***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: Introduction This study hypothesised that a reduction of sound during the night using earplugs could be beneficial in the prevention of intensive care delirium .  Two research questions were formulated . First , does the use of earplugs during the night reduce the onset of delirium or confusion in the ICU ? Second , does the use of earplugs during the night improve the quality of sleep in the ICU ? Methods A r and omized clinical trial included adult intensive care patients in an intervention group of 69 patients sleeping with earplugs during the night and a control group of 67 patients sleeping without earplugs during the night . The research ers were blinded during data collection . Assignment was performed by an independent nurse research er using a computer program . Eligible patients had an expected length of stay in the ICU of more than 24 hours , were Dutch- or English-speaking and scored a minimum Glasgow Coma Scale of 10 .  Delirium was assessed using the vali date d NEECHAM scale , sleep perception was reported by the patient in response to five questions . Results The use of earplugs during the night lowered the incidence of confusion in the studied intensive care patients . A vast improvement was shown by a Hazard Ratio of 0.47 ( 95 % confidence interval ( CI ) 0.27 to 0.82 ) . Also , patients sleeping with earplugs developed confusion later than the patients sleeping without earplugs . After the first night in the ICU , patients sleeping with earplugs reported a better sleep perception . Conclusions Earplugs may be a useful instrument in the prevention of confusion or delirium . The beneficial effects seem to be strongest within 48 hours after admission . The relation between sleep , sound and delirium , however , needs further research .Trial registration Current Controlled Trials IS RCT Background Delirium is the most frequent complication among older people following hospitalisation . Delirium may be prevented in about one-third of patients using a multicomponent intervention . However , in the United Kingdom , the National Health Service has no routine delirium prevention care systems . We have developed the Prevention of Delirium Programme , a multicomponent delirium prevention intervention and implementation process . We have successfully carried out a pilot study to test the feasibility and acceptability of implementation of the programme . We are now undertaking preliminary testing of the programme . Methods / Design The Prevention of Delirium Study is a multicentre , cluster r and omised feasibility study design ed to explore the potential effectiveness and cost-effectiveness of the Prevention of Delirium Programme .  Sixteen elderly care medicine and orthopaedic/trauma wards in eight National Health Service acute hospitals will be r and omised to receive the Prevention of Delirium Programme or usual care .  Patients will be eligible for the trial if they have been admitted to a participating ward and are aged 65 years or over . The primary objectives of the study are to provide a preliminary estimate of the effectiveness of the Prevention of Delirium Programme  as measured by the incidence of new onset delirium , assess the variability of the incidence of new-onset delirium , estimate the intracluster correlation coefficient and likely cluster size , assess barriers to the delivery of the  Prevention of Delirium Programme system of care , assess compliance with the  Prevention of Delirium Programme system of care , estimate recruitment and follow-up rates , assess the degree of contamination due to between-ward staff movements , and investigate differences in financial costs and benefits between the Prevention of Delirium Programme system of care and st and ard practice . Secondary objectives are to investigate differences in the number , severity and length of delirium episodes ( including persistent delirium ) ; length of stay in hospital ; in-hospital mortality ; destination at discharge ; health-related quality of life and health re source use ; physical and social independence ; anxiety and depression ; and patient experience . Discussion This feasibility study will be used to gather data to inform the design of a future definitive r and omised controlled trial . Trial registration IS RCT N01187372 . Registered 13 March 2014 Although it is generally appropriate for a healthy adult to consume 2000 to 2500 ml per day , the literature does not address evaluating any st and ard . The objective here was to develop a weight-based hydration management intervention and evaluate the impact of this on the incidence of acute confusion ( AC ) using an N = 98 . The intervention consisted of a fluid intake goal based on 100 ml per kg for the first 10 kg , 50ml/kg for the next 10 kg , and 15 ml for the remaining body weight . The treatment group received instruction and assistance on the fluid goal and the control group received routine care . Measurements included serum electrolytes , bioimpedance analysis , urinalysis , Mini-Mental State Exam , and the NEECHAM . There was no difference in the incidence of AC between treatment and controls , but those individuals with ≥ 90 % compliance demonstrated higher ECF volumes and also lower urine leukocyte counts OBJECTIVES To compare the benefits of a short-term occupational therapy intervention ( OTI ) when added to the conventional treatment model ( CTM ) in the functional recovery of patients admitted to an acute geriatric unit ( AGU ) . STUDY DESIGN Non-pharmacological r and omized clinical trial . 400 patients were r and omized to OTI ( n = 198 ) or CTM ( n = 202 ) group . Mean age 83.5 . Interventions included needs assessment , iatrogenic prevention , retraining in activities of daily living , and instructions for caregivers in three groups of patients defined a priori ( cardiopulmonary disease , stroke , other conditions ) 5 days a week , 30 - 45 min a day . MAIN OUTCOME MEASURE Recovery of ≥ 10 Barthel index points by discharge . Secondary outcome was the reduction in confusional episodes . RESULTS The adjusted relative risk ( RR ) of functional recovery in the OTI group was 1.16 ( 95%CI 0.91 - 1.47 ) . In participants with cardiopulmonary disease was 1.57 ( 95%CI 1.06 - 2.32 ) , number needed to treat ( NNT ) 5 . Participants with other conditions assigned to OTI had a reduction in acute confusional episodes ; RR 0.48 ( 95 % CI 0.26 - 0.87 ) , NNT 7 . CONCLUSIONS Although overall there were no significant differences , patients with cardiopulmonary disease or non-stroke pathologies admitted to an AGU , may benefit from a short-term OTI The purpose of this r and omized controlled study was to determine the effects of music listening on acute confusion that is common in older adults after hip or knee surgery . A control group demonstrated greater decreases in cognition on the first postoperative day compared to a music-listening group ( F = 8.448 , p = .009 ) . In the 3-day postoperative period , the cognitive status of the control group improved ; on the third postoperative day , there was no significant difference between the two groups ( F = 3.52 , p = .075 ) . The music-listening group had higher scores on the NEECHAM Acute Confusion Scale across the 3-day postoperative period ( F = 7.28 , p = .014 ) OBJECTIVES Delirium ( or acute confusional state ) affects 35 % to 65 % of patients after hip-fracture repair , and has been independently associated with poor functional recovery . We performed a r and omized trial in an orthopedic surgery service at an academic hospital to determine whether proactive geriatrics consultation can reduce delirium after hip fracture . DESIGN Prospect i ve , r and omized , blinded . SETTING Inpatient academic tertiary medical center . PARTICIPANTS 126 consenting patients 65 and older ( mean age 79 + /- 8 years , 79 % women ) admitted emergently for surgical repair of hip fracture . MEASUREMENTS Detailed assessment through interviews with patients and design ated proxies and review of medical records was performed at enrollment to ascertain prefracture status . Subjects were then r and omized to proactive geriatrics consultation , which began preoperatively or within 24 hours of surgery , or " usual care . " A geriatrician made daily visits for the duration of the hospitalization and made targeted recommendations based on a structured protocol . To ascertain study outcomes , all subjects underwent daily , blinded interviews for the duration of their hospitalization , including the Mini-Mental State Examination ( MMSE ) , the Delirium Symptom Interview ( DSI ) , and the Memorial Delirium Assessment Scale ( MDAS ) . Delirium was diagnosed using the Confusion Assessment Method ( CAM ) algorithm . RESULTS The 62 patients r and omized to geriatrics consultation were not significantly different ( P>.1 ) from the 64 usual-care patients in terms of age , gender , prefracture dementia , comorbidity , type of hip fracture , or type of surgical repair . Sixty-one percent of geriatrics consultation patients were seen preoperatively and all were seen within 24 hours postoperatively . A mean of 10 recommendations were made throughout the duration of the hospitalization , with 77 % adherence by the orthopedics team . Delirium occurred in 20 /62 ( 32 % ) intervention patients , versus 32 / 64 ( 50 % ) usual-care patients ( P = .04 ) , representing a relative risk of 0.64 ( 95 % confidence interval ( CI ) = 0.37 - 0.98 ) for the consultation group . One case of delirium was prevented for every 5.6 patients in the geriatrics consultation group . There was an even greater reduction in cases of severe delirium , occurring in 7/ 60 ( 12 % ) of intervention patients and 18 / 62 ( 29 % ) of usual-care patients , with a relative risk of 0.40 ( 95 % CI = 0.18 - 0.89 ) . Despite this reduction in delirium , length of stay did not significantly differ between intervention and usual-care groups ( median + /- interquartile range = 5 + /- 2 days in both groups ) , likely because protocol s and pathways predetermined length of stay . In subgroup analyses , geriatrics consultation was most effective in reducing delirium in patients without prefracture dementia or activities of daily living ( ADL ) functional impairment . CONCLUSIONS Proactive geriatrics consultation was successfully implemented with good adherence after hip-fracture repair . Geriatrics consultation reduced delirium by over one-third , and reduced severe delirium by over one-half . Our trial provides strong preliminary evidence that proactive geriatrics consultation may play an important role in the acute hospital management of hip-fracture patients Objective To determine if a programme of progressive resistance exercise , mobilisation and orientation , in addition to usual care , was superior to usual care alone in the prevention of incident delirium in older hospitalised patients . Design A r and omised controlled trial . Setting The study was performed at a secondary referral hospital in Melbourne , Australia between May 2005 and December 2007 . Participants 648 consecutive medical in patients aged 65 years or older who had been in hospital for less than 48 h and who did not have delirium . Intervention Participants were r and omly allocated to a twice-daily programme of progressive resistance exercise tailored to individual ability , mobilisation and orientation in addition to usual care or to usual care alone .  Measurements Delirium was measured using the Confusion Assessment Method at baseline and every 48 h until discharge . Secondary outcome measures were severity and duration of delirium , discharge destination and length of stay . Results Delirium occurred in 4.9 % ( 95 % CI 2.3 % to 7.3 % ) of the intervention group ( 15/305 ) and in 5.9 % ( 20/339 ; 95 % CI 3.8 % to 9.2 % ) of the group receiving usual care . No difference was observed between groups ( χ2 ; p=0.5 ) . The intervention had no effect on delirium duration , severity , discharge destination or length of stay . Conclusion A programme of progressive resistance exercise and orientation was not effective in reducing incident delirium in hospitalised elderly patients BACKGROUND delirium is a clinical syndrome associated with multiple short and long-term complications and therefore prevention is an essential part of its management . This study was design ed to assess the efficacy of multicomponent intervention in delirium prevention . METHODS a total of 287 hospitalised patients at intermediate or high risk of developing delirium were r and omised to receive a non-pharmacological intervention delivered by family members  ( 144 patients )  or st and ard management  ( 143 patients ) . The primary efficacy outcome was the occurrence of delirium at any time during the course of hospitalisation . Three vali date d observers performed the event adjudication by using the confusion assessment method screening instrument . RESULTS there were no significant differences in the baseline characteristics between the two groups . The primary outcome occurred in 5.6 % of the patients in the intervention group and in 13.3 % of the patients in the control group ( relative risk : 0.41 ; confidence interval : 0.19 - 0.92 ; P = 0.027 ) . CONCLUSION the results of this study show that there is a benefit in the non-pharmacological prevention of delirium using family members , when compared with st and ard management of patients at risk of developing this condition BACKGROUND older people undergoing elective surgery have significant post-operative problems prolonging hospitalisation . OBJECTIVE to design , embed , and evaluate an evidence -based comprehensive geriatric assessment ( CGA ) service for at-risk older patients undergoing elective surgery . SETTING urban teaching hospital . SUBJECTS elective surgical patients aged 65 + . INTERVENTION multidisciplinary preoperative CGA service with post-operative follow-through ( proactive care of older people undergoing surgery [ ' POPS ' ] ) . 
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Results The evidence for non-pharmacological , multi-component interventions is sufficiently robust for clinical practice recommendations to be formulated .
However , no conclusive effects have been demonstrated on outcomes more distal to delirium occurrence and for single-component interventions .
Conclusions The majority of studies that investigated non-pharmacological prevention of delirium were design ed as explanatory studies aim ed at demonstrating the efficacy of the intervention .