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PubMed2000

Women's midlife confusion: "why am I feeling this way?".

Midlife is a multifaceted stage of woman's development, characterized by important transitions. In an ethnographic study of women's midlife experience of their changing bodies, 11 participants voiced their uncertainty and confusion around bodily changes, responses exacerbated by the lack of consistent health-related information in this area. This confusion emerged as one of the major thematic elements of the study. Midlife women's experience of confusion may reflect a much broader problem, the locus of which is not so much in the women themselves, but rather in negative societal attitudes about aging women. This article describes various aspects of confusion that emerged from the data, and offers implications of the research and recommendations for practitioners.

Adaptation, Psychological↗

PubMed1986

Confusion ratings and abbreviated mental test performance: a comparison.

Ninety-nine residents, 10% of the total population of elderly in Part III accommodation in Newcastle upon Tyne, were examined for the presence of psychiatric disorder, tested for cognitive impairment, and rated for the presence of confusion. Those allocated a diagnosis of dementia were most impaired and confused, and those living in specialist homes for the mentally infirm were more impaired than other residents. Confusion ratings, which proved very simple and quick to perform, correlated highly with the results of testing for the presence of cognitive impairment--a slightly more laborious and less universally applicable procedure. The Confusion Rating therefore offers a reliable and easy method for identifying the prevalence of dementia among residents of institutions.

Aged↗

PubMed1990

The contribution of computerized tomography to the differential diagnosis of confusion in elderly patients.

Two hundred and eighty elderly patients who were referred because of a principal problem of confusion were investigated by computerized tomography; 94% were suffering from a 'dementia syndrome' and unrecognized receptive dysphasia was the commonest problem in the remainder. One hundred and twenty-four patients were suffering from senile dementia of the Alzheimer type, and 79 from multi-infarct dementia. Space-occupying lesions (tumour, subdural haematoma or hygroma) were found in 32 (11%). Of the 25 with other intracranial and extracranial causes, 64% had potentially treatable lesions (PTL). In only four cases was no diagnosis made. PTL were found in 31% of 170 patients with a duration of confusion of less than a year compared with 1% of 110 patients with a longer duration. In 48 of the former group, confusion was an isolated phenomenon; 12 of these (25%) had a PTL, as had 27 of 88 with confusion and a focal neurological deficit (31%). All five patients with recognized seizures, and six of 15 of those with reduced alertness had PTL. Twenty of 37 patients with neurosurgical lesions underwent surgery.

Aged↗

PubMed1990

Treatment of the classical manifestations of dementia and confusion.

Treatment of dementia or confusion relies substantially upon accurate diagnosis. Common causes of acute confusion are described and a summary provided of their usual treatments. The coexistence of dementia and depressive illness is considered and the clinical distinction between depression and depressive 'pseudo-dementia' is made. The classical manifestations of dementia and confusion (agitation, depression, and sleep disturbance) are discussed. Clinical guidelines are set out for the administration of neuroleptics, antidepressants or hypnotics in the care of the demented or confused patient.

Aged↗

PubMedDate not supplied

Validation of the structure for the "Clinical Assessment of Confusion-A".

The Clinical Assessment of Confusion-A (CAC-A) is an observational checklist developed for practicing nurses to measure the presence and level of confusion in hospitalized adults. In a previous study, the following dimensions were found using principal factor analysis: cognition, general behavior, motor activity, orientation, psychotic/neurotic behavior, and two uninterpretable factors. A replication study was conducted to evaluate the validity of a statistically derived model for confusion suggested by the CAC-A. Data from a sample of 566 nurses were analyzed. Three theoretically justified statistical models for the structure of confusion were estimated and compared using a model selection approach to covariance structures analysis: a single-factor unidimensional model, an orthogonal six-factor model, and an oblique six-factor model similar to the structure suggested in the development study. The oblique six-factor model provided the best fit in the predictive sense and was the most satisfactory from a theoretical perspective.

Adult↗

PubMed2005

The occurrence of acute postoperative confusion in patients after cardiac surgery.

This study quantified the occurrence of acute confusion in cardiac surgery patients at three German hospitals. A total of 867 patients, 22-91 years old, were examined each nursing shift postoperatively for 5 days for the presence of acute confusion using a modified version of the Glasgow Coma Scale and Confusion Rating Scale. The night shifts and the third postoperative day showed the most frequent periods of occurrence. Confusional state was noted in patients ranging from 10.5% for patients aged <70, to 40.7% for patients >80 years of age. Those found at increased risk were patients of increasing age and coexisting disease. Targeted nursing interventions for patients at increased risk of acute confusion may decrease this complication.

Acute Disease↗

PubMed1986

Confusion effects with sinusoidal and narrow-band noise forward maskers.

In some forward-masking conditions, signal thresholds may be elevated by the listener's inability to distinguish the signal from the preceding masker. In this study, such "confusion" effects are investigated for both sinusoidal and narrow-band noise forward maskers combined with sinusoidal signals of varying duration. Results for the sinusoidal maskers show effects of off-frequency listening for brief signals and possibly small effects of confusion for longer signals. Results for the narrow-band noise maskers show a marked influence of confusion over a wide range of signal durations. This range is in good agreement with that predicted from previous work with "pulsing" maskers [D. Neff, J. Acoust. Soc. Am. 78, 1966-1976 (1985)]. These results suggest that studies using narrow-band noise forward maskers or studies of psychophysical suppression should include direct tests for confusion effects in key conditions.

Acoustic Stimulation↗

PubMed1978

Sodium amylobarbitone in the differential diagnosis of confusion.

The authors describe the use of intravenous sodium amylobarbitone to differentiate between functional and organic confusion. Four psychiatric patients with functional confusion developed a clear sensorium on this drug. Since previous studies have demonstrated that organic confusion is increased by sodium amylobarbitone, the authors conclude that the drug can be an aid in the differential diagnosis of confusion. They discuss possible applications.

Acute Disease↗

PubMed2005

Psychometric properties of the Flemish translation of the NEECHAM Confusion Scale.

BACKGROUND: Determination of a patient's cognitive status by use of a valid and reliable screening instrument is of major importance as early recognition and accurate diagnosis of delirium is necessary for effective management. This study determined the reliability, validity and diagnostic value of the Flemish translation of the NEECHAM Confusion Scale. METHODS: A sample of 54 elderly hip fracture patients with a mean age of 80.9 years (SD = 7.85) were included. To test the psychometric properties of the NEECHAM Confusion Scale, performance on the NEECHAM was compared to the Confusion Assessment Method (CAM) and the Mini-Mental State Examination (MMSE), by using aggregated data based on 5 data collection measurement points (repeated measures). The CAM and MMSE served as gold standards. RESULTS: The alpha coefficient for the total NEECHAM score was high (0.88). Principal components analysis yielded a two-component solution accounting for 70.8% of the total variance. High correlations were found between the total NEECHAM scores and total MMSE (0.75) and total CAM severity scores (-0.73), respectively. Diagnostic values using the CAM algorithm as gold standard showed 76.9% sensitivity, 64.6% specificity, 13.5% positive and 97.5% negative predictive values, respectively. CONCLUSION: This validation of the Flemish version of the NEECHAM Confusion Scale adds to previous evidence suggesting that this scale holds promise as a valuable screening instrument for delirium in clinical practice. Further validation studies in diverse clinical populations; however, are needed.

Aged, 80 and over↗

PubMed2003

Homosexuality: coming out of the confusion.

The author asserts that earlier theoretical assumptions contribute to the conceptual confusion about homosexuality in much contemporary psychoanalytic research. Bergeret's article, recently published in this Journal, is exemplary of this confusion. The author refutes his contention that homosexuality is not 'true' sexuality but merely a defensive, narcissistic fixation away from, or a nearly psychotic denial of, heterosexuality. He then clarifies specific areas of conceptual confusion regarding homosexuality still prevalent in psychoanalytic discourse that derive from earlier theoretical premises. These areas of confusion include manifest versus latent homosexuality, narcissism and bisexuality, oedipal dynamics and development, and transference and technique.

Adolescent↗

PubMed1994

Self-reports of sexual abuse, mental health status, and perceived confusion of family roles: a retrospective study of college students.

This study examined the possibility that mental health problems which may result from sexual abuse are exacerbated by a confusion of family roles in the victim's perception of the family of origin. A sample of 234 undergraduate students completed a questionnaire. Analyses confirmed associations between (1) perceived sexual abuse and indicators of mental health problems, (2) confusion of family roles and perceived sexual abuse, and (3) mental health problems and confusion of family roles. A good prediction of the occurrence of mental health problems could only be obtained if both perceived sexual abuse and the confusion of family roles were considered.

Adaptation, Psychological↗

PubMed1996

The use of Functional Consequences Theory in acutely confused hospitalized elderly.

Acute confusion is a common complication of hospitalization in the elderly that impacts on both the use of health care resources and the functional status of individuals. Providing optimum nursing care for these patients depends on three factors: 1) the nurse's ability to differentiate acute confusion from other common conditions in the hospitalized elderly, chiefly dementia or depression, 2) the nurse's ability to identify factors contributing to this condition, and 3) the implementation of interventions to minimize the effects of these factors on the patient. This article differentiates the clinical features of acute confusion from those of depression and dementia, and discusses the use of the Functional Consequences Theory, developed by Miller (1990), as a framework for nursing assessment and management of care for elderly patients with this condition. The functional consequences theory framework assists the nurse to identify risk factors associated with the development of acute confusion in the hospitalized elderly. Further it guides the development of interventions to minimize the effects of this condition in this population. The use of this framework in the clinical setting is illustrated through a case study.

Acute Disease↗

PubMed2001

Studying acute confusion in long-term care: clinical investigation or secondary data analysis using the minimum data set?

Clinical investigations of acute confusion have largely been initiated in the acute care setting, where no uniform patient assessment exists. No reliable estimates of the prevalence of acute confusion in long-term care (LTC) residents have been reported. Delirium indicators are present in the nursing home Minimum Data Set (MDS), suggesting that MDS assessments could be used to facilitate studies of acute confusion in LTC. Methods to study acute confusion in LTC are discussed, with an emphasis on the advantages and disadvantages of using secondary analysis of MDS assessments as one research strategy.

Acute Disease↗

PubMed1992

[Confusion lines in dichromatism using various surface colors].

Confusion lines, convergence points, and neutral points in dichromatism were examined using various surface colors. Confusion lines were obtained from 8 cases of protanopia and 24 cases of deuteranopia by color matching with the surface colors of the Farnsworth-Munsell 100 hue test, then regression analysis was carried out on the cross-points of all confusion lines obtained. Convergence points were obtained and neutral points were also calculated. The convergence point obtained from protanopia using surface colors converged to x = 0.811 and y = 0.189, which is a point near Pitt and Judd's convergence point. The confusion line gradient obtained from deuteranopia was steeper than that of Pitt and Judd's line. The convergence point of deuteranopia was x = 1.959 and y = -0.959. Compared with previous reports, it was in the lower right region. The neutral point of protanopia was in the vicinity of 495 nm and that of deuteranopia in the vicinity of 500 nm. These two values were almost the same as the values in Judd's report. Considering the results mentioned above, the neutral point obtained with surface colors was almost the same as that obtained with spectrum color. From the above results, the convergence point was thought to be different from that obtained using spectrum color. In particular, the difference was significant in deuteranopia.

Adolescent↗

PubMed1990

[Hypoglycemia and states of confusion].

In states of hypoglycemia apart from vegetative clinical appearances, rough psychic disorders can also occur in the sense of the disruption of the levels of consciousness, as well as in the form of confusion or the clouding of narrowed consciousness. In regard to the fact that these psychoorganic disorders often occur without the classical appearance of vegetative disorders which are typical for hypoglycemia, psychoorganic disorders therefore, present a great challenge and risk in differential diagnostics. The paper presents two types of confusion states which can occur in the course of hypoglycemia. They are the stiff, stuporous confusion state, as well as the anxious, agitated confusion state.

Adult↗

PubMed1987

Postcardiotomy confusion and sleep loss.

To examine the relationship between sleep loss and confusion after open-heart surgery, 27 consecutive patients were monitored 1 day preoperatively and 5 days postoperatively with the Folstein Mini-Mental State examination, a modified sleep latency test, and a sleep log. Confusion (low Mini-Mental State scores) peaked on postoperative Days 1 and 2 and correlated with insomnia (sleep time) during the following night but not during the preceding night. The results suggest that sleep loss is not the cause but, rather, a consequence of postcardiotomy confusion. Confusion, not insomnia, should be the focus of treatment.

Adult↗

PubMed1991

The shoulder: facts, confusions and myths.

The purpose of this paper is to address some of the myths, facts and confusions about the shoulder. Myth: Recurrent subluxation or dislocation of the shoulder requires surgery. Fact: The most important shoulder muscle is the anterior deltoid. Myth: You can diagnose shoulder problems with two anterior/posterior x-rays. Fact: You must keep track of the pins you insert for shoulder problems. Confusion: The position of the shoulder for arthrodesis: which to choose? Confusion: What if the arthrodesis is painful? Myth: You don't need the clavicle and can resect it without any problems. Fact: All sternoclavicular dislocations are not dislocations. Fact: Do not repair or reconstruct spontaneous sternoclavicular dislocations in children and young adults. Confusion: What is the role of the arthroscope in the diagnosis and treatment of shoulder problems? Fact: There are more than just Type I, II and III injuries to the acromioclavicular joint. Fact: Total shoulder arthroplasty is not an experimental operation. Myth: All patients with a sore shoulder need an arthrogram. All patients with positive arthrograms need an operation. All rotator cuffs must be repaired.

Acromioclavicular Joint↗

PubMed2005

Numerical confusion errors in ishihara testing: findings from a population-based study.

PURPOSE: To describe the prevalence of numerical confusion errors in Ishihara testing in a representative sample of Australian children. DESIGN: Cross-sectional, population-based study. METHODS: The Sydney Myopia Study examined a representative stratified random cluster sample of 1,741 children (aged 6 years) attending 34 schools in Sydney, Australia (response rate, 78.9%), including color vision tests in 1,735 children. Those with any color vision defects (n = 33; 1.9%; 97% boys) were excluded. Responses for each Ishihara plate were recorded. RESULTS: Numerical confusion errors were made by 75.8% of children with normal color vision; there was no gender difference. Plates 3 and 7 were particularly prone to numerical confusion errors; 48.4% and 40.8%, respectively, of children misread these plates. CONCLUSION: Numerical confusion errors in the Ishihara test were relatively common in children with normal color vision. The frequency of such errors could indicate an inherent deficiency in this commonly used test.

Child↗