Altered Mental Status and Delirium
adults; Altered mental status; cognitive impairment; confusion assessment method; delirium; Dementia; Elderly; elderly-patients; Emergency Medicine; Emergency Medicine; emergency-department patients; haloperidol; intensive-care-unit; Length of Stay; Medical decision-making capacity; scale; screening tools
Older patients who present to the emergency department frequently have acute or chronic alterations of their mental status, including their level of consciousness and cognition. Recognizing both acute and chronic changes in cognition are important for emergency physicians. Delirium is an acute change in attention, awareness, and cognition. Numerous life threatening conditions can cause delirium; therefore, prompt recognition and treatment are critical. The authors discuss an organized approach that can lead to a prompt diagnosis within the time constraints of the emergency department.
Wilber S T; Ondrejka J E
Emergency Medicine Clinics of North America
2016
2016-08
Journal Article
<a href="http://doi.org/10.1016/j.emc.2016.04.012" target="_blank" rel="noreferrer noopener">10.1016/j.emc.2016.04.012</a>
Comparison of changes in blood pressure measurements and antihypertensive therapy in older, hypertensive, ambulatory care patients prescribed celecoxib or rofecoxib
congestive-heart-failure; controlled trial; cox-2 inhibitor; elderly-patients; gastrointestinal toxicity; nonsteroidal antiinflammatory drugs; nsaids; osteoarthritis; Pharmacology & Pharmacy; renal-function; rheumatoid-arthritis
Study Objective. To determine if changes in blood pressure and changes in class or dosing of antihypertensive drugs were significantly different in patients treated with celecoxib versus rofecoxib, two cyclooxygenase (COX)-2 inhibitors. Design. Retrospective cohort study. Setting. Thirty-one ambulatory care practices that shared an electronic medical record. Patients. Nine hundred sixty men and women over age 55 years with stable hypertension. Intervention. Patients had to have at least a 30-day supply of celecoxib or rofecoxib (any dose) prescribed between July 1, 1999, and June 30, 2000. Measurements and Main Results. Patients were followed for 6 months, and logistic regression and survival models were used to compare outcomes between groups while adjusting for confounders. Baseline characteristics of 517 patients receiving celecoxib and 443 receiving rofecoxib were similar. No significant differences were observed, regardless of the COX-2 inhibitor prescribed, in the proportion of patients whose systolic blood pressure increased by 20 mm Hg, whose diastolic blood pressure increased by 15 nun Hg, or who were prescribed a new class of antihypertensive drug. Compared with patients taking celecoxib, those taking rofecoxib were significantly more likely (odds ratio 1.68, 95% confidence interval 1.09-2.60) to have had the dosage of their antihypertensive drug increased and also the dosage increased sooner (p<0.05). New-onset cardiac and renal comorbidity, number of physician visits, and changes in body weight and laboratory values were not significantly different between the groups. Conclusion. No significant differences in blood pressure changes or in the proportion of patients who were prescribed a new class of antihypertensive drug were found between rofecoxib- and celecoxib-treated patients. However, significantly more rofecoxib-treated patients had the dosage of their existing antihypertensive drug increased compared with those receiving celecoxib.
Nietert P J; Ornstein S M; Dickerson L M; Rothenberg R J
Pharmacotherapy
2003
2003-11
Journal Article
<a href="http://doi.org/10.1592/phco.23.14.1416.31935" target="_blank" rel="noreferrer noopener">10.1592/phco.23.14.1416.31935</a>