Staff assessments of confusion and the situation of confused residents in homes for old people.
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A comparison of the effects of filtering and sensorineural hearing loss on patients of consonant confusions.
It has been found that listeners with sensorineural hearing loss who show similar patterns of consonant confusions also tend to have similar audiometric profiles. The present study determined whether normal listeners, presented with filtered speech, would produce consonant confusions similar to those previously reported for the hearing-impaired listener. Consonant confusion matrices were obtained from eight normal-hearing subjects for four sets of CV and VC nonsense syllables presented under six high-pass and six-low pass filtering conditions. Patterns of consonant confusion for each condition were described using phonological features in sequential information analysis. Severe low-pass filtering produced consonant confusions comparable to those of listeners with high-frequency hearing loss. Severe high-pass filtering gave a result comparable to that of patients with flat or rising audiograms. And, mild filtering resulted in confusion patterns comparable to those of listeners with essentially normal hearing. An explanation in terms of the spectrum, the level of speech, and the configuration of this individual listener's audiogram is given.
Audiometry↗
Sodium amylobarbitone in the differential diagnosis of confusion.
The authors describe the use of intravenous sodium amylobarbitone to differentiate between functional and organic confusion. Four psychiatric patients with functional confusion developed a clear sensorium on this drug. Since previous studies have demonstrated that organic confusion is increased by sodium amylobarbitone, the authors conclude that the drug can be an aid in the differential diagnosis of confusion. They discuss possible applications.
Acute Disease↗
AI-Supported, Integrative Prediction of Postoperative Delirium: Protocol for the CONFUSED Study.
BACKGROUND: Postoperative delirium (POD) is a frequent and serious complication in older surgical patients, characterized by acute cognitive dysfunction and fluctuating levels of consciousness. POD is associated with prolonged hospitalization, long-term cognitive decline, reduced quality of life, and increased mortality. Despite its clinical relevance, the underlying pathophysiological mechanisms remain poorly understood, and reliable biomarkers for early prediction and prevention are lacking. OBJECTIVE: The CONFUSED study aims to identify molecular and clinical predictors of POD by integrating clinical data with proteomic, transcriptomic, and epigenetic analyses. The primary objective is to develop predictive models for POD using multimodal data. Secondary objectives include the identification of delirium-associated genes, proteins, and epigenetic signatures, as well as the exploration of patient subgroups at increased risk for POD. METHODS: CONFUSED is a prospective observational cohort study conducted at a German university hospital. Adult patients undergoing major surgery under general anesthesia will be enrolled until 100 cases of POD have been observed, which is expected to require a total sample size of approximately 200 to 300 patients. Blood samples are collected at 4 predefined time points: before premedication, immediately after surgery, and on postoperative days 2 and 5. Samples undergo comprehensive proteomic profiling, transcriptomic analysis using RNA microarrays, DNA methylation analysis, and genotyping of selected polymorphisms. Clinical data, including demographics, comorbidities, perioperative variables, medications, and delirium assessments using the Confusion Assessment Method (CAM) and CAM for the intensive care unit, are systematically recorded. Statistical analyses include univariate and multivariate methods, as well as machine learning approaches such as random forests and support vector machines, to identify relevant biomarkers and develop predictive models. The study protocol follows STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) and TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis) guidelines and was approved by the responsible ethics committees. RESULTS: The study was registered in the German Clinical Trials Register (DRKS00033854) on March 18, 2024. Recruitment started in January 2024 and is ongoing at the time of manuscript submission. As of now, 135 patients have been enrolled. Sample collection and laboratory analyses are ongoing. Data analysis began in January 2026, with first results anticipated in July 2026. Final data lock is anticipated after the completion of recruitment. CONCLUSIONS: By integrating multimodal molecular data with clinical parameters and applying advanced machine learning techniques, the CONFUSED study aims to improve the prediction and understanding of POD. The results are expected to support the development of personalized preventive strategies and contribute to improved perioperative care for patients at risk of POD.
Humans↗
Use of reality orientation with aging confused patients.
Use of reality orientation with elderly confused patients in a nursing home setting was evaluated. Although no significant differences were found in degree of confusion, as measured by the questionnaire developed for this study, between an experimental group who participated in a concentrated three-week reality orientation program and a control group, many effects were positive. Nursing home staff were cooperative and helpful. Families of some of the patients were pleased with improvements in their relatives. Many patients became less confused, more open, and appeared to be more alert.
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Consonant confusions in patients with sensorineural hearing loss.
Consonant confusion matrices were obtained from 22 outpatient listeners with sensorineural hearing loss for four sets of CV and VC nonsense syllables, presented monaurally at SRT + 40 DB. Testing was typically conducted for six hours on each of two separate days. Overall performance and patterns of confusions were stable over time. Analysis of the matrices in terms of phonological features indicated that the patterns of consonant confusions varied both with degree and configuration of the subject's loss. Scaling of intersubject similarity using a pairwise multidimensional scaling analysis resulted in consistent classification of subjects according to audiometric configuration into three groups-essentially normal hearing, flat or rising audiograms, and high-frequency hearing losses.
Adult↗
Senile confusion: limitations of assessment by the face-hand test, mental status questionnaire, and staff ratings.
Three of the most common and convenient measures of senile confusion are informal staff ratings, the Face-Hand Test (FHT) and the Mental Status Questionnaire (MSQ). A group of 112 geriatric patients in two extended care facilities, and a volunteer sample of 40 community aged were examined by means of the FHT and MSQ. These instruments proved valuable in differentiating patients rated as confused from those rated as lucid and alert, and from the community subjects. However, each of these measures, as well as the staff ratings, produced false negative findings. Staff ratings incorrectly identified a hypochondriacal and paranoid patient as confused. The FHT scores of lucid and alert patients with some brain damage were low. MSQ scores of some poorly educated immigrants were very low, even though these patients were rated as lucid and alert by the staff and passed the FHT. One normally lucid and alert patient with a fever and an irregular rapid pulse failed both the FHT and the MSQ. Guidelines for further use of these instruments are presented.
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The binocular confusion in unilateral aphakia.
The first 4 symptoms of binocular confusion concern primarily daytime vision and the fifth symptom concerns nighttime vision. Even with a conventional contact lens correction, symptoms of binocular confusion occur, especially with high optical aniseikonia for near or far distance. In addition, diplopia occurs in the presence of strabismus. The important result of our research is the fact that unilateral aphakes are severely disturbed by the 5 symptoms of binocular confusion described above. These disturbances can be eliminated completely with an appropriate spectacle-contact lens combination based on echometry and intraocular optics.
Adult↗
Pharmacokinetic and clinical studies in patients with cimetidine-associated mental confusion.
15 cases of cimetidine-associated mental confusion have been reported. In order that this syndrome might be investigated changes in mental status (M.S.) were correlated with serum concentrations and renal and hepatic function in 36 patients, 30 patients had no M.S. change on cimetidine and 6 had moderate to severe changes. These 6 patients had both renal and liver dysfunction (P less than 0.05), as well as cimetidine trough-concentrations of more than 1.25 microgram/ml (P less than 0.05). The severity of M.S. changes increased as trough-concentrations rose, 5 patients had lumbar puncture. The cerebrospinal fluid: serum ratio of cimetidine concentrations was 0.24:1 and indicates that cimetidine passes the blood-brain barrier; it also raises the possibility that M.S. changes are due to blockade of histamine H2-receptors in the central nervous system. Patients likely to have both raised trough-concentrations and mental confusion are those with both severe renal and hepatic dysfunction. They should be closely observed and should be given reduced doses of cimetidine.
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University professors' self-descriptions of left-right confusability: sex and handedness differences.
In a group of 364 university faculty members, frequency of self-reported confusion in left-right orientation was related to sex and handedness: among women, reports were statistically more common among left-handers than right-handers; among men, no relationship to handedness was evident. Over-all, women reported experiencing confusion more often than men did.
Confusion↗
The use of life review activity with confused nursing home residents.
Reminiscing and life review are adaptive tasks of old age. This article describes an occupational therapy group program for confused nursing home residents designed to facilitate reminiscing and promote the review process. Results of the study indicate that behaviors of confused residents improved during group meetings and that participants who attended most frequently showed the greatest change in behavior.
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[Binocular confusion in unilateral aphakia (author's transl)].
The five symptoms of binocular confusion of the unilateral aphakic patient are described. In day vision, without strabismus and without correction, the image of the aphakic eye considerbly disturbs binocular vision, though the vision is less than 20/400 (first symptom). In night traffic the uncorrected unilateral aphakic patient sees very striking light circles and within those circles of glittering dots around bright light sources of cars or around blinking indicators and stoplights (fifth symptom). The five disturbing symptoms of binocular confusion can be positivity eliminated by an appropriate combination of spectacles and contact lens (combined correction) in regard to echometry and intraocular optics.
Adolescent↗
Auditory versus phonetic accounts of observed confusions between consonant phonemes.
The utility of phonetic features versus acoustic properties for describing perceptual relations among speech sounds was evaluated with a multidimensional scaling analysis of Miller and Nicely's [J. Acoust. Soc. Am. 27, 338-352 (1955)] consonant confusions data. The INDSCAL method and program were employed with the original data log transformed to enhance consistency with the linear INDSCAL model. A four-dimensional solution accounted for 69% of the variance and was best characterized in terms of acoustic properties of the speech signal, viz., temporal relationship of periodicity and burst onset, shape of voiced first formanant transition, shape of voiced second formanant transition, and amount of initial spectral dispersion, rather than in terms of phonetic features. The amplitude and spectral location of acoustic energy specifying each perceptual dimension were found to determine a dimension's perceptual effect as the signal was degraded by masking noise and bandpass filtering. Consequently, the perceptual bases of identification confusions between pairs of syllables were characterized in terms of the shared acoustic properties which remained salient in the degraded speech. Implications of these findings for feature-based accounts of perceptual relationships between phonemes are considered.
Female↗
[Infantile and hypoplastic uterus: a contribution to overcome the confusion of terms (author's transl)].
The confusion of terms between the radiological literature and the gynaecological and anatomical literature regarding the definitions of the infantile and the hypoplastic uterus are described. The history of this confusion is traced. The two types of uterus were clearly defined by K. Menge and K.v. Oettingen in 1930. The infantile uterus shows an abnormal relationship between the length of the cervix and the length of the uterine cavity of 1:1 or 2:1, whereas the hypoplastic uterus shows a normal relationship between the length of the cervix and the length of the uterine cavity of approximately 1:2.
Congenital Abnormalities↗
Gastroesophageal reflux: a potential source of confusion in technetium thyroid scanning:case report.
Technetium-99m as pertechnetate, excreted into the stomach after intravenous injection and refluxed as high as the cervical esophagus can present a confusing picture during thyroid scintigraphy if one is not aware of this possibility. The typical appearance of refluxed tracer is presented, and a simple method for eliminating the confusion is suggested.
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Temporal disorganization and inner-outer confusion in acute mental illness.
The authors found that changes in temporal disorganization covaried substantially and significantly with changes in Schneider's first-rank symptoms in 58 acutely ill psychiatric patients. Schneiderian symptoms reflect a confusion of inner and outer events; therefore, the findings suggest that difficulties in indexing events in time are closely related to problems in distinguishing experiences that arise within the self from outer experiences.
Acute Disease↗
[Individual conditions of pharmacogenic confusion conditions. Comparison of amitriptyline and clozapine].
The literature was surveyed concerning the frequency and conditions for confusional states and deliria following Amitriptyline and Clozapine treatment, and certain discrepancies were noted. As a result a retrospective comparative investigation was carried out as to the frequency and the conditions for such events in a group of patients treated along the same lines. While our experience with Amitriptyline is not different from that reported by others, this does not seem to be the case with Clozapine. Confusional states and deliria are four times as frequent as the average reported in the literature; it is clear that they depend on conditions different from those of confusional states and deliria due to Amitriptyline; there is a slightly significant (p less than 0.05) correlation between the appearance of confusion and a temperature of over 37.5 degrees C. The anticholinergic properties of Amitriptyline and of Clozapine cannot explain the difference in frequency, nor the differing conditions for the appearance, of pharmacogenic confusional states and deliria with those two substances.
Adult↗