human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Although several face-to-face programs are dedicated to informal caregivers of persons with dementia , they are not always accessible to overburdened or isolated caregivers . Based on a face-to-face intervention program , we adapted and design ed a Web-based fully automated psychoeducational program ( called Diapason ) inspired by a cognitive approach . Objective This study aim ed to evaluate through a pilot unblinded r and omized controlled trial the efficacy and acceptability of a Web-based psychoeducational program for informal caregivers of persons with Alzheimer ’s disease ( PWAD ) based on a mixed methods research design . Methods We recruited and r and omized offline 49 informal caregivers of a PWAD in a day care center in Paris , France . They either received the Web-based intervention and usual care for 3 months ( experimental group , n=25 ) or only usual care ( control group , n=24 ) . Caregivers ’ perceived stress ( PSS-14 , primary outcome ) , self-efficacy , burden , perceived health status , and depression ( secondary outcomes ) were measured during 3 face-to-face on-site visits : at baseline , at the end of the program ( month 3 ) , and after follow-up ( month 6 ) . Additionally , semistructured interviews were conducted with experimental group caregivers at month 6 and examined with thematic analysis . Results Intention-to-treat analysis did not show significant differences in self-perceived stress between the experimental and control groups ( P=.98 ) . The experimental group significantly improved their knowledge of the illness ( d=.79 , P=.008 ) from baseline to month 3 . Of the 25 participants allocated to the experimental group , 17 ( 71 % ) finished the protocol and entirely viewed at least 10 of 12 online sessions . On average , participants used the website 19.72 times ( SD 12.88 ) and were connected for 262.20 minutes ( SD 270.74 ) . The results of the satisfaction question naire showed that most participants considered the program to be useful ( 95 % , 19/20 ) , clear ( 100 % , 20/20 ) , and comprehensive ( 85 % , 17/20 ) . Significant correlations were found between relationship and caregivers ’ program opinion ( P=.01 ) . Thus , positive opinions were provided by husb and s and sons ( 3/3 ) , whereas qualified opinions were primarily reported by daughters ( 8/11 ) . Female spouses expressed negative ( 2/3 ) or neutral opinions ( 1/3 ) . Caregivers expected more dynamic content and further interaction with staff and peers . Conclusions In this study , quantitative results were inconclusive owing to small sample size . Qualitative results indicated/showed little acceptance of the program and high expectations from caregivers . Caregivers did not rule out their interest in this kind of intervention provided that it met their needs . More dynamic , personalized , and social interventions are desirable . Our recruitment issues pointed out the necessity of in-depth studies about caregivers ’ help-seeking behaviors and readiness factors . Trial Registration Clinical trials.gov NCT01430286 ; http:// clinical trials.gov/ct2/show/NCT01430286 ( Archived by WebCite at http://www.webcitation/6KxHaRspL ) 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 Objective : Determine if the online iCare Stress Management e-Training Program reduces stress , bother , depression , and poor life quality for dementia family caregivers ( CGs ) . Method : CGs ( N = 150 ) were r and omly assigned to the iCare Condition ( ICC ) or to the Education/Information-Only Condition ( EOC ) for a 3-month period . Change in self-report measures of stress ( PSS ) ( primary outcome ) , caregiver bother(RMBPC ) , depression ( CES-D ) , and quality of life ( PQOL ) ( secondary outcomes ) was determined , along with usage of new information in one 's own caregiving . Results : A mixed ANOVA revealed that change in perceived stress was significant for the ICC but not the EOC ( p = .017 ) . Changes in the other measures were not significant . More caregivers in the ICC used the material s in their own caregiving situation than those in the EOC . Roughly one-third of the caregivers enrolled in the study dropped prior to completion . Conclusion : Results are promising , but the high dropout is a concern . Future efforts to improve dropout rate and increase participant engagement are warranted . To our knowledge , this is the first attempt to present an evidence -based intervention for CGs via the Internet Background The doubling of the number of people with dementia in the coming decades coupled with the rapid decline in the working population in our graying society is expected to result in a large decrease in the number of professionals available to provide care to people with dementia . As a result , care will be supplied increasingly by untrained informal caregivers and volunteers . To promote effective care and avoid overburdening of untrained and trained caregivers , they must become properly skilled . To this end , the European Skills Training and Reskilling ( STAR ) project , which comprised experts from the domains of education , technology , and dementia care from 6 countries ( the Netherl and s , Sweden , Italy , Malta , Romania , and the United Kingdom ) , worked together to create and evaluate a multilingual e-learning tool . The STAR training portal provides dementia care training both for informal and formal caregivers . Objective The objective of the current study was to evaluate the user friendliness , usefulness , and impact of STAR with informal caregivers , volunteers , and professional caregivers . Methods For 2 to 4 months , the experimental group had access to the STAR training portal , a Web-based portal consisting of 8 modules , 2 of which had a basic level and 6 additional modules at intermediate and advanced levels . The experimental group also had access to online peer and expert communities for support and information exchange . The control group received free access to STAR after the research had ended . The STAR training portal was evaluated in a r and omized controlled trial among informal caregivers and volunteers in addition to professional caregivers ( N=142 ) in the Netherl and s and the United Kingdom . Assessment s were performed with self-assessed , online , st and ardized question naires at baseline and after 2 to 4 months . Primary outcome measures were user friendliness , usefulness , and impact of STAR on knowledge , attitudes , and approaches of caregivers regarding dementia . Secondary outcome measures were empathy , quality of life , burden , and caregivers ’ sense of competence . Results STAR was rated positively by all user groups on both usefulness and user friendliness . Significant effects were found on a person-centered care approach and on the total score on positive attitudes to dementia ; both the experimental and the control group increased in score . Regarding empathy , significant improvements were found in the STAR training group on distress , empathic concern , and taking the perspective of the person with dementia . In the experimental group , however , there was a significant reduction in self-reported sense of competence . Conclusions The STAR training portal is a useful and user-friendly e-learning method , which has demonstrated its ability to provide significant positive effects on caregiver attitudes and empathy 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 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Numerous studies have investigated the effect of Interactive Cancer Communication Systems ( ICCSs ) on system users ' improvements in psychosocial status . Research in this area , however , has focused mostly on cancer patients , rather than on caregivers , and on the direct effects of ICCSs on improved outcomes , rather than on the psychological mechanisms of ICCS effects . To underst and the underlying mechanisms , this study examines the mediating role of perceived caregiver bonding in the relation between one ICCS ( the Comprehensive Health Enhancement Support System [ CHESS ] ) use and caregivers ’ coping strategies . To test the hypotheses , a secondary analysis of data was conducted on 246 caregivers of lung cancer patients . These caregivers were r and omly assigned to ( a ) the Internet , with links to high- quality lung cancer websites , or ( b ) access to CHESS , which integrated information , communication , and interactive coaching tools . Findings suggest that perceived bonding has positive effects on caregivers ’ appraisal and problem-focused coping strategies , and it mediates the effect of  ICCS  on the coping strategies 6 months after the intervention has begun Abstract Purpose : This research aim ed to integrate three previously developed assistive technology ( AT ) systems into one modular , multifunctional system , which can support people with dementia and carers throughout the course of dementia . . In an explorative evaluation study , the integrated system , called Rosetta , was tested on usefulness , user-friendliness and impact , in people with dementia , their informal carers and professional carers involved . The Rosetta system was installed in participants ‘ homes in three countries : The Netherl and s , Germany and Belgium . Methods : Controlled trial with pre- and post-test measures across three 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Although several face-to-face programs are dedicated to informal caregivers of persons with dementia , they are not always accessible to overburdened or isolated caregivers . Based on a face-to-face intervention program , we adapted and design ed a Web-based fully automated psychoeducational program ( called Diapason ) inspired by a cognitive approach . Objective This study aim ed to evaluate through a pilot unblinded r and omized controlled trial the efficacy and acceptability of a Web-based psychoeducational program for informal caregivers of persons with Alzheimer ’s disease ( PWAD ) based on a mixed methods research design . Methods We recruited and r and omized offline 49 informal caregivers of a PWAD in a day care center in Paris , France . They either received the Web-based intervention and usual care for 3 months ( experimental group , n=25 ) or only usual care ( control group , n=24 ) . Caregivers ’ perceived stress ( PSS-14 , primary outcome ) , self-efficacy , burden , perceived health status , and depression ( secondary outcomes ) were measured during 3 face-to-face on-site visits : at baseline , at the end of the program ( month 3 ) , and after follow-up ( month 6 ) . Additionally , semistructured interviews were conducted with experimental group caregivers at month 6 and examined with thematic analysis . Results Intention-to-treat analysis did not show significant differences in self-perceived stress between the experimental and control groups ( P=.98 ) . The experimental group significantly improved their knowledge of the illness ( d=.79 , P=.008 ) from baseline to month 3 . Of the 25 participants allocated to the experimental group , 17 ( 71 % ) finished the protocol and entirely viewed at least 10 of 12 online sessions . On average , participants used the website 19.72 times ( SD 12.88 ) and were connected for 262.20 minutes ( SD 270.74 ) . The results of the satisfaction question naire showed that most participants considered the program to be useful ( 95 % , 19/20 ) , clear ( 100 % , 20/20 ) , and comprehensive ( 85 % , 17/20 ) . Significant correlations were found between relationship and caregivers ’ program opinion ( P=.01 ) . Thus , positive opinions were provided by husb and s and sons ( 3/3 ) , whereas qualified opinions were primarily reported by daughters ( 8/11 ) . Female spouses expressed negative ( 2/3 ) or neutral opinions ( 1/3 ) . Caregivers expected more dynamic content and further interaction with staff and peers . Conclusions In this study , quantitative results were inconclusive owing to small sample size . Qualitative results indicated/showed little acceptance of the program and high expectations from caregivers . Caregivers did not rule out their interest in this kind of intervention provided that it met their needs . More dynamic , personalized , and social interventions are desirable . Our recruitment issues pointed out the necessity of in-depth studies about caregivers ’ help-seeking behaviors and readiness factors . Trial Registration Clinical trials.gov NCT01430286 ; http:// clinical trials.gov/ct2/show/NCT01430286 ( Archived by WebCite at http://www.webcitation/6KxHaRspL ) 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 Objective : Determine if the online iCare Stress Management e-Training Program reduces stress , bother , depression , and poor life quality for dementia family caregivers ( CGs ) . Method : CGs ( N = 150 ) were r and omly assigned to the iCare Condition ( ICC ) or to the Education/Information-Only Condition ( EOC ) for a 3-month period . Change in self-report measures of stress ( PSS ) ( primary outcome ) , caregiver bother(RMBPC ) , depression ( CES-D ) , and quality of life ( PQOL ) ( secondary outcomes ) was determined , along with usage of new information in one 's own caregiving . Results : A mixed ANOVA revealed that change in perceived stress was significant for the ICC but not the EOC ( p = .017 ) . Changes in the other measures were not significant . More caregivers in the ICC used the material s in their own caregiving situation than those in the EOC . Roughly one-third of the caregivers enrolled in the study dropped prior to completion . Conclusion : Results are promising , but the high dropout is a concern . Future efforts to improve dropout rate and increase participant engagement are warranted . To our knowledge , this is the first attempt to present an evidence -based intervention for CGs via the Internet Background The doubling of the number of people with dementia in the coming decades coupled with the rapid decline in the working population in our graying society is expected to result in a large decrease in the number of professionals available to provide care to people with dementia . As a result , care will be supplied increasingly by untrained informal caregivers and volunteers . To promote effective care and avoid overburdening of untrained and trained caregivers , they must become properly skilled . To this end , the European Skills Training and Reskilling ( STAR ) project , which comprised experts from the domains of education , technology , and dementia care from 6 countries ( the Netherl and s , Sweden , Italy , Malta , Romania , and the United Kingdom ) , worked together to create and evaluate a multilingual e-learning tool . The STAR training portal provides dementia care training both for informal and formal caregivers . Objective The objective of the current study was to evaluate the user friendliness , usefulness , and impact of STAR with informal caregivers , volunteers , and professional caregivers . Methods For 2 to 4 months , the experimental group had access to the STAR training portal , a Web-based portal consisting of 8 modules , 2 of which had a basic level and 6 additional modules at intermediate and advanced levels . The experimental group also had access to online peer and expert communities for support and information exchange . The control group received free access to STAR after the research had ended . The STAR training portal was evaluated in a r and omized controlled trial among informal caregivers and volunteers in addition to professional caregivers ( N=142 ) in the Netherl and s and the United Kingdom . Assessment s were performed with self-assessed , online , st and ardized question naires at baseline and after 2 to 4 months . Primary outcome measures were user friendliness , usefulness , and impact of STAR on knowledge , attitudes , and approaches of caregivers regarding dementia . Secondary outcome measures were empathy , quality of life , burden , and caregivers ’ sense of competence . Results STAR was rated positively by all user groups on both usefulness and user friendliness . Significant effects were found on a person-centered care approach and on the total score on positive attitudes to dementia ; both the experimental and the control group increased in score . Regarding empathy , significant improvements were found in the STAR training group on distress , empathic concern , and taking the perspective of the person with dementia . In the experimental group , however , there was a significant reduction in self-reported sense of competence . Conclusions The STAR training portal is a useful and user-friendly e-learning method , which has demonstrated its ability to provide significant positive effects on caregiver attitudes and empathy 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 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Numerous studies have investigated the effect of Interactive Cancer Communication Systems ( ICCSs ) on system users ' improvements in psychosocial status . Research in this area , however , has focused mostly on cancer patients , rather than on caregivers , and on the direct effects of ICCSs on improved outcomes , rather than on the psychological mechanisms of ICCS effects . To underst and the underlying mechanisms , this study examines the mediating role of perceived caregiver bonding in the relation between one ICCS ( the Comprehensive Health Enhancement Support System [ CHESS ] ) use and caregivers ’ coping strategies . To test the hypotheses , a secondary analysis of data was conducted on 246 caregivers of lung cancer patients . These caregivers were r and omly assigned to ( a ) the Internet , with links to high- quality lung cancer websites , or ( b ) access to CHESS , which integrated information , communication , and interactive coaching tools . Findings suggest that perceived bonding has positive effects on caregivers ’ appraisal and problem-focused coping strategies , and it mediates the effect of  ICCS  on the coping strategies 6 months after the intervention has begun Abstract Purpose : This research aim ed to integrate three previously developed assistive technology ( AT ) systems into one modular , multifunctional system , which can support people with dementia and carers throughout the course of dementia . . In an explorative evaluation study , the integrated system , called Rosetta , was tested on usefulness , user-friendliness and impact , in people with dementia , their informal carers and professional carers involved . The Rosetta system was installed in participants ‘ homes in three countries : The Netherl and s , Germany and Belgium . Methods : Controlled trial with pre- and post-test measures across three 
    Output:
    