***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 Delirium in the intensive care unit ( ICU ) is associated with increased morbidity and mortality . Using an assessment tool has been shown to improve the ability of clinicians in the ICU to detect delirium . The confusion assessment method for the ICU ( CAM-ICU ) is a vali date d delirium-screening tool for critically ill intubated patients . The aim of this project was to establish the feasibility of routine delirium screening using the CAM-ICU and to identify the incidence of delirium in a UK critical care unit . Methods Routine CAM-ICU monitoring was implemented in a mixed critical care unit in January 2007 following a two-month educational and promotional campaign . Guidelines for the management of delirium were introduced . During a two-month prospect i ve audit in September and October 2007 , the daily CAM-ICU was recorded by the bedside nurse for consecutive level 2 and level 3 patients admitted to the mixed medical/surgical critical care ward in a district general hospital . This was repeated in January 2008 . Patient outcome was recorded . The records of an additional cohort of ventilated patients were review ed retrospectively to determine compliance with routine CAM-ICU assessment s. Results Seventy-one patients were included in the observational cohort , with 60 patients in the retrospective cohort . In the prospect i ve group it was not possible to assess for delirium with the CAM-ICU in nine patients due to persistent coma or inability to underst and simple instructions . Excluding elective post-operative patients , the incidence of delirium was 45 % in patients who could be assessed ; in the 27 ventilated patients who could be assessed it was 63 % . From the retrospective data compliance with the CAM-ICU assessment was 92 % . The incidence of delirium in this retrospective group of ventilated patients who could be assessed was 65 % . Conclusions We have demonstrated that delirium screening is feasible in a UK ICU population . The high incidence of delirium and the impact on outcomes in this UK cohort of patients is in line with previous reports Objectives Explore the effect of an automated reorientation intervention on ICU delirium  in a prospect i ve r and omized controlled trial . Background Delirium is common in ICU patients , and negatively affects outcomes . Few prevention strategies have been tested . Methods Thirty ICU patients were r and omized to 3 groups . Ten received hourly recorded messages in a family member 's voice during waking hours over 3 ICU days , 10 received the same messages in a non‐family voice , and 10 ( control ) did not receive any automated reorientation messages . The primary outcome was delirium free days during the intervention period ( evaluated by CAM‐ICU ) . Groups were compared by Fisher 's Exact Test . Results The family voice group had more delirium free days than the non‐family voice group , and significantly more delirium free days ( p = 0.0437 ) than the control group . Conclusions Reorientation through automated , scripted messages reduced incidence of delirium . Using identical scripted messages , family voice was more effective than non‐family voice Introduction Delirium is a common , serious and potentially preventable condition with devastating impact on the quality of life prompting a proliferation of interventional trials . Core outcome sets aim to st and ardise outcome reporting by identifying outcomes perceived fundamental for measurement in trials of a specific interest area . Our aim is to develop international consensus on two core outcome sets for trials of interventions to prevent and /or treat delirium , irrespective of study population . We aim to identify additional core outcomes specific to the critically ill , acutely hospitalised patients , palliative care and older adults . Methods and analysis We will conduct a systematic review of published and ongoing delirium trials ( 1980 onwards ) and  one-on-one interviews of patients who have experienced delirium and family members . These data will inform Delphi round 1 of a two-stage consensus process . In round 2 , we will provide participants their own response , summarised group responses and those of patient/family participants for rescoring . We will r and omise participants to receive feedback as proportion scoring the outcome as critical or as group mean responses . We will hold a consensus meeting using nominal group technique to finalise outcomes for inclusion . We will repeat the Delphi process and consensus meeting to select measures for each core outcome . We will recruit 240 Delphi participants giving us 80 % power to detect a 1.0–1.5 point ( 9-point scale ) difference by feedback method between rounds . We will analyse differences for subsequent scores , magnitude of opinion change , items retained and level of agreement . Ethics and dissemination We are obtaining research ethics approvals according to local governance . Participation will be voluntary and data deidentified . Support from three international delirium organisations will be instrumental in dissemination and core outcome set uptake . We will disseminate through peer- review ed open access publications and present at conferences selected to reach a wide range of knowledge users BACKGROUND Whilst there is a growing body of research exploring the effect of delirium in intensive care unit ( ICU ) patients , the relationship between patient delirium and long-term cognitive impairment has not been investigated in setting s where low rates of delirium have been reported . OBJECTIVES To assess the association between the incidence of delirium , duration of mechanical ventilation and long term cognitive impairment in general ICU patients . METHODS Prospect i ve cohort study conducted in a tertiary level ICU in Queensl and , Australia . Adult medical and surgical ICU patients receiving ≥12h mechanical ventilation  were assessed for delirium on at least one day . Cognitive impairment was assessed at three and /or six-months using the : Repeatable Battery for the Assessment of Neuropsychological Status ( RBANS ) ; Trail Making Test ( TMT ) Part A and B ; and Mini-Mental State Examination ( MMSE )  . RESULTS Of 148 enrollees , 91 ( 61 % ) completed assessment at three and /or six months . Incidence of delirium was 19 % , with 41 % cognitively impaired at three months and 24 % remaining impaired at six months . Delirium was associated with impaired cognition at six-months : mean TMT Part A scores ( information processing speed ) were 7.86s longer than those with no delirium ( p=0.03 ) , and mean TMT Part B scores ( executive functioning ) 24.0s longer ( p=0.04 ) . CONCLUSIONS ICU delirium was positively associated with impaired information processing speed and executive functioning at six-months post-discharge for this cohort . Testing for cognitive impairment with RBANS and TMT should be considered due to its greater sensitivity in comparison to the MMSE Importance Results of studies on use of prophylactic haloperidol in critically ill adults are inconclusive , especially in patients at high risk of delirium . Objective To determine whether prophylactic use of haloperidol improves survival among critically ill adults at high risk of delirium , which was defined as an anticipated intensive care unit ( ICU ) stay of at least 2 days . Design , Setting , and Participants R and omized , double-blind , placebo-controlled  investigator-driven study involving 1789 critically ill adults treated at 21 ICUs , at which nonpharmacological interventions for delirium prevention are routinely used in the Netherl and s. Patients without delirium whose expected ICU stay was at least a day were included . Recruitment was from July 2013 to December 2016 and follow-up was conducted at 90 days with the final follow-up on March 1 , 2017 . Interventions Patients received prophylactic treatment 3 times daily intravenously either 1 mg ( n = 350 ) or 2 mg ( n = 732 ) of haloperidol or placebo ( n = 707 ) , consisting of 0.9 % sodium chloride . Main Outcome and Measures The primary outcome was the number of days that patients survived in 28 days . There were 15 secondary outcomes , including delirium incidence , 28-day delirium-free and coma-free days , duration of mechanical ventilation , and ICU and hospital length of stay . Results All 1789 r and omized patients ( mean , age 66.6 years [ SD , 12.6 ] ; 1099 men [ 61.4 % ] ) completed the study . The 1-mg haloperidol group was prematurely stopped because of futility . There was no difference in the median days patients survived in 28 days , 28 days in the 2-mg haloperidol group vs 28 days in the placebo group , for a difference of 0 days ( 95 % CI , 0 - 0 ; P = .93 ) and a hazard ratio of 1.003 ( 95 % CI , 0.78 - 1.30 , P=.82 ) . All of the 15 secondary outcomes were not statistically different . These included delirium incidence ( mean difference , 1.5 % , 95 % CI , −3.6 % to 6.7 % ) , delirium-free and coma-free days ( mean difference , 0 days , 95 % CI , 0 - 0 days ) , and duration of mechanical ventilation , ICU , and hospital length of stay ( mean difference , 0 days , 95 % CI , 0 - 0 days for all 3 measures ) . The number of reported adverse effects did not differ between groups ( 2 [ 0.3 % ] for the 2-mg haloperidol group vs 1 [ 0.1 % ] for the placebo group ) . Conclusions and Relevance Among critically ill adults at high risk of delirium , the use of prophylactic haloperidol compared with placebo did not improve survival at 28 days . These findings do not support the use of prophylactic haloperidol for reducing mortality in critically ill adults . Trial Registration clinical trials.gov Identifier : 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 Purpose : Delirium has negative consequences such as increased mortality , hospital expenses and decreased cognitive and functional status . This research aims to determine the impact of occupational therapy intervention in duration , incidence and severity of delirium in elderly patients in the intensive care unit ; secondary outcome was to assess functionality at hospital discharge . Methods : This is a pilot r and omized clinical trial of patients without mechanical ventilation for 60 years . Patients were assigned to a control group that received st and ard strategies of prevention ( n = 70 ) or to an experimental group that received st and ard strategies plus occupational therapy twice a day for 5 days ( n = 70 ) . Delirium was valued with Confusion Assessment Method and Delirium Rating Scale , and functional outcomes at discharge with Functional Independence Measure , H and Dynamometer , and Mini‐Mental State Examination . Results : A total of 140 participants were recruited . The experimental group had lower duration ( risk incidence ratios , 0.15 [ P = .000 ; 95 % confidence interval , 0.12‐0.19 ] vs 6.6 [ P = .000 , 95 % confidence interval , 5.23‐8.3 ] ) and incidence of delirium ( 3 % vs 20 % , P = .001 ) , and had higher scores in Motor Functional Independence Measure ( 59 vs 40 points , P < .0001 ) , cognitive state ( MMSE : 28 vs 26 points , P < .05 ) , and grip strength in the dominant h and ( 26 vs 18 kg , P < .05 ) , compared with the control group . Conclusions : Occupational therapy is effective in decreasing duration and incidence of delirium in nonventilated elderly patients in the intensive care unit and improved functionality at discharge Objective : Previously , delirium has been identified as an independent risk factor for mortality in critically ill medical patients . We undertook this study to examine the relationships among medication usage , delirium , and clinical outcomes in a critically ill surgical/trauma population . Design : Prospect i ve , multicentered , observational study . Setting : Two surgical intensive care units in level 1 trauma centers . Patients : One hundred thirty-four consecutive 
    Output:
    
Conclusions Current evidence does not support the use of non-pharmacological interventions in reducing incidence and duration of delirium in critically ill patients .