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Sample records for delirium uma perspectiva

  1. [Delirium].

    PubMed

    Laurila, Jouko

    2012-01-01

    The pathophysiology of delirium is poorly known and scientific evidence of effective forms of treatment is scarce. Detection of triggering factors and their appropriate treatment still constitute the cornerstone of the treatment. If drug therapy is required, an antipsychotic drug is the first-line treatment. Only in the case of the delirium tremens syndrome benzodiazepine is chosen as the first-line treatment. The use of restraint systems should be avoided. The delirium experience is often gravely traumatizing for the patient, and the psychological aftercare of delirium must therefore not be ignored. PMID:22506327

  2. Delirium

    MedlinePlus

    ... stable, and may last for months or years. Delirium tremens is a serious type of alcohol withdrawal syndrome. It usually happens to people who stop drinking after years of alcohol abuse. People with delirium often, though not always, make a full recovery ...

  3. Delirium

    MedlinePlus

    ... occur together. Delirium starts suddenly and can cause hallucinations. The symptoms may get better or worse, and ... hand, dementia develops slowly and does not cause hallucinations. The symptoms are stable, and may last for ...

  4. Delirium (PDQ)

    MedlinePlus

    ... being hypoactive and hyperactive. Delirium may come and go during the day. The symptoms of delirium usually ... within hours or days and may come and go. Delirium is often temporary and can be treated. ...

  5. POSTOPERATIVE DELIRIUM

    PubMed Central

    Whitlock, Elizabeth L.; Vannucci, Andrea; Avidan, Michael S.

    2013-01-01

    Delirium is an unfortunately common complication seen during the postoperative course. Because of its significant association with physical and cognitive morbidity, clinicians should be aware of evidence-based practices relating to the diagnosis, treatment, and prevention of postoperative delirium. Here, we review selected recent literature pertaining to the epidemiology and impact of the condition, perioperative risk factors for its development and/or exacerbation, and strategies for management of delirium, with additional attention to the intensive care unit population. PMID:21483389

  6. Unmasking delirium.

    PubMed

    Gillis, Angela J; MacDonald, Brenda

    2006-11-01

    The authors use a case study to illustrate the risks of delirium in older adult patients and discuss ways to prevent, identify and manage its occurrence. An estimated 60 to 80 per cent of hospitalized frail older adults experience at least one preventable episode of delirium, often leading to prolonged hospitalization, functional decline, increased morbidity and eventual nursing home placement or death. Delirium is a medical emergency, characterized by acute onset and a fluctuating course that is demonstrated by abrupt changes in mental status and function. It has three categories: hyperactive, hypoactive and mixed. Although delirium is amenable to expert nursing care, it is unrecognized or misdiagnosed in up to 70 per cent of older patients. Delirium results from the interplay of multiple forces associated with illness in the older adult, including drugs, substance abuse, metabolic disturbances, nutritional deficiencies, fluid disturbances, acute trauma or illness, infection and impaired physical or functional ability A proactive strategy for delirium prevention and treatment targets defined risk factors and the management of physiologic factors that precipitate delirium. It includes assessment, therapeutic environmental modification, standardized protocols for physiological interventions and staff education. PMID:17168095

  7. [Delirium tremens].

    PubMed

    Karila, Laurent; Zarmdini, Rim; Lejoyeux, Michel

    2014-12-01

    Delirium tremens (DT) is a specific type of delirium occurring in patients who are in alcohol withdrawal states. It has a high mortality of about 8%. Hence, it is important for clinicians to be able to predict it. Treatment of DT is best achieved by the use of intravenous diazepam administered at frequent intervals while closely monitoring the patient during the procedure. Refractory DT is defined by a high requirement of intravenous diazepam with poor control of withdrawal symptoms. Once the acute phase medically controlled, the patient should be managed for his addiction to alcohol. PMID:25668827

  8. Excited Delirium

    PubMed Central

    Takeuchi, Asia; Ahern, Terence L.; Henderson, Sean O.

    2011-01-01

    Excited (or agitated) delirium is characterized by agitation, aggression, acute distress and sudden death, often in the pre-hospital care setting. It is typically associated with the use of drugs that alter dopamine processing, hyperthermia, and, most notably, sometimes with death of the affected person in the custody of law enforcement. Subjects typically die from cardiopulmonary arrest, although the cause is debated. Unfortunately an adequate treatment plan has yet to be established, in part due to the fact that most patients die before hospital arrival. While there is still much to be discovered about the pathophysiology and treatment, it is hoped that this extensive review will provide both police and medical personnel with the information necessary to recognize and respond appropriately to excited delirium. PMID:21691475

  9. Delirium Research: Where Am I?

    MedlinePlus

    ... please turn JavaScript on. Feature: Delirium Research Where Am I? Past Issues / Fall 2015 Table of Contents ... to do. Read More "Delirium Research" Articles Where Am I? / Digging Into the Mysteries of Delirium / The ...

  10. Delirium Superimposed on Dementia

    PubMed Central

    Flanagan, Nina M.; Fick, Donna M.

    2010-01-01

    Delirium remains a significant risk for hospitalized older adults and has been shown to be a persistent risk posthospitalization as well. Dementia is a risk factor for delirium. The prevalence of delirium superimposed on dementia (DSD) ranges from 22% to 89% in hospitalized and community-dwelling individuals 65 and older. Individuals with DSD have been found to have accelerated decline in cognitive and functional abilities, greater need for institutionalization, greater rehospitalization risk, and increased mortality. The purpose of this article is to define and describe DSD, outline assessment tools for its identification, and provide appropriate nursing interventions. PMID:21544961

  11. POST TRAUMATIC HYPERACTIVE DELIRIUM

    PubMed Central

    Sabhesan, S.; Natarajan, M.

    1990-01-01

    SUMMMARY Hyperactive delirium following head injury is a common problem during the early recovery phase. Twenty-nine patients who evinced hyperactive delirium were prospectively followed up during; their stay In the hospital. Compared with controls, alcohol dependence was significantly more among these patients. Occurrence of delirium was related to the generalized cerebral disturbances; due to diffuse damage in acceleration injuries and due to metabolic or post-seizure disturbances in contact injuries. Follow-up of these patients showed that psychiatric problems were more common among them. PMID:21927482

  12. Post traumatic hyperactive delirium.

    PubMed

    Sabhesan, S; Natarajan, M

    1990-10-01

    Hyperactive delirium following head injury is a common problem during the early recovery phase. Twenty-nine patients who evinced hyperactive delirium were prospectively followed up during; their stay In the hospital. Compared with controls, alcohol dependence was significantly more among these patients. Occurrence of delirium was related to the generalized cerebral disturbances; due to diffuse damage in acceleration injuries and due to metabolic or post-seizure disturbances in contact injuries. Follow-up of these patients showed that psychiatric problems were more common among them. PMID:21927482

  13. Thiamine deficiency and delirium.

    PubMed

    Osiezagha, Kenneth; Ali, Shahid; Freeman, C; Barker, Narviar C; Jabeen, Shagufta; Maitra, Sarbani; Olagbemiro, Yetunde; Richie, William; Bailey, Rahn K

    2013-04-01

    Thiamine is an essential vitamin that plays an important role in cellular production of energy from ingested food and enhances normal neuronal actives. Deficiency of this vitamin leads to a very serious clinical condition known as delirium. Studies performed in the United States and other parts of the world have established the link between thiamine deficiency and delirium. This literature review examines the physiology, pathophysiology, predisposing factors, clinical manifestations (e.g., Wernicke's encephalopathy, Wernicke-Korsakoff syndrome, structural and functional brain injuries) and diagnosis of thiamine deficiency and delirium. Current treatment practices are also discussed that may improve patient outcome, which ultimately may result in a reduction in healthcare costs. PMID:23696956

  14. Valproate Induced Hyperammonemic Delirium

    PubMed Central

    Muraleedharan, Anupama; Gangadhar, Reneega; Das, Soumitra

    2015-01-01

    Sodium valproate induced hyperammonaemic delirium with normal liver function tests is a relatively uncommon adverse effect. It may be mistaken for psychosis or worsening of mania leading to wrong diagnosis and improper management. Plasma ammonia levels should be monitored in all patients developing altered mental status after receiving valproate therapy. This is a case series of hyperammonaemic delirium due to valproate reported to the Department of Pharmacology from Department of Psychiatry over a period of one year. PMID:26816916

  15. Thiamine Deficiency and Delirium

    PubMed Central

    Ali, Shahid; Freeman, C.; Barker, Narviar C.; Jabeen, Shagufta; Maitra, Sarbani; Olagbemiro, Yetunde; Richie, William; Bailey, Rahn K.

    2013-01-01

    Thiamine is an essential vitamin that plays an important role in cellular production of energy from ingested food and enhances normal neuronal actives. Deficiency of this vitamin leads to a very serious clinical condition known as delirium. Studies performed in the United States and other parts of the world have established the link between thiamine deficiency and delirium. This literature review examines the physiology, pathophysiology, predisposing factors, clinical manifestations (e.g., Wernicke’s encephalopathy, Wernicke-Korsakoff syndrome, structural and functional brain injuries) and diagnosis of thiamine deficiency and delirium. Current treatment practices are also discussed that may improve patient outcome, which ultimately may result in a reduction in healthcare costs. PMID:23696956

  16. What to Ask: Delirium

    MedlinePlus

    ... Can these medications be stopped or lowered? Could alcohol be causing my loved one to be confused? Are there things we can do to keep my loved one safe, now that they have a delirium? © 2016 Health in Aging. All rights reserved. Feedback • Site Map • Privacy Policy • ...

  17. Delirium and epilepsy

    PubMed Central

    Kaplan, Peter W.

    2003-01-01

    Delirium (a state of usually reversible global brain disfunction due to toxic, metabolic, or infectious causes) and epilepsy (a condition of spontaneous, recurrent paroxysmal electrical excitation or dysfunction) are becoming increasingly better understood, and hence easier to diagnose and treat. The clinical features of delirium predominantly involve subacute changes in cognition, awareness, and activity levels, behavioral disturbance, clouding consciousness, and sleep-wake cycle changes. In contrast, epilepsy involves the acute interruption of brain function, often with convulsive activity, falls, and injury. States that may share the clinical features of both, such as nonconvulsive epileptic states, are also important: the cause of brain derangement is one of excessive and abnormal electrical brain activity. In such conditions, the clinical manifestations may resemble states of delirium and confusion, and the absence of convulsive clinical activity is significant. Electroencephalography remains the diagnostic test of choice: it is essential for differentiating these two conditions, enabling the distinctly different treatments and epilepsy. Ongoing research and investigation are essential to better understand the abnormal brat mechanisms underlying delirium, and to develop better tools for objective diagnosis. PMID:22034394

  18. [Delirium and delirium management in critically ill patients].

    PubMed

    Kersten, A; Reith, S

    2016-02-01

    Delirium in critically ill patients is a common entity in the intensive care unit (ICU) and is an expression of the cerebral organ dysfunction of the patient. The hallmark signs are disturbed consciousness and cognition in combination with inattentiveness and alterations in perception, which are manifested within a time interval of hours to days during treatment on the ICU. Delirium has been shown to have negative effects on patient short-term and long-term outcome parameters and increases morbidity and mortality. Despite its significance in many cases delirium remains inadequately diagnosed during routine treatment by ICU personnel. There are two validated and easily applicable scales for the standardized diagnosis of delirium: the confusion assessment method for the ICU (CAM-ICU) and the intensive care delirium screening checklist (ICDSC). These are simple to apply by medical as well as non-medical personnel. The therapy of delirium is mostly determined by non-pharmacological measures aiming at early identification, reorientation and mobilization of the patient, improving cerebral activity and establishing adequate wake-sleep cycles. There is only sparse evidence for pharmacological treatment of delirium; however, the choice of sedative agent has a proven effect on the incidence and duration of delirium in the ICU. PMID:26795215

  19. Delirium: Issues for Older Adults

    MedlinePlus

    ... develop a condition of slowly progressive cognitive or mental decline called dementia. Some of the causes of dementia ... institutions. As a person’s cognitive awareness begins to decline they may be ... delirium. To decrease the risk and chances of delirium, try to ...

  20. Delirium at high altitude.

    PubMed

    Basnyat, Buddha

    2002-01-01

    A 35-year-old man on a trek to the Mount Everest region of Nepal presented with a sudden, acute confusional state at an altitude of about 5000 m. Although described at higher altitudes, delirium presenting alone has not been documented at 5000 m or at lower high altitudes. The differential diagnosis which includes acute mountain sickness and high altitude cerebral edema is discussed. Finally, the importance of travelling with a reliable partner and using proper insurance is emphasized in treks to the Himalayas. PMID:12006167

  1. Delirium from the gliocentric perspective.

    PubMed

    Sfera, Adonis; Osorio, Carolina; Price, Amy I; Gradini, Roberto; Cummings, Michael

    2015-01-01

    Delirium is an acute state marked by disturbances in cognition, attention, memory, perception, and sleep-wake cycle which is common in elderly. Others have shown an association between delirium and increased mortality, length of hospitalization, cost, and discharge to extended stay facilities. Until recently it was not known that after an episode of delirium in elderly, there is a 63% probability of developing dementia at 48 months compared to 8% in patients without delirium. Currently there are no preventive therapies for delirium, thus elucidation of cellular and molecular underpinnings of this condition may lead to the development of early interventions and thus prevent permanent cognitive damage. In this article we make the case for the role of glia in the pathophysiology of delirium and describe an astrocyte-dependent central and peripheral cholinergic anti-inflammatory shield which may be disabled by astrocytic pathology, leading to neuroinflammation and delirium. We also touch on the role of glia in information processing and neuroimaging. PMID:26029046

  2. Delirium from the gliocentric perspective

    PubMed Central

    Sfera, Adonis; Osorio, Carolina; Price, Amy I.; Gradini, Roberto; Cummings, Michael

    2015-01-01

    Delirium is an acute state marked by disturbances in cognition, attention, memory, perception, and sleep-wake cycle which is common in elderly. Others have shown an association between delirium and increased mortality, length of hospitalization, cost, and discharge to extended stay facilities. Until recently it was not known that after an episode of delirium in elderly, there is a 63% probability of developing dementia at 48 months compared to 8% in patients without delirium. Currently there are no preventive therapies for delirium, thus elucidation of cellular and molecular underpinnings of this condition may lead to the development of early interventions and thus prevent permanent cognitive damage. In this article we make the case for the role of glia in the pathophysiology of delirium and describe an astrocyte-dependent central and peripheral cholinergic anti-inflammatory shield which may be disabled by astrocytic pathology, leading to neuroinflammation and delirium. We also touch on the role of glia in information processing and neuroimaging. PMID:26029046

  3. [Delirium tremens in accident surgery].

    PubMed

    Hofmann-von Bandel, J

    1983-12-01

    The case histories of 49 patients suffering from delirium tremens in a trauma hospital are described. Particular attention is devoted to two questions: 1. Is delirium tremens always coupled with a low serum K+? It was shown that a low serum K+ in this illness is frequent but not obligatory. 2. Is there a danger that a relapse could ensue by another operation carried out within a relatively short interval after delirium tremens? It was found that as a rule there is no relapse. PMID:6142617

  4. Diagnosis and Treatment of Delirium

    PubMed Central

    Henry, W. Desmond; Mann, Alan M.

    1965-01-01

    Delirium is not a clinical entity but a symptom-complex of manifold etiology. Its presence signifies acute cerebral insufficiency and often represents a medical and/or psychiatric emergency. Though some forms of delirium have distinctive features, the fundamental phenomena are common to all, with clouding of consciousness the sine qua non. The condition has two major components: (1) the basic “acute brain syndrome” and (2) associated release phenomena. Clinicians must first make the vital differentiation between delirium and “functional” mental disorder, then proceed with the elucidation of the underlying diagnosis and the concurrent organization of symptomatic and etiologic treatment. Proper treatment combines management of the acute brain syndrome with general and specific procedures for control of the underlying condition. Dealing with the symptom-complex itself involves the principles and practice of sedation, hydration, and nutrition, nursing care and supportive measures. Provided the basic organic condition is treatable, the prognosis today is usually good. PMID:5844423

  5. Altered Mental Status and Delirium.

    PubMed

    Wilber, Scott T; Ondrejka, Jason E

    2016-08-01

    Older patients who present to the emergency department frequently have acute or chronic alterations of their mental status, including their level of consciousness and cognition. Recognizing both acute and chronic changes in cognition are important for emergency physicians. Delirium is an acute change in attention, awareness, and cognition. Numerous life-threatening conditions can cause delirium; therefore, prompt recognition and treatment are critical. The authors discuss an organized approach that can lead to a prompt diagnosis within the time constraints of the emergency department. PMID:27475019

  6. Excited delirium: A psychiatric review.

    PubMed

    Lipsedge, Maurice

    2016-04-01

    The term 'excited delirium' (ED) is used to explain sudden and unexpected restraint-related deaths. Since the 1990s, ED has often been identified as the principal cause of death in restrained individuals, rather than the restraint procedure itself. Forensic pathologists and psychiatrists attach different meanings to the term delirium. For psychiatrists, delirium is a specific technical term, which implies a grave and potentially life-threatening underlying physical illness. If a patient dies during a bout of delirium, psychiatrists assume that there will be autopsy evidence to demonstrate the primary underlying organic cause. Conversely, pathologists appear to be using the term ED to refer to restraint-related deaths in either highly disturbed cocaine users or psychiatric patients in a state of extreme agitation. In these cases, there is no underlying physical disorder other than a terminal cardiac arrhythmia. As the term ED has different meanings for psychiatrists and for pathologists, it would be helpful for these two professional groups to develop a mutually agreed terminology. PMID:26055153

  7. Delirium Common in Cancer Patients Seen in ER

    MedlinePlus

    ... had mild delirium and four had moderate delirium. Ten percent of the 99 patients older than 65 ... found evidence of delirium in one of every ten patients with advanced cancer who are treated in ...

  8. Delirium: An Emerging Frontier in Management of Critically Ill Children

    PubMed Central

    Smith, Heidi A.B.; Fuchs, D. Catherine; Pandharipande, Pratik P.; Barr, Frederick E.; Ely, E. Wesley

    2009-01-01

    OBJECTIVES Introduce pediatric delirium and provide understanding of acute brain dysfunction with its classification and clinical presentations. Understand how delirium is diagnosed and discuss current modes of delirium diagnosis in the critically ill adult population and translation to pediatrics. Understand the prevalence and prognostic significance of delirium in the adult and pediatric critically ill population. Discuss the pathophysiology of delirium as currently understood. Provide general management guidelines for delirium. PMID:19576533

  9. [New approach to postoperative delirium treatment].

    PubMed

    Pasechnik, I N; Makhlaĭ, A V; Tepliakova, A N; Gubaĭdullin, R R; Sal'nikov, P S; Borisov, A Iu; Berezenko, M N

    2015-01-01

    The efficiency of different drugs for sedation was studied in 51 patients after large abdominal operations complicated by postoperative delirium. Diagnosis of postoperative delirium was established according to CAM-ICU criteria. Dexmedetomidine has demonstrated significantly decreased duration of delirium and hospital stay in intensive care unit in comparison with haloperidol. Besides, patients which received dexmedetomidine preserved opportunity for verbal contact. Also these patients interacted better with department's stuff. PMID:26031955

  10. Delirium and hypovitaminosis D: neuroimaging findings.

    PubMed

    Bourgeois, James A; Hategan, Ana; Ford, Jennifer; Tisi, Daniel K; Xiong, Glen L

    2015-01-01

    The authors examined the frequency of neuroimaging findings of cortical atrophy and/or cerebrovascular disease in patients with delirium with hypovitaminosis D and normal vitamin D levels. Of 32 patients with delirium with hypovitaminosis D who were neuroimaged, 91.4% had neuroimaging findings, despite only five cases having a comorbid diagnosis of dementia. Similar frequencies of cortical atrophy and/or cerebrovascular disease were found in patients with delirium with normal vitamin D levels. Further research with a larger sample size is needed to compare neuroimaging findings between normal patients and patients with hypovitaminosis D with delirium. PMID:25111282

  11. Management of common postoperative complications: delirium.

    PubMed

    Javedan, Houman; Tulebaev, Samir

    2014-05-01

    Delirium is a common postoperative surgical complication associated with poor outcomes. The complexity of delirium demands that each patient be assessed individually and a tailored prevention and treatment regimen be put in place. Nonpharmacologic and pharmacologic strategies are available to achieve this goal. PMID:24721366

  12. Future Directions of Delirium Research and Management

    PubMed Central

    Hughes, Christopher G.; Brummel, Nathan E.; Vasilevskis, Eduard E.; Girard, Timothy D.; Pandharipande, Pratik P.

    2013-01-01

    Delirium is a prevalent organ dysfunction in critically ill patients associated with significant morbidity and mortality, requiring advancements in the clinical and research realms to improve patient outcomes. Increased clinical recognition and utilization of delirium assessment tools, along with clarification of specific risk factors and presentations in varying patient populations, will be necessary in the future. To improve predictive models for outcomes, the continued development and implementation of delirium assessment tools and severity scoring systems will be required. The interplay between the pathophysiological pathways implicated in delirium and resulting clinical presentations and outcomes will need to guide the development of appropriate prevention and treatment protocols. Multicenter randomized controlled trials of interventional therapies will then need to be performed to test their ability to improve clinical outcomes. Physical and cognitive rehabilitation measures need to be further examined as additional means of improving outcomes from delirium in the hospital setting. PMID:23040289

  13. Repetitive Myocardial Infarctions Secondary to Delirium Tremens

    PubMed Central

    Schwartzberg, David; Shiroff, Adam

    2014-01-01

    Delirium tremens develops in a minority of patients undergoing acute alcohol withdrawal; however, that minority is vulnerable to significant morbidity and mortality. Historically, benzodiazepines are given intravenously to control withdrawal symptoms, although occasionally a more substantial medication is needed to prevent the devastating effects of delirium tremens, that is, propofol. We report a trauma patient who required propofol sedation for delirium tremens that was refractory to benzodiazepine treatment. Extubed prematurely, he suffered a non-ST segment myocardial infarction followed by an ST segment myocardial infarction requiring multiple interventions by cardiology. We hypothesize that his myocardial ischemia was secondary to an increased myocardial oxygen demand that occurred during his stress-induced catecholamine surge during the time he was undertreated for delirium tremens. This advocates for the use of propofol for refractory benzodiazepine treatment of delirium tremens and adds to the literature on the instability patients experience during withdrawal. PMID:25197580

  14. Repetitive myocardial infarctions secondary to delirium tremens.

    PubMed

    Schwartzberg, David; Shiroff, Adam

    2014-01-01

    Delirium tremens develops in a minority of patients undergoing acute alcohol withdrawal; however, that minority is vulnerable to significant morbidity and mortality. Historically, benzodiazepines are given intravenously to control withdrawal symptoms, although occasionally a more substantial medication is needed to prevent the devastating effects of delirium tremens, that is, propofol. We report a trauma patient who required propofol sedation for delirium tremens that was refractory to benzodiazepine treatment. Extubed prematurely, he suffered a non-ST segment myocardial infarction followed by an ST segment myocardial infarction requiring multiple interventions by cardiology. We hypothesize that his myocardial ischemia was secondary to an increased myocardial oxygen demand that occurred during his stress-induced catecholamine surge during the time he was undertreated for delirium tremens. This advocates for the use of propofol for refractory benzodiazepine treatment of delirium tremens and adds to the literature on the instability patients experience during withdrawal. PMID:25197580

  15. Refractory delirium tremens: a case report and brief review.

    PubMed

    Mattoo, Surendra Kumar; Kate, Natasha; Verma, Anant Kumar

    2012-03-01

    Delirium tremens is a common presentation in tertiary care hospitals. Severe and/or refractory delirium tremens is not as common, is potentially lethal, and requires intensive management. Usually delirium tremens responds to management with standard doses of benzodiazepines. Limited literature is available, however, for the management of refractory delirium tremens. We describe a case of refractory delirium tremens in which the patient was successfully managed with a combination of high doses of lorazapam, midazolam, and phenytoin. PMID:22567606

  16. Postoperative delirium in the elderly surgical patient.

    PubMed

    Sieber, Frederick E

    2009-09-01

    Delirium is a common complication in the geriatric population following cardiac and noncardiac procedures. Postoperative delirium is a significant financial burden on the United States health care system and is independently associated with prolonged hospital stay, increased risk of early and long term mortality, increased physical dependence, and an increased rate of nursing home placement. The Confusion Assessment Method (CAM) is a bedside rating scale developed to assist nonpsychiatrically trained clinicians in the rapid and accurate diagnosis of delirium. The CAM has been adapted for use in ventilated intensive care unit (ICU) patients in the form of the CAM-ICU. The onset of delirium involves an interaction between predisposing and precipitating risk factors for delirium. The mainstay of delirium management is prevention. The approach involves control or elimination of modifiable risk factors. It is controversial whether anesthetic technique determines delirium. However, important modifiable risk factors under the anesthesiologist's control include adequate postoperative pain management, careful drug selection, and embracing and participating in a multidisciplinary care model for these complicated patients. PMID:19825486

  17. Delirium in older persons: evaluation and management.

    PubMed

    Kalish, Virginia B; Gillham, Joseph E; Unwin, Brian K

    2014-08-01

    Delirium is defined as an acute, fluctuating syndrome of altered attention, awareness, and cognition. It is common in older persons in the hospital and long-term care facilities and may indicate a life-threatening condition. Assessment for and prevention of delirium should occur at admission and continue throughout a hospital stay. Caregivers should be educated on preventive measures, as well as signs and symptoms of delirium and conditions that would indicate the need for immediate evaluation. Certain medications, sensory impairments, cognitive impairment, and various medical conditions are a few of the risk factors associated with delirium. Preventive interventions such as frequent reorientation, early and recurrent mobilization, pain management, adequate nutrition and hydration, reducing sensory impairments, and ensuring proper sleep patterns have all been shown to reduce the incidence of delirium, regardless of the care environment. Treatment of delirium should focus on identifying and managing the causative medical conditions, providing supportive care, preventing complications, and reinforcing preventive interventions. Pharmacologic interventions should be reserved for patients who are a threat to their own safety or the safety of others and those patients nearing death. In older persons, delirium increases the risk of functional decline, institutionalization, and death. PMID:25077720

  18. Delirium: a key challenge for perioperative care.

    PubMed

    O'Regan, N A; Fitzgerald, J; Timmons, S; O'Connell, H; Meagher, D

    2013-01-01

    Delirium is highly prevalent, occurring in 20% of acute hospital inpatients and up to 62% of surgical patients. It is a significant predictor of poor outcomes including mortality and institutionalisation, however it is often viewed as simply a marker of underlying illness and is frequently overlooked in older adults. Although delirium is commonly comorbid with dementia, it represents a more urgent diagnosis, requiring prompt intervention. Delirium presents most commonly with hypoactive features (e.g. withdrawal and reduced spontaneous movement and speech). The common stereotype of hyperactive delirium tremens (e.g. agitation, hallucinations), although more visible, is less common. All presentations share acute disimprovement of cognitive function. Delirium is a highly predictable and preventable occurrence, however a major barrier to improving delirium care and impacting upon outcomes is that it remains poorly detected, particularly in surgical populations and especially in patients with hypoactive presentations. Routine ward-based screening for delirium, particularly in high-risk populations, and improved staff awareness of the significance of the problem can improve detection rates. Preventative strategies, particularly multicomponent approaches, have been most efficacious in improving patient outcomes. Optimising perioperative risk factors can lead to reduced incidence. Appropriate treatment of delirium requires thorough investigation, management of the underlying illness, avoidance of complications and simplification of the care environment. Studies suggest a role for pharmacological prophylaxis, particularly in relation to anaesthetic and sedative agents used intra- and post-operatively. Furthermore, gathering evidence suggests that judicious use of antipsychotic medications may be helpful in delirium prevention and treatment. PMID:23277227

  19. Duration of delirium in the acute stage of stroke.

    PubMed

    Dostović, Zikrija; Smajlović, Dzevdet; Sinanović, Osman; Vidović, Mirjana

    2009-03-01

    The aim of the study was to determine duration of delirium in patients with acute stroke according to sex, age, type and localization of lesion. We assessed delirium prospectively in a sample of 233 consecutive patients with an acute (< or =4 days) stroke using the Delirium Rating Scale (DRS-R-98) and Diagnostic and Statistical Manual of Mental Disorders (DSM IV). The average duration of delirium was 4 days in patients with ischemic stroke and 3 days in patients with hemorrhagic stroke. There was no statistically significant difference in delirium duration between these two patient groups. A longer duration of delirium was recorded in women and in patients older than 65. The period of delirium was longer in patients with right hemispheric lesions. Patients did not differ according to delirium duration, sex, age, type and localization of stroke. In two thirds of patients, the symptoms of delirium completely disappeared on medicamentous treatment, while in the remaining one third of patients certain symptoms of delirium persisted at discharge (p=0.003). Mortality rate was significantly higher in patients with delirium in the acute phase of stroke than in those without delirium (p=0.009). In conclusion, delirium is a temporary manifestation in two thirds of patients in the acute phase of stroke. Patient sex and age, and type and stroke localization have no influence on delirium duration. PMID:19623866

  20. Functional interrelationship of brain aging and delirium.

    PubMed

    Rapazzini, Piero

    2016-02-01

    Theories on the development of delirium are complementary rather than competing and they may relate to each other. Here, we highlight that similar alterations in functional brain connectivity underlie both the observed age-related deficits and episodes of delirium. The default mode network (DMN) is a group of brain regions showing a greater level of activity at rest than during attention-based tasks. These regions include the posteromedial-anteromedial cortices and temporoparietal junctions. Evidence suggests that awareness is subserved through higher order neurons associated with the DMN. By using functional MRI disruption of DMN, connectivity and weaker task-induced deactivations of these regions are observed both in age-related cognitive impairment and during episodes of delirium. We can assume that an acute up-regulation of inhibitory tone within the brain acts to further disrupt network connectivity in vulnerable patients, who are predisposed by a reduced baseline connectivity, and triggers the delirium. PMID:25998952

  1. Assessment scales for delirium: A review

    PubMed Central

    Grover, Sandeep; Kate, Natasha

    2012-01-01

    Over the years many scales have been designed for screening, diagnosis and assessing the severity of delirium. In this paper we review the various instruments available to screen the patients for delirium, instruments available to diagnose delirium, assess the severity, cognitive functions, motoric subtypes, etiology and associated distress. Among the various screening instruments, NEECHAM confusion scale and delirium observation scale appear to be most suitable screening instrument for patients’ in general medical and surgical wards, depending on the type of rater (physician or nurse). In general, the instruments which are used for diagnosis [i.e., confusion assessment method (CAM), CAM for intensive care unit (CAM-ICU), Delirium Rating Scale-revised version (DRS-R-98), memorial selirium assessment scale, etc.] are based on various Diagnostic and Statistical Manual criteria and have good to excellent reliability and fair to good validity. Among the various diagnostic instruments, CAM is considered to be most useful instrument because of its accuracy, brevity, and ease of use by clinicians and lay interviewers. In contrast, DRS-R-98 appears to be a comprehensive instrument useful for diagnosis, severity rating and is sensitive to change and hence can be used for monitoring patients over a period. In the ICU setting, evidence suggests that CAM-ICU and Nursing Delirium Screening Scale had comparable sensitivities, but CAM-ICU has higher specificity. With regard to assessment of delirium in pediatric age group, certain instruments like Pediatric Anesthesia Emergence Delirium scale and pediatric CAM-ICU has been designed and have been found to be useful. PMID:24175169

  2. [Delirium and intensive care unit syndrome].

    PubMed

    Muhl, E

    2006-05-01

    Delirium and intensive care unit (ICU) syndrome are frequently seen postoperatively, especially in intensive care. Hospital mortality and complication rates are higher in patients with these disorders. Delirium is characterized by disturbance of consciousness and cognition and short development time. Drugs, drug withdrawal, and manifold metabolic syndromes may be causative. Knowledge of differential diagnosis and causality is essential for curative therapy. Drug therapy is recommended for the treatment of psychotic symptoms and vegetative disorders. PMID:16521003

  3. Pediatric delirium: Evaluating the gold standard

    PubMed Central

    SILVER, GABRIELLE; KEARNEY, JULIA; TRAUBE, CHANI; ATKINSON, THOMAS M.; WYKA, KATARZYNA E.; WALKUP, JOHN

    2016-01-01

    Objective Our aim was to evaluate interrater reliability for the diagnosis of pediatric delirium by child psychiatrists. Method Critically ill patients (N = 17), 0–21 years old, including 7 infants, 5 children with developmental delay, and 7 intubated children, were assessed for delirium using the Diagnostic and Statistical Manual–IV (DSM–IV) (comparable to DSM–V) criteria. Delirium assessments were completed by two psychiatrists, each blinded to the other’s diagnosis, and interrater reliability was measured using Cohen’s κ coefficient along with its 95% confidence interval. Results Interrater reliability for the psychiatric assessment was high (Cohen’s κ = 0.94, CI [0.83, 1.00]). Delirium diagnosis showed excellent interrater reliability regardless of age, developmental delay, or intubation status (Cohen’s κ range 0.81–1.00). Significance of results In our study cohort, the psychiatric interview and exam, long considered the “gold standard” in the diagnosis of delirium, was highly reliable, even in extremely young, critically ill, and developmentally delayed children. A developmental approach to diagnosing delirium in this challenging population is recommended. PMID:24762563

  4. Postoperative Delirium: Acute Change with Long-Term Implications

    PubMed Central

    Rudolph, James L.; Marcantonio, Edward R.

    2011-01-01

    Delirium is an acute change in cognition and attention, which may include alterations in consciousness and disorganized thinking. While delirium may affect any age group, it is most common in older patients, especially those with preexisting cognitive impairment. Patients with delirium after surgery recover more slowly than those without delirium and, as a result, have increased length of stay and hospital costs. The measured incidence of postoperative delirium varies with the type of surgery, the urgency of surgery, and the type and sensitivity of the delirium assessment. While generally considered a short-term condition, delirium can persist for months and is associated with poor cognitive and functional outcomes beyond the immediate postoperative period. In this article we will provide a guide to assess delirium risk preoperatively, and to prevent, diagnose, and treat this common and morbid condition. Care improvements such as identifying delirium risk preoperatively; training surgeons, anesthesiologists and nurses to screen for delirium; implementing delirium prevention programs; and developing standardized delirium treatment protocols may reduce the risk of delirium and its associated morbidity. PMID:21474660

  5. Delirium

    MedlinePlus

    ... to Pregnancy? Health Highlights: Sept. 13, 2016 Smokers' Perceptions May Play Role in Addiction ALL NEWS > Resources ... delusions (false beliefs usually involving a misinterpretation of perceptions or experiences). Personality and mood may change. Some ...

  6. Delirium

    MedlinePlus

    ... alert at night) Changes in feeling (sensation) and perception Changes in level of consciousness or awareness Changes in movement (for example, may be slow moving or hyperactive) Changes in sleep patterns, drowsiness Confusion (disorientation) about time or place ...

  7. Delirium

    MedlinePlus

    ... urine tests Chest x-ray Cerebrospinal fluid (CSF) analysis (spinal tap) Electroencephalogram (EEG) Head CT scan Head ... Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier ...

  8. An Unusual Case of Delirium after Restarting Clozapine

    PubMed Central

    Khanra, Sourav; Sethy, Rati Ranjan; Munda, Sanjay Kumar; Khess, Christoday Raja Jayant

    2016-01-01

    Clozapine is a gold standard medication and drug of choice in refractory schizophrenia. Among many of its fatal side effects, delirium is less reported and inconsistently recognized by clinicians. We here present a case of delirium which emerged during retreatment with clozapine in a patient of paranoid schizophrenia. A patient diagnosed with paranoid schizophrenia, was restarted on clozapine after he left medications and became symptomatic. He was delirious on 22nd day after clozapine was restarted. Clozapine was stopped and the patient was managed with standard treatment for delirium. After one week interval, clozapine was restarted. Delirium was not noted till 6 weeks of his hospital stay. Clozapine induced central anticholinergic toxicity or clozapine induced seizure might cause delirium in index case. Limited literature exist delirium with clozapine. Clinicians must have high index of suspicion to detect delirium during clozapine therapy. More researches should focus to explore the association between delirium and clozapine. PMID:26792049

  9. Delirium in Elderly People: A Review

    PubMed Central

    Martins, Sónia; Fernandes, Lia

    2012-01-01

    The present review aims to highlight this intricate syndrome, regarding diagnosis, pathophysiology, etiology, prevention, and management in elderly people. The diagnosis of delirium is based on clinical observations, cognitive assessment, physical, and neurological examination. Clinically, delirium occurs in hyperactive, hypoactive, or mixed forms, based on psychomotor behavior. As an acute confusional state, it is characterized by a rapid onset of symptoms, fluctuating course and an altered level of consciousness, global disturbance of cognition or perceptual abnormalities, and evidence of a physical cause. Although pathophysiological mechanisms of delirium remain unclear, current evidence suggests that disruption of neurotransmission, inflammation, or acute stress responses might all contribute to the development of this ailment. It usually occurs as a result of a complex interaction of multiple risk factors, such as cognitive impairment/dementia and current medical or surgical disorder. Despite all of the above, delirium is frequently under-recognized and often misdiagnosed by health professionals. In particular, this happens due to its fluctuating nature, its overlap with dementia and the scarcity of routine formal cognitive assessment in general hospitals. It is also associated with multiple adverse outcomes that have been well documented, such as increased hospital stay, function/cognitive decline, institutionalization and mortality. In this context, the early identification of delirium is essential. Timely and optimal management of people with delirium should be performed with identification of any possible underlying causes, dealing with a suitable care environment and improving education of health professionals. All these can be important factors, which contribute to a decrease in adverse outcomes associated with delirium. PMID:22723791

  10. [Delirium: Concepts, Etiology, and Clinical Management].

    PubMed

    Hübscher, A; Isenmann, S

    2016-04-01

    Delirium is a common condition: up to 35 percent of non-ICU- and 80 percent of ICU-patients experience delirium - particularly the elderly suffering from cerebral dysfunction accompanied by acute infection, surgery, or change of medication. Medical staff should be alert for decrease (within hours) of concentration, memory, orientation, and consciousness - especially when agitation appears and symptoms are fluctuating. Vegetative lapses and seizures may complicate the course, in particular in delirium in withdrawal (of alcohol or drugs). Treatment comprises neuroleptic and sedative medication (be careful with benzodiazepines because of their delirogenic potential) as well as alpha-2-agonists for vegetative derangements and anti-epileptics in case of seizures. As usual: start with low doses, and keep the medical treatment as short as possible. Additionally, take care in the · search and solution of delir-causes,. · termination of unnecessary medication (in particular, anticholinergic agents),. · comfort, intimacy and orientation,. · cognitive training and mobilization.. Avoiding a delirium is the best medicine. For that reason, identification of patients at risk, early detection of signs of delirium and prevention are most important. Beside factors 2 to 4, personalized treatment has been proved to be very helpful. PMID:27100850

  11. Preventing delirium in dementia: Managing risk factors.

    PubMed

    Ford, Andrew H

    2016-10-01

    Delirium is a common, disabling medical condition that is associated with numerous adverse outcomes. A number of inter-related factors, including pre-existing cognitive impairment, usually contribute to the development of delirium in a particular susceptible individual. Non-pharmacological approaches to prevention typically target multiple risk factors in a systematic manner (multicomponent interventions). There is generally good evidence that multicomponent interventions reduce the incidence of delirium in hospital populations but there are limited data in people with dementia and those living in the community. It is likely that there is a differential effect of specific interventions in those with cognitive impairment (e.g. people with dementia may respond better to simpler, more pragmatic interventions rather than complex procedures) but this cannot be determined from the existing data. Targeted interventions focussed on hydration, medication rationalization and sleep promotion may also be effective in reducing the incidence of delirium, as well as the active involvement of family members in the care of the elderly hospitalized patient. Hospitalization itself is a potential risk factor for delirium and promising data are emerging of the benefits of home-based care as an alternative to hospitalization but this is restricted to specific sub-populations of patients and is reliant on these services being available. PMID:27621236

  12. [Delirium in the intensive care unit].

    PubMed

    von Haken, R; Gruss, M; Plaschke, K; Scholz, M; Engelhardt, R; Brobeil, A; Martin, E; Weigand, M A

    2010-03-01

    In recent years delirium in the intensive care unit (ICU) has internationally become a matter of rising concern for intensive care physicians. Due to the design of highly sophisticated ventilators the practice of deep sedation is nowadays mostly obsolete. To assess a ventilated ICU patient for delirium easy to handle bedside tests have been developed which permit a psychiatric scoring. The significance of ICU delirium is equivalent to organ failure and has been proven to be an independent prognostic factor for mortality and length of ICU and hospital stay. The pathophysiology and risk factors of ICU delirium are still insufficiently understood in detail. A certain constellation of pre-existing patient-related conditions, the current diagnosis and surgical procedure and administered medication entail a higher risk for the occurrence of ICU delirium. A favored hypothesis is that an imbalance of the neurotransmitters acetylcholine and dopamine serotonin results in an unpredictable neurotransmission. Currently, the administration of neuroleptics, enforced physiotherapy, re-orientation measures and appropriate pain treatment are the basis of the therapeutic approach. PMID:20127059

  13. Bedside coaching to improve nurses' recognition of delirium.

    PubMed

    Gordon, Susan Jean; Melillo, Karen Devereaux; Nannini, Angela; Lakatos, Barbara E

    2013-10-01

    Delirium is a widespread complication of hospitalization and is frequently unrecognized by nurses and other healthcare professionals. Patients with neuroscience diagnoses are at increased risk for delirium as compared with other patients. The aims of this quality improvement project were to (1) increase neuroscience nurses' knowledge of delirium, (2) integrate coaching into evidence-based practice, and (3) evaluate the effectiveness of this combined approach to improve nurses' recognition of delirium on a neuroscience unit. Institutional review board approval was obtained. A retrospective chart review of randomly selected patients admitted before the intervention was completed. The (modified) Nurse's Knowledge of Delirium Tool was electronically administered to nursing staff (n = 47), followed within 2 weeks by a didactic presentation on delirium. Bedside coaching was performed over a period of 4 weeks. The (modified) Nurses Knowledge of Delirium Tool was electronically readministered to nurses 4 weeks later to determine the change in aggregate knowledge. A postintervention chart review was conducted. SPSS software was used to analyze descriptive statistics with regard to chart reviews, documentation, and change in questionnaire scores. Findings reveal that neuroscience nurses recognize the absence of delirium 94.4% of the time and the presence of delirium 100% of the time after a didactic session and coaching. The postintervention chart review showed a statistically significant increase (p = .000) in the documentation of delirium screening results. Expert coaching at the bedside may be a reliable method for teaching nurses to use evidence-based screening tools to detect delirium in patients with neuroscience diagnoses. PMID:24025468

  14. The major risk factors for delirium in a clinical setting

    PubMed Central

    Kim, Harin; Chung, Seockhoon; Joo, Yeon Ho; Lee, Jung Sun

    2016-01-01

    Objective We aimed to determine the major risk factors for the development of delirium in patients at a single general hospital by comparison with a control group. Subjects and methods We reviewed the medical records of 260 delirium patients and 77 control patients. We investigated age, sex, and risk factors for delirium in the total delirium group (n=260), the delirium medical subgroup (n=142), and the delirium surgical subgroup (n=118). Logistic regression analysis adjusting for age and sex was performed to identify the odds ratio. Results The mean age and the percentage of males were significantly higher in the delirium group compared with the control group (68.9 vs 54.3 years and 70% vs 41.6%, respectively). Risk factors for the delirium group were lower plasma albumin, hypertension, mechanical ventilation, and antipsychotic drug use. Plasma sodium level and hypertension were important risk factors for the delirium medical subgroup. Stroke history, hypertension, ICU care, and medication were important risk factors for the delirium surgical subgroup. Conclusion Lower plasma albumin, hypertension, mechanical ventilation, and antipsychotic drug use are important risk factors for delirium. PMID:27499625

  15. Multicomponent delirium prevention: not as effective as NICE suggest?

    PubMed

    Teale, Elizabeth; Young, John

    2015-11-01

    Multicomponent delirium prevention strategies have been shown in intervention studies consistently to reduce the occurrence of delirium. Based on this convincing evidence base, the National Institute for Health and Care Excellence has advocated the widespread adoption of multicomponent delirium prevention interventions into the routine inpatient care of older people. However, despite successful reductions in incident delirium of about a third, anticipated reductions in mortality or admissions to long-term care--both clinically important endpoints statistically correlated with the occurrence of delirium--have not been conclusively observed. We hypothesise that the reasons for this disconnection are partly methodological, due to difficulties in delirium detection and blinding of study personnel to the intervention, but predominantly due to the underlying relationship between delirium and the abnormal health state of frailty; the interaction between these two geriatric syndromes is currently poorly understood. PMID:26316509

  16. Cholinergic deficiency hypothesis in delirium: a synthesis of current evidence.

    PubMed

    Hshieh, Tammy T; Fong, Tamara G; Marcantonio, Edward R; Inouye, Sharon K

    2008-07-01

    Deficits in cholinergic function have been postulated to cause delirium and cognitive decline. This review examines current understanding of the cholinergic deficiency hypothesis in delirium by synthesizing evidence on potential pathophysiological pathways. Acetylcholine synthesis involves various precursors, enzymes, and receptors, and dysfunction in these components can lead to delirium. Insults to the brain, like ischemia and immunological stressors, can precipitously alter acetylcholine levels. Imbalances between cholinergic and other neurotransmitter pathways may result in delirium. Furthermore, genetic, enzymatic, and immunological overlaps exist between delirium and dementia related to the cholinergic pathway. Important areas for future research include identifying biomarkers, determining genetic contributions, and evaluating response to cholinergic drugs in delirium. Understanding how the cholinergic pathway relates to delirium may yield innovative approaches in the diagnosis, prevention, and treatment of this common, costly, and morbid condition. PMID:18693233

  17. Takotsubo cardiomyopathy precipitated by delirium tremens.

    PubMed

    Agu, Chidozie Charles; Bakhit, Ahmed; Basunia, Md; Bhattarai, Bikash; Oke, Vikram; Salhan, Divya; Schmidt, Frances

    2015-01-01

    A 57-year-old woman presented with alcohol withdrawal symptoms, which later progressed to delirium tremens. During hospitalization, she developed respiratory distress with acute pulmonary edema. Electrocardiogram (ECG) showed diffuse ST elevation with elevated cardiac enzymes. Echocardiogram showed estimated ejection fraction of 20-25% with characteristic apical ballooning. After several days of supportive care, the patient showed significant clinical improvement with normalization of ECG, cardiac enzymes, and echocardiographic findings. Coronary angiogram revealed no coronary abnormalities. Although Takotsubo cardiomyopathy has been associated with diverse forms of physical or emotional stress, only a few cases have been described with delirium tremens in the medical literature. PMID:26653700

  18. Takotsubo cardiomyopathy precipitated by delirium tremens

    PubMed Central

    Agu, Chidozie Charles; Bakhit, Ahmed; Basunia, Md; Bhattarai, Bikash; Oke, Vikram; Salhan, Divya; Schmidt, Frances

    2015-01-01

    A 57-year-old woman presented with alcohol withdrawal symptoms, which later progressed to delirium tremens. During hospitalization, she developed respiratory distress with acute pulmonary edema. Electrocardiogram (ECG) showed diffuse ST elevation with elevated cardiac enzymes. Echocardiogram showed estimated ejection fraction of 20–25% with characteristic apical ballooning. After several days of supportive care, the patient showed significant clinical improvement with normalization of ECG, cardiac enzymes, and echocardiographic findings. Coronary angiogram revealed no coronary abnormalities. Although Takotsubo cardiomyopathy has been associated with diverse forms of physical or emotional stress, only a few cases have been described with delirium tremens in the medical literature. PMID:26653700

  19. A case of prolonged delirium tremens.

    PubMed

    Nicholas, Jerome; Jacob, Rajesh; Kinson, Rochelle

    2013-08-01

    We present a case of delirium tremens lasting for five weeks in an alcohol-dependent individual. The patient required high-dose benzodiazepines, which is atypical and rare. The clinical presentation and management of this patient is discussed. PMID:24005461

  20. Tryptophan Supplementation and Postoperative Delirium – A Randomized Controlled Trial

    PubMed Central

    Robinson, Thomas N.; Dunn, Christina L.; Adams, Jill C.; Hawkins, Carrie L.; Tran, Zung V.; Raeburn, Christopher D.; Moss, Marc

    2014-01-01

    Background/Objectives Tryptophan deficiency has been associated with increased incidence of postoperative delirium. Therefore, we hypothesized that the post-operative administration of tryptophan would be beneficial for elderly surgical patients who are at higher risk of developing post-operative delirium. Design Randomized, double-blind, placebo controlled trial. Setting: Participants A total of 325 individuals aged 60 years and older undergoing major elective operations requiring a postoperative intensive care unit admission. Intervention L-tryptophan, 1 gram orally, three times daily or placebo was started following the operation and continued for up to three days postoperatively. Measurements Delirium and its motor subtypes were measured using the Confusion Assessment Method-ICU and the Richmond Agitation and Sedation Scale. The primary outcome for between groups comparison was the incidence of excitatory (mixed and hyperactive) postoperative delirium. The secondary outcomes for comparison were the incidence and duration of overall postoperative delirium. Results The overall incidence of postoperative delirium was 39% (116) (95% confidence interval 34% to 44%). The percentages of patients with excitatory delirium in the tryptophan and placebo groups were 17% and 9% (p=0.176), and the duration of excitatory delirium was 3.3±1.7 and 3.1±1.9 days (p=0.741). The percentage of patients with overall delirium in the tryptophan and placebo groups was 40% and 37% (p=0.597), and the duration of overall delirium was 2.9±1.8 and 2.4±1.6 days (p=0.167). Conclusion Postoperative tryptophan supplementation in older adults undergoing major elective operations requiring postoperative intensive care unit admission demonstrated no efficacy in reducing the incidence of postoperative excitatory delirium or overall delirium, and the duration of excitatory or overall delirium. PMID:25112175

  1. Validation of a medical record-based delirium risk assessment

    PubMed Central

    Rudolph, James L.; Harrington, Mary Beth; Lucatorto, Michelle A.; Chester, Jennifer G.; Francis, Joseph; Shay, Kenneth

    2016-01-01

    Objectives To improve identification of patients at high risk for delirium, this study developed a chart abstraction tool for delirium risk and validated the tool against clinical expert diagnosis of delirium Design Prospective Cohort Study Setting Tertiary VA Hospital in New England Participants 100 Veterans admitted to the medical service Measurements While admitted, each participant underwent serial assessments for delirium by a clinical expert. Using the four criteria of a validated delirium prediction rule (e.g. cognitive impairment, sensory deficit, severe illness, and dehydration), chart review terms were selected for each criteria and delirium risk was the sum of criteria present (range 0–4; 4-worst). After discharge, the chart tool was completed by a nurse blinded to the expert’s diagnosis. Results The participants (n=100) were largely older (mean age 81 ±7years) men (94% male) and 23% developed overall delirium (14% incident). The rate of overall delirium in participants with 0, 1–2, and 3–4 risk factors was 11%, 18%, and 50% (p=.01) respectively with a c-statistic of 0.65 (95% Confidence Interval 0.54, 0.76). For incident delirium, the rate was 11%, 13%, and 25% (p=.53) and the c-statistic of 0.56 (95%CI 0.42, 0.74). Discharge to a rehabilitation center or nursing home increased with increasing delirium risk (0%, 18%, 60%, p=.02). Conclusions A chart abstraction tool was effective at identifying overall delirium risk, but not incident delirium risk. While the tool cannot replace clinical assessment and diagnosis of delirium, the use of this tool as an educational, clinical, or quality measurement aid warrants additional study. PMID:22091575

  2. Digging Into the Mysteries of Delirium | NIH MedlinePlus the Magazine

    MedlinePlus

    ... turn JavaScript on. Feature: Delirium Research Digging Into the Mysteries of Delirium Past Issues / Fall 2015 Table ... by delirium experience its effects for weeks after the first occurrence. Why is this? That's part of ...

  3. Excited delirium: Consideration of selected medical and psychiatric issues

    PubMed Central

    Samuel, Edith; Williams, Robert B; Ferrell, Richard B

    2009-01-01

    Excited delirium, sometimes referred to as agitated or excited delirium, is the label assigned to the state of acute behavioral disinhibition manifested in a cluster of behaviors that may include bizarreness, aggressiveness, agitation, ranting, hyperactivity, paranoia, panic, violence, public disturbance, surprising physical strength, profuse sweating due to hyperthermia, respiratory arrest, and death. Excited delirium is reported to result from substance intoxication, psychiatric illness, alcohol withdrawal, head trauma, or a combination of these. This communication reviews the history of the origins of excited delirium, selected research related to its causes, symptoms, management, and the links noted between it and selected medical and psychiatric conditions. Excited delirium involves behavioral and physical symptoms that are also observed in medical and psychiatric conditions such as rhabdomyolysis, neuroleptic malignant syndrome, and catatonia. A useful contribution of this communication is that it links the state of excited delirium to conditions for which there are known and effective medical and psychiatric interventions. PMID:19557101

  4. Identifying and managing patients with delirium in acute care settings.

    PubMed

    Bond, Penny; Goudie, Karen

    2015-11-01

    Delirium is an acute medical emergency affecting about one in eight acute hospital inpatients. It is associated with poor outcomes, is more prevalent in older people and it is estimated that half of all patients receiving intensive care or surgery for a hip fracture will be affected. Despite its prevalence and impact, delirium is not reliably identified or well managed. Improving the identification and management of patients with delirium has been a focus for the national improving older people's acute care work programme in NHS Scotland. A delirium toolkit has been developed, which includes the 4AT rapid assessment test, information for patients and carers and a care bundle for managing delirium based on existing guidance. This toolkit has been tested and implemented by teams from a range of acute care settings to support improvements in the identification and immediate management of delirium. PMID:26511424

  5. [Pain, delirium and sedation in intensive unit care].

    PubMed

    Mazul-Sunko, Branka; Brozović, Gordana; Goranović, Tatjana

    2012-03-01

    Delirium is a complication of intensive care treatment associated with permanent cognitive decline and increased mortality after hospital discharge. In several studies, postoperative pain was found as a possible precipitating factor. Aggressive pain treatment is part of current multicompartment protocols for delirium prevention after hip fracture. Protocol based sedation, pain and delirium management in intensive care units have been shown to have clinical and economic advantages. PMID:23088085

  6. Delirium detection and improved delirium management in older patients hospitalized for hip fracture.

    PubMed

    Todd, Kristine S; Barry, Jean; Hoppough, Susan; McConnell, Eleanor

    2015-11-01

    Delirium is a common and potentially devastating problem for older patients following hip fracture. Although early detection is recommended, description and evaluation of standardized approaches are scarce. The aims of this quality improvement project were to: (1) implement a clinical algorithm for improving delirium detection and management and (2) assess the impact of the clinical algorithm on length of stay, discharge disposition and patient satisfaction. The pilot study was implemented on an orthopedic unit to evaluate the effectiveness of a clinical protocol for delirium detection and management to improve outcomes. Outcomes of 33 elderly post-operative hip fracture patients were compared to historical controls from the same unit. Delirium was detected in 18% of patients. Length of stay was reduced by 22% (P < .001), discharge disposition showed a 13% improvement (P = .17) and patient satisfaction scores showed a 15% (P = .15) improvement post-intervention. Implementation of a clinical algorithm to promote early detection and treatment of delirium in post-operative hip fracture patients is feasible and associated with improved outcomes. PMID:26547684

  7. Olfactory dysfunction is related to postoperative delirium in Parkinson's disease.

    PubMed

    Kim, Min Seung; Yoon, Jung Han; Kim, Hyun Jae; Yong, Seok Woo; Hong, Ji Man

    2016-06-01

    Operations often lead to delirium in elderly patients, particularly those with impaired cognition, suggesting that underlying neuropathology may play a role in the development of postoperative delirium. Olfactory dysfunction is a well-known marker of underlying Lewy body pathology in Parkinson's disease (PD). However, the prognostic value of olfaction for the development of postoperative delirium in PD remains unclear. 34 PD patients with or without postoperative delirium following surgery under general anesthesia were included in this study (n = 17 for each group). Cross-Cultural Smell Identification scores were lower in PD patients with postoperative delirium (4.4 ± 1.5) relative to the delirium-free controls (6.8 ± 2.4, p < 0.005). Multivariate logistic regression analysis revealed that olfaction and operation time were significant predictors of the development of postoperative delirium. Impaired olfaction is significantly associated with postoperative delirium in PD. Olfaction may be useful for identifying PD patients susceptible to postoperative delirium. PMID:27098668

  8. PARTICIPATION IN ACTIVITY AND RISK FOR INCIDENT DELIRIUM

    PubMed Central

    Yang, Frances M.; Inouye, Sharon K.; Fearing, Michael A.; Kiely, Dan K.; Marcantonio, Edward R.; Jones, Richard N.

    2008-01-01

    Objectives To examine the mediating role of activity participation between educational attainment and risk for incidence delirium; and to examine the contribution of participation in specific activities to the development of delirium. Design and Setting Prospective cohort study. An urban teaching hospital in New Haven, Connecticut, USA. Participants Drawn from two prospective cohort studies of 779 newly hospitalized patients aged 70 and older without dementia. Measurements The main outcome was delirium measured by the full Confusion Assessment Method (CAM) algorithm, which consisted of acute onset and fluctuating course, inattention, and either disorganized thinking or altered level of consciousness, as rated by trained clinical interviewers. Results Bivariable results indicated a significant relationship between both education and the development of delirium (odds ratio, 0.92 [95% confidence interval (CI), 0.88 to 0.97], and between activity and delirium (odds ratio, 0.60 [95% CI, 0.46 to 0.79]. In multivariable analysis, activity mediated the relationship between education and risk for delirium. Considering each activity separately, multivariable logistic regression analysis showed that regular exercise significantly lowered the risk for developing delirium (odds ratio, 0.76 [95% CI, 0.60 to 0.96]. Conclusion Among older persons without dementia, activity participation before hospitalization is a mediator between education and incidence of delirium. Specifically, we found that participation in regular exercise was found to be significantly protective against delirium. PMID:18547359

  9. The Impact of Delirium | NIH MedlinePlus the Magazine

    MedlinePlus

    ... delirium, especially in older people: Use of pain medication or sedatives, or sedative drug withdrawal Drug or alcohol abuse Dehydration Electrolyte or other body chemical disturbances Infections ...

  10. Association between leptin and delirium in elderly inpatients

    PubMed Central

    Sánchez, Julio C; Ospina, Jenny P; González, Martha I

    2013-01-01

    Leptin is a hormone with significant effects on the brain, both at the cellular level and cognitive level. This study aimed to establish the association between leptin levels and delirium in a Colombian elderly population. 115 patients older than 60 years were included. Leptin was measured by enzyme-linked immunosorbent assay after overnight fasting and Mini-Mental State Examination and Confusion Assessment Method (CAM) tests were employed. Delirium was diagnosed using CAM in 23.48% of patients, being most frequent in men. There were no significant differences in hematology and renal test values between patients with delirium and those without delirium, but cerebrovascular diagnoses were more frequent in patients with delirium. No correlation with any specific medication was found, but patients with delirium had a higher number of comorbidities and medications. Leptin levels were significantly lower in patients with delirium and correlated negatively with the number of diagnoses and medications, but not with age, gender, body mass index, or hematology and renal test results. Leptin levels may have a role in the pathophysiological process of delirium and low leptin could be a useful clinical biomarker to establish risk in elderly patients given the association with delirium. PMID:23717044

  11. Neuroinflammation in sepsis: sepsis associated delirium.

    PubMed

    Piva, Simone; McCreadie, Victoria A; Latronico, Nicola

    2015-01-01

    Sepsis-associated delirium (SAD) is a clinical manifestation of the involvement of the central nervous system (CNS) during sepsis. The purpose of this review is to provide a concise overview of SAD including the epidemiology and current diagnostic criteria for SAD. We present in detail the pathophysiology with regards to blood-brain-barrier breakdown, cytokine activation and neurotransmitter deregulation. Treatment and prognosis for SAD are also briefly discussed. SAD is the most common form of delirium acquired in the ICU (Intensive Care Unit), and is described in about 50% of septic patients. Clinical features include altered level of consciousness, reduced attention, change in cognition and perceptual disturbances. Symptoms can reversible, but prolonged deficits can be observed in older patients. Pathophysiology of SAD is poorly understood, but involves microvascular, metabolic and, not least, inflammatory mechanisms leading to CNS dysfunction. These mechanisms can be different in SAD compared to ICU delirium associated with other conditions. SAD is diagnosed clinically using validated tools such as CAM-ICU (Confusion Assessment Method for the Intensive Care Medicine) or ICDSC (The Intensive Care Delirium Screening Checklist), which have good specificity but low sensitivity. Neuroimaging studies and EEG (Electroencephalography) can be useful complement to clinical evaluation to define the severity of the condition. Prompt diagnosis and eradication of septic foci whenever possible is vital. Preventive measures for SAD in the critically ill patient requiring long-term sedation include maintaining light levels of sedation using non-benzodiazepine sedatives (either propofol or dexmedetomidine). Early mobilization of patients in the ICU is also recommended. Antipsychotic drugs (haloperidol and atypical antipsychotics) are widely used to treat SAD, but firm evidence of their efficacy is lacking. PMID:25567339

  12. Melatonin based therapies for delirium and dementia.

    PubMed

    Alagiakrishnan, Kannayiram

    2016-05-01

    Melatonin levels have been shown to decline with aging. Melatonin and its analogs in addition to their effect on sleep promotion, has been shown to have multiple pleiotropic effects. It can also help with neuroprotection through different mechanisms. Evidence in animal and human studies suggests that low levels of melatonin have been linked to delirium, mild cognitive impairment, dementia, and with certain behavioral problems. Recent clinical trials have showed that both melatonin and its analogs may be useful in the prevention, treatment of delirium, and the management of dementia. These medications seem to have the advantage of less side effects and better safety profile when compared to antipsychotics and sedatives like benzodiazepines. These medications are available over the counter in North America, Europe, and Asia, and some of these medications are approved by FDA. This manuscript will discuss the promising role of these melatonergic medications alone or in combination with other medications for the management of Geriatric Psychiatric diseases like delirium and dementia. PMID:27355332

  13. Review of Postoperative Delirium in Geriatric Patients Undergoing Hip Surgery.

    PubMed

    Rizk, Paul; Morris, William; Oladeji, Philip; Huo, Michael

    2016-06-01

    Postoperative delirium is a serious complication following hip surgery in elderly patients that can adversely affect outcomes in both hip fracture and arthroplasty surgery. Recently, the incidence of hip fracture in the Medicare population was estimated at approximately 500 000 patients per year, with the majority treated surgically. The annual volume of total hip arthroplasty is nearly 450 000 patients and is projected to increase over the next 15 to 20 years. Subsequently, the incidence of postoperative delirium will rise. The incidence of postoperative delirium after hip surgery in the elderly patients ranges between 4% and 53%, and it is identified as the most common surgical complication of older patients. The most common risk factors include advanced age, hip fracture surgery (vs elective hip surgery), and preoperative delirium/cognitive impairment. Exact pathophysiology has not been fully defined. It is hypothesized that imbalances in cortical neurotransmitters or inflammatory cytokine pathway mechanisms contribute to delirium. Development of postoperative delirium is associated with longer hospital stay, increased medical complications, and poorer short-term functional outcome. Patients who develop postoperative delirium are also at increased risk for cognitive decline beyond the acute phase. Following acute care, postoperative delirium is associated with the need for a higher level of care, an additional cost. Management of postoperative delirium centers on prevention and early recognition. Medical prophylaxis has been demonstrated to have limited utility. Utilization of delirium detection methods contributed to early recognition. The most effective means of prevention involved a multidisciplinary team focused on adequate hydration, optimization of analgesia, reduction in polypharmacy, aggressive physiotherapy, and early recognition of the delirium symptoms. PMID:27239384

  14. Mental Status Change in the Elderly: Recognizing and Treating Delirium.

    ERIC Educational Resources Information Center

    Morency, Catherine Reilly

    1990-01-01

    Discusses delirium and how it differs from other types of mental status changes seen in the elderly and what interventions are most appropriate in affected individuals. Presents data from a study regarding nursing assessment of patients with delirium and outlines an educational model. (JOW)

  15. Commentary: The Diagnosis of Delirium in Pediatric Patients

    ERIC Educational Resources Information Center

    Martini, D. Richard

    2005-01-01

    Pediatric patients seem to be especially vulnerable to toxic, metabolic, or traumatic CNS insults and are at greater risk of delirium with fever regardless of the etiology. Developmental limitations, in the areas of communication and cognition, prevent a thorough evaluation of the young patient for delirium. Only the most severe cases are…

  16. Incidence and risk factors of delirium in patients post pancreaticoduodenectomy

    PubMed Central

    Gallagher, Tom K; McErlean, Sarah; O'Farrell, Aimee; Hoti, Emir; Maguire, Donal; Traynor, Oscar J; Conlon, Kevin C; Geoghegan, Justin G

    2014-01-01

    Background Post-operative delirium is an important and common complication of major abdominal surgery characterized by acute confusion with fluctuating consciousness. The aim of this study was to establish the incidence of post-operative delirium in patients undergoing a pancreaticoduodenectomy and to determine the risk factors for its development. Methods From a prospectively maintained database, a retrospective cohort analysis was performed of 50 consecutive patients who underwent a pancreaticoduodenectomy at the National Surgical Centre for Pancreatic Cancer in St. Vincent's University Hospital, Dublin and whose entire post-operative stay was in this institution, between July 2011 and December 2012. Two independent medical practitioners assessed all data and delirium was diagnosed according to criteria of the Diagnostic and Statistical Manual Disorder (DSM), fourth edition. Univariate and multivariate analyses were performed. Results Seven patients (14%) developed post-operative delirium. The median onset was on the second post-operative day. Older age was predictive of an increased risk of delirium post-operatively. Those who developed delirium had a significantly increased length of stay (LOS) as well as a significantly increased risk of developing at least a grade 3 complication (Clavien-Dindo classification). Conclusion This study demonstrates that post-operative delirium is associated with a more complicated recovery after a pancreaticoduodenectomy and that older age is independently predictive of its development. Focused screening may allow targeted preventative strategies to be used in the peri-operative period to reduce complications and costs associated with delirium. PMID:24750484

  17. Delirium in the hospitalized elder and recommendations for practice.

    PubMed

    Rigney, Ted S

    2006-01-01

    Delirium is a mental disorder of acute onset and fluctuating course, characterized by disturbances in consciousness, orientation, memory, thought, perception, and behavior. It occurs in up to 50% of elderly hospital inpatients, many with preexisting dementia, and is associated with significant increases in functional disability, length of hospital stay, rates of death, and health care costs. Despite its clinical importance, delirium often remains undetected or misdiagnosed as dementia or other psychiatric illness. Awareness of the etiologies and risk factors of delirium should enable nurses to focus on patients at risk and to recognize delirium symptoms early. Knowledge of pharmacological and nonpharmacological treatments for delirium will provide the nurse with an arsenal of potential interventions in the care of the delirious hospitalized elder. PMID:16757386

  18. Early Assessment of Delirium in Elderly Patients after Hip Surgery

    PubMed Central

    Lee, Hyo Jin; Hwang, Deuk Soo; Wang, Seong Keun; Chee, Ik Seung; Baeg, Sengmi

    2011-01-01

    Objective This study is intended to identify predictive factors of delirium, including risk factors and prodromal symptoms. Methods This study included sixty-five patients aged 65 years or older who had undergone hip surgery. Baseline assessments included age; gender; admission type (acute/elective); reason for surgery (fracture/replacement); C-reactive protein (CRP); Acute Physiology, Age, Chronic Health Evaluation (APACHE III); and the Mini-Mental State Examination (MMSE). The Korean version of the Delirium Rating Scale-Revised-98 (K-DRS-98) was used to assess prodromal symptoms daily before the onset of delirium. Results Almost 28% (n=18) of the 65 patients developed delirium after surgery. Delirium in elderly patients after hip surgery was observed more often in older patients and those with acute admission, hip fracture, higher APACHE III score, lower MMSE score, and higher CRP levels within early days after the operation. Sleep-wake cycle disturbances, thought process abnormalities, orientation, and long-term memory in symptom items of K-DRS-98 were showed significant difference on 4 days before delirium, lability of affect on 3 days before, perceptual disturbances and hallucination, and visuo-spatial ability on 2 days before, and delusion, motor agitation, and short-term memory on the day before the occurrence of delirium. CRP levels within 24 hours and 72 hours after hospitalization were significantly higher in the delirium group. Conclusion Medical professionals must pay attention to behavioral, cognitive changes and risk factors in elderly patients undergoing hip surgery and to the prodromal phase of delirium. K-DRS-98 may help in identifying the prodromal symptoms of delirium in elderly patients after hip surgery. PMID:22216044

  19. Delirium in the Nursing Home Emergency Department Patient

    PubMed Central

    Han, Jin H.; Morandi, Alessandro; Ely, E. Wesley; Callison, Clay; Zhou, Chuan; Storrow, Alan B.; Dittus, Robert S.; Habermann, Ralf; Schnelle, John

    2016-01-01

    Objectives Nursing home patients are an important segment of the aging population, but are often neglected in emergency department (ED) delirium studies. We sought to determine if nursing home patients are more likely to present to the ED with delirium compared to non-nursing home patients, and explore how variations in their delirium risk factor profiles contribute to this relationship. Design Prospective cross-sectional study. Setting Tertiary care, academic ED. Participants Three hundred forty one English speaking patients who were 65 years and older. Measurements Delirium status was determined by using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) administered by trained research assistants. Multivariable logistic regression was used to determine if nursing home residence was associated with delirium. Odds ratios (OR) with their 95% confidence intervals (95%CI) were reported. Results Of the 341 patients enrolled, 58 (17%) resided in a nursing home. A total of 38 (11.2%) patients were considered to have delirium in the ED. Twenty two (37.9%) and 16 (5.7%) of nursing home and non-nursing home patients, respectively, had delirium in the ED with an unadjusted OR (95%CI) of 10.2 (4.9 – 21.2). After adjusting for dementia, a Katz ADL < 5, hearing impairment, and the presence of systemic inflammatory response syndrome (SIRS), nursing home residence was independently associated with delirium in the ED (adjusted OR = 4.2, 95%CI: 1.8 – 9.7). Conclusion In the ED setting, nursing home patients were more likely to present with delirium, and this relationship persisted after adjusting for delirium risk factors. PMID:19484845

  20. Pharmacological and nonpharmacological management of delirium in critically ill patients.

    PubMed

    Hipp, Dustin M; Ely, E Wesley

    2012-01-01

    Delirium is a common yet under-diagnosed syndrome of acute brain dysfunction, which is characterized by inattention, fluctuating mental status, altered level of consciousness, or disorganized thinking. Although our recognition of risk factors for delirium has progressed, our understanding of the underlying pathophysiologic mechanisms remains limited. Improvements in monitoring and assessment for delirium (particularly in the intensive care setting) have resulted in validated and reliable tools such as arousal scales and bedside delirium monitoring instruments. Once delirium is recognized and the modifiable risk factors are addressed, the next step in management (if delirium persists) is often pharmacological intervention. The sedatives, analgesics, and hypnotics most often used in the intensive care unit (ICU) to achieve patient comfort are all too frequently deliriogenic, resulting in a longer duration of ICU and hospital stay, and increased costs. Therefore, identification of safe and efficacious agents to reduce the incidence, duration, and severity of ICU delirium is a hot topic in critical care. Recognizing that there are no medications approved by the Food and Drug Administration (FDA) for the prevention or treatment of delirium, we chose anti-psychotics and alpha-2 agonists as the general pharmacological focus of this article because both were subjects of relatively recent data and ongoing clinical trials. Emerging pharmacological strategies for addressing delirium must be combined with nonpharmacological approaches (such as daily spontaneous awakening trials and spontaneous breathing trials) and early mobility (combined with the increasingly popular approach called: Awakening and Breathing Coordination, Delirium Monitoring, Early Mobility, and Exercise [ABCDE] of critical care) to develop evidence-based approaches that will ensure safer and faster recovery of the sickest patients in our healthcare system. PMID:22270810

  1. [Effective Dexmedetomidine Administration for the Prevention of Emergence Agitation and Postoperative Delirium in Patients with a History of Postoperative Delirium].

    PubMed

    Fujisawa, Takanobu; Komasawa, Nobuyasu; Fujiwara, Atsushi; Kido, Haruki; Minami, Toshiaki

    2016-04-01

    We successfully performed intraoperative dexmedetomidine (DEX) administration for the prevention of emergence agitation or postoperative delirium after lung resection in four patients (71.3 ± 5.7 year old, 3 males and 1 female) with a past history of postoperative delirium. DEX was started at 0.35-0.45 μg x kg(-1) x hr(-1) continuously without loading. The average time from DEX initiation to extubation was 141.3 ± 94.4 minutes. No patient had emergence agitation, and DEX administration was continued until the following morning with monitoring in all patients without any symptoms of delirium. Intraoperative DEX administration may be beneficial for the prevention of emergence agitation or postoperative delirium in patients with a past history of postoperative delirium. PMID:27188116

  2. Pharmacological Risk Factors for Delirium after Cardiac Surgery: A Review

    PubMed Central

    Tse, Lurdes; Schwarz, Stephan KW; Bowering, John B; Moore, Randell L; Burns, Kyle D; Richford, Carole M; Osborn, Jill A; Barr, Alasdair M

    2012-01-01

    Purpose: The objective of this review is to evaluate the literature on medications associated with delirium after cardiac surgery and potential prophylactic agents for preventing it. Source: Articles were searched in MEDLINE, Cumulative Index to Nursing and Allied Health, and EMBASE with the MeSH headings: delirium, cardiac surgical procedures, and risk factors, and the keywords: delirium, cardiac surgery, risk factors, and drugs. Principle inclusion criteria include having patient samples receiving cardiac procedures on cardiopulmonary bypass, and using DSM-IV-TR criteria or a standardized tool for the diagnosis of delirium. Principal Findings: Fifteen studies were reviewed. Two single drugs (intraoperative fentanyl and ketamine), and two classes of drugs (preoperative antipsychotics and postoperative inotropes) were identified in the literature as being independently associated with delirium after cardiac surgery. Another seven classes of drugs (preoperative antihypertensives, anticholinergics, antidepressants, benzodiazepines, opioids, and statins, and postoperative opioids) and three single drugs (intraoperative diazepam, and postoperative dexmedetomidine and rivastigmine) have mixed findings. One drug (risperidone) has been shown to prevent delirium when taken immediately upon awakening from cardiac surgery. None of these findings was replicated in the studies reviewed. Conclusion: These studies have shown that drugs taken perioperatively by cardiac surgery patients need to be considered in delirium risk management strategies. While medications with direct neurological actions are clearly important, this review has shown that specific cardiovascular drugs may also require attention. Future studies that are methodologically consistent are required to further validate these findings and improve their utility. PMID:23449337

  3. Management of delirium in palliative care: a review.

    PubMed

    Grassi, Luigi; Caraceni, Augusto; Mitchell, Alex J; Nanni, Maria Giulia; Berardi, Maria Alejandra; Caruso, Rosangela; Riba, Michelle

    2015-03-01

    Delirium is a complex but common disorder in palliative care with a prevalence between 13 and 88 % but a particular frequency at the end of life (terminal delirium). By reviewing the most relevant studies (MEDLINE, EMBASE, PsycLit, PsycInfo, Cochrane Library), a correct assessment to make the diagnosis (e.g., DSM-5, delirium assessment tools), the identification of the possible etiological factors, and the application of multicomponent and integrated interventions were reported as the correct steps to effectively manage delirium in palliative care. In terms of medications, both conventional (e.g., haloperidol) and atypical antipsychotics (e.g., olanzapine, risperidone, quetiapine, aripiprazole) were shown to be equally effective in the treatment of delirium. No recommendation was possible in palliative care regarding the use of other drugs (e.g., α-2 receptors agonists, psychostimulants, cholinesterase inhibitors, melatonergic drugs). Non-pharmacological interventions (e.g., behavioral and educational) were also shown to be important in the management of delirium. More research is necessary to clarify how to more thoroughly manage delirium in palliative care. PMID:25663153

  4. Educational interventions to improve recognition of delirium: a systematic review.

    PubMed

    Yanamadala, Mamata; Wieland, Darryl; Heflin, Mitchell T

    2013-11-01

    Delirium is a common and serious condition that is underrecognized in older adults in a variety of healthcare settings. It is poorly recognized because of deficiencies in provider knowledge and its atypical presentation. Early recognition of delirium is warranted to better manage the disease and prevent the adverse outcomes associated with it. The purpose of this article is to review the literature concerning educational interventions focusing on recognition of delirium. The Medline and Cumulative Index to Nursing and Allied Health Literature (CINHAL) databases were searched for studies with specific educational focus in the recognition of delirium, and 26 studies with various designs were identified. The types of interventions used were classified according to the Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model, and outcomes were sorted according to Kirkpatrick's hierarchy. Educational strategies combining predisposing, enabling, and reinforcing factors achieved better results than strategies that included one or two of these components. Studies using predisposing, enabling, and reinforcing strategies together were more often effective in producing changes in staff behavior and participant outcomes. Based on this review, improvements in knowledge and skill alone seem insufficient to favorably influence recognition of delirium. Educational interventions to recognize delirium are most effective when formal teaching is interactive and is combined with strategies including engaging leadership and using clinical pathways and assessment tools. The goal of the current study was to systematically review the published literature to determine the effect of educational interventions on recognition of delirium. PMID:24219200

  5. [Delirium in patients with neurological diseases: diagnosis, management and prognosis].

    PubMed

    Hüfner, K; Sperner-Unterweger, B

    2014-04-01

    Delirium is a common acute neuropsychiatric syndrome. It is characterized by concurrent disturbances of consciousness and attention, perception, reasoning, memory, emotionality, the sleep-wake cycle as well as psychomotor symptoms. Delirium caused by alcohol or medication withdrawal is not the subject of the current review. Specific predisposing and precipitating factors have been identified in delirium which converge in a common final pathway of global brain dysfunction. The major predisposing factors are older age, cognitive impairment or dementia, sensory deficits, multimorbidity and polypharmacy. Delirium is always caused by one or more underlying pathologies which need to be identified. In neurology both primary triggers of delirium, such as stroke or epileptic seizures and also secondary triggers, such as metabolic factors or medication side effects play a major role. Nonpharmacological interventions are important in the prevention of delirium and lead to an improvement in prognosis. Delirium is associated with increased mortality and in the long term the development of cognitive deficits and functional impairment. PMID:24668399

  6. Detection of delirium by nurses among long-term care residents with dementia

    PubMed Central

    Voyer, Philippe; Richard, Sylvie; Doucet, Lise; Danjou, Christine; Carmichael, Pierre-Hugues

    2008-01-01

    Background Delirium is a prevalent problem in long-term care (LTC) facilities where advanced age and cognitive impairment represent two important risk factors for this condition. Delirium is associated with numerous negative outcomes including increased morbidity and mortality. Despite its clinical importance, delirium often goes unrecognized by nurses. Although rates of nurse-detected delirium have been studied among hospitalized older patients, this issue has been largely neglected among demented older residents in LTC settings. The goals of this study were to determine detection rates of delirium and delirium symptoms by nurses among elderly residents with dementia and to identify factors associated with undetected cases of delirium. Methods In this prospective study (N = 156), nurse ratings of delirium were compared to researcher ratings of delirium. This procedure was repeated for 6 delirium symptoms. Sensitivity, specificity, positive and negative predictive values were computed. Logistic regressions were conducted to identify factors associated with delirium that is undetected by nurses. Results Despite a high prevalence of delirium in this cohort (71.5%), nurses were able to detect the delirium in only a minority of cases (13%). Of the 134 residents not identified by nurses as having delirium, only 29.9% of them were correctly classified. Detection rates for the 6 delirium symptoms varied between 39.1% and 58.1%, indicating an overall under-recognition of symptoms of delirium. Only the age of the residents (≥ 85 yrs) was associated with undetected delirium (OR: 4.1; 90% CI: [1.5–11.0]). Conclusion Detection of delirium is a major issue for nurses that clearly needs to be addressed. Strategies to improve recognition of delirium could result in a reduction of adverse outcomes for this very vulnerable population. PMID:18302791

  7. Delirium prevention for cognitive, sensory, and mobility impairments.

    PubMed

    Robinson, Sherry; Rich, Catherine; Weitzel, Tina; Vollmer, Charlene; Eden, Brenda

    2008-01-01

    The purpose of this study was to determine the effectiveness of a protocol designed to prevent delirium in hospitalized elders with the risk factors of dementia and/or vision, hearing, and/or mobility impairments. A group of 80 patients with risk factors hospitalized before the protocol was implemented was matched with a group of 80 patients admitted after the implementation of the protocol. Records of patients in both groups were reviewed to identify patients with delirium. A significant reduction in delirium, from 37.5% to 13.8%, occurred in the elders receiving the protocol. PMID:18578220

  8. A case of Sheehan's syndrome with delirium.

    PubMed

    Umekawa, T; Yoshida, T; Sakane, N; Kondo, M

    1996-12-01

    A 53 year old woman was brought to a psychiatric clinic because of delirium. Upon immediate examination, severe hyponatremia (105 mEq/L) was detected. She was suspected of having internal diseases and referred to our university hospital. When she reached our hospital she was delirious and showed excitement and agitation. Her electroencephalogram showed low voltage theta waves (20 microV) in all leads. She was hospitalized and diagnosed with acute tonsillar abscess and panhypopituitarism based on various endocrine tests. Her past history suggested that Sheehan's syndrome had developed after child-bearing at age 31, resulting in panhypopituitarism. After administration of antibiotics, the fever and tonsillar abscess gradually recovered, and the correction of electrolytes improved the level of consciousness, suggesting that the hyponatremia had been closely related to the clouding of consciousness. As the subsequent administration of cortisol kept the patient's serum sodium levels within the normal range, a decrease in plasma cortisol seemed to be the major cause of the hyponatremia. Psychological symptoms of panhypopituitarism often included abulia, apathy and occasionally coma. However, it is rare for a patient with panhypopituitarism to be misdiagnosed as having a psychiatric disease with delirium. This rare case is presented. PMID:9014231

  9. Update on Pharmacotherapy for Prevention and Treatment of Post-operative Delirium: A Systematic Evidence Review

    PubMed Central

    Khan, Babar A.; Gutteridge, Daniel

    2015-01-01

    Delirium is highly prevalent among elderly post-operative patients with no pharmacological intervention approved by the Food and Drug Administration for prevention or treatment. We conducted a systematic evidence review to critically appraise literature related to the pharmacotherapy of post-operative delirium. Ten studies fulfilled our inclusion criteria with two interventions for delirium treatment and eight interventions for delirium prevention in post-operative patients. The quality of evidence of delirium treatment studies was poor, whereas the quality of evidence in delirium prevention studies ranges from moderate to high. Delirium treatment studies find similar delirium duration and length-of-stay outcomes between haloperidol and either morphine or ondansetron. Risperidone was found to reduce the conversion of sub-syndromal delirium to delirium in one study compared to placebo. Haloperidol, olanzapine, and ketamine were each found to reduce delirium incidence, whereas rivastigmine had no impact on delirium incidence or duration. Lighter anesthesia as monitored by bi-spectral index led to a decreased delirium incidence. Considering results from studies conducted prior to the dates of this review, the current evidence suggests that certain pharmacologic classes and lighter sedation using BIS monitoring may prevent post-operative delirium, although a conclusive recommendation for clinical practice must await further research. PMID:25729334

  10. [Delirium prevention and treatment in elderly hip fracture].

    PubMed

    Robles, María José; Formiga, Francesc; Vidán, M Teresa

    2014-04-22

    The fracture of the proximal femur or hip fracture in the elderly usually happens after a fall and carries a high morbidity and mortality. One of the most common complications during hospitalization for hip fracture is the onset of delirium or acute confusional state that in elderly patients has a negative impact on the hospital stay, and prognosis, worsening functional ability, cognitive status and mortality. Also the development of delirium during hospitalization increases health care costs. Strategies to prevent and treat delirium during hospitalization for hip fracture have been less studied. In this context, this paper aims to conduct a review of the literature on strategies that exist in the prevention and treatment of delirium in elderly patients with hip fracture. PMID:23790577

  11. Assessment of characteristics of patient with delirium tremens.

    PubMed

    Singh, P M; Shrestha, D M; Gautam, S C; Swar, S B; Joshi, N

    2012-09-01

    Delirium tremens is the severe form of alcohol withdrawal. It carries a certain degree of mortality and there has been and advancement in the understanding of pathophysiology and risk factors for the development of the condition. This prospective study is carried out to study the characteristic of the patient of delirium tremens in our setting using ICD-10 diagnostic criteria. Thirty seven cases of delirium tremens with majority of males and of all hill origin people were identified. Patients with delirium tremens has been using alcohol for average of 24.8 years with an average intake of around 2.2 litres per day. Most of the patient has seizure and similar episodes in past and using alcohol from morning time. PMID:24047019

  12. Delirium Research | NIH MedlinePlus the Magazine

    MedlinePlus

    ... hospital, had a serious fall and sustained multiple hip fractures that required emergency hip replacement surgery to repair. ... Alice and her sister rapidly educated themselves on delirium and became powerful advocates for their father's care— ...

  13. Antipsychotics Don't Ease Delirium in Hospitalized Patients

    MedlinePlus

    ... a patient with delirium," said lead researcher Dr. Karin Neufeld, clinical director of psychiatry at Johns Hopkins ... obvious, but they are important," he added. SOURCES: Karin Neufeld, M.D., M.P.H., clinical director, ...

  14. Hypovitaminosis D in Delirium: a Retrospective Cross-sectional Study

    PubMed Central

    Ford, Jennifer; Hategan, Ana; Bourgeois, James A.; Tisi, Daniel K.; Xiong, Glen L.

    2013-01-01

    Background As vitamin D may have a neuroprotective effect, the authors studied the association of biomarkers of vitamin D status and delirium to see if low vitamin D status was common in delirium cases. Methods Biochemical measures of vitamin D (25-hydroxyvitamin D [25-OHD]) and calcium metabolism were used in this retrospective cross-sectional analysis of adult in-patients with delirium, admitted at three Canadian academic hospitals from January 2011 to July 2012. Primary outcome was to determine estimates of the prevalence of hypovitaminosis D in this group in whom vitamin D was checked. Results Seventy-one (5.8%) out of 1,232 delirium inpatients had their vitamin D measured. Thirty-nine (55%) showed vitamin D insufficiency (25-OHD of 25-75 nmol/L) and 8 (11%) showed vitamin D deficiency (25-OHD < 25 nmol/L). Mean serum 25-OHD levels were lower in males (57.1±7.7 nmol/L) than in females (78.2±6.1 nmol/L), p = .01, even when controlled for age and season. Men were younger than the women (74.4±2.3 vs. 82.4±1.7, p = .005). Mean age was 78.7±1.5 years, and 33 (47%) were male. Conclusions Although vitamin D is rarely checked during delirium workup and/or management, high rates of hypovitaminosis D were found to be common in the delirium in-patients in whom it was checked. Larger studies would be needed to estimate the prevalence of hypovitaminosis D in delirium and whether hypovitaminosis D plays a role in the pathogenesis of delirium. PMID:24278095

  15. Inflammation biomarkers and delirium in critically ill patients

    PubMed Central

    2014-01-01

    Introduction Delirium is a common occurrence in critically ill patients and is associated with an increase in morbidity and mortality. Septic patients with delirium may differ from a general critically ill population. The aim of this investigation was to study the relationship between systemic inflammation and the development of delirium in septic and non-septic critically ill patients. Methods We performed a prospective cohort study in a 20-bed mixed intensive care unit (ICU) including 78 (delirium = 31; non-delirium = 47) consecutive patients admitted for more than 24 hours. At enrollment, patients were allocated to septic or non-septic groups according to internationally agreed criteria. Delirium was diagnosed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) during the first 72 hours of ICU admission. Blood samples were collected within 12 hours of enrollment for determination of tumor necrosis factor (TNF)-α, soluble TNF Receptor (STNFR)-1 and -2, interleukin (IL)-1β, IL-6, IL-10 and adiponectin. Results Out of all analyzed biomarkers, only STNFR1 (P = 0.003), STNFR2 (P = 0.005), adiponectin (P = 0.005) and IL-1β (P < 0.001) levels were higher in delirium patients. Adjusting for sepsis and sedation, these biomarkers were also independently associated with delirium occurrence. However, none of them were significant influenced by sepsis. Conclusions STNFR1, STNFR2, adiponectin and IL-1β were associated with delirium. Sepsis did not modify the relationship between the biomarkers and delirium occurrence. PMID:24886875

  16. Symptoms of Posttraumatic Stress after Intensive Care Delirium

    PubMed Central

    Svenningsen, Helle; Egerod, Ingrid; Christensen, Doris; Tønnesen, Else Kirstine; Frydenberg, Morten; Videbech, Poul

    2015-01-01

    Introduction. Long-term psychological consequences of critical illness are receiving more attention in recent years. The aim of our study was to assess the correlation of ICU-delirium and symptoms of posttraumatic stress disorder (PTSD) anxiety and depression after ICU-discharge in a Danish cohort. Methods. A prospective observational cohort study assessing the incidence of delirium in the ICU. Psychometrics were screened by validated tools in structured telephone interviews after 2 months (n = 297) and 6 months (n = 248) after ICU-discharge. Results. Delirium was detected in 54% of patients in the ICU and symptoms of PTSD in 8% (2 months) and 6% (6 months) after ICU-discharge. Recall of ICU stay was present in 93%. Associations between ICU-delirium and post-discharge PTSD-symptoms were weak and insignificant. Memories of delusions were significantly associated with anxiety after two months. Remaining associations between types of ICU-memories and prevalence of post-discharge symptoms of PTSD, anxiety, and depression were insignificant after adjusting for age. Incidence of ICU-delirium was unaffected by preadmission use of psychotropic drugs. Prevalence of PTSD-symptoms was unaffected by use of antipsychotics and sedation in the ICU. Conclusion. ICU-delirium did not increase the risk of PTSD-symptoms at 2 and 6 months after ICU discharge. PMID:26557708

  17. Biomarkers of postoperative delirium and cognitive dysfunction

    PubMed Central

    Androsova, Ganna; Krause, Roland; Winterer, Georg; Schneider, Reinhard

    2015-01-01

    Elderly surgical patients frequently experience postoperative delirium (POD) and the subsequent development of postoperative cognitive dysfunction (POCD). Clinical features include deterioration in cognition, disturbance in attention and reduced awareness of the environment and result in higher morbidity, mortality and greater utilization of social financial assistance. The aging Western societies can expect an increase in the incidence of POD and POCD. The underlying pathophysiological mechanisms have been studied on the molecular level albeit with unsatisfying small research efforts given their societal burden. Here, we review the known physiological and immunological changes and genetic risk factors, identify candidates for further studies and integrate the information into a draft network for exploration on a systems level. The pathogenesis of these postoperative cognitive impairments is multifactorial; application of integrated systems biology has the potential to reconstruct the underlying network of molecular mechanisms and help in the identification of prognostic and diagnostic biomarkers. PMID:26106326

  18. Digging Into the Mysteries of Delirium | NIH MedlinePlus the Magazine

    MedlinePlus

    ... delirium affect older Americans more often than their younger counterparts? Why? It does. It appears to be ... adults tend to get delirium more often than younger adults—although younger adults are subject to developing ...

  19. A new delirium phenotype with rapid high amplitude onset and nearly as rapid reversal: Central Coast Australia Delirium Intervention Study

    PubMed Central

    Regal, Paul J

    2015-01-01

    Background Traditional models for delirium based on the Diagnostic and Statistical Manual for Mental Disorders and its 1990 offspring, the Confusion Assessment Method (CAM), were not designed to distinguish behavioral and psychological symptoms of dementia from rapid cognitive decline. We examined a new diagnostic criterion for delirium plus exclusion of behavioral and psychological symptoms of dementia and recent inattention with a 25% decline in digit span forward (DSF). Methods This was a prospective, randomized controlled trial comparing management of prevalent delirium in general medical with that in geriatric medical wards in a 370-bed hospital north of Sydney. Inclusion criteria were age ≥65 years and prevalent delirium in the emergency department based on: CAM; proof that CAM elements were not better explained by behavioral and psychological symptoms of dementia; proof of recent inattention on DSF; evidence of cognitive decline not due to sedatives or antipsychotics in the emergency department. Measurements included the Instrumental Activities of Daily Living (IADL, 22-item), Selective IADL (8-item), Mini-Mental State Examination, DSF daily, Delirium Index daily, and Apathy Evaluation Scale. Pre-delirium scores from past cognitive tests and best scores were imputed after admission. Relative change (RC) was calculated as absolute change/test range and RC/MPC ratio was calculated as RC after admission/maximal possible change. Results A total of 130 subjects were recruited but 14 with subsyndromal delirium were excluded, leaving 116 subjects (mean age 83.6 years). Forty-eight percent had prior dementia. RC from pre-delirium to admission was 42% for the Mini-Mental State Examination, 41% for Selective IADL, 34% for 5-DSF, 54% for 6-DSF, and 37% for the Apathy Evaluation Scale. Improvements after admission (RC and RC/MPC ratios) were 32%/98% for 5-DSF, 54%/82% for 6-DSF, and 45%/80% for the Delirium Index. General medicine and geriatric medicine groups had

  20. Delirium in Prolonged Hospitalized Patients in the Intensive Care Unit

    PubMed Central

    Vahedian Azimi, Amir; Ebadi, Abbas; Ahmadi, Fazlollah; Saadat, Soheil

    2015-01-01

    Background: Prolonged hospitalization in the intensive care unit (ICU) can impose long-term psychological effects on patients. One of the most significant psychological effects from prolonged hospitalization is delirium. Objectives: The aim of this study was to assess the effect of prolonged hospitalization of patients and subsequent delirium in the intensive care unit. Patients and Methods: This conventional content analysis study was conducted in the General Intensive Care Unit of the Shariati Hospital of Tehran University of Medical Sciences, from the beginning of 2013 to 2014. All prolonged hospitalized patients and their families were eligible participants. From the 34 eligible patients and 63 family members, the final numbers of actual patients and family members were 9 and 16, respectively. Several semi-structured interviews were conducted face-to-face with patients and their families in a private room and data were gathered. Results: Two main themes from two different perspectives emerged, 'patients' perspectives' (experiences during ICU hospitalization) and 'family members' perspectives' (supportive-communicational experiences). The main results of this study focused on delirium, Patients' findings were described as pleasant and unpleasant, factual and delusional experiences. Conclusions: Family members are valuable components in the therapeutic process of delirium. Effective use of family members in the delirium caring process can be considered to be one of the key non-medical nursing components in the therapeutic process. PMID:26290854

  1. Elderly patients with a hip fracture: the risk for delirium.

    PubMed

    Schuurmans, Marieke J; Duursma, Sijmen A; Shortridge-Baggett, Lillie M; Clevers, Gert-Jan; Pel-Littel, Ruth

    2003-05-01

    This prospective study investigated risk factors for delirium in elderly hip fracture patients that could be recognized by nurses. Data were collected on predisposing and precipitating factors for delirium from 92 elderly patients with a hip fracture. Predisposing factors included age, gender, sensory impairments, functional impairment before the hip fracture, residency before admission, pre-existing cognitive impairment, comorbidities, and medication use. Precipitating factors included factors related to surgery and to the postoperative period. Factors related to surgery included time between admission and surgery, type of surgery, type of anesthesia, duration of surgery and anesthesia, and complications during surgery. Factors studied in the postoperative period were slow recovery, malnutrition, dehydration, addition of three or more medications, introduction of bladder catheter, infections, complications and falls, and use of morphine. Eighteen patients developed delirium, as diagnosed by a geriatrician by using the Diagnostic Statistical Manual-IV criteria. Data on delirious patients were compared with the data on non-delirious patients. The findings confirm that elderly hip fracture patients with premorbid ADL dependency, psychiatric comorbidities (including dementia), and a high number of other comorbid problems are at risk for the development of delirium. Based on these findings, it is recommended that nurses should assess patients' pre-fracture functional and cognitive capacities in an early stage of the hospital stay. Nurses should also be alert to postoperative delirium in "healthy elderly" patients. Monitoring of symptoms postoperatively in all elderly patients is advised. PMID:12764718

  2. A clinical perspective of sepsis-associated delirium.

    PubMed

    Tsuruta, Ryosuke; Oda, Yasutaka

    2016-01-01

    The term sepsis-associated encephalopathy (SAE) has been applied to animal models, postmortem studies in patients, and severe cases of sepsis. SAE is considered to include all types of brain dysfunction, including delirium, coma, seizure, and focal neurological signs. Clinical data for sepsis-associated delirium (SAD) have been accumulating since the establishment of definitions of coma or delirium and the introduction of validated screening tools. Some preliminary studies have examined the etiology of SAD. Neuroinflammation, abnormal cerebral perfusion, and neurotransmitter imbalances are the main mechanisms underlying the development of SAD. However, there are still no specific diagnostic blood, electrophysiological, or imaging tests or treatments specific for SAD. The duration of delirium in intensive care patients is associated with long-term functional disability and cognitive impairment, although this syndrome usually reverses after the successful treatment of sepsis. Once the respiratory and hemodynamic states are stabilized, patients with severe sepsis or septic shock should receive rehabilitation as soon as possible because early initiation of rehabilitation can reduce the duration of delirium. We expect to see further pathophysiological data and the development of novel treatments for SAD now that reliable and consistent definitions of SAD have been established. PMID:27011789

  3. Delirium in the elderly: current problems with increasing geriatric age

    PubMed Central

    Kukreja, Deepti; Günther, Ulf; Popp, Julius

    2015-01-01

    Delirium is an acute disorder of attention and cognition seen relatively commonly in people aged 65 yr or older. The prevalence is estimated to be between 11 and 42 per cent for elderly patients on medical wards. The prevalence is also high in nursing homes and long term care (LTC) facilities. The consequences of delirium could be significant such as an increase in mortality in the hospital, long-term cognitive decline, loss of autonomy and increased risk to be institutionalized. Despite being a common condition, it remains under-recognised, poorly understood and not adequately managed. Advanced age and dementia are the most important risk factors. Pain, dehydration, infections, stroke and metabolic disturbances, and surgery are the most common triggering factors. Delirium is preventable in a large proportion of cases and therefore, it is also important from a public health perspective for interventions to reduce further complications and the substantial costs associated with these. Since the aetiology is, in most cases, multfactorial, it is important to consider a multi-component approach to management, both pharmacological and non-pharmacological. Detection and treatment of triggering causes must have high priority in case of delirium. The aim of this review is to highlight the importance of delirium in the elderly population, given the increasing numbers of ageing people as well as increasing geriatric age. PMID:26831414

  4. Risk Factors and Outcomes for Postoperative Delirium after Major Surgery in Elderly Patients

    PubMed Central

    Raats, Jelle W.; van Eijsden, Wilbert A.; Crolla, Rogier M. P. H.; Steyerberg, Ewout W.; van der Laan, Lijckle

    2015-01-01

    Background Early identification of patients at risk for delirium is important, since adequate well timed interventions could prevent occurrence of delirium and related detrimental outcomes. The aim of this study is to evaluate prognostic factors for delirium, including factors describing frailty, in elderly patients undergoing major surgery. Methods We included patients of 65 years and older, who underwent elective surgery from March 2013 to November 2014. Patients had surgery for Abdominal Aortic Aneurysm (AAA) or colorectal cancer. Delirium was scored prospectively using the Delirium Observation Screening Scale. Pre- and peri-operative predictors of delirium were analyzed using regression analysis. Outcomes after delirium included adverse events, length of hospital stay, discharge destination and mortality. Results We included 232 patients. 51 (22%) underwent surgery for AAA and 181 (78%) for colorectal cancer. Postoperative delirium occurred in 35 patients (15%). Predictors of postoperative delirium included: delirium in medical history (Odds Ratio 12 [95% Confidence Interval 2.7–50]), advancing age (Odds Ratio 2.0 [95% Confidence Interval 1.1–3.8]) per 10 years, and ASA-score ≥3 (Odds Ratio 2.6 [95% Confidence Interval 1.1–5.9]). Occurrence of delirium was related to an increase in adverse events, length of hospital stay and mortality. Conclusion Postoperative delirium is a frequent complication after major surgery in elderly patients and is related to an increase in adverse events, length of hospital stay, and mortality. A delirium in the medical history, advanced age, and ASA-score may assist in defining patients at increased risk for delirium. Further attention to prevention of delirium is essential in elderly patients undergoing major surgery. PMID:26291459

  5. Nonpharmacological interventions to prevent delirium: an evidence-based systematic review.

    PubMed

    Rivosecchi, Ryan M; Smithburger, Pamela L; Svec, Susan; Campbell, Shauna; Kane-Gill, Sandra L

    2015-02-01

    Development of delirium in critical care patients is associated with increased length of stay, hospital costs, and mortality. Delirium occurs across all inpatient settings, although critically ill patients who require mechanical ventilation are at the highest risk. Overall, evidence to support the use of antipsychotics to either prevent or treat delirium is lacking, and these medications can have adverse effects. The pain, agitation, and delirium guidelines of the American College of Critical Care Medicine provide the strongest level of recommendation for the use of nonpharmacological approaches to prevent delirium, but questions remain about which nonpharmacological interventions are beneficial. PMID:25639576

  6. From Antiquity to the N-Methyl-D-Aspartate Receptor: A History of Delirium Tremens.

    PubMed

    Porcel, F J Rodriguez; Schutta, H S

    2015-01-01

    Delirium associated with excessive alcohol consumption has been known since antiquity. This condition became more common as the supply of distilled fermented liquors increased. Delirium, including delirium associated with excessive alcohol consumption, was for many centuries regarded as a form of brain inflammation - "phrenitis" - and was treated with depletion. At the end of the eighteenth century treatment by depletion of alcohol-related delirium began to be replaced by sedation and led to significantly better outcomes. Thomas Sutton established that alcohol-related delirium was a disease sui generis, distinct from phrenitis, and he named it delirium tremens. Because historical accounts of this disease are rare, brief, and not easily accessible, we offer this account of events that culminated in the discovery of the molecular basis of delirium tremens. PMID:26444921

  7. Pain Assessment in Hospitalized Older Adults With Dementia and Delirium

    PubMed Central

    Paulson, Christina May; Monroe, Todd; Mion, Lorraine C.

    2015-01-01

    Pain can have negative effects leading to prolonged hospital stays. Determining the presence of uncontrolled and untreated pain in patients with cognitive impairments such as delirium, dementia, and delirium superimposed on dementia (DSD) is challenging. One tool commonly suggested for use in assessment of pain in older adults with cognitive impairment is the Pain Assessment In Advanced Dementia (PAINAD) scale. Proper use of the PAINAD scale as part of a comprehensive pain management plan can help reduce the likelihood of a patient experiencing unrecognized and untreated pain. Using an individual example, this article illustrates best practices in pain assessment and management for a woman experiencing DSD during an acute hospitalization. PMID:24800815

  8. Sepsis associated delirium mimicking postoperative delirium as the initial presenting symptom of urosepsis in a patient who underwent nephrolithotomy

    PubMed Central

    Nag, Deb Sanjay; Chatterjee, Abhishek; Samaddar, Devi Prasad; Singh, Harprit

    2016-01-01

    We report a case of 70 years old male who underwent percutaneous nephrolithotomy for renal calculi. After an uneventful recovery from anaesthesia, the patient developed delirium which manifested as restlessness, agitation, irritability and combative behavior. All other clinical parameters including arterial blood gas, chest X-ray and core temperature were normal and the patient remained haemodynamically stable. But 45 min later the patient developed florid manifestations of septic shock. He was aggressively managed in a protocolized manner as per the Surviving Sepsis Guidelines in the Critical Care Unit and recovered completely. There are no case reports showing postoperative delirium as the only initial presentation of severe sepsis, with other clinical parameters remaining normal. Both urosepsis and sepsis associated delirium have very high mortality. High index of suspicion and a protocolized approach in the management of sepsis can save lives. PMID:27182528

  9. Sepsis associated delirium mimicking postoperative delirium as the initial presenting symptom of urosepsis in a patient who underwent nephrolithotomy.

    PubMed

    Nag, Deb Sanjay; Chatterjee, Abhishek; Samaddar, Devi Prasad; Singh, Harprit

    2016-05-16

    We report a case of 70 years old male who underwent percutaneous nephrolithotomy for renal calculi. After an uneventful recovery from anaesthesia, the patient developed delirium which manifested as restlessness, agitation, irritability and combative behavior. All other clinical parameters including arterial blood gas, chest X-ray and core temperature were normal and the patient remained haemodynamically stable. But 45 min later the patient developed florid manifestations of septic shock. He was aggressively managed in a protocolized manner as per the Surviving Sepsis Guidelines in the Critical Care Unit and recovered completely. There are no case reports showing postoperative delirium as the only initial presentation of severe sepsis, with other clinical parameters remaining normal. Both urosepsis and sepsis associated delirium have very high mortality. High index of suspicion and a protocolized approach in the management of sepsis can save lives. PMID:27182528

  10. Risk of Pre-and Post-Operative Delirium and the Delirium Elderly At Risk (DEAR) Tool in Hip Fracture Patients

    PubMed Central

    Freter, Susan; Dunbar, Michael; Koller, Katalin; MacKnight, Chris; Rockwood, Kenneth

    2015-01-01

    Background and Purpose Delirium is common after hip fracture. Previous work has shown that a simple delirium risk factor tool, the Delirium Elderly At Risk instrument (DEAR), has a high inter-rater reliability in this population. Little research has looked at the ability of risk factor screening tools to identify patients at high risk of pre-operative delirium. This study investigates the ability of the DEAR to identify patients at high risk of pre-operative delirium, as well as reporting its performance in a post-operative validation sample. Associations between delirium risk factors and pre-operative delirium are explored. Methods This prospective cohort study took place on an orthopedic in-patient service at a University-affiliated tertiary care hospital. Patients aged 65 and older who were admitted for surgical repair of hip fracture (N = 283) were assessed pre-operatively for 5 delirium risk factors (cognitive impairment, sensory impairment, functional dependence, substance use, age) using the DEAR. Patients were assessed for delirium using the Mini-Mental State Examination and the Confusion Assessment Method pre-operatively and on post-operative days 1, 3 and 5. Characteristics of patients who developed delirium were compared with the characteristics of those who did not. Results Delirium was present in 58% (95% CI = 52–63%) of patients pre-operatively and 42% (95% CI = 36–48%) post-operatively. Individually, sensory impairment (χ2 = 21.7, p = .0001), functional dependence (χ2 = 24.1, p = .0001), cognitive impairment (χ2 = 55.5, p = .0001) and substance use (χ2 = 7.5, p = .007) were significantly associated with pre-operative delirium, as was wait-time for surgery (t = 3.1, p = .003) and length of stay (t = 2.8, p =.03). In multivariate modeling, the strongest association with pre-operative delirium was cognitive impairment. Conclusions The DEAR, a simple, delirium risk factor screening tool, can be used to identify hip fracture patients at risk of

  11. Randomized Trial of a Delirium Abatement Program for Post-acute Skilled Nursing Facilities

    PubMed Central

    Marcantonio, Edward R.; Bergmann, Margaret A.; Kiely, Dan K.; Orav, E John; Jones, Richard N.

    2010-01-01

    Objectives To determine whether a Delirium Abatement Program (DAP) can shorten the duration of delirium among new admissions to post-acute care (PAC). Design Cluster randomized controlled trial. Setting Eight skilled nursing facilities specializing in PAC within a single metropolitan region. Participants Four hundred fifty-seven participants with delirium at PAC admission. Intervention The DAP consisted of four steps: 1) assessment for delirium within 5 days of PAC admission, 2) assessment and correction of common reversible causes of delirium, 3) prevention of complications of delirium, and 4) restoration of function. Measurements Eligible patients were screened by trained researchers. Those with Confusion Assessment Method defined delirium were eligible for participation via proxy consent. Two weeks and one month after enrollment, regardless of location, participants were re-assessed for delirium by researchers blind to intervention status. Results Nurses at DAP sites detected delirium in 41% of participants vs. 12% in usual care (UC) sites (p<.001) and completed DAP documentation in most delirium-detected participants. However, the DAP intervention had no impact on delirium persistence based on two measurements at 2 weeks (DAP 68% vs. UC 66%) and 1 month (DAP 60% vs. UC 51%), adjusted p values ≥ 0.20. Adjusting for baseline differences between DAP and UC participants and restricting analysis to delirium-detected DAP participants did not alter the results. Conclusion Detection of delirium improved at the DAP sites, however, the DAP had no impact on the persistence of delirium. This effectiveness trial demonstrated that a nurse-led DAP intervention was not effective in typical PAC facilities. PMID:20487083

  12. Delirium in Older Emergency Department Patients: Recognition, Risk Factors, and Psychomotor Subtypes

    PubMed Central

    Han, Jin H.; Zimmerman, Eli E.; Cutler, Nathan; Schnelle, John; Morandi, Alessandro; Dittus, Robert S.; Storrow, Alan B.; Ely, E. Wesley

    2016-01-01

    Objectives Missing delirium in the emergency department (ED) has been described as a medical error, yet this diagnosis is frequently unrecognized by emergency physicians. Identifying a subset of patients at high risk for delirium may improve delirium screening compliance by emergency physicians. We sought 1) to determine how often delirium is missed in the ED and how often these missed cases are detected by admitting hospital physicians at the time of admission, 2) to identify delirium risk factors in older ED patients, and 3) to characterize delirium by psychomotor subtypes in the ED setting. Methods This cross-sectional study was a convenience sample of patients conducted at a tertiary care, academic ED. English speaking patients who were 65 years and older and present in the ED for less than 12 hours at the time of enrollment were included. Patients were excluded if they refused consent, were previously enrolled, had severe dementia, were unarousable to verbal stimuli for all delirium assessments, or had incomplete data. Delirium status was determined by using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) administered by trained research assistants. Recognition of delirium by emergency and hospital physicians was determined from the medical record, blinded to CAM-ICU status. Multivariable logistic regression was used to identify independent delirium risk factors. The Richmond Agitation and Sedation Scale was used to classify delirium by its psychomotor subtypes. Results Inclusion and exclusion criteria were met in 303 patients and 25 (8.3%) presented to the ED with delirium. The vast majority (92.0%, 95%CI: 74.0% - 99.0%) of delirious patients had the hypoactive psychomotor subtype. Of the 25 patients with delirium, 19 (76.0%, 95%CI: 54.9% - 90.6%) were not recognized to be delirious by the emergency physician. Of the 16 admitted delirious patients who were undiagnosed by the emergency physicians, 15 (93.8%, 95%CI: 69.8% - 99.8%) remained

  13. Differential Diagnosis in Older Adults: Dementia, Depression, and Delirium.

    ERIC Educational Resources Information Center

    Gintner, Gary G.

    1995-01-01

    Examines three common disorders, dementia, depression, and delirium, which can be particularly difficult to diagnose in older adults. Presents three aspects that are helpful in making a decision: age-related differences, medical issues that need to be ruled out, and assessment methods particularly useful in the diagnostic process. (JPS)

  14. Effect of postoperative delirium on outcome after hip fracture.

    PubMed

    Edelstein, David M; Aharonoff, Gina B; Karp, Adam; Capla, Edward L; Zuckerman, Joseph D; Koval, Kenneth J

    2004-05-01

    Nine-hundred twenty-one community-dwelling patients 65 years of age or older, who sustained an operatively treated hip fracture from July 1, 1987 to June 30, 1998 were followed up for the development of postoperative delirium. The outcomes examined in the current study were postoperative complication rates, in-hospital mortality, hospital length of stay, hospital discharge status, 1-year mortality rate, place of residence, recovery of ambulatory ability, and activities of daily living 1 year after surgery. Forty-seven (5.1%) patients were diagnosed with postoperative delirium. Patients who had delirium develop were more likely to be male, have a history of mild dementia, and have had surgery under general anesthesia. Patients who had postoperative delirium develop had a significantly longer length of hospitalization. They also had significantly higher rates of mortality at 1 year, were less likely to recover their prefracture level of ambulation, and were more likely to show a decline in level of independence in basic activities of daily living at the 1-year followup. There was no difference in the rate of postoperative complications, in-hospital mortality, discharge residence, and recovery of instrumental activities of daily living at 1 year. PMID:15187857

  15. Proteomic and epigenomic markers of sepsis-induced delirium (SID)

    PubMed Central

    Sfera, Adonis; Price, Amy I.; Gradini, Roberto; Cummings, Michael; Osorio, Carolina

    2015-01-01

    In elderly population sepsis is one of the leading causes of intensive care unit (ICU) admissions in the United States. Sepsis-induced delirium (SID) is the most frequent cause of delirium in ICU (Martin et al., 2010). Together delirium and SID represent under-recognized public health problems which place an increasing financial burden on the US health care system, currently estimated at 143–152 billion dollars per year (Leslie et al., 2008). The interest in SID was recently reignited as it was demonstrated that, contrary to prior beliefs, cognitive deficits induced by this condition may be irreversible and lead to dementia (Pandharipande et al., 2013; Brummel et al., 2014). Conversely, it is construed that diagnosing SID early or mitigating its full blown manifestations may preempt geriatric cognitive disorders. Biological markers specific for sepsis and SID would facilitate the development of potential therapies, monitor the disease process and at the same time enable elderly individuals to make better informed decisions regarding surgeries which may pose the risk of complications, including sepsis and delirium. This article proposes a battery of peripheral blood markers to be used for diagnostic and prognostic purposes in sepsis and SID. Though each individual marker may not be specific enough, we believe that together as a battery they may achieve the necessary accuracy to answer two important questions: who may be vulnerable to the development of sepsis, and who may develop SID and irreversible cognitive deficits following sepsis? PMID:26579527

  16. Proteomic and epigenomic markers of sepsis-induced delirium (SID).

    PubMed

    Sfera, Adonis; Price, Amy I; Gradini, Roberto; Cummings, Michael; Osorio, Carolina

    2015-01-01

    In elderly population sepsis is one of the leading causes of intensive care unit (ICU) admissions in the United States. Sepsis-induced delirium (SID) is the most frequent cause of delirium in ICU (Martin et al., 2010). Together delirium and SID represent under-recognized public health problems which place an increasing financial burden on the US health care system, currently estimated at 143-152 billion dollars per year (Leslie et al., 2008). The interest in SID was recently reignited as it was demonstrated that, contrary to prior beliefs, cognitive deficits induced by this condition may be irreversible and lead to dementia (Pandharipande et al., 2013; Brummel et al., 2014). Conversely, it is construed that diagnosing SID early or mitigating its full blown manifestations may preempt geriatric cognitive disorders. Biological markers specific for sepsis and SID would facilitate the development of potential therapies, monitor the disease process and at the same time enable elderly individuals to make better informed decisions regarding surgeries which may pose the risk of complications, including sepsis and delirium. This article proposes a battery of peripheral blood markers to be used for diagnostic and prognostic purposes in sepsis and SID. Though each individual marker may not be specific enough, we believe that together as a battery they may achieve the necessary accuracy to answer two important questions: who may be vulnerable to the development of sepsis, and who may develop SID and irreversible cognitive deficits following sepsis? PMID:26579527

  17. [Summary of the Dutch College of General Practitioners' practice guideline 'Delirium in elderly people'].

    PubMed

    van der Weele, G M; Olde Rikkert, M G M; Eizenga, W H; Assendelft, W J J

    2003-05-17

    The Dutch College of General Practitioners' practice guideline 'Delirium in elderly people' contains a number of key messages. These are: Consider the diagnosis of delirium in the case of changes in consciousness and attention, incoherent thinking or disorientation, if this picture developed over a short period of time (hours to days) and if the symptoms vary over the 24-hour period. Delirium is provoked by one or more somatic disorders; investigation and treatment of these disorders is an essential part of managing delirium. It is often difficult to distinguish delirium from dementia and depression. Although delirium is generally reversible, the prognosis in the elderly is relatively poor. If delirium is accompanied by fear or agitation, haloperidol is the drug of first choice, but in delirium induced by alcohol withdrawal or benzodiazepine withdrawal, a short-acting benzodiazepine such as lorazepam or oxazepam is indicated. Part of the treatment, but also prevention of delirium is focused on inducing factors that can provoke a delirium, such as medication with an anticholinergic effect, polypharmacy, inadequate nutrition, dehydration, sleep deprivation, immobility and sensory handicaps. PMID:12784530

  18. Prevalence of Delirium in Opium Users after Coronary Artery Bypass Graft Surgery

    PubMed Central

    Eizadi-Mood, Nastaran; Aghadavoudi, Omid; Najarzadegan, Mohammad Reza; Fard, Masoud Mozhdehi

    2014-01-01

    Background: Postoperative cognitive dysfunction, especially delirium commonly occurs after cardiac surgery. Clinical evidences suggest an increase in delirium in opium abusers after Coronary Artery Bypass Graft (CABG) surgery. In this study, the prevalence of delirium in addict (opium user) and nonaddict patients after CABG were compared. Methods: In a cross-sectional study after obtaining institutional approval and informed consent, 325 patients candidate for elective CABG were included in the study. All patients with history of opium abuse met the criteria for opioid dependence using Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition definitions. Delirium after CABG was assessed in addict (opium user) and nonaddict patients up to a maximum of 5 days after surgery with the Intensive Care Delirium Screening Checklist. Results: A total of 325 patients were evaluated (208 without and 117 with a history of opium abuse). Postoperative delirium occurred within 72 h after surgery in 44.31% of all patients. There was a significant difference in the prevalence of postoperative delirium between the opium users (80.7%) and nonaddict patients (25%) in the intensive care unit (P < 0.001). Opium addiction was a risk factor for postoperative delirium after CABG Surgery. Conclusions: Delirium after CABG surgery is more prevalent in opium users compared with nonaddict patients. Therefore, opium abuse is a possible risk factor for postoperative delirium in cardiac surgical patients. PMID:25105003

  19. A Family-Focused Delirium Educational Initiative With Practice and Research Implications

    PubMed Central

    Paulson, Christina May; Monroe, Todd; Mcdougall, Graham J.; Fick, Donna M.

    2015-01-01

    Delirium is burdensome and psychologically distressing for formal and informal caregivers, yet family caregivers often have very little understanding or knowledge about delirium. As part of a large multisite intervention study, the Early Nurse Detection of Delirium Superimposed on Dementia (END-DSD), the authors identified a need for family educational materials. This educational initiative’s purpose was to develop a delirium admission brochure for family members to aid in the prevention and earlier identification of delirium during hospitalization. A brochure was developed using an iterative approach with an expert panel. Following three iterations, a final brochure was approved. The authors found that an iterative expert consensus approach can be used to develop a brochure for families. Major content areas were helping families understand the difference between delirium and dementia, signs and symptoms of delirium, causes of delirium, and strategies family members can use to prevent delirium. A caregiver-focused educational brochure is one intervention to use in targeting older adults hospitalized with delirium. PMID:26165565

  20. Symptom profile of postoperative delirium in patients with and without dementia.

    PubMed

    Lundström, Maria; Stenvall, Michael; Olofsson, Birgitta

    2012-09-01

    This study compares the symptom profile of patients with postoperative delirium after femoral neck fracture surgery in those with and without dementia. In this study, 129 patients of age ≥70 years (mean age ±SD, 86±6 yr, 72% women) with postoperative delirium, were included. Delirium and dementia were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Of the 129 patients with delirium, 54 (42%) had a dementia disorder. Patients with delirium superimposed on dementia more often had any hyperactive and pure emotional delirium. Communication difficulties and symptoms such as restlessness/agitation, aggressive behavior, and irritability were more commonly found in the dementia group. In contrast, patients with delirium but without dementia were more often diagnosed with pure hypoactive and any psychotic delirium. The symptom profile of postoperative delirium varies according to whether it occurs in patients with or without dementia. This may indicate that postoperative delirium among patients with hip fracture differs based on the presence or absence of dementia. PMID:23124010

  1. [Emergence delirium in children - prophylaxis and treatment].

    PubMed

    Wermelt, Julius Z; Ellerkmann, Richard K

    2016-07-01

    Emergence Delirium in children after general anesthesia is a common and self limitating event. Although it might be seen as being harmless it can cause other serious complications and might leave both parents and other caregivers with a negative impression behind. Although the cause may still not be clear, potential predictors can be named: preschool age, the use of fast acting volatile anesthestics, higher preoperative anxiety levels and postoperative pain.A child-focused approach to reduce preoperative anxiety focusing on distraction methods rather than pharmacological sedation may be the key as well as sufficient postoperative pain control and the use of total intravenous anesthesia. Parenteal presence during induction of anaesthesia (PPIA) may be beneficial to reduce preoperative anxiety levels, but has failed to prove a better outcome regarding ED.The use of age adopted scores/scales to diagnose ED and Pain are mandatory.In the case of an ED event it is most important to protect the child from self injury and the loss of the iv-line. Postoperative pian needs to be ruled out before treating ED. Most cases can be treated by interrupting the situation and putting the child "back to sleep". Short acting drugs as Propofol have been used successfully due to its pharmacodynamics and short acting profile. Alternatively alpha-agonists or ketamin may be preferred by other authors. If potential predictors and a positive history are present, prophylactic treatment should be considered. A TIVA or the use of alpha-2-agonists have proven to be successful in reducing the risk of an ED. Midazolam may reduce preoperative anxiety but not the incidence of ED and should therefore be used carefully and is not a good choice in PACU for the treatment of ED.Parents who witnessed ED in their children should be guided and followed up. Explaining this phenomenon to parents beforehand should be part of the pre anaesthesia clinic talk and written consent.Standard protocols should be in

  2. Developing and implementing an integrated delirium prevention system of care: a theory driven, participatory research study

    PubMed Central

    2013-01-01

    Background Delirium is a common complication for older people in hospital. Evidence suggests that delirium incidence in hospital may be reduced by about a third through a multi-component intervention targeted at known modifiable risk factors. We describe the research design and conceptual framework underpinning it that informed the development of a novel delirium prevention system of care for acute hospital wards. Particular focus of the study was on developing an implementation process aimed at embedding practice change within routine care delivery. Methods We adopted a participatory action research approach involving staff, volunteers, and patient and carer representatives in three northern NHS Trusts in England. We employed Normalization Process Theory to explore knowledge and ward practices on delirium and delirium prevention. We established a Development Team in each Trust comprising senior and frontline staff from selected wards, and others with a potential role or interest in delirium prevention. Data collection included facilitated workshops, relevant documents/records, qualitative one-to-one interviews and focus groups with multiple stakeholders and observation of ward practices. We used grounded theory strategies in analysing and synthesising data. Results Awareness of delirium was variable among staff with no attention on delirium prevention at any level; delirium prevention was typically neither understood nor perceived as meaningful. The busy, chaotic and challenging ward life rhythm focused primarily on diagnostics, clinical observations and treatment. Ward practices pertinent to delirium prevention were undertaken inconsistently. Staff welcomed the possibility of volunteers being engaged in delirium prevention work, but existing systems for volunteer support were viewed as a barrier. Our evolving conception of an integrated model of delirium prevention presented major implementation challenges flowing from minimal understanding of delirium prevention

  3. Delirium in a 74-year-old man: correct imaging revealed the truth.

    PubMed

    Wani, Abdul Majid; Manjaly, Mussa; Hussain, Waleed Mohd; Fatani, Mohamad Ibrahim; Turkistani, Ahmad; Showkat, Khalid; Maimani, Gassan Al; Qadmani, Ahmad; Akhtar, Mubeena

    2009-01-01

    Delirium is a cognitive disorder. DSM-IV criteria for delirium must include both acute onset and fluctuating symptoms; disturbance of consciousness (including inattention); at least one of the following: disorganised thinking, disorientation, memory impairment or perceptual disturbance; and evidence of a putative causal medical condition. Traditionally, the course has been described as transient in which recovery is likely to be complete if the underlying aetiological factor is promptly corrected or is self-limited. The most common precipitating causes in elderly include sepsis, dehydration and drugs. Work-up for delirium is limited to septic screening, baseline investigations and imaging. Patients with delirium without focal signs and with either evidence for a medical aetiology of delirium or pre-diagnosed dementia are at a very low risk of having focal lesions in their contrast-enhanced CT or MRI. We are presenting an interesting case of delirium with urosepsis whose imaging revealed milliary brain tuberculomas on contrast-enhanced MRI. PMID:21847424

  4. Study protocol—investigation of the Delirium Observation Screening Scale (DOSS) for the routine detection of delirium in the care home setting: a prospective cohort study

    PubMed Central

    Teale, Elizabeth; Young, John; Siddiqi, Najma; Munyombwe, Theresa; Harrison, Jennifer; Schuurmanns, Marieke

    2016-01-01

    Introduction Delirium is a common and distressing condition associated with frailty, dementia and comorbidity. These are common in long-term care settings. Residents in care homes are therefore at particular risk of delirium. Despite this, methods to detect delirium in care homes are lacking, with existing diagnostic tools taking too long, or requiring specific training to deliver. This limits their feasibility for use for the routine detection of delirium by care home staff. Routine screening for delirium in care homes would allow timely attention to exacerbating factors to attenuate the episode, and facilitate future research into delirium in the care home environment. Methods Residents from 4 large care homes will be asked to consent (or their consultees asked to provide a declaration of agreement) to participate in the study. Care home staff will administer the 25-item Delirium Observation Screening Scale (DOSS)—a delirium screening tool based on observed behaviours—and this will be tested against the research standard Confusion Assessment Method (CAM) administered by trained research assistants performed two times per week for all participating residents. Analysis Sensitivity, specificity, positive and negative predictive values, likelihood ratios and a diagnostic OR will be calculated for the detection of delirium with the 25-item DOSS. The feasibility of routine delirium screening and the scaling properties of the 25-item DOSS will also be explored. Ethics and Dissemination For residents lacking capacity to participate, a consultee will be approached for a declaration of agreement for inclusion in the study. Results will be published in peer-reviewed journals and disseminated in written format to clinical commissioning groups, general practitioners and relevant third parties. Trial registration number ISRCTN14608554. PMID:27324706

  5. Delirium Diagnosis Methodology used in Research: A Survey-Based Study

    PubMed Central

    Neufeld, KJ; Nelliot, A; Inouye, SK; Ely, EW; Bienvenu, OJ; Lee, HB; Needham, DM

    2014-01-01

    Objectives To describe methodology used to diagnose delirium in research studies evaluating delirium detection tools. Design A survey addressing reference rater methodology for delirium diagnosis, including rater characteristics, sources of patient information and diagnostic process. Setting Survey completed via web or telephone interview according to respondent preference. Participants Authors of 39 studies included in 3 recent systematic reviews of delirium detection instruments in hospitalized patients. Results Authors from 85% (n=33) of the 39 eligible studies responded to the survey. The median (Interquartile Range [IQR]) number of raters per study was 2.5 (2–3); 79% were physicians. The raters’ median (IQR) duration of clinical experience with delirium diagnosis was 7 (4–10) years, with 5% having no prior clinical experience. Inter-rater reliability was evaluated in 70% of studies. Cognitive tests and delirium detection tools were used in the delirium reference rating process in 61% (n=21) and 45% (n=15) of studies, respectively, with 33% (n=11) using both and 27% (n=9) using neither. When patients were too drowsy or declined to participate in delirium evaluation, 70% (n=23) of studies used all available information for delirium diagnosis, while 15% excluded such patients. Conclusions Significant variability exists in reference standard methods for delirium diagnosis in published research. Increasing standardization by documenting inter-rater reliability, using standardized cognitive and delirium detection tools, incorporating diagnostic expert consensus panels and using all available information in patients declining or unable to participate with formal testing may help advance delirium research by increasing consistency of case detection and improving generalizability of research results. PMID:24745562

  6. Delirium risk stratification in consecutive unselected admissions to acute medicine: validation of externally derived risk scores

    PubMed Central

    Pendlebury, Sarah T.; Lovett, Nicola; Smith, Sarah C.; Cornish, Emily; Mehta, Ziyah; Rothwell, Peter M.

    2016-01-01

    Background: reliable delirium risk stratification will aid recognition, anticipation and prevention and will facilitate targeting of resources in clinical practice as well as identification of at-risk patients for research. Delirium risk scores have been derived for acute medicine, but none has been prospectively validated in external cohorts. We therefore aimed to determine the reliability of externally derived risk scores in a consecutive cohort of older acute medicine patients. Methods: consecutive patients aged ≥65 over two 8-week periods (2010, 2012) were screened prospectively for delirium using the Confusion Assessment Method (CAM), and delirium was diagnosed using the DSM IV criteria. The reliability of existing delirium risk scores derived in acute medicine cohorts and simplified for use in routine clinical practice (USA, n = 2; Spain, n = 1; Indonesia, n = 1) was determined by the area under the receiver operating characteristic curve (AUC). Delirium was defined as prevalent (on admission), incident (occurring during admission) and any (prevalent + incident) delirium. Results: among 308 consecutive patients aged ≥65 (mean age/SD = 81/8 years, 164 (54%) female), existing delirium risk scores had AUCs for delirium similar to those reported in their original internal validations ranging from 0.69 to 0.76 for any delirium and 0.73 to 0.83 for incident delirium. All scores performed better than chance but no one score was clearly superior. Conclusions: externally derived delirium risk scores performed well in our independent acute medicine population with reliability unaffected by simplification and might therefore facilitate targeting of multicomponent interventions in routine clinical practice. PMID:26764396

  7. New aspects of delirium in elderly patients with critical limb ischemia

    PubMed Central

    van Eijsden, Willem A; Raats, Jelle W; Mulder, Paul GH; van der Laan, Lijckle

    2015-01-01

    Objective The primary objective was to identify possible risk factors for delirium in patients with critical limb ischemia undergoing surgery. The secondary objective was to study the effect of delirium on complications, the length of hospital stay, health care costs, and mortality. Methods All patients 65 years or older with critical limb ischemia undergoing surgery from February 2013 to July 2014 at Amphia Hospital, were included and followed up until December 31, 2014. Delirium was scored using the Delirium Observation Screening Scale (DOSS). Perioperative risk factors (age, comorbidity, factors of frailty, operation type, hemoglobulin, and transfusion) were collected and analyzed using logistic regression. Secondary outcomes were the number of complications, total hospital stay, extra health care costs per delirium, and mortality within 3 months and 6 months of surgery. Results We included 92 patients with critical limb ischemia undergoing surgery. Twenty-nine (32%) patients developed a delirium during admission, of whom 17 (59%) developed delirium preoperatively. After multivariable analysis, only diabetes mellitus (odds ratio [OR] =6.23; 95% confidence interval [CI]: 1.11–52.2; P=0.035) and Short Nutritional Assessment Questionnaire for Residential Care (SNAQ-RC) ≥3 (OR =5.55; 95% CI: 1.07–42.0; P=0.039) was significantly associated with the onset of delirium. Delirium was associated with longer hospital stay (P=0.001), increased health care costs, and higher mortality after 6 months (P<0.001). Conclusion Delirium is a common adverse event in patients with critical limb ischemia undergoing surgery with devastating outcome in the long term. Most patients developed delirium preoperatively, which indicates the need for early recognition and preventive strategies in the preoperative period. This study identified undernourishment and diabetes mellitus as independent risk factors for delirium. PMID:26451094

  8. Comparison of the risk of adverse events between risperidone and haloperidol in delirium patients.

    PubMed

    Miyaji, Shingo; Yamamoto, Kenji; Hoshino, Syunya; Yamamoto, Hiroaki; Sakai, Yoshiro; Miyaoka, Hitoshi

    2007-06-01

    The aim of this study was to determine the risk of adverse events for risperidone and haloperidol in delirium patients. The authors conducted a retrospective study with medical records of 266 Japanese delirium inpatients who were referred to them between July 2001 and May 2005. Information on gender, age, delirium, drug therapy, adverse events, death, and other relevant factors was collected and analyzed for each patient. As a primary antipsychotic drug for the treatment of delirium, risperidone was used in 93 patients; oral haloperidol was used in 95; and intravenous or intramuscular haloperidol was used in 61. The incidence of adverse events was 6.5% for risperidone, 31.4% for oral haloperidol, and 32.8% for haloperidol injection. The incidence of death during delirium was 3.2% for risperidone, 2.1% for oral haloperidol, and 13.1% for haloperidol injection. The incidence of death within 1 year after the onset of delirium was 30.1% for risperidone, 29.5% for oral haloperidol, and 45.9% for haloperidol injection. Between risperidone, oral haloperidol, and intravenous or intramuscular haloperidol the incidence of adverse events was significantly lowest for risperidone, and the incidence of death during delirium was significantly highest for intravenous or intramuscular haloperidol. The use of haloperidol as a first-line drug in delirium patients who can receive the drug orally will not contribute to the establishment of drug therapy for delirium based on risk-benefit assessment of the therapy. PMID:17472596

  9. Serial Administration of a Modified Richmond Agitation and Sedation Scale for Delirium Screening

    PubMed Central

    Chester, Jennifer Gonik; Harrington, Mary Beth; Rudolph, James

    2016-01-01

    Objectives Because delirium is common and frequently unrecognized, this study sought to design a brief screening tool for a core feature of mental status and to validate the instrument as a serial assessment for delirium. Design Prospective cohort Setting Tertiary VA Hospital in New England Participants 100 Veterans admitted to the medical service Methods A consensus panel developed a modified version of the Richmond Agitation and Sedation Scale (RASS) to capture alterations in consciousness. Upon admission and daily thereafter, patients were screened with the modified RASS and independently, underwent a comprehensive mental status interview by a geriatric expert, who determined if the criteria for delirium were met. The sensitivity, specificity, and positive likelihood ratio (LR) of the modified RASS for delirium are reported. Results As a single assessment, the modified RASS had a sensitivity of 64% and a specificity of 93% for delirium (LR=9.4). When used to detect change, serial modified RASS assessments had a sensitivity of 74% and a specificity of 92% (LR=8.9) in both prevalent and incident delirium. When prevalent cases were excluded, any change in the modified RASS had a sensitivity of 85% and a specificity of 92% for incident delirium (LR=10.2) Conclusion When administered daily, the modified RASS has good sensitivity and specificity for incident delirium. Given the brevity of the instrument (approximately 15 seconds), consideration should be given to incorporating the modified RASS as a daily screening measure for consciousness and delirium. PMID:22173963

  10. The unfavorable nature of preoperative delirium in elderly hip fractured patients.

    PubMed

    Adunsky, Abraham; Levy, Rami; Heim, Michael; Mizrahi, Eliyahu; Arad, M

    2003-01-01

    The onset of delirium is frequent in elderly patients who sustain hip fractures. The purpose of this study was to characterize different patterns of preoperative and postoperative delirium, to study factors associated with preoperative delirium and to evaluate the possible different outcome of these patients. This retrospective study comprised 281 elderly patients with hip fractures undergoing surgical fixation. Data collection included age, sex, length of stay, type of fracture, cognitive status by mini mental state examination (MMSE), assessment of possible delirium by the confusion assessment method (CAM) and functional outcome assessed by functional independence measure (FIM). A database search was conducted to identify whether delirium onset occurred prior to or following surgery. About 31% of the total sample developed delirium. Delirious patients tended to be more disabled (P = 0.03) and cognitively impaired (P = 0.018), compared with non-delirious patients. Most delirious cases (53%) had their onset in the preoperative period. Patients with preoperative delirium were older (P = 0.03), had a lower prefracture mobility (P < 0.01), impaired cognition (P = 0.04) and showed an adverse functional outcome in terms of FIM score. Regression analysis showed that prefracture dementia, prefracture mobility and low MMSE scores were strongly associated with higher probability of having preoperative delirium, with no additional effect of other variables. It is concluded that preoperative delirium should be viewed as a separate entity with unfavorable nature and adverse outcome. Careful preventive measures and better treating strategies should be employed to avoid this clinical condition. PMID:12849100

  11. Preoperative risk factors of postoperative delirium after transurethral prostatectomy for benign prostatic hyperplasia

    PubMed Central

    Tai, Sheng; Xu, Lingfan; Zhang, Li; Fan, Song; Liang, Chaozhao

    2015-01-01

    The aim of this observational study was to investigate the occurrence of post operation delirium in the elderly patients undergoing the transurethral prostatectomy and to identify these factors associated with the delirium. 485 patients, undergoing the transurethral prostatectomy, were selected. Demographics, medical, cognitive and functional data, IPSS and NIH-CPSI score were collected as predictors for delirium. After surgery, the patients were divided on the basis of delirium onset within one week observation period, and the delirium was diagnosed by the Confusion Assessment Method. Totally, 21.23% (103) subjects were identified as the delirium and it lasted 2.9 ± 0.8 days. Patients with post operation delirium were significantly older and single, widowed and divorced, had a previous history of prehospitalization, were with the poor International Prostate Symptom Score (IPSS) and National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score, were more impaired in the instrumental activities of daily living (IADL), and had poor clock drawing test (CDT) and geriatric depression scale (GDS) score. Age, marital status, IPSS and NIH-CPIS score, cognitive and functional status and previous history of hospitalization are the predictors of post operation delirium. Our study has implications in preventing delirium via an early and targeted evaluation. PMID:26064386

  12. Delirium is associated with poor rehabilitation outcome in elderly patients treated for femoral neck fractures.

    PubMed

    Olofsson, Birgitta; Lundström, Maria; Borssén, Bengt; Nyberg, Lars; Gustafson, Yngve

    2005-06-01

    The aim of this study was to describe risk factors for delirium and the impact of delirium on the rehabilitation outcome for patients operated for femoral neck fractures. Sixty-one patients, aged 70 years or older, consecutively admitted to the Department of Orthopaedic Surgery at Umeå University Hospital, Sweden for femoral neck fractures were assessed and interviewed during hospitalization and at follow up 4 months after surgery. Delirium occurred in 38 (62%) patients and those who developed delirium were more often demented and/or depressed. Patients with delirium were longer hospitalized and they were more dependent in their activity of daily living (ADL) on discharge and after 4 months. They had poorer psychological well-being and more medical complications than the nondelirious. A large proportion of the patients who developed delirium did not regain their previous walking ability and could not return to their prefracture living accommodation. Delirium after hip fracture surgery is very common especially among patients with dementia or depression. This study shows that delirium has a serious impact on the rehabilitation outcome from both short- and long-term perspectives. Because delirium can be prevented and treated, it is important to improve the care of elderly patients with hip fractures. PMID:15877637

  13. Impact of surgical approach on postoperative delirium in elderly patients undergoing gastrectomy: laparoscopic versus open approaches

    PubMed Central

    Shin, Young-Hee; Jeong, Hee-Joon

    2015-01-01

    Background Postoperative delirium is a frequent complication in elderly patients undergoing major abdominal surgery and is associated with a poor outcome. We compared postoperative delirium in elderly patients following laparoscopic gastrectomy (LG) versus open gastrectomy (OG). Methods In total, 130 patients aged ≥ 65 years with gastric cancer undergoing LG and OG were enrolled prospectively. Postoperative delirium and cognitive status were assessed daily using the Confusion Assessment Method (CAM) and Mini-Mental Status Examination (MMSE), respectively, for 3 days postoperatively. For CAM-positive patients, delirium severity was then assessed using the Delirium Index (DI). Results In total, 123 subjects (LG, n = 60; OG, n = 63) were included in the analysis. In both groups, the overall incidences of postoperative delirium were similar: 31.6% (19/60) in the LG group and 41.2% (26/63) in the OG group. When considering only those with delirium, the severity, expressed as the highest DI score, was similar between the groups. A decline in cognitive function (reduction in MMSE ≥ 2 points from baseline) during 3 days postoperatively was observed in 23 patients in the LG group (38.3%) and 27 patients in the OG group (42.9%) (P = 0.744). In both groups, postoperative cognitive decline was significantly associated with postoperative delirium (P < 0.001). Conclusions We found that, compared with traditional open gastrectomy, laparoscopic gastrectomy did not reduce either postoperative delirium or cognitive decline in elderly patients with gastric cancer. PMID:26257851

  14. Psychometric Properties of the Family Caregiver Delirium Knowledge Questionnaire.

    PubMed

    Bull, Margaret J; Avery, Jennifer Sjostedt; Boaz, Lesley; Oswald, Debra

    2015-01-01

    A valid, reliable measure of family caregivers' knowledge about delirium was not located in the literature; such an instrument is essential to assess learning needs and outcomes of education provided. The purpose of the current study was to (a) develop a family Caregiver Delirium Knowledge Questionnaire (CDKQ) based on the Symptom Interpretation Model; and (b) establish validity and reliability of the measure. The 19-item CDKQ was developed and administered to 164 family caregivers for community-dwelling older adults. Descriptive statistics were examined for all variables. Psychometric testing included confirmatory factor analysis, item-to-total correlations, and internal consistency reliability. A three-factor model provided the best fit for the data. The findings support initial validity and reliability of the CDKQ with family caregivers. Although the CDKQ was developed for use with family caregivers, it has potential for use with other caregivers, such as home health aides. PMID:25893726

  15. Excited delirium following use of synthetic cathinones (bath salts).

    PubMed

    Penders, Thomas M; Gestring, Richard E; Vilensky, Dmitry A

    2012-01-01

    Synthetic analogs of the cathinone molecule have seen increasing recreational use as substitutes for cocaine, 3,4-methylenedioxymethamphetamine (ecstasy) and methamphetamine. Repeated use of these drugs is associated with a paranoid hallucinatory delirium. A subset of patients using these substances develops a syndrome of extreme agitation and violent behavior that has been reported following the use of other stimulant drugs that also produce rapid changes in brain monoamines. This syndrome, characterized as "excited delirium," presents to the acute care setting with a challenging combination of paranoia, severe agitation and violent behavior. These patients frequently suffer from dehydration, skeletal muscle damage and renal failure that may lead to multiorgan failure and death. Management of these individuals requires careful consideration of the consequences of interventions commonly implemented in medical settings to control dangerous aggressive behavior. PMID:22898445

  16. Cocaine-induced agitated delirium: a case report and review.

    PubMed

    Plush, Theodore; Shakespeare, Walter; Jacobs, Dorian; Ladi, Larry; Sethi, Sheeba; Gasperino, James

    2015-01-01

    Cocaine use continues to be a major public health problem in the United States. Although many of the initial signs and symptoms of cocaine intoxication result from increased stimulation of the sympathetic nervous system, this condition can present as a spectrum of acuity from hypertension and tachycardia to multiorgan system failure. Classic features of acute intoxication include tachycardia, arterial vasoconstriction, enhanced thrombus formation, mydriasis, psychomotor agitation, and altered level of consciousness. At the extreme end of this toxidrome is a rare condition known as cocaine-induced agitated delirium. This syndrome is characterized by severe cardiopulmonary dysfunction, hyperthermia, and acute neurologic changes frequently leading to death. We report a case of cocaine-induced agitated delirium in a man who presented to our institution in a paradoxical form of circulatory shock. Rapid evaluation, recognition, and proper management enabled our patient not only to survive but also to leave the hospital without neurologic sequelae. PMID:24212597

  17. Delirium in older adults: a chronic cognitive disorder?

    PubMed

    Cole, Martin G; Mccusker, Jane

    2016-08-01

    Delirium is defined as a neurocognitive disorder characterized by sudden onset, fluctuating course, and disturbances in level of consciousness, attention, orientation, memory, thought, perception, and behavior (American Psychiatric Association, 2013). It occurs in hyperactive, hypoactive, or mixed forms in up to 50% of older hospital patients (Inouye et al., 2014) and 70% of older long-term care residents (McCusker et al., 2011), many with pre-existing dementia (Fick et al., 2002). PMID:27246118

  18. Pharmacological management of anticholinergic delirium - theory, evidence and practice.

    PubMed

    Dawson, Andrew H; Buckley, Nicholas A

    2016-03-01

    The spectrum of anticholinergic delirium is a common complication following drug overdose. Patients with severe toxicity can have significant distress and behavioural problems that often require pharmacological management. Cholinesterase inhibitors, such as physostigmine, are effective but widespread use has been limited by concerns about safety, optimal dosing and variable supply. Case series support efficacy in reversal of anticholinergic delirium. However doses vary widely and higher doses commonly lead to cholinergic toxicity. Seizures are reported in up to 2.5% of patients and occasional cardiotoxic effects are also recorded. This article reviews the serendipitous path whereby physostigmine evolved into the preferred anticholinesterase antidote largely without any research to indicate the optimal dosing strategy. Adverse events observed in case series should be considered in the context of pharmacokinetic/pharmacodynamic studies of physostigmine which suggest a much longer latency before the maximal increase in brain acetylcholine than had been previously assumed. This would favour protocols that use lower doses and longer re-dosing intervals. We propose based on the evidence reviewed that the use of cholinesterase inhibitors should be considered in anticholinergic delirium that has not responded to non-pharmacological delirium management. The optimal risk/benefit would be with a titrated dose of 0.5 to 1 mg physostigmine (0.01-0.02 mg kg(-1) in children) with a minimum delay of 10-15 min before re-dosing. Slower onset and longer acting agents such as rivastigmine would also be logical but more research is needed to guide the appropriate dose in this setting. PMID:26589572

  19. Delirium transitions in the medical ICU: exploring the role of sleep quality and other factors

    PubMed Central

    Colantuoni, Elizabeth; King, Lauren M.; Neufeld, Karin J.; Bienvenu, O. Joseph; Rowden, Annette M.; Collop, Nancy A.; Needham, Dale M.

    2014-01-01

    Objective Disrupted sleep is a common and potentially modifiable risk factor for delirium in the intensive care unit (ICU). As part of a quality improvement (QI) project to promote sleep in the ICU, we examined the association of perceived sleep quality ratings and other patient and ICU risk factors with daily transition to delirium. Design Secondary analysis of prospective observational study. Setting Medical ICU (MICU) over a 201-day period. Patients 223 patients with ≥1 night in the MICU in between two consecutive days of delirium assessment. Interventions None Measurements Daily perceived sleep quality ratings were measured using the Richards Campbell Sleep Questionnaire (RCSQ). Delirium was measured twice-daily using the Confusion Assessment Method for the ICU (CAM-ICU). Other covariates evaluated included: age, sex, race, ICU admission diagnosis, nighttime mechanical ventilation status, prior day’s delirium status, and daily sedation using benzodiazepines and opioids, via both bolus and continuous infusion. Main Results Perceived sleep quality was similar in patients who were ever versus never delirious in the ICU (median [IQR] ratings 58 [35-76] vs. 57 [33-78], respectively p=0.71), and perceived sleep quality was unrelated to delirium transition (adjusted OR 1.00, 95% CI 0.99-1.00). In mechanically ventilated patients, receipt of a continuous benzodiazepine and/or opioid infusion was associated with delirium transition (adjusted OR 4.02, 95% CI 2.19-7.38, p<0.001) and patients reporting use of pharmacological sleep aids at home were less likely to transition to delirium (adjusted OR 0.40, 95% CI 0.20-0.80, p=0.01). Conclusions We found no association between daily perceived sleep quality ratings and transition to delirium. Infusion of benzodiazepine and/or opioid medications was strongly associated with transition to delirium in the ICU in mechanically ventilated patients and is an important, modifiable risk factor for delirium in critically ill

  20. Excited delirium syndrome (ExDS): treatment options and considerations.

    PubMed

    Vilke, Gary M; Bozeman, William P; Dawes, Donald M; Demers, Gerard; Wilson, Michael P

    2012-04-01

    The term Excited Delirium Syndrome (ExDS) has traditionally been used in the forensic literature to describe findings in a subgroup of patients with delirium who suffered lethal consequences from their untreated severe agitation.(1-5) Excited delirium syndrome, also known as agitated delirium, is generally defined as altered mental status and combativeness or aggressiveness. Although the exact signs and symptoms are difficult to define precisely, clinical findings often include many of the following: tolerance to significant pain, rapid breathing, sweating, severe agitation, elevated temperature, delirium, non-compliance or poor awareness to direction from police or medical personnel, lack of fatiguing, unusual or superhuman strength, and inappropriate clothing for the current environment. It has become increasingly recognized that individuals displaying ExDS are at high risk for sudden death, and ExDS therefore represents a true medical emergency. Recently the American College of Emergency Physicians (ACEP) published the findings of a white paper on the topic of ExDS to better find consensus on the issues of definition, diagnosis, and treatment.(6) In so doing, ACEP joined the National Association of Medical Examiners (NAME) in recognizing ExDS as a medical condition. For both paramedics and physicians, the difficulty in diagnosing the underlying cause of ExDS in an individual patient is that the presenting clinical signs and symptoms of ExDS can be produced by a wide variety of clinical disease processes. For example, agitation, combativeness, and altered mental status can be produced by hypoglycemia, thyroid storm, certain kinds of seizures, and these conditions can be difficult to distinguish from those produced by cocaine or methamphetamine intoxication.(7) Prehospital personnel are generally not expected to differentiate between the multiple possible causes of the patient's presentation, but rather simply to recognize that the patient has a medical emergency

  1. Risk Factors for Delirium in Patients Undergoing Hematopoietic Stem Cell Transplantation

    PubMed Central

    Weckmann, Michelle T.; Gingrich, Roger; Mills, James A.; Hook, Larry; Beglinger, Leigh J.

    2013-01-01

    Background Delirium is common following hematopoietic stem-cell transplantation (HSCT) and is associated with increased morbidity and mortality. Early recognition and treatment have been shown to improve long term outcomes. We sought to investigate the relationship between potential risk-factors and the development of delirium following HSCT. Methods Fifty-four inpatients admitted for HSCT were assessed prospectively for delirium every 2-3 days through their inpatient stay using standardized delirium and neuropsychological measures. Patient’s self-reports of medical history, medical records, and neurocognitive and psychiatric assessments were used to identify risk factors. Both pre- and post-HSCT risk factors were examined. Results Delirium incidence was 35% and occurred with highest frequency in the 2 weeks following transplant. The only pre-transplantation risk factors was lower oxygen saturation (p=0.003). Post-transplantation risk factors for delirium included higher creatinine (p<0.0001), higher blood urea nitrogen levels (p=0.005), lower creatinine clearance (p=0.0006), lower oxygen saturation (p=0.001), lower hemoglobin (p=0.04) and lower albumin (p=0.03). There was no observed association with level of cognitive performance, transplant type, disease severity, medical co-morbidity index, age or conditioning regimen. Conclusion Routine laboratory values can assist in the identification of high risk patients before delirium onset to improve early detection and treatment of delirium following HSCT. PMID:22860240

  2. Delirium in Severely Ill Young Children in the Pediatric Intensive Care Unit (PICU)

    ERIC Educational Resources Information Center

    Schieveld, Jan N. M.; Leentjens, Albert F. G.

    2005-01-01

    Delirium is a serious neuropsychiatric disorder frequently seen in severely ill adult and geriatric patients. The clinical picture in adults is well known, as are the negative prognostic implications of delirium on length of hospital stay, morbidity, and mortality (American Psychiatric Association, 1999); however, it is less appreciated that…

  3. A Preoperative, Nurse-Led Intervention Program Reduces Acute Postoperative Delirium.

    PubMed

    Guo, Ying; Fan, Yuying

    2016-01-01

    The aim of this study was to evaluate the effect of a preoperative, multidisciplinary intervention program for the prevention of acute postoperative delirium on the incidence and severity in patients who were treated in the intensive care unit after surgery. We studied 122 patients who had been transferred into intensive care unit after surgery at a teaching general hospital in China. The intervention consisted of standardized protocols for the management of risk factors for delirium: education of nursing staff, systematic cognitive caring, maintaining a safe environment, social support, and improving sleep quality. All patients were monitored for signs of delirium after surgery, as measured by the Delirium Detection Score. The Delirium Detection Scores of patients in the intervention cohort after surgery on different time points were less than the scores of patients in the control group on the same point-in-time (p < .01). The severity degree of delirium for patients was less (p < .01) in the intervention group within 24 hours than that in the usual care cohort. This study showed the beneficial effects of a preoperative intervention program focusing on early prevention of delirium in patients before surgery. Systematic and comprehensive interventions could reduce the incidence and severity of delirium. PMID:27224685

  4. Clinical profile of delirium in patients treated for femoral neck fractures.

    PubMed

    Edlund, A; Lundström, M; Lundström, G; Hedqvist, B; Gustafson, Y

    1999-01-01

    The incidence of delirium, its predisposing factors, clinical profile, associated symptoms and consequences were investigated in 54 consecutive patients, 19 men and 35 women, mean age 77.1 years, admitted to an 'ortho-geriatric unit' with femoral neck fractures. The incidence of postoperative delirium was 15/54 (27.8%) and a logistic regression model found that dementia and a prolonged waiting time for the operation increased the risk of postoperative delirium. Delirium during the night was most common but in 5 patients the delirium was worst in the morning. Patients with delirium suffered more anxiety, depressed mood, emotionalism, delusions and hallucinations. A larger proportion of patients with delirium could not return to their previous dwelling, and a larger proportion of delirious patients were either dead, wheelchair-bound or bedridden at the 6-month follow-up (p < 0.005). The conclusion is that delirium is common and has a serious impact on the outcome after hip fracture surgery. PMID:10473932

  5. Alcohol withdrawal delirium manifested by manic symptoms in an elderly patient.

    PubMed

    Chan, Hung-Yu; Lee, Kuan-I

    2015-03-01

    Alcohol withdrawal syndrome is a commonly seen problem in psychiatric practice. Alcohol withdrawal delirium is associated with significant morbidity and mortality. Withdrawal symptoms usually include tremulousness, psychotic and perceptual symptoms, seizures, and consciousness disturbance. Herein, we report a case involving a 63-year-old man who had alcohol withdrawal delirium that was manifested mainly by manic symptoms. PMID:25515164

  6. Case Study: Delirium in an Adolescent Girl with Human Immunodeficiency Virus-Associated Dementia

    ERIC Educational Resources Information Center

    Scharko, Alexander M.; Baker, Eva H.; Kothari, Priti; Khattak, Hina; Lancaster, Duniya

    2006-01-01

    Delirium and human immunodeficiency virus (HIV)-associated dementia are well recognized neuropsychiatric consequences of HIV infection in adults. Almost nothing is known regarding the management of delirium in HIV-infected children and adolescents. HIV-related progressive encephalopathy is thought to represent the pediatric form of HIV-associated…

  7. Emergence delirium in a child given oral midazolam for conscious sedation.

    PubMed

    Doyle, W L; Perrin, L

    1994-12-01

    We report a case of emergence delirium in a 26-month-old girl after she received oral midazolam to achieve conscious sedation. This patient's clinical course is discussed. To our knowledge this is the first reported case of emergence delirium related to use of oral midazolam. PMID:7978604

  8. Baseline acetylcholinesterase activity and serotonin plasma levels are not associated with delirium in critically ill patients

    PubMed Central

    Tomasi, Cristiane Damiani; Salluh, Jorge; Soares, Márcio; Vuolo, Francieli; Zanatta, Francieli; Constantino, Larissa de Souza; Zugno, Alexandra Ioppi; Ritter, Cristiane; Dal-Pizzol, Felipe

    2015-01-01

    Objective The aim of this study was to investigate whether plasma serotonin levels or acetylcholinesterase activities determined upon intensive care unit admission could predict the occurrence of acute brain dysfunction in intensive care unit patients. Methods A prospective cohort study was conducted with a sample of 77 non-consecutive patients observed between May 2009 and September 2010. Delirium was determined using the Confusion Assessment Method for the Intensive Care Unit tool, and the acetylcholinesterase and serotonin measurements were determined from blood samples collected up to a maximum of 24 h after the admission of the patient to the intensive care unit. Results In the present study, 38 (49.6%) patients developed delirium during their intensive care unit stays. Neither serum acetylcholinesterase activity nor serotonin level was independently associated with delirium. No significant correlations of acetylcholinesterase activity or serotonin level with delirium/coma-free days were observed, but in the patients who developed delirium, there was a strong negative correlation between the acetylcholinesterase level and the number of delirium/coma-free days, indicating that higher acetylcholinesterase levels are associated with fewer days alive without delirium or coma. No associations were found between the biomarkers and mortality. Conclusions Neither serum acetylcholinesterase activity nor serotonin level was associated with delirium or acute brain dysfunction in critically ill patients. Sepsis did not modify these relationships. PMID:26340158

  9. Beyond Grand Rounds: A Comprehensive and Sequential Intervention to Improve Identification of Delirium

    ERIC Educational Resources Information Center

    Ramaswamy, Ravishankar; Dix, Edward F.; Drew, Janet E.; Diamond, James J.; Inouye, Sharon K.; Roehl, Barbara J. O.

    2011-01-01

    Purpose of the Study: Delirium is a widespread concern for hospitalized seniors, yet is often unrecognized. A comprehensive and sequential intervention (CSI) aiming to effect change in clinician behavior by improving knowledge about delirium was tested. Design and Methods: A 2-day CSI program that consisted of progressive 4-part didactic series,…

  10. Detection and Management of Delirium in the Neonatal Unit: A Case Series.

    PubMed

    Groves, Alan; Traube, Chani; Silver, Gabrielle

    2016-03-01

    Delirium is increasingly recognized as a common syndrome in critically ill children, but in our experience, it is rarely considered in the NICU. Delirium is independently associated with prolonged length of stay and adverse long-term outcomes in children. We report the cases of 3 infants cared for in our NICU at corrected gestational ages of 4, 11, and 17 weeks who presented with classic symptoms of delirium. All 3 children had complex medical problems and were receiving multiple analgesic and sedative medications. All 3 children exhibited agitation that was unresponsive to increasing doses of medications, and they all appeared to improve after treatment with quetiapine, allowing weaning of other medications. It is possible that with increased vigilance, delirium will be increasingly recognized in newborns, thus allowing tailored intervention. Further research is needed to investigate the prevalence and associated risk factors for developing delirium in the NICU and to explore possible treatment options. PMID:26908706

  11. Delirium and dementia with Lewy bodies: distinct diagnoses or part of the same spectrum?

    PubMed

    Gore, Rachel L; Vardy, Emma R L C; O'Brien, John T

    2015-01-01

    Dementia with Lewy bodies (DLB) is recognised as the second most common form of dementia in older people. Delirium is a condition of acute brain dysfunction for which a pre-existing diagnosis of dementia is a risk factor. Conversely delirium is associated with an increased risk of developing dementia. The reasons for this bidirectional relationship are not well understood. Our aim was to review possible similarities in the clinical presentation and pathophysiology between delirium and DLB, and explore possible links between these diagnoses. A systematic search using Medline, Embase and Psychinfo was performed. References were scanned for relevant articles, supplemented by articles identified from reference lists and those known to the authors. 94 articles were selected for inclusion in the review. Delirium and DLB share a number of clinical similarities, including global impairment of cognition, fluctuations in attention and perceptual abnormalities. Delirium is a frequent presenting feature of DLB. In terms of pathophysiological mechanisms, cholinergic dysfunction and genetics may provide a common link. Neuroimaging studies suggest a brain vulnerability in delirium which may also occur in dementia. The basal ganglia, which play a key role in DLB, have also been implicated in delirium. The role of Cerebrospinal fluid (CSF) and serum biomarkers for both diagnoses is an interesting area although some results are conflicting and further work in this area is needed. Delirium and DLB share a number of features and we hypothesise that delirium may, in some cases, represent early or 'prodromal' DLB. Further research is needed to test the novel hypothesis that delirium may be an early marker for future DLB, which would aid early diagnosis of DLB and identify those at high risk. PMID:24860139

  12. The development of an automated ward independent delirium risk prediction model.

    PubMed

    de Wit, Hugo A J M; Winkens, Bjorn; Mestres Gonzalvo, Carlota; Hurkens, Kim P G M; Mulder, Wubbo J; Janknegt, Rob; Verhey, Frans R; van der Kuy, Paul-Hugo M; Schols, Jos M G A

    2016-08-01

    Background A delirium is common in hospital settings resulting in increased mortality and costs. Prevention of a delirium is clearly preferred over treatment. A delirium risk prediction model can be helpful to identify patients at risk of a delirium, allowing the start of preventive treatment. Current risk prediction models rely on manual calculation of the individual patient risk. Objective The aim of this study was to develop an automated ward independent delirium riskprediction model. To show that such a model can be constructed exclusively from electronically available risk factors and thereby implemented into a clinical decision support system (CDSS) to optimally support the physician to initiate preventive treatment. Setting A Dutch teaching hospital. Methods A retrospective cohort study in which patients, 60 years or older, were selected when admitted to the hospital, with no delirium diagnosis when presenting, or during the first day of admission. We used logistic regression analysis to develop a delirium predictive model out of the electronically available predictive variables. Main outcome measure A delirium risk prediction model. Results A delirium risk prediction model was developed using predictive variables that were significant in the univariable regression analyses. The area under the receiver operating characteristics curve of the "medication model" model was 0.76 after internal validation. Conclusions CDSSs can be used to automatically predict the risk of a delirium in individual hospitalised patients' by exclusively using electronically available predictive variables. To increase the use and improve the quality of predictive models, clinical risk factors should be documented ready for automated use. PMID:27177868

  13. Delirium in the geriatric unit: proton-pump inhibitors and other risk factors

    PubMed Central

    Otremba, Iwona; Wilczyński, Krzysztof; Szewieczek, Jan

    2016-01-01

    Background Delirium remains a major nosocomial complication of hospitalized elderly. Predictive models for delirium may be useful for identification of high-risk patients for implementation of preventive strategies. Objective Evaluate specific factors for development of delirium in a geriatric ward setting. Methods Prospective cross-sectional study comprised 675 consecutive patients aged 79.2±7.7 years (66% women and 34% men), admitted to the subacute geriatric ward of a multiprofile university hospital after exclusion of 113 patients treated with antipsychotic medication because of behavioral disorders before admission. Comprehensive geriatric assessments including a structured interview, physical examination, geriatric functional assessment, blood sampling, ECG, abdominal ultrasound, chest X-ray, Confusion Assessment Method for diagnosis of delirium, Delirium-O-Meter to assess delirium severity, Richmond Agitation-Sedation Scale to assess sedation or agitation, visual analog scale and Doloplus-2 scale to assess pain level were performed. Results Multivariate logistic regression analysis revealed five independent factors associated with development of delirium in geriatric inpatients: transfer between hospital wards (odds ratio [OR] =2.78; confidence interval [CI] =1.54–5.01; P=0.001), preexisting dementia (OR =2.29; CI =1.44–3.65; P<0.001), previous delirium incidents (OR =2.23; CI =1.47–3.38; P<0.001), previous fall incidents (OR =1.76; CI =1.17–2.64; P=0.006), and use of proton-pump inhibitors (OR =1.67; CI =1.11–2.53; P=0.014). Conclusion Transfer between hospital wards, preexisting dementia, previous delirium incidents, previous fall incidents, and use of proton-pump inhibitors are predictive of development of delirium in the geriatric inpatient setting. PMID:27103793

  14. Melatonin treatment in the prevention of postoperative delirium in cardiac surgery patients

    PubMed Central

    Artemiou, Panagiotis; Bilecova-Rabajdova, Miroslava; Sabol, Frantisek; Torok, Pavol; Kolarcik, Peter; Kolesar, Adrian

    2015-01-01

    Introduction Post-cardiac surgery delirium is a severe complication. The circadian rhythm of melatonin secretion has been shown to be altered postoperatively. Aim of the study It was hypothesized that restoring normal sleeping patterns with a substance that is capable of resynchronizing circadian rhythm such as exogenous administration of melatonin may possibly reduce the incidence of postoperative delirium. Material and methods This paper represents a prospective clinical observational study. Two consecutive groups of 250 consecutive patients took part in the study. Group A was the control group and group B was the melatonin group. In group B, the patients received prophylactic melatonin treatment. The main objectives were to observe the incidence of delirium, to identify any predictors of delirium, and to compare the two groups based on the delirium incidence. Results The incidence of delirium was 8.4% in the melatonin group vs. 20.8% in the control group (p = 0.001). Predictors of delirium in the melatonin group were age (p = 0.001) and higher EuroSCORE II value (p = 0.001). In multivariate analysis, age and EuroSCORE II value (p = 0.014) were predictors of postoperative delirium. Comparing the groups, the main predictors of delirium were age (p = 0.001), EuroSCORE II value (p = 0.001), cardio-pulmonary bypass (CPB) time (p = 0.001), aortic cross-clamping (ACC) time (p = 0.008), sufentanil dose (p = 0.001) and mechanical ventilation (p = 0.033). Conclusions Administration of melatonin significantly decreases the incidence of postoperative delirium after cardiac surgery. Prophylactic treatment with melatonin should be considered in every patient scheduled for cardiac surgery. PMID:26336494

  15. Serum anticholinergic activity and cerebral cholinergic dysfunction: An EEG study in frail elderly with and without delirium

    PubMed Central

    Thomas, Christine; Hestermann, Ute; Kopitz, Juergen; Plaschke, Konstanze; Oster, Peter; Driessen, Martin; Mundt, Christoph; Weisbrod, Matthias

    2008-01-01

    Background Delirium increases morbidity, mortality and healthcare costs especially in the elderly. Serum anticholinergic activity (SAA) is a suggested biomarker for anticholinergic burden and delirium risk, but the association with cerebral cholinergic function remains unclear. To clarify this relationship, we prospectively assessed the correlation of SAA with quantitative electroencephalography (qEEG) power, delirium occurrence, functional and cognitive measures in a cross-sectional sample of acutely hospitalized elderly (> 80 y) with high dementia and delirium prevalence. Methods 61 consecutively admitted patients over 80 years underwent an extensive clinical and neuropsychological evaluation. SAA was determined by using radio receptor assay as developed by Tune, and standard as well as quantitative EEGs were obtained. Results 15 patients had dementia with additional delirium (DD) according to expert consensus using DSM-IV criteria, 31 suffered from dementia without delirium (D), 15 were cognitively unimpaired (CU). SAA was clearly detectable in all patients but one (mean 10.9 ± 7.1 pmol/ml), but was not associated with expert-panel approved delirium diagnosis or cognitive functions. Delirium-associated EEG abnormalities included occipital slowing, peak power and alpha decrease, delta and theta power increase and slow wave ratio increase during active delirious states. EEG measures correlated significantly with cognitive performance and delirium severity, but not with SAA levels. Conclusion In elderly with acute disease, EEG parameters reliable indicate delirium, but SAA does not seem to reflect cerebral cholinergic function as measured by EEG and is not related to delirium diagnosis. PMID:18793418

  16. Emerging Role of Melatonin and Melatonin Receptor Agonists in Sleep and Delirium in Intensive Care Unit Patients.

    PubMed

    Mo, Yoonsun; Scheer, Corey E; Abdallah, George T

    2016-08-01

    Delirium, an acute state of mental confusion, can lead to many adverse sequelae in intensive care unit (ICU) patients. Although the etiology of ICU delirium is often multifactorial, and at times not fully understood, sleep deprivation is considered to be a major contributing factor to its development. It has been postulated that administration of exogenous melatonin and melatonin receptor agonists such as ramelteon may prevent delirium by promoting nocturnal sleep in ICU patients. The purpose of this review is to summarize the pharmacology of melatonin and melatonin receptor agonists and investigate their potential roles in sleep promotion and delirium prevention in ICU patients. Although few studies evaluating the impact of melatonergic agents on sleep and delirium in the ICU have been completed, some data suggest their potential positive effects on sleep and delirium. However, large-scale randomized controlled trials are warranted to determine the optimal role of melatonergic agents in the prevention of ICU delirium. PMID:26092575

  17. Delirium superimposed on dementia is associated with prolonged length of stay and poor outcomes in hospitalized older adults”

    PubMed Central

    Fick, Donna M.; Steis, Melinda R.; Waller, Jennifer L.; Inouye, Sharon K.

    2014-01-01

    Background Current literature does not identify the significance of underlying cognitive impairment and delirium on older adults during and 30 days following acute care hospitalization. Objective Describe the incidence, risk factors, and outcomes associated with incident delirium superimposed on dementia. Design 24-month prospective cohort study Setting community hospital Patients 139 older adults (>65 years) with dementia Methods This prospective study followed patients daily during hospitalization and one month post-hospital. Main measures included dementia (Modified Blessed Dementia Rating Score, IQ CODE), daily mental status change, dementia stage/severity (Clinical Dementia Rating, Global Deterioration Scale), delirium (Confusion Assessment Method), and delirium severity (Delirium Rating Scale-Revised-98). All statistical analysis was performed using SAS 9.3 and significance with an alpha level of 0.05. Logistic regression, analysis of covariance or linear regression was performed controlling for age, gender and dementia stage. Results The overall incidence of new delirium was 32% (44/140). Those with delirium had a 25% short term mortality rate, increased length of stay and poorer function at discharge. At one month follow-up, subjects with delirium had greater functional decline. Males were more likely to develop delirium and for every one unit increase in dementia severity (Global Deterioration Scale), subjects were 1.5 times more likely to develop delirium. Conclusions Delirium prolongs hospitalization for persons with dementia. Thus, interventions to increase early detection of delirium have the potential to decrease the severity and duration of delirium and to prevent unnecessary suffering and costs from the complications of delirium and unnecessary readmissions to the hospital. PMID:23955965

  18. Pre- and Post-Transplantation Risk Factors for Delirium Onset and Severity in Patients Undergoing Hematopoietic Stem-Cell Transplantation

    PubMed Central

    Fann, Jesse R.; Hubbard, Rebecca A.; Alfano, Catherine M.; Roth-Roemer, Sari; Katon, Wayne J.; Syrjala, Karen L.

    2011-01-01

    Purpose To determine pre- and post-transplantation risk factors for delirium onset and severity during the acute phase of myeloablative hematopoietic stem-cell transplantation (HSCT). Patients and Methods Ninety adult patients with malignancies admitted to the Fred Hutchinson Cancer Research Center for their first HSCT were assessed prospectively from 1 week before transplantation to 30 days after transplantation. Delirium was assessed three times per week using the Delirium Rating Scale and the Memorial Delirium Assessment Scale. Potential risk factors were assessed by patient self-report, charts, and computerized records. Multivariable analysis of time to onset of a delirium episode was undertaken using Cox proportional hazards regression with time-varying covariates. Analysis for delirium severity was carried out using a linear mixed effects model. Validation and sensitivity analyses were performed on the final models. Results Forty-five patients (50%) experienced a delirium episode. Pretransplantation risk factors for onset and higher severity of delirium were higher mean alkaline phosphatase and blood urea nitrogen (BUN) levels. Poorer pretransplantation executive functioning was also associated with higher delirium severity. Higher doses of opioid medications were the only post-transplantation risk factor for delirium onset (hazard ratio, 1.05; 95% CI, 1.02 to 1.08). Higher opioid doses, current and prior pain, and higher BUN levels were post-transplantation risk factors for greater delirium severity (all P < .01). Conclusion Pre- and post-transplantation factors can assist in identifying patients who are at risk for delirium during myeloablative HSCT and may enable clinical interventions to prevent delirium onset or decrease delirium symptoms. PMID:21263081

  19. Application of Clinical Practice Guidelines for Pain, Agitation, and Delirium.

    PubMed

    Krupp, Anna; Balas, Michele C

    2016-06-01

    Critically ill patients experience several severe, distressing, and often life-altering symptoms during their intensive care unit stay. A clinical practice guideline released by the American College of Critical Care Medicine provides a template for improving the care and outcomes of the critically ill through evidence-based pain, agitation, and delirium assessment, prevention, and management. Key strategies include the use of valid and reliable assessment tools, setting a desired sedation level target, a focus on light sedation, choosing appropriate sedative medications, the use of nonpharmacologic symptom management strategies, and engaging and empowering patients and their family to play an active role in their intensive care unit care. PMID:27215361

  20. Defining the Role of Dexmedetomidine in the Prevention of Delirium in the Intensive Care Unit

    PubMed Central

    Nelson, S.; Muzyk, A. J.; Bucklin, M. H.; Brudney, S.; Gagliardi, J. P.

    2015-01-01

    Dexmedetomidine is a highly selective α2 agonist used as a sedative agent. It also provides anxiolysis and sympatholysis without significant respiratory compromise or delirium. We conducted a systematic review to examine whether sedation of patients in the intensive care unit (ICU) with dexmedetomidine was associated with a lower incidence of delirium as compared to other nondexmedetomidine sedation strategies. A search of PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews yielded only three trials from 1966 through April 2015 that met our predefined inclusion criteria and assessed dexmedetomidine and outcomes of delirium as their primary endpoint. The studies varied in regard to population, comparator sedation regimen, delirium outcome measure, and dexmedetomidine dosing. All trials are limited by design issues that limit our ability definitively to conclude that dexmedetomidine prevents delirium. Evidence does suggest that dexmedetomidine may allow for avoidance of deep sedation and use of benzodiazepines, factors both observed to increase the risk for developing delirium. Our assessment of currently published literature highlights the need for ongoing research to better delineate the role of dexmedetomidine for delirium prevention. PMID:26576429

  1. Severe, Persistent and Fatal Delirium in Psychogeriatric Patients Admitted to a Psychiatric Hospital

    PubMed Central

    Jans, Ingrid S.; Oudewortel, Letty; Brandt, Paulien M.; van Gool, Willem A.

    2015-01-01

    Background/Aims Although delirium is generally regarded as a transient syndrome, persistence of delirium in patients with cognitive impairment – even with fatal outcome – has been reported as well. This study aims to describe the clinical features and neuropathological correlates of this type of delirium. Methods Inclusion criteria for this case series were: (1) severe persistent delirium until death, (2) history of cognitive decline and (3) consent for brain autopsy. Medical records were examined in combination with collected clinical data and neuropathological findings. Result In 15 patients, all living at home before admission, episodes with delirium lasted for 4.2 months on average. No distinct medical causes of persistent delirium could be identified. Pathological diagnoses included Alzheimer's disease and dementia with Lewy bodies as well as single cases of Creutzfeldt-Jakob disease and progressive supranuclear palsy. Conclusion Severe, persistent and fatal delirium in patients with cognitive impairment can occur relatively early in the disease trajectory and is associated with diverse neuropathologies. PMID:26195981

  2. Association between frailty and delirium in older adult patients discharged from hospital

    PubMed Central

    Verloo, Henk; Goulet, Céline; Morin, Diane; von Gunten, Armin

    2016-01-01

    Background Delirium and frailty – both potentially reversible geriatric syndromes – are seldom studied together, although they often occur jointly in older patients discharged from hospitals. This study aimed to explore the relationship between delirium and frailty in older adults discharged from hospitals. Methods Of the 221 patients aged >65 years, who were invited to participate, only 114 gave their consent to participate in this study. Delirium was assessed using the confusion assessment method, in which patients were classified dichotomously as delirious or nondelirious according to its algorithm. Frailty was assessed using the Edmonton Frailty Scale, which classifies patients dichotomously as frail or nonfrail. In addition to the sociodemographic characteristics, covariates such as scores from the Mini-Mental State Examination, Instrumental Activities of Daily Living scale, and Cumulative Illness Rating Scale for Geriatrics and details regarding polymedication were collected. A multidimensional linear regression model was used for analysis. Results Almost 20% of participants had delirium (n=22), and 76.3% were classified as frail (n=87); 31.5% of the variance in the delirium score was explained by frailty (R2=0.315). Age; polymedication; scores of the Confusion Assessment Method (CAM), instrumental activities of daily living, and Cumulative Illness Rating Scale for Geriatrics; and frailty increased the predictability of the variance of delirium by 32% to 64% (R2=0.64). Conclusion Frailty is strongly related to delirium in older patients after discharge from the hospital. PMID:26848261

  3. Identifying pediatric emergence delirium by using the PAED Scale: a quality improvement project.

    PubMed

    Stamper, Matthew J; Hawks, Sharon J; Taicher, Brad M; Bonta, Juliet; Brandon, Debra H

    2014-04-01

    Pediatric emergence delirium is a postoperative phenomenon characterized by aberrant cognitive and psychomotor behavior, which can place the patient and health care personnel at risk for injury. A common tool for identifying emergence delirium is the Level of Consciousness-Richmond Agitation and Sedation Scale (LOC-RASS), although it has not been validated for use in the pediatric population. The Pediatric Anesthesia Emergence Delirium Scale (PAED) is a newly validated tool to measure emergence delirium in children. We chose to implement and evaluate the effectiveness and fidelity of using the PAED Scale to identify pediatric emergence delirium in one eight-bed postanesthesia care unit in comparison with the traditional LOC-RASS. The overall incidence of pediatric emergence delirium found by using the LOC-RASS with a retrospective chart review (3%) was significantly lower than the incidence found by using the LOC-RASS (7.5%) and PAED Scale (11.5%) during the implementation period. Our findings suggest that the PAED Scale may be a more sensitive measure of pediatric emergence delirium, and, in the future, we recommend that health care personnel at our facility use the PAED Scale rather than the LOC-RASS. PMID:24674794

  4. Improving early recognition of delirium using SQiD (Single Question to identify Delirium): a hospital based quality improvement project.

    PubMed

    McCleary, Elaine; Cumming, Pamela

    2015-01-01

    Delirium is a serious condition associated with poor outcomes which can be prevented and treated if recognised early. Older people and people with dementia or severe illness are more at risk of delirium. SQiD is a simple prompt question which asks, "Is this patient more confused than before?" Focusing specifically on patients aged 75 and over, this project aimed to increase awareness and usage of SQiD to help improve early recognition of delirium, in accordance with the Healthcare Improvement Scotland national initiative. This project was carried out by two student nurses during an eight week clinical placement in the acute surgical receiving unit (ASRU) of Ninewells Hospital, Dundee, Scotland. Qualitative and quantitative methodology was used to establish baseline data which revealed that only 35% of the multidisciplinary team (MDT) were aware of SQiD, with only 15% using SQiD. Initial activities involved raising awareness of SQiD by means of information cards and posters. Once awareness was raised, the usage of the SQiD question by nurses was tested. Finally, the SQiD question was incorporated into the nursing care round forms and usage recorded. Following these awareness raising activities we noted an increase of 83% awareness and 20% use of SQiD. Incorporating the SQiD question into the hourly care round forms increased awareness to 100% and usage to 50%. Although this small scale project could be viewed as a success, the requirements for sustainability depend upon further implementation and spreading of the change. Sustained improvement is also dependent upon the implementation of the care rounds. As nursing students, undertaking this improvement project has provided valuable lessons in both quality improvement science and personal learning. The improved knowledge and understanding of effective communication and the intricacies of team working is transferrable and can be applied to future nursing practice. PMID:26734378

  5. Associations of Markers of Inflammation and Coagulation with Delirium during Critical Illness

    PubMed Central

    Girard, Timothy D; Ware, Lorraine B; Bernard, Gordon R; Pandharipande, Pratik P; Thompson, Jennifer L; Shintani, Ayumi K; Jackson, James C; Dittus, Robert S; Ely, E Wesley

    2012-01-01

    Purpose To assess the associations between a priori-selected markers of inflammation and coagulation and delirium during critical illness. Methods In this prospective cohort study, we collected blood from mechanically ventilated medical intensive care unit (ICU) patients and measured nine plasma markers of inflammation and coagulation. We assessed patients daily for delirium using the Confusion Assessment Method for the ICU and used multivariable regression to analyze the associations between plasma markers and subsequent delirium, after adjusting for age, severity of illness, and sepsis. Results Among the 138 patients studied, with a median age of 66 years and median APACHE II of 27, 107 (78%) were delirious at some point during the study. Two markers of inflammation and one of coagulation were significantly associated with delirium. After adjusting for covariates, lower plasma concentrations of matrix metalloproteinase-9 (MMP-9) and protein C were associated with an increased probability of delirium (p=0.04 and 0.01, respectively), and higher concentrations of soluble tumor necrosis factor receptor-1 (sTNFR1) were associated with an increased probability of delirium (p<0.01). Concentrations of C-reactive protein (p=0.82), myeloperoxidase (p=0.11), neutrophil gelatinase-associated lipocalin (p=0.70), D-dimer (p=0.83), plasminogen activator inhibitor type 1 (p=0.98), and Von Willebrand Factor antigen (p=0.65) were not associated with delirium. Conclusions In this study, MMP-9, protein C, and sTNFR1 were independently associated with subsequent ICU delirium. These results suggest that specific aspects of inflammation and coagulation may play a role in the evolution of delirium during critical illness and that these markers should be examined in larger studies of ICU patients. PMID:22903241

  6. Geriatric Assessment as a Predictor of Delirium and Other Outcomes in Elderly Cancer Patients

    PubMed Central

    Korc-Grodzicki, Beatriz; Sun, Sung W.; Zhou, Qin; Iasonos, Alexia; Lu, Bryan; Root, James C.; Downey, Robert J.; Tew, William P.

    2016-01-01

    Objective This study aimed to describe the implementation of preoperative geriatric assessment (GA) in patients undergoing major cancer surgery and to determine predictors of postoperative delirium. Summary Background Data Geriatric surgical patients have unique vulnerabilities and are at increased risk of developing postoperative delirium. Methods Geriatricians at Memorial Sloan Kettering Cancer Center risk-stratify surgical patients with solid tumors, aged ≥ 75 years using preoperative GA, which includes basic and instrumental activities of daily living (ADLs, IADLs), cognition (Mini-Cog Test), history of falls, nutritional state, and comorbidities (Charlson Comorbidity Index [CCI]). The Geriatrics Service evaluates patients for postoperative delirium using the Confusion Assessment Method (CAM). A retrospective review was performed. The associations between GA and postoperative outcomes were evaluated. Univariate logistic regression analysis was performed to determine the predictive value of GA for postoperative delirium, and a multivariate model was built. Results In total, 416 patients who received preoperative evaluation by the Geriatrics Service between September 1, 2010, and December 31, 2011, were included. Delirium occurred in 19% of patients. Patients with delirium had longer length of hospital stay (P<0.001) and greater likelihood of discharge to a rehabilitation facility (P<0.001). CCI score, history of falls, dependent on IADL, and abnormal Mini-Cog Test results predicted postoperative delirium on univariate analysis. Developed using a stepwise selection method, a multivariate model to predict delirium is presented including CCI score (P=0.032), dependence IADLs (P=0.011) and falls history (P=0.056). Conclusions Preoperative GA is feasible and may achieve a better understanding of older patients’ perioperative risks, including delirium. PMID:24887981

  7. Preoperative risk assessment for delirium after noncardiac surgery: a systematic review.

    PubMed

    Dasgupta, Monidipa; Dumbrell, Andrea C

    2006-10-01

    Delirium is a common postoperative complication in older adults associated with adverse events including functional decline, longer lengths of stay, and risk of institutionalization. The purpose of this article is to systematically review preoperative risk factors associated with delirium following noncardiac surgery. A medical literature search was conducted using several bibliographic databases (PubMed, CINAHL, Cochrane, PsychInfo), supplemented by a manual search of the references of retrieved articles. Studies were retained for review after meeting strict inclusion criteria that included only operative patients with incident postoperative delirium diagnosed prospectively using criteria derived from the Diagnostic and Statistical Manual of Mental Disorders Third or Fourth Edition. Quantitative analyses included significance testing, homogeneity testing, and effect-size pooling. Twenty-five articles were included for review. The incidence of delirium ranged from 5.1% to 52.2%, with greater rates after hip fracture and aortic surgeries. This review found two scales, a clinical prediction rule, and a delirium risk classification system that were validated in other operative settings. Individual risk factor analysis suggested that cognitive impairment, older age, functional impairment, sensory impairment, depression, preoperative psychotropic drug use, psychopathological symptoms, institutional residence, and greater comorbidity were associated with postoperative delirium. Of the risk factors examined, evidence was most robust for an association between delirium and cognitive impairment or psychotropic drug use, with moderate effect sizes for both. Missing data and measurement differences did not allow for inferences to be made about other risk factors. Effect-size pooling supports the concept that delirium is a heterogeneous disorder with multiple risk factors. More research is needed to better identify patients at risk for postoperative delirium and to develop

  8. Emergence delirium with transient associative agnosia and expressive aphasia reversed by flumazenil in a pediatric patient.

    PubMed

    Drobish, Julie K; Kelz, Max B; DiPuppo, Patricia M; Cook-Sather, Scott D

    2015-06-01

    Multiple factors may contribute to the development of emergence delirium in a child. We present the case of a healthy 12-year-old girl who received preoperative midazolam with the desired anxiolytic effect, underwent a brief general anesthetic, and then exhibited postoperative delirium, consisting of a transient associative agnosia and expressive aphasia. Administration of flumazenil led to immediate and lasting resolution of her symptoms. We hypothesize that γ-aminobutyric acid type A receptor-mediated effects, most likely related to an atypical offset of midazolam, are an important subset of emergence delirium that is amenable to pharmacologic therapy with flumazenil. PMID:26035220

  9. Preventing intensive care unit delirium: a patient-centered approach to reducing sleep disruption.

    PubMed

    Stuck, Amy; Clark, Mary Jo; Connelly, Cynthia D

    2011-01-01

    Delirium in the intensive care unit is a disorder with multifactorial causes and is associated with poor outcomes. Sleep-wake disturbance is a common experience for patients with delirium. Care processes that disrupt sleep can lead to sleep deprivation, contributing to delirium. Patient-centered care is a concept that considers what is best for each individual. How can clinicians use a patient-centered approach to alter processes to decrease patient disruptions and improve sleep and rest? Could timing of blood draws and soothing music work to promote sleep? PMID:21983504

  10. Remission of Methamphetamine-Induced Withdrawal Delirium and Craving After Electroconvulsive Therapy

    PubMed Central

    Ahmadi, Jamshid; Ekramzadeh, Sara; Pridmore, Saxby

    2015-01-01

    Introduction: The aim of this study is to describe the use of electroconvulsive therapy (ECT) in the treatment of methamphetamine-induced withdrawal delirium and craving in a single case. Case Presentation: A 44-year-old male presented to the hospital in Fars province, Iran, with Methamphetamine-Induced Withdrawal Delirium who responded to ECT. Conclusions: The electroconvulsive therapy can be a suitable option for the treatment of methamphetamine withdrawal delirium and craving. Also, it can be usefully employed in these very serious conditions which may represent a risk to life. PMID:26834801

  11. Emergence Delirium with Transient Associative Agnosia and Expressive Aphasia Reversed by Flumazenil in a Pediatric Patient

    PubMed Central

    Drobish, Julie K.; Kelz, Max B.; DiPuppo, Patricia M.; Cook-Sather, Scott D.

    2014-01-01

    Multiple factors may contribute to the development of emergence delirium in a child. We present the case of a healthy 12-year-old girl who received preoperative midazolam with the desired anxiolytic effect, underwent a brief general anesthetic, and then exhibited postoperative delirium, consisting of a transient associative agnosia and expressive aphasia. Administration of flumazenil led to immediate and lasting resolution of her symptoms. We hypothesize that γ-aminobutyric acid type A receptor-mediated effects, most likely related to an atypical offset of midazolam, are an important subset of emergence delirium that is amenable to pharmacologic therapy with flumazenil. PMID:26035220

  12. Neural substrates of vulnerability to postsurgical delirium as revealed by presurgical diffusion MRI.

    PubMed

    Cavallari, Michele; Dai, Weiying; Guttmann, Charles R G; Meier, Dominik S; Ngo, Long H; Hshieh, Tammy T; Callahan, Amy E; Fong, Tamara G; Schmitt, Eva; Dickerson, Bradford C; Press, Daniel Z; Marcantonio, Edward R; Jones, Richard N; Inouye, Sharon K; Alsop, David C

    2016-04-01

    Despite the significant impact of postoperative delirium on surgical outcomes and the long-term prognosis of older patients, its neural basis has not yet been clarified. In this study we investigated the impact of premorbid brain microstructural integrity, as measured by diffusion tensor imaging before surgery, on postoperative delirium incidence and severity, as well as the relationship among presurgical cognitive performance, diffusion tensor imaging abnormalities and postoperative delirium. Presurgical diffusion tensor imaging scans of 136 older (≥70 years), dementia-free subjects from the prospective Successful Aging after Elective Surgery study were analysed blind to the clinical data and delirium status. Primary outcomes were postoperative delirium incidence and severity during the hospital stay, as assessed by the Confusion Assessment Method. We measured cognition before surgery using general cognitive performance, a composite score based on a battery of neuropsychological tests. We investigated the association between presurgical diffusion tensor imaging parameters of brain microstructural integrity (i.e. fractional anisotropy, axial, mean and radial diffusivity) with postoperative delirium incidence and severity. Analyses were adjusted for the following potential confounders: age, gender, vascular comorbidity status, and general cognitive performance. Postoperative delirium occurred in 29 of 136 subjects (21%) during hospitalization. Presurgical diffusion tensor imaging abnormalities of the cerebellum, cingulum, corpus callosum, internal capsule, thalamus, basal forebrain, occipital, parietal and temporal lobes, including the hippocampus, were associated with delirium incidence and severity, after controlling for age, gender and vascular comorbidities. After further controlling for general cognitive performance, diffusion tensor imaging abnormalities of the cerebellum, hippocampus, thalamus and basal forebrain still remained associated with delirium

  13. Battery of behavioral tests in mice to study postoperative delirium.

    PubMed

    Peng, Mian; Zhang, Ce; Dong, Yuanlin; Zhang, Yiying; Nakazawa, Harumasa; Kaneki, Masao; Zheng, Hui; Shen, Yuan; Marcantonio, Edward R; Xie, Zhongcong

    2016-01-01

    Postoperative delirium is associated with increased morbidity, mortality and cost. However, its neuropathogenesis remains largely unknown, partially owing to lack of animal model(s). We therefore set out to employ a battery of behavior tests, including natural and learned behavior, in mice to determine the effects of laparotomy under isoflurane anesthesia (Anesthesia/Surgery) on these behaviors. The mice were tested at 24 hours before and at 6, 9 and 24 hours after the Anesthesia/Surgery. Composite Z scores were calculated. Cyclosporine A, an inhibitor of mitochondria permeability transient pore, was used to determine potential mitochondria-associated mechanisms of these behavioral changes. Anesthesia/Surgery selectively impaired behaviors, including latency to eat food in buried food test, freezing time and time spent in the center in open field test, and entries and duration in the novel arm of Y maze test, with acute onset and various timecourse. The composite Z scores quantitatively demonstrated the Anesthesia/Surgery-induced behavior impairment in mice. Cyclosporine A selectively ameliorated the Anesthesia/Surgery-induced reduction in ATP levels, the increases in latency to eat food, and the decreases in entries in the novel arm. These findings suggest that we could use a battery of behavior tests to establish a mouse model to study postoperative delirium. PMID:27435513

  14. The 3 D's of geriatric psychiatry: depression, delirium, and dementia.

    PubMed

    Dharia, Sheetal; Verilla, Kailen; Breden, Ericka L

    2011-08-01

    A Caucasian female octogenarian with multiple medical problems was admitted to the inpatient geriatric psychiatry unit with intermittent altered mental status and decline in memory. She had been hospitalized four times in the previous three months. She was admitted on more than 10 medications and received more than 20 different medications in this time period. It was determined that she had delirium concurrent with dementia and/or depression. During her hospital stay a urinary tract infection (UTI) was treated, her anticholinergic medications were minimized, and her digoxin dose was adjusted. As her mental status cleared, a workup was completed to differentiate between dementia and depression. She was initially treated with memantine, but as time progressed it became more evident she was experiencing depression and a "pseudodementia," which was treated with sertraline. Her Mini-Mental State Examination returned to 29/30 (her score previously was 26/29). This case demonstrates the complexity of treating an elder individual and the importance of differentiating among delirium, depression, and dementia. The pharmacy team played an active role in medication reconciliation. Additionally, they worked with the medical team to minimize her potentially harmful medications and optimize the treatment of her UTI and depression. PMID:21840820

  15. Recent Insights on Prevalence and Corelations of Hypoactive Delirium

    PubMed Central

    Peritogiannis, Vaios; Bolosi, Maria; Lixouriotis, Charalampos; Rizos, Dimitrios V.

    2015-01-01

    Delirium is a complex neuropsychiatric syndrome which is common in all medical settings. It often goes unrecognized due to difficulties in the detection of its hypoactive variant. This review aims to provide an up-to-date account on recent research on hypoactive delirium (HD). Thirty-eight studies, which were conducted in various clinical settings, including the Intensive Care Unit (ICU), were included in this review. Those studies involved recent research that has been published during the last 6 years. Prevalence of HD was found to vary considerably among different settings. HD seems to be more common in critically ill patients and less common in patients examined by consultation-liaison psychiatric services and in mixed patient populations. The presence of HD in ICU patients was associated with higher short- and long-term mortality and other adverse outcomes, but no such association was reported in other settings. Research on other possible associations of HD with clinical variables and on symptom presentation yielded inconclusive results, although there is some evidence for a possible association of HD with benzodiazepine use. There are several methodological issues that need to be addressed by future research. Future studies should examine HD in the primary care setting; treatment interventions should also be the objective of future research. PMID:26347584

  16. Battery of behavioral tests in mice to study postoperative delirium

    PubMed Central

    Peng, Mian; Zhang, Ce; Dong, Yuanlin; Zhang, Yiying; Nakazawa, Harumasa; Kaneki, Masao; Zheng, Hui; Shen, Yuan; Marcantonio, Edward R.; Xie, Zhongcong

    2016-01-01

    Postoperative delirium is associated with increased morbidity, mortality and cost. However, its neuropathogenesis remains largely unknown, partially owing to lack of animal model(s). We therefore set out to employ a battery of behavior tests, including natural and learned behavior, in mice to determine the effects of laparotomy under isoflurane anesthesia (Anesthesia/Surgery) on these behaviors. The mice were tested at 24 hours before and at 6, 9 and 24 hours after the Anesthesia/Surgery. Composite Z scores were calculated. Cyclosporine A, an inhibitor of mitochondria permeability transient pore, was used to determine potential mitochondria-associated mechanisms of these behavioral changes. Anesthesia/Surgery selectively impaired behaviors, including latency to eat food in buried food test, freezing time and time spent in the center in open field test, and entries and duration in the novel arm of Y maze test, with acute onset and various timecourse. The composite Z scores quantitatively demonstrated the Anesthesia/Surgery-induced behavior impairment in mice. Cyclosporine A selectively ameliorated the Anesthesia/Surgery-induced reduction in ATP levels, the increases in latency to eat food, and the decreases in entries in the novel arm. These findings suggest that we could use a battery of behavior tests to establish a mouse model to study postoperative delirium. PMID:27435513

  17. Prevalence of delirium among patients at a cancer ward: Clinical risk factors and prediction by bedside cognitive tests.

    PubMed

    Grandahl, Mia Gall; Nielsen, Svend Erik; Koerner, Ejnar Alex; Schultz, Helga Holm; Arnfred, Sidse Marie

    2016-08-01

    Background Delirium is a frequent psychiatric complication to cancer, but rarely recognized by oncologists. Aims 1. To estimate the prevalence of delirium among inpatients admitted at an oncological cancer ward 2. To investigate whether simple clinical factors predict delirium 3. To examine the value of cognitive testing in the assessment of delirium. Methods On five different days, we interviewed and assessed patients admitted to a Danish cancer ward. The World Health Organization International Classification of Diseases Version 10, WHO ICD-10 Diagnostic System and the Confusion Assessment Method (CAM) were used for diagnostic categorization. Clinical information was gathered from medical records and all patients were tested with Mini Cognitive Test, The Clock Drawing Test, and the Digit Span Test. Results 81 cancer patients were assessed and 33% were diagnosed with delirium. All delirious participants were CAM positive. Poor performance on the cognitive tests was associated with delirium. Medical records describing CNS metastases, benzodiazepine or morphine treatment were associated with delirium. Conclusions Delirium is prevalent among cancer inpatients. The Mini Cognitive Test, The Clock Drawing Test, and the Digit Span Test can be used as screening tools for delirium among inpatients with cancer, but even in synergy, they lack specificity. Combining cognitive testing and attention to nurses' records might improve detection, yet further studies are needed to create a more detailed patient profile for the detection of delirium. PMID:26882016

  18. Prevalence of delirium in geriatric rehabilitation in Israel and its influence on rehabilitation outcomes in patients with hip fractures.

    PubMed

    Heyman, Neomi; Nili, Frances; Shahory, Ron; Seleznev, Irena; Ben Natan, Merav

    2015-09-01

    The aim of this study was to assess the prevalence of delirium among geriatric patients with hip fractures and to examine the influence of delirium on rehabilitation outcomes. A prospective study was carried out among 95 hip fracture patients admitted to an orthopedic geriatric rehabilitation ward. At admission, the following data were gathered: sociodemographic data, prefracture Activities of Daily Living (ADL), Functional Independence Measure (FIM), Mini-Mental State Examination, comorbidities, and medication. Delirium was assessed using the Confusion Assessment Method. The severity of delirium among patients with a positive score on the Confusion Assessment Method was assessed using the Delirium Rating Scale-Revised-98 (DRS-R-98). Rehabilitation outcomes were evaluated by comparing FIM and ADL at admission and at discharge. The research findings showed that the prevalence of delirium among patients was 30%. In addition, a significant difference was found between patients who developed delirium and those who did not. Patients who developed delirium were mostly Jewish, with lower ADL levels at admission, more significant renal failure, lower levels of FIM, and lower Mini-Mental State Examination scores. Furthermore, FIM at discharge and delta FIM were lower among patients who developed delirium than among those who did not. The research conclusions indicated that the functional recovery of patients with delirium is slower. Therefore, it is important to adjust the therapeutic approach to these patients. PMID:26154303

  19. Strategies for prevention of postoperative delirium: a systematic review and meta-analysis of randomized trials

    PubMed Central

    2013-01-01

    Introduction The ideal measures to prevent postoperative delirium remain unestablished. We conducted this systematic review and meta-analysis to clarify the significance of potential interventions. Methods The PRISMA statement guidelines were followed. Two researchers searched MEDLINE, EMBASE, CINAHL and the Cochrane Library for articles published in English before August 2012. Additional sources included reference lists from reviews and related articles from 'Google Scholar'. Randomized clinical trials (RCTs) on interventions seeking to prevent postoperative delirium in adult patients were included. Data extraction and methodological quality assessment were performed using predefined data fields and scoring system. Meta-analysis was accomplished for studies that used similar strategies. The primary outcome measure was the incidence of postoperative delirium. We further tested whether interventions effective in preventing postoperative delirium shortened the length of hospital stay. Results We identified 38 RCTs with interventions ranging from perioperative managements to pharmacological, psychological or multicomponent interventions. Meta-analysis showed dexmedetomidine sedation was associated with less delirium compared to sedation produced by other drugs (two RCTs with 415 patients, pooled risk ratio (RR) = 0.39; 95% confidence interval (CI) = 0.16 to 0.95). Both typical (three RCTs with 965 patients, RR = 0.71; 95% CI = 0.54 to 0.93) and atypical antipsychotics (three RCTs with 627 patients, RR = 0.36; 95% CI = 0.26 to 0.50) decreased delirium occurrence when compared to placebos. Multicomponent interventions (two RCTs with 325 patients, RR = 0.71; 95% CI = 0.58 to 0.86) were effective in preventing delirium. No difference in the incidences of delirium was found between: neuraxial and general anesthesia (four RCTs with 511 patients, RR = 0.99; 95% CI = 0.65 to 1.50); epidural and intravenous analgesia (three RCTs with 167 patients, RR = 0.93; 95% CI = 0.61 to 1

  20. Adverse Outcomes After Hospitalization and Delirium in Persons With Alzheimer Disease

    PubMed Central

    Fong, Tamara G.; Jones, Richard N.; Marcantonio, Edward R.; Tommet, Douglas; Gross, Alden L.; Habtemariam, Daniel; Schmitt, Eva; Yap, Liang; Inouye, Sharon K.

    2012-01-01

    Background Hospitalization, frequently complicated by delirium, can be a life-changing event for patients with Alzheimer disease (AD). Objective To determine risks for institutionalization, cognitive decline, or death associated with hospitalization and delirium in patients with AD. Design Prospective cohort enrolled between 1991 and 2006 into the Massachusetts Alzheimer’s Disease Research Center (MADRC) patient registry. Setting Community-based. Participants 771 persons aged 65 years or older with a clinical diagnosis of AD. Measurements Hospitalization, delirium, death, and institutionalization were identified through administrative databases. Cognitive decline was defined as a decrease of 4 or more points on the Blessed Information-Memory-Concentration test score. Multivariate analysis was used to calculate adjusted relative risks (RRs). Results Of 771 participants with AD, 367 (48%) were hospitalized and 194 (25%) developed delirium. Hospitalized patients who did not have delirium had an increased risk for death (adjusted RR, 4.7 [95% CI, 1.9 to 11.6]) and institutionalization (adjusted RR, 6.9 [CI, 4.0 to 11.7]). With delirium, risk for death (adjusted RR, 5.4 [CI, 2.3 to 12.5]) and institutionalization (adjusted RR, 9.3 [CI, 5.5 to 15.7]) increased further. With hospitalization and delirium, the adjusted RR for cognitive decline for patients with AD was 1.6 (CI, 1.2 to 2.3). Among hospitalized patients with AD, 21% of the incidences of cognitive decline, 15% of institutionalization, and 6% of deaths were associated with delirium. Limitations Cognitive outcome was missing in 291 patients. Sensitivity analysis was performed to test the effect of missing data, and a composite outcome was used to decrease the effect of missing data. Conclusion Approximately 1 in 8 hospitalized patients with AD who develop delirium will have at least 1 adverse outcome, including death, institutionalization, or cognitive decline, associated with delirium. Delirium prevention may

  1. Neuropathogenesis of delirium: review of current etiologic theories and common pathways.

    PubMed

    Maldonado, José R

    2013-12-01

    Delirium is a neurobehavioral syndrome caused by dysregulation of neuronal activity secondary to systemic disturbances. Over time, a number of theories have been proposed in an attempt to explain the processes leading to the development of delirium. Each proposed theory has focused on a specific mechanism or pathologic process (e.g., dopamine excess or acetylcholine deficiency theories), observational and experiential evidence (e.g., sleep deprivation, aging), or empirical data (e.g., specific pharmacologic agents' association with postoperative delirium, intraoperative hypoxia). This article represents a review of published literature and summarizes the top seven proposed theories and their interrelation. This review includes the "neuroinflammatory," "neuronal aging," "oxidative stress," "neurotransmitter deficiency," "neuroendocrine," "diurnal dysregulation," and "network disconnectivity" hypotheses. Most of these theories are complementary, rather than competing, with many areas of intersection and reciprocal influence. The literature suggests that many factors or mechanisms included in these theories lead to a final common outcome associated with an alteration in neurotransmitter synthesis, function, and/or availability that mediates the complex behavioral and cognitive changes observed in delirium. In general, the most commonly described neurotransmitter changes associated with delirium include deficiencies in acetylcholine and/or melatonin availability; excess in dopamine, norepinephrine, and/or glutamate release; and variable alterations (e.g., either a decreased or increased activity, depending on delirium presentation and cause) in serotonin, histamine, and/or γ-aminobutyric acid. In the end, it is unlikely that any one of these theories is fully capable of explaining the etiology or phenomenologic manifestations of delirium but rather that two or more of these, if not all, act together to lead to the biochemical derangement and, ultimately, to the

  2. Intraoperative Tight Glucose Control Using Hyperinsulinemic Normoglycemia Increases Delirium After Cardiac Surgery

    PubMed Central

    Saager, Leif; Duncan, Andra E.; Yared, Jean-Pierre; Hesler, Brian D.; You, Jing; Deogaonkar, Anupa; Sessler, Daniel I.; Kurz, Andrea

    2015-01-01

    Background Postoperative delirium is common in patients recovering from cardiac surgery. Tight glucose control has been shown to reduce mortality and morbidity. We therefore sought to determine the effect of tight intraoperative glucose control using a hyper-insulinemic normoglycemic clamp approach on postoperative delirium in patients undergoing cardiac surgery. Methods We enrolled 198 adult patients having cardiac surgery in this randomized, double-blinded single-center trial. Patients were randomly assigned to either tight intraoperative glucose control with a hyperinsulinemic-normoglycemic clamp (target blood glucose: 80–110 mg/dL) or standard therapy (conventional insulin administration with blood glucose target < 150 mg/dL). Delirium was assessed using a comprehensive delirium battery. We considered patients to have experienced postoperative delirium when Confusion Assessment Method testing was positive at any assessment. A positive Confusion Assessment Method test was defined by the presence of features 1 (acute onset and fluctuating course) and 2 (inattention), and either 3 (disorganized thinking) or 4 (altered consciousness). Results Patients randomized to tight glucose control were more likely to be diagnosed as being delirious than those assigned to routine glucose control (26/93 vs. 15/105; Relative Risk (RR), 95% CI: 1.89, 1.06–3.37; P = 0.03), after adjusting for preoperative usage of calcium channel blocker and American Society of Anesthesiologist (ASA) physical status. Delirium severity, among patients with delirium, was comparable with each glucose management strategy. Conclusions Intraoperative hyperinsulinemic-normoglycemia augments the risk of delirium after cardiac surgery, but not its severity. PMID:25992877

  3. Cortisol, Interleukins and S100B in Delirium in the Elderly

    ERIC Educational Resources Information Center

    van Munster, Barbara C.; Bisschop, Peter H.; Zwinderman, Aeilko H.; Korevaar, Johanna C.; Endert, Erik; Wiersinga, W. Joost; van Oosten, Hannah E.; Goslings, J. Carel; de Rooij, Sophia E. J. A.

    2010-01-01

    In independent studies delirium was associated with higher levels of cortisol, interleukin(IL)s, and S100B. The aim of this study was to simultaneously compare cortisol, IL-6, IL-8, and S100B levels in patients aged 65 years and older admitted for hip fracture surgery with and without delirium. Cortisol, IL-6, IL-8, and S100B were assayed in…

  4. Current approach to diagnosis and treatment of delirium after cardiac surgery

    PubMed Central

    Evans, Adam S.; Weiner, Menachem M.; Arora, Rakesh C.; Chung, Insung; Deshpande, Ranjit; Varghese, Robin; Augoustides, John; Ramakrishna, Harish

    2016-01-01

    Delirium after cardiac surgery remains a common occurrence that results in significant short- and long-term morbidity and mortality. It continues to be underdiagnosed given its complex presentation and multifactorial etiology; however, its prevalence is increasing given the aging cardiac surgical population. This review highlights the perioperative risk factors, tools to assist in diagnosing delirium, and current pharmacological and nonpharmacological therapy options. PMID:27052077

  5. Preliminary Development of an Ultrabrief Two-Item Bedside Test for Delirium

    PubMed Central

    Fick, Donna M.; Inouye, Sharon K.; Guess, Jamey; Ngo, Long H.; Jones, Richard N.; Saczynski, Jane S.; Marcantonio, Edward R.

    2015-01-01

    Background Delirium is common, morbid, and costly, yet is greatly under-recognized among hospitalized older adults. Objective To identify the best single and pair of mental status test items that predict the presence of delirium. Design, Setting Diagnostic test evaluation study that enrolled medicine inpatients aged 75 years or older at an academic medical center. Methods Patients underwent a clinical reference standard assessment involving a patient interview, medical record review, and interviews with family members and nurses to determine the presence or absence of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition defined delirium. Participants also underwent the three-dimensional Confusion Assessment Method (3D-CAM), a brief, validated assessment for delirium. Individual items and pairs of items from the 3D-CAM were evaluated to determine sensitivity and specificity relative to the reference standard delirium diagnosis. Results Of the 201 participants (mean age 84 years, 62% female), 42 (21%) had delirium based on the clinical reference standard. The single item with the best test characteristics was “months of the year backwards” with a sensitivity of 83% (95% confidence interval [CI]: 69%-93%) and specificity of 69% (95% CI: 61%-76%). The best 2-item screen was the combination of “months of the year backwards” and “what is the day of the week?” with a sensitivity of 93% (95% CI: 81%-99%) and specificity of 64% (95% CI: 56%-70%). Conclusions We identified a single item with >80% and pair of items with >90% sensitivity for delirium. If validated prospectively, these items will serve as an initial innovative screening step for delirium identification in hospitalized older adults. PMID:26369992

  6. Exogenous Melatonin for Delirium Prevention: a Meta-analysis of Randomized Controlled Trials.

    PubMed

    Chen, Sheng; Shi, LiGen; Liang, Feng; Xu, Liang; Desislava, Doycheva; Wu, Qun; Zhang, Jianmin

    2016-08-01

    Recently, two high-quality clinical randomized controlled trials (RCTs) regarding the preventive effect of exogenous melatonin on delirium drew inconsistent conclusions. We therefore performed a systemic review to explore whether melatonin had a benefit on delirium prevention. MEDLINE, EMBASE, and Cochrane Library were searched from January 1980 to April 2015 for English language studies. After strict selection and evaluation, the data were extracted from the included four RCTs. The primary outcome of this meta-analysis was the incidence of delirium. The secondary outcome was the improvement of sleep-wake rhythm. A total of four RCTs with 669 elderly patients were included in the present study. Melatonin group showed a tendency to decrease the incidence of delirium (relative risk [RR] 0.41, 95 % confidence interval [CI] 0.15 to 1.13; P = 0.08) compared with control group. In subgroup analysis of the elderly patients in medical wards, melatonin supplementation decreased the incidence of delirium by 75 % (RR 0.25, 95 % CI 0.07 to 0.88; P = 0.03), but not in sleep-wake disturbance (RR 1.24, 95 % CI 0.51 to 3.00; P = 0.64). No differences were found in the incidence of delirium between the two groups in the elderly patients that were presented to surgical wards. In conclusion, melatonin supplementation had a significant preventive effect in decreasing the incidence of delirium in elderly patients that were presented to medical wards. Further studies should provide sufficient evidence about the effect of melatonin on delirium in a large sample size. PMID:26189834

  7. Antipsychotics for delirium in the general hospital setting in consecutive 2453 inpatients: a prospective observational study

    PubMed Central

    Hatta, Kotaro; Kishi, Yasuhiro; Wada, Ken; Odawara, Toshinari; Takeuchi, Takashi; Shiganami, Takafumi; Tsuchida, Kazuo; Oshima, Yoshio; Uchimura, Naohisa; Akaho, Rie; Watanabe, Akira; Taira, Toshihiro; Nishimura, Katsuji; Hashimoto, Naoko; Usui, Chie; Nakamura, Hiroyuki

    2014-01-01

    Objective Attention to risk of antipsychotics for older patients with delirium has been paid. A clinical question was whether risk of antipsychotics for older patients with delirium would exceed efficacy of those even in the general hospital setting. Methods A prospective observational study proceeded over a 1-year period at 33 general hospitals, where at least one psychiatrist worked full time. Subjects were patients who developed delirium during their admission due to acute somatic diseases or surgery, and who received antipsychotics for delirium. The primary outcome was rates and kinds of serious adverse events. Results Among 2834 patients who developed delirium, 2453 patients received antipsychotics, such as risperidone (34%), quetiapine (32%), and parenteral haloperidol (20%), for delirium. Out of 2453 patients, 22 serious adverse events (0.9%) were reported. Aspiration pneumonia was the most frequent (17 patients, 0.7%), followed by cardiovascular events (4 patients, 0.2%) and venous thromboembolism (1 patient, 0.0%). There was no patient with a fracture or intracranial injury due to a fall. No one died because of antipsychotic side effects. The mean Clinical Global Impressions—Improvement Scale score was 2.02 (SD 1.09). Delirium was resolved within 1 week in more than half of the patients (54%). Conclusions In the general hospital setting under management including fine dosage adjustment and early detection of side effects, risk of antipsychotics for older patients with delirium might be low, in contrast to antipsychotics for dementia in the nursing home or outpatient settings. A point may be not how to avoid using antipsychotics but how to monitor their risk. PMID:23801358

  8. Treatment and prevention of postoperative complications in hip fracture patients: infections and delirium.

    PubMed

    Dovjak, Peter; Iglseder, Bernhard; Mikosch, Peter; Gosch, Markus; Müller, Ernst; Pinter, Georg; Pils, Katharina; Gerstofer, Inge; Thaler, Heinrich; Zmaritz, Michaela; Weissenberger-Leduc, Monique; Müller, Walter

    2013-10-01

    The course of older patients with hip fractures is often complicated by infections and delirium. Accurate care and high suspicion for these complications are essential, since these conditions are associated with an increase in mortality, length of hospital stay and nursing home placement, poorer mobility, and functional decline. Because of immunosenescence and higher infection rates, older patients need specific care, immediate diagnosis, and treatment of infections. Numerous guidelines of various medical societies outline the management of nosocomial infections, but there is a need of an individualized treatment plan because of comorbidities and polypharmacy. Hygiene measures have first priority to reduce the rate of infections. Treatment of geriatric syndromes like malnutrition, exsiccosis, gait disorders, falls, delirium, urine incontinence, and organ insufficiency are as important as immunization against pneumococci and influenza. Advanced age, cognitive impairment, hearing loss, peripheral vascular disease, prior delirium episodes, sight disorders, and polypharmacy are established risk factors for delirium; thus, older people with several chronic diseases are prone to delirium. A multifactorial approach, comprising standardized screening, oxygen support, intravenous fluid administration and augmented nutrition, monitoring of vital signs, pain treatment, optimized medication, and modification in perioperative management, significantly reduces delirium incidence during hospitalization for hip fracture. An interdisciplinary approach between surgeons and geriatricians may warrant optimized satisfaction of patients' needs. PMID:23949565

  9. The impact of delirium on the circadian distribution of breakthrough analgesia in advanced cancer patients.

    PubMed

    Gagnon, B; Lawlor, P G; Mancini, I L; Pereira, J L; Hanson, J; Bruera, E D

    2001-10-01

    Most cancer patients will experience pain requiring opioid therapy during their illness. Standard opioid therapy includes fixed scheduled doses and so-called "rescue" doses for breakthrough pain. Circadian rhythms seem to influence the expression of pain and the responsiveness to analgesic medication. Delirium is a common complication in advanced cancer patients and it also may modify the expression of pain and the use of analgesic medication. We reviewed the circadian distribution of breakthrough analgesia (BTA) doses in 104 advanced cancer patients who were part of a prospective study of the occurrence of delirium. We found that the circadian distribution of BTA is significantly different from a random distribution in the case of patients with and without delirium. Patients without delirium tended to use more BTA (P < 0.001) in the morning, whereas patients with delirium tended to use more BTA in the evening and at night (P = 0.02). We conclude that delirium is associated with changes in the circadian distribution of BTA, which is possibly related to reversal of the normal circadian rhythm. PMID:11576799

  10. The Prevention and Treatment of Delirium in Elderly Patients Following Hip Fracture Surgery.

    PubMed

    Martocchia, Antonio; Curto, Martina; Comite, Fabrizia; Scaccianoce, Sergio; Girardi, Paolo; Ferracuti, Stefano; Nicoletti, Ferdinando; Falaschi, Paolo

    2015-01-01

    Osteoporotic hip fracture needs a specific approach and treatment, since elderly patients are at high risk for adverse outcomes after surgery. In particular, delirium often occurs in the peri-operative period, and it is associated with death, hospital-acquired complications, persistent cognitive impairments, poor functional recovery after surgery and increased healthcare costs. The pre-operative assessment of the risk factors for delirium improves the preventive measures. The delirium diagnostic tools should be included in the standard of orthogeriatric cure for hip fracture. Given the increasing complexity of the clinical pictures, we present a review of the available treatment options for delirium in patients with hip fracture. The metabolic pre-operative disorders and the management of co-morbid diseases are specific targets of treatment in order to optimize the outcomes after surgery. In particular, elderly patients with Alzheimer's disease are highly vulnerable to hip fracture and delirium, and they are severely frail with reduced physiologic reserves. An integrated approach combining environmental and pharmacological strategies is useful in the delirium treatment, with a close collaboration between the orthopedic and geriatric team. PMID:25687439

  11. Different MMSE Score Is Associated with Postoperative Delirium in Young-Old and Old-Old Adults

    PubMed Central

    Wang, Meijuan; Zhu, Yingbo; Li, Cheng; Li, Guodong; Marcantonio, Edward R.; Xie, Zhongcong; Shen, Yuan

    2015-01-01

    Background Postoperative delirium is one of the most common postoperative complications in geriatric patients. Mini-mental state examination (MMSE) assesses cognitive function in patients and is associated with postoperative delirium. However, whether there is an age-dependent relationship between preoperative MMSE score and postoperative delirium remains unknown. Methods We therefore set out to investigate the association between preoperative MMSE score and postoperative delirium in young-old (≤80 year-old, 75.46±4.69 years, 27.0% male, n = 63) and old-old (>80 year-old, 84.51±3.46 years, 20.9% male, n = 67) participants, who had repairs of hip fractures under general anesthesia. The Confusion Assessment Method and Memorial Delirium Assessment Scale were administrated before surgery, and on the first, second and fourth days after surgery, to assess the incidence and severity of the delirium, respectively. A receiver operating characteristic curve analysis was used to calculate the optimal cutoff score of MMSE in predicting postoperative delirium. Results Thirty-four (26.2%) of 130 patients (80.12±6.12 years, 23.8% male) developed postoperative delirium. Preoperative MMSE scores were negatively associated with higher incidences and greater severity of postoperative delirium. The optimal cutoff scores of MMSE associated with postoperative delirium for young-old and old-old participants were 18.4 and 21.4, with a sensitivity of 60% and 83.8%, and a specificity of 92.5% and 62.8%, respectively. Conclusion The data demonstrated the optimal cutoff score of MMSE associated with postoperative delirium in young-old adults might be lower than that in old-old adults. Pending further investigation, these findings suggest that the association between preoperative MMSE score and postoperative delirium is age-dependent. PMID:26460750

  12. Postinjection Delirium/Sedation Syndrome with Olanzapine Depot Injection.

    PubMed

    Sarangula, Sadhvi Mythili; Mythri, Starlin Vijay; Sanjay, Y; Reddy, M S

    2016-01-01

    After 1 year of introduction of olanzapine long-acting injectable (LAI) in India, many psychiatrists believe that it is a very affordable, well-tolerated, and effective second generation long-acting antipsychotic depot compared to not well tolerated but cheap first generation antipsychotic depots and to other second generation depots which are costly. However, reports of its possible adverse events in clinical settings are not yet published. We report what probably might be the first case of postinjection delirium/sedation syndrome (PDSS) in India. Although the occurrence is uncommon, incorrect understanding of this event may hinder the future use of the potentially useful olanzapine LAI. We review the available literature on the proposed diagnostic guidelines, mechanism of this event, precautions, and management of PDSS. PMID:27570354

  13. Postinjection Delirium/Sedation Syndrome with Olanzapine Depot Injection

    PubMed Central

    Sarangula, Sadhvi Mythili; Mythri, Starlin Vijay; Sanjay, Y.; Reddy, M. S.

    2016-01-01

    After 1 year of introduction of olanzapine long-acting injectable (LAI) in India, many psychiatrists believe that it is a very affordable, well-tolerated, and effective second generation long-acting antipsychotic depot compared to not well tolerated but cheap first generation antipsychotic depots and to other second generation depots which are costly. However, reports of its possible adverse events in clinical settings are not yet published. We report what probably might be the first case of postinjection delirium/sedation syndrome (PDSS) in India. Although the occurrence is uncommon, incorrect understanding of this event may hinder the future use of the potentially useful olanzapine LAI. We review the available literature on the proposed diagnostic guidelines, mechanism of this event, precautions, and management of PDSS. PMID:27570354

  14. [Risk factors for delirium tremens: a literature review].

    PubMed

    Thiercelin, N; Rabiah Lechevallier, Z; Rusch, E; Plat, A

    2012-01-01

    Delirium tremens (DT) is the most severe complication from alcohol withdrawal. Risk factors for DT (before the withdrawal begins) and early predictive factors for the development of the withdrawal syndrome towards DT (once withdrawal has started) are not clearly established. We reviewed the literature from PubMed/Medline database to identify risk factors for DT. Twenty-one studies were been selected. Three only were prospective. The most commonly identified risk factors included personal history of DT, seizures, presence of acute somatic comorbidity especially infectious, presence of early withdrawal symptoms, and genetic predisposition. Most of these risk factors are still debated and prospective studies might appear useful considering the DT prevalence and the absence of consensual both diagnostic and therapeutic protocols. PMID:21920639

  15. Effectiveness of multi-component non-pharmacologic delirium interventions: A Meta-analysis

    PubMed Central

    Hshieh, Tammy T.; Yue, Jirong; Oh, Esther; Puelle, Margaret; Dowal, Sarah; Travison, Thomas; Inouye, Sharon K.

    2015-01-01

    Importance Delirium, an acute disorder with high morbidity and mortality, is often preventable through multi-component non-pharmacologic strategies. The efficacy of these strategies for preventing subsequent adverse outcomes has been limited to small studies. Objective Evaluate available evidence on multi-component non-pharmacologic delirium interventions in reducing incident delirium and preventing poor outcomes associated with delirium. Data Sources PubMed, Google Scholar, ScienceDirect and Cochrane Database of Systematic Reviews from January 1, 1999–December 31, 2013. Study Selection Studies examining the following outcomes were included: delirium incidence, falls, length of stay, rate of discharge to a long-term care institution, change in functional or cognitive status. Data Extraction and Synthesis Two experienced physician reviewers independently and blindly abstracted data on outcome measures using a standardized approach. The reviewers conducted quality ratings based on the Cochrane Risk of Bias criteria for each study. Main Outcomes and Measures We identified 14 interventional studies. Results for outcomes of delirium, falls, length of stay and institutionalization data were pooled for meta-analysis but heterogeneity limited meta-analysis of results for outcomes of functional and cognitive decline. Overall, eleven studies demonstrated significant reductions in delirium incidence (Odds Ratio 0.47, 95% Confidence Interval 0.38–0.58). The four randomized or matched (RMT) studies reduced delirium incidence by 44% (95% CI 0.42–0.76). Rate of falls decreased significantly among intervention patients in four studies (OR 0.38, 95% CI 0.25–0.60); in the two RMTs, the fall rate was reduced by 64% (95% CI 0.22–0.61). Lengths of stay and institutionalization rates also trended towards decreases in the intervention groups, mean difference −0.16 days shorter (95% CI −0.97–0.64) and odds of institutionalization 5% lower (OR 0.95, 95% CI 0.71–1

  16. Worsening Cognitive Impairment and Neurodegenerative Pathology Progressively Increase Risk for Delirium

    PubMed Central

    Davis, Daniel H.J.; Skelly, Donal T.; Murray, Carol; Hennessy, Edel; Bowen, Jordan; Norton, Samuel; Brayne, Carol; Rahkonen, Terhi; Sulkava, Raimo; Sanderson, David J.; Rawlins, J. Nicholas; Bannerman, David M.; MacLullich, Alasdair M.J.; Cunningham, Colm

    2015-01-01

    Background Delirium is a profound neuropsychiatric disturbance precipitated by acute illness. Although dementia is the major risk factor this has typically been considered a binary quantity (i.e., cognitively impaired versus cognitively normal) with respect to delirium risk. We used humans and mice to address the hypothesis that the severity of underlying neurodegenerative changes and/or cognitive impairment progressively alters delirium risk. Methods Humans in a population-based longitudinal study, Vantaa 85+, were followed for incident delirium. Odds for reporting delirium at follow-up (outcome) were modeled using random-effects logistic regression, where prior cognitive impairment measured by Mini-Mental State Exam (MMSE) (exposure) was considered. To address whether underlying neurodegenerative pathology increased susceptibility to acute cognitive change, mice at three stages of neurodegenerative disease progression (ME7 model of neurodegeneration: controls, 12 weeks, and 16 weeks) were assessed for acute cognitive dysfunction upon systemic inflammation induced by bacterial lipopolysaccharide (LPS; 100 μg/kg). Synaptic and axonal correlates of susceptibility to acute dysfunction were assessed using immunohistochemistry. Results In the Vantaa cohort, 465 persons (88.4 ± 2.8 years) completed MMSE at baseline. For every MMSE point lost, risk of incident delirium increased by 5% (p = 0.02). LPS precipitated severe and fluctuating cognitive deficits in 16-week ME7 mice but lower incidence or no deficits in 12-week ME7 and controls, respectively. This was associated with progressive thalamic synaptic loss and axonal pathology. Conclusion A human population-based cohort with graded severity of existing cognitive impairment and a mouse model with progressing neurodegeneration both indicate that the risk of delirium increases with greater severity of pre-existing cognitive impairment and neuropathology. PMID:25239680

  17. A review of recent clinical trials and guidelines on the prevention and management of delirium in hospitalized older patients.

    PubMed

    Rathier, Margaret O; Baker, William L

    2011-10-01

    Treatment of acute illness in older adults is frequently complicated by the presence of delirium. Delirium is characterized by the development of an altered mental status over the course of hours to days, and can have a fluctuating course. Patients with delirium have difficulty paying attention to their environment, have disorganized thinking, and usually have an altered level of consciousness. While scientists continue to elucidate the pathophysiologic mechanisms associated with delirium, clinicians can identify patients at risk for delirium and diagnose it using valid instruments, such as the Confusion Assessment Method and Confusion Assessment Method for the Intensive Care Unit. Delirium is an independent risk factor for death, institutionalization, and dementia, and resolves in many patients by the time of hospital discharge. For patients admitted to medical units, optimal management of delirium includes reassessment of medications, pain, sleep, nutrition, mobility, need for physical restraints, and bowel and bladder function. The use of antipsychotic medication to sedate delirious patients should be restricted to patients in danger of harming themselves or others and should be used when nonpharmacologic means fail. Multicomponent interventions performed by the hospital care team that address risk factors can prevent delirium in patients in medical units and those undergoing hip fracture repair. This includes attention to the depth of sedation during spinal anesthesia and the addition of regional nerve blocks to patient-controlled analgesia in orthopedic patients, both of which may reduce postoperative delirium. Perioperative use of antipsychotics may further reduce the incidence of delirium, although hospital length of stay has not been routinely reduced. Appropriate management of analgesia, sedation, and delirium in the intensive care unit is also associated with reduced duration of mechanical ventilation, as well as intensive care unit and hospital length of

  18. Preoperative protein profiles in cerebrospinal fluid in elderly hip fracture patients at risk for delirium: A proteomics and validation study

    PubMed Central

    Westhoff, Dunja; Witlox, Joost; van Aalst, Corneli; Scholtens, Rikie M.; de Rooij, Sophia E.; van Munster, Barbara C.; de Jonghe, Jos F.M.; Houdijk, Alexander P.J.; Eikelenboom, Piet; van Westerloo, David J.; van de Beek, Diederik; van Gool, Willem A.; Koenderman, Leo

    2015-01-01

    Background A neuroinflammatory response is suggested to play an important role in delirium, a common complication in older hospitalized patients. We examined whether hip fracture patients who develop postoperative delirium have a different proteome in cerebrospinal fluid (CSF) prior to surgery. Methods Patients (≥ 75 years) were admitted for hip fracture surgery. CSF was collected during spinal anaesthesia; proteins were separated using gel electrophoresis and identified with mass spectrometry. We compared the proteome of patients with and without postoperative delirium. Findings were validated in an independent, comparable cohort using immuno-assays. Results In the derivation cohort 53 patients were included, 35.8% developed postoperative delirium. We identified differences in levels of eight CSF proteins between patients with and without subsequent delirium: complement factor C3, contactin-1, fibulin-1 and I-beta-1,3-N-acetylglucosaminyltransferase were significantly lower in patients with postoperative delirium, while neural cell adhesion molecule-2, fibrinogen, zinc-α-2-glycoprotein and haptoglobin levels were significantly higher. In the validation cohort 21.2% of 52 patients developed postoperative delirium. Immuno-assays confirmed contactin-1 results although not statistically significant. Complement factor C3 was significantly higher in patients with postoperative delirium. Conclusion Our results show the complexity of pathophysiological mechanisms involved in delirium and emphasizes the need of independent validation of findings. General significance This study highlights the challenges and inconsistent findings in studies of delirium, a serious complication in older patients. We analysed proteins in CSF, the most proximal fluid to the brain. All patients were free from delirium at the time of sampling. PMID:26675981

  19. Delirium in Hospitalized Patients: Implications of Current Evidence on Clinical Practice and Future Avenues for Research—A Systematic Evidence Review

    PubMed Central

    Khan, Babar A.; Zawahiri, Mohammed; Campbell, Noll L.; Fox, George C.; Weinstein, Eric J.; Nazir, Arif; Farber, Mark O.; Buckley, John D.; MacLullich, Alasdair; (UK), MRCP; Boustani, Malaz A.

    2013-01-01

    BACKGROUND Despite the significant burden of delirium among hospitalized adults, critical appraisal of systematic data on delirium diagnosis, pathophysiology, treatment, prevention, and outcomes is lacking. PURPOSE To provide evidence-based recommendations for delirium care to practitioners, and identify gaps in delirium research. DATA SOURCES Medline, PubMed, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) information systems fromJanuary 1966 to April 2011. STUDY SELECTION All published systematic evidence reviews (SERs) on delirium were evaluated. DATA EXTRACTION Three reviewers independently extracted the data regarding delirium risk factors, diagnosis, prevention, treatment, and outcomes, and critically appraised each SER as good, fair, or poor using the United States Preventive Services Task Force criteria. DATA SYNTHESIS Twenty-two SERs graded as good or fair provided the data. Age, cognitive impairment, depression, anticholinergic drugs, and lorazepam use were associated with an increased risk for developing delirium. The Confusion Assessment Method (CAM) is reliable for delirium diagnosis outside of the intensive care unit. Multicomponent nonpharmacological interventions are effective in reducing delirium incidence in elderly medical patients. Low-dose haloperidol has similar efficacy as atypical antipsychotics for treating delirium. Delirium is associated with poor outcomes independent of age, severity of illness, or dementia. CONCLUSION Delirium is an acute, preventable medical condition with short- and long-term negative effects on a patient’s cognitive and functional states. PMID:22684893

  20. Outcome of delirium in critically ill patients: systematic review and meta-analysis

    PubMed Central

    Salluh, Jorge I F; Wang, Han; Schneider, Eric B; Nagaraja, Neeraja; Yenokyan, Gayane; Damluji, Abdulla; Serafim, Rodrigo B

    2015-01-01

    Objectives To determine the relation between delirium in critically ill patients and their outcomes in the short term (in the intensive care unit and in hospital) and after discharge from hospital. Design Systematic review and meta-analysis of published studies. Data sources PubMed, Embase, CINAHL, Cochrane Library, and PsychINFO, with no language restrictions, up to 1 January 2015. Eligibility criteria for selection studies Reports were eligible for inclusion if they were prospective observational cohorts or clinical trials of adults in intensive care units who were assessed with a validated delirium screening or rating system, and if the association was measured between delirium and at least one of four clinical endpoints (death during admission, length of stay, duration of mechanical ventilation, and any outcome after hospital discharge). Studies were excluded if they primarily enrolled patients with a neurological disorder or patients admitted to intensive care after cardiac surgery or organ/tissue transplantation, or centered on sedation management or alcohol or substance withdrawal. Data were extracted on characteristics of studies, populations sampled, identification of delirium, and outcomes. Random effects models and meta-regression analyses were used to pool data from individual studies. Results Delirium was identified in 5280 of 16 595 (31.8%) critically ill patients reported in 42 studies. When compared with control patients without delirium, patients with delirium had significantly higher mortality during admission (risk ratio 2.19, 94% confidence interval 1.78 to 2.70; P<0.001) as well as longer durations of mechanical ventilation and lengths of stay in the intensive care unit and in hospital (standard mean differences 1.79 (95% confidence interval 0.31 to 3.27; P<0.001), 1.38 (0.99 to 1.77; P<0.001), and 0.97 (0.61 to 1.33; P<0.001), respectively). Available studies indicated an association between delirium and cognitive impairment after discharge

  1. Pathophysiologic changes due to TASER® devices versus excited delirium: potential relevance to deaths-in-custody?

    PubMed

    Jauchem, James R

    2011-05-01

    The syndrome of excited delirium has been implicated in some deaths-in-custody which also involved the use of electronic control devices (ECDs) (including those manufactured by TASER International) on subjects. This review is an update on recent studies of pathophysiologic changes related to these two separate but parallel topics: a) first, the use of ECDs during law-enforcement activities; and b) second, the occurrence of excited delirium during such activities. This is a narrative review of elements that may be of use in generating hypotheses relating to potential similarities or differences between the two topics. Differences between changes in most factors due to excited delirium versus those of ECD applications were not readily apparent in most cases. These factors include: direct and indirect effects on the cardiovascular system, respiration, rhabdomyolysis and muscle enzymes, hyperkalemia, acidosis, hyperglycemia, and increased hematocrit. One factor that may exhibit consistent differences, however, is increased body temperature, which is often evident during excited delirium (versus a lack of increase temperature during ECD exposures). Thus, on the basis of this review, a more detailed delineation of this factor could be a major focus for future forensic investigations of deaths-in-custody involving either excited delirium or ECD exposures. PMID:21550562

  2. Does Haloperidol Prophylaxis Reduce Ketamine-Induced Emergence Delirium in Children?

    PubMed Central

    Amr, Mostafa A. M.; Shams, Tarek; Al-Wadani, Hamid

    2013-01-01

    Objectives: Ketamine is a non-barbiturate agent with rapid action onset that induces profound sedation; however, some emergency physicians tend not to use ketamine because of the risk of emergence delirium (ED). This study aimed to evaluate the effectiveness of haloperidol prophylaxis in postoperative ketamine delirium in children. Methods: Prospective data relating to any emergence dreams, delirium, hallucinations, agitation, crying, altered perceptions, and necessary interventions were recorded in consecutive cases of ketamine delirium in patients attending Mansoura University Hospital, Egypt, from June 2010 to May 2011. Results: A total of 537 records were available for analysis. Of those, 267 received prophylactic haloperidol (49.7%). There were significant differences between the two groups regarding post-anaesthetic care unit behaviour. The ketamine-haloperidol groups included more patients who were sleepy, calm (P ≤0.01) and less irritable (P ≤0.01), with a lower incidence of crying (P ≤0.01) and disorientation (P ≤0.01). Conclusion: We found that preoperative administration of haloperidol decreases the incidence of postoperative delirium in a sample of Egyptian children undergoing minor surgery. This is congruent with earlier work conducted in adults. This work carries great hope to decrease and even prevent ED in hospitalised, non-surgical patients. PMID:23862031

  3. Mahalanobis-Taguchi System to Identify Preindicators of Delirium in the ICU.

    PubMed

    Buenviaje, Bernardo; Bischoff, John E; Roncace, Robert A; Willy, Christopher J

    2016-07-01

    This paper was designed to determine if the Mahalanobis-Taguchi System (MTS) applied to the delirium-evidence-based bundle could detect medical patterns in retrospective datasets. The methodology defined the evidence-based bundle as a multidimensional system that conformed to a parameter diagram. The Mahalanobis distance (MD) was calculated for the retrospective healthy observations and the retrospective unhealthy observations. Signal-to-noise ratios were calculated to determine the relative strength of detection of 23 delirium preindicators. This study discovered that the sufficient variation in the CAM-ICU assessment, the standard for delirium assessment, would benefit from knowledge of how different the MD is from the healthy average. The sensitivity of the detection system was 0.89 with a 95% confidence interval of between 0.84 and 0.92. The specificity of the detection system was 0.93 with a 95% confidence interval between 0.90 and 0.95. The MTS applied to the delirium-evidence-based bundle could detect medical patterns in retrospective datasets. The implication of this paper to a biomedical research is an automated decision support tool for the delirium-evidence-based bundle providing an early detection capability needed today. PMID:26011872

  4. Pellagrous encephalopathy presenting as alcohol withdrawal delirium: A case series and literature review

    PubMed Central

    2012-01-01

    Background Alcohol withdrawal delirium (AWD) is associated with significant morbidity and mortality. Pellagra (niacin deficiency) can be a cause of delirium during alcohol withdrawal that may often be overlooked. Objectives We present a three-patient case series of pellagrous encephalopathy (delirium due to pellagra) presenting as AWD. Methods We provide a brief review of pellagra’s history, data on pellagra’s epidemiology, and discuss pellagra’s various manifestations, particularly as related to alcohol withdrawal. We conclude by providing a review of existing guidelines on the management of alcohol withdrawal, highlighting that they do not include pellagrous encephalopathy in the differential diagnosis for AWD. Results Though pellagra has been historically described as the triad of dementia, dermatitis, and diarrhea, it seldom presents with all three findings. The neurocognitive disturbance associated with pellagra is better characterized by delirium rather than dementia, and pellagra may present as an isolated delirium without any other aspects of the triad. Discussion Although endemic pellagra is virtually eradicated in Western countries, it continues to present as pellagrous encephalopathy in patients with risk factors for malnutrition such as chronic alcohol intake, homelessness, or AIDS. It may often be mistaken for AWD. Whenever pellagra is suspected, treatment with oral nicotinamide (100 mg three times daily for 3–4 weeks) prior to laboratory confirmation is recommended as an inexpensive, safe, and potentially life-saving intervention. PMID:23186222

  5. Sleep disorders and acute nocturnal delirium in the elderly: a comorbidity not to be overlooked.

    PubMed

    Terzaghi, Michele; Sartori, Ivana; Rustioni, Valter; Manni, Raffaele

    2014-04-01

    Delirium is a disturbance of consciousness and cognition that results in a confusional state. It tends to fluctuate in intensity and is often observed in older patients. Sleep is a window of vulnerability for the occurrence of delirium and sleep disorders can play a role in its appearance. In particular, delirious episodes have been associated with obstructive sleep apnoea syndrome, which is reported to be frequent in the elderly. Hereby, we present a case-report documenting the sudden onset of a confusional state triggered by obstructive sleep apnoea-induced arousal, together with a review of the literature on the topic. We emphasise that, among the many pathogenic factors implicated in delirium, it is worth considering the possible link between nocturnal delirium and the occurrence of impaired arousals. Indeed, the complex confusional manifestations of delirium could be due, in part, to persistence of dysfunctional sleep activity resulting in an inability to sustain full arousal during behavioural wakefulness. Arousals can be triggered by sleep disturbances or other medical conditions. Clinicians should be aware that older patients may present disordered sleep patterns, and make investigation of sleep patterns and disorders potentially affecting sleep continuity a key part of their clinical workup, especially in the presence of cognitive comorbidities. Correct diagnosis and optimal treatment of sleep disorders and disrupted sleep can have a significant impact in the elderly, improving sleep quality and reducing the occurrence of abnormal sleep-related behaviours. PMID:24636782

  6. Comparison of cognitive and neuropsychiatric profiles in hospitalised elderly medical patients with delirium, dementia and comorbid delirium–dementia

    PubMed Central

    Leonard, Maeve; McInerney, Shane; McFarland, John; Condon, Candice; Awan, Fahad; O'Connor, Margaret; Reynolds, Paul; Meaney, Anna Maria; Adamis, Dimitrios; Dunne, Colum; Cullen, Walter; Trzepacz, Paula T; Meagher, David J

    2016-01-01

    Objectives Differentiation of delirium and dementia is a key diagnostic challenge but there has been limited study of features that distinguish these conditions. We examined neuropsychiatric and neuropsychological symptoms in elderly medical inpatients to identify features that distinguish major neurocognitive disorders. Setting University teaching hospital in Ireland. Participants and measures 176 consecutive elderly medical inpatients (mean age 80.6±7.0 years (range 60–96); 85 males (48%)) referred to a psychiatry for later life consultation-liaison service with Diagnostic and Statistical Manual of Mental Disorders (DSM) IV delirium, dementia, comorbid delirium–dementia and cognitively intact controls. Participants were assessed cross-sectionally with comparison of scores (including individual items) for the Revised Delirium Rating Scale (DRS-R98), Cognitive Test for Delirium (CTD) and Neuropsychiatric Inventory (NPI-Q). Results The frequency of neurocognitive diagnoses was delirium (n=50), dementia (n=32), comorbid delirium–dementia (n=62) and cognitively intact patients (n=32). Both delirium and comorbid delirium–dementia groups scored higher than the dementia group for DRS-R98 and CTD total scores, but all three neurocognitively impaired groups scored similarly in respect of total NPI-Q scores. For individual DRS-R98 items, delirium groups were distinguished from dementia groups by a range of non-cognitive symptoms, but only for impaired attention of the cognitive items. For the CTD, attention (p=0.002) and vigilance (p=0.01) distinguished between delirium and dementia. No individual CTD item distinguished between comorbid delirium–dementia and delirium. For the NPI-Q, there were no differences between the three neurocognitively impaired groups for any individual item severity. Conclusions The neurocognitive profile of delirium is similar with or without comorbid dementia and differs from dementia without delirium. Simple tests of attention and

  7. Managing verbal agitation in people with dementia and delirium.

    PubMed

    Inkley, Francesca; Goldberg, Sarah

    2016-03-01

    Patients with dementia and delirium in acute hospitals can exhibit verbal agitation, but there is no research on rate of occurrence or how ward staff manage such behaviour. This service evaluation aimed to measure rate of occurrence of verbal agitation in confused older inpatients and understand the management strategies used by staff. An agitation inventory was completed daily by the nursing team for all verbally agitated patients on eight older person wards over two weeks. Six semi-structured interviews were conducted with staff and three hours of non-participant observations were undertaken. A mean 6% (13/223) of patients were verbally agitated each day. Management strategies included trial and error, distraction and engagement, reassurance, communication and familiarity. Staff did not adopt a systematic approach to care planning due to lack of training and support on the ward, as well as scarce resources in terms of staff, space and activities. Research is needed to develop and evaluate interventions that support staff to care for these patients. PMID:26917188

  8. A new approach to the prevention and treatment of delirium in elderly patients in the intensive care unit

    PubMed Central

    Rosenzweig, Andrew B.; Sittambalam, Charmian D.

    2015-01-01

    The pronounced prevalence of delirium in geriatric patients admitted to the intensive care unit (ICU) and its increased morbidity and mortality is a well-established phenomenon. The purpose of this review is to explore the potential use of dexmedetomidine in preventing or managing ICU delirium in older patients. Articles used were identified and selected through multiple search engines, including Google Scholar, PubMed, and MEDLINE. Keywords such as dexmedetomidine, delirium, geriatric, ICU delirium, delirium in elderly, and palliative were used to obtain the specific articles used for this paper and restricted to articles published in 1990 or later. Articles specifically looking at the use of dexmedetomidine as compared to a study drug and its potential for use in ICU patients, as opposed to overall reviews of dexmedetomidine, were compared. When compared to benzodiazepines for the prevention or treatment of ICU delirium in the elderly, dexmedetomidine was associated with a reduction in delirium, as well as decreased morbidity and mortality. Dexmedetomidine has also been shown to be effective in limiting risk factors associated with ICU delirium such as length and depth of sedation. As opposed to benzodiazepines or opiates, dexmedetomidine provides effective analgesia, sympatholysis, and anxiolysis without causing respiratory depression and allows a patient to more effectively interact with practitioners. The review of these nine articles indicates that these favorable attributes and overall decreased duration and incidence of delirium make dexmedetomidine a viable option in preventing or reducing ICU delirium in high-risk geriatric patients and as a palliative adjunct to help control symptoms and stressors. PMID:26333857

  9. How do doctors and nurses manage delirium in intensive care units? A qualitative study using focus groups

    PubMed Central

    Palacios-Ceña, Domingo; Cachón-Pérez, José Miguel; Martínez-Piedrola, Rosa; Gueita-Rodriguez, Javier; Perez-de-Heredia, Marta; Fernández-de-las-Peñas, Cesar

    2016-01-01

    Objectives The aim of this study was to explore the experiences of doctors and nurses caring for patients with delirium in the intensive care unit (ICU) and to describe the process of delirium management. Setting This study was performed in 5 ICUs located within 4 hospitals in Madrid (Spain). Participants Purposeful sampling was performed which included (1) doctors and nurses working in ICUs, (2) with >1 year experience in the ICU and (3) clinical experience with delirium. 38 professionals participated (19 doctors, 19 nurses), including 22 women and 16 men. The total mean age was 39 years. Design A qualitative study using focus groups. Methods 7 focus groups were held to collect data: 3 nurse focus groups, 3 doctor focus groups and 1 mixed focus group. Each group comprised 6–10 participants. A semistructured questions guide was used. Thematic analysis methods were used to analyse the data. Results 3 themes were identified: (1) the professional perspective on delirium; (2) implementing pharmacological and non-pharmacological treatment for delirium and (3) work organisation in the ICU. The professionals regarded patients with delirium with uncertainty, and felt they were often underdiagnosed and poorly managed. Doctors displayed discrepancies regarding pharmacological prescriptions and decision-making. The choice of medication was determined by experience. Nurses felt that, for many doctors, delirium was not considered a matter of urgency in the ICU. Nurses encountered difficulties when applying verbal restraint, managing sleep disorders and providing early mobilisation. The lack of a delirium protocol generates conflicts regarding what type of care management to apply, especially during the night shift. A degree of group pressure exists which, in turn, influences the decision-making process and patient care. Conclusions Patients with delirium represent complex cases, requiring the implementation of specific protocols. These results serve to improve the process

  10. Human herpesvirus 6 reactivation and delirium are frequent and associated events after cord blood transplantation

    PubMed Central

    Hill, Joshua A; Boeckh, Michael; Leisenring, Wendy M; Xie, Hu; Adler, Amanda L; Huang, Meei-Li; Fann, Jesse R; Delaney, Colleen; Zerr, Danielle M

    2015-01-01

    Human herpesvirus 6B (HHV-6B) frequently reactivates after cord blood transplantation (CBT). We previously reported an association between HHV-6B reactivation and delirium after hematopoietic cell transplantation. In this prospective study, 35 CBT recipients underwent twice-weekly plasma PCR testing for HHV-6 and thrice-weekly delirium assessment until day 84. There was a quantitative association between HHV-6 reactivation and delirium in univariable (odds ratio, 2.88; 95% confidence interval [CI], 0.97–8.59) and bivariable models. In addition, intensified prophylaxis with high-dose valacyclovir mitigated HHV-6 reactivation (adjusted hazard ratio, 0.39; 95% CI, 0.14–1.08). Larger trials are needed to explore the utility of HHV-6 prophylaxis after CBT. PMID:26121112

  11. Preoperative discussion with patients about delirium risk: are we doing enough?

    PubMed

    Tomlinson, Judith H; Partridge, Judith S L

    2016-01-01

    Postoperative delirium is a common complication in the older surgical population, occurring in 10-50 % of cases. It is thought to be more common if an individual is identified as frail. Postoperative delirium is associated with poor outcome including higher mortality rates, prolonged length of hospital stay, increased care needs on discharge and longer term post-traumatic stress disorder. Guidelines from the American Geriatric Society and the National Institute for Health and Care Excellence highlight the importance of risk assessment at the time of the preoperative visit. This enables the perioperative team to plan a care pathway that minimises the risk of delirium occurring postoperatively. Risk assessment also informs a discussion with patient and family regarding their risk, as part of a process of informed patient consent. This is an essential step in conforming to current legal and General Medical Council guidance on the process of consent. PMID:27594990

  12. Human herpesvirus 6B reactivation and delirium are frequent and associated events after cord blood transplantation.

    PubMed

    Hill, J A; Boeckh, M; Leisenring, W M; Xie, H; Adler, A L; Huang, M-L; Fann, J R; Delaney, C; Zerr, D M

    2015-10-01

    Human herpesvirus 6B (HHV-6B) frequently reactivates after cord blood transplantation (CBT). We previously reported an association between HHV-6B reactivation and delirium after hematopoietic cell transplantation. In this prospective study, 35 CBT recipients underwent twice-weekly plasma PCR testing for HHV-6 and thrice-weekly delirium assessment until day 84. There was a quantitative association between HHV-6B reactivation and delirium in univariable (odds ratio, 2.88; 95% confidence interval (CI), 0.97-8.59) and bivariable models. In addition, intensified prophylaxis with high-dose valacyclovir mitigated HHV-6B reactivation (adjusted hazard ratio, 0.39; 95% CI, 0.14-1.08). Larger trials are needed to explore the utility of HHV-6B prophylaxis after CBT. PMID:26121112

  13. [A 80-year-old woman with delirium after intertrochanteric fracture of femur].

    PubMed

    Piotrowicz, Karolina; Klich-Raczka, Alicja

    2010-01-01

    The aim of this study is to present a case of delirium -the state occurring frequently in elderly patients. A 80-year-old woman was hospitalized in the department of internal diseases for internal medical examinations before scheduled operation of femoral osteosynthesis. In ward, she was given analgesic medicines from the group of non-steroidal anti-inflammatory drugs (NSAID), paracetamole and opioids influencing central nervous system. On the second day after modifying the painkilling treatment (single doses of paracetamole were increased and oral opioid medication was introduced) a quickly progressing (within a few hours) delirium was observed. Its occurrence was ascribed to the application of strong medicines influencing central nervous system. Treatment was modified then; the opioid medicine was replaced with NSAID, which had already been used before, applied intravenously. Subsidence of delirium clinical symptoms and cognitive functions' improvement was observed. PMID:21387774

  14. Impaired Olfaction and Risk for Delirium or Cognitive Decline After Cardiac Surgery

    PubMed Central

    Brown, Charles H.; Morrissey, Candice; Ono, Masahiro; Yenokyan, Gayane; Selnes, Ola A.; Walston, Jeremy; Max, Laura; LaFlam, Andrew; Neufeld, Karin; Gottesman, Rebecca F.; Hogue, Charles W.

    2014-01-01

    Summary Statement Impaired olfaction, identified in 33% of patients undergoing cardiac surgery, was associated with the adjusted risk for postoperative delirium but not cognitive decline. Objectives The prevalence and significance of impaired olfaction is not well characterized in patients undergoing cardiac surgery. Because impaired olfaction has been associated with underlying neurologic disease, impaired olfaction may identify patients who are vulnerable to poor neurological outcomes in the perioperative period. The objective of this study was to determine the prevalence of impaired olfaction among patients presenting for cardiac surgery and the independent association of impaired olfaction with postoperative delirium and cognitive decline. Design Nested prospective cohort study Setting Academic hospital Participants 165 patients undergoing coronary artery bypass and/or valve surgery Measurements Olfaction was measured using the Brief Smell Identification Test, with impaired olfaction defined as an olfactory score < 5th percentile of normative data. Delirium was assessed using a validated chart-review method. Cognitive performance was assessed using a neuropsychological testing battery at baseline and 4–6 weeks after surgery. Results Impaired olfaction was identified in 54 of 165 patients (33%) prior to surgery. Impaired olfaction was associated with increased adjusted risk for postoperative delirium (relative risk [RR] 1.90, 95% CI 1.17–3.09; P=0.009). There was no association between impaired olfaction and change in composite cognitive score in the overall study population. Conclusion Impaired olfaction is prevalent in patients undergoing cardiac surgery and is associated with increased adjusted risk for postoperative delirium, but not cognitive decline. Impaired olfaction may identify unrecognized vulnerability for postoperative delirium among patients undergoing cardiac surgery. PMID:25597555

  15. Preoperative plasma leptin levels predict delirium in elderly patients after hip fracture surgery.

    PubMed

    Chen, Xue-Wu; Shi, Jun-Wu; Yang, Ping-Shan; Wu, Zhu-Qi

    2014-07-01

    Leptin is considered to be a modulator of the immune response. Hypoleptinemia increases the risk for Alzheimer's disease and vascular dementia. The present study aimed to investigate the ability of plasma leptin level to predict delirium in elderly patients after hip fracture surgery. Postoperative delirium (pod) was evaluated using the Confusion Assessment Method. Prolonged postoperative delirium (ppod) was defined as delirium lasting more than 4 weeks. Plasma leptin levels of 186 elderly patients and 186 elderly controls were measured by an enzyme-linked immunosorbent assay. Plasma leptin level was substantially lower in patients than in controls (4.6±2.2ng/ml vs. 7.5±1.8ng/ml, P<0.001). It was identified as an independent predictor for pod [odds ratio, 0.385; 95% confidence interval (CI), 0.286-0.517; P<0.001] and ppod (odds ratio, 0.283; 95% CI, 0.152-0.527; P<0.001) using a multivariate analysis, and had high area under receiver operating characteristic curve for pod [area under curve (AUC), 0.850; 95% CI, 0.790-0.898] and ppod (AUC, 0.890; 95% CI, 0.836-0.931). The predictive value of leptin was markedly bigger than that of age for pod (AUC, 0.705; 95% CI, 0.634-0.770; P=0.002) and ppod (AUC, 0.713; 95% CI, 0.642-0.777; P=0.019). In a combined logistic-regression model, leptin improved the AUC of age to 0.890 (95% CI, 0.836-0.931) (P<0.001) for pod and 0.910 (95% CI, 0.860-0.947) (P=0.005) for ppod. Thus, preoperative plasma leptin level may be a useful, complementary tool to predict delirium and also prolonged delirium in elderly patients after hip fracture surgery. PMID:24787655

  16. Low Hemoglobin Level Is Associated with the Development of Delirium after Hepatectomy for Hepatocellular Carcinoma Patients

    PubMed Central

    Chen, Yao-Li; Lin, Hui-Chuan; Lin, Kuo-Hua; Lin, Li-Si; Hsieh, Chia-En; Ko, Chih-Jan; Hung, Yu-Ju; Lin, Ping-Yi

    2015-01-01

    Background Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide and liver resection is the only potential curative treatment option for those patients. Postoperative complications specific to elderly surgical patients such as delirium will be increasingly relevant in the coming decades. Herein, we aimed to investigate the risk factors for postoperative delirium in patients who have received hepatectomy for HCC. Methods This is a single medical center observational study and the study subjects comprised 401 individuals who underwent liver resection for hepatocellular carcinoma during January 2009 to October 2013. Multivariate analysis was used to examine whether preoperative, intra-operative, or postoperative variables were associated with the development of delirium. Results Of the 401 patients who underwent hepatectomy, 34 developed postoperative delirium (8.4%). In the majority of those patients, symptoms and signs of the syndrome occurred on postoperative day 2 and the mean duration of symptoms was 3.61 ± 3.71 days. Multivariate analysis revealed that advanced age (>71 years) [odds ratio (OR) = 1.133, 95% confidence interval (CI): 1.071–1.200, p<0.001], prolonged operative time (>190 minutes) (OR = 1.009, 95% CI: 1.000–1.017, p = 0.038), a decreased postoperative hemoglobin level (< 10.16 g/dL) (OR = 0.777, 95% CI: 0.613–0.983, p = 0.036), and history of hypnotic drug use (OR = 3.074, 95% CI: 1.045–9.039, p = 0.041) were independent risk factors for the development of postoperative delirium after hepatectomy. Conclusions Although the mechanism of postoperative delirium is not well understood, numbers of studies have shown that patients with postoperative delirium tend to have prolonged hospital stay, worse postoperative outcome and an increased risk of short- and long-term mortality. In this study, we found that advanced age, prolonged operative time, postoperative low hemoglobin level and history of hypnotic drug use are

  17. The Role of Sitters in Delirium: an Update

    PubMed Central

    Carr, Frances M.

    2013-01-01

    Purpose The concept behind constant observation is not new. Whilst traditionally performed by nursing staff, it is now commonly performed by sitters. Details surrounding the usage, job description, training, clinical and cost effectiveness of sitters are not known; hence the reason for this review. Methods A literature search was performed in MEDLINE, Cochrane Database of Systematic Reviews, and PubMed from the years 1960 to October 2011. The definition for sitter used in the articles was accepted for this review. Results From this review, it is evident that sitters are being employed in a variety of settings. The question of which type of person would provide the most benefit in the sitter role is still not clear; whilst sitters have typically included family and volunteers, it may be trained volunteers who may offer the most cost-effective solution. The paucity of information available regarding the training and assessments of sitters and the lack of formal guidelines regulating sitters’ use results in a lack of information available regarding these sitters, and current available evidence is conflicting regarding the benefits in terms of cost and clinical outcome. The only strong evidence relating to clinical benefit comes from the use of fully-trained sitters as part of a multi-interventional program (i.e., HELP) Conclusions Current evidence supports a role for the sitter as part of the management of patients with delirium. The most cost-effective sitter role appears to be trained volunteers. Further research is needed to determine the specific type of training required for the sitter role. The creation of a national set of regulations or guidelines would provide safeguards in the industry to ensure safe and effective patient care. PMID:23440038

  18. "Excited delirium syndrome": is it a cause of death?

    PubMed

    Kodikara, Sarathchandra; Cunningham, Kristopher; Pollanen, Michael S

    2012-09-01

    Excited delirium syndrome (EDS) has become a controversial and vexing forensic issue due to its association with restraint and sudden unexpected death. Although some authorities and jurisdictions recognised EDS as a cause of death there is no consensus among the medical community in this regard. The overlapping nature of the spectrum of antemortem behaviours and signs with many natural disease processes complicates this issue further. We describe two deaths which initially presented as EDS-like behaviour during restraint. In the first case, the deceased was travelling on a long distance flight when he died while in the custody of air cabin crew. The autopsy revealed the cause of death as air travel-related pulmonary thromboembolism. Acute alcoholic intoxication, nicotine withdrawal, hypoxia due to acute pulmonary thromboembolism, and hypobaric environment in the air plane cabin appeared as the potential reasons for EDS-like behaviour. In the second case, the deceased died while in the custody of immigration officials. At autopsy the cause of death turned out to be tense pericardial effusion due to fibrinous pericarditis. In this case, hypoperfusion of the brain following systemic hypotension as a result of cardiac tamponade associated with pericardial effusion likely led to the EDS-like behaviour. Clinicopathologic correlation in these two cases would strongly suggest EDS as the cause of death, had the decedents not had fatal anatomical causes of death. This alerts the forensic pathologist that not all the individuals dying with signs and symptoms of EDS during restraint are accounted for EDS as the immediate cause of death. PMID:22622258

  19. Slow Gait Speed and Rapid Renal Function Decline Are Risk Factors for Postoperative Delirium after Urological Surgery

    PubMed Central

    Sato, Tendo; Okamoto, Teppei; Yamamoto, Hayato; Hosogoe, Shogo; Tobisawa, Yuki; Yoneyama, Tohru; Hashiba, Eiji; Yoneyama, Takahiro; Hashimoto, Yasuhiro; Koie, Takuya; Hirota, Kazuyoshi; Ohyama, Chikara

    2016-01-01

    Objectives The aim of this study was to identify risk factors associated with postoperative delirium in patients undergoing urological surgery. Methods We prospectively evaluated pre- and postoperative risk factors for postoperative delirium in consecutive 215 patients who received urological surgery between August 2013 and November 2014. Preoperative factors included patient demographics, comorbidities, and frailty assessment. Frailty was measured by handgrip strength, fatigue scale of depression, fall risk assessment, and gait speed (the timed Get-up and Go test). Postoperative factors included types of anesthesia, surgical procedure, renal function and serum albumin decline, blood loss, surgery time, highest body temperature, and complications. Uni- and multivariate logistic regression analyses were performed to assess pre- and postoperative predictors for the development of postoperative delirium. Results Median age of this cohort was 67 years. Ten patients (4.7%) experienced postoperative delirium. These patients were significantly older, had weak handgrip strength, a higher fall risk assessment score, slow gait speed, and greater renal function decline compared with patients without delirium. Multivariate analysis revealed slow gait speed (>13.0 s) and rapid renal function decline (>30%) were independent risk factors for postoperative delirium. Conclusions Slow gait speed and rapid renal function decline after urological surgery are significant factors for postoperative delirium. These data will be helpful for perioperative patient management. This study was registered as a clinical trial: UMIN: R000018809. PMID:27145178

  20. Reliability of delirium rating scale (DRS) and delirium rating scale-revised-98 (DRS-R98) using variance-based multivariate modelling.

    PubMed

    Adamis, Dimitrios; Slor, Chantal J; Leonard, Maeve; Witlox, Joost; de Jonghe, Jos F M; Macdonald, Alastair J D; Trzepacz, Paula; Meagher, David

    2013-07-01

    Delirium's characteristic fluctuation in symptom severity complicates the assessment of test-retest reliability of scales using classical analyses, but application of modelling to longitudinal data offers a new approach. We evaluated test-retest reliability of the delirium rating scale (DRS) and delirium rating scale-revised-98 (DRS-R98), two widely used instruments with high validity and inter-rater reliability. Two existing longitudinal datasets for each scale included DSM-IV criteria for delirium diagnosis and repeated measurements using the DRS or DRS-R98. To estimate the reliability coefficients RT and RΛ for each scale we used a macros provided by Dr. Laenen at http://www.ibiostat.be/software/measurement.asp. For each dataset a linear mixed-effects model was fitted to estimate the variance-covariance parameters. A total of 531 cases with between 4 and 9 measurement points across studies including both delirious and non-delirious patients. Comorbid dementia in the datasets varied from 27% to 55%. Overall RT for the DRS were 0.71 and 0.50 and for DRS-R98 0.75 and 0.84. RΛ values for DRS were 0.99 and 0.98 and for DRS-R98 were 0.92 and 0.96. Individual RT measures for DRS-R98 and DRS across visits within studies showed more range than overall values. Our models found high overall reliability for both scales. Multiple factors impact a scale's reliability values including sample size, repeated measurements, patient population, etc in addition to rater variability. PMID:23522935

  1. Hazards of Hospitalization: Hospitalists and Geriatricians Educating Medical Students about Delirium and Falls in Geriatric Inpatients

    ERIC Educational Resources Information Center

    Lang, Valerie J.; Clark, Nancy S.; Medina-Walpole, Annette; McCann, Robert

    2008-01-01

    Geriatric patients are at increased risk for complications from delirium or falls during hospitalization. Medical education, however, generally places little emphasis on the hazards of hospitalization for older inpatients. Geriatricians conducted a faculty development workshop for hospitalists about the hazards of hospitalization for geriatric…

  2. Delirium after transcatheter aortic valve implantation via the femoral or apical route.

    PubMed

    Sharma, V; Katznelson, R; Horlick, E; Osten, M; Styra, R; Cusimano, R J; Carroll, J; Djaiani, G

    2016-08-01

    We thought that delirium might be less frequent after transcatheter aortic valve implantation via the femoral artery compared with via the cardiac apex. We reviewed 210 patients who underwent transcatheter aortic valve implantation between January 2009 and October 2014. The proportion (95% CI) of patients who suffered delirium in the 3 days after valve implantation were: 10 (3-16%) in 105 patients who had transfemoral implantation; and 35 (25-45%) in 105 patients who had transapical implantation, p = 0.0001. The variables that independently associated with postoperative delirium were age, male sex and the transapical approach. The median (IQR [range]) hospital stay was 7 (5-13 [2-41]) days and 10 (7-15 [2-64]) days, respectively, p = 0.004. Future trials should focus on different peri-operative management strategies to reduce delirium rates after transcatheter aortic valve implantation, particularly in older men having implantations via the cardiac apex. PMID:27353560

  3. Delirium and other clinical factors with Clostridium difficile infection that predict mortality in hospitalized patients

    PubMed Central

    Archbald-Pannone, Laurie R.; McMurry, Timothy L.; Guerrant, Richard L.; Warren, Cirle A.

    2015-01-01

    Background Clostridium difficile infection (CDI) severity has increased, especially among hospitalized elderly. We evaluated clinical factors to predict mortality following CDI. Methods We collected data from inpatients diagnosed with CDI at US academic medical center (HSR-IRB# 13630). We evaluated age, Charlson comorbidity index (CCI), admission from a long-term care facility (LTCF), intensive care unit (ICU) at time of diagnosis, white blood cell count (WBC), blood urea nitrogen (BUN), low body mass index (BMI), and delirium as possible predictors. A parsimonious predictive model was chosen using Akaike information criterion (AIC) and a best subsets model selection algorithm. Area under the ROC curve was used to assess the model’s comparative; with AIC as selection criterion for all subsets to measure fit and control for over-fitting. Results From 362 subjects, the selected model included CCI, WBC, BUN, ICU, and delirium. The logistic regression coefficients were converted to a points scale and calibrated so that each unit on the CCI contributed 2 points, ICU contributed 5, unit of WBC (natural log scale) contributed 3, unit of BUN contributed 5, and delirium contributed 11. Discussion Our model shows substantial ability to predict short term mortality in patients hospitalized with CDI. Conclusion Patients who were diagnosed in the ICU and developed delirium are at highest risk for dying within 30 days of CDI diagnosis. PMID:25920706

  4. Deconstructing Dementia and Delirium Hospital Practice: Using Cultural Historical Activity Theory to Inform Education Approaches

    ERIC Educational Resources Information Center

    Teodorczuk, Andrew; Mukaetova-Ladinska, Elizabeta; Corbett, Sally; Welfare, Mark

    2015-01-01

    Older patients with dementia and delirium receive suboptimal hospital care. Policy calls for more effective education to address this though there is little consensus on what this entails. The purpose of this clarification study is to explore how practice gaps are constructed in relation to managing the confused hospitalised older patient. The…

  5. Pre- and Intraoperative Predictors of Delirium after Open Abdominal Aortic Aneurysm Repair

    PubMed Central

    Kodama, Akio; Narita, Hiroshi; Banno, Hiroshi; Yamamoto, Kiyohito; Komori, Kimihiro

    2015-01-01

    Objectives: We reviewed our series of patients who underwent open abdominal aortic aneurysm (AAA) repair and constructed a prediction model for postoperative delirium. Methods: 397 patients who underwent open AAA repair at our institution between April 2005 and June 2013 were retrospectively reviewed. Postoperative delirium was diagnosed from the patients’ medical records according to the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) criteria. Mental alterations resulting from postoperative cerebrovascular events or preexisting mental disorders were excluded. Parameters with significant differences on univariate analysis were subjected to a logistic regression analysis. Results: There were 46 patients (11.5%) diagnosed with postoperative delirium. The following parameters were significant in the univariate analysis: age, history of stroke, hyperlipidemia, forced expiratory volume in 1 s (FEV1), percent vital capacity (%VC), and blood urea nitrogen (BUN) level. A logistic regression analysis revealed that an age ≥70 years (odds ratio [95% confidence interval], 3.342 [1.437–7.774]), blood loss ≥1517 mL (2.707 [1.359–5.391]), and the absence of hyperlipidemia (2.154 [1.060–4.374]) were significant risk factors. Conclusions: Older patients with substantial intraoperative blood loss require highly vigilant postoperative care. Further studies are necessary to elucidate the relationship between cholesterol and delirium. PMID:26421070

  6. Bringing delirium into the 21st century: will physicians get the app out?

    PubMed

    Rockwood, Kenneth

    2015-08-01

    Invited commentary for International Psychogeriatrics on Tieges Z, Stíobhairt A, Scott K, Suchorab K, Weir A, Parks S, Shenkin S and MacLullich A. Development of a smartphone application for the objective detection of attentional deficits in delirium. International Psychogeriatrics. 2015 Mar 6:1-12. PMID:26149226

  7. Sedation and delirium in the intensive care unit: an Australian and New Zealand perspective.

    PubMed

    Shehabi, Y; Botha, J A; Boyle, M S; Ernest, D; Freebairn, R C; Jenkins, I R; Roberts, B L; Seppelt, I M

    2008-07-01

    A survey was conducted to determine sedation and delirium practices in Australian and New Zealand intensive care units. The survey was in two parts, comprising an online survey of reported sedation and delirium management (unit survey) and a collection of de-identified data about each patient in a unit at a given time on a specified day (patient snapshot survey). All intensive care units throughout Australia and New Zealand were invited by email to participate in the survey. Twenty-three predominantly metropolitan, level III Australian and New Zealand intensive care units treating adult patients participated. Written sedation policies were in place in 48% of units, while an additional 44% of units reported having informal sedation policies. Seventy percent of units routinely used a sedation scale. In contrast, only 9% of units routinely used a delirium scale. Continuous intravenous infusion is the primary means of patient sedation (74% of units). While 30% of units reported routinely interrupting sedation, only 10% of sedated patients in the snapshot survey had had their sedation interrupted in the preceding 12 hours. Oversedation appears to be common (46% of patients with completed sedation scales). Use of neuromuscular blockade is low (10%) compared to other published studies. Midazolam and propofol were the most frequently used sedatives. The proportion of patients developing delirium was 21% of assessable patients. Failed and self-extubation rates were low: 3.2% and 0.5% respectively. In Australian and New Zealand intensive care units, routine use of sedation scales is common but not universal, while routine delirium assessment is rare. The use of a sedation protocol is valuable and should be encouraged. PMID:18714628

  8. The Overlap Syndrome of Depression and Delirium in Older Hospitalized Patients

    PubMed Central

    Givens, Jane L.; Jones, Richard N.; Inouye, Sharon K.

    2009-01-01

    Objectives To measure the prevalence, predictors and post-hospitalization outcomes associated with the overlap syndrome of coexisting depression and incident delirium in older hospitalized patients. Design Secondary analysis of prospective cohort data from the control group of the Delirium Prevention Trial. Setting General medical service of an academic medical center. Follow-up interviews at one month and one year post-hospital discharge. Participants Four hundred and fifty nine patients aged 70 and over who were not delirious at hospital admission. Measurements Depressive symptoms assessed at hospital admission using the 15-item Geriatric Depression Scale (cutoff score of 6 used to define depression), daily assessments of incident delirium from admission to discharge using the Confusion Assessment Method. Activities of daily living at admission and one month post-discharge. New nursing home placement and mortality determined at one year. Results Of 459 participants, 23 (5%) had the overlap syndrome, 39 (9%) delirium alone, 121 (26%) depression alone and 276 (60%) neither condition. In adjusted analysis, patients with the overlap syndrome had higher odds of new nursing home placement or death at one year (adjusted odds ratio [AOR] 5.38, 95% confidence interval [CI] = 1.57– 18.38) and one month functional decline (AOR 3.30, 95% CI = 1.14–9.56) compared to patients with neither condition. Conclusion The overlap syndrome of depression and delirium is associated with significant risk of functional decline, institutionalization and death. Efforts to identify, prevent and treat this condition may reduce the risk of adverse outcomes in older hospitalized patients. PMID:19558475

  9. The Development and Evaluation of Delirium Assessment and Nursing Care Decision-Making Assistant Mobile Application for Intensive Care Unit.

    PubMed

    Yang, Fangyu; Ji, Meihua; Ding, Shu; Wu, Ying; Chang, Polun; Lin, Chiawei; Yang, Xin

    2016-01-01

    Delirium is a common complication among patients in ICU settings. Although it has been repeatedly confirmed that Confusion Assessment Model for Intensive Care Unit (CAM-ICU), one of the most commonly used ICU delirium assessment tool, is highly accurate in validation studies, it's sensitivity and specificity is relatively low during routine practice among bedside nurses. The aim of this study is to develop a mobile application (app) to detect delirium and to test its reliability and validity both by research nurses and among ICU bedside nurses. The app was programmed with Java and installed on a mobile device with Android system. After completion of reliability and validity testing, the app will be integrated into the existing Hospital Information System in order to automatically retrieve essential information for risk factor identification and formulation of care plan accordingly to prevent or manage ICU delirium. PMID:27332299

  10. Effect of melatonin on incidence of delirium among patients with hip fracture: a multicentre, double-blind randomized controlled trial

    PubMed Central

    de Jonghe, Annemarieke; van Munster, Barbara C.; Goslings, J. Carel; Kloen, Peter; van Rees, Carolien; Wolvius, Reinder; van Velde, Romuald; Levi, Marcel; de Haan, Rob J.; de Rooij, Sophia E.

    2014-01-01

    Background: Disturbance of the sleep–wake cycle is a characteristic of delirium. In addition, changes in melatonin rhythm influence the circadian rhythm and are associated with delirium. We compared the effect of melatonin and placebo on the incidence and duration of delirium. Methods: We performed this multicentre, double-blind, randomized controlled trial between November 2008 and May 2012 in 1 academic and 2 nonacademic hospitals. Patients aged 65 years or older who were scheduled for acute hip surgery were eligible for inclusion. Patients received melatonin 3 mg or placebo in the evening for 5 consecutive days, starting within 24 hours after admission. The primary outcome was incidence of delirium within 8 days of admission. We also monitored the duration of delirium. Results: A total of 452 patients were randomly assigned to the 2 study groups. We subsequently excluded 74 patients for whom the primary end point could not be measured or who had delirium before the second day of the study. After these postrandomization exclusions, data for 378 patients were included in the main analysis. The overall mean age was 84 years, 238 (63.0%) of the patients lived at home before admission, and 210 (55.6%) had cognitive impairment. We observed no effect of melatonin on the incidence of delirium: 55/186 (29.6%) in the melatonin group v. 49/192 (25.5%) in the placebo group; difference 4.1 (95% confidence interval −0.05 to 13.1) percentage points. There were no between-group differences in mortality or in cognitive or functional outcomes at 3-month follow-up. Interpretation: In this older population with hip fracture, treatment with melatonin did not reduce the incidence of delirium. Trial registration: Netherlands Trial Registry, NTR1576: MAPLE (Melatonin Against PLacebo in Elderly patients) study; www.trialregister.nl/trialreg/admin/rctview.asp?TC=1576 PMID:25183726

  11. Delirium Outcomes in a Randomized Trial of Blood Transfusion Thresholds Among Hospitalized Older Patients with Hip Fracture

    PubMed Central

    Gruber-Baldini, Ann L; Marcantonio, Edward; Orwig, Denise; Magaziner, Jay; Terrin, Michael; Barr, Erik; Brown, Jessica Pelletier; Paris, Barbara; Zagorin, Aleksandra; Roffey, Darren M.; Zakriya, Khwaja; Blute, Mary-Rita; Hebel, J. Richard; Carson, Jeffrey L.

    2013-01-01

    Objectives To determine if a higher blood transfusion threshold would prevent new or worsening delirium symptoms in the hospital after hip fracture surgery. Design Ancillary study to a randomized clinical trial. Setting Thirteen hospitals in United States and Canada. Participants One-hundred-thirty-nine hospitalized hip fracture patients, age ≥50, with cardiovascular disease or risk factors, and hemoglobin<10 g/dL within 3 days of surgery, recruited in an ancillary study of “Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair (FOCUS) trial.” Intervention Treatment groups: 1) Liberal: received one unit of packed red blood cells and as much blood as needed to maintain hemoglobin >10 g/dL; 2) Restrictive: received transfusions if developed symptoms of anemia or hemoglobin fell below 8 g/dL. Measurements Delirium assessments performed pre-randomization and up to three times post-randomization. Primary outcome: Severity of delirium using Memorial Delirium Assessment Scale (MDAS) scale. Secondary outcome: presence or absence of delirium defined by Confusion Assessment Method Diagnostic Algorithm (CAM). Results Mean age was 81.5 (SD=9.1). Liberal group received a median 2 units and Restrictive group 0 units of blood. Hemoglobin concentration on day 1 post randomization was 1.4 g/dL higher in the Liberal group. Treatment groups did not significantly differ at any time point or over time on either MDAS delirium severity (p=0.28) or CAM delirium presence (p=0.83). Conclusion Blood transfusion to maintain hemoglobin >10 g/dL alone is unlikely to influence delirium severity or rate in postoperative hip fracture patients with hemoglobin concentration <10 g/dL. Trial Registration ClinicalTrials.gov identifier: NCT00071032 http://clinicaltrials.gov/ct2/show/NCT00071032 PMID:23898894

  12. Assessment and Management of Delirium in Older Adults in the Emergency Department: Literature Review to Inform Development of a Novel Clinical Protocol.

    PubMed

    Rosen, Tony; Connors, Scott; Clark, Sunday; Halpern, Alexis; Stern, Michael E; DeWald, Jennifer; Lachs, Mark S; Flomenbaum, Neal

    2015-01-01

    Delirium occurs frequently in older patients in the emergency department (ED), is underrecognized, and has potentially serious consequences. Despite its seriousness, delirium is frequently missed by emergency providers, and patients with unrecognized delirium are often discharged from the ED. Even when it is appropriately recognized, managing delirium in older adults poses a significant challenge for ED providers. Geriatric delirium is typically caused by the interaction of multiple factors, including several that are commonly missed: pain, urinary retention, constipation, dehydration, and polypharmacy. Appropriate management includes nonpharmacological management with medication intervention reserved for emergencies. We have developed a new, comprehensive, evidence-based protocol for diagnosis/recognition, management, and disposition of geriatric delirium patients in the ED with a focus on identifying and treating commonly missed contributing causes. PMID:26218485

  13. The effect of range of motion exercises on delirium prevention among patients aged 65 and over in intensive care units.

    PubMed

    Karadas, Canan; Ozdemir, Leyla

    2016-01-01

    The purpose of this study was to determine the effect of range of motion exercises on preventing delirium and shortening the duration of delirium among patients in the intensive care unit who are aged 65 and over. The study was conducted in the intensive care unit on patients with non-invasive mechanical ventilation. The sample size included 47 patients from the intervention group and 47 from the control group. The incidence of delirium was 8.5% in the intervention group and 21.3% in the control group. The duration of delirium was 15 h for patients in the intervention group and 38 h for those in the control group. Although delirium incidence and duration decreased by 2.5-fold in the intervention group compared to the control group; there was no significant relationship between the intervention and control groups. In conclusion, as the decreases in delirium occurrence and duration were not statistically significant, the effect of range of motion exercises was limited. PMID:26763172

  14. Development of Delirium in the Intensive Care Unit in Patients after Endovascular Aortic Repair: A Retrospective Evaluation of the Prevalence and Risk Factors

    PubMed Central

    Kawatani, Yohei; Nakamura, Yoshitsugu; Hayashi, Yujiro; Taneichi, Tetsuyoshi; Ito, Yujiro; Kurobe, Hirotsugu; Suda, Yuji; Hori, Takaki

    2015-01-01

    Delirium is an acute form of nervous system dysfunction often observed in patients in the intensive care unit. Endovascular aortic repair (EVAR) is considered a minimally invasive surgical treatment for abdominal aortic aneurysm. Although the operation method is widely used, there are few investigations of the rate and risk factors of delirium development after the operation. In this study, we retrospectively examined the rate of delirium development in the intensive care unit (ICU) after EVAR, as well as the associated preoperative risk factors and effects on the lengths of ICU and hospital stays. We examined the 81 consecutive patients who underwent elective EVAR between November 2013 and August 2014. The Intensive Care Delirium Screening Checklist was used to diagnose delirium. Twenty patients (24.7%) were diagnosed with delirium in this study. The ICU and hospital length of stays of patients with delirium were 3.3 ± 2.4 days and 14.5 ± 11.9 days, respectively, the latter of which was significantly longer than that of patients without delirium (p = 0.019). Additionally, renal dysfunction, preoperative benzodiazepine use, and intraoperative transfusion were found to be risk factors for the development of delirium after elective EVAR. PMID:26421186

  15. Treating an Established Episode of Delirium in Palliative Care: Expert Opinion and Review of the Current Evidence Base With Recommendations for Future Development

    PubMed Central

    Pereira, José L.; Davis, Daniel H.J.; Currow, David C.; Meagher, David; Rabheru, Kiran; Wright, David; Bruera, Eduardo; Hartwick, Michael; Gagnon, Pierre R.; Gagnon, Bruno; Breitbart, William; Regnier, Laura; Lawlor, Peter G.

    2014-01-01

    Context Delirium is a highly prevalent complication in patients in palliative care settings, especially in the end-of-life context. Objectives To review the current evidence base for treating episodes of delirium in palliative care settings and propose a framework for future development. Methods We combined multidisciplinary input from delirium researchers and other purposely selected stakeholders at an international delirium study planning meeting. This was supplemented by a literature search of multiple databases and relevant reference lists to identify studies regarding therapeutic interventions for delirium. Results The context of delirium management in palliative care is highly variable. The standard management of a delirium episode includes the investigation of precipitating and aggravating factors followed by symptomatic treatment with drug therapy. However, the intensity of this management depends on illness trajectory and goals of care in addition to the local availability of both investigative modalities and therapeutic interventions. Pharmacologically, haloperidol remains the practice standard by consensus for symptomatic control. Dosing schedules are derived from expert opinion and various clinical practice guidelines as evidence-based data from palliative care settings are limited. The commonly used pharmacologic interventions for delirium in this population warrant evaluation in clinical trials to examine dosing and titration regimens, different routes of administration, and safety and efficacy compared with placebo. Conclusion Delirium treatment is multidimensional and includes the identification of precipitating and aggravating factors. For symptomatic management, haloperidol remains the practice standard. Further high-quality collaborative research investigating the appropriate treatment of this complex syndrome is needed. PMID:24480529

  16. A Lilliputian army under the floorboards: persistent delirium with complete though prolonged recovery

    PubMed Central

    Wakefield, Dominique; Thompson, Louise; Bruce, Stuart

    2014-01-01

    We report the case of an 83-year-old man who presented with a history of fluctuating delirium of insidious onset, secondary to an amoebic liver abscess more than 30 years after acute exposure. We describe a 2-year clinical journey that started with a fall and was additionally complicated by severe weight loss and acute kidney injury (AKI). The likely prognosis for such a combination of comorbidities in an older person is for lasting morbidity, institutionalisation and significant mortality. However, the case demonstrates that with timely assessment and care complete recovery is possible though it may take many months. It reminds us of the catalytic implications of falls for older persons and to maintain a differential diagnostic approach to delirium of insidious onset avoiding misdiagnosis as dementia with which it may be associated. Our case report includes extracts from the patient's own account providing added insight into such experiences. PMID:24792019

  17. The psychiatrist in the surgical intensive care unit. I. Postoperative delirium.

    PubMed

    Nadelson, T

    1976-02-01

    Delirium has been defined as a condition of cerebral insufficiency consisting of impairment of cognitive processes, with a characteristic slowing of the electroencephalographic pattern. Present also is a global "clouding" of consciousness, resulting from a potentially reversible impairment of ability to maintain attention. In these states there is usually a simultaneous diminution of the ability to think, perceive, and remember. Although drowsiness may be a part of this state, patients can be awake and yet delirious, with diminished consciousness of their surroundings. Postoperative delirium is seen more often in patients over 50 years of age, in those who are "vigilant" or overalert, and in those undergoing more complex surgery. Adverse influences in the postoperative period are certain drugs and the psychological stresses engendered by the ICU environment. Appropriate management obtains from attention to the impact of the strange enviornment on the patient. PMID:1252115

  18. Alcoholic delirium tremens with hollow viscus perforation scheduled for emergency laparotomy.

    PubMed

    Talikoti, Anand T; Sindhu, Bs; Kavyashree, Sp; Kumar, Ks Kishore

    2012-03-01

    Alcohol is a drug consumed at some time in life by up to 80% of the population according to western statistics. Wide differences in socioeconomic status in India contribute to various degrees and severity of alcoholism and its associated complications. The symptoms of alcohol withdrawal range from such minor ones as insomnia and tremulousness to severe complications such as withdrawal seizures and delirium tremens. Although alcohol withdrawal syndrome has been reported in the literature in post-operative periods and in Intensive Care Unit, there is paucity of information on treatment and preparation of a patient with alcohol withdrawal syndrome coming for emergency surgical procedures. The surgical stress and deranged liver function in such cases poses an additional challenge to the anaesthesiologist. Here, we report the successful management of a case of acute alcoholic delirium tremens who presented with hollow viscous perforation for emergency exploratory laparotomy. PMID:22701216

  19. Pain, Delirium and Physical Function in Skilled Nursing Home Patients with Dementia

    PubMed Central

    Kolanowski, Ann; Mogle, Jacqueline; Fick, Donna M.; Hill, Nikki; Mulhall, Paula; Nadler, Jamie; Colancecco, Elise; Behrens, Liza

    2014-01-01

    Objective Skilled Nursing Facilities (SNFs) are major sites of post-acute care for patients with dementia. A recent Office of the Inspector General report indicated that outcomes in SNFs are sub-optimal due to poor-quality treatment, including the failure to provide needed care. Pain is frequently un-recognized and un-treated in patients with dementia. The aim of this exploratory study was to examine the effect daily pain has on delirium and physical function in patients with dementia in SNFs. The association of daily pain with discharge disposition was also examined. Design Secondary analysis of data from an on-going randomized clinical trial. Setting Eight SNFs located in central and northeast Pennsylvania. Participants One hundred and three SNF patients with adjudicated dementia and delirium diagnoses and a mean age of 86 (±6.8) years; most were female (66%) and Caucasian (98%). Measurements Measures of pain (Pain Assessment in Advanced Dementia), delirium (Confusion Assessment Method), and physical function (Barthel Index) were taken daily for 30 days or until discharge. Results On days when participants experienced greater than their average level of pain they also experienced more delirium symptoms (p < .001) and lower physical function (p < .001). Participants with higher levels of average daily pain were more likely to die (OR = 6.306, 95% CI: 1.914–20.771, p = .003) or be placed in a nursing home (OR= 4.77, 95% CI:1.7–13.2, p=.003) compared to returning to the community at 3-month follow-up. Conclusion Greater attention to pain in patients with dementia may be a potential solution to some of the quality problems and high costs of care in SNFs PMID:25239018

  20. Prolonged Delirium With Catatonia Following Orthotopic Liver Transplant Responsive to Memantine.

    PubMed

    Brown, Gregory D; Muzyk, Andrew J; Preud'homme, Xavier A

    2016-03-01

    A 59-year-old man with nonalcoholic steatohepatitis cirrhosis underwent an orthotopic liver transplant and experienced a complicated postoperative course, including a prolonged delirium. After discharge to rehabilitation, he had 2 subsequent admissions for delirium. On the first readmission, the transplant team started the patient on risperidone and resumed treatment with sertraline. On his second readmission, neurology and psychiatry were consulted. On evaluation, the patient demonstrated signs of catatonia. On the basis of recommendations from psychiatry, the risperidone and sertraline were stopped, and the patient was started on mirtazapine. He failed to demonstrate improvement within the next 48 hours. Extensive work-up demonstrated a multifactorial etiology for his delirium, including calcineurin-related neuropsychiatric toxicity from tacrolimus leading to possible posterior reversible encephalopathy syndrome. However, after the initiation of memantine on hospital day 3-before the cessation of tacrolimus-the patient demonstrated marked improvement in mental status and motor symptoms. His magnetic resonance imaging, in addition to findings that raised concerns about posterior reversible encephalopathy syndrome, had demonstrated bilateral basal ganglia abnormalities on T1 imaging of uncertain origin. It is postulated that these findings served as predisposing factors for the patient's catatonic symptoms. Although it has been described in case reports following liver transplant, catatonia remains an underrecognized neuropsychiatric complication following liver transplant. This case demonstrates the effectiveness of memantine, an N-methyl-D-aspartic acid antagonist that decreases glutamine excitotoxicity, as a potential treatment for catatonia in postliver transplant patients. PMID:27138082

  1. Systemic inflammation induces acute working memory deficits in the primed brain: relevance for delirium

    PubMed Central

    Murray, Carol; Sanderson, David J.; Barkus, Chris; Deacon, Robert M.J.; Rawlins, J. Nicholas P.; Bannerman, David M.; Cunningham, Colm

    2012-01-01

    Delirium is an acute, severe neuropsychiatric syndrome, characterized by cognitive deficits, that is highly prevalent in aging and dementia and is frequently precipitated by peripheral infections. Delirium is poorly understood and the lack of biologically relevant animal models has limited basic research. Here we hypothesized that synaptic loss and accompanying microglial priming during chronic neurodegeneration in the ME7 mouse model of prion disease predisposes these animals to acute dysfunction in the region of prior pathology upon systemic inflammatory activation. Lipopolysaccharide (LPS; 100 μg/kg) induced acute and transient working memory deficits in ME7 animals on a novel T-maze task, but did not do so in normal animals. LPS-treated ME7 animals showed heightened and prolonged transcription of inflammatory mediators in the central nervous system (CNS), compared with LPS-treated normal animals, despite having equivalent levels of circulating cytokines. The demonstration that prior synaptic loss and microglial priming are predisposing factors for acute cognitive impairments induced by systemic inflammation suggests an important animal model with which to study aspects of delirium during dementia. PMID:20471138

  2. Detection and documentation of dementia and delirium in acute geriatric wards.

    PubMed

    Laurila, Jouko V; Pitkala, Kaisu H; Strandberg, Timo E; Tilvis, Reijo S

    2004-01-01

    Detection of cognitive impairment among hospitalized older individuals has shown to be insufficient. A point prevalence study in two geriatric hospitals in Helsinki, Finland, was performed among 219 acutely ill individuals over 70 years to assess the detection of dementia and delirium. Documentation of dementia and delirium in medical records, and recordings of confusional symptoms in nurses' notes were compared with the researchers' diagnosis made after a detailed assessment of cognitive status. The cognitive decline was mentioned in medical records in 70/88 (79.5%) of the cases. Cognitive testing was performed on 42/88 (47.7%) of the dementia patients, and the diagnosis of dementia was recorded in 47/88 (53.4%) of them. A specific etiological diagnosis was recorded in only 4/88 (4.5%) cases. Cognitive impairment in at least one of these four means was recorded in 80/88 (90.9%) of cases (sensitivity 0.93). Eight patients had a false-positive diagnosis of dementia (specificity 0.94). Delirium was diagnosed in 77 (35.2%) patients by the researchers, but it was recorded in only 31/77 (40.3%) in medical records. In 64/77 (83.1%) cases signs of confusion were recorded in nurses' notes. Poor detection and documentation may lead to undertreatment of both disorders. PMID:14757300

  3. Delirium, Sedation and Analgesia in the Intensive Care Unit: A Multinational, Two-Part Survey among Intensivists

    PubMed Central

    Radtke, Finn M.; Jones, Christina; Citerio, Giuseppe; Walder, Bernhard; Weiss, Bjoern; Wernecke, Klaus-Dieter; Spies, Claudia

    2014-01-01

    Analgesia, sedation and delirium management are important parts of intensive care treatment as they are relevant for patients' clinical and functional long-term outcome. Previous surveys showed that despite this fact implementation rates are still low. The primary aim of the prospective, observational multicenter study was to investigate the implementation rate of delirium monitoring among intensivists. Secondly, current practice concerning analgesia and sedation monitoring as well as treatment strategies for patients with delirium were assesed. In addition, this study compares perceived and actual practice regarding delirium, sedation and analgesia management. Data were obtained with a two-part, anonymous survey, containing general data from intensive care units in a first part and data referring to individual patients in a second part. Questionnaires from 101 hospitals (part 1) and 868 patients (part 2) were included in data analysis. Fifty-six percent of the intensive care units reported to monitor for delirium in clinical routine. Fourty-four percent reported the use of a validated delirium score. In this respect, the survey suggests an increasing use of delirium assessment tools compared to previous surveys. Nevertheless, part two of the survey revealed that in actual practice 73% of included patients were not monitored with a validated score. Furthermore, we observed a trend towards moderate or deep sedation which is contradicting to guideline-recommendations. Every fifth patient was suffering from pain. The implementation rate of adequate pain-assessment tools for mechanically ventilated and sedated patients was low (30%). In conclusion, further efforts are necessary to implement guideline recommendations into clinical practice. The study was registered (ClinicalTrials.gov identifier: NCT01278524) and approved by the ethical committee. PMID:25398099

  4. Performance And Agreement Of Risk Stratification Instruments For Postoperative Delirium In Persons Aged 50 Years Or Older

    PubMed Central

    Jansen, Carolien J.; Absalom, Anthony R.; de Bock, Geertruida H.; van Leeuwen, Barbara L.; Izaks, Gerbrand J.

    2014-01-01

    Several risk stratification instruments for postoperative delirium in older people have been developed because early interventions may prevent delirium. We investigated the performance and agreement of nine commonly used risk stratification instruments in an independent validation cohort of consecutive elective and emergency surgical patients aged ≥50 years with ≥1 risk factor for postoperative delirium. Data was collected prospectively. Delirium was diagnosed according to DSM-IV-TR criteria. The observed incidence of postoperative delirium was calculated per risk score per risk stratification instrument. In addition, the risk stratification instruments were compared in terms of area under the receiver operating characteristic (ROC) curve (AUC), and positive and negative predictive value. Finally, the positive agreement between the risk stratification instruments was calculated. When data required for an exact implementation of the original risk stratification instruments was not available, we used alternative data that was comparable. The study population included 292 patients: 60% men; mean age (SD), 66 (8) years; 90% elective surgery. The incidence of postoperative delirium was 9%. The maximum observed incidence per risk score was 50% (95%CI, 15–85%); for eight risk stratification instruments, the maximum observed incidence per risk score was ≤25%. The AUC (95%CI) for the risk stratification instruments varied between 0.50 (0.36–0.64) and 0.66 (0.48–0.83). No AUC was statistically significant from 0.50 (p≥0.11). Positive predictive values of the risk stratification instruments varied between 0–25%, negative predictive values between 89–95%. Positive agreement varied between 0–66%. No risk stratification instrument showed clearly superior performance. In conclusion, in this independent validation cohort, the performance and agreement of commonly used risk stratification instruments for postoperative delirium was poor. Although some caution is

  5. Association of Cumulative Dose of Haloperidol with Next Day Delirium in Older Medical Intensive Care Unit Patients

    PubMed Central

    Pisani, Margaret A.; Araujo, Katy L.B.; Murphy, Terrence E.

    2014-01-01

    Objective To evaluate the association between cumulative dose of haloperidol and next day diagnosis of delirium in a cohort of older MICU patients, with adjustment for its time dependent confounding with fentanyl and intubation. Design Prospective, observational study. Setting MICU at an urban, academic medical center Patients Age 60 and older admitted to the MICU who received at least one dose of haloperidol (N=93). Of these, 72 were intubated at some point in their MICU stay whereas 21 were never intubated. Interventions None Measurements Detailed data were collected concerning time, dosage, and route of administration of all medications, as well as for important clinical covariates, and daily status of intubation and delirium using the CAM-ICU and a chart-based algorithm. Main Results Among non-intubated patients, and after adjustment for time dependent confounding and important covariates, each additional cumulative milligram of haloperidol was associated with 5% higher odds of next day delirium with OR (CI) : 1.05 (1.02 – 1.09).After adjustment for time dependent confounding and covariates, intubation was associated with a five-fold increase in odds of next day delirium with OR (CI): 5.66 (2.70 – 12.02). Cumulative dose of haloperidol among intubated patients did not change their already high likelihood of next day delirium. After adjustment for time dependent confounding the positive associations between indicators of intubation and of cognitive impairment and next day delirium became stronger. Conclusions These results emphasize the need for more studies regarding the efficacy of haloperidol for treatment of delirium among older MICU patients and demonstrate the value of assessing non-intubated patients. PMID:25746748

  6. How nurses understand and care for older people with delirium in the acute hospital: a Critical Discourse Analysis.

    PubMed

    Schofield, Irene; Tolson, Debbie; Fleming, Valerie

    2012-06-01

    Delirium is a common presentation of deteriorating health in older people. It is potentially deleterious in terms of patient experience and clinical outcomes. Much of what is known about delirium is through positivist research, which forms the evidence base for disease-based classification systems and clinical guidelines. There is little systematic study of nurses' day-to-day practice of nursing patients with delirium. The aim was to uncover the kinds of knowledge that informs nurses' care and to explicate the basis of that knowledge. Critical Discourse Analysis is underpinned by the premise that powerful interests within society mediate how social practices are constructed. Links were made between the grammatical and lexical features of nurses' language about care in interviews and naturalistic settings, and the healthcare context. Care focused on the continuous surveillance of patients with delirium by nurses themselves or vicariously through other patients, and containment. Nurses influenced by major discourses of risk reduction and safety, constructed patients with delirium as risk objects. The philosophy of person-centred and dignified care advocated in nursing literature and government policy is an emerging discourse, though little evident in the data. The current dominant discourses on safety must give space to discourses of dignity and compassion. PMID:22530864

  7. Preliminary Data: An Adapted Hospital Elder Life Program to Prevent Delirium and Reduce Complications of Acute Illness in Long-Term Care Delivered by Certified Nursing Assistants.

    PubMed

    Boockvar, Kenneth S; Teresi, Jeanne A; Inouye, Sharon K

    2016-05-01

    Nursing home (NH) residents have a high prevalence of delirium risk factors, experience two to four acute medical conditions (e.g., infections) each year, and have an incidence of delirium during these conditions similar to that of hospitalized older adults. Many NH residents with delirium do not return to their prior level of cognitive function. They are more likely to die, be hospitalized, and less likely to be discharged home than those without delirium. Research on the prevention or treatment of delirium in NHs is limited. This article describes the development and pilot testing of a multicomponent delirium prevention intervention in the NH setting adapted from the Hospital Elder Life Program (HELP-LTC). Activities to reduce the risk of delirium that were appropriate for functionally impaired NH residents were developed and delivered during treatment for and recovery from acute illness, a novel resident-targeting approach. Expertly trained certified nursing assistants (CNAs - a total of 1.4 full-time equivalent (FTE) positions-) visited residents throughout the facility and delivered the activities. The current study reports on incident delirium, delirium remission, cognitive and physical function change, hospitalization, and death associated with acute medical conditions as ascertained by a program coordinator. The integration and acceptance of the CNAs' activities by residents and staff are also reported on. Hospitalization and death were ascertained in a nonintervention comparison group. Findings support a test of the intervention in a controlled trial. The potential effect is great; there are approximately 1.4 million NH residents in the United States and an estimated 1 million with dementia or cognitive impairment, an important delirium risk factor. An intervention would be broadly adoptable if a reduction in healthcare costs through prevention of hospitalization offset the cost of the program's CNAs. PMID:27160212

  8. Prevention of delirium in trauma patients: Are we giving thiamine prophylaxis a fair chance?

    PubMed Central

    Blackmore, Christopher; Ouellet, Jean-Francois; Niven, Daniel; Kirkpatrick, Andrew W.; Ball, Chad G.

    2014-01-01

    Background Delirium is associated with increased morbidity and mortality in injured patients. Wernicke encephalopathy (WE) is delirium linked to malnutrition and chronic alcoholism. It is prevented with administration of thiamine. Our primary goal was to evaluate current blood alcohol level (BAL) testing and thiamine prophylaxis in severely injured patients. Methods We retrospectively reviewed the cases of 1000 consecutive severely injured patients admitted to hospital between Mar. 1, 2009, and Dec. 31, 2009. We used the patients’ medical records and the Alberta Trauma Registry. Results Among 1000 patients (mean age 48 yr, male sex 70%, mean injury severity score 23, mortality 10%), 627 underwent BAL testing at admission; 221 (35%) had a BAL greater than 0 mmol/L, and 189 (30%) had a BAL above the legal limit of 17.4 mmol/L. The mean positive BAL was 41.9 mmol/L. More than 4% had a known history of alcohol abuse. More patients were assaulted (20% v. 9%) or hit by motor vehicles (10% v. 6%) when intoxicated (both p < 0.05). Most injuries occurred after falls (37%) and motor vehicle collisions (33%). Overall, 17% of patients received thiamine prophylaxis. Of the 221 patients with elevated BAL, 44% received thiamine prophylaxis. Of those with a history of alcohol abuse, 77% received thiamine prophylaxis. Conclusion Despite the strong link between alcohol abuse, trauma and WE, more than one-third of patients were not screened for alcohol use. Furthermore, a minority of intoxicated patients received adequate prophylaxis against WE. Given the low risk and cost of BAL testing and thiamine prophylaxis and the high cost of delirium, standard protocols for prophylaxis are essential. PMID:24666443

  9. Analysis of multi-dimensional contemporaneous EHR data to refine delirium assessments.

    PubMed

    Corradi, John P; Chhabra, Jyoti; Mather, Jeffrey F; Waszynski, Christine M; Dicks, Robert S

    2016-08-01

    Delirium is a potentially lethal condition of altered mental status, attention, and level of consciousness with an acute onset and fluctuating course. Its causes are multi-factorial, and its pathophysiology is not well understood; therefore clinical focus has been on prevention strategies and early detection. One patient evaluation technique in routine use is the Confusion Assessment Method (CAM): a relatively simple test resulting in 'positive', 'negative' or 'unable-to-assess' (UTA) ratings. Hartford Hospital nursing staff use the CAM regularly on all non-critical care units, and a high frequency of UTA was observed after reviewing several years of records. In addition, patients with UTA ratings displayed poor outcomes such as in-hospital mortality, longer lengths of stay, and discharge to acute and long term care facilities. We sought to better understand the use of UTA, especially outside of critical care environments, in order to improve delirium detection throughout the hospital. An unsupervised clustering approach was used with additional, concurrent assessment data available in the EHR to categorize patient visits with UTA CAMs. The results yielded insights into the most common situations in which the UTA rating was used (e.g. impaired verbal communication, dementia), suggesting potentially inappropriate ratings that could be refined with further evaluation and remedied with updated clinical training. Analysis of the patient clusters also suggested that unrecognized delirium may contribute to the poor outcomes associated with the use of UTA. This method of using temporally related high dimensional EHR data to illuminate a dynamic medical condition could have wider applicability. PMID:27340924

  10. Rethinking Critical Care: Decreasing Sedation, Increasing Delirium Monitoring, and Increasing Patient Mobility

    PubMed Central

    Bassett, Rick; Adams, Kelly McCutcheon; Danesh, Valerie; Groat, Patricia M.; Haugen, Angie; Kiewel, Angi; Small, Cora; Van-Leuven, Mark; Venus, Sam; Ely, E. Wesley

    2016-01-01

    Background/Methods Sedation management, delirium monitoring, and mobility programs are key features of recent evidence-based critical care guidelines and care bundles, yet implementation in the intensive care unit (ICU) remains highly variable. The Institute for Healthcare Improvement’s Rethinking Critical Care (IHI-RCC) program was established to reduce harm of critically ill patients by decreasing sedation, increasing monitoring and management of delirium, and increasing patient mobility. It involved one live case study and five iterations of an in-person seminar over 33 months (March 2011 to November 2013) that emphasized interdisciplinary teamwork and culture change. IHI-RCC has involved over 650 participants from 215 organizations. This report describes a convenience sample of five participating organizations chosen in advance of knowing their clinical outcomes. Results Qualitative descriptions of the changes tested at each of the five case study sites are provided, demonstrating the necessary teamwork, improved processes, and increased reliability of daily work. These sites all worked to implement the Richmond Agitation Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU) within the context of a bundled interventional care plan; they then tracked length of stay in the ICU and duration of mechanical ventilation, which are reported. Discussion Changing critical care practices requires an interdisciplinary approach addressing cultural, psychological, and practical issues. The IHI-RCC program is based on testing changes on a small scale, building highly effective interdisciplinary rounds, frequent data feedback to the frontline, and use of in-person demonstrations. Key lessons are emerging about effectively caring for critically ill patients in light of data about the harm of over-sedation, unrecognized and unaddressed delirium, and immobility. PMID:25976892

  11. High Yield Research Opportunities in Geriatric Emergency Medicine: Prehospital Care, Delirium, Adverse Drug Events, and Falls

    PubMed Central

    Carpenter, Christopher R.; Shah, Manish N.; Hustey, Fredric M.; Heard, Kennon; Gerson, Lowell W.

    2011-01-01

    Emergency services constitute crucial and frequently used safety nets for older persons, an emergency visit by a senior very often indicates high vulnerability for functional decline and death, and interventions via the emergency system have significant opportunities to change the clinical course of older patients who require its services. However, the evidence base for widespread employment of emergency system-based interventions is lacking. In this article, we review the evidence and offer crucial research questions to capitalize on the opportunity to optimize health trajectories of older persons seeking emergency care in four areas: prehospital care, delirium, adverse drug events, and falls. PMID:21498881

  12. Evidence-based clinical audit criteria for the prevention and management of delirium in the postoperative patient with a hip fracture.

    PubMed

    Holly, Cheryl; Rittenmeyer, Leslie; Weeks, Susan Mace

    2014-01-01

    Delirium is a frequent, yet often unrecognized, occurrence in elderly hospitalized patients. In patients with hip fracture, the incidence of delirium is reported to be as high as 62% and even greater if over 65 years of age. One approach to the prevention and management of postoperative delirium in elderly patients with hip fracture is the clinical audit. A clinical audit is a retrospective assessment of clinical care of patients and is guided by criteria that are evidence-based statements of best practice. The use of measurable, objective criterion, with an agreed standard of performance is the hallmark of an audit. The clinical audit criteria presented in this article for the prevention and management of delirium in hospitalized elderly with hip fracture were determined by a compilation of systematic reviews and existing evidence-based clinical guidelines. The following 5 audit criteria are discussed: (1) All elderly patients with a hip fracture are assessed for risk factors for developing delirium daily using a valid and reliable tool; (2) the environment of the patient with hip fracture is assessed daily for conduciveness to maintaining sensory orientation; (3) all patients with hip fracture receive essential nursing care; (4) appropriate clinical criteria are applied to confirm a diagnosis of delirium in patients with hip fracture; and (5) nonpharmacologic interventions are employed before pharmacologic interventions in patients with hip fracture with a diagnosis of delirium. PMID:24457386

  13. Perceptions and practices regarding delirium, sedation and analgesia in critically ill patients: a narrative review

    PubMed Central

    Shinotsuka, Cassia Righy; Salluh, Jorge Ibrain Figueira

    2013-01-01

    A significant number of landmark studies have been published in the last decade that increase the current knowledge on sedation for critically ill patients. Therefore, many practices that were considered standard of care are now outdated. Oversedation has been shown to be hazardous, and light sedation and no-sedation protocols are associated with better patient outcomes. Delirium is increasingly recognized as a major form of acute brain dysfunction that is associated with higher mortality, longer duration of mechanical ventilation and longer lengths of stay in the intensive care unit and hospital. Despite all the available evidence, translating research into bedside care is a daunting task. International surveys have shown that practices such as sedation interruption and titration are performed only in the minority of cases. Implementing best practices is a major challenge that must also be addressed in the new guidelines. In this review, we summarize the findings of sedation and delirium research over the last years. We also discuss the gap between evidence and clinical practice and highlight ways to implement best practices at the bedside. PMID:23917981

  14. Management of Levofloxacin Induced Anaphylaxis and Acute Delirium in a Palliative Care Setting

    PubMed Central

    Ghoshal, Arunangshu; Damani, Anuja; Salins, Naveen; Deodhar, Jayita; Muckaden, Mary Ann

    2015-01-01

    Levofloxacin is a commonly prescribed antibiotic for managing chest and urinary tract infections in a palliative care setting. Incidence of Levofloxacin-associated anaphylaxis is rare and delirium secondary to Levofloxacin is a seldom occurrence with only few published case reports. It is an extremely rare occurrence to see this phenomenon in combination. Early identification and prompt intervention reduces both mortality and morbidity. A 17-year-old male with synovial sarcoma of right thigh with chest wall and lung metastasis and with no prior psychiatric morbidity presented to palliative medicine outpatient department with community-acquired pneumonia. He was initiated on intravenous (IV) Ceftriaxone and IV Levofloxacin. Post IV Levofloxacin patient developed anaphylaxis and acute delirium necessitating IV Hydrocortisone, IV Chlorpheneramine, Oxygen and IV Haloperidol. Early detection and prompt intervention helped in complete recovery. Patient was discharged to hospice for respite after 2 days of hospitalization and then discharged home. Acute palliative care approach facilitated management of two life-threatening medical complications in a palliative care setting improving both quality and length of life. PMID:25709191

  15. Spinal anesthesia reduces postoperative delirium in opium dependent patients undergoing coronary artery bypass grafting.

    PubMed

    Tabatabaie, O; Matin, N; Heidari, A; Tabatabaie, A; Hadaegh, A; Yazdanynejad, S; Tabatabaie, K

    2015-01-01

    We investigated the effect of high spinal anesthesia on postoperative delirium in opium dependent patients undergoing coronary artery bypass grafting (CABG). The study was conducted in a tertiary referral university hospital on a population of 60 opium dependent patients undergoing CABG surgery. Patients were divided into two groups based on anesthesia protocol. One group were given general anesthesia (GA Group), the other group additionally received intrathecal morphine and bupivacaine (SGA Group). Postoperative delirium (POD) was defined as the main outcome of interest. Incidence of POD was significantly higher in patients of GA Group as compared with those in SGA Group (47% and 17% for GA and SGA respectively; P-value = 0.01). Time to extubation was on average 2.2 h shorter in SGA than in GA (7.1 h and 9.3 h respectively, P-value < 0.001). Intrathecal morphine and bupivacaine reduced the risk of POD after CABG in a population of opium dependent patients. PMID:26455008

  16. HHV-6 reactivation and its effect on delirium and cognitive functioning in hematopoietic cell transplantation recipients

    PubMed Central

    Fann, Jesse R.; Breiger, David; Boeckh, Michael; Adler, Amanda L.; Xie, Hu; Delaney, Colleen; Huang, Meei-Li; Corey, Lawrence; Leisenring, Wendy M.

    2011-01-01

    Human herpesvirus 6 (HHV-6) is detected in the plasma of approximately 40% of patients undergoing hematopoietic cell transplantation (HCT) and sporadically causes encephalitis in this population. The effect of HHV-6 reactivation on central nervous system function has not been fully characterized. This prospective study aimed to evaluate associations between HHV-6 reactivation and central nervous system dysfunction after allogeneic HCT. Patients were enrolled before HCT. Plasma samples were tested for HHV-6 at baseline and twice weekly after transplantation until day 84. Delirium was assessed at baseline, 3 times weekly until day 56, and weekly on days 56 to 84 using a validated instrument. Neurocognitive testing was performed at baseline and at approximately day 84. HHV-6 was detected in 111 (35%) of the 315 included patients. Patients with HHV-6 were more likely to develop delirium (adjusted odds ratio = 2.5; 95% confidence interval, 1.2-5.3) and demonstrate neurocognitive decline (adjusted odds ratio = 2.6; 95% confidence interval, 1.1-6.2) in the first 84 days after HCT. Cord blood and unrelated transplantation increased risk of HHV-6 reactivation. These data provide the basis to conduct a randomized clinical trial to determine whether prevention of HHV-6 reactivation will reduce neurocognitive morbidity in HCT recipients. PMID:21389320

  17. Effect of preoperative oral midazolam sedation on separation anxiety and emergence delirium among children undergoing dental treatment under general anesthesia

    PubMed Central

    El Batawi, Hisham Yehia

    2015-01-01

    Aim: To investigate the possible effects of preoperative oral Midazolam on parental separation anxiety, emergence delirium, and post-anesthesia care unit time on children undergoing dental rehabilitation under general anesthesia. Methods: Randomized, prospective, double-blind study. Seventy-eight American Society of Anesthesiology (ASA) I children were divided into two groups of 39 each. Children of the first group were premedicated with oral Midazolam 0.5 mg/kg, while children of the control group were premedicated with a placebo. Scores for parental separation, mask acceptance, postoperative emergence delirium, and time spent in the post-anesthesia care unit were compared statistically. Results: The test group showed significantly lower parental separation scores and high acceptance rate for anesthetic mask. There was no significant difference between the two groups regarding emergence delirium and time spent in post-anesthesia care unit. Conclusions: Preoperative oral Midazolam could be a useful adjunct in anxiety management for children suffering dental anxiety. The drug may not reduce the incidence of postoperative emergence delirium. The suggested dose does not seem to affect the post-anesthesia care unit time. PMID:25992332

  18. Incidence and risk factors of postoperative delirium in elderly patients undergoing transurethral resection of prostate: a prospective cohort study

    PubMed Central

    Xue, Peng; Wu, Ziyu; Wang, Kunpeng; Tu, Chuanquan; Wang, Xiangbo

    2016-01-01

    Aim The aim of the present study was to investigate the occurrence of postoperative delirium (POD) in elderly patients undergoing transurethral resection of prostate (TURP) and to identify those factors associated with delirium. Methods From July 2010 to February 2015, 358 patients, aged ≥65 years and undergoing TURP were prospectively enrolled. Personal, medical and cognitive data, laboratory assessments, pain intensity, preoperative medications, and details of hemodynamic control were collected as predictors of delirium. POD was assessed using the Confusion Assessment Method. Results In the present study, POD occurred in 28 out of 358 cases (7.8%) after TURP, with duration of 1–4 days. The multivariate analysis showed that old age and visual analog scale pain scores were associated with POD. Marital status, body mass index, education, alcohol consumption, smoking history, preoperative psychotropic medication usage, activities of daily living scores, preoperative Mini-Mental Status Examination score, anesthesia type, American Society of Anesthesiologists classification, or hypotensive episodes during surgery did not significantly correlate with the occurrence of POD. Conclusion Old age and pain intensity after surgery were found as the risk factors for the development of delirium in elderly patients undergoing TURP. These findings might help develop preventive strategies to decrease POD through targeted evaluation. PMID:26834475

  19. Association between Serum IGF-I levels and Postoperative Delirium in Elderly Subjects Undergoing Elective Knee Arthroplasty

    PubMed Central

    Yen, Timothy E.; Allen, John C.; Rivelli, Sarah K.; Patterson, Stephanie C.; Metcalf, Meredith R.; Flink, Benjamin J.; Mirrakhimov, Aibek E.; Lagoo, Sandhya A.; Vail, Thomas P.; Young, Christopher C.; Moon, Richard E.; Trzepacz, Paula T.; Kwatra, Madan M.

    2016-01-01

    Evidence is mixed for an association between serum insulin-like growth factor-I (IGF-I) levels and postoperative delirium (POD). The current study assessed preoperative serum IGF-I levels as a predictor of incident delirium in non-demented elderly elective knee arthroplasty patients. Preoperative serum levels of total IGF-I were measured using a commercially available Human IGF-I ELISA kit. POD incidence and severity were determined using DSM-IV criteria and the Delirium Rating Scale-Revised-98 (DRS-R98), respectively. Median IGF-I levels in delirious (62.6 ng/ml) and non-delirious groups (65.9 ng/ml) were not significantly different (p = 0.141). The ratio (95% CI) of geometric means, D/ND, was 0.86 (0.70, 1.06). The Hodges-Lehmann median difference estimate was 7.23 ng/mL with 95% confidence interval (−2.32, 19.9). In multivariate logistic regression analysis IGF-I level was not a significant predictor of incident POD after correcting for medical comorbidities. IGF-I levels did not correlate with DRS-R98 scores for delirium severity. In conclusion, we report no evidence of association between serum IGF-I levels and incidence of POD, although the sample size was inadequate for a conclusive study. Further efforts to investigate IGF-I as a delirium risk factor in elderly should address comorbidities and confounders that influence IGF-I levels. PMID:26846868

  20. Use of an online curriculum to teach delirium to fourth-year medical students: a comparison with lecture format.

    PubMed

    Chao, Serena H; Brett, Belle; Wiecha, John M; Norton, Lisa E; Levine, Sharon A

    2012-07-01

    Web-based learning methods are being used increasingly to teach core curriculum in medical school clerkships, but few studies have compared the effectiveness of online methods with that of live lectures in teaching the same topics to students. Boston University School of Medicine has implemented an online, case-based, interactive curriculum using videos and text to teach delirium to fourth-year medical students during their required 1-month Geriatrics and Home Medical Care clerkship. A control group of 56 students who received a 1-hour live delirium lecture only was compared with 111 intervention group students who completed the online delirium curriculum only. Evaluation consisted of a short-answer test with two cases given as a pre- and posttest to both groups. The total possible maximum test score was 34 points, and the lowest possible score was -8 points. Mean pre- and posttest scores were 10.5 ± 4.0 and 12.7 ± 4.4, respectively, in the intervention group and 9.9 ± 3.5 and 11.2 ± 4.5, respectively, in the control group. The intervention group had statistically significant improvement between the pre- and posttest scores (2.21-point difference; P < .001), as did the control group (1.36-point difference; P = .03); the difference in test score improvement between the two groups was not statistically significant. An interactive case-based online curriculum in delirium is as effective as a live lecture in teaching delirium, although neither of these educational methods alone produces robust increases in knowledge. PMID:22702385

  1. Delirium with anticholinergic symptoms after a combination of paliperidone and olanzapine pamoate in a patient known to smoke cannabis: an unfortunate coincidence.

    PubMed

    Kokalj, Anja; Rijavec, Nikolina; Tavčar, Rok

    2016-01-01

    We report a case of delirium with anticholinergic symptoms in a 19-year-old female patient with schizophrenia. On the day the symptoms emerged, the patient received olanzapine long-acting injection and a higher dose of paliperidone. We observed symptoms ranging from confusion to delirium as well as some anticholinergic symptoms. The delirium lasted 24 hours and was managed by intravenous fluid substitution and oral benzodiazepines. Olanzapine pamoate, paliperidone and cannabis are central nervous system (CNS) depressants, and their combination can increase the risks of CNS depression. In this case report, we review the symptoms of delirium in a case of antipsychotic overdose and provide general guidelines for managing these symptoms. We also review possible complications in combined use of cannabis, olanzapine and paliperidone. PMID:27335358

  2. [Plasma ACTH, STH and other hormone levels in various groups under chlormethiazole, haloperidol or reserpine load in alchohol delirium, alcoholic hallucinations, and chronic alcoholism].

    PubMed

    Dobrzański, T; Pieschl, D

    1976-01-01

    Studies of 135 men with safely diagnosed alcohol delirium mostly revealed increased ACTH blood values when sober and increased T4 values in about 1/3 of these patients. There is a correlation between the psychiatric clinical picture of the alcohol delirium and the ACTH content of the plasma. Under load with chloromethiazole, halperidole or with reserpine, there is a significant drop in the increased ACTH and T4 values. In an acute alcoholic hallucinosis (n=16) similar endocrinological changes as in most cases of safely diagnosed alcohol delirium were observed. In a chronic alcoholic hallucinosis (n=11) and in chronic alcoholics (n=31) the endocrinological values were similar to those of patients after alcohol delirium. PMID:181772

  3. Consequence of dexmedetomidine on emergence delirium following sevoflurane anesthesia in children with cerebral palsy

    PubMed Central

    Liu, Yang; Kang, Dao-Lin; Na, He-Yi; Li, Bi-Lian; Xu, Ying-Yi; Ni, Jin; Wu, Jun-Zheng

    2015-01-01

    Children with cerebral palsy can demonstrate irritability following emergence from general anaesthesia. As well, an elevated rate of emergence delirium (ED) in children has been associated with the application of sevoflurane. The current study’s intent is to administer dexmedetomidine, in a single dosage administration, at the initial phase of sevoflurane based anesthesia with regard to the occurrence and severity of ED in children afflicted with cerebral palsy. Participating in the study (American Society of Anesthesiologists I-II) are eighty children ranging in ages two through twelve years. They would be anaesthetised with sevoflurane based anesthesia while undergoing lower limb surgical procedures. The participants were equally distributed to either Group c or Group D. Group C was administered 10 ml saline 0.9%, and Group D was administered dexmedetomidine 0.5 μg•kg-1. Five minutes prior to commencement of the surgical procedures, the participants received the prescribed pharmaceutical dosages under the anesthesia of sevoflurane. In order to sustain the BIS values in a range of 45 and 55, at 60 second increments, endtidal sevoflurane concentrations (ETsev) were modified. After conclusion of the surgical procedures, in post anesthesia care unit (PACU), the frequency of ED was gauged with Aonos four point scale and the severity of ED was gauged with pediatric anesthesia emergence delirium scale upon admission (T0), after intervals of five minutes (T5), fifteen minutes (T15) and thirty minutes (T30). Extubation time, emergence time and length of at stay at the PACU were assessed. Relative to Group C, participants of Group D exhibited noticeably shortened times of emergence, extubation and PACU duration of stay. Prior to surgical incision, ETsev was elevated in the control group, (1.9±0.2 vs 1.6±0.3; P = 0.023) and amid the initial 20 minutes following the surgical incision (1.6±0.2 vs 1.1±0.2; P = 0.016). At intervals of commencement, T0, of five minutes

  4. Thirty-day prevalence of delirium among very old people: a population-based study of very old people living at home and in institutions.

    PubMed

    Mathillas, Johan; Olofsson, Birgitta; Lövheim, Hugo; Gustafson, Yngve

    2013-01-01

    Delirium has mainly been studied in various patient samples and in people living in institutions. The present study investigates the 30-day prevalence of delirium in a population-based sample of very old people in northern Sweden and Finland. Seven hundred and eight persons aged 85 years and older from the GErontological Regional DAtabase (GERDA) were assessed. Information was also collected from relatives, carers and medical records. Assessments performed were among others the Organic Brain Syndrome (OBS) scale, the Mini Mental State Examination (MMSE), and the Geriatric Depression Scale-15 (GDS-15). Delirium, depression and dementia diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. The prevalence of delirium was 17% among 85 year-olds, 21% among 90 year-olds and 39% among participants aged 95 years and older (p<0.001). Delirium prevalence among individuals without dementia was lower than among those with dementia (5% vs. 52%, p<0.001). Factors independently associated with delirium superimposed on dementia in a multivariate logistic regression model were depression (Odds Ratio (OR)=2.0, 95% Confidence Interval (CI)=1.2-3.3), heart failure (OR=2.1, 95% CI=1.2-3.7), institutional living (OR 4.4, 95% CI=2.4-8.2) and prescribed antipsychotics (OR=3.0, 95% CI=1.5-6.0). Delirium is highly prevalent among very old people with dementia. Depression, heart failure, institutional living and prescribed antipsychotic medication seem to be associated with delirium. PMID:23711428

  5. 5-HT(1A) receptor antagonist improves behavior performance of delirium rats through inhibiting PI3K/Akt/mTOR activation-induced NLRP3 activity.

    PubMed

    Qiu, Yimin; Huang, Xiaojing; Huang, Lina; Tang, Liang; Jiang, Jihong; Chen, Lianhua; Li, Shitong

    2016-04-01

    Postoperative delirium is a common complication that often results in poor outcomes in surgical and elderly patients. Accumulating evidences suggest that the pathophysiology of delirium results from multiple neurotransmitter system dysfunctions. To further clarify the effects of the selective serotonin (5-HT) (1A) antagonist WAY-100635 on the behaviors in scopolamine induced-delirium rats and to explore the molecular mechanism, in this study, we investigated the change of monoamine levels in the cerebrospinal fluid (CSF) and different brain regions using high-performance liquid chromatography and assessed the behavioral retrieval of delirium rats treated with WAY-100635. It was found that 5-hydroxy-3-indoleacetic acid (5-HIAA), 3,4-dihydroxyphenylacetic acid, and homovanillic acid concentrations in the CSF of scopolamine-induced delirium rats were significantly increased, among which 5-HIAA was also increased in hippocampus and basolateral amygdala (BLA), and 5-HT(1A) receptor was significantly higher in the hippocampuses and BLA than other brain regions. Furthermore, intrahippocampus and intra-BLA stereotactic injection of WAY-100635 improved the delirium-like behavior of rats. Mechanistically, after WAY-100635 treatment, significant reduction of IL-1β release into CSF and NOD-like receptor family, pyrin domain containing 3 (NLRP3) expression, phosphorylated phosphatidylinositol-3-kinase (PI3K), protein kinase B (AKT), and S6K was observed. Altogether, these results suggest that delirium rats induced by scopolamine may be correlated with an increased cerebral concentration of 5-HT and dopamine neurotransmitters system; the selective 5-HT(1A) antagoniszts can reverse the delirium symptoms at some extent through tendering PI3K/Akt/mammalian target of rapamycin complex 1 (mTOR) activation-induced NLRP3 activity and then reducing IL-1β release. © 2016 IUBMB Life, 68(4):311-319, 2016. PMID:26946964

  6. Effect Estimation of an Innovative Nursing Intervention to Improve Delirium among Home-Dwelling Older Adults: A Randomized Controlled Pilot Trial

    PubMed Central

    Verloo, Henk; Goulet, Céline; Morin, Diane; von Gunten, Armin

    2015-01-01

    Aims Estimating the effect of a nursing intervention in home-dwelling older adults on the occurrence and course of delirium and concomitant cognitive and functional impairment. Methods A randomized clinical pilot trial using a before/after design was conducted with older patients discharged from hospital who had a medical prescription to receive home care. A total of 51 patients were randomized into the experimental group (EG) and 52 patients into the control group (CG). Besides usual home care, nursing interventions were offered by a geriatric nurse specialist to the EG at 48 h, 72 h, 7 days, 14 days, and 21 days after discharge. All patients were monitored for symptoms of delirium using the Confusion Assessment Method. Cognitive and functional statuses were measured with the Mini-Mental State Examination and the Katz and Lawton Index. Results No statistical differences with regard to symptoms of delirium (p = 0.085), cognitive impairment (p = 0.151), and functional status (p = 0.235) were found between the EG and CG at study entry and at 1 month. After adjustment, statistical differences were found in favor of the EG for symptoms of delirium (p = 0.046), cognitive impairment (p = 0.015), and functional status (p = 0.033). Conclusion Nursing interventions to detect delirium at home are feasible and accepted. The nursing interventions produced a promising effect to improve delirium. PMID:26034489

  7. A volunteer-based Hospital Elder Life Program to reduce delirium.

    PubMed

    Sandhaus, Sonia; Zalon, Margarete L; Valenti, Donna; Dzielak, Edward; Smego, Raymond A; Arzamasova, Ulyana

    2010-01-01

    A community hospital with nearly 50% of its admitted patients 70 years or older adapted the well-established Hospital Elder Life Program (HELP). The primary adaptation entailed an enhanced participation of trained volunteers in HELP interventions designed to prevent and reduce delirium. Integral program elements include detailed volunteer training, required demonstration of competencies, and regular evaluation and feedback of volunteers provided by program staff. Nurse satisfaction with HELP increased from 64% to 91% in the second year of implementation, and a survey of patients and families indicated that 95% were satisfied with HELP. This innovative volunteer-assisted model of elder care support was positively embraced by patients, their families, and the nursing staff and supported by nursing administration. The use of volunteers is a cost-effective method of enhancing the nursing care of vulnerable elders during hospitalization. PMID:20436332

  8. Clinical review: Agitation and delirium in the critically ill – significance and management

    PubMed Central

    Chevrolet, Jean-Claude; Jolliet, Philippe

    2007-01-01

    Agitation is a psychomotor disturbance characterized by a marked increase in motor and psychological activity in a patient. It occurs very frequently in the intensive care setting. It may be isolated, or accompanied by other mental disorders, such as severe anxiety and delirium. Frequently, agitation is a sign of brain dysfunction and, as such, may have adverse consequences, for at least two reasons. First, agitation can interfere with the patient's care and second, there is evidence demonstrating that the prognosis of agitated (and delirious) patients is worse than that of non-agitated (non-delirious) patients. These conditions are often under-diagnosed in the intensive care unit (ICU). Consequently, a systematic evaluation of this problem in ICU patients should be conducted. Excellent tools are presently available for this purpose. Treatment, including prevention, must be undertaken without delay, and the ICU physician should follow logical, strict and systematic rules when applying therapy. PMID:17521456

  9. A case of γ-butyrolactone associated with severe withdrawal delirium and acute renal failure.

    PubMed

    Bhattacharya, Indrani S; Watson, Fiona; Bruce, Malcolm

    2011-01-01

    γ-Butyrolactone (GBL) is a popular drug of abuse which is easily available over the internet. Following a UK classification change to a class C drug in January 2010, internet supply has become difficult. Some of the effects have resulted in sourcing GBL from industrial solvents. We report a case of a 24-year-old man who was admitted for detoxification from GBL. He reported having sourced the GBL by diluting the contents of nail varnish remover pads with water. During his admission he developed a severe withdrawal delirium and acute renal failure. He required admission to the intensive care unit. Physicians and psychiatrists should be aware of toxic sources of GBL leading to renal failure and consider GBL in those presenting with agitation, psychosis or coma. PMID:21454980

  10. Anticholinergic delirium following Datura stramonium ingestion: Implications for the Internet age

    PubMed Central

    Vearrier, David; Greenberg, Michael I

    2010-01-01

    Recreational use of Datura to deliberately induce an anticholinergic delirium is not uncommon. We present a case of Datura intoxication in a young adult who learned about the recreational use of Datura on the Internet and subsequently purchased Datura stramonium seeds from an online vendor. Using the Google search engine, we conducted searches for “Datura,” “jimson weed” and “Datura seeds” and reviewed the first 200 search results for each search term. We found 16 websites recommending the recreational use of Datura, 12 vendors selling seeds of genus Datura and one website that both promoted the recreational use of Datura and also sold Datura stramonium leaves. The promotion of recreational use of Datura on the Internet represents a danger to public health and the ability to purchase Datura seeds from Internet vendors may increase the prevalence of Datura abuse. PMID:20930988

  11. [Pharmacological treatment of delirium in palliative care patients. A systematic literature review].

    PubMed

    Perrar, K M; Golla, H; Voltz, R

    2013-04-01

    This systematic literature review aims to collect and analyse relevant clinical trials for the drug treatment of delirium in palliative care. The search was conducted including July 2012 in Medline (from 1966) and Embase (from 1974). The search retrieved 448 studies, of which 3 studies could be included in the analysis. Treatment with the antipsychotic drug haloperidol can be recommended, which is also true to a somewhat lower extent for the antipsychotics olanzapine and aripiprazole. Treatment with lorazepam only should be avoided. This literature analysis reflects the positive clinical experience, especially when using haloperidol. To confirm these recommendations, further substantial clinical studies are needed.The English full-text version of this article can be found at SpringerLink (under "Supplemental"). PMID:23503785

  12. Sleep Disruption and Proprioceptive Delirium due to Acetaminophen in a Pediatric Patient

    PubMed Central

    Carnovale, Carla; Pozzi, Marco; Nisic, Andrea Angelo; Scrofani, Elisa; Perrone, Valentina; Antoniazzi, Stefania; Radice, Sonia

    2013-01-01

    We present the case of a 7-year-old boy, who received acetaminophen for the treatment of hyperpyrexia, due to an infection of the superior airways. 13 mg/kg (260 mg) of acetaminophen was administered orally before bedtime, and together with the expected antipyretic effect, the boy experienced sleep disruption and proprioceptive delirium. The symptoms disappeared within one hour. In the following six months, acetaminophen was administered again twice, and the reaction reappeared with similar features. Potential alternative explanations were excluded, and analysis with the Naranjo algorithm indicated a “probable” relationship between acetaminophen and this adverse reaction. We discuss the potential mechanisms involved, comprising imbalances in prostaglandin levels, alterations of dopamine, and cannabinoid and serotonin signalings. PMID:23573447

  13. Concordance of Electronic Health Record (EHR) Data Describing Delirium at a VA Hospital

    PubMed Central

    Spuhl, Joshua; Doing-Harris, Kristina; Nelson, Scott; Estrada, Nicolette; Fiol, Guilherme Del; Weir, Charlene

    2014-01-01

    BACKGROUND Delirium is a common syndrome in elderly hospitalized patients that is correlated with poor outcomes and higher costs yet health care teams often overlook its diagnosis and treatment. Poor data quality in EHR systems can be contributing to this as a common tool teams use to communicate and record data about their patients. METHODS Data were gathered from 30 patients chosen randomly that spanned various data domains in the EHR. These were analyzed for concordance as an indicator of data quality. RESULTS Concordance was high between the physician and nursing narrative documentation. The other domains of data were drastically less concordant. DISCUSSION The low concordance between structured and narrative data domains suggests that clinicians are forgoing the features available in modern EHR systems and opting to work in narrative. For informatics, this can be troubling as narrative data are difficult to compute. PMID:25954416

  14. 3D-CAM: Derivation and Validation of a 3-Minute Diagnostic Interview for CAM-defined Delirium

    PubMed Central

    Marcantonio, Edward R.; Ngo, Long H.; O’Connor, Margaret; Jones, Richard N.; Crane, Paul K.; Metzger, Eran D.; Inouye, Sharon K.

    2015-01-01

    Background Delirium is common, morbid, and costly, yet remains often unrecognized in most clinical settings. The Confusion Assessment Method (CAM) is the most widely used diagnostic algorithm, and operationalizing its features would represent a substantial advance for clinical care. Objective To derive the 3D-CAM, a new 3-minute diagnostic assessment for CAM-defined delirium, and to validate it against a clinical reference standard. Design Diagnostic test study Setting 4 general medicine units in an academic medical center Participants 201 inpatients aged ≥ 75 years old Measurements We identified 20 items that best operationalized the 4 CAM diagnostic features to create the 3D-CAM. For prospective validation, 3D-CAM assessments were administered by trained research assistants. Independently, clinicians performed an extensive assessment that included patient interviews, family interviews, and review of the medical record. These data were considered by an expert panel to determine the presence or absence of delirium and dementia (reference standard). We compared the 3D-CAM delirium determination to the reference standard in all patients and in subgroups with and without dementia. Results The 201 participants in the prospective validation study had mean age (SD) of 84 (5.5) years, and 27% had dementia. The expert panel identified delirium in 21%. Median administration time for 3D-CAM was 3 minutes (inter-quartile range: 2–5 minutes). The sensitivity [95% CI] of 3D-CAM was 95% [84%, 99%] and the specificity was 94% [90%, 97%]. The 3D-CAM performed well in patients both with dementia (sensitivity=96% [82%, 100%], specificity=86% [67%, 96%]) and without dementia (sensitivity=93% [66%, 100%], specificity=96% [91%,99%]). Limitations Limited to single center, cross-sectional, and medicine patients only Conclusion The 3D-CAM operationalizes the CAM algorithm using a 3-minute structured assessment with high sensitivity and specificity relative to a reference standard and

  15. Efficacy of Non-Pharmacological Interventions to Prevent and Treat Delirium in Older Patients: A Systematic Overview. The SENATOR project ONTOP Series

    PubMed Central

    Abraha, Iosief; Trotta, Fabiana; Rimland, Joseph M.; Cruz-Jentoft, Alfonso; Lozano-Montoya, Isabel; Soiza, Roy L.; Pierini, Valentina; Dessì Fulgheri, Paolo; Lattanzio, Fabrizia; O’Mahony, Denis; Cherubini, Antonio

    2015-01-01

    Background Non-pharmacological intervention (e.g. multidisciplinary interventions, music therapy, bright light therapy, educational interventions etc.) are alternative interventions that can be used in older subjects. There are plenty reviews of non-pharmacological interventions for the prevention and treatment of delirium in older patients and clinicians need a synthesized, methodologically sound document for their decision making. Methods and Findings We performed a systematic overview of systematic reviews (SRs) of comparative studies concerning non-pharmacological intervention to treat or prevent delirium in older patients. The PubMed, Cochrane Database of Systematic Reviews, EMBASE, CINHAL, and PsychINFO (April 28th, 2014) were searched for relevant articles. AMSTAR was used to assess the quality of the SRs. The GRADE approach was used to assess the quality of primary studies. The elements of the multicomponent interventions were identified and compared among different studies to explore the possibility of performing a meta-analysis. Risk ratios were estimated using a random-effects model. Twenty-four SRs with 31 primary studies satisfied the inclusion criteria. Based on the AMSTAR criteria twelve reviews resulted of moderate quality and three resulted of high quality. Overall, multicomponent non-pharmacological interventions significantly reduced the incidence of delirium in surgical wards [2 randomized trials (RCTs): relative risk (RR) 0.71, 95% Confidence Interval (CI) 0.59 to 0.86, I2=0%; (GRADE evidence: moderate)] and in medical wards [2 CCTs: RR 0.65, 95%CI 0.49 to 0.86, I2=0%; (GRADE evidence: moderate)]. There is no evidence supporting the efficacy of non-pharmacological interventions to prevent delirium in low risk populations (i.e. low rate of delirium in the control group)[1 RCT: RR 1.75, 95%CI 0.50 to 6.10 (GRADE evidence: very low)]. For patients who have developed delirium, the available evidence does not support the efficacy of multicomponent

  16. Interrelationship of Postoperative Delirium and Cognitive Impairment and Their Impact on the Functional Status in Older Patients Undergoing Orthopaedic Surgery: A Prospective Cohort Study

    PubMed Central

    Liang, Chih-Kuang; Chu, Chin-Liang; Chou, Ming-Yueh; Lin, Yu-Te; Lu, Ti; Hsu, Chien-Jen; Chen, Liang-Kung

    2014-01-01

    Background The impact of postoperative delirium on post-discharge functional status of older patients remains unclear, and little is known regarding the interrelationship between cognitive impairment and post-operative delirium. Therefore, the main purpose was to evaluate the post-discharge functional status of patients who experience delirium after undergoing orthopaedic surgery and the interrelationship of postoperative delirium with underlying cognitive impairment. Method This prospective cohort study, conducted at a tertiary care medical center from April 2011 to March 2012, enrolled all subjects aged over 60 years who were admitted for orthopaedic surgery. The baseline characteristics (age, gender, BMI, and living arrangement), surgery-related factors (ASA class, admission type, type of surgery, and length of hospital stay), results of geriatric assessment (postoperative delirium, cognition, depressive mood, comorbidity, pain, malnutrition, polypharmacy, ADL, and instrumental [I]ADL) and 1–12-month postoperative ADL and IADL functional status were collected for analysis. Results Overall, 9.1% of 232 patients (mean age: 74.7±7.8 years) experienced postoperative delirium, which was significantly associated with IADL decline at only 6 and 12 months postoperatively (RR: 6.22, 95% CI: 1.08–35.70 and RR: 12.54, 95% CI: 1.88–83.71, respectively). Delirium superimposed on cognitive impairment was a significant predictor for poor functional status at 6 and 12 months postoperatively (RR: 12.80, 95% CI: 1.65–99.40 for ADL at the 6th month, and RR: 7.96, 95% CI: 1.35–46.99 at the 12th month; RR: 13.68, 95% CI: 1.94–96.55 for IADL at the 6th month, and RR: 30.61, 95% CI: 2.94–318.54 at the 12th month, respectively). Conclusion Postoperative delirium is predictive of IADL decline in older patients undergoing orthopaedic surgery, and delirium superimposed on cognitive impairment is an independent risk factor for deterioration of ADL and IADL functional status

  17. Delirium tremens

    MedlinePlus

    ... goals of treatment are to: Save the person's life Relieve symptoms Prevent complications A hospital stay is needed. The health care team will regularly check: Blood chemistry results, such as electrolyte levels Body fluid levels ...

  18. Delirium tremens

    MedlinePlus

    ... abstinence) Counseling Going to support groups (such as Alcoholics Anonymous) Treatment may be needed for other medical problems that can occur with alcohol use, including: Alcoholic ... Alcoholic liver disease Alcoholic neuropathy Wernicke-Korsakoff ...

  19. Morphine for Intravenous Patient-Controlled Analgesia May Inhibit Delirium Tremens: A Case Report and Literature Review.

    PubMed

    Chan, Chia-Ta; Liao, Wen-Wei; Huang, William

    2015-10-01

    Alcoholism is common among trauma patients and often lacks the appropriate monitoring. Alcohol withdrawal syndrome (AWS), including delirium tremens (DT), can be associated with significant postoperative morbidity and mortality. However, appropriate acute pain management may protect against delirium; the administration of intravenous patient-controlled analgesia (IV - PCA) may not only alleviate pain, but also reduce the incidence of post-operative delirium. IV-PCA is widely used today; however, little attention has been paid to its influence on the development of AWS or DT post-surgery. Here we present a case in which the administration of IV-PCA may have delayed the onset of DT that interfered with postoperative care and the initiation of psychiatric consultation. The literature was reviewed to determine the potential mechanisms behind the effects of IV-PCA on the onset of AWS or DT.IV-PCA may delay the onset of DT. It is imperative to take into consideration trauma patients' psychiatric history including answers to questions on alcoholism, so that when an IV-PCA is administered and then discontinued, adequate interventions to prevent further morbidity associated with AWS and DT can be initiated in sufficient time. PMID:26512587

  20. The Prevention of Delirium and Complications Associated with Surgical Treatments (PODCAST) study: protocol for an international multicentre randomised controlled trial

    PubMed Central

    Avidan, Michael S; Fritz, Bradley A; Maybrier, Hannah R; Muench, Maxwell R; Escallier, Krisztina E; Chen, Yulong; Ben Abdallah, Arbi; Veselis, Robert A; Hudetz, Judith A; Pagel, Paul S; Noh, Gyujeong; Pryor, Kane; Kaiser, Heiko; Arya, Virendra Kumar; Pong, Ryan; Jacobsohn, Eric; Grocott, Hilary P; Choi, Stephen; Downey, Robert J; Inouye, Sharon K; Mashour, George A

    2014-01-01

    Introduction Postoperative delirium is one of the most common complications of major surgery, affecting 10–70% of surgical patients 60 years and older. Delirium is an acute change in cognition that manifests as poor attention and illogical thinking and is associated with longer intensive care unit (ICU) and hospital stay, long-lasting cognitive deterioration and increased mortality. Ketamine has been used as an anaesthetic drug for over 50 years and has an established safety record. Recent research suggests that, in addition to preventing acute postoperative pain, a subanaesthetic dose of intraoperative ketamine could decrease the incidence of postoperative delirium as well as other neurological and psychiatric outcomes. However, these proposed benefits of ketamine have not been tested in a large clinical trial. Methods The Prevention of Delirium and Complications Associated with Surgical Treatments (PODCAST) study is an international, multicentre, randomised controlled trial. 600 cardiac and major non-cardiac surgery patients will be randomised to receive ketamine (0.5 or 1 mg/kg) or placebo following anaesthetic induction and prior to surgical incision. For the primary outcome, blinded observers will assess delirium on the day of surgery (postoperative day 0) and twice daily from postoperative days 1–3 using the Confusion Assessment Method or the Confusion Assessment Method for the ICU. For the secondary outcomes, blinded observers will estimate pain using the Behavioral Pain Scale or the Behavioral Pain Scale for Non-Intubated Patients and patient self-report. Ethics and dissemination The PODCAST trial has been approved by the ethics boards of five participating institutions; approval is ongoing at other sites. Recruitment began in February 2014 and will continue until the end of 2016. Dissemination plans include presentations at scientific conferences, scientific publications, stakeholder engagement and popular media. Registration details The study is

  1. Randomized ICU Trials Do Not Demonstrate an Association Between Interventions That Reduce Delirium Duration and Short-Term Mortality: A Systematic Review and Meta-Analysis

    PubMed Central

    Al-Qadheeb, Nada S.; Balk, Ethan M.; Fraser, Gilles L.; Skrobik, Yoanna; Riker, Richard R.; Kress, John P.; Whitehead, Shawn; Devlin, John W.

    2016-01-01

    Background Interventions that reduce delirium duration may also lower short-term mortality. We reviewed randomized trials of adult ICU patients of interventions hypothesized to reduce delirium burden to determine whether interventions that are more effective at reducing delirium duration are associated with a reduction in short-term mortality. Search Methods We searched CINHAHL, EMBASE, MEDLINE and the Cochrane databases from 2001 through 2012. Citations were screened for randomized trials that enrolled critically ill adults, evaluated delirium at least daily, compared a drug or non-drug intervention hypothesized to reduce delirium burden with standard care (or control), and reported delirium duration and/or short-term mortality (≤45 days). In duplicate, we abstracted trial characteristics and results and evaluated quality using the Cochrane risk of bias tool. We performed random effects model meta-analyses and meta-regressions. Results We included 17 trials enrolling 2,849 patients which evaluated a pharmacologic intervention (n=13) [dexmedetomidine (n=6); an antipsychotic (n=4); rivastigmine (n=2); and clonidine (n=1)], a multimodal intervention (n=2) [spontaneous-awakening (n=2)]; or a non-pharmacologic intervention (n=2) [early mobilization (n=1); increased perfusion (n=1)]. Overall, average delirium duration was lower in the intervention groups [difference = −0.64 days; 95% CI, −1.15 to −0.13; P = 0.01) being reduced by ≥3 days in 3 studies, 0.1 to < 3 days in 6 studies, 0 days in 7 studies and < 0 days in 1. Across interventions, for 13 studies where short-term mortality was reported, short-term mortality was not reduced (risk ratio = 0.90; 95% CI, 0.76 to 1.06; P = 0.19). Across 13 studies that reported mortality, meta-regression revealed that delirium duration was not associated with reduced short-term mortality (P = 0.11). Conclusions A review of current evidence fails to support that ICU interventions that reduce delirium duration reduce short

  2. Safety and efficacy of flumazenil for reversal of iatrogenic benzodiazepine-associated delirium toxicity during treatment of alcohol withdrawal, a retrospective review at one center.

    PubMed

    Moore, Philip W; Donovan, J Ward; Burkhart, Keith K; Waskin, Jeffrey A; Hieger, Michelle A; Adkins, Audrey R; Wert, Yijin; Haggerty, David A; Rasimas, J J

    2014-06-01

    Both alcohol withdrawal syndrome (AWS) and benzodiazepines can cause delirium. Benzodiazepine-associated delirium can complicate AWS and prolong hospitalization. Benzodiazepine delirium can be diagnosed with flumazenil, a GABA-A receptor antagonist. By reversing the effects of benzodiazepines, flumazenil is theorized to exacerbate symptoms of AWS and precludes its use. For patients being treated for alcohol withdrawal, flumazenil can diagnose and treat benzodiazepine delirium without precipitating serious or life-threatening adverse events. Hospital admission records were retrospectively reviewed for patients with the diagnosis of AWS who received both benzodiazepines and flumazenil from December 2006 to June 2012 at a university-affiliated inpatient toxicology center. The day of last alcohol consumption was estimated from available blood alcohol content or subjective history. Corresponding benzodiazepine, flumazenil, and adjunctive sedative pharmacy records were reviewed, as were demographic, clinical course, and outcome data. Eighty-five patients were identified (average age 50.3 years). Alcohol concentrations were detectable for 42 patients with average 261 mg/dL (10-530 mg/dL). Eighty patients were treated with adjunctive agents for alcohol withdrawal including antipsychotics (n = 57), opioids (n = 27), clonidine (n = 35), and phenobarbital (n = 23). Average time of flumazenil administration was 4.7 days (1-11 days) after abstinence, and average dose was 0.5 mg (0.2-1 mg). At the time of flumazenil administration, delirium was described as hypoactive (n = 21), hyperactive (n = 15), mixed (n = 41), or not specified (n = 8). Response was not documented in 11 cases. Sixty-two (72.9 %) patients had significant objective improvement after receiving flumazenil. Fifty-six patients required more than one dose (average 5.6 doses). There were no major adverse events and minor adverse effects included transiently increased anxiety

  3. Deconstructing dementia and delirium hospital practice: using cultural historical activity theory to inform education approaches.

    PubMed

    Teodorczuk, Andrew; Mukaetova-Ladinska, Elizabeta; Corbett, Sally; Welfare, Mark

    2015-08-01

    Older patients with dementia and delirium receive suboptimal hospital care. Policy calls for more effective education to address this though there is little consensus on what this entails. The purpose of this clarification study is to explore how practice gaps are constructed in relation to managing the confused hospitalised older patient. The intent is to inform educational processes in the work-place beyond traditional approaches such as training. Adopting grounded theory as a research method and working within a social constructionist paradigm we explored the practice gaps of 15 healthcare professionals by interview and conducted five focus groups with patients, carers and Liaison mental health professionals. Data were thematically analysed by constant comparison and theoretical sampling was undertaken until saturation reached. Categories were identified and pragmatic concepts developed grounded within the data. Findings were then further analysed using cultural historical activity theory as a deductive lens. Practice gaps in relation to managing the confused older patient are determined by factors operating at individual (knowledge and skill gaps, personal philosophy, task based practice), team (leadership, time and ward environmental factors) and organisational (power relationships, dominance of medical model, fragmentation of care services) levels. Conceptually, practice appeared to be influenced by socio-cultural ward factors and compounded by a failure to join up existing "patient" knowledge amongst professionals. Applying cultural historical activity theory to further illuminate the findings, the central object is defined as learning about the patient and the mediating artifacts are the care relationships. The overarching medical dominance emerges as an important cultural historical factor at play and staff rules and divisions of labour are exposed. Lastly key contradictions and tensions in the system that work against learning about the patient are

  4. The cost-effectiveness of multi-component interventions to prevent delirium in older people undergoing surgical repair of hip fracture.

    PubMed

    Akunne, Anayo; Davis, Sarah; Westby, Maggie; Young, John

    2014-02-01

    This article summarizes the detailed cost-effectiveness analysis of delirium prevention interventions in people undergoing surgical repair of hip fracture. We compared a multi-component delirium prevention intervention with usual care using a model based on a decision tree analysis. The model was used to estimate the incremental net monetary benefit (INMB). The robustness of the cost-effectiveness result was explored using deterministic and probabilistic sensitivity analyses. The multi-component prevention intervention was cost-effective when compared to usual care. It was associated with an INMB of £8,180 using a cost-effectiveness threshold of £20,000 per QALY. It remained cost-effective in the majority of the deterministic sensitivity analyses and was cost-effective in 96.4 % of the simulations carried out in the probabilistic sensitivity analysis. We have demonstrated the cost-effectiveness of a multi-component delirium prevention intervention that targets modifiable risk factors for delirium in older people undergoing surgical repair of hip fracture. It is an attractive intervention for practitioners and health care policy makers as they address the double burden of hip fracture and delirium. PMID:23412312

  5. Delirium Accompanied by Cholinergic Deficiency and Organ Failure in a 73-Year-Old Critically Ill Patient: Physostigmine as a Therapeutic Option

    PubMed Central

    Zujalovic, Benedikt; Barth, Eberhard

    2015-01-01

    Delirium is a common problem in ICU patients, resulting in prolonged ICU stay and increased mortality. A cholinergic deficiency in the central nervous system is supposed to be a relevant pathophysiologic process in delirium. Acetylcholine is a major transmitter of the parasympathetic nervous system influencing several organs (e.g., heart and kidneys) and the inflammatory response too. This perception might explain that delirium is not an individual symptom, but rather a part of a symptom complex with various disorders of the whole organism. The cholinergic deficiency could not be quantified up to now. Using the possibility of bedside determination of the acetylcholinesterase activity (AChE activity), we assumed to objectify the cholinergic homeostasis within minutes. As reported here, the postoperative delirium was accompanied by a massive hemodynamic and renal deterioration of unclear genesis. We identified the altered AChE activity as a plausible pathophysiological mechanism. The pharmacological intervention with the indirect parasympathomimetic physostigmine led to a quick and lasting improvement of the patient's cognitive, hemodynamic, and renal status. In summary, severe delirium is not always an attendant phenomenon of critical illness. It might be causal for multiple organ deterioration if it is based on cholinergic deficiency and has to be treated at his pathophysiological roots whenever possible. PMID:26550498

  6. Alcohol prescription by surgeons in the prevention and treatment of delirium tremens: historic and current practice.

    PubMed

    Rosenbaum, Milton; McCarty, Teresita

    2002-01-01

    Beer, other alcohol beverages, and IV alcohol are still used to prevent or treat alcohol withdrawal delirium on surgical services. The history of the use of alcohol by surgeons may play a role in its continued use for withdrawal. In this policy survey 32 inpatient hospital pharmacies were called and asked if alcohol was available, if it was used to treat alcohol withdrawal, and the medical specialties that requested it. Recommendations about the use of alcohol were examined in recent textbooks and from those published early in the twentieth century. One half of the 32 hospitals surveyed had alcoholic beverages available for patient use and eleven hospitals used either package alcohol or IV alcohol in the treatment of alcohol withdrawal. Surgeons used alcohol before anesthesia to help patients tolerate procedures, and the use of alcohol for treatment of alcohol withdrawal still appears in the surgical literature. This preliminary survey indicates that some hospitals still provide beverage alcohol for the treatment of alcohol withdrawal and that surgeons are the specialty ordering alcohol for their patients. PMID:12100836

  7. Effects of Intraoperative Hemodynamics on Incidence of Postoperative Delirium in Elderly Patients: A Retrospective Study.

    PubMed

    Yang, Lin; Sun, De-Feng; Han, Jun; Liu, Ruochuan; Wang, Li-Jie; Zhang, Zhen-Zhen

    2016-01-01

    BACKGROUND Postoperative delirium (POD) is a common complication in the elderly. This retrospective study investigated the effect of intraoperative hemodynamics on the incidence of POD in elderly patients after major surgery to explore ways to reduce the incidence of POD. MATERIAL AND METHODS Based on the incidence of POD, elderly patients (81±6 y) were assigned to a POD (n=137) or non-POD group (n=343) after elective surgery with total intravenous anesthesia. POD was diagnosed based on the guidelines of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), using the confusion assessment method. The hemodynamic parameters, such as mean arterial pressure, were monitored 10 min before anesthesia (baseline) and intraoperatively. The incidence of intraoperative hypertension, hypotension, tachycardia, and bradycardia were calculated. RESULTS At 30 min and 60 min after the initiation of anesthesia and at the conclusion of surgery, the monitored hemodynamic parameter values of the POD group, but not those of the non-POD group, were significantly higher than at baseline. Multivariate logistic regression analysis showed that intraoperative hypertension and tachycardia were significantly associated with POD. CONCLUSIONS Intraoperative hypertension and tachycardia were significantly associated with POD. Maintaining intraoperative stable hemodynamics may reduce the incidence of POD in elderly patients undergoing surgery. PMID:27038856

  8. Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery in the Sugammadex Era: A Retrospective Study.

    PubMed

    Oh, Chung-Sik; Rhee, Ka Young; Yoon, Tae-Gyoon; Woo, Nam-Sik; Hong, Seung Wan; Kim, Seong-Hyop

    2016-01-01

    Background. Residual neuromuscular block (NMB) after general anesthesia has been associated with pulmonary dysfunction and hypoxia, which are both associated with postoperative delirium (POD). We evaluated the effects of sugammadex on POD in elderly patients who underwent hip fracture surgery. Methods. Medical records of 174 consecutive patients who underwent hip fracture surgery with general anesthesia were reviewed retrospectively to compare the perioperative incidence of POD, pulmonary complications, time to extubation, incidence of hypoxia, and laboratory findings between patients treated with sugammadex and those treated with a conventional cholinesterase inhibitor. Results. The incidence of POD was not significantly different between the two groups (33.3% versus 36.5%, resp.; P = 0.750). Postoperative pulmonary complications and laboratory findings did not showed significant intergroup difference. However, time to extubation (6 ± 3 versus 8 ± 3 min; P < 0.001) and the frequency of postoperative hypoxia were significantly lower (23% versus 43%; P = 0.010) in the sugammadex group than in the conventional cholinesterase inhibitor group. Conclusion. Sugammadex did not reduce POD or pulmonary complications compared to conventional cholinesterase inhibitors, despite reducing time to extubation and postoperative hypoxia in elderly patients who underwent hip fracture surgery under general anesthesia. PMID:26998480

  9. Effects of Intraoperative Hemodynamics on Incidence of Postoperative Delirium in Elderly Patients: A Retrospective Study

    PubMed Central

    Yang, Lin; Sun, De-feng; Han, Jun; Liu, Ruochuan; Wang, Li-jie; Zhang, Zhen-zhen

    2016-01-01

    Background Postoperative delirium (POD) is a common complication in the elderly. This retrospective study investigated the effect of intraoperative hemodynamics on the incidence of POD in elderly patients after major surgery to explore ways to reduce the incidence of POD. Material/Methods Based on the incidence of POD, elderly patients (81±6 y) were assigned to a POD (n=137) or non-POD group (n=343) after elective surgery with total intravenous anesthesia. POD was diagnosed based on the guidelines of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), using the confusion assessment method. The hemodynamic parameters, such as mean arterial pressure, were monitored 10 min before anesthesia (baseline) and intraoperatively. The incidence of intraoperative hypertension, hypotension, tachycardia, and bradycardia were calculated. Results At 30 min and 60 min after the initiation of anesthesia and at the conclusion of surgery, the monitored hemodynamic parameter values of the POD group, but not those of the non-POD group, were significantly higher than at baseline. Multivariate logistic regression analysis showed that intraoperative hypertension and tachycardia were significantly associated with POD. Conclusions Intraoperative hypertension and tachycardia were significantly associated with POD. Maintaining intraoperative stable hemodynamics may reduce the incidence of POD in elderly patients undergoing surgery. PMID:27038856

  10. Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery in the Sugammadex Era: A Retrospective Study

    PubMed Central

    Oh, Chung-Sik; Rhee, Ka Young; Yoon, Tae-Gyoon; Woo, Nam-Sik; Hong, Seung Wan; Kim, Seong-Hyop

    2016-01-01

    Background. Residual neuromuscular block (NMB) after general anesthesia has been associated with pulmonary dysfunction and hypoxia, which are both associated with postoperative delirium (POD). We evaluated the effects of sugammadex on POD in elderly patients who underwent hip fracture surgery. Methods. Medical records of 174 consecutive patients who underwent hip fracture surgery with general anesthesia were reviewed retrospectively to compare the perioperative incidence of POD, pulmonary complications, time to extubation, incidence of hypoxia, and laboratory findings between patients treated with sugammadex and those treated with a conventional cholinesterase inhibitor. Results. The incidence of POD was not significantly different between the two groups (33.3% versus 36.5%, resp.; P = 0.750). Postoperative pulmonary complications and laboratory findings did not showed significant intergroup difference. However, time to extubation (6 ± 3 versus 8 ± 3 min; P < 0.001) and the frequency of postoperative hypoxia were significantly lower (23% versus 43%; P = 0.010) in the sugammadex group than in the conventional cholinesterase inhibitor group. Conclusion. Sugammadex did not reduce POD or pulmonary complications compared to conventional cholinesterase inhibitors, despite reducing time to extubation and postoperative hypoxia in elderly patients who underwent hip fracture surgery under general anesthesia. PMID:26998480

  11. A neurologist's approach to delirium: diagnosis and management of toxic metabolic encephalopathies.

    PubMed

    Krishnan, Vaishnav; Leung, Lester Y; Caplan, Louis R

    2014-02-01

    Toxic metabolic encephalopathies (TMEs) present as an acute derangement in consciousness, cognition and behavior, and can be brought about by various triggers, including endocrine and metabolic disturbances, exogenous toxins, pain and infection. Also referred to as "delirium" or "acute confusional states," TMEs are characterized by (1) an altered level of consciousness and activity, (2) global changes in cognition with inattention, (3) a fluctuating course with disturbances in the sleep-wake cycle, and (4) asterixis and myoclonus. The pathophysiology of this syndrome is poorly understood. Imbalanced neurotransmitter signaling and pathologically heightened brain inflammatory cytokine signaling have been proposed as candidate mechanisms. Focal brain lesions can also occasionally mimic TMEs. A neurological examination is required to identify the presence of focal findings, which when present, identify a new focal lesion or the recrudescence of prior ischemic, inflammatory or neoplastic insults. Diagnostic testing must include a search for metabolic and infectious derangements. Offending medications should be withdrawn. Magnetic resonance imaging, cerebrospinal fluid analysis and electroencephalography should be considered in select clinical situations. In addition to being an unpleasant experience for the patient and family, this condition is associated with extended hospital stays, increased mortality and high costs. In individuals with diminished cognitive reserve, episodes of TME lead to an accelerated decline in cognitive functioning. Starting with an illustrative case, this paper provides a neurologist's approach to the diagnosis, differential diagnosis and management of toxic metabolic encephalopathies. PMID:24332366

  12. Uma Krishnaswami and International Imaginings

    ERIC Educational Resources Information Center

    Aldama, Frederick Luis

    2006-01-01

    This article presents an interview with South Asian children's book and young adult fiction writer, Uma Krishnaswami. The interviewer states that "in all her creative endeavors Uma's keen sense of detail, narrative voice, and characterization complicate and humanize portrayals of multicultural peoples worldwide." In this interview, Krishnaswami…

  13. Development and Usability Evaluation of the Mobile Delirium Assessment App Based on Confusion Assessment Method for Intensive Care Unit (CAM-ICU).

    PubMed

    Ji, Meihua; Wu, Ying; Chang, Polun; Yang, Xin; Yang, Fangyu; Xu, Shuang

    2015-01-01

    Delirium is a common complication among patients in ICU settings. The accuracy of using the assessment tool CAM-ICU to detect delirium is relatively low during routine practice among bedside nurses. The aim of this study is to develop a mobile application (app) to detect delirium in early stage and to test its usability among ICU nurses. The app was developed with Java and installed on a mobile device. A questionnaire was created based on the Technology Acceptance Model (TAM) measuring their response to the four domains of TAM: perceived usefulness (PU), perceived ease of use (PEOU), attitudes towards usage (ATU) and behavioral intention to use (BIU). One hundred and two ICU nurses completed the survey. The result indicated that the app we developed has easy to use interfaces and is easier to use compared to the regular CAM-ICU. PMID:26262201

  14. Educational Impact of a Psychiatric Liaison in the Medical Intensive Care Unit: Effects on Attitudes and Beliefs of Trainees and Nurses Regarding Delirium

    PubMed Central

    Chen, Donna T.; Huffman, Jeff C.

    2013-01-01

    Objective: Despite high rates and increased risk of mortality, delirium remains underdiagnosed and a minimal focus of formal medical education. This is the first study to examine the educational impact of a psychiatric liaison on beliefs and knowledge about delirium among both nurses and residents. Method: One psychiatrist spent 9 months rounding weekly in the medical intensive care unit, interacting with critical care nurses and internal medicine residents. Preintervention and postintervention surveys were distributed in July 2009 and June 2010, respectively, to staff (critical care nurses: n = 23 and n = 25, respectively; internal medicine residents: n = 31 and n = 23, respectively) and a comparison group (psychiatry residents: n = 29 and n = 23, respectively). Participants responded to 12 statements regarding delirium on a 5-point Likert scale. Results: There were no statistically significant differences between the presurveys and postsurveys for any item when examining all respondents together, as well as psychiatry and internal medicine residents as individual groups. Critical care nurses showed a significant change between surveys for the statements, “Patients with new-onset anxiety or depression in the intensive care unit most commonly have delirium” (17.4% agree presurvey vs 56.0% agree postsurvey, χ2 = 7.62, P = .006) and “Delirium is diagnosed less often than it actually occurs” (100% agree presurvey vs 80% agree postsurvey, χ2 = 5.13, P = .023). Conclusions: Though introduction of a psychiatric liaison was very well received by clinical staff, we did not meaningfully affect the attitudes and beliefs of trainees and nurses regarding delirium. Robust and lasting changes in attitudes regarding delirium may require more intensive efforts involving longer intervention periods, greater rounding frequency, or additional didactic teaching. PMID:24171148

  15. Study protocol for the recreational stimulation for elders as a vehicle to resolve delirium superimposed on dementia (Reserve For DSD) trial

    PubMed Central

    2011-01-01

    Background Delirium is a state of confusion characterized by an acute and fluctuating decline in cognitive functioning. Delirium is common and deadly in older adults with dementia, and is often referred to as delirium superimposed on dementia, or DSD. Interventions that treat DSD are not well-developed because the mechanisms involved in its etiology are not completely understood. We have developed a theory-based intervention for DSD that is derived from the literature on cognitive reserve and based on our prior interdisciplinary work on delirium, recreational activities, and cognitive stimulation in people with dementia. Our preliminary work indicate that use of simple, cognitively stimulating activities may help resolve delirium by helping to focus inattention, the primary neuropsychological deficit in delirium. Our primary aim in this trial is to test the efficacy of Recreational Stimulation for Elders as a Vehicle to resolve DSD (RESERVE- DSD). Methods/Design This randomized repeated measures clinical trial will involve participants being recruited and enrolled at the time of admission to post acute care. We will randomize 256 subjects to intervention (RESERVE-DSD) or control (usual care). Intervention subjects will receive 30-minute sessions of tailored cognitively stimulating recreational activities for up to 30 days. We hypothesize that subjects who receive RESERVE-DSD will have: decreased severity and duration of delirium; greater gains in attention, orientation, memory, abstract thinking, and executive functioning; and greater gains in physical function compared to subjects with DSD who receive usual care. We will also evaluate potential moderators of intervention efficacy (lifetime of complex mental activities and APOE status). Our secondary aim is to describe the costs associated with RESERVE-DSD. Discussion Our theory-based intervention, which uses simple, inexpensive recreational activities for delivering cognitive stimulation, is innovative because, to

  16. The Association between Brain Volumes, Delirium Duration and Cognitive Outcomes in Intensive Care Unit Survivors: A Prospective Exploratory Cohort Magnetic Resonance Imaging Study

    PubMed Central

    Gunther, Max L.; Morandi, Alessandro; Krauskopf, Erin; Pandharipande, Pratik; Girard, Timothy D.; Jackson, James C.; Thompson, Jennifer; Shintani, Ayumi K.; Geevarghese, Sunil; Miller, Russell R; Canonico, Angelo; Merkle, Kristen; Cannistraci, Christopher J.; Rogers, Baxter P.; Gatenby, J. Chris; Heckers, Stephan; Gore, John C.; Hopkins, Ramona O.; Ely, E. Wesley

    2012-01-01

    Objective Delirium duration is predictive of long-term cognitive impairment (LTCI) in Intensive Care Unit (ICU) survivors. Hypothesizing that a neuroanatomical basis may exist for the relationship between delirium and LTCI, we conducted this exploratory investigation of the associations between delirium duration, brain volumes and LTCI. Design, Setting, and Patients A prospective cohort of medical and surgical ICU survivors with respiratory failure or shock. Measurements Quantitative high resolution 3-Tesla brain magnetic resonance imaging was used to calculate brain volumes at discharge and three-month follow-up. Delirium was evaluated using the Confusion Assessment Method for the ICU; cognitive outcomes were tested at three- and twelve-month follow-up. Linear regression was used to examine associations between delirium duration and brain volumes, and between brain volumes and cognitive outcomes. Results A total of 47 patients completed the MRI protocol. Patients with longer duration of delirium displayed greater brain atrophy as measured by a larger ventricle-to-brain ratio (VBR) at hospital discharge [0.76, 95% confidence intervals (CI) (0.10, 1.41); p=0.03] and at 3-month follow-up [0.62 (0.02, 1.21), p=0.05]. Longer duration of delirium was associated with smaller superior frontal lobe [−2.11 cm3 (−3.89, −0.32); p=0.03] and hippocampal volumes at discharge [−0.58 cm3 (−0.85, −0.31), p<0.001] – regions responsible for executive functioning and memory, respectively. Greater brain atrophy (higher VBR) at three months was associated with worse cognitive performances at twelve months [lower RBANS battery score −11.17 (−21.12, −1.22), p=0.04]. Smaller superior frontal lobes, thalamus, and cerebellar volumes at three months were associated with worse executive functioning and visual attention at twelve months. Conclusions These preliminary data show that longer duration of delirium is associated with smaller brain volumes up to three months after

  17. Survival Prediction for Terminally Ill Cancer Patients: Revision of the Palliative Prognostic Score with Incorporation of Delirium

    PubMed Central

    Maltoni, Marco; Miceli, Rosalba; Mariani, Luigi; Caraceni, Augusto; Amadori, Dino; Nanni, Oriana

    2011-01-01

    Purpose. An existing and validated palliative prognostic (PaP) score predicts survival in terminally ill cancer patients based on dyspnea, anorexia, Karnofsky performance status score, clinical prediction of survival, total WBC, and lymphocyte percentage. The PaP score assigns patients to three different risk groups according to a 30-day survival probability—group A, >70%; group B, 30%–70%; group C, <30%. The impact of delirium is known but was not incorporated into the PaP score. Materials and Methods. Our aim was to incorporate information on delirium into the PaP score based on a retrospective series of 361 terminally ill cancer patients. We followed the approach of “validation by calibration,” proposed by van Houwelingen and later adapted by Miceli for achieving score revision with inclusion of a new variable. The discriminating performance of the scores was estimated using the K statistic. Results. The prognostic contribution of delirium was confirmed as statistically significant (p < .001) and the variable was accordingly incorporated into the PaP score (D-PaP score). Following this revision, 30-day survival estimates in groups A, B, and C were 83%, 50%, and 9% for the D-PaP score and 87%, 51%, and 16% for the PaP score, respectively. The overall performance of the D-PaP score was better than that of the PaP score. Conclusion. The revision of the PaP score was carried out by modifying the cutoff values used for prognostic grouping without, however, affecting the partial scores of the original tool. The performance of the D-PaP score was better than that of the PaP score and its key feature of simplicity was maintained. PMID:22042788

  18. Recognized homonymous hemianopsia and delirium during the admission examination leading to diagnosis and appropriate treatment of a new stroke

    PubMed Central

    Tsymbalov, Konstantin S; Fetkenhour, Douglas R

    2016-01-01

    This case report describes the detection of homonymous hemianopsia and delirium during the admission physical examination of a patient with esophageal adenocarcinoma, resulting in the new diagnosis of subacute hemorrhagic stroke. The poststroke visual field defect can result in significant disability and reduction in quality of life. Patients with visual field cut show a severely reduced quality of life and require additional neuropsychological and visual rehabilitation. Only thorough physical examination is able to challenge prior negative positron emission tomography scan, leading to the diagnosis of subacute stroke and, following appropriate treatment, secondary stroke prophylaxis and rehabilitation, instead of brain radiation and chemotherapy. PMID:27366070

  19. Creative Music Therapy in an Acute Care Setting for Older Patients with Delirium and Dementia

    PubMed Central

    Cheong, Chin Yee; Tan, Jane An Qi; Foong, Yi-Lin; Koh, Hui Mien; Chen, Denise Zhen Yue; Tan, Jessie Joon Chen; Ng, Chong Jin; Yap, Philip

    2016-01-01

    Background/Aims The acute hospital ward can be unfamiliar and stressful for older patients with impaired cognition, rendering them prone to agitation and resistive to care. Extant literature shows that music therapy can enhance engagement and mood, thereby ameliorating agitated behaviours. This pilot study evaluates the impact of a creative music therapy (CMT) programme on mood and engagement in older patients with delirium and/or dementia (PtDD) in an acute care setting. We hypothesize that CMT improves engagement and pleasure in these patients. Methods Twenty-five PtDD (age 86.5 ± 5.7 years, MMSE 6/30 ± 5.4) were observed for 90 min (30 min before, 30 min during, and 30 min after music therapy) on 3 consecutive days: day 1 (control condition without music) and days 2 and 3 (with CMT). Music interventions included music improvisation such as spontaneous music making and playing familiar songs of patient's choice. The main outcome measures were mood and engagement assessed with the Menorah Park Engagement Scale (MPES) and Observed Emotion Rating Scale (OERS). Results Wilcoxon signed-rank test showed a statistically significant positive change in constructive and passive engagement (Z = 3.383, p = 0.01) in MPES and pleasure and general alertness (Z = 3.188,p = 0.01) in OERS during CMT. The average pleasure ratings of days 2 and 3 were higher than those of day 1 (Z = 2.466, p = 0.014). Negative engagement (Z = 2.582, p = 0.01) and affect (Z = 2.004, p = 0.045) were both lower during CMT compared to no music. Conclusion These results suggest that CMT holds much promise to improve mood and engagement of PtDD in an acute hospital setting. CMT can also be scheduled into the patients' daily routines or incorporated into other areas of care to increase patient compliance and cooperation. PMID:27489560

  20. Restraint related deaths and excited delirium syndrome in Ontario (2004-2011).

    PubMed

    Michaud, Alain

    2016-07-01

    Restraint related death in individuals in excited delirium syndrome (ExDS) is a rare event that has been the subject of controversies for more than 3 decades. The purpose of this retrospective study was to retrieve data on all restraint related deaths (RRD) that occurred in Ontario during an 8-year period and compare them with an earlier study on RRD in ExDS covering the period 1988-1995 in Ontario. The Office of the Chief Coroner of Ontario website was consulted under verdicts and recommendations. The Canadian Legal Information Institute website was used to consult verdict explanations and coroner's summary of evidence. During the period 2004-2011, RRD occurred in 14 individuals in ExDS, a 33% reduction. Psychiatric illness as a cause of ExDS decreased from 57% to 14%. Cocaine was the cause of ExDS in 11 (79%) individuals. The number of RRD following a violent encounter in cocaine-induced ExDS (8) was identical in the 2 periods. RRD occurred in 6 individuals without ExDS following a violent encounter. Final restraint position preceding cardiorespiratory arrest was available in 36% of individuals with ExDS and 83% of individuals without ExDS. In both groups, cardiorespiratory arrests could be classified as immediate or delayed. All 4 individuals without ExDS who had immediate cardiorespiratory arrests were restrained in the prone position. Delayed cardiorespiratory arrest occurred in the non-prone position in both groups. Although many hypotheses may be put forward to explain changes in the epidemiology of RRD in ExDS in Ontario, multiple warnings and recommendations from coroners' inquests cannot be ignored. There is probably not a unique pathophysiological pathway leading to cardiorespiratory arrest in RRD. The death rate in RRD in ExDS is so low that drawing any conclusions based on statistical studies or on isolated case report could be hazardous. PMID:27126837

  1. Association between Intraoperative Blood Pressure and Postoperative Delirium in Elderly Hip Fracture Patients

    PubMed Central

    Wang, Nae-Yuh; Hirao, Ai; Sieber, Frederick

    2015-01-01

    Background One possible area of intervention to prevent postoperative delirium (PD) is intraoperative blood pressure management. However, the relationship between intraoperative blood pressure and PD is unclear. A secondary analysis of a RCT study examining the PD risk over the range of absolute intraoperative mean arterial blood pressure (MAP) readings and the corresponding relative changes from preoperative baseline level was performed to determine the role of MAP on PD. Methods Nonparametric locally weighted quadratic polynomial smoothing (LOESS) regression explored the pattern of PD risk at postoperative day 2 as a function of mean surgery MAP (msMAP) and percent change of msMAP from baseline in 103 elderly hip fracture patients. Segment-linear logistic regression models were then constructed to determine the odds ratios (OR) of PD over the observed range of these msMAP measures, adjusting for potential confounds. Results Twenty-three patients (22%) developed PD on day 2. LOESS regression revealed a j-shaped association between absolute levels of msMAP and PD risk. When msMAP was ≥80 mmHg, higher msMAP imparted greater PD risk (OR = 2.28 per 10 mmHg msMAP increase; 95% CI: 1.11–4.70), while higher msMAP was associated with lower PD risk (OR = 0.19 per 10 mmHg increase; CI: 0.05–0.76) if msMAP was <80 mmHg. There was no statistically significant relationship between PD risk and average percent change from baseline in these msMAP measures. Conclusion In elderly hip fracture patients, both very high and very low levels of msMAP were associated with significantly increased risk of PD. PMID:25860338

  2. Potentially preventable complications of urinary tract infections, pressure areas, pneumonia, and delirium in hospitalised dementia patients: retrospective cohort study

    PubMed Central

    Bail, Kasia; Berry, Helen; Grealish, Laurie; Draper, Brian; Karmel, Rosemary; Gibson, Diane; Peut, Ann

    2013-01-01

    Objectives To identify rates of potentially preventable complications for dementia patients compared with non-dementia patients. Design Retrospective cohort design using hospital discharge data for dementia patients, case matched on sex, age, comorbidity and surgical status on a 1 : 4 ratio to non-dementia patients. Setting Public hospital discharge data from the state of New South Wales, Australia for 2006/2007. Participants 426 276 overnight hospital episodes for patients aged 50 and above (census sample). Main outcome measures Rates of preventable complications, with episode-level risk adjustment for 12 complications that are known to be sensitive to nursing care. Results Controlling for age and comorbidities, surgical dementia patients had higher rates than non-dementia patients in seven of the 12 complications: urinary tract infections, pressure ulcers, delirium, pneumonia, physiological and metabolic derangement (all at p<0.0001), sepsis and failure to rescue (at p<0.05). Medical dementia patients also had higher rates of these complications than did non-dementia patients. The highest rates and highest relative risk for dementia patients compared with non-dementia patients, in both medical and surgical populations, were found in four common complications: urinary tract infections, pressure areas, pneumonia and delirium. Conclusions Compared with non-dementia patients, hospitalised dementia patients have higher rates of potentially preventable complications that might be responsive to nursing interventions. PMID:23794540

  3. Development and validation of the Thai version of the 4 ‘A’s Test for delirium screening in hospitalized elderly patients with acute medical illnesses

    PubMed Central

    Kuladee, Sanchai; Prachason, Thanavadee

    2016-01-01

    Background The English version of the 4 ‘A’s Test (4AT) is a rapid screening tool for delirium with a high sensitivity and specificity among hospitalized elderly patients. Objective To develop the Thai version of the 4AT (4AT-T) and assess its validity. Subjects and setting A total of 97 elderly patients aged 60 years or above who were admitted to the general medical wards were included. Methods Both authors independently translated the English version of the 4AT into Thai and thereafter developed a single reconciled forward translation by consensus. Back translation was performed by a bilingual native English speaker and it was then reviewed to ensure its agreement with the original one. After 24 hours of admission, subjects were enrolled and clinical data collected. Definite diagnosis of delirium was made by a psychiatrist using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text-Revision criteria and the 6-item Thai Delirium Rating Scale; the 4AT was then administered to participants by nurses within 30 minutes. A 4AT score ≥4 was considered positive for delirium screening. The optimal cut-off point of the 4AT-T was identified by Youden’s index. Results In all, 24 out of 97 participants met the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text-Revision criteria for delirium. At a cut-off score of 4 or greater, the 4AT-T exhibited satisfactory diagnostic performance with a sensitivity of 83.3% (95% confidence interval (CI): 62.6%–95.3%) and specificity of 86.3% (95% CI: 76.3%–93.2%). The area under the receiver operating characteristic curve was 0.92. The specified score provided maximal Youden’s index, suggesting an optimal criterion value for delirium screening. Conclusion The 4AT-T is a valid delirium-screening instrument for hospitalized elderly patients with acute medical illnesses. PMID:26966365

  4. The importance of depression and alcohol use in coronary artery bypass graft surgery patients: risk factors for delirium and poorer quality of life

    PubMed Central

    Humphreys, Joanne M; Denson, Linley A; Baker, Robert A; Tully, Phillip J

    2016-01-01

    Objective To investigate whether depression, anxiety and stress increase the risk for delirium and poor quality of life (QOL) after coronary artery bypass (CABG) surgery. Methods A total of 180 CABG patients (mean age of 63.5 ± 10.1 years, 82.2% males) completed baseline and postoperative self-report questionnaires to assess distress and QOL. Incident delirium was diagnosed postoperatively with a structured clinical interview and patients were monitored every day post-operatively for confusion and disturbance in consciousness. Results Delirium developed in 63 persons (35% of sample). After adjustment for covariates, delirium was significantly associated with depression [odds ratio (OR): 1.08; 95% confidence interval (CI): 1.03–1.13, P = 0.003], anxiety (OR: 1.07; 95% CI: 1.02–1.13, P = 0.01) and stress (OR: 1.05; 95% CI: 1.00–1.09, P = 0.03). Preoperative depression scores were associated with poorer QOL including bodily pain (β = −0.39, P = 0.013), vitality (β = −0.32, P = 0.020), social functioning (β = −0.51, P ≤ 0.001), emotional role function (β = −0.44, P = 0.003) and general health (β = −0.33, P = 0.038). Among the covariates, harmful levels of alcohol use was consistently associated with poorer QOL. Conclusions Depression and harmful levels of alcohol use were consistently associated with poorer QOL whereas depression, anxiety and stress were associated with delirium risk. These findings point to further research examining depression and harmful levels of alcohol use in coronary heart disease populations undergoing coronary revascularization. PMID:26918013

  5. Post-Injection Delirium/Sedation Syndrome after Olanzapine Long-Acting Intramuscular Injection - Who is at Risk?

    PubMed

    Łukasik-Głębocka, Magdalena; Sommerfeld, Karina; Teżyk, Artur; Panieński, Paweł; Żaba, Czesław; Zielińska-Psuja, Barbara

    2015-09-01

    The post-injection olanzapine delirium/sedation syndrome (PDSS) was observed in a 60-year-old Caucasian, schizophrenic, non-smoker and underweight [body mass index (BMI), 18.2 kg/m(2) ] women after the fourth intramuscular injection of 405 mg olanzapine pamoate. Clinical symptoms of PDSS were similar to those of acute oral olanzapine intoxication. The patient received supportive treatment and recovered fully. High olanzapine concentrations in serum, with maximum level of 698 ng/mL, were confirmed by liquid chromatography with tandem mass spectrometry (LC-MS/MS). The authors wonder whether a low BMI and advanced age may predispose patients to PDSS occurrence. PMID:25703610

  6. The Lunch Bunch: an innovative strategy to combat depression and delirium through socialization in elderly sub-acute medicine patients.

    PubMed

    Feyerer, Margot; Kruk, Dawn; Bartlett, Nicole; Rodney, Kathy; McKenzie, Cyndi; Green, Patrice; Keller, Lisa; Adcroft, Pat

    2013-01-01

    Hospitalized sub-acute medicine patients face challenges to their functional and cognitive abilities as they await transfer to long-term care facilities or return home. The Continuous Quality Improvement (CQI) Council, representing a multidisciplinary team of healthcare professionals working in the Sub-Acute Medicine Unit (SAMU), implemented a twice-weekly lunch program called the Lunch Bunch in order to combat depression and delirium in our elderly and cognitively impaired patients. The Lunch Bunch initiative includes chaplains, nurses and physiotherapists who have provided a framework through which essential socialization and exercise for this vulnerable population is facilitated. Providing a means for both mental and physical stimulation also allows patients to open up and discuss hidden feelings of loneliness and isolation, thereby beginning a journey of spiritual and emotional healing. PMID:24860951

  7. Systemic Inflammation Impairs Attention and Cognitive Flexibility but Not Associative Learning in Aged Rats: Possible Implications for Delirium

    PubMed Central

    Culley, Deborah J.; Snayd, Mary; Baxter, Mark G.; Xie, Zhongcong; Lee, In Ho; Rudolph, James; Inouye, Sharon K.; Marcantonio, Edward R.; Crosby, Gregory

    2014-01-01

    Delirium is a common and morbid condition in elderly hospitalized patients. Its pathophysiology is poorly understood but inflammation has been implicated based on a clinical association with systemic infection and surgery and preclinical data showing that systemic inflammation adversely affects hippocampus-dependent memory. However, clinical manifestations and imaging studies point to abnormalities not in the hippocampus but in cortical circuits. We therefore tested the hypothesis that systemic inflammation impairs prefrontal cortex function by assessing attention and executive function in aged animals. Aged (24-month-old) Fischer-344 rats received a single intraperitoneal injection of lipopolysaccharide (LPS; 50 μg/kg) or saline and were tested on the attentional set-shifting task (AST), an index of integrity of the prefrontal cortex, on days 1–3 post-injection. Plasma and frontal cortex concentrations of the cytokine TNFα and the chemokine CCL2 were measured by ELISA in separate groups of identically treated, age-matched rats. LPS selectively impaired reversal learning and attentional shifts without affecting discrimination learning in the AST, indicating a deficit in attention and cognitive flexibility but not learning globally. LPS increased plasma TNFα and CCL2 acutely but this resolved within 24–48 h. TNFα in the frontal cortex did not change whereas CCL2 increased nearly threefold 2 h after LPS but normalized by the time behavioral testing started 24 h later. Together, our data indicate that systemic inflammation selectively impairs attention and executive function in aged rodents and that the cognitive deficit is independent of concurrent changes in frontal cortical TNFα and CCL2. Because inattention is a prominent feature of clinical delirium, our data support a role for inflammation in the pathogenesis of this clinical syndrome and suggest this animal model could be useful for studying that relationship further. PMID:24959140

  8. Influence of Granulocyte-Macrophage Colony-Stimulating Factor or Influenza Vaccination on HLA-DR, Infection and Delirium Days in Immunosuppressed Surgical Patients: Double Blind, Randomised Controlled Trial

    PubMed Central

    Lachmann, Gunnar; Renius, Markus; von Haefen, Clarissa; Wernecke, Klaus-Dieter; Bahra, Marcus; Schiemann, Alexander; Paupers, Marco; Meisel, Christian

    2015-01-01

    Purpose Surgical patients are at high risk for developing infectious complications and postoperative delirium. Prolonged infections and delirium result in worse outcome. Granulocyte-macrophage colony-stimulating factor (GM-CSF) and influenza vaccination are known to increase HLA-DR on monocytes and improve immune reactivity. This study aimed to investigate whether GM-CSF or vaccination reverses monocyte deactivation. Secondary aims were whether it decreases infection and delirium days after esophageal or pancreatic resection over time. Methods In this prospective, randomized, placebo-controlled, double-blind, double dummy trial setting on an interdisciplinary ICU of a university hospital 61 patients with immunosuppression (monocytic HLA-DR [mHLA-DR] <10,000 monoclonal antibodies [mAb] per cell) on the first day after esophageal or pancreatic resection were treated with either GM-CSF (250 μg/m2/d), influenza vaccination (Mutagrip 0.5 ml/d) or placebo for a maximum of 3 consecutive days if mHLA-DR remained below 10,000 mAb per cell. HLA-DR on monocytes was measured daily until day 5 after surgery. Infections and delirium were followed up for 9 days after surgery. Primary outcome was HLA-DR on monocytes, and secondary outcomes were duration of infection and delirium. Results mHLA-DR was significantly increased compared to placebo (p < 0.001) and influenza vaccination (p < 0.001) on the second postoperative day. Compared with placebo, GM-CSF-treated patients revealed shorter duration of infection (p < 0.001); the duration of delirium was increased after vaccination (p = 0.003). Conclusion Treatment with GM-CSF in patients with postoperative immune suppression was safe and effective in restoring monocytic immune competence. Furthermore, therapy with GM-CSF reduced duration of infection in immune compromised patients. However, influenza vaccination increased duration of delirium after major surgery. Trial Registration www.controlled-trials.com ISRCTN27114642 PMID

  9. Economic Evaluation of a General Hospital Unit for Older People with Delirium and Dementia (TEAM Randomised Controlled Trial)

    PubMed Central

    Tanajewski, Lukasz; Franklin, Matthew; Gkountouras, Georgios; Berdunov, Vladislav; Harwood, Rowan H.; Goldberg, Sarah E.; Bradshaw, Lucy E.; Gladman, John R. F.; Elliott, Rachel A.

    2015-01-01

    Background One in three hospital acute medical admissions is of an older person with cognitive impairment. Their outcomes are poor and the quality of their care in hospital has been criticised. A specialist unit to care for older people with delirium and dementia (the Medical and Mental Health Unit, MMHU) was developed and then tested in a randomised controlled trial where it delivered significantly higher quality of, and satisfaction with, care, but no significant benefits in terms of health status outcomes at three months. Objective To examine the cost-effectiveness of the MMHU for older people with delirium and dementia in general hospitals, compared with standard care. Methods Six hundred participants aged over 65 admitted for acute medical care, identified on admission as cognitively impaired, were randomised to the MMHU or to standard care on acute geriatric or general medical wards. Cost per quality adjusted life year (QALY) gained, at 3-month follow-up, was assessed in trial-based economic evaluation (599/600 participants, intervention: 309). Multiple imputation and complete-case sample analyses were employed to deal with missing QALY data (55%). Results The total adjusted health and social care costs, including direct costs of the intervention, at 3 months was £7714 and £7862 for MMHU and standard care groups, respectively (difference -£149 (95% confidence interval [CI]: -298, 4)). The difference in QALYs gained was 0.001 (95% CI: -0.006, 0.008). The probability that the intervention was dominant was 58%, and the probability that it was cost-saving with QALY loss was 39%. At £20,000/QALY threshold, the probability of cost-effectiveness was 94%, falling to 59% when cost-saving QALY loss cases were excluded. Conclusions The MMHU was strongly cost-effective using usual criteria, although considerably less so when the less acceptable situation with QALY loss and cost savings were excluded. Nevertheless, this model of care is worthy of further evaluation

  10. Evidence and consensus-based German guidelines for the management of analgesia, sedation and delirium in intensive care – short version

    PubMed Central

    Martin, Jörg; Heymann, Anja; Bäsell, Katrin; Baron, Ralf; Biniek, Rolf; Bürkle, Hartmut; Dall, Peter; Dictus, Christine; Eggers, Verena; Eichler, Ingolf; Engelmann, Lothar; Garten, Lars; Hartl, Wolfgang; Haase, Ulrike; Huth, Ralf; Kessler, Paul; Kleinschmidt, Stefan; Koppert, Wolfgang; Kretz, Franz-Josef; Laubenthal, Heinz; Marggraf, Guenter; Meiser, Andreas; Neugebauer, Edmund; Neuhaus, Ulrike; Putensen, Christian; Quintel, Michael; Reske, Alexander; Roth, Bernard; Scholz, Jens; Schröder, Stefan; Schreiter, Dierk; Schüttler, Jürgen; Schwarzmann, Gerhard; Stingele, Robert; Tonner, Peter; Tränkle, Philip; Treede, Rolf Detlef; Trupkovic, Tomislav; Tryba, Michael; Wappler, Frank; Waydhas, Christian; Spies, Claudia

    2010-01-01

    Targeted monitoring of analgesia, sedation and delirium, as well as their appropriate management in critically ill patients is a standard of care in intensive care medicine. With the undisputed advantages of goal-oriented therapy established, there was a need to develop our own guidelines on analgesia and sedation in intensive care in Germany and these were published as 2nd Generation Guidelines in 2005. Through the dissemination of these guidelines in 2006, use of monitoring was shown to have improved from 8 to 51% and the use of protocol-based approaches increased to 46% (from 21%). Between 2006–2009, the existing guidelines from the DGAI (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin) and DIVI (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin) were developed into 3rd Generation Guidelines for the securing and optimization of quality of analgesia, sedation and delirium management in the intensive care unit (ICU). In collaboration with another 10 professional societies, the literature has been reviewed using the criteria of the Oxford Center of Evidence Based Medicine. Using data from 671 reference works, text, diagrams and recommendations were drawn up. In the recommendations, Grade “A” (very strong recommendation), Grade “B” (strong recommendation) and Grade “0” (open recommendation) were agreed. As a result of this process we now have an interdisciplinary and consensus-based set of 3rd Generation Guidelines that take into account all critically illness patient populations. The use of protocols for analgesia, sedation and treatment of delirium are repeatedly demonstrated. These guidelines offer treatment recommendations for the ICU team. The implementation of scores and protocols into routine ICU practice is necessary for their success. PMID:20200655

  11. Post-injection delirium/sedation syndrome in patients with schizophrenia treated with olanzapine long-acting injection, I: analysis of cases

    PubMed Central

    2010-01-01

    Background An advance in the treatment of schizophrenia is the development of long-acting intramuscular formulations of antipsychotics, such as olanzapine long-acting injection (LAI). During clinical trials, a post-injection syndrome characterized by signs of delirium and/or excessive sedation was identified in a small percentage of patients following injection with olanzapine LAI. Methods Safety data from all completed and ongoing trials of olanzapine LAI were reviewed for possible cases of this post-injection syndrome. Descriptive analyses were conducted to characterize incidence, clinical presentation, and outcome. Regression analyses were conducted to assess possible risk factors. Results Based on approximately 45,000 olanzapine LAI injections given to 2054 patients in clinical trials through 14 October 2008, post-injection delirium/sedation syndrome occurred in approximately 0.07% of injections or 1.4% of patients (30 cases in 29 patients). Symptomatology was consistent with olanzapine overdose (e.g., sedation, confusion, slurred speech, altered gait, or unconsciousness). However, no clinically significant decreases in vital signs were observed. Symptom onset ranged from immediate to 3 to 5 hours post injection, with a median onset time of 25 minutes post injection. All patients recovered within 1.5 to 72 hours, and the majority continued to receive further olanzapine LAI injections following the event. No clear risk factors were identified. Conclusions Post-injection delirium/sedation syndrome can be readily identified based on symptom presentation, progression, and temporal relationship to the injection, and is consistent with olanzapine overdose following probable accidental intravascular injection of a portion of the olanzapine LAI dose. Although there is no specific antidote for olanzapine overdose, patients can be treated symptomatically as needed. Special precautions include use of proper injection technique and a post-injection observation period

  12. Involvement of the NADPH Oxidase NOX2-Derived Brain Oxidative Stress in an Unusual Fatal Case of Cocaine-Related Neurotoxicity Associated With Excited Delirium Syndrome.

    PubMed

    Schiavone, Stefania; Riezzo, Irene; Turillazzi, Emanuela; Trabace, Luigia

    2016-10-01

    Here, we investigated the possible role of the Nicotinamide Adenine Dinucleotide Phosphate oxidase NOX2-derived brain oxidative stress in a fatal case of cocaine-related neurotoxicity, associated to excited delirium syndrome. We detected a strong NOX2 immunoreactivity, mainly in cortical GABAergic neurons and astrocytes, with a minor presence in microglia, glutamatergic and dopaminergic neurons as well as a significant immunostaining for other markers of oxidative stress (8OhDG, HSP70, HSP90, and NF-κB) and apoptotic phenomena. These results support a crucial role of NOX2-derived brain oxidative stress in cocaine-induced brain dysfunctions and neurotoxicity. PMID:27533346

  13. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) – short version

    PubMed Central

    Baron, Ralf; Binder, Andreas; Biniek, Rolf; Braune, Stephan; Buerkle, Hartmut; Dall, Peter; Demirakca, Sueha; Eckardt, Rahel; Eggers, Verena; Eichler, Ingolf; Fietze, Ingo; Freys, Stephan; Fründ, Andreas; Garten, Lars; Gohrbandt, Bernhard; Harth, Irene; Hartl, Wolfgang; Heppner, Hans-Jürgen; Horter, Johannes; Huth, Ralf; Janssens, Uwe; Jungk, Christine; Kaeuper, Kristin Maria; Kessler, Paul; Kleinschmidt, Stefan; Kochanek, Matthias; Kumpf, Matthias; Meiser, Andreas; Mueller, Anika; Orth, Maritta; Putensen, Christian; Roth, Bernd; Schaefer, Michael; Schaefers, Rainhild; Schellongowski, Peter; Schindler, Monika; Schmitt, Reinhard; Scholz, Jens; Schroeder, Stefan; Schwarzmann, Gerhard; Spies, Claudia; Stingele, Robert; Tonner, Peter; Trieschmann, Uwe; Tryba, Michael; Wappler, Frank; Waydhas, Christian; Weiss, Bjoern; Weisshaar, Guido

    2015-01-01

    In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from the American College of Critical Care Medicine (ACCM) in conjunction with Society of Critical Care Medicine (SCCM) and American Society of Health-System Pharmacists (ASHP) from 2013. For this update, a major restructuring and extension of the guidelines were needed in order to cover new aspects of treatment, such as sleep and anxiety management. The literature was systematically searched and evaluated using the criteria of the Oxford Center of Evidence Based Medicine. The body of evidence used to formulate these recommendations was reviewed and approved by representatives of 17 national societies. Three grades of recommendation were used as follows: Grade “A” (strong recommendation), Grade “B” (recommendation) and Grade “0” (open recommendation). The result is a comprehensive, interdisciplinary, evidence and consensus-based set of level 3 guidelines. This publication was designed for all ICU professionals, and takes into account all critically ill patient populations. It represents a guide to symptom-oriented prevention, diagnosis, and treatment of delirium, anxiety, stress, and protocol-based analgesia, sedation, and sleep-management in intensive care medicine. PMID:26609286

  14. Modifying the Electronic Health Record to Facilitate the Implementation and Evaluation of a Bundled Care Program for Intensive Care Unit Delirium

    PubMed Central

    Collinsworth, Ashley W.; Masica, Andrew L.; Priest, Elisa L.; Berryman, Candice D.; Kouznetsova, Maria; Glorioso, Oscar; Montgomery, Donna

    2014-01-01

    Context: Electronic health records (EHRs) have been promoted as a key driver of improved patient care and outcomes and as an essential component of learning health systems. However, to date, many EHRs are not optimized to support delivery of quality and safety initiatives, particularly in Intensive Care Units (ICUs). Delirium is a common and severe problem for ICU patients that may be prevented or mitigated through the use of evidence-based care processes (daily awakening and breathing trials, formal delirium screening, and early mobility—collectively known as the “ABCDE bundle”). This case study describes how an integrated health care delivery system modified its inpatient EHR to accelerate the implementation and evaluation of ABCDE bundle deployment as a safety and quality initiative. Case Description: In order to facilitate uptake of the ABCDE bundle and measure delivery of the care processes within the bundle, we worked with clinical and technical experts to create structured data fields for documentation of bundle elements and to identify where these fields should be placed within the EHR to streamline staff workflow. We created an “ABCDE” tab in the existing patient viewer that allowed providers to easily identify which components of the bundle the patient had and had not received. We examined the percentage of ABCDE bundle elements captured in these structured data fields over time to track compliance with data entry procedures and to improve documentation of care processes. Major Themes: Modifying the EHR to support ABCDE bundle deployment was a complex and time-consuming process. We found that it was critical to gain buy-in from senior leadership on the importance of the ABCDE bundle to secure information technology (IT) resources, understand the different workflows of members of multidisciplinary care teams, and obtain continuous feedback from staff on the EHR revisions during the development cycle. We also observed that it was essential to

  15. The role of the NADPH oxidase derived brain oxidative stress in the cocaine-related death associated with excited delirium: A literature review.

    PubMed

    Schiavone, Stefania; Neri, Margherita; Mhillaj, Emanuela; Pomara, Cristoforo; Trabace, Luigia; Turillazzi, Emanuela

    2016-09-01

    Excited delirium syndrome (ExDS) is a term used to describe a clinical condition characterized by bizarre and aggressive behaviour, commonly associated with the use of psychoactive compounds, especially cocaine. The pathophysiology of ExDS is complex and not yet fully understood. In addition to a central dopamine hypothesis, other mechanisms are thought to be involved in cocaine-related ExDS, such as increased reactive oxygen species production by the family of the NADPH oxidase NOX enzymes. In this review, we will summarize current knowledge on the crucial contribution of brain NADPH oxidase derived oxidative stress in the development of cocaine-induced ExDS. Data from animal models as well as human evidence will be discussed. PMID:27265246

  16. Lack of Association between Pre-Operative Insulin-Like Growth Factor-1 and the Risk of Post-Operative Delirium in Elderly Chinese Patients

    PubMed Central

    Chu, Che-Sheng; Liang, Chih-Kuang; Chou, Ming-Yueh; Lin, Yu-Te; Hsu, Chien-Jen

    2016-01-01

    Objective Postoperative delirium (POD) is a highly prevalent complex neuropsychiatric syndrome in elderly patients. However, its pathophysiology is currently unknown. Early detection and prevention of POD is important; therefore, the aim of this study was to investigate the link between preoperative insulin growth factor 1 (IGF-1) levels in the serum and POD in the Chinese elderly patients. Methods One hundred and three patients who were undergoing an orthopedic operation took part in the study. Preoperative serum IGF-1 levels were measured. POD was determined daily using the Confusion Assessment Method (CAM) and DSM-IV TR. Baseline serum IGF-1 levels were compared between patients who did and did not develop POD. Correlation coefficients were calculated to evaluate relationship between baseline characteristics and serum IGF-1 levels. The relationship between baseline biomarkers and delirium status was investigated using logistic regression analysis, adjusting for potential confounding variables. Results Twenty-three patients developed POD. The POD group had lower MMSE scores and higher CCI scores and proportions of acute admission. Preoperative serum IGF-1 levels were correlated with MMSE scores and age (MMSE: r=0.230, p<0.05; age: r=-0.419, p<0.001). Baseline serum IGF-1 levels did not differ between patients who did and did not develop POD, even after adjusting for potential confounding factors, MMSE score, and age. Conclusion No association was found between preoperative IGF-1 levels and POD, suggesting that they are not direct biomarkers of the incidence of POD among the Chinese elderly population. Further research with larger sample sizes is warranted to clarify the relationship. PMID:27247600

  17. Delirium (Beyond the Basics)

    MedlinePlus

    ... the Licensed Materials from any location via the Internet. b. STANDALONE WORKSTATION: A standalone subscription permits multiple ... computer. A Standalone Workstation license does not include Internet access to the Licensed Materials. c. INSTITUTIONAL SUBSCRIPTION: ...

  18. DK UMa: A Star on the Ascent

    NASA Technical Reports Server (NTRS)

    Simon, Theodore

    1999-01-01

    DK UMa (= 24 UMa = HD 82210) is a G4 IV-III star. According to its M(sub v) and B - V color, it is located at the base of the red giant branch, having recently exited from the Hertzsprung Gap. Now poised to start its first ascent along the giant branch, DK UMa is at a significant juncture in its post-main-sequence evolution, offering an important evolutionary comparison for magnetic activity with stars like 31 Comae, which is just entering the Hertzsprung Gap, and older stars like the Hyades giants or P Ceti, which have passed the tip of the giant branch and lie in the so-called 'clump'. As part of a major survey of the ultraviolet and X ray properties of a well-defined sample of evolved giant stars, DK UMa was observed with the Extreme Ultraviolet Explorer (EUVE) spacecraft in March 1997, for a total exposure time of 230 kiloseconds. A plot of the extracted short-wavelength (SW) spectrum of this star is shown, where it is compared with similar EUVE exposures for other yellow and red giant stars in the activity survey. In terms of the spectral lines of different ionization stages present in these spectra, the transition region and coronal temperature of DK UMa appears to be intermediate between those of 31 Com and P Ceti. Combining the relative strengths of the EUVE lines with Hubble Space Telescope (HST) data at near UV wavelengths and with ROSAT X-ray fluxes, the differential emission measure (DEM) distributions of these stars form a sequence in coronal temperature, which peaks at 10(exp 7.2) K for 31 Com, at 10(exp 6.8) K for B Ceti, and at intermediate temperatures for DK UMa - consistent with the evolutionary stages represented by the three stars. The integrated fluxes of the strongest emission lines found in the EUVE spectrum of DK UMa are listed, again compared with similar measurements for other giant stars that were observed in the course of other EUVE Guest Observer programs.

  19. Pre-Operative, High-IL-6 Blood Level is a Risk Factor of Post-Operative Delirium Onset in Old Patients

    PubMed Central

    Capri, Miriam; Yani, Stella Lukas; Chattat, Rabih; Fortuna, Daniela; Bucci, Laura; Lanzarini, Catia; Morsiani, Cristina; Catena, Fausto; Ansaloni, Luca; Adversi, Marco; Melotti, Maria Rita; Di Nino, Gianfranco; Franceschi, Claudio

    2014-01-01

    Background: Post-operative delirium (POD) is a common complication in elderly patients undergoing surgery, but the underpinning causes are not clear. We hypothesized that inflammaging, the subclinical low and chronic grade inflammation characteristic of old people, can contribute to POD onset. Accordingly, we investigated the association of pre-operative and circulating cytokines in elderly patients (>65 years), admitted for elective and emergency surgery. Methods: This is a secondary analysis of a sub-cohort of patients belonging to a previous large case–control study, where 351 patients were clinically and cognitively thoroughly characterized, together with the assessment of POD (47 patients) by confusion assessment method and delirium rating scale. Seventy-four pre-operative plasma samples were selected from a larger bio-bank and they included 37 subjects with POD and 37 without POD. Inflammaging related cytokines, i.e., IL-1β, IL-2, IL-6, IL-8, IL-10, and TNF-α, were assayed by ELISA in pre-operative blood samples; univariate and multivariable analyses have been applied to identify cytokines independently associated to POD. Associations of cytokine levels with functional status, cognitive decline, intra-hospital mortality, and comorbidity were also analyzed independently of POD onset. Results: High IL-6 and low-IL-2 levels were significantly associated with POD. After adjustment for potential confounders in multivariate analysis, high level of pre-operative IL-6 was confirmed to be significantly associated with risk of POD onset. High level of IL-6 was also associated with several baseline features (including poor functional status, cognitive impairment, emergency admission, and higher comorbidity burden) and intra-hospital mortality. Conclusion: Pre-operative, high-plasma level of IL-6 (≥9 pg/mL) was significantly associated with POD onset. We propose IL-6 as an additional risk factor of POD onset together with the previously identified factors

  20. Flip-flop Activity on the W UMa-type Binary System HH UMa

    NASA Astrophysics Data System (ADS)

    Wang, Kun; Zhang, Xiaobin; Deng, Licai; Luo, Changqing; Luo, Yangping; Zhang, Jun

    2015-05-01

    We report the discovery of flip-flop activity in a W UMa-type binary. A long-term multi-color photometric surveillance of HH UMa was carried out with three sets of light curves obtained over six weeks. The light curves of the eclipsing binary presented marked asymmetry and rapid interchange between the two light maxima. During the observations from 2014 February to 2014 April, the spot distortion phase jumped between phases 0.25 and 0.75 twice, a typical indication of flip-flop activity. We applied the Wilson-Devinney method to analyze the three light curves. The results indicate that HH UMa is a partially eclipsing contact system of A subtype with an obviously asymmetric light curve. The observed light curves can be modeled by assuming that there are two dark spots on the massive primary component that are almost persistently located around phases 0.25 and 0.75, but can interchange their intensities. We further suggest that a plausible scenario for explaining the properties of those dark spots is strong surface magnetic activity with a sudden reversal of the more active longitude. We therefore conclude that HH UMa is very likely a W UMa-type system displaying flip-flop activity.

  1. Improving Patient Care Through the Prism of Psychology: application of Maslow’s Hierarchy to Sedation, Delirium and Early Mobility in the ICU

    PubMed Central

    Jackson, James C.; Santoro, Michael J.; Ely, Taylor M.; Boehm, Leanne; Kiehl, Amy L; Anderson, Lindsay S.; Ely, E. Wesley

    2016-01-01

    The Intensive Care Unit is not only a place where lives are saved; it is also a site of harm and iatrogenic injury for millions of people treated in this setting globally every year. Increasingly, hospitals admit only the sickest patients, and, while the overall number of hospital beds remains stable in the U.S., the percentage of that total devoted to ICU beds is rising. These two realities engender a demographic imperative to address patient safety in the critical care setting. This manuscript addresses the medical community’s resistance to adopting a culture of safety in critical care with regard to issues surrounding sedation, delirium, and early mobility. Although there is currently much research and quality improvement in this area, most of what we know from these data and published guidelines has not become reality in the day-to-day management of ICU patients. This manuscript is not intended to provide a comprehensive review of the literature, but rather a framework to rethink our currently outdated culture of critical care by employing Maslow’s Hierarchy of Needs, along with a few novel analogies. Application of Maslow’s Hierarchy will help propel healthcare professionals toward comprehensive care of the whole person, not merely for survival, but toward restoration of pre-illness function of mind, body, and spirit. PMID:24636724

  2. High speed photometry of AN UMa

    SciTech Connect

    Imamura, J.N.; Steiman-Cameron, T.Y.; Durisen, R.H.

    1985-01-01

    As a class, the AM Her objects exhibit temporal variability on time scales ranging from seconds to years. Most of the variations can be adequately described by ''shot noise'' models (Cordova and Mason 1982). Exceptions to this are the strictly periodic features modulated on the orbital periods of the systems (typically several hours) and the one to two second features which show up as ''excesses'' of power in the time averaged power spectra of AN UMa (Middleditch 1982) and E1405-451 (Mason et al. 1983; Larsson 1985). It has been suggested that the short time scale features are due to an oscillatory ''instability'' of radiative accretion shocks discovered by Langer, Chanmugam, and Shaviv (1981, 1982). This is an interesting suggestion because, if true, it would allow the masses of the accreting white dwarfs to be inferred and would provide other significant constraints on the physics of the accretion flows (see Langer et al. 1981, 1982; Chevalier and Imamura 1982; Imamura, Wolff, and Durisen 1984; Imamura 1985). Unfortunately, a direct physical relationship between the one to two second optical variations and shock oscillations has not yet been demonstrated. Because of the potential importance of such a result further study of these systems is clearly warranted. In this work, we examine the short time scale behavior of AN UMa in more detail and improve on the work of Middleditch (1982) by resolving the feature in time.

  3. Discovery of a New Deeply Eclipsing SU UMa-Type Dwarf Nova, IY UMa (= TmzV 85)

    NASA Astrophysics Data System (ADS)

    Uemura, Makoto; Kato, Taichi; Matsumoto, Katsura; Takamizawa, Kesao; Schmeer, Patrick; Jensen, Lasse Teist; Vanmunster, Tonny; Novák, Rudolf; Martin, Brian; Pietz, Jochen; Buczynski, Denis; Kinnunen, Timo; Moilanen, Marko; Oksanen, Arto; Cook, Lewis M.; Watanabe, Tsutomu; Maehara, Hiroyuki; Itoh, Hiroshi

    2000-04-01

    We discovered a new deeply eclipsing SU UMa-type dwarf nova, IY UMa, which experienced a superoutburst in 2000 January. Our monitoring revealed two distinct outbursts, which suggest a superoutburst interval of ~ 800 d, or its half, and an outburst amplitude of 5.4 mag. From time-series photometry during the superoutburst, we determined a superhump and orbital period of 0.07588 d and 0.0739132 d, respectively.

  4. BZ UMa and Var Her 04: Orphan TOADS

    NASA Astrophysics Data System (ADS)

    Price, A.; Howell, S.

    2005-05-01

    Both BZ UMa and Var Her 04 are cataclysmic variable stars without a home. Neither fit easily into current classification systems so may extend the population distribution of two unique CV types: UGWZ dwarf novae and intermediate polars. New outburst photometry and archival X-Ray data shed some new light on BZ UMa's high energy state and new spectral and IR observations from Spitzer of dust around the newly discovered cataclysmic variable Var Her 04 may help find it a home as well.

  5. Neural network analysis of W UMa eclipsing binaries

    NASA Astrophysics Data System (ADS)

    Zeraatgari, F. Z.; Abedi, A.; Farshad, M.; Ebadian, M.; Riazi, N.

    2015-04-01

    We try five different artificial neural models, four models based on PNN (Perceptron Neural Network), and one using GRNN (Generalized Regression Neural Network) as tools for the automated light curve analysis of W UMa-type eclipsing binary systems. These algorithms, which are inspired by the Rucinski method, are designed and trained using MATLAB 7.6. A total of 17,820 generated contact binary light curves are first analyzed using a truncated cosine series with 11 coefficients and the most significant coefficients are applied as inputs of the neural models. The required sample light curves are systematically generated, using the WD2007 program (Wilson and Devinney 2007). The trained neural models are then applied to estimate the geometrical parameters of seven W UMa-type systems. The efficiency of different neural network models are then evaluated and compared to find the most efficient one.

  6. Perspectivas Futuras para o Observatório do Pico dos Dias

    NASA Astrophysics Data System (ADS)

    Bruch, Albert

    2004-02-01

    Com o Observatório Gemini plenamente operacional e o telescópio SOAR iniciando suas operações em breve, a astronomia observacional brasileira encontra-se no auge de uma transformação profunda que terá um impacto grave no Observatório do Pico dos Dias - OPD. Refletimos aqui sobre a natureza desse impacto e estratégias para manter a competitividade do OPD. Não queremos apresentar receitas prontas, mas idéias que poderão servir como base de discussão sobre o uso inteligente dos telescópios do OPD como parte do conjunto de instrumentos disponíveis à comunidade astronômica brasileira.

  7. Recent developments on SU UMa stars - theory vs. observation

    NASA Astrophysics Data System (ADS)

    Cannizzo, John K.

    2015-01-01

    Kepler light curves of short period dwarf novae have resparked interest in the nature of superoutbursts and led to the question: Is the thermal-tidal instability needed, or can the plain vanilla version of the accretion disk limit cycle do the job all by itself? A detailed time-resolved study of an eclipsing SU UMa system during superoutburst onset should settle the question - if there is a dramatic contraction of the disk at superoutburst onset, Osaki's thermal-tidal model would be preferred; if not, the plain disk instability model would be sufficient. I will present recent results that support the contention by Osaki & Kato that the time varying negative superhump frequencies can be taken as a surrogate for the outer disk radius variations. Finally, it may be necessaryto look beyond the short period dwarf novae to gain perspective on the nature of embedded precursors in long outbursts.

  8. Learner Responses to the Use of Television in UMA Courses. Working Paper No. 8.

    ERIC Educational Resources Information Center

    Brown, Laurence A.

    The purpose of this paper is to present and discuss learner responses to the television component of the various courses developed or offered by the University of Mid-America (UMA). Implications for courseware development are outlined, and research questions to be addressed are suggested. Four courses were offered by UMA: (1) Accounting I, (2)…

  9. O Universo das Sociedades Numa Perspectiva Relativa: Exercícios de Etnoastronomia

    NASA Astrophysics Data System (ADS)

    Fares, Érika Akel; Pessoa Martins, Karla; Maciel Araujo, Lidiane; Sauma Filho, Michel

    2004-12-01

    This work developed at the Planetarium of Pará employing workshops designed for visitor schools (public, private, specials groups), promotes the popularization of the Ethnoastronomy with the aim of diffusing values based on a cultural diversity tolerance and the need of harmonic interplay between people and environment. Using stories and debates, the relationship between humans and the Cosmos is traced from antiquity until today, with the help of slides as a didactic resource. Thus, many conceptions about the origin of the Universe are shown; as well as some constellations created along the History, ending with the present scientific manner of know and explain the World. We then demonstrate the links between space, time and culture with the Cosmos vision. The need to think the World within a plural context to create respect for other different persons is emphasized. Este trabalho, desenvolvido no Planetário do Pará através de oficinas com escolas visitantes (públicas, privadas e grupos especiais), promove a popularização da Etnoastronomia, com o objetivo de difundir valores pautados na tolerância à diversidade cultural e na necessidade da convivência harmônica entre o ser humano e o meio ambiente. Através da contação de histórias e promoção de debate, é tratada a relação dos humanos com o céu desde a antiguidade até os dias atuais, tendo como apoio didático o uso de slides. Assim, são mostradas diversas concepções de origem do Universo; algumas constelações criadas no decorrer da História; e a atual forma científica de conhecer e explicar o mundo. Demonstrando-se, então, a interligação entre espaço, tempo e cultura com a visão do Cosmo. Enfatiza-se a necessidade de se pensar o mundo numa perspectiva relativa ou plural, de forma a propiciar o respeito ao ser diferente.

  10. VizieR Online Data Catalog: Galaxies in the UMa cluster complex (Karachentsev+, 2013)

    NASA Astrophysics Data System (ADS)

    Karachentsev, I. D.; Nasonova, O. G.; Courtois, H. M.

    2015-04-01

    A nearby friable cloud in Ursa Majoris contains 270 galaxies with radial velocities 500UMa complex. According to Makarov & Karachentsev (2011MNRAS.412.2498M, Cat. J/MNRAS/412/2498), most of the UMa galaxies belong to seven bound groups, which have the following median parameters: velocity dispersion of 58k/s, harmonic projected radius of 300kpc, virial mass of 2x1012M⊙ and virial mass-to-K-band luminosity ratio of 27M⊙/L⊙. Almost a half of the UMa cloud population are gas-rich dwarfs (Ir, Im, BCD) with active star formation seen in the GALEX UV-survey. The UMa groups reside within 15-19Mpc from us, being just at the same distance as the Virgo cluster. The total virial mass of the UMa groups is 4x1013M⊙, yielding the average density of dark matter in the UMa cloud to be Ωm=0.08, i.e. a factor of 3 lower than the cosmic average. This is despite the fact that the UMa cloud resides in a region of the Universe that is an apparent overdensity. A possible explanation for this is that most mass in the Universe lies in the empty space between clusters. Herewith, the mean distances and velocities of the UMa groups follow nearly undisturbed Hubble flow without a sign of the 'Z-wave' effect caused by infall towards a massive attractor. This constrains the total amount of dark matter between the UMa groups within the cloud volume. (1 data file).

  11. New Light Curves and Period Studies of V502 OPH W UMA System

    NASA Astrophysics Data System (ADS)

    Awadalla, Nabil S.

    NEW LIGHT CURVES AND PERIOD STUDIES OF V502 OPH W UMa SYSTEM N.S.Awadalla National Research Institute of Astronomy and Geophysics( NRIAG ) Helwan Cairo EGYPT New BVR photoelectric observations of the W UMa eclipsing binary system V502 Oph have been presented and analyzed. The geometric and physical elements of the system have been obtained and compared to the previous results. The classification of the system concerning the sub-type of the W UMa binary has been studied as well as its evolution stage. Its period variation in a view of the light time effect has been examin

  12. Fundamental data for contact binaries: RZ Comae, RZ Tauri, and AW UMa

    NASA Technical Reports Server (NTRS)

    Wilson, R. E.; Devinney, E. J.

    1972-01-01

    Differential corrections analyses of three W UMa type binaries show that RZ Tau and AW UMa have common envelopes and the relatively small gravity darkening predicted by Lucy, while RZ Comae seems to have a larger gravity effect and is only marginally in contact. Some details of the method for computing contact binary light curves are given. It is suggested that W UMa binaries which have occultation primary eclipses may, in general, have large amplitudes for gravity darkening or a photometric surface brightness effect which simulates large gravity darkening.

  13. SPECTROSCOPIC METALLICITY DETERMINATIONS FOR W UMa-TYPE BINARY STARS

    SciTech Connect

    Rucinski, Slavek M.; Pribulla, Theodor; Budaj, Jan E-mail: pribulla@ta3.sk

    2013-09-15

    This study is the first attempt to determine the metallicities of W UMa-type binary stars using spectroscopy. We analyzed about 4500 spectra collected at the David Dunlap Observatory. To circumvent problems caused by the extreme spectral line broadening and blending and by the relatively low quality of the data, all spectra were subject to the same broadening function (BF) processing to determine the combined line strength in the spectral window centered on the Mg I triplet between 5080 A and 5285 A. All individual integrated BFs were subsequently orbital-phase averaged to derive a single line-strength indicator for each star. The star sample was limited to 90 W UMa-type (EW) binaries with the strict phase-constancy of colors and without spectral contamination by spectroscopic companions. The best defined results were obtained for an F-type sub-sample (0.32 < (B - V){sub 0} < 0.62) of 52 binaries for which integrated BF strengths could be interpolated in the model atmosphere predictions. The logarithmic relative metallicities, [M/H], for the F-type sub-sample indicate metal abundances roughly similar to the solar metallicity, but with a large scatter which is partly due to combined random and systematic errors. Because of the occurrence of a systematic color trend resulting from inherent limitations in our approach, we were forced to set the absolute scale of metallicities to correspond to that derived from the m{sub 1} index of the Stroemgren uvby photometry for 24 binaries of the F-type sub-sample. The trend-adjusted metallicities [M/H]{sub 1} are distributed within -0.65 < [M/H]{sub 1} < +0.50, with the spread reflecting genuine metallicity differences between stars. One half of the F-sub-sample binaries have [M/H]{sub 1} within -0.37 < [M/H]{sub 1} < +0.10, a median of -0.04 and a mean of -0.10, with a tail toward low metallicities, and a possible bias against very high metallicities. A parallel study of kinematic data, utilizing the most reliable and recently

  14. Spectroscopic Metallicity Determinations for W UMa-type Binary Stars

    NASA Astrophysics Data System (ADS)

    Rucinski, Slavek M.; Pribulla, Theodor; Budaj, Ján

    2013-09-01

    This study is the first attempt to determine the metallicities of W UMa-type binary stars using spectroscopy. We analyzed about 4500 spectra collected at the David Dunlap Observatory. To circumvent problems caused by the extreme spectral line broadening and blending and by the relatively low quality of the data, all spectra were subject to the same broadening function (BF) processing to determine the combined line strength in the spectral window centered on the Mg I triplet between 5080 Å and 5285 Å. All individual integrated BFs were subsequently orbital-phase averaged to derive a single line-strength indicator for each star. The star sample was limited to 90 W UMa-type (EW) binaries with the strict phase-constancy of colors and without spectral contamination by spectroscopic companions. The best defined results were obtained for an F-type sub-sample (0.32 < (B - V)0 < 0.62) of 52 binaries for which integrated BF strengths could be interpolated in the model atmosphere predictions. The logarithmic relative metallicities, [M/H], for the F-type sub-sample indicate metal abundances roughly similar to the solar metallicity, but with a large scatter which is partly due to combined random and systematic errors. Because of the occurrence of a systematic color trend resulting from inherent limitations in our approach, we were forced to set the absolute scale of metallicities to correspond to that derived from the m 1 index of the Strömgren uvby photometry for 24 binaries of the F-type sub-sample. The trend-adjusted metallicities [M/H]1 are distributed within -0.65 < [M/H]1 < +0.50, with the spread reflecting genuine metallicity differences between stars. One half of the F-sub-sample binaries have [M/H]1 within -0.37 < [M/H]1 < +0.10, a median of -0.04 and a mean of -0.10, with a tail toward low metallicities, and a possible bias against very high metallicities. A parallel study of kinematic data, utilizing the most reliable and recently obtained proper motion and radial

  15. The Dilemma of Delirium in Older Patients

    MedlinePlus

    ... Division of Geriatrics and Clinical Gerontology Division of Neuroscience FAQs Funding Opportunities Intramural Research Program Office of ... Molly Wagster, Chief of NIA’s Behavioral and Systems Neuroscience Branch. “At this stage, unfortunately, there are more ...

  16. Radial velocity mapping of Paczyński's star AW UMa: not a contact binary

    NASA Astrophysics Data System (ADS)

    Pribulla, T.; Rucinski, S. M.

    2008-05-01

    We present 2D (radial velocity, orbital phase) spectroscopic results for the very low mass-ratio close binary AW UMa which strongly indicate that the spectroscopic mass ratio (qsp = 0.10) does not agree with the photometrically derived one and that the widely adopted contact binary model appears to experience serious inconsistencies and limitations for this object. AW UMa is compared with V566 Oph (qsp = 0.26) which we found to behave according to the contact model. Observed broadening functions of AW UMa can be interpreted by a very strong limb darkening and/or non-solid-body rotation of the dominant primary component; the former assumption is unphysical while the differential rotation is not supported by an apparent stability of localized, dark features on the outer side of the primary. There are indications of the existence of an equatorial belt encompassing the whole system. All deficiencies in the interpretation and the discrepancy between the photometric and spectroscopic mass ratio of AW UMa can be solved within a new model of AW UMa where both components are detached and the system is submerged in a stream of hot, optically thick matter which mimics the stellar contact. While the masses and their ratio are correctly given by spectroscopy, the photometric picture is heavily modified by the matter engulfing both stars in the equatorial plane. Based on the data obtained at the David Dunlap Observatory, University of Toronto. E-mail: pribulla@ta3.sk (TP); rucinski@astro.utoronto.ca (SMR)

  17. Elemental Abundance Analyses with DAO Spectrograms. XXXIX. The Am Stars 2 UMa and 15 Vul

    NASA Astrophysics Data System (ADS)

    Çay, İpek H.; Teker Yelkenci, Aysegul; Adelman, Saul J.

    2016-05-01

    We derived the elemental abundances of the metallic-line stars 2 UMa (=HR 3354; spectral type A2m) and 15 Vul (=HR 7653; spectral type A4 III), using high-dispersion, high signal-to-noise ratio (≥200) optical region spectrograms obtained with CCD detectors at the long Coudé camera of the 1.22 m telescope of the Dominion Astrophysical Observatory (DAO) and Kurucz's ATLAS9 and WIDTH9 programs. The star 2 UMa has not been the subject of a modern detailed elemental abundances analysis. It is relatively sharp-lined and sufficiently hot (T eff = 8050 K) that the continuum placement is not a major problem in the optical region. Comparison of the results of this new study of 15 Vul with the last complete study shows a 0.15 dex mean increase in the derived abundances and a reduction in the standard deviations of the mean values. The abundance anomalies of 2 UMa are usually larger than those of 15 Vul. The greater spectral coverage of 15 Vul compared with 2 UMa results in a larger number of abundances being derived. The abundances of 2 UMa are typical for those of classical Am stars that have similar effective temperatures and surface gravities. 15 Vul, characterized by a similar effective temperature and smaller surface gravity, is a more evolved star.

  18. High-frequency variations of hydrogen spectral lines in the B3V star η UMa

    NASA Astrophysics Data System (ADS)

    Pokhvala, S. M.

    2015-09-01

    We reported the detection of high-frequency variations in the hydrogen Balmer lines in the hot star η UMa of spectral class B3V. Spectral observations of η UMa were carried out with slitless spectrograph (R˜100) installed on the 60 cm Carl Zeiss telescope in the Andrushivka Observatory. Spectra were obtained with a time resolution in the sub-second range. It has been found that the η UMa shows rapid variations in the hydrogen lines Hα, Hβ, Hγ, as well as variations in the atmospheric oxygen lines. The intensity variations in the hydrogen lines varies from 0.2% to 0.5% , and that of the oxygen lines is approximately 2%.

  19. FUSE Observations of the Bright, Eclipsing Nova-like Cataclysmic Variable, UX UMa (FUSE 2000)

    NASA Technical Reports Server (NTRS)

    Long, Knox; Froning, Cynthia

    2004-01-01

    This was a project to study the disk and wind of the eclipsing nova-like variable UX UMa, in order to better define the wind geometry of the system, including the nature of the transition region between the disk photosphere and the supersonic wind. We proposed to use phase resolved spectroscopy of the system, taking advantage of the fact that UX UMa is an eclipsing system, to isolate different regions of the wind and to use a Monte Carlo radiative transfer code to simulate the spectra through the eclipse.

  20. Genome Sequences of Gordonia Bacteriophages Obliviate, UmaThurman, and Guacamole.

    PubMed

    Pope, Welkin H; Akbar, Armaan F; Ayers, Taylor N; Belohoubek, Selena G; Chung, Connie F; Hartman, Allison C; Kayiti, Tejus; Kessler, Cecilia M; Koman, Philipp I; Kotovskiy, Grigoriy A; Morgan, Taylor M; Rohac, Rebecca M; Silva, Gabriela M; Willis, Charles E; Milliken, Katherine A; Shedlock, Kathleen A; Stanton, Ann-Catherine J; Toner, Chelsea L; Furbee, Emily C; Grubb, Sarah R; Warner, Marcie H; Montgomery, Matthew T; Garlena, Rebecca A; Russell, Daniel A; Jacobs-Sera, Deborah; Hatfull, Graham F

    2016-01-01

    We describe three newly isolated phages-Obliviate, UmaThurman, and Guacamole-that infect Gordonia terrae 3612. The three genomes are related to one another but are not closely related to other previously sequenced phages or prophages. The three phages are predicted to use integration-dependent immunity systems as described in several mycobacteriophages. PMID:27365348

  1. Discovery of a New SU UMa-Type Dwarf Nova, V 1028 Cygni

    NASA Astrophysics Data System (ADS)

    Baba, Hajime; Kato, Taichi; Nogami, Daisaku; Hirata, Ryuko; Matsumoto, Katsura; Sadakane, Kozo

    2000-06-01

    V-band high-speed CCD photometry of V 1028 Cyg revealed that hump structures existed in the early stage of its 1995 July outburst. We obtained 0.06154 (+/- 0.00002) d as the best estimated period of superhumps. We confirmed that this dwarf nova belongs to the SU UMa stars. A re-brightening occurred after the superoutburst, and may be associated with a normal outburst. An analysis of the timings of superhump maxima showed clear evidence for an increase of the superhump period (P_dot = .P/P) with 7.54 x 10-6. Only a few stars (AL Com, T Leo, SW UMa, etc.) are reported to have such an increase of the superhump period. At the end of the superoutburst, we detected that the amplitude of the superhumps increased considerably. Both of these properties are not typical features of ordinary SU UMa stars. The connection between the WZ Sge-type and the SU UMa-type dwarf novae is briefly discussed.

  2. Genome Sequences of Gordonia Bacteriophages Obliviate, UmaThurman, and Guacamole

    PubMed Central

    Akbar, Armaan F.; Ayers, Taylor N.; Belohoubek, Selena G.; Chung, Connie F.; Hartman, Allison C.; Kayiti, Tejus; Kessler, Cecilia M.; Koman, Philipp I.; Kotovskiy, Grigoriy A.; Morgan, Taylor M.; Rohac, Rebecca M.; Silva, Gabriela M.; Willis, Charles E.; Milliken, Katherine A.; Shedlock, Kathleen A.; Stanton, Ann-Catherine J.; Toner, Chelsea L.; Furbee, Emily C.; Grubb, Sarah R.; Warner, Marcie H.; Montgomery, Matthew T.; Garlena, Rebecca A.; Russell, Daniel A.; Jacobs-Sera, Deborah; Hatfull, Graham F.

    2016-01-01

    We describe three newly isolated phages—Obliviate, UmaThurman, and Guacamole—that infect Gordonia terrae 3612. The three genomes are related to one another but are not closely related to other previously sequenced phages or prophages. The three phages are predicted to use integration-dependent immunity systems as described in several mycobacteriophages. PMID:27365348

  3. Key parameters of W UMa-type contact binaries discovered by HIPPARCOS

    NASA Astrophysics Data System (ADS)

    Selam, S. O.

    2004-03-01

    A sample of W UMa-type binaries which were discovered by the HIPPARCOS satellite was constructed with the aid of well defined selection criteria described in this work. The selection process showed up that several systems of which the variability types have been assigned as EB in HIPPARCOS catalogue are genuine contact binaries of W UMa-type. The light curves of the 64 selected systems based on HIPPARCOS photometry were analyzed with the aid of light curve synthesis method by Rucinski and their geometric elements (namely mass ratio q, degree of contact f, and orbital inclination i) were determined. The solutions were obtained for the first time for many of the systems in the sample and would be a good source for their future light curve analyses based on more precise follow-up observations. Based on observations made with the ESA HIPPARCOS astrometry satellite.

  4. X-ray and optical measurements of the cataclysmic variable CH UMa

    NASA Technical Reports Server (NTRS)

    Becker, R. H.; Chanan, G. A.; Wilson, A. S.; Pravdo, S. H.

    1982-01-01

    A program to identify optical counterparts of X-ray sources discovered with the Einstein Observatory has resulted in an independent identification of CH UMa as a cataclysmic variable. Spectrophotometric observations made with the Intensified Image Dissector Scanner on the 2.1-m telescope at KPNO revealed an emission line spectrum from an approximately 15 mag object similar to the spectra of cataclysmic variables. A subsequent search of the Harvard photographic plate collection revealed outbursts of 4 mag in amplitude.

  5. Increasing Supercycle Lengths of Active SU UMa-type Dwarf Novae

    NASA Astrophysics Data System (ADS)

    Otulakowska-Hypka, M.; Olech, A.

    2014-12-01

    We present observational evidence that supercycle lengths of the most active SU UMa-type stars are increasing during the past decades. We analyzed a large number of photometric measurements from available archives and found that this effect is generic for this class of stars, independently of their evolutionary status. This finding is in agreement with previous predictions and the most recent work of Patterson et al. (2012) on BK Lyn.

  6. Thorough analysis and deep insight into the low amplitude W UMa type system FI Boo

    NASA Astrophysics Data System (ADS)

    Papageorgiou, A.; Christopoulou, P.-E.

    2013-02-01

    We present a thorough modeling of new multicolor light curves of the low amplitude W UMa type binary system FI Boo obtained at the University of Patras Observatory "Mythodea", in spring 2012, in view of the presence of a detected third body. The absolute properties of the components were derived with the phoebe software and were tested extensively by heuristic scanning with parameter kicking in order to check the solution uniqueness.

  7. The absolute parameters of two W UMa type binaries in Ursa Majoris

    NASA Astrophysics Data System (ADS)

    Yılmaz, M.; Baştürk, Ö.; Özavcı, İ.; Şenavcı, H. V.; Selam, S. O.

    2015-01-01

    We present the results of simultaneous Wilson-Devinney analyses of light and radial velocity curves of two contact binaries in the constellation Ursa Majoris. We found that HH UMa is an A-subtype W UMa binary, which conflicts with the classification of Han et al. (2014) as a W-subtype. Seasonal variations observed in the light curves of the system are well explained with two cool stellar spots in our solution as opposed to the hot-spot based solution by Han et al. (2014), the presence of which would not cause such rapid period variations. The evolutionary status of the system is in agreement with the findings of our study. We modeled II UMa, another A-subtype overcontact binary, without surface spots and found that its both components have rather low surface gravities indicating an advanced state of evolution pointing to evolved subgiants. The high contact degree (f=74%) supports this viewpoint. Our analysis shows that there is a significant third light contribution, contradicting some of the previous analyses, which lack the detection of the secondary minima as total eclipses because they were not as evident as they are in our light curves.

  8. A cool stellar companion to the δ Scuti variable star GW UMa

    NASA Astrophysics Data System (ADS)

    Wang, S.-M.; Qian, S.-B.; Li, L.-J.; Zhu, L.-Y.; Zhao, E.-G.; Zhou, X.

    2015-01-01

    GW UMa is a new high-amplitude δ Scuti variable star with a period of 0d.20319367. By using a few new determined times of light maximum together with those collected from the literature, the changes in Observed-Calculated (O-C) diagram were analyzed. It is discovered that the O-C curve of GW UMa shows a cyclic variation with a period of 13.2 years and a semi-amplitude of 0.0023 days. The periodic variation was analyzed for the light-travel time effect that may be due to the presence of a stellar companion. The mass of the stellar companion is determined to be M2 sin i=0.11(±0.01)M⊙ when a mass of 1.76 M⊙ for GW UMa is adopted. The two component stars in the binary system are orbiting each other at an orbital separation about 6.5(±0.8) AU. For orbital inclinations i⩾22.6°, the mass of the companion star would be M2<0.3M⊙ and it is a fully convective star. The detection suggests that hidden stellar companions to bright stars may be not unusual.

  9. UBVRI analysis of the totally eclipsing extreme mass ratio W UMa binary, GSC 3208 1986

    SciTech Connect

    Samec, R. G.; Kring, J. D.; Robb, Russell; Van Hamme, W.; Faulkner, D. R.

    2015-03-01

    GSC 3208 1986 is an NSVS and TYCHO binary, first observed from 1999 to 2000. It is a W UMa binary with a period of 0.405 days. The present observations were taken in 2012 September and are of high precision, averaging a standard deviation of better than 5 mmag. The amplitude of the light curve is very nearly 0.5 mag yet it undergoes total eclipses. Dominion Astrophysical Observatory spectra give an F3V type (T∼6900 K) for the system, the earliest of the extreme mass ratio W UMa binaries. The linear period determination of 0.4045672 days was calculated with the two sets of epochs available. An early NSVS light curve reveals that the period has been smoothly decreasing over its past 12,000 orbits. The binary may be undergoing sinusoidal oscillations due to the presence of a third body, possibly with a period of 23±3 years. The high inclination of 85° results in a long duration secondary total eclipse, lasting some 49.5 minutes. Findings indicate that GSC 3208 1986 is an immaculate extreme mass ratio, q(m{sub 2}/m{sub 1}) = 0.24, A-type W UMa binary.

  10. Cosmoeducação: uma proposta para o ensino de astronomia

    NASA Astrophysics Data System (ADS)

    Medeiros, L. A. L.; Jafelice, L. C.

    2003-08-01

    Entende-se por cosmoeducação o desenvolvimento vivencial da unidade homem-cosmo. Este conceito é norteado pela psicologia transpessoal, que estuda o ser humano em sua totalidade, onde suas relações ecológicas e cósmicas são de grande importância. Constata-se uma necessidade latente no ser humano moderno em resgatar uma relação holística com o Universo. Neste trabalho exploramos meios de cultivar a consciência de que o ser humano constitui parte integrante do cosmo e se relaciona com este com o objetivo de promover em si uma percepção ambiental mais ampla. Nossa hipótese de trabalho inicial foi que o ensino de conteúdos básicos em astronomia realizado através de uma abordagem holística, que incorpore práticas vivenciais correlacionadas àqueles conteúdos, pode despertar no indivíduo sua identidade cósmica. O método que utilizamos é o fenomenológico e o universo desta pesquisa é um grupo de estudantes da disciplina de Astronomia (Curso de Licenciatura em Geografia/UFRN), onde realizamos observação participante, entrevistas, depoimentos e as práticas vivenciais mencionadas. Neste caso estamos desenvolvendo e adaptando exercícios de algumas técnicas terapêuticas de psicologia transpessoal, que um de nós (LALM) tem aplicado no contexto clínico, para trabalhar aspectos cognitivos envolvidos naquele processo de conscientização cósmica. Resultados parciais claramente referendam a hipótese inicial. Um resultado a destacar é fruto de uma dinâmica de representação corporal interiorizada do eclipse lunar, envolvendo um pequeno grupo daqueles estudantes, na qual conteúdos míticos afloraram de maneira espontânea e contundente para todos, sugerindo ressonância, ou pelo menos isomorfismo, entre o macro e o microcosmo. Este e outros resultados são discutidos em detalhe neste trabalho. (PPGECNM/UFRN; PRONEX/FINEP; NUPA/USP; Temáticos/FAPESP).

  11. Infrared photometry of the RS CVn short-period systems - XY UMa and WY Cnc

    SciTech Connect

    Arevalo, M.J.; Lazaro, C. )

    1990-03-01

    Infrared J and K light curves of two RS CVn short-period systems, XY UMa and WY Cnc, are presented. Both systems show similar variability in the infrared to that observed in the visual. From the colors an infrared excess is inferred for the primary component of both systems. A new determination of their geometrical elements is presented and the resulting parameters are compared to those previously obtained from visible photometry. The light curves show peculiarities that may indicate the presence of gas streams in the systems. 27 refs.

  12. The photometric solution of W UMa-type star BW Draconis

    NASA Astrophysics Data System (ADS)

    Zhou, Hong-Nan; Leung, Kam-Ching

    1988-10-01

    The photometric solutions of W UMa-type binary BW Dra have been determined by applying the Wilson and Devinney Code to UBV observations of Rucinski and Kaluzny. It is shown that BW Dra is corresponding to a system with an overcontact configuration. A smaller mass ratio q = 0.392 and UBV light curves give converging solutions with non-zero third light. It is proved that the components of BW Dra are older stars (the spectral types are G0 and G3, respectively). According to the photometric solution and spectroscopic results of Batten and Lu, the absolute parameters are presented, too.

  13. Thorough analysis and deep insight into the low amplitude W UMa type system FI Boo

    NASA Astrophysics Data System (ADS)

    Papageorgiou, A.

    2013-09-01

    We present results of the modeling of new multicolor light curves of the low amplitude W UMa type binary system FI Boo obtained at the University of Patras Observatory "Mythodea", in spring 2012, in view of the presence of a detected third body that may play an important role in the formation and evolution. The absolute properties of the components have been derived from spectroscopic data with the PHOBE software and are tested extensively by heuristic scanning and parameter kicking in order to check the solution uniqueness. The classification as A or W subtype, the formation and the evolutionary status of the binary are also investigated in detail.

  14. The highest rate orbital period increasing contact binary LP UMa revisited

    NASA Astrophysics Data System (ADS)

    Guo, D.-F.; Li, K.; Hu, S.-M.; Jiang, Y.-G.; Gao, D.-Y.; Chen, X.

    2016-04-01

    Complete BV(RI)c photometry for the contact binary LP UMa was derived on 2015 February 23 using the 1.0 m telescope at Weihai Observatory of Shandong University. By compiling 66 newly determined times of light minimum with those published in the literature, we investigated the orbital period variation of this binary star. A possible cyclic variation, with a period of 14.84 years and an amplitude of 0.0031 days, was discovered to be superimposed on a long-term period increase (9.32 s century-1). The highest rate of orbital period increase was confirmed, which can be explained by the mass transfer from the less massive component to the more massive one. The cyclic period oscillation was possibly caused by the light travel time effect due to the presence of a third body. The multiple light curves were simultaneously analysed using the W-D program. It was found that LP UMa has a mass ratio of q = 0.331 , a contact degree of f = 7.9 % , and the temperature difference between the two components was only about 90 K, which are quite different with the previous results. A hot spot on the primary component was employed to explain the asymmetric light curve of this binary.

  15. LONG-TERM PHOTOMETRIC ANALYSIS OF THE ACTIVE W UMa-TYPE SYSTEM TU BOOTIS

    SciTech Connect

    Coughlin, Jeffrey L.; Dale, Horace A. III; Williamon, Richard M.

    2008-09-15

    We present multicolor light curves for the W UMa-type eclipsing binary TU Boo for two epochs separated by 22 years. An analysis of the O - C diagram indicates the earlier observations took place right in the middle of a major period change, thus allowing for a unique study on mass transfer and period changes in this W UMa-type system. We compute model fits to our light curves, along with the only other published set, using the Wilson-Devinney program, and find temporally correlated changes in the size of the secondary component with anomalies in the O - C diagram. We investigate the cause of these changes and find support for the existence of rapid, large-scale mass transfer between the components. We postulate that this interaction allows them to maintain nearly equal surface temperatures despite having achieved only marginal contact. We also find support for the evolutionary scenario in which TU Boo has undergone a mass ratio reversal in the past, due to large-scale mass transfer so that what is presently the secondary component of TU Boo is in an advanced evolutionary state, oversized due to a helium-enriched core, with a total system age of {>=}10 Gyr.

  16. Chromospheric activity on late-type star DM UMa using high-resolution spectroscopic observations

    NASA Astrophysics Data System (ADS)

    Zhang, LiYun; Pi, QingFeng; Han, Xianming L.; Chang, Liang; Wang, Daimei

    2016-06-01

    We present new 14 high-resolution echelle spectra to discuss the level of chromospheric activity of DM UMa in {He I} D3, {Na I} D1, D2, Hα, and {Ca II} infrared triplet lines (IRT). It is the first time to discover the emissions above the continuum in the {He I} D3 lines on 2015 February 9 and 10. The emission on February 9 is the strongest one ever detected for DM UMa. We analysed these chromospheric active indicators by employing the spectral subtraction technique. The subtracted spectra reveal weak emissions in the {Na I} D1, D2 lines, strong emission in the Hα line, and clear excess emissions in the {Ca II} IRT lines. Our values for the EW8542/EW8498 ratio are on the low side, in the range of 1.0-1.7. There are also clear phase variations of the level of chromospheric activity in equivalent width (EW) light curves in these chromospheric active lines (especially the Hα line). These phenomena might be explained by flare events or rotational modulations of the level of chromospheric activity.

  17. Survey of Period Variations of Superhumps in SU UMa-Type Dwarf Novae. IV. The Fourth Year (2011-2012)

    NASA Astrophysics Data System (ADS)

    Kato, Taichi; Hambsch, Franz-Josef; Maehara, Hiroyuki; Masi, Gianluca; Miller, Ian; Noguchi, Ryo; Akasaka, Chihiro; Aoki, Tomoya; Kobayashi, Hiroshi; Matsumoto, Katsura; Nakagawa, Shinichi; Nakazato, Takuma; Nomoto, Takashi; Ogura, Kazuyuki; Ono, Rikako; Taniuchi, Keisuke; Stein, William; Henden, Arne; de Miguel, Enrique Kiyota, Seiichiro; Dubovsky, Pavol A.; Kudzej, Igor; Imamura, Kazuyoshi; Akazawa, Hidehiko; Takagi, Ryosuke; Wakabayashi, Yuya; Ogi, Minako; Tanabe, Kenji; Ulowetz, Joseph; Morelle, Etienne; Pickard, Roger D.; Ohshima, Tomohito; Kasai, Kiyoshi; Pavlenko, Elena P.; Antonyuk, Oksana I.; Baklanov, Aleksei V.; Antonyuk, Kirill; Samsonov, Denis; Pit, Nikolaj; Sosnovskij, Aleksei; Littlefield, Colin; Sabo, Richard; Ruiz, Javier; Krajci, Thomas; Dvorak, Shawn; Oksanen, Arto; Hirosawa, Kenji; Goff, William N.; Monard, Berto; Shears, Jeremy; Boyd, David; Voloshina, Irina B.; Shugarov, Sergey Yu.; Chochol, Drahomir; Miyashita, Atsushi; Pietz, Jochen; Katysheva, Natalia; Itoh, Hiroshi; Bolt, Greg; Andreev, Maksim V.; Parakhin, Nikolai; Malanushenko, Viktor; Martinelli, Fabio; Denisenko, Denis; Stockdale, Chris; Starr, Peter; Simonsen, Mike; Tristram, Paul J.; Fukui, Akihiko; Tordai, Tamas; Fidrich, Robert; Paxson, Kevin B.; Itagaki, Koh-ichi; Nakashima, Youichirou; Yoshida, Seiichi; Nishimura, Hideo; Kryachko, Timur V.; Samokhvalov, Andrey V.; Korotkiy, Stanislav A.; Satovski, Boris L.; Stubbings, Rod; Poyner, Gary; Muyllaert, Eddy; Gerke, Vladimir; MacDonald, Walter, II; Linnolt, Michael; Maeda, Yutaka; Hautecler, Hubert

    2013-02-01

    Continuing the project described by Kato et al. (2009, PASJ, 61, S395), we collected times of superhump maxima for 86 SU UMa-type dwarf novae, mainly observed during the 2011-2012 season. We confirmed general trends recorded in our previous studies, such as the relation between period derivatives and orbital periods. There are some systems showing positive period derivatives despite the long orbital period. We observed the 2011 outburst of the WZ Sge-type dwarf nova BW Scl, and recorded an O - C diagram similar to those of previously known WZ Sge-type dwarf novae. The WZ Sge-type dwarf nova OT J184228.1+483742 showed an unusual pattern of double outbursts composed of an outburst with early superhumps and one with ordinary superhumps. We propose an interpretation that a very small growth rate of the 3:1 resonance due to an extremely low mass-ratio led to quenching the superoutburst before the ordinary superhump appeared. We systematically studied ER UMa-type dwarf novae, and found that V1159 Ori showed positive superhumps similar to ER UMa in the 1990s. The recently recognized ER UMa-type object BK Lyn dominantly showed negative superhumps, and its behavior was very similar to the present-day state of ER UMa. The pattern of period variations in AM CVn-type objects was very similar to that of short-period hydrogen-rich SU UMa-type dwarf novae, making them a helium analogue of hydrogen-rich SU UMa-type dwarf novae. SBS 1108+574, a peculiar hydrogen-rich dwarf nova below the period minimum, showed a very similar pattern of period variations to those of short-period SU UMa-type dwarf novae. The mass-ratio derived from the detected orbital period suggests that this secondary is a somewhat evolved star whose hydrogen envelope was mostly stripped during the mass-exchange. CC Scl, MASTER OT J072948.66+593824.4, and OT J173516.9+154708 showed only low-amplitude superhumps with complex profiles. These superhumps are likely to be a combination of two closely separated periods.

  18. VizieR Online Data Catalog: Search for UMa group companions (Ammler-von Eiff+, 2016)

    NASA Astrophysics Data System (ADS)

    Ammler-von Eiff, M.; Bedalov, A.; Kranhold, C.; Mugrauer, M.; Schmidt, T. O. B.; Neuhaeuser, R.; Errmann, R.

    2016-03-01

    The astrometric and photometric data of companion candidates of members of the Ursa Major (UMa) group are presented. They were identified by coronagraphic observations obtained with the S27 camera of NACO at the ESO VLT, Chile, in 2003-2006. Most of the candidates were observed a second time to assess whether they share the proper motion of the star. For this purpose, the change in position with respect to the star was compared to the stellar parallactic and proper motion known from Hipparcos. This way, all candidates with two epochs of observations were rejected being distant background objects. The layout of the included table deviates from the article version to facilitate automatic reading, i.e. the epoch date and the primary name are added to each row, and the candidate identifier is added to the corresponding data set for each epoch. (2 data files).

  19. SU UMa dwarf novae in the period gap showing the negative superhumps

    NASA Astrophysics Data System (ADS)

    Pavlenko, Elena

    2016-07-01

    There are only two known up to date SU UMa dwarf novae in the period gap showing the negative superhumps, namely, MN Dra and 1RXS J003828.7+250920. We present the results of X-ray and spectral investigation for 1RXS J003828.7+250920, multicolor optical investigation for 1RXS J003828.7+250920 and MN Dra at different stages of their activity in 2011-2016 years. We discuss a finding of the accretion disc radius for both dwarf novae, its variation during separated intervals between outbursts for MN Dra as well as high and low temperature regions in quiescent accretion disk for 1RXS J003828.7+250920.

  20. Three X-ray flares near primary eclipse of the RS CVn binary XY UMa

    NASA Astrophysics Data System (ADS)

    Gong, Hang; Osten, Rachel; Maccarone, Thomas; Reale, Fabio; Liu, Ji-Feng; Heckert, Paul A.

    2016-08-01

    We report on an archival X-ray observation of the eclipsing RS CVn binary XY UMa (P orb ≈ 0.48 d). In two Chandra ACIS observations spanning 200 ks and almost five orbital periods, three flares occurred. We find no evidence for eclipses in the X-ray flux. The flares took place around times of primary eclipse, with one flare occurring shortly (< 0.125 P orb) after a primary eclipse, and the other two happening shortly (< 0.05 P orb) before a primary eclipse. Two flares occurred within roughly one orbital period (Δα ≈ 1.024 P orb) of each other. We analyze the light curve and spectra of the system, and investigate coronal length scales during both quiescence and flares, as well as the timing of the flares. We explore the possibility that the flares are orbit-induced by introducing a small orbital eccentricity, which is quite challenging for this close binary.

  1. Ultra-weak magnetic fields in Am stars: β UMa and θ Leo

    NASA Astrophysics Data System (ADS)

    Blazère, A.; Petit, P.; Lignières, F.; Aurière, M.; Böhm, T.; Wade, G.

    2014-12-01

    An extremely weak circularly-polarized signature was recently discovered in spectral lines of the chemically peculiar Am star Sirius A (Petit et al. 2011). This signal was interpreted as a Zeeman signature related to a sub-gauss longitudinal magnetic field, constituting the first detection of a surface magnetic field in an Am star. We present here ultra-deep spectropolarimetric observations of two other bright Am stars, β UMa and θ Leo, observed with the NARVAL spectropolarimeter. The line profiles of the two stars display circularly-polarized signatures similar in shape to the observations gathered for Sirius A. These new detections suggest that very weak magnetic fields may be present in the photospheres of a significant fraction of intermediate-mass stars, although the strongly asymmetric Zeeman signatures measured so far in Am stars (featuring a prominent positive lobe and no detected negative lobe) are not expected in the standard theory of the Zeeman effect.

  2. Mapping of surface activity on the W UMa-type system VW Cephei

    NASA Technical Reports Server (NTRS)

    Bradstreet, David H.; Guinan, Edward F.

    1988-01-01

    After multifilter photometry of the W UMa-type contact binary VW Cep (P = 6.67 hr; G5V + K0V) in 1986/87 revealed large asymmetries in the light curves believed to be caused by large, cool starspot regions on the surface of the larger stars, in Apr. 1987 it was observed with IUE to study the chromospheres and transition regions of the components. During one complete orbital cycle, three SWP and four LWP low dispersion spectra were obtained, including and then excluding the suspected active region. Phase dependent TR line emission strengths were found, most notably C IV, which is 50 percent stronger when the spot region is most visible. The results could be important because VW Cep represents an extreme case for studying stellar dynamo theory and observations can play a crucial role in the unterstanding of magnetic fields and activity cycles in rapidly rotating solar-like stars.

  3. Orbital Period Investigations of Two W UMa-type Binaries: AH Aur and V728 Her

    NASA Astrophysics Data System (ADS)

    Yu, Yun-Xia; Xiang, Fu-Yuan; Hu, Ke

    2016-04-01

    The orbital period changes of two W UMa-type binaries, AH Aur and V728 Her, are investigated based on all available times of the light minimum taken from the databases and literature. It is revealed that the orbital period of AH Aur shows a long-term decrease at a rate of {dP}/{dt}=-2.491× {10}-7 days yr-1. For V728 Her, we find that the orbital period exhibits a secular increase at a rate of {dP}/{dt}=3.793× {10}-7 days yr-1. The secular period changes suggest that AH Aur and V728 Her are undergoing rapid mass transfer between the primary star and the secondary companion.

  4. Sonification of Kepler Field SU UMa Cataclysmic Variable Stars V344 Lyr and V1504 Cyg

    NASA Technical Reports Server (NTRS)

    Tutchton, Roxanne M.; Wood, Matt A.; Still, Martin D.; Howell, Steve B.; Cannizzo, John K.; Smale, Alan P.

    2012-01-01

    Sonification is the conversion of quantitative data into sound. In this work we explain the methods used in the sonification of light curves provided by the Kepler instrument from Q2 through Q6 for the cataclysmic variable systems V344 Lyr and V1504 Cyg . Both systems are SU UMa stars showing dwarf nova outbursts and superoutbursts as well as positive and negative superhumps. Focused sonifications were done from average pulse shapes of each superhump, and separate sonifications of the full, residual light curves were done for both stars. The audio of these data reflected distinct patterns within the evolutions of supercycles and superhumps that matched pervious observations and proved to be effective aids in data analysis.

  5. Precise Orbital Solutions for KEPLER Eclipsing Binaries of W UMa Type Showing Total Eclipses

    NASA Astrophysics Data System (ADS)

    Şenavcı, H. V.; Doǧruel, M. B.; Nelson, R. H.; Yılmaz, M.; Selam, S. O.

    2016-09-01

    We aim to discover the accuracy of photometric mass ratios (q ph) determined for eclipsing binary stars, in the case of the system having at least one `flat bottom' as a minimum profile, as well as the accuracy of data used in that sense. Within this context, we present the results of two-dimensional grid search (q - i) for some W UMa-type eclipsing binaries showing total eclipses, based on the high precision photometric data provided by the KEPLER Mission. The radial velocity data obtained for KIC10618253 in this study, enables us to compare both q ph and the corresponding spectroscopic mass ratio (q sp) values. The results indicate that the high precision photometric data for overcontact eclipsing binaries showing total eclipses allow us to obtain the photometric mass ratios as accurate as the spectroscopic values.

  6. Light Curve Analysis for W UMa-Type Eclipsing Binary Star Systems

    NASA Astrophysics Data System (ADS)

    Henderson, Scott; Peach, N.; Olsen, T.

    2006-12-01

    We report results from summer 2006 in an ongoing study of eclipsing binary stars. Our investigations have focused on the measurement and interpretation of light curves for W UMa-type systems 44i Boötis and VW Cephei. These contact binaries have component stars of spectral type G, and revolve with periods of 6.43 and 6.67 hours. Dome automation and scripting capabilities introduced this summer have significantly reduced experimental uncertainties in our data. In support of previous findings we continue to observe an increase in the orbital period of 44i Boo at a rate of 10.4 µs/epoch or 14.2 ms/yr. Residuals computed after incorporating the increasing period suggest an underlying sinusoidal oscillation with a 61.5 year period and amplitude of 648 seconds. AAPT Member Thomas Olsen is sponsoring the lead presenter, SPS Member Scott Henderson, and the co-presenter, SPS Member Nick Peach.

  7. Photometric and Period Investigation of the Late F-type Overcontact Binary II UMa

    NASA Astrophysics Data System (ADS)

    Zhou, X.; Qian, S.-B.; Zhang, J.; Zhang, B.; Kreiner, J.

    2016-03-01

    II UMa is a late F-type (F5) contact binary with a close-in tertiary and a distant visual companion. According to the four-color (B V RcIc) light curves’ solutions of II UMa, it is a high fill-out (f = 86.6%) and low-mass ratio (q = 0.172) contact binary system, which indicates that it is at the late evolutionary stage of late-type tidal-locked binary stars. The masses of the primary star and secondary star are calculated to be {M}1=1.99{M}⊙ and {M}2=0.34{M}⊙ . The primary star has evolved from the zero-age main sequence, but it still appeared before the terminal-age main sequence, and the secondary star is even more evolved. Considering the mass ratio ({M}3/{M}1=0.67) obtained by spectroscopic observations, the mass of the close-in tertiary is estimated to be {M}3=1.34{M}⊙ . The period variations of the binary system are investigated for the first time. According to the observed-calculated (O-C) curve analysis, a continuous period increase at a rate of {dP}/{dt}=4.88× {10}-7 {day} {{yr}}-1 is determined. The parabolic variation in the O-C curve may be part of a cyclic period of change, or the combined period of change of a parabolic variation and a cyclic one. More instances of minimum light are needed to confirm this. The presence of the tertiary component may play an important role in the formation and evolution of this binary system by drawing angular momentum from the central system during the pre-contact stage.

  8. The LEECH Exoplanet Imaging Survey: Orbit and Component Masses of the Intermediate-age, Late-type Binary NO UMa

    NASA Astrophysics Data System (ADS)

    Schlieder, Joshua E.; Skemer, Andrew J.; Maire, Anne-Lise; Desidera, Silvano; Hinz, Philip; Skrutskie, Michael F.; Leisenring, Jarron; Bailey, Vanessa; Defrère, Denis; Esposito, Simone; Strassmeier, Klaus G.; Weber, Michael; Biller, Beth A.; Bonnefoy, Mickaël; Buenzli, Esther; Close, Laird M.; Crepp, Justin R.; Eisner, Josh A.; Hofmann, Karl-Heinz; Henning, Thomas; Morzinski, Katie M.; Schertl, Dieter; Weigelt, Gerd; Woodward, Charles E.

    2016-02-01

    We present high-resolution Large Binocular Telescope LBTI/LMIRcam images of the spectroscopic and astrometric binary NO UMa obtained as part of the LBT Interferometer Exozodi Exoplanet Common Hunt exoplanet imaging survey. Our H-, Ks-, and L‧-band observations resolve the system at angular separations <0.″09. The components exhibit significant orbital motion over a span of ∼7 months. We combine our imaging data with archival images, published speckle interferometry measurements, and existing spectroscopic velocity data to solve the full orbital solution and estimate component masses. The masses of the K2.0 ± 0.5 primary and K6.5 ± 0.5 secondary are 0.83 ± 0.02 M⊙ and 0.64 ± 0.02 M⊙, respectively. We also derive a system distance of d = 25.87 ± 0.02 pc and revise the Galactic kinematics of NO UMa. Our revised Galactic kinematics confirm NO UMa as a nuclear member of the ∼500 Myr old Ursa Major moving group, and it is thus a mass and age benchmark. We compare the masses of the NO UMa binary components to those predicted by five sets of stellar evolution models at the age of the Ursa Major group. We find excellent agreement between our measured masses and model predictions with little systematic scatter between the models. NO UMa joins the short list of nearby, bright, late-type binaries having known ages and fully characterized orbits. Based on data obtained with the STELLA robotic telescope in Tenerife, an AIP facility jointly operated by AIP and IAC.

  9. Astronomia cultural e meio ambiente segundo uma abordagem holística

    NASA Astrophysics Data System (ADS)

    Jafelice, L. C.

    2003-08-01

    Neste trabalho ampliamos a discussão da abordagem holística para o ensino de astronomia que temos desenvolvido nos últimos anos, analisamos novos resultados e apresentamos exemplos práticos para interessados em experimentá-la. A constatação básica a orientar este enfoque é que cursos introdutórios em astronomia costumam ser excessiva e prematuramente técnicos, além de assumirem uma visão tradicional, muito estreita, do que seja educação científica, herdada da era cartesiana e positivista da ciência. Fundamentamos porque é importante que elementos de astronomia cultural ofereçam o mote e constituam o eixo norteador daqueles cursos e porque é urgente revermos a visão que temos da relação entre astronomia e meio ambiente. Um ponto central nesta abordagem é explorar formas de reativar e atualizar uma relação orgânica com o meio e excitar a consciência de nossa inevitável e profunda interdependência com ele em nível cósmico. Neste trabalho exemplificamos a possibilidade de concretização desta proposta em três diferentes situações: disciplinas de cursos de licenciatura em geografia e em física; escolas de nível fundamental; e, neste caso ainda a ser implementada, comunidades carentes. Estes casos envolvem públicos e espaços diferenciados para educação formal e não-formal. Dos casos já implementados, destacamos os resultados alcançados pelos alunos: enriquecimento cultural, aprendizagem significativa de conteúdos astronômicos tradicionais; mudanças de comportamento, incorporando contato diário com o céu; e freqüentes vivências de sentimentos empáticos que redirecionam a relação com a natureza e a consciência ecológica global. Além disto, para interessados em aplicar esta proposta, também socializamos procedimentos e cuidados para a implementação de ações alternativas consonantes com a mesma. (PPGECNM/UFRN; PRONEX/FINEP; NUPA/USP; Temáticos/FAPESP)

  10. A photometric study of the W UMa-type system U Pegasi

    NASA Astrophysics Data System (ADS)

    Djurašević, G.; Rovithis-Livaniou, H.; Rovithis, P.; Erkapić, S.; Milovanović, N.

    2001-03-01

    In the present study, the activity of the eclipsing binary of the W UMa-type system U Peg is examined by analysing the photoelectric observations covering the period from 1950 to 1989. During this period, the light curves show significant differences and asymmetries. The analysis of the corresponding light curves is made using Djurašević's inverse problem method. To explain the light-curve asymmetries and variations, we used a Roche model that involved regions containing spots on the components. The analysis shows that the system U Peg is in an overcontact configuration (fover ~ 14.9%). The Roche model with spotted areas on the cooler component yields a good fit of the observations for the whole set of the analysed light curves without any changes of the basic system parameters. This indicates that the complex nature of the light-curve variations during the examined period can be explained by the evolution and motion of spotted areas on the cooler component. According to the obtained results, the spotted areas cover a significant part of the stellar surface; the changes in their location and size with time are examined.

  11. Orbital Period Variation and Morphological Light Curve Studies for the W UMa Binary BB Pegasi

    NASA Astrophysics Data System (ADS)

    Hanna, Magdy A.; Awadalla, Nabil S.

    2011-06-01

    The photometric light curves of the W-type W UMa eclipsing contact binary system BB Pegasi have been found to be extremely asymmetric over all the observed 63 years in all wavelengths UBVR. The light curves have been characterized by occultation primary minima. So, the morphology of these light curves has been studied in view of these different asymmetric degrees. The system shows a distinct O'Connell effect as well as depth variation. A 22.96 years cycle, of dark spots group, has been determined for the system combined with about the same cycling for the depth variations (22.78 yr). Also, an analysis of the measurements of mid-eclipse times of BB Peg has been presented. The analysis indicates a period decrease of 5.62× 10-8 d/yr, which can be interpreted in terms of mass transfer of rate -4.38 × 10-8 M_⊙/yr, from the more to the less massive component. The O-C diagram shows a damping sine wave covering two different cycles of 17.0 yr and 12.87 yr with amplitudes equal to 0.0071 and 0.0013 day, respectively. These unequal durations show a non periodicity which may be explained as a result of magnetic activity cycling variations due to star spots. The obtained characteristics are consistent when applying Applegate's (1992) mechanism.

  12. Ultra-weak magnetic fields in Am stars: β UMa and θ Leo

    NASA Astrophysics Data System (ADS)

    Blazère, A.; Petit, P.; Lignières, F.; Aurière, M.; Ballot, J.; Böhm, T.; Folsom, C.; Ariste, A. López; Wade, G. A.

    2015-10-01

    An extremely weak circularly-polarized signature was recently detected in the spectral lines of the Am star Sirius A. With a prominent positive lobe, the shape of the phase-averaged Stokes V line profile is atypical of stellar Zeeman signatures, casting doubts on its magnetic origin. We report here on ultra-deep spectropolarimetric observations of two more bright Am stars: β Uma and θ Leo. Stokes V line signatures are detected in both objects, with a shape and amplitude similar to the one observed on Sirius A. We demonstrate that the amplitude of the Stokes V line profiles depend on various line parameters (Landé factor, wavelength, depth) as expected from a Zeeman signature, confirming that extremely weak magnetic fields are likely present in a large fraction of Am stars. We suggest that the strong asymmetry of the polarized signatures, systematically observed so far in Am stars and never reported in strongly magnetic Ap stars, bears unique information about the structure and dynamics of the thin surface convective shell of Am stars.

  13. THE MULTI-COLOR LIGHT CURVES OF THE W UMa TYPE CONTACT BINARY EP ANDROMEDAE

    SciTech Connect

    Liao, W.-P.; Qian, S.-B.; Li, K.; He, J.-J.; Zhao, E.-G.; Zhou, X.

    2013-10-01

    New multi-color CCD photometric light curves of the eclipsing binary EP And were obtained over six nights in 2006, 2011, and 2012. Using the Wilson-Devinney code, we computed the photometric elements of this system. It was discovered that EP And is a W-type W UMa contact binary system with a mass ratio of q = 2.685 and a degree of contact factor f = 24.9%, rather than an A-type system. Combining 28 newly determined times of minimum light derived from 1999 to 2012 with others collected from the literature, a long-term increase (dP/dt = +5.22 Multiplication-Sign 10{sup -8} days yr{sup -1}) with a sinusoidal variation (A = 0.0109 days; T = 40.89 yr) in the orbital period was found. The orbital period secular increases may be interpreted as conservative mass transfer from the less massive component to the more massive one, and cyclic variations of the orbital period may be caused by the light-travel time effect through the presence of a third body. The evolutionary status and the age of the system are also discussed.

  14. Light curve modeling of the short-period W UMa star GSC 02049-01164

    NASA Astrophysics Data System (ADS)

    Fox-Machado, Lester; Echevarria, Juan; Gonzalez-Buitrago, Diego; Michel, Raul

    2015-08-01

    The preliminary results of an analysis of the time-series photometric data of the binary star GSC 02049-01164 (ROTSE1 J164341.65+251748.1) are presented.GSC 02049-01164 was observed for eight consecutive nights from 2013, May 31 to June 07 UT with the 0.84m telescope of the San Pedro Martir Observatory in Mexico. The data were acquired through a Johnson V filter. The propierties of the GSC 02040-01164 light curve are consistent with a short period contact binary of W UMa type. The light curve is characterized by a small difference between the two out-of-eclipse maxima by about 0.035 mag and a flat bottom at the secondary minimum due to a total eclipse. Moreover, the primary and secondary eclipses accur almost at 0.5 phase interval suggesting a circular orbit. The period of the binary is 0.3256 d. In an effort to gain a better understanding of the binary system and determine its physical properties we have analyzed the light curve with the software PHOEBE V.0 0.31a. We have found that GSC 02049-01164 binary system has a mass ratio of ~ 0.42, an inclination of ~ 85 degrees, a semi-major axis of ~ 2.23 Rsun. The degree of overcontact of the stellar components is about 13 %.

  15. FIRST MODERN PHOTOMETRIC INVESTIGATION OF THE PUZZLING W UMa TYPE CLOSE BINARY SYSTEM OF TZ BOOTIS

    SciTech Connect

    Christopoulou, P.-E.; Parageorgiou, A.; Chrysopoulos, I.

    2011-10-15

    New CCD photometric BVRI observations of the puzzling W UMa type binary star, TZ Bootis, are presented from our observations in 2010. By using the updated version of the Wilson-Devinney code, the first modern photometric solution is deduced from new photometric observations and published spectroscopic data. This low mass ratio binary turns out to be a deep overcontact system with f = 52% of A-subtype. A spot model has been applied to fit the particular features of light curves. Based on our seven new light minimum times and all others compiled from the literature over 70 yr, we studied the orbital period from the O-C curve. It is found that a 31.2 yr cyclic variation exists with an amplitude of 0.033 days, overlaying a secular decrease at a rate of dP/dt = -2.1 x 10{sup -8} days yr{sup -1}. The cyclic period change may indicate that TZ Boo is a triple or a quadruple system as confirmed from the published spectroscopic data. The long-term orbital period decrease is interpreted by mass transfer from the more to the less massive component and/or angular momentum loss by the magnetic breaking which would cause the overcontact degree to increase and finally the binary will evolve into a single rapidly rotating star.

  16. Photometric Study of AH Cancri, a W UMa-Type System in M67

    NASA Astrophysics Data System (ADS)

    Zhang, X. B.; Zhang, R. X.; Deng, L.

    2005-02-01

    We present time-series CCD photometry of AH Cnc, a W UMa-type binary system in the old open cluster M67. Over 3500 measurements in two filters were recorded on 15 nights from 2001 to 2004. From the data, 17 new times of minima for the eclipsing binary were obtained, from which a new ephemeris was derived. The orbital period of the system is refined as 0.36045754 days. A photometric analysis for the obtained light curves is performed based on the Wilson-Devinney code. The photometric solutions reveal a totally eclipsing contact configuration for AH Cnc. The photometric mass ratio is determined to be 0.149+/-0.002. The masses and radii of the components are estimated as 1.21+/-0.08 Msolar and 1.36+/-0.03 Rsolar for the primary and 0.18+/-0.02 Msolar and 0.62+/-0.02 Rsolar for the secondary, respectively. The evolutionary status of the contact system is briefly discussed.

  17. Determination of parameters of W UMa-type systems - V757 Cen, GW Cep, BX Peg, AH VIR

    NASA Astrophysics Data System (ADS)

    Kaluzny, J.

    Photoelectric light curves of four W UMa-type systems (V757 Cen, GW Cep, BX Peg, AH Vir) have been solved using the Ruciński code. The solutions were obtained for two assumed values of the gravity darkening exponent (β = 0.00 and β = 0.08). It is concluded that it is hard to distinguish between those two values basing on the wide band photometry in the visual wavelength domain.

  18. Survey of period variations of superhumps in SU UMa-type dwarf novae. V. The fifth year (2012-2013)

    NASA Astrophysics Data System (ADS)

    Kato, Taichi; Hambsch, Franz-Josef; Maehara, Hiroyuki; Masi, Gianluca; Nocentini, Francesca; Dubovsky, Pavol A.; Kudzej, Igor; Imamura, Kazuyoshi; Ogi, Minako; Tanabe, Kenji; Akazawa, Hidehiko; Krajci, Thomas; Miller, Ian; de Miguel, Enrique; Henden, Arne; Noguchi, Ryo; Ishibashi, Takehiro; Ono, Rikako; Kawabata, Miho; Kobayashi, Hiroshi; Sakai, Daisuke; Nishino, Hirochika; Furukawa, Hisami; Masumoto, Kazunari; Matsumoto, Katsura; Littlefield, Colin; Ohshima, Tomohito; Nakata, Chikako; Honda, Satoshi; Kinugasa, Kenzo; Hashimoto, Osamu; Stein, William; Pickard, Roger D.; Kiyota, Seiichiro; Pavlenko, Elena P.; Antonyuk, Oksana I.; Baklanov, Aleksei V.; Antonyuk, Kirill; Samsonov, Denis; Pit, Nikolaj; Sosnovskij, Aleksei; Oksanen, Arto; Harlingten, Caisey; Tyyskä, Jenni; Monard, Berto; Shugarov, Sergey Yu.; Chochol, Drahomir; Kasai, Kiyoshi; Maeda, Yutaka; Hirosawa, Kenji; Itoh, Hiroshi; Sabo, Richard; Ulowetz, Joseph; Morelle, Etienne; Michel, Raúl; Suárez, Genaro; James, Nick; Dvorak, Shawn; Voloshina, Irina B.; Richmond, Michael; Staels, Bart; Boyd, David; Andreev, Maksim V.; Parakhin, Nikolai; Katysheva, Natalia; Miyashita, Atsushi; Nakajima, Kazuhiro; Bolt, Greg; Padovan, Stefano; Nelson, Peter; Starkey, Donn R.; Buczynski, Denis; Starr, Peter; Goff, William N.; Denisenko, Denis; Kochanek, Christopher S.; Shappee, Benjamin; Stanek, Krzysztof Z.; Prieto, José L.; Itagaki, Koh-ichi; Kaneko, Shizuo; Stubbings, Rod; Muyllaert, Eddy; Shears, Jeremy; Schmeer, Patrick; Poyner, Gary; Rodríguez-Marco, Miguel

    2014-04-01

    Continuing the project described in Kato et al. (2009, PASJ, 61, S395), we collected times of superhump maxima for SU UMa-type dwarf novae mainly observed during the 2012-2013 season. We found three objects (V444 Peg, CSS J203937, and MASTER J212624) having strongly positive period derivatives despite the long orbital period (Porb). By using the period of growing stage (stage A) superhumps, we obtained mass ratios for six objects. We characterized nine new WZ Sge-type dwarf novae. We made a pilot survey of the decline rate in the slowly fading parts of SU UMa-type and WZ Sge-type outbursts. The decline time scale was found to generally follow an expected P_orb^{1/4} dependence, and WZ Sge-type outbursts also generally follow this trend. There are some objects which show slower decline rates, and we consider these objects good candidates for period bouncers. We also studied unusual behavior in some objects, including BK Lyn which made a transition from an ER UMa-type state to a novalike (standstill) state in 2013, and unusually frequent occurrences of superoutbursts in NY Ser and CR Boo. We applied the least absolute shrinkage and selection operator (Lasso) power spectral analysis, which has been proven to be very effective in analyzing the Kepler data, to the ground-based photometry of BK Lyn, and detected a dramatic disappearance of the signal of negative superhumps in 2013. We suggested that the mass-transfer rates did not strongly vary between the ER UMa-type state and novalike state in BK Lyn, and this transition was less likely caused by a systematic variation of the mass-transfer rate.

  19. Patterns of behavior in Kilauea's Halema`uma`u lava lake during 2011 and 1911

    NASA Astrophysics Data System (ADS)

    Patrick, M. R.; Orr, T. R.

    2011-12-01

    The past three and a half years of activity in the Halema`uma`u vent, at the summit of Kilauea Volcano, have provided a robust observational dataset and allowed us to generalize on many aspects of behavior in the lava lake. The current lava lake normally has been 100-150 m in diameter and contained deep (70-220 m) within a slowly enlarging, fume-filled crater. The lava level fluctuates over both long- and short-term intervals, over a total height range of about 150 m. Over the long term (days to weeks) the lava level correlates directly with summit tilt at a consistent rate, sympathetic with the frequent summit deflation-inflation (DI) events, indicating the lava level is related, in large part, to the pressure state of the summit magma reservoir. On a short term, the lava level experiences rise-fall cycles ("gas pistoning") of 10-20 m height changes, with time spans of minutes to hours, which are due to shallow accumulation and release of gas. The lava lake also abruptly dropped about 150 m during the March 2011 east-rift intrusion and Kamoamoa eruption, presumably due to the rapid evacuation of magma from the summit reservoir. The lava surface is composed of large (decameter-scale) crustal plates, whose size is inversely related to the surface migration velocity. The surface crust moves at a relatively slow velocity (often 0.2-1 m/s), similar to velocities at other lava lakes on Kilauea (Mauna Ulu, Kupaianaha) and elsewhere worldwide (Erebus, Erta Ale), and usually in a direction that is maintained for months. Spattering is generally continuous and directly linked to the circulation pattern; spattering normally occurs at the spot of lava downwelling. Spattering intensity correlates directly with seismic tremor levels, suggesting that the bulk of summit tremor is related to gas release from the lava surface. These characteristics of the modern lava lake have both important similarities and differences compared to the Halema`uma`u lava lake observed by

  20. Survey of Period Variations of Superhumps in SU UMa-Type Dwarf Novae

    NASA Astrophysics Data System (ADS)

    Kato, Taichi; Imada, Akira; Uemura, Makoto; Nogami, Daisaku; Maehara, Hiroyuki; Ishioka, Ryoko; Baba, Hajime; Matsumoto, Katsura; Iwamatsu, Hidetoshi; Kubota, Kaori; Sugiyasu, Kei; Soejima, Yuichi; Moritani, Yuuki; Ohshima, Tomohito; Ohashi, Hiroyuki; Tanaka, Junpei; Sasada, Mahito; Arai, Akira; Nakajima, Kazuhiro; Kiyota, Seiichiro; Tanabe, Kenji; Imamura, Kazuyoshi; Kunitomi, Nanae; Kunihiro, Kenji; Taguchi, Hiroki; Koizumi, Mitsuo; Yamada, Norimi; Nishi, Yuichi; Kida, Mayumi; Tanaka, Sawa; Ueoka, Rie; Yasui, Hideki; Maruoka, Koichi; Henden, Arne; Oksanen, Arto; Moilanen, Marko; Tikkanen, Petri; Aho, Mika; Monard, Berto; Itoh, Hiroshi; Dubovsky, Pavol A.; Kudzej, Igor; Dancikova, Radka; Vanmunster, Tonny; Pietz, Jochen; Bolt, Greg; Boyd, David; Nelson, Peter; Krajci, Thomas; Cook, Lewis M.; Torii, Ken'ichi; Starkey, Donn R.; Shears, Jeremy; Jensen, Lasse-Teist; Masi, Gianluca; Hynek, Tomáš; Nová; K, Rudolf; Kociá; N, Radek; Krá; L, Lukáš; Kučá; Ková, Hana; Kolasa, Marek; Štastný, Petr; Staels, Bart; Miller, Ian; Sano, Yasuo; de Ponthière, Pierre; Miyashita, Atsushi; Crawford, Tim; Brady, Steve; Santallo, Roland; Richards, Tom; Martin, Brian; Buczynski, Denis; Richmond, Michael; Kern, Jim; Davis, Stacey; Crabtree, Dustin; Beaulieu, Kevin; Davis, Tracy; Aggleton, Matt; Morelle, Etienne; Pavlenko, Elena P.; Andreev, Maksim; Baklanov, Alexander; Koppelman, Michael D.; Billings, Gary; Urbancok, L'ubomír; Ögmen, Yenal; Heathcote, Bernard; Gomez, Tomas L.; Voloshina, Irina; Retter, Alon; Mularczyk, Krzysztof; Zoczewski, Kamil; Olech, Arkadiasz; Kedzierski, Piotr; Pickard, Roger D.; Stockdale, Chris; Virtanen, Jani; Morikawa, Koichi; Hambsch, Franz-Josef; Garradd, Gordon; Gualdoni, Carlo; Geary, Keith; Omodaka, Toshihiro; Sakai, Nobuyuki; Michel, Raul; Cárdenas, A. A.; Gazeas, Kosmas D.; Niarchos, Panos G.; Yushchenko, Alexander V.; Mallia, Franco; Fiaschi, Marco; Good, Gerry A.; Walker, Stan; James, Nick; Douzu, Ken-Ichi; Julian, Wm Mack, II; Butterworth, Neil D.; Shugarov, Sergey Yu.; Volkov, Igor; Chochol, Drahomir; Katysheva, Natalia; Rosenbush, Alexander E.; Khramtsova, Maria; Kehusmaa, Petri; Reszelski, Maciej; Bedient, James; Liller, William; Pojmanski, Grzegorz; Simonsen, Mike; Stubbings, Rod; Schmeer, Patrick; Muyllaert, Eddy; Kinnunen, Timo; Poyner, Gary; Ripero, Jose; Kriebel, Wolfgang

    2009-12-01

    We systematically surveyed period variations of superhumps in SU UMa-type dwarf novae based on newly obtained data and past publications. In many systems, the evolution of the superhump period is found to be composed of three distinct stages: an early evolutionary stage with a longer superhump period, a middle stage with systematically varying periods, and a final stage with a shorter, stable superhump period. During the middle stage, many systems with superhump periods of less than 0.08 d show positive period derivatives. We present observational characteristics of these stages and give greatly improved statistics. Contrary to an earlier claim, we found no clear evidence for a variation of period derivatives among different superoutbursts of the same object. We present an interpretation that the lengthening of the superhump period is a result of the outward propagation of an eccentricity wave, which is limited by the radius near the tidal truncation. We interpret that late-stage superhumps are rejuvenated excitation of a 3:1 resonance when superhumps in the outer disk are effectively quenched. The general behavior of the period variation, particularly in systems with short orbital periods, appears to follow a scenario proposed in Kato, Maehara, and Monard (2008, PASJ, 60, L23). We also present an observational summary of WZ Sge-type dwarf novae. Many of them have shown long-enduring superhumps during a post-superoutburst stage having longer periods than those during the main superoutburst. The period derivatives in WZ Sge-type dwarf novae are found to be strongly correlated with the fractional superhump excess, or consequently with the mass ratio. WZ Sge-type dwarf novae with a long-lasting rebrightening or with multiple rebrightenings tend to have smaller period derivatives, and are excellent candidates for those systems around or after the period minimum of evolution of cataclysmic variables.

  1. First Photometric Investigation of the Newly Discovered W UMa-type Binary Star MR Com

    NASA Astrophysics Data System (ADS)

    Qian, S.-B.; Liu, N.-P.; Liao, W.-P.; He, J.-J.; Liu, L.; Zhu, L.-Y.; Wang, J.-J.; Zhao, E.-G.

    2013-08-01

    By analyzing multi-color light curves of the newly discovered W UMa-type binary, MR Com, we discovered that it is a shallow-contact binary with a degree of contact factor of f = 10.0% ± 2.1%. Photometric solutions reveal that MR Com is a W-type system with a mass ratio of q = 3.9 where the less massive component is about 90 K hotter than the more massive one. By investigating all of the available times of minimum light, we found that the general trend of the Observed-Calculated (O - C) curve shows a downward parabolic variation while it undergoes a cyclic variation with a small amplitude of 0.0031 days and a period of 10.1 yr. The downward parabolic change corresponds to a long-term decrease in the orbital period at a rate of \\dot{P}=-5.3\\times {10^{-7}} days yr-1 that may be caused by a combination of a mass transfer and an angular momentum loss (AML) via magnetic braking. Among the 16 shallow-contact systems with a decreasing orbital period, MR Com has the lowest mass ratio (e.g., 1/q = 0.26). The shallow-contact configuration, the low-mass ratio, and the long-term period decrease all suggest that systems similar to MR Com are on the AML-controlled stage of the evolutionary scheme proposed by Qian. They will oscillate around a critical mass ratio and evolve into a deep contact with a higher mass ratio. The small-amplitude cyclic change in the O - C curve was analyzed for the light-travel time effect via the presence of an extremely cool stellar companion.

  2. The First Photometric Investigation of the Neglected W-UMa-type Binary Star UZ CMi

    NASA Astrophysics Data System (ADS)

    Qian, S.-B.; Li, K.; Liao, W.-P.; Liu, L.; Zhu, L.-Y.; He, J.-J.; Wang, J.-J.; Zhao, E.-G.

    2013-04-01

    UZ CMi was a W-UMa-type binary star found more than 80 years ago. However, it has been neglected in photometric investigations. Here, the first complete light curves in the B, V, R, and I bands are presented and analyzed using the Wilson and Devinney method. It is discovered that UZ CMi is a contact binary (f = 38.4(± 2.3)%) with a mass ratio of 0.45. The derived orbital inclination (i = 87°) indicates that it is a total eclipsing binary, which suggests that the determined parameters are reliable. By using 17 new eclipse times together with those collected from the literature, we found that the general trend of the observed-calculated (O - C) curve shows an upward parabolic variation that corresponds to a long-term increase in the orbital period at a rate of \\dot{P}=+4.1× {10^{-8}} days yr-1. The continuous increase may be caused by a mass transfer from the less massive component to the more massive one. This suggests that UZ CMi is in the thermal relaxation oscillation controlled stage of the evolutionary scheme proposed by Qian. UZ CMi will oscillate around a critical mass ratio and the contact configuration cannot be broken. After the upward parabolic change was removed, the (O - C)2 curve of the photoelectric and charge-coupled device data revealed a cyclic variation with a small amplitude of 0.0026 days and a period of 21.1 yr. The cyclic change was analyzed for the light-travel time effect via the presence of an extremely cool stellar companion.

  3. A CCD photometric study of the W UMa contact binary Y Sextantis

    NASA Astrophysics Data System (ADS)

    Yang, Yulan; Liu, Qingyao

    2003-07-01

    A V light curve of the W UMa contact binary Y Sex is presented in this paper. From the observations, two times of minimum light was determined and from the present times of minimum light and those collected from the references, the change in the orbital period of the system was analyzed with the method of Kalimeris et al. [A&A 282 (1994) 775]. The result reveals that the orbital period of the system oscillates with a cycle of about 50 years and an amplitude of 1.1×10 -6 days. The light curve was analyzed by means of the latest version of the Wilson-Devinney code, which was also used to correct photometric effects on the radial-velocity curve obtained by McLean and Hilditch [MNRAS 203 (1983) 1]. The results suggest that Y Sex is an A-subtype contact binary with a mass ratio of q=0.180(2). In the new photometric solution, a positive value of the third light of the system suggests that the sinusoidal variation of the period could be caused by a third component in the system. The absolute dimensions of Y Sex are found to be: M1=1.21(18) M ⊙, M2=0.22(3) M ⊙, R1=1.50(2) R ⊙, R2=0.75(1) R ⊙, L1=3.00(44) L ⊙, L2=0.69(10) L ⊙, A=2.66(11) R ⊙.

  4. An extensive analysis of the triple W UMa type binary FI BOO

    SciTech Connect

    Christopoulou, P.-E.; Papageorgiou, A.

    2013-12-01

    We present a detailed analysis of the interesting W UMa binary FI Boo in view of the spectroscopic signature of a third body through photometry, period variation, and a thorough investigation of solution uniqueness. We obtained new BVR{sub c}I{sub c} photometric data that, when combined with spectroscopic data, enable us to analyze the system FI Boo and determine its basic orbital and physical properties through PHOEBE, as well as the period variation by studying the times of the minima. This combined approach allows us to study the long-term period changes in the system for the first time in order to investigate the presence of a third body and to check extensively the solution uniqueness and the uncertainties of derived parameters. Our modeling indicates that FI Boo is a W-type moderate (f = 50.15% ± 8.10%) overcontact binary with component masses of M {sub h} = 0.40 ± 0.05 M {sub ☉} and M {sub c} = 1.07 ± 0.05 M {sub ☉}, temperatures of T {sub h} = 5746 ± 33 K and T {sub c} = 5420 ± 56 K, and a third body, which may play an important role in the formation and evolution. The results were tested by heuristic scanning and parameter kicking to provide the consistent and reliable set of parameters that was used to obtain the initial masses of the progenitors (1.71 ± 0.10 M {sub ☉} and 0.63 ± 0.01 M {sub ☉}, respectively). We also investigated the evolutionary status of massive components with several sets of widely used isochrones.

  5. KIC 7524178 - an SU UMa-Type Dwarf Nova Predominantly Showing Negative Superhumps throughout Supercycle

    NASA Astrophysics Data System (ADS)

    Kato, Taichi; Osaki, Yoji

    2013-12-01

    We analyzed Kepler long-cadence data of KIC 7524178 (= KIS J192254.92+430905.4), and found that it is an SU UMa-type dwarf nova with frequent normal outbursts. The signal of the negative superhump has always been the dominant one, even during the superoutburst, in contrast to our common knowledge about superhumps in dwarf novae. The signal of the positive superhump was only transiently seen during the superoutburst, and it quickly decayed afterward. The frequency variation of the negative superhump was similar to the two previously studied dwarf novae in the Kepler field, V1504 Cyg and V344 Lyr. This is the first object in which the negative superhumps dominate throughout the supercycle. Nevertheless, the superoutburst was faithfully accompanied by the positive superhump, indicating that the tidal eccentric instability is essential for triggering a superoutburst. All the pieces of evidence strengthen the thermal-tidal instability as being the origin of the superoutburst and supercycle, which makes this object the third example in the Kepler field. This object had an unusually small (˜1.0 mag) outburst amplitude, and we considered that this object has a high mass-transfer rate close to the thermal-stability limit of the accretion disk. The average periods of the negative and positive superhumps, and the candidate period of the orbital motion were 0.07288 d (variable in the range 0.0723-0.0731 d), 0.0785 d (variable in the range 0.0772-0.0788 d), and 0.074606(1) d, respectively.

  6. UBVRI Observations, Analysis and Spectra of the Mature W UMa Contact Binary, V444 And

    NASA Astrophysics Data System (ADS)

    Shebs, Travis; Samec, R. G.; Monroe, S.; Faulkner, D. R.; Robb, R. M.; Van Hamme, W. V.; Chamberlain, H.

    2014-01-01

    We present the first precision UBVRI light curves, synthetic light curve solution, a period study and spectra for the V444 Andromedae, an FO V contact W UMa binary. Observations were taken at Lowell Observatory with the 0.81-m reflector from 28 through 30 September 2012 and the spectra at Dominion Astrophysical Observatory’s (DAO) with the 1.8m telescope on 22 July 2013 at a resolution of 60 Å/mm. We determined three times of minimum light from these observations, JD Hel Min I = 2456199.0239±0.0011, 2456199.9616± 0.0015 and JD Hel Min II = 2456198.7907±0.0005. From our period study we determined an improved linear ephemeris, J.D. Hel Min I = 2456199.9618±0.0003d + 0.46877942±0.00000005×E The period has been stable over the past 9.6 years 7500 orbits). After an extensive mass ratio-search, the lowest residual mass ratio was found to be 0.48. Our final Wilson-Devinney Program computation determined that the system is an A-type W U Ma contact binary with a fill-out of nearly 51%. Despite its temperature (7200-7300 K), two magnetic spots were found on the primary component, a 10 degree radius equatorial dark spot, T-factor=0.88 and a 23 degree radius near polar hot spot, T-factor=1.10. The component temperature difference is only ~80K. These parameters tell us that the V444 And is a mature solar type binary.

  7. Orbital Solutions and Absolute Elements of the W UMa Binary MW Pavonis

    NASA Astrophysics Data System (ADS)

    Alvarez, Gabriella E.; Sowell, James R.; Williamon, Richard M.; Lapasset, Emilio

    2015-08-01

    We present differential UBV photoelectric photometry obtained by Williamon of the short-period A-type W UMa binary MW Pav. With the Wilson-Devinney analysis program, we obtained a simultaneous solution of these observations with the UBV photometry of Lapasset, the V measurements by the ASAS program, and the double-lined radial velocity measurements of Rucinski and Duerbeck. Our solution indicates that MW Pav is in an overcontact state, where both components exceed their critical Roche lobes. We derive masses of M1 = 1.514 ± 0.063 Msolar and M2 = 0.327 ± 0.014 Msolar, and equal-volume radii of R1 = 2.412 ± 0.034 Rsolar and R2 = 1.277 ± 0.019 Rsolar for the primary and secondary, respectively. The system is assumed to have a circular orbit and is seen at an inclination of 86.39° ± 0.63°. The effective temperature of the primary was held fixed at 6900 K, whereas the secondary's temperature was found to be 6969 ± 10 K. The asymmetry of the light curves requires a large, single star spot on the smaller, less massive secondary component. A consistent base solution, with different spot characteristics for the Williamon, Lapasset, and ASAS data, was found. The modeled spot varied little during the 40-year range of photometric observations. The combined solution utilized a third light component and found that the period is changing at a rate of dP/dt = (6.50 ± 0.19) × 10-10.

  8. BVRI Photometric Analysis of the W UMa Binary, V428, in the field of NGC188

    NASA Astrophysics Data System (ADS)

    Samec, Ronald G.; Maloney, David Edward; Clark, Jeremy; Caton, Daniel B.; Faulkner, Danny R.

    2015-01-01

    V428 is a faint 15th magnitude binary observed in a study of the open cluster NGC188. However, its distance from the core of the cluster might exclude its membership. Its light curve was classified as a short period EB type eclipsing binary with a period of 0.3079 d and amplitude of ~0.7 mags in all curves. V428 was observed as a part of our student/professional collaborative studies of interacting binaries from data taken from Dark Sky Observatory of Appalachian State University, North Carolina. The difference in component temperatures is some DT =180 K and its fill-out is 35%. This undoubtedly has a semi-extreme mass ratio (q) otherwise its fill-out might dictate a smaller △T. A brief, 2.5 year period study gives, as expected, a constant period, P=0.3076789 d. Five times of minimum light were calculated, 3 primary and 2 secondary eclipses from our present observations:HJD I = 2456598.6746±0.0007, 2456599.5990±0.0014, 2456600.8292±0.0013HJD II = 2456598.8299±0.0026, 2456599.7548±0.0025.The improved linear ephemeris is:JD Hel MinI = 2456599.5990(±0.0010) + 0.30767885(±0.00000043)d X E (1)More monitoring is needed to determine its true orbital evolution. The inclination, 80º is not quite enough to produce total eclipses, so a q-search was performed. Our best solution gives a q=0.4. A cool spot was modeled on the primary component to take care of the light curve asymmetries. It is a K-type W UMa contact binary.

  9. THE FIRST PHOTOMETRIC INVESTIGATION OF THE NEGLECTED W-UMa-TYPE BINARY STAR UZ CMi

    SciTech Connect

    Qian, S.-B.; Li, K.; Liao, W.-P.; Liu, L.; Zhu, L.-Y.; He, J.-J.; Wang, J.-J.; Zhao, E.-G.

    2013-04-15

    UZ CMi was a W-UMa-type binary star found more than 80 years ago. However, it has been neglected in photometric investigations. Here, the first complete light curves in the B, V, R, and I bands are presented and analyzed using the Wilson and Devinney method. It is discovered that UZ CMi is a contact binary (f = 38.4({+-} 2.3)%) with a mass ratio of 0.45. The derived orbital inclination (i = 87 Degree-Sign ) indicates that it is a total eclipsing binary, which suggests that the determined parameters are reliable. By using 17 new eclipse times together with those collected from the literature, we found that the general trend of the observed-calculated (O - C) curve shows an upward parabolic variation that corresponds to a long-term increase in the orbital period at a rate of P-dot = +4.1 x 10{sup -8} days yr{sup -1}. The continuous increase may be caused by a mass transfer from the less massive component to the more massive one. This suggests that UZ CMi is in the thermal relaxation oscillation controlled stage of the evolutionary scheme proposed by Qian. UZ CMi will oscillate around a critical mass ratio and the contact configuration cannot be broken. After the upward parabolic change was removed, the (O - C){sub 2} curve of the photoelectric and charge-coupled device data revealed a cyclic variation with a small amplitude of 0.0026 days and a period of 21.1 yr. The cyclic change was analyzed for the light-travel time effect via the presence of an extremely cool stellar companion.

  10. FIRST PHOTOMETRIC INVESTIGATION OF THE NEWLY DISCOVERED W UMa-TYPE BINARY STAR MR Com

    SciTech Connect

    Qian, S.-B.; Liu, N.-P.; Liao, W.-P.; He, J.-J.; Liu, L.; Zhu, L.-Y.; Wang, J.-J.; Zhao, E.-G.

    2013-08-01

    By analyzing multi-color light curves of the newly discovered W UMa-type binary, MR Com, we discovered that it is a shallow-contact binary with a degree of contact factor of f = 10.0% {+-} 2.1%. Photometric solutions reveal that MR Com is a W-type system with a mass ratio of q = 3.9 where the less massive component is about 90 K hotter than the more massive one. By investigating all of the available times of minimum light, we found that the general trend of the Observed-Calculated (O - C) curve shows a downward parabolic variation while it undergoes a cyclic variation with a small amplitude of 0.0031 days and a period of 10.1 yr. The downward parabolic change corresponds to a long-term decrease in the orbital period at a rate of P-dot = -5.3 x 10{sup -7} days yr{sup -1} that may be caused by a combination of a mass transfer and an angular momentum loss (AML) via magnetic braking. Among the 16 shallow-contact systems with a decreasing orbital period, MR Com has the lowest mass ratio (e.g., 1/q = 0.26). The shallow-contact configuration, the low-mass ratio, and the long-term period decrease all suggest that systems similar to MR Com are on the AML-controlled stage of the evolutionary scheme proposed by Qian. They will oscillate around a critical mass ratio and evolve into a deep contact with a higher mass ratio. The small-amplitude cyclic change in the O - C curve was analyzed for the light-travel time effect via the presence of an extremely cool stellar companion.

  11. Infrasonic harmonic tremor and degassing bursts from Halema'uma'u Crater, Kilauea Volcano, Hawaii

    NASA Astrophysics Data System (ADS)

    Fee, David; GarcéS, Milton; Patrick, Matt; Chouet, Bernard; Dawson, Phil; Swanson, Don

    2010-11-01

    The formation, evolution, collapse, and subsequent resurrection of a vent within Halema'uma'u Crater, Kilauea Volcano, produced energetic and varied degassing signals recorded by a nearby infrasound array between 2008 and early 2009. After 25 years of quiescence, a vent-clearing explosive burst on 19 March 2008 produced a clear, complex acoustic signal. Near-continuous harmonic infrasonic tremor followed this burst until 4 December 2008, when a period of decreased degassing occurred. The tremor spectra suggest volume oscillation and reverberation of a shallow gas-filled cavity beneath the vent. The dominant tremor peak can be sustained through Helmholtz oscillations of the cavity, while the secondary tremor peak and overtones are interpreted assuming acoustic resonance. The dominant tremor frequency matches the oscillation frequency of the gas emanating from the vent observed by video. Tremor spectra and power are also correlated with cavity geometry and dynamics, with the cavity depth estimated at ˜219 m and volume ˜3 × 106 m3 in November 2008. Over 21 varied degassing bursts were observed with extended burst durations and frequency content consistent with a transient release of gas exciting the cavity into resonance. Correlation of infrasound with seismicity suggests an open system connecting the atmosphere to the seismic excitation process at depth. Numerous degassing bursts produced very long period (0.03-0.1 Hz) infrasound, the first recorded at Kilauea, indicative of long-duration atmospheric accelerations. Kilauea infrasound appears controlled by the exsolution of gas from the magma, and the interaction of this gas with the conduits and cavities confining it.

  12. Photometric Analysis of the Recently Discovered W UMa Star NR Camelopardalis: Period Change and Spot Migration

    NASA Astrophysics Data System (ADS)

    Shoup, Jenae; Reed, Phillip A.; Joner, Michael D.; Jensen, Eric L. N.; Collins, Karen A; Pepper, Joshua

    2014-06-01

    NR Cam is a short period (P=0.26 days) eclipsing binary of the W UMa type that was relatively recently discovered in the ROTSE1 data of the Northern Sky Variability Survey (NSVS) and was originally listed in the New Catalog of Suspected Variable Stars (NSV) with the identifier NSV 3754. Here we present the first known detailed study of NR Cam, which includes multi-band light curves, color curves, and a photometric orbital solution. NR Cam exhibits a strong O'Connell effect that can be attributed to magnetically induced spot activity on one of the components. Absolute photometry was performed in B and V at the Kutztown University Observatory in 2013 October and November and complementary high precision differential light curves were obtained in BVRI at the same time, as part of the KELT follow-up network, at Brigham Young University's West Mountain Observatory, Swarthmore College's Peter Van de Kamp Observatory, and the University of Louisville's Moore Observatory. After the B-V color curves were used to approximate the stellar surface temperatures and spot locations, the Wilson-Devinney code was employed with a differential corrections routine to determine the most likely stellar properties and orbital parameters. Our solution indicates that the two stars are in contact, sharing a common envelope, and their surface temperatures are approximately 4500 K and 4200 K. The inclination of the orbit was determined to be 68.0 (±0.6) degrees. When compared with the NSVS data, we find that the orbital period of NR Cam has changed over the past decade and that the strength of the O'Connell effect, and the associated spot activity, has also varied significantly.

  13. Infrasonic harmonic tremor and degassing bursts from Halema'uma'u Crater, Kilauea Volcano, Hawaii

    USGS Publications Warehouse

    Fee, David; Garcés, Milton; Patrick, Matt; Chouet, Bernard; Dawson, Phil; Swanson, Donald A.

    2010-01-01

    The formation, evolution, collapse, and subsequent resurrection of a vent within Halema'uma'u Crater, Kilauea Volcano, produced energetic and varied degassing signals recorded by a nearby infrasound array between 2008 and early 2009. After 25 years of quiescence, a vent-clearing explosive burst on 19 March 2008 produced a clear, complex acoustic signal. Near-continuous harmonic infrasonic tremor followed this burst until 4 December 2008, when a period of decreased degassing occurred. The tremor spectra suggest volume oscillation and reverberation of a shallow gas-filled cavity beneath the vent. The dominant tremor peak can be sustained through Helmholtz oscillations of the cavity, while the secondary tremor peak and overtones are interpreted assuming acoustic resonance. The dominant tremor frequency matches the oscillation frequency of the gas emanating from the vent observed by video. Tremor spectra and power are also correlated with cavity geometry and dynamics, with the cavity depth estimated at ~219 m and volume ~3 x 106 m3 in November 2008. Over 21 varied degassing bursts were observed with extended burst durations and frequency content consistent with a transient release of gas exciting the cavity into resonance. Correlation of infrasound with seismicity suggests an open system connecting the atmosphere to the seismic excitation process at depth. Numerous degassing bursts produced very long period (0.03-0.1 Hz) infrasound, the first recorded at Kilauea, indicative of long-duration atmospheric accelerations. Kilauea infrasound appears controlled by the exsolution of gas from the magma, and the interaction of this gas with the conduits and cavities confining it.

  14. V344 Lyrae: A Touchtone SU UMa Cataclysmic Variable in the Kepler Field

    NASA Technical Reports Server (NTRS)

    Smale, Alan P.; Wood, Matt A.; Still, Martin D.; Howell, Steve B.; Cannizzo, John K.

    2012-01-01

    We report on the analysis of the Kepler short-cadence (SC) light curve of V344 Lyr obtained during 2009 June 20 through 2010 Mar 19 (Q2-Q4). The system is an SU UMa star showing dwarf nova outbursts and superoutbursts, and promises to be a touchstone for CV studies for the foreseeable future. The system displays both positive and negative super humps with periods of 2.20 and 2.06-hr, respectively, and we identify an orbital period of 2.11-hr. The positive super humps have a maximum amplitude of approximately 0.025-mag, the negative super humps a maximum amplitude of approximately 0.8 mag, and the orbital period at quiescence has an amplitude of approximately 0.025 mag. The quality of the Kepler data is such that we can test vigorously the models for accretion disk dynamics that have been emerging in the past several years. The SC data for V344 Lyr are consistent with the model that two physical sources yield positive superhumps: early in the superoutburst. the superhump signal is generated by viscous dissipation within the periodically flexing disk. but late in the superoutburst, the signal is generated as the accretion stream bright spot sweeps around the rim of the non-axisymmetric disk. The disk super humps are roughly anti-phased with the stream/late superhumps. The V344 Lyr data also reveal negative super humps arising from accretion onto a tilted disk precessing in the retrograde direction, and suggest that negative superhumps may appear during the decline of DN outbursts. The period of negative superhumps has a positive P(raised dot) in between outbursts.

  15. Uma grade de perfis teóricos para estrelas massivas em transição

    NASA Astrophysics Data System (ADS)

    Nascimento, C. M. P.; Machado, M. A.

    2003-08-01

    Na XXVIII Reunião Anual da Sociedade Astronômica Brasileira (2002) apresentamos uma grade de perfis calculados de acordo com os pontos da trajetória evolutiva de metalicidade solar, Z = 0.02 e taxa de perda de massa () padrão, para estrelas com massa inicial de 25, 40, 60, 85 e 120 massas solares. Estes perfis foram calculados com o auxílio de um código numérico adequado para descrever os ventos de objetos massivos, supondo simetria esférica, estacionaridade e homogeneidade. No presente trabalho, apresentamos a complementação da grade com os perfis teóricos relativos às trajetórias de Z = 0.02 com taxa de perda de massa dobrada em relação a padrão (2´), e de metalicidade Z = 0.008. Para cada ponto das três trajetórias obtemos os perfis teóricos de Ha, Hb, Hg e Hd, e como esperado eles se apresentam em pura emissão, pura absorção ou em P-Cygni. Para valores de taxa de perda de massa muito baixos (~10-7) não há formação de linhas, o que é visto nos primeiros pontos em todas as trajetórias. Em geral, para um mesmo ponto a componente de emissão diminui e a absorção aumenta de Ha para Hd. É verificado que as trajetórias com Z = 0.02 e padrão possuem menos circuitos (loops) do que as com metalicidade Z = 0.02 e 2´ padrão, e seus perfis são, em geral, menos intensos. Em relação a trajetória de Z = 0.008, verifica-se menos circuitos e maior variação em luminosidade, e seus perfis mostram-se em, algumas trajetórias, mais intensos. Verificamos também que, pontos distintos em uma mesma trajetória, apresentam perfis diferentes para valores similares de luminosidade e temperatura efetiva. Sendo assim, uma grade de perfis teóricos parece ser útil para fornecer uma informação preliminar sobre o estágio evolutivo de uma estrela massiva.

  16. The Impact of Delirium | NIH MedlinePlus the Magazine

    MedlinePlus

    ... doesn't make sense Emotional changes: anger, agitation, depression, irritability, overexcitement Incontinence Problem concentrating Contributing Factors A number of medical and physical conditions may ...

  17. Delirium as presenting symptom of neuro-Behcet’s disease

    PubMed Central

    Alnasser Alsukhni, Rana; Ghoubari, Mohamed Sourat; Aboras, Yasmin; Almohamad Alkhalifa, Khadija

    2016-01-01

    Objectives: Behcet’s disease is a multisystemic disorder. Most of its clinical manifestations are due to thrombosis or vasculitis. There is a predominance of mucocutaneous and ocular lesions; neurological manifestations are minority. However, this could be the first problem that leads a patient to seek medical help. Methods: We report a 30-year-old female with rapidly progressive headaches and confusion. Brain magnetic resonance imaging showed bilateral thalamic T2 hyperintense lesions and hemorrhage. Directed inquiry revealed recurrent oral ulcers and three miscarriages. During hospitalization, the patient developed a deep venous thrombosis. Results: After exclusion of other differential diagnoses, the diagnosis of Behcet’s disease was established. Conclusion: Behcet’s disease is a protean disease. Hence it should be in mind in patients with otherwise unexplained signs and symptoms, especially in endemic countries, and treatment decision should not be witheld in critical cases if no alternative diagnosis is plausible. PMID:27579169

  18. Cognitive assessment and differentiating the 3 Ds (dementia, depression, delirium).

    PubMed

    Milisen, Koen; Braes, Tom; Fick, Donna M; Foreman, Marquis D

    2006-03-01

    Differentiation between a diminished or altered cognitive functioning asa consequence of aging and one resulting from serious health problems is critical in the elderly. An unrecognized cognitive disorder or the worsening of the impairment may hamper the effectiveness and appropriateness of care and treatment; therefore, standardized assessment procedures and systematic monitoring of cognition and behavior are important aspects of the nursing care. of older adults. In this article, current notions for accurate and comprehensive cognitive assessment in older persons are delineated. Further, an overview of epidemiological screening and diagnostic dilemmas of dementia, depression, and deliriumare provided. PMID:16492451

  19. WZ Cephei: A Dynamically Active W UMa-Type Binary Star

    NASA Astrophysics Data System (ADS)

    Jeong, Jang-Hae; Kim, Chun-Hwey

    2011-09-01

    An intensive analysis of 185 timings of WZ Cep, including our new three timings, was made to understand the dynamical picture of this active W UMa-type binary. It was found that the orbital period of the system has complexly varied in two cyclical components superposed on a secularly downward parabola over about 80y. The downward parabola, corresponding to a secular period decrease of -9.d97 × 10-8 y-1, is most probably produced by the action of both angular momentum loss (AML) due to magnetic braking and mass-transfer from the massive primary component to the secondary. The period decrease rate of -6.d72 × 10-8 y-1 due to AML contributes about 67% to the observed period decrease. The mass flow of about 5.16 × 10-8 M⊙ y-1 from the primary to the secondary results the remaining 33% period decrease. Two cyclical components have an 11.y8 period with amplitude of 0.d0054 and a 41.y3 period with amplitude of 0.d0178. It is very interesting that there seems to be exactly in a commensurable 7:2 relation between their mean motions. As the possible causes, two rival interpretations (i.e., light-time effects (LTE) by additional bodies and the Applegate model) were considered. In the LTE interpretation, the minimum masses of 0.30 M⊙ for the shorter period and 0.49 M⊙ for the longer one were calculated. Their contributions to the total light were at most within 2%, if they were assumed to be main-sequence stars. If the LTE explanation is true for the WZ Cep system, the 7:2 relation found between their mean motions would be interpreted as a stable 7:2 orbit resonance produced by a long-term gravitational interaction between two tertiary bodies. In the Applegate model interpretation, the deduced model parameters indicate that the mechanism could work only in the primary star for both of the two period modulations, but could not in the secondary. However, we couldn't find any meaningful relation between the light variation and the period variability from the historical

  20. Time sequence spectroscopy of AW UMa. The 518 nm Mg I triplet region analyzed with broadening functions

    SciTech Connect

    Rucinski, Slavek M.

    2015-02-01

    High-resolution spectroscopic observations of AW UMa, obtained on three consecutive nights with a median time resolution of 2.1 minutes, have been analyzed using the broadening function method in the spectral window of 22.75 nm around the 518 nm Mg i triplet region. Doppler images of the system reveal the presence of vigorous mass motions within the binary system; their presence puts into question the solid-body rotation assumption of the contact binary model. AW UMa appears to be a very tight, semi-detached binary; the mass transfer takes place from the more massive to the less massive component. The primary, a fast-rotating star with Vsini=181.4±2.5 km s{sup −1}, is covered with inhomogeneities: very slowly drifting spots and a dense network of ripples more closely participating in its rotation. The spectral lines of the primary show an additional broadening component (called the “pedestal”) that originates either in the equatorial regions, which rotate faster than the rest of the star by about 50 km s{sup −1}, or in an external disk-like structure. The secondary component appears to be smaller than predicted by the contact model. The radial velocity field around the secondary is dominated by accretion of matter transferred from (and possibly partly returned to) the primary component. The parameters of the binary are Asini=2.73±0.11 R{sub ⊙} and M{sub 1}sin{sup 3}i=1.29±0.15 M{sub ⊙}, M{sub 2}sin{sup 3}i=0.128±0.016 M{sub ⊙}. The mass ratio, q{sub sp}=M{sub 2}/M{sub 1}=0.099±0.003, while still the most uncertain among the spectroscopic elements, is substantially different from the previous numerous and mutually consistent photometric investigations which were based on the contact model. It should be studied why photometry and spectroscopy give such discrepant results and whether AW UMa is an unusual object or if only very high-quality spectroscopy can reveal the true nature of W UMa-type binaries.

  1. A New Look at the Eclipse Timing Variation Diagram Analysis of Selected 3-body W UMa Systems

    NASA Astrophysics Data System (ADS)

    Christopoulou, P.-E.; Papageorgiou, A.

    2015-07-01

    The light travel effect produced by the presence of tertiary components can reveal much about the origin and evolution of over-contact binaries. Monitoring of W UMa systems over the last decade and/or the use of publicly available photometric surveys (NSVS, ASAS, etc.) has uncovered or suggested the presence of many unseen companions, which calls for an in-depth investigation of the parameters derived from cyclic period variations in order to confirm or reject the assumption of hidden companion(s). Progress in the analysis of eclipse timing variations is summarized here both from the empirical and the theoretical points of view, and a more extensive investigation of the proposed orbital parameters of third bodies is proposed. The code we have developed for this, implemented in Python, is set up to handle heuristic scanning with parameter perturbation in parameter space, and to establish realistic uncertainties from the least squares fitting. A computational example is given for TZ Boo, a W UMa system with a spectroscopically detected third component. Future options to be implemented include MCMC and bootstrapping.

  2. Comparing the precision 2009 and 2012 light curves of the precontact W UMa binary V1001 Cassiopeia

    SciTech Connect

    Samec, R. G.; Koenke, S. S.; Faulkner, D. R.

    2015-01-01

    A 2012 follow up to the analysis of 2009 observations is presented for the very short period (∼0.43 days) precontact W UMa binary (PCWB) V1001 Cassiopeia. Its short period, similar to the majority of W UMa binaries, and its distinct EA light curve make it a very rare and interesting system for continuing photometric investigation. Previous photometric VRI standard magnitudes give a K4 spectral type. Our solutions of light curves separated by some three years give approximately the same physical parameters. However, the spots have radically changed in temperature, area, and position. While only one dark spot was used to model the first curves, two hot spots are now needed. This affects the overall shape of the light curve, especially in the secondary eclipses in B and V. Additional eclipse timings now show that the orbital period is changing. We conclude that spots are very active on this solar-type dwarf system and that it may mimic its larger cousins, the RS CVn binaries. The conclusion is that analysis now needs to be directed at the continuous time evolution of PCWBs.

  3. Shallow Magma Accumulation at Halema'uma'u Crater, Kilauea Volcano, Revealed by Microgravity Measurements (1975-2008)

    NASA Astrophysics Data System (ADS)

    Battaglia, M.; Eggers, A.; Bagnardi, M.; Poland, M. P.; Miklius, A.

    2009-12-01

    We examined microgravity data collected during surveys of a dense network around the summit of Kilauea Volcano, Hawai'i, following the 1975 M7.2 earthquake and in 1981, 1998, 2003, and 2008. All gravity measurements are relative to a benchmark located 4 km northwest of the caldera. Gravity changes were adjusted for the free air effect by assuming a correction of -308.6 μGal/m and using leveling data (completed at approximately the same time as the gravity surveys) to determine elevation changes between successive gravity surveys. A several-year time series of water level measurements from a well within Kilauea’s caldera indicates that gravity variations due to groundwater fluctuations are negligible. Residual gravity data are characterized by a prominent positive residual gravity anomaly (an increase of 521 μGal during 1975-2008) along the east margin of Halema'uma'u Crater. The anomaly, which occurs in an area of relatively minor surface deformation, suggests subsurface magma accumulation in void space (probably a network of interconnected cracks) at shallow depths beneath Kilauea's caldera. The region beneath the southeast rim of Halema'uma'u Crater is a known volume of shallow magma storage on the basis of both geodetic and seismic data, and is near the site of several historical summit eruptive vents, including that of the 2008 explosion and subsequent eruption. Assuming a spherical source, we modeled the residual gravity changes measured at stations close to the Halema'uma'u source to estimate the source location, depth and mass change. The weighted least square inversion over the four time periods spanned by the daya gives a depth of 500-950 m (average is 725 m) with a total mass accumulation over 33 years of 6 x 1010 kg. Mass accumulation was variable over 1975-2008, with lower average rates during 1981-1998 and 1998-2003 and higher average rates during 1975-1981 and 2003-2008. The variable accumulation rates are consistent with changes in Kilauea

  4. Propriedades de estruturas temporais rápidas submilimétricas durante uma grande explosão solar

    NASA Astrophysics Data System (ADS)

    Raulin, J.-P.; Kaufmann, P.; Gimenez de Castro, C. G.; Pacini, A. A.; Makhmutov, V.; Levato, H.; Rovira, M.

    2003-08-01

    Apresentamos novas propriedades de variações rápidas da emissão submilimétrica durante uma das maiores explosões solares do ciclo solar 23. Os dados analisados neste estudo foram obtidos com o Telescópio Solar Submilimétrico (SST), que observa o Sol em 212 GHz e 405 GHz, e comparados com emissões em Raios-X duros e Raios-gama (fótons de energia > 10 MeV), que foram obtidas pelo experimento GRS do Yohkoh. Aplicamos diferentes metodologias para detectar e caracterizar, ao longo do evento, os pulsos submilimétricos (duração de 50-300 ms) detectados acima de uma componente mais lenta (alguns minutos). Os resultados mostram que durante a fase impulsiva, num instante próximo ao tempo do máximo do evento, houve um aumento da ocorrência de maiores e de mais rápidas estruturas temporais. Também identificamos uma boa correlação com as emissões em raios-X e raios-gama (até a faixa de energia 10-100 MeV), indicando que os pulsos rápidos submilimétricos refletiram injeções primárias de energia durante o evento.O espectro do fluxo desses pulsos é crescente com a freqüência entre 212 and 405 GHz, na maioria dos casos, ao contrário do observado para a componente gradual. As posições calculadas para as estruturas rápidas são discretas, compactas e localizadas em toda a área da região ativa, o que é previsto nos modelos de explosões solares decorrentes de instabilidades múltiplas em diferentes pequenas regiões. Por outro lado, a posição calculada para a componente lenta é estável durante a fase impulsiva. Assim, a comparação entre as características do espectro de fluxo e da localização da emissão, para os pulsos rápidos e para a componente gradual, sugere que as respectivas emissões são de natureza diferente.

  5. The 2006/2007 photometric activity of three chromospherically active stars: V2075 Cyg, FG UMa and BM CVn

    NASA Astrophysics Data System (ADS)

    Erdem, A.; Budding, E.; Soydugan, E.; Bakış, H.; Doğru, D.; Doğru, S. S.; Tüysüz, M.; Kaçar, Y.; Dönmez, A.; Soydugan, F.

    2009-08-01

    We present new multiband CCD photometric observations of three chromospherically active stars with long periods (V2075 Cyg, FG UMa and BM CVn). The observations were made at the Çanakkale Onsekiz Mart University Observatory in 2006 and 2007. We analyzed BVRI (Bessell) CCD observations of these three RS CVn-type SB1 binaries with the following three steps: (i) Photometric rotation periods were obtained by analyzing their light variations with a differential corrections method and a Fourier transform technique. (ii) Light variations, observed over three or more consecutive orbital cycles, were investigated by using dark (cool) spot models with the program SPOT. (iii) Surface differential rotation coefficients for the primary components of these binaries were derived using our own photometric periods together with orbital periods taken from the literature.

  6. BVR{sub c}I{sub c} observations and analyses on V2421 Cygni, a precontact W UMa binary

    SciTech Connect

    Samec, R. G.; Shebs, Travis S.; Faulkner, D. R.; Van Hamme, W.; Mathis, R. F.

    2014-01-01

    We present the first precision BVRI light curves, synthetic light curve solutions, and a period study for the high amplitude solar type binary, V2421 Cygni. The light curves have the appearance of an Algol (EA) type; however, it is made up of dwarf solar type components in a detached mode with a period of only 0.6331 days with an amplitude of about a full magnitude, i.e., it is a precontact W UMa binary. Flare-like disruptions occur in the light curves following the primary and secondary eclipses possibly due to the line-of-sight track of a gas stream. An associated stream spot and splash spot cause bright equatorial spots on the stellar surface of the primary star. The more massive star is the gainer, making this system a classic, albeit dwarf, Algol.

  7. Survey of period variations of superhumps in SU UMa-type dwarf novae. VIII. The eighth year (2015-2016)

    NASA Astrophysics Data System (ADS)

    Kato, Taichi; Hambsch, Franz-Josef; Monard, Berto; Vanmunster, Tonny; Maeda, Yutaka; Miller, Ian; Itoh, Hiroshi; Kiyota, Seiichiro; Isogai, Keisuke; Kimura, Mariko; Imada, Akira; Tordai, Tamás; Akazawa, Hidehiko; Tanabe, Kenji; Otani, Noritoshi; Ogi, Minako; Ando, Kazuko; Takigawa, Naoki; Dubovsky, Pavol A.; Kudzej, Igor; Shugarov, Sergey Yu.; Katysheva, Natalia; Golysheva, Polina; Gladilina, Natalia; Chochol, Drahomir; Starr, Peter; Kasai, Kiyoshi; Pickard, Roger D.; Miguel, Enrique de; Kojiguchi, Naoto; Sugiura, Yuki; Fukushima, Daiki; Yamada, Eiji; Uto, Yusuke; Kamibetsunawa, Taku; Tatsumi, Taiki; Takeda, Nao; Matsumoto, Katsura; Cook, Lewis M.; Pavlenko, Elena P.; Babina, Julia V.; Pit, Nikolaj V.; Antonyuk, Oksana I.; Antonyuk, Kirill A.; Sosnovskij, Aleksei A.; Baklanov, Aleksei V.; Kafka, Stella; Stein, William; Voloshina, Irina B.; Ruiz, Javier; Sabo, Richard; Dvorak, Shawn; Stone, Geoff; Andreev, Maksim V.; Antipin, Sergey V.; Zubareva, Alexandra M.; Zaostrojnykh, Anna M.; Richmond, Michael; Shears, Jeremy; Dubois, Franky; Logie, Ludwig; Rau, Steve; Vanaverbeke, Siegfried; Simon, Andrei; Oksanen, Arto; Goff, William N.; Bolt, Greg; Dębski, Bartłomiej; Kochanek, Christopher S.; Shappee, Benjamin; Stanek, Krzysztof Z.; Prieto, José L.; Stubbings, Rod; Muyllaert, Eddy; Hiraga, Mitsutaka; Horie, Tsuneo; Schmeer, Patrick; Hirosawa, Kenji

    2016-07-01

    Continuing the project described by Kato et al. (2009, PASJ, 61, S395), we collected times of superhump maxima for 128 SU UMa-type dwarf novae observed mainly during the 2015-2016 season and characterized these objects. The data have improved the distribution of orbital periods, the relation between the orbital period and the variation of superhumps, and the relation between period variations and the rebrightening type in WZ Sge-type objects. Coupled with new measurements of mass ratios using growing stages of superhumps, we now have a clearer and statistically greatly improved evolutionary path near the terminal stage of evolution of cataclysmic variables. Three objects (V452 Cas, KK Tel, and ASASSN-15cl) appear to have slowly growing superhumps, which is proposed to reflect the slow growth of the 3 : 1 resonance near the stability border. ASASSN-15sl, ASASSN-15ux, SDSS J074859.55+312512.6, and CRTS J200331.3-284941 are newly identified eclipsing SU UMa-type (or WZ Sge-type) dwarf novae. ASASSN-15cy has a short (˜0.050 d) superhump period and appears to belong to EI Psc-type objects with compact secondaries having an evolved core. ASASSN-15gn, ASASSN-15hn, ASASSN-15kh, and ASASSN-16bu are candidate period bouncers with superhump periods longer than 0.06 d. We have newly obtained superhump periods for 79 objects and 13 orbital periods, including periods from early superhumps. In order that future observations will be more astrophysically beneficial and rewarding to observers, we propose guidelines on how to organize observations of various superoutbursts.

  8. Survey of period variations of superhumps in SU UMa-type dwarf novae. VIII. The eighth year (2015-2016)

    NASA Astrophysics Data System (ADS)

    Kato, Taichi; Hambsch, Franz-Josef; Monard, Berto; Vanmunster, Tonny; Maeda, Yutaka; Miller, Ian; Itoh, Hiroshi; Kiyota, Seiichiro; Isogai, Keisuke; Kimura, Mariko; Imada, Akira; Tordai, Tamás; Akazawa, Hidehiko; Tanabe, Kenji; Otani, Noritoshi; Ogi, Minako; Ando, Kazuko; Takigawa, Naoki; Dubovsky, Pavol A.; Kudzej, Igor; Shugarov, Sergey Yu.; Katysheva, Natalia; Golysheva, Polina; Gladilina, Natalia; Chochol, Drahomir; Starr, Peter; Kasai, Kiyoshi; Pickard, Roger D.; Miguel, Enrique de; Kojiguchi, Naoto; Sugiura, Yuki; Fukushima, Daiki; Yamada, Eiji; Uto, Yusuke; Kamibetsunawa, Taku; Tatsumi, Taiki; Takeda, Nao; Matsumoto, Katsura; Cook, Lewis M.; Pavlenko, Elena P.; Babina, Julia V.; Pit, Nikolaj V.; Antonyuk, Oksana I.; Antonyuk, Kirill A.; Sosnovskij, Aleksei A.; Baklanov, Aleksei V.; Kafka, Stella; Stein, William; Voloshina, Irina B.; Ruiz, Javier; Sabo, Richard; Dvorak, Shawn; Stone, Geoff; Andreev, Maksim V.; Antipin, Sergey V.; Zubareva, Alexandra M.; Zaostrojnykh, Anna M.; Richmond, Michael; Shears, Jeremy; Dubois, Franky; Logie, Ludwig; Rau, Steve; Vanaverbeke, Siegfried; Simon, Andrei; Oksanen, Arto; Goff, William N.; Bolt, Greg; Dębski, Bartłomiej; Kochanek, Christopher S.; Shappee, Benjamin; Stanek, Krzysztof Z.; Prieto, José L.; Stubbings, Rod; Muyllaert, Eddy; Hiraga, Mitsutaka; Horie, Tsuneo; Schmeer, Patrick; Hirosawa, Kenji

    2016-08-01

    Continuing the project described by Kato et al. (2009, PASJ, 61, S395), we collected times of superhump maxima for 128 SU UMa-type dwarf novae observed mainly during the 2015-2016 season and characterized these objects. The data have improved the distribution of orbital periods, the relation between the orbital period and the variation of superhumps, and the relation between period variations and the rebrightening type in WZ Sge-type objects. Coupled with new measurements of mass ratios using growing stages of superhumps, we now have a clearer and statistically greatly improved evolutionary path near the terminal stage of evolution of cataclysmic variables. Three objects (V452 Cas, KK Tel, and ASASSN-15cl) appear to have slowly growing superhumps, which is proposed to reflect the slow growth of the 3 : 1 resonance near the stability border. ASASSN-15sl, ASASSN-15ux, SDSS J074859.55+312512.6, and CRTS J200331.3-284941 are newly identified eclipsing SU UMa-type (or WZ Sge-type) dwarf novae. ASASSN-15cy has a short (˜0.050 d) superhump period and appears to belong to EI Psc-type objects with compact secondaries having an evolved core. ASASSN-15gn, ASASSN-15hn, ASASSN-15kh, and ASASSN-16bu are candidate period bouncers with superhump periods longer than 0.06 d. We have newly obtained superhump periods for 79 objects and 13 orbital periods, including periods from early superhumps. In order that future observations will be more astrophysically beneficial and rewarding to observers, we propose guidelines on how to organize observations of various superoutbursts.

  9. Optimization of ultrasonic/microwave assisted extraction (UMAE) of polysaccharides from Inonotus obliquus and evaluation of its anti-tumor activities.

    PubMed

    Chen, Yiyong; Gu, Xiaohong; Huang, Sheng-quan; Li, Jinwei; Wang, Xin; Tang, Jian

    2010-05-01

    Recently, the use of ultrasonic and microwave has attracted considerable interest as an alternative approach to the traditional extraction methods. In this paper, in order to maximize the yield and purity of polysaccharides from Inonotus obliquus, response surface methodology (RSM) was employed to optimize the ultrasonic/microwave assisted extraction (UMAE) conditions. The results indicated that the optimal conditions for UMAE were 90W microwave power, 50W ultrasonic power together with 40kHz ultrasonic frequency, solid/water ratio was 1:20 (W/V) and the extracting time was 19min, respectively. Under the optimal conditions, the yield and purity of polysaccharides were 3.25% and 73.16%, respectively, which are above that of traditional hot water extraction and close to the predicted value (3.07% and 72.54%, respectively). These results confirmed that ultrasonic/microwave assisted extraction (UMAE) of polysaccharides had great potential and efficiency compared with traditional hot water extraction. At the same time, the anti-tumor activities of the polysaccharides from I. obliquus with UMAE were evaluated. The results suggested that polysaccharides from I. obliquus exhibited obvious anti-tumor activities. PMID:20149817

  10. VizieR Online Data Catalog: TU UMa light curves and maxima, CL Aur minima (Liska+, 2016)

    NASA Astrophysics Data System (ADS)

    Liska, J.; Skarka, M.; Mikulasek, Z.; Zejda, M.; Chrastina, M.

    2016-02-01

    Differential photometry for RR Lyrae star TU UMa in the 1st and 2nd file. The measurements were obtained using 24-inch and 1-inch telescopes, respectively. The observations were performed at the Masaryk University Observatory in Brno (3 nights, 24-inch), and at the private observatory in Brno (16 nights, 1-inch) in the Czech Republic from December 2013 to June 2014. Observing equipments consisted of 24-inch Newtonian telescope (600/2780mm, diameter/focal length) and a Moravian Instruments CCD camera G2-4000 with Stromgren photometric filters vby, and of 1-inch refractor (a photographic lens Sonnar 4/135mm, lens focal ratio/focal length) and ATIK 16IC CCD camera with green photometric filter with similar throughput as the Johnson V filter. Exposures were v - 60s, b - 30s, y - 30s, green - 30s. For the small aperture telescope, five frames were combined to a single image to achieve a better signal-to-noise ratio. The time resolution of a such combined frame is about 170s. CCD images were calibrated in a standard way (dark frame and flat field corrections). The C-Munipack software (Motl 2009) was used for this processing as well as for differential photometry. The comparison star BD+30 2165 was the same for both instruments, but the control stars were BD+30 2164 (for the 24-inch telescope) and HD 99593 (for the 1-inch telescope). The 3rd file contains maxima timings of TU UMa adopted from the GEOS RR Lyr database, from the latest publications, together with maxima timings determined in our study. Times of maxima were calculated from our observations, sky-surveys data (Hipparcos, NSVS, Pi of the Sky, SuperWASP), photographic measurements (project DASCH), and from several published datasets, in which the maxima were omitted or badly determined - Boenigk (1958AcA.....8...13B), Liakos, Niarchos (2011IBVS.6099....1L, 2011IBVS.5990....1L), Liu, Janes (1989ApJS...69..593L), Preston et al. (1961ApJ...133..484P). The 4th file contains minima timings of eclipsing binary CL Aur

  11. Detection of the white dwarf and the secondary star in the new SU UMa dwarf nova HS 2219+1824

    NASA Astrophysics Data System (ADS)

    Rodríguez-Gil, P.; Gänsicke, B. T.; Hagen, H.-J.; Marsh, T. R.; Harlaftis, E. T.; Kitsionas, S.; Engels, D.

    2005-02-01

    We report the discovery of a new, non-eclipsing SU UMa-type dwarf nova, HS 2219+1824. Photometry obtained in quiescence (V≈17.5) reveals a double-humped light curve from which we derive an orbital period of ≃86.2 min. Additional photometry obtained during a superoutburst reaching V≃12.0 clearly shows superhumps with a period of ≃89.05 min. The optical spectrum contains double-peaked Balmer and He I emission lines from the accretion disc as well as broad absorption troughs of Hβ, Hγ, and Hδ from the white dwarf primary star. Modelling of the optical spectrum implies a white dwarf temperature of 13 000 K⪉Teff⪉17 000 K, a distance of 180 pc⪉ d⪉230 pc, and suggests that the spectral type of the donor star is later than M 5. Phase-resolved spectroscopy obtained during quiescence reveals a narrow Hα emission line component which has a radial velocity amplitude and phase consistent with an origin on the secondary star, possibly on the irradiated hemisphere facing the white dwarf. This constitutes the first detection of line emission from the secondary star in a quiescent SU UMa star. Based in part on observations obtained at the German-Spanish Astronomical Center, Calar Alto, operated by the Max-Planck-Institut für Astronomie, Heidelberg, jointly with the Spanish National Commission for Astronomy; on observations made with the IAC80 and OGS telescopes, operated on the island of Tenerife by the Instituto de Astrofísica de Canarias (IAC) and the European Space Agency (ESA), respectively, in the Spanish Observatorio del Teide of the IAC; on observations made at the 1.2 m telescope, located at Kryoneri Korinthias, and owned by the National Observatory of Athens, Greece; and on observations made with the William Herschel Telescope, which is operated on the island of La Palma by the Isaac Newton Group in the Spanish Observatorio del Roque de los Muchachos of the IAC.

  12. Imagens do céu ontem e hoje - um multimídia interativo de astronomia e uma nova exposição no MAST

    NASA Astrophysics Data System (ADS)

    Caretta, C. A.; Lima, F. P.; Requeijo, F.; Vieira, G. G.; Alves, F.; Valente, M. E. A.; de Almeida, R.; de Garcia, G. C.; Quixadá, A. C.

    2003-08-01

    "Imagens do Céu Ontem e Hoje" é o título de uma nova exposição que está sendo inaugurada no Museu de Astronomia e Ciências Afins (MCT), que inclui experimentos interativos, maquetes, réplicas e 8 terminais de computador com um multimídia interativo sobre Astronomia para consulta dos visitantes. O multimídia apresenta um conteúdo bastante extenso, que engloba quase todos os temas em Astronomia, consistindo numa fonte de divulgação e pesquisa para um público que vai das crianças até estudantes universitários. O conteúdo está distribuído em mais de 500 páginas de texto divididas em 4 módulos: "O Universo", "Espectroscopia", "Telescópios" e "Observando o Céu". Cada módulo é subdividido em 5 seções, em média, cada uma iniciada por uma animação que ilustra os temas a serem abordados na seção. Ao final da animação, uma lista de temas é apresentada sob o título "Saiba Mais". Para exemplificar, o módulo "O Universo" contém as seguintes seções: "O Universo visto pelo homem", "Conhecendo o Sistema Solar", "Indo além do Sistema Solar", "Nossa Galáxia, a Via-Láctea" e "Indo mais além, a imensidão do Universo". A seção "Conhecendo o Sistema Solar", por sua vez, tem os seguintes temas: "A origem do Sistema Solar", "O Sol", "Os planetas", "Satélites, asteróides, cometas e outros bichos..." e "O Sistema Solar em números". Cada texto é repleto de imagens, quadros, desenhos, esquemas, etc, além de passatempos ao final de cada seção, incluindo jogos interativos, quadrinhos e curiosidades, que auxiliam o aprendizado de forma divertida. Apresentamos neste trabalho as idéias gerais que permearam a produção da exposição, e uma viagem pelo multimídia para exemplificar sua estrutura e conteúdo. O multimídia será posteriormente disponibilizado para o público externo pela página eletrônica do MAst e/ou por intermédio de uma publicação comercial.

  13. First BVR light curves and preliminary results of a recently discovered W UMa-type binary: V1848 Ori

    NASA Astrophysics Data System (ADS)

    Kriwattanawong, W.; Poojon, P.

    2014-04-01

    First complete photometric light curves of a recently discovered contact binary, V1848 Ori, are presented. BVR imaging data were used to derive photometric solutions, using Wilson-Devinney code. We discovered that this system is a weak-contact binary, with a fillout factor of f = 13.14%(±1.44%). Preliminary results showed that V1848 Ori is an A-type W UMa system, with a mass ratio of q = 0.7615. The more massive component was found about 400 K hotter than the other one. This system has varied from W-type to A-type during the last decade. According to the preliminary physical parameters, the weak-contact configuration of this system, with the mass ratio close to unity, and no sign of long-term orbital period change yet, is unlikely to be broken. The contact configuration is expected to be maintained and become deeper or not, depending on effect of the AML mechanism.

  14. The first photometric analysis and period investigation of the W UMa type binary system V1139 Cas

    NASA Astrophysics Data System (ADS)

    Li, K.; Hu, S.-M.; Guo, D.-F.; Jiang, Y.-G.; Gao, D.-Y.; Chen, X.

    2015-01-01

    V1139 Cas, which is a very short period W UMa type binary star, was a neglected object since its discovery. BVRI light curves of this system observed using the 1 m telescope at Weihai Observatory of Shandong University are presented and are analyzed using the Wilson-Devinney code. It is discovered that V1139 Cas is a shallow contact binary system (f=3.6%) with a mass ratio of q=1.583. By using all available times of minimum light, the orbital period variation is studied for the first time. We found that the orbital period has varied by a combination of an downward parabola and a sinusoid. The downward parabola means continuous period decrease at a rate of dP/dt=3.66×10-7 d yr-1 and may be caused by angular momentum loss via stellar wind. The sinusoidal variation with a period of 12.8 yr and a semi-amplitude of 0.0064 days can most likely be interpreted as the light travel time effect due to the existence of an unseen tertiary companion.

  15. Photometric studies of two W UMa type variables in the field of distant open cluster NGC 6866

    NASA Astrophysics Data System (ADS)

    Joshi, Yogesh Chandra; Jagirdar, Rukmini; Joshi, Santosh

    2016-04-01

    We present photometric analysis of the two W UMa type binaries identified in the field of distant open star cluster NGC 6866. Although these systems, namely ID487 and ID494, were reported by Joshi et al., a detailed study of these stars has not been carried out before. The orbital periods of these stars are found to be 0.415110±0.000001 day and 0.366709±0.000004 day, respectively. Based on the photometric and infrared colors, we find their respective spectral types to be K0 and K3. The photometric light variations of both stars show the O'Connell effect which can be explained by employing a dark spot on the secondary components. The V and I band light curves are analyzed using the Wilson-Devinney (WD) code and relations given by Gazeas which yield radii and masses for the binary components of star ID487 of R1 = 1.24 ± 0.01 R⊙, R2 = 1.11 ± 0.02 R⊙, and M1 = 1.24 ± 0.02 M⊙, M2 = 0.96 ± 0.05 M⊙ and for star ID494 of R1 = 1.22±0.02R⊙, R2 = 0.81±0.01 R⊙, and M1 = 1.20±0.06 M⊙, M2 = 0.47±0.01 M⊙.

  16. Speciation, population structure, and demographic history of the Mojave Fringe-toed Lizard (Uma scoparia), a species of conservation concern.

    PubMed

    Gottscho, Andrew D; Marks, Sharyn B; Jennings, W Bryan

    2014-06-01

    The North American deserts were impacted by both Neogene plate tectonics and Quaternary climatic fluctuations, yet it remains unclear how these events influenced speciation in this region. We tested published hypotheses regarding the timing and mode of speciation, population structure, and demographic history of the Mojave Fringe-toed Lizard (Uma scoparia), a sand dune specialist endemic to the Mojave Desert of California and Arizona. We sampled 109 individual lizards representing 22 insular dune localities, obtained DNA sequences for 14 nuclear loci, and found that U. scoparia has low genetic diversity relative to the U. notata species complex, comparable to that of chimpanzees and southern elephant seals. Analyses of genotypes using Bayesian clustering algorithms did not identify discrete populations within U. scoparia. Using isolation-with-migration (IM) models and a novel coalescent-based hypothesis testing approach, we estimated that U. scoparia diverged from U. notata in the Pleistocene epoch. The likelihood ratio test and the Akaike Information Criterion consistently rejected nested speciation models that included parameters for migration and population growth of U. scoparia. We reject the Neogene vicariance hypothesis for the speciation of U. scoparia and define this species as a single evolutionarily significant unit for conservation purposes. PMID:25360285

  17. Speciation, population structure, and demographic history of the Mojave Fringe-toed Lizard (Uma scoparia), a species of conservation concern

    PubMed Central

    Gottscho, Andrew D; Marks, Sharyn B; Jennings, W Bryan

    2014-01-01

    The North American deserts were impacted by both Neogene plate tectonics and Quaternary climatic fluctuations, yet it remains unclear how these events influenced speciation in this region. We tested published hypotheses regarding the timing and mode of speciation, population structure, and demographic history of the Mojave Fringe-toed Lizard (Uma scoparia), a sand dune specialist endemic to the Mojave Desert of California and Arizona. We sampled 109 individual lizards representing 22 insular dune localities, obtained DNA sequences for 14 nuclear loci, and found that U. scoparia has low genetic diversity relative to the U. notata species complex, comparable to that of chimpanzees and southern elephant seals. Analyses of genotypes using Bayesian clustering algorithms did not identify discrete populations within U. scoparia. Using isolation-with-migration (IM) models and a novel coalescent-based hypothesis testing approach, we estimated that U. scoparia diverged from U. notata in the Pleistocene epoch. The likelihood ratio test and the Akaike Information Criterion consistently rejected nested speciation models that included parameters for migration and population growth of U. scoparia. We reject the Neogene vicariance hypothesis for the speciation of U. scoparia and define this species as a single evolutionarily significant unit for conservation purposes. PMID:25360285

  18. Tephra deposits of impulsive explosive events during the 2008 eruption of Halema`uma`u Crater, Kilauea

    NASA Astrophysics Data System (ADS)

    Houghton, B. F.; Swanson, D.; Carey, R. J.; Rausch, J.

    2010-12-01

    Eight short-lived impulsive explosive eruptions of low intensity occurred at Halema`uma`u crater, Kilauea in March-October 2008. Estimated total erupted masses were 10E+5 to 10E+6 kg; using inferred durations of 20-50 s, these equate to eruption rates of c. 10E+3 to 10E+4 kg/s, an order of magnitude lower than typical sustained Hawaiian fountains of the 20th century. Deposits are predominantly lapilli-sized but generally contain two elements: near-circular aprons of ballistic blocks extending to 200-400 m from the vent and wind-attenuated convective fall lobes which extend several tens of kilometers downwind but barely reach single-clast thickness even along the dispersal axes. Thinning half-distances (bt) for the deposits are 10-90 m, consistent with the exceptionally low mass discharges and similar to those of mild Strombolian eruptions. This geometry is essentially cone-like (and consistent with the low discharge rates) but the short duration of the events means no permanent deposit has formed. The deposits are relatively well-sorted yet richer in wall rock than the products of typical Hawaiian or Strombolian explosions.

  19. The orbital period of the dwarf nova HS Virginis, the revised Po-Ps relation and the ``superhump" mass ratio distribution of SU UMa stars

    NASA Astrophysics Data System (ADS)

    Mennickent, R. E.; Matsumoto, K.; Arenas, J.

    1999-08-01

    A spectroscopic study of the SU UMa star HS Vir is presented. From the analysis of the radial velocities of the Hα emission line the most likely orbital period is 0\\fd07692(3), although we cannot discard two aliases at 0\\fd07678 and 0\\fd07709. The Balmer lines follow the orbital period with a radial velocity semiamplitude K = 96 +/- 9 km s(-1) , but the He I lambda 5875 emission line shows a double wave during the orbital cycle. We found that the mean Balmer, He I and He II 4686 lines can be roughly modeled with a disk radial emissivity ~ r(-2) . A revised version of the Po-Ps relation for SU UMa stars is also given, which is relevant for discriminating between +/- 1 c/d aliases of the orbital period. We calculated the mass ratio, derived from the tidal resonance model, of HS Vir (qsh = 0.22 +/- 0.04) and 43 additional SU UMa stars. The qsh distribution has a roughly gaussian shape with a mean 0.14, in sharp contrast with the orbital period distribution. Finally, a discussion of the possible stellar masses and inclination of HS Vir is given. We observe that the mass ratio derived from the dynamic solution is in disagreement with that derived from the tidal resonance model. This fact probably indicates that K does not represent the white dwarf binary motion. Based on observations obtained at ESO La Silla Observatory (ESO Proposal 61.D-0395).

  20. Environmental differences in substrate mechanics do not affect sprinting performance in sand lizards (Uma scoparia and Callisaurus draconoides).

    PubMed

    Korff, Wyatt L; McHenry, Matthew J

    2011-01-01

    Running performance depends on a mechanical interaction between the feet of an animal and the substrate. This interaction may differ between two species of sand lizard from the Mojave Desert that have different locomotor morphologies and habitat distributions. Uma scorparia possesses toe fringes and inhabits dunes, whereas the closely related Callisaurus draconoides lacks fringes and is found on dune and wash habitats. The present study evaluated whether these distribution patterns are related to differential locomotor performance on the fine sand of the dunes and the course sand of the wash habitat. We measured the kinematics of sprinting and characterized differences in grain size distribution and surface strength of the soil in both habitats. Although wash sand had a surface strength (15.4±6.2 kPa) that was more than three times that of dune sand (4.7±2.1 kPa), both species ran with similar sprinting performance on the two types of soil. The broadly distributed C. draconoides ran with a slightly (22%) faster maximum speed (2.2±0.2 m s(-1)) than the dune-dwelling U. scorparia (1.8±0.2 m s(-1)) on dune sand, but not on wash sand. Furthermore, there were no significant differences in maximum acceleration or the time to attain maximum speed between species or between substrates. These results suggest that differences in habitat distribution between these species are not related to locomotor performance and that sprinting ability is dominated neither by environmental differences in substrate nor the presence of toe fringes. PMID:21147976

  1. Teaching and Popularization of Astronomy in Latin America by the Liada Perspective. (Spanish Title: Enseñanza y Divulgación de la Astronomía en la América Latina en la Perspectiva de la Liada.) Ensino e Divulgação da Astronomia na América Latina na Perspectiva da Liada

    NASA Astrophysics Data System (ADS)

    Bretones, Paulo Sergio

    2008-12-01

    disponibilizados en la página de la Sección, faz-se una análisis y discusión sobre la importancia de tales relatos para finalidades educacionales. Es presentada una Hoja de reporte elaborado como sugestión para presentación de relatos por parte de individuos y instituciones ben como discutida la importancia de la sistematización de experiencias visando mayor visibilidad y cambio de informaciones en el área. Concluí con una evaluación de los proyectos, su potencial y limitaciones, ben como sugestiones de proyectos futuros visando mayor interacción entre los países de la América Latina y tornando disponible la Sección para esta finalidad.

    Esse trabalho visa divulgar e analisar as atividades da Seção de Ensino e Divulgação de Astronomia (SEDA) da Liga Iberoamericana de Astronomia (LIADA). Após um histórico da LIADA, são apresentados os diversos projetos da Seção que conta com a colaboração de coordenadores locais na maioria dos países da América Latina. São apresentados os projetos que visam chamar a atenção do público em geral, estudantes e professores para a observação do céu e posterior envio de relatos para colocação na página da Seção na Internet. Mais especificamente são analisados os projetos e relatos relacionados aos eclipses ocorridos desde o ano 2000. Utilizando-se os arquivos disponibilizados na página da Seção, faz-se uma análise e discussão sobre a importância de tais relatos para finalidades educacionais. É apresentado um formulário elaborado como sugestão para apresentação de relatos por parte de indivíduos e instituições bem como discutida a importância da sistematização de experiências visando maior visibilidade e troca de informações na área. Conclui com uma avaliação dos projetos, seu potencial e limitações, bem como sugestões de projetos futuros visando maior interação entre os países da América Latina e tornando disponível a Seção para esta finalidade.

  2. BVRI Photometric Study of the Short Period Solar Type Near-Contact W UMa Binary, FF Vulpeculae

    NASA Astrophysics Data System (ADS)

    Caton, Daniel B.; Samec, Ronald G.; Nyaude, Ropafadzo; Van Hamme, Walter V.

    2016-01-01

    High precision BVRcIc light curves of FF Vul were observed during the Fall, 2015 season at the Dark Sky Observatory 0.81-m reflector of Appalachian State University, and the SARA North 0.91-m reflector at KPNO. It is an eclipsing binary with a period of only 0.444983 (2) d. This is the shortest period of our recently studied Pre Contact W UMa Binary (PCWB's), V2421 Cyg, V1043 Cas, ZZ Eri, V500 Peg, and Mis V1287. Our Binary Maker fits and our Wilson-Devinney solution show that the binary is a near-contact, semidetached binary, i.e., a V1010 Oph type configuration (the more massive component has filled its critical lobe while the secondary component is under-filling). Five times of minimum light were calculated, 3 primary and 2 secondary eclipses from our present observations:HJD I = 2457285.7262 ±0.0002, 2457306.6425 ±0.0002, 2457310.6469 ±0.0002HJD II = 2457279.7222 ±0.0006, 2457280.6124 ±0.0017.The following quadratic ephemerides was determined from all available times of minimum light:JDHelMinI=2457310.6473±0.0007d + 0.4449758±0.0000002 X E -0.00000000006± 0.00000000001 X E2The continuous 20 year period study reveals a period decrease in the orbital period at about the 6 sigma level. Our modeling shows a near-equatorial hot spot on the following side of the secondary component. This is probably due to a matter transfer onto the secondary component. The light curve has a large difference in primary and secondary amplitudes and the light curve solution gives a component temperature difference of more than 1500 K. The solution shows a total secondary eclipse of 23 minutes duration. As expected in binaries of this type, it has a cool spot region on its primary component.

  3. Uma comparação entre técnicas de propagação de erros em astrofísica: Monte Carlo x Bootstrap

    NASA Astrophysics Data System (ADS)

    Waelkens, A. H.; Janot Pacheco, E.

    2003-08-01

    Recentemente Dhillon & Watson (2001) criticaram o procedimento de determinação de erros via simulações de Monte Carlo no caso do imageamento indireto de estrelas, por introduzir ruído nos dados e resultar em erros superestimados. Estes autores propuseram a utilização alternativa do método de Bootstrap como uma técnica superior para a estimativa de erros. Neste trabalho apresentamos os resultados de um estudo comparativo da performance das técnicas de simulação por Monte Carlo e por Bootstrap para a determinação de erros em duas situações de interesse: (i) ajuste de modelos a espectros observados e (ii) imageamento indireto de discos de acréscimo com técnicas de mapeamento por eclipse. No caso (i), os dados de entrada são espectros de emissão simples de hidrogênio aos quais é adicionado ruído gaussiano de amplitude selecionada. No caso (ii), são produzidas curvas de luz do eclipse de uma distribuição de brilho seguindo a lei TµR-3/4 para discos estacionários cuja taxa de acréscimo varia ao longo do eclipse segundo uma distribuição gaussiana de amplitude selecionada, simulando o ruído. A avaliação da performance é feita com o auxílio de um diagrama do erro relativo na grandeza ajustada, conforme obtido por cada método, versus o erro relativo (ruído/sinal) dos dados de entrada. O estudo mostra que as duas técnicas produzem resultados semelhantes nos dois casos, e que a suposta superioridade do método de Bootstrap não se confirma.

  4. Size-resolved chemistry of aerosols produced by Halema'uma'u eruption 2008-2009, Kilauea Volcano, Hawai'i

    NASA Astrophysics Data System (ADS)

    Ilyinskaya, E.; Martin, R.; Edmonds, M.; Sutton, A. J.; Elias, T.; Werner, C. A.

    2009-12-01

    A dense quiescent plume has been emitted continuously from the 2008 eruptive vent in Halema'uma'u crater since March 2008. Aerosol particles were sampled near-source in the young plume (<30 s old) in May 2008 and April 2009, and at 10 km downwind (April 2009 only). We also sampled the plume from Pu'u O'o vent both near-source and 8-10 km downwind (2007 to 2009). Sampling was performed using filter packs and a cascade impactor that collects and segregates PM10 (particle matter <10 μm) into 14 size fractions. The collected PM was analysed for SO42-, F-, Cl-, Na+, K+, Ca2+ and Mg2+. Our results show a distinctive peak of sulphate abundance at ~0.3-0.5 μm in the 2008 and 2009 summit samples. The total SO42- mass concentration collected in each sampling run correlates well with that of metals but poorly with Cl- and F-. Downwind measurements of PM from Halema'uma'u and Pu'u O'o show SO42- in the same narrow size bin (0.3-0.5 μm) with concentrations similar to, or higher than at source. It is noteworthy that the particles appear not to have grown when the plume has drifted 5-10 km downwind. However, a 1 μm size mode of SO42- seen at Pu'u O'o crater rim (not seen at Halema'uma'u) is absent from the downwind plume. This result leads us to believe that the particles grow rapidly after emission but get scavenged efficiently once they reach a certain size (>0.5 μm). The formation of aerosol measured downwind is dominated by oxidation of SO2 to SO42- in the plume. The ratio of Cl-/SO42- is higher downwind than at the source in both Halema'uma'u and Pu'u O'o plumes, and increases further during rainfall; we propose that the Cl--bearing aerosol is formed by dissolution of HCl gas into water droplets in the plume.

  5. The Spot Variability and Related Brightness variations of the Solar Type PreContact W UMa Binary System V1001 Cas

    NASA Astrophysics Data System (ADS)

    Samec, Ronald George; Koenke, Sam S.; Faulkner, Danny R.

    2015-08-01

    A new classification of eclipsing binary has emerged, Pre Contact WUMa Binaries (PCWB’s, Samec et al. 2012). These solar-type systems are usually detached or semidetached with one or both components under filling their critical Roche lobes. They usually have EA or EB-type light curves (unequal eclipse depths, indicating components with substantially different temperatures). The accepted scenario for these W UMa binaries is that they are undergoing steady but slow angular momentum losses due to magnetic braking as stellar winds blow radially away on stiff bipolar field lines. These binaries are believed to come into stable contact and eventually coalesce into blue straggler type, single, fast rotating A-type stars (Guinan and Bradstreet,1988). High precision 2012 and 2009 light curves are compared for the very short period (~0.43d) Precontact W UMa Binary (PCWB), V1001 Cassiopeia. This is the shortest period PCWB found so far. Its short period, similar to the majority of W UMa’s, in contrast to its distinct Algol-type light curve, make it a very rare and interesting system. Our solutions of light curves separated by some three years give approximately the same physical parameters. However the spots radically change, in temperature, area and position causing a distinctive variation in the shape of the light curves. We conclude that spots are very active on this solar type dwarf system and that it may mimic its larger cousins, the RS CVn binaries.

  6. Uma Visão do Universo Segundo um Grupo de Alunos do Ensino Médio de São Paulo

    NASA Astrophysics Data System (ADS)

    Elias, D. S.; Araújo, M.; Amaral, L. H.; Voelzke, M. R.; Araújo, M.

    2005-08-01

    A astronomia, embora seja uma ciência popular, com inúmeras descobertas de interesse público, ainda é apresentada desconsiderando-se os aspectos históricos e científicos relacionados ao seu desenvolvimento, sendo geralmente veiculada nos meios de comunicação de maneira pouco esclarecedora e não raro com imprecisões. Neste trabalho analisou-se a concepção de um grupo de estudantes de Ensino Médio sobre conceitos de astronomia, visando identificar sua visão de mundo a respeito do Universo, envolvendo idéias sobre espaço e tempo. Para issso, foi aplicado um questionário em três escolas da grande São Paulo em um espaço amostral de 270 alunos. Constatou-se que, embora o ensino de astronomia esteja previsto nos PCNEM, os resultados obtidos na pesquisa mostram que há grande deficiência no conhecimento dos temas investigados. Nesse sentido, verificou-se que apenas 20% dos alunos eram capazes de relacionar a sucessão das semanas com as fases da lua, enquanto 28% associaram as estações do ano à inclinação do eixo de rotação da Terra. Por outro lado, somente 23% dos alunos tinham noções das distâncias entre os objetos celestes próximos da Terra e 56% conseguiram relacionar o Big Bang com a origem do Universo. Finalmente, constatou-se que 37% reconheciam o ano-luz como uma unidade de distância e 60% reconheciam o Sol como sendo uma estrela. Apesar de 60% dos alunos indicarem que a escola é a principal fonte para aquisição dos conhecimentos de astronomia, conclui-se que seus conceitos nessa área ainda são inadequados, havendo necessidade de ampliação e aprimoramento da abordagem desses conteúdos nos ambientes escolares.

  7. BVR{sub c}I{sub c} OBSERVATIONS AND ANALYSES OF THE DWARF DETACHED BINARY V1043 CASSIOPEIA AND A COMMENT ON PRECONTACT W UMa'S

    SciTech Connect

    Samec, R. G.; Smith, P. M.; Chamberlain, H.; Faulkner, D. R.; Van Hamme, W.

    2013-01-01

    Complete Bessel BVR{sub c}I{sub c} light curves of V1043 Cassiopeia [2MASS J00371195+5301324, Mis V1292, USNO-A2.0 1425-00875743, {alpha}(2000) = 00{sup h}37{sup m}11.{sup s}95, {delta}(2000) = +53 Degree-Sign 01'32.''5] are analyzed. The system is a member of the small group of pre-contact W UMa binaries (PCWBs). Its light curve has the appearance of an Algol (EA) light curve, however it is made up of dwarf solar type components in a detached mode with a period of only 0.6616 days. The analysis includes a period study, an improved ephemeris, a mass ratio search, and a simultaneous BVR{sub c}I{sub c} Wilson-Devinney solution. We document about 20 other PCWBs given in the literature. Several have RS CVn-like properties.

  8. Photometric observations and light curve solutions of the W UMa stars NSVS 2244206, NSVS 908513, CSS J004004.7+385531 and VSX J062624.4+570907

    NASA Astrophysics Data System (ADS)

    Kjurkchieva, Diana Petrova; Popov, Velimir Angelov; Vasileva, Doroteya Lyubenova; Petrov, Nikola Ivanov

    2016-09-01

    Photometric observations in Sloan g‧ and i‧ bands of four W UMa stars, NSVS 2244206, NSVS 908513, CSS J004004.7+385531 and VSX J062624.4+570907, are presented. The light curve solutions reveal that all targets have overcontact configurations with fillout factors within 0.15–0.26. Their components are G-K spectral types and are almost in thermal contact. They are also relatively close in size and luminosity: the radius ratios r2/r1 are within 0.75–0.90 the luminosity ratios l2/l1 are within 0.53–0.63. The results of the light curve solution of CSS J004004.7+385531 imply the weak limb-darkening effect of its primary component and possible presence of additional absorbing features in the system.

  9. Detecção da fase impulsiva de uma explosão solar gigante até 405 GHz

    NASA Astrophysics Data System (ADS)

    Raulin, J.-P.; Makhmutov, V.; Kaufmann, P.; Pacini, A. A.; Luethi, T.; Hudson, H. S.; Gary, D. E.; Yoshimori, M.

    2003-08-01

    A explosão ocorrida no dia 25/08/2001 foi uma das mais intensas do presente ciclo solar em ondas de rádio de altas frequências. Foram medidas em ondas milimétricas e submilimétricas, aproximadamente, 105 e vários milhares de unidades de fluxo solar, respectivamente. Apresentamos um estudo deste evento em múltiplas frequências, desde microondas (1GHz), até ondas submilimétricas (405 GHz) detectadas pelo Telescópio Solar para ondas Submilimétricas (SST). Esta base de dados foi complementada utilizando-se o experimento Yohkoh, incluindo a emissão em raios-X duros e raios-g (até 100 MeV), e imagens em raios-X moles da região ativa envolvida. Enfocamos e discutimos principalmente os seguintes aspectos da fase impulsiva do evento: (i) as implicações deduzidas do espectro eletromagnético, obtido pela primeira vez até 405 GHz; (ii) a dinâmica da região ativa. Os resultados mostram que para explicar o espectro rádio observado, são necessários entre 3.5×1037 e 1.5×1039 elétrons acelerados acima de 20 keV em uma região de campo magnético entre 300 e 800 Gauss. A estimativa do fluxo de fótons que seria produzido por estes elétrons, mostra que grande parte deles não precipitou na baixa atmosfera. A evolução temporal da emissão em raios-X moles revela que a configuração magnética da região ativa foi muito dinâmica durante a fase impulsiva da explosão. Em particular, mostramos que a produção dos elétrons altamente energéticos foi iniciada junto com a aparição, na baixa coroa solar, de um novo sistema compacto de estruturas magnéticas. Este fato sugere que os locais de aceleração estão localizados na baixa atmosfera do Sol, como resultado da interação entre o novo sistema compacto e o campo magnético ambiente da região ativa.

  10. Ensino de gravitação clássica no nível médio: uma proposta de abordagem e resultados preliminares

    NASA Astrophysics Data System (ADS)

    Medeiros, G. C. M.; Jafelice, L. C.

    2003-08-01

    O ensino de gravitação clássica é comumente realizado de maneira formal e descontextualizado da experiência com a força-peso e da história do tema. Fustigados por anos de experiência de ensino no assunto, nem sempre com bons resultados, propomos uma abordagem ancorada nos eixos: a) contextualização histórica; e b) reconhecimento do peso como a força de atração gravitacional. O primeiro eixo integra o tema no desenvolvimento cultural do ser humano, praticando a interdisciplinaridade. O segundo eixo embasa construtivamente a abordagem, levando o aluno a realizar experiências e a vivenciar o reconhecimento de uma força universal. A abordagem foi construída através das etapas: 1) análise crítica do tema em livros didáticos; 2) elaboração de um curso para professores das várias disciplinas do ensino médio, identificando conexões para a prática da interdisciplinaridade; 3) elaboração de material didático; e 4) avaliação da eficácia da abordagem. No trabalho discutimos em detalhe as quatro etapas. Como resultados, adiantamos que: tabulamos a abordagem de gravitação nos livros didáticos, ainda muito tradicional e carecedora de atividades criativas que poderiam melhor explorar esse assunto; mapeamos, junto aos professores, padrões de conceitos espontâneos e erros associados ao tema; e, no curso, adaptamos e testamos a eficiência de materiais instrucionais existentes e criamos outros novos (e.g., para trabalhar excentricidades das órbitas planetárias), além disto elaboramos roteiros e figuras para tratamentos qualitativo e quantitativo da lei da gravitação universal. As avaliações feitas pelos professores foram muito animadoras. O espaço da presente reunião será aproveitado para socializar a proposta e os resultados obtidos e para submeter o projeto à análise crítica. (PPGECNM/UFRN; PRONEX/FINEP; NUPA/USP; Temáticos/FAPESP)

  11. Analysis of the southern pre-contact W UMa binary ZZ Eridani: A 34 year period study yields a possible low-mass companion

    SciTech Connect

    Samec, R. G.; Clark, J. D.; Hamme, W. Van; Faulkner, D. R.

    2015-02-01

    Complete Bessel BVRI light curves of ZZ Eridani [2MASS J04130109-1044545, HV 6280, NSVS 14888164 α(2000) = 04{sup h}13{sup m}1{sub ·}{sup s}10, δ(2000) = −10°44′54{sub ·}{sup ″}5 (ICRS), V = 13.9-14.4-15.0] are observed and analyzed. The system is a southern pre-contact W UMa binary. Its light curve has the appearance of an Algol (EA) light curve, however, it is made up of dwarf solar-type components with a period of only 0.4521 days. Our 34 year period study yields a sinusoidal fit or an increasing quadratic fit. The sinusoid may indicate that a third body is orbiting the close binary. The lower-limit mass of the third body is near that of the brown dwarf limit (0.095 M α). Also included is an improved ephemeris, a mass ratio search, and a simultaneous BVRI Wilson–Devinney solution.

  12. Lichtkurve und Periode des RR-Lyrae-Sterns HO Her und GSC 02589-00332, ein W-UMa-Veraenderlicher im Feld

    NASA Astrophysics Data System (ADS)

    Groebel, Rainer

    2015-01-01

    Based on data from the SWASP database and on recent observations 110 maxima and 78 minima timings of the little studied star HO Her could be derived. During the reduction of SWASP data, discrepancies between magnitudes given by series taken simultaneously through different cameras appeared, so that in the present case the reliability of the TAMFLUX correction must be questioned. From the variations in amplitude, a regular secondary cycle could not be derived, but the variations in phase revealed a 17.4 d Blazhko period. Since the discovery, the period remains essentially constant. The ephemeris is improved to HJD (max.) = 2456802.4954(9) + 0.47269795(16) x E One of the comparison stars, GSC 02589-00332 (16:56:31.98 +30:22:22.5) revealed itself as a variable of the W UMa type presenting 0.6 mag. deep total eclipses at primary and 0.5 mag. partial eclipse at secondary minimum. As a variable, it is already known as ROTSE1 J165631.98+302222.0. From SWASP data, 138 minima spreading over 4 years could be derived. The 2014 minima showed positive (O-C) values, indicating a progressive lengthening of the period. The minima timings could be best represented by the quadratic ephemeris HJD (max.) = 2456797.5267 + 0.41111232 x E + 2.625*10 -10 x E^2

  13. Dissemination strategies: the evolution of learning resources on the evaluation of delirium, dementia, and depression.

    PubMed

    Horvath, Kathy J; Tumosa, Nina; Thielke, Stephen; Moorer, Julie; Huh, Terri; Cooley, Susan; Craft, Suzanne; Burns, Theressa

    2011-01-01

    Clinicians experience great pressures to provide timely, effective, and evidence-based medical care. Educators can aid these clinicians through the development of new tools that can facilitate timely completion of clinical tasks. These tools should summarize evidence-based information in a convenient format that allows easy use. This article describes one process in which a group of Geriatric Research, Education, and Clinical Center educators identified an area where important new information accrued, their development of a new clinical and teaching tool for imparting the new information, the initial dissemination of the tool to a preliminary target audience, and the initial evaluation of the new tool to determine how to improve its distribution and use beyond the original target audience. PMID:21347932

  14. From Delirium to Coherence: Shamanism and Medicine Plants in Silko's "Ceremony"

    ERIC Educational Resources Information Center

    Weso, Thomas F.

    2004-01-01

    A nondescript rock shelter in Texas provides the evidence for shamanism in Leslie Marmon Silko's novel, "Ceremony". There, archaeologists found identifiable images of antlered human figures and entheogenic plant substances, which are medicinal plants, associated with shamanistic practices.

  15. Dissemination Strategies: The Evolution of Learning Resources on the Evaluation of Delirium, Dementia, and Depression

    ERIC Educational Resources Information Center

    Horvath, Kathy J.; Tumosa, Nina; Thielke, Stephen; Moorer, Julie; Huh, Terri; Cooley, Susan; Craft, Suzanne; Burns, Theressa

    2011-01-01

    Clinicians experience great pressures to provide timely, effective, and evidence-based medical care. Educators can aid these clinicians through the development of new tools that can facilitate timely completion of clinical tasks. These tools should summarize evidence-based information in a convenient format that allows easy use. This article…

  16. Delirium Quantum Or, where I will take quantum mechanics if it will let me

    NASA Astrophysics Data System (ADS)

    Fuchs, Christopher A.

    2007-02-01

    Once again, I take advantage of the wonderfully liberal and tolerant mood Andrei Khrennikov sets at his yearly conferences by submitting a nonstandard paper for the proceedings. This pseudo-paper consists of excerpts drawn from two of my samizdats [Quantum States: What the Hell Are They? and Darwinism All the Way Down (and Probabilism All the Way Back Up)] that I think best summarize what I am aiming for on the broadest scale with my quantum foundations program. Section 1 tries to draw a picture of a physical world whose essence is "Darwinism all the way down." Section 2 outlines how quantum theory should be viewed in light of that, i.e., as being an expression of probabilism (in Bruno de Finetti or Richard Jeffrey's sense) all the way back up. Section 3 describes how the idea of "identical" quantum measurement outcomes, though sounding atomistic in character, nonetheless meshes well with a William Jamesian style "radical pluralism." Sections 4 and 5 further detail how quantum theory should not be viewed so much as a "theory of the world," but rather as a theory of decision-making for agents immersed within a quantum world—that is, a world in continual creation. Finally, Sections 6 and 7 attempt to sketch once again the very positive sense in which quantum theory is incomplete, but still just as complete is it can be. In total, I hope these heady speculations convey some of the excitement and potential I see for the malleable world quantum mechanics hints of.

  17. Adapting a Common Photographic Camera to Take Pictures of the Sky. (Spanish Title: Adaptando Una Camara Fotografica Comun Para Obtener Fotografias del Cielo.) Adaptando Uma Câmera Fotográfica Manual Simples Para Fotografar o Céu

    NASA Astrophysics Data System (ADS)

    Danhoni Neves, Marcos Cesar; Pereira, Ricardo Francisco

    2007-12-01

    In this paper will be introduced a method of astrophotography using a non-reflex photographic camera (a low-cost method). It will be revised some photographic processes commonly used nowadays for comparison with the aims of this paper. En este trabajo será introducido un método de astrofotografia que utiliza una cámara fotográfica non-reflex (un método de bajo costo). Serán revisados algunos procesos fotográficos comúnmente utilizados actualmente para comparación con los objetivos de este trabajo. O presente artigo procura introduzir um método de astrofotografia utilizando uma câmera fotográfica não reflex, de baixo custo. É feita uma revisão do processo fotográfico comumente empregado para fins de comparação com os objetivos pretendidos no presente trabalho.

  18. Ambient air quality effects of the 2008-2009 Halema`uma`u eruption on the Island of Hawai`i

    NASA Astrophysics Data System (ADS)

    Elias, T.; Sutton, A. J.; Kauahikaua, J. P.; Ray, J. D.; Babb, J. L.

    2009-12-01

    While the Halema`uma`u eruption has enlivened volcanologists with the rare opportunity to observe eruptive processes at Kilauea’s summit, it has also caused significant environmental impact on the Island of Hawai`i. Since the beginning of 2008, the combined SO2 emissions from the east rift zone (ERZ) and summit of Kilauea have increased by ~40% as compared to the 2003-2007 long-term average. However, emissions from Kilauea’s summit have increased ~6-fold, averaging 850 t/d during January 2008-August 2009. Although average emissions from the ERZ during this period have been 1-2 times that of the summit, the relative impact of summit emissions is disproportionately large due to the location of the vent and the plume dispersal pattern to downwind communities. Ambient air quality data show that federal standards have been exceeded frequently in various communities on the south half of the island. Between April 2008 and August 2009, primary health standards for SO2 and PM2.5 were exceeded on 41 and 19 occasions respectively in Pahala, located ~30 km downwind of the Kilauea summit under prevailing trade wind conditions. Pahala, which exceeded the SO2 annual standard for 2008, had not exceeded standards prior to the opening of the Halema`uma`u vent in March 2008. In July 2008, the U.S. Secretary of Agriculture designated Hawai`i County a primary natural disaster area due to agricultural losses from volcanic emissions. Many growers of exotic flower crops in the Ka`u district suffered irrecoverable losses. Coffee and macadamia nut farmers also reported damage to their fields. While some livestock farmers reported eye irritation in cattle, more significant damage was observed in the accelerated deterioration of galvanized fencing, gates, pipelines and other infrastructure. The increase in volcanic pollution has spurred health concerns. A rise in respiratory emergencies for visitors to Kilauea caldera in early 2008 led Hawai`i Volcanoes National Park to close areas

  19. Dynamics of an open basaltic magma system: The 2008 activity of the Halema'uma'u Overlook vent, Kīlauea Caldera

    NASA Astrophysics Data System (ADS)

    Eychenne, Julia; Houghton, Bruce F.; Swanson, Donald A.; Carey, Rebecca J.; Swavely, Lauren

    2015-01-01

    On March 19, 2008 a small explosive event accompanied the opening of a 35-m-wide vent (Overlook vent) on the southeast wall of Halema'uma'u Crater in Kīlauea Caldera, initiating an eruptive period that extends to the time of writing. The peak of activity, in 2008, consisted of alternating background open-system outgassing and spattering punctuated by sudden, short-lived weak explosions, triggered by collapses of the walls of the vent and conduit. Near-daily sampling of the tephra from this open system, along with exceptionally detailed observations, allow us to study the dynamics of the activity during two eruptive sequences in late 2008. Each sequence includes background activity preceding and following one or more explosions in September and October 2008 respectively. Componentry analyses were performed for daily samples to characterise the diversity of the ejecta. Nine categories of pyroclasts were identified in all the samples, including wall-rock fragments. The six categories of juvenile clasts can be grouped in three classes based on vesicularity: (1) poorly, (2) uniformly highly to extremely, and (3) heterogeneously highly vesicular. The wall-rock and juvenile clasts show dissimilar grainsize distributions, reflecting different fragmentation mechanisms. The wall-rock particles formed by failure of the vent and conduit walls above the magma free surface and were then passively entrained in the eruptive plume. The juvenile componentry reveals consistent contrasts in degassing and fragmentation processes before, during and after the explosive events. We infer a crude 'layering' developed in the shallow melt, in terms of both rheology and bubble and volatile contents, beneath a convecting free surface during background activity. A tens-of-centimetres thick viscoelastic surface layer was effectively outgassed and relatively cool, while at depths of less than 100 m, the melt remained slightly supersaturated in volatiles and actively vesiculating. Decoupled metre

  20. Uso de modelos mecânicos em curso informal de astronomia para deficientes visuais. Resgate de uma experiência

    NASA Astrophysics Data System (ADS)

    Tavares, E. T., Jr.; Klafke, J. C.

    2003-08-01

    O presente trabalho propõe-se a resgatar uma experiência que teve lugar no Planetário de São Paulo nos anos 60. Em 1962, o Sr. Acácio, então com 37 anos, deficiente visual desde os 27, passou a assistir às aulas ministradas pelo Prof. Aristóteles Orsini aos integrantes do corpo de servidores do Planetário. O Sr. Acácio era o único deficiente da turma e, embora possuísse conhecimentos básicos e relativamente avançados de matemática, enfrentava dificuldades na compreensão e acompanhamento da exposição, como também em estudos posteriores. Com o intuito de auxiliá-lo na superação desses problemas, o Prof. Orsini solicitou a construção de modelos mecânicos que, através do sentido do tato, permitissem o acompanhamento das aulas e a transposição do modelo para o "constructo" mental. Essa prática mostrou-se tão eficaz que facilitou sobejamente o aprendizado da matéria pelo sujeito. O Sr. Acácio passou a integrar o corpo de professores do Planetário/Escola Municipal de Astrofísica, tendo ficado responsável pelo curso de "Introdução à Astronomia" por vários anos. Além disso, a experiência foi tão bem sucedida que alguns dos modelos tiveram seus elementos constitutivos pintados diferencialmente para serem utilizados em cursos regulares do Planetário, tornando-se parte integrante do conjunto de recursos didáticos da instituição. É pensando nessa eficácia, tanto em seu objetivo original permitir o aprendizado de um deficiente visual quanto no subsidiário recurso didático sistemático da instituição que decidimos resgatar essa experiência. Estribados nela, acreditamos ser extremamente produtivo, em termos educacionais, o aperfeiçoamento dos modelos originais, agora resgatados e restaurados, e a criação de outros que pudessem ser utilizados no ensino dessa ciência a deficientes visuais.

  1. Variação temporal do gradiente radial de o/h a partir de uma amostra de nebulosas planetárias

    NASA Astrophysics Data System (ADS)

    Maciel, W. J.; Costa, R. D. D.; Uchida, M. M. M.

    2003-08-01

    Gradientes radiais de abundância são observados no disco de nossa Galáxia e também em outras galáxias espirais. No caso da Galáxia, o principal problema relativo aos gradientes é sua variação temporal, que constitui um dos principais vínculos aos modelos de evolução química da Galáxia. As nebulosas planetárias são particularmente interessantes no estudo dos gradientes e suas variações, tanto espaciais como temporais. São objetos brilhantes, podendo ser observadas a grandes distâncias, e têm abundâncias relativamente precisas de diversos elementos químicos. Além disso, sendo originadas de estrelas com massas entre 0.8 e 8 massas solares na sequência principal, incluem objetos com idades e populações diferentes, o que as torna especialmente interessantes ao estudo da variação temporal dos gradientes. Neste trabalho, apresentamos resultados recentes sobre a variação temporal do gradiente de O/H a partir de uma amostra contendo cerca de 200 nebulosas, para as quais obtivemos distâncias por métodos estatísticos. As abundâncias foram parcialmente obtidas a partir de observações em Itajubá e La Silla, sendo as restantes obtidas da literatura. Os resultados mostram, pela primeira vez, evidências de um achatamento do gradiente de O/H, de -0.11 dex/kpc para -0.06 dex/kpc nos últimos 9 giga-anos ou de -0.08 dex/kpc para -0.06 dex/kpc nos últimos 5 giga-anos. Esses valores apresentam um bom acordo com alguns modelos recentes para a evolução química da Galáxia. (FAPESP/CNPq)

  2. Percepção astronómica de um grupo de alunos do ensino médio de uma escola da rede estadual de São Paulo

    NASA Astrophysics Data System (ADS)

    de Oliveria, E. F.; Voelzke, M. R.

    2009-03-01

    Sendo a Astronomia uma das cièncias mais antigas da humanidade, e considerando sua importáncia histórica e cultural, é de extrema releváncia que tópicos relacionados a ela sejam tratados nas escolas. Embora os Parámetros Curriculares Nacionais do Ensino Médio (PCN-EM) e as Orientaçiacute;es Complementares aos Parámetros (PCN+) apontem a importáncia de uma abordagem significativa de conceitos relacionados à Astronomia nas aulas de Física, muitos estudantes terminam o Ensino Médio (EM) sem compreender a razão de certos acontecimentos de origem celeste, ainda que estes façam parte de seu cotidiano e sejam alvos da curiosidade natural dos jovens. Da observação dessa curiosidade em alunos de uma escola pública paulista, na cidade de Suzano, surgiu o interesse em investigar os conhecimentos básicos em Astronomia dos alunos do Ensino Médio desta escola, constituindo-se este como principal objetivo desta pesquisa. Para tanto foi elaborado um questionário de múltipla escolha aplicado inicialmente a 34 alunos do primeiro ano e, posteriormente, a mais 310, distribuídos entre as très séries do Ensino Médio dos períodos matutino e noturno. Dessa forma, observou-se que 73,9% dos estudantes identificaram o Sol como sendo uma estrela, 67,1% mostraram compreender a sucessão entre dia e noite e 52,3% relacionaram o Big Bang à origem do Universo. Em contrapartida, apenas 34,5% relacionaram as estaçíes do ano à inclinação do eixo de rotação da Terra, 21,3% indicaram a influència gravitacional simultánea da Lua e do Sol como responsável pelo fenòmeno das marés, 24,5% indicaram corretamente quais são os objetos celestes mais próximos da Terra, 36,1% identificaram ano-luz como uma medida de distáncia e 34,2% reconheceram as estrelas cadentes como meteoros, evidenciando-se assim o pequeno discernimento dos estudantes quanto aos fenòmenos e termos astronòmicos do cotidiano. Além disso, foram comparadas as respostas de alun! os de diferentes s

  3. Multiwavelength optical observations of chromospherically active binary systems. V. FF UMa (2RE J0933+624): a system with orbital period variation

    NASA Astrophysics Data System (ADS)

    Gálvez, M. C.; Montes, D.; Fernández-Figueroa, M. J.; de Castro, E.; Cornide, M.

    2007-09-01

    Context: This is the fifth paper in a series aimed at studying the chromospheres of active binary systems using several optical spectroscopic indicators to obtain or improve orbital solution and fundamental stellar parameters. Aims: We present here the study of FF UMa (2RE J0933+624), a recently discovered, X-ray/EUV selected, active binary with strong Hα emission. The objectives of this work are, to find orbital solutions and define stellar parameters from precise radial velocities and carry out an extensive study of the optical indicators of chromospheric activity. Methods: We obtained high resolution echelle spectroscopic observations during five observing runs from 1998 to 2004. We found radial velocities by cross correlation with radial velocity standard stars to achieve the best orbital solution. We also measured rotational velocity by cross-correlation techniques and have studied the kinematic by galactic space-velocity components (U, V, W) and Eggen criteria. Finally, we have determined the chromospheric contribution in optical spectroscopic indicators, from Ca ii H & K to Ca ii IRT lines, using the spectral subtraction technique. Results: We have found that this system presents an orbital period variation, higher than previously detected in other RS CVn systems. We determined an improved orbital solution, finding a circular orbit with a period of 3.274 days. We derived the stellar parameters, confirming the subgiant nature of the primary component (MP = 1.67 M⊙ and R sin{i}_P=2.17 R⊙) and obtained rotational velocities (v sin{i}), of 33.57 ± 0.45 km s-1 and 32.38 ± 0.75 km s-1 for the primary and secondary components respectively. From our kinematic study, we can deduce its membership to the Castor moving group. Finally, the activity study has given us a better understanding of the possible mechanisms that produce the orbital period variation. Based on observations collected with the 2.2 m telescope at the Centro Astronómico Hispano Alemán (CAHA

  4. Learning Astronomy by Playing in a Park. (Spanish Title: Aprender AstronoMía Jugando en Una Plaza.) Aprender Astronomia Brincando em Uma Praça

    NASA Astrophysics Data System (ADS)

    Camino, Néstor

    2012-12-01

    trabalho alguns jogos de praça, considerados como módulos didáticos para imaginar processos astronômicos, a partir da concepção de que a aprendizagem em Astronomia deve-se desenvolver fortalecendo a relação do próprio corpo com o espaço tridimensional e com o tempo, tal como se vive ao observar o céu, construindo um "diálogo" entre o mundo real e as aprendizagens a construir. Os jogos apresentados (carrosséis e tobogãs) foram desenhados para trabalhar sobre a translação da Terra em torno do Sol, as fases da Lua e a gravidade, e sobre o que um observador percebe dos mesmos. Dá-se a descrição de cada jogo, discutem-se seus fundamentos físicos e astronômicos, e desenvolve-se uma crítica didática dos mesmos. Finalmente, comenta-se o papel que deveriam ter os docentes no apoio aos aprendizes no processo de interação com os jogos apresentados.

  5. Uma análise do fenômeno “alternância de línguas” na fala de bilíngues intermodais (Libras e Português)

    PubMed Central

    de Sousa, Aline Nunes; de Quadros, Ronice Müller

    2013-01-01

    Um interessante fenômeno lingüístico presente nas interações das pessoas bilíngues é a alternância de línguas. Neste trabalho, estamos investigando a alternância entre a língua portuguesa oral e a língua de sinais brasileira – Libras, numa mesma cadeia enunciativa, com o objetivo de identificar e analisar o uso dessa alternância na fala de uma criança e de um adulto (ambos ouvintes, filhos de pais surdos), interagindo em uma situação de bilinguismo intermodal, com interlocutores surdos e ouvintes. A alternância de línguas, nesse caso, ocorre quando se para de falar em português e se alterna para sinalizar. O presente trabalho se caracteriza como um estudo inicial, com análise qualitativa de dados. Fazem parte do nosso corpus nove sessões de interações em Libras e em português oral, gravadas em vídeo, que fazem parte do Projeto Desenvolvimento Bilíngue Bimodal da UFSC. Os dados revelam que as características da alternância de línguas pelo adulto e pela criança parecem ter semelhanças e diferenças. O sujeito adulto parece ter feito um uso da alternância mais preocupado com o curso da interação. A criança, por sua vez, não parece tê-la usado com propósitos pragmáticos específicos. Quanto à extensão das alternâncias, pode-se perceber que tanto a criança quanto o adulto utilizaram enunciados maiores do que uma única palavra isolada. O papel dos interlocutores parece ter sido decisivo nas interações aqui investigadas – especialmente nas do adulto, já que a criança ainda está em processo de tomada de consciência do papel do interlocutor na interação. PMID:24379831

  6. [The logical basis of mental confusion in Delasiauve, Bonhoeffer and Llopis versus DSM-III-R delirium].

    PubMed

    Villarino Herrería, H

    1996-01-01

    Delasiauve, Bonhoeffer and Llopis, conceived confusional scenes contrasting the theory of Unique Psychosis, Nosologic Unit, and Psychical Atomism respectively. The a-theoric DSM-III-R, doesn't establish any new concept, limiting itself to arrange in other way, that which was discovered by those and others authors, without rational justifications, having priority over clinical considerations, verbal definitions, with a practice and scientific value that may be debatable. PMID:8999727

  7. Use of a Multimodal Implementation Strategy to Improve Delirium Screening by Nurses on an Acute Care for Elders Unit.

    PubMed

    Afriyie-Boateng, Mavis; Loftus, Carla; Hamelin, Mary Ann

    2015-12-01

    This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1741-6787. PMID:26460598

  8. Perspectivas en Chicano Studies I (Perspectives in Chicano Studies I).

    ERIC Educational Resources Information Center

    Macias, Reynaldo Flores, Ed.

    The first of 12 papers, "Colonial Labor and Theories of Inequality: The Case of International Harvestor", reports on the role of minority labor in one of the largest corporations in the U.S. and interprets the patterns of inequality within a framework of colonial theory. "Casimiro Barela: A Case Study of Chicano Political History in Colorado"…

  9. Una Perspectiva de Mexico: Its People, Places and History.

    ERIC Educational Resources Information Center

    Bianchi, Gary; Bianchi, Maria Eugenia Matute

    Evolving from a general commitment to the goals of cultural pluralism and bicultural education, this portfolio of 24 full color and halftone photographs aims to reinforce those curricular objectives which emphasize a respect for the value and individuality of different cultures and groups, affirm the right of an individual to maintain a bicultural…

  10. Neuroimagen en la enfermedad de Alzheimer: nuevas perspectivas

    PubMed Central

    Becker, James T.

    2012-01-01

    Introducción y desarrollo En los próximos 50 años vamos a presenciar un incremento significativo de la población mayor de 65 años y por lo tanto va a aumentar, considerablemente, el número de individuos con riesgo de desarrollar demencias neurodegenerativas, especialmente la enfermedad de Alzheimer (EA). Las estrategias actuales de tratamiento farmacológico y no farmacológico se han centrado en las fases sintomáticas de esta enfermedad y, gradualmente, vamos teniendo una mayor comprensión de los posibles factores de riesgo del síndrome clínico. Conclusiones Los estudios de neuroimagen han sido muy útiles para mostrar los cambios estructurales del envejecimiento normal y patológico, así como también los factores de riesgo para la EA. Los tratamientos apropiados de los factores de riesgo y su posible combinación con tratamientos específicos para la EA podrían prolongar el período presintomático de la EA y, por tanto, mejorar la calidad de vida y disminuir la carga para el paciente, la familia y la sociedad. PMID:20517866

  11. Eclipsing SU UMa-Type Dwarf Nova 1RXS J003828.7+250920 During thE "Period Gap". I. Multiperiodicity and Color Features in 2011-2012

    NASA Astrophysics Data System (ADS)

    Pavlenko, E. P.; Sosnovskij, A. A.; Katysheva, N. A.; Kato, T.; Littlefield, K.

    2016-09-01

    Results are reported from multicolor photometric observations of the SU UMa-type dwarf nova 1RXS J003828.7+250920 in 2011, roughly a year after the super-outburst of 2010, and in 2012, when the object was in a quiescent state and underwent an outburst. Partial eclipses were observed in the system with depths of about 0m.6 in all color bands, both in the quiescent state and during the outburst. The orbital period of the system, 0.09451001(4) days, was determined for the first time and identifies the object as a dwarf nova in the "gap" in the orbital-period distribution of the cataclysmic variables. The ephemerides for the middle of the eclipse are determined. The average light curve profile resembles the "classical" light curve of U Gem. The orbital periodicity in the brightness variations of 1RXS J003828.7+250920 coexists with another signal with a period of 0.092 days, which we interpret as a period of negative superhumps. The color temperatures derived from the color indices may indicate multicomponent emission from 1RXS J003828.7+250920 by sources which appear to be hot and cold parts of the accretion disk and a hot spot on the accretion disk.

  12. Basic Concepts of Astronomy: a Methodological Proposal. (Spanish Title: Conceptos Básicos de Astronomía: Una Propuesta Metodológica.) Conceitos Básicos de Astronomia: Uma Proposta Metodológica

    NASA Astrophysics Data System (ADS)

    Darroz, Luiz Marcelo; Heineck, Renato; Samudio Pérez, Carlos Ariel

    2011-12-01

    obtenidos en diferentes momentos, por los comentarios efectuados por los participantes durante las actividades y por los altos índices de aprobación al final de la etapa, consideramos que la propuesta atingió los objetivos establecidos y puede ser repetida con certeza de éxito. Neste relato, descreve-se o desenvolvimento de uma proposta metodológica que aborda conceitos básicos de astronomia fundamentada pedagogicamente na Aprendizagem Significativa. A proposta, que compreende quatro encontros, foi desenvolvida por professores e acadêmicos do curso de Licenciatura em Física da Universidade de Passo Fundo (UPF), através de um curso de extensão, a um grupo de dez estudantes do ensino médio de uma escola pública da cidade de Passo Fundo, RS. O trabalho centrou-se em conceitos básicos de astronomia. Os indícios da aprendizagem significativa foram obtidos por instrumentos de pesquisa e avaliação aplicados ao término de cada encontro. A avaliação da proposta foi efetuada através de um questionário final respondido pelos participantes ao término do desenvolvimento das atividades. Pelos resultados obtidos nos diferentes instrumentos, pelos comentários efetuados pelos participantes durante as atividades e pelos altos índices de aprovação alcançados no questionário final, consideramos que a proposta atingiu os objetivos estabelecidos e pode ser repetida com convicção de sucesso.

  13. A Proposed Activity for a Meaningful Learning about the Moon Phases. (Breton Title: Uma Proposta de Atividade Para a Aprendizagem Significativa sobre as Fases da Lua.) Una Actividad Propuesta Para EL Aprendizaje Significativo Acerca de Las Fases de la Luna

    NASA Astrophysics Data System (ADS)

    Martins, Bruno Andrade; Langhi, Rodolfo

    2012-12-01

    This paper presents one of the concepts of Astronomy and its consequent failure in teaching this topic in high school, even when the official documents point out the necessity of Astronomy teaching at this school level. Among the spontaneous conceptions in Astronomy that high school students carry with them, even after the end of the school, we emphasized in this research the Moon phases. The development of different strategies in relation to traditional methods, aimed to teaching-learning process on this topic was considered in this study. These strategies were devised based on the reference frame of the Meaningful Learning, as elaborated by Ausubel. The proposals presented here include the active participation of students in experimental activities and other didactic activities, for their continuous evaluation during the process. These activities finished with a Comics elaboration about the Moon phases. Therefore, the objective of this paper is to present a proposal for differentiated teaching activity about Moon phases supported by the theoretical principles of Meaningful Learning at Physics classes. Este texto foca um dos conteúdos de Astronomia e a consequente falha no ensino deste tema no ensino médio, apesar de os documentos oficiais apresentarem a necessidade de se trabalhar a Astronomia neste nível de ensino. Dentre as concepções alternativas em Astronomia que os alunos do ensino médio carregam consigo, mesmo após o término dos estudos, destacamos, nesta pesquisa, o fenômeno das fases da Lua. O desenvolvimento de estratégias diferenciadas em relação ao ensino tradicional, visando o processo de ensino-aprendizagem sobre este tema, foi contemplado neste trabalho como um dos resultados obtidos sob a luz dos referenciais da aprendizagem significativa, fundamentados em Ausubel. Segundo a proposta aqui apresentada, a participação ativa dos alunos na execução de uma atividade experimental e outras atividades didáticas, que visam sua cont

  14. Recognizing Changes in Cognition in Sub Types of Acute Confusional State

    PubMed Central

    Mushtaq, Raheel; Shoib, Sheikh; Shah, Tabindah; Mushtaq, Sahil

    2014-01-01

    Background: Delirium or acute confusional state is an acute neuropsychiatric syndrome, with varied cognitive dysfunctions. However, no comprehensive studies about this common condition have been carried out in India. Objectives: To assess cognitive dysfunctions in hypoactive and hyperactive delirium. Materials and Methods:Forty cases of delirium including hypoactive and hyperactive delirium and 40 other patients (neuropsychiatric patients) were studied as controls. Cognitive status estimation test, mini mental state examination and memorial delirium assessment scale were administered to each patient. All assessments were carried out three times in 24 hour cycle of day and night. The data was analysed using two sample independent t-test. Results: The mean age (standard deviation) of study and control group was 27.85 (13.73) and 33.10 (11.26) years respectively. 70% patients had hyperactive delirium while 30% were having hypoactive delirium. Hypoactive delirium had more cognitive impairment compared to hyperactive delirium (p=0.001). The difference between highest and lowest score of MMSE in both types of delirium (day to night) was found to be statically significant (p=0.001). Conclusion: The fluctuation in intensity of cognitive symptoms varies from day to night in both types of delirium, but more in hypoactive delirium and wider fluctuation in cognitive dysfunctions was noted in delirium cases with psychosis. PMID:25177586

  15. Evolution of Wernicke-Korsakoff syndrome in self-neglecting alcoholics: preliminary results of relation with Wernicke-delirium and diabetes mellitus.

    PubMed

    Wijnia, Jan W; van de Wetering, Ben J M; Zwart, Elles; Nieuwenhuis, K Gerrit A; Goossensen, M Anne

    2012-01-01

    We present a descriptive, retrospective study of initial symptoms, comorbidity, and alcohol withdrawal in 73 alcoholic patients with subsequent Korsakoff syndrome. In 25/73 (35%) of the patients the classic triad of Wernicke's encephalopathy with ocular symptoms, ataxia and confusion, was found. In at least 6/35 (17%) of the initial deliria (95% confidence interval: 10-25%) we observed no other underlying causes, thus excluding other somatic causes, medication, (recent) alcohol withdrawal, or intoxication. We suggest that these deliria may have been representing Wernicke's encephalopathy. A high frequency (15%) of diabetics may reflect a contributing factor of diabetes mellitus in the evolution of the Wernicke-Korsakoff syndrome. PMID:22332852

  16. International Psychogeriatrics Paper of the year 2015: the use of modern technology to tackle an old challenge - improving the diagnosis of delirium in the hospital setting.

    PubMed

    Lautenschlager, Nicola T; Ames, David

    2016-06-01

    In 2014, International Psychogeriatrics (IPG) for the first time introduced a "paper of the month" category as part of the 25th year's milestone celebrations. Papers of the month were chosen through an internal selection process by the IPG editorial team. Each month, the seven editors ranked suitable accepted papers from the categories "original research articles" and "reviews" according to scientific quality and clinical relevance. Each paper of the month was accompanied by a brief commentary written by one of the IPG editors, one of the reviewers for the paper, or an international expert on the specific topic of the paper. From the 12 papers of the month, an IPG paper of the year was selected after a ranking process involving three independent expert reviewers. PMID:27053429

  17. Last Days of Life (PDQ)

    MedlinePlus

    ... for more information. Symptoms During the Final Months, Weeks, and Days of Life Key Points Delirium Delirium ... may get worse during the final days or weeks of life. Shortness of breath or not being ...

  18. [An insane dialogue].

    PubMed

    Boer, Max; Brignole, Éric

    2015-01-01

    How should madness and in particular delusional manifestations be considered? The caregiver's perception of delirium has an impact on how they view the function of the caregiver in psychiatry. Should delirium be suppressed? Delirium is an individual phenomenon but the themes are linked to social issues. Must we not take into account everyone's "thresholds" with regard to the place of delirium, in order to make it part of "living together". Two patients of a psychiatric care system discuss these issues. PMID:26564489

  19. Analysis of the Presence of Content about Astronomy in a Decade of the National High School Examination (1998-2008). (Spanish Title: Análisis de la Presencia de Contenidos de Astronomía em Uma Década del Examen Nacional de Enseñaza Secundária (1998-2008).) Análise da Presença de Conteúdos de Astronomia em Uma DÉcada do Exame Nacional do Ensino Médio (1998-2008)

    NASA Astrophysics Data System (ADS)

    Gomide, Hanny Angeles; Longhini, Marcos Daniel

    2011-07-01

    In this paper we analyzed the presence of contents of Astronomy in the National High School Examination (ENEM) in its first decade (1998-2008). We verified the number of questions addressing this topic that were present over the years, as well as the most recurrent subjects. We discussed the results from what is proposed by the official documents regarding the teaching of Astronomy in the Elementary and Secondary Education and we entertain future expectations about the presence of contents of this science in future official examinations. En este trabajo realizamos un análisis de la presencia de contenidos de Astronomía em las pruebas del Examen Nacional de Enseñanza Secundaria (ENEM) em su primera década de existência (1998-2008). Contabilizamos la cantidad de preguntas incluyendo este tema que estuvieron presentes en el transcurso de los años, así como los temas más recurrentes. Discutimos los resultados a partir de lo propuesto por los documentos oficiales en relación a la enseñanza de Astronomía en la Educación Básica y elaboramos algunos apuntes sobre futuras expectativas em relación a la presencia de contenidos de esta ciencia en examenes oficiales. No presente trabalho fizemos uma análise da presença de conteúdos de Astronomia nas provas do Exame Nacional do Ensino Médio (ENEM), em sua primeira década de existência (1998-2008). Verificamos a quantidade de questões envolvendo essa temática que estiveram presentes no decorrer dos anos, assim como os temas mais recorrentes. Discutimos os resultados a partir do que é proposto pelos documentos oficiais em relação ao ensino de Astronomia na Educação Básica e tecemos alguns apontamentos sobre a expectativa futura quanto à presença de conteúdos dessa ciência nesse exame oficial.

  20. The Universe in a Box: Introduction to the Study of Astronomy in the Initial Formation of Physics Teachers. (Spanish Title: El Universo Representado en Una Caja: Introducción al Estudio de la Astronomía en la Formación Inicial de Profesores de Física.) O Universo Representado em Uma Caixa: Introdução ao Estudo da Astronomia NA Formação Inicial de Professores de Física

    NASA Astrophysics Data System (ADS)

    Longhini, Marcos Daniel

    2009-07-01

    This is a report of an activity of introduction to the study of Astronomy developed with a group of future Physics teachers at a Brazilian public university. Such activity had the goal of giving privileged emphasis to notions of spatiality, alternative conceptions of the participants and the process of interaction among peers, and consisted of the representation, in a three dimensional space, of the models of the universe that the participants had. The results, which were categorized as miscellaneous, geocentric, heliocentric and acentric models of the universe, were qualitatively analyzed. Analyses of the activity in the perspective of the participants are indicated and additional considerations are made regarding its use as a resource for teaching Astronomy and for teacher training. Este es el informe de una actividad para presentar un estudio introductorio de la Astronomía, desarrollado con una clase de futuros profesores de física en una universidad pública brasileña. Esta actividad tuvo como objetivo centrar las nociones de espacialidad, las concepciones alternativas de los participantes y el proceso de interacción entre pares, y consistió en la representación en un espacio tridimensional, de los modelos del universo que los participantes habían. Los resultados, que se clasificaron en universo miscelania, geocéntrico, heliocéntrico y acentrico, se analizaron cualitativamente. Son identificadas análisis de la actividad por los participantes, e hizo observaciones sobre su uso como recurso para la enseñanza de la astronomía y la formación de docentes. Trata-se do relato de uma atividade de introdução ao estudo da Astronomia, desenvolvida com uma turma de futuros professores de Física, em uma universidade pública brasileira. Tal atividade teve como meta privilegiar noções de espacialidade, as concepções alternativas dos participantes e o processo de interação entre pares e constou da representação, em um espaço tridimensional, dos

  1. Nuevas Perspectivas en la Efficiencia del Uso Nirogeno en Vaca Lecheras

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Dairy cows utilize feed crude protein (CP) with greater efficiency than other ruminants, but still excrete about 2 to 3 times more nitrogen (N) in manure than they secrete in milk. This increases milk production costs plus environmental N pollution. Optimizing microbial protein formation in the rume...

  2. MIRADA A LA MENTORÍA EN INVESTIGACIÓN DESDE LA PERSPECTIVA SOCIOCULTURAL DE VYGOTSKY

    PubMed Central

    SANTIAGO, NILDA G. MEDINA; RIVERA, TANIA M. CRUZ; ORTIZ, NATALIA JORDÁN

    2015-01-01

    In this article the authors illustrate the mentoring process through the framework of Vygotsky's sociocultural perspective regarding education and human development. To achieve this goal, they describe their experience as mentor and mentees in a research training mentoring program for undergraduate students. The authors argue that this theoretical and philosophical perspective offers a solid background to mentoring as a real option that contributes to the learning process. They recommend these programs to be encouraged by academic institutions in order for more students and professors to benefit from this process. PMID:27042255

  3. Undocumented Immigrants in the Labor Market: Recent Research Findings. Perspectivas Publicas: Issue Brief.

    ERIC Educational Resources Information Center

    National Council of La Raza, Washington, DC.

    Most early research on the impact of undocumented workers on the labor market held that it results in the widespread displacement of native workers. More recent and more sophisticated theory argues that immigrants, both legal and illegal, create jobs by consuming goods and services, and by starting new businesses. This latter idea may not be as…

  4. Perspectiva sobre una Personalidad Senera: Carmen Fischer Ramirez (Perspective on a Singular Personality: Carmen Fischer Ramirez).

    ERIC Educational Resources Information Center

    Quezeda, Dina Alarcon

    1992-01-01

    Traces the career of Carmen Fischer Ramirez, focusing on her work in improving early childhood education in Chile. Reviews her university career, work with the World Organization for Early Childhood Education, and major publications. (AC)

  5. The Understanding of Astronomy Concepts by Students from Basic Education of a Public School. (Spanish Title: El Entendimiento de Conceptos de Aastronmía Por Los Alumnos de Educación Básica en Una Escuela Pública.) O Entendimento de Conceitos de Astronomia Por Alunos da Educação Básica: O Caso de Uma Escola Pública Brasileira

    NASA Astrophysics Data System (ADS)

    Iria Machado, Daniel; dos Santos, Carlos

    2011-07-01

    movimiento de la Luna, el movimiento aparente del Sol sobre la esfera celeste, los eclipses, las dimensiones y las distancias en el Universo, el brillo de las estrellas y su observación de la Tierra. Si bien ha habido un pequeño progreso en la proporción de respuestas aceptables científicamente cuando se cotejó el octavo grado de la enseñanza primaria con el quinto, y el último año de la enseñanza secundaria con el primero, se observó un predominio de las concepciones alternativas en relación a la mayoría de los temas explorados, que continuó hasta los últimos años de la educación básica. Una comparación con los datos encontrados en investigaciones realizadas en otros contextos socioculturales revelaron, en muchos aspectos, conceptos y dificultades similares expresadas por los estudiantes. Apresentam-se os resultados de uma investigação sobre a compreensão de conceitos astronômicos básicos, da qual participaram 561 estudantes da quinta série do Ensino Fundamental ao terceiro ano do Ensino Médio de uma escola pública da cidade de Foz do Iguaçu. Um teste com 20 questões de múltipla escolha foi aplicado para identificar as concepções mais comuns expressadas pelos alunos. Esse instrumento de coleta de dados foi elaborado com base na literatura sobre concepções alternativas e abordou os seguintes temas: o ciclo dia-noite; os fusos horários; as estações do ano; as fases da Lua; o movimento da Lua; o movimento aparente do Sol na esfera celeste; os eclipses; as dimensões e distâncias no Universo; o brilho das estrelas e sua observação da Terra. Embora se tenha verificado um pequeno progresso na proporção de respostas cientificamente aceitáveis ao se cotejar a oitava série do Ensino Fundamental com a quinta, e a terceira série do Ensino Médio com a primeira, houve o predomínio de concepções alternativas em relação à maior parte dos temas explorados, as quais persistiram até o último ano da Educação Básica. A comparação com

  6. The Understanding of Astronomy Concepts by Students from Basic Education of a Public School. (Spanish Title: El Entendimiento de Conceptos de Aastronmía Por Los Alumnos de Educación Básica en Una Escuela Pública.) O Entendimento de Conceitos de Astronomia Por Alunos da Educação Básica: O Caso de Uma Escola Pública Brasileira

    NASA Astrophysics Data System (ADS)

    Iria Machado, Daniel; dos Santos, Carlos

    2011-07-01

    movimiento de la Luna, el movimiento aparente del Sol sobre la esfera celeste, los eclipses, las dimensiones y las distancias en el Universo, el brillo de las estrellas y su observación de la Tierra. Si bien ha habido un pequeño progreso en la proporción de respuestas aceptables científicamente cuando se cotejó el octavo grado de la enseñanza primaria con el quinto, y el último año de la enseñanza secundaria con el primero, se observó un predominio de las concepciones alternativas en relación a la mayoría de los temas explorados, que continuó hasta los últimos años de la educación básica. Una comparación con los datos encontrados en investigaciones realizadas en otros contextos socioculturales revelaron, en muchos aspectos, conceptos y dificultades similares expresadas por los estudiantes. Apresentam-se os resultados de uma investigação sobre a compreensão de conceitos astronômicos básicos, da qual participaram 561 estudantes da quinta série do Ensino Fundamental ao terceiro ano do Ensino Médio de uma escola pública da cidade de Foz do Iguaçu. Um teste com 20 questões de múltipla escolha foi aplicado para identificar as concepções mais comuns expressadas pelos alunos. Esse instrumento de coleta de dados foi elaborado com base na literatura sobre concepções alternativas e abordou os seguintes temas: o ciclo dia-noite; os fusos horários; as estações do ano; as fases da Lua; o movimento da Lua; o movimento aparente do Sol na esfera celeste; os eclipses; as dimensões e distâncias no Universo; o brilho das estrelas e sua observação da Terra. Embora se tenha verificado um pequeno progresso na proporção de respostas cientificamente aceitáveis ao se cotejar a oitava série do Ensino Fundamental com a quinta, e a terceira série do Ensino Médio com a primeira, houve o predomínio de concepções alternativas em relação à maior parte dos temas explorados, as quais persistiram até o último ano da Educação Básica. A comparação com

  7. A Diagnostic Assessment for the Teaching of Astronomy. (Spanish Title: Una Evaluación Diagnóstica Para la Enseñanza de la Astronomia.) Uma Avaliação Diagnóstica Para o Ensino da Astronomia

    NASA Astrophysics Data System (ADS)

    Pacifico Ribeiro de Assis Silveira, Felipa; Soares Gomes de Sousa, Célia Maria; Moreira, Antonio

    2011-07-01

    interpretación, lo que nos permite comprender los significados asignados por el estudiante a estos conceptos. Se desprende de la evaluación diagnóstica que la mayoría de los encuestados ha tenido dificultades para exponer los conceptos científicos sobre el Universo y la Tierra, para iniciar el 6 º grado. Sin embargo, se identificaron ideas relevantes y las representaciones que contribuyeron a la re-significación de los conceptos científicos propuestos para la enseñanza del tema en esta serie. Los resultados de la evaluación diagnóstica han servido como referencia para la organización del Programa, facilitando el proceso de aprendizaje, haciendo coincidir la secuencia didáctica a las características de los estudiantes y el contexto del aula. Se espera que el instrumento presentado en este documento también pueda ser utilizado por otros investigadores en investigaciones relacionadas con el tema. Este artigo tem como objetivo apresentar os resultados de uma avaliação diagnóstica, utilizada como instrumento para a coleta de dados sobre o conhecimento prévio de conceitos científicos, necessários à compreensão do tema Terra e Universo, de um grupo composto por 47 estudantes, da 6ª série do Ensino Fundamental. A ação pedagógica de diagnosticar os conhecimentos prévios, do estudante, antes de ensiná-los, tem fundamento na teoria da Aprendizagem Significativa, proposta por David Ausubel. Essa avaliação diagnóstica foi composta por 25 questões, cujas respostas foram analisadas e categorizadas visando sua interpretação, o que permitiu compreender os significados atribuídos pelo estudante a esses conceitos. Conclui-se, a partir da avaliação diagnóstica, que a maioria dos estudantes pesquisados apresentou dificuldades em expor conceitos científicos sobre o tema Terra e Universo ao iniciar a 6ª série. Entretanto, foram identificadas ideias e representações relevantes que contribuíram para a (re)significação dos conceitos científicos propostos

  8. A Diagnostic Assessment for the Teaching of Astronomy. (Spanish Title: Una Evaluación Diagnóstica Para la Enseñanza de la Astronomia.) Uma Avaliação Diagnóstica Para o Ensino da Astronomia

    NASA Astrophysics Data System (ADS)

    Pacifico Ribeiro de Assis Silveira, Felipa; Soares Gomes de Sousa, Célia Maria; Moreira, Antonio

    2011-07-01

    interpretación, lo que nos permite comprender los significados asignados por el estudiante a estos conceptos. Se desprende de la evaluación diagnóstica que la mayoría de los encuestados ha tenido dificultades para exponer los conceptos científicos sobre el Universo y la Tierra, para iniciar el 6 º grado. Sin embargo, se identificaron ideas relevantes y las representaciones que contribuyeron a la re-significación de los conceptos científicos propuestos para la enseñanza del tema en esta serie. Los resultados de la evaluación diagnóstica han servido como referencia para la organización del Programa, facilitando el proceso de aprendizaje, haciendo coincidir la secuencia didáctica a las características de los estudiantes y el contexto del aula. Se espera que el instrumento presentado en este documento también pueda ser utilizado por otros investigadores en investigaciones relacionadas con el tema. Este artigo tem como objetivo apresentar os resultados de uma avaliação diagnóstica, utilizada como instrumento para a coleta de dados sobre o conhecimento prévio de conceitos científicos, necessários à compreensão do tema Terra e Universo, de um grupo composto por 47 estudantes, da 6ª série do Ensino Fundamental. A ação pedagógica de diagnosticar os conhecimentos prévios, do estudante, antes de ensiná-los, tem fundamento na teoria da Aprendizagem Significativa, proposta por David Ausubel. Essa avaliação diagnóstica foi composta por 25 questões, cujas respostas foram analisadas e categorizadas visando sua interpretação, o que permitiu compreender os significados atribuídos pelo estudante a esses conceitos. Conclui-se, a partir da avaliação diagnóstica, que a maioria dos estudantes pesquisados apresentou dificuldades em expor conceitos científicos sobre o tema Terra e Universo ao iniciar a 6ª série. Entretanto, foram identificadas ideias e representações relevantes que contribuíram para a (re)significação dos conceitos científicos propostos

  9. Reye Syndrome

    MedlinePlus

    ... without warning. It is most common during flu season. Symptoms include Nausea and vomiting Listlessness Personality change - such as irritability, combativeness or confusion Delirium Convulsions ...

  10. Yellow fever

    MedlinePlus

    ... the heart, liver, and kidney. Bleeding disorders, seizures, coma, and delirium may also occur. Symptoms may include: ... heartbeats (arrhythmias) Bleeding (may progress to hemorrhage) Seizures Coma

  11. Central pontine myelinolysis

    MedlinePlus

    ... or from the other conditions themselves. Risks include: Alcoholism Liver disease Malnutrition from serious illnesses Symptoms Confusion , delirium Balance problems Difficulty swallowing Hallucinations Reduced ...

  12. The Long-Term Safety and Efficacy Follow-Up Study of Subjects Who Completed the Phase I Clinical Trial of Neurostem®-AD

    ClinicalTrials.gov

    2012-09-27

    Alzheimer Disease; Dementia; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Tauopathies; Neurodegenerative Diseases; Delirium, Dementia, Amnestic, Cognitive Disorders; Mental Disorders

  13. MedlinePlus: Cancer--Living with Cancer

    MedlinePlus

    ... Cardiopulmonary Syndrome Overview (National Cancer Institute) Also in Spanish Chemo Brain (Mayo Foundation for Medical Education and Research) Chemotherapy Effects (American Cancer Society) Delirium ( ...

  14. Inclusion of Astronomy Themes in an Inovative Approach of Informal Physics Teaching for High School Students. (Spanish Title: Inclusión de Temas Astronómicos en Uma Abordaje Innovadora de la Enseñanza Informal de Física Para Estudiantes de Secumdaria.) Inclusão de Temas Astronômicos Numa Abordagem Inovadora do Ensino Informal de Física Para Estudantes do Ensino Médio

    NASA Astrophysics Data System (ADS)

    Tiara Mota, Aline; de Morais Bonomini, Iracema Ariel; Meloni Martins Rosado, Ricardo

    2009-12-01

    The current work reports on an experience on Astronomy education at the Federal University of Itajubá through an extra-curricular course offered for High School students. This initiative was motivated by the low attention paid to the Astronomy subjects at this stage of the Brazilian Formal Education, in spite that the National Curricular Parameters (PCN and PCN+, in Brazil) point out the importance of their inclusion Este artículo relata una experiencia en la enseñanza de la astronomía efectuada en la Universidad Federal de Itajubá en la forma de un curso de extensión orientado para los estudiantes del colegio secundario. Esta iniciativa surgió de constatar la poca atención dada a la Astronomía en esta etapa de la Educación formal brasileña, a pesar que los Parámetros Curriculares Nacionales (PCN y PCN+, en Brasil) destacan la importancia de su inclusión. Este artigo relata uma experiência em ensino de Astronomia realizada na Universidade Federal de Itajubá na forma de um curso de extensão voltado para alunos do Ensino Médio. Esta iniciativa surgiu da pouca atenção que se dá à Astronomia nesta etapa da Educação embora os Parâmetros Curriculares Nacionais (PCN e PCN+) apontem a importância de sua inclusão.

  15. Alcohol detoxification in Ysbyty Gwynedd: Two small sips or one big gulp? Two-step screening more reliable for identification of alcohol dependency syndrome at risk of delirium tremens for routine care.

    PubMed

    Salman, Muhammad; Subbe, Christian

    2015-01-01

    Compliance with pathways for hospitalised patients with alcohol dependency syndrome is often poor. A pathway for recognition and treatment of alcohol dependency was redesigned as part of a 12 month service improvement project in the acute medical unit using plan, do, study, act (PDSA) cycles. A needs assessment was undertaken: Audit data from 2013 showed over-prescription of chlordiazepoxide for detoxification treatment (DT) leading to prolonged hospital admissions with an average length of stay of 5.5 days in 2012/2013. Acceptability of screening tools was tested: Common screening tools (CEWA, AUDIT) were rejected by junior doctors due to the high number of questions as too cumbersome for routine practice. Compliance with usage in random samples over a three month period was persistently (n=10%. Testing of an abbreviated AUDIT questionnaire with only two questions and a specified threshold showed a AUROC of 1 (p<0.001 for correct identification). The screening tool was implemented in several PDSAs cycles. After the final cycle a random sample of 100 patients was reviewed for pathway compliance over a three months period. Eighty-six patients were screened with the two-question tool of these 18 were identified as possible risk. Of these 16 patients had the full AUDIT questionnaire, only eight with elevated values were started on DT. Overall compliance with the pathway increased to 84%. PMID:26734413

  16. Alcohol detoxification in Ysbyty Gwynedd: Two small sips or one big gulp? Two-step screening more reliable for identification of alcohol dependency syndrome at risk of delirium tremens for routine care

    PubMed Central

    Salman, Muhammad; Subbe, Christian

    2015-01-01

    Compliance with pathways for hospitalised patients with alcohol dependency syndrome is often poor. A pathway for recognition and treatment of alcohol dependency was redesigned as part of a 12 month service improvement project in the acute medical unit using plan, do, study, act (PDSA) cycles. A needs assessment was undertaken: Audit data from 2013 showed over-prescription of chlordiazepoxide for detoxification treatment (DT) leading to prolonged hospital admissions with an average length of stay of 5.5 days in 2012/2013. Acceptability of screening tools was tested: Common screening tools (CEWA, AUDIT) were rejected by junior doctors due to the high number of questions as too cumbersome for routine practice. Compliance with usage in random samples over a three month period was persistently (n=10%. Testing of an abbreviated AUDIT questionnaire with only two questions and a specified threshold showed a AUROC of 1 (p<0.001 for correct identification). The screening tool was implemented in several PDSAs cycles. After the final cycle a random sample of 100 patients was reviewed for pathway compliance over a three months period. Eighty-six patients were screened with the two-question tool of these 18 were identified as possible risk. Of these 16 patients had the full AUDIT questionnaire, only eight with elevated values were started on DT. Overall compliance with the pathway increased to 84%. PMID:26734413

  17. The Meanings of Astronomical Observation: An Analysis on the Basis of Relationship with Knowledge. (Spanish Title: Los Sentidos de la Observación Astronómica: un Análisis sobre la Base de la Relación con el Saber.) Os Sentidos da Observação Astronômica: Uma Análise com Base na Relação com o Saber

    NASA Astrophysics Data System (ADS)

    Klein, Alberto Eduardo; de Mello Arruda, Sergio; Meneghello Passos, Marinez; Vinicius Domenes Zapparoli, Ferdinando

    2010-12-01

    This article presents results of a research which aimed to understand the meanings that people construct for astronomical observation. The subjects, students and school teachers, initially received some instruction on how to view astronomical objects through the telescope. After the observation was realized, they were interviewed. The data analysis allowed the creation of 12 categories, later interpreted on the basis of relationship with knowledge (relation to the world, with himself and with others), as presented by Bernard Charlot. Este artículo presenta los resultados de una investigación que tuvo como objetivo comprender los sentidos que las personas construyen para la observación astronómica. Los sujetos, los estudiantes y maestros de escuela, recibieron inicialmente algunas instrucciones sobre cómo ver los objetos astronómicos a través del telescopio. Al término de la observación, fueron entrevistados. El análisis de datos permitió la creación de 12 categorías que más tarde fueron interpretadas sobre la base de la relación con el conocimiento (relación con el mundo, consigo mismo y con los demás), tal como presentado por Bernard Charlot. Este artigo apresenta resultados de uma pesquisa que objetivou entender quais os sentidos que as pessoas constroem para a observação astronômica. Os sujeitos da pesquisa, estudantes e professores do ensino médio, receberam inicialmente alguma instrução sobre como visualizar os objetos astronômicos através do telescópio. Após a realização da observação, eles foram entrevistados. A análise dos dados permitiu a elaboração de 12 categorias que foram posteriormente interpretadas com base nas relações com o saber (relação com o mundo, consigo mesmo e com o outro), conforme apresentadas por Bernard Charlot.

  18. Perspectiva Historica de la Educacion Bilingue en los Estados Unidos (A Historical Perspective of Bilingual Education in the United States)

    ERIC Educational Resources Information Center

    Zamora, Juan Clemente

    1978-01-01

    This article defines bilingualism and bilingual education and traces the history of bilingual education in the United States, starting with the Spanish missions in the west. (Text is in Spanish.) (NCR)

  19. Espectroscopia infravermelha para a determinacao de carbono do solo: Perspectiva de um metodo economicamente viavel e ambientalmente seguro

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The Kyoto Protocol is an agreement among many of the world’s nations to, among other things, reduce atmospheric carbon dioxide concentrations in order to reduce global warming. One potential method to do so is to sequester carbon in soils. This has had the effect of stimulating the establishment of ...

  20. Ampliacion Interdisciplinar de los Estudios Hispanicos: Temas y Perspectivas (The Expansion of Interdisciplinary Hispanic Studies: Themes and Perspectives)

    ERIC Educational Resources Information Center

    Poyatos, Fernando

    1978-01-01

    States that works concerning hispanic studies traditionally deal with analyses of the Spanish language or with literary works. Emphasis is made on the need for an interdisciplinary approach. (Text is in Spanish.) (NCR)

  1. Ecocardiografía tridimensional. Nuevas perspectivas sobre la caracterización de la válvula mitral

    PubMed Central

    Solis, Jorge; Sitges, Marta; Levine, Robert A.; Hung, Judy

    2010-01-01

    Recent developments in three-dimensional echocardiography have made it possible to obtain images in real time, without the need for off-line reconstruction. These developments have enabled the technique to become an important tool for both research and daily clinical practice. A substantial proportion of the studies carried out using three-dimensional echocardiography have focused on the mitral valve, the pathophysiology of mitral valve disease and, in particular, functional mitral regurgitation. The aims of this article were to review the contribution of three-dimensional echocardiography to understanding of the functional anatomy of the mitral valve and to summarize the resulting clinical applications and therapeutic implications. PMID:19232192

  2. Learning about the Sky from the Environment: An Experience Working Along One Year with Students of Elementary Education. (Spanish Title: Aprendiendo sobre EL Cielo Desde el Entorno: Una Experiencia Trabajando Durante un Año Junto a Estudiantes del Primario.) Aprendendo sobre o Céu a Partir do Entorno: Uma Experiência de Trabalho ao Longo de um Ano com Alunos de Ensino Fundamental

    NASA Astrophysics Data System (ADS)

    Longhini, Marcos Daniel; Gomide, Hanny Angeles

    2014-12-01

    percepción limitada que los estudiantes tienen de su alrededor la cual, sin embargo, se expandió debido a las actividades llevadas a cabo, sobre todo en relación con la Luna. Trabajar con medidas sistemáticas revela el manejo cuidadoso de los datos para que sean comprensibles para los estudiantes, así como el trabajo con las sombras para que comprendan primero como se forman estas para después trabajarlas en Astronomía. Por último, llegamos a la conclusión de que el proceso desarrollado consistió en una etapa inicial de una obra que debe ser profundizado en los años posteriores de la formación de estos estudiantes. Projeto de pesquisa desenvolvido com 95 alunos do 6º ano do Ensino Fundamental de uma escola pública estadual de Uberlândia, Minas Gerais. Foi um trabalho contínuo, de fevereiro a dezembro de 2013, o qual levou os alunos a participarem de atividades de observação do entorno, dentre ele, o céu, analisando as mudanças ocorridas. Focamos no estudo das variações de temperaturas, chuvas, duração do dia, variações do tamanho das sombras e mudanças nos aspectos da Lua. Nosso foco de análise centrou-se em discutir os conhecimentos que os referidos alunos tinham acerca dos temas indicados no início e ao término da implementação da proposta. Os resultados mostraram a percepção limitada que os estudantes possuem de seu entorno, todavia, ampliada em função das atividades desenvolvidas, principalmente no que se refere à Lua. O trabalho com medidas sistemáticas revela o cuidado no tratamento dos dados para que eles se tornem compreensíveis aos alunos, assim como o trabalho com as sombras sinaliza para que os alunos primeiramente compreendam como as sombras são formadas para depois trabalhar isso em Astronomia. Por fim, concluímos que o processo vivido constituiu-se em uma etapa inicial de um trabalho que deve ser estimulado para os anos subsequentes da formação desses alunos.

  3. [Community-acquired pneumonia in the elderly].

    PubMed

    Füri, Julia; Oestmann, Andreas; Repond, Fernand

    2016-04-13

    We report the case of a 88 years old patient with cough and new onset confusion. Delirium was caused by a necrotizing Methicillin-sensible staphylococcus aureus pneumonia with bacteremia. Despite antibiotic therapy for several weeks and fall of inflammatory markers the patient died from consequences of delirium. PMID:27078731

  4. Establishing the Empirical Relationship Between Non-Science Majoring Undergraduate Learners' Spatial Thinking Skills and Their Conceptual Astronomy Knowledge. (Spanish Title: Estableciendo Una Relación Empírica Entre el Razonamiento Espacial de los Estudiantes de Graduación de Carreras no Científicas y su Conocimento Conceptual de la Astronomía.) Estabelecendo Uma Relação Empírica Entre o RacioCínio Espacial dos Estudantes de Graduação EM Carreiras Não Científicas e Seu Conhecimento Conceitual da Astronomia

    NASA Astrophysics Data System (ADS)

    Heyer, Inge; Slater, Stephanie J.; Slater, Timothy F.

    2013-12-01

    normalizadas, en el desempeño de los estudiantes en estos dos asuntos foram pequenas, 0.26 e 0.13 respectivamente. El razonamiento espacial de los estudiantes fue medido utilizando un instrumento específico desarrollado para este trabaljo. Las correlaciones entre los resultados de los tests astronómicos y este instrumento específico, antes y después del curso mostraron una relación entre moderada y fuerte, sugiriendo que la relación entre el razonamiento espacial y el conocimiento astronómico puede explicar hasta un 25% de la variación em el desempeño de los estudiantes. A comunidade da educação em astronomia tem suposto de forma implícita que o aprendizado da astronomia consiste em um domínio conceitual fundamentado no raciocínio espacial. Como um primeiro passo para identificar formalmente uma relação empírica entre estas duas coisas, utilizamos como amostra os estudantes de graduação de carreiras não científicas de um curso exploratório em uma universidade norte-americana do meio-oeste de médio porte com programa de Doutorado em andamento, onde estes estudantes foram submetidos a um diagnóstico de raciocino espacial e conceitos astronômicos antes e depois do mesmo. As ferramentas utilizadas foram o Test Of Astronomy Standards (TOAST) e o questionário What do you know? Utilizando somente dados completamente consistentes para esta análise, nossa amostra consistiu de 86 estudantes de graduação. As melhoras, depois de normalizadas, do desempenho dos estudantes nos dois quesitos foram pequenas, 0.26 e 0.13 respectivamente. O raciocínio espacial dos estudantes foi medido utilizando um instrumento específico desenhado para este trabalho. As correlações entre os resultados dos testes astronômicos e este instrumento específico antes e depois do curso mostraram uma relação entre moderada e forte, sugerindo que a relação entre o raciocínio espacial e o conhecimento astronômico pode explicar até um 25% na variação no desempenho dos

  5. First photometric study of the W UMa system GSC 1042-2191

    NASA Astrophysics Data System (ADS)

    Bulut, A.; Bulut, İ.; Demircan, O.

    2016-04-01

    We present new photometric observations covering eight minima times for the eclipsing binary GSC 1042-2191. The light curves in BVRI colors were analyzed by using WD-code for the system parameters. Eight minima times were obtained from the new observations. The system is found a low mass ratio (q = 0.148), A-type over-contact binary with a fill out parameter of f = 65.01 ± 12.18%. The preliminary absolute dimensions (M1= 1.26 ± 0.06 M⊙, M2 = 0.18 ± 0.06 M⊙, R1 = 1.54 ± 0.20 R⊙, R2 = 0.69 ± 0.01 R⊙, L1 =3.30 ± 0.30 L⊙ and L2 = 0.59 ± 0.20 L⊙) indicate the very much oversized and over-luminous secondary component, by assuming the present luminosity of the secondary is its main sequence luminosity, we predict the original mass is about 0.8 M⊙, this means the present secondary could be transferred and/or lost 77% of its original mass and only its core is left.

  6. The active W UMa type binary star V781 Tau revisited

    NASA Astrophysics Data System (ADS)

    Li, K.; Gao, D.-Y.; Hu, S.-M.; Guo, D.-F.; Jiang, Y.-G.; Chen, X.

    2016-02-01

    In this paper, new determined BVRcIc light curves and radial velocities of V781 Tau are presented. By analyzing the light curves and radial velocities simultaneously, we found that V781 Tau is a W-subtype medium contact binary star with a mass ratio of q=2.207±0.005 and a contact degree of f=21.6(±1.0) %. The difference between the two light maxima was explained by a dark spot on the less massive primary component. The change of the orbital period of V781 Tau was also investigated. A secular decrease at a rate of -6.01(±2.28)× 10^{-8} d/yr and a cyclic modulation with a period of 44.8 ± 5.7 yr and an amplitude of 0.0064±0.0011 day were discovered. The continuous period decrease may be caused by angular momentum loss due to a magnetic stellar wind. The Applegate mechanism failed to explain the cyclic modulation. It is highly possible that the cyclic oscillation is the result of the light travel time effect by a third companion.

  7. VizieR Online Data Catalog: Radial velocities of TX UMa (Komzik+, 2008)

    NASA Astrophysics Data System (ADS)

    Komzik, R.; Chochol, D.; Grygar, J.

    2012-03-01

    Our spectroscopy of TXUMa consist of: * 96 spectra taken by JG with the Cassegrain spectrograph of the 1.8m telescope at the DAO Observatory in the period December 1969 - July 1970. * 52 spectra taken by JG in 1972-80 and 7 spectra taken by RK in 1992-93 with the coude spectrograph of the 2.0m telescope at the Ondrejov Observatory. (1 data file).

  8. CCD photometric analysis of the W UMa-type binary V376 Andromeda

    NASA Astrophysics Data System (ADS)

    Çiçek, C.

    2011-01-01

    This study presents the absolute parameters of the contact binary system V376 And. CCD photometric observations were made at the Çanakkale Onsekiz Mart University Observatory in 2004. The instrumental magnitudes of all observed stars were converted into standard magnitudes. New BV light curves of the system were analysed using the Wilson-Devinney method supplemented with a Monte Carlo type algorithm. Since there are large asymmetries between maxima (i.e., O'Connell effect) in these light curves, two different models (one with a cool spot and one with a hot spot) were applied to the photometric data. The best fit, which was obtained with a large hot spot on the secondary component, gives V376 And as an A sub-type contact binary in poor thermal contact and a small value of the filling factor ( f ≈ 0.07). Combining the solutions of our light curves and Rucinski et al. (2001)'s radial velocity curves, the following absolute parameters of the components were determined: M1 = 2.44 ± 0.04 M ⊙, M2 = 0.74 ± 0.03 M ⊙, R1 = 2.60 ± 0.03 R ⊙, R2 = 1.51 ± 0.02 R ⊙, L1 = 40 ± 4 L ⊙ and L2 = 5 ± 1 L ⊙. We also discuss the evolution of the system, which appears to have an age of 1.6 Gyr. The distance to V376 And was calculated as 230 ± 20 pc from this analysis, taking into account interstellar extinction.

  9. An Invited Preface for the Following Book: Astrobiologia, Uma Ciencia Emergente

    NASA Technical Reports Server (NTRS)

    Rothschild, Lynn J.

    2016-01-01

    Since the dawn of civilization, we have beheld at the beauty and wonder of the natural world around us and wondered how it came to be. We have pondered the past, and have been intrigued about the future. For this we are unique. Our ancestors looked to the vastness of space and thought surely there are others out there. We are now at a new time in human history where we can address these age-old questions with a scientific approach and study rigorously the three big questions of astrobiology: Where do we come from? Where are we going? and Are we alone? These fundamental questions of astrobiology correspond to those of humanity, and arguably, what makes us human. And so we cannot help but be drawn to the field. Unlike other scientific disciplines, Astrobiology draws on the latest advances in a multitude of fields, from evolutionary and molecular biology, to prebiotic and interstellar chemistry, from astrophysics to astronomy, with a healthy dose of earth and planetary science. Astrobiology is in reality a "metadiscipline" drawing on useful science wherever it is to be found. From a practical point of view, this endeavor requires the interaction of scientists who might not normally meet each other, much less work on a common research project. And, unlike most other scientific disciplines, Astrobiology has implications for how we see ourselves, and how we interact with the earth and beyond. "Where do we come from" touches on the "why" questions that have intrigued not just scientists but philosophers and theologians. "Where are we going" adds to these an economic and political involvement that is currently being played out with discussions of climate change. "And are we alone" will someday force us to face the fact that we as living creatures are not unique, or perhaps that we are utterly alone in the universe, the result of a chemical history that was so improbable as to result in a sample size of one. Either result will force ethical considerations of either "the other" and their relationship to us, or our solitude and thus responsibility as the only life form in our cosmos. So what is Astrobiology? Let's start with the "Where do we come from?" A biologist will approach this looking at the evolution of life on earth, using such traditional tools as comparative anatomy and paleontology and newer tools such as molecular techniques. But this doesn't address why this happened the way it did without a comprehensive understanding of the environment. What was the temperature at such and such a time? Was the earth in a snowball phase or being bombarded by meteorites -- or even just a single large, well-placed one such as struck off the Yucatan peninsula 65 million years ago. This event could not have been predicted by population genetics alone, yet it had the most profound influence on our evolution as without it, we could still be in a world dominated by dinosaurs with the mammals cowering under cover. But it is not enough to go back to LUCA, the Last Universal Common Ancestor of all extant life. One must go back to the dawn of life. How did life arise? What was the environmental backdrop that allowed it to happen? How did we happen to end up with a habitable planet? Indeed, what is the origin and evolution of our solar system, galaxy, biogenic elements all the way back to the Big Bang. The "Where are we going?" tends to be ignored in many astrobiology programs, but in fact this is of the most immediate importance to us. Whereas the past was dominated by physical and chemical processes, and organismal interactions, the future has a new major player: us. While we probably don't have the power (yet) to stop our galaxy passing through another, or even reset the sun or stop the movement of the moon away from the earth, all of these things will influence the future of life on earth. We are already proving that we have the power to visit other bodies in our solar system, either with humans or our robotic surrogates. We are changing our atmospheric composition and thus our climate. We have the power to render species extinct, including our own. But we also have the power to use these tools for the common good, to extend our lifetimes and reclaim our rivers and forests. Which will it be? And then there is the question where science fiction becomes a reality: "Are we alone?" While many people are anxious to find signs of intelligent life out there, such a creature may not share either our curiosity or values. But what if there was a beneficent alien civilization that could communicate with us, perhaps forging a mutual understanding? More likely in the forseeable future is finding a small life, less evolved, life form. Note I did not use the word "simple" as there is nothing "simple" about life, ever. Which brings us back to the question: what is life? So where does Brazil come in? For nearly a decade there has been interest in a Brazilian astrobiology program, from a small side meeting held by the Brazilian Exobiology Program (BEP) of the Brazilian National Research Council, held in Rio de Janeiro, Brazil, on August 12, 2009, in association with the IAU Assembly to subsequent workshops held in several locations and membership of the Brazilian program in the NASA Astrobiology Institute (NAI). Each time I go to Brazil, I am impressed by the enthusiasm of the community, both scientific and student, the latter an excellent omen for the future of astrobiology in Brazil. Facilities are being built to supplement the natural laboratories that Brazil is blessed to have. In my own lab I have been privileged to have a wonderful Brazilian postdoctoral fellow, Dr. Ivan Paulino-Lima, resulting in a daily reminder of the program. I am honored to have been part of the development of astrobiology in Brazil, and hope that this relationship will continue to flourish. Clearly to advance astrobiology needs new knowledge, a reorganization of that which is known, and space missions. To help the reader join on this quest, what follows is a buffet of topics that will allow the reader to nibble on the richness that is Astrobiology. And, like a fabulous meal, it should make you want more. Welcome to Astrobiology.

  10. Spot activity on HD 89546 (FG UMa) from long-term photometry

    NASA Astrophysics Data System (ADS)

    Özdarcan, O.; Evren, S.; Henry, G. W.

    2012-02-01

    We present the analysis of 20 years of time-series BV photometry of the SB1 RS CVn binary HD 89546. The system's yearly mean V brightness, the B-V color index, the photometric period, and the light curve amplitude all show clear cyclic variability with an ≈9-year time scale. We also find some evidence for brightness variability on a time scale longer than the 20-year time span of our observations, perhaps indicating a longer cycle analogous to the solar Gleissberg cycle. We estimate the unspotted V magnitude of HD 89546 to be 7.154m, which is ≈0.2m brighter than the observed maximum brightness. Spot modelling of the system shows that spot temperature variations affect the observed B-V color as well as the V brightness. Two active longitudes are observed, centered around 180° and 360° longitude on the G9 III primary, each covering a longitude range of 120°. Furthermore, two inactive longitude zones are seen spanning only 60° between the two active longitudes. The longitudinal distribution of the spots exhibits no strong cyclic variability but does show rapid jumps of 120° that look like the flip-flop phenomenon. We estimate the differential rotation coefficient of the star as k=0.086 by considering the range of observed photometric period variations and assumed latitudinal spot variations over 45°. Based on data obtained with the Tennessee State University T3 0.4 m APT at Fairborn Observatory, operated by Tennessee State University, and T30 0.3 m telescope of the Ege University Observatory in Izmir.

  11. Model computations of blue stragglers and W UMa-type stars in globular clusters

    NASA Astrophysics Data System (ADS)

    Stȩpień, K.; Kiraga, M.

    2015-05-01

    Context. It was recently demonstrated that contact binaries occur in globular clusters (GCs) only immediately below turn-off point and in the region of blue straggler stars (BSs). In addition, observations indicate that at least a significant fraction of BSs in these clusters was formed by the binary mass-transfer mechanism. Aims: The aim of our present investigation is to obtain and analyze a set of evolutionary models of cool, close detached binaries with a low metal abundance, which are characteristic of GC. Methods: We computed the evolution of 975 models of initially detached, cool close binaries with different initial parameters. The models include mass exchange between components as well as mass and angular momentum loss due to the magnetized winds for very low-metallicity binaries with Z = 0.001. The models are interpreted in the context of existing data on contact binary and blue straggler members of GCs. The models are based on our recently developed code for evolutionary modeling of cool close and contact binaries. Results: The model parameters agree well with the observed positions of the GC contact binaries in the Hertzsprung-Russell diagram, and we achieve detailed parameters of several individual contact and near-contact binaries. Contact binaries in the lower part of the cluster main sequence are absent because there are no binaries with initial orbital periods shorter than 1.5 d. Contact binaries end their evolution as mergers that appear in the BS region. Binary-formed BSs populate the whole observed BS region in a GC, but a gap is visible between low-mass mergers that are concentrated along the zero-age main sequence and binary BSs occupying the red part of the BS region. Very few binary mergers are expected to rotate rapidly and/or possess chemical peculiarities resulting from the exposure of the layers processed by CNO nuclear reactions. All other binary mergers are indistinguishable from the collisionally formed mergers. The results show that binary-formed BSs may constitute at least a substantial fraction of all BSs in a GC. Tables 2-7 are available in electronic form at http://www.aanda.org

  12. Controls on lava lake level at Halema`uma`u Crater, Kilauea Volcano

    NASA Astrophysics Data System (ADS)

    Patrick, M. R.; Orr, T. R.

    2013-12-01

    Lava level is a fundamental measure of lava lake activity, but very little continuous long-term data exist worldwide to explore this aspect of lava lake behavior. The ongoing summit eruption at Kilauea Volcano began in 2008 and is characterized by an active lava lake within the eruptive vent. Lava level has been measured nearly continuously at Kilauea for several years using a combination of webcam images, laser rangefinder, and terrestrial LIDAR. Fluctuations in lava level have been a common aspect of the eruption and occur over several timescales. At the shortest timescale, the lava lake level can change over seconds to hours owing to two observed shallow gas-related processes. First, gas pistoning is common and is driven by episodic gas accumulation and release from the surface of the lava lake, causing the lava level to rise and fall by up to 20 m. Second, rockfalls into the lake trigger abrupt gas release, and lava level may drop as much as 10 m as a result. Over days, cyclic changes in lava level closely track cycles of deflation-inflation (DI) deformation events at the summit, leading to level changes up to 50 m. Rift zone intrusions have caused large (up to 140 m) drops in lava level over several days. On the timescale of weeks to months, the lava level follows the long-term inflation and deflation of the summit region, resulting in level changes up to 140 m. The remarkable correlation between lava level and deflation-inflation cycles, as well as the long-term deformation of the summit region, indicates that the lava lake acts as a reliable 'piezometer' (a measure of liquid pressure in the magma plumbing system); therefore, assessments of summit pressurization (and rift zone eruption potential) can now be carried out with the naked eye. The summit lava lake level is closely mirrored by the lava level within Pu`u `O`o crater, the vent area for the 30-year-long eruption on Kilauea's east rift zone, which is 20 km downrift of the summit. The coupling of these lava levels implies an efficient hydraulic connection between the summit and east rift zone vents. This connection has been indicated previously with geophysical data and is reinforced in a new quantitative manner with lava level data. Lastly, the current lava level at the summit is significantly lower than the mean level measured in the crater during continuous lava lake activity in the early 1900s. This is probably because the ongoing eruption at Pu`u `O`o 'taps' the magma supplied to the summit reservoir. Should the Pu`u `O`o eruption stop, the lava level at the summit would certainly rise in response. The precise correspondence between lava lake level and deformation of the summit implies that the lake level is a good indication of the pressure state of the magma reservoir. Tracking lava level over time may therefore provide an indication of the potential for future changes in eruptive activity. Such an observation has clear relevance for monitoring analogous open-vent basaltic volcanoes, especially where other measures of volcanic activity, like seismic or deformation measurements, may be lacking.

  13. KSI UMA and the FIP Effect Versus Metal Poor Coronae Conundrum

    NASA Technical Reports Server (NTRS)

    Drake, Jeremy; White, Nicholas (Technical Monitor)

    2001-01-01

    Analysis of the data has been completed. ASCA data indicate a metal-poor corona, with metals down by a factor of 3 or more relative to the photospheric values. EUVE data show a FIP Effect, which is Expected if the metals are enhanced rather than depleted. Some finishing touches need to be applied to an absolute measure of metal Abundance based on the EUVE data. A paper aimed for the Astrophysical journal is in preparation.

  14. Unified Multi-speed analysis (UMA) for the condition monitoring of aero-engines

    NASA Astrophysics Data System (ADS)

    Nembhard, Adrian D.; Sinha, Jyoti K.

    2015-12-01

    For rotating machinery in which speeds and dynamics constantly change, performing vibration-based condition monitoring can be challenging. Thus, an effort is made here to develop a Unified Multi-speed fault diagnosis technique that can exploit useful vibration information available at various speeds from a rotating machine in a single analysis. Commonly applied indicators are computed from data collected from a rig at different speeds for a baseline case and different faults. Four separate analyses are performed: single speed at a single bearing, integrated features from multiple speeds at a single bearing, single speed for integrated features from multiple bearings and the proposed Unified Multi-speed analysis. The Unified Multi-speed approach produces the most conspicuous separation and isolation among the conditions tested. Observations made here suggest integration of more dynamic features available at different speeds improves the learning process of the tool which could prove useful for aero-engine condition monitoring.

  15. The Moon Phases in a Paper Box. (Spanish Title: Las Fases de la Luna en Una Caja de Cartón.) As Fases da Lua Numa Caixa de Papelão

    NASA Astrophysics Data System (ADS)

    de Fátima O. Saraiva, Maria; Amador, Cláudio B.; Kemper, Érico; Goulart, Paulo; Muller, Angela

    2007-12-01

    material didático de baixo custo para demonstração do conceito de fases de um corpo iluminado. O principal objetivo de nosso material é facilitar a compreensão das fases da Lua da perspectiva de um observador na Terra. O material ajuda na visualização de dois efeitos importantes: (1º) mesmo tendo sempre a metade da "Lua" (representada por uma bolinha de isopor ou de ping-pong) iluminada pelo "Sol" (representado por uma fonte de luz natural ou artificial), nós vemos diferentes frações de sua superfície iluminada, dependendo do ângulo pelo qual a olhamos; (2º) a orientação da borda convexa da Lua nas fases Crescente e Minguante também depende da perspectiva pela qual a olhamos da Terra. O uso de uma caixa fechada permite observar o contraste entre as diferentes fases sem necessidade de estar em uma sala escurecida. Apresentamos também um texto explicativo sobre fases da Lua, enfatizando a dependência da aparência da parte iluminada com o ângulo de visada.

  16. Alcohol withdrawal

    MedlinePlus

    ... Seeing or feeling things that aren't there (hallucinations) Seizures Severe confusion ... alcohol withdrawal. You will be watched closely for hallucinations and other signs of delirium tremens. Treatment may ...

  17. Systematic Assessment and Targeted Improvement of Services Following Yearlong Surgical Outcomes Surveys

    ClinicalTrials.gov

    2015-12-23

    Heart Attack; Cardiac Arrest; Congestive Heart Failure; Atrial Fibrillation; Angina; Deep Vein Thrombosis; Pulmonary Embolism; Respiratory Arrest; Respiratory Failure; Pneumonia; Gastrointestinal Bleed; Stomach Ulcer; Delirium; Stroke; Nerve Injury; Surgical Wound Infection

  18. Pentobarbital overdose

    MedlinePlus

    Symptoms of a pentobarbital overdose may include: Coma Confusion Decreased energy Delirium (confusion and agitation) Difficulty breathing Headache Large blisters Rash Sleepiness Slowed or stopped breathing Slurred speech Unsteady gait

  19. 75 FR 3165 - Vocational Rehabilitation and Employment Program-Periods of Eligibility

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-20

    ... (74 FR 9975). We proposed to amend VA's regulations in 38 CFR Part 21, Subpart A--Vocational... habitual intoxication, withdrawal, delirium, amnesia, dementia, and other like manifestations that:...

  20. Anxiety

    MedlinePlus

    ... the Experts Tools & Tips Latest Research Related Topics COPD Delirium Dementia Depression Drug and Substance Abuse High Blood Pressure Join our e-newsletter! Aging & Health A to Z Anxiety Basic Facts & Information ...