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Liu Y, Shen W, Tian Z. Using Machine Learning Algorithms to Predict High-Risk Factors for Postoperative Delirium in Elderly Patients. Clin Interv Aging 2023; 18:157-168. [PMID: 36789284 PMCID: PMC9922512 DOI: 10.2147/cia.s398314] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
Purpose Postoperative delirium (POD) is a common postoperative complication in elderly patients, and it greatly affects the short-term and long-term prognosis of patients. The purpose of this study was to develop a machine learning model to identify preoperative, intraoperative and postoperative high-risk factors and predict the occurrence of delirium after nonbrain surgery in elderly patients. Patients and Methods A total of 950 elderly patients were included in the study, including 132 patients with POD. We collected 30 characteristic variables, including patient demographic characteristics, basic medical history, preoperative examination characteristics, type of surgery, and intraoperative information. Three machine learning algorithms, multilayer perceptron (MLP), extreme gradient boosting (XGBoost), and k-nearest neighbor algorithm (KNN), were applied to construct the model, and the k-fold cross-validation method, ROC curve, calibration curve, decision curve analysis (DCA) and external validation were used for model evaluation. Results XGBoost showed the best performance among the three prediction models. The ROC curve results showed that XGBoost had a high area under the curve (AUC) value of 0.982 in the training set; the AUC value in the validation set was 0.924, and the prediction model was highly accurate. The k-fold cross-validation method was used for internal validation, and the XGBoost model was stable The calibration curve showed high predictive power of the XGBoost model. The DCA curve showed a higher benefit rate for patients who received interventional treatment under the XGBoost model. The AUC value for the external validation set was 0.88, indicating that the predictive model was extrapolative. Conclusion The prediction model of POD derived from the machine learning algorithm in this study has high prediction accuracy and clinical utility, which is beneficial for clinicians to diagnose and treat patients in a timely manner.
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Affiliation(s)
- Yuan Liu
- Department of General Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, People’s Republic of China
| | - Wei Shen
- Department of General Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, People’s Republic of China,Correspondence: Wei Shen, Department of General Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, People’s Republic of China, Tel +86 13385110723, Email
| | - Zhiqiang Tian
- Department of General Surgery, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, People’s Republic of China
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Abstract
Delirium is a common and underdiagnosed problem in hospitalized older adults. It is associated with an increased risk of poor cognitive and functional outcomes, institutionalization, and death. Timely diagnosis of delirium and non-pharmacological prevention and management strategies can improve patient outcomes. The Confusion Assessment Method (CAM) is the most widely used clinical assessment tool for the diagnosis of delirium. Multiple variations of the CAM have been developed for ease of administration and for the unique needs of specific patient populations, including the 3-min diagnostic CAM (3D CAM), CAM-Intensive Care Unit (CAM-ICU), Delirium Triage Screen (DTS)/Brief CAM (b-CAM), 4AT tool, and ultrabrief delirium assessment. Strong evidence supports the effectiveness of nonpharmacologic strategies as the primary intervention for the prevention of delirium. Multicomponent delirium prevention strategies can reduce the incidence of delirium by 40%. Investigation of underlying medical precipitants and optimization of non-pharmacological interventions are first line in the management of delirium. Despite a lack of evidence supporting use of antipsychotics, low dose antipsychotics remain second line for off-label treatment of distressing psychoses and/or agitated behaviors that are refractory to non-pharmacological behavioral interventions and pose an imminent risk of harm to self or others. Any antipsychotic prescription for delirium should be accompanied by an appropriate taper plan. Follow up with primary care providers on discharge from hospital for ongoing screening of cognitive impairment is important.
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Affiliation(s)
- Katie M Rieck
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sandeep Pagali
- Division of Hospital Internal Medicine, and Division of Geriatrics and Gerontology, Mayo Clinic, Rochester, MN, USA
| | - Donna M Miller
- Division of Hospital Internal Medicine, and Division of Geriatrics and Gerontology, Mayo Clinic, Rochester, MN, USA
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O’Regan NA, Fitzgerald J, Adamis D, Molloy DW, Meagher D, Timmons S. Predictors of Delirium Development in Older Medical Inpatients: Readily Identifiable Factors at Admission. J Alzheimers Dis 2018; 64:775-785. [DOI: 10.3233/jad-180178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Niamh A. O’Regan
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
- Department of Medicine, Division of Geriatric Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- St. Joseph’s Healthcare London – Parkwood Institute, London, Ontario, Canada
| | - James Fitzgerald
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | | | - David William Molloy
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - David Meagher
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
- Cognitive Impairment Research Group, Centre for Interventions in Infection, Inflammation & Immunity (4i), Graduate Entry Medical School, University of Limerick, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
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Castro V, Guinguis R, Carrasco M. Are antipsychotics effective for the prevention of postoperative delirium? Medwave 2018; 18:e7196. [DOI: 10.5867/medwave.2018.02.7195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 12/20/2017] [Indexed: 11/27/2022] Open
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van der Sluis FJ, Buisman PL, Meerdink M, Aan de Stegge WB, van Etten B, de Bock GH, van Leeuwen BL, Pol RA. Risk factors for postoperative delirium after colorectal operation. Surgery 2016; 161:704-711. [PMID: 28341442 DOI: 10.1016/j.surg.2016.09.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/10/2016] [Accepted: 09/12/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND A clear understanding of risk factors for postoperative delirium helps in the selection of individuals who might benefit from targeted perioperative intervention. The aim of this study was to identify risk factors for postoperative delirium after colorectal operation for malignancy. METHODS All consecutive patients who underwent elective or emergency operation because of malignancy of the colon, sigmoid, or rectum between 2009 and 2012 were included in this study. Potential risk factors for postoperative delirium were selected based on previous studies. These candidate factors were analyzed using univariate and multivariate logistic regression analysis. Based on this analysis, odds ratios and 95% confidence intervals were estimated. RESULTS A total of 436 patients underwent an oncologic resection of the colon, sigmoid, or rectum. Postoperative delirium was observed in 45 (10.3%) patients. Patients with a delirium had a greater in-hospital mortality rate (8.9% vs 3.6%, P = .09), spent more days in the intensive care unit, and had a longer total hospital stay. Variables associated with postoperative delirium in univariate analyses were age, American Society of Anesthesiologists classification, blood transfusion, history of psychiatric disease, history of cerebrovascular disease, postoperative pain management, postoperative renal impairment, C-reactive protein levels, leukocyte blood count, and postoperative complications. Independent risk factors were history of psychiatric disease (odds ratio 8.38, 95% confidence interval: 1.50-46.82), age (odds ratio 4.01, 95% confidence interval; 1.55-10.37), and perioperative blood transfusion (odds ratio 2.37, 95% confidence interval; 1.11-5.06). CONCLUSION This study shows that postoperative delirium is a frequently encountered complication after colorectal operation. Three independent risk factors for postoperative delirium were identified (history of psychiatric disease, age, and perioperative transfusion) that may contribute to risk estimation in this patient population.
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Affiliation(s)
- Frederik J van der Sluis
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Pieter L Buisman
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mark Meerdink
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wouter B Aan de Stegge
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Boudewijn van Etten
- Department of Colorectal Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert A Pol
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Zegers M, Hesselink G, Geense W, Vincent C, Wollersheim H. Evidence-based interventions to reduce adverse events in hospitals: a systematic review of systematic reviews. BMJ Open 2016; 6:e012555. [PMID: 27687901 PMCID: PMC5051502 DOI: 10.1136/bmjopen-2016-012555] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To provide an overview of effective interventions aimed at reducing rates of adverse events in hospitals. DESIGN Systematic review of systematic reviews. DATA SOURCES PubMed, CINAHL, PsycINFO, the Cochrane Library and EMBASE were searched for systematic reviews published until October 2015. STUDY SELECTION English-language systematic reviews of interventions aimed at reducing adverse events in hospitals, including studies with an experimental design and reporting adverse event rates, were included. Two reviewers independently assessed each study's quality and extracted data on the study population, study design, intervention characteristics and adverse patient outcomes. RESULTS Sixty systematic reviews with moderate to high quality were included. Statistically significant pooled effect sizes were found for 14 types of interventions, including: (1) multicomponent interventions to prevent delirium; (2) rapid response teams to reduce cardiopulmonary arrest and mortality rates; (3) pharmacist interventions to reduce adverse drug events; (4) exercises and multicomponent interventions to prevent falls; and (5) care bundle interventions, checklists and reminders to reduce infections. Most (82%) of the significant effect sizes were based on 5 or fewer primary studies with an experimental study design. CONCLUSIONS The evidence for patient-safety interventions implemented in hospitals worldwide is weak. The findings address the need to invest in high-quality research standards in order to identify interventions that have a real impact on patient safety. Interventions to prevent delirium, cardiopulmonary arrest and mortality, adverse drug events, infections and falls are most effective and should therefore be prioritised by clinicians.
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Affiliation(s)
- Marieke Zegers
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Gijs Hesselink
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Wytske Geense
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Hub Wollersheim
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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Mota SSD, Delgado VB, Schumacher-Schuh AF, Chaves MLF. Association of education with occurrence of delirium in patients from an emergency department. Dement Neuropsychol 2016; 10:198-203. [PMID: 29213455 PMCID: PMC5642415 DOI: 10.1590/s1980-5764-2016dn1003005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Delirium is a neuropsychiatric syndrome with multiple etiological factors.
Evaluation of delirium in different settings, especially the Emergency Department
(ED) pertaining to different regions of the world with patients from different
cultural and educational backgrounds is needed. Objective: To determine the prevalence of delirium and its association with education in an
ED in Brazil during a 6-month period. Methods: Patients aged >18 years were
randomly selected from ED admissions. The instruments Confusion Assessment Method (CAM) scale, Mini-Mental State Examination (MMSE), Wechsler Logical Memory (WLM)
and Charlson comorbidity score were applied to evaluate delirium, cognitive
status, and comorbidities. Results: The prevalence of delirium was10.7%. Delirium patients had significantly lower
education, MMSE and WLM (immediate and delayed) scores, with 97.4% presenting
episodic memory impairment. Patients with delirium had more history of
neurological disorders. Three logistic regression models evaluating the
association of variables with delirium were developed. Age and MMSE were retained
in the first model, WLM scores in the second, and education in the third. Conclusion: To the best of our knowledge, this is the first study estimating the prevalence
of delirium in a Brazilian ED. Lower education was associated with the occurrence
of delirium.
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Cognitive Impairment in Hospitalized Seniors. Geriatrics (Basel) 2016; 1:geriatrics1010004. [PMID: 31022800 PMCID: PMC6371190 DOI: 10.3390/geriatrics1010004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 12/17/2015] [Accepted: 12/29/2015] [Indexed: 11/16/2022] Open
Abstract
Cognitive disorders are highly prevalent in hospitalized seniors, and can be due to delirium, dementia, as well as other disorders. Hospitalization can have adverse cognitive effects, and cognitive dysfunction adversely affects hospital outcomes. In this article, the literature is reviewed on how hospitalization affects cognitive function and how cognitive impairment affects hospital outcomes. Possible interventions in cognitively impaired hospitalized seniors are reviewed.
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9
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Current Concepts in the Diagnosis, Pathophysiology, and Treatment of Delirium: A European Perspective. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-015-0142-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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10
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Abraha I, Trotta F, Rimland JM, Cruz-Jentoft A, Lozano-Montoya I, Soiza RL, Pierini V, Dessì Fulgheri P, Lattanzio F, O’Mahony D, Cherubini A. Efficacy of Non-Pharmacological Interventions to Prevent and Treat Delirium in Older Patients: A Systematic Overview. The SENATOR project ONTOP Series. PLoS One 2015; 10:e0123090. [PMID: 26062023 PMCID: PMC4465742 DOI: 10.1371/journal.pone.0123090] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/27/2015] [Indexed: 01/08/2023] Open
Abstract
Background Non-pharmacological intervention (e.g. multidisciplinary interventions, music therapy, bright light therapy, educational interventions etc.) are alternative interventions that can be used in older subjects. There are plenty reviews of non-pharmacological interventions for the prevention and treatment of delirium in older patients and clinicians need a synthesized, methodologically sound document for their decision making. Methods and Findings We performed a systematic overview of systematic reviews (SRs) of comparative studies concerning non-pharmacological intervention to treat or prevent delirium in older patients. The PubMed, Cochrane Database of Systematic Reviews, EMBASE, CINHAL, and PsychINFO (April 28th, 2014) were searched for relevant articles. AMSTAR was used to assess the quality of the SRs. The GRADE approach was used to assess the quality of primary studies. The elements of the multicomponent interventions were identified and compared among different studies to explore the possibility of performing a meta-analysis. Risk ratios were estimated using a random-effects model. Twenty-four SRs with 31 primary studies satisfied the inclusion criteria. Based on the AMSTAR criteria twelve reviews resulted of moderate quality and three resulted of high quality. Overall, multicomponent non-pharmacological interventions significantly reduced the incidence of delirium in surgical wards [2 randomized trials (RCTs): relative risk (RR) 0.71, 95% Confidence Interval (CI) 0.59 to 0.86, I2=0%; (GRADE evidence: moderate)] and in medical wards [2 CCTs: RR 0.65, 95%CI 0.49 to 0.86, I2=0%; (GRADE evidence: moderate)]. There is no evidence supporting the efficacy of non-pharmacological interventions to prevent delirium in low risk populations (i.e. low rate of delirium in the control group)[1 RCT: RR 1.75, 95%CI 0.50 to 6.10 (GRADE evidence: very low)]. For patients who have developed delirium, the available evidence does not support the efficacy of multicomponent non-pharmacological interventions to treat delirium. Among single component interventions only staff education, reorientation protocol (GRADE evidence: very low)] and Geriatric Risk Assessment MedGuide software [hazard ratio 0.42, 95%CI 0.35 to 0.52, (GRADE evidence: moderate)] resulted effective in preventing delirium. Conclusions In older patients multi-component non-pharmacological interventions as well as some single-components intervention were effective in preventing delirium but not to treat delirium.
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Affiliation(s)
- Iosief Abraha
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
- * E-mail:
| | - Fabiana Trotta
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Joseph M. Rimland
- Scientific Direction, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | | | | | - Roy L. Soiza
- Department of Medicine for the Elderly, Woodend Hospital, Aberdeen, United Kingdom
| | - Valentina Pierini
- Clinica di Medicina Interna e Geriatria, Politecnica University of the Marche Region, Ancona, Italy
| | - Paolo Dessì Fulgheri
- Clinica di Medicina Interna e Geriatria, Politecnica University of the Marche Region, Ancona, Italy
| | - Fabrizia Lattanzio
- Scientific Direction, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
| | - Denis O’Mahony
- Department of Medicine, University College Cork, Cork, Ireland
| | - Antonio Cherubini
- Geriatrics and Geriatric Emergency Care, Italian National Research Center on Aging (IRCCS-INRCA), Ancona, Italy
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11
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Zywiel MG, Hurley RT, Perruccio AV, Hancock-Howard RL, Coyte PC, Rampersaud YR. Health economic implications of perioperative delirium in older patients after surgery for a fragility hip fracture. J Bone Joint Surg Am 2015; 97:829-36. [PMID: 25995494 DOI: 10.2106/jbjs.n.00724] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients who experience a fragility hip fracture are at high risk for perioperative delirium. The purpose of the present study was to evaluate the impact, from a hospital perspective, of perioperative delirium on the length of the hospital stay and episode-of-care costs for elderly patients who underwent surgical treatment of a fragility hip fracture. METHODS A total of 242 patients sixty-five years of age or older (mean age, eighty-two years; range, sixty-five to 103 years) who underwent surgical treatment of a fragility hip fracture at a single center between January 2011 and December 2012 were evaluated. Demographic, clinical, surgical, and adverse-events data were extracted and analyzed. The confusion assessment method (CAM) was used prospectively to detect perioperative delirium. RESULTS One hundred and sixteen (48%) of the 242 patients developed perioperative delirium during their stay in the hospital. Compared with patients with no delirium, delirium was associated with a mean incremental total length of hospital stay of 7.4 days (95% confidence interval [CI] = 3.7 to 11.2 days; p < 0.001), a mean incremental length of stay following surgery of 7.4 days (95% CI = 3.8 to 11.1 days; p < 0.001), and a mean incremental episode-of-care cost (in 2012 Canadian dollars) of $8286 (95% CI = $3690 to $12,881; p < 0.001). The total incremental episode-of-care cost attributable to delirium over the study period was $961,131 in 2012 Canadian dollars. CONCLUSIONS Nearly 50% of elderly patients who underwent surgery for a fragility hip fracture developed perioperative delirium, which was associated with a significant incremental in-hospital length of stay and significant incremental episode-of-care costs. These findings highlight the importance of implementing cost-effective interventions to reduce the prevalence of perioperative delirium in elderly patients with a low-energy hip fracture.
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Affiliation(s)
- Michael G Zywiel
- Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, 1E441, Toronto, ON M5T 2S8, Canada. E-mail address for M.G. Zywiel: . E-mail address for Y.R. Rampersaud:
| | - Richard T Hurley
- Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, 1E441, Toronto, ON M5T 2S8, Canada. E-mail address for M.G. Zywiel: . E-mail address for Y.R. Rampersaud:
| | - Anthony V Perruccio
- Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, 1E441, Toronto, ON M5T 2S8, Canada. E-mail address for M.G. Zywiel: . E-mail address for Y.R. Rampersaud:
| | - Rebecca L Hancock-Howard
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th floor, Toronto, ON M5T 3M6, Canada
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th floor, Toronto, ON M5T 3M6, Canada
| | - Y Raja Rampersaud
- Division of Orthopaedic Surgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, 1E441, Toronto, ON M5T 2S8, Canada. E-mail address for M.G. Zywiel: . E-mail address for Y.R. Rampersaud:
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Abstract
With the demands for improved experiences of care, improved outcomes, and greater efficiency/lower costs, the need for an evidence-based approach to care in rehabilitation settings has never been more urgent. This article guides practitioners in how to find the best available evidence for rehabilitation settings. It then discusses the use of evidence from systematic reviews through a high-impact case study: delirium in patients with postoperative hip fracture.
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Mailhot T, Cossette S, Bourbonnais A, Côté J, Denault A, Côté MC, Lamarche Y, Guertin MC. Evaluation of a nurse mentoring intervention to family caregivers in the management of delirium after cardiac surgery (MENTOR_D): a study protocol for a randomized controlled pilot trial. Trials 2014; 15:306. [PMID: 25073881 PMCID: PMC4133622 DOI: 10.1186/1745-6215-15-306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the use of evidence-based preventive measures, delirium affects about 40% of patients following cardiac surgery with the potential for serious clinical complications and anxiety for caregivers. There is some evidence that family involvement as a core component of delirium management may be beneficial since familiarity helps patients stay in contact with reality, however, this merits further investigation. There is also currently a gap in the scientific literature regarding objective indicators that could enhance early detection and monitoring of delirium. Therefore, this randomized pilot trial examines the acceptability, feasibility, and preliminary efficacy of an experimental nursing intervention to help family caregivers manage post-cardiac surgery delirium in their relatives. It also explores the validity of a new and innovative measure that has potential as an indicator for delirium. METHODS/DESIGN In this two-group randomized pilot study (n = 30), the control group will receive usual care and the intervention group will receive the experimental intervention aimed at reducing delirium severity. The intervention nurse's objective will be to foster the family caregiver's self-efficacy in behaving in a supportive manner during delirium episodes. Data will be collected from standard delirium assessment scales and a novel measure of delirium, i.e., cerebral oximetry obtained using near infrared spectroscopy, as well as medical records and participants' responses to questionnaires. DISCUSSION New strategies for early detection, monitoring, and management of delirium are needed in order to improve outcomes for both patients and families. The present article exposes feasibility issues based on the first few months of the empirical phase of the study that may be useful to the scientific community interested in improving the care of patients with delirium. Another potentially important contribution is in the exploration of cerebral oximetry, a promising measure as an objective indicator for early detection and continuous monitoring of delirium. The proposed pilot study will build towards a larger trial with the potential to improve knowledge about delirium management and monitoring. TRIAL REGISTRATION This pilot study was registered at Controlled Trials on March 27th 2013 and was assigned #ISRCTN95736036.
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Affiliation(s)
- Tanya Mailhot
- Faculty of Nursing, University of Montreal, C,P, 6128 succ, Centre-ville, Montreal, Quebec H3C 3J7, Canada.
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14
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Abstract
Delirium is a common, severe and acute neuropsychiatric syndrome that affects mainly older patients. Delirium is a well-recognised complication of trauma and is important as it is associated with an increase in mortality as well as cognitive and functional decline, increased length of hospital stay and increased risk of institutionalisation on discharge. Recognition and management is challenging and the psychological impact for patients and relatives devastating. This review discusses the current understanding of delirium with specific reference to trauma patients.
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Affiliation(s)
- S Eliza Griffiths
- Queen Elizabeth Hospital Birmingham, Queen Elizabeth Medical Centre, UK
| | - U Tandon
- Queen Elizabeth Hospital Birmingham, Queen Elizabeth Medical Centre, UK
| | - J Treml
- Queen Elizabeth Hospital Birmingham, Queen Elizabeth Medical Centre, UK
| | - TA Jackson
- School of Immunity and Infection, University of Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, UK
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Sabzwari S, Kumar D, Bhanji S, Sheerani M, Azhar G. Proportion, Predictors and Outcomes of Delirium at a Tertiary care Hospital in Karachi, Pakistan. AGEING INTERNATIONAL 2014. [DOI: 10.1007/s12126-012-9152-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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O'Hanlon S, O'Regan N, Maclullich AMJ, Cullen W, Dunne C, Exton C, Meagher D. Improving delirium care through early intervention: from bench to bedside to boardroom. J Neurol Neurosurg Psychiatry 2014; 85:207-13. [PMID: 23355807 DOI: 10.1136/jnnp-2012-304334] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Delirium is a complex neuropsychiatric syndrome that impacts adversely upon patient outcomes and healthcare outcomes. Delirium occurs in approximately one in five hospitalised patients and is especially common in the elderly and patients who are highly morbid and/or have pre-existing cognitive impairment. However, efforts to improve management of delirium are hindered by gaps in our knowledge and issues that reflect a disparity between existing knowledge and real-world practice. This review focuses on evidence that can assist in prevention, earlier detection and more timely and effective pharmacological and non-pharmacological management of emergent cases and their aftermath. It points towards a new approach to delirium care, encompassing laboratory and clinical aspects and health services realignment supported by health managers prioritising delirium on the healthcare change agenda. Key areas for future research and service organisation are outlined in a plan for improved delirium care across the range of healthcare settings and patient populations in which it occurs.
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Affiliation(s)
- Shane O'Hanlon
- Graduate Entry Medical School, , University of Limerick, Ireland
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Huisman MG, van Leeuwen BL, Ugolini G, Montroni I, Spiliotis J, Stabilini C, de’Liguori Carino N, Farinella E, de Bock GH, Audisio RA. "Timed Up & Go": a screening tool for predicting 30-day morbidity in onco-geriatric surgical patients? A multicenter cohort study. PLoS One 2014; 9:e86863. [PMID: 24475186 PMCID: PMC3901725 DOI: 10.1371/journal.pone.0086863] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 12/18/2013] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To determine the predictive value of the "Timed Up & Go" (TUG), a validated assessment tool, on a prospective cohort study and to compare these findings to the ASA classification, an instrument commonly used for quantifying patients' physical status and anesthetic risk. BACKGROUND In the onco-geriatric surgical population it is important to identify patients at increased risk of adverse post-operative outcome to minimize the risk of over- and under-treatment and improve outcome in this population. METHODS 280 patients ≥70 years undergoing elective surgery for solid tumors were prospectively recruited. Primary endpoint was 30-day morbidity. Pre-operatively TUG was administered and ASA-classification was registered. Data were analyzed using multivariable logistic regression analyses to estimate odds ratios (OR) and 95% confidence intervals (95%-CI). Absolute risks and area under the receiver operating characteristic curves (AUC's) were calculated. RESULTS 180 (64.3%) patients (median age: 76) underwent major surgery. 55 (20.1%) patients experienced major complications. 50.0% of patients with high TUG and 25.6% of patients with ASA≥3 experienced major complications (absolute risks). TUG and ASA were independent predictors of the occurrence of major complications (TUG:OR 3.43; 95%-CI = 1.14-10.35. ASA1 vs. 2:OR 5.91; 95%-CI = 0.93-37.77. ASA1 vs. 3&4:OR 12.77; 95%-CI = 1.84-88.74). AUCTUG was 0.64 (95%-CI = 0.55-0.73, p = 0.001) and AUCASA was 0.59 (95%-CI = 0.51-0.67, p = 0.04). CONCLUSIONS Twice as many onco-geriatric patients at risk of post-operative complications, who might benefit from pre-operative interventions, are identified using TUG than when using ASA.
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Affiliation(s)
- Monique G. Huisman
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- * E-mail:
| | - Barbara L. van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Isacco Montroni
- Department of Surgery, S. Orsola Malpighi Hospital, Bologna, Italy
| | - John Spiliotis
- Department of Surgery, Metaxa Cancer Hospital, Piraeus, Greece, and Regional University Hospital of Patras, Patras, Greece
| | - Cesare Stabilini
- Department of Surgery, San Martino University Hospital, Genua, Italy
| | | | - Eriberto Farinella
- Department of Surgery, S. Maria Hospital, Perugia, Italy, and Luton & Dunstable Hospital, Luton, United Kingdom
| | - Geertruida H. de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Riccardo A. Audisio
- Department of Surgery, University of Liverpool St. Helens Teaching Hospital, St. Helens, United Kingdom
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Evidence-Based Clinical Audit Criteria for the Prevention and Management of Delirium in the Postoperative Patient With a Hip Fracture. Orthop Nurs 2014; 33:27-34; quiz 35-6. [DOI: 10.1097/nor.0000000000000020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Maclullich AMJ, Anand A, Davis DHJ, Jackson T, Barugh AJ, Hall RJ, Ferguson KJ, Meagher DJ, Cunningham C. New horizons in the pathogenesis, assessment and management of delirium. Age Ageing 2013; 42:667-74. [PMID: 24067500 PMCID: PMC3809721 DOI: 10.1093/ageing/aft148] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Delirium is one of the foremost unmet medical needs in healthcare. It affects one in eight hospitalised patients and is associated with multiple adverse outcomes including increased length of stay, new institutionalisation, and considerable patient distress. Recent studies also show that delirium strongly predicts future new-onset dementia, as well as accelerating existing dementia. The importance of delirium is now increasingly being recognised, with a growing research base, new professional international organisations, increased interest from policymakers, and greater prominence of delirium in educational and audit programmes. Nevertheless, the field faces several complex research and clinical challenges. In this article we focus on selected areas of recent progress and/or uncertainty in delirium research and practice. (i) Pathogenesis: recent studies in animal models using peripheral inflammatory stimuli have begun to suggest mechanisms underlying the delirium syndrome as well as its link with dementia. A growing body of blood and cerebrospinal fluid studies in humans have implicated inflammatory and stress mediators. (ii) Prevention: delirium prevention is effective in the context of research studies, but there are several unresolved issues, including what components should be included, the role of prophylactic drugs, and the overlap with general best care for hospitalised older people. (iii) Assessment: though there are several instruments for delirium screening and assessment, detection rates remain dismal. There are no clear solutions but routine screening embedded into clinical practice, and the development of new rapid screening instruments, offer potential. (iv) Management: studies are difficult given the heterogeneity of delirium and currently expert and comprehensive clinical care remains the main recommendation. Future studies may address the role of drugs for specific elements of delirium. In summary, though facing many challenges, the field continues to make progress, with several promising lines of enquiry and an expanding base of interest among researchers, clinicians and policymakers.
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Affiliation(s)
- Alasdair M J Maclullich
- Edinburgh Delirium Research Group, Geriatric Medicine Unit, University of Edinburgh, Room S1642, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, UK
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Antipsychotic prophylaxis in surgical patients modestly decreases delirium incidence--but not duration--in high-incidence samples: a meta-analysis. Gen Hosp Psychiatry 2013; 35:370-5. [PMID: 23351526 DOI: 10.1016/j.genhosppsych.2012.12.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 12/18/2012] [Accepted: 12/19/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective was to examine whether prophylactic treatment with antipsychotics can decrease the incidence and severity of postsurgical delirium. METHOD A meta-analysis of existing trials comparing delirium incidence between patients given prophylactic antipsychotic and placebo was performed. Secondary outcomes were total hospital days, total days of delirium and severity. Pooled odds ratios (ORs) and mean differences were calculated using a random-effects model. RESULTS Five randomized placebo-controlled trials comprising a total of 1491 patients were included. In the pooled analysis, prophylactic antipsychotic administration showed a reduction in delirium incidence (OR: 0.42; 95% confidence interval (CI): 0.24, 0.74). Among the studies reporting other outcomes, patients receiving antipsychotics prophylactically showed no differences in total hospital days (0.1; 95% CI: -0.73, 0.94), days of delirium (-1.17; 95% CI: -5.22, 2.88) or delirium severity (-1.02; 95% CI: -6.81, 4.76). CONCLUSIONS Prophylactic antipsychotic treatment in surgical patients modestly decreases the incidence of delirium, but not the length of hospital stay, duration of delirium or its severity. Given the modest protective effect of antipsychotics and their potential adverse reactions, there is insufficient evidence to support its universal use as a preventive agent, though potential benefit may be seen in populations at high risk of developing delirium.
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Jeffs KJ, Berlowitz DJ, Grant S, Lawlor V, Graco M, de Morton NA, Savige JA, Lim WK. An enhanced exercise and cognitive programme does not appear to reduce incident delirium in hospitalised patients: a randomised controlled trial. BMJ Open 2013; 3:bmjopen-2013-002569. [PMID: 23794558 PMCID: PMC3686162 DOI: 10.1136/bmjopen-2013-002569] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To determine if a programme of progressive resistance exercise, mobilisation and orientation, in addition to usual care, was superior to usual care alone in the prevention of incident delirium in older hospitalised patients. DESIGN A randomised controlled trial. SETTING The study was performed at a secondary referral hospital in Melbourne, Australia between May 2005 and December 2007. PARTICIPANTS 648 consecutive medical inpatients aged 65 years or older who had been in hospital for less than 48 h and who did not have delirium. INTERVENTION Participants were randomly allocated to a twice-daily programme of progressive resistance exercise tailored to individual ability, mobilisation and orientation in addition to usual care or to usual care alone. MEASUREMENTS Delirium was measured using the Confusion Assessment Method at baseline and every 48 h until discharge. Secondary outcome measures were severity and duration of delirium, discharge destination and length of stay. RESULTS Delirium occurred in 4.9% (95% CI 2.3% to 7.3%) of the intervention group (15/305) and in 5.9% (20/339; 95% CI 3.8% to 9.2%) of the group receiving usual care. No difference was observed between groups (χ(2); p=0.5). The intervention had no effect on delirium duration, severity, discharge destination or length of stay. CONCLUSION A programme of progressive resistance exercise and orientation was not effective in reducing incident delirium in hospitalised elderly patients.
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Hempenius L, Slaets JPJ, van Asselt D, de Bock GH, Wiggers T, van Leeuwen BL. Outcomes of a Geriatric Liaison Intervention to Prevent the Development of Postoperative Delirium in Frail Elderly Cancer Patients: Report on a Multicentre, Randomized, Controlled Trial. PLoS One 2013; 8:e64834. [PMID: 23840308 PMCID: PMC3686791 DOI: 10.1371/journal.pone.0064834] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 04/16/2013] [Indexed: 02/03/2023] Open
Abstract
Background Delirium is a serious and common postoperative complication, especially in frail elderly patients. The aim of this study was to evaluate the effect of a geriatric liaison intervention in comparison with standard care on the incidence of postoperative delirium in frail elderly cancer patients treated with an elective surgical procedure for a solid tumour. Methods Patients over 65 years of age who were undergoing elective surgery for a solid tumour were recruited to a multicentre, prospective, randomized, controlled trial. The patients were randomized to standard treatment versus a geriatric liaison intervention. The intervention consisted of a preoperative geriatric consultation, an individual treatment plan targeted at risk factors for delirium, daily visits by a geriatric nurse during the hospital stay and advice on managing any problems encountered. The primary outcome was the incidence of postoperative delirium. The secondary outcome measures were the severity of delirium, length of hospital stay, complications, mortality, care dependency, quality of life, return to an independent preoperative living situation and additional care at home. Results In total, the data of 260 patients were analysed. Delirium occurred in 31 patients (11.9%), and there was no significant difference between the incidence of delirium in the intervention group and the usual-care group (9.4% vs. 14.3%, OR: 0.63, 95% CI: 0.29–1.35). Conclusions Within this study, a geriatric liaison intervention based on frailty for the prevention of postoperative delirium in frail elderly cancer patients undergoing elective surgery for a solid tumour has not proven to be effective. Trial Registration Nederlands Trial Register Trial ID NTR 823
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Affiliation(s)
- Liesbeth Hempenius
- University Center for Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Geriatric Center, Medical Center Leeuwarden, Leeuwarden, The Netherlands
- * E-mail:
| | - Joris P. J. Slaets
- University Center for Geriatric Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dieneke van Asselt
- Geriatric Center, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Geertruida H. de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Theo Wiggers
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, T`he Netherlands
| | - Barbara L. van Leeuwen
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, T`he Netherlands
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Yoo JW, Kim S, Seol H, Kim SJ, Yang JM, Ryu WS, Min TJ, Choi JB, Kwon M, Nakagawa S. Effects of an internal medicine floor interdisciplinary team on hospital and clinical outcomes of seniors with acute medical illness. Geriatr Gerontol Int 2013; 13:942-8. [PMID: 23441847 DOI: 10.1111/ggi.12035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2012] [Indexed: 11/29/2022]
Abstract
AIM To examine whether an internal medicine interdisciplinary floor team enhances the hospital and clinical outcomes for seniors with acute medical illness. METHODS Seniors admitted to medical floor teaching services of a USA teaching hospital were recruited and allocated to the interdisciplinary (ITD; n = 236) and usual care teams (n = 248). Compared with the usual care team, the interdisciplinary team physicians carried out daily "geriatric" assessment and management, and led the interdisciplinary team meeting designed for improving interprofessional collaboration. RESULTS After controlling for patient and physician characteristics, the mean hospital length of stay in the ITD team (6.1 days; 95% CI 5.2-7.7 days) was 0.7 days shorter than that in the usual care team (6.8 days; 95% CI 5.7-8.3 days; P = 0.008). There was no significant difference in delirium and 30-day hospital readmission between care groups. CONCLUSIONS Notwithstanding partly positive associations, the results from the present study suggest that interdisciplinary team-based care is, at best, associated with enhancing the clinical and hospital outcomes for seniors with acute medical illness.
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Affiliation(s)
- Ji Won Yoo
- Department of Internal Medicine and Institute of Gerontology, University of Michigan Medical School, Michigan, USA; Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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Holly C, Cantwell ER, Kamienski MC. Evidence-Based Practices for the Identification, Screening, and Prevention of Acute Delirium in the Hospitalized Elderly: An Overview of Systematic Reviews. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13670-012-0031-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Abstract
PURPOSE OF REVIEW To review recent findings and developments in strategies for prevention and treatment of postoperative delirium. RECENT FINDINGS Current advances in the field include improved knowledge about predisposing and precipitating factors, evidence for efficacy of multicomponent prevention programmes, refinement of perioperative procedures, and promising pharmacological approaches for prophylaxis and management of postoperative delirium. SUMMARY Postoperative delirium is a common and serious complication in elderly patients. Preoperative assessment of risk profiles and tailored multimodal prevention approaches proved effective and should be integrated into clinical practice. Despite promising recent findings, at present, the routine use of pharmacological prophylaxis cannot be recommended. Validated and easy-to-use bedside diagnostic tools are available and should be regularly applied for delirium screening in the first days after surgery. In patients developing delirium, causal conditions and contributing factors need to be identified and addressed. Whereas administration of antipsychotics may represent an option for symptomatic treatment, further studies are needed to evaluate the effects of pharmacological approaches on long-term outcomes in elderly patients with delirium.
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Yoo JW, Nakagawa S, Kim S. Delirium and transition to a nursing home of hospitalized older adults: a controlled trial of assessing the interdisciplinary team-based "geriatric" care and care coordination by non-geriatrics specialist physicians. Geriatr Gerontol Int 2012; 13:342-50. [PMID: 22762723 DOI: 10.1111/j.1447-0594.2012.00905.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To examine whether a team-based inpatient "geriatric" care model provided by non-geriatrics specialist physicians was associated with changes in the occurrence of delirium and transition to a nursing home. METHODS We carried out an intervention (interdisciplinary; ITD group) control (usual care group) study comparing the outcomes of hospitalized older adults cared for by non-geriatrics specialist physicians. Compared with the usual care group, the ITD intervention group provided additional value: geriatric care and care coordination by leading daily ITD team meetings. RESULTS After adjusting for patient demographics and clinical characteristics, the probability of transition to a nursing home in the ITD intervention group was significantly lower (odds ratio 0.52; 95% confidence intervals, 0.16-0.94; P = 0.008) than that in the usual care group. However, there was no significant difference in the predicted probabilities of delirium between the ITD intervention and usual care groups. CONCLUSION As compared with the usual care group, a significantly lower probability of transition to a nursing home was observed in the ITD intervention group, but the probabilities of delirium between the ITD intervention and usual care groups did not differ significantly.
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Affiliation(s)
- Ji Won Yoo
- Cleveland Clinic Health System, Cleveland, Ohio, USA.
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Current world literature. Curr Opin Psychiatry 2012; 25:251-9. [PMID: 22456191 DOI: 10.1097/yco.0b013e328352dd8d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Current World Literature. Curr Opin Anaesthesiol 2012; 25:111-20. [DOI: 10.1097/aco.0b013e32834fd93c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Day HR, Perencevich EN, Harris AD, Gruber-Baldini AL, Himelhoch SS, Brown CH, Dotter E, Morgan DJ. Association between contact precautions and delirium at a tertiary care center. Infect Control Hosp Epidemiol 2011; 33:34-9. [PMID: 22173520 DOI: 10.1086/663340] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the relationship between contact precautions and delirium among inpatients, adjusting for other factors. DESIGN Retrospective cohort study. SETTING A 662-bed tertiary care center. PATIENTS All nonpyschiatric adult patients admitted to a tertiary care center from 2007 through 2009. METHODS Generalized estimating equations were used to estimate the association between contact precautions and delirium in a retrospective cohort of 2 years of admissions to a tertiary care center. RESULTS During the 2-year period, 60,151 admissions occurred in 45,266 unique nonpsychiatric patients. After adjusting for comorbid conditions, age, sex, intensive care unit status, and length of hospitalization, contact precautions were significantly associated with delirium (as defined by International Classification of Diseases, Ninth Revision), medication, or restraint exposure (adjusted odds ratio [OR], 1.40 [95% confidence interval {CI}, 1.24-1.51]). The association between contact precautions and delirium was seen only in patients who were newly placed under contact precautions during the course of their stay (adjusted OR, 1.75 [95% CI, 1.60-1.92]; P < .01) and was not seen in patients who were already under contact precautions at admission (adjusted OR, 0.97 [95% CI, 0.86-1.09]; P = .06). CONCLUSIONS Although delirium was more common in patients who were newly placed under contact precautions during the course of their hospital admission, delirium was not associated with contact precautions started at hospital admission. Patients newly placed under contact precautions after admission but during hospitalization appear to be at a higher risk and may benefit from proven delirium-prevention strategies.
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Affiliation(s)
- Hannah R Day
- University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Current World Literature. Curr Opin Anaesthesiol 2011; 24:705-12. [DOI: 10.1097/aco.0b013e32834e25f9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Stransky M, Schmidt C, Ganslmeier P, Grossmann E, Haneya A, Moritz S, Raffer M, Schmid C, Graf BM, Trabold B. Hypoactive Delirium After Cardiac Surgery as an Independent Risk Factor for Prolonged Mechanical Ventilation. J Cardiothorac Vasc Anesth 2011; 25:968-74. [DOI: 10.1053/j.jvca.2011.05.004] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Indexed: 11/11/2022]
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