Updates in Person-Centered Rehabilitation for Critically Ill Patients.

Background/Objectives: Delirium is a common and serious neurocognitive disorder among hospitalised adults, which is associated with prolonged hospital stays, increased treatment costs, and increased mortality. Nurses, as healthcare professionals in constant contact with patients, play crucial roles in the early recognition, prevention, and management of delirium. This systematic review aimed to synthesise the evidence on nursing roles and interventions in the recognition, prevention, and treatment of delirium in hospitalised adult patients. Methods: A systematic literature search was conducted in PubMed/MEDLINE, Scopus, and CINAHL/EBSCO for studies published between January 2015 and August 2025. The protocol was registered in PROSPERO. Results: Out of the 3791 records identified, 39 met the inclusion criteria. Studies included randomised controlled trials, systematic reviews, and cross-sectional studies conducted in various hospital settings. Key nursing roles included early detection of risk factors, routine use of tools (e.g., CAM, CAM-ICU, 4AT), and implementation of multicomponent nonpharmacological prevention programs for patients with delirium. The evidence regarding the effectiveness of nurse-led interventions has been mixed: several studies reported reductions in delirium incidence and duration with early mobilisation, sleep promotion, cognitive stimulation, pain control and family involvement, whereas others reported no statistically significant effects. Conclusions: Routine screening, targeted nonpharmacological interventions, and interdisciplinary collaboration are essential for improving delirium-related outcomes. However, the findings should be interpreted with caution due to differences in the study design, variability in nursing practice across countries, and language restrictions that may have limited the scope of the review. Further high-quality studies are needed to clarify the impact of specific nursing-led strategies on delirium outcomes.

Chronic pain after COVID-19: implications for rehabilitation

Objective To explore the preventive effects of early postoperative cognitive stimulation on delirium after radical gastrectomy in elderly patients with gastric cancer. Methods Totally 78 elderly patients who received radical gastrectomy from January to October 2017 were selected by convenient sampling and divided into the control group (n=39) and the observation group (n=39) according to the random number table. Patients in the control group received conventional nursing care for gastric cancer patients, while patients in the observation group received cognitive interventions on this basis. The Confusion Assessment Method-Chinese Revision (CAM-CR) , Self-Anxiety Scale (SAS) and Satisfaction Questionnaire were used to evaluate the effects of the interventions. Results The morbidity of delirium postoperatively in the observation group was 5.13%, lower than that of the control group (χ2=5.186, P=0.023) , which was 23.08%. The SAS score of the observation group was (47.36±5.28) after the interventions, lower than that of the control group (t=2.311, P=0.024) , which was (50.23±5.68) . The satisfaction score in the treatment group before discharge was (92.46±3.35) , higher than that of the control group (t=6.335, P<0.001) , which was (87.64±3.37) . Conclusions Elderly patients with gastric cancer are at high risk of postoperative delirium. And early cognitive stimulation can effectively reduce the incidence of delirium, which is worth promoting in clinical practice. Key words: Aged; Gastric neoplasms; Delirium; Cognition

Long-term recovery of survivors of coronavirus disease (COVID-19) treated with extracorporeal membrane oxygenation: The next imperative

Delirium is a common yet underrecognized neuropsychiatric syndrome in cardiovascular medicine associated with prolonged hospitalization, increased mortality, and long-term cognitive decline. Patients undergoing interventional or surgical cardiovascular procedures-such as transcatheter aortic valve replacement, surgical aortic valve replacement, coronary artery bypass grafting, or percutaneous coronary interventions-may be particularly vulnerable to its development. Delirium incidence varies widely across cardiovascular procedures, influenced by patient characteristics, procedural invasiveness, and diagnostic methodology. Risk factors include advanced age, baseline cognitive impairment, cerebrovascular disease, extended operative times, perioperative complications, and systemic inflammation. Diagnostic tools such as the Confusion Assessment Method (CAM) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) score are established but underutilized in the diagnosis of delirium. While preventive strategies emphasizing non-pharmacological, multicomponent approaches-such as early mobilization, cognitive stimulation, and sleep hygiene-are supported by strong evidence, preventive use of pharmacologic agents remains controversial. Pharmacologic treatment is reserved for select cases; dexmedetomidine shows benefits in intensive care unit settings, while antipsychotics like quetiapine and risperidone may be used cautiously. Overall, delirium poses a significant clinical challenge in cardiovascular medicine and requires a proactive, interdisciplinary approach. Systematic risk assessment and multimodal preventive strategies should be the standard of care, while pharmacologic treatment should be symptom- and context-specific. Further high-quality studies are needed to inform evidence-based guidelines tailored to cardiovascular populations. The present state-of-the-art review summarizes the current literature on the epidemiology, mechanisms, clinical manifestations, diagnosis, prevention, and treatment of delirium in cardiovascular medicine. By integrating findings and interdisciplinary expert discussions from interventional cardiology, cardiac surgery, and psychiatry, it aims to define the unique vulnerability of this patient population, highlight critical knowledge gaps, and lay the foundation for developing targeted, evidence-based management strategies.

Quality of life, functional status, and persistent symptoms after intensive care of COVID-19 patients

Apesar da evocação constante do espírito de caridade e da acção misericordiosa das Rainhas de Portugal, escasseiam, ainda hoje, trabalhos de grande fôlego que estudem na sua pluridimensionalidade o patrocínio religioso e assistencial das consortes régias. Com uma ou outra excepção, para os tempos medievos e para a época moderna, muito está ainda por fazer. Quer para as terras do Reino, quer para as longínquas paragens da Índia, da China e do Brasil. Um outro campo de estudo apenas recentemente explorado é o das relações entre a Casa das Rainhas e as várias instituições religiosas existentes nas terras pertencentes a este domínio senhorial. Como tivemos oportunidade de sublinhar noutro trabalho, as rainhas dispunham de amplos e diversos direitos de natureza eclesiástica, que incluíam o direito de padroado das cidades, vilas e terras sob sua alçada jurisdicional, a que estava anexa a prerrogativa de provimento dos respectivos cargos e benefícios eclesiásticos; a apresentação de lugares de freiras e de merceeiras; e, por fim, a protecção a mosteiros, a conventos, a misericórdias, a confrarias, a irmandades e a hospitais. Sem esquecer as esmolas múltiplas a pessoas e a instituições. Não é esse, porém, o objectivo do presente texto, que apenas pretende estudar a natureza, o âmbito e a especificidade das ligações institucionais entre a Casa das Rainhas - através do orgão central de gestão administrativa, o Conselho da Fazenda - e a confraria hospitalar do Espírito Santo de Alenquer, entre 1645 e 1653. [...]

Attention‐deficit hyperactivity disorder (ADHD) is highly heritable; however, an adequate home environment may moderate its development. This study examined the early home environment of 70 male adolescents (M age = 13.5 years, SD = 0.95) participating in a prospective high‐risk longitudinal study. Results demonstrated that adolescents who were eventually diagnosed with ADHD tended to have higher home chaos and less enriched home environments in early childhood. Within the different aspects of enriched home environment, less cognitive stimulation—but not less emotional/physical support—was found between diagnosed and nondiagnosed adolescents. This effect was also found among the subgroup of those who, a priori, were at familial risk for ADHD. Early cognitive stimulation longitudinally predicted both ADHD diagnosis and ADHD symptom domains, above and beyond parental ADHD symptoms and other aspects of the early home environment. Results suggest the possible protective role of early cognitive stimulation in the development of ADHD.Highlights This study examined the aspects of early childhood home environment that serve as risk/protective factors in the developmental course of ADHD. Early cognitive stimulation, but not home chaos and emotional/physical environment, longitudinally predicted both ADHD symptoms and diagnosis in adolescence. Early cognitive stimulation might have a protective role in the developmental course of ADHD.

Brain Injury in Critical Illness and a Note on the Virus

BackgroundEarly childhood obesity disproportionately affects children of low socioeconomic status. Children attending Head Start are reported to have an obesity rate of 17.9%.This longitudinal study aimed to understand the relationship between cognitive stimulation at home and intake of junk food, physical activity and body size, for a nationally representative sample of 3- and 4-year old children entering Head Start.MethodsWe used The Family and Child Experiences Survey 2006. Cognitive stimulation at home was measured for 1905 children at preschool entry using items from the Home Observation Measurement of the Environment Short Form. Junk food consumption and physical activity were obtained from parent interviews at kindergarten entry. BMI z scores were based on CDC national standards. We analyzed the association between early cognitive stimulation and junk food consumption, physical activity and BMI, using multinomial and binary logistic regression on a weighted sample.ResultsChildren who received moderate levels of cognitive stimulation at home had a 1.5 increase in the likelihood of consuming low amounts of junk food compared to children from low cognitive stimulation environments. Children who received moderate and high levels of cognitive stimulation were two and three times, respectively, more likely to be physically active than those in low cognitive stimulation homes. No direct relationship was identified between cognitive stimulation and BMI.ConclusionPrevention and treatment efforts to address early childhood obesity may consider strategies that support parents in providing cognitively stimulating home environments. Existing evidence-based programs can guide intervention in pediatric primary care.

Comparative effectiveness of non-pharmacological interventions for preventing delirium in critically ill adults: A systematic review and network meta-analysis

Developmental support in early parent-infant interactions has been shown to predict children's early development and later academic success, but the long-term combined impacts of maternal and paternal interactions are rarely examined. For 229 low-income children in the US Early Head Start Research and Evaluation Project, parent-toddler interactions at age 2, observed separately with fathers and mothers, were examined in relation to child outcomes at age 3 and 5th grade. In families with resident biological fathers, both mother and father cognitive stimulation independently predicted 5th grade math and reading, over and above program impacts and child gender. In other families, only mother cognitive stimulation predicted later child outcomes, even if fathers were involved in children's lives. Adding early developmental indicators to the model showed that the contributions of mothers' early cognitive stimulation on children's later academic skills were significantly mediated by children's early development in biological father-resident families, but not in other families. Similarly, adding early developmental indicators to the reading model showed that the contributions of fathers' early cognitive stimulation on children's later reading was partially mediated by children's early vocabulary in biological father-resident families, but not in other families. These results suggest that fathers' and mothers' cognitive stimulation in early play with toddlers both have the potential to make long-term direct and indirect impacts on their children's academic success.

To explore the relationship between early cognitive stimulation in the home, 6-month infant communication, and 24-month toddler language in a low-socioeconomic status sample. Longitudinal analyses of mother-child dyads participating in larger study of early child development were performed. Dyads enrolled postpartum in an urban public hospital. Cognitive stimulation in the home at 6 months was assessed using StimQ-lnfant, including provision of toys, shared reading, teaching, and verbal responsivity. Early infant communication was assessed at 6 months including the following: (1) Emotion and eye gaze (Communication and Symbolic Behavior Scale DP-CSBS DP), (2) Communicative bids (CSBS DP), and (3) Expression of emotion (Short Temperament Scale for Infants). Toddler language was assessed at 24 months using the Preschool Language Scale-4, including the following: (1) expressive language and (2) auditory comprehension. Three hundred twenty families were assessed. In structural equation models, cognitive stimulation in the home was strongly associated with early infant communication (β = 0.63, p <.0001) and was predictive of 24-month language (β = 0.20, p <.05). The effect of early cognitive stimulation on 24-month language was mediated through early impacts on infant communication (Indirect β = 0.28, p =.001). Reading, teaching, availability of learning materials, and other reciprocal verbal interactions were all related directly to infant communication and indirectly to language outcomes. The impact of early cognitive stimulation on toddler language is manifested through early associations with infant communication. Pediatric primary care providers should promote cognitive stimulation beginning in early infancy and support the expansion and dissemination of intervention programs such as Reach Out and Read and the Video Interaction Project.

Critically Ill Adults With Coronavirus Disease 2019 in New Orleans and Care With an Evidence-Based Protocol

Survival from critical illness has improved in recent years, leading to increased attention to the sequelae of such illness. Neuromuscular weakness in the intensive care unit (ICU) is common, persistent, and has significant public health implications. The differential diagnosis of weakness in the ICU is extensive and includes critical illness neuromyopathy. Prolonged immobility and bedrest lead to catabolism and muscle atrophy, and are associated with critical illness neuromyopathy and ICU-acquired weakness. Early mobilization therapy has been advocated as a mechanism to prevent ICU-acquired weakness. Early mobilization is safe and feasible in most ICU patients, and improves outcomes. Implementation of early mobilization therapy requires changes in ICU culture, including decreased sedation and bedrest. Various technologies exist to increase compliance with early mobilization programs. Drugs targeting muscle pathways to decrease atrophy and muscle-wasting are in development. Additional research on early mobilization in the ICU is needed.