What do geriatric patients experience during an episode of delirium in acute care hospitals? : A qualitative study.

BACKGROUND: Predispositions and triggers for delirium, such as noxious agents are known and behavior can be monitored; however, there is little to no information available regarding the experience of patients during delirium episodes. Not much is known about a person's world of experiences, which therefore mostly remains as a sort of black box. OBJECTIVE: This study was motivated by the following question: "What do (Austrian) geriatric patients experience during an episode of delirium in an acute care hospital?" The main objective of this article is to present little snippets from the experiences and to allow geriatric patients to speak for themselves. PATIENTS AND METHODS: From 2013 to 2016 interviews were carried out within the framework of a qualitative investigation. For data collection narrative interviews according to Fritz Schütze were employed and 10 interviews were conducted in a hospital setting with German-speaking Austrian patients aged between 75 and 90 years (mean age 80.2 years; 7 female and 3 male). The individual interviews lasted between 60 and 120 min. Primary data in the form of individual interpretation and interpretation groups from interview transcripts were marked and coded according to Mayring. RESULTS: All patients who participated in the interviews subjectively recognized delirium as a negative experience. The data analysis led to three main categories with subcategories: changes in sensory perception, extraordinarily strong emotions and memories. It is important to differentiate between two very different types of memories: firstly, personal fate or life changes and secondly, those regarding experiences of war. CONCLUSION: Scandinavian and Anglo-American literature describe different categories, such as a change in reality, strong emotions and dramatic episodes in the experience of delirium, which can be transferred to Austria. Others consider the biography of each individual patient in context with the sociocultural history of Austria, especially following developments after 1940.

Developing a CVTAE-based conceptual framework for examining emotions in higher education teaching: a systematic literature review.

A number of studies on higher education (HE) teachers' emotions have been carried out, but overall, the literature on this issue is relatively limited, even though HE teaching can be regarded as an emotional endeavor and represents an important topic in HE research. The main goal of this article was to develop a conceptual framework for examining teaching-related emotions of HE teachers by revising and extending the control-value theory of achievement emotions (CVTAE) developed to systematically classify existing findings on emotions in HE teachers and to identify a research agenda for future studies in this field. Therefore, we conducted a systematic literature review on empirical studies investigating HE teachers' teaching-related emotions to gain insights into (1) the theoretical concepts and approaches used to study HE teachers' emotions as well as the (2) antecedents and (3) consequences of experienced emotions identified in the existing studies. By applying a systematic literature review, 37 studies were found. Based on the conducted systematic review, we propose a CVTAE-based conceptual framework for examining HE teachers' emotions in HE teaching with additional components relating to both antecedents and consequences of HE teachers' experienced emotions. We discuss the proposed conceptual framework from the theoretical perspective, pointing out new aspects that should be considered in future research on HE teachers' emotions. From the methodological perspective, we address aspects related to research designs and mixed-method approaches. Finally, we list implications for future higher education development programs.

Ipsilateral electric acoustic stimulation of the auditory system: results of long-term hearing preservation.

OBJECTIVE: To evaluate long-term ipsilateral hearing preservation in patients who underwent cochlear implantation for the combined electric acoustic stimulation of the auditory system. METHODS: This was a prospective observational study conducted at a tertiary referral center. Twenty-three subjects were implanted with the MED-EL C40+ standard or C40+ medium electrode using an atraumatic surgical protocol via an anterior-inferior cochleostomy approach. The desired insertion depth was 18-24 mm or 360 degrees. All patients showed significant low-frequency hearing prior to surgery and monosyllabic word scores did not exceed 40% in the best aided condition. Pure-tone audiometry was performed prior to implantation and at distinct intervals after surgery. RESULTS: Nine patients (39.1%) showed complete pure-tone audiometric hearing preservation (0-10 dB) over an average of 29 months. Seven subjects (30.4%) showed partial preservation of residual hearing (hearing loss 15-40 dB) until an average of 25 months. Delayed loss of residual hearing was observed in 5 cases (21.7%) and 2 patients (8.6%) completely lost residual hearing during or immediately after surgery. Freiburger Monosyllabic word understanding scores in a group of patients with complete hearing preservation increased from 13.1% preoperatively to 75% in the electric acoustic stimulation condition. CONCLUSION: This study documents that complete and partial preservation of ipsilateral hearing after cochlear implantation can be achieved in about 70% of cases over an average period of 27.25 months when using 360 degrees electrode insertions.