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1. A multifaceted intervention package to improve the diagnosis and management of delirium.

Author

Fleet, J., Chen, S., Martin, F.C., and Ernst, T.

Abstract

Background:Delirium is a major cause of morbidity and mortality amongst hospital patients. Previous studies have shown that it is often poorly recognized and managed. We wanted to assess the impact of a multifaceted intervention on delirium management.Methods:A pre/post-intervention design was used. The local hospital delirium guideline was adapted into A7 sized cards and A3/A2 posters. Cards were distributed to junior doctors and teaching sessions were held. Computer screen savers were displayed and delirium promotion days held. The pre/post-intervention data were used to audit the following: delirium knowledge through questionnaires, documented use of the confusion assessment method (CAM) and identification and management of eight common precipitating factors. Re-audit was four months post baseline with interventions within this period. χ2 tests were used for statistical analysis.Results:A convenience sample of randomly selected doctors in postgraduate training posts completed 100 questionnaires and 25 clinical notes were selected via retrospective identification of delirium. Results from questionnaires demonstrated significant improvements in: recognizing CAM as the diagnostic tool for delirium (24% vs. 71%, p < 0.01); identifying haloperidol as first line in pharmacological management (55% vs. 98%, p <0.01) and its correct dose (40% vs. 67%, p <0.01). In clinical practice, there was significant improvement in documentation of CAM for inpatient delirium assessments (0% vs. 77%, p <0.01). Trainees found the delirium card “very helpful” (82%) and carried it with them at all times (70%).Conclusion:This multifaceted intervention increased CAM use in delirium recognition and improved the knowledge of pharmacological management. The delirium card was highly popular. [ABSTRACT FROM PUBLISHER]

Published
2015
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3. A comprehensive fracture prevention strategy in older adults : The European union geriatric medicine society (EUGMS) statement

Author

H. Blain, T. Masud, P. Dargent-Molina, F.C. Martin, E. Rosendahl, N. van der Velde, J. Bousquet, A. Benetos, C. Cooper, J.A. Kanis, J.Y. Reginster, R. Rizzoli, B. Cortet, M. Barbagallo, K. Dreinhöfer, B. Vellas, S. Maggi, T. Strandberg, M.N. Alvarez, C. Annweiler, P.-L. Bernard, N. Beswetherick, H.A. Bischoff-Ferrari, F. Bloch, J. Boddaert, M. Bonnefoy, V. Bousson, I. Bourdel-Marchasson, A. Capisizu, H. Che, J.G. Clara, B. Combe, D. Delignieres, P. Eklund, M. Emmelot-Vonk, E. Freiberger, J.-B. Gauvain, N. Goswami, N. Guldemond, Á.C. Herrero, M.-E. Joël, A.B. Jónsdóttir, G. Kemoun, I. Kiss, H. Kolk, M.L. Kowalski, Š. Krajcík, Y.G. Kutsal, F. Lauretani, J. Macijauskienė, M. Mellingsæter, J. Morel, F. Mourey, F. Nourashemi, C. Nyakas, F. Puisieux, P. Rambourg, A.G. Ramírez, K. Rapp, Y. Rolland, J. Ryg, O. Sahota, S. Snoeijs, Y. Stephan, E. Thomas, C. Todd, J. Treml, R. Adachi, D. Agnusdei, J.-J. Body, V. Breuil, O. Bruyère, P. Burckardt, J.B. Cannata-Andia, J. Carey, D.-C. Chan, L. Chapuis, T. Chevalley, M. Cohen-Solal, B. Dawson-Hughes, E.M. Dennison, J.-P. Devogelaer, P. Fardellone, J.-M. Féron, A.D. Perez, D. Felsenberg, C. Glueer, N. Harvey, M. Hiligsman, M.K. Javaid, N.R. Jörgensen, D. Kendler, M. Kraenzlin, M. Laroche, E. Legrand, W.D. Leslie, E. Lespessailles, E.M. Lewiecki, T. Nakamura, A. Papaioannou, C. Roux, S. Silverman, M.S. Henriquez, T. Thomas, S. Vasikaran, N.B. Watts, G. Weryha, Euromov (EuroMov), Université de Montpellier (UM), Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon (MACVIA-LR), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-European Innovation Partnership on Active and Healthy Ageing Reference Site (EIP on AHA), Commission Européenne-Commission Européenne-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre Antonin Balmès, Nottingham University Hospitals, Equipe 6 : ORCHAD - Origines précoces de la santé du développement de l'enfant (CRESS - U1153), Université Paris Descartes - Paris 5 (UPD5)-Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Guy's & St Thomas' NHS Foundation Trust, Umeå University, Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA), Département pneumologie et addictologie [Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve, Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Centre d'investigation clinique [Nancy] (CIC), University of Southampton, University of Oxford [Oxford], University of Sheffield [Sheffield], Université de Liège, Geneva University Hospitals and Geneva University, Hôpital Roger Salengro [Lille], Università degli studi di Palermo - University of Palermo, Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], CHU Toulouse [Toulouse], CNR Institute of Neuroscience, University of Padova, University of Helsinki, University of Oulu, Department of Geriatrics - Efficiency and Deficiency Laboratory, Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité ( CRESS (U1153 / UMR_A 1125) ), Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut National de la Recherche Agronomique ( INRA ), Service de médecine gériatrique, Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Department of public health, Service of Bone Diseases, Department of Rehabilitation and Geriatrics, Geneva University Hospital and Geneva University, Service de rhumatologie[Lille], Hôpital Roger Salengro-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Cognition, Action, et Plasticité Sensorimotrice [Dijon - U1093] ( CAPS ), Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), UFR des Sciences de Santé (Université de Bourgogne), Université de Bourgogne ( UB ), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Nottingham University Hospitals NHS Trust [UK], Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Department of Electrical Engineering and Automation [Aalto University], Aalto University (A?), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lorraine (UL), Centre Hospitalier Universitaire de Nancy (CHU Nancy), C.H.U. Sart Tilman [Liège], Charité-University Medical Center - UniversitätsMedizin [Berlin], Gérontopôle, CHU Toulouse [Toulouse]-Epidémiologie et Analyses en Santé Publique : risques, maladies chroniques et handicap (LEASP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Department of Biomedical Sciences [Padova, Italy] (Neuroscience Institute), Italian National Research Council [Padova, Italy]-University of Padova [Padova, Italy], Helsinki University Central Hospital [Finland] (HUCH), Department of Ageing and Health, Guy's and St. Thomas' NHS Foundation Trust, Geneva University Hospital (HUG), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Roger Salengro-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Cognition, Action, et Plasticité Sensorimotrice [Dijon - U1093] (CAPS), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Bourgogne (UB), Clinicum, Department of Medicine, Timo Strandberg / Principal Investigator, Geriatrian yksikkö, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nîmes (CHRU Nîmes)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-European Innovation Partnership on Active and Healthy Ageing Reference Site (EIP on AHA), Commission Européenne-Commission Européenne-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), Hôpital Paul Brousse-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), CIC-Nancy, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy]-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Roger Salengro, Hôpital Roger Salengro [Lille]-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC), APH - Amsterdam Public Health, AMS - Amsterdam Movement Sciences, Geriatrics, Blain, H., Masud, T., Dargent-Molina, P., Martin, F.C., Rosendahl, E., van der Velde, N., Bousquet, J., Benetos, A., Cooper, C., Kanis, J.A., Reginster, J.Y., Rizzoli, R., Cortet, B., Barbagallo, M., Dreinhöfer, K.E., Vellas, B., Maggi, S., Strandberg, T., Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Herrada, Anthony, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-European Innovation Partnership on Active and Healthy Ageing Reference Site (EIP on AHA), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), University of Oxford, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Università degli Studi di Padova = University of Padua (Unipd), and Helsingin yliopisto = Helsingfors universitet = University of Helsinki

Subjects
Gerontology, Aging, Statement (logic), Cost effectiveness, Osteoporosis, Poison control, Medicine (miscellaneous), postmenopausal women, Position statement, Suicide prevention, Occupational safety and health, law.invention, Fractures, Bone, zoledronic acid, 0302 clinical medicine, Randomized controlled trial, Bone Density, law, Secondary Prevention, Fall, Nutrition and Dietetic, Medicine, 030212 general & internal medicine, risk-factors, ComputingMilieux_MISCELLANEOUS, media_common, Geriatrics, Aged, 80 and over, Hip fracture, Nutrition and Dietetics, [SDV.MHEP.GEG] Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, osteoporotic fractures, [SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, Accidental Fall, fall induced injuries, Fragility fracture, 3. Good health, Primary Prevention, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, randomized controlled-trials, Fracture prevention, bone-mineral density, Falls, Human, medicine.drug, medicine.medical_specialty, education, hip-fracture, 030209 endocrinology & metabolism, [ SDV.MHEP.GEG ] Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontology, Article, 03 medical and health sciences, pharmacological-treatments, media_common.cataloged_instance, Humans, European Union, European union, cost-effectiveness, Aged, Postmenopausal women, business.industry, Public health, Prevention, Osteoporosi, medicine.disease, [SDV.AEN] Life Sciences [q-bio]/Food and Nutrition, Zoledronic acid, 3121 General medicine, internal medicine and other clinical medicine, ddc:618.97, Physical therapy, Accidental Falls, fragility fracture, older people, position statement, prevention, Geriatrics and Gerontology, Older people, business, [SDV.AEN]Life Sciences [q-bio]/Food and Nutrition, Geriatric
Abstract

Published also in Aging Clinical and Experimental Research, Vol.28, No.4, WOS: 000379034800030 Prevention of fragility fractures in older people has become a public health priority, although the most appropriate and cost-effective strategy remains unclear. In the present statement, the Interest group on falls and fracture prevention of the European union geriatric medicine society (EUGMS), in collaboration with the International association of gerontology and geriatrics for the European region (IAGG-ER), the European union of medical specialists (EUMS), the Fragility fracture network (FFN), the International osteoporosis foundation (IOF) - European society for clinical and economic aspects of osteoporosis and osteoarthritis (ECCEO), outlines its views on the main points in the current debate in relation to the primary and secondary prevention of falls, the diagnosis and treatment of bone fragility, and the place of combined falls and fracture liaison services for fracture prevention in older people. (C) 2016 Published by Elsevier Masson SAS.

Published
2016

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