***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: OBJECTIVE To investigate the short- and long-term effects of a multidisciplinary postoperative rehabilitation programme in patients with femoral neck fracture . DESIGN AND SUBJECTS A r and omized controlled trial in patients ( n = 199 ) with femoral neck fracture , aged > or= 70 years . METHODS The primary outcomes were : living conditions , walking ability and activities of daily living performance on discharge , 4 and 12 months postoperatively . The intervention consisted of staff education , individualized care planning and rehabilitation , active prevention , detection and treatment of postoperative complications . The staff worked in teams to apply comprehensive geriatric assessment , management and rehabilitation . A geriatric team assessed those in the intervention group 4 months postoperatively , in order to detect and treat any complications . The control group followed conventional postoperative routines . RESULTS Despite shorter hospitalization , significantly more people from the intervention group had regained independence in personal activities of daily living performance at the 4- and 12-month follow-ups ; odds ratios ( 95 % confidence interval ( CI ) ) 2.51 ( 1.00 - 6.30 ) and 3.49 ( 1.31 - 9.23 ) , respectively . More patients in the intervention group had also regained the ability to walk independently indoors without walking aids by the end of the study period , odds ratio ( 95 % confidence interval ) 3.01 ( 1.18 - 7.61 ) . CONCLUSION A multidisciplinary postoperative intervention programme enhances activities of daily living performance and mobility after hip fracture , from both a short-term and long-term perspective Background : The aim of this r and omized , parallel-arm trial was to study the effect of treating subsyndromal delirium with risperidone on the incidence of clinical delirium in elderly patients who underwent on-pump cardiac surgery . Methods : One hundred one patients aged 65 yr or older who experienced subsyndromal delirium after on-pump cardiac surgery were r and omized using a computer-generated list to receive 0.5 mg risperidone ( n = 51 ) or placebo ( n = 50 ) every 12 h by mouth . Patients were assessed at 8 h by a blinded observer using the Intensive Care Delirium Screening Checklist , and those scoring more than 3 were evaluated by a blinded psychiatrist to confirm delirium . Patients in either group who experienced delirium were treated according to the same algorithm . Initially , risperidone was administered and if symptoms were not controlled , haloperidol was administered . The primary outcome was the proportion of patients who experienced delirium in either group . Results : Seven ( 13.7 % ) patients in the risperidone group experienced delirium versus 17 ( 34 % ) in the placebo group ( P = 0.031 ) Competing-risks regression analysis showed that failure to treat subsyndromal delirium with risperidone was an independent risk factor for delirium ( subhazard ratio , 3.83 ; 95 % CI , 1.63–8.98 ; P = 0.002 ) . Two ( 3.9 % ) patients in the risperidone group experienced extrapyramidal manifestations versus one ( 2 % ) in the placebo group ( P = 1.0 ) . Conclusion : Administration of risperidone to elderly patients who experienced subsyndromal delirium after on-pump cardiac surgery was associated with significantly lower incidence of delirium . Larger studies are required to determine whether early administration of risperidone during the subsyndromal phase of delirium would influence the clinical course of such patients BACKGROUND Delirium is a serious postoperative condition for which few pharmacologic prevention trials have been conducted . OBJECTIVE The authors tested the efficacy of perioperative olanzapine administration to prevent postoperative delirium in elderly patients after joint-replacement surgery . METHOD The authors conducted a r and omized , double-blind , placebo-controlled , prophylaxis trial at an orthopedic teaching hospital , enrolling 495 elderly patients age ≥65 years , who were undergoing elective knee- or hip-replacement surgery ; 400 patients received either 5 mg of orally-disintegrating olanzapine or placebo just before and after surgery . The primary efficacy outcome was the incidence of ( DSM-III-R ) delirium . RESULTS The incidence of delirium was significantly lower in the olanzapine group than in the placebo group ; this held true for both knee- and hip-replacement surgery . However , delirium lasted longer and was more severe in the olanzapine group . Advanced age , a high level of medical comorbidity , an abnormal albumin level , and having knee-replacement surgery were independent risk factors for postoperative delirium ( Clinical trials.gov Identifier : NCT000699946 ) . CONCLUSION Administration of 10 mg of oral olanzapine perioperatively , versus placebo , was associated with a significantly lower incidence of delirium . These findings suggest that olanzapine prophylaxis of postoperative delirium may be an effective strategy 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 Study Design . Retrospective clinical review and prospect i ve report of postoperative delirium after cervical spine surgeries . Objective . To investigate factors contributing to the development of delirium after cervical surgery and see whether amended therapeutic protocol s could improve or alter postoperative outcomes . Summary of Background Data . Important consequences of postoperative delirium for the orthopedic patients include impaired recovery and increased morbidity and mortality . Although its risk factors have been reported in orthopedic surgery , there are a very few reports regarding postoperative delirium in spine surgery . Methods . Eighty-one cervical myelopathy patients were retrospectively examined about the incidence of postoperative delirium and the risk factors . Similarly , 41 patients who received postoperative care under modified protocol s were prospect ively examined . Results . Postoperative delirium occurred more commonly in patients over 70 years and those with hearing impairment . Patients who received high-dose methylprednisolone ( > 1000 mg ) demonstrated an increased incidence of postoperative delirium . Under modified protocol , we reduced the usage of methylprednisolone and encouraged free body movement with cervical orthosis immediately after surgery . The incidence of postoperative delirium was significantly lower under the modified protocol . Conclusion . Early commencement of mobilization after cervical spine surgery would be crucial to the prevention of postoperative delirium in the elderly 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 95 % and 90 % ; values for positive predictive accuracy were 91 % and 94 % ; and values for negative predictive accuracy were 100 % and 90 % . The CAM algorithm had the highest predictive accuracy for all possible combinations of the nine features of delirium . The CAM was shown to have convergent agreement with four other mental status tests , including the Mini-Mental State Examination . The interobserver reliability of the CAM was high ( kappa = 0.81 - 1.0 ) . CONCLUSIONS The CAM is sensitive , specific , reliable , and easy to use for identification of delirium 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 , we conducted a r and omized clinical trial to evaluate the effectiveness of a strategy of systematic detection and multidisciplinary treatment of depression in this population . Methods : Consecutive patients aged 65 years or more admitted to general medical services in a primary care hospital between October 1999 and November 2002 were screened for depression with the Diagnostic Interview Schedule ( DIS ) within 48 hours after admission . Patients found to have major depression were r and omly allocated to receive the intervention or usual care . The intervention involved consultation and treatment by a psychiatrist and follow-up by a research nurse and the patient 's family physician . Research assistants , blind to group allocation , collected data from the patients at enrolment and at 3 and 6 months later using the Hamilton Depression Rating Scale ( HAMD ) , the Medical Outcomes 36-item Short Form ( SF-36 ) , the DIS , the Mini-Mental State Examination ( MMSE ) , the Older Americans Re sources and Services ( OARS ) question naire to assess basic and instrumental activities of daily living ( OARS-ADL and OARS-IADL ) and the Rating Scale for Side Effects . Data on the severity of illness , length of hospital stay , health services and medication use , mortality and process of care were also collected . The primary outcome measures were the HAMD and SF-36 . Results : Of 1500 eligible patients who were screened , 157 were found to have major depression and consented to participate ( 78 in the intervention group and 79 in the usual care group ) . At r and omization , there were no clinical ly or statistically significant differences between the 2 groups . Sixty-four patients completed follow-up to 6 months , 57 withdrew , and 36 died . At 6 months , there were no clinical ly or statistically significant differences the 2 groups in HAMD or SF-36 scores or any of the secondary outcome measures . Interpretation : We were unable to demonstrate that systematic detection and multidisciplinary care of depression was more beneficial than usual care for elderly medical in patients In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias BACKGROUND delirium is a frequent adverse consequence of hospitalisation for older patients , but there has been little research into its prevention . A recent study of Hospital in the Home ( admission substitution ) noted less delirium in the home-treated group . SETTING a 
    Output:
    
For patients who have developed delirium , the available evidence does not support the efficacy of multicomponent non-pharmacological interventions to treat delirium .
In older patients  multi-component non-pharmacological interventions as well as some single-components intervention were effective in preventing delirium but not to treat delirium