Browsing by Author "Li, Hsiu-Ching"

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Delirium, Subsyndromal Delirium, and Cognitive Changes in Individuals Undergoing Elective Coronary Artery Bypass Graft Surgery
(2015-07-01)
Li, Hsiu-Ching
;
Chen, Yih-Sharng
;
Chiu, Ming-Jang
;
Fu, Mei-Chiung
;
Huang, Guan-Hua
Background: The course of incident delirium and subsyndromal delirium (SSD) after cardiac surgery is not well studied. Objective: The aim of this study was to evaluate the course of incident delirium and SSD, their risk factors, and impact on patients\' cognitive function after elective coronary artery bypass graft (CABG) surgery. Methods: Consecutive patients scheduled for an isolated CABG at a tertiary medical center in Taiwan were enrolled if they had no preoperative delirium symptoms. Delirium was assessed daily for 1 week after surgery using the Confusion Assessment Method. Subsyndromal delirium was defined as presenting with any core symptom below the diagnostic threshold for delirium. Cognitive function was assessed by the Mini-mental State Examination. Results: Of 38 participants, 7 had incident (first-time) delirium (18.4% incidence) and 13 had incident SSD (34.2% incidence). Whereas SSD usually lasted 1 day, delirium changed gradually to SSD to recovery and its symptomatology lasted longer. We identified 6 delirium risk factors: older age, more comorbidities, cardiac pulmonary bypass, blood transfusion, larger transfusion volume, and longer duration of intraoperative blood pressure less than 60 mm Hg. The frequencies of these risk factors for SSD were often intermediate between those of risk factors in groups with and without delirium. By hospital discharge, participants with delirium had the longest hospital stays and lowest cognitive scores, those with SSD had intermediate stays and scores, and those without delirium had the lowest stays and scores. Conclusion: Delirium and SSD after CABG are common. Greater number and severity of risk factors for delirium may predict increasingly poor outcomes, with the dose-response relationship between risk factors and outcomes for SSD intermediate between that for no symptoms and full delirium. Intervention trials are indicated, particularly for patients with a greater number and severity of predisposing and precipitating risk factors.
Effect of a Modified Hospital Elder Life Program on Delirium and Length of Hospital Stay in Patients Undergoing Abdominal Surgery A Cluster Randomized Clinical Trial
(2017-09-01)
Chen, Cheryl Chia-Hui
;
Li, Hsiu-Ching
;
Liang, Jin-Tung
;
Lai, I-Rue
;
Purnomo, Jerry Dwi Trijoyo
IMPORTANCE Older patients undergoing abdominal surgery commonly experience preventable delirium, which extends their hospital length of stay (LOS). OBJECTIVE To examine whether a modified Hospital Elder Life Program (mHELP) reduces incident delirium and LOS in older patients undergoing abdominal surgery. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized clinical trial of 577 eligible patients enrolled 377 older patients (>= 65 years of age) undergoing gastrectomy, pancreaticoduodenectomy, and colectomy at a 2000-bed urban medical center in Taipei, Taiwan, from August 1, 2009, through October 31, 2012. Consecutive older patients scheduled for elective abdominal surgery with expected LOS longer than 6 days were enrolled, with a recruitment rate of 65.3%. Participants were cluster randomized by room to receive the mHELP or usual care. INTERVENTIONS The intervention (implemented by an mHELP nurse) consisted of 3 protocols administered daily: orienting communication, oral and nutritional assistance, and early mobilization. Intervention group participants received all 3 mHELP protocols postoperatively, in addition to usual care, as soon as they arrived in the inpatient ward and until hospital discharge. Adherence to protocols was tracked daily. MAIN OUTCOMES AND MEASURES Presence of delirium was assessed daily by 2 trained nurses who were masked to intervention status by using the Confusion Assessment Method. Data on LOS were abstracted from the medical record. RESULTS Of 577 eligible patients, 377 (65.3%) were enrolled and randomly assigned to the mHELP (n = 197; mean [SD] age, 74.3 [5.8] years; 111 [56.4%] male) or control (n = 180; mean [SD] age, 74.8 [6.0] years; 103 [57.2%] male) group. Postoperative delirium occurred in 13 of 196 (6.6%) mHELP participants vs 27 of 179 (15.1%) control individuals, representing a relative risk of 0.44 in the mHELP group (95% CI, 0.23-0.83; P = .008). Intervention group participants received the mHELP for a median of 7 days (interquartile range, 6-10 days) and had a shorter median LOS (12.0 days) than control participants (14.0 days) (P = .04). CONCLUSIONS AND RELEVANCE For older patients undergoing abdominal surgery who received the mHELP, the odds of delirium were reduced by 56% and LOS was reduced by 2 days. Our findings support using the mHELP to advance postoperative care for older patients undergoing major abdominal surgery.
Three Nurse-administered Protocols Reduce Nutritional Decline and Frailty in Older Gastrointestinal Surgery Patients: A Cluster Randomized Trial
(2019-05-01)
Chen, Cheryl Chia-Hui
;
Yang, Yi-Ting
;
Lai, I-Rue
;
Lin, Been-Ren
;
Yang, Ching-Yao
Objective: To evaluate the effects of the modified Hospital Elder Life Program (mHELP) comprising 3 nurse-administered protocols in older patients undergoing gastrointestinal (GI) surgery. Design: Cluster randomized trial. Setting: Two 36-bed GI wards at a university-affiliated medical center in Taiwan. Participants: Older patients (>= 65 years, N = 377) were recruited if they were scheduled for elective GI surgery with an expected length of hospital stay > 6 days. After transferring to the GI ward after surgery, participants were randomly assigned to the mHELP or control group (1: 1) by room rather than individually because most patient units are double-or triple-occupancy rooms. Intervention: The mHELP protocols (early mobilization, oral and nutritional assistance, and orienting communication) were administered daily with usual care by a trained nurse until hospital discharge. The control group received usual care only. Measures: Outcomes were in-hospital nutritional decline, measured by body weight and Mini-Nutritional Assessment (MNA) scores, and Fried's frailty phenotype. Return of GI motility was examined as a potential mechanism contributing to observed outcomes. Results: Participants (mean age = 74.5 years; 56.8% male) primarily underwent colorectal (56.5%), gastric (21.2%), and pancreatobiliary (13.8%) surgery. Participants who received the mHELP [for a median of 7 days (interquartile range = 6-10 days)] had significantly lower in-hospital weight loss and decline in MNA scores (weight -2.1 vs -4.0 lb, P = .002; score -3.2 vs -4.0, P =.03) than the control group. The mHELP group also had significantly lower rates of incident frailty during hospitalization (12.0% vs 21.7%, P = .022), and persistent frailty (50.0% vs 92.9%, P = .03). Participants in the mHELP group had trends toward an accelerated return of GI motility. Conclusion and Implications: The mHELP effectively reduced nutritional decline, prevented new frailty, and promoted recovery of frailty present before admission. These nurse-administered protocols might be useful in other settings, including conditions managed at home or in nursing facilities. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.