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Delirium in emergancy

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https://www.readbyqxmd.com/read/29346380/rapidly-progressive-dementia-an-eight-year-2008-2016-retrospective-study
#1
Patil Anuja, Vishnu Venugopalan, Naheed Darakhshan, Pandit Awadh, Vinny Wilson, Goyal Manoj, Modi Manish, Lal Vivek
BACKGROUND AND PURPOSE: Rapidly progressive dementia (RPD) is an emergency in cognitive neurology, defined as cognitive impairment affecting the daily living activities developed over less than 1 year. This study investigated the profile of patients with rapidly progressive dementia at first presentation. METHODS: Retrospective case analysis was done in 187 patients with rapidly progressive dementia who presented to the Postgraduate Institute of Medical Education and Research, Chandigarh, India from January 2008 to August 2016...
2018: PloS One
https://www.readbyqxmd.com/read/29343034/-a-study-on-the-effects-and-safety-of-sequential-humidified-high-flow-nasal-cannula-oxygenation-therapy-on-the-copd-patients-after-extubation
#2
J C Zhang, F X Wu, L L Meng, C Y Zeng, Y Q Lu
Objective: To investigate and compare the effect and safety of nasal high-flow oxygen therapy (HFNCO) and noninvasive ventilation (NIV) therapy after extubation in patients with chronic obstructive pulmonary disease (COPD). Methods: All COPD patients subjected to mechanical ventilation in the Emergency Intensive Unit of the First Affiliated Hospital of Zhejiang University during January 2015 to June 2016 were included in the study. The patients were divided into two groups after extubation and HFNCO and NIV were adopted on each group respectively...
January 9, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29341529/-when-the-ward-overflows%C3%A2-the-impact-of-outlying-beds-on-patient-care
#3
Valérie Mosimann, Olivier Lamy, Julien Castioni
Due to the chronic lack of beds in hospitals, patients are often hospitalized in other departments (outlier patients), with a responsible physician working in another department. This causes increased thromboembolics risks, nosocomial infections, falls and delirium in the elderly, morbidity and mortality. Outlier patients, compared to standard patients, stay longer in the emergency department and their discharge documents are available later. Outlying is used daily in the CHUV hospital and new strategies are elaborated to manage patient flow, especially during the flu epidemic...
January 17, 2018: Revue Médicale Suisse
https://www.readbyqxmd.com/read/29321714/cavum-vergae-liability-and-steroid-treatment-manic-episode-brain-imaging-findings-and-clinical-follow-up-of-a-systemic-lupus-erythematosus-case
#4
Emre Misir, İbrahim Tolga Binbay, Bilge Targitay, Hidayet Ece Arat, Gerçek Can, Köksal Alptekin
Systemic lupus erythematosus (SLE) or Lupus is a chronic and idiopathic autoimmune connective tissue disease that involves several organs and organ systems. SLE may lead to a group of psychiatric manifestations, including delirium, anxiety disorders, cognitive dysfunction, mood disorders, and psychosis, which are caused by organic or non-organic factors. In addition, it is thought that the most common cause of neuropsychiatric lupus is corticosteroid use; central nervous system involvement and inflammatory processes also have an important role in the development of psychiatric manifestations...
December 2017: Noro Psikiyatri Arsivi
https://www.readbyqxmd.com/read/29290048/screening-and-detection-of-delirium-in-older-ed-patients-performance-of-the-modified-confusion-assessment-method-for-the-emergency-department-mcam-ed-a-two-step-tool
#5
Wolfgang Hasemann, Florian F Grossmann, Rahel Stadler, Roland Bingisser, Dieter Breil, Martina Hafner, Reto W Kressig, Christian H Nickel
Delirium is frequent in older Emergency Department (ED) patients, but detection rates for delirium in the ED are low. To aid in identifying delirium, we developed and implemented a two-step systematic delirium screening and assessment tool in our ED: the modified Confusion Assessment Method for the Emergency Department (mCAM-ED). Components of the mCAM-ED include: (1) screening for inattention, the main feature of delirium, which was performed with the Months Backwards Test (MBT); (2) delirium assessment based on a structured interview with questions from the Mental Status Questionnaire by Kahn et al...
December 30, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/29287876/effect-of-preoperative-visiting-operation-room-on-emergence-agitation-in-preschool-children-under-sevoflurane-anesthesia
#6
Qiaosheng Zhong, Xianfeng Qu, Chuanhua Xu
BACKGROUND: Emergence agitation (EA) is a common complication in children during recovery from sevoflurane anesthesia with an high incidence. The main objective of this study was to compare the effects of preoperative visiting operation room (PVOR) to administration of propofol at the end of anesthesia on EA in preschool children under sevoflurane anesthesia. METHODS: Sixty-nine preschool children aged from 3 to 6 years scheduled for tonsillectomy under sevoflurane anesthesia were randomly allocated to one of the three groups to receive either PVOR (Group PV), routine preoperative visit (Group RV) or routine preoperative visit plus propofol (Group RP), 23 patients were included in each group...
January 2018: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29278266/regional-nerve-blockade-for-early-analgesic-management-of-elderly-patients-with-hip-fracture-a-narrative-review
#7
REVIEW
A Scurrah, C T Shiner, J A Stevens, S G Faux
Elderly patients with hip fracture experience high morbidity and mortality, and are often undertreated for pain. Acute pain management in the elderly is challenging, with physiological frailty, medical comorbidities and cognitive impairment commonly compounding pain assessment and treatment. Guidelines outlining current best practice for acute pain management in the elderly now exist, but evidence suggests that practice remains variable and there continues to be scope for improvement. We conducted a narrative review of the literature to examine the challenges of acute pain management in the elderly, and to evaluate evidence for the role of regional nerve blocks for acute pain associated with hip fracture in the elderly...
December 26, 2017: Anaesthesia
https://www.readbyqxmd.com/read/29277168/subclinical-thiamine-deficiency-in-patients-with-abdominal-cancer
#8
Hideki Onishi, Mayumi Ishida, Iori Tanahashi, Takao Takahashi, Yoshitada Taji, Kenji Ikebuchi, Daisuke Furuya, Tatsuo Akechi
OBJECTIVE: Thiamine is an essential coenzyme for oxidative metabolisms; however, it is not synthesized in the human body, and the average thiamine storage capacity is approximately 18 days. Therefore, thiamine deficiency (TD) can occur in any condition of unbalanced nutrition. If TD is left untreated, it causes the neuropsychiatric disorder Wernicke encephalopathy (WE). Although WE is a medical emergency, it is sometimes overlooked because most patients with WE do not exhibit all of the typical symptoms, including delirium, ataxia, and ophthalmoplegia...
December 26, 2017: Palliative & Supportive Care
https://www.readbyqxmd.com/read/29247265/end-of-life-care-pathway-of-head-and-neck-cancer-patients-single-institution-experience
#9
T Heinonen, V Loimu, K Saarilahti, T Saarto, A Mäkitie
BACKGROUND: Studies on palliative care of head and neck cancer (HNC) patients are scarce although the affected patient population is quite large. OBJECTIVE: To evaluate the role of a specialised palliative-care pathway of HNC patients. PATIENTS AND METHODS: Data on all HNC patients who were treated at the Helsinki University Hospital Palliative Care Center during 1 year were retrospectively reviewed. The analysis comprised 60 patients (49 males; mean age 67 years; range 28-88)...
December 15, 2017: European Archives of Oto-rhino-laryngology
https://www.readbyqxmd.com/read/29239148/effects-of-closed-loop-intravenous-anesthesia-guided-by-the-bispectral-index-in-adult-patients-on-emergence-delirium-a-randomized-controlled-study
#10
Antonella Cotoia, Lucia Mirabella, Renata Beck, Pompeo Matrella, Valentina Assenzo, Thierry Chazot, Gilda Cinnella, Ngai Liu, Michele Dambrosio
BACKGROUND: Emergence delirium (ED) is an acute change in cognition after general anesthesia (GA) occurring in operative room, recovery room or in postanesthesia care. The automated propofolremifentanil titration by Bispectral index (BIS) (AutoTIVA) avoids period of deep (BIS<40) anesthesia and could potentially decrease the ED. The aim of this study was to evaluate ED in surgical patients under AutoTIVA, manual titration of propofol-remifentanil (ManualTIVA) or volatile BIS-guided GA...
December 13, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29237068/screening-for-frailty-in-older-emergency-department-patients-the-utility-of-the-survey-of-health-ageing-and-retirement-in-europe-frailty-instrument-share-fi
#11
Aoife Fallon, Lorna Kilbane, Robert Briggs, Adam Dyer, Shamis Nabeel, Paul McElwaine, Ronan Collins, Tara Coughlan, Des O'Neill, Dan Ryan, Sean P Kennelly
Background: Greater numbers of older patients are accessing hospital services. Specialist geriatric input at presentation may improve outcomes for at-risk patients. The SHARE-FI (Survey of Health, Ageing and Retirement in Europe Frailty Instrument) frailty measure, developed for use in the community, has also been used in the emergency department (ED). Aim: To measure frailty, review its prevalence in older patients presenting to ED and compare characteristics and outcomes of frail patients with their non-frail counterparts...
December 11, 2017: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/29230342/the-treatment-of-clozapine-withdrawal-delirium-with-electroconvulsive-therapy
#12
Anish Modak, Arne Åhlin
Clozapine, a commonly used atypical antipsychotic, can precipitate a severe withdrawal syndrome. In this report, we describe a case of delirium with catatonic features emerging after the immediate cessation of clozapine subsequent to concerns of developing neuroleptic malignant syndrome. After multiple treatments were found to be inefficacious, electroconvulsive therapy (ECT) was initiated, resulting in significant improvement. A literature search revealed six previous cases of clozapine-withdrawal syndromes of varied symptomatology treated with ECT...
2017: Case Reports in Psychiatry
https://www.readbyqxmd.com/read/29227367/practice-patterns-and-outcomes-associated-with-early-sedation-depth-in-mechanically-ventilated-patients-a-systematic-review-and-meta-analysis
#13
Robert J Stephens, Matthew R Dettmer, Brian W Roberts, Enyo Ablordeppey, Susan A Fowler, Marin H Kollef, Brian M Fuller
OBJECTIVES: Emerging data suggest that early deep sedation may negatively impact clinical outcomes. This systematic review and meta-analysis defines and quantifies the impact of deep sedation within 48 hours of initiation of mechanical ventilation, as described in the world's literature. The primary outcome was mortality. Secondary outcomes included hospital and ICU lengths of stay, mechanical ventilation duration, and delirium and tracheostomy frequency. DATA SOURCES: The following data sources were searched: MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews and Effects, Cochrane Database of Systematic Reviews databases, ClinicalTrials...
December 8, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29224711/-risk-factors-associated-with-anesthesia-emergence-delirium-in-children-undergoing-outpatient-surgery
#14
Ana Carolina Tavares Paes Barreto, Ana Carolina Rangel da Rocha Paschoal, Carolina Barbosa Farias, Paulo Sérgio Gomes Nogueira Borges, Rebeca Gonelli Albanez da Cunha Andrade, Flávia Augusta de Orange
INTRODUCTION: Anesthesia emergence delirium (AED) is a self-limiting clinical phenomenon very common in children. Although pathophysiology is still uncertain, some factors seem to be involved, such as rapid awakening in an unknown environment, agitation during anesthetic induction, preoperative anxiety, environmental disorders, use of preanesthetic medication, use of inhalational anesthetics, and postoperative pain. OBJECTIVE: To determine the prevalence and risk factors associated with AED in children undergoing outpatient surgery...
December 7, 2017: Revista Brasileira de Anestesiologia
https://www.readbyqxmd.com/read/29222181/fifteen-minute-consultation-an-approach-to-a-child-presenting-to-the-emergency-department-with-acute-psychotic-symptoms
#15
Anil Vasudev Israni, Sumant Kumar, Nahin Hussain
Presentation of a child in the A&E with altered behaviour including psychotic features is not unusual. New-onset psychotic symptoms in children pose a significant diagnostic challenge due to several reasons. First, primary psychotic conditions are uncommon in pre-pubertal children. Second, differentiating between delirium and psychosis can be difficult in children, more so in infants, toddlers and young children. Third, intervening and managing a secondary cause of psychosis can significantly optimise outcome...
December 8, 2017: Archives of Disease in Childhood. Education and Practice Edition
https://www.readbyqxmd.com/read/29214512/anticholinergic-prescribing-in-medicare-part-d-beneficiaries-residing-in-nursing-homes-results-from-a-retrospective-cross-sectional-analysis-of-medicare-data
#16
Joshua Niznik, Xinhua Zhao, Tao Jiang, Joseph T Hanlon, Sherrie L Aspinall, Joshua Thorpe, Carolyn Thorpe
BACKGROUND: Prescribing of medications with anticholinergic properties in older nursing home residents is relatively common, despite an association with an increased risk for falls, delirium, and other outcomes. Few studies have investigated what factors influence different levels of prescribing of these agents. OBJECTIVES: The primary objective was to identify factors associated with low- and high-level anticholinergic burden in nursing home residents. A secondary objective was to examine in detail the contribution of different medications to low versus high burden to aid in determining which drugs to target in interventions...
December 6, 2017: Drugs & Aging
https://www.readbyqxmd.com/read/29208069/the-delirium-drug-scale-is-associated-to-delirium-incidence-in-the-emergency-department
#17
Patrick Viet-Quoc Nguyen, Lucie Pelletier, Isabelle Payot, Judith Latour
BACKGROUND: The Delirium Drug Scale (DDS) is an evaluation scale developed to assess a patient's drug burden for delirium. The primary goal is to validate the association between the DDS score and the incidence of delirium. METHODS: This study was an observational retrospective cross-sectional chart review study in patients aged 75 years and older. It was carried out in three emergency departments of a tertiary care university health center. Patients were included if a medication list was available...
December 6, 2017: International Psychogeriatrics
https://www.readbyqxmd.com/read/29205261/report-and-research-agenda-of-the-american-geriatrics-society-and-national-institute-on-aging-bedside-to-bench-conference-on-urinary-incontinence-in-older-adults-a-translational-research-agenda-for-a-complex-geriatric-syndrome
#18
Camille P Vaughan, Alayne D Markland, Phillip P Smith, Kathryn L Burgio, George A Kuchel
The American Geriatrics Society, with support from the National Institute on Aging and other funders, held its ninth Bedside-to-Bench research conference, entitled "Urinary Incontinence in the Older Adult: A Translational Research Agenda for a Complex Geriatric Syndrome," October 16 to 18, 2016, in Bethesda, Maryland. As part of a conference series addressing three common geriatric syndromes-delirium, sleep and circadian rhythm disturbance, and urinary incontinence-the series highlighted relationships and pertinent clinical and pathophysiological commonalities between these conditions...
December 4, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29196594/perceptions-of-families-of-intensive-care-unit-patients-regarding-involvement-in-delirium-prevention-activities-a-qualitative-study
#19
Pamela L Smithburger, Amanda S Korenoski, Sheila A Alexander, Sandra L Kane-Gill
BACKGROUND: Nonpharmacologic delirium-prevention strategies are commonly used in the intensive care unit by bedside nurses. With up to 80% of intensive care unit patients becoming delirious, and lacking treatment options, prevention is key. However, with increasing nurse workloads, innovative delirium-prevention strategies such as involving the patient's family are needed. OBJECTIVE: To gain insight into opinions of patients' families regarding active participation in delirium-prevention activities to inform specific recommendations for involving patients' families in such activities...
December 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/29179627/delirium-is-associated-with-increased-mortality-in-the-geriatric-population
#20
Pinar Tosun Tasar, Sevnaz Sahın, Nur Ozge Akcam, Cıgdem Dınckal, Merve Gulsah Ulusoy, Ozan Fatih Sarıkaya, Soner Duman, Fehmi Akcıcek, Aysin Noyan
OBJECTIVE: The aim of this study was to investigate the prevalence of delirium and its association with mortality rates in elderly inpatients. METHODS: The medical records of 1435 patients over 65 years old who were treated at a regional university hospital and were referred to the university's Consultation and Liaison Psychiatry Clinic for psychological evaluation were retrospectively analyzed. Patients with and without a diagnosis of delirium were compared. The National Survival Database was used to determine mortality rates...
November 27, 2017: International Journal of Psychiatry in Clinical Practice
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