3 results
Delirium diagnosis and handover to primary care providers and medical teams
- Saba Inam, Joanne Flood, Aine Butler
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S31-S32
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- Article
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Aims
Delirium is a common medical problem with a prevalence of over 50% in over 65s admitted to general hospitals (1,2) . Delirium is linked with poor clinical outcome, including increased risk of falls, prolonged admissions and an overall increased risk of morbidity and mortality (2,3,4). Delirium in older adults is also associated with an increased rate of cognitive decline, future risk of cognitive decline and a risk of depression (5,6,7). There is potential to improve clinical practice by improving assessment and management of delirium. It is imperative that where delirium is detected, it should be clearly documented to aid handover to primary care providers and medical teams (8,9).
MethodThe standard for this audit was set according to SIGN 157 (9). Data were collected retrospectively from consults sent to a liaison psychiatry of old age service within an acute hospital setting. The medical discharge summaries from July to December 2019 were reviewed. Two key data points were collated, the diagnoses of delirium by either medical or liaison psychiatry team and the inclusion of this diagnosis in the patient discharge summaries. An updated delirium protocol was devised and introduced in the hospital setting in January 2020 to include tools for effective diagnosis of delirium and instruction to include this diagnosis if made in patient's discharge summaries. Re-audit was initiated following the introduction of the updated delirium protocol for the period of January to March 2020.
ResultA total of 116 patients were assessed from July to December 2019. 102 discharge summaries were available for review for the purpose of this audit. Prior to the introduction of the updated delirium protocol, delirium was diagnosed by the liaison team in 57% of all referrals. Delirium was underdiagnosed by medical teams in 73% of those subsequently diagnosed. The diagnosis of delirium was present in 42% of all discharge summaries to primary care providers. Subsequent to the introduction of the updated protocol, delirium was diagnosed in 48% of all liaison referrals during the time period specified. The proportion of under-diagnosis of delirium by medical teams stayed at 73%, the diagnosis of delirium was present in 53% of discharge summaries.
ConclusionThe recognition and diagnosis of delirium in the general medical setting continues to be a key issue in the management of older adults. The importance of this diagnosis and it's associated after effects needs to be disseminated amongst all care providers. Greater efforts to enhance these aspects of delirium management in the acute hospital setting are required.
Association between major patterns of dietary intake and weight status in adolescents
- Gretchen J. Cutler, Andrew Flood, Peter J. Hannan, Joanne L. Slavin, Dianne Neumark-Sztainer
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- Journal:
- British Journal of Nutrition / Volume 108 / Issue 2 / 28 July 2012
- Published online by Cambridge University Press:
- 13 October 2011, pp. 349-356
- Print publication:
- 28 July 2012
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The relationship between dietary intake and obesity is complex, and dietary pattern analysis may offer new insight. We examined associations between dietary patterns identified in a diverse cohort of adolescents and weight status cross-sectionally and over a 5-year period. Project EAT (Eating Among Teens) (Time 1) collected data on 4746 middle (younger cohort) and high school (older cohort) students in 1998–9. EAT-II (Time 2) resurveyed 2516 of the original cohort in 2003–4. All analyses were run separately by age cohort and sex. The relationship between dietary patterns identified previously (vegetable, fruit, vegetable & fruit, starchy food, sweet & salty snack food, and fast food) and weight status was examined using logistic regression. All analyses were adjusted for socioeconomic status, race/ethnicity and activity level (longitudinal analyses were also adjusted for baseline weight status). In cross-sectional analyses, higher adherence to dietary patterns loading heavily on vegetables was associated with lower risk of overweight/obese weight status in older and younger girls, whereas higher adherence to a ‘sweet & salty snack food’ pattern was associated with lower risk in older and younger boys. These associations were found prospectively in older boys and girls, but were no longer significant in analyses adjusting for baseline weight status. We did not find consistent or intuitive associations between dietary patterns and weight status. Identified patterns may not capture the elements of diet that are truly important in determining adolescent weight, or diet may not be the primary driver in determining weight status at this age. Methodological difficulties in assessing diet must also be taken into consideration.
5 - Benthic Habitat Mapping in the Hudson River Estuary
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- By Robin E. Bell, Lamont-Doherty Earth Observatory, Roger D. Flood, Marine Sciences Research Center, Stony Brook University, Suzanne Carbotte, Lamont-Doherty Earth Observatory, William B. F. Ryan, Ryan, Lamont-Doherty Earth Observatory, Cecilia McHugh, School of Earth and Environmental Sciences, Queens College, City University of New York, Milene Cormier, Lamont-Doherty Earth Observatory, Roelof Versteeg, Idaho National Engineering and Environmental Laboratory, Henry Bokuniewicz, Marine Sciences Research Center, Stony Brook University, Vicki Lynn Ferrini, Marine Sciences Research Center, State University of New York at Stony Brook, Joanne Thissen, Lamont-Doherty Earth Observatory, John W. Ladd, Hudson River National Estuarine Research Reserve, New York State Dept of Environmental Conservation, Elizabeth A. Blair, New York State Department of Environmental Conservation, Bard College Field Station
- Edited by Jeffrey S. Levinton, State University of New York, Stony Brook, John R. Waldman
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- Book:
- The Hudson River Estuary
- Published online:
- 06 January 2010
- Print publication:
- 09 January 2006, pp 51-64
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Summary
abstract Successful management of underwater lands requires detailed knowledge of the terrain and the interrelationships between landscape and habitat characteristics. While optical techniques can be used where the water is shallow or clear, other techniques are needed where the water is deeper or where optical transmission is limited by water clarity. Marine geophysical techniques provide quantitative measures of the nature of the estuary floor that can provide constraints on the distribution and movement of contaminated sediments as well as the nature of benthic habitats. The Benthic Mapping Program, supported by the Hudson River Estuary Program of the New York State Department of Environmental Conservation (NYSDEC) and the Hudson River Action Project, is being conducted in the Hudson River to characterize the river bed from the Verrazano Narrows in New York Harbor to the Federal Dam at Troy, New York. The study is using a range of acoustic and sampling techniques to gain new information on the river bed. The first phase of the Benthic Mapping Program, which occurred from 1998 to 2000, focused on four areas (about 40 river miles; 65 km). The products from the study have been incorporated into a GIS data management system for NYSDEC (see http://benthic.info for the DEC Benthic Mapper web site, an online version of the GIS database). This effort, supplemented by studies of benthic fauna and bathymetric change, is being continued under NYSDEC support for the remainder of the Hudson River. The second phase of the program worked in four areas in 2001 and 2002 (about 35 river miles; 57 km) and we completed the study by working in three areas in 2003 (about 66 river miles; 121 km).
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