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Severity delirium

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https://www.readbyqxmd.com/read/28741278/italian-intersociety-consensus-on-prevention-diagnosis-and-treatment-of-delirium-in-hospitalized-older-persons
#1
Giuseppe Bellelli, Alessandro Morandi, Marco Trabucchi, Guido Caironi, Daniele Coen, Carlo Fraticelli, Ciro Paolillo, Carolina Prevaldi, Angela Riccardi, Gianfranco Cervellin, Corrado Carabellese, Salvatore Putignano, Stefania Maggi, Antonio Cherubini, Paola Gnerre, Andrea Fontanella, Nicola Latronico, Concezione Tommasino, Antonio Corcione, Giovanni Ricevuti, Nicola Ferrara, Francesco De Filippi, Alberto Ferrari, Mario Guarino, Maria Pia Ruggieri, Pietro Amedeo Modesti, Carlo Locatelli, Patrizia Hrelia, Marco Otto Toscano, Emi Bondi, Antonio Tarasconi, Luca Ansaloni, Francesco Perticone
Delirium is a severe neuropsychiatric syndrome characterized by inattention and global cognitive dysfunction in the setting of an acute medical illness, medical complication, drug intoxication, or drug withdrawal. The most important risk factors are advanced age and dementia, whereas pain, dehydration, infections, stroke, metabolic disturbances, and surgery are the most common triggering factors. Although delirium is a common clinical syndrome in different settings of care (acute care hospitals, inpatient rehabilitation facilities, nursing homes, and hospices), it often remains under-recognized, poorly understood, and inadequately managed...
July 24, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/28739068/management-of-emergence-delirium-in-adult-ptsd-patients-recommendations-for-practice
#2
Donnamarie Lovestrand, Steven Lovestrand, Denise M Beaumont, Jonathan G Yost
Emergence delirium is a known phenomenon which occurs after general anesthesia in approximately 5% of the general population. However, individuals who have been diagnosed with post-traumatic stress disorder may present with symptoms refractory to conventional methods of reorientation. In the past several years, literature has begun to address the problem, but no standardized guidelines exist at present. The authors synthesize the available literature, combining data with evidence-driven principles from multiple disciplines, to submit an initial set of guidelines until research either supports or disproves these recommendations...
August 2017: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/28737064/the-effects-of-delirium-prevention-guidelines-on-elderly-stroke-patients
#3
Jihye Song, Minkyung Lee, Dukyoo Jung
This study aimed to evaluate the effectiveness of the delirium prevention interventions recommended by the Delirium Prevention Guidelines for Elderly Stroke Patients (DPGESP). The DPGESP comprises nine dimensions with 28 interventions, including risk factor assessment, orientation disorder prevention, sleeping pattern maintenance, sensory interventions, constipation, dehydration, hypoxia and infection prevention, pain management, and appropriate nutrition maintenance. This quasi-experimental study used a nonequivalent control group and a pretest-posttest design...
July 1, 2017: Clinical Nursing Research
https://www.readbyqxmd.com/read/28728515/the-prevalence-of-constipation-at-admission-and-after-one-week-of-palliative-care-a-multicenter-study
#4
Sebastiano Mercadante, Francesco Masedu, Marco Maltoni, Daniela De Giovanni, Luigi Montanari, Cristina Pittureri, Raffaella Bertè, Laura Ursini, Franco Marinangeli, Federica Aielli
AIM: To assess the prevalence and intensity of constipation in advanced-cancer patients referred to palliative care, and to assess changes after one week of specialist palliative care. METHODS: Prospective multicenter study in advanced patients for a period of one year. At admission (T0), age, gender, primary tumor, concomitant diseases, Karnofsky status, Palliative prognostic score (PaP) Edmonton Symptom Assessment scale (ESAS), MDAS (Memorial Delirium Assessment Scale), and bowel function index (BFI) were collected...
July 20, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28725569/psychiatric-adult-onset-of-urea-cycle-disorders-a-case-series
#5
Adrien Bigot, Paul Brunault, Christian Lavigne, François Feillet, Sylvie Odent, Elsa Kaphan, Christel Thauvin, Vanessa Leguy, Pierre Broué, Michel C Tchan, François Maillot
Adult onset urea cycle disorders (UCD) may present with psychiatric symptoms, occasionally as the initial presentation. We aimed to describe the characteristics of patients presenting with a psychiatric adult-onset of UCDs, to discuss which signs could suggest this diagnosis in such a situation, and to determine which tests should be conducted. A survey of psychiatric symptoms occurring in teenagers or adults with UCD was conducted in 2010 among clinicians involved in the French society for the study of inborn errors of metabolism (SFEIM)...
September 2017: Molecular Genetics and Metabolism Reports
https://www.readbyqxmd.com/read/28721543/-decision-aids-in-complex-polypharmacy-medication-data-bases-and-counselling-by-clinical-pharmacists
#6
REVIEW
W Weinrebe, R Preda, S Bischoff, D Nussbickel, M Humm, K Jeckelmann, S Goetz
The number of older people with polypharmacy (more than six drugs taken simultaneously) is increasing. The greatest proportion consists of guideline drugs, analgesics and psychopharmaceuticals because in many cases of geriatric multimorbidity several underlying main diseases are present which must be treated according to the guidelines. Polypharmacy is a complex and difficult situation for all treating physicians because substantial side effects and intoxication can be induced but it can also be very difficult to recognize which drug was at fault and how a reduction can be safely made...
July 18, 2017: Zeitschrift Für Gerontologie und Geriatrie
https://www.readbyqxmd.com/read/28715077/age-and-gender-related-peculiarities-of-patients-with-delirium-in-the-cardiac-intensive-care-unit
#7
Pranas Serpytis, Petras Navickas, Alvydas Navickas, Rokas Serpytis, Giedrius Navickas, Sigita Glaveckaite
BACKGROUND: The overall evidence base regarding delirium has been growing steadily over the past few decades. There has been considerable analysis of delirium concerning, for example, mechanically ventilated patients, patients in the general intensive care unit (ICU) setting, and patients with exclusively postoperative delirium. Nevertheless, there are few studies regarding delirium in a cardiovascular ICU (ICCU) setting and especially scarce literature about the particular features of delirium relating to patient age and gender...
July 17, 2017: Kardiologia Polska
https://www.readbyqxmd.com/read/28710219/comparison-of-propofol-and-dexmedetomidine-infused-overnight-to-treat-hyperactive-and-mixed-icu-delirium-a-protocol-for-the-basel-prodex-clinical-trial
#8
Alexa Hollinger, Katrin Ledergerber, Stefanie von Felten, Raoul Sutter, Stephan Rüegg, Lukas Gantner, Sibylle Zimmermann, Andrea Blum, Luzius A Steiner, Stephan Marsch, Martin Siegemund
BACKGROUND/OBJECTIVES: Delirium is a neurobehavioural disturbance that frequently develops particularly in the intensive care unit (ICU) population. It was first described more than half a century ago, where it was already discovered as a state that might come along with serious complications such as prolonged ICU and hospital stay, reduced quality of life and increased mortality. However, in most cases, there is still lack of proof for causal relationship. Its presence frequently remains unrecognised due to suggested predominance of the hypoactive form...
July 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/28700610/perioperative-hemodynamics-and-risk-for-delirium-and-new-onset-dementia-in-hip-fracture-patients-a-prospective-follow-up-study
#9
Bjørn Erik Neerland, Maria Krogseth, Vibeke Juliebø, Anette Hylen Ranhoff, Knut Engedal, Frede Frihagen, Johan Ræder, Torgeir Bruun Wyller, Leiv Otto Watne
BACKGROUND: Delirium is common in hip fracture patients and many risk factors have been identified. Controversy exists regarding the possible impact of intraoperative control of blood pressure upon acute (delirium) and long term (dementia) cognitive decline. We explored possible associations between perioperative hemodynamic changes, use of vasopressor drugs, risk of delirium and risk of new-onset dementia. METHODS: Prospective follow-up study of 696 hip fracture patients, assessed for delirium pre- and postoperatively, using the Confusion Assessment Method...
2017: PloS One
https://www.readbyqxmd.com/read/28699845/development-and-implementation-of-an-alcohol-withdrawal-protocol-using-a-5-item-brief-alcohol-withdrawal-scale-baws
#10
Darius A Rastegar, Dinah Applewhite, Anika A H Alvanzo, Christopher Welsh, Timothy Niessen, Edward S Chen
BACKGROUND: The standard of care for management of alcohol withdrawal is symptom-triggered treatment using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale. Many items of this 10-question scale rely on subjective assessments of withdrawal symptoms, making it time-consuming and cumbersome to use. Therefore, there is interest in shorter and more objective methods to assess alcohol withdrawal symptoms. METHODS: We initially piloted a 6-item withdrawal scale developed at another institution...
July 12, 2017: Substance Abuse
https://www.readbyqxmd.com/read/28692620/delirium-in-the-icu-what-about-the-floor
#11
Anthony Cahill, Christopher Pearcy, Vaidehi Agrawal, Phillip Sladek, Michael S Truitt
Delirium was first described in the 1800s as acute, fluctuating confusion. Recent studies note an incidence of 15% in adult intensive care unit patients. Here we present the first prospective study to evaluate the incidence and risk factors for delirium in patients admitted to the trauma surgeon (TS) in non-critical care areas (NCCAs). Patients 18 years or older admitted to any TS in the designated NCCA were evaluated and consented for participation over a 3-month period. Participants were screened with the Confusion Assessment Method (CAM) every 12 hr...
July 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/28690539/neurimmirs-and-postoperative-delirium-in-elderly-patients-undergoing-total-hip-knee-replacement-a-pilot-study
#12
Rui Dong, Lingling Sun, Yayuan Lu, Xi Yang, Mian Peng, Zongze Zhang
Objective: Postoperative delirium (POD) is a frequent complication after surgery and its occurrence is associated with poor outcomes. The pathophysiology of this complication is not clear, but identification of risk factors is important for positive postoperative outcomes. The purpose of this study was to investigate the associations between the preoperative expression levels of microRNA (miR)-146a, miR-125b, and miR-181c in cerebrospinal fluid (CSF) and serum and the development and severity of POD. Methods: Forty elderly patients aged 65 years old and older admitted for elective total hip/knee replacement under spinal anesthesia...
2017: Frontiers in Aging Neuroscience
https://www.readbyqxmd.com/read/28677160/risk-factors-for-the-incidence-of-delirium-in-cerebrovascular-patients-in-a-neurosurgery-intensive-care-unit-icu-a-prospective-study
#13
Jun Wang, Yuanyuan Ji, Ning Wang, Wenjin Chen, Yuehong Bao, Qinpu Qin, Qian Xiao, Shulan Li
AIMS AND OBJECTIVES: To explore the incidence of delirium in cerebrovascular patients admitted in our Neurosurgery Intensive Care Unit (NICU) and analyze the risk factors leading to delirium. BACKGROUND: Delirium is one of the most common mental disorders in general hospitals, but the incidence of different kinds of diseases and studies varies. Cerebrovascular patients in our NICU are high-risk groups for delirium; identifying risk factors for delirium and taking early interventions are crucial for patient prognosis...
July 5, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28668927/delirium-after-transcatheter-aortic-valve-replacement
#14
Jennifer L Giuseffi, Nyal E Borges, Leanne M Boehm, Li Wang, John A McPherson, Joseph L Fredi, Rashid M Ahmad, E Wesley Ely, Pratik P Pandharipande
BACKGROUND: Postoperative delirium is associated with increased mortality. Patients undergoing transcatheter aortic valve replacement are at risk for delirium because of comorbid conditions. OBJECTIVE: To compare the incidence, odds, and mortality implications of delirium between patients undergoing transcatheter replacement and patients undergoing surgical replacement. METHODS: The Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit were used to assess arousal level and delirium prospectively in all patients with severe aortic stenosis who had transcatheter or surgical aortic valve replacement at an academic medical center...
July 2017: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/28668925/perceptions-of-workload-burden-and-adherence-to-abcde-bundle-among-intensive-care-providers
#15
Leanne M Boehm, Mary S Dietrich, Eduard E Vasilevskis, Nancy Wells, Pratik Pandharipande, E Wesley Ely, Lorraine C Mion
BACKGROUND: Use of the interprofessional Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility (ABCDE) bundle is recommended practice in intensive care, but its adoption remains limited. OBJECTIVE: To examine the relationship between intensive care unit provider attitudes regarding the ABCDE bundle and ABCDE bundle adherence. METHODS: A 1-time survey of 268 care providers in 10 intensive care units across the country who had worked at least 4 shifts per month to examine their attitudes toward workload burden, difficulty carrying out the bundle, perceived safety, confidence, and perceived strength of evidence...
July 2017: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/28660596/risk-factors-for-mortality-in-elderly-patients-with-hip-fractures-a-meta-analysis-of-18-studies
#16
Yan Liu, Zhiqian Wang, Wenliang Xiao
BACKGROUND: Hip fracture is common and associated with poor outcomes in elderly patients. This meta-analysis aims to investigate the risk factors that might increase the mortality rate in elderly patients with hip fracture. METHODS: PubMed, Embase, and Web of Science were systematically searched for observational studies regarding the prognostic factors of mortality in elderly patients with hip fracture. A fixed-effects or random-effects model was used to calculate pooled hazard ratio (HR) and 95% confidence intervals (95% CIs)...
June 28, 2017: Aging Clinical and Experimental Research
https://www.readbyqxmd.com/read/28658156/comprehensive-geriatric-care-reduces-acute-perioperative-delirium-in-elderly-patients-with-hip-fractures-a-meta-analysis
#17
REVIEW
Yiyang Wang, Jun Tang, Feiya Zhou, Lei Yang, Jianbin Wu
BACKGROUND: The aim of the current meta-analysis was to assess the treatment effect of comprehensive geriatric care in reducing acute perioperative delirium in older patients with hip fractures, compared with the effect of a routine orthopedic treatment protocol. METHODS: We conducted a search of multiple databases to identify randomized controlled trials (RCTs) and quasi-RCTs comparing comprehensive geriatric care and routine orthopedic treatment regarding the following outcomes: incidence of delirium, assessment of cognitive status, and duration of delirium...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28652635/-risk-factors-for-delirium-in-intensive-care-unit-br-in-liver-transplant-patients
#18
Filippo Binda, Alessandro Galazzi, Alessandra Brambilla, Ileana Adamini, Dario Laquintana
. Risk factors for delirium in intensive care unit in liver transplant patients. INTRODUCTION: Delirium is a disorder of the state of consciousness characterized by acute onset and temporal variability of cognitive abilities. It is frequent in intensive care unit (ICU) and it is associated with worst outcomes. AIM: To identify risk factors for the development of delirium in patients in intensive care unit (ICU) after orthotopic liver transplantation (OLTx). METHODS: Observational retrospective study on all the patients undergoing OLTx between January 2014 and December 2015...
April 2017: Assistenza Infermieristica e Ricerca: AIR
https://www.readbyqxmd.com/read/28639340/impact-of-frailty-and-residual-subsyndromal-delirium-on-1-year-functional-recovery-a-prospective-cohort-study
#19
Justin Chew, Wee Shiong Lim, Mei Sian Chong, Yew Yoong Ding, Laura Tay
AIM: To investigate the association between frailty and incomplete delirium recovery at discharge (residual subsyndromal delirium [RSSD]), and to examine the mediating role of RSSD in the relationship between frailty and functional recovery at 12 months post-delirium. METHODS: This was a prospective observational study of 234 individuals aged ≥65 years admitted to a specialized delirium unit. A 20-item frailty index was derived using items from a comprehensive geriatric assessment...
June 22, 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/28625252/-cerebral-injury-induced-by-heat-stroke-and-the-therapeutic-effect-of-hyperbaric-oxygen-therapy
#20
Xiaoxiao Ni, Zhifeng Liu, Qiuyou Xie, Huasheng Tong, Lei Su, Ronghao Yu
With the global warming, the incidence of heat stroke was significantly higher than before. Severe heat stroke has a high mortality, high morbidity and consolidated central nervous system injury characteristics. The main features of severe heat stroke cerebral injury include cognitive impairment, delirium, convulsions and coma. Its mechanism is related with heat shock induced cerebral tissue ischemia and hypoxia, vascular dysfunction, secondary cascade inflammation and so on. Currently, the main treatment of heat stroke cerebral injury is the hypothermia therapy, dehydration for the reduction of intracranial pressure, naloxone and other cerebral protection and nutrition treatments...
June 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
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