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https://www.readbyqxmd.com/read/28547318/a-systematic-review-of-alpha-2-agonists-for-sedation-in-mechanically-ventilated-neurocritical-care-patients
#1
Alexandre Tran, Henrietta Blinder, Brian Hutton, Shane W English
The use of sedative medications is commonplace in intensive care units (ICUs) and an invaluable clinical tool for the intensive care physician. Sedation for critically ill, mechanically ventilated patients provides an opportunity to reduce anxiety, discomfort as well as ventilator intolerance and dyssynchrony. Alpha-2 agonists in particular have become increasingly popular for use in the neurocritical care population due to their proposed effectiveness in facilitating examinations and procedures as well as reducing the need for adjunctive agents...
May 25, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28546253/hypoactive-delirium
#2
Christian Hosker, David Ward
No abstract text is available yet for this article.
May 25, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28546233/a-case-of-confusion-paraneoplastic-encephalomyelitis-in-an-elderly-patient-suspected-of-having-urinary-tract-infection-associated-delirium
#3
Chris McKinnon, Simmie Manchanda
Acute confusion is a common symptom of physical illness in the older patient. In the majority, it is transient and resolves on treatment of precipitants. In a subset of patients, however, neurological decline is progressive, raising concern about a serious underlying cause. We describe the case of a 71-year-old woman who developed progressive cognitive impairment following insertion of a permanent pacemaker for sinoatrial arrests. An initial diagnosis of delirium secondary to a urinary tract infection was suspected; however, the patient became increasingly confused despite treatment...
May 24, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28545782/autoimmune-encephalopathy-for-psychiatrists-when-to-suspect-autoimmunity-and-what-to-do-next
#4
REVIEW
Mark Oldham
OBJECTIVE: To provide a critical review of autoimmune encephalopathy-broadly defined as neuropsychiatric features directly related to an autoimmune process-relevant for psychiatric practice. METHODS: We consulted rheumatology textbooks to define the scope of autoimmune conditions and identified recent reviews of rheumatic conditions, autoimmune vasculitis, and autoimmune encephalitis. We integrated these with primary reports to provide a clinically relevant overview of autoimmune encephalopathy...
May 2017: Psychosomatics
https://www.readbyqxmd.com/read/28542707/-urinary-tract-infection-requiem-for-a-heavyweight
#5
Thomas E Finucane
"Urinary tract infection" ("UTI") is an ambiguous, expansive, overused diagnosis that can lead to marked, harmful antibiotic overtreatment. "Significant bacteriuria," central to most definitions of "UTI," has little significance in identifying individuals who will benefit from treatment. "Urinary symptoms" are similarly uninformative. Neither criterion is well defined. Bacteriuria and symptoms remit and recur spontaneously. Treatment is standard for acute uncomplicated cystitis and common for asymptomatic bacteriuria, but definite benefits are few...
May 19, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28540116/using-care-bundles-to-improve-surgical-outcomes-and-reduce-variation-in-care-for-fragility-hip-fracture-patients
#6
Stephanie Bandara, Genni Lynch, Cameron Cooke, Paul Varghese, Nicola Ward
INTRODUCTION: Fragility hip fractures constitute a large proportion of orthogeriatric admissions to orthopedic wards. This study looked at reducing variation in care in fragility hip fracture patients using a novel approach with care bundles. The care bundle comprises 5 elements targeted at providing adequate analgesia, early mobilization, improving recognition of delirium, and decreasing rates of urinary infections. METHODS: A total of 198 patients who sustained a fragility hip fracture during the intervention period were included in the study...
June 2017: Geriatric Orthopaedic Surgery & Rehabilitation
https://www.readbyqxmd.com/read/28539958/cognitive-impairment-and-psychological-distress-at-discharge-from-intensive-care-unit
#7
Chi Ryang Chung, Hye Jin Yoo, Jinkyeong Park, Seunghyong Ryu
This study aimed to investigate cognitive impairment and psychological distress of critically ill patients at discharge from intensive care unit (ICU). This study included 30 critically ill patients who had neither pre-existing dementia nor ongoing delirium. At ICU discharge, they performed a screening test for cognitive impairment (Mini-Cog test) and completed questionnaires for depression (Patient Health Questionnaire-2, PHQ-2) and for 4 stressful experiences during ICU stay including nightmares, severe anxiety or panic, severe pain, and trouble to breathe or feeling of suffocation (Post-Traumatic Stress Syndrome 14-Question Inventory, PTSS-14 Part A)...
May 2017: Psychiatry Investigation
https://www.readbyqxmd.com/read/28539034/-the-short-term-outcome-and-safety-of-laparoscopic-colorectal-cancer-resection-in-very-elderly-patients
#8
Won Beom Jung, Jin Yong Shin, Byoung Jo Suh
Background/Aims: Due to the recent increase in elderly population, laparoscopic surgery is more frequently performed in the elderly. This study aimed to compare the short-term outcomes of laparoscopic colorectal cancer surgery between the very elderly group (VEG), categorized as those with age over 80 years and the elderly group (EG), categorized as those with age 65 to 79 years. Methods: We retrospectively compared 48 very elderly patients with 96 elderly patients (1:2 matched) who underwent laparoscopic resection for colorectal cancers at our institution between March 2010 and December 2014...
May 25, 2017: Korean Journal of Gastroenterology, Taehan Sohwagi Hakhoe Chi
https://www.readbyqxmd.com/read/28538964/effect-of-a-modified-hospital-elder-life-program-on-delirium-and-length-of-hospital-stay-in-patients-undergoing-abdominal-surgery-a-cluster-randomized-clinical-trial
#9
Cheryl Chia-Hui Chen, Hsiu-Ching Li, Jin-Tung Liang, I-Rue Lai, Jerry Dwi Trijoyo Purnomo, Yi-Ting Yang, Been-Ren Lin, John Huang, Ching-Yao Yang, Yu-Wen Tien, Chiung-Nien Chen, Ming-Tsan Lin, Guan-Hua Huang, Sharon K Inouye
Importance: Older patients undergoing abdominal surgery commonly experience preventable delirium, which extends their hospital length of stay (LOS). Objective: To examine whether a modified Hospital Elder Life Program (mHELP) reduces incident delirium and LOS in older patients undergoing abdominal surgery. Design, Setting, and Participants: This cluster randomized clinical trial of 577 eligible patients enrolled 377 older patients (≥65 years of age) undergoing gastrectomy, pancreaticoduodenectomy, and colectomy at a 2000-bed urban medical center in Taipei, Taiwan, from August 1, 2009, through October 31, 2012...
May 24, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28538959/interventions-to-reduce-postoperative-delirium-aligning-surgical-care-with-patients-needs-and-priorities
#10
Pasithorn A Suwanabol, Daniel B Hinshaw
No abstract text is available yet for this article.
May 24, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28537937/dexmedetomidine-the-new-all-in-one-drug-in-paediatric-anaesthesia
#11
Cedric E Sottas, Brian J Anderson
PURPOSE OF REVIEW: Dexmedetomidine is a drug with sedative, anxiolytic, sympatholytic and analgesic properties, which is finding widespread practice in paediatric anaesthesia and related practices. The present review summarizes its pharmacology and current experience with the drug. RECENT FINDINGS: Dexmedetomidine is proving useful in many diverse areas in paediatric anaesthesia where its sedative properties are useful for premedication, fibreoptic intubation and radiologic procedures...
May 22, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28535577/-delirium-a-frequent-neuropsychiatric-complication
#12
G R Fink
No abstract text is available yet for this article.
May 2017: Fortschritte der Neurologie-Psychiatrie
https://www.readbyqxmd.com/read/28534181/assessing-decision-making-capacity-for-do-not-resuscitate-requests-in-depressed-patients-how-to-apply-the-communication-and-appreciation-criteria
#13
Benjamin D Brody, Ellen C Meltzer, Diana Feldman, Julie B Penzner, Janna S Gordon-Elliot
The Patient Self Determination Act (PSDA) of 1991 brought much needed attention to the importance of advance care planning and surrogate decision-making. The purpose of this law is to ensure that a patient's preferences for medical care are recognized and promoted, even if the patient loses decision-making capacity (DMC). In general, patients are presumed to have DMC. A patient's DMC may come under question when distortions in thinking and understanding due to illness, delirium, depression or other psychiatric symptoms are identified or suspected...
May 22, 2017: HEC Forum: An Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
https://www.readbyqxmd.com/read/28533746/intraoperative-frontal-alpha-band-power-correlates-with-preoperative-neurocognitive-function-in-older-adults
#14
Charles M Giattino, Jacob E Gardner, Faris M Sbahi, Kenneth C Roberts, Mary Cooter, Eugene Moretti, Jeffrey N Browndyke, Joseph P Mathew, Marty G Woldorff, Miles Berger
Each year over 16 million older Americans undergo general anesthesia for surgery, and up to 40% develop postoperative delirium and/or cognitive dysfunction (POCD). Delirium and POCD are each associated with decreased quality of life, early retirement, increased 1-year mortality, and long-term cognitive decline. Multiple investigators have thus suggested that anesthesia and surgery place severe stress on the aging brain, and that patients with less ability to withstand this stress will be at increased risk for developing postoperative delirium and POCD...
2017: Frontiers in Systems Neuroscience
https://www.readbyqxmd.com/read/28533149/prevalence-and-characteristics-of-catatonia-on-admission-to-an-acute-geriatric-psychiatry-ward
#15
Jorge Cuevas-Esteban, Maria Iglesias-González, Maria Rubio-Valera, Jordi Serra-Mestres, Antoni Serrano, Luisa Baladon
BACKGROUND: This study aims to describe the prevalence of catatonia in a population of older acute psychiatric inpatients according to different diagnostic criteria. Secondary objectives are: to compare the catatonic symptom profile, prevalence, and severity, in respect to the underlying aetiology, and to evaluate the association between catatonic and somatic comorbidity. METHODS: The study included 106 patients admitted to an acute geriatric psychiatry ward. Catatonia was assessed using the Bush Francis Catatonia Rating Scale (BFCRS)...
May 19, 2017: Progress in Neuro-psychopharmacology & Biological Psychiatry
https://www.readbyqxmd.com/read/28533062/predicting-inpatient-delirium-the-awol-delirium-risk-stratification-score-in-clinical-practice
#16
Ethan G Brown, S Andrew Josephson, Noriko Anderson, Mary Reid, Melissa Lee, Vanja C Douglas
Inpatient delirium improves with multicomponent interventions by hospital staff, though the resources needed are often limited. Risk-stratification to predict delirium is a useful first step to help triage resources, but the performance of risk-stratification as part of a functioning multicomponent pathway has not been assessed. We retrospectively studied the performance of a validated delirium prediction rule, the AWOL score, as a part of a multicomponent delirium care pathway in practice on a university hospital ward...
May 19, 2017: Geriatric Nursing
https://www.readbyqxmd.com/read/28532896/healing-of-fracture-nonunions-treated-with-low-intensity-pulsed-ultrasound-lipus-a-systematic-review-and-meta-analysis
#17
Ross Leighton, J Tracy Watson, Peter Giannoudis, Costas Papakostidis, Andrew Harrison, R Grant Steen
INTRODUCTION: Bone fractures fail to heal and form nonunions in roughly 5% of cases, with little expectation of spontaneous healing thereafter. We present a systematic review and meta-analysis of published papers that describe nonunions treated with low-intensity pulsed ultrasound (LIPUS). METHODS: Articles in PubMed, Ovid MEDLINE, CINAHL, AMED, EMBASE, Cochrane Library, and Scopus databases were searched, using an approach recommended by the Methodological Index for Non-Randomized Studies (MINORS), with a Level of Evidence rating by two reviewers independently...
May 15, 2017: Injury
https://www.readbyqxmd.com/read/28531254/frailty-status-at-admission-to-hospital-predicts-multiple-adverse-outcomes
#18
Ruth E Hubbard, Nancye M Peel, Mayukh Samanta, Leonard C Gray, Arnold Mitnitski, Kenneth Rockwood
Aims: frailty is proposed as a summative measure of health status and marker of individual vulnerability. We aimed to investigate the discriminative capacity of a frailty index (FI) derived from interRAI Comprehensive Geriatric Assessment for Acute Care (AC) in relation to multiple adverse inpatient outcomes. Methods: in this prospective cohort study, an FI was derived for 1,418 patients ≥70 years across 11 hospitals in Australia. The interRAI-AC was administered at admission and discharge by trained nurses, who also screened patients daily for geriatric syndromes...
May 22, 2017: Age and Ageing
https://www.readbyqxmd.com/read/28526147/pharmacologic-considerations-of-anesthetic-agents-in-geriatric-patients
#19
REVIEW
Maunak V Rana, Lara K Bonasera, Gregory J Bordelon
Aging is a natural process of declining organ function and reserve. Census data show that the geriatric population is expected to grow to nearly 30%. More than half of geriatric patients have 1 or more surgical procedures in their lifetimes. Moreover, this is the population at greatest risk of morbidity and mortality with any given complication. There is remarkable variability in health across the age spectrum, from fit to frail and compromised. This variability requires a unique approach to anesthetic delivery and drug dosing on an individual basis to avoid complications such as postoperative cognitive dysfunction and delirium...
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28525512/parecoxib-supplementation-to-morphine-analgesia-decreases-incidence-of-delirium-in-elderly-patients-after-hip-or-knee-replacement-surgery-a-randomized-controlled-trial
#20
Dong-Liang Mu, Da-Zhi Zhang, Dong-Xin Wang, Geng Wang, Chun-Jing Li, Zhao-Ting Meng, Ya-Wei Li, Chao Liu, Xue-Ying Li
BACKGROUND: Severe pain and high-dose opioids are both associated with increased risk of postoperative delirium. The authors investigated whether parecoxib-supplemented IV morphine analgesia could decrease the incidence of delirium in elderly patients after total hip or knee replacement surgery. METHODS: In a randomized, double-blind, 2-center trial, patients of 60 years or older who underwent elective total hip or knee replacement surgery were assigned in a 1:1 ratio to receive either parecoxib (40 mg at the end of surgery and then every 12 hours for 3 days) or placebo (normal saline)...
June 2017: Anesthesia and Analgesia
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