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Early recognition of delirium

Cornel N Stanciu, Thomas M Penders, Samantha A Gnanasegaram, Elvin Pirapakaran, Juvraj S Padda, Jeeven S Padda
BACKGROUND: New psychoactive substances are emerging at an alarming rate. With novel structures and properties they produce unique behavioral characteristics during intoxication. Synthetic cathinones are some of the most common. More and more are presenting to emergency departments due to consequences of use. Aside from isolated reports, little is known about these compounds. OBJECTIVE: Here we review literature pertaining to two common synthetic cathinones, MDPV and alphaPVP, and correlate clinically with guidance on management of intoxications...
March 21, 2017: Current Drug Abuse Reviews
Suresh Arumugam, Ayman El-Menyar, Ammar Al-Hassani, Gustav Strandvik, Mohammad Asim, Ahammed Mekkodithal, Insolvisagan Mudali, Hassan Al-Thani
Delirium is characterized by impaired cognition with nonspecific manifestations. In critically ill patients, it may develop secondary to multiple precipitating or predisposing causes. Although it can be a transient and reversible syndrome, its occurrence in Intensive Care Unit (ICU) patients may be associated with long-term cognitive dysfunction. This condition is often under-recognized by treating physicians, leading to inappropriate management. For appropriate management of delirium, early identification and risk factor assessment are key factors...
January 2017: Journal of Emergencies, Trauma, and Shock
Gayane Harutyunyan, Larissa Hauer, Martin W Dünser, Anush Karamyan, Tobias Moser, Slaven Pikija, Markus Leitinger, Helmut F Novak, Eugen Trinka, Johann Sellner
BACKGROUND: Early recognition and treatment of autoimmune encephalitis (AE) has become an essential issue in clinical practice. However, little is known about patients with deteriorating conditions and the need for intensive care treatment. Here, we aimed to characterize underlying aetiologies, clinical symptoms, reasons for intensive care admission, and mortality of critically ill patients with AE. METHODS: We conducted a retrospective chart review of all patients with "definite" or "probable" diagnoses of AE treated at our neurological intensive care unit between 2002 and 2015...
December 27, 2016: Neurocritical Care
Sarah T Pendlebury, Nicola G Lovett, Sarah C Smith, Rose Wharton, Peter M Rothwell
Background: recognition of prevalent delirium and prediction of incident delirium may be difficult at first assessment. We therefore aimed to validate a pragmatic delirium susceptibility (for any, prevalent and incident delirium) score for use in front-line clinical practice in a consecutive cohort of older acute medicine patients. Methods: consecutive patients aged ≥65 years over two 8-week periods (2010-12) were screened prospectively for delirium using the Confusion Assessment Method (CAM), and delirium was diagnosed using the DSM IV criteria...
March 1, 2017: Age and Ageing
Mohannad Eid AbuRuz
INTRODUCTION: Delirium is a clinical syndrome that negatively affects the outcomes of the intensive care units patients if undetected early and treated well. However, this condition remains under recognized and poorly managed by health care providers including nurses. The objective of this study was to check nurses' knowledge level about delirium recognition. MATERIALS & METHODS: This was a cross-sectional study on 176 intensive care units nurses working in four major hospitals in Amman, Jordan...
August 26, 2016: Global Journal of Health Science
Craig Nolan, Lisa M DeAngelis
PURPOSE OF REVIEW: The purpose of this review is to provide a practical clinical approach to confusion in the patient with cancer. Confusion in the cancer population has a broader differential diagnosis than in the general medical population. The clinician must consider the usual differential diagnoses as well as causes unique to the cancer patient including direct complications from the cancer and indirect complications related to cancer treatment. RECENT FINDINGS: In the recent age of precision medicine, the oncologist now utilizes the genomic profile of both the patient and the tumor to provide advanced biologic therapies including targeted anticancer drugs, antiangiogenic agents, and immunotherapy...
December 2016: Current Opinion in Neurology
Emily Jane Tomlinson, Nicole M Phillips, Mohammadreza Mohebbi, Alison M Hutchinson
AIMS AND OBJECTIVES: To determine predisposing and precipitating risk factors for incident delirium in medical patients during an acute hospital admission. BACKGROUND: Incident delirium is the most common complication of hospital admission for older patients. Up to 30% of hospitalised medical patients experience incident delirium. Determining risk factors for delirium is important for identifying patients who are most susceptible to incident delirium. DESIGN: Retrospective case-control study with two controls per case...
March 2017: Journal of Clinical Nursing
Emel Ünal Bilge, Menşure Kaya, Gülçin Özalp Şenel, Süheyla Ünver
OBJECTIVE: In this study, we aimed to determine the risk factors and the incidence of delirium in patients who were followed postoperatively in our surgical intensive care unit for 24 h using the confusion assessment method (CAM). METHODS: After obtaining approval from the ethics committee, 250 patients were included in the study. Patients who were operated under general anaesthesia or regional anaesthesia and followed in the surgical intensive care unit were evaluated by the Ramsay Sedation Scale on the first postoperative day...
August 2015: Turkish Journal of Anaesthesiology and Reanimation
Paul Rizk, William Morris, Philip Oladeji, Michael Huo
Postoperative delirium is a serious complication following hip surgery in elderly patients that can adversely affect outcomes in both hip fracture and arthroplasty surgery. Recently, the incidence of hip fracture in the Medicare population was estimated at approximately 500 000 patients per year, with the majority treated surgically. The annual volume of total hip arthroplasty is nearly 450 000 patients and is projected to increase over the next 15 to 20 years. Subsequently, the incidence of postoperative delirium will rise...
June 2016: Geriatric Orthopaedic Surgery & Rehabilitation
Jean P Gelinas, Keith R Walley
Recognition and management of agitation, delirium, and pain are key areas. Reduced use of sedatives is an important measure that must be coupled with increased patient engagement, mobilization, and exercise. Use of low tidal volumes and low mean airway pressures during mechanical ventilation is helpful. A key hemodynamic principle following early aggressive volume resuscitation is subsequent careful assessment to avoid unnecessary additional volume administration and adverse consequences of frank volume overload...
June 2016: Clinics in Chest Medicine
Vicente Cés Souza-Dantas, Pedro Póvoa, Fernando Bozza, Marcio Soares, Jorge Salluh
Delirium is the most frequent and severe clinical presentation of brain dysfunction in critically ill septic patients with an incidence ranging from 9% to 71%. Delirium represents a significant burden for patients and relatives, as well as to the health care system, resulting in higher costs, long-term cognitive impairment and significant risk of death after 6 months. Current interventions for the prevention of delirium typically involve early recognition and amelioration of modifiable risk factors and treatment of underlying conditions that predisposes the individual to delirium...
June 3, 2016: Hospital Practice (Minneapolis)
Deepali Dixit, Jeffrey Endicott, Lisa Burry, Liz Ramos, Siu Yan Amy Yeung, Sandeep Devabhakthuni, Claire Chan, Anthony Tobia, Marilyn N Bulloch
Approximately 16-31% of patients in the intensive care unit (ICU) have an alcohol use disorder and are at risk for developing alcohol withdrawal syndrome (AWS). Patients admitted to the ICU with AWS have an increased hospital and ICU length of stay, longer duration of mechanical ventilation, higher costs, and increased mortality compared with those admitted without an alcohol-related disorder. Despite the high prevalence of AWS among ICU patients, no guidelines for the recognition or management of AWS or delirium tremens in the critically ill currently exist, leading to tremendous variability in clinical practice...
July 2016: Pharmacotherapy
Angela Malik, Todd Harlan, Janice Cobb
AIMS AND OBJECTIVES: The paper examines the ability of nursing staff to detect delirium and apply early intervention to decrease adverse events associated with delirium. To characterise nursing practices associated with staff knowledge, delirium screening utilising the Modified Richmond Assessment Sedation Score (mRASS), and multicomponent interventions in an acute inpatient medical unit. BACKGROUND: Delirium incidence rates are up to 60% in frail elderly hospitalised patients...
November 2016: Journal of Clinical Nursing
Margaret J Bull, Lesley Boaz, Martha Jermé
BACKGROUND: Delirium in older adults is considered a medical emergency; it contributes to a cascade of functional decline and to increased mortality. Early recognition of delirium symptoms is critical to prevent these negative consequences. Family caregivers who are educated about delirium could partner with nurses and other healthcare professionals in early recognition of delirium symptoms. Before implementing such partnership models, it is important to examine the effectiveness of educating family caregivers about delirium...
June 2016: Worldviews on Evidence-based Nursing
Kari Johnson, Shelly Diana, Jodi Todd, Amanda McFarren, Alisa Domb, Alicia Mangram, Kevin Veale
OBJECTIVE: Evaluate change in practice and beliefs regarding delirium among nurses, pharmacists, respiratory therapists and physicians in a trauma intensive care unit. METHODOLOGY/DESIGN/SETTING: Descriptive pre and post-design at a Level One Trauma Center. Education on causes of delirium, risk factors, strategies to prevent delirium and routine screening. OUTCOME MEASURES: Change in practice and beliefs regarding delirium. RESULTS: McNemars test measured the differences between pre- and post-questionnaires comparing the proportion of staff changed their responses in one direction to those who went in the opposite direction...
June 2016: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
S J Moug, M Stechman, K McCarthy, L Pearce, P K Myint, J Hewitt
INTRODUCTION: Older patients (>65 years of age) admitted as general surgical emergencies increasingly require improved recognition of their specific needs relative to younger patients. Two such needs are frailty and cognitive impairment. These are evolving research areas that the emergency surgeon increasingly requires knowledge of to improve short- and long-term patient outcomes. METHODS: This paper reviews the evidence for frailty and cognitive impairment in the acute surgical setting by defining frailty and cognitive impairment, introducing methods of diagnosis, discussing the influence on prognosis and proposing strategies to improve older patient outcomes...
March 2016: Annals of the Royal College of Surgeons of England
William P Cheshire
Thermoregulation is a vital function of the autonomic nervous system in response to cold and heat stress. Thermoregulatory physiology sustains health by keeping body core temperature within a degree or two of 37°C, which enables normal cellular function. Heat production and dissipation are dependent on a coordinated set of autonomic responses. The clinical detection of thermoregulatory impairment provides important diagnostic and localizing information in the evaluation of disorders that impair thermoregulatory pathways, including autonomic neuropathies and ganglionopathies...
April 2016: Autonomic Neuroscience: Basic & Clinical
Elaine McCleary, Pamela Cumming
Delirium is a serious condition associated with poor outcomes which can be prevented and treated if recognised early. Older people and people with dementia or severe illness are more at risk of delirium. SQiD is a simple prompt question which asks, "Is this patient more confused than before?" Focusing specifically on patients aged 75 and over, this project aimed to increase awareness and usage of SQiD to help improve early recognition of delirium, in accordance with the Healthcare Improvement Scotland national initiative...
2015: BMJ Quality Improvement Reports
Mary Bozzo
No abstract text is available yet for this article.
September 2015: Australian Nursing & Midwifery Journal
Willem A van Eijsden, Jelle W Raats, Paul Gh Mulder, Lijckle van der Laan
OBJECTIVE: The primary objective was to identify possible risk factors for delirium in patients with critical limb ischemia undergoing surgery. The secondary objective was to study the effect of delirium on complications, the length of hospital stay, health care costs, and mortality. METHODS: All patients 65 years or older with critical limb ischemia undergoing surgery from February 2013 to July 2014 at Amphia Hospital, were included and followed up until December 31, 2014...
2015: Clinical Interventions in Aging
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