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Relevant bibliographies by topics / Acute confusion

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Academic literature on the topic 'Acute confusion'

Author: Grafiati

Published: 4 June 2021

Last updated: 25 January 2023

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Journal articles on the topic "Acute confusion"

1

Morrow-Barnes, Abby. "Acute confusion." Nursing Standard 28, no. 50 (August 13, 2014): 61. http://dx.doi.org/10.7748/ns.28.50.61.s48.

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HELD, JEANNE L. "MANAGING ACUTE CONFUSION." Nursing 25, no. 1 (January 1995): 75–82. http://dx.doi.org/10.1097/00152193-199501000-00034.

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Sendelbach, Sue, and Patty Finch Guthrie. "Acute Confusion/Delirium." Journal of Gerontological Nursing 35, no. 11 (November 1, 2009): 11–18. http://dx.doi.org/10.3928/00989134-20090930-01.

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Foreman, Marquis D. "Complexities of acute confusion." Geriatric Nursing 11, no. 3 (May 1990): 136–39. http://dx.doi.org/10.1016/s0197-4572(06)80098-4.

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Rapp, Carla Gene. "Acute Confusion/Delirium Protocol." Journal of Gerontological Nursing 27, no. 4 (April 1, 2001): 21–33. http://dx.doi.org/10.3928/0098-9134-20010401-07.

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Osterbrink, Jürgen, John P. McDonough, Andre Ewers, and Herbert Mayer. "The Occurrence of Acute Postoperative Confusion in Patients after Cardiac Surgery." Scientific World JOURNAL 5 (2005): 874–83. http://dx.doi.org/10.1100/tsw.2005.109.

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This study quantified the occurrence of acute confusion in cardiac surgery patients at three German hospitals. A total of 867 patients, 22–91 years old, were examined each nursing shift postoperatively for 5 days for the presence of acute confusion using a modified version of the Glasgow Coma Scale and Confusion Rating Scale. The night shifts and the third postoperative day showed the most frequent periods of occurrence. Confusional state was noted in patients ranging from 10.5% for patients aged <70, to 40.7% for patients >80 years of age. Those found at increased risk were patients of increasing age and coexisting disease. Targeted nursing interventions for patients at increased risk of acute confusion may decrease this complication.

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Williams, Margaret A. "Delirium/Acute Confusional States: Evaluation Devices in Nursing." International Psychogeriatrics 3, no. 2 (December 1991): 301–8. http://dx.doi.org/10.1017/s1041610291000741.

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Characteristics of instruments developed by nurses for use in evaluating delirium/acute confusional states include relative emphasis on observable behavior and the need to impose low respondent burden. Two instruments that have been most used by nurse researchers are described: The Confusion Rating Scale and the NEECHAM Confusion Scale. The former is based on observable behavior; the latter incorporates vital function and oxygen saturation measurements that may serve as early warning sings of impending delirium.

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FOREMAN, MARQUIS D. "Acute Confusion in the Elderly." Annual Review of Nursing Research 11, no. 1 (January 1993): 3–30. http://dx.doi.org/10.1891/0739-6686.11.1.3.

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9

O’Brien, James G. "Evaluation of Acute Confusion (Delirium)." Primary Care: Clinics in Office Practice 16, no. 2 (June 1989): 349–60. http://dx.doi.org/10.1016/s0095-4543(21)01094-0.

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Holden, Una, and Mary Marshall. "Dementia in acute units: confusion." Nursing Standard 9, no. 17 (January 18, 1995): 37–39. http://dx.doi.org/10.7748/ns.9.17.37.s49.

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Dissertations / Theses on the topic "Acute confusion"

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Brooks, Daryl. "The experience of acute confusion in older women with hip fracture." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0003/MQ45026.pdf.

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Moloney, Clint. "To what extent will the annual number of episodes of acute confusion within a medical unit be reduced following the introduction of high risk indicators and early intervention strategies." University of Southern Queensland, Faculty of Sciences, 2005. http://eprints.usq.edu.au/archive/00001475/.

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This simple quantitative descriptive case controlled research compared cases (subjects at risk for acute confusion) with controls (subjects without the attribute); comparison was made on the exposure to potential contributing factors suspected of causing acute confusion, for example, heavy smoking, or the number of alcoholic drinks consumed per day. Case-control studies were also retrospective, because they focused on conditions in the past that might have caused subjects to become cases, rather than controls. The basic purpose of this research design was essentially the same as that of experimental research: to determine the relationships among variables. This report demonstrates that, with relatively good adherence by the nursing team, proactive screening using a structured risk assessment protocol can be successfully implemented for medical patients. This assessment was associated with a statistically significant 50 per cent reduction in the incidence of acute confusion in the intervention group, compared with usual care retrospectively. Reduction in acute confusion was not associated with shortened length of stay, but length of stay was often predetermined by protocol or critical pathway. Correlation analysis demonstrated that risk screening appeared most effective in preventing or reducing acute confusion in patients without preadmission dementia or ADL impairment. In patients with significant preadmission impairment, the stress of hospitalisation may be sufficient to precipitate an episode, despite otherwise optimal management. Less-impaired patients may require additional insults to precipitate acute confusion, some of which are avertable by risk screening and subsequent early intervention. Determined risk indicators were consistent throughout the four year timeframe set for this research project. This demonstrated that although there were multiple patient types presenting to this clinical area, they were consistently the same over a longitudinal timeframe. It meant they were reproducible, which gave this research additional strength. Also, based on the descriptive statistics, this research has shown that in this clinical area where intervention was introduced the combination did have a positive impact on annual numbers of acute confusion. In summary, these findings suggest that without risk screening and the direction for appropriate management the likelihood of an episode can more than double. In the three subgroups expected to pose the greatest challenges for the risk assessment (i.e. those 70 years or older, those with suspected drug dependency, and those with symptomatic infection), risk assessment retained excellent sensitivity, (a) (d) specificity, and relevant correlation with reduction of episodes. This research has demonstrated throughout that high risk screening and associated intervention based on the risk indicator can decrease the annual number of actual episodes of acute confusion. Interventions to prevent or reduce an episode of acute confusion, as outlined by Wakefield (2002) and this research, definitely increases as a result of high risk screening. Beyond doubt, from both the literature reviewed and the findings of this research, is that risk screening does need to be adapted to the individual clinical setting and cannot be generic.

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Rogers, Ada Christina. "An exploratory study of the experiences of surgical nurses caring for elderly patients with acute confusion." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0022/MQ62149.pdf.

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4

Moti, Nora Nurten. "Development of education curriculum and standards of practice for the management of acute confusion syndrome/delirium among hospitalized patients." CSUSB ScholarWorks, 2003. https://scholarworks.lib.csusb.edu/etd-project/2413.

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The primary objective of this project is the development and implementation of an educational program for the staff nurses for the effective management of Acute Confusion (AC), Delirium among hospitalized patients at Kaiser Hospital in Fontana.

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Zvizdic, Jasmina, and Maria Öresjö. "Sjuksköterskors erfarenhet kring vårdandet av patienter med akut förvirring." Thesis, Högskolan i Halmstad, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:hh:diva-30186.

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Akut förvirring är en kognitiv förändring som uppkommer plötsligt. Drabbade patienter upplevs exempelvis agiterade, rastlösa och apatiska. Patienter beskriver upplevelsen av akut förvirring som en abstrakt verklighet, vilket komplicerar vårdprocessen. Syftet var att beskriva sjuksköterskors erfarenhet kring vårdandet av akut förvirrade patienter. Metoden som användes var en litteraturstudie med systematisk ansats där databearbetningen inspirerades av kvalitativ innehållsanalys. Litteraturstudien visar att sjuksköterskor som möter akut förvirrade patienter på vårdavdelningar kan uppleva ökad tidspress och stress. Den akut förvirrade påverkar även övriga medarbetare och patienter, kräver mer resurser i form av övervakning och sjuksköterskor med rätt kompetens. Sjuksköterskor fokuserar på att bevara säkerheten för de akut förvirrade patienterna, detta uppmärksammas mer än människan bakom den akuta förvirringen. Sjuksköterskors förhållningssätt till de akut förvirrade blir att försöka få kontroll över patienterna genom olika strategier. Okunskap om akut förvirring visas genom att sjuksköterskor inte använder sig av vetenskapligt baserad kunskap. Prioritering blir nödvändigt för att effektivisera arbetet och för att sjuksköterskor ska kunna vara tillgängliga åt alla patienter - effektivisering av tid faller på bekostnad av akut förvirrade patienter. God kommunikation och medvetenhet om den åldersdiskriminering som förekommer är av vikt för att patienters upplevelser ska bli optimala och leda till minskat lidande vid akut förvirring.
Acute confusion is a cognitive impairment that occurs suddenly. Affected patients are for example perceived as agitated, restless and apathetic. Patients describe the experience of acute confusion as an abstract reality, this complicates the care process. The aim of this study was to describe nurses’ experience in the care of acutely confused patients. The method was a literature study with a systematic approach where the data processing was inspired by qualitative content analysis. The literature study shows that nurses who meet acute confused patients in wards may experience a lack of time and increased stress. The patient with acute confusion also affects other health careers and patients, requiring more resources in terms of monitoring and nurses with the right skill sets. Nurses are more focused on preserving the safety of the acutely confused patients than the person behind the acute confusion. Nurses’ attitudes towards the acutely confused patients are based on gaining control of the patients through various strategies. Unawareness of acute confusion is displayed by nurses’ inconsistency of the use of evidence-based knowledge. Prioritizing work is necessary to make the work more effective, it also helps the nurse to be at hand for all patients, although, managing and using time more effectively falls at the expense of the acutely confused patients. Good communication and awareness of the ageism that occurs is of importance so that the patients’ experiences become optimal and for reduction of suffering when in or after an acute confusion state.

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Lindgren, Frida, and Kaski Monica Weman. "Intensivvårdssjuksköterskors erfarenheter av IVA-delirium." Thesis, Röda Korsets Högskola, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-266.

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Bakgrund: Intensivvårdspatienter utsätts för en påfrestande situation, vilket kan bidra till utvecklandet av iva-delirium. Iva-delirium är en form av hjärndysfunktion som leder till ökad sjuklighet, ökad mortalitet och ökade vårdkostnader i form av förlängd vårdtid. Studier visar att trots att iva-delirium är vanligt förekommande inom intensivvården så missas tillståndet ofta. Bedömningsinstrument för att identifiera iva-delirium finns men används vanligen i liten utsträckning inom svensk intensivvård. Detta kan leda till att intensivvårdssjuksköterskor, utifrån personlig erfarenhet, utvecklar olika strategier för att vårda patienter med iva-delirium. Syfte: Att beskriva intensivvårdssjuksköterskors personliga erfarenheter av att bedöma patienter som riskerar att drabbas av iva-delirium samt hur syndromet identifieras och förebyggs. Metod: En kvalitativ studie innehållande sex intervjuer genomfördes och analyserades utifrån en deskriptiv innehållsanalys. Resultat: Resultatet visade att intensivvårdssjuksköterskorna med hjälp av personliga erfarenheter skapade en framförhållning genom att förutse riskfaktorer och att identifiera kliniska tecken. Vidare visade intensivvårdssjuksköterskorna en förmåga att förebygga och resonera kring utförda åtgärder. En förståelse för vården av patienter med iva-delirium skapades genom etiska reflektioner. Slutsats: Intensivvårdssjuksköterskornas erfarenheter utgjordes av tre domäner; att se, att göra och att känna. Dessa olika erfarenheter interagerade med varandra, skedde simultant och skapade ett expertkunnande hos intensivvårdssjuksköterskorna. Trots denna förmåga framkom det att intensivvårdssjuksköterskornas kunskaper om iva-delirium och deras strategier varierade beroende på personlig erfarenhet. Klinisk betydelse: Genom att belysa intensivvårdssjuksköterskornas erfarenheter kan en ökad medvetenhet kring iva-delirium skapas och därmed förhoppningsvis medföra minskad prevalens.
Background: Critical care patients are exposed to a stressful situation, which could contribute to the development of icu-delirium. Icu-delirium is a form of brain dysfunction leading to higher morbidity, higher mortality and higher cost of care due to extended hospital stays. Even though studies show that icu-delirium is common within critical care the syndrome is often unrecognized. Delirium screening tools exist but are rarely used within Swedish critical care. The low implementation of screening tools could lead to that critical care nurses, based on personal experience, develop individual strategies for care of patients with icu-delirium. Aim: To describe experiences of assessing patients with risk for developing icu-delirium and how the syndrome is identified and prevented by critical care nurses. Methods: A qualitative study with six interviews was conducted and analyzed based on a descriptive qualitative content analysis. Results: The results showed that critical care nurses, based on earlier experiences, created an anticipation by discerning risk factors and identifying clinical signs. The critical care nurses showed an ability to perform preventive measurements while reasoning about already performed measurements. Through ethical reflections an understanding for the care of patients with icu-delirium was created. Conclusions: The experiences by critical care nurses was based on three domains; to see, to do and to feel. These domains occurred simultaneously and created the expertise of the critical care nurse. Despite this ability the knowledge of critical care nurses and their clinical assessment methods varied depending on earlier experiences. Relevance to clinical practice: By illuminating the experiences of critical care nurses hopefully a higher awareness regarding icu-delirium is created which will hopefully result in a lower prevalence.

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Olofsson, Susanne. "Att beskriva och jämföra en expertgrupp och intensivvårdssjuksköterskors överensstämmelse i att detektera delirium hos intuberade, respiratorbehandlade patienter med sedering/analgesi, före och efter en utbildningsintervention : En kvasiexperimentell studie." Thesis, Högskolan i Gävle, Avdelningen för hälso- och vårdvetenskap, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-18598.

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The aim: was to describe and compare a group of experts and critical care nurses' agreement in detecting delirium in intubated, ventilator treated patients with sedation / analgesia, before and after an in house training intervention with the instrument Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Method: A quasi-experimental study, one group pretest - posttest design. A convenience sample of 17 critical care nurses in a general intensive care unit included. To detect delirium the instrument CAM-ICU was used, 21 paired tests before and 22 after an educational intervention. Main Results: The results showed that after an in house training intervention sensitivity and kappa coefficient improved of the characteristic 1 "acute onset and fluctuating course," an improvement that was significant. In other features, and overall values were signs of numerical improvement and deterioration in sensitivity, specificity and kappa coefficient but no significant change. Conclusion: Implementing a new instrument for detecting delirium in clinical practice requires education and follow-up. A small sample of critical care nurses with varying ability to use the new instrument and the fact that patients' status may change rapidly making it difficult to draw any conclusions from this study. It is clear, however, that education and follow-up is needed when new care routines are introduced, and that further studies are needed to clarify whether the CAM-ICU is a valit and reliable instrument to use in clinical practice.
Syftet var att beskriva och jämföra en expertgrupp och intensivvårdssjuksköterskors överensstämmelse i att detektera delirium hos intuberade, respiratorbehandlade patienter med sedering/analgesi, före och efter en utbildningsintervention med instrumentet Confusion assessment method for the intensive care unit (CAM-ICU). Metod: En kvasiexperimentell studie, en grupps pretest – posttest design. Ett bekvämlighetsurval på en allmän intensivvårdsavdelning där inkluderades 17 intensivvårdssjuksköterskor. För att detektera delirium användes instrumentet CAM-ICU, 21 parmätningarna före och 22 efter en utbildningsintervention. Huvudresultat: Resultatet visade att efter utbildningsinterventionen förbättrades sensitiviteten och kappa koefficienten i kännetecken 1 ”akut insättande eller fluktuerande förlopp”, en förbättring som var signifikant. I övriga kännetecken och totalvärden fanns tecken på numerär förbättring och försämring i sensitivitet, specificitet och kappakoefficient men ingen signifikant förändring. Slutsats: Att implementera ett nytt instrument för att detektera delirium i klinisk verksamhet kräver utbildning och uppföljning. Ett litet sample av intensivvårdssjuksköterskor med varierad förmåga att använda det nya instrumentet samt det faktum att patienters status hastigt kan förändras gör det svårt att dra några slutsatser av denna studie. Klart är dock att utbildning och uppföljning behövs när nya vårdrutiner införs, och att ytterligare studier behövs för att klargöra om CAM-ICU är ett valit och reliabelt instrument att använda i klinisk verksamhet.

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Beijer, Martina, and Tomas Celander. "Riskfaktorer för och omvårdnadsåtgärder vid akut delirium : En litteraturstudie." Thesis, Högskolan Dalarna, Omvårdnad, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:du-1644.

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Syftet med litteraturstudien var att beskriva vilka faktorer som i omvårdnadsforskningen beskrivs som bidragande faktorer till akut delirium. Syftet var vidare att beskriva vilka omvårdnadsåtgärder som omvårdnadsforskningen tar upp som kan minska risken för uppkomst av akut delirium. Resultatet baserades på vetenskapliga artiklar som söktes i följande databaser: Elin@dalarna, BlackwellSynergy, PubMed och EBSCO host. Följande sökord användes: delirium, acute, elderly, nursing, patients, caring, management, confusional state, needs. Artiklarna granskades enligt en granskningsmall med avseende på vetenskaplig kvalité. Betydande riskfaktorer för akut delirium var ålder, flera samtidiga sjukdomar, antalet mediciner och typ av medicin. Förutom att genomgå operation var också många åtgärder, framför allt invasiva åtgärder, tidigt under sjukhusvistelsen riskfaktorer för akut delirium. Även flera rumsbyten var en riskfaktor. Viktiga åtgärder för att förebygga akut delirium var psykiatrisk konsultation, tekniker för att underlätta orientering, emotionellt stöd, patientundervisning och anhörigundervisning, patientorientering, fysisk kontakt med patient samt att upprätta kontakt med kurator.

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Barugh, Amanda Jayne. "Delirium and long-term cognitive impairment after stroke : the role of the hypothalamic-pituitary-adrenal axis." Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/28800.

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Delirium is a severe neuropsychiatric syndrome, characterised by the acute onset of inattention, altered level of arousal, and other mental status abnormalities. Delirium is extremely common in acute stroke, affecting at least 1 in 5 such patients admitted to hospital. It is a serious complication of stroke, being associated with higher mortality, longer length of hospital stay and higher dependency at discharge. The pathophysiology of delirium is not completely understood, and there are no specific treatments. This thesis investigated the role of cortisol in the development of delirium after stroke and also investigated the role of delirium and of cortisol in the development of cognitive impairment in the 12 months after stroke. The thesis specifically investigated whether levels of cortisol in saliva are elevated in delirium and also whether there is a loss of the normal diurnal rhythm in delirium, evidenced by elevated afternoon salivary cortisol levels and reduced morning level to afternoon level ratio. The thesis also investigated whether cortisol levels are persistently elevated in the year after stroke in those who developed delirium and whether cortisol levels are associated with cognitive decline. Finally it investigated whether acute and/or chronic changes seen on Computed Tomography (CT) brain scans taken around the time of stroke onset are associated with the development of delirium after stroke A longitudinal cohort study was conducted in 95 participants aged 60 years or over, who were admitted to hospital with a clinically confirmed stroke. Participants gave informed consent, or proxy consent was obtained if they lacked capacity to consent. At baseline participants underwent brief cognitive testing and were then assessed for the presence of delirium, using DSM IV criteria, at regular intervals during the first two weeks after stroke. At each assessment a saliva sample was collected in the morning and in the afternoon, to measure cortisol. Participants were then visited at 1 month, 4 months and 12 months after stroke onset, at which point they were assessed for the presence of delirium, further saliva samples were taken and a cognitive test battery was completed. 26 (27%) participants developed delirium during the course of the study period. The study found elevated salivary cortisol levels in those with delirium at up to 4 months after stroke, but at 12 months there was no difference between the delirium and no delirium group. A loss of the diurnal rhythm was seen in those who developed delirium at 5 days after stroke, but the diurnal variation had returned to a normal pattern at follow-up. However, in a multivariate analysis, controlling for age, sex, stroke severity (NIHSS), current illness burden (APACHE II), chronic illness burden (CCI) and prior cognitive impairment (IQCODE), neither median salivary cortisol levels in the first two weeks after stroke, nor the ratio of morning to afternoon cortisol levels were independent predictors of delirium diagnosis, although median 9am cortisol approached significance (OR=0.95, 95% confidence interval (CI) 0.89-1.01, p=0.08). In a random effects logistic regression analysis, the probability of developing delirium decreased over time from stroke onset and increased per unit increase in salivary cortisol (nmol/L), however this effect was not statistically significant (OR 1.02, CI 0.84-1.19 P=0.70 for morning cortisol and OR 1.05, CI 0.82-1.25 p=0.46 for afternoon cortisol). Global cognition, measured by the MoCA, was significantly poorer in the delirium group at each time point throughout the 12 months after stroke. However, there was a trend towards improvement in MoCA scores in the whole cohort throughout the 12 month follow-up, with the exception of those who developed the most severe delirium. The presence of delirium at any point during the 12 month follow-up did not affect the rate of change of the MoCA scores over the 12 months after stroke. The presence of brain atrophy identified on admission CT brain scans was independently associated with delirium (OR 3.7, CI 1.15-11.88, p=0.02), however the presence of a visible acute or chronic stroke lesion and the presence of white matter lesions were not. Finally, those who developed delirium had a worse functional outcome, longer length of hospital stay and were more likely to require institutional care or a package of care at home, compared with those who did not develop delirium. This thesis has contributed to our understanding of the mechanisms and phenomenology of delirium after stroke, and has also highlighted areas for further research which will be required to unpick the complex pathophysiology of delirium.

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Sörensen, Duppils Gill. "Delirium during Hospitalisation : Incidence, Risk Factors, Early Signs and Patients' Experiences of Being Delirious." Doctoral thesis, Uppsala University, Department of Public Health and Caring Sciences, 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3814.

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Delirium is common among old patients admitted to hospital, but is often a neglected problem in patient care. The principal aim of this thesis was to evaluate aspects of delirium in relation to incidence, risk factors, behavioural changes, cognitive function and health-related quality of life (HRQOL). A further aim was to describe patients’ experiences of being delirious. The study was prospective, descriptive and comparative, with repeated measures (six-month follow up). The sample consisted of 225 consecutive patients, aged 65 years or older, who were to be operated on due to hip fracture or hip replacement. Exclusion criteria were serious cognitive disorder or delirium on admission. Data were collected via frequent daily observations, cognitive functioning tests (MMSE), HRQOL questionnaires (SF-36) and interviews. Delirium was assessed according to the DSM-IV criteria. A total of 45/225 became delirious, with an incidence of 24.3% among patients undergoing hip fracture surgery and 11.7% among those with hip replacement surgery. A predictive model for delirium included four factors: impaired hearing, passivity, low cognitive functioning, and waiting more than 18h for hip fracture surgery. Disorientation and urgent calls for attention were the most frequent behavioural changes in the prodromal phase prior to delirium. Delirium in connection with hip fracture revealed deteriorated HRQOL and cognitive functioning when measured at a six-month follow-up. The experience of being delirious was described by the patients as a sudden change of reality. Such an experience gave rise to strong emotional feelings, as did recovery from delirium. Nurses’ observations of behavioural changes in old patients with impaired cognitive function may be the first step in managing and reducing delirium. The predictive model of delirium ought to be tested further before use in clinical practice.

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Books on the topic "Acute confusion"

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Gallen, Anella. Nurses' knowledge regarding the management of acute confusion/delirium in patients receiving palliative care at home. [s.l: The author], 2003.

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Delirium: Acute confusional states. New York: Oxford University Press, 1990.

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Anderson, Carol L. Relationship between a systematic program of nursing care for elderly hip fracture patients and the occurrence of acute confusional states. Ottawa: National Library of Canada = Bibliothèque nationale du Canada, 1992.

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Watkins, Julie E. Assessing confusion in elderly patients on an acute medical ward. SIHE, 1992.

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Hogg, Jenny. Delirium. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199644957.003.0040.

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Delirium (acute confusional state) is a common condition affecting between ten and thirty percent of a general hospital inpatient population. The diagnosis is suspected when there is an acute onset of confusion in the presence of a physical precipitant. Pre-existing dementia, advancing age, previous delirium and increasing illness severity favour the development of delirium. The diagnosis of delirium is solely clinical and can be quickly arrived at using assessment tools such as the cognitive Assessment Method (CAM). Historical perspectives, diagnosis, the use of assessment tools, differential diagnosis, communication with patients and relatives, prevention, prognosis, and treatment are discussed in this chapter, along with the pathophysiology of this common condition

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Waldmann, Carl, Neil Soni, and Andrew Rhodes. Neurological disorders. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199229581.003.0022.

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Agitation and confusion 360Status epilepticus 362Meningitis 364Intracerebral haemorrhage 366Subarachnoid haemorrhage 368Ischaemic stroke 370Guillain–Barre syndrome 372Myasthenia gravis 374ICU neuromuscular disorders 376Tetanus 378Botulism 380Neurorehabilitation 382Hyperthermias 384Agitation and confusion are common features in critical illness. Agitation is a symptom or sign of numerous acute and chronic disease states that include pain, anxiety and delirium. Agitation is present in around half of ICU patients, with 15% experiencing severe agitation. Confusion may also be chronic or acute and arise from an overlapping set of pathological processes that includes hypoxia, hypotension, hypoglycaemia and dementia. It is possible to be agitated and not confused, and vice versa. Recognition and treatment of the underlying condition is of utmost importance, rather than treating the symptoms alone....

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Vasilevskis, Eduard E., and E. Wesley Ely. Causes and epidemiology of agitation, confusion, and delirium in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0226.

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Confusion is a non-specific, non-diagnostic term to describe a patient with disorientation, impaired memory, or abnormal thought process. Agitation describes an increased level of psychomotor activity, and anxious or aggressive behaviour. Many agitated patients may also be delirious, yet they only represent a minority of all delirious patients. ICU delirium is an acute cognitive disorder of both consciousness and content of thought. The hallmark of ICU delirium is a fluctuating mental status, inattention, and an altered level of consciousness. Delirium is the end product of a sequence of insults and injury that lead to a common measurable manifestation of end-organ brain injury. It does not have a single aetiology, but often has multiple different and potentially interacting aetiologies. Both non-modifiable and modifiable risk factors play important roles in the development of delirium. Importantly, the new onset of delirium should prompt the physician to investigate the underlying cause. Cognitive impairment and age are among the most important non-modifiable risk factors, whereas administration of benzodiazepines is the greatest. The alpha-2 adrenoceptor agonist dexmedetomidine shows promise as a sedative reducing the risk for delirium when compared with benzodiazepines.

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Aged, Help the, and Royal College of Nursing, eds. Dignity on the ward: Improving the experience of acute hospital care for older people with dementia or confusion : a pocket guide for hospital staff. London: Help the Aged, 2000.

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Sprigings, David. Delirium (acute confusional state). Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0041.

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Delirium is a functional brain disorder characterized by disturbances of consciousness, attention, and cognition. The term ‘acute confusional state’ is often used synonymously with ‘delirium’. Delirium may be associated with a range of associated clinical features including increased or decreased psychomotor activity (hyperactive and hypoactive variants), hallucinations and delusions, and efferent sympathetic hyperactivity. Delirium with pronounced psychomotor and sympathetic hyperactivity is more often seen in younger patients with alcohol or substance intoxication/withdrawal (delirium tremens), but no cause is specific to a clinical subtype. Delirium is distinguished from dementia (with which it may coexist, as dementia is a major risk factor for delirium) by its speed of onset (over hours or days) and reversibility with correction of the underlying cause. In some patients, however, delirium may be followed by long-term cognitive impairment, suggesting that the pathophysiology of delirium overlaps with that of dementia.

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Lipowski, Zbigniew J. Delirium: Acute Confusional States. Oxford University Press, USA, 1990.

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Book chapters on the topic "Acute confusion"

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Briggs, R. "Acute Confusion." In Acute Geriatric Medicine, 113–34. Dordrecht: Springer Netherlands, 1985. http://dx.doi.org/10.1007/978-94-009-4890-7_7.

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Fok, Henry, Kerry Layne, and Adam Nabeebaccus. "Acute Confusion." In 100 Cases in Acute Medicine, 1–3. 2nd ed. Boca Raton: CRC Press, 2022. http://dx.doi.org/10.1201/9781003241171-1.

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Woodford, Henry, James George, and David Oliver. "Confusion." In Acute Medicine in the Frail Elderly, 105–24. London: CRC Press, 2021. http://dx.doi.org/10.1201/9781909368330-4.

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Fok, Henry, Kerry Layne, and Adam Nabeebaccus. "Constipation with Confusion." In 100 Cases in Acute Medicine, 20–23. 2nd ed. Boca Raton: CRC Press, 2022. http://dx.doi.org/10.1201/9781003241171-6.

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Fok, Henry, Kerry Layne, and Adam Nabeebaccus. "Abdominal Pain, Bruising, and Confusion." In 100 Cases in Acute Medicine, 183–85. 2nd ed. Boca Raton: CRC Press, 2022. http://dx.doi.org/10.1201/9781003241171-63.

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Fok, Henry, Kerry Layne, and Adam Nabeebaccus. "Collapse and Confusion in a Young Woman." In 100 Cases in Acute Medicine, 13–14. 2nd ed. Boca Raton: CRC Press, 2022. http://dx.doi.org/10.1201/9781003241171-4.

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Poeck, Klaus. "Acute Confusional State." In Diagnostic Decisions in Neurology, 7–11. Berlin, Heidelberg: Springer Berlin Heidelberg, 1985. http://dx.doi.org/10.1007/978-3-642-70693-6_3.

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Scherrmann, Jean-Michel, Kim Wolff, Christine A. Franco, Marc N. Potenza, Tayfun Uzbay, Lisiane Bizarro, David C. S. Roberts, et al. "Acute Confusional State." In Encyclopedia of Psychopharmacology, 19. Berlin, Heidelberg: Springer Berlin Heidelberg, 2010. http://dx.doi.org/10.1007/978-3-540-68706-1_3017.

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Champion, Howard R., Nova L. Panebianco, Jan J. De Waele, Lewis J. Kaplan, Manu L. N. G. Malbrain, Annie L. Slaughter, Walter L. Biffl, et al. "Acute Confusional State." In Encyclopedia of Intensive Care Medicine, 58. Berlin, Heidelberg: Springer Berlin Heidelberg, 2012. http://dx.doi.org/10.1007/978-3-642-00418-6_1055.

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Scharnagl, Hubert, Winfried März, Markus Böhm, Thomas A. Luger, Federico Fracassi, Alessia Diana, Thomas Frieling, et al. "Acute Confusional State." In Encyclopedia of Molecular Mechanisms of Disease, 30. Berlin, Heidelberg: Springer Berlin Heidelberg, 2009. http://dx.doi.org/10.1007/978-3-540-29676-8_7729.

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Conference papers on the topic "Acute confusion"

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Marvin, V., E. Ward, and E. Whiting. "4CPS-238 Medication and confusion in acute hospital older patients." In 24th EAHP Congress, 27th–29th March 2019, Barcelona, Spain. British Medical Journal Publishing Group, 2019. http://dx.doi.org/10.1136/ejhpharm-2019-eahpconf.387.

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Moen, Hans, Kai Hakala, Farrokh Mehryary, Laura-Maria Peltonen, Tapio Salakoski, Filip Ginter, and Sanna Salanterä. "Detecting mentions of pain and acute confusion in Finnish clinical text." In BioNLP 2017. Stroudsburg, PA, USA: Association for Computational Linguistics, 2017. http://dx.doi.org/10.18653/v1/w17-2347.

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Miyahira, Clara Kimie, Beatriz Medeiros Correa, Raphael Palomo Barreira, Thomas Zurga Markus Torres, Natália Figueiredo Miranda, Natasha Soares Cutolo, Thiago da Cruz Marques, Vanessa Moraes Rossette, and Eduardo de Almeida Guimarães Nogueira. "Acute Disseminated Encephalomyelitis after endophthalmitis in immunosuppresed patient." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.028.

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Context: Acute Disseminated Encephalomyelitis (ADEM) usually happens after an infectious event, vaccination reaction and with history of immunosuppression. Clinical features can be varied: headache, fever, seizure, blurred vision, ataxia, motor deficits and mental confusion. Case report: A 35-yearsold woman, in a social risk situation, complained about pain and blurred vision, history of cocaine abuse, victim of sexual and physical abuse and recent Measles vaccination. She had corneal ulcer with bilateral endophthalmitis and optic nerve infection. Despite intravitreal injections of Vancomycin + Ceftazidime, patient had to eviscerate the left eye. After surgery, patient evolved with mental confusion and paraparesis, CSF cell 69, lymphomonocyte, proteins 257, MRI showed central bulbar hyperintensity, lesions in the dentate nucleus and periaqueductal of gray substance in T2 / FLAIR, thoracic and lumbar spine with demyelinating pattern, extensive longitudinal myelitis. Patient obtained clinical improvement after treatment with Methylprednisolone 1gr for 5 days. It is important to discard other hypothesis: transverse myelitis, neuromyelitis optica, multiple sclerosis and systemic lupus erythematosus. The diagnosis is clinical and radiological with multifocal and confluent areas of hypersignal on MRI, CSF analysis reveals high protein and lymphocytic pleocytosis. Treatment with Methylprednisolone is the first choice and then Plasmapheresis. Conclusion: there are several risk factors for the development of ADEM correlated with a rapid and aggressive evolution in this patient.

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Dantas, Madson Caio dos Santos, and João Pedro Cardoso Prudêncio. "Acute cerebellar ataxia associated with varicella zoster virus encephalitis." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.423.

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Context: Varicella-zoster virus (VZV) primary infection causes a diffuse vesicular rash and affects mainly young people. VZV-associated encephalitis is a rare complication since the advent of vaccination, and can present as different neurological syndromes. This report aims to describe a case of acute cerebellar ataxia after VZV-associated encephalitis in a child, admitted to the Onofre Lopes University Hospital (HUOL) in Natal, Brazil. Case report: We present the case of a 9-year-old girl referred to HUOL with polymorphic skin lesions for 8 days. She evolved with headache, vomiting, drowsiness and confusion. Upon admission, she was pale (+/4+), anicteric, confused (GCS=14), hemodynamically stable, SaO2=99%, with pupillary response and no meningism. Laboratory tests showed Hb 11.7g/dl, leukocytes 7,200/mm³ (93% segmented, 1% eosinophils, 5% lymphocytes and 2% monocytes), AST 38U/ml and ALT 46U/ml. Once clinical diagnosis of VZVencephalitis was made, the patient was admitted to the ICU for monitoring and treatment. Cranial CT showed hypodensities on the frontal and occipital lobes; CSF analysis: glucose=76mg/dl, proteins=24mg/dl, leukocytes=9/mm3 (monocytes 78%). She improved progressively and was transferred to the ward, evolving with ataxia, suggesting cerebellitis. Conclusions: This case describes a chickenpox rare complication nowadays: encephalitis. Along evolution, the patient presented acute cerebellar ataxia, a more prevalent condition in children, usually having a limited course.

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Carneiro, Lays Oliveira, Ivã Taiuan Fialho Silva, Tayla Samanta Silva dos Santos, and Pedro Antonio Pereira de Jesus. "Predictors of delirium in poststroke patients." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.699.

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Introduction: Delirium is a common disorder in patients after stroke. We designed a study to evaluate the incidence of delirium and risk factors for its occurrence after stroke. Design and setting: Prospective cohort study at Hospital Geral Roberto Santos. Methods: Patients were admitted within 72h of ictus. Delirium was assessed using the Confusion Assessment Method in an Intensive Care Unit scale. Results: 279 patients were enrolled, with a mean age of 61.08 (± 13.05) years, 54.0% of whom were men. The incidence of delirium was 28% (n = 78). Delirium patients were older (68.9 ± 12.6 vs 58.8 ± 12.5; p <0.001) and had a higher NIHSS on admission [11 (7-15) vs 8 (5-12); p <0.001]. The occurrence of delirium was associated with a previous diagnosis of hypertension [RR = 2.62 (1.13-6.09)], hemorrhagic stroke [RR 1.94 (1.13-2.86)], cardioembolic etiology [RR 2.21 (1.22-3.97)] and infection during hospitalization [RR 5.27 (3.54-7.84)]. Independent predictors of delirium: age ≥ 65 years [OR 1.06 (1.02 -1.10)], epileptic seizures in ictus [OR 6.28 (1.65 - 23.91)], infection [OR 14.17 (6.39 - 31.43)] and hemorrhagic stroke [OR 4.04 (1.51-10.78)]. Conclusion: Delirium is a common complication after acute stroke, affecting 28% of patients. In view of the importance of identifying risk factors in the acute setting of stroke, further studies are needed to elucidate the association of the findings with the occurrence of delirium.

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"PV-004 - THE COMPLEXITY OF DUAL PATHOLOGY: REGARDING A CASE REPORT OF SEIZURES." In 24 CONGRESO DE LA SOCIEDAD ESPAÑOLA DE PATOLOGÍA DUAL. SEPD, 2022. http://dx.doi.org/10.17579/abstractbooksepd2022.pv004.

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Objectives: Wernicke's encephalopathy (WE) is a potentially reversible neuropsychiatric emergency caused by thiamine deficiency, whose classical triad consists of confusion, ataxia, and oculomotor dysfunction. The diagnosis is missed in 75-80% of cases and approximately 80% of untreated patients develop Korsakoff Syndrome, whereby recognition of nutritional deficiency or any portion of the triad should prompt treatment. We present a case of a 44-year-old Ukrainian man with suspected background of chronic alcohol abuse and psychiatric history of schizoaffective disorder, who presented with acute onset of confusion, psychomotor agitation, gait ataxia and nystagmus. Anamnesis was hampered by the language barrier and absence of past medical history and patient's alcoholic habits remained unclear. After suspicion of WE it was introduced thiamine and diazepam, with significant improvement. After discontinuation of diazepam, the patient presented with several episodes of tonic-clonic seizures. Starting from this case report, we pretend to discuss the differential diagnosis of seizures in dual pathology. Materials and methods: Clinical records and Pubmed search using the keywords: Wernicke’s Encephalopathy, Seizures, Alcohol, Benzodiazepines. Results and conclusions: Seizures are a common presentation of various conditions associated with alcohol use, whose differential diagnosis is difficult, especially in patients with dubious alcohol consumption. Alcohol abuse is a major precipitant of status epilepticus as seizure threshold is raised by alcohol drinking. Seizures may also occur during alcohol withdrawal for which treatment with benzodiazepines is recommended, however carefully, since both abrupt cessation and high-dose use are critical for the appearance of seizures. Although very rare, WE may also present with seizures, whereby overdiagnosis and overtreatment are preferred to prevent persistent neurocognitive impairments. At discharge the diagnostic discussion prevailed and the patient was medicated for seizures with clinical stabilization. The complexity of psychiatric diagnoses in dual pathology requires a longitudinal assessment for a better understanding of clinical conditions as illustrated here.

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Hsueh, Andy, Kelly Fong, Kayla Kendrics, Nadia Saddiqi, Tammy Phan, Ellen Reibling, and Brian Wolk. "Unwitting Adult Marijuana Poisoning: A Case Series." In 2021 Virtual Scientific Meeting of the Research Society on Marijuana. Research Society on Marijuana, 2022. http://dx.doi.org/10.26828/cannabis.2022.01.000.34.

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Study purpose: With increasing state legalization, marijuana use has become commonplace throughout much of the United States. This has resulted in expected and potentially dangerous consequences. Existing literature on unintentional exposure focuses primarily on the pediatric population. Despite mounting cases of unintentional exposure to marijuana, minimal research has been published on the effects of non-consensual marijuana consumption in adults. Here, we report on a cluster of adults with unwitting marijuana exposure. Methods: A cluster of patients who presented to the Emergency Department (ED) within one hour of ingesting marijuana-contaminated food at a wedding reception event were subsequently referred to the Medical Toxicology Service. We conducted a retrospective analysis of twelve subject charts who were exposed to the marijuana-contaminated food and a qualitative analysis of six of the 12 subjects’ experiences who willingly consented to be interviewed. The interviews were then analyzed and coded to categorize common themes within the subjects’ experiences. Themes categorically selected throughout the interview analysis included “Thoughts & Feelings” and “Effect on Work.” The study was approved by the Institutional Review Board. Results: Three of the subjects (25%) required prolonged observation due to persistent symptoms of acute marijuana intoxication. Eleven (92%) were urine immunoassay positive for tetrahydrocannabinol (THC). Two subjects (17%) tested positive for ethanol in their blood. None of the subjects reported a prior history of marijuana use. Common symptoms experienced by the subjects included confusion (50%), difficulty speaking (67%), nausea (25%), tremors (17%), and feelings of unreality (33%). All interviewed subjects reported sleepiness and three (50%) reported a negative impact on work. Subjects also reported multiple emotions, including anger, confusion, disbelief, and helplessness. None of the cases resulted in admission to the intensive care unit or death. Conclusions: Our case series illuminates the effects of unwitting and/or unintentional marijuana exposure in adults, with sufficient systemic effects resulting in individuals seeking emergency care. Legal and ethical barriers have limited the study of marijuana outside of controlled conditions. While the exposure in this study did not result in admission to the ICU or death, it did result in psychological distress and reported symptoms lasting weeks after the incident. As marijuana becomes readily available, the potential as an unwitting or even malicious intoxicant may increase.

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Miyahira, Clara Kimie, Beatriz Medeiros Correa, Raphael Palomo Barreira, Thomas Zurga Markus Torres, Natália Figueiredo Miranda, Natasha Soares Cutolo, Thiago da Cruz Marques, Vanessa Moraes Rossette, and Eduardo de Almeida Guimarães Nogueira. "Polyradiculoneuropathy and encephalitis secondary to sarcoidosis in young patient." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.288.

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Context: Neurosarcoidosis is common in 50-70% of cases of sarcoidosis, but polyradiculoptia in sarcoidosis is rare in 1.3% of cases. Case Report: a 48-year- old woman diagnosed with Sarcoidosis after skin, evolved with sporadic paresthesia of the lower limbs. The use of Methotrexate controlled the disease. However, she developed acute pancreatitis secondary to the treatment and suspended it. After 2 months, the patient presented paraparesis. In view of probable polyradiculoneuropathy, Human Immunoglobulin was administered. However, she evolved with mental confusion, flaccid tetraparesis and global arreflexia. CT of skull showed paramedian bridge hypodensity and left cerebellum, suggestive of vasculitis, and normal liquor. Methylprednisolone was administered. And despite the treatment, patient worsened with decreased level of consciousness and respiratory failure. MRI of skull showed hypersignal in bilateral temporal region, suggesting viral encephalitis secondary to immunosuppression, after methylprednisolone and immunoglobulin. Thus, Aciclovir was administered and there was improvement in the use of BIPAP. Discussion: Other differential diagnoses were considered: Guillain-Barré syndrome, inflammatory and chronic demyelinating polyneuropathies, spirochete infections, fungi or toxoplasmosis. The diagnosis of neurosarcoidosis is mainly due to MRI, high sensitivity and low specificity. Neural tissue biopsy is gold standard, but difficult to access. Conclusion: This clinical history shows an atypical involvement of the Central and Peripheral Nervous System for sarcoidosis: a viral encephalitis after polyradiculopathy and vasculitis treated.

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Amaral Neto, Antonio Serpa do, Eduarda Jaskulski, Eduardo Martins Leal, Matheus Marquardt, Gabriel de Deus Vieira, and Joana Capano Hawerroth. "Neurotuberculosis with intracerebral tuberculoma and PCR for detectable Mycobacterium in CSF." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.710.

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Introduction: Neurotuberculosis is the most serious form of extrapulmonary tuberculosis. The main clinical presentation is meningoencephalitis, which may be associated with tuberculomas. The detection of Mycobacterium tuberculosis by CSF in CSF is still a diagnostic challenge. Objectives: To report a clinical case of neurotuberculosis associated with intracranial tuberculoma with detection of Mycobacterium tuberculosis by CSF in CSF. Methods: Neurotuberculosis is the most serious form of extrapulmonary tuberculosis. The main clinical presentation is meningoencephalitis, which may be associated with tuberculomas. The detection of Mycobacterium tuberculosis by CSF in CSF is still a diagnostic challenge. Results: C. A. G., 45 years old, female, admitted to the hospital in January 2020, presenting holocranial, pulsatile headache, which had worsened for 5 days, with little response to analgesics, associated with an episode of tonic-clonic seizure crisis, without other clinical signs. Previous diagnosis of asthma, using continuously salbutamol and beclomethasone. Examinations were requested - BAAR search for positive sputum, rapid molecular sputum test revealing Mycobacterium tuberculosis, clear-looking CSF, detectable CRP for Mycobacterium tuberculosis, glucose 63, protein 56.3, total cytology 74 (35% neutrophils, 19% lymphocytes , 46% macrophages). The cranial tomography showed a nodular lesion in the corticosubcortical region of the left frontal lobe, with annular enhancement by means of contrast, measuring 3.9 x 3.9 cm, in addition to accentuated meningeal enhancement. Chest tomography showed hollowed-out lesions with thickened walls, with the appearance of a sprouting tree, predominating in the lower lobe of the right lung. The diagnoses of neurotuberculosis (cerebral tuberculoma and meningitis) and pulmonary tuberculosis were then established. Referred to the infectious disease referral hospital using RHZE associated with dexamethasone and phenytoin. After 48 hours of hospitalization, the patient evolved with confusion and mental disorientation, suspecting complex subentrant partial seizures with a confused post-ictal state. A new skull tomography was requested, which showed an expansive lesion with an ovoid aspect 4.5 x 3.3 cm with liquefied content and ring impregnation by means of contrast in the upper left frontal region with mass effect and significant perilesional edema. Electroencephalogram showed disorganized base activity, periodically, sometimes with three-phase morphology, sometimes acute, in both hemispheres, with greater projection to the left and epileptiform activity also in the frontal- temporal region, bilaterally and independently. After therapeutic adjustment, the patient remained clinically stable and was discharged from the hospital with outpatient followup due to infectious diseases and neurology. Conclusion: The case addressed draws attention to the different neurological manifestations observed in neurotuberculosis, such as headache, seizures, confusion and disorientation. Early diagnosis and treatment is important to achieve a favorable outcome.

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Heredia, M., JL Sanchez, MC Conde, B. Proy, C. Notario, and JC Valenzuela. "CP-148 Acute confusional state: case report." In 22nd EAHP Congress 22–24 March 2017 Cannes, France. British Medical Journal Publishing Group, 2017. http://dx.doi.org/10.1136/ejhpharm-2017-000640.147.

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Reports on the topic "Acute confusion"

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Quak, Evert-jan. Lessons Learned from Community-based Management of Acute Malnutrition (CMAM) Programmes that Operate in Fragile or Conflict Affected Settings. Institute of Development Studies (IDS), September 2021. http://dx.doi.org/10.19088/k4d.2021.133.

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This rapid review synthesises the literature on how community-based management of acute malnutrition (CMAM) programmes could be adapted in settings of conflict and fragility. It identifies multiple factors affecting the quality and effectiveness of CMAM services including the health system, community engagement and linkages with other programmes, including education, sanitation, and early childhood development. Family MUAC (Mid-Upper Arm Circumference) is a useful tool to increase community participation and detect early cases of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) more effectively and less likely to require inpatient care. The literature does not say a lot about m-Health solutions (using mobile devises and applications) in data collection and surveillance systems. Many of the above-mentioned issues are relevant for CMAM programmes in settings of non-emergency, emergency, conflict and fragility. However, there are special circumstance in conflict and fragile settings that need adaptation and simplification of the standard protocols. Because of a broken or partly broken health system in settings of conflict and fragility, local governments are not able to fund access to adequate inpatient and outpatient treatment centres. NGOs and humanitarian agencies are often able to set up stand-alone outpatient therapeutic programmes or mobile centres in the most affected regions. The training of community health volunteers (CHVs) is important and implementing Family MUAC. Importantly, research shows that: Low literacy of CHVs is not a problem to achieve good nutritional outcomes as long as protocols are simplified. Combined/simplified protocols are not inferior to standard protocols. However, due to complexities and low funding, treatment is focused on SAM and availability for children with MAM is far less prioritised, until they deteriorate to SAM. There is widespread confusion about combined/simplified protocol terminology and content, because there is no coherence at the global level.

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MacFarlane, Andrew. 2021 medical student essay prize winner - A case of grief. Society for Academic Primary Care, July 2021. http://dx.doi.org/10.37361/medstudessay.2021.1.1.

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As a student undertaking a Longitudinal Integrated Clerkship (LIC)1 based in a GP practice in a rural community in the North of Scotland, I have been lucky to be given responsibility and my own clinic lists. Every day I conduct consultations that change my practice: the challenge of clinically applying the theory I have studied, controlling a consultation and efficiently exploring a patient's problems, empathising with and empowering them to play a part in their own care2 – and most difficult I feel – dealing with the vast amount of uncertainty that medicine, and particularly primary care, presents to both clinician and patient. I initially consulted with a lady in her 60s who attended with her husband, complaining of severe lower back pain who was very difficult to assess due to her pain level. Her husband was understandably concerned about the degree of pain she was in. After assessment and discussion with one of the GPs, we agreed some pain relief and a physio assessment in the next few days would be a practical plan. The patient had one red flag, some leg weakness and numbness, which was her ‘normal’ on account of her multiple sclerosis. At the physio assessment a few days later, the physio felt things were worse and some urgent bloods were ordered, unfortunately finding raised cancer and inflammatory markers. A CT scan of the lung found widespread cancer, a later CT of the head after some developing some acute confusion found brain metastases, and a week and a half after presenting to me, the patient sadly died in hospital. While that was all impactful enough on me, it was the follow-up appointment with the husband who attended on the last triage slot of the evening two weeks later that I found completely altered my understanding of grief and the mourning of a loved one. The husband had asked to speak to a Andrew MacFarlane Year 3 ScotGEM Medical Student 2 doctor just to talk about what had happened to his wife. The GP decided that it would be better if he came into the practice - strictly he probably should have been consulted with over the phone due to coronavirus restrictions - but he was asked what he would prefer and he opted to come in. I sat in on the consultation, I had been helping with any examinations the triage doctor needed and I recognised that this was the husband of the lady I had seen a few weeks earlier. He came in and sat down, head lowered, hands fiddling with the zip on his jacket, trying to find what to say. The GP sat, turned so that they were opposite each other with no desk between them - I was seated off to the side, an onlooker, but acknowledged by the patient with a kind nod when he entered the room. The GP asked gently, “How are you doing?” and roughly 30 seconds passed (a long time in a conversation) before the patient spoke. “I just really miss her…” he whispered with great effort, “I don’t understand how this all happened.” Over the next 45 minutes, he spoke about his wife, how much pain she had been in, the rapid deterioration he witnessed, the cancer being found, and cruelly how she had passed away after he had gone home to get some rest after being by her bedside all day in the hospital. He talked about how they had met, how much he missed her, how empty the house felt without her, and asking himself and us how he was meant to move forward with his life. He had a lot of questions for us, and for himself. Had we missed anything – had he missed anything? The GP really just listened for almost the whole consultation, speaking to him gently, reassuring him that this wasn’t his or anyone’s fault. She stated that this was an awful time for him and that what he was feeling was entirely normal and something we will all universally go through. She emphasised that while it wasn’t helpful at the moment, that things would get better over time.3 He was really glad I was there – having shared a consultation with his wife and I – he thanked me emphatically even though I felt like I hadn’t really helped at all. After some tears, frequent moments of silence and a lot of questions, he left having gotten a lot off his chest. “You just have to listen to people, be there for them as they go through things, and answer their questions as best you can” urged my GP as we discussed the case when the patient left. Almost all family caregivers contact their GP with regards to grief and this consultation really made me realise how important an aspect of my practice it will be in the future.4 It has also made me reflect on the emphasis on undergraduate teaching around ‘breaking bad news’ to patients, but nothing taught about when patients are in the process of grieving further down the line.5 The skill Andrew MacFarlane Year 3 ScotGEM Medical Student 3 required to manage a grieving patient is not one limited to general practice. Patients may grieve the loss of function from acute trauma through to chronic illness in all specialties of medicine - in addition to ‘traditional’ grief from loss of family or friends.6 There wasn’t anything ‘medical’ in the consultation, but I came away from it with a real sense of purpose as to why this career is such a privilege. We look after patients so they can spend as much quality time as they are given with their loved ones, and their loved ones are the ones we care for after they are gone. We as doctors are the constant, and we have to meet patients with compassion at their most difficult times – because it is as much a part of the job as the knowledge and the science – and it is the part of us that patients will remember long after they leave our clinic room. Word Count: 993 words References 1. ScotGEM MBChB - Subjects - University of St Andrews [Internet]. [cited 2021 Mar 27]. Available from: https://www.st-andrews.ac.uk/subjects/medicine/scotgem-mbchb/ 2. Shared decision making in realistic medicine: what works - gov.scot [Internet]. [cited 2021 Mar 27]. Available from: https://www.gov.scot/publications/works-support-promote-shared-decisionmaking-synthesis-recent-evidence/pages/1/ 3. Ghesquiere AR, Patel SR, Kaplan DB, Bruce ML. Primary care providers’ bereavement care practices: Recommendations for research directions. Int J Geriatr Psychiatry. 2014 Dec;29(12):1221–9. 4. Nielsen MK, Christensen K, Neergaard MA, Bidstrup PE, Guldin M-B. Grief symptoms and primary care use: a prospective study of family caregivers. BJGP Open [Internet]. 2020 Aug 1 [cited 2021 Mar 27];4(3). Available from: https://bjgpopen.org/content/4/3/bjgpopen20X101063 5. O’Connor M, Breen LJ. General Practitioners’ experiences of bereavement care and their educational support needs: a qualitative study. BMC Medical Education. 2014 Mar 27;14(1):59. 6. Sikstrom L, Saikaly R, Ferguson G, Mosher PJ, Bonato S, Soklaridis S. Being there: A scoping review of grief support training in medical education. PLOS ONE. 2019 Nov 27;14(11):e0224325.

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