The detection of delirium in admitted oncology patients: a scoping review

Abstract Purpose Delirium leads to poor outcomes for patients and careers and has negative impacts on staff and service provision. Cancer rates in elderly populations are increasing and frequently, cancer diagnoses are a co-morbidity in the context of frailty. Data relating to the epidemiology of delirium in hospitalised cancer patients are limited. With the overarching purpose of improving delirium detection and reducing the morbidity and mortality of delirium in cancer patients, we reviewed the epidemiological data and approach to delirium detection in hospitalised, adult oncology patients. Methods MEDLINE, EMBASE, CINAHL, PsycINFO, and SCOPUS databases were searched from January 1996 to August 2017. Key concepts were delirium, cancer, inpatient oncology and delirium screening/detection. Results Of 896 unique studies identified; 91 met full-text review criteria. Of 12 eligible studies, four applied recommended case ascertainment methods to all patients, three used delirium screening tools alone or with case ascertainment tools sub-optimally applied, four used tools not recommended for delirium screening or case ascertainment, one used the Confusion Assessment Method with insufficient information to determine if it met case ascertainment status. Two studies presented delirium incidence rates: 7.8%, and 17% respectively. Prevalence rates ranged from 18–33% for general medical or oncology wards; 42–58% for Acute Palliative Care Units (APCU); and for older cancer patients: 22% and 57%. Three studies reported reversibility; 26% and 49% respectively (APCUs) and 30% (older patients with cancer). Six studies had a low risk of bias according to QUADAS-2 criteria; all studies in the APCU setting were rated at higher risk of bias. Tool selection, study flow and recruitment bias reduced study quality. Conclusion The knowledge base for improved interventions and clinical care for adults with cancer and delirium is limited by the low number of studies. A clear distinction between screening tools and diagnostic tools is required to provide an improved understanding of the rates of delirium and its reversibility in this population.

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“SQiD, the Single Question in Delirium; can a single question help clinicians to detect delirium in hospitalised cancer patients?” running heading Single Question in Delirium” (Bcan-D-20-01665)

BMC Cancer ◽

10.1186/s12885-020-07504-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Megan B. Sands ◽

Swapnil Sharma ◽

Lindsay Carpenter ◽

Andrew Hartshorn ◽

Jessica T. Lee ◽

...

Keyword(s):

Cancer Patients ◽

Clinical Care ◽

Length Of Hospital Stay ◽

Confusion Assessment Method ◽

Assessment Method ◽

Clinical Staff ◽

Screening Tools ◽

Diagnostic Values ◽

D 20 ◽

Single Question

Abstract Aim A serious syndrome for cancer in-patients, delirium risk increases with age and medical acuity. Screening tools exist but detection is frequently delayed or missed. We test the ‘Single Question in Delirium’ (SQiD), in comparison to psychiatrist clinical interview. Methods Inpatients in two comprehensive cancer centres were prospectively screened. Clinical staff asked informants to respond to the SQiD: “Do you feel that [patient’s name] has been more confused lately?”. The primary endpoint was negative predictive value (NPV) of the SQiD versus psychiatrist diagnosis (Diagnostic and Statistics Manual criteria). Secondary endpoints included: NPV of the Confusion Assessment Method (CAM), sensitivity, specificity and Cohen’s Kappa coefficient. Results Between May 2012 and July 2015, the SQiD plus CAM was applied to 122 patients; 73 had the SQiD and psychiatrist interview. Median age was 65 yrs. (interquartile range 54–74), 46% were female; median length of hospital stay was 12 days (5–18 days). Major cancer types were lung (19%), gastric or other upper GI (15%) and breast (14%). 70% of participants had stage 4 cancer. Diagnostic values were similar between the SQiD (NPV = 74, 95% CI 67–81; kappa = 0.32) and CAM (NPV = 72, 95% CI 67–77, kappa = 0.32), compared with psychiatrist interview. Overall the CAM identified only a small number of delirious cases but all were true positives. The specificity of the SQiD was 87% (74–95) The SQiD had higher sensitivity than CAM (44% [95% CI 41–80] vs 26% [10–48]). Conclusion The SQiD, administered by bedside clinical staff, was feasible and its psychometric properties are now better understood. The SQiD can contribute to delirium detection and clinical care for hospitalised cancer patients.

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How much cost can one patient bear? The influence of income and education on drug purchasing decisions in Hong Kong Chinese cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.19584 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 19584-19584

Author(s):

T. Chan ◽

S. Chan ◽

Y. Poon ◽

J. Fok ◽

J. Epstein ◽

...

Keyword(s):

Hong Kong ◽

Cancer Patients ◽

Low Income ◽

Household Income ◽

Large Population ◽

Purchasing Decisions ◽

Oncology Patients ◽

Mainland Chinese ◽

Income Groups ◽

Co Morbidity

19584 Background: Inflation of anticancer drug prices is a growing problem worldwide. This problem is especially challenging in Asia, where rising healthcare expectations clash with low incomes and weak insurance. To clarify the factors influencing drug purchasing decisions in this context, we conducted a survey of Hong Kong oncology patients. Methods: A questionnaire was designed to assess the effect of cost on purchasing decisions relating to drug variables such as (1) efficacy, (2) tolerability, (3) convenience, (4) safety, (5) novelty and (6) reliability. Validation of the original 33-part survey resulted in a final set of 21 questions that was administered to 51 oncology patients. These respondents were characterised in terms of age, household income, insurance, educational level, family circumstances, occupation, ethnicity, religious beliefs, prognosis, and co-morbidity. Results: Most respondents were Hong Kong (68.8%), mainland Chinese (18.8%) or Caucasian (10.4%). There was a strong correlation between household income and education. Patients from middle-income (US$7,000–14,000 per month) households were most influenced in their decisions by costs and insurance rebates, whereas those from low-income households (less than US$3,000 per month) were keenest to purchase expensive medications, whether Western or traditional Chinese remedies. Demand for drug safety was cost-inelastic across all income groups, independent of gains in efficacy. Even when free treatment was offered, therapeutic uncertainties (e.g., early-phase drugs or randomization) proved unpopular with all income groups. Only the most affluent and well-educated patients valued overall survival above disease-free survival in making decisions, suggesting that less educated cohorts did not understand these concepts. Conclusion: These data suggest that low-income cancer patients and their families may have unrealistic expectations of high-priced medications, based either on misunderstanding or cultural pressures. Greater educational efforts targeting this large population sector may be needed to avoid worsening dissatisfaction and social unrest in the future. No significant financial relationships to disclose.

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Delirium in Acute Stroke: A Survey of Screening and Diagnostic Practice in Scotland

ISRN Stroke ◽

10.1155/2013/620186 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Gail Carin-Levy ◽

Kath Nicol ◽

Frederike van Wijck ◽

Gillian E. Mead

Keyword(s):

Acute Stroke ◽

Clinical Judgment ◽

Confusion Assessment Method ◽

Assessment Method ◽

Screening Tools ◽

Diagnostic Tools ◽

Free Text ◽

Stroke Patients ◽

Nominal Data ◽

Doctors And Nurses

Aims. To survey the use of delirium screening and diagnostic tools in patients with acute stroke across Scotland and to establish whether doctors and nurses felt the tools used were suitable for stroke patients. Methods. An invitation to participate in a web-based survey was e-mailed to 217 doctors and nurses working in acute stroke across Scotland. Descriptive statistics were used to report nominal data, and content analysis was used to interpret free text responses. Results. Sixty-five responses were logged (30% return rate). 48% of the respondents reported that they routinely screened newly admitted patients for delirium. Following initial screening, 38% reported that they screened for delirium as the need arises. 43% reported using clinical judgment to diagnose delirium, and 32% stated that they combined clinical judgment with a standardised tool. 28% of the clinicians reported that they used the Confusion Assessment Method; however, only 13.5% felt that it was suitable for stroke patients. Conclusions. Screening for delirium is inconsistent in Scottish stroke services, and there is uncertainty regarding the suitability of screening tools with stroke patients. As the importance of early identification of delirium on stroke outcomes is articulated in recent publications, validating a screening tool to detect delirium in acute stroke is recommended.

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Delirium Screening in the Emergency Department: A Systematic Review and Meta-analysis

10.21203/rs.3.rs-97690/v1 ◽

2020 ◽

Author(s):

Qian Zhang ◽

Meixi Chen ◽

Liangying Hou ◽

Ziqi Guo ◽

Qing Zhang ◽

...

Keyword(s):

Emergency Department ◽

Diagnostic Accuracy ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Relative Sensitivity ◽

Confusion Assessment Method ◽

Assessment Method ◽

Screening Tools ◽

Cochrane Library ◽

Diagnostic Tools

Abstract Background: Delirium is a complex syndrome characterized by a disturbance in attention and awareness, with a prevalence of 10-20% in patients admitted to the Emergency Department (ED). Screening tools have been developed to identify delirium in the ED, but their accuracy of screening remains unclear. To address this challenge, we conducted a comprehensive meta-analysis to systematically review the accuracy of delirium screening tools currently being used to assess ED patients.Methods: PubMed, PsycINFO, EMBASE, and the Cochrane Library were searched. Studies involving ED inpatients which compared diagnostic tools with the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria as a reference standard were included. Two reviewers independently screened the studies, extracted data, and assessed the quality of studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 scale. We conducted a conventional meta-analysis for each screening tool. Then we used network meta-analysis method to calculate the relative sensitivity and specificity among the diagnostic tests. The diagnostic accuracies were then ranked through the superiority index.Results: Thirteen studies included six screening tools. The pooled sensitivity and specificity for the Confusion Assessment Method (CAM) were 0.71 and 0.98, and for 4AT (Arousal, Attention, Abbreviated Mental Test 4, Acute change) were 0.83 and 0.93, respectively. The other four tools used were only reported in one or two studies. Their sensitivity ranged from 0.70 to 1.00, and their specificity ranged from 0.64 to 0.99. Moreover, network meta-analysis indicated that the CAM and 4AT had a greater superiority index and a higher diagnostic accuracy.Conclusions: The available data suggested that both the CAM and 4AT can be used as efficient screening tools for the ED patients.

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Gastroesophageal Reflux Disease: A Gastroenterologist's Perspective

Perspectives on Voice and Voice Disorders ◽

10.1044/vvd21.3.89 ◽

2011 ◽

Vol 21 (3) ◽

pp. 89-99

Author(s):

Michael F. Vaezi

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Best Practice ◽

Clinical Care ◽

Diagnostic Testing ◽

Diagnostic Tools ◽

Swallowing Function ◽

Atypical Symptoms

Gastroesophageal reflux disease (GERD) is a commonly diagnosed condition often associated with the typical symptoms of heartburn and regurgitation, although it may present with atypical symptoms such as chest pain, hoarseness, chronic cough, and asthma. In most cases, the patient's reduced quality of life drives clinical care and diagnostic testing. Because of its widespread impact on voice and swallowing function as well as its social implications, it is important that speech-language pathologists (SLPs) understand the nature of GERD and its consequences. The purpose of this article is to summarize the nature of GERD and GERD-related complications such as GERD-related peptic stricture, Barrett's esophagus and adenocarcinoma, and laryngeal manifestations of GERD from a gastroenterologist's perspective. It is critical that SLPs who work with a multidisciplinary team understand terminology, diagnostic tools, and treatment to ensure best practice.

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VTE risk assessment in cancer

Onkologische Welt ◽

10.1055/s-0038-1624994 ◽

2016 ◽

Vol 07 (01) ◽

pp. 20-25

Author(s):

I. Pabinger ◽

C. Ay

Keyword(s):

Risk Assessment ◽

Cancer Patients ◽

Medical Oncology ◽

Clinical Importance ◽

Cancer Surgery ◽

Ambulatory Setting ◽

Oncology Patients ◽

Related Factors ◽

Risk Assessment Models ◽

Increased Risk

SummaryVenous thromboembolism (VTE) in patients with cancer is associated with an increased morbidity and mortality, and its prevention is of major clinical importance. However, the VTE rates in the cancer population vary between 0.5% - 20%, depending on cancer-, treatment- and patient-related factors. The most important contributors to VTE risk are the tumor entity, stage and certain anticancer treatments. Cancer surgery represents a strong risk factor for VTE, and medical oncology patients are at increased risk of developing VTE, especially when receiving chemotherapy or immunomodulatory drugs. Also biomarkers have been investigated for their usefulness to predict risk of VTE (e.g. elevated leukocyte and platelet counts, soluble P-selectin, D-dimer, etc.). In order to identify cancer patients at high risk of VTE and to improve risk stratification, risk assessment models have been developed, which contain both clinical parameters and biomarkers. While primary thromboprophylaxis with lowmolecular- weight-heparin (LMWH) is recommended postoperatively for a period of up to 4 weeks after major cancer surgery, the evidence is less clear for medical oncology patients. Thromboprophylaxis in hospitalized medical oncology patients is advocated, and is based on results of randomized controlled trials which evaluated the efficacy and safety of LMWH for prevention of VTE in hospitalized medically ill patients. In recent trials the benefit of primary thromboprophylaxis in cancer patients receiving chemotherapy in the ambulatory setting has been investigated. However, at the present stage primary thromboprophylaxis for prevention of VTE in these patients is still a matter of debate and cannot be recommended for all cancer outpatients.

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Low levels of frailty in HIV-positive older adults on antiretroviral therapy in northern Tanzania

Journal of NeuroVirology ◽

10.1007/s13365-020-00915-3 ◽

2021 ◽

Author(s):

Clare Bristow ◽

Grace George ◽

Grace Hillsmith ◽

Emma Rainey ◽

Sarah Urasa ◽

...

Keyword(s):

Antiretroviral Therapy ◽

High Standard ◽

Female Gender ◽

Screening Tools ◽

Sub Saharan Africa ◽

Hiv Care ◽

Diagnostic Tools ◽

Clinical Frailty Scale ◽

Frailty Phenotype ◽

Sub Saharan

Abstract There are over 3 million people in sub-Saharan Africa (SSA) aged 50 and over living with HIV. HIV and combined antiretroviral therapy (cART) exposure may accelerate the ageing in this population, and thus increase the prevalence of premature frailty. There is a paucity of data on the prevalence of frailty in an older HIV + population in SSA and screening and diagnostic tools to identify frailty in SSA. Patients aged ≥ 50 were recruited from a free Government HIV clinic in Tanzania. Frailty assessments were completed, using 3 diagnostic and screening tools: the Fried frailty phenotype (FFP), Clinical Frailty Scale (CFS) and Brief Frailty Instrument for Tanzania (B-FIT 2). The 145 patients recruited had a mean CD4 + of 494.84 cells/µL, 99.3% were receiving cART and 72.6% were virally suppressed. The prevalence of frailty by FFP was 2.758%. FFP frailty was significantly associated with female gender (p = 0.006), marital status (p = 0.007) and age (p = 0.038). Weight loss was the most common FFP domain failure. The prevalence of frailty using the B-FIT 2 and the CFS was 0.68%. The B-FIT 2 correlated with BMI (r = − 0.467, p = 0.0001) and CD4 count in females (r = − 0.244, p = 0.02). There is an absence of frailty in this population, as compared to other clinical studies. This may be due to the high standard of HIV care at this Government clinic. Undernutrition may be an important contributor to frailty. It is unclear which tool is most accurate for detecting the prevalence of frailty in this setting as levels of correlation are low.

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AB0903-HPR DURATION OF TELEPHONE CONSULTATIONS AMONGST RHEUMATOLOGY PRACTITIONERS IN A DISTRICT GENERAL HOSPITAL - ADAPTING TO REMOTE CONSULTATION IN A COVID-19 PANDEMIC

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1282 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1474.1-1474

Author(s):

L. Parker ◽

F. Coldstream

Keyword(s):

General Hospital ◽

Controlled Trial ◽

Clinical Care ◽

District General Hospital ◽

British Society ◽

Nice Guideline ◽

Face To Face ◽

Co Morbidity ◽

Randomised Controlled ◽

Remote Consultations

Background:The Covid-19 pandemic has resulted in a rapid adoption of remote consultations in order to limit face to face clinical contact wherever appropriate, as recommended by the British Society for Rheumatology. The same clinic templates which existed for face-to-face encounters have been retrospectively adapted, without consideration of any potential difference in duration of consultations. Rheumatology practitioners from a variety of clinical backgrounds work alongside the rheumatology consultants, providing clinical care to patients with both inflammatory arthritis and connective tissue disease.Objectives:To record the duration of all scheduled telephone consultations carried out by advances rheumatology practitioners in a 4-week period.Methods:All scheduled telephone clinic encounters over a 4-week period were timed and the duration recorded in a spreadsheet. Data was collected in real time by all 8 rheumatology advanced practitioners working within the rheumatology department of a district general hospital, following each clinic episode.Results:Data was recorded from a total of 337 clinic appointments. Of these, 317 (94%) were booked as routine, 3 (0.9%) as urgent, 4 (1.2%) were expedited following an advice line contact, and 13 (3.9%) no data was recorded. 28 (8%) of the patients did not answer when contacted. 80 (24%) clinic appointments lasted 15 minutes or less, 186 (55%) lasted 16 - 30 minutes, 37 (11%) lasted 31 - 45 minutes, and 6 (2%) lasted 46 - 60 minutes. The average duration was 22 minutes.Conclusion:Within this department, remote consultations appear to have a similar duration when compared against the traditional clinic template for a fully face-to-face clinic, with some encounters lasting significantly longer than the planned duration. This would appear to differ to telephone consultations used in other settings, such as general practice where the duration is reportedly shorter1. This may be representative of the additional complexity and co-morbidity of a typical rheumatology patient, or due to the multi-faceted nature of a rheumatology follow-up appointment2. Although remote consultations are effective in limiting risk of exposure to Covid-19, they may not offer a quicker or more efficient service compared with the face-to-face model. Further study in this field is required to evaluate this widely adopted new pattern of working.References:[1]Pinnock H, Bawden R, Proctor S, Wolfe S, Scullion J, Price D, Sheikh A. Accessibility, acceptability, and effectiveness in primary care of routine telephone review of asthma: pragmatic, randomised controlled trial. BMJ. 2003 Mar 1;326(7387):477-9. doi: 10.1136/bmj.326.7387.477. PMID: 12609944; PMCID: PMC150181.[2]National Institute for Health and Care Excellence (NICE) (2018) rheumatoid arthritis in adults: management (NICE Guideline NG100). Available at https://www.nice.org.uk/guidance/ng100 [Accessed 05 January 2021].Disclosure of Interests:None declared

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Diagnostic tools for neurosyphilis: a systematic review

BMC Infectious Diseases ◽

10.1186/s12879-021-06264-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Gustavo Henrique Pereira Boog ◽

João Vitor Ziroldo Lopes ◽

João Vitor Mahler ◽

Marina Solti ◽

Lucas Tokio Kawahara ◽

...

Keyword(s):

New Technologies ◽

Clinical Suspicion ◽

Risk Of Bias ◽

Diagnostic Methods ◽

Diagnostic Tools ◽

Test Accuracy ◽

Cerebrospinal Fluid Analysis ◽

Evaluation Methodologies ◽

Fluid Analysis ◽

Criteria For Diagnosis

Abstract Purpose Increasing incidences of syphilis highlight the preoccupation with the occurrence of neurosyphilis. This study aimed to understand the current diagnostic tools and their performance to detect neurosyphilis, including new technologies and the variety of existing methods. Methods We searched databases to select articles that reported neurosyphilis diagnostic methods and assessed their accuracy, presenting sensitivity and specificity values. Information was synthesized in tables. The risk of bias was examined using the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy recommendations. Results Fourteen studies were included. The main finding was a remarkable diversity of tests, which had varied purposes, techniques, and evaluation methodologies. There was no uniform criterion or gold standard to define neurosyphilis. The current basis for its diagnosis is clinical suspicion and cerebrospinal fluid analysis. There are new promising tests such as PCR tests and chemokine measurement assays. Conclusions The diagnosis of neurosyphilis is still a challenge, despite the variety of existing and developing tests. We believe that the multiplicity of reference standards adopted as criteria for diagnosis reveals the imprecision of the current definitions of neurosyphilis. An important next step for the scientific community is to create a universally accepted diagnostic definition for this disease.

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419 STOP-Bang Score and History of Radiation Predicts Risk of Obstructive Sleep Apnea in Cancer Patients: A Machine Learning Study

SLEEP ◽

10.1093/sleep/zsab072.418 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A166-A166

Author(s):

Ankita Paul ◽

Karen Wong ◽

Anup Das ◽

Diane Lim ◽

Miranda Tan

Keyword(s):

Machine Learning ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cancer Patients ◽

Prediction Accuracy ◽

Screening Tools ◽

Cancer Type ◽

Sleep Study ◽

Obstructive Sleep ◽

History Of

Abstract Introduction Cancer patients are at an increased risk of moderate-to-severe obstructive sleep apnea (OSA). The STOP-Bang score is a commonly used screening questionnaire to assess risk of OSA in the general population. We hypothesize that cancer-relevant features, like radiation therapy (RT), may be used to determine the risk of OSA in cancer patients. Machine learning (ML) with non-parametric regression is applied to increase the prediction accuracy of OSA risk. Methods Ten features namely STOP-Bang score, history of RT to the head/neck/thorax, cancer type, cancer stage, metastasis, hypertension, diabetes, asthma, COPD, and chronic kidney disease were extracted from a database of cancer patients with a sleep study. The ML technique, K-Nearest-Neighbor (KNN), with a range of k values (5 to 20), was chosen because, unlike Logistic Regression (LR), KNN is not presumptive of data distribution and mapping function, and supports non-linear relationships among features. A correlation heatmap was computed to identify features having high correlation with OSA. Principal Component Analysis (PCA) was performed on the correlated features and then KNN was applied on the components to predict the risk of OSA. Receiver Operating Characteristic (ROC) - Area Under Curve (AUC) and Precision-Recall curves were computed to compare and validate performance for different test sets and majority class scenarios. Results In our cohort of 174 cancer patients, the accuracy in determining OSA among cancer patients using STOP-Bang score was 82.3% (LR) and 90.69% (KNN) but reduced to 89.9% in KNN using all 10 features mentioned above. PCA + KNN application using STOP-Bang score and RT as features, increased prediction accuracy to 94.1%. We validated our ML approach using a separate cohort of 20 cancer patients; the accuracies in OSA prediction were 85.57% (LR), 91.1% (KNN), and 92.8% (PCA + KNN). Conclusion STOP-Bang score and history of RT can be useful to predict risk of OSA in cancer patients with the PCA + KNN approach. This ML technique can refine screening tools to improve prediction accuracy of OSA in cancer patients. Larger studies investigating additional features using ML may improve OSA screening accuracy in various populations Support (if any):

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