***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: Abstract Objective To assess the effectiveness of a targeted , multiple intervention falls prevention programme in reducing falls and injuries related to falls in a subacute hospital . Design R and omised controlled trial of a targeted multiple intervention programme implemented in addition to usual care compared with usual care alone . Setting Three subacute wards in a metropolitan hospital specialising in rehabilitation and care of elderly patients . Participants 626 men and women aged 38 to 99 years ( average 80 years ) were recruited from consecutive admissions to subacute hospital wards . Intervention Falls risk alert card with information brochure , exercise programme , education programme , and hip protectors . Main outcome measures Incidence rate of falls , injuries related to falls , and proportion of participants who experienced one or more falls during their stay in hospital . Results Participants in the intervention group ( n = 310 ) experienced 30 % fewer falls than participants in the control group ( n = 316 ) . This difference was significant ( Peto log rank test P = 0.045 ) and was most obvious after 45 days of observation . In the intervention group there was a trend for a reduction in the proportion of participants who experienced falls ( relative risk 0.78 , 95 % confidence interval 0.56 to 1.06 ) and 28 % fewer falls result ed in injury ( log rank test P = 0.20 ) . Conclusions A targeted multiple intervention falls prevention programme reduces the incidence of falls in the subacute hospital setting 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 Patients in hospitals and nursing homes are at risk of the development of , often preventable , adverse events ( AEs ) , which threaten patient safety . Guidelines for prevention of many types of AEs are available , however , compliance with these guidelines appears to be lacking . Besides general barriers that inhibit implementation , this non-compliance is associated with the large number of guidelines competing for attention . As implementation of a guideline is time-consuming , it is difficult for organisations to implement all available guidelines . Another problem is lack of feedback about performance using quality indicators of guideline based care and lack of a recognisable , unambiguous system for implementation . A program that allows organisations to implement multiple guidelines simultaneously may facilitate guideline use and thus improve patient safety . The aim of this study is to develop and test such an integral patient safety program that addresses several AEs simultaneously in hospitals and nursing homes . This paper reports the design of this study . Methods and design The patient safety program addresses three AEs : pressure ulcers , falls and urinary tract infections . It consists of bundles and outcome and process indicators based on the existing evidence based guidelines . In addition it includes a multifaceted tailored implementation strategy : education , patient involvement , and a computerized registration and feedback system . The patient safety program was tested in a cluster r and omised trial on ten hospital wards and ten nursing home wards . The baseline period was three months followed by the implementation of the patient safety program for fourteen months . Subsequently the follow-up period was nine months . Primary outcome measure was the incidence of AEs on every ward . Secondary outcome measures were the utilization of preventive interventions and the knowledge of nurses regarding the three topics . R and omisation took place on ward level . The results will be analysed separately for hospitals and nursing homes . Discussion Major challenges were the development of the patient safety program including a digital registration and feedback system and the implementation of the patient safety program . Trial registration Trial registration : Clinical Trials.gov ID [ NCT00365430 Abstract Objectives : To identify clinical characteristics of elderly in patients that predict their chance of falling ( phase 1 ) and to use these characteristics to derive a risk assessment tool and to evaluate its power in predicting falls ( phases 2 and 3 ) . Design : Phase 1 : a prospect i ve case-control study . Phases 2 and 3 : prospect i ve evaluations of the derived risk assessment tool in predicting falls in two cohorts . Setting : Elderly care units of St Thomas 's Hospital ( phase 1 and 2 ) and Kent and Canterbury Hospital ( phase 3 ) . Subjects : Elderly hospital in patients ( aged 65 years ) : 116 cases and 116 controls in phase 1 , 217 patients in phase 2 , and 331 in phase 3 . Main outcome measures : 21 separate clinical characteristics were assessed in phase 1 , including the abbreviated mental test score , modified Barthel index , a transfer and mobility score obtained by combining the transfer and mobility sections of the Barthel index , and several nursing judgments . Results : In phase 1 five factors were independently associated with a higher risk of falls : fall as a presenting complaint ( odds ratio 4.64 ( 95 % confidence interval 2.59 to 8.33 ) ; a transfer and mobility score of 3 or 4 ( 2.10 ( 1.22 to 3.61 ) ) ; and primary nurses ' judgment that a patient was agitated ( 20.9 ( 9.62 to 45.62 ) ) , needed frequent toileting ( 2.48 ( 1.08 to 5.70 ) ) , and was visually impaired ( 3.56 ( 1.26 to 10.05 ) ) . A risk assessment score ( range 0 - 5 ) was derived by scoring one point for each of these five factors . In phases 2 and 3 a risk assessment score > 2 was used to define high risk : the sensitivity and specificity of the score to predict falls during the following week was 93 % and 88 % respectively in phase 2 and 92 % and 68 % respectively in phase 3 . Conclusion : This simple risk assessment tool predicted with clinical ly useful sensitivity and specificity a high percentage of falls among elderly hospital in patients Introduction This study evaluates whether a postoperative multidisciplinary , intervention program , including systematic assessment and treatment of fall risk factors , active prevention , detection , and treatment of postoperative complications , could reduce inpatient falls and fall-related injuries after a femoral neck fracture . Methods A r and omized , controlled trial at the orthopedic and geriatric departments at Umeå University Hospital , Sweden , included 199 patients with femoral neck fracture , aged ≥70 years . Results Twelve patients fell 18 times in the intervention group compared with 26 patients suffering 60 falls in the control group . Only one patient with dementia fell in the intervention group compared with 11 in the control group . The crude postoperative fall incidence rate was 6.29/1,000 days in the intervention group vs 16.28/1,000 days in the control group . The incidence rate ratio was 0.38 [ 95 % confidence interval ( CI ) : 0.20 – 0.76 , p = 0.006 ] for the total sample and 0.07 ( 95 % CI : 0.01–0.57 , p=0.013 ) among patients with dementia . There were no new fractures in the intervention group but four in the control group . Conclusion A team applying comprehensive geriatric assessment and rehabilitation , including prevention , detection , and treatment of fall risk factors , can successfully prevent inpatient falls and injuries , even in patients with dementia The consequences of falls among hospital patients are a great problem , for the patient , the family and society , and cost billions of dollars . In Sweden , almost one-third of all hip fractures occur in the hospital population . Despite this , very few prevention strategies have been developed and tested . In this study , a risk assessment and recording programme in relation to the risk of falling among patients in a geriatric department at a Swedish hospital was implemented . The records of all patients admitted to a geriatric unit during one year , and a stratified r and om sample of patient records , constituting the control group from the year before , were review ed . No recording of assessment s regarding the patients ' risk of falling , and no preventive nursing interventions , were found in the records of the control group . The study group , however , increased the recording of risk assessment to 96 % . Only implemented nursing interventions were found in the patients ' records , despite the fact that Swedish law makes it obligatory for the registered nurse to record both the planning and implementation of nursing care . In the study group there were explicit descriptions of problems of concern for nursing regarding the patients ' risk of falling in less than one-third of the records , the nursing care plans were rare , and the evaluations were not satisfactory . Nursing interventions consisted mostly of information or education , promotion of patient participation , and structuring of the environment . There was no agreement on any st and ard-care plan . Recording of falls was found more often in the study group than in the control group ( probably due to more careful recording ) , but the proportion of injuries in relation to falls was higher in the control group . The results of this study may be used as a baseline for developing a nursing strategy and documentation relating to falls CONTEXT Falls cause injury and death for persons of all ages , but risk of falls increases markedly with age . Hospitalization further increases risk , yet no evidence exists to support short-stay hospital-based fall prevention strategies to reduce patient  falls . OBJECTIVE To investigate whether a fall prevention tool kit ( FPTK ) using health information technology ( HIT ) decreases patient falls in hospitals . DESIGN , SETTING , AND PATIENTS Cluster r and omized study conducted January 1 , 2009 , through June 30 , 2009 , comparing patient fall rates in 4 urban US hospitals in units that received usual care ( 4 units and 5104 patients ) or the intervention ( 4 units and 5160 patients ) . INTERVENTION The FPTK integrated existing communication and workflow patterns into the HIT application . Based on a valid fall risk assessment scale completed by a nurse , the FPTK software tailored fall prevention interventions to address patients ' specific determinants of fall risk . The FPTK produced bed posters composed of brief text with an accompanying icon , patient education h and outs , and plans of care , all communicating patient-specific alerts to key stakeholders . MAIN OUTCOME MEASURES The primary outcome was patient falls per 1000 patient-days adjusted for site and patient care unit . A secondary outcome was fall-related injuries . RESULTS During the 6-month intervention period , the number of patients with falls differed between control ( n = 87 ) and intervention ( n = 67 ) units ( P=.02 ) . Site-adjusted fall rates were significantly higher in control units ( 4.18 [ 95 % confidence interval { CI } , 3.45 - 5.06 ] per 1000 patient-days ) than in intervention units ( 3.15 [ 95 % CI , 2.54 - 3.90 ] per 1000 patient-days ; P = .04 ) . The FPTK was found to be particularly effective with patients aged 65 years or older ( adjusted rate difference , 2.08 [ 95 % CI , 0.61 - 3.56 ] per 1000 patient-days ; P = .003 ) . No significant effect was noted in fall-related injuries . CONCLUSION The use of a fall prevention tool kit in hospital units compared with usual care significantly reduced rate of falls . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00675935 BACKGROUND falls and related injuries are known to be a significant problem for older people . There is evidence that identifying and addressing individual risk factors can reduce the incidence of falls in the community but no evidence of the effectiveness of targeted risk factor reduction methods applied to hospital in- patients . OBJECTIVE to test the efficacy of a targeted risk factor reduction core care plan in reducing risk of falling while in hospital . DESIGN a group ( ward ) r and omised trial . SETTING elderly care wards and associated community units of a district general hospital in the North of Engl and . SUBJECTS all elderly patients who received care in eight wards and community units during a 12-month study period . METHODS matched pairs of wards were r and omly allocated to intervention or control groups . In the intervention wards , staff used a pre-printed care plan for patients identified as at risk of falling and introduced appropriate remedial measures . Numbers of falls in each group were then compared . RESULTS after introduction of the care plan there was a significant reduction in the relative risk of recorded falls on intervention wards ( relative risk 0.79 , 95 % CI 0.65 - 0.95 ) but not on control wards ( RR 1.12 , 95 % CI 0.96 - 1.31 ) . The difference in change between the intervention wards and control wards was highly significant ( RR 0.71 , 95 % CI 0.55 
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Harms were not systematic ally examined , but potential harms included increased use of restraints and sedating drugs and decreased efforts to mobilize patients .