Delirium in the United States: Results From the 2023 Cross-Sectional World Delirium Awareness Day Prevalence Study.

Background: Delirium is an acute brain dysfunction associated with an increased risk of mortality and future dementia.

Objectives: To describe the prevalence of clinically documented delirium in the United States on World Delirium Awareness Day 2023.

Methods: This is a sub-analysis of a prospective, cross-sectional, online, international survey.

Relationship between in-hospital angiotensin converting enzyme inhibitors and Angiotensin receptor blockers administration and delirium in the cardiac ICU.

Objectives: Delirium may be associated with neuroinflammation and reduced blood-brain barrier (BBB) stability. ACE Inhibitors (ACEIs) and Angiotensin Receptor Blockers (ARBs) reduce neuroinflammation and stabilize the BBB, thus slowing the progression of memory loss in patients with dementia. This study evaluated the effect of these medications on delirium prevalence.

Supervised deep learning with vision transformer predicts delirium using limited lead EEG.

As many as 80% of critically ill patients develop delirium increasing the need for institutionalization and higher morbidity and mortality. Clinicians detect less than 40% of delirium when using a validated screening tool. EEG is the criterion standard but is resource intensive thus not feasible for widespread delirium monitoring.

Impact of risk for severe COVID-19 illness on physical activity during the pandemic.

Background: Precautions to mitigate spread of COVID-19 such as the closing of exercise facilities impacted physical activity behaviors. Varied risks for severe COVID-19 may have influenced participation in regular physical activity to maintain precautions.

Objective: Describe differences in the amount and intensity of physical activity between adults at high versus low risk for severe COVID-19 illness during the pandemic.

Relationship between angiotensin-converting enzyme inhibitors and angiotensin receptor blockers prescribing and delirium in the ICU-A secondary analysis.

Background: Studies suggest Angiotensin-Converting Enzyme inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) may slow the decline of memory function in individuals with mild to moderate Alzheimer's disease by regulating migroglial activation and oxidative stress within the brain's reticular activating system. Therefore, we evaluated the relationship between delirium prevalence and being prescribed ACEI and ARB in participants admitted to the intensive care units (ICU).

Methods: A secondary analysis of data from two parallel pragmatic randomized controlled trials was performed.

Delirium Screening of Patients on a Neuroscience Step-Down Unit.

This project aimed to identify patients who had experienced a stroke and were at risk for delirium earlier, and implement evidence-based protocols to reduce overall length of stay and mortality. Nurses were motivated to perform screening and implement strategies that benefit patients who had experienced acute stroke. Results suggest early identification and treatment of delirium, use of prevention strategies, and treatment of the underlying etiology can improve patient outcomes and reduce cost of care.

Nonpharmacological Cognitive Impairment Prevention Interventions in Older Adults Undergoing Cardiac Surgery: A Systematic Review.

Background: More than 1 million individuals undergo cardiothoracic surgery for coronary artery bypass graft or valve repair/replacement annually in the United States. There is an increased risk of developing serious cognitive impairment post cardiothoracic surgery. Pharmacological interventions and surgical techniques were associated with improvements in cognitive function in previous systematic reviews.

Minimizing Post-Intensive Care Syndrome to Improve Outcomes for Intensive Care Unit Survivors.

Topic: Post-intensive care syndrome is a collection of symptoms that more than half of patients who survive a critical illness, and their family caregivers, experience after the illness. Those symptoms include weakness/ fatigue, sleep disturbances/insomnia, cognitive dysfunction, posttraumatic stress disorder, other mental health conditions, and a lack of effective coping strategies.

Clinical Relevance: To minimize the risk of a patient developing post-intensive care syndrome, intensive care unit nurses must adopt practices that reduce the severity of disability and optimize patient outcomes.

Rapid Handheld Continuous Electroencephalogram (EEG) Has the Potential to Detect Delirium in Older Adults.

Background: Delirium-related biochemical derangements lead to electrical changes that can be detected in electroencephalographic (EEG) patterns followed by behavioral signs and symptoms. Studies using limited lead EEG show a large difference between patients with and without delirium while discriminating delirium from other causes. Handheld rapid EEG devices may be capable of detecting delirium before symptom onset, thus providing an objective physiological method to detect delirium when it is most amenable to interventions.

Increasing the Effectiveness of Targeted Temperature Management.

Topic: Targeted temperature management and therapeutic hypothermia are essential components of the multimodal approach to caring for compromised patients after cardiac arrest and severe traumatic brain injury.

Clinical Relevance: The continuously evolving science necessitates summation of individual facets and concepts to enhance knowledge and application for optimally delivering care. Targeted temperature management is a complex therapy that requires fine-tuning the most effective interventions to maintain high-quality targeted temperature management and maximize patient outcomes.

Using a Behavioral Response Team on Non-Psychiatric Nursing Units.

Negative behaviors often are directed toward nursing staff in verbal or physical assaults. Nursing staff on non-psychiatric units may not be prepared to manage such situations and need additional support. Behavioral Emergency Response Teams (BERTs) have been effective in supporting nursing staff faced with patients exhibiting these behaviors.

Calming the Agitated Patient: Providing Strategies to Support Clinicians.

Agitation is a symptom of many medical and psychiatric disorders that can manifest along a spectrum of severity. Agitation often delays treatment onset, potentially impacting morbidity and mortality, and may require emergency interventions. Management of acute agitation centers around three main goals: early recognition and treatment of the underlying etiology, rapid control of the behavior, and prevention of harm to the patient and personnel.

Engaging Bedside Nurse in Research and Quality Improvement.

Nurses are expected to participate in research and scholarly inquiry; despite ongoing attempts, the practice-research gap continues to be fraught with significant barriers. System strategies have not addressed concerns at the individual nurse level. Given the implications on quality and safety, focusing on identification of individual nurse strategies should be an important focus of attention for nursing leaders and researchers.

Delirium Tremens in the Older Adult.

Introduction: Caring for patients experiencing alcohol withdrawal syndrome can be challenging. Patients 65 and older are at increased risk for alcohol withdrawal syndrome related complications. The higher prevalence of co-morbidities, including cognitive impairment, longer drinking history and greater sensitivity to alcohol withdrawal syndrome treatment are the result of decreased ability of the brain to adapt to stressors such as illness, trauma, or surgery.

Sedation selection to reduce delirium risk: Why dexmedetomidine may be a better choice.

In 2018, the Society of Critical Care Medicine published the Pain Agitation Delirium Immobility and Sleep Disruption guidelines that recommend protocol assessment-based pain and sedation management. Since the publication of these guidelines, multiple studies and meta-analyses have been conducted comparing sedative options in the Intensive Care Unit (ICU) setting including dexmedetomidine and propofol. Sedatives are on a continuum when it comes to delirium risk.

Fronto-temporal dementia: a case study and strategies and support for caregivers.

Fronto-temporal dementia, also known as fronto-temporal lobular degeneration, is the second most common form of early-onset dementia with a prevalence equal to Alzheimer's dementia. Behavioural variant fronto-temporal dementia primarily involves the frontal and temporal lobes of the brain. Myelination of nerve fibres in these areas allow for highly synchronized action potential timing.

Detecting Delirium Using a Physiologic Monitor.

For the past 2500 years, delirium has been described based on the presence of behavioral symptoms. Each year, as many as 1 in 5 acute care and 80% of critically ill patients develop delirium. The United States spends approximately $164 million annually to combat the associated consequences of delirium.

Methods of identifying delirium: A research protocol.

Delirium is an acute disorder affecting up to 80% of intensive care unit (ICU) patients. It is associated with a 10-fold increase in cognitive impairment, triples the rate of in-hospital mortality, and costs $164 billion annually. Delirium acutely affects attention and global cognitive function with fluctuating symptoms caused by underlying organic etiologies.

Choosing the Right Delirium Assessment Tool.

Delirium is an increasing concern with current combined annual costs for the United States and Europe of approximately $350 billion. Although standardized definitions and diagnostic criteria exist, more than 80% of delirium in the acute care setting is overlooked or misdiagnosed. Delays in identification result in increases in severity and mortality and a reduction in quality of life.

Conducting a Device Feasibility Study.

Feasibility studies are often the first attempt researchers use to test whether a new process or part of a process is practical for use in a clinical setting or a device will provide the desired information. When conducting a device feasibility study there are several unique considerations that must be addressed. This manuscript describes the processes and considerations.

Pathophysiology Review: Seven Neurotransmitters Associated With Delirium.

Delirium affects 70% to 80% of intensive care unit patients and is associated with a 10-fold increase in rates of cognitive impairment at discharge and a 3-fold increase in mortality rates. Estimated costs are $152 billion in Medicare charges annually, 17.5 million inpatient days, and 30-day postdischarge costs of $238 726 per patient.