Latin American Delirium Society
Special Interest Groups Breakfast
The American Delirium Society recently introduced special interest groups. The Latin American Delirium Society (LADS) gathered for breakfast and collaboration prior to the official start of the annual meeting.
Welcome and Presidential Address
Jose Maldonado, MD, FAPM, FACFE
American Delirium Society President Jose Maldonado, MD, FAPM, FACFE opened the meeting with a welcome and Presidential Address. He stated it has been a wonderful honor to be the President of ADS. He thanked the Board of Directors, Conference Planning Committee, and the generous Sponsors.
Dr. Maldonado introduced a new partnership with the management company, Svinicki Association Management, Inc. (SAMI) and recognized the ongoing relationship with the Network for Investigation of Delirium: Unifying Scientists (NIDUS). He noted upcoming annual meetings for sister Delirium organizations, the Australasian Delirium Association and the European Delirium Association. Dr. Maldonado introduced the theme for this year's meeting, "Delirium Throughout the Life Cycle" and officially announced the dates and location of the 2019 American Delirium Society meeting.
Plenary Session I: Presidential Rapid-Fire Session: "Delirium Throughout The Life Cycle"
Chani Traube, MD asserted the need for additional research on Pediatric Delirium. She urged caution with extrapolating from the adult literature and noted that until recently there has been a scarcity in pediatric delirium research. Dr. Traube stated that routine screening of delirium is called for in all critically ill children, and highlighted a study in which 1 out of 4 critically ill children were diagnosed with delirium. She presented pediatric risk factors including: age under 2, high severity of illness (specifically use of mechanical ventilation & vasopressors) and iatrogenic factors (restraints), as well as longer lengths of stay in the PICU particularly after 4-5 days (Traube, et. al. CCM 2017a). Dr. Traube announced that there is a projected 120 articles focused on pediatric delirium this year and encouraged the audience that there has been a shift from heavy sedation to children being more alert and participatory in their care.
Eric Widera, MD, Chani Traube, MD, Jose Maldonado, MD, FAPM, FACFE
Dr. Jose Maldonado addressed the topic of Delirium in Hospitalized Adults by providing eight reasons why delirium matters. Specifically: 1. Delirium is the most common psychiatric syndrome found in the general hospital setting, 2. Delirium is one of the 6 leading causes of preventable conditions in the hospitalized elderly, 3. After controlling for other factors- patients with delirium will fare worse than others, 4. Increased morbidity, 5. Baseline cognitive impairment increases risk for delirium, 6. Increased adverse long term sequelae- cognitive impairment, 7. Adverse long term problems- emotional sequelae, and 8. Increased mortality. He urged that increased detection is needed as it is missed between 50 and 90% of the time. He presented the Stanford Proxy Test for Delirium (S-PTD) and asserted the need for more focus on prevention versus treatment.
Eric Widera, MD presented on Delirium at the End of Life. He raised the question of whether patients at this stage are improving due to the use of pharmacology or if this form of treatment is actually detrimental at that point of care. Dr. Widera asserted that the use of Benzodiazepines unfortunately often result in converting hyperactive delirium to hypoactive delirium. He reported that end of life factors are rated as very important by more than 90% of patients but significantly lower by physicians. He shared family member recommendations on the management of terminal delirium including: respect the patient’s subjective world, facilitate preparations for death, discuss care strategies, and provide information about delirium.
Plenary Session II
Meera Agar, MBBS, PhD spoke about the importance of Humanizing Delirium Management at the End of Life. She addressed 'Care versus management' with practical examples including using clarity and precision in how we communicate about delirium, the need to gain essential information about the person by listening and understanding goals, as well as the prioritization of screening and early detection.
Dr. Agar encouraged the audience to address issues of loss and grief, enable and foster choice, understand background and context, discover what is important to patients, provide clear explanations, acknowledge and validate concerns, make the environment more familiar, treat with dignity and respect, recognize that mental awareness is valued at the end of life, not make assumptions about treatment priorities, provide delirium education to family caregivers, and consider non-pharmacological approaches first
Symposium I: Year in Review
Noll Campbell, PharmD, MS, Sean Barnes, MD, MBA, Elizabeth Udeh, PharmD, Matt Duprey, PharmD, BCCCP, Mark Oldham, MD
A review of literature published from March 1st, 2017 to February 28th, 2018 was presented based on two-round modified Delphi process among the ADS Research Committee. The session was moderated by ADS Research Committee Chair Noll Campbell, PharmD, MS and presentations were provided by Mark Oldham, MD on 'Selection Process and Delirium Recognition Literature', Sean Barnes, MD, MBA on 'Review of Pediatric & Implementation Literature', Matt Duprey, PharmD, BCCP on 'Review of ICU & Implementation Literature' and Elizabeth Udeh, PharmD on 'Delirium Prevention and Cognitive Outcomes'.
Symposium II: ICU Liberation and the ABCDEF Bundle
J. Matthew Aldrich, MD, Ashley Thompson-Quan, PharmD, Kendall Gross, PharmD, BCPS, BCCCP, Denise Barchas, RN, Gregory Blair, MD, Juliana Blair, MD
This symposium was presented by J. Matthew Aldrich, MD with an 'Overview of UCSF's Implementation of the ABCDEF Bundle', Ashley Thompson-Quan, PharmD on 'Implementation & Improvement of the ABCDEF Bundle', Denise Barchas, RN on the 'Role and Challenges of the ICU Nurse in Optimizing Delirium Prevention and Management', Kendall Gross, PharmD, BCPS, BCCP on the 'EHR Role in Facilitating High Quality Care, Data Reusability, and Reliability', Juliana Barr, MD, FCCM on 'The Society for Critical Care Medicine's ABCDEF Bundle' and Gregory Blair, MD on 'Non-pharmacologic Management of ICU Delirium Literature Review'.
Workshop 1: Using Social Media to Increase Delirium Awareness and Recognition
Eleni Fixter, MD, James Rudolph, MD, SM, Rakesh Arora, MD, PhD, FRCSC, Alasdair MacLullich, BSc, PhD, Mani Santhana Krishnan, DPM, FRCPsych
This interactive workshop highlighted the professional benefits of social media use and guided learners through setting up and using at Twitter account.
Oral Presentations I: Recognition, Epidemiology and Implementation
The first session of oral presentations featured talks on the ‘Development and Validation of a Machine Learning Model to Identify Delirium Risk in Newly Hospitalized Patients’ by Andrew Wong and Albert Young; ‘Digital Bedside Avatars Psychosocially Support Hospitalized Elders and Mitigate Delirium and Falls in a Community Teaching Hospital in Queens, New York’ by Victor Wang and Sharon Wexler, PhD, RN; ‘Build it and They will Leave Earlier! How a Delirium Care Path in the EMR Drove Down LOS’ by Leopoldo Pozuelo, MD; ‘Disease Specific Care Certification to Establish an Interdisciplinary Approach to Delirium Prevention for Hospitalized Older Adults’ by Jeanette Previdi, MPH, BSN, RN, CPPS; ‘Feasibility of Employing Family-administered Delirium Detection Tools in the Intensive Care Unit (ICU)’ by Kirsten Fiest, PhD; and ‘What is Known About the Epidemiology of Delirium in Hospitalized Cancer Patients: Detection Tools, Reference Standards, Incidence, Prevalence and Reversibility’ by Megan Sand, BMBS, FAChPM.
Workshop II: Statistical Methods for Delirium Research: Existing and Novel Statistical Methods that can Improve Your Research
'The Statistical Power Team'- Alden Gross, PhD, MHS, Christina Tripp Saunders, PhD, Elizabeth Colantuoni, PhD, Rameela Chandrasekhar, PhD
This practical workshop equipped researchers with the knowledge needed to advance their work on behalf of patients and families impacted by Delirium.
Symposium III: Delirium Detection and Management
Sikander Khan, DO, Carrie Goodson, MD, MHS, Niamh O'Regan, MB, BCh, Rakesh Arora MD, PhD, FRCSC, Noll Campbell, PharmD, MS, (Not pictured: Alasdair MacLullich, BSc, PhD)
This symposium provided a variety of perspectives and tools including, ‘A Novel Method for Delirium Risk Stratification in Pre-operative Cardiac Surgery Patients’ by Rakesh Arora, MD, PhD, FRCSC; ‘Diagnostic Accuracy of Five Short Cognitive Tests in Screening for Delirium and Frequency and Stability of Motor Subtypes of Delirium in Older Medical Inpatients’ by Niamh O’Regan, MB BCh; ‘Non-pharmacological Interventions for Delirium in the ICU’ by Carrie Goodson, MD, MHS; ‘Non-pharmacologic Trials for ICU Delirium- Music Therapy’ by Sikandar Khan, DO; ‘Pharmacologic Management of ICU Delirium’ by Noll Campbell, PharmD, MS; and ‘Trial Evidence and Grey Literature on the Treatment of Delirium- An Overview’ by Alasdair MacLullich, BSc, PhD.
Symposium IV: Clinical Track: Inter-professional Delirium Management Program
Dale Timothy, RPH, MBA, Donna Grant, RN, MSN, CNML, Kristen Brooks, MD, Emily Simmons, MSN, RN, CNL, FGNLA, Katrina Booth, MD
Presentations on clinical care were provided by Katrina Booth, MD on ‘Inter-professional Delirium Management Program UAB Hospital’; Emily Simmons, MSN, RN, CNL, FGNLA on ‘Proactive Inter-Professional Delirium Prevention’; and Kristen Brooks, MD, Donna Grant, RN, MSN, CNML and Dale Timothy, RPH, MBA presented ‘Findings and Learnings from Pilots’.
Plenary Session III: Research Track: Overview of the Latest Network for Investigation of Delirium: Unifying Scientists (NIDUS) Activities and Resources
Michael Avidan, MBBCh, FCASA, Jan Busby-Whitehead, MD, Pratik Pandharipande, MD, MSCI, Kristen Erickson, MPH, Sharon Inouye, MD, MPH, Edward Marcantonio, MD, SM, (Not Pictured: Alden Gross, PhD, MHS)
This session included an ‘Introduction and Overview of NIDUS’ by Sharon Inouye, MD, MPH; a ‘Pilot Task Force Update’ by Michael Avidan, MBBCh, FCASA, a ‘Dissemination Task Force Update’ by Jan Busby-Whitehead, MD; a ‘Research Resource Core Database-- Overview and Demonstration’ by Edward Marcantonio, MD, SM, Thomas Travison, PhD & Pratik Pandharipande, MD, MSCI; and ‘The Measurement and Harmonization Core-- Resources and Demonstration’ by Alden Gross, PhD, MHS.
Workshop III: Latin American Delirium Society
The Latin American Delirium Society spent dedicated time to collaborate on their efforts to further delirium research and care. Representatives at ADS2018 are from Brazil, Chile, Guatemala, Mexico, Puerto Rico, and Uruguay.
An ADS record setting 64 high quality posters were presented at the networking reception, including 17 International submissions.
Thank you to our generous sponsors:
You are invited to the Australasian Delirium Association 2018 Conference:
You are invited to the European Delirium Association 2018 Annual Meeting: