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Delirium assessment

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https://www.readbyqxmd.com/read/29156483/-interventions-for-assisting-geriatric-patients-with-frailty-before-surgery
#1
Jörn Kiselev
Frailty is a complex syndrome leading to a higher vulnerability in elderly patients, especially during and after surgery. It is characterized by the simultaneous presence of at least three of five phenotypical symptoms: unintentional weight loss, exhaustion, muscle weakness, slow walking speed, and low activity levels. The presence of two of these symptoms is often labelled as pre-frailty.By identifying these symptoms of frailty, medical teams can plan and perform suitable interventions prior to a planned surgery in order to lower these risk factors and to avoid complications, such as delir, hospital re-admission, loss of independence, and increased mortality...
November 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29155290/factors-associated-with-attrition-in-a-multicenter-longitudinal-observational-study-of-patients-with-advanced-cancer
#2
Pedro E Perez-Cruz, Omar Shamieh, Carlos Eduardo Paiva, Jung Hye Kwon, Mary Ann Muckaden, Eduardo Bruera, David Hui
CONTEXT: Attrition is common in longitudinal observational studies in palliative care. Few studies have examined predictors of attrition. OBJECTIVES: To identify patient characteristics at enrollment associated with attrition in palliative oncology outpatient setting. METHODS: In this longitudinal observational study, advanced cancer patients [ACP] enrolled in an outpatient multicenter study were assessed at baseline and 2-5 weeks later. We compared baseline characteristics between patients who returned for follow-up and those who dropped out...
November 15, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29155289/the-diagnostic-sensitivity-of-the-memorial-delirium-assessment-scale-mdas-spanish-version
#3
Elena Barahona, Rita Pinhao, Victoria Galindo, Antonio Noguera
Although Memorial Delirium Assessment Scale (MDAS) is a successful tool for delirium evaluation and monitoring, it is nevertheless important to determine whether cut-off scores vary according to the studied population. The main objective of this study is to evaluate the diagnostic sensitivity of the recently validated Spanish version of the MDAS. The secondary objective is to analyze possible diagnostic differences when used in a hospice or general hospital setting. METHODOLOGY: A prospective study was conducted with advanced cancer patients in two settings (hospice & general hospital)...
November 15, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29153931/disturbances-in-oxygen-balance-during-cardiopulmonary-bypass-a-risk-factor-for-postoperative-delirium
#4
Nina Smulter, Helena Claesson Lingehall, Yngve Gustafson, Birgitta Olofsson, Karl Gunnar Engström, Micael Appelblad, Staffan Svenmarker
OBJECTIVE: The aim of this study was to determine risk factors for postoperative delirium after cardiac surgery, specifically associated with the conduct of cardiopulmonary bypass (CPB). DESIGN: Prospective observational study. SETTING: Heart Centre, University Hospital. PARTICIPANTS: The study included 142 patients aged 70 years and older scheduled for elective cardiac surgery with CPB. INTERVENTIONS: Risk factor analysis comprised information collected from the hospital clinical and CPB dedicated databases in addition to the medical chart...
August 25, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29153005/screening-for-delirium-development-and-validation-of-the-buffalo-delirium-scale-for-use-in-a-home-based-hospice-setting
#5
Jennifer M Breier, Scott T Meier, Christopher W Kerr, Scott T Wright, Pei C Grant, Rachel M Depner
BACKGROUND: Delirium is a challenging occurrence among people at end of life. It can be difficult to detect and treat because of its episodic nature. The Buffalo Delirium Scale (BDS) was designed to identify risk factors for hospice patients in the prodromal stage of delirium. OBJECTIVE: This study evaluated the psychometric properties of items assessing delirium risk factors related to cognitive problems, psychological distress, and sleep problems. METHODS: Hospice nursing staff assessed patients with the 11-item BDS over a 6-month period as part of standard weekly visits to monitor for emerging signs of delirium, for example, sleep patterns, cognition, and behavior...
January 1, 2017: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29148046/delirium-and-effect-of-circadian-light-in-the-intensive-care-unit-a-retrospective-cohort-study
#6
S Estrup, C K W Kjer, L M Poulsen, I Gøgenur, O Mathiesen
BACKGROUND: Delirium is a serious condition often experienced by critically ill patients in intensive care units (ICUs). The role of circadian light for this condition is unclear. The aim of this study was to describe incidence of delirium, risk factors for delirium, and the association between delirium and circadian light for patients in the ICU. METHODS: This is a retrospective cohort study of all patients at a Danish ICU from 1 August 2015 to 31 January 2016...
November 17, 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29137682/cefepime-induced-neurotoxicity-a-systematic-review
#7
Lauren E Payne, David J Gagnon, Richard R Riker, David B Seder, Elizabeth K Glisic, Jane G Morris, Gilles L Fraser
BACKGROUND: Cefepime is a widely used antibiotic with neurotoxicity attributed to its ability to cross the blood-brain barrier and exhibit concentration-dependent ϒ-aminobutyric acid (GABA) antagonism. Neurotoxic symptoms include depressed consciousness, encephalopathy, aphasia, myoclonus, seizures, and coma. Data suggest that up to 15% of ICU patients treated with cefepime may experience these adverse effects. Risk factors include renal dysfunction, excessive dosing, preexisting brain injury, and elevated serum cefepime concentrations...
November 14, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29132782/midterm-outcomes-after-postoperative-delirium-on-cognition-and-mood-in-patients-after-cardiac-surgery
#8
Quyen Nguyen, Kelsey Uminski, Brett M Hiebert, Navdeep Tangri, Rakesh C Arora
OBJECTIVE: Delirium is a common neurologic complication after cardiac surgery. Our primary objective was to determine the impact of delirium on self-reported problems with midterm cognitive functioning and mood postcardiac surgery. METHODS: A single-center, prospective cohort study was conducted, enrolling 197 patients undergoing coronary artery bypass grafting or valve replacement. Baseline cognition and mood were assessed preoperatively in elective patients as a part of routine care using the Montreal Cognitive Assessment and Patient Health Questionnaire 9, respectively...
October 20, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29132662/-delirium-in-a-nursing-home-a-survey-of-general-practitioners
#9
REVIEW
Léa Elkouby, Sophie Moulias
Delirium is all the more frequent and serious when it occurs in a nursing home. A study was carried out to assess the current practices of general practitioners in the management of delirium in a nursing home in order to identify the issues involved and to suggest areas for improvement. The doctors identified three main difficulties: the management of behavioural disorders, the conditions of practice of a private practitioner in a healthcare institution and the relations with the different caregivers of the nursing home...
November 2017: Soins. Gérontologie
https://www.readbyqxmd.com/read/29125432/association-between-baseline-cognitive-impairment-and-postoperative-delirium-in-elderly-patients-undergoing-surgery-for-adult-spinal-deformity
#10
Owoicho Adogwa, Aladine A Elsamadicy, Victoria D Vuong, Jared Fialkoff, Joseph Cheng, Isaac O Karikari, Carlos A Bagley
OBJECTIVE Postoperative delirium is common in elderly patients undergoing spine surgery and is associated with a longer and more costly hospital course, functional decline, postoperative institutionalization, and higher likelihood of death within 6 months of discharge. Preoperative cognitive impairment may be a risk factor for the development of postoperative delirium. The aim of this study was to investigate the relationship between baseline cognitive impairment and postoperative delirium in geriatric patients undergoing surgery for degenerative scoliosis...
November 10, 2017: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/29124114/impact-of-programs-to-reduce-antipsychotic-and-anticholinergic-use-in-nursing-homes
#11
Ryan M Carnahan, Grant D Brown, Elena M Letuchy, Linda M Rubenstein, Brian M Gryzlak, Marianne Smith, Jeffrey C Reist, Michael W Kelly, Susan K Schultz, Michelle T Weckmann, Elizabeth A Chrischilles
Introduction: Antipsychotics are used for managing behavioral and psychological symptoms of dementia (BPSD) but have risks. Anticholinergics can worsen outcomes in dementia. The Improving Antipsychotic Appropriateness in Dementia Patients educational program (IA-ADAPT) and Centers for Medicare and Medicaid Services Partnership to Improve Dementia Care (CMS Partnership) promote improved care for BPSD. The purpose of this study was to evaluate the impact of these programs on medication use and BPSD among nursing home residents...
November 2017: Alzheimer's & Dementia: Translational Research & Clinical Interventions
https://www.readbyqxmd.com/read/29118783/cerebrospinal-fluid-phosphate-in-delirium-after-hip-fracture
#12
Ane-Victoria Idland, Torgeir Bruun Wyller, Randi Støen, Gry Torsæter Dahl, Frede Frihagen, Anne Brækhus, Bjørnar Hassel, Leiv Otto Watne
Aims: Phosphate is essential for neuronal activity. We aimed to investigate whether delirium is associated with altered phosphate concentrations in cerebrospinal fluid (CSF) and serum. Methods: Seventy-seven patients with hip fracture were assessed for delirium before and after acute surgery. Prefracture dementia was diagnosed by an expert panel. Phosphate was measured in CSF obtained immediately before spinal anesthesia (n = 77) and in serum (n = 47). CSF from 23 cognitively healthy elderly patients undergoing spinal anesthesia was also analyzed...
September 2017: Dementia and Geriatric Cognitive Disorders Extra
https://www.readbyqxmd.com/read/29110954/effect-of-motor-subtypes-of-delirium-in-the-intensive-care-unit-on-fast-track-failure-after-cardiac-surgery
#13
Anna Lee, Jing Lan Mu, Chun Hung Chiu, Tony Gin, Malcolm John Underwood, Gavin Matthew Joynt
OBJECTIVE: The purpose of the study was to evaluate the association between motor subtypes of postoperative delirium in the intensive care unit and fast-track failure (a composite outcome of prolonged stay in the intensive care unit >48 hours, intensive care unit readmission, and 30-day mortality) after cardiac surgery. METHODS: This was a secondary analysis of a prospective cohort study of 600 consecutive adults undergoing cardiac surgery at a university hospital in Hong Kong (July 2013 to July 2015)...
September 30, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29109625/postoperative-delirium-in-elderly-citizens-and-current-practice
#14
REVIEW
Siddareddygari Velayudha Reddy, Jawaharlal Narayanasa Irkal, Ananthapuram Srinivasamurthy
Postoperative delirium (POD) represents an acute brain dysfunction in the postsurgical period. Perioperative physicians caring for the older adults are familiar with the care of dysfunction of organs such as lungs, heart, liver, or kidney in the perioperative setting, but they are less familiar with management of brain dysfunction. As early detection and prompt treatment of inciting factors are utmost important to prevent or minimize the deleterious outcomes of delirium. The purpose of this review is to prepare perioperative physicians with a set of current clinical practice recommendations to provide optimal perioperative care of older adults, with a special focus on specific perioperative interventions that have been shown to prevent POD...
July 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29103316/interdem-academy-special-section-what-effect-does-delirium-have-on-family-and-nurses-of-older-adult-patients
#15
Sónia Martins, Elika Pinho, Raquel Correia, Emília Moreira, Luís Lopes, José Artur Paiva, Luís Azevedo, Lia Fernandes
OBJECTIVES: This study aims to analyse the level of distress caused by delirium in patients' family and their nurses, and to identify factors associated with psychological distress in families of older adult inpatients in Intermediate Care Units/IMCUs regarding their global experience during hospitalization. METHOD: A prospective pilot study was carried out with families and nurses of older adult patients (≥65 y.o.) consecutively recruited from two IMCUs in Intensive Care Medicine Service in a University Hospital...
November 6, 2017: Aging & Mental Health
https://www.readbyqxmd.com/read/29097068/evaluation-of-cognitive-function-following-transcatheter-aortic-valve-replacement
#16
Masieh Abawi, Rehana de Vries, Pieter R Stella, Pierfrancesco Agostoni, Dirk H M Boelens, Romy C van Jaarsveld, Charlotte S van Dongen, Pieter A F M Doevendans, Mariëlle H Emmelot-Vonk
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is associated with procedural-related neurological events and acute cognitive decline. However, data on the effect of TAVR on mid-term cognitive outcome are scarce. Therefore, we aimed to assess the impact of TAVR on mid-term cognitive outcome using different neurocognitive test batteries. METHODS: Patients with severe aortic valve stenosis scheduled for TAVR were enrolled. Cognitive assessment was performed at baseline and 4 months post-TAVR using an eight-word verbal-learning test ("Immediate Recall Memory Test" [IRMT], "Delayed Recall Memory Test" [DRMT], "Recognition of Verbal Information Test" [RVIT]), global cognitive function ("Mini Mental State Examination" [MMSE]), and executive function ("Trail Making Test" [TMT], "Clock-Drawing Test" [CDT])...
October 20, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/29094525/prevention-recognition-and-management-of-delirium-in-patients-who-are-critically-ill
#17
Jaime Hyde-Wyatt
Delirium is common in patients who are critically ill, often resulting in extended hospital stays and increased mortality and morbidity. There are several subtypes of delirium, which are often undiagnosed and untreated, resulting in suboptimal patient outcomes. This article examines delirium in patients in the intensive care unit, including its signs and symptoms, incidence, causes and subtypes. It outlines the assessment of delirium and the pharmacological and non-pharmacological interventions that can be used to manage the condition, as well as describing the optimal prevention measures...
October 4, 2017: Nursing Standard
https://www.readbyqxmd.com/read/29092867/subsyndromal-delirium-and-institutionalization-among-patients-with-critical-illness
#18
Nathan E Brummel, Leanne M Boehm, Timothy D Girard, Pratik P Pandharipande, James C Jackson, Christopher G Hughes, Mayur B Patel, Jin H Han, Eduard E Vasilevskis, Jennifer L Thompson, Rameela Chandrasekhar, Gordon R Bernard, Robert S Dittus, E Wesley Ely
BACKGROUND: The prognostic importance of subsyndromal delirium is unknown. OBJECTIVE: To test whether duration of subsyndromal delirium is independently associated with institutionalization. METHODS: The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was used twice daily to assess for subsyndromal delirium in patients with respiratory failure or shock. Delirium was considered present if the assessment was positive. Subsyndromal delirium was considered present if the assessment was negative but the patient exhibited any CAM-ICU features...
November 2017: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
https://www.readbyqxmd.com/read/29081151/-effects-of-preconditioning-with-hypertonic-saline-solution-on-postoperative-delirium-in-the-aged
#19
X Xin, S P Huo, Q Zhang, Y N Li, L Wang, Q J Wang
Objective: To evaluate and explore the mechanism of the effect of hypertonic pre-injection on postoperative delirium in the aged. Methods: From June 2016 to February 2017, participants scheduled hip arthroplasty surgery were randomly divided into four groups: Group 1 (H1) 30 patients pre-injected 4 ml/kg hypertonic solution were proceeded general anesthesia; Group 2 (H2) 30 patients pre-injected 4 ml/kg hypertonic solution were proceeded spinal canal anesthesia; Group 3 (C1) 30 patients pre-injected 4 ml/kg isotonic saline were proceeded general anesthesia; Group 4 (C2) 30 patients pre-injected 4 ml/kg isotonic saline were proceeded spinal canal anesthesia in Department of Anesthesiology, Third Hospital of Hebei Medical University...
October 24, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29079365/postoperative-continuous-flow-cryocompression-therapy-in-the-acute-recovery-phase-of-hip-fracture-surgery-a-randomized-controlled-clinical-trial
#20
Nick C Leegwater, Frank W Bloemers, Niels de Korte, Martin J Heetveld, Kees J Kalisvaart, Casper P Schönhuth, Bas A C M Pijnenburg, Bart J Burger, Kornelis J Ponsen, Andrea B Maier, Barend J van Royen, Peter A Nolte
BACKGROUND: The acute recovery phase after hip fracture surgery is often complicated by severe pain, postoperative blood loss with subsequent transfusion, and delirium. Prevalent comorbidity in hip fracture patients limit the use of opioid-based analgesic therapies, yielding a high risk for inferior pain treatment. Postoperative cryotherapy is suggested to provide an analgesic effect, and to reduce postoperative blood loss. In this prospective, open-label, parallel, multicentre, randomized controlled, clinical trial, we aimed to determine the efficacy of continuous-flow cryocompression therapy (CFCT) in the acute recovery phase after hip fracture surgery...
October 10, 2017: Injury
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