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[PMID]: 29523900
[Au] Autor:Hughes CG; Patel MB; Brummel NE; Thompson JL; McNeil JB; Pandharipande PP; Jackson JC; Chandrasekhar R; Ware LB; Ely EW; Girard TD
[Ad] Address:Department of Anesthesiology, Division of Anesthesiology Critical Care Medicine and Center for Health Services Research, Vanderbilt University Medical Center, Nashville, USA. christopher.hughes@vanderbilt.edu.
[Ti] Title:Relationships between markers of neurologic and endothelial injury during critical illness and long-term cognitive impairment and disability.
[So] Source:Intensive Care Med;, 2018 Mar 09.
[Is] ISSN:1432-1238
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: Neurologic and endothelial injury biomarkers are associated with prolonged delirium during critical illness and may reflect injury pathways that lead to poor long-term outcomes. We hypothesized that blood-brain barrier (BBB), neuronal, and endothelial injury biomarkers measured during critical illness are associated with cognitive impairment and disability after discharge. METHODS: We enrolled adults with respiratory failure and/or shock and measured plasma concentrations of BBB (S100B), neuronal (UCHL1, BDNF), and endothelial (E-selectin, PAI-1) injury markers within 72 h of ICU admission. At 3 and 12 months post-discharge, we assessed participants' global cognition, executive function, and activities of daily living (ADL). We used multivariable regression to determine whether biomarkers were associated with outcomes after adjusting for relevant demographic and acute illness covariates. RESULTS: Our study included 419 survivors of critical illness with median age 59 years and APACHE II score 25. Higher S100B was associated with worse global cognition at 3 and 12 months (P = 0.008; P = 0.01). UCHL1 was nonlinearly associated with global cognition at 3 months (P = 0.02). Higher E-selectin was associated with worse global cognition (P = 0.006 at 3 months; P = 0.06 at 12 months). BDNF and PAI-1 were not associated with global cognition. No biomarkers were associated with executive function. Higher S100B (P = 0.05) and E-selectin (P = 0.02) were associated with increased disability in ADLs at 3 months. CONCLUSIONS: S100B, a marker of BBB and/or astrocyte injury, and E-selectin, an adhesion molecule and marker of endothelial injury, are associated with long-term cognitive impairment after critical illness, findings that may reflect mechanisms of critical illness brain injury.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher
[do] DOI:10.1007/s00134-018-5120-1

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[PMID]: 29523559
[Au] Autor:Émond M; Boucher V; Carmichael PH; Voyer P; Pelletier M; Gouin É; Daoust R; Berthelot S; Lamontagne ME; Morin M; Lemire S; Minh Vu TT; Nadeau A; Rheault M; Juneau L; Le Sage N; Lee J
[Ad] Address:Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada.
[Ti] Title:Incidence of delirium in the Canadian emergency department and its consequences on hospital length of stay: a prospective observational multicentre cohort study.
[So] Source:BMJ Open;8(3):e018190, 2018 Mar 08.
[Is] ISSN:2044-6055
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:OBJECTIVE: We aim to determine the incidence of delirium and describe its impacts on hospital length of stay (LOS) among non-delirious community-dwelling older adults with an 8-hour exposure to the emergency department (ED) environment. DESIGN: This is a prospective observational multicentre cohort study (March-July 2015). Patients were assessed two times per day during their entire ED stay and up to 24 hours on hospital ward. SETTING: The study took place in four Canadian EDs. PARTICIPANTS: 338 included patients: (1) aged ≥65 years; (2) who had an ED stay ≥8 hours; (3) were admitted to hospital ward and (4) were independent/semi-independent. MAIN OUTCOMES AND MEASURES: The primary outcomes of this study were incident delirium in the ED or within 24 hours of ward admission and ED and hospital LOS. Functional and cognitive status were assessed using validated Older Americans Resources and Services and the modified Telephone Interview for Cognitive Status tools. The Confusion Assessment Method was used to detect incident delirium. Univariate and multivariate analyses were conducted to evaluate outcomes. RESULTS: Mean age was 76.8 (±8.1), 17.7% were aged >85 years old and 48.8% were men. The mean incidence of delirium was 12.1% (n=41). Median IQR ED LOS was 32.4 (24.5-47.9) hours and hospital LOS was 146.6 (75.2-267.8) hours. Adjusted mean hospital LOS was increased by 105.4 hours (4.4 days) (95% CI 25.1 to 162.0, P<0.001) for patients who developed an episode of delirium compared with non-delirious patient. CONCLUSIONS: An incident delirium was observed in one of eight independent/semi-independent older adults after an 8-hour ED exposure. An episode of delirium increases hospital LOS by 4 days and therefore has important implications for patients and could contribute to ED overcrowding through a deleterious feedback loop.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Data-Review
[do] DOI:10.1136/bmjopen-2017-018190

  3 / 22606 MEDLINE  
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[PMID]: 29523558
[Au] Autor:Kaufmann CP; Stämpfli D; Mory N; Hersberger KE; Lampert ML
[Ad] Address:Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
[Ti] Title:Drug-Associated Risk Tool: development and validation of a self-assessment questionnaire to screen for hospitalised patients at risk for drug-related problems.
[So] Source:BMJ Open;8(3):e016610, 2018 Mar 09.
[Is] ISSN:2044-6055
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:INTRODUCTION: Identifying patients with a high risk for drug-related problems (DRPs) might optimise the allocation of targeted pharmaceutical care during the hospital stay and on discharge. OBJECTIVE: To develop a self-assessment screening tool to identify patients at risk for DRPs and validate the tool regarding feasibility, acceptability and the reliability of the patients' answers. DESIGN: Prospective validation study. SETTING: Two mid-sized hospitals (300-400 beds). PARTICIPANTS: 195 patients, exclusion criteria: under 18 years old, patients with a health status not allowing a meaningful communication (eg, delirium, acute psychosis, advanced dementia, aphasia, clouded consciousness state), palliative or terminally ill patients. METHODS: Twenty-seven risk factors for the development of DRPs, identified in a previous study, provided the basis of the self-assessment questionnaire, the Drug-Associated Risk Tool (DART). Consenting patients filled in DART, and we compared their answers with objective patient data from medical records and laboratory data. RESULTS: One hundred and sixty-four patients filled in DART V.1.0 in an average time of 7 min. After a first validation, we identified statements with a low sensitivity and revised the wording of the questions related to heart insufficiency, renal impairment or liver impairment. The revised DART (V.2.0) was validated in 31 patients presenting heart insufficiency, renal impairment or liver impairment as comorbidity and reached an average specificity of 88% (range 27-100) and an average sensitivity of 67% (range 21-100). CONCLUSIONS: DART showed a satisfying feasibility and reliability. The specificity of the statements was mostly high. The sensitivity varied and was higher in statements concerning diseases that require regular disease control and attention to self-care and drug management. Asking patients about their conditions, medications and related problems can facilitate getting a first, broad picture of the risk for DRPs and possible pharmaceutical needs.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Data-Review
[do] DOI:10.1136/bmjopen-2017-016610

  4 / 22606 MEDLINE  
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[PMID]: 29523082
[Au] Autor:Kork F; Rimek A; Andert A; Becker NJ; Heidenhain C; Neumann UP; Kroy D; Roehl AB; Rossaint R; Hein M
[Ad] Address:Department of Anaesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany. fkork@ukaachen.de.
[Ti] Title:Visual quality assessment of the liver graft by the transplanting surgeon predicts postreperfusion syndrome after liver transplantation: a retrospective cohort study.
[So] Source:BMC Anesthesiol;18(1):29, 2018 Mar 09.
[Is] ISSN:1471-2253
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: The discrepancy between demand and supply for liver transplants (LT) has led to an increased transplantation of organs from extended criteria donors (ECD). METHODS: In this single center retrospective analysis of 122 cadaveric LT recipients, we investigated predictors of postreperfusion syndrome (PRS) including transplant liver quality categorized by both histological assessment of steatosis and subjective visual assessment by the transplanting surgeon using multivariable regression analysis. Furthermore, we describe the relevance of PRS during the intraoperative and postoperative course of LT recipients. RESULTS: 53.3% (n = 65) of the patients suffered from PRS. Risk factors for PRS were visually assessed organ quality of the liver grafts (acceptable: OR 12.2 [95% CI 2.43-61.59], P = 0.002; poor: OR 13.4 [95% CI 1.48-121.1], P = 0.02) as well as intraoperative norepinephrine dosage before reperfusion (OR 2.2 [95% CI 1.26-3.86] per 0.1 µg kg min , P = 0.01). In contrast, histological assessment of the graft was not associated with PRS. LT recipients suffering from PRS were hemodynamically more instable after reperfusion compared to recipients not suffering from PRS. They had lower mean arterial pressures until the end of surgery (P < 0.001), received more epinephrine and norepinephrine before reperfusion (P = 0.02 and P < 0.001, respectively) as well as higher rates of continuous infusion of norepinephrine (P < 0.001) and vasopressin (P = 0.02) after reperfusion. Postoperative peak AST was significantly higher (P = 0.001) in LT recipients with PRS. LT recipients with intraoperative PRS had more postoperative adverse cardiac events (P = 0.05) and suffered more often from postoperative delirium (P = 0.04). CONCLUSIONS: Patients receiving ECD liver grafts are especially prone to PRS. Anesthesiologists should keep these newly described risk factors in mind when preparing for reperfusion in patients receiving high-risk organs.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Data-Review
[do] DOI:10.1186/s12871-018-0493-9

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[PMID]: 29505513
[Au] Autor:Zou YQ; Li XB; Yang ZX; Zhou JM; Wu YN; Zhao ZH; Liu XZ; Hu CL
[Ad] Address:Department of Anesthesiology and Intensive Care Unit, the 476 Hospital of Fuzhou General Hospital.
[Ti] Title:Impact of inhalational anesthetics on postoperative cognitive function: Study protocol of a systematic review and meta-analysis.
[So] Source:Medicine (Baltimore);97(1):e9316, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Conflict findings of the impact of inhalational anesthetics on postoperative cognitive function are reported. No systematic review has been performed to solve the problem. The aim of the study was to assess the effect of different inhalational anesthetics on postoperative cognitive function in a network meta-analysis. METHODS: We will search MEDLINE, EMBASE, the Central Register of Controlled Trials in the Cochrane library, and CINAHL for randomized controlled trials or cohort studies assessing the short-term or long-term cognitive function of elderly patients (over 60 years) receiving major surgeries and inhalational anesthetics (desflurane, isoflurane, sevoflurane, halothane, and nitrous oxide) during surgery. Two reviewers will independently screen study eligibility, extract information from eligible studies, and appraise study quality. The impact of inhalational anesthetics will be assessed through: incidence of postoperative cognitive dysfunction at 1 week, 3 months, 1 year, and over 1 year after surgery; incidence of post-operative delirium; test of postoperative cognitive function. RESULTS: The results of this systematic review and meta-analysis will be published in a peer-reviewed journal. CONCLUSION: To our knowledge, this systematic review will be the first to evaluate existing research on the incidence of postoperative cognitive function after inhalational anesthetics. Our study will assess the effect of different inhalational anesthetics on postoperative cognitive function. ETHICS AND DISSEMINATION: The review will be finished in December 2017, and the result will be published in a peer-reviewed journal or disseminated through conference posters or abstracts. REVIEW REGISTRATION NUMBER: CRD42017056675 (www.crd.york.ac.uk/PROSPERO).
[Mh] MeSH terms primary: Anesthetics, Inhalation/adverse effects
Cognition/drug effects
[Mh] MeSH terms secundary: Humans
[Pt] Publication type:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Name of substance:0 (Anesthetics, Inhalation)
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:180306
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009316

  6 / 22606 MEDLINE  
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[PMID]: 29521857
[Au] Autor:McNeil J; Denis AM; Michel U; Concert CM
[Ad] Address:College of Health Professions, Pace University, New York, USA.
[Ti] Title:Effectiveness of non-pharmacological strategies for managing delirium in hospitalized postoperative adults: an umbrella review protocol.
[So] Source:JBI Database System Rev Implement Rep;16(3):594-602, 2018 Mar.
[Is] ISSN:2202-4433
[Cp] Country of publication:Australia
[La] Language:eng
[Ab] Abstract:REVIEW QUESTION/OBJECTIVE: The question of this review: What is the effectiveness of non-pharmacological strategies for the management of delirium in hospitalized adult postoperative patients?The objective of this umbrella review is to determine the effectiveness of non-pharmacological strategies for the management of delirium in adult postoperative patients, 18 years and over, in an acute care hospitalized setting.More specifically, the review aims to identify which non-pharmacological strategy/strategies, provided as a single strategy or combined as two or more strategies, is the most effective for management of delirium in hospitalized postoperative adult patients?
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Data-Review
[do] DOI:10.11124/JBISRIR-2017-003455

  7 / 22606 MEDLINE  
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[PMID]: 29521716
[Au] Autor:Donovan AL; Aldrich JM; Gross AK; Barchas DM; Thornton KC; Schell-Chaple HM; Gropper MA; Lipshutz AKM; University of California, San Francisco Critical Care Innovations Group
[Ad] Address:Division of Critical Care Medicine, Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA.
[Ti] Title:Interprofessional Care and Teamwork in the ICU.
[So] Source:Crit Care Med;, 2018 Mar 07.
[Is] ISSN:1530-0293
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVES: We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success. DATA SOURCES: Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives. Additional articles were identified through a review of the reference lists of identified articles. STUDY SELECTION: Original articles, review articles, and systematic reviews were considered. DATA EXTRACTION: Manuscripts were selected for inclusion based on expert opinion of well-designed or key studies and review articles. DATA SYNTHESIS: "Interprofessional care" refers to care provided by a team of healthcare professionals with overlapping expertise and an appreciation for the unique contribution of other team members as partners in achieving a common goal. A robust body of data supports improvement in patient-level outcomes when care is provided by an interprofessional team. Critical care nurses, advanced practice providers, pharmacists, respiratory care practitioners, rehabilitation specialists, dieticians, social workers, case managers, spiritual care providers, intensivists, and nonintensivist physicians each provide unique expertise and perspectives to patient care, and therefore play an important role in a team that must address the diverse needs of patients and families in the ICU. Engaging patients and families as partners in their healthcare is also critical. Many important ICU quality improvement initiatives require an interprofessional approach, including Awakening and Breathing Coordination, Delirium, Early Exercise/Mobility, and Family Empowerment bundle implementation, interprofessional rounding practices, unit-based quality improvement initiatives, Patient and Family Advisory Councils, end-of-life care, coordinated sedation awakening and spontaneous breathing trials, intrahospital transport, and transitions of care. CONCLUSIONS: A robust body of evidence supports an interprofessional approach as a key component in the provision of high-quality critical care to patients of increasing complexity and with increasingly diverse needs.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.1097/CCM.0000000000003067

  8 / 22606 MEDLINE  
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[PMID]: 29518791
[Au] Autor:Shen YZ; Peng K; Zhang J; Meng XW; Ji F
[Ti] Title:Effects of Haloperidol on Delirium in Adult Patients: A Systematic Review and Meta-analysis.
[So] Source:Med Princ Pract;, 2018 Mar 08.
[Is] ISSN:1423-0151
[Cp] Country of publication:Switzerland
[La] Language:eng
[Ab] Abstract:OBJECTIVE: The aim of this systematic review and meta-analysis was to investigate whether or not the use of haloperidol could reduce the incidence of delirium in adult patients. SUBJECTS AND METHODS: PubMed, Embase, the Cochrane Library, Elsevier, Wiley, and Ovid were searched for randomized controlled trials and prospective interventional cohort studies that compared haloperidol with placebo for delirium prophylaxis or with second generation antipsychotics for delirium treatment. The primary end point was the incidence and severity of delirium. After reviewing 272 relevant articles, ten studies with 1,861 patients were finally included (haloperidol versus placebo in 8 studies (n = 1734), and haloperidol versus second-generation antipsychotics in 2 studies (n = 127)). Revman 5.3 was used for the data analysis. RESULTS: Compared with placebo, a high dose of prophylactic haloperidol (≥ 5 mg/d) may help reduce the incidence of delirium in surgical patients (risk ratio (95% confidence interval), 0.50 (0.32, 0.79)). There were no differences in the duration of delirium, QTc interval prolongation, extrapyramidal symptoms, intensive care unit stay, hospital stay, or mortality between the haloperidol and placebo groups. For delirium treatment, haloperidol exhibited similar effects as the second-generation antipsychotics. CONCLUSIONS: In this study, the limited available data revealed that prophylaxis haloperidol at dose of ≥ 5 mg/d might help reduce delirium in adult surgical patients. Further outcome studies with larger sample sizes are required to confirm these findings.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1159/000488243

  9 / 22606 MEDLINE  
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[PMID]: 29498534
[Au] Autor:Skrobik Y; Duprey MS; Hill NS; Devlin JW
[Ad] Address:McGill University, Montreal, Quebec, Canada ; skrobik@sympatico.ca.
[Ti] Title:Low-dose Nocturnal Dexmedetomidine Prevents ICU Delirium: A Randomized, Placebo-controlled Trial.
[So] Source:Am J Respir Crit Care Med;, 2018 Mar 02.
[Is] ISSN:1535-4970
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:RATIONALE: Dexmedetomidine is associated with less delirium than benzodiazepines, and better sleep architecture than either benzodiazepines or propofol; its effect on delirium and sleep when administered at night to patients requiring sedation remains unclear. OBJECTIVES: To determine if nocturnal dexmedetomidine prevents delirium and improves sleep in critically ill adults. METHODS: This two-center, double-blind, placebo-controlled trial randomized 100 delirium-free critically ill adults receiving sedatives to receive nocturnal (21:30 to 6:15h) intravenous dexmedetomidine (0.2 mcg/kg/hr, titrated by 0.1 mcg/kg/hr every 15 minutes until a goal RASS = -1 or maximum rate of 0.7 mcg/kg/hr was reached) or placebo until ICU discharge. During study infusions, all sedatives were halved; opioids were unchanged. Delirium was assessed using the Intensive Care Delirium Screening Checklist every 12 hours throughout the ICU admission. Sleep was evaluated each morning by the Leeds Sleep Evaluation Questionnaire (LSEQ). MEASUREMENTS AND MAIN RESULTS: Nocturnal dexmedetomidine (versus placebo) was associated with a greater proportion of patients who remained delirium-free during the ICU stay [dexmedetomidine [40 (80%) of 50 patients] vs. placebo [27 (54%) of 50 patients] (RR = 0.44, 95% CI, 0.23 to 0.82, p=0.006). The average LSEQ score was similar [MD 0.02; 95% CI, 0.42 to 1.92] between the 34 dexmedetomidine (average 7 assessments/patient) and 30 placebo (6/patient) group patients able to provide ≥ 1 assessment. Incidence of hypotension, bradycardia or both did not differ significantly between groups. CONCLUSIONS: Nocturnal administration of low-dose dexmedetomidine in critically ill adults reduces the incidence of delirium during the ICU stay; patient-reported sleep quality appears unchanged. Clinical trial registration available at www.clinicaltrials.gov, ID NCT01791296.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[Cl] Clinical Trial:ClinicalTrial
[St] Status:Publisher
[do] DOI:10.1164/rccm.201710-1995OC

  10 / 22606 MEDLINE  
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[PMID]: 29408342
[Au] Autor:Vella Azzopardi R; Beyer I; Vermeiren S; Petrovic M; Van Den Noortgate N; Bautmans I; Gorus E; Gerontopole Brussels Study group
[Ad] Address:Gerontology department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090, Brussels, Belgium; Frailty in Ageing (FRIA) Research department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090, Brussels, Belgium; Department of Geriatrics, Universitair Ziekenhuis Brussel (UZ Brussel),
[Ti] Title:Increasing use of cognitive measures in the operational definition of frailty-A systematic review.
[So] Source:Ageing Res Rev;43:10-16, 2018 Feb 07.
[Is] ISSN:1872-9649
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Ageing is associated both with frailty and cognitive decline. The quest for a unifying approach has led to a new concept: cognitive frailty. This systematic review explores the contribution of cognitive assessment in frailty operationalization. PubMed, Web of Knowledge and PsycINFO were searched until December 2016 using the keywords aged; frail elderly; aged, 80 and over; frailty; diagnosis; risk assessment and classification, yielding 2863 hits. Seventy-nine articles were included, describing 94 frailty instruments. Two instruments were not sufficiently specified and excluded. 46% of the identified frailty instruments included cognition. Of these, 85% were published after 2010, with a significant difference for publication date (X = 8.45, p < .05), indicating increasing awareness of the contribution of cognitive deficits to functional decline. This review identified 7 methods of cognitive assessment: dementia as co-morbidity; objective cognitive-screening instruments; self-reported; specific signs and symptoms; delirium/clouding of consciousness; non-specific cognitive terms and mixed assessments. Although cognitive assessment has been increasingly integrated in recently published frailty instruments, this has been heterogeneously operationalized. Once the domains most strongly linked to functional decline will have been identified and operationalized, this will be the groundwork for the identification of reversible components, and for the development of preventive interventional strategies.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1802
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher


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