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March Journal Club (2012)
Thursday, March 29
6:30 PM
Room 400 A & B Prior Health Science Library
Journal Club Vignette
You are working a shift at a community ED when a 72-year-old female is brought for evaluation by her family. The patient's daughter states that she has been acting differently for the past week. She lives alone and you discover that her husband of 51 years just passed away 2 months ago. Her daughter states that she handled everything well but has been withdrawn and acting "different" during her daily visits over the last couple of weeks. The daughter is unsure if she is eating and taking her medications properly. The patient has numerous medical problems including type 2 DM, CAD, HTN, back pain, depression, COPD, afib. She takes numerous medications that you are unable to obtain. The patient refuses to talk to you during the encounter. Her vitals are HR 101, BP 168/96, RR 18, T 99 F, and 96% on RA. Given the patient history and physical you are unsure if the patient's symptoms are due to grieving process, delirium, dementia, or psychiatric cause. You decide to review the literature to identify an effective and efficient screening tool to detect mental status impairment in geriatric ED patients.
To investigate this, the following approach is explored:
PICO Question
| Population: |
Geriatric patients with potential cognitive impairment |
| Intervention: |
Formal screening tools to detect cognitive impairment |
| Comparison: |
Standard screening evaluation techniques |
| Outcome: |
Sensitivity, specificity, NPV, PPV of identifying cognitive impairment in ED |
| Search Strategy: |
Pubmed; Keywords: cognitive impairment AND emergency medicine Results: 77 articles. 3 selected for review: |
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| Article 1: |
Hustey FM, Meldon SW, Smith MD, Lex CK: The effect of mental status screening on the care of elderly emergency department patients. (Pub Med link) Ann Emerg Med 2003 41:5 p678-84.
Download Article |
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| Article 2: |
Carpenter CR, Bassett ER, Fischer GM, Shirshekan J, Galvin JE, Morris JC: Four sensitive screening tools to detect cognitive dysfunction in geriatric emergency department patients: brief Alzheimer's Screen, Short Blessed Test, Ottawa 3DY, and the caregiver-completed AD8. (Pub Med link) Acad Emerg Med 2011 18:4 p374-84.
Download Article |
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| Article 3: |
Shah MN, Karuza J, Rueckmann E, Swanson P, Conwell Y, Katz P: Reliability and validity of prehospital case finding for depression and cognitive impairment. (Pub Med link) J Am Geriatr Soc 2009 57:4 p697-702.
Download Article |
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First article use the "Diagnosis Critical Review Form" (Download)
Sceond article use the "Diagnosis Critical Review Form" (Download)
Third article use the "Diagnosis Critical Review Form" (Download) |
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