American Delirium Society 2018 Annual Meeting: day two

On the first night of the conference, many attendees enjoyed an evening out in San Francisco.

Congratulations to the 2018 ADS Poster Award Winners:

Stephanie Hadley

Best Trainee Poster Award: Delirium and Developmental Delay among Critically Ill Infants and Children: A Pilot Study; Author: Stephanie Hadley

Babar Khan, MD accepting on behalf of Farhaan Vahidy MBBS, MPH, PhD

Best Research Poster Award: Higher In-Hospital Mortality, Length of Stay, and 30-day Readmission Rates among Stroke Patients with Delirium: A Population based Analysis; Author: Farhaan Vahidy MBBS, MPH, PhD

Kendall Gross, PharmD

Best Clinical/Implementation Poster Award: Sustainability in Quality Improvement: Reducing Quetiapine Continuation at Transitions of Care; Author: Kendall Gross, PharmD

Robert De Santis

Best International Research Poster Award: Outcomes of Full and Subsyndromal Delirium in Older Medical Inpatients; Author: Robert De Santis

Kathleen Sheehan, MD, DPhil

Best International Clinical/Implementation Poster Award: Lost in Transition: A Study Exploring Documentation and Management of Delirium During Hospitalization and at Discharge; Author: Kathleen Sheehan, MD, DPhil

Congratulations to the 2018 Delirium Hero Award Recipients:

Clay Angel, MD & Leanne Boehm, PhD, RN, ACNS-BC

Thank you to Tom Moses for his years of service to ADS:

The ADS Board accepting the award on behalf of Tom Moses

Congratulations to 2018 Twitter Cup Champion Roberta Castro, MD, MSc:

Alasdair MacLullich, MRCP, PhD, Roberta Castro, MD, MSc, James Rudolph, MD, SM

James Rudolph MD, SM and Alasdair MacLullich, MRCP, PhD presented the Twitter Cup and Delirium Superhero Cape to Dr. Roberta Castro from Brazil to recognize her tremendous efforts to inspire an entire continent to tweet.

Save the Date for the 2019 World Delirium Day: March 13th, 2019, #WDAD2019

The second day of the Annual Meeting began with an opportunity for conference attendees to network with mentors in the field at a breakfast with groups focused on a variety of topics.

Plenary Session IV: Biomarkers of Brain Metabolic Failures

Gideon Caplan, MD

Dr. Caplan stated that none of the usually considered etiologies such as neuroinflammation or neurotransmitters meet the criteria for causation. He presented findings, that despite small numbers, changes are consistent, unique and pathognomonic during delirium. He noted that these changes vary with severity of illness & outcomes and that they meet criteria for pathophysiological causation.

Plenary Session V: Debate: The Use of Antipsychotic Agents in Delirium Management

John Devlin, PharmD, FCCM, FCCP, Karin Neufeld, MD, MPH, Mark Oldham, MD

Mark Oldham, MD moderated this debate between John Devlin, PharmD, FCCM, FCCP taking the con position and Karin Neufeld, MD, MPH taking the pro position.

Karin Neufeld, MD, MPH

Dr. Neufeld asserted that pharmacologic approaches are worth pursuing. She stated that antipsychotics such as haloperidol may make sense in terms of decreasing ischemic damage and neuroreceptor imbalance. She noted that postoperative studies are heterogenous but many suggest a positive impact on delirium prevention.

Dr. Neufeld asserted that guidelines have supported personalized short term use of antipsychotics in patients who are at risk and that safety concerns are more theoretical than actual. She urged that it is important to treat distress of patients even if there is no change in shortening or decreasing of overall severity. Dr. Neufeld concluded that use of these agents can actually allow for the implementation of non-pharmacologic approaches.

John Devlin, PharmD, FCCM, FCCP

Dr. Devlin highlighted that two recent RCTs demonstrated IV Haloperidol neither prevents delirium nor reduces mortality in critically ill adults and that there are many safety concerns with antipsychotics in routine clinical practice. He stated that multiple practice guidelines do not support use of antipsychotics for delirium prevention in perioperative and/or critically ill adults. He concluded that clinicians should focus on use of proven ICU delirium risk reduction strategies (particularly non-pharmacological) to prevent delirium.

Final conclusions offered by both speakers included: the importance of minimizing risk factors for delirium prior to considering antipsychotic therapy; that there is no role for low-dose antipsychotic therapy to prevent delirium in high risk ICU patients; there is minimal evidence to support the routine administration of antipsychotic therapy for delirium unless symptoms are severe; antipsychotics should be administered at the lowest dose and shortest duration possible; and that additional research is needed to determine the specific roles of antipsychotic therapy for delirium.

Plenary VI: Delirium and Cholinergic Pathways

Georg Winterer, MD, PhD

Georg Winterer, MD, PhD introduced the BioCog Consortium which focuses on Biomarker Development for postoperative cognitive impairment in the elderly. He presented potential contributions to the field with relevance from a patient and health care perspective, including: prevention of delirium, limitation of cognitive impairment, reduction of costs, and no elective surgery in certain patients.

More information can be found at: www.biocog.eu

Representatives from the ADS Education Committee

The ADS Communications & Membership and Education Committees met during lunch.

If you would like to join one of the 5 ADS Member Committees please visit: www.americandeliriumsociety.org/committees and send an email to the contact person listed.

Oral Presentations II: Epidemiology/Biomarkers

Gen Shinozaki, MD, Mark Oldham, MD, Bryan Hansen, PhD, Anita Nitchingham, MBBS (Not pictured: Jin Han, MD, MSc)

Mark Oldham, MD, presented 'Refining Delirium: A Trans-theoretical Model of Delirium with Preliminary Neurophysiological Subtypes'; Anita Nitchingham, MBBS, addressed 'Patients with Delirium Demonstrate a Distinct Pattern of Cortical Glucose Hypometabolism not Present in Cognitively Intact Sick Controls on FDG-PET'; Jin Han, MD, MSc, spoke about 'Delirium's Pathophysiologic Subtypes and their Effect on 6-month Cognition'; Bryan Hansen, PhD offered, 'Point Prevalence Studies on Delirium: A Systematic Review' and Gen Shinozaki, MD, provided, 'Bispectral EEG Screening for Delirium'.

Symposium V: Delirium in Special Medical Populations

Mariana Schmajuk, MD, Andrea Ament, MD, Sheila Lahijani, MD, Filza Hussain, MD, Yelizaveta Sher, MD

Symposium presentations included: 'Post-TBI Delirium' by Andrea Ament, MD, 'Delirium and HIV/AIDS' by Filza Hussain, MD, 'Delirium after Organ Transplantation' by Yelizaveta Sher, MD, 'Delirium in Neurological Disorders' by Mariana Schmajuk, MD and 'Terminal Delirium' by Sheila Lahijani, MD.

Workshop IV: Creating Inter-professional Delirium Competencies Across Practice Settings

Cynthia Holle, DNP, Kerri Maya, MSN, Anna Satake, RN, MSN

This interactive workshop helped the audience understand how to sketch out educational strategies and delirium competencies in their practice settings.

Workshop V: From C-suite to Hospital Wide Delirium Program

Kristine Harper, MSN, RN, NE-BC, Ralph Gonzales, MD, Benjamin Kalivas, MD, Vanja Douglas, MD, Stephanie Rogers, MD

This practical workshop provided learners with several road maps to present implementation of delirium programs to hospital leadership.

Oral Presentations III: Network for Investigation of Delirium: Unifying Scientists (NIDUS) Scientific Presentations

Sharon Inouye, MD, MPH, Tamara Fong, MD, PhD, Jo Wilson, MD, MPH, Matthew Duprey, PharmD, Sarinnapha Vasunilashorn, PhD, Dae Hyun Kim, MD, MPH

Presentations were provided by Jo Wilson, MD, MPH on 'Advancing Age and Catatonia and Risk for Delirium in Critically Ill Patients'; Sharon Inouye, MD, MPH on 'New Instrumentation for Measuring Delirium Burden: Quantifying Aspects of the Subjective Experience of In-Hospital Delirium for Patients and Family Caregivers'; Matthew Duprey, PharmD on 'Incident ICU Delirium, its Duration, and Coma/Delirium Days: Association with 28- and 90- day Mortality'; Tamara Fong, MD, PhD on 'SOMAscan as a Discovery Platform to Identify Plasma Proteome Changes Associated with Surgery and Clinical Outcomes from Surgery'; Dae Hyun Kim, MD, MPH on 'Incidence and Outcomes of Postoperative Delirium after Transcatheter and Surgical Aortic Valve Replacement'; and Sarinnapha Vasunilashorn, PhD on 'Development of a Dynamic Multi-Protein Signature of Postoperative Delirium'.

Symposium VI: Post Intensive Care Syndrome and Survivorship

Leanne Boehm, PhD, RN, ACNS-BC, Sophia Wang, MD, Kelly Drumright, RN (Not pictured: Babar Khan, MD, MS)

Leanne Boehm, PhD, RN, ACNS-BC addressed, 'The Post-Intensive Care Syndrome (PICS)'; Kelly Drumright, RN spoke about 'Healthcare Diaries and Support Groups'; Babar Khan, MD, MS presented 'The Mobile Critical Care Recovery Program (m-CCRP) and Improving Recovery and Outcomes Every Day after the ICU (IMPROVE)'; and Sophia Wang, MD provided a 'Focus Group Study of ICU Survivors and their Caregivers'.

Workshop VI: Best Practice Competencies in Action: An Interprofessional Approach to Teaching and Reinforcing Delirium Care

James Rudolph, MD, SM portraying a patient with Delirium

Claire Copeland, MBCHB, Robert Dicks, MD, FACP, Mary Kate Eanniello, DNP-C, RN, ONC, Gwen Redler, MSN, RN, RRT, Elizabeth Udeh, PharmD, BCPS and Christine Waszynski, DNP-C, RN, GNP-C.

The presenters acted out a skit of how to do delirium care the wrong way and then after a period of group discussion gave the audience the opportunity to redo the skit and provide quality delirium care.

Workshop VII: Implementation Science Skills

Nadia Adams, MHA, Malaz Boustani, MD, MPH

This workshop provided a guide on how to progress from Healthcare 101 to Healthcare 102 via agile implementation.

Oral Presentations IV: Delirium and Risk Prediction

Sean Jeffrey, PharmD, Christine Waszynski, DNP-C, RN, GNP-C, Joanna Stollings, PharmD, Sara LaHue, MD, Lis Evered, MBiostat, PhD, Charles Austin, MD, Flavia Garcez, MD

These presentations were provided by Sean Jeffrey, PharmD and Christine Waszynski, DNP-C, RN, GNP-C, on 'Delirium Associated Potentially Inappropriate Medications and Prevalence of Delirium in Hospitalized Patients from Skilled Nursing and Assisted Living Facilities'; Joanna Stollings, PharmD on 'Antibiotics and the Risk of Delirium'; Charles Austin, MD on 'Outpatient Psychoactive Medication Usage and the Association with Post-operative Delirium After Major Surgery'; Flavia Garcez, MD on the 'Association Between Delirium, Arousal and 30-day Mortality in Acutely Ill Older Adults: Results from a Large Brazilian Cohort'; Sara LaHue, MD on 'Delirium is a Major Predictor of Hospital Readmission'; Lis Evered, MBiostat, PhD on 'Delirium Predicts Neurocognitive Disorders at 3 Months Following Cardiac and Non-cardiac Surgery'.

Oral Presentations V: Neurocognition/Post-Hospital Outcomes

Pictured: Mark Oldham, MD and Vanja Douglas, MD

This session was presented by Mark Oldham, MD, on 'Preoperative Depression and Mild Cognitive Impairment Independently Predict Delirium After CABG: Results from the Neuropsychiatric Outcomes After Heart Surgery Study'; Charles Brown, MD, on 'Cognitive Decline after Delirium in Patients Undergoing Cardiac Surgery'; Jo Wilson, MD, MPH on 'Deficits in Self-Reported Initiation are Associated with Future Functional Disability in ICU Survivors'; Michael Wood on 'Persistent Executive and Visuospatial Impairments Following Critical Illness as Assessed by Robotic Technology- Is Delirium Associated with Delayed Recovery?'; Nathan Brummel, MD, MSCI on 'Prevalence of and Risk Factors for Frailty after Hospitalization for Critical Illness'; and Flavia Garcez, MD on the 'Association between Delirium and Post-discharge Dementia in Acutely Ill Older Adults'.

Symposium VII: Delirium Monitoring Myths

Jose Maldonado, MD, FAPM, FACFE, Joseph Rasimas, MD, Christopher Hughes, MD, Mayur Patel, MD, MPH, Jo Wilson, MD, MPH, Arjen Slooter, MD, PhD, Pratik Pandharipande, MD, MSCI

These myths were explored by talks entitled, 'My Patient May Have Catatonia!' by Jo Wilson, MD, MPH; 'My Patient is Under the Effect of the Anesthetic/Sedative!' by Christopher Hughes, MD; 'My Patient has Dementia and Chronic Mental Illness!' by Jose Maldonado, MD, FAPM, FACFE; 'My Patient has a Neurological Injury!' by Mayur Patel, MD, MPH; 'My Patient is on a CNS Acting Substance!' by Joseph Rasimas, MD; and 'I do not Trust any SUBJECTIVE Delirium Monitoring Instrument!' by Arjen Slooter, MD, PhD.

Workshop VIII: Innovation Forum

Nadia Adams, MHA and Malaz Boustani, MD, MPH encouraging the group to be innovative!

This forum encouraged learners to utilize engagement platforms for a group based problem solving process.

Join us at ADS 2019:

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:

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Liz Archambault


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