***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 test the effectiveness of a nursing-centered intervention to prevent functional decline among hospitalized elderly medical patients . DESIGN Prospect i ve cohort study with stratified and matched cohort analyses . SETTING General medicine wards of a university teaching hospital . PATIENTS Two hundred sixteen patients aged > or = 70 years ( 85 intervention and 131 control patients ) . INTERVENTION The intervention included identification and surveillance of frail older patients , twice-weekly rounds of the Geriatric Care Team , and a nursing-centered educational program . MAIN OUTCOME MEASURE Functional decline , defined as a net decline in five activities of daily living ( ADLs ) . RESULTS In stratified analyses , the intervention result ed in a beneficial effect with a relative risk of 0.82 ( 95 % confidence interval [ CI ] 0.54 to 1.24 ) in patients ( n = 106 ) with one of four geriatric target conditions at baseline ( eg , delirium , functional impairment , incontinence , and pressure sores ) . The intervention had no effect in patients without target conditions at baseline ( n = 110 ) ; thus , this subgroup was excluded from further analyses . When patients were matched on number of target conditions and risk for functional decline at baseline ( n = 66 ) , the intervention result ed in a significant beneficial effect , with a reduction in functional decline from 64 % in controls to 41 % in the intervention group , for a relative risk of 0.64 ( 95 % CI , 0.43 to 0.96 ) . The intervention group had significantly less decline in ADL score and in individual ADLs than control subjects . Specific interventions aim ed at maximizing function , such as physical therapy , were received more often by intervention patients ; however , the beneficial effects of the intervention were achieved without increasing per-day hospital costs . CONCLUSIONS The intervention appears effective to decrease functional decline in targeted elderly hospitalized medical patients 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 STUDY OBJECTIVE To determine if early mobilization ( EM ) of hospitalized adults with community-acquired pneumonia ( CAP ) reduces hospital length of stay . DESIGN Group r and omized trial . SETTING Three Midwestern hospitals . PARTICIPANTS Four hundred fifty-eight patients with CAP admitted to 17 general medical units between November 1997 and April 1998 . INTERVENTION EM was defined as sitting out of bed or ambulating for at least 20 min during the first 24 h of hospitalization . Progressive mobilization occurred each subsequent day during hospitalization . MEASUREMENTS AND RESULTS Intervention ( n = 227 ) and usual-care patients ( n = 231 ) were similar in age , gender , disease severity , door-to-drug delivery time , and IV-to-po switchover time . Hospital length of stay for EM vs usual care was significantly less ( mean , 5.8 vs 6.9 days ; adjusted absolute difference , 1.1 days ; 95 % confidence interval , 0.0 to 2.2 days ) . There were no differences in adverse events or other secondary outcomes between treatment groups . CONCLUSIONS Like patients hospitalized with acute myocardial infa rct ion and total knee replacements , EM of hospitalized patients with CAP reduces overall hospital length of stay and institutional re sources without increasing the risk of adverse outcomes OBJECTIVE to prove the effectiveness of geriatric evaluation and management for elderly , hospitalized patients , combined with post-discharge home intervention by an interdisciplinary team . DESIGN r and omized controlled trial with outcome and costs assessed for 12 months after the date of admission . SETTING university-affiliated geriatric hospital and the homes of elderly patients . SUBJECTS 545 patients with acute illnesses admitted from home to the geriatric hospital . INTERVENTIONS patients were r and omly assigned to receive either comprehensive geriatric assessment and post-discharge home intervention ( intervention ) , comprehensive geriatric assessment alone ( assessment ) or usual care . MAIN OUTCOME MEASURES survival , functional status , rehospitalization , nursing home placement and direct costs over 12 months . RESULTS the intervention group showed a significant reduction in length of hospital stay ( 33.49 days vs 40.7 days in the assessment group and 42.7 days in the control group ; P < 0.05 ) and rate of immediate nursing home placement ( 4.4 % vs 7.3 % and 8.1 % ; P < 0.05 ) . There was no difference in survival , acute care hospital readmissions or new admissions to nursing homes but the intervention group had significantly shorter hospital readmissions ( 22.2 days vs 34.2 days and 35.7 days ; P < 0.05 ) and nursing home placements ( 114.7 days vs 161.6 days and 170.0 days ; P < 0.05 ) . Direct costs were lower in the intervention group [ about DM 7000 ( US $ 4000 ) per person per year ] . Functional capacities were significantly better in the intervention group . CONCLUSIONS comprehensive geriatric assessment in combination with post-discharge home intervention does not improve survival , but does improve functional status and can reduce the length of the initial hospital stay and of subsequent readmissions . It can reduce the rate of immediate nursing home admissions and delay permanent nursing home placement . It may also substantially reduce direct costs of hospitalized patients BACKGROUND Older persons who re hospitalized for acute illnesses often lose their independence and are discharged to institutions for long-term care . METHODS We studied 651 patients 70 years of age or older who were admitted for general medical care at a teaching hospital ; these patients were r and omly assigned to receive usual care or to be cared for in a special unit design ed to help older persons maintain or achieve independence in self-care activities . The key elements of this program were a specially prepared environment ( with , for example , uncluttered hallways , large clocks and calendars , and h and rails ) ; patient-centered care emphasizing independence , including specific protocol s for prevention of disability and for rehabilitation ; discharge planning with the goal of returning the patient to his or her home ; and intensive review of medical care to minimize the adverse effects of procedures and medications . The main outcome we measured ws the change from admission to discharge in the number of five basic activities of daily living ( bathing , getting dressed , using the toilet , moving from a bed to a chair , and eating ) that the patient could perform independently . RESULTS Twenty-four patients in each group died in the hospital . At the time of discharge , 65 ( 21 percent ) of the 303 surviving patients in the intervention group were classified as much better in terms of their ability to perform basic activities of daily living , 39 ( 13 percent ) as better , 151 ( 50 percent ) as unchanged , 22 ( 7 percent ) as worse , and 26 ( 9 percent ) as much worse . In the usual care group , 40 ( 13 percent ) of the 300 surviving patients were classified as much better , 33 ( 11 percent ) as better , 163 ( 54 percent ) as unchanged , 39 ( 13 percent ) as worse , and 25 ( 8 percent ) as much worse ( P = 0.009 ) . The difference between the groups remained significant ( P = 0.04 ) in a multivariable model in which we controlled for potentially confounding base-line characteristics of the patients . Lengths of stay and hospital charges were similar in the two groups . Fewer patients assigned to the intervention group were discharged to long-term care institutions ( 43 patients [ 14 percent ] , as compared with 67 patients [ 22 percent ] in the usual-care group ; P = 0.01 ) . Among the 493 patients discharged to private homes , similar proportions ( about 10 percent ) in the two groups were admitted to long-term care institutions during the three months after discharge . CONCLUSIONS Specific changes in the provision of acute hospital care can improve the ability of a heterogeneous group of acutely ill older patients to perform basic activities of daily living at the time of discharge from the hospital and can reduce the frequency of discharge to institutions for long-term care The objective of this study , design ed as a r and omized controlled trial , was to decrease the length- of- stay ( LOS ) of hospitalized patients on a waiting list for admission to an inpatient geriatric assessment unit ( GAU ) , and to optimize use of the GAU and other hospital services . The participants included 108 elderly , functionally impaired in patients referred for geriatric consultation , and appropriate for GAU admission , stratified into high and low ADL functioning groups . They were admitted to a 354- bed acute hospital , with a 31- bed long- stay ward and a 15- bed GAU ; a 25–30 day delay occurred between screening and admission of in patients to the GAU . Experimental subjects ( N=56 ) received the consultative services of a geriatric assessment and intervention team ( GAIT ) immediately after being qualified for GAU admission , in place of waiting for GAU services . Controls ( N=52 ) received usual hospital care until admitted to the GAU . While high- function patients r and omized to the GAIT had significantly shorter hospital LOS than comparable controls ( 41.4 vs 56.5 days ; p=0.03 , LOS reduction was even greater in the low- function stratum ( 44.5 vs 74.5 days ; p=0.001 . Further , significantly more GAIT than control patients were discharged home ( 28 % vs 11 % ; p=0.044 ) . A trend toward reduced mortality in the GAIT group was non- significant . We conclude that for Canadian hospitals in which extensive stays of frail elderly patients , “ bed blockage ” , and thus access to unit- based geriatric services are common problems , the GAIT can efficiently decrease hospital LOS , increase home placement , and may improve outcomes . ( Aging Clin . Exp . Res . 7 : 55–60 , 1995 Background : Major depression is a frequent and serious disorder in older medical in patients . Because the condition goes undetected and untreated in most of these patients , we conducted a r and omized clinical trial to evaluate the effectiveness of a strategy of systematic detection and multidisciplinary treatment of depression in this population . Methods : Consecutive patients aged 65 years or more admitted to general medical services in a primary care hospital between October 1999 and November 2002 were screened for depression with the Diagnostic Interview Schedule ( DIS ) within 48 hours after admission . Patients found to have major depression were r and omly allocated to receive the intervention or usual care . The intervention involved consultation and treatment by a psychiatrist and follow-up by a research nurse and the patient 's family physician . Research assistants , blind to group allocation , collected data from the patients at enrolment and at 3 and 6 months later using the Hamilton Depression Rating Scale ( HAMD ) , the Medical Outcomes 36-item Short Form ( SF-36 ) , the DIS , the Mini-Mental State Examination ( MMSE ) , the Older Americans Re sources and Services ( OARS ) question naire to assess basic and instrumental activities of daily living ( OARS-ADL and OARS-IADL ) and the Rating Scale for Side Effects . Data on the severity of illness , length of hospital stay , health services and medication use , mortality and process of care were also collected . The primary outcome measures were the HAMD and SF-36 . Results : Of 1500 eligible patients who were screened , 157 were found to have major depression and consented to participate ( 78 in the intervention group and 79 in the usual care group ) . At r and omization , there were no clinical ly or statistically significant differences between the 2 groups . Sixty-four patients completed follow-up to 6 months , 57 withdrew , and 36 died . At 6 months , there were no clinical ly or statistically significant differences the 2 groups in HAMD or SF-36 scores or any of the secondary outcome measures . Interpretation : We were unable to demonstrate that systematic detection and multidisciplinary care of depression was more beneficial than usual care for elderly medical in patients OBJECTIVES In August 1993 a group of house staff and nursing staff at 
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The effect of exercise on functional outcome measures is unclear .
No intervention effect was found on adverse events .
Pooled analysis of exercise intervention trials found no effect on the proportion of patients discharged to home or acute hospital length of stay .
AUTHORS ' CONCLUSIONS There is ' silver ' level evidence ( www.cochranemsk.org ) that multidisciplinary intervention that includes exercise may increase the proportion of patients discharged to home and reduce length and cost of hospital stay for acutely hospitalised older medical patients