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https://www.readbyqxmd.com/read/28738033/how-can-i-implement-accurate-delirium-screening-and-prevention-practices
#1
Kimberly Sanchez
As a clinical nurse specialist (CNS), I am tasked with improving patient outcomes through collaborative research, evidence-based practice, and process improvement efforts that affect the quality and safety of patient care. However, I have learned over time that it is not enough to simply incorporate the latest evidence into organizational policies and procedures; it has to be followed in practice. 
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August 1, 2017: Clinical Journal of Oncology Nursing
https://www.readbyqxmd.com/read/28737064/the-effects-of-delirium-prevention-guidelines-on-elderly-stroke-patients
#2
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/28736089/long-term-cognitive-impairment-and-delirium-in-intensive-care-a-prospective-cohort-study
#3
Marion L Mitchell, David H K Shum, Gabor Mihala, Jenny E Murfield, Leanne M Aitken
BACKGROUND: Whilst there is a growing body of research exploring the effect of delirium in intensive care unit (ICU) patients, the relationship between patient delirium and long-term cognitive impairment has not been investigated in settings where low rates of delirium have been reported. OBJECTIVES: To assess the association between the incidence of delirium, duration of mechanical ventilation and long term cognitive impairment in general ICU patients. METHODS: Prospective cohort study conducted in a tertiary level ICU in Queensland, Australia...
July 20, 2017: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/28734825/trials-of-statins-in-delirium-stymied-by-complex-methods
#4
Yoanna Skrobik, John Devlin
No abstract text is available yet for this article.
July 19, 2017: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/28734823/evaluation-of-early-administration-of-simvastatin-in-the-prevention-and-treatment-of-delirium-in-critically-ill-patients-undergoing-mechanical-ventilation-modus-a-randomised-double-blind-placebo-controlled-trial
#5
Valerie J Page, Annalisa Casarin, E Wesley Ely, Xiao Bei Zhao, Cliona McDowell, Lynn Murphy, Daniel F McAuley
BACKGROUND: Delirium in critically ill patients is associated with poor clinical outcomes. Neuroinflammation might be an important mechanism in the pathogenesis of delirium, and since simvastatin has anti-inflammatory properties it might reduce delirium. We aimed to establish whether early treatment with simvastatin would decrease the time that survivors of critical illness spent in delirium or coma. METHODS: We undertook this randomised, double-blind, placebo-controlled trial in a general adult intensive care unit (ICU) in Watford General Hospital (Watford, UK)...
July 19, 2017: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/28733841/analgosedation-of-adult-patients-with-elevated-intracranial-pressure-survey-of-current-clinical-practice-in-austria
#6
Guenther Herzer, Claudia Mirth, Udo M Illievich, Wolfgang G Voelckel, Helmut Trimmel
BACKGROUND: Analgesia and sedation are key items in intensive care. Recently published S3 guidelines specifically address treatment of patients with elevated intracranial pressure. METHODS: The Austrian Society of Anesthesiology, Resuscitation and Intensive Care Medicine carried out an online survey of neurointensive care units in Austria in order to evaluate the current state of practice in the areas of analgosedation and delirium management in this high-risk patient group...
July 21, 2017: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/28731948/managing-cancer-pain-in-older-adults
#7
Emily J Guerard, James F Cleary
Managing cancer pain in older adults can be complex and challenging. Understanding the unique needs of older patients with cancer is important to safe and effective pain management. The goals of this review are to discuss the assessment of older adults with cancer-related pain, treatment of cancer pain, and adverse effects or potential risks from treatment that are unique to older patients. A detailed pain assessment and when possible utilizing the geriatric assessment are vital to developing a cancer pain management plan...
July 2017: Cancer Journal
https://www.readbyqxmd.com/read/28728515/the-prevalence-of-constipation-at-admission-and-after-one-week-of-palliative-care-a-multicenter-study
#8
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/28728199/-polypharmacy-solutions-for-enhanced-drug-safety
#9
Olaf Krause, Gesine Picksak, Ulrike Junius-Walker
Polypharmacy (≥ 5 drugs) is common among older people and may lead to falls, ADEs and delirium. Adherence is an important part in the medication management. Simple questions (i. e. for OTC, handling and omission of drugs) are effective. As most old people are treated by general practitioners (GP), they play a key role for drug safety and reducing polypharmacy. The involvement of pharmacists in analyzing one patient's drugs can enhance solutions for drug problems ("two-man rule"). An IT-based medication plan acts as an important communication tool for an enhanced team work between doctors, pharmacists and nursing care...
July 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28727581/perioperative-gabapentin-does-not-reduce-postoperative-delirium-in-older-surgical-patients-a-randomized-clinical-trial
#10
Jacqueline M Leung, Laura P Sands, Ningning Chen, Christopher Ames, Sigurd Berven, Kevin Bozic, Shane Burch, Dean Chou, Kenneth Covinsky, Vedat Deviren, Sakura Kinjo, Joel H Kramer, Michael Ries, Bobby Tay, Thomas Vail, Philip Weinstein, Stacey Chang, Gabriela Meckler, Stacey Newman, Tiffany Tsai, Vanessa Voss, Emily Youngblom
BACKGROUND: Postoperative pain and opioid use are associated with postoperative delirium. We designed a single-center, randomized, placebo-controlled, parallel-arm, double-blinded trial to determine whether perioperative administration of gabapentin reduced postoperative delirium after noncardiac surgery. METHODS: Patients were randomly assigned to receive placebo (N = 347) or gabapentin 900 mg (N = 350) administered preoperatively and for the first 3 postoperative days...
July 20, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28725854/improving-the-patient-experience-by-implementing-an-icu-diary-for-those-at-risk-of-post-intensive-care-syndrome
#11
K Taylor A Blair, Sarah D Eccleston, Hannah M Binder, Mary S McCarthy
The critical care literature in the US has recently brought attention to the impact an ICU experience can have long after the patient survives critical illness, particularly if delirium was present. Current recommendations to mitigate post-intensive care syndrome (PICS) are embedded in patient and family-centered care and aim to promote family presence in the ICU, provide support for decision-making, and enhance communication with the health-care team. Evidence-based interventions are few in number but include use of an ICU diary to minimize the psychological and emotional sequelae affecting patients and family members in the months following the ICU stay...
March 2017: Journal of patient experience
https://www.readbyqxmd.com/read/28725569/psychiatric-adult-onset-of-urea-cycle-disorders-a-case-series
#12
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/28725244/optimal-perioperative-anesthesia-management-for-gynecologic-interstitial-brachytherapy
#13
Alison A Nielsen, Tehani A Liyanage, Gary S Leiserowitz, Jyoti Mayadev
PURPOSE: To propose an optimal perioperative pain management clinical care pathway for interstitial brachytherapy for gynecologic cancer based on our interdepartmental experience. MATERIAL AND METHODS: We conducted a retrospective review of 23 women who underwent 32 interstitial brachytherapy procedures for gynecological cancers, analyzing patient demographics, type of anesthetic, medications, postoperative pain scores, adverse events, and delays in discharge. We measured the association of postoperative nausea and/or vomiting (PONV) with hydromorphone use, and postoperative pain scores and total narcotic administration with type of anesthesia...
June 2017: Journal of Contemporary Brachytherapy
https://www.readbyqxmd.com/read/28725169/postoperative-delirium-after-pharyngolaryngectomy-with-esophagectomy-a-role-for-ramelteon-and-suvorexant
#14
Eisuke Booka, Yasuhiro Tsubosa, Teruaki Matsumoto, Mari Takeuchi, Takashi Kitani, Masato Nagaoka, Atsushi Imai, Tomoyuki Kamijo, Yoshiyuki Iida, Ayako Shimada, Katsushi Takebayashi, Masahiro Niihara, Keita Mori, Tetsuro Onitsuka, Hiroya Takeuchi, Yuko Kitagawa
BACKGROUND: Postoperative delirium is common after extensive surgery, and is known to be associated with sleeping medications. In this study, we aimed to investigate the relationships between sleeping medications and postoperative delirium after pharyngolaryngectomy with esophagectomy. METHODS: We performed a retrospective analysis of 65 patients who underwent pharyngolaryngectomy with esophagectomy at Shizuoka Cancer Center Hospital between January 2012 and March 2016...
2017: Esophagus: Official Journal of the Japan Esophageal Society
https://www.readbyqxmd.com/read/28723773/development-and-validation-of-risk-stratification-delirium-prediction-model-for-critically-ill-patients-a-prospective-observational-single-center-study
#15
Yu Chen, Hang Du, Bao-Hua Wei, Xue-Ni Chang, Chen-Ming Dong
The objective is to develop a model based on risk stratification to predict delirium among adult critically ill patients and whether early intervention could be provided for high-risk patients, which could reduce the incidence of delirium.We designed a prospective, observational, single-center study. We examined 11 factors, including age, APACHE-II score, coma, emergency operation, mechanical ventilation (MV), multiple trauma, metabolic acidosis, history of hypertension, delirium and dementia, and application of Dexmedetomidine Hydrochloride...
July 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28721543/-decision-aids-in-complex-polypharmacy-medication-data-bases-and-counselling-by-clinical-pharmacists
#16
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/28720164/the-detection-diagnosis-and-impact-of-cognitive-impairment-among-inpatients-aged-65-years-and-over-in-an-irish-general-hospital-a-prospective-observational-study
#17
Clodagh Power, Richard Duffy, Helena Bates, Mike Healy, Petrina Gleeson, Brian A Lawlor, Elaine Greene
BACKGROUND: The diagnosis of dementia remains inadequate, even within clinical settings. Data on rates and degree of impairment among inpatients are vital for service planning and the provision of appropriate patient care as Ireland's population ages. METHODS: Every patient aged 65 years and over admitted over a two-week period was invited to participate. Those who met inclusion criteria were screened for delirium then underwent cognitive screening. Demographic, functional, and outcome data were obtained from medical records, participants, and family...
July 19, 2017: International Psychogeriatrics
https://www.readbyqxmd.com/read/28718100/risk-factors-for-delirium-after-cardiac-surgery-a-historical-cohort-study-outlining-the-influence-of-cardiopulmonary-bypass
#18
Jason B O'Neal, Frederic T Billings, Xulei Liu, Matthew S Shotwell, Yafen Liang, Ashish S Shah, Jesse M Ehrenfeld, Jonathan P Wanderer, Andrew D Shaw
PURPOSE: Cardiopulmonary bypass (CPB) induces a significant inflammatory response that may increase the risk for delirium. We hypothesized that exposure to CPB during coronary artery bypass grafting (CABG) surgery would correlate with an increased risk of delirium. METHODS: We reviewed clinical data from two databases at our medical centre - the Cardiac Surgery Perioperative Outcomes Database and the Society of Thoracic Surgeons Database. Patients undergoing elective CABG surgery (on-pump and off-pump) from November 1, 2009 to September 30, 2015 were included in the study...
July 17, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28715077/age-and-gender-related-peculiarities-of-patients-with-delirium-in-the-cardiac-intensive-care-unit
#19
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/28711314/independent-predictors-of-the-duration-and-overall-burden-of-postoperative-delirium-after-cardiac-surgery-in-adults-an-observational-cohort-study
#20
Christian Cereghetti, Martin Siegemund, Sabine Schaedelin, Jens Fassl, Manfred D Seeberger, Friedrich S Eckstein, Luzius A Steiner, Nicolai Goettel
OBJECTIVE: Postoperative delirium (POD) is a common complication after cardiac surgery and is associated with increased patient morbidity and mortality. The objective of this study was to identify risk factors for long duration and overall burden of POD after cardiac surgery. DESIGN: One-year, single-center, retrospective, observational cohort study. SETTING: University hospital. PARTICIPANTS: Adult patients undergoing cardiac surgery with cardiopulmonary bypass in 2013...
March 31, 2017: Journal of Cardiothoracic and Vascular Anesthesia
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