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P OSTER
A BSTRACTS
binge drinking daily. One week prior to admission he slipped on wet
concrete floor suffering a small forehead laceration but refused medical
attention.Admission vital signs were within normal limits.The patient
was alert and well oriented,but agitated,rude,cursing and laughing.He
made self-deprecating comments, dirty jokes and mocked
physicians of “being stupid”.The pupils were anisocoric but reactive
to light and the extraocular movements were intact. He had a regular
cardiac rhythm, and clear lungs. Strength was 5/5 in the upper extremities
and 4/5 in the lower extremities.Cranial nerves II-XII were
grossly intact and the DTR’s +2 throughout. He had a Glasgow coma
scale of 15/15,a MMSE of 28/30 and a normal Geriatric Depression
Scale.Laboratory work up revealed slight hyponatremia
(132mmol/L),a compensated metabolic alkalosis and mild hypoxemia.A
brain CT scan demonstrated a right chronic subdural
hematoma with evidence of re-bleeding. Haldol 2 mg every 12 hours
was administered that controlled his aggressiveness and hallucinations,but
his inappropriate behavior and bouts of laughter continued.
Eight hours after the hematoma was evacuated all inappropriate behavior
resolved.Involuntary emotional expression disorder is a distressing
disorder that is frequently overlooked and misdiagnosed.The
clinical impact can be severe,with unremitting and persistent symptoms
that can be disabling to patients.
D85 Encore Presentation
Psychoeducational Interventions for Caregivers of Seniors: A
Systematic Review.
K. Aung, K. Stevens. UT Health Science Center at San Antonio, San
Antonio, TX.
Supported By: This research was supported by the MESA Center
for Health Disparities, which was funded by a grant from the
National Institute for Nursing Research.
Background: Psychoeducational interventions are structured
programs designed to train caregivers to effectively deal with problems
associated with caregiving. By teaching specific skills to manage
stress on an ongoing basis, such interventions could improve caregiver
depression, caregiver burden, the level of perceived stress, anxiety,
and coping skills. Objective: To assess the effects of psychoeducational
interventions compared to the standard levels of knowledge
provision in enhancing the support and guidance offered to caregivers
of seniors. Methods: Electronic searches of Medline, EM-
BASE, the Cochrane Central Register of Controlled Trials, the
CINAHL, and PsycINFO were undertaken, supplemented by crossreference
searching. All relevant randomized controlled trials were
selected. Quasi-randomized trials, non-randomized trials and observational
studies were excluded. Data were extracted from included
papers. Risk of bias in the included studies was assessed using the
methodology of the Cochrane Collaboration. Data from all trials
were synthesized and summarized. Results: All included trials involved
caregiving to seniors with dementia. Inadequate reporting of
incomplete outcome data increases the risk of attrition bias. Failure to
report allocation concealment led to difficulty in judging the risk of
selection bias. The nature of intervention, duration of intervention
and tools used for measurement of outcomes were different across
the trials. Marked heterogeneity of interventions and outcome measures
across the trials precluded pooling of data and conducting metaanalysis.
Psycho-educational intervention probably has a positive effect
on caregiver depression and possibility has positive effects on
caregiver burden, coping, perceived stress, and anxiety but the effects
were not consistent across the studies. Most of the intervention programs
resulted in improvement of some domains of caregiver outcomes
rather than globally. Conclusions: Psychoeducational interventions
could be potentially useful but interventions should be
customized in accordance with the particular needs of the individual
caregivers. Lack of consistency of beneficial effects on some outcomes
across different studies and the potential risks for selection
and attrition bias prohibited us from drawing firm conclusions. More
well-designed, conducted and reported randomized studies investigating
the effectiveness of psychoeducational interventions are
needed.
D86 Encore Presentation
Medication Reconciliation in Transition of Care: Broken Telephone
or Patient Safety Goal?
L. Sinvani, 1 J. Beizer, 4 M. Akerman, 2 L. Lutsky, 3 C. Cal, 3 Y. Dlugacz, 3
K. Masick, 3 R. Shah, 1 G. Wolf-Klein. 1 1. NSLIJ Health System, New
Hyde Park, NY; 2. Feinstein Institute for Medical Research,
Manhasset, NY; 3. Krasnoff Quality Mgt. Institute, Great Neck, NY; 4.
College of Pharmacy, St. John’s University, Queens, NY.
BACKGROUND: There has been a dearth of studies on the
transition of older patients from hospital admission to subacute rehabilitation
and discharge home. We studied medication discrepancies
across a large Health Care system.
METHODS: Chart review utilizing randomized electronic medical
records (EMR) and paper chart medication reconciliation lists
across three transitions: hospital admission to discharge (time I), hospital
discharge to sub-acute rehab (time II) and sub-acute rehab admission
to discharge home or long term care (time III). Medication
discrepancies were grouped as intentional or unintentional.
RESULTS: In the 44 charts analyzed, average age was 71.4
(range: 41-91), with 68% female, 77.3% surgery versus 22.7% medicine.
Median stay in the hospital was 5.5 days and 14.5 days in skilled
facilities. Total number of medications documented at time I, II, and
III were 284, 472, and 545 respectively. Total medication discrepancies
were 358 (time I), 318 (time II), and 330 (time III); 100% of patients’
records had drug discrepancies and 58% were unintentional.
When analyzing average number of medications per patient at each
transition, time I increased from 6.5 to 10.7 (p