***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 Knowledge of symptom prevalence and adequate assessment of such symptoms at the end of life is important in clinical practice . We determined the frequency and severity of symptom distress and delirium using the Edmonton Assessment Scale ( ESAS ) and the Memorial Delirium Assessment Scale ( MDAS ) and evaluated the clinical utility of the Nursing Delirium Screening Scale  ( Nu-DESC ) as scored by a caregiver as a screening tool for delirium . METHOD We conducted a secondary analysis of the data from a previous r and omized controlled trial on parenteral hydration at the end of life of patients admitted to home hospice . Only patients that had assessment s within the last week of life were included . We collected the  ESAS , MDAS , Nu-DESC , and Richmond Agitation Sedation Scale ( RASS ) results  . The sensitivity and specificity of the Nu-DESC were then calculated . RESULTS Some 78 of 261 patients were included in our study , 62 ( 80 % ) of which had moderate-to-severe symptoms corresponding to an ESAS score > 4 . These symptoms include : 73 ( 94 % ) anorexia , 63 ( 81 % ) fatigue , 56 ( 73 % ) drowsiness , 58 ( 75 % ) decreased well-being , and 39 ( 51 % ) pain . Delirium was diagnosed in 34 ( 44 % ) of patients using the MDAS . The Nu-DESC was found to have a sensitivity of 35 % , a specificity of 80 % , a positive predictive value ( PPV ) of 58 % , and an negative predictive value ( NPV ) of 61 % when used by caregivers . SIGNIFICANCE OF RESULTS Hospice patients at the end of life have a high rate of symptom distress and delirium . The Nu-DESC is not a reliable tool for screening delirium when scoring is conducted by a caregiver . Our study illustrates the need for routine use of assessment tools to improve care Introduction : Patients with end-stage interstitial lung disease ( ILD ) do not appear to receive adequate palliative care despite apparent suffering before death . The aim of this study was to evaluate their signs , symptoms , and treatment received before death . Methods : Patients with ILD and lung cancer ( LC ) who were hospitalized and died in our hospital were enrolled retrospectively . Signs and symptoms and treatments at 7 days , 3 days , and 1 day before death were evaluated and compared between the two groups of patients . Results : A total of 23 patients with ILD and 59 patients with LC group were eligible for participation . Significantly more LC patients had loss of consciousness than ILD patients on 7 days ( ILD : LC = 1 [5.6%]:24 [ 41 % ] , P = 0.013 ) , 3 days ( 1 [5.6%]:33 [ 56 % ] , P < 0.001 ) . Significantly more ILD patients had dyspnea than LC patients on 3 days ( 16 [89%]:38 [ 64 % ] , P = 0.047 ) 1 day before death ( 21 [91%]:33 [ 56 % ] , P = 0.001 ) . On 1 day before death , significantly more LC patients received morphine  than ILD patients ( 2 [ 8.7 % ] : 14 [ 24 % ] , P = 0.015 ) . More ILD patients received  sedation  ( 11 [ 48 % ] : 11 [ 19 % ] , P = 0.007 ) . Conclusions : End-stage ILD patients may experience dyspnea more frequently than terminal LC patients , and they need sedation . Morphine should be administered to ILD patients who have dyspnea . Additional prospect i ve studies are needed Importance The use of benzodiazepines to control agitation in delirium in the last days of life is controversial . Objective To compare the effect of lorazepam vs placebo as an adjuvant to haloperidol for persistent agitation in patients with delirium in the setting of advanced cancer . Design , Setting , and Participants Single-center , double-blind , parallel-group , r and omized clinical trial conducted at an acute palliative care unit at MD And erson Cancer Center , Texas , enrolling 93 patients with advanced cancer and agitated delirium despite scheduled haloperidol from February 11 , 2014 , to June 30 , 2016 , with data collection completed in October 2016 . Interventions Lorazepam ( 3 mg ) intravenously ( n = 47 ) or placebo ( n = 43 ) in addition to haloperidol ( 2 mg ) intravenously upon the onset of an agitation episode . Main Outcomes and Measures The primary outcome was change in Richmond Agitation-Sedation Scale ( RASS ) score ( range , −5 [ unarousable ] to 4 [ very agitated or combative ] ) from baseline to 8 hours after treatment administration . Secondary end points were rescue neuroleptic use , delirium recall , comfort ( perceived by caregivers and nurses ) , communication capacity , delirium severity , adverse effects , discharge outcomes , and overall survival . Results Among 90 r and omized patients ( mean age , 62 years ; women , 42 [ 47 % ] ) , 58 ( 64 % ) received the study medication and 52 ( 90 % ) completed the trial .  Lorazepam + haloperidol result ed in a significantly greater reduction of RASS score at 8 hours ( −4.1 points ) than placebo + haloperidol ( −2.3 points ) ( mean difference , −1.9 points [ 95 % CI , −2.8 to −0.9 ] ; P < .001 ) . The lorazepam + haloperidol group required less median rescue neuroleptics ( 2.0 mg ) than the placebo + haloperidol group ( 4.0 mg ) ( median difference , −1.0 mg [ 95 % CI , −2.0 to 0 ] ; P = .009 ) and was perceived to be more comfortable by both blinded caregivers and nurses ( caregivers : 84 % for the lorazepam + haloperidol group vs 37 % for the placebo + haloperidol group ; mean difference , 47 % [ 95 % CI , 14 % to 73 % ] , P = .007 ; nurses : 77 % for the lorazepam + haloperidol group vs 30 % for the placebo + haloperidol group ; mean difference , 47 % [ 95 % CI , 17 % to 71 % ] , P = .005 ) . No significant between-group differences were found in delirium-related distress and survival . The most common adverse effect was hypokinesia ( 3 patients in the lorazepam + haloperidol group [ 19 % ] and 4 patients in the placebo + haloperidol group [ 27 % ] ) . Conclusions and Relevance In this preliminary trial of hospitalized patients with agitated delirium in the setting of advanced cancer , the addition of lorazepam to haloperidol compared with haloperidol alone result ed in a significantly greater reduction in agitation at 8 hours . Further research is needed to assess generalizability and adverse effects . Trial Registration clinical trials.gov Identifier : Introduction Continuous palliative sedation ( PS ) is currently titrated based on clinical observation ; however , it is often unclear if patients are still aware of their suffering . The aim of this prospect i ve study is to characterize the level of consciousness in patients undergoing PS using Bispectral Index ( BIS ) monitoring . Patients and methods We enrolled consecutive patients with refractory symptoms requiring PS . We documented the level of sedation using Ramsay Sedation Scale ( RSS ) and BIS at 0 , 2 , 4 , 6 , 12 , and 24 h during the first day of PS and examined their degree of association . Intravenous midazolam or propofol was titrated according to the sedation level . Results Twenty patients on PS were recruited and had BIS continuous monitoring . Delirium was the most frequent reason for PS ( n = 15 , 75 % ) . The median time of sedation was 24.5 h ( interquartile range 6–46 ) . The average time to achieve the desired sedation level was 6 h , and dose titration was required in 80 % of the cases . At baseline , 14 ( 70 % ) patients were considered to be awake according to RSS ( i.e. , 1–3 ) and 19 ( 95 % ) were awake according to BIS ( i.e. , > 60 % ) . This proportion decreased to 31 and 56 % at 4 h , 27 % and 53 at 6 h , and 22 and 33 % at 24 h. RS and BIS had moderate correlation ( rho = −0.58 to −0.65 ) ; however , a small proportion of patients were found to be awake by BIS ( i.e. , ≥60 % ) despite clinical observation ( i.e. , RSS 4–6 ) indicating otherwise . Conclusions The BIS is a noninvasive , bedside , real-time continuous monitoring method that may facilitate the objective assessment of level of consciousness and dose titration in patients undergoing PS CONTEXT Knowledge of determinants that are associated with the administration of continuous palliative sedation ( CPS ) helps physicians identify patients who are at risk of developing refractory symptoms , thereby enabling proactive care planning . OBJECTIVES This study aims to explore which patient-related factors at admission are associated with receiving CPS later in the terminal phase of life . METHODS A prospect i ve multicenter observational study was performed in six Dutch hospices and three nursing home-based palliative care units . The association between patient-related variables at admission ( age , gender , diagnosis , use of opioids or psycholeptics  , number  of  medications , Karnofsky Performance Status scale score , Edmonton Symptom Assessment System distress score , and Glasgow Coma Scale score ) and the administration of CPS at the end of life was analyzed . RESULTS A total of 467 patients died during the study period , of whom 130 received CPS .  In univariate analysis , statistically significant differences were noted between the se date d and nonse date d patients with respect to younger age ( P = 0.009 ) , malignancy as a diagnosis ( P = 0.05 ) , higher Karnofsky Performance Status score ( P = 0.03 ) , the use of opioids ( P < 0.001 ) , the use of psycholeptics ( P = 0.003 ) , and higher Edmonton Symptom Assessment System distress score ( P = 0.05 ) . Multivariate logistic regression analysis showed that only the use of opioids at admission ( odds ratio 1.90 ; 95 % confidence interval 1.18 - 3.05 ) was significantly associated with the administration of CPS . CONCLUSION Physicians should be aware that patients who use opioids at admission have an increased risk for the administration of CPS  at the end of life . In this group of patients , a comprehensive personalized care plan starting at admission is m and atory to try to prevent the development of refractory symptoms . Further research is recommended , to identify other determinants of the administration of CPS and to investigate which early interventions will be effective to prevent the need for CPS in patients at high risk CONTEXT If regular therapies can not relieve symptoms sufficiently in the last days of life , continuous palliative sedation may serve to reduce consciousness . Sedation level can be measured with EEG monitoring with the bispectral index ( BIS ) monitor . OBJECTIVES To determine the feasibility and validity of BIS monitoring in terminally ill patients . METHODS In this prospect i ve study , BIS registration s were performed in unconscious end-of-life patients admitted to a palliative care center . Vali date d scores were used to measure level of sedation ( Ramsay score ) , pain ( Numeric Rating Scale or Rotterdam Elderly Pain Observations Scale ) , delirium ( Delirium Observation Screening score ) , and overall comfort ( Numeric Rating Scale ) . Validity and sensitivity to change of BIS values were considered , and the effects of medication and the time till death on BIS values were evaluated in a linear mixed model analysis . RESULTS Fifty-eight patients were included for analysis . BIS monitoring was acceptable to patients , relatives , and medical staff . BIS values were moderately correlated with Ramsay scores ( 0.46 ) but were highly variable for deeply se date d patients . BIS values changed significantly before and after a midazolam dose ( P < 0.001 ) . Midazolam treatment result ed on average in a statistically significant reduction of the BIS values ( -4.5 , 95 % CI -7.0 to -2.0 ) , whereas morphine and haloperidol did not . CONCLUSION This is one of the first validation studies in which BIS monitoring in end-of-life patients is described . BIS monitoring is feasible in unconscious terminally ill patients . However , based on our results , the wide range of BIS values in deeply se date d and comfortable patients seems to hamper its use in daily clinical practice Purpose To describe the practice of palliative sedation ( PS ) in patients with advanced cancer in a specialized palliative care ( PC ) unit in Colombia . Methods Descriptive prospect i ve study including all adults with cancer hospitalized under PS in a cancer institute between January and July 2015 in Colombia . Variables examined were diagnosis , physical functioning , symptoms at the start of sedation , medications and dosages used , and type , level , and time of sedation . Descriptive and correlational statistics were obtained . Results Sixty-six patients were included , 70 % of which were women . The patients had an average age of 61 years ( range 24–87 ) , and  
    Output:
    
Conclusion : An increasing number of studies in palliative care are using observational measures of level of consciousness .
However , only a few of these tools have been tested for their psychometric performance in that context .