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The ACE model of care provides benefit after emergency surgery in older adults with reduced complications, reduced LOS , and a greater proportion of patients returning directly home after surgery. jamanetwork.com/journals/jamas…

Specific drugs that may exacerbate #delirium from American Geriatrics Society Beers Criteria: anticholinergics (including some antidepressants, antiemetics, antihistamines), benzodiazepines, H2-receptor antagonists Sharon Inouye, MD NIDUS Delirium Network #WDAD2020

Reframing Surgical Risk Using Geriatric Assessment Measures ja.ma/3cQumjj

COVID-19 is a #geriatric emergency, and we need to make sure we are protecting vulnerable older adults from #delirium in the ED during this time - please consider sharing this resource widely: gedcollaborative.com/article/covid-… Sharon Inouye, MD NIDUS Delirium Network

12 Unsettling Lessons Learned Trying To Make Healthcare Better ⁦Sachin H. Jain, MD, MBA⁩ These resonate with me and are important truths for all trying time drive change in healthcare ⁦HELP⁩ forbes.com/sites/sachinja…

Geriatric pre-op evaluation can help patients clarify their goals, promote shared decision making, and may help reduce preventable cancellations. Thanks World Journal of Surgery for publishing our work examining surgical cancellations within Duke Geriatrics #POSH link.springer.com/article/10.100…

"The current unresolved tension between #delirium and acute #encephalopathy is more than word-deep and calls for a unified approach to the clinical syndrome and its underlying neuropathophysiology." thelancet.com/journals/lanps… C-L Psychiatry NIDUS Delirium Network American Delirium Society

Important to move away from imprecise terms such as “altered mental status” - “delirium” is the clinical syndrome while “acute encephalopathy” describes the neuropathophysiology.

Perioperative Optimization of Senior Health (POSH) improves postop outcomes for older adults. It's a proven model at Duke Geriatrics and now successfully implemented at UTSW! Congrats Sarah Wingfield Shelley McDonald! #ThisisGeriatrics JAGS agsjournals.onlinelibrary.wiley.com/doi/abs/10.111…

NIDUS Delirium Network AustralasianDelirium European Delirium ASA® Delirium in the ICU delirium_LMU Sharon Inouye, MD Duke Science&Society Duke University School of Medicine Duke Department of Medicine Shelley McDonald Mitch Heflin MarieAngele Marie-Louise Meng Kam Ghadimi IARS360 Elizabeth Malinzak, MD, FASA Arney Abcejo MD Boris D Heifets Bryan Glezerson

$ 33 billion in total direct 1-year health care costs attributable to postoperative delirium should be enough to prompt us all to make every possible effort for prevention. jamanetwork.com/journals/jamas…

Delirium is a serious, costly and often preventable complication of elective surgery in older adults.

Steven Cohn, MD The outcomes for our patients Duke Anesthesiology Duke Geriatrics say otherwise. The PASS-POSH collaboration has published plenty on our effective model. Be on the lookout for more to come! Shelley McDonald Miles Berger SPAQI

Geriatric Medicine tip of the day: Distraction techniques and normal reassuring conversation are invaluable when dealing with agitated/anxious and delirious patients. Asking someone to relax is akin to saying “don’t look/no peeking”

Love this JAMA Internal Medicine teachable moment on nonpharm management of #cachexia. Address contributing conditions (nausea, oral ulcers), counsel on physiology, and set appropriate expectations - all more effective than medications!

"Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain: Meta-analysis" (2020) - "These results do not support the routine use of pregabalin or gabapentin for the management of postoperative pain in adult patients." - pubs.asahq.org/anesthesiology…

Mobility is medicine!

Greed harms the cultures of compassion and professionalism that are bedrock to healing care. First, health care professionals in all disciplines need to become noisier about the conflict between unchecked greed and the duty to heal. jamanetwork.com/journals/jama/…

Meta Analysis incl 11 RCT and 3,113 ICU patients with family integration vs usual care found a significant reduction in risk of delirium (RR 0.46), delirium duration (WMD -2.18) and LoS in ICU, with different effects between specific interventions pubmed.ncbi.nlm.nih.gov/39486106/

Exciting News! Duke Health's POSH model is inspiring global change! 🇰🇷 South Korea's first geriatric surgery optimization center, COGS, is now open, bringing Duke's innovative approach overseas. Kudos to Dr. Woo-Young Shin for leading the charge! 🌍 🔗 medicine.duke.edu/news/duke-heal…