***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: Purpose Systematic monitoring of sedation , pain and delirium in the ICU is of paramount importance in delivering adequate patient care . While the use of systematic monitoring instruments is widely agreed upon , these tools are infrequently implemented into daily ICU care . The aim of this study is to compare the effectiveness of two different training strategies ( training according to the local st and ard vs. modified extended method ) on the implementation rate of scoring instruments on the ICU . Methods In this experimental cohort study we analyzed the frequency of scoring on three surgical ICUs before and after training , and in a 1 year follow-up . A modified extended training included establishing a local support team helping to resolve immediate problems . In addition we evaluated the impact on patients ’ outcome . Results ICUs trained by the modified extended method showed increased documentation rates of all scores per patient and day . In a 1 year follow-up , increased scoring rates for all scores were maintained . Scoring rates with training according to the local st and ard training protocol did not increase significantly . Implementation of delirium and pain monitoring were associated with a decrease in mortality [ odds ratio ( OR ) 0.451 ; 95 % confidence interval ( CI ) : 0.22–0.924 , and , respectively , OR 0.348 ; 95 % CI : 0.140–0.863 ] . Monitoring had no significant influence on ventilation time or ICU length of stay . Conclusions A modified extended training strategy for ICU monitoring tools ( sedation , pain , delirium ) leads to higher intermediate and long-term implementation rates and is associated with improved patient outcome . However , these findings may have been biased by unmeasured confounders Recent studies suggest that delirium is associated with risk of dementia and also acceleration of decline in existing dementia . However , previous studies may have been confounded by incomplete ascertainment of cognitive status at baseline . Herein , we used a true population sample to determine if delirium is a risk factor for incident dementia and cognitive decline . We also examined the effect of delirium at the pathological level by determining associations between dementia and neuropathological markers of dementia in patients with and without a history of delirium . The Vantaa 85 + study examined 553 individuals ( 92 % of those eligible ) aged ≥85 years at baseline , 3 , 5 , 8 and 10 years .  Brain autopsy was performed in 52 % . Fixed and r and om-effects regression models were used to assess associations between ( i ) delirium and incident dementia and ( ii ) decline in Mini-Mental State Examination scores in the whole group . The relationship between dementia and common neuropathological markers ( Alzheimer-type , infa rcts and Lewy-body ) was modelled , stratified by history of delirium . Delirium increased the risk of incident dementia ( odds ratio 8.7 , 95 % confidence interval 2.1–35 ) . Delirium was also associated with worsening dementia severity ( odds ratio 3.1 , 95 % confidence interval 1.5–6.3 ) as well as deterioration in global function score ( odds ratio 2.8 , 95 % confidence interval 1.4–5.5 ) . In the whole study population , delirium was associated with loss of 1.0 more Mini-Mental State Examination points per year ( 95 % confidence interval 0.11–1.89 ) than those with no history of delirium . In individuals with dementia and no history of delirium ( n = 232 ) , all pathologies were significantly associated with dementia . However , in individuals with delirium and dementia ( n = 58 ) , no relationship between dementia and these markers was found . For example , higher Braak stage was associated with dementia when no history of delirium ( odds ratio 2.0 , 95 % confidence interval 1.1–3.5 , P = 0.02 ) , but in those with a history of delirium , there was no significant relationship ( odds ratio 1.2 , 95 % confidence interval 0.2–6.7 , P = 0.85 ) . This trend for odds ratios to be closer to unity in the delirium and dementia group was observed for neuritic amyloid , apolipoprotein ε status , presence of infa rcts , α-synucleinopathy and neuronal loss in substantia nigra . These findings are the first to demonstrate in a true population study that delirium is a strong risk factor for incident dementia and cognitive decline in the oldest-old . However , in this study , the relationship did not appear to be mediated by classical neuropathologies associated with dementia Objective : To study the outcome of delirium in elderly hip surgery patients . Design : Prospect i ve matched controlled cohort study . Hip surgery patients ( n = 112 ) aged 70 years and older , who participated in a controlled clinical trial of haloperidol prophylaxis for delirium , were followed for an average of 30 months after discharge . Patients with a diagnosis of dementia or mild cognitive impairment ( MCI ) were identified using psychiatric interviews . Proportions of patients with dementia/MCI were compared across patients who had postoperative delirium and selected control patients matched for preoperatively assessed risk factors who had not developed delirium during index hospitalization . Other outcomes were mortality rate and rate of institutionalization . Results : During the follow-up period , 54.9 % of delirium patients had died compared to 34.1 % of the controls ( relative risk = 1.6 , 95 % CI = 1.0–2.6 ) . Dementia or MCI was diagnosed in 77.8 % of the surviving patients with postoperative delirium and in 40.9 % of control patients ( relative risk = 1.9 , 95 % CI = 1.1–3.3 ) . Half of the patients with delirium were institutionalized at follow-up compared to 28.6 % of the controls ( relative risk = 1.8 , 95 % CI = 0.9–3.4 ) . Conclusion : The risk of dementia or MCI at follow-up is almost doubled in elderly hip surgery patients with postoperative delirium compared with at-risk patients without delirium . Delirium may indicate underlying dementia BACKGROUND International guidelines recommend systematic assessment of pain , agitation/sedation and delirium with vali date d scales for all ICU patients . However , these evaluations are often not done . We have created an e-learning training platform for the continuous medical education , and assessed its efficacy in increasing the use of vali date d tools by all medical and nursing staff of the participating ICUs during their daily practice . METHODS Multicenter , r and omized , before and after study . The eight participating centers were r and omized in two groups , and received training at different times . The use of vali date d tools  ( Verbal Numeric Rating or Behavioral Pain Scale for pain ; Richmond Agitation-Sedation Scale for agitation ; Confusion Assessment Method for the ICU for delirium ) was evaluated from clinical data recorded in medical charts during a week , with follow-up up to six months after the training . All the operators were invited to complete a question naire , at baseline and after the training . RESULTS Among the 374 nurses and physicians involved , 140 ( 37.4 % ) completed at least one of the three courses . The assessment of pain ( 38.1 vs. 92.9 % , P<0.01 ) and delirium ( 0 vs. 78.6 % , P<0.01 ) using vali date d tools significantly increased after training . Observation in the follow-up showed further improvement in delirium monitoring , with no signs of extinction for pain and sedation/agitation measurements . CONCLUSIONS This e-learning program shows encouraging effectiveness , and the increase in the use of vali date d tools for neurological monitoring in critically ill patients lasts over time Background Delirium , a common problem among hospitalized elderly patients , is not usually diagnosed by doctors for various reasons . The primary aim of this study was to evaluate the effect of a short training course on the identification of delirium and the diagnostic rate of delirium among hospitalized patients aged ≥65 years . The secondary aim was to identify the risk factors for delirium . Methods A prospect i ve study was conducted in an acute-care hospital in Moscow , Russia . Six doctors underwent a short training course on delirium .  Data collected included assessment by the confusion assessment method for the intensive care units , sociodemographic data , functional state before hospitalization , comorbidity , and hospitalization indices ( indication for hospitalization , stay in intensive care unit , results of laboratory tests , length of hospitalization , and in-hospital mortality ) . Results Delirium was diagnosed in 13 of 181 patients ( 7.2 % ) who underwent assessment . Cognitive impairment was diagnosed more among patients with delirium ( 30.0 % vs 6.1 % , P=0.029 ) ; Charlson comorbidity index was higher ( 3.6±2.4 vs 2.3±1.8 , P=0.013 ) ; and Barthel index was lower ( 43.5±34.5 vs 94.1±17.0 , P=0.000 ) . The length of hospitalization was longer for patients with delirium at 13.9±7.3 vs 8.8±4.6 days ( P=0.0001 ) , and two of the 13 patients with delirium died during hospitalization compared with none of the 168 patients without delirium ( P=0.0001 ) . Conclusion Although the rate of delirium was relatively low compared with studies from the West , this study proves that an educational intervention among doctors can bring about a significant change in the diagnosis of the condition This study investigates the relationships between delirium , cognitive impairment and acute illness severity with adverse clinical outcomes ; in-hospital mortality , hospital length of stay , or new entry to a care home . It is a prospect i ve observational study of medical in patients 70 years or older , with repeated measurements of  cognition , delirium status , delirium severity , and severity of physical illness  every 3 days until the 18th day and then the 28th day of hospitalization . Of 94 participants , 33 had delirium and 14 recovered during their hospitalization . Predictor variables for recovery were initial Mini Mental State Examination ( MMSE ) ( p=0.003 ) and severity of delirium at second assessment ( p=0.02 ) , for mortality initial MMSE ( p=0.002 ) and for discharge to care home were initial delirium status ( p=0.008 ) and age ( p=0.004 ) .  Delirious people newly discharged to care homes stayed longer in hospital than those discharged to their previous address ( p=0.016 ) . We conclude that delirium is not a transient disorder . The presence of delirium was not related to measures of the severity of physical illness or disability . High mortality was associated with delirium but was specifically associated with cognitive impairment . Prolonged length of stay of  delirious people may depend on discharge destination Background and aims : Delirium is a common postoperative complication in elderly patients which has a serious impact on outcome in terms of morbidity and costs . We examined whether a postoperative multi-factorial intervention program can reduce delirium and improve outcome in patients with femoral neck fractures . Methods : One hundred and ninety-nine patients , aged 70 years and over ( mean age±SD , 82±6 , 74 % women ) , were r and omly assigned to  postoperative care in a specialized geriatric ward or a conventional orthopedic ward . The intervention consisted of staff education focusing on the assessment , prevention and treatment of delirium and associated complications . The staff worked as a team , applying comprehensive geriatric assessment , management and rehabilitation . Patients were assessed using the Mini Mental State Examination and the Organic Brain Syndrome Scale , and delirium was diagnosed according to DSM-IV criteria . Results : The number of days of postoperative delirium among intervention patients was fewer ( 5.0±7.1 days vs 10.2±13.3 days , p=0.009 ) compared with controls . A lower proportion of intervention patients were delirious postoperatively than controls ( 56/102 , 54.9 % vs 73/97 , 75.3 % , p=0.003 ) . Eighteen percent in the intervention ward and 52 % of controls were delirious after the seventh postoperative day ( p<0.001 ) . Intervention patients suffered from fewer complications , such as decubitus ulcers , urinary tract infections , nutritional complications , sleeping problems and falls , than controls . Total postoperative hospitalization was shorter in the intervention ward ( 28.0±17.9 days vs 38.0±40.6 days , p=0.028 ) . Conclusions : Patients with postoperative delirium can be successfully treated , result ing in fewer days of delirium , fewer other complications , and shorter length of hospitalization Delirium is a significant problem for older hospitalized people and is associated with poor outcomes . It is poorly recognized and evidence suggests that a major reason is lack of education . Nurses , who are educated about delirium , can play a significant role in improving delirium recognition . This study evaluated the impact of a delirium specific educational website . A cluster r and omized controlled trial , with a pretest/post-test time series design , was conducted to measure delirium knowledge ( DK ) and delirium recognition ( DR ) over three time-points . Statistically significant differences were found between the intervention and non-intervention group . The intervention groups ' DK scores were higher and the change over time results were statistically significant [ T3 and T1 ( t=3.78 p=<0.001 ) and T2 and T1 baseline ( t=5.83 p=<0.0 
    Output:
    
Overall , the majority of studies reported improved outcomes post-intervention .
There was evidence of impact on patient and healthcare outcomes as well as learners ’ behaviour and knowledge .
The current evidence base supports the use of education as an effective non-pharmacological approach to prevent and treat delirium .
Healthcare professional education has benefits for inpatient delirium care , as shown by the high number of good- quality studies and the majority demonstrating improved outcomes post-intervention .