IndraLab
Statements
sparser
"Participants’ knowledge of the intervention and post-surgical management was tested via Knowledge Expectations of significant others (KEso) and Received Knowledge of significant others (RKso) [ xref ]; confusion assessment method (CAM) and family version (FAM-CAM) [ xref ] were used to measure empowering by knowledge."
sparser
"TRADE consists of three parts
(CCI), Patient Health Questionnaire 4 (PHQ-4), Numeric Rating Pain Scale (NRS)*, Pittsburgh Sleep Quality Index (PSQI), Simplified nutritional appetite questionnaire (SNAQ), Mini Nutritional Assessment-Short Form (MNA-SF)*, Lubben-6 Social Network Skala (LSNS-6), Clinical Frailty Scale (CSHA), Informant Questionnaire on Cognitive Decline (IQCODE), Delirium risk factors (including alcohol, history of falls, sensory impairment, subjective cognitive decline, pain, history of delirium), ICD-10 supplemented Confusion Assessment Method Severity Score (I-CAM-S), 3-Minute Diagnostic Interview for Confusion Assessment Method defined Delirium (3D-CAM) *, Bedside Confusion Scale (BCS)*, Montreal Cognitive Assessment (MoCA), Nurses Delirium Rating Scale (Nu-DESC), Single Question in Delirium (SQiD) with Nurse and Caregiver*, Family-Confusion Assessment Method (FAM-CAM), Barthel Index (BI), Instrumental Activities of Daily Living (IADL)
Study timelines."
sparser
"Among patients with dementia, the FAM-CAM showed higher sensitivity (with dementia, 61%; 95% CI: 41 % - 81% versus without dementia, 43%; 95% CI: 6% - 80%) and lower specificity (with dementia, 74%; 95% CI: 60% - 89% versus without dementia, 91%; 95% CI: 82% - 99%; xref ) and lower LR+ (with dementia 2.2; 95% CI: 0.7 – 3.6 versus without dementia 5.6 95% CI: −1.1, - 12.3)."
sparser
"Dans cette étude quasi expérimentale avant après, les membres éligibles consécutifs de familles de patients en état critique admis dans une USI ont pris part à une formation familiale sur le delirium à deux volets : 1) le visionnement d’une vidéo de six minutes sur le delirium à l’USI (facteurs de risque, prévention/prise en charge, symptômes, communication avec l’équipe de soins de l’USI), et 2) deux vignettes pour pratiquer le dépistage du delirium à l’aide de questionnaires de dépistage du delirium administrés par la famille (Méthode d’évaluation de la confusion par la famille [FAM-CAM] et Questionnaire de dépistage du delirium ‘ Sour Seven ’)."
sparser
"The Confusion Assessment Method (CAM) is the most widely used standardized method for the identification of delirium with high sensitivity (94–100%) and specificity (90–95%). xref A version of the CAM for family members and informal caregivers, the Family Confusion Assessment Method (FAM-CAM), has been validated in outpatient and medical inpatient settings. xref , xref The FAM-CAM is completed by family caregivers with the goal of guiding them through describing their observations on the key symptoms of delirium."
sparser
"In this pre-test post-test quasi-experimental study, consecutive eligible family members of critically ill patients admitted to an ICU completed an ICU Family Education Delirium intervention in two parts: 1) six-minute video on ICU delirium (risk factors, prevention/management, symptoms, communication with the ICU care team), and 2) two case vignettes to practice detecting delirium using family-administered delirium detection questionnaires (Family Confusion Assessment Method [FAM-CAM] and Sour Seven)."
sparser
"First, there is a potential bias as one
of the authors (S.K.I.) is a creator or co-creator of four delirium identification
instruments found in our review [CAM, Chart Delirium Identification (CHART-DEL),
Family-Confusion Assessment Method (FAM-CAM), and 3-Minute Diagnostic Assessment
(3D-CAM)]."
sparser
"In adjusted models controlling for age, sex, IQCODE, Emergency Severity Index at triage, and Charlson score, patients who had a hospitalization over the next 6 months were more than three times as likely to have had a positive FAM-CAM score than those who did not have a hospitalization (OR = 3.24, 95% CI = 1.2, 8.9) ( xref )."
sparser
"To complete the intervention, participants were asked to review two case vignettes of hypothetical ICU patients to determine whether the patients had delirium using the previously validated familyadministered delirium detection questionnaires, the Family Confusion Assessment Method (FAM-CAM) and the Sour Seven."
sparser
"Charlson Comorbidity Index (CCI), Patient Health Questionnaire 4 (PHQ-4), Numeric Rating Pain Scale (NRS)*, Pittsburgh Sleep Quality Index (PSQI), Simplified nutritional appetite questionnaire (SNAQ), Mini Nutritional Assessment-Short Form (MNA-SF)*, Lubben-6 Social Network Skala (LSNS-6), Clinical Frailty Scale (CSHA), Informant Questionnaire on Cognitive Decline (IQCODE), Delirium risk factors (including alcohol, history of falls, sensory impairment, subjective cognitive decline, pain, history of delirium), ICD-10 supplemented Confusion Assessment Method Severity Score (I-CAM-S), 3-Minute Diagnostic Interview for Confusion Assessment Method defined Delirium (3D-CAM) *, Bedside Confusion Scale (BCS)*, Montreal Cognitive Assessment (MoCA), Nurses Delirium Rating Scale (Nu-DESC), Single Question in Delirium (SQiD) with Nurse and Caregiver*, Family-Confusion Assessment Method (FAM-CAM), Barthel Index (BI), Instrumental Activities of Daily Living (IADL)
Table 2: Stepped wedge design and intervention entry in the pilot intervention trial."
sparser
"HELP Program -Reasons for deferred visits Family and Caregivers -Reasons for deferred FAM-CAM completion HELP staff unavailable Family unavailable for assessment Patient engaged with other clinical staff Patient engaged with other clinical staff Undergoing medical testing or procedure Undergoing medical testing or procedure HELP, Hospital Elder Life Program; FAM-CAM, Family Confusion Assessment Method."
sparser
"While a larger sample size would significantly improve the power of the study, this was not possible due to (1); a high proportion of patient-carer pairs not providing consent, and (2); factors which did not allow for the FAM-CAM interview to be administered 24–48 h pre and post procedure (i.e. procedures being brought forward)."
sparser
"As for informant-based tools such as the Single Question in Delirium (SQiD) which asks ‘ Is this patient more confused than before ’, the FAM-CAM has the benefit of including information on additional features of delirium while not adding burden to the clinicians in the ED. xref The FAM-CAM may be especially helpful in cases when patients present with ‘confusion’ or altered mental status’ as the chief complain associated with the ED visit, common in our cohort, and in patients with dementia where confusion may be part of the patient’s baseline."
sparser
"In contrast, both the Steis and Martins teams offered intensive training for family caregivers that would not be practical in an ED setting. xref , xref In the Bull study, family caregivers were trained in the three weeks before their family member’s elective surgery, to increase their knowledge of delirium and the use of the FAM-CAM. xref Another important distinction between our study and the previous validations of the FAM-CAM was our double blinding of ratings of caregivers and research staff."
sparser
"The SQiD asks, “Do you think [name of patient] has been more
confused lately?” and has comparable diagnostic test characteristics (77%
sensitive and 88% specific for ED delirium). xref Mailhot et al note that one of the benefits of
the FAM-CAM over the SQiD is that the FAM-CAM provides information on all 4 domains of
delirium, whereas the SQiD only provides information on the first feature in delirium,
namely an acute change in cognition."
sparser
"Recent studies showed that administering two family-administered delirium detection tools (Family Confusion Assessment Method [FAM-CAM] and Sour Seven) among critically ill patients is feasible but has fair but lower diagnostic accuracy than clinical assessments using the Intensive Care Unit Delirium Screening Checklist (ICDSC) and Confusion Assessment Method for the ICU (CAM-ICU). xref Nevertheless, perspectives and expectations of family members and the ICU team on delirium detection by the family have not been explored."
sparser
"For family-based interventions, the following measures will be reported: cumulative time family members spent with patients, proportion of daily tasks (e.g., assistance with glasses/hearing aids, handwashing), successfully completed, length of time spent on stimulating activity, and overall agreement of the FAM-CAM with interview-rated CAM assessments."
sparser
"Preoperative education on recognizing delirium symptoms prepares family members to identify postoperative delirium and reduces caregiver distress. xref , xref The Family Confusion Assessment Method (FAM-CAM) xref is an adaptation of the Confusion Assessment Method (CAM), xref a widely-used delirium screening tool."
sparser
"During telephone interviews, the following tests were conducted: the Patient-Reported
Outcomes Measurement Information System (PROMIS) 13 Cognitive Function Abilities 4a, Short Blessed Test (score 0-4 = normal cognition, score 5-9 = questionable impairment, score ≥10 = impairment consistent with dementia), 14 Family Confusion Assessment Method (FAM-CAM) for delirium, 15 and the Patient Health Questionnaire-9
(scores ≥10 were considered positive screens for depression)."
sparser
"In this issue of CCM, Fiest et at [ref] present results from a diagnostic accuracy study in which they test two family administered delirium screening tools, the Family Confusion Assessment Method (FAM-CAM) ( xref ), and the Sour Seven ( xref ) against the diagnosis of delirium according to the Diagnosis and Statistical Manual of Mental Disorders, Edition 5 (DSM-5)."
sparser
"The fact that the FAM-CAM performed with 77% specificity (compared to 83% specificity for the CAM-ICU) suggests that within the ICU setting, family proxies using this screening tool have a capacity to identify acute delirium that approaches that of experienced and trained providers."
sparser
"The sensitivity of delirium detection by ED providers may be as low as 20%, and other tools that have been examined, such as the modified Richmond Agitation Sedation Scale, have also demonstrated moderate to low sensitivity in the ED setting (70%; 95% CI: 48%; 85%), especially among patients with dementia (55%; 95% CI: 28%; 79%) and there is no family-member equivalent to augment clinician assessments. xref , xref Although the sensitivity and likelihood ratios of the FAM-CAM were modest, it shows promise in increasing delirium detection if supplemented to current systematic screening strategies suggested in best practice guidelines."
sparser
"Inattention, which is easily measured at the bedside, was identified as a symptom of delirium that family members have difficulty identifying and was responsible for 66% of family members’ missed cases of delirium. xref In addition, the sensitivity of the FAM-CAM was higher in patients with dementia compared to those without dementia, highlighting the ability of family members to detect delirium manifestations (e.g., acute change) in a population that is challenging to assess in the ED."
sparser
"The CAM was initially designed for evaluating an acute confusion state, called delirium, among older hospitalized patients to decrease their morbidity and mortality, and then the FAM-CAM was further developed to be less time intensive and more user-friendly, which could be administered to FCPs either in person, by telephone, or electronically based on their observations ( xref )."
sparser
"Among older persons with pre-existing cognitive impairment, Steis et al reported high sensitivity (88%, 95% CI: 47–99) and specificity (98%, 95% CI: 86–100) of the FAM-CAM against the CAM. xref Similarly, among hospitalised older patients, Martins et al used the Portuguese version of the FAM-CAM and also observed high sensitivity (91%, 95% CI:74–97) and specificity (91%, 95% CI:74–97) against the CAM and against the DSM-IV-TR criteria (sensitivity: 75%, 95% CI:35–95; specificity: 86%, 95% CI:42–99). xref Finally, in a study conducted by Bull et al among post-knee or hip surgery patients, a Kappa of 0.47 was observed between the FAM-CAM and the CAM. xref The current study differs from these previous studies in several ways, in particular with regards to the training of family caregivers who completed the FAM-CAM and the blinding of assessors."
sparser
"Although FAM-CAM screening would require approximately an hour of staff training and additional per-patient time to distribute the FAM-CAM to families and interpret the results, it is a relatively simple tool and interpretation is quick and straightforward since the FAM-CAM is designed for use by non-medically trained caregivers."
sparser
"There are three existing tools that can be independently completed by family caregivers – the FAM-CAM, the informant Assessment of Geriatric Delirium (I-AGeD) and the Sour Seven. xref – xref A strength of the FAM-CAM is that it allows families to systematically report their observations of features of delirium, as well as to detail when the changes (i.e., whether or not the changes were acute or progressive) began and if they have been getting better or worse (items 8 to 11)."
sparser
"For peer review only -http://bmjopen.bmj.com/site/about/guidelines.xhtml
Post-Discharge Neuropsychological Outcomes † FAM-CAM Family-based Confusion Assessment Method for delirium, PROMIS Patient-Reported Outcomes Measurement Information System, PHQ Patient Health Questionnaire."
sparser
"During telephone interviews, the following tests were conducted: the Patient-Reported Outcomes Measurement Information System (PROMIS)17 Cognitive Function Abilities 4a, Short Blessed Test (score 0–4=normal cognition, score 5–9=questionable impairment, score ≥10 = impairment consistent with dementia),18 Family Confusion Assessment Method (FAM-CAM) for delirium19 and the Patient Health Questionnaire-9 (scores ≥10 were considered positive screens for depression)."