Goals of care in the Wellington Emergency Department: a clinical audit.

Aims: To determine how often goals of care (GOC) are being discussed with older patients in the emergency department (ED).

Methods: This clinical audit included 300 presentations of patients aged 80 years and over in the Wellington ED. The timeframe was from 1 July to 17 July 2021.

Doctors' views on the impact of the absence of an in-person rheumatology service at a major New Zealand hospital.

Aim: To describe the views of doctors in one hospital service about the impact of the lack of an in-person rheumatology consultation service and to identify service improvements informed by those views and services at comparable district health boards (DHB).

Methods: Qualitative study using focus groups of resident and senior medical officers (RMOs and SMOs) from the general medical service at Wellington Regional Hospital. A national survey of DHB heads of rheumatology was also used.

Research activities in general medicine: a scoping survey by the Internal Medicine Society of Australia and New Zealand.

Background: In developing an effective framework for a collaborative research network (RN) that supports members involved in research, the Internal Medicine Society of Australia and New Zealand (IMSANZ) required a better understanding of the current level of research activity and engagement by general physicians, and factors influencing such engagement.

Aims: To explore the current research landscape amongst general physicians in Australia and Aotearoa New Zealand.

Methods: A questionnaire exploring research participation, scope, research enablers and barriers was disseminated to IMSANZ members over a 3-month period.

Whānau experience of patients' deaths in Wellington Hospital during 2020 COVID-19 pandemic Levels 3 & 4.

Aim: A qualitative exploration of the experience of whānau whose relatives died in an acute hospital setting during Levels 3 ∓ 4 of the 2020 COVID-19 pandemic in Aotearoa New Zealand.

Methods: Next of kin for 22 patients who had died in Wellington Hospital during Levels 3 & 4 of the 2020 COVID-19 pandemic (16/22 under General Medicine with an additional 6/22 who identified as Māori) from a total of 70 hospital deaths were interviewed by phone in August 2020. Whānau were asked to describe their experience of a relative dying.

Patient and public involvement in paediatric medical education.

The benefits of involving patients and the public in medical education are well documented, however there is a need to further explore how this can be translated to the setting of paediatric medical education. This article aims to identify how organisations can facilitate the involvement of paediatric patients and their parents/carers.While involving children in research can present challenges, we describe examples where organisations have successfully involved young people in clinical research and selection of research topics.

Enabling first and second year doctors to negotiate ethical challenges in end-of-life care: a qualitative study.

Objective: To understand the unique ethical and professional challenges confronting first and second year doctors in caring for people who are dying, and to learn what factors help or hinder them in managing these.

Method: 6 first year and 7 second year doctors were interviewed one-to-one by a senior palliative medicine physician (SD), quarterly over 12 months, using a semistructured approach. Thematic analysis was conducted with the findings, following the general inductive approach.

The handover room: a qualitative enquiry into the experience of morning clinical handover for acute medical teams.

Background: Effective clinical handover has always been integral to delivering safe, high-quality care in medical wards.

Aim: As handover activity increases in importance we wanted to explore the experience of physicians and trainee doctors. There is little research on internal medicine handover with even less based on direct observational research.

A longitudinal study of motor subtypes in delirium: frequency and stability during episodes.

Objective: Motor-defined subtypes are a promising means of identifying clinically relevant patient subgroups but little is known about their course and stability during a delirium episode.

Methods: We assessed 100 consecutive adult palliative care patients with DSM-IV delirium twice weekly during their episodes using the Delirium Motor Subtype Scale (DMSS), Delirium Rating Scale-Revised-98 (DRS-R98) and Cognitive Test for Delirium (CTD). DMSS subtypes were assigned for each assessment and analysed for stability within patients during episodes.

A longitudinal study of motor subtypes in delirium: relationship with other phenomenology, etiology, medication exposure and prognosis.

Objective: Motor subtypes have promise as a means of identifying clinically relevant delirium subgroups. Little is known about their relationship to etiologies, medication exposure, and outcomes.

Methods: Consecutive cases of DSM-IV delirium in palliative care patients were assessed twice-weekly throughout their delirium episodes using the Delirium Motor Subtype Scale (DMSS), Delirium Etiology Checklist (DEC) and Delirium Rating Scale Revised-98 (DRS-R98).

Phenomenological and neuropsychological profile across motor variants of delirium in a palliative-care unit.

Studies using composite measurement of cognition suggest that cognitive performance is similar across motor variants of delirium. The authors assessed neuropsychological and symptom profiles in 100 consecutive cases of DSM-IV delirium allocated to motor subtypes in a palliative-care unit: Hypoactive (N=33), Hyperactive (N=18), Mixed (N=26), and No-Alteration motor groups (N=23). The Mixed group had more severe delirium, with highest scores for DRS-R-98 sleep-wake cycle disturbance, hallucinations, delusions, and language abnormalities.

A comparison of neuropsychiatric and cognitive profiles in delirium, dementia, comorbid delirium-dementia and cognitively intact controls.

Purpose: Delirium and dementia have overlapping features that complicate differential diagnosis. Delirium symptoms overshadow dementia symptoms when they co-occur, but delirium phenomenology in comorbid cases has not been compared to both conditions alone.

Methods: Consecutive adults with DSM-IV delirium, dementia, comorbid delirium-dementia and cognitively intact controls were assessed using the Revised Delirium Rating Scale (DRS-R98) and Cognitive Test for Delirium (CTD).

Validating a new clinical subtyping scheme for delirium with electronic motion analysis.

The usefulness of motor subtypes of delirium is unclear due to inconsistency in sub-typing methods and a lack of validation with objective measures of activity. The activity of 40 patients was measured with 24 h accelerometry monitoring. Patients with Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) delirium (n=30) were allocated into hyperactive, hypoactive and mixed motor subtypes.

Motor symptoms in 100 patients with delirium versus control subjects: comparison of subtyping methods.

Background: Different motor presentations of delirium may represent clinically meaningful subtypes.

Objective: Authors sought to evaluate delirium phenomena.

Method: They used three non-validated delirium psychomotor subtype schemas, applied to a palliative-care population.

A new data-based motor subtype schema for delirium.

The authors sought to validate a new approach to motor subtyping in delirium based on data from a controlled comparison of items from three existing psychomotor schema combined into the Delirium Motoric Checklist. Principal components analysis of the Delirium Motoric Checklist identified two factors that correlated significantly with independently assessed motor agitation and retardation. Symptoms loading at >0.

Motion analysis in delirium: a novel method of clarifying motoric subtypes.

The usefulness of motor subtypes of delirium is unclear due to inconsistency in subtyping methods and a lack of validation with objective measures of motor activity levels. We studied patients with hyperactive, hypoactive, and mixed presentations of delirium were studied with 24-h accelerometer-based monitoring. The procedures were well tolerated and motor presentations were readily distinguished using the accelerometer-based measurements.

Phenomenology of delirium. Assessment of 100 adult cases using standardised measures.

Background: Delirium phenomenology is understudied.

Aims: To investigate the relationship between cognitive and non-cognitive delirium symptoms and test the primacy of inattention in delirium.

Method: People with delirium (n=100) were assessed using the Delirium Rating Scale-Revised-98 (DRS-R98) and Cognitive Test for Delirium (CTD).

Symptoms and prognosis in advanced cancer.

As death from cancer approaches, the associated symptoms become more important. Not only do these symptoms impair quality of life and guide palliative management of the patient, but some also appear to have prognostic value in determining clinical course and survival. A comprehensive prospective analysis of symptoms in 1,000 patients on initial referral to the Palliative Medicine Program of the Cleveland Clinic was conducted.

Morphine in cancer pain management: a practical guide.

Morphine is the most practical and versatile analgesic for the relief of severe pain associated with advanced cancer. Information is available in the literature about its use in routine clinical practice. Morphine induces analgesia by reducing neurotransmitter release presynaptically and hyperpolarizing dorsal horn neurons at the postsynaptic level, thus preventing rostral transmission of nociception.