***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: RATIONALE There is no effective pharmacological treatment for acute lung injury ( ALI ) .  Statins are a potential new therapy because they modify many of the underlying processes important in ALI . OBJECTIVES To test whether simvastatin improves physiological and biological outcomes in ALI . METHODS We conducted a r and omized , double-blinded , placebo-controlled trial in patients with ALI . Patients received 80 mg simvastatin or placebo until cessation of mechanical ventilation or up to 14 days . Extravascular lung water was measured using thermodilution . Measures of pulmonary and nonpulmonary organ function were assessed daily . Pulmonary and systemic inflammation was assessed by bronchoalveolar lavage fluid and plasma cytokines . Systemic inflammation was also measured by plasma C-reactive protein . MEASUREMENTS AND MAIN RESULTS Sixty patients were recruited . Baseline characteristics , including demographics and severity of illness scores , were similar in both groups . At Day 7 , there was no difference in extravascular lung water . By Day 14 , the simvastatin-treated group had improvements in nonpulmonary organ dysfunction . Oxygenation and respiratory mechanics improved , although these parameters failed to reach statistical significance . Intensive care unit mortality was 30 % in both groups . Simvastatin was well tolerated , with no increase in adverse events .  Simvastatin decreased bronchoalveolar lavage IL-8 by 2.5-fold ( P = 0.04 ) . Plasma C-reactive protein decreased in both groups but failed to achieve significance in the placebo-treated group . CONCLUSIONS Treatment with simvastatin appears to be safe and may be associated with an improvement in organ dysfunction in ALI . These clinical effects may be mediated by a reduction in pulmonary and systemic inflammation . Clinical trial registered with www.controlled-trials.com ( IS RCT N70127774 ) PURPOSE Up to 80 % of critically ill patients have acute neurologic dysfunction syndromes . We evaluated interrater reliability between the examination by the investigator and the charted assessment by the nurse because the accuracy and reliability of detailed data sets extracted from the electronic medical records represents a keystone for creating EMR-based definitions . MATERIAL S AND METHODS We conducted a prospect i ve observational study of intensive care unit ( ICU ) patients to assess the reliability of charted Confusion Assessment Method  for the ICU , Glasgow Coma Scale ( GSC ) , Full Outline of Unresponsiveness , and Richmond Agitation Sedation Scale ( RASS ) scores , and a composite measure of ABF defined as new-onset coma or delirium . Trained investigator blinded to nursing assessment s performed the neurologic evaluations that were compared with nursing documentation . RESULTS A total of 202 observations were performed in 55 ICU patients . Excellent correlation was noted for GCS and Full Outline of Unresponsiveness scores on Bl and -Altman plots ( Pearson correlation 0.87 and 0.92 , respectively ) . Correlation for Confusion Assessment Method for the ICU was also high ( κ= 0.86 ; 95 % confidence interval [ CI ] , 0.70 - 1.01 ) . Richmond Agitation Sedation Scale had good agreement when scores were dichotomized as overse date d ( less than -2 ) vs not overse date d , with κ= 0.76 ( 95 % CI , 0.54 - 0.98 ) . Investigator assessment and nurse charting were highly concordant ( κ= 0.84 ; 95 % CI , 0.71 - 0.99 ) . CONCLUSION Neurologic assessment s documented on the EMR are reliable BACKGROUND Neutrophils play a central role in systemic inflammatory reaction after cardiopulmonary bypass . Apoptosis is significantly delayed , and this might exacerbate systemic and myocardial damage . We tested the hypothesis of whether pretreatment with simvastatin increases the apoptotic rate of neutrophils and hence reduces the entity of inflammatory reaction . METHODS Thirty patients undergoing coronary surgery with cardiopulmonary bypass were r and omized to treatment with either simvastatin ( 40 mg/day ) or placebo for 3 weeks before surgery . A group of 15 patients undergoing off-pump coronary surgery served as controls . Blood sample s for detection of serum cytokine levels were obtained before anesthesia , at the end of surgery , and at 4 , 24 , 48 , and 72 hours postoperatively . Apoptosis and indices of activation were assessed in cultured neutrophils . RESULTS Simvastatin significantly reduced the postoperative peak values of interleukin (IL)-6 and IL-8 . The neutrophil apoptotic rate was significantly higher among neutrophils obtained from patients pretreated with simvastatin ( p < 0.05 at both 8 and 24 hours ) compared with placebo . Neutrophils from the statin group had depressed functional activity , as underscored by significantly lower values of CD11b ( p < 0.01 at 24 hours ) and a significantly less percentage of cells positive for nitro-blue tetrazolium ( p < 0.01 at 12 and 24 hours ) compared with placebo . CONCLUSIONS This r and omized , double-blind study indicates that statin therapy before cardiopulmonary bypass is associated with reduction of circulating markers of inflammation and increased neutrophil apoptosis . These data support a routine inclusion of statins as an adjuvant pharmacologic therapy before cardiopulmonary bypass surgery IMPORTANCE Statins affect several mechanisms underlying acute kidney injury ( AKI ) . OBJECTIVE To test the hypothesis that short-term high-dose perioperative atorvastatin would reduce AKI following cardiac surgery . DESIGN , SETTING , AND PARTICIPANTS Double-blinded , placebo-controlled , r and omized clinical trial of adult cardiac surgery patients conducted from November 2009 to October 2014 at V and erbilt University Medical Center . INTERVENTIONS Patients naive to statin treatment ( n = 199 ) were r and omly assigned 80 mg of atorvastatin the day before surgery , 40 mg of atorvastatin the morning of surgery , and 40 mg of atorvastatin daily following surgery ( n = 102 ) or matching placebo ( n = 97 ) . Patients already taking a statin prior to study enrollment ( n = 416 ) continued taking the preenrollment statin until the day of surgery , were r and omly assigned 80 mg of atorvastatin the morning of surgery and 40 mg of atorvastatin the morning after ( n = 206 ) or matching placebo ( n = 210 ) , and resumed taking the previously prescribed statin on postoperative day 2 . MAIN OUTCOMES AND MEASURES Acute kidney injury defined as an increase of 0.3 mg/dL in serum creatinine concentration within 48 hours of surgery ( Acute Kidney Injury Network criteria ) . RESULTS The data and safety monitoring board recommended stopping the group naive to statin treatment due to increased AKI among these participants with chronic kidney disease ( estimated glomerular filtration rate < 60 mL/min/1.73 m2 ) receiving atorvastatin . The board later recommended stopping for futility after 615 participants ( median age , 67 years ; 188 [ 30.6 % ] were women ; 202 [ 32.8 % ] had diabetes ) completed the study . Among all participants ( n = 615 ) , AKI occurred in 64 of 308 ( 20.8 % ) in the atorvastatin group vs 60 of 307 ( 19.5 % ) in the placebo group ( relative risk [ RR ] , 1.06 [ 95 % CI , 0.78 to 1.46 ] ; P = .75 ) . Among patients naive to statin treatment ( n = 199 ) , AKI occurred in 22 of 102 ( 21.6 % ) in the atorvastatin group vs 13 of 97 ( 13.4 % ) in the placebo group ( RR , 1.61 [ 0.86 to 3.01 ] ; P = .15 ) and serum creatinine concentration increased by a median of 0.11 mg/dL ( 10th-90th percentile , -0.11 to 0.56 mg/dL ) in the atorvastatin group vs by a median of 0.05 mg/dL ( 10th-90th percentile , -0.12 to 0.33 mg/dL ) in the placebo group ( mean difference , 0.08 mg/dL [ 95 % CI , 0.01 to 0.15 mg/dL ] ; P = .007 ) . Among patients already taking a statin ( n = 416 ) , AKI occurred in 42 of 206 ( 20.4 % ) in the atorvastatin group vs 47 of 210 ( 22.4 % ) in the placebo group ( RR , 0.91 [ 0.63 to 1.32 ] ; P = .63 ) . CONCLUSIONS AND RELEVANCE Among patients undergoing cardiac surgery , high-dose perioperative atorvastatin treatment compared with placebo did not reduce the risk of AKI overall , among patients naive to treatment with statins , or in patients already taking a statin . These results do not support the initiation of statin therapy to prevent AKI following cardiac surgery . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00791648 OBJECTIVE To test the hypothesis that perioperative statin use reduces  acute kidney injury ( AKI ) after cardiac surgery . DESIGN A retrospective analysis of prospect ively collected data from an ongoing clinical trial . SETTING A quaternary-care university hospital . PARTICIPANTS Three hundred twenty-four adult elective cardiac surgery patients . INTERVENTIONS None . MEASUREMENTS AND MAIN RESULTS The authors assessed the association of preoperative statin use , early postoperative statin use , and acute statin withdrawal with the incidence of AKI . Early postoperative statin use was defined as statin treatment within the first postoperative day . Statin withdrawal was defined as the discontinuation of preoperative statin treatment before surgery until at least postoperative day 2 . Logistic regression and propensity score modeling were used to control for AKI risk factors . Sixty-eight of 324 patients ( 21.0 % ) developed AKI . AKI patients stayed in the hospital longer ( p = 0.03 ) and were more likely to develop pneumonia ( p = 0.002 ) or die ( p = 0.001 ) . A higher body mass index ( p = 0.003 ) , higher central venous pressure ( p = 0.03 ) , and statin withdrawal ( 27.4 v 14.7 % , p = 0.046 ) were associated with a higher incidence of AKI , whereas early postoperative statin use was protective ( 12.5 % v 23.8 % , p = 0.03 ) . Preoperative statin use did not affect the risk of AKI . In multivariate logistic regression , age ( p = 0.03 ) , male sex ( p = 0.02 ) , body mass index ( p < 0.001 ) , and early postoperative statin use ( odds ratio = 0.32 ; 95 % confidence interval , 0.14 - 0.72 ; p = 0.006 ) independently predicted AKI . Propensity score-adjusted risk assessment confirmed the association between early postoperative statin use and reduced AKI ( odds ratio = 0.30 ; 95 % confidence interval , 0.13 - 0.70 ; p = 0.005 ) . CONCLUSIONS Early postoperative statin use is associated with a lower incidence of AKI among both chronic statin users and statin-naive cardiac surgery patients OBJECTIVE To develop and vali date a new st and ardized confusion assessment method ( CAM ) that enables nonpsychiatric clinicians to detect delirium quickly in high-risk setting s. DESIGN Prospect i ve validation study . SETTING Conducted in general medicine wards and in an outpatient geriatric assessment center at Yale University ( site 1 ) and in general medicine wards at the University of Chicago ( site 2 ) . PATIENTS The study included 56 subjects , ranging in age from 65 to 98 years . At site 1 , 10 patients with and 20 without delirium participated ; at site 2 , 16 patients with and 10 without delirium participated . MEASUREMENTS AND MAIN RESULTS An expert panel developed the CAM through a consensus building process . The CAM instrument , which can be completed in less than 5 minutes , consists of nine operationalized criteria from the Diagnostic and Statistical Manual of Mental Disorders ( DSM-III-R ) . An a priori hypothesis was established for the diagnostic value of four criteria : acute onset and fluctuating course , inattention , disorganized thinking , and altered level of consciousness . The CAM algorithm for diagnosis of delirium required the presence of both the first and the second criteria and of either the third or the fourth criterion . At both sites , the diagnoses made by the CAM were concurrently vali date d against the diagnoses made by psychiatrists . At sites 1 and 2 values for sensitivity were 100 % and 94 % , respectively ; values for specificity were  
    Output:
    
Conclusions : In critically ill and cardiac surgery patients , this meta‐ analysis did not show a benefit with statin therapy in the prevention of delirium