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1.
Z Gerontol Geriatr ; 52(Suppl 4): 229-242, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31628611

RESUMO

BACKGROUND: Older people represent a risk group for acquiring or further development of delirium during hospitalization, therefore requiring suitable nonpharmacological delirium interventions. OBJECTIVE: This scoping review analyzed nonpharmacological intervention programs for older inpatients with or without cognitive decline on regular or acute geriatric wards to present the range of interventions. METHODS: A systematic literature search was conducted using scientific databases. A total of 4652 records were screened by two independent reviewers, leaving 81 eligible articles for full-text screening and 25 studies were finally included. Inclusion criteria were older patients ≥65 years in regular or acute geriatric wards and nonpharmacological multicomponent interventions. RESULTS: More than a half of the included studies (14, 56%) recruited patients with pre-existing cognitive decline as part of the study population and 12% focused exclusively on patients with cognitive decline. On average 11 intervention components were integrated in the programs and two programs included full coverage of all 18 identified components. CONCLUSION: Only few programs were described for older inpatients and even fewer regarding pre-existing cognitive decline. The low numbers of interventions and data heterogeneity restricted the assessment of outcomes; however, delirium incidence, as reported by two thirds of the studies was reduced by nonpharmacological multicomponent interventions.


Assuntos
Disfunção Cognitiva/epidemiologia , Delírio/epidemiologia , Delírio/terapia , Hospitalização/estatística & dados numéricos , Pacientes Internados/psicologia , Tempo de Internação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/psicologia , Delírio/psicologia , Feminino , Humanos , Incidência , Pacientes Internados/estatística & dados numéricos , Masculino , Prevalência , Fatores de Risco , Resultado do Tratamento
2.
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
3.
Anesthesiology ; 131(3): 492-500, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31335550

RESUMO

BACKGROUND: Postoperative delirium is one of the most common complications in the elderly surgical population. However, its long-term outcomes remain largely to be determined. Therefore a prospective cohort study was conducted to determine the association between postoperative delirium and long-term decline in activities of daily living and postoperative mortality. The hypothesis in the present study was that postoperative delirium was associated with a greater decline in activities of daily living and higher mortality within 24 to 36 months after anesthesia and surgery. METHODS: The participants (at least 65 yr old) having the surgeries of (1) proximal femoral nail, (2) hip replacement, or (3) open reduction and internal fixation under general anesthesia were enrolled. The Confusion Assessment Method algorithm was administered to diagnose delirium before and on the first, second, and fourth days after the surgery. Activities of daily living were evaluated by using the Chinese version of the activities of daily living scale (range, 14 to 56 points), and preoperative cognitive function was assessed by using the Chinese Mini-Mental State Examination (range, 0 to 30 points). The follow-up assessments, including activities of daily living and mortality, were conducted between 24 and 36 months after anesthesia and surgery. RESULTS: Of 130 participants (80 ± 6 yr, 24% male), 34 (26%) developed postoperative delirium during the hospitalization. There were 32% of the participants who were lost to follow-up, resulting in 88 participants who were finally included in the data analysis. The participants with postoperative delirium had a greater decline in activities of daily living (16 ± 15 vs. 9 ± 15, P = 0.037) and higher 36-month mortality (8 of 28, 29% vs. 7 of 75, 9%; P = 0.009) as compared with the participants without postoperative delirium. CONCLUSIONS: Postoperative delirium was associated with long-term detrimental outcomes, including greater decline in activities of daily living and a higher rate of postoperative mortality.


Assuntos
Atividades Cotidianas/psicologia , Delírio/epidemiologia , Delírio/psicologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/psicologia , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Estudos Prospectivos , Fatores de Risco
4.
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
5.
Rev Med Suisse ; 15(654): 1204, 2019 Jun 05.
Artigo em Francês | MEDLINE | ID: mdl-31166678
6.
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
7.
Qual Life Res ; 28(9): 2565-2578, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31102155

RESUMO

PURPOSE: Our purpose was to create a content domain framework for delirium severity to inform item development for a new instrument to measure delirium severity. METHODS: We used an established, multi-stage instrument development process during which expert panelists discussed best approaches to measure delirium severity and identified related content domains. We conducted this work as part of the Better ASsessment of ILlness (BASIL) study, a prospective, observational study aimed at developing and testing measures of delirium severity. Our interdisciplinary expert panel consisted of twelve national delirium experts and four expert members of the core research group. Over a one-month period, experts participated in two rounds of review. RESULTS: Experts recommended that the construct of delirium severity should reflect both the phenomena and the impact of delirium to create an accurate, patient-centered instrument useful to interdisciplinary clinicians and family caregivers. Final content domains were Cognitive, Level of consciousness, Inattention, Psychiatric-Behavioral, Emotional dysregulation, Psychomotor features, and Functional. Themes debated by experts included reconciling clinical geriatrics and psychiatric content, mapping symptoms to one specific domain, and accurate capture of unclear clinical presentations. CONCLUSIONS: We believe this work represents the first application of instrument development science to delirium. The identified content domains are inclusive of various, wide-ranging domains of delirium severity and are reflective of a consistent framework that relates delirium severity to potential clinical outcomes. Our content domain framework provides a foundation for development of delirium severity instruments that can help improve care and quality of life for patients with delirium.


Assuntos
Delírio/diagnóstico , Delírio/psicologia , Índice de Gravidade de Doença , Cuidadores , Prova Pericial , Feminino , Humanos , Masculino , Estudos Prospectivos , Qualidade de Vida/psicologia
8.
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
10.
Holist Nurs Pract ; 33(3): 163-176, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30973436

RESUMO

Postoperative delirium (incidence estimated up to 82%) can be ameliorated with nonpharmacologic methods. Mindfulness has not yet been incorporated into these methods, although mindfulness has been demonstrated to help patients adapt to illness and hospitalization. To reduce postoperative delirium incidence and increase patient satisfaction, this study employs a program of thought exercises based on Langerian mindfulness. Preoperatively, cardiac surgical patients listened to a mindfulness or informational audio; mindfulness subjects were also guided by the principal investigator through mindfulness exercises. Postoperatively, mindfulness subjects were visited twice daily for mindfulness exercises. For all patients, delirium screening was performed twice daily. Before discharge, affective status and satisfaction with hospital stay were assessed. No patients who completed the study screened positive for delirium. Trends include (1) lower (improved) median anxiety and depression scores postoperatively when considering both study groups together; (2) both groups rated the hospital more favorably on global satisfaction measures; (3) both groups shared generally positive comments regarding the audio files (qualitative data). Audio files and mindfulness exercises are associated with patient satisfaction among cardiothoracic surgery patients. The absence of delirium precludes determination of the effectiveness of the intervention in reducing delirium incidence.


Assuntos
Delírio/prevenção & controle , Atenção Plena/métodos , Atenção Plena/normas , Satisfação do Paciente , Adulto , Idoso , Delírio/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Assistência Perioperatória/normas , Projetos Piloto , Inquéritos e Questionários
11.
J Adv Nurs ; 75(8): 1782-1791, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30937929

RESUMO

AIM: To understand family caregiver involvement in delirium prevention care for older adults hospitalized for orthopaedic surgery hospitals and family caregiver integration by nurses. DESIGN: Multiple-case study. METHODS: The model of Care Partner Engagement was selected as theoretical framework. Eight cases will comprise an older adult hospitalized a family caregiver and a ward nurse. They will be recruited with a non-probability sampling on two orthopaedic surgery wards in two hospitals. Semi-structured interviews with participants will be audiotaped. Sociodemographic data will be collected. These data, researcher field notes and interview transcripts will be subjected to within- and across-case thematic analysis. Regional ethics committee approved the study protocol in August 2018. DISCUSSION: The study will allow surgical nursing teams to gain a better understanding of the issues and possibilities regarding family caregiver integration in delirium prevention care for older adults.


Assuntos
Cuidadores/psicologia , Delírio/enfermagem , Delírio/prevenção & controle , Família/psicologia , Pacientes Internados/psicologia , Enfermagem Ortopédica/métodos , Medicina Preventiva/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Delírio/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
12.
Int J Geriatr Psychiatry ; 34(7): 1070-1077, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30945343

RESUMO

OBJECTIVES: Delirium is a common postoperative complication with implications on morbidity and mortality. Less is known about the psychological impact of delirium in patients and relatives. This study aimed to quantitatively describe distress related to postoperative delirium in older surgical patients and their relatives using the distress thermometer, examine the association between degree of distress and features of delirium on the Delirium Rating Scale (DRS), and examine the association between recall of delirium and features of delirium on the DRS. METHODS: This prospective study recruited postoperative patients and their relatives following delirium. The distress thermometer was used to examine the degree of distress pertaining to delirium and was conducted during the hospitalization on resolution of delirium and then at 12-month follow-up. Associations between delirium-related distress in patient and relative participants and severity and features of delirium (DRS) were examined. RESULTS: One hundred two patients and 49 relatives were recruited. Median scores on the distress thermometer in patients who recalled delirium were 8/10. Relatives also showed distress (median distress thermometer score of 8/10). Associations were observed between severity and phenotypic features of delirium (delusions, labile affect, and agitation). Distress persisted at 12 months in patients and relatives. CONCLUSION: Distress related to postoperative delirium can be measured using a distress thermometer. Alongside approaches to reduce delirium incidence, interventions to minimize distress from postoperative delirium should be sought. Such interventions should be developed through robust research and if effective administered to patients, relatives, or carers.


Assuntos
Delírio/psicologia , Complicações Pós-Operatórias/psicologia , Estresse Psicológico/etiologia , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Cuidadores/psicologia , Feminino , Humanos , Masculino , Rememoração Mental , Pessoa de Meia-Idade , Estudos Prospectivos
13.
Int J Geriatr Psychiatry ; 34(7): 1018-1028, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30907449

RESUMO

OBJECTIVES: Delirium is an important postoperative complication, yet predictive risk factors for postoperative delirium severity remain elusive. We hypothesized that the NSQIP risk calculation for serious complications (NSQIP-SC) or risk of death (NSQIP-D), and cognitive tests of executive function (Trail Making Tests A and B [TMTA and TMTB]), would be predictive of postoperative delirium severity. Further, we demonstrate how advanced statistical techniques can be used to identify candidate predictors. METHODS/DESIGN: Data from an ongoing perioperative prospective cohort study of 100 adults (65 y old or older) undergoing noncardiac surgery were analyzed. In addition to NSQIP-SC, NSQIP-D, TMTA, and TMTB, participant age, sex, American Society of Anesthesiologists (ASA) score, tobacco use, surgery type, depression, Framingham risk score, and preoperative blood pressure were collected. The Delirium Rating Scale-R-98 (DRS) measured delirium severity; the Confusion Assessment Method (CAM) identified delirium. LASSO and best subsets linear regression were employed to identify predictive risk factors. RESULTS: Ninety-seven participants with a mean age of 71.68 ± 4.55, 55% male (31/97 CAM+, 32%), and a mean peak DRS of 21.5 ± 6.40 were analyzed. LASSO and best subsets regression identified NSQIP-SC and TMTB to predict postoperative delirium severity (P < 00.001, adjusted R2 : 0.30). NSQIP-SC and TMTB were also selected as predictors for postoperative delirium incidence (AUROC 0.81, 95% CI, 0.72-0.90). CONCLUSIONS: In this cohort, we identified NSQIP risk score for serious complications and a measure of executive function, TMT-B, to predict postoperative delirium severity using advanced modeling techniques. Future studies should investigate the utility of these variables in a formal delirium severity prediction model.


Assuntos
Delírio/etiologia , Função Executiva/fisiologia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Delírio/epidemiologia , Delírio/psicologia , Feminino , Humanos , Incidência , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/psicologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco
14.
BMC Geriatr ; 19(1): 87, 2019 03 20.
Artigo em Inglês | MEDLINE | ID: mdl-30894131

RESUMO

BACKGROUND: Due to the increase in elderly patients who undergo major abdominal surgery there is a subsequent increase in postoperative complications, prolonged hospital stays, health-care costs and mortality rates. Delirium is a frequent and severe complication in the 'frail' elderly patient. Different preoperative approaches have been suggested to decrease incidence of delirium by improving patients' baseline health. Studies implementing these approaches are often heterogeneous, have a small sample and do not provide high-quality or successful strategies. The aim of this study is to prevent postoperative delirium and other complications by implementing a unique multicomponent and multidisciplinary prehabilitation program. METHODS: This is a single-center controlled before-and-after study. Patients aged ≥70 years in need of surgery for colorectal cancer or an abdominal aortic aneurysm are considered eligible. Baseline characteristics (such as factors of frailty, physical condition and nutritional state) are collected prospectively. During 5 weeks prior to surgery, patients will follow a prehabilitation program to optimize overall health, which includes home-based exercises, dietary advice and intravenous iron infusion in case of anaemia. In case of frailty, a geriatrician will perform a comprehensive geriatric assessment and provide additional preoperative interventions when deemed necessary. The primary outcome is incidence of delirium. Secondary outcomes are length of hospital stay, complication rate, institutionalization, 30-day, 6- and 12-month mortality, mental health and quality of life. Results will be compared to a retrospective control group, meeting the same inclusion and exclusion criteria, operated on between January 2013 and October 2015. Inclusion of the prehabilitation cohort started in November 2015; data collection is ongoing. DISCUSSION: This is the first study to investigate the effect of prehabilitation on postoperative delirium. The aim is to provide evidence, based on a large sample size, for a standardized multicomponent strategy to improve patients' preoperative physical and nutritional status in order to prevent postoperative delirium and other complications. A multimodal intervention was implemented, combining physical, nutritional, mental and hematinic optimization. This research involves a large cohort, including patients most at risk for postoperative adverse outcomes. TRIAL REGISTRATION: The protocol is retrospectively registered at the Netherlands National Trial Register (NTR) number: NTR5932 . Date of registration: 05-04-2016.


Assuntos
Delírio/psicologia , Delírio/reabilitação , Idoso Fragilizado/psicologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/psicologia , Cuidados Pré-Operatórios/métodos , Idoso , Idoso de 80 Anos ou mais , Delírio/epidemiologia , Feminino , Avaliação Geriátrica/métodos , Humanos , Incidência , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos
15.
Semin Pediatr Surg ; 28(1): 33-42, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30824132

RESUMO

The alleviation of discomfort and distress is an essential component of the management of critically ill surgical patients. Pain and anxiety have multifocal etiologies that may be related to an underlying disease or surgical procedure, ongoing medical therapy, invasive monitors, an unfamiliar, complex and chaotic environment, as well as fear. Pharmacologic and non-pharmacologic therapies have complex risk benefit profiles. A fundamental understanding of analgesia, sedation, and delirium is essential for optimizing important outcomes in critically ill pediatric surgical patients. There has been a recent emphasis on goal directed, evidence based, and patient-centered management of the physical and psychological needs of these children. The purpose of this article is to review and summarize recent advances and describe current practice of these important subjects in the pediatric surgical intensive care environment.


Assuntos
Analgesia/métodos , Sedação Consciente/métodos , Cuidados Críticos/métodos , Sedação Profunda/métodos , Delírio , Assistência Perioperatória/métodos , Analgesia/efeitos adversos , Anestesia/efeitos adversos , Anestesia/métodos , Anestesia/psicologia , Ansiolíticos/uso terapêutico , Ansiedade/tratamento farmacológico , Ansiedade/etiologia , Criança , Sedação Consciente/efeitos adversos , Sedação Consciente/psicologia , Cuidados Críticos/psicologia , Estado Terminal , Sedação Profunda/efeitos adversos , Sedação Profunda/psicologia , Delírio/diagnóstico , Delírio/etiologia , Delírio/prevenção & controle , Delírio/psicologia , Humanos , Pediatria , Assistência Perioperatória/efeitos adversos , Assistência Perioperatória/psicologia
16.
Gerontologist ; 59(2): 327-337, 2019 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-30870568

RESUMO

BACKGROUND AND OBJECTIVES: While there are qualitative studies examining the delirium-related experiences of patients, family caregivers, and nurses separately, little is known about common aspects of delirium burden among all three groups. We describe common delirium burdens from the perspectives of patients, family caregivers, and nurses. RESEARCH DESIGN AND METHODS: We conducted semistructured qualitative interviews about delirium burden with 18 patients who had recently experienced a delirium episode, with 16 family caregivers, and with 15 nurses who routinely cared for patients with delirium. We recruited participants from a large, urban teaching hospital in Boston, Massachusetts. Interviews were recorded and transcribed. We used interpretive description as the approach to data analysis. RESULTS: We identified three common burden themes of the delirium experience: Symptom Burden (Disorientation, Hallucinations/Delusions, Impaired Communication, Memory Problems, Personality Changes, Sleep Disturbances); Emotional Burden (Anger/Frustration, Emotional Distress, Fear, Guilt, Helplessness); and Situational Burden (Loss of Control, Lack of Attention, Lack of Knowledge, Lack of Resources, Safety Concerns, Unpredictability, Unpreparedness). These burdens arise from different sources among patients, family caregivers, and nurses, with markedly differing perspectives on the burden experience. DISCUSSION AND IMPLICATIONS: Our findings advance the understanding of common burdens of the delirium experience for all groups and offer structure for instrument development and distinct interventions to address the burden of delirium as an individual or group experience. Our work reinforces that no one group experiences delirium in isolation. Delirium is a shared experience that will respond best to systemwide approaches to reduce associated burden.


Assuntos
Cuidadores , Efeitos Psicossociais da Doença , Delírio/enfermagem , Enfermeiras e Enfermeiros , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Delírio/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto Jovem
17.
Clin Neuropharmacol ; 42(2): 64-65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30747749

RESUMO

OBJECTIVE: Long-acting depot preparations of antipsychotics are the mainstay of treatment for patients with schizophrenia who show nonadherence to their medications. Olanzapine pamoate is one of the recently approved long-acting depot psychotropic preparations that have shown its efficacy both in clinical trials and in clinical uses against the illness. However, emerging literature indicates toward a cluster of adverse effects known as postinjection delirium/sedation syndrome (PDSS). METHODS: We here present a case of PDSS in a woman with paranoid schizophrenia. After maintaining well for almost 1½ years, she developed PDSS at her 31st scheduled long-acting olanzapine injection. RESULTS: Several features of PDSS including its mechanism and course have been discussed. CONCLUSIONS: More research is necessary to understand the syndrome and the association between PDSS and long-acting olanzapine injection. Clinicians should keep in mind that PDSS may worsen compliance in an index patient and affect the course of the illness.


Assuntos
Antipsicóticos/efeitos adversos , Delírio/induzido quimicamente , Hipnóticos e Sedativos/efeitos adversos , Olanzapina/efeitos adversos , Esquizofrenia Paranoide/tratamento farmacológico , Adulto , Antipsicóticos/administração & dosagem , Preparações de Ação Retardada/administração & dosagem , Preparações de Ação Retardada/efeitos adversos , Delírio/diagnóstico , Delírio/psicologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/psicologia , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Olanzapina/administração & dosagem , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/psicologia , Síndrome
18.
Trials ; 20(1): 110, 2019 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-30736826

RESUMO

BACKGROUND: Preoperative anxiety and postoperative delirium affect both short- and long-term prognoses in patients with cancer; therefore, these conditions require early prevention and treatment. However, no standard preventive or therapeutic methods have been established for them. Yokukansan, a Japanese herbal medicine for the treatment of insomnia and anxiety, causes relatively few adverse drug reactions and effectively improves the behavioral and psychological symptoms of dementia. Thus, it is expected to be useful for treating and/or preventing perioperative psychiatric symptoms in patients with cancer. The objective of this study is to clarify the therapeutic effect of Yokukansan for preoperative anxiety and its preventive effect on postoperative delirium in cancer patients, as well as to confirm its safety profile. METHODS: This study is a randomized, double-blind, placebo-controlled study in cancer patients scheduled to undergo tumor resection. Patients who provide consent are randomly allocated to receive oral administration of Yokukansan or placebo, and study drug administration is continued for 4 days or longer prior to surgery. We defined two primary endpoints, change in preoperative anxiety and incidence of postoperative delirium. Secondary endpoints are severity score of postoperative delirium, duration of postoperative delirium, amount of benzodiazepines used prior to surgery, amount of antipsychotic agents used after surgery, and number of postoperative hospitalization days. We plan to complete the analysis on March 31, 2021. The target number of registered patients is 110 per group, or 220 in total. DISCUSSION: This study is the first randomized, double-blind, placebo-controlled study intended to clarify the effects of a Japanese herbal medicine, Yokukansan, in the prevention and treatment of perioperative psychiatric symptoms in patients with cancer. The trial was initiated on August 14, 2017, with 195 subjects randomized by October 5, 2018. TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN-CTR), UMIN000027561 . Registered on 31 May 2017.


Assuntos
Ansiolíticos/administração & dosagem , Ansiedade/prevenção & controle , Delírio/prevenção & controle , Medicamentos de Ervas Chinesas/administração & dosagem , Neoplasias/cirurgia , Procedimentos Cirúrgicos Operatórios/psicologia , Administração Oral , Ansiolíticos/efeitos adversos , Antipsicóticos/uso terapêutico , Ansiedade/diagnóstico , Ansiedade/etiologia , Ansiedade/psicologia , Benzodiazepinas/uso terapêutico , Delírio/diagnóstico , Delírio/etiologia , Delírio/psicologia , Método Duplo-Cego , Esquema de Medicação , Medicamentos de Ervas Chinesas/efeitos adversos , Humanos , Tempo de Internação , Neoplasias/diagnóstico , Neoplasias/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Fatores de Tempo , Tóquio , Resultado do Tratamento
19.
Palliat Support Care ; 17(1): 42-45, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30700336

RESUMO

OBJECTIVE: Delirium is a frequent and severe complication of serious pediatric illness. Development of a nonpharmacologic approach to prevent pediatric delirium may improve short- and long-term outcomes in children and their families. In this brief report, we describe the development of a quality improvement project designed to methodically promote the family member's engagement, comforting, and orienting activities with their critically ill child to decrease delirium rates. METHOD: We created a developmentally specific Delirium Prevention Toolkit for families. In a feasibility pilot, March through June 2016, we offered the kit to 15 patients and their families. On discharge, families were asked to describe use of the toolkit and whether or not it was helpful for them. RESULTS: Twelve of 15 patients and families used various elements of the toolkit, particularly the headphones, music, and games; no one regularly used the blank journal. All reported that it was easy and helpful to have as support for their stay in the pediatric intensive care unit.Significance of resultsThis pilot demonstrated practicality of a nonpharmacologic delirium prevention toolkit in the pediatric intensive care unit, and satisfaction from patients and families.


Assuntos
Delírio/prevenção & controle , Família/psicologia , Participação do Paciente/métodos , Adolescente , Criança , Pré-Escolar , Estado Terminal/terapia , Delírio/psicologia , Delírio/terapia , Relações Familiares/psicologia , Estudos de Viabilidade , Feminino , Humanos , Unidades de Terapia Intensiva Pediátrica/organização & administração , Masculino , Participação do Paciente/psicologia , Projetos Piloto , Adulto Jovem
20.
Trials ; 20(1): 146, 2019 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-30795794

RESUMO

BACKGROUND: Postoperative delirium may manifest in the immediate post-anaesthesia care period. Such episodes appear to be predictive of further episodes of inpatient delirium and associated adverse outcomes. Frontal electroencephalogram (EEG) findings of suppression patterns and low proprietary index values have been associated with postoperative delirium and poor outcomes. However, the efficacy of titrating anaesthesia to proprietary index targets for preventing delirium remains contentious. We aim to assess the efficacy of two strategies which we hypothesise could prevent post-anaesthesia care unit (PACU) delirium by maximising the alpha oscillation observed in frontal EEG channels during the maintenance and emergence phases of anaesthesia. METHODS: This is a 2 × 2 factorial, double-blind, stratified, randomised control trial of 600 patients. Eligible patients are those aged 60 years or over who are undergoing non-cardiac, non-intracranial, volatile-based anaesthesia of expected duration of more than 2 h. Patients will be stratified by pre-operative cognitive status, surgery type and site. For the maintenance phase of anaesthesia, patients will be randomised (1:1) to an alpha power-maximisation anaesthesia titration strategy versus standard care avoiding suppression patterns in the EEG. For the emergence phase of anaesthesia, patients will be randomised (1:1) to early cessation of volatile anaesthesia and emergence from an intravenous infusion of propofol versus standard emergence from volatile anaesthesia only. The primary study outcomes are the power of the frontal alpha oscillation during the maintenance and emergence phases of anaesthesia. Our main clinical outcome of interest is PACU delirium. DISCUSSION: This is a largely exploratory study; the extent to which EEG signatures can be modified by titration of pharmacological agents is not known. The underlying concept is maximisation of anaesthetic efficacy by individualised drug titration to a clearly defined EEG feature. The interventions are already clinically used strategies in anaesthetic practice, but have not been formally evaluated. The addition of propofol during the emergence phase of volatile-based general anaesthesia is known to reduce emergence delirium in children; however, the efficacy of this strategy in older patients is not known. TRIAL REGISTRATION: Australian and New Zealand Clinical Trial Registry, ID: 12617001354370 . Registered on 27/09/2017.


Assuntos
Anestesia Geral/métodos , Encéfalo/efeitos dos fármacos , Delírio/prevenção & controle , Eletroencefalografia , Monitorização Neurofisiológica Intraoperatória/métodos , Fatores Etários , Ritmo alfa , Período de Recuperação da Anestesia , Anestesia Geral/efeitos adversos , Encéfalo/fisiopatologia , Cognição/efeitos dos fármacos , Estado de Consciência/efeitos dos fármacos , Delírio/etiologia , Delírio/fisiopatologia , Delírio/psicologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Valor Preditivo dos Testes , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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