Thesis (doctoral)--Universität Erlangen.

No description available.

Thesis (doctoral)--Universität Jena, 1906. / Bibliography: p. [5]-8.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Introduction: Patients who develop delirium while hospitalized are increasingly recognized as at risk for the development of long term cognitive impairment. We became interested in the contribution of delirium to the development of post-operative cognitive dysfunction (POCD) when we found that patients at Mayo Clinic in Arizona, compared to patients at the Mayo facilities in Rochester, MN, were 17 times more likely to receive the drug physostigmine (Antilirium®) for the treatment of delirium in the Post Anesthesia Care Unit (PACU). However, before we could examine the relationship between delirium and POCD we needed to validate a tool we could use to quickly assess the presence of delirium in patients emerging from anesthesia in the PACU. Hypothesis: The Confusion Assessment Method in the Intensive Care Unit (CAM-ICU) can be used in the PACU to identify patients with delirium. Methods: Patients 65 years of age or greater who were going to have a standardized general anesthetic for a surgical procedure were identified on the day of surgery and consent to participate in the study was obtained. The CAM-ICU was used preoperatively to determine study eligibility (patients who scored less than 7 [scale of 1-10], indicating delirium, on the test were not followed further) and postoperatively, one hour after the patient was admitted to the PACU, to assess for delirium. The CAM-ICU was administered after we asked the patient’s nurse whether or not he or she had determined that the patient was delirious. Results: 168 patients, mean age 75 ± 7 (SD) with the majority of participants having urologic or orthopedic procedures were assessed pre- and post-operatively with the CAM-ICU, and post-operatively by a nursing assessment for delirium. The CAM-ICU took little time to administer and was easy for patients to understand and use. The nurse at the bedside identified 5 of 168 patients as delirious (prevalence of 2.98%). The CAM-ICU was positive for delirium in 11 of 168 (6.55%). The CAM-ICU had a sensitivity of 60% (3/5) and a specificity of 95% (155/163). Conclusion: In this investigation, the CAM-ICU was easy to use and had a high specificity for identifying post-operative delirium.

No description available.

No description available.

Thèse d'exercice : Médecine. Médecine générale : Paris 12 : 2004. / Titre provenant de l'écran-titre. Bibliogr. f. 99-104.

L’entrée à la « grande école » représente un passage : de l’école maternelle à l’école élémentaire, il s’agit symboliquement pour l’enfant de se séparer davantage de ses parents et d’entrer sur la voie des apprentissages. Or, quelquefois le développement de troubles comportementaux est corrélé à ce passage. Parmi les enfants qui présentent de tels troubles certains sont soumis à un secret de filiation. La situation d’apprentissage, en encensant le savoir, fait flamber la problématique de l’enfant concernant ses origines et génère un conflit intrapsychique qui se traduit dans le comportement explosif. L’enfant doute d’être le rejeton de ses parents et il les soupçonne de dissimuler « la vérité ». Il est partagé entre le désir et l’interdit de savoir. Les parents font obstacle à la transmission de ce savoir car leur relation avec l’enfant s’est fondée sur un mensonge par omission et ils craignent d’être désavoués si l’enfant apprenait qu’ils ont menti. Malgré les mots tus et les non-dits, la relation aux savoirs scolaires n’est pas entachée ; au contraire, les enfants sont avides de connaissances. Mais face au silence de sa famille, la résistance de l’enfant s’érige dans son corps et son langage subversifs : à l’école, la relation aux autres est investie sur un mode agressif, revendicatif et le mensonge est presque une seconde nature. Toutefois, révéler le secret de filiation n’a pas les effets escomptés pour l’école ; c’est-à-dire la disparition du trouble du comportement. L’enfant ne renonce pas facilement aux bénéfices secondaires que lui procurait son symptôme. D’autre part, le fonctionnement psychique de l’enfant s’était clivé à partir de la dichotomie entre famille, lieu du secret, et école, lieu du savoir ; un temps de latence est donc logiquement nécessaire, suite à la révélation du secret, pour que l’enfant puisse réaliser un travail de réélaboration psychique de sa place dans la généalogie et l’histoire familiale. Pourtant, le risque d’une rupture entre institution scolaire et famille est constamment présent avec le spectre d’une exclusion de l’école, voire d’une déscolarisation. / Entry to “Grade School” represents a passage : from Pre-School to Elementary School. It is symbolic for the child to be separated from his parents. Sometimes, the development of behavioral troubles is correlated to this passage. Among children who show such troubles, some face to a “secret of filiation”. The situation of apprenticeship, by praising the knowledge, lights the fire of his own origins and leads an intrapsychic conflict. Child doubts to be the “offspring” of the parents and suspects them to hide “the Truth”. He is torn between the desire and the prohibition of Knowledge. Parents interfere with this transmission of knowledge because their relationship, with the child, is based on a lie by omission. They are feared to be disowned by their child if he knew that they were lying. Despite the “silent an unspoken words”, the desire of knowledge is not questioned. Children are hungering for knowledge. But, in front of the family silence, the resistance of the child is erecting in his body and in his subversive language : in school, the relationship with the other is invested on an aggressive stance and the lie is almost a second nature. However, exposing the “secret of filiation” does not having the desired effects. That is : there is no disappearance of behavioral troubles. On the one hand, the child does not give up easily on his problem. On the other hand, his psychic functioning was cleft from the dichotomy between the family as a place of secret, and the school, as a place of knowledge ; latency is therefore necessary, following the exposure of the secret, so that the child can realise a psychic reorganization from his place in genealogy and family history. However, the risk of rupture between school institution and family constantly exists with the spectrum of school exclusion.

The purpose of this thesis is twofold: to explicate and to translate into English Celebrando la ceremonia de la confusión by Fernando Arrabal. / Arts, Faculty of / English, Department of / Graduate

Delirium in adults aged 65 and older is a common occurrence in the acute care setting and is often unrecognized by bedside nurses. Delirium can trigger a negative cascade of events resulting in an increase in morbidity and mortality, functional decline, longer length of stay, and high rates of post hospital institutionalization and has a significant socioeconomic impact. The purpose of this quality improvement project was to establish a solid foundation using scholarly literature to support the development of a delirium prevention, recognition, and treatment program in the medical-surgical acute care setting applying the program logic framework. The goal was accomplished by developing a structured program to enhance nurse education (phase 1) using a pretest/posttest design. Phase 2 will be implemented at a later date. The null hypothesis for the project was there is no difference between the pretest group knowledge of delirium scores and the posttest group scores following education. The results of the 36-paired pretests/posttests indicated a significant difference (p < 0.05) following the educational PowerPoint on delirium. Providing education and opportunities for bedside nurses to apply this new knowledge is an effective strategy to increase the identification of delirium, which can lead to improved patient outcomes, reduced socioeconomic burden associated with delirium, and increased positive social change. The economic impact of delirium is considerable with the average cost per day of delirium patients reaching nearly 3 times the cost of patients not having delirium. The elderly population is projected to continue to rise, which will have a profound impact on hospitals and health care as a whole.