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Query: UMLS:C0009676 (confusion)
 21,692 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Delirium in the intensive care unit is a serious problem that has recently attracted much attention. User-friendly and reliable tools, such as the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), offer the clinician the opportunity to identify delirium in patients better. Diagnosis of delirium in a critical care population is often a difficult task because classical psychiatric evaluation is impossible for a number of reasons. The CAM-ICU makes use of nonverbal assessments to evaluate the cardinal features of delirium (i.e. acute or fluctuating onset, inattention, disorganized thinking and altered level of consciousness). Its development for use in the critical care setting represents a significant advance that could lead to better care for such patients.
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PMID:Delirium in critically ill patients. 1213 71

This review describes the characteristics and evaluates the psychometric qualities (process of testing and the results) of thirteen delirium instruments. Delirium instruments differ in goal (diagnosis, screening symptoms severity), type of data on which the rating is based (observation, interview or test of patients), the rater qualities required, the number of items and the rating time needed. Most instruments are based on the Diagnostic Statistical Manual criteria and measure signs and symptoms as described by these criteria. Reliability of delirium instruments shows good to excellent results. Validity of the delirium instruments is overall fair to good. Differences exist, however, in the degree to which reliability and validity were tested and the quality of the testing procedures. Most instruments are not further developed and tested after the initial study. Conclusion of this review is that most delirium instruments show promising results but need further testing. Testing is needed in different samples and on a broader range of aspects with regard to reliability and validity. Much emphasis should be given to the procedures used in future studies. Ease of use is an aspect of testing that is so far not taken into account, however, is important for use of instruments in clinical practice. A minority of instruments can be seen as "ready to use" instruments meaning well tested in more than one sample with good results. For screening high-risk, elderly hospitalized patients, the NEECHAM Confusion Scale and the Delirium Observation Screening Scale are recommended. The Confusion Assessment Method is the best diagnostic tool and the Delirium Rating Scale shows best results in screening symptom severity. For ICU patients the CAM-ICU is recommended. The MDAS is well tested in cancer patients. Nurses, however, have not yet tested the DRS and MDAS in practice.
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PMID:The measurement of delirium: review of scales. 1465 74

We present a brief review of epithelioid trophoblastic tumor, a rare trophoblastic neoplasm derived from chorionic-type intermediate trophoblastic cells that typically presents in reproductive-age women between 1 and 18 years following a previous gestation. Histologic features include a nodular growth pattern of monomorphic, epithelioid cells within a hyaline matrix. Areas of necrosis and mitotic activity (0-9 mitoses per 10 high-power fields) are additional features of this neoplasm. Positive immunostaining for p63 and cytokeratin, frequent location in the lower uterine segment and endocervix, as well as the epithelioid appearance can lead to confusion with squamous cell carcinoma. Inhibin-alpha is typically expressed, as well as focal, more variable expression of other trophoblastic markers including beta-human chorionic gonadotropin, human placental lactogen, placental alkaline phosphate, and Mel-CAM (CD148). The clinical behavior of this rare form of gestational trophoblastic disease is difficult to predict. Although most cases follow a benign course following resection, there is a potential for metastatic disease.
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PMID:Epithelioid trophoblastic tumor: review of a rare neoplasm of the chorionic-type intermediate trophoblast. 1714 67

This study was designed to evaluate the reliability and validity of the Chinese version of the diagnostic and statistical manual (DSM) of mental disorders written by Ely et al as a confusion assessment method for the intensive care unit (CAM-ICU) for diagnosing delirium. Purposive sampling was used to recruit 31 patients in a southern medical center ICU. Data were collected by two interviewers who used CAM-ICU to test inter-rater consistency. DSM served as the delirium diagnosis standard to test CAM-ICU validity and calculate sensitivity and specificity. The inter-rater reliability Kappa value for CAM-ICU applied to delirium diagnosis was .48 (p< .01). The validity PABAK value was .48 (p< .01) and McNemar's test value was p = .72. The sensitivity achieved by the two interviewers was 89%, versus 96% for the doctor. The CAM-ICU is a method that helps ICU nursing staff to detect occurrences of delirium rapidly and easily, permitting early intervention treatment with fewer complications.
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PMID:[Evaluation of the reliability and validity of the Chinese version of the confusion assessment method for the intensive care unit]. 1765 27

Once analgesia is assured, sedation has special relevance in the critically ill ventilated patient's global treatment. Sedatives should be adjusted to individual needs, by administering minimal effective doses to achieve the AIM. This aim must be clearly identified, defined at the beginning of the treatment and revised on a regular basis, ideally at least once per shift. Sedation strategies should foresee the different needs throughout the day within dynamic sedation concept framework. Required sedation depth depends on the patient's psychological characteristics, foreseen evolution and patient tolerance to the support techniques used in treatment. Sedation monitoring permits identification and correction of under- or over-sedation, either of which could negatively influence critically ill patient evolution. The over-sedation concept must be applied to all situations where patients receive more sedation than required. This Spanish Society of Critical Care Medicine's Analgesia and Sedation Work Group recommends the Richmond Agitation Sedation Scale, due to its interrelationship with the Confusion Assessment Method Scale (CAM-ICU), for sedation monitoring in patients under light sedation while it recommends bispectral index sedation monitoring in patients under deep sedation. In the latter case, maintaining values under 40 on the bispectral index doesn't produce any benefits except in patients who require a maximum decrease in neuronal metabolism. To avoid recall phenomena, bispectral monitoring is highly advisable in patients treated with neuromuscular blockers.
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PMID:[Monitoring of sedation]. 1840 38

We aimed to identify fall incidence, predictors and characteristics and to investigate hospitalization outcomes for elderly inpatients. In 340 men and 280 women consecutively admitted to a Acute Geriatric Ward of a University Hospital the following variables were evaluated: demographics, clinical history, main disease responsible for hospitalization, comorbidity (cumulative illness rating scale: CIRS 1 and 2) gait and balance deficit (Tinetti's scales), cognition/function (short portable mental status questionnaire: SPMSQ); activities of daily living: ADL; instrumental activities of daily living: IADL; delirium (confusion assessment method: CAM), drugs administered during hospitalization. Overall 80 falls occurred in 70 patients. The incidence rate of falls was of 6.0 per 1000 patient-days with 2.0 falls per bed/year. Age (relative risk=RR=1.050; 95% confidence interval=CI=1.013-1.087), delirium (RR=3.577; 95% CI 1.096-11.672), diabetes (RR=5.913; 95% CI 1.693-20.644), balance deficit (RR=0.914; 95% CI 0.861-0.970) and polypharmacy (RR=1.226; 95% CI 1.122-1.340) were independently predictive of falling. Fallers had a prolonged length of stay (LOS) (35.5+/-47.8 days vs. 23.2+/-27.2; p=0.01) and more frequent nursing home placements (12.9% vs.5.6%; p<0.005). The knowledge of falling predictors might help in planning specific preventive strategies to improve the patients' global health status and to reduce the costs of medical care.
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PMID:Predictors of falls and hospitalization outcomes in elderly patients admitted to an acute geriatric unit. 1867 24

The confusion assessment method for the intensive care unit (CAM-ICU) is a tool for screening for delirium in ventilated patients that with proper training can be administered quickly by staff nurses in the ICU. Unrecognized delirium can have a range of negative consequences, and in the elderly patients, it may be the first sign of an acute illness that, if left untreated, could result in death. Appropriate and early recognition is therefore imperative. Training staff to use the CAM-ICU requires not only a basic understanding of delirium and a firm orientation to the tool's features but also some preparatory decisions about tool usage and a defined approach to integrate the tool into the physical assessment process. Preparatory decisions include (1) how the tool will be used, (2) defining the process for identifying and recording baseline mental status, and (3) defining how documentation will occur. On the basis of the experience of teaching this tool to staff nurses, a 6-step process is explicated to facilitate integration: (1) putting it in context, (2) defining the features, (3) talking about tough cases, (4) doing the assessment, (5) documenting the assessment, and (6) continuing to discuss.
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PMID:Teaching staff nurses the CAM-ICU for delirium screening. 1930 78

The article presents the clinical picture of delirium characterized with acute, fluctuating altered levels of consciousness, inattention and cognitive function disorders. The article is comprised the most popular assessment scales for detecting (CAM - Confusion Assessment Method) and monitoring the course of delirium (DRS-R-98: Delirium Rating Scale-Revised-98; DOM: Delirium-O-Meter). The scales mentioned above contain unequivocally defined rating criteria of the patient's clinical state. The article mentions scientific studies concerning predisposing and precipitating factors for delirium such as age, severity of illnesses, cognitive impairment, metabolic and electrolyte disturbances, grouped according to the recommendation grades based on scientific evidence and the opinion of experts. Categories of recommendation of possible therapeutic intervention are presented with special emphasis being put on interventions that are always beneficial, useful, successful and safe. Moreover, recommendable pharmacological treatment methods (haloperidol, new antipsychotic drugs) as well as non-pharmacological ones (comprising routine screening of cognitive functions, comprehensive medical and nursing care) are described.
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PMID:[Delirium in the light of the most recent guidelines]. 1970 8

Sertoli cell tumor is a potential histologic mimic of other tumors, such as seminoma due to similar histology and overlapping clinical presentation. Sclerosing Sertoli cell tumor is a rare sex cord stromal tumor variant, with 16 cases reported in the English literature. We present an unusual case of sclerosing Sertoli cell tumor in a 33-year-old Caucasian male, which was negative or weakly reactive using immunohistochemical markers typically positive in Sertoli cell tumors. The tumor was positive for cytokeratin AE1/AE3, CAM 5.2, vimentin, CD56, CK8, synaptophysin and S100, and negative for inhibin, calretinin, WT1, CD99, CD117, CK5/6, CK7, chromogranin A, placental alkaline phosphatase, neuron specific enolase, D2-40, smooth muscle actin, Melan-A, epithelial membrane antigen and carbonic anhydrase IX. This is the second reported case of a Sertoli cell tumor with reactivity limited to neuroendocrine markers and the first such case of the sclerosing variant. A literature review of sclerosing Sertoli cell tumor, including English and non-English literature, is described. Our case highlights that expected immunohistochemical markers may be negative, and awareness of antigenically unreactive tumors is needed to avoid confusion between Sertoli cell tumor and other entities.
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PMID:Sclerosing Sertoli cell tumor without expression of typical sex cord stromal tumor markers: case report and literature review. 2222 90

Delirium affects up to 80% of critically ill patients and negatively influences patient outcome. Consensus guidelines advocate that a validated screening tool like the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) or the Intensive Care Delirium Screening Checklist (ICDSC) be used to identify delirium rather than a subjective approach. The CAM-ICU and ICDSC have the most rigorous psychometric data to support their use. The differences between these two instruments are far less important to the outcome of patients than the regular and reliable use of either in routine ICU care. Implementation of a large-scale delirium screening effort is both feasible and sustainable and should be accompanied by both didactic and bedside education. An ICU clinical road map should be used on a daily basis that promotes delirium assessment, establishes a targeted sedation goal and defines the analgesic/sedative regimen that is best suited to maintain patient comfort, prevent delirium and promote wakefulness.
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PMID:Optimising the recognition of delirium in the intensive care unit. 2304 Feb 88


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