***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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    Input: BACKGROUND Postoperative delirium and cognitive decline are common in elderly surgical patients after non-cardiac surgery . Despite this prevalence and clinical importance , no specific aetiological factor has been identified for postoperative delirium and cognitive decline . In experimental setting in a rat model , nitrous oxide ( N(2)O ) produces neurotoxic effect at high concentrations and in an age-dependent manner . Whether this neurotoxic response may be observed clinical ly has not been previously determined . We hypothesized that in the elderly patients undergoing non-cardiac surgery , exposure to N(2)O result ed in an increased incidence of postoperative delirium than would be expected for patients not receiving N(2)O. METHODS Patients who were > or=65 yr of age , undergoing non-cardiac surgery and requiring general anaesthesia were r and omized to receive an inhalational agent and either N(2)O with oxygen or oxygen alone . A structured interview was conducted before operation and for the first two postoperative days to determine the presence of delirium using the Confusion Assessment Method . RESULTS A total of 228 patients were studied with a mean ( range ) age of 73.9 ( 65 - 95 ) yr . After operation , 43.8 % of patients developed delirium . By multivariate logistic regression , age [ odds ratio ( OR ) 1.07 ; 95 % confidence interval ( CI ) 1.02 - 1.26 ] , dependence on performing one or more independent activities of daily living ( OR 1.54 ; 95 % CI 1.01 - 2.35 ) , use of patient-controlled analgesia for postoperative pain control ( OR 3.75 ; 95 % CI 1.27 - 11.01 ) and postoperative use of benzodiazepine ( OR 2.29 ; 95 % CI 1.21 - 4.36 ) were independently associated with an increased risk for postoperative delirium . In contrast , the use of N(2)O had no association with postoperative delirium . CONCLUSIONS Exposure to N(2)O result ed in an equal incidence of postoperative delirium when compared with no exposure to OBJECTIVES To determine whether donepezil hydrochloride can reduce the prevalence and severity of delirium in older adults undergoing hip fracture repair . DESIGN Pilot double-masked r and omized placebo-controlled trial . SETTING Large academic medical center . PARTICIPANTS Sixteen individuals aged 70 and older with hip fracture . INTERVENTION Donepezil 5 mg or placebo was r and omly allocated and initiated within 24 hours of surgery , preoperatively or postoperatively . Daily treatment was continued for 30 days or until side effects or the clinical situation required termination . MEASUREMENTS All outcomes were ascertained masked to treatment status . Information on drug tolerability and safety was obtained from the participant , nurse , and medical record . Delirium presence and severity were measured during daily hospital interviews and at 2 , 4 , and 6 weeks after surgery after a st and ardized assessment using the Confusion Assessment Method ( CAM ) and the Memorial Delirium Assessment Scale ( MDAS ) . RESULTS Participants in the donepezil and placebo arms had similar baseline characteristics . Participants in the donepezil arm experienced significantly more side effects . In longitudinal models , there were no significant differences between the donepezil and placebo arms with regard to delirium presence over time ( odds ratio = 0.9 , 95 % confidence interval ( CI ) = 0.4 - 2.3 ) or delirium severity over time ( effect size = -0.2 on 30-point MDAS scale , 95%CI = -1.5 - 1.2 ) . CONCLUSION Participants r and omized to donepezil had no significant improvement in delirium presence or severity but experienced more side effects . Overall , sufficient evidence was not found from this pilot study to warrant a definitive Phase III trial Background Hip fractures are common among frail elderly persons and often have serious consequences on function , mobility and mortality . Traditional treatment of these patients is performed in orthopedic departments without additional geriatric assessment . However , studies have shown that interdisciplinary geriatric treatment may be beneficial compared to traditional treatment . The aim of the present study is to investigate whether treatment of these patients in a Department of Geriatrics ( DG ) during the entire hospital stay gives additional benefits as compared to conventional treatment in a Department of Orthopaedic Surgery ( DOS ) . Findings A new clinical pathway for in-hospital treatment of hip fracture patients was developed . In this pathway patients were treated pre- and postoperatively in DG .  Comprehensive geriatric assessment  was performed as an interdisciplinary , multidimensional , systematic assessment of all patients focusing on each patient ’s capabilities and limitations as recommended in guidelines and systematic review s. Identification and treatment of co-morbidities , pain relief , hydration , oxygenation , nutrition , elimination , prevention and management of delirium , assessment of falls and osteoporosis were emphasized .  Discharge planning  started as early as possible . Initiation of rehabilitation with focus on early mobilisation and development of individual plans was initiated in hospital and continued after discharge from hospital . Fracture specific treatment was based upon st and ard treatment for the hospital , expert opinions and a review of the literature . Conclusion A new treatment program for old hip fracture patients was developed , introduced and run in the DG , the potential benefits of which being compared with traditional care of hip fracture patients in the DOS in a r and omised clinical trial Background and objectives : Postoperative confusion and delirium is a common complication in the elderly with a poorly understood pathophysiology . The aim of this study was to examine whether the type of anaesthesia ( general or regional ) plays a role in the development of cognitive impairment in elderly patients during the immediate postoperative period . Methods : Forty‐seven patients > 60 yr of age and undergoing major surgery were r and omly allocated to receive either regional or general anaesthesia .  The mental status of the patients was assessed preoperatively and during the first three postoperative days with the Mini Mental State Examination . The incidence of delirium was also examined during the same period with the use of DSM III criteria . Results : Overall , during the first three postoperative days , the mean Mini Mental State Examination score decreased significantly ( P < 0.001 ) . However , this decline was very significant only in patients assigned to receive general anaesthesia ( P < 0.001 ) compared to regional anaesthesia . Nine patients developed delirium but the type of anaesthesia did not affect its incidence . The only important factor for the development of delirium was pre‐existing cardiovascular disease irrespective of anaesthesia type ( P < 0.025 ) . Conclusions : Elderly patients subjected to general anaesthesia  displayed more frequent cognitive impairment during the immediate postoperative period in comparison to those who received a regional technique OBJECTIVE To determine whether limiting intraoperative sedation depth during spinal anesthesia for hip fracture repair in elderly patients can decrease the prevalence of postoperative delirium . PATIENTS AND METHODS We performed a double-blind , r and omized controlled trial at an academic medical center of elderly patients ( > or=65 years ) without preoperative delirium or severe dementia who underwent hip fracture repair under spinal anesthesia with propofol sedation . Sedation depth was titrated using processed electroencephalography with the bispectral index ( BIS ) , and patients were r and omized to receive either deep ( BIS , approximately 50 ) or light ( BIS , > or=80 ) sedation . Postoperative delirium was assessed as defined by Diagnostic and Statistical Manual of Mental Disorders ( Third Edition Revised ) criteria using the Confusion Assessment Method beginning at any time from the second day after surgery . RESULTS From April 2 , 2005 , through October 30 , 2008 , a total of 114 patients were r and omized . The prevalence of postoperative delirium was significantly lower in the light sedation group ( 11/57 [ 19 % ] vs 23/57 [ 40 % ] in the deep sedation group ; P=.02 ) , indicating that 1 incident of delirium will be prevented for every 4.7 patients treated with light sedation . The mean + /- SD number of days of delirium during hospitalization was lower in the light sedation group than in the deep sedation group ( 0.5+/-1.5 days vs 1.4+/-4.0 days ; P=.01 ) . CONCLUSION The use of light propofol sedation decreased the prevalence of postoperative delirium by 50 % compared with deep sedation . Limiting depth of sedation during spinal anesthesia is a simple , safe , and cost-effective intervention for preventing postoperative delirium in elderly patients that could be widely and readily adopted Introduction We hypothesized that delirium symptoms may respond differently to antipsychotic therapy . The purpose of this paper was to retrospectively compare duration and time to first resolution of individual delirium symptoms from the data base of a r and omized , double-blind , placebo-controlled study comparing quetiapine ( Q ) or placebo ( P ) , both with haloperidol rescue , for critically ill patients with delirium . Methods Data for 10 delirium symptoms from the eight-domain , intensive care delirium screening checklist ( ICDSC ) previously collected every 12 hours were extracted for 29 study patients . Data between the Q and P groups were compared using a cut-off P- value of ≤0.10 for this exploratory study . Results Baseline ICDSC scores ( 5 ( 4 to 7 ) ( Q ) vs 5 ( 4 to 6 ) ) ( median , interquartile range ( IQR ) ) and % of patients with each ICDSC symptom were similar in the two groups ( all P > 0.10 ) . Among patients with the delirium symptom at baseline , use of Q may lead to a shorter time ( days ) to first resolution of symptom fluctuation ( 4 ( Q ) vs. 14 , P = 0.004 ) , inattention ( 3 vs. 8 , P = .10 ) and disorientation ( 2 vs. 10 , P = 0.10 ) but a longer time to first resolution of agitation ( 3 vs. 1 , P = 0.04 ) and hyperactivity ( 5 vs. 1 , P = 0.07 ) . Among all patients , Q-treated patients tended to spend a smaller percent of time with inattention ( 47 ( 0 to 67 ) vs. 78 ( 43 to 100 ) , P = 0.025 ) , hallucinations ( 0 ( 0 to 17 ) vs. 28 ( 0 to 43 ) , P = 0.10 ) and symptom fluctuation ( 47 ( 19 to 67 ) vs. 89 ( 33 to 00 ) , P = 0.04 ] and there was a trend for Q-treated patients to spend a greater percent of time at an appropriate level of consciousness ( 26 % ( 13 to 63 % ) vs. 14 % ( 0 to 33 % ) , P = 0.17 ] . Conclusions Our exploratory analysis suggests that quetiapine may resolve several intensive care unit ( ICU ) delirium symptoms faster than the placebo . Individual symptom resolution appears to differ in association with the pharmacologic intervention ( that is , P vs Q , both with as needed haloperidol ) . Future studies evaluating antipsychotics in ICU patients with delirium should measure duration and resolution of individual delirium symptoms and their relation to long-term outcomes BACKGROUND People with cognitive impairment and dementia have a poor outcome after a hip fracture surgery , about 30 - 50 % of all those who sustain a hip fracture have dementia . Therefore the aim was to investigate whether a multidisciplinary postoperative intervention program could reduce postoperative complications and improve functional recovery among people with dementia . METHODS A r and omized controlled trial with subgroup analyses among patients with dementia . Sixty-four patients with femoral neck fracture , aged ≥70 years at Umeå University Hospital , Sweden . The intervention consisted of staff education , individualized care planning and rehabilitation , active prevention , detection and treatment of postoperative complications , especially delirium . The staff worked in teams to apply comprehensive geriatric assessment , management and rehabilitation , including a follow-up at 4 months postoperatively . The control group followed conventional postoperative routines . RESULTS There were fewer postoperative complications in the intervention group such as urinary tract infections , p=0.001 ; nutritional problems , p=0.025 ; postoperative delirium , p=0.002 ; falls , p=0.006 . At 4 months a larger proportion in the intervention group had regained their previous independent indoor walking ability performance , p=0.005 . At 12 months a larger proportion in the intervention group had regained the activities of daily living ( ADL ) performance level they had before the fracture , p=0.027 . CONCLUSION This study demonstrates that patients with dementia who suffer a hip fracture can benefit from multidisciplinary geriatric assessment and rehabilitation and should not be excluded from rehabilitation programs Background Approximately 40 % of hospitalized older adults have cognitive impairment ( CI ) and are more prone to hospital-acquired complications . The Institute of Medicine suggests using health information technology to improve the overall safety and quality of the health care system . Objective Evaluate the efficacy of a clinical decision support system ( CDSS ) to improve the quality of care for hospitalized older adults with CI . Design A r and 
    Output:
    
Meta- analysis supported dexmedetomidine sedation , multicomponent interventions and antipsychotics were useful in preventing postoperative delirium