Symptoms of delirium predict incident delirium in older long-term care residents.

Background: Detection of long-term care (LTC) residents at risk of delirium may lead to prevention of this disorder. The primary objective of this study was to determine if the presence of one or more Confusion Assessment Method (CAM) core symptoms of delirium at baseline assessment predicts incident delirium. Secondary objectives were to determine if the number or the type of symptoms predict incident delirium.

Symptoms of delirium occurring before and after episodes of delirium in older long-term care residents.

Objective: To describe Confusion Assessment Method (CAM) core symptoms of delirium occurring before and after incident episodes of delirium in older long-term care (LTC) residents. A secondary objective was to describe the mean number of symptoms before and after episodes by dementia status.

Design: Secondary analysis of data collected for a prospective cohort study of delirium, with repeated weekly assessments for up to 6 months.

Subsyndromal delirium in older people: a systematic review of frequency, risk factors, course and outcomes.

Objective: To determine the frequency, risk factors, course and outcomes of subsyndromal delirium (SSD) in older people by systematically reviewing evidence on these topics.

Methods: Subsyndromal delirium was defined as the presence of one or more symptoms of delirium, not meeting criteria for delirium and not progressing to delirium. MEDLINE, EMBASE, PsycINFO and the Web of Science were searched for potentially relevant articles published from 1996 to June 2011.

The value of repeat Clostridium difficile toxin testing during and after an outbreak of C difficile-associated diarrhea.

Background: The recent increase in Clostridium difficile-associated diarrhea (CDAD) has led to questions about the reproducibility and sensitivity of C difficile toxin testing (CDTT). While there have been recommendations to repeat CDTT following a negative result, previous studies have failed to show a benefit. However, no studies were performed during an outbreak of CDAD.

The course of delirium in older long-term care residents.

Objective: The purpose of this study was to determine the course of delirium in older long-term care (LTC) residents.

Methods: A prospective cohort study of 279 residents in seven LTC facilities in Montreal and Quebec City, Canada, was conducted. The Mini Mental State Examination (MMSE), Confusion Assessment Method (CAM), Delirium Index (DI), Hierarchic Dementia Scale, Barthel Index, and Cornell Scale for Depression were completed at baseline.

Influence of the DSM-IV Outline for Cultural Formulation on multidisciplinary case conferences in mental health.

The Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM-IV-TR) includes an Outline for Cultural Formulation (CF) that identifies cultural information that can be used to modify diagnosis, clinical assessment and treatment plan. This study examined the use of the CF by a Cultural Consultation Service in the psychiatric assessment of patients referred by primary care providers. The study uses conversation analysis of 12 clinical case conferences to explore the ways in which the CF influenced the interaction of a multidisciplinary group of mental health professionals in conceptualizing the implications of patients' cultural background and current context for diagnosis and treatment planning.

Women's experience of an emergency caesarean birth.

Aims: To explore women's experience of an emergency caesarean birth to gain a better understanding of their thoughts, and feelings throughout the birth process.

Background: Women who experience an emergency caesarean birth have an increased risk of psychological distress, however, little is known about the nature of this experience from their perspective. Given the sudden and unexpected nature of this type of birth and the increased risk of psychological distress for these women, it is important for nurses to understand the experience of women who have had an emergency caesarean birth.

Persistent delirium in older hospital patients.

Purpose Of Review: There are two contradictory views on the prognosis of delirium in older hospital patients. On one hand, the Diagnostic and Statistical Manual, 4th Text Revision (DSM-IV-TR), describes delirium as a transient cognitive disorder, the majority of affected individuals having a full recovery. On the other hand, longitudinal studies of delirium in this population report that the outcomes are poor.

Persistent delirium in older hospital patients: a systematic review of frequency and prognosis.

Background: one explanation for the poor prognosis of delirium among older hospital patients may be that many of these patients do not recover from delirium. We sought to determine the frequency and prognosis of persistent delirium (PerD) in older hospital patients by systematically reviewing original research on this topic.

Methods: MEDLINE, EMBASE, PsycINFO and the Cochrane Database of Systematic Reviews were searched for potentially relevant articles.

The 6- and 12-month outcomes of older medical inpatients who recover from subsyndromal delirium.

Objectives: To compare the 6- and 12-month outcomes of patients who recovered from subsyndromal delirium (SSD) by 8 weeks with the outcomes of patients who did not recover or did not have an index episode.

Design: Secondary analysis of data collected for a cohort study of the prognosis of delirium.

Setting: University-affiliated primary acute care hospital.

Improving the quality of surgical pathology reports for breast cancer: a centralized audit with feedback.

Context: Good communication of pathologic characteristics of a malignancy is crucial to therapy choices and accurate prognostication. The information must be easily retrieved from a surgical pathology report.

Objectives: To evaluate, first in 1999, the quality of surgical pathology reports for segmental breast resections for cancer in Quebec hospitals.

Sperm DNA damage is associated with an increased risk of pregnancy loss after IVF and ICSI: systematic review and meta-analysis.

Background: Sperm DNA damage is common amongst infertile men and may adversely impact natural reproduction, IUI-assisted reproduction and to a lesser degree IVF pregnancy. The aim of this study was to examine the influence of sperm DNA damage on the risk of spontaneous pregnancy loss after IVF and ICSI.

Methods: We conducted a systematic review and meta-analysis of studies on sperm DNA damage and pregnancy loss after an IVF and/or ICSI pregnancy.

Survey of nursing perceptions of medication administration practices, perceived sources of errors and reporting behaviours.

In January 2003, St. Mary's Hospital Center in Montreal, Quebec, established an interdisciplinary Committee on the Systematic Approach to Medication Error Control to review the whole process of medication administration within the hospital and to develop a systematic approach to medication error control. A cross-sectional survey on medication administration practices, perceived sources of errors and medication error reporting of nurses, adapted from a nursing practice survey and medication variance report (Sim and Joyner 2002), was conducted over a two-week period in February 2004.

Implementing fit testing for N95 filtering facepiece respirators: practical information from a large cohort of hospital workers.

Qualitative fit testing for N95 respirators was conducted on 1271 health care workers. All male participants were fitted with a respirator. Six females, all under age 40 years, were not successfully fitted.

Comparing rates of trial of labour attempts, VBAC success, and fetal and maternal complications among family physicians and obstetricians.

Objectives: To determine differences between family physicians and obstetricians in rates of trial of labour (TOL) attempt, vaginal birth after Caesarean section (VBAC) success, and maternal-fetal complications.

Methods: We undertook a database evaluation study in an urban Quebec secondary care hospital centre that serves a multiethnic population. Study subjects were pregnant women with at least one previous Caesarean section (CS), who delivered singletons at St.

Risk factors for major depression in older medical inpatients: a prospective study.

Objective: To determine risk factors for major depression in older medical inpatients.

Method: In a prospective cohort study, 86 older medical inpatients without depression or antidepressant medication were assessed 3, 6, and 12 months after enrollment. Incident major depression was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.

Latissimus dorsi tendon transfer for massive irreparable cuff tears: an anatomic study.

The purpose of this study was to describe landmarks for latissimus dorsi tendon transfer in massive irreparable tears of the rotator cuff. Nine pairs of embalmed cadaveric shoulders were dissected. Crucial structures were identified, and their relationship with various bony and soft-tissue reference points was documented.

Health services use for mental health problems by community-living seniors with depression.

Background: The literature on health services (HS) use for mental health problems by community-living seniors with depression is sparse. This study aimed to characterize patterns of HS use for mental health problems by seniors with depressive disorders and symptoms during the previous 12 months.

Method: The study used data from the Canadian Community Health Survey Cycle 1.

Does depression in older medical inpatients predict mortality? A systematic review.

Objective: To determine whether depression in older medical inpatients predicts mortality.

Method: Medline, PsycINFO, Embase, and the Cochrane Database of Systematic Reviews were searched for potentially relevant articles; the bibliographies of relevant articles were searched for additional references. Retrieved studies were screened to meet five inclusion criteria.

The 6 and 12 month outcomes of older medical inpatients who recover from delirium.

Objective: To compare the 6 and 12 month outcomes of patients who recovered from delirium by 8 weeks with those who did not have an index episode.

Methods: Older medical inpatients were assessed for delirium using the Confusion Assessment Method. All patients with delirium and a sample of patients without delirium were enrolled.

On a wing and a prayer: medical emergencies on board commercial aircraft.

Medical emergencies sometimes arise in the isolated and confined environment of a commercial aircraft. Because a physician passenger may be on board in 40% to 90% of all commercial flights, it follows that this physician may be asked to render assistance to an acutely ill passenger. Although data suggest that the incidence of such emergencies is low, the potential for serious events necessitates a degree of familiarity with the nature of emergencies in the air and with the options available to the travelling physician.