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Delirium Morbidity

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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
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
https://www.readbyqxmd.com/read/29061612/comparison-of-regional-with-general-anaesthesia-on-postoperative-delirium-raga-delirium-in-the-older-patients-undergoing-hip-fracture-surgery-study-protocol-for-a-multicentre-randomised-controlled-trial
#8
Ting Li, Joyce Yeung, Jun Li, Yan Zhang, Teresa Melody, Ye Gao, Yi Wang, Qianquan Lian, Fang Gao
INTRODUCTION: Postoperative delirium (POD) is a common serious postoperative complication especially in older people and is associated with increased mortality, morbidity and healthcare costs. There is no clear consensus which anaesthesia is associated with less incidence of POD for older patients. We aim to assess whether regional anaesthesia results in lower incidence of POD comparing with general anaesthesia (GA) among older patients undergoing hip fracture surgery. METHODS AND ANALYSIS: RAGA-delirium is a pragmatic, multicentre, prospective, parallel grouped, randomised controlled clinical trial comparing RA or GA for hip fracture surgery...
October 22, 2017: BMJ Open
https://www.readbyqxmd.com/read/29058541/anesthetic-immunomodulation-of-the-neuroinflammation-in-postoperative-cognitive-dysfunction
#9
Matthew Umholtz, Nader D Nader
Postoperative delirium and cognitive dysfunction are phenomena that are associated with increases in morbidity, mortality, and resource utilization after surgery. This review scrutinized a number of studies in order to better characterize the biochemical basis for associated cognitive dysfunction and delirium, with particular focus paid to the interactions of the cholinergic system with innate immunity and how the modulation of the immune system contributes to associated neuroinflammation. Despite the clinical impact of postoperative cognitive dysfunction, evidence-based protocols for the prevention and treatment of these disorders are still lacking...
November 2017: Immunological Investigations
https://www.readbyqxmd.com/read/29054389/optimizing-surgical-quality-datasets-to-care-for-older-adults-lessons-from-the-american-college-of-surgeons-nsqip-geriatric-surgery-pilot
#10
Julia R Berian, Lynn Zhou, Melissa A Hornor, Marcia M Russell, Mark E Cohen, Emily Finlayson, Clifford Y Ko, Thomas N Robinson, Ronnie A Rosenthal
BACKGROUND: Surgical quality datasets can be better tailored toward older adults. The American College of Surgeons (ACS) NSQIP Geriatric Surgery Pilot collected risk factors and outcomes in 4 geriatric-specific domains: cognition, decision-making, function, and mobility. This study evaluated the contributions of geriatric-specific factors to risk adjustment in modeling 30-day outcomes and geriatric-specific outcomes (postoperative delirium, new mobility aid use, functional decline, and pressure ulcers)...
September 28, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29043462/an-experimental-model-to-measure-the-ability-of-headphones-with-active-noise-control-to-reduce-patient-s-exposure-to-noise-in-an-intensive-care-unit
#11
Stuart Gallacher, Doyo Enki, Sian Stevens, Mark J Bennett
BACKGROUND: Defining the association between excessive noise in intensive care units, sleep disturbance and morbidity, including delirium, is confounded by the difficulty of implementing successful strategies to reduce patient's exposure to noise. Active noise control devices may prove to be useful adjuncts but there is currently little to quantify their ability to reduce noise in this complex environment. METHODS: Sound meters were embedded in the auditory meatus of three polystyrene model heads with no headphones (control), with headphones alone and with headphones using active noise control and placed in patient bays in a cardiac ICU...
October 17, 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/28991949/post-intensive-care-unit-psychiatric-comorbidity-and-quality-of-life
#12
Sophia Wang, Chris Mosher, Anthony J Perkins, Sujuan Gao, Sue Lasiter, Sikandar Khan, Malaz Boustani, Babar Khan
The prevalence of psychiatric symptoms ranges from 17% to 44% in intensive care unit (ICU) survivors. The relationship between the comorbidity of psychiatric symptoms and quality of life (QoL) in ICU survivors has not been carefully examined. This study examined the relationship between psychiatric comorbidities and QoL in 58 survivors of ICU delirium. Patients completed 3 psychiatric screens at 3 months after discharge from the hospital, including the Patient Health Questionnaire-9 (PHQ-9) for depression, the Generalized Anxiety Disorder-7 (GAD-7) questionnaire for anxiety, and the Post-Traumatic Stress Syndrome (PTSS- 10) questionnaire for posttraumatic stress disorder...
October 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28988183/neurological-outcome-after-minimal-invasive-coronary-artery-surgery-nomics-protocol-for-an-observational-prospective-cohort-study
#13
Kristof Nijs, Jeroen Vandenbrande, Fidel Vaqueriza, Jean-Paul Ory, Alaaddin Yilmaz, Pascal Starinieri, Jasperina Dubois, Luc Jamaer, Ingrid Arijs, Björn Stessel
INTRODUCTION: Adverse neurocognitive outcomes are still an important cause of morbidity and mortality after cardiac surgery. The most common neurocognitive disorders after conventional cardiac surgery are postoperative cognitive dysfunction (POCD), stroke and delirium. Minimal invasive cardiac procedures have recently been introduced into practice. Endoscopic coronary artery bypass grafting (Endo-CABG) is a minimal invasive cardiac procedure based on the conventional CABG procedure. Neurocognitive outcome after minimal invasive cardiac surgery, including Endo-CABG, has never been studied...
October 6, 2017: BMJ Open
https://www.readbyqxmd.com/read/28971468/post-operative-delirium-in-elderly-people-diagnostic-and-management-issues-of-post-operative-delirium-in-elderly-people
#14
Christina Florou, Dimitrios Theofilopoulos, Styliani Tziaferi, Maria Chania
Hippocrates a Greek physician commonly known as the Father of Medicine was the first to describe delirium, 'phrenitis', differencing it from other disorders such as melancholia and mania. Since then, it still remains a clinical problem which is not yet resolved.Postoperative delirium is a common medical problem that occurs preferentially in surgical patients aged 65 years and older. It is a true medical emergency that requires immediate professional attention and treatment. Faced by health professionals and especially nurses it is often undetected, misdiagnosed, and under-treated as a complication by them during clinical care...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/28965506/psychiatric-disorders-as-main-discharge-diagnosis-by-the-portuguese-oldest-old-from-2000-to-2014-exploring-national-acute-inpatient-admissions
#15
Daniela Brandão, Alberto Freitas, Constança Paúl, Oscar Ribeiro
BACKGROUND: Mental health problems have been reported as one of the principal causes of incapacity and morbidity. According to the World Health Organization approximately 15% of adults aged 60+ and over suffer from a mental disorder. In the oldest old population, a higher deterioration in the mental state is expected, which is ought to increase the risk of incidence of mental problems and use of healthcare services. The aim of this study is to examine inpatient episodes with a mental disorder coded as primary discharge diagnosis between 2000 and 2014 by patients aged 80+ in Portugal mainland...
October 2, 2017: International Psychogeriatrics
https://www.readbyqxmd.com/read/28964314/optimal-dose-of-rocuronium-bromide-undergoing-adenotonsillectomy-under-5-sevoflurane-with-fentanyl
#16
RANDOMIZED CONTROLLED TRIAL
Hyub Huh, Jeong Jun Park, Ji Yeong Kim, Tae Hoon Kim, Seung Zhoo Yoon, Hye Won Shin, Hye-Won Lee, Hye-Ja Lim, Jang Eun Cho
OBJECTIVE: Adenotonsillectomy is a short surgical procedure under general anaesthesia in children. An ideal muscle relaxant for adenotonsillectomy would create an intense neuromuscular block while having a quick recovery time without postoperative morbidity. We compared the effect of different doses of rocuronium for the tracheal intubation in children under 5% sevoflurane and fentanyl. MATERIALS AND METHODS: 75 children (aged 3-10 years, ASA I) scheduled for adenotonsillectomy were enrolled...
October 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28963037/disruption-of-the-ascending-arousal-system-and-cortical-attention-networks-in-post-stroke-delirium-and-spatial-neglect
#17
REVIEW
Olga Boukrina, A M Barrett
Delirium is an acute attention and cognitive dysfunction, adversely affecting functional outcomes and mortality. As many as half of hospitalized right brain stroke survivors may develop delirium. Further, about 50% of right stroke patients experience spatial neglect, impairing safety and recovery. In this review we explore the brain mechanisms, which may explain the high incidence of delirium and spatial neglect after right-brain stroke. We suggest that brain networks for spatial attention and arousal, composed of ascending projections from the midbrain nuclei and integrating dorsal and ventral cortical and limbic components, may underlie impairments in delirium and spatial neglect...
September 27, 2017: Neuroscience and Biobehavioral Reviews
https://www.readbyqxmd.com/read/28949771/delirium-in-the-critically-ill-child-assessment-and-sequelae
#18
Rebecca S Paterson, Justin A Kenardy, Alexandra C De Young, Belinda L Dow, Debbie A Long
Delirium is a common and serious neuropsychiatric complication in critically ill patients of all ages. In the context of critical illness, delirium may emerge as a result of a cascade of underlying pathophysiologic mechanisms and signals organ failure of the brain. Awareness of the clinical importance of delirium in adults is growing as emerging research demonstrates that delirium represents a serious medical problem with significant sequelae. However, our understanding of delirium in children lags significantly behind the adult literature...
2017: Developmental Neuropsychology
https://www.readbyqxmd.com/read/28947274/post-operative-delirium-is-associated-with-increased-5-year-mortality
#19
Eliza E Moskowitz, Douglas M Overbey, Teresa S Jones, Edward L Jones, Todd R Arcomano, John T Moore, Thomas N Robinson
BACKGROUND: Post-operative delirium is associated with increased short term morbidity and mortality. Limited data exists on long term outcomes for older adults with postoperative delirium. We hypothesize that postoperative delirium is associated with increased 5-year mortality. METHODS: Patients ≥50 years undergoing elective operations with planned intensive care unit (ICU) admissions were prospectively enrolled. The Confusion Assessment Method ICU (CAM-ICU) was used to diagnose delirium...
September 20, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28942855/a-systematic-review-and-meta-analysis-of-factors-for-delirium-in-vascular-surgical-patients
#20
REVIEW
Christopher Oldroyd, Anna F M Scholz, Robert J Hinchliffe, Kathryn McCarthy, Jonathan Hewitt, Terrence J Quinn
BACKGROUND: Delirium is a common syndrome responsible for a large burden of morbidity and mortality. In surgical settings, research into risk factors for postoperative delirium has largely focused on elective orthopedic patients. We performed a systematic review and meta-analysis to evaluate the evidence surrounding risk factors for delirium in vascular surgical populations. METHODS: Two independent reviewers searched five databases (MEDLINE, Web of Science, Embase, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO) from January 1987 to December 2015...
October 2017: Journal of Vascular Surgery
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