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Subsyndromal delirium in older long-term care residents: incidence, risk factors, and outcomes To determine the incidence of, risk factors for, and outcomes of subsyndromal delirium (SSD) in older long-term care (LTC) residents and, secondarily, to explore the use of a more-restrictive definition of SSD.Cohort study with repeated weekly assessments for up to 6 months.Seven LTC facilities in Montreal and Quebec City, Canada.One hundred four LTC residents aged 65 and older and free of delirium (...) core symptoms at baseline.The Mini-Mental State Examination (MMSE), Confusion Assessment Method (CAM), Delirium Index (DI), Hierarchic Dementia Scale (HDS), and Barthel Index (BI) were completed at baseline. The MMSE, CAM, and DI were repeated weekly for 6 months. SSD1 required one or more CAM core symptoms; SSD2, a more-restrictive definition, required two or more CAM core symptoms. Outcomes at 6 months were decline on the MMSE, HDS, and BI; mortality; and a composite outcome.Sixty-eight of 104
Review: Insufficient evidence exists about which drugs are associated with delirium; benzodiazepines may increase risk 21690588 2011 08 19 2018 11 13 1539-3704 154 12 2011 Jun 21 Annals of internal medicine Ann. Intern. Med. ACP Journal Club. Review: Insufficient evidence exists about which drugs are associated with delirium; benzodiazepines may increase risk. JC6-10 10.7326/0003-4819-154-12-201106210-02010 Carpenter Christopher R CR Washington University, St. Louis, MO, USA. eng KM1 CA156708
Delirium. This issue provides a clinical overview of delirium focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. Only ACP members and individual subscribers can access the electronic features of In the Clinic. Non-subscribers who wish to access this issue of In the Clinic can elect "Pay for View." Subscribers can receive 1.5 category 1 CME credits by completing the CME quiz that accompanies
Synopsis of the National Institute for Health and Clinical Excellence Guideline for Prevention of Delirium. Delirium is common, is often underrecognized, and is associated with poor outcomes and high costs. In July 2010, the National Institute for Health and Clinical Excellence released a guideline that addressed diagnosis, prevention, and management of delirium. This synopsis focuses on the main recommendations about prevention of delirium.The National Clinical Guideline Centre developed (...) and public comment informed guideline development and modifications.Considering prevention a feasible and cost-effective health strategy, the guideline development group made 13 specific recommendations that addressed the stability of the care environment (both the care team and location) and the provision of a multicomponent intervention package tailored for persons at risk for delirium. The multicomponent intervention package included assessment and modification of key clinical factors that may
Diagnosing delirium in critically ill children: Validity and reliability of the Pediatric Confusion Assessment Method for the Intensive Care Unit To validate a diagnostic instrument for pediatric delirium in critically ill children, both ventilated and nonventilated, that uses standardized, developmentally appropriate measurements.A prospective observational cohort study investigating the Pediatric Confusion Assessment Method for Intensive Care Unit (pCAM-ICU) patients in the pediatric medical (...) , surgical, and cardiac intensive care unit of a university-based medical center.A total of 68 pediatric critically ill patients, at least 5 years of age, were enrolled from July 1, 2008, to March 30, 2009.None.Criterion validity including sensitivity and specificity and interrater reliability were determined using daily delirium assessments with the pCAM-ICU by two critical care clinicians compared with delirium diagnosis by pediatric psychiatrists using Diagnostic and Statistical Manual, 4th Edition
Which Medications are Associated With Incident Delirium? SystematicReviewSnapshot ClinicalSynopsis TAKE-HOME MESSAGE According to limited evidence, emergency physicians should avoid meperidine and consider prescribing oxycodone to elderly patients when narcotics are indicated for pain control. METHODS DATA SOURCES MEDLINE, EMBASE, PsychInfo, and Allied & Complementary Medicine from 1966 through October 2009 were used; bibli- ographies of selected studies were re- viewed for additional relevant (...) articles. STUDY SELECTION Randomized controlled trials, prospective cohort studies, and case-control studies that reported on medications and delir- ium in hospitalized patients or long-term care residents were included. Delirium was de?ned by the Diagnostic and Statisti- cal Manual for Mental Disorders (DSM), International Classi?cation of Diseases, 10th Revision (ICD-10), or a diagnostic tool vali- dated against the DSM, Third Edition; DSM, Third Edition, Revised; DSM, Fourth Edition; or ICD-10. DATA
Delirium: Screening, Prevention and Diagnosis Management Briefs Enter search terms Button to search HSRD ® Inside VA Budget and Performance Inside the News Room National Observances Special Events » » » » » Management Briefs Health Services Research & Development Management Briefs Management eBriefs: Provide VA senior managers with results from VA Health Services Research in a concise and timely manner. , April 2019, Issue 152 , March 2019, Issue 151 , March 2019, Issue 150 , March 2019, Issue
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.
Delirium: Screening, Prevention, and Diagnosis ? A Systematic Review of the Evidence Evidence-based Synthesis Program Department of Veterans Affairs Health Services Research & Development Service Evidence-based Synthesis Program Delirium: Screening, Prevention, and Diagnosis – A Systematic Review of the Evidence Department of Veterans Affairs Health Services Research & Development Service September 2011 Prepared for: Department of Veterans Affairs Veterans Health Administration Health Services (...) Research & Development Service Washington, DC 20420 Prepared by: Evidence-based Synthesis Program (ESP) Center Minneapolis VA Medical Center Minneapolis, MN Timothy J. Wilt, MD, MPH, Director Investigators: Principal Investigator: Rebecca Rossom, MD, MSCR Co-Investigators: Pauline Anderson, RN Nancy Greer, PhD Research Associates: Roderick MacDonald, MS Indulis Rutks, BS James Tacklind, BSi Delirium: Screening, Prevention, and Diagnosis – A Systematic Review of the Evidence Evidence-based Synthesis
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
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
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
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
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
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
2010LancetControlled trial quality: predicted high
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