scholarly journals Protocol for the Prognosticating Delirium Recovery Outcomes Using Wakefulness and Sleep Electroencephalography (P-DROWS-E) study: a prospective observational study of delirium in elderly cardiac surgical patients

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e044295
Author(s):  
S Kendall Smith ◽  
Thomas Nguyen ◽  
Alyssa K Labonte ◽  
MohammadMehdi Kafashan ◽  
Orlandrea Hyche ◽  
...  
Keyword(s):  
Observational Study ◽  
Postoperative Delirium ◽  
Prospective Observational Study ◽  
Peak Frequency ◽  
Assessment Method ◽  
Clinical Syndrome ◽  
Study Patient ◽  
Eligibility Criteria ◽  
Scientific Publications ◽  
Elective Cardiac Surgery

IntroductionDelirium is a potentially preventable disorder characterised by acute disturbances in attention and cognition with fluctuating severity. Postoperative delirium is associated with prolonged intensive care unit and hospital stay, cognitive decline and mortality. The development of biomarkers for tracking delirium could potentially aid in the early detection, mitigation and assessment of response to interventions. Because sleep disruption has been posited as a contributor to the development of this syndrome, expression of abnormal electroencephalography (EEG) patterns during sleep and wakefulness may be informative. Here we hypothesise that abnormal EEG patterns of sleep and wakefulness may serve as predictive and diagnostic markers for postoperative delirium. Such abnormal EEG patterns would mechanistically link disrupted thalamocortical connectivity to this important clinical syndrome.Methods and analysisP-DROWS-E (Prognosticating Delirium Recovery Outcomes Using Wakefulness and Sleep Electroencephalography) is a 220-patient prospective observational study. Patient eligibility criteria include those who are English-speaking, age 60 years or older and undergoing elective cardiac surgery requiring cardiopulmonary bypass. EEG acquisition will occur 1–2 nights preoperatively, intraoperatively, and up to 7 days postoperatively. Concurrent with EEG recordings, two times per day postoperative Confusion Assessment Method (CAM) evaluations will quantify the presence and severity of delirium. EEG slow wave activity, sleep spindle density and peak frequency of the posterior dominant rhythm will be quantified. Linear mixed-effects models will be used to evaluate the relationships between delirium severity/duration and EEG measures as a function of time.Ethics and disseminationP-DROWS-E is approved by the ethics board at Washington University in St. Louis. Recruitment began in October 2018. Dissemination plans include presentations at scientific conferences, scientific publications and mass media.Trial registration numberNCT03291626.

scholarly journals Emergence delirium is associated with increased postoperative delirium in elderly: a prospective observational study

2020 ◽  
Vol 34 (5) ◽  
pp. 675-687
Author(s):  
Yan Zhang ◽  
Shu-Ting He ◽  
Bin Nie ◽  
Xue-Ying Li ◽  
Dong-Xin Wang
Keyword(s):  
Observational Study ◽  
General Anesthesia ◽  
Postoperative Delirium ◽  
Prospective Observational Study ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Emergence Delirium ◽  
Confusion Assessment ◽  
Increased Risk ◽  
Pacu Stay

Abstract Background The clinical significance of emergence delirium remains unclear. The purpose of this study was to investigate the association between emergence delirium and postoperative delirium in elderly after general anesthesia and surgery. Methods This prospective observational study was done in a tertiary hospital in Beijing, China. Elderly patients (65–90 years) who underwent major noncardiac surgery under general anesthesia and admitted to the postanesthesia care unit (PACU) after surgery were enrolled. Emergence delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit during PACU stay. Postoperative delirium was assessed with the Confusion Assessment Method during the first 5 postoperative days. The association between emergence delirium and postoperative delirium was analyzed with a multivariable logistic regression model. Results A total of 942 patients were enrolled and 915 completed the study. Emergence delirium developed in 37.0% (339/915) of patients during PACU stay; and postoperative delirium developed in 11.4% (104/915) of patients within the first 5 postoperative days. After adjusted confounding factors, the occurrence of emergence delirium is independently associated with an increased risk of postoperative delirium (OR 1.717, 95% CI 1.078–2.735, P = 0.023). Patients with emergence delirium stayed longer in PACU and hospital after surgery, and developed more non-delirium complications within 30 days. Conclusions Emergence delirium in elderly admitted to the PACU after general anesthesia and major surgery is independently associated with an increased risk of postoperative delirium. Patients with emergence delirium had worse perioperative outcomes. Chinese Clinical Trial Registry (chictr.org.cn) ChiCTR-OOC-17012734

scholarly journals Risk factors for postoperative delirium and subsyndromal delirium in older surgical patients in the surgical ward: a prospective observational study

2020 ◽  
Author(s):  
Maya Kanno ◽  
Mana Doi ◽  
Kazumi Kubota ◽  
Yuka Kanoya
Keyword(s):  
Risk Factors ◽  
Observational Study ◽  
Older Patients ◽  
Postoperative Delirium ◽  
Prospective Observational Study ◽  
Physical Restraint ◽  
Assessment Method ◽  
Subsyndromal Delirium ◽  
Laboratory Test Results ◽  
Surgical Ward

Abstract Background: Postoperative delirium (POD) among older patients is a common, serious disease and is associated with a high incidence of negative outcomes. For early detection of POD and subsyndromal delirium (SSD), this study was conducted to identify risk factors of POD and SSD in older patients who were scheduled for surgery in a surgical ward.Methods: This was a prospective observational study. Study participants were older than 65 years, underwent urology surgery, and were hospitalized in the surgical ward between April and September 2019. Both POD and SSD were assessed by using the Confusion Assessment Method (CAM) on the preoperative day, the day of surgery, and postoperative days 1–3 by the surgical ward nurses. SSD was defined as the presence of one or more CAM criteria and the absence of a diagnosis of delirium based on the CAM algorithm. Personal characteristics, clinical data, cognitive function, physical functions, laboratory test results, medication use, type of surgery and anesthesia, and use of physical restraint were collected from medical records. Logistic regression analyses were conducted to identify the risk factors for POD and SSD.Results: A total of 101 participants (mean age 74.9 years) were enrolled; 19 (18.8%) developed POD and SSD. The use of bed sensors (odds ratio 10.2, p=.001) were identified as risk factors for POD and SSD.Conclusions: Our study shows that the use of bed sensors might be related to the development of POD and SSD among older patients in surgical wards.

scholarly journals Risk factors for postoperative delirium and subsyndromal delirium in older patients in the surgical ward: A prospective observational study

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255607
Author(s):  
Maya Kanno ◽  
Mana Doi ◽  
Kazumi Kubota ◽  
Yuka Kanoya
Keyword(s):  
Risk Factors ◽  
Observational Study ◽  
Older Patients ◽  
Postoperative Delirium ◽  
Prospective Observational Study ◽  
Physical Restraint ◽  
Assessment Method ◽  
Subsyndromal Delirium ◽  
Laboratory Test Results ◽  
Surgical Ward

Postoperative delirium (POD) and subsyndromal delirium (SSD) among older patients is a common, serious condition associated with a high incidence of negative outcomes. However, there are few accurate methods for the early detection of POD and SSD in surgical wards. This study aimed to identify risk factors of POD and SSD in older patients who were scheduled for surgery in a surgical ward. This was a prospective observational study. Study participants were older than 65 years, underwent urology surgery, and were hospitalized in the surgical ward between April and September 2019. Delirium symptoms were assessed using the Confusion Assessment Method (CAM) on the preoperative day, the day of surgery, and postoperative days 1–3 by the surgical ward nurses. SSD was defined as the presence of one or more CAM criteria and the absence of a diagnosis of delirium based on the CAM algorithm. Personal characteristics, clinical data, cognitive function, physical functions, laboratory test results, medication use, type of surgery and anesthesia, and use of physical restraint and bed sensor were collected from medical records. Multiple logistic regression analyses were conducted to identify the risk factors for both POD and SSD. A total of 101 participants (mean age 74.9 years) were enrolled; 19 (18.8%) developed POD (n = 4) and SSD (n = 15). The use of bed sensors (odds ratio 10.2, p = .001) was identified as a risk factor for both POD and SSD. Our findings suggest that the use of bed sensors might be related to the development of both POD and SSD among older patients in surgical wards.

A PROSPECTIVE STUDY OF HD LAPAROSCOPIC VARICOCELE LIGATION FOR CHRONIC SCROTAL PAIN

2021 ◽  
pp. 8-11
Author(s):  
Devashish Kaushal ◽  
Sandeep Kumar ◽  
Arun Makkar
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Conservative Therapy ◽  
Vision System ◽  
Tertiary Care ◽  
Study Patient ◽  
Scrotal Pain ◽  
Pain Scores ◽  
Pain Symptoms ◽  
Chronic Scrotal Pain

Introduction: The prevalence of varicocele is approximately 15% in the general population, and about 2 -10 % of them have chronic scrotal pain. Microsurgical or Laparoscopic testicular vein ligations are preferred surgical options for the patient refractory to conservative therapy. Previous studies have proved the superiority of microscopic surgeries in painful varicocele treatment but the newer HD endo-vision system has improved laparoscopic vision quality signicantly and testicular veins are identied more precisely than ever before. So there is a need to relook the results of laparoscopic varicocele ligation. We have done a prospective observational study to assess patients' perceived changes in scrotal pain scores preand-post HD laparoscopic varicocele ligation. Materials and Methods: This prospective observational study was conducted at a tertiary care referral center. All patients with scrotal pain were evaluated for varicocele between September 2017 and December 2018. Varicocele patients with normal semen count with chronic scrotal pain not responding to conservative therapy were included in the study. The Laparoscopic varicocele ligation surgeries were done by HD endo-vision system under general or spinal anesthesia. Preoperative and post-operative universal pain scores were compared by Student's pair t-test. Result: A total of 34 patients (mean age, 26.2±3.9 years) underwent Laparoscopic varicocele ligation for scrotal pain symptoms. Thirty-two patients (94.11%) reported complete or marked resolution of pain at 3 months follow-up. There was no early or late postoperative complication reported in any study patient. There was a marked improvement in the mean universal pain score, from 5.6 preoperatively to 1.1 postoperatively (p=0.00011). Conclusion: HD Laparoscopic varicocele ligation has a very high success rate with minimal post-operative complications in painful varicocele management.

Diaphragmatic Dysfunction After Elective Cardiac Surgery: A Prospective Observational Study

2020 ◽  
Vol 34 (12) ◽  
pp. 3336-3344 ◽  
Author(s):  
Andrea Bruni ◽  
Eugenio Garofalo ◽  
Laura Pasin ◽  
Giuseppe Filiberto Serraino ◽  
Gianmaria Cammarota ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Diaphragmatic Dysfunction ◽  
Elective Cardiac Surgery

scholarly journals Intraoperative burst suppression is associated with postoperative delirium following cardiac surgery: a prospective, observational study

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Martin Soehle ◽  
Alexander Dittmann ◽  
Richard K Ellerkmann ◽  
Georg Baumgarten ◽  
Christian Putensen ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Observational Study ◽  
Postoperative Delirium ◽  
Prospective Observational Study ◽  
Burst Suppression

scholarly journals Correlation between Symptom Burden and Perceived Distress in Advanced Head and Neck Cancer: A Prospective Observational Study

2021 ◽  
Vol 27 ◽  
pp. 419-425
Author(s):  
Shrenik P. Ostwal ◽  
Richa Singh ◽  
Priti Rashmin Sanghavi ◽  
Himanshu Patel ◽  
Queenjal Anandi
Keyword(s):  
Quality Of Life ◽  
Head And Neck Cancer ◽  
Observational Study ◽  
Head And Neck ◽  
Neck Cancer ◽  
Prospective Observational Study ◽  
Well Being ◽  
Physical Symptoms ◽  
Eligibility Criteria

Objectives: Head and neck cancer (HNC) account for major cancer burden in the Indian population. Patients often present with a diversity of distressing physical and psychological symptoms, significantly affecting their quality of life. This study aims to determine the correlation between symptom cluster and perceived distress in such patients. Materials and Methods: This single center prospective observational study was done on 175 adults advanced HNC patients referred to palliative medicine outpatient clinic. Patients fulfilling eligibility criteria were regularly assessed for their symptoms and distress at baseline and followed up at days 7, 14, and 28. Results: Most patients belong to the age group of 40–50 years and having a diagnosis carcinoma of the tongue. The most common symptoms presented were pain, tiredness, loss of appetite, and feeling of well-being. We observed statistically significant correlation between total ESAS score and distress levels in patients at days 0, 7, and 14, respectively, (P = 0.003 vs. 0.0004 vs. 0.002). However, at day 28, no such statistically significant correlation was found (P = 0.085) suggesting attention to other factors during assessment. Conclusion: Outpatient palliative care consultations have shown significant improvement in symptom and distress score. Perceived distress in a person can not only be related to physical symptoms. Acute control of symptom may uncover underlying psychosocial and spiritual issues which need to be addressed promptly for better quality of life.

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