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1.
Am J Geriatr Psychiatry ; 32(9): 1093-1104, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38171949

RESUMO

OBJECTIVES: To measure the diagnostic accuracy of DeltaScan: a portable real-time brain state monitor for identifying delirium, a manifestation of acute encephalopathy (AE) detectable by polymorphic delta activity (PDA) in single-channel electroencephalograms (EEGs). DESIGN: Prospective cross-sectional study. SETTING: Six Intensive Care Units (ICU's) and 17 non-ICU departments, including a psychiatric department across 10 Dutch hospitals. PARTICIPANTS: 494 patients, median age 75 (IQR:64-87), 53% male, 46% in ICUs, 29% delirious. MEASUREMENTS: DeltaScan recorded 4-minute EEGs, using an algorithm to select the first 96 seconds of artifact-free data for PDA detection. This algorithm was trained and calibrated on two independent datasets. METHODS: Initial validation of the algorithm for AE involved comparing its output with an expert EEG panel's visual inspection. The primary objective was to assess DeltaScan's accuracy in identifying delirium against a delirium expert panel's consensus. RESULTS: DeltaScan had a 99% success rate, rejecting 6 of the 494 EEG's due to artifacts. Performance showed and an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.86 (95% CI: 0.83-0.90) for AE (sensitivity: 0.75, 95%CI=0.68-0.81, specificity: 0.87 95%CI=0.83-0.91. The AUC was 0.71 for delirium (95%CI=0.66-0.75, sensitivity: 0.61 95%CI=0.52-0.69, specificity: 72, 95%CI=0.67-0.77). Our validation aim was an NPV for delirium above 0.80 which proved to be 0.82 (95%CI: 0.77-0.86). Among 84 non-delirious psychiatric patients, DeltaScan differentiated delirium from other disorders with a 94% (95%CI: 87-98%) specificity. CONCLUSIONS: DeltaScan can diagnose AE at bedside and shows a clear relationship with clinical delirium. Further research is required to explore its role in predicting delirium-related outcomes.


Assuntos
Encefalopatias , Delírio , Eletroencefalografia , Unidades de Terapia Intensiva , Humanos , Delírio/diagnóstico , Masculino , Feminino , Idoso , Estudos Transversais , Estudos Prospectivos , Idoso de 80 Anos ou mais , Eletroencefalografia/métodos , Pessoa de Meia-Idade , Encefalopatias/diagnóstico , Encefalopatias/complicações , Algoritmos , Sensibilidade e Especificidade
2.
Age Ageing ; 50(3): 631-640, 2021 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-33951156

RESUMO

BACKGROUND: During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, older patients had an increased risk of hospitalisation and death. Reports on the association of frailty with poor outcome have been conflicting. OBJECTIVE: The aim of the present study was to investigate the independent association between frailty and in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands. METHODS: This was a multicentre retrospective cohort study in 15 hospitals in the Netherlands, including all patients aged ≥70 years, who were hospitalised with clinically confirmed COVID-19 between February and May 2020. Data were collected on demographics, co-morbidity, disease severity and Clinical Frailty Scale (CFS). Primary outcome was in-hospital mortality. RESULTS: A total of 1,376 patients were included (median age 78 years (interquartile range 74-84), 60% male). In total, 499 (38%) patients died during hospital admission. Parameters indicating presence of frailty (CFS 6-9) were associated with more co-morbidities, shorter symptom duration upon presentation (median 4 versus 7 days), lower oxygen demand and lower levels of C-reactive protein. In multivariable analyses, the CFS was independently associated with in-hospital mortality: compared with patients with CFS 1-3, patients with CFS 4-5 had a two times higher risk (odds ratio (OR) 2.0 (95% confidence interval (CI) 1.3-3.0)) and patients with CFS 6-9 had a three times higher risk of in-hospital mortality (OR 2.8 (95% CI 1.8-4.3)). CONCLUSIONS: The in-hospital mortality of older hospitalised COVID-19 patients in the Netherlands was 38%. Frailty was independently associated with higher in-hospital mortality, even though COVID-19 patients with frailty presented earlier to the hospital with less severe symptoms.


Assuntos
COVID-19/mortalidade , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/complicações , Hospitalização/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Fragilidade/diagnóstico , Mortalidade Hospitalar , Humanos , Masculino , Países Baixos/epidemiologia , Estudos Retrospectivos , SARS-CoV-2
3.
Age Ageing ; 47(1): 48-55, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-28985255

RESUMO

Background: because the few randomised placebo-controlled trials investigating the potential role for prophylactic haloperidol in delirium prevention have focused on specific surgical populations, we investigated its efficacy and safety in acutely hospitalised older patients. Methods: this multi-centre, double-blind, stratified, block randomised, placebo-controlled trial was conducted at six Dutch hospitals. Patients age ≥70 years, acutely admitted through the emergency department for general medicine or surgical specialties and at risk for delirium were randomised (n = 245) to haloperidol or placebo 1 mg orally twice-daily (maximum of 14 doses) on top of standard nonpharmacological prevention strategies. The primary outcome was delirium incidence. Other endpoints included delirium severity and duration, drug safety and clinical outcomes. Results: intention-to-treat analysis included 242 participants (calculated sample size n = 390, statistical power of current sample 59%) allocated to haloperidol (n = 118) or placebo (n = 124). In the haloperidol and placebo group, delirium incidence was 19.5 versus 14.5% (OR 1.43, 95% CI 0.72 to 2.78); median (IQR) delirium duration 4 (2, 5) versus 3 (1, 6) days (P = 0.366); maximum DRS-R-98 score 16 (9.8, 19.5) versus 10 (5.5, 22.5) (P = 0.549; 53.7% missing data); hospital LOS 7 (4, 10.3) versus 7 (5, 11.8) days (P = 0.343); 3-month mortality 9.9 versus 12.5% (OR 0.77, 95% CI 0.34 to 1.75), respectively. No treatment-limiting side effects were noted. Conclusions: prophylactic low-dose oral haloperidol did not reduce delirium incidence in acutely hospitalised older patients. Therefore, prophylactic use of haloperidol in this population is not recommended.


Assuntos
Antipsicóticos/administração & dosagem , Delírio/prevenção & controle , Haloperidol/administração & dosagem , Admissão do Paciente , Administração Oral , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antipsicóticos/efeitos adversos , Distribuição de Qui-Quadrado , Delírio/diagnóstico , Delírio/epidemiologia , Delírio/psicologia , Método Duplo-Cego , Esquema de Medicação , Feminino , Haloperidol/efeitos adversos , Humanos , Incidência , Análise de Intenção de Tratamento , Tempo de Internação , Masculino , Países Baixos/epidemiologia , Razão de Chances , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
4.
BMC Geriatr ; 14: 96, 2014 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-25168927

RESUMO

BACKGROUND: Delirium is associated with substantial morbidity and mortality rates in elderly hospitalised patients, and a growing problem due to increase in life expectancy. Implementation of standardised non-pharmacological delirium prevention strategies is challenging and adherence remains low. Pharmacological delirium prevention with haloperidol, currently the drug of choice for delirium, seems promising. However, the generalisability of randomised controlled trial results is questionable since studies have only been performed in selected postoperative hip-surgery and intensive care unit patient populations. We therefore present the design of the multicenter, randomised, double-blind, placebo-controlled clinical trial on early pharmacological intervention to prevent delirium: haloperidol prophylaxis in older emergency department patients (The HARPOON study). METHODS/DESIGN: In six Dutch hospitals, at-risk patients aged 70 years or older acutely admitted through the emergency department for general medicine and surgical specialties are randomised (n = 390) for treatment with prophylactic haloperidol 1 mg or placebo twice daily for a maximum of seven consecutive days. Primary outcome measure is the incidence of in-hospital delirium within seven days of start of the study intervention, diagnosed with the Confusion Assessment Method, and the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria for delirium. Secondary outcome measures include delirium severity and duration assessed with the Delirium Rating Scale Revised 98; number of delirium-free days; adverse events; hospital length-of-stay; all-cause mortality; new institutionalisation; (Instrumental) Activities of Daily Living assessed with the Katz Index of ADL, and Lawton IADL scale; cognitive function assessed with the Six-item Cognitive Impairment Test, and the Dutch short form Informant Questionnaire on Cognitive Decline in the Elderly. Patients will be contacted by telephone three and six months post-discharge to collect data on cognitive- and physical function, home residency, all-cause hospital admissions, and all-cause mortality. DISCUSSION: The HARPOON study will provide relevant information on the efficacy and safety of prophylactic haloperidol treatment for in-hospital delirium and its effects on relevant clinical outcomes in elderly at-risk medical and surgical patients. TRIAL REGISTRATION: EudraCT Number: 201100476215; ClinicalTrials.gov Identifier: NCT01530308; Dutch Clinical Trial Registry: NTR3207.


Assuntos
Antipsicóticos/administração & dosagem , Delírio/prevenção & controle , Serviço Hospitalar de Emergência , Haloperidol/administração & dosagem , Admissão do Paciente , Idoso , Idoso de 80 Anos ou mais , Antipsicóticos/efeitos adversos , Doenças dos Gânglios da Base/induzido quimicamente , Delírio/diagnóstico , Método Duplo-Cego , Serviço Hospitalar de Emergência/tendências , Feminino , Seguimentos , Haloperidol/efeitos adversos , Humanos , Masculino , Admissão do Paciente/tendências , Fatores de Risco , Centro Cirúrgico Hospitalar/tendências , Resultado do Tratamento
5.
Atherosclerosis ; 170(1): 59-72, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12957683

RESUMO

This randomised double-blind, placebo-controlled, clinical trial investigated the effect of 3 months of treatment with calcium dobesilate on endothelium-dependent vasodilation, markers of endothelial function, blood pressure, and markers of oxidation in obese, male smokers. Vascular effects may depend on the type of vessel and we, therefore, investigated both smaller arteries, i.e. resistance arteries and small arterioles, and large conduit arteries. Vascular function was measured by acetylcholine- and sodium-nitroprusside-mediated vasodilation, and capillary recruitment, in the skin microcirculation; by forearm blood flow (FBF) responses to several agonists and to N-G-monomethyl L-arginine (L-NMMA) in the forearm vascular bed; by flow-mediated vasodilation in the brachial artery; and by determination of soluble levels of vascular cell adhesion molecule-1 (sVCAM-1), intercellular adhesion molecule-1 (sICAM-1) and E-selectin. Twenty-eight individuals received dobesilate and 24 placebo. No effect of calcium dobesilate on endothelial function, blood pressure or markers of oxidation was observed compared with placebo. The difference in acetylcholine-mediated vasodilation in the microcirculation was -52.1%-point (95% confidence interval -132.8 to 28.1); in sodium-nitroprusside-mediated vasodilation in the microcirculation, 2.6%-point (-95.1 to 100.2); in capillary recruitment, 2.5%-point (-6.8 to 11.7); in acetylcholine-induced increases in FBF (n=28), 23%-point (-173 to 126); in L-NMMA-induced reduction of basal FBF, -2.8%-point (-29.3 to 23.8); in flow-mediated vasodilation of the brachial artery, 0.3%-points (-2.7 to 3.3); in 24-h systolic blood pressure, 2.1 mmHg (-1.3 to 5.5); in soluble VCAM-1, 54 ng/ml (-8 to 115); in soluble ICAM-1, 9 ng/ml (-49 to 67); in sE-selectin, -17 ng/ml (-44 to 11); in ketocholesterol 5 nM (-17 to 26); and in oxidised LDL -1.6 U/l (-6.7 to 3.5). We have shown that endothelial function, blood pressure, and markers of oxidation were not affected by 3 months of treatment with calcium dobesilate in mildly obese, smoking men. Thus, our data provide no evidence of an effect on vascular function of calcium dobesilate in humans.


Assuntos
Pressão Sanguínea/efeitos dos fármacos , Dobesilato de Cálcio/uso terapêutico , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/fisiopatologia , Hemostáticos/uso terapêutico , Obesidade/tratamento farmacológico , Obesidade/fisiopatologia , Fumar/tratamento farmacológico , Fumar/fisiopatologia , Adolescente , Adulto , Alanina Transaminase/sangue , Biomarcadores/sangue , Monitorização Ambulatorial da Pressão Arterial , Dobesilato de Cálcio/efeitos adversos , Capilares/efeitos dos fármacos , Capilares/fisiologia , Diástole/efeitos dos fármacos , Método Duplo-Cego , Inibidores Enzimáticos/administração & dosagem , Seguimentos , Antebraço/irrigação sanguínea , Frequência Cardíaca/efeitos dos fármacos , Hemostáticos/efeitos adversos , Humanos , Cetocolesteróis/sangue , Lipoproteínas LDL/sangue , Lipoproteínas LDL/efeitos dos fármacos , Masculino , Microcirculação/efeitos dos fármacos , Pessoa de Meia-Idade , Doadores de Óxido Nítrico/uso terapêutico , Nitroprussiato/uso terapêutico , Obesidade/sangue , Oxirredução , Cooperação do Paciente , Valores de Referência , Fluxo Sanguíneo Regional/efeitos dos fármacos , Fumar/sangue , Sístole/efeitos dos fármacos , Resultado do Tratamento , Vasodilatação/efeitos dos fármacos , Vasodilatadores/uso terapêutico , ômega-N-Metilarginina/administração & dosagem
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