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Delirium Morbidity

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https://www.readbyqxmd.com/read/29333531/patient-reported-outcome-measures-prom-as-a-preoperative-assessment-tool
#1
Sunghye Kim, Pamela W Duncan, Leanne Groban, Hannah Segal, Rica Moonyeen Abbott, Jeff D Williamson
Aim of review: Patient-reported outcomes (PRO) on functional, social, and behavioral factors might be important preoperative predictors of postoperative outcomes. We conducted a literature review to explore associations of preoperative depression, socioeconomic status, social support, functional status/frailty, cognitive status, self-management skills, health literacy, and nutritional status with surgical outcomes. Methods: Two electronic data bases, including PubMed and Google Scholar, were searched linking either depression, socioeconomic status, social support, functional status/frailty, cognitive status, self-management skills, health literacy, or nutritional status with surgery, postoperative complications, or perioperative period within the past 2 decades...
November 28, 2017: Journal of Anesthesia and Perioperative Medicine
https://www.readbyqxmd.com/read/29314374/falls-and-delirium-in-an-acute-care-setting-a-retrospective-chart-review-before-and-after-an-organization-wide-interprofessional-education
#2
Rhonda L Babine, Kristiina E Hyrkäs, Sarah Hallen, Heidi R Wierman, Deborah A Bachand, Joanne L Chapman, Valerie J Fuller
AIM AND OBJECTIVES: To describe and compare identification of delirium, length of stay, and discharge locations in two patient samples of falls, before and after an organization wide interprofessional delirium education and practice change along with implementation of a policy. BACKGROUND: Delirium is a common and severe problem for hospitalized patients, with occurrence ranging from 14-56%, morbidity and mortality from 25-33%. Recent studies report that 73-96% of patients who fell during a hospital stay had symptoms of delirium; however the delirium went undiagnosed and untreated in 75% of the cases...
January 4, 2018: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/29313909/peri-operative-neurological-complications
#3
REVIEW
R Hood, A Budd, F A Sorond, C W Hogue
Brain injury from cardiac surgery is an important source of patient morbidity and mortality. The relationship between risk of brain injury and advanced age portends a rising frequency of these complications due to an increasing proportion of elderly patients undergoing cardiac surgery. This review will explore the aetiology and risk factors for peri-operative stroke, postoperative cognitive dysfunction and postoperative delirium. The prevention of each of these conditions will also be discussed, with a focus on brain protection strategies and the avoidance of cerebral embolism and hypoperfusion...
January 2018: Anaesthesia
https://www.readbyqxmd.com/read/29299599/association-of-integrated-care-coordination-with-postsurgical-outcomes-in-high-risk-older-adults-the-perioperative-optimization-of-senior-health-posh-initiative
#4
Shelley R McDonald, Mitchell T Heflin, Heather E Whitson, Thomas O Dalton, Michael E Lidsky, Phillip Liu, Cornelia M Poer, Richard Sloane, Julie K Thacker, Heidi K White, Mamata Yanamadala, Sandhya A Lagoo-Deenadayalan
Importance: Older adults undergoing elective surgery experience higher rates of preventable postoperative complications than younger patients. Objective: To assess clinical outcomes for older adults undergoing elective abdominal surgery via a collaborative intervention by surgery, geriatrics, and anesthesia focused on perioperative health optimization. Design, Setting, and Participants: Perioperative Optimization of Senior Health (POSH) is a quality improvement initiative with prospective data collection...
January 3, 2018: JAMA Surgery
https://www.readbyqxmd.com/read/29298664/the-prevention-of-delirium-in-elderly-with-obstructive-sleep-apnea-podesa-study-protocol-for-a-multi-centre-prospective-randomized-controlled-trial
#5
Jean Wong, David Lam, Stephen Choi, Mandeep Singh, Naveed Siddiqui, Sanjeev Sockalingam, Frances Chung
BACKGROUND: Delirium is a common problem that occurs in 5-50% of elderly individuals following surgery. Patients who develop delirium after surgery are at increased risk for serious complications. Recent studies suggest that patients with obstructive sleep apnea (OSA), a sleep disorder characterized by repeated episodes of complete or partial blockage of the upper airway - are at greater risk to develop delirium. OSA is more common in elderly individuals but is often undiagnosed. Identification and treatment of unrecognized OSA may reduce the incidence of postoperative delirium...
January 3, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29278266/regional-nerve-blockade-for-early-analgesic-management-of-elderly-patients-with-hip-fracture-a-narrative-review
#6
REVIEW
A Scurrah, C T Shiner, J A Stevens, S G Faux
Elderly patients with hip fracture experience high morbidity and mortality, and are often undertreated for pain. Acute pain management in the elderly is challenging, with physiological frailty, medical comorbidities and cognitive impairment commonly compounding pain assessment and treatment. Guidelines outlining current best practice for acute pain management in the elderly now exist, but evidence suggests that practice remains variable and there continues to be scope for improvement. We conducted a narrative review of the literature to examine the challenges of acute pain management in the elderly, and to evaluate evidence for the role of regional nerve blocks for acute pain associated with hip fracture in the elderly...
December 26, 2017: Anaesthesia
https://www.readbyqxmd.com/read/29221748/hydroxyethyl-starch-is-associated-with-early-postoperative-delirium-in-patients-undergoing-esophagectomy
#7
Dae Myung Jung, Hyun Joo Ahn, Mikyung Yang, Jie Ae Kim, Duck Kyung Kim, Sangmin Maria Lee, Joo Hyun Park
OBJECTIVE: Postoperative delirium is associated with longer hospital stay and increased morbidities. Patients undergoing esophagectomy have a high chance of developing postoperative delirium because of their advanced age, comorbidities, and intensive care unit care. In this study, we investigated the risk factors of early postoperative delirium in patients undergoing esophagectomy, focusing on perioperative fluid type to test the hypothesis that colloids with high oncotic pressure and anti-inflammatory action would decrease the incidence of postoperative delirium compared with crystalloids...
December 5, 2017: Journal of Thoracic and Cardiovascular Surgery
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
#8
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 6, 2017: Drugs & Aging
https://www.readbyqxmd.com/read/29202254/incidence-correlates-and-outcomes-associated-with-falls-in-the-intensive-care-unit-a-retrospective-cohort-study
#9
Drayton Trumble, Michael A Meier, Maryellen Doody, Xiaoming Wang, Sean M Bagshaw
BACKGROUND: Falls among hospitalised patients contribute to avoidable morbidity and prolonged hospital stay. We aimed to describe the incidence, circumstances and outcomes associated with patient falls occurring in intensive care units. METHODS: Retrospective cohort study of adult admissions to an academic, tertiary ICU in Edmonton, Canada between 1 January 2013 and 30 April 2016. Fall events were ascertained by interrogation of an electronic health record. Each fall was independently adjudicated by two intensivists to confirm that a fall did occur, and to determine if the fall was potentially avoidable...
December 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/29187230/decreasing-delirium-through-music-ddm-in-critically-ill-mechanically-ventilated-patients-in-the-intensive-care-unit-study-protocol-for-a-pilot-randomized-controlled-trial
#10
Sikandar H Khan, Sophia Wang, Amanda Harrawood, Stephanie Martinez, Annie Heiderscheit, Linda Chlan, Anthony J Perkins, Wanzhu Tu, Malaz Boustani, Babar Khan
BACKGROUND: Delirium is a highly prevalent and morbid syndrome in intensive care units (ICUs). Changing the stressful environment within the ICU via music may be an effective and a scalable way to reduce the burden of delirium. METHODS/DESIGN: The Decreasing Delirium through Music (DDM) study is a three-arm, single-blind, randomized controlled feasibility trial. Sixty patients admitted to the ICU with respiratory failure requiring mechanical ventilation will be randomized to one of three arms (20 participants per arm): (1) personalized music, (2) non-personalized relaxing music, or (3) attention-control...
November 29, 2017: Trials
https://www.readbyqxmd.com/read/29178096/-risk-factors-and-outcomes-of-postoperative-delirium-in-colorectal-cancer-patients-over-60-years
#11
Haitao Zhang, Yuanzhi Tang, Ying Qin
OBJECTIVE: To determine the incidence, risk factors and clinical outcomes of postoperative delirium in colorectal cancer patients over 60 years. METHODS: Consecutive 382 patients older than 60 years undergoing colorectal cancer surgery at Shenzhen Second People's Hospital from June 2013 to June 2016 were recruited prospectively in this study. These patients were evaluated daily after surgery for 7 days by confusion assessment method. Clinical outcomes were compared between patients with and without postoperative delirium, including postoperative complications, length of hospital stay, and mortality within 30 days...
November 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/29176438/delirium-monitoring-and-management-in-the-acute-care-setting
#12
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/29173782/new-psychoactive-substances-in-pediatric-patients
#13
REVIEW
Brandon J Warrick, Anita Paula Tataru, Roy Gerona
New psychoactive substances (NPS), namely cannabinoids, cathinones, and opioids, have surged in popularity among school-age children, resulting in serious morbidity and mortality globally. In the last decade, there has been a rapid evolution of NPS resulting in hundreds of new compounds. Little to no evidence for humans is available on most compounds. The clinical presentations of patients intoxicated with cannabinoids and cathinones are highly variable but most commonly present with a sympathomimetic toxidrome, for example, agitation, delirium, and tachycardia...
December 2017: Pediatric Clinics of North America
https://www.readbyqxmd.com/read/29146958/third-repeat-microvascular-reconstruction-in-head-and-neck-cancer-patients-aged-65-years-and-older-a-longitudinal-and-sequential-analysis
#14
Jonas Löfstrand, Kai-Ping Chang, Jennifer An-Jou Lin, Charles Yuen Yung Loh, Hsuan-Yu Chou, Huang-Kai Kao
Performing a sequential third free flap for reconstruction of a head and neck defect after cancer resection can be challenging, and the problem is further compounded in elderly patients. The outcomes in this clinical scenario are currently unknown and this study aims to compare the results in elderly patients with younger patients in a high-volume microsurgical unit. A retrospective review of 126 consecutive patients who had undergone three sequential free flap reconstructions after head and neck cancer was performed...
November 16, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29133855/effect-of-short-term-exposure-to-ambient-air-particulate-matter-on-incidence-of-delirium-in-a-surgical-population
#15
Lu Che, Yan Li, Cheng Gan
Delirium remains an independent risk factor for morbidity and mortality among older surgical adults. Recent research has shed light on the relationship between pollution and dementia, yet little is known about the health impacts of particulate matter (PM) on delirium. Therefore, we aim to further explore association of PM and delirium among surgical population. We conducted a time-stratified case-crossover study. Electronic hospitalization summary reports derived from 26 major cities in China between 1 January 2014 and 31 December 2015 were used...
November 13, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29133765/geriatric-anesthesia-related-morbidity-and-mortality-in-china-current-status-and-trend
#16
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/29132506/intensive-care-unit-delirium-and-intensive-care-unit-related-posttraumatic-stress-disorder
#17
REVIEW
Annachiara Marra, Pratik P Pandharipande, Mayur B Patel
Delirium is one of the most common behavioral manifestations of acute brain dysfunction in the intensive care unit (ICU) and is a strong predictor of worse outcome. Routine monitoring for delirium is recommended for all ICU patients using validated tools. In delirious patients, a search for all reversible precipitants is the first line of action and pharmacologic treatment should be considered when all causes have been ruled out, and it is not contraindicated. Long-term morbidity has significant consequences for survivors of critical illness and for their caregivers...
December 2017: Surgical Clinics of North America
https://www.readbyqxmd.com/read/29132195/current-evidence-for-the-use-of-n-acetylcysteine-following-liver-resection
#18
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/29094525/prevention-recognition-and-management-of-delirium-in-patients-who-are-critically-ill
#19
Jaime Hyde-Wyatt
Delirium is common in patients who are critically ill, often resulting in extended hospital stays and increased mortality and morbidity. There are several subtypes of delirium, which are often undiagnosed and untreated, resulting in suboptimal patient outcomes. This article examines delirium in patients in the intensive care unit, including its signs and symptoms, incidence, causes and subtypes. It outlines the assessment of delirium and the pharmacological and non-pharmacological interventions that can be used to manage the condition, as well as describing the optimal prevention measures...
October 4, 2017: Nursing Standard
https://www.readbyqxmd.com/read/29064259/the-cardiovascular-implications-of-sedatives-in-the-cardiac-intensive-care-unit
#20
Sammy Zakaria, Helaine J Kwong, Jonathan E Sevransky, Marlene S Williams, Nisha Chandra-Strobos
Patients admitted to the cardiac intensive care unit frequently develop multi-organ system dysfunction associated with their cardiac disease. In many cases, invasive mechanical ventilation is required, which often necessitates sedation for patient-ventilator synchrony, reduction of work of breathing, and patient comfort. In this paper, we describe the use of common sedatives available in the endotracheally intubated critically ill patient and emphasize the clinical and cardiovascular effects. We review γ-aminobutyric acid agonists such as etomidate, benzodiazepines, and propofol, the centrally acting α2-agonist dexmedetomidine, and the N-methyl-D-aspartate receptor antagonist ketamine...
February 1, 2017: European Heart Journal. Acute Cardiovascular Care
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