***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: Background Research ers are increasingly investigating the potential for ordinal tasks such as ranking and discrete choice experiments to estimate QALY health state values . However , the assumptions of r and om utility theory , which underpin the statistical models used to provide these estimates , have received insufficient attention . In particular , the assumptions made about the decisions between living states and the death state are not satisfied , at least for some people . Estimated values are likely to be incorrectly anchored with respect to death ( zero ) in such circumstances . Methods Data from the Investigating Choice Experiments for the preferences of older people CAPability instrument ( ICECAP ) valuation exercise were analysed . The values ( previously anchored to the worst possible state ) were rescaled using an ordinal model proposed previously to estimate QALY-like values . Bootstrapping was conducted to vary artificially the proportion of people who conformed to the conventional r and om utility model underpinning the analyses . Results Only 26 % of respondents conformed unequivocally to the assumptions of conventional r and om utility theory . At least 14 % of respondents unequivocally violated the assumptions . Varying the relative proportions of conforming respondents in sensitivity analyses led to large changes in the estimated QALY values , particularly for lower-valued states . As a result these values could be either positive ( considered to be better than death ) or negative ( considered to be worse than death ) . Conclusion Use of a statistical model such as conditional ( multinomial ) regression to anchor quality of life values from ordinal data to death is inappropriate in the presence of respondents who do not conform to the assumptions of conventional r and om utility theory . This is clearest when estimating values for that group of respondents observed in valuation sample s who refuse to consider any living state to be worse than death : in such circumstances the model can not be estimated . Only a valuation task requiring respondents to make choices in which both length and quality of life vary can produce estimates that properly reflect the preferences of all respondents BACKGROUND Selecting elderly persons who need geriatric interventions  and making accurate treatment decisions are recurring challenges in geriatrics . Chronological age , although often used , does not seem to be the best selection criterion . Instead , the concept of frailty , which indicates several concurrent losses in re sources , can be used . METHODS The predictive values of chronological age and frailty were investigated in a large community sample of persons aged 65 years and older , r and omly drawn from the register of six municipalities in the northern regions of the Netherl and s ( 45 % of the original addressees ) . The participants ' generative capacity to sustain well-being ( i.e. , self-management abilities ) was used as the main outcome measure . RESULTS When using chronological age instead of frailty , both too many and too few persons were selected . Furthermore , frailty related more strongly ( with beta values ranging from -.25 to -.39 ) to a decline in the participants ' self-management abilities than did chronological age ( with beta values ranging from -.06 to -.14 ) . Chronological age added very little to the explained variances of all outcomes once frailty was included . CONCLUSIONS Using frailty as the criterion to select older persons at risk for interventions may be better than selecting persons based only on their chronological age Proximal femoral fractures in elderly patients are a serious problem in the aging society . Recently , surgical indications have changed due to advancements in medical technology . The purpose of this study was to investigate the outcome of elderly patients with displaced proximal hip fractures according to our positive criteria for surgical treatment . Exclusion criteria included ( 1 ) terminal-stage malignancy ; ( 2 ) a combination of an inability to walk , a severe mental disorder , and caregiver refusal of surgery ; and ( 3 ) nonapproval of the anesthesiologist for surgery .  The study group comprised 666 elderly patients . They were categorized into surgically and nonsurgically treated groups , and their treatment outcomes were retrospectively analyzed . The majority of patients were treated surgically ( 97.0 % vs 3.0 % ) . One-year survival rate was higher among surgically treated patients ( 82.2%-91.8 % ) than non-surgically treated patients ( 55 % ) . The major cause of death in nonsurgically treated patients was deterioration of comorbidities ( 66.7 % ) , whereas this was the cause of death in 18.9 % of surgically treated patients . One-year survival rates were worse in both groups with a lower American Society of Anesthesiologists grade . The 1-year survival rate of our patients suggests that our surgical criteria offer a reasonable outcome in surgically and nonsurgically treated patients . American Society of Anesthesiologists grade and preexisting comorbidities were strongly correlated with patient outcome We report a prospect i ve clinical trial of 150 cases for the treatment of unstable intertrochanteric fracture of the neck of the femur . Three methods were tested in our series -- skeletal traction with a tibial pin , medial displacement osteotomy and valgus osteotomy -- with 50 patients in each group . Our results showed no significant difference between those treated with the Dimon and Hughston osteotomy and those treated by the Sarmiento osteotomy . Conservative treatment of skeletal traction for unstable fracture was found to be well tolerated by the Chinese patient . A low mortality and morbidity rate was found in this series with an overall infection rate of 4 per cent Background : Because of specific method ological difficulties in conducting r and omized trials , surgical research remains dependent predominantly on observational or non‐r and omized studies . Few vali date d instruments are available to determine the method ological quality of such studies either from the reader 's perspective or for the purpose of meta‐ analysis . The aim of the present study was to develop and vali date such an instrument All elderly patients with extracapsular hip fractures seen in hospitals in Newcastle upon Tyne over a 12-month period were studied and followed up for six months . At one of the hospitals , patients were r and omised to treatment by AO dynamic hip-screw or by traction .  Complications specific to the two treatments were low , and general complications , six-month mortality and prevalence of pain , leg swelling and unhealed sores , showed no difference between the two modes of treatment . Operative treatment gave better anatomical results and a shorter hospital stay , but significantly more of the patients treated by traction showed loss of independence six months after injury INTRODUCTION Mortality after hip fracture remains high in spite of the progress of medicine . Due to the trend toward longer life , the problem of hip fracture is getting more significant . The aim of this study is to determine the effects of surgical treatment in patients with high risk of hip fracture on mortality reduction . METHODS In the retrospective- prospect i ve study , 66 patients aged 65 - 92 with a hip fracture and a high cardiac risk have been analyzed . The risk estimation was based on the Lee index . The patients with three or more risk factors were considered high-risk . The first group consisted of surgically treated patients with a hip fracture and at high cardiac risk , and in the second group were conservatively treated patients with a hip fracture and high cardiac risk . RESULTS In the group of conservatively treated patients , 75 % were women and in operatively treated group 67.6 % . Patient in both group are similar in relation to the participation of risk factor . A difference has been noticed in terms of renal insufficiency ( RI ) . There was 18.8 % conservatively treated patient with RI and 2.9 % in operatively treated group . CONCLUSION Patients with hip fracture and at high cardiac risk have lower mortality when treated surgically The outcome of patients with a displaced intracapsular femoral neck fracture treated non-operatively  was assessed at 1 year and compared with patients  managed operatively over the same time period . Data were collected prospect ively for 102 consecutive patients . 80 patients underwent hemiarthroplasty and 22 were managed non-operatively .  Patients were managed non-operatively if they were felt to have an unacceptably high risk of death within the perioperative period despite medical optimisation . Non-operative management entailed active early mobilisation without bed rest or traction . Patients managed non-operatively had a greater 30-day mortality compared with operatively managed patients . Deaths were due to pre-existing medical conditions or events , which had occurred at the time of hip fracture . No patient in the non-operative treatment group developed pneumonia , pressure sores or thrombo-embolic events . Patients treated non-operatively , who survived 30 days after fracture , had a mortality rate over the following year comparable with those who had undergone surgery . At 1 year , all non-operatively managed patients were able to transfer without pain and 6 of the 11 surviving patients were able to mobilise with walking aids . At 1 year , the majority of surviving non-operatively managed patients were living in their own homes . Surgical intervention is the treatment of choice for the majority of elderly patients with a displaced intracapsular femoral neck fracture . However , in patients with life-threatening medical co-morbidity , non-operative treatment with early mobilisation can yield acceptable results 
    Output:
    
A significantly higher 30-day and 1-year mortality was revealed in nonoperatively treated hip fracture patients .
No data were found examining (HR)QOL and costs .