***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: 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 To investigate the controlling efficacy of ondasetron and haloperidol in regard to the postcardiotomy delirium .  Methods We included in this prospect i ve , r and omized , double-blinded study 80 patients who developed delirium after heart surgery with the application of heart lung-machine . The patients were divided into two , equally-sized groups , which on detection of delirium received ondasetron 8 mg iv or haloperidol 5 mg iv respectively . The statistical analysis compared the baseline and demographic characteristics of the two groups ( age , gender , comorbidities , years of education , type of surgery etc . ) . Results Both ondasetron and haloperidol had very good delirium controlling effects , without statistically significant differences . Discussion - Conclusions Ondasetron and haloperidol are efficient agents as far as the treatment of postcardiotomy delirium is concerned . As , in addition , ondasetron bares milder side-effects , we believe this could be the agent of choice in patients developing postcardiotomy delirium in the future Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background — Delirium is a common outcome after cardiac surgery .  Delirium prediction rules identify patients at risk for delirium who may benefit from targeted prevention strategies , early identification , and treatment of underlying causes . The purpose of the present prospect i ve study was to develop a prediction rule for delirium in a cardiac surgery cohort and to vali date it in an independent cohort . Methods and Results — Prospect ively , cardiac surgery patients ≥60 years of age were enrolled in a derivation sample ( n=122 ) and then a validation sample ( n=109 ) . Beginning on the second postoperative day , patients underwent a st and ardized daily delirium assessment  , and delirium was diagnosed according to the confusion assessment method . Delirium occurred in 63 ( 52 % ) of the derivation cohort patients . Multivariable analysis identified 4 variables independently associated with delirium : prior stroke or transient ischemic attack , Mini Mental State Examination score , abnormal serum albumin , and the Geriatric Depression Scale . Points were assigned to each variable : Mini Mental State Examination ≤23 received 2 points , and Mini Mental State Examination score of 24 to 27 received 1 point ; Geriatric Depression Scale > 4 , prior stroke/transient ischemic attack , and abnormal albumin received 1 point each . In the derivation sample , the cumulative incidence of delirium for point levels of 0 , 1 , 2 , and ≥3 was 19 % , 47 % , 63 % , and 86 % , respectively ( C statistic , 0.74 ) . The corresponding incidence of delirium in the validation sample was 18 % , 43 % , 60 % , and 87 % , respectively ( C statistic , 0.75 ) . Conclusions — Delirium occurs frequently after cardiac surgery . Using 4 preoperative characteristics , clinicians can determine cardiac surgery patients ' risk for delirium . Patients at higher delirium risk could be c and i date s for close postoperative monitoring and interventions to prevent delirium Objectives To develop and vali date a delirium prediction model for adult intensive care patients and determine its additional value compared with prediction by caregivers . Design Observational multicentre study . Setting Five intensive care units in the Netherl and s ( two university hospitals and three university affiliated teaching hospitals ) . Participants 3056 intensive care patients aged 18 years or over . Main outcome measure Development of delirium ( defined as at least one positive delirium screening ) during patients ’ stay in intensive care . Results The model was developed using 1613 consecutive intensive care patients in one hospital and temporally vali date d using 549 patients from the same hospital . For external validation , data were collected from 894 patients in four other hospitals . The prediction ( PRE-DELIRIC ) model contains 10 risk factors — age , APACHE-II score , admission group , coma , infection , metabolic acidosis , use of sedatives and morphine , urea concentration , and urgent admission . The model had an area under the receiver operating characteristics curve of 0.87 ( 95 % confidence interval 0.85 to 0.89 ) and 0.86 after bootstrapping . Temporal validation and external validation result ed in areas under the curve of 0.89 ( 0.86 to 0.92 ) and 0.84 ( 0.82 to 0.87 ) . The pooled area under the receiver operating characteristics curve ( n=3056 ) was 0.85 ( 0.84 to 0.87 ) . The area under the curve for nurses ’ and physicians ’ predictions ( n=124 ) was significantly lower at 0.59 ( 0.49 to 0.70 ) for both . Conclusion The PRE-DELIRIC model for intensive care patients consists of 10 risk factors that are readily available within 24 hours after intensive care admission and has a high predictive value . Clinical prediction by nurses and physicians performed significantly worse . The model allows for early prediction of delirium and initiation of preventive measures . Trial registration Clinical trials NCT00604773 ( development study ) and NCT00961389 ( validation study ) BACKGROUND We evaluated the use of dexmedetomidine to facilitate the weaning of delirious postoperative patients from mechanical ventilation . METHODS We included 72 consecutive patients who underwent elective cardiac surgery in this prospect i ve observational study . Each patient had failed at least 1 trial of continuous positive airway pressure ( CPAP ) and had agitation . Patients were assessed with the Richmond Agitation-Sedation Scale ( RASS ) and the Confusion Assessment Method for the Intensive Care Unit ( CAMICU ) 12 to 18 hours after their admission to the ICU . Midazolam and fentanyl were then given to all patients according to the sedation protocol . At 36 hours in the ICU , patients who had agitation and an inability to wean were r and omly divided into 2 groups : group M , 34 patients who continued to follow the routine sedative protocol ; and group D , 38 patients who were given dexmedetomidine .  Arterial blood gas measurements , hemodynamic parameters , and time to extubation were recorded . Statistical analysis was performed with GraphPad InStat ( version 2.02 for DOS ) . RESULTS All patients tested positive in the CAM-ICU assessment , and all had a delirium diagnosis . The 38 patients in group D tolerated a spontaneous breathing trial with CPAP and were extubated after a mean ( ±SD ) of 49.619 ± 6.96 hours . The 2 groups had significantly different extubation times ( 58.389 ± 3.958 hours versus 49.619 ± 6.96 hours ) . The 2 groups had significantly different RASS scores at 48 and 60 hours and significantly different heart rates and PO2 values at 12 and 24 hours . The 2 groups showed no significant differences with regard to hemodynamic parameters . CONCLUSIONS Dexmedetomidine may help to eliminate the emergence of agitation and can be a good treatment choice for the delirium state after cardiac surgery Background : Delirium is an acute deterioration of brain function characterized by fluctuating consciousness and an inability to maintain attention . Use of statins has been shown to decrease morbidity and mortality after major surgical procedures . The objective of this study was to determine an association between preoperative administration of statins and postoperative delirium in a large prospect i ve cohort of patients undergoing cardiac surgery with cardiopulmonary bypass . Methods : After Institutional Review Board approval , data were prospect ively collected on consecutive patients undergoing cardiac surgery with cardiopulmonary bypass from April 2005 to June 2006 in an academic hospital . All patients were screened for delirium during their hospitalization using the Confusion Assessment Method in the intensive care unit . Multivariable logistic regression analysis was used to identify independent perioperative predictors of delirium after cardiac surgery . Statins were tested for a potential protective effect . Results : Of the 1,059 patients analyzed , 122 patients ( 11.5 % ) had delirium at any time during their cardiovascular intensive care unit stay . Administration of statins had a protective effect , reducing the odds of delirium by 46 % . Independent predictors of postoperative delirium included older age , preoperative depression , preoperative renal dysfunction , complex cardiac surgery , perioperative intraaortic balloon pump support , and massive blood transfusion . The model was reliable ( Hosmer-Lemeshow test , P = 0.3 ) and discriminative ( area under receiver operating characteristic curve = 0.77 ) . Conclusions : Preoperative administration of statins is associated with the reduced risk of postoperative delirium after cardiac surgery with cardiopulmonary bypass Objective : To compare validity and reliability of three instruments for detection and assessment of delirium in intensive care unit ( ICU ) patients . Delirium in critically ill patients is associated with higher mortality , prolonged duration of ICU stay , and greater healthcare costs . Currently , there are several assessment tools available for detection of delirium , but only a few of these assessment systems are developed specifically to screen for delirium in ICU patients . Design : Prospect i ve cohort study . Setting : ICU at a university hospital . Patients : A total of 156 surgical patients aged ≥60 yrs consecutively admitted to the ICU , with a length of stay of at least 24 hrs . Measurements and Main Results : This study was approved by the institutional ethics committee . Trained staff members performed daily and independently the  Confusion Assessment Method for the ICU ( CAM-ICU ) , the Nursing Delirium Screening Scale ( Nu-DESC ) , and the Delirium Detection Score ( DDS ) . These evaluations were compared against the reference st and ard conducted by a delirium expert ( blinded to the study ) , who used delirium criteria from the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ( DSM-IV ) . Of 156 patients , 63 ( 40 % ) were identified as delirious by the reference st and ard during the study . Using the CAM-ICU and the Nu-DESC , we measured comparable sensitivities ( CAM-ICU , 81 % ; Nu-DESC , 83 % ) . The specificity of the CAM-ICU was significantly higher than that of the Nu-DESC ( 96 % vs. 81 % , p < .01 ) . In contrast , the DDS showed poor sensitivity ( 30 % ) , whereas the specificity was significantly higher compared with the Nu-DESC ( DDS , 91 % ; Nu-DESC , 81 % , p < .05 ) . The interrater reliability was “ almost perfect ” for the CAM-ICU ( & kgr ; = 0.89 ) and “ substantial ” for DDS and Nu-DESC ( & kgr ; = 0.79 , 0.68 ) . Conclusion : The CAM-ICU showed the best validity of the evaluated scales to identify delirium in ICU patients . The Nu-DESC might be an alternative tool for detection of ICU delirium . The DDS should not be used as a screening tool OBJECTIVES Patients who undergo cardiac surgery have an increased risk of delirium . Currently , there are few choices of treatment for postoperative hyperactive delirium in cardiac surgical patients . The aim of this study was to assess the effect of morphine compared with a haloperidol-based regimen in hyperactive-type delirium in patients after cardiac surgery . DESIGN A prospect i 
    Output:
    
The evidence for treating postcardiac surgery delirium with pharmacologic agents is inconclusive