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At least 37 records · Page 2Linked to original sources
PubMed2002

Estimation of confusion prevalence in hospice patients.

BACKGROUND: Confusion is common among ill patients and has broad consequences for their care and well-being. The prevalence of confusion in hospice patients is unknown. OBJECTIVES: Describe the prevalence, severity, and manifestations of nurse-identified confusion and estimate the prevalence of delirium in hospice patients. DESIGN: Cross-sectional descriptive study. SETTING: Nineteen hospices in the Population-based Palliative Care Research Network (PoPCRN). PATIENTS: Adult patients receiving care from participating hospices, February 15 to April 1, 2000. MEASUREMENT/ANALYSIS: Hospice nurses estimated prevalence, severity, behavioral manifestations, and consequences of confusion during the preceding week. Confused and nonconfused patients were compared using standard bivariate and stratification techniques. Logistic regression identified manifestations associated with problematic confusion. RESULTS: Median age of the 299 patients was 78 years; 59% were female, 52% lived at home, and cancer was the most common diagnosis (54%). Fifty percent were confused during the preceding week, 36% of those were severely confused or disabled by confusion. Compared with nonconfused patients, confused patients were less likely to have cancer (64% vs. 43%, p < or = 0.001) and more likely to live in nursing home/assisted living (21% vs. 33%, p < or = 0.01). Disorientation to time or place, impaired short-term memory, drowsiness, and easy distractibility were common manifestations of confusion. When present, confusion caused a problem for the patient, someone else, or both 79% of the time. Inappropriate mood, cancer diagnosis, agitation, and age were the variables predicting problematic confusion. Only 14% of confused patients met criteria for delirium. CONCLUSIONS: Confusion among hospice patients was common, frequently severe, and usually problematic.

Adult↗
PubMed2005

Effects and modeling of phonetic and acoustic confusions in accented speech.

Accented speech recognition is more challenging than standard speech recognition due to the effects of phonetic and acoustic confusions. Phonetic confusion in accented speech occurs when an expected phone is pronounced as a different one, which leads to erroneous recognition. Acoustic confusion occurs when the pronounced phone is found to lie acoustically between two baseform models and can be equally recognized as either one. We propose that it is necessary to analyze and model these confusions separately in order to improve accented speech recognition without degrading standard speech recognition. Since low phonetic confusion units in accented speech do not give rise to automatic speech recognition errors, we focus on analyzing and reducing phonetic and acoustic confusability under high phonetic confusion conditions. We propose using likelihood ratio test to measure phonetic confusion, and asymmetric acoustic distance to measure acoustic confusion. Only accent-specific phonetic units with low acoustic confusion are used in an augmented pronunciation dictionary, while phonetic units with high acoustic confusion are reconstructed using decision tree merging. Experimental results show that our approach is effective and superior to methods modeling phonetic confusion or acoustic confusion alone in accented speech, with a significant 5.7% absolute WER reduction, without degrading standard speech recognition.

Decision Trees↗
PubMed1989

Confusion in the hospitalized elderly: incidence, onset, and associated factors.

Seventy-one non-surgical patients over age 60 years were studied to obtain information about the incidence, onset and variables associated with the onset of confusion. The incidence of confusion was 38%; 27 of the 71 subjects developed confusion during hospitalization. Nineteen of the 27 patients developed confusion by the second day of hospitalization; no new cases of confusion were detected after the sixth day of hospitalization. An examination of the psychophysiologic variables associated with the onset of confusion produced a profile of the confused elderly patient. Confused patients were: hypernatremic, hypokalemic, hyperglycemic, hypotensive, had elevated blood levels of creatinine and urea nitrogen, received more medications, were more frequently perceived by nurses as confused, had more orienting objects in their immediate environment, and fewer interactions with significant others. Recommendations for the continued investigation and care of confused patients are offered.

Adaptation, Psychological↗
PubMed1993

Identification of confusion among the elderly in an acute care setting.

An exploratory, descriptive study was conducted in a large acute care hospital to determine: (1) the indicator/descriptors used by staff nurses to arrive at the diagnosis of confusion, and (2) which indicators/descriptors are perceived as most significant in such a diagnosis. In addition, because the literature frequently cites the occurrence of nurses stereotyping patients as confused and thereby treating them as confused (Libow's self-fulfilling prophecy), the third question explored was the type and quantity of information that was given to nurses at intershift report. A self-constructed interview schedule was used on a sample of 25 staff nurses who were primary caregivers of a confused patient on a given day. Content analysis revealed emergent themes of confusion in two domains: cognitive and behavioral. The findings from this study revealed nurses used cognitive descriptors more frequently to diagnose confusion; however, a large majority of nurses used a combination of both cognitive and behavioral descriptors for diagnosis. Nurses also used independent assessment based on their own observations rather than those from the night nurse in arriving at a nursing diagnosis of confusion. This investigation responds to the need to "confirm defining characteristics of the phenomenon of confusion" posited by Foreman. In addition, results from this study will provide a basis for a taxonomy on the phenomenon of confusion. It is hoped that such a taxonomical classification will enable nurses to assess the confused patient more effectively.

Adult↗
PubMed2005

Postoperative interleukin-6 and cortisol concentrations in elderly patients with postoperative confusion.

OBJECTIVE: To investigate changes in plasma interleukin (IL)-6, cortisol or noradrenaline concentrations after surgery in elderly patients with postoperative confusion. METHODS: We studied 80 patients aged 70-90 years undergoing abdominal surgery and measured plasma IL-6, cortisol or noradrenaline concentrations before surgery, at the end of surgery, and 24 and 48 h after surgery. RESULTS: Plasma IL-6 concentrations in elderly patients with postoperative confusion were 83.2 +/- 30.5, 49.3 +/- 14.1 and 42.9 +/- 19.4 pg.ml(-1) at the end of surgery, and 24 and 48 h after surgery, respectively, being significantly higher than in elderly patients without postoperative confusion (58.0 +/- 37.5, 36.1 +/- 20.0 and 28.2 +/- 16.7 pg.ml(-1)). Plasma cortisol concentrations in elderly patients with postoperative confusion (42.2 +/- 7.8, 38.3 +/- 8.3 and 33.1 +/- 8.4 microg.dl(-1) at the end of surgery, and 24 and 48 h after surgery, respectively) were significantly higher than in elderly patients without postoperative confusion (32.9 +/- 6.7, 30.4 +/- 8.6 and 25.6 +/- 6.5 microg.dl(-1), respectively). There were no significant differences in plasma norepinephrine concentrations at all sampling points between elderly patients with and without postoperative confusion. However, plasma IL-6 and cortisol concentrations were related in elderly patients with postoperative confusion (at the end of surgery and 24 and 48 h after surgery). However, there was no relationship between plasma IL-6 and cortisol concentrations 24 and 48 h after surgery in elderly patients without postoperative confusion. CONCLUSION: Elderly patients with postoperative confusion had increased plasma IL-6 and cortisol concentrations. The interaction between IL-6 and cortisol after surgery is associated with developing postoperative confusion in the elderly patients.

Adult↗
PubMed2003

Postoperative confusion in schizophrenic patients is affected by interleukin-6.

STUDY OBJECTIVE: To investigate whether epidural analgesia with local anesthetics affects postoperative confusion in schizophrenic patients or the relationships between cortisol or interleukin-6 (IL-6) and postoperative confusion. DESIGN: Prospective, randomized study. SETTING: Hakodate Watanabe Hospital and Hirosaki National Hospital. PATIENTS: 105 patients who were scheduled to undergo abdominal surgery with general anesthesia. INTERVENTIONS: The schizophrenic patients were rendomly divided into two groups: patients in Group A received epidural anesthesia and patients in Group B did not receive epidural anesthesia. MEASUREMENTS AND MAIN RESULTS: Postoperative confusion during the first 48 hours after the end of operation occurred in 7 of 33 patients (21%) in Group A and 10 of 33 patients (30%) in Group B. There were no significant differences in the frequency of postoperative confusion between Groups A and B. Plasma cortisol concentrations in schizophrenic patients in Group A were significantly lower 15 minutes after incision and the end of surgery than those levels of patients in Group B; however, there was no significant difference between groups in plasma cortisol concentrations after anesthesia. Plasma IL-6 concentrations (51.7 +/- 22.0 and 31.4 +/- 8.2 pg mL(-1)) in patients with postoperative confusion at the end of surgery and 24 hours after surgery were significantly higher than those levels (34.4 +/- 16.2 and 16.9 +/- 7.7 pg mL(-1)) in patients without postoperative confusion. CONCLUSIONS: Epidural anesthesia does not significantly decrease the frequency of postoperative confusion in schizophrenic patients. Plasma IL-6 concentrations at the end of the operation and 24 hours after surgery in schizophrenic patients with postoperative confusion were significantly higher than those concentrations in patients without postoperative confusion.

Abdomen↗