ABSTRACT
INTRODUCTION: Postoperative delirium (POD) is seen in approximately 15% of elderly patients and is related to poorer outcomes. In 2017, the Federal Joint Committee (Gemeinsamer Bundesausschuss) introduced a 'quality contract' (QC) as a new instrument to improve healthcare in Germany. One of the four areas for improvement of in-patient care is the 'Prevention of POD in the care of elderly patients' (QC-POD), as a means to reduce the risk of developing POD and its complications.The Institute for Quality Assurance and Transparency in Health Care identified gaps in the in-patient care of elderly patients related to the prevention, screening and treatment of POD, as required by consensus-based and evidence-based delirium guidelines. This paper introduces the QC-POD protocol, which aims to implement these guidelines into the clinical routine. There is an urgent need for well-structured, standardised and interdisciplinary pathways that enable the reliable screening and treatment of POD. Along with effective preventive measures, these concepts have a considerable potential to improve the care of elderly patients. METHODS AND ANALYSIS: The QC-POD study is a non-randomised, pre-post, monocentric, prospective trial with an interventional concept following a baseline control period. The QC-POD trial was initiated on 1 April 2020 between Charité-Universitätsmedizin Berlin and the German health insurance company BARMER and will end on 30 June 2023. INCLUSION CRITERIA: patients 70 years of age or older that are scheduled for a surgical procedure requiring anaesthesia and insurance with the QC partner (BARMER). Exclusion criteria included patients with a language barrier, moribund patients and those unwilling or unable to provide informed consent. The QC-POD protocol provides perioperative intervention at least two times per day, with delirium screening and non-pharmacological preventive measures. ETHICS AND DISSEMINATION: This protocol was approved by the ethics committee of the Charité-Universitätsmedizin, Berlin, Germany (EA1/054/20). The results will be published in a peer-reviewed scientific journal and presented at national and international conferences. TRIAL REGISTRATION NUMBER: NCT04355195.
Subject(s)
Anesthesia , Emergence Delirium , Aged , Humans , Prospective Studies , Academies and Institutes , Insurance, HealthABSTRACT
It is widely acknowledged that visual input is processed along two anatomically and functionally distinct pathways--a ventral pathway for conscious perception and a dorsal pathway for action control. The present study investigated whether the apparent direct and unmediated processing in the dorsal stream is subject to capacity limitations. Specifically, we tested whether a simple dorsal task of grasping an object is affected by the psychological refractory period (PRP), a well-known indication of capacity limitations. Subjects performed an auditory choice reaction task and then, following varying delays, had to judge an object's width (ventral task) or grasp an object across its width (dorsal task). Although these tasks were differentially affected by irrelevant variation of the objects' length, they were subject to comparable dual-task interference. These results show that despite important differences between ventral and dorsal information processing, both modes of processing are constrained by limited capacities.