***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: OBJECTIVES : To evaluate the effectiveness of a home visiting program on health-related measures in a population of older people with poor health status . DESIGN : R and omized , clinical trial . SETTING : Community-dwelling citizens in the Netherl and s. PARTICIPANTS : Three hundred thirty people aged 70 to 84 r and omly assigned to an intervention group ( n=160 ) or a control group ( n=170 ) . INTERVENTION : Eight home visits , lasting 1 hour or more , with telephone follow-up , over an 18-month period , conducted by experienced home nurses under supervision of a public health nurse ; key elements of the ( systematic ) visits were assessment of health problems and risks , advice , and referral to professional and community services . MEASUREMENTS : Self-rated health , functional status , quality of life , and changes in self-reported problems . RESULTS : No differences were found between the intervention and control group in these and other outcome measures at the end of the intervention BACKGROUND The benefit of multidimensional assessment and management of older people remains controversial . Most trials have been too small to produce adequate evidence to inform policy . We aim ed to measure the effects of different approaches to assessment and management of older people . METHODS We undertook a cluster-r and omised factorial trial in 106 general practice s ( 43219 eligible patients aged 75 years and older , 78 % participation ) , comparing ( 1 ) universal versus targeted assessment and ( 2 ) subsequent management by hospital outpatient geriatric team versus the primary -care team .  All participants received a brief multidimensional assessment followed by a nurse-led in-depth assessment in the universal group , whereas in the targeted group the in-depth assessment was offered only to those with problems established at the brief assessment . Referrals to the r and omised team ( geriatric management or primary care ) , other medical or social services , health-care workers , or agencies , and emergency referrals to the general practitioner were based on a st and ard protocol at the in-depth assessment . The primary endpoints were mortality , admissions to hospital and institution , and quality of life . Analysis was by intention to treat and per protocol . This trial has been assigned the International St and ardised R and omised Controlled Trial Number IS RCT N23494848 . FINDINGS Mortality and hospital or institutional admissions did not differ between groups . During 3 years ' follow-up , significant improvements in quality of life result ed from universal versus targeted assessment in terms of homecare , and from management by geriatric team versus primary -care team , in terms of mobility , social interaction , and morale . However , only the result for social interaction was consistent with a small but important effect . INTERPRETATION The different forms of multidimensional assessment offered almost no differences in patient outcome Are meta-analyses the brave new world , or are the critics of such combined analyses right to say that the biases inherent in clinical trials make them uncombinable ? Negative trials are often unreported , and hence can be missed by meta-analysts . And how much heterogeneity between trials is acceptable ? A recent major criticism is that large r and omised trials do not always agree with a prior meta- analysis . Neither individual trials nor meta-analyses , reporting as they do on population effects , tell how to treat the individual patient . Here we take a more rounded approach to meta-analyses , arguing that their strengths outweigh their weaknesses , although the latter must not be brushed aside Health visitors were employed specifically to care for two years for a r and om sample of patients in general practice who were aged over 70 . Independent assessment s made at the beginning and end of the study showed that the health visitor in an urban practice had some impact on her caseload of patients ; she provided more services for them , their mortality was reduced , and their quality of life improved , though the last measure just failed to be statistically significant . The health visitor working in a rural practice had no such effect BACKGROUND The effectiveness of community-based geriatric intervention models for vulnerable older adults is controversial . We evaluated a problem-based multidisciplinary intervention targeting vulnerable older adults at home that promised efficacy through better timing and increased commitment of patients and primary care physicians . This study compared the effects of this new model to usual care . METHODS Primary care physicians referred older people for problems with cognition , nutrition , behavior , mood , or mobility . One hundred fifty-one participants ( mean age 82.2 years , 74.8 % women ) were included in a pseudocluster r and omized trial with 6-month follow-up for the primary outcomes . Eighty-five participants received the new intervention , and 66 usual care .  In the intervention arm , geriatric nurses visited patients at home for geriatric assessment and management in cooperation with primary care physicians and geriatricians . Modified intention-to-treat analyses focused on differences between treatment arms in functional abilities ( Groningen Activity Restriction Scale-3 ) and mental well-being ( subscale mental health Medical Outcomes Study [MOS]-20 ) , using a mixed linear model . RESULTS After 3 months , treatment arms showed significant differences in favor of the new intervention .  Functional abilities improved 2.2 points ( 95 % confidence interval [ CI ] , 0.3 - 4.2 ) and well-being 5.8 points ( 95 % CI , 0.1 - 11.4 ) . After 6 months , the favorable effect increased for well-being ( 9.1 ; 95 % CI , 2.4 - 15.9 ) , but the effect on functional abilities was no longer significant ( 1.6 ; 95 % CI , -0.7 to 3.9 ) . CONCLUSIONS This problem-based geriatric intervention improved functional abilities and mental well-being of vulnerable older people . Problem-based interventions can increase the effectiveness of primary care for this population Aims : In controlled intervention studies , a selective non-response or refusal to participate at baseline may bias measurable effects of the intervention . The aim of this study was to compare mortality and nursing home admission among older persons who accepted ( participants ) and older person who declined ( non- participants ) to join a controlled feasibility trial , and to describe and evaluate defined subgroups of non- participants . Methods : Prospect i ve controlled three-year intervention study ( 1999—2001 ) in 34 Danish municipalities with five-year follow-up . R and omization and intervention ( education of municipality employees ) was done at municipality level . In total 5,788 home-dwelling 75- and 80-year-olds living in these municipalities were invited to participate in the study . Written consent was obtained from 4,060 persons ( participation rate 71 % ) . Results : During five-year follow-up non- participants had a higher mortality rate ( survival analysis risk ratio RR=1.5 , 95 % CI=1.3—1.7 , p<0.0001 ) and a higher rate of nursing home admissions ( RR=1.7 , 95 % CI=1.3— 2.1 , p<0.0001 ) compared with participants . Subgroups of non- participants describing themselves as ` ` too ill ' ' and persons ` ` not reached ' ' had a significantly higher mortality rate and risk of admission to nursing home than participants , whereas the subgroups of non- participants describing themselves as ` ` too healthy ' ' and having ` ` another reason for refusal ' ' did not differ from the participants . There was no difference in mortality rates between non- participants living in intervention municipalities compared with non- participants living in control municipalities . Conclusions : Mortality and nursing home admissions were higher among non- participants . Selection participation bias was of no clinical importance since subgroups of non- participants eligible for the intervention did not differ from the participants BACKGROUND Baseline data collected on each patient at r and omisation in controlled clinical trials can be used to describe the population of patients , to assess comparability of treatment groups , to achieve balanced r and omisation , to adjust treatment comparisons for prognostic factors , and to undertake subgroup analyses . We assessed the extent and quality of such practice s in major clinical trial reports . METHODS A sample of 50 consecutive clinical -trial reports was obtained from four major medical journals during July to September , 1997 . We tabulated the detailed information on uses of baseline data by use of a st and ard form . FINDINGS Most trials presented baseline comparability in a table . These tables were often unduly large , and about half the trials inappropriately used significance tests for baseline comparison . Methods of r and omisation , including possible stratification , were often poorly described . There was little consistency over whether to use covariate adjustment and the criteria for selecting baseline factors for which to adjust were often unclear . Most trials emphasised the simple unadjusted results and covariate adjustment usually made negligible difference . Two-thirds of the reports presented subgroup findings , but mostly without appropriate statistical tests for interaction . Many reports put too much emphasis on subgroup analyses that commonly lacked statistical power . INTERPRETATION Clinical trials need a predefined statistical analysis plan for uses of baseline data , especially covariate-adjusted analyses and subgroup analyses . Investigators and journals need to adopt improved st and ards of statistical reporting , and exercise caution when drawing conclusions from subgroup findings Over three years 285 r and omly selected subjects aged 75 years or more and living in a suburb of Copenhagen were visited every three months in their own homes ( the intervention group ) to assess whether scheduled medically and socially preventive intervention would influence the number of admissions to hospitals or nursing homes , the number of contacts with general practice , or mortality .  A r and omly selected group of 287 people of the same age and sex were visited during the final three months of the study ( the control group ) . Two hundred and nineteen admissions to hospitals ( 4884 bed days ) were registered for the intervention group compared with 271 ( 6442 bed days ) for the control group . Especially during the second half of the study , a significant reduction in the number of admissions to hospitals was seen in the intervention group . Twenty people in the intervention group and 29 in the control group moved into nursing homes ( p greater than 0.05 ) . The corresponding numbers of deaths were 56 and 75 ( p less than 0.05 ) . No difference was seen in the number of contacts with general practice . Significantly fewer emergency medical calls , however , were registered for the intervention group . Subjects in the intervention group benefited from the regular visits and the increased distribution of aids and modifications  to their homes to which these led . The regular visits probably also produced an important increase in confidence CONTEXT Low-income seniors frequently have multiple chronic medical conditions for which they often fail to receive the recommended st and ard of care . OBJECTIVES To test the effectiveness of a geriatric care management model on improving the quality of care for low-income seniors in primary care . DESIGN , SETTING , AND PATIENTS Controlled clinical trial of 951 adults 65 years or older with an annual income less than 200 % of the federal poverty level , whose primary care physicians were r and omized from January 2002 through August 2004 to participate in the intervention ( 474 patients ) or usual care ( 477 patients ) in community-based health centers . INTERVENTION Patients received 2 years of home-based care management by a nurse practitioner and social worker who collaborated with the primary care physician and a geriatrics interdisciplinary team and were guided by 12 care protocol s for common geriatric conditions . MAIN OUTCOME MEASURES The Medical Outcomes 36-Item Short-Form ( SF-36 ) scales and summary measures ; instrumental and basic activities of daily living ( ADLs ) ; and emergency department ( ED ) visits not result ing in hospitalization and hospitalizations . RESULTS Intention-to-treat analysis revealed significant improvements for intervention patients compared with usual care at 24 months in 4 of 8 SF-36 scales : general health ( 0.2 vs -2.3 , P = .045 ) , vitality ( 2.6 vs -2.6 , P < .001 ) , social functioning ( 3.0 vs -2.3 , P = .008 ) , and mental health ( 3.6 vs -0.3 , P = .001 ) ; and in the Mental Component Summary ( 2.1 vs -0.3 , P < .001 ) . No group differences were found for ADLs or death . The cumulative 2-year ED visit rate per 1000 was lower in the intervention group ( 1445 [ n = 474 ] vs 1748 [ n = 477 ] , P = .03 ) but hospital admission rates per 1000 were not significantly different between groups ( 700 [ n = 474 ] vs 740 [ n = 477 ] , P = .66 ) . In a predefined group at high risk of hospitalization ( comprising 112 intervention and 114 usual-care patients ) , ED visit and hospital admission rates were lower for intervention patients in the second year ( 848 [ n = 106 ] vs 1314 [ n = 105 ] ; P = .03 and 396 [ n = 106 ] vs 705 [ n = 105 ] ; P = .03 , respectively ) . CONCLUSIONS Integrated and home-based geriatric care management result ed in improved quality of care and reduced acute care utilization among a high-risk group . Improvements in health-related quality of life were mixed and physical function outcomes did not differ between groups . Future studies are needed to determine whether more specific targeting will improve the program 's effectiveness and whether reductions in acute care utilization will offset program costs . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00182962 Background There is a debate on whether preventive home visits to older people have any impact . This study was undertaken to investigate whether preventive home visits by professional health workers to older persons can postpone mortality in a Swedish context . Method A controlled 
    Output:
    
There was no single factor explaining the heterogenous effects of trials on nursing home admissions .
Multidimensional preventive home visits have the potential to reduce disability burden among older adults when based on multidimensional assessment with clinical examination .
Effects on nursing home admissions are heterogeneous and likely depend on multiple factors including population factors , program characteristics , and health care setting