***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 Undernutrition and weight loss are important determinants of clinical outcome in older patients after hip fracture but the effectiveness of nutritional support programs in routine clinical practice remains controversial . AIMS OF THE PROJECT : To determine if oral nutritional supplements given daily for 28 days after hip fracture surgery could prevent weight loss and /or lead to improved clinical outcomes ( mortality rates , discharge destination , activities of daily living or length of hospital stay ) in non-malnourished community-dwelling older women with hip fracture . METHODS One hundred and nine women with BMI range 20 - 30 kg/m(2 ) were allocated to either nutritional supplements ( 352 kcal/day ) or usual hospital nutrition using a quasi-r and omisation technique . Body weight changes were monitored at 4 and 8 weeks and clinical outcomes were recorded at discharge and at 6 months . RESULTS No significant differences in weight change or clinical outcomes were seen between the two groups . Compliance with consuming the nutritional supplements was quite variable and there was a significant negative correlation between the amount of supplement consumed and subsequent weight change ( r=-0.36 , P=0.019 ) . CONCLUSIONS Poor compliance with oral nutritional supplements is an important determinant of the effectiveness of oral nutritional interventions in preventing weight loss after hip fracture . Whilst this may explain the lack of clinical improvements seen , our data do not support the routine use of oral nutritional supplements in non-malnourished hip fracture patients To comprehend the results of a r and omised controlled trial ( RCT ) , readers must underst and its design , conduct , analysis , and interpretation . That goal can be achieved only through total transparency from authors . Despite several decades of educational efforts , the reporting of RCTs needs improvement . Investigators and editors developed the original CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to help authors improve reporting by use of a checklist and flow diagram . The revised CONSORT statement presented here incorporates new evidence and addresses some criticisms of the original statement . The checklist items pertain to the content of the Title , Abstract , Introduction , Methods , Results , and Discussion . The revised checklist includes 22 items selected because empirical evidence indicates that not reporting this information is associated with biased estimates of treatment effect , or because the information is essential to judge the reliability or relevance of the findings . We intended the flow diagram to depict the passage of participants through an RCT . The revised flow diagram depicts information from four stages of a trial ( enrolment , intervention allocation , follow- up , and analysis ) . The diagram explicitly shows the number of participants , for each intervention group , included in the primary data analysis . Inclusion of these numbers allows the reader to judge whether the authors have done an intention- to-treat analysis . In sum , the CONSORT statement is intended to improve the reporting of an RCT , enabling readers to underst and a trial 's conduct and to assess the validity of its results This study aim ed to evaluate whether food fortification and snacks could increase the energy and protein intakes of hospital patients . The control group of 82 consecutive admissions on medical , elderly care and orthopaedic wards ate freely from the hospital menu . Subsequently , an intervention group of 62 patients were offered fortified food and snacks , providing an extra 22.2|g protein/day and 966 kcal/day in addition to the st and ard menu . Fortification significantly increased energy intake in the intervention group ( P = 0.007 , independent sample s t-test ) , having the greatest effect on groups with the lowest energy intake , that is male and female orthopaedic , female medical and female elderly patients ( 84 cent of total ) . The increases in energy intake were 21.3 cent , 21.4 cent , 23 cent and 19.6 cent respectively . Although the increased energy and protein intake represented 25.6 cent and 22.5 cent respectively , of the supplements given , and suggested that wastage was high , it was nevertheless sufficient to remove energy deficit . We therefore propose that provision of fortified food and snacks is a convenient method of improving the nutritional intakes of hospital patients 59 elderly patients ( mean age 82 ) with femoral neck fractures were r and omised into two groups . 27 patients received daily an oral nutrition supplement ( 250 ml , 20 g protein , 254 kcal ) for a mean of 32 days ; 32 patients acted as controls . On admission most patients had nutritional deficiencies . Despite being offered adequate quantities , nutritional requirements were not met during the hospital stay . Clinical outcome was significantly better in the supplemented group ( 56 % favourable course vs 13 % in controls ) during the stay in the convalescent hospital . The rates of complications and deaths were also significantly lower in supplemented patients ( 44 % vs 87 % ) . 6 months after the fracture the rates of complications and mortality were significantly lower in supplemented patients ( 40 % vs 74 % ) . The median duration of hospital stay was significantly shorter in the supplemented group ( 24 vs 40 days ) . Thus the clinical outcome of elderly patients with femoral neck fracture can be improved by once daily dietary oral supplementation A total of 744 elderly women with fractured neck of femur were classified into three groups according to anthropometric measurements on admission : group 1 , well nourished ; group 2 , thin ; group 3 , very thin . Group 1 ate well and had a low mortality and a short rehabilitation time . The thinner the patients the lower their voluntary food intake , the higher their mortality and the longer their rehabilitation time . A series of 122 patients from groups 2 and 3 were entered postoperatively into a r and omised controlled trial of overnight supplementary nasogastric tube feeding ( 4.2 MJ ( 1000 kcal ) , including 28 g protein ) in addition to their normal ward diet . This treatment was associated with improvements not only in anthropometric and plasma protein measurements but also in clinical outcome , especially in the very thin group 3 patients . Rehabilitation time and hospital stay were shortened . Mortality in group 3 was less in the tube fed patients ( 8 % ) than in the controls ( 22 % ) but this difference did not reach statistical significance . One in five patients could not tolerate the nasogastric tube , but in the remainder the treatment caused no side effects and did not seriously diminish voluntary oral food intake by day OBJECTIVE To examine how improved attention to nutritional status and dietary intake , achieved through the employment of dietetic assistants ( DAs ) , will affect postoperative clinical outcome among elderly women with hip fracture . DESIGN Open prospect i ve r and omised controlled trial , comparing conventional nursing care with the additional nutritional support provided by DA . SETTING Thirty-eight bedded acute trauma ward in a teaching hospital . PARTICIPANTS All but 11 of 344 consecutive admissions with acute nonpathological hip fracture were approached . Three hundred and eighteen ( 93 % ) agreed to inclusion . Sixteen were ineligible as they were immediately transferred to another acute ward , were managed conservatively or died preoperatively . PRIMARY OUTCOME MEASURE Postoperative mortality in the acute trauma unit . SECONDARY OUTCOME MEASURES Postoperative mortality at 4 months after fracture , length of stay , energy intake and nutritional status . RESULTS DA-supported participants were less likely to die in the acute ward ( 4.1 versus 10.1 % , P = 0.048 ) . This effect was still apparent at 4 month follow-up ( 13.1 versus 22.9 % , P = 0.036 ) . DA-supported subjects had significantly better mean daily energy intake ( 1,105 kcal versus 756 kcal/24 h , 95 % CI 259 - 440 kcal/24 h , P<0.001 ) , significantly smaller reduction in mid-arm circumference during their inpatient stay ( 0.39 cm , P = 0.002 ) and nonsignificantly favourable results for other anthropometric and laboratory measurements . CONCLUSION Dietetic or nutrition assistants are being introduced in units across the UK . This , the largest ever study of nutritional support after hip fracture , shows that their employment significantly reduced patients ' risk of dying in the acute trauma unit ; an effect that persisted at 4 month follow-up BACKGROUND & AIMS Malnutrition is common in hip fracture elderly patients . The purpose of this study was to examine the relationship between the  Mini Nutrition Assessment Short Form ( MNA-SF )  and cognitive , functional status , comorbidity and outcome of operated patients . METHODS Clinical data , MNA , functioning , cognition were prospect ively determined . Retrospectively , the Charlson Comorbidity Index ( CCI ) and Cumulative Illness Rating Scale for Geriatrics ( CIRS-G ) were applied . RESULTS The study consisted of 95 well-nourished ( WN ) , 95 at risk of malnutrition ( ARM ) and 25 malnourished ( MN ) patients . More WN patients were independent vs. partially or fully dependent ; more WN patients were cognitively normal vs. cognitively impaired ( p < 0.001 ) . CIRS-G was higher in MN vs. WN patients and CCI was higher in MN and ARM vs. WN patients ( p < 0.001 ) . During a 6 month period , 100 patients were readmitted  , with less readmissions in the WN group ( p = 0.024 ) . During a 36 month follow-up , 79 patients died . The mortality rate was lower in the WN group ( p = 0.01 ) . Stepwise regression analysis found that the only independent variables for mortality were CCI and functioning ( p < 0.01 ) . CONCLUSIONS Patients with higher cognitive and functional status were in superior nutritional condition . Poor nutritional status was associated with higher comorbidity indices , mortality and readmissions . However , we found that only comorbidity and low functioning can predict long-term mortality A group of 40 consecutive patients with hip fractures were studied and confirmed to have a high incidence of protein-calorie malnutrition . The prospect i ve nutritional assessment performed for this study included :  serum albumin , serum transferrin , anthropometric measurements , skin testing for delayed hypersensitivity , total lymphocyte count , and a 24-h urine collection for metabolic and nitrogen balance determinations . At 3 months after their hip fracture , 37.5 % returned to their premorbid ambulatory status ; 42.5 % sustained a decrement in their ambulatory status or independence ; 12.5 % died ; 7.5 % were lost to follow-up . Of the nutritional parameters studied , albumin was significantly associated with mortality ( p = 0.004 ) . Considering those patients with an albumin less than 3.0 , a mortality rate of 70 % was observed in follow-up ( maximum of 11 months ) , compared with a mortality rate of 18 % in patients with an albumin greater than or equal to 3.0 . It is concluded that the serum albumin has value as a nutritional index without specialized nutritional parameters , and that a more aggressive approach to nutritional support is needed for the hypoalbuminemic patient with a hip fracture , particularly for those with a serum albumin below 3.0 OBJECTIVE Hip fractures are a major cause of morbidity for older women , which result in impaired health related quality of life ( HRQOL ) . Few studies have prospect ively evaluated the effect of hip fractures in women on HRQOL with different health state preference measures . We compared how 4 different preference measures change in women post-hip fracture and evaluated the responsiveness of the preference measures . We also compared HRQOL in women with recent hip fractures to a control sample at baseline and to normative Canadian data at followup . METHODS Health status measures [ the Medical Outcomes Study Short Form-36 ( SF-36 ) ] and preferences ( direct and indirect ) of women over age 50 years with hip fractures were measured at baseline and at 3 and 9 months . Baseline preferences [ Health Utilities Index ( HUI ) , Feeling Thermometer , St and ard Gamble , and SF-36 ] were obtained from women without hip fractures for comparison . Independent sample t tests were used to compare baseline scores of fracture and nonfracture controls . Correlations between preference and health status measures were assessed and repeated measures ANOVA was used to assess change in health status and preferences over time . RESULTS Health status and preference measures were lower in women with hip fractures in comparison to nonfracture controls . After 9 months , the SF-36 , HUI , Feeling Thermometer , and SF-6D scores improved significantly . Values for the SF-36 remained lower than an age-matched normative sample . The HUI and SF-6D were sensitive to change over time , but the St and ard Gamble was not . CONCLUSION HRQOL and preference measures improve over time in women with recent hip fractures , with the majority of the change occurring in the initial 3 months . Our results suggest that the HUI and SF-6D are valid measures to assess change over time post-hip fracture BACKGROUND Oral nutritional supplements have been recommended after orthopedic surgery in geriatric patients . This has been shown to be effective even in normally nourished or mildly undernourished geriatric patients . Whether perioperative administration of these products is also effective and suitable is not known . METHODS R and omized , controlled , open , paralleled two-arms clinical trial , comparing energy-protein supplements ( 40 g of protein and 400 kcal per day ) , with no intervention in normally nourished or mildly undernourished patients . Outcomes were serum proteins , body mass index , postoperative complications among others . RESULTS 60 E 
    Output:
    
Nasogastric feeding was poorly tolerated .
There is very low- quality evidence from one trial ( 57 participants , mainly men ) of no evidence for an effect of tube feeding followed by oral supplementation on mortality or complications .
Tube feeding , however , was poorly tolerated .
There is very low- quality evidence from one trial ( 80 participants ) that a combination of intravenous feeding and oral supplements may not affect mortality but could reduce complications .
There is low- quality evidence that oral multinutrient supplements started before or soon after surgery may prevent complications within the first 12 months after hip fracture , but that they have no clear effect on mortality .
There is very low- quality evidence that oral supplements may reduce ' unfavourable outcome ' ( death or complications ) and that they do not result in an increased incidence of vomiting and diarrhoea .