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Management of agitated

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https://www.readbyqxmd.com/read/29685062/prospective-observational-evaluation-of-sedation-and-pain-management-guideline-adherence-across-new-jersey-intensive-care-units
#1
Alison Brophy, Maria Cardinale, Liza B Andrews, Justin B Kaplan, Christopher Adams, Yekaterina Opsha, Kimberly A Brandt, Deepali Dixit, Steven F Nerenberg, Julie A Saleh
BACKGROUND: The practice guidelines for the management of pain, agitation, and delirium (PAD) from the Society of Critical Care Medicine shifted from primarily focusing on the treatment of anxiety in 2002 to the treatment of pain in 2013. OBJECTIVE: This prospective, observational, multicenter study aimed to assess the degree of practice adherence to the PAD guidelines for ventilated patients in New Jersey intensive care units (ICUs). METHODS: Pharmacist investigators at 8 centers designated 4 days at least 10 days apart to evaluate all patients on mechanical ventilation...
January 1, 2018: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/29682241/drug-administration-adjustments-for-elderly-patients-with-dysphagia-a-case-report
#2
Patrícia de Carvalho Mastroianni, Marcela Forgerini
An elderly patient, aged 76 years, diagnosed with dysphagia, depression, hypothyroidism, Alzheimer's disease and mild cognitive deficit, was identified with sertraline and levothyroxine- drug-related problems. Medication Therapy Management (MTM) was used to adjust therapy to the patient's needs by macerating sertraline tablets and solubilizing them in 10-30 mL of orange juice. The patient was advised to take levothyroxine after fasting. Six months later, pharmaceutical follow-up identified an increase in the Mini-Mental State Exam score from 22 to 26 and a decrease in the Clinical Dementia Rating (CDR) scale score from 1...
January 2018: Dementia & Neuropsychologia
https://www.readbyqxmd.com/read/29680485/-seclusion-and-mechanical-restraints-in-psychiatric-care-prescriptions-procedures-pharmacological-management-and-monitoring
#3
Chloé Tezenas du Montcel, Célia Kowal, Audrey Leherle, Soraya Kabbaj, Ariel Frajerman, Emmanuel Le Guen, Nora Hamdani, Franck Schürhoff, Marion Leboyer, Antoine Pelissolo, Baptiste Pignon
We will briefly summarize the French recommendations concerning the use of seclusion and mechanical restraint. Acute agitation and aggression or self-injurious activity during psychotic and manic episodes are the main indication of prescription of the coercive measures. Their prescriptions respect specific modalities that will be explained. Although they proved to be efficient, seclusion and restrain need to stay a last resort option, considering the risk of physical complications and psychological consequences...
April 18, 2018: La Presse Médicale
https://www.readbyqxmd.com/read/29661160/characterizing-the-experience-of-agitation-in-patients-with-bipolar-disorder-and-schizophrenia
#4
Jenna Roberts, Alfredo Gracia Canales, Sophee Blanthorn-Hazell, Anca Craciun Boldeanu, Davneet Judge
BACKGROUND: Agitation is a common manifestation of bipolar disorder and schizophrenia which includes symptoms ranging from inner tension and unease to violence and aggression. Much of the existing literature has focused on agitation in the acute setting, with the patient experience poorly defined. Thus, the aim of this study was to characterize agitation and its management from a patient perspective, with the focus on those who reside in the community. METHODS: Surveys were completed across Germany, Spain and the UK by 583 community dwelling patients with schizophrenia or bipolar disorder who experienced episodes of agitation...
April 16, 2018: BMC Psychiatry
https://www.readbyqxmd.com/read/29656713/symptom-management-nutrition-and-hydration-at-end-of-life-a-qualitative-exploration-of-patients-carers-and-health-professionals-experiences-and-further-research-questions
#5
Jessica Baillie, Despina Anagnostou, Stephanie Sivell, Jordan Van Godwin, Anthony Byrne, Annmarie Nelson
BACKGROUND: Symptom management is an essential aspect of palliative and end-of-life care, but evidence suggests that patients' symptoms may not always be relieved, causing significant harm to patients and magnifying their relatives' distress. A growing body of evidence focuses on symptom management at the end-of-life, but research funding for palliative care remains disproportionately low. It is therefore crucial that research funding is targeted at areas of importance to patients and relatives...
April 16, 2018: BMC Palliative Care
https://www.readbyqxmd.com/read/29623620/economic-evaluation-of-midazolam-droperidol-combination-versus-droperidol-or-olanzapine-for-the-management-of-acute-agitation-in-the-emergency-department-a-within-trial-analysis
#6
Celene Y L Yap, Ya-Seng Arthur Hsueh, Jonathan C Knott, David McD Taylor, Esther W Chan, David C M Kong
BACKGROUND: The combination of midazolam and droperidol has proven superior to droperidol or olanzapine monotherapy in the management of acute agitation in emergency departments (EDs). OBJECTIVE: This is the first economic analysis to evaluate the cost-benefit and cost effectiveness of the midazolam-droperidol combination compared with droperidol or olanzapine for the management of acute agitation in EDs. METHODS: This analysis used data derived from a randomised, controlled, double-blind clinical trial conducted in two metropolitan Australian EDs between October 2014 and August 2015...
July 24, 2017: PharmacoEconomics Open
https://www.readbyqxmd.com/read/29613919/addressing-dual-patient-and-staff-safety-through-a-team-based-standardized-patient-simulation-for-agitation-management-in-the-emergency-department
#7
Ambrose H Wong, Marc A Auerbach, Halley Ruppel, Lauren J Crispino, Alana Rosenberg, Joanne D Iennaco, Federico E Vaca
INTRODUCTION: Emergency departments (EDs) have seen harm rise for both patients and health workers from an increasing rate of agitation events. Team effectiveness during care of this population is particularly challenging because fear of physical harm leads to competing interests. Simulation is frequently employed to improve teamwork in medical resuscitations but has not yet been reported to address team-based behavioral emergency care. As part of a larger investigation of agitated patient care, we designed this secondary study to examine the impact of an interprofessional standardized patient simulation for ED agitation management...
April 3, 2018: Simulation in Healthcare: Journal of the Society for Simulation in Healthcare
https://www.readbyqxmd.com/read/29610916/should-this-patient-receive-prophylactic-medication-to-prevent-delirium-grand-rounds-discussion-from-beth-israel-deaconess-medical-center
#8
Anjala V Tess, Melissa L P Mattison, Joshua R Leo, Eileen E Reynolds
In 2015, the American Geriatrics Society released recommendations for prevention and management of postoperative delirium, based on a systematic literature review and evaluation of nonpharmacologic and pharmacologic approaches by an expert panel. The guidelines recommend an interdisciplinary focus on nonpharmacologic measures (reorientation, medication management, early mobility, nutrition, and gastointestinal motility) for prevention and consideration of this strategy for acute management. They also recommend optimizing nonopioid medication as a means to manage pain and avoiding benzodiazepines other than to treat substance withdrawal...
April 3, 2018: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29606317/behavioral-disorders-the-blind-spot-of-neurology-and-psychiatry
#9
REVIEW
C Azuar, R Levy
Behavioral disorders occupy the crossroads between neurology and psychiatry, and emerging disorders, such as frontotemporal lobar degeneration of genetic origin and autoimmune encephalitis, can present with both neurological and psychiatric signs. Thus, the primary aim of this introductory article is to review frequently encountered behavioral clinical features, such as apathy and agitation, and their related syndromes, including frontal and anterior temporal syndromes. These behavioral states and their underlying etiologies are also here illustrated with clinical case reports...
March 29, 2018: Revue Neurologique
https://www.readbyqxmd.com/read/29605483/severe-opioid-withdrawal-precipitated-by-vivitrol%C3%A2
#10
R S Wightman, L S Nelson, J D Lee, L M Fox, S W Smith
The risk of severe precipitated opioid withdrawal (POW) is amplified when precipitated by a long-acting opioid antagonist. IM extended release naltrexone (XRNTX;Vivitrol®) is an FDA approved therapy to prevent relapse of opioid and alcohol abuse. Two cases of precipitated opioid withdrawal from XRNTX are presented that illustrate different patient reactions to POW. A 56-year-old woman developed a hypertensive emergency and required continuous intravenous vasodilator, clonidine, and intensive care monitoring after re-initiation of XRNTX following opioid relapse...
March 21, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29580965/designing-a-nurse-delivered-delirium-bundle-what-intensive-care-unit-staff-survivors-and-their-families-think
#11
Leona Bannon, Jennifer McGaughey, Mike Clarke, Daniel F McAuley, Bronagh Blackwood
BACKGROUND: Implementation of quality improvement interventions can be enhanced by exploring the perspectives of those who will deliver and receive them. We designed a non-pharmacological bundle for delirium management for a feasibility trial, and we sought to obtain the views of intensive care unit (ICU) staff, survivors, and families on the barriers and facilitators to its implementation. OBJECTIVE: The objective of this study is to determine the barriers and facilitators to a multicomponent bundle for delirium management in critically ill patients comprising (1) education and family participation, (2) sedation minimisation and pain, agitation, and delirium protocol, (3) early mobilisation, and (4) environmental interventions for sleep, orientation, communication, and cognitive stimulation...
March 23, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/29576822/predisposing-factors-clinical-assessment-management-and-outcomes-of-agitation-in-the-trauma-intensive-care-unit
#12
Saeed Mahmood, Omaima Mahmood, Ayman El-Menyar, Mohammad Asim, Hassan Al-Thani
BACKGROUND: Agitation occurs frequently among critically ill patients admitted to the intensive care unit (ICU). We aimed to evaluate the frequency, predisposing factors and outcomes of agitation in trauma ICU. METHODS: A retrospective analysis was conducted to include patients who were admitted to the trauma ICU between April 2014 and March 2015. Data included patient's demographics, initial vitals, associated injuries, Ramsey Sedation Scale, Glasgow Coma Scale, head injury lesions, use of sedatives and analgesics, head interventions, ventilator days, and ICU length of stay...
2018: World Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29571595/-sedation-is-tricky-a-qualitative-content-analysis-of-nurses-perceptions-of-sedation-administration-in-mechanically-ventilated-intensive-care-unit-patients
#13
Breanna Hetland, Jill Guttormson, Mary Fran Tracy, Linda Chlan
INTRODUCTION: Critical care nurses are responsible for administering sedative medications to mechanically ventilated patients. With significant advancements in the understanding of the impact of sedative exposure on physiological and psychological outcomes of ventilated patients, updated practice guidelines for assessment and management of pain, agitation, and delirium in the intensive care unit were released in 2013. The primary aim of this qualitative study was to identify and describe themes derived from critical care nurses' comments regarding sedation administration practices with mechanically ventilated patients...
March 20, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/29561867/do-care-homes-deliver-person-centred-care-a-cross-sectional-survey-of-staff-reported-abusive-and-positive-behaviours-towards-residents-from-the-marque-managing-agitation-and-raising-quality-of-life-english-national-care-home-survey
#14
Claudia Cooper, Louise Marston, Julie Barber, Deborah Livingston, Penny Rapaport, Paul Higgs, Gill Livingston
BACKGROUND: There are widespread concerns about abuse of care home residents. We report, in the largest care home survey, prevalence of staff anonymously-reported, perpetrated/witnessed abusive behaviours towards care home residents over 3 months. We also report positive care behaviours. METHODS: 1544 staff in 92 English care home units completed the revised Modified Conflict Tactics Scale and Maslach Burnout Inventory. OUTCOMES: Most staff reported positive care behaviours, but specific person-centred activities were sometimes infrequent...
2018: PloS One
https://www.readbyqxmd.com/read/29543606/ce-original-research-recognizing-delirium-in-hospitalized-children-a-systematic-review-of-the-evidence-on-risk-factors-and-characteristics
#15
Cheryl Holly, Sallie Porter, Mercedes Echevarria, Margaret Dreker, Sevara Ruzehaji
The findings can facilitate earlier recognition and prevention of pediatric delirium. ABSTRACT: Purpose: The purpose of this study was to examine the evidence regarding the risk factors for and characteristics of acute pediatric delirium in hospitalized children. METHODS: The systematic review method within an epidemiological framework of person, place, and time was used. Fifty-two studies were selected for initial retrieval. Of these, after assessment for methodological quality, 21 studies involving 2,616 subjects were included in the review...
March 14, 2018: American Journal of Nursing
https://www.readbyqxmd.com/read/29535649/1st-international-experts-meeting-on-agitation-conclusions-regarding-the-current-and-ideal-management-paradigm-of-agitation
#16
REVIEW
José Martínez-Raga, Mario Amore, Guido Di Sciascio, Radu Ioan Florea, Marina Garriga, Gabriel Gonzalez, Kai G Kahl, Per-Axel Karlsson, Jens Kuhn, Maria Margariti, Bruno Pacciardi, Konstantinos Papageorgiou, Maurizio Pompili, Fabrice Rivollier, Ángel Royuela, Gemma Safont, Joachim Scharfetter, Bo Skagen, Kazuhiro Tajima-Pozo, Pierre Vidailhet
Agitation is a heterogeneous concept without a uniformly accepted definition, however, it is generally considered as a state of cognitive and motor hyperactivity characterized by excessive or inappropriate motor or verbal activity with marked emotional arousal. Not only the definition but also other aspects of agitated patients' care are still unsolved and need consensus and improvement. To help the discussion about agitation among experts and improve the identification, management, and treatment of agitation, the 1st International Experts' Meeting on Agitation was held in October 2016 in Madrid...
2018: Frontiers in Psychiatry
https://www.readbyqxmd.com/read/29534916/metoclopramide-induced-pheochromocytoma-crisis
#17
James B Leonard, Kashif M Munir, Hong K Kim
Metoclopramide (MCP) is a commonly used anti-emetic in the emergency department (ED). Its use is generally well tolerated; although infrequent adverse reactions such as extrapyramidal reactions or tardive dyskinesia are reported. However, many ED providers are not familiar with the potentially life-threatening hypertensive emergency that can be precipitated by MCP administration in patients with pheochromocytoma. A previously healthy 36-year-old woman presented to the ED with headache and nausea. She developed acute hypertensive emergency (acute agitation, worsening headache, chest pain and wide complex tachycardia) when her blood pressure (BP) increased to 223/102mmHg (initial BP, 134/86mmHg) after receiving intravenous MCP...
March 5, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29521195/neuropharmacological-properties-of-the-essential-oil-of-bergamot-for-the-clinical-management-of-pain-related-bpsds
#18
Damiana Scuteri, Laura Rombola, Laura Tridico, Hirokazu Mizoguchi, Chizuko Watanabe, Tsukasa Sakurada, Shinobu Sakurada, Maria TIziana Corasaniti, Giacinto Bagetta, Luigi Antonio Morrone
1.1. BACKGROUND: Alzheimer's Disease (AD) accounts for approximately 50% of all cases of dementia and, in spite of the great effort for the development of disease-modifying drugs, a definitive treatment of cognitive impairment is not available yet. A perfect adherence to the current therapy of cognitive decline is needed for a better control of the disease and this is proven to reduce, though not completely abolish, the associated Behavioural and Psychological Symptoms of Dementia (BPSDs) from occurring...
March 6, 2018: Current Medicinal Chemistry
https://www.readbyqxmd.com/read/29493650/-managing-insomnia-in-the-elderly-patient-from-pharmacology-to-subthreshold-depression
#19
Francesco Scaglione, Claudio Vampini, Liborio Parrino, Orazio Zanetti
Insomnia is the most common and widespread sleep disorder. Managing insomnia in the elderly patient becomes a difficult challenge for the presence of a multi-disease and multi-drug condition. An organic and functional background that becomes even more fragile when the picture is complicated by psychomotor agitation and cognitive impairment. From the contribution of four experts of different fields and disciplines, stems the need to share an integrated vision that starts from the pharmacological basis of hypnotic drugs, delineates the features of depression in the elderly, addressed the delicate issue of chronic use/abuse of benzodiazepines and ultimately arrives to the management of behavioral disturbances...
January 2018: Rivista di Psichiatria
https://www.readbyqxmd.com/read/29485197/testing-the-evidence-integration-triangle-for-implementation-of-interventions-to-manage-behavioral-and-psychological-symptoms-associated-with-dementia-protocol-for-a-pragmatic-trial
#20
Barbara Resnick, Ann Kolanowski, Kimberly Van Haitsma, Elizabeth Galik, Marie Boltz, Jeanette Ellis, Liza Behrens, Nina M Flanagan, Karen J Eshraghi, Shijun Zhu
Behavioral and psychological symptoms of dementia (BPSD) include aggression, agitation, resistiveness to care, depression, anxiety, apathy, and hallucinations. BPSD are common in nursing home residents and can be ameliorated using person-centered approaches. Despite regulatory requirements, less than 2% of nursing homes consistently implement person-centered behavioral approaches. In a National Institute of Nursing Research-funded research protocol, we are implementing a pragmatic cluster randomized clinical trial designed to enable staff in nursing homes to reduce BPSD using behavioral approaches while optimizing function, preventing adverse events, and improving quality of life of residents...
February 27, 2018: Research in Nursing & Health
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