July 11, 2019

NYACP Newsletter: Your Chapter in Action
Prevention and Management of Delirium. . . Final Call for Abstracts. . . Resources Available from ACP


Committee Spotlight


Geriatrics Committee

Prevention and Management of Delirium in the Hospital
This is the second in an ongoing series highlighting issues faced by geriatricians and their patients

by Donna Seminara, MD, MACP

Delirium, also known as metabolic encephalopathy or a change in mental status, is sudden severe confusion that occurs with physical or mental illness.  Delirium is a medical emergency.  Sequelae of delirium may persist for up to 6 months and it is associated with poor clinical outcomes including risk of death in the hospital, prolonged length of stay and increased need for SNF placement.

Identifying patients at risk is a cornerstone of delirium prevention. Patients who have previously experienced delirium are at risk for recurrence. For instance, patients who present for perioperative assessments with a history of hospital or post anesthesia delirium should have delirium risk addressed.  Patients with all causes of dementia and those with mild cognitive impairment are also at risk. Consider also patients with alcohol, analgesic and anxiolytic withdrawal as being at risk for hospital based delirium.

Successful hospital management of patients at risk mandates close communication with hospitalists and surgical specialists about an individual’s predictive risk of delirium. For elective procedures, careful medication reconciliation preoperatively can decrease risk of medication induced encephalopathies. As was emphasized by Dr. Dharmarajan in the previous Geriatric Spotlight on Deprescription, doing what I call a “Medication Debridement” is a key focus of geriatric assessments. Geriatric consultations may be helpful in situations where polypharmacy is a trigger for delirium.1 Predict medication needs and address potential challenges to minimize delirium from occurring. For example a patient requiring stress dose steroids or ongoing steroid treatment with a history of delirium may require a more rapid steroid taper. Furthermore, transitioning information from previous experiences of the individual can be extremely valuable for a patient’s safety (ie: documented  ICU psychosis or adverse behavioral reactions to specific analgesics.)

A series of preventive measures can significantly decrease delirium risk in patients on medical/surgical units. Patients in the hospital should not have glasses, hearing aids, and dentures taken away for “safe keeping”. Patients sensorily deprived have increased difficulty in interpreting their highly charged hospital experience. Patients also need a good night’s sleep so avoidance of disturbances overnight is another key to delirium prevention. Early mobility and avoidance of dehydration are important factors to prioritize for older patients to avoid delirium.

A cornerstone of treating delirium is to identify it early. While 25% of older delirious patients are hyperactive, 75% are hypoactive.  They are the quiet, older persons who don’t make noise or cause problems for staff. The hypoactive patient is however at the same risk as the loud hyperactive “sundowner” who requires a lot of staff time and attention. Whatever the patient’s presentation, comprehensive analysis of data and observation is mandated. The culprit precipitating delirium is often multifactorial. The “Confusion Assessment Method” is helpful in quick bedside evaluations of patients suspected of having delirium, by assessing acute changes in mental status with fluctuating course, inattention, disorganized thinking and altered levels of consciousness.2

A common precipitant of delirium in hospitalized patients is the experience of pain. Barriers to adequate analgesia include the current predisposition against prescribing opioids and delay in medication delivery to patients. IV acetaminophen studies show promise in decreasing delirium risk and opioid use.3

Prescribers for older adults in the hospital need to remember the adage to “start low and go slow”. If a delirious patient requires antipsychotic medication to disrupt behaviors that acutely put the patient or staff at risk for harm, then starting with low doses of Haloperidol or Risperidone may be required.

Geriatric consultation is helpful. Complex older patients often require input from the whole team to best design a personalized care plan geared towards the best functional outcomes.

Bibliography

  1. JAGS Editorial February 2019: “Doc I think My Meds are Killing Me!Please Help…”
  2. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
  3. JAMA February 2019: “Effect of IV Acetaminophen vs Placebo Combined with Propofol or Dexmedetomidine on Post-OP Delirium Among Older Patients Following cardiac Surgery"

Early Career Physicians Task Force

Become a Mentor with NYACP

YOUR chance to be INVOLVED! - Volunteer to mentor or become a mentee.

NYACP’s Early Career Physician Taskforce is developing a regional mentorship program for all NYACP members: medical students, residents, fellows, early career, and seasoned members. All are welcome to participate

The first event will be held on Saturday, October 12, 2019 during the NYACP Annual Scientific Meeting. Please sign up ahead of time by contacting the NYACP Early Career Physicians Task Force here!


Practice Management


Resources from ACP Advance: Chronic Pain and Substance Use Disorder Management

The ACP Center for Quality has partnered with the American Academy of Addiction Psychiatry (AAAP) and a coalition of national professional organizations on two SAMHSA-funded initiatives, the Provider Clinical Support System (PCSS)1 and Opioid Response Network (ORN)2 programs to combat the opioid crisis.

As a part of these programs, ACP hosted a virtual Quality Improvement (QI) leadership training webinar on May 2nd, 2019. This virtual training was the kick-off to the ACP Advance: Chronic Pain and Substance Use Disorder Management QI program, which takes a collaborative, team-based approach to overcome challenges associated with caring for patients with chronic pain.

Resources highlighted and utilized throughout the program include:

1. Funding for this initiative was made possible (in part) by grant no. 5U79TI026556 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

2. Funding for this initiative was made possible (in part) by grant no. 6H79TI080816 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.


ACP Introduces Adult Immunization Resource Hub

ACP's Adult Immunization Resource Hub was developed as part of ACP’s I Raise the Rates initiative to assist physicians and their teams to assess, understand and improve adult immunization rates and patient outcomes in their clinical settings.

I Raise the Rates is a collaborative, data-driven campaign to support patients, physicians, health care teams, systems, and communities in raising adult immunization rates and reducing vaccine preventable diseases. The program seeks to assist internists and other primary care providers in both understanding the immunization rates of their patients and making practice changes that promote immunizations.

To learn more about the Adult Immunization Resource Hub, please click here.

Funding for the I Raise the Rates program was made possible by Center for Disease Control and Prevention (CDC), GlaxoSmithKline, Merck & Co., Inc., Pfizer, Inc. and Sanofi Pasteur Inc.


Education


Attention NYACP Residents and Medical Students: Abstract Submissions Due TOMORROW

The Chapter is now accepting abstracts online for the NYACP Annual Scientific Meeting poster competition on Saturday, October 12, 2019 at the Westchester Hilton Hotel in Rye Brook, NY.

The deadline to submit your abstract is TOMORROW, June 12 at 5:00 PM. - now closed

If you have worked on a research project or have an interesting clinical case, submit your abstract for a chance to present in the following categories:

  • Research
  • Clinical Vignette
  • Quality, Advocacy and Public Policy Category (Resident & Medical Student combined category)

Click on each category to learn more:

Program/Clerkship Directors will be notified of competition results the week of September 2, 2019. 
NYACP staff DOES NOT notify individuals of the results.

Submit Your Abstract Here****Please note: we no longer require a username and password when submitting an abstract


2019 NYACP Annual Scientific Meeting: Registration Open
Friday, October 11: MOC Pre-Courses | Saturday, October 12: Annual Meeting

Hilton Westchester Hotel | Rye Brook, NY
Register Here | Course Schedule and Details | Call for Abstracts

Message from the Program Chair:

Dr. Masani will welcome attendees at 8:00 am

Naveed Masani, MD, FACP
Education and Program Committee Chair

We hope you will join us on Friday, October 11 and Saturday, October 12 for the next NYACP Scientific Meeting in Rye Brook, New York. This two-day event will have something for everyone! If you need MOC points and CME Credits - sign up for the ABIM Pre-courses on Friday, October 11th. On Saturday, begin the day with the very popular poster competition which will display over 100 posters from the Resident/Fellow and Medical Student Members. We hope you will mark the date in your calendar as we continue to update you with faculty highlights and educational opportunities!
 

ABIM MOC Sessions and MLMIC Course: Friday, October 11, 2019
Topics:

  • 2019-2020 Update in Hospital Medicine
  • 2019-2020 Update in Internal Medicine
  • MLMIC Session: Million Dollar Claims Session

Annual Scientific Meeting: Saturday, October 12, 2019
Plenary and Breakout Sessions:

  • The Technology of Healthcare -
    Artificial Intelligence
  • Direct Oral Anticoagulants: Pearls & Pitfalls
  • Women's Health: Cardiovascular Issues in Pregnancy
  • Point of Care Ultrasound
  • Repurposing Old Medicines for New Uses
  • Managing of Osteoporosis
  • Evidence Based Management
    of Hypertension in 2019
  • "Social Media" Strategies for Meaningful
    Engagement as Clinicians and Educators
  • Burnout and Physician Wellness
  • MACRA Update
  • Conflicting Date of Aspirin
  • Update on Lipids Management
  • Musculoskeletal Diagnosis Utilizing History
    and Physical Examination: Focus on Spine
  • Population  Health
  • Women's Health: Diabetes and Cardiac Problems
  • Medical Marijuana
  • Leadership in Medicine
  • Final Plenary: Avoiding Medical Liability Suits
 

Upcoming Events:


Co-Sponsored Events


SAVE THE DATE!
1st Annual International Geriatrics Symposium for the Primary Care Provider
Provided by Albany Medical College in collaboration with the New York Chapter American College of Physicians

September 18-20, 2019 - 8.5 AMA PRA Category I Credits™
The Conference Center

2608 Main Street • Lake Placid, NY 12946

More information will be available soon!


SAVE THE DATE!
Current Topics in Primary Care and Neurology: Update for the Primary Care Practitioner

Provided by Albany Medical College in collaboration with the New York Chapter American College of Physicians

September 20-22, 2019 - 12 AMA PRA Category I Credits™
The Conference Center

2608 Main Street • Lake Placid, NY 12946

More information will be available soon!


Dietary and Lifestyle Strategies for Cardiovascular Risk Reduction
Jointly provided by NYU School of Medicine and the New York Chapter American College of Physicians

Friday, October 18, 2019 - 7.25 AMA PRA Category I Credits™
NYU Langone Health: Alumni Hall

550 First Avenue • New York, NY  10016

Event Brochure • Register Online


Career Link


                                                                                  

 

Physicians, are you looking for a change?  Tired of working long shifts with an overwhelming patient load?  Come work at a well-equipped and staffed correctional facility where you can make a difference, working with a smaller number of patients for reasonable hours.

The NYS Department of Corrections and Community Supervision’s Department of Health Services operates as a Core Service to promote, restore and maintain the health of incarcerated individuals within safe facilities. There are 54 facilities located throughout the State of New York, serving approximately 50,000 inmates. Medical staff are made up of multi-interdisciplinary teams, which include Physicians, Physician Assistants, Nurse Practitioners, Nurses, Dentists, Pharmacists and other Ancillary positions.

We have great career opportunities for Clinical Physicians.  You must have possession of a license and current registration to practice medicine in New York State, and have two years of post-licensure medical experience.

Starting salary: $143,381 - $171,631 *(Additional $20,000 geographical differential for Clinton and Franklin County, and $10,000 for Greene and Seneca county).

Benefits include: comprehensive health insurance, including dental, vision and prescriptions. NYS retirement system, deferred compensation plan, flexible spending plan, 13 vacation days, 5 personal days, 13 sick days and 12 paid holidays annually.

We have openings in the following counties offering a choice of urban, suburban or rural living:

Clinton*   Clinton Correctional Facility (sporting and recreational outlets)
Dutchess      Fishkill and Green Haven Correctional Facilities (Hudson River Valley Beauty)
Franklin* Franklin and Upstate Correctional Facility (North Country, 1 hour to Montreal)
Greene* Greene Correctional Facility (rural charm yet only 2 hours to New York City)
Oneida                       Mohawk Correctional Facility (Cooperstown, breweries)
Sullivan   Woodbourne Correctional Facility (mountains, outlets, casinos & entertainment)
Seneca*  Five Points Correctional Facility (heart of wine country)
St. Lawrence Riverview Correctional Facility (hiking, boating and museums)
Washington Great Meadow Correctional Facility (Between Vermont & the Green Mountains)
Westchester Bedford Hills Correctional Facility (Less than 1 Hour to NYC)
 

Contact: www.doccs.ny.gov or DOCCS Personnel Office at (518) 457-8132 for more information and to apply.

image widget