***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: CONTEXT Comprehensive discharge planning by advanced practice nurses has demonstrated short-term reductions in readmissions of elderly patients , but the benefits of more intensive follow-up of hospitalized elders at risk for poor outcomes after discharge has not been studied . OBJECTIVE To examine the effectiveness of an advanced practice nurse-centered discharge planning and home follow-up intervention for elders at risk for hospital readmissions .  DESIGN R and omized clinical trial with follow-up at 2 , 6 , 12 , and 24 weeks after index hospital discharge . SETTING Two urban , academically affiliated hospitals in Philadelphia , Pa. PARTICIPANTS Eligible patients were 65 years or older , hospitalized between August 1992 and March 1996 , and had 1 of several medical and surgical reasons for admission . INTERVENTION Intervention group patients received a comprehensive discharge planning and home follow-up protocol design ed specifically for elders at risk for poor outcomes after discharge and implemented by advanced practice nurses . MAIN OUTCOME MEASURES Readmissions , time to first readmission , acute care visits after discharge , costs , functional status , depression , and patient satisfaction . RESULTS A total of 363 patients ( 186 in the control group and 177 in the intervention group ) were enrolled in the study ; 70 % of intervention and 74 % of control subjects completed the trial . Mean age of sample was 75 years ; 50 % were men and 45 % were black . By week 24 after the index hospital discharge , control group patients were more likely than intervention group patients to be readmitted at least once ( 37.1 % vs 20.3 % ; P<.001 ) . Fewer intervention group patients had multiple readmissions ( 6.2 % vs 14.5 % ; P = .01 ) and the intervention group had fewer hospital days per patient ( 1.53 vs 4.09 days ; P<.001 ) . Time to first readmission was increased in the intervention group ( P<.001 ) . At 24 weeks after discharge , total Medicare reimbursements for health services were about $ 1.2 million in the control group vs about $ 0.6 million in the intervention group ( P<.001 ) . There were no significant group differences in post-discharge acute care visits , functional status , depression , or patient satisfaction . CONCLUSIONS An advanced practice nurse-centered discharge planning and home care intervention for at-risk hospitalized elders reduced readmissions , lengthened the time between discharge and readmission , and decreased the costs of providing health care . Thus , the intervention demonstrated great potential in promoting positive outcomes for hospitalized elders at high risk for rehospitalization while reducing costs OBJECTIVE We hypothesised that all areas of health status after total hip replacement could be improved in patients aged over 65 years and over by using telephone support and counselling 2 and 10 weeks after surgery compared with a control group receiving conventional care and treatment . DESIGN A r and omised clinical trial focusing on patients ' health status by using short-form 36 at 4 weeks preoperatively and 3 and 9 months postoperatively was carried out . SAMPLE 180 patients aged 65 years and over were r and omised 4 weeks preoperatively to either control or intervention groups . MEASUREMENTS both groups received conventional surgical treatment , but the intervention group was interviewed by telephone 2 and 10 weeks after surgery . Patients were given counselling within eight main dimensions with reference to their postoperative situation . RESULTS All patients experienced improvement in health status . The intervention significantly reduced the time patients needed to reach their habitual levels in three of eight areas of their health status : the intervention patients reached their habitual levels at 3 months whereas the control patients reached theirs after 9 months . CONCLUSION Intervention by telephone support and counselling in the postoperative phase seems to benefit patients ' improvement in health status Newly discharged older adults with heart failure continue to experience frequent hospital readmissions , lower quality of life , and decreased satisfaction with health services .  A theory-guided intervention delivered by home health nurses via the telephone was studied using a r and omized controlled trial to assess its feasibility and inform further studies . Findings generated a profile of older adults with heart failure , utilization by patients and nurses , operational issues , and preliminary data on intended outcomes . Implication s for further study are presented OBJECTIVE This double-blind r and omised controlled trial compared the effects of tap water and normal saline on the healing and infection rates of acute and chronic wounds . METHOD The trial was conducted in two metropolitan community health centres in New South Wales , Australia . Thirty-five patients with 49 acute or chronic wounds were r and omised to receive  wound irrigation  with either normal saline or tap water . RESULTS Statistical analysis demonstrated there was no significant difference between the infection and healing rates in wounds irrigated with normal saline or tap water . CONCLUSION Although the small sample size is a limitation of this study , the research ers conclude that drinkable tap water appears to provide a safe alternative to normal saline for wound cleansing and may be preferred by some patients CONTEXT Most older adults with dementia will be cared for by primary care physicians , but the primary care practice environment presents important challenges to providing quality care . OBJECTIVE To test the effectiveness of a collaborative care model to improve the quality of care for patients with Alzheimer disease . DESIGN , SETTING , AND PATIENTS Controlled clinical trial of 153 older adults with Alzheimer disease and their caregivers who were r and omized by physician to receive collaborative care management ( n = 84 ) or augmented usual care ( n = 69 ) at primary care practice s within 2 US university-affiliated health care systems from January 2002 through August 2004 . Eligible patients ( identified via screening or medical record ) met diagnostic criteria for Alzheimer disease and had a self-identified caregiver . INTERVENTION Intervention patients received 1 year of care management by an interdisciplinary team led by an advanced practice nurse working with the patient 's family caregiver and integrated within primary care . The team used st and ard protocol s to initiate treatment and identify , monitor , and treat behavioral and psychological symptoms of dementia , stressing nonpharmacological management . MAIN OUTCOME MEASURES Neuropsychiatric Inventory ( NPI ) administered at baseline and at 6 , 12 , and 18 months . Secondary outcomes included the Cornell Scale for Depression in Dementia ( CSDD ) , cognition , activities of daily living , re source use , and caregiver 's depression severity . RESULTS Initiated by caregivers ' reports , 89 % of intervention patients triggered at least 1 protocol for behavioral and psychological symptoms of dementia with a mean of 4 per patient from a total of 8 possible protocol s. Intervention patients were more likely to receive  cholinesterase inhibitors  ( 79.8 % vs 55.1 % ; P = .002 ) and  antidepressants  ( 45.2 % vs 27.5 % ; P = .03 ) . Intervention patients had significantly fewer behavioral and psychological symptoms of dementia as measured by the total NPI score at 12 months ( mean difference , -5.6 ; P = .01 ) and at 18 months ( mean difference , -5.4 ; P = .01 ) . Intervention caregivers also reported significant improvements in distress as measured by the caregiver NPI at 12 months ; at 18 months , caregivers showed improvement in depression as measured by the Patient Health Question naire-9 . No group differences were found on the CSDD , cognition , activities of daily living , or on rates of hospitalization , nursing home placement , or death . CONCLUSIONS Collaborative care for the treatment of Alzheimer disease result ed in significant improvement in the quality of care and in behavioral and psychological symptoms of dementia among primary care patients and their caregivers . These improvements were achieved without significantly increasing the use of antipsychotics or sedative-hypnotics . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00246896 Objectives To evaluate the effects of an advanced practice nurse ( APN ) in-home health consultation program ( HCP ) on quality of life , health indicators ( falls , acute events ) , and healthcare utilization . Design R and omized clinical trial . Setting One urban area in the German-speaking part of Switzerl and . Participants Four hundred sixty-one community-dwelling individuals aged 80 and older ( mean age 85 , 72.7 % female , all Caucasian ) participated in the intervention ( n = 231 ) and control ( n = 230 ) groups . Intervention After a comprehensive geriatric assessment , participants were r and omly assigned to the 9-month HCP with four in-home visits and three phone calls from APNs or to a control group with st and ard care with no intervention . Measurements The primary outcome was quality of life at 3 , 6 , and 9 months . Secondary outcomes were incidence of falls , acute events due to health problems , and healthcare utilization measured for 3-month periods at 3 , 6 , and 9 months . Results The intervention and control groups did not differ significantly on any dimension of the World Health Organization Quality of Life question naire but differed significantly over 9 months in self-reported acute events ( 116 vs 168 , relative risk ( RR ) = 0.70 , P = .001 ) , falls ( 74 vs 101 , RR = 0.71 , P = .003 ) , consequences of falls ( 63.1 % vs 78.7 % , chi-square = 7.39 , P = .007 ) , and hospitalizations ( 47 vs 68 , RR = .70 , P = .03 ) . Conclusion The in-home HCP provided by APNs and guided by the principles of health promotion , empowerment , partnership , and family-centeredness , can be effective in reducing adverse health outcomes such as falls , acute events , and hospitalizations Older adults are at high risk of readmission on discharge from the Acute Medical and Emergency Department ( ED ) . This study examines the effect of a two-stage nursing assessment and intervention to address older adults ' uncompensated problems and thus intend to prevent readmission and functional decline . A r and omized controlled study was conducted . Included were 271 patients aged 70 and over admitted to an ED . A brief st and ardized nursing assessment and intervention was carried out after discharge and at follow-up . No effect was found on readmission to hospital , admission to nursing home , or death but the intervention group was less likely to be at risk of depression after 180 days . Whether this method can be recommended needs further study as well as knowledge is needed as to the organization and to reveal older adults ' experiences on follow-up after ED stay 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 . T 
    Output:
    
Advanced practice nurses were integrated within multidisciplinary teams and the main interventions deployed were patient education , multidimensional assessment s and coordination of multiple providers .
Positive results have been found in older people in long-term care setting s , although it is difficult to discern the specific effect attributable to them because they are inserted in multidisciplinary teams .