***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: CONTEXT Post hoc analysis of a previous trial has suggested that prone positioning may improve survival in patients with severe hypoxemia and with acute respiratory distress syndrome ( ARDS ) . OBJECTIVE To assess possible outcome benefits of prone positioning in patients with moderate and severe hypoxemia who are affected by ARDS . DESIGN , SETTING , AND PATIENTS The Prone-Supine II Study , a multicenter , unblinded , r and omized controlled trial conducted in 23 centers in Italy and 2 in Spain . Patients were 342 adults with ARDS receiving mechanical ventilation , enrolled from February 2004 through June 2008 and prospect ively stratified into subgroups with moderate ( n = 192 ) and severe ( n = 150 ) hypoxemia . INTERVENTIONS Patients were r and omized to undergo supine ( n = 174 ) or prone ( 20 hours per day ; n = 168 ) positioning during ventilation . MAIN OUTCOME MEASURES The primary outcome was 28-day all-cause mortality . Secondary outcomes were 6-month mortality and mortality at intensive care unit discharge , organ dysfunctions , and the complication rate related to prone positioning . RESULTS Prone and supine patients from the entire study population had similar 28-day ( 31.0 % vs 32.8 % ; relative risk [ RR ] , 0.97 ; 95 % confidence interval [ CI ] , 0.84 - 1.13 ; P = .72 ) and 6-month ( 47.0 % vs 52.3 % ; RR , 0.90 ; 95 % CI , 0.73 - 1.11 ; P = .33 ) mortality rates , despite significantly higher complication rates in the prone group . Outcomes were also similar for patients with moderate hypoxemia in the prone and supine groups at 28 days ( 25.5 % vs 22.5 % ; RR , 1.04 ; 95 % CI , 0.89 - 1.22 ; P = .62 ) and at 6 months ( 42.6 % vs 43.9 % ; RR , 0.98 ; 95 % CI , 0.76 - 1.25 ; P = .85 ) . The 28-day mortality of patients with severe hypoxemia was 37.8 % in the prone and 46.1 % in the supine group ( RR , 0.87 ; 95 % CI , 0.66 - 1.14 ; P = .31 ) , while their 6-month mortality was 52.7 % and 63.2 % , respectively ( RR , 0.78 ; 95 % CI , 0.53 - 1.14 ; P = .19 ) . CONCLUSION Data from this study indicate that prone positioning does not provide significant survival benefit in patients with ARDS or in subgroups of patients with moderate and severe hypoxemia . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00159939 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 Background Pressure ulcers/injuries ( PrUs ) , a critical concern for nursing homes ( NH ) , are responsible for chronic wounds , amputations , septic infections , and premature deaths . PrUs occur most commonly in older adults and NH residence is a risk factor for their development , with at least one of every nine U.S. NH residents experiencing a PrU and many NHs having high incidence and prevalence rates , in some instances well over 20 % . PrU direct treatment costs are greater than prevention costs , making prevention-focused protocol s critical . Current PrU prevention protocol s recommend repositioning residents at moderate , high , and severe risk every 2 h. The advent of visco-elastic ( VE ) high-density foam support-surfaces over the past decade may now make it possible to extend the repositioning interval to every 3 or 4 h without increasing PrU development . The TEAM-UP ( Turn Everyone And Move for Ulcer Prevention ) study aims to determine : 1 ) whether repositioning interval can be extended for NH residents without compromising PrU incidence and 2 ) how changes in medical severity interact with changes in risk level and repositioning schedule to predict PrU development . Methods In this proposed cluster r and omized study , 9 NHs will be r and omly assigned to one of three repositioning intervals ( 2 , 3 , or 4 h ) for a 4-week period . Each enrolled site will use a single NH-wide repositioning interval as the st and ard of care for residents at low , moderate , and high risk of PrU development ( N = 951 ) meeting the following criteria : minimum 3-day stay , without PrUs , no adhesive allergy , and using VE support surfaces ( mattresses ) . An FDA -cleared patient monitoring system that records position/movement of these residents via individual wireless sensors will be used to visually cue staff when residents need repositioning and document compliance with repositioning protocol s. Discussion This study will advance knowledge about repositioning frequency and clinical ly assessed PrU risk level in relation to PrU incidence and medical severity . Outcomes of this research will contribute to future guidelines for more precise preventive nursing practice s and refinement of PrU prevention guidelines .Trial registration Clinical Trial Registration : NCT02996331 IMPORTANCE Though theoretically sound , studies have failed to demonstrate the benefit of routine repositioning of at-risk patients for the prevention of hospital acquired pressure injuries . OBJECTIVE To assess the clinical effectiveness of a wearable patient sensor to improve care delivery and patient outcomes by increasing the total time with turning compliance and preventing pressure injuries in acutely ill patients . DESIGN Pragmatic , investigator initiated , open label , single site , r and omized clinical trial . SETTING Two Intensive Care Units in a large Academic Medical Center in California . PARTICIPANTS Consecutive adult patients admitted to one of two Intensive Care Units between September 2015 to January 2016 were included ( n = 1564 ) . Of the eligible patients , 1312 underwent r and omization . INTERVENTION Patients received either turning care relying on traditional turn reminders and st and ard practice s ( control group , n = 653 ) , or optimal turning practice s , influenced by real-time data derived from a wearable patient sensor ( treatment group , n = 659 ) . MAIN OUTCOME ( S ) AND MEASURE(S ) The primary and secondary outcomes of interest were occurrence of hospital acquired pressure injury and turning compliance . Sensitivity analysis was performed to compare intention-to-treat and per- protocol effects . RESULTS The mean age was 60 years ( SD , 17 years ) ; 55 % were male . We analyzed 103,000 h of monitoring data . Overall the intervention group had significantly fewer Hospital Acquired Pressure Injuries during Intensive Care Unit admission than the control group ( 5 patients [ 0.7 % ] vs. 15 patients [ 2.3 % ] ( OR = 0.33 , 95%CI [ 0.12 , 0.90 ] , p = 0.031 ) . The total time with turning compliance was significantly different in the intervention group vs. control group ( 67 % vs 54 % ; difference 0.11 , 95%CI [ 0.08 , 0.13 ] , p < 0.001 ) . Turning magnitude ( 21 ° , p = 0.923 ) and adequate depressurization time ( 39 % , p = 0.145 ) were not statistically different between groups . CONCLUSIONS AND RELEVANCE Among acutely ill adult patients requiring Intensive Care Unit admission , the provision of optimal turning was greater with a wearable patient sensor , increasing the total time with turning compliance and demonstrated a statistically significant protective effect against the development of hospital acquired pressure injuries . These are the first quantitative data on turn quality in the Intensive Care Unit and highlight the need to reinforce optimal turning practice s. Additional clinical trials leveraging technologies like wearable sensors are needed to establish the appropriate frequency and dosing of individualized turning protocol s to prevent pressure injuries in at-risk hospitalized patients Purpose Placing patients with severe acute respiratory distress syndrome ( ARDS ) in the prone position has been shown to improve survival as compared to the supine position . However , a higher frequency of pressure ulcers has been reported in patients in the prone position . The objective of this study was to verify the impact of prone positioning on pressure ulcers in patients with severe ARDS . Methods This was an ancillary study of a prospect i ve multicentre r and omised controlled trial in patients with severe ARDS in which the early application of long prone-positioning sessions was compared to supine positioning in terms of mortality . Pressure ulcers were assessed at the time of r and omisation , 7 days later and on discharge from the intensive care unit ( ICU ) , using the four-stage Pressure Ulcers Advisory Panel system . The primary end-point was the incidence ( with reference to 1,000 days of invasive mechanical ventilation or 1,000 days of ICU stay ) of new patients with pressure ulcers at stage 2 or higher from r and omisation to ICU discharge . Results At r and omisation , of the 229 patients allocated to the supine position and the 237 patients allocated to the prone position  , the number of patients with pressure ulcers was not significantly different between groups . The incidence of new patients with pressure ulcers from r and omisation to ICU discharge was 20.80 and 14.26/1,000 days of invasive mechanical ventilation ( P = 0.061 ) and 13.92 and 7.72/1,000 of ICU days ( P = 0.002 ) in the prone and supine groups , respectively . Position group [ odds ratio ( OR ) 1.5408 , P = 0.0653 ] , age > 60 years ( OR 1.5340 , P = 0.0019 ) , female gender ( OR 0.5075 , P = 0.019 ) , body mass index of > 28.4 kg/m2 ( OR 1.9804 , P = 0.0037 ) , and a Simplified Acute Physiology Score II at inclusion of > 46 ( OR 1.2765 , P = 0.3158 ) were the covariates independently associated to the acquisition of pressure ulcers . Conclusion In patients with severe ARDS , prone positioning was associated with a higher frequency of pressure ulcers than the supine position . Prone positioning improves survival in patients with severe ARDS and , therefore , survivors who received this intervention had a greater likelihood of having pressure ulcers documented as part of their follow-up . There are risk groups for the development of pressure ulcers in severe ARDS , and these patients need surveillance and active prevention Purpose The objective was to compare the effectiveness of repositioning every 2 or 4 h for preventing pressure ulcer development in patients in intensive care unit under mechanical ventilation ( MV ) . Methods This was a pragmatic , open-label r and omized clinical trial in consecutive patients on an alternating pressure air mattress ( APAM ) requiring invasive MV for at least 24 h in a university hospital in Spain . Eligible participants were r and omly assigned to groups for repositioning every 2 ( n = 165 ) or 4 ( n = 164 ) h. The primary outcome was the incidence of a pressure ulcer of at least grade II during ICU stay . Results A pressure ulcer of at least grade II developed in 10.3 % ( 17/165 ) of patients turned every 2 h versus 13.4 % ( 22/164 ) of those turned every 4 h ( hazard ratio [ HR ] 0.89 , 95 % confidence interval [ CI ] 0.46–1.71 , P = 0.73 ) . The composite end point of device-related adverse events was recorded in 47.9 versus 36.6 % ( HR 1.50 , CI 95 % 1.06–2.11 , P = 0.02 ) , unplanned extubation in 11.5 versus 6.7 % ( HR 1.77 , 95 % CI 0.84–3.75 , P = 0 . 13 ) , and endotracheal tube obstruction in 36. 
    Output:
    
Given the limited data from economic evaluations , it remains unclear whether repositioning every three hours using the 30 ° tilt versus " usual care " ( 90 ° tilt ) or repositioning 3-to-4-hourly versus 2-hourly is less costly relative to nursing time