Managing delirium

Delirium is common among hospitalized patients, but not always easy to spot or treat. In our June issue, we passed along some tips on managing delirium courtesy of Edward Marcantonio's session at IM '09. Now comes an article in the Journal of General Internal Medicine's July issue which reviews the evidence for various pharmacological interventions that aim to prevent or manage delirium.

Researchers looked at antipsychotics, an antiepileptic, sedatives and a benzodiazepine, among other things. They found no difference between first and second generation antipsychotics in treating delirium; they also found that cholinesterase inhibitors and procholinergic drugs didn't work particularly well in preventing the condition. The good news is that, while more research is needed (as it always is), a few studies suggest one can cut the duration or severity of delirium by using risperidone, haloperidol, gabapentin, or a combo of sedatives in patients having surgery.

For more of the researchers' findings, read on....

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posted by Jessica Berthold at 3:34 PM   0 Comments

Sorry, doctor, I paged the wrong resident

Ever been paged when you're no longer on call? It's probably no surprise to learn you're not alone. In a recent issue of Archives of Internal Medicine, Canadian researchers looked at two months' worth of pager records from two tertiary care academic teaching hospitals to determine how often residents were paged when they weren't supposed to be. A page was considered a "wrong number" when it involved a resident who was off duty (postcall, on vacation, etc.) and out of the hospital. The authors found that of 10,190 pages studied, 1,409, or 14%, were misdirected. Of those 1,409 "wrong number" pages, 15% were considered emergency pages needing immediate attention and 32% were considered urgent pages needing a response within an hour.

How long does it take to discover a paging error, track down the correct physician, page him or her, and wait for the response? Regardless, it's time wasted. "These incorrect pages create delays and inefficiencies in care that disrupt workflow and represent potential threats to patient safety," the authors wrote. "We believe that the frequency of pages sent to the wrong physician is too high and are taking steps to reduce the potential for these errors."

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posted by Jennifer Kearney-Strouse at 3:18 PM   0 Comments

Digestive Disease Week: NOTES

CHICAGO--Removing a gallbladder through the mouth? That's how natural orifice translumenal endoscopic surgery (NOTES), a new surgical procedure that even its backers call "a bit unorthodox," would work. In the experimental procedure, the doctor inserts a tube down the esophagus, makes a small incision in the stomach or digestive tract to access the abdominal cavity and takes the organ out.

The idea is that the procedure would be easier on patients because it is less invasive and would thus reduce recovery time, be less uncomfortable, and leave virtually no visible scarring. It could also be used for gastric bypass, fallopian tubal ligation, and ovary removal. Some operations might be done via the rectum or vagina. (See more on this subject in ACP Hospitalist.)

This initiative, discussed at DDW yesterday, is from the Natural Orifice Surgery Consortium for Assessment and Research, a joint effort supported by the American Society for Gastrointestinal Endoscopy and the Society of American Gastrointestinal and Endoscopic Surgeons.

--By Paula S. Katz, special to ACP Hospitalist

Labels: digestive disease week, NOTES

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posted by Janet Colwell at 1:00 PM   0 Comments