Delirium in older COVID-19 patients:Evaluating risk factors and outcomes

Objectives: A high incidence of delirium has been reported in older patients with Coronavirus disease 2019 (COVID-19). We aimed to identify determinants of delirium, including the Clinical Frailty Scale, in hospitalized older patients with COVID-19. Furthermore, we aimed to study the association of delirium independent of frailty with in-hospital outcomes in older COVID-19 patients. Methods: This study was performed within the framework of the multi-center COVID-OLD cohort study and included patients aged ≥60 years who were admitted to the general ward because of COVID-19 in the Netherlands between February and May 2020. Data were collected on demographics, co-morbidity, disease severity, and geriatric parameters. Prevalence of delirium during hospital admission was recorded based on delirium screening using the Delirium Observation Screening Scale (DOSS) which was scored three times daily. A DOSS score ≥3 was followed by a delirium assessment by the ward physician In-hospital outcomes included length of stay, discharge destination, and mortality. Results: A total of 412 patients were included (median age 76, 58% male). Delirium was present in 82 patients. In multivariable analysis, previous episode of delirium (Odds ratio [OR] 8.9 [95% CI 2.3–33.6] p = 0.001), and pre-existent memory problems (OR 7.6 [95% CI 3.1–22.5] p < 0.001) were associated with increased delirium risk. Clinical Frailty Scale was associated with increased delirium risk (OR 1.63 [95%CI 1.40–1.90] p < 0.001) in univariable analysis, but not in multivariable analysis. Patients who developed delirium had a shorter symptom duration and lower levels of C-reactive protein upon presentation, whereas vital parameters did not differ. Patients who developed a delirium had a longer hospital stay and were more often discharged to a nursing home. Delirium was associated with mortality (OR 2.84 [95% CI1.71–4.72] p < 0.001), but not in multivariable analyses. Conclusions: A previous delirium and pre-existent memory problems were associated with delirium risk in COVID-19. Delirium was not an independent predictor of mortality after adjustment for frailty

Raising positive expectations helps patients with minor ailments: A cross-sectional study

Background: Consultations for minor ailments constitute a large part of the workload of general practitioners (GPs). As medical interventions are not always available, specific communication strategies, such as active listening and positive communication, might help GPs to handle these problems adequately. This study examines to what extent GPs display both strategies during consultations for minor ailments and investigates how each of these relate to the patients' perceived health, consultation frequency and medication adherence. Methods: 524 videotaped consultations between Dutch GPs and patients aged 18 years or older were selected. All patients presented a minor ailment, and none of them suffered from a diagnosed chronic illness. The observation protocol included the validated Active Listening Observation Scale (ALOS-global), as well as three domains of positive communication, i.e. providing reassurance, a clear explanation, and a favourable prognosis. Patients completed several questionnaires before, immediately after, and two weeks after the consultation. These included measures for state anxiety (STAI), functional health status (COOP/ WONCA charts) and medication adherence (MAQ). Consultation frequency was available from an ongoing patient registration. Data were analysed using multivariate regression analyses. Results: Reassurance was related to patients' better overall health. Providing a favourable prognosis was linked to patients feeling better, but only when accompanied by a clear explanation of the complaints. A clear explanation was also related to patients feeling better and less anxious, except when patients reported a low mood pre-visit. Active listening alone was positively associated with patients feeling worse. Among patients in a good mood state, active listening was associated with less adherence. Conclusion: To some extent, it seems helpful when GPs are at the same time clear and optimistic about the nature and course of minor ailments. Yet, it does not seem helpful always and in all cases, e.g. when patients feel low upon entering the consulting room. Although communication strategies might to some extent contribute to the management of minor ailments, the results of this observational study also indicate that it is important for a physician to pay attention to the mood of the patient who enters the consulting room. (aut. ref.

Consequences of additional use of PET information for target volume delineation and radiotherapy dose distribution for esophageal cancer

Background and purpose. To determine the consequences of target volume (TV) modifications, based on the additional use of PET information, on radiation planning, assuming PET/CT-imaging represents the title extent of the tumour Materials and methods. For 21 patients with esophageal cancer, two separate TV's were retrospectively defined based on CT (CT-TV) and co-registered PET/CT Images (I'ET/CT-TV). Two 3D-CRT plans (prescribed close 504 Gy) were constructed to cover. the corresponding TV's. Subsequently, these plans were compared for. target coverage. normal tissue dose-volume histograms and the corresponding normal tissue complication probability (NTCP) values Results The addition of PET led to the modification of CT-TV with at least 10% in 12 of 21 patients (57%) (reduction in 9. enlargement in 3). PET/Cr-TV was inadequately coveted by the CT-based treatment plan in 8 patients (36%) Treatment plan modifications resulted in significant changes (p <0 05) in dose distributions to heart and lungs Cot responding changes in NTCP values ranged horn -3% to +2% for. radiation pneumonitis and from -0 2% to +12% for cardiac mortality Conclusions. This study demonstrated that TV's based on CT might exclude PET-avid disease Consequences are under dosing and thereby possibly ineffective treatment Moreover. the addition of PET in radiation planning might result in clinical Important changes in NTCP (C) 2009 Elsevier Ireland Ltd All rights reserved Radiotherapy and Oncology 93 (2009) 447-45

Better assessment of nodal metastases by PET/CT fusion compared to side-by-side PET/CT in oesophageal cancer

Background: Recently, positron emission tomography/computed tomography (PET/CT) has been introduced in the staging of oesophageal cancer. The impact of PET/CT fusion in comparison with side-by-side PET/CT in these tumours, was analyzed. Patients and Methods: In 61 patients, 18-F-fluorodeoxyglucose (FDG)-PET and multidetector (md)-CT were performed within a two week interval. Software-fusion of md-CT and FDG-PET was correlated with side-by-side FDG-PET/CT reading by two independent investigators. The gold standard was the pathological outcome or clinical evidence of progression during the first year of follow-up. Results: In 18 patients (18/61; 30%), nodal staging improved with software-fusion. The number of nodal metastases increased in five patients and decreased in four patients, leading to up-staging in one patient (2%) and down-staging in three patients (5%). In nine cases (15%), certainty and localization of metastases improved. However, the number of distant metastases did not change and software-fusion did not have an influence on resectability. Conclusion: PET/CT fusion substantially improves detection and localization of nodal metastases and may have an impact on locoregional treatment options

Self-reported applicability of an online continuing professional development (G-eCPD) module and a live training module on oncogenetics, by GPs who participated in one of these CPD modules.

<p><i>95%-CI</i>: <i>95% confidence interval; G-eCPD</i>: <i>online continuing professional development on oncogenetics; GP</i>: <i>general practitioner; p</i>: <i>p-value for the Chi-square test for the between-group difference (Online CPD vs</i>. <i>Live training) of the percentage (Agree</i>,<i>Agree completely) in response to the statements</i>, <i>and independent-samples t-test for the between-group difference in the global rating (significant results indicated in italic and bold)</i></p><p>Self-reported applicability of an online continuing professional development (G-eCPD) module and a live training module on oncogenetics, by GPs who participated in one of these CPD modules.</p

Genetics educational framework.

<p>Based on Kirkpatrick’s Evaluation Framework for Educational Outcomes [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0122648#pone.0122648.ref016" target="_blank">16</a>,<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0122648#pone.0122648.ref018" target="_blank">18</a>]</p

Website visitor numbers (Top figure) and percentage returning visitors per month.

<p>Website visitor numbers (Top figure) and percentage returning visitors per month.</p

Levels of oncogenetics training modules and evaluation according to Kirkpatrick and Moore (Adjusted according to Davis et al., 2008 [4]).

<p><i>G-eCPD</i>: <i>online continuing professional development on oncogenetics; GP</i>: <i>general practitioner; SP</i>: <i>standardized patient</i></p><p>Levels of oncogenetics training modules and evaluation according to Kirkpatrick and Moore (Adjusted according to Davis et al., 2008 [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0122648#pone.0122648.ref004" target="_blank">4</a>]).</p