Beyond grand rounds: a comprehensive and sequential intervention to improve identification of delirium.

Purpose Of The Study: Delirium is a widespread concern for hospitalized seniors, yet is often unrecognized. A comprehensive and sequential intervention (CSI) aiming to effect change in clinician behavior by improving knowledge about delirium was tested.

Design And Methods: A 2-day CSI program that consisted of progressive 4-part didactic series, including evidence-based reviews of delirium recognition, prevention, and management, interspersed with interactive small group sessions and practical case conferences was conceptualized in consultation with a leading expert on delirium.

Potentially inappropriate prescribing in elderly: assessing doctor knowledge, confidence and barriers.

Introduction: Inappropriate medication prescribing by doctors is an important preventable cause of morbidity and mortality in the elderly. This study investigates doctor knowledge about potentially inappropriate prescribing (PIP) in elderly, their confidence in prescribing for the elderly and explores perceived barriers.

Methods: Family and Internal Medicine resident and attending doctors at three teaching hospitals were asked to complete a survey.

Oppositional defiant disorder.

Oppositional defiant disorder is defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., as a recurrent pattern of developmentally inappropriate, negativistic, defiant, and disobedient behavior toward authority figures. This behavior often appears in the preschool years, but initially it can be difficult to distinguish from developmentally appropriate, albeit troublesome, behavior.

Urinary incontinence evaluation and the utility of pessaries in older women.

Urinary incontinence and pelvic organ prolapse are common conditions affecting the elderly. A careful evaluation of urinary incontinence, including history and physical examination, will often determine the etiology of this condition. Vaginal pessaries are a safe and efective treatment for both urinary incontinence and pelvic organ prolapse.

Evaluation of children with reading difficulties.

Reading difficulties are common and are associated with poor long-term academic achievement. Evaluation of a child's developmental, educational, and family histories in conjunction with standardized screening tests (e.g.

Uses and abuses of wrist arthroscopy.

Purpose Of Review: The use of wrist arthroscopy in the diagnosis and treatment of carpal pathology continues to expand. The purpose of this paper is to summarize recent advances in the utility of this diagnostic, therapeutic, and research tool.

Recent Findings: The indications for wrist arthroscopy are growing with the description of volar portals for the radiocarpal and scaphotrapezial trapezoid joint.

Opiate dependence treatment with buprenorphine: one year's experience in a family practice residency setting.

Buprenorphine became available for office-based treatment of opiate dependence in January 2003, at which time the Underwood-Memorial Hospital Family Practice Residency Program began offering buprenorphine treatment at its family practice center. This article describes the patient selection process, outcomes, and obstacles to treatment. Patients who had a pharmaceutical benefit were much more likely to remain in treatment than those who had to pay for the medication.

Use of a total quality management model to reduce pressure ulcer prevalence in the acute care setting.

As the population ages and becomes more frail, pressure ulcer prevalence and incidence within specific care settings are being evaluated through outcomes review. This article summarizes the process and outcomes of an ongoing prevalence study at a 300-bed acute care community hospital. All patients on the adult medical, surgical, and critical care units were examined regularly by the "Rear Admirals," a team comprising a skin care resource person and a nursing unit representative.

Fecal Clostridium difficile carriage among medical housestaff.

Housestaff, physician assistants, and hospitalized patients at a teaching hospital were tested for fecal carriage of Clostridium difficile. The test results showed that fecal carriage of C. difficile may not be important in the epidemiology of hospital-acquired diarrhea.

The emergency department medical record.

Emergency physicians are overwhelmed by the load of medical record documentation in the emergency department. This article reviews the important reasons for better documentation and today's increasing regulatory requirements in medical record documentation.

Affiliated state chapter experience with a professional lobbyist for pharmacy legislative activities.

The experiences of the New Jersey Society of Hospital Pharmacists (NJSHP) with a professional lobbyist are described. NJSHP hired a part-time lobbyist in 1985 for direct lobbying services, legislative monitoring, and public relations duties. Accomplishments of the lobbyist include reappointment of a hospital pharmacist to the state board of pharmacy, formation of a political action committee, development of a specific political action plan, and creation of position statements.