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Butala A, Gilbert JM, Griffiths AA, Lim WK. Hospitalized Patients with Delirium and 28-Day Unplanned Hospital Readmissions: A Longitudinal Retrospective Cohort Study. J Am Med Dir Assoc 2024:105005. [PMID: 38677321 DOI: 10.1016/j.jamda.2024.03.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE To establish the predictors of 28-day unplanned hospital readmissions (28D-UHR) in older adults (aged >65 years) with delirium during index hospital admission. DESIGN Retrospective longitudinal cohort study. SETTING AND PARTICIPANTS 1634 patients (aged >65 years) admitted to a Melbourne quaternary hospital with delirium during index admission. METHODS Delirium during hospital admission was defined by the inclusion of one of the following International Classification of Diseases, Tenth Revision, codes F05.0, F05.1, F05.8, or F05.9 in the hospital medical discharge summary. Descriptive statistics were obtained for baseline characteristics. Multivariate logistic regression model was developed to assess predictors of 28D-UHR. RESULTS A total of 1634 patients with delirium during their inpatient admission were included, with 9.8% (160 patients) incidence of 28D-UHR. For patients who were readmitted, a shorter length of stay [odds ratio (OR) 0.98, 95% CI 0.96-0.99], higher number of medications on discharge from index admission (OR 1.10, 95% CI 1.06-1.14), and residing in a nursing home preadmission (OR 1.35, 95% CI 1.04-1.75) were associated with 28D-UHR. CONCLUSIONS AND IMPLICATIONS This study found that nursing home residence pre index admission, shorter length of stay (LOS), and polypharmacy were predictors of 28D-UHR. Further research into strategies to minimize 28D-UHR is required. Exploration of predischarge pharmacy-driven deprescribing programs and hospital-based postdischarge support for nursing home staff are important areas for future intervention.
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Affiliation(s)
- Anvi Butala
- Department of Geriatrics, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
| | - Jacqueline M Gilbert
- Department of Geriatrics, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alyssa A Griffiths
- Department of Geriatrics, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Wen K Lim
- Department of Geriatrics, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Setiati S, Ardian LJ, Fitriana I, Azwar MK. Improvement of scoring system used before discharge to predict 30-day all-cause unplanned readmission in geriatric population: a prospective cohort study. BMC Geriatr 2024; 24:281. [PMID: 38528454 DOI: 10.1186/s12877-024-04875-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/05/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Data taken from tertiary referral hospitals in Indonesia suggested readmission rate in older population ranging between 18.1 and 36.3%. Thus, it is crucial to identify high risk patients who were readmitted. Our previous study found several important predictors, despite unsatisfactory discrimination value. METHODS We aimed to investigate whether comprehensive geriatric assessment (CGA) -based modification to the published seven-point scoring system may increase the discrimination value. We conducted a prospective cohort study in July-September 2022 and recruited patients aged 60 years and older admitted to the non-surgical ward and intensive coronary care unit. The ROC curve was made based on the four variables included in the prior study. We conducted bivariate and multivariate analyses, and derived a new scoring system with its discrimination value. RESULTS Of 235 subjects, the incidence of readmission was 32.3% (95% CI 26-38%). We established a new scoring system consisting of 4 components. The scoring system had maximum score of 21 and incorporated malignancy (6 points), delirium (4 points), length of stay ≥ 10 days (4 points), and being at risk of malnutrition or malnourished (7 points), with a good calibration test. The C-statistic value was 0.835 (95% CI 0.781-0.880). The optimal cut-off point was ≥ 8 with a sensitivity of 90.8% and a specificity of 54.7%. CONCLUSIONS Malignancy, delirium, length of stay ≥ 10 days, and being at risk of malnutrition or malnourished are predictors for 30-day all-cause unplanned readmission. The sensitive scoring system is a strong model to identify whether an individual is at higher risk for readmission. The new CGA-based scoring system had higher discrimination value than that of the previous seven-point scoring system.
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Affiliation(s)
- Siti Setiati
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Laurentius Johan Ardian
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ika Fitriana
- Division of Geriatrics, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Muhammad Khifzhon Azwar
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Denninger NE, Brefka S, Skudlik S, Leinert C, Mross T, Meyer G, Sulmann D, Dallmeier D, Denkinger M, Müller M. Development of a complex intervention to prevent delirium in older hospitalized patients by optimizing discharge and transfer processes and involving caregivers: A multi-method study. Int J Nurs Stud 2024; 150:104645. [PMID: 38091654 DOI: 10.1016/j.ijnurstu.2023.104645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/09/2023] [Accepted: 11/09/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Delirium is a common yet challenging condition in older hospitalized patients, associated with various adverse outcomes. Environmental factors, such as room changes, may contribute to the development or severity of delirium. Most previous research has focused on preventing and reducing this condition by addressing risk factors and facilitating reorientation during hospital stay. OBJECTIVE We aimed to systematically develop a complex intervention to prevent delirium in older hospitalized patients by optimizing discharge and transfer processes and involving caregivers during and after these procedures. The intervention combines stakeholder and expert opinions, evidence, and theory. This article provides guidance and inspiration to research groups in developing complex interventions according to the recommendations in the Medical Research Council framework for complex interventions. DESIGN AND METHODS A stepwise multi-method study was conducted. The preparation phase included analysis of the context and current practice via focus groups. Based on these results, an expert workshop was organized, followed by a Delphi survey. Finally, the intervention was modeled and a program theory was developed, including a logic model. RESULTS A complex intervention was developed in an iterative process, involving healthcare professionals, delirium experts, researchers, as well as caregiver and patient representatives. The key intervention component is an 8-point-program, which provides caregivers with recommendations for preventing delirium during the transition phase and in the post-discharge period. Information materials (flyers, handbook, videos, posters, defined "Dos and Don'ts", discharge checklist), training for healthcare professionals, and status analyses are used as implementation strategies. In addition, roles were established for gatekeepers to act as leaders, and champions to serve as knowledge multipliers and trainers for the multi-professional team in the hospitals. CONCLUSIONS This study serves as an example of how to develop a complex intervention. In an additional step, the intervention and implementation strategies will be investigated for feasibility and acceptability in a pilot study with an accompanying process evaluation. TWEETABLE ABSTRACT Delirium prevention can benefit from optimizing discharge and transfer processes and involving caregivers of older patients in these procedures. STUDY REGISTRATION DRKS00017828, German Register of Clinical Studies, date of registration 17.09.2019.
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Affiliation(s)
- Natascha-Elisabeth Denninger
- Rosenheim Technical University of Applied Sciences, Centre for Research, Development and Technology Transfer, Rosenheim, Germany; Martin Luther University Halle-Wittenberg, International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Halle (Saale), Germany; Heidelberg University, Medical Faculty Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany; University Hospital Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany.
| | - Simone Brefka
- Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Ulm University Hospital, Institute for Geriatric Research at Agaplesion Bethesda Hospital Ulm, Ulm, Germany
| | - Stefanie Skudlik
- Rosenheim Technical University of Applied Sciences, Centre for Research, Development and Technology Transfer, Rosenheim, Germany
| | - Christoph Leinert
- Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Ulm University Hospital, Institute for Geriatric Research at Agaplesion Bethesda Hospital Ulm, Ulm, Germany
| | - Thomas Mross
- Agaplesion Bethanien Hospital Heidelberg, Centre for Geriatric Medicine, University of Heidelberg, Heidelberg, Germany
| | - Gabriele Meyer
- Martin Luther University Halle-Wittenberg, International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Halle (Saale), Germany
| | | | - Dhayana Dallmeier
- Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Boston University School of Public Health, Department of Epidemiology, Boston, USA
| | - Michael Denkinger
- Agaplesion Bethesda Hospital Ulm, Research Unit on Ageing, Ulm, Germany; Geriatric Centre Ulm at the Ulm University, Ulm, Germany; Ulm University Hospital, Institute for Geriatric Research at Agaplesion Bethesda Hospital Ulm, Ulm, Germany
| | - Martin Müller
- Rosenheim Technical University of Applied Sciences, Centre for Research, Development and Technology Transfer, Rosenheim, Germany; Heidelberg University, Medical Faculty Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany; University Hospital Heidelberg, Department of Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg, Germany
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Mulkey MA, Hauser P, Aucoin J. Relationship between in-hospital angiotensin converting enzyme inhibitors and Angiotensin receptor blockers administration and delirium in the cardiac ICU. Hosp Pract (1995) 2023; 51:199-204. [PMID: 37391685 PMCID: PMC10771528 DOI: 10.1080/21548331.2023.2232501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 06/27/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVES Delirium may be associated with neuroinflammation and reduced blood-brain barrier (BBB) stability. ACE Inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs) reduce neuroinflammation and stabilize the BBB, thus slowing the progression of memory loss in patients with dementia. This study evaluated the effect of these medications on delirium prevalence. METHODS This was a retrospective study of data from all patients admitted to a Cardiac ICU between 1 January 2020-31 December 2020. The presence of delirium was determined based on the International Classification of Diseases (ICD) 10 codes and nurse delirium screening. RESULTS Of the 1684 unique patients, almost half developed delirium. Delirious patients who did not receive either ACEI or ARB had higher odds (odds ratio [OR] 5.88, 95% CI 3.7-9.09, P < .001) of in-hospital death and experienced significantly shorter ICU lengths of stay (LOS) (P = .01). There was no significant effect of medication exposure on the time to delirium onset. CONCLUSIONS While ACEIs and ARBs have been shown to slow the progression of memory loss for patients with Alzheimer's disease, we did not observe a difference in time to delirium onset.
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Affiliation(s)
| | - Paloma Hauser
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Julia Aucoin
- University of North Carolina-Rex Hospital, Raleigh, NC, USA
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Wang J, Niu S, Wu Y. Effect of the clinical decision assessment system on clinical outcomes of delirium in hospitalized older adults: study protocol for a pair-matched, parallel, cluster randomized controlled superiority trial. Trials 2023; 24:581. [PMID: 37697324 PMCID: PMC10494451 DOI: 10.1186/s13063-023-07607-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/28/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Prompt recognition of delirium is the first key step in its proper management. A previous study has demonstrated that nurses' delirium screening using the usual paper version assessment tool has no effect on clinical outcomes. Clinical decision assessment systems have been demonstrated to improve patients' adherence and clinical outcomes. Therefore, We developed a clinical decision assessment system (3D-DST) based on the usual paper version (3-min diagnostic interview for CAM-defined delirium), which was developed for assessing delirium in older adults with high usability and accuracy. However, no high quality evidence exists on the effectiveness of a 3D-DST in improving outcomes of older adults compared to the usual paper version. METHODS A pair-matched, open-label, parallel, cluster randomized controlled superiority trial following the SPIRIT checklist. Older patients aged 65 years or older admitted to four medical wards of a geriatric hospital will be invited to participate in the study. Prior to the study, delirium prevention and treatment interventions will be delivered to nurses in both the intervention and control groups. The nurses in the intervention group will perform routine delirium assessments on the included older patients with 3D-DST, while the nurses in the control group will perform daily delirium assessments with the usual paper version. Enrolled patients will be assessed twice daily for delirium by a nurse researcher using 3D-DST. The primary outcome is delirium duration. The secondary outcomes are delirium severity, incidence of delirium, length of stay, in-hospital mortality, adherence to delirium assessment, prevention, and treatment of medical staff. DISCUSSION This study will incorporate the 3D-DST into clinical practice for delirium assessment. If our study will demonstrate that 3D-DST will improve adherence with delirium assessment and clinical outcomes in older patients, it will provide important evidence for the management of delirium in the future. TRIAL REGISTRATION Chinese Clinical Trial Registry, Identifier: ChiCTR1900028402. https://www.chictr.org.cn/showproj.aspx?proj=47127 . PROTOCOL VERSION 1, 29/7/22.
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Affiliation(s)
- Jiamin Wang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, 102488, China
- School of Nursing, Capital Medical University, 10 You-an-Men Wai Xi-Tou-Tiao, Fengtai District, Beijing, 100069, China
| | - Sen Niu
- School of Nursing, Beijing University of Chinese Medicine, Beijing, 102488, China
| | - Ying Wu
- School of Nursing, Capital Medical University, 10 You-an-Men Wai Xi-Tou-Tiao, Fengtai District, Beijing, 100069, China.
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Thilges S, Egbert J, Jakuboski S, Qeadan F. Associations between delirium and SARS-CoV-2 pandemic visitor restrictions among hospitalized patients. Public Health 2023; 222:45-53. [PMID: 37517161 PMCID: PMC10293895 DOI: 10.1016/j.puhe.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES Delirium is associated with increased morbidity and mortality, but environmental and behavioral factors may decrease the risk of developing delirium and thus must be considered. To investigate trends in delirium prevalence and examine associations of visitor restrictions with delirium diagnoses among all patients hospitalized during and prior to the novel coronavirus SARS-CoV-2 (COVID-19) pandemic. STUDY DESIGN Retrospective epidemiological assessment. METHODS The medical records of all patients (n = 33,141) hospitalized within a three-hospital academic medical center system in a large Midwestern metropolitan area from March 20, 2019, through March 19, 2021, were analyzed. RESULTS The overall prevalence of delirium during COVID-19 was 11.26% (confidence interval [CI]: 10.79%, 11.73%) compared to 9.28% (CI: 8.82%, 9.73%) before COVID-19. From our adjusted logistic regression analyses, we observed that the odds of delirium among non-isolated patients were significantly higher during COVID-19 visitor restrictions (adjusted odds ratio [aOR]: 1.354; 95% CI: 1.233, 1.488; P < 0.0001) than before. The odds of delirium among isolated patients were not significantly higher during COVID-19 visitor restrictions (aOR: 1.145; 95% CI: 0.974, 1.346; P = 0.1006) than before. CONCLUSIONS Medically isolated patients remained at high risk of developing delirium both prior to and during COVID-19 era visitor restrictions. However, non-medically isolated patients had a significantly increased risk of delirium during the social isolation of visitor restrictions compared to prior to visitor restrictions.
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Affiliation(s)
- S Thilges
- Loyola University Medical Center, Department of Psychiatry and Behavioral Neurosciences, 2160 South First Avenue, Maywood, IL, United States.
| | - J Egbert
- Loyola University Chicago, Parkinson School of Health Sciences and Public Health, 2160 South First Avenue, Maywood, IL, United States.
| | - S Jakuboski
- Loyola University Chicago, Stritch School of Medicine, 2160 South First Avenue, Maywood, IL, United States.
| | - F Qeadan
- Loyola University Chicago, Parkinson School of Health Sciences and Public Health, 2160 South First Avenue, Maywood, IL, United States.
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Mulkey MA, Khan S, Perkins A, Gao S, Wang S, Campbell N, Khan B. Relationship between angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prescribing and delirium in the ICU-A secondary analysis. J Am Geriatr Soc 2023; 71:1873-1880. [PMID: 36905601 PMCID: PMC10258121 DOI: 10.1111/jgs.18285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/14/2023] [Accepted: 01/25/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Studies suggest Angiotensin-Converting Enzyme inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) may slow the decline of memory function in individuals with mild to moderate Alzheimer's disease by regulating migroglial activation and oxidative stress within the brain's reticular activating system. Therefore, we evaluated the relationship between delirium prevalence and being prescribed ACEI and ARB in participants admitted to the intensive care units (ICU). METHODS A secondary analysis of data from two parallel pragmatic randomized controlled trials was performed. ACEI and ARB exposure was defined as being prescribed an ACEI or an ARB within six months prior to the ICU admission. The primary endpoint was the first positive delirium assessment based on Confusion Assessment Method for the ICU (CAM-ICU) for up to thirty days. RESULTS A total of 4791 patients admitted to the medical, surgical, and progressive ICU and screened for eligibility for the parent studies between February 2009 and January 2015 from two level 1 trauma and one safety net hospital in a large urban academic health system were included. Delirium rates in the ICU were not significantly different among participants with no exposure to ACEI/ARB (12.6%), or exposure to ACEI (14.4%), ARB (11.8%), or ACEI and ARB in combination (15.4%) in six months prior to the ICU admission. Exposure to ACEI (OR = 0.97[0.77, 1.22]), ARB (OR = 0.70 [0.47, 1.05]), or both (OR = 0.97 [0.33, 2.89]) in six months prior to ICU admission was not significantly associated with odds of delirium during the ICU admission after adjusting for age, gender, race, co-morbidities, and insurance status. CONCLUSIONS While the impact of ACEI and ARB exposure prior to the ICU admission was not associated with the prevalence of delirium in this study, further research is needed to fully understand the impact of antihypertensive medications on delirium.
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Affiliation(s)
- Malissa A Mulkey
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Sikandar Khan
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University-Purdue University, Indianapolis, Indiana, USA
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
- Center for Aging Research, Indiana University, Indianapolis, Indiana, USA
- Indiana University Center of Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Anthony Perkins
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
- Department of Biostatistics and Health Data Science, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | - Sujuan Gao
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
- Department of Biostatistics and Health Data Science, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | - Sophia Wang
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
- Department of Psychiatry, Department of Biostatistics and Health Data Science, Indianapolis, Indiana, USA
| | - Noll Campbell
- Center for Aging Research, Indiana University, Indianapolis, Indiana, USA
- Indiana University Center of Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA
- Department of Pharmacy Practice, Purdue University, Lafayette, Indiana, USA
| | - Babar Khan
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Indiana University-Purdue University, Indianapolis, Indiana, USA
- School of Medicine, Indiana University, Indianapolis, Indiana, USA
- Center for Aging Research, Indiana University, Indianapolis, Indiana, USA
- Indiana University Center of Aging Research, Regenstrief Institute, Indianapolis, Indiana, USA
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Desai AP, Gandhi D, Xu C, Ghabril M, Nephew L, Patidar KR, Campbell NL, Chalasani N, Boustani M, Orman ES. Confusion assessment method accurately screens for hepatic encephalopathy and predicts short-term mortality in hospitalized patients with cirrhosis. Metab Brain Dis 2023; 38:1749-1758. [PMID: 36529762 PMCID: PMC10935593 DOI: 10.1007/s11011-022-01149-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Hepatic encephalopathy (HE), a subtype of delirium, is common in cirrhosis and associated with poor outcomes. Yet, objective bedside screening tools for HE are lacking. We examined the relationship between an established screening tool for delirium, Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and short-term outcomes while comparing its performance with previously established measures of cognitive function such as West Haven criteria (WHC). Prospectively enrolled adults with cirrhosis who completed the CAM-ICU from 6/2014-6/2018 were followed for 90 days. Blinded provider-assigned West Haven Criteria (WHC) and other measures of cognitive function were collected. Logistic regression was used to test associations between CAM-ICU status and outcomes. Mortality prediction by CAM-ICU status was assessed using Area under the Receiver Operating Characteristics curves (AUROC). Of 469 participants, 11% were CAM-ICU( +), 55% were male and 94% were White. Most patients were Childs-Pugh class C (59%). CAM-ICU had excellent agreement with WHC (Kappa = 0.79). CAM-ICU( +) participants had similar demographic features to those CAM-ICU(-), but had higher MELD (25 vs. 19, p < 0.0001), were more often admitted to the ICU (28% vs. 7%, p < 0.0001), and were more likely to be admitted for HE and infection. CAM-ICU( +) participants had higher mortality (inpatient:37% vs. 3%, 30-day:51% vs. 11%, 90-day:63% vs. 23%, p < 0.001). CAM-ICU status predicted mortality with AUROC of 0.85, 0.82 and 0.77 for inpatient, 30-day and 90-day mortality, respectively. CAM-ICU easily screens for delirium/HE, has excellent agreement with WHC, and identifies a hospitalized cirrhosis cohort with high short-term mortality.
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Affiliation(s)
- Archita P Desai
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA.
- Center for Health Innovation and Implementation Science, Indiana University, Indianapolis, IN, USA.
| | - Devika Gandhi
- Division of Gastroenterology and Hepatology, Loma Linda University Health, Loma Linda, CA, USA
| | - Chenjia Xu
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Marwan Ghabril
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA
| | - Lauren Nephew
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA
| | - Kavish R Patidar
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA
| | - Noll L Campbell
- Center for Health Innovation and Implementation Science, Indiana University, Indianapolis, IN, USA
- Department of Pharmacy Practice, Purdue University College of Pharmacy, Indianapolis, IN, USA
- Indiana University Center for Aging Research at the Regenstrief Institute, Indianapolis, IN, USA
| | - Naga Chalasani
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA
| | - Malaz Boustani
- Center for Health Innovation and Implementation Science, Indiana University, Indianapolis, IN, USA
- Indiana University Center for Aging Research at the Regenstrief Institute, Indianapolis, IN, USA
- Division of Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eric S Orman
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Circle, Suite 225, Indianapolis, IN, 46202, USA
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Friedrich M, Perera G, Leutgeb L, Haardt D, Frey R, Stewart R, Mueller C. Predictors of hospital readmission for patients diagnosed with delirium: An electronic health record data analysis. Acta Psychiatr Scand 2023; 147:506-515. [PMID: 36441117 PMCID: PMC10463092 DOI: 10.1111/acps.13523] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/13/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Delirium is an acute and fluctuating change in attention and cognition that increases the risk of functional decline, institutionalisation and death in hospitalised patients. After delirium, patients have a significantly higher risk of readmission to hospital. Our aim was to investigate factors associated with hospital readmission in people with delirium. METHODS We carried out an observational retrospective cohort study using linked mental health care and hospitalisation records from South London. Logistic regression models were used to predict the odds of 30-day readmission and Cox proportional hazard models to calculate readmission risks when not restricting follow-up time. RESULTS Of 2814 patients (mean age 78.9 years SD ±11.8) discharged from hospital after an episode of delirium, 823 (29.3%) were readmitted within 30 days. Depressed mood (odds ratio (OR) 1.34 (95% confidence interval (CI) 1.08-1.66)), moderate-to-severe physical health problems (OR 1.67 (95% CI 1.18-2.2.36)) and a history of serious circulatory disease (OR 1.29 (95% CI 1.07-1.55)) were associated with higher odds of hospital readmission, whereas a diagnosis of delirium superimposed on dementia (OR 0.67 (95% CI 0.53-0.84)) and problematic alcohol/substance (OR 0.54 (95% CI 0.33-0.89)) use were associated with lower odds. Cox proportionate hazard models showed similar results. CONCLUSION Almost one-third of patients with delirium were readmitted within a short period of time, a more detailed understanding of the underlying risk factors could help prevent readmissions. Our findings indicate that the aetiology (as alcohol-related delirium), the recognition that delirium occurred in the context of dementia, as well as potentially modifiable factors, as depressed mood affect readmission risk, and should be assessed in clinical settings.
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Affiliation(s)
- Michaela‐Elena Friedrich
- Department of Child and Adolescent PsychiatryKlinik HietzingViennaAustria
- Department of Psychiatry and PsychotherapyKlinik FloridsdorfViennaAustria
| | - Gayan Perera
- King's College London, Institute of Psychiatry, Psychology and NeuroscienceLondonUK
| | - Lisa Leutgeb
- Department of Psychiatry and PsychotherapyKlinik FloridsdorfViennaAustria
| | - David Haardt
- Department of Psychiatry and PsychotherapyKlinik FloridsdorfViennaAustria
| | - Richard Frey
- Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
| | - Robert Stewart
- King's College London, Institute of Psychiatry, Psychology and NeuroscienceLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Christoph Mueller
- King's College London, Institute of Psychiatry, Psychology and NeuroscienceLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
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Park DY, Hu JR, Alexander KP, Nanna MG. Readmission and adverse outcomes after percutaneous coronary intervention in patients with dementia. J Am Geriatr Soc 2023; 71:1034-1046. [PMID: 36409823 PMCID: PMC10089937 DOI: 10.1111/jgs.18120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND As the population ages, clinicians increasingly encounter ischemic heart disease in patients with underlying dementia. Therefore, we quantified differences in inhospital adverse events and 30-day readmission rates among patients with and without dementia undergoing percutaneous coronary intervention (PCI). METHODS Using the National Readmissions Database 2017-2018, we identified 755,406 index hospitalizations in which PCI was performed, of which 17,309 (2.3%) had a diagnosis of dementia. After propensity score matching patients with and without dementia, we assessed 30-day readmission and inhospital adverse events by Cox proportional hazards and logistic regression modeling and compared them with those of other common cardiac (pacemaker placement [PP]) and noncardiac (hip replacement surgery [HRS]) procedures. RESULTS Thirty-day readmission was significantly higher in patients with dementia than patients without dementia (hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.60-1.74). Patients with dementia also experienced higher odds of delirium (odds ratio [OR] 4.37, CI 3.69-5.16), inhospital mortality (OR 1.15, CI 1.01-1.30), cardiac arrest (OR 1.19, CI 1.01-1.39), acute kidney injury (OR 1.30, CI 1.21-1.39), and fall (OR 2.51, CI 2.06-3.07). On multivariable Cox modeling, dementia independently predicted 30-day readmission (HR 1.14, CI 1.07-1.20). The higher readmission risk with PCI (11%) among those with dementia was similar to that of patients undergoing PP (10%), but lower than in those undergoing HRS (41%). CONCLUSION Patients with dementia who undergo PCI experience significantly increased rates of inhospital delirium, mortality, kidney injury, falls, and 30-day readmission. These adverse outcomes should be considered during shared decision-making with patients and their families.
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Affiliation(s)
- Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, Illinois, USA
| | - Jiun-Ruey Hu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Karen P Alexander
- Department of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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11
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Mavragani A, Kreca S, van Dieren S, van der Wal-Huisman H, Romijn JA, Chaboyer W, Nieveen van Dijkum EJM, Eskes AM. Activating Relatives to Get Involved in Care After Surgery: Protocol for a Prospective Cohort Study. JMIR Res Protoc 2023; 12:e38028. [PMID: 36440980 PMCID: PMC9862329 DOI: 10.2196/38028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Postoperative complications and readmissions to hospital are factors known to negatively influence the short- and long-term quality of life of patients with gastrointestinal cancer. Active family involvement in activities, such as fundamental care activities, has the potential to improve the quality of health care. However, there is a lack of evidence regarding the relationship between active family involvement and outcomes in patients with gastrointestinal cancer after surgery. OBJECTIVE This protocol aims to evaluate the effect of a family involvement program (FIP) on unplanned readmissions of adult patients undergoing surgery for malignant gastrointestinal tumors. Furthermore, the study aims to evaluate the effect of the FIP on family caregiver (FC) burden and their well-being and the fidelity of the FIP. METHODS This cohort study will be conducted in 2 academic hospitals in the Netherlands. The FIP will be offered to adult patients and their FCs. Patients are scheduled for oncological gastrointestinal surgery and have an expected hospital stay of at least 5 days after surgery. FCs must be willing to participate in fundamental care activities during hospitalization and after discharge. Consenting patients and their families will choose to either participate in the FIP or be included in the usual care group. According to the power calculation, we will recruit 150 patients and families in the FIP group and 150 in the usual care group. The intervention group will receive the FIP that consists of information, shared goal setting, task-oriented training, participation in fundamental care, presence of FCs during ward rounds, and rooming-in for at least 8 hours a day. Patients in the comparison group will receive usual postoperative care. The primary outcome measure is the number of unplanned readmissions up to 30 days after surgery. Several secondary outcomes will be collected, that is, total number of complications (sensitive to fundamental care activities) at 30 and 90 days after surgery, emergency department visits, intensive care unit admissions up to 30 and 90 days after surgery, hospital length of stay, patients' quality of life, and the amount of home care needed after discharge. FC outcomes are caregiver burden and well-being up to 90 days after participating in the FIP. To evaluate fidelity, we will check whether the FIP is executed as intended. Univariable regression and multivariable regression analyses will be conducted. RESULTS The first participant was enrolled in April 2019. The follow-up period of the last participant ended in May 2022. The study was funded by an unrestricted grant of the University hospital in 2018. We aim to publish the results in 2023. CONCLUSIONS This study will provide evidence on outcomes from a FIP and will provide health care professionals practical tools for family involvement in the oncological surgical care setting. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/38028.
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Affiliation(s)
| | - Sani Kreca
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, Netherlands
| | - Susan van Dieren
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Wendy Chaboyer
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - Els J M Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC, Amsterdam Gastroenterology Endocrinology Metabolism and Cancer Center Amsterdam, University of Amsterdam,, Amsterdam, Netherlands
| | - Anne M Eskes
- Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, Netherlands.,Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
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12
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Park DY, Sana MK, Shoura S, Hammo H, Hu JR, Forrest JK, Lowenstern A, Cleman M, Ahmad Y, Nanna MG. Readmission and In-Hospital Outcomes After Transcatheter Aortic Valve Replacement in Patients With Dementia. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 46:70-77. [PMID: 35973922 PMCID: PMC10940024 DOI: 10.1016/j.carrev.2022.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND/PURPOSE The prevalence of dementia and aortic stenosis (AS) increases with each decade of age. Transcatheter aortic valve replacement (TAVR) is a definitive treatment for AS, but there are scarce data on morbidity, mortality, and readmission risk after TAVR in patients with dementia. METHODS/MATERIALS We identified all admissions for TAVR in patients with AS in the National Readmissions Database in 2017-2018 and stratified them according to the presence or absence of a secondary diagnosis of dementia. Inpatient outcomes were compared using logistic regression. Cox proportional-hazards models were used to compare 30-, 60-, and 90-day readmissions. RESULTS A total of 48,923 index hospitalizations for TAVR were identified, of which 2192 (4.5 %) had a secondary diagnosis of dementia. Presence of dementia was associated with higher odds of delirium, pacemaker placement, acute kidney injury, and fall in hospital. The hazard of 30-day readmission was not significantly different between patients with and without dementia, but patients with dementia experienced a higher hazard of 60-day readmission (HR 1.15, 95 % CI 1.03-1.26, p = 0.011) in the unadjusted model and higher hazard of 90-day readmission in both unadjusted (HR 1.18, 95 % CI 1.08-1.30, p < 0.001) and adjusted models (aHR 1.14, 95 % CI 1.04-1.25, p = 0.004). CONCLUSIONS Patients with dementia who undergo TAVR are at higher risk of in-hospital adverse outcomes and 60- and 90-day readmissions compared with patients without dementia. These estimates should be integrated into shared decision-making discussions with patients and families.
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Affiliation(s)
- Dae Yong Park
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | | | - Sami Shoura
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | - Hasan Hammo
- Department of Medicine, Cook County Health, Chicago, IL, USA
| | - Jiun-Ruey Hu
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - John K Forrest
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Angela Lowenstern
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Cleman
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Yousif Ahmad
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Michael G Nanna
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA.
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13
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Schonnop R, Dainty KN, McLeod SL, Melady D, Lee JS. Understanding why delirium is often missed in older emergency department patients: a qualitative descriptive study. CAN J EMERG MED 2022; 24:820-831. [PMID: 36138324 DOI: 10.1007/s43678-022-00371-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/29/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Unrecognized delirium is associated with significant adverse outcomes. Despite decades of effort and educational initiatives, validated screening tools have not improved delirium recognition in the emergency department (ED). There remains a fundamental knowledge gap of why it is consistently missed. The objective of this study was to explore the perceptions of ED physicians and nurses regarding factors contributing to missed delirium in older ED patients. METHODS We conducted a qualitative descriptive study at two academic tertiary care EDs in Toronto, Canada. Emergency physicians and nurses were interviewed by a trained qualitative researcher using a semi-structured interview guide. We coded transcripts with an iteratively developed codebook. Interviews were conducted until thematic saturation occurred. Thematic data analysis occurred in conjunction with data collection to continuously monitor emerging themes and areas for further exploration. RESULTS We interviewed 26 ED physicians and nurses. We identified key themes at four levels: clinical practice, provider attitudes, systematic processes, and education. The four themes include: (1) there are varied approaches to delirium recognition and infrequent use of screening tools; (2) delirium assessment is perceived as overly time consuming and of lower priority than other symptoms and syndromes; (3) it is unclear whose responsibility it is to recognize delirium; and (4) there is a need for a deeper or "functional" understanding of delirium that includes its consequences. CONCLUSIONS Our findings demonstrate a need for ED leadership to identify clear team roles for delirium recognition, standardize use of delirium screening tools, and prioritize delirium as a symptom of an acute medical emergency.
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Affiliation(s)
- Rebecca Schonnop
- Department of Emergency Medicine, Royal Alexandra Hospital, University of Alberta, Edmonton, AB, Canada.
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, ON, Toronto, Canada.
| | - Katie N Dainty
- North York General Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Shelley L McLeod
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, ON, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Don Melady
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, ON, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Jacques S Lee
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, ON, Toronto, Canada
- Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
- Division of Emergency Services, Sunnybrook Research Institute, Toronto, ON, Canada
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Dulin JD, Zhang J, Marsden J, Mauldin PD, Moran WP, Kalivas BC. Association of delirium screening on hospitalized adults and postacute care utilization: A retrospective cohort study. Am J Med Sci 2022; 364:554-564. [PMID: 35793733 DOI: 10.1016/j.amjms.2022.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 04/11/2022] [Accepted: 06/28/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patients with delirium have increased hospital length of stay (LOS), morbidity and mortality. Impact of delirium on postacute care (PAC) utilization is not fully characterized. Impact of screening for delirium on general medicine patients is unknown. The objective of this study was to assess impact of screening for delirium on inpatient PAC utilization. METHODS This was a single center, retrospective cohort study at an academic tertiary care center in Charleston, SC. Patients were selected from adults hospitalized from home and discharged alive between June 2014 and June 2018. The brief confusion assessment method (bCAM) screening was conducted and documented by nursing on admission and every shift thereafter. Outcome measure was the proportion of patients discharged to facility. RESULTS Of 93,388 non-ICU adult admission between June 2014 and June 2018, 4.4% of those not screened for delirium were discharged to facility versus 15.0% in those screened and 41.4% in those screening positive. Multivariable regression analysis showed that patients screened for delirium were 2.3 times more likely to discharge to facility (95% CI (2.145, 2.429)) while those with a positive bCAM were 3.3 times more likely than those with a negative bCAM to discharge to facility (95% CI (2.949, 3.712)). CONCLUSIONS After adjusting for demographics, medication orders and comorbidities there was an association between screening for delirium, positive delirium screen and discharge to facility. An appreciation of where and why patients are discharged is imperative to optimize both patient care and cost utilization.
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Affiliation(s)
- Jennifer D Dulin
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
| | - Jingwen Zhang
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Justin Marsden
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Patrick D Mauldin
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - William P Moran
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Benjamin C Kalivas
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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15
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Anand A, Cheng M, Ibitoye T, Maclullich AMJ, Vardy ERLC. Positive scores on the 4AT delirium assessment tool at hospital admission are linked to mortality, length of stay and home time: two-centre study of 82,770 emergency admissions. Age Ageing 2022; 51:6548791. [PMID: 35292792 PMCID: PMC8923813 DOI: 10.1093/ageing/afac051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Studies investigating outcomes of delirium using large-scale routine data are rare. We performed a two-centre study using the 4 'A's Test (4AT) delirium detection tool to analyse relationships between delirium and 30-day mortality, length of stay and home time (days at home in the year following admission). METHODS The 4AT was performed as part of usual care. Data from emergency admissions in patients ≥65 years in Lothian, UK (n = 43,946) and Salford, UK (n = 38,824) over a period of $\sim$3 years were analysed using logistic regression models adjusted for age and sex. RESULTS 4AT completion rates were 77% in Lothian and 49% in Salford. 4AT scores indicating delirium (≥4/12) were present in 18% of patients in Lothian, and 25% of patients in Salford. Thirty-day mortality with 4AT ≥4 was 5.5-fold greater than the 4AT 0/12 group in Lothian (adjusted odds ratio (aOR) 5.53, 95% confidence interval [CI] 4.99-6.13) and 3.4-fold greater in Salford (aOR 3.39, 95% CI 2.98-3.87). Length of stay was more than double in patients with 4AT scores of 1-3/12 (indicating cognitive impairment) or ≥ 4/12 compared with 4AT 0/12. Median home time at 1 year was reduced by 112 days (Lothian) and 61 days (Salford) in the 4AT ≥4 group (P < 0.001). CONCLUSIONS Scores on the 4AT used at scale in practice are strongly linked with 30-day mortality, length of hospital stay and home time. The findings highlight the need for better understanding of why delirium is linked with poor outcomes and also the need to improve delirium detection and treatment.
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Affiliation(s)
- Atul Anand
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Michael Cheng
- Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Temi Ibitoye
- Edinburgh Delirium Research Group, Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Alasdair M J Maclullich
- Edinburgh Delirium Research Group, Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
- Address correspondence to: Alasdair MacLullich, Professor of Geriatric Medicine, Ageing and Health, Usher Institute, University of Edinburgh, Room S1642, Royal Infirmary of Edinburgh, Edinburgh, UK. Tel: 0131 650 1000. Email ; Emma Vardy, Consultant in Geriatric Medicine, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford, Manchester, UK. Tel: 0161 789 7373.
| | - Emma R L C Vardy
- Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford, UK
- NIHR Applied Research Collaboration Greater Manchester, University of Manchester, Manchester, UK
- Address correspondence to: Alasdair MacLullich, Professor of Geriatric Medicine, Ageing and Health, Usher Institute, University of Edinburgh, Room S1642, Royal Infirmary of Edinburgh, Edinburgh, UK. Tel: 0131 650 1000. Email ; Emma Vardy, Consultant in Geriatric Medicine, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Stott Lane, Salford, Manchester, UK. Tel: 0161 789 7373.
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LaHue SC, Douglas VC. Approach to Altered Mental Status and Inpatient Delirium. Neurol Clin 2021; 40:45-57. [PMID: 34798974 DOI: 10.1016/j.ncl.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Altered mental status is a nonspecific diagnosis that encompasses a wide spectrum of disease and is frequently cited as a reason for both hospital admission and inpatient neurologic consultation. There are numerous etiologies of altered mental status, and so although many are facile with the workup of this potentially life-threatening entity, it can nevertheless be overwhelming. Our goal was to provide a practical framework embedded in a current, comprehensive review of the epidemiology, clinical evaluation, and management of undifferentiated altered mental status. We pay particular attention to the management of a critical yet underdiagnosed subtype of altered mental status: delirium.
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Affiliation(s)
- Sara C LaHue
- Department of Neurology, School of Medicine, University of California, San Francisco, CA, USA; Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA.
| | - Vanja C Douglas
- Department of Neurology, School of Medicine, University of California, San Francisco, CA, USA; Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
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Lau HL, Patel SD, Garg N. Causes and Predictors of 30-Day Readmission in Elderly Patients With Delirium. Neurol Clin Pract 2021; 11:e251-e260. [PMID: 34484899 DOI: 10.1212/cpj.0000000000000976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/18/2020] [Indexed: 11/15/2022]
Abstract
Objective To study 30-day readmission (30-DR) rate and predictors for readmission among elderly patients with delirium. Methods This was a retrospective observational cohort study of patients aged ≥65 years with discharge diagnosis of delirium identified from the Nationwide Readmission Database using common International Classification of Diseases, Ninth Revision, and Clinical Modification codes linked to delirium diagnosis. Multivariate logistic regression analyses were performed adjusting for stratified cluster design to identify patient/system-specific factors associated with 30-DR. Results Overall, the 30-DR rate was 17% (7,140 of 42,655 weighted index admissions). The common causes of readmission were systemic diseases (43%), infections (27%), and neurologic diseases (18%). Compared with initial hospitalization, readmission costs were higher ($11,442 vs $10,350, p < 0.0001) with a longer length of stay (6.6 vs 6.1 days, p < 0.0001). Independent predictors of readmission included discharge against medical advice (odds ratio [OR] 1.8, p < 0.0034), length of stay (OR 1.3, p < 0.0001), and chronic systemic diseases (anemia, OR 2.4, p < 0.0001, chronic renal failure OR 1.4, p < 0.0001, congestive heart failure OR 1.3, p < 0.0001, lung disease OR 1.2, p < 0.0004, and liver disease OR 1.2, p < 0.03). Private insurance was associated with a lower risk of readmission (OR 0.78, p < 0.02). Conclusions The main predictors of readmission were chronic systemic diseases and discharge against medical advice. These data may help design directed clinical care pathways to optimize medical management and postdischarge care to reduce readmission rates.
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Affiliation(s)
- H Lee Lau
- Department of Neurology (HLL, NG), Miller School of Medicine University of Miami, FL; and Department of Neurology (SDP), University of Connecticut, Hartford
| | - Smit D Patel
- Department of Neurology (HLL, NG), Miller School of Medicine University of Miami, FL; and Department of Neurology (SDP), University of Connecticut, Hartford
| | - Neeta Garg
- Department of Neurology (HLL, NG), Miller School of Medicine University of Miami, FL; and Department of Neurology (SDP), University of Connecticut, Hartford
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Moccia MJ, Keyes D. Improving Care Transitions: An Initiative between the Emergency Department and Senior Care Facilities. Spartan Med Res J 2021; 6:26862. [PMID: 34532624 PMCID: PMC8405283 DOI: 10.51894/001c.26862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The transfer of individuals (i.e., residents) between senior care facilities (SCF) and the emergency department (ED) remains an ongoing healthcare quality gap as communication of key resident information is often lost. For this study, a sample of SCF representatives were invited to join a collaborative group termed Safe Transition of All Residents For yoU and Me (STARForUM, STAR-F) to improve SCF resident transitions of care. STUDY PURPOSE The purpose of this pilot study was to invite a convenience sample of SCF facilities to join a collaborative intervention named Safe Transition of All Residents For yoU and Me (STARForUM, STAR-F) to improve information exchange during SCF residents' transitions of care. The potential influence of a hospital-SCF collaboration program to improve transfer of essential SCF resident information sent to the hospital ED was used as an evaluation measure. METHODS This study project enrolled a total of 120 residents (i.e., patients) with 40 (33%) transferred from participating STAR-F facilities. RESULTS Following the authors' development of a transfer checklist, STAR-F facilities sent a significantly greater number of essential elements comprised of the resident's medical history information to the ED compared to non-STAR-F facilities. Controlling for the standard classification of skill level of the individual facility, STAR-F residents had significantly higher essential information transmission composite scores (10.5 + 2.9 for STAR-F patients vs. 7.75 + 3.1 for non-STAR-Fs p = < 0.01) that may have served to reduce number of associated transition errors. CONCLUSIONS The findings of this study suggest that a collaborative hospital-SCF initiative can significantly improve transfer of information for elderly residents during ED visits, help guide clinical decision-making and optimize care coordination.
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Barr J, Paulson SS, Kamdar B, Ervin JN, Lane-Fall M, Liu V, Kleinpell R. The Coming of Age of Implementation Science and Research in Critical Care Medicine. Crit Care Med 2021; 49:1254-1275. [PMID: 34261925 PMCID: PMC8549627 DOI: 10.1097/ccm.0000000000005131] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Juliana Barr
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Shirley S Paulson
- Regional Adult Patient Care Services, Kaiser Permanente, Northern California, Oakland, CA
| | - Biren Kamdar
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego School of Medicine, La Jolla, CA
| | - Jennifer N Ervin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Meghan Lane-Fall
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Vincent Liu
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
- Regional Adult Patient Care Services, Kaiser Permanente, Northern California, Oakland, CA
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, San Diego School of Medicine, La Jolla, CA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
- Division of Research, Kaiser Permanente Northern California, Santa Clara, CA
- Kaiser Permanente Medical Center, Santa Clara, CA
- Stanford University, Stanford, CA
- Hospital Advanced Analytics, Kaiser Permanente Northern California, Santa Clara, CA
- Vanderbilt University School of Nursing, Nashville, TN
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Ramos-Martínez A, Parra-Ramírez LM, Morrás I, Carnevali M, Jiménez-Ibañez L, Rubio-Rivas M, Arnalich F, Beato JL, Monge D, Asín U, Suárez C, Freire SJ, Méndez-Bailón M, Perales I, Loureiro-Amigo J, Gómez-Belda AB, Pesqueira PM, Gómez-Huelgas R, Mella C, Díez-García LF, Fernández-Sola J, González-Ferrer R, Aroza M, Antón-Santos JM, Bermejo CL. Frequency, risk factors, and outcomes of hospital readmissions of COVID-19 patients. Sci Rep 2021; 11:13733. [PMID: 34215803 PMCID: PMC8253752 DOI: 10.1038/s41598-021-93076-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 06/10/2021] [Indexed: 12/15/2022] Open
Abstract
To determine the proportion of patients with COVID-19 who were readmitted to the hospital and the most common causes and the factors associated with readmission. Multicenter nationwide cohort study in Spain. Patients included in the study were admitted to 147 hospitals from March 1 to April 30, 2020. Readmission was defined as a new hospital admission during the 30 days after discharge. Emergency department visits after discharge were not considered readmission. During the study period 8392 patients were admitted to hospitals participating in the SEMI-COVID-19 network. 298 patients (4.2%) out of 7137 patients were readmitted after being discharged. 1541 (17.7%) died during the index admission and 35 died during hospital readmission (11.7%, p = 0.007). The median time from discharge to readmission was 7 days (IQR 3–15 days). The most frequent causes of hospital readmission were worsening of previous pneumonia (54%), bacterial infection (13%), venous thromboembolism (5%), and heart failure (5%). Age [odds ratio (OR): 1.02; 95% confident interval (95% CI): 1.01–1.03], age-adjusted Charlson comorbidity index score (OR: 1.13; 95% CI: 1.06–1.21), chronic obstructive pulmonary disease (OR: 1.84; 95% CI: 1.26–2.69), asthma (OR: 1.52; 95% CI: 1.04–2.22), hemoglobin level at admission (OR: 0.92; 95% CI: 0.86–0.99), ground-glass opacification at admission (OR: 0.86; 95% CI:0.76–0.98) and glucocorticoid treatment (OR: 1.29; 95% CI: 1.00–1.66) were independently associated with hospital readmission. The rate of readmission after hospital discharge for COVID-19 was low. Advanced age and comorbidity were associated with increased risk of readmission.
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Affiliation(s)
- Antonio Ramos-Martínez
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda UAM, IDIPHSA, Maestro Rodrigo 2, 28222, Majadahonda, Madrid, Spain. .,Infectious Diseases Unit, Hospital Universitario Puerte de Hierro-Majadahonda Majadahonda, Calle Maestro Rodrigo 2, 28222, Majadahonda, Madrid, Spain.
| | - Lina Marcela Parra-Ramírez
- Preventive Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda UAM, IDIPHSA, Maestro Rodrigo 2, 28222, Majadahonda, Madrid, Spain
| | - Ignacio Morrás
- Internal Medicine Department, Hospital Universitario Puerta de Hierro-Majadahonda UAM, IDIPHSA, Maestro Rodrigo 2, 28222, Majadahonda, Madrid, Spain
| | - María Carnevali
- Internal Medicine Department, 12 de Octubre University Hospital, Av. de Córdoba, s/n, 28041, Madrid, Spain
| | - Lorena Jiménez-Ibañez
- Internal Medicine Department, Gregorio Marañon University Hospital, Dr. Esquerdo, 46, 28007, Madrid, Spain
| | - Manuel Rubio-Rivas
- Internal Medicine Department, Bellvitge University Hospital, Carrer de La Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco Arnalich
- Internal Medicine Department, La Paz University Hospital, Paseo de La Castellana, 261, 28046, Madrid, Spain
| | - José Luis Beato
- Internal Medicine Department, Albacete University Hospital Complex, Hermanos Falco, 37, 02006, Albacete, Spain
| | - Daniel Monge
- Internal Medicine Department, Segovia Hospital Complex, Luis Erik Clavería Neurólogo s/n, 40002, Segovia, Spain
| | - Uxua Asín
- Internal Medicine Department, Miguel Servet Hospital, Paseo Isabel la Católica, 1-3, 50009, Zaragoza, Spain
| | - Carmen Suárez
- Internal Medicine Department, La Princesa University Hospital, Diego de León, 62, 28006, Madrid, Spain
| | - Santiago Jesús Freire
- Internal Medicine Department, A Coruña University Hospital, Xubias de Arriba, 84, 15006 A, Coruña, Spain
| | - Manuel Méndez-Bailón
- Internal Medicine Department, San Carlos Clinical Hospital, Prof Martín Lagos, s/n, 28040, Madrid, Spain
| | - Isabel Perales
- Internal Medicine Department, Infanta Sofía Hospital, Paseo de Europa, 34, 28703, San Sebastián de los Reyes, Madrid, Spain
| | - José Loureiro-Amigo
- Internal Medicine Department, Moisès Broggi Hospital, Carrer de Jacint Verdaguer, 90, 08970, Sant Joan Despí, Barcelona, Spain
| | - Ana Belén Gómez-Belda
- Internal Medicine Department, Dr. Peset University Hospital, Av. de Gaspar Aguilar, 90, 46017, Valencia, Spain
| | - Paula María Pesqueira
- Internal Medicine Department, Santiago Clinical Hospital, Rúa da Choupana, s/n, 15706, Santiago de Compostela, A Coruña, Spain
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Av. de Carlos Haya, 84, 29010, Málaga, Spain
| | - Carmen Mella
- Internal Medicine Department, Hospital Architect Marcide-Novoa Santos, Rúa Pardo Bazán, s/n, 15404, Ferrol, A Coruña, Spain
| | - Luis Felipe Díez-García
- Internal Medicine Department, Torrecárdenas Hospital, Hermandad de Donantes de Sangre, s/n, 04009, Almería, Spain
| | - Joaquim Fernández-Sola
- Internal Medicine Department, Clinic Barcelona Hospital, Villarroel, 170, 08036, Barcelona, Spain
| | - Ruth González-Ferrer
- Internal Medicine Department, Tajo Hospital, Av. Amazonas Central, s/n, 28300, Aranjuez, Madrid, Spain
| | - Marina Aroza
- Internal Medicine Department, Insular de Gran Canaria Hospital, Av. Marítima del Sur, s/n, 35016, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Juan Miguel Antón-Santos
- Internal Medicine Department, Infanta Cristina University Hospital, Av. 9 de Junio, 2, 28981, Parla, Madrid, Spain
| | - Carlos Lumbreras Bermejo
- Internal Medicine Department, 12 de Octubre University Hospital, Av. de Córdoba, s/n, 28041, Madrid, Spain
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21
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LaHue SC, Maselli J, Rogers S, Casatta J, Chao J, Croci R, Gonzales R, Holt B, Josephson SA, Lama S, Lau C, McCulloch C, Newman JC, Terrelonge M, Yeager J, Douglas VC. Outcomes Following Implementation of a Hospital-Wide, Multicomponent Delirium Care Pathway. J Hosp Med 2021; 16:397-403. [PMID: 34197303 PMCID: PMC9621338 DOI: 10.12788/jhm.3604] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/21/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Delirium is associated with poor clinical outcomes that could be improved with targeted interventions. OBJECTIVE To determine whether a multicomponent delirium care pathway implemented across seven specialty nonintensive care units is associated with reduced hospital length of stay (LOS). Secondary objectives were reductions in total direct cost, odds of 30-day hospital readmission, and rates of safety attendant and restraint use. METHODS This retrospective cohort study included 22,708 hospitalized patients (11,018 preintervention) aged ≥50 years encompassing seven nonintensive care units: neurosciences, medicine, cardiology, general and specialty surgery, hematology-oncology, and transplant. The multicomponent delirium care pathway included a nurse-administered delirium risk assessment at admission, nurse-administered delirium screening scale every shift, and a multicomponent delirium intervention. The primary study outcome was LOS for all units combined and the medicine unit separately. Secondary outcomes included total direct cost, odds of 30-day hospital readmission, and rates of safety attendant and restraint use. RESULTS Adjusted mean LOS for all units combined decreased by 2% post intervention (proportional change, 0.98; 95% CI, 0.96-0.99; P = .0087). Medicine unit adjusted LOS decreased by 9% (proportional change, 0.91; 95% CI, 0.83-0.99; P = .028). For all units combined, adjusted odds of 30-day readmission decreased by 14% (odds ratio [OR], 0.86; 95% CI, 0.80-0.93; P = .0002). Medicine unit adjusted cost decreased by 7% (proportional change, 0.93; 95% CI, 0.89-0.96; P = .0002). CONCLUSION This multicomponent hospital-wide delirium care pathway intervention is associated with reduced hospital LOS, especially for patients on the medicine unit. Odds of 30-day readmission decreased throughout the entire cohort.
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Affiliation(s)
- Sara C LaHue
- Department of Neurology, School of Medicine, University of California, San Francisco, California
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, California
- Corresponding Author: Sara C LaHue, MD;
| | - Judy Maselli
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Stephanie Rogers
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Julie Casatta
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Jessica Chao
- Clinical Innovation Center, University of California, San Francisco, California
| | - Rhiannon Croci
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Ralph Gonzales
- Department of Medicine, School of Medicine, University of California, San Francisco, California
- Clinical Innovation Center, University of California, San Francisco, California
| | - Brian Holt
- Continuous Improvement Department, University of California, San Francisco, California
| | - S Andrew Josephson
- Department of Neurology, School of Medicine, University of California, San Francisco, California
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, California
| | - Sudha Lama
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Catherine Lau
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Charles McCulloch
- Epidemiology & Biostatistics, University of California, San Francisco, California
| | - John C Newman
- Department of Medicine, School of Medicine, University of California, San Francisco, California
- Buck Institute for Research on Aging, Novato, California
| | - Mark Terrelonge
- Department of Neurology, School of Medicine, University of California, San Francisco, California
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, California
| | - Jan Yeager
- Clinical Innovation Center, University of California, San Francisco, California
| | - Vanja C Douglas
- Department of Neurology, School of Medicine, University of California, San Francisco, California
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, California
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22
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Fazlollah A, Babatabar Darzi H, Heidaranlu E, Moradian ST. The effect of foot reflexology massage on delirium and sleep quality following cardiac surgery: A randomized clinical trial. Complement Ther Med 2021; 60:102738. [PMID: 34029674 DOI: 10.1016/j.ctim.2021.102738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Delirium is the most common neurologic disorder after cardiac surgery and affects both short and long-term outcomes. This study was conducted to evaluate the effect of foot reflexology massage on the incidence of delirium and sleep quality in patients undergoing cardiac surgery. METHODS In this randomized clinical trial, 60 patients who were candidates for CABG surgery were randomly assigned into two equal groups (n = 30); intervention and control groups. In the intervention group, foot reflexology massage was done on each foot for 15 min, for two consecutive days. Delirium observation screening scale, the Richard Campbell sleep questionnaire (RSCQ), and pain intensity using VAS were compared. RESULTS in the second postoperative day, delirium was observed in 8 (26.7 %) and 7 (23.3 %) of patients in the intervention and control groups, respectively (p > 0.05). The measured odds ratio for the effect of massage on delirium is 0.83 (95 %CI 0.71-2.69, p = 0.76). The difference in RSCQ scores was not significant between groups of intervention and control (68.32 ± 10.41 VS. 62.80 ± 11.86, P = 0.06). The pain intensity was lower in the intervention group (P < 0.001). CONCLUSION Foot reflexology was not effective in reducing delirium and improving the sleep quality, but the pain intensity was decreased. It seems that the precise pathology and predicting model of delirium should be identified, and appropriate interventions should be planned accordingly.
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Affiliation(s)
| | - Hosein Babatabar Darzi
- Atherosclerosis Research Center & Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Esmail Heidaranlu
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| | - Seyed Tayeb Moradian
- Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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23
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LaHue SC, Douglas VC, Miller BL. The One-Two Punch of Delirium and Dementia During the COVID-19 Pandemic and Beyond. Front Neurol 2020; 11:596218. [PMID: 33224102 PMCID: PMC7674550 DOI: 10.3389/fneur.2020.596218] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/07/2020] [Indexed: 01/10/2023] Open
Affiliation(s)
- Sara C LaHue
- Department of Neurology, School of Medicine, University of California, San Francisco, San Francisco, CA, United States.,Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Vanja C Douglas
- Department of Neurology, School of Medicine, University of California, San Francisco, San Francisco, CA, United States.,Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Bruce L Miller
- Department of Neurology, School of Medicine, University of California, San Francisco, San Francisco, CA, United States.,Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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24
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LaHue SC, James TC, Newman JC, Esmaili AM, Ormseth CH, Ely EW. Collaborative Delirium Prevention in the Age of COVID-19. J Am Geriatr Soc 2020; 68:947-949. [PMID: 32277467 PMCID: PMC7262233 DOI: 10.1111/jgs.16480] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Sara C LaHue
- Department of Neurology, School of Medicine, University of California, San Francisco, California.,Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, California
| | - Todd C James
- Division of Geriatrics, School of Medicine, University of California, San Francisco, California
| | - John C Newman
- Division of Geriatrics, School of Medicine, University of California, San Francisco, California.,Buck Institute for Research on Aging, Novato, California
| | - Armond M Esmaili
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, California
| | - Cora H Ormseth
- School of Medicine, University of California, San Francisco, California
| | - E Wesley Ely
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Geriatric Research, Education and Clinical Center (GRECC), Tennessee Valley Veterans Affairs Healthcare System, Nashville, Tennessee
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25
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Nguyen TH, Atayee RS, Derry KL, Hirst J, Biondo A, Edmonds KP. Characteristics of Hospitalized Patients Screening Positive for Delirium. Am J Hosp Palliat Care 2019; 37:142-148. [PMID: 31362517 DOI: 10.1177/1049909119867046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Delirium in the hospitals leads to worse outcomes for patients. There were no previous studies that characterize patients with delirium from multiple hospital locations. OBJECTIVE To describe patient characteristics screening positive for delirium and identify any correlations with hospital location and medication use. DESIGN, SETTINGS, PATIENTS Retrospective chart review of 227 hospitalized patients from a large, academic, tertiary referral, 2-campus health system. Patients were ≥18 years old and had delirium for at least ≥24 hours. Validated delirium screening tools were utilized. MEASUREMENTS Patients' demographics, inpatient stay information, delirium episodes characteristics, drugs, and palliative and psychiatry teams' involvement. RESULTS Most patients were older with a mean age of 64.1 years. The most common primary diagnoses were infection, cardiac, and pulmonary. Average length of delirium was 7.2 days (standard deviation [SD] = 8.2), and average length of stay (LOS) was 18.7 days (median = 10.5, SD = 35.1, 95% confidence interval = 14.1-23). Thirty-day readmission rate was 24.8% (65/262 hospitalizations); 12.8% of patients died in the hospital (29/227). Around one-third of hospitalizations had involvement of palliative care, palliative psychiatry, or general psychiatry team. There was a decrease in the number of medications administered 24 hours after the first recording of delirium compared to the immediate preceding 48 hours. Those hospitalizations where delirium first occurred in the intensive care unit (ICU) did have a longer LOS (average = 22.9, SD = 45.7) than those where delirium first occurred outside the ICU (average = 14.8, SD = 20.5). Patients were likely to have received an opioid within 48 hours in 51% of hospitalizations and to have received benzodiazepines in 16% of hospitalizations. CONCLUSION In our study, we found that delirium significantly impacted length of delirium episode, number of episodes of delirium, length of hospital admission, and mortality. The population most sensitive to the impacts of delirium were elderly patients.
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Affiliation(s)
- Trinh H Nguyen
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA
| | - Rabia S Atayee
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA.,Doris A. Howell Palliative Care Teams, UC San Diego Health, La Jolla, CA, USA.,Department of Pharmacy, UC San Diego Health, La Jolla, CA, USA
| | - Katrina L Derry
- Department of Pharmacy, UC San Diego Health, La Jolla, CA, USA
| | - Jeremy Hirst
- Doris A. Howell Palliative Care Teams, UC San Diego Health, La Jolla, CA, USA
| | - Anthony Biondo
- Department of Pharmacy, UC San Diego Health, La Jolla, CA, USA
| | - Kyle P Edmonds
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA, USA.,Doris A. Howell Palliative Care Teams, UC San Diego Health, La Jolla, CA, USA
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