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Delirium education

Floriana Pinto, Gianni Biancofiore
BACKGROUND: The ABCDE (Awakening and Breathing coordination of daily sedation and ventilator removal trials; Choice of sedative or analgesic exposure; Delirium monitoring and management; and Early mobility and exercise) bundle is a multidisciplinary set of evidence-based practices for improving patient outcomes in the intensive care unit. Nurses are critical to all the bundle's requirements. Therefore, understanding their knowledge, attitudes, and perception of the different bundle's components might help for an easier implementation into everyday clinical practice...
November 2016: Dimensions of Critical Care Nursing: DCCN
Yun Kang, Wendy Moyle, Marie Cooke, Siobhan T O'Dwyer
BACKGROUND: The population is ageing in South Korea, increasing the incidence of dementia and delirium. Despite this, registered nurses in South Korea tend to have poor understanding and limited involvement in the assessment of delirium. AIM: To evaluate the effect of an educational programme on acute care nurses' knowledge, attitudes and the potential for family caregiver involvement in care for older adults with cognitive impairment. METHODS: A mixed-methods study that included a single group, pre-post design and individual interviews was used...
October 11, 2016: Scandinavian Journal of Caring Sciences
Andy Dworkin, David S H Lee, Amber R An, Sarah J Goodlin
OBJECTIVES: To identify a quick clinical tool to assess the risk of delirium after elective surgery. DESIGN: Prospective observational study. SETTING: Preoperative assessment clinic at the Veterans Affairs Portland Health Care System. PARTICIPANTS: Community-living veterans aged 65 and older scheduled for elective surgery requiring general or major anesthesia. MEASUREMENTS: Confusion Assessment Method (CAM) or Family Confusion Assessment Method (FAM-CAM)...
September 21, 2016: Journal of the American Geriatrics Society
Giovanni Mistraletti, Michele Umbrello, Stefania Anania, Elisa Andrighi, Alessandra Di Carlo, Federica Martinetti, Serena Barello, Giovanni Sabbatini, Paolo Formenti, Tommaso Maraffi, Francesco Marrazzo, Alessandra Palo, Giacomo Bellani, Riccarda Russo, Silvia Francesconi, Federico Valdambrini, Marco Cigada, Francesca Riccardi, Egidio A Moja, Gaetano Iapichino
BACKGROUND: International guidelines recommend systematic assessment of pain, agitation/sedation and delirium with validated scales for all ICU patients. However, these evaluations are often not done. We have created an e-learning training platform for the continuous medical education, and assessed its efficacy in increasing the use of validated tools by all medical and nursing staff of the participating ICUs during their daily practice. METHODS: Multicenter, randomized, before and after study...
September 20, 2016: Minerva Anestesiologica
Clay Angel, Kristen Brooks, Julie Fourie
CONTEXT: Delirium is common among inpatients aged 65 years and older and is associated with multiple adverse consequences, including increased length of stay (LOS). However, delirium is frequently unrecognized and poorly understood. At one hospital, baseline management of delirium on medical-surgical units varied greatly, and psychiatric consultations focused exclusively on crisis management. OBJECTIVE: To implement a multidisciplinary program for rapid identification and proactive management of patients with delirium on medical-surgical units...
September 9, 2016: Permanente Journal
Natalie R Heriot, Michele R Levinson, Amber C Mills, Thinn Thinn Khine, Anthea L Gellie, Gaya Sritharan
OBJECTIVE: To determine the incidence of delirium in elderly intensive care patients and to compare incidence using two retrospective chart-based diagnostic methods and a hospital reporting measure (ICD-10). DESIGN: Retrospective study. SETTING: An ICU in a large metropolitan private hospital in Melbourne, Australia. PATIENTS: English-speaking participants (n=348) 80+ years, admitted to ICU for >24 hours. MEASUREMENTS AND MAIN RESULTS: Medical files of ICU patients admitted October 2009-October 2012 were retrospectively assessed for delirium using the Inouye chart review method, DSM-IV diagnostic criteria and ICD-10 coding data...
September 3, 2016: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
Tássia Nery Faustino, Larissa Chaves Pedreira, Yasmin Seixas de Freitas, Rosana Maria de Oliveira Silva, Juliana Bezerra do Amaral
OBJECTIVE: to conduct an educational intervention with the nursing team members of an intensive care unit (ICU), aiming to increase knowledge and to introduce improvements in their practices regarding prevention and monitoring of delirium in older patients. METHOD: this is an action research, in which workshops were conducted with eleven nurses and a nursing technician from an ICU unit in Salvador, Bahia, Brazil. RESULTS: ten problems regarding nursing practices for prevention and monitoring of delirium were identified...
July 2016: Revista Brasileira de Enfermagem
Sónia Martins, José Artur Paiva, Mário R Simões, Lia Fernandes
OBJECTIVE: Among cognitive reserve markers, educational attainment is the most widely studied, with several studies establishing a strong association with risk of dementia. However, it has not yet been fully examined in delirium. This study aims to analyse the relationship between educational attainment and delirium. METHODS: The study included elderly hospitalised patients admitted (≥48 h) into an intermediate care unit (IMCU) of Intensive Care Medicine Service...
August 9, 2016: Acta Neuropsychiatrica
Márlon J R Aliberti, Claudia K Suemoto, Sileno Q Fortes-Filho, Juliana A Melo, Carolina B Trindade, Juliana Y T Kasai, Marcelo Altona, Daniel Apolinario, Wilson Jacob-Filho
Older adults have a greater risk of experiencing functional decline and iatrogenic complications during hospitalization than younger individuals. Geriatric day hospitals (GDHs) have been implemented mainly for rehabilitation. The goal of the current study was to expand the GDH spectrum of care to prevent hospital admissions in this population. This study details an innovative model of GDH care that offers short-term, nonrehabilitative treatment to older adults who have experienced an acute event, those with a decompensated chronic disease, or those in need of a minor procedure that would be unattainable in a regular outpatient setting...
July 26, 2016: Journal of the American Geriatrics Society
Christopher G Hughes, Mayur B Patel, James C Jackson, Timothy D Girard, Sunil K Geevarghese, Brett C Norman, Jennifer L Thompson, Rameela Chandrasekhar, Nathan E Brummel, Addison K May, Mark R Elstad, Mitzi L Wasserstein, Richard B Goodman, Karel G Moons, Robert S Dittus, E Wesley Ely, Pratik P Pandharipande
OBJECTIVE: The aim of this study was to determine whether surgery and anesthesia exposure is an independent risk factor for cognitive impairment after major noncardiac surgery associated with critical illness. SUMMARY OF BACKGROUND DATA: Postoperative cognitive impairment is a prevalent individual and public health problem. Data are inconclusive as to whether this impairment is attributable to surgery and anesthesia exposure versus patients' baseline factors and hospital course...
July 18, 2016: Annals of Surgery
Christine Toye, Su Kitchen, Andrew Hill, Deborah Edwards, Michelle Sin, Sean Maher
This study piloted a hospital-based delirium and falls education program to investigate the impacts on staff knowledge and practice plus patient falls. On a medical ward, staff knowledge was compared before and after education sessions. Other data - collected a day before and after program implementation - addressed documentation of patients' delirium and evidence of compliance with falls risk minimization protocols. These data, and numbers of patient falls, were compared before and after program implementation...
July 13, 2016: Nursing & Health Sciences
T S Wildes, A C Winter, H R Maybrier, A M Mickle, E J Lenze, S Stark, N Lin, S K Inouye, E M Schmitt, S L McKinnon, M R Muench, M R Murphy, R T Upadhyayula, B A Fritz, K E Escallier, G P Apakama, D A Emmert, T J Graetz, T W Stevens, B J Palanca, R L Hueneke, S Melby, B Torres, J Leung, E Jacobsohn, M S Avidan
INTRODUCTION: Postoperative delirium, arbitrarily defined as occurring within 5 days of surgery, affects up to 50% of patients older than 60 after a major operation. This geriatric syndrome is associated with longer intensive care unit and hospital stay, readmission, persistent cognitive deterioration and mortality. No effective preventive methods have been identified, but preliminary evidence suggests that EEG monitoring during general anaesthesia, by facilitating reduced anaesthetic exposure and EEG suppression, might decrease incident postoperative delirium...
2016: BMJ Open
Maria I Castillo, Marie Cooke, Bonnie Macfarlane, Leanne M Aitken
BACKGROUND: Anxiety is an unpleasant emotion that most intensive care patients experience. This emotion is an important issue in intensive care settings because of its prevalence, adverse effects and severity. Little is known about the factors associated with state and trait anxiety during critical illness. OBJECTIVES: To describe the patterns of state anxiety reported by intensive care patients, and identify factors associated with state and trait anxiety. DESIGN: Prospective observational cohort study...
August 2016: International Journal of Nursing Studies
Leanne Monterosso, Gail M Ross-Adjie, Ian R Rogers, Freya M Shearer, Jeremy R Rogers
OBJECTIVES: Despite palliative care being standard for patients with chronic and/or life-limiting conditions, a perceived lack of clarity regarding the definition and scope of palliative care persists. We aimed to identify health care professionals' (HCPs) perspectives, education, and support needs related to palliative care provision in a large private Australian tertiary hospital. METHODS: A validated survey was administered and four focus groups were conducted with multidisciplinary HCPs...
July 2016: Journal of Palliative Medicine
Ying Guo, Yuying Fan
The aim of this study was to evaluate the effect of a preoperative, multidisciplinary intervention program for the prevention of acute postoperative delirium on the incidence and severity in patients who were treated in the intensive care unit after surgery. We studied 122 patients who had been transferred into intensive care unit after surgery at a teaching general hospital in China. The intervention consisted of standardized protocols for the management of risk factors for delirium: education of nursing staff, systematic cognitive caring, maintaining a safe environment, social support, and improving sleep quality...
July 2016: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Najma Siddiqi, Francine Cheater, Michelle Collinson, Amanda Farrin, Anne Forster, Deepa George, Mary Godfrey, Elizabeth Graham, Jennifer Harrison, Anne Heaven, Peter Heudtlass, Claire Hulme, David Meads, Chris North, Angus Sturrock, John Young
BACKGROUND AND OBJECTIVES: delirium is a distressing but potentially preventable condition common in older people in long-term care. It is associated with increased morbidity, mortality, functional decline, hospitalization and significant healthcare costs. Multicomponent interventions, addressing delirium risk factors, have been shown to reduce delirium by one-third in hospitals. It is not known whether this approach is also effective in long-term care. In previous work, we designed a bespoke delirium prevention intervention, called 'Stop Delirium!' In preparation for a definitive trial of Stop Delirium, we sought to address key aspects of trial design for the particular circumstances of care homes...
September 2016: Age and Ageing
Brett C Norman, James C Jackson, John A Graves, Timothy D Girard, Pratik P Pandharipande, Nathan E Brummel, Li Wang, Jennifer L Thompson, Rameela Chandrasekhar, E Wesley Ely
OBJECTIVES: To characterize survivors' employment status after critical illness and to determine if duration of delirium during hospitalization and residual cognitive function are each independently associated with decreased employment. DESIGN: Prospective cohort investigation with baseline and in-hospital clinical data and follow-up at 3 and 12 months. SETTING: Medical and surgical ICUs at two tertiary-care hospitals. PATIENTS: Previously employed patients from the Bringing to Light the Risk Factors and Incidence of Neuropsychological Dysfunction in ICU Survivors study who survived a critical illness due to respiratory failure or shock were evaluated for global cognition and employment status at 3- and 12-month follow-up...
May 11, 2016: Critical Care Medicine
Melvyn Zhang, Kathleen Bingham, Karin Kantarovich, Jennifer Laidlaw, David Urbach, Sanjeev Sockalingam, Roger Ho
BACKGROUND: Delirium is a common medical condition with a high prevalence in hospital settings. Effective delirium management requires a multi-component intervention, including the use of Interprofessional teams and evidence-based interventions at the point of care. One vehicle for increasing access of delirium practice tools at the point of care is E-health. There has been a paucity of studies describing the implementation of delirium related clinical application. The purpose of this current study is to acquire users' perceptions of the utility, feasibility and effectiveness of a smartphone application for delirium care in a general surgery unit...
2016: BMC Medical Informatics and Decision Making
Lauren Massimo, Elizabeth Munoz, Nikki Hill, Jacqueline Mogle, Paula Mulhall, Corey T McMillan, Linda Clare, David Vandenbergh, Donna Fick, Ann Kolanowski
OBJECTIVE: To determine (1) whether delirium severity was associated with Apolipoprotein E (APOE) genotype status and occupational complexity, a measure of cognitive reserve, in individuals with delirium superimposed on dementia; and (2) whether decline in delirium severity was associated with these same factors over a post-acute care (PAC) stay. METHODS: Control group data (n = 142) from a completed randomized clinical trial were used to address the aims of the study...
April 27, 2016: International Journal of Geriatric Psychiatry
Angela Malik, Todd Harlan, Janice Cobb
AIMS AND OBJECTIVES: The paper examines the ability of nursing staff to detect delirium and apply early intervention to decrease adverse events associated with delirium. To characterise nursing practices associated with staff knowledge, delirium screening utilising the Modified Richmond Assessment Sedation Score (mRASS), and multicomponent interventions in an acute inpatient medical unit. BACKGROUND: Delirium incidence rates are up to 60% in frail elderly hospitalised patients...
April 22, 2016: Journal of Clinical Nursing
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