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https://www.readbyqxmd.com/read/29792239/screening-for-delirium-with-the-intensive-care-delirium-screening-checklist-icdsc-symptom-profile-and-utility-of-individual-items-in-the-identification-of-delirium-dependent-on-the-level-of-sedation
#1
Soenke Boettger, Rafael Meyer, André Richter, Susana Franco Fernandez, Alain Rudiger, Maria Schubert, Josef Jenewein, David Garcia Nuñez
OBJECTIVE: The importance of the proper identification of delirium, with its high incidence and adversities in the intensive care setting, has been widely recognized. One common screening instrument is the Intensive Care Delirium Screening Checklist (ICDSC); however, the symptom profile and key features of delirium dependent on the level of sedation have not yet been evaluated. METHOD: In this prospective cohort study, the ICDSC was evaluated versus the Diagnostic and Statistical Manual, 4th edition, text revision, diagnosis of delirium set as standard with respect to the symptom profile, and correct identification of delirium...
May 24, 2018: Palliative & Supportive Care
https://www.readbyqxmd.com/read/29791307/symptomatic-pneumocephalus-a-rare-complication-of-discal-herniation-s-surgery
#2
Ghassen Gader, Nadhir Karmeni, Imed Ben Saïd, Hafedh Jemel
Context We report the case of a 40-year-old woman with no pathological history, operated from an L4-L5 disc herniation by a left unilateral approach. The dura mater enveloping the left L5 root was accidentally injured at its lateral face causing a breach with CSF leakage. This breach could not be sutured. A few hours after waking, the patient presented an agitation followed by three generalized tonico-clonic seizures. Cerebral imaging revealed pneumocephalus. The patient was hospitalized in an intensive care unit...
May 23, 2018: Journal of Spinal Cord Medicine
https://www.readbyqxmd.com/read/29791238/low-dose-ketamine-infusion-for-adjunct-management-during-vaso-occlusive-episodes-in-adults-with-sickle-cell-disease-a-case-series
#3
Nicole Palm, Catherine Floroff, Tanna B Hassig, Alice Boylan, Julie Kanter
The optimal management of recurrent painful episodes in individuals living with sickle cell disease (SCD) remains unclear. Currently, the primary treatment for these episodes remains supportive, using fluids and intravenous opioid and anti-inflammatory medications. Few reports have described the use of adjunct subanesthetic doses of ketamine to opioids for treatment of refractory pain in SCD. This article reports a retrospective case series of five patients admitted to the intensive care unit (ICU) with prolonged vaso-occlusive episodes (VOEs)...
May 23, 2018: Journal of Pain & Palliative Care Pharmacotherapy
https://www.readbyqxmd.com/read/29785552/suppression-of-pupillary-unrest-by-general-anesthesia-and-propofol-sedation
#4
Matthias Behrends, Merlin D Larson, Andrew E Neice, Michael P Bokoch
The pupil undergoes irregular oscillations when exposed to light. These oscillations, known as pupillary unrest in ambient light, originate from oscillatory activity within the Edinger-Westphal nucleus in the midbrain. The midbrain and upper pons also contain nuclei known to be very sensitive to the effects of anesthetics that play a central role in maintaining wakefulness. We hypothesized that anesthetics may display similar effects on wakefulness and pupillary unrest. Repeat measurements of pupillary unrest using infrared pupillometry were performed in 16 patients undergoing general anesthesia and 8 patients undergoing propofol sedation...
May 21, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29785112/treatment-of-behavioral-and-psychological-symptoms-of-dementias-with-psychopharmaceuticals-a-review
#5
REVIEW
Jiří Masopust, Dita Protopopová, Martin Vališ, Zbyšek Pavelek, Blanka Klímová
Behavioral and psychological symptoms represent common complications in patients with different types of dementia. Predominantly, they comprise psychosis, agitation and mood disorders, disinhibited behavior, impairment of the sleep and wakefulness rhythm, wandering, perseveration, pathological collecting, or shouting. Their appearance is related to more rapid progression of the disease, earlier institutionalization, use of physical restraints, and higher risk of mortality. Consequently, appearance of behavioral and psychological symptoms of dementia leads to higher costs of care provided and greater distress for caregivers...
2018: Neuropsychiatric Disease and Treatment
https://www.readbyqxmd.com/read/29784218/sleep-disturbance-and-the-change-from-white-to-red-lighting-at-night-on-old-age-psychiatry-wards-a-quality-improvement-project
#6
David Martin, Anya Hurlbert, David Andrew Cousins
Psychiatric inpatient units often maintain a degree of lighting at night to facilitate the observation of patients, but this has the potential to disrupt sleep. Certain wavelengths of light may be less likely to disturb sleep and if such lighting permitted adequate observations, patient wellbeing may be improved. AIMS AND METHOD: This study explored the effects of changing night-lights from broad-band white to narrow-band red on the amount of sleep observed, 'as required' medication administered and number of falls, in an old age psychiatry inpatient setting...
June 2018: Archives of Psychiatric Nursing
https://www.readbyqxmd.com/read/29782995/efficacy-of-antipsychotics-in-dementia-depended-on-the-definition-of-patients-and-outcomes-a-meta-epidemiological-study
#7
REVIEW
C H W Smeets, S U Zuidema, T A Hulshof, M Smalbrugge, D L Gerritsen, R T C M Koopmans, H J Luijendijk
OBJECTIVE: Postulating that efficacy of antipsychotics for agitation and psychosis in dementia is best estimated in trials among patients with these symptoms and with symptom-specific outcomes, we investigated whether clinically broader definitions affected the pooled efficacy. STUDY DESIGN AND SETTING: Trials were searched in multiple databases and categorized according to patient population (agitated, psychotic, mixed) and outcome scale (agitation, psychosis, generic)...
May 18, 2018: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/29782222/clinical-effectiveness-of-a-resin-modified-glass-ionomer-cement-and-a-mild-one-step-self-etch-adhesive-applied-actively-and-passively-in-noncarious-cervical-lesions-an-18-month-clinical-trial
#8
M Jassal, S Mittal, S Tewari
OBJECTIVES: To evaluate the clinical effectiveness of two methods of application of a mild one-step self-etch adhesive and composite resin as compared with a resin-modified glass ionomer cement (RMGIC) control restoration in noncarious cervical lesions (NCCLs). METHODS: A total of 294 restorations were placed in 56 patients, 98 in each one of the following groups: 1) G-Bond active application combined with Solare-X composite resin (A-1SEA), 2) G-Bond passive application combined with Solare-X composite resin (P-1SEA), and 3) GC II LC RMGIC...
May 21, 2018: Operative Dentistry
https://www.readbyqxmd.com/read/29780333/neurological-soft-signs-spontaneous-and-treatment-emergent-extrapyramidal-syndromes-in-black-africans-with-first-episode-schizophrenia
#9
Akin Ojagbemi, Bonga Chiliza, Toyin Bello, Laila Asmal, Oluyomi Esan, Robin Emsley, Oye Gureje
Background: Very little is known about the relationship between spontaneous and treatment-induced motor syndromes in Africans with first episode schizophrenia. Objective: We investigated the association between spontaneous NSS and EPS, with treatment-induced EPS in a homogenous sample of Black Africans with first episode schizophrenia. Methods: We examined Xhosa (South Africa) and Yoruba (Nigeria) patients, using the Neurological Evaluation Scale and extrapyramidal symptoms scale before and at 3 months after exposure to low dose flupenthixol decanoate...
2018: Frontiers in Psychiatry
https://www.readbyqxmd.com/read/29776768/-topical-anesthesia-without-the-use-of-an-anesthesiologist-in-adult-outpatient-cataract-surgery-assessment-of-selection-criteria-on-consultation-report-of-248-cases
#10
M Pepin, E Rineau, A Caignard, S Leruez, P Gohier
INTRODUCTION: This work aims to evaluate selection criteria used during the cataract surgery scheduling visit, to choose whether or not there will be an anesthesiologist available during the surgery, depending upon the patient's comorbidities. MATERIALS AND METHODS: Retrospective study performed in 2016 in Angers university medical center. Two groups were established on the cataract surgery scheduling visit, based on patients' comorbidities and vital signs (blood pressure, heart rate)...
May 15, 2018: Journal Français D'ophtalmologie
https://www.readbyqxmd.com/read/29776706/gaps-in-pain-agitation-and-delirium-management-in-intensive-care-outputs-from-a-nurse-workshop
#11
REVIEW
Carsten Hermes, Maria Acevedo-Nuevo, Andrea Berry, Thomas Kjellgren, Alessandra Negro, Paola Massarotto
Significant improvements in our understanding of pain, agitation, and delirium management within the Intensive Care Unit have been made in recent years. International guidelines and implementation bundles have become more evidence-based, patient-centred, and provide clear recommendations on the best-practice management of critically ill patients. However, the intensive care community has highlighted the need for higher-order evidence in several areas of pain, agitation and delirium research and studies suggest that a significant number of intensive care patients still receive outdated treatment as a consequence of inadequate guideline implementation...
May 15, 2018: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29773957/perioperative-predictors-of-delirium-and-incidence-factors-in-adult-patients-post-cardiac-surgery
#12
Stavros Theologou, Konstantinos Giakoumidakis, Christos Charitos
Background: Delirium is a quite common complication in adult patients post-cardiac surgery. The purpose of our study was to identify perioperative characteristics and also focus on incidence factors that could predict delirium in the cardiac surgery intensive care unit (CICU) postoperatively. Methods: We conducted a prospective study of 179 consecutive patients, who underwent open-heart surgical operation and were admitted to the CICU of a general tertiary hospital in Athens, Greece...
2018: Pragmatic and Observational Research
https://www.readbyqxmd.com/read/29769783/trichotillomania-ranging-from-ritual-to-illness-and-as-a-rare-clinical-manifestation-of-frontotemporal-dementia-review-of-literature-and-case-report
#13
Thomas Gregor Issac, Ashay Vivek Telang, Sadanandavalli Retnaswami Chandra
Frontotemporal dementia (FTD) is the most common form of dementia in the younger age group and often exists with comorbid obsessions and compulsions in up to 80% of the patients. Trichotillomania or compulsive "hair-pulling" disorder is a rare manifestation of FTD and is a poorly evaluated symptom in this condition. The release of "grooming functions" due to frontal disinhibition is often attributed to the evolutionary perspective; however, recent findings also implicate the role of neurotransmitter dysfunction...
March 2018: International Journal of Trichology
https://www.readbyqxmd.com/read/29764824/achieving-full-neurological-recovery-in-snakebite-using-best-supportive-care
#14
Sally Wright, Genevieve Haddock
A 29-year-old woman presented to a community hospital in Sierra Leone 2 hours after being bitten by an unknown snake. On arrival, she was agitated though alert, however deteriorated into respiratory arrest. There was no local availability of antivenom. The patient remained in respiratory arrest undergoing best supportive care in a low-resource setting for 2 hours 55 minutes before returning to spontaneous ventilation. She went on to make a full neurological recovery. Though spontaneous recovery following snakebite envenoming is rare, this case showcases that good communication and basic manoeuvres can have a hugely positive impact on patient outcome...
May 14, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29764554/-efficacy-and-safety-of-nalbuphine-on-analgesia-of-patients-in-intensive-care-unit
#15
Shaohua Liu, Youdong Wan, Yonggang Luo, Li Wan, Wenjing Yun, Haixu Wang, Zhenhua Wang, Xiaoguang Duan, Ruifang Zhang, Yingying Zhao, Hongwei Cui, Tongwen Sun
OBJECTIVE: To analyze the efficacy and safety of nalbuphine in patients with sedative analgesia in intensive care unit (ICU). METHODS: A prospective observation was conducted. The adult patients with mild and moderate analgesia in general ICU of the First Affiliated Hospital of Zhengzhou University from January to November in 2017 were enrolled, and they were divided into nalbuphine group and sufentanil group in proper order. The nabobrown group was given 40 mg nabobrown, the sufentanil group was given 0...
May 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/29762074/use-of-artificial-hydration-at-the-end-of-life-a-survey-of-australian-and-new-zealand-palliative-medicine-doctors
#16
Jacqueline Oehme, Caitlin Sheehan
BACKGROUND: Dying is ubiquitous, yet the optimal management of hydration in the terminal phase is undetermined. Palliative care (PC) doctors' practices may act as a de facto measure of the benefits and burdens of artificial hydration (AH) use. OBJECTIVE: To identify PC doctors' AH prescribing practices for imminently dying patients and possible influencing factors. METHODS: An online survey of doctors belonging to the Australian and New Zealand Society of Palliative Medicine...
May 15, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29760857/retrospective-chart-review-of-synthetic-cannabinoid-intoxication-with-toxicologic-analysis
#17
Payal Sud, Miles Gordon, Laura Tortora, Matthew Stripp, Damon Borg, Adam Berman
Introduction: Use of synthetic cannabinoids (SC) has recently emerged as a new drug epidemic. Our emergency departments (EDs) received a surge of SC users presenting with lethargy and bradycardia, contrasting prior reports of SC-induced tachycardia and agitation. Our goal was to describe these novel presentations and characterize the compounds. Methods: We present a case series of patients with SC intoxication who presented to our toxicology service covering two tertiary care EDs between 2/11/2015 and 6/23/2015...
May 2018: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29759800/-hypertensive-crisis-and-anticholinergic-toxidrome-secondary-to-accidental-consumption-of-datura-stramonium-in-two-children
#18
D D Batouche, N-F Benatta, K Tabeliouna, S Boudjahfa, Y Touhami, S Hakkoum
OBJECTIVE: To identify a hypertensive clinical form of atropine or anticholinergic toxidrome secondary to accidental consumption of Datura seeds. PATIENTS AND METHODS: We report two cases of Datura intoxication in two children who presented marked anticholinergic syndrome whose diagnosis was made by the anamnesis and the clinic. RESULT: Patient 1: A 5-year-old boy, returns home agitated with balance disorders. He was admitted to pediatric resuscitation unit...
May 11, 2018: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/29759261/deriving-a-framework-for-a-systems-approach-to-agitated-patient-care-in-the-emergency-department
#19
Ambrose H Wong, Halley Ruppel, Lauren J Crispino, Alana Rosenberg, Joanne D Iennaco, Federico E Vaca
BACKGROUND: The rising agitated patient population presenting to the emergency department (ED) has caused increasing safety threats for health care workers and patients. Development of evidence-based strategies has been limited by the lack of a structured framework to examine agitated patient care in the ED. In this study, a systems approach from the patient safety literature was used to derive a comprehensive theoretical framework for addressing ED patient agitation. METHODS: A mixed-methods approach was used with ED staff members at an academic site and a community site of a regional health care network...
May 2018: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/29755713/a-mobile-multimedia-reminiscence-therapy-application-to-reduce-behavioral-and-psychological-symptoms-in-persons-with-alzheimer-s
#20
Danish Imtiaz, Arshia Khan, Adriana Seelye
The goal of this project is to develop a novel and innovative mobile solution to address behavioral and psychological symptoms of dementia (BPSD) that occur in individuals with Alzheimer's. BPSD can include agitation, restlessness, aggression, apathy, obsessive-compulsive and repetitive behaviors, hallucinations, delusions, paranoia, and wandering. Alzheimer's currently affects 5.4 million adults in the United States and that number is projected to increase to 14 million by 2050. Almost 90% of all affected with AD experience BPSD, resulting in increased healthcare costs, heavier burden on caregivers, poor patient outcomes, early nursing home placement, long-term hospitalizations, and misuse of medications...
2018: Journal of Healthcare Engineering
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