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 Evidence for improved outcomes for people with dementia through provision of person-centred care and dementia-care mapping is largely observational . We aim ed to do a large , r and omised comparison of person-centred care , dementia-care mapping , and usual care . METHODS In a cluster r and omised controlled trial , urban residential sites were r and omly assigned to person-centred care , dementia-care mapping , or usual care . Carers received training and support in either intervention or continued usual care . Treatment allocation was masked to assessors . The primary outcome was agitation measured with the Cohen-Mansfield agitation inventory ( CMAI ) . Secondary outcomes included psychiatric symptoms including hallucinations , neuropsychological status , quality of life , falls , and cost of treatment . Outcome measures were assessed before and directly after 4 months of intervention , and at 4 months of follow-up . Hierarchical linear models were used to test treatment and time effects . Analysis was by intention to treat . This trial is registered with the Australia and New Zeal and Clinical Trials Registry , number ACTRN12608000084381 . FINDINGS 15 care sites with 289 residents were r and omly assigned . Pairwise contrasts revealed that at follow-up , and relative to usual care , CMAI score was lower in sites providing mapping ( mean difference 10.9 , 95 % CI 0.7 - 21.1 ; p=0.04 ) and person-centred care ( 13.6 , 3.3 - 23.9 ; p=0.01 ) . Compared with usual care , fewer falls were recorded in sites that used mapping ( 0.24 , 0.08 - 0.40 ; p=0.02 ) but there were more falls with person-centred care ( 0.15 , 0.02 - 0.28 ; p=0.03 ) . There were no other significant effects . INTERPRETATION Person-centred care and dementia-care mapping both seem to reduce agitation in people with dementia in residential care BACKGROUND Well-being and various forms of agitation in people with dementia can be improved in a person-centered long-term care setting . Data obtained during the Person-Centered Dementia Care and Environment ( PerCEN ) r and omized controlled trial shed light on the factors that influenced the adoption and outcomes of person-centered interventions in long-term care from the perspective of study participants . METHODS Data were obtained from PerCEN participants : individual semi-structured interviews with care managers ( 29 ) , nurses and care staff ( 70 ) ; telephone surveys with family members ( 73 ) ; staff reports of care approaches ; and 131 field note entries recorded by the person-centered care and environment facilitators .  Data were interpreted inductively using content analysis , code building , theme development , and synthesis of findings . RESULTS All data sources confirmed that , when adopted , the person-centered model increased the number and variety of opportunities for resident interaction , improved flexibility in care regimens , enhanced staff 's attention to resident needs , reduced resident agitation , and improved their well-being . Barriers and enablers for the person-centered model related to leadership , manager , staff and family appreciation of the model , staff 's capacity , effective communication and team work among direct care staff , care service flexibility , and staff education on how to focus care on the person 's well-being . CONCLUSIONS Successful knowledge translation of the person-centered model starts with managerial leadership and support ; it is sustained when staff are educated and assisted to apply the model , and , along with families , come to appreciate the benefits of flexible care services and teamwork in achieving resident well-being . The Australian New Zeal and Clinical Trials Registry number is ACTRN 12608000095369 Background Challenging behaviors exhibited by individuals with dementia might result from an unmet need that they can not communicate directly due to cognitive restrictions . A dementia-specific case conference represents a promising means of analyzing and exploring these unmet needs . The ongoing FallDem study is a stepped-wedged , cluster-r and omized trial evaluating the effects of two different types of dementia-specific case conferences on the challenging behaviors of nursing home residents . This study protocol describes the process evaluation that is conducted , along with the FallDem study .The goal of the process evaluation is to explain potential discrepancies between expected and observed outcomes , and to provide insights into implementation processes and recruitment strategies , as well as the context s and context ual factors that promote or inhibit the implementation of dementia-specific case conferences . Methods / Design The process evaluation will use a mixed- method design comprising longitudinal elements , in which quantitative and qualitative data will be gathered . Qualitative data will be analyzed using content analysis , documentary analysis and a documentary method . Quantitative data ( st and ardized question naires ) will be analyzed using descriptive statistics . Both types of data will complement one another and provide a more comprehensive picture of the different objects under investigation . Discussion The process evaluation will allow for a comprehensive underst and ing of the changing processes and mechanisms underlying the ‘ black box ’ of the complex intervention of the FallDem study . These findings will provide practical knowledge regarding issues related to the implementation of dementia-specific case conferences in nursing homes . Trial registration Current Controlled Trials identifier : IS RCT N20203855 , registered on 10th July 2013 Objective While nearly half of all people with Alzheimer 's disease ( AD ) have agitation symptoms every month , little is known about the costs of agitation in AD . We calculated the monetary costs associated with agitation in older adults with AD in the UK from a National Health Service and personal social services perspective . Design Prospect i ve cohort study . Setting London and the South East Region of the UK ( LASER-AD study ) . Participants 224 people with AD recruited between July 2002 and January 2003 and followed up for 54 months . Primary and secondary outcome measures The primary outcome was health and social care costs , including accommodation costs and costs of contacts with health and social care services . Agitation was assessed using the Neuropsychiatric Inventory ( NPI ) agitation score . Results After adjustment , health and social care costs varied significantly by agitation , from £ 29 000 over a 1 year period with no agitation symptoms ( NPI agitation score=0 ) to £ 57 000 at the most severe levels of agitation ( NPI agitation score=12 ; p=0.01 ) . The mean excess cost associated with agitation per person with AD was £ 4091 a year , accounting for 12 % of the health and social care costs of AD in our data , and equating to £ 2 billion a year across all people with AD in the UK . Conclusions Agitation in people with AD represents a substantial monetary burden over and above the costs associated with cognitive impairment OBJECTIVE This study evaluated the impact of an eight-session training program for aged care staff  in managing dementia-related challenging behaviours .  Participation in the training program with an additional five-session peer support group was compared with both participation in training only and a wait-list control condition . METHODS Outcomes were evaluated for 90 participating staff members and 113 residents with challenging behaviours from six aged care facilities . Measures of staff attitudes and the behaviours of staff and residents were collected pre- and post-intervention , and at six month follow-up . RESULTS Staff members in both dementia training groups reported improved attitudes regarding their knowledge and skills in managing residents with challenging behaviours , immediately after the training and six months later . Facility supervisors rated the nursing performance of trained staff more positively , particularly those who participated in a peer support group . The dementia training programs , whether with or without the inclusion of peer support , did not impact on levels of staff burnout or substantially reduce the level of challenging behaviours among aged care residents . CONCLUSIONS While training programs may impact positively on staff performance , organisational characteristics of aged care facilities , including low levels of management support for staff training initiatives , limit the potential outcomes . Method ological limitations are discussed 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 PURPOSE When cognitively impaired nursing home residents exhibit agitated and aggressive behaviors during bathing , nursing home caregivers are in a unique position to improve residents ' experience . This report addresses whether certified nursing assistants ( CNAs ) who received training in a person-centered approach with showering and with the towel bath showed improved caregiving behaviors ( gentleness and verbal support ) and experienced greater preparedness ( confidence and ease ) and less distress ( hassles ) when assisting residents with bathing . DESIGN AND METHODS We used a crossover design and r and omized 15 nursing homes into two treatment groups and a control group of 5 facilities each . In one treatment group , CNAs received person-centered training , first with showering for 6 weeks ( Time 1 ) and then with the towel bath for 6 weeks ( Time 2 ) . We reversed the treatment order in the other treatment group . Control group CNAs used usual showering procedures without person-centered training . We collected observational and self-report data at baseline and at the end of Time 1 and Time 2 on five caregiving outcomes . We analyzed data from 37 CNAs assisting 69 residents by using 3x2 repeated measures analyses of variance to compare the three groups on change from baseline . RESULTS Compared with the control group , treatment groups significantly improved in the use of gentleness and verbal support and in the perception of ease . IMPLICATION S A person-centered approach with showering and with the towel bath improved not only how care is given to residents who become agitated and aggressive during bathing but also how CNAs perceive their experience when bathing these residents The objective of the study was to investigate the effect of introducing a dance-based psychomotor intervention using Danzón ( Latin ballroom ) for people with dementia in care homes . This was a grounded theory qualitative study . Thirteen of the 22 participants had dementia and were care-home residents . The remaining participants were care staff and facilitators of the dance sessions .  Inter 
    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 Evidence for improved outcomes for people with dementia through provision of person-centred care and dementia-care mapping is largely observational . We aim ed to do a large , r and omised comparison of person-centred care , dementia-care mapping , and usual care . METHODS In a cluster r and omised controlled trial , urban residential sites were r and omly assigned to person-centred care , dementia-care mapping , or usual care . Carers received training and support in either intervention or continued usual care . Treatment allocation was masked to assessors . The primary outcome was agitation measured with the Cohen-Mansfield agitation inventory ( CMAI ) . Secondary outcomes included psychiatric symptoms including hallucinations , neuropsychological status , quality of life , falls , and cost of treatment . Outcome measures were assessed before and directly after 4 months of intervention , and at 4 months of follow-up . Hierarchical linear models were used to test treatment and time effects . Analysis was by intention to treat . This trial is registered with the Australia and New Zeal and Clinical Trials Registry , number ACTRN12608000084381 . FINDINGS 15 care sites with 289 residents were r and omly assigned . Pairwise contrasts revealed that at follow-up , and relative to usual care , CMAI score was lower in sites providing mapping ( mean difference 10.9 , 95 % CI 0.7 - 21.1 ; p=0.04 ) and person-centred care ( 13.6 , 3.3 - 23.9 ; p=0.01 ) . Compared with usual care , fewer falls were recorded in sites that used mapping ( 0.24 , 0.08 - 0.40 ; p=0.02 ) but there were more falls with person-centred care ( 0.15 , 0.02 - 0.28 ; p=0.03 ) . There were no other significant effects . INTERPRETATION Person-centred care and dementia-care mapping both seem to reduce agitation in people with dementia in residential care BACKGROUND Well-being and various forms of agitation in people with dementia can be improved in a person-centered long-term care setting . Data obtained during the Person-Centered Dementia Care and Environment ( PerCEN ) r and omized controlled trial shed light on the factors that influenced the adoption and outcomes of person-centered interventions in long-term care from the perspective of study participants . METHODS Data were obtained from PerCEN participants : individual semi-structured interviews with care managers ( 29 ) , nurses and care staff ( 70 ) ; telephone surveys with family members ( 73 ) ; staff reports of care approaches ; and 131 field note entries recorded by the person-centered care and environment facilitators .  Data were interpreted inductively using content analysis , code building , theme development , and synthesis of findings . RESULTS All data sources confirmed that , when adopted , the person-centered model increased the number and variety of opportunities for resident interaction , improved flexibility in care regimens , enhanced staff 's attention to resident needs , reduced resident agitation , and improved their well-being . Barriers and enablers for the person-centered model related to leadership , manager , staff and family appreciation of the model , staff 's capacity , effective communication and team work among direct care staff , care service flexibility , and staff education on how to focus care on the person 's well-being . CONCLUSIONS Successful knowledge translation of the person-centered model starts with managerial leadership and support ; it is sustained when staff are educated and assisted to apply the model , and , along with families , come to appreciate the benefits of flexible care services and teamwork in achieving resident well-being . The Australian New Zeal and Clinical Trials Registry number is ACTRN 12608000095369 Background Challenging behaviors exhibited by individuals with dementia might result from an unmet need that they can not communicate directly due to cognitive restrictions . A dementia-specific case conference represents a promising means of analyzing and exploring these unmet needs . The ongoing FallDem study is a stepped-wedged , cluster-r and omized trial evaluating the effects of two different types of dementia-specific case conferences on the challenging behaviors of nursing home residents . This study protocol describes the process evaluation that is conducted , along with the FallDem study .The goal of the process evaluation is to explain potential discrepancies between expected and observed outcomes , and to provide insights into implementation processes and recruitment strategies , as well as the context s and context ual factors that promote or inhibit the implementation of dementia-specific case conferences . Methods / Design The process evaluation will use a mixed- method design comprising longitudinal elements , in which quantitative and qualitative data will be gathered . Qualitative data will be analyzed using content analysis , documentary analysis and a documentary method . Quantitative data ( st and ardized question naires ) will be analyzed using descriptive statistics . Both types of data will complement one another and provide a more comprehensive picture of the different objects under investigation . Discussion The process evaluation will allow for a comprehensive underst and ing of the changing processes and mechanisms underlying the ‘ black box ’ of the complex intervention of the FallDem study . These findings will provide practical knowledge regarding issues related to the implementation of dementia-specific case conferences in nursing homes . Trial registration Current Controlled Trials identifier : IS RCT N20203855 , registered on 10th July 2013 Objective While nearly half of all people with Alzheimer 's disease ( AD ) have agitation symptoms every month , little is known about the costs of agitation in AD . We calculated the monetary costs associated with agitation in older adults with AD in the UK from a National Health Service and personal social services perspective . Design Prospect i ve cohort study . Setting London and the South East Region of the UK ( LASER-AD study ) . Participants 224 people with AD recruited between July 2002 and January 2003 and followed up for 54 months . Primary and secondary outcome measures The primary outcome was health and social care costs , including accommodation costs and costs of contacts with health and social care services . Agitation was assessed using the Neuropsychiatric Inventory ( NPI ) agitation score . Results After adjustment , health and social care costs varied significantly by agitation , from £ 29 000 over a 1 year period with no agitation symptoms ( NPI agitation score=0 ) to £ 57 000 at the most severe levels of agitation ( NPI agitation score=12 ; p=0.01 ) . The mean excess cost associated with agitation per person with AD was £ 4091 a year , accounting for 12 % of the health and social care costs of AD in our data , and equating to £ 2 billion a year across all people with AD in the UK . Conclusions Agitation in people with AD represents a substantial monetary burden over and above the costs associated with cognitive impairment OBJECTIVE This study evaluated the impact of an eight-session training program for aged care staff  in managing dementia-related challenging behaviours .  Participation in the training program with an additional five-session peer support group was compared with both participation in training only and a wait-list control condition . METHODS Outcomes were evaluated for 90 participating staff members and 113 residents with challenging behaviours from six aged care facilities . Measures of staff attitudes and the behaviours of staff and residents were collected pre- and post-intervention , and at six month follow-up . RESULTS Staff members in both dementia training groups reported improved attitudes regarding their knowledge and skills in managing residents with challenging behaviours , immediately after the training and six months later . Facility supervisors rated the nursing performance of trained staff more positively , particularly those who participated in a peer support group . The dementia training programs , whether with or without the inclusion of peer support , did not impact on levels of staff burnout or substantially reduce the level of challenging behaviours among aged care residents . CONCLUSIONS While training programs may impact positively on staff performance , organisational characteristics of aged care facilities , including low levels of management support for staff training initiatives , limit the potential outcomes . Method ological limitations are discussed 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 PURPOSE When cognitively impaired nursing home residents exhibit agitated and aggressive behaviors during bathing , nursing home caregivers are in a unique position to improve residents ' experience . This report addresses whether certified nursing assistants ( CNAs ) who received training in a person-centered approach with showering and with the towel bath showed improved caregiving behaviors ( gentleness and verbal support ) and experienced greater preparedness ( confidence and ease ) and less distress ( hassles ) when assisting residents with bathing . DESIGN AND METHODS We used a crossover design and r and omized 15 nursing homes into two treatment groups and a control group of 5 facilities each . In one treatment group , CNAs received person-centered training , first with showering for 6 weeks ( Time 1 ) and then with the towel bath for 6 weeks ( Time 2 ) . We reversed the treatment order in the other treatment group . Control group CNAs used usual showering procedures without person-centered training . We collected observational and self-report data at baseline and at the end of Time 1 and Time 2 on five caregiving outcomes . We analyzed data from 37 CNAs assisting 69 residents by using 3x2 repeated measures analyses of variance to compare the three groups on change from baseline . RESULTS Compared with the control group , treatment groups significantly improved in the use of gentleness and verbal support and in the perception of ease . IMPLICATION S A person-centered approach with showering and with the towel bath improved not only how care is given to residents who become agitated and aggressive during bathing but also how CNAs perceive their experience when bathing these residents The objective of the study was to investigate the effect of introducing a dance-based psychomotor intervention using Danzón ( Latin ballroom ) for people with dementia in care homes . This was a grounded theory qualitative study . Thirteen of the 22 participants had dementia and were care-home residents . The remaining participants were care staff and facilitators of the dance sessions .  Inter 
    Output:
    