Monika Halicka

Nonpharmacological Interventions Targeted at Delirium Risk Factors, Delivered by Trained Volunteers (Medical and Psychology Students), Reduced Need for Antipsychotic Medications and the Length of Hospital Stay in Aged Patients Admitted to an Acute Internal Medicine Ward: Pilot Study

Purpose. Effectiveness of nonpharmacological multicomponent prevention delivered by trained volunteers (medical and psychology students), targeted at delirium risk factors in geriatric inpatients, was assessed at an internal medicine ward in Poland. Patients and Methods. Participants were recruited to intervention and control groups at the internal medicine ward (inclusion criteria: age ≥ 75, acute medical condition, basic orientation, and logical contact on admission; exclusion criteria: life expectancy < 24 hours, surgical hospitalization, isolation due to infectious disease, and discharge to other medical wards). Every day trained volunteers delivered a multicomponent standardized intervention targeted at risk factors of in-hospital complications to the intervention group. The control group, selected using a retrospective individual matching strategy (1u2009:u20091 ratio, regarding age, gender, and time of hospitalization), received standard care. Outcome Measures. Hospitalization time, deaths, falls, delirium episodes, and antipsychotic prescriptions were assessed retrospectively from medical documentation. Results. 130 patients (38.4% males) participated in the study, with 65 in the intervention group. Antipsychotic medications were initiated less frequently in the intervention group compared to the control group. There was a trend towards a shorter hospitalization time and a not statistically significant decrease in deaths in the intervention group. Conclusion. Nonpharmacological multicomponent intervention targeted at delirium risk factors effectively reduced length of hospitalization and need for initiating antipsychotic treatment in elderly patients at the internal medicine ward.

Investigating the spatial characteristics of the crossmodal interaction between nociception and vision using gaze direction

The present study investigated the influence of nociceptive stimuli on visual stimuli processing according to the relative spatial congruence between the two stimuli of different sensory modalities. Participants performed temporal order judgments on pairs of visual stimuli, one presented near the hand on which nociceptive stimuli were occasionally applied, the other one either to its left or to its right. The visual hemifield in which the stimulated hand and the near visual stimulus appeared was manipulated by changing gaze direction. The stimulated hemibody and the stimulated visual hemifield were therefore either congruent or incongruent, in terms of anatomical locations. Despite the changes in anatomical congruence, judgments were always biased in favor of the visual stimuli presented near the stimulated hand. This indicates that nociceptive-visual interaction may rely on a realignment of the respective initial anatomical representations of the somatic and retinotopic spaces toward an integrated, multimodal representation of external space.

Factors Contributing to Memory of Acute Pain in Older Adults Undergoing Planned and Unplanned Hip Surgery

Objectives: Previous research on pain memory provides inconsistent evidence about the accuracy of pain recall, and few studies have attempted to examine broad affective and contextual contributions to this phenomenon. The present research aimed to determine the accuracy of postoperative pain recall after 3 months, with respect to the context of the surgery and the congruence of affective states concurrent with the initial experience and its recall. The study also aimed to identify predictors of remembered pain by analyzing a range of sensory, cognitive, and affective factors. Methods: Older adults, undergoing planned (N=40) and unplanned hip surgery (N=31), were enrolled in this prospective study to investigate their presurgery, postsurgery, and delayed ratings of expected, experienced, and recalled pain intensity and unpleasantness, state anxiety, and positive and negative affect. Results: Memory of postoperative pain was found to be accurate, regardless of the context of the surgery. Affective states in the postoperative period were congruent with those during pain recall. The study also revealed that in planned surgery context, remembered pain was predicted by experienced postoperative pain, cognitive functions, positive and negative affect; whereas in unplanned surgery context its significant predictors included age, anxiety, and negative and positive affect. Discussion: The results of this study suggest that older orthopedic patients remember postoperative pain correctly after 3 months and that mood dependence effect may contribute to memory of pain. Pain recall after planned surgery seems to depend mainly on the actual experience, while following unplanned surgery it depends on affective factors. Present findings contribute to knowledge about pain memory in older adults and have implications for patients’ recovery and best practice in perioperative hospital care.