The Delphi Delirium Management Algorithms. A practical tool for clinicians, the result of a modified Delphi expert consensus approach.

Delirium is common in hospitalised patients, and there is currently no specific treatment. Identifying and treating underlying somatic causes of delirium is the first priority once delirium is diagnosed. Several international guidelines provide clinicians with an evidence-based approach to screening, diagnosis and symptomatic treatment.

Time course of optic nerve sheath dilation: In vitro response characteristics to controlled pressure elevations.

Background: Optic nerve sheath (ONS) dilation indicates intracranial pressure elevation under clinical conditions but limited data exist with regard to the dynamics of sheath expansion.

Objective: To assess the time course of ONS widening and its stability under controlled pressure conditions in vitro.

Methods: Pre-defined pressure steps up to 65 mmHg were applied to the perineural space of ex-vivo human optic nerves (n = 16).

Optic Nerve Sheath Viscoelastic Properties: Re-Examination of Biomechanical Behavior and Clinical Implications.

Background: Meta-analyses show a variable relationship between optic nerve sheath diameter (ONSD) and the presence of raised intracranial pressure (ICP). Because optic nerve sheath (ONS) tissue can be deformed, it is possible that ONSD reflects not only the current ICP but also prior deforming biomechanical exposures. In this post hoc analysis of two published data sets, we characterize ONS Young's modulus (E, mechanical stress per unit of strain) and calculate threshold pressure for plastic deformation.

Delirium on stroke units: a prospective, multicentric quality-improvement project.

Background: Post-stroke delirium (POD) in patients on stroke units (SU) is associated with an increased risk for complications and poorer clinical outcome. The objective was to reduce the severity of POD by implementing an interprofessional delirium-management.

Methods: Multicentric quality-improvement project on five SU implementing a delirium-management with pre/post-comparison.

[Disorientation and delirium assessment : A secondary analysis of a prospective, observational study].

Disorientation may present as a warning sign of developing delirium. The most commonly used delirium assessment tool in Germany, the Confusion Assessment Method for Intensive Care Unit (CAM-ICU), does not rate "disorientation", since intubated patients cannot communicate verbally. However, the majority of German ICU patients are not orally intubated, so they could be examined for their orientation.

[Pitfalls in the diagnosis of delirium].

Background: The diagnosis of delirium is challenging and requires precise definitions in both clinical routine and in studies.

Aim: To point out various pitfalls in the clinical diagnosis of delirium and discuss solutions.

Methods: Review.

Coma and cerebral imaging.

The clinical sign of coma is a common feature in critical care medicine. However, little information has been put forth on the correlations between coma and cerebral imaging methods. The purpose of the article is to compile the available information derived from various imaging methods and placing it in a context of clinical knowledge of coma and related states.

Optic disc edema in an astronaut after repeat long-duration space flight.

Background: A number of ophthalmic findings including optic disc edema, globe flattening, and choroidal folds have been observed in several astronauts after long-duration space flights. The authors report the first astronaut with previously documented postflight ophthalmic abnormalities who developed new pathological changes after a repeat long-duration mission.

Methods: A case study of an astronaut with 2 long-duration (6 months) exposures to microgravity.

Persistent intrathecal antibody synthesis 15 years after recovering from anti-N-methyl-D-aspartate receptor encephalitis.

Background: Anti- N-methyl-D-aspartate receptor (NMDAR) encephalitis is a severe autoimmune disorder characterized by high intrathecal antibody synthesis. Little is known about the long-term follow-up of the cerebrospinal fluid antibody status.

Objective: To describe persistent intrathecal antibody synthesis in a clinically healthy person 15 years after recovering from anti-NMDAR encephalitis.

Vivianite precipitation and phosphate sorption following iron reduction in anoxic soils.

Phosphorus retention in lowland soils depends on redox conditions. The aim of this study was to evaluate how the Fe(III) reduction degree affects phosphate adsorption and precipitation. Two similarly P-saturated, ferric Fe-rich lowland soils, a sandy and a peat soil, were incubated under anaerobic conditions.

Dependence of the optic nerve sheath diameter on acutely applied subarachnoidal pressure - an experimental ultrasound study.

Purpose: To determine the distensibility and elastic characteristics of the optic nerve sheath for development of a basic understanding of ultrasound studies aimed to measure optic nerve sheath diameter (ONSD) for detection of acutely elevated intracranial pressure (ICP).

Methods: Isolated human optic nerves preparations obtained from autopsies were submitted to predefined pressure alterations, and consecutive changes in ONSD were measured by B-scan ultrasound under defined conditions.

Results: Following submission to pressure, the diameter of the nerve sheath increased up to 140% of its baseline value.

What determines length of stay after total hip and knee arthroplasty? A nationwide study in Denmark.

Introduction: The goal of this study was (1) to identify logistical and clinical areas of importance for length of stay (LOS) by identifying departments with short and long LOS and to evaluate their set-up; and (2) to evaluate patient satisfaction in relation to LOS.

Materials And Methods: Based on the National Register on Patients in 2004 on LOS following total hip and knee arthroplasty (THA and TKA), departments with short and long LOS were identified. The three departments with the shortest and the three departments with the longest postoperative hospital stay were chosen for evaluation.

Morphometry of the retrobulbar human optic nerve: comparison between conventional sonography and ultrafast magnetic resonance sequences.

Purpose: To compare different methods for quantification of optic nerve and nerve sheath diameter. To apply a novel magnetic resonance protocol using half-Fourier acquired single-shot turbo spin-echo (HASTE) sequences to analyze optic nerve dimensions.

Methods: Measurements were taken in right eyes of 33 subjects whose median age was 25 years.

[Accelerated versus conventional hospital stay in total hip and knee arthroplasty III: patient satisfaction].

Introduction: The goal of this study was to evaluate patient satisfaction with the hospital stay in relation to the length of stay for patients operated on with primary total hip- and knee-arthroplasty (THA and TKA).

Materials And Methods: According to the National Register on Patients, the three departments with the shortest and the three departments with the longest postoperative hospital stay at the end of 2003 were chosen for evaluation. The patients, operated on with THA or TKA from September 2004 to April 2005, from the selected departments answered a questionnaire regarding satisfaction with elected parts of their stay, co-morbidity, sex and age.

[Accelerated versus conventional hospital stay in total hip and knee arthroplasty II: organizational and clinical differences].

Introduction: The goal of this study was to evaluate hospital stays for patients operated on with primary total hip- and knee-arthroplasty (THA and TKA) in order to identify important logistical and clinical areas for the duration of the hospital stay.

Materials And Methods: According to the National Register on Patients, the three departments with the shortest and the three departments with the longest postoperative hospital stay at the end of 2003 were chosen for evaluation. This took place from late 2004 to mid 2005, and all written material and 25 journals from each department were evaluated, and interviews with the heads of the departments as well as the staff were conducted.

[Length of stay in total hip and knee arthroplasty in Danmark I: volume, morbidity, mortality and resource utilization. A national survey in orthopaedic departments in Denmark].

Introduction: The goal of this study was to evaluate hospital stays for patients operated on with primary total hip- and knee-arthroplasty (THA and TKA) in Denmark in order to focus on the relationship between duration of hospital stay, surgical volume, morbidity and mortality and resources.

Materials And Methods: According to the National Register on Patients in 2004 concerning postoperative length of hospital stay, readmissions (30 days) and mortality (30 and 90 days), departments with short and long hospital stay were compared and potential economical savings were estimated if all departments reduced their stays to match the departments with the shortest hospital stay.

Results: Postoperative hospital stay varied between departments from 4.

[Length of stay after primary total hip and knee arthroplasty in Denmark, 2001-2003].

Introduction: We studied length of stay (LOS) after operation with total hip arthroplasty (THA) and total knee arthroplasty (TKA) in Denmark from 2001 to 2003 to determine whether experiences from published accelerated tracks had been implemented in Denmark, resulting in reduced LOS.

Materials And Methods: Through the National Patient Registry (Landspatientregistret) we obtained information on numbers, sex, age and LOS for each year during the period 2001-2003, inclusive.

Results: In 2003 the male-female sex ratios for THA and TKA were 1:1.

Neurological recovery by EEG bursting after resuscitation from cardiac arrest in rats.

Introduction: The return of neurological function during the early period after resuscitation from cardiac arrest (CA) has not been evaluated systematically. We report the temporal analysis of EEG bursting pattern during the very early periods after resuscitation.

Design/method: A balanced group of good and poor outcome animals was selected from a population of rats subjected to either 5 or 7 min of asphyxial cardiac arrest (ACA) on the basis of a single criteria: 24 h neurobehavioral function based on the neurodeficit score (NDS).