scholarly journals Approach To: Delirium

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Alfiya Mukharyamova
Keyword(s):  
Functional Impairment ◽  
Acute Onset ◽  
Adverse Outcomes ◽  
Geriatric Syndrome ◽  
Prolonged Hospitalization ◽  
Work Up ◽  
Core Features

Delirium is a common and serious geriatric syndrome with core features of acute onset and inattention. It is often underdiagnosed and is associated with many adverse outcomes, such as prolonged hospitalization, institutionalization, functional impairment and death. This review summarizes an approach to the recognition, work-up, management and prevention of delirium.

scholarly journals Combinations of Symptoms in Emergency Presentations: Prevalence and Outcome

2019 ◽  
Vol 8 (3) ◽  
pp. 345 ◽  
Author(s):  
Tobias Kuster ◽  
Christian Nickel ◽  
Mirjam Jenny ◽  
Lana Blaschke ◽  
Roland Bingisser
Keyword(s):  
Time Course ◽  
Predictive Power ◽  
Secondary Analysis ◽  
Clinical Work ◽  
Adverse Outcomes ◽  
University Hospital ◽  
Chief Complaints ◽  
The University ◽  
Work Up ◽  
Inclusion Period

The predictive power of certain symptoms, such as dyspnoea, is well known. However, research is limited to the investigation of single chief complaints. This is in contrast to patients in the emergency department (ED) presenting usually more than one symptom. We aimed to identify the most common combinations of symptoms and to report their related outcomes: hospitalisation, admission to intensive care units, and mortality. This is a secondary analysis of a consecutive sample of all patients presenting to the ED of the University Hospital Basel over a total time course of 6 weeks. The presence of 35 predefined symptoms was systematically assessed upon presentation. A total of 3960 emergency patients (median age 51, 51.7% male) were included. Over 130 combinations of two, 80 combinations of three, and 10 combinations of four symptoms occurred 42 times or more during a total inclusion period of 42 days. Two combinations of two symptoms were predictive for in-hospital mortality: weakness and fatigue (Odds ratio (OR) = 2.45), and weakness and headache (OR = 3.01). Combinations of symptoms were frequent. Nonspecific complaints (NSCs), such as weakness and fatigue, are among the most frequently reported combinations of symptoms, and are associated with adverse outcomes. Systematically assessing symptoms may add valuable information for prognosis and may therefore influence triage, clinical work-up, and disposition.

Psychosocial support for people with dementia with Lewy bodies

2021 ◽  
Vol 23 (5) ◽  
pp. 1-8
Author(s):  
Alison Killen
Keyword(s):  
Dementia With Lewy Bodies ◽  
Psychosocial Support ◽  
Lewy Bodies ◽  
Lewy Body Dementia ◽  
Adverse Outcomes ◽  
Care Staff ◽  
The Core ◽  
People With Dementia ◽  
Age Related ◽  
Core Features

Background Lewy body dementia is the second most common form of age-related neurodegenerative dementia. It has two forms: dementia with Lewy bodies and Parkinson's disease dementia. Methods There are specific core symptoms associated with dementia with Lewy bodies. Optimum care requires awareness of the features associated with these, as well as appropriate support and management strategies, which are provided in this article. Results The core features of dementia with Lewy bodies are visual hallucinations, cognitive fluctuations, Parkinsonism and rapid eye movement sleep behaviour disorder. Appropriate psychosocial strategies includes psychoeducation, social support and environmental modification. Adoption of these approaches can reduce adverse outcomes. Conclusions The core features of dementia with Lewy bodies can significantly impair quality of life. Nursing and residential care staff are ideally placed to address this through the implementation of psychosocial strategies both directly, and through the provision of psychoeducation for family caregivers.

scholarly journals Acute Flaccid Myelitis Cases Presenting During a Spike in Respiratory Enterovirus D68 Circulation: Case Series From a Single Pediatric Referral Center.

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S305-S306 ◽  
Author(s):  
Samia Naccache ◽  
Jeffery Bender ◽  
Jay Desai ◽  
Tam Van ◽  
Lindsay Meyers ◽  
...  
Keyword(s):  
Case Series ◽  
Acute Onset ◽  
Case Definition ◽  
Rt Pcr ◽  
Significant Past Medical History ◽  
Upper Respiratory Infection ◽  
Acute Flaccid Myelitis ◽  
Enterovirus D68 ◽  
Ebv Dna ◽  
Work Up

Abstract Background In 2014, a global outbreak of Enterovirus D68 (EV-D68) caused severe respiratory disease and was associated with an increase in acute flaccid myelitis (AFM) cases. Despite heightened surveillance, both EV-D68 detection and AFM reporting dropped in 2015. As AFM reporting increased in 2016, we sought to better understand AFM and EV-D68 epidemiology at our institution. Methods Chart review of clinical presentation and workup was conducted on patients meeting the case definition for AFM for 2015-16. To determine EV-D68 prevalence at CHLA, samples positive for Rhinovirus/Enterovirus (RV/EV) by FilmArray® Respiratory Panel (FA-RP) in September 2016 were screened for EV-D68 by RT-PCR. Results were compared with a research algorithm developed within the FilmArray®Trend epidemiology software. After establishing accurate EV-D68 prediction, the algorithm was used on historic FA-RP assays to measure EV-D68 prevalence at CHLA in 2015 and 2016. Results 7 patients with a median age of 3.3 years and no significant past medical history presented with AFM between July 15 - October 15, 2016, while none were identified in 2015. All had acute onset patchy weakness involving mostly the upper limbs and grey matter involvement on MRI. 6/7 reported fever/upper respiratory infection prior to AFM onset. CSF from 7/7 was negative by FilmArray®meningitis/encephalitis Panel and 2/7 were positive for EBV DNA. Further work up on CSF and blood were negative. 4/7 (57.1%) patients were RV/EV positive from respiratory samples and 3 were confirmed as EV-D68 by RT-PCR. IVIG was given in 7/7 cases. Patients were discharged after an average of 8.8 (4.8-13.6) days. The FilmArray Trend monitoring revealed that during the time of AFM presentation in 2016, 226/778 patients tested for respiratory viruses by the FA-RP were positive for RV/EV. Of those, 29.2% (66/226) were positive for EV-D68 compared with 0.02% (2/224) over the same period in 2015. Conclusion As shown by CDC surveillance data, we saw a resurgence of AFM cases in 2016 compared with 2015. All 7 patients identified were previously healthy and had persistent weakness at discharge. Cases were accompanied by increases in circulating respiratory EV-D68. Further investigation of the correlation between EV-D68 resurgence and AFM is warranted. Disclosures L. Meyers, BioFire Diagnostics: Employee, Salary. J. Jones, Biofire Diagnostics LLC: Employee, Salary. J. Dien Bard, BioFire: Consultant and Investigator, Research grant and Speaker honorarium.

scholarly journals Linking epidemiology and molecular mechanisms in sarcopenic obesity in populations

2020 ◽  
Vol 79 (4) ◽  
pp. 448-456 ◽  
Author(s):  
Issam El Bizri ◽  
John A. Batsis
Keyword(s):  
Molecular Mechanisms ◽  
Epidemiological Data ◽  
Adverse Outcomes ◽  
Sarcopenic Obesity ◽  
Geriatric Syndrome ◽  
Clinical Settings ◽  
Biological Mechanisms ◽  
Obese Adults ◽  
Targeted Interventions ◽  
Different Populations

Recognising the adverse outcomes that occur to obese adults over the age of 65 years with loss of muscle mass or strength, or sarcopenia is important. We will review the definitions of sarcopenic obesity, and attempt to link the epidemiological data with the molecular pathways. Upon understanding the model of sarcopenic obesity, we will discuss targeted interventions and further challenges to address this geriatric syndrome. As our understanding of this syndrome is growing, more data are emerging to help define sarcopenic obesity across different populations. We now have a better understanding of biological pathways in ageing such as changes in body composition, sex-specific hormones, pro-inflammatory markers and myocellular mechanisms. We will review a comprehensive model that shows the interactions between the different pathways leading to sarcopenic obesity. Such a model will explain the promising interventions in place and invite future ones. Sarcopenic obesity is an important geriatric syndrome with significant clinical and healthcare implications. Further research is needed to harmonise definitions, clarify mechanisms contributing to syndrome and use evidence-based interventions to target biological mechanisms in both research and clinical settings.

scholarly journals An Atypical Presentation of Pediatric Acute Neuropsychiatric Syndrome Responding to Plasmapheresis Treatment

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Drew H. Barzman ◽  
Hannah Jackson ◽  
Umesh Singh ◽  
Marcus Griffey ◽  
Michael Sorter ◽  
...  
Keyword(s):  
Treatment Options ◽  
Abrupt Onset ◽  
Acute Onset ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Acute Infections ◽  
The Family ◽  
Work Up ◽  
Severe Anxiety ◽  
Very High

Here we report a case of a 15-year-old female who had originally been diagnosed and treated unsuccessfully for schizophrenia, psychosis, severe anxiety, and depression. More in-depth history revealed an abrupt onset of her symptoms with remote acute infections and many exhibited characteristics of obsessive compulsive disorder with rituals. Work-up for underlying infectious, immunodeficiency, and autoimmune causes was unrevealing except for very high levels of anti-neuronal antibodies which have been linked to Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). Treatment options were discussed with the family and it was decided to use a course of plasmapheresis based on previous studies demonstrating efficacy and its safety profile. After course of therapy, there was a dramatic resolution of her psychosis, OCD traits, and anxiety. She was able to stop all of her antipsychotic and anxiety medications and resume many of her previous normal daily activities. The effect of this treatment has been sustained to the present time. This case emphasizes the importance of exploring nontraditional treatments for severe, treatment-resistant mental illness which requires a multidisciplinary approach. Further research is warranted in larger populations to investigate pathomechanisms and treatment of PANs/PANDAs.

Sarcopenia: a clinical review

2013 ◽  
Vol 23 (4) ◽  
pp. 267-274 ◽  
Author(s):  
AJ Cruz-Jentoft
Keyword(s):  
Muscle Mass ◽  
Poor Quality ◽  
Adverse Outcomes ◽  
Life And Death ◽  
Syndromic Approach ◽  
Muscle Mass Loss ◽  
Intervention Trials ◽  
Diagnostic Work ◽  
Work Up ◽  
Near Future

SummaryAlthough sarcopenia has been used to define muscle mass loss in older subjects, muscle mass is not directly linked to muscle function. Recent definitions consider sarcopenia as a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength with a risk of adverse outcomes, such as physical disability, poor quality of life, and death. It is closely linked with physical frailty, and also with other muscle wasting disorders, including cachexia and malnutrition. This review focuses on the incorporation of sarcopenia into clinical practice, reviews case finding and diagnosis of sarcopenia, proposes a syndromic approach for the diagnostic work-up of sarcopenic patients, and looks at intervention trials with physical exercise and nutrition, as drugs to treat this condition are not expected to be available in the near future.

Mastery learning of toxicology life support skills by nurses and doctors, utilizing simulation technology in Nepal

2020 ◽  
Vol 6 (01) ◽  
Author(s):  
Vivekanshu Verma ◽  
Ajay Thapa ◽  
Narendra Nath Jena ◽  
S. Nath Senthilkumaran ◽  
Devendra Richhariya ◽  
...  
Keyword(s):  
Life Support ◽  
Clinical Performance ◽  
Research Training ◽  
Patient Simulation ◽  
Educational Interventions ◽  
Modern Medicine ◽  
Acute Onset ◽  
Adverse Outcomes ◽  
Rapid Progression ◽  
Forensic Professionals

Modern Medicine has been at the forefront in the use of patient simulation for research, training and performance assessment. With simulation, no patients are at risk for exposure to novice caregivers or unproven technologies. It becomes very important in field of toxicological emergencies, due to its acute onset of presentation, rapid progression of symptoms, and early deterioration of vitals and adverse outcomes in morbidity and mortality of patients in extremes of ages. Our observational study suggests that Emergency, Forensic Medicine and Toxicology (FMT) residents and Nurses have limited exposure to critically ill patients of trauma and toxicology and the budding forensic professionals lack the skills to manage them. Simulation has the potential to fill this educational void in managing clinical forensic and toxicological emergencies. The following review will attempt to answer this call by quantifying the effect of simulation-based educational interventions on retention of knowledge and clinical performance, as applied to acute care toxicology.

Dementia of acute onset in the Canadian Study of Health and Aging

2005 ◽  
Vol 17 (3) ◽  
pp. 451-459 ◽  
Author(s):  
Paige King ◽  
Pratima Devichand ◽  
Kenneth Rockwood
Keyword(s):  
Risk Factors ◽  
Acute Onset ◽  
Vascular Risk Factors ◽  
Adverse Outcomes ◽  
Vascular Risk ◽  
Canadian Study ◽  
People With Dementia ◽  
Gradual Onset ◽  
Insidious Onset ◽  
Onset Group

Background: Although most people with dementia experience an insidious onset of symptoms, in some cases onset can be acute. The importance of acute onset is unclear. Some reports suggest that it portends a worse course.Methods: We performed a secondary analysis of the clinical examination cohort (n=2914) of the Canadian Study of Health and Aging (CSHA). We defined “acute onset of dementia” from the Cambridge Examination for Mental Disorders in the Elderly (CAMDEX) questionnaire, conducted with an informant. People with dementia of acute onset were compared to those with dementia of insidious onset for development of adverse outcomes of death and institutionalization over 5years.Results: Of the 1132 people who had dementia, 130 (11.5%) met criteria for acute onset. Compared with gradual-onset dementia patients, those with acute-onset dementia were more often men (42% vs. 30%, p<0.05), resided in nursing homes (75% vs. 63%, p<0.05), had vascular risk factors (72% vs. 47%, p<0.05), and a Hachinski Ischemia Scale (HIS) score ≥7 (64% vs. 19%, p<0.05). More patients with dementia of acute onset than gradual onset were diagnosed with vascular dementia (55% vs. 13%; p<0.05). Adjusted hazard ratios (HRs) for survival and institutionalization in the acute-onset group were 0.93 [95% confidence interval (CI) 0.7–1.2] and 0.76 (95% CI 0.4–1.3), respectively, compared with the gradual-onset group.Conclusions: People with acute-onset dementia had more vascular risk factors than those with gradual-onset dementia across all dementia diagnoses, and lower risks of institutionalization but worse survival. Routine inquiry about the onset of dementia might help to better clarify prognoses in patients with dementia.

scholarly journals Living alone with dementia: lack of awareness adds to functional and cognitive vulnerabilities

2010 ◽  
Vol 22 (5) ◽  
pp. 778-784 ◽  
Author(s):  
Susan W. Lehmann ◽  
Betty S. Black ◽  
Andrew Shore ◽  
Judith Kasper ◽  
Peter V. Rabins
Keyword(s):  
Cognitive Impairment ◽  
Functional Impairment ◽  
Cognitive Abilities ◽  
Primary Care Physicians ◽  
Psychiatric Symptoms ◽  
Cognitive Status ◽  
Adverse Outcomes ◽  
Living Alone ◽  
Cognitive Vulnerabilities ◽  
Functional Factors

ABSTRACTBackground: Approximately 25% of individuals with dementia live alone, yet little is known about the cognitive and functional factors that impact detection of impairment.Methods: Subjects with dementia (n = 349) from a community study of dementia management were administered the Mini-mental State Examination (MMSE) and were asked to rate their cognitive status. Each participant's knowledgeable informant (KI) was interviewed to provide information about the subject's mental health and levels of cognitive and functional impairment. Subjects with dementia living alone (n = 97, 27.8%) were compared to subjects living with others (n = 252, 72.2%) regarding functional impairment, psychiatric symptoms, cognitive functioning, and dementia recognition.Results: While subjects with dementia living alone had significantly fewer ADL impairments (p < 0.0001) and less cognitive impairment (p < 0.0001) than subjects with dementia who were living with others, nearly half of subjects living alone had two or more IADL impairments. Both knowledgeable informants (p < 0.001) and primary care physicians (p < 0.009) were less likely to detect dementia in subjects living alone, while 77.3% of subjects with dementia living alone rated their cognitive abilities as “good” or “a little worse”. Subjects with dementia living alone and those living with others had similar rates of psychosis (p = 0.2792) and depressive symptoms (p = 0.2076).Conclusions: Lack of awareness of cognitive impairment by individuals with dementia living alone as well as their knowledgeable informants and physicians, combined with frequent functional impairment and psychiatric symptoms, heightens risk for adverse outcomes. These findings underscore the need for increased targeted screening for dementia and functional impairment among older persons living alone.

scholarly journals Using the Bergman-Paris Question to screen seniors in the emergency department

CJEM ◽  
2017 ◽  
Vol 20 (5) ◽  
pp. 753-761 ◽  
Author(s):  
Antoine Laguë ◽  
Philippe Voyer ◽  
Marie-Christine Ouellet ◽  
Valérie Boucher ◽  
Marianne Giroux ◽  
...  
Keyword(s):  
Emergency Department ◽  
Odds Ratio ◽  
Screening Tool ◽  
Adverse Outcomes ◽  
Screening Tools ◽  
Screening Tests ◽  
Geriatric Syndrome ◽  
Geriatric Syndromes ◽  
Fast Pace ◽  
Geriatric Screening

AbstractObjectivesIn the fast pace of the Emergency Department (ED), clinicians are in need of tailored screening tools to detect seniors who are at risk of adverse outcomes. We aimed to explore the usefulness of the Bergman-Paris Question (BPQ) to expose potential undetected geriatric syndromes in community-living seniors presenting to the ED.MethodsThis is a planned sub-study of the INDEED multicentre prospective cohort study, including independent or semi-independent seniors (≥65 years old) admitted to hospital after an ED stay ≥8 hours and who were not delirious. Patients were assessed using validated screening tests for 3 geriatric syndromes: cognitive and functional impairment, and frailty. The BPQ was asked upon availability of a relative at enrolment. BPQ’s sensitivity and specificity analyses were used to ascertain outcomes.ResultsA response to the BPQ was available for 171 patients (47% of the main study’s cohort). Of this number, 75.4% were positive (suggesting impairment), and 24.6% were negative. To detect one of the three geriatric syndromes, the BPQ had a sensitivity of 85.4% (95% CI [76.3, 92.0]) and a specificity of 35.4% (95% CI [25.1, 46.7]). Similar results were obtained for each separate outcome. Odds ratio demonstrated a higher risk of presence of geriatric syndromes.ConclusionThe Bergman-Paris Question could be an ED screening tool for possible geriatric syndrome. A positive BPQ should prompt the need of further investigations and a negative BPQ possibly warrants no further action. More research is needed to validate the usefulness of the BPQ for day-to-day geriatric screening by ED professionals or geriatricians.

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