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Latest & greatest articles for delirium
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on delirium or other clinical topics then use Trip today.
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Validation of the 6-Item Cognitive Impairment Test and the 4AT test for combined delirium and dementia screening in older Emergency Department attendees screening for cognitive impairment in Emergency Department (ED) requires short, reliable tools.to validate the 4AT and 6-Item Cognitive Impairment Test (6-CIT) for ED dementia and delirium screening.diagnostic accuracy study.attendees aged ≥70 years in a tertiary care hospital's ED.trained researchers assessed participants using (...) the Standardised Mini Mental State Examination, Delirium Rating Scale-Revised 98 and Informant Questionnaire on Cognitive Decline in the Elderly, informing ultimate expert diagnosis using Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria for dementia and delirium (reference standards). Another researcher blindly screened each participant, within 3 h, using index tests 4AT and 6-CIT.of 419 participants (median age 77 years), 15.2% had delirium and 21.5% had dementia. For delirium detection
Haloperidol versus placebo for delirium prevention in acutely hospitalised older at risk patients: a multi-centre double-blind randomised controlled clinical trial because the few randomised placebo-controlled trials investigating the potential role for prophylactic haloperidol in delirium prevention have focused on specific surgical populations, we investigated its efficacy and safety in acutely hospitalised older patients.this multi-centre, double-blind, stratified, block randomised, placebo (...) -controlled trial was conducted at six Dutch hospitals. Patients age ≥70 years, acutely admitted through the emergency department for general medicine or surgical specialties and at risk for delirium were randomised (n = 245) to haloperidol or placebo 1 mg orally twice-daily (maximum of 14 doses) on top of standard nonpharmacological prevention strategies. The primary outcome was delirium incidence. Other endpoints included delirium severity and duration, drug safety and clinical outcomes.intention
Development of the Japanese version of the Cornell Assessment of Pediatric DeliriumDelirium is a form of acute cerebral dysfunction and is associated with increased length of hospital stay, mortality, and health-care costs for adult patients in intensive care. However, in Japan, there are currently no reliable criteria or tools for diagnosing delirium in critically ill pediatric patients. The purpose of this study was to translate the Cornell Assessment of Pediatric Delirium (CAPD)-a screening (...) tool for pediatric delirium-from English to Japanese for use in the diagnosis of delirium for pediatric patients in pediatric intensive care units.The back-translation method was used to ensure equivalence in the Japanese version of the CAPD and its accompanying developmental anchor points. The translation process was repeated by a multidisciplinary committee of medical researchers and clinicians.The final back-translated version of the CAPD was submitted to the original author, who gave her
Delirium in Older Persons: Advances in Diagnosis and Treatment. Delirium is defined as an acute disorder of attention and cognition. It is a common, serious, and often fatal condition among older patients. Although often underrecognized, delirium has serious adverse effects on the individual's function and quality of life, as well as broad societal effects with substantial health care costs.To summarize the current state of the art in diagnosis and treatment of delirium and to highlight (...) critical areas for future research to advance the field.Search of Ovid MEDLINE, Embase, and the Cochrane Library for the past 6 years, from January 1, 2011, until March 16, 2017, using a combination of controlled vocabulary and keyword terms. Since delirium is more prevalent in older adults, the focus was on studies in elderly populations; studies based solely in the intensive care unit (ICU) and non-English-language articles were excluded.Of 127 articles included, 25 were clinical trials, 42 cohort
Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care: A Randomized Clinical Trial. The use of benzodiazepines to control agitation in delirium in the last days of life is controversial.To compare the effect of lorazepam vs placebo as an adjuvant to haloperidol for persistent agitation in patients with delirium in the setting of advanced cancer.Single-center, double-blind, parallel-group, randomized clinical (...) trial conducted at an acute palliative care unit at MD Anderson Cancer Center, Texas, enrolling 93 patients with advanced cancer and agitated delirium despite scheduled haloperidol from February 11, 2014, to June 30, 2016, with data collection completed in October 2016.Lorazepam (3 mg) intravenously (n = 47) or placebo (n = 43) in addition to haloperidol (2 mg) intravenously upon the onset of an agitation episode.The primary outcome was change in Richmond Agitation-Sedation Scale (RASS) score (range
Perioperative Gabapentin Does Not Reduce Postoperative Delirium in Older Surgical Patients: A Randomized Clinical Trial Postoperative pain and opioid use are associated with postoperative delirium. We designed a single-center, randomized, placebo-controlled, parallel-arm, double-blinded trial to determine whether perioperative administration of gabapentin reduced postoperative delirium after noncardiac surgery.Patients were randomly assigned to receive placebo (N = 347) or gabapentin 900 mg (N (...) = 350) administered preoperatively and for the first 3 postoperative days. The primary outcome was postoperative delirium as measured by the Confusion Assessment Method. Secondary outcomes were postoperative pain, opioid use, and length of hospital stay.Data for 697 patients were included, with a mean ± SD age of 72 ± 6 yr. The overall incidence of postoperative delirium in any of the first 3 days was 22.4% (24.0% in the gabapentin and 20.8% in the placebo groups; the difference was 3.20%; 95% CI
CRACKCast E104 – Delirium and Dementia CRACKCast E104 – Delirium and Dementia - CanadiEM CRACKCast E104 – Delirium and Dementia In , by Adam Thomas August 28, 2017 This episode of CRACKCast covers Rosen’s Chapter 94, Delirium and Dementia. These are common presentations in the emergency department, and this episode will focus on screening, diagnosis, and management. Shownotes – Rosens in Perspective: “Delirium is characterized by a fluctuating neurobehavioral disturbance typically progressing (...) over a short period. It is a direct consequence of an acute systemic or central nervous system (CNS) stressor. Dementia, on the other hand, tends to follow a more gradual course, with evolution occurring over months to years. Although patients with dementia exhibit confusion, unlike delirium, manifestations of autonomic nervous system abnormalities are minimal or absent and a disturbance in level of consciousness usually is not a feature.” These big topics fall under the term neurobehavioural
Delirium Risk of Dexmedetomidine and Midazolam in Patients Treated with Postoperative Mechanical Ventilation: a Meta-analysis. To evaluate by meta-analysis the effects of dexmedetomidine versus midazolam on postoperative delirium in patients that received postoperative mechanical ventilation.The electronic databases of PubMed, Web of Science, EMbase, CNKI, CBM, Cochrane library and WanFang were searched by two reviewers. All the clinical studies related to dexmedetomidine versus midazolam (...) on postoperative delirium were screened and collected in this meta-analysis. The combined postoperative delirium risk between dexmedetomidine and midazolam groups was pooled by random effect model. The publication bias was assessed by Begg's funnel plot and Egger's line regression test.A total of six studies including 386 subjects (202 in the dexmedetomidine group and 184 in the midazolam group) were finally included in this meta-analysis. All six studies reported adequate sequence generation. Three studies
Postinjection delirium/sedation syndrome in patients with schizophrenia receiving olanzapine long-acting injection: results from a large observational study Postinjection delirium/sedation syndrome (PDSS) has been reported uncommonly during treatment with olanzapine long-acting injection (LAI), a sustained-release formulation of olanzapine.The primary aim of the study was to estimate the incidence per injection and per patient of PDSS events in adult patients with schizophrenia who were
The role of occupational and physiotherapy in multi-modal approach to tackling delirium in the intensive care The presence of delirium within critical care remains a long-standing challenge for patients and clinicians alike. A myriad of pre-disposing and precipitating factors lead to this patient cohort being high risk for developing delirium during their critical care stay. Until now, non-pharmacological management of these patients usually encompasses a 'bundle' of principles to reduce (...) delirium days. These bundles have limited focus on the entire multi-disciplinary team (including occupational therapists and physiotherapists) who could assist with the reduction of delirium. The purpose of this analysis is to review the current literature and develop a mnemonic, which may help facilitate collaborative working for patients with delirium. Electronic databases were searched for non-pharmacological managements of delirium within intensive care settings, after 2006. Critical appraisal
Effectiveness of preoperative intranasal dexmedetomidine, compared with oral midazolam, for the prevention of emergence delirium in the pediatric patient undergoing general anesthesia: a systematic review. Emergence delirium is defined as a cognitive disturbance during emergence from general anesthesia resulting in hallucinations, delusions and confusion manifested by agitation, restlessness, involuntary physical movement and extreme flailing in bed. Postoperative emergence delirium develops (...) in response to painful surgical stimulation. In current literature, there is not a systematic review that compares the effectiveness of preoperative intranasal dexmedetomidine administration against oral midazolam for the prevention of emergence delirium.The objective of this review was to identify the effectiveness of preoperative intranasal dexmedetomidine compared to oral midazolam for the prevention of emergence delirium in the pediatric patient undergoing general anesthesia.This review considered
Intraoperative Infusion of Dexmedetomidine for Prevention of Postoperative Delirium and Cognitive Dysfunction in Elderly Patients Undergoing Major Elective Noncardiac Surgery: A Randomized Clinical Trial Postoperative delirium occurs in 10% to 60% of elderly patients having major surgery and is associated with longer hospital stays, increased hospital costs, and 1-year mortality. Emerging literature suggests that dexmedetomidine sedation in critical care units is associated with reduced (...) incidence of delirium. However, intraoperative use of dexmedetomidine for prevention of delirium has not been well studied.To evaluate whether an intraoperative infusion of dexmedetomidine reduces postoperative delirium.This study was a multicenter, double-blind, randomized, placebo-controlled trial that randomly assigned patients to dexmedetomidine or saline placebo infused during surgery and for 2 hours in the recovery room. Patients were assessed daily for postoperative delirium (primary outcome
Parecoxib Supplementation to Morphine Analgesia Decreases Incidence of Delirium in Elderly Patients After Hip or Knee Replacement Surgery: A Randomized Controlled Trial Severe pain and high-dose opioids are both associated with increased risk of postoperative delirium. The authors investigated whether parecoxib-supplemented IV morphine analgesia could decrease the incidence of delirium in elderly patients after total hip or knee replacement surgery.In a randomized, double-blind, 2-center trial (...) , patients of 60 years or older who underwent elective total hip or knee replacement surgery were assigned in a 1:1 ratio to receive either parecoxib (40 mg at the end of surgery and then every 12 hours for 3 days) or placebo (normal saline). All patients received combined spinal-epidural anesthesia during surgery and IV morphine for postoperative analgesia. The primary outcome was the incidence of delirium within 5 days after surgery.Between January 2011 and May 2013, 620 patients were enrolled and were
Effect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients Undergoing Abdominal Surgery: A Cluster Randomized Clinical Trial Older patients undergoing abdominal surgery commonly experience preventable delirium, which extends their hospital length of stay (LOS).To examine whether a modified Hospital Elder Life Program (mHELP) reduces incident delirium and LOS in older patients undergoing abdominal surgery.This cluster randomized clinical trial of 577 (...) nurse) consisted of 3 protocols administered daily: orienting communication, oral and nutritional assistance, and early mobilization. Intervention group participants received all 3 mHELP protocols postoperatively, in addition to usual care, as soon as they arrived in the inpatient ward and until hospital discharge. Adherence to protocols was tracked daily.Presence of delirium was assessed daily by 2 trained nurses who were masked to intervention status by using the Confusion Assessment Method. Data
Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults: an international, multicentre, double-blind, randomised clinical trial. Delirium is a common and serious postoperative complication. Subanaesthetic ketamine is often administered intraoperatively for postoperative analgesia, and some evidence suggests that ketamine prevents delirium. The primary purpose of this trial was to assess the effectiveness of ketamine for prevention (...) of postoperative delirium in older adults.The Prevention of Delirium and Complications Associated with Surgical Treatments [PODCAST] study is a multicentre, international randomised trial that enrolled adults older than 60 years undergoing major cardiac and non-cardiac surgery under general anaesthesia. Using a computer-generated randomisation sequence we randomly assigned patients to one of three groups in blocks of 15 to receive placebo (normal saline), low-dose ketamine (0·5 mg/kg), or high dose ketamine (1
Effectiveness of haloperidol prophylaxis in critically ill patients with a high risk of delirium: a systematic review. Delirium is associated with increased intensive care unit and hospital length of stay, prolonged duration of mechanical ventilation, unplanned removal of tubes and catheters, and increased morbidity and mortality. Prophylactic treatment with low-dose haloperidol may have beneficial effects for critically ill patients with a high risk of delirium.To identify the effectiveness (...) of haloperidol prophylaxis in critically ill patients with a high risk for delirium.Patients with a predicted high risk of delirium, aged 18 years or over, and in intensive care units. Patients with a history of concurrent antipsychotic medication use were excluded.Haloperidol prophylaxis for preventing delirium.Experimental and epidemiological study designs.Primary outcome is the incidence of delirium. Secondary outcomes are duration of mechanical ventilation, incidence of re-intubation, incidence
Effectiveness of multi-component interventions on incidence of delirium in hospitalized older patients with hip fracture: a systematic review protocol. The objective of this systematic review is to identify, evaluate and synthesize evidence on the effectiveness of multi-component interventions on the incidence of delirium in hospitalized elderly patients with hip fracture.Specifically, the review question is: In hospitalized older patients with hip fracture, what is the effectiveness of multi (...) -component interventions on the incidence of delirium?
Screening for delirium within the Emergency Department BestBets: Screening for delirium within the Emergency Department Screening for delirium within the Emergency Department Report By: L K Beales - ACCS Emergency Medicine CT2, Search checked by M Mecuri - Assistant Professor McMaster University, Hamilton, Ontario, Canada Institution: Sheffield Teaching Hospitals Date Submitted: 12th May 2016 Date Completed: 11th February 2017 Last Modified: 11th February 2017 Status: Green (complete) Three (...) Part Question In [patients, greater than 75 years, presenting to the emergency department] is [an abbreviated mental test score assessment better than other cognitive screening tools] at [identifying delirium]? Clinical Scenario A confused patient presents to the ED. Is the abbreviated mental test score the best method to screen for delirium/acute confusional state? Search Strategy MEDLINE 1946 to June week 2 2016, EMBASE 1974–June 2016 and the COCHRANE LIBRARY (2016). [exp delirium/or impaired