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Berntzen H, Bjørk IT, Storsveen AM, Wøien H. "Please mind the gap": A secondary analysis of discomfort and comfort in intensive care. J Clin Nurs 2020; 29:2441-2454. [PMID: 32242994 DOI: 10.1111/jocn.15260] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/01/2020] [Accepted: 03/23/2020] [Indexed: 02/06/2023]
Abstract
AIMS AND OBJECTIVES To explore in depth discomfort in intensive care as experienced by patients and attended to by critical care nurses. BACKGROUND Discomfort in illness is complex and persistent, and its alleviation is a challenge for nurses working in intensive care units (ICU). In previous studies, we showed that ICU patients described little actual pain but suffer from much discomfort. Critical care nurses had a systematic approach to the treatment of pain, but were more haphazard in dealing with other types of discomfort. DESIGN Secondary qualitative analysis of data from two previous exploratory studies. METHODS Content analysis was used on existing data from 28 interviews with ICU patients, and 16 field notes and interviews with critical care nurses. Kolcaba's Comfort Theory was applied for further analysis. The COREQ checklist was used. RESULTS Three themes, "Being deprived of a functioning body", "Being deprived of a functioning mind" and "Being deprived of integrity" characterised the discomfort experienced by ICU patients. The nurses appeared to attend to all areas of discomfort expressed by patients. In need of, and providing acknowledgment and alleviation became a common overarching theme. We identified a comfort gap caused by the discrepancy between the patients' needs and the nurses' achievements in fulfilling these needs. CONCLUSIONS A gap exists between ICU patients' comfort needs and nurses' achievements in fulfilling these, indicating that discomfort currently is an inevitable part of the critical illness trajectory. Increased knowledge about how the brain is affected in ICU patients and more systematic approaches to assessing comfort needs and enhancing comfort may support nurses in fulfilling patient needs and possibly diminish the existing comfort gap. RELEVANCE FOR CLINICAL PRACTICE An increased understanding of the complex experience of discomfort in ICU patients may bring about more systematic approaches to enhance comfort and direct for education and further research.
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Affiliation(s)
- Helene Berntzen
- Department of Postoperative and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Nursing Science, University of Oslo, Oslo, Norway
| | | | - Ann-Marie Storsveen
- Department of Postoperative and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Hilde Wøien
- Department of Postoperative and Intensive Care, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Nursing Science, University of Oslo, Oslo, Norway
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Pozzi C, Tatzer VC, Álvarez EA, Lanzoni A, Graff MJL. The applicability and feasibility of occupational therapy in delirium care. Eur Geriatr Med 2020; 11:209-216. [DOI: 10.1007/s41999-020-00308-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 03/07/2020] [Indexed: 01/20/2023]
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Alvarez EA, Garrido M, Ponce DP, Pizarro G, Córdova AA, Vera F, Ruiz R, Fernández R, Velásquez JD, Tobar E, Salech F. A software to prevent delirium in hospitalised older adults: development and feasibility assessment. Age Ageing 2020; 49:239-245. [PMID: 31957783 DOI: 10.1093/ageing/afz166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND non-pharmacological interventions to prevent delirium are useful in hospitalised older adults. However, they are poorly implemented in clinical practice. We aimed to develop a software for bedside use by hospitalised older adults and to improve their access to these interventions. METHODS a transdisciplinary team composed of healthcare professionals, designers, engineers and older adults participated in the development of the software. Scrum methodology was used to coordinate the work of the team, and the software was evaluated in a feasibility study. RESULTS a software for touchscreen mobile devices that supports Android 5.0 or later was produced, including modules for time-spatial re-orientation, cognitive stimulation, early mobilisation, sensorial support use promotion, sleep hygiene and pain management optimisation. Horizontal disposition, use of colour contrast and large interaction areas were used to improve accessibility. The software's usability and accessibility were evaluated in 34 older adults (average age 73.2 ± 9.1 years) showing that 91.1% of them got access to all the software functions without previous instructions. The clinical feasibility assessment showed that 83.3% of the 30 enrolled hospitalised patients (76 ± 8 years) completed the 5-day protocol of software usage during hospitalisation. Software use was associated with a decreased trend in delirium incidence of 5 of 32 (15.6%) at baseline to 2 of 30 (6.6%) after its implementation. CONCLUSION a highly accessible and implementable software, designed to improve access to non-pharmacological interventions to prevent delirium in hospitalised older adults, was developed. The effectiveness of the software will be evaluated in a randomised clinical trial.
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Affiliation(s)
- Evelyn A Alvarez
- Escuela de Terapia Ocupacional, Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago, Metropolitana, Chile
- Departamento de Terapia Ocupacional y Ciencia de la Ocupación, Facultad de Medicina, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Maricel Garrido
- Departamento de Medicina Interna Norte, Servicio Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
| | - Daniela P Ponce
- Centro de Investigación Clínica Avanzada (CICA), Universidad de Chile, Santiago, Metropolitana, Chile
| | - Gaspar Pizarro
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Andres A Córdova
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Felipe Vera
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Rocio Ruiz
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Raul Fernández
- Departamento de Medicina Interna Norte, Servicio Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
- Departamento de Medicina Interna Norte, Sección Geriatría, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
| | - Juan D Velásquez
- Web Intelligence Center, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Santiago, Metropolitana, Chile
- Instituto Sistemas Complejos de Ingeniería (ISCI), Universidad de Chile, Santiago, Metropolitana, Chile
| | - Eduardo Tobar
- Departamento de Medicina Interna Norte, Unidad de Pacientes Críticos, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
- Facultad de Medicina, Universidad de Chile, Santiago, Metropolitana, Chile
| | - Felipe Salech
- Centro de Investigación Clínica Avanzada (CICA), Universidad de Chile, Santiago, Metropolitana, Chile
- Departamento de Medicina Interna Norte, Sección Geriatría, Hospital Clínico Universidad de Chile, Santiago, Metropolitana, Chile
- Facultad de Medicina, Universidad de Chile, Santiago, Metropolitana, Chile
- Unidad de Cuidados Adulto Mayor, Clínica Las Condes, Santiago, Chile
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Tobar E, Alvarez E. DELIRIUM EN EL ADULTO MAYOR HOSPITALIZADO. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2019.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Algeo N, Aitken LM. The evolving role of occupational therapists in adult critical care in England. IRISH JOURNAL OF OCCUPATIONAL THERAPY 2019. [DOI: 10.1108/ijot-04-2019-0005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
A recent paradigm-shift in patient care advocates for long-term recovery and quality of life in survivors of critical illness. Evidence suggests that occupational therapists in critical care can contribute to recovery in areas such as functional outcomes, length of stay and delirium, although poor role understanding can limit service-utilisation. The purpose of this study is to investigate current and future roles and practices of critical care occupational therapists in the UK.
Design/methodology/approach
Occupational therapists with clinical experience in adult critical care were invited to participate in a mixed-methods design using a locally developed online questionnaire and semi-structured interviews, concurrently. Descriptive statistics were generated through SPSS. Qualitative data were analysed using the framework approach.
Findings
Twelve occupational therapists participated in the survey element, with five continuing to interview. Occupational therapists described a multifaceted role in critical care where the majority reported practice in upper limb function, seating/positioning, cognition, psychosocial sequelae and discharge planning. Role and internal characteristics impacted on service delivery. It is envisaged that earlier intervention in a greater percentage of patients, a greater evidence-base, raising awareness and adequate staffing will be features for future development.
Originality/value
This study provides new insight into the current role and practices of adult critical care occupational therapists in England and generates insights into their role in addressing physical and non-physical morbidity for this patient cohort. Findings are preliminary in nature; however, future research is warranted to evaluate the effectiveness of interventions.
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Gutierrez R, Egaña JI, Saez I, Reyes F, Briceño C, Venegas M, Lavado I, Penna A. Intraoperative Low Alpha Power in the Electroencephalogram Is Associated With Postoperative Subsyndromal Delirium. Front Syst Neurosci 2019; 13:56. [PMID: 31680886 PMCID: PMC6813625 DOI: 10.3389/fnsys.2019.00056] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/03/2019] [Indexed: 12/15/2022] Open
Abstract
Background Postoperative delirium (PD) and subsyndromal delirium (PSSD) are frequent complications in older patients associated with poor long-term outcome. It has been suggested that certain electroencephalogram features may be capable of identifying patients at risk during surgery. Thus, the goal of this study was to characterize intraoperative electroencephalographic markers to identify patients prone to develop PD or PSSD. Methods We conducted an exploratory observational study in older patients scheduled for elective major abdominal surgery. Intraoperative 16 channels electroencephalogram was recorded, and PD/PSSD were diagnosed after surgery with the confusion assessment method (CAM). The total power spectra and relative power of alpha band were calculated. Results PD was diagnosed in 2 patients (6.7%), and 11 patients (36.7%) developed PSSD. All of them (13 patients, PD/PSSD group) were compared with patients without any alterations in CAM (17 patients, control group). There were no detectable power spectrum differences before anesthesia between both groups of patients. However, PD/PSSD group in comparison with control group had a lower intraoperative absolute alpha power during anesthesia (4.4 ± 3.8 dB vs. 9.6 ± 3.2 dB, p = 0.0004) and a lower relative alpha power (0.09 ± 0.06 vs. 0.21 ± 0.08, p < 0.0001). These differences were independent of the anesthetic dose. Finally, relative alpha power had a good ability to identify patients with CAM alterations in the ROC analysis (area under the curve 0.90 (CI 0.78-1), p < 0.001). Discussion In conclusion, a low intraoperative alpha power is a novel electroencephalogram marker to identify patients who will develop alterations in CAM - i.e., with PD or PSSD - after surgery.
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Affiliation(s)
- Rodrigo Gutierrez
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Clínico, Universidad de Chile, Santiago, Chile.,Centro de Investigación Clínica Avanzada (CICA), Facultad de Medicina, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Jose I Egaña
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Iván Saez
- Centro de Investigación Clínica Avanzada (CICA), Facultad de Medicina, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Fernando Reyes
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Clínico, Universidad de Chile, Santiago, Chile
| | - Constanza Briceño
- Departamento de Terapia Ocupacional y Ciencia de la Ocupación, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Mariana Venegas
- Escuela de Medicina, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Isidora Lavado
- Escuela de Medicina, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Antonello Penna
- Departamento de Anestesiología y Medicina Perioperatoria, Hospital Clínico, Universidad de Chile, Santiago, Chile.,Centro de Investigación Clínica Avanzada (CICA), Facultad de Medicina, Hospital Clínico, Universidad de Chile, Santiago, Chile
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Abstract
OBJECTIVES We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success. DATA SOURCES Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives. Additional articles were identified through a review of the reference lists of identified articles. STUDY SELECTION Original articles, review articles, and systematic reviews were considered. DATA EXTRACTION Manuscripts were selected for inclusion based on expert opinion of well-designed or key studies and review articles. DATA SYNTHESIS "Interprofessional care" refers to care provided by a team of healthcare professionals with overlapping expertise and an appreciation for the unique contribution of other team members as partners in achieving a common goal. A robust body of data supports improvement in patient-level outcomes when care is provided by an interprofessional team. Critical care nurses, advanced practice providers, pharmacists, respiratory care practitioners, rehabilitation specialists, dieticians, social workers, case managers, spiritual care providers, intensivists, and nonintensivist physicians each provide unique expertise and perspectives to patient care, and therefore play an important role in a team that must address the diverse needs of patients and families in the ICU. Engaging patients and families as partners in their healthcare is also critical. Many important ICU quality improvement initiatives require an interprofessional approach, including Awakening and Breathing Coordination, Delirium, Early Exercise/Mobility, and Family Empowerment bundle implementation, interprofessional rounding practices, unit-based quality improvement initiatives, Patient and Family Advisory Councils, end-of-life care, coordinated sedation awakening and spontaneous breathing trials, intrahospital transport, and transitions of care. CONCLUSIONS A robust body of evidence supports an interprofessional approach as a key component in the provision of high-quality critical care to patients of increasing complexity and with increasingly diverse needs.
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McCaskell DS, Molloy AJ, Childerhose L, Costigan FA, Reid JC, McCaughan M, Clarke F, Cook DJ, Rudkowski JC, Farley C, Karachi T, Rochwerg B, Newman A, Fox-Robichaud A, Herridge MS, Lo V, Feltracco D, Burns KE, Porteous R, Seely AJE, Ball IM, Seczek A, Kho ME. Project management lessons learned from the multicentre CYCLE pilot randomized controlled trial. Trials 2019; 20:532. [PMID: 31455384 PMCID: PMC6712681 DOI: 10.1186/s13063-019-3634-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/08/2019] [Indexed: 11/16/2022] Open
Abstract
Background Clinical trials management can be studied using project management theory. The CYCLE pilot randomized controlled trial (RCT) was conducted to determine the feasibility of a future rehabilitation trial of early in-bed cycling in the intensive care unit (ICU). In-bed cycling is a novel intervention, not typically available in ICUs. Implementation of this intervention requires personnel with specialized clinical expertise caring for critically ill patients and use of the in-bed cycle. Our objective was to describe the implementation and conduct of our pilot RCT using a project management approach. Methods We retrospectively reviewed activities, timelines, and personnel involved in the trial. We organized activities into four project management phases: initiation, planning, execution, and monitoring and controlling. Data sources included Methods Centre documents used for trial coordination and conduct, and the trial data set. We report descriptive statistics as counts and proportions and also medians and quartiles, and we summarize the lessons learned. Results Seven ICUs in Canada participated in the trial. Time from research ethics board and contracts submission to first enrolment was a median (first quartile, third quartile) of 185 (146, 209) and 162 (114, 181) days, respectively. We trained 128 personnel on the CYCLE pilot RCT protocol, and 80 (63%) completed trial-related activities. Four sites required additional training after start-up due to staff turnover and leaves of absence. Over 15 months, we screened 864 patients: 256 were eligible and 66 were enrolled. Despite an 85% consent rate, 74% (190/256) of eligible patients were not randomized, largely (80% [152/190]) due to physiotherapist availability. Thirteen percent of recruitment weeks were lost due to physiotherapist staffing shortages. We highlight five key lessons learned: (1) prepare and anticipate site needs; (2) communicate regularly; (3) proactively analyse and act on process measure data; (4) develop contingency plans; (5) express appreciation to participating sites. Conclusions Our analysis highlights the scope of relevant activities, rigorous training and monitoring, number and types of required personnel, and time required to conduct a multicentre ICU rehabilitation intervention trial. Our lessons learned can help others interested in implementing complex intervention trials, such as rehabilitation. Trial registration ClinicalTrials.gov, NCT02377830. Registered prospectively on 4 March 2015. Electronic supplementary material The online version of this article (10.1186/s13063-019-3634-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Devin S McCaskell
- The Research Institute of St. Joe's Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Alexander J Molloy
- The Research Institute of St. Joe's Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Laura Childerhose
- McMaster University, School of Rehabilitation Science, Institute of Applied Health Science, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.,Department of Health Research Methods, Evidence and Impact McMaster University Health Sciences Centre, Room 2C16, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - F Aileen Costigan
- The Research Institute of St. Joe's Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Julie C Reid
- McMaster University, School of Rehabilitation Science, Institute of Applied Health Science, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Magda McCaughan
- Department of Physiotherapy, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - France Clarke
- Department of Health Research Methods, Evidence and Impact McMaster University Health Sciences Centre, Room 2C16, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Deborah J Cook
- Department of Physiotherapy, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada.,Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Jill C Rudkowski
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.,Department of Critical Care, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Christopher Farley
- Juravinski Hospital, Hamilton, 711 Concession St, Hamilton, ON, L8V 1C3, Canada
| | - Tim Karachi
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.,Department of Critical Care, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.,Department of Critical Care, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada
| | - Anastasia Newman
- McMaster University, School of Rehabilitation Science, Institute of Applied Health Science, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada.,Hamilton General Hospital, 237 Barton St E, Hamilton, ON, L8L 2X2, Canada
| | - Alison Fox-Robichaud
- Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.,Hamilton General Hospital, 237 Barton St E, Hamilton, ON, L8L 2X2, Canada
| | | | - Vincent Lo
- Department of Physical Therapy, University of Toronto, Rehabilitation Sciences Centre, 8th Floor, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Deanna Feltracco
- St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - Karen Ea Burns
- St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | | | | | - Ian M Ball
- Department of Medicine and Department of Epidemiology and Biostatistics, Western University, Critical Care Trauma Centre, London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Amy Seczek
- McMaster University, School of Rehabilitation Science, Institute of Applied Health Science, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada
| | - Michelle E Kho
- The Research Institute of St. Joe's Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada. .,McMaster University, School of Rehabilitation Science, Institute of Applied Health Science, Room 403, 1400 Main Street West, Hamilton, ON, L8S 1C7, Canada. .,Department of Physiotherapy, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada.
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Effectiveness of occupational therapy interventions in acute geriatric wards: A systematic review. Maturitas 2019; 127:43-50. [PMID: 31351519 DOI: 10.1016/j.maturitas.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/06/2019] [Accepted: 06/06/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To review the evidence on the effectiveness of specific occupational therapy programs in elderly people hospitalized for acute medical pathology. MATERIALS AND METHODS Relevant randomized clinical trials were selected by searching the main bibliographic databases to evaluate the effectiveness of in-hospital occupational therapy interventions for people aged 65 years and over who were hospitalized for acute medical pathology. RESULTS Six studies were finally selected. The interventions consisted of individualized programs of occupational therapy: training and re-education in the activities of daily living (ADL); evaluation, prescription and training in the use of support devices; and providing reports regarding recommendations and referrals on discharge. In five studies, the patients in the intervention group obtained higher scores on assessment tools used to measure functionality in ADL. In one of the studies there was a statistically significant reduction in delirium, as well as an improvement in cognitive function. There was no evidence for the effectiveness of occupational therapy interventions for anxiety, fear and/or perceived safety, in any of the studies analyzed. CONCLUSIONS The evidence is limited as to whether specific occupational therapy programs are effective in improving functionality in ADL in this group of patients. However, occupational therapy was significantly effective in reducing delirium and improving cognitive function. There is insufficient evidence to claim that specific occupational therapy programs are effective in reducing levels of anxiety, increasing perceived quality of life, reducing readmission rates, or reducing the length of hospital stay.
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Provancha-Romeo AF, Hoffman AL, Malcolm MP, Coatsworth JD, Laxton LR, Freeman KM, Schmid AA. Mind-body interventions utilized by an occupational therapist in a medical intensive care unit: An exploratory case study. Work 2019; 63:191-197. [DOI: 10.3233/wor-192920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Alexa F. Provancha-Romeo
- Department of Occupational Therapy, Colorado State University, Integrative Rehabilitation Lab, Fort Collins, CO, USA
| | - Amanda L. Hoffman
- Department of Occupational Therapy, University of Colorado Hospital, Aurora, CO, USA
| | - Matt P. Malcolm
- Colorado School of Public Health, Colorado State University, Fort Collins, CO, USA
| | - J. Douglas Coatsworth
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Lyndsay R. Laxton
- Department of Occupational Therapy, University of Colorado Hospital, Aurora, CO, USA
| | - Katherine M. Freeman
- Department of Occupational Therapy, University of Colorado Hospital, Aurora, CO, USA
| | - Arlene A. Schmid
- Department of Occupational Therapy, Colorado State University, Integrative Rehabilitation Lab, Fort Collins, CO, USA
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Bannon L, McGaughey J, Verghis R, Clarke M, McAuley DF, Blackwood B. The effectiveness of non-pharmacological interventions in reducing the incidence and duration of delirium in critically ill patients: a systematic review and meta-analysis. Intensive Care Med 2019; 45:1-12. [PMID: 30506354 DOI: 10.1007/s00134-018-5452-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 11/03/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the effect of non-pharmacological interventions versus standard care on incidence and duration of delirium in critically ill patients. METHODS We searched electronic and grey literature for randomised clinical trials up to March 2018. Two reviewers independently screened, selected and extracted data. Meta-analysis was undertaken using random effects modelling. RESULTS We identified 15 trials (2812 participants). Eleven trials reported incidence of delirium. Pooled data from four trials of bright light therapy showed no significant effect between groups (n = 829 participants, RR 0.45, 99% CI 0.10-2.13, P = 0.19, very low quality evidence). Seven trials of various individual interventions also failed to report any significant effects. A total of eight trials reported duration of delirium. Pooled data from two trials of multicomponent physical therapy showed no significant effect [n = 404 participants, MD (days) - 0.65, 99% CI - 2.73 to 1.44, P = 0.42, low quality of evidence]. Four trials of various individual interventions also reported no significant effects. A trial of family voice reorientation showed a beneficial effect [n = 30, MD (days) - 1.30, 99% CI - 2.41 to - 0.19, P = 0.003, very low quality evidence]. CONCLUSIONS Current evidence does not support the use of non-pharmacological interventions in reducing incidence and duration of delirium in critically ill patients. Future research should consider well-designed and well-described multicomponent interventions and include adequately defined outcome measures.
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Affiliation(s)
- Leona Bannon
- School of Medicine, Dentistry and Biomedical Sciences, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK.
| | - Jennifer McGaughey
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Rejina Verghis
- School of Medicine, Dentistry and Biomedical Sciences, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Mike Clarke
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, UK
| | - Daniel F McAuley
- School of Medicine, Dentistry and Biomedical Sciences, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Bronagh Blackwood
- School of Medicine, Dentistry and Biomedical Sciences, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
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Herling SF, Greve IE, Vasilevskis EE, Egerod I, Bekker Mortensen C, Møller AM, Svenningsen H, Thomsen T. Interventions for preventing intensive care unit delirium in adults. Cochrane Database Syst Rev 2018; 11:CD009783. [PMID: 30484283 PMCID: PMC6373634 DOI: 10.1002/14651858.cd009783.pub2] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Delirium is defined as a disturbance in attention, awareness and cognition with reduced ability to direct, focus, sustain and shift attention, and reduced orientation to the environment. Critically ill patients in the intensive care unit (ICU) frequently develop ICU delirium. It can profoundly affect both them and their families because it is associated with increased mortality, longer duration of mechanical ventilation, longer hospital and ICU stay and long-term cognitive impairment. It also results in increased costs for society. OBJECTIVES To assess existing evidence for the effect of preventive interventions on ICU delirium, in-hospital mortality, the number of delirium- and coma-free days, ventilator-free days, length of stay in the ICU and cognitive impairment. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, BIOSIS, International Web of Science, Latin American Caribbean Health Sciences Literature, CINAHL from 1980 to 11 April 2018 without any language limits. We adapted the MEDLINE search for searching the other databases. Furthermore, we checked references, searched citations and contacted study authors to identify additional studies. We also checked the following trial registries: Current Controlled Trials; ClinicalTrials.gov; and CenterWatch.com (all on 24 April 2018). SELECTION CRITERIA We included randomized controlled trials (RCTs) of adult medical or surgical ICU patients receiving any intervention for preventing ICU delirium. The control could be standard ICU care, placebo or both. We assessed the quality of evidence with GRADE. DATA COLLECTION AND ANALYSIS We checked titles and abstracts to exclude obviously irrelevant studies and obtained full reports on potentially relevant ones. Two review authors independently extracted data. If possible we conducted meta-analyses, otherwise we synthesized data narratively. MAIN RESULTS The electronic search yielded 8746 records. We included 12 RCTs (3885 participants) comparing usual care with the following interventions: commonly used drugs (four studies); sedation regimens (four studies); physical therapy or cognitive therapy, or both (one study); environmental interventions (two studies); and preventive nursing care (one study). We found 15 ongoing studies and five studies awaiting classification. The participants were 48 to 70 years old; 48% to 74% were male; the mean acute physiology and chronic health evaluation (APACHE II) score was 14 to 28 (range 0 to 71; higher scores correspond to more severe disease and a higher risk of death). With the exception of one study, all participants were mechanically ventilated in medical or surgical ICUs or mixed. The studies were overall at low risk of bias. Six studies were at high risk of detection bias due to lack of blinding of outcome assessors. We report results for the two most commonly explored approaches to delirium prevention: pharmacologic and a non-pharmacologic intervention.Haloperidol versus placebo (two RCTs, 1580 participants)The event rate of ICU delirium was measured in one study including 1439 participants. No difference was identified between groups, (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.87 to 1.17) (moderate-quality evidence). Haloperidol versus placebo neither reduced or increased in-hospital mortality, (RR 0.98, 95% CI 0.80 to 1.22; 2 studies; 1580 participants (moderate-quality evidence)); the number of delirium- and coma-free days, (mean difference (MD) -0.60, 95% CI -1.37 to 0.17; 2 studies, 1580 participants (moderate-quality of evidence)); number of ventilator-free days (mean 23.8 (MD -0.30, 95% CI -0.93 to 0.33) 1 study; 1439 participants, (high-quality evidence)); length of ICU stay, (MD 0.18, 95% CI -0.60 to 0.97); 2 studies, 1580 participants; high-quality evidence). None of the studies measured cognitive impairment. In one study there were three serious adverse events in the intervention group and five in the placebo group; in the other there were five serious adverse events and three patients died, one in each group. None of the serious adverse events were judged to be related to interventions received (moderate-quality evidence).Physical and cognitive therapy interventions (one study, 65 participants)The study did not measure the event rate of ICU delirium. A physical and cognitive therapy intervention versus standard care neither reduced nor increased in-hospital mortality, (RR 0.94, 95% CI 0.40 to 2.20, I² = 0; 1 study, 65 participants; very low-quality evidence); the number of delirium- and coma-free days, (MD -2.8, 95% CI -10.1 to 4.6, I² = 0; 1 study, 65 participants; very low-quality evidence); the number of ventilator-free days (within the first 28/30 days) was median 27.4 (IQR 0 to 29.2) and 25 (IQR 0 to 28.9); 1 study, 65 participants; very low-quality evidence, length of ICU stay, (MD 1.23, 95% CI -0.68 to 3.14, I² = 0; 1 study, 65 participants; very low-quality evidence); cognitive impairment measured by the MMSE: Mini-Mental State Examination with higher scores indicating better function, (MD 0.97, 95% CI -0.19 to 2.13, I² = 0; 1 study, 30 participants; very low-quality evidence); or measured by the Dysexecutive questionnaire (DEX) with lower scores indicating better function (MD -8.76, 95% CI -19.06 to 1.54, I² = 0; 1 study, 30 participants; very low-quality evidence). One patient experienced acute back pain accompanied by hypotensive urgency during physical therapy. AUTHORS' CONCLUSIONS There is probably little or no difference between haloperidol and placebo for preventing ICU delirium but further studies are needed to increase our confidence in the findings. There is insufficient evidence to determine the effects of physical and cognitive intervention on delirium. The effects of other pharmacological interventions, sedation, environmental, and preventive nursing interventions are unclear and warrant further investigation in large multicentre studies. Five studies are awaiting classification and we identified 15 ongoing studies, evaluating pharmacological interventions, sedation regimens, physical and occupational therapy combined or separately, and environmental interventions, that may alter the conclusions of the review in future.
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Affiliation(s)
- Suzanne Forsyth Herling
- Rigshospitalet, University of CopenhagenThe Neuroscience CentreBlegdamsvej 9CopenhagenDenmark2100
- Herlev and Gentofte Hospital, University of CopenhagenDepartment of AnaesthesiaHerlev Ringvej 75HerlevDenmark2730
| | - Ingrid E Greve
- Bispebjerg and Frederiksberg Hospitals, University of CopenhagenDepartment of Anaesthesia and Intensive careCopenhagenDenmark
| | - Eduard E Vasilevskis
- Division of General Internal Medicine and Public Health, Vanderbilt University and theTennessee Valley Geriatric Research, Education and Clinical Center (GRECC)Department of Medicine1215 21st Ave. S.6005 Medical Center East, NTNashvilleTNUSA37232‐8300
| | - Ingrid Egerod
- Rigshospitalet, University of CopenhagenIntensive Care Unit 4131Blegdamsvej 9Copenhagen ØDenmark2100
| | - Camilla Bekker Mortensen
- Zealand University HospitalIntensive Care Unit, Department of AnaesthesiologyLykkebækvej 1KøgeDenmark4600
| | - Ann Merete Møller
- Herlev and Gentofte Hospital, University of CopenhagenDepartment of AnaesthesiaHerlev Ringvej 75HerlevDenmark2730
- Herlev and Gentofte Hospital, University of CopenhagenCochrane AnaesthesiaHerlev RingvejHerlev Ringvej 75HerlevDenmark2730
- Herlev and Gentofte Hospital, University of CopenhagenCochrane Emergency and Critical CareHerlev Ringvej 75HerlevDenmark2730
| | - Helle Svenningsen
- VIA University CollegeFaculty of Health SciencesAarhus NDenmarkDK‐8200
| | - Thordis Thomsen
- Rigshospitalet, The Abdominal CentreDepartment of Nursing ResearchBlegdamsvej 9CopenhagenDenmark2200
- University of CopenhagenDepartment of Clinical MedicineCopenhagenDenmark
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Tobar E, Alvarez E, Garrido M. Cognitive stimulation and occupational therapy for delirium prevention. Rev Bras Ter Intensiva 2018; 29:248-252. [PMID: 28977265 PMCID: PMC5496760 DOI: 10.5935/0103-507x.20170034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/22/2016] [Indexed: 12/31/2022] Open
Abstract
Delirium is a relevant condition in critically ill patients with long-term impacts on mortality, cognitive and functional status and quality of life. Despite the progress in its diagnosis, prevention and management during the last years, its impact persists being relevant, so new preventive and therapeutic strategies need to be explored. Among non-pharmacologic preventive strategies, recent reports suggest a role for occupational therapy through a series of interventions that may impact the development of delirium. The aim of this review is to evaluate the studies evaluating the role of occupational therapy in the prevention of delirium in critically ill patient populations, and suggests perspectives to future research in this area.
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Affiliation(s)
- Eduardo Tobar
- Departamento de Clínica Médica, Campus Norte, Facultad de Medicina, Universidad de Chile - Santiago, Chile.,Unidade de Terapia Intensiva, Hospital Clínico, Universidad de Chile - Santiago, Chile
| | - Evelyn Alvarez
- Departamento de Ciências da Saúde, Escola de Terapia Ocupacional, Universidad Central de Chile - Santiago, Chile
| | - Maricel Garrido
- Departamento de Medicina Física e Reabilitação, Hospital Clínico, Universidad de Chile - Santiago, Chile
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Blair GJ, Mehmood T, Rudnick M, Kuschner WG, Barr J. Nonpharmacologic and Medication Minimization Strategies for the Prevention and Treatment of ICU Delirium: A Narrative Review. J Intensive Care Med 2018; 34:183-190. [PMID: 29699467 DOI: 10.1177/0885066618771528] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Delirium is a multifactorial entity, and its understanding continues to evolve. Delirium has been associated with increased morbidity, mortality, length of stay, and cost for hospitalized patients, especially for patients in the intensive care unit (ICU). Recent literature on delirium focuses on specific pharmacologic risk factors and pharmacologic interventions to minimize course and severity of delirium. While medication management clearly plays a role in delirium management, there are a variety of nonpharmacologic interventions, pharmacologic minimization strategies, and protocols that have been recently described. A PubMed search was performed to review the evidence for nonpharmacologic management, pharmacologic minimization strategies, and prevention of delirium for patients in the ICU. Recent approaches were condensed into 10 actionable steps to manage delirium and minimize medications for ICU patients and are presented in this review.
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Affiliation(s)
- Gregory J Blair
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Talha Mehmood
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Mona Rudnick
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Ware G Kuschner
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Pulmonary Section, Medicine Service, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Juliana Barr
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA, USA
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Bannon L, McGaughey J, Clarke M, McAuley DF, Blackwood B. Designing a nurse-delivered delirium bundle: What intensive care unit staff, survivors, and their families think? Aust Crit Care 2018; 31:174-179. [PMID: 29580965 DOI: 10.1016/j.aucc.2018.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/31/2018] [Accepted: 02/04/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Implementation of quality improvement interventions can be enhanced by exploring the perspectives of those who will deliver and receive them. We designed a non-pharmacological bundle for delirium management for a feasibility trial, and we sought to obtain the views of intensive care unit (ICU) staff, survivors, and families on the barriers and facilitators to its implementation. OBJECTIVE The objective of this study is to determine the barriers and facilitators to a multicomponent bundle for delirium management in critically ill patients comprising (1) education and family participation, (2) sedation minimisation and pain, agitation, and delirium protocol, (3) early mobilisation, and (4) environmental interventions for sleep, orientation, communication, and cognitive stimulation. METHODS Nine focus group interviews were conducted with ICU staff (n = 68) in 12 UK ICUs. Three focus group interviews were conducted with ICU survivors (n = 12) and their family members (n = 2). Interviews were digitally recorded, transcribed, and thematically analysed using the Braun and Clarke framework. RESULTS Overall, staff, survivors, and their families agreed the bundle was acceptable. Facilitating factors for delivering the bundle were staff and relatives' education about potential benefits and encouraging family presence. Facilitating factors for sedation minimisation were evening ward rounds, using non-verbal pain scores, and targeting sedation scores. Barriers identified by staff were inadequate resources, poor education, relatives' anxiety, safety concerns, and ICU culture. Concerns were raised about patient confidentiality when displaying orientation materials and managing resources for early mobility. Survivors cited that flexible visiting and re-establishing normality were important factors; and staff workload, lack of awareness, and poor communication were factors that needed to be considered before implementation. CONCLUSION Generally, the bundle was deemed acceptable and deliverable. However, like any complex intervention, component adaptations will be required depending on resources available to the ICU; in particular, involvement of pharmacists in the ward round and physiotherapists in mobilising intubated patients.
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Affiliation(s)
- Leona Bannon
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK.
| | - Jennifer McGaughey
- School of Nursing & Midwifery, Queen's University Belfast, Northern Ireland, UK
| | - Mike Clarke
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK
| | - Daniel F McAuley
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK; Regional Intensive Care Unit, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Bronagh Blackwood
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK
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Ibrahim K, McCarthy CP, McCarthy KJ, Brown CH, Needham DM, Januzzi JL, McEvoy JW. Delirium in the Cardiac Intensive Care Unit. J Am Heart Assoc 2018; 7:JAHA.118.008568. [PMID: 29453307 PMCID: PMC5850211 DOI: 10.1161/jaha.118.008568] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Khalil Ibrahim
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | | | | | - Charles H. Brown
- Department of Anesthesiology and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - Dale M. Needham
- Department of Physical Medicine and RehabilitationJohns Hopkins University School of MedicineBaltimoreMD,Outcomes After Critical Illness and Surgery (OACIS) GroupDivision of Pulmonary and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMD
| | - James L. Januzzi
- Division of CardiologyDepartment of MedicineMassachusetts General HospitalBaim Institute for Clinical ResearchBostonMA,Cardiometabolic TrialsBaim Institute for Clinical ResearchBostonMA
| | - John W. McEvoy
- Division of CardiologyDepartment of MedicineJohns Hopkins University School of MedicineBaltimoreMD
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Maldonado JR. Acute Brain Failure: Pathophysiology, Diagnosis, Management, and Sequelae of Delirium. Crit Care Clin 2017; 33:461-519. [PMID: 28601132 DOI: 10.1016/j.ccc.2017.03.013] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Delirium is the most common psychiatric syndrome found in the general hospital setting, with an incidence as high as 87% in the acute care setting. Delirium is a neurobehavioral syndrome caused by the transient disruption of normal neuronal activity secondary to systemic disturbances. The development of delirium is associated with increased morbidity, mortality, cost of care, hospital-acquired complications, placement in specialized intermediate and long-term care facilities, slower rate of recovery, poor functional and cognitive recovery, decreased quality of life, and prolonged hospital stays. This article discusses the epidemiology, known etiological factors, presentation and characteristics, prevention, management, and impact of delirium.
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Affiliation(s)
- José R Maldonado
- Psychosomatic Medicine Service, Emergency Psychiatry Service, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Suite 2317, Stanford, CA 94305-5718, USA.
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Pozzi C, Lucchi E, Lanzoni A, Gentile S, Trabucchi M, Bellelli G, Morandi A. Preliminary Evidence of a Positive Effect of Occupational Therapy in Patients With Delirium Superimposed on Dementia. J Am Med Dir Assoc 2017; 18:1091-1092. [PMID: 29042265 DOI: 10.1016/j.jamda.2017.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/07/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Christian Pozzi
- University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Manno, Switzerland; Società Italiana di Terapia Occupazionale, Rome, Italy; Geriatric Research Group, Brescia, Italy
| | - Elena Lucchi
- Deparment of Rehabilitazion Fondazione Camplani, Cremona, Italy; Geriatric Research Group, Brescia, Italy
| | - Alessandro Lanzoni
- Società Italiana di Terapia Occupazionale, Nursing Home Fondazione L. Boni-Suzzara (MN), Rome, Italy
| | - Simona Gentile
- Deparment of Rehabilitazion Fondazione Camplani, Cremona, Italy; Geriatric Research Group, Brescia, Italy
| | | | - Giuseppe Bellelli
- Geriatric Research Group, Brescia, Italy; Acute Geriatric Unit, School of Medicine and Surgery, University Milano-Bicocca, Milan, Italy
| | - Alessandro Morandi
- Deparment of Rehabilitazion Fondazione Camplani, Cremona, Italy; Geriatric Research Group, Brescia, Italy
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Álvarez EA, Garrido MA, Tobar EA, Prieto SA, Vergara SO, Briceño CD, González FJ. Occupational therapy for delirium management in elderly patients without mechanical ventilation in an intensive care unit. A pilot randomized clinical trial. J Crit Care 2017; 40:265. [PMID: 28385485 DOI: 10.1016/j.jcrc.2017.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Evelyn A Álvarez
- Escuela de Terapia Ocupacional, Universidad Central de Chile, Lord Cochrane # 417, Santiago Centro 8330507, Chile; Departamento de Terapia Ocupacional y Ciencia de la Ocupación, Universidad de Chile, Avenida Independencia # 1027, Independencia 8380453, Chile.
| | - Maricel A Garrido
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santos Dumont # 999, Independencia 8380456, Chile
| | - Eduardo A Tobar
- Unidad de Pacientes Críticos, Departamento de Medicina Interna Norte, Hospital Clínico Universidad de Chile, Santos Dumont # 999, Independencia 8380456, Chile
| | - Stephanie A Prieto
- Escuela de Terapia Ocupacional, Universidad Central de Chile, Lord Cochrane # 417, Santiago Centro 8330507, Chile; Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santos Dumont # 999, Independencia 8380456, Chile
| | - Sebastian O Vergara
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santos Dumont # 999, Independencia 8380456, Chile
| | - Constanza D Briceño
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santos Dumont # 999, Independencia 8380456, Chile; Departamento de Terapia Ocupacional y Ciencia de la Ocupación, Universidad de Chile, Avenida Independencia # 1027, Independencia 8380453, Chile
| | - Francisco J González
- Servicio de Medicina Interna, Departamento de Medicina, Hospital Clínico Universidad de Chile, Santos Dumont # 999, Independencia 8380456, Chile
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Williamson L. Occupational therapy for delirium management in elderly patients without mechanical ventilation in an intensive care unit: A pilot randomized clinical trial. J Crit Care 2017; 40:266. [PMID: 28254436 DOI: 10.1016/j.jcrc.2017.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 02/21/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Launa Williamson
- Graduate student at UTA School of Nursing and Health Innovation, Arlington, TX, 75052, United States.
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