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Latest & greatest articles for delirium
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Effect of Haloperidol on Survival Among Critically Ill Adults With a High Risk of Delirium: The REDUCE Randomized Clinical Trial. Importance: Results of studies on use of prophylactic haloperidol in critically ill adults are inconclusive, especially in patients at high risk of delirium. Objective: To determine whether prophylactic use of haloperidol improves survival among critically ill adults at high risk of delirium, which was defined as an anticipated intensive care unit (ICU) stay of (...) at least 2 days. Design, Setting, and Participants: Randomized, double-blind, placebo-controlled investigator-driven study involving 1789 critically ill adults treated at 21 ICUs, at which nonpharmacological interventions for delirium prevention are routinely used in the Netherlands. Patients without delirium whose expected ICU stay was at least a day were included. Recruitment was from July 2013 to December 2016 and follow-up was conducted at 90 days with the final follow-up on March 1, 2017
Assessment of delirium Assessment of delirium - Differential diagnosis of symptoms | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Assessment of delirium Last reviewed: August 2018 Last updated: June 2018 Summary Introduction Delirium is an acute, fluctuating change in mental status, with inattention, disorganised thinking, and altered levels of consciousness. Inouye SK, Schlesinger MJ, Lydon TJ. Delirium: a symptom of how hospital care is failing (...) older persons and a window to improve quality of hospital care. Am J Med. 1999;106:565-573. http://www.ncbi.nlm.nih.gov/pubmed/10335730?tool=bestpractice.com It is a potentially life-threatening disorder characterised by high morbidity and mortality. Guidelines address recognition, risk factors, and treatment for delirium. Barr J, Fraser GL, Puntillo K, et al; American College of Critical Care Medicine. Clinical practice guidelines for the management of pain, agitation, and delirium in adult
A Proactive Approach to High Risk Delirium Patients Undergoing Total Joint Arthroplasty 29174758 2017 11 27 1532-8406 2017 Nov 13 The Journal of arthroplasty J Arthroplasty A Proactive Approach to High Risk Delirium Patients Undergoing Total Joint Arthroplasty. S0883-5403(17)30988-9 10.1016/j.arth.2017.11.015 Delirium is a common complication among elderly patients undergoing total joint arthroplasty (TJA). Its incidence has been reported from 4% to 53%. The Centers for Medicare and Medicaid (...) Services consider delirium following TJA a "never-event." The purpose of this study is to evaluate a simple perioperative protocol used to identify delirium risk patients and prevent its incidence following TJA. Our group developed a protocol to identify and prevent delirium in patients undergoing TJA. All patients were screened and scored in the preoperative assessment, on criteria such as age, history of forgetfulness, history of agitation or visual hallucinations, history of falls, history
Delirium and Benzodiazepines Associated With Prolonged ICU Stay in Critically Ill Infants and Young Children PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
A prospective observational study to investigate utility of the Delirium Observational Screening Scale (DOSS) to detect delirium in care home residents 29036302 2017 10 16 2017 10 16 1468-2834 2017 Oct 05 Age and ageing Age Ageing A prospective observational study to investigate utility of the Delirium Observational Screening Scale (DOSS) to detect delirium in care home residents. 1-6 10.1093/ageing/afx155 care home residents are particularly at risk of delirium due to high prevalence (...) of dementia. The Delirium Observation Screening Scale (DOSS) identifies behavioural changes associated delirium onset that nursing staff are uniquely placed to recognise. We tested the psychometric properties of the DOSS in UK care homes compared with the Confusion Assessment Method (CAM). prospective observational cohort study performed between 1 March 2015 and 30 June 2016. nine UK residential and nursing care homes. residents over 65 years except those approaching end of life or unable to complete
Validation of the 6-Item Cognitive Impairment Test and the 4AT test for combined delirium and dementia screening in older Emergency Department attendees 28985260 2017 10 06 2017 10 06 1468-2834 2017 Sep 01 Age and ageing Age Ageing Validation of the 6-Item Cognitive Impairment Test and the 4AT test for combined delirium and dementia screening in older Emergency Department attendees. 1-7 10.1093/ageing/afx149 screening for cognitive impairment in Emergency Department (ED) requires short (...) , reliable tools. to validate the 4AT and 6-Item Cognitive Impairment Test (6-CIT) for ED dementia and delirium screening. diagnostic accuracy study. attendees aged ≥70 years in a tertiary care hospital's ED. trained researchers assessed participants using the Standardised Mini Mental State Examination, Delirium Rating Scale-Revised 98 and Informant Questionnaire on Cognitive Decline in the Elderly, informing ultimate expert diagnosis using Diagnostic and Statistical Manual of Mental Disorders (DSM-V
Haloperidol versus placebo for delirium prevention in acutely hospitalised older at risk patients: a multi-centre double-blind randomised controlled clinical trial 28985255 2017 10 06 2017 10 06 1468-2834 2017 Jul 15 Age and ageing Age Ageing Haloperidol versus placebo for delirium prevention in acutely hospitalised older at risk patients: a multi-centre double-blind randomised controlled clinical trial. 1-8 10.1093/ageing/afx124 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. 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
Development of the Japanese version of the Cornell Assessment of Pediatric Delirium 29445507 2018 11 13 2052-8817 5 1 2018 01 Acute medicine & surgery Acute Med Surg Development of the Japanese version of the Cornell Assessment of Pediatric Delirium. 98-101 10.1002/ams2.312 Delirium is a form of acute cerebral dysfunction and is associated with increased length of hospital stay, mortality, and health-care costs for adult patients in intensive care. However, in Japan, there are currently (...) no reliable criteria or tools for diagnosing delirium in critically ill pediatric patients. The purpose of this study was to translate the Cornell Assessment of Pediatric Delirium (CAPD)-a screening tool for pediatric delirium-from English to Japanese for use in the diagnosis of delirium for pediatric patients in pediatric intensive care units. The back-translation method was used to ensure equivalence in the Japanese version of the CAPD and its accompanying developmental anchor points. The translation
Delirium in Older Persons: Advances in Diagnosis and Treatment. Importance: Delirium is defined as an acute disorder of attention and cognition. It is a common, serious, and often fatal condition among older patients. Although often underrecognized, delirium has serious adverse effects on the individual's function and quality of life, as well as broad societal effects with substantial health care costs. Objective: To summarize the current state of the art in diagnosis and treatment of delirium (...) and to highlight critical areas for future research to advance the field. Evidence Review: Search of Ovid MEDLINE, Embase, and the Cochrane Library for the past 6 years, from January 1, 2011, until March 16, 2017, using a combination of controlled vocabulary and keyword terms. Since delirium is more prevalent in older adults, the focus was on studies in elderly populations; studies based solely in the intensive care unit (ICU) and non-English-language articles were excluded. Findings: Of 127 articles included
Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care: A Randomized Clinical Trial. Importance: The use of benzodiazepines to control agitation in delirium in the last days of life is controversial. Objective: To compare the effect of lorazepam vs placebo as an adjuvant to haloperidol for persistent agitation in patients with delirium in the setting of advanced cancer. Design, Setting, and Participants: Single (...) -center, double-blind, parallel-group, randomized clinical trial conducted at an acute palliative care unit at MD Anderson Cancer Center, Texas, enrolling 93 patients with advanced cancer and agitated delirium despite scheduled haloperidol from February 11, 2014, to June 30, 2016, with data collection completed in October 2016. Interventions: Lorazepam (3 mg) intravenously (n = 47) or placebo (n = 43) in addition to haloperidol (2 mg) intravenously upon the onset of an agitation episode. Main Outcomes
Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients: A Randomized Clinical Trial 28727581 2017 07 20 2017 09 22 1528-1175 127 4 2017 Oct Anesthesiology Anesthesiology Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients: A Randomized Clinical Trial. 633-644 10.1097/ALN.0000000000001804 Postoperative pain and opioid use are associated with postoperative delirium. We designed a single-center, randomized, placebo (...) -controlled, parallel-arm, double-blinded trial to determine whether perioperative administration of gabapentin reduced postoperative delirium after noncardiac surgery. Patients were randomly assigned to receive placebo (N = 347) or gabapentin 900 mg (N = 350) administered preoperatively and for the first 3 postoperative days. The primary outcome was postoperative delirium as measured by the Confusion Assessment Method. Secondary outcomes were postoperative pain, opioid use, and length of hospital stay
Intraoperative Infusion of Dexmedetomidine for Prevention of Postoperative Delirium and Cognitive Dysfunction in Elderly Patients Undergoing Major Elective Noncardiac Surgery: A Randomized Clinical Trial 28593326 2017 06 08 2017 06 08 2168-6262 2017 Jun 07 JAMA surgery JAMA Surg Intraoperative Infusion of Dexmedetomidine for Prevention of Postoperative Delirium and Cognitive Dysfunction in Elderly Patients Undergoing Major Elective Noncardiac Surgery: A Randomized Clinical Trial. e171505 (...) 10.1001/jamasurg.2017.1505 Postoperative delirium occurs in 10% to 60% of elderly patients having major surgery and is associated with longer hospital stays, increased hospital costs, and 1-year mortality. Emerging literature suggests that dexmedetomidine sedation in critical care units is associated with reduced incidence of delirium. However, intraoperative use of dexmedetomidine for prevention of delirium has not been well studied. To evaluate whether an intraoperative infusion of dexmedetomidine
Parecoxib Supplementation to Morphine Analgesia Decreases Incidence of Delirium in Elderly Patients After Hip or Knee Replacement Surgery: A Randomized Controlled Trial 28525512 2017 05 19 2017 05 19 1526-7598 124 6 2017 Jun Anesthesia and analgesia Anesth. Analg. Parecoxib Supplementation to Morphine Analgesia Decreases Incidence of Delirium in Elderly Patients After Hip or Knee Replacement Surgery: A Randomized Controlled Trial. 1992-2000 10.1213/ANE.0000000000002095 Severe pain and high-dose (...) opioids are both associated with increased risk of postoperative delirium. The authors investigated whether parecoxib-supplemented IV morphine analgesia could decrease the incidence of delirium in elderly patients after total hip or knee replacement surgery. In a randomized, double-blind, 2-center trial, patients of 60 years or older who underwent elective total hip or knee replacement surgery were assigned in a 1:1 ratio to receive either parecoxib (40 mg at the end of surgery and then every 12 hours
Effect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients Undergoing Abdominal Surgery: A Cluster Randomized Clinical Trial 28538964 2017 05 24 2017 05 24 2168-6262 2017 May 24 JAMA surgery JAMA Surg Effect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients Undergoing Abdominal Surgery: A Cluster Randomized Clinical Trial. 10.1001/jamasurg.2017.1083 Older patients undergoing abdominal surgery commonly (...) experience preventable delirium, which extends their hospital length of stay (LOS). To examine whether a modified Hospital Elder Life Program (mHELP) reduces incident delirium and LOS in older patients undergoing abdominal surgery. This cluster randomized clinical trial of 577 eligible patients enrolled 377 older patients (≥65 years of age) undergoing gastrectomy, pancreaticoduodenectomy, and colectomy at a 2000-bed urban medical center in Taipei, Taiwan, from August 1, 2009, through October 31, 2012
Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults: an international, multicentre, double-blind, randomised clinical trial. BACKGROUND: Delirium is a common and serious postoperative complication. Subanaesthetic ketamine is often administered intraoperatively for postoperative analgesia, and some evidence suggests that ketamine prevents delirium. The primary purpose of this trial was to assess the effectiveness of ketamine for prevention (...) of postoperative delirium in older adults. METHODS: The Prevention of Delirium and Complications Associated with Surgical Treatments [PODCAST] study is a multicentre, international randomised trial that enrolled adults older than 60 years undergoing major cardiac and non-cardiac surgery under general anaesthesia. Using a computer-generated randomisation sequence we randomly assigned patients to one of three groups in blocks of 15 to receive placebo (normal saline), low-dose ketamine (0·5 mg/kg), or high dose
Screening for delirium within the Emergency Department BestBets: Screening for delirium within the Emergency Department Screening for delirium within the Emergency Department Report By: L K Beales - ACCS Emergency Medicine CT2, Search checked by M Mecuri - Assistant Professor McMaster University, Hamilton, Ontario, Canada Institution: Sheffield Teaching Hospitals Date Submitted: 12th May 2016 Date Completed: 11th February 2017 Last Modified: 11th February 2017 Status: Green (complete) Three (...) Part Question In [patients, greater than 75 years, presenting to the emergency department] is [an abbreviated mental test score assessment better than other cognitive screening tools] at [identifying delirium]? Clinical Scenario A confused patient presents to the ED. Is the abbreviated mental test score the best method to screen for delirium/acute confusional state? Search Strategy MEDLINE 1946 to June week 2 2016, EMBASE 1974�June 2016 and the COCHRANE LIBRARY (2016). [exp delirium/or impaired