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Segrest, Charles Austin. "Delirium Tremens." Digital Archive @ GSU, 2009. http://digitalarchive.gsu.edu/english_theses/57.
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These poems tell lyrical stories primarily about violence, language, loss and love. Often with an edge of nightmare, they capture the voices of fringe characters in a variety of settings and circumstances. The poems also deal with books, history, family, ritual/myth and the natural world.
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Siddiqi, Najma. "A complex intervention for delirium, preventing delirium in care homes." Thesis, University of Leeds, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.511151.
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Machado, Sara Alexandra Fernandes. "Delirium do idoso." Master's thesis, Faculdade de Medicina da Universidade do Porto, 2009. http://hdl.handle.net/10216/53774.
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Machado, Sara Alexandra Fernandes. "Delirium do idoso." Dissertação, Faculdade de Medicina da Universidade do Porto, 2009. http://hdl.handle.net/10216/53774.
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Bäcke, My, and Ida Lindström. "Delirium - En litteraturstudie om äldre patienters upplevelser i samband med delirium." Thesis, Umeå universitet, Institutionen för omvårdnad, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-100801.
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Bastos, Alessandra Soler. "Sedação, gravidade, mortalidade, delirium subsindromático e delirium em pacientes de terapia intensinva." Faculdade de Medicina de São José do Rio Preto, 2017. http://hdl.handle.net/tede/383.
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Previous issue date: 2017-06-28<br>Introduction: The use of sedation in critically ill patients is necessary because it provides anxiolysis, aminosia, and comfort when mechanically ventilated. However, it may be a risk factor for the development of delirium in these patients, increasing length of hospital stay and mortality. Objective: To identify delirium and subsyndromal delirium in critically ill patients and to associate it with age, length of hospital stay, mortality, sedation administered, medical specialty of hospitalization and predictive scale of mortality Sepse Related Organ Failure Assessment. Methods: A cross-sectional study was conducted in a teaching hospital with 157 patients using the Richmond Agitation-Sedation Scale for sedation evaluation and Intensive Care Deli¬rium Screening Checklist for delirium evaluation. Results: Most patients presented subsyndromal delirium. The relationship between delirium and the subindromous with the time of intensive care hospitalization was statistically significant for both, while age was significant only in subsyndromatics. The most commonly used sedatives were fentanyl, midazolan, propofol and clonidine. There were significant differences between delirium and clonidine use, and subsindromatic delirium with fentanyl and midazolan. Most were discharged from the intensive care unit and the main medical specialty was neurosurgery. There were no significant differences between mortality, occurrence of discharge and death and medical specialty. Conclusion: The daily evaluation by nurses for identification and monitoring of subsyndromal delirium in intensive care patients assists in the adoption of measures that minimize the stressors that trigger delirium. The evaluation of the use of sedation by the nurse is necessary since the patients who used some sedative presented more delirium than those who did not use.<br>Introducción: El uso de sedación en pacientes críticos es necesario pues proporciona ansiólisis, amnesia, y confort cuando son ventilados mecánicamente. Pero puede ser un factor de riesgo para el desarrollo de delirium en ellos, aumentando el tiempo de internación hospitalaria y mortalidad. Objetivo: Identificar delirium y delirium subsindromático en pacientes críticos y asociar a la edad, tiempo de internación, mortalidad, sedación administrada, especialidad médica de la internación y escala predictora de mortalidad Sepse Related Organ Failure Assessment. Métodos: Estudio transversal, realizado en un hospital de enseñanza, con 157 pacientes, utilizando las escalas Richmond Agitation-Sedation Scale para la evaluación de la sedación e Intensive Care Delihrio Screening Checklist para la evaluación del delirium. Resultados: La mayoría de los pacientes presentó delirium subsindromático. La relación entre el delirium y el subsindromático con el tiempo de internación en terapia intensiva fue estadísticamente significante para ambos, mientras que la edad fue significativa sólo en el subsindromático. Los sedantes más utilizados fueron fentanil, midazolan, propofol y clonidina. Hubo diferencias significativas entre delirium y uso de clonidina, y delirium subsindromático con fentanil y midazolan. La mayoría recibió alta de la unidad de terapia intensiva y la principal especialidad médica fue neurocirugía. No hubo diferencias significativas entre mortalidad, ocurrencia de alta y muerte y especialidad médica. Conclusión: La evaluación diaria hecha por enfermeros para identificación y monitoreo del delirium subsindromático en pacientes de terapia intensiva auxilia en la adopción de medidas que minimicen los factores estresantes desencadenantes del delirium. La evaluación del uso de sedación por el enfermero se hace necesaria ya que los pacientes que hicieron uso de algún sedante presentaron más delirium que aquellos que no hicieron uso.<br>Introdução: O uso de sedação em pacientes críticos é necessário pois proporciona ansiólise, aminésia, e conforto quando ventilados mecanicamente. Porém pode ser um fator de risco para desenvolvimento de delirium nesses, aumentando tempo de internação hospitalar e mortalidade. Objetivo: Identificar delirium e delirium subsindromático em pacientes críticos e associar à idade, tempo de internação, mortalidade, sedação administrada, especialidade médica da internação e escala preditora de mortalidade Sepse Related Organ Failure Assessment. Métodos: Estudo transversal, realizado em hospital de ensino, com 157 pacientes, utilizando as escalas, Richmond Agitation-Sedation Scale para avaliação da sedação e Intensive Care Delirium Screening Checklist para avaliação do delirium. Resultados: A maioria dos pacientes apresentou delirium subsindromático. A relação entre o delirium e o subsindromático com o tempo de internação em terapia intensiva foi estatisticamente significante para ambos, enquanto a idade foi significativa apenas no subsindromático. Os sedativos mais utilizados foram fentanil, midazolan, propofol e clonidina. Houve diferenças significativas entre delirium e uso de clonidina, e delirium subsindromático com fentanil e midazolan. A maioria recebeu alta da unidade de terapia intensiva e a principal especialidade médica foi neurocirurgia. Não houve diferenças significativas entre mortalidade, ocorrência de alta e óbito e especialidade médica. Conclusão: A avaliação diária feita por enfermeiros para identificação e monitoração do delirium subsindromático em pacientes de terapia intensiva auxilia na adoção de medidas que minimizem os fatores estressores desencadeantes do delirium. A avaliação do uso de sedação pelo enfermeiro se faz necessária visto que o os pacientes que fizeram uso de algum sedativo apresentaram mais delirium do que aqueles que não fizeram uso.
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Germain, Marcel. "La réversibilité du delirium." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0019/MQ61758.pdf.
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Germain, Marcel. "La réversibilité du delirium." 2Sherbrooke : Université de Sherbrooke, 2000.
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Kilsand, Kristina. "Svårigheter att upptäcka delirium hos intensivvårdspatienten och konsekvenser av ett oupptäckt delirium : en litteraturöversikt." Thesis, Sophiahemmet Högskola, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-2966.
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Åtskilliga studier har visat att delirium inom intensivvård är vanligt förekommande. Så många som 80 procent av alla vuxna patienter som behandlas med respirator på en intensivvårdsavdelning drabbas av någon form. Risken att en intensivvårdspatient utvecklar ett delirium kan minskas genom att sjuksköterskan har i åtanke och försöker hantera och behandla de riskfaktorer patienten har men för att upptäcka och behandla ett delirium måste patienten screenas regelbundet. Det finns validerade instrument och behandling som gör det möjligt att såväl förebygga som upptäcka och behandla ett delirium. Trots det är det inte ovanligt att ett delirium passerar oupptäckt på IVA. Syftet med studien var att belysa varför patienter med ett delirium inte identifieras av intensivvårdssjuksköterskan och vilka konsekvenser ett oupptäckt delirium kan medföra för patienten. Metoden som användes var en allmän litteraturöversikts. Resultatet visade att delirium är vanligt förekommande och kan innebära stora konsekvenser för de patienter som drabbas av ett delirium. Det finns en kunskapslucka hos intensivvårdssjuksköterskan om delirium och dess konsekvenser. Många sjuksköterskor efterfrågar utbildning om delirium då flera beskriver att de aldrig fått någon undervisning i ämnet. Det saknas även kunskap hos intensivvårdssjuksköterskan om vilka konsekvenser ett delirium kan innebära för patienterna i såväl det akuta skedet som efter IVA. Studien pekar även på att det finns en bristande tilltro och kunskap om screeninginstrument. Det behövs mer utbildning och riktlinjer om hur de olika screeninginstrumenten ska användas och då inte enbart vid implementeringen. Slutsats: Det finns en kunskapslucka hos intensivvårdssjuksköterskan beträffande delirium och dess konsekvenser men även en bristande tilltro till de screeninginstrument som finns. Studien visade att ett delirium kan innebära risker för patienten med komplikationer såväl under som efter intensivvårdsbehovet men även en ökad dödlighet men genom att arbeta evidensbaserat kan vi minska ett onödigt lidande hos intensivvårdspatienten.
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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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<p>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.</p>
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Sörensen, Duppils Gill. "Delirium during hospitalisation : incidence, risk factors, early signs and patients' experiences of being delirious /." Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3814.
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Johansson, Caroline, and Anna Nordenberg. "Hur kan intensivvårdssjuksköterskan förebygga delirium?" Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-255573.
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Bakgrund: Delirium är ett vanligt tillstånd hos patienter på intensivvårdsavdelning (IVA) och kännetecknas av en akut förändring eller variation i patientens mentala status. Tillståndet är mycket underdiagnostiserat, trots vedertagna bedömningsinstrument. Flertalet riskfaktorer är identifierade och innefattar patientens tidigare sjukdomar och levnadsvanor, aktuellt sjukdomstillstånd och den omgivande miljön. Delirium leder till ett lidande för patienten och har även negativa konsekvenser för samhället. Syfte: Att studera vilka omvårdnadsåtgärder som visats vara effektiva för att förebygga delirium och därmed kunna lindra lidande. Metod: Litteraturstudie. Resultat: De omvårdnadsåtgärder som visades kunna förebygga delirium resulterade i tre huvudområden. Inom "Sömn, ljud och ljus" ledde åtgärder som reducerade ljud- och ljusnivåer samt samordning av omvårdnadsåtgärder nattetid till förbättring av patienternas nattsömn och lägre incidens och duration av delirium. Att vårdas på enkelrum och tillgång till dagsljus ledde till lägre incidens och duration av delirium. Inom området "Vakenhet" ledde minskad sedering och införande av så kallade sederingsprotokoll till lägre incidens och duration av delirium. Tidig mobilisering ledde till lägre duration av delirium. Inom det sista området "Orientering och närstående" visades att reorientering av patienterna ledde till lägre incidens och duration av delirium och att involvera närstående i omvårdnaden ledde till att patienterna hade en bättre psykisk återhämtning vid utskrivning från IVA. Slutsats: Det har framkommit att omvårdnadsåtgärder kan förebygga delirium på en intensivvårdsavdelning. Dessa åtgärder är kliniskt tillämpbara och kan gynna såväl patienter som samhället.
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Hatherill, Sean. "Delirium in children and adolescents." Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/2797.
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Jonsson, Adam, and Leila Maye. "Upplevelse av delirium. : En litteraturstudie." Thesis, Umeå universitet, Institutionen för omvårdnad, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-182248.
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Bakgrund: Delirium är en neuropsykiatrisk störning som främst påverkar förmågan att meningsfullt uppmärksamma och tolka stimuli. Tillståndet upplevs ofta som mycket skrämmande och förvirrande, med långt bestående minnen av upplevelsen som kan vara mycket plågsamma. Det råder stor brist på kunskap gällande erfarenheter av detta tillstånd trots data på hur allvarligt tillståndet är och dess konsekvenser. Syfte: Denna studie har som syfte att beskriva patienters erfarenheter av delirium. Metod: Litteraturstudie på nio kvalitativa artiklar. Forskningsartiklar har utvärderats, kvalitets granskats och analyserats enligt kvalitativ metodik. Resultat: Delirium är ett syndrom med många oförklarliga upplevelser och ett syndrom som väcker många känslor. Tre Kategorier presenteras; att existera i kaos, ett utdraget lidande för patienten samt en önskan att förstå och bli förstådd. Kategorierna delades in i sex underkategorier; att känna sig vilsen, obegripliga upplevelser, rädslans olika former, bärande av skam och skuld från delirium, behovet av stöd hos den sårbara och behovet att få information Slutsats: Delirium är ofta mycket kaotiskt, ångestfyllt och utgöra en kraftig barriär mellan den sjuke och omvärlden. Tillståndet kan sätta djupa spår emotionellt och innebära långsiktiga konsekvenser. Involvering av anhöriga, utbildning av personal, miljöanpassning och extra stöd skulle kunna göra signifikant skillnad för denna sårbara patientgrupp.<br>Background: Delirium is a neuropsychiatric disorder that primarily affects the ability to notice and meaningfully interpret stimuli. The lived experience of delirium can be very frightening and confusing, with long lasting memories of the experience that can be very agonizing. There is a large gap in current literature regarding the lived experience of delirium, despite the severity of the condition and its consequences. Purpose: This study's purpose is to describe patients' lived experience of delirium. Method: Literature study on nine qualitative articles. Research articles have been evaluated, quality checked and analyzed according to qualitative methodology. Result: Delirium is a syndrome with many unexplained experiences and is a syndrome that evokes many feelings. Three categories are presented; To exist in chaos, the feeling of being lost and a need for understanding. The categories were further explored in six sub-categories; Feeling lost, incomprehensible experiences, different forms of fear, carrying shame and guilt from delirium, the vulnerable person’s need for support and the need for information. Conclusion: A delirium is often very chaotic and anxiety filled, creating a serious barrier between the person suffering a delirium and the surrounding world. Delirium can leave deep emotional marks and cause long term consequences. Involvement of next of kin, education of staff, environmental adaptation and additional support could mean a significant difference for this patient groups long term health.
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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.<br>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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Arwidson, Marina, and Hanna Engstrand. "DELIRIUM I INTENSIVVÅRD : En empirisk studie om intensivvårdssjuksköterskors erfarenheter av att vårda patienter med delirium." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-54247.
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Bakgrund: Delirium är ett tillstånd som kan drabba patienter inneliggande på intensivvårdsavdelningar. En stor del patienter riskerar att drabbas, orsaken är inte helt känd men många riskfaktorer och konsekvenser är identifierade. Delirium kan ge upphov till olika symtom som kan resultera i utåtagerande patienter. Detta kan försvåra intensivvårdssjuksköterskors arbete med att vårda dessa patienter, på grund av både fysiska och mentala påfrestningar. Syfte: Syftet är att beskriva intensivvårdssjuksköterskors erfarenheter av att vårda patienter med delirium. Metod: Kvalitativ intervjustudie med elva intensivvårdssjuksköterskor från tre sjukhus i Mellansverige. Data analyserades enligt manifest innehållsanalys. Resultat: I resultatet uppstod tre kategorier; att upptäcka delirium, att förebygga delirium, och att hantera delirium. Slutsats: Att vårda patienter med delirium är svårt och komplext. Möjligheter och förutsättningar för att ge patienter bästa möjliga vård kräver tid, engagemang och ett väl fungerande teamarbete.
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Ferreira, Gustafsson Marcelo. "Delirium : From the depths of mania." Thesis, Konstfack, Ädellab/Metallformgivning, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:konstfack:diva-6309.
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This document explores and expands my perspective on dealing with mental health issues, grieving and sorrow through a material based practice. It portrays private spaces that grows and seeks universal connections. Feelings that is persevered between layers that takes physical form between the skin and the fabric. Adornments manifests themselves through the body, and when they are passive and sleeping, they dream of belonging.
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Fuller, Valerie J., and Valerie J. Fuller. "The Patient Experience of Postoperative Delirium." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/625719.
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Background: Postoperative delirium (POD) is a common neurocognitive disorder in patients undergoing surgical procedures. Delirium is a disorder that is poorly understood, frequently unrecognized and associated with numerous adverse outcomes including longer hospital stays, significantly higher costs and increased morbidity and mortality. While there has been a great deal of research on proposed etiologies, risk factors and outcomes of delirium, few studies have explored the patient’s subjective experience of the phenomenon.
Purpose: The purpose of this qualitative descriptive research was to investigate the patient experience of postoperative delirium and measure the distress associated with the experience. The Delirium Symptoms Experience Model (DSEM) provided the theoretical framework in which to understand the postoperative delirium experience. The three specific aims used to guide the investigation were: 1) Identify patient age, gender, race, type and length of surgery, past medical and surgical history, length of admission, delirium subtype (if known), and medications (including anesthetic agents) used in the perioperative period to better characterize the sample and provide context for the qualitative findings; 2) Describe the postoperative patients’ experience of being and feeling delirious; and, 3) Measure the distress associated with the recall of delirium using the Delirium Experience Questionnaire (DEQ)
Methods: Ten participants ranging in age from 33-75 years (mean = 66.2 years of age) who experienced postoperative delirium were interviewed. Patients were screened for persistent delirium or cognitive impairment as assessed with the Confusion Assessment Method and the Mini-Cog™ Instruments.
Results: Three organizing themes emerged from the content analysis: 1) Altered Perceptions of Reality; 2) Stuck in the Confusion; and, 3) Seeking Reality. The analysis of the quantitative measures and descriptive data demonstrated a high rate of psychological distress associated with delirium recall with 80% participants reporting it caused severe to very severe distress. The anesthetic drug propofol was the common medication prescribed in the perioperative period and given to all ten participants.
Conclusion: Understanding this phenomenon from the patients’ perspective may provide a better understanding of the delirium experience and aid in the development of interventions and treatments to improve care and reduce suffering.
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Schneider, Moritz [Verfasser]. "Das frühe postoperative Delirium : Vergleich des Nursing Delirium Screening Scale und der Confusion Assessment Method / Moritz Schneider." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2009. http://d-nb.info/1027813674/34.
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Silva, Patrícia da Conceição Salvadinha da. "Promoção da segurança do doente cirúrgico com delirium." Master's thesis, Universidade de Évora, 2018. http://hdl.handle.net/10174/23288.
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Com a elaboração deste Relatório de Estágio pretende-se refletir crítica e fundamentadamente sobre
as práticas desenvolvidas ao longo da Unidade Curricular Estágio Final. Neste, será enfatizado o processo
de aquisição e desenvolvimento das competências do Mestre em Enfermagem, assim como das competências
comuns e específicas do Enfermeiro Especialista em Enfermagem Médico-cirúrgica, na vertente
da pessoa em situação crítica.
Constituindo-se como a complicação mais frequente no pós-operatório em idosos, da qual decorrem
importantes complicações a curto e longo prazo, o delirium assume-se como um grave problema de saúde
e de segurança do doente. Importam então implementar medidas multicomponentes de enfermagem na
abordagem a estes doentes como forma a melhorar os cuidados prestados, promovendo simultaneamente
a sua segurança. Nesta lógica, foi desenvolvida uma intervenção de maior relevância junto de doentes
cirúrgicos com delirium e cujas estratégias de intervenção se descrevem neste relatório; Safety promotion of the surgical patient with delirium ABSTRACT:
With this final paper elaboration, it is intended to reflect critically and founded on the practices developed
throughout the Course Final Stage. In this report the acquisition process and development of
master’s degree competences will be emphasized, as well as general and specific specialist nurse competences
in Medical-Surgical, in the scope of the person in critical situation.
As one of the most common postoperative complication among older patients, which as been causing
important short- and long-term complications, delirium is a serious health and safety problem for the
patient.
It is important to implement multi-component nursing measures in the approach to these patients
in order to improve care while promoting their safety. In this logic, a more relevant intervention was
developed among surgical patients with delirium and whose intervention strategies are described in this
report.
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Gabriel, Alexander. "Phänomenologie des Delirs : neuropsychologische und psychopathologische Differenzierung des Delirsyndroms /." Saarbrücken : VDM Verlag Dr. Müller, 2008. http://opac.nebis.ch/cgi-bin/showAbstract.pl?u20=9783836482615.
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Englesson, Karin, and Anna Maria Lundgren. "Sjuksköterskans upplevelse av att bedöma delirium på en intensivvårdsavdelning med hjälp av The Nursing Delirium Screening Scale (NuDesc)." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-254628.
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SAMMANFATTNING Syftet med studien var att studera hur sjuksköterskan inom intensivvård använder NuDesc(The Nursing Delirium Screening Scale) och om de anser sig ha tillräcklig kunskap för attbedöma delirium med hjälp av NuDesc. Studien är en kvantitativ tvärsnittsstudie med datainsamling via en enkät som konstrueratsspeciellt för denna studie. Enkäten besvarades av 15 intensivvårdssjuksköterskor på ettuniversitetssjukhus i Mellansverige. Resultatet visade att bedöma delirium på en intensivvårdsavdelning uppfattas avrespondenterna som ganska svårt även om de tycker sig ha tillräckligt med kompetens attanvända bedömningsinstrument NuDesc. Den psykomotoriska förlångsamningen tillsammansmed hallucinationer/ illusioner uppfattas av sjuksköterskorna som svårast att bedöma.<br>ABSTRACT The aim of the study was to examine how the nurse in intensive care use NuDesc (TheNursing Delirium Screening Scale) and if they feel they have sufficient knowledge to assessdelirium using NuDesc. The study is a quantitative cross-sectional study with data collection through a questionnairedesigned specifically for this study. The survey was answered by 15 ICU nurses at auniversity hospital in central Sweden. The results showed that to assess delirium in intensive care was perceived by respondents tobe quite difficult even if they think they have enough skills to use the assessment instrumentNuDesc. Psychomotor retardation with illusions/ hallucinations are perceived by nurses as themost difficult to assess.
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Seeling, Matthes [Verfasser]. "Validierung der Nursing Delirium Scale und der Delirium Detection Scale zur Detektion des frühen postoperativen Delirs / Matthes Seeling." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2009. http://d-nb.info/1023400863/34.
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Cardholm, Ann-Christin. "Postoperativt delirium efter höftfraktur : Prevention och bemötande." Thesis, Stockholm University, Department of Education in Arts and Professions, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-8673.
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<p>Akut förvirring hos höftfrakturpatienter är vanlig. Den akuta förvirringen kan förebyggas eller kortas och rehabiliteringstiden kan då också kortas. Ett förvirringstillstånd innebär stora påfrestningar på kroppen. Syftet med denna litteraturstudie är att se hur litteraturen beskriver hur man kan ge en god postoperativ omvårdnad och ett gott bemötande till de patienter som drabbas eller riskerar att drabbas av postoperativ förvirring. Till grund för arbetet ligger ett antal vetenskapliga artiklar samt facklitteratur. Trots att den postoperativa förvirringen är mycket vanlig, att den orsakar stort lidande och stora vårdkostnader, saknas tillfredsställande studier som kan ligga till grund för farmakologiska behandlingsrekommendationer. Oaktat detta ges ofta farmaka till dessa patienter. Enligt litteraturen har sjuksköterskans möte med den deliriösa patienten stor betydelse för att förebygga och lindra ett förvirringsbeteende. Eftersom det saknas riktlinjer för omvårdnad av akut förvirrade patienter beror det på den enskilda sjuksköterskans bemötande hur mötet med patienten blir. Den postoperativa förvirringen måste lyftas fram eftersom antalet patienter med höftfrakturer ständigt ökar. Rutiner och vårdprogram måste tas fram eller ses över. Vi måste lära oss att bemöta dessa patienter på ett professionellt sätt. Att möta den förvirrade höftledspatienten på ett etiskt och förberett sätt är en förutsättning för en bra vård.</p>
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Lemos, Maria João. "O delirium no idoso em contexto hospitalar." Master's thesis, [s.n.], 2012. http://hdl.handle.net/10400.26/16030.
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Mestrado, Enfermagem Médico Cirurgica - Pessoa Idosa, 2012, Escola Superior de Enfermagem de Lisboa<br>O crescimento exponencial da população idosa, ocorre simultaneamente com o
aumento da incidência das doenças crónicas e consequente hospitalização da
população idosa. A pessoa idosa em contexto hospitalar tem grande probabilidade de
desenvolver delirium, sendo fundamental o seu correto diagnóstico para que as
intervenções adequadas a cada caso, sejam aplicadas o mais precocemente possível,
com vista a minimizar as complicações adjacentes a este problema. Desta forma, foi
importante e pertinente a realização deste projeto no serviço de Medicina de um
Hospital Central de Lisboa, uma vez que não existia um instrumento de avaliação nem
se utilizavam intervenções de enfermagem de uma forma uniformizada.
Este projeto teve como objetivos desenvolver competências como enfermeira
especialista na área da especialização à pessoa idosa e promover o Cuidado de Si na
pessoa idosa com delirium, utilizando o modelo de parceria na intervenção de
enfermagem. O mesmo decorreu no período de outubro de 2011 a janeiro de 2012 e o
seu desenvolvimento foi assente na metodologia de projeto, que tem o seu foco na
resolução de problemas. A análise dos dados foi feita através da análise de conteúdo e
estatística descritiva. Como participantes, este projeto teve 17 enfermeiros e 10 idosos
internados, cujo diagnóstico de delirium foi efetuado através do “Algoritmo de
diagnóstico” da Confusion Assessment Method (CAM). Foi também efetuado um
levantamento das intervenções de enfermagem adequadas e, paralelamente, foram
transmitidos e refletidos conhecimentos relativamente aos factores de risco, factores
precipitantes e medidas preventivas, de forma a capacitar a equipa para a prestação de
cuidados que visam minimizar a ocorrência de episódios de delirium.
Os resultados da avaliação mostraram uma adesão à utilização da CAM em
100% dos casos de confusão aguda, um aumento de 50% do tipo de intervenções
utilizadas e um aumento dos registos das práticas dos cuidados diferenciados,
permitindo desta forma uma continuidade dos mesmos. As intervenções efetuadas em
parceria com a pessoa idosa/família, revelaram-se fundamentais para a promoção do
Cuidado de Si, pelo que se tornou uma prática nos cuidados de enfermagem uma vez
que foi possível observar as implicações diretas na melhoria dos quadros de delirium.
Palavras-chave: pessoa idosa; delirium; intervenções de enfermagem; hospitalização;
parceria; promoção do cuidado de si.
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Kakuma, Ritsuko. "Delirium in the elderly : a survival analysis." Thesis, McGill University, 2000. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=33414.
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Mortality rates have consistently been shown to be greater in patients with delirium compared to those without. Published work over the last decade has revealed however, that several confounding factors play key roles in contributing to the excess mortality in the delirium population and that statistical adjustment for these factors in multivariate analyses minimizes, if not eliminates, the association between delirium and mortality. These factors include pre-existing dementia, advanced age, severe medical illness, diminished functional status, and intoxication or withdrawal from medications. However, studies on prognosis and prognostic indicators of delirium in the past have been limited to subjects admitted to the hospital where the sample may include both incident and prevalent cases of delirium.<br>Objective. To determine whether prevalent delirium is an independent predictor for mortality among elderly patients seen in the Emergency department. Potentially confounding factors were assessed to reveal their prognostic contributions in this population. Survival analysis was carried out using the Cox Proportional Hazards Modelling technique.<br>Methods. As part of a larger study, 268 patients seen in the Emergency department in two Montreal hospitals (107 delirium cases, 161 controls) were followed up in 6 month intervals for a total of 18 months. Dates of deaths for the deceased were obtained from the Ministere de la Sante et des Service Sociaux.<br>Results. The analysis revealed a non-significant association between delirium and mortality rate for the English speaking subjects, when adjusted for age, sex, pre-morbid cognitive decline (IQCODE), Basic ADL, Instrumental ADL, comorbidity, number of medication, education (years), eyesight, and hearing problems (p = 0.752, HR =1 .095, CI: 0.622--1.929). On the other hand, for the French speaking subjects, the same model revealed a highly significant association between delirium and death rate (p = 0.001, HR = 9.078, CI: 2.362--34.892). Possible explanations for the different results are discussed.
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Lowery, David Peter. "Quantifying fluctuating cognition and consciousness of delirium." Thesis, University of Newcastle Upon Tyne, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.440585.
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Stellman, Joan Lindsay. "Free radicals in the pathogenesis of delirium." Thesis, University of Aberdeen, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.394588.
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The aim of this thesis was to look for evidence of increased serum free radical activity in elderly hospital patients with delirium. The following parameters were measured: serum iron, copper, zinc, ascorbic acid, antioxidant activity and markers of lipid peroxidation. The results did not show evidence of increased free radical activity in patients with delirium compared to non-delirious control patients. However, the results did show that, compared to healthy community controls, inpatients with infection and delirium (Group A), or with infection only (Group C) or (unexpectedly) with delirium but without clinical or microbiological evidence of infection (Group D) showed biochemical evidence of a systemic inflammatory response. The pattern of change observed in the inpatient groups was: a reduced serum iron and transferrin saturation, reduced serum zinc, elevated serum copper and reduced plasma ascorbic acid. This pattern of change is associated with inflammation. As a result of these findings, the hypothesis is proposed that delirium represents an epiphenomenon of the systematic inflammatory response syndrome (SIRS). Reduced iron levels, reduced zinc levels and low ascorbic acid levels have all, separately, been associated with altered brain function or cognitive impairment in studies of non-inflammatory states. It is therefore argued that these biochemical changes, individually or in combination with other biochemical and immunological changes that occur during the SIRS, such as HPA axis dysfunction, may result in cognitive impairment during inflammation, and, in severe or predisposing cases, contribution to the clinical manifestation of delirium. It is suggested that the area of the brain most vulnerable to the effects of these changes and, in consequence, most likely to produce cognitive dysfunction during delirium is the limbic system and, in particular, the thalamus, hypothalamus and hippocampus.
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Comeau, Odette. "Delirium Screening in Adult Critical Care Patients." ScholarWorks, 2016. http://scholarworks.waldenu.edu/dissertations/1675.
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Delirium is an acute change in cognition accompanied by inattention, which affects up to 88% of adult critical care patients. Delirium causes increased hospital complications, longer lengths of hospital stay, functional disability, cognitive impairment, and increased mortality. The purpose of this evidence-based quality-improvement project was to implement and evaluate a delirium screening process in adult intensive care units at a large medical center. This included education of nurses, implementation of a structured, validated tool, and review of tool use documentation. The implementation of this project was guided by an evidence-based practice model, Disciplined Clinical Inquiry© and Lewin's change theory. Evaluation of this quality-improvement project used audits of the electronic medical record. The audits included the presence and accuracy of delirium screening documentation in the patients' medical records. Results of 3 sequential documentation audits revealed a gradual adoption of this practice change by nurse clinicians. The percentage of charts with missing, incomplete, or inaccurate data decreased from 50% on the first week to 27.9% and 25.0% on the 2nd and 3rd weeks, respectively. These findings were an indication of practice change by validating the requirement for delirium screening on the units. In the first 3 weeks alone, 17 patient audits were positive for delirium, indicating the potential for poor short-term and long-term patient outcomes if not addressed promptly. Implementation of delirium screening ensures the dignity and worth of adult critical care patients by decreasing the poor outcomes associated with the diagnosis, which is an important contribution to positive social change.
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Helfand, Benjamin K. I. "Measurement in Health: Advancing Assessment of Delirium." eScholarship@UMMS, 2021. https://escholarship.umassmed.edu/gsbs_diss/1122.
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Rationale: Delirium is a serious, morbid condition affecting 2.6 million older Americans annually. A major problem plaguing delirium research is difficulty in identification, given a plethora of existing tools. The lack of consensus on key features and approaches has stymied progress in delirium research. The goal of this project was to use advanced measurement methods to improve delirium’s identification.
Aims and Findings:
(1) Determine the 4 most commonly used and well-validated instruments for delirium identification. Through a rigorous systematic review, I identified the Confusion Assessment Method (CAM), Delirium Observation Screening Scale (DOSS), Delirium Rating Scale-Revised-98 (DRS-R-98), and Memorial Delirium Assessment Scale (MDAS).
(2) Harmonize the 4 instruments to generate a delirium item bank (DEL-IB), a dataset containing items and estimates of their population level parameters. In a secondary analysis of 3 datasets, I equated instruments on a common metric and created crosswalks.
(3) Explore applications of the harmonized item bank through several approaches. First, identifying different cut-points that will optimize: (a) balanced high accuracy (Youden’s J-Statistic), (b) screening (sensitivity), and (c) confirmation of diagnosis (specificity) in identification of delirium. Second, comparing performance characteristics of example forms developed from the DEL-IB.
Impact: The knowledge gained includes harmonization of 4 instruments for identification of delirium, with crosswalks on a common metric. This will pave the way for combining studies, such as meta-analyses of new treatments, essential for developing guidelines and advancing clinical care. Additionally, the DEL-IB will facilitate creating big datasets, such as for omics studies to advance pathophysiologic understanding of delirium.
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Markström, Söder Erika, and Jon Melin. "Äldres erfarenheter av postoperativt delirium : en litteraturstudie." Thesis, Umeå universitet, Institutionen för omvårdnad, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-178142.
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Bakgrund: Delirium är ett akut tillstånd som kan drabba olika individer. Tillståndet ärvanligt förekommande på intensivvårdsavdelningar och uppvaknings avdelningar ochpåverkar individens tankeverksamhet och koncentrationsförmåga vilket kan leda tillförvirring. Om tillståndet förekommer efter en operation benämns det som Postoperativtdelirium (POD). POD beskrivs som ett tillstånd som förlänger patientens sjukhusvistelseoch ökar dödligheten och drabbar främst äldre. Syfte: Att beskriva äldre patienters erfarenheter av postoperativt delirium. Metod: Denna litteratursammanställning baseras på nio kvalitativa studier. Studiernahittades i två databaser, Cinahl och Pubmed samt via manuella sökningar av referenslistor.Analysen genomfördes med Fribergs modell för analys av kvalitativa studier. Resultat: Genom analysen skapades tre huvudkategorier och nio subkategorier.Huvudkategorierna var: ‘Känslomässiga reaktioner’, ‘Kroppsliga obehag’ samt ‘Viktigtstöd’. Konklusion: Patienter behöver mer information gällande POD för att förstå sin situationbättre och kunna delta i sin egen vård. Vårdpersonal behöver mer utbildning för att förståpatientens behov under POD samt för att kunna förmedla kunskap om POD till anhöriga.En ökad kunskap kan även reducera kostnader för verksamheter där POD förekommer.Vidare forskning bör belysa hur patienter och verksamheten påverkas av att ge informationtill patienter angående POD.<br>Background: Delirium is an acute condition that can affect different individuals. Thecondition is common in intensive care units and wake-up wards and affects the individual'sthinking activity and ability to concentrate witch leads to confusion. If the condition occursafter surgery, it is referred to as Postoperative Delirium (POD). POD is described as acondition that prolongs the patient's hospital stay and increases mortality and mainlyaffects the elderly. Aim: To describe elderly patients´experiences of postoperative delirium. Methods: This literature review is based on nine qualitative studies. The studies werefound in two databases, Cinahl, Pubmed and also via manual searches of reference lists.The analysis was performed with Friberg's model for analysis of qualitative studies. Results: The analysis created three main categories and nine subcategories. The maincategories were: ‘Emotional reactions’, ‘Physical discomfort’ and ‘Significant support’. Conclusion: Patients need more information regarding POD to better understand theirsituation and be able to participate in their own care. Nursing staff need more training tounderstand the patient's needs during POD and to be able to convey knowledge about PODto relatives. Increased knowledge can also reduce costs for operations where POD occurs.Further research should shed light on how patients and operations are affected byproviding information to patients regarding POD.<br><p>Pågrund av pågående pandemi hölls presentationen av examensarbetet via zoom möte.</p>
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Sands, Megan Bernice. "DETECTION OF DELIRIUM IN HOSPITALISED CANCER PATIENTS." Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/18948.
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Delirium is an important syndrome associated with poor outcomes for patients, carers and staff. The incidence and prevalence of delirium in people with cancer in the hospital in-patient setting, is not established. The few studies from this setting, report wide-ranging incidence and prevalence rates. Similarly, some data exist relating to reversibility of delirium in the index setting, but not a great deal is known about reversibility. Delirium detection is critical for treatment, but not well established for in-patient oncology settings. The first chapter of this thesis is a scoping review of the literature relating to incidence, prevalence and reversibility of delirium in the index setting. In addition, we sought to determine which delirium screening tools and which reference standards were used as the basis of case ascertainment to underpin epidemiological studies. Critical appraisal of methodological constraints of the studies was considered and the implications for knowledge gaps were identified. The second chapter reports findings from our original study investigating the clinical utility of the Single Question in Delirium (SQiD), a novel tool which was previously developed by the author. The methodological approach compared the SQiD against clinical review by consultant liaison psychiatrists in admitted, oncology patients. In summary this thesis provides a synthesis of knowledge to August 2017 relating to the epidemiology of delirium in admitted cancer patients and tests a short pragmatic delirium screening tool against a diagnostic reference standard. It contributes to the knowledge base relating to delirium in cancer patients admitted in the acute setting and is hypothesis generating for future research.
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Rigney, Jr Theodore Smith. "Allostatic Load and Delirium among Hospitalized Elders." Diss., The University of Arizona, 2009. http://hdl.handle.net/10150/194458.
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Delirium is a state of acute confusion and is common in hospitalized older adults. Delirium is associated with significant increases in morbidity and mortality, as well as healthcare costs. Delirium also is associated with functional and cognitive decline, as well as need for institutionalization and rehabilitation. Delirium can cause psychosocial distress for patients and families. While much is understood about the epidemiology of delirium, the pathophysiological mechanisms that lead to the development of delirium are less clearly defined.The purpose of this study was to investigate the relationship of allostatic load (AL), a composite measure of primary (i.e. acute) stress mediators and secondary (i.e. chronic) stress outcomes and delirium in the hospitalized older adult. Development of the Allostatic Load & Delirium in Hospitalized Elderly model provided a theoretical framework for the study.Forty- four participants, ranging from 66 to 93 years of age (M = 76 years of age) were recruited from three intensive care units and enrolled once they were determined not to have a cognitive deficit or prevalent delirium, as assessed by the Standardized Mini-Mental State Examination and Confusion Assessment Method (CAM), respectively. Ten AL components reflective of acute and chronic stress were collected upon admission. Allostatic load was calculated as the sum of the number of components for which the participant was rated in the highest risk quartile. Allostatic load subsets based on acute and chronic components were also calculated. Incident delirium was assessed 48 -72 hours after admission with the CAM.Findings indicated that the incidence of delirium was 29.2%. The subset AL score based on components considered primary stress mediators was significantly related to delirium; however, no other variables were associated with delirium. Logistic regression modeling indicated that an AL subset of primary stress mediators did predict the incidence of delirium (OR 2.5, 95% CI = 1.12, 5.79; X2 (1) = 5.668, p < .05).The findings from this study exploring the relationship between AL and delirium in the hospitalized older adult suggest that an AL score based on primary mediators may be useful in predicting delirium in the hospitalized older adult.
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Snell, Jennifer Miranda. "Pediatric Emergence Delirium in the Postoperative Setting." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3921.
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Emergence delirium (ED), also known as emergence agitation, is a postoperative condition characterized by aberrant cognitive and psychomotor behaviors following general anesthesia. The incidence of ED is 3 to 8 times higher in children 5 years of age or less. There is no standard of nursing practice for managing ED symptoms in the pediatric surgical population. The purpose of this quality improvement project was to address a gap in knowledge needed to inform clinical decision-making when managing ED in the postoperative setting. Using an educational presentation for post anesthesia care unit (PACU) nurses, this project introduced the use of non-pharmacological interventions to mitigate symptoms of ED in the pediatric population as inspired by The Green Star Initiative, an Army program at Fort Carson. The project aim was to describe the effectiveness of ED-specific interventions from the nursing perspective. Using tenets of the Iowa model, this quality improvement project included a needs assessment survey, PowerPoint presentation, parent education leaflet, ED cheat sheet, and a post-intervention survey. Applying the context, input, process, product model for evaluation, this project increased knowledge of ED-specific interventions used by nurses that demonstrates a change in clinical decision-making. PACU nurses rated the interventions 43% effective on pediatric patients. This project addressed the gap in practice by providing structured education on ED, inspiring the use of ED-specific interventions, and promoting readiness to care for the pediatric surgical population. Outcomes add to the nursing literature by introducing ED-specific interventions to manage pediatric ED in facilities nationwide. A social implication of this project is to improve the care of pediatric surgical patients.
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Ahmed, Saima Shabbir. "Delirium and acute stroke : the occurrence of delirium and its association with long term outcomes for patients post-stroke." Thesis, University of Leeds, 2014. http://etheses.whiterose.ac.uk/8053/.
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Introduction: Delirium is an acute generalised impairment of brain function and a common complication of illness in older people. However it is commonly overlooked or misdiagnosed in clinical practice. Previous studies have found that delirium is linked to longer hospital stays, an increased need for institutionalisation and future complications e.g. increased risk of dementia and mortality. Delirium onset may be associated with an acute stroke, although few studies have investigated this association. The aims of this study were to identify delirium incidence in stroke, compare long term patient outcomes and identify confounding variables that may affect delirium onset. Methods: Based on the findings from the systematic review, a UK based prospective cohort study with a one year follow up period was designed to recruit stroke patients with and without delirium. Additional assessments were administered within 72 hours of admission to assess physical function, mood, risk of dementia and cognitive impairment. These assessments were repeated six months post-stroke as well as monitoring outcomes such as mortality, length of stay and discharge destination. Results: A total of 298 patients were recruited from the stroke unit at the Leeds Teaching Hospitals Trust, with a delirium incidence of 32.9%. Patients with delirium were associated with longer hospital stays, higher mortality rates at one and six months and an increased need for institutionalisation, as well as positive associations with a number of predisposing factors. Delirium patients also had lower assessment scores for physical function and dementia risk at six months. Conclusion: The results of this study show that delirium has a significant effect on outcomes for stroke patients. Increased emphasis and awareness of delirium on the stroke units could help increase detection rates of delirium. Suggestions for the implementation of better education programmes and screening protocols may aid delirium management and these require further research.
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Sepúlveda, Ramos Esteban. "Phenomenology and diagnostic criteria for delirium and subsyndromal delirium in a population with high prevalence of dementia. An empirical study." Doctoral thesis, Universitat Rovira i Virgili, 2016. http://hdl.handle.net/10803/399585.
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La validesa i fiabilitat de les modernes classificacions diagnòstiques per delírium han estat qüestionades per motius diferents.
En aquest treball demostrem la baixa coincidència diagnòstica del DSM-IIIR, DSM-IV, DSM-5 i CIE-10. Les noves edicions del DSM milloren en fiabilitat inter-avaluador, però la seva validesa empitjora i la CIE-10 obté en general pitjors resultats.
L'escala DRS-R98 avalua de forma àmplia i amb una clara descripció fenomenològica els símptomes del delírium. Confirmem la validesa de la versió espanyola en una població amb alta prevalença de demència, amb independència del criteri diagnòstic emprat.
Finalment, avaluem una nova proposta diagnòstica per delírium subsindròmic i trobem que presenta símptomes amb severitat intermèdia entre delírium i controls així com un perfil fenomenològic similar independentment del context clínic.
Són necessaris criteris diagnòstics per delírium més clars i basats en els seus símptomes nuclears, possiblement recolzats en un biomarcador per millorar la seva validesa.<br>La validez y fiabilidad de las modernas clasificaciones diagnósticas para delírium han sido cuestionadas de un modo u otro.
En este trabajo demostramos la baja coincidencia diagnóstica del DSM-IIIR, DSM-IV, DSM-5 y CIE-10. Las nuevas ediciones del DSM mejoran en fiabilidad inter-evaluador, pero su validez empeora y la CIE-10 obtiene en general peores resultados.
La escala DRS-R98 evalúa de forma amplia y con una clara descripción fenomenológica los síntomas del delírium. Confirmamos la validez de la versión española en una población con alta prevalencia de demencia, al margen del criterio diagnóstico usado.
Por último, evaluamos una nueva propuesta diagnóstica para delírium subsindrómico y encontramos que presenta síntomas con severidad intermedia entre delírium y controles así como un perfil fenomenológico similar independientemente del contexto clínico.
Son necesarios criterios diagnósticos para delírium más claros y basados en sus síntomas nucleares, posiblemente apoyados en un biomarcador para mejorar su validez.<br>The validity and reliability of modern diagnostic classifications for delirium have been challenged to varying degrees.
In this paper we demonstrate the low diagnostic coincidence of DSM-III-R, DSM-IV, DSM-5 and ICD-10. The inter-rater reliability improves in the newer DSM editions, but its validity worsens and ICD-10 generally has worse results.
The DRS-R98 scale assesses broadly and with a clear phenomenological description delirium symptoms. We confirmed the validity of its Spanish version in a population with a high prevalence of dementia, regardless of the criteria used for diagnosis.
Finally, we evaluated a new diagnostic proposal for subsyndromal delirium and found it presents symptoms with intermediate severity between delirium and controls as well as a similar phenomenological profile regardless of the clinical setting.
Clearer diagnostic criteria for delirium, based on its core symptoms, and possibly supported by a biomarker are necessary to improve their validity.
37
Gabriel, Alexander. "Phänomenologie des Delirs neuropsychologische und psychopathologische Differenzierung des Delirsyndroms." Saarbrücken VDM Verlag Dr. Müller, 2007. http://d-nb.info/989111881/04.
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Eriksson, Sofia, and Simone Steffen. "Delirium på IVA : En litteraturstudie av sjuksköterskans omvårdnadsåtgärder." Thesis, Röda Korsets Högskola, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-1394.
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SAMMANFATTNING Bakgrund: Risken för att drabbas av ett intensivvårds-delirium under vårdtiden är av varierande storlek. Om patienten drabbas av ett delirium kan det leda till allvarliga konsekvenser. Konsekvenserna innefattar en ökad mortalitet, längre vårdtid, ett ökat lidande och även att kostnaderna blir högre. De bedömningsinstrument som finns används i varierande grad på olika intensivvårds-avdelningar världen över. Det mest valida och användbara är Confusion Assesment Method, CAM-ICU; ett mätverktyg utarbetat för att användas inom intensivvården där det kan användas på patienter som fortfarande är intuberade och således inte har en möjlighet att uttrycka sig verbalt. Syfte: Belysa den aktuella forskningen gällande omvårdnad av patienter som drabbats av intensivvårds-delirium. Metod: Studien är en litteraturöversikt med mixad metod och konvergent design. Resultat: Studien visar att omvårdnadsåtgärder gällande behandling av intensivvårdsdelirium används men det finns inga riktlinjer för hur patienterna ska behandlas. Den forskning som finns visar få signifikanta resultat. De kategorier av omvårdnadsåtgärder som litteraturen visar är kognitiv stimulans, miljö, läkemedelsanvändning och fysisk fasthållning. Slutsats: Studien visar att det är svårt att mäta effekterna av olika omvårdnadsåtgärder som patienter med intensivvårds-delirium blir behandlade med. Klinisk betydelse: Genom fördjupad kunskap om delirium får sjuksköterskan en bättre förståelse för tillståndet och således även för omvårdnaden som ges. Att belysa det faktum att forskningen kring omvårdnadsåtgärderna vid delirium är bristfällig skapas möjlighet till vidare efterforskning.<br>ABSTRACT Background: The risk for intensive care delirium during hospitalization is of varying size. If the patient experiences a delirium it can lead to serious consequences. The consequences include increased mortality, longer hospital stay, increased suffering and even higher costs. The screening tools that are available are used in varying degrees in different intensive care units worldwide. The most valid one are the Confusion Assessment Method, the CAM-ICU; a screening tool developed for use in intensive care where it can be used on patients who are still intubated and thus do not have a chance to express themselves verbally. Aim: Highlighting the current research regarding the care of patients suffering from intensive care delirium. Method: The study is a literature review with a mixed approach and convergent design. Results: The study shows that nursing interventions regarding the treatment of intensive care delirium are used but there are no guidelines for how the patients should be treated. The research shows few significant results. The categories found from the literature were cognitive stimulation, environment, medication and physical restraint. Conclusion: The study shows that it is difficult to measure the impact of nursing interventions that patients with intensive care delirium are treated with. Relevance to clinical practice: Increased knowledge of delirium may give the nurse a better understanding of the condition and thus also for the care they provide. To highlight the fact that the research on nursing interventions for delirium is flawed which creates the opportunity for further research.
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Morais, Cristina Margarida Gonçalves. "Intervenções de enfermagem no idoso hospitalizado com delirium." Master's thesis, [s.n.], 2013. http://hdl.handle.net/10400.26/15991.
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Mestrado, Enfermagem Médico-Cirúrgica - Pessoa Idosa, 2013, Escola Superior de Enfermagem de Lisboa<br>A população idosa assume-se como um grupo particularmente vulnerável aos efeitos adversos da hospitalização. O delirium é das complicações mais comuns, apresentando-se associado ao declínio funcional e cognitivo, aumento do tempo de internamento, morbilidade, institucionalização e mortalidade. De modo a contrariar este fato, os enfermeiros encontram-se numa posição privilegiada, junto dos idosos hospitalizados, no sentido de intervir em situações de delirium. Desta forma, com o intuito de desenvolver competências de enfermeira especialista e mestre na saúde da pessoa idosa, considerou-se pertinente o desenvolvimento de um projeto num serviço de Medicina de um HCL, com a finalidade de desenvolver intervenções de enfermagem em parceria com o cliente idoso hospitalizado com delirium. Este foi elaborado sob a metodologia de projeto, tendo como participantes toda a equipa de enfermagem e os clientes idosos hospitalizados no serviço. Nas atividades desenvolvidas recorreu-se a vários instrumentos de colheita de dados, permitindo a realização do diagnóstico de situação e a avaliação dos contributos do projeto, refletindo sobre as aprendizagens alcançadas. Na prestação de cuidados diretos ao cliente idoso, através da operacionalização do Modelo de Parceria, foram desenvolvidas intervenções de enfermagem com o idoso hospitalizado com delirium, avaliando-o multidimensionalmente, identificando as suas necessidades afetadas e elaborando planos de atuação personalizados. A interação com a equipa de enfermagem permitiu adquirir capacidades de liderança e de gestão dos cuidados, cultivando a mudança e momentos de formação. O conhecimento dos principais fatores de risco e características do delirium capacitaram os enfermeiros para uma identificação precoce, e a utilização do algoritmo do CAM, facilitou a sua deteção, fomentando uma prática baseada na evidência. A prevenção, deteção e gestão de casos de delirium no cliente idoso hospitalizado, permitiram uma melhoria da qualidade dos cuidados prestados pela equipa de enfermagem, promovendo a construção de um ambiente terapêutico, seguro e promotor da independência, facilitando os processos de transição e a promoção do cuidado de Si.
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Spriggs, Shelley, of Western Sydney Hawkesbury University, and Faculty of Environmental Management and Agriculture. "Participatory decision making : new democracy or new delirium?" THESIS_FEMA_xxx_Spriggs_S.xml, 1999. http://handle.uws.edu.au:8081/1959.7/109.
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Ever since the laborious consultation process to set the National Greenhouse Response Strategy (1991-1992), stakeholder 'consultation' has been something Australian governments do. Or attempt to do. A recent trend in NSW in particular has been to expand the concept and practice of consultation to multi-party, collaborative decision-making, also referred to as participatory democracy. One such initiative officially begun in August 1997 is the River Management Committee (RMC) exercise. For this tremendous outlay of financial and human resources, the government is taking a punt that the committee will deliver better decisions, and more timely actions, on river flows and water quality in each of the major regulated river valleys in the state. The set up and first year of operation of the RMC exercise is the subject of this thesis. Specifically it examines the design of the process and its appropriateness to the task at hand; the reality of consensus decision-making amongst people with opposing views; the democratic ideal of participants learning to be 'other directed' in terms of putting aside their own positions to work for the common good; and affordability of such exercises from both the government and non-government participants' points of view. The themes emerging from this thesis have become the focus for further research.<br>Master of Science (Hons)
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Lindgren, Andreas, and Simonsson Rikard. "Omvårdnad i samband med postoperativt delirium : -En litteraturstudie." Thesis, Karlstads universitet, Institutionen för hälsovetenskaper, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:kau:diva-32097.
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Hos äldre som vårdas på sjukhus efter en operation är delirium en vanlig komplikation. Tidigare studier visar att postoperativt delirium resulterar i förlängd sjukhusvistelse och ökad mortalitet. Syftet med studien var att beskriva omvårdnad i samband med postoperativt delirium. Metoden var en litteraturstudie byggd på 17 artiklar ur databaserna CINAHL och Medline. Studien genomfördes enligt en modifierad version av Polit och Becks (2012) modell för litteraturstudier. Utifrån detta framkom ett resultat med tre huvudteman varav ett delades upp i underkategorier. De huvudteman som framkom var screening för att upptäcka riskfaktorer, åtgärder vidtas vid underliggande problem och konsultation med geriatrisk specialist. Resultatet redovisar även interventionsprogram som bygger på omvårdnadsåtgärder från ovan nämnda teman. Slutsatsen beskriver att postoperativt delirium har en mängd bakomliggande orsaker och omvårdnaden bör inriktas på att behandla alla dessa orsaker då åtgärder mot enskilda problem sällan löser det deliriska tillståndet.
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Therese, Andersson. "Att vårda äldre patienter med delirium : Sjuksköterskors erfarenheter." Thesis, Röda Korsets Högskola, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-1447.
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Bakgrund: Delirium är ett sjukdomssyndrom som yttrar sig genom desorientering, problem med minne, perception och akut beteendeförändring. Delirium är en organisk psykisk störning och är ett övergående tillstånd som ofta drabbar äldre med en komorbiditet. Den äldre befolkningen i Sverige beräknas att öka kraftigt och eftersom att risken för delirium väntas öka med åldern finns en risk att andelen med delirium inom sjukhusvården kommer att öka. Orsaker för att utveckla delirium är multifaktoriella, några föreslagna är demenssjukdom, polyfarmaci, infektion, elektrolytiska rubbningar, hjärt- och kärlsjukdom, akut sjukdom eller trauma och miljömässiga faktorer. Syfte: Att beskriva sjuksköterskors erfarenheter av att vårda äldre patienter med delirium inom sjukhusvården. Metod: En litteraturstudie baserad på tio artiklar med kvalitativ ansats. Resultat: Tre teman framkom ur analysen: kännedom om delirium, säkerhetsåtgärder och vårdmiljö. Brister i kunskap om delirium och saknad av evidensbaserade metoder för att vårda äldre patienter med delirium förklarades. Sjuksköterskorna använde sig av mer erfaren vårdpersonal och patientens närstående som hjälp i vårdandet. En kontinuerlig övervakning var en utbredd metod för att kontrollera en äldre patient med delirium. Men vid resursbrist eller behov av ytterligare åtgärder, var användandet av begränsning för att skydda en patient med delirium vanligt förekommande. Det fanns en tvetydighet huruvida fysisk begränsning eller nyttjandet av sederande läkemedel var att föredra vid behov av att kontrollera en äldre patient med delirium. Slutsats: Studien visar ett behov av utbildning och evidensbaserade riktlinjer för att vårda äldre patienter med delirium. Klinisk betydelse: Att behoven av kunskap om delirium bland äldre uppmärksammas.<br>Background: Delirium is a disease syndrome that manifests through disorientation, problems with memory, perception and acute behavioural change. Delirium is an organic mental disorder and a transient condition that often affects older with a comorbidity. The elderly population of Sweden is estimated to increase considerably and since the risk of delirium is expected to alter with age there is a risk that the proportion of delirium in hospital care will increase. Reasons for developing delirium is multifactorial, some suggestions are dementia, polypharmacy, infection, electrolyte disorders, cardiovascular disease, acute illness or trauma and environmental factors. Aim: To describe nurses experiences of caring for elderly patients with delirium in hospital care. Method: A literature study based on ten articles with qualitative approach. Findings: Three themes emerged from the analysis: knowledge of delirium, safety measure and health care environment. Deficiencies in knowledge of delirium and loss of evidence-based practices to care for elderly patients with delirium were explained. The nurses used the more experienced nursing staff and the patient's family to help in the care. Continuous monitoring was a widespread method of checking up on an elderly patient with delirium. Though when there was a lack of resources or a need for further action, the use of restriction to protect a patient with delirium became common. There was an ambiguity whether physical restriction or the use of sedating drugs was preferable if necessary to check up on an elderly patient with delirium. Conclusion: The study shows a need of education and evidence-based guidelines to care for elderly patients with delirium. Clinical significance: That the needs of knowledge about delirium among elderly gets more attention.
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Karlsson, Petter, and Niclas Öman. "Intesivvårdssjuksköterskors erfarenheter av att vårda patienter med delirium." Thesis, Umeå universitet, Institutionen för omvårdnad, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-131976.
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Syfte: Att undersöka intensivvårdssjuksköterskors erfarenheter av att vårda patienter med delirium. Bakgrund: Delirium är vanligt förekommande på intensivvårdsavdelningar. Det leder till ett stort lidande för patienten. Forskningen har varit mer inriktad på patofysiologi, etiologi, farmakologisk behandling och screeninginstrument. Tidigare forskning har inte fokuserat på sjuksköterskans erfarenheter i stor utsträckning. Design: En kvalitativ intervjustudie. Metod: Tio intensivvårdssjuksköterskor på två sjukhus i norra Sverige intervjuades hösten 2016 med stöd av en semistrukturerad intervjuguide. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat: Intensivvårdssjuksköterskornas erfarenheter formulerades i tre kategorier: Strategier som underlättar att vårda patienter med delirium, Svårigheter med att vårda patienter med delirium och ställas inför svåra etiska situationer. Slutats: Resultatet visar att det finns ett behov av att öka kunskapen om delirium, att införa och använda screeninginstrument samt bättre rutiner kring vården av patienter med delirium. Svåra situationer kan uppstå där det etiska sätts åt sidan för patientens bästa.Vårdmiljöns utformning och ljudnivåer kunde påverka intensivvårdssjuksköterskornas erfarenheter av att vårda patienter med delirium. Studiens resultat visar att rättviseprincipen inte alltid tillämpas och att vård på lika villkor inte alltid säkerställs på grund av tidsbrist eller negativa attityder. Resultatet visar på bristande kunskap och rutiner kring att upptäcka, förebygga och behandla delirium. Intensivvårdssjuksköterskorna bör erbjudas utbildning om delirium och screeninginstrument samt att rutiner kring vården av deliriösa patienter förbättras
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Spriggs, Shelley. "Participatory decision making : new democracy or new delirium?" Thesis, [Richmond, N.S.W.] : Faculty of Environmental Management & Agriculture, University of Western Sydney, Hawkesbury, 1999. http://handle.uws.edu.au:8081/1959.7/109.
Full textAbstract:
Ever since the laborious consultation process to set the National Greenhouse Response Strategy (1991-1992), stakeholder 'consultation' has been something Australian governments do. Or attempt to do. A recent trend in NSW in particular has been to expand the concept and practice of consultation to multi-party, collaborative decision-making, also referred to as participatory democracy. One such initiative officially begun in August 1997 is the River Management Committee (RMC) exercise. For this tremendous outlay of financial and human resources, the government is taking a punt that the committee will deliver better decisions, and more timely actions, on river flows and water quality in each of the major regulated river valleys in the state. The set up and first year of operation of the RMC exercise is the subject of this thesis. Specifically it examines the design of the process and its appropriateness to the task at hand; the reality of consensus decision-making amongst people with opposing views; the democratic ideal of participants learning to be 'other directed' in terms of putting aside their own positions to work for the common good; and affordability of such exercises from both the government and non-government participants' points of view. The themes emerging from this thesis have become the focus for further research.
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Spriggs, Shelley. "Participatory decision making : new democracy or new delirium? /." [Richmond, N.S.W.] : Faculty of Environmental Management & Agriculture, University of Western Sydney, Hawkesbury, 1999. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20030505.110740/index.html.
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Ribeiro, Simone Cidade Lima. "Delirium no paciente em unidade de terapia intensiva." reponame:Repositório Institucional da UFSC, 2012. https://repositorio.ufsc.br/handle/123456789/106775.
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Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-graduação em Gestão do cuidado em Enfermagem, Florianópolis, 2012.<br>Made available in DSpace on 2013-12-05T22:19:30Z (GMT). No. of bitstreams: 1
317824.pdf: 664626 bytes, checksum: c06caff83ca4f4788fe1d0440a6bbddc (MD5)
Previous issue date: 2012<br>Delirium é uma manifestação de disfunção cerebral aguda, freqüente em pacientes criticamente enfermos e está associado a um aumento da morbidade e mortalidade. Para minimizar os efeitos deletérios dessa disfunção, esta pesquisa, de abordagem qualitativa, teve como objetivo elaborar coletivamente propostas de intervenções de enfermagem a essa clientela hospitalizada em uma Unidade de Terapia Intensiva (UTI) . O estudo foi realizado na UTI de adulto em um hospital público, localizado na região sul do Brasil e que atende exclusivamente pelo Sistema Único de Saúde (SUS). Como sustentação teórica foi utilizada a literatura nacional e internacional sobre o tema publicada entre 2005 e 2011. O Referencial Metodológico adotado foi a Pesquisa Convergente Assistencial (PCA). Participaram do estudo 14 enfermeiros lotados na UTI. Os dados foram coletados no período de julho a outubro de 2011 em duas etapas, a primeira por meio de entrevista semi estruturada com o objetivo de identificar o conhecimento dos participantes sobre o delirium e em especial as intervenções de enfermagem. Para a segunda etapa utilizou-se grupos de discussão com a realização de três encontros cujo objetivo foi o discutir e refletir sobre delirium e elaborar uma proposta de intervenção de enfermagem Para a organização e análise dos dados das entrevistas utilizou-se o método do Discurso do Sujeito Coletivo (DSC). Os resultados deram origem a cinco discursos com as Idéias Centrais: compreensão sobre delirium; sedação em UTI e o delirium, a restrição mecânica e o delirium ; o ambiente de UTI e o delirium; preparo dos enfermeiros para a intervenção no paciente. Os DSC retrataram que delirium é compreendido pelos participantes como uma alteração neurológica; está associado ao uso abusivo de sedativos; a restrição mecânica é usada inadvertidamente na UTI em pacientes com delirium; o ambiente da UTI favorece o aparecimento do delirium; falta preparo do profissional para a intervenção no paciente. Percebeu-se nos discursos uma lacuna no conhecimento acerca do delirium em especial na prevenção e no manejo do paciente. Com base nos dados, foi desenvolvida a segunda etapa e que deu origem a elaboração de um instrumento/guia de intervenções de enfermagem ao paciente com delirium. O instrumento contempla as intervenções amplamente discutidas nos encontros e originadas tanto da literatura quanto da vivência dos profissionais envolvidos no estudo e relacionadas principalmente a prevenção do delirium. A PCA serviu como caminho para discussões acerca de delirium em unidade de terapia intensiva, e igualmente, levou a reflexões sobre a prática, que culminou com a construção coletiva de um instrumento com intervenções de enfermagem. No transcorrer do estudo observou-se, no cenário estudado, mudanças, apesar de sutis e de modo individual, com a aplicação de algumas medidas de prevenção do delirium. Acredita-se que A PCA, reafirmou o seu propósito de convergência entre o assistir e o pensar e em paralelo a participação no processo de construção do conhecimento. Modificar positivamente o ambiente de terapia intensiva para que se torne menos hostil, humanizando o cuidado, prevenindo o delirium, é um cuidado que a enfermagem deve fomentar <br>
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Innervik, Sanna, and Helena Lewin. "Postoperativt Delirium : Intervention och prevention ur ett omvårdnadsperspektiv." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-398151.
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Postoperative delirium is a common complication that occurs in elderly patients undergoing surgery with anaesthesia. This condition causes feelings of fear, discomfort and suffering for the patient. The aim with this study was to describe what interventions that can be used to prevent or treat postoperative delirium and what effect they have on the condition. This study is a systematic review with a descriptive design which examines existing research on nursing interventions with the aim of preventing and treating postoperative delirium. The study is based on nine scientific original articles, seven were randomized controlled trials and two were quasi experimental studies. The literature search was made through Cinahl, psycINFO and PubMed. When all studies had been examined the results showed multiple interventions and most of them had a preventive or treating effect on postoperative delirium. The interventions focus on different ways to affect the condition. Some of them are geriatric consultation, music therapy and family as caregivers. Postoperative delirium can be both prevented and treated through different kinds of interventions. This study contributes to expanded knowledge on how the condition can be managed, however further research is needed to provide increased evidence and prove which interventions that can provide the most effective affect on postoperative delirium.<br>Postoperativt delirium är en vanlig komplikation hos äldre som genomgått någon form av kirurgi under anestesi. Tillståndet innebär rädsla, obehag och lidande för patienten. Syftet med studien är att beskriva vilka omvårdnadsinterventioner som finns för att förebygga och behandla postoperativt delirium samt vilken effekt dessa har. Denna studie är en litteraturöversikt med beskrivande design som undersöker befintlig forskning kring omvårdnadsinterventioner med syfte att förebygga och behandla postoperativt delirium. Studien består av nio vetenskapliga originalartiklar, sju var randomiserade kontrollerade studier och två var kvasiexperimentella studier. Datainsamlingen genomfördes i databaserna Cinahl, psycINFO och PubMed. Efter att samtliga studier granskats framkommer ett resultat med flera olika omvårdnadsinterventioner där majoriteten har förebyggande eller behandlande effekt på postoperativt delirium. De interventioner som resultatet baseras på använder sig av olika sätt som tillståndet kan påverkas av. Några av dessa är geriatrisk konsultation, musikterapi och anhörig som vårdgivare. Postoperativt delirium kan förebyggas och behandlas på olika sätt via omvårdnadsinterventioner. Denna studie kan ge läsaren ökad kunskap om hur tillståndet kan hanteras, dock krävs det ytterligare forskning inom området för att ge ökad evidens och fastställa vilka typer av interventioner som har störst inverkan på postoperativt delirium.
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Lukas, Yani Stella <1976>. "Risk factors for postoperative delirium in the elderly." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2011. http://amsdottorato.unibo.it/3578/1/Lukas_Yani_Stella_Tesi.pdf.
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Background: Delirium is defined as an acute disorder of attention and cognition. Delirium is common in hospitalized elderly patient and is associated with increased morbidity, length of stay and patient care costs. Although Delirium can develop at any time during hospitalization, it typically presents early in the post-operative period (Post-Operative Delirium, POD) in the surgery context. The molecular mechanism and possible genetics basis of POD onset are not known, as well as all the risk factors are not completely defined. Our hypothesis is that genetic risk factor involving the inflammatory response could have possible effects on the immunoneuroendocrine system. Moreover, our previous data (inflamm-aging) suggest that aging is associated with an increase of inflammatory status, favouring age-related diseases such as neurodegenerative diseases, frailty, depression among other. Some pro-inflammatory or anti-inflammatory cytokines, seem to play a crucial role in increasing the inflammatory status and in the communication and regulation of immunoneuroendocrine system.
Objective: this study evaluated the incidence of POD in elderly patients undergoing general surgery, clinical/physical and psychological risk factors of POD insurgency and investigated inflammatory and genetic risk factors. Moreover, this study evaluated the consequence of POD in terms of institutionalization, development of permanent cognitive dysfunction or dementia and mortality
Methods: patients aged over 65 admitted for surgery at the Urgency Unit of S.Orsola-Malpighi Hospital were eligible for this case–control study. Risk factors significantly associated with POD in univariate analysis were entered into multivariate analysis to establish those independently associated with POD. Preoperative plasma level of 9 inflammatory markers were measured in 42 control subjects and 43 subjects who developed POD. Functional polymorphisms of IL-1 α , IL-2, IL-6, IL-8, IL-10 and TNF-alpha cytokine genes were determined in 176 control subjects and 27 POD subjects.
Results: A total of 351 patients were enrolled in the study. The incidence of POD was 13•2 %. Independent variables associated with POD were: age, co-morbidity, preoperative cognitive impairment, glucose abnormalities. Median length of hospital stay was 21 days for patients with POD versus 8 days for control patients (P < 0•001). The hospital mortality rate was 19 and 8•4 % respectively (P = 0•021) and mortality rate after 1 year was also higher in POD (P= 0.0001). The baseline of IL-6 concentration was higher in POD patients than patients without POD, whereas IL-2 was lower in POD patients compared to patients without POD. In a multivariate analysis only IL-6 remained associated with POD. Moreover IL-6, IL-8 and IL-2 are associated with co-morbidity, intra-hospital mortality, compromised functional status and emergency admission. No significant differences in genotype distribution were found between POD subjects and controls for any SNP analyzed in this study.
Conclusion: In this study we found older age, comorbidity, cognitive impairment, glucose abnormalities and baseline of IL-6 as independent risk factors for the development of POD. IL-6 could be proposed as marker of a trait that is associated with an increased risk of delirium; i.e. raised premorbid IL-6 level predict for the development of delirium.
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Lukas, Yani Stella <1976>. "Risk factors for postoperative delirium in the elderly." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2011. http://amsdottorato.unibo.it/3578/.
Full textAbstract:
Background: Delirium is defined as an acute disorder of attention and cognition. Delirium is common in hospitalized elderly patient and is associated with increased morbidity, length of stay and patient care costs. Although Delirium can develop at any time during hospitalization, it typically presents early in the post-operative period (Post-Operative Delirium, POD) in the surgery context. The molecular mechanism and possible genetics basis of POD onset are not known, as well as all the risk factors are not completely defined. Our hypothesis is that genetic risk factor involving the inflammatory response could have possible effects on the immunoneuroendocrine system. Moreover, our previous data (inflamm-aging) suggest that aging is associated with an increase of inflammatory status, favouring age-related diseases such as neurodegenerative diseases, frailty, depression among other. Some pro-inflammatory or anti-inflammatory cytokines, seem to play a crucial role in increasing the inflammatory status and in the communication and regulation of immunoneuroendocrine system.
Objective: this study evaluated the incidence of POD in elderly patients undergoing general surgery, clinical/physical and psychological risk factors of POD insurgency and investigated inflammatory and genetic risk factors. Moreover, this study evaluated the consequence of POD in terms of institutionalization, development of permanent cognitive dysfunction or dementia and mortality
Methods: patients aged over 65 admitted for surgery at the Urgency Unit of S.Orsola-Malpighi Hospital were eligible for this case–control study. Risk factors significantly associated with POD in univariate analysis were entered into multivariate analysis to establish those independently associated with POD. Preoperative plasma level of 9 inflammatory markers were measured in 42 control subjects and 43 subjects who developed POD. Functional polymorphisms of IL-1 α , IL-2, IL-6, IL-8, IL-10 and TNF-alpha cytokine genes were determined in 176 control subjects and 27 POD subjects.
Results: A total of 351 patients were enrolled in the study. The incidence of POD was 13•2 %. Independent variables associated with POD were: age, co-morbidity, preoperative cognitive impairment, glucose abnormalities. Median length of hospital stay was 21 days for patients with POD versus 8 days for control patients (P < 0•001). The hospital mortality rate was 19 and 8•4 % respectively (P = 0•021) and mortality rate after 1 year was also higher in POD (P= 0.0001). The baseline of IL-6 concentration was higher in POD patients than patients without POD, whereas IL-2 was lower in POD patients compared to patients without POD. In a multivariate analysis only IL-6 remained associated with POD. Moreover IL-6, IL-8 and IL-2 are associated with co-morbidity, intra-hospital mortality, compromised functional status and emergency admission. No significant differences in genotype distribution were found between POD subjects and controls for any SNP analyzed in this study.
Conclusion: In this study we found older age, comorbidity, cognitive impairment, glucose abnormalities and baseline of IL-6 as independent risk factors for the development of POD. IL-6 could be proposed as marker of a trait that is associated with an increased risk of delirium; i.e. raised premorbid IL-6 level predict for the development of delirium.
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Ström, Joel. "Intensivvårdssjuksköterskors uppfattning och bedömning av IVA-delirium i jämförelse med bedömning av sederingsdjup : en kvantitativ studie." Thesis, Högskolan i Gävle, Medicin- och vårdvetenskap, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-24061.
Full textAbstract:
Background. Patients, who are receiving life-threatening treatment at the intensive care unit (ICU), often suffer from failure in their vital organs. Supporting treatement of their organs is a important part of the work in the ICU. An overlooked complication in these patients is cognitive failure due to critical illness, also known as ICU-delirium. Research studies show that patients with ICU-delirium have increased care time and increased mortality. Aims The aim of this study was to describe the intensive care nurse's perception of and how ICU-delirium is assessed. The aim was also to compare how often assessment of ICU-delirium occurs with the frequency of assessment of sedation depth. Results 45 intensive care nurses responded that ICU delirium requires active measures from healthcare professionals. 43 considered that ICU delirium is a common response to the environment in an intensive care unit. Some (n= 40) indicated that their department has a routine regarding sedation, but 21 states that the protocol does not specify how often ICU delirium is to be assessed. The most common method for assessing ICU delirium was to see if the patient can follow instructions (n= 19) and if the patient has an outgoing behavior (n = 10). 42 indicated that ICU delirium is an under-diagnosed problem and 40 that it is a challenge to assess the patient. The study showed a significant difference (p = .0001) between how often intensive care nurses assess sedation depth and how often ICU delirium is assessed. Conclusions. The conclusion is that sedation assessment is performed more often than assessment of ICU-delirium. More education in the subject and more in-depth research is recommended.<br>Bakgrund. Patienter som vårdas inom intensivvården har ofta drabbats av kritisk sjukdom med svikt i vitala organ som följd. Understödjande behandling av dessa organ är en viktig del i arbetet inom intensivvården. En förbisedd komplikation hos patienten är sviktande kognitiva funktioner på grund av kritisk sjukdom, även benämnt intensivvårdsdelirium (IVA-delirium). Patienter med IVA-delirium har tidigare forskning visat ge längre vårdtider och ökad mortalitet. Syfte Syftet med studien var att beskriva intensivvårdssjuksköterskans uppfattning om och hur IVA-delirium bedöms. Syftet var också att jämföra hur ofta bedömning av IVAdelirium sker med hur ofta bedömning av sederingsdjup sker. Metod En beskrivande och jämförande studie med kvantitativ ansats. Enkäter (n=112) delades ut till intensivvårdssjuksköterskor där 45 besvarades. Huvudresultat 45 intensivvårdssjuksköterskor svarade att IVA-delirium kräver aktiva åtgärder från vårdpersonalen. 43 ansåg att IVA-delirium är en vanlig respons på miljön vid en intensivvårdsavdelning. En del (n=40) angav att deras avdelning har en rutin angående sedering men 21 uppger att protokollet inte anger hur ofta IVA-delirium ska bedömas. Den vanligaste metoden för att bedöma IVA-delirium var att se om patienten kan följa instruktioner (n=19) och om patienten har ett utåtagerande beteende (n=10). 42 angav att IVA-delirium är ett underdiagnosticerat problem och 40 angav att det är en utmaning att bedöma hos patienten. Studien visade en signifikant skillnad (p=.0001) mellan hur ofta intensivvårdssjuksköterskor bedömer sederingsdjup och hur ofta IVA-delirium bedöms. Slutsatser Slutsatsen är att bedömning av sedering utförs oftare än bedömning av IVA-delirium. Mer utbildning inom ämnet och mer djupgående forskning rekommenderas.