***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 People with cognitive impairment and dementia have a poor outcome after a hip fracture surgery , about 30 - 50 % of all those who sustain a hip fracture have dementia . Therefore the aim was to investigate whether a multidisciplinary postoperative intervention program could reduce postoperative complications and improve functional recovery among people with dementia . METHODS A r and omized controlled trial with subgroup analyses among patients with dementia . Sixty-four patients with femoral neck fracture , aged ≥70 years at Umeå University Hospital , Sweden . The intervention consisted of staff education , individualized care planning and rehabilitation , active prevention , detection and treatment of postoperative complications , especially delirium . The staff worked in teams to apply comprehensive geriatric assessment , management and rehabilitation , including a follow-up at 4 months postoperatively . The control group followed conventional postoperative routines . RESULTS There were fewer postoperative complications in the intervention group such as urinary tract infections , p=0.001 ; nutritional problems , p=0.025 ; postoperative delirium , p=0.002 ; falls , p=0.006 . At 4 months a larger proportion in the intervention group had regained their previous independent indoor walking ability performance , p=0.005 . At 12 months a larger proportion in the intervention group had regained the activities of daily living ( ADL ) performance level they had before the fracture , p=0.027 . CONCLUSION This study demonstrates that patients with dementia who suffer a hip fracture can benefit from multidisciplinary geriatric assessment and rehabilitation and should not be excluded from rehabilitation programs Objective : To investigate if motivational interviewing improved physical activity , self-efficacy , quality of life , mobility and mental health in people living in the community after hip fracture . Design : Single-blind r and omized controlled trial . Setting : Community . Participants : A total of 30 adults after hip fracture who had been discharged from rehabilitation to independent living in the community and allocated to a control group ( n = 14 ) or an intervention group ( n = 16 ) . Intervention : All participants received usual care . The intervention group also received eight weekly sessions of motivational interviewing as additional input , with the control group having no additional matching input . Main outcomes : The primary outcome was physical activity levels as measured by an accelerometer ( steps taken per day , time spent walking per day , and time spent sitting or lying each day ) . Secondary outcomes included self-efficacy ( confidence about walking and not falling ) , health-related quality of life , mobility and mental health . Results : Relative to usual care , the motivational interviewing group took significantly more steps per day ( mean = 1237 steps , 95 % confidence interval ( CI ) 12 to 2463 ) , walked for longer per day ( mean = 14.4 minutes , 95 % CI 0.6 to 28.8 ) , had improved self-efficacy evidence d by being more confident about walking ( mean = 1.6 units out of 10 , 95 % CI 0.3 to 2.9 ) and not falling ( mean = 1.1 units out of 10 , 95 % CI 0.3 to 1.9 ) and improved health-related quality of life and mental health . Conclusion : This study provides preliminary evidence that motivational interviewing can result in clinical ly meaningful improvements in physical activity and psychosocial outcomes for people recovering from hip fracture Abstract Objective : To evaluate the effect of intensive geriatric rehabilitation on demented patients with hip fracture . Design : Preplanned sub analysis of r and omised intervention study . Settting : Jyväskylä Central Hospital , Finl and . Participants : 243 independently living patients aged 65 years or older admitted to hospital with hip fracture . Intervention : After surgery patients in the intervention group ( n=120 ) were referred to the geriatric ward whereas those in the control group were discharged to local hospitals . Main outcome measures : Length of hospital stay , mortality , and place of residence three months and one year after surgery for hip fracture . Results : The median length of hospital stay of hip fracture patients with moderate dementia ( mini mental state examination score 12 - 17 ) was 47 days in the intervention group ( n=24 ) and 147 days in the control group ( n=12 , P=0.04 ) . The corresponding figures for patients with mild dementia ( score 18 - 23 ) were 29 days in the intervention group ( n=35 ) and 46.5 days in the control group ( n=42 , P=0.002 ) . Three months after the operation , in the intervention group 91 % ( 32 ) of the patients with mild dementia and 63 % ( 15 ) of the patients with moderate dementia were living independently . In the control group , the corresponding figures were 67 % ( 28 ) and 17 % ( 2 ) . There were no significant differences in mortality or in the lengths of hospital stay of severely demented patients and patients with normal mini mental state examination scores . Conclusions : Hip fracture patients with mild or moderate dementia can often return to the community if they are provided with active geriatric rehabilitation OBJECTIVE to compare the effects of two different exercise programmes after hip fracture . DESIGN assessor-blinded r and omised controlled trial . SETTING hospital rehabilitation units , with continued intervention at home . SUBJECTS 160 people with surgical fixation for hip fracture transferred to inpatient rehabilitation . METHOD in addition to other rehabilitation strategies , the intervention group received a higher dose ( 60 min/day ) exercise programme conducted whilst st and ing and the control group received a lower dose exercise programme ( 30 min/day ) primarily conducted whilst seated/supine . The primary outcome measures were knee extensor muscle strength in the fractured leg and walking speed , measured at 4 and 16 weeks . RESULTS 150 participants ( 94 % of those recruited ) completed the trial . There were no differences between the groups for the two primary outcome measures . Post hoc analyses revealed increased walking speed among those in the higher dose , weight-bearing exercise group with cognitive impairment at 4 and 16 weeks . CONCLUSIONS there was no benefit ( or harm ) due to the higher dose , weight-bearing exercise programme with respect to the primary outcome measures . However , people with hip fracture and cognitive impairment gained greater benefit from the higher dose programme than from the lower dose programme BACKGROUND Hip fracture is a common injury with associated high mortality . Recent drives by the Department of Health have sought to prioritise these patients ' care . In April 2010 , the Best Practice Tariff was introduced in Engl and and Wales . This offers financial incentives to institutions that provide holistic care and surgery within 36h for hip fracture patients . The Engl and and Wales National Institute for Health and Clinical Excellence ( NICE ) published its first guidance on hip fracture management in June 2011 , and emphasised the need for surgery on the day or day after admission . In spite of the emphasis placed on this injury , the predictors of in-hospital mortality remain ill-defined . In particular the effect of the timing of surgery remains contentious . OBJECTIVE To address the issues raised by NICE around surgical timing and examine whether surgery before a 36h watershed improves survival . In addition , to examine survival outcomes for each 12h watershed following admission . MATERIAL S AND METHODS Prospect ively collected data on 2056 patients presenting to our unit with hip fractures between February 2008 and May 2011 were retrospectively review ed . Multivariate regression analysis was used to correct for confounders , and so determine the effect of various parameters on in-patient mortality . RESULTS Age ( p<0.0001 ) , male-gender ( p<0.0001 ) , source of admission ( p<0.05 ) , ASA- grade ( p<0.0001 ) and delay of surgery ( p<0.01 ) were associated with an increased risk of in-hospital mortality . The adjusted odds of in-hospital mortality were 1.58 ( p<0.05 ) times higher in those undergoing surgery after 36h compared to surgery before this time . Early surgery ( within 24h ) result ed in reduced in-hospital mortality when compared to the 36h watershed . Similarly ultra-early surgery ( within 12h ) was even better still ( adjusted odds ratio 3.9 p<0.05 ) . CONCLUSIONS Expeditious surgery is associated with improved patient survival . Other predictors of in-hospital mortality include age , gender , in-hospital fracture and ASA- grade . Ultra-early surgery ( within 12h ) reduces risk of in-hospital mortality Background Hip fractures frequently occur in older persons and severely decrease life expectancy and independence . Several care pathways have been developed to lower the risk of negative outcomes but most pathways are limited to only one aspect of care . The aim of this study was therefore to develop a comprehensive care pathway for older persons with a hip fracture and to conduct a preliminary analysis of its effect . Methods A comprehensive multidisciplinary care pathway for patients aged 60 years or older with a hip fracture was developed by a multidisciplinary team . The new care pathway was evaluated in a clinical trial with historical controls . The data of the intervention group were collected prospect ively . The intervention group included all patients with a hip fracture who were admitted to University Medical Center Groningen between 1 July 2009 and 1 July 2011 . The data of the control group were collected retrospectively . The control group comprised all patients with a hip fracture who were admitted between 1 January 2006 and 1 January 2008 . The groups were compared with the independent sample t-test , the Mann – Whitney U-test or the Chi-squared test ( Phi test ) . The effect of the intervention on fasting time and length of stay was adjusted by linear regression analysis for differences between the intervention and control group . Results The intervention group included 256 persons ( women , 68 % ; mean age ( SD ) , 78 ( 9 ) years ) and the control group 145 persons ( women , 72 % ; mean age ( SD ) , 80 ( 10 ) years ) .  Median preoperative fasting time and median length of hospital stay were significantly lower in the intervention group : 9 vs. 17 hours ( p < 0.001 ) , and 7 vs. 11 days ( p < 0.001 ) , respectively . A similar result was found after adjustment for age , gender , living condition and American Society of Anesthesiologists ( ASA ) classification . In-hospital mortality was also lower in the intervention group : 2 % vs. 6 % ( p < 0.05 ) . There were no statistically significant differences in other outcome measures . Conclusions The new comprehensive care pathway was associated with a significant decrease in preoperative fasting time and length of hospital stay BACKGROUND This report describes changes in eight areas of functioning after a hip fracture , identifies the point at which maximal levels of recovery are reached in each area , and evaluates the sequence of recuperation across multiple functional domains . METHODS . Community-residing hip fracture patients ( n = 674 ) admitted to eight hospitals in Baltimore , Maryl and , 1990 - 1991 were followed prospect ively for 2 years from the time of hospitalization . Eight areas of function ( i.e. , upper and lower extremity physical and instrumental activities of daily living ; gait and balance ; social , cognitive , and affective function ) were measured by personal interview and direct observation during hospitalization at 2 , 6 , 12 , 18 , and 24 months . Levels of recovery are described in each area , and time to reach maximal recovery was estimated using Generalized Estimating Equations and longitudinal data . RESULTS Most areas of functioning showed progressive lessening of dependence over the first postfracture year , with different levels of recovery and time to maximum levels observed for each area . New dependency in physical and instrumental tasks for those not requiring equipment or human assistance prefracture ranged from as low as 20.3 % for putting on pants to as high as 89.9 % for climbing five stairs . Recuperation times were specific to area of function , ranging from approximately 4 months for depressive symptoms ( 3.9 months ) , upper extremity function ( 4.3 months ) , and cognition ( 4.4 months ) to almost a year for lower extremity function ( 11.2 months ) . CONCLUSIONS Functional disability following hip fracture is significant , patterns of recovery differ by area of function , and there appears to be an orderly sequence by which areas of function reach their maximal levels The objective of this study was to develop a prospect ively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies . A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients . The 1-yr mortality rates for the different scores were : " 0 " , 12 % ( 181 ) ; " 1 - 2 " , 26 % ( 225 ) ; " 3 - 4 " , 52 % ( 71 ) ; and " greater than or equal to 5 " , 85 % ( 82 ) . The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up . The percent of patients who died of comorbid disease for the different scores were : " 0 " , 8 % ( 588 ) ; " 1 " , 25 % ( 54 ) ; " 2 " , 48 % ( 25 ) ; " greater than or equal to 3 " , 59 % ( 18 ) . With each increased level of the comorbidity index , there were stepwise increases in the cumulative mortality 
    Output:
    
There is currently insufficient evidence to draw conclusions about how effective the models of enhanced rehabilitation and care after hip fracture used in these trials are for people with dementia above active usual care .