This updated review (Lancet, March) summarizes the epidemiology, causes, pathophysiology, diagnosis, assessment and workup, non-pharmacological prevention and treatment, pharmacological prevention and treatment, controversies and future directions with recommendations. “Delirium is an acute disorder of attention and cognition in elderly peiople that is common, serious, costly, under-recognised, and often fatal. A formal cognitive assessment and history of acute onset of symptoms are necessary for diagnosis. In view of the complex multifactorial causes of delirium, multicomponent pharacological approaches are recommended.” Click here to read full-text.
News You Can Use
“Use of mortality after bilateral mastectomy compared with other surgical treatments for breast Cancer” and accompanying editorial, “Contralateral prophylactic mastectomy: Is it a reasonable option?”by jmiller on September 11, 2014
This article concludes that the “use of bilateral mastectomy increased significantly through California from 1998 to 2011 and was not associated with lower mortaligy than that achieved with breast-conserving surgery plus radiation. Unilateral mastectomy was associated with higher mortality than the other 2 surgical options.” (JAMA, Sept) Click here to read full-text.
This review article (NEJM, Aug 28) updates the pathogenesis, diagnosis, screening and surveillance, management, endoscopic eradication of dysplasia, management of low-grade dysplasia, and radiofrequency ablation of nondysplastic metaplasia. Click here to read full-text
This article (Mayo Clin Proc, Aug) concludes, “Medication errors are present in approximately half of patients after hospital discharge and are more common among patients with lower numeracy or health literacy. Click here to read full-text.
Is hospital admission for heart failure really necessary? The role of the ED and observation unit in preventing hospitalization and rehospitalizationby jmiller on August 20, 2014
“Evidence-based therapies have resulted in improvements in the outpatient mangement of HF. Despite an increasingly complex population of patients, the overall length of hospital stay has decreased. However, post-discharge event rates remain disturbingly high and it is not clear that hospitalization mitigates these event rates. Emergency physicians are key stake holders in this process, as the ED is the point of triage and disposition fo rthe majority of HF patients who are considered for hospital admission. Alternatives to hospitalization, such as the one posed in this article, are crucail to the overall goal of allocating resources to those high-risk patients in need of intense evalutation and therapy, while simultaneously faiclitating outpatient management of lower-risk patients.” (J Am Coll Cardiol, Jan 2013) Click here to read full text
“Running, even 5 to 10 min/day and at slow speeds <6 mi. hr, is associated with markedly reduced risks of death from all causes and cardiovascular disease. This study may motivate health but sendentary individuals to begin and continue running for substantial and attainable mortality benefits.” (J Am Coll Cardiol, June) Click here to read full-text
“Effects of nurse-managed protocols in the outpatient management of adults with chronic conditions” and accompanying editorial “Are nurses an answer to new primary care needs?”by jmiller on July 30, 2014
This systematic review and editorial appear not in a nursing journal, but rather in the current, prestigious Annals of Internal Medicine. The article concludes “A team approach that uses nurse-managed protocols may have positive effects on the outpatient management of adults with chronic conditions, such as diabetes, hypertension, and hyperlipidemia.” “A recent report projects a shortage of as many as 44,000 primary care physicians by 2025 mainly because of poor pay. Studies have shown that nurse-coordinated programs for patients with heart failure, including early follow-up after hospitalizations and intensive patient education, have the potential to prolong survival and decrease the frequency of hospital admissions. We need new models of primary care, and enlisting nurses will be central to this effort.” Click here to read full-text.
“Although the optimal choice of HCP attire for inpatient care remains undefined, we provide recommendations on the use of white coats, neckties, footwear, the bare-below-the-elbows strategy, and laundering. Institutions considering these optional measures should introduct them with a well-organized communications and education effort directed at both HCP and patients.” (Infect Control and Hosp Epidemiol, Feb) Click here to read full-text.