***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 
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    Input: Background Falls are one of the most frequently occurring adverse events that impact upon the recovery of older hospital in patients . Falls can threaten both immediate and longer-term health and independence . There is need to identify cost-effective means for preventing falls in hospitals . Hospital-based falls prevention interventions tested in r and omized trials have not yet been subjected to economic evaluation . Methods Incremental cost-effectiveness analysis was undertaken from the health service provider perspective , over the period of hospitalization ( time horizon ) using the Australian Dollar ( A$ ) at 2008 values . Analyses were based on data from a r and omized trial among n = 1,206 acute and rehabilitation in patients . Decision tree modeling with three-way sensitivity analyses were conducted using burden of disease estimates developed from trial data and previous research . The intervention was a multimedia patient education program provided with trained health professional follow-up shown to reduce falls among cognitively intact hospital patients . Results The short-term cost to a health service of one cognitively intact patient being a faller could be as high as A$ 14,591 ( 2008 ) . The education program cost A$ 526 ( 2008 ) to prevent one cognitively intact patient becoming a faller and A$ 294 ( 2008 ) to prevent one fall based on primary trial data . These estimates were unstable due to high variability in the hospital costs accrued by individual patients involved in the trial . There was a 52 % probability the complete program was both more effective and less costly ( from the health service perspective ) than providing usual care alone . Decision tree modeling sensitivity analyses identified that when provided in real life context s , the program would be both more effective in preventing falls among cognitively intact in patients and cost saving where the proportion of these patients who would otherwise fall under usual care conditions is at least 4.0 % . Conclusions This economic evaluation was design ed to assist health care providers decide in what circumstances this intervention should be provided . If the proportion of cognitively intact patients falling on a ward under usual care conditions is 4 % or greater , then provision of the complete program in addition to usual care will likely both prevent falls and reduce costs for a health service . Trial registration Australia and New Zeal and Clinical Trials Register : ACTRN12608000015347 BACKGROUND admission to a Geriatric Evaluation and Management Unit ( GEMU ) can optimise a patient 's chance of functional recovery . OBJECTIVE to evaluate the ability of several commonly used frailty and functional decline indices to predict GEMU outcomes , both at discharge and at 6 months . DESIGN prospect i ve , observational study . SETTING AND PARTICIPANTS consecutive GEMU patients aged ≥70 years . METHODS patients were classified as ' frail ' or ' at high risk of functional decline ' using several frailty and functional decline instruments . Predictive ability was evaulated using logistic regression and area under receiver operator characteristic ( ROC ) curves ( auROC ) . RESULTS a total of 172 patients were included . Frailty prevalence varied from 24 to 94 % depending on the instrument used . Several instruments predicted patients at risk of poor outcome , including the Frailty Index of Accumulative Deficits ( FI-CD ) , Fried 's Cardiovascular Health Study index , the Study of Osteoporotic Fractures index , an adapted Katz score of activities of daily living ( ADL ) , Instrumental ADL , the Score Hospitalier d'Evaluation du Risque de Perte d'Autonomie ( SHERPA ) and grip strength [ odds ratio ( OR ) range of 2.06 - 6.47 ] . Adequate discriminatory power for discharge outcome was achieved by the FI-CD ( auROC = 0.735 , P < 0.001 ) and an adapted Katz score ( auROC = 0.704 , P = < 0.001 ) . The FI-CD also showed adequate discriminatory power for a poor 6-month outcome ( auROC = 0.702 , P < 0.001 ) . CONCLUSION frailty and functional decline instruments can predict older patients at risk of poor outcome . However , only the FI-CD showed adequate discriminatory power for outcome prediction at both follow-up time-points Objective This investigation utilised the expertise of allied members of multidisciplinary teams working in emergency care setting s to develop and vali date a Rapid Assessment Prioritisation and Referral Tool ( RAPaRT ) . This instrument is intended for use among patients ( with non-life threatening acuity ) presenting to emergency care setting s to indicate when referral to an allied member of the multidisciplinary team is warranted . Method This three stage instrument development and validation study included : a Delphi panel process to determine key criteria to guide instrument development and identify potential items to be carried forward for testing ( stage 1 ) ; a prospect i ve cohort of consecutive admissions ( n=153 ) to investigate item sensitivity and specificity and retain only the most suitable items ( stage 2 ) ; then final consultation with the Delphi panel to ensure the final instrument was clinical ly amenable ( stage 3 ) . Results 23 potential items were identified following stage 1 . At the completion of item sensitivity and specificity analysis and in consultation with the Delphi panel , seven items were retained in the instrument . Area under the receiver operating characteristic curve was 0.803 for these seven items in predicting when a referral was warranted . Final consultation with the Delphi panel members also result ed in the addition of an open ended ( eighth ) item to allow description of any infrequent , but important , reason for referral . Conclusions The RAPaRT has demonstrated substantial promise as an efficient clinical ly amenable instrument to assist multidisciplinary teams in emergency care setting s. Further research to investigate the wider implementation of the RAPaRT is warranted Background People who have complex health care needs frequently access emergency departments for treatment of acute illness and injury . In particular , evidence suggests that those who are homeless , or suffer mental illness , or have a history of substance misuse , are often repeat users of emergency departments . The aim of this study was to describe the socio-demographic and clinical characteristics of emergency department re-presentations . Re-presentation was defined as a return visit to the same emergency department within 28 days of discharge from hospital . Methods A retrospective cohort study was conducted of emergency department presentations occurring over a 24-month period to an Australian inner-city hospital . Characteristics were examined for their influence on the binary outcome of re-presentation within 28 days of discharge using logistic regression with the variable patient fitted as a r and om effect . Results From 64,147 presentations to the emergency department the  re-presentation rate was 18.0 % ( n = 11,559 ) of visits and 14.4 % ( 5,894/40,942 ) of all patients . Median time to re-presentation was 6 days , with more than half occurring within one week of discharge ( 60.8 % ; n = 6,873 ) , and more than three-quarters within two weeks ( 80.9 % ; n = 9,151 ) . The odds of re-presentation increased three-fold for people who were homeless compared to those living in stable accommodation ( adjusted OR 3.09 ; 95 % CI , 2.83 to 3.36 ) . Similarly , the odds of re-presentation were significantly higher for patients receiving a government pension compared to those who did not ( adjusted OR 1.73 ; 95 % CI , 1.63 to 1.84 ) , patients who left part-way through treatment compared to those who completed treatment and were discharged home ( adjusted OR 1.64 ; 95 % CI , 1.36 to 1.99 ) , and those discharged to a residential-care facility compared to those who were discharged home ( adjusted OR 1.46 : 95 % CI , 1.03 to 2.06 ) . Conclusion Emergency department re-presentation rates cluster around one week after discharge and rapidly decrease thereafter . Housing status and being a recipient of a government pension are the most significant risk factors . Early identification and appropriate referrals for those patients who are at risk of emergency department re-presentation will assist in the development of targeted strategies to improve health service delivery to this vulnerable group BACKGROUND This study aim ed to determine ( i ) risk factors for postdischarge falls and ( ii ) the effect of inpatient falls prevention education on rates of falls after discharge . METHODS Participants ( n = 343 ) were a prospect i ve cohort nested within a r and omized controlled trial ( n = 1,206 ) of falls prevention patient education in hospital compared with usual care .  Participants were followed up for 6 months after discharge and falls recorded via a falls diary and monthly telephone calls . Potential falls risk factors were assessed at point of discharge and at 6 months postdischarge using a telephone survey . RESULTS There were 276 falls among 138 ( 40.2 % ) participants in the 6 months following discharge ( 4.52/1,000 person days ) of which 150 were injurious falls ( 2.46/1,000 person days ) . Pairwise comparisons found no significant differences between groups in rates of falls after adjustment for confounding variables . Independent risk factors for all falls outcomes were male gender , history of falls prior to hospital admission , fall during hospital admission , depressed mood at discharge , using a walking aid at discharge , and receiving assistance with activities of daily living at 6 months following discharge . Receiving assistance with activities of daily living significantly reduced the risk of falls and injurious falls for high risk patients . CONCLUSIONS Older patients are at increased risk of falls and falls injuries following discharge . Education that effectively reduced inpatient falls appears to have no ongoing protective effect after discharge . Independent risk factors for falls in this population differ from both hospital and general community setting BACKGROUND Falls are the most frequent adverse events that are reported in hospitals . We examined the effectiveness of individualised falls-prevention education for patients  , supported by training and feedback for staff , delivered as a ward-level programme . METHODS Eight rehabilitation units in general hospitals in Australia participated in this stepped-wedge , cluster-r and omised study , undertaken during a 50 week period . Units were r and omly assigned to intervention or control groups by use of computer-generated , r and om allocation sequences . We included patients admitted to the unit during the study with a Mini-Mental State Examination ( MMSE ) score of more than 23/30 to receive individualised education that was based on principles of changes in health behaviour from a trained health professional , in addition to usual care . We provided information about patients ' goals , feedback about the ward environment , and perceived barriers to engagement in falls-prevention strategies to staff who were trained to support the uptake of strategies by patients . The co primary outcome measures were patient rate of falls per 1000 patient-days and the proportion of patients who were fallers . All analyses were by intention to treat . This trial is registered with the Australian New Zeal and Clinical Trials registry , number ACTRN12612000877886 ) . FINDINGS Between Jan 13 , and Dec 27 , 2013 , 3606 patients were admitted to the eight units ( n=1983 control period ; n=1623 intervention period ) . There were fewer falls ( n=196 , 7·80/1000 patient-days vs n=380 , 13·78/1000 patient-days , adjusted rate ratio 0·60 [ robust 95 % CI 0·42 - 0·94 ] , p=0·003 ) , injurious falls ( n=66 , 2·63/1000 patient-days vs 131 , 4·75/1000 patient-days , 0·65 [ robust 95 % CI 0·42 - 0·88 ] , p=0·006 ) , and fallers ( n=136 [ 8·38 % ] vs n=248 [ 12·51 % ] adjusted odds ratio 0·55 [ robust 95 % CI 0·38 to 0·81 ] , p=0·003 ) in the intervention compared with the control group . There was no significant difference in length of stay ( intervention median 11 days [ IQR 7 - 19 ] , control 10 days [ 6 - 18 ] ) . INTERPRETATION Individualised patient education programmes combined with training and feedback to staff added to usual care reduces the rates of falls and injurious falls in older patients in rehabilitation hospital-units . FUNDING State Health Research Advisory Council , Department of Health , Government of Western Australia AIM To describe the factors most commonly associated with re-presentation to the emergency department ( ED ) and related hospital admissions by those aged 65 years and over in one New Zeal and district health board ( DHB ) region . METHODS  Computerised and paper-based records of 59 patients were examined . The sample was selected using proportionate stratified r and om sampling to ensure equivalent proportions of patients re-presenting to the tertiary hospital 's ED and the secondary hospital 's accident and medical department . RESULTS Those who re-presented to the ED within 3 months had an average of 3.4 comorbidities . Hypertension and ischaemic heart disease were the most common comorbidities . Abdominal pain , chest pain and shortness of breath were the most frequently presenting complaints . Patients were less likely ( p=0.05 ) to re-present within 7 days if their capacity to mobilise prior to presentation , and on discharge , was documented . Few patients were instructed to see their primary care provider within any given timeframe . CONCLUSION Better documentation about changes in levels of function , both prior to presentation and on discharge , is needed to ensure that patients are physically able to manage at home . Specific interventions could be targeted to improve function if needs have been identified . The frequency of cardiovascular comorbidities and cardiac discharge diagnoses suggest that those aged 65 years and over re-present with an acute illness and not because of failure to cope at home . Findings support early 
    Output:
    
Discussion The best evidence synthesis will outline correlates of hospital re-presentations in this clinical group .