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Agitated patient management

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https://www.readbyqxmd.com/read/28100176/effect-of-training-and-structured-medication-review-on-medication-appropriateness-in-nursing-home-residents-and-on-cooperation-between-health-care-professionals-the-intherakt-study-protocol
#1
Angelika Mahlknecht, Nadja Nestler, Ulrike Bauer, Nadine Schüßler, Jochen Schuler, Sebastian Scharer, Ralf Becker, Isabel Waltering, Georg Hempel, Oliver Schwalbe, Maria Flamm, Jürgen Osterbrink
BACKGROUND: Pharmacotherapy in residents of nursing homes is critical due to the special vulnerability of this population. Medical care and interprofessional communication in nursing homes are often uncoordinated. As a consequence, polypharmacy and inappropriate medication use are common and may lead to hospitalizations and health hazards. The aim of this study is to optimize communication between the involved professional groups by specific training and by establishing a structured medication review process, and to improve medication appropriateness and patient-relevant health outcomes for residents of nursing homes...
January 18, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28079675/recent-advances-in-the-management-of-neuropsychiatric-symptoms-in-dementia
#2
Orestes V Forlenza, Júlia Cunha Loureiro, Marcos Vasconcelos Pais, Florindo Stella
PURPOSE OF REVIEW: The present article addresses intriguing questions related to the clinical intervention in distinct neuropsychiatric syndromes of patients with dementia. RECENT FINDINGS: We reviewed 154 articles published between 2015 and 2016 targeting psychopharmacological and nonpharmacological interventions, and safety-tolerability concerns. We selected 115 articles addressing the purpose of this study. Of these, 33 were chosen because they were dedicated to subtopics: agitation (42), depression (33), apathy (18), sleep disorders/anxiety (8), and psychosis (4)...
January 12, 2017: Current Opinion in Psychiatry
https://www.readbyqxmd.com/read/28076656/combined-inhaled-beta-agonist-and-anticholinergic-agents-for-emergency-management-in-adults-with-asthma
#3
REVIEW
Scott W Kirkland, Christine Vandenberghe, Britt Voaklander, Taylor Nikel, Sandra Campbell, Brian H Rowe
BACKGROUND: Inhaled short-acting anticholinergics (SAAC) and short-acting beta₂-agonists (SABA) are effective therapies for adult patients with acute asthma who present to the emergency department (ED). It is unclear, however, whether the combination of SAAC and SABA treatment is more effective in reducing hospitalisations compared to treatment with SABA alone. OBJECTIVES: To conduct an up-to-date systematic search and meta-analysis on the effectiveness of combined inhaled therapy (SAAC + SABA agents) vs...
January 11, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28074297/-delirium-analgesia-and-sedation-in-intensive-care-medicine-development-of-a-protocol-based-management-approach
#4
A Wolf, R Mörgeli, A Müller, B Weiss, C Spies
Intensive care treatment has long-term consequences that are often not immediately apparent to the health care providers. The combination of muscle weakness, cognitive damage, and psychological disorders is comprised under the term post-intensive care syndrome (PICS). Analgesia and sedation protocols, as well as nonpharmacological preventive and therapeutic approaches, are effective tools for avoiding complications and improving long-term survival. The principle of "early goal-directed therapy" is fundamental...
January 10, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/27999518/serotonin-syndrome-with-fluoxetine-two-case-reports
#5
Dipen Dineshkumar Patel, David Galarneau
BACKGROUND: Serotonin syndrome is a rare but serious complication of treatment with serotonergic agents. In its severe manifestations, death can ensue. Early recognition and aggressive management are crucial to mitigating the syndrome. Often the presentation can be subtle and easy to miss. CASE REPORTS: We present 2 cases of serotonin syndrome seen in the psychiatric consultation service of a busy academic hospital. Both patients had favorable outcomes because of early recognition and aggressive management...
2016: Ochsner Journal
https://www.readbyqxmd.com/read/27996984/-consensus-document-a-model-of-integrated-management-of-patients-with-psycomotor-agitation
#6
(no author information available yet)
Psychomotor agitation (PMA) is a heterogeneous clinical syndrome associated with a widenumber of pathological conditions. The currently available recommendations and guidelines on PMA correct assessment and management are significantly dishomogeneous and suffer from a lack of standardization, especially regarding pharmacological interventions. Based on this deficiency, and on multidisciplinary nature of PMA, that includes factors shared by different health professionals other than pharmacoeconomic and risk management aspects, we started a project aimed to elaborate a shared model of integrated management for PMA patients...
November 2016: Rivista di Psichiatria
https://www.readbyqxmd.com/read/27992257/agitation-management-in-pediatric-males-with-anti-n-methyl-d-aspartate-receptor-encephalitis
#7
Lauren T Schumacher, Andrea P Mann, James G MacKenzie
OBJECTIVES: Severe agitation is a common symptom in pediatric cases of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis-an autoimmune encephalitis with prominent neuropsychiatric symptoms. Agitation is a major barrier to treatment of the underlying disease process and increases patients' risk of harming themselves and others. Furthermore, male patients often have undetectable tumors and are especially at risk for extended hospitalization, but have been infrequently studied...
December 2016: Journal of Child and Adolescent Psychopharmacology
https://www.readbyqxmd.com/read/27982202/a-boy-with-prader-willi-syndrome-unmasking-precocious-puberty-during-growth-hormone-replacement-therapy
#8
Natasha G Ludwig, Rafael F Radaeli, Mariana M X Silva, Camila M Romero, Alexandre J F Carrilho, Danielle Bessa, Delanie B Macedo, Maria L Oliveira, Ana Claudia Latronico, Tânia L Mazzuco
Prader-Willi syndrome (PWS) is a genetic disorder frequently characterized by obesity, growth hormone deficiency, genital abnormalities, and hypogonadotropic hypogonadism. Incomplete or delayed pubertal development as well as premature adrenarche are usually found in PWS, whereas central precocious puberty (CPP) is very rare. This study aimed to report the clinical and biochemical follow-up of a PWS boy with CPP and to discuss the management of pubertal growth. By the age of 6, he had obesity, short stature, and many clinical criteria of PWS diagnosis, which was confirmed by DNA methylation test...
November 2016: Archives of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/27979642/severe-carisoprodol-withdrawal-after-a-14-year-addiction-and-acute-overdose
#9
Kathy T Vo, Howard Horng, Craig G Smollin, Neal L Benowitz
BACKGROUND: Carisoprodol, a centrally acting muscle relaxant with a high abuse potential, has barbiturate-like properties at the GABA-A receptor, leading to central nervous system depression and desired effects. Its tolerance and dependence has been previously demonstrated in an animal model, and withdrawal has been described in several recent case reports. Many cases can be effectively managed with a short course of benzodiazepines or antipsychotic agents. However, abrupt cessation in a patient with a history of long-term and high-dose carisoprodol abuse may result in symptoms that are more difficult for providers to treat...
December 12, 2016: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27941413/agitation-in-patients-recovering-from-traumatic-brain-injury-nursing-management
#10
Diane Schretzman Mortimer, Wesley Berg
This article reviews clinical and research literature regarding the nursing management of agitation after severe traumatic brain injury. Neuroscience nurses in acute rehabilitation settings use an evidence-based approach to perform multifaceted assessments and implement effective individualized plans of care. These essential efforts minimize the effects of agitation and help patients achieve optimal outcomes.
December 8, 2016: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
https://www.readbyqxmd.com/read/27925607/therapeutic-touch-in-the-management-of-responsive-behavior-in-patients-with-dementia
#11
Ananthavalli Kumarappah, Helen Senderovich
Patients with dementia experience various behavioral symptoms in the course of their illnesses, which greatly affect their quality of life. Current treatment modalities are not always effective, and, thus, nonpharmacological approaches are the preferred first-line therapy for managing such symptoms. They generally address the basic needs of the person with dementia and provide humane care, often producing noticeable improvements in symptoms. Thus, such therapies should precede pharmacological interventions...
October 2016: Advances in Mind-body Medicine
https://www.readbyqxmd.com/read/27918121/prevalence-and-severity-of-behavioural-symptoms-in-patients-with-korsakoff-syndrome-and-other-alcohol-related-cognitive-disorders-a-systematic-review
#12
REVIEW
Ineke J Gerridzen, Wiltine G Moerman-van den Brink, Marja F Depla, Els M L Verschuur, Ruth B Veenhuizen, Johannes C van der Wouden, Cees M P M Hertogh, Karlijn J Joling
OBJECTIVE: Experiences from clinical practice suggest that behavioural symptoms in patients with Korsakoff syndrome (KS) are a frequent problem. Knowledge about behavioural symptoms is important in understanding and managing these symptoms. The aim of this study is to review the prevalence and severity of behavioural symptoms in KS. METHODS: Relevant articles were identified by searching Medline (PubMed), PsycINFO, Embase and CINAHL up to 4 June 2014. Two reviewers independently selected the studies, extracted their baseline data and assessed methodological quality using a standardized checklist...
December 5, 2016: International Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/27907964/critical-care-neurology-perspective-on-delirium
#13
Matthew B Maas, Andrew M Naidech
The evidence linking delirium to poor outcomes after critical illness is compelling, including higher mortality, prolonged mechanical ventilation, longer length of intensive care unit stay, and long-term cognitive impairments. The attitude toward delirium in the neurologic community is shifting away from viewing it as an unmodifiable, inevitable consequence of severe illness to treating it is as a neurologic emergency, akin to seizures or encephalitis. Delirium, like other manifestations of critical illness encephalopathy, is an organ dysfunction syndrome...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27891229/nicotine-replacement-therapy-for-agitation-and-delirium-management-in-the-intensive-care-unit-a-systematic-review-of-the-literature
#14
Melanie Kowalski, Andrew A Udy, Hayden J McRobbie, Michael J Dooley
BACKGROUND: Active smokers are prevalent within the intensive care setting and place a significant burden on healthcare systems. Nicotine withdrawal due to forced abstinence on admission may contribute to increased agitation and delirium in this patient group. The aim of this systematic review was to determine whether management of nicotine withdrawal, with nicotine replacement therapy (NRT), reduces agitation and delirium in critically ill patients admitted to the intensive care unit (ICU)...
2016: Journal of Intensive Care
https://www.readbyqxmd.com/read/27861180/improving-hospital-survival-and-reducing-brain-dysfunction-at-seven-california-community-hospitals-implementing-pad-guidelines-via-the-abcdef-bundle-in-6-064-patients
#15
Mary Ann Barnes-Daly, Gary Phillips, E Wesley Ely
OBJECTIVES: To track compliance by an interprofessional team with the Awakening and Breathing Coordination, Choice of drugs, Delirium monitoring and management, Early mobility, and Family engagement (ABCDEF) bundle in implementing the Pain, Agitation, and Delirium guidelines. The aim was to study the association between ABCDEF bundle compliance and outcomes including hospital survival and delirium-free and coma-free days in community hospitals. DESIGN: A prospective cohort quality improvement initiative involving ICU patients...
February 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/27857778/state-of-acute-agitation-at-psychiatric-emergencies-in-europe-the-stage-study
#16
Luis San, Josef Marksteiner, Peter Zwanzger, María Aragüés Figuero, Francisco Toledo Romero, Grigorios Kyropoulos, Alberto Bessa Peixoto, Roxana Chirita, Anca Boldeanu
BACKGROUND: Agitation is an array of syndromes and types of behaviors that are common in patients with psychiatric disorders. In Europe, the estimation of prevalence of agitation has been difficult due to the lack of standard studies or systematic data collection done on this syndrome. OBJECTIVE: An observational, cross-sectional, multicenter study aimed to assess the prevalence of agitation episodes in psychiatric emergencies in different European countries. METHOD: For 1 week, all episodes of acute agitation that were attended to at the psychiatric emergency room (ER) or Acute Inpatient Unit (AIU) in the 27 participating centers were registered...
2016: Clinical Practice and Epidemiology in Mental Health: CP & EMH
https://www.readbyqxmd.com/read/27855720/pharmacological-interventions-for-agitation-in-patients-with-traumatic-brain-injury-protocol-for-a-systematic-review-and-meta-analysis
#17
David R Williamson, Anne Julie Frenette, Lisa Burry, Marc M Perreault, Emmanuel Charbonney, François Lamontagne, Marie-Julie Potvin, Jean-François Giguère, Sangeeta Mehta, Francis Bernard
BACKGROUND: Traumatic brain injury (TBI) is a worldwide leading cause of mortality and disability. Among TBI complications, agitation is a frequent behavioural problem. Agitation causes potential harm to patients and caregivers, interferes with treatments, leads to unnecessary chemical and physical restraints, increases hospital length of stay, delays rehabilitation, and impedes functional independence. Pharmacological treatments are often considered for agitation management following TBI...
November 17, 2016: Systematic Reviews
https://www.readbyqxmd.com/read/27849239/importance-of-the-use-of-protocols-for-the-management-of-analgesia-and-sedation-in-pediatric-intensive-care-unit
#18
Emiliana Motta, Michele Luglio, Artur Figueiredo Delgado, Werther Brunow de Carvalho
Introduction: Analgesia and sedation are essential elements in patient care in the intensive care unit (ICU), in order to promote the control of pain, anxiety and agitation, prevent the loss of devices, accidental extubation, and improve the synchrony of the patient with mechanical ventilation. However, excess of these medications leads to rise in morbidity and mortality. The ideal management will depend on the adoption of clinical and pharmacological measures, guided by scales and protocols...
September 2016: Revista da Associação Médica Brasileira
https://www.readbyqxmd.com/read/27842752/management-of-sedation-and-paralysis
#19
REVIEW
Michael A Fierro, Raquel R Bartz
Sedatives are administered to decrease patient discomfort and agitation during mechanical ventilation and to maintain patient-ventilator synchrony. Titration of infusions and or bolus dosing to maintain light sedation goals according to validated scales is recommended. However, it is important to consider deeper sedation for patients with refractory patient-ventilator dyssynchrony (PVD) to prevent volutrauma and barotrauma. Deep sedation plus muscle relaxants may be required to treat PVD or to reduce oxygen consumption and carbon dioxide production...
December 2016: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/27826871/anti-n-methyl-d-aspartate-receptor-encephalitis-after-herpes-simplex-virus-associated-encephalitis-an-emerging-disease-with-diagnosis-and-therapeutic-challenges
#20
Flora Schein, Amandine Gagneux-Brunon, Jean-Christophe Antoine, Sylvie Lavernhe, Sylvie Pillet, Stéphane Paul, Anne Frésard, Claire Boutet, Rémi Grange, Céline Cazorla, Frédéric Lucht, Elisabeth Botelho-Nevers
INTRODUCTION: Morbidity and mortality of Herpes simplex virus encephalitis (HSE) remain high. Relapses of neurological signs may occur after initial clinical improvement under acyclovir treatment. METHODS: We report here a case of post-HSE anti-N-methyl-d-aspartate receptor-mediated encephalitis in an adult and perform a systematic search on PubMed to identify other cases in adults. RESULTS: We identified 11 previously published cases, to discuss diagnostic and therapeutic management...
November 8, 2016: Infection
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