Differences in the Course of Alcohol Withdrawal in Women and Men: A Polish Sample

A retrospective study compared the course of alcohol withdrawal, including delirium tremens, in women and men hospitalized in the Nowowiejski Hospital in Warsaw from 1973 to 1987. Medical records pertaining to 1179 patients were analyzed; 13.8% of these patients were women and 86.2% were men. The study showed that women began intensive alcohol drinking later than men ( p < 0.0001), but the period between the onset of alcohol abuse and the first occurrence of alcohol withdrawal was shorter in women than in men ( p < 0.0001). In the period of heavy drinking before hospitalization, women consumed significantly less alcohol then men ( p < 0.0001); moreover, women drank nonbeverage alcohol less frequently than men ( p < 0.05). Women were hospitalized substantially longer than men ( p < 0.0001), whereas the duration of alcohol withdrawal symptoms at the time of hospitalization was comparable in both groups. Withdrawal seizures were significantly more frequent among men than among women ( p < 0.001). Significant differences in the patients'somatic conditions were not noted between the groups, with the exception of anemia and decreased potassium concentration, which were more frequently observed in women (both p < 0.0001), and of increased concentration of ALT and hypoproteinemia, which were more frequent in men (respectively, p < 0.05 and p < 0.01). Co-existing personality disorders, depressive disorders, and anxiety disorders—as well as abuse of benzodiazepines and barbiturates—were more frequently observed in women ( p < 0.0001). The period between the first hospitalization due to alcohol withdrawal and the time of death was significantly shorter in men than in women ( p < 0.05). The results point to differences in the conditions and the course of alcohol dependence and alcohol withdrawal between women and men.     

Identifying patients at risk for,and treatment of major psychiatric complications of cancer

A critically important aspect of supportive care in cancer is the prompt recognition and effective treatment of psychiatric complications. Psychiatric disorders such as depression, anxiety and delirium occur in a signifcant percentage of cancer patients, particularly as disease advances and as cancer treatments become more aggressive. This paper reviews factors that can be utilized to identify patients who are at increased risk for developing psychiatric complications, such as those with advanced disease, certain cancer treatments, uncontrolled physical symptoms, functional limitations, lack of social support, and past history of psychiatric disorder. Methods of diagnostic assessment and strategies for managing depression, anxiety, delirium and suicidal ideation are also reviewed.Presented as an invited lecture at the 6th International Symposium: Supportive Care in Cancer, New Orleans, La., USA, 2–5 March 1994     

Über die beziehungen zwischen halluzinationen im alkoholdelir and testpsychologisch objektivierbaren persönlichkeitsvariablen

Zusammenfassung Bei 83 Patienten, die sich wegen Delirium tremens bei chronischem Alkoholismus in der Psychiatrischen Universitätsklinik Würzburg zur stationären Behandlung befanden, wurde der Zusammenhang zwischen Auftreten und Qualität von Halluzinationen im Delir mit Persönlichkeitsmerkmalen im postdeliranten Statium untersucht. Die Persönlichkeitsmerkmale wurden in 13 Variablen kognitiver Leistungen und in 12 Variablen der Emotionalät t and der Motivation erfaßt. Es wurden der Status am Beginn des postdeliranten Stadiums auf diesen Variablen und ihre Veränderungen bei einer Kontrolle in der 4. Woche in die Berechnung einbezogen. Zwischen jener Patientengruppe, bei der Halluzinationen im Delir festgestellt wurden waren, and den Patienten, bei denen sich kein Hinweis auf Halluzinationen ergeben hatte, war weder im Ausgangszustand noch in den Veranderungen der Personlichkeitsvariablen im postdeliranten Stadium ein statistisch bedeutsamer Unterschied nachzuweisen. Hier gilt es allerdings zu beachten, daß der Anted der Patienten ohne Halluzinationen verhältnismäßig gering war. Deutliche Beziehungen ergaben sich dagegen zwischen der Gestaltung der Halluzinationen and den Persönlichkeitsvariblen: Patienten, die polymorph halluziniert hatten, wiesen geringere Leistungsdefizite und im affektiven Bereich deutlichere Zeichen der Ängstlichkeit auf als jene, die monomorph halluziniert hatten. Letztere hoben sich in der Affektivität durch Zeichen eher gehemmter Depressivität von ersteren ab. Die Restitution der kognitiven Fähigkeiten nahm bei den polymorph Halluzinierenden einen günstigeren Verlauf. Die wenigen Korrelationen, die sich zwischen Sinnesmodalitäten der Halluzinationen und Persönlichkeitsvariablen ergeben hatten, waren unter die Differenzierung zwischen poly und monomorpher Halluzination unterzuordnen.Die Untersuchung fand mit treundlicher Unterstützung des verstorbenen Direktors der Psychiatrischen Universitätsklinik Würzburg, Prof. Dr. Otto Schrappe, dessen die Autoren hier dankbar gedenken, start. Herr Schrappe gestattete die Datenerhebung in seiner Klinik, und er stand den Autoren his zur Fertigstellung des Manuskripts mit wertvollen Ratschlägen zur Seite.     

Probable Delirium and Associated Patient Characteristics in Long-Term Care and Complex Continuing Care: A Population-Based Observational Study

ObjectivesTo estimate the prevalence of probable delirium in long-term care (LTC) and complex continuing care (CCC) settings and to describe the resident characteristics associated with probable delirium.DesignPopulation-based cross-sectional study using routinely collected administrative health data.Setting and ParticipantsAll LTC and CCC residents in Ontario, Canada, assessed with the Resident Assessment Instrument–Minimum Dataset (RAI-MDS) assessment between July 1, 2016, and December 31, 2016 (LTC n=86,454, CCC n=10,217).MethodsProbable delirium was identified via the delirium Clinical Assessment Protocol on the RAI-MDS assessment, which is triggered when individuals display at least 1 of 6 delirium symptoms that are of recent onset and different from their usual functioning. RAI-MDS assessments were linked to demographic and health services utilization databases to ascertain resident demographics and health status. Multivariable logistic regression was used to identify characteristics associated with probable delirium, with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) reported.ResultsDelirium was probable in 3.6% of LTC residents and 16.5% of CCC patients. LTC patients displayed fewer delirium symptoms than CCC patients. The most common delirium symptom in LTC was periods of lethargy (44.6% of delirium cases); in CCC, it was mental function varying over the course of the day (63.5% of delirium cases). The odds of probable delirium varied across individual demographics and health characteristics, with increased health instability having the strongest association with the outcome in both care settings (LTC: OR 30.4, 95% CI 26.2-35.3; CCC: OR 21.0, 95% CI 16.7-26.5 for high vs low instability).Conclusions and ImplicationsThere were differences in the presentation and burden of delirium symptoms between LTC and CCC, potentially reflecting differences in delirium severity or symptom identification. Several risk factors for probable delirium in LTC and CCC were identified that may be amenable to interventions to prevent this highly distressing condition.     

谵妄护理压力量表的汉化及信效度评价

目的 对谵妄护理压力量表（Strain of Care for Delirium Index,SCDI）进行汉化及信效度评价。方法 获得源量表开发者的授权后,采用Brislin法进行翻译、回译,并进行跨文化调适。调查337名具有谵妄患者护理经历的护士,采用临界比值法和相关系数法进行量表项目分析;探索性因子分析和验证性因子分析评价量表的效度;采用Cronbach α系数、重测信度评价量表的信度。结果 （1）中文版SCDI包含4个维度,20个条目。各条目与总分之间的相关系数为0.334～0.693（均P<0.05）,临界值为4.933～14.952（均P<0.05）。（2）探索性因子分析共提取出四个公因子,累计方差贡献率 63.638%,每个条目的因子负荷量为0.487～0.866（均＞0.45）;验证性因子分析显示,〖XC小五号.EPS;P〗/df为2.275、CFI为0.942、GFI为0.907、AGFI为0.875、RMSEA为0.062、RMR为0.021、IFI为0.943、TLI为0.929,模型的适配度良好。（3）总量表的Cronbach α系数是0.894,四个维度的 Cronbach α系数在 0.744～0.920之间;总量表的重测信度为0.898,四个维度的重测信度在 0.706～0.806之间。结论 中文版SCDI具有良好的信效度,可用于量化评估我国护理人员的谵妄护理压力。     

Validation of the Korean Version of the Delirium Diagnostic Tool-Provisional (K-DDT-Pro)

Objective The Delirium Diagnostic Tool-Provisional (DDT-Pro) was designed to detect the presence and severity of delirium briefly and objectively regardless of psychiatric expertise. We translated the DDT-Pro into Korean and validated it in elderly Korean patients. Methods To validate the translation and evaluate inter-rater reliability, a psychiatric trainee and a research nurse independently assessed the same patients referred to the Department of Psychiatry. The results were compared with the reference evaluations performed by a psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Results We enrolled 42 elderly patients. The Cronbach’s alpha coefficient were 0.839 (the trainee), 0.822 (the nurse). The Cohen’s weighted κ between the trainee and nurse, ranged from 0.555±0.102 to 0.776±0.062. The Pearson correlation coefficients (Korean version of the DDT-Pro [K-DDT-Pro] and Korean version of the Delirium Rating Scale-Revised-98 [DRS-R98-K] total score) were γ=-0.850 (the trainee), and γ=-0.821 (the nurse). The areas under the ROC curves (AUCs) were 0.974 (the trainee) and 0.893 (the nurse). Conclusion The K-DDT-Pro exhibited high internal consistency and relatively substantial inter-rater reliability. The correlation with the DRS-R98-K was strongly negative. The accuracy of the K-DDT-Pro was excellent, regardless of expertise. In conclusion, the K-DDT-Pro is a brief and simple tool that usefully screens for delirium in elderly patients.     

患儿术后谵妄非药物管理的最佳证据总结

目的 检索和总结患儿术后谵妄非药物管理的最佳证据,为提高医护人员对其的管理质量提供循证依据.方法 计算机检索UpToDate、BMJ Best Practice、Cochrane Library、围手术期注册护士协会指南库、乔安娜布里格斯研究所循征卫生保健中心数据库、美国指南网、国际指南网、欧洲儿科麻醉协会网站、美国麻...     

ERAS理念对PFNA治疗老年股骨转子间骨折术后谵妄和预后的影响

目的探讨加速康复外科(ERAS)理念指导下股骨近端防旋髓内钉(PFNA)固定手术治疗老年股骨转子间骨折,对术后谵妄的发生及治疗效果的影响。方法选择2018年1月至2020年1月在沈阳医学院附属中心医院就诊并行PFNA固定手术治疗的64例老年股骨转子间骨折患者。采用随机数字表法,分为试验组与对照组,每组32例。试验组围手术期间采用ERAS理念指导,对照组采用传统理念指导。比较两组患者谵妄发生率、疼痛评分、并发症发生率、卧床时间、住院费用、住院时间及术后1年Harris评分的差异。结果试验组患者术后1周谵妄发生率为12.50%,术后1周VAS评分为(3.09±0.93)分,术后并发症发生率为12.50%,均低于对照组,差异有统计学意义(P<0.05)。试验组患者平均卧床时间为(2.59±0.67)d,平均住院时间为(9.97±1.94)d,平均住院费用为(0.74±0.06)万元,均低于对照组,差异有统计学意义(P<0.05)。试验组患者术后1年Harris评分优良率为84.38%,高于对照组,差异有统计学意义(P<0.05)。结论 ERAS理念应用于PFNA治疗的老年股...     

Poor outcomes of delirium in the intensive care units are amplified by increasing age: A retrospective cohort study

BACKGROUND: Delirium in patients in intensive care units(ICUs) is an acute disturbance and fluctuation of cognition and consciousness. Though increasing age has been found to be related to ICU delirium, there is limited evidence of the effect of age on delirium outcomes. The aim of this study is to investigate the relationship between age categories and outcomes among ICU delirium patients.METHODS: Data were extracted from the electronic ICU(e ICU) Collaborative Research Database with records from 3,931 patients with delirium. Patients were classified into non-aged(<65 years), youngold(65–74 years), middle-old(75–84 years), and very-old(≥85 years) groups. A Cox regression model was built to examine the role of age in death in ICU and in hospital after controlling covariates. RESULTS: The sample included 1,667(42.4%) non-aged, 891(22.7%) young-old, 848(21.6%) middle-old, and 525(13.3%) very-old patients. The ICU mortality rate was 8.3% and the hospital mortality rate was 15.4%. Compared with the non-aged group, the elderly patients(≥65 yeras) had higher mortality at ICU discharge(χ2=13.726, P=0.001) and hospital discharge(χ2=56.347, P<0.001). The Cox regression analysis showed that age was an independent risk factor for death at ICU discharge(hazard ratio [HR]=1.502, 1.675, 1.840, 95% confidence interval [CI] 1.138–1.983, 1.250–2.244, 1.260–2.687;P=0.004, 0.001, 0.002 for the young-, middle-and very-old group, respectively) as well as death at hospital discharge(HR=1.801, 2.036, 2.642, 95% CI 1.454–2.230, 1.638–2.530, 2.047–3.409;all P<0.001).CONCLUSIONS: The risks of death in the ICU and hospital increase with age among delirious patients.