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Table 3, Chapter 20. Delirium prevention—single interventionsAuthor/YearDescription of PSPStudy Design and patientsTheory or Logic ModelDescription of OrganizationImplementation DetailsOutcomes: BenefitsOutcomes: HarmsInfluence of Contexts on OutcomesOverall Risk of BiasInpatient hospital careAl-Aama et al. 2010 ADDIN REFMGR.CITE <Refman><Cite><Author>Al-Aama</Author><Year>2011</Year><RecNum>573419</RecNum><IDText>Melatonin decreases delirium in elderly patients: a randomized, placebo-controlled trial</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>573419</Ref_ID><Title_Primary>Melatonin decreases delirium in elderly patients: a randomized, placebo-controlled trial</Title_Primary><Authors_Primary>Al-Aama,T.</Authors_Primary><Authors_Primary>Brymer,C.</Authors_Primary><Authors_Primary>Gutmanis,I.</Authors_Primary><Authors_Primary>Woolmore-Goodwin,S.M.</Authors_Primary><Authors_Primary>Esbaugh,J.</Authors_Primary><Authors_Primary>Dasgupta,M.</Authors_Primary><Date_Primary>2011/7</Date_Primary><Keywords>aged</Keywords><Keywords>article</Keywords><Keywords>brain protection</Keywords><Keywords>Canada</Keywords><Keywords>comorbidity</Keywords><Keywords>confusion</Keywords><Keywords>confusion assessment method</Keywords><Keywords>controlled study</Keywords><Keywords>*delirium</Keywords><Keywords>di [Diagnosis]</Keywords><Keywords>*delirium</Keywords><Keywords>dm [Disease Management]</Keywords><Keywords>*delirium</Keywords><Keywords>dt [Drug Therapy]</Keywords><Keywords>*delirium</Keywords><Keywords>et [Etiology]</Keywords><Keywords>*delirium</Keywords><Keywords>pc [Prevention]</Keywords><Keywords>disease severi</Keywords><Reprint>Not in File</Reprint><Start_Page>687</Start_Page><End_Page>694</End_Page><Periodical>Int J Geriatr Psychiatry</Periodical><Volume>26</Volume><Issue>7</Issue><User_Def_2>MEDLINE - Ovid 8/23/2011, EMBASE (OVID) 7/21/2011, EMBASE (OVID) 7/11/2011</User_Def_2><User_Def_3>Given to Jim Reston on 7/29/2011 for EPC0018</User_Def_3><ISSN_ISBN>20845391</ISSN_ISBN><Availability>Sharepoint , EPC0018 , SREMEPC18_070711 , SREMEPC18_071911 , SRMLEPC18_082311 , EPC18_cites_11-17-11</Availability><ZZ_JournalStdAbbrev><f name="System">Int J Geriatr Psychiatry</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>74CanadaLow dose melatonin for patients with hip fractureDouble-blind RCT145 patients aged ≥65?years admitted to internal medicine serviceThe article cites a theory that delirium may be related to abnormal tryptophan metabolism, which can be regulated by melatonin supplementationInternal medicine service in a tertiary care centerStudy medication was?administered (in double-blind fashion) daily between 1,800?and 2,400 h depending upon patient availability and medication administration schedules for up to 14 daysIncidence of delirium:Melatonin:2/56 (3.6%)Placebo:10/52 (19.2%)RR = 0.19(95% CI: 0.04-0.81)P<0.022/61 patients on melatonin had side effects of nightmares or hallucinationsNot applicableModerateLarsen et al. 2010 ADDIN REFMGR.CITE <Refman><Cite><Author>Larsen</Author><Year>2010</Year><RecNum>573345</RecNum><IDText>Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>573345</Ref_ID><Title_Primary>Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial</Title_Primary><Authors_Primary>Larsen,K.A.</Authors_Primary><Authors_Primary>Kelly,S.E.</Authors_Primary><Authors_Primary>Stern,T.A.</Authors_Primary><Authors_Primary>Bode,R.H.,Jr.</Authors_Primary><Authors_Primary>Price,L.L.</Authors_Primary><Authors_Primary>Hunter,D.J.</Authors_Primary><Authors_Primary>Gulczynski,D.</Authors_Primary><Authors_Primary>Bierbaum,B.E.</Authors_Primary><Authors_Primary>Sweeney,G.A.</Authors_Primary><Authors_Primary>Hoikala,K.A.</Authors_Primary><Authors_Primary>Cotter,J.J.</Authors_Primary><Authors_Primary>Potter,A.W.</Authors_Primary><Date_Primary>2010/9</Date_Primary><Keywords>Aged</Keywords><Keywords>*Antipsychotic Agents</Keywords><Keywords>tu [Therapeutic Use]</Keywords><Keywords>*Arthroplasty,Replacement,Hip</Keywords><Keywords>*Arthroplasty,Replacement,Knee</Keywords><Keywords>*Benzodiazepines</Keywords><Keywords>tu [Therapeutic Use]</Keywords><Keywords>Chi-Square Distribution</Keywords><Keywords>Delirium</Keywords><Keywords>et [Etiology]</Keywords><Keywords>*Delirium</Keywords><Keywords>pc [Prevention & Control]</Keywords><Keywords>Double-Blind Method</Keywords><Keywords>F</Keywords><Reprint>Not in File</Reprint><Start_Page>409</Start_Page><End_Page>418</End_Page><Periodical>Psychosomatics</Periodical><Volume>51</Volume><Issue>5</Issue><User_Def_2>MEDLINE - Ovid 8/23/2011, MEDLINE - Ovid 7/11/2011</User_Def_2><User_Def_3>Given to Jim Reston on 9/7/2011 for EPC0018</User_Def_3><ISSN_ISBN>20833940</ISSN_ISBN><Availability>Sharepoint , EPC0018 , SRMLEPC18_070711 , SRMLEPC18_082311 , EPC18_cites_11-17-11</Availability><Address>Beth Israel Deaconess Medical Center, New England Baptist Hospital, Boston, MA, USA</Address><ZZ_JournalStdAbbrev><f name="System">Psychosomatics</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>75USAAtypical antipsychoticPerioperative olanzapine (5?mg orally before and after surgery) or placebo to prevent postop delirium in elderly patients after joint replacement surgeryDouble-blind RCT400 patients aged ≥65?years under-going elective knee or hip replace-ment surgeryOlanzapine is an antipsychotic with some prior evidence of efficacy for delirium treatment and prevention.Academic hospitalPerioperative olanzapine (5 mg orally) or placebo was administered before and after surgery by nurses not involved in ongoing care of the patients.Incidence of delirium:Olanzapine:28 (14.3%)Placebo:82 (40.2%)RR = 0.36(95% CI: 0.24-0.52)P<0.0001The difference was also significant in separate subgroups (knee replacement, hip replacement)Severity of delirium was greater in the olanzapine group (DRSR-98 score: 16.44?vs. 14.5, p?=?0.02), and lasted longer (2.2 vs. 1.6?days, p?=?0.02). Medical complications did not differ significantly between groups.Not applicableModeratePrakanrattana and Prapaitrakool 2007 ADDIN REFMGR.CITE <Refman><Cite><Author>Prakanrattana</Author><Year>2007</Year><RecNum>574434</RecNum><IDText>Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>574434</Ref_ID><Title_Primary>Efficacy of risperidone for prevention of postoperative delirium in cardiac surgery</Title_Primary><Authors_Primary>Prakanrattana,U.</Authors_Primary><Authors_Primary>Prapaitrakool,S.</Authors_Primary><Date_Primary>2007/10</Date_Primary><Keywords>*Antipsychotic Agents</Keywords><Keywords>tu [Therapeutic Use]</Keywords><Keywords>Coronary Artery Bypass</Keywords><Keywords>Delirium</Keywords><Keywords>ep [Epidemiology]</Keywords><Keywords>*Delirium</Keywords><Keywords>pc [Prevention & Control]</Keywords><Keywords>Epidemiologic Methods</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Postoperative Complications</Keywords><Keywords>ep [Epidemiology]</Keywords><Keywords>*Postoperative Complication</Keywords><Reprint>Not in File</Reprint><Start_Page>714</Start_Page><End_Page>719</End_Page><Periodical>Anaesth Intensive Care</Periodical><Volume>35</Volume><Issue>5</Issue><User_Def_2>MEDLINE - Ovid 7/21/2011</User_Def_2><User_Def_3>Given to Jim Reston on 7/29/2011 for EPC0018</User_Def_3><ISSN_ISBN>17933157</ISSN_ISBN><Availability>Sharepoint , EPC0018 , SRMLEPC18_071911 , EPC18_cites_11-17-11</Availability><Address>Department of Anaesthesiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand</Address><ZZ_JournalStdAbbrev><f name="System">Anaesth Intensive Care</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>76ThailandAtypical antipsychoticRisperidone (1 mg) or placebo taken orally (sublingually) a single time following cardiac surgeryDouble-blind RCT126 patients aged >40?years undergoing elective cardiac surgeryRisperidone is an antipsychotic with some previous evidence of efficacy for treatment of deliriumAcademic hospitalRisperidone (1 mg orally) or placebo was given by nurses when patients began to wake in the ICUPost-op delirium:Risperidone:7/63 (11.1%)Placebo:20/63 (31.7%)RR = 0.35(95% CI: 0.16-0.77)P = 0.009None reported (post-op complications did not differ significantly between groups)Not applicableLowSieber et al. 2010 ADDIN REFMGR.CITE <Refman><Cite><Author>Sieber</Author><Year>2010</Year><RecNum>573353</RecNum><IDText>Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair.[Erratum appears in Mayo Clin Proc. 2010 Apr;85(4):400 Note: Dosage error in article text</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>573353</Ref_ID><Title_Primary>Sedation depth during spinal anesthesia and the development of postoperative delirium in elderly patients undergoing hip fracture repair.[Erratum appears in Mayo Clin Proc. 2010 Apr;85(4):400 Note: Dosage error in article text</Title_Primary><Authors_Primary>Sieber,F.E.</Authors_Primary><Authors_Primary>Zakriya,K.J.</Authors_Primary><Authors_Primary>Gottschalk,A.</Authors_Primary><Authors_Primary>Blute,M.R.</Authors_Primary><Authors_Primary>Lee,H.B.</Authors_Primary><Authors_Primary>Rosenberg,P.B.</Authors_Primary><Authors_Primary>Mears,S.C.</Authors_Primary><Date_Primary>2010/1</Date_Primary><Keywords>Aged,80 and over</Keywords><Keywords>*Anesthesia,Spinal</Keywords><Keywords>ae [Adverse Effects]</Keywords><Keywords>*Conscious Sedation</Keywords><Keywords>ae [Adverse Effects]</Keywords><Keywords>*Deep Sedation</Keywords><Keywords>ae [Adverse Effects]</Keywords><Keywords>Delirium</Keywords><Keywords>ci [Chemically Induced]</Keywords><Keywords>*Delirium</Keywords><Keywords>et [Etiology]</Keywords><Keywords>Double-Blind Method</Keywords><Keywords>Female</Keywords><Keywords>*Hip Fractures</Keywords><Keywords>su [Surgery]</Keywords><Keywords>Humans</Keywords><Reprint>Not in File</Reprint><Start_Page>18</Start_Page><End_Page>26</End_Page><Periodical>Mayo Clin Proc</Periodical><Volume>85</Volume><Issue>1</Issue><User_Def_2>MEDLINE - Ovid 8/23/2011, EMBASE (OVID) 7/21/2011, MEDLINE - Ovid 7/11/2011</User_Def_2><User_Def_3>Given to Jim Reston on 7/29/2011 for EPC0018</User_Def_3><ISSN_ISBN>20042557</ISSN_ISBN><Availability>Sharepoint , EPC0018 , SRMLEPC18_070711 , SREMEPC18_071911 , SRMLEPC18_082311 , EPC18_cites_11-17-11</Availability><Address>Department of Anesthesiology & Critical Care Medicine, Johns Hopkins Bayview Medical Center, 4940 Eastern Ave, Baltimore, MD 21224, USA. fsieber1@jhmi.edu</Address><ZZ_JournalStdAbbrev><f name="System">Mayo Clin Proc</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>12USALight propofol sedation during hip?repair surgeryDouble-blind RCT114 patients aged ≥65?years under-going hip fracture repairThe authors hypothesized that minimizing sedation depth during spinal anesthesia for hip fracture repair in elderly patients could decrease the occurrence of postop deliriumAcademic medical centerImplemented by anesthesiologists during surgery.Post-op delirium:Light sedation:11/57 (19%)Deep sedation: 23/57 (40%)RR = 0.48(95% CI: 0.26-0.89)P = 0.02Complication rates were similar in both?groups.Light sedation: 26/57 (46%)Deep sedation: 30/57 (53%p = 0.57Not applicableModerateMaldonado et al. 2009 ADDIN REFMGR.CITE <Refman><Cite><Author>Maldonado</Author><Year>2009</Year><RecNum>576307</RecNum><IDText>Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>576307</Ref_ID><Title_Primary>Dexmedetomidine and the reduction of postoperative delirium after cardiac surgery</Title_Primary><Authors_Primary>Maldonado,J.R.</Authors_Primary><Authors_Primary>Wysong,A.</Authors_Primary><Authors_Primary>van der Starre,P.J.</Authors_Primary><Authors_Primary>Block,T.</Authors_Primary><Authors_Primary>Miller,C.</Authors_Primary><Authors_Primary>Reitz,B.A.</Authors_Primary><Date_Primary>2009/5</Date_Primary><Keywords>Adult</Keywords><Keywords>Aged</Keywords><Keywords>*Cardiopulmonary Bypass</Keywords><Keywords>Delirium</Keywords><Keywords>chemically induced</Keywords><Keywords>diagnosis</Keywords><Keywords>*drug therapy</Keywords><Keywords>Dexmedetomidine</Keywords><Keywords>adverse effects</Keywords><Keywords>*therapeutic use</Keywords><Keywords>Dose-Response Relationship,Drug</Keywords><Keywords>Drug Administration Schedule</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Heart Valve Diseases</Keywords><Keywords>*surgery</Keywords><Keywords>He</Keywords><Reprint>Not in File</Reprint><Start_Page>206</Start_Page><End_Page>217</End_Page><Periodical>Psychosomatics</Periodical><Volume>50</Volume><Issue>3</Issue><User_Def_2>MEDLINE - Ovid 8/10/2011</User_Def_2><User_Def_3>Given to Jim Reston on 8/10/2011 for EPC0018</User_Def_3><ISSN_ISBN>19567759</ISSN_ISBN><Availability>Sharepoint , EPC0018 , EPC18_cites_11-17-11</Availability><Address>Dept. of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd., Suite 2317, Stanford, CA 94305-5546, USA. jrm@stanford.edu</Address><ZZ_JournalStdAbbrev><f name="System">Psychosomatics</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>17USADifferent types of postop sedation after?cardiac surgeryRCT118 patients aged ≥18?years under-going elective cardiac valve surgeryThe authors hypothesized that dexmedetomidine may be associated with a lower incidence of delirium due to its pharmacologic propertiesAcademic medical centerImplemented in the ICU following cardiac surgery. Patients were randomized to three different sedatives.Post-op delirium (Intention-to-treat):Dexmedetomidine: 4/40 (10%)Propofol:16/36 (44%)Midazolam:17/40 (44%)p<0.001Per protocol analysis also significantly different (p<0.001)Not reportedNot applicableHighShehabi et al. 2009 ADDIN REFMGR.CITE <Refman><Cite><Author>Shehabi</Author><Year>2009</Year><RecNum>577783</RecNum><IDText>Prevalence of delirium with dexmedetomidine compared with morphine based therapy after cardiac surgery: a randomized controlled trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study)</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>577783</Ref_ID><Title_Primary>Prevalence of delirium with dexmedetomidine compared with morphine based therapy after cardiac surgery: a randomized controlled trial (DEXmedetomidine COmpared to Morphine-DEXCOM Study)</Title_Primary><Authors_Primary>Shehabi,Y.</Authors_Primary><Authors_Primary>Grant,P.</Authors_Primary><Authors_Primary>Wolfenden,H.</Authors_Primary><Authors_Primary>Hammond,N.</Authors_Primary><Authors_Primary>Bass,F.</Authors_Primary><Authors_Primary>Campbell,M.</Authors_Primary><Authors_Primary>Chen,J.</Authors_Primary><Date_Primary>2009/11</Date_Primary><Keywords>*Adrenergic alpha-Agonists</Keywords><Keywords>ae [Adverse Effects]</Keywords><Keywords>Aged</Keywords><Keywords>*Analgesics,Opioid</Keywords><Keywords>ae [Adverse Effects]</Keywords><Keywords>*Delirium</Keywords><Keywords>ci [Chemically Induced]</Keywords><Keywords>*Dexmedetomidine</Keywords><Keywords>ae [Adverse Effects]</Keywords><Keywords>Double-Blind Method</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>*Hypnotics and Sedatives</Keywords><Keywords>ae [Adverse Effects]</Keywords><Keywords>Intensive</Keywords><Reprint>Not in File</Reprint><Start_Page>1075</Start_Page><End_Page>1084</End_Page><Periodical>Anesthesiology</Periodical><Volume>111</Volume><Issue>5</Issue><User_Def_2>MEDLINE - Ovid 8/23/2011</User_Def_2><User_Def_3>Given to Jim Reston on 9/7/2011 for EPC0018</User_Def_3><ISSN_ISBN>19786862</ISSN_ISBN><Availability>Sharepoint , EPC0018 , SRMLEPC18_082311 , EPC18_cites_11-17-11</Availability><Address>University of New South Wales Clinical School, Sydney, Australia. y.shehabi@unsw.edu.au</Address><ZZ_JournalStdAbbrev><f name="System">Anesthesiology</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>77AustraliaSedationDexmedetomidine vs. morphine, effect on prevalence of delirium in patients at?least 60?years old after cardiac surgeryDouble-blind RCT306 patients aged ≥60?years under-going cardiac surgeryDexmedetomidine is a selective and potent α2?adrenergic receptor agonist. In?theory, it’s?specificity may provide an advantage for delirium prevention compared to other postsurgical sedatives or analgesicsTwo tertiary referral academic hospitalsStudy drug infusion began at 3 ml/h within?1 h of admission to the ICU; dexmedetomidine dose was 0.10.7??g/kg; morphine dose was 10-70 ?g/kg; a propofol infusion and/or boluses were given if deemed necessary for rapid control of hypertensive episodes or unplanned awakening; open label morphine was allowed in the dexmed group to achieve equivalent analgesia, and propofol was allowed in the morphine arm to maintain equivalent sedation; drug infusion was continued until removal of chest drains when patient was ready for discharge from ICU, or for up to 48?h of mechanical ventilation.Incident Delirium:Dexmedetomidine: 13/152 (8.6%)Morphine:22/147 (15%)Rate Ratio: 0.57 (95% CI: 0.26-1.1), P?= 0.09Duration of delirium, median:Dexmedetomidine: 2?daysMorphine: 5 days(95% CI: 1.1-6.7)P = 0.03Bradycardia occurred more often in Dex group (16.5%) than in the Morphine group (6.1%)P = 0.006Systolic hypotension occurred more often in Morphine group (38.1%) compared to Dex group (23%)P = 0.006Not applicableModerateHudetz et al. 2009 ADDIN REFMGR.CITE <Refman><Cite><Author>Hudetz</Author><Year>2009</Year><RecNum>574430</RecNum><IDText>Ketamine attenuates delirium after cardiac surgery with cardiopulmonary bypass</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>574430</Ref_ID><Title_Primary>Ketamine attenuates delirium after cardiac surgery with cardiopulmonary bypass</Title_Primary><Authors_Primary>Hudetz,J.A.</Authors_Primary><Authors_Primary>Patterson,K.M.</Authors_Primary><Authors_Primary>Iqbal,Z.</Authors_Primary><Authors_Primary>Gandhi,S.D.</Authors_Primary><Authors_Primary>Byrne,A.J.</Authors_Primary><Authors_Primary>Hudetz,A.G.</Authors_Primary><Authors_Primary>Warltier,D.C.</Authors_Primary><Authors_Primary>Pagel,P.S.</Authors_Primary><Date_Primary>2009/10</Date_Primary><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>*Cardiac Surgical Procedures</Keywords><Keywords>ae [Adverse Effects]</Keywords><Keywords>*Cardiopulmonary Bypass</Keywords><Keywords>ae [Adverse Effects]</Keywords><Keywords>Delirium</Keywords><Keywords>et [Etiology]</Keywords><Keywords>*Delirium</Keywords><Keywords>pc [Prevention & Control]</Keywords><Keywords>Humans</Keywords><Keywords>Inflammation Mediators</Keywords><Keywords>tu [Therapeutic Use]</Keywords><Keywords>*Ketamine</Keywords><Keywords>tu [Therapeutic U</Keywords><Reprint>Not in File</Reprint><Start_Page>651</Start_Page><End_Page>657</End_Page><Periodical>J Cardiothorac Vasc Anesth</Periodical><Volume>23</Volume><Issue>5</Issue><User_Def_2>MEDLINE - Ovid 8/23/2011, MEDLINE - Ovid 7/21/2011</User_Def_2><User_Def_3>Given to Jim Reston on 7/29/2011 for EPC0018</User_Def_3><ISSN_ISBN>19231245</ISSN_ISBN><Availability>Sharepoint , EPC0018 , SRMLEPC18_071911 , SRMLEPC18_082311 , EPC18_cites_11-17-11</Availability><Address>Department of Anesthesiology, Medical College of Wisconsin and Clement J. Zablocki Veterans Administration Medical Center, Milwaukee, WI, USA. judith.hudetz@</Address><ZZ_JournalStdAbbrev><f name="System">J Cardiothorac Vasc Anesth</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>78USAAnesthetic (NMDA receptor antagonist)Ketamine during anesthetic induction in older patients undergoing cardiac surgery with CPB.RCT58 patients aged ≥55?years under-going cardiac surgery with CPB.Citing prior evidence that ketamine may have neuroprotective effects, the authors hypothesized that a single dose of ketamine during anesthetic induction would attenuate postop delirium in older patients undergoing cardiac surgery with CPB.Veterans Affairs medical centerKetamine (0.5 mg/kg) or placebo was administered intravenously during anesthetic induction for cardiac surgery.Post-op delirium:Ketamine:1/29 (3.4%)Placebo:9/29 (31%)RR = 0.11(95% CI: 0.02-0.81)P = 0.01Not reportedNot applicableModerateMouzopoulos et al. 2009 ADDIN REFMGR.CITE <Refman><Cite><Author>Mouzopoulos</Author><Year>2009</Year><RecNum>574462</RecNum><IDText>Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>574462</Ref_ID><Title_Primary>Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: a randomized placebo-controlled study</Title_Primary><Authors_Primary>Mouzopoulos,G.</Authors_Primary><Authors_Primary>Vasiliadis,G.</Authors_Primary><Authors_Primary>Lasanianos,N.</Authors_Primary><Authors_Primary>Nikolaras,G.</Authors_Primary><Authors_Primary>Morakis,E.</Authors_Primary><Authors_Primary>Kaminaris,M.</Authors_Primary><Date_Primary>2009</Date_Primary><Keywords>aged</Keywords><Keywords>article</Keywords><Keywords>clinical trial</Keywords><Keywords>controlled clinical trial</Keywords><Keywords>controlled study</Keywords><Keywords>*delirium</Keywords><Keywords>co [Complication]</Keywords><Keywords>*delirium</Keywords><Keywords>dt [Drug Therapy]</Keywords><Keywords>*delirium</Keywords><Keywords>pc [Prevention]</Keywords><Keywords>disease duration</Keywords><Keywords>disease severity</Keywords><Keywords>drug efficacy</Keywords><Keywords>female</Keywords><Keywords>high risk patient</Keywords><Keywords>*hip fracture</Keywords><Keywords>human</Keywords><Keywords>major cli</Keywords><Reprint>Not in File</Reprint><Start_Page>127</Start_Page><End_Page>133</End_Page><Periodical>J Orthop Traumatol</Periodical><Volume>10</Volume><Issue>3</Issue><User_Def_2>EMBASE (OVID) 8/23/2011, EMBASE (OVID) 7/21/2011</User_Def_2><User_Def_3>Given to Jim Reston on 7/29/2011 for EPC0018</User_Def_3><Availability>Sharepoint , EPC0018 , SREMEPC18_071911 , SREMEPC18_082311 , EPC18_cites_11-17-11</Availability><Address>(Mouzopoulos, Lasanianos, Nikolaras, Morakis, Kaminaris) Orthopaedic Department, Evangelismos Hospital, Athens, Greece (Vasiliadis) Euromedica Geniki Kliniki of Thessaloniki, Thessaloniki, Greece (Vasiliadis) 3rd Department of Neurology, Aristotle's University of Thessaloniki, Thessaloniki, Greece (Mouzopoulos) Post-Graduate Department of Biostatistics, Medical School, University of Athens, Athens, Greece (Mouzopoulos) Sof. Venizelou 23, Peristeri Attikis 12131 Athens, Greece</Address><ZZ_JournalStdAbbrev><f name="System">J Orthop Traumatol</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>79GreeceLocal anestheticFascia iliac block prophylaxis (via Bupivacaine) for hip?fracture patientsRCT207 patients aged ≥70?years admitted for hip fractureThe authors cite prior studies suggesting that hip fracture patients are at increased risk of delirium due to severe pain; therefore, a fascia iliac block might prevent delirium by preventing severe pain.Hospital (type not reported) (980 beds)Bupivacaine was injected on admission (in blinded fashion) and repeated daily every 24 h until delirium occurrence or hip surgery; 24 hr after surgery it was re-administered and repeated daily until delirium occurrence or discharge.Incident delirium:Prophylaxis:10.8% (11/102)Placebo:23.8% (25/105)OR = 0.45(95% CI: 0.23-0.87)No complications other than 3?local hematomas at injection site which resolved spontaneouslyNot applicableModerateGamberini et al. 2009 ADDIN REFMGR.CITE <Refman><Cite><Author>Gamberini</Author><Year>2009</Year><RecNum>571630</RecNum><IDText>Rivastigmine for the prevention of postoperative delirium in elderly patients undergoing elective cardiac surgery--a randomized controlled trial</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>571630</Ref_ID><Title_Primary>Rivastigmine for the prevention of postoperative delirium in elderly patients undergoing elective cardiac surgery--a randomized controlled trial</Title_Primary><Authors_Primary>Gamberini,M.</Authors_Primary><Authors_Primary>Bolliger,D.</Authors_Primary><Authors_Primary>Lurati Buse,G.A.</Authors_Primary><Authors_Primary>Burkhart,C.S.</Authors_Primary><Authors_Primary>Grapow,M.</Authors_Primary><Authors_Primary>Gagneux,A.</Authors_Primary><Authors_Primary>Filipovic,M.</Authors_Primary><Authors_Primary>Seeberger,M.D.</Authors_Primary><Authors_Primary>Pargger,H.</Authors_Primary><Authors_Primary>Siegemund,M.</Authors_Primary><Authors_Primary>Carrel,T.</Authors_Primary><Authors_Primary>Seiler,W.O.</Authors_Primary><Authors_Primary>Berres,M.</Authors_Primary><Authors_Primary>Strebel,S.P.</Authors_Primary><Authors_Primary>Monsch,A.U.</Authors_Primary><Authors_Primary>Steiner,L.A.</Authors_Primary><Date_Primary>2009/5</Date_Primary><Keywords>Administration,Oral</Keywords><Keywords>Age Factors</Keywords><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>*Cardiac Surgical Procedures</Keywords><Keywords>ae [Adverse Effects]</Keywords><Keywords>Cardiac Surgical Procedures</Keywords><Keywords>mt [Methods]</Keywords><Keywords>Cardiopulmonary Bypass</Keywords><Keywords>ae [Adverse Effects]</Keywords><Keywords>Cardiopulmonary Bypass</Keywords><Keywords>mt [Methods]</Keywords><Keywords>Delirium</Keywords><Keywords>ep [Epidemiology]</Keywords><Keywords>*</Keywords><Reprint>Not in File</Reprint><Start_Page>1762</Start_Page><End_Page>1768</End_Page><Periodical>Crit Care Med</Periodical><Volume>37</Volume><Issue>5</Issue><User_Def_2>MEDLINE - Ovid 8/23/2011, MEDLINE - Ovid 7/11/2011, MEDLINE - Ovid 6/15/2011</User_Def_2><User_Def_3>Given to Jim Reston on 6/22/2011 for EPC0018</User_Def_3><ISSN_ISBN>19325490</ISSN_ISBN><Availability>Sharepoint , EPC0018 , SRPMEPC18_061011 , SRMLEPC18_070711 , SRMLEPC18_082311 , EPC18_cites_11-17-11</Availability><Address>Department of Anesthesia, University Hospital Basel, Basel, Switzerland</Address><ZZ_JournalStdAbbrev><f name="System">Crit Care Med</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>80SwitzerlandAcetylchol-inesterase inhibitorRivastigmine administered every 8 hrs from night before surgery until 6th postop day in a high-risk group of elderly patients undergoing elective cardiac surgery with CPBDouble-blind RCT120 patients aged ≥65?years under-going elective cardiac surgery with CPBBased on prior studies suggesting cholinesterase inhibitors can successfully treat delirium, the authors hypothesized that short-term administration of oral rivastigmine would reduce the incidence of postop delirium in a high-risk group of elderly patients undergoing elective cardiac surgery with CPBAcademic hospitalRivastigmine administered every 8?hrs as a colorless odorless solution from night before surgery until 6th postop dayIncident delirium as assessed by CAM:Rivastigmine:18/56 (32%)Placebo:17/57 (30%)RR = 1.12(95% CI: 0.50-2.48)P = 0.80No significant between-group difference for any adverse events.Not applicableLowLiptzin et al. 2005 ADDIN REFMGR.CITE <Refman><Cite><Author>Liptzin</Author><Year>2005</Year><RecNum>574441</RecNum><IDText>Donepezil in the prevention and treatment of post-surgical delirium</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>574441</Ref_ID><Title_Primary>Donepezil in the prevention and treatment of post-surgical delirium</Title_Primary><Authors_Primary>Liptzin,B.</Authors_Primary><Authors_Primary>Laki,A.</Authors_Primary><Authors_Primary>Garb,J.L.</Authors_Primary><Authors_Primary>Fingeroth,R.</Authors_Primary><Authors_Primary>Krushell,R.</Authors_Primary><Date_Primary>2005/12</Date_Primary><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>*Cholinesterase Inhibitors</Keywords><Keywords>tu [Therapeutic Use]</Keywords><Keywords>Delirium</Keywords><Keywords>dt [Drug Therapy]</Keywords><Keywords>*Delirium</Keywords><Keywords>pc [Prevention & Control]</Keywords><Keywords>Double-Blind Method</Keywords><Keywords>Female</Keywords><Keywords>Humans</Keywords><Keywords>*Indans</Keywords><Keywords>tu [Therapeutic Use]</Keywords><Keywords>Male</Keywords><Keywords>Middle Aged</Keywords><Keywords>Pilot Projects</Keywords><Keywords>*Piperidines</Keywords><Keywords>tu [Therapeut</Keywords><Reprint>Not in File</Reprint><Start_Page>1100</Start_Page><End_Page>1106</End_Page><Periodical>Am J Geriatr Psychiatry</Periodical><Volume>13</Volume><Issue>12</Issue><User_Def_2>MEDLINE - Ovid 7/21/2011</User_Def_2><User_Def_3>Given to Jim Reston on 7/29/2011 for EPC0018</User_Def_3><ISSN_ISBN>16319303</ISSN_ISBN><Availability>Sharepoint , EPC0018 , SRMLEPC18_071911 , EPC18_cites_11-17-11</Availability><Address>Department of Psychiatry, Baystate Medical Center, 759 Chestnut Street (S1581), Springfield, MA 01199, USA. benjamin.liptzin@</Address><ZZ_JournalStdAbbrev><f name="System">Am J Geriatr Psychiatry</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>81USAAcetylchol-inesterase inhibitorDonepezil (given at 5?mg/day) or placebo for 14 days preop and 14?days postop in patients undergoing total joint replacement (knee or hip)Double-blind RCT80 patients aged ≥50?years under-going knee or joint replace-mentDonepezil is a cholinesterase inhibitor (disruption in cholinergic transmission is thought to be in causal pathway of delirium)Academic medical centerEach patient was evaluated before surgery then given either Donepezil (given at 5 mg/day) or placebo for 14 days preop and 14 days postopPost-op delirium:Donepezil:8/39 (20.5%)Control:7/41 (17.1%)Rate Ratio = 1.2(95% CI: 0.6-2.6)P = 0.69Not reportedNot applicableModerateMcCaffrey et al. 2006 ADDIN REFMGR.CITE <Refman><Cite><Author>McCaffrey</Author><Year>2006</Year><RecNum>576561</RecNum><IDText>The effect of music on pain and acute confusion in older adults undergoing hip and knee surgery</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>576561</Ref_ID><Title_Primary>The effect of music on pain and acute confusion in older adults undergoing hip and knee surgery</Title_Primary><Authors_Primary>McCaffrey,R.</Authors_Primary><Authors_Primary>Locsin,R.</Authors_Primary><Date_Primary>2006/9</Date_Primary><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>Arthroplasty,Replacement,Hip</Keywords><Keywords>*adverse effects</Keywords><Keywords>nursing</Keywords><Keywords>Arthroplasty,Replacement,Knee</Keywords><Keywords>*adverse effects</Keywords><Keywords>nursing</Keywords><Keywords>Confusion</Keywords><Keywords>nursing</Keywords><Keywords>*prevention & control</Keywords><Keywords>Female</Keywords><Keywords>Geriatric Assessment</Keywords><Keywords>methods</Keywords><Keywords>Holistic Nursing</Keywords><Keywords>*methods</Keywords><Keywords>Humans</Keywords><Keywords>Male</Keywords><Keywords>Middl</Keywords><Reprint>Not in File</Reprint><Start_Page>218</Start_Page><End_Page>224</End_Page><Periodical>Holist Nurs Pract</Periodical><Volume>20</Volume><Issue>5</Issue><User_Def_2>MEDLINE - Ovid 8/11/2011</User_Def_2><User_Def_3>Given to Jim Reston on 8/17/2011 for EPC0018</User_Def_3><ISSN_ISBN>16974175</ISSN_ISBN><Availability>Sharepoint , EPC0018 , EPC18_cites_11-17-11</Availability><Address>Christine E Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL 33431, USA. rmccaffr@fau.edu</Address><ZZ_JournalStdAbbrev><f name="System">Holist Nurs Pract</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>82USAMusic therapy (musical selection with bedside CD turned on 13?times/day + standard postop care from anesthesia awakening time until discharged) for patients undergoing hip or knee surgeryRCT (music therapy + usual care vs. usual?care alone)124 patients aged ≥65?years under-going elective hip or knee surgeryPrior studies have shown evidence that music can improve cognition and calm agitated patientsLarge tertiary care centerNurses blinded to room designation made room assignments. Various CDs were available in the music therapy rooms. Music was played when patients were awakening from anesthesia. CD was set to play for 1 hour 4 times daily. Also, nurses were asked to turn on the music each time they entered the room, and family members and patients were instructed how to use the CD player. Research assistants checked that CD players were working and that the music and timing of play suited patient preferences.Patients who experienced acute confusion:Music therapy:2/62 (3.2%)Usual care:36/62 (58.1%)RR = 0.06(95% CI: 0.01-0.22)P<0.0001None reportedNot applicableHighMcCaffrey and Locsin 2004 ADDIN REFMGR.CITE <Refman><Cite><Author>McCaffrey</Author><Year>2004</Year><RecNum>529305</RecNum><IDText>The effect of music listening on acute confusion and delirium in elders undergoing elective hip and knee surgery</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>529305</Ref_ID><Title_Primary>The effect of music listening on acute confusion and delirium in elders undergoing elective hip and knee surgery</Title_Primary><Authors_Primary>McCaffrey,R.</Authors_Primary><Authors_Primary>Locsin,R.</Authors_Primary><Date_Primary>2004</Date_Primary><Reprint>Not in File</Reprint><Start_Page>91</Start_Page><Periodical>J Clin Nurs</Periodical><Volume>13</Volume><Issue>s2</Issue><User_Def_2>Hand Entry 10/5/2009</User_Def_2><User_Def_3>Given to Jim Reston on 8/17/2011 for EPC0018</User_Def_3><Availability>ZZZ_NGC0001 , NGC0010 , Sharepoint , NGC0001 , EPC0018 , EPC18_cites_11-17-11</Availability><ZZ_JournalStdAbbrev><f name="System">J Clin Nurs</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>83USAMusic therapy (musical selection with bedside CD turned on 13?times/day + standard postop care from anesthesia awakening time until discharged) for patients undergoing elective hip and knee surgeryRCT (music therapy + usual care vs. usual?care alone)66 patients aged ≥65?years under-going elective hip or knee surgeryPrior studies have shown evidence that music can improve cognition and calm agitated patientsLarge tertiary care centerNurses blinded to room designation made room assignments. Various CDs were available in the music therapy rooms. Music was played when patients were awakening from anesthesia. CD was set to play for 1 hour 3 times daily. Also, nurses were asked to turn on the music each time they entered the room, and family members and patients were instructed how to use the CD player. Research assistants checked that CD players were working and that the music and timing of play suited patient preferences.Significantly fewer patients in the music therapy group had episodes of confusion and delirium (F = 19.568, P = 0.001)None reportedNot applicableHighKalisvaart et al. 2005 ADDIN REFMGR.CITE <Refman><Cite><Author>Kalisvaart</Author><Year>2005</Year><RecNum>573392</RecNum><IDText>Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>573392</Ref_ID><Title_Primary>Haloperidol prophylaxis for elderly hip-surgery patients at risk for delirium: a randomized placebo-controlled study</Title_Primary><Authors_Primary>Kalisvaart,K.J.</Authors_Primary><Authors_Primary>de Jonghe,J.F.</Authors_Primary><Authors_Primary>Bogaards,M.J.</Authors_Primary><Authors_Primary>Vreeswijk,R.</Authors_Primary><Authors_Primary>Egberts,T.C.</Authors_Primary><Authors_Primary>Burger,B.J.</Authors_Primary><Authors_Primary>Eikelenboom,P.</Authors_Primary><Authors_Primary>van Gool,W.A.</Authors_Primary><Date_Primary>2005/10</Date_Primary><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>Antipsychotic Agents</Keywords><Keywords>ae [Adverse Effects]</Keywords><Keywords>*Antipsychotic Agents</Keywords><Keywords>tu [Therapeutic Use]</Keywords><Keywords>*Delirium</Keywords><Keywords>pc [Prevention & Control]</Keywords><Keywords>Double-Blind Method</Keywords><Keywords>Female</Keywords><Keywords>Haloperidol</Keywords><Keywords>ae [Adverse Effects]</Keywords><Keywords>*Haloperidol</Keywords><Keywords>tu [Therapeutic Use]</Keywords><Keywords>*Hip Fractures</Keywords><Keywords>su</Keywords><Reprint>Not in File</Reprint><Start_Page>1658</Start_Page><End_Page>1666</End_Page><Periodical>J Am Geriatr Soc</Periodical><Volume>53</Volume><Issue>10</Issue><User_Def_2>MEDLINE - Ovid 7/21/2011, MEDLINE - Ovid 7/11/2011</User_Def_2><User_Def_3>Given to Jim Reston on 7/29/2011 for EPC0018</User_Def_3><ISSN_ISBN>16181163</ISSN_ISBN><Availability>Sharepoint , EPC0018 , SRMLEPC18_070711 , SRMLEPC18_071911 , EPC18_cites_11-17-11</Availability><Address>Department of Geriatric Medicine, Medical Center Alkmaar, Alkmaar, The Netherlands. k.kalisvaart@mca.nl</Address><ZZ_JournalStdAbbrev><f name="System">J Am Geriatr Soc</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>84The NetherlandsTypical antipsychoticHaloperidol or placebo (0.5?mg 3?times daily) was started on admission and continued until 3 days postop to prevent delirium after hip surgeryDouble-blind RCT430 patients aged ≥70?years under-going hip surgeryHaloperidol is a dopamine antagonist which can enhance acetylcholine release. Since delirium is highly associated with cholinergic deficiency, the?authors hypothesized that haloperidol may have an indirect beneficial effect on delirium.Teaching hospitalHaloperidol (0.5 mg 3?times daily) or placebo was started on admission and continued until 3 days after surgery. Experienced geriatric nurses and geriatricians provided proactive geriatric consultation (based on a structured multimodal protocol) to all patients.Post-op delirium:Haloperidol:32/212 (15.1%)Placebo:36/218 (16.5%)RR = 0.91 (95% CI 0.59-1.42)P = 0.69Duration of delirium (days):Haloperidol: 5.4±4.9Placebo: 11.8±7.5P<0.001No drug-related side effects were reportedNot applicableModerateAizawa et al. 2002 ADDIN REFMGR.CITE <Refman><Cite><Author>Aizawa</Author><Year>2002</Year><RecNum>576559</RecNum><IDText>A novel approach to the prevention of postoperative delirium in the elderly after gastrointestinal surgery</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>576559</Ref_ID><Title_Primary>A novel approach to the prevention of postoperative delirium in the elderly after gastrointestinal surgery</Title_Primary><Authors_Primary>Aizawa,K.</Authors_Primary><Authors_Primary>Kanai,T.</Authors_Primary><Authors_Primary>Saikawa,Y.</Authors_Primary><Authors_Primary>Takabayashi,T.</Authors_Primary><Authors_Primary>Kawano,Y.</Authors_Primary><Authors_Primary>Miyazawa,N.</Authors_Primary><Authors_Primary>Yamamoto,T.</Authors_Primary><Date_Primary>2002</Date_Primary><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>Analgesics,Opioid</Keywords><Keywords>administration & dosage</Keywords><Keywords>Anti-Anxiety Agents</Keywords><Keywords>*administration & dosage</Keywords><Keywords>Delirium</Keywords><Keywords>etiology</Keywords><Keywords>*prevention & control</Keywords><Keywords>Diazepam</Keywords><Keywords>administration & dosage</Keywords><Keywords>Digestive System Surgical Procedures</Keywords><Keywords>*adverse effects</Keywords><Keywords>Drug Therapy,Com</Keywords><Reprint>Not in File</Reprint><Start_Page>310</Start_Page><End_Page>314</End_Page><Periodical>Surg Today</Periodical><Volume>32</Volume><Issue>4</Issue><User_Def_2>MEDLINE - Ovid 8/11/2011</User_Def_2><User_Def_3>Given to Jim Reston on 8/17/2011 for EPC0018</User_Def_3><ISSN_ISBN>12027195</ISSN_ISBN><Availability>Sharepoint , EPC0018 , EPC18_cites_11-17-11</Availability><Address>Department of Surgery, Hiratsuka City Hospital, Kanagawa, Japan</Address><ZZ_JournalStdAbbrev><f name="System">Surg Today</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>85JapanBenzo-diazepinesDiazepam + flunitrazepam drip infusion and pethidine drip infusion for first 3?days (day of operation and first 2 postop days) in patients undergoing gastrointestinal surgeryRCT (delirium-free protocol [DFP] vs. non-DFP)40 patients aged >70?years under-going gastro-intestinal surgerySleep-wake cycle disorders have been reported to be associated with postop delirium, so medications that target sleep cycle disorders might prevent deliriumA city hospital, no?other details providedDiazepam (0.1?mg/kg intramuscular) + flunitrazepam (0.04?mg/kg drip infusion) and pethidine (1 mg/kg drip infusion) at specific times during first 3 days (day of operation and first 2?postop days)Incidence of post-op delirium:DFP:1/20 (5%)Non-DFP:7/20 (35%)P = 0.023DFP was reported to cause “morning lethargy” in 8/20 patients (40%). No other side effects were reported.Not applicableHighLong-term careMentes and Culp 2003 ADDIN REFMGR.CITE <Refman><Cite><Author>Mentes</Author><Year>2003</Year><RecNum>387286</RecNum><IDText>Reducing hydration-linked events in nursing home residents</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>387286</Ref_ID><Title_Primary>Reducing hydration-linked events in nursing home residents</Title_Primary><Authors_Primary>Mentes,J.C.</Authors_Primary><Authors_Primary>Culp,K.</Authors_Primary><Date_Primary>2003/8</Date_Primary><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>Comparative Study</Keywords><Keywords>Confusion</Keywords><Keywords>etiology</Keywords><Keywords>prevention & control</Keywords><Keywords>Dehydration</Keywords><Keywords>complications</Keywords><Keywords>*prevention & control</Keywords><Keywords>*Fluid Therapy</Keywords><Keywords>Human</Keywords><Keywords>Iowa</Keywords><Keywords>*Nursing Homes</Keywords><Keywords>Respiratory Tract Infections</Keywords><Keywords>etiology</Keywords><Keywords>prevention & control</Keywords><Keywords>Risk Factors</Keywords><Keywords>Specific Grav</Keywords><Reprint>Not in File</Reprint><Start_Page>210</Start_Page><End_Page>225</End_Page><Periodical>Clin Nurs Res</Periodical><Volume>12</Volume><Issue>3</Issue><User_Def_2>MEDLINE - Ovid 8/11/2011, MEDLINE - Ovid 7/10/2008, MEDLINE 4/30/2004</User_Def_2><User_Def_3>Given to Jim Reston on 8/17/2011 for EPC0018</User_Def_3><ISSN_ISBN>12918647</ISSN_ISBN><Availability>ZZZ_NGC0001 , NGC0010 , SP0037 , Sharepoint , NGC0001 , EPC0018 , EPC18_cites_11-17-11</Availability><Address>School of Nursing, University of California Los Angeles, USA</Address><ZZ_JournalStdAbbrev><f name="System">Clin Nurs Res</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>86USAHydration (individually calculated fluid intake goal) over an 8-week period in nursing home residents aged ≥65?yearsQuasi-RCT (randomization by coin toss of different partici-pating facilities)49 participants aged ≥65 yearsPrior studies have shown that chronic under-hydration may lead to delirium and other adverse events2 Veteran’s Administration (VA), 2?community nursing homesAll RNs responsible for coordinating implementation at their site received intensive training on intervention/ usual care implementation. The project director made weekly visits to each site to ensure that the protocol was being implemented. RNs were responsible for most implementation details with assistance from NAs. NAs were responsible for providing fluids for participants.Episodes of acute confusion:Treatment:0/25 (0%)Control:2/24 (8.2%)P = not significantNone reportedNot clear, but the possibility was raised that control group staff might have altered their standard hydration practices due to awareness of research staff data collection.HighMoretti et al. 2004 ADDIN REFMGR.CITE <Refman><Cite><Author>Moretti</Author><Year>2004</Year><RecNum>576560</RecNum><IDText>Cholinesterase inhibition as a possible therapy for delirium in vascular dementia: a controlled, open 24-month study of 246 patients</IDText><MDL Ref_Type="Journal"><Ref_Type>Journal</Ref_Type><Ref_ID>576560</Ref_ID><Title_Primary>Cholinesterase inhibition as a possible therapy for delirium in vascular dementia: a controlled, open 24-month study of 246 patients</Title_Primary><Authors_Primary>Moretti,R.</Authors_Primary><Authors_Primary>Torre,P.</Authors_Primary><Authors_Primary>Antonello,R.M.</Authors_Primary><Authors_Primary>Cattaruzza,T.</Authors_Primary><Authors_Primary>Cazzato,G.</Authors_Primary><Date_Primary>2004/11</Date_Primary><Keywords>Aged</Keywords><Keywords>Aged,80 and over</Keywords><Keywords>Antihypertensive Agents</Keywords><Keywords>therapeutic use</Keywords><Keywords>Cholinesterase Inhibitors</Keywords><Keywords>*therapeutic use</Keywords><Keywords>Delirium</Keywords><Keywords>*drug therapy</Keywords><Keywords>*etiology</Keywords><Keywords>Dementia,Vascular</Keywords><Keywords>*complications</Keywords><Keywords>Female</Keywords><Keywords>Follow-Up Studies</Keywords><Keywords>Humans</Keywords><Keywords>Hypertension</Keywords><Keywords>drug therapy</Keywords><Keywords>Male</Keywords><Keywords>Neuropsychological</Keywords><Reprint>Not in File</Reprint><Start_Page>333</Start_Page><End_Page>339</End_Page><Periodical>Am J Alzheimers Dis Other Demen</Periodical><Volume>19</Volume><Issue>6</Issue><User_Def_2>MEDLINE - Ovid 8/11/2011</User_Def_2><User_Def_3>Given to Jim Reston on 8/17/2011 for EPC0018</User_Def_3><ISSN_ISBN>15633941</ISSN_ISBN><Availability>Sharepoint , EPC0018 , EPC18_cites_11-17-11</Availability><Address>Dipartimento di Fisiologia e Patologia, Universita degli Studi di Trieste, Trieste, Italy</Address><ZZ_JournalStdAbbrev><f name="System">Am J Alzheimers Dis Other Demen</f></ZZ_JournalStdAbbrev><ZZ_WorkformID>1</ZZ_WorkformID></MDL></Cite></Refman>87ItalyRivastigmine (3-6 mg/day) for 2 years in patients with vascular dementiaRCT (Rivastig-mine vs. cardio-aspirin)246 patients aged 68-85 years with vascular dementiaDelirium in patients with vascular dementia might be due to lack of acetylcholine in the brain. Rivastigmine is an anti-cholinesterase inhibitorAcademic hospitalRivastigmine (36?mg/day) or aspirin (100 mg/day) for 2 years in patients with vascular dementiaPatients with episodes of delirium during follow-up:Rivastigmine: 46/115 (40%)Cardioaspirin: 71/115 (62%)RR = 0.65(95% CI: 0.50-0.85)P<0.001Mean duration of delirium:Rivastigmine: 4?±1.71 daysCardioaspirin: 7.86?±2.73 daysP<0.01Not reportedNot applicableHighReferences1. National Clinical Guideline Centre. Delirium: diagnosis, prevention and management. London (UK): Royal College of Physicians; 2010 Jul. 662 p. (Clinical guideline; no. 103). Available: .uk/nicemedia/live/13060/49908/49908.pdf. 2. Cochrane Effective Practice and Organisation of Care (EPOC) Group. Risk?of bias. Replaces quality criteria in the EPOC data collection checklist. Ottawa?(ON): Cochrane Collaboration; 2001 May 1. 3 p. Also available: . 3. Slor CJ, De Jonghe JF, Vreeswijk R, et al. 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