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Kozub E, Hedquist K, Tu L, Bryant R. Sustained delirium reduction in an inpatient neuroscience unit. Worldviews Evid Based Nurs 2024; 21:263-270. [PMID: 38178795 DOI: 10.1111/wvn.12704] [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] [Accepted: 11/19/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Delirium is described as acute brain dysfunction that often fluctuates throughout the day and is highly prevalent in hospitalized adults. Delirium negatively affects patient outcomes with consequences including decreased cognitive functioning and increased mortality and healthcare costs. Furthermore, neurological patients are at increased risk for developing delirium due to their underlying diagnoses. PURPOSE The purpose of this evidence-based practice project was to evaluate the long-term impact of nursing education and use of trained volunteers to prevent the development of delirium in an inpatient neuroscience unit. IMPLEMENTATION PLAN This was a pre-post designed evidence-based practice project to educate and prioritize nursing care interventions for delirium prevention compared to a delirium management framework. The interventions included delirium education for nurses and nursing assistants along with the development of a specialized volunteer program to implement non-pharmacological, multi-component delirium prevention interventions. Long-term sustainment and enculturation occurred over the subsequent year. OUTCOMES The baseline data collection period included 2520 patients. The intervention period included 4515 patients, with both groups being similar in age, race, gender, and length of stay. The total number of patients with a discharge diagnosis of delirium decreased from 29.2% to 19.8% (p < .001). Fewer patients in the intervention group were discharged to a skilled nursing facility (p < .001) and other post-acute facility (p = .008), along with more patients being discharged to home care (p < .001). LINKING EVIDENCE TO ACTION This evidence-based practice project demonstrates long-term sustained reduction of delirium in the neuroscience population. Despite the challenges during the COVID-19 pandemic, delirium prevention strategies were found to be effective in decreasing the rate at which patients develop delirium.
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Affiliation(s)
| | - Katie Hedquist
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Lisa Tu
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Ruth Bryant
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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Yang Q, Wang J, Chen Y, Lian Q, Shi Z, Zhang Y. Incidence and risk factors of postoperative delirium following total knee arthroplasty: A retrospective Nationwide Inpatient Sample database study. Knee 2022; 35:61-70. [PMID: 35220134 DOI: 10.1016/j.knee.2022.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/21/2021] [Accepted: 02/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postoperative delirium is a common complication following major surgeries, causing a variety of adverse effects. However, the incidence and risk factors of delirium after primary total knee arthroplasty (TKA) has not been well studied using a large-scale national database. METHODS A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005-2014. Patients who underwent primary TKA were included. Patient demographics, comorbidities, length of stay (LOS), total charges, type of payer, in-hospital mortality, and perioperative complications were evaluated. RESULTS A total of 1,228,879 TKAs were obtained from the NIS database. The general incidence of delirium after TKA was 1.00%, which peaked in the year 2008.Patients with delirium after TKA presented increased comorbidities, LOS, hospital charges, usage of medicare, and in-hospital mortality (P < 0.0001). Delirium following TKA was associated with medical complications during hospitalization including acute renal failure, acute myocardial infarction, pneumonia, pulmonary embolism, stroke, and urinary tract infection. Risk factors of postoperative delirium included advanced age, neurological disorders, alcohol and drug abuse, depression, psychoses, fluid and electrolyte disorders, diabetes, weight loss, deficiency and chronic blood loss anemia, coagulopathy, congestive heart failure, chronic pulmonary disease, pulmonary circulation disorders, peripheral vascular disorders, chronic renal failure, and teaching hospital. Notably, neurological disorders were found to have the strongest association with the occurrence of postoperative delirium. CONCLUSION A relatively low incidence of delirium after TKA was identified. It is of benefit to study risk factors of postoperative delirium to ensure the appropriate management and moderate its consequences.
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Affiliation(s)
- Qinfeng Yang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Jian Wang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Yuhang Chen
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Qiang Lian
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Zhanjun Shi
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China.
| | - Yang Zhang
- Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China.
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Abstract
PURPOSE OF REVIEW Postoperative delirium (POD) is a common phenomenon among general surgery patients, but it is not well described in urologic surgical patients. We sought to define the incidence and predictive risk factors for POD in patients undergoing urologic surgery. RECENT FINDINGS Eighteen articles were included for review. The pooled incidence rate of postoperative delirium after urologic surgery was 1.69% (0.69-46.97%). Longer intraoperative time, male sex, unmarried status, and age were shown to be risk factors for POD. POD is common after many urologic surgeries and leads to worse postoperative outcomes and higher healthcare utilization. Future studies are needed to better assess for and prevent POD.
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Zeng X, Zhu S, Xu C, Wang Z, Su X, Zeng D, Long H, Zhu B. Effect of Comorbidity on Outcomes of Patients with Advanced Non-Small Cell Lung Cancer Undergoing Anti-PD1 Immunotherapy. Med Sci Monit 2020; 26:e922576. [PMID: 32893263 PMCID: PMC7496511 DOI: 10.12659/msm.922576] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Comorbidities are reportedly related to the survival of patients with non-small cell lung cancer (NSCLC). The purpose of this study was to explore the impact of comorbidity, assessed by the Charlson comorbidity index (CCI) and the simplified comorbidity scores (SCS) on clinical outcomes of patients with NSCLC treated with immune checkpoint inhibitors. MATERIAL AND METHODS Sixty-six patients with NSCLC who received programmed cell death protein 1 (PD1) inhibitors in our institution in the past 2 years were enrolled in this retrospective study. Data on comorbidity (CCI and SCS) and clinical outcomes, including progression-free survival (PFS), immunotherapy responses, and immunotherapy-related adverse events, were analyzed. RESULTS The disease control rate was obviously higher among patients in the CCI <1 group than the CCI ≥1 group (P<0.001), but were similar between the SCS <8 group and SCS ≥8 group (P=0.585). The median PFS in the CCI <1 group was 271.0 days (95% CI: 214.3-327.7 days) compared with 232.0 days (95% CI: 66.2-397.8 days) for the CCI ≥1 group (P=0.0084). However, the median PFS showed no difference between the groups with SCS <8 at 271.0 days (95% CI: 138.7-403.3 days) versus SCS ≥8 at 222.0 days (95% CI: 196.2-247.8 days), P=0.2106). The incidence of adverse events was similar among patients with high versus low comorbidity indexes (CCI: 35.8% versus 23.6%, P=0.286, respectively; and SCS: 28.0% versus 29.3%, respectively, P=0.912). CONCLUSIONS The comorbidity burden might be a predictor for survival in patients with NSCLC undergoing PD1 inhibitor immunotherapy.
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Affiliation(s)
- Xianghua Zeng
- Institute of Cancer, Xinqiao Hospital of The Third Military Medical University, Chongqing, China (mainland).,Chongqing Key Laboratory of Immunotherapy, Xinqiao Hospital of Third Military Medical University, Chongqing, China (mainland).,Division of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, China (mainland)
| | - Shicong Zhu
- Institute of Cancer, Xinqiao Hospital of The Third Military Medical University, Chongqing, China (mainland).,Chongqing Key Laboratory of Immunotherapy, Xinqiao Hospital of Third Military Medical University, Chongqing, China (mainland)
| | - Cheng Xu
- Department of Oncology, General Hospital of The Central Theater Command of The People's Liberation Army, Wuhan, Hubei, China (mainland)
| | - Zhongyu Wang
- Institute of Cancer, Xinqiao Hospital of The Third Military Medical University, Chongqing, China (mainland).,Chongqing Key Laboratory of Immunotherapy, Xinqiao Hospital of Third Military Medical University, Chongqing, China (mainland)
| | - Xingxing Su
- Institute of Cancer, Xinqiao Hospital of The Third Military Medical University, Chongqing, China (mainland).,Chongqing Key Laboratory of Immunotherapy, Xinqiao Hospital of Third Military Medical University, Chongqing, China (mainland)
| | - Dong Zeng
- Institute of Cancer, Xinqiao Hospital of The Third Military Medical University, Chongqing, China (mainland).,Chongqing Key Laboratory of Immunotherapy, Xinqiao Hospital of Third Military Medical University, Chongqing, China (mainland)
| | - Haixia Long
- Institute of Cancer, Xinqiao Hospital of The Third Military Medical University, Chongqing, China (mainland).,Chongqing Key Laboratory of Immunotherapy, Xinqiao Hospital of Third Military Medical University, Chongqing, China (mainland)
| | - Bo Zhu
- Institute of Cancer, Xinqiao Hospital of The Third Military Medical University, Chongqing, China (mainland).,Chongqing Key Laboratory of Immunotherapy, Xinqiao Hospital of Third Military Medical University, Chongqing, China (mainland)
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Wang M, Yang YF, Guo BD, Hou HM, Meng LF, Wang X, Amankwah M, Liu BQ, Jin CY, Liu M, Wang JY. The impact of atrial fibrillation on outcomes in patients undergoing radical prostatectomy. World J Urol 2020; 39:1509-1519. [PMID: 32623501 DOI: 10.1007/s00345-020-03337-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/28/2020] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To assess the role of atrial fibrillation (AF) on complicating inpatient outcomes of radical prostatectomy (RP). MATERIALS AND METHODS We identified patients treated with RP during 2012-2014 within National Inpatient Sample (NIS) database. Length of stay, cost of hospitalization, and in-hospital complications were compared between patients with or without diagnosis of AF. Propensity score matching methods and multivariable regression analysis were used to adjust for potential confounders and a trend analysis was conducted. RESULTS Patients with AF had a significantly longer hospital stay (coefficient 0.19, 95% CI 0.09-0.29, P < 0.001) and higher cost (coefficient 0.10, 95% CI 0.06-0.15, P < 0.001). Post-operative cardiac complications were significantly higher for patients with AF (OR 16.38, 95% CI 7.72-34.74, P < 0.001), while no differences were found in other complications between the two groups. Similar results were shown in propensity score matching methods. The cardiac complications after laparoscopic RP (OR: 37.71, 95% CI 1.85-768.73, P = 0.018) and open RP (OR: 16.78, 95% CI 1.41-199.51, P = 0.026) were significantly higher than robot-assisted RP (RARP) in patients with AF. The results of trend study indicated that postoperative cardiac complication rates showed a trend of decreasing year by year while the prevalence of AF was rising. CONCLUSIONS Perioperative AF is associated with increased cardiac complications, longer hospital stay and higher cost in PCa patients undergoing RP. RARP may be a preferred choice for patients with AF. Attention should be paid to this special patient population. Reasonable pre-operative risk stratification and standardized management should be done to decrease perioperative complications.
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Affiliation(s)
- Miao Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Road, Dongcheng District, Beijing, 100730, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yi-Feng Yang
- Department of Medicine, St. Vincent's Medical Center, Bridgeport, CT, USA
- The Frank H. Netter MD School of Medicine at, Quinnipiac University, North Haven, USA
| | - Bo-da Guo
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Road, Dongcheng District, Beijing, 100730, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Hui-Min Hou
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Road, Dongcheng District, Beijing, 100730, China
| | - Ling-Feng Meng
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Road, Dongcheng District, Beijing, 100730, China
| | - Xuan Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Road, Dongcheng District, Beijing, 100730, China
| | - Millicent Amankwah
- Department of Medicine, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Bao-Qiong Liu
- Department of Medicine, AdventHealth, Orlando, FL, USA
| | - Cheng-Yue Jin
- New York Medical College, Internal Medicine, New York, USA
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Road, Dongcheng District, Beijing, 100730, China.
| | - Jian-Ye Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Road, Dongcheng District, Beijing, 100730, China.
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