Levels Of Agitation Research Articles

Impact of agitation status during intensive care on functional outcomes and mortality in patients with cardiovascular disease

Abstract Background Agitation in patients during intensive care is a frequent complication. Several studies have reported that restlessness and agitation are risk factors for prolonged intensive care unit (ICU) stay and poor prognosis. Since patients with cardiovascular disease (CVD) requiring intensive care are ageing and thereby easily affected by responses, including changes in mental status, optimal management of sedation and agitation statuses during ICU stay is considered crucial. However, the influence of different agitation levels during CVD treatment in the ICU on clinical outcomes after ICU discharge is still unclear. Purpose To investigate the associations of the agitation level during ICU stay with mortality after ICU admission and functional outcomes at hospital discharge. Methods We studied 2236 patients (mean age 67.8±0.3 years) who were admitted to the ICU of a university hospital for CVD treatment and whose highest Richmond Agitation-Sedation Scale (RASS) ≥0, measured daily during ICU stay. In addition to clinical characteristics, we investigated the incidence of all-cause mortality during hospitalization and after hospital discharge. We also measured functional outcomes at discharge among 1625 patients, including 6 minutes walk distance (6MWD), Mini-Cog test, and Patient Health Questionnaire-2 (PHQ-2) as physical, cognitive, and mental functions, respectively. In statistical analysis, patients were divided into three groups based on the highest RASS levels during ICU stay in each patient (Calm: RASS=0, Restless: RASS=1, Agitation: RASS≥2). Kaplan-Meier analysis with a log-rank test and the multivariate Cox proportional hazard model were used to clarify whether higher agitation levels were associated with all-cause mortality. Moreover, the differences between the agitation levels and functional outcomes at hospital discharge were compared using the analysis of covariance. Results During the median follow-up of 1.9 years, all-cause death occurred in 280 patients (12.5%), with an incidence rate of 5.57/100 person-years. The Restless and Agitation groups showed higher mortality than the Calm group (P<0.001), and higher agitation levels in the ICU were significantly associated with a higher rate of all-cause mortality (adjusted hazard ratio: 1.37, 95% confidence interval: 1.19–1.57, P<0.001). Furthermore, as compared with the Calm group, the Restless and Agitation groups showed significantly lower levels of 6MWD (all P<0.001) and Mini-cog (P=0.004 and P<0.001, respectively) and a higher PHQ-2 (all P<0.001), even after adjusting for clinical confounders. Conclusions Agitation during ICU stay in CVD patients was associated with low functional outcomes at hospital discharge and high mortality rate after discharge, irrespective of agitation level. Detailed information on the agitation status during intensive care may be an important indicator in developing management and treatment strategies for patients with CVD admitted to ICU.

Can ketamine administration prevent intubation in patients who cannot comply with NIV due to agitation?

BackgroundIn patients presenting to the emergency department (ED) with acute respiratory failure, non-invasive mechanical ventilation (NIMV) is applied when conventional oxygen support is not sufficient. Patients who are agitated often have very low NIMV compliance and a transition to invasive mechanical ventilation (IMV) is often required. To avoid IMV, a suitable sedative agent can be utilized. The aim of this research is to investigate the relationship between ketamine administration to patients who are non-compliant with NIMV due to agitation and the outcome of their intubation.MethodsThis retrospective study included patients with acute respiratory failure who were admitted to the ED from 2021 to 2022 and used Richmond Agitation Sedation Scale (RASS) to identify agitation level of patients. The relationship between ketamine administration in this patient group and NIMV compliance and intubation rate was evaluated.ResultsA total of 81 patients, including 35 (43.2%) men and 46 (56.8%) women, were included in the study. Of these patients, 46 (56.8%) were intubated despite ketamine administration, while 35 (43.2%) were compliant with NIMV and were not intubated. When evaluating the RASS, which shows the agitation levels of the patients, the non-intubated group was found to be 2.17 ± 0.68, while the intubated group was 2.66 ± 0.73, and it was statistically significant that the NIMV intubated group was higher (p = 0.003).ConclusionThis study showed that agitation can impair NIMV compliance in patients with acute respiratory failure. However, a significant proportion of this patient group can be avoided through IMV with proper sedative agents.

Investigating screw-agitator speed ratio impact on feeding performance in pharmaceutical manufacturing using discrete element method

In continuous powder handling processes, precise and consistent feeding is crucial for ensuring the quality of the final product. The intermixing effect caused by agitators, which alters the powder’s bulk density, flow rate, and flow patterns, plays a significant role in this process, yet it is often overlooked. This study combines discrete element method (DEM) modeling and experiments using a commercial-scale feeder to propose a Digital Twin (DT) framework. The DEM model accurately captures key flow features, such as bypass trajectories, stagnant zones, and preferential flow patterns, while providing quantitative predictions for the feed factor and zones prone to material accumulation. Scenario analysis is performed to identify the most favorable operating ranges of the screw-agitator ratio and screw speed, considering the cohesive properties of the powder. The study demonstrates that powders with poor flow characteristics require tighter operational constraints, as the screw-agitator ratio is susceptible to variations in mass feed rate. This contribution highlights the importance of selecting an appropriate screw-agitator ratio instead of maintaining a fixed value. Properly choosing this ratio helps determine an optimal operation window, which aims to achieve a minimum agitation level needed to induce unhindered flow and reduce variability in the mass flow rate.

A mixed methods study into the effectiveness of sensory rooms in reducing agitation levels in a psychiatric intensive care unit

Background:Reducing incidences of violence, and the use of restrictive interventions within psychiatric intensive care units (PICUs), is a priority nationally. One method for reducing violence and aggression from escalating in PICUs is sensory rooms. This study aimed to explore the effectiveness of sensory rooms as an alternative strategy to manage agitation levels in a PICU and understand the patient and staff experiences of using sensory rooms as an alternative intervention to standard approaches for agitation reduction. Method:A mixed methods approach collected data over six months using an observational rating scale pre and post-sensory room, and conducting nine semi-structured interviews with patients and staff. Results:71 patient contacts recorded, there was a statistically significant difference in pre and post-sensory room agitation ratings (p<0.001), with 66% (n = 47) experiencing a reduction in agitation rating post-usage. The sensory room was used as both a proactive and reactive strategy to manage agitation. Five themes emerged from the interviews: the sensory room supports emotional regulation, improves the patient's experience, develops therapeutic relationships, and offers an alternative agitation management strategy; however, it can be an underused resource due to access limitations. Conclusion:Staff and patients had positive experiences using a sensory room to manage agitation; it offers a safe space away from the busy ward environment. Several different factors impact staff using the intervention. Findings provide considerations for services when developing sensory rooms in PICUs, to ensure they are established as a reliable alternative for the management of agitation.

Preparation of modified Jordanian bentonite with cetyltrimethylammonium bromide as novel adsorbent for phosphate ion removal from synthetic and real wastewater

Jordanian bentonite was examined for its capacity to remove phosphate ions from aqueous solutions, both synthetic and natural. by converting Jordanian bentonite to organo-bentonite (CTAB-bentonite). Investigation on the ability of organo-bentonite to remove phosphate ions under different conditions including initial concentration, temperature, particle size, pH levels, adsorbent dosage, and contact time. Kinetic experiments results were analyzed employing first and second pseudo order models. The results of R2 for both kinetic models confirmed that fill in the pseudo- second-order and was preferred for the transport of phosphates other than pseudo-first order. For both synthetic and actual wastewater, the activation energy for removal was computed and determined to be 22.88 kJ/mol and 58.73 kJ/mol, respectively. The rate of phosphate ion absorbing was investigated at different temperatures, particle sizes, agitation levels, and pH values. The study predicted both particle diffusion (Dp) and film diffusion (Df) coefficients, concluding that film diffusion (Df) determines rate.

Effects of Natural Sound Therapy on Pain and Agitation Induced by Endotracheal Suctioning: A Real-World Study.

Music therapy has been used as a complementary intervention to provide synergistic analgesia for various procedures. To evaluate the effects of natural sound therapy on pain intensity and agitation scores in intubated adult Chinese patients who received endotracheal suctioning in a critical care unit. A prospective, real-world, randomized, double-blind, controlled study was conducted from July 2021 through February 2022 among intubated surgical intensive care unit patients in a Chinese hospital. Patients were randomly assigned to a control group receiving conventional treatment or an intervention group receiving natural sound therapy plus conventional treatment (50 patients in each group). Patients' pain intensity and agitation levels were analyzed before, during, immediately after, 5 minutes after, and 15 minutes after completion of endotracheal suctioning. Pain intensity was assessed with the Critical-Care Pain Observation Tool (CPOT); agitation was assessed with the Richmond Agitation-Sedation Scale (RASS). According to CPOT scores, patients in the intervention group had significant relief of pain intensity during, immediately after, and 5 minutes after endotracheal suctioning compared with patients in the control group (all P < .001). The RASS scores showed that agitation levels were significant lower in the intervention group than in the control group during (P = .002) and immediately after (P < .001) endotracheal suctioning. In this real-world study, natural sound therapy was part of a holistic bundle of interventions used to reduce pain and agitation in surgical intensive care unit patients during endotracheal suctioning.

Non-pharmacological methods and techniques used in the therapy of children diagnosed with adhd. Study of literature

Attention deficit and hyperactivity disorder (ADHD) is seen as a long-lasting and chal-lenging condition that affects various areas of life, such as academic and career success, relationships, and daily activities. Both the mind and the muscles jump from one task to another, failing to complete the activity, and thus difficulties arise in carrying out activities such as writing, tying shoelaces, riding a bicycle and more. Banal activities we would say, but essential for a normal lifestyle. Medical recovery has a signifiant contribution in relieving symptoms and treating many pathologies, in both physical and mental relaxation. Moreover, it has been shown countless times that physical activity reduces stress, mainly based on muscle relaxation and improving cognitive and motor function through the development of neural functions. More and more children are diagnosed with this disorder, but, not enough attention is paid to these cases, which is one of the reasons why we chose to address this topic. The paper aims to analyze studies carried out in recent years in different countries on motor impairments and other complications that can present children with ADHD, but also the way that balneophysiokinetotherapy has a positive effect in their therapy, being an essential form of therapy, alongside the psychological or medicinal one. The studies analyzed confirm the benefits of physical exercise for children diagnosed with ADHD, showing visible effects on both the motor skills of the children and their lev-els of agitation and attention deficit. Although movement therapy is widely used in this condition, there are no protocols standardizing the type, duration, and intensity of exer-cise programs used. Occupational therapy, massage, and yoga have been noted for their beneficial effects on patients diagnosed with ADHD. Keywords: ADHD, hyperactivity, therapy

Optimization of Growth Response Parameters, Screening and Molecular Detection of Pesticide Degradation Genes in Bacterial Isolates from Agricultural Soils

Study’s Novelty/ Excerpt This study demonstrated the capability of bacteria isolated from farmland soils in Kano Metropolis to biodegrade dichlorvos and carbofuran pesticides, identifying Bacillus sp., Serratia sp., and Pseudomonas sp. as key degraders. Optimization experiments revealed that Serratia sp. thrived at 100 mg/L dichlorvos concentration and 35°C, while Pseudomonas sp. showed maximum growth at 300 mg/L carbofuran concentration and 30°C, both with a pH of 7.0, 100 rpm agitation, and 5-day incubation period. Molecular analysis confirmed the presence of opd and mcd genes in Serratia sp. and Pseudomonas sp., respectively, highlighting their potential for effective bioremediation of pesticide-contaminated soils. Full Abstract Pesticides are organic compounds synthesized and used for pest control. The excessive and continuous dispersion of pesticides in the environment results in environmental pollution, necessitating remediation. This study investigated the potential of bacteria isolated from farmland soils in Kano Metropolis, Kano State, Nigeria, with a history of dichlorvos (2,2-dichlorovinyldimethylphosphate) and carbofuran (2,3-dihydro-2,2-dimethyl-7-benzofuranyl methylcarbamate) application, to biodegrade these pesticides. Three sampling sites were involved in sample collection, and the soil physicochemical parameters from each sample were determined. Isolation, identification, and screening of the bacterial isolates capable of utilizing the pesticides as sole sources of carbon were carried out. The following parameters (concentration of the pesticides, pH, temperature, agitation, and incubation time) were optimized to maximize degradation. The potent bacterial isolates were further subjected to molecular analysis for the detection of opd and mcd genes. The pesticide-degrading bacteria were identified as Bacillus sp., Serratia sp., and Pseudomonas sp. Serratia sp. recorded the highest growth in the presence of 1% v/v dichlorvos, while Pseudomonas sp. exhibited maximum growth at a 1% w/v carbofuran concentration. The optimized conditions that yielded the maximum microbial growth are: 100 mg/L pesticide concentration for Serratia sp and 300 mg/L for Pseudomonas sp, a pH of 7.0 and an agitation level of 100 rpm for both organisms, a temperature of 35°C for Serratia sp and 30°C for Pseudomonas sp, and an incubation time of 5 days for both organisms. The opd and mcd genes were identified from Serratia sp. and Pseudomonas sp. respectively. These results suggest that the isolated bacteria have the potential to degrade dichlorvos and carbofuran pesticides from the contaminated soil

A Novel Objective Measure for Terminal Delirium: Activity Scores Measured by a Sheet-Type Sensor

ContextDelirium is a significant concern in end-of-life care. Continuous monitoring of agitation levels using objective methods may have advantages over existing measurement scales. ObjectivesTo examine whether an objective measure of activity scores measured using a sheet-type non-wearable sensor (Nemuri SCAN [NSCAN]) was correlated with agitation levels measured using the modified Richmond Agitation-Sedation Scale (RASS) in terminally ill patients with cancer. MethodsWe conducted a single-center, prospective, observational study in a palliative care unit using the NSCAN to measure activity scores and the RASS to assess agitation levels. RASS scores were prospectively measured by ward nurses blinded to the NSCAN variables. A database was created to pair the RASS scores and activity scores at night on the same day. ResultsDuring the observation period, 1209 patients were hospitalized, and 3028 pairs of assessments of 971 patients were analyzed. The NSCAN activity scores significantly increased with increasing RASS scores (Jonckheere–Terpstra test, p < 0.001). The mean values of the activity scores for each RASS score were RASS −5, 28.9; RASS −4, 36.4; RASS −3, 41.7; RASS −2, 57.4; RASS −1, 58.8; RASS 0, 62.6; RASS 1, 79.6; RASS 2, 106.5; and RASS 3, 118.7. ConclusionThe NSCAN activity significantly correlated with modified RASS agitation scores. Real-time NSCAN data on agitation may aid timely interventions for optimal symptom control. To improve outcomes for patients suffering from terminal delirium, more research on monitoring tools is warranted.

Person-centered approach to suicide ideation in posttraumatic stress disorder in veterans: a latent profile analysis

IntroductionWhile most research on suicidal ideation (SI) in veterans adopts a variable-oriented perspective, this approach often fails to capture the complex interplay of symptoms and comorbid disorders. We hypothesised that a person-centred approach can identify distinct subpopulations of veterans with varying profiles of SI, PTSD symptoms, depression, and agitation.ObjectivesTo examine whether distinct subpopulations of veterans exists, characterized by different profiles of PTSD severity, depression and agitation, and intensity of SI.MethodsWe conducted a cross-sectional study in one big University Hospital Centre in Croatia on the sample of men, war veterans aged 30-65 years, undergoing treatment for chronic PTSD. Latent profiles indicators included the Clinician-Administered PTSD Scale (CAPS), Beck Scale for Suicide Ideation (SSI), Hamilton Depression Rating Scale-17 (HDRS-17) and Corrigan Agitated Behaviour Scale (CABS).Results We included 203 male participants with a median age of 47 (IQR 43-45) years. The optimal model, allowing variances of indicators to vary between profiles while constraining covariances to zero, yielded five distinct latent profiles. Notably, the highest SI was found in a subpopulation with elevated CABS scores, but moderate PTSD and depression symptoms (13% of participants). Next in SI intensity were 11% of veterans with severe symptoms across all assessed disorders. Next in SI severity were 21% of veterans with low levels of agitation but high levels of depression. The last two profiles, one with mild symptoms of all assessed disorders (43%) and the other with high agitation (12%), have low SI severity.ConclusionsOur findings affirm the utility of a person-centred approach in identifying nuanced subpopulations of veterans with diverse symptom profiles related to SI. This stratification can inform targeted interventions, thereby enhancing the efficacy of suicide prevention strategies.Disclosure of InterestNone Declared

Fungal pellets of Pleurotus ostreatus and Rhizopus stolonifer for biotechnological applications: Characterization and production optimization using Taguchi methodology

Filamentous fungi are known for their significant potential in biotechnology, thanks to their versatile enzyme systems with various applications. However, dealing with their growth patterns and structural configurations presents significant challenges. To tackle these issues, fungal pellets are emerging as potential solutions, providing compact biomass aggregates that offer distinct advantages for bioprocesses. This study delves into characterization and optimizing pellet formation for Pleurotus ostreatus and Rhizopus stolonifer using the Taguchi methodology, aiming to enhance their biotechnological applications. By systematically varying parameters such as agitation level (AL), glucose concentration (GC), and inoculum size (IS), we identified key factors influencing pellet formation. Results indicate that P. ostreatus forms pellets in rich media from mycelium, while R. stolonifer requires a minimal medium with pH modifications for pelletization via a coagulative mechanism. The optimization process reveals that agitation level is a crucial factor for maximizing pellet production in both models, while the other factors do not seem to influence the process significantly but impact the morphology and quantity of pellets. The results suggest that by optimizing parameters using the Taguchi method, it is possible to achieve acceptable pellet formation performance in both fungi. Understanding these factors is essential for improving the efficiency of biotechnological processes involving fungal biomass, providing valuable insights into enhancing fungal pellet production for various applications.

Wi-Gitation: Replica Wi-Fi CSI Dataset for Physical Agitation Activity Recognition

Agitation is a commonly found behavioral condition in persons with advanced dementia. It requires continuous monitoring to gain insights into agitation levels to assist caregivers in delivering adequate care. The available monitoring techniques use cameras and wearables which are distressful and intrusive and are thus often rejected by older adults. To enable continuous monitoring in older adult care, unobtrusive Wi-Fi channel state information (CSI) can be leveraged to monitor physical activities related to agitation. However, to the best of our knowledge, there are no realistic CSI datasets available for facilitating the classification of physical activities demonstrated during agitation scenarios such as disturbed walking, repetitive sitting–getting up, tapping on a surface, hand wringing, rubbing on a surface, flipping objects, and kicking. Therefore, in this paper, we present a public dataset named Wi-Gitation. For Wi-Gitation, the Wi-Fi CSI data were collected with twenty-three healthy participants depicting the aforementioned agitation-related physical activities at two different locations in a one-bedroom apartment with multiple receivers placed at different distances (0.5–8 m) from the participants. The validation results on the Wi-Gitation dataset indicate higher accuracies (F1-Scores ≥0.95) when employing mixed-data analysis, where the training and testing data share the same distribution. Conversely, in scenarios where the training and testing data differ in distribution (i.e., leave-one-out), the accuracies experienced a notable decline (F1-Scores ≤0.21). This dataset can be used for fundamental research on CSI signals and in the evaluation of advanced algorithms developed for tackling domain invariance in CSI-based human activity recognition.

EMOTIONAL CLOSENESS, SOCIAL NETWORK, NEGATIVE AND POSITIVE AFFECTS, AND AGITATION IN OLDER ADULTS WITH DEMENTIA

Abstract Background If given a choice, people with dementia (PWD) would prefer to live in their homes instead of nursing homes. Living in older adults’ own houses would positively impact their quality of life and be associated with more privacy, security, and social support. In addition, living in a nursing home is not culturally and religiously accepted, especially in a religious and conservative country like Jordan. However, with increased financial obligations and hardships in Jordan, women are forced to work outsides their houses. Therefore, PWD stay alone in their homes without care or attention. This neglect would put PWD at significant risk for adverse physical and psychosocial health consequences. Method: This descriptive cross-sectional study was conducted on a convenience sample of 102 Jordanian PWD (51 Community-dwelling older adults and 51 NH residents) to examine the association of their emotional closeness and social networks with agitation and positive and negative affects. Result: The finding of this study based on an independent samples t-test showed that NH residents were significantly more likely to have physically non-aggressive behaviors than community-dwelling older adults. The study showed that the PWD’s sex (male), higher educational levels, and patients with a family member in the healthcare field are associated significantly with their mean positive affects score. Conclusion Future research would consider exploring potential factors associated with agitation and affect in PWD. Experimental studies that intend to increase the levels of social support and emotional closeness, thus alleviating negative affect and levels of agitation, are recommended in the future.

Longitudinal patterns of behavioral and psychological symptoms of dementia in community‐dwelling older people

AbstractBackgroundBehavioral and psychological symptoms of dementia (BPSD) exhibit fluctuate by symptoms. This can cause difficulty for caregivers in addressing symptoms and a greater care burden. Few studies have analyzed the longitudinal course of multiple BPSD together. We aimed to identify the trajectory groups of 12 BPSD symptoms and assess the predictors of trajectory group membership.MethodData were drawn from the National Alzheimer’s Coordinating Center Uniform Data Set comprising participants who were followed up approximately annually in the United States. We examined home‐dwelling participants who were followed‐up for at least 1 year from 2015 to 2020. Individuals with cognitive decline (Clinical Dementia Rating of more than 0.5 and diagnosis of mild cognitive impairment or dementia) were included (n = 1,585). Twelve symptoms of BPSD were measured using the Neuropsychiatric Inventory. We used group‐based multi‐trajectory models to identify latent trajectory groups. Multinomial logistic regression analysis was conducted to assess participants’ characteristics at baseline associated with trajectory groups.ResultAmong participants, mean age was 75.7 years, median annual number of visits was 3 (interquartile range: 2‐5 visits), 44% were female, 74% lived with their spouse/partner, and 38% were able to live independently. Four trajectory groups were identified. One group showed relatively higher levels of all symptoms across years. In two groups, moderate levels of agitation, irritability, and depression, and moderate levels of apathy, appetite disturbances, and hallucinations were observed. The fourth group exhibited lower levels of all symptoms. Multinomial logistic regression models revealed that, compared with the lower‐level group, older age was associated with lower odds of other group membership. The level of dependence and cognitive decline were associated with higher odds of other group membership, although their interaction indicated lower odds. Male was a predictor of higher‐level group. Living with someone was a predictor for a group with moderate levels of apathy, appetite disturbances, and hallucinations.ConclusionWe identified at least four trajectories in 12 BPSD symptoms over 5 years, and their common and specific predictors among community‐dwelling people with dementia. Inferring individual group membership using these predictors may be helpful for determining appropriate measures for addressing expected BPSD.

Examining the Effects of Music Therapy on Decreasing Agitation in Alzheimer's Disease.

Background: Alzheimer's disease (AD) is a crippling epidemic that is predicted to affect over 15 million people worldwide by the year 2050. Symptoms such as refusal to cooperate, impaired communication and cognition, and agitation and anxiety can play a large part in the difficulties that surround caring for an AD patient. There are medications that are marketed to treat AD symptoms, but many have harmful side effects. Holistic methods, such as music therapy, are gaining attention for their ease of implementation and limited side effects. Aim: The purpose of this project was to implement a music therapy intervention for people with AD in hospice and evaluate the levels of agitation experienced by the patient. Method: The study was conducted over a period of eight weeks. Music therapy was administered nightly for 20 minutes by caregivers and the Pittsburgh Agitation Scale was completed at the beginning of the study, at four weeks into the study, and at the completion of the study. Results: The intervention was found to be significant in reducing aberrant vocalization, motor agitation, aggressiveness, and resisting care. Conclusion: Based on the findings, music therapy may be useful as a holistic intervention for decreasing agitation in individuals with AD.

The OptimaMed intervention to reduce medication burden in nursing home residents with severe dementia: results from a pragmatic, controlled study

BackgroundNursing home (NH) residents with severe dementia use many medications, sometimes inappropriately within a comfort care approach. Medications should be regularly reviewed and eventually deprescribed. This pragmatic, controlled trial assessed the effect of an interprofessional knowledge exchange (KE) intervention to decrease medication load and the use of medications of questionable benefit among these residents.MethodsA 6-month intervention was performed in 4 NHs in the Quebec City area, while 3 NHs, with comparable admissions criteria, served as controls. Published lists of “mostly”, “sometimes” or “exceptionally” appropriate medications, tailored for NH residents with severe dementia, were used. The intervention included 1) information for participants’ families about medication use in severe dementia; 2) a 90-min KE session for NH nurses, pharmacists, and physicians; 3) medication reviews by NH pharmacists using the lists; 4) discussions on recommended changes with nurses and physicians. Participants’ levels of agitation and pain were evaluated using validated scales at baseline and the end of follow-up.ResultsSeven (7) NHs and 123 participants were included for study. The mean number of regular medications per participant decreased from 7.1 to 6.6 in the intervention, and from 7.7 to 5.9 in the control NHs (p-value for the difference in differences test: < 0.05). Levels of agitation decreased by 8.3% in the intervention, and by 1.4% in the control NHs (p = 0.026); pain levels decreased by 12.6% in the intervention and increased by 7% in the control NHs (p = 0.049). Proportions of participants receiving regular medications deemed only exceptionally appropriate decreased from 19 to 17% (p = 0.43) in the intervention and from 28 to 21% (p = 0.007) in the control NHs (p = 0.22). The mean numbers of regular daily antipsychotics per participant fell from 0.64 to 0.58 in the intervention and from 0.39 to 0.30 in the control NHs (p = 0.27).ConclusionsThis interprofessional intervention to reduce inappropriate medication use in NH residents with severe dementia decreased medication load in both intervention and control NHs, without important concomitant increase in agitation, but mixed effects on pain levels. Practice changes and heterogeneity within these 7 NHs, and a ceiling effect in medication optimization likely interfered with the intervention.Trial registrationThe study is registered at ClinicalTrials.gov: # NCT05155748 (first registration 03–10-2017).

Can a personalised music listening intervention decrease agitation in hospitalised patients with dementia? A feasibility trial.

Agitation is a common manifestation of the behavioural and psychological symptoms of dementia (BPSD). Pharmacotherapy is not the first-line management because of its potential harms, particularly in the elderly. Music as a non-pharmacological intervention for agitation has been explored in residential aged-care facilities, but few studies have been situated in hospitals. This pilot aims to evaluate the feasibility of a personalised music listening intervention for reducing agitation in hospitalised patients with dementia in a metropolitan Geriatric Evaluation and Management (GEM) unit. Two-arm randomised control feasibility trial. Eligible patients were assigned to the music intervention or control group, with the intervention group receiving music daily between 15:00-16:00, and agitation levels measured in both groups hourly based on the Pittsburgh Agitation Score (PAS) over 5 days of hospitalisation. Post-trial semi-structured interviews assessed feasibility of the intervention. Twenty-one patients were recruited over 8 months. Interviews with staff involved indicated that the music intervention was manageable to deliver, assisted engagement with patients which increased efficiency of some clinical tasks, and challenged staff mindset around using psychotropic medication to address agitation. PAS results were inconclusive, because of underpowered numbers in this pilot study. It is feasible for nursing staff to deliver a personalised music listening intervention to patients with dementia in a geriatric unit of a tertiary hospital, without compromising on usual clinical care.

Healthcare Experience of Pediatric Patients with Autism Spectrum Disorders in Saudi Arabia: A Cross-Sectional Study.

Children with autism spectrum disorder (ASD) face several challenges in the healthcare setting. This study defines the challenges experienced by children with autism in hospitals in Saudi Arabia. A cross-sectional study was conducted using a questionnaire for guardians of autistic children in outpatient clinics, autism support groups, and rehabilitation centers. A total of 199 participants were included. The medical procedures causing the most anxiety to children were injections and getting their blood drawn (68.3%), vital sign measurement (41.6%), and height and weight measurement (37.8%). Long waiting hours (44.1%), increased sensory stimuli (33.2%), and overcrowding of hospital staff (27.9%) were stress-inducing in the healthcare environment. The guardians recommended that loud noises (44.7%), crowdedness (41.2%), and long waiting hours (42.1%) be avoided. The nonverbal children experienced significantly higher levels (p < 0.001) of agitation, irritability, and outbursts during doctor visits than their verbal counterparts. The children with intellectual disabilities were more tense and unresponsive during doctor visits (33.3%) than their intellectually able counterparts, who more frequently were calm and responsive (44.9%) during visits. Most patients with ASD face hardships during hospital visits. Nonverbal patients and those with intellectual disabilities have a higher tendency for hospital setting anxiety-induced outbursts, which may be eased by avoiding loud noise and overcrowding.

Delirium and delirium severity screening in the intensive care—correspondence of screenings tools

BackgroundDelirium severity scores are gaining acceptance for measuring delirium in the intensive care unit (ICU). ObjectiveThe aim of this study was to evaluate the concordance between the Confusion Assessment Method for the intensive care unit (CAM-ICU)-7 and the Intensive Care Delirium Screening Checklist (ICDSC) as delirium severity measurement tools. MethodsThis was a prospective, comparative, observational multicentre study. This study was conducted in 18 Danish ICUs. Delirium was assessed in adult critically ill patients admitted to an ICU with a Richmond Agitation and Sedation Score (RASS) of −2 or above. ICU nurses assessed delirium with randomised paired delirium screening instruments, using the CAM-ICU, the ICDSC, and the CAM-ICU-7. The correlation between the CAM-ICU-7 and the ICDSC severity scores was evaluated for all predefined patient subgroups. ResultsA total of 1126 paired screenings were conducted by 127 ICU nurses in 850 patients. The patients' median age was 70 years (interquartile range: 61–77), 40% (339/850) were female, and 54% (457/850) had at least one positive delirium score. Delirium severity ranges (CAM-ICU-7: 0–7; and ICDSC: 0–8) were positively correlated (Pearson's correlation coefficient, r = 0.83; p < 0.0001). The overall agreement between the CAM-ICU-7 and the ICDSC for delirium measurement (CAM-ICU-7: >2, and ICDSC: >3) was substantial (kappa = 0.74), but the agreement decreased to fair (kappa = 0.38) if a patient had a RASS less than 0. ConclusionsThe agreement between the CAM-ICU-7 and the ICDSC for delirium severity measurement was substantial but might be affected by the patient's sedation and agitation level at the time of assessment. Implications for practiceBoth CAM-ICU-7 and ICDSC can be implemented for delirium severity measurement. Attention is warranted in both scores if a patient has a RASS of −2.

Alkaloid content in microsporidia-infected Adalia bipunctata (Coleoptera: Coccinellidae) life stages, and pathogen spore load in adults after exposure to physical stress

The two-spotted lady beetle, Adalia bipunctata L., displays warning colouration that is reinforced by the production of adaline and adalinine. These alkaloids are thought to provide defense against predation throughout all life stages of A. bipunctata and may play a role in the insect immune system. Vairimorpha (Nosema) adaliae, a microsporidium described from A. bipunctata, has minimal effects on its host (delayed larval development) when reared under optimum conditions but stress factors are shown to affect the development of microsporidiosis. The objectives of this study were to determine the effects of V. adaliae on relative alkaloid content (adaline) during A. bipunctata development, and to evaluate the combined effects of physical stress and infection on adult beetles (relative alkaloid content and infection load). First-instar larvae were isolated from uninfected and V. adaliae-infected colonies. Eggs and first-instar larvae were immediately prepared for alkaloid analysis, whereas late-instar larvae, pupae and adults were systematically processed when each reached their designated developmental stage. Upon eclosion, a subsample of beetles was exposed to varying amounts of physical agitation: control (no shaking), alternate shaking (every other day), and daily shaking. Immediately following these stress trials, alkaloid samples were collected for analysis and spore loads were assessed. Overall, relative adaline proportions increased from egg to adult. Uninfected individuals had significantly higher relative proportions of adaline than did infected individuals during early development; however, adaline content was higher in infected A. bipunctata from the third-instar onwards, when compared to their uninfected counterparts. Following exposure to physical agitation on alternate days, uninfected adults had a significantly higher relative proportion of adaline than did infected adults. Interestingly, exposure to different levels of agitation had no significant effect on alkaloid production for either uninfected or infected beetles. Mean spore counts were significantly higher for adults that were exposed to daily shaking when compared to individuals from the control and alternate shaking groups. From a biological perspective, one would expect to observe differences in alkaloid production through coccinellid development, as each successive life stage faces different external pressures and risks. When infected with the microsporidium V. adaliae, however, adaline production was reduced during early development but increased significantly in late life stages.