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delirium management

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https://www.readbyqxmd.com/read/29222181/fifteen-minute-consultation-an-approach-to-a-child-presenting-to-the-emergency-department-with-acute-psychotic-symptoms
#1
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/29221736/differential-effects-of-operative-complications-on-survival-after-surgery-for-primary-lung-cancer
#2
Felix G Fernandez, Andrzej S Kosinski, Anthony P Furnary, Mark Onaitis, Sunghee Kim, Robert H Habib, Betty C Tong, Patricia Cowper, Daniel Boffa, Jeffrey P Jacobs, Cameron D Wright, Joe B Putnam
OBJECTIVE: Complications adversely affect survival after lung cancer surgery. We tested the hypothesis that effects of complications after lung cancer surgery on survival vary substantially across the spectrum of postoperative complications. METHODS: The Society of Thoracic Surgeons General Thoracic Surgery Database was linked to Medicare data for lung cancer resections from 2002 through 2013. Linkage was achieved for 29,899 patients. A survival model was created that included operative complications as explanatory variables and adjusted for relevant baseline covariates...
November 13, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29213513/prolonged-delirium-misdiagnosed-as-a-mood-disorder
#3
Fei Cao, Haitham Salem, Caesa Nagpal, Antonio L Teixeira
Delirium can be conceptualized as an acute decline in cognitive function that typically lasts from hours to a few days. Prolonged delirium can also affect patients with multiple predisposing and/or precipitating factors. In clinical practice, prolonged delirium is often unrecognized, and can be misdiagnosed as other psychiatric disorders. We describe a case of a 59-year-old male presenting with behavioral and cognitive symptoms that was first misdiagnosed as a mood disorder in a general hospital setting. After prolonged delirium due to multiple factors was confirmed, the patient was treated accordingly with symptomatic management...
April 2017: Dementia & Neuropsychologia
https://www.readbyqxmd.com/read/29207426/-management-of-delirium-in-the-intensive-care-unit
#4
Stephan Braune, Simone Gurlit
No abstract text is available yet for this article.
December 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/29202534/-investigation-of-doctors-and-nurses-perceptions-and-implementation-of-delirium-management-in-intensive-care-unit
#5
H B Luo, X T Wang, B Tang, Z N Zhu, H L Guo, Z Z Li, J H Sun, D W Liu
Objective: To investigate doctors' and nurses' perceptions and implementation of delirium management in intensive care unit. Methods: A total of 197 doctors and nurses in 2 general ICUs and 3 special ICUs at Peking Union Medical College Hospital finished a self-designed questionnaire of delirium management. Results: There were 47 males and 150 females, 43 doctors and 154 nurses who participated in the survey.One hundred and twenty five participators were from general ICU and the others from special ICU. The ICU staff had a significant difference on the perceptions and implementation of delirium management(P< 0...
December 1, 2017: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://www.readbyqxmd.com/read/29196585/feasibility-of-a-nurse-managed-pain-agitation-and-delirium-protocol-in-the-surgical-intensive-care-unit
#6
Alan Rozycki, Andrew S Jarrell, Rachel M Kruer, Samantha Young, Pedro A Mendez-Tellez
BACKGROUND: Society of Critical Care Medicine guidelines recommend the use of pain, agitation, and delirium protocols in the intensive care unit. The feasibility of nurse management of such protocols in the surgical intensive care unit has not been well assessed. OBJECTIVES: To evaluate the percentage of adherent medication interventions for patients assessed by using a pain, sedation, and delirium protocol. METHODS: Data on all adult patients admitted to a surgical intensive care unit from January 2013 through September 2013 who were assessed at least once by using a pain, sedation, and delirium protocol were retrospectively reviewed...
December 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/29192579/-heterogeneity-of-delirium-cannot-be-captured-by-a-simple-diagnostic-instrument
#7
J H Oudenes, M B van Iersel, M G M Olde Rikkert
The latest criteria for delirium (DSM-5) still encompass a very heterogeneous group of patients, as both risk factors and causes differ greatly between patients. This makes it unlikely that a single biomarker (e.g. an EEG signal) can be a valid and reliable diagnostic tool in clinical practice. Researchers should be very aware of this heterogeneity, as striving for uniform biomarkers would otherwise result in a considerable waste of research effort. In clinical practice, the delineation of delirium syndrome from dementia and coma using these DSM-5 criteria remains challenging...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/29176438/delirium-monitoring-and-management-in-the-acute-care-setting
#8
Elizabeth Cullen, Michele C Balas
Associated with substantial morbidity and mortality, delirium is a syndrome commonly experienced by hospitalized adults. This article presents a case study highlighting how delirium may go unrecognized by the healthcare team and provides 10 suggestions for improving delirium assessment, prevention, and management in the acute care setting.
December 15, 2017: Nurse Practitioner
https://www.readbyqxmd.com/read/29168884/transformation-of-a-geriatric-department-in-china
#9
Birong Dong, Jirong Yue, Li Cao, Ming Yang, Ning Ge, Hao Qiukui, Lujia He, Ying Wang, Joseph H Flaherty
China has the world's largest elderly population, and the oldest-old population, with a current disability rate greater than 50%, will triple in the next 35 years. The field of geriatrics is young, because almost all geriatric departments were established after 2000, and so faces many challenges. Management of diseases and hospital care is the focus. Senior physicians were trained in other subspecialties, such as pulmonary or cardiology, and junior physicians entered geriatrics departments as masters or doctorate students after medical school...
November 23, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/29167039/psychological-and-psychiatric-symptoms-of-terminally-ill-patients-with-cancer-and-their-family-caregivers-in-the-home-care-setting-a-nation-wide-survey-from-the-perspective-of-bereaved-family-members-in-japan
#10
Makoto Kobayakawa, Asao Ogawa, Michiko Konno, Akiko Kurata, Jun Hamano, Tatsuya Morita, Yoshiyuki Kizawa, Satoru Tsuneto, Yasuo Shima, Maho Aoyama, Mitsunori Miyashita
OBJECTIVE: The psychological and psychiatric symptoms of terminally ill cancer patients are highly problematic and have been associated with greater burden among caregivers. Until now, the extent of these problems in the home care setting was unclear. METHODS: This retrospective study was conducted as part of a nationwide survey from the perspective of bereaved family members in Japan (J-HOPE3). The bereaved family members rated the symptoms of delirium and suicidal ideation of patients with cancer, and the sleeplessness and depressed mood of family caregivers utilizing home care services in the one month before the patients' deaths...
December 2017: Journal of Psychosomatic Research
https://www.readbyqxmd.com/read/29162132/comparison-of-the-effect-of-high-versus-low-mean-arterial-pressure-levels-on-clinical-outcomes-and-complications-in-elderly-patients-during-non-cardiothoracic-surgery-under-general-anesthesia-study-protocol-for-a-randomized-controlled-trial
#11
Anmin Hu, Yan Qiu, Peng Zhang, Bailong Hu, Yali Yang, Shutao Li, Rui Zhao, Zhongjun Zhang, Yaoxian Zhang, Zihao Zheng, Chen Qiu, Furong Li, Xiaolei Gong
BACKGROUND: Intraoperative blood pressure (BP) is a concern in daily clinic anesthesia and contributes to the differences in clinical outcome. We conducted a randomized controlled trial (RCT) to compare the effect of high vs. low mean arterial pressure (MAP) levels on clinical outcomes and complications in elderly patients under general anesthesia (GA). METHODS: In this multicenter, randomized, parallel-controlled, open-label, assessor-blinded clinical trial, 322 patients aged more than 65 years will be randomized for a low-level MAP (60-70 mmHg) or high-level MAP (90-100 mmHg) during non-cardiothoracic surgery under GA...
November 21, 2017: Trials
https://www.readbyqxmd.com/read/29161390/thiopental-to-desflurane-an-anaesthetic-journey-where-are-we-going-next
#12
J R Sneyd
Development targets in anaesthetic pharmacology have evolved from minimizing harm caused by unwanted effects through an era in which rapid onset and offset of drug effect were prioritised. Today's anaesthetists have access to a library of effective drugs whose characteristics offer controllable hypnosis, analgesia and paralysis with manageable off-target effects. The availability of these agents at generic prices inhibits commercial interest and this is reflected in the limited number of current anaesthetic drug development projects...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29156483/-interventions-for-assisting-geriatric-patients-with-frailty-before-surgery
#13
Jörn Kiselev
Frailty is a complex syndrome leading to a higher vulnerability in elderly patients, especially during and after surgery. It is characterized by the simultaneous presence of at least three of five phenotypical symptoms: unintentional weight loss, exhaustion, muscle weakness, slow walking speed, and low activity levels. The presence of two of these symptoms is often labelled as pre-frailty.By identifying these symptoms of frailty, medical teams can plan and perform suitable interventions prior to a planned surgery in order to lower these risk factors and to avoid complications, such as delir, hospital re-admission, loss of independence, and increased mortality...
November 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29156482/-how-to-reduce-the-rate-of-postoperative-complications-in-frail-patients
#14
Rudolf Mörgeli, Tobias Wollersheim, Claudia Spies, Felix Balzer, Susanne Koch, Sascha Treskatsch
Frail patients are more prone to develop complications during and after surgery. As the syndrome becomes more common, recognition and special management of frail patients in the perioperative setting is becoming crucial to improve short- and long-term outcomes. Based on current literature and guidelines, we present a compilation of strategies that could be employed to reduce postoperative complication rates in frail patients. Due to their impaired response to stressors, potential perioperative hazards to frail patients are identified and discussed...
November 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/29152432/acute-changes-in-mentation-in-a-patient-with-hepatic-cirrhosis-treated-with-high-doses-of-dexamethasone
#15
Luis Dabul, Andrew Droney, Juan Oms, Marcos A Sanchez-Gonzalez
Despite the anti-inflammatory benefits of steroids in the management of multiple medical conditions, they are associated with undesired metabolic and psychiatric side effects. We present a case of a 57-year-old Hispanic man with hepatic cirrhosis due to hepatitis C and no past medical history of psychiatric illnesses who became delirious after treatment with high doses of intravenous Dexamethasone. The patient presented to Larkin Community Hospital, USA with complaints of lower back pain requiring treatment with steroids for severe lumbar central canal stenosis...
September 10, 2017: Curēus
https://www.readbyqxmd.com/read/29136301/ketamine-for-the-acute-management-of-excited-delirium-and-agitation-in-the-prehospital-setting
#16
Kyle A Weant, Lauren M Linder, Clint A Ross
BACKGROUND: Traditional first-line therapy in the prehospital setting for the acutely agitated patient includes an antipsychotic in combination with a benzodiazepine. Recently, interest has grown regarding the use of ketamine in the prehospital setting as an attempt to overcome the limitations of the traditional medications and provide a more safe and effective therapy. This review provides an overview of the pharmacology of ketamine, evaluates the literature regarding ketamine use for prehospital agitation, and proposes an algorithm that may be used within the prehospital setting...
November 14, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/29133765/geriatric-anesthesia-related-morbidity-and-mortality-in-china-current-status-and-trend
#17
REVIEW
Yang Liu, Wei Xiao, Ling-Zhong Meng, Tian-Long Wang
OBJECTIVE: The population of elderly patients and the amount of geriatric anesthesia have been growing rapidly in China. Thus, understanding the morbidity and mortality associated with geriatric anesthesia in China is critical to the improvement of anesthesia quality and outcome. The aim of the review was to discuss the geriatric anesthesia-related morbidity and mortality in China, as well as to point out the future trend. DATA SOURCES: Articles in this review were all searched from Wanfang, China National Knowledge Infrastructure (CNKI), VIP, PubMed, and Web of Science databases, based on the reports originated in China from January 2011 to December 2016...
November 20, 2017: Chinese Medical Journal
https://www.readbyqxmd.com/read/29132662/-delirium-in-a-nursing-home-a-survey-of-general-practitioners
#18
REVIEW
Léa Elkouby, Sophie Moulias
Delirium is all the more frequent and serious when it occurs in a nursing home. A study was carried out to assess the current practices of general practitioners in the management of delirium in a nursing home in order to identify the issues involved and to suggest areas for improvement. The doctors identified three main difficulties: the management of behavioural disorders, the conditions of practice of a private practitioner in a healthcare institution and the relations with the different caregivers of the nursing home...
November 2017: Soins. Gérontologie
https://www.readbyqxmd.com/read/29132195/current-evidence-for-the-use-of-n-acetylcysteine-following-liver-resection
#19
REVIEW
Richard Kemp, Jonathan Mole, Dhanny Gomez
BACKGROUND: N-acetylcysteine (NAC) has many uses in medicine; notable in the management of paracetamol toxicity, acute liver failure and liver surgery. The aim of this review was to critically appraise the published literature for the routine use of NAC in liver resection surgery. METHODS: An electronic search was performed of EBSCOhost (Medline and CINAHL database), PubMed and the Cochrane Library for the period 1990-2016. MeSH headings: 'acetyl-cysteine', 'liver resection' and 'hepatectomy' were used to identify all relevant articles published in English...
November 13, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/29124114/impact-of-programs-to-reduce-antipsychotic-and-anticholinergic-use-in-nursing-homes
#20
Ryan M Carnahan, Grant D Brown, Elena M Letuchy, Linda M Rubenstein, Brian M Gryzlak, Marianne Smith, Jeffrey C Reist, Michael W Kelly, Susan K Schultz, Michelle T Weckmann, Elizabeth A Chrischilles
Introduction: Antipsychotics are used for managing behavioral and psychological symptoms of dementia (BPSD) but have risks. Anticholinergics can worsen outcomes in dementia. The Improving Antipsychotic Appropriateness in Dementia Patients educational program (IA-ADAPT) and Centers for Medicare and Medicaid Services Partnership to Improve Dementia Care (CMS Partnership) promote improved care for BPSD. The purpose of this study was to evaluate the impact of these programs on medication use and BPSD among nursing home residents...
November 2017: Alzheimer's & Dementia: Translational Research & Clinical Interventions
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