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Delirium managment

Bastiaan Van Grootven, Lynn McNicoll, Daniel A Mendelson, Susan M Friedman, Katleen Fagard, Koen Milisen, Johan Flamaing, Mieke Deschodt
OBJECTIVE: To find consensus on appropriate and feasible structure, process and outcome indicators for the evaluation of in-hospital geriatric co-management programmes. DESIGN: An international two-round Delphi study based on a systematic literature review (searching databases, reference lists, prospective citations and trial registers). SETTING: Western Europe and the USA. PARTICIPANTS: Thirty-three people with at least 2 years of clinical experience in geriatric co-management were recruited...
March 16, 2018: BMJ Open
Cheryl Holly, Sallie Porter, Mercedes Echevarria, Margaret Dreker, Sevara Ruzehaji
The findings can facilitate earlier recognition and prevention of pediatric delirium. ABSTRACT: Purpose: The purpose of this study was to examine the evidence regarding the risk factors for and characteristics of acute pediatric delirium in hospitalized children. METHODS: The systematic review method within an epidemiological framework of person, place, and time was used. Fifty-two studies were selected for initial retrieval. Of these, after assessment for methodological quality, 21 studies involving 2,616 subjects were included in the review...
March 14, 2018: American Journal of Nursing
Sandeep Grover, Ajit Avasthi
No abstract text is available yet for this article.
February 2018: Indian Journal of Psychiatry
John W Wax, Amy W An, Nicole Kosier, Timothy E Quill
Voluntary stopping of eating and drinking (VSED) is a deliberate, self-initiated attempt to hasten death in the setting of suffering refractory to optimal palliative interventions or prolonged dying that a person finds intolerable. Individuals who consider VSED tend to be older, have a serious but not always imminently terminal illness, place a high value on independence, and have significant illness burden. VSED can theoretically be performed independent of clinician assistance and therefore avoids many of the ethical and legal concerns associated with physician-assisted dying or other palliative measures of last resort, However, VSED is an intense process fraught with new sources of somatic and emotional suffering for individuals and their caregivers, so VSED is best supervised by an experienced, well-informed clinician who can provide appropriate pre-intervention assessment, anticipatory guidance, medical treatment of symptoms, and emotional support...
March 2018: Journal of the American Geriatrics Society
Masataka Tanaka, Naoki Tani, Tomoyuki Maruo, Satoru Oshino, Koichi Hosomi, Youichi Saitoh, Haruhiko Kishima
OBJECTIVE: The aim of this study was to investigate the incidence of and risk factors for postoperative delirium (POD) after deep brain stimulation (DBS) surgery in patients with Parkinson's disease (PD). METHODS: We analyzed the preoperative T1-weigthed magnetic resonance imaging data of 71 PD patients who underwent DBS surgery. Multiple regression analysis was done with age, l-dopa equivalent daily dose, laterality of the surgery, target regions, number of electrode trajectories tried, grey matter (GM) volume, and white matter (WM) volume as explanatory variables and the duration (number of days) of POD as the response variable...
March 9, 2018: World Neurosurgery
Mary V Seeman, Alexandre González-Rodríguez
PURPOSE OF REVIEW: Drugs have been extensively prescribed for the treatment of psychotic symptoms in schizophrenia and related disorders, as well as for the management of psychotic features in delirium, dementia and affective disorders. The aim of this narrative review is to focus on the recent literature on drug treatment in women with psychosis at the transition to menopause and subsequently. RECENT FINDINGS: The recent literature emphasizes the following points: the efficacy of antipsychotic medication in psychosis is largely confined to the alleviation of delusions and hallucinations; menopause and ageing alter the kinetics and dynamics of drug action; drugs other than antipsychotics are currently being tested to address the cognitive, affective and negative symptoms of psychotic illnesses; menopausal symptoms add to comorbidities and require simultaneous treatment, raising the probability of deleterious drug interactions; antipsychotic drugs have many side effects and contribute to high mortality rates in the older psychosis population...
March 9, 2018: Current Opinion in Psychiatry
Carole P Kaufmann, Dominik Stämpfli, Nadine Mory, Kurt E Hersberger, Markus L Lampert
INTRODUCTION: Identifying patients with a high risk for drug-related problems (DRPs) might optimise the allocation of targeted pharmaceutical care during the hospital stay and on discharge. OBJECTIVE: To develop a self-assessment screening tool to identify patients at risk for DRPs and validate the tool regarding feasibility, acceptability and the reliability of the patients' answers. DESIGN: Prospective validation study. SETTING: Two mid-sized hospitals (300-400 beds)...
March 9, 2018: BMJ Open
Joan McNeil, Anne Marie Denis, Urick Michel, Catherine M Concert
The question of this review: What is the effectiveness of non-pharmacological strategies for the management of delirium in hospitalized adult postoperative patients?The objective of this umbrella review is to determine the effectiveness of non-pharmacological strategies for the management of delirium in adult postoperative patients, 18 years and over, in an acute care hospitalized setting.More specifically, the review aims to identify which non-pharmacological strategy/strategies, provided as a single strategy or combined as two or more strategies, is the most effective for management of delirium in hospitalized postoperative adult patients?...
March 2018: JBI Database of Systematic Reviews and Implementation Reports
Anne L Donovan, J Matthew Aldrich, A Kendall Gross, Denise M Barchas, Kevin C Thornton, Hildy M Schell-Chaple, Michael A Gropper, Angela K M Lipshutz
OBJECTIVES: We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success. DATA SOURCES: Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives...
March 7, 2018: Critical Care Medicine
Rachel Meyen, Elia E Acevedo-Diaz, Sparsha S Reddy
BACKGROUND: Untangling catatonia and delirium can be challenging. Furthermore, treatment of one syndrome can potentially worsen another. CASE PRESENTATION: We present the case of a 71-year-old patient with a history of schizoaffective disorder, bipolar subtype, who developed catatonia and delirium with prominent psychotic symptoms, during a single hospitalization. Treatment of this patient's catatonia with benzodiazepines exacerbated delirium, while treatment of psychotic symptoms precipitated by delirium with antipsychotics led to catatonia...
March 3, 2018: Schizophrenia Research
Jung Eun Choi, Mi So Kim
Prevention of delirium is considered a critical part of the agenda for patient safety and an indicator of healthcare quality for older patients. As the incidence rate of delirium for older patients has increased in recent years, there has been a significant expansion in knowledge relevant to nursing care. The purposes of this study were to analyze the knowledge structure and trends in nursing care for older adults with delirium based on a keyword network analysis, and to provide a foundation for future research...
February 28, 2018: Computers, Informatics, Nursing: CIN
Carles Subirà, Candelaria de Haro, Rudys Magrans, Rafael Fernández, Lluís Blanch
Patient-ventilator asynchrony exists when the phases of breath delivered by the ventilator do not match those of the patient. Asynchronies occur throughout mechanical ventilation and negatively affect patient comfort, duration of mechanical ventilation, length of ICU stays, and mortality. Identifying asynchronies requires careful attention to patients and their ventilator waveforms. This review discusses the different types of asynchronies, how they are generated, and their impact on patient comfort and outcome...
February 27, 2018: Respiratory Care
(no author information available yet)
No abstract text is available yet for this article.
March 2018: Nursing Management
Emmanuelle Magny, Hélène Le Petitcorps, Maria Pociumban, Zineb Bouksani-Kacher, Éric Pautas, Joël Belmin, Sylvie Bastuji-Garin, Carmelo Lafuente-Lafuente
BACKGROUND: Factors associated with delirium among community-dwelling older adults have been poorly studied. Our aim was to describe the prevalence of predisposing and precipitating factors for delirium among patients admitted for delirium and to assess whether these factors were appropriately recognized at the first patient assessment at hospital. METHODS: Consecutive community-dwelling individuals admitted to three geriatric acute care units with a confirmed initial diagnosis of delirium were prospectively included...
2018: PloS One
Rajesh M Shetty, Antonio Bellini, Dhuleep S Wijayatilake, Mark A Hamilton, Rajesh Jain, Sunil Karanth, ArunKumar Namachivayam
BACKGROUND: Patients admitted to intensive care and on mechanical ventilation, are administered sedative and analgesic drugs to improve both their comfort and interaction with the ventilator. Optimizing sedation practice may reduce mortality, improve patient comfort and reduce cost. Current practice is to use scales or scores to assess depth of sedation based on clinical criteria such as consciousness, understanding and response to commands. However these are perceived as subjective assessment tools...
February 21, 2018: Cochrane Database of Systematic Reviews
Lais Lopes Delfino, Ricardo Shoiti Komatsu, Caroline Komatsu, Anita Liberalesso Neri, Meire Cachioni
This study aims to investigate the association between management and communication strategies and the presence of neuropsychiatric symptoms presented by elderly people with Alzheimer's disease. One hundred and thirty-four family caregivers answered a questionnaire with socio-demographic data and questions regarding the care context, the Small Communication Strategies Scale, the Dementia Management Strategy Scale, and the Neuropsychiatric Inventory. Caregivers used the criticism management strategy more when the elderly presented hallucination, agitation, depression, anxiety, irritability, nighttime behavior, and appetite abnormalities...
January 1, 2018: Dementia
M Barbateskovic, S R Kraus, M O Collet, O Mathiesen, J C Jakobsen, A Perner, J Wetterslev
BACKGROUND: In the intensive care unit, the prevalence of delirium is high. Delirium has been associated with morbidity and mortality including more ventilator days, longer intensive care unit stay, increased long-term mortality, and cognitive impairment. Thus, the burden of delirium for patients, relatives, and societies is considerable. The objective of this systematic review was to critically access the evidence of randomised clinical trials on the effects of haloperidol vs. placebo or any other agents for delirium in critically ill patients...
February 14, 2018: Acta Anaesthesiologica Scandinavica
Angela Star, Jason W Boland
Symptom management is an important part of both palliative care and end-of-life care. This article will examine the recent research evidence about drugs commonly used for symptom management in adult patients receiving palliative care. In particular, the management of symptoms where recent palliative care-based evidence has changed recommended practice will be reviewed. This includes: breathlessness, delirium, nausea and vomiting in bowel obstruction, opioid-induced constipation and upper respiratory tract secretions...
February 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
Cynthia L Holle, James L Rudolph
Facilitating throughput with systems thinking.
March 2018: Nursing Management
Andres Zorrilla-Vaca, Ryan Healy, Michael C Grant, Brijen Joshi, Lucia Rivera-Lara, Charles Brown, Marek A Mirski
PURPOSE: Although evidence from observational studies in a variety of clinical settings supports the utility of cerebral oximetry as a predictor of outcomes, prospective clinical trials thus far have reported conflicting results. This systematic review and meta-analysis was designed to evaluate the influence of management associated with intraoperative cerebral oximetry on postoperative outcomes. The primary outcome was postoperative cognitive dysfunction (POCD), with secondary outcomes that included postoperative delirium, length of intensive care unit (ICU) stay, and hospital length of stay (LOS)...
January 18, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
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