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Latest & greatest articles for delirium
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Structured analyses of interventions to prevent delirium Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Does this patient have delirium?: value of bedside instruments. Delirium occurs in many hospitalized older patients and has serious consequences including increased risk for death and admission to long-term care. Despite its importance, health care clinicians often fail to recognize delirium. Simple bedside instruments may lead to improved identification.To systematically review the evidence on the accuracy of bedside instruments in diagnosing the presence of delirium in adults.Search (...) of MEDLINE (from 1950 to May 2010), EMBASE (from 1980 to May 2010), and references of retrieved articles to identify studies of delirium among inpatients.Prospective studies of diagnostic accuracy that compared at least 1 delirium bedside instrument to the Diagnostic and Statistical Manual of Mental Disorders-based diagnosis made by a geriatrician, psychiatrist, or neurologist.There were 6570 unique citations identified with 25 prospectively conducted studies (N = 3027 patients) meeting inclusion
Clearing up the confusion: The results of two pilot studies of antipsychotics for ICU delirium Expanded Abstracts Citation #1 Girard TD, Pandharipande PP, Carson SS, Schmidt GA, Wright PE, Canonico AE, Pun BT, Th ompson JL, Shintani AK, Meltzer HY, Bernard GR, Dittus RS, Ely EW: Feasibility, e? cacy, and safety of antipsychotics for inten- sive care unit delirium: the MIND randomized, placebo- controlled trial. Crit Care Med 2010, 38:428-437 . Background Given the lack of compelling evidence (...) supporting the use of antipsychotics for delirium in critically ill patients and the potential adverse e? ects associated with these medica tions, placebo-controlled clinical trials are greatly needed. Methods Objective: To demonstrate the feasibility of a placebo- controlled trial of antipsychotics for delirium in the inten sive care unit and to test the hypothesis that antipsychotics would improve days alive without delirium or coma. Design: Randomized, double-blind, placebo-controlled trial. Setting
Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. Delirium is a common and serious complication in elderly patients. Evidence suggests that delirium is associated with long-term poor outcome but delirium often occurs in individuals with more severe underlying disease.To assess the association between delirium in elderly patients and long-term poor outcome, defined as mortality, institutionalization, or dementia, while (...) controlling for important confounders.A systematic search of studies published between January 1981 and April 2010 was conducted using the databases of MEDLINE, EMBASE, PsycINFO, and CINAHL.Observational studies of elderly patients with delirium as a study variable and data on mortality, institutionalization, or dementia after a minimum follow-up of 3 months, and published in the English or Dutch language. Titles, abstracts, and articles were reviewed independently by 2 of the authors. Of 2939 references
How can delirium best be prevented and managed in older patients in hospital? 19687107 2010 04 15 2018 11 13 1488-2329 182 5 2010 Mar 23 CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne CMAJ How can delirium best be prevented and managed in older patients in hospital? 465-70 10.1503/cmaj.080519 Holroyd-Leduc Jayna M JM Division of Geriatrics and General Internal Medicine, University of Calgary, Calgary, Alta. Khandwala Farah F Sink Kaycee M KM eng P30 (...) AG021332 AG NIA NIH HHS United States P30-AG21332 AG NIA NIH HHS United States Journal Article Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't Review 2009 08 17 Canada CMAJ 9711805 0820-3946 0 Antipsychotic Agents 0 Cholinesterase Inhibitors 0 Hypnotics and Sedatives AIM IM Aged Antipsychotic Agents therapeutic use Cholinesterase Inhibitors therapeutic use Delirium diagnosis etiology prevention & control Hospitalization Humans Hypnotics and Sedatives therapeutic use Patient Care
Different assessment tools for intensive care unit delirium: which score to use? To compare validity and reliability of three instruments for detection and assessment of delirium in intensive care unit (ICU) patients. Delirium in critically ill patients is associated with higher mortality, prolonged duration of ICU stay, and greater healthcare costs. Currently, there are several assessment tools available for detection of delirium, but only a few of these assessment systems are developed (...) specifically to screen for delirium in ICU patients.Prospective cohort study.ICU at a university hospital.A total of 156 surgical patients aged > or = 60 yrs consecutively admitted to the ICU, with a length of stay of at least 24 hrs.This study was approved by the institutional ethics committee. Trained staff members performed daily and independently the Confusion Assessment Method for the ICU (CAM-ICU), the Nursing Delirium Screening Scale (Nu-DESC), and the Delirium Detection Score (DDS
Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study To compare the efficacy and safety of scheduled quetiapine to placebo for the treatment of delirium in critically ill patients requiring as-needed haloperidol.Prospective, randomized, double-blind, placebo-controlled study.Three academic medical centers.Thirty-six adult intensive care unit patients with delirium (Intensive Care Delirium (...) Screening Checklist score > or = 4), tolerating enteral nutrition, and without a complicating neurologic condition.Patients were randomized to receive quetiapine 50 mg every 12 hrs or placebo. Quetiapine was increased every 24 hrs (50 to 100 to 150 to 200 mg every 12 hrs) if more than one dose of haloperidol was given in the previous 24 hrs. Study drug was continued until the intensive care unit team discontinued it because of delirium resolution, therapy > or = 10 days, or intensive care unit
The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review with meta-analysis The impact of general and regional anesthesia on the incidence of post-operative cognitive dysfunction and post-operative delirium: a systematic review (...) with meta-analysis Mason SE, Noel-Storr A, Ritchie CW CRD summary The authors concluded that general anaesthesia could increase the risk of postoperative cognitive dysfunction, compared with regional or combined anaesthesia, but this was not shown for delirium after surgery. This conclusion should be interpreted with caution as the outcomes varied between trials, and the differences between general, regional, and combined anaesthesia were not statistically significant. Authors' objectives To compare
Effectiveness of melatonin treatment on circadian rhythm disturbances in dementia: are there implications for delirium? A systematic review Effectiveness of melatonin treatment on circadian rhythm disturbances in dementia: are there implications for delirium? A systematic review Effectiveness of melatonin treatment on circadian rhythm disturbances in dementia: are there implications for delirium? A systematic review de Jonghe A, Korevaar JC, van Munster BC, de Rooij SE CRD summary The review (...) concluded that sundowning (exacerbation of delirium during the evening or night)/agitated behaviour improved with melatonin treatment in patients with dementia. The authors’ conclusions appear overly strong given the limitations of the evidence presented. Authors' objectives To evaluate the effectiveness of melatonin treatment on circadian rhythm disturbances in patients with dementia. Searching PubMed, EMBASE, CINAHL and Cochrane Database of Systematic Reviews were searched from 1985 up to April 2009
Effect of rivastigmine as an adjunct to usual care with haloperidol on duration of delirium and mortality in critically ill patients: a multicentre, double-blind, placebo-controlled randomised trial. Delirium is frequently diagnosed in critically ill patients and is associated with adverse outcome. Impaired cholinergic neurotransmission seems to have an important role in the development of delirium. We aimed to establish the effect of the cholinesterase inhibitor rivastigmine on the duration (...) of delirium in critically ill patients.Patients (aged ≥18 years) who were diagnosed with delirium were enrolled from six intensive care units in the Netherlands, and treated between November, 2008, and January, 2010. Patients were randomised (1:1 ratio) to receive an increasing dose of rivastigmine or placebo, starting at 0·75 mL (1·5 mg rivastigmine) twice daily and increasing in increments to 3 mL (6 mg rivastigmine) twice daily from day 10 onwards, as an adjunct to usual care based on haloperidol
How can delirium best be prevented and managed in older patients in hospital? How can delirium best be prevented and managed in older patients in hospital? How can delirium best be prevented and managed in older patients in hospital? Holroyd-Leduc JM, Khandwala F, Sink KM CRD summary This review evaluated strategies for the prevention and management of delirium in hospitalised older patients. The authors concluded that limited evidence supported multicomponent strategies for preventing delirium (...) in such patients. The authors' conclusion reflects the evidence presented, but potential methodological limitations in the search and review processes made the reliability of this conclusion unclear. Authors' objectives To evaluate strategies for the prevention and management of delirium in hospitalised older patients. Searching MEDLINE, EMBASE and Cochrane Database of Systematic Reviews were searched for articles in English. Search dates spanned from 1950 to 2007. Search terms were reported. Reference lists
Does this patient have delirium: value of bedside instruments Does this patient have delirium: value of bedside instruments Does this patient have delirium: value of bedside instruments Wong CL, Holroyd-Leduc J, Simel DL, Straus SE CRD summary This review concluded that the choice of instrument to diagnose delirium may depend on time available and the experience of the diagnosing professional. The evidence supported use of the Confusion Assessment Method. The authors' conclusions reflected (...) the evidence presented, but the limited search strategy and reporting of quality suggest that the conclusions should be interpreted with some caution. Authors' objectives To assess the accuracy of bedside instruments in diagnosing delirium in adult patients. Searching MEDLINE (from 1950) and EMBASE (from 1980) were searched to May 2010 for articles published in English. Search terms were reported. Reference lists of retrieved articles were searched manually. Study selection Prospective studies
Evidence-based practice guideline. Acute confusion/delirium. Guidelines and Measures | Agency for Healthcare Research & Quality HHS.gov Search ahrq.gov Search ahrq.gov Menu Topics A - Z Healthcare Delivery Latest available findings on quality of and access to health care Searchable database of AHRQ Grants, Working Papers & HHS Recovery Act Projects AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund You are here Guidelines and Measures Funding for the National Guideline
Benzodiazepines for delirium. Delirium occurs in 30% of hospitalised patients and is associated with prolonged hospital stay and increased morbidity and mortality. The results of uncontrolled studies have been unclear, with some suggesting that benzodiazepines may be useful in controlling non-alcohol related delirium.To determine the effectiveness and incidence of adverse effects of benzodiazapines in the treatment of non-alcohol withdrawal related delirium.The trials were identified from (...) the selection criteria could be identified. In this trial, comparing the effect of the benzodiazepine, lorazepam, with dexmedetomidine, a selective alpha-2-adrenergic receptor agonist, on delirium among mechanically ventilated intensive care unit patients, dexmedetomidine treatment was associated with an increased number of delirium- and coma-free days compared with lorazepam treated patients (dexmedetomidine patients, average seven days; lorazepam patients, average three days; P = 0.01). One partially
Comparison of delirium assessment tools in a mixed intensive care unit Delirium is a frequent problem in the intensive care unit (ICU) associated with poor prognosis. Delirium in the ICU is underdiagnosed by nursing and medical staff. Several detection methods have been developed for use in ICU patients. The aim of this study was to compare the value of three detection methods (the Confusion Assessment Method for the ICU [CAM-ICU], the Intensive Care Delirium Screening Checklist [ICDSC (...) was delirious or not. A psychiatrist, geriatrician, or neurologist serving as reference rater diagnosed delirium using established criteria.The CAM-ICU showed superior sensitivity and negative predictive value (64% and 83%) compared with the ICDSC (43% and 75%). The ICDSC showed higher specificity and positive predictive value (95% and 82% vs. 88% and 72%). The sensitivity of the physicians view was only 29%.ICU physicians underdiagnose delirium in the ICU, which underlines the necessity of standard
Executive function and depression as independent risk factors for postoperative delirium Postoperative delirium has been associated with greater complications, medical cost, and increased mortality during hospitalization. Recent evidence suggests that preoperative executive dysfunction and depression may predict postoperative delirium; however, the combined effect of these risk factors remains unknown. This study examined the association among preoperative executive function, depressive (...) symptoms, and established clinical predictors of postoperative delirium among 998 consecutive patients undergoing major noncardiac surgery.A total of 998 patients were screened for postoperative delirium (n = 998) using the Confusion Assessment Method as well as through retrospective chart review. Patients underwent cognitive, psychosocial, and medical assessments preoperatively. Executive function was assessed using the Concept Shifting Task, Letter-Digit Coding, and a modified Stroop Color Word
Measures of executive function and depression identify patients at risk for postoperative delirium Postoperative delirium is associated with increased morbidity and mortality. Preexisting cognitive impairment and depression have been frequently cited as important risk factors for this complication. This prospective cohort study was designed to determine whether individuals who perform poorly on preoperative cognitive tests and/or exhibited depressive symptoms would be at high risk (...) for the development of postoperative delirium.One hundred nondemented patients, aged 50 yr and older, scheduled to undergo major, elective noncardiac surgery completed a preoperative test battery that included measures of global cognition, executive function, and symptoms of depression. Known preoperative risk factors for delirium were collected and examined with the results of the preoperative test battery to determine the independent predictors of delirium.The overall incidence of delirium was 16
Persistent delirium in older hospital patients: a systematic review of frequency and prognosis one explanation for the poor prognosis of delirium among older hospital patients may be that many of these patients do not recover from delirium. We sought to determine the frequency and prognosis of persistent delirium (PerD) in older hospital patients by systematically reviewing original research on this topic.MEDLINE, EMBASE, PsycINFO and the Cochrane Database of Systematic Reviews were searched (...) for potentially relevant articles. The bibliographies of relevant articles were searched for additional references. Eighteen reports (involving 1,322 patients with delirium) met the following seven inclusion criteria: original research published in English or French, prospective study design, study population of at least 20 hospital patients, patients aged 50 years or more, follow-up of at least 1 week, acceptable definition of delirium at enrollment and included at least one assessment for PerD at discharge