Objective:The aim of this study was to examine the effectiveness of ramelteon and suvorexant for delirium prevention in real-world practice. It explored whether ramelteon and/or suvorexant would affect delirium prevention among both patients at risk for but without delirium (patients at risk) and those with delirium the night before a consultation. Methods: This multicenter, prospective, observational study was conducted by trained psychiatrists at consultation-liaison psychiatric services from October 1, 2017, to October 7, 2018. Patients who were aged 65 years or older and hospitalized because of acute diseases or elective surgery, had risk factors for delirium, and had insomnia or delirium on the night before the consultation were prescribed ramelteon and/or suvorexant. The decision to take medication was left to the discretion of each patient. The primary outcome was incidence of delirium based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, during the first 7 days.
Results:Among 526 patients at risk, those taking ramelteon and/or suvorexant developed delirium significantly less frequently than those who did not, after control for the effects of risk factors on the estimate of an independent association between the effects of ramelteon and/or suvorexant and the outcome of developing delirium (15.7% vs 24.0%; odds ratio [OR] = 0.48;, 95% CI, 0.29-0.80; P = .005). Similar results were found among 422 patients with delirium (39.9% vs 66.3%; OR = 0.36; 95% CI, 0.22-0.59; P < .0001). Conclusions: Ramelteon and suvorexant appear to be effective for delirium prevention in real-world practice. J Clin Psychiatry 2020;81 (1):19m12865 To cite: Hatta K, Kishi Y, Wada K, et al. Real-world effectiveness of ramelteon and suvorexant for delirium prevention in 948 patients with delirium risk factors.
We present an investigation of the structure of 13 Be obtained via a kinematically complete measurement of the (p, pn) reaction in inverse kinematics at 265 MeV/nucleon. The relative energy spectrum of 13 Be is compared to Transfer-to-the-Continuum calculations which use as structure inputs the overlaps of the 14 Be ground-state wave function, computed in a three-body model, with the unbound states of the 13 Be residual nucleus. The key role of neutron p-wave orbital in the interpretation of the low-relative-energy part of the spectrum is discussed.
These results suggest that alterations in telomere length, telomerase activity, and the expression of hTERT mRNA may (i) play roles in pathogenesis in pulmonary neuroendocrine tumors, and (ii) be a useful tool for differential diagnosis between TCs and LCNECs.
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