC postpones institutionalization , probably because of less exhaustion of spouses and decreased supervision need A 14-item , self-administered , multidimensional , functional social support question naire was design ed and evaluated on 401 patients attending a family medicine clinic . Patients were selected from r and omized time-frame sampling blocks during regular office hours . The population was predominantly white , female , married , and under age 45 . Eleven items remained after test-retest reliability was assessed over a 1- to 4-week follow-up period . Factor analysis and item remainder analysis reduced the remaining 11 items to a brief and easy-to-complete two-scale , eight-item functional social support instrument . Construct validity , concurrent validity , and discriminant validity are demonstrated for the two scales ( confidant support — five items and affective support —three items ) . Factor analysis and correlations with other measures of social support suggest that the three remaining items ( visits , instrumental support , and praise ) are distinct entities that may need further study Applicants for a newly opened special unit for dementia sufferers were r and omly allocated to full-time care in the unit or placed on a waiting list and offered periodic respite care in the 
    Output:
    