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PubMed2006

Clustering, seriation, and subset extraction of confusion data.

The study of confusion data is a well established practice in psychology. Although many types of analytical approaches for confusion data are available, among the most common methods are the extraction of 1 or more subsets of stimuli, the partitioning of the complete stimulus set into distinct groups, and the ordering of the stimulus set. Although standard commercial software packages can sometimes facilitate these types of analyses, they are not guaranteed to produce optimal solutions. The authors present a MATLAB *.m file for preprocessing confusion matrices, which includes fitting of the similarity-choice model. Two additional MATLAB programs are available for optimally clustering stimuli on the basis of confusion data. The authors also developed programs for optimally ordering stimuli and extracting subsets of stimuli using information from confusion matrices. Together, these programs provide several pragmatic alternatives for the applied researcher when analyzing confusion data. Although the programs are described within the context of confusion data, they are also amenable to other types of proximity data.

Cluster Analysis↗
PubMed1999

Confusion about mammography: prevalence and consequences.

Over the last decade, there has been significant controversy about the schedule on which women, particularly women in their 40s, should have mammograms. The purpose of the analysis reported here was to assess whether women in their 40s and 50s were confused as a result of the controversy following the January 1997 National Institutes of Health Consensus Development Conference on Breast Cancer Screening For Women Ages 40-49. We also examined if confusion was related to being off schedule for mammography. The study sample included 1287 women recruited from a random sample of 2165 Blue Cross/Blue Shield of North Carolina members. The data described in this analysis were derived from a baseline telephone interview conducted as part of a larger intervention trial. Study measures included a variety of sociodemographic, medical, belief, and behavioral variables. Overall, 28% of women were confused, and 35% were off schedule. Although a higher proportion of women in their 40s than 50s were confused, more women in their 50s were off schedule. Confusion was a significant predictor for the outcome being off schedule. Predictors of confusion included several belief variables, risk perceptions, age (40s), whether the woman had a regular physician, and whether she had enough information about mammography. Healthcare providers should ask some simple questions to determine if women are confused and then seek to meet their information needs.

Adult↗
PubMed1989

Visual and auditory coding confusability in students with and without learning disabilities.

The nature of visual and auditory coding processes in students with learning disabilities (SLDs) and student controls (SCs) was examined with a letter-matching task on four types of successively presented letter pairs: identical (A,A), visually confusable (P,R), auditorily confusable (F,S), and neither visually nor auditorily confusable (N,T). Two delay intervals (0 and 2 seconds) were used between the presentation of the first and second letters. Analysis of decision latencies on the nonidentical letter pair trials revealed that with initial exposure to the task, the SLDs responded more slowly than SCs, but their general confusability patterns (visual and auditory) were similar. With additional practice, overall decision latencies were comparable for the two groups, while confusability differences emerged: SCs showed maximal visual confusability at a 0-second delay and maximal auditory confusability at a 2-second delay, while SLDs did not. Evidently, SLDs make less extensive use of visual and auditory coding processes compared to SCs.

Attention↗
PubMed2003

The development and testing of the PATCOA to assess pain in confused older adults.

The purposes of this study were to develop and evaluate the psychometric properties of an instrument with nonverbal cues to assess pain in confused older adults, and to describe the differences among selected demographic variables and scores on the pain and confusion measures. The Pain Assessment Tool in Confused Older Adults (PATCOA) was evaluated with 116 cognitively intact older adults undergoing orthopedic surgery. The interrater reliability for each nonverbal cue ranged from 56.5% to 100%, and the Spearman correlations were .16 to 1.00. Nine nonverbal pain cues were subjected to exploratory factor analysis. Four components explained 69.83% variance. Older adults reported significantly higher levels of pain on the visual analog scale, yet age was not related to the nonverbal pain cues. Women reported significantly more pain than did men. No significant gender differences were found regarding the display of nonverbal pain cues and the level of acute confusion, or with race and self-report of pain, display of nonverbal pain cues, or level of confusion. The development and testing of the PATCOA are initial steps that contribute to our knowledge about acute pain assessment in confused older adults.

Activities of Daily Living↗
PubMed2002

[Incidence and prevalence of postoperative acute confusion in heart surgery patients after coronary artery bypass and heart valve replacement surgeries].

Compared to foreign countries, Germany does not have data about the occurrence of acute confusion following heart-surgery. However, the occurrence of acute confusion does extend the hospital length of stay for up to 13 days. Thus, this phenomenon is of high relevance to nursing. This prevalence/incidence study was implemented with the goal of obtaining exact information on the incidence rate of acute postoperative confusion after a heart surgery through a multicenter evaluation. The data evaluation took place in the form of a convenience sample survey in three different German clinics specializing on heart surgeries. The observation period lasted from the day of the surgery up to the fifth postoperative day. In the context of this prospective Cohort-study all patients aged 18 and older who had heart surgery between February 1st and April 30th, 2000, were considered suitable as participants in the study. In the end, 860 patients were included in this study. 152 patients (17.4%) showed symptoms of acute confusion (confidence interval 14-20%). Certain circumstances seemed to predispose patients to acute confusion. A widespread occurrence could be observed particularly at night. Patients aged 81-91 were mainly affected. A confusion rate of 43.5% could be determined for this group. These results confirm the clinical importance and suggest interdisciplinary approaches for solution.

Adult↗
PubMed2002

Temporary confusion: a fearful experience.

Older people admitted to hospital often develop acute temporary confusion. Earlier studies have focused on problems in providing care to the confused, causes of the confusion and the key aspects of caring. The aims of this study were to describe, from a nursing perspective, how older people experienced the phenomenon of temporary confusion and to describe the older peoples' reasoning when they described their experiences. Interviews with five older informants who had recovered from their confusional state were conducted and analysed using the phenomenological method. Two phenomena were studied, 'being temporarily confused' and 'reasoning about experiences of temporary confusion', each was found to be represented by four inter-related constituents. The phenomena can be understood as aspects of suffering and power imbalance between staff and older people.

Aged↗
PubMed2004

Increased cortisol response to surgery in patients with alcohol problems who developed postoperative confusion.

BACKGROUND: Patients with alcohol problems often develop postoperative confusion and have impaired cortisol, ACTH, and norepinephrine. However, the relationship between neuroendocrine responses to surgical stress and postoperative confusion remains unclear in patients with alcohol problems. METHODS: Plasma cortisol, ACTH, and norepinephrine concentrations during and after surgery in 30 patients with alcohol problems and 30 control patients who underwent lower abdominal surgery were measured before the induction of anesthesia, 15 and 60 min after skin incision, 60 min after the end of surgery, the next day, and the second day after the operation. RESULTS: Plasma cortisol concentrations (21.2 +/- 4.7 microg x dl) of patients with alcohol problems before anesthesia were significantly higher than 15.6 +/- 4.8 microg x dl(-1) of control patients. Plasma cortisol and ACTH responses to surgery in patients with alcohol problems were not significantly increased compared with preoperative values. The incidence of postoperative confusion was significantly higher in patients with alcohol problems than that of control patients (33% vs. 3%). Plasma cortisol concentrations (29.7 +/- 7.0, 31.2 +/- 6.6, 30.3 +/- 8.0, and 28.4 +/- 6.2 microg x dl(-1)) 15 and 60 min after the skin incision, 60 min after the end of surgery, and the next day after operation in postoperatively confused patients with alcohol problems were significantly higher than those of nonconfused patients with alcohol problems (23.0 +/- 5.8, 22.7 +/- 4.1, 22.4 +/- 7.2, and 21.9 +/- 5.5 microg x dl(-1)). CONCLUSION: The cortisol response to surgical stress increases in patients with alcohol problems who develop postoperative confusion, although cortisol response to surgical stress decreases in patients with alcohol problems without postoperative confusion.

Adrenocorticotropic Hormone↗
PubMed1994

Measuring clinical confusion in critically ill patients.

Confusion is frequently undetected by nurses due to superficial patient interviews. This is potentially dangerous for critically ill patients because they may injure themselves and prolong their recovery. Reliable and valid methods of identifying those at risk for developing confusion are needed. As part of a larger study, we tested three measures of confusion in a medical intensive care unit. The Mini-mental State Examination, Clinical Assessment of Confusion-A and Visual Analog Scale of Confusion were administered to 53 critically ill patients for 3-8 days yielding 140 sets of data. Psychometric analyses demonstrated the MMSE, CAC-A and VAS-C were reliable, valid instruments in this population. High correlations were found between instruments, and in over 75% of study days there was agreement in all test scores and clinical assessment of confusion.

Acute Disease↗
PubMed1991

ADL performance and dependency on nursing care in patients with hip fractures and acute confusion in a task allocation care system.

In a prospective study 35 patients operated on for cervical hip-fractures were followed with respect to Acute Confusional State (ACS), problems of basic nursing care and dependency on care-givers. Fifteen patients became acutely confused after the fracture. They turned out to be more dependent on help from others than the non-confused patients were even before the fracture. They rapidly reached a significantly higher level of dependence than the non-confused patients and remained on that level throughout the study month. Six months after the fracture the post-operatively confused patients were still highly dependent on care-givers, significantly more than they were before the fracture. Only three of them were not hospitalised. All the non-confused patients lived in their own homes six months after the fracture and had regained the same level of independence as before it. These findings will be discussed in relation to the organisation of the nursing care. Task allocation nursing care was applied in the wards. A model for the development of dependency in acutely confused hip-fracture patients will be presented and suggestions for how to reduce nurse/patient dependency induced by nursing care will be made.

Activities of Daily Living↗
PubMed1985

Diagnosing boredom, confusion, and adaptation in school children.

An instrument was developed to determine if middle-school children could be diagnosed as being in a bored, confused, or adaptive state of mind. Boredom and confusion were viewed as maladaptive states. Reliability was demonstrated for the boredom, confusion, and adaptation subscales. Indications of validity were obtained for the three subscales. Boredom, confusion, and adaptation subscale scores were correlated with standardized achievement test scores and with teacher grades in academic subject areas for 136 sixth and seventh grade students. Confusion scores correlated significantly and negatively with eight of nine standardized achievement test scores, and with two of four teacher grades in academic subject areas. All correlations obtained were in the expected directions. Implications for interventions, especially in the diagnosis of confusion, are discussed.

Adaptation, Psychological↗
PubMed2002

Cortisol response to surgery and postoperative confusion in depressed patients under general anesthesia with fentanyl.

The purpose of this study was to investigate the relationship between postoperative confusion and plasma cortisol response to surgery in depressed patients. We studied 80 depressed patients and 40 control patients who had undergone orthopedic surgery and perioperatively measured plasma cortisol and adrenocorticotropin levels. Postoperative confusion in the first 3 postoperative days occurred in 5 (13%) depressed patients given fentanyl during anesthesia, 13 (33%) patients without fentanyl and 1 (3%) control patients. Plasma cortisol concentration (19.7 +/- 6.9 and 19.2 +/- 8.0 microg dl(-1)) 15 min after skin incision and 60 min after the end of surgery in depressed patients with fentanyl was significantly lower than that (24.2 +/- 7.2 and 23.5 +/- 8.1 microg dl(-1)) of depressed patients without fentanyl. Plasma cortisol levels during and after surgery in depressed patients with postoperative confusion were higher than those of depressed patients without postoperative confusion. We conclude that the occurrence of postoperative confusion in depressed patients is associated with an increase in plasma cortisol levels during and after surgery. The incidence of postoperative confusion in depressed patients with fentanyl was significantly lower than that of depressed patients without fentanyl.

Adrenocorticotropic Hormone↗
PubMed2004

Endocrine response to surgical stress and postoperative confusion in depressed patients with alcohol abuse.

Both alcohol drinking and depression are risk factors for postoperative confusion and are associated with alteration of pituitary-adrenal function. We investigated the incidence of postoperative confusion, plasma cortisol and ACTH response to surgical stress in depressed patients with alcohol abuse. We studied sixty depressed patients with and without alcohol abuse who underwent abdominal surgery. Postoperative confusion occurred in 4 of 30 patients (13%) in depressed patients without alcohol abuse, 10 of 30 patients (33%) in depressed patients with alcohol abuse. Plasma cortisol concentrations (27.2 +/- 7.0, 28.3 +/- 8.2, 29.2 +/- 4.1, 28.0 +/- 6.3 and 27.9 +/- 5.7 microg dl(-1)) 15, 60 min after the skin incision, 60 min after the end of surgery, the next day and the third day after surgery in depressed patients with alcohol abuse were significantly higher than that (20.1 +/- 6.4, 21.7 +/- 9.6, 22.3 +/- 8.0, 21.9 +/- 6.7 and 20.3 +/- 5.4 microg dl(-1)) in depressed patients without alcohol abuse. In depressed patients with alcohol abuse, plasma cortisol concentrations (34.9 +/- 7.1, 33.2 +/- 5.8 and 33.4 +/- 5.5 microg dl(-1)) 60 min after the end of surgery, the next day and third day after surgery in postoperatively confused depressed patients were significantly higher than those (26.4 +/- 6.3, 25.4 +/- 5.0 and 25.2 +/- 4.9 microg dl(-1)) of nonconfused depressed patients. In conclusion, the incidence of postoperative confusion was significantly higher in depressed patients with alcohol abuse than in depressed patients without alcohol abuse. Increased plasma cortisol concentrations after surgery were associated with postoperative confusion in depressed patients with alcohol abuse.

Abdomen↗
PubMed1991

Nurses' perception of the phenomenon confusion in elderly hospitalized patients.

The purpose of this descriptive study was to identify nurses' perception of signs, symptoms, assessment and reversibility of confusion in elderly hospitalized patients. The convenience sample consisted of 10 registered nurses working in an acute care setting. Data were collected using an open-ended interview guide and analyzed via qualitative analysis. The results showed that all of the subjects found behaviours indicative of disorientation, memory impairment, altered awareness of own situation and safety needs, aggressive behaviour, and altered ability to interact were components of confusion. Altered awareness of own situation, disorientation and altered ability to interact were found to be critical indicators of confusion. No consistent means to assess the presence and level of confusion was identified. The assessment of causes of confusion was primarily physical in nature with some psycho-social factors included. Confusion was considered reversible if it had an acute onset and a physiological cause. Replication of the study is recommended using a larger sample of nurses in a variety of settings, to more clearly define and delineate categories of mental functioning and develop assessment tools.

Adult↗
PubMedDate not supplied

Clinical decision making: recognition of confusion and application of restraints.

PURPOSE: The purpose of this study was to test the effects of patients' social, behavioral and medical characteristics on nurses' clinical decision for patient confusion. DESIGN: Factorial survey. METHODS: A random sample of 100 registered nurses scored 30 unique situation based vignettes on the likelihood the patient described was confused and whether restraints should be used. Every vignette contained a combination of eight independent patient variables: age; gender; race; patient affect; type, seriousness and time of patient act and medical diagnosis. FINDINGS: Examination of the recognition model and the intervention (applying restraints) models showed that patient variables explained approximately 40% and 43% of the variance respectively. Type of act, seriousness of act, time of act, and patient age all significantly increased nurses identifying patients as confused. The variables that were strong predictors for recognizing confusion were strong predictors for restraint use except that patients who exhibited a negative affect were more likely to be restrained than patients' who were portrayed as pleasant. CONCLUSION: Confusion is a complex clinical phenomenon with many dimensions. Confusion tools should be standardized and routinely used.

Adult↗
PubMed1990

Postoperative confusion.

Confusion is a terrible feeling, a feeling of being lost in the most basic sense. The markers, maps, cues, and senses used to orient oneself to the immediate environment are not recognizable. This applies to what one sees, hears, and feels. The person searches for something that makes sense, that he or she can anchor thoughts or actions to. Sitting up, getting up, and walking are anchoring responses. Using hands to touch one's own body, fingering objects, and "calling out" reflect a searching for something that is meaningful to the individual. Patients in various clinical settings who have experienced confusion all report common feelings: anxiety, fear of dying or being hurt, pain, falling, floating, suffocating, feelings of being crazy, being chained, or being lost. The severely confused seem only able to share the experience through their behavior; but it is clear that acute confusion is a physiologic and psychological assault on the body and mind, often worsened by nursing and medical interventions. Acute confusion continues to be a misdiagnosed and undertreated problem. Continued clinical inquiry and research into acute confusion and the use of such knowledge in the practice setting can reverse this trend.

Confusion↗
PubMed1990

Confusion in older adults: assessment and differential diagnosis.

Confusion has long been considered a normal consequence of aging. The growing incidence and cost of this untreated symptom has unfairly condemned many elders to live out their lives at a low level of functioning and has placed unnecessary hardships on their families. This article offers a complete protocol to assess and differentiate arrestible and reversible causes of confusion from irreversible presenile dementia. The history is the most important aspect of the examination of the confused elder. Onset of symptoms, corresponding illness, medication use and time of day that the confusion occurs should be included. Objective data include mental-status exams, but only as a screening tool and stepping stone for other exams. Judgment and abstraction are examined by assessing the client's ability to interpret proverbs and plot a sensible course of action. Special cortical function is assessed by asking the client to draw a house, a clock and a person. A functional pattern assessment specific to the confused elder is included. The general assessment centers on ruling out systemic or mechanical problems in the brain. Possible pathological causes with corresponding lab results, symptoms and clinical data are presented. Confusion is a symptom of many different and often unrelated disease entities. Many of these diseases are preventable, curable or arrestible. A diagnosis of irreversible presenile dementia should never be made without thorough evaluation. The health care provider should refer clients suspected of having irreversible presenile dementia to neurological specialists for confirmation of clinical findings.

Aged↗
PubMed1990

Confusion.

The term confusion describes a plethora of possible cognitive deficits and behavioral manifestations. A subjective assessment of confusion must be followed by an objective systematic evaluation to develop the cognitive-behavior profile. Because of age-associated physiologic and pathologic changes, elderly patients are at high risk for developing acute confusion. The management of confusion presents a challenge to nursing. Nursing can play a significant role in the prevention and the early detection of acute confusion. Preventing or identifying confusion early will decrease the physical and psychological stress of the patient as well as decrease the cost of hospitalization by shortening length of stay. Additional research is needed to determine the efficacy of present nursing activities and to identify new approaches for management.

Aged↗
PubMed1992

The wheat and the chaff: or four confusions regarding CHILDES.

Edwards (1992) presents a set of examples from the Child Language Data Exchange System (CHILDES) as prototypes of bad transcription practice. Her discussion is based upon four basic confusions. First, Edwards confuses old and discarded versions of CHAT with current CHAT. Second, she confuses the relation between CHAT standards with the implementation of these standards during the process of reformatting older corpora. Third, she confuses transcription for automatic analysis with transcription for documentation. Fourth, she confuses the CHAT guidelines with the larger CHILDES system. We argue that these confusions have misled Edwards into developing an overly rigid set of principles for data analysis which, if followed literally, could choke off progress in the analysis of spontaneous language samples.

Archives↗