Associations between delirium and SARS-CoV-2 pandemic visitor restrictions among hospitalized patients.

OBJECTIVES: Delirium is associated with increased morbidity and mortality, but environmental and behavioral factors may decrease the risk of developing delirium and thus must be considered. To investigate trends in delirium prevalence and examine associations of visitor restrictions with delirium diagnoses among all patients hospitalized during and prior to the novel coronavirus SARS-CoV-2 (COVID-19) pandemic. STUDY DESIGN: Retrospective epidemiological assessment. METHODS: The medical records of all patients (n = 33,141) hospitalized within a three-hospital academic medical center system in a large Midwestern metropolitan area from March 20, 2019, through March 19, 2021, were analyzed. RESULTS: The overall prevalence of delirium during COVID-19 was 11.26% (confidence interval [CI]: 10.79%, 11.73%) compared to 9.28% (CI: 8.82%, 9.73%) before COVID-19. From our adjusted logistic regression analyses, we observed that the odds of delirium among non-isolated patients were significantly higher during COVID-19 visitor restrictions (adjusted odds ratio [aOR]: 1.354; 95% CI: 1.233, 1.488; P < 0.0001) than before. The odds of delirium among isolated patients were not significantly higher during COVID-19 visitor restrictions (aOR: 1.145; 95% CI: 0.974, 1.346; P = 0.1006) than before. CONCLUSIONS: Medically isolated patients remained at high risk of developing delirium both prior to and during COVID-19 era visitor restrictions. However, non-medically isolated patients had a significantly increased risk of delirium during the social isolation of visitor restrictions compared to prior to visitor restrictions.

Predictors of non-compliance in autologous hematopoietic SCT patients undergoing out-patient transplants.

Non-compliance has received significant attention in medicine, yet few studies have examined its correlates in autologous hematopoietic SCT (AHSCT) patients. This study examined predictors of non-compliance in a sample of 151 AHSCT patients treated in an outpatient setting. Before AHSCT, participants completed a validated measure of mood and retrospective chart reviews were conducted to assess non-compliance during AHSCT, defined as refusal of oral hygiene, prescribed exercise programs, oral nutrition and/or prescribed medications. We found 121 patients (80%) were non-compliant with an aspect of the AHSCT regimen on 1 or more days; mean percentage of non-compliant days was 16.6 (s.d. 15.6). Men were more likely than women to be non-compliant (P<0.05); as were participants with an elevated depression score (P<0.05). Stepwise regression models identified significant predictors of non-compliance: gender, depression, global distress and nausea and vomiting severity (P-values all <0.01). Further analysis revealed that the interaction of the psychological variables with gender was a more robust predictor of non-compliance (P<0.001). For outpatient AHSCT, our findings suggest the need to broaden conceptualizations of risk factors for non-compliance and the importance of assessing patient barriers to compliance to ensure optimal treatment outcome.

Comparison of early quality of life outcomes in autologous and allogeneic transplant patients.

The Functional Assessment of Cancer Therapy-Bone Marrow Transplant measures quality of life (QOL) in SCT patients. Prior reports found mixed results regarding QOL differences among autologous and allogeneic SCT patients. In addition, there is a paucity of literature examining differences in QOL patterns over time between autologous and allogeneic patients. The present study examines differences in QOL between patients free of clinical depression undergoing autologous (n = 41) and allogeneic (n = 64) SCT during early stages of treatment. Despite clinical differences, autologous and allogeneic patients demonstrated similar changes in QOL. The exception was the Functional subscale which indicated worse QOL for allogeneic patients at discharge (F test = 4.61, df = 1, P < 0.05); allogeneic patients (Mean = 13.06, s.d. = 5.36) indicated they were less able to function at work and were less accepting of their illness than autologous patients (Mean = 16.02, s.d. = 6.73). There was a significant main effect for time on nearly all QOL subscales (P < 0.05) demonstrating decline during treatment and return to baseline by discharge; only the Social Well-Being scale did not significantly change over time. These results help to understand patients' response to SCT in the earliest stages and ultimately help identify patients at risk who could benefit from therapeutic interventions.