A pilot trial exploring the use of music in the emergency department and its association with delirium and other clinical outcomes

Emergency Medicine Australasia, Год журнала: 2025, Номер 37(1)

Опубликована: Фев. 1, 2025

Abstract Objective To assess potential feasibility of a targeted music intervention trial in older ED patients and association with clinical outcomes. Methods Prospective pragmatic adults aged ≥65 years the ED, prevalent delirium or increased risk incident delirium, receiving either 2‐h via headphones usual care. The primary outcomes were (i) as assessed by actual use (target 70% offered patients) (ii) delirium‐free patients. Results Among 211 initially screened patients, 44 included. planned randomised controlled proved difficult due to poor adherence, resulting move patient self‐selection routine care intervention. There 19 control (13 delirium) 25 participants (20 delirium); target duration was achieved 17/25 (68%) (8/25 achieving <2 h). those without occurred 1/6 4/5 ( P = 0.08). no between‐group differences terms improved resolved pain scores agitation/sedation (all > 0.1). Conclusions Self‐selected feasible cohort While we likely underpowered detect associations between outcome, collection selected outcome measures feasible; these may be helpful larger scale studies. Exploration barriers facilitators use, well preferred delivery methods, are wider investigations therapy this high‐risk cohort.

Язык: Английский

---

The Italian guideline on diagnosis and treatment of dementia and mild cognitive impairment

Age and Ageing, Год журнала: 2024, Номер 53(11)

Опубликована: Окт. 31, 2024

Abstract Introduction Approximately 2 million people in Italy are currently living with dementia or mild cognitive impairment (MCI), and 4 involved as family members caregivers. Considering the significant impact of dementia, Italian Ministry Health entrusted National Institute (Istituto Superiore di Sanità) development a guideline within Guideline System (Sistema Nazionale Linee Guida, SNLG) on diagnosis treatment MCI. The main objective was to provide evidence-based recommendations aimed at reducing variability ensuring appropriateness clinical practices throughout whole care process from identification end life for (PwD) MCI their families/caregivers. Methods GRADE-ADOLOPMENT approach used adopt, adapt update developed by Care Excellence 2018 (NG97). methodology based Methodological Handbook produced SNLG. A multidisciplinary panel 29 experts four representatives members/caregivers discussed approved 47 review questions. Of these, 34 questions were adopted NG97, 13 new questions, including 10 referring Systematic literature reviews performed each question, team methodological qualitatively assessed summarised results included studies GRADE approach. To facilitate implementation dissemination contents this guideline, pathway leaflet dedicated PwD families/caregivers also developed. Results published up November 2023. More than 1000 peer-reviewed publications included, covering following areas: (i) identification, post-diagnostic support; (ii) models coordination; (iii) pharmacological interventions symptoms; (iv) non-pharmacological (v) non-cognitive symptoms, intercurrent illnesses palliative care. 167 practice 39 research recommendations. Commentary Italy’s first addresses diagnosis, Healthcare System. It includes approaches, emphasises tailored interventions, comprehensive assessment, staff training underlines need involve decision-making supporting caregivers entire course disease. Conclusions Structured strategies will be defined Fund Alzheimer other Dementias 2024–2026. An interactive carers already available. updated starting January 2027, but early updates may planned case breakthrough advancements.

Язык: Английский

---

Delirium Prevention and Management in Older Adults in the Emergency Department

Emergency Medicine Clinics of North America, Год журнала: 2025, Номер unknown

Опубликована: Фев. 1, 2025

Язык: Английский

---

Delayed neurological sequelae of carbon monoxide intoxication initially treated as infectious meningo encephalitis

European Journal of Case Reports in Internal Medicine, Год журнала: 2025, Номер unknown

Опубликована: Март 3, 2025

We report the case of a 75-year-old woman admitted to emergency department for confusion, gait disturbances and mutism associated with an inflammatory syndrome occurring 3 weeks after acute carbon monoxide intoxication. The main hypothesis upon arrival was infectious meningoencephalitis, patient put on acyclovir antibiotics in meningeal doses. After short stay intensive care, patient's condition did not improve, revaluation her history imaging studies led diagnosis post-interval secondary intoxication 3-week asymptomatic period. Post-interval is complication poorly known clinicians, manifesting as neuropsychiatric disorders despite initial period improvement. Repeated magnetic resonance imaging, conjunction compatible clinical findings, allow be made. No neurological improved noted 6 months follow-up. little-known clinicians should considered any presenting symptom-free interval following intoxication.Repeated at distance from onset (more than month) helps distinguish it cytotoxic oedema which may initially confused.The prognosis poor no proven effective treatment date.

Язык: Английский

---

Detection and differentiation of undiagnosed dementia in the emergency department: A pilot referral pathway

Alzheimer s & Dementia, Год журнала: 2025, Номер 21(4)

Опубликована: Апрель 1, 2025

Abstract INTRODUCTION Cognitive impairment (CI) is under‐recognized by emergency department (ED) clinicians, and processes for cognitive screening outpatient referrals are limited. METHODS This pilot study tested the feasibility of ED clinicians referring older adult patients identified through CI direct clinician referral evaluation. Telephone interviews chart reviews were conducted on 100 about their care, function, status. RESULTS A total 9359 screened memory thinking problems, with 650 (6.9%) reporting such issues. discharged referred evaluation, consisting 37 from 67 referral. Of these, 26 (26.0%) scheduled 19 (19.0%) completed evaluations within days. Fifteen (78.9%) formally diagnosed dementia, CI, or loss. DISCUSSION able to identify appropriately refer Future studies can improve rates solutions addressing detection follow‐up challenges. Highlights Screening evaluation feasible in department. Nearly 80% who impairment, including probable dementia Alzheimer's disease. Significant gaps barriers remain maintaining initial department, less than one five completing evaluations.

Язык: Английский

---

Risk factors and risk stratification approaches for delirium screening: A Geriatric Emergency Department Guidelines 2.0 systematic review

Academic Emergency Medicine, Год журнала: 2024, Номер unknown

Опубликована: Июнь 7, 2024

Abstract Objective As part of the Geriatric Emergency Department (ED) Guidelines 2.0 project, we conducted a systematic review to find risk factors or stratification approaches that can be used identify subsets older adults who may benefit from targeted ED delirium screening. Methods An electronic search strategy was developed with medical librarian, in April 2021 and November 2022. Full‐text studies patients ≥65 years assessed for prevalent were included. Risk bias using McMaster University Clarity Group tool. Outcomes measures pertained method used. Due heterogeneity patient populations, methods, outcomes, meta‐analysis not conducted. Results Our yielded 1878 unique citations, which 13 Six novel score without evaluation specific factors, six evaluated only, one study an existing nondelirium association delirium. The most common factor history dementia, odds ratios ranging 3.3 (95% confidence interval [CI] 1.2–8.9) 18.33 CI 8.08–43.64). Other consistently associated increased included age, use certain medications (such as antipsychotics, antidepressants, opioids, among others), functional impairments. Of scores, reported area under curve ranged 0.77 0.90. Only two potential impact tool on screening burden. Conclusions There is significant heterogeneity, but results suggest such age over 75, impairments should are at highest No implementation patient‐oriented outcomes.

Язык: Английский

---

High-risk factors for delirium in severely ill patients and the application of emotional nursing combined with pain nursing

World Journal of Psychiatry, Год журнала: 2024, Номер 14(7), С. 1027 - 1033

Опубликована: Июль 11, 2024

BACKGROUND Delirium is a neuropsychiatric syndrome characterized by acute disturbances of consciousness with rapid onset, progression, obvious fluctuations, and preventable, reversible, other characteristics. Patients delirium in the intensive care unit (ICU) are often missed or misdiagnosed do not receive adequate attention. AIM To analyze risk factors for ICU patients explore application emotional nursing pain management delirium. METHODS General data 301 critically ill were retrospectively collected, including histories (cardiovascular cerebrovascular diseases, hypertension, smoking, alcoholism, diabetes), age, sex, diagnosis, whether surgery was performed, patient origin (emergency/clinic). Additionally, duration sedation, Richmond Agitation Sedation Scale score, combined care, ventilator use duration, vasoactive drug use, drainage tube retention, stay C-reactive protein, procalcitonin, white blood cell count, body temperature, Acute Physiology Chronic Health Evaluation II (APACHE II) Sequential Organ Failure Assessment score recorded within 24 h after admission. assessed according to confusion assessment method ICU, univariate multivariate logistic regression analyses performed identify patients. RESULTS Univariate analysis on potential associated The results showed that 16 closely related delirium, history diabetes, origin. Multivariate revealed no emergency source, surgery, long smoking history, high APACHE independent CONCLUSION diabetes and/or postoperative patients, those admission need flexible visiting modes, early intervention reduce incidence.

Язык: Английский

---

Delirium prevalence in emergency department patients: A systematic review and meta‐analysis

Nursing in Critical Care, Год журнала: 2024, Номер 29(6), С. 1215 - 1223

Опубликована: Авг. 13, 2024

Delirium is a common acute mental disorder, and its adverse outcomes often cause distress to both patients their families. Despite prevalence in treated emergency departments, delirium frequently overlooked.

Язык: Английский

---

Outcomes of Older Adults With Delirium Discharged From the Emergency Department

Annals of Emergency Medicine, Год журнала: 2025, Номер unknown

Опубликована: Март 1, 2025

Язык: Английский

---

Enhancing healthcare access for an older population: The age‐friendly emergency department

Journal of the American College of Emergency Physicians Open, Год журнала: 2024, Номер 5(3)

Опубликована: Май 8, 2024

Abstract Healthcare systems face significant challenges in meeting the unique needs of older adults, particularly acute setting. Age‐friendly healthcare is a comprehensive approach using 4Ms framework—what matters, medications, mentation, and mobility—to ensure that settings are responsive to patients. The Age‐Friendly Emergency Department (AFED) crucial component holistic age‐friendly health system. Our objective provide an overview AFED model, its core principles, benefits adults clinicians. optimizes delivery emergency care by integrating age‐specific considerations into various aspects (1) ED physical infrastructure, (2) clinical policies, (3) transitions. Physical infrastructure incorporates environmental modifications enhance patient safety, including adequate lighting, nonslip flooring, devices for sensory ambulatory impairment. Clinical policies address physiological, cognitive, psychosocial while preserving focus on issues. Care transitions include communication involving community partners case management services. prioritizes collaboration between interdisciplinary team members (ED clinicians, geriatric specialists, nurses, physical/occupational therapists, social workers). By adopting approach, EDs have potential improve patient‐centered outcomes, reduce adverse events hospitalizations, functional recovery. Moreover, clinicians benefit from model through increased satisfaction, multidisciplinary support, enhanced training care. Policymakers, administrators, must collaborate standardize guidelines, barriers AFEDs, promote adoption practices ED.

Язык: Английский

---