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Winter 2013 – Can Donepezil Hydrochloride Reduce the Role of Neuroleptic Drugs in Delirium? A Case Report

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Can Donepezil Hydrochloride Reduce the Role of Neuroleptic Drugs in Delirium? A Case Report.
 
Lloyd D Hughes*, Emily McKay.
 
Author Affiliations:
Medical School, Liverpool University, Liverpool, England

 
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/05/MSRJ-Winter-2013-Can-Donepezil-Hydrochloride-Reduce-the-Role-of-Neuroleptic-Drugs-in-Delirium-A-Case-Report.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]

 
*Corresponding author: Lloyd D. Hughes; L.D.Hughes[at]dundee.ac.uk
 
Key Words: geriatrics; delirium; psychiatry; acetylcholinesterase inhibitors.
 
Abstract:
Background: Recent evidence shows that a confirmed diagnosis of delirium increases both patient morbidity and mortality. Importantly, these increases are independent of patient age, and presence of co-morbid disease. In the last few years, there has been evidence that acetylcholinesterase inhibitors may have a limited role in managing episodes of mild/moderate delirium. Methods: This case study reports a patient whose behavioral disturbances caused by delirium, responded well to donepezil hydrochloride in a nursing home in Dundee, United Kingdom. Results:Our clinical case focuses on a patient who was diagnosed with a mixed picture delirium after developing PUO. This case report notes that Mr A, a patient already prescribed donepezil hydrochloride, saw an improvement in his behavioral symptoms after an increase in his dose. This enabled the patient to avoid receiving neuroleptic or benzodiazepine medication, known to be particularly problematic in older patients.
Conclusion: The authors tentatively propose that patients in community care already prescribed acetylcholinesterase inhibitors, may benefit from an increased dose in cases of mild delirium (where there is no clear cause or requirement for hospital admission). In line with the significant impact that delirium has upon older patients in community care, we would call for further studies looking at the influence that these medications may have on the sequelae of delirium in patients in the community.

 
Published: February 27, 2013
 
Senior Editor: Skyler Johnson
 
Junior Editor: Bobby Gambhir
 
DOI: Pending
 

Citation:
Hughes LD, McKay E. Can Donepezil Hydrochloride Reduce the Role of Neuroleptic Drugs in Delirium? A Case Report. Medical Student Research Journal. 2013;2(Winter):11-16.
 
 
References:
Can donepezil hydrochloride reduce the role of
neuroleptic drugs in delirium? A case report

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30. Cerejeira J, Batista P, Nogueira V. Low preoperative plasma cholinesterase activity as a risk marker of post-operative delirium in elderly patients. Age Ageing. 2011; 40(5): 621-6. http://dx.doi/org/10.1093/ageing/afr053.

31. van Eijk MMJ, Roes KCB, Honing MLH, et al. Effect of rivastigmine as an adjunct to usual care with haloperidol on duration of delirium and mortality in critically ill patients: a multicentre, double-blind, placebo-controlled randomized trial. Lancet. 2010; 376:1829-37. http://dx.doi.org/10.1016/S0140-6736(10)61855-7.

32. de Pont AC, van Geer MA, Schultz MJ. Cholinesterase inhibitor treatment in patients with delirium. Lancet. 2011; 377(9769):899. http://dx.doi.org/10.1016/S0140-6736(11)60342-5.

33. Frölich L, Forstl H. Cholinesterase inhibitor treatment in patients with delirium. Lancet. 2011; 377(9769):899. http://dx.doi.org/10.1016/S0140-6736(11)60341-3.

34. MacLullich AM, Hall RJ. Who understands delirium? Age Ageing. 2011; 40(4):412-4. http://dx.doi.org/10.1093/ageing/afr062.

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38. Maclullich AM, Ferguson KJ, Miller T, de Rooij SE, Cunningham C. Unravelling the pathophysiology of delirium: a focus on the role of aberrant stress responses. J Psychosom Res. 2008; 65(3):229-38. http://dx.doi.org/10.1016/j.jpsychores.2008.05.019.

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40. Pandharipande PP, Morandi A, Adams JR, et al. Plasma tryptophan and tyrosine levels are independent risk factors for delirium in critically ill patients. Intensive Care Med. 2009; 35(11):1886-92. http://dx.doi.org/10.1007/s00134-009-1573-6.

41. Shahid A, Milapkumar P, Shagufta J, et al. Insight into delirium. Innov Clin Neurosci. 2011; 8(10):25-34. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225129/

Winter 2013 – The Role of Ultrasound Screening in Reducing AAA Mortality: A Review

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The Role of Ultrasound Screening in Reducing AAA Mortality: A Review.
 
Kashif Imran Ahmad.
 
Author Affiliations:
Medical School, Liverpool University, Liverpool, England

 
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/05/MSRJ-Winter-2013-The-Role-of-Ultrasound-Screening-in-Reducing-AAA-Mortality-a-Review.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]

 
Corresponding author: Kashif Imran Ahmad; K.Ahmad[at]Lancaster.ac.uk
 
Key Words: population; screening; ultrasonography; abdominal aortic aneurysms; mortality; systematic review.
 
Abstract:
Men aged 65-79 are at the highest risk of having an abdominal aortic aneurysm (AAA) as well as a high incidence of rupture; this is treated as a surgical emergency, which has a total mortality of 75-90%. The diameter of an AAA proves to be the most useful risk factor in predicting mortality rates.

 
Published: February 27, 2013
 
Senior Editor: Emina Bajrovic
 
Junior Editor: Bobby Gambhir
 
DOI: Pending
 
Citation:
Ahmad KI. The Role of Ultrasound Screening in Reducing AAA Mortality: A Review. Medical Student Research Journal. 2013;2(Winter):3-10.
 
 
References:
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2. Scott R, Vardulaki K, Walker N, Day N, Duffy S, Ashton H. The long-term benefits of a single scan for abdominal aortic aneurysm (AAA) at age 65. Eur J Vasc Endovasc. 2001; 21:535-40. http://dx.doi.org/10.1053/ejvs.2001.1368.

3. Scott R, Bridgewater S, Ashton H. Randomized clinical trial of screening for abdominal aortic aneurysm in women. Brit J Surg. 2002; 89:283-5. http://dx.doi.org/10.1046/j.0007-1323.2001.02014.x.

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29. Leger A, Spencely M, McCollum C, Mossa M. Screening for abdominal aortic aneurysms: a computer assisted cost-utility analysis. Eur J Vasc Endovasc. 1996; 11:183-90. http://www.ejves.com/article/S1078-5884%2896%2980049-9/abstract

30. Wilmink A, Forshaw M, Quick C, Hubbard C, Day N. Accuracy of serial screening for abdominal aortic aneurysms by ultrasound. J Med Screen. 2002; 9:125-7. http://dx.doi.org/10.1136/jms.9.3.125.

31. Lindholt J, Vammen S, Juul S, Henneberg E, Fasting H. The validity of ultrasonographic scanning as screening method for abdominal aortic aneurysm. Eur J Vasc Endovasc. 1999; 17(6):472-5. http://dx.doi.org/10.1053/ejvs.1999.0835.

32. Greenhalgh T. How to read a paper – the basics of evidence-based medicine. 4th ed. BMJ Books. London: Wiley-Blackwell; 2010.

33. NHS (2011). CASP tools – RCT appraisal tool. Available from: http://www.sph.nhs.uk/sph-files/casp-appraisal-tools/rctap9-praisaltool.pdf/view [cited 17 April 2011].

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35. Scott R, Wilson N, Ashton H, Kay D. Influence of screening on the incidence of ruptured abdominal aortic aneurysm: 5-year results of a randomized controlled study. Brit J Surg. 1995; 82(8):1066-70. http://dx.doi.org/10.1002/bjs.1800820821.

36. Ashton H, Buxton M, Day N, et al. The multicentre aneurysm screening study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet. 2002; 360(9345):1531-39. http://dx.doi.org/10.1016/S0140-6736(02)11522-4.

37. Norman P, Jamrozik K, Lawrence-Brown M, et al. Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm. Brit Med J. 2004; 329:1259-62. http://dx.doi.org/10.1136/bmj.330.7491.596.

38. Lindholt J, Juul S, Fasting H, Henneberg E. Hospital costs and benefits of screening for abdominal aortic aneurysms. Results from a randomised population screening trial. Eur J Vasc Endovasc. 2002; 23(1):55-60. http://dx.doi.org/10.1053/ejvs.2001.1534.

Winter 2013 – The Color of Medicine

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The Color of Medicine.
 
Diana Salinas.
 
Author Affiliations:
College of Human Medicine, Michigan State University, East Lansing, MI, USA

 
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/05/MSRJ-Winter-2013-The-Color-of-Medicine.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]
 
Corresponding Author: Diana Salinas; email not available.
 
Key Words: N/A
 
Abstract:
’I will not permit considerations of religion, nationality, race, gender, politics, socioeconomic standing, or sexual orientation to intervene between my duty and my patient.’ This bullet point from the physician’s oath is engraved around the margins to remind us that as physicians we should treat and care for each patient equally and in an unbiased manner, but at the same time understand that a universal treatment plan will not apply to all patients.

 
Published: February 27, 2013
 
Senior Editor: N/A
 
Junior Editor: N/A
 
DOI: Pending
 
Citation:
Salinas D. The Color of Medicine. Medical Student Research Journal. 2013;2(Winter):2.
 
 
References:
N/A

Winter 2013 – Letter From the Editors

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Letter From the Editors.
 
Chad Klochko, David Ortiz.
 
Author Affiliations:
College of Human Medicine, Michigan State University, East Lansing, MI, USA

 
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/05/MSRJ-Winter-2013-Letter-from-the-Editors.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]
 
Corresponding Author: Chad Klochko; Chad[at]msrj.chm.msu.edu
 
Key Words: N/A

 
Abstract:
The year 2013 is going to be a very exciting year for the Medical Student Research Journal (MSRJ). MSRJ has made great strides in the past 12 months and can look forward to a bright furture in the year ahead. We have more than tripled our editoral staff, which now consists of 12 second – through fourth – year medical students.

 
Published: February 27, 2013
 
Senior Editor: N/A
 
Junior Editor: N/A
 
DOI: Pending
 
Citation:
Klochko C, Ortiz D. Letter From the Editors. Medical Student Research Journal. 2013;2(Winter):1.
 
 
References:
N/A

Winter 2011 – 10 Minutes with Paul Hebert, Editor-in-Chief of the Canadian Medical Association Journal

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10 Minutes with Paul Hebert, Editor-in-Chief of the Canadian Medical Association Journal.

Pamela Verma, Diane Wu.

Author Affiliations:
University of British Columbia, Vancouver, BC, Canada
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/04/MSRJ-Spring-2011-10-minutes-with-Paul-Hebert-Editor-in-Chief-of-the-Canadian-Medical-Association-Journal.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]

*Corresponding Author: Pamela Verma; pamverma[at]interchange.ubc.ca

Key Words: N/A

Abstract:
Background: Most medical students, at some point in their career, aspire to publish a research paper of enough significance to join the pages of the major international medical journals. At the helm of these journals are physicians renowned for their academic and research acumen; in Canada, one of these physicians is Dr. Paul Hebert. We sat down with Dr. Hebert to talk about submission tips, becoming a journal editor, and how he got the job. This feature is part of Editors in Medicine, an ongoing series within student medical journals. Other interviews will be published periodically in various student journals internationally.
Published: June 30, 2011

Senior Editor: Andrew Wyman

Junior Editor: Steven Plato

DOI: http://dx.doi.org/10.15404/msrj.001.001.winter/03

Citation:
Verma P, Wu D. 10 Minutes with Paul Hebert, Editor-in-Chief of the Canadian Medical Association Journal. Medical Student Research Journal. 2011;1(Spring):8-9.

References:
N/A

Winter 2011 – Pregnant Patient Presenting with Syncope and a Medulloblastoma: A Case Report

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Pregnant Patient Presenting with Syncope and a Medulloblastoma: A Case Report.

Mark Ishak.

Author Affiliations:
New York College of Osteopathic Medicine of NYIT, Old Westbury, NY, USA
[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/04/MSRJ-Spring-2011-Pregnant-patient-presenting-with-syncope-and-a-medulloblastoma-a-case-report.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]

*Corresponding Author: Mark Ishak, mishak[at]nyit.edu

Key Words: Adult medulloblastoma; pregnant; syncope.
Abstract:
Medulloblastoma is a primary cerebellar tumor seen most commonly in the pediatric population. In adults, it represents about 1% of cancer found in the central nervous system. In adult medulloblastoma, only one third of cases occur in women and even less in pregnant women. This case describes a 34-year-old pregnant woman who presented to the emergency department with the syncope, which was found to be secondary to a medulloblastoma.
Published: June 25, 2011

Senior Editor: Steven Plato

Junior Editor: David Hobbs

DOI: http://dx.doi.org/10.15404/msrj.001.001.winter/02

Citation:
Ishak M. Pregnant Patient Presenting with Syncope and a Medulloblastoma: A Case Report. Medical Student Research Journal. 2011;1(Spring):5-7.

References:
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Winter 2011 – Retention of Cardiopulmonary Resuscitation Skills in Medical Students Utilizing a High-Fidelity Patient Simulator

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Retention of Cardiopulmonary Resuscitation Skills in Medical Students Utilizing a High-Fidelity Patient Simulator.

Travis Behrend*, John Heineman, Lei Wu, Chad Burk, Ngoc-Truc Duong, Mark Munoz, Dawn Pruett, Michael Seropian, Dawn Dillman.

Author Affiliations:
Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University (OHSU), Portland, OR, USA

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/04/MSRJ-Spring-2011-Retention-of-cardiopulmonary-resuscitation-skills-in-medical-students-utilizing-a-high-fidelity-patient-simulator.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF [/button]

*Corresponding author: Travis Behrend; behrendt[at]ohsu.edu

Key Words: CPR; simulation; medical education; medical students; skills retention.

Abstract:
Objective: To evaluate the difference in retention of cardiopulmonary resuscitation (CPR) skills between first and second year medical students in accordance with American Heart Association (AHA) recommended basic life support (BLS) guidelines from 2005. Introduction: Cardiopulmonary resuscitation has a narrow window of opportunity. It must be started early and followed by defibrillation in a timely manner for maximal benefit. Many studies have demonstrated that health care providers trained in CPR lose their skills quickly. However, little research has been done to evaluate the retention of CPR skills in pre-clinical medical students prior to beginning their clinical training.
Methods: 22 first-year and 19 second-year medical students were voluntarily enrolled in the prospective cohort study. Participants were queried regarding BLS training, familiarity with the computerized mannequin simulator (SimMan), and CPR experience. Each participant was then introduced to SimMan and a standardized cardiac arrest scenario was read to them. Data was collected manually behind a two-way mirror. Participants were scored on their compliance with BLS criteria.
Results: Overall, key steps in CPR were omitted by many participants. One out of five subjects began CPR without first checking for a response, two out of three subjects did not request a defibrillator, and an average of 35.9 (0.0, 100.7) seconds elapsed before CPR was initiated. The average compression rate per minute in first-year medical students (MS1s) (22 subjects) was 63.6 (37.2, 90.1) compared to 52.5 (13.4, 91.6) in second-year students (MS2s) (19 subjects) with a BLS recommendation of 100 (p-0.04). There were 84.2% of MS1s and 68.2% of MS2s that completed an average compressions to two breaths ratio of (greater than or equal to) 27 with BLS recommendation of 30 compressions for every 2 breaths (p=0.04).
Conclusion: Despite their training and proximity to a health care environment, medical students quickly forget important CPR rates and maneuvers. This deterioration of skills occurs regardless of training latency, a potential problem as they enter the patient care environment. Simulation provides a more real-life scenario in which to both train and evaluate medical students CPR skills.
Published: June 25, 2011

Senior Editor: Andrew Wyman

Junior Editor: Marissa Baca

DOI: http://dx.doi.org/10.15404/msrj.001.001.winter/01

Citation:
Behrend T, Heineman J, Wu L, Burk C, Duong N, Munoz M, Pruett M, Seropian M, Dillman D. Retention of Cardiopulmonary Resuscitation Skills in Medical Students Utilizing a High-Fidelity Patient Simulator. Medical Student Research Journal. 2011;1(Spring):1-4.

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