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  • Better

    Abstract Full Text
    JAMA. 2017; 318(15):1441-1442. doi: 10.1001/jama.2017.13537
  • Delirium in Older Persons: Advances in Diagnosis and Treatment

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    JAMA. 2017; 318(12):1161-1174. doi: 10.1001/jama.2017.12067

    This narrative review summarizes recent advances in the prevention, diagnosis, and treatment of delirium and highlights critical areas for future research.

  • Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care: A Randomized Clinical Trial

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    JAMA. 2017; 318(11):1047-1056. doi: 10.1001/jama.2017.11468

    This randomized clinical trial compares the effect of lorazepam vs placebo added to haloperidol for persistent agitation in patients with advanced cancer and delirium.

  • JAMA September 19, 2017

    Figure 1: Flow of Patients Through the Study

    At the time of enrollment, patients were randomized to lorazepam or placebo. All enrolled patients immediately began a standardized regimen with haloperidol 2 mg every 4 hours intravenously and 2 mg every hour as needed for agitation. Because of the fluctuating nature of delirium, the Richmond Agitation-Sedation Scale score of each patient was monitored every 2 hours until the patient’s score was 1 or more and required rescue medication per the judgment of the bedside nurse. Once the dose of haloperidol was increased and standardized, 27 of 90 randomized patients (30%) did not develop further agitation until death or discharge and thus did not require the study medication.
  • JAMA August 8, 2017

    Figure 3: Prevalence of Delirium Over Time

    Delirium was measured by Confusion Assessment Method assessment at baseline and at days 1, 3, and 7. The probability of delirium over time was modeled using generalized estimating equations. The interaction term between days from surgery and randomization group was statistically significant (P < .05), indicating that the incidence of delirium over time was significantly different between the treatment groups and the control group.
  • Delirium: An Important Postoperative Complication

    Abstract Full Text
    JAMA. 2017; 317(1):77-78. doi: 10.1001/jama.2016.18174

    This commentary discusses a cohort study published in JAMA Surgery that reported associations between major postoperative complications, delirium, and prolonged increases in health resource use.

  • Effect of Dexmedetomidine Added to Standard Care on Ventilator-Free Time in Patients With Agitated Delirium: A Randomized Clinical Trial

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    JAMA. 2016; 315(14):1460-1468. doi: 10.1001/jama.2016.2707

    This randomized clinical trial assesses the effectiveness of dexmedetomidine when added to standard care in patients with agitated delirium receiving mechanical ventilation.

  • The Evolving Approach to Brain Dysfunction in Critically Ill Patients

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    JAMA. 2016; 315(14):1455-1456. doi: 10.1001/jama.2016.2708
  • Critical Care and the Brain

    Abstract Full Text
    JAMA. 2016; 315(8):749-750. doi: 10.1001/jama.2016.0701

    This Viewpoint discusses the importance of preserving cerebral function in critical care settings and the challenges of providing care that promotes recovery of brain function and improved functional outcomes.

  • Ramelteon for Prevention of Delirium in Hospitalized Older Patients

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    JAMA. 2015; 313(17):1745-1746. doi: 10.1001/jama.2014.17394
  • Association Between Skilled Nursing Facility Quality Indicators and Hospital Readmissions

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    JAMA. 2014; 312(15):1542-1551. doi: 10.1001/jama.2014.13513

    This article reports that among Medicare beneficiaries discharged to a skilled nursing facility after hospitalization, rates of readmission or death were not different according to facility performance metrics.

  • Hospital at Home Program Cuts Costs, Improves Patient Health and Satisfaction

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    JAMA. 2012; 308(2):122-122. doi: 10.1001/jama.2012.7420
  • Postoperative Delirium: A 76-Year-Old Woman With Delirium Following Surgery

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    JAMA. 2012; 308(1):73-81. doi: 10.1001/jama.2012.6857
    Ms R, a 76-year-old woman, developed delirium first after colectomy with complications and again after routine surgery. Marcantonio discusses diagnosis, prevention, and treatment of delirium in the postoperative setting.
  • JAMA July 4, 2012

    Figure: Inflammatory Model of the Pathophysiology of Postoperative Delirium

    This figure depicts a theoretical inflammatory model for the pathophysiology of delirium that has direct relevance for Ms R and is gaining acceptance in the literature.aThe extent and magnitude of the systemic inflammatory response varies widely among individuals, possibly related to chronic activity of stress response systems.bIt is unknown which specific cytokines or mediators cross the blood-brain barrier.cLikely risk factors for the long-term consequences of neuroinflammation include preexisting cognitive impairment, cerebrovascular disease, and severe illness.
  • Does This Patient Have Delirium? Value of Bedside Instruments

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    JAMA. 2010; 304(7):779-786. doi: 10.1001/jama.2010.1182
  • Delirium

    Abstract Full Text
    JAMA. 2010; 304(7):814-814. doi: 10.1001/jama.304.7.814
  • Delirium in Elderly Patients and the Risk of Postdischarge Mortality, Institutionalization, and Dementia: A Meta-analysis

    Abstract Full Text
    JAMA. 2010; 304(4):443-451. doi: 10.1001/jama.2010.1013
  • JAMA July 28, 2010

    Figure: Delirium Often Not Recognized or Treated Despite Serious Long-term Consequences

    Delirium is a common but often overlooked problem among critically ill patients that can lead to poor long-term outcomes.
  • Delirium Often Not Recognized or Treated Despite Serious Long-term Consequences

    Abstract Full Text
    JAMA. 2010; 304(4):389-395. doi: 10.1001/jama.2010.965
  • JAMA July 28, 2010

    Figure 2: Primary Analyses

    Analyses of the association between delirium and mortality, institutionalization, and dementia adjusted for age, sex, comorbid illness or illness severity, and baseline dementia. CI indicates confidence interval. Weighting was assigned according to the inverse of the variance. Hazard ratios and odds ratios larger than 1 indicate increased risk of mortality, institutionalization, or dementia among participants who experienced delirium.