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Delirium screening emergancy room

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...
November 2017: Anesthesiology
Fermín García-Gollarte, José Baleriola-Júlvez, Isabel Ferrero-López, Álvaro Cuenllas-Díaz, Alfonso J Cruz-Jentoft
OBJECTIVE: Inappropriate drug prescription is a common problem in people living in nursing homes and is linked to adverse health outcomes. This study assessed the effect of an educational intervention directed to nursing home physicians in reducing inappropriate prescription and improving health outcomes and resource utilization. DESIGN: Prospective, randomized, multicenter study. SETTING: A private organization of nursing homes in Spain. PARTICIPANTS: Sixty nursing home physicians caring for approximately 3900 nursing home residents in 37 centers were randomized to receive an educational intervention (30) or as a control group (30)...
December 2014: Journal of the American Medical Directors Association
A Pickard, P Davies, K Birnie, R Beringer
Undergoing general anaesthesia is distressing for children, with up to two-thirds demonstrating abnormal behaviours after their procedure, such as emergence delirium (ED) and post-hospitalization behaviour change. The aim of this systematic review was to determine the effect of intraoperative i.v. α₂-adrenergic agonists on postoperative behaviour in children. We included published full-text reports of randomized controlled trials involving children who received i.v. clonidine or dexmedetomidine after induction of general anaesthesia, who were assessed for postoperative behavioural disturbance...
June 2014: British Journal of Anaesthesia
Ary Serpa Neto, Antônio P Nassar, Sérgio O Cardoso, José A Manetta, Victor G M Pereira, Daniel C Espósito, Maria C T Damasceno, Arjen J Slooter
OBJECTIVE: Despite its frequency and impact, delirium in critically ill patients is poorly recognized. Our aim was to systematically review the accuracy of delirium screening instruments in critically ill patients. DATA SOURCE: Systematic review and meta-analysis of publications between 1966 and 2011. The Medline and Embase databases were searched for studies on delirium in critically ill patients. STUDY SELECTION: The meta-analysis was limited to studies in critically ill patients in intensive care units, surgical wards, or emergency rooms...
June 2012: Critical Care Medicine
F M Radtke, M Franck, L Hagemann, M Seeling, K D Wernecke, C D Spies
AIM: Inadequate emergence after anesthesia in the adult patient may be distinguished by the patients' activity level into two subtypes: emergence delirium and hypoactive emergence. The aim of this study was to determine the incidence of inadequate emergence in its different forms, to identify causative factors and to examine the possible influence on postoperative length of stay in the recovery room and in the hospital. METHODS: In this prospective observational study, 1868 non-intubated adult patients who had been admitted to the recovery room were analyzed...
June 2010: Minerva Anestesiologica
Prometheas Constantinides, Philippe Vincent
INTRODUCTION: Gamma-hydroxybutyric-acid is a potentially addictive drug known for its use in "rave" parties. Users have described heightened sexual drive, sensuality and emotional warmth. Its euphoric, sedative and anxiolytic-like properties are also sought by frequent users. Abrupt gamma-hydroxybutyric-acid withdrawal can rapidly cause tremor, autonomic dysfunction and anxiety, and may later culminate in severe confusion, delirium, auditory, visual or tactile hallucinations, or even death...
2009: Cases Journal
Amy Heritage Miller, Kathleen Kline Mangione
BACKGROUND AND PURPOSE: This case report describes the clinical decision making process of a physical therapist whose examination of a home bound elderly woman led to a referral for hospitalization. We illustrate how the use of a comprehensive systems screen and thorough examination identified a patient with treatable conditions that required medical care. CASE DESCRIPTION: The patient was a frail 93-year-old woman. She was referred for home-care physical therapy with multiple medical comorbidities and functional decline following a short hospitalization for fall-related injuries...
2006: Journal of Geriatric Physical Therapy
Jan-Philipp Breuer, Tim Neumann, Andreas Heinz, Wolfgang J Kox, Claudia Spies
Chronic alcohol abuse is of significant clinical and economic relevance. A major part of internal medical pathology is associated with chronic alcoholism. 50% of all accidents with subsequent traumatic injuries are related to alcohol intake. Patients who are chronic alcohol abusers have prolonged hospital stays and substantial increases in postoperative morbidity. A sophisticated diagnosis of alcoholism within standard clinical routine is often difficult, and in most cases the treatment of alcohol-related diseases and complications is protracted and requires increased energy expenditure by the treating physicians...
September 30, 2003: Wiener Klinische Wochenschrift
J M Flacker, J Y Wei
BACKGROUND: The purpose of this study was to determine if serum anticholinergic activity (SACA) arises from endogenous substances produced during illness. METHODS: Elderly medical inpatients (N = 612) were screened for anticholinergic medication use in the week prior to the study by interviews of subjects and proxies and review of emergency room, hospital, and nursing home medication administration records. Of 24 subjects without a recent anticholinergic medication history, 15 were recruited and 10 completed the study...
June 2001: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
K Milisen, M D Foreman, I L Abraham, S De Geest, J Godderis, E Vandermeulen, B Fischler, H H Delooz, B Spiessens, P L Broos
OBJECTIVES: To develop and test the effect of a nurse-led interdisciplinary intervention program for delirium on the incidence and course (severity and duration) of delirium, cognitive functioning, functional rehabilitation, mortality, and length of stay in older hip-fracture patients. DESIGN: Longitudinal prospective before/after design (sequential design). SETTING: The emergency room and two traumatological units of an academic medical center located in an urban area in Belgium...
May 2001: Journal of the American Geriatrics Society
J Monette, G Galbaud du Fort, S H Fung, F Massoud, Y Moride, L Arsenault, M Afilalo
The objective of this study was to compare the results of the Confusion Assessment Method (CAM) obtained by a trained non-physician interviewer to those obtained by a geriatrician, among a sample of elderly patients seen in an emergency room. A group of 110 elderly patients (> or =66 years) were evaluated in the emergency room by a lay interviewer. The geriatrician conducted an interview in the presence of the lay interviewer. Subsequently, the geriatrician and the lay interviewer completed a CAM checklist independently...
January 2001: General Hospital Psychiatry
M Elie, F Rousseau, M Cole, F Primeau, J McCusker, F Bellavance
BACKGROUND: Delirium is a complex medical disorder associated with high morbidity and mortality among elderly patients. The goals of our study were to determine the prevalence of delirium in emergency department (ED) patients aged 65 years and over and to determine the sensitivity and specificity of a conventional clinical assessment by an ED physician for the detection of delirium in the same population. METHODS: All elderly patients presenting to the ED in a primary acute care, university-affiliated hospital who were triaged to the observation room on a stretcher because of the severity of their illness were screened for delirium by a research psychiatrist using the Mini-Mental State Examination and the Confusion Assessment Method...
October 17, 2000: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
I I Galynker, P D Harvey
In a pilot study, a neuropsychological minibattery of tests consisting of Trail-Making Test A (TMA), Trail-Making Test B (TMB), and the Visual Reproduction subtest (VR) of the Wechsler Memory Scale was administered to patients with common psychiatric diagnoses in a psychiatric emergency room (ER). Patients with adjustment disorders were not distinguishable from normal controls, while patients with affective disorders and schizophrenia were more impaired than both of these samples. It is suggested that this or a similar minibattery of tests can be of use as an adjunct screening device for differential diagnosis of adjustment disorder versus more serious psychopathology in psychiatric ERs...
September 1992: Comprehensive Psychiatry
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