Purpose The objective of this study was to quantify the rate at which newly-initiated antipsychotic therapy is continued on discharge from the Intensive Care Unit and describe risk factors for continuation post ICU discharge. Materials and Methods Retrospective cohort study of all patients receiving an antipsychotic in the Intensive Care Units of a large academic medical center from January 1, 2005, to October 31, 2011. Chart review was conducted to ascertain whether a patient was newly-started on antipsychotic therapy and whether therapy was continued post ICU discharge. Results A total of 39,248 ICU admissions over the 7 year period were evaluated. Of these, 4468 (11%) were exposed to antipsychotic therapy, of which 3119 (8%) were newly-initiated. In the newly-initiated cohort, 642 (21%) were continued on therapy on discharge from the hospital. Type of drug (use of quetiapine versus no use of quetiapine, odds ratio 3.2, 95% CI 2.5–4.0, p<0.0001 and use of olanzapine OR 2.4, 95% CI 2.0–3.1 p=<0.0001) were significant risk factors for continuing antipsychotics on discharge, despite adjustment for clinical factors. Conclusions Antipsychotic use is common in the intensive care unit setting, and a significant number of newly-initiated patients have therapy continued upon discharge from the hospital.

Background/Objectives Although antipsychotics are used for treatment of delirium/agitation in hospitalized patients, the scope of use is unknown. We investigated patterns and predictors of use in hospitalized patients. Design Retrospective cohort study. Setting Academic medical center. Participants ≥18 years old, hospitalized 8/2012–8/2013. We excluded patients admitted to obstetrics/gynecology, psychiatry, or with a psychotic disorder. Measurements Use ascertained from pharmacy charges. Potentially excessive dosing defined using guidelines for long-term care facilities. A review of 100 records was performed to determine reasons for use. Results Our cohort included 17,775 admissions, median age 64 years. Antipsychotics were used in 9%, 55% of which were initiations. The most common reasons for initiation were delirium (53%) and probable delirium (12%). Potentially excessive dosing occurred in 16% of exposed. Among admissions with antipsychotic initiation, 26% were discharged on these medications. Characteristics associated with initiation included: age ≥ 75 years (RR 1.4 [1.2–1.7]); male sex (RR 1.2 [1.1–1.4]); black race vs. white (RR 0.8 [0.6–0.96]; delirium (RR 4.8 [4.2–5.7]); dementia (RR 2.1 [1.7–2.6]); admission to a medical service (RR 1.2 [1.1–1.4]); intensive care unit stay (RR 2.1 [1.8–2.4]); and mechanical ventilation (RR 2.0 [1.7–2.4]). Characteristics associated with discharge on antipsychotics among initiators included: age ≥ 75 years (RR 0.6 [0.4–0.7]); discharge to any location other than home (RR 2.5 [1.8–3.3]) and class of in-hospital antipsychotic exposure (RR 1.6 [1.1–2.3] for atypical vs. typical; RR 2.7 [1.9–3.8] for both vs. typical). Conclusion Antipsychotic initiation and use were common during hospitalization, most often for delirium, and patients were frequently discharged on these medications. We identified several predictors of use on discharge, suggesting potential targets for decision support tools prompting consideration of ongoing necessity.

The aim of the study was to evaluate the validity of the Alcohol Use Disorders Identification Test (AUDIT), the five-item version (AUDIT-5) and the CAGE as screening tests for problem drinking in mentally ill older people. The study was of prospective cross-sectional design with questionnaire survey and interview and included all consecutive referrals to an old age psychiatry service fulfilling inclusion criteria. Sensitivity, specificity and positive predictive values and areas under the receiver operating characteristic curves (AUROC) for the AUDIT, AUDIT-5, and CAGE were the primary outcome measures. Using clinical criteria as the gold standard, the AUDIT, AUDIT-5 and CAGE had AUROCs of 0.961, 0.964, and 0.780 respectively. The AUDIT-5 performed best of the three scales with a sensitivity of 75.0%, specificity of 97.2% and positive predictive value of 83.3% when using a 4/5 cut-point. The AUDIT-5 performed as well as the AUDIT and better than the CAGE in identifying problem drinking in this sample. The AUDIT-5 may be a useful addition to the specialist mental health assessment of older people.

Aims and MethodHome treatment offers an alternative to in-patient care, but little has been written about the practicalities of running such a service. Using routine information sources, details of referral and outcome are presented for patients assessed by a home treatment service over 6 months.ResultsForty-eight per cent of referrals were not accepted, mainly because of lack of cooperation, risk to self or others or the illness not being acute enough. Referrals from junior doctors and accident & emergency were least likely to be accepted. Seventy-two per cent of patients accepted suffered from schizophrenia, bipolar affective disorder or depression with psychosis, similar to the diagnoses for in-patients. Twenty per cent of patients accepted had to be transferred to in-patient care later.Clinical ImplicationsStaffing levels need to take account of time spent assessing patients. Junior doctors need training in how to use home treatment services appropriately and a wider range of options are needed to manage patients in crisis out of hours. It is possible to target patients with severe mental illness in a home treatment setting, but a significant number will need transfer to inpatient care.

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Three flocks of wild sulphur-crested cockatoos in southeastern Australia had a 10-20% prevalence of feather and beak deformities. In affected birds, the crest, tail, contour and down feathers were lost or reduced in length owing to a "pinching off" 0.5-1 cm above the skin. The underlying skin was discolored brown. Flight feathers appeared normal and could sustain flight. In mildly affected birds, only the crest and down feathers were involved. Histological examination of affected feathers showed necrosis of developing cells in their epidermal collars. The epidermis was moderately hyperplastic and contained numerous large macrophages, with large intracytoplasmic granules. Electron microscopic examination showed these granules to consist of regular lattices of 17-20-nm-diameter particles, resembling parvovirus particles. In some birds the upper beak was enlarged and had longitudinal cracks. Histological examination of the beak showed necrosis of its epidermis. It was concluded that a viral infection may have caused feather and beak dystrophy in these birds.

Specific interventions for dual diagnosis patients should be introduced and assessed in terms of individual outcomes, service use and costs.

Research has shown that the primary reason women seek cancer screening is when they are encouraged by a healthcare provider. If other care providers are focused on disease management, nurses who provide holistic care can build on the advocacy role inherent in nursing and encourage screening in underserved areas of the country.