Delirium Prevention: CPCP by Dr. Evan Ouyang

This is yet another outstanding  presentation about a new topic, delirium prevention, specifically about the use of gabapentin as prophylaxis, at one of our recent weekly conferences on the psychiatry consultation service. It’s part of the Clinical Problems in Consultation Psychiatry (CPCP).

In order to see the picture galleries of photos or Powerpoint slides, click on the one of the slides, which will open up the presentation to fill the screen. Use the arrow buttons to scroll left and right through the slides or up and down to view the annotations.

Geezernote—J. Amos: The HELP program has been replicated in over 100 sites in the U.S. and at least 7 countries. It prevents delirium in patients on general medical units. HELP uses a large number of volunteers to apply cognitive stimulation and other therapeutic activities on a daily basis. It tends to be more effective in patients at intermediate risk rather than high risk for delirium. It can save hospitals a lot of money (Zaubler, T. S., M.D., M.P.H. et al (2012). “Delirium Prevention on a General Medical Floor: A Replication of the Hospital Elder Life Program in a Community Hospital”. Academy of Psychosomatic Medicine 59th Annual Meeting. Atlanta, Ga, Unpublished PowerPoint presentation).

I don’t know if any of them involve psychiatrists—we don’t seem to be a necessary component. On the other hand, delirium prevention and management studies are still being pursued; one of the largest is the MIND study, currently under way:

 

The Modifying the Impact of ICU-Associated Neurological Dysfunction-USA (MIND-USA) Study – Full Text View – ClinicalTrials.gov

 

The previous feasibility study with the same acronym (Modifying the Incidence of Delirium) didn’t find a difference between antipsychotics and placebo in preventing delirium (Girard, T. D., P. P. Pandharipande, et al. (2010). “Feasibility, efficacy, and safety of antipsychotics for intensive care unit delirium: the MIND randomized, placebo-controlled trial.” Crit Care Med 38(2): 428-437).

 

A little more about the CPCP at Iowa:

Clinical Problems in Consultation Psychiatry (CPCP):

A weekly case conference held Wednesdays from 8:00 a.m. to approximately 8:45 a.m. Each week, a case is selected from the Daily Review Rounds Records to illustrate a clinical problem for the next week’s meeting.  The residents are assigned dates when they rotate. The medical students are welcome and even encouraged to participate as well.

This is a practical way to approach teaching the Practice-Based Learning & Improvement Core Competency. This helps develop the habit of reflecting on and analyzing one’s practice performance; locating and applying scientific evidence to  the care of patients; critically appraising the medical literature; using the computer to support learning and patient care; facilitating the education of other health care professionals. This is applying principles of evidence-based medicine (EBM) to clinical practice.

  • Evidence-based medicine is a systematic approach to use up to date information in the practice of medicine
  • Skills are needed to integrate the available evidence with clinical experience and patient concerns
  • Application and evaluation of EBM skills will provide a frame-work for life-long learning.

Self-evaluation is vital to the successful practice of EBM:

  • Am I asking answerable clinical questions?
  • Am I searching the literature?
  • Am I becoming more efficient in my searches?
  • Am I integrating my critical appraisals into my practice?

The assigned resident is responsible for searching the literature and selecting one or two teaching papers for the conference. Presentations will begin with a review of the case, followed by a summary of the references with subsequent round table discussion.

Circulate copies of 2-4 pertinent articles to team members including psychiatric nurses and faculty. A copy machine is available in the departmental administration office. Consult staff can also assist with obtaining copies.

Presentations begin with a 5-minute summary of the case with discussion of both psychiatric and medical aspects of evaluation and management. The remaining time is spent summarizing the pertinent data in the articles. Residents and medical students are encouraged to use the case conference material as preparation for submitting a case report or letter to the editor.

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