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Delirium assessment

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https://www.readbyqxmd.com/read/28642002/development-of-geriatric-mental-health-learning-objectives-for-medical-students-a-response-to-the-institute-of-medicine-2012-report
#1
Susan W Lehmann, William B Brooks, Dennis Popeo, Kirsten M Wilkins, Mary C Blazek
America is aging as the population of older adults increases. The shortage of geriatric mental health specialists means that most geriatric mental healthcare will be provided by physicians who do not have specialty training in geriatrics. The Institute of Medicine Report of 2012 highlighted the urgent need for development of national competencies and curricula in geriatric mental health for all clinicians. Virtually all physicians can expect to treat older patients with mental health symptoms, yet currently there are no widely accepted learning objectives in geriatric mental health specific for medical students...
May 12, 2017: American Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/28639340/impact-of-frailty-and-residual-subsyndromal-delirium-on-1-year-functional-recovery-a-prospective-cohort-study
#2
Justin Chew, Wee Shiong Lim, Mei Sian Chong, Yew Yoong Ding, Laura Tay
AIM: To investigate the association between frailty and incomplete delirium recovery at discharge (residual subsyndromal delirium [RSSD]), and to examine the mediating role of RSSD in the relationship between frailty and functional recovery at 12 months post-delirium. METHODS: This was a prospective observational study of 234 individuals aged ≥65 years admitted to a specialized delirium unit. A 20-item frailty index was derived using items from a comprehensive geriatric assessment...
June 22, 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/28632519/age-is-the-most-significantly-associated-risk-factor-with-the-development-of-delirium-in-patients-hospitalized-for-more-than-five-days-in-surgical-wards-retrospective-cohort-study
#3
Keisuke Kubota, Akihiro Suzuki, Sachiko Ohde, Ui Yamada, Takashi Hosaka, Fumiko Okuno, Ikumi Fujitani, Aya Koitabashi, Gen Shimada, Akihiro Kishida
OBJECTIVE: The primary purpose of this study was to assess risk factors for delirium in patients staying in a surgical ward for more than 5 days. The secondary purpose was to assess outcomes in patients with delirium. BACKGROUND: Delirium is a syndrome characterized by acute fluctuations in mental status. Patients with delirium are at increased risk of adverse inpatient events, higher mortality and morbidity rates, prolonged hospital stays, and increased health care costs...
June 19, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28631875/nursing-assessment-as-an-effective-tool-for-the-identification-of-delirium-risk-in-older-in-patients-a-case-control-study
#4
Elena Solà-Miravete, Carlos López, Estrella Martínez-Segura, Mireia Adell-Lleixà, Maria Eulàlia Juvé-Udina, Mar Lleixà-Fortuño
AIMS: To evaluate the usefulness of comprehensive nursing assessment as a strategy for determining the risk of delirium in older in-patients from a model of care needs based on variables easily measured by nurses. BACKGROUND: There are many scales of assessment and prediction of risk of delirium, but they are little known and infrequently used by professionals. Recognition of delirium by doctors and nurses continues to be limited. DESIGN AND METHODS: A case-control study...
June 20, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28628893/one-year-mortality-after-hip-fracture-in-older-individuals-the-effects-of-delirium-and-dementia
#5
Rebecca Mitchell, Lara Harvey, Henry Brodaty, Brian Draper, Jacqueline Close
BACKGROUND: Delirium is common in older hip fracture patients, yet its association with mortality after hip fracture remains uncertain. This study aimed to determine whether delirium was associated with all-cause one-year mortality after hip fracture in older patients and whether the effect of delirium was independent of dementia status. METHOD: A retrospective analysis of linked hospitalisation and mortality data for patients aged ≥65 years with a hip fracture during 1 January 2010 to 30 June 2014 in New South Wales, Australia...
June 13, 2017: Archives of Gerontology and Geriatrics
https://www.readbyqxmd.com/read/28622167/statin-and-its-association-with-delirium-in-the-medical-icu
#6
Jeffrey F Mather, John P Corradi, Christine Waszynski, Adam Noyes, Yinghui Duan, James Grady, Robert Dicks
OBJECTIVES: To examine the association between statin use and the risk of delirium in hospitalized patients with an admission to the medical ICU. DESIGN: Retrospective propensity-matched cohort analysis with accrual from September 1, 2012, to September 30, 2015. SETTING: Hartford Hospital, Hartford, CT. PATIENTS: An initial population of patients with an admission to a medical ICU totaling 10,216 visits were screened for delirium by means of the Confusion Assessment Method...
June 15, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28620924/childhood-preoperative-anxiolysis-is-sedation-and-distraction-better-than-either-alone-a-prospective-randomized-study
#7
Chrystelle Sola, Audrey Lefauconnier, Sophie Bringuier, Olivier Raux, Xavier Capdevila, Christophe Dadure
BACKGROUND: Preoperative anxiety management receives special attention in pediatric anesthesia. Different pharmacological and nonpharmacological techniques can be employed. This study was designed to assess three different strategies for childhood preoperative anxiolysis: midazolam premedication, midazolam in combination with portable Digital Video-Disk player, or video distraction strategy alone. METHODS: In this prospective randomized study, children aged 2-12 years were assigned to one of the three study groups...
June 16, 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28618688/re-association-of-pre-operative-medication-use-with-post-operative-delirium-in-surgical-oncology-patients-receiving-comprehensive-geriatric-assessment
#8
https://www.readbyqxmd.com/read/28618686/re-comprehensive-geriatric-assessment-is-a-useful-predictive-tool-for-postoperative-delirium-after-gastrointestinal-surgery-in-old-old-adults
#9
Tomas L Griebling
No abstract text is available yet for this article.
July 2017: Journal of Urology
https://www.readbyqxmd.com/read/28618293/pilot-prospective-study-of-post-surgery-sleep-and-eeg-predictors-of-post-operative-delirium
#10
Joanna L Evans, Jacob W Nadler, Xavier A Preud'homme, Eric Fang, Rommie L Daughtry, Joseph B Chapman, David Attarian, Samuel Wellman, Andrew D Krystal
OBJECTIVE: Delirium is a common post-operative complication associated with significant costs, morbidity, and mortality. We sought sleep/EEG predictors of delirium present prior to delirium symptoms to facilitate developing and targeting therapies. METHODS: Continuous EEG data were obtained in 12 patients post-orthopedic surgery from the day of surgery until delirium assessment on post-operative day 2 (POD2). RESULTS: Diminished total sleep time (r=-0...
May 17, 2017: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
https://www.readbyqxmd.com/read/28608136/early-impairment-of-intracranial-conduction-time-predicts-mortality-in-deeply-sedated-critically-ill-patients-a-prospective-observational-pilot-study
#11
Eric Azabou, Benjamin Rohaut, Nicholas Heming, Eric Magalhaes, Régine Morizot-Koutlidis, Stanislas Kandelman, Jeremy Allary, Guy Moneger, Andrea Polito, Virginie Maxime, Djillali Annane, Frederic Lofaso, Fabrice Chrétien, Jean Mantz, Raphael Porcher, Tarek Sharshar
BACKGROUND: Somatosensory (SSEP) and brainstem auditory (BAEP) evoked potentials are neurophysiological tools which, respectively, explore the intracranial conduction time (ICCT) and the intrapontine conduction time (IPCT). The prognostic values of prolonged cerebral conduction times in deeply sedated patients have never been assessed. Sedated patients are at risk of developing new neurological complications, undetected. In this prospective observational bi-center pilot study, we investigated whether early impairment of SSEP's ICCT and/or BAEP's IPCT could predict in-ICU mortality or altered mental status (AMS), in deeply sedated critically ill patients...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28601133/assessment-and-management-of-toxidromes-in-the-critical-care-unit
#12
REVIEW
J J Rasimas, Courtney M Sinclair
The most important diagnostic factor in uncovering a toxic etiology for delirium or critical illness is the clinician's openness to the possibility of its existence. Therefore, a consulting psychiatrist, already prepared to perform the detail-oriented work of sorting out behavioral manifestations of disease, can be a vital asset at the bedside if also attuned to the role of purposeful, accidental, and iatrogenic exposures in the intensive care unit. This article summarizes the presentation, evaluation, and treatment of toxidromes relevant to the work of acute psychosomatic medicine...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28594681/delirium-and-benzodiazepines-associated-with-prolonged-icu-stay-in-critically-ill-infants-and-young-children
#13
Heidi A B Smith, Maalobeeka Gangopadhyay, Christina M Goben, Natalie L Jacobowski, Mary Hamilton Chestnut, Jennifer L Thompson, Rameela Chandrasekhar, Stacey R Williams, Katherine Griffith, E Wesley Ely, D Catherine Fuchs, Pratik P Pandharipande
OBJECTIVES: Delirium is prevalent among critically ill children, yet associated outcomes and modifiable risk factors are not well defined. The objective of this study was to determine associations between pediatric delirium and modifiable risk factors such as benzodiazepine exposure and short-term outcomes. DESIGN: Secondary analysis of collected data from the prospective validation study of the Preschool Confusion Assessment Method for the ICU. SETTING: Tertiary-level PICU...
June 7, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28593326/intraoperative-infusion-of-dexmedetomidine-for-prevention-of-postoperative-delirium-and-cognitive-dysfunction-in-elderly-patients-undergoing-major-elective-noncardiac-surgery-a-randomized-clinical-trial
#14
Stacie Deiner, Xiaodong Luo, Hung-Mo Lin, Daniel I Sessler, Leif Saager, Frederick E Sieber, Hochang B Lee, Mary Sano, Christopher Jankowski, Sergio D Bergese, Keith Candiotti, Joseph H Flaherty, Harendra Arora, Aryeh Shander, Peter Rock
Importance: Postoperative delirium occurs in 10% to 60% of elderly patients having major surgery and is associated with longer hospital stays, increased hospital costs, and 1-year mortality. Emerging literature suggests that dexmedetomidine sedation in critical care units is associated with reduced incidence of delirium. However, intraoperative use of dexmedetomidine for prevention of delirium has not been well studied. Objective: To evaluate whether an intraoperative infusion of dexmedetomidine reduces postoperative delirium...
June 7, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28591818/yokukansan-for-the-treatment-of-preoperative-anxiety-and-postoperative-delirium-in-colorectal-cancer-patients-a-retrospective-study
#15
Saho Wada, Hironobu Inoguchi, Takatoshi Hirayama, Yutaka J Matsuoka, Yosuke Uchitomi, Hiroki Ochiai, Shunsuke Tsukamoto, Dai Shida, Yukihide Kanemitsu, Ken Shimizu
Background: Yokukansan (YKS), a Japanese traditional herbal medicine for neurosis and insomnia, is speculated to be useful for perioperative psychiatric symptoms in cancer patients, but there exists little empirical evidence. This study provides preliminary data about the efficacy, feasibility, and side effects of YKS for the treatment of preoperative anxiety and postoperative delirium in cancer patients. Methods: We retrospectively reviewed the medical records of colorectal cancer patients who took YKS for preoperative anxiety, evaluating the following: (1) patient characteristics, (2) feasibility of taking YKS, (3) changes in preoperative anxiety based on the Clinical Global Impression (CGI) scale and Edmonton Symptom Assessment System-revised (ESAS-r-anxiety), (4) incidence of postoperative delirium and (5) YKS-related side effects...
June 7, 2017: Japanese Journal of Clinical Oncology
https://www.readbyqxmd.com/read/28590990/delirium-upon-presentation-to-the-pediatric-emergency-department-a-case-series
#16
Julie A Augenstein, Eileen J Klein, Chani Traube
The following cases describe children who presented to the emergency department (ED) with a constellation of symptoms consistent with delirium. In each case, there was no identified inciting cause (eg, fever, medications) other than the presence of influenza. All children had variable workups, with 2 children undergoing extensive neurologic evaluation and testing. Clinical recognition of delirium in the pediatric acute care setting can be challenging, but heightened awareness by ED and primary care physicians may lead to earlier diagnosis, prevent unwarranted investigations, and decrease hospitalization...
June 6, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28587754/delirium-screening-in-intensive-care-a-life-saving-opportunity
#17
REVIEW
E Lamond, S Murray, C E Gibson
BACKGROUND: Delirium is described as 'acute brain failure' and constitutes a medical emergency which presents a hazard for people cared for in intensive care units. The Scottish intensive care society audit group recommend that all people cared for in intensive care units be screened for signs of delirium so that treatment and management of complications can be implemented at an early stage. CLINICAL IMPLICATION: There is inconsistent evidence about when and how the assessment of delirium is carried out by nursing staff in the intensive care setting...
June 3, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/28587598/methodologic-considerations-in-the-design-and-analysis-of-nested-case-control-studies-association-between-cytokines-and-postoperative-delirium
#18
Long H Ngo, Sharon K Inouye, Richard N Jones, Thomas G Travison, Towia A Libermann, Simon T Dillon, George A Kuchel, Sarinnapha M Vasunilashorn, David C Alsop, Edward R Marcantonio
BACKGROUND: The nested case-control study (NCC) design within a prospective cohort study is used when outcome data are available for all subjects, but the exposure of interest has not been collected, and is difficult or prohibitively expensive to obtain for all subjects. A NCC analysis with good matching procedures yields estimates that are as efficient and unbiased as estimates from the full cohort study. We present methodological considerations in a matched NCC design and analysis, which include the choice of match algorithms, analysis methods to evaluate the association of exposures of interest with outcomes, and consideration of overmatching...
June 6, 2017: BMC Medical Research Methodology
https://www.readbyqxmd.com/read/28585290/csf-biomarkers-in-delirium-a-systematic-review
#19
Roanna J Hall, Leiv Otto Watne, Emma Cunningham, Henrik Zetterberg, Susan D Shenkin, Torgeir Bruun Wyller, Alasdair M J MacLullich
OBJECTIVE: In recent years, there has been a blossoming of studies examining cerebrospinal fluid (CSF) as a method of studying the pathophysiology of delirium. We systematically reviewed the literature for CSF studies in delirium and provide here a summary of the implications for our understanding of delirium pathophysiology. We also summarise the methods used for CSF analysis and discuss challenges and implications for future studies. METHODS: In this systematic review, we screened MEDLINE, EMBASE, PsycINFO, Web of Science, PubMed and the Cochrane Library for articles on CSF biomarkers in delirium, published on 3 September 2016...
June 6, 2017: International Journal of Geriatric Psychiatry
https://www.readbyqxmd.com/read/28576285/intraoperative-ketamine-for-prevention-of-postoperative-delirium-or-pain-after-major-surgery-in-older-adults-an-international-multicentre-double-blind-randomised-clinical-trial
#20
Michael S Avidan, Hannah R Maybrier, Arbi Ben Abdallah, Eric Jacobsohn, Phillip E Vlisides, Kane O Pryor, Robert A Veselis, Hillary P Grocott, Daniel A Emmert, Emma M Rogers, Robert J Downey, Heidi Yulico, Gyu-Jeong Noh, Yonghun H Lee, Christine M Waszynski, Virendra K Arya, Paul S Pagel, Judith A Hudetz, Maxwell R Muench, Bradley A Fritz, Witold Waberski, Sharon K Inouye, George A Mashour
BACKGROUND: Delirium is a common and serious postoperative complication. Subanaesthetic ketamine is often administered intraoperatively for postoperative analgesia, and some evidence suggests that ketamine prevents delirium. The primary purpose of this trial was to assess the effectiveness of ketamine for prevention of postoperative delirium in older adults. METHODS: The Prevention of Delirium and Complications Associated with Surgical Treatments [PODCAST] study is a multicentre, international randomised trial that enrolled adults older than 60 years undergoing major cardiac and non-cardiac surgery under general anaesthesia...
May 30, 2017: Lancet
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