Delirium Prevention, Detection, and Treatment in Emergency Medicine Settings: A Geriatric Emergency Care Applied Research (GEAR) Network Scoping Review and Consensus Statement.
Delirium Prevention, Detection, and Treatment in Emergency Medicine Settings: A Geriatric Emergency Care Applied Research (GEAR) Network Scoping Review and Consensus Statement.
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DOI：
10.1111/acem.14166
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
GEAR Network
中科院分区：
文献类型：
--
作者：
Carpenter CR;Hammouda N;Linton EA;Doering M;Ohuabunwa UK;Ko KJ;Hung WW;Shah MN;Lindquist LA;Biese K;Wei D;Hoy L;Nerbonne L;Hwang U;Dresden SM;GEAR Network
急诊科 (ED) 常常无法识别老年人谵妄症，但克服知识与实践缺陷的最引人注目的研究问题仍未明确。老年急救护理应用研究 (GEAR) 网络的组织目的是识别谵妄临床问题并确定其优先顺序。 GEAR 确定并吸引了 49 名跨学科利益相关者，包括急诊科医生、老年科医生、护士、社会工作者、药剂师和患者权益倡导者。遵循系统评价的首选报告项目和范围界定评价的荟萃分析，得出临床问题，进行医学图书馆员电子检索，并综合适用的研究证据，用于 ED 谵妄的检测、预防和管理。范围界定审查是共识会议的基础，以确定最优先的研究重点。在范围界定审查中，48 项 ED 研究中描述了 27 种谵妄检测“工具”，并使用了可变标准，结果谵妄患病率从 6% 到 38% 不等。临床医生格式塔是最常见的评估“工具”，其敏感性范围为 0% 至 81%，特异性为 65% 至 100%。对于谵妄管理，确定了 15 项相关研究，其中包括一项随机对照试验。一些干预研究通过教育针对临床医生，另一些则使用临床路径。评估了三种药物可减少或预防 ED 谵妄。没有干预措施能够持续预防或治疗谵妄。在审查范围审查结果后，GEAR 利益相关者将不依赖额外护士或医生努力的 ED 谵妄预防干预措施确定为最优先的研究。跨学科利益相关者优先考虑不依赖于医护人员任务的 ED 谵妄预防研究，而不是其他研究方向，例如定义病因谵妄表型以针对预防或干预策略。
Older adult delirium is often unrecognized in the emergency department (ED), yet the most compelling research questions to overcome knowledge-to-practice deficits remain undefined. The Geriatric Emergency care Applied Research (GEAR) Network was organized to identify and prioritize delirium clinical questions. GEAR identified and engaged 49 transdisciplinary stakeholders including emergency physicians, geriatricians, nurses, social workers, pharmacists, and patient advocates. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews, clinical questions were derived, medical librarian electronic searches were conducted, and applicable research evidence was synthesized for ED delirium detection, prevention, and management. The scoping review served as the foundation for a consensus conference to identify the highest priority research foci. In the scoping review, 27 delirium detection “instruments” were described in 48 ED studies and used variable criterion standards with the result of delirium prevalence ranging from 6% to 38%. Clinician gestalt was the most common “instrument” evaluated with sensitivity ranging from 0% to 81% and specificity from 65% to 100%. For delirium management, 15 relevant studies were identified, including one randomized controlled trial. Some intervention studies targeted clinicians via education and others used clinical pathways. Three medications were evaluated to reduce or prevent ED delirium. No intervention consistently prevented or treated delirium. After reviewing the scoping review results, the GEAR stakeholders identified ED delirium prevention interventions not reliant on additional nurse or physician effort as the highest priority research. Transdisciplinary stakeholders prioritize ED delirium prevention studies that are not reliant on health care worker tasks instead of alternative research directions such as defining etiologic delirium phenotypes to target prevention or intervention strategies.
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影响因子：
1.8
作者：
Fleury N;Chevalley F;Rubli E;Coti P;Farron A;Jolles BM
通讯作者：
Jolles BM
影响因子：
6.3
作者：
Carpenter, Christopher R.;McFarland, Frances;Verghese, Joe
通讯作者：
Verghese, Joe
Stard 2015：用于报告诊断准确性研究的基本项目的更新列表。
DOI：
10.1136/bmj.h5527
发表时间：
2015-10-28
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Bossuyt PM;Reitsma JB;Bruns DE;Gatsonis CA;Glasziou PP;Irwig L;Lijmer JG;Moher D;Rennie D;de Vet HC;Kressel HY;Rifai N;Golub RM;Altman DG;Hooft L;Korevaar DA;Cohen JF;STARD Group
通讯作者：
STARD Group
影响因子：
4.4
作者：
Carpenter, Christopher R.;Banerjee, Jay;LaMantia, Michael A.
通讯作者：
LaMantia, Michael A.
影响因子：
6.3
作者：
Bo, Mario;Bonetto, Martina;Bellelli, Giuseppe
通讯作者：
Bellelli, Giuseppe