A prospective study of delirium in hospitalized elderly
Article Abstract:
Delirium, or acute confusion, is a common complication seen in hospitalized elderly patients. Delirious patients may show an inability to concentrate, distractibility, disorientation, impaired memory and rambling or irrelevant speech. Researchers have encountered difficulty in evaluating the prevalence of delirium and how it affects a patient's prognosis, because physicians often do not recognize it. Hospitalized elderly typically have multiple medical problems and take various medications, thus their symptoms are many and complex; delirium and its effects may be masked by these other conditions. Patients over age 70 who were admitted to a general hospital were screened for delirium using various tests. Those with certain illnesses such as advanced cancer, psychiatric illness, or communication deficits were excluded. Of 229 patients, 50 (22 percent) were diagnosed with delirium and 176 served as controls. The incidence of delirium was much higher than noted by physicians in previous surveys. Factors that were associated with a higher risk for delirium were fever or hypothermia (low body temperature), illness severity, dementia, use of psychoactive medications, abnormal blood sodium concentrations, and azotemia (elevated blood levels of nitrogen compounds such as urea). For patients with at least three of these risk factors, there was a 60 percent incidence of delirium. Delirious individuals had a longer average hospital stay than controls (12 versus 7 days), a higher mortality rate (eight versus one percent), and a greater chance of being institutionalized (16 versus 3 percent). It appears that the higher mortality of delirious patients was due to the increased severity of their illnesses. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1990
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Evaluation and management of the patient with syncope
Article Abstract:
Syncope (fainting) can have many causes, including heart disease, low blood pressure, and drugs. Studies have found that the cause can be determined in only 38% to 47% of cases. When a patient reports an episode of syncope, a thorough history and physical exam may reveal an incident or physical anomaly that may have caused the episode. A history and physical alone may reveal the cause in 56% to 85% of cases. If not, an electrocardiogram (ECG) or Holter monitor may reveal an arrhythmia, which could cause syncope. The patient's ECG can be monitored for weeks using an intermittent loop recorder. Electrophysiologic studies can be used in patients with an underlying heart disorder. Placing the patient on a tilt table is useful in detecting vasovagal syncope. Certain psychiatric illnesses, such as anxiety, panic disorder and depression, can cause syncope. Patients without heart disease who have syncopal episodes have an excellent prognosis.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1992
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Time to clinical stability in patients hospitalized with community-acquired pneumonia: implications for practice guidelines
Article Abstract:
It may be possible to shorten the hospital stay of patients with pneumonia without compromising their health. Researchers used measurements of heart rate, breathing, blood pressure, blood oxygen levels and body temperature to determine when 686 pneumonia patients became stable enough to be discharged from the hospital. The median time to stability ranged from 3 to 7 days depending on the definition of stability. Most of the patients remained in the hospital 3 to 4 days after they stabilized, indicating that their hospital stay could have been shortened.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1998
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