***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 develop and vali date a new st and ardized confusion assessment method ( CAM ) that enables nonpsychiatric clinicians to detect delirium quickly in high-risk setting s. DESIGN Prospect i ve validation study . SETTING Conducted in general medicine wards and in an outpatient geriatric assessment center at Yale University ( site 1 ) and in general medicine wards at the University of Chicago ( site 2 ) . PATIENTS The study included 56 subjects , ranging in age from 65 to 98 years . At site 1 , 10 patients with and 20 without delirium participated ; at site 2 , 16 patients with and 10 without delirium participated . MEASUREMENTS AND MAIN RESULTS An expert panel developed the CAM through a consensus building process . The CAM instrument , which can be completed in less than 5 minutes , consists of nine operationalized criteria from the Diagnostic and Statistical Manual of Mental Disorders ( DSM-III-R ) . An a priori hypothesis was established for the diagnostic value of four criteria : acute onset and fluctuating course , inattention , disorganized thinking , and altered level of consciousness . The CAM algorithm for diagnosis of delirium required the presence of both the first and the second criteria and of either the third or the fourth criterion . At both sites , the diagnoses made by the CAM were concurrently vali date d against the diagnoses made by psychiatrists . At sites 1 and 2 values for sensitivity were 100 % and 94 % , respectively ; values for specificity were 95 % and 90 % ; values for positive predictive accuracy were 91 % and 94 % ; and values for negative predictive accuracy were 100 % and 90 % . The CAM algorithm had the highest predictive accuracy for all possible combinations of the nine features of delirium . The CAM was shown to have convergent agreement with four other mental status tests , including the Mini-Mental State Examination . The interobserver reliability of the CAM was high ( kappa = 0.81 - 1.0 ) . CONCLUSIONS The CAM is sensitive , specific , reliable , and easy to use for identification of delirium 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 Since in hospitalized older patients delirium is associated with poor outcomes , we evaluated the effectiveness of a multicomponent strategy for the prevention of delirium . METHODS We studied 852 patients 70 years of age or older who had been admitted to the general-medicine service at a teaching hospital . Patients from one intervention unit and two usual-care units were enrolled by means of a prospect i ve matching strategy . The intervention consisted of st and ardized protocol s for the management of six risk factors for delirium : cognitive impairment , sleep deprivation , immobility , visual impairment , hearing impairment , and dehydration . Delirium , the primary outcome , was assessed daily until discharge . RESULTS Delirium developed in 9.9 percent of the intervention group as compared with 15.0 percent of the usual-care group , ( matched odds ratio , 0.60 ; 95 percent confidence interval , 0.39 to 0.92 ) . The total number of days with delirium ( 105 vs. 161 , P=0.02 ) and the total number of episodes ( 62 vs. 90 , P=0.03 ) were significantly lower in the intervention group . However , the severity of delirium and recurrence rates were not significantly different . The overall rate of adherence to the intervention was 87 percent , and the total number of targeted risk factors per patient was significantly reduced . Intervention was associated with significant improvement in the degree of cognitive impairment among patients with cognitive impairment at admission and a reduction in the rate of use of sleep medications among all patients . Among the other risk factors per patient there were trends toward improvement in immobility , visual impairment , and hearing impairment . CONCLUSIONS The risk-factor intervention strategy that we studied result ed in significant reductions in the number and duration of episodes of delirium in hospitalized older patients . The intervention had no significant effect on the severity of delirium or on recurrence rates ; this finding suggests that primary prevention of delirium is probably the most effective treatment strategy This large case/control study of fall and non-fall patients , in an acute care tertiary facility , was design ed to concurrently test the Hendrich Fall Risk Model .  Cases and controls ( 355/780 ) were r and omly enrolled and assessed for more than 600 risk factors ( intrinsic/extrinsic ) . St and ardized instruments were used for key physical attributes as well as clinician assessment s. A risk factor model was developed through stepwise logistic regression . Two-way interactions among the risk factors were tested for significance . The best fitting model included 2 Log L chi square statistic as well as sensitivity and specificity values retrospectively . The result of the study is an easy to use vali date d  Hendrich Fall Risk Model  with eight assessment parameters for high-risk fall identification tested in acute care environments 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:
    
A systematic review of the literature revealed many risk factors for falls in the acute care setting .
The intent was to closely observe whether delirium prevention result ed in fall prevention