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Delirium intervention

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https://www.readbyqxmd.com/read/29137682/cefepime-induced-neurotoxicity-a-systematic-review
#1
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/29123562/the-role-of-occupational-and-physiotherapy-in-multi-modal-approach-to-tackling-delirium-in-the-intensive-care
#2
REVIEW
Jenny Rains, Nigel Chee
The presence of delirium within critical care remains a long-standing challenge for patients and clinicians alike. A myriad of pre-disposing and precipitating factors lead to this patient cohort being high risk for developing delirium during their critical care stay. Until now, non-pharmacological management of these patients usually encompasses a 'bundle' of principles to reduce delirium days. These bundles have limited focus on the entire multi-disciplinary team (including occupational therapists and physiotherapists) who could assist with the reduction of delirium...
November 2017: J Intensive Care Soc
https://www.readbyqxmd.com/read/29109625/postoperative-delirium-in-elderly-citizens-and-current-practice
#3
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
#4
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/29100197/using-simulated-family-presence-to-decrease-agitation-in-older-hospitalized-delirious-patients-a-randomized-controlled-trial
#5
Christine M Waszynski, Kerry A Milner, Ilene Staff, Sheila L Molony
BACKGROUND: Simulated family presence has been shown to be an effective nonpharmacological intervention to reduce agitation in persons with dementia in nursing homes. Hyperactive or mixed delirium is a common and serious complication experienced by hospitalized patients, a key feature of which is agitation. Effective nonpharmacological interventions to manage delirium are needed. OBJECTIVES: To examine the effect of simulated family presence through pre-recorded video messages on the agitation level of hospitalized, delirious, acutely agitated patients...
October 7, 2017: International Journal of Nursing Studies
https://www.readbyqxmd.com/read/29094525/prevention-recognition-and-management-of-delirium-in-patients-who-are-critically-ill
#6
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/29061618/critical-care-cycling-study-cyclist-trial-protocol-a-randomised-controlled-trial-of-usual-care-plus-additional-in-bed-cycling-sessions-versus-usual-care-in-the-critically-ill
#7
Marc R Nickels, Leanne M Aitken, James Walsham, Adrian G Barnett, Steven M McPhail
INTRODUCTION: In-bed cycling with patients with critical illness has been shown to be safe and feasible, and improves physical function outcomes at hospital discharge. The effects of early in-bed cycling on reducing the rate of skeletal muscle atrophy, and associations with physical and cognitive function are unknown. METHODS AND ANALYSIS: A single-centre randomised controlled trial in a mixed medical-surgical intensive care unit (ICU) will be conducted. Adult patients (n=68) who are expected to be mechanically ventilated for more than 48 hours and remain in ICU for a further 48 hours from recruitment will be randomly allocated into either (1) a usual care group or (2) a group that receives usual care and additional in-bed cycling sessions...
October 22, 2017: BMJ Open
https://www.readbyqxmd.com/read/29061612/comparison-of-regional-with-general-anaesthesia-on-postoperative-delirium-raga-delirium-in-the-older-patients-undergoing-hip-fracture-surgery-study-protocol-for-a-multicentre-randomised-controlled-trial
#8
Ting Li, Joyce Yeung, Jun Li, Yan Zhang, Teresa Melody, Ye Gao, Yi Wang, Qianquan Lian, Fang Gao
INTRODUCTION: Postoperative delirium (POD) is a common serious postoperative complication especially in older people and is associated with increased mortality, morbidity and healthcare costs. There is no clear consensus which anaesthesia is associated with less incidence of POD for older patients. We aim to assess whether regional anaesthesia results in lower incidence of POD comparing with general anaesthesia (GA) among older patients undergoing hip fracture surgery. METHODS AND ANALYSIS: RAGA-delirium is a pragmatic, multicentre, prospective, parallel grouped, randomised controlled clinical trial comparing RA or GA for hip fracture surgery...
October 22, 2017: BMJ Open
https://www.readbyqxmd.com/read/29061154/a-multi-centre-randomised-trial-to-compare-the-effectiveness-of-geriatrician-led-admission-avoidance-hospital-at-home-versus-inpatient-admission
#9
Sasha Shepperd, Andrea Cradduck-Bamford, Chris Butler, Graham Ellis, Mary Godfrey, Alastair Gray, Anthony Hemsley, Pradeep Khanna, Peter Langhorne, Patricia McCaffrey, Lubena Mirza, Maj Pushpangadan, Scott Ramsay, Rebekah Schiff, David Stott, John Young, Ly-Mee Yu
BACKGROUND: There is concern that existing models of acute hospital care will become unworkable as the health service admits an increasing number of frail older people with complex health needs, and that there is inadequate evidence to guide the planning of acute hospital level services. We aim to evaluate whether geriatrician-led admission avoidance to hospital at home is an effective alternative to hospital admission. METHODS/DESIGN: We are conducting a multi-site randomised open trial of geriatrician-led admission avoidance hospital at home, compared with admission to hospital...
October 23, 2017: Trials
https://www.readbyqxmd.com/read/29042822/antipsychotic-prescription-to-identify-delirium-results-from-two-cohorts
#10
Kristin M Zimmerman, Allison M Paquin, James L Rudolph
OBJECTIVES: Detection of delirium in hospitalized patients remains challenging. The objective was to determine if the prescription of antipsychotic medications was associated with delirium. PATIENTS AND METHODS: Two patient cohorts were utilized from a tertiary Veterans Affairs hospital: a palliative care retrospective cohort and a prospective medical cohort. Patients prescribed outpatient antipsychotics were excluded. Retrospectively, delirium was identified using a validated medical record-review instrument...
2017: Clinical Pharmacology: Advances and Applications
https://www.readbyqxmd.com/read/29034255/perioperative-management-of-elderly-patients-with-gastrointestinal-malignancies-the-contribution-of-anesthesia
#11
REVIEW
Rudolf Mörgeli, Kathrin Scholtz, Johannes Kurth, Sascha Treskatsch, Bruno Neuner, Susanne Koch, Lutz Kaufner, Claudia Spies
INTRODUCTION: Elderly patients suffering from gastrointestinal malignancies are particularly prone to perioperative complications. Elderly patients often present with reduced physiological reserves, and comorbidities can limit treatment options and promote complications. Surgeons and anesthesiologists must be aware of strategies required to deal with this vulnerable subgroup. METHODS: We provide a brief review of current and emerging perioperative strategies for the treatment of elderly patients with gastrointestinal malignancies and frequent comorbidities...
August 2017: Visceral Medicine
https://www.readbyqxmd.com/read/29028151/delirium-care-real-world-solutions-to-real-world-problems
#12
Eamonn Eeles, Judy McCrow, Andrew Teodorczuk, Gideon A Caplan
OBJECTIVES: Implementation research into delirium care is lacking. Exploiting known practice barriers to understand what management strategies work best in delirium is a means of prioritising care interventions. A consensus approach to determining priority interventions in delirium was derived and related to reference standards in health-care practice. METHODS: A workshop of 20 experts was held at the Australasian Delirium Association conference 2016. Structured small group work, iterative ranking and a 21-member check were undertaken to (i) explore research barriers in delirium care; (ii) explore how barriers related to individual items of multicomponent interventions; and (iii) rank multicomponent interventions in relation to each statement within the newly released Australian Commission on Safety and Quality in Health Care delirium standard...
October 13, 2017: Australasian Journal on Ageing
https://www.readbyqxmd.com/read/29026932/-protocol-based-mobilization-on-intensive-care-units-design-of-a%C3%A2-cluster-randomized-pilot-study
#13
REVIEW
P Nydahl, A Diers, U Günther, B Haastert, S Hesse, C Kerschensteiner, S Klarmann, S Köpke
BACKGROUND: Despite convincing evidence for early mobilization of patients on intensive care units (ICU), implementation in practice is limited. Protocols for early mobilization, including in- and exclusion criteria, assessments, safety criteria, and step schemes may increase the rate of implementation and mobilization. HYPOTHESIS: Patients (population) on ICUs with a protocol for early mobilization (intervention), compared to patients on ICUs without protocol (control), will be more frequently mobilized (outcome)...
October 12, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28988183/neurological-outcome-after-minimal-invasive-coronary-artery-surgery-nomics-protocol-for-an-observational-prospective-cohort-study
#14
Kristof Nijs, Jeroen Vandenbrande, Fidel Vaqueriza, Jean-Paul Ory, Alaaddin Yilmaz, Pascal Starinieri, Jasperina Dubois, Luc Jamaer, Ingrid Arijs, Björn Stessel
INTRODUCTION: Adverse neurocognitive outcomes are still an important cause of morbidity and mortality after cardiac surgery. The most common neurocognitive disorders after conventional cardiac surgery are postoperative cognitive dysfunction (POCD), stroke and delirium. Minimal invasive cardiac procedures have recently been introduced into practice. Endoscopic coronary artery bypass grafting (Endo-CABG) is a minimal invasive cardiac procedure based on the conventional CABG procedure. Neurocognitive outcome after minimal invasive cardiac surgery, including Endo-CABG, has never been studied...
October 6, 2017: BMJ Open
https://www.readbyqxmd.com/read/28980071/prevalence-of-delirium-in-advanced-cancer-patients-in-home-care-and-hospice-and-outcomes-after-1%C3%A2-week-of-palliative-care
#15
Sebastiano Mercadante, Francesco Masedu, Isabella Balzani, Daniela De Giovanni, Luigi Montanari, Cristina Pittureri, Raffaella Bertè, Domenico Russo, Laura Ursini, Franco Marinangeli, Federica Aielli
AIM: The aim of this study was to assess the prevalence of delirium in advanced cancer patients admitted to different palliative care services in Italy and possible related factors. The secondary outcome was to assess the changes of delirium after 1 week of palliative care. METHODS: A consecutive sample of patients was screened for delirium in period of 1 year in seven palliative care services. General data, including primary tumor, age, gender, concomitant disease, palliative prognostic score (PaP), and Karnofsky status, were collected...
October 5, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/28977265/cognitive-stimulation-and-occupational-therapy-for-delirium-prevention
#16
Eduardo Tobar, Evelyn Alvarez, Maricel Garrido
Delirium is a relevant condition in critically ill patients with long-term impacts on mortality, cognitive and functional status and quality of life. Despite the progress in its diagnosis, prevention and management during the last years, its impact persists being relevant, so new preventive and therapeutic strategies need to be explored. Among non-pharmacologic preventive strategies, recent reports suggest a role for occupational therapy through a series of interventions that may impact the development of delirium...
April 2017: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/28953788/benzodiazepines-in-combination-with-antipsychotic-drugs-for-schizophrenia-gaba-ergic-targeted-therapy
#17
Adam Włodarczyk, Joanna Szarmach, Wiesław Jerzy Cubała, Mariusz Stanisław Wiglusz
Antipsychotics are a key intervention strategy in pharmacotherapy of schizophrenia. However, benzodiazepines are often prescribed to control sleep disturbances, anxiety or behavioural disinhibition. There is clinical evidence for the beneficial effect of the combined treatment of antipsychotics and benzodiazepines resulting in more favorable treatment outcome in schizophrenia with regard to positive and negative symptoms. This clinical phenomenon seems to be associated with the GABA-ergic activit ythat is believed to be disrupted in the schizophrenia and direct benzodiazepines effect on GABA-A receptors...
September 2017: Psychiatria Danubina
https://www.readbyqxmd.com/read/28944590/effect-of-the-use-of-earplugs-and-eye-mask-on-the-quality-of-sleep-in-intensive-care-patients-a-systematic-review
#18
Hana Locihová, Karel Axmann, Hana Padyšáková, Jakub Fejfar
Intensive care unit (ICU) environment has a very strong and unavoidable negative impact on patients' sleep. Sleep deprivation in ICU patients has been already studied and negative effects on their outcome (prolonged ICU stay, decreased recovery) and complication rates (incidence of delirium, neuropsychological sequels of critical illness) discussed. Several interventions potentially improving the sleep disturbance in ICU (sleep-promotion strategies) have been assumed and tested for clinical practice. We present a review of recent literature focused on chosen types of non-pharmacological interventions (earplugs and eye mask) analysing their effect on sleep quality/quantity...
September 25, 2017: Journal of Sleep Research
https://www.readbyqxmd.com/read/28940368/cerebral-oximetry-and-postoperative-delirium-after-cardiac-surgery-a-randomised-controlled-trial
#19
L Lei, R Katznelson, L Fedorko, J Carroll, H Poonawala, M Machina, R Styra, V Rao, G Djaiani
Postoperative delirium is associated with increased morbidity and mortality. We hypothesised that restoration of regional cerebral oxygen desaturation would reduce the incidence of postoperative delirium in elderly patients after cardiac surgery. After institutional ethics review board approval and informed consent, a double-blinded, prospective, randomised, controlled trial was conducted in patients ≥ 60 years of age undergoing cardiac surgery with cardiopulmonary bypass. In the intervention group, an algorithm was commenced if regional cerebral oxygen saturation decreased below 75% of baseline value for 1 min or longer...
December 2017: Anaesthesia
https://www.readbyqxmd.com/read/28928181/development-of-core-outcome-sets-for-effectiveness-trials-of-interventions-to-prevent-and-or-treat-delirium-del-cors-study-protocol
#20
Louise Rose, Meera Agar, Lisa D Burry, Noll Campbell, Mike Clarke, Jacques Lee, Najma Siddiqi, Valerie J Page
INTRODUCTION: Delirium is a common, serious and potentially preventable condition with devastating impact on the quality of life prompting a proliferation of interventional trials. Core outcome sets aim to standardise outcome reporting by identifying outcomes perceived fundamental for measurement in trials of a specific interest area. Our aim is to develop international consensus on two core outcome sets for trials of interventions to prevent and/or treat delirium, irrespective of study population...
September 18, 2017: BMJ Open
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