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Ieong C, Chen T, Chen S, Gao X, Yan K, He W, Hong H, Gu Y, Chen X, Yuan G. Differences of anticholinergic drug burden between older hospitalized patients with and without delirium: a systematic review and meta-analysis based on prospective cohort studies. BMC Geriatr 2024; 24:599. [PMID: 38997670 PMCID: PMC11241997 DOI: 10.1186/s12877-024-05197-6] [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: 11/29/2023] [Accepted: 07/02/2024] [Indexed: 07/14/2024] Open
Abstract
OBJECTIVES This review aims to comprehensively summarize the differences in anticholinergic drug burden (ADB) scores between older hospitalized patients with and without delirium. METHODS We searched PubMed, Embase, Web of Science, Cochrane Library and CINAHL EBSCOhost databases to identify prospective cohort studies exploring the relationship between ADB and the occurrence of delirium in older hospitalized patients. The primary outcome of the review was the mean ADB scores for the delirium and non-delirium groups, and the secondary outcome was the scores for the subsyndromal and non-delirium groups. The standardized mean difference (SMD) and corresponding 95% confidence intervals (95% CI) were incorporated using a fixed-effect method. Moreover, we performed subgroup analysis according to the admission type, age, the ADB scale type and the ADB classification. RESULTS Nine prospective cohort studies involving 3791 older patients with a median age of 75.1 (71.6-83.9) were included. The ADB score was significantly higher in the delirium group than in the non-delirium group (SMD = 0.21, 95%CI 0.13-0.28). In subgroup analysis, the age subgroup was split into < 75 and ≥ 75 according to the median age of the older people. There were significant differences in ADB scores between older people with delirium and those without delirium in various subgroups: surgical (SMD = 0.20, 95%CI 0.12-0.28), internal medicine (SMD = 0.64, 95%CI 0.25-1.02), age < 75 (SMD = 0.17, 95%CI 0.08-0.26), age ≥ 75 (SMD = 0.27, 95%CI 0.15-0.39), ADS scale (SMD = 0.13, 95%CI 0.13-0.40), ARS scale (SMD = 0.15, 95%CI 0.03-0.26), ACB scale (SMD = 0.13, 95%CI 0.01-0.25), pre-admission ADB (SMD = 0.24, 95%CI 0.05-0.43) and ADB during hospitalization (SMD = 0.20, 95%CI 0.12-0.27). CONCLUSIONS We found a quantitative relationship between ADB and delirium in older patients admitted for internal medicine and surgery. And this relationship remained significant in different age, ADB scale type and ADB classification subgroups. However, the actual difference in ADB scores between patients with delirium and without delirium was small. More high-quality observational studies should be conducted to explore the impact of ADB on delirium and subsyndromal delirium. CLINICAL TRIAL REGISTRATION The protocol was published in the International Prospective Register of Systematic Reviews (PROSPERO) [Ref: CRD42022353649].
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Affiliation(s)
- Chifong Ieong
- Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Department of Pharmacy, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tingjia Chen
- Healthcare Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Sai Chen
- Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiang Gao
- Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Department of Pharmacy, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kemin Yan
- Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wen He
- Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hua Hong
- Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yong Gu
- Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao Chen
- Department of Pharmacy, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Gang Yuan
- Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Ferraz-Gonçalves JA, Silva AS, Reis JS, Assis JG, Matos MI, Matias P, Alves S. How are agitated patients dealt with in internal medicine departments? Porto Biomed J 2024; 9:260. [PMID: 38993951 PMCID: PMC11236411 DOI: 10.1097/j.pbj.0000000000000260] [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: 04/19/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 07/13/2024] Open
Abstract
Background Studies on agitation in internal medicine departments are scarce, especially regarding how doctors and nurses act in these situations. The objective of this study was to clarify how agitation is dealt with in these departments. Methods This prospective observational study was performed in the internal medicine departments of four Portuguese hospitals. The researchers at each hospital contacted the nursing team that identifies patients who were agitated in the previous shifts. The researcher reviewed these patients' files, recording the research protocol's parameters. Results During the study period, 331 patients were observed; 177 (54%) were female, and the median age was 80 years (19-99). Episodes of agitation occurred in 69 patients (21%); of them, 44 (64%) were female, and the median age was 84 years (31-98). In the first episode of agitation, the doctor on duty was called in 49 times (71%). These doctors prescribed a new medication for the crisis in 30 cases (43%). After the crisis, the assistant doctor recorded the episode in the patient file in 41 cases (59%). According to the medical notes, after the acute phase, in only 21 patients (30%), there was an attempt to clarify the cause of agitation. The prescription after the crisis was regular medication in 32 cases (46%), rescue medication in 27 (39%), and physical restraint in 9 (13%), isolated or in various combinations. Conclusion This study suggests that there is room to improve how agitated patients are managed in internal medicine departments.
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Affiliation(s)
| | - Ana Sofia Silva
- Serviço de Medicina Interna, Unidade Local de Saúde Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Joana Silva Reis
- Serviço de Oncologia Médica, Unidade Local de Saúde São João, Porto, Portugal
| | - José Guilherme Assis
- Serviço de Medicina Interna, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Maria Inês Matos
- Serviço de Medicina Interna, Unidade Local de Saúde São João, Porto, Portugal
| | - Paula Matias
- Serviço de Medicina Interna, Unidade Local de Saúde São João, Porto, Portugal
| | - Sérgio Alves
- Serviço de Medicina Interna, Unidade Local de Saúde Nordeste, Bragança, Portugal
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Xing H, Zhu S, Liu S, Xia M, Jing M, Dong G, Ni W, Li L. Knowledge, attitudes and practices of ICU nurses regarding subsyndromal delirium among 20 hospitals in China: a descriptive cross-sectional survey. BMJ Open 2022; 12:e063821. [PMID: 36127111 PMCID: PMC9490617 DOI: 10.1136/bmjopen-2022-063821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study sought to investigate nurses' knowledge, attitudes and practices, and analyse the influencing factors for subsyndromal delirium (SSD). DESIGN A descriptive cross-sectional survey. SETTING E-questionnaires were distributed to intensive care unit (ICU) nurses from 20 tertiary-grade, A-class hospitals in Henan Province, China. PARTICIPANTS A total of 740 ICU nurses participated in the questionnaire survey. MAIN OUTCOME MEASURES Each dimension score is converted to a percentage scale. A score of ≤60% on each dimension of the questionnaire was considered a negative score, <80% was considered a intermediate score and ≥80% was considered an excellent score. RESULTS A total of 733 questionnaires were included in the study. More than half of the nurses were at the intermediate level, and a few nurses were at the excellent level. Nurses self-assessed their level of knowledge was intermediate. In the attitudes dimension, nurses' attitudes were negative. The results of the practical dimension showed that most nurses could carry out the clinical practice. Multiple linear regression analysis showed that educational level and received SSD training were influencing factors. CONCLUSIONS ICU nursing staff overestimated their knowledge of SSD and showed a negative attitude towards it. Various forms of education and training are necessary.
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Affiliation(s)
- Huanmin Xing
- Department of Intensive Care Unit, Henan Provincial People's Hospital, Zhengzhou, China
- Department of Intensive Care Unit, People's Hospital of Zhengzhou University, Zhengzhou, China
- Department of Intensive Care Unit, People's Hospital of Henan University, Zhengzhou, China
- Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, China
| | - Shichao Zhu
- Department of Intensive Care Unit, Henan Provincial People's Hospital, Zhengzhou, China
- Department of Intensive Care Unit, People's Hospital of Zhengzhou University, Zhengzhou, China
- Department of Intensive Care Unit, People's Hospital of Henan University, Zhengzhou, China
- Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, China
| | - Shiqing Liu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ming Xia
- Department of Intensive Care Unit, Henan Provincial People's Hospital, Zhengzhou, China
- Department of Intensive Care Unit, People's Hospital of Zhengzhou University, Zhengzhou, China
- Department of Intensive Care Unit, People's Hospital of Henan University, Zhengzhou, China
- Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, China
| | - Mengjuan Jing
- Department of Intensive Care Unit, Henan Provincial People's Hospital, Zhengzhou, China
- Department of Intensive Care Unit, People's Hospital of Zhengzhou University, Zhengzhou, China
- Department of Intensive Care Unit, People's Hospital of Henan University, Zhengzhou, China
- Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, China
| | - Guangyan Dong
- Department of Intensive Care Unit, Henan Provincial People's Hospital, Zhengzhou, China
- Department of Intensive Care Unit, People's Hospital of Zhengzhou University, Zhengzhou, China
- Department of Intensive Care Unit, People's Hospital of Henan University, Zhengzhou, China
- Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, China
| | - Weiwei Ni
- Department of Intensive Care Unit, Henan Provincial People's Hospital, Zhengzhou, China
- Department of Intensive Care Unit, People's Hospital of Zhengzhou University, Zhengzhou, China
- Department of Intensive Care Unit, People's Hospital of Henan University, Zhengzhou, China
- Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, China
| | - Liming Li
- Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, China
- Nursing Department, Henan Provincial People's Hospital, Zhengzhou, China
- Nursing Department, People's Hospital of Zhengzhou University, Zhengzhou, China
- Nursing Department, People's Hospital of Henan University, Zhengzhou, China
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Chen Y, Hu Y, Li X, Chen P, Wang C, Wang J, Wu J, Sun Y, Zheng G, Lu Y, Guo Y. Clinical Features and Factors Associated With Sepsis-Associated Encephalopathy in Children: Retrospective Single-Center Clinical Study. Front Neurol 2022; 13:838746. [PMID: 35711261 PMCID: PMC9196026 DOI: 10.3389/fneur.2022.838746] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background Sepsis-associated encephalopathy (SAE) is a common complication in septic patients with a higher ICU and hospital mortality in adults and poorer long-term outcomes. Clinical presentation may range from mild confusion to convulsions and deep coma; however, little is known about SAE in children. We aimed to retrospectively analyze the data for children with sepsis, to illustrate the epidemiology, performance, and adverse outcome, and to evaluate the association between risk factors and SAE in children. Methods All children with sepsis who were admitted to the Department of Pediatrics, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China from January 2010 to December 2020 were retrospectively analyzed. Results A total of 210 patients with sepsis were retrospectively assigned to the SAE and non-SAE groups, of which 91 (43.33%) were diagnosed with SAE with a mortality of 6.70% (14/210). Significant differences were observed in the level of white blood platelet, platelets, international normalized ratio, prothrombin time, activated partial thromboplastin time, total protein, Ccr, UREA, blood urea nitrogen, alanine transaminase, aspartate transaminase, creatine kinase, creatine kinase isoenzymes, lactate dehydrogenase, procalcitonin, and lactic acid (p < 0.05). In the risk assessment scales, significant differences were observed in the modified Glasgow Coma score, PCIS, Pediatric Logistic Organ Dysfunction Score 2 (PELOD-2), Pediatric Sequential Organ Failure Assessment Score, and Pediatric Risk of Mortality III (p < 0.05). The incidence of septic shock, acute kidney disease, liver dysfunction, and coagulation disorder were higher in the SAE group (p < 0.05). The mechanical ventilation time ([6.57 d ± 16.86 d] vs. [2.05 d ± 5.79 d]; p < 0.001), CRRT time ([1.74 d ± 6.77 d] vs. [0.11 d ± 0.63 d]; p < 0.001), ICU stay time ([299.90 h ± 449.50 h] vs. [177.67 h ± 245.36 h]); p < 0.001 was longer than that of non-SAE. Both the PCT, Ca2+, septic shock, PELOD-2, and midazolam were identified as independent risk factors, and fentanyl was a protective factor for SAE in pediatric patients (p < 0.05). The main clinical neurological symptoms consisted of agitation, hypnosia, hypnosis alternates agitated, anterior fontanelle full/bulging/high tension, coma, muscle hypertonia, muscle hypotonia, hyperreflexia, focal seizure, and generalized seizure. Conclusions The incidence of SAE in children was found high and the prognosis poor. In this retrospective study, the identified patients were more susceptible to SAE, with an inflammatory storm with hypocalcemia or septic shock. The use of midazolam will increase the occurrence of SAE, whereas fentanyl will reduce the incidence of SAE, and PELOD-2 may predict the occurrence of SAE.
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Affiliation(s)
- Yihao Chen
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Pediatric Intensive Care Unit, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yan Hu
- Pediatric Intensive Care Unit, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xufeng Li
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Pediatric Intensive Care Unit, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Peiling Chen
- Pediatric Intensive Care Unit, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chun Wang
- Pediatric Intensive Care Unit, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jing Wang
- Pediatric Intensive Care Unit, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiaxing Wu
- Pediatric Intensive Care Unit, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yueyu Sun
- Pediatric Intensive Care Unit, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guilang Zheng
- Pediatric Intensive Care Unit, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yiyun Lu
- Pediatric Intensive Care Unit, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yuxiong Guo
- Pediatric Intensive Care Unit, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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