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1.
Anasthesiol Intensivmed Notfallmed Schmerzther ; 54(11-12): 652-667, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31805585

RESUMO

Perioperative neurocognitive disorders (pNCD) are relevant to long term treatment outcome after elective surgery. The detection of pNCD is challenging and based on extended neuropsychological testing that often is not feasible due to economy driven time constraints during preoperative risk assessment. Only recently new recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery facilitated the transition of the former research diagnosis postoperative cognitive dysfunction (POCD) as a clinical diagnosis based on DSM-5 criteria. In our article we provide an overview of the new recommended diagnostic criteria for pNCD based on the publication by the Nomenclature Consensus Working Group in November 2018. We discuss ideas for the implementation of clinical routine pNCD screening in patients aged 70 years or older with elective surgery and possible options for further support of patients screened positively and their families and care givers.


Assuntos
Anestesia , Transtornos Cognitivos , Delírio , Idoso , Anestesia/efeitos adversos , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Delírio/diagnóstico , Delírio/etiologia , Humanos , Transtornos Neurocognitivos , Complicações Pós-Operatórias
2.
Medicine (Baltimore) ; 98(50): e18234, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852087

RESUMO

The aim of this prospective observational single-centre pilot study was to evaluate the association between alterations in carotid artery blood flow velocities during cardiac surgery and postoperative delirium.Carotid artery blood flow velocity was determined perioperatively at 5 different timepoints by duplex sonography in 36 adult cardiac surgical patients. Delirium was assessed using the Confusion Assessment Method for the ICU and the Intensive Care Delirium Screening Checklist. Additionally, blood flow velocities in the middle cerebral arteries, differences in regional cerebral tissue oxygenation and quantity and quality of microemboli were measured.Delirium was detected in 7 of 36 patients. After cardiopulmonary bypass carotid artery blood flow velocities increased by +23 cm/second (95% confidence interval (CI) 9-36 cm/second) in non-delirious patients compared to preoperative values (P = .002), but not in delirious patients (+3 cm/second [95% CI -25 to 32 cm/second], P = .5781). Middle cerebral artery blood flow velocities were higher at aortic de-cannulation in non-delirious patients (29 cm/second [inter-quartile range (IQR), 24-36 cm/second] vs 12 cm/second [IQR, 10-19 cm/second]; P = .017). Furthermore, brain tissue oxygenation was higher in non-delirious patients during surgery.Our results suggest that higher cerebral blood flow velocities after aortic de-clamping and probably also improved brain oxygenation might be beneficial to prevent postoperative delirium.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Artéria Carótida Primitiva/fisiopatologia , Delírio/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Ultrassonografia Doppler Dupla/métodos , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Artéria Carótida Primitiva/diagnóstico por imagem , Delírio/etiologia , Delírio/fisiopatologia , Feminino , Seguimentos , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos
3.
Crit Care Resusc ; 21(4): 299-302, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31778637

RESUMO

OBJECTIVE: To develop a library of delirium-suggestive words. DESIGN: Cross-sectional survey. SETTING: Single tertiary referral hospital. PARTICIPANTS: Medical, nursing and allied health staff and medical coders. MAIN OUTCOME MEASURES: Frequency of graded response on a 5-point Likert scale to individual delirium-suggestive words. RESULTS: Two-hundred and three complete responses were received from 227 survey respondents; the majority were medical and nursing staff (42.4% and 43.8% respectively), followed by allied health practitioners and medical coders (10.3% and 3.4%). Words that were "very likely" to suggest delirium were "confused/ confusion", "delirious", "disoriented/disorientation" and "fluctuating conscious state". Differences in word selection were noted based on occupational background, prior knowledge of delirium, and experience in caring for intensive care unit patients. Distractor words included in the survey were rated as "unlikely" or "very unlikely" by respondents as expected. Textual responses identified several other descriptors of delirium-suggestive words. CONCLUSION: A comprehensive repertoire of delirium-suggestive words was validated using a multidisciplinary survey and new words suggested by respondents were added. The use of natural language processing algorithms may allow for earlier detection of delirium using our delirium library and be deployed for real-time decision making and clinical care.


Assuntos
Codificação Clínica , Cuidados Críticos/normas , Delírio/diagnóstico , Linguagem , Inquéritos e Questionários , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Unidades de Terapia Intensiva , Corpo Clínico/estatística & dados numéricos , Médicos/estatística & dados numéricos
4.
Nurs Clin North Am ; 54(4): 541-550, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31703779

RESUMO

Delirium superimposed on dementia is an acute medical illness that is difficult to diagnose because of the similarities of the symptoms to dementia. Delirium can contribute to the suffering of the patient as well as the family and caregiver. An initial holistic assessment of the patient is critical in establishing the cognitive baseline symptoms of delirium. Prevention of delirium can be assisted by ongoing reassessment of the patient for symptoms of delirium. The goal of treatment is to treat the underlying cause of the delirium.


Assuntos
Delírio/diagnóstico , Delírio/terapia , Demência/complicações , Papel do Profissional de Enfermagem , Avaliação em Enfermagem , Idoso , Humanos
6.
Med. clín (Ed. impr.) ; 153(7): 284-289, oct. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185338

RESUMO

El delirium, a pesar de su alta incidencia, graves consecuencias y potencial reversibilidad, sigue siendo un síndrome infradiagnosticado. En pacientes con demencia, el profesional sanitario puede encontrar dificultades para diferenciar si el paciente presenta alteraciones cognitivas y trastornos conductuales propios de la demencia o, por el contrario, se encuentra ante un cuadro de delirium superpuesto a la demencia (DSD). Ante esta dificultad, se han propuesto en los últimos años distintas herramientas para mejorar el diagnóstico de DSD. Estas herramientas intentan ser fáciles y rápidas de aplicar, y a pesar de centrarse en la evaluación de aspectos cognitivos como la atención o el nivel de consciencia, algunas de ellas han incorporado la valoración de otros aspectos más novedosos, como la capacidad de responder a estímulos externos (estado de alerta o activación) o el grado de movilidad


Delirium, despite its high incidence, serious consequences and potential reversibility, remains an underdiagnosed syndrome. In patients with dementia, the healthcare professional may find significant difficulties in differentiating whether the patient presents cognitive alterations and behavioural disorders characteristic of dementia or, on the contrary, is faced with a delirium superimposed on dementia (DSD). In view of this difficulty, many tools have been proposed in recent years to improve the diagnosis of DSD in these highly complex patients. The aim of these tools is to be easy and quick to apply, and although focusing on assessing cognitive aspects such as attention or level of consciousness, some of them have also incorporated the assessment of other more novel aspects, such as the ability to respond to external stimuli (Arousal) or the degree of mobility


Assuntos
Humanos , Idoso , Delírio/diagnóstico , Demência/complicações , Fatores de Risco , Transtornos Motores , Disfunção Cognitiva , Sensibilidade e Especificidade , Consciência , Curva ROC
7.
Vnitr Lek ; 65(6): 433-439, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484484

RESUMO

Delirium in intensive care patients occurs with high prevalence and is associated with increased morbidity and mortality, worse long-term clinical outcome and higher economic costs. The article describes the pathophysiology, risk factors and individual types of delirium in patients in the intensive care. The current concepts of access to patients in intensive care are presented with the aim of early detection, treatment and prevention of delirium development.


Assuntos
Delírio , Unidades de Terapia Intensiva , Delírio/diagnóstico , Delírio/prevenção & controle , Diagnóstico Precoce , Humanos , Prevalência , Fatores de Risco
8.
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
9.
BMC Med ; 17(1): 138, 2019 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-31337404

RESUMO

BACKGROUND: Delirium affects > 15% of hospitalised patients but is grossly underdetected, contributing to poor care. The 4 'A's Test (4AT, www.the4AT.com ) is a short delirium assessment tool designed for routine use without special training. The primary objective was to assess the accuracy of the 4AT for delirium detection. The secondary objective was to compare the 4AT with another commonly used delirium assessment tool, the Confusion Assessment Method (CAM). METHODS: This was a prospective diagnostic test accuracy study set in emergency departments or acute medical wards involving acute medical patients aged ≥ 70. All those without acutely life-threatening illness or coma were eligible. Patients underwent (1) reference standard delirium assessment based on DSM-IV criteria and (2) were randomised to either the index test (4AT, scores 0-12; prespecified score of > 3 considered positive) or the comparator (CAM; scored positive or negative), in a random order, using computer-generated pseudo-random numbers, stratified by study site, with block allocation. Reference standard and 4AT or CAM assessments were performed by pairs of independent raters blinded to the results of the other assessment. RESULTS: Eight hundred forty-three individuals were randomised: 21 withdrew, 3 lost contact, 32 indeterminate diagnosis, 2 missing outcome, and 785 were included in the analysis. Mean age was 81.4 (SD 6.4) years. 12.1% (95/785) had delirium by reference standard assessment, 14.3% (56/392) by 4AT, and 4.7% (18/384) by CAM. The 4AT had an area under the receiver operating characteristic curve of 0.90 (95% CI 0.84-0.96). The 4AT had a sensitivity of 76% (95% CI 61-87%) and a specificity of 94% (95% CI 92-97%). The CAM had a sensitivity of 40% (95% CI 26-57%) and a specificity of 100% (95% CI 98-100%). CONCLUSIONS: The 4AT is a short, pragmatic tool which can help improving detection rates of delirium in routine clinical care. TRIAL REGISTRATION: International standard randomised controlled trial number (ISRCTN) 53388093 . Date applied 30/05/2014; date assigned 02/06/2014.


Assuntos
Confusão/diagnóstico , Delírio/diagnóstico , Testes Diagnósticos de Rotina , Testes Neuropsicológicos , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Lista de Checagem/métodos , Lista de Checagem/normas , Testes Diagnósticos de Rotina/métodos , Testes Diagnósticos de Rotina/normas , Manual Diagnóstico e Estatístico de Transtornos Mentais , Serviço Hospitalar de Emergência , Feminino , Avaliação Geriátrica/métodos , Humanos , Pacientes Internados , Masculino , Testes Neuropsicológicos/normas , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
10.
J Forensic Leg Med ; 66: 134-137, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31301637

RESUMO

PURPOSE: The purpose of the work is to show and compare three reported cases of Excited Delirium Syndrome, which happened in Warsaw, Poland, from 2013 to 2017. We compared the results of three autopsy and toxicological findings of unexpectedly deceased males and the circumstances of their death, based on the police records. RESULTS: There were no significant findings of chronic diseases or multiple traumas leading us to the clear explanation of cause of death. We noted a rapid cardiopulmonary failure accompanied by drug abuse in all three cases, that happened following a stressful stimulus, evoked by a police restraint in prone position. All patients resembled similar external characteristics and BMI and had used drugs before death. CONCLUSION: A lack of the autopsy findings suggests the Excited Delirium Syndrome as a cause of death. The syndrome may be diagnosed after death, following the definition of exclusion of other somatic causes of death, preceded by symptoms during a stressful event. The syndrome occurs in overweight males, abusing especially stimulants. The physical restraint plays an important role in the initiation of the symptoms. The pathophysiology of the syndrome is poorly understood, but some theories underline dopamine transporters stimulation. To this day, there are no published Excited Delirium guidelines for forensic specialists or pathologists.


Assuntos
Morte Súbita/etiologia , Delírio/diagnóstico , Restrição Física/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Índice de Massa Corporal , Humanos , Masculino , Entorpecentes/análise , Obesidade/complicações , Polícia , Prisioneiros , Decúbito Ventral , Detecção do Abuso de Substâncias
11.
J Clin Neurosci ; 66: 262-264, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31178301

RESUMO

Delirium is the most frequent complication of hospitalization for elders and a potentially devastating problem. It is accompanied by high morbidity and mortality rate, and despite sensitive methods for its detection, delirium often is unrecognized and is missed by clinicians in up to 70% of delirious patients. Medications are considered one of the most common causes of delirium with sedatives, narcotics, dihydroperidines, antihistamines, and anticholinergics are most often implicated in its causation. Antibiotic-induced delirium has been infrequently reported where cephalosporins and macrolides are implicated in the majority of cases published. Delirium associated with fluoroquinolones has rarely been reported, and to the best of our knowledge only eight cases of levofloxacin-induced delirium have been described until yet in the medical literature, two of which from our medical ward. We describe another case of delirium associated with levofloxacin treatment in an elderly patient who was hospitalized in our medical ward for acute bronchitis. Description of three cases of levofloxacin-induced delirium from one medical ward (ours) and the other six from the rest of the world reflects the extreme under-recognition and under-diagnosis of drug-induced delirium generally, and levofloxacin-induced delirium specifically by physicians world-wide. It also seems likely that this severe and potentially fetal adverse effect of levofloxacin is much more common than previously reported. The present case and the other previously reported emphasize the urgent need of much more awareness by physicians to the occurrence of this serious but preventable and potentially reversible CNS complication of levofloxacin.


Assuntos
Antibacterianos/efeitos adversos , Delírio/induzido quimicamente , Delírio/diagnóstico , Levofloxacino/efeitos adversos , Idoso , Delírio/psicologia , Hospitalização , Humanos , Masculino
12.
Prof Inferm ; 72(1): 25-33, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31162040

RESUMO

INTRODUCTION: Paediatric delirium is associated with a longer duration of hospitalization in paediatric intensive care units, the emergence of post-traumatic symptoms and possible neurocognitive dysfunction after discharge. In preschool children, the diagnosis of delirium appears rather challenging: their pre-verbal status and the presence of cognitive skills still in development make accurate diagnosis difficult. Recently, a pediatric delirium screening tool suitable for critical preschool children has also been developed and identified in international literature, with excellent results also in critical infants under 2 years of age: the Cornell Assessment of Pediatric Delirium (CAPD). The CAPD, using a Likert scale, bases the assessment of paediatric delirium within the context of child development. This scale follows the development of the infant by comparing the detection of specific items on the scale as the anchor points that characterize the development of infants by age groups. OBJECTIVE: Culturally and linguistically validation in Italian language and prior testing of the Cornell Assessment of Pediatric Delirium. METHOD: Translation and Cultural Validation of the Cornell Assessment of Pediatric Delirium (CAPD) for the Evaluation/Diagnosis of Pediatric Delirium within Pediatric Intensive Care. The translation and adaptation of this instrument followed the phases of the model proposed by the World Health Organization. Prior testings, such as item descriptive analysis, item-total correlation and Cronbach's alpha, were conducted. RESULTS: All phases of the cultural-linguistic validation process were carried out in a satisfactory manner. For the prior testing, the scale was administered to a sample of 42 children, with age ranged 0-5 years old (66.6%), with a higher prevalence of the male gender. All items were normally distributed and there was no excessive Skeweness and Kurtosis. Each item contributed to the scale fairly well and all coefficients of item total correlation (rjx) were higher than the recommended level of 0.30. The composite reliability index was 0.94 and Cronbach's alpha was 0.96. CONCLUSIONS: The process has meticulously followed the recommendations in international literature. The final version was approved by the authors of the original instrument.


Assuntos
Delírio/diagnóstico , Diagnóstico de Enfermagem/métodos , Pré-Escolar , Estudos Transversais , Características Culturais , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva Pediátrica , Tempo de Internação , Masculino , Inquéritos e Questionários , Traduções
13.
Geriatr Gerontol Int ; 19(8): 762-767, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31237088

RESUMO

AIM: To evaluate the diagnostic performance of the Confusion Assessment Method for the intensive care unit (CAM-ICU) among postoperative older patients in non-ICU settings. METHODS: The CAM-ICU was used by trained staff to prospectively evaluate postoperative patients for delirium. The patients were aged ≥60 years, were in general wards and had no critical illnesses. The assessments occurred for 7 consecutive days after surgery. The results were compared with delirium diagnoses obtained by geriatricians using Diagnostic and Statistical Manual of Mental Disorders 5th edition criteria as the reference standard. RESULTS: The sensitivity of delirium detection for the CAM-ICU was 31.6% (95% confidence interval [CI] 12.6-56.6), while the specificity was 97.6% (95% CI 94.9-99.1), positive predictive value was 50.0% (95% CI 26.3-73.7) and negative predictive value was 95.0% (95% CI 93.3-96.3). Feature 4 (disorganized thinking) yielded the highest sensitivity (60%; 95% CI 14.7-94.7), whereas feature 2 (inattention) had low sensitivity (36.8%; 95% CI 16.3-61.6). Further analyses to explore the highest sensitive criteria showed that if CAM-ICU diagnoses were made by the presence of any two out of feature 1 (acute change or fluctuation of cognition), feature 3 (altered level of consciousness) or feature 4, the sensitivity increased substantially to 80.0% (95% CI 28.4-99.5), with a reasonably high specificity of 81.8% (95% CI 48.2-97.7). CONCLUSIONS: Modification of the flow of delirium diagnosis using the CAM-ICU appears to offer a better sensitivity for detecting delirium in non-ICU settings. Furthermore, changing feature 2 to evaluate patients' attention levels over a longer period of time might yield a better diagnostic performance. Geriatr Gerontol Int 2019; 19: 762-767.


Assuntos
Confusão , Delírio , Avaliação Geriátrica/métodos , Quartos de Pacientes , /diagnóstico , Idoso , Confusão/diagnóstico , Confusão/etiologia , Cuidados Críticos/métodos , Delírio/diagnóstico , Delírio/etiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Padrões de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
14.
Res Nurs Health ; 42(4): 246-255, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31148216

RESUMO

Delirium is an acute disorder affecting up to 80% of intensive care unit (ICU) patients. It is associated with a 10-fold increase in cognitive impairment, triples the rate of in-hospital mortality, and costs $164 billion annually. Delirium acutely affects attention and global cognitive function with fluctuating symptoms caused by underlying organic etiologies. Early detection is crucial because the longer a patient experiences delirium the worse it becomes and the harder it is to treat. Currently, identification is through intermittent clinical assessment using standardized tools, like the Confusion Assessment Method for ICU. Such tools work well in clinical research but do not translate well into clinical practice because they are subjective, intermittent and have low sensitivity. As such, healthcare providers using these tools fail to recognize delirium symptoms as much as 80% of the time. Delirium-related biochemical derangement leads to electrical changes in electroencephalographic (EEG) patterns followed by behavioral signs and symptoms. However, continuous EEG monitoring is not feasible due to cost and need for skilled interpretation. Studies using limited-lead EEG show large differences between patients with and without delirium while discriminating delirium from other causes. The Ceribell is a limited-lead device that analyzes EEG. If it is capable of detecting delirium, it would provide an objective physiological monitor to identify delirium before symptom onset. This pilot study was designed to explore relationships between Ceribell and delirium status. Completion of this study will provide a foundation for further research regarding delirium status using the Ceribell data.


Assuntos
Cuidados Críticos/métodos , Cuidados Críticos/normas , Delírio/diagnóstico , Técnicas e Procedimentos Diagnósticos/normas , Pesquisa em Enfermagem/normas , Guias de Prática Clínica como Assunto , Projetos de Pesquisa/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto
15.
Ir J Psychol Med ; 36(2): 89-98, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31187719

RESUMO

OBJECTIVES: Improving knowledge about delirium care is a key target for health care. We describe the implementation of a four-part workshop focusing upon key aspects of delirium care. METHODS: Attitudes towards and understanding of delirium diagnosis and management amongst psychiatrists were surveyed before and immediately after an educational workshop. RESULTS: There were 62 participants. Pre-workshop, delirium was rated highly relevant to psychiatry. Overall level of confidence in diagnosis was modest, with the behavioural and psychological symptoms of dementia considered the most challenging differential diagnosis. Only nine participants (15%) correctly identified DSM-5 delirium criteria. Preferred assessment of attention varied with six different approaches endorsed. Confidence was higher for managing hyperactive compared with hypoactive delirium (p<0.001). Pharmacotherapy was more frequently endorsed for hyperactive compared with hypoactive presentations, with haloperidol the most popular agent (p<0.001). A total of 41 (66%) participants completed post-workshop assessments. Post-workshop, there were significant increases to the perceived relevance of delirium (p = 0.003), confidence in overall diagnosis (p<0.001) accuracy of awareness of DSM-5 criteria (p<0.001), and confidence in treating different presentations (p<0.001). The Months Backward Test was the preferred bedside test of attention (38/40 respondents). CONCLUSIONS: This interactive educational intervention impacted positively upon knowledge and attitudes amongst psychiatrists towards key aspects of delirium care. Further investigation can examine the impact upon longer term knowledge and behaviour.


Assuntos
Delírio/tratamento farmacológico , Haloperidol/uso terapêutico , Psiquiatria/educação , Idoso , Atitude do Pessoal de Saúde , Delírio/diagnóstico , Demência , Diagnóstico Diferencial , Humanos , Irlanda , Inquéritos e Questionários
16.
Ir J Psychol Med ; 36(2): 121-127, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31187721

RESUMO

OBJECTIVE: To describe the behavioural and psychiatric problems found in nursing home psychiatric referrals in the Dublin South city area. METHODS: We undertook two consecutive surveys of nursing home referrals to the St James's Hospital psychiatry of old age service over a 2-year period. During the second survey a new clinical nurse specialist was specifically appointed to manage the seven nursing homes included in the study. RESULTS: The most common reason for referral during survey one was uncooperative/aggressive behaviour (22%). For survey two, patients were most commonly referred for low mood (31%) or agitation (29%). During survey one, the majority of patients assessed were diagnosed with behavioural and psychological symptoms of dementia (41%). This was also a prevalent diagnosis during survey two, affecting 27% of those referred. Only 7% of patients were considered to be delirious during survey one. This rose to 31% the following year making it the most common diagnosis during survey two. Over the 2-year study period, 7% of referred patients were diagnosed with depression. In terms of prescribing practices, the discontinuation rate of antipsychotic mediation following psychiatric input was 13% in survey one. By survey two, this had risen to 47%. CONCLUSIONS: Delirium is often undetected and untreated in nursing homes. Residents presenting with psychiatric symptoms should undergo routine bloods and urinalysis prior to psychiatric referral. Dedicated input from trained psychiatric nursing staff can lead to both an improvement in the recognition of delirium and reduced prescribing rates of antipsychotic medication.


Assuntos
Agressão/psicologia , Delírio/diagnóstico , Psiquiatria Geriátrica , Casas de Saúde , Encaminhamento e Consulta , Idoso de 80 Anos ou mais , Demência/diagnóstico , Depressão/psicologia , Feminino , Humanos , Irlanda , Masculino , Inquéritos e Questionários
17.
BMC Psychol ; 7(1): 27, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046844

RESUMO

BACKGROUND: Previous studies have shown a relationship between delirium and depressive symptoms after cardiac surgery with distress personalities linking to negative surgical outcomes. The aim of the present study is to further investigate the association between patients with Type D (distressed) personality with regards to delirium after cardiac surgery. METHODS: We conducted a consecutive-sample observational cohort pilot study with an estimated 142 patients needed. Enrollment criteria included patients aged ≥18 years who were undergoing planned cardiovascular, thoracic and abdominal artery surgery between October 2015 to August 2016 at the University of Tsukuba Hospital, Japan. All patients were screened by Type-D Personality Scale-14 (DS14) as well as the Hospital Anxiety and Depression Scale (HADS) the day before surgery. Following surgery, daily data was collected during recovery and included severity of organ dysfunction, sedative/analgesic exposure and other relevant information. We then evaluated the association between Type D personality and delirium/coma days (DCDs) during the 7-day study period. We applied regression and mediation modeling for this study. RESULTS: A total of 142 patients were enrolled in the present study and the total prevalence of delirium was found to be 34% and 26% of the patients were Type D. Non-Type D personality patients experienced an average of 1.3 DCDs during the week after surgery while Type D patients experienced 2.1 days over the week after surgery. Multivariate analysis showed that Type D personality was significantly associated with increased DCDs (OR:2.8, 95%CI:1.3-6.1) after adjustment for depressive symptoms and clinical variables. Additionally, there was a significant Type D x depression interaction effect (OR:1.7, 95% CI:1.2-2.2), and depressive symptoms were associated with DCDs in Type D patients, but not in non-Type D patients. Mediation modeling showed that depressive symptoms partially mediated the association of Type D personality with DCDs (Aroian test =0.04). CONCLUSIONS: Type D personality is a prognostic predictor for prolonged acute brain dysfunction (delirium/coma) in cardiovascular patients independent from depressive symptoms and Type D personality-associated depressive symptoms increase the magnitude of acute brain dysfunction.


Assuntos
Procedimentos Cirúrgicos Cardíacos/psicologia , Coma/etiologia , Delírio/etiologia , Personalidade Tipo D , Idoso , Encéfalo/fisiopatologia , Estudos de Coortes , Delírio/diagnóstico , Depressão/diagnóstico , Depressão/etiologia , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Personalidade , Projetos Piloto , Prevalência
19.
Zhonghua Er Ke Za Zhi ; 57(5): 344-349, 2019 May 02.
Artigo em Chinês | MEDLINE | ID: mdl-31060126

RESUMO

Objective: To evaluate the clinical application of Chinese version of Cornell assessment of pediatric delirium (CAPD) scale in children by a pilot study. Methods: A prospective observational study. From June 2017 to December 2017, the original CAPD screen was translated into Chinese and debugged cross-culturally according to the guidelines, which was further applied in the Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University. The clinical data of 250 patients who were evaluated with the Chinese version of CAPD scale and Richmond agitation-sedation scale were extracted and analyzed with chi-square test or Mann-Whitney U test. Cronbach's α coefficient,Split-half coefficient and intra-group correlation coefficient were used to evaluate the reliability, while exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the structural validity of the scale. The result was compared with the gold standard diagnostic results to evaluate the diagnostic efficacy of the CAPD. Results: Sixty-one (24.4%) patients had delirium during pediatric intensive care unit hospitalization,and significant differences existed between them and 189 patients without delirium in age (χ(2)=11.220, P=0.011), rates of mechanical ventilation (χ(2)=6.691, P=0.010) and length of PICU hospitalization (Z=10.656, P=0.001). The Chinese version of the CAPD scale had high discrimination among the 8 items in the main table without skewed distribution and discrete items. The internal and external reliability of the scale were preferable as the Cronbach's α coefficient was 0.819 and ICC value was 0.835. The KMO value of EFA was 0.834 and Bartlett spherical test showed statistical significance (χ(2)=661.440, P<0.01). CFA constructed a two-factor structural equation model with favorable fit index:Chi-square/degree of freedom (DF) ratio was 1.786 (χ(2)=33.930, P=0.019), goodness of fit index (GFI) was 0.967,adjusted GFI was 0.938,root mean square of the approximate error (RMSEA) was 0.056. A good diagnostic efficacy of this scale was demonstrated by receiver operating characteristic curve analysis as when the cut-off was 10, the area under curve was 0.99 (95%CI: 0.97-0.99), sensitivity was 96.7% (95%CI: 88.7-99.6), specificity was 93.1% (95%CI: 88.5-96.3), positive likelihood ratio was 14.0 (95%CI: 13.2-14.9), and the negative likelihood ratio was 0.035 (95%CI: 0.008-0.200). Conclusion: The Chinese version of the CAPD Scale has favorable reliability,validity,diagnostic efficacy, as well as feasibility, which should be applied in evaluation of pediatric delirium in clinical observation and research in the future.


Assuntos
Delírio/diagnóstico , Programas de Rastreamento/métodos , Inquéritos e Questionários/normas , Criança , Humanos , Projetos Piloto , Estudos Prospectivos , Psicometria , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de Doença
20.
Ann Vasc Surg ; 60: 270-278.e2, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31077770

RESUMO

BACKGROUND: Delirium in patients with critical limb ischemia (CLI) is associated with increased mortality. The main goal of this study was to investigate the association between delirium and mortality in patients undergoing major lower limb amputation for CLI. In addition, other risk factors associated with mortality were analyzed. METHODS: An observational cohort study was conducted including all patients aged ≥70 years with CLI undergoing a major lower limb amputation between January 2014 and July 2017. Delirium was scored using the Delirium Observation Screening Score in combination with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Risk factors for mortality were analyzed by calculating hazard ratios using a Cox proportional hazards model. RESULTS: In total, 95 patients were included; of which, 29 (31%) patients developed a delirium during admission. Delirium was not associated with an increased risk of mortality (hazard ratio [HR] = 0.84; 95 % confidence interval [CI]: 0.51-1.73; P = 0.84). Variables independently associated with an increased risk of mortality were age (HR 1.1; 95% CI 1.0-1.1), cardiac history (HR 3.3; 95% CI 1.8-6.1), current smoking (HR 2.9; 95% CI 1.6-5.5), preoperative anemia (HR 2.8; 95% CI 1.1-7.2), and living in a nursing home (HR 2.2; 95% CI 1.1-4.4). CONCLUSION: Delirium was not associated with an increased mortality risk in elderly patients with CLI undergoing a major lower limb amputation. Factors related to an increased mortality risk were age, cardiac history, current smoking, preoperative anemia, and living in a nursing home.


Assuntos
Amputação/mortalidade , Delírio/mortalidade , Isquemia/cirurgia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Amputação/efeitos adversos , Estado Terminal , Delírio/diagnóstico , Delírio/psicologia , Feminino , Humanos , Incidência , Isquemia/diagnóstico por imagem , Isquemia/mortalidade , Isquemia/fisiopatologia , Masculino , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/mortalidade , Doença Arterial Periférica/fisiopatologia , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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