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Delirium: A Medical Emergency

Course Description | Faculty | Accreditation | General Information

Course Description

Acknowledgement: This module is supported by a grant from the Donald Reynolds Foundation.

The diagnosis and supportive management of delirium in elderly patients represents a clinical challenge for many clinicians and most trainees. Delirium is common, underrecognized, and potentially preventable condition that is associated with high morbidity and mortality. This web-based, interactive virtual patient program aims to educate clinicians on the diagnosis, management, and prevention of delirium in the elderly. The module consists of two cases in the inpatient setting: 1) a 72 year-old female admitted to the hospital to rule out myocardial infarction who ends up with a medication-induced delirium after cardiac catheterization, and 2) a 69 year-old male who undergoes total hip arthroplasty complicated by post-operative delirium. The module ends with a third case depicting delirium in the outpatient setting, a unique but not uncommon scenario. Questions are interspersed within each case and text and/or video feedback are provided to reinforce learning. At the completion of the module, the learner is presented with a teaching summary that emphasizes the most salient points of the module. References are provided with links to full PubMed abstracts.

Original Release: 11/7/2008
Most Recent Update: 9/22/2011
Termination Date: 9/22/2014

NUMBER OF CREDIT HOURS: The Harvard Medical School designates this enduring material for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This course should take approximately 2 hours to complete.

COST: $40.00 for the average learner. Participants living in emerging nations receive a 50% discount or can register for free. See our International Pricing Page for details.

OVERALL LEARNING OBJECTIVES:

  1. The learner will recognize that delirium is a common complication of hospitalization in older patients.
  2. The learner will acknowledge that most providers are notoriously poor at detecting and diagnosing delirium despite a mortality that reaches that of sepsis.
  3. The learner will recognize that delirium is associated with significant morbidity to the patient after hospitalization that result in increased cost to the medical system.

CLINICAL LEARNING OBJECTIVES:

  1. The learner will recognize and diagnose delirium based on the criteria set forth in the Confusion Assessment Method.
  2. The learner will enumerate appropriate history, physical exam, laboratory, and imaging studies in the workup of delirium.
  3. The learner will recognize that the key step in treatment for delirium is the identification and treatment of the underlying causes.
  4. The learner will understand that some delirium is preventable.

METHOD OF PARTICIPATION:

Registrants participate in the learning process by answering interactive multiple choice questions that are dispersed throughout the case presentation. You must answer a question correctly in order to continue through the course. If you answer a question incorrectly, you will be prompted to try again.

In order to earn credit, physicians must complete the entire educational activity before the termination date (see above). Non-physicians may register for the course but are not eligible for AMA PRA Category 1 Credits™. Instead, non-physicians will earn a certificate of participation after successfully completing the course before its termination date.

COMBINATION OF MEDIA USED:

This internet enduring material is a case-based, interactive presentation comprised mainly of text, interactive questions, and images. A variety of media, including video clips, audio clips, and Flash animation, may be presented. Links to any necessary plugins are provided when necessary, but no plugins are required for general use of the CME website, and you may skip the multimedia presentation(s) within the course if you choose.

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Faculty
JAMES RUDOLPH, MD
Course Director
Dr Rudolph is a board certified internist and geriatrician at the the Brigham and Women's Hospital and the VA Boston Healthcare System, where he is the Director of the Postoperative Delirium Service. He has written several articles on delirium after surgery and is currently conducting research to better identify and manage patients with delirium after surgery. At Harvard Medical School, he is an Assistant Professor of Medicine and is the Co-Director of Harvard Medical Student Training in Aging Research (MSTAR) Program, which introduces talented medical students to aging research. Dr. Rudolph lives in suburban Boston with his wife and 2.3 children. He is the author of Rudolph JL, Marcantonio ER. Postoperative Delirium: Acute Change with Long-term Implications 2011;112(5):1202-11.

DISCLOSURE:
The commercial entities with which I have relationships do not produce health-care related products or services relevant to the content I am planning, developing or presenting for this activity.



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Reviewers
CAROL BATES, MD
Reviewer
Carol Bates, M.D. is general internist in the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center and an Associate Professor of Medicine at Harvard Medical School. She received her medical degree from the Johns Hopkins University School of Medicine. Dr Bates is the Primary Care Program Director at Beth Israel Deaconess Medical Center. During her tenure, more than 100 residents have graduated from the primary care track; most of them remain practicing general internists. Dr Bates has been very active in the Society of General Internal Medicine. She has served as New England Regional President and as co-chair of the annual scientific meeting of the society in 2000. Dr Bates has an active practice focused in particular on women's health.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities



JOE FRANCIS, MD, MPH
Reviewer
After receiving his MD in 1984 (Washington University, St. Louis) and completing a residency and fellowship in General Internal Medicine and a Masters in Public Health at the University of Pittsburgh, Dr. Francis conducted NIH-supported research on acute confusional states (delirium) among older patients. Dr Francis joined the VA in 1991, continuing his research and assuming progressive clinical leadership responsibilities in geriatrics and extended care. In 1996, he was appointed Chief Medical Officer of Veterans Integrated Service Network (VISN) 9, where he managed and oversaw clinical operations, medical education, and research, and contributed to the design and implementation of key VA policy initiatives including performance measurement, surgical quality improvement, and patient safety.

In October, 2006, Dr. Francis began serving as the acting Deputy Chief Research and Development Officer, having responsibility for overall administration and policy development for VA’s $1.7 billion research operations. In January, 2007, he was formally appointed to that position.

In May, 2008, Dr. Francis was appointed VA’s Deputy Chief Quality and Performance Officer. In that role, he is responsible for coordinating all of VA’s quality management programs, including performance measurement, utilization management, clinical guidelines development, risk management, peer review, and accreditation.

Board-certified in internal medicine, geriatrics, and medical management, Dr. Francis has been on the medical faculty of the University of Pittsburgh, University of Tennessee, and Vanderbilt University.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities



MARTIN QUAN, MD
Reviewer
Martin Quan, MD, is Professor of Clinical Family Medicine at the David Geffen School of Medicine at UCLA. He also serves as the director of the Office of Continuing Medical Education of the school of medicine. Dr. Quan is a former member of the UCLA family medicine residency program and currently serves on the Residency Review Committee-Family Medicine of the Accreditation Council for Graduate Medical Education. Dr. Quan currently serves as the Senior Advisor to the President of the American Board of Family Medicine.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities



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Course Planners
SANJIV CHOPRA, MD
Planner
Dr. Sanjiv Chopra is Professor of Medicine at Harvard Medical School. He is also the the James Tullis Firm Chief in the Department of Medicine and a Senior Consultant in Hepatology at the Beth Israel Deaconess Medical Center, Boston. He served as Faculty Dean for Continuing Education at HMS for 12 years. Dr. Chopra has more than 150 publications and seven books to his credit. Dr. Chopra is Editor-in-Chief of the Hepatology Section of UpToDate, the most widely used electronic textbook in the world subscribed to by more than 850,000 physicians in 149 countries. He is also the recipient of numerous awards and accolades. For a complete bio, click here.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities



ANDI LONG, EdM
Planner
Andi Long directs the Department of Continuing Education’s Distance Learning group, which offers a variety of online continuing medical education programs to health care professionals around the world. Andi develops strategies for new pilot programs and systematically rolls out new distance learning initiatives and has a leadership role in IT planning and other online processes for HMS DCE. She oversees the day-to-day operations of each distance learning activity and ensures ACCME compliance across all enduring programs. She has had the privilege of working with hundreds of Harvard Medical School Faculty members to develop high-quality, engaging online programs that physicians in more than 170 countries have taken part in. Andi earned her Ed.M. in Technology, Innovation, and Education from Harvard Graduate School of Education and graduated from Bridgewater State College with a degree in English. Her professional interests focus on teaching and learning with new technologies and online course development.

DISCLOSURE:
Reported no relevant financial relationships with commercial entities



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Accreditation

NUMBER OF CREDITS: 2 

The Harvard Medical School is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Harvard Medical School designates this enduring material for a maximum of 2 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This course should take approximately 2 hours to complete.

Within 2 weeks of completing the course, you will receive your certificate via email.

Click the image to view a sample of the certificate


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General Information

HARDWARE/SOFTWARE REQUIREMENTS

Computers
Any computer running Windows, Mac OS, or Unix machines are supported.


Internet Connection
Your computer should be configured to access the Internet. A high speed internet connection may be required to view some of the large multimedia files.

Browsers
Firefox or Internet Explorer 5.5 or higher are recommended. JavaScript and cookies must be enabled.

Plugins
Some of the multimedia resources in this course require Apple Quicktime, RealMedia, or a Flash player. You will be prompted to download the appropriate plugin when necessary. No plugins are required for general use of the CME website, and you may skip the multimedia presentation(s) within the course if you choose.


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