Pharmacologic and nonpharmacologic approaches to the prevention and management of delirium

Schwartz, Ann C.; Fisher, Travis J; Greenspan, Heather; Heinrich, Thomas

doi:10.1177/0091217416636578

Cited by 10 publications

(4 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…To the best of our knowledge, this is the first study to verify the association between 5-HT 3 receptor antagonist use and the occurrence of POD in older patients who underwent orthopedic lower limb surgery. These findings are relevant because they provide important information regarding the delirium-sparing effect of 5-HT 3 receptor antagonists at a time when the debates continue regarding the pharmacological prevention of POD (Gosch and Nicholas 2014 ; Schwartz et al 2016 ; Serafim et al 2015 ).…”

Section: Discussionmentioning

confidence: 93%

5-HT3 receptor antagonists decrease the prevalence of postoperative delirium in older patients undergoing orthopedic lower limb surgery

Shin

Yoon

2021

Perioper Med

View full text Add to dashboard Cite

Background Delirium is an important postoperative complication. Recent research suggested that 5-hydroxytryptamine 3 (5-HT3) receptor antagonists may have clinical effect in the treatment and prevention of delirium. We investigated the association between 5-HT3 receptor antagonists and the occurrence of postoperative delirium (POD). Methods Retrospectively, the electronic medical records were reviewed in patients aged ≥ 65 years who underwent orthopedic lower limb surgery under regional anesthesia (spinal or combined spinal-epidural anesthesia) and administered intravenous 0.075 mg palonosetron or 0.3 mg ramosetron prior to the end of surgery between July 2012 and September 2015. POD incidence and anesthesia-, surgery-, and patient-related factors were evaluated. To investigate the association between 5-HT3 receptor antagonists and the occurrence of POD, multivariable logistic regression analysis was performed. Results Of the 855 patients included, 710 (83%) were administered 5-HT3 receptor antagonists. POD was confirmed in 46 (5.4%) patients. 5-HT3 receptor antagonists reduced the POD incidence by 63% (odds ratio [OR] 0.37; 95% confidence interval [CI], 0.15–0.94; P = 0.04). Moreover, the POD incidence decreased by 72% (OR 0.28, 95% CI 0.10–0.77, P = 0.01) when palonosetron was administered. Other identified risk factors for POD were emergency surgery, older age, hip surgery, lower body mass index, and intraoperative propofol sedation. Conclusion 5-HT3 receptor antagonists may be related with a significantly reduced risk for POD in older patients undergoing orthopedic lower limb surgery. Notably, palonosetron was more effective for POD prevention.

show abstract

Section: Discussionmentioning

confidence: 93%

5-HT3 receptor antagonists decrease the prevalence of postoperative delirium in older patients undergoing orthopedic lower limb surgery

Shin

Yoon

2021

Perioper Med

View full text Add to dashboard Cite

show abstract

“…Bu bireylerin yakınlarıyla telefonla sesli ve/veya görüntülü görüşmeleri sağlanmalı, odalarında zamanı takip edebilecekleri bir saat bulunmalı ve bu odalar çok aydınlık olmamalıdır. Odaya her girişte tedavi ekibinin kendini tanıtması, günü ve zamanı söylemesi, bu kişiye nasıl olduğunu sorması ve kişinin anlayabileceği biçimde tıbbi durumuyla ilgili bilgilendirmesi büyük önem taşır (17)(18)(19)(20)(21). Eğer tıbbi durumları el veriyorsa ve koşullar sağlanabiliyorsa, bu bireylerin alışık olduğu koşullarda (ev, huzurevi, bakımevi gibi) izolasyonda kalıp tedavilerini sürdürmesi daha uygun bir yaklaşım olabilir.…”

Section: Deliryumunclassified

İzolasyon, Karantina, Sosyal Mesafe ve Ruh Sağlığı

Direk¹,

Ucuz²,

Özel³

2020

Bull Leg Med

View full text Add to dashboard Cite

COVID-19 pandemisi dünyada 4 milyonun üzerinde insanı doğrudan, hemen hemen tüm dünyayı ise toplusal sonuçları nedeniyle dolaylı yollardan etkileyen bir süreç olarak hayatlarımıza girdi. Pandemi olarak kabul edilen bulaşıcı hastalıkların yayılmasını engellemek için tüm dünyada kabul gören izolasyon, karantina, sosyal mesafenin kısıtlanması gibi yöntemler bulunmaktadır. Modern çağda hızla uygulamaya geçirilen bu yöntemler enfeksiyonların yayılmasını ciddi biçimde engellese de, yarattığı ruhsal sorunlar bireylerin ve tüm toplumun yaşamını uzun süre olumsuz biçimde etkilemektedir. Bu yazıda izolasyon, karantina ve sosyal mesafe gibi uygulamaların insanların ruh sağlığı üzerindeki etkilerinin incelenmesi hedeflenmiştir. Bu uygulamalar insanlarda başta kaygı ve depresif belirtiler olmak üzere, farklı emosyonel yanıtlara yol açmaktadır. Stresle baş etme biçimi ve stresin şiddetine bağlı olarak, yatkınlığı olan bireylerde bu uygulamalar başta anksiyete bozuklukları, depresif bozukluklar ve stresle ilişkili bozukluklar olmak üzere pek çok ruhsal bozukluğa neden olabilmektedir. COVID-19 enfeksiyonu yaşlı bireylerde daha kötü seyrettiğinden, bu bireylerde sıkça deliryum tablosu görülebilmektedir. Bu süreçte yaşanan ölümler izole ortamlarda olduğundan komplike yas gelişme riski yüksektir. Ek olarak, bireylere ciddi zararı olan stigmatizasyon bu dönemde izolasyon ya da karantinada olan bireyler için gelişebilecek tehlikeli bir durumdur. Bu sürecin en az zararla atlatılabilmesi için bu uygulamaların süresinin olabildiğince kısa tutulması, sosyal ve ekonomik açıdan toplumun desteklenmesi, sağlık sistemine ulaşımın kolaylaştırılması ve ruh sağlığı hizmetlerinin yaygınlaştırılması önemlidir.

show abstract

“…The majority of them are inpatients in emergency and care of the elderly departments [1,2]. A number of publications have stressed the importance of the management of delirium in various medical settings [1,3,4]. Whereas research advancement has largely concentrated on causes, detection and management of delirium [5,6] and educational interventions [7], there is scant work on potential stigma experienced by people with delirium by professionals involved in their care.…”

Section: Introductionmentioning

confidence: 99%

Delirium Stigma Among Healthcare Staff

et al. 2018

View full text Add to dashboard Cite

Older people with delirium occupy more than one third of acute medical beds and require increased medical attention, as care at present is suboptimal. In addition, since delirium is undetected, it should form a target for teaching in wards. Moreover, as people with delirium are largely dependent on daily interactions and care by inpatients professional staff, it is important to address stigmatisation of these vulnerable patients. This is especially important as previous studies have shown that negative staff attitudes towards these patients undermine good care. This single center cross-sectional study was designed to determine the extent of institutional stigma among health professionals involved in the care of people with delirium. For this, professional staff working on medical wards and in communities were approached to fill in a questionnaire containing the adapted Delirium Stigma Scale and the EuroQol five dimensions (EQ-5D-5L) questionnaire. Additional demographic information concerning their education and professional and personal experience with delirium was also collected. The characteristics associated with stigma were determined from the sample. The findings of our study provide an insight into the high level of stigmatisation of delirium patients among professionals (mean 11.66/18 points). This was not related to professionals’ own experiences of delirium, their educational and professional backgrounds, or them having received formal delirium education. However, working closely with people with delirium seems to have a positive impact on the de-stigmatisation of this population among health professionals. Our findings that attitudes are not influenced by formal delirium teaching need to be incorporated into the design of interprofessional educational interventions. Accordingly, we advocate more direct patient-oriented and care delivered teaching interventions.

show abstract

Pharmacologic and nonpharmacologic approaches to the prevention and management of delirium

Cited by 10 publications

References 32 publications

5-HT3 receptor antagonists decrease the prevalence of postoperative delirium in older patients undergoing orthopedic lower limb surgery

5-HT3 receptor antagonists decrease the prevalence of postoperative delirium in older patients undergoing orthopedic lower limb surgery

İzolasyon, Karantina, Sosyal Mesafe ve Ruh Sağlığı

Delirium Stigma Among Healthcare Staff

Contact Info

Product

Resources

About