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1.
Br J Anaesth ; 126(2): 423-432, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33413977

RESUMO

Delirium and postoperative neurocognitive disorder are the commonest perioperative complications in patients more than 65 yr of age. However, data suggest that we often fail to screen patients for preoperative cognitive impairment, to warn patients and families of risk, and to take preventive measures to reduce the incidence of perioperative neurocognitive disorders. As part of the American Society of Anesthesiologists (ASA) Perioperative Brain Health Initiative, an international group of experts was invited to review published best practice statements and guidelines. The expert group aimed to achieve consensus on a small number of practical recommendations that could be implemented by anaesthetists and their partners to reduce the incidence of perioperative neurocognitive disorders. Six statements were selected based not only on the strength of the evidence, but also on the potential for impact and the feasibility of widespread implementation. The actions focus on education, cognitive and delirium screening, non-pharmacologic interventions, pain control, and avoidance of antipsychotics. Strategies for effective implementation are discussed. Anaesthetists should be key members of multidisciplinary perioperative care teams to implement these recommendations.


Assuntos
Anestesiologia/normas , Anestesistas/normas , Encéfalo/fisiopatologia , Cognição , Delírio/prevenção & controle , Equipe de Assistência ao Paciente/normas , Assistência Perioperatória/normas , Complicações Cognitivas Pós-Operatórias/prevenção & controle , Fatores Etários , Idoso , Antipsicóticos/efeitos adversos , Consenso , Delírio/fisiopatologia , Delírio/psicologia , Medicina Baseada em Evidências/normas , Humanos , Liderança , Pessoa de Meia-Idade , Complicações Cognitivas Pós-Operatórias/fisiopatologia , Complicações Cognitivas Pós-Operatórias/psicologia , Medição de Risco , Fatores de Risco
2.
PLoS One ; 15(12): e0242519, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33362277

RESUMO

BACKGROUND/OBJECTIVES: Endoscopic coronary artery bypass grafting (Endo-CABG) is a minimally invasive CABG procedure with retrograde arterial perfusion. The main objective of this study is to assess neurocognitive outcome after Endo-CABG. METHODS/DESIGN: In this prospective observational cohort study, patients were categorised into: Endo-CABG (n = 60), a comparative Percutaneous Coronary Intervention (PCI) group (n = 60) and a healthy volunteer group (n = 60). A clinical neurological examination was performed both pre- and postoperatively, delirium was assessed postoperatively. A battery of 6 neurocognitive tests, Quality of life (QoL) and the level of depressive feelings were measured at baseline and after 3 months. Patient Satisfaction after Endo-CABG was assessed at 3-month follow-up. Primary endpoints were incidence of postoperative cognitive dysfunction (POCD), stroke and delirium after Endo-CABG. Secondary endpoints were QOL, patient satisfaction and the incidence of depressive feelings after Endo-CABG. RESULTS: In total, 1 patient after Endo-CABG (1.72%) and 1 patient after PCI (1.67%) suffered from stroke during the 3-month follow-up. POCD in a patient is defined as a Reliable Change Index ≤-1.645 or Z-score ≤-1.645 in at least two tests, and was found in respectively 5 and 6 patients 3 months after Endo-CABG and PCI. Total incidence of POCD/stroke was not different (PCI: n= 7 [15.9%]; Endo-CABG: n= 6 [13.0%], p = 0.732). ICU delirium after Endo-CABG was found in 5 (8.6%) patients. QoL increased significantly three months after Endo-CABG and was comparable with QoL level after PCI and in the control group. Patient satisfaction after Endo-CABG and PCI was comparable. At follow-up, the level of depressive feelings was decreased in all groups. CONCLUSIONS: The incidence of poor neurocognitive outcome, including stroke, POCD and postoperative ICU delirium until three months after Endo-CABG is low and comparable with PCI. TRIAL REGISTRATION: Registered on ClinicalTrials.gov (NCT02979782).


Assuntos
Ponte de Artéria Coronária/psicologia , Doença da Artéria Coronariana/psicologia , Delírio/psicologia , Depressão/psicologia , Intervenção Coronária Percutânea/psicologia , Acidente Vascular Cerebral/psicologia , Idoso , Estudos de Casos e Controles , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/patologia , Doença da Artéria Coronariana/cirurgia , Delírio/etiologia , Depressão/etiologia , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Intervenção Coronária Percutânea/efeitos adversos , Estudos Prospectivos , Qualidade de Vida/psicologia , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
3.
J Stroke Cerebrovasc Dis ; 29(11): 105219, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33066899

RESUMO

BACKGROUND: Delirium is common after stroke and associated with poor functional outcomes and mortality. It is unknown whether delirium is a modifiable risk factor, or simply an indicator of prognosis, but in order to intervene successfully, those at greatest risk must be identified early. We created a tool to predict the development of delirium in patients admitted to the intensive care unit for stroke, focusing on factors present on hospital admission. METHODS: Charts of 102 patients admitted to the ICU or IMC after ischemic stroke or intracranial hemorrhage with symptom onset within 72 hours were reviewed. Delirium was identified using the Confusion Assessment Method for the ICU (CAM-ICU). Factors significantly associated with delirium were included in a multivariable logistic regression analysis to create a predictive model. The model was validated in a unique inpatient cohort. RESULTS: In regression analyses, the variables present on admission most strongly associated with the development of delirium after stroke included: age greater than 64 years; intraventricular hemorrhage; intubation; presence of either cognitive dysfunction, aphasia, or neglect; and acute kidney injury. Using these variables in our predictive model, an ROC analysis resulted in an area under the curve of 0.90, and 0.82 in our validation cohort. CONCLUSIONS: Factors available on admission can be used to accurately predict risk of delirium following stroke. Our model can be used to implement more rigorous screening paradigms, allowing for earlier detection and timely treatment. Futures studies will focus on determining if prevention can mitigate the poor outcomes with which delirium is associated.


Assuntos
Isquemia Encefálica/complicações , Delírio/diagnóstico , Unidades de Terapia Intensiva , Hemorragias Intracranianas/complicações , Acidente Vascular Cerebral/complicações , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/psicologia , Comorbidade , Delírio/etiologia , Delírio/psicologia , Diagnóstico Precoce , Feminino , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/psicologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/psicologia , Fatores de Tempo
4.
J Stroke Cerebrovasc Dis ; 29(9): 105013, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807428

RESUMO

BACKGROUND: Higher rates of delirium have been reported among patients with acute stroke. However, poorly modifiable risk factors have been documented to date while sign and symptoms capable of early detecting its onset and outcomes in this specific population have been largely neglected. The aim of this study was to emerge nurses' clinical knowledge and experiences regarding post-stroke delirium (a) risk factors, (b) signs and symptoms of delirium onset, and (c) outcomes. METHOD: A qualitative study based upon focus groups have been performed on 2019 and here reported according to the COnsolidated criteria for REporting Qualitative research. A purposeful sample of 28 nurses was invited to participate in focus groups at two Italian hospitals, and 20 participated. A semi-structured question guide was developed; all focus groups were audio recorded and then transcribed verbatim. Two researchers independently analysed, coded and categorised the findings according to the main research question. A member checking with ten nurses was also performed to ensure rigour. RESULTS: Four risk factors emerged (a) at the individual level; (b) associated with previous (e.g., dementia) and the current clinical condition (stroke), (c) associated with the nursing care delivered, and (d) associated with the hospital environment. In their daily practice, nurses suspect the onset of delirium when some motor, verbal or multidimensional signs and symptoms occur. The delirium episodes affect outcomes at the individual, family, and at the system levels. CONCLUSIONS: In a field of research in need of study, we have involved expert nurses who shared their tacit knowledge to gain insights regarding risk factors, early signs and symptoms of delirium and its outcomes to address future directions of this research field.


Assuntos
Atitude do Pessoal de Saúde , Competência Clínica , Delírio/enfermagem , Conhecimentos, Atitudes e Prática em Saúde , Enfermeiras e Enfermeiros/psicologia , Acidente Vascular Cerebral/enfermagem , Adulto , Delírio/diagnóstico , Delírio/etiologia , Delírio/psicologia , Feminino , Humanos , Entrevistas como Assunto , Itália , Masculino , Pessoa de Meia-Idade , Prognóstico , Pesquisa Qualitativa , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/psicologia
5.
Psychosomatics ; 61(6): 585-596, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32828569

RESUMO

BACKGROUND: The pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as one of the biggest health threats of our generation. A significant portion of patients are presenting with delirium and neuropsychiatric sequelae of the disease. Unique examination findings and responses to treatment have been identified. OBJECTIVE: In this article, we seek to provide pharmacologic and treatment recommendations specific to delirium in patients with COVID-19. METHODS: We performed a literature search reviewing the neuropsychiatric complications and treatments in prior coronavirus epidemics including Middle Eastern respiratory syndrome and severe acute respiratory syndrome coronaviruses, as well as the emerging literature regarding COVID-19. We also convened a work group of consultation-liaison psychiatrists actively managing patients with COVID-19 in our hospital. Finally, we synthesized these findings to provide preliminary pharmacologic recommendations for treating delirium in these patients. RESULTS: Delirium is frequently found in patients who test positive for COVID-19, even in the absence of respiratory symptoms. There appears to be a higher rate of agitation, myoclonus, abulia, and alogia. No data are currently available on the treatment of delirium in patients with COVID-19. Extrapolating from general delirium treatment, Middle Eastern respiratory syndrome/severe acute respiratory syndrome case reports, and our experience, preliminary recommendations for pharmacologic management have been assembled. CONCLUSIONS: COVID-19 is associated with neuropsychiatric symptoms. Low-potency neuroleptics and alpha-2 adrenergic agents may be especially useful in this setting. Further research into the pathophysiology of COVID-19 will be key in developing more targeted treatment guidelines.


Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Antipsicóticos/uso terapêutico , Encefalopatias/fisiopatologia , Infecções por Coronavirus/fisiopatologia , Delírio/tratamento farmacológico , Agonistas de Dopamina/uso terapêutico , Pneumonia Viral/fisiopatologia , Betacoronavirus , Encefalopatias/psicologia , Depressores do Sistema Nervoso Central/uso terapêutico , Infecções por Coronavirus/psicologia , Delírio/fisiopatologia , Delírio/psicologia , Moduladores GABAérgicos/uso terapêutico , Humanos , Lorazepam/uso terapêutico , Melatonina/uso terapêutico , Pandemias , Pneumonia Viral/psicologia , Guias de Prática Clínica como Assunto
6.
Asian Cardiovasc Thorac Ann ; 28(9): 566-571, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32757652

RESUMO

BACKGROUND: Postoperative delirium is common in patients undergoing coronary artery bypass grafting, characterized by cognitive decline. This study aimed to evaluate the effect of early planned mobilization on delirium after coronary artery bypass grafting. METHODS: This double-blind randomized clinical trial enrolled 92 consecutive patients who underwent coronary artery bypass grafting from September to December 2018. The patients were divided into two groups of 46: a mobilization protocol was applied in the intervention group in the first 2 days after surgery; the control group received routine nursing care only. Demographic data, medical records, and Neecham confusion scores were analyzed. RESULTS: Patients in the control group used cigarettes (31.1% vs. 11.1%, p = 0.020) and opium poppy for recreation (35.6% vs. 8.9%, p = 0.002) more frequently, had longer intubation times (11.91 ± 3.87 vs. 10.23 ± 2.71 h, p = 0.020), and fewer blood components infused (15.6% vs. 33.3%, p = 0.05). More patients in the intervention group had normal function on the 2nd postoperative day compared to the control group (25 vs. 2, respectively, p = 0.001). The intervention group had significantly higher Neecham scores on postoperative day 2 (22.49 ± 2.03 vs. 26.82 ± 2.10, p = 0.001). Multivariable analysis showed significant associations between Neecham score and age (p = 0.022), ejection fraction (p = 0.015), myocardial infarction (p = 0.016), systolic pressure (p = 0.009), and diastolic pressure (p = 0.008). CONCLUSIONS: Early planned mobilization was effective in reducing postoperative delirium in patients undergoing coronary artery bypass grafting.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Delírio/prevenção & controle , Deambulação Precoce , Idoso , Cognição , Delírio/etiologia , Delírio/psicologia , Método Duplo-Cego , Feminino , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Proteção , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
Psychosomatics ; 61(5): 544-550, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32591212

Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/uso terapêutico , Antipsicóticos/uso terapêutico , Infecções por Coronavirus/terapia , Delírio/tratamento farmacológico , Hipnóticos e Sedativos/efeitos adversos , Pneumonia Viral/terapia , Agitação Psicomotora/tratamento farmacológico , Medicamentos Indutores do Sono/uso terapêutico , Idoso , Analgésicos Opioides/efeitos adversos , Azepinas/uso terapêutico , Betacoronavirus , Depressores do Sistema Nervoso Central/uso terapêutico , Clordiazepóxido/efeitos adversos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/psicologia , Delírio/etiologia , Delírio/fisiopatologia , Delírio/psicologia , Dexmedetomidina/efeitos adversos , Feminino , Guanfacina/uso terapêutico , Haloperidol/uso terapêutico , Humanos , Hidromorfona/efeitos adversos , Unidades de Terapia Intensiva , Ketamina/efeitos adversos , Melatonina/uso terapêutico , Midazolam/efeitos adversos , Oxicodona/efeitos adversos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/fisiopatologia , Pneumonia Viral/psicologia , Propofol/efeitos adversos , Agitação Psicomotora/etiologia , Agitação Psicomotora/fisiopatologia , Agitação Psicomotora/psicologia , Respiração Artificial , Transtornos do Sono do Ritmo Circadiano/tratamento farmacológico , Transtornos do Sono do Ritmo Circadiano/etiologia , Transtornos do Sono do Ritmo Circadiano/fisiopatologia , Traqueostomia , Triazóis/uso terapêutico , Ácido Valproico/uso terapêutico
9.
Asclepio ; 72(1): 0-0, ene.-jun. 2020.
Artigo em Espanhol | IBECS | ID: ibc-195646

RESUMO

OBJETIVO: comprender la semiología del delirio místico-religioso y la incidencia del contenido sociocultural en la configuración de los síntomas en la psicopatología moderna en Colombia, 1920-1960. METODOLOGÍA: investigación histórico-hermenéutica, mediante análisis de una serie de historias clínicas del antiguo Manicomio Departamental de Antioquia y del Asilo Psiquiátrico San Isidro del Valle del Cauca. RESULTADOS: entre las psicopatologías más recurrentes en las que se manifestaron los delirios se encuentra el grupo de las manías, principalmente la intermitente, psicosis maniaco-depresiva y melancolía; seguido por la esquizofrenia paranoide, y también fue frecuente en la psicosis puerperal o posparto; asimismo, se presentó en la parálisis general progresiva (neurosífilis) y en el síndrome cerebral agudo o estado de confusión agudo, nosografía moderna dada al delirio. Según las historias clínicas, la exaltación de ideas religiosas confluye en un delirio polimorfo. Los síntomas más recurrentes fueron las alucinaciones visuales y auditivas, logorrea o locuacidad, insomnio, negativismo alimentario acompañado de miedo a ser envenenado, excitación psicomotora o hiperquinética, accesos de furia controlados con camisa de fuerza y otros medios de contención, intento de suicidio y tendencia a la fuga de la casa, por lo tanto, se consideraba de peligrosidad para sí mismos y para los demás


OBJECTIVE: To understand the semiotics of mystical-religious delirium and the incidence of sociocultural content in the configuration of symptoms in modern psychiatry in Colombia, 1920-1960. METHODOLOGY: hermeneutic historical, research by analysis of a series of case histories of the old Madhouse Department of Antioquia and the Psychiatric Asylum San Isidro del Valle del Cauca. RESULTS: Among the most frequent psychopathologies in which delusions demonstrated is the group of hobbies, mainly intermittent, manic depression and melancholy; followed by paranoid schizophrenia, and was also common in puerperal or postpartum psychosis; He also appeared in general paresis (neurosyphilis) and acute brain syndrome or acute confusional state, delirium given modern nosography. According to medical records, the exaltation of religious ideas comes together in a polymorph delirium. The most frequent symptoms were visual and auditory hallucinations, logorrea or talkativeness, insomnia, accompanied food negativism fear of being poisoned, psychomotor or hyperkinetic excitement, fits of rage controlled straitjacket and other means of containment, attempted suicide and trend the escape of the house, therefore it was considered dangerous to themselves and others


Assuntos
Humanos , História do Século XIX , História do Século XX , Religião e Psicologia , Psicopatologia/história , Delírio/história , Delírio/psicologia , Esquizofrenia Paranoide/psicologia , Alucinações/história , Alucinações/psicologia , Transtornos Mentais/psicologia , Esquizofrenia Paranoide/história , Colômbia , Cristianismo
10.
Anaesthesiol Intensive Ther ; 52(2): 132-138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32419438

RESUMO

In March 2020, the World Health Organisation announced the COVID-19 pandemic caused by the SARS-CoV-2 virus. As well as respiratory failure, the SARS-CoV-2 may cause central nervous system (CNS) involvement, including delirium occurring in critically ill patients (ICU delirium). Due attention must be paid to this subject in the face of the COVID-19 pandemic. Delirium, the detection of which takes less than two minutes, is frequently underestimated during daily routine ICU care, but it may be a prodromal symptom of infection or hypoxia associated with severe respiratory failure. During the COVID-19 pandemic, systematic delirium monitoring using validated tests (CAM-ICU or ICDSC) may be sacrificed. This is likely to be due to the fact that the main emphasis is placed on organisational issues, i.e. the lack of ventilators, setting priorities for limited mechanical ventilation options, and a shortage of personal protective equipment. Early identification of patients with delirium is critical in patients with COVID-19 because the occurrence of delirium may be an early symptom of worsening respiratory failure or of infectious spread to the CNS mediated by potential neuroinvasive mechanisms of the coronavirus. The purpose of this review is to identify problems related to the development of delirium during the COVID-19 epidemic, which are presented in three areas: i) factors contributing to delirium in COVID-19, ii) potential pathophysiological factors of delirium in COVID-19, and iii) long-term consequences of delirium in COVID-19. This article discusses how healthcare workers can reduce the burden of delirium by identifying potential risk factors and difficulties during challenges associated with SARS-CoV-2 infection.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Delírio/etiologia , Unidades de Terapia Intensiva , Pneumonia Viral/complicações , Delírio/diagnóstico , Delírio/prevenção & controle , Delírio/psicologia , Humanos , Pandemias
11.
Medicine (Baltimore) ; 99(20): e20159, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443331

RESUMO

Postoperative delirium (PD), characterized by acute onset of global impairment in consciousness and cognition, is a common complication following major surgeries and is often associated with adverse outcomes. Because of the multiple comorbidities of the patient along with extensive nature of the surgery, patients undergoing surgery for bone metastases may be prone to developing PD. However, no study exists regarding PD in patients who undergo surgery for bone metastases.Two hundred seventy six patients with mean age of 64 years (range, 16-94) who underwent surgery for bone metastases were reviewed. The diagnosis of PD was made by the psychiatrist, according to fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. Possible perioperative clinic-pathologic factors that may be associated with the development of PD were investigated.Among the 276 patients, 9% (n = 25) developed PD. On multivariate logistic regression analysis, history of psychiatric disorders (odds ratio [OR] = 9.63; 95% confidence interval [CI] 1.78-21.74, P = .004), high preoperative serum C-reactive protein (CRP) level (OR = 1.17; 95% CI 1.06-1.29, P = .001), low preoperative serum albumin level (OR = 0.13; 95% CI 0.03-0.48, P = 0.002), and high dose of opioid analgesics received in the immediate postoperative period (OR = 1.05; 95% CI 1.01-1.07, P = .001) were independently associated with the development of PD. Patients with PD had lower survival (log rank, P = .001) than patients without PD.Incidence of PD is considerable in patients undergoing surgery for bone metastases. History of psychiatric disorders, preoperative serum albumin and CRP levels, and the dose of postoperative opioid analgesics are associated with the development of PD.


Assuntos
Neoplasias Ósseas/cirurgia , Delírio/etiologia , Metástase Neoplásica/patologia , Idoso , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Neoplasias Ósseas/secundário , Proteína C-Reativa/análise , Cognição/efeitos dos fármacos , Cognição/fisiologia , Comorbidade , Delírio/epidemiologia , Delírio/mortalidade , Delírio/psicologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Período Pré-Operatório , Estudos Retrospectivos , Fatores de Risco , Albumina Sérica/análise
12.
J Clin Nurs ; 29(13-14): 2363-2377, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32220101

RESUMO

AIMS AND OBJECTIVES: To explore older inpatients' experiences and perceptions of delirium and nonpharmacological delirium prevention strategies (NDPS). BACKGROUND: Delirium is a distressing and serious complication in hospitalised older adults. NDPS (supporting nutrition, mobility and cognitive participation) have strong supporting evidence. Few studies have explored older inpatients' perspectives of these strategies. This information may assist staff to better support patient participation in NDPS. DESIGN: Qualitative study using an interpretive descriptive (ID) methodological approach to explore older patient's experience of delirium and NDPS. METHODS: Structured interviews of inpatients aged over 65 years across 6 medical and surgical wards explored patients' experiences and perceptions of delirium and prevention activities related to nutrition, mobility and cognition; and barriers and enablers to participation. Reporting used COREQ. RESULTS: Twenty-three participants were included (12 male, 11 reported delirium experience). Participants reported a range of physiological, emotional and psychological responses to delirium, hearing about delirium was different to experiencing it. Most participants were aware of the benefits of maintaining nutrition and hydration, physical activity and cognitive engagement in hospital. Barriers included poor symptom control, inflexible routines and inconsistent communication, whilst enablers included access to equipment, family involvement, staff encouragement and individual goals. These were organised into themes: outlook, feeling well enough, hospital environment, feeling informed and listened to, and support networks. CONCLUSION: A more patient-centred approach to delirium prevention requires consideration of older people's values, needs, preferences and fit within the hospital environment and routines. Feeling informed, listened to and receiving support from staff and family carers can improve older inpatients' engagement in NPDS to prevent delirium in hospital. RELEVANCE TO CLINICAL PRACTICE: Nurses are ideally placed to improve patient participation in NDPS through holistic assessment and care, addressing symptoms, providing clear information about delirium and delirium prevention, and facilitating family carer support and patient interactions.


Assuntos
Enfermagem de Cuidados Críticos/métodos , Delírio/prevenção & controle , Relações Enfermeiro-Paciente , Assistência Centrada no Paciente/métodos , Idoso , Idoso de 80 Anos ou mais , Delírio/enfermagem , Delírio/psicologia , Feminino , Hospitalização , Humanos , Masculino , Pesquisa Qualitativa
14.
Lancet Child Adolesc Health ; 4(4): 312-321, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32087768

RESUMO

Delirium is a syndrome characterised by an acute and fluctuating alteration in cognition and awareness. It occurs frequently in children with serious medical illness, and is associated with adverse outcomes such as increased length of hospital stay, duration of mechanical ventilation, hospital costs, and mortality. Delirium-especially the hypoactive subtype-is often overlooked by paediatric practitioners, but can be reduced by mitigating risks and effectively managed if detected early. Non-modifiable risk factors of delirium include young age (age <2 years), cognitive or neurological disabilities, need for invasive mechanical ventilation, severe underlying illness and pre-existing chronic conditions, and poor nutritional status. Routine bedside screening using validated tools can enable early detection of delirium. To reduce delirium in hospitalised children, health-care providers should optimise the hospital environment (eg, by reducing sleep disruption and keeping the child stimulated during the day), improve pain management, and decrease sedation (particularly use of benzodiazepines).


Assuntos
Criança Hospitalizada/psicologia , Delírio/prevenção & controle , Delírio/psicologia , Respiração Artificial/efeitos adversos , Estudos de Casos e Controles , Criança Hospitalizada/estatística & dados numéricos , Pré-Escolar , Disfunção Cognitiva/epidemiologia , Delírio/classificação , Delírio/mortalidade , Diagnóstico Precoce , Humanos , Lactente , Tempo de Internação/tendências , Programas de Rastreamento/métodos , Doenças do Sistema Nervoso/epidemiologia , Estado Nutricional , Testes Imediatos/normas , Respiração Artificial/estatística & dados numéricos , Fatores de Risco
15.
J Grad Med Educ ; 12(1): 115-116, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32064065
17.
Neuropsychiatr ; 34(1): 22-26, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-31970717

RESUMO

BACKGROUND: Despite the demographic development and the increasing number of psychiatric diseases in older people, there are only few scientific investigations on the characteristics of patients in gerontopsychiatry and their mortality. In this retrospective case control study patient data were examined in order to establish which features of patients who died in a department of gerontopsychiatry show differences to those of patients who were discharged. METHOD: A total of 284 patient files from the department of gerontopsychiatry and geriatric psychotherapy of the State Hospital Graz II were evaluated. Between 1 January 2015 and 31 December 2017, a total of 51 women and 91 men died (= cases) in hospital. These patients were compared with 142 sex-matched patients (control group) who were discharged during the same period of time. The evaluation was carried out using logistic regression models. RESULTS: Patients who died on the geriatric psychiatry ward were clearly older and were in a clearly poorer physical state of health than the discharged patients. The deceased patients had a 2.7-fold higher chance of an ischemic cardiac disease as well as a 2.5-fold and 3.5-fold higher chance of being referred from a nursing home or hospital, respectively. They also had a threefold higher chance for a lower functional status, a fourfold increased chance of higher C­reactive protein (CRP) values and a diagnosis of delirium compared to discharged patients. CONCLUSION: The deceased patients had a substantially poorer state of health and tended to suffer more from delirium compared to the discharged patients. Structural health policy precautions must be undertaken so that unnecessary transfers to gerontopsychiatry departments do not become necessary.


Assuntos
Delírio/epidemiologia , Delírio/psicologia , Pacientes Internados/psicologia , Pacientes Internados/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Áustria/epidemiologia , Feminino , Humanos , Masculino , Estudos Retrospectivos
18.
Anesth Analg ; 130(1): 79-86, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31478933

RESUMO

BACKGROUND: Post-hip fracture surgery delirium (PHFD) is a significant clinical problem in older patients, but an adequate, simple risk prediction model for use in the preoperative period has not been developed. METHODS: The 2016 American College of Surgeons National Surgical Quality Improvement Program Hip Fracture Procedure Targeted Participant Use Data File was used to obtain a cohort of patients ≥60 years of age who underwent hip fracture surgery (n = 8871; randomly assigned to derivation [70%] or validation [30%] cohorts). A parsimonious prediction model for PHFD was developed in the derivation cohort using stepwise multivariable logistic regression with further removal of variables by evaluating changes in the area under the receiver operator characteristic curve (AUC). A risk score was developed from the final multivariable model. RESULTS: Of 6210 patients in the derivation cohort, PHFD occurred in 1816 (29.2%). Of 32 candidate variables, 9 were included in the final model: (1) preoperative delirium (adjusted odds ratio [aOR], 8.32 [95% confidence interval {CI}, 6.78-10.21], 8 risk score points); (2) preoperative dementia (aOR, 2.38 [95% CI, 2.05-2.76], 3 points); (3) age (reference, 60-69 years of age) (age 70-79: aOR, 1.60 [95% CI, 1.20-2.12], 2 points; age 80-89: aOR, 2.09 [95% CI, 1.59-2.74], 2 points; and age ≥90: aOR, 2.43 [95% CI, 1.82-3.23], 3 points); (4) medical comanagement (aOR, 1.43 [95% CI, 1.13-1.81], 1 point); (5) American Society of Anesthesiologists (ASA) physical status III-V (aOR, 1.40 [95% CI, 1.14-1.73], 1 point); (6) functional dependence (aOR, 1.37 [95% CI, 1.17-1.61], 1 point); (7) smoking (aOR, 1.36 [95% CI, 1.07-1.72], 1 point); (8) systemic inflammatory response syndrome/sepsis/septic shock (aOR, 1.34 [95% CI, 1.09-1.65], 1 point); and (9) preoperative use of mobility aid (aOR, 1.32 [95% CI, 1.14-1.52], 1 point), resulting in a risk score ranging from 0 to 20 points. The AUCs of the logistic regression and risk score models were 0.77 (95% CI, 0.76-0.78) and 0.77 (95% CI, 0.76-0.78), respectively, with similar results in the validation cohort. CONCLUSIONS: A risk score based on 9 preoperative risk factors can predict PHFD in older adult patients with fairly good accuracy.


Assuntos
Técnicas de Apoio para a Decisão , Delírio/etiologia , Fixação de Fratura/efeitos adversos , Fraturas do Quadril/cirurgia , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Delírio/diagnóstico , Delírio/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Resultado do Tratamento
19.
Brain Stimul ; 13(1): 15-19, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31492631

RESUMO

BACKGROUND: Lithium is a helpful adjunct to patients undergoing ECT. However, only case reports and limited data suggest increase risk of delirium. Thus, this continues to be a controversial issue. OBJECTIVE: In this study, we examine 1) The association and odds of delirium and cognitive problems with ECT and lithium (ECT + Li) combination compared to ECT alone, 2) If positively associated, would this association vary by both type of mood episode and type of disorder? METHODS: A national sample of 64,728 adult psychiatric inpatients across the US (identified from a total data of about 70 million total discharges annually) was analyzed using linear-by-linear association and logistic regression to assess the odds ratio (OR) for delirium and cognitive impairment for those treated with lithium (N = 158), ECT (N = 64148), or ECT + Li (N = 422) after adjusting for demographics and psychiatric diagnoses. RESULTS: The prevalence of delirium was higher in the ECT + Lithium group (5.7%) vs. ECT only (0.6%) or lithium only groups (0%). Patients managed with ECT + Lithium have 11.7-fold higher odds (95% CI 7.55-17.99, P < 0.001) of delirium compared to ECT alone. In the ECT + Li group, delirium prevalence was 7.8% in unipolar depression, 3.4% in bipolar depressed, 0% in bipolar mania. CONCLUSION: These results are surprising given the fading concern about delirium association with ECT + lithium combination. The high odds in the combination group warrant clinical caution, use of lower lithium doses (if combinations cannot be avoided), and vigilance regarding early signs of delirium. These results warrant replication in future studies.


Assuntos
Disfunção Cognitiva/etiologia , Delírio/etiologia , Transtorno Depressivo Maior/terapia , Transtorno Depressivo Resistente a Tratamento/terapia , Eletroconvulsoterapia/efeitos adversos , Carbonato de Lítio/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Delírio/epidemiologia , Delírio/psicologia , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Resistente a Tratamento/epidemiologia , Transtorno Depressivo Resistente a Tratamento/psicologia , Eletroconvulsoterapia/métodos , Feminino , Humanos , Carbonato de Lítio/administração & dosagem , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
20.
Anesth Analg ; 130(3): 586-595, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31569161

RESUMO

BACKGROUND: Postoperative delirium and postoperative cognitive dysfunction (POCD) are common after cardiac surgery and contribute to an increased risk of postoperative complications, longer length of stay, and increased hospital mortality. Cognitive training (CT) may be able to durably improve cognitive reserve in areas deficient in delirium and POCD and, therefore, may potentially reduce the risk of these conditions. We sought to determine the feasibility and potential efficacy of a perioperative CT program to reduce the incidence of postoperative delirium and POCD in older cardiac surgery patients. METHODS: Randomized controlled trial at a single tertiary care center. Participants included 45 older adults age 60-90 undergoing cardiac surgery at least 10 days from enrollment. Participants were randomly assigned in a 1:1 fashion to either perioperative CT via a mobile device or a usual care control. The primary outcome of feasibility was evaluated by enrollment patterns and adherence to protocol. Secondary outcomes of postoperative delirium and POCD were assessed using the Confusion Assessment Method and the Montreal Cognitive Assessment, respectively. Patient satisfaction was assessed via a postoperative survey. RESULTS: Sixty-five percent of eligible patients were enrolled. Median (interquartile range [IQR]) adherence (as a percentage of prescribed minutes played) was 39% (20%-68%), 6% (0%-37%), and 19% (0%-56%) for the preoperative, immediate postoperative, and postdischarge periods, respectively. Median (IQR) training times were 245 (136-536), 18 (0-40), and 122 (0-281) minutes for each period, respectively. The incidence of postoperative delirium (CT group 5/20 [25%] versus control 3/20 [15%]; P = .69) and POCD (CT group 53% versus control 37%; P = .33) was not significantly different between groups for either outcome in this limited sample. CT participants reported a high level of agreement (on a scale of 0-100) with statements that the program was easy to use (median [IQR], 87 [75-97]) and enjoyable (85 [79-91]). CT participants agreed significantly more than controls that their memory (median [IQR], 75 [54-82] vs 51 [49-54]; P = .01) and thinking ability (median [IQR], 78 [64-83] vs 50 [41-68]; P = .01) improved as a result of their participation in the study. CONCLUSIONS: A CT program designed for use in the preoperative period is an attractive target for future investigations of cognitive prehabilitation in older cardiac surgery patients. Changes in the functionality of the program and enrichment techniques may improve adherence in future trials. Further investigation is necessary to determine the potential efficacy of cognitive prehabilitation to reduce the risk of postoperative delirium and POCD.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cognição , Terapia Cognitivo-Comportamental , Delírio/prevenção & controle , Assistência Perioperatória , Complicações Cognitivas Pós-Operatórias/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Boston , Delírio/etiologia , Delírio/psicologia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Satisfação do Paciente , Complicações Cognitivas Pós-Operatórias/etiologia , Complicações Cognitivas Pós-Operatórias/psicologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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