Efforts to Prevent Delirium in Hospitalized Older Patients Show Promise
- Thu, 12/30/10 - 3:44pm
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In this issue of Clinical Geriatrics, Angela Botts, MD, has written an article on delirium that I believe presents information of great value to anyone caring for older hospitalized patients. Delirium is a common and serious problem that affects as many as 70% of older persons admitted to critical care units and between 6% and 50% of older persons admitted to general medical and surgical floors, based on a composite of numerous studies that have examined this serious and growing problem. It is associated with an approximate 35% 1-year mortality, and is thought to result in as many as 17.5 million inpatient days annually. It has been referred to as “The beginning of the end,”1 and is considered by many to be one of the leading causes of “preventable” injury in persons over the age of 65 years.
Bradycardia in a Fit, 82-Year-Old Male
- Fri, 10/15/10 - 9:58am
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I was asked to help evaluate an 82-year-old man who was admitted to the hospital after falling off his bicycle. He was noted to be confused, though initially he had no other focal neurological findings. The patient was diagnosed as having a left subdural hematoma and subarachnoid hemorrhage. While he initially reported only a mild headache, over the next 12 hours his speech became garbled and he developed an inability to grasp items with his right hand. It was determined that he would benefit from surgery to relieve excess pressure that was thought to be compromising his brain function. Upon admission, the patient’s pulse was noted to be 51 beats per minute and his electrocardiogram revealed a sinus bradycardia with moderate left ventricular hypertrophy.
Clinical Practice Guideline—or Mandate?
- Thu, 4/15/10 - 3:16pm
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This past month, the Infectious Diseases Society of America (IDSA), in collaboration with the American Geriatrics Society, American Society of Nephrology, American Urological Association, and other organizations in the United States and throughout the world, released their Guidelines for the Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America.1 I read these guidelines with great interest and consider this to be a most welcome addition to other us
Words to Live By, From George Carlin
- Mon, 9/15/08 - 8:51am
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Ever since George Carlin died this past June, I have been impressed by just how many people have openly admitted to liking his stand-up comedy, each sending me a favorite monologue or video from YouTube to watch and hopefully enjoy as much as they did. While perhaps best known for his censored “Seven Words You Can Never Say on Television” routine, Carlin amazed many with his wit, wisdom, and insight into mainstream America. His views on the aging process were no less thought-provoking and, I think, worthy of sharing with readers.
August: A Month of Important Births and Other Events
- Tue, 8/12/08 - 8:46am
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Dr. Gambert is Chairman, Department of Medicine, and Physician-in-Chief, Sinai Hospital of Baltimore, and Professor of Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
August has always been a special month to me (and not just because it contains my birthday). I thought I would share some facts with you about August events, and end with one that forever changed the way people function in their daily lives—a phenomenon that has opened new horizons to the practice of medicine an
Physician-Assisted Suicide: A Resident’s Dilemma
- Mon, 7/14/08 - 10:14am
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While I have been writing this column in Clinical Geriatrics for some time now, I thought you might appreciate the following “Physician’s Perspective” from an Internal Medicine resident still in his first year of training. Clearly, learning to be a board-certified internist takes more than memorizing a list of differential diagnoses, understanding medication use and side effects, and developing physical examination skills. It requires a mastery of the Six Core Competencies established by the Accreditation Council for Graduate Medical Education (ACGME)
The Growing Insurance Crisis in America: Uninsurable, Unaffordable, Unacceptable
- Mon, 6/16/08 - 10:36am
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Dr. Gambert is Chairman, Department of Medicine, and Physician-in-Chief, Sinai Hospital of Baltimore, and Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Although there are currently between 46 and 48 million persons in the United States without health insurance, and there is talk among the Presidential hopefuls of finding some solution to this growing crisis, an equally important crisis is the growing number of “uninsurable” Americans—even if one is willing to fund his/her own heal
Medication Error: An All-Too-Common Preventable Problem
- Fri, 5/16/08 - 8:05am
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I have written previously about National Patient Safety initiatives and the need to ensure that all physicians do whatever possible to reduce medication errors. Whether it is writing more clearly, using only “approved” abbreviations, monitoring side effects, or other techniques, morbidity and mortality from medication use can be reduced. A couple of months ago, I watched on national television as a celebrity couple discussed a medication error that occurred when their twins were born. Apparently, the babies were given one form of heparin that contained 10,000 u
“Don’t You Think They Should Have Told Me?” Is Full Disclosure Always Necessary?
- Tue, 5/13/08 - 9:48am
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We hear a lot about the need to provide “full disclosure” to our patients—and rightfully so—but what exactly is appropriate? Just listen to the ads on television for various medications; one is struck by the litany of possible side effects that would make anyone fear taking the medication if they gave it any thought. Is this the right forum in the first place to let the public know about a medication for a specific problem? Some would argue that it is not.
What exactly is full disclosure, and when is it okay to hold back
Weighing the Benefits and Risks of Searching for the Fountain of Youth
- Fri, 4/4/08 - 9:13am
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"Healthy aging,” “life extension,” “successful aging.” These phrases are frequently used to promote a special lifestyle, diet, medication regimen, or treatment. While the eternal search for the Fountain of Youth remains elusive, it is easy to see how normal aging and age-associated illness can bring thoughts of vulnerability and the need to do something “different.” While some are searching for a prolongation of the lifespan itself, others are merely trying to live healthier and more productive lives for as long as possible.
