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1.
West Afr J Med ; 36(2): 183-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385606

RESUMO

OBJECTIVE: There is paucity of information on delirium in sub-Saharan Africa (SSA) particularly in the older persons (>60 years of age), leaving questions about the burden of the disease in an environment with lower health care standards. In this article, we set out to determine the frequency, precipitants and symptomatology of delirium in elderly patients admitted into medical wards in a teaching hospital in South-West Nigeria. METHODS: This was a descriptive study involving a pre-planned sample of one hundred and fifty patients aged 60 years and over, assessed for cognitive impairment and delirium using the previously validated IDEA cognitive screen, and the Confusion Assessment Method (CAM) respectively. Diagnosis of delirium was made using the CAM and DSM-IV criteria. RESULTS: Delirium was diagnosed in 32 patients giving a frequency of 21.3% (95%CI: 14.7-30.0%). Patients with delirium were significantly older (p<0.05). A quarter of the patients had dementia. Hypertension was a notable co-morbid condition. All the patients had altered sleep wake cycle, inattention, disorientation, and altered consciousness. Neurological diseases were the most common precipitant. There was a good agreement between the DSM-IV and CAM diagnoses. CONCLUSION: Delirium is common in hospitalised elderly patients particularly those with neurological diseases. Co-morbidities like hypertension, dementia, and depression should be looked for in delirious elderly patients.


Assuntos
Disfunção Cognitiva/diagnóstico , Confusão/diagnóstico , Delírio/diagnóstico , Demência/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/epidemiologia , Comorbidade , Confusão/psicologia , Delírio/epidemiologia , Delírio/psicologia , Demência/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Hipertensão/epidemiologia , Entrevista Psiquiátrica Padronizada/estatística & dados numéricos , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Testes Neuropsicológicos/estatística & dados numéricos , Nigéria/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Centros de Atenção Terciária
2.
Pediatr Rheumatol Online J ; 17(1): 30, 2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31215480

RESUMO

BACKGROUND: Juvenile Dermatomyositis is a rare, potentially life-threatening condition with no known cure. There is no published literature capturing how children and young people feel about their condition, from their perspective. This study was therefore unique in that it asked children and young people what is it like to live with Juvenile Dermatomyositis. METHODS: Data were obtained from fifteen young people with Juvenile Dermatomyositis, between eight and nineteen years of age from one Paediatric Rheumatology department using audio-recorded interpretive phenomenology interviews. Data were analyzed phenomenologically, using a process that derives narratives from transcripts resulting in a collective composite of participants shared experiences, called a 'phenomenon'. RESULTS: The overarching metaphor of a rollercoaster captures the phenomenon of living with Juvenile Dermatomyositis as a young person, with the ups and downs at different time points clearly described by those interviewed. The five themes plotted on the rollercoaster, began with confusion; followed by feeling different, being sick, steroidal and scared from the medications; uncertainty; and then ended with acceptance of the disease over time. CONCLUSION: Young people were able to talk about their experiences about having Juvenile Dermatomyositis. Our findings will aid clinicians in their practice by gaining a deeper understanding of what daily life is like and highlighting ways to enhance psychosocial functioning. Hopefully, this study and any further resulting studies, will raise understanding of Juvenile Dermatomyositis worldwide and will encourage health care professionals to better assess psychosocial needs in the future.


Assuntos
Dermatomiosite/psicologia , Atividades Cotidianas , Adaptação Psicológica , Adolescente , Atitude Frente a Saúde , Criança , Pré-Escolar , Doença Crônica , Confusão/psicologia , Fármacos Dermatológicos/uso terapêutico , Dermatomiosite/tratamento farmacológico , Feminino , Humanos , Relações Interpessoais , Masculino , Metotrexato/uso terapêutico , Qualidade de Vida , Doenças Raras , Autoimagem , Esteroides/uso terapêutico
3.
BMC Geriatr ; 19(1): 107, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-30991945

RESUMO

BACKGROUND: Delirium occurs commonly in older adults and is associated with adverse outcomes. Multicentre clinical trials evaluating interventions to prevent delirium are needed. The Confusion Assessment Method (CAM) is a validated instrument for delirium detection. We hypothesised it would be possible for a large feasibility study to train a large number of research assistants, with varying experience levels, to conduct CAM assessments reliably in multiple hospital sites. METHODS: A standardised training programme was followed, incorporating structured training at a central location and at study sites. CAM practice sessions on both delirious and non-delirious patients by research assistants were conducted and, thereafter, there was ongoing inter-rater reliability assessment on the CAM between research assistant pairs at study sites. The setting was eight acute care hospitals in England and Wales. Participants were research assistants working on a multicentre feasibility study of delirium prevention. The measurement used was the Confusion Assessment Method. RESULTS: Thirty-seven research assistants were trained in CAM assessment and 33 returned training logs. The logs showed there was 100% overall agreement between research assistant pairs on 295 CAM assessments, of which 263 (89.2%) were negative for delirium and 32 (10.8%) were positive. In the course of the feasibility study, research assistants successfully completed 5065 (89.7%) of the 5645 expected CAM assessments, with minimal missing data. CONCLUSION: Using the training methods described in this study, it is possible to achieve high quality delirium assessments for large numbers of patients with little missing data across geographically dispersed sites in multicentre studies. The standardisation of multisite delirium assessments is an important contribution to research methodology, and provides a much-needed advance for the field. TRIAL REGISTRATION: ISRCT ISRCTN01187372 . Registered 13 March 2014.


Assuntos
Confusão/diagnóstico , Confusão/psicologia , Pessoal de Saúde/educação , Pessoal de Saúde/normas , Idoso , Idoso de 80 Anos ou mais , Confusão/epidemiologia , Delírio/diagnóstico , Delírio/epidemiologia , Delírio/psicologia , Inglaterra/epidemiologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , País de Gales/epidemiologia
4.
Respir Res ; 20(1): 22, 2019 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-30704469

RESUMO

BACKGROUND: Infectious Disease Society of America/American Thoracic Society (IDSA/ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality, but the major problem associated with IDSA/ATS minor criteria might be a lack of consideration of weight in prediction in clinical practice. Would awarding different points to the presences of the minor criteria improve the accuracy of the scoring system? It is warranted to explore this intriguing hypothesis. METHODS: A total of 1230 CAP patients were recruited to a retrospective cohort study. This was tested against a prospective two-center cohort of 1749 adults with CAP. 2 points were assigned for the presence of PaO2/FiO2 ≤ 250 mmHg, confusion, or uremia on admission and 1 point for each of the others. RESULTS: The mortality rates, and sequential organ failure assessment (SOFA) and pneumonia severity index (PSI) scores increased significantly with the numbers of IDSA/ATS minor criteria present and minor criteria scores. The correlations of the minor criteria scores with the mortality rates were higher than those of the numbers of IDSA/ATS minor criteria present. As were the correlations of the minor criteria scores with SOFA and PSI scores, compared with the numbers of IDSA/ATS minor criteria present. The pattern of sensitivity, specificity, positive predictive value, and Youden's index of scored minor criteria of ≥2 scores or the presence of 2 or more IDSA/ATS minor criteria for prediction of mortality was the best in the retrospective cohort, and the former was better than the latter. The validation cohort confirmed a similar pattern. The area under the receiver operating characteristic curve of scored minor criteria was higher than that of IDSA/ATS minor criteria in the retrospective cohort, implying higher accuracy of scored version for predicting mortality. The validation cohort confirmed a similar paradigm. CONCLUSIONS: Scored minor criteria orchestrated improvements in predicting mortality and severity in patients with CAP, and scored minor criteria of ≥2 scores or the presence of 2 or more IDSA/ATS minor criteria might be more valuable cut-off value for severe CAP, which might have implications for more accurate clinical triage decisions.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/mortalidade , Pneumonia/diagnóstico , Pneumonia/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Estudos de Coortes , Confusão/etiologia , Confusão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Oxigênio/sangue , Valor Preditivo dos Testes , Padrões de Referência , Estudos Retrospectivos , Uremia/etiologia , Adulto Jovem
5.
Int J Ment Health Nurs ; 28(2): 582-591, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30549214

RESUMO

Delirium is a common neuropsychiatric disorder that causes fluctuations in consciousness and attention, impairments in cognitive functioning and information processing, and changes in how individuals perceive what is going on around them. Delirium is associated with increased mortality, ongoing impairment in cognitive functioning, and a high possibility of discharge to residential care. The experience of delirium may be distressing for the patient and their family. Despite the frequency of delirium in hospitalized elderly patients, there is a dearth of literature that examines their experience of this phenomenon, and how it affects individuals as they continue their lives. This study uses descriptive qualitative methodology to explore the question: 'What is the experience of delirium for older adults during hospitalisation?' Data were collected from older adults who had received hospital care in a tertiary general hospital setting. Seven participants were recruited between January and June 2017. Semi-structured individual interviews were used to gather data which was analysed using content analysis. Four themes were identified. These were sense of confusion, disrupted sense of autonomy, perceptual disturbances, and emotional response. Participants exercised agency in the way they responded to these experiences. The study highlighted the need for delirium prevention, and education to improve nurses' recognition, understanding, and management of delirium. In particular, there is a need for nurses to attend to the psychological and emotional experience of delirium.


Assuntos
Delírio/psicologia , Idoso , Idoso de 80 Anos ou mais , Confusão/psicologia , Emoções , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Autonomia Pessoal , Transtornos das Sensações/psicologia
6.
Anaesthesia ; 74(1): 33-44, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30338515

RESUMO

This aim of this prospective observational cohort study was to evaluate any association between postoperatively impaired cerebrovascular autoregulation and the onset of delirium following cardiac surgery. Previous studies have shown that impaired intra-operative cerebrovascular autoregulation during cardiopulmonary bypass is associated with delirium. However, postoperative changes in cerebrovascular autoregulation and its association with delirium have not been investigated. One-hundred and eight consecutive adult cardiac surgical patients without baseline cognitive dysfunction or aphasia were included in the study. Cerebrovascular autoregulation was assessed by the Pearson correlation between near-infrared spectroscopy-derived cerebral tissue oxygen saturation and mean arterial pressure to derive the tissue oximetry index. Cerebrovascular autoregulation was monitored for a minimum of 90 min on postoperative day 0 and postoperative day 1. Delirium was assessed throughout intensive care unit admission using the confusion assessment method for the intensive care unit. We observed delirium in 24 of the 108 patients studied. The mean (SD) tissue oximetry index was higher in delirious patients on postoperative day 0 compared with non-delirious patients; 0.270 (0.199) vs. 0.180 (0.142), p = 0.044, but not on postoperative day 1; 0.130 (0.160) vs. 0.150 (0.130), p = 0.543. All patients showed improvement in tissue oximetry index on postoperative day 1 compared with postoperative day 0. Logistic regression analysis demonstrated tissue oximetry index on postoperative day 0 to be independently associated with delirium; odds ratio 1.05 (95%CI 1.01-1.10), p = 0.043. In conclusion, we found an association between impaired cerebrovascular autoregulation, measured by near-infrared spectroscopy, and delirium in the early postoperative period.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Circulação Cerebrovascular , Delírio do Despertar/fisiopatologia , Homeostase , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Afasia/etiologia , Afasia/psicologia , Pressão Arterial , Procedimentos Cirúrgicos Cardíacos/psicologia , Ponte Cardiopulmonar/efeitos adversos , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Estudos de Coortes , Confusão/psicologia , Delírio do Despertar/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oximetria , Oxigênio/sangue , Estudos Prospectivos , Espectroscopia de Luz Próxima ao Infravermelho , Adulto Jovem
7.
Phys Sportsmed ; 47(3): 312-317, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30477376

RESUMO

Objectives: This study aimed to analyze the association between sleep quality and mood in elite athletes of different competitive levels. Methods: Participants were 1041 elite athletes (aged 20.82 ± 6.62 years), with 671 men (64.5%/21.52 ± 6.90 years) and 370 women (35.5%/19.55 ± 5.89 years) from 10 individual sports and 6 team sports. Participants self-reported sleep quality on a Likert-type scale and mood was measured with the Brunel Mood Scale (BRUMS). The data were analyzed using the Kruskal-Wallis test, and binary logistic regression. Results: Results revealed that athletes who compete internationally are 84% more likely to have poor sleep quality than athletes who compete at a regional level. International athletes with good sleep quality showed greater vigor. National athletes with poor sleep quality showed more confusion, depression, and fatigue. Thus, mood and competitive level are factors associated with sleep quality. Confusion, fatigue, and tension impair sleep, and vigor reduces the likelihood of poor sleep. Conclusions: Sleep should be monitored, especially in international level athletes, in order to prevent sleep disorders during competitions. Coaches and athletes should use techniques and strategies for appropriate management of sleep and mood, to maintain the athletes in optimal condition before important competitions.


Assuntos
Afeto , Atletas/psicologia , Sono , Adolescente , Adulto , Confusão/psicologia , Depressão/psicologia , Fadiga/psicologia , Feminino , Humanos , Masculino , Autorrelato , Adulto Jovem
8.
Anasthesiol Intensivmed Notfallmed Schmerzther ; 53(11-12): 793-796, 2018 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-30458577

RESUMO

Postoperative delirium (POD) is an acute change in the mental state with consciousness and attention deficits. It is a common complication after surgical procedures and can have serious consequences. Thus, the evidence- and consensus-based guidelines for POD appeals with the highest recommendation level that patients be regularly screened for delirium in the postoperative phase, from the recovery room to the fifth postoperative day and at least once per shift, using a validated test instrument for the detection of POD. In 2014, Marcantonio et al. published the 3D-CAM (3-Minute Diagnostic Interview for CAM-defined Delirium). In the 3D-CAM, the algorithm of the Confusion Assessment Method (CAM) is maintained by using individual elements that operationalize the evaluation of the criteria. Therefore, it requires less training, be faster to use, and, due to a standardized approach, has less interrater variability than the CAM, whereas the high sensitivity and specificity are maintained. Our goal was to translate the 3D-CAM from English to German, so as to make this instrument available to German-speaking countries. The translation of the 3D-CAM was based on the 2005 published guideline on Translation and Cultural Adaptation of Patient Reported Outcome Measures of the International Society for Pharmacoeconomics and Outcome Research. Three independent forward translations were harmonized to a preliminary translation, which then was translated back into the original language. Original authors reviewed the back translation. According to a cognitive debriefing, the translation was revised and in addition was adapted for use in the recovery room. Due to close contact with the original authors during the translation process, it was possible to ensure that the contents of the test instrument were remained intact during the translation process.


Assuntos
Anestesia Geral/efeitos adversos , Delírio do Despertar/diagnóstico , Entrevista Psicológica/métodos , Complicações Pós-Operatórias/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Confusão/diagnóstico , Confusão/psicologia , Delírio do Despertar/etiologia , Humanos , Complicações Pós-Operatórias/psicologia , Complicações Pós-Operatórias/terapia , Reprodutibilidade dos Testes , Traduções
9.
Exp Psychol ; 65(5): 314-321, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30451107

RESUMO

Reaction time (RT) of erroneous responses in go/no-go tasks tends to be shorter than RT of correct responses. An opposite difference has been reported ( Halperin, Wolf, Greenblatt, & Young, 1991 ) which could be attributed to differences in go trial probability, or to high memory demand. Two experiments aimed here to test these two explanations, a simultaneous matching task with low memory load (Experiment 1), and a sequential matching task with high memory load (Experiment 2). Go trial probability was also manipulated. Short false positive RT was obtained only in the sequential matching task with high go trial probability, while long false positive RT was obtained in the other three conditions. Low go trial probability and high memory load were both found to be sufficient, by themselves, to create long false positives attributable to confusion. Short false positives in the high go trial probability/low memory load condition were attributed to failure of response inhibition.


Assuntos
Desempenho Psicomotor/fisiologia , Tempo de Reação/fisiologia , Adolescente , Adulto , Confusão/psicologia , Feminino , Humanos , Masculino , Memória/fisiologia , Probabilidade , Adulto Jovem
10.
J Neuroimmunol ; 325: 29-31, 2018 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-30366206

RESUMO

We report the case of a pregnant female presenting with behavioral change and hallucinations followed by focal seizures with impaired awareness. EEG revealed generalized slowing interspersed with extreme delta-brush pattern and MRI brain was normal. Both Serum and CSF anti-N-methyl-d-aspartate receptor (NMDAR) antibodies were positive. Patient had a prolonged hospital stay with full recovery and delivered a healthy baby, highlighting the significance of early diagnosis and management in this disorder.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato/complicações , Encefalite Antirreceptor de N-Metil-D-Aspartato/diagnóstico por imagem , Confusão/complicações , Confusão/diagnóstico por imagem , Complicações na Gravidez/diagnóstico por imagem , Adulto , Encefalite Antirreceptor de N-Metil-D-Aspartato/psicologia , Confusão/psicologia , Feminino , Humanos , Gravidez , Complicações na Gravidez/psicologia
11.
Acta Psychol (Amst) ; 190: 142-149, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30119047

RESUMO

The study of how the cognitive system encodes letter identities from the visual input has received much attention in models of visual word recognition but it has typically been overlooked in models of eye movement control in reading. Here we examined how visual letter similarity affects early word processing during reading using Rayner's (1975) boundary change technique in which the parafoveal preview of the target word was either identical (e.g., frito-frito [fried]) or a one-letter-different nonword (e.g., frjto-frito vs. frgto-frito). Critically, the substituted letter in the nonword was visually similar (based on letter confusability norms) or visually dissimilar. Results showed shorter viewing times on the target word when the parafoveal preview was visually similar than when it was visually dissimilar. Thus, visual letter similarity modulates the integration of parafoveal and foveal information during sentence reading. Future implementations of models of eye movement control in reading should incorporate a more developed orthographic-lexical module to capture these effects.


Assuntos
Movimentos Oculares/fisiologia , Fixação Ocular/fisiologia , Reconhecimento Visual de Modelos/fisiologia , Leitura , Testes de Associação de Palavras , Atenção/fisiologia , Confusão/psicologia , Feminino , Humanos , Masculino , Adulto Jovem
12.
Neurol Sci ; 39(9): 1519-1528, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29948464

RESUMO

Topographical disorientation (TD) refers to navigational impairment as an effect of aging or brain damage. Decreases in navigational performance with aging are more due to deficits in the ability to mentally represent space in an object-centered (allocentric) than in a self-centered (egocentric) format. Familiarity/remoteness of spatial memory traces can represent a protective factor for TD in aging. Conversely, using newly learned information for assessment may lead to overestimating TD severity as it combines two contributing factors: heading (allocentric) disorientation and anterograde agnosia. A supplementary evaluation of TD with aging according to ecological spatial tasks is recommended. The core tasks should focus on landmark positioning, both on a blind map (allocentric) and along a route (egocentric) of the hometown so as to disentangle spatial memory for familiar/remote information from decline due to recent encoding of information.


Assuntos
Envelhecimento Cognitivo/psicologia , Confusão/psicologia , Navegação Espacial , Doença de Alzheimer/psicologia , Animais , Disfunção Cognitiva/psicologia , Humanos
14.
Rev Epidemiol Sante Publique ; 66(3): 187-194, 2018 May.
Artigo em Francês | MEDLINE | ID: mdl-29625860

RESUMO

INTRODUCTION: The Confusion Assessment Method (CAM) is a validated key tool in clinical practice and research programs to diagnose delirium and assess its severity. There is no validated French version of the CAM training manual and coding guide (Inouye SK). The aim of this study was to establish a consensual French version of the CAM and its manual. METHODS: Cross-cultural adaptation to achieve equivalence between the original version and a French adapted version of the CAM manual. RESULTS: A rigorous process was conducted including control of cultural adequacy of the tool's components, double forward and back translations, reconciliation, expert committee review (including bilingual translators with different nationalities, a linguist, highly qualified clinicians, methodologists) and pretesting. A consensual French version of the CAM was achieved. CONCLUSION: Implementation of the CAM French version in daily clinical practice will enable optimal diagnosis of delirium diagnosis and enhance communication between health professionals in French speaking countries. Validity and psychometric properties are being tested in a French multicenter cohort, opening up new perspectives for improved quality of care and research programs in French speaking countries.


Assuntos
Confusão/diagnóstico , Características Culturais , Delírio/diagnóstico , Linguagem , Psicometria/métodos , Traduções , Doença Aguda , Idoso , Confusão/psicologia , Comparação Transcultural , Delírio/psicologia , Avaliação Geriátrica/métodos , Humanos , Reprodutibilidade dos Testes , Inquéritos e Questionários
15.
J Med Syst ; 42(5): 79, 2018 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-29557053

RESUMO

Optical illusions are involved in the perception of false or erroneous images which might involve disorientation. They occur by a discordance by the peripheral systems about the information captured and generally, resulting in pilots failure to recognize key signals. The aim of this study is to review the state of the art of spatial disorientation and optical illusions in aviation pilots. This kind of disorientation has important practical consequences, because a remarkable percentage of plane accidents are related to pilot's optical illusions. An exhaustive review using pubmed and semantic scholar databases was conducted to find out the most frequent optical illusions in aviation pilots. A total of 45 full text articles published English or Spanish were reviewed. To our knowledge, this is the first study to review exhaustively and describe the main factors involved in spatial disorientation and optical illusions affecting aviation pilots. Mainly, contextual factors: width of landing track lights, nocturnal operations or low visibility, inclination of the landing track, decline of the ground, size of habitual references, low level approach on the water, black hole, sky/terrain confusion, distortion by climatic factors, autokinesis or autocinetics, optional investment illusion, illusions by vection, false horizon, rain on the windshield, misalignment in the approach, vibrations, somatogravic illusion, coriolis illusion and "G" forces. In a lesser extent, human factors and pathologies of the visual systems involved in spatial disorientation and associated optical illusions affecting aviation pilots are also described. DISCUSSION: Practical implications are further discussed.


Assuntos
Confusão/psicologia , Ilusões Ópticas , Pilotos/psicologia , Humanos , Iluminação , Visão Noturna , Vibração , Água , Tempo (Meteorologia)
16.
Georgian Med News ; (274): 48-51, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29461226

RESUMO

The purpose of the study is to determine the correlation between the oral hygienic condition and the psycho-social factors in the elderly population of Imereti. The research was based on the findings of 374 persons who were older than 50 years of age from the contingent of Kutaisi Regional Dental Center and From the contingent of the boarding house of the Kutaisi elderly and disabled people. The oral hygienic level was determined by the method of GreeneVermilion, and we used the E. Ambjornsen method to evaluate hygienic conditions of removable prostheses. The difference between the groups was determined by F Fischer's criterion; The relationship between the factors was determined by the correlation analysis - the Spearerman's Rank Test. Correlation analysis shows the level of hygiene and behavioral factors that show positive correlation with good hygienic levels of the mouth: self-efficiency r=0.113; P=0.029; Self control r=0.104; P=0.045; Optimism r=0.144; P=0.005; Social opportunities r=.144; P=0.005; Psychosocial function r=0.227; P=0.000; Self-service r=0.127; P=0.014; Motor function r=0.128; P=0.013; Reliable positive correlation with a bad hygienic level - the need for other medical assistance - r=0.327; P=0.000; Disorders of behavior - r=0.378; P=0.000; Chronic pain - r=0.484; P=0.000; Decreased mobility - r=0.492; P=0.000; Inconvenience - r=0.533; P=0.000; Physical weakness - r=0.487; P=0.000; Disorientation - r=0.403; P=0.000; Bad memory - r=0.417; P=0.000; Psychological weakness - r=0.462; P=0.000; Lack of support - r=0.318; P=0.000; The oral hygienic level in elderly persons correlates with psycho-social and behavioral factors.


Assuntos
Atividades Cotidianas/psicologia , Amnésia/psicologia , Dor Crônica/psicologia , Confusão/psicologia , Boca/fisiologia , Higiene Bucal/psicologia , Idoso , Idoso de 80 Anos ou mais , Amnésia/epidemiologia , Amnésia/fisiopatologia , Dor Crônica/epidemiologia , Dor Crônica/fisiopatologia , Participação da Comunidade/psicologia , Confusão/epidemiologia , Confusão/fisiopatologia , Feminino , República da Geórgia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora/fisiologia , Otimismo/psicologia , Higiene Bucal/métodos , Análise de Regressão , Autocontrole/psicologia , Distância Social
17.
Can J Anaesth ; 65(6): 619-626, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29368313

RESUMO

PURPOSE: Hip and knee arthroplasty surgeries are associated with embolism of materials such as air, cement, and fat. Patent foramen ovale (PFO) is a common congenital cardiac condition that has been reported to lead to paradoxical embolism. This observational study aimed to investigate if the presence of a PFO was associated with an increased risk of postoperative delirium in patients undergoing primary elective hip or knee arthroplasties. METHOD: This was a prospective cohort study at a tertiary teaching hospital. We enrolled patients undergoing primary elective hip or knee arthroplasty who did not have any risk factors for embolism or delirium. Bedside transthoracic echocardiography (TTE) with a bubble study was performed on all patients to detect the presence of PFO. The primary outcome was postoperative delirium as assessed by the standardized Confusion Assessment Method. Secondary outcomes included the ease of performing a TTE bubble study in the perioperative setting, the quality of the TTE images, length of stay, major cardiovascular and neurologic complications, and effects of anesthetic or analgesic management techniques on delirium. RESULTS: Two hundred two patients completed the study. The median [interquartile range] duration of stay was 2 [2-3] days. Only 16 patients (8%) had a positive bubble study. Postoperative delirium was observed in only one patient. Major adverse events were not seen. The inter-rater reliability for the TTE image quality scores was fair (kappa statistic = 0.22). CONCLUSION: Given the very low incidence of PFO and postoperative delirium in this study, we could not form any conclusions regarding the impact of a PFO on important outcomes including delirium or other major adverse events. No recommendation can be made regarding screening for PFO in patients scheduled for lower extremity arthroplasty surgery. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02400892). Registered 27 March 2015.


Assuntos
Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Delírio/etiologia , Ecocardiografia/métodos , Procedimentos Cirúrgicos Eletivos/métodos , Forame Oval Patente/complicações , Forame Oval Patente/diagnóstico por imagem , Sistemas Automatizados de Assistência Junto ao Leito , Idoso , Estudos de Coortes , Confusão/epidemiologia , Confusão/etiologia , Confusão/psicologia , Delírio/epidemiologia , Delírio/psicologia , Feminino , Forame Oval Patente/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Reprodutibilidade dos Testes
18.
Psychosomatics ; 59(1): 67-74, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28935115

RESUMO

BACKGROUND: The use of constant observers ("sitters") has been common practice in many medical centers to maintain patient safety. RESULTS: A retrospective chart review of patients who required sitters from October 1, 2007 to September 31, 2013 at a large, private hospital serving a multiethnic community showed that the top reasons for sitters include suicide risk, agitation, fall risk, interfering with medical devices, and confusion/disorientation. Sitters were used for a mean of 3.4 days ranging from 1 to 287 days, with a mean hospital length of stay of 18.9 days. Although 42.4% of all cases with sitters had a psychiatric consultation, psychiatry was consulted on only 8.5% of those with agitation, 6.3% of those who were disoriented, and 12.7% of those with decisional capacity concerns. Psychiatry was consulted on 87.4% of patients with a constant observer for suicide risks. Sitters were most often discontinued when behaviors improved or when patients were discharged. CONCLUSION: This information will be useful for understanding the optimal way to implement a program that will increase patient safety and decrease cost.


Assuntos
Cuidadores , Grupos Étnicos/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Estado Civil/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Acidentes por Quedas/prevenção & controle , Adolescente , Adulto , Distribuição por Idade , Idoso , Confusão/psicologia , Grupos Étnicos/psicologia , Feminino , Hospitais Privados , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Agitação Psicomotora/psicologia , Encaminhamento e Consulta , Estudos Retrospectivos , Comportamento Autodestrutivo/prevenção & controle , Comportamento Autodestrutivo/psicologia , Distribuição por Sexo , Adulto Jovem
19.
Arch Suicide Res ; 22(3): 380-393, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28786756

RESUMO

The unbearable mental pain experience is recognized as a key antecedent of suicidal behavior. We aimed to examine the precise nature of the mental pain among medically serious suicide attempters (MSSAs), a population closely resembling those who died by suicide. We evaluated various factors of mental pain from the Orbach and Mikulincer Mental Pain Scale, as well as medical lethality and suicide intent. MSSAs were higher than non-MSSAs and psychiatric controls for Irreversibility of pain. Moreover, Emptiness predicted medical lethality, while Cognitive Confusion negatively predicted suicide intent level, controlling for hopelessness and depression. high sense of Irreversibility of pain as well as high Emptiness and low Cognitive Confusion are important risk factors for more severe suicidal behavior. Implications for identification of at-risk groups for suicide as well as for suicide prevention and treatment of suicidal individuals are discussed.


Assuntos
Intenção , Dor/psicologia , Estresse Psicológico/psicologia , Tentativa de Suicídio/psicologia , Adulto , Estudos de Casos e Controles , Cognição , Confusão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
Trials ; 18(1): 583, 2017 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-29202786

RESUMO

BACKGROUND: Health and social care provision for an ageing population is a global priority. Provision for those with dementia and hip fracture has specific and growing importance. Older people who break their hip are recognised as exceptionally vulnerable to experiencing confusion (including but not exclusively, dementia and/or delirium and/or cognitive impairment(s)) before, during or after acute admissions. Older people experiencing hip fracture and confusion risk serious complications, linked to delayed recovery and higher mortality post-operatively. Specific care pathways acknowledging the differences in patient presentation and care needs are proposed to improve clinical and process outcomes. METHODS: This protocol describes a multi-centre, feasibility, cluster-randomised, controlled trial (CRCT) to be undertaken across ten National Health Service hospital trusts in the UK. The trial will explore the feasibility of undertaking a CRCT comparing the multicomponent PERFECTED enhanced recovery intervention (PERFECT-ER), which acknowledges the differences in care needs of confused older patients experiencing hip fracture, with standard care. The trial will also have an integrated process evaluation to explore how PERFECT-ER is implemented and interacts with the local context. The study will recruit 400 hip fracture patients identified as experiencing confusion and will also recruit "suitable informants" (individuals in regular contact with participants who will complete proxy measures). We will also recruit NHS professionals for the process evaluation. This mixed methods design will produce data to inform a definitive evaluation of the intervention via a large-scale pragmatic randomised controlled trial (RCT). DISCUSSION: The trial will provide a preliminary estimate of potential efficacy of PERFECT-ER versus standard care; assess service delivery variation, inform primary and secondary outcome selection, generate estimates of recruitment and retention rates, data collection difficulties, and completeness of outcome data and provide an indication of potential economic benefits. The process evaluation will enhance knowledge of implementation delivery and receipt. TRIAL REGISTRATION: ISRCTN, 99336264 . Registered on 5 September 2016.


Assuntos
Lista de Checagem , Confusão/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Geriatria/organização & administração , Fraturas do Quadril/terapia , Protocolos Clínicos , Confusão/diagnóstico , Confusão/psicologia , Estudos de Viabilidade , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/fisiopatologia , Humanos , Recuperação de Função Fisiológica , Projetos de Pesquisa , Medicina Estatal/organização & administração , Fatores de Tempo , Resultado do Tratamento , Reino Unido
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