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: The objective is to test the effectiveness of Partners in Dementia Care ( PDC ) , a care-coordination program that integrates and improves access to medical and nonmedical services , while strengthening the informal care network and providing information , coaching , and emotional support . PDC was delivered via a partnership between Veterans Affairs ( VA ) Medical Centers ( VAMCs ) and Alzheimer 's Association chapters , for caregivers of veterans with dementia living in the community and receiving primary care from the VA . The initial sample was 486 caregivers of 508 veterans with diagnosed dementia . Outcomes were evaluated for 394 and 324 caregivers who completed 6- and 12- month follow-up , respectively . PDC had a st and ardized protocol that included assessment and re assessment , action planning , and ongoing monitoring . It was delivered by telephone and e-mail for cost efficiency and the ability to h and le caseloads of 100 to 125 . Care coordinators from VAMCs and Alzheimer 's Association chapters worked as a team using a shared computerized record . A variety of caregiver outcomes was measured after 6 and 12 months . Intervention group caregivers had significant improvements in outcomes representing unmet needs , three types of caregiver strains , depression , and two support re sources . Most improvements were evident after 6 months , with more-limited improvements from Months 6 to 12 . Some outcomes improved for all caregivers , whereas some improved for caregivers experiencing more initial difficulties or caring for veterans with more-severe impairments . PDC is a promising model that improves linkages between healthcare services and community services , which is a goal of several new national initiatives such as the National Plan to Address Alzheimer 's Disease and a proposed amendment to the Older Americans Act OBJECTIVE To determine the effectiveness of community based occupational therapy on daily functioning of patients with dementia and the sense of competence of their care givers . DESIGN Single blind r and omised controlled trial . Assessors were blinded for treatment allocation . SETTING Memory clinic and day clinic of a geriatrics department and participants ' homes . PARTICIPANTS 135 patients aged > or = 65 with mild to moderate dementia living in the community and their primary care givers . INTERVENTIONS 10 sessions of occupational therapy over five weeks , including cognitive and behavioural interventions , to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision . MAIN OUTCOME MEASURES Patients ' daily functioning assessed with the assessment of motor and process skills ( AMPS ) and the performance scale of the interview of deterioration in daily activities in dementia ( IDDD ) . Care giver burden assessed with the sense of competence question naire ( SCQ ) . Participants were evaluated at baseline , six weeks , and three months . RESULTS Scores improved significantly relative to baseline in patients and care givers in the intervention group compared with the controls ( differences were 1.5 ( 95 % confidence interval 1.3 to 1.7 ) for the process scale ; -11.7 ( -13.6 to -9.7 ) for the performance scale ; and ( 11.0 ; 9.2 to 12.8 ) for the competence scale ) . This improvement was still significant at three months . The number needed to treat to reach a clinical ly relevant improvement in motor and process skills score was 1.3 ( 1.2 to 1.4 ) at six weeks . Effect sizes were 2.5 , 2.3 , and 1.2 , respectively , at six weeks and 2.7 , 2.4 , and 0.8 , respectively , at 12 weeks . CONCLUSIONS Occupational therapy improved patients '  daily functioning and reduced the burden on the care giver , despite the patients ' limited learning ability . Effects were still present at 12 weeks , which justifies implementation of this intervention . TRIAL REGISTRATION Clinical Trials NCT00295152 [ Clinical Trials.gov ] Objective To assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint . Design Cost effectiveness study alongside a single blind r and omised controlled trial . Setting Memory clinic , day clinic of a geriatrics department , and participants ’ homes . Patients 135 patients aged ≥65 with mild to moderate dementia living in the community and their primary care givers . Intervention 10 sessions of occupational therapy over five weeks , including cognitive and behavioural interventions , to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision . Main outcome measures Incremental cost effectiveness ratio expressed as the difference in mean total care costs per successful treatment ( that is , a combined patient and care giver outcome measure of clinical ly relevant improvement on process , performance , and competence scales ) at three months after r and omisation . Bootstrap methods used to determine confidence intervals for these measures . Results The intervention cost € 1183 ( £ 848 , $ 1738 ) ( 95 % confidence interval € 1128 ( £ 808 , $ 1657 ) to € 1239 ( £ 888 , $ 1820 ) ) per patient and primary care giver unit at three months . Visits to general practitioners and hospital doctors cost the same in both groups but total mean costs were € 1748 ( £ 1279 , $ 2621 ) lower in the intervention group , with the main cost savings in informal care . There was a significant difference in proportions of successful treatments of 36 % at three months . The number needed to treat for successful treatment at three months was 2.8 ( 2.7 to 2.9 ) . Conclusions Community occupational therapy intervention for patients with dementia and their care givers is successful and cost effective , especially in terms of informal care giving Background Current guidelines for dementia care recommend the combination of drug therapy with non-pharmaceutical measures like counselling and social support . However , the scientific evidence concerning non-pharmaceutical interventions for dementia patients and their informal caregivers remains inconclusive . Targets of modern comprehensive dementia care are to enable patients to live at home as long and as independent as possible and to reduce the burden of caregivers . The objective of the study is to compare a complex intervention including caregiver support groups and counselling against usual care in terms of time to nursing home placement . In this paper the study protocol is described . Methods / Design The IDA ( Initiative Demenzversorgung in der Allgemeinmedizin ) project is design ed as a three armed cluster-r and omized trial where dementia patients and their informal caregivers are recruited by general practitioners . Patients in the study region of Middle Franconia , Germany , are included if they have mild or moderate dementia , are at least 65 years old , and are members of the German AOK ( Allgemeine Ortskrankenkasse ) sickness fund . In the control group patients receive regular treatment , whereas in the two intervention groups general practitioners participate in a training course in evidence based dementia treatment , recommend support groups and offer counseling to the family caregivers either beginning at baseline or after the 1-year follow-up . The study recruitment and follow-up took place from July 2005 to January 2009 . 303 general practitioners were r and omized of which 129 recruited a total of 390 patients .  Time to nursing home admission within the two year intervention and follow-up period is the primary endpoint . Secondary endpoints are cognitive status , activities of daily living , burden of care giving as well as healthcare costs . For an economic analysis from the societal perspective , data are collected from caregivers as well as by the use of routine data from statutory health insurance and long-term care insurance . Discussion From a public health perspective , the IDA trial is expected to lead to evidence based results on the community effectiveness of non-pharmaceutical support measures for dementia patients and their caregivers in the primary care sector . For health policy makers it is necessary to make their decisions about financing new services based on strong knowledge about the acceptance of measures in the population and their cost-effectiveness . Trial registration IS RCT Background The provision of appropriate medical and nursing care for people with dementia is a major challenge for the healthcare system in Germany . New models of healthcare provision need to be developed , tested and implemented on the population level . Trials in which collaborative care for dementia in the primary care setting were studied have demonstrated its effectiveness . These studies have been conducted in different healthcare systems , however , so it is unclear whether these results extend to the specific context of the German healthcare system . The objective of this population -based intervention trial in the primary care setting is to test the efficacy and efficiency of implementing a subsidiary support system on a population level for persons with dementia who live at home . Methods and study design The study was design ed to assemble a general physician-based epidemiological cohort of people above the age of 70 who live at home ( DelpHi cohort ) . These people are screened for eligibility to participate in a trial of dementia care management ( DelpHi trial ) . The trial is a cluster-r and omised , controlled intervention trial with two arms ( intervention and control ) design ed to test the efficacy and efficiency of implementing a subsidiary support system for persons with dementia who live at home . This subsidiary support system is initiated and coordinated by a dementia care manager : a nurse with dementia-specific qualifications who delivers the intervention according to a systematic , detailed protocol . The primary outcome is quality of life and healthcare for patients with dementia and their caregivers . This is a multidimensional outcome with a focus on four dimensions : ( 1 ) quality of life , ( 2 ) caregiver burden , ( 3 ) behavioural and psychological symptoms of dementia and ( 4 ) pharmacotherapy with an antidementia drug and prevention or suspension of potentially inappropriate medication . Secondary outcomes include the assessment of dementia syndromes , activities of daily living , social support health status , utilisation of health care re sources and medication . Discussion The results will provide evidence for specific needs in ambulatory care for persons with dementia and will show effective ways to meet those needs . Qualification requirements will be evaluated , and the results will help to modify existing guidelines and treatment paths . Trial registration Importance Dementia care management ( DCM ) can increase the quality of care for people with dementia . Method ologically rigorous clinical trials on DCM are lacking . Objective To test the effectiveness and safety of DCM in the treatment and care of people with dementia living at home and caregiver burden ( when available ) . Design , Setting , and Participants This pragmatic , general practitioner – based , cluster-r and omized intervention trial compared the intervention with care as usual at baseline and at 12-month follow-up . Simple 1:1 r and omization of general practice s in Germany was used . Analyses were intent to treat and per protocol . In total , 6838 patients were screened for dementia ( eligibility : 70 years and older and living at home ) from January 1 , 2012 , to March 31 , 2016 . Overall , 1167 ( 17.1 % ) were diagnosed as having dementia , and 634 ( 9.3 % ) provided written informed consent to participate . Interventions Dementia care management was provided for 6 months at the homes of patients with dementia . Dementia care management is a model of collaborative care , defined as a complex intervention aim ing to provide optimal treatment and care for patients with dementia and support caregivers using a computer-assisted assessment determining a personalized array of intervention modules and subsequent success monitoring . Dementia care management was targeted at the individual patient level and was conducted by 6 study nurses with dementia care – specific qualifications . Main Outcomes and Measures Quality of life , caregiver burden , behavioral and psychological symptoms of dementia , pharmacotherapy with antidementia drugs , and use of potentially inappropriate medication . Results The mean age of 634 patients was 80 years . A total of 407 patients received the intended treatment and were available for primary outcome measurement . Of these patients , 248 ( 60.9 % ) were women , and 204 ( 50.1 % ) lived alone . Dementia care management  significantly decreased behavioral and psychological symptoms of dementia ( b = −7.45 ; 95 % CI , −11.08 to −3.81 ; P < .001 ) and caregiver burden ( b = −0.50 ; 95 % CI , −1.09 to 0.08 ; P = .045 ) compared with care as usual . Patients with dementia receiving DCM had an increased chance of receiving antidementia drug treatment ( DCM , 114 of 291 [ 39.2 % ] vs care as usual , 31 of 116 [ 26.7 % ] ) after 12 months ( odds ratio , 1.97 ; 95 % CI , 0.99 to 3.94 ; P = .03 ) . Dementia care management significantly increased quality of life ( b = 0.08 ; 95 % CI , 0 to 0.17 ; P = .03 ) for patients not living alone but did not increase quality of life overall . There was no effect on potentially inappropriate medication ( odds ratio , 1.86 ; 95 % CI , 0.62 to 3.62 ; P = .97 ) . Conclusions and Relevance Dementia care management provided by specifically trained nurses is an effective collaborative care model that improves relevant patient- and caregiver-related outcomes in dementia . Implementing DCM in different health care systems should become an active area of research . Trial Registration clinical trials.gov Identifier : BACKGROUND Most persons with dementia live at home and are treated in the primary care . However , the ambulatory health care system in Germany contains a lot of " interface problems " and is not optimized for the future challenges . Innovative concepts like 
    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: The objective is to test the effectiveness of Partners in Dementia Care ( PDC ) , a care-coordination program that integrates and improves access to medical and nonmedical services , while strengthening the informal care network and providing information , coaching , and emotional support . PDC was delivered via a partnership between Veterans Affairs ( VA ) Medical Centers ( VAMCs ) and Alzheimer 's Association chapters , for caregivers of veterans with dementia living in the community and receiving primary care from the VA . The initial sample was 486 caregivers of 508 veterans with diagnosed dementia . Outcomes were evaluated for 394 and 324 caregivers who completed 6- and 12- month follow-up , respectively . PDC had a st and ardized protocol that included assessment and re assessment , action planning , and ongoing monitoring . It was delivered by telephone and e-mail for cost efficiency and the ability to h and le caseloads of 100 to 125 . Care coordinators from VAMCs and Alzheimer 's Association chapters worked as a team using a shared computerized record . A variety of caregiver outcomes was measured after 6 and 12 months . Intervention group caregivers had significant improvements in outcomes representing unmet needs , three types of caregiver strains , depression , and two support re sources . Most improvements were evident after 6 months , with more-limited improvements from Months 6 to 12 . Some outcomes improved for all caregivers , whereas some improved for caregivers experiencing more initial difficulties or caring for veterans with more-severe impairments . PDC is a promising model that improves linkages between healthcare services and community services , which is a goal of several new national initiatives such as the National Plan to Address Alzheimer 's Disease and a proposed amendment to the Older Americans Act OBJECTIVE To determine the effectiveness of community based occupational therapy on daily functioning of patients with dementia and the sense of competence of their care givers . DESIGN Single blind r and omised controlled trial . Assessors were blinded for treatment allocation . SETTING Memory clinic and day clinic of a geriatrics department and participants ' homes . PARTICIPANTS 135 patients aged > or = 65 with mild to moderate dementia living in the community and their primary care givers . INTERVENTIONS 10 sessions of occupational therapy over five weeks , including cognitive and behavioural interventions , to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision . MAIN OUTCOME MEASURES Patients ' daily functioning assessed with the assessment of motor and process skills ( AMPS ) and the performance scale of the interview of deterioration in daily activities in dementia ( IDDD ) . Care giver burden assessed with the sense of competence question naire ( SCQ ) . Participants were evaluated at baseline , six weeks , and three months . RESULTS Scores improved significantly relative to baseline in patients and care givers in the intervention group compared with the controls ( differences were 1.5 ( 95 % confidence interval 1.3 to 1.7 ) for the process scale ; -11.7 ( -13.6 to -9.7 ) for the performance scale ; and ( 11.0 ; 9.2 to 12.8 ) for the competence scale ) . This improvement was still significant at three months . The number needed to treat to reach a clinical ly relevant improvement in motor and process skills score was 1.3 ( 1.2 to 1.4 ) at six weeks . Effect sizes were 2.5 , 2.3 , and 1.2 , respectively , at six weeks and 2.7 , 2.4 , and 0.8 , respectively , at 12 weeks . CONCLUSIONS Occupational therapy improved patients '  daily functioning and reduced the burden on the care giver , despite the patients ' limited learning ability . Effects were still present at 12 weeks , which justifies implementation of this intervention . TRIAL REGISTRATION Clinical Trials NCT00295152 [ Clinical Trials.gov ] Objective To assess the cost effectiveness of community based occupational therapy compared with usual care in older patients with dementia and their care givers from a societal viewpoint . Design Cost effectiveness study alongside a single blind r and omised controlled trial . Setting Memory clinic , day clinic of a geriatrics department , and participants ’ homes . Patients 135 patients aged ≥65 with mild to moderate dementia living in the community and their primary care givers . Intervention 10 sessions of occupational therapy over five weeks , including cognitive and behavioural interventions , to train patients in the use of aids to compensate for cognitive decline and care givers in coping behaviours and supervision . Main outcome measures Incremental cost effectiveness ratio expressed as the difference in mean total care costs per successful treatment ( that is , a combined patient and care giver outcome measure of clinical ly relevant improvement on process , performance , and competence scales ) at three months after r and omisation . Bootstrap methods used to determine confidence intervals for these measures . Results The intervention cost € 1183 ( £ 848 , $ 1738 ) ( 95 % confidence interval € 1128 ( £ 808 , $ 1657 ) to € 1239 ( £ 888 , $ 1820 ) ) per patient and primary care giver unit at three months . Visits to general practitioners and hospital doctors cost the same in both groups but total mean costs were € 1748 ( £ 1279 , $ 2621 ) lower in the intervention group , with the main cost savings in informal care . There was a significant difference in proportions of successful treatments of 36 % at three months . The number needed to treat for successful treatment at three months was 2.8 ( 2.7 to 2.9 ) . Conclusions Community occupational therapy intervention for patients with dementia and their care givers is successful and cost effective , especially in terms of informal care giving Background Current guidelines for dementia care recommend the combination of drug therapy with non-pharmaceutical measures like counselling and social support . However , the scientific evidence concerning non-pharmaceutical interventions for dementia patients and their informal caregivers remains inconclusive . Targets of modern comprehensive dementia care are to enable patients to live at home as long and as independent as possible and to reduce the burden of caregivers . The objective of the study is to compare a complex intervention including caregiver support groups and counselling against usual care in terms of time to nursing home placement . In this paper the study protocol is described . Methods / Design The IDA ( Initiative Demenzversorgung in der Allgemeinmedizin ) project is design ed as a three armed cluster-r and omized trial where dementia patients and their informal caregivers are recruited by general practitioners . Patients in the study region of Middle Franconia , Germany , are included if they have mild or moderate dementia , are at least 65 years old , and are members of the German AOK ( Allgemeine Ortskrankenkasse ) sickness fund . In the control group patients receive regular treatment , whereas in the two intervention groups general practitioners participate in a training course in evidence based dementia treatment , recommend support groups and offer counseling to the family caregivers either beginning at baseline or after the 1-year follow-up . The study recruitment and follow-up took place from July 2005 to January 2009 . 303 general practitioners were r and omized of which 129 recruited a total of 390 patients .  Time to nursing home admission within the two year intervention and follow-up period is the primary endpoint . Secondary endpoints are cognitive status , activities of daily living , burden of care giving as well as healthcare costs . For an economic analysis from the societal perspective , data are collected from caregivers as well as by the use of routine data from statutory health insurance and long-term care insurance . Discussion From a public health perspective , the IDA trial is expected to lead to evidence based results on the community effectiveness of non-pharmaceutical support measures for dementia patients and their caregivers in the primary care sector . For health policy makers it is necessary to make their decisions about financing new services based on strong knowledge about the acceptance of measures in the population and their cost-effectiveness . Trial registration IS RCT Background The provision of appropriate medical and nursing care for people with dementia is a major challenge for the healthcare system in Germany . New models of healthcare provision need to be developed , tested and implemented on the population level . Trials in which collaborative care for dementia in the primary care setting were studied have demonstrated its effectiveness . These studies have been conducted in different healthcare systems , however , so it is unclear whether these results extend to the specific context of the German healthcare system . The objective of this population -based intervention trial in the primary care setting is to test the efficacy and efficiency of implementing a subsidiary support system on a population level for persons with dementia who live at home . Methods and study design The study was design ed to assemble a general physician-based epidemiological cohort of people above the age of 70 who live at home ( DelpHi cohort ) . These people are screened for eligibility to participate in a trial of dementia care management ( DelpHi trial ) . The trial is a cluster-r and omised , controlled intervention trial with two arms ( intervention and control ) design ed to test the efficacy and efficiency of implementing a subsidiary support system for persons with dementia who live at home . This subsidiary support system is initiated and coordinated by a dementia care manager : a nurse with dementia-specific qualifications who delivers the intervention according to a systematic , detailed protocol . The primary outcome is quality of life and healthcare for patients with dementia and their caregivers . This is a multidimensional outcome with a focus on four dimensions : ( 1 ) quality of life , ( 2 ) caregiver burden , ( 3 ) behavioural and psychological symptoms of dementia and ( 4 ) pharmacotherapy with an antidementia drug and prevention or suspension of potentially inappropriate medication . Secondary outcomes include the assessment of dementia syndromes , activities of daily living , social support health status , utilisation of health care re sources and medication . Discussion The results will provide evidence for specific needs in ambulatory care for persons with dementia and will show effective ways to meet those needs . Qualification requirements will be evaluated , and the results will help to modify existing guidelines and treatment paths . Trial registration Importance Dementia care management ( DCM ) can increase the quality of care for people with dementia . Method ologically rigorous clinical trials on DCM are lacking . Objective To test the effectiveness and safety of DCM in the treatment and care of people with dementia living at home and caregiver burden ( when available ) . Design , Setting , and Participants This pragmatic , general practitioner – based , cluster-r and omized intervention trial compared the intervention with care as usual at baseline and at 12-month follow-up . Simple 1:1 r and omization of general practice s in Germany was used . Analyses were intent to treat and per protocol . In total , 6838 patients were screened for dementia ( eligibility : 70 years and older and living at home ) from January 1 , 2012 , to March 31 , 2016 . Overall , 1167 ( 17.1 % ) were diagnosed as having dementia , and 634 ( 9.3 % ) provided written informed consent to participate . Interventions Dementia care management was provided for 6 months at the homes of patients with dementia . Dementia care management is a model of collaborative care , defined as a complex intervention aim ing to provide optimal treatment and care for patients with dementia and support caregivers using a computer-assisted assessment determining a personalized array of intervention modules and subsequent success monitoring . Dementia care management was targeted at the individual patient level and was conducted by 6 study nurses with dementia care – specific qualifications . Main Outcomes and Measures Quality of life , caregiver burden , behavioral and psychological symptoms of dementia , pharmacotherapy with antidementia drugs , and use of potentially inappropriate medication . Results The mean age of 634 patients was 80 years . A total of 407 patients received the intended treatment and were available for primary outcome measurement . Of these patients , 248 ( 60.9 % ) were women , and 204 ( 50.1 % ) lived alone . Dementia care management  significantly decreased behavioral and psychological symptoms of dementia ( b = −7.45 ; 95 % CI , −11.08 to −3.81 ; P < .001 ) and caregiver burden ( b = −0.50 ; 95 % CI , −1.09 to 0.08 ; P = .045 ) compared with care as usual . Patients with dementia receiving DCM had an increased chance of receiving antidementia drug treatment ( DCM , 114 of 291 [ 39.2 % ] vs care as usual , 31 of 116 [ 26.7 % ] ) after 12 months ( odds ratio , 1.97 ; 95 % CI , 0.99 to 3.94 ; P = .03 ) . Dementia care management significantly increased quality of life ( b = 0.08 ; 95 % CI , 0 to 0.17 ; P = .03 ) for patients not living alone but did not increase quality of life overall . There was no effect on potentially inappropriate medication ( odds ratio , 1.86 ; 95 % CI , 0.62 to 3.62 ; P = .97 ) . Conclusions and Relevance Dementia care management provided by specifically trained nurses is an effective collaborative care model that improves relevant patient- and caregiver-related outcomes in dementia . Implementing DCM in different health care systems should become an active area of research . Trial Registration clinical trials.gov Identifier : BACKGROUND Most persons with dementia live at home and are treated in the primary care . However , the ambulatory health care system in Germany contains a lot of " interface problems " and is not optimized for the future challenges . Innovative concepts like 
    Output:
    