gykwak03/KISS_delirium_papaers huggingface dataset:
Title: COVID-19 환자에서 나타나는 섬망에 대한 고찰

We reviewed the clinical features, prevalence, pathophysiology, and prevention and treatment of delirium in patients with coronavirus disease of 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, has neurotropic properties, and can penetrate the central nervous system and affect brain neurons. These characteristics may explain the fact that COVID-19 patients may be particularly susceptible to delirium. COVID-19 delirium occurred more frequently in intensive care unit and emergency room settings. Patients with neurologic disorders and the elderly were more vulnerable to delirium. Clinical symptoms of COVID-19 delirium may manifest as a hyper/hypoactive type. Prevention and treatment appear to be similar to conventional treatment strategies. And the patient’s feeling of isolation due to social distancing and a highly intensive labor force of medical personnel must be overcome. Melatonin, alpha-2 agonist, antipsychotics, and valproic acid have been recommended for the treatment of delirium symptoms. However, this article did not go through a systematic literature review.
Title: 외상중환자실 환자의 섬망 발생 위험요인

Purpose: This descriptive study aimed to present the incidence of delirium and identify risk factors for delirium in TraumaIntensive Care Unit (TICU) patients. Methods: The participants were 184 patients who were hospitalized in the TICUat a Regional Trauma Center in Gyeonggi-do. Data were collected between April and November 2019. For deliriummeasurement, the author used the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Diversedependent variables were collected through electronic medical records. Data were analyzed using descriptivestatistics, independent t-test, x2-test, and binomial logistic regression. Results: Incidence of delirium in TICU patientswas 34.8%. Logistic regression analysis showed that the risk factors for delirium in TICU patients were hemoglobin(Odds Ratio [OR]=0.62, 95% Confidence Interval [CI]=0.43~0.88), injury severity score (OR=1.10, 95% CI=1.01~1.20),length of TICU stay (OR=1.15, 95% CI=1.03~1.29), administered sedatives (OR=6.04, 95% CI=2.47~14.76), and useof restraints (OR=5.75, 95% CI=2.29~14.42). Conclusion: Based on the results of this study, healthcare providers,especially TICU nurses, should try to detect the signs and symptoms of delirium as early as possible, taking into accountthe specified risk factors of the patient. Preventive and practical intervention programs considering the risk factors mustalso be developed to prevent and alleviate delirium in TICU patients in the future.
Title: 호스피스 말기암환자의 섬망 증상에 영향을 미치는 요인

Objectives：Hyperactive delirium is a state of acute mental confusion including aggressive and impulsive behavior and it is burdensome for the family and caregivers of terminal cancer patients. Therefore, predicting the symptoms of hyperactive delirium can provide benefits to care terminal cancer patients. In this study, several risk factors were evaluated during hospitalization for predicting delirious symptom in terminal cancer patients. Methods：Patients who died of cancer in a palliative care unit from January 2011 to September 2012 were investigated by retrospective chart review. Clinical and laboratory data were collected to identify the factors associated with hyperactive delirium. Univariate and multivariate analysis by logistic regression were applied. Additional survival analysis was conducted to measure the onset of delirium symptoms after pneumonia. Results：During hospitalization, 49 of 201 patients showed the symptoms of hyperactive delirium (24.4%). Developing a delirious symptom was associated with male (OR=3.36, p=0.002), bone metastasis (OR=3.70, p=0.002), pneumonia during hospitalization (OR=3.17, p=0.02) and depressive mood (OR=2.53, p80.011). In additional survival analysis, half of patients developed symptoms of delirium within 3 days after pneumonia. Conclusion：Our results suggest that male, bone metastasis, depressive mood, and pneumonia are risk factors that can affect hyperactive delirium in terminally ill cancer patients. In addition, many patients with pneumonia abruptly developed the symptoms of hyperactive delirium within 3 days. Our finding may provide clues for predicting hyperactive delirium, and it can be helpful to manage delirium symptoms.
Title: 노인 입원환자에서 Delirium Drug Scale과 섬망 발생의 연관성 분석

Background : Drugs are one of the major causes of delirium in elderly patients. As drug-associated delirium is usually reversible, evaluating the drug burden is clinically important in terms of delirium prevention. The Delirium Drug Scale (DDS) is a quantification tool developed to assess the impact of drugs on delirium in elderly patients. This study aimed to investigate the association between the scores and the occurrence of delirium in Korean elderly hospitalized patients. Methods : We retrospectively reviewed the electronic medical records of patients who were admitted to a tertiary university hospital from January to December 2017, and underwent Comprehensive Geriatric Assessment. Lists of medications taken by the patients at the time of admission were collected and the occurrence of delirium within two days after admission was identified. The DDS score of each patient was calculated based on the collected medication data. The relationship between DDS scores and delirium occurrence was analyzed using logistic regression. Results : A total of 452 patients were included in the study. The mean age of the patients was 82.0 ± 7.2 years. Delirium was detected in 54 patients (11.9%) and 258 patients (57.1%) were exposed to one or more drugs known to be associated with delirium. The unadjusted odds ratio (OR) for the DDS score was 2.02 (95% confidence interval [CI]:1.66; 2.46). In the multivariable analysis, a history of delirium, polypharmacy, infection, dementia, and age were significantly associated with delirium. When the confounding variables were adjusted, DDS scores were associated with the occurrence of delirium with an OR of 2.15 (95% CI: 1.69; 2.73). Conclusion : DDS scores were associated with delirium occurrence among hospitalized older patients in Korea. The DDS can be considered an objective index when providing medication review services as part of a delirium prevention practice.
Title: 완화의료병동 암환자들의 섬망 치료를 위해 사용된 항정신병 약물의 효과 및 안전성 비교

Background: Delirium is a neuropsychiatric disorder characterized by sudden impairments in consciousness, attention, and perception. The evidence of successful pharmacological interventions for delirium is limited, and medication recommendations for managing delirium are not standardized. This study aimed to provide evidence of antipsychotics for symptomatic treatment of delirium in cancer patients receiving palliative care. Methods: We retrospectively reviewed adult cancer patients in palliative care who received antipsychotic delirium treatment at Severance Hospital between January 2016 and June 2019. The efficacy was evaluated primarily by resolution rates. The resolution of delirium was defined as neurological changes from drowsiness, confusion, stupor, sedation, or agitation to alertness or significant symptomatic improvements described in the medical records. The safety was studied primarily by adverse drug reaction incidence ratios. Results: Of the 63 enrolled patients, 60 patients were included in the statistical analysis and were divided into three groups based on which antipsychotic medication they were prescribed [quetiapine (n=27), haloperidol (n=25) and co-administration of quetiapine and haloperidol (n=8)]. The resolution ratio showed quetiapine to be more effective than haloperidol (p=0.001). No significant differences were seen in adverse drug reaction rates among the three groups (p=0.332). Conclusions: Quetiapine was considered the most effective medication for delirium, with no significant differences in adverse drug reaction rates. Therefore, quetiapine may be considered a first-line medication for treating delirium in cancer patients receiving palliative care. However, further studies comparing more diverse antipsychotics among larger populations are still needed.
Title: 청력 저하 환자에서 발생하는 섬망의 특성에 대한 연구

Objectives Several studies have delineated the relationship between hearing disturbances and the prevalence or characteristics of psychotic symptoms; however, most of those studies focused on psychiatric patients and not general inpatients. Delirium has a high incidence among general inpatients, and patients with delirium are easily affected by psychotic symptoms that lead to irritable behaviors. This study examined the relationship between hearing disturbance and psychotic symptoms among patients with delirium. Methods At the Asan Medical Center in Seoul, South Korea, this study examined 27 inpatients who had both delirium and hearing disturbances between January 1, 2009 and December 31, 2018, and 146 inpatients at the Asan Medical Center who had delirium but no hearing disturbances between July 1, 2018 and December 31, 2018. This study investigated whether the two groups showed differences in the prevalence and characteristics of delirium symptoms, particularly psychotic symptoms. In addition, the correlation between clinical characteristics of delirium and the recommended dosage of antipsychotics was analyzed in patients who had been diagnosed with delirium and had hearing disturbances. Results Compared to inpatients who only had delirium, those who had both delirium and hearing disturbances had a significantly higher prevalence of hallucination and delusion. Conclusion The prevalence of psychotic symptoms, such as hallucination and delusion, was higher in patients who had both delirium and hearing disturbances, which is in line with the results from previous studies on psychiatric patients. Physicians should focus on improving communication with such patients by employing non-verbal communication methods.
Title: 응급실에서 섬망 위험이 높은 환자를 조기 인지하기 위한 평점표의 활용

Objective: This study was conducted to evaluate scorecards for early recognition of high-risk patients of delirium in the emergency department (ED). Methods: Data from 399 consecutive patients aged 65 years or older between January 1, 2015 and December 31, 2015 were retrospectively analyzed. Delirium was identified by reviewing medical records and was confirmed by a psychiatrist. The study population was divided into a training and validation group. Predisposing factors were evaluated and validated by multivariate logistic regression analysis and a calibration plot, after which a scorecard was constructed using these factors and applying points to double odds to each regression coefficient. Results: Dementia, transfer from a long-term care facility, acute acid-base imbalance, moderate pain, and stroke were independent predisposing factors for delirium in ED, with assigned scores in the scorecard of 3, 2, 2, 2, and 2, respectively. The total score of the scorecard for delirious patients was significantly higher than that for non-delirious patients in both the training and validation groups. The coefficient of determination (R2) of the calibration plot was 0.74 and 0.68 in the training and validation group, respectively. In the receiver operation characteristic curve, the cut-off point of the scorecard for delirium was 2.5 and the sensitivity, specificity, and accuracy were 75.0%, 87.8%, and 86.7% in training group, while they were 76.9%, 85.1%, and 84.2% in the validation group, respectively. Conclusion: The scorecard was a useful screening tool for early recognition of patients with a high-risk of developing delirium in the ED.
Title: 소아중환자실 입원 아동의 섬망 발생 관련 요인

Purpose: This study aimed to investigate incidence of delirium in the pediatric intensive care unit (PICU) and to analyze associated risk factors. Methods: The participants were 95 patients, newborn to 18 years, who were admitted to the PICU. The instruments used were the Richmond Agitation Sedation Scale (RASS), and the Cornell Assessment of Pediatric Delirium. Data analysis was performed using the descriptive, x2 test, t-test, and logistic regression analyses. Results: The incidence of delirium in children admitted to the PICU was 42.1%. There were significant differences according to age (x2=14.10, p=.007), admission type (x2=7.40, p=.007), use of physical restraints (x2=26.11, p<.001), RASS score (x2=14.80, p=.001), need for oxygen (x2=5.31, p=.021), use of a mechanical device (x2=9.97, p=.041), feeding (x2=7.85, p=.005), and the presence of familiar objects (x2=29.21, p<.001). Factors associated with the diagnosis of delirium were the use of physical restraint (odds ratio [OR]=13.82, 95% confidence interval [CI]=4.16~45.95, p<.001) and the presence of familiar objects (OR=0.09, 95% CI=0.03~0.30, p=.002). Conclusion: Periodic delirium assessments and intervention should be actively performed. The use of restraints should be minimized if possible. The caregiver should surround the child with familiar objects and ensure a friendly hospital environment that is appropriate for the child.
Title: 소음인 알츠하이머 환자의 외상성 지주막하 출혈로 인한 섬망과 인지저하 치험 1례

Objectives This study is to investigate the effect of sasang constitutional medicine on the delirium and cognitive decline caused by traumatic subarachnoid hemorrhage in a soeumin alzheimer patient Methods We have treated a 79-year-old Soeumin patient mainly with Doksampalmul-tang. She was already suffering from Alzheimer's disease. After traumatic subarachnoid hemorrhage, there were symptoms of delirium and cognitive decline. The degree of improvement was checked by K-MMSE and K-MOCA scores. Results The K-MMSE score improved from 0 to 11 and the K-MOCA score from 0 to 3. Conclusions Sasang constitutional medicine has been effective in the treatment of delirium and cognitive decline caused by traumatic subarachnoid hemorrhage.
Title: 중환자실 급성중독환자에서 섬망의 위험인자

Purpose: This study estimated the incidence of delirium and associated risk factors and outcomes in ICU patients with acute poisoning. Methods: Data were collected from ICU patients over 18 years of age that were admitted via the emergency center after presenting with poisoning from 2010 to 2015. Delirium was assessed retrospectively using the Intensive Care Delirium Screening Checklist (ICDSC). Risk factors were evaluated by univariate and multivariate analysis. Results: A total of 199 patients participated in this study and 68 (34.2%) were diagnosed with delirium based on the ICDSC score. The delirium group showed a significantly higher association with prolonged length of stay in the hospital and ICU in comparison with the non-delirium group. The delirium group was associated with greater use of physical restraint. A statistically greater number of patients with pharmaceutical substance poisoning developed delirium over a short period of time than those with non-pharmaceutical substance poisoning. There was no significant difference between the two groups with respect to age, sex, past history, GCS score, vital signs, application of ventilator care and renal replacement therapy. Conclusion: The finding that the delirium group had a greater length of stay in both the hospital and the ICU is consistent with the results of previous worldwide studies of the effects of delirium on the prognosis of patients who were admitted to the ICU, suggesting the possibility for domestic application. Additionally, use of physical restraint was positively related to the incidence of delirium. Thus, interventions for minimizing the use of physical restraints and considering alternatives are needed.
Title: 일개 상급종합병원 신경과 병동 노인 입원 환자의 섬망 발생률과섬망 발생 위험요인

Purpose: Although there is a high incidence of delirium with increased age, the risk factors have been too various. We investigated the incidence and risk factors in the older inpatient with neurological disorders. Methods: We reviewedthe Electronic Medical Records (EMR) of older patients admitted to a neurology unit from August 2016 toJanuary 2017. We analyzed the incidence and risk factors of delirium in 382 patients in a tertiary hospital. Deliriumwas determined daily using the Nursing Delirium Screening Scale (Nu-DESC). Demographic, disease, and environmentalcharacteristics were obtained by using structured EMR data. Results: The incidence rate of delirium was6.0% (n=23). Delirium was prevalent in patients who were older, had a lower serum hemoglobin, had hypertensionor had diabetes mellitus. Delirium was also observed in patients on antibiotics, having a higher number of drugsor catheters, or receiving mechanical monitoring. A longer hospital stay, being admitted to a sub-intensive careunit, and sleep deprivation were significantly associated with delirium. Multiple logistic regression analysis foundolder age, having sleep deprivation, a higher number of catheters placed, and having diabetes mellitus to be significantpredictors of delirium. Conclusion: This study shows that age, sleep deprivation, number of catheters, andcomorbidity of diabetes mellitus were identified as a risk factor for delirium. And it will guide the development ofalgorithms through its possible applications for the future in hospitalized older adults.
Title: 하지 골절 노인환자의 수술 후 섬망 위험성 평가

Objective：Delirium is very common in orthopedic elderly patients and increase comorbidity and mortality rates. By controling the risk factors of delirium, prevention strategy can be effective and reduce negative outcomes. The purpose of this study was to explore the usefulness of delirium risk assessment with some simple collateral questionaires. Methods：The subjects were 50 elderly patients (≥65 years old) who admitted to a department of orthopedic surgery for operations of lower extremity fractures. They were evaluated with Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Confusion Assessment Method and Korean Dementia Screening Questionnaire (KDSQ) by psychiatrists. The demographic data, medical histories, and orthopedic chart were checked through medical records of patients. Results：27 subjects (54.0%) were diagnosed as delirium. There was a significant difference between delirium group and control group with all KDSQ scores. Depressive category of KDSQ score had the highest correlation (coefficient=0.399) and can be independent risk factor of delirium (p=0.045). Conclusion：Cognitive impairment and depressive symptoms have high correlation with delirium. We found that just a few questions of cognitive impairment and depressive symptoms by caregivers can evaluate the risk factors of delirium. The simple collateral questionaires can be useful tool for exploring delirium risk factors.
Title: 암 환자의 심리적 디스트레스, 섬망에 대한 간호사의 인식 및 직무 스트레스

Purpose: The purpose of this study was to investigate nurses’ awareness of psychological distress and delirium in cancer patients and job stress. Methods: The participants were 256 nurses in a cancer general hospital. The nurses’ awareness of psychological distress and delirium was investigated using a self-report questionnaire (1-4 scale) developed by the researcher. Psychological distress was measured by depression, anxiety, and insomnia. Job stress was measured using the Korean version of the Expanded Nursing Stress Scale (1-4 scale). Results: The analysis of 9 questionnaires about nurses’ awareness was divided into two factors: nurses’ competence and importance. Nurses’ competence results were 2.06 (depression), 2.17 (anxiety), 2.29 (insomnia), and 2.41 (delirium). Importance results were 3.23 (depression), 3.20 (anxiety), 3.15 (insomnia), and 3.37 (delirium). Most nurses have experienced nursing psychological distress and delirium in cancer patients, but only about a quarter have received the relevant education. Job stress was 2.52 and in subcategories, work load received the highest score 2.92. Conclusion: Nurses recognize that psychological distress and delirium in cancer patients are very important, but they are less aware of their competence. Therefore, it is suggested to develop an educational program to improve nurses’ competence when dealing with psychological distress and delirium.
Title: 한방치료로 호전된 섬망을 동반한 좌측 중대뇌동맥경색 환자의 치험 1례

Objectives: The purpose of this case study is to describe the effect of Korean medicine on a patient with delirium caused by a left middle cerebral artery infarct. Methods: The patient was treated with Sopungbosimdodam-tang, acupuncture, and moxibustion. The Korean version of the Delirium Rating Scale (K-DRS), Neelon and Champagne (NEECHAM) Confusion Scale, and Korean Version of the Mini-Mental State Examination (MMSE-K) were used to evaluate the effect of the treatment. Results: After 50 days of treatment with Sopungbosimdodam-tang, the patient’s K-DRS score decreased from 16 to 8. The NEECHAM Confusion Scale also improved from 17 to 23, and the MMSE-K score improved from 1 to 7. Conclusion: This clinical study suggested that Korean medicine could contribute greatly to the treatment of delirium caused by a left middle cerebral artery infarct.
Title: 섬망 돌봄 교육 프로그램 적용이 수술 후 노인을 돌보는 한국계 중국 간병인의 섬망 돌봄 지식 및 수행에 미치는 효과

Purpose: Knowledge and performance of delirium care is important for caregivers of older people and in particular older postsurgical patients. The purpose of this study was to examine the effects of a delirium care education program for Korean-Chinese caregivers. Methods: A nonequivalent control group pretest-posttest design was used. Participants were 55 Korean-Chinese caregivers caring for elderly patients with delirium (27 in the experimental group and 28 in the control group) from one hospital in Seoul. The delirium care education program, which consisted of discussion on the experience of caring for patients with delirium, lecture, and quiz, was given individually. Effects were evaluated through pre-and post-tests that included measurement of knowledge and performance of delirium care. Results: After the delirium care education knowledge of delirium care significantly increased in the experimental group compared to the control group. There was no significant improvement in either group in the performance of delirium care after delirium care education. Conclusion: The findings of this study provide evidence for the potential utility of the delirium care education program for Korean-Chinese caregivers. This program could allow caregivers to provide quality care, and ultimately contribute to achieving excellence in delirium patient care.
Title: 중환자실 섬망의 약물요법

Delirium is defined as an acute disturbance of consciousness with inattention difficulties, changes in cognition or perceptual disturbance, which can develop over hours to days. Delirium is common in the medical and surgical intensive care units (ICU) and associated with many negative outcomes such as increased mortality, ICU and hospital length of stay, and cognitive impairment. A large number of studies have been conducted on various nonpharmacologic and pharmacologic strategies for prevention or treatment of delirium. The purpose of this article was to review the nonpharmacologic and pharmacologic agents used for delirium and review current studies on each strategy. Nonpharmacologic delirium managements using early mobilization and spontaneous awakening trials/spontaneous breathing trials have been demonstrated to reduce the incidence or duration of delirium in ICU patients. Pharmacologic medications such as haloperidol, atypical antipsychotics (e.g., risperidone, olanzapine, quetiapine, ziprasidone), and dexmedetomidine can be used to treat delirium in the ICU, although there are limited data on when to treat and which agents to use. Haloperidol and atypical antipsychotics have the potential to cause QT prolongation and should be used cautiously in ICU patients.