Publications by authors named "Margaret Puelle"
Background: Postoperative delirium and postoperative cognitive dysfunction share risk factors and may co-occur, but their relationship is not well established. The primary goals of this study were to describe the prevalence of postoperative cognitive dysfunction and to investigate its association with in-hospital delirium. The authors hypothesized that delirium would be a significant risk factor for postoperative cognitive dysfunction during follow-up.
View Article and Find Full Text PDFObjectives: To determine whether an interprofessional intervention would improve the use and timing of a geriatric consultation on a hospitalist service.
Design: Difference-in-differences (DID), which measures the difference in improvement over time between intervention and control team patients attributable to the intervention.
Setting: 1,000-bed U.
Despite known benefits, palliative care (PC) consultation for hospitalized patients remains underutilized. The objective was to improve frequency and timeliness of appropriate inpatient PC consultation. On 2 of 11 hospitalist teams, a PC representative attended discharge rounds twice a week.
View Article and Find Full Text PDFElectronic medical records (EMRs) offer the opportunity to streamline the search for patients with possible delirium. The purpose of the current study was to identify words and phrases commonly noted in charts of patients with delirium. The current study included 67 patients (nested within a cohort study of 300 patients) ages 70 and older undergoing major elective surgery with evidence of confusion in their medical charts.
View Article and Find Full Text PDFObjectives: To examine baseline (preoperative) neuropsychological test performance in a cohort of elderly individuals undergoing elective surgery and the association between specific neuropsychological domains and postoperative delirium.
Design: Ongoing prospective cohort study.
Setting: Successful Aging after Elective Surgery Study.
Importance: Delirium, an acute disorder with high morbidity and mortality, is often preventable through multicomponent nonpharmacological strategies. The efficacy of these strategies for preventing subsequent adverse outcomes has been limited to small studies to date.
Objective: To evaluate available evidence on multicomponent nonpharmacological delirium interventions in reducing incident delirium and preventing poor outcomes associated with delirium.
Background: Preoperative pain and depression predispose patients to delirium. Our goal was to determine whether pain and depressive symptoms interact to increase delirium risk.
Methods: We enrolled 459 persons without dementia aged ≥70 years scheduled for elective orthopedic surgery.
Background: Quantifying the severity of delirium is essential to advancing clinical care by improved understanding of delirium effect, prognosis, pathophysiology, and response to treatment.
Objective: To develop and validate a new delirium severity measure (CAM-S) based on the Confusion Assessment Method.
Design: Validation analysis in 2 independent cohorts.
The National Institute for Health and Clinical Excellence (NICE) in the United Kingdom developed guidelines for the diagnosis, prevention, and management of delirium in July 2010 that included 10 recommendations for delirium prevention. The Hospital Elder Life Program (HELP) is a targeted multicomponent strategy that has proven effective and cost-effective at preventing functional and cognitive decline in hospitalized older persons. HELP provided much of the basis for seven of the NICE recommendations.
View Article and Find Full Text PDFObjectives: To compare chart- and interview-based methods for identification of delirium.
Design: Prospective cohort study.
Setting: Two academic medical centers.