Whilst there is a growing body of research exploring the effect of delirium in intensive care unit (ICU) patients, the relationship between patient delirium and long-term cognitive impairment has not been investigated in settings where low rates of delirium have been reported.
Objectives
To assess the association between the incidence of delirium, duration of mechanical ventilation and long term cognitive impairment in general ICU patients.
Methods
Prospective cohort study conducted in a tertiary level ICU in Queensland, Australia. Adult medical and surgical ICU patients receiving ≥12 h mechanical ventilation were assessed for delirium on at least one day. Cognitive impairment was assessed at three and/or six-months using the: Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); Trail Making Test (TMT) Part A and B; and Mini-Mental State Examination (MMSE).
Results
Of 148 enrollees, 91 (61%) completed assessment at three and/or six months. Incidence of delirium was 19%, with 41% cognitively impaired at three months and 24% remaining impaired at six months. Delirium was associated with impaired cognition at six-months: mean TMT Part A scores (information processing speed) were 7.86 s longer than those with no delirium (p = 0.03), and mean TMT Part B scores (executive functioning) 24.0 s longer (p = 0.04).
Conclusions
ICU delirium was positively associated with impaired information processing speed and executive functioning at six-months post-discharge for this cohort. Testing for cognitive impairment with RBANS and TMT should be considered due to its greater sensitivity in comparison to the MMSE. 相似文献
Purpose: Tactile impairments affect over 77% of children with unilateral cerebral palsy (CP). This study aimed to examine the current practices of pediatric therapists in relation to tactile assessment and the barriers to carrying out tactile assessment in children with CP.Method: The study was in two parts. In part one, pediatric therapists (n?=?35) completed a questionnaire detailing their current knowledge and the use of tactile assessments in children. In part two, therapists (n?=?12) completed a questionnaire based on the Theoretical Domains Framework examining the barriers and facilitators to completing tactile assessments in clinical practice.Results: Most therapists (over 90%) carry out tactile assessments in the minority (less than 25%) of children with CP that they treat. Therapists reported the need for improved knowledge/skills (n?=?24) and confidence (n?=?19) in carrying out tactile assessments, alongside the provision of necessary equipment (n?=?17). Qualitative reports also suggested that organizational assessment guidelines and templates may facilitate the implementation of tactile assessment.Conclusions: A multi-faceted knowledge translation strategy to address the barriers to tactile assessment among pediatric therapists needs to be developed.
Implications for rehabilitation
Pediatric occupational therapists and physiotherapists may not be completing tactile assessments according to current evidence-based recommendations.
Therapists identified five main barriers, including a lack of knowledge, skills, belief in their capabilities (confidence), behavioral regulation (organizational procedures), and environmental context (e.g., equipment).
Therapists recommended several potential facilitators, including access to necessary equipment, procedures, record sheets, training in tactile assessments, and research supporting related interventions.
Service providers are encouraged to develop multi-faceted knowledge translation strategies that address these barriers and maximize facilitators.
OBJECTIVE The human pituitary gland is affected selectively by conditions associated with iron deposition, but the mechanisms for this are unknown. In this study we have determined whether the transferrin receptor, which mediates iron uptake by cells, could be detected immunocytochemically in human pituitary adenomas in vitro . PATIENTS Data were derived from 35 patients undergoing transsphenoidal surgery and included 13 with clinically non-functioning adenomas, 15 with acromegaly, 4 prolactinomas, 2 patients with Cushing's disease and one patient with Nelson's syndrome. MEASUREMENTS Transferrin receptor immunopositivity was determined for each adenoma in dispersed cell culture using a specific monoclonal antibody. RESULTS Eight of 13 clinically functionless adenomas showed immunopositive transferrin receptor expression, whilst adenomas from 15 patients with acromegaly, 4 prolactinomas, 2 Cushing's syndrome and one patient with Nelson's syndrome were negative. The eight transferrin receptor positive tumours were gonadotrophinomas and accounted for eight of the nine tumours which secreted and immunostained for FSH; all eight also secreted and immunostained for LH. CONCLUSIONS These findings may reflect a special requirement for iron by gonadotrophin secreting cells in comparison to other pituitary cell types and this could underlie the reasons why in the normal pituitary these cells are especially susceptible to malfunction in iron overload syndromes such as genetic haemochromatosis and β-thalassaemia. 相似文献
ObjectivesTo evaluate the accuracy and reproducibility of antimicrobial susceptibility testing methods in Burkholderia cepacia complex (BCC).MethodsMinocycline, ciprofloxacin, trimethoprim/sulphamethoxazole, meropenem, ceftazidime and chloramphenicol were tested against 155 BCC strains using broth microdilution at 35 ± 1°C (BMD35) in triplicate, then BMD at 30 ± 1°C (BMD30), agar dilution at 30°C and 35°C (AD30 and AD35), gradient strip (GS) and EUCAST standardized disc diffusion (DD) testing methods once.ResultsBMD35 reproducibility ranged from 70% to 84.5% for all agents. Correlations of MICs from BMD35 with BMD30 ranged from 63% to 85%, with AD35 from 32.9% to 87% and with GS methods from 36% to 83.9%. Essential agreement (EA) of MICs by GS with BMD35 ranged from 62.6% (trimethoprim-sulphamethoxazole) to 83.9% (minocycline). EA of EUCAST DD zone diameters using CLSI breakpoint criteria was between 85.8% and 97.4%, however Very Major Errors (VME) for trimethoprim/sulphamethoxazole were 31%.ConclusionsBMD at 35 ± 1°C was poorly reproducible for most agents and no method showed acceptable performance. Of particular concern were the GS results. Although this is the most commonly used method for determining MICs in laboratories, there was poor correlation with BMD35 for meropenem and trimethoprim/sulphamethoxazole. EUCAST DD correlated poorly with BMD35 MICs. This study confirms that no susceptibility method is capable of providing reproducible and accurate MICs when testing BCC. 相似文献
Recent findings from visual scanpath research are considered in relation to cognitive theories of delusion formation. Contemporary theories converge in proposing that both perceptual and cognitive aberrations are crucial to the development of delusional beliefs (Garety & Freeman, 1999). Deluded individuals have reliably demonstrated attributional and probabilistic reasoning biases, manifesting as hasty decision making and an inclination to blame other people for negative experiences (Bentall, Kinderman, & Kaney, 1994; Garety & Hemsley, 1994). Deluded people have also displayed attentional preference for threat-related material and a ''negative'' world view (Kaney, Wolfenden, Dewey, & Bentall, 1992; Kaney, Bowen-Jones, Dewey, & Bentall, 1997). In combination, these biases might reflect a general tendency for deluded individuals to ''jump to conclusions'' when evaluating others' intentions (Garety & Freeman, 1999), influenced by the perception of threat and persecution everywhere (Kaney et al., 1997). This thesis would be consistent with reports of an inability of paranoid patients to correctly infer the intentions of others during ''theory of mind'' tasks but would not predict a total lack of mentalising ability as proposed by Frith (1992). In visual scanpath paradigms, deluded schizophrenics tend to display excessive staring behaviour and to avoid gazing at facial features when viewing human faces (Phillips & David, 1997, 1998; Streit, Wolwer, & Gaebel, 1997; Williams et al., 1999). These abnormal scanpath strategies could underlie aberrations in social reasoning (including misinterpretation of others' intentions) and data gathering exhibited by deluded individuals. Exploration of the relationship between visual scanpaths and biases in social cognition is therefore warranted. 相似文献
Background Personal health records (PHR) provide opportunities for improved patient engagement, collection of patient-generated data, and overcome health-system inefficiencies. While PHR use is increasing, uptake in rural populations is lower than in urban areas. Objectives The study aimed to identify priorities for PHR functionality and gain insights into meaning, value, and use of patient-generated data for rural primary care providers. Methods We performed PHR preimplementation focus groups with rural providers and their health care teams from five primary care clinics in a sparsely populated mountainous region of British Columbia, Canada to obtain their understanding of PHR functionality, needs, and perceived challenges. Results Eight general practitioners (GP), five medical office assistants, two nurse practitioners (NP), and two registered nurses (14 females and 3 males) participated in focus groups held at their respective clinics. Providers (GPs, NPs, and RNs) had been practicing for a median of 9.5 (range = 1–38) years and had used an electronic medical record for 7.0 (1–20) years. Participants expressed interest in incorporating functionality around two-way communication and appointment scheduling, previsit data gathering, patient and provider data sharing, virtual care including visits using videoconferencing tools, and postvisit sharing of educational materials. Three further themes emerged from the focus groups: (1) the context in which the providers'' practice matters, (2) the need for providing patients and providers with choice (e.g., which data to share, who gets to initiate/respond in communications, and processes around virtual care visits), and (3) perceived risks of system use (e.g., increased complexity for older patients and workload barriers for the health care team). Conclusion Rural primary care teams perceived PHR opportunities for increased patient engagement and access to patient-generated data, while worries about changes in workflow were the biggest perceived risk. Recommendations for PHR adoption in a rural primary health network include setting provider-patient expectations about response times, ability to share notes selectively, and automatically augmented note-taking from virtual-care visits. 相似文献