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      Specialty experience in geriatric medicine is associated with a small increase in knowledge of delirium

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          Abstract

          Background: delirium is underdiagnosed and undertreated. Understanding of delirium among doctors in medical and ICU settings has previously been shown to be low. We hypothesised that junior doctors who had gained experience in geriatrics, neurology or psychiatry may have an increased knowledge of delirium.

          Methods: we used data from a large multi-centre study of junior doctors conducted between December 2006 and January 2007 which is, to date, the largest survey of understanding of delirium among junior doctors. The original survey used a questionnaire within which certain key items led to a correct or incorrect answer. Total correct answers were recorded giving a maximum total knowledge score of 17 for each participant. The relationship between total knowledge score achieved on the questionnaire and time since qualification; specialty experience in geriatric medicine, psychiatry and/or neurology and self-reported experience with the Confusion Assessment Method (independent variables) were modelled using linear regression.

          Results: around half (53.2%; 399 of 750) of those surveyed stated that they had experience in geriatric medicine. In contrast only 4.1 and 8.0% of respondents had experience in psychiatry and neurology, respectively. Experience in geriatric medicine was significantly associated with a modest increase in correct answers (4.7 versus 4.3 points, P = 0.020). No other variables were significantly associated with better scores.

          Conclusion: experience in geriatric medicine leads to a small improvement in understanding of delirium among junior doctors.

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          Most cited references 4

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          Detection of delirium in the acute hospital.

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            Current opinions regarding the importance, diagnosis, and management of delirium in the intensive care unit: a survey of 912 healthcare professionals.

            Recently published clinical practice guidelines of the Society of Critical Care Medicine recommend monitoring for the presence of delirium in all mechanically ventilated patients because of the potential for adverse outcomes associated with this comorbidity, yet little is known about healthcare professionals' opinions regarding intensive care unit delirium or how they manage this organ dysfunction. The aim of this survey was to assess the medical community's beliefs and practices regarding delirium in the intensive care unit. Survey administration was conducted both without a delirium definition (phase 1) and then with a definition of delirium (phase 2). Critical care meetings and continuing medical education/board review courses from October 2001 to July 2002. A convenience sample of physicians (n = 753), nurses (n = 113), pharmacists (n = 13), physician assistants (n = 12), respiratory care practitioners (n = 8), and others (n = 13). Survey. Participants completed 912 of the surveys. The majority (68%) of respondents thought that >25% of adult mechanically ventilated patients experience delirium. Delirium was considered a significant or very serious problem in the intensive care unit by 92% of healthcare professionals, yet underdiagnosis was acknowledged by 78%. Only 40% reported routinely screening for delirium, and only 16% indicated using a specific tool for delirium assessment. Delirium was considered important in the outcome of elderly and young patients by 89% and 60% of the respondents, respectively (p 50 mg/day of either medication. Most healthcare professionals consider delirium in the intensive care unit a common and serious problem, although few actually monitor for this condition and most admit that it is underdiagnosed. Data from this survey point to a disconnect between the perceived significance of delirium in the intensive care unit and current practices of monitoring and treatment.
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              Understanding barriers to delirium care: a multicentre survey of knowledge and attitudes amongst UK junior doctors.

              delirium is under-diagnosed and under-treated in comparison to other common and serious acute disorders. The reasons for this are unclear. we conducted a multicentre survey of knowledge of and attitudes to delirium in trainee general physicians. questionnaire-based survey in 34 acute hospitals in the UK. we developed a questionnaire designed to test knowledge of delirium prevalence, DSM-IV diagnostic criteria, use of specific screening tools, association with adverse outcomes, and pharmacological management. Questionnaires were completed and returned by hand to the researchers immediately after recruitment. Participants were a convenience sample of trainee doctors in general and emergency medicine. 784 trainee physicians participated. Most participants expressed the view that delirium has a high prevalence and that it is associated with serious adverse outcomes. However, they had poor knowledge of its diagnosis and treatment, reporting the need for better training. Experience working in geriatric medicine had only a modest effect on the ability to diagnose delirium. UK training doctors' lack of basic knowledge of the diagnosis and management of delirium, rather than a lack of awareness of its high prevalence and clinical significance, appears to be important in determining its under-recognition.
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                Author and article information

                Journal
                Age Ageing
                Age Ageing
                ageing
                ageing
                Age and Ageing
                Oxford University Press
                0002-0729
                1468-2834
                January 2014
                16 October 2013
                16 October 2013
                : 43
                : 1
                : 141-144
                Affiliations
                [1 ]Department of Medicine for the Elderly, St Mary's Hospital , Praed Street, London W2 1NY, UK
                [2 ]Norwich Medical School, University of East Anglia, Centre for Infectious Disease Research , NorwichUK
                [3 ]Edinburgh Delirium Research Group, University of Edinburgh , Edinburgh, UK
                [4 ]Academic Department of Medicine for the Elderly, University of East Anglia , Norwich, Norfolk, UK
                [5 ]Department of Public Health and Primary Care, University of Cambridge , Cambridge, UK
                Author notes
                Address correspondence to: R. P. L. Jenkin. Tel: 02077008428; Email: rodricjenkin@ 123456nhs.net ; rodricjenkin@ 123456hotmail.com
                Article
                aft159
                10.1093/ageing/aft159
                3861341
                24132853
                3ac9600e-f4ad-42b8-bee9-afc0f40891de
                © The Author 2013. Published by Oxford University Press on behalf of the British Geriatrics Society.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Categories
                Short Reports

                Geriatric medicine

                survey, doctor, specialty, delirium, geriatric, older people

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