Rep. Lowenstein cancels Missoula visit

Purpose: The purpose of this systematic review is to summarize the reported risk prediction models and identify the most prevalent factors for incident delirium in older inpatient populations (age ≥ 65 years). In the future, these risk factors could be used to develop a delirium risk prediction model in the electronic health record that can be used by the Hospital Elder Life Program to reduce the incidence of delirium. Methods: A medical librarian customized and conducted a search strategy for all published articles on delirium prediction models using an array of electronic databases and specific inclusion and exclusion criteria. Then, a geriatrician and two research associates assessed the quality of the selected studies using the Newcastle-Ottawa Scale (NOS). Results: A total of 4,351 articles were identified from initial literature search. After review, data were extracted from 12 studies. The quality of these studies was assessed using NOS and ranged from 4 to 8. The most common risk factors reported were dementia, decreased functional status, high blood urea nitrogen-to-creatinine ratio, infection and severe illness. Conclusions: The most prevalent factors associated with incidence of delirium in hospitalized older patients identified by this systematic review could be used to develop an electronic health record-generated risk prediction model to identify inpatients at risk of developing delirium

Bilateral Moyamoya Disease in a 2-Year-Old Pakistani Male Treated with Bilateral Encephaloduroarteriosynangiosis: A Positive Outcome.

Background. We present a rare case of bilateral moyamoya disease presenting as multiple strokes and neurological deficits, treated with the neurosurgical procedure, encephaloduroarteriosynangiosis (EDAS), in a 2-year-old male Pakistani minor. A positive outcome was achieved and the patient recovered fully. Case Summary. Our patient presented with a history of seizures and multiple episodes of hemiparesis (on and off weakness) at the age of 2 years. He had a delayed speech development and could not speak more than a few words. He had a slight slurring of speech too. He was diagnosed with bilateral moyamoya disease on Computed Tomography Angiography (CTA). Bilateral EDAS was done in the same year, after which his symptoms improved and patient had moderate functional recovery. Conclusion. A rare disease, moyamoya has been left unexplored in Pakistan; physicians and surgeons when dealing with cases in the pediatric population presenting with symptoms of stroke, signs of generalized weakness, and seizures should consider moyamoya disease as a possibility. Furthermore, this case demonstrates the effectiveness of EDAS procedure for the treatment of moyamoya disease

Low-vision education for the health care workforce: strategy to create a vision-friendly hospital

BACKGROUND: Aging of the baby boomers presents a unique set of challenges for health care workers. Low vision among patients may be a barrier to providing appropriate patient care, may impede communication, and may decrease patients\u27 satisfaction with health care. It is important to train the medical workforce to understand the unique challenges of the aging population. OBJECTIVE: To test an interactive educational learning model targeting health care workers to improve knowledge and awareness of low vision. METHODS: Participants completed a survey prior to and after an educational intervention that consisted of 4 components: (1) normal aging, (2) eye-disease of the elderly, (3) experiential learning, and (4) written material with references and further resources. RESULTS: Three hundred eight-six members of the hospital workforce completed the training. There was statistically significant improvement in 7 of the 8 test questions. One question demonstrated a positive trend but was not statistically significant. CONCLUSION: An interactive educational model on low vision can improve the knowledge of the health care team. This may lead to improvement in patients\u27 satisfaction and quality of care and help create a vision-friendly hospital

Delirium Recognition in Hospitalized Older Patients: A Quality Improvement Project

Background: We noted a low reported prevalence of delirium (3%) in hospitalized older patients at a community teaching hospital in north central Wisconsin. Purpose: This was a quality improvement project to report recognition of delirium by nurses before and after an educational intervention. Methods: This project was performed on one medical unit in our hospital. Quality improvement data was collected at baseline and after the educational intervention. Data collected included observation by a geriatrician attending weekly interdisciplinary rounds to note any mention by nurses of delirium or confusion. The patient’s electronic health record (EHR) was reviewed to note delirium assessment by “confusion assessment method for the intensive care unit (Vanderbilt)” (CAM-ICU) by the nurses for 2 days prior to the team meeting. The numbers of positive and total attempted CAM-ICU were recorded. Use of antipsychotics or benzodiazepines was reported as a “delirium marker.” Diagnosis of delirium and dementia was obtained from the problem list in the EHR. The educational intervention included Just-in-Time Teaching during weekly Acute Care for Elders rounds during a 1-month period. Results: In month 1, before intervention, CAM-ICU was performed 140 times in 2 days on 32 patients with an average CAM-ICU performed 2.2 times per patient/day. There were 3 concerning quotes for confusion during team rounds and 0 for delirium by nurses during team rounds. EHR review noted 7 patients had dementia, 2 had a positive CAM-ICU and 3 had a diagnosis of delirium. In month 2, after intervention, CAM-ICU was performed 163 times in 2 days on 35 patients with an average CAM-ICU performed 2.35 times per patient/day. There were 6 concerning quotes regarding confusion and 1 regarding delirium by nurses during team rounds. EHR review noted 1 patient had dementia, 0 had a positive CAM-ICU and 0 patients with delirium diagnosis. Conclusion: This quality improvement project using Just-in-Time Teaching by a geriatrician during weekly rounds resulted in a modest increase in number of times CAM-ICU was performed, increased discussion of delirium during rounds, but no increase in delirium recognition using CAM-ICU. Areas for improvement include involving more physicians and nursing staff along with more structured delirium education

Addressing complex primary care needs for an older man recently released from incarceration with multiple emergency department visits.

Purpose: Older prisoners being released into the community need to be placed in a system to help them transition from living in prison to living in a free society. They must adapt in order to find housing, community services, medical, dental and psychiatric care. When the complex social needs of these persons are not fully met, the emergency department is used as a safety net. Methods and Findings: This paper describes a patient who had multiple emergency department visits which was his routine method of seeking medical care. Health Care Policy Implications: We believe that public health policy requiring a comprehensive geriatrics assessment with a focus on memory and abilities prior to release from prison for older inmates may optimize care. The emergency department in this case is in a unique position to provide geriatric appropriate assessments and hopefully halt the multiple emergency department visits. Changes in public health policy may be beneficial in the care of our patient. Clinicians may be able to advocate for changes in public policy through their health system public policy advocate or professional organizations. This change may positively impact unnecessary ED usage and reduce expenditure