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Delirium intervention

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https://www.readbyqxmd.com/read/29784256/perioperative-delirium-protocol-for-the-older-patient
#1
Thomas J Pallaria, Casey Panebianco, Mary C Kamienski
PURPOSE: Delirium is an acute change in cognition and attention. It may affect any age group. It is most common in older patients and is associated with a significant increase in mortality. The purpose of this project was to implement an assessment protocol to identify patients at risk for postoperative delirium. DESIGN: A case study approach was used. METHODS: The Confusion Assessment Method (CAM) tool for screening and diagnostic purposes was used to train surgeons, anesthesia providers, and nurses...
June 2018: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/29784254/evidence-based-practice-in-perianesthesia-nursing-application-of-the-american-geriatrics-society-clinical-practice-guideline-for-postoperative-delirium-in-older-adults
#2
Catherine Hebert
Delirium is a pervasive and dangerous syndrome for older adults in the perianesthesia setting, occurring in up to 60% of surgical cases. The American Geriatrics Society performed a systematic review to develop recommendations for the prevention and management of postoperative delirium in older adults. The recommendations emphasize nonpharmacologic interventions with a strong focus on reducing the use of psychoactive medication. Perianesthesia nurses can serve as leaders in translating these recommendations into evidence-based practice at the bedside for older adults...
June 2018: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/29775510/educational-intervention-on-delirium-assessment-using-confusion-assessment-method-icu-cam-icu-in-a-general-intensive-care-unit
#3
Vimala Ramoo, Harlinna Abu, Vineya Rai, Surindar Kaur Surat Singh, Ayuni Asma' Baharudin, Mahmoud Danaee, Raveena Rajalachimi R Thinagaran
AIMS AND OBJECTIVES: The primary objective was to assess intensive care unit nurses' knowledge of intensive care unit delirium and delirium assessment before and after an educational intervention. In addition, nurses' perception on the usefulness of a delirium assessment tool and barriers against delirium assessment were assessed as secondary objectives. BACKGROUND: Early identification of delirium in intensive care units is crucial for patient care. Hence, nurses require adequate knowledge to enable appropriate evaluation of delirium using standardised practice and assessment tools...
May 18, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29767323/prevalence-and-risk-factors-related-to-haloperidol-use-for-delirium-in-adult-intensive-care-patients-the-multinational-aid-icu-inception-cohort-study
#4
Marie O Collet, Jesús Caballero, Romain Sonneville, Fernando A Bozza, Peter Nydahl, Anna Schandl, Hilden Wøien, Giuseppe Citerio, Mark van den Boogaard, Johanna Hästbacka, Matthias Haenggi, Kirsten Colpaert, Louise Rose, Marija Barbateskovic, Theis Lange, Aksel Jensen, Martin B Krog, Ingrid Egerod, Helle L Nibro, Jørn Wetterslev, Anders Perner
PURPOSE: We assessed the prevalence and variables associated with haloperidol use for delirium in ICU patients and explored any associations of haloperidol use with 90-day mortality. METHODS: All acutely admitted, adult ICU patients were screened during a 2-week inception period. We followed the patient throughout their ICU stay and assessed 90-day mortality. We assessed patients and their variables in the first 24 and 72 h in ICU and studied their association together with that of ICU characteristics with haloperidol use...
May 16, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29762304/effectiveness-and-harms-of-pharmacological-interventions-in-the-treatment-of-delirium-in-adults-in-intensive-care-units-post-cardiac-surgery-a-systematic-review-protocol
#5
Vivienne Leigh, Catalin Tufanaru, Rosalind Elliott
The review objective is to synthesize the best available evidence on the effectiveness and harms of pharmacological interventions in the treatment of delirium in adults in intensive care units (ICU) after cardiac surgery.The specific review question is: What is the effectiveness and what are the harms of pharmacological interventions in relation to the duration and severity of delirium episodes, length of stay in ICU, length of stay in hospital, functional capacity and quality of life and mortality for critically ill adult patients treated in intensive care after cardiac surgery?...
May 2018: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/29742533/delirium-screening-and-management-in-inpatient-rehabilitation-facilities
#6
Mooyeon Oh-Park, Peii Chen, Vickie Romel-Nichols, Kimberly Hreha, Olga Boukrina, A M Barrett
Delirium is an acute and fluctuating disturbance in cognition attention, and awareness that is often a reflection of abnormal physiological condition of an individual. Delirium is highly prevalent among an older population and is associated with high mortality, poor medical and functional outcomes and high healthcare cost. Delirium often has iatrogenic triggers and it has been recognized as a quality indicator of healthcare organizations. In spite of its high prevalence and significance, more than 50% of the delirium cases are underrecognized by healthcare professionals and remained untreated...
May 7, 2018: American Journal of Physical Medicine & Rehabilitation
https://www.readbyqxmd.com/read/29742525/impact-of-dexmedetomidine-on-long-term-outcomes-after-noncardiac-surgery-in-elderly-3-year-follow-up-of-a-randomized-controlled-trial
#7
Dan-Feng Zhang, Xian Su, Zhao-Ting Meng, Hong-Liang Li, Dong-Xin Wang, Xue-Ying Li, Mervyn Maze, Daqing Ma
OBJECTIVES: The aim was to compare the long-term outcomes of low-dose dexmedetomidine versus placebo in a randomized controlled trial (ChiCTR-TRC-10000802). BACKGROUND: Low-dose dexmedetomidine infusion decreased delirium occurrence within 1 week after surgery in elderly admitted to the intensive care unit (ICU) after noncardiac surgery, but the long-term outcome of this intervention is unknown. METHODS: Patients or their family members were telephone-interviewed for a 3-year follow-up data collection of survival, cognitive function assessed with the modified Telephone Interview for Cognitive Status, and quality of life evaluated with the World Health Organization Quality of Life...
May 8, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29739655/identifying-research-priorities-around-psycho-cognitive-and-social-factors-for-recovery-from-hip-fractures-an-international-decision-making-process
#8
Mohammad Auais, Simon D French, Lauren Beaupre, Lora Giangregorio, Jay Magaziner
Hip fractures rank in the top ten disabling conditions worldwide. With an ageing population, this public health problem is expected to increase. Despite the success of surgery for hip fractures and the extensive health services utilisation, health outcomes are often poor. Considering the recovery process as multifactorial and intervening to address all relevant factors may improve recovery rates. However, we need first to fully understand the factors contributing to recovery after hip fractures, including psycho-cognitive and social factors...
April 20, 2018: Injury
https://www.readbyqxmd.com/read/29735284/music-intervention-to-prevent-delirium-among-older-patients-admitted-to-a-trauma-intensive-care-unit-and-a-trauma-orthopaedic-unit
#9
Kari Johnson, Julie Fleury, Darya McClain
PURPOSE: Evaluate music listening for delirium prevention among patients admitted to a Trauma Intensive Care and Trauma Orthopaedic Unit. The Roy Adaptation Model provided the theoretical framework focusing on modifying contextual stimuli. METHODS: Randomised controlled trial, 40 patients aged 55 and older. INTERVENTION: Participants randomly assigned to receive music listening or usual care for 60 minutes, twice a day, over three days. Pre-recorded self-selected music using an iPod and headsets, with slow tempo, low pitch and simple repetitive rhythms to alter physiologic responses...
May 4, 2018: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/29729659/improving-health-care-for-critically-ill-patients-using-an-evidence-based-collaborative-approach-to-abcdef-bundle-dissemination-and-implementation
#10
Mary Ann Barnes-Daly, Brenda T Pun, Lori A Harmon, Diane G Byrum, Vishakha K Kumar, John W Devlin, Joanna L Stollings, Kathleen A Puntillo, Heidi J Engel, Patricia J Posa, Juliana Barr, William D Schweickert, Cheryl L Esbrook, Ken D Hargett, Shannon S Carson, J Matthew Aldrich, E Wesley Ely, Michele C Balas
BACKGROUND: Patients admitted to intensive care units (ICUs) often experience pain, oversedation, prolonged mechanical ventilation, delirium, and weakness. These conditions are important in that they often lead to protracted physical, neurocognitive, and mental health sequelae now termed postintensive care syndrome. Changing current ICU practice will not only require the adoption of evidence-based interventions but the development of effective and reliable teams to support these new practices...
May 5, 2018: Worldviews on Evidence-based Nursing
https://www.readbyqxmd.com/read/29720578/targeting-inflammatory-monocytes-in-sepsis-associated-encephalopathy-and-long-term-cognitive-impairment
#11
Graciela Andonegui, Erin L Zelinski, Courtney L Schubert, Derrice Knight, Laura A Craig, Brent W Winston, Simon C Spanswick, Björn Petri, Craig N Jenne, Janice C Sutherland, Rita Nguyen, Natalie Jayawardena, Margaret M Kelly, Christopher J Doig, Robert J Sutherland, Paul Kubes
Sepsis-associated encephalopathy manifesting as delirium is a common problem in critical care medicine. In this study, patients that had delirium due to sepsis had significant cognitive impairments at 12-18 months after hospital discharge when compared with controls and Cambridge Neuropsychological Automated Test Battery-standardized scores in spatial recognition memory, pattern recognition memory, and delayed-matching-to-sample tests but not other cognitive functions. A mouse model of S. pneumoniae pneumonia-induced sepsis, which modeled numerous aspects of the human sepsis-associated multiorgan dysfunction, including encephalopathy, also revealed similar deficits in spatial memory but not new task learning...
May 3, 2018: JCI Insight
https://www.readbyqxmd.com/read/29717845/assessment-and-management-of-older-patients-with-delirium-in-acute-settings
#12
Martha Dixon
This article aims to assist nurses and nursing students to consider the presentation of delirium in older patients and the resulting assessment and nursing interventions required. It considers the three types of delirium: hyperactive, hypoactive and mixed. It also discusses potential causes of delirium. Older patients are at increased risk of delirium due to factors such as cognitive impairment, co-morbidities and acute illness. Nurses should be confident in the use of the 4AT score to assess patients with delirium...
May 2, 2018: Nursing Older People
https://www.readbyqxmd.com/read/29717689/advancing-our-diagnostic-tools-and-treatment-options-for-delirium
#13
Dan G Blazer
Delirium is one of the most prevalent and disabling conditions impacting older adults in hospitals and long-term care settings. The estimates of frequency of delirium in hospitals and nursing homes among older adults range widely, yet it is safe to assume that perhaps as many as 25-30% of elderly individuals in hospitals experience an episode of delirium, often undetected unless a regular screening process is implemented. Until the past couple of decades, actual research into delirium had been sparse and done little to inform clinical practice...
April 2018: International Psychogeriatrics
https://www.readbyqxmd.com/read/29710871/characteristics-and-management-of-community-acquired-pneumonia-in-the-era-of-global-aging
#14
REVIEW
Catia Cillóniz, Diana Rodríguez-Hurtado, Antoni Torres
Community-acquired pneumonia (CAP) can occur at any time of life, but its incidence and risk of death are linked to increasing age. CAP in the elderly is a major health problem associated with high rates of readmission, morbidity, and mortality. Since the clinical presentation of pneumonia in the elderly may be atypical, clinicians should suspect pneumonia in older patients presenting symptoms such as falls and altered mental status, fatigue, lethargy, delirium, anorexia, in order to avoid the complications associated with delayed diagnosis and therapy...
April 30, 2018: Medical Sciences: Open Access Journal
https://www.readbyqxmd.com/read/29704689/postictal-delirium-and-violent-behavior-in-patients-with-post-neurosurgical-epilepsy
#15
Bilel Oueslati, Feten Fekih-Romdhane, Rym Ridha
Neurosurgical brain interventions may result in lesions which can cause epilepsy. Diagnosis may in some situations be delayed. Meanwhile violent behavior can occur during postictal delirium states. While benign behavioral manifestations are well documented in literature, violent offenses with post neurosurgical epilepsy are sparsely reported. Our aim was to illustrate such situations, to focus on management and to emphasize on prevention's necessity. Our paper reports data related to two patients. Both were suffering from a post-neurosurgical epilepsy and offended during postictal delirium states...
April 25, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29699467/nonpharmacologic-and-medication-minimization-strategies-for-the-prevention-and-treatment-of-icu-delirium-a-narrative-review
#16
Gregory J Blair, Talha Mehmood, Mona Rudnick, Ware G Kuschner, Juliana Barr
Delirium is a multifactorial entity, and its understanding continues to evolve. Delirium has been associated with increased morbidity, mortality, length of stay, and cost for hospitalized patients, especially for patients in the intensive care unit (ICU). Recent literature on delirium focuses on specific pharmacologic risk factors and pharmacologic interventions to minimize course and severity of delirium. While medication management clearly plays a role in delirium management, there are a variety of nonpharmacologic interventions, pharmacologic minimization strategies, and protocols that have been recently described...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29678977/minimizing-icu-neurological-dysfunction-with-dexmedetomidine-induced-sleep-mindds-protocol-for-a-randomised-double-blind-parallel-arm-placebo-controlled-trial
#17
Kenneth T Shelton, Jason Qu, Federico Bilotta, Emery N Brown, Gaston Cudemus, David A D'Alessandro, Hao Deng, Alan DiBiasio, Jacob A Gitlin, Eunice Y Hahm, Lauren E Hobbs, Timothy T Houle, Reine Ibala, Marco Loggia, Kara J Pavone, Shahzad Shaefi, George Tolis, M Brandon Westover, Oluwaseun Akeju
INTRODUCTION: Delirium, which is prevalent in postcardiac surgical patients, is an acute brain dysfunction characterised by disturbances in attention, awareness and cognition not explained by a pre-existing neurocognitive disorder. The pathophysiology of delirium remains poorly understood. However, basic science and clinical studies suggest that sleep disturbance may be a modifiable risk factor for the development of delirium. Dexmedetomidine is a α-2A adrenergic receptor agonist medication that patterns the activity of various arousal nuclei similar to sleep...
April 20, 2018: BMJ Open
https://www.readbyqxmd.com/read/29671186/the-role-of-randomized-cluster-crossover-trials-for-comparative-effectiveness-testing-in-anesthesia-design-of-the-benzodiazepine-free-cardiac-anesthesia-for-reduction-in-postoperative-delirium-b-free-trial
#18
Jessica Spence, Emilie Belley-Côté, Shun Fu Lee, Shrikant Bangdiwala, Richard Whitlock, Yannick LeManach, Summer Syed, Andre Lamy, Eric Jacobsohn, Sarah MacIsaac, P J Devereaux, Stuart Connolly
Increasingly, clinicians and researchers recognize that studies of interventions need to evaluate not only their therapeutic efficacy (i.e., the effect on an outcome in ideal, controlled settings) but also their real-world effectiveness in broad, unselected patient groups. Effectiveness trials inform clinical practice by comparing variations in therapeutic approaches that fall within the standard of care. In this article, we discuss the need for studies of comparative effectiveness in anesthesia and the limitations of individual patient randomized-controlled trials in determining comparative effectiveness...
April 18, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/29670988/reducing-complications-and-overall-healthcare-costs-of-hip-fracture-management-a-retrospective-study-on-the-application-of-a-diagnostic-therapeutic-pathway-in-the-cosenza-general-hospital
#19
M Loizzo, F Gallo, D Caruso
BACKGROUND: Diagnostic Therapeutic Pathways (DTPs) are multidisciplinary plans designed by each healthcare organization for a specific category of patients to reduce the variability of professional behaviors and to ensure greater safety and better overall healthcare outcomes. Hip fractures are a frequent traumatic injury, particularly in the elderly, and DTPs recommend early surgical intervention, often not done due to organizational challenges and bureaucracy. Medical conditions suggesting a delay are not frequent, however long waiting times not only increase the risk of complications and mortality, but also increase the number of diagnostic test and physician consultations...
May 2018: Annali di Igiene: Medicina Preventiva e di Comunità
https://www.readbyqxmd.com/read/29614992/a-research-study-review-of-effectiveness-of-treatments-for-psychiatric-conditions-common-to-end-stage-cancer-patients-needs-assessment-for-future-research-and-an-impassioned-plea
#20
Ralph J Johnson
BACKGROUND: Rates of psychiatric conditions common to end-stage cancer patients (delirium, depression, anxiety disorders) remain unchanged. However, patient numbers have increased as the population has aged; indeed, cancer is a chief cause of mortality and morbidity in older populations. Effectiveness of psychiatric interventions and research to evaluate, inform, and improve interventions is critical to these patients' care. This article's intent is to report results from a recent review study on the effectiveness of interventions for psychiatric conditions common to end-stage cancer patients; the review study assessed the state of research regarding treatment effectiveness...
April 3, 2018: BMC Psychiatry
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