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AANA Journal Dec 2019This article provides a systematic review of pediatric emergence agitation, also known as emergence delirium. Major topics of this review include the incidence, risk...
This article provides a systematic review of pediatric emergence agitation, also known as emergence delirium. Major topics of this review include the incidence, risk factors, and impact of the phenomenon, in addition to current evidence-based strategies for prevention of pediatric emergence agitation. Emergence agitation causes tremendous psychological distress for the patient, family, and healthcare providers, as well as concerns for physical safety. Risk factors for pediatric emergence agitation are the child's age, genetic profile, length and type of surgical procedure, and use of inhalational anesthesia. In an attempt to prevent this problem, anesthesia providers should consider these factors and possible interventions when implementing an anesthetic plan. Evidence-based interventions that may decrease the incidence of pediatric emergence agitation include technology, familial involvement, pharmacologic adjuncts, and alternative methods of general anesthesia.
Topics: Adolescent; Akathisia, Drug-Induced; Anesthesia Recovery Period; Anesthesia, General; Anesthetics, Inhalation; Child; Child, Preschool; Emergence Delirium; Evidence-Based Practice; Female; Humans; Incidence; Infant; Infant, Newborn; Male; Pediatrics; Practice Guidelines as Topic
PubMed: 31920204
DOI: No ID Found -
The American Journal of Emergency... Mar 2020Prior studies suggest that ketamine is effective for acute agitation in the emergency department (ED) and prehospital settings. This systematic review and meta-analysis... (Meta-Analysis)
Meta-Analysis
Prior studies suggest that ketamine is effective for acute agitation in the emergency department (ED) and prehospital settings. This systematic review and meta-analysis aims to evaluate the rate of sedation and need for airway management in patients given ketamine for management of acute agitation. Methods: We performed a systematic review of publications describing the use of ketamine to control agitation in the ED and prehospital settings. Studies were included if they included agitated patients, used ketamine to control agitation, occurred in the ED and prehospital setting and measured sedation status or need for airway management. Following data abstraction, a meta-analysis was performed to synthesize the rate of effective sedation and the need for airway management. Result: 13 studies met the inclusion criteria. 10 studies were conducted in the prehospital setting and 3 in the ED setting. The overall proportion of subjects receiving airway management across all 13 studies was 20% (95% CI = 0.0489-1.6505). The estimate of the proportion of subjects that achieved sedation was 85% (95% CI = 0.71-0.93). After synthesizing data from the four studies that compared ketamine to controls, ketamine was associated with increased rates of sedation (RR, 1.95 [CI, 0.47-8.1]) and increased need for intubation (RR, 2.44 [CI, 0.75-7.91]). The differences were not significant by random effects model.
Topics: Airway Management; Anesthesia; Anesthetics, Dissociative; Emergencies; Emergency Medical Services; Humans; Ketamine; Psychomotor Agitation
PubMed: 31902698
DOI: 10.1016/j.ajem.2019.11.007 -
Psychiatry Research Feb 2020Psychomotor symptoms of depression are understudied despite having a severe impact on patient outcomes. This review aims to summarize the evidence on motor features of...
Psychomotor symptoms of depression are understudied despite having a severe impact on patient outcomes. This review aims to summarize the evidence on motor features of depression assessed with instrumental procedures, and examine age-related differences. We included studies investigating posture, balance and gait ascertained with instrumental measurements among individuals with depressive symptoms or disorders. Studies on subjects with specific physical illnesses were excluded. Methodological quality was assessed with the Newcastle - Ottawa Scale (NOS) and PRISMA guidelines were followed. 33 studies (13 case-control, five cross-sectional, nine longitudinal and six intervention) with overall low-medium quality were included. Different instruments were employed to assess posture (e.g. digital cameras), balance (balance, stepping platform) or gait (e.g. Six-Minute-Walking Test, instrumented walkways). Results suggest that depression in adults is associated with significant impairments of posture, balance and gait. Motor abnormalities among depressed older adults may depend on the interplay of physical diseases, cognitive impairment and mood. Very few intervention studies measured motor symptoms as outcome. Available evidence suggests, however, that antidepressant drugs and physical exercise may be beneficial for motor abnormalities. Despite the lack of high-quality studies, instrumental assessments confirm the presence and importance of motor abnormalities in depression, with potential age-related differences in their pathophysiology.
Topics: Antidepressive Agents; Case-Control Studies; Cross-Sectional Studies; Depressive Disorder; Exercise; Gait; Humans; Longitudinal Studies; Postural Balance
PubMed: 31740213
DOI: 10.1016/j.psychres.2019.112687 -
Zeitschrift Fur Evidenz, Fortbildung... Nov 2019Long-term care insurance funds have been mandated by the German Prevention Act to support long-term care facilities in the implementation of health-promoting structures....
BACKGROUND
Long-term care insurance funds have been mandated by the German Prevention Act to support long-term care facilities in the implementation of health-promoting structures. One area of action is the promotion of the nursing home residents' psychosocial health. The objective of this systematic review was to describe and analyze interventions and intervention components related to the psychosocial health of nursing home residents.
METHODS
First, we conducted a search for systematic reviews and meta-analyses in Medline via PubMed, the Cochrane Library, CINAHL, Gerolit, Embase, Psyndex, and Livivo, and hand-searched additional sources. Second, references of all relevant randomized controlled trials (n=86) were extracted from the identified systematic reviews (n=27). The original articles of the included primary studies were then analyzed using criteria for the evaluation of complex interventions. The GRADE approach was used to assess the quality of the evidence.
RESULTS
Seventeen interventions for promoting the psychosocial health of nursing home residents were identified. The majority of the study participants were nursing home residents with dementia. Since the underlying evidence was predominantly very low, it was not possible to draw clear conclusions concerning the efficacy of the interventions for psychosocial health outcomes. The best indications of positive effects were found for reminiscence, mealtime interventions, music therapy, and special care staff training.
CONCLUSION
The diversity and heterogeneity of the interventions made both classification and consistent judgments of the quality of the evidence difficult. From the perspective of promoting the psychosocial health of nursing home residents, the identified interventions should only be considered as suggestions or proposals for prevention and health promotion measures, and future studies should evaluate their implementation.
Topics: Antipsychotic Agents; Dementia; Germany; Health Personnel; Health Promotion; Humans; Mental Health; Nursing Homes; Psychomotor Agitation; Randomized Controlled Trials as Topic
PubMed: 31727536
DOI: 10.1016/j.zefq.2019.09.005 -
American Journal of Alzheimer's Disease... 2020World Health Organization has communicated that dementia as a public health priority in 2012. Behavioral and psychological symptoms of dementia are the main reason... (Meta-Analysis)
Meta-Analysis
BACKGROUND
World Health Organization has communicated that dementia as a public health priority in 2012. Behavioral and psychological symptoms of dementia are the main reason results in hospitalization of dementia patients. Horticulture is one of the favorite activity for many peoples to relax their minds.
OBJECTIVES
To investigate psychological health benefits of horticulture intervention in dementia patients.
METHODS
The databases including Cochrane Library, ProQuest, PubMed, EMBASE, EBSCO, Web of Science, and Ovid Medline were searched up to August 2017.
RESULTS
Twenty-three articles for systematic review, whereas 8 articles were included in meta-analysis. Meta-analysis verified the beneficial effect of horticultural therapy (HT) on agitation level (standard mean difference: -0.59; < .00001); increase time spent on activity engagement (mean differences [MD]: 45.10%, < .00001); decrease time for doing nothing (MD: -29.36%, = .02).
CONCLUSIONS
Patients with dementia benefit from horticultural by alleviating their degrees of agitate behaviors, increasing time of engaging in activities and decrease time of doing nothing.
Topics: Dementia; Horticultural Therapy; Humans; Psychomotor Agitation
PubMed: 31690084
DOI: 10.1177/1533317519883498 -
Annals of Internal Medicine Nov 2019Both pharmacologic and nonpharmacologic interventions are used to treat neuropsychiatric symptoms in persons with dementia. (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Both pharmacologic and nonpharmacologic interventions are used to treat neuropsychiatric symptoms in persons with dementia.
PURPOSE
To summarize the comparative efficacy of pharmacologic and nonpharmacologic interventions for treating aggression and agitation in adults with dementia.
DATA SOURCES
MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO between inception and 28 May 2019 without language restrictions; gray literature; and reference lists scanned from selected studies and systematic reviews.
STUDY SELECTION
Randomized controlled trials comparing interventions for treating aggression and agitation in adults with dementia.
DATA EXTRACTION
Pairs of reviewers independently screened studies, abstracted data, and appraised risk of bias.
DATA SYNTHESIS
After screening of 19 684 citations, 163 studies (23 143 patients) were included in network meta-analyses. Analysis of interventions targeting aggression and agitation (148 studies [21 686 patients]) showed that multidisciplinary care (standardized mean difference [SMD], -0.5 [95% credible interval {CrI}, -0.99 to -0.01]), massage and touch therapy (SMD, -0.75 [CrI, -1.12 to -0.38]), and music combined with massage and touch therapy (SMD, -0.91 [CrI, -1.75 to -0.07]) were clinically more efficacious than usual care. Recreation therapy (SMD, -0.29 [CrI, -0.57 to -0.01]) was statistically but not clinically more efficacious than usual care.
LIMITATIONS
Forty-six percent of studies were at high risk of bias because of missing outcome data. Harms and costs of therapies were not evaluated.
CONCLUSION
Nonpharmacologic interventions seemed to be more efficacious than pharmacologic interventions for reducing aggression and agitation in adults with dementia.
PRIMARY FUNDING SOURCE
Alberta Health Services Critical Care Strategic Clinical Network. (PROSPERO: CRD42017050130).
Topics: Aggression; Dementia; Humans; Network Meta-Analysis; Psychomotor Agitation
PubMed: 31610547
DOI: 10.7326/M19-0993 -
International Journal of Mental Health... Apr 2020One approach to manage people with behaviours of concern including agitated or aggressive behaviours in health care settings is through the use of fast-acting...
One approach to manage people with behaviours of concern including agitated or aggressive behaviours in health care settings is through the use of fast-acting medication, called chemical restraint. Such management often needs to be delivered in crisis situations to patients who are at risk of harm to themselves or others. This paper summarizes the available evidence on the effectiveness and safety of chemical restraint from 21 randomized controlled trials (RCTs) involving 3788 patients. The RCTs were of moderate to high quality and were conducted in pre-hospital, hospital emergency department, or ward settings. Drugs used in chemical restraint included olanzapine, haloperidol, droperidol, risperidol, flunitrazepam, midazolam, promethazine, ziprasidone, sodium valproate, or lorazepam. There was limited comparability between studies in drug choice, combination, dose, method of administration (oral, intramuscular, or intravenous drip), or timing of repeat administrations. There were 31 outcome measures, which were inconsistently reported. They included subjective measures of behaviours, direct measures of treatment effect (time to calm; time to sleep), indirect measures of agitation (staff or patient injuries, duration of agitative or aggressive episodes, subsequent violent episodes), and adverse events. The most common were time to calm and adverse events. There was little clarity about the superiority of any chemical method of managing behaviours of concern exhibited by patients in Emergency Departments or acute mental health settings. Not only is more targeted research essential, but best practice recommendations for such situations requires integrating expert input into the current evidence base.
Topics: Aggression; Conscious Sedation; Humans; Hypnotics and Sedatives; Psychomotor Agitation; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 31498960
DOI: 10.1111/inm.12654 -
The Journal of Nervous and Mental... Sep 2019We sought to identify clinical features that best discriminate melancholia from nonmelancholic depressive conditions. An extensive review of studies using latent factor...
We sought to identify clinical features that best discriminate melancholia from nonmelancholic depressive conditions. An extensive review of studies using latent factor models that identified a melancholic depression dimension/factor was undertaken. Clinical variables extracted from these studies were analyzed in terms of their contribution to a diagnosis of melancholia and their consistency across studies. Psychomotor retardation and mood nonreactivity were the most relevant clinical features for the identification of melancholic depressions. Other clinical features commonly described as weighted to melancholia, such as anhedonia, psychomotor agitation, late insomnia, or appetite/weight loss, seemed less useful in distinguishing these subtypes of depression. Study results are considered in relation to the potential limitations of current operational definitions of melancholia, and how symptom sets could be modified.
Topics: Depressive Disorder; Humans
PubMed: 31464990
DOI: 10.1097/NMD.0000000000001090 -
Journal of Attention Disorders Apr 2021Mind wandering, the unintended shifting of attention from a task, has been previously associated with symptoms of ADHD. To this end, we conducted a literature search to...
Mind wandering, the unintended shifting of attention from a task, has been previously associated with symptoms of ADHD. To this end, we conducted a literature search to investigate the association between mind wandering and ADHD. We conducted a systematic search of the literature of relevant articles assessing mind wandering and ADHD in PubMed, PsycINFO/OVID, and Medline. Included were original articles in English that had operationalized definitions of ADHD and mind wandering, adequate sample size, and reliance on statistical evaluation of findings. Excluded were reviews, opinions, and case reports. Only nine studies met our a priori inclusion and exclusion criteria ( = 8 in adults; = 1 in pediatrics). Findings suggest that ADHD is frequently associated with spontaneous mind wandering and when present heralds more functional impairments. The limited research on mind wandering in ADHD indicates that it is prevalent and morbid supporting further research on the subject.
Topics: Adult; Attention Deficit Disorder with Hyperactivity; Child; Humans; Psychomotor Agitation
PubMed: 31364436
DOI: 10.1177/1087054719865781 -
BMJ Open Jul 2019The aim of this systematic review was to assess the efficacy and safety of pharmacological agents in the management of agitated behaviours following traumatic brain...
OBJECTIVE
The aim of this systematic review was to assess the efficacy and safety of pharmacological agents in the management of agitated behaviours following traumatic brain injury (TBI).
METHODS
We performed a search strategy in PubMed, OvidMEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Google Scholar, Directory of Open Access Journals, LILACS, Web of Science and Prospero (up to 10 December 2018) for published and unpublished evidence on the risks and benefits of 9 prespecified medications classes used to control agitated behaviours following TBI. We included all randomised controlled trials, quasi-experimental and observational studies examining the effects of medications administered to control agitated behaviours in TBI patients. Included studies were classified into three mutually exclusive categories: (1) agitated behaviour was the presenting symptom; (2) agitated behaviour was not the presenting symptom, but was measured as an outcome variable; and (3) safety of pharmacological interventions administered to control agitated behaviours was measured.
RESULTS
Among the 181 articles assessed for eligibility, 21 studies were included. Of the studies suggesting possible benefits, propranolol reduced maximum intensities of agitation per week and physical restraint use, methylphenidate improved anger measures following 6 weeks of treatment, valproic acid reduced weekly agitated behaviour scale ratings and olanzapine reduced irritability, aggressiveness and insomnia between weeks 1 and 3 of treatment. Amantadine showed variable effects and may increase the risk of agitation in the critically ill. In three studies evaluating safety outcomes, antipsychotics were associated with an increased duration of post-traumatic amnesia (PTA) in unadjusted analyses. Small sample sizes, heterogeneity and an unclear risk of bias were limits.
CONCLUSIONS
Propranolol, methylphenidate, valproic acid and olanzapine may offer some benefit; however, they need to be further studied. Antipsychotics may increase the length of PTA. More studies on tailored interventions and continuous evaluation of safety and efficacy throughout acute, rehabilitation and outpatient settings are needed.
PROSPERO REGISTRATION NUMBER
CRD42016033140.
Topics: Antipsychotic Agents; Brain Injuries, Traumatic; Humans; Psychomotor Agitation; Psychoses, Substance-Induced; Randomized Controlled Trials as Topic
PubMed: 31289093
DOI: 10.1136/bmjopen-2019-029604