***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: OBJECTIVES To examine the proportion of time spent in three levels of mobility ( lying , sitting , and st and ing or walking ) by a cohort of hospitalized older veterans as measured by vali date d wireless accelerometers . DESIGN A prospect i ve , observational cohort study . SETTING One hundred fifty-bed Department of Veterans Affairs hospital . PARTICIPANTS Forty-five hospitalized medical patients , aged 65 and older who were not delirious , did not have dementia , and were able to walk in the 2 weeks before admission were eligible . MEASUREMENTS Wireless accelerometers were attached to the thigh and ankle of patients for the first 7 days after admission or until hospital discharge , whichever came first . The mean proportion of time spent lying , sitting , and st and ing or walking  was determined for each hour after hospital admission using a previously vali date d algorithm . RESULTS Forty-five male patients ( mean age 74.2 ) with a mean length of stay of 5.1 days generated 2,592 one-hour periods of data . A baseline functional assessment indicated that 35 ( 77.8 % ) study patients were willing and able to walk a short distance independently . No patient remained in bed the entire measured hospital stay , but on average , 83 % of the measured hospital stay was spent lying in bed . The average amount of time that any one individual spent st and ing or walking ranged from a low of 0.2 % to a high of 21 % , with a median of 3 % , or 43 minutes per day . CONCLUSION This is the first study to continuously monitor mobility levels early during a hospital stay . On average , older hospitalized patients spent most of their time lying in bed , despite an ability to walk independently Background The Hospital Elder Life Program ( HELP ) has been shown to be highly efficient and (cost-)effective in reducing delirium incidence in the USA . HELP provides multicomponent protocol s targeted at specific risk factors for delirium and introduces a different view on care organization , with trained volunteers playing a pivotal role . The primary aim of this study is the quantification of the (cost-)effectiveness of HELP in the Dutch health care system . The second aim is to investigate the experiences of patients , families , professionals and trained volunteers participating in HELP .  Methods / Design A multiple baseline approach ( also known as a stepped-wedge design ) will be used to evaluate the ( cost- ) effectiveness of HELP in a cluster r and omized controlled study . All patients aged 70 years and older who are at risk for delirium and are admitted to cardiology , internal medicine , geriatrics , orthopedics and surgery at two participating community hospitals will be included . These eight units are implementing the intervention in a successive order that will be determined at r and om . The incidence of delirium , the primary outcome , will be measured with the Confusion Assessment Method ( CAM ) . Secondary outcomes include the duration and severity of delirium , quality of life , length of stay and the use of care services up to three months after hospital discharge . The experiences of patients , families , professionals and volunteers will be investigated using a qualitative design based on the grounded theory approach . Professionals and volunteers will be invited to participate in focus group interviews . Additionally , a r and om sample of ten patients and their families from each hospital unit will be interviewed at home after discharge . Discussion We hypothesize that HELP will reduce delirium incidence during hospital admission and decrease the duration and severity of delirium and length of hospital stays among these older patients , which will lead to reduced health care costs . The results of this study may fundamentally change our views on care organization for older patients at risk for delirium . The stepped-wedge design was chosen for ethical , practical and statistical reasons . The study results will be generalizable to the Dutch hospital care system , and the proven cost-effectiveness of HELP will encourage the spread and implementation of this program . Trial Registration Netherl and s Trial register : OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity OBJECTIVES To estimate the prevalence of different levels of mobility in a hospitalized older cohort , to measure the degree and rate of adverse outcomes associated with different mobility levels , and to examine the physician activity orders and documented reasons for bedrest in the lowest mobility group . DESIGN A prospect i ve cohort study . SETTING An 800-bed university teaching hospital . PARTICIPANTS Four hundred ninety-eight hospitalized medical patients , aged 70 and older . MEASUREMENTS Using average mobility level , scored from 0 to 12 , the low-mobility group was defined as having a score of 4 or less , intermediate as a score of higher than 4 to 8 , and high as higher than 8 . Outcomes were functional decline , new institutionalization , death , and death or new institutionalization . RESULTS Low and intermediate levels of mobility were common , accounting for 80 ( 16 % ) and 157 ( 32 % ) study patients , respectively . Overall , any activity of daily living ( ADL ) decline occurred in 29 % , new institutionalization in 13 % , death in 7 % , and death or new institutionalization in 22 % of patients in this cohort . When compared with the high mobility group , the low and intermediate groups were associated with the adverse outcomes in a grade d fashion , even after controlling for multiple confounders . The low-mobility group had an adjusted odds ratio ( OR ) of 5.6 ( 95 % confidence interval (CI)=2.9 - 11.0 ) for ADL decline , 6.0 ( 95 % CI=2.5 - 14.8 ) for new institutionalization , 34.3 ( 95 % CI=6.3 - 185.9 ) for death , and 7.2 ( 95 % CI=3.6 - 14.4 ) for death or new institutionalization . The intermediate group had adjusted ORs of 2.5 ( 95 % CI=1.5 - 4.1 ) , 2.9 ( 95 % CI=1.4 - 6.0 ) , 10.1 ( 95 % CI=1.9 - 52.9 ) , and 3.3 ( 95 % CI=1.8 - 5.9 ) for ADL decline , new institutionalization , death , and death or new institutionalization , respectively . Bedrest was ordered at some point during hospitalization in 165 ( 33 % ) patients . For most patients , mobility was limited involuntarily ( bedrest orders ) , and almost 60 % of bedrest episodes in the lowest mobility group had no documented medical indication . CONCLUSION Low mobility and bedrest are common in hospitalized older patients and are important predictors of adverse outcomes . This study demonstrated that the adverse outcomes associated with low mobility and bedrest may be viewed as iatrogenic events leading to complications , such as functional decline 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:
    
They were not formally evaluated but report positive effects of the volunteers on patient and staff satisfaction .