NEECHAM Confusion Scale Research Articles

Validity and reliability of the Turkish version of the Informant Assessment of Geriatric Delirium Scale.

<p>Delirium is a common complication developing in el&shy;der&shy;ly patients. Therefore, it is important to diagnose delirium earlier. Family caregivers&nbsp;play an active role in early diagnosis of de&shy;lirium and build a bridge between health pro&shy;fessionals and patients. The purpose of this research was to achieve the validity and reliability of the Turkish version of the Informant Assessment of Geriatric Delirium Scale (I-AGeD).</p>. <p>This is a methodological study. The sample comprised 125 caregivers ac&shy;cepting to participate in the study and offering care to older patients with hip fracture aged &ge;60 years. Data were gathered preoperatively and on postoperative days 0, 1 and 2. After achieving the linguistic and content validity of the scale, the known-groups comparison was used to achieve its construct validity. The ROC curve analysis was made to determine the sensitivity and specificity of the scale. Item-total correlations, item analysis based on the difference between the upper 27% and lower 27%, Kuder&ndash;Richardson 20 (KR-20) coefficient and parallel forms reliability with the NEECHAM Confusion Scale were adapted to assess discriminant indices of the items in the I-AGeD.</p>. <p>The item-total correlation coeffi&shy;cients of the scale ranged from 0.54 to 0.89 and KR-20 coefficient ranged from 0.09 to 0.91 depending on the measurement times. According to the ROC curve analysis, the sensitivity and specificity of the scale were &ge; 91% and &ge; 96% respectively. The parallel forms reliability analysis showed a highly significant, strong negative relation at each measurement between the I-AGeD and the NEECHAM Confusion Scale.&nbsp;</p>. <p>The I-AGeD is valid and reliable to diagnose delirium in older Turkish patients in perioperative processes.</p>.

Metabolic disturbance affects postoperative cognitive function in patients undergoing cardiopulmonary bypass.

Postoperative delirium is a common neuropsychiatric syndrome after coronary artery bypass grafting (CABG). We aimed to assess and compare clinical outcomes of CABG patients with delirium with a specific focus on the blood biochemical parameters. This investigation was carried out on the 90 eligible patients undergoing CABG. Delirium was measured using the Neecham confusion scale and assessed patients were divided into two groups of delirium (n = 43) and non-delirium (n = 47). Preoperative variables and intraoperative and postoperative outcomes were compared. Delirium patients were older (p = 0.003) and had longer intubation time (p = 0.003). Non-delirium patients obtained a significantly higher Neecham confusion score (p = 0.001), and delirium patients experienced a hyperglycemic state at intraoperative (p = 0.004), intubation (p = 0.03), and extubation time (p = 0.02). Lower value of pH was seen at intubation (p = 0.03) and extubation periods (p = 0.001) in delirium group. A significant difference in base excess was observed between two groups at intubation (p = 0.04) and extubation periods (p = 0.004). Potassium level showed a significant decrease in delirium group at intubation (p = 0.01) and extubation periods (p = 0.001). Multivariate regression indicated that aging (OR = 1.08, p = 0.01), narcotic consumption (OR = 3.27, p = 0.05), DM (OR = 3.03, p=0.03), and prolonged intubation (OR = 1.18, p = 0.03) are predictors of delirium. Postoperative hyperglycemia (OR = 1.01, p = 0.002), low pH value (OR = 2.62, p = 0.02), and low potassium level (OR = 3.25, p = 0.03) are associated with development of delirium. Postoperative metabolic disturbance and electrolyte imbalances are closely related to the development of delirium after CABG and need to be considered more carefully. Aging, DM, and preoperative use of narcotics are strong predictors of delirium following CABG.

Preoperative Anxiety and Depression Increases the Incidence of Delirium After Coronary Artery Bypass Graft Surgery

PurposeTo address the effect of anxiety and depression before coronary artery bypass graft surgery on the postoperative delirium and the length of hospitalization. DesignProspective cohort study. MethodsThe anxiety and depression before surgery was measured using the 14-item Hospital Anxiety and Depression Scale. The main outcome of interest was delirium, which was assessed at baseline and then on the second, third, fourth, and fifth days after surgery, using the nine-item Neecham Confusion Scale. The incidence of delirium was compared in the positive group (153 patients with anxiety and depression at baseline) versus the negative group (153 patients without anxiety and depression at baseline). FindingsThere was a significant difference between the mean score of delirium in the two groups on the second, third, fourth, and fifth days after surgery (P = .001). The incidence of mild and moderate/severe delirium was significantly higher in the positive group than in the negative group for the entire length of follow-up (P = .001). The average length of hospitalization was nearly the same in the two groups (P = .156). ConclusionsThis study indicated that anxiety and depression before coronary artery bypass graft surgery can significantly increase the incidence of postoperative delirium, but it has no significant effect on the length of hospitalization.

Three-Month Mortality and Related Risk Factors in Delirium Patients: A Prospective Cohort Study

Background: Delirium is a common problem in elderly patients. Recently, therapists have shifted their attention away from treatment towards prevention; therefore, investigation of related risk factors is essential in these patients. Methods: In this prospective cohort study, newly admitted elderly patients, with a Glasgow Coma Scale score above 10, were screened and enrolled. The patients were evaluated for delirium using the Neecham Confusion Scale (NCS). The risk factors included four major domains: patient characteristics (age, gender, and substance abuse), chronic diseases, acute diseases, and blood biochemical factors. Results: A total of 100 patients were assessed for delirium. The mean age of the participants was 79.9 ± 15.1 years (24% female). The proportion of in-hospital deaths was 12%, with a cumulative three-month mortality of 40%. The rate of delirium development was significantly associated with underlying factors, including cancer, hypertension, cerebrovascular accident, cirrhosis, dementia, and substance abuse. The laboratory results showed a blood urea nitrogen (BUN) level ≥ 50 mg/dL in 33% of patients with delirium. There was a significant association between BUN level and NSC score (P < 0.05). Among other laboratory variables, higher erythrocyte sedimentation rate and C-reactive protein level were significantly associated with delirium. Moreover, Kaplan-Meier survival curves for effective factors, such as drug effect, cancer, cirrhosis, dementia, and BUN, showed significant differences. Conclusions: In elderly patients, symptoms of delirium persist for three months after diagnosis. Private nursing care at home or nursing home placement, besides the assessment of delirium risk factors, is important for optimal care of elderly patients after hospitalization.

Effectiveness and Safety of Ultrasound Guided Lower Extremity Nerve Blockade in Infragenicular Bypass Grafting for High Risk Patients With Chronic Limb Threatening Ischaemia

Surgical revascularisation to accomplish limb salvage remains preferable in some patients with chronic limb threatening ischaemia (CLTI). The aim of this study was to evaluate the effectiveness and safety of ultrasound guided lower extremity nerve blockade (UGNB) in infragenicular bypass surgery (IGBS). This was a single centre, retrospective clinical study. Fifty-nine patients with CLTI (67 limbs) who underwent IGBS under UGNB (femoral and sciatic nerve blockade) at Asahikawa Medical University between January 2012 and December 2017 were compared with patients with CLTI (137 limbs) who underwent IGBS under general anaesthesia (GA) over the same period. Propensity score matching based on pre-operative comorbidities was used to minimise background differences of the two groups. Fifty-six pairs of CLTIs were matched and analysed (55% dialysis dependent). Procedure duration was similar between the two groups, but intraoperative catecholamine index and intravenous fluid volume were lower with UGNB compared with GA (2.9 ± 4.6 vs. 5.9 ± 6.5; p < .01 and 1831 ± 990 vs. 2335 ± 931 mL; p < .01, respectively). The mean arterial blood pressure during induction of anaesthesia was significantly decreased with GA. Post-operatively, the time period to resume a clear liquid and solid food diet was significantly shorter with UGNB (P < 0.01 for both outcome measures). Intravenous fluid volume was significanlty lower, while cardiac complications and delirium, based on the NEECHAM confusion scale, occurred significantly less often with UGNB than GA. These significant differences show advantages of UGNB compared to GA. No mortality or major amputations were observed in either group. Early graft thrombosis was observed in five limbs (8.9%) with UGNB and in four limbs with GA (7.1%) (p = .73). UGNB has advantages for intra- and post-operative management and could be a useful method to prevent peri-operative complications for high risk patients with CLTI. To ensure the effectiveness of UGNB for IGBS for future indications, a randomised study is required.

Effectiveness and Safety of Ultrasound Guided Lower Extremity Nerve Blockade in Infragenicular Bypass Grafting for High Risk Patients With Chronic Limb Threatening Ischaemia

Surgical revascularisation to accomplish limb salvage remains preferable in some patients with chronic limb threatening ischaemia (CLTI). The aim of this study was to evaluate the effectiveness and safety of ultrasound guided lower extremity nerve blockade (UGNB) in infragenicular bypass surgery (IGBS). This was a single centre, retrospective clinical study. Fifty-nine patients with CLTI (67 limbs) who underwent IGBS under UGNB (femoral and sciatic nerve blockade) at Asahikawa Medical University between January 2012 and December 2017 were compared with patients with CLTI (137 limbs) who underwent IGBS under general anaesthesia (GA) over the same period. Propensity score matching based on pre-operative comorbidities was used to minimise background differences of the two groups. Fifty-six pairs of CLTIs were matched and analysed (55% dialysis dependent). Procedure duration was similar between the two groups, but intraoperative catecholamine index and intravenous fluid volume were lower with UGNB compared with GA (2.9±4.6 vs. 5.9±6.5; p<.01 and 1831±990 vs. 2335±931mL; p<.01, respectively). The mean arterial blood pressure during induction of anaesthesia was significantly decreased with GA. Post-operatively, the time period to resume a clear liquid and solid food diet was significantly shorter with UGNB (P<0.01 for both outcome measures). Intravenous fluid volume was significanlty lower, while cardiac complications and delirium, based on the NEECHAM confusion scale, occurred significantly less often with UGNB than GA. These significant differences show advantages of UGNB compared to GA. No mortality or major amputations were observed in either group. Early graft thrombosis was observed in five limbs (8.9%) with UGNB and in four limbs with GA (7.1%) (p=.73). UGNB has advantages for intra- and post-operative management and could be a useful method to prevent peri-operative complications for high risk patients with CLTI. To ensure the effectiveness of UGNB for IGBS for future indications, a randomised study is required.

Effect of Listening to Music on Postoperative Cognitive Function in Older Adults After Hip or Knee Surgery: A Randomized Controlled Trial

This study aimed to assess the effect of listening to music on postoperative cognitive function in older adults after hip or knee surgery. This work was a randomized controlled study that involved an intervention group and control group. Study data were recollected by using a patient information form, Mini-Mental State Examination (MMSE), and NEECHAM Confusion Scale. Music was played three times a day to the participants in the intervention group for 3days postoperatively. The mean MMSE and NEECHAM scores of the intervention and control groups were compared. No statistically significant difference was found in the mean MMSE (P>.05) between the two groups. A statistically significant difference in the mean NEECHAM Confusion Scale score was observed between the groups (P<.001). This study demonstrated that listening to music was important in preventing postoperative cognitive dysfunction in patients who underwent hip or knee arthroplasty.

Turkish adaptation of NEECHAM Confusion Scale

Objectives: Delirium is common in hospitalized individuals and it is hard to recognize by nurses and doctors. There are many scales in the world to screen and diagnose delirium. NEECHAM Confusion Scale is a scale to screen and diagnose delirium in hospitalized patients. The aim of this study is to establish the Turkish adaptation of NEECHAM Confusion Scale, validity and reliability. Methods: The sample of this study was selected from patients who were hospitalized in Kocaeli University Research and Practice Hospital’s Internal Medicine and Sur-gery Clinics. Patients who had head trauma, cerebrovascular disorders, intracranial surgery or intracranial mass were not included in the study. One hundred and two participants were enrolled in the study; all participants were 60 years old or older and conscious. Standardized Mini Mental Test as a reference test with NEECHAM Confu-sion Scale. Results: Internal consistency (Cronbach’s alpha) of the scale was calculated as 0.744 and after interrater reliability evaluation Fleiss kappa was calculated as 0.70. Reference test correlation with Standardized Mini Mental Test was found to be statistically significant. Discussion: Application of NEECHAM confusion scale for screening and diagnosing delirium in hospitalized patients and use in early recognition and prevention of delirium was satisfactory.

Use of measurement tools for screening of postoperative delirium in nursing practice

Aim: The aim of the literary overview was to search quantitative research studies focusing on screening for postoperative patient delirium by nurses with the aid of measurement tools; and, afterwards, to compare the tools used with respect to their psychometric characteristics and use in clinical nursing practice. Design: Overview study - literary review. Methods: Electronic databases were searched for relevant documents (i.e., Web of Science, SCOPUS, Science Direct, and Summon Discovery Tool), from the period 1990-2017. Key words used for databases were: postoperative delirium, screening, tool, validity, reliability, psychometric characteristic, and nursing, combined with Boolean operators. Results: A total of 253 documents were identified. Based on the chosen selection criteria, eight studies dealing with screening of postoperative delirium were included in the analysis and overview. The following measurement tools were used in the studies: the Confusion Assessment Method for Intensive Care Units - CAM-ICU, the Nursing Delirium Screening Scale - Nu-DESC, the NEECHAM Confusion Scale, the Delirium Observation Screening Scale - DOSS, and the Intensive Care Delirium Screening Checklist - ICDSC. The tool with the optimum psychometric characteristics for detection of postoperative delirium is the CAM-ICU tool. Conclusion: The results of the studies analysed indicate the importance of the implementation of a relevant tool for screening of postoperative delirium. It is essential to examine the psychometric characteristics and usability of screening tools in Slovak clinical practice.

Prevention and Management of Postoperative Delirium in Elderly Patients Following Elective Spinal Surgery.

This study is a systematic review. Propose an evidence-based algorithm for prevention, diagnosis, and management of postoperative delirium in geriatric patients undergoing elective spine surgery. Delirium is associated with longer stays after elective surgery, increased risk of readmission, and $6.9 billion annually in medical costs. Early diagnosis and treatment of delirium can reduce length of stay (LOS), in-hospital morbidity, and health care costs. After spinal surgery, postoperative delirium increases average LOS to >7 days and is diagnosed in 12.5%-24.3% of geriatric patients. Currently, studies for management of postoperative delirium after elective spinal procedures are not available. A literature review was performed for observational studies, randomized controlled trials, and systematic reviews between 1990 and 2015. Risk factors for delirium after elective spinal surgery include age, functional impairment, preexisting dementia, general anesthesia, surgical duration >3 hours, intraoperative hypercapnia and hypotension, greater blood loss, low hematocrit and albumin, preoperative affective dysfunction, and postoperative sleep disorders. Postoperatively, decreasing the use of methylprednisolone and promoting movement with an appropriate orthosis can reduce delirium incidence (P=0.0091). Polypharmacy is an independent risk factor for delirium (P=0.01) and decreasing use of delirium-inducing medications may reduce incidence. The delirium observation screening scale diagnoses and monitors delirium and is rated by nurses as easier to use than the NEECHAM Confusion Scale (P<0.003). Haloperidol is used widely to treat postoperative delirium. Randomized controlled trials show that adding quetiapine results in delirium resolution an average of 3.5 days faster than haloperidol alone (P=0.001) and decreases agitation and LOS (P=0.02; P=0.05). An evidence-based algorithm is proposed to prevent, diagnose, and manage postoperative delirium that can be used clinically for geriatric patients undergoing elective spine surgery. Prevention and diagnosis involve efforts from the anesthesiologist and postoperative clinical care team. Treatment may include a therapeutic regimen of low-dose neuroleptic medications as needed. Level II.

Validation of Finnish Neecham Confusion Scale and Nursing Delirium Screening Scale using Confusion Assessment Method algorithm as a comparison scale

BackgroundDelirium is a common clinical problem with acute and fluctuating onset. Early notification of its symptoms can lead to earlier detection and management of this state. Valid and reliable instruments are required for successful nursing practice. The purpose of the study was to psychometrically test the Finnish versions of the Neecham Confusion Scale (NEECHAM) and the Nursing Delirium Screening Scale (Nu-DESC) in surgical nursing care, utilizing the Confusion Assessment Method (CAM) algorithm as a comparison scale.MethodsThis randomized, blinded, instrument testing study was conducted at one university hospital in one surgical unit. Study patients (n = 112) meeting the pre-set criteria were assessed by the principal investigator (PI) and a registered nurse (RN, n = 18). Internal consistency, inter-rater reliability, and concurrent validity of the scales were calculated and face validity and usability evaluated.ResultsInternal consistency was from .76 to .86 for all three scales. Inter-rater reliability between PI and RNs was .87 with NEECHAM, .60 with CAM and .47 with Nu-DESC. Concurrent validity was .56 and .59 between CAM and NEECHAM, and .68 and .72 between NEECHAM and Nu-DESC. In the PI group, the correlation between CAM and Nu-DESC was .91, in the RN’s group .42. Nu-DESC was evaluated as the most usable scale.ConclusionThe findings strengthen the earlier research on the scales and indicate that the Finnish NEECHAM and Nu-DESC correlates with CAM algorithm and with each other. They seem to be clinically viable in assessing patients’ delirium in surgical wards but more validity testing is needed.

Integrate Literature Review of Delirium on the Elders

Delirium is a common problem for elderly hospitalized patients and those transferred from one place to another. The risk of delirium increases considerably with age. This article provides an integrated review of the literature on delirium in elderly patients; on the basis of this review, the characteristics of elderly delirium can be defined as follows: acute confusion with fluctuating changes in consciousness, orientation, attention, perceptions, emotion, thinking, sleeping patterns, and behaviors, which could develop and disappear in a short period. The related factors of elderly delirium include demographic and physical factors, as well as cognitive, functional, psychosocial, and other factors. Furthermore, scales for assessing elderly delirium include the short portable mental status questionnaire, mini-mental status examination, Confusion Assessment Method-ICU (CAM-ICU), delirium observation screening scale, NEECHAM Confusion Scale, Groningen Frailty Indicator, and Hasegawa’s Dementia Scale-Revised. Although the CAM-ICU has the least items and affords the fastest assessment, it lacks the items to measure orientation, perceptions, emotions, sleeping patterns, and behaviors, which are the characteristics of elderly delirium identified in the integrated literature review. Based on the literature review findings, the authors recommend that future studies should develop a comprehensive delirium assessment scale for elderly patients, including the related factors and defining characteristics, thus enabling health care professionals to care for and manage delirium problems effectively and efficiently. Moreover, the authors suggest developing an assessment scale to distinguish between the three problems (delirium, dementia, and depression) and reduce misdiagnosis rates, which would result in reduced hospitalization times, death rates, cost to the health care system, and patients being transferred to nursing homes.©

A novel scale predicting postoperative delirium (POD) in patients undergoing cerebrovascular surgery

PurposeThe purpose of this study was to develop and test a scale for predicting POD in patients undergoing cerebrovascular surgery. MethodsThe predictive scale for POD was composed of 32 items reflecting the strongest risk factors as determined by a literature review. The NEECHAM Confusion Scale determined POD onset and severity. ResultsDelirium developed in 38 (31.1%) of the 122 patients in our sample. Logistic regression revealed the following risk factors: dehydration, age, disturbance of consciousness, underlying illness, and anxiety or depression. The final scale was weighted by referring to odds ratios. The area under the curve was 0.844 (95% CI=0.766–0.921). The possible total score on this scale was 20 points. A cutoff score of 11 was set for risk of POD (patients scoring over 12 were considered at higher risk). The median score was 8 (range: 4–9) in the non-delirium group and 13 (range: 9–16) in the delirium group (U=499.0; df=120; p<0.001). Scale scores were moderately correlated with delirium duration (ρ=0.532; p<0.001). ConclusionThe present scale is a promising a tool for predicting POD but needs to be studied further.

Bright light treatment for prevention of perioperative delirium in elderly patients

Background: Bright light treatment aims to improve circadian rhythms in patients living indoors with poor light-dark transitions by complementing insufficient natural light and highlighting the difference between their day- and night-time activities. In addition to bright light treatment, it is called “phototherapy” or “high-intensity light therapy”, and has been reported to be effective to prevent delirium and sleep disorders in the elderly. Under such circumstances, this study examined the validity of bright light treatment as a perioperative care approach for the elderly who are regarded as vulnerable to delirium due to hospitalization or therapeutic intervention. Methods: The study was conducted in the mixed surgical ward of approximately 200 beds, located in Kyoto Prefecture. Subjects were elderly male and female patients who underwent surgery for lower limbs, mainly the femur, and were randomly divided into intervention and control groups. The intervention group received bright light treatment with approximately 2,500 lx of bright light from the day after admission; on the day of surgery and at postoperative week 1, while the control group was treated with normal light during this period. The evaluation of delirium was conducted based on the results of nurses’ observation and the Japanese-Version NEECHAM Confusion Scale (NEECHAM scale). In addition to this, information regarding the patients’ activities of daily living was also collected. As physiological indices, light-exposure-dependent changes in blood serotonin levels and stress-dependent changes in blood cortisol levels were also evaluated. The period of the study was between 2008 and 2010; data were collected from November to February in each year, when the number of target patients increased. Results: As a result, data regarding 24 patients were obtained within this 2-year period. Excluding those with severe dementia, a total of 16 (intervention: 6; and control: 10) were studied. As a result, delirium occurred in the patients who underwent surgery of the lower limbs, mainly the femur, within the period between the day of surgery and postoperative day 3. The type of delirium was hyperactive in all cases, and its symptoms persisted for 3 to 4 days. Conclusion: The incidence of delirium was generally lower in the intervention than in the control group, suggesting the validity of bright light treatment.

Comparison of Delirium Screening Instruments for the Elderly

Purpose: This study was undertaken to identify which delirium screening instrument would be more useful in clin- ical practice. Methods: Data were collected from 118 nurses from six hospitals in five provinces in Korea. For the delirium screening three instruments were compared: NEECHAM Confusion Scale (NEECHAM), Nursing Delirium Screening Scale (Nu-DESC), Delirium Observation Scale (DOS). The MMSE-K was used for concurrent validity. The nurse subjects were surveyed as to the practical clinical value of each instrument. Cronbach's ⍺ coefficient and Kuder-Richardson 20 were used to confirm the reliability. Results: The range of three scales reli- ability was .70~.82 and the range of correlation coefficient was .63~.82 with MMSE-K. For sensitivity of NEECHAM, Nu-DESC and DOS was 1.00, 1.00 and 0.81 respectively and specificity NEECHAM, Nu-DESC and DOS was 0.88, 0.89 and 0.89 respectively. Nurses rated the practical use of the DOS scale as significantly easier to use than the NEECHAM and Nu-DESC. Conclusion: NEECHAM, Nu-DESC and DOS scales were acceptable in terms of reliability, validity, sensitivity and specificity. However, nurses rated the DOS scale as easier scale to use and had more relevance to their practice.

Delirium in older patients: a diagnostic study of NEECHAM Confusion Scale in surgical intensive care unit

To estimate the diagnostic value and determine the feasibility of the NEECHAM Confusion Scale on critically ill older patients. Delirium is a common syndrome in hospitalised older patients, especially in surgical intensive care units, and the consequences of under-detection can be very serious for older people. Therefore, assessment of the cognitive status of older patients using a valid instrument is important in intensive care units. A descriptive prospective design was used. Consecutive nonintubated patients aged 65 and older, admitted to a surgical intensive care unit of an Italian hospital during a seven months period, were assessed for delirium using the NEECHAM scale and the Confusion Assessment Method for intensive care unit, once per shift, for 48 hours after admission. Cohen's kappa coefficient, ROC curve, sensitivity and specificity were estimated. An open ended questionnaire was used to assess user-friendliness of the scale. A sample of 41 older patients with a mean age of 78·3 years was studied. The kappa coefficient was 0·95. The sensitivity was 99·19%, specificity 95% at cut-off of 25, and the area under the curve was 0·99 (CI 0·99-1·00). Nurses evaluated positively the scale as they were able to collect data during care process in maximum 10 minutes, but experienced problems in rating the appearance behaviour and physiological control items of the scale. Findings from this study confirm the good diagnostic value and ease of application of the NEECHAM scale with nonventilated intensive care patients. The NEECHAM scale can be used to detect delirium during the routine nursing assessment of nonintubated older patients as it requires minimal demand and stress on the patient as well as on the bedside nurse.

Voie d’abord endovasculaire contre voie d’abord ouverte pour la chirurgie de l’anévrysme de l’aorte: incidence de delirium postopératoire

Our objective was to compare open and endovascular aortic aneurysm repair with respect to postoperative delirium. After Institutional Ethics Review Board approval, we conducted a retrospective review of all patients who underwent abdominal and thoraco-abdominal aortic aneurysm repair surgery at Toronto General Hospital during June 2006 to December 2007. Patients were classed into either the OPEN or the endovascular (EVAR) group based on the type of surgery and were assessed for the presence of delirium after surgery. The NEECHAM Confusion Scale and the validated chart review instrument were used for diagnosis of delirium. Patients with dementia and/or abnormal levels of consciousness preoperatively were excluded. There were 256 patients included in the study, 149 (58%) in the OPEN group and 107 (42%) in the EVAR group. Patients in the EVAR group were considerably older, 74 (10) yr vs 68 (9) yr, and they had shorter duration of surgery, 150 [119, 180] min vs 200 [165, 260] min, respectively, P < 0.0001. Postoperative delirium was present in 43 (29%) patients in the OPEN group and 14 (13%) patients in the EVAR group (95% confidence interval [CI], 22 to 36 vs 95% CI, 7 to 19, respectively; P = 0.003). Hospital length of stay was 8.3 [6.6, 13.4] days in the OPEN group and 4.5 [3.1, 6.4] days in the EVAR group, P < 0.0001. Perioperative management of patients undergoing endovascular aortic aneurysm repair was associated with lower rates of delirium after surgery than that of patients undergoing open aortic aneurysm repair.

Assessment scales for delirium: A review

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.

Disaster Strikes! Long-Term Care Resident Outcomes Following a Natural Disaster

This report describes the outcomes of 17 long-term care residents who were participating in a nursing intervention study. The residents were evacuated for 5 days due to a severe summer storm that caused widespread power outages. These residents were seen the day of the storm and three times per week for 2 weeks following their return to the nursing home. More than half of the participants had significant changes in their NEECHAM Confusion Scale scores ( n = 11) and modified Confusion Assessment Method scores ( n = 9) scores, suggesting the onset of delirium. Two participants were hospitalized within the 2 weeks of the evacuation. One participant died unexpectedly. This report provides a rare look into the negative effects of a short-term evacuation due to a natural disaster.

Disaster Strikes! Long-Term Care Resident Outcomes Following a Natural Disaster

This report describes the outcomes of 17 long-term care residents who were participating in a nursing intervention study. The residents were evacuated for 5 days due to a severe summer storm that caused widespread power outages. These residents were seen the day of the storm and three times per week for 2 weeks following their return to the nursing home. More than half of the participants had significant changes in their NEECHAM Confusion Scale scores (n = 11) and modified Confusion Assessment Method scores (n = 9) scores, suggesting the onset of delirium. Two participants were hospitalized within the 2 weeks of the evacuation. One participant died unexpectedly. This report provides a rare look into the negative effects of a short-term evacuation due to a natural disaster.