Delirium in Older Persons: Prevention, Evaluation, and Management.

Delirium is an acute disturbance in attention, cognition, and awareness that fluctuates over time. Delirium is characterized by three subtypes: hyperactive, hypoactive, and mixed. It occurs in 11% to 25% of older adults in inpatient settings and is associated with a significant financial burden. Older age, multiple comorbidities, recent surgery, and polypharmacy are independent risk factors for delirium. The diagnosis is clinical but can be challenging due to overlapping symptoms with dementia and depression. The Confusion Assessment Method is a screening tool that is 94% to 100% sensitive haloperidol because of their faster onset of action and fewer adverse effects. Patients hospitalized with prolonged delirium have approximately three times the chance of dying in the following year compared with patients with a quick resolution of delirium or no symptoms; therefore, prevention and early detection should be emphasized.

Conventional Versus New Treatment: Comparing the Effects of Acetylcholinesterase Inhibitors and N-Methyl-D-Aspartate Receptor Antagonist With Aducanumab.

Alzheimer's dementia (AD) is the most common major neurocognitive impairment and the fifth leading cause of death in older adults in the United States. The diagnosis is clinical; however, laboratory tests and imaging frequently rule out secondary causes of dementia. Unfortunately, the treatment available for AD does not reverse dementia, but it may help improve the symptoms and slow the progression of the disease. The conventional treatment - acetylcholinesterase inhibitor (AChEI) therapy and N-methyl-D-aspartate (NMDA) receptor antagonist - is considered to enhance executive function, overall cognition, and activities of daily living. AChEIs such as donepezil, rivastigmine, and galantamine are approved for mild-to-moderate dementia. Furthermore, memantine, an NMDA receptor antagonist, is authorized for moderate-to-severe dementia. Aducanumab, the newest drug available, is an amyloid-beta (Aß) monoclonal antibody approved only for mild AD. Treatment with either AChEIs or memantine is more cost-effective than aducanumab and the best supportive care. Aducanumab has particular recommendations with strict monitoring and several adverse effects, including amyloid-related imaging abnormalities. The most common adverse effects of AChEIs and memantine include gastrointestinal symptoms, dizziness, confusion, and headaches. Therefore, monitoring should be performed periodically at the clinician's discretion for clinical response and tolerability of medication. Conventional therapies are only for symptom management but are still beneficial to patients and caregivers. Unfortunately, at this time, aducanumab's risks outweigh the benefits with a questionable approval process by the Food and Drug Administration (FDA). However, given the potential disease-modifying capabilities of aducanumab, other disease-modifying options may become available by possibly reducing inflammation, preventing Aß plaques from clumping, or keeping tau proteins from tangling.

Improving Cervical Cancer Screening Rates at an Urban Federally Qualified Health Center Family Medicine Residency Clinic.

Background Family medicine residency clinics and underserved Federally Qualified Health Center clinics often have lower rates of cervical cancer screening (CCS). Methods A series of resident-run, team-based quality improvement projects were conducted to iteratively improve CCS rates in an urban Federally Qualified Health Center in a high-need and high-demand region. Results The authors were able to improve CCS rates from 52.2% to 66.3% through 6 quality improvement projects. Conclusion Improving the clinical workflows and systems to promote better rates of CCS likely requires a series of changes, however, promoting CCS in the usual clinic workflow, regardless of the reason for visit, demonstrated the greatest gains in CCS in our setting.