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Delirium in Emergency room

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https://www.readbyqxmd.com/read/28893727/development-of-a-virtual-reality-exposure-tool-as-psychological-preparation-for-elective-pediatric-day-care-surgery-methodological-approach-for-a-randomized-controlled-trial
#1
Robin Eijlers, Jeroen S Legerstee, Bram Dierckx, Lonneke M Staals, Johan Berghmans, Marc P van der Schroeff, Rene Mh Wijnen, Elisabeth Mwj Utens
BACKGROUND: Preoperative anxiety in children is highly prevalent and is associated with adverse outcomes. Existing psychosocial interventions to reduce preoperative anxiety are often aimed at distraction and are of limited efficacy. Gradual exposure is a far more effective way to reduce anxiety. Virtual reality (VR) provides a unique opportunity to gradually expose children to all aspects of the operating theater. OBJECTIVE: The aims of our study are (1) to develop a virtual reality exposure (VRE) tool to prepare children psychologically for surgery; and (2) to examine the efficacy of the VRE tool in a randomized controlled trial (RCT), in which VRE will be compared to care as usual (CAU)...
September 11, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28891828/poor-performance-on-a-preoperative-cognitive-screening-test-predicts-postoperative-complications-in-older-orthopedic-surgical-patients
#2
Deborah J Culley, Devon Flaherty, Margaret C Fahey, James L Rudolph, Houman Javedan, Chuan-Chin Huang, John Wright, Angela M Bader, Bradley T Hyman, Deborah Blacker, Gregory Crosby
BACKGROUND: The American College of Surgeons and the American Geriatrics Society have suggested that preoperative cognitive screening should be performed in older surgical patients. We hypothesized that unrecognized cognitive impairment in patients without a history of dementia is a risk factor for development of postoperative complications. METHODS: We enrolled 211 patients 65 yr of age or older without a diagnosis of dementia who were scheduled for an elective hip or knee replacement...
September 8, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28593326/intraoperative-infusion-of-dexmedetomidine-for-prevention-of-postoperative-delirium-and-cognitive-dysfunction-in-elderly-patients-undergoing-major-elective-noncardiac-surgery-a-randomized-clinical-trial
#3
RANDOMIZED CONTROLLED TRIAL
Stacie Deiner, Xiaodong Luo, Hung-Mo Lin, Daniel I Sessler, Leif Saager, Frederick E Sieber, Hochang B Lee, Mary Sano, Christopher Jankowski, Sergio D Bergese, Keith Candiotti, Joseph H Flaherty, Harendra Arora, Aryeh Shander, Peter Rock
Importance: Postoperative delirium occurs in 10% to 60% of elderly patients having major surgery and is associated with longer hospital stays, increased hospital costs, and 1-year mortality. Emerging literature suggests that dexmedetomidine sedation in critical care units is associated with reduced incidence of delirium. However, intraoperative use of dexmedetomidine for prevention of delirium has not been well studied. Objective: To evaluate whether an intraoperative infusion of dexmedetomidine reduces postoperative delirium...
August 16, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28494898/the-effect-of-desflurane-versus-propofol-anesthesia-on-postoperative-delirium-in-elderly-obese-patients-undergoing-total-knee-replacement-a-randomized-controlled-double-blinded-clinical-trial
#4
Pedro Tanaka, Stuart Goodman, Barbara R Sommer, William Maloney, James Huddleston, Hendrikus J Lemmens
STUDY OBJECTIVE: The goal of this study was to investigate the incidence of delirium, wake-up times and early post-operative cognitive decline in one hundred obese elderly patients undergoing total knee arthroplasty. DESIGN: Prospective randomized trial. SETTINGS: Operating room, postoperative recovery area, hospital wards. PATIENTS: 100 obese patients (ASA II and III) undergoing primary total knee replacement under general anesthesia with a femoral nerve block catheter...
June 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28361438/drug-utilization-of-japanese-patients-diagnosed-with-schizophrenia-an-administrative-database-analysis
#5
Stephane Cheung, Yukinobu Hamuro, Jörg Mahlich, Takanobu Nakahara, Rosarin Sruamsiri, Sunny Tsukazawa
BACKGROUND AND OBJECTIVE: Patient characteristics require consideration for optimal treatment in order to achieve clinical remission for an improved quality of life and social functioning. Prior evidence supports long-acting injectable antipsychotics (LAIs) in the relapse prevention of schizophrenia. This study aimed to characterize Japanese patients diagnosed with schizophrenia and to compare the outcomes of LAIs and oral antipsychotics (AP) in re-hospitalization or emergency room visit rates...
June 2017: Clinical Drug Investigation
https://www.readbyqxmd.com/read/28146459/smartphone-based-behavioural-intervention-alleviates-children-s-anxiety-during-anaesthesia-induction-a-randomised-controlled-trial
#6
Débora O Cumino, Joaquim E Vieira, Luciana C Lima, Livia P Stievano, Raquel A P Silva, Ligia A S T Mathias
BACKGROUND: Preoperative anxiety negatively influences children's anaesthetic and surgical experience, and results in postoperative complications, such as emergence delirium and behavioural changes. Nonpharmacological management using alternative therapies that alleviate psychological stress can be as important as pharmacological ones in reducing children's anxiety. Nevertheless, their validity as an effective anxiety-reducing strategy in children remains controversial. OBJECTIVE(S): To verify whether nonpharmacological strategies, that is, leaflet and distraction with smartphone application presented to parents/guardians and children, respectively, were effective in preventing children's anxiety during anaesthesia induction...
March 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28068834/design-considerations-of-a-randomized-controlled-trial-of-sedation-level-during-hip-fracture-repair-surgery-a-strategy-to-reduce-the-incidence-of-postoperative-delirium-in-elderly-patients
#7
Tianjing Li, L Susan Wieland, Esther Oh, Karin J Neufeld, Nae-Yuh Wang, Kay Dickersin, Frederick E Sieber
Background Delirium is an acute change in mental status characterized by sudden onset, fluctuating course, inattention, disorganized thinking, and abnormal level of consciousness. The objective of the randomized controlled trial "A STrategy to Reduce the Incidence of Postoperative Delirium in Elderly Patients" (STRIDE) is to assess the effectiveness of light versus heavy sedation on delirium and other outcomes in elderly patients undergoing hip fracture repair surgery. Our goal is to describe the design considerations and lessons learned in planning and implementing the STRIDE trial...
June 2017: Clinical Trials: Journal of the Society for Clinical Trials
https://www.readbyqxmd.com/read/27871601/effects-of-low-dose-propofol-vs-ketamine-on-emergence-cough-in-children-undergoing-flexible-bronchoscopy-with-sevoflurane-remifentanil-anesthesia-a-randomized-double-blind-placebo-controlled-trial
#8
RANDOMIZED CONTROLLED TRIAL
Tulun Ozturk, Arzu Acıkel, Ozge Yılmaz, Ismet Topçu, Eralp Çevıkkalp, Hasan Yuksel
STUDY OBJECTIVE: To determine the effects of low-dose ketamine and propofol on cough during emergence and the recovery period when administered at emergence in children undergoing fiberoptic bronchoscopy for bronchoalveolar lavage (FOBL) with sevoflurane-remifentanil anesthesia. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Operating room, postoperative recovery area. PATIENTS: Sixty-eight children aged 1 to 8 years old undergoing elective diagnostic FOBL...
December 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27821819/-effect-of-ultra-fast-track-extubation-in-cardiovascular-surgery
#9
Toshiro Kobayashi, Hiroshi Kurazumi, Hidenori Gohra, Seiichi Shibasaki, Yuko Kudo, Naoko Yamauchi, Takashi Tamura, Michio Shigedomi
Fast-track surgery has been widely implemented and allows such immediate extubation as in the operating room(OR). We retrospectively investigated the effect of routine ultra-fast-track(UFT) surgery extubating in the OR in patients undergoing cardiovascular operations. Among 333 consecutive patients, 224 (67.3%)were extubated in the OR. Five patients were re-intubated, but none were because of heart or respiratory failure. Independent predictors for failure of OR extubation were preoperative renal failure, pre-existent cerebrovascular disease, emergency surgery, and prolonged operation and/or cardiopulmonary bypass times...
November 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/27609207/partial-and-no-recovery-from-delirium-after-hospital-discharge-predict-increased-adverse-events
#10
Martin G Cole, Jane McCusker, Robert Bailey, Michael Bonnycastle, Shek Fung, Antonio Ciampi, Eric Belzile
BACKGROUND: the implications of partial and no recovery from delirium after hospital discharge are not clear. We sought to explore whether partial and no recovery from delirium among recently discharged patients predicted increased adverse events (emergency room visits, hospitalisations, death) during the subsequent 3 months. METHOD: prospective study of recovery from delirium in older hospital inpatients. The Confusion Assessment Method was used to diagnose delirium in hospital and determine recovery status after discharge (T0)...
September 8, 2016: Age and Ageing
https://www.readbyqxmd.com/read/27110366/risk-factors-for-30-day-readmission-following-hypoglycemia-related-emergency-room-and-inpatient-admissions
#11
M F Emons, J P Bae, B J Hoogwerf, S L Kindermann, R J Taylor, B H Nathanson
OBJECTIVE: Hypoglycemia is a serious complication of diabetes treatment. This retrospective observational study characterized hypoglycemia-related hospital emergency room (ER) and inpatient (in-pt) admissions and identified risk factors for 30-day all-cause and hypoglycemia-related readmission. RESEARCH DESIGN AND METHODS: 4476 hypoglycemia-related ER and in-pt encounters with discharge dates from 1/1/2009 to 3/31/2014 were identified in a large, multicenter electronic health record database...
2016: BMJ Open Diabetes Research & Care
https://www.readbyqxmd.com/read/27022817/anesthesia-for-off-floor-dental-and-oral-surgery
#12
Joseph A Giovannitti
PURPOSE OF REVIEW: Anesthesia for dentistry is commonly performed outside the operating room. The combination of a shared airway between surgeon and anesthetist, the variety of open airway techniques, and the out-of-operating room setting often results in anxiety and avoidance of dental cases among anesthesia personnel. This review attempts to demystify dental treatment and facilitate the anesthesia provider in providing effective sedation of dental procedures performed in the nonoperating room setting...
August 2016: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/26968337/post-anaesthetic-emergence-delirium-in-adults-incidence-predictors-and-consequences
#13
L Munk, G Andersen, A M Møller
BACKGROUND: Emergence delirium (ED) after general anaesthesia (GA) is a well-known phenomenon, yet the risk factors are still unclear. The aims of this study were to determine the incidence and independent predictors of ED and secondly to determine to which degree ED has any relevant, clinical consequences to medical staff as well as to patients. METHOD: This prospective, observational cohort study assessed adult patients emerging from GA in the operating room, using the Richmond Agitation-Sedation Scale (RASS)...
September 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/26372077/drawmd-app-aided-preoperative-anesthesia-education-reduce-parents-anxiety-and-improve-satisfaction
#14
RANDOMIZED CONTROLLED TRIAL
Liting Ji, Xiaoping Zhang, Hui Fan, Mei Han, Haitao Yang, Lihua Tang, Yan Shao, Yunping Lan, Dongbai Li
OBJECTIVE: There is no existing standard format for preoperative anesthesia education. The drawMD APP is an visible preoperative education tool. The aim of this study was to evaluate the effects of drawMD APP on pre-operative anesthesia education. METHODS: The parents were randomized to receive drawMD APP-aided pre-operative anesthesia education or standard verbal education. Parental anxiety was measured before education (T0) and immediately after education (T1), and after operation (T4)...
February 2016: Patient Education and Counseling
https://www.readbyqxmd.com/read/26316813/regional-anesthesia-for-the-trauma-patient-improving-patient-outcomes
#15
REVIEW
Jeff Gadsden, Alicia Warlick
Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform...
2015: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/26290854/delirium-in-prolonged-hospitalized-patients-in-the-intensive-care-unit
#16
Amir Vahedian Azimi, Abbas Ebadi, Fazlollah Ahmadi, Soheil Saadat
BACKGROUND: Prolonged hospitalization in the intensive care unit (ICU) can impose long-term psychological effects on patients. One of the most significant psychological effects from prolonged hospitalization is delirium. OBJECTIVES: The aim of this study was to assess the effect of prolonged hospitalization of patients and subsequent delirium in the intensive care unit. PATIENTS AND METHODS: This conventional content analysis study was conducted in the General Intensive Care Unit of the Shariati Hospital of Tehran University of Medical Sciences, from the beginning of 2013 to 2014...
May 2015: Trauma Monthly
https://www.readbyqxmd.com/read/26237623/preparing-parents-to-be-present-for-their-child-s-anesthesia-induction-a-randomized-controlled-trial
#17
RANDOMIZED CONTROLLED TRIAL
Kristen M Bailey, Sally J Bird, Patrick J McGrath, Jill E Chorney
BACKGROUND: The purpose of this study is to compare the effectiveness of a brief preparation intervention for parental presence during induction of anesthesia (PPIA preparation) with a PPIA with standard preparation (PPIA standard). METHODS: Ninety-three children, aged 2 to 10 years, undergoing elective surgery at a children's hospital participated together with their parents. Parents were randomly assigned to receive either PPIA preparation or PPIA standard before their children's induction of anesthesia...
October 2015: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/26204548/-calcium-pyrophosphate-dihydrate-crystal-deposition-disease-as-an-example-of-illness-presentation-in-the-elderly
#18
Paola R Fuentes, Javier Webar, Carla Matus, Cristián Vergara, Michelle Herrera, Elizabeth M Barthel, Jorge S Vega
Illness presentation in the elderly may be entirely non-specific, with fatigue, loss of function or the presence of geriatric syndromes. We report a 90 years old male consulting in the emergency room for delirium that persisted throughout hospitalization without finding a cause. During the course of hospitalization mild fever appeared and a left knee swelling became apparent. A synovial fluid aspiration showed a leukocyte count of 360 per field with 60% polymorphonuclear cells. The culture was negative. With a presumptive diagnosis of pseudogout, cochicine and celecoxib were started with remission of the confusional state...
April 2015: Revista Médica de Chile
https://www.readbyqxmd.com/read/26176357/video-distraction-and-parental-presence-for-the-management-of-preoperative-anxiety-and-postoperative-behavioral-disturbance-in-children-a-randomized-controlled-trial
#19
RANDOMIZED CONTROLLED TRIAL
Hyuckgoo Kim, Sung Mee Jung, Hwarim Yu, Sang-Jin Park
BACKGROUND: The anxiolytic efficacy of video watching, in the absence of parents, during the mask induction of anesthesia in young children with high separation anxiety has not been clearly established. We performed this study to determine whether the effect of video distraction on alleviating preoperative anxiety is independent of parental presence and whether a combination of both interventions is more effective than either single intervention in alleviating preoperative anxiety and postoperative behavioral disturbance in preschool children...
September 2015: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/25540068/emergence-from-general-anaesthesia-and-evolution-of-delirium-signs-in-the-post-anaesthesia-care-unit
#20
E Card, P Pandharipande, C Tomes, C Lee, J Wood, D Nelson, A Graves, A Shintani, E W Ely, C Hughes
BACKGROUND: Emergence from anaesthesia is often accompanied by signs of delirium, including fluctuating mental status and inattention. The evolution of these signs of delirium requires investigation since delirium in the post-anaesthesia care unit (PACU) may be associated with worse outcomes. METHODS: Adult patients emerging from anaesthesia were assessed for agitated emergence in the operating room using the Richmond Agitation-Sedation Scale (RASS). The Confusion Assessment Method for the Intensive Care Unit was then used to evaluate delirium signs at PACU admission and during PACU stay at 30 min, 1 h, and discharge...
September 2015: British Journal of Anaesthesia
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