***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 
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    ***EXAMPLES*** 
    Input: BACKGROUND Hospital-acquired delirium is a known risk factor for negative outcomes in patients admitted to the surgical intensive care unit ( SICU ) . Outcomes worsen as the duration of delirium increases . The purpose of this study was to evaluate the efficacy of a delirium prevention program and determine whether it decreased the incidence and duration of hospital-acquired delirium in older adults ( age>50 y ) admitted to the SICU . METHODS A prospect i ve pre- or post-intervention cohort study was done at an academic level I trauma center . Older adults admitted to the SICU were enrolled in a delirium prevention program .  Those with traumatic brain injury , dementia , or 0 d of obtainable delirium status were excluded from analysis . The intervention consisted of multidisciplinary education , a pharmacologic protocol to limit medications associated with delirium , and a nonpharmacologic sleep enhancement protocol . Primary outcomes were incidence of delirium and delirium-free days/30 . Secondary outcomes were ventilator-free days/30 , SICU length of stay ( LOS ) , daily and cumulative doses of opioids ( milligram , morphine equivalents ) and benzodiazepines ( milligram , lorazepam equivalents ) , and time spent in severe pain ( greater than or equal to 6 on a scale of 1 - 10 ) . Delirium was measured using the Confusion Assessment Method for the ICU . Data were analyzed using Chi-squared and Wilcoxon rank sum analysis . RESULTS Of 624 patients admitted to the SICU , 123 met inclusion criteria : 57 preintervention ( 3/12 - 6/12 ) and 66 postintervention ( 7/12 - 3/13 ) . Cohorts were similar in age , gender , ratio of trauma patients , and Injury Severity Score . Postintervention , older adults experienced delirium at the same incidence ( pre 47 % versus 58 % , P=0.26 ) , but for a significantly decreased duration as indicated by an increase in delirium-free days/30 ( pre 24 versus 27 , P=0.002 ) . After intervention , older adults with delirium had more vent-free days ( pre 21 versus 25 , P=0.03 ) , shorter SICU LOS ( pre 13 [ median 12 ] versus 7 [ median 6 ] , P=0.01 ) and were less likely to be treated with benzodiazepines ( pre 85 % versus 63 % , P=0.05 ) with a lower daily dose when prescribed ( pre 5.7 versus 3.6 mg , P=0.04 ) . After intervention , all older adults spent less time in pain ( pre 4.7 versus 3.1 h , P=0.02 ) , received less total opioids ( pre 401 versus 260 mg , P=0.01 ) , and had shorter SICU LOS ( pre 9 [ median 5 ] versus 6 [ median 4 ] , P=0.04 ) . CONCLUSIONS Although delirium prevention continues to be a challenge , this study successfully decreased the duration of delirium for older adults admitted to the SICU . Our simple , cost-effective program led to improved pain and sedation outcomes . Older adults with delirium spent less time on the ventilator and all patients spent less time in the SICU BACKGROUND The objective of this study was to evaluate implementation of an innovative intervention design ed to prevent complications and stimulate early rehabilitation among frail elderly in patients . METHODS The program was implemented in April 2011 . A mixed- methods process evaluation and before-after study were performed . Primary effect outcomes included incidence of hospital-acquired delirium , cognitive decline , and decline in activities of daily living ( ADL ) during hospital stay . Secondary endpoints included ADL performance 3 months postdischarge , readmission , and caregiver burden . RESULTS One hundred ninety-one preintervention and 195 postintervention patients aged 70 years or older were included . Overall , no significant differences in primary endpoints were found . Mean ADL between discharge and follow-up improved ( 3.2 vs 5.7 , P = .058 ) . Caregivers rated burden of care lower at 3 months postdischarge ( .5 vs -.6 , P = .049 ) . CONCLUSIONS The CareWell in Hospital program was implemented satisfactorily . Although the low baseline delirium incidence ( 11 % ) , higher comorbidity , and an increasing learning curve during a restricted implementation period potentially influenced the overall effects , this integrated care program may have beneficial effects on outcomes among frail elderly surgical patients 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 : OBJECTIVES To determine whether a higher blood transfusion threshold would prevent new or worsening delirium symptoms in the hospital after hip fracture surgery . DESIGN Ancillary study to a r and omized clinical trial . SETTING Thirteen hospitals in the United States and Canada . PARTICIPANTS One hundred thirty-nine individuals hospitalized with hip fracture aged 50 and older ( mean age 81.5 ± 9.1 ) with cardiovascular disease or risk factors and hemoglobin concentrations of less than 10 g/dL within 3 days of surgery recruited in an ancillary study of the Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair . INTERVENTION Individuals in the liberal treatment group received one unit of packed red blood cells and as much blood as needed to maintain hemoglobin concentrations at greater than 10 g/dL ; those in the restrictive treatment group received transfusions if they developed symptoms of anemia or their hemoglobin fell below 8 g/dL. MEASUREMENTS Delirium assessment s were performed before r and omization and up to three times after r and omization . The primary outcome was severity of delirium according to the Memorial Delirium Assessment Scale ( MDAS ) . The secondary outcome was the presence or absence of delirium defined according to the Confusion Assessment Method ( CAM ) . RESULTS The liberal group received a median two units of blood and the restrictive group zero units of blood . Hemoglobin concentration on Day 1 after r and omization was 1.4 g/dL higher in the liberal group . Treatment groups did not differ significantly at any time point or over time on MDAS delirium severity ( P = .28 ) or CAM delirium presence ( P = .83 ) . CONCLUSION Blood transfusion to maintain hemoglobin concentrations greater than 10 g/dL alone is unlikely to influence delirium severity or rate in individuals with hip fracture after surgery with a hemoglobin concentration less than 10 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 The objective of this study was to develop a prospect ively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies . A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients . The 1-yr mortality rates for the different scores were : " 0 " , 12 % ( 181 ) ; " 1 - 2 " , 26 % ( 225 ) ; " 3 - 4 " , 52 % ( 71 ) ; and " greater than or equal to 5 " , 85 % ( 82 ) . The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up . The percent of patients who died of comorbid disease for the different scores were : " 0 " , 8 % ( 588 ) ; " 1 " , 25 % ( 54 ) ; " 2 " , 48 % ( 25 ) ; " greater than or equal to 3 " , 59 % ( 18 ) . With each increased level of the comorbidity index , there were stepwise increases in the cumulative mortality attributable to comorbid disease ( log rank chi 2 = 165 ; p less than 0.0001 ) . In this longer follow-up , age was also a predictor of mortality ( p less than 0.001 ) . The new index performed similarly to a previous system devised by Kaplan and Feinstein . The method of classifying comorbidity provides a simple , readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies . Further work in larger population s is still required to refine the approach because the number of patients with any given condition in this study was relatively small Background : Major depression is a frequent and serious disorder in older medical in patients . Because the condition goes undetected and untreated in most of these patients , 
    Output:
    
Conclusion : Non-pharmacological delirium interventions have frequently excluded and under-characterised people requiring palliative care and infrequently reported their outcomes