PICO Analysis of Delirium
Kukreja, Günther, and Popp (2015) describe delirium as an acute medical condition characterized by a loss or reduced recognition or attention. Delirium is a common medical disorder among patients aged be sixty-five and above. With a life expectancy of 78.7 in the US, cognitive aging is gaining a significant concern in the country’s healthcare system. On a global scale, countries with a life expectancy of 70 and above are becoming more bothered by the fact that the aging population is facing more complications ranging from loss of brain functionality to immobility in some cases. Research suggests that the prevalence of delirium among the elderly population is growing high each year (Kukreja, Günther, & Popp, 2015). Currently, the prevalence of the disorder is estimated to be 42% among this population. Severe cases of delirium have been characterized by high rates of mortality or permanent decline in functionality, long-term cognitive malfunction, with higher incidences of institutionalization of the patients. The identification of the condition in time is thought to present some potential prevention of the condition from running into long-term consequences for the victims. The most common diagnoses used are DSM, ICD, CAM-ICU, or the use of simple tools like DRS-R-98. The simple screening tools are often recommended as instant assessment tools because this population is thought to be more vulnerable to delirium than the population below 60 years of age. The effectiveness of the tools presents hospitals with a chance to identify the disorder in time and design an appropriate care plan for the patient.. Don't use plagiarised sources.Get your custom essay just from $11/page
PICO Question
P-Geriatric Patients
I- Intensive Care Delirium Screening Checklist (ICDSC) for assessment of patient
C- Using the ICDSC tool versus the DSM/CAM-ICU
Outcome-Higher level and efficient identification of patients with Delirium
PICO Question- Is the instant use of ICDSC simple tool more effective in assessing patients with delirium?
(Brummel, Eduard, Jin, Leanne, Brenda, & Wesley, 2013)
| Electronic Databases | Research or Professional Organizations | Experts in the Field to Consult | Books, Encyclopedias, Handbooks |
| CINHAL | American Psychological Association | Dr. Marvin Swartz | Journals |
| EBSCOhost | CDC | Dr. David Shern | Journals, Books |
| NCBI | FDA | Delaney Ruston | Journals |
| Research gate | Keiser Family Foundation | David M Taylor | Journals |
| PubMed | Mayo Clinic | Journals |
| Keywords and Phrases
| Major Authors | Inclusion Criteria | Exclusion Criteria |
| Delirium | Jayta De and AnneWand | The first step to inclusion was informed by the currency of the articles. Articles older than ten years were automatically left out. The search criteria customized the articles to fall between 2010 and 2020. The articles were also included based on the setting and the sample of population or sample of participants of review sources Articles were included only on the basis that they were empirical research The particular outcome expected in the study was to establish that the screening tools used are effective or ineffective. Only articles whose findings maintained this course were included. | Articles older than ten years were automatically excluded. Articles that deviated from the expected outcomes or did not discuss the outcome at in-depth were left out. Non-peer reviewed articles were automatically left out when the study focused on retri8eving the articles from medical and approved research databases like PubMed. |
| Assessment | Nathan Brummel Jin Ho Han Leanne Boehm Brenda Pun E. Wesley Ely Eduard Vasilevskis | ||
| Screening | Ishii et al. | ||
| Screening Tools | TF Kallenbach LA Amado | ||
| Elderly | Gusmao-Flores Figueira Salluh RT Chalhub LC Quarantini | ||
| Prevention | |||
| ICDSC | |||
| DSM | |||
| CAM-ICU |
| Boolean Operator | Where used |
| AND | The Clinical Judgment of ICDSC, DSM, and ICD |
| OR | Simple screening tools or ICDSC |
| NOT | Why is the DSM criterion not as effective as the Intensive Care Delirium Screening Checklist? |
| Quotation Marks “ “ | “Systematic Review” |
| Citation | Conceptual Framework/ Theory | Main Finding | Research Method | Strengths of the Study | Weaknesses | Level of Evidence |
| Brummel, Eduard, Jin, Leanne, Brenda, and Wesley (2013) | The theory of organ dysfunction in ICU settings | The authors examined the secret to the successful implementation of screening tools in the ICU. Their findings suggest that the implementation of the screening tools is feasible, and the success of the process lies in routine screening of the patients. CAM-ICU and ICDSC are found to be some of the commonly used screening tools with excellent validity. The long-term effectiveness of the tools, however, depends on the methods of implementation adopted, such as a change in cultures that perceive delirium as an abnormal illness. | Authors reviewed the literature on delirium and compared the findings with expert opinion | The objective of the research is stated. The use of expert opinion makes the study simple to follow through | Expert opinions are subject to bias as they are quite subjective | Level VII-Expert Opinion |
| Gusmao-Flores, Salluh, Chalhub, and Quarantini (2012) | The authors gave a conceptual organization of the selection process for the articles reviewed in their study | The authors reviewed nine studies that examined CAM-ICU and four studies that examined ICDSC. CAM-ICU reported an average effectiveness of 80% while ICDSC scored an average efficacy of 74% | The authors used a systematic review to evaluate data on CAM-ICU and ICDSC on articles sampled from various databases. The results from the articles were compared with the results of the DSM-IV criteria previously used. Meta-analysis was employed to summarize the findings. | The authors give a detailed conceptual framework on the inclusion and exclusion criteria. Article selection was made concurrently | The critical synthesis of the findings in an unbiased manner makes the study quite authentic and relevant to this research | Level 1-Systematic review and meta-analysis |
| Ishii et al. (2018) | Theory: Tele-ICU is associated with reduced mortality | The authors examined the effectiveness of combining CAM-ICU with ICDSC in assessing geriatric patients with delirium. On an independent assessment using the ICDSC tool, the tool recorded 50.8% effectiveness. In combination with CAM-ICU, the tools recorded effectiveness of 65.4%, suggesting that the success of the screening depends on the number of screening tools used. | A prospective observational study. The nurses assessed all patients admitted to the ICU using each tool independently after every eight hours. Each patient was evaluated using CAM-ICU and ICDSC. The patients were later assessed using the DSM-V manual. | There is a clear statement of objective. The data collection is described in details which include prospective observation | Authors fail to mention whether a conflict of interest was established which could have interfered with observational processes | Level IV-Prospective observation of patients admitted and assessed through the screening tools |
| Jayita and Wand (2015) | There are no detailed conceptual and theoretical frameworks | CAM-ICU had a higher concentration in research, followed by the revised version of the DRS-R-98. The CAM-ICU tool was associated with greater excellence in reporting delirium signs than other delirium screening tools. The tool reported 95% effectiveness across all the studies making it the most effective tool for assessment among the elderly | The authors performed a systematic review of the sampled articles and carried out a meta-analysis of the results. They obtained their articles for review from CINHAL and MEDLINE. They developed search criteria using the Boolean thread. STARD was then used to assess the quality of data reporting. | The researchers followed a detailed process to obtain the sample articles that were included for review. The critical synthesis of the findings in an unbiased manner makes the study quite authentic and relevant to this research | The authors do not state if publication bias was considered while selecting the articles for review. The possibility that the credibility of the selected samples was undermined is quite high | Level I-Systematic review and meta-analysis |
| Kallenbach and Amado (2017) | The authors applied the theories of cerebral inflammation Cerebral hypoperfusion, Imbalance of neurotransmitters Cerebral hypohypoxaemia, and Genetics | The authors evaluated the mode of assessment of delirium among geriatric patients admitted to ICU. They used the ICDSC and CAM-ICU as the main tools of examination. Their findings indicate that the two tools were the most commonly used. The results also suggested that ICDSC was more effective than CAM-ICU. The ICDSC was easier to use and can be used by any nurse without the intervention of a specialist. | The authors employed the explorative research design, which facilitated the review of the literature in-depth. CAM-ICU and ICDSC are the primary tools explored
| The research provides a comprehensive the two main screening tools, delirium and the theories connecting delirium to organ failure among the geriatric population | The research lacks a study sample or secondary data from which reference can be made to ascertain the validity of the research conclusion | Level V- Evidence from systematic reviews of multiple literature |
A Summary of History and Purpose of Research Question
There has been developing attention and focus on delirium, dementia, and depression among the geriatric population in the last few decades Lawlor and Shirley (2014) note the diagnostic criteria for delirium and other mental disorders are updated almost yearly. However, Delirium is characterized by a history of negligence so that its clinical characteristics have not been fully and adequately correlated to its outcomes. The screening techniques gaining attention in recent years are under-researched. Evidently, there are various screening tools ranging from DSM, ICD, ICDSC, CAM-ICU. DRS-R-98, MDAS, and Nu-DESC, among others. Yet, the most commonly used and researched screening tools are CAM-ICU and ICDSC. This trend and attitude present the two dominant tools with a high level of effectiveness. This study purposed to establish the efficacy of ICDSC, alongside CAM-ICU against other authentic tools like DSM and ICD.
The Strengths and Weaknesses of the Existing Literature.
| Strengths
| Weaknesses |
| The literature on CAM-ICU and ICDSC is exhaustive and numerous. This makes it easier to carry out a comparative analysis of the two tools vs. the rest and compare the findings of various authors against each other to establish the validity | There is a gap in literature examining delirium among the elderly. The majority of the existing literature is quite recent creating a difference between modern mental health and traditional mental health |
| The literature on delirium, despite being limited, explore the complication at in-depth touching dynamics of attack, effects, prevalence, diagnosis, management, and screening, especially among the geriatric population | Much of the literature on the screening tools is focused on ICDSC and CAM-ICU. There are several screening tools whose effectiveness can be established by exhaustive literature. The inadequacy in literature exploring the other tools makes it quite hard to explore them as feasible tools in healthcare. |
References
Brummel, N. E., Eduard, V. E., Jin, H. H., Leanne, B., Brenda, P. T., & Wesley, E. E. (2013). Implementing Delirium Screening in the Intensive Care Unit: Secrets to Success. Critical Care Medicine.
Gusmao-Flores, D., Salluh, F. J., Chalhub, R., & Quarantini, L. (2012). The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies.
Ishii, K., Ono, K., Hidaka, H., Koyama, Y., Fujishige, A., Arai, M., et al. (2018). The Effectiveness of a Delirium Assessment Method that Combines ICDSC and CAM-ICU. Critical Care Medicine.
Jayita, D., & Wand, A. P. (2015). Delirium Screening: A Systematic Review of delirium Screening Tools in Hospitalized Patients. The Gerontologist.
Kallenbach, T., & Amado, L. (2017). Assessment of delirium in the intensive care unit. Southern African Journal of Anaesthesia and Analgesia.
Kukreja, D., Günther, U., & Popp, J. (2015). Delirium in the elderly: current problems with increasing geriatric age. Indian Journal of Medical Research.
Lawlor, P. G., & Shirley, B. H. (2014). Delirium diagnosis, screening, and management. Current Opinion in Supportive and Palliative Care.