***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: Introduction .Delirium , or acute confusional state , is a common and serious occurrence among hospitalized older persons . Current estimates suggest that delirium complicates hospital stays for more than 2.3 million older persons each year , involving more than 17.5 million hospital days and accounting for more than $ 4 billion ( 1994 dollars ) of Medicare expenditures . A 40 % reduction was recently reported in the risk for delirium among hospitalized older persons receiving a multicomponent targeted risk factor intervention ( MTI ) strategy to prevent delirium , compared with subjects receiving usual hospital care .  1 Before recommending that this preventive strategy be implemented in clinical practice , however , the cost implication s must be thoroughly examined as well . Methods .The present analysis performs net cost evaluations of the MTI for the prevention of delirium among hospitalized patients . Hospital charge and cost-to-charge ratio data are linked to a data base of 852 subjects , who were treated with MTI or usual care .  Multivariable regression methods were used to help isolate the impact of MTI on hospital costs . These results were then combined with our earlier work on the impact of the MTI on delirium prevention to assess the cost effectiveness of this intervention . Results .The MTI significantly reduced nonintervention costs among subjects at intermediate risk for developing delirium , but not among subjects at high risk . When MTI  intervention costs were included , MTI had no significant effect on overall health care costs in the intermediate risk cohort , but raised overall costs in the high risk group . Conclusions .Because the MTI prevented delirium in the intermediate risk group without raising costs , the conclusion reached is that it is a cost effective treatment option for patients at intermediate risk for developing delirium . In contrast , the results suggest that the MTI is not cost effective for subjects at high risk OBJECTIVES To determine whether costs of long-term nursing home ( NH ) care for patients who received a multicomponent targeted intervention ( MTI ) to prevent delirium while hospitalized were less than for those who did not receive the intervention . DESIGN Longitudinal follow-up from a r and omized trial . SETTING Posthospital discharge setting s : community-based care and NHs . PARTICIPANTS Eight hundred one hospitalized patients aged 70 and older . MEASUREMENTS Patients were followed for 1 year after discharge , and measures of NH service use and costs were constructed . Total long-term NH costs were estimated using a two-part regression model and compared across intervention and control groups . RESULTS Of the 400 patients in the intervention group and 401 patients in the matched control group , 153 ( 38 % ) and 148 ( 37 % ) , respectively , were admitted to a NH during the year , and 54 ( 13 % ) and 51 ( 13 % ) , respectively , were long-term NH patients . The MTI had no effect on the likelihood of receiving long-term NH care , but of patients receiving long-term NH care , those in the MTI group had significantly lower total costs , shorter length of stay and lower cost per survival day . Adjusted total costs were $ 50,881 per long-term NH patient in the MTI group and $ 60,327 in the control group , a savings of 15.7 % ( P=.01 ) . CONCLUSION Active methods to prevent delirium are associated with a 15.7 % decrease in long-term NH costs . Shorter length of stay of patients receiving long-term NH services was the primary source of these savings BACKGROUND Delirium is a common problem for frail , older patients in hospital and a marker of poor outcome and mortality . The aim of this study was to test a volunteer-mediated delirium prevention programme for efficacy , cost-effectiveness and sustainability on an Australian geriatric ward . METHODS Two controlled before- and -after studies were conducted . In study 1 , 37 patients ( > 70 years , admitted to the geriatric wards ) were enrolled during 5 months in 2003 for intensive individual study . Twenty-one patients received usual care and 16 patients received the volunteer-mediated intervention of daily orientation , therapeutic activities , feeding and hydration assistance , vision and hearing protocol s. In study 2 , we examined the effects of a general implementation for the whole department by measuring use of assistants in nursing , who were employed for individual nursing of delirious patients . RESULTS In study 1 , we found a lower incidence ( intervention vs control , 6.3 % vs 38 % ; P = 0.032 ) and lower severity of delirium ( 1.2 vs 5.1 ; P = 0.045 ) . There was a trend towards decreased duration of delirium ( 5.0 vs 12.5 ; P = 0.64 ) . In study 2 , use of assistants in nursing was reduced by 314 h per month suggesting a total annual saving of 129,186 Australian dollars for the hospital . CONCLUSION The programme prevents delirium and improves outcomes for elderly in patients .  Cost-effectiveness supports the continuation of the programme and extension to other geriatric units 
    Output:
    
The protocol s were revised based on the review process and incorporated into the HELP material s. Inclusion of these protocol s enhances the scope of the HELP program and allows fulfillment of NICE guideline recommendations for delirium prevention .