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Severity delirium

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https://www.readbyqxmd.com/read/28927394/laboratory-markers-of-cardiac-and-metabolic-complications-after-generalized-tonic-clonic-seizures
#1
Robert D Nass, Sina Meiling, René P Andrié, Christian E Elger, Rainer Surges
BACKGROUND: Generalized tonic-clonic seizures (GTCS) frequently lead to emergency inpatient referrals. Laboratory blood values are routinely performed on admission to detect underlying causes and metabolic or cardiac complications. Our goal was to assess the nature and frequency of complications occurring in association with GTCS. METHODS: We retrospectively extracted data from emergency protocols and discharge letters of adult patients admitted to the Department of Epileptology between 01/2010 and 06/2015...
September 19, 2017: BMC Neurology
https://www.readbyqxmd.com/read/28914375/central-nervous-system-involvement-in-patients-with-granulomatosis-with-polyangiitis-a-single-center-retrospective-study
#2
George E Fragoulis, Sophia Lionaki, Aliki Venetsanopoulou, Panayiotis G Vlachoyiannopoulos, Haralampos M Moutsopoulos, Athanasios G Tzioufas
The aims of this study were to estimate the frequency of central nervous system (CNS) involvement in Greek patients with granulomatosis with polyangiitis (GPA) and describe the related clinical characteristics and long-term outcomes of these patients. Medical charts of all ANCA-associated vasculitis patients were retrospectively reviewed, and GPA patients with CNS involvement were identified. Demographics, serological, and clinical features throughout the disease course were recorded. Comparisons of disease characteristics and long-term outcomes were performed between GPA patients with and without CNS involvement...
September 15, 2017: Clinical Rheumatology
https://www.readbyqxmd.com/read/28903799/a-comparison-of-outcomes-according-to-different-diagnostic-systems-for-delirium-dsm-5-dsm-iv-cam-and-drs-r98
#3
Dimitrios Adamis, David Meagher, Siobhan Rooney, Owen Mulligan, Geraldine McCarthy
Studies indicate that DSM-5 criteria for delirium are relatively restrictive, and identify different cases of delirium compared with previous systems. We evaluate four outcomes of delirium (mortality, length of hospital stay, institutionalization, and cognitive improvement) in relation to delirium defined by different DSM classification systems. Prospective, longitudinal study of patients aged 70+ admitted to medical wards of a general hospital. Participants were assessed up to a maximum of four times during two weeks, using DSM-5 and DSM-IV criteria, DRS-R98 and CAM scales as proxies for DSM III-R and DSM III...
September 14, 2017: International Psychogeriatrics
https://www.readbyqxmd.com/read/28888918/effects-of-psychopharmacological-treatment-with-antipsychotic-drugs-on-the-vascular-system
#4
REVIEW
Kai G Kahl, Mechthild Westhoff-Bleck, Tillmann H C Krüger
Psychopharmacological treatment with antipsychotic drugs is an essential part of guideline-based treatment strategies in psychotic disorders, such as schizophrenia, schizoaffective disorders, and delusional disorders. Other mental disorders frequently treated with antipsychotic drugs are bipolar disorders, and major depressive disorder. Furthermore, antipsychotic drugs are often given in emergency and surgical units for the treatment of metabolic or postoperative delirium. Antipsychotic drugs can exert direct and indirect effects on the vascular system, potentially leading to severe complications such as thromboembolism...
September 6, 2017: Vascular Pharmacology
https://www.readbyqxmd.com/read/28887627/-sepsis-masquerading-as-delirium
#5
REVIEW
A Seifert, C S Hartog, J Zweigner, W Schummer, K Reinhart
A previously healthy 60-year-old patient presented to the emergency department with severe headache, altered personality and fever. He was treated for bacterial meningitis with delirium of unknown cause but presumed to be due to alcohol withdrawal. Despite receiving the antibiotic therapy regimen recommended for bacterial meningitis the patient's condition rapidly deteriorated with profound delirium and tachypnea. The intensivist who was consulted immediately suspected sepsis-associated organ failure and admitted the patient to the intensive care unit (ICU)...
September 8, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28876970/responding-to-ten-common-delirium-misconceptions-with-best-evidence-an-educational-review-for-clinicians
#6
Mark A Oldham, Nina M Flanagan, Ariba Khan, Olga Boukrina, Edward R Marcantonio
Delirium (acute confusion) is a serious, common health condition, and it predicts poor outcomes, including greater rates of mortality, institutionalization, prolonged hospitalization, and cognitive impairment. Expedient diagnosis and management are critical to address modifiable delirium causes and improve both quality of care and outcomes. Moreover, more than a third of delirium is preventable. Despite the clear significance of delirium and our increasingly sophisticated understanding of the condition, the gap between evidence and practice persists...
September 6, 2017: Journal of Neuropsychiatry and Clinical Neurosciences
https://www.readbyqxmd.com/read/28875384/rare-cause-of-delirium-and-hypoxemia-after-coronary-bypass-surgery-transdermal-lidocaine-patch-associated-methemoglobinemia
#7
Fidel A Acevedo, Esther J Kim, David A Chyatte, Vance G Nielsen
We present a case of a patient administered parasternal transdermal lidocaine patch therapy as part of a multimodal analgesic regime designed to diminish opioid-associated delirium after coronary bypass surgery. The patient presented with delirium and severe methemoglobinemia (41%) that responded to discontinuation of lidocaine therapy, oxygen administration, and methylene blue administration. The clinical contributors and medicolegal implications of this degree of lidocaine-associated methemoglobin-mediated delirium are presented in the hope of avoiding similar complications in the postoperative setting after coronary bypass surgery...
September 5, 2017: International Journal of Legal Medicine
https://www.readbyqxmd.com/read/28869952/risk-factors-for-delirium-in-older-medical-inpatients-in-tanzania
#8
Emma Grace Lewis, Jessica Banks, Stella-Maria Paddick, Ashanti Duinmaijer, Laura Tucker, Aloyce Kisoli, Jane Cletus, Carolyn Lissu, Kajiru Kilonzo, Glynis Cosker, Elizabeta Blagoja Mukaetova-Ladinska, Catherine Dotchin, William Gray, Richard Walker, Sarah Urasa
BACKGROUND: The risk factors for prevalent delirium in older hospitalised adults in Sub-Saharan Africa (SSA) remain poorly characterised. METHODS: A total of 510 consecutive admissions of adults aged ≥60 years to acute medical wards of Kilimanjaro Christian Medical Centre in northern Tanzania were recruited. Patients were assessed within 24 h of admission with a risk factor questionnaire, physiological observations, neurocognitive assessment, and informant interview...
September 5, 2017: Dementia and Geriatric Cognitive Disorders
https://www.readbyqxmd.com/read/28869145/the-early-diagnosis-and-management-of-mixed-delirium-in-a-patient-placed-on-ecmo-and-with-difficult-sedation-a-case-report
#9
María Acevedo-Nuevo, Maria Teresa González-Gil, Miguel Ángel Romera-Ortega, Ignacio Latorre-Marco, Maria Dolores Rodríguez-Huerta
Delirium represents a serious problem that impacts the physical and cognitive prognosis of patients admitted to intensive care units and requires prompt diagnosis and management. This article describes the case and progress of a patient placed on Extracorporeal Membrane Oxygenation with difficult sedation criteria and an early diagnosis of mixed delirium. During the case report, we reflect on the pharmacological and non-pharmacological strategies employed to cope with delirium paying special attention to the non-use of physical restraint measures in order to preserve vital support devices (endotracheal tube or Extracorporeal Membrane Oxygenation cannula)...
August 28, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/28868035/a-novel-stress-diathesis-model-to-predict-risk-of-post-operative-delirium-implications-for-intra-operative-management
#10
Renée El-Gabalawy, Ronak Patel, Kayla Kilborn, Caitlin Blaney, Christopher Hoban, Lawrence Ryner, Duane Funk, Regina Legaspi, Joseph A Fisher, James Duffin, David J Mikulis, W Alan C Mutch
Introduction: Risk assessment for post-operative delirium (POD) is poorly developed. Improved metrics could greatly facilitate peri-operative care as costs associated with POD are staggering. In this preliminary study, we develop a novel stress-diathesis model based on comprehensive pre-operative psychiatric and neuropsychological testing, a blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI) carbon dioxide (CO2) stress test, and high fidelity measures of intra-operative parameters that may interact facilitating POD...
2017: Frontiers in Aging Neuroscience
https://www.readbyqxmd.com/read/28864877/clinical-assessment-and-management-of-delirium-in-the-palliative-care-setting
#11
Shirley Harvey Bush, Sallyanne Tierney, Peter Gerard Lawlor
Delirium is a neurocognitive syndrome arising from acute global brain dysfunction, and is prevalent in up to 42% of patients admitted to palliative care inpatient units. The symptoms of delirium and its associated communicative impediment invariably generate high levels of patient and family distress. Furthermore, delirium is associated with significant patient morbidity and increased mortality in many patient populations, especially palliative care where refractory delirium is common in the dying phase. As the clinical diagnosis of delirium is frequently missed by the healthcare team, the case for regular screening is arguably very compelling...
September 1, 2017: Drugs
https://www.readbyqxmd.com/read/28863011/sedation-and-mobilization-during-venovenous-extracorporeal-membrane-oxygenation-for-acute-respiratory-failure-an-international-survey
#12
Jonathan D Marhong, Julian DeBacker, Julien Viau-Lapointe, Laveena Munshi, Lorenzo Del Sorbo, Lisa Burry, Eddy Fan, Sangeeta Mehta
OBJECTIVES: To characterize sedation, analgesia, delirium, and mobilization practices in patients supported with venovenous extracorporeal membrane oxygenation for severe acute respiratory failure. DESIGN: Cross-sectional electronic survey administered January 2016 to March 2016. SETTING: Three-hundred ninety-four extracorporeal membrane oxygenation centers registered with the Extracorporeal Life Support Organization. SUBJECTS: Extracorporeal membrane oxygenation medical directors and program coordinators...
August 31, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28858917/why-do-we-fail-to-deliver-evidence-based-practice-in-critical-care-medicine
#13
Curtis H Weiss
PURPOSE OF REVIEW: The use of evidence-based practices in clinical practice is frequently inadequate. Recent research has uncovered many barriers to the implementation of evidence-based practices in critical care medicine. Using a comprehensive conceptual framework, this review identifies and classifies the barriers to implementation of several major critical care evidence-based practices. RECENT FINDINGS: The many barriers that have been recently identified can be classified into domains of the consolidated framework for implementation research (CFIR)...
October 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/28854540/electroencephalography-and-delirium-in-the-postoperative-period
#14
B J A Palanca, T S Wildes, Y S Ju, S Ching, M S Avidan
Delirium commonly manifests in the postoperative period as a clinical syndrome resulting from acute brain dysfunction or encephalopathy. Delirium is characterized by acute and often fluctuating changes in attention and cognition. Emergence delirium typically presents and resolves within minutes to hours after termination of general anaesthesia. Postoperative delirium hours to days after an invasive procedure can herald poor outcomes. Easily recognized when patients are hyperactive or agitated, delirium often evades diagnosis as it most frequently presents with hypoactivity and somnolence...
August 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28854401/post-icu-psychological-morbidity-in-very-long-icu-stay-patients-with-ards-and-delirium
#15
Farshid R Bashar, Amir Vahedian-Azimi, Mohammadreza Hajiesmaeili, Mahmood Salesi, Behrooz Farzanegan, Seyedpouzhia Shojaei, Reza Goharani, Seyed J Madani, Kivan G Moghaddam, Sevak Hatamian, Hosseinali J Moghaddam, Seyed M M Mosavinasab, Elamin M Elamin, Andrew C Miller
PURPOSE: We investigated the impact of delirium on illness severity, psychological state, and memory in acute respiratory distress syndrome patients with very long ICU stay. MATERIALS AND METHODS: Prospective cohort study in the medical-surgical ICUs of 2 teaching hospitals. Very long ICU stay (>75days) and prolonged delirium (≥40days) thresholds were determined by ROC analysis. Subjects were ≥18years, full-code, and provided informed consent. Illness severity was assessed using Acute Physiology and Chronic Health Evaluation IV, Simplified Acute Physiology Score-3, and Sequential Organ Failure Assessment scores...
August 24, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28846882/alzheimer-s-related-cortical-atrophy-is-associated-with-postoperative-delirium-severity-in-persons-without-dementia
#16
Annie M Racine, Tamara G Fong, Thomas G Travison, Richard N Jones, Yun Gou, Sarinnapha M Vasunilashorn, Edward R Marcantonio, David C Alsop, Sharon K Inouye, Bradford C Dickerson
Patients with dementia due to Alzheimer's disease (AD) have increased risk of developing delirium. This study investigated the relationship between a magnetic resonance imaging (MRI)-derived biomarker associated with preclinical AD and postoperative delirium. Participants were older adults (≥70 years) without dementia who underwent preoperative MRI and elective surgery. Delirium incidence and severity were evaluated daily during hospitalization. Cortical thickness was averaged across a published set of a priori brain regions to derive a measure known as the "AD signature...
August 4, 2017: Neurobiology of Aging
https://www.readbyqxmd.com/read/28843663/risk-factors-and-outcomes-of-critically-ill-patients-with-acute-brain-failure-a-novel-end-point
#17
Tarun D Singh, John C O'Horo, Ognjen Gajic, Amra Sakusic, Courtney N Day, Jay Mandrekar, Rahul Kashyap, Dereddi Raja Shekar Reddy, Alejandro A Rabinstein
OBJECTIVE: To determine the incidence, risk factors and outcomes of acute brain failure (ABF) in a mixed medical and surgical cohort of critically ill patients and its effect on ICU & hospital mortality. DESIGN: Observational electronic medical record (EMR) based retrospective cohort study of critically ill patients admitted to the ICU between 2006 and 2013. SETTING: Tertiary academic medical center. PATIENTS: Consecutive adult (>18years) critically ill patients admitted to medical and surgical ICUs...
August 18, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28843537/sophia-observation-withdrawal-symptoms-paediatric-delirium-scale-a-tool-for-early-screening-of-delirium-in-the-picu
#18
Erwin Ista, Harma Te Beest, Joost van Rosmalen, Matthijs de Hoog, Dick Tibboel, Babette van Beusekom, Monique van Dijk
BACKGROUND: Delirium in critically ill children is a severe neuropsychiatric disorder which has gained increased attention from clinicians. Early identification of delirium is essential for successful management. The Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) scale was developed to detect Paediatric Delirium (PD) at an early stage. OBJECTIVE: The aim of this study was to determine the measurement properties of the PD component of the SOS-PD scale in critically ill children...
August 23, 2017: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/28836711/delirium-tremens-and-alcohol-withdrawal-nationally-in-the-veterans-health-administration
#19
David Thomas Moore, Brian Scott Fuehrlein, Robert Alan Rosenheck
BACKGROUND AND OBJECTIVES: Alcohol withdrawal-especially delirium tremens (DT)-is a potentially life-threatening condition. While short-term treatment regimens and factors that predispose to more severe symptomatology have been extensively studied, little attention has been paid to the clinical epidemiology and long-term care of the chronic medical, addictive, psychiatric, and psychosocial problems faced by these patients. METHODS: National Veterans Health Administration data from fiscal year 2012 were examined to identify veterans diagnosed with DT; with withdrawal but not DT (WNDT); and with Alcohol Use Disorder (AUD) but neither DT nor WNDT...
August 24, 2017: American Journal on Addictions
https://www.readbyqxmd.com/read/28835678/altered-cortical-brain-activity-in-end-stage-liver-disease-assessed-by-multi-channel-near-infrared-spectroscopy-associations-with-delirium
#20
Atsushi Yoshimura, Carrie Goodson, Jordan T Johns, Maxwell M Towe, Esme S Irvine, Nada A Rendradjaja, Laura K Max, Andrew LaFlam, Emily C Ledford, Julia Probert, Zoë Tieges, David H Edwin, Alasdair M J MacLullich, Charles W Hogue, Martin A Lindquist, Ahmet Gurakar, Karin J Neufeld, Atsushi Kamiya
Delirium is a common and serious psychiatric syndrome caused by an underlying medical condition. It is associated with significant mortality and increased healthcare resource utilization. There are few biological markers of delirium, perhaps related to the etiologic heterogeneity of the syndrome. Functional near-infrared spectroscopy (fNIRS) is an optical topography system to measure changes in the concentration of oxygenated hemoglobin ([oxy-Hb]) in the cerebral cortex. We examined whether altered cortical brain activity in delirious patients with end stage liver disease (ESLD) is detected by fNIRS...
August 23, 2017: Scientific Reports
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