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Delirium in emergancy

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https://www.readbyqxmd.com/read/29769154/performance-of-the-french-version-of-the-4at-for-screening-the-elderly-for-delirium-in-the-emergency-department
#1
Anne-Julie Gagné, Philippe Voyer, Valérie Boucher, Alexandra Nadeau, Pierre-Hugues Carmichael, Mathieu Pelletier, Emilie Gouin, Simon Berthelot, Raoul Daoust, Machelle Wilchesky, Hélène Richard, Isabelle Pelletier, Stephanie Ballard, Antoine Laguë, Marcel Émond
CLINICIAN'S CAPSULE What is known about the topic? Delirium is frequent in older inpatients but often goes undetected. A short tool, the 4 A's Test (4AT), was created and validated for the detection of delirium. What did this study ask? This study compared the performance of the French version of the 4AT (4AT-F) with the Confusion Assessment Method (CAM) for the screening of delirium. What did this study find? The 4AT-F was a fast and reliable screening tool for delirium in the emergency department (ED). Why does this study matter to clinicians? Because of its quick administration time, it allows for systematic screening of patients at risk of delirium and cognitive impairment...
May 17, 2018: CJEM
https://www.readbyqxmd.com/read/29764723/frailty-assessment-to-help-predict-patients-at-risk-of-delirium-when-consulting-the-emergency-department
#2
Marianne Giroux, Marie-Josée Sirois, Valérie Boucher, Raoul Daoust, Émilie Gouin, Mathieu Pelletier, Simon Berthelot, Philippe Voyer, Marcel Émond
BACKGROUND: Delirium is underdiagnosed in seniors at emergency departments (EDs) even though it is a frequent complication and is associated with functional and cognitive decline. As frailty is an independent predictor of adverse events in seniors, screening for frailty in EDs may help identify those at risk of delirium. OBJECTIVES: To assess if screening older patients for frailty in EDs could help identify those at risk of delirium. METHODOLOGY: This study was part of the multicenter prospective cohort INDEED study...
May 12, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29752853/dexmedetomidine-for-the-reduction-of-emergence-delirium-in-children-undergoing-tonsillectomy-with-propofol-anesthesia-a-double-blind-randomized-study
#3
Adelais G Tsiotou, Anna Malisiova, Elena Kouptsova, Maria Mavri, Maria Anagnostopoulou, Evagelia Kalliardou
BACKGROUND: Postanesthesia emergence delirium is a motor agitation state complicating pediatric anesthesia. We investigated the efficacy of dexmedetomidine in reducing emergence delirium in children undergoing tonsillectomy with and without adenoidectomy using total intravenous anesthesia with propofol. METHODS: This was a prospective, single-center, double-blind, randomized study. The primary outcome was the presence or absence of emergence delirium with and without dexmedetomidine...
May 12, 2018: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29752842/correlation-between-duration-of-preoperative-fasting-and-emergence-delirium-in-pediatric-patients-undergoing-ophthalmic-examination-under-anesthesia-a-prospective-observational-study
#4
Puneet Khanna, Kulbhushan Saini, Renu Sinha, Niseville Nisa, Shailendra Kumar, Souvik Maitra
BACKGROUND: Preoperative fasting in children can cause anxiety, which may ultimately lead to postoperative emergence delirium. However, no data are available whether duration of preoperative fasting correlates with postoperative emergence delirium. AIMS: The aim of this study was to identify if there is any correlation between the duration of preoperative fasting and emergence delirium in children undergoing ophthalmic examination under anesthesia. METHODS: In this prospective observational study, 100 children between the age group 2-6 years of American Society of Anesthesiologists physical status I or II, scheduled for examination of the eye under general anesthesia with sevoflurane were recruited...
May 12, 2018: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29738102/validation-of-the-brief-confusion-assessment-method-for-screening-delirium-in-elderly-medical-patients-in-a-german-emergency-department
#5
Verena Baten, Hans-Jörg Busch, Caroline Busche, Bonaventura Schmid, Miriam Heupel-Reuter, Evgeniy Perlov, Jochen Brich, Stefan Klöppel
BACKGROUND: Delirium is frequent in elderly patients presenting in the emergency department (ED). Despite the severe prognosis, the majority of delirium cases remain undetected by emergency physicians (EPs). At the time of our study there was no valid delirium screening tool available for EDs in German-speaking regions. We aimed to evaluate the brief Confusion Assessment Method (bCAM) for a German ED during the daily work routine. METHODS: We implemented the bCAM into practice in a German interdisciplinary high volume ED, and evaluated the bCAM's validity in a convenience sample of medical patients aged ≥70 years...
May 8, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/29730630/delirium-as-a-predictor-of-mortality-in-us-medicare-beneficiaries-discharged-from-the-emergency-department-a-national-claims-level-analysis-up-to-12-months
#6
Juhi Israni, Adriane Lesser, Tyler Kent, Kelly Ko
BACKGROUND: Delirium is common among seniors discharged from the emergency department (ED) and associated with increased risk of mortality. Prior research has addressed mortality associated with seniors discharged from the ED with delirium, however has generally relied on data from one or a small number of institutions and at single time points. OBJECTIVES: Analyse mortality rates among seniors discharged from the ED with delirium up to 12 months at the national level...
May 5, 2018: BMJ Open
https://www.readbyqxmd.com/read/29714431/emotion-regulation-and-premedication-success-relationship-in-children-who-underwent-general-anesthesia
#7
Aslıhan Aykut, Berrin Işık
Background/aim: This study aims to investigate the relationship between emotion regulation characteristics and the efficacy of midazolam premedication. Materials and methods: Sixty-three children, aged 3 to 8 years old, with tonsillectomy and/or adenoidectomy and taking premedication with midazolam (Group 2) or without premedication (Group 1), were included in this study. The behavioral and emotional status of the children was evaluated with the Conners Parent Rating Scale-48 (CPRS-48) and Emotion Regulation Checklist (ERC)...
April 30, 2018: Turkish Journal of Medical Sciences
https://www.readbyqxmd.com/read/29699898/an-evaluation-of-single-question-delirium-screening-tools-in-older-emergency-department-patients
#8
Jin H Han, Amanda Wilson, John F Schnelle, Robert S Dittus, E Wesley Ely
OBJECTIVES: To determine the diagnostic performances of several single question delirium screens. To the patient we asked: "Have you had any difficulty thinking clearly lately?" To the patient's surrogate, we asked: "Is the patient at his or her baseline mental status?" and "Have you noticed the patient's mental status fluctuate throughout the course of the day?" METHODS: This was a prospective observational study that enrolled English speaking patients 65 years or older...
March 22, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29681419/physostigmine-reversal-of-dysarthria-and-delirium-after-iatrogenic-atropine-overdose-from-a-dental-procedure
#9
Jon B Cole, Benjamin S Orozco, Ann M Arens
BACKGROUND: Sublingual atropine, dosed at 0.4-0.8 mg, is used by dentists as an antisialogogue to facilitate and increase the speed of procedures. Concentrated ophthalmic atropine drops (10 mg/mL) are commonly used off-label for this purpose. These highly concentrated drops may result in medication errors, atropine toxicity, and the antimuscarinic toxidrome. We report a case of a man who suffered acute delirium and dysarthria (from dry mouth) after an iatrogenic overdose from a dental procedure...
April 19, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29666130/does-dexmedetomidine-given-as-a-premedication-or-intraoperatively-reduce-post-hospitalisation-behaviour-change-in-children-a-study-protocol-for-a-randomised-controlled-trial-in-a-tertiary-paediatric-hospital
#10
Paul Lee-Archer, Craig McBride, Rebecca Paterson, Michael Reade, Britta Regli-von Ungern-Sternberg, Deborah Long
INTRODUCTION: It has been reported that post-hospitalisation behaviour change (PHBC) occurs in over 50% of children undergoing a general anaesthetic and manifests as behaviours such as sleep and eating disorders, defiance of authority, nightmares, enuresis and temper tantrums. The effect is usually short-lived (2-4 weeks); however, in 5-10% of children, these behaviours can last up to 12 months. The risk factors for developing PHBC include underlying anxiety in the child or parent, a previous bad hospital experience, emergence delirium and preschool age...
April 17, 2018: BMJ Open
https://www.readbyqxmd.com/read/29628028/-disorders-associated-with-mild-cognitive-impairment-risk-factors-and-predictors
#11
Manuel Antón Jiménez, José Luis González Guerrero
Traditionally, cognitive impairment has been associated not only with ageing itself but also with concomitant comorbidities that interact in the disease continuum from the prodromic phases. Notable among these are delirium, nutritional alterations, balance and gait, infections and even a progressive incidence of neoplasms. However, with regard to diagnosis and staging, clinicians should perhaps remain especially alert to the possibility of pharmacological iatrogeny, which is not limited to psychopharmacological treatment...
June 2017: Revista Española de Geriatría y Gerontología
https://www.readbyqxmd.com/read/29578552/focusing-on-inattention-the-diagnostic-accuracy-of-brief-measures-of-inattention-for-detecting-delirium
#12
Annachiara Marra, James C Jackson, E Wesley Ely, Amy J Graves, John F Schnelle, Robert S Dittus, Amanda Wilson, Jin H Han
BACKGROUND: Delirium is frequently missed in most clinical settings. Brief delirium assessments are needed. OBJECTIVE: To determine the diagnostic accuracy of reciting the months of year backwards (MOTYB) from December to July (MOTYB-6) and December to January (MOTYB-12) for delirium as diagnosed by a psychiatrist and to explore the diagnostic accuracies of the following other brief attention tasks: (1) spell the word "LUNCH" backwards, (2) recite the days of the week backwards, (3) 10-letter vigilance "A" task, and (4) 5 picture recognition task...
March 26, 2018: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/29565512/observation-and-analysis-of-clinical-efficacy-of-melatonin-on-aopp-induced-delirium-patients
#13
L-B Zhao, G-D Zhen, Y Zhang, Y-Y Pan, G-H Du, S-Z Zhou, Z-F Li
OBJECTIVE: To observe the clinical efficacy of melatonin on acute organophosphorus pesticide poisoning (AOPP). PATIENTS AND METHODS: In this randomized control trial, a total of 59 AOPP patients with subsequent delirium were randomly divided into two groups, the melatonin group (n=29) and the placebo-controlled group (n=30). Patients in the melatonin group (n=29) underwent oral administration of melatonin in addition to the symptomatic treatment, while those in the placebo-controlled group took a placebo in addition to the symptomatic treatment...
March 2018: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/29546287/degree-of-peripheral-thyroxin-deiodination-frailty-and-long-term-survival-in-hospitalized-older-patients
#14
Giuseppe Pasqualetti, Valeria Calsolaro, Sara Bernardini, Giuseppe Linsalata, Renato Bigazzi, Nadia Caraccio, Fabio Monzani
Introduction: Although the association between low FT3 and poor outcome has been extensively reported in literature, the degree of peripheral thyroxin deiodination and its relationship with frailty and survival in hospitalized older patients has not been fully established yet. The aim of the current study was to evaluate the possible correlation between FT3/FT4 ratio reduction, an indirect marker of thyroxin deiodination impairment, and frailty status and survival in hospitalized older patients...
March 12, 2018: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/29523559/incidence-of-delirium-in-the-canadian-emergency-department-and-its-consequences-on-hospital-length-of-stay-a-prospective-observational-multicentre-cohort-study
#15
Marcel Émond, Valérie Boucher, Pierre-Hugues Carmichael, Philippe Voyer, Mathieu Pelletier, Émilie Gouin, Raoul Daoust, Simon Berthelot, Marie-Eve Lamontagne, Michèle Morin, Stéphane Lemire, Thien Tuong Minh Vu, Alexandra Nadeau, Marcel Rheault, Lucille Juneau, Natalie Le Sage, Jacques Lee
OBJECTIVE: We aim to determine the incidence of delirium and describe its impacts on hospital length of stay (LOS) among non-delirious community-dwelling older adults with an 8-hour exposure to the emergency department (ED) environment. DESIGN: This is a prospective observational multicentre cohort study (March-July 2015). Patients were assessed two times per day during their entire ED stay and up to 24 hours on hospital ward. SETTING: The study took place in four Canadian EDs...
March 8, 2018: BMJ Open
https://www.readbyqxmd.com/read/29508484/a-psychometric-evaluation-of-the-pediatric-anesthesia-emergence-delirium-scale
#16
Jenny Ringblom, Ingrid Wåhlin, Marie Proczkowska
BACKGROUND: Emergence delirium and emergence agitation have been a subject of interest since the early 1960s. This behavior has been associated with increased risk of injury in children and dissatisfaction with anesthesia care in their parents. The Pediatric Anesthesia Emergence Delirium Scale is a commonly used instrument for codifying and recording this behavior. AIMS: The aim of this study was to psychometrically evaluate the Pediatric Anesthesia Emergence Delirium scale, focusing on the factor structure, in a sample of children recovering from anesthesia after surgery or diagnostic procedures...
April 2018: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/29488398/cervical-spine-immobilisation-in-the-elderly-a-literature-review
#17
George Edward Peck, David James Heming Shipway, Kevin Tsang, Michael Fertleman
Developed populations are ageing rapidly and by 2040, approximately 1 in 4 adults will be over 65 years of age. This is resulting in higher incidence of traumatic injury in older patients. Cognitive and physical comorbidities in this group can pose significant challenges. Due to mechanisms of injury and pre-existing degenerative spinal disease, cervical spine fractures are particularly prevalent in elderly patients. These are associated with significant morbidity and mortality. In this literature review we examine current evidence surrounding the use of cervical spine immobilisation in elderly patients in the pre-hospital and emergency department setting and also as a treatment option for cervical spine fractures...
February 28, 2018: British Journal of Neurosurgery
https://www.readbyqxmd.com/read/29440152/protocol-for-validation-of-the-4at-a-rapid-screening-tool-for-delirium-a-multicentre-prospective-diagnostic-test-accuracy-study
#18
Susan D Shenkin, Christopher Fox, Mary Godfrey, Najma Siddiqi, Steve Goodacre, John Young, Atul Anand, Alasdair Gray, Joel Smith, Tracy Ryan, Janet Hanley, Allan MacRaild, Jill Steven, Polly L Black, Julia Boyd, Christopher J Weir, Alasdair Mj MacLullich
INTRODUCTION: Delirium is a severe neuropsychiatric syndrome of rapid onset, commonly precipitated by acute illness. It is common in older people in the emergency department (ED) and acute hospital, but greatly under-recognised in these and other settings. Delirium and other forms of cognitive impairment, particularly dementia, commonly coexist. There is a need for a rapid delirium screening tool that can be administered by a range of professional-level healthcare staff to patients with sensory or functional impairments in a busy clinical environment, which also incorporates general cognitive assessment...
February 10, 2018: BMJ Open
https://www.readbyqxmd.com/read/29429053/program-of-gastrointestinal-rehabilitation-and-early-postoperative-enteral-nutrition-a-prospective-study
#19
Frank Daniel Martos-Benítez, Anarelys Gutiérrez-Noyola, Andrés Soto-García, Iraida González-Martínez, Ilionanys Betancourt-Plaza
Nutritional depletion is commonly observed in patients undergoing surgical treatment for a gastrointestinal malignancy. An appropriate nutritional intervention could be associated with improved postoperative outcomes. The study was aimed to determine the effect of a program of gastrointestinal rehabilitation and early postoperative enteral nutrition upon complications and clinical outcomes in patients who experienced gastrointestinal surgery for cancer. This is a prospective study (2013 January-2015 December) of 465 consecutive patients submitted to gastrointestinal surgery for cancer and admitted to an Oncological Intensive Care Unit...
March 2018: Updates in Surgery
https://www.readbyqxmd.com/read/29415580/a-non-interventional-comparative-study-of-the-20-1-combination-of-cafedrine-theodrenaline-versus-ephedrine-for-the-treatment-of-intra-operative-arterial-hypotension-the-hypotens-study-design-and-rationale
#20
Leopold Eberhart, Götz Geldner, Susanne Huljic, Kerstin Marggraf, Thomas Keller, Tilo Koch, Peter Kranke
OBJECTIVE: To compare the effectiveness of 20:1 cafedrine/theodrenaline approved for use in Germany to ephedrine in the restoration of arterial blood pressure and on post-operative outcomes in patients with intra-operative arterial hypotension of any origin under standard clinical practice conditions. METHODS AND RESULTS: 'HYPOTENS' is a national, multi-center, prospective, open-label, two-armed, non-interventional study. Effectiveness and post-operative outcome following cafedrine/theodrenaline or ephedrine therapy will be evaluated in two cohorts of hypotensive patients...
February 28, 2018: Current Medical Research and Opinion
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