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  • 11
    Online Resource
    Online Resource
    The Language of Delirium: Keywords for Identifying Delirium from Medical Records
    SLACK, Inc. ; 2015
    In:  Journal of Gerontological Nursing Vol. 41, No. 8 ( 2015-08), p. 34-42
    Details
    In: Journal of Gerontological Nursing, SLACK, Inc., Vol. 41, No. 8 ( 2015-08), p. 34-42
    Abstract: Electronic medical records (EMRs) offer the opportunity to streamline the search for patients with possible delirium. The purpose of the current study was to identify words and phrases commonly noted in charts of patients with delirium. The current study included 67 patients (nested within a cohort study of 300 patients) ages 70 and older undergoing major elective surgery with evidence of confusion in their medical charts. Eight keywords or phrases had positive predictive values of 60% to 100% for delirium. Keywords were charted more often in nursing notes than physician notes. A brief list of keywords may serve as a building block for a methodology to screen for possible delirium from charts, with particular attention to nursing notes, for research and real-time clinical decision making. [ Journal of Gerontological Nursing, 41 (8), 34–42.]
    Type of Medium: Online Resource
    ISSN: 0098-9134 , 1938-243X
    URL: Article
    DOI: 10.3928/00989134-20150723-01
    Language: English
    Publisher: SLACK, Inc.
    Publication Date: 2015
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  • 12
    Online Resource
    Online Resource
    Antipsychotic medication utilization in nonpsychiatric hospitalizations
    Wiley ; 2016
    In:  Journal of Hospital Medicine Vol. 11, No. 8 ( 2016-08), p. 543-549
    Details
    In: Journal of Hospital Medicine, Wiley, Vol. 11, No. 8 ( 2016-08), p. 543-549
    Abstract: Although antipsychotics are used for treatment of delirium/agitation in hospitalized patients, their scope of use has not been investigated in a large, multicenter cohort. OBJECTIVE To determine rates of use and hospital variation in use of antipsychotics in nonpsychiatric admissions. DESIGN, SETTING, PATIENTS Cohort study of adult, nonpsychiatric admissions to 300 US hospitals contributing data to the Premier database, from July 1, 2009 to June 30, 2010. MEASUREMENTS Antipsychotic exposure defined using pharmacy charges. Potentially excessive dosing defined using guidelines for long‐term care facilities. RESULTS Our cohort included 2,695,081 admissions (median age, 63 years; 56% female). Antipsychotic exposure occurred in 160,773 (6%) admissions; 102,148 (64%) received atypical antipsychotics, 76,979 (48%) received typical, and 18,354 (11%) received both. Among exposed admissions, 47% received ≥1 potentially excessive daily dose. Among the variables we analyzed, the strongest predictors of antipsychotic receipt were delirium (relative risk [RR]: 2.93, 95% CI: 2.88‐2.98) and dementia (RR: 2.78, 95% CI: 2.72‐2.83). After adjustment for patient characteristics, patients admitted to hospitals in the highest antipsychotic prescribing quintile were more than twice as likely to be exposed compared to patients admitted to hospitals in the lowest prescribing quintile (RR: 2.56, 95% CI: 2.50‐2.61). This relationship was similar across subgroups of admissions with delirium and dementia. CONCLUSIONS Antipsychotic medication exposure is common in nonpsychiatric admissions to US hospitals. The observed variation in antipsychotic prescribing was not fully explained by measured patient characteristics, suggesting the possibility of differing hospital prescribing cultures. Additional research and guidelines are necessary to define appropriate use of these potentially harmful medications in the hospital setting. Journal of Hospital Medicine 2016;11:543–549. © 2016 Society of Hospital Medicine
    Type of Medium: Online Resource
    ISSN: 1553-5592 , 1553-5606
    URL: Issue
    URL: Article
    DOI: 10.1002/jhm.v11.8
    DOI: 10.1002/jhm.2596
    Language: English
    Publisher: Wiley
    Publication Date: 2016
    detail.hit.zdb_id: 2221544-X
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  • 13
    Online Resource
    Online Resource
    〈p〉Physical Performance and Risk of Postoperative Delirium in Older Adults Undergoing Aortic Valve Replacement〈/p〉
    Informa UK Limited ; 2020
    In:  Clinical Interventions in Aging Vol. Volume 15 ( 2020-08), p. 1471-1479
    Details
    In: Clinical Interventions in Aging, Informa UK Limited, Vol. Volume 15 ( 2020-08), p. 1471-1479
    Type of Medium: Online Resource
    ISSN: 1178-1998
    URL: Article
    DOI: 10.2147/CIA.S257079
    Language: English
    Publisher: Informa UK Limited
    Publication Date: 2020
    detail.hit.zdb_id: 2212420-2
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  • 14
    Online Resource
    Online Resource
    Intraoperative Oxygen Concentration and Neurocognition after Cardiac Surgery
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Anesthesiology Vol. 134, No. 2 ( 2021-02-01), p. 189-201
    Details
    In: Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 134, No. 2 ( 2021-02-01), p. 189-201
    Abstract: Despite evidence suggesting detrimental effects of perioperative hyperoxia, hyperoxygenation remains commonplace in cardiac surgery. Hyperoxygenation may increase oxidative damage and neuronal injury leading to potential differences in postoperative neurocognition. Therefore, this study tested the primary hypothesis that intraoperative normoxia, as compared to hyperoxia, reduces postoperative cognitive dysfunction in older patients having cardiac surgery. Methods A randomized double-blind trial was conducted in patients aged 65 yr or older having coronary artery bypass graft surgery with cardiopulmonary bypass. A total of 100 patients were randomized to one of two intraoperative oxygen delivery strategies. Normoxic patients (n = 50) received a minimum fraction of inspired oxygen of 0.35 to maintain a Pao2 above 70 mmHg before and after cardiopulmonary bypass and between 100 and 150 mmHg during cardiopulmonary bypass. Hyperoxic patients (n = 50) received a fraction of inspired oxygen of 1.0 throughout surgery, irrespective of Pao2 levels. The primary outcome was neurocognitive function measured on postoperative day 2 using the Telephonic Montreal Cognitive Assessment. Secondary outcomes included neurocognitive function at 1, 3, and 6 months, as well as postoperative delirium, mortality, and durations of mechanical ventilation, intensive care unit stay, and hospital stay. Results The median age was 71 yr (interquartile range, 68 to 75), and the median baseline neurocognitive score was 17 (16 to 19). The median intraoperative Pao2 was 309 (285 to 352) mmHg in the hyperoxia group and 153 (133 to 168) mmHg in the normoxia group (P & lt; 0.001). The median Telephonic Montreal Cognitive Assessment score on postoperative day 2 was 18 (16 to 20) in the hyperoxia group and 18 (14 to 20) in the normoxia group (P = 0.42). Neurocognitive function at 1, 3, and 6 months, as well as secondary outcomes, were not statistically different between groups. Conclusions In this randomized controlled trial, intraoperative normoxia did not reduce postoperative cognitive dysfunction when compared to intraoperative hyperoxia in older patients having cardiac surgery. Although the optimal intraoperative oxygenation strategy remains uncertain, the results indicate that intraoperative hyperoxia does not worsen postoperative cognition after cardiac surgery. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
    Type of Medium: Online Resource
    ISSN: 0003-3022 , 1528-1175
    URL: Article
    DOI: 10.1097/ALN.0000000000003650
    RVK:
    XA 22600
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
    detail.hit.zdb_id: 2016092-6
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  • 15
    Online Resource
    Online Resource
    Preventability of Early Versus Late Hospital Readmissions in a National Cohort of General Medicine Patients
    American College of Physicians ; 2018
    In:  Annals of Internal Medicine Vol. 168, No. 11 ( 2018-06-05), p. 766-774
    Details
    In: Annals of Internal Medicine, American College of Physicians, Vol. 168, No. 11 ( 2018-06-05), p. 766-774
    Type of Medium: Online Resource
    ISSN: 0003-4819 , 1539-3704
    URL: Article
    DOI: 10.7326/M17-1724
    RVK:
    XA 23600
    Language: English
    Publisher: American College of Physicians
    Publication Date: 2018
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  • 16
    Online Resource
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    Neural substrates of vulnerability to postsurgical delirium as revealed by presurgical diffusion MRI
    Oxford University Press (OUP) ; 2016
    In:  Brain Vol. 139, No. 4 ( 2016-04), p. 1282-1294
    Details
    In: Brain, Oxford University Press (OUP), Vol. 139, No. 4 ( 2016-04), p. 1282-1294
    Type of Medium: Online Resource
    ISSN: 0006-8950 , 1460-2156
    URL: Article
    DOI: 10.1093/brain/aww010
    RVK:
    XA 10000
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2016
    detail.hit.zdb_id: 1474117-9
    SSG: 12
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  • 17
    Online Resource
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    Does Alzheimer's Disease and Related Dementias Modify Delirium Severity and Hospital Outcomes?
    Wiley ; 2020
    In:  Journal of the American Geriatrics Society Vol. 68, No. 8 ( 2020-08), p. 1722-1730
    Details
    In: Journal of the American Geriatrics Society, Wiley, Vol. 68, No. 8 ( 2020-08), p. 1722-1730
    Abstract: We examined the association between delirium severity and outcomes of delirium among persons with and without Alzheimer's disease and related dementias (ADRD). DESIGN Prospective cohort study. SETTING Academic tertiary medical center. PARTICIPANTS A total of 352 medical and surgical patients. MEASUREMENTS Delirium incidence and severity were rated daily using the Confusion Assessment Method (CAM) and CAM‐Severity (CAM‐S) score during hospitalization. Severe delirium was defined as a CAM‐S Short Form score in the highest tertile (3‐7 points out of 7). ADRD status was determined by a clinical consensus process. Clinical outcomes included prolonged length of stay ( 〉 6 d), discharge to post‐acute nursing facility, any decline in activities of daily living (ADLs) at 1 month from prehospital baseline, ongoing nursing facility stay, and mortality. RESULTS Patients with ADRD (n = 85 [24%]) had a significantly higher relative risk (RR) for incident delirium (RR = 2.31; 95% confidence interval [CI] = 1.64‐3.28) and higher peak CAM‐S scores (mean difference = 1.24 points; CI = .83‐1.65; P   〈  .001). Among patients with ADRD, severe delirium significantly increased the RR for nursing facility stay (RR = 2.22; CI = 1.05‐4.69; P = .04) and increased the RR for mortality (RR = 2.10; CI = .89‐4.98; P = .09). Among patients without ADRD, severe delirium was associated with a significantly increased risk for all poor outcomes except mortality including prolonged length of stay in the hospital (RR = 1.47; CI = 1.18‐1.82) and discharge to a post‐acute nursing facility (RR = 2.17; CI = 1.58‐2.98) plus decline in ADLs (RR = 1.30; CI = 1.05‐1.60) and nursing facility stay at 1 month (RR = 1.93; CI = 1.31‐2.83). CONCLUSION Severe delirium is associated with increased risk for poor clinical outcomes in patients with and without ADRD. In both groups, severe delirium increased risk of nursing home placement. In patients with ADRD, delirium was more severe and associated with a trend toward increased mortality at 1 month. Although the increased risk remains substantial by RR, the study had limited power to examine the rarer outcome of death. J Am Geriatr Soc 68:1722‐1730, 2020.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Issue
    URL: Article
    DOI: 10.1111/jgs.v68.8
    DOI: 10.1111/jgs.16420
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2040494-3
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  • 18
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    Delirium Incidence and Functional Outcomes After Transcatheter and Surgical Aortic Valve Replacement
    Wiley ; 2019
    In:  Journal of the American Geriatrics Society Vol. 67, No. 7 ( 2019-07), p. 1393-1401
    Details
    In: Journal of the American Geriatrics Society, Wiley, Vol. 67, No. 7 ( 2019-07), p. 1393-1401
    Abstract: Transcatheter aortic valve replacement (TAVR) may be associated with less delirium and allow faster recovery than surgical aortic valve replacement (SAVR). Objective To examine the association of delirium and its severity with clinical and functional outcomes after SAVR and TAVR. Design Prospective cohort study. Setting An academic medical center. Participants A total of 187 patients, aged 70 years and older, undergoing SAVR (N = 77) and TAVR (N = 110) in 2014 to 2016. Measurements Delirium was assessed daily using the Confusion Assessment Method (CAM), with severity measured by the CAM‐Severity (CAM‐S) score (range = 0‐19). Outcomes were prolonged hospitalization (9 days or more); institutional discharge; and functional status, measured by ability to perform 22 daily activities and physical tasks over 12 months. Results SAVR patients had a higher incidence of delirium than TAVR patients (50.7% vs 25.5%; P   〈  .001), despite younger mean age (77.9 vs 83.7 years) and higher baseline Mini‐Mental State Examination score (26.9 vs 24.7). SAVR patients with delirium had a shorter duration (2.2 vs 3.4 days; P  = .04) with a lower mean CAM‐S score (4.5 vs 5.7; P  = .01) than TAVR patients with delirium. The risk of prolonged hospitalization in no, mild, and severe delirium was 18.4%, 30.8%, and 61.5% after SAVR ( P for trend = .009) and 26.8%, 38.5%, and 73.3% after TAVR ( P for trend = .001), respectively. The risk of institutional discharge was 42.1%, 58.3%, and 84.6% after SAVR ( P for trend = .01) and 32.5%, 69.2%, and 80.0% after TAVR ( P for trend 〈 .001), respectively. Severe delirium was associated with delayed functional recovery after SAVR and persistent functional impairment after TAVR at 12 months. Conclusion Less invasive TAVR was associated with lower incidence of delirium than SAVR. Once delirium developed, TAVR patients had more severe delirium and worse functional status trajectory than SAVR patients did. Registration NCT01845207.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Issue
    URL: Article
    DOI: 10.1111/jgs.2019.67.issue-7
    DOI: 10.1111/jgs.15867
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2040494-3
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  • 19
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    Reducing Delirium After Hip Fracture: A Randomized Trial
    Wiley ; 2001
    In:  Journal of the American Geriatrics Society Vol. 49, No. 5 ( 2001-05), p. 516-522
    Details
    In: Journal of the American Geriatrics Society, Wiley, Vol. 49, No. 5 ( 2001-05), p. 516-522
    Abstract: DESIGN: Prospective, randomized, blinded. SETTING: Inpatient academic tertiary medical center. PARTICIPANTS: 126 consenting patients 65 and older (mean age 79 ± 8 years, 79% women) admitted emergently for surgical repair of hip fracture. MEASUREMENTS: Detailed assessment through interviews with patients and designated proxies and review of medical records was performed at enrollment to ascertain prefracture status. Subjects were then randomized to proactive geriatrics consultation, which began preoperatively or within 24 hours of surgery, or “usual care.” A geriatrician made daily visits for the duration of the hospitalization and made targeted recommendations based on a structured protocol. To ascertain study outcomes, all subjects underwent daily, blinded interviews for the duration of their hospitalization, including the Mini‐Mental State Examination (MMSE), the Delirium Symptom Interview (DSI), and the Memorial Delirium Assessment Scale (MDAS). Delirium was diagnosed using the Confusion Assessment Method (CAM) algorithm. RESULTS: The 62 patients randomized to geriatrics consultation were not significantly different ( P 〉 .1) from the 64 usual‐care patients in terms of age, gender, prefracture dementia, comorbidity, type of hip fracture, or type of surgical repair. Sixty‐one percent of geriatrics consultation patients were seen preoperatively and all were seen within 24 hours postoperatively. A mean of 10 recommendations were made throughout the duration of the hospitalization, with 77% adherence by the orthopedics team. Delirium occurred in 20  /62 (32%) intervention patients, versus 32  /  64 (50%) usual‐care patients ( P = .04), representing a relative risk of 0.64 (95% confidence interval (CI) = 0.37–0.98) for the consultation group. One case of delirium was prevented for every 5.6 patients in the geriatrics consultation group. There was an even greater reduction in cases of severe delirium, occurring in 7/ 60 (12%) of intervention patients and 18  / 62 (29%) of usual‐care patients, with a relative risk of 0.40 (95% CI = 0.18–0.89). Despite this reduction in delirium, length of stay did not significantly differ between intervention and usual‐care groups (median ± interquartile range = 5 ± 2 days in both groups), likely because protocols and pathways predetermined length of stay. In subgroup analyses, geriatrics consultation was most effective in reducing delirium in patients without prefracture dementia or activities of daily living (ADL) functional impairment. CONCLUSIONS: Proactive geriatrics consultation was successfully implemented with good adherence after hip‐fracture repair. Geriatrics consultation reduced delirium by over one‐third, and reduced severe delirium by over one‐half. Our trial provides strong preliminary evidence that proactive geriatrics consultation may play an important role in the acute hospital management of hip‐fracture patients.
    Type of Medium: Online Resource
    ISSN: 0002-8614 , 1532-5415
    URL: Article
    DOI: 10.1046/j.1532-5415.2001.49108.x
    Language: English
    Publisher: Wiley
    Publication Date: 2001
    detail.hit.zdb_id: 2040494-3
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  • 20
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    Risk of in-hospital falls among medications commonly used for insomnia in hospitalized patients
    Oxford University Press (OUP) ; 2021
    In:  Sleep Vol. 44, No. 9 ( 2021-09-13)
    Details
    In: Sleep, Oxford University Press (OUP), Vol. 44, No. 9 ( 2021-09-13)
    Abstract: To investigate the risk of in-hospital falls among patients receiving medications commonly used for insomnia in the hospital setting. Methods Retrospective cohort study of all adult hospitalizations to a large academic medical center from January, 2007 to July, 2013. We excluded patients admitted for a primary psychiatric disorder. Medication exposures of interest, defined by pharmacy charges, included benzodiazepines, non-benzodiazepine benzodiazepine receptor agonists, trazodone, atypical antipsychotics, and diphenhydramine. In-hospital falls were ascertained from an online patient safety reporting system. Results Among the 225,498 hospitalizations (median age = 57 years; 57.9% female) in our cohort, 84,911 (37.7%) had exposure to at least one of the five medication classes of interest; benzodiazepines were the most commonly used (23.5%), followed by diphenhydramine (8.3%), trazodone (6.6%), benzodiazepine receptor agonists (6.4%), and atypical antipsychotics (6.3%). A fall occurred in 2,427 hospitalizations (1.1%). The rate of falls per 1,000 hospital days was greater among hospitalizations with exposure to each of the medications of interest, compared to unexposed: 3.6 versus 1.7 for benzodiazepines (adjusted hazard ratio [aHR] 1.8, 95%CI 1.6–1.9); 5.4 versus 1.8 for atypical antipsychotics (aHR 1.6, 95%CI 1.4–1.8); 3.0 versus 2.0 for benzodiazepine receptor agonists (aHR 1.5, 95%CI 1.3–1.8); 3.3 versus 2.0 for trazodone (aHR 1.2, 95%CI 1.1–1.5); and 2.5 versus 2.0 for diphenhydramine (aHR 1.2, 95%CI 1.03–1.5). Conclusions In this large cohort of hospitalizations at an academic medical center, we found an association between each of the sedating medications examined and in-hospital falls. Benzodiazepines, benzodiazepine receptor agonists, and atypical antipsychotics had the strongest associations.
    Type of Medium: Online Resource
    ISSN: 0161-8105 , 1550-9109
    URL: Article
    DOI: 10.1093/sleep/zsab064
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2056761-3
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