***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 evaluate a nurse-led management plan and care pathway for older people discharged from an Accident and Emergency Department after a fall . DESIGN r and omized controlled trial . SETTING a large teaching hospital . SUBJECTS 348 consecutive patients aged 65 or over attending the Accident and Emergency Department with a fall . INTERVENTIONS we r and omized patients to falls nurse intervention or usual care . Within 4 weeks , the intervention group received a home assessment to address easily modifiable risk factors for falls . This included assessment s of medication , ECG , blood pressure , cognition , visual acuity , hearing , vestibular dysfunction , balance , mobility , feet and footwear . All patients were given advice and education about general safety in the home . MAIN OUTCOME MEASURES Further falls , functional ability , re-attendance at the Accident and Emergency Department and admission to hospital . RESULTS at 6 months post-Index fall , 36 patients in the intervention group and 39 patients in the control group had had 89 and 145 falls respectively . Although the intervention group had less falls , this was not significant ( P>0.05 ) . Similarly , the intervention group had fewer fall-related admissions and bed days ( 8 and 69 respectively ) than the control group ( 10 and 233 respectively ) . The intervention group scored significantly higher in indicators of function ( P<0.05 ) and mobility within the community ( P<0.02 ) . CONCLUSIONS although the differences were not significant , patients in the intervention group had fewer falls , less hospital attendances and spent less time in hospital . Moreover , patients in the intervention group were more functionally independent at 6 months post-Index fall Background Falls are one of the most frequently occurring adverse events that impact upon the recovery of older hospital in patients . Falls can threaten both immediate and longer-term health and independence . There is need to identify cost-effective means for preventing falls in hospitals . Hospital-based falls prevention interventions tested in r and omized trials have not yet been subjected to economic evaluation . Methods Incremental cost-effectiveness analysis was undertaken from the health service provider perspective , over the period of hospitalization ( time horizon ) using the Australian Dollar ( A$ ) at 2008 values . Analyses were based on data from a r and omized trial among n = 1,206 acute and rehabilitation in patients . Decision tree modeling with three-way sensitivity analyses were conducted using burden of disease estimates developed from trial data and previous research . The intervention was a multimedia patient education program provided with trained health professional follow-up shown to reduce falls among cognitively intact hospital patients . Results The short-term cost to a health service of one cognitively intact patient being a faller could be as high as A$ 14,591 ( 2008 ) . The education program cost A$ 526 ( 2008 ) to prevent one cognitively intact patient becoming a faller and A$ 294 ( 2008 ) to prevent one fall based on primary trial data . These estimates were unstable due to high variability in the hospital costs accrued by individual patients involved in the trial . There was a 52 % probability the complete program was both more effective and less costly ( from the health service perspective ) than providing usual care alone . Decision tree modeling sensitivity analyses identified that when provided in real life context s , the program would be both more effective in preventing falls among cognitively intact in patients and cost saving where the proportion of these patients who would otherwise fall under usual care conditions is at least 4.0 % . Conclusions This economic evaluation was design ed to assist health care providers decide in what circumstances this intervention should be provided . If the proportion of cognitively intact patients falling on a ward under usual care conditions is 4 % or greater , then provision of the complete program in addition to usual care will likely both prevent falls and reduce costs for a health service . Trial registration Australia and New Zeal and Clinical Trials Register : ACTRN12608000015347 Reports of cluster r and omised trials require additional information to allow readers to interpret them accurately The effective reporting of r and omised controlled trials has received useful attention in recent years . Many journals now require that reports conform to the guidelines in the Consoli date d St and ards of Reporting Trials ( CONSORT ) statement , first published in 1996 and revised in 2001 . The statement includes a checklist of items that should be included in the trial report . These items are evidence based whenever possible and are regularly review ed . The statement also recommends including a flow diagram to show the flow of participants from group assignment through to the final analysis . The CONSORT statement focused on reporting parallel group r and omised trials in which individual participants are r and omly assigned to study groups . However , in some situations it is preferable to r and omly assign groups of individuals ( such as families or medical practice s ) rather than individuals . Reasons include the threat of contamination of some interventions ( such as dietary interventions ) if individual r and omisation is used . 5 Also , in certain setting s r and omisation by group may be the only feasible method of conducting a trial . Trials with this design are variously known as field trials , community based trials , place based trials , or ( as in this paper ) cluster r and omised trials . In an earlier discussion paper we considered the implication s of the CONSORT statement for the reporting of cluster r and omised trials . Here we present up date d guidance , based on the 2001 revision of the CONSORT statement Introduction Falls are the most frequent adverse event reported in hospitals . Approximately 30 % of in-hospital falls lead to an injury and up to 2 % result in a fracture . A large r and omised trial found that a trained health professional providing individualised falls prevention education to older in patients reduced falls in a cognitively intact subgroup . This study aims to investigate whether this efficacious intervention can reduce falls and be clinical ly useful and cost-effective when delivered in the real-life clinical environment . Methods A stepped-wedge cluster r and omised trial will be used across eight subacute units ( clusters ) which will be r and omised to one of four date s to start the intervention . Usual care on these units includes patient 's screening , assessment and implementation of individualised falls prevention strategies , ongoing staff training and environmental strategies .  Patients with better levels of cognition ( Mini-Mental State Examination > 23/30 ) will receive the individualised education from a trained health professional in addition to usual care while patient 's feedback received during education sessions will be provided to unit staff . Unit staff will receive training to assist in intervention delivery and to enhance uptake of strategies by patients . Falls data will be collected by two methods : case note audit by research assistants and the hospital falls reporting system . Cluster-level data including patient 's admissions , length of stay and diagnosis will be collected from hospital systems . Data will be analysed allowing for correlation of outcomes ( clustering ) within units . An economic analysis will be undertaken which includes an incremental cost-effectiveness analysis . Ethics and dissemination The study was approved by The University of Notre Dame Australia Human Research Ethics Committee and local hospital ethics committees . Results The results will be disseminated through local site networks , and future funding and delivery of falls prevention programmes within WA Health will be informed . Results will also be disseminated through peer- review ed publications and medical conferences . Trial registration The study is registered with the Australian New Zeal and Clinical Trials registry ( ACTRN12612000877886 ) BACKGROUND People with cognitive impairment and dementia have a poor outcome after a hip fracture surgery , about 30 - 50 % of all those who sustain a hip fracture have dementia . Therefore the aim was to investigate whether a multidisciplinary postoperative intervention program could reduce postoperative complications and improve functional recovery among people with dementia . METHODS A r and omized controlled trial with subgroup analyses among patients with dementia . Sixty-four patients with femoral neck fracture , aged ≥70 years at Umeå University Hospital , Sweden . The intervention consisted of staff education , individualized care planning and rehabilitation , active prevention , detection and treatment of postoperative complications , especially delirium . The staff worked in teams to apply comprehensive geriatric assessment , management and rehabilitation , including a follow-up at 4 months postoperatively . The control group followed conventional postoperative routines . RESULTS There were fewer postoperative complications in the intervention group such as urinary tract infections , p=0.001 ; nutritional problems , p=0.025 ; postoperative delirium , p=0.002 ; falls , p=0.006 . At 4 months a larger proportion in the intervention group had regained their previous independent indoor walking ability performance , p=0.005 . At 12 months a larger proportion in the intervention group had regained the activities of daily living ( ADL ) performance level they had before the fracture , p=0.027 . CONCLUSION This study demonstrates that patients with dementia who suffer a hip fracture can benefit from multidisciplinary geriatric assessment and rehabilitation and should not be excluded from rehabilitation programs Background The CONSORT statement is intended to improve reporting of r and omised controlled trials and focuses on minimising the risk of bias ( internal validity ) . The applicability of a trial ’s results ( generalisability or external validity ) is also important , particularly for pragmatic trials . A pragmatic trial ( a term first used in 1967 by Schwartz and Lellouch ) can be broadly defined as a r and omised controlled trial whose purpose is to inform decisions about practice . This extension of the CONSORT statement is intended to improve the reporting of such trials and focuses on applicability . Methods At two , two-day meetings held in Toronto in 2005 and 2008 , we review ed the CONSORT statement and its extensions , the literature on pragmatic trials and applicability , and our experiences in conducting pragmatic trials . Recommendations We recommend extending eight CONSORT checklist items for reporting of pragmatic trials : the background , participants , interventions , outcomes , sample size , blinding , participant flow , and generalisability of the findings . These extensions are presented , along with illustrative examples of reporting , and an explanation of each extension . Adherence to these reporting criteria will make it easier for decision makers to judge how applicable the results of r and omised controlled trials are to their own conditions . Empirical studies are needed to ascertain the usefulness and comprehensiveness of these CONSORT checklist item extensions . In the meantime we recommend that those who support , conduct , and report pragmatic trials should use this extension of the CONSORT statement to facilitate the use of trial results in decisions about health care . Pragmatic trials are design ed to inform decisions about practice , but poor reporting can reduce their usefulness . The CONSORT and Practihc groups describe modifications to the CONSORT guidelines to help readers assess the applicability of the Background Interventions for preventing  falls in older people often involve several components , multidisciplinary teams , and implementation in a variety of setting s. We have developed a classification system ( taxonomy ) to describe interventions used to prevent falls in older people , with the aim of improving the design and reporting of clinical trials of fall-prevention interventions , and synthesis of evidence from these trials . Methods Thirty three international experts in falls prevention and health services research participated in a series of meetings to develop consensus . Robust techniques were used including literature review s , expert presentations , and structured consensus workshops moderated by experienced facilitators . The taxonomy was refined using an international test panel of five health care practitioners . We assessed the chance corrected agreement of the final version by comparing taxonomy completion for 10 r and omly selected published papers describing a variety of fall-prevention interventions . Results The taxonomy consists of four domains , summarized as the " Approach " , " Base " , " Components " and " Descriptors " of an intervention . Sub-domains include ; where participants are identified ; the theoretical approach of the intervention ; clinical targeting criteria ; details on assessment s ; descriptions of the nature and intensity of interventions . Chance corrected agreement of the final version of the taxonomy was good to excellent for all items . Further independent evaluation of the taxonomy is required . Conclusions The taxonomy is a useful instrument for characterizing a broad range of interventions used in falls prevention . Investigators are encouraged to use the taxonomy to report their interventions Adequate reporting of r and omized , controlled trials ( RCTs ) is necessary to allow accurate critical appraisal of the validity and applicability of the results . The CONSORT ( Consoli date d St and ards of Reporting Trials ) Statement , a 22-item checklist and flow diagram , is intended to address this problem by improving the reporting of RCTs . However , some specific issues that apply to trials of nonpharmacologic treatments ( for example , surgery , technical interventions , devices , rehabilitation , psychotherapy , and behavioral intervention ) are not specifically addressed in the CONSORT Statement . Furthermore , considerable evidence suggests that the reporting of nonpharmacologic trials still needs improvement . Therefore , the CONSORT group developed an extension of the CONSORT Statement for trials assessing nonpharmacologic treatments . A consensus meeting of 33 experts was organized in Paris , France , in February 2006 , to develop an extension of the CONSORT Statement for trials of nonpharmacologic treatments . The participants extended 11 items from the CONSORT Statement , added 1 item , and developed a modified flow diagram . To allow adequate underst and ing and implementation of the CONSORT extension , the CONSORT group developed this elaboration and explanation document from a review of the literature to provide examples of adequate reporting . This extension , in conjunction with the main CONSORT Statement and other CONSORT extensions , should help to improve the reporting of RCTs performed in this field OBJECTIVE Falls and fall-related injuries are leading problems in residential aged care facilities . The objective of this study was to provide descriptive data about falls in nursing homes . DESIGN / SETTING / PARTICIPANTS Prospect i ve recording of all  falls over 1 year covering all residents from 528 nursing homes in Bavaria , Germany . MEASUREMENTS Falls were reported on a st and ardized form that included a facility identification 
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Authors ' conclusions In care facilities : we are uncertain of the effect of exercise on rate of falls and it may make little or no difference to the risk of falling .
General medication review may make little or no difference to the rate of falls or risk of falling .
Vitamin D supplementation probably reduces the rate of falls but not risk of falling .
We are uncertain of the effect of multifactorial interventions on the rate of falls ; they may make little or no difference to the risk of falling .
In hospitals : we are uncertain of the effect of additional physiotherapy on the rate of falls or whether it reduces the risk of falling .
We are uncertain of the effect of providing bed sensor alarms on the rate of falls or risk of falling .
Multifactorial interventions may reduce rate of falls , although subgroup analysis suggests this may apply mostly to a subacute setting ; we are uncertain of the effect of these interventions on risk of falling