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Delirium in Emergency Department

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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/29738102/validation-of-the-brief-confusion-assessment-method-for-screening-delirium-in-elderly-medical-patients-in-a-german-emergency-department
#3
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
#4
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/29699898/an-evaluation-of-single-question-delirium-screening-tools-in-older-emergency-department-patients
#5
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/29578552/focusing-on-inattention-the-diagnostic-accuracy-of-brief-measures-of-inattention-for-detecting-delirium
#6
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/29523559/incidence-of-delirium-in-the-canadian-emergency-department-and-its-consequences-on-hospital-length-of-stay-a-prospective-observational-multicentre-cohort-study
#7
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/29488398/cervical-spine-immobilisation-in-the-elderly-a-literature-review
#8
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
#9
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/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
#10
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
https://www.readbyqxmd.com/read/29386096/cost-analysis-of-an-integrated-aged-care-program-for-residential-aged-care-facilities
#11
Rod Ling, Andrew Searles, Jacqueline Hewitt, Robyn Considine, Catherine Turner, Susan Thomas, Kelly Thomas, Keith Drinkwater, Isabel Higgins, Karen Best, Jane Conway, Carolyn Hullick
Objective To compare annual costs of an intervention for acutely unwell older residents in residential age care facilities (RACFs) with usual care. The intervention, the Aged Care Emergency (ACE) program, includes telephone clinical support aimed to reduce avoidable emergency department (ED) presentations by RACF residents. Methods This costing of the ACE intervention examines the perspective of service providers: RACFs, Hunter Medicare Local, the Ambulance Service of New South Wales, and EDs in the Hunter New England Local Health District...
February 1, 2018: Australian Health Review: a Publication of the Australian Hospital Association
https://www.readbyqxmd.com/read/29373255/delirium-in-patients-with-heart-failure-influence-of-attendance-times-in-an-emergency-department
#12
Laura de Pablos, Rita Ainhoa Jorge-Brito, Veena Amarnani, Alejandro Jiménez-Sosa, Magali González-Colaço Harmand, Alberto Domínguez-Rodríguez
No abstract text is available yet for this article.
January 16, 2018: Revista Española de Cardiología
https://www.readbyqxmd.com/read/29341529/-when-the-ward-overflows%C3%A2-the-impact-of-outlying-beds-on-patient-care
#13
Valérie Mosimann, Olivier Lamy, Julien Castioni
Due to the chronic lack of beds in hospitals, patients are often hospitalized in other departments (outlier patients), with a responsible physician working in another department. This causes increased thromboembolics risks, nosocomial infections, falls and delirium in the elderly, morbidity and mortality. Outlier patients, compared to standard patients, stay longer in the emergency department and their discharge documents are available later. Outlying is used daily in the CHUV hospital and new strategies are elaborated to manage patient flow, especially during the flu epidemic...
January 17, 2018: Revue Médicale Suisse
https://www.readbyqxmd.com/read/29290048/screening-and-detection-of-delirium-in-older-ed-patients-performance-of-the-modified-confusion-assessment-method-for-the-emergency-department-mcam-ed-a-two-step-tool
#14
Wolfgang Hasemann, Florian F Grossmann, Rahel Stadler, Roland Bingisser, Dieter Breil, Martina Hafner, Reto W Kressig, Christian H Nickel
Delirium is frequent in older Emergency Department (ED) patients, but detection rates for delirium in the ED are low. To aid in identifying delirium, we developed and implemented a two-step systematic delirium screening and assessment tool in our ED: the modified Confusion Assessment Method for the Emergency Department (mCAM-ED). Components of the mCAM-ED include: (1) screening for inattention, the main feature of delirium, which was performed with the Months Backwards Test (MBT); (2) delirium assessment based on a structured interview with questions from the Mental Status Questionnaire by Kahn et al...
December 30, 2017: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/29247265/end-of-life-care-pathway-of-head-and-neck-cancer-patients-single-institution-experience
#15
T Heinonen, V Loimu, K Saarilahti, T Saarto, A Mäkitie
BACKGROUND: Studies on palliative care of head and neck cancer (HNC) patients are scarce although the affected patient population is quite large. OBJECTIVE: To evaluate the role of a specialised palliative-care pathway of HNC patients. PATIENTS AND METHODS: Data on all HNC patients who were treated at the Helsinki University Hospital Palliative Care Center during 1 year were retrospectively reviewed. The analysis comprised 60 patients (49 males; mean age 67 years; range 28-88)...
February 2018: European Archives of Oto-rhino-laryngology
https://www.readbyqxmd.com/read/29237068/screening-for-frailty-in-older-emergency-department-patients-the-utility-of-the-survey-of-health-ageing-and-retirement-in-europe-frailty-instrument
#16
A Fallon, L Kilbane, R Briggs, A Dyer, S Nabeel, P McElwaine, R Collins, T Coughlan, D O'Neill, D Ryan, S P Kennelly
Background: Greater numbers of older patients are accessing hospital services. Specialist geriatric input at presentation may improve outcomes for at-risk patients. The Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI) frailty measure, developed for use in the community, has also been used in the emergency department (ED). Aim: To measure frailty, review its prevalence in older patients presenting to ED and compare characteristics and outcomes of frail patients with their non-frail counterparts...
March 1, 2018: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/29227367/practice-patterns-and-outcomes-associated-with-early-sedation-depth-in-mechanically-ventilated-patients-a-systematic-review-and-meta-analysis
#17
Robert J Stephens, Matthew R Dettmer, Brian W Roberts, Enyo Ablordeppey, Susan A Fowler, Marin H Kollef, Brian M Fuller
OBJECTIVES: Emerging data suggest that early deep sedation may negatively impact clinical outcomes. This systematic review and meta-analysis defines and quantifies the impact of deep sedation within 48 hours of initiation of mechanical ventilation, as described in the world's literature. The primary outcome was mortality. Secondary outcomes included hospital and ICU lengths of stay, mechanical ventilation duration, and delirium and tracheostomy frequency. DATA SOURCES: The following data sources were searched: MEDLINE, EMBASE, Scopus, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews and Effects, Cochrane Database of Systematic Reviews databases, ClinicalTrials...
March 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29222181/fifteen-minute-consultation-an-approach-to-a-child-presenting-to-the-emergency-department-with-acute-psychotic-symptoms
#18
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/29214512/anticholinergic-prescribing-in-medicare-part-d-beneficiaries-residing-in-nursing-homes-results-from-a-retrospective-cross-sectional-analysis-of-medicare-data
#19
Joshua Niznik, Xinhua Zhao, Tao Jiang, Joseph T Hanlon, Sherrie L Aspinall, Joshua Thorpe, Carolyn Thorpe
BACKGROUND: Prescribing of medications with anticholinergic properties in older nursing home residents is relatively common, despite an association with an increased risk for falls, delirium, and other outcomes. Few studies have investigated what factors influence different levels of prescribing of these agents. OBJECTIVES: The primary objective was to identify factors associated with low- and high-level anticholinergic burden in nursing home residents. A secondary objective was to examine in detail the contribution of different medications to low versus high burden to aid in determining which drugs to target in interventions...
December 2017: Drugs & Aging
https://www.readbyqxmd.com/read/29208069/the-delirium-drug-scale-is-associated-to-delirium-incidence-in-the-emergency-department
#20
Patrick Viet-Quoc Nguyen, Lucie Pelletier, Isabelle Payot, Judith Latour
BACKGROUND: The Delirium Drug Scale (DDS) is an evaluation scale developed to assess a patient's drug burden for delirium. The primary goal is to validate the association between the DDS score and the incidence of delirium. METHODS: This study was an observational retrospective cross-sectional chart review study in patients aged 75 years and older. It was carried out in three emergency departments of a tertiary care university health center. Patients were included if a medication list was available...
December 6, 2017: International Psychogeriatrics
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