IndraLab

Statements


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sparser
"We compared clinical outcomes in the 6-months after enrollment by FAM-CAM status."

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
"FAM-CAM, Family-based Confusion Assessment Method for delirium; PHQ, Patient Health Questionnaire; PROMIS, Patient-Reported Outcomes Measurement Information System."

sparser
"As such, the Family Confusion Assessment Method (FAM-CAM) was developed to screen for delirium by interviewing family caregivers."

sparser
"Similarly, missing CAM and FAM-CAM data are expected as well."

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
"This study found an incidence of delirium to be 1.4% (2 of 141 patients) three to 5 days after surgery using the FAM-CAM tool."

sparser
"The FAM-CAM xref is an informant-based delirium assessment that may help EDs overcome the barriers to delirium screening by sharing the workload of screening with a caregiver, when available."

sparser
"The FAM-CAM had a specificity of 83% and NPV of 83%."

sparser
"Again, the majority of false negatives in patients with dementia (n=6 out of 9, 67%) were due to the caregiver not identifying inattention on the FAM-CAM."

sparser
"For concurrent validity, performance of the FAM-CAM was compared to the CAM."

sparser
"These studies should explore whether providing education on the FAM-CAM and Sour Seven improves a family member’s confidence and ability to detect delirium using these family-administered tools."

sparser
"Results from the FAM-CAM could then be used by clinicians to inform their own assessments for delirium and subsequent medical decision making."

sparser
"Additionally, while family members will receive basic training and education on FAM-CAM administration, they will not receive rigorous training for assessing reliability or accuracy."

sparser
"Efforts to improve the readability of the FAM-CAM and Sour Seven may improve family member’s understanding of the questionnaires and may improve their identification of disorganized thinking and altered level of consciousness."

sparser
"The majority of the false negatives (n=9 out of 13, 69%) were due to caregivers not identifying inattention on the FAM-CAM."

sparser
"The FAM-CAM had moderate sensitivity (57%; 95% confidence interval [CI]: 39% - 74%), but higher specificity (83%; 95% CI: 75% - 92%), when compared to the reference standard CAM, and acceptable NPV (83%) ( xref )."

sparser
"Un nombre plus élevé de membres des familles est parvenu à dépister correctement les symptômes de delirium dans les vignettes à l’aide du questionnaire Sour Seven (92 %) comparativement au FAM-CAM (78 %)."

sparser
"The FAM-CAM may help ED providers recognize delirium and could be used in conjunction with clinician’s delirium screening because the FAM-CAM obtains standardized information from family members who are often an untapped source of information."

sparser
"A validated, standardised chart review method was used to identify delirium23 and the study measures used to characterise cognitive function, such as the FAM-CAM, Short Blessed Test and PROMIS assessments, are standard measures that increase confidence in the results."

sparser
"We over-enrolled patients with a history of dementia allowing us to compare the validity of the FAM-CAM in this group that is clinically challenging and where family assessments may be particularly useful."

sparser
"What advantages does the FAM-CAM have over simpler informant-based delirium assessments, such as the Single Question in Delirium (SQiD)?"

sparser
"The aim of this study was to examine the performance of the family-rated FAM-CAM in the ED compared to the reference standard CAM rated by trained research interviewers and to determine whether the FAM-CAM performed similarly in patients with and without dementia."

sparser
"Two tools for family caregivers to detect delirium have been validated and deemed feasible to employ in ICU populations: the Family Confusion Assessment Method (FAM-CAM) and Sour Seven [ xref ]."

sparser
"FAM-CAM assessments will be requested once daily in the afternoon."

sparser
"In this issue of the Journal of the American Geriatric Society , Mailhot et al xref report on their study evaluating the FAM-CAM in the ED, enrolling 108 patient-caregiver dyads, of whom 55 patients had pre-existing dementia."

sparser
"FAM-CAM data in relation to CAM data is presented in xref for the overall sample and xref and xref respectively for patients with and without dementia."

sparser
"The secondary aim was to examine whether delirium identified by the FAM-CAM is associated with clinical outcomes over 6-months (ED readmission, hospitalization and mortality), as evidence of its predictive validity."

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
"Among patients with and without dementia, the FAM-CAM shows qualities that are important in the ED setting for identification of delirium."

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
"65 In community dwelling older patients with cognitive impairment (N=52) the FAM-CAM had a sensitivity of 88% (CI [47% - 99%]) and specificity of 98% (CI [86% - 100%])."

sparser
"The FAM-CAM consists of 11 items that characterize changes in attention, speech, arousal, and orientation and is completed by a patient’s family member or caregiver who knows the patient’s baseline mental and cognitive status well."

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
"xref presents the FAM-CAM data in relation to the CAM data for the overall sample, xref , for patients with dementia and xref for patients without dementia."

sparser
"Cohen’s kappa will be used to assess agreement between research-based CAM delirium assessments and FAM-CAM assessments."

sparser
"These approaches likely increased agreement between the FAM-CAM and CAM ratings. xref "

sparser
"Minimal explanation of the instrument is required as the FAM-CAM measure includes instructions and examples to guide the caregiver."

sparser
"The FAM-CAM is not meant to take the place of the clinical providers’ assessment, but rather as an adjunct tool, to educate family members in the recognition of delirium."

sparser
"In the current study, we did not provide any training to family caregivers, since we aimed to test the validity of the FAM-CAM under conditions that would increase the applicability of the results to real-world ED settings."

sparser
"No patients in the study population were found to have post-operative delirium 24–48 h after their procedure based on the FAM-CAM screening tool."

sparser
"By using the FAM-CAM rather than the SQiD, clinicians may choose to use only information on acute change or more detailed information in the setting of dementia or altered mental status."

sparser
"Family members of older patients in the ED were able to systematically complete a delirium screening tool, the FAM-CAM, independently, without an education session or support from research staff, and correctly rule out delirium in the majority of patients (NPV= 83%)."

sparser
"After watching the iFAM-ED video module, family members correctly classified delirium in 78% (95% CI, 69 to 85) and 92% (95% CI, 86 to 96) of the provided case vignettes using the FAM-CAM or Sour Seven, respectively."

sparser
"Based on the LR+ of 3.4, adding the FAM-CAM as a screening tool would increase detection of delirium by 28% overall. xref In patients with dementia (LR+2.2), it would increase detection by 20%, and in patients without dementia (LR+5.6) it would increase detection by 35%."

sparser
"While the FAM-CAM could potentially serve as an adjunct to existing ED delirium monitoring programs, additional research is needed."

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
"The reviewer raises important points about CAM and FAM-CAM methodology."

sparser
"Our results represent the performance of the FAM-CAM without any additional instructions provided to the family when completing the instrument."

sparser
"For participants randomized to the family-based system, family members (or caretakers) will receive preoperative education on delirium (including an educational video), a folder with an informational flyer and therapeutic activities checklists, and FAM-CAM training."

sparser
"The agreement between the family member’s detection of delirium in the case vignette was moderate using the FAM-CAM (kappa = 0.44) and substantial using the Sour Seven (kappa = 0.75)."

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
"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
"Using the FAM-CAM as part of a systematic screening strategy for the ED in which families’ assessments could supplement health care professionals’ assessments, is promising."

sparser
"HELP = Hospital Elder Life Program; FAM-CAM = Family Confusion Assessment Method."

sparser
"17) scored positive for delirium based on family assessment (FAM-CAM), and all of these patients were delirious during hospitalization."

sparser
"The strengths of this study include the “real world” setting in which the FAM-CAM was tested, maximizing translation of our findings into clinical settings."

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
"These diagnostic test characteristics are lower than a prior study which trained family members on the FAM-CAM (88% sensitive and 98% specific). xref Mailhot et al did not provide such training to better simulate how the tool would be used in the ED setting."

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
"A validated chart review method was used to identify delirium, 26 and the study measures used to characterize cognitive function, such as the FAM-CAM, Short Blessed Test, and PROMIS assessments, are validated measures that increase confidence in the results."
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sparser
"The majority of the false negatives (n=9 out of 13, 69%) were due to caregivers not identifying the inattention criteria for delirium on the FAM-CAM."

sparser
"Family caregivers completed the FAM-CAM assessment which was compared to a reference standard, the CAM completed by a trained interviewer."

sparser
"In total, 25 surveys were completed for the PROMIS 4A test, 25 surveys were completed for the PHQ-9, 17 surveys were completed for the FAM-CAM, and 22 surveys were completed for the Short Blessed Test."

sparser
"In addition, the readability of the FAM-CAM (Flesch-Kinkaid reading level ~11 th grade) and the Sour Seven (Flesch-Kinkaid reading level ~12 th grade) are higher than the suggested grade six level."

sparser
"In this study, the FAM-CAM had an overall sensitivity of 57% and specificity of 82% for delirium."

sparser
"The authors acknowledge that without caregiver training, the sensitivity and specificity of the FAM-CAM are modest, and it should not serve as a stand-alone test for ED delirium."

sparser
"For those enrolled in the intervention bundle, family members (or caretakers) will perform the FAM-CAM 20 independently of the research team."

sparser
"Patients who returned to the ED at 6 months were also more likely to have had a positive FAM-CAM score than those who did not (OR= 1.11, 95% CI = 0.4, 2.8)."

sparser
"To examine the ability of the family-rated Family-Confusion Assessment Method (FAM-CAM) to identify delirium in the Emergency Department (ED) among patients with and without dementia, as compared to the reference-standard Confusion Assessment Method (CAM)."

sparser
"Although never in an ED setting, the validity of the FAM-CAM has been previously assessed in three studies with varying results."

sparser
"In adjusted models, a hospitalization in the following 6-months was more than 3 times as likely in FAM-CAM positive compared to negative patients (OR=3.4, 95% CI=1.2, 9.3)."

sparser
"This included 78% and 92% of participants correctly classifying delirium in the provided case vignettes using the FAM-CAM and Sour Seven, respectively."

sparser
"Family caregivers correctly classified delirium in 84.5% (95% CI: 72.6-92.7%) of the provided case vignettes using the FAM-CAM or Sour Seven."

sparser
"In previous studies, some of the trained interviewers using the CAM were not blinded to the FAM-CAM results and used the results of the FAM-CAM to score specific CAM items, such as acute change."

sparser
"Reasons for missing assessments will be presented in conjunction with barriers that family members and caretakers report for conducting FAM-CAM assessments."

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
"In the ED we do not envision the FAM-CAM serving as a stand-alone test to screen for delirium."

sparser
"In total, 25 surveys were completed for the PROMIS 4A test, 25 surveys For peer review only -http://bmjopen.bmj.com/site/about/guidelines.xhtml were completed for the PHQ-9, 17 surveys were completed for the FAM-CAM, and 22 surveys were completed for the Short Blessed Test."

sparser
"For predictive validity, clinical outcomes (ED visits, hospitalization and mortality) over 6-months were compared in FAM-CAM positive and negative patients controlling for age, sex, comorbidity and cognitive status."

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
"If the FAM-CAM is to serve as an adjunct to existing ED delirium monitoring, the first step is to determine the optimal way to monitor delirium in busy clinical environments such as the ED, balancing diagnostic accuracy and efficiency."

sparser
"An additional benefit of the FAM-CAM is that it may empower caregivers to assess for delirium in family members outside the hospital and seeking medical care in a timely fashion."

sparser
"ED visits and mortality rates within 6 months were significantly higher among patients who screened positive on the FAM-CAM than in those who screened negative (hospital admission: 40% vs. 18%; mortality: 13% vs. 3%; ps<0.05, xref )."

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
"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
"However, in at risk patients in the ED where delirium status was unclear it would be feasible for a nurse or physician to provide a copy of the FAM-CAM to caregivers to complete."

sparser
"More family members correctly detected delirium symptoms in case vignettes using the Sour Seven (92%) compared with the FAM-CAM (78%)."

sparser
"The caregiver self-administered the FAM-CAM."

sparser
"Validation of the FAM-CAM."

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
"Of note, three of these five patients also screened positive for delirium based on the FAM-CAM."

sparser
"Family members in the intervention group will also be provided with preoperative education on delirium and training in the Family Confusion Assessment Method (FAM-CAM) instrument 20."

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)."

sparser
"Exploratory outcomes will include the incidence of positive FAM-CAM assessments (%) 30 days post-discharge, PROMIS Cognitive Function Abilities (Short Form 4a), 36-Item Short Form Survey, and 30-day readmission rates."

sparser
"Among patients who were still alive and available to complete survey materials, nearly 25% of patients (4/17) scored positive for delirium based on family assessment (FAM-CAM), and all of these patients were delirious during hospitalisation."

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
"In an ED sample that included patients with and without dementia, the FAM-CAM was found to have the potential to aid in the identification of patients with delirium."

sparser
"For the caregivers the Family Confusion Assessment Method (FAM-CAM) will be used [31]."

sparser
"While this is true, it is unclear whether this benefit is great enough to outweigh the increased complexity of incorporating the FAM-CAM into the evaluation of delirium in the chaotic ED-setting."