1
|
Otani H, Yokomichi N, Imai K, Toyota S, Yamauchi T, Miwa S, Yuasa M, Okamoto S, Kogure T, Inoue S, Morita T. A Novel Objective Measure for Terminal Delirium: Activity Scores Measured by a Sheet-Type Sensor. J Pain Symptom Manage 2024; 68:246-254. [PMID: 38810949 DOI: 10.1016/j.jpainsymman.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
CONTEXT Delirium is a significant concern in end-of-life care. Continuous monitoring of agitation levels using objective methods may have advantages over existing measurement scales. OBJECTIVES To examine whether an objective measure of activity scores measured using a sheet-type non-wearable sensor (Nemuri SCAN [NSCAN]) was correlated with agitation levels measured using the modified Richmond Agitation-Sedation Scale (RASS) in terminally ill patients with cancer. METHODS We conducted a single-center, prospective, observational study in a palliative care unit using the NSCAN to measure activity scores and the RASS to assess agitation levels. RASS scores were prospectively measured by ward nurses blinded to the NSCAN variables. A database was created to pair the RASS scores and activity scores at night on the same day. RESULTS During the observation period, 1209 patients were hospitalized, and 3028 pairs of assessments of 971 patients were analyzed. The NSCAN activity scores significantly increased with increasing RASS scores (Jonckheere-Terpstra test, p < 0.001). The mean values of the activity scores for each RASS score were RASS -5, 28.9; RASS -4, 36.4; RASS -3, 41.7; RASS -2, 57.4; RASS -1, 58.8; RASS 0, 62.6; RASS 1, 79.6; RASS 2, 106.5; and RASS 3, 118.7. CONCLUSION The NSCAN activity significantly correlated with modified RASS agitation scores. Real-time NSCAN data on agitation may aid timely interventions for optimal symptom control. To improve outcomes for patients suffering from terminal delirium, more research on monitoring tools is warranted.
Collapse
Affiliation(s)
- Hiroyuki Otani
- Department of Palliative and Supportive Care(H.O.), St. Mary's Hospital, Kurume City, Fukuoka 830-8543, Japan; Department of Palliative Care Team and Palliative and Supportive Care(H.O.), National Hospital Organization Kyushu Cancer Center, Mitami-ku, Fukuoka 811-1395, Japan.
| | - Naosuke Yokomichi
- Palliative and Supportive Care Division(N.Y., T.M.), Seirei Mikatahara General Hospital, Hamamatsu City, Shizuoka 433-8558, Japan
| | - Kengo Imai
- Seirei Hospice(K.I., T.Y., S.M., M.Y.), Seirei Mikatahara General Hospital, Hamamatsu city, Shizuoka 433-8558, Japan
| | - Saori Toyota
- Paramount Bed Sleep Research Laboratory(S.T., T.K.), PARAMOUNT BED CO., Tokyo 136-8670, Japan
| | - Toshihiro Yamauchi
- Seirei Hospice(K.I., T.Y., S.M., M.Y.), Seirei Mikatahara General Hospital, Hamamatsu city, Shizuoka 433-8558, Japan
| | - Satoru Miwa
- Seirei Hospice(K.I., T.Y., S.M., M.Y.), Seirei Mikatahara General Hospital, Hamamatsu city, Shizuoka 433-8558, Japan
| | - Misuzu Yuasa
- Seirei Hospice(K.I., T.Y., S.M., M.Y.), Seirei Mikatahara General Hospital, Hamamatsu city, Shizuoka 433-8558, Japan
| | - Soichiro Okamoto
- Uguisu home clinic(S.O.), Hamamatsu City, Shizuoka Prefecture 430-0856
| | - Takamasa Kogure
- Paramount Bed Sleep Research Laboratory(S.T., T.K.), PARAMOUNT BED CO., Tokyo 136-8670, Japan
| | - Satoshi Inoue
- Clinical Laboratory Department(S.I.), Seirei Mikatahara General Hospital, Hamamatsu City, Shizuoka 433-8558, Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division(N.Y., T.M.), Seirei Mikatahara General Hospital, Hamamatsu City, Shizuoka 433-8558, Japan; Research Association for Community Health(T.M.), Hamamatsu city, Shizuoka 434-0046, Japan
| |
Collapse
|
2
|
la Cour KN, Andersen-Ranberg NC, Mortensen C, Poulsen LM, Mathiesen O, Egerod I, Collet M. Patient recall of intensive care delirium: A qualitative investigation. Acta Anaesthesiol Scand 2024; 68:1050-1058. [PMID: 38850120 DOI: 10.1111/aas.14463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 04/28/2024] [Accepted: 05/21/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Many patients in the Intensive Care Unit (ICU) experience delirium. Understanding the patient perspective of delirium is important to improve care and reduce suffering. The aim of our study was to investigate the subjective patient experience of delirium, delirium-related distress, and delirium management in ICU. METHODS Our study had a qualitative multicenter design applying individual interviews and thematic analysis. Participants were critically ill adult patients that were determined delirium positive according to validated delirium screening tools during ICU admission. The interviews were conducted after ICU discharge when patients were delirium-free as assessed by the "Rapid clinical test for delirium" (4AT) and able to participate in an interview. RESULTS We interviewed 30 patients choosing the main themes deductively: Delirium experience; Delirium related distress; and Delirium management. Despite variations in recollection detail, ICU survivors consistently reported delirium-related distress during and after their ICU stay, manifesting as temporal confusion, misinterpretations, and a sense of distrust towards ICU staff. Delusions were characterized by a blend of factual and fictional elements. Impaired short-term memory hindered communication and intensified feelings of isolation, neglect, and loss of control. CONCLUSION The ICU survivors in our study recalled delirium as an unpleasant and frightening experience, often leading to delirium-related distress during and after their ICU stay, indicating the necessity for enhanced assessment and treatment.
Collapse
Affiliation(s)
- Kirstine N la Cour
- Zealand University Hospital, Centre for Anaesthesiological Research, Koge, Denmark
| | | | - Camilla Mortensen
- Zealand University Hospital, Centre for Anaesthesiological Research, Koge, Denmark
| | - Lone M Poulsen
- Zealand University Hospital, Centre for Anaesthesiological Research, Koge, Denmark
| | - Ole Mathiesen
- Zealand University Hospital, Centre for Anaesthesiological Research, Koge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ingrid Egerod
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Intensive Care Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Marie Collet
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Intensive Care Medicine, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
3
|
Kako J, Kobayashi M, Matsuda Y, Inoue S, Tanimukai H, Wada S, Hasegawa T. Nonpharmacological Intervention for Delirium in Patients With Cancer: A Scoping Review. J Pain Symptom Manage 2024:S0885-3924(24)00901-1. [PMID: 39089397 DOI: 10.1016/j.jpainsymman.2024.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/05/2024] [Accepted: 07/21/2024] [Indexed: 08/04/2024]
Affiliation(s)
- Jun Kako
- Department of Nursing (J.K.), Mie University, Tsu 514-8507, Japan.
| | - Masamitsu Kobayashi
- Department of Nursing (M.K.), St. Luke's International University, Tokyo 104-0044, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine (Y.M.), NHO Kinki Chuo Chest Medical Center, Sakai 591-8555, Japan
| | - Shinichiro Inoue
- Department of Nursing (S.I.), Niimi University, Niimi 718-8585, Japan
| | - Hitoshi Tanimukai
- Department of Nursing (H.T.), Nagoya City University, Mizuho-ku 467-8601, Japan
| | - Saho Wada
- Division of Quality Assurance Programs (S.W.), National Cancer Center Institute for Cancer Control, Tokyo 104-0045, Japan
| | - Takaaki Hasegawa
- Center for Psycho-oncology and Palliative Care (T.H.), Nagoya City University Hospital, Mizuho-ku 467-8601, Japan
| |
Collapse
|
4
|
Tuohy D, Boland P, Stark P, Cook L, Anderson T, Barry HE, Birch M, Brown-Wilson C, Cunningham E, McMahon J, Graham M, Curran GM, Mitchell G, Murphy J, Tierney A, Coffey A. Digital education about delirium for health care professional students: a mixed methods systematic review. BMC MEDICAL EDUCATION 2024; 24:762. [PMID: 39010110 PMCID: PMC11247797 DOI: 10.1186/s12909-024-05725-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/28/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Competence in delirium care begins with pre-registration education for health care professionals. Although a common complication for hospitalised patients, delirium is avoidable and reversible. Delirium requires early recognition in person-centred care. Students need to learn how to identify and effectively care for 'at risk' patients. AIM To identify and examine literature on how pre-registration health care professional students are prepared to recognise, assess, and deliver interventions to prevent delirium in practice, using digital/web based educational interventions. METHOD Mixed methods systematic review with narrative synthesis. A protocol was registered with PROSPERO. The review questions and search strategy were guided by the Population, Phenomena of Interest, Context (PICo) framework. The PRISMA framework guided the screening, data extraction and analysis. Database searches (MEDLINE, Web of Science, Embase, CINAHL, Cochrane Central Register of Controlled Trials, PsycINFO & Scopus) were undertaken in April 2023 for publications from 2012 to 2023. Covidence software [30] was used to extract and manage the data. Quality appraisal was guided by the Crowe Critical Appraisal Tool (CCAT) [31]. FINDINGS Ten papers were included: mixed methods (2), qualitative (1) and quantitative (7). Medical students were the most studied group (n = 5), followed by student nurses (n = 4) and mixed nursing and medical students (n = 1). Length of learning experience varied from 12 min virtual reality (VR) to a two-week 'geriatrics' elective. Learning was enhanced by player autonomy, engagement, safety, applicability, choices, multiple perspectives and moral reasoning opportunities. DISCUSSION Digital programmes should be visually appealing, interactive with opportunities for practice and timely appropriate feedback.
Collapse
Affiliation(s)
- Dympna Tuohy
- Department of Nursing and Midwifery, University of Limerick, Limerick, V94T9PX, Ireland.
| | - Pauline Boland
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Patrick Stark
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, BT9 7BL, Northern Ireland
| | - Lana Cook
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, BT9 7BL, Northern Ireland
| | - Tara Anderson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, BT9 7BL, Northern Ireland
| | - Heather E Barry
- Primary Care Research Group, School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland
| | - Matt Birch
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, BT9 7BL, Northern Ireland
| | - Christine Brown-Wilson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, BT9 7BL, Northern Ireland
| | - Emma Cunningham
- Centre for Public Health, Institute of Clinical Sciences, Queen's University Belfast, Block B, Belfast, BT12 6BA, Northern Ireland
| | - James McMahon
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, BT9 7BL, Northern Ireland
| | - Margaret Graham
- Department of Nursing and Midwifery, University of Limerick, Limerick, V94T9PX, Ireland
| | - Geoffrey M Curran
- Department of Nursing and Midwifery, University of Limerick, Limerick, V94T9PX, Ireland
- Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Gary Mitchell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, BT9 7BL, Northern Ireland
| | - Jill Murphy
- Department of Nursing and Midwifery, University of Limerick, Limerick, V94T9PX, Ireland
| | - Audrey Tierney
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Alice Coffey
- Department of Nursing and Midwifery, University of Limerick, Limerick, V94T9PX, Ireland
| |
Collapse
|
5
|
Thomas C, Alici Y, Breitbart W, Bruera E, Blackler L, Sulmasy DP. Drugs, delirium, and ethics at the end of life. J Am Geriatr Soc 2024; 72:1964-1972. [PMID: 38240387 PMCID: PMC11226357 DOI: 10.1111/jgs.18766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024]
Abstract
For older persons with delirium at the end of life, treatment involves complex trade-offs and highly value-sensitive decisions. The principles of beneficence, nonmaleficence, respect for autonomy, and justice establish important parameters but lack the structure necessary to guide clinicians in the optimal management of these patients. We propose a set of ethical rules to guide therapeutics-the canons of therapy-as a toolset to help clinicians deliberate about the competing concerns involved in the management of older patients with delirium at the end of life. These canons are standards of judgment that reflect how many experienced clinicians already intuitively practice, but which are helpful to articulate and apply as basic building blocks for a relatively neglected but emerging ethics of therapy. The canons of therapy most pertinent to the care of patients with delirium at the end of life are as follows: (1) restoration, which counsels that the goal of all treatment is to restore the patient, as much as possible, to homeostatic equilibrium; (2) means-end proportionality, which holds that every treatment should be well-fitted to the intended goal or end; (3) discretion, which counsels that an awareness of the limits of medical knowledge and practice should guide all treatment decisions; and (4) parsimony, which maintains that only as much therapeutic force as is necessary should be used to achieve the therapeutic goal. Carefully weighed and applied, these canons of therapy may provide the ethical structure needed to help clinicians optimally navigate complex cases.
Collapse
Affiliation(s)
- Columba Thomas
- Kennedy Institute of Ethics, Georgetown University, Washington, DC, USA
| | - Yesne Alici
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - William Breitbart
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Liz Blackler
- Ethics Committee, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel P. Sulmasy
- Kennedy Institute of Ethics, Georgetown University, Washington, DC, USA
- Departments of Medicine and Philosophy and the Pellegrino Center for Clinical Bioethics, Georgetown University, Washington, DC, USA
| |
Collapse
|
6
|
Meyers G, Bubalo J, Eckstrom E, Winsnes K, Carpenter PA, Artz A, Lin RJ. Transplantation-Associated Altered Mentation and Encephalopathy: A New Classification for Acute Neurocognitive Changes Associated with Hematopoietic Cell Transplantation from the ASTCT Committee on Practice Guidelines. Transplant Cell Ther 2024; 30:646-662. [PMID: 38663768 DOI: 10.1016/j.jtct.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 05/16/2024]
Abstract
Acute encephalopathy, manifesting clinically as delirium, is a common but often unrecognized complication of hematopoietic cell transplantation (HCT). Delirium can occur in patients of any age and is observed after autologous or allogeneic HCT. Although delirium has been studied primarily during initial HCT hospitalizations in recipients of myeloablative conditioning, recent investigations have identified delirium later post-transplantation and in recipients of reduced-intensity conditioning. Acute encephalopathy can be driven by infectious complications, medications, tissue damage, and/or organ dysfunction. Altered consciousness, either mild or profound, is often its only clinical manifestation. Identifying delirium is essential to overall HCT care, because patients who experience delirium have longer hospitalization and recovery times and are at risk for other poor post-HCT outcomes. Given the critical nature of this common complication and the ongoing expansion of HCT for more vulnerable populations, the American Society of Transplantation and Cellular Therapy (ASTCT) recommends intensifying research into post-HCT cognitive changes and establishing standardized definitions that encompass the full spectrum of altered consciousness for clinical care purposes and to provide benchmark endpoints for future research studies. To capture a range of acute neurocognitive changes specifically found in HCT patients (often referred to as acute encephalopathy), the ASTCT proposes a new diagnosis, transplantation-associated altered mentation and encephalopathy (TAME). The TAME diagnosis includes HCT patients who meet Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for delirium and those with acute neurocognitive changes who do not meet all the DSM-5 criteria for delirium (subsyndromal delirium). Early TAME is defined as occurring during conditioning or ≤100 days post-HCT, whereas late TAME occurs >100 days post-HCT in patients with additional HCT-related complications. This manuscript establishes clear diagnostic criteria and discusses factors that can potentially impact the development of TAME, as well as the workup and management of TAME.
Collapse
Affiliation(s)
- Gabrielle Meyers
- Center for Hematologic Malignancies, Oregon Health & Science University, Knight Cancer Institute, Portland, Oregon.
| | - Joseph Bubalo
- Department of Pharmacy, Oregon Health & Science University, Portland, Oregon
| | - Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Katrina Winsnes
- Division of Pediatrics Hematology and Oncology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Andrew Artz
- Division of Leukemia, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Richard J Lin
- Adult BMT and Cellular Therapy Services, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
7
|
Yoshikai S, Ueda M, Ikeda K. Effect of Morphine Used to Relieve Dyspnea Due to Heart Failure on Delirium. J Palliat Med 2024. [PMID: 38916066 DOI: 10.1089/jpm.2023.0704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024] Open
Abstract
Background: Delirium management is crucial in palliative care. Morphine effectively relieves dyspnea due to heart failure. However, the effect of morphine, which is used to relieve dyspnea due to heart failure, on the incidence of delirium has not been examined to date. Objective: To evaluate the effect of morphine, which is used to relieve dyspnea due to heart failure, on delirium. Design: Retrospective observational study. Setting/Subjects: Subjects were identified from Osaka University Hospital records, located in Japan, from January 1, 2010, to September 30, 2021. The case group consisted of admissions for heart failure or cardiomyopathy registered in electronic medical records. Morphine was administered to relieve dyspnea due to heart failure, and no surgeries or procedures were performed. The control group consisted of admissions for heart failure or cardiomyopathy in the Diagnosis Procedure Combination (DPC) database, which did not include administration of morphine, oxycodone, or fentanyl during the hospitalization period and patients did not undergo surgery or any other procedure. Measurements: The incidence of delirium was assessed. Results: The odds ratios for morphine in the multivariate logistic regression analysis with propensity score and univariate logistic regression analysis after propensity score matching were 1.406 (95% confidence interval (CI) [0.249-7.957]) and 1.034 (95% CI [0.902-1.185]), respectively. Conclusions: Morphine, which is used to relieve dyspnea due to heart failure, had minimal effect on the incidence of delirium. This information is likely to be beneficial for the future use of morphine in the management of dyspnea in patients with heart failure.
Collapse
Affiliation(s)
- Shoichi Yoshikai
- Department of Clinical Pharmacy Research and Education, Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Japan
| | - Mikiko Ueda
- Department of Clinical Pharmacy Research and Education, Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Japan
| | - Kenji Ikeda
- Department of Clinical Pharmacy Research and Education, Graduate School of Pharmaceutical Sciences, Osaka University, Suita, Japan
| |
Collapse
|
8
|
Ma Y, Cui N, Guo Z, Zhang Y, Jin J. Exploring patients' and families' preferences for auditory stimulation in ICU delirium prevention: A qualitative study. Intensive Crit Care Nurs 2024; 82:103629. [PMID: 38252983 DOI: 10.1016/j.iccn.2024.103629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/07/2024] [Accepted: 01/13/2024] [Indexed: 01/24/2024]
Abstract
OBJECTIVES To explore the preferences of patients and families for delirium prevention by auditory stimulation in intensive care units. RESEARCH METHODOLOGY One-on-one, face-to-face, semistructured interviews with 17 participants (6 patients and 11 family members) were conducted at a step-down unit in a tertiary general hospital using a descriptive qualitative design. The data were analyzed via inductive thematic analysis. RESULTS Four major themes and ten subthemes emerged from the interviews: (1) reality orientation; (2) emotional support; (3) links to the outside; and (4) promising future. CONCLUSIONS The results in this qualitative study shed light on patients' and families' preferences for auditory stimulation in preventing ICU delirium. The participation of family members plays a crucial role in preventing ICU delirium. Family members can assist patients in reducing confusion about the situation by providing accurate and clear reality orientation. The emotional support and promising future provided by family members can help patients regain confidence and courage, which are often lacking in ICU patients. Linking patients to the outside world helps them stay connected, understand what is happening outside and reduce feelings of isolation. IMPLICATIONS FOR CLINICAL PRACTICE These findings can help health care staff gain insight into patients' and families' preferences and needs for auditory stimulation. Furthermore, these findings pave the way for crafting effective auditory interventions.
Collapse
Affiliation(s)
- Yajun Ma
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Nianqi Cui
- School of Nursing, Kunming Medical University, China.
| | - Zhiting Guo
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Yuping Zhang
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Jingfen Jin
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, Zhejiang, China; Changxing Branch Hospital of SAHZU, Huzhou, Zhejiang, China.
| |
Collapse
|
9
|
Hui D, Cheng SY, Paiva CE. Pharmacologic Management of End-of-Life Delirium: Translating Evidence into Practice. Cancers (Basel) 2024; 16:2045. [PMID: 38893163 PMCID: PMC11170992 DOI: 10.3390/cancers16112045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/13/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
End-of-life delirium affects a vast majority of patients before death. It is highly distressing and often associated with restlessness or agitation. Unlike delirium in other settings, it is considered irreversible, and non-pharmacologic measures may be less feasible. The objective of this review is to provide an in-depth discussion of the clinical trials on delirium in the palliative care setting, with a particular focus on studies investigating pharmacologic interventions for end-of-life delirium. To date, only six randomized trials have examined pharmacologic options in palliative care populations, and only two have focused on end-of-life delirium. These studies suggest that neuroleptics and benzodiazepines may be beneficial for the control of the terminal restlessness or agitation associated with end-of-life delirium. However, existing studies have significant methodologic limitations. Further studies are needed to confirm these findings and examine novel therapeutic options to manage this distressing syndrome.
Collapse
Affiliation(s)
- David Hui
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei 10617, Taiwan;
| | - Carlos Eduardo Paiva
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos 1331, SP, Brazil;
| |
Collapse
|
10
|
Kim YJ, Lee H, Woo HG, Lee SW, Hong M, Jung EH, Yoo SH, Lee J, Yon DK, Kang B. Machine learning-based model to predict delirium in patients with advanced cancer treated with palliative care: a multicenter, patient-based registry cohort. Sci Rep 2024; 14:11503. [PMID: 38769382 PMCID: PMC11106243 DOI: 10.1038/s41598-024-61627-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/07/2024] [Indexed: 05/22/2024] Open
Abstract
This study aimed to present a new approach to predict to delirium admitted to the acute palliative care unit. To achieve this, this study employed machine learning model to predict delirium in patients in palliative care and identified the significant features that influenced the model. A multicenter, patient-based registry cohort study in South Korea between January 1, 2019, and December 31, 2020. Delirium was identified by reviewing the medical records based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The study dataset included 165 patients with delirium among 2314 patients with advanced cancer admitted to the acute palliative care unit. Seven machine learning models, including extreme gradient boosting, adaptive boosting, gradient boosting, light gradient boosting, logistic regression, support vector machine, and random forest, were evaluated to predict delirium in patients with advanced cancer admitted to the acute palliative care unit. An ensemble approach was adopted to determine the optimal model. For k-fold cross-validation, the combination of extreme gradient boosting and random forest provided the best performance, achieving the following accuracy metrics: 68.83% sensitivity, 70.85% specificity, 69.84% balanced accuracy, and 74.55% area under the receiver operating characteristic curve. The performance of the isolated testing dataset was also validated, and the machine learning model was successfully deployed on a public website ( http://ai-wm.khu.ac.kr/Delirium/ ) to provide public access to delirium prediction results in patients with advanced cancer. Furthermore, using feature importance analysis, sex was determined to be the top contributor in predicting delirium, followed by a history of delirium, chemotherapy, smoking status, alcohol consumption, and living with family. Based on a large-scale, multicenter, patient-based registry cohort, a machine learning prediction model for delirium in patients with advanced cancer was developed in South Korea. We believe that this model will assist healthcare providers in treating patients with delirium and advanced cancer.
Collapse
Affiliation(s)
- Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Hayeon Lee
- Department of Biomedical Engineering, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin, 17104, South Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Si Won Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
- Palliative Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
| | - Moonki Hong
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
- Palliative Cancer Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
| | - Eun Hee Jung
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, South Korea
| | - Jinseok Lee
- Department of Biomedical Engineering, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin, 17104, South Korea.
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea.
- Department of Pediatrics, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea.
| | - Beodeul Kang
- Division of Medical Oncology, Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam, 13496, South Korea.
| |
Collapse
|
11
|
Kawashima N, Yokomichi N, Morita T, Yabuki R, Hisanaga T, Imai K, Hirose Y, Shimokawa M, Miwa S, Yamauchi T, Okamoto S, Satomi E. Comparison of Pharmacological Treatments for Agitated Delirium in the Last Days of Life. J Pain Symptom Manage 2024; 67:441-452.e3. [PMID: 38355071 DOI: 10.1016/j.jpainsymman.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/02/2024] [Accepted: 02/04/2024] [Indexed: 02/16/2024]
Abstract
CONTEXT Antipsychotics are often used in managing symptoms of terminal delirium, but evidence is limited. OBJECTIVES To explore the comparative effectiveness of haloperidol with as-needed benzodiazepines (HPD) vs. chlorpromazine (CPZ) vs. levomepromazine (LPZ) for agitated delirium in the last days. METHODS A prospective observational study was conducted in two palliative care units in Japan. Adult cancer patients who developed agitated delirium with a modified Richmond Agitation-Sedation Scale (RASS-PAL) of one or more were included; palliative care specialist physicians determined that the etiology was irreversible; and estimated survival was 3 weeks or less. Patients treated with HPD, CPZ, or LPZ were analyzed. We measured RASS, NuDESC, Agitation Distress Scale (ADS), and Communication Capacity Scale (CCS) on Days 1 and 3. RESULTS A total of 277 patients were enrolled, and 214 were analyzed (112 in HPD, 50 in CPZ, and 52 in LPZ). In all groups, the mean RASS-PAL score significantly decreased on Day 3 (1.37 to -1.01, 1.87 to -1.04, 1.79 to -0.62, respectively; P < 0.001); the NuDESC and ADS scores also significantly decreased. The percentages of patients with moderate to severe agitation and those with full communication capacity on Day 3 were not significantly different. The treatments were well-tolerated. While one-fourth of HPD group changed antipsychotics, 88% or more of CPZ and LPZ groups continued the initial antipsychotics. CONCLUSION Haloperidol with as-needed benzodiazepine, chlorpromazine, or levomepromazine may be effective and safe for terminal agitation. Chlorpromazine and levomepromazine may have an advantage of no need to change medications.
Collapse
Affiliation(s)
- Natsuki Kawashima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative and Supportive Care, University of Tsukuba Hospital, Tsukuba, Japan
| | - Naosuke Yokomichi
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
| | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Research Association for Community Health, Hamamatsu, Japan
| | - Ritsuko Yabuki
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Takayuki Hisanaga
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Yumi Hirose
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Miho Shimokawa
- Department of Palliative Care, Tsukuba Central Hospital, Ushiku, Japan
| | - Satoru Miwa
- Seirei Hospice, Seirei Miyahara General Hospital, Hamamatsu, Japan
| | | | | | - Eriko Satomi
- Department of Palliative Medicine, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
12
|
Lee-Steere K, Mudge A, Liddle J, Bennett S. Understanding family carer experiences and perceptions of engagement in delirium prevention and care for adults in hospital: Qualitative systematic review. J Clin Nurs 2024; 33:1320-1345. [PMID: 38284503 DOI: 10.1111/jocn.16990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/29/2023] [Accepted: 11/01/2023] [Indexed: 01/30/2024]
Abstract
AIM To identify, describe and synthesise what is known about family carers' experiences and perspectives of engagement in delirium prevention and care for adults in hospital. DESIGN Systematic review and synthesis of qualitative evidence. DATA SOURCES Comprehensive literature search within PubMed, CINAHL, EMBASE, Scopus, Cochrane Central and PsycInfo databases to August 2022. Peer reviewed original qualitative research published in English. METHODS Data were extracted using Covidence systematic review software. Methodological quality was reviewed against the Critical Appraisal Skills Program (CASP) Qualitative Checklist. Thematic synthesis was used to develop analytical themes. Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) framework was applied to findings. RESULTS Of 3429 records identified, 29 met criteria for final inclusion. Studies included a range of settings (intensive care, medical and surgical wards) and family carer types (spouse, daughter, parent and friend). Three primary themes Shared Caregiving, Partnership and Support, Communication for Shared Understanding and three cross-cutting contextual themes Care Transitions, Family Carer Context and Hospital Context were identified. Family carers have mixed experiences of involvement in delirium care and prevention. Family carer engagement in care impacted perceptions of care quality and their own self-efficacy. Where person-centred care expectations were not met, some family carers adopted compensatory or care contingency strategies. Information sharing and timely support from hospital staff who understood the carer context supported carer involvement. Supportive physical environments and addressing power imbalances allowed greater engagement. CONCLUSION Family carers often wish to be involved in delirium prevention and care, but need to be recognised as individuals, listened to, informed and supported to optimise their contribution. IMPACT The review findings can guide health professional and decision makers to optimise family carer involvement in delirium care programs. PROTOCOL REGISTRATION PROSPERO [CRD42020221854]. REPORTING ENTREQ. No Patient or Public Contribution.
Collapse
Affiliation(s)
- Karen Lee-Steere
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Eat Walk Engage Program, Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Alison Mudge
- Eat Walk Engage Program, Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jacki Liddle
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Sally Bennett
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
13
|
Yamagata H, Takihara T, Kobayashi R, Hirose K, Higuchi K, Miyahara M, Komatsu D. Burnout and perceived burden levels related to delirium in physicians and nurses. Gen Hosp Psychiatry 2024; 87:162-163. [PMID: 38216409 DOI: 10.1016/j.genhosppsych.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 12/29/2023] [Accepted: 12/30/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Hirotaka Yamagata
- Kokoro Hospital Machida, 2140 Kamioyamadamachi, Machida, Tokyo 194-0201, Japan; Department of Psychiatry, Ebina General Hospital, 1320 Kawaraguchi, Ebina, Kanagawa 243-0433, Japan; Department of Internal Medicine, Hirose Hospital, 2-3-16 Kubosawa, Midori-ku, Sagamihara, Kanagawa 252-0105, Japan.
| | - Takahisa Takihara
- Department of Respiratory Medicine, Ebina General Hospital, 1320 Kawaraguchi, Ebina, Kanagawa 243-0433, Japan
| | - Rieko Kobayashi
- Department of Nursing, Ebina General Hospital, 1320 Kawaraguchi, Ebina, Kanagawa 243-0433, Japan
| | - Kenichi Hirose
- Department of Internal Medicine, Hirose Hospital, 2-3-16 Kubosawa, Midori-ku, Sagamihara, Kanagawa 252-0105, Japan
| | - Kuniko Higuchi
- Mediva Incorporated, 2-32-18-301, Yoga, Setagaya-ku, Tokyo 158-0097, Japan
| | - Maki Miyahara
- Mediva Incorporated, 2-32-18-301, Yoga, Setagaya-ku, Tokyo 158-0097, Japan
| | - Daisuke Komatsu
- Mediva Incorporated, 2-32-18-301, Yoga, Setagaya-ku, Tokyo 158-0097, Japan
| |
Collapse
|
14
|
Hirayama T, Igarashi E, Wada S, Sadahiro R, Oshikiri H, Suzuka M, Sato Y, Utsumi Y, Sakuma A, Nakahara R, Imai T, Tomita H, Matsuoka H. Concomitant use of hydroxyzine and haloperidol did not worsen delirium in patients with cancer: A multicenter, retrospective, observational study. Palliat Support Care 2024:1-8. [PMID: 38409802 DOI: 10.1017/s1478951524000117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVES There is concern that hydroxyzine exacerbates delirium, but a recent preliminary study suggested that the combination of haloperidol and hydroxyzine was effective against delirium. This study examined whether the concomitant use of hydroxyzine and haloperidol worsened delirium in patients with cancer. METHODS This retrospective, observational study was conducted at 2 general hospitals in Japan. The medical records of patients with cancer who received haloperidol for delirium from July to December 2020 were reviewed. The treatments for delirium included haloperidol alone or haloperidol combined with hydroxyzine. The primary outcome was the duration from the first day of haloperidol administration to the resolution of delirium, defined as its absence for 2 consecutive days. The time to delirium resolution was analyzed to compare the haloperidol group and hydroxyzine combination group using the log-rank test with the Kaplan-Meier method. Secondary outcomes were (1) the total dose of antipsychotic medications, including those other than haloperidol (measured in chlorpromazine-equivalent doses), and (2) the frequencies of detrimental incidents during delirium, specifically falls and self-removal of drip infusion lines. The unpaired t-test and Fisher's exact test were used to analyze secondary outcomes. RESULTS Of 497 patients who received haloperidol, 118 (23.7%) also received hydroxyzine. No significant difference in time to delirium resolution was found between the haloperidol group and the hydroxyzine combination group (log-rank test, P = 0.631). No significant difference between groups was found in either chlorpromazine-equivalent doses or the frequency of detrimental incidents. SIGNIFICANCE OF RESULTS This study showed that the concomitant use of hydroxyzine and haloperidol did not worsen delirium in patients with cancer.
Collapse
Affiliation(s)
- Takatoshi Hirayama
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Emi Igarashi
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Saho Wada
- Division of Quality Assurance Programs, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Ryoichi Sadahiro
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hanae Oshikiri
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan
| | - Masato Suzuka
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan
| | - Yuji Sato
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan
| | - Yusuke Utsumi
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
| | - Atsushi Sakuma
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
| | - Rika Nakahara
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Toru Imai
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroaki Tomita
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Psychiatry, Tohoku University Hospital, Sendai, Japan
| | - Hiromichi Matsuoka
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
15
|
Kurisu K, Inada S, Maeda I, Nobata H, Ogawa A, Iwase S, Uchida M, Akechi T, Amano K, Nakajima N, Morita T, Sumitani M, Yoshiuchi K. Effectiveness of antipsychotics for managing agitated delirium in patients with advanced cancer: a secondary analysis of a multicenter prospective observational study in Japan (Phase-R). Support Care Cancer 2024; 32:147. [PMID: 38326487 PMCID: PMC10850172 DOI: 10.1007/s00520-024-08352-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/31/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE Delirium is a common and serious comorbidity in patients with advanced cancer, necessitating effective management. Nonetheless, effective drugs for managing agitated delirium in patients with advanced cancer remain unclear in real-world settings. Thus, the present study aimed to explore an effective pharmacotherapy for this condition. METHODS We conducted a secondary analysis of a multicenter prospective observational study in Japan. The analysis included patients with advanced cancer who presented with agitated delirium and received pharmacotherapy. Agitation was defined as a score of the Richmond Agitation-Sedation Scale for palliative care (RASS-PAL) of ≥ 1. The outcome was defined as -2 ≤ RASS-PAL ≤ 0 at 72 h after the initiation of pharmacotherapy. Multiple propensity scores were quantified using a multinomial logistic regression model, and adjusted odds ratios (ORs) were calculated for haloperidol, chlorpromazine, olanzapine, quetiapine, and risperidone. RESULTS The analysis included 271 patients with agitated delirium, and 87 (32%) showed -2 ≤ RASS-PAL ≤ 0 on day 3. The propensity score-adjusted OR of olanzapine was statistically significant (OR, 2.91; 95% confidence interval, 1.12 to 7.80; P = 0.030). CONCLUSIONS The findings suggest that olanzapine may effectively improve delirium agitation in patients with advanced cancer.
Collapse
Affiliation(s)
- Ken Kurisu
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shuji Inada
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Psychosomatic Medicine, Saitama Cancer Center, Saitama, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri-Chuo Hospital, Osaka, Japan
| | | | - Asao Ogawa
- Department of Psycho-Oncology Service, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Satoru Iwase
- Department of Palliative Medicine, Saitama Medical University, Iruma, Saitama, Japan
| | - Megumi Uchida
- Department of Psychiatry and Cognitive-Behavioral Medicine, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Aichi, Japan
- Center for Psycho-Oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Aichi, Japan
| | - Koji Amano
- Palliative and Supportive Care Center, Osaka University Hospital, Osaka, Japan
| | - Nobuhisa Nakajima
- Division of Community Medicine and International Medicine, University of the Ryukyus Hospital, Okinawa, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
- Research Association for Community Health, Hamamatsu, Shizuoka, Japan
| | - Masahiko Sumitani
- Department of Pain and Palliative Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| |
Collapse
|
16
|
Jose S, Cyriac MC, Dhandapani M. Nurses' Knowledge and Subjective Strain in Delirium Care: Impact of a Web-based Instructional Module on Nurses Competence. Indian J Crit Care Med 2024; 28:111-119. [PMID: 38323249 PMCID: PMC10839928 DOI: 10.5005/jp-journals-10071-24626] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/10/2023] [Indexed: 02/08/2024] Open
Abstract
Background Delirium, a prevalent condition among elderly individuals admitted to hospitals, particularly in intensive care settings, necessitates specialized medical intervention. The present study assessed the proficiency of nurses in the management of delirium and their subjective experience of stress while providing care for patients with delirium in emergency rooms and critical care units. Materials and methods The study adopted a quantitative descriptive approach, utilizing standardized self-reporting measures that assessed the nurses' expertise and perceived burden of care. A cohort of 86 nurses from a tertiary care hospital in North India participated in the study. Additionally, the impact of the web-based instructional module in enhancing the nurses' knowledge in delirium management was assessed by one group pretest-posttest quasi-experimental study. Findings The research revealed that nurses exhibited significant deficiencies in their knowledge, particularly in relation to the symptoms and causes of delirium. The most significant source of subjective stress was attributed to hyperactive delirium-associated behaviors, characterized by uncooperative and aggressive conduct. The utilization of the web-based instructional program significantly enhanced the comprehension of nurses about the management of delirium. Conclusion This study revealed a significant knowledge gap among nurses in delirium management and emphasizes the considerable subjective stress, particularly in dealing with hyperactive delirium-associated behaviors. The positive impact of the web-based instructional program underscores its potential as a valuable tool for enhancing nurses' knowledge and addressing these challenges in healthcare settings. How to cite this article Jose S, Cyriac MC, Dhandapani M. Nurses' Knowledge and Subjective Strain in Delirium Care: Impact of a Web-based Instructional Module on Nurses Competence. Indian J Crit Care Med 2024;28(2):111-119.
Collapse
Affiliation(s)
- Sinu Jose
- Postgraduate Institute of Medical Education and Research, PGIMER, Chandigarh, India
| | | | - Manju Dhandapani
- National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, PGIMER, Chandigarh, India
| |
Collapse
|
17
|
Sato J, Tanaka R. Effects of Opioids, Steroids, Benzodiazepines, Anticholinergics, and Antihistamines on the Efficacy of Antipsychotics for Treating Delirium in End-of-Life Adult Patients Undergoing Palliative Care. J Pain Palliat Care Pharmacother 2023; 37:298-307. [PMID: 37702451 DOI: 10.1080/15360288.2023.2253241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 08/17/2023] [Indexed: 09/14/2023]
Abstract
The purpose of the study was to determine the effect of combination therapy involving opioids, steroids, benzodiazepines, anticholinergics, and antihistamines on antipsychotics efficacy for delirium. The study included adult inpatients receiving end-of-life palliative care and diagnosed with hyperactive delirium. Changes in delirium symptoms were assessed using the Intensive Care Delirium Screening Checklist (ICDSC). A retrospective analysis was conducted on 97 patients with ICDSC scores of ≥4, comparing the scores before and after antipsychotic administration. A mean score <4 sustained for 3 days after antipsychotics administration was considered effective. The mean days with ICDSC <4 within a 3-day period were evaluated as well. The efficacy of antipsychotics was compared between cases with and without the use of opioids, steroids, benzodiazepines, anticholinergics, and antihistamines. The results revealed no significant differences in the efficacy of antipsychotics for delirium when used in conjunction with opioids (odds ratio 0.614, 95% CI [0.179-2.105]), benzodiazepines (0.387, [0.108-1.390]), steroids (1.258, [0.276-5.746]), or anticholinergics (2.085, [0. 148-29.458]). Additionally, no significant differences were observed in the mean days with ICDSC <4 within 3-day period. Although opioids, benzodiazepines, steroids, anticholinergics, and antihistamines are recognized as delirium risk factors, their use for symptom relief in patients with delirium may not affect antipsychotic efficacy.
Collapse
Affiliation(s)
- Junya Sato
- Department of Pharmacy, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi Prefecture, Japan
- School of Pharmacy, International University of Health and Welfare, Ohtawara City, Tochigi Prefecture, Japan
| | - Rei Tanaka
- Department of Pharmacy, Shizuoka Cancer Center, Sunto-gun, Shizuoka Prefecture, Japan
- Faculty of Pharmaceutical Sciences, Tokyo University of Science, Noda City, Chiba Prefecture, Japan
| |
Collapse
|
18
|
Tronstad O, Patterson S, Sutt AL, Pearse I, Hay K, Liu K, Sato K, Koga Y, Matsuoka A, Hongo T, Rätsep I, Fraser JF, Flaws D. A protocol of an international validation study to assess the clinical accuracy of the eDIS-ICU delirium screening tool. Aust Crit Care 2023; 36:1043-1049. [PMID: 37003849 DOI: 10.1016/j.aucc.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Delirium is a common, yet underdiagnosed neuropsychiatric complication of intensive care unit (ICU) admission, associated with significant mortality and morbidity. Delirium can be difficult to diagnose, with gold standard assessments by a trained specialist being impractical and rarely performed. To address this, various tools have been developed, enabling bedside clinicians to assess for delirium efficiently and accurately. However, the performance of these tools varies depending on factors including the assessor's training. To address the shortcomings of current tools, electronic tools have been developed. AIMS AND OBJECTIVES The aims of this validation study are to assess the feasibility, acceptability, and generalisability of a recently developed and pilot-tested electronic delirium screening tool (eDIS-ICU) and compare diagnostic concordance, sensitivity, and specificity between eDIS-ICU, Confusion Assessment Method for the ICU (CAM-ICU), and the Diagnostic and Statistical Manual of Mental Disorders - 5th edition (DSM-V) gold standard in diverse ICU settings. METHODS Seven hundred participants will be recruited across five sites in three countries. Participants will complete three assessments (eDIS-ICU, CAM-ICU, and DSM-V) twice within one 24-h period. At each time point, assessments will be completed within one hour. Assessments will be administered by three different people at any given time point, with the assessment order and assessor for eDIS-ICU and CAM-ICU randomly allocated. Assessors will be blinded to previous and concurrent assessment results. RESULTS The primary outcome is comparing diagnostic sensitivity of eDIS-ICU and CAM-ICU against the DSM-V. RELEVANCE TO CLINICAL PRACTICE This protocol describes a definitive validation study of an electronic diagnostic tool to assess for delirium in the ICU. Delirium remains a common and difficult challenge in the ICU and is linked with multiple neurocognitive sequelae. Various challenges to routine assessment mean many cases are still unrecognised or misdiagnosed. An improved ability for bedside clinicians to screen for delirium accurately and efficiently will support earlier diagnosis, identification of underlying cause(s) and timely treatments, and ultimately improved patient outcomes. CLINICAL TRIAL REGISTRATION NUMBER This study was prospectively registered on the Australian New Zealand Clinical Trials Registry (ANZCTR) on 8th February 2022 (ACTRN12622000220763).
Collapse
Affiliation(s)
- Oystein Tronstad
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Physiotherapy Department, The Prince Charles Hospital, Brisbane, Queensland, Australia.
| | - Sue Patterson
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia.
| | - Anna-Liisa Sutt
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - India Pearse
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Menzies Health Institute QLD, Griffith University, Gold Coast, Australia.
| | - Karen Hay
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; QIMR Berghofer Medical Research Institute, Brisbane, Australia.
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.
| | - Kei Sato
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - Yuji Koga
- Kawasaki University of Medical Welfare, Kawasaki, Japan; Kawasaki Medical School Hospital, Kawasaki, Japan.
| | | | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Indrek Rätsep
- Department of Intensive Care, North Estonia Medical Centre, Tallinn, Estonia.
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - Dylan Flaws
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia; Metro North Mental Health, Caboolture Hospital, Queensland, Australia; School of Clinical Science, Queensland University of Technology, Brisbane, Queensland, Australia.
| |
Collapse
|
19
|
Mercadante S. Opioid-induced Neurotoxicity in Patients with Cancer Pain. Curr Treat Options Oncol 2023; 24:1367-1377. [PMID: 37688712 DOI: 10.1007/s11864-023-01117-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 09/11/2023]
Abstract
OPINION STATEMENT Opioid-induced neurotoxicity (OINT) is a neuropsychiatric syndrome observed with opioid therapy. The mechanism of OINT is thought to be multifactorial, and many risk factors may facilitate its development. If symptoms of OINT are seen, the prescriber should consider hydration, discontinuation of the offending opioid drug, or switching of opioid medication, or the use of some adjuvants. Multiple factors like inter- and intraindividual differences in opioid pharmacology may influence the accuracy of dose calculations for opioid switching. Experience and clinical judgment in a specialistic palliative care setting should be used and individual patient characteristics considered when applying any conversion table.
Collapse
Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center for Pain Relief & Supportive/Palliative Care, La Maddalena Cancer Center, Via San Lorenzo 312, 90146, Palermo, Italy.
| |
Collapse
|
20
|
Mortensen CB, Collet MO, Samuelson K. Struggling to return to everyday life-The experiences of quality of life 1 year after delirium in the intensive care unit. Nurs Crit Care 2023; 28:670-678. [PMID: 37317066 DOI: 10.1111/nicc.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 04/14/2023] [Accepted: 05/18/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Many critically ill patients report a change in their health-related quality of life after intensive care unit (ICU) discharge. Patients who experience delirium during their ICU stay are perceived as a fragile group of ICU survivors, and the 'quality of life' phenomenon needs to be studied among these patients. AIM To explore everyday life experiences of critically ill patients with delirium during the ICU stay, from ICU discharge until 1-year follow-up, focusing on their health-related quality of life and cognitive function. STUDY DESIGN We used a descriptive qualitative research design and interviewed patients 1 year after ICU admission. The participants were recruited from a pre-planned one-year follow-up study of 'Agents Intervening against Delirium for patients in the Intensive Care Unit trial'. Data were analysed using Framework Analysis Method and content analysis. RESULTS Nine women and eight men participated and reported a struggle when returning to everyday life or adapting to a new normality from hospital discharge to 1 year later. None of the participants had been aware of the challenges they would face after hospital discharge. They described a need for more information about these challenges to themselves and about primary care to better understand their situation and the struggles they experience during recovery. One overall theme emerged from the analysis 'From enduring to adapting' with three subthemes: 'Struggling to regain a functional life', 'Struggling to regain normal cognition' and 'Distressing manifestations from the ICU'. CONCLUSIONS To improve recovery and the quality of rehabilitation for critically ill patients suffering from delirium, it is essential to understand the phenomenon of ICU survivorship and what this fragile group of patients is going through. It is necessary to bridge the gap between secondary and primary care so patients can receive optimal training and support when needed. RELEVANCE TO CLINICAL PRACTICE Bridging the gap between primary and secondary healthcare services is urgently needed to improve rehabilitation for ICU survivors after critical illness.
Collapse
Affiliation(s)
- Camilla Bekker Mortensen
- Department of Anaesthesiology and Intensive Care Medicine, Centre for Anaesthesiological Research, Zealand University Hospital, Koege, Denmark
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Marie Oxenbøll Collet
- Department of Intensive Care, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Karin Samuelson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| |
Collapse
|
21
|
Matsuda Y, Tanimukai H, Inoue S, Hirayama T, Kanno Y, Kitaura Y, Inada S, Sugano K, Yoshimura M, Harashima S, Wada S, Hasegawa T, Okamoto Y, Dotani C, Takeuchi M, Kako J, Sadahiro R, Kishi Y, Uchida M, Ogawa A, Inagaki M, Okuyama T. A revision of JPOS/JASCC clinical guidelines for delirium in adult cancer patients: a summary of recommendation statements. Jpn J Clin Oncol 2023; 53:808-822. [PMID: 37190819 DOI: 10.1093/jjco/hyad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/26/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE The Japanese Psycho-Oncology Society and the Japanese Association of Supportive Care in Cancer have recently revised the clinical practice guidelines for delirium in adult cancer patients. This article reports the process of developing the revised guidelines and summarizes the recommendations made. METHODS The guidelines were developed in accordance with the Medical Information Network Distribution Service creation procedures. The guideline development group, consisting of multi-disciplinary members, created three new clinical questions: non-pharmacological intervention and antipsychotics for the prevention of delirium and trazodone for the management of delirium. In addition, systematic reviews of nine existing clinical questions have been updated. Two independent reviewers reviewed the proposed articles. The certainty of evidence and the strength of the recommendations were graded using the grading system developed by the Medical Information Network Distribution Service, following the concept of The Grading of Recommendations Assessment, Development, and Evaluation system. The modified Delphi method was used to validate the recommended statements. RESULTS This article provides a compendium of the recommendations along with their rationales, as well as a short summary. CONCLUSIONS These revised guidelines will be useful for the prevention, assessment and management of delirium in adult cancer patients in Japan.
Collapse
Affiliation(s)
- Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Hitoshi Tanimukai
- Faculty of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichiro Inoue
- Department of Neuropsychiatry, Okayama University Hospital, Dentistry, and Pharmaceutical Science, Okayama, Japan
| | - Takatoshi Hirayama
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yusuke Kanno
- Department of Home Health and Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuichi Kitaura
- Department of Psychiatry, Panasonic Health Insurance Organization Matsushita Memorial Hospital, Moriguchi, Japan
| | - Shuji Inada
- Department of Psychosomatic Medicine, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - Koji Sugano
- Division of Respiratory Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Masafumi Yoshimura
- Department of Occupational Therapy, Faculty of Rehabilitation, Kansai Medical University, Hirakata, Japan
| | - Saki Harashima
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Saho Wada
- Department of Neuropsychiatry, Nippon Medical School Tamanagayama Hospital, Tokyo, Japan
| | - Takaaki Hasegawa
- Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
| | - Yoshiaki Okamoto
- Department of pharmacy, Ashiya Municipal Hospital, Ashiya, Japan
| | - Chikako Dotani
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Mari Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Jun Kako
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Ryoichi Sadahiro
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuhiro Kishi
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
| | - Megumi Uchida
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Asao Ogawa
- Division of Psycho-Oncology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Masatoshi Inagaki
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
| | - Toru Okuyama
- Department of Psychiatry/Palliative Care Center, Nagoya City University West Medical Center, Nagoya, Japan
| |
Collapse
|
22
|
Varghese MP, Selwyn T, Nair S, Samuel S, Chacko B, Pichamuthu K. Assessment of Family Satisfaction with Remote Communication for Critically Ill COVID-19 Patients: An Observational Cohort Study. Indian J Crit Care Med 2023; 27:537-544. [PMID: 37636852 PMCID: PMC10452773 DOI: 10.5005/jp-journals-10071-24504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/13/2023] [Indexed: 08/29/2023] Open
Abstract
Background During the pandemic, traditional family meetings were replaced by remote telecommunications. We assessed the families' satisfaction with these communications using a survey-based questionnaire. Methods The study involved 20-minute telephonic surveys conducted with the family member who was updated during the hospitalization of the patient. A thematic-based questionnaire with responses on a scale of 5 ranging from very dissatisfied to very satisfied was used. The responses were dichotomized into bad and good reports for analysis. Results A total of 196 patients were eligible. Only 154 patients' family representatives consented to the study. The frequency and content of the telephonic updates were satisfactory. The bad report was assigned to 5% of families only. Among features assessing empathy of communication providers, the satisfaction rate was much higher with 3% of families alone providing a bad report. The response was significantly biased against the final outcome of the patient with poor review often provided by relatives of patients who had succumbed to the illness. The dissatisfaction rate was much higher, above 12% for the trust of communication and ICU visitation. However, the final outcome of the patient did not affect the trust in the information conveyed by the physician. Interpretation This study highlights several drawbacks in the communication strategy during the second surge of coronavirus disease-2019 (COVID-19). The final outcome of the patient was the key decisive factor for the response to most of the questionnaire. Sustained faith in communication by the physician despite the final outcome of the patient, re-emphasizes the need for emotional connection and training for breaking bad news. How to cite this article Varghese MP, Selwyn T, Nair S, Samuel S, Chacko B, Pichamuthu K. Assessment of Family Satisfaction with Remote Communication for Critically Ill COVID-19 Patients: An Observational Cohort Study. Indian J Crit Care Med 2023;27(8):537-544.
Collapse
Affiliation(s)
- Mammen Philip Varghese
- Department of Neuro Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Tryphena Selwyn
- Department of Neuro Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shalini Nair
- Department of Neuro Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shobha Samuel
- Department of Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Binila Chacko
- Department of Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Kishore Pichamuthu
- Department of Medical Intensive Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
23
|
Sri-iesaranusorn P, Sadahiro R, Murakami S, Wada S, Shimizu K, Yoshida T, Aoki K, Uezono Y, Matsuoka H, Ikeda K, Yoshimoto J. Data-driven categorization of postoperative delirium symptoms using unsupervised machine learning. Front Psychiatry 2023; 14:1205605. [PMID: 37441147 PMCID: PMC10333495 DOI: 10.3389/fpsyt.2023.1205605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023] Open
Abstract
Background Phenotyping analysis that includes time course is useful for understanding the mechanisms and clinical management of postoperative delirium. However, postoperative delirium has not been fully phenotyped. Hypothesis-free categorization of heterogeneous symptoms may be useful for understanding the mechanisms underlying delirium, although evidence is currently lacking. Therefore, we aimed to explore the phenotypes of postoperative delirium following invasive cancer surgery using a data-driven approach with minimal prior knowledge. Methods We recruited patients who underwent elective invasive cancer resection. After surgery, participants completed 5 consecutive days of delirium assessments using the Delirium Rating Scale-Revised-98 (DRS-R-98) severity scale. We categorized 65 (13 questionnaire items/day × 5 days) dimensional DRS-R-98 scores using unsupervised machine learning (K-means clustering) to derive a small set of grouped features representing distinct symptoms across all participants. We then reapplied K-means clustering to this set of grouped features to delineate multiple clusters of delirium symptoms. Results Participants were 286 patients, of whom 91 developed delirium defined according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria. Following the first K-means clustering, we derived four grouped symptom features: (1) mixed motor, (2) cognitive and higher-order thinking domain with perceptual disturbance and thought content abnormalities, (3) acute and temporal response, and (4) sleep-wake cycle disturbance. Subsequent K-means clustering permitted classification of participants into seven subgroups: (i) cognitive and higher-order thinking domain dominant delirium, (ii) prolonged delirium, (iii) acute and brief delirium, (iv) subsyndromal delirium-enriched, (v) subsyndromal delirium-enriched with insomnia, (vi) insomnia, and (vii) fit. Conclusion We found that patients who have undergone invasive cancer resection can be delineated using unsupervised machine learning into three delirium clusters, two subsyndromal delirium clusters, and an insomnia cluster. Validation of clusters and research into the pathophysiology underlying each cluster will help to elucidate the mechanisms of postoperative delirium after invasive cancer surgery.
Collapse
Affiliation(s)
| | - Ryoichi Sadahiro
- Department of Immune Medicine, National Cancer Center Research Institute, Tokyo, Japan
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Syo Murakami
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Saho Wada
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
- Department of Neuropsychiatry, Nippon Medical School, Tama Nagayama Hospital, Tokyo, Japan
| | - Ken Shimizu
- Department of Psycho-Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Teruhiko Yoshida
- Department of Clinical Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Kazunori Aoki
- Department of Immune Medicine, National Cancer Center Research Institute, Tokyo, Japan
| | - Yasuhito Uezono
- Department of Pain Control Research, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiromichi Matsuoka
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kazushi Ikeda
- Division of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | - Junichiro Yoshimoto
- Division of Information Science, Nara Institute of Science and Technology, Nara, Japan
- Department of Biomedical Data Science, Fujita Health University School of Medicine, Aichi, Japan
| |
Collapse
|
24
|
Liu Y, Li Z, Li Y, Ge N, Yue J. Detecting delirium: a systematic review of ultrabrief identification instruments for hospital patients. Front Psychol 2023; 14:1166392. [PMID: 37251016 PMCID: PMC10214704 DOI: 10.3389/fpsyg.2023.1166392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Early identification of delirium, which often occurs in older patients, can effectively reduce adverse prognoses. One way to increase the detection rate of delirium is to use an effective ultrabrief instrument for higher-frequency screening. The purpose of this review is to evaluate the diagnostic accuracy of ultrabrief screening tools for delirium. Methods The Cochrane Library, PubMed and EMBASE were searched from January 1, 1974, to November 31, 2022. We assessed the measurement properties of screening instruments using the consensus-based standards for selecting health measurement instruments (COSMIN) checklist and evaluated the risk bias of the included studies using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. The diagnostic test accuracy of instruments for delirium was reported using sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR). Result Of the 4,914 items identified, 26 met the eligibility criteria, resulting in 5 different delirium identification tools. The overall study quality assessed by the QUADAS-2 tool was moderate to good. Of the five screening tools, two instruments had sensitivity ≥80% and specificities ≥80%: 4AT and UB-2. The most comprehensive is the 4AT scale, which has a sensitivity of 0.80 [95% confidence interval (CI):0.68, 0.88] and a specificity of 0.89 (95%CI: 0.83, 0.93) and contains 4 items. UB-2 has a sensitivity of 0.88 (95%CI: 0.72, 0.96) and a specificity of 0.64 (95%CI: 0.56, 0.70). Conclusion UB-2 and MOTYB had excellent sensitivity for delirium screening at an early stage. In terms of sensitivity and intentionality, the 4AT is the best recommended scale.
Collapse
Affiliation(s)
- Yadong Liu
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital/West China School of Medicine, Sichuan University, Sichuan, China
| | - Zhenzhen Li
- Health Management Center, General Practice Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Sichuan, China
| | - Ying Li
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital/West China School of Medicine, Sichuan University, Sichuan, China
| | - Ning Ge
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital/West China School of Medicine, Sichuan University, Sichuan, China
| | - Jirong Yue
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital/West China School of Medicine, Sichuan University, Sichuan, China
| |
Collapse
|
25
|
Featherstone I, Siddiqi N, Jones L, Coppo E, Sheldon T, Hosie A, Wolkowski A, Bush SH, Taylor J, Teodorczuk A, Johnson MJ. 'It's tough. It is hard': A qualitative interview study of staff and volunteers caring for hospice in-patients with delirium. Palliat Med 2023:2692163231170655. [PMID: 37129262 DOI: 10.1177/02692163231170655] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Delirium is a distressing condition often experienced by hospice in-patients. Increased understanding of current multidisciplinary care of delirium is needed to develop interventions in this setting. AIM(S) To explore hospice staff and volunteers' practice, its influences and what may need to change to improve hospice delirium care. DESIGN Qualitative interview study using behaviour change theory from a critical realist stance. SETTING/PARTICIPANTS Thirty-seven staff, including different professional groups and roles, and volunteers were purposively sampled from two in-patient hospices. RESULTS We found that participants' practice focus was on managing hyperactive symptoms of delirium, through medication use and non-pharmacological strategies. Delirium prevention, early recognition and hypoactive delirium received less attention. Our theoretically-informed analysis identified this focus was influenced by staff and volunteers' emotional responses to the distress associated with hyperactive symptoms of delirium as well as understanding of delirium prevention, recognition and care, which varied between staff groups. Non-pharmacological delirium management was supported by adequate staffing levels, supportive team working and a culture of person-centred and family-centred care, although behaviours that disrupted the calm hospice environment challenged this. CONCLUSIONS Our findings can inform hospice-tailored behaviour change interventions that develop a shared team understanding and engage staff's emotional responses to improve delirium care. Reflective learning opportunities are needed that increase understanding of the potential to reduce patient distress through prevention and early recognition of delirium, as well as person-centred management. Organisational support for adequate, flexible staffing levels and supportive team working is required to support person-centred delirium care.
Collapse
Affiliation(s)
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of Hull, Hull, UK
| | - Lesley Jones
- Hull York Medical School, University of Hull, Hull, UK
| | - Eleonora Coppo
- Cardinal Massaia Hospital of Asti, Asti, Piemonte, Italy
| | - Trevor Sheldon
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Annmarie Hosie
- School of Nursing, The University of Notre Dame Australia, Sydney, NSW, Australia
- The Cunningham Centre for Palliative Care, St Vincent's Health Network, Sydney, NSW, Australia
- IMPAACT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | | | - Shirley H Bush
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, ON, Canada
- Bruyere Research Institute, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Johanna Taylor
- Department of Health Sciences, University of York, York, UK
| | - Andrew Teodorczuk
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- The Prince Charles Hospital, Metro North Mental Health, Brisbane, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| |
Collapse
|
26
|
Akhtar H, Chaudhry SH, Bortolussi-Courval É, Hanula R, Akhtar A, Nauche B, McDonald EG. Diagnostic yield of CT head in delirium and altered mental status-A systematic review and meta-analysis. J Am Geriatr Soc 2023; 71:946-958. [PMID: 36434820 DOI: 10.1111/jgs.18134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 10/27/2022] [Accepted: 10/30/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND CT head is commonly performed in the setting of delirium and altered mental status (AMS), with variable yield. We aimed to evaluate the yield of CT head in hospitalized patients with delirium and/or AMS across a variety of clinical settings and identify factors associated with abnormal imaging. METHODS We included studies in adult hospitalized patients, admitted to the emergency department (ED) and inpatient medical unit (grouped together) or the intensive care unit (ICU). Patients had a diagnosis of delirium/AMS and underwent a CT head that was classified as abnormal or not. We searched Medline, Embase and other databases (informed by PRISMA guidelines) from inception until November 11, 2021. Studies that were exclusively performed in patients with trauma or a fall were excluded. A meta-analysis of proportions was performed; the pooled proportion of abnormal CTs was estimated using a random effects model. Heterogeneity was determined via the I2 statistic. Factors associated with an abnormal CT head were summarized qualitatively. RESULTS Forty-six studies were included for analysis. The overall yield of CT head in the inpatient/ED was 13% (95% CI: 10.2%-15.9%) and in ICU was 17.4% (95% CI: 10%-26.3%), with considerable heterogeneity (I2 96% and 98% respectively). Heterogeneity was partly explained after accounting for study region, publication year, and representativeness of the target population. Yield of CT head diminished after year 2000 (19.8% vs. 11.1%) and varied widely depending on geographical region (8.4%-25.9%). The presence of focal neurological deficits was a consistent factor that increased yield. CONCLUSION Use of CT head to diagnose the etiology of delirium and AMS varied widely and yield has declined. Guidelines and clinical decision support tools could increase the appropriate use of CT head in the diagnostic etiology of delirium/AMS.
Collapse
Affiliation(s)
- Haris Akhtar
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Shazia H Chaudhry
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Émilie Bortolussi-Courval
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Ryan Hanula
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada
| | - Anas Akhtar
- Department of General Surgery, Letterkenny University Hospital, Letterkenny, Ireland
| | - Bénédicte Nauche
- McGill University Health Centre Medical Libraries, Montreal, Canada
| | - Emily G McDonald
- Division of General Internal Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, Canada
- Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montreal, Canada
| |
Collapse
|
27
|
Jordano JO, Vasilevskis EE, Duggan MC, Welch SA, Schnelle JF, Simmons SF, Ely EW, Han JH. Effect of physical and occupational therapy on delirium duration in older emergency department patients who are hospitalized. J Am Coll Emerg Physicians Open 2023; 4:e12857. [PMID: 36776211 PMCID: PMC9902677 DOI: 10.1002/emp2.12857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/22/2022] [Accepted: 11/03/2022] [Indexed: 02/10/2023] Open
Abstract
Objective Delirium in older emergency department (ED) adults is associated with poorer long-term physical function and cognition. We sought to evaluate if the time to and intensity of physical and/or occupational therapy (PT/OT) are associated with the duration of ED delirium into hospitalization (ED delirium duration). Methods This is a secondary analysis of a prospective cohort study conducted from March 2012 to November 2014 at an urban, academic, tertiary care hospital. Patients aged ≥65 years presenting to the ED and who received PT/OT during their hospitalization were included. Days from enrollment to the first PT/OT session and PT/OT duration relative to hospital length of stay (PT/OT intensity) were abstracted from the medical record. ED delirium duration was defined as the duration of delirium detected in the ED using the Brief Confusion Assessment Method. Data were analyzed using a proportional odds logistic regression adjusted for multiple variables. Adjusted odds ratios (ORs) were calculated with 95% confidence intervals (95%CI). Results The median log PT/OT intensity was 0.5% (interquartile range [IQR]: 0.3%, 0.9%) and was associated with shorter delirium duration (adjusted OR, 0.39; 95% CI, 0.21-0.73). The median time to the first PT/OT session was 2 days (IQR: 1, 3 days) and was not associated with delirium duration (adjusted OR, 1.02; 95% CI, 0.82-1.27). Conclusion In older hospitalized adults, higher PT/OT intensity may be a useful intervention to shorten delirium duration. Time to first PT/OT session was not associated with delirium duration but was initiated a full 2 days after the ED presentation.
Collapse
Affiliation(s)
| | - Eduard E. Vasilevskis
- Department of Medicine, Section of Hospital MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA,Geriatric Research, Education, and Clinical Center (GRECC)Tennessee Valley Healthcare SystemNashvilleTennesseeUSA
| | - Maria C. Duggan
- Geriatric Research, Education, and Clinical Center (GRECC)Tennessee Valley Healthcare SystemNashvilleTennesseeUSA,Department of Medicine, Division of Geriatric MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Sarah A. Welch
- Geriatric Research, Education, and Clinical Center (GRECC)Tennessee Valley Healthcare SystemNashvilleTennesseeUSA,Department of Physical Medicine and RehabilitationVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - John F. Schnelle
- Geriatric Research, Education, and Clinical Center (GRECC)Tennessee Valley Healthcare SystemNashvilleTennesseeUSA,Department of Medicine, Division of Geriatric MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Sandra F. Simmons
- Geriatric Research, Education, and Clinical Center (GRECC)Tennessee Valley Healthcare SystemNashvilleTennesseeUSA,Department of Medicine, Division of Geriatric MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - E. Wesley Ely
- Geriatric Research, Education, and Clinical Center (GRECC)Tennessee Valley Healthcare SystemNashvilleTennesseeUSA,Critical Illness, Brain Dysfunction, and Survivorship (CIBS) CenterDivision of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jin H. Han
- Geriatric Research, Education, and Clinical Center (GRECC)Tennessee Valley Healthcare SystemNashvilleTennesseeUSA,Department of Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| |
Collapse
|
28
|
Imai K, Morita T, Mori M, Kiuchi D, Yokomichi N, Miwa S, Okamoto S, Yamauchi T, Naito AS, Matsuda Y, Maeda I, Sugano K, Ikenaga M, Inoue S, Satomi E. Visualizing How to Use Antipsychotics for Agitated Delirium in the Last Days of Life. J Pain Symptom Manage 2023; 65:479-489. [PMID: 36682673 DOI: 10.1016/j.jpainsymman.2023.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/21/2023]
Abstract
CONTEXT How physicians use antipsychotics for agitated delirium in the last days of life varies markedly, which could hamper the quality of care. OBJECTIVES To examine adherence to an algorithm-based treatment for terminal agitated delirium, and explore its effectiveness and safety. METHODS A single-center, prospective, observational study was conducted in a 27-bed palliative care unit in Japan. All adult cancer patients who developed agitated delirium with a modified Richmond Agitation-Sedation Scale (RASS) of +1 or more were included; the palliative care specialists determined that the etiology was irreversible, the estimated survival was three weeks or less, and the Eastern Cooperative Oncology Group (ECOG) performance status was three or four. Patients were treated with an algorithm to visualize how to use antipsychotics, with the treatment goal defined as no agitation (RASS≤0) or acceptable agitation for patients and families. We provided all patients nonpharmacological management to alleviate the symptoms of delirium and administered antipsychotic medications when the nonpharmacological approach was insufficient. We measured the adherence rate, RASS, Nursing Delirium Screening Scale items 2, 3, 4 (Nu-DESC), and Agitation Distress Scale item 2 (ADS) on days 0, 1, 3, 7, 14, 21, and 24 hours before death. RESULTS A total of 164 patients were enrolled. Adherence rates were 99, 94, and 89%, and treatment goals were achieved in 66, 83, and 93% on days one, three, and seven, respectively. The mean RASS decreased from +1.41 to -0.84 on day three; Nu-DESC decreased from 4.19 to 1.83, and ADS decreased from 1.54 to 0.38. There were seven severe adverse events (Common Terminology Criteria for Adverse Events (CTCAE) of 3), including aspiration (n = 3), apnea (n = 2), tremor (n = 1), and muscle rigidity (n = 1) on day three. CONCLUSION The algorithm-based treatment could be feasible, effective, and safe. Visualizing how palliative care specialists provide pharmacological management could be beneficial for nonspecialist clinicians, and clinical, educational, and research implications warrant further empirical testing.
Collapse
Affiliation(s)
- Kengo Imai
- Seirei Hospice (K.I., S.M., T.Y., S.I.), Seirei Miyahara General Hospital, Hamamatsu, Japan.
| | - Tatsuya Morita
- Division of Palliative and Supportive Care (T.M., M.M., N.Y.), Seirei Miyahara General Hospital, Hamamatsu, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care (T.M., M.M., N.Y.), Seirei Miyahara General Hospital, Hamamatsu, Japan
| | - Daisuke Kiuchi
- Department of Palliative Medicine (D.K., E.S.), National Cancer Center Hospital, Tokyo, Japan
| | - Naosuke Yokomichi
- Division of Palliative and Supportive Care (T.M., M.M., N.Y.), Seirei Miyahara General Hospital, Hamamatsu, Japan
| | - Satoru Miwa
- Seirei Hospice (K.I., S.M., T.Y., S.I.), Seirei Miyahara General Hospital, Hamamatsu, Japan
| | | | - Toshihiro Yamauchi
- Seirei Hospice (K.I., S.M., T.Y., S.I.), Seirei Miyahara General Hospital, Hamamatsu, Japan
| | - Akemi Shirado Naito
- Department of Palliative Care (A.S.N.), Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine (Y.M.), National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Isseki Maeda
- Department of Palliative Care (I.M.), Seri-Chuo Hospital, Toyonaka, Japan
| | - Koji Sugano
- Division of Respiratory Medicine (K.S.), Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Masayuki Ikenaga
- Department of Palliative Medicine (M.I.), Yodogawa Christian Hospital, Osaka, Japan
| | - Satoshi Inoue
- Seirei Hospice (K.I., S.M., T.Y., S.I.), Seirei Miyahara General Hospital, Hamamatsu, Japan
| | - Eriko Satomi
- Department of Palliative Medicine (D.K., E.S.), National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
29
|
Abe A, Fujisawa D, Miyajima K, Takeuchi E, Takeuchi M, Mimura M, Imai K, Uemura K, Watanabe H, Matsuo N, Matsuda Y, Maeda I, Ogawa A, Yoshiuchi K, Iwase S. Influence of dosing pattern of antipsychotics on treatment outcome of delirium in patients with advanced cancer. Jpn J Clin Oncol 2023; 53:321-326. [PMID: 36647601 DOI: 10.1093/jjco/hyac205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 12/17/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Clinical guidelines recommend antipsychotics for the treatment of delirium; however, there has been no confirmed recommendation regarding their administrating patterns. This study aims to investigate whether different dosing patterns of antipsychotics (single or multiple administrations) influence the outcomes of delirium treatment. METHODS This is a secondary analysis of a prospective observational study involving patients with advanced cancer and delirium receiving antipsychotics. The Delirium Rating Scale Revised-98 was administered at baseline and after 72 h of starting pharmacotherapy. Patients were classified into single administration group (received a single dosage within 24 h before the assessment) and multiple administration group (received more than one dosage). RESULTS A total of 555 patients (single administration 492 (88.6%); multiple administration 63 (11.4%)) were subjected to analyses. The patients in the multiple administration group were more likely to be male, in psycho-oncology consulting settings, with lower performance status, with hyperactive delirium and with severer delirium symptoms. In the multivariate analysis, single administration was significantly associated with better improvement of delirium (p < 0.01, 95% confidence interval: 1.83-5.87) even after controlling covariates. There were no significant differences in the mean dosages of antipsychotics per day in chlorpromazine equivalent (single administration 116.8 mg/day, multiple administration 123.5 mg/day) and the incidence of adverse events between the two groups. CONCLUSIONS In this observational study sample, Delirium Rating Scale severity score improvement in single administration was higher than that seen in multiple administration. There was no difference in adverse events between the two groups.
Collapse
Affiliation(s)
- Akiko Abe
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Palliative Care Center, Keio University Hospital, Tokyo, Japan
| | - Daisuke Fujisawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Palliative Care Center, Keio University Hospital, Tokyo, Japan.,Division of Patient Safety, Keio University Hospital, Tokyo, Japan
| | - Kaya Miyajima
- Department of Neuropsychiatry, Sakuramachi Hospital, Tokyo, Japan
| | - Emi Takeuchi
- Division of Quality Assurance Programs, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Mari Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Palliative Care Center, Keio University Hospital, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kengo Imai
- Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Keiichi Uemura
- Department of Psychiatry, Tonan Hospital, Sapporo, Japan
| | | | - Naoki Matsuo
- Hospice Medical Corporation, Junkei-kai Sotoasahikawa Hospital, Akita, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Osaka, Japan
| | - Asao Ogawa
- Division of Psycho-Oncology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, Kashiwa, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Satoru Iwase
- Department of Palliative Medicine, Saitama Medical University, Iruma, Saitama, Japan
| |
Collapse
|
30
|
Ijaopo EO, Zaw KM, Ijaopo RO, Khawand-Azoulai M. A Review of Clinical Signs and Symptoms of Imminent End-of-Life in Individuals With Advanced Illness. Gerontol Geriatr Med 2023; 9:23337214231183243. [PMID: 37426771 PMCID: PMC10327414 DOI: 10.1177/23337214231183243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 07/11/2023] Open
Abstract
Background: World population is not only aging but suffering from serious chronic illnesses, requiring an increasing need for end-of-life care. However, studies show that many healthcare providers involved in the care of dying patients sometimes express challenges in knowing when to stop non-beneficial investigations and futile treatments that tend to prolong undue suffering for the dying person. Objective: To evaluate the clinical signs and symptoms that show end-of-life is imminent in individuals with advanced illness. Design: Narrative review. Methods: Computerized databases, including PubMed, Embase, Medline,CINAHL, PsycInfo, and Google Scholar were searched from 1992 to 2022 for relevant original papers written in or translated into English language that investigated clinical signs and symptoms of imminent death in individuals with advanced illness. Results: 185 articles identified were carefully reviewed and only those that met the inclusion criteria were included for review. Conclusion: While it is often difficult to predict the timing of death, the ability of healthcare providers to recognize the clinical signs and symptoms of imminent death in terminally-ill individuals may lead to earlier anticipation of care needs and better planning to provide care that is tailored to individual's needs, and ultimately results in better end-of-life care, as well as a better bereavement adjustment experience for the families.
Collapse
Affiliation(s)
| | - Khin Maung Zaw
- University of Miami Miller School of Medicine, FL, USA
- Miami VA Medical Center, FL, USA
| | | | | |
Collapse
|
31
|
Recall of delirium and related distress in elderly hospitalized patients: A prospective study. Porto Biomed J 2022; 7:e196. [PMID: 37152084 PMCID: PMC10158885 DOI: 10.1097/j.pbj.0000000000000196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Delirium is a very common neuropsychiatric disorder in the elderly, with a significant physical and psychological burden. Much is still unknown about its psychological effects. This study aims to identify the proportion of patients who recall delirium and to analyze the distress caused by it. In addition, this study aims to analyze the association between delirium recall and related distress and global psychological distress regarding hospitalization. Methods: This is a prospective study with elderly hospitalized patients in level-2 units of intensive care medicine department of a university hospital. Exclusion criteria were a Glasgow Coma Scale total ≤11, brain injury, blindness, deafness, or inability to communicate. Delirium was daily assessed with the Confusion Assessment Method. Delirium recall and related distress in patients were measured using the Delirium Experience Questionnaire. Global psychological distress was assessed with the Kessler Psychological Distress Scale. Results: From 105 patients, 38 (36.2%) developed delirium. Most patients did not remember the delirium episode (64.7%). Among those who remembered (35.3%), most described delirium as a distressing experience (75%). Delirium recall was associated with high global psychological distress (P = .029). Conclusions: Distress related to delirium is high, namely in patients who recall the episode. Global psychological distress during hospitalization is associated with delirium recall. This study highlights the need to assess the experience of delirium in these patients, as well as the importance of providing support and psychological interventions to minimize the associated distress.
Collapse
|
32
|
Lange S, Mędrzycka-Dąbrowska W, Friganović A, Religa D, Krupa S. Patients' and Relatives' Experiences of Delirium in the Intensive Care Unit-A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11601. [PMID: 36141873 PMCID: PMC9517594 DOI: 10.3390/ijerph191811601] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/06/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
(1) Introduction: Delirium is a cognitive disorder that affects up to 80% of ICU patients and has many negative consequences. The occurrence of delirium in an ICU patient also negatively affects the relatives caring for these patients. The aim of this study was to explore patients' and their families' experiences of delirium during their ICU stay. (2) Method: The study used a qualitative design based on phenomenology as a research method. A semi-structured interview method was used to achieve the aim. The responses of patients and their families were recorded and transcribed, and the data were coded and analyzed. (3) Results: Eight interviews were conducted with past ICU patients who developed delirium during hospitalization and their family members. The mean age of the participants was 71 years. Of the eight patients, 2 (25%) were female and 6 (75%) were male. The relationships of the 8 carers with the patients were wife (in 4 cases), daughter (in 2 cases), and son (in 2 cases). The average length of time a patient stayed in the ICU was 24 days. The following themes were extracted from the interviews: education, feelings before the delirium, pain, thirst, the day after, talking to the family/patient, and return home. (4) Conclusions: Post-delirium patients and their families feel that more emphasis should be placed on information about delirium. Most patients feel embarrassed and ashamed about events during a delirium episode. Patients fear the reaction of their families when delirium occurs. Patients' families are not concerned about their relatives returning home and believe that the home environment will allow them to forget the delirium events more quickly during hospitalization.
Collapse
Affiliation(s)
- Sandra Lange
- Department of Internal and Pediatric Nursing, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Wioletta Mędrzycka-Dąbrowska
- Department of Anaesthesiology Nursing & Intensive Care, Faculty of Health Sciences, Medical University of Gdańsk, Dębinki 7, 80-211 Gdańsk, Poland
| | - Adriano Friganović
- Department of Anesthesiology and Intensive Medicine, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
- Department of Nursing, University of Applied Health Sciences, Mlinarska Cesta 38, 10000 Zagreb, Croatia
| | - Dorota Religa
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, 17177 Stockholm, Sweden
| | - Sabina Krupa
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, Warzywna 1A, 35-310 Rzeszow, Poland
| |
Collapse
|
33
|
Kako J, Kobayashi M, Kanno Y, Kajiwara K, Nakano K, Morikawa M, Matsuda Y, Shimizu Y, Hori M, Niino M, Suzuki M, Shimazu T. Nursing support for symptoms in patients with cancer and caregiver burdens: a scoping review protocol. BMJ Open 2022; 12:e061866. [PMID: 36104140 PMCID: PMC9476151 DOI: 10.1136/bmjopen-2022-061866] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Terminally ill patients with cancer experience a variety of symptoms, and their families experience certain caregiver burdens. Most studies on this topic have focused on the symptoms experienced by patients with cancer. There is little established evidence to show how nursing support affects these symptoms and burdens. Nurses provide support by extrapolating their clinical experience, practical knowledge and insights gained from the treatment phase of patients with cancer, regardless of the existence or degree of evidence. This study presents a scoping review protocol with the aim of categorising the feasibility of nursing support from the initial to the terminal phases in the trajectory of cancer care. METHOD AND ANALYSIS This review will be guided by Arksey and O'Malley's five-stage scoping review framework and Levac's extension. Our research project team will focus on the pain, dyspnoea, nausea and vomiting, constipation, delirium, fatigue and skin disorders experienced by patients with cancer as well as the burdens experienced by caregivers of such patients. All available published articles from database inception to 31 January 2022 will be systematically searched using the following electrical databases: PubMed, CINAHL, CENTRAL in the Cochrane Library and Ichushi-Web of the Japan Medical Abstract Society databases. In addition, we will assess relevant studies from the reference list and manually search each key journal. The formula creation phase of the literature search involves working with a librarian to identify relevant keywords. At least two reviewers will independently screen and review articles and extract data using a data chart form. Results will be mapped according to study design and analysed for adaptation in the field of terminal cancer. ETHICS AND DISSEMINATION This review does not require ethical approval as it is a secondary analysis of pre-existing, published data. The findings will be disseminated through peer-reviewed publications and conference presentations.
Collapse
Affiliation(s)
- Jun Kako
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Masamitsu Kobayashi
- Graduate of Nursing Science, St. Luke's International University, Chuo-ku, Japan
| | - Yusuke Kanno
- Nursing Science, Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Kohei Kajiwara
- Japanese Red Cross Kyushu International College of Nursing, Munakata, Japan
| | - Kimiko Nakano
- Clinical Research Center for Developmental Therapeutics, Tokushima University Hospital, Tokushima, Japan
| | | | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Yoichi Shimizu
- School of Nursing, National College of Nursing, Kiyose, Japan
| | - Megumi Hori
- Faculty of Nursing, Shizuoka University, Shizuoka, Japan
| | - Mariko Niino
- Center for Cancer Registries, Institute for Cancer Control, National Cancer Center, Chuo-ku, Japan
| | - Miho Suzuki
- Faculty of Nursing and Medical Care, Keio University, Minato-ku, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, Institute for Cancer Control, National Cancer Center, Chuo-ku, Japan
| |
Collapse
|
34
|
Oya K, Morita T, Tagami K, Matsuda Y, Naito AS, Kashiwagi H, Otani H. Physicians' Beliefs and Attitudes Toward Hypoactive Delirium in The Last Days of Life. J Pain Symptom Manage 2022; 64:110-118. [PMID: 35490994 DOI: 10.1016/j.jpainsymman.2022.04.176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 12/31/2022]
Abstract
CONTEXT The perspective toward hypoactive delirium in the last days of life could be different among physicians. OBJECTIVES To clarify the attitudes, beliefs, and opinions of palliative care physicians and liaison psychiatrists toward hypoactive delirium in the last days of life and to explore the association among these factors. METHODS A nationwide cross-sectional questionnaire survey was conducted among 1667 physicians who were either certified palliative care specialists or liaison psychiatrists. Physicians' agreement with the appropriateness of pharmacological management (e.g., antipsychotics) (one item), their beliefs (11 items), and their opinions (four items) were measured. RESULTS 787 (47%) physicians responded. 481 (62%) agreed to use of medications for hypoactive delirium in the last days of life, whereas 296 (38.1%) disagreed. More than 95% agreed with "hypoactive delirium at the end of life can be considered as a part of natural dying process." Multivariate analysis identified two belief subscales of "hypoactive delirium at the end of life is a natural dying process" and "antipsychotics are futile and harmful in managing hypoactive delirium" had a significant negative correlation with the use of medications. On the other hand, one belief subscale of "hypoactive delirium can be distressing even if patients' consciousness is impaired" had significant positive correlations with the use of medications. CONCLUSION Pharmacological management of hypoactive delirium in the last days of life differs depending on physicians' beliefs. Future research is needed to clarify the efficacy and safety of pharmacological management of hypoactive delirium.
Collapse
Affiliation(s)
- Kiyofumi Oya
- Peace Home Care Clinic, Otsu, (K.O,) Shiga, Japan; Clinical Research Support Office, (K.O., T.M) Iizuka Hospital, Iizuka-shi, Fukuoka, Japan.
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, 3453 Mikatahara-cho, Kita-ku, Hamamatsu, (T.M.) Shizuoka Japan
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, (K.T.) Miyagi, Japan
| | - Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, (Y.M.) Osaka, Japan
| | - Akemi Shirado Naito
- Department of Palliative Care, Miyazaki Medical Association Hospital, Miyazaki-shi, (A.S.N.) Miyazaki, Japan
| | - Hideyuki Kashiwagi
- Department of Transitional and Palliative Care, Iizuka Hospital, Iizuka-shi, (H.K.) Fukuoka, Japan
| | - Hiroyuki Otani
- Department of Palliative Care Team, and Palliative and Supportive Care, National Hospital Organization Kyushu Cancer Center, Mitami-ku, (H.O.) Fukuoka Japan
| |
Collapse
|
35
|
Kotfis K, van Diem-Zaal I, Williams Roberson S, Sietnicki M, van den Boogaard M, Shehabi Y, Ely EW. The future of intensive care: delirium should no longer be an issue. Crit Care 2022; 26:200. [PMID: 35790979 PMCID: PMC9254432 DOI: 10.1186/s13054-022-04077-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 06/30/2022] [Indexed: 01/02/2023] Open
Abstract
In the ideal intensive care unit (ICU) of the future, all patients are free from delirium, a syndrome of brain dysfunction frequently observed in critical illness and associated with worse ICU-related outcomes and long-term cognitive impairment. Although screening for delirium requires limited time and effort, this devastating disorder remains underestimated during routine ICU care. The COVID-19 pandemic brought a catastrophic reduction in delirium monitoring, prevention, and patient care due to organizational issues, lack of personnel, increased use of benzodiazepines and restricted family visitation. These limitations led to increases in delirium incidence, a situation that should never be repeated. Good sedation practices should be complemented by novel ICU design and connectivity, which will facilitate non-pharmacological sedation, anxiolysis and comfort that can be supplemented by balanced pharmacological interventions when necessary. Improvements in the ICU sound, light control, floor planning, and room arrangement can facilitate a healing environment that minimizes stressors and aids delirium prevention and management. The fundamental prerequisite to realize the delirium-free ICU, is an awake non-sedated, pain-free comfortable patient whose management follows the A to F (A-F) bundle. Moreover, the bundle should be expanded with three additional letters, incorporating humanitarian care: gaining (G) insight into patient needs, delivering holistic care with a 'home-like' (H) environment, and redefining ICU architectural design (I). Above all, the delirium-free world relies upon people, with personal challenges for critical care teams to optimize design, environmental factors, management, time spent with the patient and family and to humanize ICU care.
Collapse
Affiliation(s)
- Katarzyna Kotfis
- Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Szczecin, Poland.
| | - Irene van Diem-Zaal
- Department of Intensive Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Shawniqua Williams Roberson
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Center for Health Services Research, Nashville, TN, USA.,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Marek Sietnicki
- Department of Architecture, West Pomeranian University of Technology in Szczecin, Szczecin, Poland
| | - Mark van den Boogaard
- Department of Intensive Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Yahya Shehabi
- Monash Health School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.,School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Center for Health Services Research, Nashville, TN, USA.,Division of Allergy, Department of Medicine, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Geriatric Research, Education and Clinical Center (GRECC) Service, Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA
| |
Collapse
|
36
|
Maximiliano B, Sebastian B, Estefania A, Irma C, Gutierrez P, Daniela P PDLV, Roberta C, Eduardo T, Jose M, Felipe S. Epidemiology of delirium in hospitalized patients in Latin America: A systematic review. Acta Psychiatr Scand 2022; 147:420-429. [PMID: 35791060 DOI: 10.1111/acps.13468] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/29/2022] [Accepted: 06/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Accurate epidemiological data are essential for the planning of policies aimed at the identification, prevention, and management of delirium. The reported occurrence of delirium in hospitalized patients varies widely among studies, ranging between 5% to more than 80% in the international literature. The exact occurrence in Latin America is not well described. OBJECTIVE The aim of this study is to conduct a systematic analysis of the published data on the epidemiology of delirium in hospitalized patients in Latin America. METHODS We conducted a systematic review following PRISMA guidelines. Both MEDLINE and LILACS databases were searched for original research articles reporting the occurrence of delirium among adult hospitalized patients in Latin American countries. Studies including pediatric populations were excluded from this analysis. Two authors independently applied eligibility criteria, assessed quality, and extracted data. The corresponding authors of the original articles were contacted to obtain relevant information about the study when this was not present in the published manuscripts. RESULTS Seven hundred and eighteen original articles were identified. After screening titles and abstracts, 149 studies were included in the final analysis. The occurrence of delirium varied depending on the clinical scenario: (1) in the general medico-surgical wards, it ranged from 2.1% to 60.4%, (2) in the Intensive Care Units (ICUs), from 9.6% to 94.8%, (3) in the post-operatory population, from 5.45% and 52.3%, and (4) it was found to be between 10.7% and 62% in the emergency department setting. The most used delirium assessment tools were the "Confusion Assessment Method" (CAM; in the general population), and the "Confusion Assessment Method for the ICU" (CAM-ICU). Fourteen out of 149 studies were conducted in clinical settings who actively implemented some form of non-pharmacological delirium prevention bundles, most of them as part of ICU sedation-analgesia protocols. CONCLUSION Delirium occurs frequently in hospitalized patients in Latin America throughout a variety of clinical scenarios, including ICU, general wards, post-operatory populations, and among the emergency department setting. The CAM and the CAM-ICU are the most used delirium assessment tools. Bundles of non-pharmacological interventions to prevent delirium are not universally implemented.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Castro Roberta
- Universidad del Estado de Río de Janeiro, Rio de Janeiro, Brazil.,Latin America Delirium Special Interest Group (LADIG), part of the American Delirium Society (ADS)
| | - Tobar Eduardo
- Latin America Delirium Special Interest Group (LADIG), part of the American Delirium Society (ADS).,Unidad de Pacientes Críticos Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Maldonado Jose
- Latin America Delirium Special Interest Group (LADIG), part of the American Delirium Society (ADS).,Stanford University, Palo Alto, California, USA
| | - Salech Felipe
- Sección Geriatría HCUCH, Santiago, Chile.,Facultad de Medicina Universidad de, Santiago, Chile.,Hospital Clínico Universidad de Chile, Santiago, Chile.,Latin America Delirium Special Interest Group (LADIG), part of the American Delirium Society (ADS).,Centro de gerociencia, Salud Mental y Metabolismo, Santiago, Chile
| |
Collapse
|
37
|
Yokomichi N, Maeda I, Morita T, Yoshiuchi K, Ogawa A, Hisanaga T, Sakashita A, Nakahara R, Kaneishi K, Iwase S. Association of Antipsychotic Dose With Survival of Advanced Cancer Patients With Delirium. J Pain Symptom Manage 2022; 64:28-36. [PMID: 35339614 DOI: 10.1016/j.jpainsymman.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 11/18/2022]
Abstract
CONTEXT Delirium is common in patients with advanced cancer, and antipsychotics are widely used for its management. OBJECTIVES We aimed to explore the association of the antipsychotic dose with survival of terminally ill cancer patients with delirium. METHODS A secondary analysis of a multicenter prospective observational study was conducted. We enrolled adult advanced cancer patients who developed delirium and received antipsychotics at 14 palliative care units in Japan between September 2015 and May 2016. Hazard ratios of survival after starting antipsychotics between groups with different oral chlorpromazine equivalent doses: low: <100 mg, moderate: 100-200 mg, high: ≥200 mg, were calculated with adjustment for potential confounders using Cox regression. The antipsychotic dose-specific mortality risk was estimated with smooth splines. RESULTS Of 453 patients enrolled, 422 patients were analyzed. The median antipsychotic dose was 92.6 mg: low-dose (N = 231), moderate-dose (122), and high-dose (69). The median survival of all patients was 11 days. Compared with the low-dose group, the high-dose group showed a significantly shorter survival (HR: 1.46, 95%CI: 1.08-1.98). Smooth splines demonstrated that HR continuously increased as the antipsychotic dose increased. In patients treated with atypical antipsychotics, the high-dose group showed a significantly shorter survival than the low-dose group (HR: 2.86), while in patients treated with typical antipsychotics, survival was not significantly different (0.99). CONCLUSIONS Higher doses of antipsychotics were associated with increased mortality in terminally ill cancer patients with delirium. To minimize the potential mortality risk, antipsychotics should be started at low doses and titrated carefully.
Collapse
Affiliation(s)
- Naosuke Yokomichi
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan.
| | - Isseki Maeda
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan
| | - Tatsuya Morita
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan
| | - Kazuhiro Yoshiuchi
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan
| | - Asao Ogawa
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan
| | - Takayuki Hisanaga
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan
| | - Akihiro Sakashita
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan
| | - Rika Nakahara
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan
| | - Keisuke Kaneishi
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan
| | - Satoru Iwase
- Division of Palliative and Supportive Care (N.Y.), Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Palliative Care (I.M.), Senri-Chuo Hospital, Osaka, Japan; Division of Palliative and Supportive Care (T.M.), Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan; Department of Stress Sciences and Psychosomatic Medicine (K.Y.), Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Psycho-Oncology Service (A.O.), National Cancer Center Hospital East, Kashiwa, Japan; Department of Palliative Medicine (T.H.), Tsukuba Medical Center Hospital, Tsukuba, Japan; Department of Palliative Medicine (A.S.), Hyogo Brain and Heart Center, Himeji, Japan; Department of Psycho-Oncology (R.N.), National Cancer Center Hospital, Tokyo, Japan; Department of Palliative Care Unit (K.K.), JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan; Department of Palliative Medicine (S.I.), Saitama Medical University, Saitama, Japan
| |
Collapse
|
38
|
Boz M, Aksu NM, Öztürk E, Kunt MM, Batur A. How Can We Detect Delirium Easier Among Oncologic Patients in the Emergency Department? EURASIAN JOURNAL OF EMERGENCY MEDICINE 2022. [DOI: 10.4274/eajem.galenos.2021.93653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
39
|
Tachibana M, Inada T, Ichida M, Ozaki N. Prevalence, clinical features, and risk factors of delusions in patients with delirium. Int J Geriatr Psychiatry 2022; 37. [PMID: 35603676 DOI: 10.1002/gps.5763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/12/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Delirium may be divided into multiple subtypes with different pathological factors. This study aimed to focus on the delirium subtype in which delusions are conspicuous and explore its prevalence, clinical characteristics, and risk factors. METHODS The subjects were 601 delirium cases referred to the department of psychiatry over 5 years at a general hospital. The Delirium Rating Scale-Revised-98 was used to assess the delusions in patients with delirium, and the features of delusions (delusional form, object, and content) were examined. Multiple regression analysis was applied to determine whether individual factors were associated with the delusions. RESULTS A total of 78 patients with delirium experienced delusions (13.0%). Most were classified as delusion of reference, such as persecution or poisoning, and 84.3% of patients believed that the persecutors were medical staff members. Older age (p < 0.001), female gender (p < 0.001), and living alone (p < 0.001) were significantly associated with delusions in patients with delirium. CONCLUSIONS The content of delusions was rooted in the distress caused by the patients' medical situation, and the features and risk factors of the delusions suggested a formal similarity with late paraphrenia and "lack-of-contact paranoia." Psychological interventions that consider the isolation, anxiety, and fear behind delusions may be necessary in the care and treatment of these patients.
Collapse
Affiliation(s)
- Masako Tachibana
- Department of Psychiatry, Nagoya University Hospital, Aichi, Japan.,Department of Psychiatry, Nagoya Ekisaikai Hospital, Aichi, Japan
| | - Toshiya Inada
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Masaru Ichida
- Department of Psychiatry, Nagoya Ekisaikai Hospital, Aichi, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Aichi, Japan
| |
Collapse
|
40
|
Matsuda Y, Morita T, Oya K, Tagami K, Naito AS, Kashiwagi H, Otani H. Current practice of pharmacological treatment for hyperactive delirium in terminally ill cancer patients: results of a nationwide survey of Japanese palliative care physicians and liaison psychiatrists. Jpn J Clin Oncol 2022; 52:905-910. [PMID: 35595535 DOI: 10.1093/jjco/hyac081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The objective of this survey was to identify areas where doctors have divergent practices in pharmacological treatment for hyperactive delirium in terminally ill patients with cancer. METHODS We conducted a survey of Japanese palliative care physicians and liaison psychiatrists. Inquiries were made regarding: (i) choice of drug class in the first-line treatment, (ii) administration methods of the first-line antipsychotic treatment, (iii) starting dose of antipsychotics in the first line treatment and maximum dose of antipsychotics in refractory delirium, and (iv) choice of treatment when the first-line haloperidol treatment failed. Respondents used a five-point Likert scale. RESULTS Regarding choice of drug class in the first-line treatment, more doctors reported that they 'frequently' or 'very frequently' use antipsychotics only than antipsychotics and benzodiazepine (oral: 73.4 vs. 12.2%; injection: 61.3 vs. 11.6%, respectively). Regarding administration methods of the first-line antipsychotic treatment, the percentage of doctors who reported that they used antipsychotics as needed and around the clock were 55.4 and 68.8% (oral), 49.2 and 45.4% (injection), respectively. There were different opinions on the maximum dose of antipsychotics in refractory delirium. Regarding the choice of treatment when the first-line haloperidol treatment failed, the percentage of doctors who reported that they increased the dose of haloperidol, used haloperidol and benzodiazepines, and switched to chlorpromazine were 47.0, 32.1 and 16.4%, respectively. CONCLUSIONS Doctors have divergent practices in administration methods of the first-line antipsychotic treatment, maximum dose of antipsychotics, and choice of treatment when the first-line haloperidol treatment failed. Further studies are needed to determine the optimal treatment.
Collapse
Affiliation(s)
- Yoshinobu Matsuda
- Department of Psychosomatic Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | | | - Keita Tagami
- Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Akemi Shirado Naito
- Department of Palliative Care, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Hideyuki Kashiwagi
- Department of Transitional and Palliative Care, Aso Iizuka Hospital, Iizuka, Japan
| | - Hiroyuki Otani
- Department of Palliative and Supportive Care, Palliative Care Team, National Kyushu Cancer Center, Fukuoka, Japan.,Department of Palliative and Supportive Care, Palliative Care Team, St. Mary's Hospital, Kurume, Japan
| |
Collapse
|
41
|
You W, Fan XY, Lei C, Nie CC, Chen Y, Wang XL. Melatonin intervention to prevent delirium in hospitalized patients: A meta-analysis. World J Clin Cases 2022; 10:3773-3786. [PMID: 35647160 PMCID: PMC9100708 DOI: 10.12998/wjcc.v10.i12.3773] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/01/2021] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Evaluation of the effectiveness of melatonin is necessary to prevent the development of delirium in hospitalized patients. Melatonin (N-acetyl-5-methoxytryptamine) is a hormone produced by the pineal gland of the brain from the amino acid tryptophan. Synthetic melatonin supplements have been used for various medical conditions, especially sleep-related diseases, and have proved to be successful.
AIM To determine the effect of melatonin on the prevention of delirium in hospitalized patients.
METHODS A literature search of the CNKI, Wanfang Database, VIP Database, China Biomedical Literature Database, PubMed, Embase, Cochrane Library, Web of Science, and other databases was conducted. The CNKI, Wanfang Database, VIP Database (VIP), and China Biomedical Literature Database were searched for Chinese studies, and PubMed, Embase, Cochrane Library, Web of Science and other databases were searched for international studies. It will be established in June 2021 in a randomized controlled trial (RCT) whether melatonin treatment for 6 mo prevents delirium in hospitalized patients. Literature screening, quality review, and data extraction were carried out using the Cochrane Manual 5.1.0 systematic evaluation method, and Stata 15.0 software and Review Manager 5.3 were used for meta-analysis and processing.
RESULTS A total of 18 new RCT articles and 18 experimental subjects were identified. The results of the meta-analysis showed that following the occurrence of delirium, melatonin reduced the incidence of delirium in patients (RR = 0.69, 95%CI: 0.60-0.80), which is of significance, but heterogeneity was significant I2 = 62%. Subgroup analysis was performed to examine the source of heterogeneity, and it was found that different patient types were the source of heterogeneity; the research on subgroup analysis was of high quality and homogeneous. To determine the reliability and robustness of the research results, a sensitivity analysis was carried out. The results showed that after excluding individual studies one by one, the effect size was still within 95%CI, which strengthened the reliability of the original meta-analysis results. Melatonin has a significant preventive effect on delirium in hospitalized medical patients [RR = 0.60, 95%CI: 0.47-0.76), P < 0.001].
CONCLUSION Melatonin can reduce the rate of delirium in medical patients, and the role of melatonin in reducing the incidence of delirium in surgical patients and critical care unit patients requires further study.
Collapse
Affiliation(s)
- Wei You
- Emergency Department Intensive Care Unit, Zigong Fourth People's Hospital, Zigong 643000, Sichuan Province, China
| | - Xiao-Yu Fan
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong 643000, Sichuan Province, China
| | - Cheng Lei
- School of Public Health and Management, Chongqing Medical University, Chongqing 400000, Chongqing, China
| | - Chen-Cong Nie
- Department of Nursing, Zigong Fourth People's Hospital, Zigong 643000, Sichuan Province, China
| | - Yao Chen
- Emergency Department Intensive Care Unit, Zigong Fourth People's Hospital, Zigong 643000, Sichuan Province, China
| | - Xue-Lian Wang
- Emergency Department Intensive Care Unit, Zigong Fourth People's Hospital, Zigong 643000, Sichuan Province, China
| |
Collapse
|
42
|
Hatano Y, Morita T, Mori M, Aoyama M, Yoshida S, Amano K, Terabayashi T, Oya K, Tsukuura H, Hiratsuka Y, Isseki M, Kizawa Y, Tsuneto S, Shima Y, Masukawa K, Miyashita M. Association between experiences of advanced cancer patients at the end of life and depression in their bereaved caregivers. Psychooncology 2022; 31:1243-1252. [DOI: 10.1002/pon.5915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Yutaka Hatano
- Department of Palliative Care Daini Kyoritsu Hospital Kawanishi Japan
| | - Tatsuya Morita
- Palliative and Supportive Care Division Seirei Mikatahara General Hospital Hamamatsu Japan
| | - Masanori Mori
- Palliative Care Team Seirei Mikatahara General Hospital Hamamatsu Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences Tohoku University Graduate School of Medicine Sendai Japan
| | - Saran Yoshida
- Graduate School of Education, Tohoku University Sendai Japan
| | - Koji Amano
- Department of Palliative Medicine National Cancer Center Hospital Tokyo Japan
| | | | - Kiyofumi Oya
- Department of Palliative and Transitional Care Aso Iizuka Hospital Iizuka Japan
| | | | - Yusuke Hiratsuka
- Department of Palliative Medicine Tohoku University School of Medicine Sendai Japan
- Department of Palliative Medicine Takeda General Hospital Aizu Wakamatsu Japan
| | - Maeda Isseki
- Department of Palliative Care Senri‐chuo Hospital Toyonaka Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine Kobe University Graduate School of Medicine Kobe Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Yasuo Shima
- Tsukuba Medical Center Foundation, Home Care Service, Tsukuba Medical Center Hospital, Department of Palliative Medicine Tsukuba Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences Tohoku University Graduate School of Medicine Sendai Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences Tohoku University Graduate School of Medicine Sendai Japan
| |
Collapse
|
43
|
Kim SY, Jhon M, Kang HJ, Lee JY, Kim SW, Kim JM, Shin IS. Depressed mood, associated factors, and understanding of delirium among caregivers of patients with delirium. Int J Psychiatry Med 2022; 57:153-164. [PMID: 33653170 DOI: 10.1177/0091217421989146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Delirium is stressful for both the patient and caregiver. However, caregivers have attracted minimal attention. We here identify depressed moods and associated factors among caregivers and caregiver knowledge of the delirium and non-pharmacological management. METHODS This was a cross-sectional study. Caregiver and patient demographic characteristics, and patient clinical data, were collected. Caregiver depressed mood was analysed using the Hospital Anxiety and Depression Scale-depression subscale (HADS-D). We explored caregiver understanding of delirium and knowledge of non-pharmacological management. We used a multivariate linear regression model to identify factors associated with caregiver depressed mood. RESULTS For 224 caregivers, the median (interquartile range) HADS-D score was 8.0 (4.0-11.8). More than half (54.9%) had scores ≥8. Answers to multiple choice questions revealed that delirium was frequently misinterpreted as "anxiety" (25.9%) or "dementia" (25.4%). Of all caregivers, 74% had received no information on non-pharmacological delirium management. Younger age of patient, a longer time from delirium detection to consultation, a patient past history of depression, a spousal relation with the patient, and misinterpretation of delirium as dementia were associated with the depressed mood of caregivers. CONCLUSIONS The mental health of caregivers of patients with delirium requires more attention; they should be recommended to be informed and educated about delirium. Also, the clinicians need to find an easier term for the delirium to help caregivers understand.
Collapse
Affiliation(s)
- Seon-Young Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Mental Health Clinic, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Min Jhon
- Mental Health Clinic, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | | | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| |
Collapse
|
44
|
Venkataramu VN, Ghotra HK, Chaturvedi SK. Management of psychiatric disorders in patients with cancer. Indian J Psychiatry 2022; 64:S458-S472. [PMID: 35602367 PMCID: PMC9122176 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_15_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
| | | | - Santosh K Chaturvedi
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India.,Leicestershire Partnership NHS Trust, Thurmaston, Leicestershire, UK E-mail:
| |
Collapse
|
45
|
Najafi Ghezeljeh T, Rahnamaei F, Omrani S, Haghani S. The effects of interactive E-learning on delirium recognition ability and delirium-related strain of care among critical care nurses. J Intensive Care Soc 2022; 23:44-52. [PMID: 37593534 PMCID: PMC10427842 DOI: 10.1177/1751143720972627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Abstract
Background Nursing care for patients with delirium is very complex and stressful and is associated with considerable care strain for nurses. Delirium recognition is the first step to the prevention and management of delirium and reduction of strain of care. Education is one of the strategies for improving nurses' delirium recognition ability. Objectives This study aimed to evaluate the effects of interactive E-learning on delirium recognition ability and delirium-related strain of care among critical care nurses. Methods This quasi-experimental study was conducted in 2019 using a two-group pretest-posttest design. Participants were 98 critical care nurses recruited through a census from two hospitals in Iran. They were non-randomly allocated to an intervention and a control group. Study intervention was an interactive E-learning program with four parts on delirium, its prevention, its treatment, and its diagnostic and screening procedures. The program was uploaded on a website and its link was provided to participants in the intervention group. Before and two months after the intervention, data were collected using the Strain of Care for Delirium Index and five case vignettes. For data analysis, the Chi-square, Fisher's exact, independent-sample t, and paired-sample t tests were performed usingthe SPSS software (v. 16.0). Findings Groups did not significantly differ from each other regarding the pretest mean scores of delirium recognition ability and strain of care. After the intervention, the mean score of delirium recognition ability in the intervention group was significantly greater and the mean score of strain of care was significantly lower than the control group (P < 0.05). Conclusion Interactive E-learning is effective in significantly improving critical care nurses' delirium recognition ability and reducing their strain of care. As nurses' heavy workload and limited free time are among the main barriers to their participation in face-to-face educational programs, interactive E-learning can be used for in-service education.
Collapse
Affiliation(s)
- Tahereh Najafi Ghezeljeh
- Nursing Care Research Center, Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rahnamaei
- Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Soghra Omrani
- Distance Education Planning, Iran University of Medical Sciences, Tehran, Iran
| | - Shima Haghani
- Statistic and Mathematics Department, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
46
|
Association of Nutritional Status with New-Onset Delirium in Elderly, Acute Care, Orthopaedic Trauma Patients: A Single-Center Observational Study. J Orthop Trauma 2022; 36:67-72. [PMID: 35061654 DOI: 10.1097/bot.0000000000002213] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether nutritional status at hospital admission is independently associated with new-onset delirium (NOD) in elderly, orthopaedic trauma patients. DESIGN Single-center, retrospective, cross-sectional study. SETTING Data from patients at a large teaching hospital in Boston, MA, were analyzed. PATIENTS All patients were ≥65 years and hospitalized for acute surgical management of their major fractures after trauma. INTERVENTION None. MAIN OUTCOME MEASUREMENT Nutritional status was assessed at admission using the Mini Nutritional Assessment-Short Form (MNA-SF). Delirium was assessed using the Confusion Assessment Method within 24 hours of admission and daily throughout hospitalization. RESULTS The incidence of delirium was 20% (94/471). Each unit decrement in MNA-SF was associated with a 14% higher risk of NOD (adjusted OR 1.14; 95% CI 1.05-1.28). Moreover, malnourished patients (MNA-SF score 0-7) were twice as likely to develop NOD (adjusted OR 2.07; 95% CI 1.01-4.35) compared with patients who were not malnourished (MNA-SF score 8-14). CONCLUSIONS In hospitalized, elderly, orthopaedic trauma patients, poor nutritional status may be a modifiable risk factor for NOD. Future studies are needed to determine whether aggressive nutritional interventions can reduce the incidence of NOD and improve outcomes in this cohort of patients. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
47
|
The detection of delirium in admitted oncology patients: a scoping review. Eur Geriatr Med 2022; 13:33-51. [PMID: 35032322 PMCID: PMC8860783 DOI: 10.1007/s41999-021-00586-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/03/2021] [Indexed: 02/07/2023]
Abstract
Aim To understand the validation of delirium detection tools in medical oncology, as well as identify data on incidence, prevalence and reversibility in this setting. Findings Of twelve studies, only four used case ascertainment methods following published recommendations, six studies had a low risk of bias. Message In delirium tool validation studies in the oncology setting, choice of appropriate gold standard for case ascertainment is a critical factor. New tools and new validations are not recommended, rather the critical application of existing tools depending on appropriate validation and clinical practicality for the setting. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00586-1. Purpose Delirium leads to poor outcomes for patients and careers and has negative impacts on staff and service provision. Cancer rates in elderly populations are increasing and frequently, cancer diagnoses are a co-morbidity in the context of frailty. Data relating to the epidemiology of delirium in hospitalised cancer patients are limited. With the overarching purpose of improving delirium detection and reducing the morbidity and mortality of delirium in cancer patients, we reviewed the epidemiological data and approach to delirium detection in hospitalised, adult oncology patients. Methods MEDLINE, EMBASE, CINAHL, PsycINFO, and SCOPUS databases were searched from January 1996 to August 2017. Key concepts were delirium, cancer, inpatient oncology and delirium screening/detection. Results Of 896 unique studies identified; 91 met full-text review criteria. Of 12 eligible studies, four applied recommended case ascertainment methods to all patients, three used delirium screening tools alone or with case ascertainment tools sub-optimally applied, four used tools not recommended for delirium screening or case ascertainment, one used the Confusion Assessment Method with insufficient information to determine if it met case ascertainment status. Two studies presented delirium incidence rates: 7.8%, and 17% respectively. Prevalence rates ranged from 18–33% for general medical or oncology wards; 42–58% for Acute Palliative Care Units (APCU); and for older cancer patients: 22% and 57%. Three studies reported reversibility; 26% and 49% respectively (APCUs) and 30% (older patients with cancer). Six studies had a low risk of bias according to QUADAS-2 criteria; all studies in the APCU setting were rated at higher risk of bias. Tool selection, study flow and recruitment bias reduced study quality. Conclusion The knowledge base for improved interventions and clinical care for adults with cancer and delirium is limited by the low number of studies. A clear distinction between screening tools and diagnostic tools is required to provide an improved understanding of the rates of delirium and its reversibility in this population. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00586-1.
Collapse
|
48
|
White L, Jackson T. Delirium and COVID‐19: a narrative review of emerging evidence. Anaesthesia 2022; 77 Suppl 1:49-58. [DOI: 10.1111/anae.15627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 12/27/2022]
Affiliation(s)
- L. White
- Institute of Inflammation and Ageing University of Birmingham Birmingham UK
| | - T. Jackson
- Institute of Inflammation and Ageing University of Birmingham Birmingham UK
- University Hospitals Birmingham NHS Foundation Trust Birmingham UK
| |
Collapse
|
49
|
Castro VM, Hart KL, Sacks CA, Murphy SN, Perlis RH, McCoy TH. Longitudinal validation of an electronic health record delirium prediction model applied at admission in COVID-19 patients. Gen Hosp Psychiatry 2022; 74:9-17. [PMID: 34798580 PMCID: PMC8562039 DOI: 10.1016/j.genhosppsych.2021.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To validate a previously published machine learning model of delirium risk in hospitalized patients with coronavirus disease 2019 (COVID-19). METHOD Using data from six hospitals across two academic medical networks covering care occurring after initial model development, we calculated the predicted risk of delirium using a previously developed risk model applied to diagnostic, medication, laboratory, and other clinical features available in the electronic health record (EHR) at time of hospital admission. We evaluated the accuracy of these predictions against subsequent delirium diagnoses during that admission. RESULTS Of the 5102 patients in this cohort, 716 (14%) developed delirium. The model's risk predictions produced a c-index of 0.75 (95% CI, 0.73-0.77) with 27.7% of cases occurring in the top decile of predicted risk scores. Model calibration was diminished compared to the initial COVID-19 wave. CONCLUSION This EHR delirium risk prediction model, developed during the initial surge of COVID-19 patients, produced consistent discrimination over subsequent larger waves; however, with changing cohort composition and delirium occurrence rates, model calibration decreased. These results underscore the importance of calibration, and the challenge of developing risk models for clinical contexts where standard of care and clinical populations may shift.
Collapse
Affiliation(s)
- Victor M. Castro
- Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA,Research Information Science and Computing, Mass General Brigham, 399 Revolution Drive, Somerville, MA 02145, USA
| | - Kamber L. Hart
- Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA
| | - Chana A. Sacks
- Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, Boston, MA 02114, USA
| | - Shawn N. Murphy
- Research Information Science and Computing, Mass General Brigham, 399 Revolution Drive, Somerville, MA 02145, USA,Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Roy H. Perlis
- Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA
| | - Thomas H. McCoy
- Center for Quantitative Health, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, USA,Corresponding author at: Simches Research Building, Massachusetts General Hospital, 185 Cambridge St, 6th Floor, Boston, MA 02114, USA
| |
Collapse
|
50
|
Hui D, De La Rosa A, Urbauer DL, Nguyen T, Bruera E. Personalized sedation goal for agitated delirium in patients with cancer: Balancing comfort and communication. Cancer 2021; 127:4694-4701. [PMID: 34432293 DOI: 10.1002/cncr.33876] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/01/2021] [Accepted: 08/06/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Agitated delirium is common and highly distressing. Medications are often needed to reduce agitation, but it is unclear what the desired level of sedation is. This study assessed personalized sedation goals (PSGs) and their predictors for patients in a delirium clinical trial and in clinical vignettes. METHODS This was a preplanned secondary analysis of a double-blind randomized clinical trial examining the sedative effect of chlorpromazine and/or haloperidol in patients with agitated delirium. At the baseline, caregivers and nurses were independently asked to select the PSG for the trial patient from 5 choices corresponding to Richmond Agitation Sedation Scale (RASS) scores of 0 or higher (no sedation), -1 to -2, -3, -4, and -5 (deep sedation). Respondents also selected a PSG for 6 vignettes that differed by the level of agitation, ability to communicate, and survival. RESULTS Forty-two caregivers and 39 nurses answered questions regarding PSGs. For the trial patient, caregivers preferred RASS scores of -1 to -2 most often (36%), whereas nurses preferred an RASS score of -3 most often (51 %). Caregivers were significantly more likely than nurses to choose lighter sedation (odds ratio [OR], 4.8; P = .01) despite reporting greater delirium-related distress (P = .0006). Patients were undersedated 33% to 53% of the time and oversedated 0% to 15% of the time according to the PSG response criteria. In the case vignettes, deeper sedation was preferred by nurses (P < .0001) and for patients who were unable to communicate (OR, 3.1-4.4; P < .0001) and had a shorter life expectancy (OR, 1.7; P = .002). CONCLUSIONS Caregivers often preferred lighter sedation than nurses. Many patients were undersedated in comparison with caregivers' PSGs, and this highlights room for improvement. LAY SUMMARY In the last days of life, many patients with cancer develop delirium and become restless/agitated; this can be highly distressing. Caregivers and physicians alike are often concerned about the use of sedatives for agitated delirium and try to find a balance between maximizing comfort and maintaining communication. This study examined the concept of a personalized sedation goal for setting an individualized target for the level of sedation. Caregivers often preferred lighter sedation than nurses. Many patients were undersedated in comparison with caregivers' stated goals, and this highlights room for improvement.
Collapse
Affiliation(s)
- David Hui
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Allison De La Rosa
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diana L Urbauer
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thuc Nguyen
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|