***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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    ***EXAMPLES*** 
    Input: Abstract Objective : To evaluate the effect of intensive geriatric rehabilitation on demented patients with hip fracture . Design : Preplanned sub analysis of r and omised intervention study . Settting : Jyväskylä Central Hospital , Finl and . Participants : 243 independently living patients aged 65 years or older admitted to hospital with hip fracture . Intervention : After surgery patients in the intervention group ( n=120 ) were referred to the geriatric ward whereas those in the control group were discharged to local hospitals . Main outcome measures : Length of hospital stay , mortality , and place of residence three months and one year after surgery for hip fracture . Results : The median length of hospital stay of hip fracture patients with moderate dementia ( mini mental state examination score 12 - 17 ) was 47 days in the intervention group ( n=24 ) and 147 days in the control group ( n=12 , P=0.04 ) . The corresponding figures for patients with mild dementia ( score 18 - 23 ) were 29 days in the intervention group ( n=35 ) and 46.5 days in the control group ( n=42 , P=0.002 ) . Three months after the operation , in the intervention group 91 % ( 32 ) of the patients with mild dementia and 63 % ( 15 ) of the patients with moderate dementia were living independently . In the control group , the corresponding figures were 67 % ( 28 ) and 17 % ( 2 ) . There were no significant differences in mortality or in the lengths of hospital stay of severely demented patients and patients with normal mini mental state examination scores . Conclusions : Hip fracture patients with mild or moderate dementia can often return to the community if they are provided with active geriatric rehabilitation Background : An orthopaedic management/patient‐focused care unit ( OMPFCU ) involving a dedicated orthopaedic – geriatrics liaison team was established at the Royal Brisbane Hospital in 1994 in an effort to safely accelerate rehabilitation of patients with proximal femoral fractures Des vieillards atteints de fracture du femur sont suivis pendant 1 an , avec ou sans traitement de reeducation specialisee . Survie a 1 an : 67 % des temoins , 81 % des malades reeduques . 69 % des malades reeduques peuvent vivre de nouveau dans leur ancien domicile , contre 39 % seulement des OBJECTIVES Delirium ( or acute confusional state ) affects 35 % to 65 % of patients after hip-fracture repair , and has been independently associated with poor functional recovery . We performed a r and omized trial in an orthopedic surgery service at an academic hospital to determine whether proactive geriatrics consultation can reduce delirium after hip fracture . DESIGN Prospect i ve , r and omized , blinded . SETTING Inpatient academic tertiary medical center . PARTICIPANTS 126 consenting patients 65 and older ( mean age 79 + /- 8 years , 79 % women ) admitted emergently for surgical repair of hip fracture . MEASUREMENTS Detailed assessment through interviews with patients and design ated proxies and review of medical records was performed at enrollment to ascertain prefracture status . Subjects were then r and omized to proactive geriatrics consultation , which began preoperatively or within 24 hours of surgery , or " usual care . " A geriatrician made daily visits for the duration of the hospitalization and made targeted recommendations based on a structured protocol . To ascertain study outcomes , all subjects underwent daily , blinded interviews for the duration of their hospitalization , including the Mini-Mental State Examination ( MMSE ) , the Delirium Symptom Interview ( DSI ) , and the Memorial Delirium Assessment Scale ( MDAS ) . Delirium was diagnosed using the Confusion Assessment Method ( CAM ) algorithm . RESULTS The 62 patients r and omized to geriatrics consultation were not significantly different ( P>.1 ) from the 64 usual-care patients in terms of age , gender , prefracture dementia , comorbidity , type of hip fracture , or type of surgical repair . Sixty-one percent of geriatrics consultation patients were seen preoperatively and all were seen within 24 hours postoperatively . A mean of 10 recommendations were made throughout the duration of the hospitalization , with 77 % adherence by the orthopedics team . Delirium occurred in 20 /62 ( 32 % ) intervention patients , versus 32 / 64 ( 50 % ) usual-care patients ( P = .04 ) , representing a relative risk of 0.64 ( 95 % confidence interval ( CI ) = 0.37 - 0.98 ) for the consultation group . One case of delirium was prevented for every 5.6 patients in the geriatrics consultation group . There was an even greater reduction in cases of severe delirium , occurring in 7/ 60 ( 12 % ) of intervention patients and 18 / 62 ( 29 % ) of usual-care patients , with a relative risk of 0.40 ( 95 % CI = 0.18 - 0.89 ) . Despite this reduction in delirium , length of stay did not significantly differ between intervention and usual-care groups ( median + /- interquartile range = 5 + /- 2 days in both groups ) , likely because protocol s and pathways predetermined length of stay . In subgroup analyses , geriatrics consultation was most effective in reducing delirium in patients without prefracture dementia or activities of daily living ( ADL ) functional impairment . CONCLUSIONS Proactive geriatrics consultation was successfully implemented with good adherence after hip-fracture repair . Geriatrics consultation reduced delirium by over one-third , and reduced severe delirium by over one-half . Our trial provides strong preliminary evidence that proactive geriatrics consultation may play an important role in the acute hospital management of hip-fracture patients A r and omised controlled trial comparing an accelerated rehabilitation program  after proximal femoral fracture with conventional care and rehabilitation was conducted with 252 elderly patients treated at an Australian general hospital in 1989/1990 . This paper presents a cost-effectiveness analysis of the accelerated rehabilitation program . The measure of cost was all direct costs of treatment and subsequent care ( medical and non-medical ) incurred during the 4 months after fracture . Effectiveness was defined as whether the patient returned to semi-independent living ; or if moderately or severely disabled prior to the fracture to the premorbid level of physical independence . The cost for treatment up to 4 months after fracture was estimated at A$ 10,600 per accelerated rehabilitation patient and A$ 12,800 per conventional care patient ( 1990 Australian dollars , A$ ) . Thus , accelerated rehabilitation releases re sources equivalent to approximately 17 % of costs for treatment per patient . When cost effectiveness is considered , the potential cost savings rise to 38 % per recovered patient We tested the hypothesis that since the implementation of the prospect i ve payment system ( PPS ) , elderly patients hospitalized for hip fractures receive shorter , less care-intensive hospitalizations and are more frequently institutionalized . In blinded fashion , we review ed the charts of elderly patients with hip fractures admitted to a municipal hospital from 1981 through 1985 . Demographic and clinical characteristics of patients treated before implementation of the PPS were similar to patients treated thereafter . After implementation of the PPS , the mean length of hospitalization fell from 16.6 to 10.3 days , and the mean number of physical therapy sessions received decreased from 9.7 to 4.9 . Concomitantly , the proportion of patients discharged to a nursing home increased ( 21 % to 48 % ) , as did the proportion receiving nursing home care at six months after discharge ( 13 % to 39 % ) . This increase in long-term nursing home placement suggests that the quality of care for elderly patients with hip fractures may have deteriorated A r and omised controlled trial of two management regimens was carried out in women patients over 65 years of age with hip fractures . Ninety seven patients were admitted to a design ated orthopaedic geriatric unit and 125 to orthopaedic wards . No difference was observed in mortality , length of stay , or placement of patients between the two groups . More medical conditions were recognised and treated in patients in the orthopaedic geriatric unit group . It is concluded that design ated orthopaedic geriatric units can provide medical care to these patients and should be administered without additional cost Orthopaedic geriatric care has become widely accepted despite relatively little formal evaluation . In the East Dorset health authority all patients with fractured neck of femur initially share common orthopaedic facilities but only those from one geographical sector have subsequent access to an orthopaedic geriatric unit , patients from the other sector receiving st and ard care . We have carried out a prospect i ve population -based comparison of the outcome of 155 consecutive incident cases of fractured neck of femur aged over 65 years . On admission to hospital the two population s were similar in respect of age , sex , fracture type , social status , medical and orthopaedic problems , mental status and dependency ( Clifton assessment procedure for the elderly ) . Multiple regression analysis showed that the mean length of stay was 9.5 days shorter in patients from the sector with access to orthopaedic geriatric care ( p less than 0.05 , 95 % confidence interval 0.6 to 18.4 days ) . This reduction was not due to any difference between the two groups as regards dependency or the level of support provided on discharge . There was no difference in outcome at 6 months post-operatively in terms of mortality , functional outcome ( pain and mobility ) , change in dependency or social status . We conclude that in the East Dorset health authority this combined approach has result ed in a significant reduction in the length of inpatient stay without any other apparent effect on patient outcome OBJECTIVE To assess outcomes of using a clinical pathway for managing patients with fractured neck of femur . DESIGN Prospect i ve , pseudor and omised , controlled trial . SETTING St Vincent 's Hospital , Melbourne , Victoria ( a tertiary referral , university teaching hospital ) , 1 October 1997 to 30 November 1998 . PARTICIPANTS 111 patients ( 80 women and 31 men ; mean age , 81 years ) admitted via the emergency department with a primary diagnosis of fractured neck of femur . INTERVENTIONS Management guided by a clinical pathway ( 55 patients ) or established st and ard of care ( control group , 56 patients ) . MAIN OUTCOME MEASURES Timing of referrals and discharge planning ; total length of stay ; and complication and readmission rates within 28 days of discharge . RESULTS Patients managed according to the clinical pathway had a shorter total stay ( 6.6 versus 8.0 days ; P = 0.03 ) , even if assessment for placement by the Aged Care Assessment Service was required ( 9.5 versus 13.6 days ; P = 0.03 ) . There were no significant differences in complication and readmission rates between pathway and control patients ( complication rates , 24 % versus 36 % ; P = 0.40 ; readmission rates , 4 % versus 11 % ; P = 0.28 ) . CONCLUSION Coordinated multidisciplinary care of patients with fractured neck of femur reduces length of stay without increasing complications Objective : To compare hospital and home setting s for the rehabilitation of patients following hip fracture . Design : R and omized controlled trial comparing accelerated discharge and home-based rehabilitation ( n = 34 ) with conventional hospital care ( n = 32 ) for patients admitted to hospital with hip fracture . Setting : Three metropolitan hospitals in Adelaide , Australia . Subjects : Sixty-six patients with fractured hip . Interventions : Patients assigned to the home-based rehabilitation group were discharged within 48 hours of r and omization . The project team therapists made visits to the patient ’s home and negotiated a set of realistic , short-term and measurable treatment goals with both the patient and carer . Those r and omized to usual care remained in hospital for conventional rehabilitation . Main outcome measures : Physical and social dependence , balance con”dence , quality of life , carer strain , patient and carer satisfaction , use of community services and incidence of adverse events such as re-admission and falls . Results : While there was no difference between the groups for all measures of quality of life , patients in the accelerated discharge and home-based rehabilitation group recorded a greater improvement in MBI from r and omization ( p < 0.05 ) and scored higher on the Falls Ef”cacy Scale ( p < 0.05 ) at four months . There was no difference in falls rates . Patients in the home-based rehabilitation group had a shorter stay in hospital ( p < 0.05 ) but a longer stay in rehabilitation overall ( p < 0.001 ) . The groups were comparable on the rate and length of admissions after discharge , use of community services , need for carer input and contact with general practitioner ( GP ) after discharge 1 . Although there are sophisticated surgical procedures for hip fracture repair , a substantial proportion of patients never return to pre-fracture levels of physical function . Factors that influence the recovery of older hip fracture patients represent important areas to study in order to more precisely predict outcome . 2 . Research findings suggest that elevated depressive symptoms and cognitive impairment may negatively affect recovery , while mental alertness , emotional stability , and social involvement positively affect recovery . Thus , hip fracture and its subsequent disability must be studied as a biopsychosocial phenomenon , rather than merely as a physiological event . 3 . Older hip fracture patients may be at higher risk for psychological problems related to the traumatic nature of the injury . A comprehensive psychological assessment at admission can assist the nursing staff to determine which patients are at higher risk for emot 
    Output:
    
There was considerable heterogeneity in length of stay and cost data .
There is a trend to effectiveness when combined outcome variables ( death and institutional care , death and deterioration in function ) are considered .