***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: Objective To determine the efficacy of a targeted multifactorial falls prevention programme in elderly care wards with relatively short lengths of stay . Design Cluster r and omised trial . Setting 24 elderly care wards in 12 hospitals in Sydney , Australia . Participants 3999 patients , mean age 79 years , with a median hospital stay of seven days . Interventions A nurse and physiotherapist each worked for 25 hours a week for three months in all intervention wards . They provided a targeted multifactorial intervention that included a risk assessment of falls , staff and patient education , drug review , modification of bedside and ward environments , an exercise programme , and alarms for selected patients . Main outcome measure Falls during hospital stay . Results Intervention and control wards were similar at baseline for previous rates of falls and individual patient characteristics . Overall , 381 falls  occurred during the study . No difference was found in fall rates during follow-up between intervention and control wards : respectively , 9.26 falls per 1000 bed days and 9.20 falls per 1000 bed days ( P=0.96 ) . The incidence rate ratio adjusted for individual lengths of stay and previous fall rates in the ward was 0.96 ( 95 % confidence interval 0.72 to 1.28 ) . Conclusion A targeted multifactorial falls prevention programme was not effective among older people in hospital wards with relatively short lengths of stay . Trial registration Australian New Zeal and Clinical Trials Registry ACTRNO 12605000467639 OBJECTIVE To evaluate the impact of in-hospital pressure ulcer development on mortality among older , high-risk , hospitalized patients up to 1 year post-hospital discharge , after adjusting for baseline patient characteristics , disease severity , hospital complications , and discharge activity level . DESIGN A prospect i ve , inception , cohort study . SETTING An urban , tertiary , acute care , university teaching hospital . PATIENTS A total of 286 patients aged 55 or older , expected to be confined to bed or chair for at least 5 days , who were admitted to the hospital without a Stage 2 or greater pressure ulcer . MEASUREMENTS The primary outcome measurement was time to death from admission to 1-year post-hospital discharge . Baseline information included demographic , medical , functional , and nutritional variables known to be associated with increased mortality . Measures of global disease severity and co-morbidity included the admitting physician 's estimate of illness severity and life expectancy , the acute physiology score of APACHE II , the Co-morbidity Damage Index , and the Medicus Nursing Classification Score . Baseline infections , incident infections , and noninfectious hospital complications were determined . Functional activity level was determined at hospital discharge . Post-discharge vital status was determined by telephone interviews at 3,6,9 , and 12 months after discharge and confirmed by death certificate review . MAIN RESULTS Development of an in-hospital pressure ulcer was associated with greater risk of death at 1 year ( 59.5 % vs 38.2 % , P = .02 ) . However , pressure ulcer development did not remain independently associated with decreased survival after adjusting for other predictors of mortality . Predictors of mortality at hospital admission by multivariate Cox regression analysis included weight loss in the 6 months before admission ( RR 2.4 , CI 1.6 , 3.6 ) , physician estimate of life expectancy ( RR 2.1 , CI 1.7 , 2.6 ) , and the Co-morbidity Damage Index ( RR 1.1 , CI 1.0 , 1.2 ) . Multivariate predictors of 1-year mortality at discharge included physician estimate of life expectancy ( RR 2.2 , CI 1.8,2.6 ) , weight loss in the 6 months before admission ( RR 2.2 , CI 1.5,3.2 ) , remaining confined to bed or chair ( RR 1.9 , CI 1.2,3.1 ) , and the total number of hospital complications ( RR 1.3 , CI 1.2,1.5 ) . CONCLUSIONS Pressure ulcers that develop during acute hospitalization are not associated with reduced 1-year survival among high risk older persons after adjusting for nutritional and functional status , global measures of disease severity and co-morbidity , and noninfectious hospital complications OBJECTIVE To identify specific demographic , medical , functional status , and nutritional characteristics that predict the development of stage 2 or greater pressure ulcers among patients whose activity is limited to bed or chair . DESIGN Prospect i ve inception cohort study . SETTING Tertiary care , urban , university teaching hospital . PATIENTS A total of 286 patients fulfilling the following criteria : admitted to the hospital within the previous 3 days , age 55 years or more , expected to be confined to bed or chair for at least 5 days or had a hip fracture , and without a stage 2 or greater pressure ulcer . MAIN OUTCOME MEASURE Time to in-hospital development of a stage 2 or greater pressure ulcer . RESULTS Total cumulative incidence of pressure ulcers was 12.9 % ( n = 37 ) after a median time of 9 days from admission to final skin examination . Age of 75 years or more ,  dry skin , nonblanchable erythema ( a stage 1 pressure ulcer ) , previous pressure ulcer history , immobility , fecal incontinence , depleted triceps skinfold , lymphopenia ( lymphocyte count < 1.50 x 10(9)/L ) , and decreased body weight ( < 58 kg ) were significantly associated with pressure ulcer development by univariate Kaplan-Meier survival analyses ( P < .05 by log-rank test ) . Risk ratios ( and 95 % confidence intervals ) for predictors ( P < or = .05 ) of pressure ulcer development after multivariable Cox regression analysis included the following : nonblanchable erythema , 7.52 ( 1.00 to 59.12 ) ; lymphopenia , 4.86 ( 1.70 to 13.89 ) ; immobility , 2.36 ( 1.14 to 4.85 ) ; dry skin , 2.31 ( 1.02 to 5.21 ) ; and decreased body weight , 2.18 ( 1.05 to 4.52 ) . The 3-week cumulative incidence of pressure ulcers with none , one , two , or three or more of these characteristics was 0 % , 11.4 % , 39.6 % , and 67.9 % , respectively ( P < .001 by log-rank test ) . CONCLUSIONS These results suggest that nonblanchable erythema , lymphopenia , immobility , dry skin , and decreased body weight are independent and significant risk factors for pressure ulcers in hospitalized patients whose activity is limited to bed or chair The purpose of this study was to determine the cost for prevention and treatment of  pressure ulcers  from a hospital perspective and to identify the least re source -intensive pressure ulcer prevention strategy .  Cost analyses  were examined from a hospital perspective using direct costs . The study was carried out alongside a prospect i ve cohort study on the incidence and risk factors for pressure ulcers . Two large teaching hospitals in the Netherl and s with ( partly ) opposing approaches in prevention , a technological versus a human approach  , were analyzed . The main outcome measures were re source use , costs of preventive measures and treatment , and pressure ulcer incidence in both hospitals . Pressure ulcer prevention through a predominantly technical approach result ed in a similar incidence rate as prevention through a predominantly human approach . However , the technical approach was considerably less expensive BACKGROUND AND PURPOSE Sleep disturbances are frequently reported in hospitalized patients . We have recently shown significant daily relationships between poor sleep and acute burn pain during the first week of hospitalization , where poor sleep leads to reports of higher pain intensity and in return , greater pain affects quality of sleep . This prospect i ve study was design ed to objective ly evaluate sleep disturbances in hospitalized burn patients and further evaluate their relationships with pain intensity and administered medication . PATIENTS AND METHODS Sixteen non-ventilated burn patients wore an actigraph ( Ambulatory Monitoring , Inc. )  during hospitalization ( N of 24-h observations 164 ) . Sleep measures included duration and fragmentation ( # of awakenings , mean duration of awakenings , mean duration of sleep episodes ( MDAW ) ) . Pain intensity was assessed at rest ( nighttime , morning , during the day ) and following therapeutic procedures known to be painful ( e.g. dressing changes ) . RESULTS Although sleep duration was extremely variable , patients slept an average of 5.5 h a night with numerous awakenings . During the day , patients often took naps , bringing their total sleep time ( TST ) to 8 h. Regression analyses showed significant temporal relationships between sleep , pain and analgesic medication such that a night of poor sleep was followed by a significantly more painful day and higher analgesic intake . Further , high levels of pain and analgesic medication during the day were both significant predictors of poor sleep on the following night . CONCLUSIONS These results obtained with objective measures support previous findings that subjective sleep quality following burn injuries is poor , and strengthen the evidence of a relationship between sleep and sensitivity to pain . Nonetheless , further analyses are necessary to determine and dissociate the effects of pain intensity and analgesic medication on sleep UNLABELLED BACKGROUND L : Pressure ulcers are common , costly and impact negatively on individuals . Pressure is the prime cause , and immobility is the factor that exposes individuals to pressure . International guidelines advocate repositioning ; however , there is confusion surrounding the best method and frequency required . DESIGN A pragmatic , multi-centre , open label , prospect i ve , cluster-r and omised controlled trial was conducted to compare the incidence of  pressure ulcers among older persons nursed using two different repositioning regimens . METHOD Ethical approval was received . Study sites ( n=12 ) were allocated to study arm using cluster r and omisation . The experimental group ( n=99 ) were repositioned three hourly at night , using the 30 ° tilt ; the control group ( n=114 ) received routine prevention ( six-hourly repositioning , using 90 ° lateral rotation ) . Data analysis was by intention to treat ; follow-up was for four weeks . RESULTS All participants ( n=213 ) were Irish and white , among them 77 % were women and 65 % aged 80 years or older . Three patients ( 3 % ) in the experimental group and 13 patients ( 11 % ) in the control group developed a pressure ulcer ( p=0·035 ; 95 % CI 0·031 - 0·038 ; ICC=0·001 ) . All pressure ulcers were grade 1 ( 44 % ) or grade 2 ( 56 % ) . Mobility and activity were the highest predictors of pressure ulcer development ( β=-0·246 , 95 % CI=-0·319 to -0·066 ; p=0·003 ) ; ( β=0·227 , 95 % CI=0·041 - 0·246 ; p = 0·006 ) . CONCLUSION Repositioning older persons at risk of pressure ulcers every three hours at night , using the 30 ° tilt , reduces the incidence of pressure ulcers compared with usual care . The study supports the recommendations of the 2009 international pressure ulcer prevention guidelines . RELEVANCE TO CLINICAL PRACTICE An effective method of pressure ulcer prevention has been identified ; in the light of the problem of pressures ulcers , current prevention strategies should be review ed . It is important to implement appropriate prevention strategies , of which repositioning is one The aim of this investigation was to determine which positions result ed in the lowest pressures to the skin of persons lying in bed .  Pressures were recorded in 10 different lying positions on 2 mattresses in 62 healthy volunteers . The study revealed that the 30 degrees semi-Fowler position and the prone position result ed in the lowest interface pressures . The 30 degrees laterally inclined position had lower pressure readings than the 90 degrees side lying position ; 90 degrees side lying position gives the highest pressure readings and thus should be avoided . A Tempur polyethylene-urethane mattress reduces interface pressures by 20 to 30 % in comparison to a st and ard hospital mattress ( 12-cm-thick cold foam ) AIM This paper reports a study investigating whether repositioning patients lying on a pressure-reducing mattress alternately for 2 hours in a lateral position and 4 hours in a supine position reduces the incidence of pressure ulcers in comparison with repositioning every 4 hours . BACKGROUND Repositioning is commonly recognized as an effective preventive measure . Almost no research has been carried out so far on the necessary turning frequencies to prevent pressure ulcer lesions . The pressure is higher in a lateral than in a supine position . METHOD A two-arm r and omized controlled trial was conducted in 16 Belgian elder care nursing homes . Patients with non-blanchable erythema were r and omly assigned to either an experimental or a control group . In the experimental group ( n = 122 ) , patients were repositioned alternately 2 hours in a lateral position and 4 hours in a supine position . In the control group ( n = 113 ) , patients were repositioned every 4 hours . The sitting protocol was identical in both groups . Pressure areas were observed daily and classified according to the four grade s of the European Pressure Ulcer Advisory Panel . RESULTS In the experimental group , 16.4 % patients developed a pressure ulcer lesion ( grade 2 - 4 ) , while 21.2 % did so in the control group . The incidence was not statistically significantly different between the two groups ( P = 0.40 ) . The severity ( P = 0.65 ) and location ( P = 0.19 ) of pressure ulcer lesions , and the time to developing 
    Output:
    
Repositioning is an integral component of pressure ulcer prevention and treatment ; it has a sound theoretical rationale , and is widely recommended and used in practice .
Current evidence is small in volume and at risk of bias and there is currently no strong evidence of a reduction in pressure ulcers with the 30 ° tilt compared with the st and ard 90º position or good evidence of an effect of repositioning frequency .
The limited data derived from one economic evaluation means it remains unclear whether repositioning every 3 hours using the 30º tilt is less costly in terms of nursing time and more effective than st and ard care involving repositioning every 6 hours using a 90º tilt