Delirium communications最新文献

{"title":"What delirium follow-up is routinely offered after elective arthroplasty surgery? A survey of UK and Irish clinicians.","authors":"Jordan Walker, Emily M. L. Bowman, E. Cunningham, S. O’Brien, Owen Diamon","doi":"10.56392/001c.74538","DOIUrl":"https://doi.org/10.56392/001c.74538","url":null,"abstract":"Postoperative delirium (POD) is a serious complication occurring after approximately 17% of elective arthroplasty surgeries. However, it is unclear if any routine clinical follow-up services are available to patients post-discharge. This study aims to determine what routine postoperative delirium screening and documentation processes are in place and what follow-up services are currently offered. A brief online survey of multiple-choice and free-text questions was devised for clinicians in the United Kingdom (UK) and Republic of Ireland (ROI). An email invitation to complete the survey was sent to relevant clinicians in the UK and ROI by non-NHS professional bodies. Twitter was used to highlight and disseminate the survey. Of the 43 participating clinicians, 18 (42%) respondents indicated that delirium is routinely screened for after elective arthroplasty and 17 respondents stated that the 4AT tool is used. Most respondents (62%) indicated that delirium is documented upon discharge to patients’ GPs. Only 11 respondents (26%) describe routine clinical follow-up practices. These included a joint arthroplasty clinic, geriatric outpatient department and liaison psychiatry. Results of this survey suggest that a) post-arthroplasty delirium screening and documentation is not widespread and b) clinical follow-up services for delirium in the UK and ROI are neither standardised nor routine.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79903889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delirium is under-reported in discharge summaries and in hospital administrative systems: a systematic review.","authors":"Temi Ibitoye, Sabrina So, Susan D Shenkin, Atul Anand, Matthew J Reed, Emma R L C Vardy, Sarah T Pendelbury, Alasdair M J MacLullich","doi":"10.56392/001c.74541","DOIUrl":"10.56392/001c.74541","url":null,"abstract":"<p><strong>Background: </strong>Accurate recording of delirium in discharge summaries (DS) and hospital administrative systems (HAS) is critical for patient care.</p><p><strong>Objective: </strong>To systematically review studies reporting the frequency of delirium documentation and coding in DS and HAS, respectively.</p><p><strong>Method: </strong>We searched Medline, Embase, PsycINFO and Web of Science databases from inception to 23 June 2021. Eligibility criteria included requiring the term <i>delirium</i> in DS or HAS. Screening and full-text reviews were performed independently by two reviewers. Risk of bias (RoB) was assessed using the Effective Public Health Practice Project tool.</p><p><strong>Results: </strong>The search yielded 7,910 results; 24 studies were included. The studies were heterogeneous in design and size (N=25 to 809,512). Mean age ranged from 57 to 84 years. Four studies reported only overall DS documentation and HAS coding in whole hospital or healthcare databases. Twenty studies used additional delirium ascertainment methods (e.g. chart review) in smaller patient subsets. Studies reported either DS figures only (N=8), HAS figures only (N=11), or both (N=5). Documentation rates in DS ranged from 0.1% to 64%. Coding rates in HAS ranged from 1.5% to 49%. Some studies explored the impact of race, and nurse versus physician practice. No significant differences were reported for race; one study reported that nurses showed higher documentation rates in DS relative to physicians. Most studies (N=22) had medium to high RoB.</p><p><strong>Conclusion: </strong>Delirium is a common and serious medical emergency, yet studies show considerable under-documentation and under-coding in healthcare systems. This has important implications for patient care and service planning. Healthcare systems need to take action to reach satisfactory delirium documentation and coding rates.</p>","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"54 1","pages":"74541"},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7617113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87556572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with cognitive decline and delirium after transcatheter aortic valve implantation: Preliminary evidence","authors":"E. Ghezzi, P. Psaltis, T. Loetscher, Daniel Davis, M. Boord, D. Greaves, J. Montarello, S. Delacroix, J. Lau, Alice Bourke, J. McLoughlin, Megan Keage, H. Keage","doi":"10.56392/001c.74542","DOIUrl":"https://doi.org/10.56392/001c.74542","url":null,"abstract":"Transcatheter aortic valve implantation (TAVI) has become the standard for treating severe symptomatic aortic stenosis in those with prohibitive surgical risk. Cognitive complications, including delirium and cognitive decline are common following TAVI, yet an understanding of pre-procedural factors associated with these outcomes is lacking. This prospective observational study set out to identify geriatric pre-procedural factors associated with post-procedural delirium and cognitive decline in patients undergoing TAVI. Cognitive outcomes of TAVI patients aged ≥60 years (N=32) were measured over one-year post-TAVI. Pre-procedural measures included frailty, gait, visual symptoms, voice pitch, dysphagia, blink rate, mood, and sleep. Primary outcomes were post-procedural delirium and cognitive decline. Delirium was present in 25% of patients over two days following TAVI and 26% experienced cognitive decline in the year post-TAVI. Daily physical activity was a protective factor against cognitive decline, and worse baseline visual memory was associated with delirium. While non-significant and with very large confidence intervals, moderate to large effect sizes were found for associations between slowed gait speed, pre-existing atrial fibrillation, and dysphagia for delirium, and slower gait speed, higher blink rate, pre-existing atrial fibrillation for cognitive decline. Though underpowered, measures of considerable effect size were identified (although non-significant and with large variability). In larger studies, these novel geriatric factors could further be explored for predicting cognitive complications following TAVI. Improvement of risk prediction for cognitive decline and delirium following TAVI could assist with early identification of those at risk, informing clinical decision-making and allowing for targeted intervention to reduce post-procedural incidence of these complications.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"115 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79059445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delirium, polypharmacy and adverse outcomes: findings from a hospital in Kerala, India","authors":"Steve Manjaly, Aqueen Joju, Anu Francis","doi":"10.56392/001c.74100","DOIUrl":"https://doi.org/10.56392/001c.74100","url":null,"abstract":"Delirium is an acute disorder of attention and awareness, a medical emergency associated with increased morbidity and mortality. Delirium remains under-recognised, and few studies are from India. This study aimed to estimate the prevalence of delirium and its risk factors among hospitalised older patients admitted to medical and surgical wards in a teaching hospital in Central South India. We performed a retrospective cross-sectional study on 100 older patients admitted to medical and surgical wards in April-October, 2020. Patient data were obtained from a record review, extracting information on comorbidities, medications, and terms indicating delirium. Delirium was present in 39% of the study population and was significantly associated with older age (88%), abnormal electrolytes (59%), and polypharmacy (87%). Delirium was also significantly associated with mortality (28%) and prolonged hospital stay. (36%) The prevalence of delirium is high among older hospitalised patients and is significantly related to adverse hospital outcomes. The findings of this study could trigger changes in hospital policies in screening for delirium in older persons for its prompt recognition and prevention of adverse health outcomes.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84523376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reporting Essentials for DElirium bioMarker Studies (REDEEMS): Explanation and Elaboration","authors":"Ingrid Amgarth-Duff, Annemarie Hosie, G. Caplan, D. Adamis, L. O. Watne, C. Cunningham, E. Oh, Sophia Wang, H. Lindroth, Robert D. Sanders, B. Olofsson, T. Girard, L. Steiner, S. Vasunilashorn, M. Agar","doi":"10.56392/001c.57389","DOIUrl":"https://doi.org/10.56392/001c.57389","url":null,"abstract":"Despite many studies of potential delirium biomarkers, delirium pathophysiology remains unclear. Evidence shows that the quality of reporting delirium biomarker studies is sub-optimal. Better reporting of delirium biomarker studies is needed to understand delirium pathophysiology better. To improve robustness, transparency and uniformity of delirium biomarker study reports, the REDEEMS (Reporting Essentials for DElirium bioMarker Studies) guideline was developed by an international group of delirium researchers through a three-stage process, including a systematic review, a three-round Delphi study, and a follow-up consensus meeting. This process resulted in a 9-item guideline to inform delirium fluid biomarker studies. To enhance implementation of the REDEEMS guideline, this Explanation and Elaboration paper provides a detailed explanation of each item. We anticipate that the REDEEMS guideline will help to accelerate our understanding of delirium pathophysiology by improving the reporting of delirium biomarker research and, consequently the capacity to synthesise results across studies.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"146 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74684268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Recovery from Delirium: An International Survey of Healthcare Professionals Involved in Delirium Care.","authors":"Erin Noble,&nbsp;Haruno McCartney,&nbsp;Alasdair M MacLullich,&nbsp;Susan D Shenkin,&nbsp;Graciela Muniz-Terrera,&nbsp;Jonathan J Evans,&nbsp;Daniel Davis,&nbsp;Daisy Sandeman,&nbsp;Zoë Tieges","doi":"10.56392/001c.56675","DOIUrl":"https://doi.org/10.56392/001c.56675","url":null,"abstract":"<p><strong>Background: </strong>A crucial part of delirium care is determining if the delirium episode has resolved. Yet, there is no clear evidence or consensus on which assessments clinicians should use to assess for delirium recovery.</p><p><strong>Objective: </strong>To evaluate current opinions from delirium specialists on assessment of delirium recovery.</p><p><strong>Design: </strong>Online questionnaire-based survey distributed internationally to healthcare professionals involved in delirium care.</p><p><strong>Methods: </strong>The survey covered methods for assessing recovery, the importance of different symptom domains for capturing recovery, and local guidance or pathways that recommend monitoring for delirium recovery.</p><p><strong>Results: </strong>Responses from 199 clinicians were collected. Respondents were from the UK (51%), US (13%), Australia (9%), Canada (7%), Ireland (7%) and 16 other countries. Most respondents were doctors (52%) and nurses (27%). Clinicians worked mostly in geriatrics (52%), ICUs (21%) and acute assessment units (17%). Ninety-four percent of respondents indicated that they conduct repeat delirium assessments (i.e., on ≥2 occasions) to monitor delirium recovery. The symptom domains considered most important for capturing recovery were: arousal (92%), inattention (84%), motor disturbance (84%), and hallucinations and delusions (83%). The most used tool for assessing recovery was the 4 'A's Test (4AT, 51%), followed by the Confusion Assessment Method (CAM, 26%), the CAM for the ICU (CAM-ICU, 17%) and the Single Question in Delirium (SQiD, 11%). Twenty-eight percent used clinical features only. Less than half (45%) of clinicians reported having local guidance that recommends monitoring for delirium recovery.</p><p><strong>Conclusions: </strong>The survey results suggest a lack of standardisation regarding tools and methods used for repeat delirium assessment, despite consensus surrounding the key domains for capturing delirium recovery. These findings emphasise the need for further research to establish best practice for assessing delirium recovery.</p>","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"1 ","pages":"56675"},"PeriodicalIF":0.0,"publicationDate":"2022-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7614362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9192763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot testing of a new electronic diagnostic support tool (AiD-DST) designed to identify the cause(s) of delirium","authors":"E. Eeles, Peter Worthy, A. Teodorczuk, Paven Kaur, N. Dissanayaka","doi":"10.56392/001c.37365","DOIUrl":"https://doi.org/10.56392/001c.37365","url":null,"abstract":"Delirium is frequently multifactorial, and causes are often missed in clinical practice. The Aetiology in Delirium - Diagnostic Support Tool (AiD-DST) was developed to improve recognition of the causes. We undertook an evaluation of an electronic version of AiD-DST. A development and evaluation life cycle of improvement was used. In phase 1, alpha testing among the development group evaluated technical performance of AiD-DST. In phase 2, we performed a cycle of beta testing among junior doctors to assess impressions of AiD-DST using Think Aloud methodology. We grouped responses into themes and made changes to AiD-DST by the development group accordingly. In phase 3, usability and acceptance of AiD-DST was assessed using the mHealth App Usability Questionnaire (MAUQ). In phase 1, software issues were identified, and modifications made. In phase 2, feedback was obtained from 29 junior doctors. Three cycles of feedback were obtained. The number of items identified after each cycle were 20, 12 and 7, respectively. Content was grouped into themes of; ‘style and grammar’, ‘formatting’, ‘IT’, ‘missed diagnosis’ and ‘other concerns.’ In phase 3, 20 participants completed MAUQ questionnaire. Overall, the average score was 6.36 (SD=0.8) with 7 as the highest attainable score. This translates to agreement up to strong agreement concerning usability of AiD-DST. After a process of optimisation, AiD-DST has been shown to be a usable and potentially useful diagnostic support tool to help junior doctors identify cause(s) of delirium. An implementation study is planned.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"320 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76460074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of the Reporting Essentials for DElirium bioMarker Studies (REDEEMS) guideline","authors":"Ingrid Amgarth-Duff, Annmarie Hosie, G. Caplan, M. Agar","doi":"10.56392/001c.36531","DOIUrl":"https://doi.org/10.56392/001c.36531","url":null,"abstract":"Delirium is a serious and distressing neurocognitive condition manifesting as an acute change in mental status due to medical illness, injury and/or treatment. The understanding of delirium pathophysiology is limited and largely hypothetical and this evidence gap impedes the development of effective therapies. Delirium biomarker studies have a key role in building knowledge of the pathophysiology of delirium, subject to the robustness of their methods and reporting. Our objective was to describe the multi-method development and finalisation of a new reporting guideline for delirium fluid biomarker studies: REDEEMS. A previously published systematic review on delirium and advanced cancer biomarkers informed a three-round modified Delphi study with international experts in delirium research in 2019. We held a follow-up consensus meeting with a newly configured expert panel of 12 delirium researchers in June, 2020 to determine the inclusion or exclusion of 16 items that achieved 70-80% (i.e., borderline) consensus in the Delphi study. Of the 16 items presented at the consensus meeting, seven were excluded, six remained as discrete items, and three were merged with another item. The final REDEEMS guideline contained nine items specific to reporting delirium biomarker studies. The REDEEMS guideline was developed through a rigorously conducted Delphi and follow-up consensus meeting with international experts in delirium research. The REDEEMS will support the improved reporting rigour and synthesis of future delirium biomarker research. The next step is dissemination to promote uptake of the guideline and evaluate the influence on improved study methods and capacity to address research hypotheses.","PeriodicalId":72776,"journal":{"name":"Delirium communications","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84767527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}