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Delirium Morbidity

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https://www.readbyqxmd.com/read/28742701/postoperative-delirium-as-a-target-for-surgical-quality-improvement
#1
Julia R Berian, Lynn Zhou, Marcia M Russell, Melissa A Hornor, Mark E Cohen, Emily Finlayson, Clifford Y Ko, Ronnie A Rosenthal, Thomas N Robinson
OBJECTIVE: To explore hospital-level variation in postoperative delirium using a multi-institutional data source. BACKGROUND: Postoperative delirium is closely related to serious morbidity, disability, and death in older adults. Yet, surgeons and hospitals rarely measure delirium rates, which limits quality improvement efforts. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Geriatric Surgery Pilot (2014 to 2015) collects geriatric-specific variables, including postoperative delirium using a standardized definition...
July 24, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28711314/independent-predictors-of-the-duration-and-overall-burden-of-postoperative-delirium-after-cardiac-surgery-in-adults-an-observational-cohort-study
#2
Christian Cereghetti, Martin Siegemund, Sabine Schaedelin, Jens Fassl, Manfred D Seeberger, Friedrich S Eckstein, Luzius A Steiner, Nicolai Goettel
OBJECTIVE: Postoperative delirium (POD) is a common complication after cardiac surgery and is associated with increased patient morbidity and mortality. The objective of this study was to identify risk factors for long duration and overall burden of POD after cardiac surgery. DESIGN: One-year, single-center, retrospective, observational cohort study. SETTING: University hospital. PARTICIPANTS: Adult patients undergoing cardiac surgery with cardiopulmonary bypass in 2013...
March 31, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28681427/delirium-after-fast-track-hip-and-knee-arthroplasty-a-cohort-study-of-6331-elderly-patients
#3
P B Petersen, C C Jørgensen, H Kehlet
BACKGROUND: Postoperative delirium (PD) is a well-known complication among elderly surgical patients and associated with increased morbidity, mortality and length of stay (LOS). In elective orthopedic surgery, including hip and knee arthroplasty (THA/TKA), most studies report incidences between 5% and 10%. The multimodal optimization of perioperative care (fast-track) aims to enhance recovery and reduce morbidity and LOS, but limited data are available on the effect on PD. Consequently, the study investigated signs of PD associated with LOS > 4 days...
August 2017: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/28666930/delirium-following-transcatheter-aortic-valve-replacement-national-inpatient-sample-analysis
#4
Amritha Soundhar, Reshmi Udesh, Amol Mehta, John Schindler, Vinodh Jeevanantham, Thomas Gleason, Parthasarathy D Thirumala
OBJECTIVE: To investigate the risk factors for postoperative delirium and the impact of delirium on mortality and morbidity following transcatheter aortic valve implantation (TAVI). DESIGN: Patients who underwent TAVI were identified using the International Classification of Diseases, 9th revision clinical modification codes from the National Inpatient Sample database. Statistical analysis of preoperative and perioperative risk factors was done to identify the independent risk factors for delirium after TAVI...
March 16, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/28638240/perioperative-management-of-neurological-conditions
#5
REVIEW
Manjeet Singh Dhallu, Ahmed Baiomi, Madhavi Biyyam, Sridhar Chilimuri
Perioperative care of the patients with neurological diseases can be challenging. Most important consideration is the management and understanding of pathophysiology of these disorders and evaluation of new neurological changes that occur perioperatively. Perioperative generally refers to 3 phases of surgery: preoperative, intraoperative, and postoperative. We have tried to address few commonly encountered neurological conditions in clinical practice, such as delirium, stroke, epilepsy, myasthenia gravis, and Parkinson disease...
2017: Health Services Insights
https://www.readbyqxmd.com/read/28632519/age-is-the-most-significantly-associated-risk-factor-with-the-development-of-delirium-in-patients-hospitalized-for-more-than-five-days-in-surgical-wards-retrospective-cohort-study
#6
Keisuke Kubota, Akihiro Suzuki, Sachiko Ohde, Ui Yamada, Takashi Hosaka, Fumiko Okuno, Ikumi Fujitani, Aya Koitabashi, Gen Shimada, Akihiro Kishida
OBJECTIVE: The primary purpose of this study was to assess risk factors for delirium in patients staying in a surgical ward for more than 5 days. The secondary purpose was to assess outcomes in patients with delirium. BACKGROUND: Delirium is a syndrome characterized by acute fluctuations in mental status. Patients with delirium are at increased risk of adverse inpatient events, higher mortality and morbidity rates, prolonged hospital stays, and increased health care costs...
June 19, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28625272/-research-progress-in-the-multiple-organ-dysfunction-syndrome-caused-by-heat-stroke
#7
Mengmeng Yang, Yu Zhang, Yan Zhao, Hongjun Kang
Heat stroke (HS) is a life-threatening illness characterized by core body temperatures above 40 °C coupled with central nervous system (CNS) dysfunction, including delirium, convulsions, and/or coma. Its morbidity has increased dramatically in the past few decades. Multiple organ dysfunction syndrome (MODS) is not only the most serious complication of HS, but also the leading cause of deaths. Understanding the pathogenesis, characteristic and advancement pattern of MODS caused by HS will have a profound effect on the clinical treatment, research and mortality decrease...
February 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28625252/-cerebral-injury-induced-by-heat-stroke-and-the-therapeutic-effect-of-hyperbaric-oxygen-therapy
#8
Xiaoxiao Ni, Zhifeng Liu, Qiuyou Xie, Huasheng Tong, Lei Su, Ronghao Yu
With the global warming, the incidence of heat stroke was significantly higher than before. Severe heat stroke has a high mortality, high morbidity and consolidated central nervous system injury characteristics. The main features of severe heat stroke cerebral injury include cognitive impairment, delirium, convulsions and coma. Its mechanism is related with heat shock induced cerebral tissue ischemia and hypoxia, vascular dysfunction, secondary cascade inflammation and so on. Currently, the main treatment of heat stroke cerebral injury is the hypothermia therapy, dehydration for the reduction of intracranial pressure, naloxone and other cerebral protection and nutrition treatments...
June 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28618293/pilot-prospective-study-of-post-surgery-sleep-and-eeg-predictors-of-post-operative-delirium
#9
Joanna L Evans, Jacob W Nadler, Xavier A Preud'homme, Eric Fang, Rommie L Daughtry, Joseph B Chapman, David Attarian, Samuel Wellman, Andrew D Krystal
OBJECTIVE: Delirium is a common post-operative complication associated with significant costs, morbidity, and mortality. We sought sleep/EEG predictors of delirium present prior to delirium symptoms to facilitate developing and targeting therapies. METHODS: Continuous EEG data were obtained in 12 patients post-orthopedic surgery from the day of surgery until delirium assessment on post-operative day 2 (POD2). RESULTS: Diminished total sleep time (r=-0...
May 17, 2017: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
https://www.readbyqxmd.com/read/28612089/the-intensive-care-delirium-research-agenda-a-multinational-interprofessional-perspective
#10
REVIEW
Pratik P Pandharipande, E Wesley Ely, Rakesh C Arora, Michele C Balas, Malaz A Boustani, Gabriel Heras La Calle, Colm Cunningham, John W Devlin, Julius Elefante, Jin H Han, Alasdair M MacLullich, José R Maldonado, Alessandro Morandi, Dale M Needham, Valerie J Page, Louise Rose, Jorge I F Salluh, Tarek Sharshar, Yahya Shehabi, Yoanna Skrobik, Arjen J C Slooter, Heidi A B Smith
Delirium, a prevalent organ dysfunction in critically ill patients, is independently associated with increased morbidity. This last decade has witnessed an exponential growth in delirium research in hospitalized patients, including those critically ill, and this research has highlighted that delirium needs to be better understood mechanistically to help foster research that will ultimately lead to its prevention and treatment. In this invited, evidence-based paper, a multinational and interprofessional group of clinicians and researchers from within the fields of critical care medicine, psychiatry, pediatrics, anesthesiology, geriatrics, surgery, neurology, nursing, pharmacy, and the neurosciences sought to address five questions: (1) What is the current standard of care in managing ICU delirium? (2) What have been the major recent advances in delirium research and care? (3) What are the common delirium beliefs that have been challenged by recent trials? (4) What are the remaining areas of uncertainty in delirium research? (5) What are some of the top study areas/trials to be done in the next 10 years? Herein, we briefly review the epidemiology of delirium, the current best practices for management of critically ill patients at risk for delirium or experiencing delirium, identify recent advances in our understanding of delirium as well as gaps in knowledge, and discuss research opportunities and barriers to implementation, with the goal of promoting an integrated research agenda...
June 13, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28601132/acute-brain-failure-pathophysiology-diagnosis-management-and-sequelae-of-delirium
#11
REVIEW
José R Maldonado
Delirium is the most common psychiatric syndrome found in the general hospital setting, with an incidence as high as 87% in the acute care setting. Delirium is a neurobehavioral syndrome caused by the transient disruption of normal neuronal activity secondary to systemic disturbances. The development of delirium is associated with increased morbidity, mortality, cost of care, hospital-acquired complications, placement in specialized intermediate and long-term care facilities, slower rate of recovery, poor functional and cognitive recovery, decreased quality of life, and prolonged hospital stays...
July 2017: Critical Care Clinics
https://www.readbyqxmd.com/read/28592789/are-sutureless-aortic-valves-suitable-for-severe-high-risk-patients-suffering-from-active-infective-aortic-valve-endocarditis
#12
Alexander Weymann, Johanna Konertz, Michael Laule, Karl Stangl, Pascal M Dohmen
BACKGROUND Sutureless aortic valves were introduced to facilitate minimally invasive aortic valve surgery. Since sutureless aortic valves are a feasible procedure, we evaluated if any benefits could be identified in severe high-risk patients with active infective endocarditis of the aortic valve. MATERIAL AND METHODS Between April 2014 and April 2015, a total of 42 patients received a sutureless Perceval® aortic valve (Sorin Biomedica Cardio Srl, Saluggia, Italy) for different indications. Nine of these patients (median age 71 years, range 47-83 years) suffered from active infective endocarditis, including four patients with prosthetic aortic valve endocarditis...
June 8, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/28587754/delirium-screening-in-intensive-care-a-life-saving-opportunity
#13
REVIEW
E Lamond, S Murray, C E Gibson
BACKGROUND: Delirium is described as 'acute brain failure' and constitutes a medical emergency which presents a hazard for people cared for in intensive care units. The Scottish intensive care society audit group recommend that all people cared for in intensive care units be screened for signs of delirium so that treatment and management of complications can be implemented at an early stage. CLINICAL IMPLICATION: There is inconsistent evidence about when and how the assessment of delirium is carried out by nursing staff in the intensive care setting...
June 3, 2017: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
https://www.readbyqxmd.com/read/28574333/depression-as-an-independent-predictor-of-postoperative-delirium-in-spine-deformity-patients-undergoing-elective-spine-surgery
#14
Aladine A Elsamadicy, Owoicho Adogwa, Emily Lydon, Amanda Sergesketter, Rayan Kaakati, Ankit I Mehta, Raul A Vasquez, Joseph Cheng, Carlos A Bagley, Isaac O Karikari
OBJECTIVE Depression is the most prevalent affective disorder in the US, and patients with spinal deformity are at increased risk. Postoperative delirium has been associated with inferior surgical outcomes, including morbidity and mortality. The relationship between depression and postoperative delirium in patients undergoing spine surgery is relatively unknown. The aim of this study was to determine if depression is an independent risk factor for the development of postoperative delirium in patients undergoing decompression and fusion for deformity...
June 2, 2017: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/28572112/delirium-in-children-identification-prevention-and-management
#15
Amanda Bettencourt, Jodi E Mullen
Delirium in children is an often underrecognized but serious complication of hospitalization. Delirium in this age group has been described as behaviors such as refractory agitation and restlessness, visual or auditory hallucinations, children being "not themselves," and a lethargic state. Often, children with delirium are at risk for harming themselves by dislodging tubes, falling, or refusing care. Pediatric nurses must recognize and intervene to prevent and treat delirium in hospitalized children because the delirium may be an indicator of worsening clinical status and is associated with high mortality and morbidity in children of all ages and with posttraumatic stress disorder...
June 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/28561177/-risk-factors-for-postoperative-delirium-after-cardiac%C3%A2-surgery
#16
Christian Gernhardt, Sophie Kluge, Mira Meon, Claudia Schmidtke, Antje Karluß, Beate Sedemund-Adib, Tilman Wetterling, Hans-Hinrich Sievers, Klaus Junghanns
Background Delirium is a common psychiatric disorder after cardiac surgery and predisposes patients to increased mortality and morbidity. Its prevention requires knowledge of the risk factors involved. Objective What are preoperative risk factors for postoperative delirium after cardiac surgery? Methods Prospective longitudinal study of 241 elective cardiac surgical patients with preoperative assessment of potential risk factors and delirium assessment twice daily over five postoperative days. Results 13 % of the patients experienced delirium...
May 2017: Fortschritte der Neurologie-Psychiatrie
https://www.readbyqxmd.com/read/28561149/-preoperative-evaluation-and-arrangements-the-elderly-patient
#17
Cynthia Olotu-Steffen, Simone Gurlit, Rainer Kiefmann
With a constantly growing portion of elderly within our population and the advances of modern medicine, surgery on aged and very aged patients has become a daily hospital routine. Due to the physical and mental features of ageing these patients face special perioperative risks. They display a higher rate of complications, morbidity and cognitive deficits which might in the end lead to persisting need of care. Even in the healthy elderly, most organ functions are "physiologically" instable or deficient and the homeostasis of health and disease is fragile...
May 2017: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
https://www.readbyqxmd.com/read/28526147/pharmacologic-considerations-of-anesthetic-agents-in-geriatric-patients
#18
REVIEW
Maunak V Rana, Lara K Bonasera, Gregory J Bordelon
Aging is a natural process of declining organ function and reserve. Census data show that the geriatric population is expected to grow to nearly 30%. More than half of geriatric patients have 1 or more surgical procedures in their lifetimes. Moreover, this is the population at greatest risk of morbidity and mortality with any given complication. There is remarkable variability in health across the age spectrum, from fit to frail and compromised. This variability requires a unique approach to anesthetic delivery and drug dosing on an individual basis to avoid complications such as postoperative cognitive dysfunction and delirium...
June 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28514272/identifying-delirium-in-older-adults-with-pre-existing-mental-illness
#19
Courtney Bennett
Acute delirium complicates care and can be easily overlooked in older adults with preexisting mental illness. Evidence-based measures have demonstrated that early diagnosis, identification, and correction of modifiable factors can lead to improved care and less morbidity in these patients.
June 16, 2017: Nurse Practitioner
https://www.readbyqxmd.com/read/28508776/development-and-validation-of-a-multivariable-prediction-model-for-the-occurrence-of-delirium-in-hospitalized-gerontopsychiatry-and-internal-medicine-patients
#20
Diether Kramer, Sai Veeranki, Dieter Hayn, Franz Quehenberger, Werner Leodolter, Christian Jagsch, Günter Schreier
Delirium is an acute confusion condition, which is common in elderly and often misdiagnosed in hospitalized patients. Early identification and prevention of delirium could reduce morbidity and mortality rates in those affected and reduce hospitalization costs. We have developed and validated a multivariate prediction model that predicts delirium and gives an early warning to physicians. A large set of patient electronic medical records have been used in developing the models. Classical learning algorithms have been used to develop the models and compared the results...
2017: Studies in Health Technology and Informatics
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